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This paper explores the level and sustainability of intergenerational practice in early years and elder care settings in Ireland. The paper is based on a small-scale research study involving interviews with staff in five organizations and builds on findings from previous research conducted for the TOY project (http://www.toyproject.net). The paper examines the pedagogies involved as well as the community context of intergenerational practice in early years and elder care settings. The findings highlight that sustainable intergenerational practice is facilitated by strong pedagogies that support active and relational learning across the life course and by being embedded in robust community networks. [ABSTRACT FROM PUBLISHER]

This paper reports on the findings of a pre-post and follow-up evaluation of a sexual health promotion programme in Ireland. Substantial progress in skills, knowledge, confidence and comfort were reported by participants which were to a large extent maintained over time. Evidence emerged of the successful translation of learning into practice in a number of areas, including engaging proactively with service users about sexual health and developing educational programmes and materials. The paper highlights contextual factors that support and inhibit sustainable changes to practice that need to be addressed in order to maximise the impact of capacity building education. [ABSTRACT FROM AUTHOR]

Public health nurses (PHNs) in Ireland provide preventative child health. An evidence‐based National Healthy Childhood Program (NHCP) has been in development since 2016. The final program implementation, including training all PHNs coincided with the Covid‐19 pandemic. Objective: To describe implementation and evaluation of a blended training program for PHNs Design: The evaluation used quantitative and qualitative methods underpinned by an implementation science framework to assess the training program. The three‐phase blended training was led by a Training and Resources implementation team. Data from a national cohort of PHNs (n = 1671) who completed training were descriptively analysed. Results: The majority of PHNs completed a suite of four online units (phase 1), as well as self‐directed and asynchronous content in phase 2. Results of phase 2 indicated it met participant needs in terms of knowledge but outstanding needs in terms of skills remained. Phase 3 (a modified Face to Face Clinical Skills Review) was completed by 1671 PHNs over a 5‐month period in 2020. Evaluation was very positive in terms of organisation and usefulness for practice. Conclusions: Despite challenges the NHCP training implementation goals were met. A well‐designed blended learning training program met service delivery imperatives and PHN needs. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Patient and public involvement (PPI) is recognized as an increasingly important feature of healthcare research, education and public policy.In mental health, PPI is increasingly seen as evidence of the further democratization of services, which started with de‐institutionalization in the 1960s and the recovery movement in the 1990s.While much is known about learning enablers and learning gains on generic community‐based training programmes, less is known about PPI‐specific programmes in mental health. What this paper adds to existing knowledge?: Participants at a national training programme to support the engagement of service users, their families and carers in mental health services identified training topics of greatest importance to them and reported on what they learnt and what helped their learning.Patient and public involvement training initiatives aimed at supporting the engagement of service users, their families and carers should emphasize individual needs and local contexts.Training programmes should not make artificial or actual distinctions between the programme participants who are health professionals and those who are non‐professionals, such as service users.To our knowledge, this PPI initiative is the first time a national health service provider has sought to develop an engagement structure in mental health on a state‐wide basis. What are the implications for practice?: Participants in training programmes designed to support patient and public involvement believe that such programmes should include understanding how conflict is resolved, how committees work effectively and how to develop interpersonal and facilitation skills.Training programmes in mental health involving both professional and non‐professional participants requires all the participants to work together in particular at commissioning and design stages to achieve their desired outcome.The evaluation of the training programme to support the roll‐out of this initiative offers lessons to others who may wish to pursue similar structures in other jurisdictions. Introduction: The Irish national mental health service provider commissioned a national training programme to support a patient and public involvement (PPI) initiative in mental health services. The programme evaluation afforded an opportunity to describe the learning gains and learning enablers and the factors that support PPI in mental health. Aim: We aimed to evaluate a PPI training programme across nine regional administrative units in a national mental health service. Methods: We conducted a participant exit survey, using the Student Assessment of Learning Gains (SALG) instrument. We analysed the survey responses using SPSS version 24 software and applied directed content analysis to the narrative comments provided in open‐ended questions. Results: A total of 54 participants returned the completed questionnaire, yielding a response rate of 60%. The overall mean SALG score yielded was 3.97 (SD 0.66; range 1–5), indicating that participants reported very good to excellent gains in their learning from the programme. Participants who offered narrative comments indicated an overall positive experience but suggested that all stakeholders should work together to co‐produce the training. Discussion: All the stakeholders in a PPI training initiative to support the engagement of service users, their families and carers in mental health should work together to achieve their desired outcome. This requires co‐production in the design, delivery and evaluation of the training initiative, and co‐production can impact at both individual and local levels. Implications for Practice: PPI training initiatives in mental health should retain a focus on understanding conflict resolution, committee effectiveness, interpersonal and facilitation skills. Ensuring a shared understanding of key concepts, such as co‐production, is a necessary prerequisite at the co‐commissioning, co‐design, co‐planning, co‐delivery and co‐assessment stages of programme development, as is the need to avoid artificial or actual distinctions between health professionals and those who are non‐professionals, such as service users. Relevance statement: Mental health engagement and PPI are key principles underpinning modern mental health services and may increasingly impact on wider health service provision including policy and research imperatives. This paper discusses the evaluation of a PPI training programme and offers practical insights as to how such initiatives can be improved. [ABSTRACT FROM AUTHOR]

Aims and objectives This paper describes the steps used in developing and piloting a structured education programme - the Structured Education Reminiscence-based Programme for Staff ( SERPS). The programme aimed to prepare nurses and care assistants to use reminiscence when caring for people with dementia living in long-term care. Reminiscence involves facilitating people to talk or think about their past. Background Structured education programmes are used widely as interventions in randomised controlled trials. However, the process of developing a structured education programme has received little attention relative to that given to evaluating the effectiveness of such programmes. This paper makes explicit the steps followed to develop the SERPS, thereby making a contribution to the methodology of designing and implementing effective structured education programmes. Design The approach to designing the SERPS was informed by the Van Meijel et al. (2004) model ( Journal of Advanced Nursing 48, 84): (1) problem definition, (2) accumulation of building blocks for intervention design, (3) intervention design and (4) intervention validation. Methods Grounded theory was used (1) to generate data to shape the 'building blocks' for the SERPS and (2) to explore residents, family and staff's experience of using/receiving reminiscence. Results Analysis of the pilot data indicated that the programme met its objective of preparing staff to use reminiscence with residents with dementia. Staff were positive both about the SERPS and the use of reminiscence with residents with dementia. Conclusions This paper outlines a systematic approach to developing and validating a structured education programme. Participation in a structured education programme is more positive for staff if they are expected to actively implement what they have learnt. Ongoing support during the delivery of the programme is important for successful implementation. Relevance to clinical practice The incorporation of client and professional experience in the design phase is a key strength of this approach to programme design. [ABSTRACT FROM AUTHOR]

