Organizational Staff Research Articles

SHEA practice update: infection prevention and control (IPC) in residential facilities for pediatric patients and their families.

In 2011, the Society for Healthcare Epidemiology of America (SHEA) and Ronald McDonald House Charities® (RMHC®) established a formal collaboration to develop the first IPC guideline. Both organizations agreed that RMH programs staff and other organizations operating similar programs would benefit from a standardized approach. In 2023, the collaboration was re-established to revise and update the original IPC guideline. This SHEA Practice Update on "Infection Prevention and Control (IPC) in Residential Facilities for Pediatric Patients and Their Families" addresses preventing transmission of infectious agents in "home away from home" residential settings, of which the Ronald McDonald Houses (RMHs) serve as a prototype.

Creating an inclusive workforce in 2024: Are pharmacy teams across England committed to embedding equality, diversity, and inclusion?

Abstract Introduction The Pharmacy Workforce Race Equality Standard (PWRES) published in 2023 provided evidence of the varied experiences that registered pharmacy professionals in NHS trusts face, particularly in relation to gender and ethnicity.1 Following this, the Inclusive Pharmacy Practice delivery group at NHS England set out to raise awareness of the data and to support regions in developing action plans to drive improvements in equality, diversity and inclusion (EDI) within pharmacy teams. Aim The aim of this study was to identify current initiatives within NHS providers that promote EDI within the pharmacy workforce with a view to enabling the sharing of good practice, and identifying implementation barriers. Methods A questionnaire was created by the Chief Pharmaceutical Officer’s Clinical Fellows and distributed by the 6 regional chief pharmacists within NHS England to their networks. The questionnaire was also promoted in regional pharmacy leadership meetings. Responses were collected between 1st February and 31st May 2024. Data was collected on an Excel spreadsheet. London was excluded from data collection as a similar questionnaire was distributed in 2023. No ethical approval was needed for non-sensitive anonymised data. Results There were 77 responses: 75% (n = 58) from hospital trusts, 13% (n = 10) from integrated care boards and the remaining 9 responses included the Local Pharmaceutical Committee, Hospice and Mental Health Trust. 86% of respondents (n = 66) indicated that their organisation has EDI initiatives in place. These have been summarised into six key themes: 1) EDI network/steering group (n = 44), 2) action plan (n = 14), 3) EDI training/accreditation (n =14), 4) reverse/reciprocal mentoring (n = 11), 5) awareness days (n = 10) and 6) inclusive recruitment practices (n = 10). In contrast, only half of respondents indicated that their team had EDI initiatives. The impact of any initiatives was measured by feedback from staff (e.g. Internal staff survey, NHS staff survey, focus groups, open staff forums) and regular staff demographic data collection. 55% of respondents (n = 36) indicated that recruitment panel members received compulsory EDI training for interviews and 54% of respondents (n = 35) received mandatory recruitment training. Barriers and challenges identified with implementing EDI initiatives included organisational change, workforce capacity, competing priorities and staff apathy. Discussion The survey results highlight a strong commitment to EDI initiatives at an organisational level, with most organisations having established EDI frameworks. However, the lower prevalence of EDI initiatives within individual pharmacy teams suggests a gap in implementation. This discrepancy indicates a need for better dissemination and integration of EDI practices within pharmacy team settings. There is evidence of varied practice in terms of EDI training requirements of interview panellists, and these variations are opportunities where improvements can be made in terms of IPP. The survey was only sent to the managed NHS sector and is not reflective of primary care or community pharmacy. One of the next steps is for regions to use the results of the questionnaire in combination with the PWRES data to develop and implement local action plans to address these issues. Reference 1. NHS England. Pharmacy Workforce Race Equality Standard Report 2023. [Accessed 4th June 2024]. Available from https://www.england.nhs.uk/long-read/pharmacy-workforce-race-equality-standard-report/

The Organisational Characteristics That Enable Successful Employment Transition for People With Intellectual Disabilities.

