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Theory-driven evaluation
Published in Frances Rapport, Robyn Clay-Williams, Jeffrey Braithwaite, Implementation Science, 2022
Despite its popularity, TDE argues that the top-down approach for disseminating behavioural EBIs has a range of limitations: the conditions for designing and testing EBIs do not resemble real-world operation, EBIs do not address the nuts and bolts of implementation issues of interest to stakeholders, EBIs are ignorant of real-world social environments, and the EBI efficacy does not necessarily imply real-world effectiveness (Chen 2010, Chen and Garbe 2011). Because of these limitations, TDE argues that the top-down approach should be used as a discretionary option rather than as the gold standard for disseminating and implementing behavioural or social EBIs. TDE recognizes the merit of the bottom-up approach (Chen 2010, Chen and Garbe 2011) as illustrated in the right-hand side of Figure 43.2. This approach stresses that when developing and disseminating behavioural or social interventions, the initial evaluation should start with a viability evaluation to assure that a proposed intervention is practical, affordable, suitable, evaluable, and helpful for a community. If the intervention is viable, its subsequent effectiveness evaluation is likely to provide sufficient objective evidence for its merit. If necessary, an efficacy evaluation can rigorously assess causal relationships between the intervention and the outcomes. TDE argues that the bottom-up approach has several merits, including assuring that the intervention is useful to stakeholders and not the least, avoiding wasting money (Chen and Garbe 2011).
Care pathways and the Allied Health Professional
Published in Robert Jones, Fiona Jenkins, Penny Humphris, Jim Easton, Key Tools and Techniques in management and leadership of the Allied Health Professions, 2021
The model has been shown to offer the following benefits: it is a simple approachit reduces risk by starting small—of particular importance when bringing about changes to clinical systems or care processesit can be used to help plan, develop, and implement changeit supports rapid cycles of improvementit can be highly effectiveit supports a ‘bottom up’ approach to change consistent with systems of continuous improvementit can also be used to facilitate large-scale strategic plans. There are many other successful models of service improvement that may be better suited for ICP development.
Specialist ServicesWorking with Children in Care and Residential Schools (a Whole Service/Systems Approach to Emotion-Regulation)
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
A bottom-up approach attends to the emergency, the brain stem/nervous system of the organisation, which in residential environments can become the overall culture of the organisation. This mirrors the order of brain development in new-borns and is essential in trauma work involving a real understanding of emotion-regulation.
Care as a creative practice: comics, dementia and graphic medicine
Published in Journal of Visual Communication in Medicine, 2023
Sathyaraj Venkatesan, Livine Ancy A.
The term graphic medicine is coined by a British medical practitioner and a comics artist Ian Williams in 2007. Graphic medicine, as Czerwiec et al., defines, is the ‘the intersection of the medium of comics and the discourse of healthcare’ (p. 1). The interdisciplinary field takes a bottom-up approach by making patients and their care partners as the authentic representatives of their experiential realities. In doing so, it provides subjective insights into the experiences of person with dementia, thus ‘taking back the experience of somatic dysfunction from medical authority and talking back to medical discourse’ (Couser, 2018, p. 1). In the essay titled Graphic Medicine’s Possible Futures: Reconsidering Poetics and Reading published in Biography Issue, Erin La Cour and Anna Poletti uses graphic medicine as ‘an umbrella term for comics that explore healthcare issues, the theoretical discourse these comics engender, and the study of comics as expressive communicative tools’ (p. 1). Utilising the distinctive affordances of comics medium, graphic medical narratives challenge the dominant methods of scholarship in healthcare through exposing the subjective realities interwoven with biological symptoms of illness. According to Czerwiec et al., ‘Comics have often been associated with cultural change and are ideal for exploring taboo or forbidden areas of illness and healthcare’ (p. 3).
Equitable access to healthcare: identifying barriers for refugee access to healthcare during the COVID-19 pandemic
Published in Journal of Communication in Healthcare, 2023
Refugees with linguistic and cultural barriers face additional hurdles seeking, accessing, and using critical health information both in camp settings and host countries. In the absence of accurate, reliable, and accessible health information, many refugees relied more on informal networks and social media, leaving them vulnerable to COVID-19 vaccine misinformation [4]. Where public healthcare efforts fail to meet the needs of refugee groups, CBOs step in to save lives, counter misinformation, and address concerns around vaccine hesitancy, providing essential knowledge, creating awareness, and properly communicating risk [13]. However, this is unsustainable and burdensome on refugee communities. A comprehensive framework, integrating proactive engagement with refugee CBOs, is urgently needed. This ‘agenda of solutions’ [14] includes prioritizing social determinant of health frameworks to identify health needs, developing more culturally competency amongst providers, and working with and along-side refugee communities, ensuring their voices are heard in the decision-making process and roll-out of plans [14]. However, the burden to launch these initiatives must not fall on refugee communities themselves. A holistic, bottom-up approach is encouraged, shifting power to inform and shape better healthcare and policies. While holding a bottom-up approach, refugee communities can actively and meaningfully participate in decision-making and health promotion [15].
“You’re Part of Us and We’re Happy to Have You Here”: Practices of Social Inclusion for Persons with Dementia
Published in Clinical Gerontologist, 2021
Rossio Motta-Ochoa, Annette Leibing, Paola Bresba, Meghan Williams, Shaindl Shaffer, Omega Julien, Eric Racine, Stefanie Blain-Moraes
Through participant observation, informal and semi-structured interviews, we identified seven social inclusion practices experienced as meaningful by both persons with dementia and staff members at a community-based organization: ensuring time for individualized relationships, building schedules centered around flexibility, empowering decision-making, normalizing dementia-related behaviors, involving family members, soliciting and integrating persons with dementia’s feedback, and supporting persons with dementia to practice social inclusion. The detailed description of these practices contributes to the growing literature about programs and interventions for persons with dementia implemented by community-based organizations. Additionally, the bottom-up approach used to explore in-action practices of social inclusion illustrates how to enact them in specific contexts, complementing the top-down approach of the abundant recommendations for implementing quality dementia care. This bottom-up approach also revealed practices (e.g. supporting persons with dementia to practice social inclusion and care for others) that have a significant potential for empowering persons with dementia to become active care partners. Finally, our study demonstrates that ethnographic methods are valuable and effective tools for incorporating the perspective of persons with dementia to the understanding of in-action practices of social inclusion. An ethnographic detailed description of these practices can potentially facilitate their dissemination to similar community-based organizations.