The national child welfare agency in Ireland identified the integration of trauma-informed practices as a service need, in the current significantly challenging practice climate. A promising program that meets the need of child welfare professionals to support need has been developed and is reported on in this paper. This study aimed to evaluate the effects of a newly developed post-graduate level trauma-informed care program for professionals in the national child welfare agency in Ireland. Study participants were 41 child welfare professionals that included front-line practitioners, supervisors, and senior managers. A pretest–posttest study design was used, data was collected over three-time points to measure the effects of the program on pre-defined outcomes of Trauma-informed Knowledge, Professional Self-efficacy, Professional Quality of Life, and Intention to Leave. Statistically significant positives effects were found in trauma-informed knowledge, professional confidence, burn-out and compassion fatigue/secondary traumatic stress, with effect sizes ranging from medium-large to large ( η 2 =. 133 t o η 2 =. 721) across the intervention time period. The positive impacts arising from the program were sustained for 3 months post-intervention. The results of this initial evaluation are promising in supporting child welfare professionals' capacity to integrate trauma-informed practices and addressing the need for trauma informed practitioners. The need for further research is highlighted. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to present a case study of the implementation of Lean Six Sigma techniques through a series of student projects carried out in a hospital setting. Design/methodology/approach – The five projects were carried out by teams of Masters' students taking a module on operations and quality management. The students were all staff members of the hospital. The study analysed each of the five projects under a number of headings: setting and context, approach, key success factors, benefits and lessons learnt. The projects were then examined to identify patterns among the projects. Findings – All student projects adopted a single foundation methodology as the basis for the project, but supported this with additional techniques from the Lean Six Sigma stable. The primary methodology was Lean in the case of three projects, Six Sigma in the case of one project and mistake proofing in the case of the final project. The most commonly used supporting techniques were process mapping, seven wastes, 5S and logic tree/root cause which were each used in two of the five projects. Other techniques used were control charts, checklists and theory of constraints, which were each used by one project team. Support from top management and regular communication with stakeholders were identified as key factors for success by three of the five project teams. All of the projects, although implemented during a time period of less than three months, and by relatively novice users of Lean Six Sigma techniques, yielded practical benefit to the hospital. Research limitations/implications – This paper examines a number of Lean Six Sigma projects carried out in an Irish hospital. Students were tasked to examine and improve the efficiency and effectiveness of a clinical or/and an administrative process within the hospital. Arguably, a single module on a Master's program in healthcare leadership and organisational change is insufficient to bring about large-scale process change in a single hospital in particular, or to the Irish healthcare sector in general, but it is a start, and as these projects demonstrate it provides a set of tools, techniques and effective methods for instigating process change. Practical implications – Lean Six Sigma offer a variety of methodologies and techniques for use on a process improvement project. It is vital that the project team select for use those techniques which are most appropriate to the particular context of the project. Adoption of an overall methodology (philosophy) supported by specific techniques, proved to be an effective approach. Originality/value – This paper provides useful information for practitioners who are introducing the Lean Six Sigma approach into a hospital setting. The study demonstrates that relatively novice users of Lean Six Sigma can provide value to the organisation in a relatively short period of time. The paper also demonstrates that Lean Six Sigma can be used and provide benefit in a variety of settings within a hospital. [ABSTRACT FROM AUTHOR]

BACKGROUND: Falls have a detrimental effect on Ireland's ageing population and result in a significant personal and healthcare cost burden. Evidence-based falls prevention programmes reduce the harmful effects of falls. The Covid-19 pandemic disrupted in-person programme delivery and necessitated a shift to telerehabilitation. The feasibility and acceptability of falls prevention telerehabilitation needs further investigation. OBJECTIVE: The objective of this study was to explore the opinions of participants and physiotherapists about a falls prevention telerehabilitation programme, and identify key barriers and facilitators to improve the quality of future similar programmes. METHODS: A qualitative study design was used, 13 semi-structured one-to-one telephone interviews (n = 11 participants, n = 2 physiotherapists) were performed. Data were coded and thematic analysed. RESULTS: Four inter-related themes were identified: technical considerations for change in mode of programme delivery to online and blended; facilitators and barriers for effective delivery of the online and blended programmes; factors promoting programme engagement and progress; significance of supportive interpersonal relationships. CONCLUSIONS: Participants and physiotherapists reported improvements in strength, balance and confidence, and willingness to continue the exercises long-term. Telerehabilitation had some advantages over in-person including flexibility and convenience; however, these gains must be considered against the drawbacks of less social interaction and group cohesion. Key insights identified regarding satisfaction with the technology, format and delivery can be used to improve the quality of future online and blended programmes. [ABSTRACT FROM AUTHOR]

Background: Most adolescent girls fail to meet current physical activity guidelines. Physical activity behaviours track from childhood into adulthood and providing adolescent girls with opportunities to be physically active may have health benefits beyond childhood. The effects of walking interventions on adult cardiometabolic health are known, however less is understood about the potential of walking to promote physical activity in adolescents. Following the Walking In ScHools (WISH) feasibility study, this definitive trial aimed to evaluate the effectiveness of a novel, low-cost, school-based walking intervention at increasing physical activity levels of adolescent girls (aged 12–14 years). Methods: Female pupils were recruited from eighteen schools across the border region of Ireland and in Northern Ireland. In intervention schools (n = 9), girls aged 15–18 years, were trained as walk leaders, and led the younger pupils in 10–15 min walks before school, at break and lunch recess. All walks took place in school grounds and pupils were encouraged to participate in as many walks as possible each week. The primary outcome measure was accelerometer determined total physical activity (counts per minutes, cpm). Results: In total, 589 pupils were recruited to the study. At baseline, pupils engaged in a median (interquartile range (IQR)) 35.7 (21.2) mins moderate-vigorous physical activity (MVPA) per day and only 12% (n = 66) of participants met physical activity guidelines (60 min MVPA per day). The intervention was delivered for a mean (standard deviation (SD)) 19.9 ± 0.97 weeks. The mean post-intervention total physical activity for the intervention group was 676 cpm and 710 cpm in the control group. Post-intervention total physical activity did not statistically differ between groups when adjusted for age, body mass index z-scores and baseline physical activity (mean difference, -33.5, 95% CI = -21.2 to 88.1; p = 0.213). Conclusions: 'Scaling-up' physical activity interventions is challenging and despite a promising feasibility study, the results of this fully powered trial suggest that in this context, the WISH intervention did not increase device measured physical activity. Since the COVID-19 pandemic, school environments have changed and although pupils enjoyed the programme, attendance at walks was low, indicating that there is a need to better understand how to implement interventions within schools. Trial registration: ISRCTN; ISRCTN12847782; Registered 2nd July 2019. [ABSTRACT FROM AUTHOR]

Programme implementation is a complex process, and literature around the area of implementation science is growing, particularly with respect to programme fidelity (Dusenbury et al, 2003; Carroll et al, 2007). This paper draws on the findings from an evaluation in one area involving restructuring of the Public Health Nursing service from a generalist, geographically based service, to a team-based specialist approach. From this evaluation, it is clear that careful consideration must be given to a number of key issues that could arise in moving from a pilot project to a more mainstream or wide-scale implementation. These issues could relate to workforce planning; the role of the team leader; formation, maintenance, and development of teams; expertise and knowledge, including knowledge of local communities; active caseload management; continuity across a range of areas; alignment with primary care teams; co-location; and the need for support, particularly in the IT infrastructure. [ABSTRACT FROM AUTHOR]

Aim The educational approach towards practice placement education in health-related disciplines has changed in recent years. The use of collaborative or peer learning models has increased, associated with positive effects on desired outcomes such as learning, competence and reflective practice. At present, there is little published literature on the implementation or use of such models in dietetics practice placement education. The aim of this study was to conduct a pilot study of a collaborative peer learning 2 students to 1 educator (2:1 model). Methods Experienced practice placement educators from four clinical sites in the discipline of dietetics in the Republic of Ireland were invited to participate in the study and form an advisory group. Feedback from this group was used to inform the design and development of a framework to guide the wider implementation of the 2:1 model. Results Feedback from the pilot study was largely positive, with all four sites willing to facilitate a 2:1 model again. The main recommendation was that the practice placement educators require more practical information on the implementation of a 2:1 model, particularly the facilitation of the peer feedback process. In response to this feedback, the Lynam framework was designed, which is the focus of this paper. Conclusions This pilot study of a 2:1 model in dietetics practice placement education informed the design and development of a framework for implementation of the model. Further research into the use of the 2:1 model for practice placement education and the effectiveness of the Lynam framework to guide the implementation of this model is required. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to evaluate the evidence base of the Food Dudes healthy eating programme, specifically the short- and long-term effectiveness of the intervention for consumption of fruit and vegetables both at school and at home and displacement of unhealthy snack consumption. Design/methodology/approach - Articles were identified using Academic Search Complete, PsycARTICLES, Medline and PubMed databases keywords for the period January 1995 to August 2013. Articles were included if they reported an empirical evaluation of the Food Dudes programme aimed at children aged between 4-11 years. Articles were included regardless of geographical location and publication type (i.e. published and "grey" literature). Findings -- Six articles were included for review. Findings indicated that the programme was moderately effective in the short term; however, the long-term effectiveness of the programme is unknown. The ability of the programme to generalise to the home setting and to displace unhealthy snack foods also requires further investigation. Originality/value -- This is the first independent review of the Food Dudes programme. In light of the extensive roll out of the Food Dudes programme, an appraisal of the evidence surrounding the programme is timely. The review highlights that sustaining fruit and vegetable intake cannot be achieved through behaviour-based interventions alone and the long-term maintenance of fruit and vegetable consumption requires more than the implementation of an intervention found to be effective in a controlled research environment. [ABSTRACT FROM AUTHOR]

