Why Is Case Management Effective? A Realist Evaluation of Case Management for Frail, Community-Dwelling Older People: Lessons Learned from Belgium

Despite many attempts to evaluate the effectiveness of case management for frail older people, systematic reviews including experimental designs show inconsistent results. Starting from the view that case management is a complex intervention occurring in multilayered realities, we conducted a realist evaluation of case management in Belgium, where this type of intervention is new. Realist approaches are particularly well suited to evaluate complex interventions as they seek to investigate iteratively the literature and empirical data to uncover mid-range theories underpinning the intervention under study. As such, realist evaluations are works in progress which provide tools to describe how, why and for whom an intervention is supposed to work. In this paper, we describe two mid-range theories that can explain why case management can help frail older people to remain at home, through the lens of capacity and social support.

A protocol paper:community engagement interventions for cardiovascular disease prevention in socially disadvantaged populations in the UK:an implementation research study

Background:Cardiovascular disorders(CVD)are the single greatest cause of mortality worldwide.In the UK,the National Health Service(NHS)has launched an initiative of health checks over and above current care to tackle CVD.However,the uptake of Health Checks is poor in disadvantaged communities.This protocol paper sets out a UK-based study(Sussex and Nottingham)aiming to co-produce a community delivered CVD risk assessment and coaching intervention to support community members to reduce their risk of CVD.The overall aim of the project is to implement a tailored-to-context community engagement(CE)intervention on awareness of CVD risks in vulnerable populations in high,middle and low-income countries.The specific objectives of the study are to enhance stakeholder’engagement;to implement lifestyle interventions for cardiovascular primary prevention,in disadvantaged populations and motivate uptake of NHS health checks.Methods:This study uses both qualitative and quantitative methods in three phases of evaluation,including pre-,per-and post-implementation.To ensure contextual appropriateness the‘Scaling-up Packages of Interventions for Cardiovascular disease prevention in selected sites in Europe and Sub-Saharan Africa:An implementation research’(SPICES)project will organize a multi-component community-engagement intervention.For the qualitative component,the pre-implementation phase will involve a contextual assessment and stakeholder mapping,exploring potentials for CVD risk profiling strategies and led by trained Community Health Volunteers(CHV)to identify accessibility and acceptability.The per-implementation phase will involve healthy lifestyle counselling provided by CHVs and evaluation of the outcome to identify fidelity and scalability.The post-implementation phase will involve developing sustainable community-based strategies for CVD risk reduction.All three components will include a process evaluation.A stepped wedge cluster randomised trial of the roll out will focus on implementation outcomes including uptake and engagement and changes in risk profiles.The quantitative component includes pre and post-intervention surveys.The theory of the socio-ecological framework will be applied to analyse the community engagement approach.Discussion:Based on the results ultimately a sustainable community engagement-based strategy for the primary prevention of CVD risk will be developed to enhance the performance of NHS health care in the UK.