Search results
Found 19972 matches for
©
NIHR
Storylines of research in diffusion of innovation: A meta-narrative approach to systematic review
Producing literature reviews of complex evidence for policymaking questions is a challenging methodological area. There are several established and emerging approaches to such reviews, but unanswered questions remain, especially around how to begin to make sense of large data sets drawn from heterogeneous sources. Drawing on Kuhn's notion of scientific paradigms, we developed a new method - meta-narrative review - for sorting and interpreting the 1024 sources identified in our exploratory searches. We took as our initial unit of analysis the unfolding 'storyline' of a research tradition over time. We mapped these storylines by using both electronic and manual tracking to trace the influence of seminal theoretical and empirical work on subsequent research within a tradition. We then drew variously on the different storylines to build up a rich picture of our field of study. We identified 13 key meta-narratives from literatures as disparate as rural sociology, clinical epidemiology, marketing and organisational studies. Researchers in different traditions had conceptualised, explained and investigated diffusion of innovations differently and had used different criteria for judging the quality of empirical work. Moreover, they told very different over-arching stories of the progress of their research. Within each tradition, accounts of research depicted human characters emplotted in a story of (in the early stages) pioneering endeavour and (later) systematic puzzle-solving, variously embellished with scientific dramas, surprises and 'twists in the plot'. By first separating out, and then drawing together, these different meta-narratives, we produced a synthesis that embraced the many complexities and ambiguities of 'diffusion of innovations' in an organisational setting. We were able to make sense of seemingly contradictory data by systematically exposing and exploring tensions between research paradigms as set out in their over-arching storylines. In some traditions, scientific revolutions were identifiable in which breakaway researchers had abandoned the prevailing paradigm and introduced a new set of concepts, theories and empirical methods. We concluded that meta-narrative review adds value to the synthesis of heterogeneous bodies of literature, in which different groups of scientists have conceptualised and investigated the 'same' problem in different ways and produced seemingly contradictory findings. Its contribution to the mixed economy of methods for the systematic review of complex evidence should be explored further. © 2005 Elsevier Ltd. All rights reserved.
Experiences of general practitioners and practice nurses of training courses in evidence-based health care: A qualitative study
Background. Clinical governance will require general practitioners (GPs) and practice nurses (PNs) to become competent in finding, appraising, and implementing research evidence - the skills of evidence-based health care (EBHC). Aim. To report the experiences of GPs and PNs in training in this area. Method. We held 30 in-depth, semi-structured interviews throughout North Thames region with three groups of informants: primary care practitioners recruited from the mailing lists of established EBHC courses; organizers and teachers on these courses; and educational advisers from Royal Colleges, universities, and postgraduate departments. Detailed qualitative analysis was undertaken to identify themes from each of these interview groups. Results. At the time of the fieldwork for this study (late 1997), remarkably few GPs or PNs had attended any formal EBHC courses in our region. Perceived barriers to attendance on courses included inconsistency in marketing terminology, cultural issues (e.g. EBHC being perceived as one aspect of rapid and unwanted change in the workplace), lack of confidence in the subject matter (especially mathematics and statistics), lack of time, and practical and financial constraints. Our interviews suggested, however, that the principles and philosophy of EBHC are beginning to permeate traditional lecture-based continuing medical education courses, and consultant colleagues increasingly seek to make their advice 'evidence based'. Conclusion. We offer some preliminary recommendations for the organizers of EBHC courses for primary care. These include offering a range of flexible training, being explicit about course content, recognizing differences in professional culture between primary and secondary care and between doctors and nurses, and addressing issues of funding and accreditation at national level. Introducing EBHC through traditional topic-based postgraduate teaching programmes may be more acceptable and more effective than providing dedicated courses in its theoretical principles.
