Double helix of research and practice—developing a practice model for crisis resolution and home treatment through participatory action research

Over the last five years Crisis Resolution/Home Treatment (CR/HT) teams have been established in Norway. These teams provide an alternative to in-patient acute care services offering assessment as well as direct care. This paper addresses a method of examining the nature of practice models that are being developed in a CR/HT team incorporating the philosophy of open dialogue and the open lifeworld approach. The overall design of this research is action research applying a cooperative inquiry perspective. Multistage focus group interviews are used as a method for generating data, followed by phenomenological–hermeneutic approach in analyzing the data. Three themes were identified: (a) “keeping the dialogue open” referring to the emphasis of openness in dialogues and opening up for a variety of perspectives on what''s going on; (b) “tolerance of uncertainty” referring to the need to accept and deal with uncertainty and multiplicity; and (c) “nurturing everyday life issues” referring to the emphasis on illustrating clinical situations in detail through remaking of stories. The on-going co-processes of research and practice was a double helix that links the happenings in the practice with the findings in the research revealing the knowledge in practice and further developing that knowledge.     

Games for health research—past,present, and future

Background

A substantial number of studies have been published on many games for diverse aspects of health. Despite the potential contributions of games for health (G4H), it has not been easy to obtain funding for research in this field.

Aim

This paper attempts to identify why there has been difficulty in obtaining funding for G4H research, create an awareness of the importance of evidence-based research, and provide recommendations to enhance research and understanding in this area.

Materials and methods

This article describes the past and current state of research in G4H and identifies implications for the future.

Results

The current state of research in the field of games does not match the criteria for good standards of research. The poor quality of studies limits what can be concluded about the effectiveness of G4H.

Conclusions

Outcomes research on G4H must make a quantum leap in quality to realistically assess the efficacy or effectiveness of G4H, and which aspects of G4H offer the most promise for change among which target groups. Research is also needed on the effectiveness of behavior change procedures and game mechanics within the context of games.

     

Opportunities for linking research to policy: lessons learned from implementation research in sexual and reproductive health within the ANSER network

Background

The uptake of findings from sexual and reproductive health and rights research into policy-making remains a complex and non-linear process. Different models of research utilisation and guidelines to maximise this in policy-making exist, however, challenges still remain for researchers to improve uptake of their research findings and for policy-makers to use research evidence in their work.

Methods

A participatory workshop with researchers was organised in November 2017 by the Academic Network for Sexual and Reproductive Health and Rights Policy (ANSER) to address this gap. ANSER is a consortium of experienced researchers, some of whom have policy-making experience, working on sexual and reproductive health and rights issues across 16 countries and 5 continents. The experiential learning cycle was used to guide the workshop discussions based on case studies and to encourage participants to focus on key lessons learned. Workshop findings were thematically analysed using specific stages from Hanney et al.’s (Health Res Policy Syst 1:2, 2003) framework on the place of policy-making in the stages of assessment of research utilisation and outcomes.

Results

The workshop identified key strategies for translating research into policy, including joint agenda-setting between researchers and policy-makers, as well as building trust and partnerships with different stakeholders. These were linked to stages within Hanney et al.’s framework as opportunities for engaging with policy-makers to ensure uptake of research findings.

Conclusion

The engagement of stakeholders during the research development and implementation phases, especially at strategic moments, has a positive impact on uptake of research findings. The strategies and stages described in this paper can be applied to improve utilisation of research findings into policy development and implementation globally.

     

Practising what we preach? A practical approach to bringing research, policy and practice together in relation to children and health inequalities

This paper explores the need for better links between research and practice in relation to work with children and health inequalities. Despite continuing discussion about the need to improve dissemination of research activity in general, study of this area remains largely neglected. As a result, despite the rhetoric, the research and practice gap continues to exist. An attempt to remedy this was undertaken through the support of a user fellowship as part of the UK Economic and Social Research Council Health Variations Programme. The paper describes a number of activities that were undertaken during the fellowship, and discusses the implications of these for improving connections and minimizing the research and practice 'gap'. It argues that a need exists for researchers to develop innovative dissemination strategies and suggests that potential exists for an interactive model of dissemination. Such a model implies a more active role for users of research in the shaping of research agendas.     

