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Pamungkas DR, O'Sullivan B, McGrail M, Chater B. Tools, frameworks and resources to guide global action on strengthening rural health systems: a mapping review. Health Res Policy Syst 2023; 21:129. [PMID: 38049824 PMCID: PMC10694960 DOI: 10.1186/s12961-023-01078-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Inequities of health outcomes persist in rural populations globally. This is strongly associated with there being less health coverage in rural and underserviced areas. Increasing health care coverage in rural area requires rural health system strengthening, which subsequently necessitates having tools to guide action. OBJECTIVE This mapping review aimed to describe the range of tools, frameworks and resources (hereafter called tools) available globally for rural health system capacity building. METHODS This study collected peer-reviewed materials published in 15-year period (2005-2020). A systematic mapping review process identified 149 articles for inclusion, related to 144 tools that had been developed, implemented, and/or evaluated (some tools reported over multiple articles) which were mapped against the World Health Organization's (WHO's) six health system building blocks (agreed as the elements that need to be addressed to strengthen health systems). RESULTS The majority of tools were from high- and middle-income countries (n = 85, 59% and n = 43, 29%, respectively), and only 17 tools (12%) from low-income countries. Most tools related to the health service building block (n = 57, 39%), or workforce (n = 33, 23%). There were a few tools related to information and leadership and governance (n = 8, 5% each). Very few tools related to infrastructure (n = 3, 2%) and financing (n = 4, 3%). This mapping review also provided broad quality appraisal, showing that the majority of the tools had been evaluated or validated, or both (n = 106, 74%). CONCLUSION This mapping review provides evidence that there is a breadth of tools available for health system strengthening globally along with some gaps where no tools were identified for specific health system building blocks. Furthermore, most tools were developed and applied in HIC/MIC and it is important to consider factors that influence their utility in LMIC settings. It may be important to develop new tools related to infrastructure and financing. Tools that have been positively evaluated should be made available to all rural communities, to ensure comprehensive global action on rural health system strengthening.
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Affiliation(s)
- Dewi Retno Pamungkas
- Mayne Academy of Rural and Remote Medicine, Rural and Remote Medicine Clinical Unit, Medical School, Faculty of Medicine, The University of Queensland, Theodore, QLD, Australia.
| | - Belinda O'Sullivan
- Toowoomba Regional Clinical Unit, Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, QLD, Australia.
- Murray Primary Health Network, Bendigo, VIC, Australia.
| | - Matthew McGrail
- Rockhampton Regional Clinical Unit, Rural Clinical School, Faculty of Medicine, The University of Queensland, Rockhampton, QLD, Australia
| | - Bruce Chater
- Mayne Academy of Rural and Remote Medicine, Rural and Remote Medicine Clinical Unit, Medical School, Faculty of Medicine, The University of Queensland, Theodore, QLD, Australia
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Ibrahim ZA, Konlan KD, Moonsoo Y, Kwetishe P, Ryu J, Ro DS, Kim SY. Influence of Basic Health Care Provision Fund in improving primary Health Care in Kano state, a descriptive cross-sectional study. BMC Health Serv Res 2023; 23:885. [PMID: 37608275 PMCID: PMC10463796 DOI: 10.1186/s12913-023-09708-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 06/15/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The Basic Health Care Provision Fund (BHCPF) is a direct financial investment that funds Primary Healthcare (PHC) to improve the quality of services. This study assessed the influence of the BHCPF in improving PHC services. METHODS A descriptive cross-sectional study was conducted among PHC workers in 100 facilities randomly selected from the 484 designated PHCs for implementing the BHCPF project in Kano state. Using multiple sampling methods, 200 healthcare workers in PHC facilities were selected and assisted by trained data collectors to respond to the questionnaires. Chi-square analysis was used to show associated factors, while binary regression analysis was used to determine the relationship between factors influencing the BHCPF implementation in PHC. RESULT The findings showed healthcare workers had higher awareness (61.7%) and good utilization (57.1%) of BHCPF. Challenges of the BHCPF implementation were insufficiently skilled health professionals (85%), lack of data management capacity (52.6%), low community participation and awareness (52.0%), delay in releasing funds (60.7%), poor infrastructure (87.8%), and weak financial management and accountability system (58.2%). Healthcare professionals having a diploma were four times more likely to have the National Health Management Information System (NHMIS) in their facilities (AOR = 4.955, 95% CI = 1.120-21.036; P-value 0.035) than those without. Primary healthcare facilities were two times more likely to have the NHMIS (AOR = 2.549, 95% CI = 1.167-5.566: P-value 0. 019) than health post. CONCLUSION The factors that influenced PHC facilities to promote the implementation of BHCPF included: periodic evaluation of the facilities, availability of functional storage facilities, and improving the standard of care in PHC facilities. There is a need for retraining healthcare workers and creating more community awareness of the BHCPF.
