abstract: Anxiety is one of the most common psychiatric disorders among children yet characterized by lower use of mental health services. Preventive efforts have demonstrated promise in the ability to reduce anxiety symptoms. However, as evidence-based interventions move into real-world settings, there is a need to systematically examine potential implementation factors that may affect program outcomes. The current study investigates the relations between different aspects of implementation and their effect on outcomes of a school-based preventive intervention targeting anxiety symptoms. Specifically, the study examines: (1) the measurement of quality of delivery, (2) specific relations among implementation components, (3) relations between these facets and anxiety program outcomes. Implementation data were collected from nine school-based mental health staff and observer ratings. Program outcomes (pretest and immediate posttest) were measured from 59 participants and their parents (mostly mothers) in the intervention condition. Implementation components included adherence, quality of delivery, time spent, participant responsiveness, and perceived usefulness of program materials. Program outcomes included child-reported emotional expressivity, physiological hyperarousal, negative cognitions, social skills, self-efficacy, and child and parent reported levels of child anxiety. Study findings indicated that quality of delivery was best captured as two facets: skillful presentation and positive engagement. Adherence and quality of delivery were associated with greater participant responsiveness, although time spent was not. Significant relations were found between some implementation components and some program outcomes. Further efforts can be used to optimize the translation of evidence-based programs into real-world settings. / Dissertation/Thesis / Doctoral Dissertation Psychology 2017

For decades the problems of access to and sustained use of water and sanitation (WATSAN) technologies in developing countries has dominated the political agendas of international organisations and governments. Despite the significant investments made and the apparent appropriateness of technologies transferred, the effective implementation and sustained use of WATSAN technologies remains a chimera. More importantly, improving access to water and sanitation does not necessarily guarantee the longevity of those systems transferred. Lessons from past interventions suggest that the success of WATSAN interventions depends on the ability of ensuring users‟ broad acceptance of the technologies and sustained used after donor assistance ends. Yet, in the academic literature users‟ feedback and experiences in the post-implementation stage of technologies has received scarce attention. Against this background, this thesis aims to contribute to understanding the dynamics involved in the process of WATSAN technology adoption and sustained use in developing countries by reporting the design and evaluation of a diagnostic post- implementation tool, called RECAP, to address and investigate the problem. This research employs a multiple case study approach to evaluate users‟ post-implementation experience of WATSAN technologies in South Africa and Indonesia. Semi-structured interviews with technology users as well as in depth interviews with local governments and health clinics were conducted in three case studies. By comparing and contrasting technology intended performance and users‟ experiences in the post-implementation stage this study aims to identify potential challenges to technology sustained used. Conclusions relate to the existence of discrepancies between performance and experience, manifested in the post-implementation stage, which suggest the necessity to develop evolving mechanisms to routinely assess users‟ feedbacks of the technologies and assist them with appropriate interventions. Further conclusions relate to the validity, reliability and flexibility of a post-implementation diagnostic tool in investigating user experiences, diagnosing emerging challenges and suggesting remedial intervention to contribute to sustained technology use.

Farmer support programmes are aimed at assisting in unlocking barriers faced by smallholder farmers. These programmes were implemented many years ago by the public and private sector. However, research continues to show that the increase in the number of these initiatives and in budgets/expenditures have not equally translated into an increase in the number of smallholder farmers advancing to commercial status. Therefore, this evaluation research is focused on assessing the implementation progress of a farmer support programme being implemented in Jozini, KwaZulu-Natal. The aim is to assess whether or not the programme is implemented according to the theory of change and to assess the likelihood of the programme achieving its intended outcomes. Both the quantitative and qualitative approaches were applied to collect and analyse data. Quantitative data was made up of project data and qualitative data was obtained through conducting in-depth interviews with farmers currently participating in the programme. Findings from this paper are expected to add to the existing body of knowledge in terms of strengthening and improving the design of farmer support programmes; to emphasise the importance of conducting implementation evaluations to assess programme performance early in implementation; to better understand what is working or not during implementation; and to understand why this is so.

