ORCID Profile
0000-0002-5429-429X
Current Organisation
Portland State University
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Publisher: Informa UK Limited
Date: 30-07-2022
Publisher: Bristol University Press
Date: 08-2019
DOI: 10.1332/174426419X15679623018185
Abstract: A number of ways to conduct research are designed to maximise the likelihood that evidence from research is quickly transferred into practice. This includes action research and partnership research between researchers and policy makers. Such approaches focus research effort on questions of highest relevance to practice and policy so as to create ownership of the results. However, such approaches on their own do not necessarily visualise or illuminate possible pathways of action or create a sense of personal connection to these possible actions. Our intent is to foster high-level engagement with possible project findings by policymakers and researchers involved in partnership research. We describe a simple, creative, innovative device: production of co-authored mock (i.e., fake) in-house abstracts of peer reviewed papers as an aid in this process This occurs in advance of knowing real results of the study. The fake abstracts process described here occurs within a research-policy maker-practitioner partnership studying the scaling-up of childhood statewide obesity prevention programs and the electronic monitoring system being used to track progress. The fake abstracts are a tool for identifying priority interests among a large data set. They act as a trigger to uncovering different interpretations of findings among the team. They foster discussion and mental rehearsal of actions based on different scenarios. And they help the team coordinate participation in the analysis and writing-up of the real findings. They also represent a hypothetical variety of research endpoints which also assist with maintaining project momentum during long phases of analysis.
Publisher: Informa UK Limited
Date: 07-10-2021
Publisher: Springer Science and Business Media LLC
Date: 12-06-2020
DOI: 10.1186/S12889-020-08644-2
Abstract: There is a pressing need for policy makers to demonstrate progress made on investments in prevention, but few ex les of monitoring systems capable of tracking population-level prevention policies and programs and their implementation. In New South Wales, Australia, the scale up of childhood obesity prevention programs to over 6000 childcare centres and primary schools is monitored via an electronic monitoring system, “PHIMS”. Via a focussed ethnography with all 14 health promotion implementation teams in the state, we set out to explore what aspects of program implementation are captured via PHIMS, what aspects are not, and the implications for future IT implementation monitoring systems as a result. Practitioners perform a range of activities in the context of delivering obesity prevention programs, but only specific activities are captured via PHIMS. PHIMS thereby defines and standardises certain activities, while non-captured activities can be considered as “extra” work by practitioners. The achievement of implementation targets is influenced by multi-level contextual factors, with only some of the factors accounted for in PHIMS. This evidences incongruencies between work done, recorded and, therefore, recognised. While monitoring systems cannot and should not capture every aspect of implementation, better accounting for aspects of context and “extra” work involved in program implementation could help illuminate why implementation succeeds or fails. Failure to do so may result in policy makers drawing false conclusions about what is required to achieve implementation targets. Practitioners, as experts of context, are well placed to assist policy makers to develop accurate and meaningful implementation targets and approaches to monitoring.
Publisher: Springer Science and Business Media LLC
Date: 31-01-2020
DOI: 10.1186/S12961-019-0514-2
Abstract: In coproduction research, traditional ‘end-users’ are involved in the entire research process. The aim is to facilitate research translation by improving the timeliness and relevance of research. Because end-users often come from multiple sectors and hold erse perspectives and priorities, involving them in coproduction can be challenging. Tools and approaches are needed to support coproduction teams to successfully navigate ergent viewpoints while producing rigorous but meaningful research outcomes. Rich pictures are a systems thinking tool to help make sense of complexity. In this paper, we describe how we developed and applied a ‘rich picture’ in a coproduction project with policy-level partners. Guided by systems thinking principles, we conducted a systemic analysis of ethnographic fieldnotes collected as part of a broader study that examined the dynamics between an IT system and the implementation of the state-wide childhood obesity prevention programmes it was designed to monitor. Translating qualitative themes into metaphor and imagery, we created a visual depiction of the system to reflect the experience of the system’s users (health promotion practitioners) and facilitated a workshop with policy-level programme administrators (i.e. participants, n = 7). Our aim was to increase the transparency of the system for our research partners and to spark new insights to improve the quality of programme implementation. Guided by provocative questions, participants discussed and challenged each other’s thinking on the current functioning of the system. They identified future lines of inquiry to explore for quality improvement. Participants strongly agreed that the picture was a constructive way to engage with the ethnographic data but were challenged by the information and its implications. The opportunity for participants to co-learn from each other as well as from the picture was an added value. In the context of the facilitated workshop, the rich picture enabled research partners to engage with complex research findings and gain new insights. Its value was harnessed via the guided participatory process. This demonstrates the importance that, in the future, such tools should be accompanied by practices that enable participants to think with and apply systems thinking concepts and principles.
