Statistical Methods for Health Care Research

Table of contentsKEYNOTE PRESENTATIONSK1 Researching complex interventions: the need for robust approachesPeter CraigK2 Complex intervention studies: an important step in developing knowledge for practiceIngalill Rahm-HallbergK3 Public and patient involvement in research: what, why and how?Nicky BrittenK4 Mixed methods in health service research – where do we go from here?Gunilla BorglinSPEAKER PRESENTATIONSS1 Exploring complexity in systematic reviews of complex interventionsGabriele Meyer, Sascha Köpke, Jane Noyes, Jackie ChandlerS2 Can complex health interventions be optimised before moving to a definitive RCT? Strategies and methods currently in useSara LevatiS3 A systematic approach to develop theory based implementation interventionsAnne SalesS4 Pilot studies and feasibility studies for complex interventions: an introductionLehana Thabane, Lora GiangregorioS5 What can be done to pilot complex interventions?Nancy Feeley, Sylvie CossetteS6 Using feasibility and pilot trials to test alternative methodologies and methodological procedures prior to full scale trialsRod TaylorS7 A mixed methods feasibility study in practiceJacqueline Hill, David A Richards, Willem KuykenS8 Non-standard experimental designs and preference designsLouise von EssenS9 Evaluation gone wild: using natural experimental approaches to evaluate complex interventionsAndrew WilliamsS10 The stepped wedge cluster randomised trial: an opportunity to increase the quality of evaluations of service delivery and public policy interventionsKarla Hemming, Richard Lilford, Alan Girling, Monica TaljaardS11 Adaptive designs in confirmatory clinical trials: opportunities in investigating complex interventionsMunyaradzi DimairoS12 Processes, contexts and outcomes in complex interventions, and the implications for evaluationMark PetticrewS13 Processes, contexts and outcomes in complex interventions, and the implications for evaluationJanis Baird, Graham MooreS14 Qualitative evaluation alongside RCTs: what to consider to get relevant and valuable resultsWillem Odendaal, Salla Atkins, Elizabeth Lutge, Natalie Leon, Simon LewinS15 Using economic evaluations to understand the value of complex interventions: when maximising health status is not sufficientKatherine PayneS16 How to arrive at an implementation planTheo van AchterbergS17 Modelling process and outcomes in complex interventionsWalter SermeusS18 Systems modelling for improving health careMartin Pitt, Thomas Monks

Researching Complex Interventions in Health: The State of the Art (vol 16, 101, 2016)

Objective To investigate the relationship between job satisfaction, work stress, work–family conflict and turnover intention, and explore factors associated with turnover intention, among physicians in Guangdong Province, China. Methods From August to October 2013, physicians completed questionnaires and scales with regard to their job satisfaction, work stress, work–family conflict, and turnover intention. Binary logistic regression and structural equation modelling (SEM) were used in data analysis. Results A total of 3963 physicians were approached, with 3563 completing the questionnaire. The mean score of the overall perception of turnover intention of physicians who worked in Guangdong was 2.71 on a scale ranging from 1 to 6. Hours worked per week, working in an urban/rural area, type of institution, and age significantly impacted on turnover intention. Turnover intention was directly and negatively related to job satisfaction, and it was directly, indirectly and positively related to work stress and work–family conflict. Conclusion Job satisfaction, work stress, work–family conflict, hours worked per week, working in an urban/rural area, types of institution and age are influencing factors of turnover intention. Reducing working hours, raising salary, providing more opportunities for career development and training, supporting and encouraging physicians by senior managers could potentially contribute to the reduction in turnover intention.

https://bmjopen.bmj.com/content/bmjopen/7/5/e014894.full.pdf

The relationship between job satisfaction, work stress, work-family conflict, and turnover intention among physicians in Guangdong, China: a cross-sectional study.

Background Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses, physicians, psychologists and social workers, are exposed to various work-related stressors (e.g. patient care, time pressure, administration) and are at increased risk of developing mental disorders. This population may benefit from resilience-promoting training programmes. Objectives To assess the effects of interventions to foster resilience in healthcare professionals, that is, healthcare staff delivering direct medical care (e.g. nurses, physicians, hospital personnel) and allied healthcare staff (e.g. social workers, psychologists). Search methods We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results. Selection criteria Randomised controlled trials (RCTs) in adults aged 18 years and older who are employed as healthcare professionals, comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, wait-list, usual care, active or attention control. Primary outcomes were resilience, anxiety, depression, stress or stress perception and well-being or quality of life. Secondary outcomes were resilience factors. Data collection and analysis Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only). Main results We included 44 RCTs (high-income countries: 36). Thirty-nine studies solely focused on healthcare professionals (6892 participants), including both healthcare staff delivering direct medical care and allied healthcare staff. Four studies investigated mixed samples (1000 participants) with healthcare professionals and participants working outside of the healthcare sector, and one study evaluated training for emergency personnel in general population volunteers (82 participants). The included studies were mainly conducted in a hospital setting and included physicians, nurses and different hospital personnel (37/44 studies). Participants mainly included women (68%) from young to middle adulthood (mean age range: 27 to 52.4 years). Most studies investigated group interventions (30 studies) of high training intensity (18 studies; > 12 hours/sessions), that were delivered face-to-face (29 studies). Of the included studies, 19 compared a resilience training based on combined theoretical foundation (e.g. mindfulness and cognitive-behavioural therapy) versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. hospitals, universities), or a combination of different sources. Fifteen studies did not specify the source of their funding, and one study received no funding support. Risk of bias was high or unclear for most studies in performance, detection, and attrition bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.45, 95% confidence interval (CI) 0.25 to 0.65; 12 studies, 690 participants), lower levels of depression (SMD -0.29, 95% CI -0.50 to -0.09; 14 studies, 788 participants), and lower levels of stress or stress perception (SMD -0.61, 95% CI -1.07 to -0.15; 17 studies, 997 participants). There was little or no evidence of any effect of resilience training on anxiety (SMD -0.06, 95% CI -0.35 to 0.23; 5 studies, 231 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.14, 95% CI -0.01 to 0.30; 13 studies, 1494 participants; very-low certainty evidence). Effect sizes were small except for resilience and stress reduction (moderate). Data on adverse effects were available for three studies, with none reporting any adverse effects occurring during the study (very-low certainty evidence). Authors' conclusions For healthcare professionals, there is very-low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post-intervention. The paucity of medium- or long-term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high-quality replications and improved study designs.

