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.

Pathway from vocational education and associate degree to higher education: Chinese international students in Australia

Understanding factors influencing international students' decision to engage in international education is essential for education providers to better cater for students' educational expectations and enhance their attractiveness to international students. Whilst there has been extensive research on the reasons why international students undertake cross-border higher education, international students' motivations for enrolling in vocational education and associate degree programmes are still under-researched. Drawing on semi-structured interviews with 30 international students from China, this research found that pathway to higher education appears to be the most important factor motivating international students to undertake vocational education and associate degree programmes. In addition, prospect of immigration, English language proficiency, previous academic performance, agent's recommendations and relatives' and friends' advice are amongst the important factors that students take into account in their decision to choose vocational education and associate degree programmes. This research also examines why Chinese international students have chosen vocational education programmes in a dual-sector university over vocational education colleges. It found that the flexibility to articulate to higher education, international reputation of the programme, practical training and favourable location are key issues that these students draw on when making their decision to study in a dual-sector university.

Methods and technologies to promote information-centered knowledge construction

This alternative event for the 2013 iConference is a combination of lightning talks, a demonstration of an assessment technology for knowledge construction in complex domains, and a hands-on exercise in using the tools discussed. The unifying logic for this presentation is that meaningful learning often involves solving challenging and complex problems that allow for multiple solution approaches and a variety of acceptable solutions. While it is important to prepare students to solve such problems, it is difficult to determine the extent to which various interventions and programs are contributing to the development of appropriate problem-solving strategies and attitudes. Simply testing domain knowledge or the ability to solve simple, single-solution problems may not provide support for improving individual student ability or relevant programs and activities. A reliable and robust methodology for assessing the relevant knowledge constructions of students engaged in solving challenging problems is needed, and that is our focus.

Using birthing kits to promote clean birth practices in Ethiopia

This article explores three NGO projects that assemble and distribute clean birthing kits in Ethiopia. It contrasts the government's health strategy that aims to increase skilled birth attendance, with local realities as most women in rural and remote settings give birth at home, often in unhygienic conditions, and without skilled assistance. Many health facilities are also unable to provide hygienic conditions for birthing women. The findings indicate that clean birth kits have assisted the NGOs to effectively promote clean delivery at home or in health facilities, and to encourage antenatal care, and early referral to emergency obstetric and new-born care.

Using internet enabled mobile devices and social networking technologies to promote exercise as an intervention for young first episode psychosis patients

Young people with first episode psychosis are at an increased risk for a range of poor health outcomes. In contrast to the growing body of evidence that suggests that exercise therapy may benefit the physical and mental health of people diagnosed with schizophrenia, there are no studies to date that have sought to extend the use of exercise therapy among patients with first episode psychosis. The aim of the study is to test the feasibility and acceptability of an exercise program that will be delivered via internet enabled mobile devices and social networking technologies among young people with first episode psychosis.

An accountability framework to promote healthy food environments

Objective
To review the available literature on accountability frameworks to construct a framework that is relevant to voluntary partnerships between government and food industry stakeholders.

Design
Between November 2012 and May 2013, a desk review of ten databases was conducted to identify principles, conceptual frameworks, underlying theories, and strengths and limitations of existing accountability frameworks for institutional performance to construct a new framework relevant to promoting healthy food environments.

Setting
Food policy contexts within high-income countries to address obesity and diet-related non-communicable diseases.

Subjects Eligible resources (n 26) were reviewed and the guiding principles of fifteen interdisciplinary frameworks were used to construct a new accountability framework.

Results
Strengths included shared principles across existing frameworks, such as trust, inclusivity, transparency and verification; government leadership and good governance; public deliberations; independent bodies recognizing compliance and performance achievements; remedial actions to improve accountability systems; and capacity to manage conflicts of interest and settle disputes. Limitations of the three-step frameworks and ‘mutual accountability’ approach were an explicit absence of an empowered authority to hold all stakeholders to account for their performance.

Conclusions
We propose a four-step accountability framework to guide government and food industry engagement to address unhealthy food environments as part of a broader government-led strategy to address obesity and diet-related non-communicable diseases. An independent body develops clear objectives, a governance process and performance standards for all stakeholders to address unhealthy food environments. The empowered body takes account (assessment), shares the account (communication), holds to account (enforcement) and responds to the account (improvements).

Capacity-building in nonprofit organizations using blended learning as a gateway to practitioner education

Experience to date in for-profit as well as in educational settings has demonstrated that blended learning models are effective training vehicles for online instruction and workplace training. Increasingly, technology is playing a critical role in how e-learning is being delivered. Concern for the sustainability and relevance of nonprofit organizations has heightened interest in building effective capacity-building models for the sector. Because blended learning is a remarkably adaptable and fluid model, its potential for transforming capacity-building models in the nonprofit sector can be significant. Are web-based technologies enhancing capacity-building models in the Third Sector? This chapter explores the use of blended learning models within different educational environments to provide the context for asking the question: can blended learning paradigms that incorporate interactive next-generation technologies be widely accepted and implemented in the Third Sector? To establish a baseline for future studies, researchers surveyed nonprofit practitioners in Western Pennsylvania, US and Victoria, Australia. Results from three surveys conducted in 2011 reflect an awareness of the value of web-based training and education for nonprofit practitioners, but do not provide evidence of widespread usage. © 2013 Nova Science Publishers, Inc. All rights reserved.

Interventions designed to promote exclusive breastfeeding in high-income countries: a systematic review

Worldwide, women fail to reach the recommended exclusive breastfeeding target of 6 months postpartum. The objective of this study was to present a conceptual and methodological synthesis of interventions designed to promote exclusive breastfeeding to 6 months in high-income countries.