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The value of health service-based research to health service organisations: a qualitative study with senior health service executives
Background
Research evidence has demonstrably improved health care practices and patient outcomes. However, systemic translation of evidence into practice is far from optimal. The reasons are complex, but often because research is not well aligned with health service priorities. The aim of this study was to explore the experiences and perspectives of senior health service executives on two issues: (1) the alignment between local research activity and the needs and priorities of their health services, and (2) the extent to which research is or can be integrated as part of usual health care practice.
Methods
In this qualitative study, semi-structured interviews were conducted with senior health leaders from four large health service organisations that are members of Sydney Health Partners (SHP), one of Australia’s nationally accredited research translation centres committed to accelerating the translation of research findings into evidence-based health care. The interviews were conducted between November 2022 and January 2023, and were either audio-recorded and transcribed verbatim or recorded in the interviewer field notes. A thematic analysis of the interview data was conducted by two researchers, using the framework method to identify common themes.
Results
Seventeen health executives were interviewed, including chief executives, directors of medical services, nursing, allied health, research, and others in executive leadership roles. Responses to issue (1) included themes on re-balancing curiosity- and priority-driven research; providing more support for research activity within health organisations; and helping health professionals and researchers discuss researchable priorities. Responses to issue (2) included identification of elements considered essential for embedding research in health care; and the need to break down silos between research and health care, as well as within health organisations.
Conclusions
Health service leaders value research but want more research that aligns with their needs and priorities. Discussions with researchers about those priorities may need some facilitation. Making research a more integrated part of health care will require strong and broad executive leadership, resources and infrastructure, and investing in capacity- and capability-building across health clinicians, managers and executive staff.
Journal Article
Pilot testing of the Research Impact Assessment Framework
Traditional academic impact frameworks and metrics have been criticised, because they fail to assess the ‘real-world’ value of research. The Research Impact Assessment Framework was developed to complement and extend existing impact assessment frameworks by focusing on health system needs and priorities. This paper reports on piloting of the Research Impact Assessment Framework for feasibility and utility with researchers working in health and research organisations in Sydney, Australia. The Framework’s Research Environment domain was assessed through a bespoke employee survey, and the Alignment and Influence of Research domain through independent review of case studies. Using synthetic data, the outputs from the two domains were combined to compare institutions. The tools tested in this pilot are feasible to use in assessing an organisation’s capacity to produce impactful research that is aligned with identified health, social and economic priorities. The case study reviews illustrated the challenge of determining potential versus realised impact. This study identified that implementation of the Research Impact Assessment Framework will be enabled by use of existing routinely collected data, such as annual employee surveys, and the use of artificial intelligence tools to reduce administrative burden and ensure consistency of outputs.
Journal Article
Feasibility of video recording interpersonal interactions between patients and hospital staff during usual care
Background
Video-reflexive ethnography (VRE) has been used to record aspects of patient care which are then shared with staff to drive self-identified improvements. Interpersonal interactions between patients and hospital staff are key to high-quality, patient-centred care and mostly occur randomly throughout a patient’s hospital stay. One of the most common types of hospital admission is for women giving birth.
Aims
To assess the feasibility of adapting the VRE methodology to capture naturally occurring interactions between patients and health staff over an extended period during hospital admission, and to assess whether the approach would yield useful interaction data.
Participants
Twelve women, who had a planned caesarean section at 37+ weeks, were considered low risk (no known medical or obstetric complication) and were admitted to a postnatal unit after giving birth, and the staff who attended them.
Methods
This study took place in a large hospital in Sydney, Australia, where approximately 2200 women give birth each year. Continuous unattended video recordings were made during each woman’s hospital stay to capture interactions with hospital staff. The recordings were reviewed to determine what kinds of interaction data could be obtained.
Results
In order to recruit 12 eligible women, we needed to invite 45 to participate. The estimated recruitment period of 3–4 months had to be extended to 8 months. A fixed video camera was successfully installed in the hospital room of each woman and a remote control provided. A total of 246.5 h of video recordings was obtained, of which 38 h (15.5%) involved interpersonal interactions with staff. Two women reported negative responses from staff about being video recorded. Both quantitative and qualitative data could be obtained from the recordings.
Conclusion
Video recordings of interpersonal interactions between patients and staff in an in patient hospital care setting can be obtained and can provide unique insights into the complexity of healthcare delivery. However, significant contextual barriers can exist to engaging staff in quality improvement initiatives that are not part of their usual healthcare activities.