Yes / In the last six years, hospitals in developed countries have been trialling the use of command centres for improving organisational efficiency and patient care. However, the impact of these Command Centres has not been systematically studied in the past. Methods: It is a retrospective population based study. Participants were patients who visited Bradford Royal Infirmary Hospital, accident and emergency (A&E) department, between Jan 01, 2018 and August 31, 2021. Outcomes were patient flow (measured as A&E waiting time, length of stay and clinician seen time)and data quality (measured by the proportion of missing treatment and assessment dates and valid transition between A&E care stages).Interrupted time-series segmented regression and process mining were used for analysis. Results: A&E transition time from patient arrival to assessment by a clinician marginally improved during the intervention period; there was a decrease of 0.9 minutes (95% CI: 0.35 to 1.4), 3 minutes (95% CI: 2.4 to 3.5), 9.7 minutes (95% CI: 8.4 to 11.0) and 3.1 minutes (95% CI: 2.7 to 3.5) during ‘patient flow program’, ‘command centre display roll-in’, ‘command centre activation’ and ‘hospital wide training program’, respectively. However, the transition time from patient treatment until conclusion of consultation showed an increase of 11.5 minutes (95% CI: 9.2 to 13.9), 12.3 minutes (95% CI: 8.7 to 15.9), 53.4 minutes (95% CI: 48.1 to 58.7) and 50.2 minutes (95% CI: 47.5 to 52.9) for the respective four post-intervention periods. Further, length of stay was not significantly impacted; the change was -8.8hrs (95% CI: -17.6 to 0.08), -8.9hrs (95% CI: -18.6 to 0.65), -1.67hrs (95% CI: -10.3 to 6.9) and -0.54hrs (95% CI: -13.9 to 12.8) during the four respective post intervention periods. It was a similar pattern for the waiting and clinician seen times. Data quality as measured by the proportion of missing dates of records was generally poor (treatment date=42.7% and clinician seen date=23.4%) and did not significantly improve during the intervention periods. Conclusion: The findings of the study suggest that a command centre package that includes process change and software technology does not appear to have consistent positive impact on patient safety and data quality based on the indicators and data we used. Therefore, hospitals considering introducing a Command Centre should not assume there will be benefits in patient flow and data quality. / This project is funded by the National Institute for Health Research Health Service and Delivery Research Programme (NIHR129483).

Chaque année, de nombreux programmes de prévention des dépendances sont implantés dans les écoles québécoises. L'efficacité de ces programmes peut être minée par différents facteurs, dont le manque d’adaptation du programme aux caractéristiques de la population ciblée (Grover, 2010; Grover, Cram et Bowman, 2007; McKennitt, 2007) et les problèmes d'implantation (Janosz, 2010; Joly, Tourigny et Thibaudeau, 2005). Ainsi, un programme probant pourrait s'avérer peu efficace s’il est mal adapté ou mal implanté (Botvin, Baker, Dusenbury, Tortu et Botvin, 1990; Chen, 2015; Dumas, Lynch, Laughlin, Smith et Prinz, 2001; Dusenbury, Brannigan, Falco et Hansen, 2003; Janosz, 2010; Rohrbach, Graham et Hansen, 1993; Rossi, Lipsey et Freeman, 2004) ou encore créer des effets iatrogènes chez la population ciblée (Botvin et Griffin, 2007; Craplet, 2006; Sohn, 2000; Werch et Owen, 2002). Au Québec, si l’étude de l'adaptation et de l’implantation des programmes de prévention en milieu scolaire apparait limitée pour la population générale (Janosz, 2010; Roberge, Choinière et Laverdure, 2009), elle semble absente chez la population autochtone. Or, dans certaines communautés