Dealing with context in logic model development: Reflections from a realist evaluation of a community health worker programme in Nigeria

Logic models (LMs) have been used in programme evaluation for over four decades. Current debate questions the ability of logic modelling techniques to incorporate contextual factors into logic models. We share experience of developing a logic model within an ongoing realist evaluation which assesses the extent to which, and under what circumstances a community health workers (CHW) programme promotes access to maternity services in Nigeria. The article contributes to logic modelling debate by: i) reflecting on how other scholars captured context during LM development in theory-driven evaluations; and ii) explaining how we explored context during logic model development for realist evaluation of the CHW programme in Nigeria. Data collection methods that informed our logic model development included documents review, email discussions and teleconferences with programme stakeholders and a technical workshop with researchers to clarify programme goals and untangle relationships among programme elements. One of the most important findings is that, rather than being an end in itself, logic model development is an essential step for identifying initial hypotheses for tentative relevant contexts, mechanisms and outcomes (CMOs) and CMO configurations of how programmes produce change. The logic model also informed development of a methodology handbook that is guiding verification and consolidation of underlying programme theories.     

Fear,Defensive Strategies and Caring for Cognitively Impaired Family Members

One topic rarely addressed in the literature on older adults and interpersonal violence is the violence that can be experienced by family carers in relationship with a person living with cognitive impairment. This violence tends to remain hidden and is rarely framed as intimate partner violence. We examine how situations of intimidation and violence invoked fear in family carers and how they interpreted and reacted to these circum- stances. Interview and diary data were collected from family members who had previously or were currently experiencing some form of aggression in caring for someone with cognitive impairment or dementia. Drawing on discussions of fear and applying the analytic lens of defensive strategies, we explore how these carers responded to situations of intimidation and violence.     

Open spaces for dialogue promoting mental health as a social work education methodology

ABSTRACT

The authors discuss service user involvement as a key approach regarding training of social workers. In many European Union countries this is a stable practice with a lengthy tradition in research and application. However, in Poland it is almost entirely absent and marginalized. This article presents the results of a participatory action research project conducted at the Institute of Sociology of the Jagiellonian University in Krakow, the objective of which was to identify and critically analyze the key substantive and formal aspects of training of social workers with the participation of individuals with experience of mental illness. This research project adopted an open approach to cognizing reality based on qualitative co-participatory methods. In the conclusion, the authors emphasize that the fundamental criterion for the success of this particular form of training is voluntary and differentiated participation of students—both in the role of people sharing their own experience and as learners—as well as shaping a culture of open dialogue, educational alliances of recognition and recovery, the foundation of which is axiological experience.     

户外健康教学活动中乡村幼儿园教师运用专业知识现状的调查

保护幼儿的生命和健康是幼儿园教育工作的首位。对甘肃六个经济落后县域的乡村幼儿园教师进行问卷调查和访谈，了解到乡村幼儿园教师对待户外健康教学活动的态度是积极的、户外健康教学活动实施的胜任水平有待提高、教学理论支持户外健康教学活动的实施不尽如人意、对幼儿运动负荷量的把握情况不容乐观、对户外健康教学活动与游戏活动的关系理解不清晰。提出调动乡村幼儿园男教师设计与实施健康教学活动的热情、开展丰富乡村幼儿园教师教学理论知识的专项培训、通过专题研讨帮助乡村幼儿园教师理解幼儿运动负荷量的重要性、分析优秀案例帮助乡村幼儿园教师厘清教学和游戏的关系等建议。     

基于可能自我概念的高职生心理健康教育

可能自我概念属于心理学范畴，本文通过分析当前环境下高职生的心理特点，结合可能自我横向和纵向两个方面的内容及其形成原因，介绍了在实际学生工作中如何利用这一概念做好思想教育工作，改善高职生自我认知，从根本上对这一群体给予心灵和行为上的关怀。     

Receipt of Formal and Informal Help with Specific Care Tasks among Older People Living in their Own Home. National Trends over Two Decades

Sweden is seen as a typical example of a social democratic welfare regime, with universal and generous welfare policies. However, in the last decades, there have been substantial reductions in the Swedish provision of care for older people. This study aimed to examine trends in sources of care‐receipt in older people (77+) living in their own home and with a perceived need for help with two specific tasks: house cleaning and/or food shopping. Trends in care‐receipt were examined in relation to gender, living alone, having children and socio‐economic position. Data from the 1992, 2002 and 2011 data collection waves of the national study, Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), were used. Response rates varied between 86 and 95 per cent, and the sample represents the population well. Trends and differences between groups were explored in bivariate and logistic regression analyses. There was a reduction in formal care‐receipt regarding house cleaning and food shopping over the study period. It was more common for women than men to receive formal care, and more common for men than women to receive informal care. Reductions in formal care have affected older women more than older men. Still, living alone was the most influential factor in care‐receipt, associated with a greater likelihood of formal care‐receipt and a lower likelihood of informal care‐receipt. It can be concluded that public responsibility for care is becoming more narrowly defined in Sweden, and that more responsibility for care is placed on persons in need of care and their families.     

