Background: Patient Reported Experience Measures are promoted to be used as an integrated measurement approach in which outcomes are used to improve individual care (micro level), organisational quality (meso level) and external justification (macro level). However, a deeper understanding of implementation issues of these measures is necessary. The narrative Patient Reported Experience Measure “Dit vind ik ervan!” (English “How I feel about it!”) is used in the Dutch disability care sector, but insight into its’ current use is lacking. We aimed to provide insight into experiences with the implementation and current ways of working with “Dit vind ik ervan!” as an integrated measurement strategy. A descriptive qualitative study was done at a disability care organisation. Data were collected by nine documentations, seven observations, 11 interviews and three focus groups. We applied deductive content analysis using the Consolidated Framework for Implementation Research as a framework. Results: Our analysis revealed facilitators and barriers for the implementation of “Dit vind ik ervan!”. We found most barriers at the micro level. Professionals and clients appreciated the measure’s narrative approach, but struggled to perform it with communication vulnerable clients. Some clients, professionals and team leaders were unfamiliar with the measure’s aim and benefit. On the meso level, implementation was done top-down, and the management’s vision using the measure as an integrated measurement approach was insufficiently shared throughout the organisation. Conclusions: Our study shows that Patient Reported Experience Measures have the potential to be used as an integrated measurement strategy. Yet, we found barriers at the micro level, which might have influenced using the measurement outcomes at the meso and macro level. Tailored implementation strategies, mostly focusing on designing and preparing the implementation on themicro level, need to be developed in co-creation with all stakeholders.
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In order to design effective Persuasive Technology (PT) interventions, it is essential that designers understand the multitude of factors that lead to behavioral change, rather than guessing at a solution or imitating successful techniques without understanding why. The few available PT design frameworks solely distinguish behavioral determinants on an individual (micro) level (e.g., motivation), whereas successfully persuading a user is a multifaceted and complex task depending also on factors on a meso (e.g., available resources) and macro (e.g., social support and praise) level. We developed an analysis grid that enables PT designers to acknowledge the multifaceted character of determinants leading to behavioral change and select appropriate PT channels and strategies, preventing the failure of PT design. This analysis grid was validated in a case study in which we designed a PT intervention aimed at reporting minor crime incidents among citizens.
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Assistive technology supports maintenance or improvement of an individual’s functioning and independence, though for people in need the access to assistive products is not always guaranteed. This paper presents a generic quality framework for assistive technology service delivery that can be used independent of the setting, context, legislative framework, or type of technology. Based on available literature and a series of discussions among the authors, a framework was developed. It consists of 7 general quality criteria and four indicators for each of these criteria. The criteria are: accessibility; competence; coordination; efficiency; flexibility; user centeredness, and infrastructure. This framework can be used at a micro level (processes around individual users), meso level (the service delivery scheme or programme) or at a macro level (the whole country). It aims to help identify in an easy way the main strengths and weaknesses of a system or process, and thus guide possible improvements. As a next step in the development of this quality framework the authors propose to organise a global consultancy process to obtain responses from stakeholders across the world and to plan a number of case studies in which the framework is applied to different service delivery systems and processes in different countries.
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Rationale/Purpose: High-performance sport systems offer athletes access to a range of experts including excellent coaches. This study examines the macro-, meso- and micro-level factors associated with coaching elite women athletes within a high-performance sport system. Design/methodology/approach: This research was underpinned by constructionism and critical feminism. The data were collected via semi-structured in-depth interviews with 10 international male elite rowing coaches with experience in coaching men and women athletes and analysed using thematic analysis. Findings: The data shows that at the micro-level, coaches differentiate their practices based on the gender of the athlete. These practices are influenced by meso-level factors (perceived value of sport participated by women) and shaped by macro-level factors (socio-cultural background of the coaches). Practical implications: Coaches’ socio-cultural experiences influence their construct of gender and affect their approach to coaching women athletes. Hence identifying macro-level factors can help managers understand coaches’ perspectives, philosophy and practice at a micro-level. https://doi.org/10.1080/23750472.2019.1641139 LinkedIn: https://www.linkedin.com/in/donna-de-haan/
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Background: The integrated uptake of patient-reported experience measures, using outcomes for the micro, meso and macro level, calls for a successful implementation process which depends on how stakeholders are involved in this process. Currently, the impact of stakeholders on strategies to improve the integrated use is rarely reported, and information about how stakeholders can be engaged, including care-users who are communication vulnerable, is limited. This study illustrates the impact of all stakeholders on developing tailored implementation strategies and provides insights into supportive conditions to involve care-users who are communication vulnerable. Methods: With the use of participatory action research, implementation strategies were co-created by care-users who are communication vulnerable (n = 8), professionals (n = 12), management (n = 6) and researchers (n = 5) over 9 months. Data collection consisted of audiotapes, reports, and researchers’ notes. Conventional content analysis was performed. Results: The impact of care-users concerned the strategies’ look and feel, understandability and relevance. Professionals influenced impact on how to use strategies and terminology. The impact of management was on showing the gap between policy and practice, and learning from previous improvement failures. Researchers showed impact on analysis, direction of strategy changes and translating academic and development experience into practice. The engagement of care-users who are communication vulnerable was supported, taking into account organisational issues and the presentation of information. Conclusions: The impact of all engaged stakeholders was identified over the different levels strategies focused on. Care-users who are communication vulnerable were valuable engaged in co-creation implementation strategies by equipping them to their needs and routines, which requires adaptation in communication, delimited meetings and a safe group environment. Trial registration: Reviewed by the Medical Ethics Committee of Zuyderland-Zuyd (METCZ20190006). NL7594 registred at https://www.trialregister.nl/. Plain English summary Exploring care-users experiences is important for decisions to improve quality of care. This applies to care-users in the disability care in particular, as these care-users are highly dependent on their care professional. Instruments that facilitate a dialogue between care-users and care professionals about experiences with care are not always used correctly. Furthermore, it is difficult to translate outcomes into decisions about improving quality of care for the individual care-user and the organisation. In our study, care-users, care professionals, management and researchers developed strategies together to improve the use of care-user experience measures. This study aims to show the impact of all participants, including care-users, professionals, management and researchers, on developing implementation strategies. Additionally, the study aims to show how care-users can participate in developing strategies whilst having problems with communication due to intellectual, developmental and acquired disabilities. We found that care-users gave crucial input to the look and feel, and understandability and relevance of the strategies. The contribution of the professionals had impact on how to use strategies and terminology used in instructions and visuals. Management shared lessons learned and represented the needs on the policy level. Researchers used their analytical skills and facilitated the group process. Care-users were able to collaborate by taking into account their needs and because information was presented to them clearly and attractively.
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This study investigated the implementation of mHealth apps in an early stage of the implementation process. Key stakeholders were involved, who attributed to the possibilities and limitations of the implementation. It is crucial to have a clear vision from an organizational perspective and specific prerequisites for implementation strategies at micro, meso, and macro levels. Essential strategies at the national level include guidelines for regulations, privacy, and security; the integration of mHealth into T2DM care guidelines; and sufficient reimbursement by health insurers.
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OBJECTIVE: The World Health Organization (WHO) recently proposed an Integrated Care for Older People approach to guide health systems and services in better supporting functional ability of older people. A knowledge gap remains in the key elements of integrated care approaches used in health and social care delivery systems for older populations. The objective of this review was to identify and describe the key elements of integrated care models for elderly people reported in the literature.DESIGN: Review of reviews using a systematic search method.METHODS: A systematic search was performed in MEDLINE and the Cochrane database in June 2017. Reviews of interventions aimed at care integration at the clinical (micro), organisational/service (meso) or health system (macro) levels for people aged ≥60 years were included. Non-Cochrane reviews published before 2015 were excluded. Reviews were assessed for quality using the Assessment of Multiple Systematic Reviews (AMSTAR) 1 tool.RESULTS: Fifteen reviews (11 systematic reviews, of which six were Cochrane reviews) were included, representing 219 primary studies. Three reviews (20%) included only randomised controlled trials (RCT), while 10 reviews (65%) included both RCTs and non-RCTs. The region where the largest number of primary studies originated was North America (n=89, 47.6%), followed by Europe (n=60, 32.1%) and Oceania (n=31, 16.6%). Eleven (73%) reviews focused on clinical 'micro' and organisational 'meso' care integration strategies. The most commonly reported elements of integrated care models were multidisciplinary teams, comprehensive assessment and case management. Nurses, physiotherapists, general practitioners and social workers were the most commonly reported service providers. Methodological quality was variable (AMSTAR scores: 1-11). Seven (47%) reviews were scored as high quality (AMSTAR score ≥8).CONCLUSION: Evidence of elements of integrated care for older people focuses particularly on micro clinical care integration processes, while there is a relative lack of information regarding the meso organisational and macro system-level care integration strategies.
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In this review the knowledge status of and future research options on a green gas supply based on biogas production by co-digestion is explored. Applications and developments of the (bio)gas supply in The Netherlands have been considered, whereafter literature research has been done into the several stages from production of dairy cattle manure and biomass to green gas injection into the gas grid. An overview of a green gas supply chain has not been made before. In this study it is concluded that on installation level (micro-level) much practical knowledge is available and on macro-level knowledge about availability of biomass. But on meso-level (operations level of a green gas supply) very little research has been done until now. Future research should include the modeling of a green gas supply chain on an operations level, i.e. questions must be answered as where to build digesters based on availability of biomass. Such a model should also advise on technology of upgrading depending on scale factors. Future research might also give insight in the usability of mixing (partly upgraded) biogas with natural gas. The preconditions for mixing would depend on composition of the gas, the ratio of gases to be mixed and the requirements on the mixture.
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