Esra Alagoz

Successful Organizational Strategies to Sustain Use of A-CHESS: A Mobile Intervention for Individuals With Alcohol Use Disorders.

Background Mobile health (mHealth) services are growing in importance in health care research with the advancement of wireless networks, tablets, and mobile phone technologies. These technologies offer a wide range of applications that cover the spectrum of health care delivery. Although preliminary experiments in mHealth demonstrate promising results, more robust real-world evidence is needed for widespread adoption and sustainment of these technologies. Objective Our aim was to identify the problems/challenges associated with sustained use of an mHealth addiction recovery support app and to determine strategies used by agencies that successfully sustained client use of A-CHESS. Methods Qualitative inquiry assessed staff perceptions about organizational attributes and strategies associated with sustained use of the mobile app, A-CHESS. A total of 73 interviews of clinicians and administrators were conducted. The initial interviews (n=36) occurred at the implementation of A-CHESS. Follow-up interviews (n=37) occurred approximately 12 and 24 months later. A coding scheme was developed and Multiuser NVivo was used to manage and analyze the blinded interview data. Results Successful strategies used by treatment providers to sustain A-CHESS included (1) strong leadership support, (2) use of client feedback reports to follow up on non-engaged clients, (3) identify passionate staff and incorporate A-CHESS discussions in weekly meetings, (4) develop A-CHESS guidelines related to client use, (5) establish internal work groups to engage clients, and (6) establish a financial strategy to sustain A-CHESS use. The study also identified attributes of A-CHESS that enhanced as well as inhibited its sustainability. Conclusions Mobile apps can play an important role in health care delivery. However, providers will need to develop strategies for engaging both staff and patients in ongoing use of the apps. They will also need to rework business processes to accommodate the changes in communication frequency and style, learn to use app data for decision making, and identify financing mechanisms for supporting these changes.

Social argumentation in online synchronous communication

The ability to argue well is a valuable skill for students in both formal and informal learning environments. While many studies have explored the argumentative practices in formal environments and some researchers have developed tools to enhance the argumentative skills, the social argumentation that is occurring in informal spaces has yet to be broadly investigated. The challenges associated with observing and capturing the interactions in authentic settings can be identified as the main reasons for this deficiency. On the other hand, the advancements in information technologies and the way these improvements lift the barriers between school and afterschool settings present ways to eliminate these challenges. To this end, this study utilizes a popular Massively Multiplayer Online Role-Playing Game (MMORPG), World of Warcraft (WoW), which provides an authentic environment, to investigate the quality of argumentation in online synchronous communication without interfering with the substantial characteristics of the interaction. The results of the study demonstrate the quality of argumentation skills that a group of adolescents are displaying in online synchronous WoW chat as well as the patterns that emerge from the interplay between a number of contextual variables including synchronicity, interest, and authenticity.

A Cross Case Analysis of Two Out-of-School Programs Based on Virtual Worlds

There is renewed interest in out-of-school programs for informal learning as a way to complement or supplement formal classrooms. Compelling evidence of learning in the context of virtual worlds is emerging, but few empirically detailed comparisons of programs based on such technologies exist. This article presents a crosscase analysis conducted on two out-of-school programs based on virtual environments involving Global Kid’s “I Dig Science” situated in the virtual platform Teen Second Life and Games, Learning & Society Program’s “Casual Learning Lab” based on the massively multiplayer online game World of Warcraft. Ethnographic methods were used for data collection across both in-game and face-to-face contexts at both sites with virtual and face-to-face data collection techniques used in combination. Analysis involved a code set of eleven a priori themes based on the shared goals of each program, resulting in 44 codes total. In this paper, the authors detail contrasts between the two programs in terms of argumentation, problem-solving, information literacy, and workplace skills, highlighting differences between the two programs in terms of their contrasting “locus of intentionality” (designer versus participant) and concluding with a set of “petite generalizations” in the form of design heuristics for future virtual worlds based programs. DOI: 10.4018/jgcms.2012010102 26 International Journal of Gaming and Computer-Mediated Simulations, 4(1), 25-54, January-March 2012 Copyright

The use of external change agents to promote quality improvement and organizational change in healthcare organizations: a systematic review

BackgroundExternal change agents can play an essential role in healthcare organizational change efforts. This systematic review examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare—specifically, in primary care settings.MethodsWe searched PubMed, CINAHL, Cochrane, Web of Science, and Academic Search Premier Databases in July 2016 for randomized trials published (in English) between January 1, 2005 and June 30, 2016 in which external agents were part of multifaceted organizational change strategies. The review was conducted according to PRISMA guidelines. A total of 477 abstracts were identified and screened by 2 authors. Full text articles of 113 studies were reviewed. Twenty-one of these studies were selected for inclusion.ResultsAcademic detailing (AD) is the most prevalently used organizational change strategy employed as part of multi-component implementation strategies. Out of 21 studies, nearly all studies integrate some form of audit and feedback into their interventions. Eleven studies that included practice facilitation into their intervention reported significant effects in one or more primary outcomes.ConclusionsOur results demonstrate that practice facilitation with regular, tailored follow up is a powerful component of a successful organizational change strategy. Academic detailing alone or combined with audit and feedback alone is ineffective without intensive follow up. Provision of educational materials and use of audit and feedback are often integral components of multifaceted implementation strategies. However, we didn’t find examples where those relatively limited strategies were effective as standalone interventions. System-level support through technology (such as automated reminders or alerts) is potentially helpful, but must be carefully tailored to clinic needs.