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Affiliation(s)
| | - Kennedy Diema Konlan
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Yoon Moonsoo
- Institute of Tropical Medicine, College of Medicine, Yonsei University, Seoul, 03722, Korea
| | - Paul Kwetishe
- Federal Ministry of Health Dept. of Hospital services Abuja, Abuja, Nigeria
| | - Jongsoo Ryu
- Division of Medical Law and Bioethics, Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul, Korea
| | - Da Sol Ro
- Department of Medical Humanities and Social Sciences College of Medicine, Yonsei University, Seoul, 03722, Korea
| | - So Yoon Kim
- Department of Medical Humanities and Social Sciences College of Medicine, Yonsei University, Seoul, 03722, Korea.
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Termansen T, Bloch P, Tørslev MK, Vardinghus-Nielsen H. Spaces of participation: Exploring the characteristics of conducive environments for citizen participation in a community-based health promotion initiative in a disadvantaged neighborhood. Health Place 2023; 80:102996. [PMID: 36857895 DOI: 10.1016/j.healthplace.2023.102996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023]
Abstract
Research has shown that community participation in health programmes is vital to ensure positive health outcomes and sustainable solutions. This is often challenged by difficulties to engage socially disadvantaged population groups. Through ethnographic fieldwork in a community initiative in a disadvantaged neighbourhood in Copenhagen, Denmark, we explored which factors contributed to a conducive environment for participation. Data material consists of observation notes taken during fieldwork in a community hub from January 2020 until August 2021 and 19 semi-structured interviews with professional stakeholders and participants. We applied the analytical concept of space to elucidate how the organizational, social, and physical environments played important roles in ensuring possibilities for participation. We termed these environments Spaces of Participation. Our results highlight the importance of ensuring spaces that are flexible, informal, and responsive when engaging those who are hard to reach.
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Affiliation(s)
- Tina Termansen
- Steno Diabetes Center Copenhagen, Department of Health Promotion Research, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark; Aalborg University, Department of Health Sciences and Technology, Frederik Bayers Vej 7D, 9220, Aalborg, Denmark.
| | - Paul Bloch
- Steno Diabetes Center Copenhagen, Department of Health Promotion Research, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
| | - Mette Kirstine Tørslev
- Steno Diabetes Center Copenhagen, Department of Health Promotion Research, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
| | - Henrik Vardinghus-Nielsen
- Aalborg University, Department of Health Sciences and Technology, Frederik Bayers Vej 7D, 9220, Aalborg, Denmark.
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Shibata A, Suzuki A, Takahashi K. Gender Differences in Socio-Demographic Factors Associated with Pre-Frailty in Japanese Rural Community-Dwelling Older Adults: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1091. [PMID: 36673846 PMCID: PMC9858746 DOI: 10.3390/ijerph20021091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To prevent frailty, it is necessary to focus on pre-frailty and consider preventive interventions that incorporate social aspects. This study aimed to explore socio-demographic associations with pre-frailty, focusing on modifiable social factors among community-dwelling older adults in a rural Japanese city. METHODS We conducted a self-administered survey on social, physical, and mental factors, and basic attributes, in September 2021. Respondents were classified as frail, pre-frail, or healthy according to their The Kihon Checklist scores. Of the 494 valid responses, 93 respondents classified as pre-frail and 110 as healthy were analyzed. The socio-demographic associations with pre-frailty were investigated by multiple logistic regression, and interactions between gender and other factors were examined. RESULTS The analysis identified that for both genders, no-community participation in middle age (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.16-2.92) was found to be a social factor associated with pre-frailty. Having friends who listen to one's concerns (OR, 2.54; 95% CI, 1.26-5.10) was a factor for women. CONCLUSIONS This study showed that modifiable social factors associated with pre-frailty were community involvement and being able to share concerns with friends. The findings suggest the need for support that emphasizes social aspects to prevent pre-frailty.
