Knowledge translation strategies to improve the use of evidence in public health decision making in local government: intervention design and implementation plan

Background: 

The plan to increase Fiji's rice production - is it worthwhile?

In a recent initiative, the Fiji government has established a revitalisation program for the rice industry, with assistance expected from the Republic of China, India and Indonesia. Using the computable general equilibrium model of the Fijian economy, the economy-wide impact of a 40 per cent increase in rice production is simulated. This analysis finds that even such a large increase in production would have an insignificant impact on Fiji's economic growth.

Scaling-up from an implementation trial to state-wide coverage : results from the preliminary Melbourne Diabetes Prevention Study

Background
The successful Greater Green Triangle Diabetes Prevention Program (GGT DPP), a small implementation trial, has been scaled-up to the Victorian state-wide ‘Life!’ programme with over 10,000 individuals enrolled. The Melbourne Diabetes Prevention Study (MDPS) is an evaluation of the translation from the GGT DPP to the Life! programme. We report results from the preliminary phase (pMDPS) of this evaluation.
Methods
The pMDPS is a randomised controlled trial with 92 individuals aged 50 to 75 at high risk of developing type 2 diabetes randomised to Life! or usual care. Intervention consisted of six structured 90-minute group sessions: five fortnightly sessions and the final session at 8 months. Participants underwent anthropometric and laboratory tests at baseline and 12 months, and provided self-reported psychosocial, dietary, and physical activity measures. Intervention group participants additionally underwent these tests at 3 months. Paired t tests were used to analyse within-group changes over time. Chi-square tests were used to analyse differences between groups in goals met at 12 months. Differences between groups for changes over time were tested with generalised estimating equations and analysis of covariance.
Results
Intervention participants significantly improved at 12 months in mean body mass index (−0.98 kg/m2, standard error (SE) = 0.26), weight (−2.65 kg, SE = 0.72), waist circumference (−7.45 cm, SE = 1.15), and systolic blood pressure (−3.18 mmHg, SE = 1.26), increased high-density lipoprotein-cholesterol (0.07 mmol/l, SE = 0.03), reduced energy from total (−2.00%, SE = 0.78) and saturated fat (−1.54%, SE = 0.41), and increased fibre intake (1.98 g/1,000 kcal energy, SE = 0.47). In controls, oral glucose at 2 hours deteriorated (0.59 mmol/l, SE = 0.27). Only waist circumference reduced significantly (−4.02 cm, SE = 0.95).

Intervention participants significantly outperformed controls over 12 months for body mass index and fibre intake. After baseline adjustment, they also showed greater weight loss and reduced saturated fat versus total energy intake.

At least 5% weight loss was achieved by 32% of intervention participants versus 0% controls.
Conclusions
pMDPS results indicate that scaling-up from implementation trial to state-wide programme is possible. The system design for Life! was fit for purpose of scaling-up from efficacy to effectiveness.

Using the theory of planned behaviour and implementation intentions to predict and facilitate upward family communication about mammography

Regular mammography facilitates early detection of breast cancer, and thus increases the chances of survival from this disease. Daughter-initiated (i.e. upward) communication about mammography within mother–daughter dyads may promote mammography to women of screening age. The current study examined this communication behaviour within the context of the Theory of Planned Behaviour (TPB), and aimed to bridge the intention-behaviour gap by trialling an implementation intention (II) intervention that aimed to facilitate upward family communication about mammography. Young women aged 18–39 (N = 116) were assigned to either a control or experimental condition, and the latter group formed IIs about initiating a conversation with an older female family member about mammography. Overall, those who formed IIs were more likely to engage in the target communication behaviour, however the intervention was most effective for those who reported low levels of intention at baseline. Perceived behavioural control emerged as the most important variable in predicting the target behaviour. The altruistic nature of this behaviour, and the fact that it is not wholly under volitional control, may have contributed to this finding. Future studies that systematically explore the relative roles of intention and perceived behavioural control in behaviours of this nature are warranted.

ePortfolios in business education: a national study of ePortfolio implementation 2013 to 2015

To be launched in March 2016, this study explores the transformative potential of ePortfolios in business education. Educators and higher education institutions are increasingly looking for innovative ways to enhance learning outcomes through technology. Given their potential to aid in the development of engaged, reflective lifelong learners, and develop and showcase employability skills, ePortfolios are increasingly being used around the globe.

This study shares the experience of, and lessons learned from, the implementation of ePortfolios in one general business management course and three accounting related courses at three higher education institutions. The recommendations and principles proposed provide benchmarks for best practice and practical guidance for embedding ePortfolios into business curricula.

Critical pre-implementation elements in engendering change for sustainability in SMEs : insights from SME sustainability leaders