Publisher: SAGE Publications
Date: 11-04-2019
Abstract: Introduction. To maximize limited resources, many health promotion programs are designed to be delivered by volunteer lay leaders. But this model poses challenges to implementation in real-world settings and barriers to successfully scaling-up programs. This study examines the current lay leader training model for Walk With Ease, a Centers for Disease Control and Prevention–funded evidence-based arthritis program delivered at-scale. Method. Recruited volunteers ( n = 106) opted into free online or in-person training and agreed to deliver one Walk With Ease program within the following year—only 49%, however, did. Using logistic regression models and qualitative interviews, we explored predictors of volunteer delivery. Results. Volunteers had higher odds of delivering programs if they trained online (odds ratio [OR] = 9.04, 95% confidence interval [CI: 2.30, 48.36]), previously taught health programs (OR = 15.52, 95% CI [3.51, 103.55]) or trained in the second year of implementation (OR = 27.08, 95% CI [2.63, 415.78]). Qualitative findings underscored that successful volunteers were readied by their previous health education experience. Conclusions. While online training modes appear effective to prepare experienced volunteers, lay leaders required additional support. This calls into question whether lay-led delivery models are suitable for scaling-up programs with limited resources. Given the many lay-led health interventions for chronic disease self-management, investing in common training and infrastructures for lay leader development could advance the quality and sustainability of real-world program delivery.
Publisher: Oxford University Press (OUP)
Date: 22-01-2014
Publisher: Springer Science and Business Media LLC
Date: 18-09-2019
DOI: 10.1186/S13012-019-0938-7
Abstract: Bespoke electronic information management systems are being used for large-scale implementation delivery of population health programs. They record sites reached, coordinate activity, and track target achievement. However, many systems have been abandoned or failed to integrate into practice. We investigated the unusual endurance of an electronic information management system that has supported the successful statewide implementation of two evidence-based childhood obesity prevention programs for over 5 years. Upwards of 80% of implementation targets are being achieved. We undertook co-designed partnership research with policymakers, practitioners, and IT designers. Our working hypothesis was that the science of getting evidence-based programs into practice rests on an in-depth understanding of the role programs play in the ongoing system of local relationships and multiple accountabilities. We conducted a 12-month multisite ethnography of 14 implementation teams, including their use of an electronic information management system, the Population Health Information Management System (PHIMS). All teams used PHIMS, but also drew on additional informal tools and technologies to manage, curate, and store critical information for implementation. We identified six functions these tools performed: (1) relationship management, (2) monitoring progress towards target achievement, (3) guiding and troubleshooting PHIMS use, (4) supporting teamwork, (5) evaluation, and (6) recording extra work at sites not related to program implementation. Informal tools enabled practitioners to create locally derived implementation knowledge and provided a conduit between knowledge generation and entry into PHIMS. Implementation involves knowing and formalizing what to do, as well as how to do it. Our ethnography revealed the importance of hitherto uncharted knowledge about how practitioners develop implementation knowledge about how to do implementation locally, within the context of scaling up. Harnessing this knowledge for local use required adaptive and flexible systems which were enabled by informal tools and technologies. The use of informal tools also complemented and supported PHIMS use suggesting that both informal and standardized systems are required to support coordinated, large-scale implementation. While the content of the supplementary knowledge required to deliver the program was specific to context, functions like managing relationships with sites and helping others in the team may be applicable elsewhere.
Publisher: Oxford University Press (OUP)
Date: 06-2019
Abstract: Despite a clear need, ‘closing the gap’ in health disparities for Aboriginal and Torres Strait Islander communities (hereafter, respectfully referred to as Aboriginal) continues to be challenging for western health care systems. Globally, community health workers (CHWs) have proven effective in empowering communities and improving culturally appropriate health services. The global literature on CHWs reflects a lack of differentiation between the types of roles these workers carry out. This in turn impedes evidence syntheses informing how different roles contribute to improving health outcomes. Indigenous CHW roles in Australia are largely operationalized by Aboriginal Health Workers (AHWs)—a role situated primarily within the clinical health system. In this commentary, we consider whether the focus on creating professional AHW roles, although important, has taken attention away from the benefits of other types of CHW roles particularly in community-based health promotion. We draw on the global literature to illustrate the need for an Aboriginal CHW role in health promotion one that is distinct from, but complementary to, that of AHWs in clinical settings. We provide ex les of barriers encountered in developing such a role based on our experiences of employing Aboriginal health promoters to deliver evidence-based programmes in rural and remote communities. We aim to draw attention to the systemic and institutional barriers that persist in denying innovative employment and engagement opportunities for Aboriginal people in health.