Social enterprises have the potential to address some of the current barriers that people with an intellectual disability experience in transitioning to open employment opportunities. However, it is unknown in detail how social enterprises are able to facilitate this transition, which limits ability to scale-up these organisational characteristics and strategies. Twenty-seven in-depth interviews were conducted with staff, supported employees and partner organisations of a social enterprise to understand the organisational characteristics that enables successful transitions. The organisational characteristics of the social enterprise that enabled transitions included offering a variety of roles and workplace environments for people with intellectual disabilities. Organisational characteristics also included having dedicated staff roles to support people with intellectual disabilities to develop skills to transition and for these support staff to network with open employers to facilitate the transition. The results provide an adaptable model for other social enterprises in how to structure their organisation to facilitate transition to open employment opportunities.

Examining the complex dynamics influencing acute malnutrition in Turkana and Samburu counties: Study protocol.

Acute malnutrition in children under 5 years is persistent in Eastern Africa's arid and semiarid lands. This study aimed to identify the drivers of acute malnutrition in Turkana and Samburu counties, Kenya. This was a population-based longitudinal mixed-methods observational study. Qualitative and quantitative data were collected at Wave 1, but only quantitative data were collected during follow-up. Participants were a representative sample of children and their primary caregivers from households with children under 3 years at Wave 1. Anthropometric measurements of all children under 5 years in the sampled households were taken at Wave 1 (May to July 2021), and one child under 3 years was randomly selected for follow-up about every 4 months over 2 years for six data collection waves. The study also collected data on sociodemographics; child feeding practices and morbidity; household water and food insecurity; shocks; coping strategies, social safety nets and economic safeguards; water, sanitation and hygiene; women's decision-making and food consumption. Qualitative data were collected through community dialogues, focus group discussions, in-depth interviews, photovoice and key informant interviews with mothers and fathers with children under 5 years, community leaders, county officials and staff of nongovernmental organisations. Data collection is complete and analysis is ongoing. The analysis includes thematic analysis of qualitative data and descriptive and multi-variable regression analyses of quantitative data.

Evaluation of a public health workplace staff psychosocial risk assessment and wellbeing initiative

Abstract Adverse psychosocial work environments can have a detrimental effect on staff wellbeing causing chronic stress leading to burnout. Despite legislation mandating regular risk assessments, only one third of workplaces assess psychosocial risks. A 2020 European report identified one of the main barriers being a reluctance to talk openly about psychosocial issues. This paper describes an evaluation of a staff psychosocial risk assessment and wellbeing initiative in a Public Health Department in Ireland. The initiative commenced in October 2022 during a period of major health service organisational change. Informed by positive organisational psychology conceptual frameworks, guided by the European Psychosocial risk assessment framework (PRIMA-EF) and utilising the HSE Work Positive (CI) survey tool it was possible to constructively identify and categorise psychosocial risks across the Public Health team. In the evaluation, a mixed methods approach was used based on Donabedian’s structures, processes and outcomes overarching framework and Nielsen’s Model of Process Evaluation Framework. The first three iterative quality improvement cycles of the intervention were reviewed. The evaluation demonstrated that all of Nielson’s three indicators for a successful organisational level staff wellbeing intervention had been met: there was evidence of improvement in both working conditions and staff wellbeing; iterative quality improvement cycles including appreciative inquiry staff collaborative engagement ensured staff views and key learning was captured; new organisational structures within the Department enabled the sustainability of this process. The evaluation indicates that the staff psychosocial risk assessment process is beneficial for staff wellbeing and that the methods used are appropriate. The resources used in this process continue to be readily available within the health service organisation. The evaluation supports continuation of this process in its present form. Key messages • This evaluation supports staff psychosocial risk assessment and mitigation processes and provides a framework for healthcare managers to implement such processes and comply with legislation. • This evaluation indicates that effective and sustainable collaborative staff engagement can be achieved using a positive focus which builds on team strengths and harnesses collective wisdom.

