Agnostic qualities in Hodges' model

In the previous post I highlighted "Holistic approaches to learning are agnostic as to method." 

I added that there would be more to follow as Hodges' model can be viewed as agnostic on several levels. The following is taken from a paper on Hodges' model and its application in forensic nursing:

Hodges’ model claims to be person-centred and situated (Jones, 2008). What exactly does this mean for forensic nursing? The utility of Hodges’ model lies in it being agnostic. By ‘agnostic’ this means that the model is not dependent upon, dedicated to, sanctioned by, or owned by any particular discipline (even nursing). It was not designed with a particular media, clinical setting, situation or organization in mind. It is true, however, that the model was formulated within academia and health and social care, being taught and applied by community mental health nurses, learning disability and health visiting students. Apart from the history and universality of the model’s cruciform structure and its inherent 2 x 2 matrix form [often referred to as a Johari window (Luft and Ingham, 1955)], the model is also culturally neutral. This is an essential requirement to reflect and enact nursing values and codes of conduct (Nursing and Midwifery Council, 2008).

Doyle, M., Jones, P. (2013). Hodges’ Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. 20, 7, 631-640.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2012.01961.x/abstract

Paper: Low-cost strategies to improve dementia care

An interest in health and science invites some thought about chaos, complexity and catastrophe theory. These suggest quite a cold - mechanistic - perspective of reality. So trying to think of clinical and nursing examples beyond fluid dynamics, the heart muscle... to more socially oriented applications demands some creative thinking.

In my work within intermediate support in the community for decades my colleagues and I come across cases were husband, wife, partner have looked their significant other to the nth degree. That degree can include hiding the extent of a person's cognitive problems from other family members. Suddenly there is a real catastrophe as the carer is taken acutely ill and hospitalised.

Left at home soon the dependency is revealed. Trying to negotiate care at home can then be a real challenge.

Alternately, when people living with dementia are hospitalised for physical reasons another host of challenges arise.

I've a relative who works over at Warrington General Hospital and it's great to be able to help highlight a paper written by Michelle Beavan their dementia champion and published in Nursing Times:

Beavan M (2014) Low-cost strategies to improve dementia care. Nursing Times; 110: online issue.

h2cm - Latest paper published in International Journal of Person Centered Medicine

The latest paper on Hodges' model is now published online:

Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination

Abstract

The concept of recovery is widely applied within service delivery in the field of mental health. The dimensions of recovery were explored using a singular conceptual framework known as Hodges’ model, which is shown to be suited to this particular task. This arises from the model’s structure, in that it encompasses the individual-group and a care domain specific to the political aspects of both health and social care. The evidence was found by relating recovery to the model’s care domains, which is also relevant to the experience of mental health service users and developments over the past decade in mental health service provision. Particular attention is given to the ‘Recovery Star’. This can be used as a key-working and outcomes tool. The discussion is also placed in a context of the current socio-economic climate, notably the ‘politics of recovery’ at a time of austerity.

With thanks to the editors, referees and to Gerry Bennison and Dawn Talbot for assisting in the beginning of this paper including their directions on the Recovery STAR; and for very helpful advice on the final drafts provided by Dr. Andrew Shepherd, and Prof. George Kernohan.

L-earning a Living with McLuhan

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

group

In 1964, Marshall McLuhan predicted that the future of work would involve -

"learning a living"... .	production
communities of practice	earning a living

Source:
Parchoma, G. (2006). A proposed e-learning policy field for the Academy. International Journal of Teaching and Learning in Higher Education, 18(3), 230-40. (p.232).
Reading for module 2.

Making learning visible dodging bullet points

Since January and the start of the course in Technology Enhanced Education there's been - and still is - a lot of reading to do. I've gained new and renewed insights into possible research methods and I'll share some of this in the next few weeks. The figure below is from:

Hay, D., Kinchin, I., Lygo‐Baker, S., 2008. Making learning visible: the role of concept mapping in higher education. Studies in Higher Education. 33, 295–311. doi:10.1080/03075070802049251

Figure 4 from Hay.

Over the years I've noticed and been rewarded when after a session on the care domains model some audience members have commented that the exercise made them think. There's nothing special in that of course, simple maths makes me think. Perhaps, people felt relief for a change from the passive absorption of facts, images, acting as static targets for a slew of bullet points. What comes across though is that there was some effort involved. In the figure above we can imagine the energy needed to not only create new and maintain existing concepts, but reject others. This might also constitute one front of the theory - practice gap?