Publisher: Informa UK Limited
Date: 17-10-2014
Publisher: Oxford University Press (OUP)
Date: 09-03-2017
Publisher: BMJ
Date: 05-2021
DOI: 10.1136/BMJOPEN-2020-045101
Abstract: Though multidisciplinary research networks support the practice and effectiveness of continuous quality improvement (CQI) programmes, their characteristics and development are poorly understood. In this study, we examine publication outputs from a research network in Australian Indigenous primary healthcare (PHC) to assess to what extent the research network changed over time. Australian CQI research network in Indigenous PHC from 2002 to 2019. Authors from peer-reviewed journal articles and books published by the network. Coauthor networks across four phases of the network (2002–2004 2005–2009 2010–2014 2015–2019) were constructed based on author affiliations and examined using social network analysis methods. Descriptive characteristics included organisation types, Indigenous representation, gender, student authorship and thematic research trends. We identified 128 publications written by 308 in idual authors from 79 different organisations. Publications increased in number and ersity over each funding phase. During the final phase, publication outputs accelerated for organisations, students, project officers, Indigenous and female authors. Over time there was also a shift in research themes to encompass new clinical areas and social, environmental or behavioural determinants of health. Average degree (8.1), clustering (0.81) and diameter (3) indicated a well-connected network, with a core-periphery structure in each phase (p≤0.03) rather than a single central organisation (degree centralisation=0.55–0.65). Academic organisations dominated the core structure in all funding phases. Collaboration in publications increased with network consolidation and expansion. Increased productivity was associated with increased authorship ersity and a decentralised network, suggesting these may be important factors in enhancing research impact and advancing the knowledge and practice of CQI in PHC. Publication ersity and growth occurred mainly in the fourth phase, suggesting long-term relationship building among erse partners is required to facilitate participatory research in CQI. Despite improvements, further work is needed to address inequities in female authorship and Indigenous authorship.
Publisher: BMJ
Date: 2021
DOI: 10.1136/BMJGH-2020-003852
Abstract: Indigenous communities worldwide are leading calls for all research involving Indigenous people to be underpinned by values and principles articulated by them. Many researchers are explicitly adopting these principles to guide what, where, how and when research is undertaken with Indigenous people. With critical reflection to support the implementation of such principles largely absent from published literature, this paper explores both the implementation of, and the outcomes from a set of guiding principles used in a large-scale Australian research collaboration to improve Indigenous health. In this inductive qualitative study, we adopted a principles-focused evaluation approach. Based on interviews with 35 actors in the collaboration and a review of project documents, we generated themes that were then iteratively discussed, refined and categorised into (1) ‘strategies’—activities by which implementation of our guiding principles were recognised (2) ‘outcomes’—results seen from implementing the principles and (3) ‘conditions’—aspects of the context that facilitated and constrained implementation of the principles. Respondents found it difficult to articulate how the guiding principles were actually implemented, and frequently referred to them as part of the fabric of the collaboration. They viewed the set of principles as mutually reinforcing, and as providing a rudder for navigating complexity and conflict. Implementation of the principles occurred through five strategies—honouring the principles being dynamic and adaptable sharing and dispersing leadership collaborating purposefully and adopting a culture of mutual learning. Outcomes included increased Indigenous leadership and participation the ability to attract principled and values-driven researchers and stakeholders, and the development of trusting and respectful relationships. The conditions that facilitated the implementation of the principles were collaborating over time an increasing number of Indigenous researchers and taking an ‘innovation platform’ approach. Our findings show that principles guiding collaborations are valuable in providing a focus, direction and a way of working together when they are collaboratively developed, hold genuine meaning for all members and are implemented within a culture of continuous critical reflection, learning and adaptation, with ongoing reinterpretation of the principles over time.
