title: The state of the art of twinning, a concept analysis of twinning in healthcare.
abstract: Inequities in health have garnered international attention and are now addressed in Sustainable Development Goal 3 (SDG3), which seeks to 'promote well-being for all'. To attain this goal globally requires innovative approaches, one of which is twinning. According to the International Confederation of Midwives, twinning focusses on empowering professionals, who can subsequently be change-agents for their communities. However, twinning in healthcare is relatively new and because the definition and understanding of twinning lacks clarity, rigorous monitoring and evaluation are rare. A clear definition of twinning is essential for the development of a scientific base for this promising form of collaboration.
  
  
  
  We conducted a Concept Analysis (CA) of twinning in healthcare using Morse's method. A qualitative study of the broad literature was performed, including scientific papers, manuals, project reports, and websites. We identified relevant papers through a systematic search using scientific databases, backtracking of references, and experts in the field.
  
  
  
  We found nineteen papers on twinning in healthcare. This included twelve peer reviewed research papers, four manuals on twinning, two project reports, and one website. Seven of these papers offered no definition of twinning. In the other twelve papers definitions varied. Our CA of the literature resulted in four main attributes of twinning in healthcare. First, and most frequently mentioned, was reciprocity. The other three attributes were that twinning: 2) entails the building of personal relationships, 3) is dynamic process, 4) is between two named organisations across different cultures. The literature also indicated that these four attributes, and especially reciprocity, can have an empowering effect on healthcare professionals.
  
  
  
  Based on these four attributes we developed the following operational definition: Twinning is a cross-cultural, reciprocal process where two groups of people work together to achieve joint goals. A greater understanding and a mature definition of twinning results in clear expectations for participants and thus more effective twinning. This can be the starting point for new collaborations and for further international studies on the effect of twinning in healthcare.
authors: CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. frankacadee@gmail.com.|Research Centre for Midwifery Science, Zuyd University, Universiteitssingel 60, 6229 ER, Maastricht, The Netherlands. frankacadee@gmail.com.
authors: Franka
authors: 0000-0002-8054-3667
authors: F
authors: Cadée
authors: Research Centre for Midwifery Science Maastricht, Zuyd University, Universiteitssingel 60, 6229 ER, Maastricht, The Netherlands.
authors: Marianne J
authors: MJ
authors: Nieuwenhuijze
authors: Department of Primary and Community Care, Gender and Women's Health, Radboud University Medical Center, P.O.Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors: A L M
authors: AL
authors: Lagro-Janssen
authors: Center for Bioethics and Social Sciences in Medicine University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, 419W, Ann Arbor, MI, 48109-2800, USA.|CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors: Raymond
authors: R
authors: De Vries
mesh_terms: D019058:Community Networks / Q000592:standards*; D003210:Concept Formation; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards; D006801:Humans; D011209:Power, Psychological; D017009:Professional Autonomy
keywords: Healthcare professionals; International collaboration; Midwives; Nurses; Physicians; Reciprocity; Twinning