A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency

Background
Change agency in its various forms is one intervention aimed at improving the effectiveness of the uptake of evidence. Facilitators, knowledge brokers and opinion leaders are examples of change agency strategies used to promote knowledge utilization. This review adopts a realist approach and addresses the following question: What change agency characteristics work, for whom do they work, in what circumstances and why?

Methods
The literature reviewed spanned the period 1997-2007. Change agency was operationalized as roles that are aimed at effecting successful change in individuals and organizations. A theoretical framework, developed through stakeholder consultation formed the basis for a search for relevant literature. Team members, working in sub groups, independently themed the data and developed chains of inference to form a series of hypotheses regarding change agency and the role of change agency in knowledge use.

Results
24, 478 electronic references were initially returned from search strategies. Preliminary screening of the article titles reduced the list of potentially relevant papers to 196. A review of full document versions of potentially relevant papers resulted in a final list of 52 papers. The findings add to the knowledge of change agency as they raise issues pertaining to how change agents’ function, how individual change agent characteristics effect evidence-informed health care, the influence of interaction between the change agent and the setting and the overall effect of change agency on knowledge utilization. Particular issues are raised such as how accessibility of the change agent, their cultural compatibility and their attitude mediate overall effectiveness. Findings also indicate the importance of promoting reflection on practice and role modeling. The findings of this study are limited by the complexity and diversity of the change agency literature, poor indexing of literature and a lack of theory-driven approaches.

Conclusion
This is the first realist review of change agency. Though effectiveness evidence is weak, change agent roles are evolving, as is the literature, which requires more detailed description of interventions, outcomes measures, the context, intensity, and levels at which interventions are implemented in order to understand how change agent interventions effect evidence-informed health care.

Building environmentally sustainable food systems on informed citizen choices: evidence from Australia

To address imminent concerns of global food security and agricultural sustainability, international research activities are increasingly focusing on ways of improving the food system’s efficiency and effectiveness at providing nutritious food for all in an environmentally sustainable manner. A significant component of this will involve understanding and ultimately influencing people’s dietary choices. However, for people-oriented intervention strategies to be effective, the gaps between existing behaviour and what is required for environmentally sustainable and healthy food choices must be specified. This paper identifies priority areas for behavioural change in relation to the types of food purchased, how they have been produced and the individual’s food provisioning behaviour. In order to determine the most effective ways to influence people’s consumption behaviour in light of these priority areas, the authors conducted a pilot study on a group of 163 Australians who would be expected to be ‘early adopters’ of a sustainable diet. Results show that only around 1 in 10 are presently actively engaged in reducing the environmental impact of their diets in these priority areas. Hence, there is a significant need to engage many more people in sustainable dietary behaviours. Furthermore, it was found that areas where interventions are most likely to have the largest impact, based on high cost to the environment and likelihood of citizens changing their behaviour, are reducing the amount of food waste generated in the household and lowering the amount of junk food eaten.

Implications for Australian anaesthetists and proceduralists of a recent court decision regarding informed consent and patient positioning

 This article discusses the medicolegal implications of a recent judgment in relation to a patient who suffered significant morbidity as a result of patient positioning during an operative procedure. The patient developed an unexpected serious complication following surgery, in the context of a preoperative consent that did not cover every potential complication or contingency. The court held that the failure to warn of a particular risk that would have prevented the patient from undergoing a procedure but did not occur will not necessarily result in a finding of negligence in relation to another risk where the harm did occur. This finding is well aligned to current clinical practice and at the same time does not abrogate the practitioner's duty to provide a comprehensive list of possible complications during the consent process for any proceduralist. In the context of a procedure requiring anaesthesia, the importance of communication and understanding between the anaesthetist and proceduralist as to which aspects of the consent process are undertaken by whom, and to ensure the process is done comprehensively, is of great importance and is indirectly highlighted by this recent judgment.