Accessible summary Because Recovery is an important idea, an educational course was run to help service users and professionals to introduce Wellness Recovery Action Planning ( WRAP) to interested parties in their communities., The evaluation of this course made use of group interviews in which participants were asked about their experiences on the course., Although they enjoyed the course and were positive about Recovery and WRAP, they felt that they still lacked confidence in the presentation skills that they felt they required., Abstract In recent years, there has been a consistent drive to incorporate Recovery principles into the Irish mental health services. A group of Irish mental health service providers came together and delivered a 5-day Wellness Recovery Action Planning ( WRAP) facilitator's programme. The programme was developed and delivered by key stakeholders including people with self-experience of mental health problem. This paper presents the qualitative findings from an evaluation of these facilitator's programmes. Three focus groups were held with 22 people, the majority of who described themselves as mental health professionals and/or people with self-experience of mental health problems. Data were analysed using a thematic approach and yielded four themes. Although the participants were positive about the programme and felt that their knowledge of Recovery and WRAP had improved, they felt that they still lacked confidence in terms of the presentation skills required for facilitating Recovery and WRAP programmes. The findings suggest that mental health service providers who wish to develop service users and clinicians as WRAP facilitators need to put more emphasis on the provision of facilitation and presentation skills in the programmes they develop. [ABSTRACT FROM AUTHOR]

Entry level physiotherapy education began in Singapore in 1992 with the commencement of a three-year diploma. The yearly numbers of diploma graduates has risen over the years and currently over 100 students graduate from Nanyang Polytechnic (NYP) each year. Physiotherapy education in Ireland changed from diploma to degree level in 1986, and since the 1990s there has been a growing focus on post graduate education and research. This paper describes the background to the development of a one-year programme leading to a BSc (Physiotherapy) (from the University of Dublin, Trinity College) with recognition of the three-year diploma in Physiotherapy from NYP in Singapore. The first graduates of the one-year programme will receive their degrees in 2013. [ABSTRACT FROM AUTHOR]

Aims: This paper discusses the evaluation of a multi-sector oral health promotion intervention in the Republic of Ireland for children with disabilities. It argues that a lack of awareness about the context of interventions means that sometimes people's health concerns remain unaddressed through a lack of participation. This may actually increase rather than decrease health inequalities. Implementing qualitative methods to provide a context before proceeding with interventions may assist in providing approaches that are fit for purpose when trying to include people in health promotion. Methods: A purposive sample of 15 parents or carers of children with disabilities and 18 non-dental professionals were interviewed in either focus groups or on a one-to-one basis. Results: The qualitative analysis indicated that budget constraints were affecting joint working because non-dental professionals were overstretched, feeling that they only had the capacity to carry out day-to-day work with parents and children. The daily demands of caring for a child with disabilities for many parents meant that they were tied to a day-to-day existence. Conclusions: The qualitative evaluation suggested that an initial lack of knowledge about structural, procedural, and budgetary barriers, coupled with insight into the daily demands on parents caring for children with disabilities, meant that all parents were not enabled. Therefore, achieving the aims of the plan could not be a total success for all parents and children from the outset. [ABSTRACT FROM AUTHOR]

Higher Education Institutions (HEIs) have the potential to impact positively on the health and wellbeing of their staff and students. Using and expanding on the 'health promoting university' (HPU) platform within HEIs, this article provides a description of 'Healthy Trinity', which is an initiative underway in Trinity College Dublin, the University of Dublin. First, Healthy Trinity is contextualized in background literature including international and national policy and practice. Second, an overview of Healthy Trinity is provided including its vision and goals. Third, the article describes the steps taken relating to the identification of stakeholders and use of a network and a co-lead model. Within this approach, the article describes a partnership approach whereby responsibilities regarding health and wellbeing are shared by individuals and the institution. Fourth, the design and implementation of Healthy Trinity is discussed by taking a 'settings approach', in which the emphasis for change is placed on individual behaviours, environment, policy and organizational culture. Consideration is given to the interplay between intervention, implementation strategy and context for successful systemic implementation. The fifth element presented is the early-stage challenges encountered during implementation, such as the need to secure recurrent funding and the importance of having a direct input to the governance of the University to enable systemic change. The sixth and final component of the article is an outline of Healthy Trinity's intention to utilize a process evaluation of the early implementation phases of this complex intervention within a settings approach. Potential deliverables and impacts of this HPU initiative are presented and discussed. [ABSTRACT FROM AUTHOR]

Background/Aims: The extension of termination of pregnancy services in the Republic of Ireland represents a significant change to practice. Education is required so that nurses and midwives can fulfil their expanded role. The aim of this study was to provide an evaluation of a national termination of pregnancy education programme for midwives and nurses in the Republic of Ireland. Methods: Kirkpatrick's framework for evaluation was used to create an online questionnaire that captured nurses' and midwives' reactions to a training experience at a termination of pregnancy education programme and their self-assessed knowledge before and after training. Results: Participation in the training programme increased the participants' knowledge and confidence in caring for women having a termination. Participants reported that the training was relevant, met their expectations and new knowledge would be used. Recommendations for programme enhancement were also received. Conclusions: Participants were satisfied with the education that they received. The positive impact that a short educational intervention had on participants' knowledge and confidence in providing care for women choosing termination of pregnancy was demonstrated. [ABSTRACT FROM AUTHOR]

Background This study describes the design, implementation and evaluation of a national bereavement helpline developed as proactive tiered response to immediate be reavement care during the COVID pandemic, operated in partnership between a national charity and the National Health Service. The service was based on Psychological First Aid principles adapted to integrate bereavement education. Its aim was to provide asupportive compassionate listening service, education advice resources and sign posting to community services. Methods Two independent psychologist were commissioned to undertake a retrospective service evaluation of six months of the operation of the line, using a volunteer survey, interviews and line usage data. Results and Conclusions Results show that the line is meeting a need, PFA + Bereavement is providing a useful framework for service delivery, and there is good adherence to the model. Volunteers are experiencing working on the line as challenging but rewarding. Supervision and debriefing are essential for volunteer well being and confidence. Approximately 10% of callers were referred onto other services. Management report that they good oversight of governance issues and are planning for the future development, and funding of the line for the next two years. [ABSTRACT FROM AUTHOR]

Background: Healthcare-associated infections (HCAIs) pose a significant threat to the health and safety of patients, staff, and visitors. Infection prevention and control (IPC) teams play a crucial role in ensuring that systems and processes are in place to keep everyone safe within the healthcare environment. Aim: The aim of this study was to identify components of infection prevention services, priorities, indicators of successes and how they are measured, and facilitators and barriers to success. Methods: A s urvey questionnaire was developed and circulated to infection prevention leaders and managers. Findings/results: Seventy IPC leaders/managers completed the survey. Participants were responsible for a range of IPC services within and across healthcare organisations, with significant variations to IPC delivery components. Additionally, a range of budget availability was reported. Several IPC service requirements were considered core work of IPC teams, including providing IPC advice and support, surveillance and audit and education and training. Discussion: An optimal IPC service needs to be in place to ensure HCAIs are minimised or prevented. In a post pandemic era, this is more important than ever before. This is also as crucial for the health and wellbeing of those working in IPC, who have endured unprecedented demand for their services during the pandemic. [ABSTRACT FROM AUTHOR]