autochtones québécoises, des taux élevés de consommation de psychotropes sont rapportés, sans compter que l'initiation à l’alcool et aux drogues survient à un âge précoce (Cotton et Laventure, 2013; Pronovost, Plourde, Alain, Eveno et Laperrière, 2009). Les particularités culturelles et la dispersion géographique de certaines communautés d'une même Nation peuvent complexifier l'implantation des programmes (Dell et al., 2012; Grover, 2010; Grover et al., 2007; McKennitt, 2007; Whitbeck, Walls et Welch, 2012). Pour offrir des programmes de prévention qui répondent aux besoins des jeunes autochtones, leur adaptation et l’évaluation de leur implantation apparaissent alors essentielles (Kumpfer, Pinyuchon, de Melo et Henry, 2008; McKleroy et al., 2006; Ringwalt et Bliss, 2006; Wingood et DiClemente, 2008). Cette thèse par articles a pour but d’expérimenter l'adaptation culturelle d'un programme de prévention. À cette fin, le premier article vise à identifier les facteurs facilitant ou entravant l’implantation initiale d’un programme de prévention des dépendances (Système d) chez les élèves innus du Québec d'âge scolaire primaire. Le second article vise à illustrer le processus d’adaptation de ce même programme, puis à vérifier la fidélité de son implantation en ce qui a trait à l'adhérence au contenu. Cette thèse comporte un devis de recherche mixte incorporé. Dans le volet qualitatif, différents répondants ont été rencontrés afin de documenter leur satisfaction et d’identifier les facteurs ayant facilité et entravé l'implantation: les animateurs du programme (n=6), les intervenants scolaires (n=2), les enseignants (n=2), la direction de l'école (n=1) et les parents des élèves ayant participé à la version initiale du programme (n=9). Dans le volet quantitatif, des journaux de bord ont permis de compléter l'identification des facteurs, en plus de mesurer l'adhérence au contenu de la version initiale du programme puis de sa version adaptée. Les résultats obtenus ont permis d’identifier différents facteurs entravant l'implantation du programme (manque de disponibilité des membres du personnel scolaire, complexité de certains concepts). D’autres facteurs ont toutefois facilité l’implantation du programme (adaptation en cours d’animation, capacité de résolution de problèmes des animateurs et des enseignants). Si certains de ces facteurs (formation au programme, aptitudes des personnes qui implantent) sont également observés en milieu scolaire non autochtone, d'autres facteurs (implication de membres du Conseil de bande, barrières de la langue et de la culture) apparaissent plus spécifiques au contexte communautaire autochtone. L’identification de ces facteurs, bien qu'elle ne concerne qu'une communauté autochtone, pourrait être transposée à d’autres communautés afin optimiser l’implantation et l'adaptation des programmes de prévention dans leurs écoles. Les principales adaptations apportées au programme Système d concernent la restructuration du protocole d'intervention (réduction de la durée des ateliers, ajout d'un cinquième atelier ainsi que d'un volet communautaire), la diversification des méthodes pédagogiques utilisées et l’intégration de références culturelles autochtones dans le contenu du programme. Il semble toutefois que l'adaptation du programme, bien que nécessaire pour correspondre à la réalité des élèves innus, se soit avérée insuffisante pour augmenter l'adhérence à son contenu. L'ensemble des résultats obtenus dans cette thèse permet de sensibiliser les différents praticiens des milieux scolaires autochtones, dont les psychoéducateurs, sur l'importance de sélectionner, implanter et adapter avec soin des programmes afin de prévenir adéquatement les dépendances auprès des jeunes autochtones.