HPV vaccine acceptance among a sample of Southern men who have sex with men: A comparison of younger and older men

Objectives: Do short, online educational messages about the human papillomavirus (HPV) influence younger and older men who have sex with men (MSM) differently? Second, what are the HPV knowledge levels and risk perceptions of Southern MSM living outside of major metropolitan areas? Methods: This study draws on participants who completed an anonymous online survey asking about their knowledge, risk assessment, and vaccine acceptance regarding HPV. Results: Knowledge about HPV was low among the MSM in this study. After reading a one-page information intervention, vaccine acceptability increased by a statistically significant amount among both a Younger and Older cohort but risk perception only increased among the younger respondents. Single men regardless of age cohort reported sharper increases in perceived risk after the intervention, but relationship status did not produce significant differences in vaccine acceptability. Conclusion: Online, brief interventions may be effective means of increasing motivation to vaccinate among Southern MSM.     

Heterogeneity in treatment effects across diverse populations

Differences in patient characteristics, including age, sex, and race influence the safety and effectiveness of drugs, biologic products, and medical devices. Here we provide a summary of the topics discussed during the opening panel at the 2018 Johns Hopkins Center for Excellence in Regulatory Science and Innovation symposium on Assessing and Communicating Heterogeneity of Treatment Effects for Patient Subpopulations: Challenges and Opportunities. The goal of this session was to provide a brief overview of FDA-regulated therapeutics, including drugs, biologics and medical devices, and some of the major sources of heterogeneity of treatment effects (HTE) related to patient demographics, such as age, sex and race. The panel discussed the US Food and Drug Administration's role in reviewing and regulating drugs, devices, and biologic products and the challenges associated with ensuring that diverse patient populations benefit from these therapeutics. Ultimately, ensuring diverse demographic inclusion in clinical trials, and designing basic and clinical research studies to account for the intended patient population's age, sex, race, and genetic factors among other characteristics, will lead to better, safer therapies for diverse patient populations.     

Modeling the Adenoma and Serrated Pathway to Colorectal CAncer (ASCCA)

Several colorectal cancer (CRC) screening models have been developed describing the progression of adenomas to CRC. Currently, there is increasing evidence that serrated lesions can also develop into CRC. It is not clear whether screening tests have the same test characteristics for serrated lesions as for adenomas, but lower sensitivities have been suggested. Models that ignore this type of colorectal lesions may provide overly optimistic predictions of the screen‐induced reduction in CRC incidence. To address this issue, we have developed the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model that includes the adenoma‐carcinoma pathway and the serrated pathway to CRC as well as characteristics of colorectal lesions. The model structure and the calibration procedure are described in detail. Calibration resulted in 19 parameter sets for the adenoma‐carcinoma pathway and 13 for the serrated pathway that match the age‐ and sex‐specific adenoma and serrated lesion prevalence in the COlonoscopy versus COlonography Screening (COCOS) trial, Dutch CRC incidence and mortality rates, and a number of other intermediate outcomes concerning characteristics of colorectal lesions. As an example, we simulated outcomes for a biennial fecal immunochemical test screening program and a hypothetical one‐time colonoscopy screening program. Inclusion of the serrated pathway influenced the predicted effectiveness of screening when serrated lesions are associated with lower screening test sensitivity or when they are not removed. To our knowledge, this is the first model that explicitly includes the serrated pathway and characteristics of colorectal lesions. It is suitable for the evaluation of the (cost)effectiveness of potential screening strategies for CRC.     

Telling and Re‐telling Stories: The Use of Narrative and Drawing in a Group Intervention with Parents and Children in a Remote Aboriginal Community

The Let's Start Parent‐Child Program is a manualised parent‐child program which aims to improve educational, social and emotional outcomes for Aboriginal parents and their four‐ to seven‐year‐old children. It has been implemented in the Northern Territory, Australia on the Tiwi Islands and in Darwin since 2005. This paper outlines the adaptation of the program to include narrative approaches, the sharing of stories and the use of expressive arts as a way to build understanding between program leaders and participating families. An example from a recent program is used to illustrate how the sharing of stories and expressive use of art engages and binds group participants together. It supports parents to tell their own stories, to speak about their lived experience, to reconsider aspects of their own and their children's experiences and to achieve an increased awareness of their personal resources and a sense of self‐empowerment. The program is designed and delivered with sensitivity to individual parents, children and families, where cultural and interpersonal differences and different developmental and family situations can be taken into account.