Symposium ESWRA - ECSWR 2016: empirical ethics in social work. Objective: ethical aspects of social work (esp. at home) Structure: cooperation of the research group of UAS Utrecht Netherlands with six regional welfare organizations Method: practice based ethics research Focus on professional practice: learning from moral experiences in frontline practice (cf. Van Doorn, 2008) Hybrid approach: combining theoretical resources and professional practice (cf. Banks & Gallagher, 2009) Mixed methods: desk research, interviews, best practice units (BPU), development of ethical tools
Aim: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse-coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design: A mixed-methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods: Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi-structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data-analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results: The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in-hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion: Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non-significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact: In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.
How the availability of residential parking facilities affects travel behaviour has received little attention. Some studies show that longer distances between home and the residential parking facility reduce the car’s modal share. However, no insight exists in the question whether a change in residential parking facilities would lead to a change in attitudes and transport mode choice of residents. Therefore, the research question the proposed research aims to answer is: to what extent do travel mode attitudes, travel behaviours (walking, cycling, bus, train, car use) and car ownership of residents change after the removal of parking spaces in residential areas? In 2020, parking spots will be removed in several areas in the city centre of Utrecht. Residents of these areas will have to park their car further away from home after the removal. We apply a mixed-methods design in order to: 1) gain insight in impacts of the removal of residential parking spots (effect evaluation), and 2) gain insight in the underlying mechanisms that may explain these changes (qualitative interviews). The results of our project are highly relevant for the municipality of Utrecht, as for other cities in the Netherlands. Having parking spaces nearby (home and/or destination) is often seen as having positive effects (for economic competitiveness). Our research can show that parking further away can also have important positive effects, namely all the beneficial effects of a modal shift from car to walking, cycling or public transport use, in terms of health, environment, use of space, and social aspects.
