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Myers B, Regenauer KS, Johnson K, Brown I, Rose A, Ciya N, Ndamase S, Jacobs Y, Anvari M, Hines A, Dean D, Baskar R, Magidson J. A stakeholder-driven approach to designing a peer recovery coach role for implementation in community-oriented primary care teams in South Africa. RESEARCH SQUARE 2024:rs.3.rs-4566640. [PMID: 39070655 PMCID: PMC11275972 DOI: 10.21203/rs.3.rs-4566640/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Introduction In South Africa (SA), community-oriented primary care (COPC) teams work to re-engage out-of-care people with HIV (PWH) in treatment, many of whom have substance use (SU) concerns. SU stigma is high among these teams, limiting care engagement efforts. Integrating peer recovery coaches (PRCs) into COPC teams could shift SU stigma and improve patients' engagement in care. The PRC role does not exist in SA and represents a workforce innovation. To enhance acceptability, feasibility, and appropriateness for the local context, we engaged multiple stakeholder groups to co-design a PRC role for COPC team integration. Methods We used a five-step human-centered design process: (i) semi-structured interviews with healthcare worker (HCW, n = 25) and patient (n = 15) stakeholders to identify priorities for the role; (ii) development of an initial role overview; (iii) six ideation workshops with HCW (n = 12) and patient (n = 12) stakeholders to adapt this overview; (iv) refinement of the role prototype via four co-design workshops with HCW (n = 7) and patient (n = 9) stakeholders; and (v) consultation with HIV and SU service leaders to assess the acceptability and feasibility of integrating this prototype into COPC teams. Results Although all stakeholders viewed the PRC role as acceptable, patients and HCWs identified different priorities. Patients prioritized the care experience through sharing of lived experience and confidential SU support. HCWs prioritized clarification of the PRC role, working conditions, and processes to limit any impact on the COPC team. A personal history of SU, minimum 1 year in SU recovery, and strong community knowledge were considered role prerequisites by all stakeholders. Through the iterative process, stakeholders clarified their preferences for PRC session structure, location, and content and expanded proposed components of PRC training to include therapeutic and professional work practice competencies. Service leaders endorsed the prototype after the addition of PRC integration training for COPCs and PRC mentoring to address community and COPC dynamics. Conclusion Stakeholder engagement in an iterative HCD process has been integral to co-designing a PRC role that multiple stakeholder groups consider acceptable and that COPC teams are willing to implement. This offers a methodological framework for other teams designing SU workforce innovations.
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Affiliation(s)
| | | | - Kim Johnson
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | - Imani Brown
- Department of Psychology, University of Maryland
| | | | - Nonceba Ciya
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | - Sibabalwe Ndamase
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | - Yuche Jacobs
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | | | | | - Dwayne Dean
- Department of Psychology, University of Maryland
| | | | - Jessica Magidson
- Center for Substance Use, Addiction & Health Research, University of Maryland
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Johnson EM, Possemato K, Chinman M, True G, Hedges J, Hampton BN, Edelman EJ, Maisto SA. Integrating stakeholder feedback into the design of a peer-delivered primary care wellness program: A rapid qualitative study. BMC Health Serv Res 2023; 23:1370. [PMID: 38062433 PMCID: PMC10701982 DOI: 10.1186/s12913-023-10324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Individuals seen in Primary Care with behavioral health concerns who decline behavioral health treatment may benefit from the support of peers (consumers in recovery from behavioral health concerns employed to support other consumers). Whole Health STEPS is a new intervention for Veterans in Primary Care with behavioral health concerns which combines essential elements of peers' role and the Whole Health model using a stepped-care design. We incorporated stakeholder feedback in the Whole Health STEPS design to improve fit with Veterans, peers, and primary care settings. METHODS We conducted semi-structured qualitative interviews with VA staff using questions derived from the Consolidated Framework for Implementation Research (CFIR). Participants were recruited via a maximum variation strategy across a national sample and interviewed between January 2021-April 2021. The analytic design was a rapid qualitative analysis. Interviews addressed design decisions and potential barriers and facilitators to future implementation. Then, we made adaptations to Whole Health STEPS and catalogued changes using the Framework for Adaptations and Modifications-Enhanced (FRAME). A VA peer conducted the interviews, participated in analyses, assisted with design modifications, and co-wrote this paper. RESULTS Sixteen staff members from 9 VA primary care peer programs participated (8 peers and 8 supervisors/administrators). Feedback themes included: capitalizing on peer skills (e.g., navigation), ensuring patient-centered and flexible design, and making it easy and efficient (e.g., reducing session length). Understanding the structure of primary care peers' roles and their interactions with other programs helped us identify role conflicts (e.g., overlap with Whole Health Coaches and Health Behavior Coordinators), which led to design modifications to carve out a unique role for Whole Health STEPS. Staff also made recommendations about marketing materials and training tools to support Whole Health STEPS roll out. CONCLUSIONS Feedback from frontline staff, including peers, in the design process was crucial to identifying essential modifications that would not have been possible after initial trials without re-evaluating efficacy due to the extent of the changes. Whole Health STEPS was adapted to fit within a range of program structures, emphasize peers' unique contributions, and streamline delivery. Lessons learned can be applied to other interventions.
