Suchergebnisse

This is the final version. Available on open access from BMC via the DOI in this record ; Availability of data and materials: This paper uses data from Understanding Society, a UK Household Longitudinal Study. Understanding Society is an initiative funded by the Economic and Social Research Council and various Government Departments, with scientific leadership by the Institute for Social and Economic Research, University of Essex, and survey delivery by NatCen Social Research and Kantar Public. The research data are publicly available and distributed by the UK Data Service, http://doi.org/10.5255/UKDA-SN-6614-14. ; Background Loneliness and unemployment are each detrimental to health and well-being. Recent evidence suggests a potential bidirectional relationship between loneliness and unemployment in working age individuals. As most existing research focuses on the outcomes of unemployment, this paper seeks to understand the impact of loneliness on unemployment, potential interaction with physical health, and assess bidirectionality in the working age population. Methods This study utilised data from waves 9 (2017–19) and 10 (2018–2020) of the Understanding Society UK Household Longitudinal Study. Nearest-neighbour probit propensity score matching with at least one match was used to infer causality by mimicking randomisation. Analysis was conducted in three steps: propensity score estimation; matching; and stratification. Propensity scores were estimated controlling for age, gender, ethnicity, education, marital status, household composition, number of own children in household and region. Findings were confirmed in panel data random effect models, and heterogeneous treatment effects assessed by the matching-smoothing method. Results Experience of loneliness in at least one wave increased the probability of being unemployed in wave 10 by 17.5 [95%CI: 14.8, 20.2] percentage points. Subgroup analysis revealed a greater effect from sustained than transitory loneliness. Further exploratory analysis identified a positive average treatment effect, of smaller magnitude, for unemployment on loneliness suggesting bidirectionality in the relationship. The impact of loneliness on unemployment was further exacerbated by interaction with physical health. Conclusions This is the first study to directly consider the potentially bidirectional relationship between loneliness and unemployment through analysis of longitudinal data from a representative sample of the working age population. Findings reinforce the need for greater recognition of wider societal impacts of loneliness. Given the persisting and potentially scarring effects of both loneliness and unemployment on health and the economy, prevention of both experiences is key. Decreased loneliness could mitigate unemployment, and employment abate loneliness, which may in turn relate positively to other factors including health and quality of life. Thus, particular attention should be paid to loneliness with additional support from employers and government to improve health and well-being. ; National Institute for Health Research (NIHR)

El Parlamento Europeo ya expuso la necesidad de adoptar medidas de apoyo con el fin de garantizar una mayor pluralidad del sistema de medios y mayor participación de la ciudadanía. Con esta premisa y las recomendaciones de la UNESCO sobre la importancia de los indicadores para medir el correcto comportamiento de los medios audiovisuales, esta investigación evalúa las radios comunitarias usando el Indicador de Rentabilidad Social en Comunicación (IRSCOM). Una herramienta cuyo funcionamiento, ha demostrado su utilidad habiendo incidido en la mejora de los medios de proximidad.El IRSCOM valora las buenas prácticas que realizan estos medios, así como las posibles carencias que presentan con el objetivo de proponer mejoras.

Background Having investigated avoidable deaths and other occurrences of harm to patients at Mid-Staffordshire Hospital, the Francis Inquiry made 290 recommendations for actions to reduce the likelihood of such events recurring. A prominent part of the government's response was to ask Don Berwick to chair a National Patient Safety Advisory Group to advise the government on a 'whole-system' Patient Safety Improvement Programme. The Group proposed establishing Patient Safety Collaboratives (PSC), drawing upon the experience of Quality Improvement Collaboratives, particularly the Institute of Healthcare Improvement (IHI) 'Breakthrough Series' From 2014, Collaboratives in the NHS were implemented through the regional Academic Health Science Networks (AHSN). Most research about the effects of Collaboratives has been uncontrolled and fragmented across a range of activities and target outcomes, often self-reported. Few studies report clearly how Collaboratives carried their work out, making it hard to identify what the 'active ingredient' is. Few contained evidence about the determinants of 'success' (as opposed to abundant hypotheses and conjectures). Neither is it known what kinds of clinical work (e.g. for which care groups) may be more amenable than others to improvement by PSC methods, although Collaboratives based hospitals have been most widely reported. We evaluated how this action taken in response to the Francis Inquiry was implemented and some of the consequences, and used our findings as the evidence base to present some some policy implications and further research proposals. Research Questions (RQ) This study addressed six research questions: RQ1: How has PSC implementation varied across the 15 Academic Health Science Network (AHSN) regions? RQ2: What organisational changes have providers made? How have they done this and what have they learned from the PSCs? RQ3: How were resources used for PSCs' implementation activities? What are the costs of participation and implementation? RQ4: Have the PSCs made a detectable difference on rates of harm and adverse events involving patients as measured using routine data? RQ5: Has change in practice taken place on the front-line of services? RQ6: What generalisable knowledge can be shared about this? Methods We made a mixed methods observational comparison of PSC mechanisms, contexts and outcomes. We combined three methods each of which broadly corresponded to one stage of PSC implementation: 1. An Implementation study of how PSCs were set up, of AHSN roles in establishing and maintaining regional networks, and of how provider-level NHS managers and clinicians used PSC-initiated ideas and resources to influence clinical practice, monitor and improve clinical quality and safety. Our study looked at all 15 PSCs, studied three of them in greater detail, and within them selected different types of provider for in-depth study. 