Benjamin Marent

Participation by different stakeholders in participatory evaluation of health promotion: A literature review

Participatory evaluation has been increasingly used in health promotion (HP) and various forms of participatory evaluation have been put into practice. Simultaneously, the concept of participation has become more important for evaluation research in general, which is equally diverse and the subject of various discourses. This study addresses the issue of how the concept of participation has been established in HP evaluation practice. An analytical framework was developed, which served as a basis for a literature review, but can also be used as a general framework for analyzing and planning the scope of participation by various stakeholders within different phases of participatory evaluation. Three dimensions of participation, which refer to decision making (decision power, deliberation) and action processes are distinguished. The results show that only a few articles discussed participatory evaluation processes and participatory (evaluation) research was largely put forth by participatory (action) research in communities. The articles analyzed referred mostly to three stakeholder groups - evaluators, program staff and beneficiaries - and to participation processes in the initial evaluation phases. The application of the framework revealed that decision power seems to be held predominantly by program staff, evaluators seem to be more involved in action processes and beneficiaries in deliberation processes.

Conceptualizing lay participation in professional health care organizations

Lay participation in health care decision making lacks an adequate analysis from an organizational perspective. This article aims to develop conceptual devices to analyze policies and practices and the ways in which these could be further developed. By recapping established frameworks and drawing on theories of professional organizations, four participatory roles and their potential to adapt organizational decisions to internal requirements and external challenges are elaborated. While individual patient participation is widely acknowledged, there is still a lack of systematic approaches to the roles of significant others, patient groups, and the broader community and their implementation within health care organizations.

Hospitals as professional organizations: challenges for reorientation towards health promotion

Health promotion, as one tool of hospital managers to reorient hospitals towards more client-oriented healthcare services, has been emphasized for almost three decades. Yet, it is recognized that change in hospitals is challenging and is more desired than substantially enacted. To overcome organizational challenges, health promotion has, so far, adapted organizational change strategies primarily applied in business organizations. However, in this paper, it is argued that such strategies do not adequately reflect the nature of hospitals as ‘professional organizations’. To gain a better understanding of the challenges for health promotion reorientation, this paper combines well-established theories from the sociology of professions and organizational science. These theories provide a useful framework that advances the role of professionals as powerful agents within any reorientation efforts in hospitals. This framework guided the narrative review of empirical literature on critical dimensions along which professionals engage with reorientation efforts in hospitals. Accordingly, specific managerial strategies to facilitate health promotion reorientation are formulated. With its theoretical underpinnings and related empirical studies, the paper offers a new perspective on the challenges of implementing health promotion and proposes strategies that may help hospital managers to push forward health promotion reorientation in their organizations.

The struggle for inter-professional teamwork and collaboration in maternity care: Austrian health professionals' perspectives on the implementation of the Baby-Friendly Hospital Initiative

BackgroundThe health benefits of breastfeeding for mothers and babies are well documented in the scientific literature. Research suggests that support of breastfeeding during pre- and postnatal maternity care is an important determinant of breastfeeding initiation and duration. To support and promote breastfeeding on maternity units, the Baby-Friendly Hospital Initiative (BFHI) was launched in 1991. In Austria, however, less than one fifth of hospitals with a maternity unit are currently BFHI-certified. Implementation of BFHI and adjunct changes in work practices seem to represent a major challenge to maternity units. This article builds upon previous research that has identified a number of facilitators of and barriers to BFHI implementation in Austria. A major barrier has been the lack of intra- and inter-professional collaboration. Therefore, this article investigates the ways in which different healthcare professionals struggle to work together to successfully integrate the BFHI into practice.MethodsIn this study, a qualitative research approach was used. Thirty-six semi-structured interviews with 11 midwives, 11 nurses, 13 physicians, and one quality manager, working across three maternity units, were interviewed on-site. Data analysis followed thematic analysis.ResultsMidwives, nurses, and physicians had diverse approaches to childbirth and breastfeeding (medicalization vs. naturalness) and worked along different jurisdictions that became manifest in strict spatial divisions of maternity units. In their engagement within the BFHI, midwives, nurses, and physicians pursued different strategies (safeguarding vs. circumvention strategies). These differences hindered inter-professional teamwork and collaboration and, therefore, the integration of BFHI into practice.ConclusionsDiffering approaches to childbirth and breastfeeding, deep seated professional jurisdictions, as well as spatial constraints, challenge inter-professional teamwork and collaboration on maternity units. Inter-professional teamwork and collaboration are widely espoused goals of contemporary healthcare improvement strategies. Yet, critical debate on how these goals can be integrated into practice is needed. To enable collaboration and facilitate the implementation of programs such as BFHI, the different perspectives of health professionals should be brought together and the potential for integrating different forms of knowledge and practices should be considered.