Journal Article
Mobile Phone Apps for Intimate Partner and Sexual Violence Prevention and Response: Systematic Search on App Stores
Since the 2008 advent of the smartphone, more than 180 billion copies of apps have been downloaded from Apple App Store, with more than 2.6 million apps available for Android and 2.2 million apps available for iOS. Many violence prevention and response apps have been developed as part of this app proliferation.
This study aims to evaluate the prevalence and quality of freely available mobile phone apps targeting intimate partner violence (IPV) and sexual violence (SV) prevention and response.
We conducted a systematic search of violence prevention and response mobile phone apps freely available in Apple App Store (iOS; March 2016) and Google Play Store (Android; July 2016). Search terms included violence prevention, sexual assault, domestic violence, intimate partner violence, sexual violence, forensic nursing, wife abuse, and rape. Apps were included for review if they were freely available, were available in English, and had a primary purpose of prevention of or response to SV or IPV regardless of app target end users.
Using the Mobile Application Rating Scale (MARS), we evaluated a total of 132 unique apps. The majority of included apps had a primary purpose of sharing information or resources. Included apps were of low-to-moderate quality, with the overall subjective quality mean for the reviewed apps being 2.65 (95% CI 2.58-2.72). Quality scores for each of the 5 MARS categories ranged from 2.80 (engagement) to 4.75 (functionality). An incidental but important finding of our review was the difficulty in searching for apps and the plethora of nonrelated apps that appear when searching for keywords such as \"rape\" and \"domestic violence\" that may be harmful to people seeking help.
Although there are a variety of mobile apps available designed to provide information or other services related to SV and IPV, they range greatly in quality. They are also challenging to find, given the current infrastructure of app store searches, keyword prioritization, and highlighting based on user rating. It is important for providers to be aware of these resources and be knowledgeable about how to review and recommend mobile phone apps to patients, when appropriate.
Journal Article
Developing a national strategy of consumer and community involvement (CCI) for women’s health research
Objective
To develop a consumer and community involvement (CCI) strategy for the Women’s Health Research, Translation and Impact Network (WHRTN), an initiative of the Australian Health Research Alliance (AHRA).
Type of program
A national network, comprising representatives from 14 nationally-accredited research translation centres that aims to embed CCI at a systems level, to improve equity and health outcomes across women’s health.
Methods
A CCI Sub-Committee of WHRTN was established, chaired by a Consumer Advisor/Advocate. This committee invited both internal and external Consumer Advisor/Advocates to participate in a workshop, to guide the development of WHRTN’s CCI Strategy in women’s health research.
Results
A CCI Strategy document was written with input from workshop attendees and leading academics in women’s health and has now been implemented into WHRTN, informing all aspect of the Network’s programs and activities.
Discussion
Broad and early consumer involvement can facilitate meaningful partnerships between researchers and community, and enable genuine consumer contributions to research across strategy development, priority setting and undertaking research. Appropriate finances and time need to be allocated for CCI, with training in CCI a key enabler for its effective implementation.
Plain English summary
Consumer and community involvement in research is increasingly recognised as an important component of high-quality research. It is now required by many research funders and organisations. However, researchers and organisations often struggle with how to initiate and implement consumer and community involvement at a systems level. In this paper, we outline the processes used to develop a national consumer and community involvement strategy for the Australian Health Research Alliance, Women’s Health Research Translation and Impact Network. This provides a roadmap of how organisations can achieve a framework that supports consumer and community involvement across the research pathway. The strategy highlights the need for broad and early inclusion of consumers in decision making, financing consumer involvement, allowing time to build partnerships, and inclusion of training for researchers and consumers.
Journal Article
Pre-notification letter type and response rate to a postal survey among women who have recently given birth
Background
Surveys are commonly used in health research to assess patient satisfaction with hospital care. Achieving an adequate response rate, in the face of declining trends over time, threatens the quality and reliability of survey results. This paper evaluates a strategy to increase the response rate in a postal satisfaction survey with women who had recently given birth.
Methods
A sample of 2048 Australian women who had recently given birth at seven maternity units in New South Wales were invited to participate in a postal survey about their recent experiences with maternity care. The study design included a randomised controlled trial that tested two types of pre-notification letter (with or without the option of opting out of the survey). The study also explored the acceptability of a request for consent to link survey data with existing routinely collected health data (omitting the latter data items from the survey reduced survey length and participant burden). This consent was requested of all women.
