Suchergebnisse

The provision of parenting support is a key feature of wealthier nations' health and social care services. However, attendance and engagement by the neediest parents remains poor. Barriers experienced by parents include personal life factors (beliefs, lifestyles and limited resources) and programme‐specific factors (delivery, content and support arrangements). Here we give consideration to these issues, drawing on published reviews of parenting programme effectiveness identified through a comprehensive search of electronic databases. We suggest ways of improving attendance and engagement, by providing programmes as part of a comprehensive framework of family support.

This article offers for wider discussion a description of the approach used in a situation where the gold standard of a randomized controlled trial (RCT) was not immediately feasible. It explains how the methods and research design of a developmental project known as `WRAP' (Woundcare Research for Appropriate Products) evolved, and discusses their implications for complex wound care evaluations.The project was guided by the UK Medical Research Council (MRC) framework for the development and evaluation of RCTs (MRC and Board, 2000). It is proposed that dressing performance in chronic wound care may best be evaluated by a focus on the first two phases of the framework, theorizing and modelling, to design interventions and measurement tools, before proceeding to the third phase, exploratory trials.When the data generated in such trials are deemed valid and reliable, using specified criteria, alternative forms of evaluation to the randomized controlled trial, such as post-market surveillance studies, can follow. It is also proposed that these adaptations of the MRC framework may apply to complex evaluations more generally.

This article draws on two research designs, which were used in a study of the palliative management of malignant wounds, to demonstrate the inherent challenges in producing generalizable knowledge from a complex subject. The designs included quasi-experimentation and a form of theory- driven evaluation. The focus of the study was the performance of dressings to reduce the impact of the wounds on daily life. The convention for evaluating the outcomes of interventions is a controlled study design. This approach is considered the valid way of producing evidence that is generalizable. An experimental design was therefore adopted to conduct a series of n = 1 quasi-experiments on wound dressing performance with qualitative methods to explore individual experiences. Problems with the methods, in particular the failure to capture complex inter-relationships between clinical problems and patient experiences, forced the researcher to abandon the experimental design. An alternative approach to measurement was adopted to maintain the study focus, the TELER® system of treatment evaluation, which includes indicators of patient-centred outcomes of care. The philosophical position of the study was reviewed. Consensus emerged as an unalterable, major in uence on the design and paradigmatic assumptions of the study. A `system of reasoning' was adopted to overcome the inherent relativist position of knowledge derived from this approach. The system abstracts general issues from case study data to construct theoretical explanations that may be consistent with, or challenge, current knowledge. This article is based on the evolution of one particular study. However, it makes a more general contribution to evaluation research by explaining the rationale for a form of theory-driven evaluation that uses evidence, reason and theory to develop generalizable explanations from complex, individual case study data. The methodology is proposed for other complex situations where speci c and rigorous evidence, capable of generalization is needed.

Action for Children commissioned a research team at King's College London to evaluate the impact of Action for Children Children's Centres on outcomes for vulnerable children. The study took place during 2010-11. Within the wider context of early intervention to meet wider family support needs, the study also addressed key topics including health, inter-agency collaboration; access to services; and the role of outreach. The study period coincided with robust public and political debate around the allocation of public spending, alongside an extensive review of services and outcomes for children and young people, through five parallel reviews.1 Proposed developments in the configuration of community health services for children and their families, put a spotlight on the existing and potential contribution of Children's Centres to undertake the co-ordination of services, as well as have a positive impact on child outcomes, alongside supporting workforce recruitment and retention; and the enhancement of inter-agency collaboration.