1
|
Brubacher LJ, Lau LL, Bustos M, Kelly Mijares M, Lim Mar K, Dodd W. Exploring the Use of Multiple Participatory Tools to Engage Community Health Workers in Program Evaluation and Implementation: A Case Study From the Philippines. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241280353. [PMID: 39241210 DOI: 10.1177/2752535x241280353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2024]
Abstract
This study explored the use of three participatory tools within a Philippines-based case study with community health workers (CHWs) by comparing and contrasting the process and data generated across the tools, and critically reflecting on adaptations and facilitation considerations that affected the tools' use. Facilitator notes and audio-recordings of discussions were integrated and analyzed thematically. Tools differed by the type of data generated: program-specific data related to CHWs' roles and responsibilities or data on broader structural factors. A stepwise approach within each tool facilitated focused, in-depth sharing, as did initial paired discussions that allowed exchange of knowledge and experiences among CHWs. Facilitators required topic- and context-specific knowledge to guide discussion effectively. CHWs discussed challenges and successes in their roles; program recommendations; and broader challenges related to healthcare delivery in their communities. This study contributes critical insights on the use of participatory tools to promote the inclusion of implementer perspectives in health program co-design, implementation, and evaluation.
Collapse
Affiliation(s)
- Laura J Brubacher
- School of Public Health Sciences, University of Waterloo, Ontario, Canada
| | - Lincoln L Lau
- School of Public Health Sciences, University of Waterloo, Ontario, Canada
- International Care Ministries, Metro Manila, Philippines
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Monica Bustos
- School of Public Health Sciences, University of Waterloo, Ontario, Canada
| | | | - Krisha Lim Mar
- International Care Ministries, Metro Manila, Philippines
| | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, Ontario, Canada
| |
Collapse
|
2
|
Nicosia FM, Zamora K, Rizzo A, Spar MJ, Silvestrini M, Brown RT. Using multiple qualitative methods to inform intervention development: Improving functional status measurement for older veterans in primary care settings. PLoS One 2023; 18:e0290741. [PMID: 37616266 PMCID: PMC10449158 DOI: 10.1371/journal.pone.0290741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
Functional status, or the ability to perform activities of daily living, is central to older adults' health and quality of life. However, health systems have been slow to incorporate routine measurement of function into patient care. We used multiple qualitative methods to develop a patient-centered, interprofessional intervention to improve measurement of functional status for older veterans in primary care settings. We conducted semi-structured interviews with patients, clinicians, and operations staff (n = 123) from 7 Veterans Health Administration (VHA) Medical Centers. Interviews focused on barriers and facilitators to measuring function. We used concepts from the Consolidated Framework for Implementation Science and sociotechnical analysis to inform rapid qualitative analyses and a hybrid deductive/inductive approach to thematic analysis. We mapped qualitative findings to intervention components. Barriers to measurement included time pressures, cumbersome electronic tools, and the perception that measurement would not be used to improve patient care. Facilitators included a strong interprofessional environment and flexible workflows. Findings informed the development of five intervention components, including (1) an interprofessional educational session; (2) routine, standardized functional status measurement among older patients; (3) annual screening by nurses using a standardized instrument and follow-up assessment by primary care providers; (4) electronic tools and templates to facilitate increased identification and improved management of functional impairment; and (5) tailored reports on functional status for clinicians and operations leaders. These findings show how qualitative methods can be used to develop interventions that are more responsive to real-world contexts, increasing the chances of successful implementation. Using a conceptually-grounded approach to intervention development has the potential to improve patient and clinician experience with measuring function in primary care.
Collapse
Affiliation(s)
- Francesca M. Nicosia
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Kara Zamora
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Anael Rizzo
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Malena J. Spar
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Molly Silvestrini
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Rebecca T. Brown
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| |
Collapse
|
3
|
Olmos-Ochoa TT, Luger TM, Oishi A, Dyer KE, Sumberg A, Canelo I, Gideonse TK, Cheney A, Yano EM, Hamilton AB. Challenges to Engaging Women Veterans in Quality Improvement From Patient Care to Policy: Women's Health Managers' Perspectives. Womens Health Issues 2023; 33:199-207. [PMID: 36153165 DOI: 10.1016/j.whi.2022.08.004] [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: 08/02/2021] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Patients are uniquely positioned to identify issues and to provide innovative solutions to problems impacting their care. Yet, patient engagement in quality improvement (QI) and health care governance remains limited and underexplored. In the Veterans Health Administration, the work of women's health managers (WHMs) includes engaging women veterans, a numerical minority with unique health care needs, in QI. We aimed to understand the extent to which WHMs engage women veterans along a continuum, highlight challenges to engagement, and identify potential strategies to facilitate multilevel patient engagement. METHODS Data were generated from a multisite evaluation to improve delivery of comprehensive women's health care in Veterans Health Administration primary care sites. We conducted 39 semistructured interviews with WHMs across 21 sites. Guided by Carman et al.'s patient engagement framework, we analyzed the interviews using rapid-qualitative and content analysis methods. RESULTS When effectively engaged, women veterans were important champions and partners in QI activities to improve the structure and delivery of care. However, most WHMs engaged women veterans in mainly informal or passive ways-that is, solicited feedback through comment cards, surveys, focus groups, and townhall meetings-and did not report pursuing more in-depth or long-term forms of engagement. WHMs also identified a variety of facilitators and challenges to engaging women veterans in QI. CONCLUSIONS There may be unanticipated benefits to health care policy from engaging patients in QI, especially for patients with unique health care needs who represent a minority within the health care system. However, managers require training and workflow integration of patient engagement tasks to increase their efficiency and allow for meaningful patient engagement.