Best research - For what? Best health - For whom? A critical exploration of primary care research using discourse analysis
Health research is fundamental to the development of improved health and healthcare. Despite its importance, and the role of policy in guiding the kind of research that gets addressed, there are very few empirical studies of health research policy. This paper redresses this, exploring the means by which one area of health research policy is shaped, enabled and constrained. We ask: what are the historical, social and political origins of research policy in primary care in England? What are the key discourses that have dominated debate; and what are the tensions between discourses and the implications this raises for practitioners and policymakers? To answer these questions we employed a Foucauldian approach to discourse analysis to explicitly recognise the historical, social and ideological origins of policy texts; and the role of power and knowledge in policy development. We adapted Parker's framework for distinguishing discourses as a means of selecting and analysing 29 key policy documents; 16 narrative interviews with historical and contemporary policy stakeholders; and additional contextual documents. Our analysis involved detailed deconstruction and linking across texts to reveal prevailing storylines, ideologies, power relations, and tensions. Findings show how powerful policy discourses shaped by historical and social forces influence the type of research undertaken, by whom and how. For instance, recent policy has been shaped by discourse associated with the knowledge-based economy that emphasises microscopic 'discovery', exploitation of information and the contribution of highly technological activities to 'UK plc' and has re-positioned primary care research as a strategic resource and 'population laboratory' for clinical research. Such insights challenge apolitical accounts of health research and reveal how health research serves particular interests. © 2008 Elsevier Ltd. All rights reserved.
General practices as emergent research organizations: A qualitative study into organizational development
Background. An increasing proportion of research in primary care is locally undertaken in designated research practices. Capacity building to support high quality research at these grass roots is urgently needed and is a government priority. There is little previously published research on the process by which GP practices develop as research organizations or on their specific support needs at organizational level. Methods. Using in-depth qualitative interviews with 28 key informants in 11 research practices across the UK, we explored their historical accounts of the development of research activity. We analysed the data with reference to contemporary theories of organizational development. Results. Participants identified a number of key events and processes, which allowed us to produce a five-phase model of practice development in relation to research activity (creative energy, concrete planning, transformation/differentiation, consolidation and collaboration). Movement between these phases was not linear or continuous, but showed emergent and adaptive properties in which specific triggers and set-backs were often critical. Conclusion. This developmental model challenges previous categorical taxonomies of research practices. It forms a theory-driven framework for providing appropriate support at the grass roots of primary care research, based on the practice's phase of development and the nature of external triggers and potential setbacks. Our findings have important implications for the strategic development of practice-based research in the UK, and could serve as a model for the wider international community. © The Author (2005). Published by Oxford University Press. All rights reserved.
Why study narrative?
One day when Pooh Bear had nothing else to do, he thought he would do something, so he went round to Piglet's house to see what Piglet was doing. It was snowing as he stumped over the white forest track, and he expected to find Piglet warming his toes in front of the fire, but to his surprise he saw that the door was open, and the more he looked inside the more Piglet wasn't there.1.
Narrative based medicine. An action research project to develop group education and support for bilingual health advocates and elderly South Asian patients with diabetes
The objective of this study was to develop bilingual health advocate (BHA)-led group education and support groups for South Asian patients with diabetes, based on a storytelling format. The design and setting were action research in a deprived inner London district. The research team worked developmentally with BHAs, service users and other stakeholders to assess need, train staff, and set up and evaluate the storytelling groups. Stories were chosen as the main vehicle for education because of their universal appeal, memorability, holistic perspective, ethical dimensions, and potential for multiple interpretations. Key challenges in the project were: high burden of need; multiple stakeholders; a shifting baseline of policy directives; frequent staff changes; resource constraints; and resistance of top and middle management to new service models. These difficulties made progress slow, and several early initiatives failed to take root. However, we succeeded in developing a nationally accredited training programme ('Storytelling for group work in health and care') for BHAs, and in supporting the graduates from this course to set up two groups for South Asian patients with diabetes - one in a hospital and one in a community centre. The patient storytelling groups, once established, were popular and well evaluated. Blood glucose levels in regular attenders fell, but changes did not reach statistical significance. An action research approach allowed us successfully to develop an innovative training programme for BHAs and support them in developing and mainstreaming new service models. BHA-led diabetes storytelling groups, supported by health professionals, are feasible and popular with non-English speaking Asian patients. Their impact on diabetes outcomes should now be formally evaluated in clinical trials. Copyright © 2005 John Wiley & Sons, Ltd.
