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Jamie Murdoch

The University Of East Anglia, Health Sciences, Post-Doc

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Papers by Jamie Murdoch

TRIPLE C reporting principles for case study evaluations of the role of context in complex interventions

BMC Medical Research Methodology, May 13, 2023

Background Guidance and reporting principles such as CONSORT (for randomised trials) and PRISMA (... more Background Guidance and reporting principles such as CONSORT (for randomised trials) and PRISMA (for systematic reviews) have greatly improved the reporting, discoverability, transparency and consistency of published research. We sought to develop similar guidance for case study evaluations undertaken to explore the influence of context on the processes and outcomes of complex interventions. Methods A range of experts were recruited to an online Delphi panel, sampling for maximum diversity in disciplines (e.g. public health, health services research, organisational studies), settings (e.g. country), and sectors (e.g. academic, policy, third sector). To inform panel deliberations, we prepared background materials based on: [a] a systematic metanarrative review of empirical and methodological literatures on case study, context and complex interventions; [b] the collective experience of a network of health systems and public health researchers; and [c] the established RAMESES II standards (which cover one kind of case study). We developed a list of topics and issues based on these sources and encouraged panel members to provide free text comments. Their feedback informed development of a set of items in the form of questions for potential inclusion in the reporting principles. We circulated these by email, asking panel members to rank each potential item twice (for relevance and validity) on a 7-point Likert scale. This sequence was repeated twice. Results We recruited 51 panel members from 50 organisations across 12 countries, who brought experience of a range of case study research methods and applications. 26 completed all three Delphi rounds, reaching over 80% consensus on 16 items covering title, abstract, definitions of terms, philosophical assumptions, research question(s), rationale, how context and complexity relates to the intervention, ethical approval, empirical methods, findings, use of theory, generalisability and transferability, researcher perspective and influence, conclusions and recommendations, and funding and conflicts of interest. Conclusion The 'Triple C' (Case study, Context, Complex interventions) reporting principles recognise that case studies are undertaken in different ways for different purposes and based on different philosophical assumptions. They are designed to be enabling rather than prescriptive, and to make case study evaluation reporting on context and complex health interventions more comprehensive, accessible and useable.

Process evaluation for the PREPARE-ABC study: context mapping, pinchpoints and implications for implementation and theoretical fidelity

Background Shoulder dysfunction and pain following breast cancer treatment is common, impacting u... more

104GOAL Setting for Patients with Multimorbidity in Primary Care: A Cluster Randomised Feasibility Trial

Age and Ageing, Feb 1, 2019

Implementing integrated care clinics for HIV-infection, diabetes and hypertension in Uganda (INTE-AFRICA): process evaluation of a cluster randomised controlled trial

BMC Health Services Research, Jun 2, 2023

Background Sub-Saharan Africa is experiencing a dual burden of chronic human immunodeficiency vir... more Background Sub-Saharan Africa is experiencing a dual burden of chronic human immunodeficiency virus and non-communicable diseases. A pragmatic parallel arm cluster randomised trial (INTE-AFRICA) scaled up ' one-stop' integrated care clinics for HIV-infection, diabetes and hypertension at selected facilities in Uganda. These clinics operated integrated health education and concurrent management of HIV, hypertension and diabetes. A process evaluation (PE) aimed to explore the experiences, attitudes and practices of a wide variety of stakeholders during implementation and to develop an understanding of the impact of broader structural and contextual factors on the process of service integration.

Strengthening the quality and scope of paediatric primary care in South Africa: Evaluating contextual impacts of the introduction of the Practical Approach to Care Kit for children (PACK Child)

Background: Despite significant reductions in mortality, preventable and treatable conditions rem... more Background: Despite significant reductions in mortality, preventable and treatable conditions remain leading causes of death and illness in children aged under five in South Africa. The PACK Child intervention, comprising a clinical decision support tool (guide), training strategy and health systems strengthening components, was developed to expand on WHO's Integrated Management of Childhood Illness programme, and in 2017-2018 was piloted in 10 primary healthcare facilities in the Western Cape Province. Here we report findings from an investigation into the contextual features of South African primary care that shaped how clinicians delivered the PACK Child intervention within clinical consultations. Methods: Process evaluation using semi-structured interviews, focus groups, observation, audiorecorded consultations and documentary analysis. Linguistic ethnographic analysis of relationship between primary care contextual features and clinician-caregiver interactions. Results: Primary healthcare facilities demonstrated dominance of a risk minimisation approach upheld by provincial documentation, providing curative episodic care to children presenting with acute symptoms, and preventive care including immunisations, feeding and growth monitoring, all in children 5 years or younger. Children with chronic illnesses such as asthma rarely received routine

