"An on-going individual adjustment" : a qualitative study of midwives' experiences counselling pregnant women on physical activity in Sweden

Background: In Sweden, midwives play prominent supportive role in antenatal care by counselling and promoting healthy lifestyles. This study aimed to explore how Swedish midwives experience the counselling of pregnant women on physical activity, specifically focusing on facilitators and barriers during pregnancy. Also, addressing whether the midwives perceive that their own lifestyle and body shape may influence the content of the counselling they provide. Methods: Eight focus group discussions (FGD) were conducted with 41 midwives working in antenatal care clinics in different parts of Sweden between September 2013 and January 2014. Purposive sampling was applied to ensure a variation in age, work experience, and geographical location. The FGD were digitally recorded, transcribed verbatim, and analyzed using manifest and latent content analysis. Results: The main theme- "An on-going individual adjustment" was built on three categories: "Counselling as a challenge"; "Counselling as walking the thin ice" and "Counselling as an opportunity" reflecting the midwives on-going need to adjust their counselling depending on each woman's specific situation. Furthermore, counselling pregnant women on physical activity was experienced as complex and ambiguous, presenting challenges as well as opportunities. When midwives challenged barriers to physical activity, they risked being rejected by the pregnant women. Despite risking rejection, the midwives tried to promote increased physical activity based on their assessment of individual needs of the pregnant woman. Some participants felt that their own lifestyle and body shape might negatively influence the counselling; however, the majority of participants did not agree with this perspective. Conclusions: Counselling on physical activity during pregnancy may be a challenging task for midwives, characterized by on-going adjustments based on a pregnant woman's individual needs. Midwives strive to find individual solutions to encourage physical activity. However, to improve their counselling, midwives may benefit from further training, also organizational and financial barriers need to be addressed. Such efforts might result in improved opportunities to further support pregnant women's motivation for performance of physical activity.

Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden

BACKGROUND: With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study. METHODS: We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR). RESULTS: In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care. CONCLUSIONS: If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process.

Exploring the influence of context in a community-based facilitation intervention focusing on neonatal health and survival in Vietnam : a qualitative study

Background In the Neonatal health – Knowledge into Practice (NeoKIP) trial in Vietnam, local stakeholder groups, supported by trained laywomen acting as facilitators, promoted knowledge translation (KT) resulting in decreased neonatal mortality. In general, as well as in the community-based NeoKIP trial, there is a need to further understand how context influences KT interventions in low- and middle-income countries (LMICs). Thus, the objective of this study was to explore the influence of context on the facilitation process in the NeoKIP intervention. Methods A secondary content analysis was performed on 16 Focus Group Discussions with facilitators and participants of the stakeholder groups, applying an inductive approach to the content on context through naïve understanding and structured analysis. Results The three main-categories of context found to influence the facilitation process in the NeoKIP intervention were: (1) Support and collaboration of local authorities and other communal stakeholders; (2) Incentives to, and motivation of, participants; and (3) Low health care coverage and utilization. In particular, the role of local authorities in a KT intervention was recognized as important. Also, while project participants expected financial incentives, non-financial benefits such as individual learning were considered to balance the lack of reimbursement in the NeoKIP intervention. Further, project participants recognized the need to acknowledge the needs of disadvantaged groups. Conclusions This study provides insight for further understanding of the influence of contextual aspects to improve effects of a KT intervention in Vietnam. We suggest that future KT interventions should apply strategies to improve local authorities’ engagement, to identify and communicate non-financial incentives, and to make disadvantaged groups a priority. Further studies to evaluate the contextual aspects in KT interventions in LMICs are also needed.

Lessons learned from stakeholders in a facilitation intervention targeting neonatal health in Quang Ninh province, Vietnam

