Search

Background: Community champions have been employed across various settings to disseminate evidence-based public health information. The Building Babies' Brains programme trains champions to work with parents in communities, equipping them with child development knowledge and parental engagement strategies. We explored what makes community champions effective in distributing information to parents, including how the champion–parent relationship and champions' personal characteristics affect information dissemination. Methods: Champions included both peers and professionals working with parents in target communities. We administered an online survey (n = 53) and follow-up interviews (n = 14) with champions, with representation from across all training cohorts. We conducted a realist-informed reflexive thematic analysis to generate themes in the data and highlight the contexts, mechanisms, and outcome patterns identified. Results: We observed 15 Context–Mechanism–Outcome configurations across five themes: information sharing opportunities, information relevance, the nature of the champion–parent relationship, interaction expectations, and champion confidence. Our programme theory for how the community champion approach works identified that peer champions focused more on building rapport, modelling behaviours, and being a trusted community resource than direct information transfer. Professional champions, in contrast, showed greater expertise and confidence in discussing parenting practices directly. For both groups, traits such as friendliness and the ability to establish a trusting relationship enhanced effectiveness. Conclusions: This research identifies the impacts of champion role, characteristics, and the champion–parent relationship on the effectiveness of knowledge mobilisation in this context, with implications for training and recruitment of champions. Those using a champion model in comparable settings should ensure that champions have the necessary knowledge, skills, and confidence to engage parents and share information effectively. [ABSTRACT FROM AUTHOR]

The burden of health inequities borne by Indigenous peoples can be overwhelming, especially when mothers and newborns' lives are at stake and health services seem slow to invest in responsiveness. In Aotearoa (New Zealand), urgent action is required to eliminate persistent systemic inequities for Māori (Indigenous) whānau (family collectives that extend beyond the household). This Kaupapa Māori (by Māori, for Māori) qualitative study aimed to explore the views of health practitioners identified as champions by whānau of preterm Māori infants. Ten health practitioners were interviewed and asked about their involvement with the whānau, their role in explanations and communication, and their thoughts on whānau coping. Interview data were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: working together in partnership, a problem shared is a problem halved, and sacred space. Collaboration between health practitioners and with whānau was important to the champions and central to their goal of enabling whānau autonomy. This was built on a foundation of connectivity, relationships, and a full appreciation that childbirth is a sacred time that is potentially disrupted when an infant is born prematurely. The values- and relationship-based practices of these champions protected and uplifted whānau. They showed that health practitioners have important roles in both the elimination of inequities and the sustaining of Māori self-determination. This championship is an exemplar of what culturally safe care looks like in day-to-day practice with Māori and is a standard that other health practitioners should be held to. [ABSTRACT FROM AUTHOR]

Background: Physically Active Children in Education (PACE) is composed of eight implementation strategies that improves schools' implementation of a government physical activity policy. A greater understanding of each discrete implementation strategy could inform improvements to PACE for delivery at-scale. This study aimed to: (A) measure the dose delivered, fidelity, adoption and acceptability of each strategy using quantitative data; (B) identify implementation barriers and facilitators using qualitative data; and (C) explore the importance of each strategy by integrating both data sets (mixed methods). Methods: This study used data from a cluster randomised noninferiority trial comparing PACE with an adapted version (Adapted PACE) that was delivered with reduced in-person external support to reduce costs and increase scalability. Data were collected from both trials arms for between-group comparison. Descriptive statistics were produced using surveys of principals, in-school champions and teachers; and project records maintained by PACE project officers (objective A). Thematic analysis was performed using in-school champion and project officer interviews (objective B). Both data sets were integrated via a triangulation protocol and findings synthesized in the form of meta-inferences (objective C). Results: Eleven in-school champions and six project officers completed interviews; 33 principals, 51 in-school champions and 260 teachers completed surveys. Regardless of group allocation, implementation indicators were high for at least one component of each strategy: dose delivered =100%, fidelity ≥95%, adoption ≥83%, acceptability ≥50%; and several implementation barriers and facilitators were identified within three broad categories: external policy landscape, inner organizational structure/context of schools, and intervention characteristics and processes. All strategies were considered important as use varied by school, however support from a school executive and in-school champions' interest were suggested as especially important for optimal implementation. Conclusion: This study highlights the importance of both executive support and in-school champions for successful implementation of school physical activity policies. In particular, identifying and supporting an in-school champion to have high power and high interest is recommended for future implementation strategies. This may reduce the need for intensive external support, thus improving intervention scalability. [ABSTRACT FROM AUTHOR]

A social accountability mandate for Canadian medical schools formally emerged in Canada with changes to accreditation standards in 2015. However, how social accountability is defined and operationalized within medical schools has transpired independently. Key enablers of social accountability in Canadian medical schools have been largely unexplored. This paper is the first of a two part series that seeks to explore drivers of social accountability in a sample of Canadian medical schools. Nine key drivers of social accountability emerged from the data including a unified vision, committed leadership, accreditation standards, champions of social accountability, authentic community engagement, community-based learning opportunities, a supportive organizational and governance structure, diversity within medical schools, and measurement of progress and outcomes. This is the first study of its kind to examine what is driving social accountability across Canadian medical schools. An appreciative inquiry approach highlights areas of progress for future work to focus and build upon. This paper presents the findings from part one of the study – exploring the themes emerging from key informant interviews with senior leaders. A second paper will dive into the broader perspectives of faculty, staff and students, to explore more fully the varying perspectives of social accountability within colleges. [ABSTRACT FROM AUTHOR]