Women living with HIV, diabetes and/or hypertension multi-morbidity in Uganda: a qualitative exploration of experiences accessing an integrated care service

Journal of Integrated Care, Dec 2, 2022

Women living with HIV, diabetes and/or hypertension multimorbidity in Uganda: A qualitative explo... more

Question design in nurse-led and GP-led telephone triage for same-day appointment requests: a comparative investigation

BMJ Open, Mar 1, 2014

Question design in nurse-led and GP-led telephone triage for same-day appointment requests: a com... more

Strengthening the quality of paediatric primary care: A process evaluation of a complex health systems intervention in South Africa

Research Square (Research Square), Dec 13, 2019

Brief education supported psychological treatment for adolescent borderline personality disorder: the BEST feasibility RCT

Health and social care delivery research, Dec 1, 2022

Reports are published in Health and Social Care Delivery Research (HSDR) if (1) they have resulte... more Reports are published in Health and Social Care Delivery Research (HSDR) if (1) they have resulted from work for the HSDR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HSDR programme The HSDR programme funds research to produce evidence to impact on the quality, accessibility and organisation of health and social care services. This includes evaluations of how the NHS and social care might improve delivery of services.

Proactive review for people with diabetes in hospital: a cluster randomised feasibility trial with process evaluation protocol

Research Square (Research Square), Dec 14, 2022

Background: Inpatient diabetes management is sub-optimal as demonstrated in successive National D... more Background: Inpatient diabetes management is sub-optimal as demonstrated in successive National Diabetes Inpatient Audits. Diabetes inpatient specialist services vary across the country, with limited evidence to guide service delivery. Currently referrals in hospitals to diabetes specialists are usually 'reactive' after diabetes related events, such as hypoglycaemia and hyperglycaemia, both of which are associated with increased risk of morbidity/mortality and increased length of hospital stay. Method: We will conduct a cluster randomised feasibility study with process evaluation. The Proactive Diabetes Review Model (PDRM) is a complex intervention that aims to minimise rather than respond to potentially modi able diabetes related harms by preempting them. The PDRM differs from usual care in its focus on early prevention. All eligible patients will be reviewed by a diabetes inpatient specialist nurse within one working day of admission. Trial duration will be approximately 32-weeks. Eight wards will be randomised to either PDRM or usual care. Adult patients with a known diagnosis of diabetes admitted to an included ward will be eligible. Data collection will be limited to that typically collected as part of usual care. Data collected will include descriptive data at both the ward and patient level and glucose measures, such as frequency and results of capillary glucose testing, ketonaemia and hypoglycaemic events. Analysis aims to determine the feasibility of both the intervention and a future de nitive trial. A qualitative process evaluation will be conducted in parallel to the trial. A minimum of 22 patients, nurses, doctors, and managers will be recruited with methods including direct non-participant observation and semi-structured interviews. The feasibility of a future de nitive trial will be assessed by evaluating recruitment and randomisation processes, sta ng resources, and quality of available data.

Addressing the quality of paediatric primary care: Health worker and caregiver perspectives of PACK Child, a health systems intervention in South Africa

Research Square (Research Square), Aug 13, 2020

Background: The WHO's Integrated Management of Childhood Illness (IMCI) has resulted in progress ... more Background: The WHO's Integrated Management of Childhood Illness (IMCI) has resulted in progress in addressing infant and child mortality. However, unmet needs of children continue to present a burden upon primary healthcare services. The capacity of services and quality of care offered require greater support to address these needs by extending and integrating curative and preventive care for the child with a long-term health condition and the child older than 5, not prioritised in IMCI. In response to these needs, the PACK Child intervention was developed, to expand the scope of integrated management and training programmes for paediatric primary care. We report health worker and caregiver perspectives of the existing paediatric primary care context as well as the extent to which PACK Child functions to address perceived problems within the current local healthcare system. Methods: This process evaluation involved 52 individual interviews with caregivers, 10 focus group discussions with health workers, 3 individual interviews with trainers, and 31 training observations. Interviews and focus groups explored participants' experiences of paediatric primary care, perspectives of the PACK Child intervention, and tensions with implementation in each context. Inductive thematic analysis was used to analyse verbatim interview and discussion transcripts. Results: Perspectives of caregivers and health workers suggest an institutionalised focus of paediatric primary care to treating children's symptoms as acute episodic conditions. Health workers' reports imply that this focus is perpetuated by interactions between contextual features such as, IMCI policy, documentation-driven consultations, overcrowded clinics and verticalised care. Whilst these contextual conditions constrained health workers' ability to translate skills developed within PACK Child training into practice, the intervention initiated expanded care of children 0-13 years and those with long-term health conditions, enhanced professional competence, improved teamwork and referrals, streamlined triaging, and facilitated probing for psychosocial risk. Conclusion PACK Child appears to be catalysing paediatric primary care to address the broader needs of children,

