Program theory, that is, the specific idea about how a program causes the intended or observed outcomes, should be the central aspect of any realist evaluation or synthesis. The methods used for explicating or building initial rough program theories (IRPTs) in realist research are varied and arguably often underreported. In addition, preexisting psychological and sociological theories, at a higher level of abstraction, could be used to a greater extent to inform their development. This article illustrates a method for building IRPTs for use in realist research evaluation and synthesis. This illustration involves showing how the IRPTs were developed in a realist evaluation concerning sexual health services for young people. In this evaluation, a broad framework of abstract theories was constructed early in the process to support IRPT building and frame more specific program theories as they were developed. These abstract theories were selected to support theorizing at macro-, meso-, and microlevels of social structure. This article discusses the benefits of using this method to build initial theories for particular types of interventions that are large, complex, and messy. It also addresses challenges relating to the selection of suitable theories.Keywords realist, program theory, sexual health, young people, middle-range theory, adolescents, organizational change, conceptual framework What Is Already Known?Methods for developing initial theories in realist research are varied and underreported. Additionally, existing abstract theories are often used to substantiate rather than inform program theory development. What This Paper Adds?This paper provides an account of program theory development in a realist evaluation of positive comprehensive youth sexual health services. It offers a rationale for early development of a framework of abstract theories to improve coherence, quality, and transparency in realist research and a set of criteria for selecting abstract theories.

This document is the author deposited version. You are advised to consult the publisher's version if you wish to cite from it. Published versionGERRISH, Kate and PIERCY, Hilary (2014). Capacity development for knowledge translation : evaluation of an experiential approach through secondment opportunities. Worldviews on Evidence-Based Nursing, 11 (3), 209-216. Copyright and re-use policySee http://shura.shu.ac.uk/information.html Sheffield Hallam University Research Archivehttp://shura.shu.ac.uk 1 CAPACITY DEVELOPMENT FOR KNOWLEDGE TRANSLATION: EVALUATION OF AN EXPERIENTIAL APPROACH THROUGH SECONDMENT OPPORTUNITIES ABSRACT BackgroundExperiential approaches to skills development using a secondment model have been shown to be beneficial to healthcare organisations more generally, but little is known about the potential of this approach to develop capacity for knowledge translation (KT). AimTo evaluate the success of KT capacity development secondments from the perspective of multiple stakeholders. MethodsA pluralistic evaluation design was used. Data were collected during 2011-12 using focus group and individual interviews with 14 clinical and academic secondees, and five managers from host and seconding organisations to gain insight into parti ipa ts per eptio s of the su ess of se o d e ts and the criteria by which they judged success. Six After Action Reviews were subsequently undertaken with KT proje t tea s to e plore parti ipa ts per eptio s of the o tri utio se o dees made to KT projects. Semi-structured interviews were undertaken with three healthcare managers on completion of projects to explore the impact of secondments on the organisation, staff and patients. Qualitative content analysis was used to identify criteria for success. The criteria provided a framework through which the overall success of secondments could be judged. ResultsSix criteria for judging the success of KT capacity development secondments at individual, team and organisation level were identified: KT skills development, effective workload management, team 2 working, enabling KT objectives to be achieved, enhanced care delivery, enhanced education delivery. Benefits to the individual, the KT team, seconding and host organisations were identified. Implications for practiceHosting teams need to provide mentorship support to secondees, and be flexible to accommodate the needs of secondees as team members. On-going support from managers in seconding organisations is needed to maximise the benefits to the individual secondee and to the organisation. ConclusionsExperiential approaches to KT capacity development using secondments can benefit individual secondees, project teams, seconding and host organisations. secondments have the potential to benefit all parties involved. Secondees benefit from developing expertise in a specific area. The seconding organisation can benefit in that secondees acquire transferable skills that they can apply once they return to their substantive post. These skills can then be communicated across teams/departme...

School nurses need to be pragmatic about the fact that there will be some attempts by the school to regulate sex education. Developing an early dialogue with the school can mediate this. Closer working practices and the involvement of school nurses in the development of sex education policy and practice is vital to ensure that they continue to make a valuable contribution to sex education in schools.

The reproductive and sexual health of adolescents is an important health concern and a focus of global attention. In Sri Lanka, a lack of understanding about adolescent reproductive and sexual health needs is a matter of national concern.A survey was undertaken to examine the sexual knowledge, attitudes and behaviours of school going adolescents in Sri Lanka. A random sample of schools was selected from one district. Data were collected by a self-completion questionnaire and analysed using SPSS. Response rate was 90%. 2020 pupils (26% boys, 74% girls) aged 16-19 years (mean = 16.9) participated, the majority Singhalese (97%).Most reported a good parent-child relationship (88%). A minority (34%) discussed sexual issues with parents. Health professionals were the preferred source of sexual information (32%) rather than parents (12.5%) or friends (5.6%). Less than 1% demonstrated satisfactory sexual and reproductive knowledge levels. 1.7% were sexually active (30 boys vs 5 girls), the majority with same age partners. 57% used contraception at first intercourse.There is an imperative to address the lack of sexual and reproductive knowledge. A minority of school going adolescents become sexually active. These individuals are potentially vulnerable and services need to be developed to meet their needs.