The findings from evaluations of parenting programmes can help inform policy and practice decisions, including how best to allocate scarce resources designed to support families. However, studies often fail to consider the extent to which the findings can be generalised to other settings or populations. One, yet unexplored solution, is to compare study findings and large‐scale data sets including publicly available population data. The aims of this study were to assess the feasibility of assessing sample representativeness using publicly available data and to identify the challenges involved in considering the generalisability of study findings. Sociodemographic data from two community‐based evaluations of parenting programmes conducted in England and Ireland between 2015 and 2018 were used in the study (N = 395 parent‐infant dyads). The results indicated some differences between the trial samples and the wider population. However, it is difficult to reach definitive conclusions about these findings due to the limitations associated with using the comparative data sets. Our study revealed three key challenges, including: (1) how best to define and conceptualise representativeness; (2) the availability of comparative data sets; and (3) the quality of the available data. Our study suggests that there is a need for up‐to‐date, good‐quality comparative data sets to allow for the assessment of representativeness. Further work is required to identify parameters for making claims about representativeness, specifically regarding the acceptable level of difference between the target population and the study sample. This is the first study to explore the feasibility of using publicly available population data in two jurisdictions, for the purpose of making judgements about the representativeness of the findings from parent programmes. It is hoped that our results will encourage further investigation around the reporting of trial external validity to enable effective decision‐making at policy and practice level. [ABSTRACT FROM AUTHOR]

Project ECHO (Extension for Community Healthcare Outcomes) uses videoconferencing technology to support and train healthcare professionals (HCPs) remotely. A 4‐month fortnightly ECHO programme was developed and implemented to enhance palliative care provision by primary care therapists. Teaching and case‐based discussions were facilitated by palliative care specialists. A mixed‐methods cohort study was used to evaluate the project. ECHO participants completed pre‐ and post‐programme questionnaires regarding their knowledge and skills across key palliative care domains. Focus groups were held before programme commencement to explore participants' attitudes and experiences of palliative care and after programme conclusion to explore their experiences of ECHO. Twenty‐six primary care HCPs commenced the ECHO programme. Mean scores in self‐rated confidence in knowledge and skill improved significantly (p <.002) following the programme. Twenty‐one primary care HCPs completed the post‐ECHO surveys and scores of self‐rated confidence in knowledge and skills were significantly higher than pre‐ECHO scores. Ninety‐five percent of participants (n = 19) reported ECHO met their learning needs and was an effective format to enhance clinical knowledge. Eighty‐five percent of participants (n = 17) would recommend ECHO to their colleagues. Project ECHO improved palliative care knowledge and skills of primary care HCPs in Ireland, with potential to address the growing need for integrated palliative care services. [ABSTRACT FROM AUTHOR]

The social needs of frail or isolated older people are sometimes aided by referrals to day centres in the United Kingdom. Since the late 1940s, day centres have had a role to play promoting socialisation in later life. Additionally, attendance at day centres is often open ended, with participants only leaving due to moving to a nursing home or dying. In this study, the views of those attending time-limited day centre programmes in seven day centres in Northern Ireland have been sought in relation to their thoughts about the service as well as how they feel when it ends. Seventeen participants completed diaries for the programme duration and/or engaged in an interview process. Participants reflected on the social and educational benefits of attending but also recognised impositions in the centres that impinged upon individual choices and also the length of time they could remain. This study reveals that, in order to maintain socialisation, time-limited programmes must have clear follow-on strategies for participants. Additionally, respondents' experiences reflect that a paternalistic model of care delivery remains in place that, whilst restrictive, reveals that access to the service is more specialised and not universal. Nevertheless, should day centres wish to remain relevant, it is important that service users are fully consulted about their desires and choices within the setting. [ABSTRACT FROM AUTHOR]

High levels of perceived motor competence and low levels of actual motor competence in youth populations have been reported world-wide. Both perceived and actual motor competence have been deemed independent correlates of health and physical activity (PA) behavior, and past research has indicated that their alignment may be linked to more consistent PA. Moreover, there is potential for a movement-based intervention to strengthen the alignment between perceived and actual motor competence, perhaps then guiding future health, PA, and community sport engagement globally. Thus, the objective of this study was to investigate the effectiveness of an 8-week movement-based intervention on increasing the alignment (i.e., veridicality) between PMC and AMC among Irish adolescent youth. We collected data on adolescents (n = 324; females = 149; M age = 14.5, SD = 0.88 years) across six second-level schools in Ireland, including measurements of actual and perceived, motor competence at pre- and post-intervention. We observed low levels of actual in contrast to high levels of perceived motor competence. We found a small but significant veridical alignment between perceived and actual motor competence, but there was no intervention effect on alignment. Future research should prioritize a longer intervention duration that targets student learning and understanding in order to develop veridical perceptions in adolescents that might sustain their participation in PA. [ABSTRACT FROM AUTHOR]

Background: Implementing task specific training is a commonly reported challenge for less experienced therapists. A potential method to improve the ability of recent graduate and student therapists is to upskill regarding task specific training via an online education resource. Purpose: To evaluate the use and acceptability of the TRAIN program as an online learning resource for physiotherapists. Methods: Data from Google Analytics was sourced to determine use of the program and details about the users. Users of the TRAIN program were also invited to complete two surveys; prior to beginning and upon completion of the program. The surveys collected information about the demographics of the users, perceptions of usefulness of the online resource and overall sentiment. Results: Almost 6000 new users interacted with the TRAIN modules during the 15‐months study period. The surveys indicated a high level of usability (mean score 9/10, SD 1.5) and clinical utility (mean score 8.8/10, SD 1.6) of the TRAIN program. Perceived knowledge and user confidence in implementing task‐specific training was higher for those users completing the post compared to those completing the pre‐module survey (knowledge 1.9 and confidence 1.7 out of 10 points higher). Recurring comments in the open‐ended feedback pertained to the usefulness, clarity, and ease of use of the TRAIN program. Discussion and Conclusion: This study provides preliminary evidence supporting the use and acceptability of the TRAIN program as an online learning resource for physiotherapists. This further contributes to the growing body of literature indicating online learning is generally a well‐received teaching tool for physiotherapists. [ABSTRACT FROM AUTHOR]

Past research has found intergroup contact to be a promising intervention to reduce prejudice and has identified adolescence as the developmental period during which intergroup contact is most effective. Few studies, however, have tested whether contact-based interventions can be scaled up to improve intergroup relations at a large scale. The present research evaluated whether and when the National Citizen Service, a large-scale contact-based intervention reaching one in six 15- to 17-year-olds in England and Northern Ireland, builds social cohesion among adolescents from different ethnic backgrounds. In a diverse sample of adolescents (N = 2099; Mage = 16.37, age range: 15–17 years; 58% female), this study used a pretest–posttest design with a double pretest to assess the intervention's effectiveness. Controlling for test–retest effects, this study found evidence that the intervention decreased intergroup anxiety and increased outgroup perspective-taking—but not that it affected intergroup attitudes, intergroup trust, or perceptions of relative (dis-)advantage. These (small) effects were greater for adolescents who had experienced less positive contact before participating and who talked more about group differences while participating. These findings suggest that the intervention might not immediately improve intergroup relations—but that it has the potential to prepare adolescents, especially those with less positive contact experiences before the intervention, for more positive intergroup interactions in the future. [ABSTRACT FROM AUTHOR]

Bipolar disorder (BD) is a chronic condition that requires continued care. Psychological interventions are recommended by clinical guidelines but there are treatment barriers that prevent patients to access these services. Internet‐delivered self‐management interventions are promising alternatives to improve treatment accessibility in patients with BD. Several studies indicate that these interventions are acceptable and beneficial for patients with BD, but no studies have been conducted in routine care settings. This trial aimed to examine the feasibility, acceptability, and preliminary efficacy of implementing an internet‐delivered, clinician‐supported intervention for BD as an adjunct to treatment as usual at two secondary‐care services in Ireland. This study used an uncontrolled design with mixed‐methods evaluation. Feasibility and acceptability were assessed in terms of recruitment, use of the intervention, and satisfaction from both clinicians and patients' perspectives. Personal recovery, quality of life, and severity of symptoms were measured at baseline and post‐intervention. Fifteen patients signed consent and used the programme for 10 weeks. Usage of the intervention was adequate with high frequency of tool usage. There was a significant improvement in patients' sense of personal recovery (z = 2.38, p =.017). The intervention was found acceptable and easy‐to‐use; however, implementation barriers will need to be overcome for scaling the intervention. This is the first study testing the feasibility of a digital intervention for patients with BD in public mental health services in Ireland. More research is needed in order to increase the understanding of how to promote the integration and the uptake of digital interventions for individuals with BD. [ABSTRACT FROM AUTHOR]