2. Patient safety culture surveys. The Francis and Berwick reports emphasised strengthening safety culture as a method for making clinical practice safer. Using the Safety, Communication, Operational Reliability and Engagement (SCORE) survey, we measured changes in patient safety 'culture' in six clinical teams undertaking PSC-initiated activities. We also analysed NHS Staff Survey data. 3. Analysis of routine administrative data. To assess how much patient safety and outcomes had changed we quantitatively analysed routinely collected administrative data relevant to PSCs' intended outcomes. Our data sources were 61 semi structured in-depth interviews of key informants: SCORE survey data from 72 sites (first round) and from the six of these sites which had also made a second-round (repeat) survey during the study period: and England-wide data on in-patient satisfaction, quality improvement, managerial support for staff, fairness and effectiveness of procedures for reporting errors, recommendation of one's own work-place, incident reporting and hospital mortality. Findings How PSC implementation varied across the 15 AHSNs (RQ1) Each AHSN applied elements of three strategies for improving patient quality and safety at provider level: • A facilitative strategy, which built where possible on existing QI and safety work in healthcare providers, but was constrained by the local history and resources – or lack of them – in these areas of work. A facilitative strategy made it harder to attribute any changes in working practices and outcomes unequivocally to PSC activities. • An educative strategy of educating, training and developing individual 'change agents' to implement changed working practices to improve patient safety at clinic level. • A national priority focussed strategy of adopting 'work-streams' from among the current national priorities, resulting in several PSCs developing similar work-streams (e.g. sepsis prevention). There were tensions between the facilitative approach and the national priority focus, which some informants thought was closer to a performance management approach. In general, PSCs and NHS staff favoured shifting from a 'blame' culture to learning culture focused on service development as more conducive to activities to improve patient safety. Where SCORE surveys were used (which was increasingly, but from a small base), they were implemented the same way everywhere. PSCs differed in terms of which elements and mechanisms of collaboratives they emphasised. Partly because the Francis report was a response to problems in hospital services, and because Collaboratives originated in (US) hospitals, participation was proportionately greater among acute hospitals than elsewhere, which partly reflected the technical challenges of making the Collaborative model relevant to non-hospital services. General practices apart, the only non-NHS providers participating were some care homes and pharmacies. Organisational changes that providers made and what they have learned from the PSCs (RQ2) Not all provider organisations participated in the PSCs. The willingness of NHS senior managers to engage with PSCs varied across setting. When they were willing, organisational upheaval including leadership changes made trusts' engagement harder to sustain. In providers that did participate, the main organisational factors reported to aid PSC implementation were: • Initial expenditure for start-up training and preparing management information systems to serve (also) as a measurement system for clinical teams' QI work • Recruiting trained QI and safety experts or 'champions' at all organisational levels, most critically at Board and clinical team levels; this was often done with PSC support and encouragement. • Ensuring that these champions had the leadership skills to motivate and empower clinical teams and to create safe spaces for staff to speak up or suggest changes. • Building structures and processes, at both whole-organisation and at clinical team levels, to sustain the changed working practices. • Allocating staff time not only to engage in QI and learning events, but so that they can subsequently utilise their learning at work. • 'Bottom-up' approaches to safety improvement promoted provider-level engagement and motivation by adapting the activities that PSCs were promoting to local needs. • Measurement support for front-line staff At the time of this study, the development and use of formal measurement systems to support QI activities had not yet materialised. The other change we had expected but did not observe was in safety climate, particularly at clinical team level. Although PSC activity, including the SCORE surveys, had impacts upon clinical teams' working practices in the sites we studied (see below) these changes occurred without measurable changes in workplace safety climate. In summary, we found: 1. Some qualitative evidence of safety climate change in the intended direction, including increased staff engagement and shifts away from a blame culture towards a more 'open learning culture'. 2. No significant change safety climate in six study sites by early 2018 on most of the SCORE survey domains. 