This article aims to consider the current situation with regard to the issue of consent in relation to health-based research on the under-16s. It considers the legal situation with regard to the issues of consent, assent and dissent, and their application to research. Although under-16s can consent to treatment if deemed competent according to the 'Fraser guidelines', application of this principle in relation to research appears to be less clear with variability in published guidance and the approach taken by ethics committees. Recent policy changes including Research Governance have increased the scrutiny of consent to research, and current changes appear likely to increase the requirement for parental consent for those aged below 18 years. The impact of these ambiguities and changes upon young people as service users are considered with particular reference to sexual health, where they often access the service as autonomous individuals.

ObjectivesThis report describes the patients who used additional out-of-hours (OOH) appointments offered through a UK scheme intended to increase patient access to primary care by extending OOH provision.DesignCohort study and survey data.SettingOOH appointments offered in four units in one region in England (October 2015 to November 2016).MethodsUnidentifiable data on all patients were abstracted from a bespoke appointment system and the responses to a patient opinion questionnaire about this service. Descriptive analysis of the appointment data was conducted. Multivariate analysis of the opinion survey data examined the characteristics of the patients who would have gone to the emergency department (ED) had the OOH appointments not been available.ResultsThere were 24 448 appointments for 19 701 different patients resulting in 29 629 service outcomes. Women dominated the uptake and patients from the poorest fifth of the population used nearly 40% of appointments. The patient survey found OOH appointments were extremely popular—93% selecting ‘extremely likely’ or ‘likely’ to recommend the service. Multivariate analysis of patient opinion survey data on whether ED would have been an alternative to the OOH service found that men, young children, people of Asian heritage and the most deprived were more likely to have gone to ED without this service.ConclusionsThe users of the OOH service were substantially different from in-hours service users with a large proportion of children under age 5, and the poor, which support the idea that there may be unmet need as the poor have the least flexible working conditions. These results demonstrate the need for equality impact assessment in planning service improvements associated with policy implementation. It suggests that OOH need to take account of patients expectations about convenience of appointments and how patients use services for urgent care needs.

(2013). The contribution of the HIV specialist nurse to HIV care : a scoping review. Journal of clinical nursing, 22 (23-24), 3349-3360. Copyright and re-use policySee http://shura.shu.ac.uk/information.html Sheffield Hallam University Research Archivehttp://shura.shu.ac.ukThe contribution of the HIV specialist nurse to HIV care: a scoping review ABSTRACT Aims and ObjectivesTo systematically identify and critically examine the evidence on the contribution of the HIV nurse specialist to provision of HIV care in the UK and other developed countries. BackgroundThe HIV clinical nurse specialist role has evolved over the past two decades in response to changes in two areas of HIV care: Firstly changes in the treatment and care of those with HIV and secondly changes and development in advanced nursing practice. The challenges facing HIV care require the development of innovative services including a greater contribution of HIV specialist nurses. A review of current evidence is required to inform developments. Design A scoping review. Methods A broad search strategy was used to search electronic databases. Grey literature was accessed through a variety of approaches. Preference was given to UK literature with inclusion of international publications from other developed countries where relevant. Results 14 articles were included. Four themes were identified: The diversity of the clinical role; a knowledge and skills framework for HIV nursing practice; the education and training role of the HIV nurse specialist; and the effectiveness of the HIV nurse specialist. The findings mainly focus on the clinical aspects of the role with little evidence concerning other aspects. There is limited evidence to indicate clinical effectiveness. Conclusions HIV care is facing substantial challenges and there is a clear need to develop effective and efficient services, including expanding the contribution of HIV nurse specialists. Such developments need to occur within a framework that optimises nursing contribution and measures their impact on HIV care. This review provides a baseline to inform such developments. Clinical relevanceCurrent understanding of HIV nurse specialist provision to inform service development and optimisation of patient care.

Objectives:To determine the level of awareness of genital chlamydial infection, and level of knowledge related to this infection, in genitourinary medicine (GUM) clinic attenders. Methods: 500 consecutive patients attending a GUM clinic for the first time during a 3 month study period were invited to complete an anonymous self administered questionnaire on aspects of chlamydial infection. Results: 482 (96.4%) questionnaires were available for analysis (57% female). 289 (60%) respondents had heard of Chlamydia trachomatis compared with 472 (98%) for thrush, 467 (97%) for HIV/AIDS, and 434 (90%) for gonorrhoea. Subjective knowledge of chlamydia, relative to the other infections, was poor. Overall, the mean chlamydial knowledge score was 0.38 (range 0.0-1.0). Females scored significantly higher than males (0.45 v 0.26; p<0.00001) and younger females scored significantly higher than older females (p=0.001). More females had experienced genital chlamydial infection than males (22.4% v 12.1%, p=0.004). Those with prior exposure to C trachomatis had higher mean knowledge scores than those without (males 0.55 v 0.25, p<0.00001; females 0.68 v 0.37, p<0.00001). Conclusion:Even for a population considered as "high risk" by their attendance at a GUM clinic, there was poor awareness of genital chlamydial infection, and mean knowledge scores were low. Whether increased knowledge was due to successful health education at the time of diagnosis in those with previous infection remains to be determined. In the future, one would hope for increased knowledge scores in those at risk before the acquisition of infection, which may be achieved by national health education programmes for C trachomatis. (Sex Transm Inf 1999;75:36-40)