Team Relationships Research Articles

Behavioral Health Models to Understand High-Risk Prenatal Patient Adherence to Visit Schedule in Camden

Methods: This study included adult, English speaking patients of the high-risk prenatal clinic at Cooper University Hospital that missed at least one appointment. We completed three, one hour focus groups with seven participants. Constant comparison analysis was used to determine common themes discussed by participants. Axial coding and basic unit descriptors were defined by both facilitators to determine common themes discussed during the focus group sessions. Results: We identified two main themes in regards to patient visit non-adherence in our population: logistic issues and perceived relationship issues between the patient and the care team. Logistic issues included issues with rescheduling, seeing different providers, parking, wait time and office hours. In regards to patient-care team relationships, subjects frequently brought up issues with respect, feeling heard by providers, communication and professionalism. All seven patients identified at least one of the five domains of logistic barriers as a concern. Five of the seven participants identified an issue across the four domains of relationship issues. Discussion: The focus group analysis illustrated recurrent themes of logistic barriers and deficiencies in patient-care team relationships that contributed to high-risk prenatal visit non-adherence. A follow-up survey study is necessary to quantitatively assess the most prominent reasons for visit non-adherence based on the themes identified in our study.

Supporting Youth With A Parent Who Is Living Younger-Onset Alzheimer's: A Crucial Component In Integrated Care.

Supporting Youth With A Parent Who Is Living Younger-Onset Alzheimer's: A Crucial Component In Integrated Care Lorenzo's House, a nonprofit in Chicago, focuses on a transformative approach that supports children and young adults who are living with a parent with younger-onset Alzheimer's. Youth are often affected by a parent's diagnosis at a neurobiologically vulnerable time in their lives. Youth frequently don't know how to explain their experience as a care partner with their peers, leaving them isolated and managing the ongoing change by themselves. By creating spaces specifically catered towards these young care partners, we are radically shifting the journey of what younger-onset Alzheimer's looks like for children and young adults. We focus on the relationship between the parent diagnosed and their children, what children need as care partners, and what issues and struggles they face at a variety of ages in this journey. Our three youth programs focus on innovation to support youth living with a parent with younger-onset Alzheimer's: Lorenzo's Camp, a camp designed by youth care partners, therapists, medical professionals - intended to share common stories and build an alliance; the Light Club, a virtual youth care partner group injected with team building and relationship development; and lastly youth-led advocacy work. Our model shifts the narrative for how youth experience being a member of a family that is navigating a younger-onset Alzheimer's diagnosis.

Determinants of health professionals’ engagement at Mizan-Tepi University Teaching Hospital in Southwest Ethiopia

BackgroundEmployee engagement, undoubtedly, is one of the top priorities for organizations today, especially for service organizations where labor accounts for a large ratio of what customers pay for. Therefore, this study aimed to assess the determinants of employee engagement at Mizan-Tepi University Teaching Hospital in Southwest Ethiopia. MethodsA hospital-based cross-sectional study was conducted at Mizan-Tepi University Teaching Hospital from January 1–30, 2020. A total of 212 study participants were recruited using a simple random sampling technique. The data were collected using a pretested self-administered questionnaire. The collected data were entered into SPSS version 21. Descriptive statistics such as mean and standard deviation were used. Inferential statistics of multiple linear regressions were done to analyze the effect of independent variables. ResultsThe mean age of respondents was 26.6 (±3.37 SD) years, ranging from 19 to 45 years. One hundred sixty-six (78.3%) were degree holders, 30 (14.2%) were diploma holders, 12 (5.7%) and 4 (1.8%) were masters holders and specialists respectively. The mean service year of respondents was 3.82 (±2.58 SD) years, ranging from 1 to 15 years. The study also found that working environment, perceived supervisory support, team and co-worker relationship, job characteristics, and reward and recognition affect employees’ engagement with a p-value < 0.05. Conclusionall the explanatory variables used to explain employees' engagement were found to be capable of explaining the engagement of the employees in the health sector as well. Therefore, health institutions should work on the identified explanatory variables to increase their employees’ engagement at work.