3. Change in the intended direction in the relevant NHS staff survey data domains, but evidence that this change began before PSCs existed. To suggest that any safety culture changes in particular clinical teams are diluted within much larger NHS Digital data-sets might be valid for the NHS Staff Survey but is not applicable for the SCORE survey results, which were precisely localised to the relevant clinical teams. A possible explanation is that safety climate changes are as much a consequence as a cause of changes in working practices, in a virtuous circle of mutual reinforcement. Organisational changes do not occur straight away; sufficient time is required to implement a complex set of activities across all levels of the NHS: 1. At least 18 months for PSCs and then providers to establish themselves and start to change working practices. In practice this can take a lot longer before any impact is seen at the patient level. 2. Allowing individual staff members time at work to attend learning events and then put what they learnt into practice. 3. Continuing the PSCs long enough to engage 'late adopters' besides 'early adopters'. 4. Time for plan-do-study-act (PDSA) cycles and other QI activities be repeated and become institutionalised on an open-ended time-scale. Other major constraints surrounding the activities of PSCs we found were NHS providers' concurrent operational pressures and the concomitant resource and financial constraints, staff shortages and turnover. At an individual level the barriers included difficulties utilising expertise post training due to factors including a performance culture (i.e. conflicting priorities in the work-place), lack of time, high staff turnover (including shift rotations and moves between work locations), and psychological resistance to change. Costs of participation in and implementation of PSCs (RQ3) One of our study PSCs provided broad information how spending on PSCs had been allocated at AHSN level (to which programmes, and to broad categories such as support staff, training etc.). At the time of our fieldwork detailed information to account for; the training and network activity the PSCs provided, monetary flows from PSCs to providers, as well as indirect opportunity costs the provider organisations incurred was not completely available. The same applied to information about how these extra resources impacted on health benefits for the patients due to changes in working practices noted below, making it unfeasible to evaluate the cost effectiveness of the PSC programme. Have the PSCs made a detectable difference to rates of harm and adverse events involving patients as measured using routine data? (RQ4) We analysed routine administrative data about relevant safety outcomes and found that: 1. Qualitative evidence of changed working practices which one would expect (given their supporting evidence) to improve patient safety and service quality. 2. Quantitative analysis of administrative data showed no significant change by early 2018 that could plausibly be attributed to PSCs alone. 3. Longer-term changes in the intended direction were occurring. In our judgement the reasons for these paradoxical patterns are: 1. Dilution of any effects of PSCs upon service outcomes because the available datasets combine data about activities in which PSCs were involved with data about much larger activities in which PSCs were not yet involved,such as trust-level data. 2. PSCs' effects were constrained by countervailing factors: demand overloads, insufficient staffing relative to demand, staff turnover and financial constraints. 3. Time lags: when our fieldwork finished PSCs were about half-way through their initially-planned life-span and had spent much of it getting their activities started. This meant the period for which routine data could have captured any relevant effects was a year or less. We infer that PSC activity had many of its intended effects but they were too localised and diluted to be measurable in the larger-scale routinely-reported administrative datasets. Change in practice on the front-line of services (RQ5) In our case study sites we found evidence of changes in practice at front-line, clinical team level. In practice the participating clinical teams had become more multidisciplinary. They had also started to undertake what in effect was the Model for Improvement: collecting information about their working practices, changing the latter, reviewing the effects, then making further adjustments: the quality improvement cycle. The SCORE survey, and its practical impacts, can be understood as a special case of such activity, and one with a relatively quick impact upon working practices. SCORE surveys developed beyond measurement activity into a practical intervention on the part of PSCs. Changes in working practices were both clinical (e.g. falls reduction) and organisational (e.g. pathway re-design) and were reported in both hospitals and general practices. Conclusions: Policy and management implications The findings summarised above tend to support some of the policy-makers' original assumptions about how PSCs would work but suggests revisions to other policy assumptions that would lead to more effective PSCs and thus safer care for patients:- 1. PSCs have not yet had sufficient time to establish and sustain the clinical team-level safety improvement activities and outcomes that current policy intends. Our evidence suggests three years from the outset is in practice too short a time for that. In our opinion (albeit an opinion consistent with our findings so far) PSCs should continue in their current form for longer before any judgement can be meaningfully made about their impact on patients. 2. The PSCs are complex adaptive systems, reacting and responding to different local situations in varied ways. Attempts to manage PSCs uniformly and force them into particular directions (including work streams) are likely to hamper their ability to promote the locally-originating work that will ultimately lead to better patient care. In our opinion NHSI should study the emergent systems, support positive behaviours and resist the temptation to apply a 'one size fits all' managerial approach. 