Abstract Objective This was to elucidate the experiences and perceptions of people with severe mental illness (SMI) and their health care professionals with the SMILE (Severe Mental Illness Lifestyle Evaluation) group-based lifestyle intervention. SMILE focuses primarily on promoting healthy diet, physical activity and weight loss. Method A qualitative study with semi-structured interviews was conducted using purposive sampling. Interviews were conducted with 15 clients and 13 health care professionals (HCPs). Data were analysed according to a thematic analysis. Results Four overall themes were identified: interest in a lifestyle programme; group-based setting; changes in lifestyle behaviour; and preconditions for changing health behaviour. The results showed that clients valued the programme and were interested in the subject of lifestyle. The group-based setting was seen as a positive and important aspect of the intervention. Making lifestyle changes was acknowledged as difficult, especially in combination with the presence of psychiatric symptoms. Clients acquired an improved awareness of different aspects related to lifestyle behaviour. Irrespective of weight loss achieved, clients found their efforts successful with relatively ‘small’ changes. Some needed more support during the intervention than others. The practical activities in group sessions were regarded as most useful. HCPs were enthusiastic about the programme and their interactions with lifestyle improvements. Conclusions The results of this study shed light on different aspects that were considered important when delivering a lifestyle intervention to people with SMI. We recommend considering these aspects when implementing a lifestyle intervention in a mental health care setting for clients with SMI.
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.
Jongerenwerk en scholen voor voortgezet onderwijs werken steeds meer samen om een gezamenlijke preventieve aanpak te bieden voor schooluitval en radicalisering van jongeren. Tegelijkertijd weten we nog weinig over wat de werkzame elementen zijn van samenwerking tussen jongerenwerk en scholen voor voortgezet onderwijs en welke randvoorwaarden nodig zijn om deze samenwerking plaats te laten vinden. Middels kwalitatief onderzoek bestaande uit verschillende methoden en technieken die de stappen van de grounded theory volgen hebben wij zeven samenwerkingspraktijken tussen het jongerenwerk en scholen voor voortgezet onderwijs in Nederland verkend. In deze verkenning hebben wij vier potentiële werkzame elementen en drie potentiële randvoorwaarden geïdentificeerd die mogelijk bijdragen aan een goed verloop van de samenwerking. Verder onderzoek is nodig om de geïdentificeerde werkzame elementen en randvoorwaarden te onderbouwen en vast te stellen of, hoe en in welke mate samenwerking bijdraagt aan de ontwikkeling van jongeren. --English:There is an increase of collaborations between professional youth work and schools for secondary education in the Netherlands, in an attempt to provide a joint preventive approach to adolescent school dropout and radicalization. At the same time, there is limited evidence explaining which elements contribute to a successful collaboration and which conditions must be met to start collaboration between professional youth work and schools for secondary education. Through qualitative research consisting of different methods and techniques that follow the steps of groundedtheory we explored seven collaborative practices between youth work and schools voor secondary education in the Netherlands. Within this exploration we identified four potential elements and three potential preconditions that may contribute to a successful progress of collaboration. Further research is needed to substantiate these elements and preconditions for successful collaboration and to show how collaboration contributes to the development of youngsters.
MULTIFILE
Dit project omvat een verkennend onderzoek dat beoogt de technische route, de scope en de randvoorwaarden van de energietransitie op vakantieparken en campings in beeld te brengen. De sector voor vakantieparken en campings zal, net als alle andere sectoren, binnen dertig jaar nul-emissies van broeikasgassen moeten bereiken. De gemeente Goeree-Overflakkee en de Provincie Zuid-Holland zijn voornemens om een project op te zetten om de voor Goeree-Overflakkee belangrijke sector te helpen de energietransitie te maken. De gemeente en provincie willen graag antwoord op de vraag welke kennis en welke partijen nodig zijn om de duurzaamheidsdoelstelling zodanig in een beleidsproces te gieten dat de belangen van de vele stakeholders in deze sector samenkomen op een wijze dat de doelstelling gehaald wordt.This project entails an exploratory study that aims to map the technical route, scope and preconditions of the energy transition at holiday parks and campsites. The holiday park and camping sector, like all other sectors, will have to achieve zero greenhouse gas emissions within thirty years. The municipality of Goeree-Overflakkee and the Province of South Holland intend to set up a project to help this important sector on Goeree-Overflakkee to make the energy transition. The municipality and province would like an answer to the question of what knowledge and which parties are needed to put the sustainability objective into a policy process in such a way that the interests of the many stakeholders in this sector come together in a way that the objective is achieved.
