Emily K. Jenkins

Sustaining organizational culture change in health systems

PURPOSE The questions addressed by this review are: first, what are the guiding principles underlying efforts to stimulate sustained cultural change; second, what are the mechanisms by which these principles operate; and, finally, what are the contextual factors that influence the likelihood of these principles being effective? The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH The authors conducted a literature review informed by rapid realist review methodology that examined how interventions interact with contexts and mechanisms to influence the sustainability of cultural change. Reference and expert panelists assisted in refining the research questions, systematically searching published and grey literature, and helping to identify interactions between interventions, mechanisms and contexts. FINDINGS Six guiding principles were identified: align vision and action; make incremental changes within a comprehensive transformation strategy; foster distributed leadership; promote staff engagement; create collaborative relationships; and continuously assess and learn from change. These principles interact with contextual elements such as local power distributions, pre-existing values and beliefs and readiness to engage. Mechanisms influencing how these principles sustain cultural change include activation of a shared sense of urgency and fostering flexible levels of engagement. PRACTICAL IMPLICATIONS The principles identified in this review, along with the contexts and mechanisms that influence their effectiveness, are useful domains for policy and practice leaders to explore when grappling with cultural change. These principles are sufficiently broad to allow local flexibilities in adoption and application. ORIGINALITY/VALUE This is the first study to adopt a realist approach for understanding how changes in organizational culture may be sustained. Through doing so, this review highlights the broad principles by which organizational action may be organized within enabling contextual settings.

Approaches to Understanding and Addressing Treatment-Resistant Depression: A Scoping Review

Treatment-resistant depression is associated with significant disability and, due to its high prevalence, results in substantive economic and societal burden at a population level. The objective of this study is to synthesize extant literature on approaches currently being applied to understand and address this condition. It is hoped that the findings can be used to inform practitioners and guide future research. A scoping review of the scientific literature was conducted with findings categorized and charted by underlying research paradigm. Currently, the vast majority of research stems from a biological paradigm (81%). Research on treatment-resistant depression would benefit from a broadened field of study. Given that multiple etiological mechanisms likely contribute to treatment-resistant depression and current efforts at prevention and treatment have substantial room for improvement, an expanded research agenda could more effectively address this significant public health issue.

Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice

The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self‐harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re‐centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re‐evaluating the risk management culture that gives rise to and legitimizes harmful practices.

Strengthening population health interventions: developing the CollaboraKTion Framework for Community-Based Knowledge Translation

BackgroundMuch of the research and theorising in the knowledge translation (KT) field has focused on clinical settings, providing little guidance to those working in community settings. In this study, we build on previous research in community-based KT by detailing the theory driven and empirically-informed CollaboraKTion framework.MethodsA case study design and ethnographic methods were utilised to gain an in-depth understanding of the processes for conducting a community-based KT study as a means to distilling the CollaboraKTion framework. Drawing on extensive field notes describing fieldwork observations and interactions as well as evidence from the participatory research and KT literature, we detail the processes and steps undertaken in this community-based KT study as well as their rationale and the challenges encountered. In an effort to build upon existing knowledge, Kitson and colleagues’ co-KT framework, which provides guidance for conducting KT aimed at addressing population-level health, was applied as a coding structure to inform the current analysis. This approach was selected because it (1) supported the application of an existing community-based KT framework to empirical data and (2) provided an opportunity to contribute to the theory and practice gaps in the community-based KT literature through an inductively derived empirical example.ResultsAnalysis revealed that community-based KT is an iterative process that can be viewed as comprising five overarching processes: (1) contacting and connecting; (2) deepening understandings; (3) adapting and applying the knowledge base; (4) supporting and evaluating continued action; and (5) transitioning and embedding as well as several key elements within each of these processes (e.g. building on existing knowledge, establishing partnerships). These empirically informed theory advancements in KT and participatory research traditions are summarised in the CollaboraKTion framework. We suggest that community-based KT researchers place less emphasis on enhancing uptake of specific interventions and focus on collaboratively identifying and creating changes to the contextual factors that influence health outcomes.ConclusionsThe CollaboraKTion framework can be used to guide the development, implementation and evaluation of contextually relevant, evidence-informed initiatives aimed at improving population health, amid providing a foundation to leverage future research and practice in this emergent KT area.