Electronic Health Record Adoption and Its Effects on Healthcare Staff: A Qualitative Study of Well-Being and Workplace Stress

Adopting electronic health records (EHRs) offers improved communication and information sharing and reduces medical staff errors. Despite these potential benefits, EHR adoption often introduces new challenges for healthcare staff, including increased administrative burdens and workplace stress. This study examines the impact of EHR systems on the well-being and workplace stress of healthcare staff in a hospital setting. Using a qualitative multi-perspective research approach, 16 guideline-based interviews were conducted to explore experiences, insight, and perceptions surrounding the anticipated introduction of EHRs. Data analysis reveals a complex interplay between the perceived advantages of EHRs, such as improved data accessibility and patient safety, and the challenges related to increased workload. Based on interviewers’ perceptions, emerging themes were categorized as technostress creators or inhibitors. The findings highlight a dual impact of EHRs: while participants acknowledged improvements in patient safety and information access, they also expressed concerns about increased workload, technostress, and potential disruptions to team dynamics. This study identified two major themes: “EHR Adoption as a Double-Edged Sword” and “EHRs’ Influence on Professional Dynamics”. These findings underscore the need for organizational readiness and staff support to mitigate the negative impacts of EHRs on healthcare workers’ well-being and job satisfaction.

An exploration of factors leading to readiness for organizational health literacy change in community-based health organizations.

Healthcare systems have a responsibility to improve organizational health literacy (OHL) to increase health equity. This study explored two organizational cultural factors, leadership support and staff buy-in, for organizations planning OHL change. Ten community-based health organizations participated in an OHL program. The study design was mixed methods. The qualitative inquiry was interviews with senior leaders to explore awareness of OHL and: impetus to transform, leadership commitment, staff engagement, alignment to organizational goals, and integration of health literacy change with current practices. The quantitative assessment was the Organizational Readiness for Implementing Change (ORIC) questionnaire to assess staff's perceptions about OHL change readiness. Senior leaders articulated the effects of low health literacy in their patient and client population. Support for OHL change was seen at both leadership and staff levels. Impetus for change was primarily a response to a community need or for quality improvement. Most of the non-clinical organizations had higher ORIC scores than the clinical organizations, indicating a perceived higher level of readiness for OHL change. Leadership commitment and staff buy-in are important factors of readiness for OHL change. A novel finding is that community-based health organizations are able and willing to engage in OHL change.

It’s ‘Gut Feeling’ Mostly: Online Hate, Uncivil Comments and Content Moderation in Australian Sports Media

There is evidence that online hate speech is increasing significantly on social media pages related to sport, but less research on how sport and media organisations are managing it. This research explored the management of content moderation in Australian sport media through qualitative interviews (16) with social media and communications staff in Australian sport and media organisations. It found that content moderation, or the moderating and removal of comments under social media posts, happened mostly as an addition to content creation work. Strategies for dealing with online hate and incivility were mostly the same between media and sport organisations, interviewees used some automated filters, but mostly manually hid, deleted and blocked comments and users to ‘clean’ their spaces. Overall there was a lack of formal guidelines and policies to direct moderation. Instead the work of content moderation was reliant on the actions of individuals, who took it on with a significant level of personal responsibility, and developed individual coping mechanisms to deal with the work. With its focus on communication staff in sport and media organisations this research contributes a different and important perspective to the growing field of research of online hate in sport.

Ethical aspects of staff responses when older people with dementia express false beliefs.

