UNO Amsterdam, theAmsterdam UMC University Network of Organizations for care for older adults, connects science with practice. Nursing professionals, physicians, allied health professionals, managers and researchers join forces to improve care for frail older adults. Together they seek scientific answers to practical questions and share the knowledge they have acquired. In this way, the development of care for older people is influenced by researchers, care professionals, and clients. APH-researcher Laura van Buul and implementation advisor Josien Wijffels take part in UNO Amsterdam and help co-creating solutions to improve healthcare for the elderly. One of the topics they worked on includes interventions to reduce antibiotic use for suspected urinary tract infections.

Combatting antibiotic resistance

The development of antibiotic resistance is an urgent public health concern, by the WHO referred to as ‘one of the biggest threats to health worldwide’. In 2015, research showed substantial antibiotic overuse for presumed urinary tract infections (UTI) in frail older adults. New methods to improve diagnoses of UTI were needed, to prevent antibiotic overuse. This also required behavioral and cultural changes around the management of UTI. UNO Amsterdam has investigated and implemented tools to stimulate these changes around management of UTI.

Co-creating interventions

Implementation took place in co-creation with caregivers to allow adaptation of the intervention to their daily practice. In this case, physicians and nursing professionals were involved in the project, by translating their needs into research questions and interventions to be studied. After study completion, the interventions were optimized and professionalized, based on process evaluation studies, and actively returned to the target group. During this cycle, new needs were identified and addressed in follow-up studies in close collaboration with the target group. Currently, over 10 different tools are available on the webpage of UNO Amsterdam1, such as an e-learning, educational video, pocket cards and observation instruments.

Poster with impact

Josien Wijffels: “It is a real challenge to actually achieve impact in nursing homes properly, because of staff shortages, multidisciplinary collaborations and the required awareness and behavior change.” A good example of co-creation and an intervention that worked really well was a poster about the use(lessness) of ‘urine dipsticks’, developed by Laura and her team. The poster was created with the target group: nursing professionals. It explains when a urine stick should be used to detect UTI and when it’s not needed. Wijffels: “The poster appeared to fulfill the needs of the target group, as many (over 2000) copies were requested by nursing professionals to be displayed on their nursing departments.”

Keys to create impact

Van Buul: “A crucial element to create impact is that you create knowledge that is needed and wanted by the target group you are focusing on. In the case of combatting antibiotic resistance, there was a clear call for support in causing behavioral change regarding UTI diagnosis and treatment.” Furthermore, financial support funding is essential to create impact. Funding from ZonMW and the Regional Cooperative Networks Antibiotic Resistance have contributed to the success of the interventions and implementation activities. Other skills that are needed to create impact are knowledge of communication, implementation, networking and collaborating with external parties.

Finally, a piece of advice from van Buul: “If you have research findings or interventions that could be of value for a specific target group, it is worth exploring if and how you can be part of the implementation. This process can bring you a nice variety of work activities and teaches you new skills, broadens your network and provides new opportunities for research. In conclusion, it is an experience with which you can truly make a difference.”

Do:
  • Organize and collaborate with complementary skills, talents and networks in the impact creating process.
  • Involve and collaborate closely with the target group to see what is helpful in their daily practice and what they need to support their implementation process.
  • From the start of your project, think of how your work really can make a difference to a specific target group.
Don’t:
  • Think that creating impact is a quick fix. ‘Impact’ is an important theme from the beginning of a research project, but it generally becomes most visible towards the end.
  • Think creating impact isn’t for you and leave your valuable pieces of work left on the book shelve. If you don’t have the time or funding, at least look for opportunities to transfer your work to other parties that can bring it one step further.
  • Don't make your impact creation plans too big, start with what is feasible at the moment. Perhaps from there, new opportunities arise for more impact creating activities.

Website UNO Amsterdam