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Affiliation(s)
- Aki Shibata
- Graduate School of Public Health, Teikyo University, 2 11 1 Kaga Itabashi ku, Tokyo 173 8605, Japan
- Department of Nursing, Saitama Prefectural University, 820 Sannomiya Koshigaya shi, Saitama 343 8540, Japan
| | - Asuka Suzuki
- Graduate School of Public Health, Teikyo University, 2 11 1 Kaga Itabashi ku, Tokyo 173 8605, Japan
| | - Kenzo Takahashi
- Graduate School of Public Health, Teikyo University, 2 11 1 Kaga Itabashi ku, Tokyo 173 8605, Japan
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Belaid L, Sarmiento I, Dimiti A, Andersson N. Community Participation in Primary Healthcare in the South Sudan Boma Health Initiative: A Document Analysis. Int J Health Policy Manag 2022; 11:2869-2875. [PMID: 35418007 PMCID: PMC10105198 DOI: 10.34172/ijhpm.2022.6639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 03/27/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Community participation is central to primary healthcare, yet there is little evidence of how this works in conflict settings. In 2016, South Sudan's Ministry of Health launched the Boma Health Initiative (BHI) to improve primary care services through community participation. METHODS We conducted a document analysis to examine how well the BHI policy addressed community participation in its policy formulation. We reviewed other policy documents and published literature to provide background context and supplementary data. We used a deductive thematic analysis that followed Rifkin and colleagues' community participation framework to assess the BHI policy. RESULTS The BHI planners included inputs from communities without details on how the needs assessment was conducted at the community level, what needs were considered, and from which community. The intended role of communities was to implement the policy under local leadership. There was no information on how the Initiative might strengthen or expand local women's leadership. Official documents did not contemplate local power relations or address gender imbalance. The policy approached households as consumers of health services. CONCLUSION Although the BHI advocated community participation to generate awareness, increase acceptability, access to services and ownership, the policy document did not include community participation during policy cycle.
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Affiliation(s)
- Loubna Belaid
- CIET-PRAM (Participatory Research at McGill), Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Iván Sarmiento
- CIET-PRAM (Participatory Research at McGill), Department of Family Medicine, McGill University, Montreal, QC, Canada
- Grupo de Estudios en Sistemas Tradicionales de Salud, Universidad del Rosario, Bogotá, Colombia
| | - Alexander Dimiti
- Department of Reproductive Health, Ministry of Health, Juba, South Sudan
| | - Neil Andersson
- CIET-PRAM (Participatory Research at McGill), Department of Family Medicine, McGill University, Montreal, QC, Canada
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
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Achstetter K, Köppen J, Hengel P, Blümel M, Busse R. Drivers of patient perceptions of health system responsiveness in Germany. Int J Health Plann Manage 2022; 37 Suppl 1:166-186. [PMID: 36184993 DOI: 10.1002/hpm.3570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Health system responsiveness (HSR)-the ability of a health system to meet the non-medical legitimate expectations of patients-is a key to patient-centred health systems. Although responsiveness is essential to provide equitable and accountable health care, little is known about patient-side drivers of HSR. This study aims to narrow this gap. METHODS A survey among 20,000 Germans with substitutive private health insurance included questions on HSR and patient characteristics such as health literacy (HL), experienced discrimination, and sociodemographic information. Survey data were linked to patient-level claims data. Logistic regression was applied to assess the association between HSR and patient characteristics. RESULTS The sample (age 54.0 ± 16.1; 60.5% male) contains 2951 respondents with outpatient physician care in the past year. Of the nine HSR items, eight are rated as (very) good (74.4%-94.3%), except for coordination between providers (60.2%). Patient characteristics highly influence HSR: patients with high HL, for instance, are more likely to assess responsiveness as (very) good (e.g., clear explanations from physicians: OR 4.17). Poor assessment of responsiveness is seen among users who experienced discrimination. CONCLUSION This study revealed new associations between HSR and patient characteristics. Incorporating this knowledge in practice would help strengthen patient-centred health services by considering patient experiences and expectations. This highlights that HSR can be used as a tool to evaluate and promote patient-centred health services. Future research should investigate additional drivers of HSR, both on the patient and the provider sides.