Challenging false beliefs are common situations among people living with dementia. They frequently imply time-shifts, that is, situations in which the person re-lives past experiences. Since they have emotional implications and important ethical implications, they are difficult to manage by caregivers, who are faced with the decision of telling or not telling the truth. The study aimed to explore professional staff's perceptions of common and best practices to manage a situation in which a person living with dementia is having a false belief, specifically a time-shift. The study compares technical staff's and assistant carers' responses. Forty-two staff members working in four Spanish long-term care facilities were interviewed. 21 were assistant carers and 21 were technical staff. This study involved a qualitative design, content-analyzing participant's responses to semi-structured interviews. Participants read a vignette about a person living with dementia having a time-shift and were asked (1) how a situation like that is commonly managed and (2) how it should be managed. The principles of informed consent, confidentiality, and assessment of consequences for participants were observed throughout the entire study, which was approved by the University of Barcelona Ethics Committee (IRB 00003099). Written participant's consent was obtained prior to interviews. All the participants mentioned having experienced a situation similar to that described in the vignette. In the case of common practices, lying was the most frequently mentioned strategy. As for best practices, lying and telling the truth were mentioned as well as responses that lie in-between, such as distracting or relaxing. However, most assistant carers reported that they do not know how a challenging false belief should be managed. Our findings stress the importance of organizational guidelines and staff development in the management of challenging false beliefs (and specifically time-shifts) in PLWD.

Do job demands and resources differ between permanent and temporary eldercare workers in Sweden?

Eldercare organizations face high sickness absence rates and staff turnover and rely heavily on temporary workers to fill staffing gaps. Temporary workers may experience differences in job demands and resources compared with permanent workers, but this has been largely understudied. To compare perceived job demands and resources between permanent and temporary Swedish eldercare workers. Permanent and temporary eldercare workers in a Swedish municipality were invited to answer a digital survey on work environment conditions. Differences between permanent and temporary workers in job demands and resources were analyzed using multivariate analysis of variance adjusted for age, sex, place of birth, and percent of full-time work and univariate analyses were conducted to consider differences in specific factors. A total of 1076 permanent and 675 temporary workers received the survey, and the final study sample included 451 permanent and 151 temporary workers. Multivariate analyses revealed that temporary workers reported statistically significant lower job demands compared to permanent workers, but no statistically significant differences in resources were found between the groups. Univariate analyses showed that temporary workers reported lower quantitative demands, perceived exertion, and time spent bending forward, than permanent workers. These data suggest comparable support across groups, but a higher workload among permanent workers. Our findings indicate that temporary workers experienced lower job demands than permanent workers, but that no notable difference was found in resources. Interventions aimed at distributing job demands more evenly among eldercare workers with different employment forms may be necessary.

Organizational readiness to implement bundled interventions to increase HIV linkage and retention in care and treatment: results from the Black Women First (BWF) initiative

BackgroundEvidence-based and evidence-informed interventions designed to address gaps in the HIV care continuum have the potential to improve HIV care and treatment. However, inadequate organizational readiness can derail intervention uptake, prevent the integration of interventions, and contribute to suboptimal HIV treatment outcomes. This study sought to understand organizational readiness to implement bundled interventions for Black women with HIV and inform facilitators and barriers to implementation.MethodsWe conducted a mixed methods readiness assessment across 12 sites participating in the Black Women First (BWF) initiative to gauge preparedness to implement bundled interventions. Readiness was assessed using the organizational readiness for implementing change (ORIC) scale, and two open-ended questions examined facilitators and barriers. Associations between participant and organizational level factors were evaluated using linear models with clustering by site at baseline, 6- and 12-months. Pre-implementation interviews were conducted with staff virtually and transcripts were managed in NVivo. Directed content analysis was used to explore implementation barriers and facilitators.FindingsSites demonstrated high levels of organizational readiness at baseline; overall organizational readiness for implementing change (ORIC) (mean 56.4, median 59, interquartile range [IQR] 5) and subscales of the ORIC change efficacy (mean 32.4, median 35, IQR 4), change commitment (mean 24, median 25, IQR 1), which is consistent with willingness and capability to implement bundled interventions for Black women with HIV. Organizational readiness remained high at 6- and 12-month follow-up periods. Staff role was significantly associated with organizational readiness (p = 0.007), change efficacy (p = 0.006), and change commitment (p = 0.020) at 6 months. Qualitative analysis indicated strategic planning and assessment (e.g., team coordination and the development of workflows to support implementation); organizational change through network weaving across silos within the organization, and communications systems that engage external partners, as well as resources available for hiring and training, supported readiness. Collaborative leadership and organizational buy-in, staff motivation, and partnerships facilitated implementation processes.ConclusionsOrganizations in the BWF initiative have high levels of organizational readiness reflecting willingness and capability to implement bundled interventions for Black women with HIV. Future research should examine the relationship between readiness and clinical outcomes.