BACKGROUND: In northern Vietnam the Neonatal health - Knowledge Into Practice (NeoKIP, Current Controlled Trials ISRCTN44599712) trial has evaluated facilitation as a knowledge translation intervention to improve neonatal survival. The results demonstrated that intervention sites, each having an assigned group including local stakeholders supported by a facilitator, lowered the neonatal mortality rate by 50% during the last intervention year compared with control sites. This process evaluation was conducted to identify and describe mechanisms of the NeoKIP intervention based on experiences of facilitators and intervention group members. METHODS: Four focus group discussions (FGDs) were conducted with all facilitators at different occasions and 12 FGDs with 6 intervention groups at 2 occasions. Fifteen FGDs were audio recorded, transcribed verbatim, translated into English, and analysed using thematic analysis. RESULTS: Four themes and 17 sub-themes emerged from the 3 FGDs with facilitators, and 5 themes and 18 sub-themes were identified from the 12 FGDs with the intervention groups mirroring the process of, and the barriers to, the intervention. Facilitators and intervention group members concurred that having groups representing various organisations was beneficial. Facilitators were considered important in assembling the groups. The facilitators functioned best if coming from the same geographical area as the groups and if they were able to come to terms with the chair of the groups. However, the facilitators' lack of health knowledge was regarded as a deficit for assisting the groups' assignments. FGD participants experienced the NeoKIP intervention to have impact on the knowledge and behaviour of both intervention group members and the general public, however, they found that the intervention was a slow and time-consuming process. Perceived facilitation barriers were lack of money, inadequate support, and the function of the intervention groups. CONCLUSIONS: This qualitative process evaluation contributes to explain the improved neonatal survival and why this occurred after a latent period in the NeoKIP project. The used knowledge translation intervention, where facilitators supported multi-stakeholder coalitions with the mandate to impact upon attitudes and behaviour in the communes, has low costs and potential for being scaled-up within existing healthcare systems.

Främjande faktorer för sjuksköterskor att bedriva en evidensbaserad vård

Bakgrund Evidensbaserad vård (EBV) är ett välkänt begrepp som används för att tillförsäkra patienter en säker vård som vilar på bästa tillgängliga bevis, beprövad erfarenhet och patientens individuella preferenser. Många studier har tidigare undersökt hinder för sjuksköterskor att bedriva och/eller implementera EBV för att förklara gapet som kan uppstå mellan teori och praktik. Färre studier har undersökt vilka faktorer som främjar sjuksköterskors användande av EBV. Syfte Att genom en litteraturöversikt beskriva vilka faktorer som främjar sjuksköterskors möjligheter att bedriva en evidensbaserad vård. Metod Studien genomfördes som en litteraturöversikt. Databaserna CINAHL, PubMed och Web of Science genomsöktes och 15 artiklar valdes ut (8 kvalitativa, 4 kvantitativa och 3 mixedmethod). Resultat Fem kategorier identifierades som främjande faktorer för sjuksköterskor att bedriva och/eller implementera EBV; arbetsmiljö, stöd, kunskap, sjuksköterskans inställning och organisation. Stöd i form utav underlättare var den mest framträdande faktorn. Slutsats Sjuksköterskan har ett individuellt ansvar att bedriva EBV och kan genom sin egen inställning påverka att en sådan vård bedrivs. De flesta främjande faktorer som framkom var dock tydligare kopplade till ledningen och chefens del i att främja användandet av EBV.

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

O uso da tecnologia da informação no varejo brasileiro

A competição no varejo tem levado as empresas a uma busca constante por uma maior eficiência em seus processos de negócio, tanto no âmbito interno como externo, seja no relacionamento com clientes ou fornecedores. Esta busca da eficiência através da melhoria dos processos tem feito uso intensivo de Tecnologia de Informação (TI) nas mais diversas formas. O objetivo deste trabalho é investigar como está o uso da TI no varejo brasileiro em grandes corporações, numa visão de propósitos, contribuições, facilitadores e obstáculos a partir da percepção de especialistas (pesquisadores e consultores) e executivos do varejo. Para o desenvolvimento do trabalho foram realizadas entrevistas com 24 especialistas e estudos de casos com executivos de 16 grandes empresas varejistas.

Repensar a graduação da EAESP: um estudo de caso de inovação

Esta pesquisa pretende analisar os diversos fatores que influenciam a realização e consecução de um projeto de inovação, tratando especificamente do projeto de reformulação do curso de graduação em administração da FGV-EAESP. Tomando-se como base os estudos realizados pelo MIRP (Minnesota Innovation Research Program), a pesquisa irá utilizar a mesma ferramenta metodológica para avaliar algumas variáveis - idéias, pessoas, interações, contextos e resultados que influenciam os projetos de inovação. A pesquisa justifica-se pela necessidade de se testar, desenvolver ou adaptar metodologias que permitam a análise de projetos de inovação, levantando empecilhos e facilitadores do processo. É importante também por gerar resultados que poderão eventualmente ser utilizados em outros projetos de cunho acadêmico.