Objectives: A pilot NHS dental contract was introduced in Northern Ireland between 2015 and 2016, which involved changing the method for paying general dental practitioners working in the NHS from fee‐for‐service (FFS) to capitation‐based payments, providing an opportunity for a robust evaluation. We investigated the impact of a change in payment methods on clinical activity and the quality of care provided. Design: A difference‐in‐difference (DiD) evaluation was applied to clinical activity data from pilot NHS dental practices in Northern Ireland compared to matched control NHS practices and applied to a questionnaire survey of patient‐rated outcomes of health outcomes and care quality. We estimated the impact on access to care, treatment activity levels, practice finances and patient‐rated outcomes of care of a change from FFS to a capitation‐based system for 1 year, as well as the impact of a reversion back to FFS at the end of the pilot period. Results: The monthly number of registered patients in the pilot practices increased more than the control practices during the capitation period, by 1.5 registrations per 1000 registered patients. The monthly reductions in the volumes of all treatments in the pilot practices during the capitation period were much larger than the control practices, with 175 fewer treatment items. All measures rapidly returned to baseline levels following reversion from capitation back to FFS. NHS income per month increased in pilot practices, by £5920 per month (calculated on FFS item cost basis) more than controls in the capitation period. The analysis of patient questionnaires suggest found that patients notice differences only in waiting times, skill‐mix and number of radiographs, but not on other measures of healthcare process and quality. Conclusion: General dental practitioners working in the NHS respond rapidly and consistently to changes in provider payment methods. A move from FFS to a capitation‐based system had little impact on access to care, but did produce large reductions in clinical activity and patient charge income. Patients noticed little change in the service they received. This shows that changes in remuneration contracts have the potential to meet policy goals, such as meeting the expectations of patients within a predictable cost envelope. However, it is unlikely that all policy goals can be met simply by changing payment methods. Therefore, work is also needed to identify and evaluate interventions that can complement changes in remuneration to achieve desirable outcomes. [ABSTRACT FROM AUTHOR]

Background Amid increasing concerns about rising obesity rates and unhealthy lifestyle behaviours, physical activity (PA) is seen as a prophylactic to many chronic conditions affecting men. Men respond best to community-based PA programmes, using gender-specific promotional and delivery strategies. 'Men on the Move' (MOM) was developed on this basis and targeted inactive adult men in Ireland. Methods Sedentary men (n = 927; age = 50.7 ± 10.9 years; weight = 92.7 ± 16.0 kg; METS = 6.06 ± 2.13) were recruited across eight counties: four 'intervention group' (IG; n = 501) and four 'comparison-in-waiting group' (CG; n = 426). The MOM programme involved structured group exercise twice weekly for 12 weeks (W), along with health-related workshops with the groups maintained up to 52 W. Primary outcome measures [aerobic fitness, bodyweight and waist circumference (WC)] together with self-administered questionnaires were used to gather participant data at baseline, 12, 26 and 52 W. Results Results show a net positive effect on aerobic fitness, bodyweight and WC, with significant (P < 0.05) net change scores observed in the IG compared to the CG (METS: 12 W = +2.20, 26 W = +1.89, 52 W = +0.92; weight: 12 W = −1.72 kg, 26 W = −1.95 kg, 52 W = −1.89 kg; WC: 12 W = −4.54 cm, 26 W = −2.69 cm, 52 W = −3.16 cm). The corresponding reduction in cardiovascular disease risk is particularly significant in the context of a previously inactive and overweight cohort. The high 'dropout' (42.7% presenting at 52 W), however, is of particular concern, with 'dropouts' having lower levels of aerobic fitness and higher bodyweight/WC at baseline. Conclusions Notwithstanding dropout issues, findings address an important gap in public health practice by informing the translational scale-up of a small controllable gender-specific PA intervention, MOM, to a national population-based PA intervention targeting inactive men. [ABSTRACT FROM AUTHOR]

BACKGROUND: Irish farmers are a high-risk group for cardiovascular disease (CVD) which imposes not only a risk to their health but has more far-reaching implications for occupational health and safety. OBJECTIVE: This study assessed the impact of a workplace health screening and health behaviour change programme among a sub-group of male Irish farmers. METHODS: Data were collected from male livestock farmers (n = 310) who attended health screenings at livestock marts. Participating farmers also received lifestyle advice to prompt health behaviour change. Health behaviour change was tracked by two phone questionnaires at Week 1 (n = 224) and Week 12 (n = 172). All data were entered into SPSS v22 and analysed using chi-square and regression techniques. RESULTS: At Week 12, 48% reported having changed at least one health behaviour. The majority of farmers were referred to their GP and by Week 12, 32% had acted on this advice. Participants most in need of health behaviour change based on adverse health screening results were, paradoxically, the least likely to contemplate or engage in health behaviour change. CONCLUSIONS: Findings demonstrate that whilst workplace health screenings can be a catalyst for behaviour change for some farmers, more follow-up supports are needed to encourage sustainable behaviour change. [ABSTRACT FROM AUTHOR]

Background: Dialectical behaviour therapy for adolescents (DBT‐A) is an intervention with a growing evidence base for treating adolescents with emotional and behavioural dysregulation. This study describes the implementation and effectiveness of 16‐week DBT‐A across multiple sites in publicly funded child/adolescent mental health services (CAMHS) in Ireland. Method: The Consolidated Framework for Implementation Research was used to guide this national implementation. Fifty‐four clinicians from seven CAMHS teams completed DBT training and delivered the 16‐week DBT‐A programme. Eighty‐four adolescents with emotional and behavioural dysregulation participated in the intervention and outcome measures were administered at preintervention, postintervention and 16‐week follow‐up. Results: Significant reductions on all outcome measures were observed for DBT‐A participants including presence and frequency of self‐harm, suicidal ideation and depression. Reductions in the number of acute inpatient admissions, bed days and emergency department visits were also reported. Conclusions: DBT‐A can be successfully implemented in CAMHS settings and yield positive outcomes for adolescents with emotional and behavioural dysregulation. [ABSTRACT FROM AUTHOR]

An occupational therapy memory strategy education group (MSEG) was developed to assist clients with varying levels of memory impairment to adopt strategies to manage memory impairment in their daily lives. Participants were healthy older adults presenting with subjective memory complaints (SMC, n = 14), mild cognitive impairment (MCI, n = 33), or early stages of dementia (n = 13). Clients and their caregivers attended a one-hour session each week for six weeks. Outcome measures were taken at baseline, two weeks post completion of the group, and at a 3-month follow-up for 47 participants. Statistically significant improvements post-program were scored on the Rivermead Behavioural Memory Test (p = 0.001) and a dementia quality of life measure (p = 0.02), with increased use of external memory aids (p < 0.001) and significant improvements in participants' self-ratings of performance (p < 0.001) and satisfaction with their performance (p < 0.001) using the Canadian Occupational Performance Measure. Findings suggest positive outcomes that were maintained at 3-month follow-up and thus, support the role of occupational therapy in delivering occupation-focused memory strategy programs. [ABSTRACT FROM AUTHOR]

The challenging nature of change is well documented and adequate preparation before implementing a change initiative is critical to reducing resistance and increasing its chances of success. This article describes a service review conducted in preparation for possible change and improvement at an internationally ranked school of nursing and midwifery in an Irish tertiary education institution. The purpose of the review was to examine organisational structures and work activities, including pressures facing the administrative team that supports the school, and to establish whether operations were fit for purpose and capable of continuing to support the international ranking. The article outlines the importance of change to maintain a competitive edge and the critical role of leadership during change. The background and rationale for the service review are discussed along with the methods used to prepare staff. The article also reports outcomes of the surveys and focus groups undertaken and discusses the main recommendations and changes implemented so far. It also suggests how the outcomes are relevant to clinical practice. [ABSTRACT FROM AUTHOR]