Digital psychosocial intervention for older adults with subthreshold depression in primary care in Brazil (PRODIGITAL): protocol for an individually randomised controlled trial

BackgroundSubthreshold depression is a substantial risk factor for the development of major depre... more BackgroundSubthreshold depression is a substantial risk factor for the development of major depression and is, for example, associated with poorer health in older adults, functional disabilities, and reduced quality of life. There is a paucity of cost-effective psychosocial interventions for this population in primary care worldwide, particularly in low- and middle-income countries.ObjectiveWe will evaluate the effectiveness and cost-effectiveness of the Viva Vida Programme, a 6-week digital psychosocial intervention for treating older adults with subthreshold depression in primary care.MethodsA two-arm, individually randomised controlled trial with a 1:1 allocation ratio with integrated economic and process evaluations. We will recruit 450 individuals 60 years of age and older with subthreshold depression (essentially, at least 5 and below 10 on the 9-item Patient Health Questionnaire (PHQ-9)) registered with one of the 46 primary care clinics in Guarulhos, Brazil. The intervention...

A health systems intervention to strengthen the integration of tuberculosis and COVID‐19 detection: Outcomes of a quasi‐experimental study in a high burden tuberculosis district in KwaZulu Natal, South Africa

Tropical Medicine & International Health

ObjectivesThe adverse effects of the COVID‐19 pandemic on tuberculosis (TB) detection have been w... more ObjectivesThe adverse effects of the COVID‐19 pandemic on tuberculosis (TB) detection have been well documented. Despite shared symptoms, guidance for integrated screening for TBand COVID‐19 are limited, and opportunities for health systems strengthening curtailed by lockdowns. We partnered with a high TB burden district in KwaZulu‐Natal, South Africa, to co‐develop an integrated approach to assessing COVID‐19 and TB, delivered using online learning and quality improvement, and evaluated its performance on TB testing and detection.MethodsWe conducted a mixed methods study incorporating a quasi‐experimental design and process evaluation in 10 intervention and 18 control clinics. Nurses in all 28 clinics were all provided access to a four‐session online course to integrate TB and COVID‐19 screening and testing, which was augmented with some webinar and in‐person support at the 10 intervention clinics. We estimated the effects of exposure to this additional support using interrupted ti...

Applying learning health systems thinking in codeveloping integrated tuberculosis interventions in the contexts of COVID-19

BMJ Global Health

The COVID-19 pandemic reversed much of global progress made in combatting tuberculosis, with Sout... more The COVID-19 pandemic reversed much of global progress made in combatting tuberculosis, with South Africa experiencing one of the largest impacts on tuberculosis detection. The aim of this paper is to share our experiences in applying learning health systems (LHS) thinking to the codevelopment of an intervention improving an integrated response to COVID-19 and tuberculosis in a South African district. A sequential partially mixed-methods study was undertaken between 2018 and 2021 in the district of Amajuba in KwaZulu-Natal. Here, we report on the formulation of a Theory of Change, codesigning and refining proposed interventions, and piloting and evaluating codesigned interventions in primary healthcare facilities, through an LHS lens. Following the establishment and formalisation of a district Learning Community, diagnostic work and a codevelopment of a theory of change, intervention packages tailored according to pandemic lockdowns were developed, piloted and scaled up. This proces...