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Affiliation(s)
- Katharina Achstetter
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
| | - Julia Köppen
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
| | - Philipp Hengel
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
| | - Miriam Blümel
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
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Pedersen JF, Overgaard C, Egilstrød B, Petersen KS. The added value and unintended negative consequences of public involvement processes in the planning, development and implementation of community health services: Results from a thematic synthesis. Int J Health Plann Manage 2022; 37:3250-3268. [PMID: 35983639 DOI: 10.1002/hpm.3553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Public involvement is widely considered a means to improve health and quality of health services. The research literature reveals ambiguities concerning added value and unintended negative consequences of public involvement processes. The aim of this study is to identify, synthesise and present an overview of added value and unintended negative consequences of public involvement processes in the planning, development and implementation of community health services. METHODS Data from 36 peer-reviewed articles retrieved from a systematic search in the CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, ProQuest, and Scopus databases in October 2019 and updated in April 2021 were extracted. A three-step thematic synthesis was conducted involving (1) line-by-line text coding, (2) developing descriptive themes and (3) generating analytical themes. RESULTS Two main themes along with their corresponding themes provided an overview of the added value of public involvement processes at the individual, service and political levels. Unintended negative consequences concerning individual resources, uncertainty about the effect of involvement and power differences were revealed. CONCLUSION Added value of public involvement processes is primarily reported on an individual and service level. The added value seems to be accompanied by unintended negative consequences. Training of professional facilitators and recruitment of participants that come from vulnerable groups could help promote equality in public involvement. Unintended negative consequences need to be further explored in future evaluations in order to achieve the desired goals of public involvement.
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Affiliation(s)
- Johanne Frøsig Pedersen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Charlotte Overgaard
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Barbara Egilstrød
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsten Schultz Petersen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Pedersen JF, Egilstrød B, Overgaard C, Petersen KS. Public involvement in the planning, development and implementation of community health services: A scoping review of public involvement methods. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:809-835. [PMID: 34363264 DOI: 10.1111/hsc.13528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/20/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
Services have improved due to public involvement in the planning, development, and implementation of health services. A wide range of public involvement methods, based on highly diversified methodological approaches and conceptualisations, have been developed. However, the extensive growth of new and different involvement methods lacks consistency and promotes uncertainty about which methods to apply when, how, and why. Aiming to identify, chart and summarise public involvement methods in the planning, development and implementation of community health services, we conducted a systematic search in April 2021. Seven databases were searched: CINAHL, Cochrane, Embase, PsycINFO, PubMed, ProQuest and Scopus. The systematic facet search corresponded with the PCC framework: Patient (P), Concept (C) and Context (C). A descriptive synthesis and a thematic analysis of included studies were conducted. Thirty-nine studies met the inclusion criteria. Two main categories of public involvement methods were identified: multiple methods approaches and single method approaches involving a variety of involvement activities. The characteristics of the two categories of methods were coded in accordance with methodological approach, activity and facilitation technique. The majority of the studies` methodological approach was either participatory or community-based. A variety of techniques to facilitate group discussions, sharing of ideas, and group processes were used. The results provide an overview of the characteristics of different public involvement methods, which may inform agencies and practitioners in choosing appropriate methods to qualify the public involvement in planning, developing, and implementing community health services. Further research is needed on how to manage public involvement in the implementation of community health services. In addition, rigorous evaluation studies of the impact of public involvement methods are needed.
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Affiliation(s)
- Johanne F Pedersen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Barbara Egilstrød
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Charlotte Overgaard
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsten S Petersen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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King K, Hall T, Oostermeijer S, Currier D. Community participation in Australia's National Suicide Prevention Trial. Aust J Prim Health 2022; 28:255-263. [PMID: 35473643 DOI: 10.1071/py21083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/05/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND National systems-based suicide prevention approaches are increasingly being implemented. Community participation is fundamental to the successful implementation of these approaches, but can be challenging to undertake. We present findings from the evaluation of Australia's National Suicide Prevention Trial (the Trial). METHODS We completed consultations with 127 community members and 46 Primary Health Network (PHN) staff. Thematic analysis was undertaken to understand the process of community participation in the planning and implementation of the Trial. RESULTS Themes were identified regarding: a collaborative PHN; an engaged and passionate community; maintaining engagement; getting the right people involved; and getting stakeholders to work together. Continuous negotiation about Trial ownership, acceptability of the Trial model, and choice of activities was required. Community participation was somewhat challenging for PHNs, taking much longer than anticipated for a range of reasons. CONCLUSIONS Future system-based approaches could benefit from the provision of community participation skills training and support to enable a more coordinated, and perhaps more easily achieved, approach to the involvement of community. Despite a long process of relationship building between stakeholders, this led to improved community cohesion and integration in local suicide prevention, ready for future collaborative work.