Publisher: Informa UK Limited
Date: 25-11-2022
Publisher: American Nurses Association
Date: 08-2022
DOI: 10.3912/OJIN.VOL27NO03PPT75
Abstract: Nursing workforce retention is critical to provide quality healthcare, raising concern as nurse turnover rates continue to increase. In this study, we examined older Registered Nurse (RN) perceptions of their work experiences during the COVID-19 pandemic to identify facilitators and barriers in workplace environments that relate to RN workforce retention. The methods section describes our study population that included RNs aged 50 years and older (n=195) who completed surveys containing open and closed-ended questions between August 2020 and January 2021. Our study results indicate that most respondents (86.2%) worked during the COVID-19 pandemic in moderate-to-high patient acuity settings and felt their employers provided employees adequate Personal Protective Equipment (73.3%). The discussion section notes implications for nursing and study limitations. In conclusion, workforce retention facilitators included offering resources and implementations that made experienced, older RNs feel included, valued, supported, and protected. Workforce retention barriers were short/rushed workplace orientation, unsafe patient assignments, micromanaging, perceived ageist policies, and implementing pay and benefit-related policy changes without RN input.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 23-06-2016
DOI: 10.5888/PCD13.160098
Publisher: Frontiers Media SA
Date: 11-09-2018
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: Springer Science and Business Media LLC
Date: 03-01-2020
DOI: 10.1186/S12961-019-0494-2
Abstract: Promising health interventions tested in pilot studies will only achieve population-wide impact if they are implemented at scale across communities and health systems. Scaling up effective health interventions is vital as not doing so denies the community the most effective services and programmes. However, there remains a paucity of practical tools to assess the suitability of health interventions for scale-up. The Intervention Scalability Assessment Tool (ISAT) was developed to support policy-makers and practitioners to make systematic assessments of the suitability of health interventions for scale-up. The ISAT was developed over three stages the first stage involved a literature review to identify similar tools and frameworks that could be used to guide scalability assessments, and expert input to develop draft ISAT content. In the second stage, the draft ISAT tool was tested with end users. The third stage involved revising and re-testing the ISAT with end users to further refine the language and structure of the final ISAT. A variety of information and sources of evidence should be used to complete the ISAT. The ISAT consists of three parts. Part A: ‘setting the scene’ requires consideration of the context in which the intervention is being considered for scale-up and consists of five domains, as follows: (1) the problem (2) the intervention (3) strategic olitical context (4) evidence of effectiveness and (5) intervention costs and benefits. Part B asks users to assess the potential implementation and scale-up requirements within five domains, namely (1) fidelity and adaptation (2) reach and acceptability (3) delivery setting and workforce (4) implementation infrastructure and (5) sustainability. Part C generates a graphical representation of the strengths and weaknesses of the readiness of the proposed intervention for scale-up. Users are also prompted for a recommendation as to whether the intervention (1) is recommended for scale-up, (2) is promising but needs further information before scaling up, or (3) does not yet merit scale-up. The ISAT fills an important gap in applied scalability assessment and can become a critical decision support tool for policy-makers and practitioners when selecting health interventions for scale-up. Although the ISAT is designed to be a health policy and practitioner tool, it can also be used by researchers in the design of research to fill important evidence gaps.
Publisher: Wiley
Date: 14-10-2014
DOI: 10.1002/JCOP.21659
Publisher: Springer Science and Business Media LLC
Date: 06-06-2019
Publisher: American Public Health Association
Date: 12-2016
Abstract: Objectives. To evaluate the effectiveness of Walk With Ease (WWE), an evidence-based arthritis self-management program that was scaled up in Oregon in 2012 to 2014. Methods. Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, we collected participant surveys and attendance records and conducted observations. Preprogram and postprogram, participants self-reported pain and fatigue (scale: 0–10 points high scores indicate more pain and fatigue) and estimated episodes of physical activity per week in the last month. Results. Recruitment successfully reached the targeted population—sedentary adults with arthritis (n = 598). Participants reported significant reduction in pain (−0.47 points P = .006) and fatigue (−0.58 points P = .021) and increased physical activity (0.86 days/week P .001). WWE was adopted by workplaces and medical, community, faith, and retirement centers. Most WWE programs were delivered with high fidelity average attendance was 47%. Conclusions. WWE is suitable for implementation by erse organizations. Effect sizes for pain and fatigue were less than those in the original WWE studies, but this is to be expected for a large-scale implementation. Public Health Implications. WWE can be effectively translated to erse, real-world contexts to help sedentary adults increase physical activity and reduce pain and fatigue.
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.YPMED.2017.09.024
Abstract: Children attending centre based childcare services consume as much as two thirds of their daily dietary requirements while in care. However, such services often fail to provide foods that are consistent with guideline recommendations. Developing strategies to improve childcare service adherence to menu dietary guidelines requires a comprehensive understanding of factors that may impede or promote implementation. The primary aim of this systematic review is to describe factors (barriers and facilitators) that may influence the implementation of menu dietary guidelines regarding food provision in centre-based childcare services and to map these factors to a theoretical framework. Over 7000 citations were identified from all sources. Duplicate abstracts were removed and selection criteria applied. Twelve studies (1994-2015) were included in the review. Dual data extraction was conducted and the reported factors were synthesised using the theoretical domains framework (TDF). Barriers and facilitators identified in qualitative studies were classified into 8 and 10 of the 14 TDF domains. Barriers and facilitators reported in quantitative studies covered 6 and 3 TDF domains respectively. The most common domain of which both barriers and facilitators to the implementation of menu dietary guidelines were identified was 'environmental context and resources'. This is the first study that comprehensively assesses literature to identify factors that influence the implementation of menu dietary guidelines in childcare services utilising a theoretical framework. Findings provide guidance to support researchers and policy makers design strategies to improve menu dietary guideline implementation and, as such have the potential to improve food provision in care.
Start Date: 2018
End Date: 2023
Funder: National Health and Medical Research Council
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End Date: End date not available
Funder: National Health and Medical Research Council
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