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Engaging community-dwelling older adults in fall prevention programs

Introduction: Fall rates and fall-related injuries among community-dwelling older adults (≥65 years) are expected to increase rapidly, due to the aging population worldwide. Fall prevention programs (FPPs), consisting of strength and balance exercises, have been proven effective in reducing fall rates among older adults. However, these FPPs have not reached their full potential as most programs are under-enrolled. Therefore, this study aims to identify promising strategies that promote participation in FPPs among community-dwelling older adults. Methods: This is an exploratory qualitative study. Previously, barriers and facilitators for participation in FPPs by older adults had been identified. Next, six strategies had been designed using the Intervention Mapping approach: (1) reframing; (2) informing about benefits; (3) raising awareness of risks; (4) involving social environment; (5) offering tailored intervention; (6) arranging practicalities. Strategies were validated during semi-structured interviews with communitydwelling older adults (n = 12) at risk of falling. Interviews were audio-recorded, transcribed, and analyzed following a qualitative thematic methodology, with a hybrid approach. Results: All strategies were considered important by at least some of the respondents. However, two strategies stood out: (1) reframing ‘aging’ and ‘fall prevention’: respondents preferred to be approached differently, taking a ‘life course’ perspective about falls, and avoiding confronting words; and (2) ‘informing about benefits’ (e.g., ‘living independently for longer’); which was mentioned to improve the understanding of the relevance of participating in FPPs. Other strategies were considered important to take into account too, but opinions varied more strongly. Discussion: This study provides insight into potential strategies to stimulate older adults to participate in FPPs. Results suggest that reframing ‘aging’ and ‘fall prevention’ may facilitate the dialogue about fall prevention, by communicating differently about the topic, for example ‘staying fit and healthy’, while focusing on the benefits of participating in FPPs. Gaining insight into the strategies’ effectiveness and working mechanisms is an area for future research. This could lead to practical recommendations and help professionals to enhance older adults’ participation in FPPs. Currently, the strategies are further developed to be applied and evaluated for effectiveness in multiple field labs in a central Dutch region (Utrecht).

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Engaging community-dwelling older adults in fall prevention programs

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Implementing CDIO in twelve programs simultaneously: Change Management

Since March 2015 the Faculty of Technology, Innovation and Society (TIS) of The Hague University of Applied Sciences (THUAS) is a CDIO member with all its twelve programs: Mechanical Engineering, Engineering Management, Mechatronics, Electrical Engineering, Building Engineering, Civil Engineering, Climate and Management, Industrial Design Engineering, Industrial Design Engineering [Open Innovator], Engineering Physics, Mathematics & Applications, and Process & Food Technology. This paper describes the implementation of CDIO at TIS and discusses methods, opportunities and challenges of such a large endeavor. The CDIO standards have been coupled to the faculty and program policy plans, based on a comparison of CDIO and the Dutch/Flemish compulsory NVAO accreditation standards. The self-evaluation process has exposed differences between the programs, which has lead to grouping them in a fast track (already working with CDIO), a drawing board track (implementing CDIO in a future new curriculum design) and a quality track (using CDIO to improve the quality of the current program). Each track has its own needs and challenges, and thus requires a different approach and will show a different speed of adaptation. Other factors also plea for a more customized implementation process. Challenges discussed are the varying level of understanding of CDIO, combining CDIO with educational blueprints such as 4C/ID or design thinking, technical bachelor of applied sciences programs versus engineering ones and the motivational drivers for change on faculty staff member level. Working in a professional CDIO learning community leads to ownership of CDIO. Despite being a top-down decision, the adoption of CDIO in the twelve programs takes place bottom-up, ensuring continuous education improvement. LinkedIn: https://www.linkedin.com/in/suzannececiliabrink/ https://www.linkedin.com/in/oda-kok-007590b/

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Implementing CDIO in twelve programs simultaneously: Change Management

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Priorities for the effective implementation of osteoarthritis management programs: an OARSI international consensus exercise