The Moderating Role of the Five-Factor Model of Personality in the Relationship between Job Demands/Resources and Work Engagement: An Online Cross-Sectional Study.

When organizations or managers utilize personality assessments for their workers, it is crucial to consider not only personality profiles but also the interaction between these profiles and the psychosocial environmental factors in the workplace. The present study aimed to examine the moderating effects of the five-factor model (FFM) of personality traits on the relationship between job demands/resources and work engagement (WE). A cross-sectional online survey was conducted between November and December 2022, targeting full-time workers in Japan. Data were collected from 1500 participants (757 men and 743 women). The survey included demographic variables, job demands and resources (job control, supervisor, and coworker support), WE, and the FFM. The primary statistical analysis was hierarchical regression analysis, which tested the interactions between job demands/resources and each personality trait. Four significant interactions were found: job demands and neuroticism, control and neuroticism, control and conscientiousness, and supervisor support and extraversion. High conscientiousness was associated with higher WE when job control was abundant. Moreover, low levels of both neuroticism and extraversion were linked to higher WE. The results suggest that managers can enhance WE by aligning workplace factors with employee personality traits. These insights can be applied to organizational staffing decisions.

Even if you build it, they may not come: challenges in the uptake of workplace mental health toolkits

BackgroundStrategies to promote workplace mental health can target system, organization, team, and individual levels exclusively or in concert with each other. Creating toolkits that include these different levels is an emerging innovative strategy to support employees working in various sectors. Our paper describes the development, implementation, and refinement of two different online toolkits: the Healthy Professional Worker Toolkit for Education Workers and the Health Worker Burnout Toolkit.MethodsThe Knowledge to Action Framework guided the team during the development and early interventions phases of toolkit development. Stakeholder engagement regarding the intended use of the toolkit of promising practices for workplace interventions was integrated throughout with different forms of feedback in a research capacity between 2022 and 2024.ResultsReflecting on the different phases of the KTA Framework, we describe first the engagement involved in building the toolkits and then on their utilization. Our toolkits were built to include different resources aimed at empowering workers, teams, and employers offering innovative ideas to address the mental health-leaves of absence and return to work cycle in one case and the different forms and consequences of burnout in the other. Criteria for inclusion were informed by ongoing research with a range of stakeholders and other intended toolkit users including managers, supervisors, executives, human resource specialists, staff, and others in healthcare and educational organizations and settings. In the implementation phase, the volume of resources available in each toolkit considered a strength by some was overwhelming for some partners and individual workers to navigate. Capacity, engagement, time, and readiness for change, are themes that heavily influenced if and when organizations interacted with each toolkit, and how much time they spent exploring the resources provided.ConclusionIt is critical to ground toolkits in the experiential evidence of workplace mental health as is linking these to evidence-informed interventions that correspond to workplace concerns. Organizational readiness to adopt and adapt resources and implement changes is a key consideration. Ultimately, user engagement is what brought these toolkits to life.