Defence mechanisms as predictors of trust and positive relationships in top management teams

BACKGROUND: Top managers are heavily exposed to strong negative emotions due to the difficult decisive situations that they experience and the persistent pressure of time and uncertainty. At the same time, the relationships they build within TMTs shape their decisions, experiences and reactions at work. The paper refers to defence mechanisms as relatively persistent means of individual response to unwanted emotions and affects. OBJECTIVE: The aim of the paper is to examine the defence mechanisms of TMT members as antecedents of perceived trustworthiness of other team members and positive relationships in the team. METHODS: The empirical study was conducted in a sample of 123 members of top management teams representing furniture industry companies in Poland. RESULTS: The results show that defence mechanisms determine TMT members’ perception of trustworthiness of other team-members and that perceived trustworthiness mediates the relation between the defence mechanisms of TMT members and their evaluation of relationships within a team. CONCLUSIONS: The study explains links between individual characteristics of TMT members and processes within the teams. It contributes to upper echelon theory and literature on trust and positive relationships at work. It also contributes to the line of research introducing unconscious processes and emotions to management studies.

Effect of Increased Interprofessional Familiarity on Team Performance, Communication, and Psychological Safety on Inpatient Medical Teams

In large academic centers, medical residents work on multiple clinical floors with transient interactions with nursing colleagues. Although teamwork is critical in delivering high-quality medical care, little research has evaluated the effect of interprofessional familiarity on inpatient team performance. To determine the effectiveness of increased familiarity between medical residents and nurses on team performance, psychological safety, and communication. A 12-month randomized clinical trial in an inpatient general medical service at a large academic medical center was completed from June 25, 2019, to June 24, 2020. Participants included 33 postgraduate year (PGY)-1 residents in an internal medicine residency program and 91 general medicine nurses. Fifteen PGY-1 residents were randomized to complete all 16 weeks of their general medicine inpatient time on 1 medical nursing floor (intervention group with 43 nurses). Eighteen PGY-1 residents completed 16 weeks on 4 different general medical floors as per usual care (control group with 48 nurses). The primary outcome was an assessment of team performance in physician-nurse simulation scenarios completed at 6 and 12 months. Interprofessional communication was assessed via a time-motion study of both work rounds and individual resident clinical work. Psychological safety and teamwork culture were assessed via surveys of both residents and nurses at multiple time points. Of the intervention and control PGY-1 residents, 8 of 15 (54%) and 8 of 18 (44%) were women, respectively. Of the nurses in the intervention and control groups with information available, 37 of 40 (93%) and 34 of 38 (90%) were women, respectively, and more than 70% had less than 10 years of clinical experience. There was no difference in overall team performance during the first simulation. At the 12-month simulation, the intervention teams received a higher mean overall score in leadership and management (mean [SD], 2.47 [0.53] vs 2.17 [0.39]; P = .045, Cohen d = 0.65) and on individually rated items were more likely to work as 1 unit (100% vs 62%; P = .003), negotiate with the patient (61% vs 10%; P = .001), support other team members (61% vs 24%; P = .02), and communicate as a team (56% vs 19%; P = .02). The intervention teams were more successful in achieving the correct simulation case outcome of negotiating a specific insulin dose with the patient (67% vs 14%; P = .001). Time-motion analysis noted intervention teams were more likely to have a nurse present on work rounds (47% vs 28%; P = .03). At 6 months, nurses in the intervention group were more likely to report their relationship with PGY-1 residents to be excellent to outstanding (74% vs 40%; P = .003), feel that the input of all clinical practitioners was valued (95% vs 53%; P < .001), and say that feedback between practitioners was delivered in a way to promote positive interactions (90% vs 60%; P = .003). These differences diminished at the 12-month survey. In this randomized clinical trial, increased familiarity between nurses and residents promoted more rapid improvement of nursing perception of team relationships and, over time, led to higher team performance on complex cognitive tasks in medical simulations. Medical centers should consider team familiarity as a potential metric to improve physician-nursing teamwork and patient care. ClinicalTrials.gov Identifier: NCT05213117.

The impact of self-directed team on high-performance organization with the mediating role of knowledge sharing culture: Organizational support as a moderator.