This in a way reflects my thinking that although we refer to person-centred care in theory, practice and policy, this does not automatically follow. Person-centredness should take effort, work and energy. If that is the case, it also needs time.

A *prospective* journal issue devoted to the "Health Career - Care Domains - Model"

Last month I was contacted regards the possibility of acting as associate editor for a journal issue devoted to Hodges' model, or a related theme.

At present with part-time studies having started in January and a residential week to following at the end of March I have rather got my hands full. I hope to post in the near future on how these studies are helping to shape my ideas.

One clear 'result' is the prompt to engage with residential and nursing homes in preparation for a 'small research study' I have to complete this northern Spring. I've two meetings organised thus far with home managers.

A journal issue is a great prospect however, a giant step in fact - for the conceptual framework and myself (I'd also contribute an editorial). Perhaps I could share this project with someone similarly minded regards the potential of Hodges' model in health and social care and without in education and informatics? It seems that this invitation will stand even if I can only pick it up in the future, end of 2015-2016...

In the sidebar, below the bibliography I've listed a publications to-do list that could be extended:

• Hodges' model, structure, content and applications 
• taking the 'career' out of Hodges' model and putting it back;
• curriculum development;
• reflective practice;
• case formulation;
• holistic care (and related perspectives, but in informatics, SOCIO-TECHNICAL);
• the theory - practice gap;
• threshold concepts;
• and conceptual spaces;
• integrated care; 
• Nursing theory: future history - why they still matter;
• quality assurance and care values;
• multidisciplinary care and interprofessional education;
• diagrams that care;
• student contribution;
• patient, service user contribution;
• .... ?

The distance learning Technology Enhanced Learning course is stimulating many other insights. The learning is very collaborative and a great demonstrator in so many ways. The recent trip to London and meeting at London South Bank University also stressed the need for publishing in the 'popular' nursing press. Recent writing (recovery, recovery model) and studies also points to not being tied to original purposes of Hodges' model - but going beyond this ... far beyond: global health integration, health literacy, self-care, methodological approaches to critique and investigate Hodges' model. ...

Social Science Research Questions & Methodological Challenges in the 21st Century

ICOSS, University of Sheffield
219 Portobello, Sheffield, S1 4DP

www.shef.ac.uk/icoss

This seminar series will explore some of the key methodological challenges that the social sciences face in addressing research priorities in the 21st Century. Some of these areas involve continuity in topic and approach, whereas others involve new characteristics and aspects of social life.

The seminars will involve researchers discussing the kinds of research questions they are beginning to ask and looking at the methodological approaches and challenges that these questions pose. We will explore this in four seminars that relate to contemporary social issues, covering:

• Wellbeing and disadvantage
• Diversity and community
• Vulnerabilities and risks
• The relationship between social and digital worlds.

Following these four seminars, there will be a roundtable event, where there will be broad discussion about the methodological challenges and how the research community might address these.


Read more about the seminars.

Seminar dates:
• Tuesday 20 May 2014
• Monday 30 June 2014
• Wednesday 16 July 2014
• Wednesday 15 October 2014

Final roundtable event:
• Wednesday 26 November 2014

How to participate:
There are a number of ways in which you can participate in the series and join the conversation:
* All submissions will be subject to peer review.

1. Submit an abstract to present a 20-minute paper at one of the four seminars
We welcome abstracts for papers related to one of the 4 seminar themes. Based on ESRC priority areas, these themes are purposefully broad and papers may be based on work in progress, methodological or empirical issues you are currently grappling with as well as thoughts on future research potential and papers relating to completed projects. We welcome paper presentations from researchers of all career stages.

If you would like to present a paper please submit a title and abstract of no more than 250 words by completing the online abstract submission form(link)/by emailing your abstract to http://methodologicalchallenges.group.shef.ac.uk/ (please indicate which seminar you would like to present at and state whether you will be presenting in person or via weblink) three abstracts will be selected for each seminar.
The deadline for abstracts is 14^th April 2014.

2. Submit a written ‘think piece’ for dissemination on the seminar series’ website
We invite 400 word peer reviewed ‘think pieces’ for dissemination on the website. These could include (but are not limited to): reflections upon a particular research issue, experience or dilemma; thoughts or opinions on a particular issue affecting today’s research community; an annotated extract from your data or field diary. Think pieces may or may not relate to the themes of the seminars. Think pieces can be emailed to http://methodologicalchallenges.group.shef.ac.uk/ for peer review from 14^th April. Think pieces will be accepted throughout the duration of the series.