Tackling health inequalities and social exclusion through partnership and community engagement? A reality check for policy and practice aspirations from a Social Inclusion Partnership in Scotland

In the contemporary UK policy context, multisectoral partnership initiatives and community participation are increasingly viewed as appropriate mechanisms for tackling health and social disadvantage. Such initiatives are often put into practice in contexts of industrial and economic decline, fragmented neighbourhoods, hard-pressed public services, and sustained under-investment in voluntary and community sector organisations. This paper draws on ethnographic fieldwork in a Social Inclusion Partnership (SIP) in Scotland to suggest that policy-makers and public health practitioners need a better understanding of the difficulties involved in implementing partnership and participation initiatives in this kind of context. The East Kirkland SIP was set up to tackle social exclusion and health inequalities within the most deprived neighbourhoods of a Scottish town, yet community engagement remained elusive. Partnership proved to be risky territory for all involved, marked by rivalry and suspicion between SIP members, rather than co-operation, whilst health promotion and social inclusion priorities conflicted with those of community development and regeneration. In sum, this paper presents a reality check for some contemporary policy and practice aspirations.     

The impact of the European Environment and Health Process on UK environment and health policy, plans and practice: what difference has it made?

The European Environment and Health Process (EEHP), led by theWorld Health Organization (WHO) Regional Office for Europe,aims to support WHO Member States as they plan and implementnational and international environment and health policies.An evaluation of the impact of the EEHP in the UK was conductedin preparation for the fourth Ministerial Conference on Environmentand Health in Budapest, 2004. The evaluation identified a numberof impacts and influences of the EEHP. This concluded that theprocess had only a marginal direct influence on policy withinthe UK. However, it was also concluded that the process hadresulted in several indirect influences, including better cooperationbetween government departments, greater awareness of environmentand health issues from an international perspective, and a higherpolitical profile of environment and health issues. A few outcomesof the EEHP also appear to have been taken into account in somenational and local policy documents. The National EnvironmentalHealth Action Plan, which was produced as a direct result ofthe EEHP, appears to have had little direct impact in the UK,probably because of the lack of an implementation process andindicators, and because it was superseded by other policy initiativesrelatively soon after publication. A need for better coordinationand promotion of the EEHP amongst stakeholders responsible forenvironment and health policy areas was also identified.     

Conditions for research in general practice. Can the Dutch and British experiences be applied to other countries, for example Spain?

The aim of this study is to identify conditions for research as part of professional development in general practice. Based on the work of Andrew Abbott, who studied the dynamics of professional development, five conditions were identified. These are: the creation of associations among professionals; control of work; the establishment of specialised education; the development of professional knowledge; and the creation of organised structures for professional work. Two countries with a well-established research tradition in general practice (the UK and the Netherlands) and one country where GP research development is still limited (Spain) were evaluated on the basis of these conditions. The conditions identified as favourable were as follows: the existence of a scientific association; a peer-reviewed journal; a defined population resulting in a population denominator for practices; a gatekeeping system; chairs and departments of general practice at universities; the integration of education centres and research centres; GPs working in group practices or health centres; a certain degree of independence from the Ministry of Health; and financial support for practicing GPs to conduct research activities. We showed that most conditions for the successful scientific progress of general practice in Spain are present. However there is still a gap between academia and general practice and a lack of research organisation and support.     

Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 6: reaction on commentaries - how to continue with the Research Agenda?

The Research Agenda should be used as a key reference point to which new research should relate its usefulness and added value. Primary care evolves towards more interdisciplinary care, and research should focus more on the core competency of person-centred team care. There is an urgent need to develop clear definitions and appropriate research instruments for this domain. It will be a particular challenge to study comprehensive approaches in primary-care patients with multi-morbidity. The Research Agenda and the commentaries on it show future directions for primary care research. There are challenges related to a changing society, the shared responsibility and guidance of research by professionals and citizens (patients), and the need to fully integrate research as part of primary healthcare provision. There will be a need for a prioritization of spearheads to guide primary care research for the next decade: translational research, research on equity and health differences, on chronic disease and health systems research. This can not be realized without the development and maintenance of a solid research infrastructure: easily maintained and accessed observational databases, helpful information technology, strategies and techniques for patient involvement, advanced research training possibilities, and the development and validation of appropriate research instruments and outcome measures to capture the different challenges. Worldwide, primary care not only is a priority for health care policy, but it needs to become a research priority as well.     