The Association of Anaesthetists of Great Britain and Ireland and the then Uganda Society of Anaesthesia established the Uganda Fellowship Scheme in 2006, to provide scholarships to encourage doctors to train in anaesthesia in Uganda. We conducted an evaluation of this programme using online questionnaires and face-to-face semi-structured interviews with trainees who received scholarships, as well as with senior surgeons and anaesthetists. Focus group discussions were held to assess changes in attitudes towards anaesthesia over the last 10 years. Interviews were recorded, transcribed and analysed using the constant comparative method. A total of 54 Ugandan doctors have received anaesthesia scholarships since 2006 (median funding per trainee (IQR [range]) £5520 (£5520-£6750 [£765-£9000]). There has been a four-fold increase in the number of physician anaesthetists in Uganda during this time. All those who received funding remain in the region. The speciality of anaesthesia is undergoing a dramatic transformation led by this group of motivated young anaesthetists. There is increased access to intensive care, and this has allowed surgical specialities to develop. There is greater understanding and visibility of anaesthesia, and the quality of education in anaesthesia throughout the country has improved. The Uganda Fellowship Scheme provided a relatively small financial incentive to encourage doctors to train as anaesthetists. Evaluation of the project shows a wide-ranging impact that extends beyond the initial goal of simply improving human resource capacity. Financial incentives combined with strong 'north-south' links between professional organisations can play an important role in tackling the shortage of anaesthesia providers in a low-income country and in improving access to safe surgery and anaesthesia. [ABSTRACT FROM AUTHOR]

Although Article 19 of the Universal Declaration of Human Rights states that “everyone has a right to freedom of opinion and expression”, for people with communication disability this may not be a reality. This commentary shares a practical example of how people with communication disabilities together with speech–language pathology (SLP) students, academics and clinical staff co-designed and co-implemented a Communication Awareness Training Programme for catering staff to enable communication access in coffee shops and restaurants. This is an example of how SLPs can embrace their social responsibility to break down barriers for people with communication disabilities. This commentary shares the reflections of those involved and how they felt empowered because they had learned new skills and made a difference. This commentary highlights the need for co-design and co-delivery of programs to raise awareness of communication disability among catering staff and how the stories of people with communication disabilities served as a catalyst for change. It also highlights the need to SLPs to move intervention to a social and community space. [ABSTRACT FROM PUBLISHER]

A non-randomized effectiveness trial was conducted in an urban secondary care public mental health service in Ireland. The effectiveness of an 8 session group cognitive behavior therapy program (gCBT-8), where the focus was on behavioral activation and cognitive restructuring, was compared with that of an enhanced 12 session group cognitive behavior therapy program (gCBT-12), which contained additional sessions on schema work, and a 12 session information and support control group program (gIS-12) in which there was no CBT skills training. One hundred and eighty-one adults with unipolar mood disorders were allocated to gCBT-8 (N = 67), gCBT-12 (N = 62), or gIS-12 (N = 52). Before and after treatment, and at 6 months follow-up participants completed the Beck Depression Inventory II (BDI-II), the Beck Anxiety Inventory, the Clinical Outcome and Routine Evaluation, the Dysfunctional Attitudes Scale, and the brief World Health Organization Quality of Life Scale. An intention-to-treat analysis of mean scores showed that the three programs had similar outcomes. There were significant improvements on all dependent variables with post-treatment gains maintained at follow-up. The three programs also led to similar remission and combined reliable improvement and remission rates on the BDI-II. It was concluded that all three programs had similar levels of effectiveness. [ABSTRACT FROM AUTHOR]

Aims and Objectives To evaluate a dignity care intervention provided by community nurses seeking to address dignity concerns for people with advanced and life-limiting conditions. Background Evidence would suggest that dying people fear a loss of dignity and a central focus of palliative care is to assist people to die with dignity. Whilst community nurses have a key role to play in the delivery of palliative care, specific interventions for dignity are lacking. Design A mixed methods study using online survey and focus group interviews and thematic analysis to examine data. Methods Twenty four community nurses implemented the dignity care intervention for people with advanced and life-limiting conditions were recruited from four pilot sites across Ireland. Four focus group interviews and on line survey were conducted between March-June 2015. Results The community nurses found the dignity care intervention useful. It helped the nurses to provide holistic end-of-life care and assisted in the overall assessment of palliative care patients, identifying areas that might not otherwise have been noted. Whilst it was a useful tool for communication, they noted that it stimulated some emotionally sensitive conversations for which they felt unprepared. Conclusions Implementing the dignity care intervention in practice was challenging . However, the dignity care intervention facilitated holistic assessment and identified patient dignity-related concerns that may not have been otherwise identified. Further support is required to overcome barriers and enable dignity-conserving care. Relevance to clinical practice Ensuring dignity is a key aspect of palliative and end-of-life care; however, community nurses may not feel equipped to address this aspect of care. Implementing a dignity care intervention can assist in identifying patient dignity-related concerns and provision of holistic care. Community nurses need more training to assist in difficult conversations relating to dignity and end-of-life care. [ABSTRACT FROM AUTHOR]

The ‘dementia friends’ programme was launched by the Alzheimer’s Society in the UK two years ago with the purpose of educating members of the public about the things they can do which can enhance the lives of people living with dementia. The aim of this project was to deliver a two-hour ‘Dementia Friendly Community Workshop’ written by the Alzheimer’s Society, to an entire cohort of first-year undergraduate nursing students in one Higher Education Institutions in Northern Ireland. Following delivery of the programme, students were asked to complete a short questionnaire on their knowledge and confidence in relation to dementia care before and after the Dementia Friendly Community programme. A total of 322 undergraduate first-year nursing students took part in the Dementia Friendly Community programme. Of these, 304 returned questionnaires; 31.25% of students stated their perceived improvement in dementia knowledge was ‘good’ while 49.01% stated their perceived improvement in dementia knowledge was ‘very good’ and 13.49% stated their perceived improvement in dementia knowledge was ‘excellent’. In relation to confidence in engaging with people with dementia, 31.91% stated ‘good’ improvement, 40.79% stated ‘very good’ improvement and 11.84% stated ‘excellent’ improvement. The Dementia Friendly Community programme was positively reviewed by the undergraduate students as it enhanced knowledge and confidence in relation to care of someone living with dementia. [ABSTRACT FROM AUTHOR]

Background: Decreased sexual activity and sexual problems are common among people with cardiovascular disease, negatively impacting relationship satisfaction and quality of life. International guidelines recommend routine delivery of sexual counselling to cardiac patients. The Cardiac Health and Relationship Management and Sexuality (CHARMS) baseline study in Ireland found, similar to international findings, limited implementation of sexual counselling guidelines in practice. The aim of the current study was to develop the CHARMS multi-level intervention to increase delivery of sexual counselling by healthcare professionals. We describe the methods used to develop the CHARMS intervention following the three phases of the Behaviour Change Wheel approach: understand the behaviour, identify intervention options, and identify content and implementation options. Survey (n = 60) and focus group (n = 14) data from two previous studies exploring why sexual counselling is not currently being delivered were coded by two members of the research team to understand staff's capability, opportunity, and motivation to engage in the behaviour. All potentially relevant intervention functions to change behaviour were identified and the APEASE (affordability, practicability, effectiveness, acceptability, side effects and equity) criteria were used to select the most appropriate. The APEASE criteria were then used to choose between all behaviour change techniques (BCTs) potentially relevant to the identified functions, and these BCTs were translated into intervention content. The Template for Intervention Description and Replication (TIDieR) checklist was used to specify details of the intervention including the who, what, how and where of proposed intervention delivery.Results: Providing sexual counselling group sessions by cardiac rehabilitation staff to patients during phase III cardiac rehabilitation was identified as the target behaviour. Education, enablement, modelling, persuasion and training were selected as appropriate intervention functions. Twelve BCTs, linked to intervention functions, were identified for inclusion and translated into CHARMS intervention content.Conclusions: This paper details the use of Behaviour Change Wheel approach to develop an implementation intervention in an under-researched area of healthcare provision. The systematic and transparent development of the CHARMS intervention will facilitate the evaluation of intervention effectiveness and future replication and contribute to the advancement of a cumulative science of implementation intervention design. [ABSTRACT FROM AUTHOR]

