Prozessevaluation einer Intervention zur kooperativen Raucherentwöhnung

Background

The study “ENTER: Evaluation of a collaborative smoking cessation intervention” is a cluster-randomized controlled trial to assess the effectiveness of a smoking cessation intervention implemented in the German primary care setting in collaboration with AOK NORDWEST in Westphalia-Lippe and Schleswig-Holstein.

Objectives

A process evaluation was performed with the aim of investigating barriers and facilitators to intervention implementation and giving recommendations for future interventions.

Materials and methods

Between November 2015 and January 2016 semistructured qualitative interviews were conducted with AOK employees and general practitioners of the intervention group. Interviews focused on contextual factors (e.?g. responsibilities for implementing the intervention), the communication between network partners and the process of referring patients to smoking cessation courses.

Results

Overall, 21 interviews were completed (8 AOK employees, 13 general practitioners). Intervention implementation was facilitated because physicians perceived smoking cessation counseling to be important and were supported by their office staff. Challenges were seen in patients’ motivation for participation in smoking cessation courses and meeting the minimum number of course participants.

Conclusions

Successful intervention implementation would be facilitated by motivating patients to participate in smoking cessation courses and informing them about the effectiveness of the courses. Patient’s preferences for different smoking cessation aids should be investigated in order to increase the use of effective aids.

     

Strengthening the Coordination of Pediatric Mental Health and Medical Care: Piloting a Collaborative Model for Freestanding Practices

Background

Collaborative pediatric mental health and primary care is increasingly recognized as optimal for meeting the needs of children with mental health problems. This paper describes the challenges faced by freestanding specialty mental health clinics and pediatric health practices to provide such coordinated mind-and-body treatment. It describes critical elements of a proactive approach to achieving collaborative pediatric care under real-world circumstances using the patient-centered medical home neighborhood (PCMH-N) model.

Objective

The current study evaluates the field test of the practitioner-informed model to facilitate interdisciplinary collaboration (PIM-FIC), a systematic approach to improving inter-professional collaboration by building relationships and enhancing communication between pediatric mental health and primary care practices.

Methods

Thirty-nine providers at two mental health and two pediatric primary care practices participated in a pilot project and completed surveys prior to and following their participation. Key informant interviews were also conducted prior to the project.

Results

Participating practitioners’ survey and interview responses indicate that the quantity and quality of communication between pediatric mental and medical health care providers increased post-project, as did satisfaction with overall collaboration.

Conclusions

Improving relationships and communication are first steps in building the infrastructure to support effective coordinated care. Project results highlight practical and easily implemented strategies that pediatric mental health and primary care practices can take to strengthen their collaboration. Findings also suggest a need for collaborative care policies and competencies for child mental health providers working in freestanding practices within the PCMH-N.

     

Familienhebammen im System Früher Hilfen

Background

During the last 10 years, family midwives have become increasingly integrated into the Early Intervention System in Germany. As representatives of the health care professions and based on a trusting relationship with vulnerable families, they use several strategies to promote positive health behavior and health conditions.

Objectives

The aim of the study was to obtain insight into subjective theories of family midwives, which influence their dealings with families and taking a guiding role for the families.

Methods

Following a qualitative research approach, 13 family midwives were interviewed. The interviews were interpreted according to methods recommendations by Witzel.

Results

Structural circumstances influence family midwives’ subjective theories of good quality. In spite of disclaiming controlling function, family midwives who work directly with representatives of child welfare services, by trend follow the aims of child welfare services. Family midwives working in conjunction with a private agency emphasize their strategies of health promotion.

Conclusion

Family midwives can be supported in their strategies of health promotion. Association with a private agency seems to be helpful for maintaining the salutogenetic perspective of midwives.

     

Förderung des Wohlbefindens durch „Gamification“

Background

Wellbeing is an important element of a holistic health approach. However, it is barely considered in health promotion and prevention programs. In this context, serious games and gamification provide new and effective measures to promote wellbeing and mental health.