3. NHSI and the Department of Health need to provide clear and supportive timelines and financial arrangements for the PSCs. One disruptive aspect of the implementation of the PSCs was the lack of clear direction from the central NHS bodies, partly due to the perceived chaos surrounding the change from NHSE to NHSI, and to the financial uncertainly that PSC leads felt. At the time of writing there are suggestions that NHSI should review the PSCs. In our opinion it is too soon for that and it will again create an impeding uncertainty. 4. Recognition of the influence of the wider evidence-based medicine (EBM) movement and institutions (e.g. NICE) in promoting safety culture, something PSCs' activity reinforced and exploited. However development of EBM is uneven (for example, it is better developed in general medicine than mental health). Start-up support for Collaboratives may be especially important in domains where EBM remains less developed and embedded. 5. Culture change is too big for PSCs alone to achieve without a massive increase in their scale. Learning by clinical teams is a discrete step linking culture change to changed working practices and this has implications for the kind of training required. The necessary kernels for this training are quality improvement methodologies and the psychology of change ('human factors'). As PSCs have shown, clinical teams are the critical audience for this training. 6. If providers are to become 'learning organisations' for PSC purposes the requirements include: a 'bottom-up' approach to safety management; that provider managers allow clinical teams discretion to adapt QI activities to their local needs; that clinical teams are allowed to take ownership of a given project or changes in work processes, something our evidence suggests also promotes staff engagement and motivation. This is a different approach from the work-stream specific collaboratives; mandating clinical teams to work on areas they have not chosen will probably not have as effective outcomes for patient care. 7. NHSI is now addressing the absence of cross-provider measurement systems for PSC purposes (for clinical teams across different providers to compare activities and learn from each other). Caution will be needed in how these cross-provider data are used. The focus has to be on data for improvement; if the data are used for performance management (or even perceived as such) the benefits of the collaborative approach will diminish.

El objetivo de esta investigación es analizar la efectividad de la gamificación para fidelizar muestras participantes en estudios de audiencias. El trabajo se centra en la gamificación de la herramienta AEDO, aplicación móvil para estudios de audiencias que permite análisis cuantitativos y cualitativos sobre consumos, usos y gratificaciones mediáticas. El artículo describe sus características conceptuales y funcionales; su rendimiento en la fidelización de la muestra y su aportación en la implantación de valores ecosistémicos, temática de la herramienta. La gamificación de AEDO se diseñó mediante revisión bibliográfica y está inspirada en distintos formatos lúdico-educomunicativos. El estudio de audiencias se implementó entre octubre y diciembre de 2022. Durante este proceso se contó con observación participante de personas expertas en comunicación y análisis prospectivo a través de encuestas. Una vez finalizado el estudio, se aplicó un cuestionario a la muestra para conocer sus percepciones. Los resultados determinan que la estrategia de gamificación es un elemento atractivo de cara a la fidelización de la muestra participante en el estudio de audiencias. También quedó demostrada su utilidad como herramienta de aprendizaje y concienciación sobre asuntos relacionados con la transición ecosocial, especialmente aquellos enfocados a la incorporación de prácticas respetuosas con el medio ambiente.

Este capítulo analiza la campaña "Medio Ambiente" emitida por el canal infantil Clan, de la televisión pública española (RTVE) durante el mes de junio de 2021. Se realiza un análisis del discurso de los diez vídeos desde la perspectiva de la transición ecosocial (Chaparro, Espinar, El-Mohammadiane y Peralta, 2020). El estudio señala tanto los aciertos que favorecen la transmisión de imaginarios ecosociales como los desaciertos que la limitan. Los resultados denotan un interés de la cadena por transmitir mensajes ecológicos en aspectos como el respeto y protección de los animales, cuidado de bosques y prevención de incendios, uso excesivo de toallitas, basura en la naturaleza, ahorro de agua y energía, alimentación de proximidad y temporada, así como contaminación de mares y océanos. No obstante, se observan carencias en el tono de los mensajes que podrían plantearse de una manera más imperativa y centrarse en la reducción de residuos y no tanto del lugar donde se depositan. Por ejemplo, en la campaña de toallitas higiénicas, en vez de recomendar la "disminución de su uso", recomendar "no usarlas". Es posible que estas deficiencias deriven de la limitación en el formato narrativo; spots de menos de un minuto, sin conexión clara entre sí, que hacen casi imposible abordar un fenómeno tan complejo y multicausal como es la crisis medioambiental en un lenguaje adaptado al público más joven. Por tanto, se recomienda que este tipo de iniciativas hagan parte de una estrategia de alfabetización medioambiental global y transversal al medio, como parte de su programación permanente, con contenidos que permitan el aprendizaje exhaustivo del mundo natural, los peligros que afronta, sus causantes y las posibles soluciones, incluyendo hábitos de consumo para promover actitudes proambientales. ; Investigación enmarcada en el Proyecto "Estudio de cumplimiento legislativo y rentabilidad social de las cadenas de radio y televisión públicas y privadas generalistas con cobertura estatal para determinar el indicador IRSCOM", ...

