Supervision, support and mentoring interventions for health practitioners in rural and remote contexts: an integrative review and thematic synthesis of the literature to identify mechanisms for successful outcomes

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Abstract

Objective

To identify mechanisms for the successful implementation of support strategies for health-care practitioners in rural and remote contexts.

Design

This is an integrative review and thematic synthesis of the empirical literature that examines support interventions for health-care practitioners in rural and remote contexts.

Results

This review includes 43 papers that evaluated support strategies for the rural and remote health workforce. Interventions were predominantly training and education programmes with limited evaluations of supervision and mentoring interventions. The mechanisms associated with successful outcomes included: access to appropriate and adequate training, skills and knowledge for the support intervention; accessible and adequate resources; active involvement of stakeholders in programme design, implementation and evaluation; a needs analysis prior to the intervention; external support, organisation, facilitation and/or coordination of the programme; marketing of the programme; organisational commitment; appropriate mode of delivery; leadership; and regular feedback and evaluation of the programme.

Conclusion

Through a synthesis of the literature, this research has identified a number of mechanisms that are associated with successful support interventions for health-care practitioners in rural and remote contexts. This research utilised a methodology developed for studying complex interventions in response to the perceived limitations of traditional systematic reviews. This synthesis of the evidence will provide decision-makers at all levels with a collection of mechanisms that can assist the development and implementation of support strategies for staff in rural and remote contexts.

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Most cited references 45

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A hierarchy of evidence for assessing qualitative health research.

Michelle Kealy, Karen Willis, Nicky Welch … (2007)

The objective of this study is to outline explicit criteria for assessing the contribution of qualitative empirical studies in health and medicine, leading to a hierarchy of evidence specific to qualitative methods. This paper arose from a series of critical appraisal exercises based on recent qualitative research studies in the health literature. We focused on the central methodological procedures of qualitative method (defining a research framework, sampling and data collection, data analysis, and drawing research conclusions) to devise a hierarchy of qualitative research designs, reflecting the reliability of study conclusions for decisions made in health practice and policy. We describe four levels of a qualitative hierarchy of evidence-for-practice. The least likely studies to produce good evidence-for-practice are single case studies, followed by descriptive studies that may provide helpful lists of quotations but do not offer detailed analysis. More weight is given to conceptual studies that analyze all data according to conceptual themes but may be limited by a lack of diversity in the sample. Generalizable studies using conceptual frameworks to derive an appropriately diversified sample with analysis accounting for all data are considered to provide the best evidence-for-practice. Explicit criteria and illustrative examples are described for each level. A hierarchy of evidence-for-practice specific to qualitative methods provides a useful guide for the critical appraisal of papers using these methods and for defining the strength of evidence as a basis for decision making and policy generation.

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Effective in-service training design and delivery: evidence from an integrative literature review

Julia Bluestone, Peter Johnson, Judith Fullerton … (2013)

Background In-service training represents a significant financial investment for supporting continued competence of the health care workforce. An integrative review of the education and training literature was conducted to identify effective training approaches for health worker continuing professional education (CPE) and what evidence exists of outcomes derived from CPE. Methods A literature review was conducted from multiple databases including PubMed, the Cochrane Library and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between May and June 2011. The initial review of titles and abstracts produced 244 results. Articles selected for analysis after two quality reviews consisted of systematic reviews, randomized controlled trials (RCTs) and programme evaluations published in peer-reviewed journals from 2000 to 2011 in the English language. The articles analysed included 37 systematic reviews and 32 RCTs. The research questions focused on the evidence supporting educational techniques, frequency, setting and media used to deliver instruction for continuing health professional education. Results The evidence suggests the use of multiple techniques that allow for interaction and enable learners to process and apply information. Case-based learning, clinical simulations, practice and feedback are identified as effective educational techniques. Didactic techniques that involve passive instruction, such as reading or lecture, have been found to have little or no impact on learning outcomes. Repetitive interventions, rather than single interventions, were shown to be superior for learning outcomes. Settings similar to the workplace improved skill acquisition and performance. Computer-based learning can be equally or more effective than live instruction and more cost efficient if effective techniques are used. Effective techniques can lead to improvements in knowledge and skill outcomes and clinical practice behaviours, but there is less evidence directly linking CPE to improved clinical outcomes. Very limited quality data are available from low- to middle-income countries. Conclusions Educational techniques are critical to learning outcomes. Targeted, repetitive interventions can result in better learning outcomes. Setting should be selected to support relevant and realistic practice and increase efficiency. Media should be selected based on the potential to support effective educational techniques and efficiency of instruction. CPE can lead to improved learning outcomes if effective techniques are used. Limited data indicate that there may also be an effect on improving clinical practice behaviours. The research agenda calls for well-constructed evaluations of culturally appropriate combinations of technique, setting, frequency and media, developed for and tested among all levels of health workers in low- and middle-income countries.

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Effects of continuing medical education on improving physician clinical care and patient health: a review of systematic reviews.

Bernard Bloom (2005)

The objective of physician continuing medical education (CME) is to help them keep abreast of advances in patient care, to accept new more-beneficial care, and discontinue use of existing lower-benefit diagnostic and therapeutic interventions. The goal of this review was to examine effectiveness of current CME tools and techniques in changing physician clinical practices and improving patient health outcomes. Results of published systematic reviews were examined to determine the spectrum from most- to least-effective CME techniques. We searched multiple databases, from 1 January 1984 to 30 October 2004, for English-language, peer-reviewed meta-analyses and other systematic reviews of CME programs that alter physician behavior and/or patient outcomes. Twenty-six reviews met inclusion criteria, that is, were either formal meta-analyses or other systematic reviews. Interactive techniques (audit/feedback, academic detailing/outreach, and reminders) are the most effective at simultaneously changing physician care and patient outcomes. Clinical practice guidelines and opinion leaders are less effective. Didactic presentations and distributing printed information only have little or no beneficial effect in changing physician practice. Even though the most-effective CME techniques have been proven, use of least-effective ones predominates. Such use of ineffective CME likely reduces patient care quality and raises costs for all, the worst of both worlds.

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Author and article information

Contributors

Anna M Moran

Julia Coyle

Rod Pope

Dianne Boxall

Susan A Nancarrow

Jennifer Young

Journal

Journal ID (nlm-ta): Hum Resour Health

Journal ID (iso-abbrev): Hum Resour Health

Title: Human Resources for Health

Publisher: BioMed Central

ISSN (Electronic): 1478-4491

Publication date Collection: 2014

Publication date (Electronic): 13 February 2014

Volume: 12

Page: 10

Affiliations

[1 ]Centre for Inland Health, Charles Sturt University, PO Box 789, Albury, NSW 2640, Australia

[2 ]School of Health and Human Sciences, Southern Cross University, PO Box 157, Lismore, NSW 2480, Australia

Article

Publisher ID: 1478-4491-12-10

DOI: 10.1186/1478-4491-12-10

PMC ID: 3944003

PubMed ID: 24521004

SO-VID: 0d4f499e-120a-44e7-8c84-89c3340006f1

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 22 August 2013

Date accepted : 28 January 2014

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Supervision, support and mentoring interventions for health practitioners in rural and remote contexts: an integrative review and thematic synthesis of the literature to identify mechanisms for successful outcomes

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Most cited references 45

A hierarchy of evidence for assessing qualitative health research.

Effective in-service training design and delivery: evidence from an integrative literature review

Effects of continuing medical education on improving physician clinical care and patient health: a review of systematic reviews.

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