The primary aim of this investigation is to identify the relationship between self-directed teams and high-performance organizations (work). Furthermore, exploring the mediating role of knowledge-sharing culture with the self-directed team and high-performance organization relationships. Moreover, this study analyzed the moderating role of a sense of organizational support in the relationship between knowledge-sharing culture and high-performance organizations. Using the PLS-SEM approach (SmartPLS 3.3.7) in this study, we obtained data from employees of high-tech enterprises listed on the Shanghai Stock Exchange China to analyze this study. The present research seeks to determine the direct and indirect effects of the study-related factors on the outcome of the investigation. According to the findings, a self-directed team positively impacts knowledge sharing culture, knowledge sharing behavior, knowledge sharing strategy, and mutual trust among its members. Knowledge-sharing culture has no mediating role and its component in the relationship between independent and dependent constructs. This study also indicated that a sense of organizational support has no moderating effect on the relationship between a knowledge-sharing culture and high-performance organizations. This study may practically contribute to high-tech enterprises to develop and implement business development and proper self-directed team, knowledge-sharing culture, and sense of organizational support, and consequently, can contribute to the growth of overall high-performance organizations.

Organizational and psychological features of attracting children of middle school age to health-improving motor activity

The article substantiates the organizational and methodological features of attracting children of middle school age to recreational activities on roller skates and skiing. According to the results of Aizenko's test, among 36 adolescents, 44.4% were found to be choleric, 33.3% - sanguine, 11.1% - melancholic, 11.1% - phlegmatic types of temperament. For every kind of temperament, average values were determined by categories of motivation. So, in adolescents of the sanguine type of temperament, the highest level of motivation is the approval of the coach (peers) and self- improvement; the lowest level - is material reward and staying in competitive conditions. For adolescents of the melancholic type of temperament, the highest level of motivation is the approval of the coach and peers, competition, friendship, and team relationships. The lowest level is staying in competition conditions. For adolescents of the choleric temperament type, the highest level of motivation is physical fitness, interest in competitive activity, and training as a means of comprehensive self- improvement. Material rewards and attractiveness to the opposite sex have the least motivational influence. The top categories of motivation for adolescents with the phlegmatic type of temperament are self-improvement and increased physical fitness. The lowest level is the attraction to the opposite sex and being in competitive conditions. Methodological recommendations are proposed for involving children of middle school age in recreational and health-improving physical activity.

Types of demands and well-being in correctional officers: The protective role of psychological capital.

Correctional officers' personal resources, such as psychological capital (PsyCap), may help them better manage their work environment in the penitentiary; however, there is limited research on the relationship between indicators of well-being and types of demands in this cohort and whether this relationship depends on PsyCap. The aim of this study was to examine three types of demands (job, personal, and group) and the effect of each on three indicators of low well-being: burnout, physical and mental health complaints. We also tested the potential moderating role of PsyCap in the relationship between the three types of demands and indicators of well-being. The potential moderating role of personal resources (PsyCap) between demands and well-being was tested via hierarchical multiple regression on a sample of 350 correctional officers. Results show that psychological capital attenuates the effect of personal distress and negative team relationships on all three indicators of low well-being. Psychological capital also moderates the relation between work-family conflict and mental health complaints. However, it does not act as a moderator between work-family conflict and burnout or physical health complaints. The findings are of value because they emphasize the importance of psychological capital, as a personal and malleable resource, for the occupational health of correctional officers.

Aging workforce with reduced work capacity: From organizational challenges to successful accommodations sustaining productivity and well-being

Israel is experiencing accelerated workforce aging and increasing retirement age that began in the last two decades. Aging workers suffer from increased illness and impairment rates, challenging employing organizations with reduced work capacity. Occupational health practitioners often assist employers in accommodating these challenges. However, insufficient evidence on prognostic factors, organizational practices, and age management tools hamper successful accommodation. Research on the organizational perceptions of aging workers is also limited.Our study aims to (1) identify the domains in which the aging workforce challenges Israeli organizations according to a multi-level theoretical model we developed, and (2) assess the practices employed by organizations to address the declines in work capacity from employers' and workers’ perspectives.Our qualitative study employed semi-structured interviews of 26 employers and workers' representatives from eight Israeli organizations sampled by maximum variation according to organizational characteristics. Thematic framework analysis of organizational perceptions on challenges, facilitators, and practices in use, via aging workers’ cases was utilized.We identified organizational challenges on five levels: individual worker, work environment, interpersonal team relationships, organization, and community relationships, stemming from the aging workers' reduced capacity to meet job demands and conditions. Time adjustments, work environment changes, and job task changes were common accommodations practices used by the organizations. Successful accommodations from the employers' perspective preserved workers' and teams' productivity, and from the workers’ perspective, those that lowered demand and improved job control without damaging earnings or job status.Taken together, organizations from all economic sectors should prepare for the increasing need to accommodate work conditions for aging workers with limitations to preserve their health and safety. Balancing employers' and workers' perspectives when accommodating workers with reduced work capacity is imperative to promote healthy aging at the workplace. Government intervention is advised to encourage continued job participation to reduce employment termination.