Objectives

This article presents the application “The Wellbeing Game” as a gamification-based approach to promote wellbeing. Furthermore, a project to adapt and evaluate the Wellbeing Game for the German context is presented.

Materials and methods

As part of a preliminary analysis, expert interviews were conducted for a structured analysis of the application. Based on the results, the technical and content elements of the application will be redesigned. For formative and summative evaluation, a randomized controlled study will be conducted in different settings.

Results

This article presents the results of the preliminary analysis which identified needs for adaptation concerning gamification elements, technical implementation, user experience as well as culture-specific requirements.

Conclusions

Gamification-based applications, such as the Wellbeing Game provide effective measures to promote individual wellbeing. The present results provide important insights into the mechanisms of the Wellbeing Game as well as the need for adaptation for the German target group.

     

School development in Austria and implementation factors for health promotion

Aim

This article investigates the associations between different approaches to the implementation of health promotion and existing structures that facilitate long-term implementation.

Subject and Methods

The data was collected in a survey amongst heads of Austrian secondary schools. For analyses, four groups of schools were differentiated: (1) schools that implement health promotion voluntarily with the help of specialised organisations, (2) schools that implement health promotion as part of their obligatory school development programme, (3) schools that use a combined approach, and (4) for comparison schools that use neither of these strategies. The groups are compared according to a number of indicators for a supportive HP programme.

Results

The first three groups show more desirable characteristics in regards to aspects that facilitate the implementation of health promotion (e.g. high teacher support) than the comparison group. The best conditions are found in schools that use a combined approach. Hardly any differences are observed between the groups on the level of the outcomes of health promotion activities.

Conclusion

The findings are discussed in the context of change management and the differences between programmed and participatory strategies of implementation. Some of the presented differences can be explained via this approach and hold valuable conclusions for policy makers and practitioners.

     

Increasing Youth Engagement in Residential Group Care: A Mixed Methods Pilot Study of a Youth-Guided Incentive Program

Background

Lack of engagement in child welfare services is a salient issue impeding client outcomes. Research findings indicate that providing incentives may be a promising strategy for enhancing client engagement.

Objective

In response to low youth engagement and repeated re-entry into care, a Southeastern child welfare agency developed an incentive program aimed at increasing youths’ participation and success in meeting treatment goals. This mixed methods study examined elements of effective implementation and the effectiveness of the incentive program piloted in a group home serving adolescent boys (n?=?16).

Method

A semi-structured focus group with service providers (n?=?7) was used to inform the development of the pilot incentive program. We used a time-series design to measure youth perceptions of the therapeutic alliance with their therapists and weekly goal attainment. Baseline data was collected for 6 weeks (phase one) followed by 6 weeks of the incentive program (phase two).

Results

Results of qualitative analyses revealed four themes related to therapeutic engagement, and two themes related to intervention implementation. Providers emphasized the importance of youth-driven care and building a strong therapeutic alliance. Findings also suggest that staff buy-in is critical to the success of intervention implementation. These results, along with suggested strategies for effective implementation, informed the development of the piloted incentive program. Results of simulation modeling analyses of time series data showed significant increases in therapeutic alliances and goal attainment following the incentive program.

Conclusions

This study provides preliminary support for the use of incentive programs to facilitate youth engagement in residential programs.

     

Gesundheitsförderung im Setting Kita

Background

The German law to strengthen health promotion and prevention (Prevention Law, PraevG 2015) along with the Federal Recommendations Framework recognize daycare centers for children as a central setting for health promotion. However, concrete regulations and strategies to support implementation are currently lacking.

Objective

The objective of this article is to discuss how day-care centers for children can be established as a central setting for health promotion in practice.

Methods

The new legal regulations for the setting approach and the agreements with daycare centers of the national prevention conference are presented, the field-specific challenges for health care promotion in daycare enters are compared, the current situation is analyzed, and the needs for action are identified based on the evaluation of the health objective and the federal health report.