The Role of NGOs in Health Capacity Building for Organizational Staff and Volunteers in Myanmar

The role of non-governmental organizations (NGOs) in health capacity building for trained community volunteers in Myanmar, a Least Developed Country (LDC) is significantly noteworthy. The study highlights the training programs and initiatives conducted by NGOs in areas such as sexual and reproductive health and rights (SRHR) and Gender-Based Violence (GBV) prevention, addressing critical needs in family planning, maternal health, GBV prevention, and the prevention of TB, HIV/AIDS, and other infectious diseases. The training programs and packages are designed to equip healthcare providers and community volunteers with fundamental skills, thereby enabling them to effectively address the health issues facing by the community especially among the vulnerable population. The study also points to the effective use of participatory learning methods by NGOs, such as interactive workshops, role-plays, case studies, and group discussions, which actively engage participants and promote an environment conducive to collective learning and knowledge sharing. Furthermore, through FGD, it was found that NGO interventions contribute to positive changes in health behaviors, such as increased awareness of preventive measures and adoption of healthier lifestyles.

Patient and Public Involvement in Research Evaluating Integrated Care for People Experiencing Homelessness: Findings From the PHOENIx Community Pharmacy Pilot Randomised-Controlled Trial.

There is a paucity of research on and a limited understanding of patient and public involvement (PPI) in the context of research in homelessness and, in particular, direct involvement of people with lived and living experience of homelessness (PEH) as expert advisors. We aim to report on outcomes and reflections from lived experience advisory panel (LEAP) meetings and PPI activities, held throughout the study lifecycle of a pilot randomised-controlled trial (RCT) focused on evaluating integrated health and practical support for PEH. Community Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx (PHOENIx Community Pharmacy RCT) is an integrated health and social care intervention for people experiencing homelessness who present to community pharmacy. Intervention includes weekly support from a pharmacist prescriber and a third sector support worker for up to 6 months. PPI activities undertaken throughout the study were documented, including outcomes of LEAP meetings. Outcome reporting followed Guidance for Reporting Involvement of Patients and the Public 2 Short Form (GRIPP2-SF). In total, 17 members were recruited into the LEAP; six meetings (three in two study sites) were held. PPI input was also received through representation from homelessness third sector organisation staff as study co-applicants and core membership in the trial steering committee. Together, the PPI activities helped shape the study proposal, design of study materials, data analysis and dissemination materials. LEAP panel members offered valuable input via their experience and expertise into the delivery and refinement of interventions. Although longitudinal input was received from some LEAP members, ensuring repeat attendance in the pre-planned meetings was challenging. People who face social exclusion and marginalisation can provide highly valuable input as equal partners in co-design and delivery of interventions seeking to improve their health and well-being. Fluid membership and flexible methods of seeking and incorporating advice can offer pragmatic approaches to minimising barriers to continued involvement in research. This study reports findings and learning relevant to involvement of people with lived and living experience of homelessness as advisors in a research study. It is important for researchers to offer fluid memberships and use diverse methods to receive input from lived experience members, as traditional PPI methodology may be insufficient to ensure inclusivity. Staff and volunteers from third sector organisations were important PPI partners who bring their experience based on frontline service provision, often as the first port of call for people experiencing severe and multiple disadvantage. ISRCTN88146807.

Restorative and regenerative green spaces for vulnerable communities in social housing: The impact of a community greening program

Vulnerable communities represent the most at-risk populations facing inequities and negative health, economic and social wellbeing outcomes. Community gardening has emerged globally as a community-based remedy to reduce these inequities and enhance wellbeing. This paper examines the psychological, socio-cultural and health impact of social housing design that includes access to, and engagement with green spaces. The project was multi-disciplinary and used mixed-method research to examine the impact of community gardening for people in social housing. Two interrelated studies were conducted; study 1 involved 33 social housing gardeners in a pre-post program survey. Statistically significant improvements were found in participants' satisfaction with personal wellbeing, health, and community connectedness; as well as increased gardening skills, positive social experiences, and time spent in nature. Study 2 involved 34 semi-structured interviews conducted with program facilitators and partner organisation staff. Results uncovered that participant's engagement with gardening was restorative and regenerative. Four salient themes emerged from our mixed methods study: 1) connection to self; 2) connection to others, 3) connection to place; and 4) connection to purpose. The findings showcase some of the key principles of a successful social and nature prescription intervention for vulnerable people. Community gardening was shown to amplify civic pride and bolster community resilience. Our research suggests the broad impact of community gardening on participant outcomes for vulnerable populations and enhances the capacity of practitioners to translate research into policy and practice for sustainable, restorative residential communities.