Big is beautiful? A survey of body image perception and its relation to health in British Bangladeshis with diabetes
It is widely believed that some ethnic minorities consider large body size to be attractive and indicative of health and fertility. We surveyed 96 Bangladeshis with diabetes, randomly sampled from GP diabetes registers in London. Participants were interviewed in their mother tongue by a Bangladeshi anthropologist, and asked to select which of nine standard body forms (from 1 = very thin to 9 = very fat) matched each of 57 statements including "[the figure with the] best health", "most beautiful", "most fertile", and so on. We discerned an important linguistic distinction between "most health" and "best health". Over 80% of participants linked "most health" with the fattest figure and "least health" with the thinnest. In contrast, "best health", "most beautiful", "most fertile" and "least likely to get diabetes" were linked with a medium-sized figure, and "worst health" with extremes of body size. Participants accurately estimated their own body size, and women (but not men) felt they were significantly larger than they would like to be. Participants believed they had got thinner by (on average) 0.6 figure sizes since the onset of diabetes and would continue to do so. This perception was significantly greater in those with fewer years of formal education. Our findings suggest that Bangladeshis with diabetes see obesity as unattractive, unhealthy, associated with low fertility, and linked to diabetes and heart disease. However, they believe that they have lost weight since developing diabetes and that their weight loss will continue. These findings have implications for the design of health education programmes, which should move beyond the erroneous stereotype that "Asians like to be fat". © 2005 Taylor & Francis Group Ltd.
The 57 mm thermal clearance probe: A non-invasive tool for measuring subcutaneous blod flow
The segmented thermal clearance probe is a non-invasive instrument which measures heat thermal clearance, a variable directly proportional to superficial blood flow, with a depth sensitivity theoretically proportional to the sensor diameter. We compared an 18 mm sensor and a recently developed 57 mm sensor with the reference technique of xenon washout. The theoretical depth sensitivity of the sensors was assessed using Perspex spacers. Ninety-five per cent of sensitivity had been lost at the respective depths of 3.5 mm and 7.1 mm for the 18 mm and 57 mm sensors. A comparison was made between heat thermal clearance reading and 133Xe decay curves using the two probes for 15 min after injectioon of 133Xe at 2 mm and 6 mm depths in the anterior thigh in 41 subjects. The 57 mm sensor showed similar correlation with xenon washout at 2 mm injection depth (r = 0.89) and 6 mm injection depth (r = 0.86), whereas the 18 mm sensor showed greater correlaton at 2 mm (r = 0.92) than at 6 mm (r = 0.62). The 57 mm sensor was compared with xenon washout at 6 mm in eight insulin-treated diabetic subjects. The relationship was similar to that in non-diabetic subjects (r = 0.79), with no significant difference in slope or intercept. It is concluded that the 57 mm thermal clearance probe may be used to study blood flow at the depth of insulin injection (6 mm) in diabetic and non-diabetic subjects.
Commercial partnerships in chronic disease management: Proceeding with caution
Commercial companies, especially the manufacturers of drugs and medicines, increasingly seek to work in collaboration with NHS service providers to manage particular diseases or problems. With such relations there are risks, but also potential benefits, and it may be more realistic to require all parties to be explicit about their potential conflicts of interest than to impose a blanket ban on negotiations. One London health authority developed and used a set of standards for collaborating with the commercial sector in 'managed care' initiatives. The draft proposals could be used with a view to developing definitive guidance for health authorities, primary care groups, and trusts when considering such collaborative relations.
Seeing what you want to see in randomised controlled trials: Versions and perversions of UKPDS data
Randomised trials are subject to interpretation bias as shown by the example of the UK prospective diabetes study. The UK prospective diabetes study shows no benefit on macrovascular end points in patients with type 2 diabetes treated with sulphonylureas or insulin over 10 years. The study shows a clinically important benefit on macrovascular end points from metformin in patients with type 2 diabetes that seems somewhat independent of the drug's ability to lower blood glucose concentrations. Nevertheless, many authors, journal editors, and the wider scientific community interpreted the study as providing evidence of the benefit of intensive glucose control. Journal editors should be aware of this important potentialbias and encourage authors to present their results initially with, a minimum of discussion so as to invite a range of comments and perspectives from readers.