ObjectiveThe Joint Effort Initiative was endorsed by Osteoarthritis Research Society International (OARSI) in 2018 as a collaboration between international researchers and clinicians with an interest in the implementation of osteoarthritis management programs (OAMPs). This study aimed to identify and prioritise activities for future work of the Joint Effort Initiative.DesignA survey was emailed to delegates of the 2018 OARSI World Congress attending a pre-conference workshop or with a known interest in OAMPs (n = 115). Delegates were asked about the most important issues regarding OAMP implementation. The top 20 issues were synthesised into 17 action statements, and respondents were invited to participate in a priority ranking exercise to determine the order of importance of the statements.ResultsSurvey respondents (n = 51, 44%) were most commonly female (71%), with an allied health background (57%), affiliated with universities (73%) from Oceania (37%), and Europe/UK (45%). The five highest ranked action statements were:i)Establish guidelines for the implementation of different OAMP models to ensure consistency of delivery and adherence to international best practice.ii)Develop and assess training and education programs for health care professionals (HCPs) delivering OAMPs.iii)Develop and evaluate the implementation and outcomes of novel models of OAMPs.iv)Develop and assess core skill sets and resources for HCPs delivering OA care.v)Develop a framework for enhancing the quality of care provided by OAMPs.ConclusionPrioritising statements will bring focus to the future work of the Joint Effort Initiative in the future and provide a basis for longer-term actions.

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Evaluating Osteoarthritis Management Programs

ObjectiveTo develop sets of core and optional recommended domains for describing and evaluating Osteoarthritis Management Programs (OAMPs), with a focus on hip and knee Osteoarthritis (OA).DesignWe conducted a 3-round modified Delphi survey involving an international group of researchers, health professionals, health administrators and people with OA. In Round 1, participants ranked the importance of 75 outcome and descriptive domains in five categories: patient impacts, implementation outcomes, and characteristics of the OAMP and its participants and clinicians. Domains ranked as “important” or “essential” by ≥80% of participants were retained, and participants could suggest additional domains. In Round 2, participants rated their level of agreement that each domain was essential for evaluating OAMPs: 0 = strongly disagree to 10 = strongly agree. A domain was retained if ≥80% rated it ≥6. In Round 3, participants rated remaining domains using same scale as in Round 2; a domain was recommended as “core” if ≥80% of participants rated it ≥9 and as “optional” if ≥80% rated it ≥7.ResultsA total of 178 individuals from 26 countries participated; 85 completed all survey rounds. Only one domain, “ability to participate in daily activities”, met criteria for a core domain; 25 domains met criteria for an optional recommendation: 8 Patient Impacts, 5 Implementation Outcomes, 5 Participant Characteristics, 3 OAMP Characteristics and 4 Clinician Characteristics.ConclusionThe ability of patients with OA to participate in daily activities should be evaluated in all OAMPs. Teams evaluating OAMPs should consider including domains from the optional recommended set, with representation from all five categories and based on stakeholder priorities in their local context.

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Self-management among community-dwelling people with chronic conditions

Objective: Self-management is a core theme within chronic care and several evidence-based interventions (EBIs) exist to promote self-management ability. However, these interventions cannot be adapted in a mere copy-paste manner. The current study describes and demonstrates a planned approach in adapting EBI’s in order to promote self-management in community-dwelling people with chronic conditions. Methods: We used Intervention Mapping (IM) to increase the intervention’s fit with a new context. IM helps researchers to take decisions about whether and what to adapt, while maintaining the working ingredients of existing EBI’s. Results: We present a case study in which we used IM to adapt EBI’s to the Flemish primary care context to promote self-management in people with one or more chronic disease. We present the reader with a contextual analysis, intervention aims, and content, sequence and scope of the resulting intervention. Conclusion: IM provides an excellent framework in providing detailed guidance on intervention adaption to a new context, while preserving the essential working ingredients of EBI’s. Practice Implications: The case study is exemplary for public health researchers and practitioners as a planned approach to seek and find EBI’s, and to make adaptations.