Gestão de parcerias na administração pública: uma experiência no setor de telecomunicações

O tema parceria vem sendo objeto de estudo em todo o mundo. Ganhando força, com as Joint-venture Internacionais, nas áreas de telecomunicações, informática, automobilística, aeroespacial etc., o elemento inovador passou a ser a constituição de alianças estratégicas com potenciais concorrentes, seja na exploração de novos nichos de mercado, seja em atividades de pesquisa e desenvolvimento de novos serviços e produtos. Considerando como normal esta troca ou sinergia entre parceiros, o trabalho apresenta e analisa os dados relativos ao estudo de campo realizado (pesquisa seletiva) junto a profissionais envolvidos com o dia-a-dia do processo de parceria de empresas líderes dos setores de Telecomunicações (Empresa Estatal) e do setor de serviços de Rede e Informática ( Empresa Privada). As considerações estão estruturadas nas seguintes partes: a caracterização e segmentação da amostra utilizada (caracterização dos respondentes); a análise descritiva e avaliação das variáveis representativas dos fatores inibidores e facilitadores; as percepções diferenciadas face aos elementos dependendo da experiência profissional e grau de envolvimento com os processos da parceria; os elementos inibidores e facilitadores apontados como de maior relevância; e os resultados obtidos a partir do uso da técnica de análise fatorial.

Coordenação interinstitucional para o desenvolvimento local: um estudo em Araçuaí, Minas Gerais

This essay aims to discuss local development under the prospect of coordinated intervention of multiple organizations, considering different thematic areas of action, different economic sectors and regions of origin; structured in different methodologies and owners of different social technologies field of expertises. Search to identify determinants, facilitators, and restrictive factors of cross sectorial and cross organizational coordination processes for a common purpose. The field research was conducted at a region of State of Minas Gerais, Brazil, where a group of 13 organizations that fit the profile described above, joined up to work jointly, facilitating the environment for local development. The region is between those with the lowest incomes in Brazil. The objective of this study was to verifry what extent the practices implemented by the organizations context (the municipality in question has population of less than 40.000 inhabitants), are contributing to the formation and / or strengthening of a local scene of more opportunities that compete for the quality of life of the population. To meet this goal were interviewd 52 citizens between representatives of organizations, the government, civil society and citizens directly benefit from the Sustainable Araçuaí iniciative, using the semi-structured interview. The result has been the relationship between partnerships determining factors, facilitators and restrictive labour, structured on a conceptual map, and the perception of the impact that these actions have caused coordinates the council from the perspective of the interviewees

Os impactos do acirramento da competitividade na gestão dos hospitais privados na região metropolitana de Vitória

O objetivo deste estudo é considerar e avaliar os impactos do acirramento da competitividade, que promoveram as mudanças que vêm acontecendo na gestão dos hospitais privados da Região Metropolitana de Vitória. Para cumprir tais metas, foi preciso apontar a natureza dessas mudanças, bem como os beneficios e perdas acarretados pelas empresas, que incidem diretamente sobre os serviços prestados à comunidade. A pesquisa - descritiva e explicativa - foi realizada por meio de pesquisa de campo e bibliográfica. O estudo foi realizado a partir de uma amostra de hospitais privados da Região Metropolitana de Vitória e os dados foram coletados com superintendentes, diretores, gerentes e trabalhadores dos serviços, por intermédio de questionários e entrevistas com diversos outros atores que pertencem ao cenário constituído - médicos, consultores e usuários, planos e seguros de saúde, Conselho Regional de Medicina, Associação dos Hospitais e Sindicato dos Enfermeiros. A partir da pesquisa realizada, foi possível concluir que os gestores devem rever alguns conceitos que influem na gestão hospitalar e prepararse para enfrentar as mudanças que ocorrem no mercado. É preciso flexibilizar-se e buscar a incorporação de novos paradigmas que se façam necessários.