Strengthening respectful communication with patients and colleagues in neonatal units - developing and evaluating a communication and emotional competence training for nurse managers in Kenya.

Introduction: Effective communication is essential to delivering compassionate, high-quality nursing care. The intensive, stressful and technical environment of a new-born unit (NBU) in a low-resource setting presents communication-related challenges for nurses, with negative implications for nurse well-being, team relationships and patient care. We adapted a pre-existing communication and emotional competence course with NBU nurse managers working in Kenya, explored its' value to participants and developed a theory of change to evaluate its' potential impact. Methods: 18 neonatal nurse managers from 14 county referral hospitals helped adapt and participated in a nine-month participatory training process. Training involved guided 'on the job' self-observation and reflection to build self-awareness, and two face-to-face skills-building workshops. The course and potential for future scale up was assessed using written responses from participant nurses (baseline questionnaires, reflective assignments, pre and post workshop questionnaires), workshop observation notes, two group discussions and nine individual in-depth interviews. Results: Participants were extremely positive about the course, with many emphasizing its direct relevance and applicability to their daily work. Increased self-awareness and ability to recognize their own, colleagues' and patients' emotional triggers, together with new knowledge and practical skills, reportedly inspired nurses to change; in turn influencing their ability to provide respectful care, improving their confidence and relationships and giving them a stronger sense of professional identity. Conclusion: Providing respectful care is a major challenge in low-resource, high-pressure clinical settings but there are few strategies to address this problem. The participatory training process examined addresses this challenge and has potential for positive impacts for families, individual workers and teams, including worker well-being. We present an initial theory of change to support future evaluations aimed at exploring if and how positive gains can be sustained and spread within the wider system.

COMMUNICATION AND INTERDISCIPLINARY TEAM WORK IN PALLIATIVE CARE

Palliative care is a treatment modality that aims to improve the quality of life of patients and their families. Communication and interdisciplinary relationships are significant elements in the palliative care process. The present study aims to point out the importance of interdisciplinary communication, based on the approach of different authors, in the, care of patients in palliative care. This is an exploratory research, having as a tool the bibliographic review of authors who discuss the subject. In this study, the importance of communication in interdisciplinary teamwork in the team, patient and family relationship is verified.

The empirical research of teamwork competency factors and prediction on academic achievement using machine learning for students in Thailand

Introduction. Teamwork competencies are important for achieving the success of education, developing a meaningful and lifelong career, bringing new ideas, helping to solve problems, academic achievement, and building morale. the current problems with teamwork competency factors are still vague and unclear, and lack of predictive data on education. The research objectives were to analyse factors of students’ teamwork competencies, to confirm factors of students’ teamwork competencies, and to predict the effect of teamwork competencies on academic achievement using machine learning. Methods. Participants were students in an advanced professional innovation programme undergoing an empowerment process. They were divided into two groups: 205 students for exploratory factor analysis achieved through stratified random sampling and 418 students for confirmatory factor analysis, correlation analysis, and prediction of academic achievement, also achieved via stratified random sampling. Instruments included a teamwork competency self-assessment digital form, which had item-total correlations between 0.67 and 0.77 and a Cronbach’s alpha coefficient of reliability equal to 0.98. The data were analysed by summary statistics (mean, standard deviation), correlation analysis, exploratory factor analysis, confirmatory factor analysis, regression analysis and decision trees. Results. The results showed that teamwork competencies factors included building a team relationship (BTR), participation in team exchanges (PTE), adapting and creating a team atmosphere (ACT), and supporting a team (STE), which explained 65.752% of the total variance. Teamwork competency factors fit the empirical data (chi-square=618.54, df=565, p=0.059, GFI=0.93, AGFI=0.90, RMSEA=0.015), and teamwork competency sub-factors were correlated with the total score by 0.97, 0.94, 0.95 and 0.92, respectively. In addition, the machine learning predicted by regression BTR, PTE, and ACT were predictive of academic achievement, explaining 60.80% of the variance in this variable, and predicted by decision trees ACT and PTE were predictive of academic achievement as well. Practical significance. The novelty created by this research is that innovative product of teamwork competencies factor, that is suitable for a studied and modern context, and prediction of machine learning that will increase empirical strength and create a methodological novelty of empirical research that uses multi-stage, multi-methods and robust validation. The utility of practice, the colleges apply to students for accurate measurement, good academic achievement and leads to reflection and improvement of teamwork for performance efficacy, bringing success to individuals and society.