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Self-management among community-dwelling people with chronic conditions

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The OARSI Joint Effort Initiative

ObjectiveThe Joint Effort Initiative (JEI) is an international collaboration of clinicians, researchers, and consumer organisations with a shared vision of improving the implementation of osteoarthritis management programs (OAMPs). This study aimed to identify JEI's future priorities and guide direction. DesignA two-part international survey to prioritise topics of importance to our membership and research stakeholders. Survey one presented a list of 40 topics under 5 themes. Consenting participants were asked to choose their top three topics in each theme. A short list of 25 topics was presented in survey two. Participants were asked to rank the importance (100-point NRS scale, 100 = highest priority). Response frequency (median, IQR) was used to rank the top priorities by theme. Results Ninety-five participants completed survey one (61% female, 48% clinicians) and 57 completed survey two. The top ranked topic/s were: i. Promotion and advocacy: support training for health professionals (median 85, IQR 24). ii. Education and training: incorporating behaviour change into OAMPs (80, 16), advanced OA skills (80, 30), and integration of OA education into clinical training (80, 36). iii. Improving OAMPs delivery: regular updates on changes to best-evidence OA care (84, 24). iv. Future research: improve uptake of exercise, physical activity, and weight-loss (89, 16). v. Enhancing relationships, alliances, and shared knowledge: promote research collaborations (81, 30), share challenges and opportunities for OAMP implementation (80, 23). ConclusionsThese topics will set the JEI's research and collaboration agenda for the next 5 years and stimulate ideas for others working in the field.

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Support programs for entrepreneurial refugees in the Netherlands

This report maps different programs that supportrefugees on the road to entrepreneurship. The municipality of The Hague, along with the refugee and migrant support organization EnterStart (MigrantINC) asked for an evaluation of the program The Hague Test Garden (from now on called The Test Garden) where refugees can ask for help starting their own businesses. The evaluation is not just based on the experiences in The Test Garden; other programs have been included in the evaluation to come to a broader view of the road to entrepreneurship and the obstacles encountered. The increased inflow of refugees in Dutch society and on the Dutch labor market has generated different support programs for starting-up a business. Some of these programs already existed but shifted to accommodate the needs of this specific target group. Other programs were initiated to support refugees because of perceived barriers in Dutch society. Most programs are private initiatives, funded on a project basis. In the Netherlands, refugees that hold a residence permit are called ‘status holders’. Upon arrival, they received a temporary permit for at least five years. They need to follow a civic integration and language program and they are expected to be part of the (regular) education system or labor market as soon as possible. The Test Garden started in 2016, a time when multiple support systems for refugee-entrepreneurs began their programs. This report starts with a short overview ofrefugee flows to the Netherlands. The main part of the report consists of the comparison and evaluation of the different programs. The information was gathered through literature, websites, and in-depth interviews with program managers and others involved. Interviews with the participants are only included for The Test Garden (Appendix 1 gives an overview of the meetings and interviews). LinkedIn: https://www.linkedin.com/in/karijn-nijhoff-89589316/

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Support programs for entrepreneurial refugees in the Netherlands

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Raising the Professionalism of Teachers?

In the European policies to increase the quality of teachers, much attention is given to the upgrading of qualifications. However, in European debates on teacher education, e.g. within the context of the Education & Training 2020 program, discussions about the qualification level are mostly restricted to initial teacher education. This raises the question what possibilities there are to raise the qualification level of teachers already working in schools. From this perspective, there is a need to take a closer look at in-service Master’s qualification programs, at existing arrangements and programs, at their focus and their impact on the professionalism of teachers. The paper addresses issues with respect to the conditions for successful in-service Master’s level qualification programs and reflects on content elements that should be part of the curriculum of these programs. In answering the question what content elements should be part of inservice Master’s programs that extend the minimum standards for teachers, the paper focuses on the ‘secondary role’ of teachers that extends beyond the primary process of teaching and learning and connects this to the concept of extended professionalism (Hoyle 1975, Stenhouse 1975). The paper concludes with a frame of reference that can be used to analyse the contribution of in-service Master’s level qualification programs to the professionalism of teachers.

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Raising the Professionalism of Teachers?

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Methods and Concepts for Business Rules Management

The main question in this PhD thesis is: How can Business Rules Management be configured and valued in organizations? A BRM problem space framework is proposed, existing of service systems, as a solution to the BRM problems. In total 94 vendor documents and approximately 32 hours of semi-structured interviews were analyzed. This analysis revealed nine individual service systems, in casu elicitation, design, verification, validation, deployment, execution, monitor, audit, and version. In the second part of this dissertation, BRM is positioned in relation to BPM (Business Process Management) by means of a literature study. An extension study was conducted: a qualitative study on a list of business rules formulated by a consulting organization based on the Committee of Sponsoring Organizations of the Treadway Commission risk framework. (from the summary of the Thesis p. 165)

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