3. Submit a poster to be displayed on the accompanying website
We invite posters for dissemination on the website. Posters should be in PDF format… and could be based on a particular project, method, idea or experience. Posters may or may not relate to the themes of the 4 seminars. If you would like to submit a poster please submit an expression of interest using the abstract submission form http://methodologicalchallenges.group.shef.ac.uk/. Posters will be accepted throughout the duration of the series.

4. Attend a seminar and/or the roundtable event either in person or virtually
You are very welcome to attend the seminars and round table event and join in the discussion. You can do this in person by coming along to an event here in Sheffield or by joining us via web link. However you wish to attend, please register first by contacting Jayne Parkin, j.e.parkin AT sheffield.ac.uk.

If you wish to attend the seminar series in person, you can find directions to ICOSS here. If you would prefer to participate virtually, join us here at http://methodologicalchallenges.group.shef.ac.uk/ and submit your questions via Twitter, using the hashtag: #socmethods. You can also follow us at: @SocMethods

* This seminar series is funded by The Faculty of Social Sciences at the University of Sheffield, with additional support and guidance from NatCen Learning.
* Seminar series organiser: Dr Bridgette Wessels.

Best wishes,

Jenny Smith
Marketing Officer
Department of Politics / Department of Sociological Studies
The University of Sheffield
Elmfield, Northumberland Road
Sheffield, S10 2TU.

To-do list and challenges ... 2014

...in no particular order of priority or level of challenge presented...

Graduate study - distance learning, assignments, supervision, residential week
Research question
Role of simulations - games?

Hosting

E-mail address (beyond yahoo and demon)

Video and Audio skills

 Drupal 8 (stable Windows install - Linux)

the Drupal stack (still)
Abandon/transition from this blogging platform to other

Complete and format recovery, recovery model and Hodges' model paper for submission to journal
Prioritise and relate conference attendance and presentations/workshops to post-grad studies
Complete remaining three books for review

focus, focus, focus...

Happy holidays a Healthy and Prosperous New Year to All!

The EQUATOR Network: Support for “Declaration of transparency”

Following publication in the BMJ, in October 2013, of a proposed declaration of transparency a number of journals have now expressed their support for the transparency declaration and now ask lead authors to sign a declaration affirming that:

"this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained".

The following journals have now expressed their support:

BMJ
BMJ Open
BJOG: An International Journal of Obstetrics and Gynaecology
Canadian Journal of Anesthesia
NIHR Journals Library

Reference: Altman DG, Moher D. Declaration of transparency for each research article. BMJ 2013;347:f4796 [free full text].


My source: equator network - newsletter December 2013

Papers, possible post-grad studies, conferences and a visit to Brian Hodges

This coming Monday and Wednesday I'm investigating post graduate study options with visits to Sheffield and Lancaster Universities.

Heading to Sheffield on Monday I'm also looking forward to catching up with Brian Hodges the creator of Hodges' model in the 1980s. It has been a long time since Brian and I met. I'll see if there is anything I can feedback here.

There is one conference abstract submitted for a presentation next year and another abstract almost completed. This for a workshop which I'm structuring such that it might also inform possible future studies. With these two abstracts for UK based events, I'm also looking at conferences abroad in the latter half of 2014 and 2015. So if anyone has any suggestions please let me know.

The paper on recovery in mental health and Hodges' model is not too far from a complete first draft. It runs to 5,000 words now. I had a great start with the help of two people. Twitter can be a great help in garnering assistance and with a quick response.

There is some feedback and contacts to follow up on the service-user research side (see references below). One research project to cite is True Colours an online self-management system. The advice over the past few weeks is also quite illuminating in evidencing Hodges' model. Another draft paper on case formulation, diagrams and h2cm is well advanced, but on hold at present.

Rose, D., Sweeney, A., Leese, M., Clement, S, Burns, T, Catty, J & Wykes, T. (2009) Developing a user-generated measure of continuity of care: Brief report. Acta Psychiatrica Scandinavica.: 119: 320–324.

 

Rose, D. Fleischmann, P and Wykes, P. (2008) What are mental health service users’ priorities for research in the UK? Journal of Mental Health, 17 (3): 520-530.