This research is concerned with the pre-implementation evaluation of investments in Information Systems (IS). IS evaluation is important as organisations need to assess the financial justifiability of business change proposals that include (but usually are not limited to) the introduction of IS applications. More specifically, this research addresses the problem of benefits assessment within IS evaluation. We contend that benefits assessment should not be performed at the level of the IS application, as most extant evaluation methods advocate. Instead, to study the dynamics and the interactions of the IS applications with their surrounding environment, we propose to adopt the business process as the analytic lens of evaluation and to assess the impacts of IS on organisational, rather than on technical, performance indicators. Drawing on these propositions, this research investigates the potential of dynamic process modelling (via discrete-event simulation) as a facilitator of IS evaluation. We argue that, in order to be effective evaluation tools, business process models should be able to explicitly incorporate the effects of IS introduction on business performance, an issue that is found to be under-researched in previous literature. The above findings serve as the central theme for the development of a design theory of IS evaluation by simulation. The theory provides prescriptive elements that refer both to the design products of the evaluation and the design process by which these products can come into reality. The theory draws on a set of kernel theories from the business engineering domain and proposes a set of meta-requirements that should be satisfied by business process models, a meta-design structure that meets these requirements, and a design method that provides guidance in applying the theoretical propositions in practice. The design theory is developed and empirically tested by means of two real-life case studies. The first study is used to complement the findings of a literature review and to drive the development of the design theory's components, while the second study is employed to validate and further enhance the theory's propositions. The research results support the arguments for simulation-assisted IS evaluation and demonstrate the contribution of the design theory to the field.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

The present study constitutes the qualitative part of a project with aim to evaluate the implementation of Region Skåne’s care program to prevent intimate partner violence. Due to the increasing awareness of youth intimate partner violence in Sweden, the study aim was to evaluate the extent to which the care program has been implemented, as well as what the perceptions of the care program were, in three care settings specialized in young patients. A qualitative focus group study with an inductive approach was chosen. Four focus groups with 12 participants recruited from three care settings specialized in young patients within the region of Skåne county were held. Three of the participants were not explicitly governed by regional guidelines due to working in units which constituted a partnership between the region and the municipality. The data was analysed by using thematic analysis. Two main themes appeared in the findings, with the first being organizational leadership. Factors associated was that the care program had not been fully communicated and/or implemented in any regional unit. Further, the extent to which the professionals had obtained extensive training and/or perceived themselves as supported from the management varied. The second main theme, the clinical practice, reflected the clinical experiences of various types of violence, tasks that could appear challenging such as documenting IPV, screening for IPV online and making reports of concern. The main conclusion is that there are gaps between policy and practice in all contexts where the program is to be used. Recommendations are that organizational leaders should ensure the program to be sufficiently communicated to all professionals, and be responsive to requests for local adjustments and/or insecurities in relation to following the program, in order for neither screenings, nor documentation, nor making reports to fall between the cracks. / Den ingår i en ännu pågående utvärdering av Region Skånes vårdprogram mot våld i nära relationer. Projektet är finansierat av BRÅ.

The research was directed at assessing the strengths and weaknesses in the application-to-approval process of social grants up to the payment of social grants at pay-points in the South African Social Security Agency (hereafter SASSA). The general aim of the research project was to assess the application-to-approval process of grant administration in SASSA up to the payment of social grants at pay-points. The specific objectives of the study were therefore: * To describe the current application-to-approval process of grant administration; * To assess the strengths and weaknesses in the grant administration process of specified administrative procedures and structural issues as perceived by attesting officials (front-line staff responsible for taking down the grant applications), data-capturer officials (staff responsible for capturing the information on the application form onto the SOCPEN system, pay-point team members (staff responsible for rendering services at pay-points) and beneficiaries at pay-points; and * To provide a report on the strengths and weaknesses of the grant administration process from application to pay-out to the top management of SASSA. The study was conducted in two regions, namely the Northern Cape and the Western Cape. Various offices in the Northern Cape and the Western Cape were therefore part of the research. The grant administration process from application-to-approval includes various stages. The staff members include the screening official (step one) who checks the completeness of the required documentation, followed by attesting official (step two) who takes down the application and captures it on SOCPEN and then forwards it to the next level, namely quality control (step three). Thereafter a verifying official verifies the information captured on SOCPEN against documentation submitted and approves or