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Affiliation(s)
- Kylie King
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Vic. 3168, Australia
| | - Teresa Hall
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Sanne Oostermeijer
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Dianne Currier
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3010, Australia
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Heumann M, Röhnsch G, Hämel K. Primary healthcare nurses' involvement in patient and community participation in the context of chronic diseases: An integrative review. J Adv Nurs 2021; 78:26-47. [PMID: 34288041 DOI: 10.1111/jan.14955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/23/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Primary healthcare nurses' potential to enable patient and community participation has been increasingly acknowledged. A conceptual understanding of their contributions within a broad range of participation processes is still lacking. AIMS The aims of this study were to develop a conceptual framework that provides information on the role of primary healthcare nurses in shaping participation processes with patients and communities in the context of chronic diseases and to identify conditions that enable or hinder the promotion of patient and community participation by nurses. DESIGN An integrative review was conducted. DATA SOURCES Twenty-three articles published from 2000 to 2019 were included in the analysis: 19 retrieved from PubMed and CHINAL and 4 added through other sources. REVIEW METHODS An inductive data analysis and quality appraisal of studies were conducted. RESULTS The analysis reveals four areas where nurses are involved in facilitating patient and community participation: (1) sharing understanding of health problems and needs, (2) developing resources and facilitating patient education for self-management, (3) raising patients' voices as an advocate in service development and (4) supporting individual and community networks. The conditions affecting nurses' engagement in fostering participation processes are as follows: (1) care priorities and overall workload, (2) nurses' attitudes towards participation and (3) users' acceptance of nurses as partners. CONCLUSIONS Future research can use the framework as a basis for empirical studies investigating nurses' involvement in pursuing patient and community participation. Interventions should focus less on indirect forms of participation, like patient education or advocacy, but should also focus on active forms of participation. Research is needed on nurses' involvement in community participation processes. IMPACT This framework can be used and adapted in future research on patient and community participation in primary healthcare. It describes areas of participation and the facilitators and barriers within the broad range of activities of primary healthcare nurses.
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Affiliation(s)
- Marcus Heumann
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Gundula Röhnsch
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Kerstin Hämel
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
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Damiaens A, Fraeyman J, Fakroune S, Hutsebaut C, Roussel S, Van Dyck L, Van Hal G, Van den Broucke S, Foulon V. General Practitioners and Community Pharmacists' Collaboration in Primary Care: Small Steps for a Major Change. Int J Integr Care 2021; 21:10. [PMID: 33976599 PMCID: PMC8064283 DOI: 10.5334/ijic.5612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Healthcare authorities worldwide search for ways to develop integrated care and interprofessional collaboration. In Belgium, Medical-Pharmaceutical Concertation (MPC) was introduced as a format to promote constructive dialogues between GPs and community pharmacists (CPs) with a focus on pharmacotherapy. OBJECTIVE To evaluate the implementation of MPC from the perspective of healthcare authorities and GPs/CPs. METHODS Mixed-methods approach, including semi-structured interviews with stakeholders and service users, observations of MPC meetings and surveys in GPs/CPs. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed inductively. RESULTS The implementation of MPC took a slow start. Parties involved had divergent views on the goals of the MPC: stakeholders focused on measurable results, while service users aimed on improving interprofessional communication. Additionally, service users felt that the lack of local structures hindered consensus building and implementation of agreements in daily practice. Support from professional associations was considered indispensable for the implementation of MPC. In order to organize this efficiently, the establishment of an independent institution, coordinating the MPC initiative, was highly recommended. CONCLUSION The study confirms that a thorough context assessment prior to implementation of a complex project is needed and that a step-wise approach should be respected to achieve effective interprofessional relationships.