While there is a strong movement in favor of the use of manual-based programs in the arena of social care, there is a view that such programs are not applicable in the more fluid setting of youth work, which operates informally, using dynamic and organic methods. A critical pedagogical approach to youth work engages young people by encouraging them to become inquisitive, to question why things are the way they are and to pose problems through which they can learn. For some, manualized or evidence-based programs are not seen as having a role in such contexts. However, to date, the international debate in relation to this issue has been limited by an absence of published studies focusing specifically on strategies to implement evidence-informed practice in youth work contexts. This article aims to address this gap in the literature. The Irish national youth organization Foróige, which works with more than 56,000 young people in Ireland on an annual basis, has developed a range of manualized evidence-informed resources to support its youth work over recent years. Drawing on research findings from a range of studies conducted with youth workers focusing on implementation of these resources, the article explores the benefits and tensions associated with the use of program manuals in a youth work context. The findings suggest that such resources have a valuable role to play in youth work if designed in collaboration with youth workers, showing respect for core youth work values and allowing for flexibility and adaptability in implementation. [ABSTRACT FROM PUBLISHER]

Background: Early detection of patient deterioration is a key element of patient safety as it allows timely clinical intervention and potential rescue, thus reducing the risks of serious patient safety incidents. Longitudinal patient monitoring systems have been widely recommended for use to detect clinical deterioration. However, there is conflicting evidence on whether they improve patient outcomes. This may in part be related to variation in the rigour with which they are implemented and evaluated. This study aims to evaluate the implementation and effectiveness of a longitudinal patient monitoring system designed for adult patients in the unique environment of the Emergency Department (ED).Methods: A novel participatory action research (PAR) approach is taken where socio-technical systems (STS) theory and analysis informs the implementation through the improvement methodology of 'Plan Do Study Act' (PDSA) cycles. We hypothesise that conducting an STS analysis of the ED before beginning the PDSA cycles will provide for a much richer understanding of the current situation and possible challenges to implementing the ED-specific longitudinal patient monitoring system. This methodology will enable both a process and an outcome evaluation of implementing the ED-specific longitudinal patient monitoring system. Process evaluations can help distinguish between interventions that have inherent faults and those that are badly executed.Discussion: Over 1.2 million patients attend EDs annually in Ireland; the successful implementation of an ED-specific longitudinal patient monitoring system has the potential to affect the care of a significant number of such patients. To the best of our knowledge, this is the first study combining PAR, STS and multiple PDSA cycles to evaluate the implementation of an ED-specific longitudinal patient monitoring system and to determine (through process and outcome evaluation) whether this system can significantly improve patient outcomes by early detection and appropriate intervention for patients at risk of clinical deterioration. [ABSTRACT FROM AUTHOR]

‘Individualised funding’, which is rooted in the Independent Living Movement, has formed part of a global paradigm shift in support services for disabled people. Against the backdrop of international experience, a political system aligned with the United Kingdom and emergent critics of individualised funding, this article presents findings from an evaluation of four pilot programmes in Ireland. Exemplified by independent-skills development and community integration, these initiatives have been welcomed as a progressive development beyond traditional service provision, with perceived improvements across a range of organisational, personal, health and social care domains. The article explores the importance of ‘natural supports’ and how overly protective behaviour may unintentionally act as a barrier to full implementation. The findings also indicate that unnecessarily complex systems can lead to individual burn-out. Furthermore, a national resource allocation system working in partnership with existing social care professionals and the wider community is recommended, as is learning from overly simplified, group-based ideologies. [ABSTRACT FROM PUBLISHER]

Background: Over the last three decades in response to the growing burden of diabetes, countries worldwide have developed national and regional multifaceted programmes to improve the monitoring and management of diabetes and to enhance the coordination of care within and across settings. In Ireland in 2010, against a backdrop of limited dedicated strategic planning and engrained variation in the type and level of diabetes care, a national programme was established to standardise and improve care for people with diabetes in Ireland, known as the National Diabetes Programme (NDP). The NDP comprises a range of organisational and service delivery changes to support evidence-based practices and policies. This realist evaluation protocol sets out the approach that will be used to identify and explain which aspects of the programme are working, for whom and in what circumstances to produce the outcomes intended.Methods/design: This mixed method realist evaluation will develop theories about the relationship between the context, mechanisms and outcomes of the diabetes programme. In stage 1, to identify the official programme theories, documentary analysis and qualitative interviews were conducted with national stakeholders involved in the design, development and management of the programme. In stage 2, as part of a multiple case study design with one case per administrative region in the health system, qualitative interviews are being conducted with frontline staff and service users to explore their responses to, and reasoning about, the programme's resources (mechanisms). Finally, administrative data will be used to examine intermediate implementation outcomes such as service uptake, acceptability, and fidelity to models of care.Discussion: This evaluation is using the principles of realist evaluation to examine the implementation of a national programme to standardise and improve services for people with diabetes in Ireland. The concurrence of implementation and evaluation has enabled us to produce formative feedback for the NDP while also supporting the refinement and revision of initial theories about how the programme is being implemented in the dynamic and unstable context of the Irish healthcare system. [ABSTRACT FROM AUTHOR]

Background: Potentially inappropriate prescribing (PIP) is common in older people in primary care and can result in increased morbidity, adverse drug events and hospitalisations. We previously demonstrated the success of a multifaceted intervention in decreasing PIP in primary care in a cluster randomised controlled trial (RCT).Objective: We sought to determine whether the improvement in PIP in the short term was sustained at 1-year follow-up.Methods: A cluster RCT was conducted with 21 GP practices and 196 patients (aged ≥70) with PIP in Irish primary care. Intervention participants received a complex multifaceted intervention incorporating academic detailing, medicine review with web-based pharmaceutical treatment algorithms that provide recommended alternative treatment options, and tailored patient information leaflets. Control practices delivered usual care and received simple, patient-level PIP feedback. Primary outcomes were the proportion of patients with PIP and the mean number of potentially inappropriate prescriptions at 1-year follow-up. Intention-to-treat analysis using random effects regression was used.Results: All 21 GP practices and 186 (95 %) patients were followed up. We found that at 1-year follow-up, the significant reduction in the odds of PIP exposure achieved during the intervention was sustained after its discontinuation (adjusted OR 0.28, 95 % CI 0.11 to 0.76, P = 0.01). Intervention participants had significantly lower odds of having a potentially inappropriate proton pump inhibitor compared to controls (adjusted OR 0.40, 95 % CI 0.17 to 0.94, P = 0.04).Conclusion: The significant reduction in the odds of PIP achieved during the intervention was sustained after its discontinuation. These results indicate that improvements in prescribing quality can be maintained over time.Trial Registration: Current controlled trials ISRCTN41694007 . [ABSTRACT FROM AUTHOR]

Background: Ireland has the fourth highest incidence of asthma in the world, with Irish children losing on average 10 days of school per annum due to their asthma. It is highly probable that a large percentage of students in each class in Irish schools have asthma and are required to manage symptoms during the out-of-home period. Young people with chronic illnesses such as asthma find themselves labelled and marginalized due to a lack of awareness of others about their condition. Aims and objectives: Young people who feel supported by their peers have been shown to have higher levels of self-efficacy and fewer exacerbations of their asthma symptoms. Methods: An on-line asthma e-learning program was developed to provide support to teenagers who have asthma, and help them inform their classmates and friends about asthma. A quasi-experimental approach was used to pilot the educational intervention. Results: The results of the pilot demonstrate that the program is effective. Teenagers who have asthma found the e-learning program to be informative and relevant to them. The increase in awareness of asthma among teenagers who did not have asthma is shown to influence their confidence in assisting their peers who are experiencing asthma symptoms. [ABSTRACT FROM AUTHOR]