Weeding out the information: an ethnographic approach to exploring how young people make sense of the evidence on cannabis

BackgroundContradictory evidence on cannabis adds to the climate of confusion regarding the health harms related to use. This is particularly true for young people as they encounter and make sense of opposing information on cannabis. Knowledge translation (KT) is in part focused on ensuring that knowledge users have access to and understand best evidence; yet, little attention has focused on the processes youth use to weigh scientific evidence. There is growing interest in how KT efforts can involve knowledge users in shaping the delivery of youth-focused public health messages. To date, the youth voice has been largely absent from the creation of public health messages on cannabis.MethodsThis ethnographic study describes a knowledge translation project that focused on engaging young people in a review of evidence on cannabis that concluded with the creation of public health messages generated by youth participants. We facilitated two groups with a total of 18 youth participants. Data included transcribed segments of weekly sessions, researcher field notes, participant research logs, and transcribed follow-up interviews. Qualitative, thematic analysis was conducted.ResultsGroup dynamics were influential in terms of how participants made sense of the evidence. The processes by which participants came to understand the current evidence on cannabis are described, followed by the manner in which they engaged with the literature for the purpose of creating an individual public health message to share with the group. At project end, youth created collaborative public health messages based on their understanding of the evidence illustrating their capacity to “weed out” the information. The content of these messages reflect a youth-informed harm reduction approach to cannabis use.ConclusionsThis study demonstrates the feasibility of involving young people in knowledge translation initiatives that target peers. Youth participants demonstrated that they were capable of reading scientific literature and had the capacity to engage in the creation of evidence-informed public health messages on cannabis that resonate with young people. Rather than simply being the target of KT messages, they embraced the opportunity to engage in dialogue focused on cannabis.

Photovoice Ethics: Critical Reflections From Men’s Mental Health Research

As photovoice continues to grow as a method for researching health and illness, there is a need for rigorous discussions about ethical considerations. In this article, we discuss three key ethical issues arising from a recent photovoice study investigating men’s depression and suicide. The first issue, indelible images, details the complexity of consent and copyright when participant-produced photographs are shown at exhibitions and online where they can be copied and disseminated beyond the original scope of the research. The second issue, representation, explores the ethical implications that can arise when participants and others have discordant views about the deceased. The third, vicarious trauma, offers insights into the potenial for triggering mental health issues among researchers and viewers of the participant-produced photographs. Through a discussion of these ethical issues, we offer suggestions to guide the work of health researchers who use, or are considering the use of, photovoice.

Injury, Interiority, and Isolation in Men’s Suicidality

Men’s high suicide rates have been linked to individual risk factors including history of being abused as a child, single marital status, and financial difficulties. While it has also been suggested that the normative influences of hegemonic masculinities are implicated in men’s suicide, the gendered experiences of male suicidality are poorly understood. In the current photovoice study, 20 men who previously had suicidal thoughts, plans, and/or attempts were interviewed as a means to better understanding the connections between masculinities and their experiences of suicidality. The study findings revealed injury, interiority, and isolation as interconnected themes characterizing men’s suicidality. Injury comprised an array of childhood and/or cumulative traumas that fueled men’s ruminating thoughts inhibiting recovery and limiting hopes for improved life quality. In attempting to blunt these traumas, many men described self-injuring through the overuse of alcohol and other drugs. The interiority theme revealed how suicidal thoughts can fuel hopelessness amid summonsing remedies from within. The challenges to self-manage, especially when experiencing muddled thinking and negative thought were evident, and led some participants to summons exterior resources to counter suicidality. Isolation included separateness from others, and was linked to abandonment issues and not having a job and/or partner. Self-isolating also featured as a protection strategy to avoid troubling others and/or reducing exposure to additional noxious stimuli. The study findings suggest multiple intervention points and strategies, the majority of which are premised on promoting men’s social connectedness. The destigmatizing value of photovoice methods is also discussed.

A Guide to Multisite Qualitative Analysis

The aims of multisite qualitative research, originally developed within the case study tradition, are to produce findings that are reflective of context, while also holding broader applicability across settings. Such knowledge is ideal for informing health and social interventions by overcoming the limitations of research developed through methodological approaches that either “strip” context, or that hold relevance for a site-specific group or population. Yet, despite the potential benefits of multisite qualitative research, there is a paucity of analytical guidance to support researchers in achieving these yields. In this article, we present an analytical approach for conducting multisite qualitative analysis (MSQA) across various methodologies to maximize the potential of qualitative research, enhance rigor, and support the development of interventions that are tailored to the populations that they are intended to serve.

Setting the Legal Age for Access to Cannabis in Canada: Bridging Neuroscience, Policy, and Prevention

Setting the Legal Age for Access to Cannabis in Canada: Bridging Neuroscience, Policy, and Prevention

Understanding Adolescent Narratives About “Bullying” Through an Intersectional Lens: Implications for Youth Mental Health Interventions:

This article is based on findings from a qualitative study with 27 adolescents in northern British Columbia, Canada. Our aim was to explore youths’ perspectives on the sources of emotional distress in their lives and how these are connected to peer-based aggression and victimization within their community. Our analysis of narrative findings suggests that youths’ narratives about bullying reflect intersecting and socially embedded configurations of “race,” neocolonialism, and place. We argue that mainstream approaches to addressing bullying as a relationship-based problem must be re-oriented to account for the role of the social or structural contexts of youths’ lives. By applying an intersectional lens, we make the case for a widening of the focus of interventions away from individual victims and perpetrators, toward a contextual approach that addresses how adolescents experience bullying as a site of health and social inequities in their community.