Results
The survey had an overall response rate of 46 % (913 completed surveys returned, total sample 1989). Women receiving the pre-notification letter with the option of opting out of the survey were more likely to actively decline to participate than women receiving the letter without this option, although the overall numbers of women declining were small (27 versus 12). Letter type was not significantly associated with the return of a completed survey. Among women who completed the survey, 97 % gave consent to link their survey data with existing health data.
Conclusions
The two types of pre-notification letters used in our study did not influence the survey response rate. However, seeking consent for record linkage was highly acceptable to women who completed the survey, and represents an important strategy to add to the arsenal for designing and implementing effective surveys. In addition to aspects of survey design, future research should explore how to more effectively influence personal constructs that contribute to the decision to participate in surveys.
Journal Article
Enterovirus 74 Infection in Children
Notes how, in 2010, the Enterovirus 74 (EV74) viral infection was identified in New Zealand in a 2 year old child with a further three cases identified in children within six months - the first report of EV74 in New Zealand. Describes the near complete genome sequence of four EV74 isolates from New Zealand, including the first complete EV74 genome sequenced from a patient with acute flaccid paralysis. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
Journal Article
Detection and whole genome sequence analysis of an enterovirus 68 cluster
Background
Enteroviruses are a common cause of human disease and are associated with a wide range of clinical manifestations. Enterovirus 68 is rarely detected yet was reported in many countries in 2010. Here enterovirus 68 was identified for the first time in New Zealand in 2010 and was detected in a further fourteen specimens over a six month period.
Objectives
To genetically characterise enterovirus 68 specimens identified in New Zealand in 2010.
Study design
The genome sequence of a New Zealand representative enterovirus 68 isolate was obtained. Ten clinical specimens were analysed by sequencing the VP1 region of the enterovirus 68 genome.
Results
Based on sequence analysis of the VP1 region and the full genome of one representative isolate, the New Zealand enterovirus 68 isolates clustered with contemporary enterovirus 68 viruses and do not show any clear distinguishing genetic diversity when compared to other strains. All fifteen specimens showed high similarity with enterovirus 68 by VP1 sequencing. The majority of New Zealand patients suffered from bronchiolitis, were less than two years of age and were of Pacific Island or Maori descent.
Conclusions
We document the rare occurrence of an enterovirus 68 cluster in New Zealand in 2010. These viruses shared similarity with other clusters of enterovirus 68 that occurred globally in 2010. A greater awareness in enterovirus 68 infection may help detect this virus with increased frequency and enable us to better understand the role this strain plays in disease and the reasons behind this global emergence in 2010.
Journal Article
Pathways to a rising caesarean section rate: a population-based cohort study
Objectives To determine whether the obstetric pathways leading to caesarean section changed from one decade to another. We also aimed to explore how much of the increase in caesarean rate could be attributed to maternal and pregnancy factors including a shift towards delivery in private hospitals. Design Population-based record linkage cohort study. Setting New South Wales, Australia. Participants For annual rates, all women giving birth in NSW during 1994 to 2009 were included. To examine changes in obstetric pathways two cohorts were compared: all women with a first-birth during either 1994–1997 (82 988 women) or 2001–2004 (85 859 women) and who had a second (sequential) birth within 5 years of their first-birth. Primary outcome measures Caesarean section rates, by parity and onset of labour. Results For first-births, prelabour and intrapartum caesarean rates increased from 1994 to 2009, with intrapartum rates rising from 6.5% to 11.7%. This fed into repeat caesarean rates; from 2003, over 18% of all multiparous births were prelabour repeat caesareans. In the 1994–1997 cohort, 17.7% of women had a caesarean delivery for their first-birth. For their second birth, the vaginal birth after caesarean (VBAC) rate was 28%. In the 2001–2004 cohort, 26.1% of women had a caesarean delivery for their first-birth and the VBAC rate was 16%. Among women with a first-birth, maternal and pregnancy factors and increasing deliveries in private hospitals, only explained 24% of the rise in caesarean rates from 1994 to 2009. Conclusions Rising first-birth caesarean rates drove the overall increase. Maternal factors and changes in public/private care could explain only a quarter of the increase. Changes in the perceived risks of vaginal birth versus caesarean delivery may be influencing the pregnancy management decisions of clinicians and/or mothers.
Journal Article