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Affiliation(s)
- Amber Damiaens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Jessica Fraeyman
- Association of Community Health Centers, Vooruitgangstraat 333 box 10, B-1030 Brussels
- Department of Epidemiology and Social Medicine, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk
| | - Sarah Fakroune
- Psychological Sciences Research Institute, UCLouvain, Place Cardinal Mercier 10, B-1348, Louvain-La-Neuve, Belgium
| | - Caroline Hutsebaut
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Sandrine Roussel
- Psychological Sciences Research Institute, UCLouvain, Place Cardinal Mercier 10, B-1348, Louvain-La-Neuve, Belgium
| | - Lieve Van Dyck
- Department of Epidemiology and Social Medicine, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk
| | - Guido Van Hal
- Department of Epidemiology and Social Medicine, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, UCLouvain, Place Cardinal Mercier 10, B-1348, Louvain-La-Neuve, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
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O’Sullivan B, Hickson H, Kippen R, Cohen D, Cohen P, Wallace G. A Framework to Guide the Implementation of Best Practice Clinical Learning Environments in Community General Practice: Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041482. [PMID: 33557408 PMCID: PMC7914810 DOI: 10.3390/ijerph18041482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/22/2022]
Abstract
Clinical education/training is increasingly being expanded to community general practice settings (primary care clinics led by doctors). This plays an important role in developing a skilled “primary-care ready” workforce. However, there is limited information to guide the implementation of high-quality learning environments suitable for the range of general practices and clinical learners they oversee. We aimed to develop a consensus-based framework to address this. A co-design participatory action research method involved working with stakeholders to agree a project plan, collect and interpret data and endorse a final framework. As a starting point, an initial draft framework was adapted from an existing framework, the Best Practice Clinical Learning Environment (BPCLE) Framework. We gathered feedback about this from a national GP Supervisor Liaison Officer Network (SLON) (experienced GP clinical supervisors) during a 90-minute face-to-face focus group. They rated their agreement with the relevance of objectives and elements, advising on clear terminology and rationale for including/excluding various components. The resulting framework was refined and re-tested with the SLON and wider GP educational stakeholders until a final graphically designed version was endorsed. The resulting “GP Clinical Learning Environment” (GPCLE) Framework is applicable for planning and benchmarking best practice learning environments in general practice.
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Affiliation(s)
- Belinda O’Sullivan
- Rural Clinical School, Faculty of Medicine, University of Queensland, Toowoomba 4350, Australia
- Correspondence: ; Tel.: +61-427405030
| | - Helen Hickson
- General Practice Supervisors Australia, Bendigo 3550, Australia; (H.H.); (G.W.)
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo 3550, Australia
| | - Rebecca Kippen
- School of Rural Health, Monash University, Bendigo 3550, Australia;
| | - Donna Cohen
- MEERQAT Pty Ltd., St Kilda, Melbourne 3182, Australia; (D.C.); (P.C.)
| | - Phil Cohen
- MEERQAT Pty Ltd., St Kilda, Melbourne 3182, Australia; (D.C.); (P.C.)
| | - Glen Wallace
- General Practice Supervisors Australia, Bendigo 3550, Australia; (H.H.); (G.W.)
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Santos EPFCD, Moreira DC, Bispo Júnior JP. Avaliação de desempenho dos conselhos de saúde em municípios de pequeno e médio porte. SAUDE E SOCIEDADE 2021. [DOI: 10.1590/s0104-12902021200356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Este artigo objetiva avaliar o desempenho dos conselhos de saúde (CS) em municípios de pequeno e médio porte. Trata-se de pesquisa avaliativa com a utilização do método spidergram adaptado à realidade dos CS. A matriz avaliativa foi composta por cinco dimensões: autonomia, organização, representatividade, envolvimento comunitário e influência política. O estudo foi desenvolvido nos municípios de Nova Canaã e Itapetinga, ambos no estado da Bahia, por meio de análise documental, observação das reuniões e 31 entrevistas com conselheiros de saúde. Utilizou-se a análise de conteúdo temática para a categorização dos dados. Os CS apresentaram baixo nível de desempenho, com resultados mais desfavoráveis ao menor município. Verificaram-se limitações na autonomia, como fragilidades no apoio técnico, estrutura física e dotação orçamentária. A dimensão organização revelou irregularidades na realização das reuniões e a inexistência de comissões temáticas. Foram evidenciadas fragilidades da relação entre representantes e representados. Sobre o envolvimento comunitário, observou-se o esvaziamento dos CS e baixos índices de comparecimento dos representantes. A influência política revelou diminuta capacidade dos CS em influenciar na definição das políticas de saúde locais. A adaptação da matriz avaliativa se mostrou oportuna e adequada. Os dois casos avaliados demostraram insuficiências no processo participativo e na capacidade de influência política.