A gestão do conhecimento no corpo de intendentes da Marinha do Brasil: desafios e oportunidades na busca pela excelência da aprendizagem organizacional

Utilizando-se da perspectiva das teorias sobre Gestão do Conhecimento (GC), este trabalho tem como objetivo principal identificar os problemas e desafios que se apresentam às Organizações Militares responsáveis pela formação, especialização, aperfeiçoamento e capacitação dos Oficiais do Corpo de Intendentes da Marinha (CIM). Para tanto, são apresentados alguns conceitos relevantes sobre a Gestão do Conhecimento, bem como a sua importância na Administração Pública, em particular nos ambientes hierarquizados, como é o caso das Forças Armadas. Posteriormente, é feita uma breve contextualização sobre o caso, no que tange à estrutura organizacional analisada e os princípios do Programa Netuno, bem como sobre a busca pela excelência na gestão pública como fonte inspiradora. Utilizando-se da metodologia qualitativa de pesquisa, o trabalho busca compreender os principais aspectos relacionados à gestão do conhecimento, ressaltando as principais barreiras e facilitadores ao compartilhamento do conhecimento neste segmento, bem como elencando as principais ferramentas práticas observadas, e não se privando de trazer à tona algumas ferramentas sugeridas pelos entrevistados. Na sequência, traz a percepção de que o próprio Programa Netuno, fazendo uso de seu sítio eletrônico, possui atributos para assumir o papel de um contexto capacitante – “Ba” – especialmente no ambiente virtual de compartilhamento do conhecimento, o qual oferece muitas oportunidades para consolidação da GC no Corpo de Intendentes da Marinha. E por fim, não menos importante, o trabalho conclui que o Centro de Instrução Almirante Newton Braga (CIANB) tem enorme potencial para se tornar a “Universidade Corporativa do Corpo de Intendentes da Marinha”.

Aspectos limitadores e incentivadores para a adoção do mobile payment na realização de operações de microcrédito

Este estudo tem por objetivo identificar os aspectos que podem promover ou limitar o surgimento de arranjos de pagamentos de mobile payment (pagamentos móveis) que possam ser utilizados nas iniciativas de microcrédito no Brasil. O tema microcrédito foi escolhido em função do enorme potencial para a realização de operações de microcrédito no Brasil, bem como pelo aspecto de integração econômico-social que as operações de microcrédito podem proporcionar. A escolha do tema mobile payment ocorreu em função da versatilidade e inovação desta modalidade de pagamento, com potencial para uma grande transformação dos meios de pagamentos no mercado brasileiro. A análise da utilização do mobile payment nas iniciativas de microcrédito surgiu em função das contribuições que tal modalidade de pagamento pode trazer para a realização de operações de microcrédito. O objetivo deste estudo qualitativo é auxiliar na compreensão dos aspectos limitadores e incentivadores para a utilização do mobile payment nas iniciativas de microcrédito, bem como verificar quais contribuições a utilização do mobile payment pode trazer para a realização de operações de microcrédito. Adicionalmente, por meio das informações obtidas junto aos Grupos Sociais Relevantes (GSR) envolvidos nos arranjos de pagamentos, a presente pesquisa pretende ainda identificar as influências destes agentes para a formação e adaptação desses arranjos. As informações para a realização deste estudo foram coletadas principalmente por meio de entrevistas em profundidade com representantes selecionados dos GSR participantes dos arranjos de pagamentos. As entrevistas realizadas foram transcritas e constam no final do trabalho, representando uma fonte importante de informação aos interessados no tema, em função da riqueza de detalhes apresentados. Para a compreensão e interpretação do objeto de estudo, foi utilizado o referencial teórico apresentado por Coase e Williamson (Teoria dos Custos de Transação), Gannamaneni e Ondrus (Multilevel Framework). Com a publicação da Resolução 4.282 do Banco Central do Brasil em novembro de 2013, instituindo o marco regulatório que disciplina a autorização e o funcionamento de arranjos e instituições de pagamento no Brasil, o objeto de análise em questão torna-se ainda mais relevante para a comunidade acadêmica, participantes do mercado de microcrédito e GSR integrantes dos arranjos de mobile payment. Espera-se com isso contribuir para um melhor entendimento das barreiras e facilitadores para a adoção e desenvolvimento dos arranjos de pagamentos de mobile payment, e, principalmente, que esta pesquisa possa contribuir para uma maior interação destes arranjos com as iniciativas de microcrédito.

