Zoekresultaten

The Cardiac Care Bridge randomized trial in high-risk older cardiac patients

Aim: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse-coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design: A mixed-methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods: Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi-structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data-analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results: The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in-hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion: Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non-significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact: In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.

Implementation, Mechanisms of Effect and Context of an Integrated Care Intervention for Vulnerable Families in Central Sydney Australia

Introduction: In March 2014, the New South Wales (NSW) Government (Australia) announced the NSW Integrated Care Strategy. In response, a family-centred, population-based, integrated care initiative for vulnerable families and their children in Sydney, Australia was developed. The initiative was called Healthy Homes and Neighbourhoods. A realist translational social epidemiology programme of research and collaborative design is at the foundation of its evaluation. Theory and Method: The UK Medical Research Council (MRC) Framework for evaluating complex health interventions was adapted. This has four components, namely 1) development, 2) feasibility/piloting, 3) evaluation and 4) implementation. We adapted the Framework to include: critical realist, theory driven, and continuous improvement approaches. The modified Framework underpins this research and evaluation protocol for Healthy Homes and Neighbourhoods. Discussion: The NSW Health Monitoring and Evaluation Framework did not make provisions for assessment of the programme layers of context, or the effect of programme mechanism at each level. We therefore developed a multilevel approach that uses mixed-method research to examine not only outcomes, but also what is working for whom and why.

A Method for Battery Energy Storage Evaluation

Self-evaluation of learning activities by children in a library-makerspace

Learning activities in a makerspace are hands-on and characterized by design and inquiry. Evaluation is needed both for learners and their coaches in order to effectively guide the learning process of the children and for feedback on the effectiveness of the after-school maker activities. Due to its constructionist nature, learning in a makerspace requires specific forms of evaluation. In this paper we describe the development of an instrument that facilitates and captures reflection on the activities that children undertook in a library makerspace. Our aim is to capture learning in this context with multiple instruments: analysis of the artifacts that are made, observation of hands-on activities and interviews - which all are time consuming methods. Hence, we developed an easy to use tool for self-evaluation of maker learner activities for children. We build on the design of a visual instrument used for learning by design and inquiry in primary education. The findings and results are transferable to (formative) assessment and evaluation of learning activities by learners in other types of education and specific in maker education.

Feasibility of emotion-regulating improvisational music therapy for young adult students with depressive symptoms

Introduction: Depression can be a serious problem in young adult students. There is a need to implement and monitor prevention interventions for these students. Emotion-regulating improvisational music therapy (EIMT) was developed to prevent depression. The purpose of this study was to evaluate the feasibility of EIMT for use in practice for young adult students with depressive symptoms in a university context. Method: A process evaluation was conducted embedded in a larger research project. Eleven students, three music therapists and five referrers were interviewed. The music therapists also completed evaluation forms. Data were collected concerning client attendance, treatment integrity, musical components used to synchronise, and experiences with EIMT and referral. Results: Client attendance (90%) and treatment integrity were evaluated to be sufficient (therapist adherence 83%; competence 84%). The music therapists used mostly rhythm to synchronise (38 of 99 times). The students and music therapists reported that EIMT and its elements evoked changes in all emotion regulation components. The students reported that synchronisation elicited meaningful experiences of expressing joy, feeling heard, feeling joy and bodily responses of relaxation. The music therapists found the manual useful for applying EIMT. The student counsellors experienced EIMT as an appropriate way to support students due to its preventive character. Discussion: EIMT appears to be a feasible means of evoking changes in emotion regulation components in young adult students with depressive symptoms in a university context. More studies are needed to create a more nuanced and evidence-based understanding of the feasibility of EIMT, processes of change and treatment integrity.

An alternative intervention for juvenile hackers? A qualitative evaluation of the Hack_Right intervention

While traditional crime rates are decreasing, cybercrime is on the rise. As a result, the criminal justice system is increasingly dealing with criminals committing cyber-dependent crimes. However, to date there are no effective interventions to prevent recidivism in this type of offenders. Dutch authorities have developed an intervention program, called Hack_Right. Hack_Right is an alternative criminal justice program for young first-offenders of cyber-dependent crimes. In order to prevent recidivism, this program places participants in organizations where they are taught about ethical hacking, complete (technical) assignments and reflect on their offense. In this study, we have evaluated the Hack_Right program and the pilot interventions carried out thus far. By examining the program theory (program evaluation) and implementation of the intervention (process evaluation), the study adds to the scarce literature about cybercrime interventions. During the study, two qualitative research methods have been applied: 1) document analysis and 2) interviews with intervention developers, imposers, implementers and participants. In addition to the observation that the scientific basis for linking specific criminogenic factors to cybercriminals is still fragile, the article concludes that the theoretical base and program integrity of Hack_Right need to be further developed in order to adhere to principles of effective interventions.