Development of an mHealth platform for HIV Care: Gathering User Perspectives Through Co-Design Workshops and Interviews

Background Despite advances in testing and treatment, HIV incidence rates within European countries are at best stable or else increasing. mHealth technology has been advocated to increase quality and cost-effectiveness of health services while dealing with growing patient numbers. However, studies suggested that mHealth apps are rarely adopted and often considered to be of low quality by users. Only a few studies (conducted in the United States) have involved people living with HIV (PLWH) in the design of mHealth. Objective The goal of this study was to facilitate a co-design process among PLWH and clinicians across 5 clinical sites in the European Union to inform the development of an mHealth platform to be integrated into clinical care pathways. We aimed to (1) elicit experiences of living with HIV and of working in HIV care, (2) identify mHealth functionalities that are considered useful for HIV care, and (3) identify potential benefits as well as concerns about mHealth. Methods Between January and June 2016, 14 co-design workshops and 22 semistructured interviews were conducted, involving 97 PLWH and 63 clinicians. Data were analyzed thematically and iteratively, drawing on grounded theory techniques. Results Findings were established into 3 thematic clusters: (1) approaching the mHealth platform, (2) imagining the mHealth platform, and (3) anticipating the mHealth platform’s implications. Co-design participants approached the mHealth platform with pre-existing concerns arising from their experiences of receiving or providing care. PLWH particularly addressed issues of stigma and questioned how mHealth could enable them to manage their HIV. Clinicians problematized the compatibility of mHealth with existing information technology systems and questioned which patients should be targeted by mHealth. Imagining the potential of mHealth for HIV care, co-design participants suggested medical functionalities (accessing test results, managing medicines and appointments, and digital communication channels), social functionalities (peer support network, international travel, etc), and general features (security and privacy, credibility, language, etc). Co-design participants also anticipated potential implications of mHealth for self-management and the provision of care. Conclusions Our approach to co-design enabled us to facilitate early engagement in the mHealth platform, enabling patient and clinician feedback to become embedded in the development process at a preprototype phase. Although the technologies in question were not yet present, understanding how users approach, imagine, and anticipate technology formed an important source of knowledge and proved highly significant within the technology design and development process.

Gesundheitsförderung in der stationären Altenbetreuung

ZusammenfassungHintergrundImplementationsforschung rückt immer stärker in den Fokus der Gesundheitsförderungsforschung. Sie zielt darauf, innovative und wirksame Gesundheitsprogramme der Praxis zugänglich zu machen und deren effektive Umsetzung sicherzustellen. Für das Setting der stationären Altenbetreuung wurden bislang kaum Studien durchgeführt, die aufzeigen, welche Faktoren den Implementationsprozess von Gesundheitsförderungsprogrammen begünstigen oder behindern.MethodeDurch eine qualitative Studie wurde der Implementationsprozess eines Programms zur Mobilitätsförderung für alte Menschen in drei Wiener Pensionisten-Wohnhäusern untersucht. Dabei wurden 12 teilstrukturierte Interviews mit Personen geführt, die bei der Implementation in einer leitenden oder operativen Verantwortung standen.ErgebnisseDie strategische Verankerung des Programms und die damit verbundene starke Wahrnehmung der Führungsrolle der leitenden Mitarbeiter/innen haben sich als förderliche Faktoren erwiesen. Des Weiteren war das Programm anschlussfähig an das Rollenverständnis und die Expertise der für die Umsetzung verantwortlichen Berufsgruppe und bot dieser Möglichkeiten zur beruflichen Weiterentwicklung sowie Spielräume für Autonomie. Hinderlich war ein zeitgleicher organisationaler Umstrukturierungsprozess, im Zuge dessen die Implementation des Programms von allen befragten Personen als zusätzliche Belastung wahrgenommen wurde. Außerdem fehlten Strukturen für Austausch und Kooperationen.SchlussfolgerungNeben der strategischen Verankerung benötigt eine erfolgreiche Implementierung eines Mobilitätsprogramms ein operatives Management, das Koordinationsaufgaben wahrnimmt und notwendige Unterstützungsstrukturen (für Austausch und Kooperation) schafft.AbstractBackgroundImplementation research is an emerging topic in the field of health promotion research. It aims to translate innovative and efficacious health programs into practice and to ensure their effective implementation. In the setting of residential aged care, to date, there has been little research on factors which enable or hinder the implementation of health promotion programs.MethodsIn a qualitative study, the implementation of a physical activity program for the elderly in three Viennese residential care homes were investigated. Twelve semi-structured interviews with persons responsible for program implementation (executives and adopters) were conducted.ResultsThe strategic anchoring of the program and therewith the strong adoption of leadership roles by executive staff proved as facilitating factors. The program was compatible with the role identity and expertise of the occupational group responsible for implementation. Furthermore, it offered opportunities for professional development and autonomy. An obstacle was a simultaneously occurring organizational restructuring process; thus, the implementation of the program was perceived as an additional burden by all person surveyed. Moreover, structures for exchange and cooperation were missing.ConclusionBeside strategic commitment, successful implementation of a mobility program relies on an operative management that adopts coordinating tasks and creates supporting structures (for collaboration and exchange).

