Full publication of results initially presented in abstracts (Review)

Objective: A growing proportion of older people live in care homes and are at high risk of preventable harm. This study describes a participatory qualitative evaluation of a complex safety improvement intervention, comprising training, performance measurement and culture-change elements, on the safety of care provided for residents. Design: A participatory qualitative study. Setting: Ninety care homes in one geographical locality in southern England. Participants: A purposeful sample of care home managers, front-line staff, residents, quality improvement facilitators and trainers, local government and health service commissioners, and an embedded researcher. Main outcome measures: Changes in care home culture and work processes, assessed using documentary analysis, interviews, observations and surveys and analysed using a framework-based thematic approach. Results: Participation in the programme appears to have led to changes in the value that staff place on resident safety and to changes in their working practices, in particular in relation to their desire to proactively manage resident risk and their willingness to use data to examine established practice. The results suggest that there is a high level of commitment among care home staff to address the problem of preventable harm. Mobilisation of this commitment appears to benefit from external facilitation and the introduction of new methods and tools. Conclusions: An evidence-based approach to reducing preventable harm in care homes, comprising an intervention with both technical and social components, can lead to changes in staff priorities and practices which have the potential to improve outcomes for people who live in care homes.

The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding and producing high-quality evidence of what works, how, why and at what cost. We believe that better and policy-relevant evidence will make development more effective and improve people's lives. 3ie evidence gap map reports 3ie evidence gap maps are thematic collections of information about impact evaluations or systematic reviews that measure the effects of international development policies and programmes. The maps present a visual overview of existing and ongoing studies in a sector or sub-sector in terms of the types of programmes (or interventions) evaluated and the outcomes measured. The evidence gap map reports provide all the supporting documentation for the maps themselves, including the background information for the theme of the map, the methods and results, including the protocols, and the analysis of the results. About this evidence gap map reportThis report provides the supporting documentation for the 3ie evidence gap map on adolescent sexual and reproductive health, which was developed as part of a project funded by the William and Flora Hewlett Foundation. All of the content is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors or its Board of Commissioners. Any errors and omissions are also the sole responsibility of the authors. Any comments or queries should be directed to the corresponding author, Kristen Rankin, at krankin@3ieimpact.org. Additionally, 3ie would like to thank the wide range of stakeholders who participated in consultative workshops and a roundtable event. A complete list of participants can be found in the accompanying scoping report (Rankin et al. 2016).ii Summary Adolescence (ages 10-19) is a critical time period in life during which people undergo extensive biological, psychological and social changes. Sexual and reproductive health (SRH) plays an integral role during adolescence and can affect many aspects of a person's life during and after this time. Adolescents face a multitude of risks and challenges related to SRH, including those related to early pregnancy and sexually transmitted infections (STIs) (Fatusi and Hindin 2010;Dick and Ferguson 2015). Programming that addresses this health area has the potential to greatly improve not only adolescents' SRH, but also their overall health and their ability to reach their full potential. This programming can range from clinical interventions such as STI treatment, to health systems strengthening, to community engagement approaches aimed at changing norms around gender, marriage and sexual health.To best invest finite resources in programming aimed at improving adolescent sexual and reproductive health (ASRH), decision-makers need to know what works and what does not, particularly within a low-and middle-income country (L&MIC) context. Impact evaluations -studies using experimental or quasi...

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IntroductionOptimal care of patients who are at risk of acute deterioration requires compassionate and competent communication and shared decision making (Department of Health 2008). ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is a new national process that creates personalised recommendations for a person’s clinical care in a future emergency in which they are unable to make or express choices (ReSPECT Steering Group 2017).The ReSPECT Educational Material Project Operations Group at UCLPartners is creating an innovative web-app to support health and care staff of all disciplines, in all settings, in the ReSPECT process.AimsUnderstand user learning needs and utilise their experience and knowledge to inform the content of the web-app.MethodsWe conducted interviews and focus groups with 31 health and care staff from a range of settings, in the NHS, third and private sectors, including a NHS trust that has implemented ReSPECT. We explored the pedagogy of online learning and the reality of engaging in such conversations.Results• Users need to see representations of themselves to learn from and connect with the material.• Apprenticeship learning models that encourage reflection are the most effective for the difficult conversations.• Length and credibility of information are key factors in engaging with learning materials.• Online learning is often rushed through to get to the evaluation part.ConclusionThese insights are guiding the development of the web-app. We will use iterative-design to test the content and improve usability. The educational impact of the web-app and impact on patient outcomes will be evaluated in future studies.References. Department of Health, 2008.End of Life Care Strategy – promoting high quality care for all adults at the end of life,. ReSPECT Steering Group, 2017. ReSPECT (Recommended Summary Plan for Emergency Care and Treatment). Available at: http://www.respectprocess.org.uk.