Aims: To develop and test the relationship between nurse champions' personal social networks and innovation success in terms of spread. Design: A cross sectional. Method(s): Data were collected on 94 nurse champions at three medium‐large tertiary medical centres from 2015–2016. Data from champions on their personal network were assessed via a standardized and acceptable three‐step network survey. Success in terms of innovation spread was assessed via perceived extent of spread. Network structural and relational characteristics were depicted by level of spread. Multivariate linear regression was used to assess the relationship between network characteristics and innovation spread. Findings: Above and beyond various project and network control variables, network density was significantly and positively related to project spread, tie‐strength diversity was significantly and negatively related to project spread and difference in ethnic origin between champions and alters was significantly and positively related to project spread. Maximum age of network members was marginally significantly related to project spread. Conclusion(s): Our findings show that high‐density personal social networks; networks where tie strength among network members is similar, thus, creating liking and trust among members; having at least one older network member who might have close access to professional and organizational resources acquired throughout their career; and having ties with network members from different ethnic groups to prevent knowledge stickiness, all promote innovation spread. Champions should be carefully nominated based on their ability to engage network members and to build ties with various network members inside and outside the nursing unit; once selected, champions should be aware of their social networks. Impact: The current study explored champions' personal‐network structure, composition and variance measures and their implications for innovation project spread. The findings demonstrated that nursing champions' personal social networks matter for innovation spread. This finding has implications for the nominating and the coaching of champions. [ABSTRACT FROM AUTHOR]

Emergency department (ED) providers may fail to recognize or report child abuse and/or neglect (CAN). To improve recognition and reporting, we designed the Community ED CAN Program, in which teams of local clinicians (nurses, physicians, physician assistants) received training in CAN and 1) disseminated evidence-based education; 2) provided consultation, case follow-up, and access to specialists; and 3) facilitated multidisciplinary case review. The aims of this study were to understand the Program's strengths andchallenges and to explore factors that influenced implementation. We used a qualitative research design with semistructured, one-on-one interviews to understand key stakeholders' perspectives of the Community ED CAN Program. We interviewed 27 stakeholders at 3 community hospitals and 1 academic medical center. Researchers analyzed transcribed data using constant comparative method of grounded theory and developed themes. Program strengths included 1) comfort in seeking help from local champions, 2) access to CAN experts, 3) increased CAN education/awareness, and 4) improved networks and communication. Facilitators of implementation included: 1) leadership support, 2) engaged local champions and external change agents (eg, CAN experts), 3) positive attributes of the champions, and 4) implementation flexibility. Program challenges/barriers to implementation included 1) variability of institutional support for the champions and 2) variability in awareness about the program. A Community ED CAN Program has the potential to improve recognition and reporting of CAN. Key steps to facilitate implementation include the identification of committed local champions, strong leadership support, connections to experts, program publicity, and support of the champions' time. [ABSTRACT FROM AUTHOR]

Aims: To identify the sociodemographic attributes, project characteristics and champion strategies that differentiate formal from informal nursing champions, and to test their success in terms of project spread and novelty. Background: Champions spread innovation in healthcare organizations. Empirical research has not explored the differences between formal and informal champions in terms of their antecedents and success. Design: A quantitative cross‐sectional design. Method: Data were collected on 93 nursing champions in three hospitals from 2015 ‐ 2016. Champions were identified according to a validated approach; data on their sociodemographic attributes, project characteristics and strategies were assembled through interviews and validated questionnaires. Their success in terms of novelty and spread was assessed via expert ratings and validated questionnaire. Findings: Informal champions had longer tenure and were involved mainly in bottom‐up projects aimed mostly at improving human resources and services; formal champions were mostly involved in top‐down projects aimed at quality control. Informal champions expressed more enthusiasm and confidence about the innovation; formal champions tended to use more online resources and peer‐monitoring strategies. Projects of informal champions were more novel than those of formal champions. Project spread did not differ between the two groups. Conclusion: Formal and informal champions differ in their characteristics and implementation strategies. To encourage project's innovation, the organizational climate should encourage the emergence of informal champions; formal and informal champions should be chosen wisely, assuring that they possess enough organizational resources; and coaching programmes for junior champions should be planned to equip them with championing behaviours. [ABSTRACT FROM AUTHOR]

Background Translating promising research findings into routine clinical care has proven difficult to achieve; even highly efficacious programmes remain unadopted. Critical to changing care is an understanding of the context within which the improvement effort occurs, including the climate or culture. Health care systems are multicultural due to the wide variety of professionals, subgroups, divisions and teams within them. Yet, little work describes and compares different stakeholders' views on their and others' roles in promoting successful quality improvement implementation. Objective To identify manager and frontline staff perspectives about which organizational stakeholders should play a role in implementation efforts as well as what implementation roles these stakeholders should perform. Methods We conducted qualitative semi-structured interviews of a purposive sample of stakeholders at the clinic, medical centre and regional network levels. Participants included stakeholders across five clinics ( n = 49), their four affiliated medical centres ( n = 12) and three regional networks ( n = 7). Working in coding teams, we conducted a content analysis utilizing Atlas.ti Version 5. Results According to informants, individuals at each organizational level have unique and critical roles to play in implementing and sustaining quality improvement efforts. Informants advocated for participation of a wide range of organizational members, described distinct roles for each group, and articulated the need for and defined the characteristics of frontline programme champions. Conclusions Involvement of multiple types of stakeholders is likely to be costly for health care organizations. Yet, if such organizations are to achieve the highest quality care, it is also likely that such involvement is essential. [ABSTRACT FROM AUTHOR]