Gesundheit und Wohlbefinden im Kontext jugendlicher Lebenswelten@@@Youth perspectives on health and wellbeing: Ergebnisse einer Photovoice-Studie@@@Results from a photovoice study

ZusammenfassungHintergrundIm Rahmen eines Vorarlberger (Österreich) Gesundheitsförderungsprojekts haben Jungendliche Perspektiven auf Gesundheit und Wohlbefinden generiert. Diese Perspektiven wurden nutzbar gemacht, um regionale Gesundheitsangebote zielgruppengerecht weiterzuentwickeln.MethodikPhotovoice wurde als partizipative Forschungsmethode herangezogen. 45 Jugendliche fertigten Fotos zu ihrer Lebenswelt und ihrem Gesundheitsverständnis an und präsentierten und diskutierten diese Fotos untereinander. Die Diskussionen wurden aufgezeichnet und transkribiert und zusammen mit den Fotos anhand der dokumentarischen Methode ausgewertet.ErgebnisseDer Gesundheitsbegriff wird von vielen Jugendlichen eher negativ konnotiert, diese richten ihr Verhalten stärker an ihrem subjektiven Wohlbefinden aus. Hierfür ist es wichtig soziale Kontakte zu pflegen und die Freizeit als Ausgleich zur Schul- und Arbeitswelt zu entwerfen.SchlussfolgerungDurch die Photovoice-Methode konnten Jugendliche ihr Wissen und ihre subjektive Bedürfnislagen zu Gesundheit und Wohlbefinden erschließen und an Entscheidungsträger herantragen. Dabei konnten sie auch selbst neues Wissen und kommunikative Fertigkeiten erlernen.AbstractBackgroundIn the context of a regional (Vorarlberg/Austria) health promotion project, youth have explored their perspectives on health and wellbeing. These perspectives have been used to adapt and develop regional health programs towards the needs of youth target groups.MethodsPhotovoice was used as participatory research method. Forty-five youngsters produced photographs about their life-worlds and their understanding of health. Youngsters have presented and discussed these photographs among themselves. The discussions have been recorded and transcribed and were, together with the photo material, analyzed by means of documentary method.ResultsThe term health has a rather negative connotation for many youngsters. They rather orientate their behavior upon subjective wellbeing. For this purpose they maintain social contacts and arrange their free time as compensation vis-à-vis the school and working time.ConclusionBy means of photovoice youth were enabled to generate knowledge and assess their needs about health and wellbeing. They gain new knowledge and communicative skills and thus were empowered to voice their perspectives face-to-face with decision-makers.