Sales Promotion Decision Making: Concepts, Principles, and Practice

Up to 74% of marketing budgets can be spent on sales promotions, with manufacturers, suppliers and retailers employing a wide range of incentives from price discounts to complex Omni-channel consumer competitions and contests. Sales promotions are a vital strategic and tactical tool within the marketing value chain and those responsible for campaign planning must negotiate objectives, options and outcomes to ensure their initiatives deliver real results in competitive trading environments. Managers with limited understanding of the principles and practices of sales promotions often rely on past experience or preferences to guide their decision-making. Not surprisingly, without guiding principles, many sales promotions fail to achieve their full potential. This book is a resource for sales promotion professionals looking to improve the effectiveness of their sales promotions. The book is based on an extensive review of over 400 articles and cases. It presents the findings of global research which explores the very DNA of sales promotions, including their role, rationale, nature and function, key decision-making processes and campaign evaluation. Illustrations of sales promotion decision-making in practice based on research conducted in the retail supply chain is also incorporated. This book offers a comprehensive and critical appreciation of the core concepts that underpin sales promotion thinking. The goal is to empower decision-makers, consultants and stakeholders to make confident, informed and effective campaign decisions in the complex field of sales promotions.

Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting

 Background: The value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions.
Methods: The study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate in the survey and up to four people from each organization were invited to complete the survey (n = 175). To further explore definitions of evidence and generate experiential data on EIDM practice, key informant interviews were conducted with a range of LG employees working in areas relevant to public health.
Results: In total, 135 responses were received (75% response rate) and 13 interviews were conducted. Analysis revealed varying levels of access, confidence and organizational culture to support EIDM. Significant relationships were found between domains: confidence, culture and access to research evidence. Some forms of evidence (e.g. community views) appeared to be used more commonly and at the expense of others (e.g. research evidence). Overall, a mixture of evidence (but more internal than external evidence) was influential in public health decision-making in councils. By comparison, a mixture of evidence (but more external than internal evidence) was deemed to be useful in public health decision-making.
Conclusions: This study makes an important contribution to understanding how evidence is used within the public health LG context.

Is carbon emissions trading profitable?

The European Carbon Emissions Trading Scheme introduced in 2005 has led to both spot and futures market trading of carbon emissions. However, despite seven years of trading, we have no knowledge on how profitable carbon emissions trading is. In this paper, we first test whether carbon forward returns predict carbon spot returns. We find strong evidence on both in-sample and out-of-sample predictability. Based on this evidence, we forecast carbon spot returns using both carbon forward returns and a constant. We consider a mean-variance investor and a CRRA investor, and show that they have higher utility and can make more statistically significant profits by following forecasts generated from the forward returns model than from a constant returns model.

Is exchange rate trading profitable?

We Test whether exchange rate trading is profitable in the emerging markets of Brazil, China, India, And South Africa. Using Momentum trading strategies applied to high frequency data, we discover that: (a) momentum-based trading strategies lead to statistically significant profits from the currencies of all four emerging markets; (b) The South African Rand Is generally the most profitable, followed by the Brazilian Real And the Indian Rupee; (c) Profits are persistent during the day and are trading frequency dependent; and (d) During the period of the global financial crisis currency profits were maximised.

Creative architectural design with children: a collaborative design project informed by Rhodes's theory

Since the United Nations adopted the Convention on the Rights of the Child in 1989, there has been global consensus that children need to be involved in the planning and design of their environment. There exist various international initiatives that support collaborative design with children, with co-design projects conducted in different areas of the world. Evolving from the global context of co-design, this project explores creativity in relation to architectural design with children. Between October and December 2011, a team of architecture students from Deakin University worked with children from Roslyn Primary School (both institutions located in Victoria, Australia) to design a playground structure. Informed by Rhodes’s (1961) theory, creativity in this co-design project was addressed through the four dimensions of creative designers, creative context, creative process, and creative design outcomes. The findings of this study corroborate Rhodes’s theory of creativity, and suggest that it is useful to engender creative architectural design with children.