Workplace Foam Roller Exercise for Hotel Housekeepers: An Exploratory Study

Hotel housekeepers face multiple serious work-induced hazards that can cause occupational disabilities affecting their health. This study investigated the short-term impact of a foam roller exercise as an intervention to improve hotel housekeeper range of motion (ROM). Researchers conducted a quasi-experimental study among hotel housekeepers at two hotels. Five housekeepers at the first hotel participated in 30-minute per day group foam roller exercises during a six-week study period. Seven housekeepers at the second hotel served as a comparison group, not participating in the exercises but completing the range of motion measurements at the beginning and end of the study. Interviews were conducted among the experimental exercise group to obtain their personal feedback regarding the foam roller exercises. This study found significantly improved range of motion in the shoulders, hips, and wrists of the exercise group after six weeks of daily foam roller exercises. No significant changes in range of motion were found in the comparison group. Qualitative data collected from interviews with exercise participants revealed the following benefits of the group foam roller exercises: muscle relaxation, reduction of body pain, providing a feeling of overall wellness, enhancing energy, and improving team relationships. This study provides evidence that foam roller exercises may be an effective intervention to improve range of motion for hotel housekeepers and may mitigate their body pain induced by their cleaning tasks. Foam rollers are user-friendly and cost-effective and can be used by hotel housekeepers or workers involved in physically demanding jobs as recovery tools.

#WhyIDoIt: A Multidisciplinary Wellness Initiative in an Academic Emergency Department.

IntroductionHealthcare clinicians in critical care settings such as the emergency department (ED) experience workplace stressors and are at high risk for burnout. This correlates with substance abuse, suicidality, career dissatisfaction, early retirement, and suboptimal patient care. Therefore, recognizing, and mitigating, burnout is critical to a healthcare worker’s health and wellbeing. While gratitude and positive psychology are shown to increase resilience and decrease burnout, no prior studies have examined specific ED care team motivators for continued career satisfaction and workplace engagement. To increase the wellness in our ED, we implemented a wellness initiative titled #WhyIDoIt. Our goal was to have all care team members share what motivates them to work in our ED.MethodsParticipants were asked what motivates them in the workplace. We gathered responses each February for three consecutive years, 2017–2019, at our academic Level I trauma center. Emergency department clinicians, nurses, and staff were recruited to participate at grand rounds, nursing huddles, and sign out. Participants self-selected to contribute by writing their response on a sticky note and posting it in the department. After three years of implementing this initiative, we analyzed the collected qualitative data using thematic analysis based on grounded theory. Submissions were subjectively categorized into initial themes and then reconciled into three overarching classifications.ResultsIn total, we collected 149 responses. Themes included team work (35, 23.5%), pride in a unique skill set (26, 17.4%), helping patients in a time of need (26, 17.4%), teaching/learning opportunities (15,10.1%), humor and levity (14, 9.4%), building relationships with patients (11,7.4%), financial motivation (9, 6.0%), patient gratitude (7, 4.7%), and philosophical and moral motivators (6, 4.0%). These themes were reconciled into three overarching classifications including team-centered motivators (76, 51%), patient-centered motivators (37, 24.8%), and reward-centered motivators (36, 24.2%).ConclusionResponses that showed the greatest motivator for ED clinicians and nurses were team-centered. This highlights the importance of relationship building and a sense of shared purpose and suggests that future workplace well-being initiatives should include strengthening and maintaining professional team relationships.