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Carlisle K, Felton-Busch C, Cadet-James Y, Taylor J, Bailie R, Farmer J, Passey M, Matthews V, Callander E, Evans R, Kelly J, Preston R, Redman-MacLaren M, Fox H, Esterman A, Zwarenstein M, Larkins S. WOmen's Action for Mums and Bubs (WOMB) Trial Protocol: A Non-randomized Stepped Wedge Implementation Trial of Participatory Women's Groups to Improve the Health of Aboriginal and Torres Strait Islander Mothers and Children in Australia. Front Public Health 2020; 8:73. [PMID: 32257990 PMCID: PMC7093577 DOI: 10.3389/fpubh.2020.00073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/25/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: In Australia, there have been improvements in Aboriginal and Torres Strait Islander maternal health, however inequities remain. There is increasing international evidence illustrating the effectiveness of Participatory Women's Groups (PWGs) in improving Maternal and Child Health (MCH) outcomes. Using a non-randomized, cluster stepped-wedge implementation of a complex intervention with mixed methods evaluation, this study aims to test the effectiveness of PWGs in improving MCH within Indigenous primary care settings in Australia and how they operate in various contexts. Methods: This study takes place in ten primary health care services across Australia and involves the recruitment of existing PWGs or the setting up of new PWGs. Services are paired based on geography for practical reasons and two services commence the PWG intervention at three monthly intervals, with the initial four services being those with existing women's groups. Implementation of the PWGs as an intervention involves training local facilitators of PWG groups, supported engagement with local MCH data through workshops, PWGs identifying and prioritizing issues and strengths and co-implementing solutions with health services. Outcomes are measured with yearly MCH audits, a cost-effectiveness study, and process evaluation of community participation and empowerment. Discussion: This study is the first to formally implement and quantitatively, yet with contextual awareness, measure the effect of applying a community participation intervention to improve the quality of Aboriginal and Torres Strait Islander MCH in Australia. Findings from this work, including detailed theory-producing qualitative analysis, will produce new knowledge of how to facilitate improved quality of MCH care in Indigenous PHC settings and how to best engage community in driving health care improvements. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618000945224. Web address: http://www.ANZCTR.org.au/ACTRN12618000945224.aspx.
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Affiliation(s)
- Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Catrina Felton-Busch
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.,Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
| | - Yvonne Cadet-James
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.,Indigenous Education and Research Centre, James Cook University, Douglas, QLD, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Ross Bailie
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Jane Farmer
- Social Innovation Research Unit, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Megan Passey
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Veronica Matthews
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Emily Callander
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Janet Kelly
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | - Robyn Preston
- School of Health, Medical and Applied Science, CQUniversity, Townsville, QLD, Australia
| | - Michelle Redman-MacLaren
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.,College of Medicine and Dentistry, James Cook University, Smithfied, QLD, Australia
| | - Haylee Fox
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Adrian Esterman
- Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, QLD, Australia
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine and Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
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15
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Rocha MB, Moreira DC, Bispo Júnior JP. [Health councils and participatory effectiveness: a performance assessment study]. CAD SAUDE PUBLICA 2019; 36:e00241718. [PMID: 31939553 DOI: 10.1590/0102-311x00241718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 07/10/2019] [Indexed: 11/22/2022] Open
Abstract
The article aims to analyze the results of a performance assessment model for health councils. The theoretical and methodological frame of reference was the spider graph method, adapted to the reality of health councils. The assessment matrix considered five dimensions with the greatest influence on participation: autonomy, organization, representativeness, community involvement, and political influence. Based on assessment of the indicators, we estimated the performance value for each dimension and located it on the five-axis graph. The matrix was applied to the Health Council in Vitória da Conquista, Bahia State, Brazil. We used document analysis, observation of meetings, and interviews with 18 council members as the data collection techniques. The results show an advanced level of the council's autonomy with adequate structural conditions, but with limitations in financial independence. The organizational dimension reached the maximum level of performance, with regular meetings, availability of information for council members, and functioning of thematic commissions. Representativeness was the dimension with the worst performance, displayed by the weak relationship between the representatives and the organizations. The community involvement dimension displayed an advanced level with high participation by council and non-council members in the meetings and action with numerous proposals. The political influence dimension showed intermediate performance. We observed greater influence by the social representatives on the decision-making process and low capacity for follow-up on policies. The matrix proved adequate and feasible for performance assessment of health councils.