Introducción. Las transiciones ecosociales, es decir aquellas que plantean modelos relacionales y de consumo circulares, solidarios, ecológicos, equitativos, feministas y en armonía con la naturaleza, entre otros atributos, son un sector en auge. Objetivos. Este estudio propone, desde la perspectiva del ecofeminismo, medir el funcionamiento interno de 55 proyectos de transición eco-social en la provincia de Castilla-La Mancha. Metodología. Para ello se realizó un censo con un total de 156 iniciativas, una muestra representativa del sector, del que recibimos respuesta por parte de 55, el equivalente a un 35,2% de la muestra. Como eje central metodológico se aplicó el Indicador de Transición Ecosocial (ITE), un valor de referencia elaborado a través de la cumplimentación de un cuestionario con preguntas cerradas que nos permite establecer rankings a través de ponderaciones validadas en las respuestas. La metodología se complementa con entrevistas semiestructuradas, de orden cualitativo, a un total de 16 fundadoras, directoras, socias o participantes en proyectos de ecotransición en Castilla-La Mancha. Nuestras preguntas de investigación son las siguientes: ¿existen mecanismos en la entidad que permiten a las mujeres conciliar el trabajo con otras necesidades? ¿La diversidad de géneros está presente en todos los ámbitos de poder o en la toma de decisiones? ¿En el seno de la entidad existe un reparto equitativo de las tareas? ¿En qué términos prácticos se aplica el ecofeminismo?. Resultados. Los resultados son positivos en cuanto a la presencia de mecanismos de conciliación, diversidad de géneros y reparto equitativo de tareas. Sin embargo, el estudio muestra que mientras algunas mujeres mujeres practican la economía basada en los principios ecofeministas con conocimiento de causa, otras muchas no tienen consciencia de estar haciéndolo, por desconocimiento o por errónea aproximación al concepto. Conclusiones y discusión. Es necesario expandir el concepto más allá de los círculos académicos, allá donde se está practicando

Realist evaluation has become widespread partly because of its sensitivity to the influence of contexts on policy implementation. In many such evaluations, the range of contexts considered relevant nevertheless remains disparate and under-conceptualised. This article uses findings from a realist evaluation of English Patient Safety Collaboratives during 2015–2018 to develop a realist taxonomy of contexts, differentiating contexts according to how they affect the corresponding policy mechanism. By analysing the main context-mechanism-outcome configurations that made up the English Patient Safety Collaboratives, we derive a taxonomy of the contexts that affected implementation and outcomes. The categories of context were structural (network, hierarchy, market and organisational contexts); resource-based (actors, material, financial); motivational (receptivity, outcome headroom), and temporal (continuity, history and convergence). To the categories found in previous studies, this study adds the three temporal contexts.

This research analyzes the media literacy initiatives implemented in the Autonomus Community of Andalucía outside the official education system. The research studies the involved actors, the promoters and the content of the Government Order subsidizing the said activities. It also draws conclusions aiming at correcting the different interests that intersect in the initiative of the Andalusian Government, related to the clientelism of private commercial media and the need to provide critical tools to citizens for media consumption and content creation. In essence, this research deals with both promoting consumptionper seand qualifying in critical thinking for decision-making processes and prosumer activity. As a result, criteria to apply indicators that allow the evaluation of the results achieved by the subsidized projects are proposed. ; Esta investigación analiza las iniciativas de alfabetización mediática puestas en marcha en la Comunidad de Andalucía al margen del sistema de enseñanza reglado. Estudia los actores que participan, las entidades promotoras y el contenido de la Orden de Gobierno que subvenciona las actividades. También establece conclusiones para corregir los diferentes intereses que se cruzan en la iniciativa de la Junta de Andalucía, relacionados con el clientelismo de los medios privados comerciales y la necesidad de facilitar herramientas críticas a la ciudadanía para el consumo de medios y la creación de contenidos; en definitiva, entre el fomento del consumo per se y la capacitación en pensamiento crítico para la toma de decisiones y la actividad prosumidora. Como resultado final propone criterios para aplicar indicadores que permitan evaluar los resultados alcanzados por los proyectos subvencionados.