A Double-Edged Sword? The Impact of COVID-19 on Work Relationships in Virtual Teams

Due to COVID-19, remote work, online learning, and virtual team work have become ubiquitous in today’s higher education and corporate world. This study develops and empirically tests a conceptual model of how work relationships develop over time in virtual teams while under the influence of COVID-19. By integrating fundamental interpersonal relations orientation theory, the model of team development stages, and the threat-rigidity theory, we propose that work relationships in virtual teams progress through four stages (increase-decline-increase-decline). Moreover, we conceive external crises, as exemplified by COVID-19, as both opportunities and threats that exert positive and negative effects, respectively, on work relationships in virtual teams. We use a multi-level approach (e.g., time, individual, and country level) to analyze a longitudinal dataset from a virtual team work project of university students, with the random coefficient growth modeling approach. Results from a seven-wave survey of 3,578 participants from 62 countries and universities around the world, combined with archival data, largely support our hypotheses. We discuss the theoretical and practical implications of our findings.

How Does Feedback Valence Improve Team Creativity by Influencing Team Relationship Conflict?

IntroductionTeam creativity is increasingly important to organizations, and the enhancement of creativity has become a key management challenge. Feedback is a very important management tool in the creativity enhancement process. Its use to enhance team creativity raises an important question, namely if positive or negative feedback valence affects team creativity. This is particularly important because researchers still only have a limited understanding of this impact.MethodsThis study adopts an experimental research method to explore the influence mechanism of feedback valence on team creativity. One hundred seven teams and 379 college students participated in experiments that lasted for a total of 1600 minutes.ResultsIt is found that feedback valence positively affects team creativity and confirmed that positive feedback (relative to negative feedback) is more conducive to team creativity. Team relationship conflict is also found to mediate the relationship between feedback valence and team creativity. Positive feedback helps to reduce team relationship conflict, which (indirectly) positively affects team creativity; negative feedback increases team relationship conflict, which (indirectly) negatively affects team creativity. Meanwhile, creative time pressure moderates the relationship between: 1) feedback valence and team creativity; and 2) feedback valence and team relationship conflict.DiscussionThe research results do not just enrich theoretical research (into feedback valence, team relationship conflict, creative time pressure and team creativity), as they also provide valuable inspiration to managers seeking to improve team creativity in management practice.

Unraveling the Relationship Between High Performance Work Systems and Team Performance

This study develops a moderated mediation model examining the relationship between high-performance work systems (HPWS) and team performance. Adopting a dialectical view on the effects of HPWS, it posits for a dual -positive and negative- path between HPWS and team performance that is jointly mediated by team coordination and team relationship conflict. Further, it theorizes that a supportive and a competitive team climate can significantly shape these relationships. The proposed research model was tested using multisource data from a sample of 403 team members and 96 team managers from a total of 56 different firms. Results revealed that HPWS are positively associated with both team coordination and team relationship conflict and that both these relationships are moderated by supportive and competitive team climate. This paper contributes to the strategic human resource management (SHRM) literature by revealing that HPWS can be associated with team performance both through a positive and through a negative intermediary mechanism and that team climate constitutes an important boundary condition that can both amplify and inhibit the effect of HPWS on team performance.

School nurses' experiences of health-promoting work to prevent stress in Swedish adolescents.

AimTo investigate school nurses’ experiences of health-promoting work to prevent stress in Swedish adolescents.Materials and methodsSwedish school nurses (n = 225) responded to a web survey with open-ended questions. The results were subjected to a qualitative content analysis.ResultsSix categories were identified from the analysis: (1) Knowledge of body and soul, (2) Identifying stress and ill health, (3) Collaborative working within/outside school, (4) Make yourself (i.e., school nurses) visible to the students, (5) Support students’ learning, and (6) Tools for stress management. One of the most important themes in preventing and counteracting stress in school-aged children and adolescents was promoting healthy living habits. That school nurses were easily accessible and visible were important for them to identify stress as early as possible. The close collaboration with the school health care team and building relationships with the students were emphasized. The stress in adolescents was largely linked to schoolwork and performance anxiety. To counteract this, the dialogue with the teachers was important to increase their knowledge of mental health problems and stress and influence the scheduling of school exams.ConclusionThe study contributes to increased knowledge in the field and provides concrete strategies for how school nurses can work to counteract stress in students.