Psychological interventions to foster resilience in healthcare professionals

Will we have the same employees in hospitality after all? The impact of COVID-19 on employees’ work attitudes and turnover intentions

Objectives This cross-sectional study aimed to explore job satisfaction among healthcare staff in Guangdong following the health system reforms in 2009, and to investigate the association between job satisfaction and work stress, work–family conflict and doctor–patient relationship. Design Cross-sectional survey. Setting The Fifth National Health Service Survey was carried out in Guangdong, China. Participants All participants in this study were healthcare staff including physicians, nurses and public health staff from hospitals, health service centres and health clinics. A total of 6583 questionnaires were distributed and collected. After excluding the incomplete questionnaires, 5845 questionnaires were included for the analysis. Outcome measures Sociodemographic information and scores for evaluating job satisfaction, work stress, work–family conflict and doctor–patient relationship were obtained using the questionnaire developed by the National Health and Family Planning Commission of the People9s Republic of China. To assess the significantly associated factors on job satisfaction of the healthcare staff in Guangdong, a binary logistic regression model was used. Results Based on the 5845 valid responses of the healthcare staff who worked in Guangdong, the mean score of overall perception of job satisfaction was 3.99 on a scale of 1–6. Among the sociodemographic variables, occupation, educational background, professional status, years of service, annual income and night shift frequency significantly influenced the level of job satisfaction. Work stress, work–family conflict and doctor–patient relationship also had significant effect on job satisfaction. Conclusions The overall job satisfaction exceeded slightly dissatisfied (score 3) and approached slightly satisfied (score 4). Measures to enhance job satisfaction include the reduction of workload, increase of welfare, maintaining moderate stress and balancing work–family conflict. Moreover, relevant laws should be issued to protect the healthcare staff from violent acts.

https://bmjopen.bmj.com/content/bmjopen/6/7/e011388.full.pdf

Job satisfaction and associated factors among healthcare staff: a cross-sectional study in Guangdong Province, China

The two-week illness prevalence rate is an important and comparable indicator of health service needs. High-spatial-resolution, age-specific risk mapping of this indicator can provide valuable information for health resource allocation. The age-prevalence relationships may be different among areas of the study region, but previous geostatistical models usually ignored the spatial-age interaction. We took Guangdong province, the province with the largest population and economy in China, as a study case. We collected two-week illness data and other potential influencing predictors from the fifth National Health Services Survey in 2013 and other open-access databases. Bayesian geostatistical binary regression models were developed with spatial-age structured random effect, based on which, high-resolution, age-specific two-week illness prevalence rates, as well as number of people reporting two-week illness, were estimated. The equality of health resource distribution was further evaluated based on the two-week illness mapping results and the health supply data. The map across all age groups revealed that the highest risk was concentrated in the central (i.e., Pearl River Delta) and northern regions of the province. These areas had a two-week illness prevalence > 25.0%, compared with 10.0–20.0% in other areas. Age-specific maps revealed significant differences in prevalence between age groups, and the age-prevalence relationships also differed across locations. In most areas, the prevalence rates decrease from age 0 to age 20, and then increase gradually. Overall, the estimated age- and population-adjusted prevalence was 16.5% [95% Bayesian credible interval (BCI): 14.5–18.6%], and the estimated total number of people reporting illness within the two-week period was 17.5 million (95% BCI: 15.5–19.8 million) in Guangdong Province. The Lorenz curve and the Gini coefficient (resulted in 0.3526) showed a moderate level of inequality in health resource distribution. We developed a Bayesian geostatistical modeling framework with spatial-age structured effect to produce age-specific, high-resolution maps of the two-week illness prevalence rate and the numbers of people reporting two-week illness in Guangdong province. The methodology developed in this study can be generalized to other global regions with available relevant survey data. The mapping results will support plans for health resource allocation.

/pdf/high-resolution-age-specific-mapping-of-the-two-week-illness-1y3ar4bnxf.pdf

High-resolution age-specific mapping of the two-week illness prevalence rate based on the National Health Services Survey and geostatistical analysis: a case study in Guangdong province, China

Xiao-Liang Huang

Papers

The relationship between job satisfaction, work stress, work-family conflict, and turnover intention among physicians in Guangdong, China: a cross-sectional study.

Job satisfaction and associated factors among healthcare staff: a cross-sectional study in Guangdong Province, China

High-resolution age-specific mapping of the two-week illness prevalence rate based on the National Health Services Survey and geostatistical analysis: a case study in Guangdong province, China