The art of being together: a social constructionist perspective on dialogic methods in the organizational context

The purpose of this project is to understand, under a social constructionist approach, what are the meanings that external facilitators and organizational members (sponsors) working with dialogic methods place on themselves and their work. Dialogic methods, with the objective of engaging groups in flows of conversations to envisage and co-create their own future, are growing fast within organizations as a means to achieve collective change. Sharing constructionist ideas about the possibility of multiple realities and language as constitutive of such realities, dialogue has turned into a promising way for transformation, especially in a macro context of constant change and increasing complexity, where traditional structures, relationships and forms of work are questioned. Research on the topic has mostly focused on specific methods or applications, with few attempts to study it in a broader sense. Also, despite the fact that dialogic methods work on the assumption that realities are socially constructed, few studies approach the topic from a social constructionist perspective, as a research methodology per se. Thus, while most existing research aims at explaining whether or how particular methods meet particular results, my intention is to explore the meanings sustaining these new forms of organizational practice. Data was collected through semi-structured interviews with 25 people working with dialogic methods: 11 facilitators and 14 sponsors, from 8 different organizations in Brazil. Firstly, the research findings indicate several contextual elements that seem to sustain the choices for dialogic methods. Within this context, there does not seem to be a clear or specific demand for dialogic methods, but a set of different motivations, objectives and focuses, bringing about several contrasts in the way participants name, describe and explain their experiences with such methods, including tensions on power relations, knowledge creation, identity and communication. Secondly, some central ideas or images were identified within such contrasts, pointing at both directions: dialogic methods as opportunities for the creation of new organizational realities (with images of a ‘door’ or a ‘flow’, for instance, which suggest that dialogic methods may open up the access to other perspectives and the creation of new realities); and dialogic methods as new instrumental mechanisms that seem to reproduce the traditional and non-dialogical forms of work and relationship. The individualistic tradition and its tendency for rational schematism - pointed out by social constructionist scholars as strong traditions in our Western Culture - could be observed in some participants’ accounts with the image of dialogic methods as a ‘gym’, for instance, in which dialogical – and idealized –‘abilities’ could be taught and trained, turning dialogue into a tool, rather than a means for transformation. As a conclusion, I discuss what the implications of such taken-for-granted assumptions may be, and offer some insights into dialogue (and dialogic methods) as ‘the art of being together’.

Acompanhando o crescimento e o desenvolvimento da criança : uma intervenção integrada entre enfermagem e família

The accompanying the growth and development of the child is the guiding line of basic health measures directed at this public, acting within the scope of health monitoring and inferring positively in the rate of infant morbidity and mortality, which are still a preoccupation worldwide and in Brazil. However, mostly, this practice is based on the biomedical model of care, individualized, with emphasis on the medicalization and complaints, favoring the passivity of users. Given this issue, aim to develop accompanying the growth and development of the child in a Basic Unit Family Health, through a collective approach of medical care next to a health team, especially nurses and caregivers. This is a qualitative study, with the research-action method. Involved the four nurses and twenty-six of children's caregivers of the area of Basic Unit Family Health of Cidade Nova, in Natal, in the period from February to July 2010. The results were analyzed following the direction of the thematic analysis of Freire. In the situation analysis of the current reality of the accompanying the growth and development the children in the Basic Unit Family Health, through participant observation and applying a questionnaire to the nurses, we realize that despite these professionals have a knowledge tied to the paradigm of health promotion, in practice the monitoring of child is done through individual consultations in outpatient room, based on complaints brought by caregivers, with little solvability in actions employed. Given the need for change in medical care model, we decided jointly, in the focal group, for the collective monitoring of children's the growth and development, featuring then this proposal to the multidisciplinary team, discussing the participation of professional categories and planned collectively the actions. In the implementation stage of collective action, we contemplate the execution by the caregivers of anamnesis and physical examination, recording data in the Child Health Handbook and discussion of clinical findings, under the supervision of nurses and facilitators. In the evaluation, we found that this collective accompanying strategy allowed to caregivers learn new knowledge, exchange experiences, assistance in home care, beyond reduce the waiting time for medical care and creating opportunity of more time for debate about the children‟s health situation, differing of ambulatory care. As difficulties, we face with a high rate of defaulters (53.8%), lack of motivation and passivity of the users, little participation of other health professionals and nurses' involvement in other activities, technical and bureaucratic in the moment of care. Thus, we note also a strong rooting of individual clinical model on the way of thinking and acting of nurses and caregivers