Becoming an eCoach: Training therapists in online cognitive-behavioral therapy for chronic pain

Objective

Online cognitive-behavioral therapy (iCBT) is effective in supporting patients’ self-management. Since iCBT differs from face-to-face CBT on several levels, proper training of therapists is essential. This paper describes the development and evaluation of a therapist training based on theoretical domains that are known to influence implementation behavior, for an iCBT for chronic pain.

Understanding similarities in the local implementation of a healthy environment programme: insights from policy studies

This paper reports findings from an evaluation of the local implementation of a procedural public health programme whose objective is to create healthy environments (HE) for vulnerable families in the province of Quebec (Canada) through the funding of local projects. Considering the potential issue of programme–context interaction, our research question was the following: Does the procedural nature of this HE programme result in variation between local cases in terms of the types of projects and collaborations it subsidizes? Given that the creation of healthy environments requires intersectoral health action to address social determinants of health, the data were analysed with respect to intersectorality and cooperation. Results of this qualitative multiple case study (n = 8), for the period 2004–2009, show that the majority of subsidized projects were in the health and social services sector and focused on parenting, parent–child attachment, nutrition and the social networks of families. Only a few initiatives reached beyond the health and social services sector to address social health determinants such as education, housing and transportation. Membership and mandates of the local groups responsible for programme implementation also showed little intersectorality. The limited variation between these eight cases can be attributed to the configuration of the local networks, as well as to specific issues in urban and rural areas. To explain the overall similarity of results across cases, we turned to the literature on policy instruments which suggests that particular characteristics of a programme may produce effects that are independent of its intended objective. In our study, several programme mechanisms, such as those framing the definition of «healthy environment» and budget management rules, could have encouraged the local development of initiatives that focus on individual skills related to parenting and attachment rather than the development of intersectoral health action to address social determinants of health.     

The implementation of a global fund grant in Lesotho: applying a framework on knowledge absorptive capacity

One of the biggest challenges in scaling up health interventions in sub-Saharan Africa for government recipients is to effectively manage the rapid influx of aid from different donors, each with its own requirements and conditions. However, there is little empirical evidence on how governments absorb knowledge from new donors in order to satisfy their requirements. This case study applies Cuellar and Gallivan's (2006) framework on knowledge absorptive capacity (AC) to illustrate how recipient government organisations in Lesotho identified, assimilated and utilised knowledge on how to meet the disbursement and reporting requirements of Lesotho's Round 5 grant from the Global Fund to Fight AIDS, TB and Malaria (Global Fund). In-depth topic guided interviews with 22 respondents and document reviews were conducted between July 2008 and February 2009. Analysis focused on six organisational determinants that affect an organisation's absorptive capacity: prior-related knowledge, combinative capabilities, motivation, organisational structure, cultural match, and communication channels. Absorptive capacity was mostly evident at the level of the Principal Recipient, the Ministry of Finance, who established a new organisational unit to meet the requirements of Global Fund Grants, while the level of AC was less advanced among the Ministry of Health (Sub-Recipient) and district level implementers. Recipient organisations can increase their absorptive capacity, not only through prior knowledge of donor requirements, but also by deliberately changing their organisational form and through combinative capabilities. The study also revealed how vulnerable African governments are to loss of staff capacity. The application of organisational theory to analyse the interactions of donor agencies with public and non-public country stakeholders illustrates the complexity of the environment that aid recipient governments have to manage.     

护患沟通竞赛在优质护理服务工作中的实施与应用

目的:探讨护患沟通竞赛在优质护理服务工作中实施的价值与意义。方法:对全院护士进行护患沟通意义、护患沟通技巧、护患沟通形式等内容的培训,并公布了护患沟通竞赛方案,建立护理三级质控监督机制,将护患沟通落到护理工作实处。结果:开展护理沟通竞赛后,提高了患者满意度,提高了护理工作质量,提高了综合素质和业务能力,营造科室团结协作的工作氛围。结论:护患沟通竞赛对"优质护理服务示范工程"活动的开展起到了重要作用,取得了满意效果。