rejects the application on SOCPEN (step four). Staff at pay-points (where beneficiaries receive their payments) and beneficiaries at pay-points were also part of the research focus. Four different data-collection instruments were therefore used during the research project. The first data-collection instrument was designed to collect data on the actual grant application process and problems and strengths in this regard (questionnaire front-line staff). The empirical investigation revealed the following with regard to the front-line staff: * The majority of front-line staff have considerable working experience (more than five years) in SASSA; * The majority of front-line staff have inadequate work space; * Training, supervision and mentoring support from supervisors and colleagues occurs haphazardly; * The majority of front-line staff receive between 11-29 applications per day and spent 30 minutes or less to take down an application; * Policy documents that regulate the implementation of new policy changes are not always available; * Grant application files get misplaced or lost after processing; * Staff carelessness is one of the main reasons why files get lost or misplaced and * Front-line staff experience technical difficulties with the computer on a regular basis and it takes one to three days to resolve technical difficulties. The second data-collection instrument was developed to collect data on the capturing of the application (questionnaire data-capturer) onto the SOCPEN system. The empirical investigation revealed the following with regard to data-capturers: * The majority of data-capturers have solid work experience as data-capturers in SASSA although some data-capturers have inadequate work space; * Training on the implementation of new policy changes occurs irregularly; * Supervision, mentoring and support from supervisors happen haphazardly; * Data-capturers receive between 20 and 29 applications per day and they capture all applications successfully; * Data-capturers receive support from colleagues on a more regular basis than from supervisors; * Documents or guidelines that regulate the implementation of policy changes are not always available in the work place; * Applications sometimes get misplaced or lost after capturing; * No proper mechanisms are in place to record the movement of files, staff carelessness and either lack of office space or filing space, are the main reasons why applications get lost or misplaced; * Data-capturers sometimes experience technical problems with computers and it takes one to less than five days to resolve technical difficulties; * Data-capturers receive sometimes incomplete applications from the attesting officials (those staff officials who are responsible for taking down the application) and they usually take such applications back to the first attesting officer; * Backlogs in the capturing and approving of normal applications exist and staff shortages and system-related problems are the main reasons why backlogs exist; * Backlogs exist with regard to the capturing and approving of review cases and * Staff shortages, a centralized review management approach, lack of office space and lack of connectivity points constitute the main reasons why review backlogs exist. The third data-collection instrument (questionnaire pay-point team member) was developed to measure services at pay-points and to determine the problems experienced at pay-points. The empirical investigation revealed the following with regard to this category as seen by pay-point team members: * Some pay-points are not disabled-friendly; * There are not always enough chairs, toilet facilities or drinking water available at pay-points; * Payment contractors and SASSA staff sometimes arrive late at pay-points; * Payments are usually delayed between 15 minutes to less than an hour, but beneficiaries are not always informed about delays; * There are sometimes broken machines at pay-points and this causes 15 to 45 minutes delay in payments; * There is not always enough money at pay-points and it takes an hour to just under two hours to get more money; * Grant recipients hardly ever receive wrong grant amounts; * Hawkers and vendors operate mainly outside the pay-point; * Security guards are available at pay-points and there is access control at pay-points (mainly driven by security guards from the payment contractor) * Not all pay-points are fenced all round and * First Aid kits are available at pay-points most of the time. The fourth data-collection instrument (questionnaire for beneficiaries) was developed to target the beneficiaries who receive grant payments at pay-points. The empirical investigation revealed the following: * Some pay-points are not disabled-friendly; * There are not always enough chairs, toilet facilities or drinking water available at pay-points; * Payment contractors and SASSA staff sometimes arrive late at pay-points; * Payments are usually delayed between 15 minutes to less than an hour, but beneficiaries are not always informed about delays; * There are sometimes broken machines at pay-points and this causes 15 to 45 minutes‟ delay in payments; * There is not always enough money at pay-points and it takes an hour to less than two hours to get more money; * Grant recipients rarely receive wrong grant amounts; * Hawkers and vendors operate mainly outside the pay-point, but there are exceptional cases where they operate inside the pay-points; * Beneficiaries do feel safe at pay-points most of the time; * Beneficiaries mostly live within walking distance from the pay-point; * Beneficiaries hardly experience problems at pay-points and if they do, their problems get resolved; * Not all pay-points provide shelter from the elements; * Beneficiaries are satisfied with the services SASSA renders and the grant has improved their quality of life. Grant administration processes in SASSA are labour-intensive and officials play a vital role in the correct administration of social grants. The study has revealed that although there is clearly some strength in the grant administration process from application-to-approval up the payment of social grants at pay-points, it is unfortunately true that the weaknesses are overwhelming. / Thesis (PhD (Social Work))--North-West University, Potchefstroom Campus, 2013