Evaluation is an essential component of structured diabetes education with most established programmes showing positive effects at group level. However, evaluation of post-educational intervention outcomes is dependent on the participant completing the programme. There is, currently, little research into the psychological or demographic attributes of non-attendees for post-educational intervention evaluation. This study aimed to use the evaluation of a structured diabetes education programme in order to explore the characteristics of participants and determine if any association existed between personal characteristics and benefits of attendance and/or non-attendance for post-programme evaluation. Using a convenience sample of people, a pre-post research design was employed to identify the psychological characteristics of people who benefit from and those who fail to complete an educational intervention programme for type 2 diabetes. The sample consisted of valid responses from 392 (98%, n=401) participants attending the Community Orientated Diabetes Education (CODE) programme, a structured diabetes education programme delivered to people with type 2 diabetes in the Republic of Ireland. The programme is based on an empowering philosophy with the main outcome measurement being diabetes-related empowerment, quality of life (QOL), knowledge, weight and biomedical markers. In all, 237 (60%) completed the post-programme evaluation and demonstrated positive outcomes in empowerment, QOL and knowledge at group level but these were not sustained at individual level. However, over one-third of participants did not attend for post-evaluation and these were more likely to be younger and report poorer QOL. The findings indicate the need to evaluate change at an individual level and to target younger people to retain their attendance for the full educational intervention. Copyright © 2011 FEND. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This article describes the development of a Structured Education Pulmonary Rehabilitation Programme (SEPRP), for the PRINCE (Pulmonary Rehabilitation In Nurse-led Community Environments) study. This process involved a literature review of existing PR programmes, a content analysis of national and international PR programmes and a concept analysis of empowerment. Secondly, two small descriptive qualitative studies were undertaken to further inform programme content exploring the views of health professionals and clients on programme content, as well as their perceptions of living with COPD. The findings of these two stages led to the development of the eight-week PRINCE SEPRP, based on a philosophy of empowerment and the SEPRP was underpinned by the Transtheoretical model (TTM) of behaviour change. Programme content included managing medications and managing breathlessness, knowing and managing symptoms, recognizing and managing acute exacerbations as well as an individualized exercise programme. Participants' experiences of self management following participation in the SEPRP were also examined. The findings indicate that nurses working in primary care have an important role in informing the development of SEPRP as well as having a key role in their delivery. They have the potential to work in empowering ways with COPD clients and the PRINCE SEPRP is just one example of how this can be put into practice. [ABSTRACT FROM AUTHOR]

Background: Untreated diabetic retinopathy is the most common cause of sight loss in people of working age. The Diabetic RetinaScreen programme (DRS) is the national diabetic retinopathy screening programme in Ireland which commenced in 2013 with aim to prevent diabetic retinopathy and subsequent blindness, through free screening and ophthalmology services. High uptake is crucial for the effectiveness of the programme. This study aimed to determine the sociodemographic, lifestyle and healthcare factors associated with attendance at the DRS programme in Ireland, using data from a national cohort study, the Irish Longitudinal Study on Ageing (TILDA). Methods: The TILDA wave-4 dataset (anonymised) was utilised for the current study. Questions on DRS invitation and attendance formed part of the wave 4 study questionnaire. Multivariate logistic regression was used to examine independent factors associated with attendance. SPSS was used for analysis. Results: 418 respondents (7.3%) were invited to DRS and 373 (89.2%) attended. Among all those who were invited to DRS, 244 (58.4%) were male and 174 (41.6%) were female. The mean age was 69.8 years (53-84 years). Following multivariate logistic regression, following a good diet/taking exercise (OR = 0.29, 95% CI 0.10-0.82) was negatively associated with attendance, after adjustment for age, male gender, higher education and medical card. Conclusions: Recognising factors linked with uptake is important to develop goal directed strategies. Interestingly those who stated they followed a good diet & took exercise and were compliant with DM prevention were less likely to attend DRS. Previous research has also indicated that a higher physical activity level is associated with higher self-perceived health status Key messages: Persons with DM with good compliance to diet and exercise were found to have poor attendance at the DRS programme. Targeted advertising is required to raise awareness of diabetic retinopathy. [ABSTRACT FROM AUTHOR]

Background: In the Republic of Ireland (RoI), fluoridation has been effective and efficient for caries prevention at population level, regardless of income status; however, at individual level it still has limitations. This study aimed to compare personalised versus non-personalised text messaging on 'chance of avoiding new cavities' with the Cariogram, a computer-based caries risk assessment (CRA) model, in an economically disadvantaged adult population in the RoI. Methods: The intervention was via a CRA summary letter plus 24 weekly personalised mobile-phone short text messages (text messages) based on the individual's CRA, compared with a non-personalised approach via a non-personalised letter and a predetermined, fixed set of 24 weekly text messages. The study was designed as a two-arm parallel-group, single-blinded (assessor), randomised controlled study in County Cork, RoI. The primary outcome was a comparison of 'chance of avoiding new cavities' calculated by the Cariogram with clinical examination, interview, CRT® (Ivoclar Vivadent, Liechtenstein) and three-day food diary between the two groups at follow-up. We combined stratified randomisation with blocked randomisation for 171 participants who completed baseline. Of them, 111 completed follow-up and were analysed (56 and 55 from the personalised and non-personalised groups, respectively). Due to protocol violations, both intent-to-treat (ITT) and per-protocol analyses were conducted. Results: The ITT analysis did not show a personalised intervention effect on 'chance of avoiding new cavities'. Of the secondary outcome measures, only the stimulated saliva flow factor showed a personalised intervention effect, p = 0.036, OR = 0.3 (95% CI = 0.1, 0.9). The per-protocol analysis with 21 personalised and 33 non-personalised participants within two-message deviations showed no significant effect on 'chance of avoiding new cavities'. Conclusions: The null hypothesis in regard to the primary outcome for both ITT and per-protocol analyses was not rejected; however, as the minimal clinically important difference was included in the 95% CI for the per-protocol analysis, replication studies will be worth conducting to explore the potential of mobile devices for individual caries risk reduction. Trial registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN000027253) on 10 May 2017. The study was retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to explore the implementation of school based diet and physical activity interventions with respect to the barriers and facilitators to adoption, implementation and sustainability; supportive actions required for implementation and recommendations to overcome identified barriers. Two interventions rolled out nationally in Ireland were chosen; Food Dudes, a programme to encourage primary school children to consume more fruit and vegetables and Green Schools Travel (GST), an active travel to school programme in primary and secondary schools. Trained school coordinators (teachers) cascade the programmes to other teaching staff.Methods: Multiple case study design using qualitative semi-structured interviews with key stakeholders: primary and secondary school teachers, school coordinators, project coordinators/managers, funders and intermediaries. Fifteen interviews were conducted. Data were coded using a common categorization matrix. Thematic analysis was undertaken using the Adoption, Implementation and Maintenance elements of the RE-AIM implementation framework.Results: Good working relationships within and across government departments, intermediaries and schools were critical for intervention adoption, successful implementation and sustainability. Organisational and leadership ability of coordinators were essential. Provision of participation incentives acted as motivators to engage children's interest. A deep understanding of the lives of the target children was an important contextual factor. The importance of adaptation without compromising core components in enhancing intervention sustainability emerged. Successful implementation was hindered by: funding insecurity, school timetable constraints, broad rather than specific intervention core components, and lack of agreement on conduct of programme evaluation. Supportive actions for maintenance included ongoing political support, secure funding and pre-existing healthy lifestyle policies.Conclusions: Successful implementation and scale up of public health anti-obesity interventions in schools is dependent on good contextual fit, engagement and leadership at multiple levels and secure funding. Recommendations to overcome barriers include: capacity to deliver within an already overcrowded curriculum and clear specification of intervention components within a conceptual framework to facilitate evaluation. Our findings are generalisable across different contexts and are highly relevant to those involved in the development or adaptation, organisation or execution of national public health interventions: policy makers, guidelines developers, and staff involved in local organisation and delivery. [ABSTRACT FROM AUTHOR]