Surveys, Nursing Education, Drupal and Webform

Just before heading to Drupalcon Prague I learned of a new paper by Gill et al.:

Using a web-based survey tool to undertake a Delphi study: Application for nurse education research

Background: The Internet is increasingly being used as a data collection medium to access research participants. This paper reports on the experience and value of using web-survey software to conduct an eDelphi study to develop Australian critical care course graduate practice standards.
Methods: The eDelphi technique used involved the iterative process of administering three rounds of surveys to a national expert panel. The survey was developed online using SurveyMonkey. Panel members responded to statements using one rating scale for round one and two scales for rounds two and three. Text boxes for panel comments were provided.
Collecting data and providing feedback: For each round, the SurveyMonkey's email tool was used to distribute an individualized email invitation containing the survey web link. The distribution of panel responses, individual responses and a summary of comments were emailed to panel members. Stacked bar charts representing the distribution of responses were generated using the SurveyMonkey software. Panel response rates remained greater than 85% over all rounds.
(in press)

The paper is interesting in combining surveys and an e-variant of the Delphi research method. Conclusions highlight the improved accessibility to experts and how ethics needs to keep pace with technical change and affordances.

Yesterday at Drupalcon there was a presentation on Webform:

Webform 4.0: Surveys in Drupal Improved

I've mocked up a enquiry form using Webform, but this session pointed to how the module can be extended for polls and contact forms. Based on Gill et al. and the eDelphi technique they explain this could be a really powerful combination.


Gill, F.J., et al., Using a web-based survey tool to undertake a Delphi study: Application for nurse education research, Nurse Education Today (2013), http://dx.doi.org/10.1016/j.nedt.2013.02.016

HIFA publishes paper in The Lancet Global Health: Governments are legally obliged to ensure adequate access to health information

The Lancet Global Health published a paper on 2nd August 2013 that we can all use in our advocacy to increase the availability and use of healthcare information in low- and middle-income countries. The paper was written by three HIFA Country Representatives for India – Soumyadeep Bhaumik, Tamoghna Biswas, Pranab Chetterjee – together with the HIFA Coordinator, Neil Pakenham-Walsh. The full text is freely available, open-access, here.

Here is a brief extract: ‘Should governments be held responsible for ensuring that every citizen and every health professional has access to the information they need to protect their own health and the health of those they care for? Should governments be held to account for, and to stop, any action that denies the availability of health information, or that misinforms the public or health professionals contrary to scientific evidence? The answers to these questions are yes and yes, as clearly stated in international human rights law.’

My source - above text: HIFA2015

Papers in progress, book reviews and volcanoes

There are three papers currently in process. There is some good and bad news; plus some similarity with volcanoes. This is in the sense of active, dormant and extinct.

The papers are - with no prizes for guessing the common feature:

1. The Scope of Nursing and Hodges' model
2. Case Formulation (Conceptualization), Diagrams and Hodges' model
3. Recovery and Hodges' model

Two papers are active, that's Case Formulation and Recovery. On the stove is Recovery and it's cookin. I've two co-authors providing invaluable input.

I've just read Terry Marks-Tarlow's Clinical Intuition in Psychotherapy The Neurobiology of Embodied Response and a review will follow my recommending this book right now.

There's a review copy of another book in the post that I believe can inform the recovery paper:

Values-Based Commissioning of Health and Social Care (thanks CUP)

I'm sure the concept of values-based commissioning is a gift to Hodges' model and the recovery paper. A theme to return to on W2tQ. The paper includes the Recovery STAR and relates this to Hodges' model.

The case formulation effort is with my co-author, and after a meeting in Manchester one early evening may incorporate risk formulation too.

The good news is none of these projects are extinct. The first nursing scope paper was rejected. The nursing scope paper is dormant, but is stirring following the symposium on person centredness in nursing early in May 2013.

There are two other books to get to grips with and a project that is in danger of extinction. The sight of Vesuvius next month may help: shift matters.

Computer-based 'avatar' therapy promising for persecutory auditory hallucinations

A study in the British Journal of Psychiatry has reported symptom reductions among patients hearing voices, who developed computerised 'avatars' of the voices and then engaged in dialogue with them. When compared with treatment as usual during a randomised trial, the therapy group showed mean reductions in scores for auditory hallucinations and for the omnipotence and malevolence of the voices. The researchers conclude: 'Patients who are able to sustain a dialogue with their persecutor feel much more in control.'
BJP June 2013, 202:428-433

Source:
http://www.mental-health-forum.co.uk/news-blog.html

In addition see and listen to:

UCL news:  Avatar therapy helps silence voices in schizophrenia

BBC Radio 4: http://www.bbc.co.uk/news/health-23141916

The Lancet: Several articles on health in China and HIFA2015

As well as highlighting some very useful papers, the post below c/o HIFA2015 is also an appeal as follows:

HIFA currently has only eight members in China (compared with 510 in India and 655 in Nigeria), and we would welcome more. If you have contacts with health professionals, researchers and/or policymakers in China, please invite them to join us at www.hifa2015.org


Dear HIFA members,

This week's Lancet includes several articles on health in China. One of them explores the challenge of evidence-based public health policy. Here is the citation and selected extracts:

Fan Jiang, Jun Zhang, Xiaoming Shen. Towards evidence-based public health policy in China.
The Lancet, Volume 381, Issue 9882, Pages 1962 - 1964, 8 June 2013 doi:10.1016/S0140-6736(13)61083-1
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61083-1/fulltext?_eventId=login

'In China, most biomedical and even public health research stops at publication. We believe that completing a public health study is not the end of the process, but, in many cases, marks the beginning of the next phase in which research results are applied to solve real-life problems. Efforts are warranted to raise such awareness among researchers and policy makers.'

'A clear, streamlined system is crucial to promote evidence-based public health policy at a large scale. Several mechanisms might be useful. First, a platform for bilateral communication between researchers and policy makers is needed to improve mutual understanding and to establish an effective and efficient dialogue channel. In addition to informal public meetings and knowledge brokers, rapidly spreading social media has been shown to be a very useful means to obtain feedback.11, 12 [...] Although still early in a long journey, China is moving towards evidence-based public health policy.4 With the right knowledge, attitude, and practice, adequate investment in the capability and capacity of implementation, and an efficient system, this goal will be reached.'

[The editor of HIFA2015 also mailed the following to the list]

A Comment in The Lancet makes an observation that is highly relevant to global health professionals, and especially those who undertake systematic reviews (which are often limited to papers in English):

'Any attempt to analyse global data needs to access work published in Chinese. This need is not straightforward to address, but the east-west collaboration of Chan and colleagues is exemplary. The western, anglophone hegemony in the generation and dissemination of research is coming to an end. This change creates challenges for peer review and synthesis of knowledge, but western investigators should no more assume that their Chinese counterparts have published high quality research in English than vice versa.'

Martin J Prince. Dementia in China: east-west collaboration bears fruit. The Lancet, Volume 381, Issue 9882, Pages 1967 - 1968, 8 June 2013.
doi:10.1016/S0140-6736(13)60770-9 Cite or Link Using DOI
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60770-9/fulltext

The full text is freely available, after free online registration.

Best wishes,
Neil

HIFA2015 profile: Neil Pakenham-Walsh is the coordinator of the HIFA2015 campaign and co-director of the Global Healthcare Information Network

Author's copy: Humans, Information and Science - now on Academia.edu

Humans, Information and Science

This evening I went through some old directories from two PCs ago and added the two figures missing from a paper published in 1996. This is now available on Academia.edu:

http://www.academia.edu/3555654/Humans_information_and_science

I've mentioned this paper before on W2tQ. I thought I would upload a copy as the basic details seems to have prompted some interest. At some point I would like to return to this subject:

ABSTRACT

The use of information forms the basis of nursing policies, standards and professional codes of conduct. Although used intuitively, nurses must now also grapple empirically with information needs often defined by others, and with the technology used to capture and process it. Even the briefest contemplation of 'information' reveals a truly pervasive concept. Information is ubiquitous. In order to care effectively in the so-called "information age" health care professionals need to understand information. This paper is a small contribution to that effort, attempting to conjoin the disparate fields of health and the information sciences; and the basic sciences upon which they are based.

This paper explores how definitions of 'information' formulated in computing and communication theory relate to health and other aspects of human experience. The strategy adopted to achieve this is threefold. First, there is the vexed question of defining data, information and knowledge. Second, I consider how communication - that essential nursing activity - relates to information, meaning and the messages people seek to convey to each other. Thirdly, clinical situations are described in an information oriented manner, using the concepts of 'redundancy' and 'entropy'. The conclusion provides an historical perspective.

Jones, P. (1996) Humans, Information, and Science, Journal of Advanced Nursing, 24(3),591-598.

In the meantime a draft paper on Hodges' model, case formulation (conceptualization) and diagrams is at a reduced 4,000 words ready for a meeting with my co-author later in June.

Early next month I'll post a book review and crack on with other reading for reviews.

3rd Int. Conference on Integrated Information: IC-ININFO, Prague Sept

Hi everyone!

I have been invited to Chair a session at the IC-ININFO 2013 conference in Prague in September and am now looking for abstracts by people interested in attending.