Gesundheit und Wohlbefinden im Kontext jugendlicher LebensweltenYouth perspectives on health and wellbeing

ZusammenfassungHintergrundIm Rahmen eines Vorarlberger (Österreich) Gesundheitsförderungsprojekts haben Jungendliche Perspektiven auf Gesundheit und Wohlbefinden generiert. Diese Perspektiven wurden nutzbar gemacht, um regionale Gesundheitsangebote zielgruppengerecht weiterzuentwickeln.MethodikPhotovoice wurde als partizipative Forschungsmethode herangezogen. 45 Jugendliche fertigten Fotos zu ihrer Lebenswelt und ihrem Gesundheitsverständnis an und präsentierten und diskutierten diese Fotos untereinander. Die Diskussionen wurden aufgezeichnet und transkribiert und zusammen mit den Fotos anhand der dokumentarischen Methode ausgewertet.ErgebnisseDer Gesundheitsbegriff wird von vielen Jugendlichen eher negativ konnotiert, diese richten ihr Verhalten stärker an ihrem subjektiven Wohlbefinden aus. Hierfür ist es wichtig soziale Kontakte zu pflegen und die Freizeit als Ausgleich zur Schul- und Arbeitswelt zu entwerfen.SchlussfolgerungDurch die Photovoice-Methode konnten Jugendliche ihr Wissen und ihre subjektive Bedürfnislagen zu Gesundheit und Wohlbefinden erschließen und an Entscheidungsträger herantragen. Dabei konnten sie auch selbst neues Wissen und kommunikative Fertigkeiten erlernen.AbstractBackgroundIn the context of a regional (Vorarlberg/Austria) health promotion project, youth have explored their perspectives on health and wellbeing. These perspectives have been used to adapt and develop regional health programs towards the needs of youth target groups.MethodsPhotovoice was used as participatory research method. Forty-five youngsters produced photographs about their life-worlds and their understanding of health. Youngsters have presented and discussed these photographs among themselves. The discussions have been recorded and transcribed and were, together with the photo material, analyzed by means of documentary method.ResultsThe term health has a rather negative connotation for many youngsters. They rather orientate their behavior upon subjective wellbeing. For this purpose they maintain social contacts and arrange their free time as compensation vis-à-vis the school and working time.ConclusionBy means of photovoice youth were enabled to generate knowledge and assess their needs about health and wellbeing. They gain new knowledge and communicative skills and thus were empowered to voice their perspectives face-to-face with decision-makers.

Gesundheit und Wohlbefinden im Kontext jugendlicher Lebenswelten

ZusammenfassungHintergrundIm Rahmen eines Vorarlberger (Österreich) Gesundheitsförderungsprojekts haben Jungendliche Perspektiven auf Gesundheit und Wohlbefinden generiert. Diese Perspektiven wurden nutzbar gemacht, um regionale Gesundheitsangebote zielgruppengerecht weiterzuentwickeln.MethodikPhotovoice wurde als partizipative Forschungsmethode herangezogen. 45 Jugendliche fertigten Fotos zu ihrer Lebenswelt und ihrem Gesundheitsverständnis an und präsentierten und diskutierten diese Fotos untereinander. Die Diskussionen wurden aufgezeichnet und transkribiert und zusammen mit den Fotos anhand der dokumentarischen Methode ausgewertet.ErgebnisseDer Gesundheitsbegriff wird von vielen Jugendlichen eher negativ konnotiert, diese richten ihr Verhalten stärker an ihrem subjektiven Wohlbefinden aus. Hierfür ist es wichtig soziale Kontakte zu pflegen und die Freizeit als Ausgleich zur Schul- und Arbeitswelt zu entwerfen.SchlussfolgerungDurch die Photovoice-Methode konnten Jugendliche ihr Wissen und ihre subjektive Bedürfnislagen zu Gesundheit und Wohlbefinden erschließen und an Entscheidungsträger herantragen. Dabei konnten sie auch selbst neues Wissen und kommunikative Fertigkeiten erlernen.AbstractBackgroundIn the context of a regional (Vorarlberg/Austria) health promotion project, youth have explored their perspectives on health and wellbeing. These perspectives have been used to adapt and develop regional health programs towards the needs of youth target groups.MethodsPhotovoice was used as participatory research method. Forty-five youngsters produced photographs about their life-worlds and their understanding of health. Youngsters have presented and discussed these photographs among themselves. The discussions have been recorded and transcribed and were, together with the photo material, analyzed by means of documentary method.ResultsThe term health has a rather negative connotation for many youngsters. They rather orientate their behavior upon subjective wellbeing. For this purpose they maintain social contacts and arrange their free time as compensation vis-à-vis the school and working time.ConclusionBy means of photovoice youth were enabled to generate knowledge and assess their needs about health and wellbeing. They gain new knowledge and communicative skills and thus were empowered to voice their perspectives face-to-face with decision-makers.