Despite the increased awareness surrounding sustainability issues and growing pressure on businesses to adopt sustainable business practices, there is little understanding of management processes and practices necessary for SMEs to implement environmental sustainable (ES) practices. Through qualitative in-depth interviews, this paper draws on the experiences and perspectives from twelve SME sustainability leaders to present answers to the 'what' and 'why' of critical pre-implementation elements in engendering change for sustainability within the SME context. The research questions examined in this study are: In the views of SME sustainability leaders: what pre-implementation elements are important in setting the foundations of ES success in SMEs; what are the most important elements in the decision to introduce and encourage improved ES practices; and how do SME sustainability leaders plan for ES change in their firms. We also examine how the pre-implementation elements identified in this study, fit with the steps of one of the most well-known sustainability change management frameworks by Dunphy et al (2003). The results show that elements playing a role in setting the foundations for ES success in participating firms include: the SME leader challenging the status quo, gathering of initial information; clarifying the internal know-how about ES, identifying who the ES leader(s) is, and what the associated roles are; creating a theme of environmental sustainability in the firm (what sustainability means to the firm); and the personal mindset of leaders regarding ES. In addition, it was evident from the interview data that apart from providing valuable data regarding what must change and why, the drivers and benefits of ES provide a strong rationale and motivation to the rest of the organisation why sustainability is important to the organisation. Furthermore, it is evident from the interview data that the most used strategic approach to planning by SME sustainability leaders, is a deliberate approach even though the emergent approach to planning has also featured in some SMEs. Furthermore, the CEOs are the main players in the strategic process, with the majority involving staff in planning for ES. The results also indicate that in matching the pre-implementation elements to Dunphy et al‘s (2003) sustainability change management steps, the execution of two of their steps may need adjustment to be fully applicable to SMEs. Several practical implications for other SMEs are outlined. In conclusion, the framework outlined in this paper provides an example of a critically reflective approach to a specific phase of the environmental sustainability puzzle in SMEs.

Understanding the sources of uncertainty to reduce the risks of undesirable outcomes in large-scale freshwater ecosystem restoration projects: an example from the Murray–Darling Basin, Australia

There are a growing number of large-scale freshwater ecological restoration projects worldwide. Assessments of the benefits and costs of restoration often exclude an analysis of uncertainty in the modelled outcomes. To address this shortcoming we explicitly model the uncertainties associated with measures of ecosystem health in the estuary of the Murray– Darling Basin, Australia and how those measures may change with the implementation of a Basin-wide Plan to recover water to improve ecosystem health. Specifically, we compare two metrics – one simple and one more complex – to manage end-of-system flow requirements for one ecosystem asset in the Basin, the internationally important Coorong saline wetlands. Our risk assessment confirms that the ecological conditions in the Coorong are likely to improve with implementation of the Basin Plan; however, there are risks of a Type III error (where the correct answer is found for the wrong question) associated with using the simple metric for adaptive management. 

Using care plans to better manage multimorbidity

BACKGROUND: The health care for patients having two or more long-term medical conditions is fragmented between specialists, allied health professionals, and general practitioners (GPs), each keeping separate medical records. There are separate guidelines for each disease, making it difficult for the GP to coordinate care. The TrueBlue model of collaborative care to address key problems in managing patients with multimorbidity in general practice previously reported outcomes on the management of multimorbidities. We report on the care plan for patients with depression, diabetes, and/or coronary heart disease that was embedded in the TrueBlue study. METHODS: A care plan was designed around diabetes, coronary heart disease, and depression management guidelines to prompt implementation of best practices and to provide a single document for information from multiple sources. It was used in the TrueBlue trial undertaken by 400 patients (206 intervention and 194 control) from 11 Australian general practices in regional and metropolitan areas. RESULTS: Practice nurses and GPs successfully used the care plan to achieve the guideline-recommended checks for almost all patients, and successfully monitored depression scores and risk factors, kept pathology results up to date, and identified patient priorities and goals. Clinical outcomes improved compared with usual care. CONCLUSION: The care plan was used successfully to manage and prioritise multimorbidity. Downstream implications include improving efficiency in patient management, and better health outcomes for patients with complex multimorbidities.

Balancing the risk of injury to gymnasts : how effective are the counter measures?

Background—To minimise injury risk and maximise gymnastics performance, coaches, parents, and health professionals working with young gymnasts need to understand and practise safe gymnastics.

Aims—To (a) identify the various injury counter measures specific to gymnastics, (b) critically review the literature describing each injury prevention measure, and (c) assess, using available risk factor and injury data, the weight of evidence to support each of these counter measures. Specific recommendations for further research and implementation strategies to prevent injury and improve safety are also given.

Methods—The relevant literature was identified through the use of Medline (1966 to May 1998) and SPORT Discus (1975 to May 1998) searches, hand searching of journals and reference lists, and discussions with key Australian gymnastics organisations.

Results—The key gymnastics injury counter measures identified in this review include coaching (physical preparation, education, spotting, and performance technique), equipment, and the health support system (medical screening, treatment, and rehabilitation). Categorisation of the type of evidence for the effectiveness of each of these counter measures in preventing injury showed that most of it is based on informal opinion/anecdotal evidence, uncontrolled data based studies, and several prospective epidemiological studies. There is no evidence from formally controlled trials or specific evaluation studies of counter measures for gymnastics.

Conclusions—Although gymnastics is a sport associated with young participants and frequent high volume, high impact training, there is a paucity of information on injury risk factors and the effectiveness of injury practices. Further controlled trials are needed to examine the extent to which injury prevention counter measures can prevent or reduce the occurrence of injury and re-injury. Particular attention should be devoted to improving training facilities, the design and testing of apparatus and personal equipment used by gymnasts, and coaching and the role of spotting in preventing injury.

Social policy for sport events : leveraging (relationships with) teams from other nations for community benefit

Recent work on sport events has argued that host governments should do more to leverage events in order to obtain and spread the benefits. This study uses ethnographic methods to compare two cities' implementation of a programme designed to leverage the presence of visiting teams training for the 2006 Commonwealth Games. Whereas one city formulated and implemented a detailed strategic plan to obtain benefits from its relationship with its adopted visiting team (Papua New Guinea), the other made no effort to benefit from adopting a visiting team (Wales). The city that leveraged its visiting team obtained new relationships, cultural insights, and improved organisational networks, whereas the city that did not leverage obtained no comparable benefits. The difference was due to the disparity in strategic vision by the two city governments and the vague mandate of the state programme which had caused each city to adopt its chosen team. Future work should explore factors that foster and that inhibit effective leverage before and during sport events.