Digital psychosocial intervention for depression among older adults in socioeconomically deprived areas in Brazil (PRODIGITAL-D): protocol for an individually randomised controlled trial

Trials

Background Depression in older adults is a challenge for health systems in most low- and middle-i... more Background Depression in older adults is a challenge for health systems in most low- and middle-income countries (LMICs). Digital strategies for the management of this condition have been emerging worldwide, but the effectiveness of most of them is still unclear, especially among older adults. Thus, we aim to assess the effectiveness and cost-effectiveness of a digital psychosocial intervention to treat depression among older adults living in socioeconomically deprived areas in Guarulhos, Brazil. Methods We will conduct a two-arm individually randomised controlled trial with 1:1 allocation ratio. Five hundred older adults aged 60 years or over with depressive symptomatology (9-item Patient Health Questionnaire score, PHQ-9 ≥ 10) and registered with one of the primary care clinics will be recruited to participate in this study. A 6-week digital psychosocial programme, named Viva Vida, will be delivered via WhatsApp to participants allocated to the intervention arm. The Viva Vida will...

“After all, we are all sick”: Multi-stakeholder understandings of stigma associated with integrated management of HIV, diabetes and hypertension at selected government clinics in Uganda

Background: Integrated care is increasingly used to manage chronic conditions. In Uganda, the int... more Background: Integrated care is increasingly used to manage chronic conditions. In Uganda, the integration of HIV, diabetes and hypertension care has been piloted leveraging the well facilitated and established HIV health care provision structures. This qualitative study aimed to investigate the perceptions and experiences of patients, health care providers, clinical researchers, representatives from international NGOs, community members/leaders and policy makers on integrated management of HIV, diabetes and hypertension at selected government clinics in Central Uganda. Methods: We adopted a qualitative-observational design and participants were purposively selected. In-depth interviews were conducted with patients and with health care providers, clinical researchers, policy makers, and representatives from international NGOs. Focus group discussions were conducted with community members and leaders. Clinical procedures in the integrated care clinic were also observed. Data were mana...

Personal and occupational experiences of COVID-19 and their effects on South African health workers’ wellbeing

South African Medical Journal, 2021

Personal and occupational experiences of COVID-19 and their effects on South African health worke... more Personal and occupational experiences of COVID-19 and their effects on South African health workers' wellbeing To the Editor: COVID-19-related psychological stressors and health risks among health workers are increasingly reported, particularly among those who are hospital based and are directly responsible for caring for patients with COVID-19. [1-4] We report findings from an online survey conducted between September and November 2020 in the Amajuba District of KwaZulu-Natal, reflecting experiences of the first COVID-19 wave. It investigated risk factors for severe COVID-19, experience of COVID-19-related problems, causes of anxiety, and effects on psychological wellbeing. The survey was completed as part of an intervention intended to support primary care workers in managing COVID-19 in the context of a high tuberculosis burden, and to address their psychological wellbeing. All Department of Health employees in Amajuba were invited to participate. Of 450 who responded, 53% were clinically practising nurses or nursing assistants, 12% operational managers or coordinators , 19% non-clinical support staff and 15% in other job categories; 83% worked in primary care, 14% in hospitals and 3% in the district office. Eleven percent of respondents were aged >55 years, 6% reported having diabetes, and 9% reported obesity; 22% of all respondents, including 45% of managers, reported having one or more of these risk factors for severe COVID-19. Twenty-two percent of respondents reported having tested positive for COVID-19, 2% had been hospitalised for COVID-19, 20% had quarantined because they had close contact with someone who tested positive, 35% had a relative or friend who tested positive, 9% had a relative or friend who was hospitalised for COVID-19, and 14% had a relative or friend who died due to COVID-19; 74% reported at least one of these experiences. Personal experiences of COVID-19 were associated with worse mental health, measured with the General Health Questionnaire 12 (GHQ12). [5,6] The GHQ score was calculated from responses, on a Likert scale, to 12 questions about concentration, lost sleep, feeling useful, ability to make decisions, strain, difficulties, enjoyment, ability to face problems, losing confidence, feeling worthless, unhappiness and happiness. In a linear regression model, higher GHQ12 scores, indicating worse mental health, were statistically significant (p<0.05) and independently associated with reporting testing positive for COVID-19, having quarantined as a close contact of someone who tested positive, a relative or friend testing positive, a relative or friend dying due to COVID-19, and being a manager, but not with age or gender. Anxiety about COVID-19 was assessed using 15 statements we developed, informed by our work on health workers' concerns about COVID-19 (Table 1). The most common worries were about infection at work (78%) and infecting household members (84%), and most respondents worried about the effects of COVID-19 on their own and their families' health, and the stresses of managing COVID-19 clinically. This study highlights adverse effects of COVID-19 on health workers' wellbeing in a diverse, mostly primary care-based workforce. Worries and personal experiences of COVID-19 were common and associated with worse mental health. Managers were most at risk of severe COVID-19 and had worse GHQ12 scores; non-clinical support staff were also affected. With the active roll-out of the COVID-19 vaccine for health workers currently underway, [7] it is This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Addressing the quality of paediatric primary care: health worker and caregiver perspectives from a process evaluation of PACK child, a health systems intervention in South Africa

