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Objectives. To determine the effectiveness of the COMmunity of Practice And Safety Support (COMPASS) Total Worker Health intervention for home care workers. Methods. We randomized 16 clusters of workers (n = 149) to intervention or usual-practice control conditions. The 12-month intervention was scripted and peer-led, and involved education on safety, health, and well-being; goal setting and self-monitoring; and structured social support. We collected measures at baseline, 6 months, and 12 months, which included workers’ experienced community of practice (i.e., people engaged in a common activity who interact regularly for shared learning and improvement). Implementation occurred during 2013 and 2014 in Oregon. Results. In an intent-to-treat analysis, relative to control, the intervention produced significant and sustained improvements in workers’ experienced community of practice. Additional significant improvements included the use of ergonomic tools or techniques for physical work, safety communication with consumer–employers, hazard correction in homes, fruit and vegetable consumption, lost work days because of injury, high-density lipoprotein cholesterol, and grip strength. Consumer–employers’ reports of caregiver safety behaviors also significantly improved. Conclusions. COMPASS was effective for improving home care workers’ social resources and simultaneously impacted both safety and health factors.

The RULER Approach (“RULER”) is a setting-level, social and emotional learning program that is grounded in theory and evidence. RULER is designed to modify the quality of classroom social interactions so that the climate becomes more supportive, empowering, and engaging. This is accomplished by integrating skill-building lessons and tools so that teachers and students develop their emotional literacy. In a clustered randomized control trial, we tested the hypothesis that RULER improves the social and emotional climate of classrooms. Depending upon condition assignment, 62 schools either integrated RULER into fifth- and sixth-grade English language arts (ELA) classrooms or served as comparison schools, using their standard ELA curriculum only. Multi-level modeling analyses showed that compared to classrooms in comparison schools, classrooms in RULER schools were rated as having higher degrees of warmth and connectedness between teachers and students, more autonomy and leadership among students, and teachers who focused more on students’ interests and motivations. These findings suggest that RULER enhances classrooms in ways that can promote positive youth development.

Background Burnout is a critical factor that can influence the quality of care that doctors provide to their patients. Previous research suggests a link between inadequate communication skills training and burnout, and various approaches to enhance communication skills have been explored as a means to address this issue. However, evidence of the effect of these approaches is lacking. The aim of this study is to assess the effect of the novel On-site Supportive Communication Training (On-site SCT) in enhancing communication skills among oncologists and thereby addressing burnout. Methods This randomized, controlled, multicenter study was conducted across three oncological departments in Denmark. Doctors were eligible if they worked in the outpatient clinic at least four days per month and provided informed consent. Doctors in the intervention group underwent a two-hour introduction followed by three full days of On-site SCT facilitated by in-house psychologists, while those in the control group continued standard practices. Pre- and post-intervention assessments on burnout (Copenhagen Burnout Inventory) were conducted, as were assessments of related constructs (job satisfaction and communication self-efficacy). Differences in pre- and post- assessments were analyzed using a paired t-test. Feasibility was assessed descriptively by comparing intervention days with planned schedule, and doctors’ satisfaction with the intervention was assessed systematically by questionnaire. Results Of 101 screened doctors, 89 (88%) consented and were randomized. 65% were female, and the mean age was 46 (range 27 to 75). Due to nine exclusions, data from 39 doctors in the intervention group and 41 doctors in the control group were available for analysis. At baseline, doctors exhibited lower levels of burnout than reported in international literature. No statistically significant improvements in burnout ( p  > 0.05) were demonstrated post-intervention. Despite non-significant changes, the doctors reported an improvement in communication self-efficacy. The program showed high feasibility and received positive feedback from participating doctors. Conclusions Our findings caution against assuming a causal relationship between short-term interventions and a complex phenomenon like burnout. On-site SCT demonstrated high feasibility, participation rate and acceptance. This underscores its potential value in clinical settings. Consequently, On-site SCT will be implemented at the Department of Oncology, Vejle University Hospital, to facilitate further refinement based on ongoing feedback and to explore long-term outcomes. Trial registration December 2022– The Region of Southern Denmark (22/57137). April 2023– ClinicalTrials.gov (NCT05842083). April 2023– The Research Ethics Committee at the University of Southern Denmark (23/19397).