Results

The Prevention Law (PraevG 2015) has substantially improved the situation to initiate health promotion activities in daycare centers for children. Educational frameworks offer a number of points for further contact regarding health promotion activities. While a large number of health promotion activities already exist, they mainly tend to be isolated projects offered by various health insurance funds rather than a coordinated approach.

Conclusion

New opportunities should be used to focus on quality development and coordination of the existing programs with due consideration of field-specific requirements. A comprehensive strategy to promote and guide coordinated efforts for activities is needed to replace the current trend of isolated programs.

     

„Der Depression Beine machen“

Background

The positive effects of physical activity and exercise on physical and psychological well-being are well documented. The project “To make a move on depression” offers walking meetings for persons with depression under supervision of an exercise instructor and a psychotherapist in each group, taking place at three sites in Rhineland–Palatinate. The project was evaluated in a pilot phase of one year.

Methods

Standardized and self-developed questionnaires were used to gather data on different physical and psychological dimensions. Furthermore, the participants were asked to evaluate the project themselves.

Results

A total of 36 participants filled in questionnaires at the beginning and at the end of the project. Significant improvements could be shown with regard to physical and psychological well-being, depression and self-efficacy as well as improvements of the physical and psychological well-being after every walking session. The evaluation of the project by the participants turns out positive almost without exception.

Conclusions

Walking meetings with supervision of an exercise and a psychotherapeutic professional seem to have a positive impact for persons with depression. The experience that walking feels good and especially the effects of a common activity in a group have to be pointed out.

     

Drogenkonsum unter Studierenden der Sozialen Arbeit

Background

The study surveyed extent of drug use among students of social work and explored if there was a relationship between drug use and demands of study program.

Methods

Social work students (n = 240) filled in an online questionnaire about their drug use and rated demands of their study program.

Results

A third of the students took cannabis, 10?% tranquilizer or sleeping pills and almost 10?% amphetamines. Students used cannabis und tranquilizers deliberately to obtain recovery times in everyday student life. However, there were only low rates of brain doping observed.

Conclusion

Students should receive coaching on alternative methods of relaxation and strategies for time management and self-care.

     

Prävention sexualisierter Gewalt. Zur Implementierung des IGEL-Programms in Grundschulen

Background

A large variety of interventions have been developed and implemented to prevent child sexual abuse in schools and other educational institutions. With regard to school-based prevention programs, little is known about their effectiveness and feasibility.

Objectives

The goal of this work was to identify conditions conducive to successful implementation of a school-based program for the prevention of sexual violence.

Methods

To analyze the implementation fidelity, feasibility, and acceptability of a German school-based program for the prevention of sexual violence (IGEL program), documentation sheets with prestructured contents were used, and (group) interviews with participating teachers were conducted as part of a process evaluation.

Results

The results suggest that the implementation of the IGEL program under practical everyday conditions in elementary schools could be realized as planned. The acceptance of the program by teachers and children was high. The flexibility of the program, the elaborateness of the IGEL sessions and materials, as well as the continuous offer of advice and support during the program implementation emerged as important conditions conducive to successful implementation.

Conclusions

Successful implementation of a school-based program for the prevention of sexual violence depends on various factors at different levels. On the one hand, there are specific characteristics of the program itself (e.g., practicality of the IGEL materials). On the other hand, there are characteristics of teachers and children (e.g., trust-based relationship) as well as of the school curriculum or school organization (e.g., linking of the program with the sexual education).

     

MRSA-Screening als Routine vor elektiven Eingriffen? Wer trägt die Kosten?

Background

Increasing number of healthcare-associated infections caused by multiresistant bacteria has become a major problem. Low-cost MRSA-screening before elective surgery could reduce infection rates.

Aims

The previous regulations in handling MRSA shows, that statutory rules to pay the screening costs are missed. The aim of an ongoing project is to show the possibilities for sponsors in helping patient safety and a legal based framework.