Assessing the Psychological Well-being of Healthcare Workers During the COVID-19 Pandemic

During the COVID-19 pandemic, working in any medical organization is associated with the risk of coronavirus infection. This applies first and foremost to specialized medical organizations dealing with the treatment of patients infected with coronavirus. Medical workers experiencing increased psychological stress are at an increased risk of infection with the SARS-CoV-2 virus while providing medical care. Therefore, studying the psychological states of medical workers – doctors, nurses, orderlies - is of particular importance and relevance. Our research goal is to investigate the psychological responses of medical professionals amid the COVID-19 pandemic. The research focused on the Aktobe Medical Center (AMC), which hosts the regional pulmonology center for COVID-19 patients and the Regional Clinical Infectious Diseases Hospital (RCIDH). The study is a selective, single-stage cross-sectional analysis. To assess the psychological reactions of medical workers, standardized questionnaires are used, including the PSM-25, GAD-7, and MFI-20. Statistical analysis of the data is conducted using the STATISTICA 10.0 software package from StatSoft, Inc., USA. An analysis of the research results indicates that medical personnel, nurses, and administrative staff in medical organizations associated with the risk of coronavirus infection are susceptible to adverse psychophysiological disorders. The study revealed that stress levels, anxiety, and asthenia in doctors and nursing staff are significantly higher compared to those in nurses and administrative personnel. Medical workers at risk of COVID- 19 clearly require support measures, as the potential for occupational infection has been definitively established. Additionally, the psychological risk is largely influenced by the nature of their work and their direct contact with the population and patients infected with the coronavirus. Senior and mid-level medical workers at the forefront of combating coronavirus infection is at a high risk of experiencing psycho-emotional and psychophysiological health issues. Doctors and nurses have been found to exhibit high levels of physical and mental asthenia, anxiety, and moderate-to-high levels of stress. Evaluating potential risk factors for psychophysiological disorders among healthcare workers not only provides an objective assessment of their health status, but also aids in the effective and rational organization of their work.

Enabling better carer involvement: A qualitative evaluation of the involvement service belonging to a carers organisation in the United Kingdom

Background: Globally, unpaid carers face economic and societal pressures. Unpaid carers’ support is valued at £132 billion a year in the United Kingdom (UK) alone. However, this care comes at a high cost for the carers themselves. Carers providing round the clock care are more than twice as likely to be in bad health than non-carers. These carers are therefore proportionately more likely to need statutory services such as health care provision. It is critical that carers are better supported to be involved in the shaping, delivery and evaluation of the services they receive. Unfortunately, qualitative evidence on how carer organisations can do this better is scarce. Methods: Working collaboratively with a community-based carers organization, we undertook a qualitative study. Purposive sampling was used to recruit 23 participants. Online, semi-structured, one-to-one interviews were conducted with carers, community organization staff and stakeholders to ascertain their experience and views on the involvement service. Results: Firstly, there are a range of benefits resulting from the involvement service. The carers see the service as an opportunity to connect with other carers and share their views and ideas. Secondly, staff and service providers also reported how involvement gave a platform for carers and was of value in helping them shape needs-led services. Thirdly, we found that barriers to good involvement include the lack of a clearly understood, shared definition of involvement as well as the lack of a diverse pool of carer representatives available for involvement activities. Conclusion: The findings from our study provide important insights into how carers, staff and service stakeholders view barriers and enablers to good involvement. The findings will be of interest to a range of community-based organizations interested in further involving members of their community in shaping the services they receive.