ObjectivesThe authors conducted a randomised controlled trial of four pedagogical methods commonly used to deliver teamwork training and measured the effects of each method on the acquisition of student teamwork knowledge, skills, and attitudes.MethodsThe authors recruited 203 senior nursing students and 235 fourth-year medical students (total N=438) from two major universities for a 1-day interdisciplinary teamwork training course. All participants received a didactic lecture and then were randomly assigned to one of four educational methods: didactic (control), audience response didactic, role play and human patient simulation. Student performance was assessed for teamwork attitudes, knowledge and skills using: (a) a 36-item teamwork attitudes instrument (CHIRP), (b) a 12-item teamwork knowledge test, (c) a 10-item standardised patient (SP) evaluation of student teamwork skills performance and (d) a 20-item modification of items from the Mayo High Performance Teamwork Scale (MHPTS).ResultsAll four cohorts demonstrated an improvement in attitudes (F1,370=48.7, p=0.001) and knowledge (F1,353=87.3, p=0.001) pre- to post-test. No educational modality appeared superior for attitude (F3,370=0.325, p=0.808) or knowledge (F3,353=0.382, p=0.766) acquisition. No modality demonstrated a significant change in teamwork skills (F3,18=2.12, p=0.134).ConclusionsEach of the four modalities demonstrated significantly improved teamwork knowledge and attitudes, but no modality was demonstrated to be superior. Institutions should feel free to utilise educational modalities, which are best supported by their resources to deliver interdisciplinary teamwork training.

Background Preterm birth (birth before 37 weeks of gestation) and its complications are the leading contributors to neonatal and under-5 mortality. The majority of neonatal deaths in Kenya and Uganda occur during the intrapartum and immediate postnatal period. This paper describes our study protocol for implementing and evaluating a package of facility-based interventions to improve care during this critical window. Methods/design This is a pair-matched, cluster randomized controlled trial across 20 facilities in Eastern Uganda and Western Kenya. The intervention facilities receive four components: (1) strengthening of routine data collection and data use activities; (2) implementation of the WHO Safe Childbirth Checklist modified for preterm birth; (3) PRONTO simulation training and mentoring to strengthen intrapartum and immediate newborn care; and (4) support of quality improvement teams. The control facilities receive both data strengthening and introduction of the modified checklist. The primary outcome for this study is 28-day mortality rate among preterm infants. The denominator will include all live births and fresh stillbirths weighing greater than 1000 g and less than 2500 g; all live births and fresh stillbirths weighing between 2501 and 3000 g with a documented gestational age less than 37 weeks. Discussion The results of this study will inform interventions to improve personnel and facility capacity to respond to preterm labor and delivery, as well as care for the preterm infant. Trial registration ClinicalTrials.gov, ID: NCT03112018 . Registered on 13 April 2017.

State health departments commonly use quality improvement coaching as an implementation strategy for improving low human papillomavirus (HPV) vaccination coverage, but such coaching can be resource intensive. To explore opportunities for improving efficiency, we compared in-person and webinar delivery of coaching sessions on implementation outcomes, including reach, acceptability, and delivery cost. In 2015, we randomly assigned 148 high-volume primary care clinics in Illinois, Michigan, and Washington State to receive either in-person or webinar coaching. Coaching sessions lasted about 1 hr and used our Immunization Report Card to facilitate assessment and feedback. Clinics served over 213,000 patients ages 11-17. We used provider surveys and delivery cost assessment to collect implementation data. This report is focused exclusively on the implementation aspects of the intervention. More providers attended in-person than webinar coaching sessions (mean 9 vs. 5 providers per clinic, respectively, p = .004). More providers shared the Immunization Report Card at clinic staff meetings in the in-person than webinar arm (49% vs. 20%; p = .029). In both arms, providers' belief that their clinics' HPV vaccination coverage was too low increased, as did their self-efficacy to help their clinics improve (p < .05). Providers rated coaching sessions in the two arms equally highly on acceptability. Delivery cost per clinic was$733 for in-person coaching versus $ 461 for webinar coaching. In-person and webinar coaching were well received and yielded improvements in provider beliefs and self-efficacy regarding HPV vaccine quality improvement. In summary, in-person coaching cost more than webinar coaching per clinic reached, but reached more providers. Further implementation research is needed to understand how and for whom webinar coaching may be appropriate. Keywords HPV vaccine, Immunization programs, Quality improvement coaching, Primary care, State health departments, Assessment and feedback

Background Ineffective management of obstetric emergencies contributes significantly to maternal and neonatal morbidity and mortality in Mexico. PRONTO ( Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno ) is a highly-realistic, low-tech simulation-based obstetric and neonatal emergency training program. A pair-matched hospital-based controlled implementation trial was undertaken in three states in Mexico, with pre/post measurement of process indicators at intervention hospitals. This report assesses the impact of PRONTO simulation training on process indicators from the pre/post study design for process indicators. Methods Data was collected in twelve intervention facilities on process indicators, including pre/post changes in knowledge and self-efficacy of obstetric emergencies and neonatal resuscitation, achievement of strategic planning goals established during training and changes in teamwork scores. Authors performed a longitudinal fixed-effects linear regression model to estimate changes in knowledge and self-efficacy and logistic regression to assess goal achievement. Results A total of 450 professionals in interprofessional teams were trained. Significant increases in knowledge and self-efficacy were noted for both physicians and nurses (p <0.001- 0.009) in all domains. Teamwork scores improved and were maintained over a three month period. A mean of 58.8% strategic planning goals per team in each hospital were achieved. There was no association between high goal achievement and knowledge, self-efficacy, proportion of doctors or nurses in training, state, or teamwork score. Conclusions These results suggest that PRONTO’s highly realistic, locally appropriate simulation and team training in maternal and neonatal emergency care may be a promising avenue for optimizing emergency response and improving quality of facility-based obstetric and neonatal care in resource-limited settings. Trial registration NCT01477554