Adaptations to relational facilitation for two national care coordination programs during COVID-19.

Adaptations to implementation strategies are often necessary to support adoption and scale-up of evidence-based practices. Tracking adaptations to implementation strategies is critical for understanding any impacts on outcomes. However, these adaptations are infrequently collected. In this article we present a case study of how we used a new method during COVID-19 to systematically track and report adaptations to relational facilitation, a novel implementation strategy grounded in relational coordination theory. Relational facilitation aims to assess and improve communication and relationships in teams and is being implemented to support adoption of two Quadruple Aim Quality Enhancement Research Initiative (QA QUERI) initiatives: Care Coordination and Integrated Case Management (CC&ICM) and the Transitions Nurse Program for Home Health Care (TNP-HHC) in the Veterans Health Administration (VA). During 2021-2022, relational facilitation training, activities and support were designed as in-person and/or virtual sessions. These included a site group coaching session to create a social network map of care coordination roles and assessment of baseline relationships and communication between roles. Following this we administered the Relational Coordination Survey to assess the relational coordination strength within and between roles. COVID-19 caused challenges implementing relational facilitation, warranting adaptations. We tracked relational facilitation adaptations using a logic model, REDCap tracking tool based on the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) with expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) dimensions, and member checking. Adaptations were analyzed descriptively and for themes using matrix content analysis. COVID-19's impact within the VA caused barriers for implementing relational facilitation, warranting eight unique adaptations to the implementation strategy. Most adaptations pertained to changing the format of relational facilitation activities (n = 6; 75%), were based on external factors (n = 8; 100%), were planned (n = 8; 100%) and initiated by the QA QUERI implementation team (n = 8; 100%). Most adaptations impacted adoption (n = 6; 75%) and some impacted implementation (n = 2; 25%) of the CC&ICM and TNP-HHC interventions. Systematically tracking and discussing adaptations to relational facilitation during the COVID-19 pandemic enhanced engagement and adoption of two VA care coordination interventions. The impact of these rapid, early course adaptations will be followed in subsequent years of CC&ICM and TNP-HHC implementation.

Effects of sociodemographic and health factors on the self-management of non-communicable diseases among Chilean adults during the Covid-19 pandemic.

Individuals with non-communicable diseases (NCDs) are potentially at increased vulnerability during the Covid-19 pandemic and require additional help to reduce risk. Self-management is one effective strategy and this study investigated the effect of sociodemographic and health factors on the self-management of some non-communicable diseases, namely hypertension, type 2 diabetes mellitus and dyslipidemia, among Chilean adults during the Covid-19 pandemic. A cross-sectional telephone survey was carried out on 910 participants with NCDs, from Santiago, Chile. An adapted and validated version of the "Partners in Health" scale was used to measure self-management. Exploratory Factor analysis yielded five dimensions of this scale: Disease Knowledge, Healthcare Team Relationship, General Self-Management and Daily Routines, Drug Access and Intake, and Monitoring and Decision-Making. The average of these dimensions was calculated to create a new variable Self-Management Mean, which was used as a dependent variable together with the five separate dimensions. Independent variables included age, gender, years of schooling, number of diseases, the percentage of Multidimensional Poverty Index in the commune of residence, and self-rated health status. Beta regressions and ANOVA for the Beta regression residuals were utilized for analyses. Beta regression model explained 8.1% of the variance in Self-Management Mean. Age, years of schooling, number of diseases and self-rated health status were statistically associated with Self-Management Mean and dimensions related to daily routines and health decision making, such as Disease Knowledge, General Self-Management and Daily Routines, and Monitoring and Decision-Making. Gender and the percentage of Multidimensional Poverty Index in the commune of residence were insignificant. Strategies for self-management of NCDs during a crisis should consider age, years of schooling, number of diseases, and self-rated health status in their design.