Stakeholder analysis and their roles in livestock disease reporting and response in Northern Kenya

IntroductionLivestock are central to pastoral livelihoods. A major constraint in pastoral production is livestock diseases, which is often exacerbated by inadequate surveillance systems. Reporting of disease outbreaks from pastoral communities to animal health workers is one of the challenges that affects effective and timely response to disease outbreaks. This study aimed to understand animal disease reporting and response in pastoral areas of Northern Kenya. Stakeholders, their roles, information flow among them and methods used for both livestock disease reporting and response and their strengths and challenges were identified.MethodsThe study was carried out in Marsabit County, a pastoral county in Kenya. Pretested tools were used to guide data collection through Focus Group Discussions, Narrative and Key Informant Interviews with pastoralists, County government Animal Health Workers, agrovets and private animal health workers, Community Disease Reporters, Chiefs, County Public Health Officers and local Non-Governmental Organization staff. Net mapping was further used where participants drew links among the various stakeholders and assigned them perceived influence and power. Output from thematic analysis, notes taken during data collection and net maps were used to produce a network of stakeholders and their links using Gephi software. Centrality measures were generated and recorded. Perceived power and influence scores were used to produce a graph and the reasons for the scores documented. Methods used for livestock disease reporting and response were obtained from thematic analysis.ResultsA network of 19 stakeholders with 67 links among them was identified. Major stakeholders were the Animal Owners/Pastoralists, Government Animal Health Workers, County Director of Veterinary Services, the Chief and radio based on network indices of Total degree and Betweenness Centrality, and also based on perceived scores of influence and power. Pastoralists had pivotal roles in both livestock disease reporting and response, Government Animal Health Workers (GAHWs) were mainly involved in disease surveillance and mass interventions including treatment and vaccinations. Non-state actors like NGOs and iNGOs collaborated and supported the County Government with resources to manage outbreaks. Various methods were used for reporting diseases, with use of mobile phones highly mentioned while for response to disease occurrences, the methods included trainings and treatment by both Government and Private AHWs and use of alternative veterinary practices by pastoralists. Various challenges constraining livestock disease response were highlighted, the most frequent challenges centered around low numbers and under resourcing of Animal Health Workers.ConclusionThese findings show that designing an efficient livestock disease surveillance system in pastoral areas requires recognition and utilization of all stakeholders and understanding of their roles. Gaps highlighted in disease response should be prioritized by the government and its development partners for improved animal health service delivery in pastoral areas. These inadequacies in livestock disease response have a direct effect on veterinary practice as mandated by the Government of Kenya Veterinary Surgeons and Para-professionals Act. The results are important for guiding policy formulation to support mitigation of disease impacts in similar areas with limited access to quality veterinary services.

The spinal cord injury (SCI) peer support evaluation tool: the development of a tool to assess outcomes of peer support programs within SCI community-based organizations.

Guided by the 4-step process outlined in the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline, multiple methodologies were used: Delphi, literature reviews, ratings with consensus, think-aloud, and test-retest. The purpose of this study was to develop and test a spinal cord injury (SCI) peer support evaluation tool that meets the needs of community-based SCI organizations in Canada. Peer support programs for people with SCI delivered by community-based SCI organizations. This research was co-constructed with executives and staff from SCI community-based organizations, people with SCI, researchers, and students. Given the multiple steps of this study, sample size and characteristics varied based on each step. Participants included people with SCI who received peer support (mentees) or provided peer support (mentors/supporters) and staff of community-based organizations. In step 1, the 20 most important outcomes for SCI peer support were identified. In step 2 and 3, the 97 items were identified to assess the outcomes and by using rating and multiple consensus methodologies 20 items, one to assess each outcome, were selected. In step 4, content and face validity and test-retest reliability were achieved. The resulting SCI Peer Support Evaluation Tool consists of 20single-item questions to assess 20 outcomes of SCI peer support. Through a systematic process, the SCI Peer Support Evaluation Tool is now ready to be implemented to assess outcomes of SCI peer support programs delivered by community-based SCI organizations.