Results

In the current project the screening costs are very low. The success of eradication is about 100?%. The present article document the need for implementing MRSA screening as routine in hospitals to complete the current activities of the policy (i.?e. this year G7 summit).

     

Aktive Gefährdungsvermeidung bei psychischer Belastung

Background

The German Occupational Safety and Health Act obliges employers to ensure that psychosocial risks of work are identified and targeted measures are taken to reduce them.

Aim

Within a field research project, companies’ procedures and experiences were explored in order to broaden the knowledge about opportunities and limitations of psychosocial risk management in organizations.

Methods

Semistructured interviews were conducted with stakeholders among 41 enterprises, having a leading role in managing psychosocial risks. Various organizational pathways of psychosocial risk management were differentiated by comparing and contrasting cases.

Results

Psychosocial risk management activities are organized and conducted in the areas of (1) occupational safety and health, (2) employee-oriented leadership, (3) professional practice, (4) collective care, and/or (5) workplace health promotion. Thus, the study discriminates different contexts of company practice to actively organize and implement strategies for hazard prevention in case of psychosocial risks. However, each of them poses specific limitations: for example, hazard prevention in the context of professional practice is restricted to occupation-specific psychosocial risks.

Conclusions

Psychosocial risk management is not realized exclusively within the structures of occupational safety and health, but (at the same time) also in other contexts of company activities. Both research and practice should focus more on opportunities for effective psychosocial risk management which lie beyond structures of occupational safety and health as well as develop and strengthen them more systematically.

     

Applying Collaborative Learning and Quality Improvement to Public Health: Lessons from the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality

Objectives

Infant mortality remains a significant public health problem in the U.S. The Collaborative Improvement & Innovation Network (CoIIN) model is an innovative approach, using the science of quality improvement and collaborative learning, which was applied across 13 Southern states in Public Health Regions IV and VI to reduce infant mortality and improve birth outcomes. We provide an in-depth discussion of the history, development, implementation, and adaptation of the model based on the experience of the original CoIIN organizers and participants. In addition to the political genesis and functional components of the initiative, 8 key lessons related to staffing, planning, and implementing future CoIINs are described in detail.

Methods

This paper reports the findings from a process evaluation of the model. Data on the states’ progress toward reducing infant mortality and improving birth outcomes were collected through a survey in the final months of a 24-month implementation period, as well as through ongoing team communications.

Results

The peer-to-peer exchange and platform for collaborative learning, as well as the sharing of data across the states, were major strengths and form the foundation for future CoIIN efforts. A lasting legacy of the initiative is the unique application and sharing of provisional “real time” data to inform “real time” decision-making.

Conclusion

The CoIIN model of collaborative learning, QI, and innovation offers a promising approach to strengthening partnerships within and across states, bolstering data systems to inform and track progress more rapidly, and ultimately accelerating improvement toward healthier communities, States, and the Nation as a whole.

     

Körperliche Aktivität zur Stärkung kognitiver Ressourcen

Background

Nursing care insurance funds are supposed to deliver preventive services in nursing homes. The strengthening of cognitive resources is considered as one field of action.

Aim

The preventive effectiveness of physical activity on cognitive performance in nursing home residents shall be evaluated.

Methods

A systematic search was carried out in the databases MEDLINE, the Cochrane Library, EMBASE, CINAHL, PsycINFO and PEDro. Results were combined in random-effects meta-analyses.

Results

Taking into account 13 primary studies, it was shown that those participating in physical activity showed statistically significant greater cognitive performance compared to controls (SMD = 0.43, 95% CI 0.20–0.66, p = 00002). Subgroup analyses suggest that nursing home residents with different cognitive impairments might benefit from long-lasting physical activity interventions. Due to the high risk of bias in included studies, the results must be interpreted with caution.

Conclusion

Physical activity might be effective in the inpatient care setting. Further studies with longer intervention periods are required.

     

Gesundheitskommunikationsstrategien zu Hantaviren in Deutschland

Background

A hantavirus risk perception and communication study was performed in the years 2011–2012 as part of the EU-funded EDENext project in endemic areas of Germany.