Background The teacher’s role in school mental health initiatives cannot be overemphasized. Despite global evidence of educational interventions in improving teachers’ knowledge and attitudes regarding mental health, this area remains under researched in Pakistan. This paper presents a study protocol of a pilot randomized controlled trial to examine the effectiveness of a teacher training intervention for improving mental health literacy and self-efficacy among school teachers in urban Lahore, Pakistan. Methods The randomized controlled trial will follow the CONSORT guidelines. Participants will be allocated to the Intervention group (receiving the World Health Organization, Eastern Mediterranean Region (WHO-EMRO) School Mental Health Manual-based intervention in three 6-h, face-to-face sessions) or a waitlist control group (not receiving training during the study period). Participants will be teachers of private schools with similar broad demographic characteristics in an inner city area of Lahore. The primary outcome measures for the trial is teachers’ mental health literacy. It will be assessed by using the previously applied (during WHO training of Master Trainers) self-administered questionnaire in both groups pre and post training and at 3 months’ follow-up. Secondary outcomes include: for teachers: Teachers’ self-efficacy (assessed by the Teachers’ Sense of Self Efficacy Scale (TSES) short form.); for students (11–16 years): socio-emotional skills and psychological problems measured by the Strengths and Difficulties Questionnaire (assessed at baseline and 3 months post intervention); for schools: the WHO School Psychosocial Profile Questionnaire (baseline and 3 months post intervention). Discussion Given the high prevalence of child mental health problems, stigma and lack of services, it is important to consider alternate avenues for promoting positive mental health among youth. This pilot study should establish the effectiveness of the WHO-EMRO School Mental Health Manual-based Intervention improving teacher’s mental health literacy and helping them to learn practical steps that can be implemented at low cost in school settings. It will also provide information regarding intervention implementation and sustainability. Trial registration ClinicalTrials.gov, ID: NCT02937714 . Registered on 18 October 2016.

Two non-U.S. quasi-experimental studies reported Active Support training was associated with increased engagement in individuals with IDD, but no randomized controlled trials (RCTs) exist. We evaluated effects of Active Support training on staff assistance, and social and nonsocial engagement in 75 individuals with intellectual and developmental disabilities (IDD) in U.S. group homes. We detected no significant effects of active support training. Individuals with more skills and less challenging behavior engaged more in nonsocial activities. Younger individuals with more skills living in homes with fewer staff changes were more socially engaged. Factors associated with nonsocial engagement mirrored those reported in Qian, Tichá, Larson, Stancliffe, & Wuorio, (2015). Staffing-related implementation challenges and statistical power limited our ability to detect differences.

Background To improve patient care, and to reduce unnecessary referrals for diagnostic imaging and medical specialist care for low back pain, an evidence-based guideline for low back pain was developed in the Netherlands in 2010. The current study evaluated the effect of a multifaceted implementation strategy on guideline adherence among Dutch general practitioners. Methods The implementation strategy included a multidisciplinary training, provision of educational material and an interactive website for healthcare professionals, supported by a multimedia eHealth intervention for patients with low back pain. Adherence was measured using performance indicators based on 3 months data extracted from the contacts with patients with low back pain recorded in the electronic medical records of participating general practitioners. Performance indicators were compared between two groups: a usual care group and an implementation group. Performance indicators were referrals to consultations with medical specialists, to diagnostic imaging, and to psychosocial and/or occupational physician consultations, and inquiries about psychosocial and occupational risk factors. Results The electronic medical records of 5130 patient contacts for LBP were analysed; 2453 patient contacts in the usual care group and 2677 patient contacts in the implementation group. Overall, rates of referral and of recorded inquiries regarding psychosocial and occupational risk factors remained low in both groups over time. The only statistically significant difference found was a reduction in the number of referrals to neurologists in the implementation group (from 100 (7%) to 50 (4%)) compared to the usual care group (from 48 (4%) to 50 (4%), ( p  < 0.01)). There were no other between-group differences in referrals. Conclusion In the short term, the strategy did not result in improved guideline adherence among general practitioners, and it is not recommended for widespread use. However, baseline referral rates in participating practices were already low, possibly leaving only little room for improvement. Inquiries for psychosocial and occupational risk factors remained low and this leaves room for improvement. Trial registration This trial is registered in the Netherlands Trial Register (NTR): NTR4329 . Registration date: December 20th, 2013.