BMC Pediatrics, 2021

Background The WHO’s Integrated Management of Childhood Illness (IMCI) has resulted in progress i... more Background The WHO’s Integrated Management of Childhood Illness (IMCI) has resulted in progress in addressing infant and child mortality. However, unmet needs of children continue to present a burden upon primary healthcare services. The capacity of services and quality of care offered require greater support to address these needs by extending and integrating curative and preventive care for the child with a long-term health condition and the child older than 5, not prioritised in IMCI. In response to these needs, the PACK Child intervention was developed and piloted in October 2017–February 2019 in the Western Cape Province of South Africa. We report health worker and caregiver perspectives of the existing paediatric primary care context as well as the extent to which PACK Child functions to address perceived problems within the current local healthcare system. Methods This process evaluation involved 52 individual interviews with caregivers, 10 focus group discussions with health...

Review: Delivering mental health support within schools and colleges – a thematic synthesis of barriers and facilitators to implementation of indicated psychological interventions for adolescents

Child and Adolescent Mental Health, 2020

BackgroundIncreasing the role of schools and colleges in the provision of mental health services ... more BackgroundIncreasing the role of schools and colleges in the provision of mental health services for young people has the potential to improve early intervention and access to treatment. We aimed to understand what factors influence the successful implementation of indicated psychological interventions within schools and colleges to help guide increased provision of mental health support within education settings.MethodsSystematic search for studies that have reported barriers or facilitators to the implementation of indicated interventions for adolescent emotional disorders delivered within schools and further education/sixth form colleges (CRD42018102830). Databases searched were EMBASE, MEDLINE, PsycINFO, CINAHL, British Nursing Index, ASSIA, ERIC and British Education Index. A thematic synthesis of factors reported to impact implementation was conducted.ResultsTwo thousand five hundred and sixty‐nine records and 177 full texts were screened. Fifty studies were identified for inc...

Mobilising context as complex and dynamic in evaluations of complex health interventions

BMC Health Services Research, Dec 17, 2023

Background The relationship between healthcare interventions and context is widely conceived as i... more Background The relationship between healthcare interventions and context is widely conceived as involving complex and dynamic interactions over time. However, evaluations of complex health interventions frequently fail to mobilise such complexity, reporting context and interventions as reified and demarcated categories. This raises questions about practices shaping knowledge about context, with implications for who and what we make visible in our research. Viewed through the lens of case study research, we draw on data collected for the Triple C study (focused on Case study, Context and Complex interventions), to critique these practices, and call for system-wide changes in how notions of context are operationalised in evaluations of complex health interventions. Methods The Triple C study was funded by the Medical Research Council to develop case study guidance and reporting principles taking account of context and complexity. As part of this study, a one-day workshop with 58 participants and nine interviews were conducted with those involved in researching, evaluating, publishing, funding and developing policy and practice from case study research. Discussions focused on how to conceptualise and operationalise context within case study evaluations of complex health interventions. Analysis focused on different constructions and connections of context in relation to complex interventions and the wider social forces structuring participant's accounts. Results We found knowledge-making practices about context shaped by epistemic and political forces, manifesting as: tensions between articulating complexity and clarity of description; ontological (in)coherence between conceptualisations of context and methods used; and reified versions of context being privileged when communicating with funders, journals, policymakers and publics. Conclusion We argue that evaluations of complex health interventions urgently requires wide-scale critical reflection on how context is mobilised-by funders, health services researchers, journal editors and policymakers. Connecting with how scholars approach complexity and context across disciplines provides opportunities for creatively expanding the field in which health evaluations are conducted, enabling a critical standpoint to long-established traditions and opening up possibilities for innovating the design of evaluations of complex health interventions.