I am particularly interested in papers around sociotechnology or knowledge management. At this stage an abstract is required of around 250 words to me in the first instance and if I accept it, then it will go through the online review system. After acceptance of their abstract the authors have to prepare their Conference paper of up to 8 pages.

The paper submission will initiate a further single blind peer review process and the final paper will be published in the Conference Proceedings Book. More over, each author can submit a full paper to one of the supporting journals.

Please get in touch if you have an idea for this conference.

Elayne Coakes (Dr)
Senior Lecturer, Information and Knowledge Management
Room M112
The University of Westminster
coakese at WESTMINSTER.AC.UK

My source: SOCIOTECH at JISCMAIL.AC.UK

International Women’s Day 2013 (three items)

I received three emails concerning IWD which I have reduced and edited here:


KIVA - every day we at Kiva hear stuff like this:

• 70% of the world's poorest people are women.
• Two-thirds of illiterate adults are women.
• HIV is still the leading cause of illness for women in many places.

Kiva loans help thousands of powerful, inspiring women start businesses, educate their children, and realize their dreams.
You can tip the balance!

Want to make a difference? Send a Free Trial to your friends and family so they can empower a woman on Kiva too. Just send them to kiva.org/women

<>

Miss Representation.org - Cause and Effect: Why We Need to Tell Herstory

<> 

Join Wiley in celebrating International Women’s Day on March 8^th 2013! This free compendium of thought-provoking research from Wiley's leading publications celebrates women’s accomplishments, past and present, and examines the barriers that continue to obstruct equality of the sexes.

We hope that you enjoy reading this research and wish you a happy International Women’s Day!

Read FREE Research on Gender Equality

Scaling Up mHealth: Where Is the Evidence? PLoS Med essay (c/o HIFA2015)

Dear HIFA members,

An essay in the open-access journal PLoS Medicine discusses the evidence base for mHealth and makes recommendations for scale-up. Below is the citation, summary points, selected extracts and recommendations for scale-up. The full text is available here:
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001382

Best wishes,
Neil Pakenham-Walsh
HIFA moderator
[ HIFA2015: Healthcare Information For All by 2015 ]

CITATION: Tomlinson M, Rotheram-Borus MJ, Swartz L, Tsai AC (2013) Scaling Up mHealth: Where Is the Evidence? PLoS Med 10(2): e1001382. doi:10.1371/journal.pmed.1001382

SUMMARY POINTS
- Despite hundreds of mHealth pilot studies, there has been insufficient programmatic evidence to inform implementation and scale-up of mHealth.
- We discuss what constitutes appropriate research evidence to inform scale up.
- Potential innovative research designs such as multi-factorial strategies, randomized controlled trials, and data farming may provide this evidence base.
- We make a number of recommendations about evidence, interoperability, and the role of governments, private enterprise, and researchers in relation to the scale up of mHealth.

SELECTED EXTRACTS:
'A recent World Bank report tracked more than 500 mHealth studies, and many donor agencies are lining up to support the 'scaling up' of mHealth interventions [7]. Yet, after completion of these 500 pilot studies, we know almost nothing about the likely uptake, best strategies for engagement, efficacy, or effectiveness of these initiatives...  mHealth is in a period very similar to the early days of the Internet: not creating robust, interoperable platforms will ensure failure for mHealth initiatives to be scaled to improve health outcomes for at least the next decade.'

RECOMMENDATIONS FOR SCALE UP OF MHEALTH
- Existing standards for research should be reconsidered in order to provide guidance as to when scale up is appropriate.
- mHealth interventions should be guided by a plausible theory of behaviour change and should use more than one technique depending on the targeted behaviour [38].
- We need to establish an open mHealth architecture based on a robust platform with standards for app development which would facilitate scalable and sustainable health information systems.
- Implementation strategies such as factorial designs that are able to test the multiple features of interventions must be explored, in order to provide the necessary evidence base.
- Scale-up of mHealth in LAMICs should be preceded by efficacy and effectiveness trials so that they are founded on an appropriate evidence base.
Governments, funders, and industry must cooperate in order to set standards to create a self-governing commercially viable ecosystem for innovation.

Cognitive continua ( ... just a sentence of promise)

The idea of a cognitive continuum has much to offer nurses and its potential has yet to be fully exploited. p.136.


Thompson, C. (2001) JAN Forum: Clinical decision making in nursing: theoretical perspectives and their relevance to practice - a response to Jean Harbison. Journal of Advanced Nursing, 35(1), 134-137.