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Affiliation(s)
- Maricélia Braga Rocha
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
| | - Diane Costa Moreira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
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16
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Turner NN, Taylor J, Larkins S, Carlisle K, Thompson S, Carter M, Redman-MacLaren M, Bailie R. Conceptualizing the Association Between Community Participation and CQI in Aboriginal and Torres Strait Islander PHC Services. QUALITATIVE HEALTH RESEARCH 2019; 29:1904-1915. [PMID: 31014184 DOI: 10.1177/1049732319843107] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Drawing from Australian Aboriginal and Torres Strait Islander perspectives, we conceptualize the association between community participation and continuous quality improvement (CQI) processes in Indigenous primary health care (PHC) services. Indigenous experiences of community participation were drawn from our study identifying contextual factors affecting CQI processes in high-improving PHC services. Using case study design, we collected quantitative and qualitative data at the micro-, meso-, and macro-health system level in 2014 and 2015 in six services in northern Australia. Analyzing qualitative data, we found community participation was an important contextual factor in five of the six services. Embedded in cultural foundations, cultural rules, and expectations, community participation involved interacting elements of trusting relationships in metaphorically safe spaces, and reciprocated learning about each other's perspectives. Foregrounding Indigenous perspectives on community participation might assist more effective participatory processes in Indigenous PHC including in CQI processes.
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Affiliation(s)
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, Geraldton, Western Australia, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Western Australia, Australia
| | | | - Ross Bailie
- The University of Sydney, University Centre for Rural Health, Lismore, New South Wales, Australia
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17
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Sturm H, Colombo M, Hebeiss T, Joos S, Koch R. Patient Input in Regional Healthcare Planning-A Meaningful Contribution. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3754. [PMID: 31590364 PMCID: PMC6801500 DOI: 10.3390/ijerph16193754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 11/25/2022]
Abstract
Background: There are well-known methodological and analytical challenges in planning regional healthcare services (HCS). Increasingly, the need for data-derived planning, including user-perspectives, is discussed. This study aims to better understand the possible contribution of citizen experience in the assessment of regional HCS needs in two regions of Germany. Methods: We conducted a written survey in two regions of differing size-a community (3653 inhabitants) and a county (165,211 inhabitants). Multinomial logistic regression was used to assess the impact of sociodemographic and regional factors on the assessment of HCS provided by general practitioners (GPs) and specialists. Results: Except for age and financial resources available for one's own health, populations did not differ significantly between the regions. However, citizens' perception of HCS (measured by satisfaction with 1 = very good to 5 = very poor) differed clearly between different services (e.g., specialists: 3.8-4.3 and pharmacies: 1.7-2.5) as well as between regions (GPs: 1.7-3.1; therapists: 2.9-4). In the multivariate model, region (next to income and age) was a consistent predictor of the perception of GP- and specialist-provided care. Discussion: Citizens' perceptions of HCS correspond to regional provider density (the greater the density, the better the perception) and add insights into citizens' needs. Therefore, they can provide valuable information on regional HCS strengths and weaknesses and are a valid resource to support decision makers in shaping regional care structures.
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Affiliation(s)
- Heidrun Sturm
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076 Tübingen, Germany.
| | - Miriam Colombo
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076 Tübingen, Germany.
| | - Teresa Hebeiss
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076 Tübingen, Germany.
| | - Stefanie Joos
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076 Tübingen, Germany.
| | - Roland Koch
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076 Tübingen, Germany.
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18
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Eljiz K, Greenfield D, Derrett A, Radmore S. Health system redesign: Changing thoughts, values, and behaviours for the co-production of a safety culture. Int J Health Plann Manage 2019; 34:1477-1484. [PMID: 31120155 DOI: 10.1002/hpm.2798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Simultaneous incremental and revolutionary systems change is a norm for many health care organisations. Organisational redesign, incorporating physical redevelopments and technological innovations, drives revolutionary transformations. Redesigning health facilities provides opportunities for improving and sustaining safe, high-quality patient care. There is a need for the creation of knowledge, based on empirical research, to inform how to effectively plan, implement, and evaluate health organisational redesign, underpinned by co-production principles. FINDINGS Using an Australian case study, we identify and discuss the opportunities and challenges, aligned with safety and quality requirements, to undertake redesign projects. Through an analysis of redesign and governance accountabilities, we identify five key foci for health leaders, and their communities, to plan, implement and evaluate organisational redesign. CONCLUSION By rebuilding and engaging with patients and consumers to organise, manage and deliver care, the redesign process allows us to change thoughts, values, and behaviours to achieve better patient outcomes.
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Affiliation(s)
- Kathy Eljiz
- Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia
| | - David Greenfield
- Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia
| | - Alison Derrett
- South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Simon Radmore
- South Western Sydney Local Health District, Sydney, New South Wales, Australia
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