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Affiliation(s)
- Emily M Johnson
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA.
| | - Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- RAND Corporation, Pittsburgh, PA, USA
- VISN 4 Mental Illness Research, Education, and Clinical Center, Pittsburgh, PA, USA
| | - Gala True
- South Central Mental Illness Research Education and Clinical Center, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
- Department of Medicine, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jacob Hedges
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA
| | - Brittany N Hampton
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine and Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Stephen A Maisto
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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Eliacin J, Matthias MS, Cameron KA, Burgess DJ. Veterans' views of PARTNER-MH, a peer-led patient navigation intervention, to improve patient engagement in care and patient-clinician communication: A qualitative study. PATIENT EDUCATION AND COUNSELING 2023; 114:107847. [PMID: 37331280 PMCID: PMC11184508 DOI: 10.1016/j.pec.2023.107847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE In this study, we report on participants' experiences of PARTNER-MH, a peer-led, patient-navigation intervention for racially and ethnically minoritized patients in Veterans Health Administration mental health services aimed at improving patient engagement in care and patient-clinician communication. Participants described their views of PARTNER-MH, barriers and facilitators to the intervention's implementation, and their application of varied intervention concepts to improve engagement in care and communication with their mental health clinicians. METHODS This is a qualitative analysis of the PARTNER-MH pilot randomized controlled trial. Participants participated in semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). Rapid data analysis approach was used to analyze the data. RESULTS Participants (n = 13) perceived PARTNER-MH as an acceptable intervention, and viewed use of peers as interventionists, long-term outreach and engagement efforts, and navigation services favorably. Barriers to implementation included limited flexibility in peers' schedules and lack of peer/participant gender concordance, as well as limited options for program delivery modality. Three main themes summarized participants' views and perceived benefits of PARTNER-MH that contributed to improved patient-clinician communication: 1) increased patient engagement, 2) improved patient-clinician relationship, and 3) enhanced communication self-efficacy. CONCLUSIONS Participants viewed PARTNER-MH as beneficial and identified several intervention components that contributed to improved engagement in care, communication self-efficacy, and patient-clinician communication. PRACTICE IMPLICATION Some patients, especially minoritized patients and those who have been disenfranchised from healthcare systems may benefit from peer-led interventions that facilitate engagement in care and communication self-efficacy to improve patient-clinician communication and healthcare outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04515771.
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Affiliation(s)
- Johanne Eliacin
- National Center for PTSD, VA Boston Healthcare System, Boston, USA; HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA; Regenstrief Institute, Indianapolis, USA; Indiana University School of Medicine, Department of General Internal Medicine and Geriatrics, Indianapolis, USA.
| | - Marianne S Matthias
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA; Regenstrief Institute, Indianapolis, USA; Indiana University School of Medicine, Department of General Internal Medicine and Geriatrics, Indianapolis, USA
| | - Kenzie A Cameron
- Northwestern University, Feinberg School of Medicine, Division of General Internal Medicine, Chicago, USA
| | - Diana J Burgess
- Minneapolis VA Healthcare System, Center for Care Delivery and Outcomes Research, Minneapolis, USA; University of Minnesota, Department of Medicine, Minneapolis, USA
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