Health care for older people in Italy: The U.L.I.S.S.E. project (Un Link Informatico sui Servizi Sanitari Esistenti per l’anziano — a computerized network on health care services for older people)

Objectives

The U.L.I.S.S.E. study is aimed at describing older patients who are cared for in hospitals, home care or nursing homes in Italy.

Design

The U.L.I.S.S.E. study is an observational multicenter prospective 1-year study.

Setting

Overall, 23 acute geriatric or internal medicine hospital units, 11 home care services and 31 nursing homes participated in the study.

Measurements

The patient’s evaluation was performed using comprehensive geriatric assessment instruments, i.e. the interRAI Minimum Data Set, while data on service characteristics were recorded using ad-hoc designed questionnaires.

Results

The older subjects who are in need of acute and long term care in Italy have similar characteristics: their mean age is higher than 80 years, they have a high level of disability in ADL, an important multimorbidity, and are treated with several drugs. The prevalence of cognitive impairment is particularly high in nursing homes, where almost 70% of residents suffer from it and 40% have severe cognitive impairment. On the other hand, there is a shortage of health care services, which are heterogeneous and fragmented.

Conclusions

Health care services for older people in Italy are currently inadequate to manage the complexity of the older patients. An important effort should be undertaken to create a more integrated health care system.     

Earlier detection of public health risks – Health policy lessons for better compliance with the International Health Regulations (IHR 2005): Insights from low-, mid- and high-income countries

The International Health Regulations (IHR 2005) require all Member States to build and maintain the capacities to prevent, detect and respond to public health emergencies. Early detection of public health risks is one of the core functions. In order to improve surveillance and detection, a better understanding of the health system conditions and their influencing factors are needed. The Israeli Ministry of Health/IHR National Focal Point held a workshop to elucidate health system conditions and their influencing factors that enable earlier detection. The workshop methodology employed a stepwise, small working group analysis approach to elucidate the conditions and their influencing factors affecting each stage of recognition, assessment, and reporting of infectious disease outbreaks, at the local, regional and national levels. In order to detect public health risks earlier, the detection process needs to be moved closer to the local communities and start with building capacity within communities. Building capacity and engaging with local and diverse communities requires significant changes in the governance approach and include information sharing, multi-sectoral communication and coordination across various levels before, during and after public health emergencies. Across the regions, low-, mid- and high-income countries seem to struggle more with governance and information sharing rather than with technical capacities and capabilities.     

The fight against poliomyelitis through the history: past,present and hopes for the future. Albert Sabin's missing Nobel and his “gift to all the world's children”

Polio, or poliomyelitis, is a disabling and life-threatening disease caused by three poliovirus (PV) serotypes. The virus spreads from person to person and can infect a person’s spinal cord, causing paralysis. In 1988, when the WHO registered 350,000 cases of poliomyelitis in the world and 70,000 which occurred in Africa alone, global poliomyelitis eradication was proposed by the World Health Organization to its member States. On 25 August 2020, while the world was waging war against the Coronavirus pandemic, a historic milestone was reached: Africa was officially declared polio-free.It is an important result obtained thanks to an intensive large-scale vaccination campaign.The road was far from smooth, nevertheless, according to the WHO, a great effort needs to be made in order to facilitate access to vaccination and to promote its implementation in those countries where coverage is low and vaccine hesitancy is high because the risk of the spread of poliomyelitis is still relevant. Eradication of the virus in Africa provides us with an excellent opportunity to commemorate the many scientists who contributed to achieving this epoch-making goal: first of all, Jonas Salk, who developed a killed-virus vaccine in 1952, and, especially, Albert Sabin, who in 1961 launched programs of mass immunisation with his oral vaccine against poliomyelitis.