Methods

Three focus groups were conducted: one in urban and two in rural regions. Participants of one rural group were exposed to the hantavirus due to their occupation. All groups were analysed regarding their risk perception, their risk knowledge about the hantavirus and its transmission, their coping strategies and their information behaviour and expectations in case of an outbreak.

Results

The analysed groups living in endemic areas are well aware of the hantavirus risk. They have basic knowledge about protection measures. However, not all of them who know the latter would also apply protection measurements for practical reasons. Information provided by mass media or others are more trustworthy if the source mentioned is a public (health) authority. Static warning signs, such as tables, are less appreciated than risk maps for reasons of timeliness.

Conclusions

The development of health communication strategies, including health campaigns, should be based on risk perception studies, in order to reach the target groups. This is particularly relevant in case of rare or locally limited diseases.

     

Resilienzförderung

Background

Nearly every second person suffers from mental illness at some point in their life. In this regard, stress-induced illnesses play a central role. Stress cannot be avoided; thus, interventions that promote resilience in the face of stress are particularly significant.

Objective

The paper gives a short overview of the current status quo in the development of evidence-based resilience interventions.

Materials and methods

The chosen method is a narrative review that takes into account papers with relational resilience constructs such as concept analysis, systematic reviews, and empirical studies of international resilience research.

Results

Currently, the main challenge for program developers is to identify valid protective factors within resilience research which match the target and target group of a special intervention.

Conclusion

There is a need for systematic reviews to systematize heterogeneous resilience studies. Based on such reviews, the selection of protective factors that should be promoted in an intervention can be justified.

     

Erfassung der Selbsteinschätzung körperlicher Aktivität von jungen Erwachsenen

Background

Patterns of activity in adulthood are often established during adolescence, making this stage of life an important period for promoting physical activity (PA). Success of such health promotion depends on many factors. One of these factors is the awareness of one’s own PA level.

Objective

This study examines PA awareness in vocational school students in Germany.

Methods

The study uses data of 53 vocational school students (54.7?% female, age: 20.7 years, standard deviation 3.1 years; BMI: 24.1 kg/m², standard deviation 4.5 kg/m²) from the 2013 project “Make Move – Bewegt in die Arbeitswelt”.

Results

Comparison of subjective and objective measurements (accelerometry) of physical activity showed a high prevalence of over- and underestimation of PA (each 45.3?%). Pearson correlation coefficients of subjective and objective measurements were low (r=?0.40–0.49; p?<?0.05).

Conclusion

Overall, PA awareness of students in this sample was low. Hence, the awareness levels have to be considered in the conception of future health promotion interventions.

     

A mixed-methods study of system-level sustainability of evidence-based practices in 12 large-scale implementation initiatives

Background

In recent decades, evidence-based practices (EBPs) have been broadly promoted in community behavioural health systems in the United States of America, yet reported EBP penetration rates remain low. Determining how to systematically sustain EBPs in complex, multi-level service systems has important implications for public health. This study examined factors impacting the sustainability of parent-child interaction therapy (PCIT) in large-scale initiatives in order to identify potential predictors of sustainment.

Methods

A mixed-methods approach to data collection was used. Qualitative interviews and quantitative surveys examining sustainability processes and outcomes were completed by participants from 12 large-scale initiatives.

Results

Sustainment strategies fell into nine categories, including infrastructure, training, marketing, integration and building partnerships. Strategies involving integration of PCIT into existing practices and quality monitoring predicted sustainment, while financing also emerged as a key factor.

Conclusions

The reported factors and strategies impacting sustainability varied across initiatives; however, integration into existing practices, monitoring quality and financing appear central to high levels of sustainability of PCIT in community-based systems. More detailed examination of the progression of specific activities related to these strategies may aide in identifying priorities to include in strategic planning of future large-scale initiatives.

Trial registration

ClinicalTrials.gov ID NCT02543359; Protocol number PRO12060529.