Collapse
Affiliation(s)
- Tanya T Olmos-Ochoa
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California.
| | - Tana M Luger
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California; Covenant Health Network, Phoenix, Arizona
| | - Anneka Oishi
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Karen E Dyer
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Annie Sumberg
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Ismelda Canelo
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Theodore K Gideonse
- Department of Health, Science, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California
| | - Ann Cheney
- Department of Social Medicine, Population, and Public Health, University of California Riverside School of Medicine, Riverside, California
| | - Elizabeth M Yano
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; Department of Medicine, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Alison B Hamilton
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Psychiatry & Biobehavioral Sciences, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
4
|
Snell-Rood C, Jaramillo ET, Hamilton AB, Raskin SE, Nicosia FM, Willging C. Advancing health equity through a theoretically critical implementation science. Transl Behav Med 2021; 11:1617-1625. [PMID: 33904908 PMCID: PMC8367016 DOI: 10.1093/tbm/ibab008] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
While implementation science is driven by theory, most implementation science theories, models, and frameworks (TMF) do not address issues of power, inequality, and reflexivity that are pivotal to achieving health equity. Theories used in anthropology address these issues effectively and could complement prevailing implementation science theories and constructs. We propose three broad areas of theory that complement and extend existing TMF in implementation science to advance health equity. First, theories of postcoloniality and reflexivity foreground attention to the role of power in knowledge production and to the ways that researchers and interventionists may perpetuate the inequalities shaping health. Second, theories of structural violence and intersectionality can help us to better understand the unequal burden of health disparities in the population, thereby encouraging researchers to think beyond single interventions to initiate partnerships that can impact overlapping health vulnerabilities and influence the upstream causes of vulnerability. Finally, theories of policy and governance encourage us to examine the social-political forces of the "outer context" crucial for implementation and sustainability. The incorporation of critical theories could enhance implementation science and foster necessary reflexivity among implementation scientists. We contend that a theoretically critical implementation science will promote better science and, more importantly, support progress toward health equity.
Collapse
Affiliation(s)
- Claire Snell-Rood
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Elise Trott Jaramillo
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, Albuquerque, NM, USA
| | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Sarah E Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Richmond, VA, USA
| | - Francesca M Nicosia
- Institute for Health & Aging, University of California, Integrative Health, San Francisco VA Health Care System, San Francisco, CA, USA
| | - Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, Albuquerque, NM, USA
| |
Collapse
|
5
|
Verburg AC, van Dulmen SA, Kiers H, Ypinga JH, Nijhuis-van der Sanden MW, van der Wees PJ. Development of a Standard Set of Outcome Domains and Proposed Measures for Chronic Obstructive Pulmonary Disease in Primary Care Physical Therapy Practice in the Netherlands: a Modified RAND/UCLA Appropriateness Method. Int J Chron Obstruct Pulmon Dis 2019; 14:2649-2661. [PMID: 31819398 PMCID: PMC6886541 DOI: 10.2147/copd.s219851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background Standardization of measures in a common set opens the opportunity to learn from differences in treatment outcomes which can be used for improving the quality of care. Furthermore, a standard set can provide the basis for development of quality indicators and is therefore useful for quality improvement and public reporting purposes. The aim of this study was to develop a standard set of outcome domains and proposed measures for patients with COPD in Dutch primary care physical therapy practice, including a proposal to stratify patients in subgroups. Material and methods A consensus-driven modified RAND-UCLA appropriateness method was conducted with relevant stakeholders (patients, physical therapists, researchers, policy makers and health insurers) in Dutch primary physical therapy care in eight steps: (1) literature search, (2) first online survey, (3) patient interviews, (4) expert meeting, resulting in a concept standard set and methods to identify subgroups' (5) consensus meeting, (6) expert meeting (7) second online survey and (8) final approval of an advisory board resulting of the approved standard set. Results Five outcome domains were selected for COPD: physical capacity, muscle strength, physical activity, dyspnea and quality of life. A total of 21 measures were rated and discussed. Finally, eight measures were included, of which four mandatory measures: Characteristics of practices and physical therapists, Clinical COPD Questionnaire (CCQ) for quality of life, Global Perceived Effect (GPE) for experience, 6-mins Walk Test (6-MWT) for physical capacity; two conditional measures: Hand-Held Dynamometer (HHD) (with Microfet™) for Quadriceps strength, Medical Research Council Dyspnea (MRC) for monitoring dyspnea; and two exploratory measures: Accelerometry for physical activity, and the Assessment of Burden of COPD tool (ABC). To identify subgroups, a method described in the Dutch standard of care from the Lung Alliance was included. Conclusion This study described the development of a standard set of outcome domains and proposed measures for patients with COPD in primary care physical therapy. Each measure was accepted for relevance and feasibility by the involved stakeholders. The set is currently used in daily practice and tested on validity and reliability in a pilot for the development of quality indicators.
Collapse
Affiliation(s)
- Arie C Verburg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands
| | - Simone A van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands
| | - Henri Kiers
- Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, Netherlands.,Association for Quality in Physical Therapy (SKF), Zwolle, Netherlands
| | | | | | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands
| |
Collapse
|
6
|
Verburg AC, van Dulmen SA, Kiers H, Nijhuis-van der Sanden MWG, van der Wees PJ. Development of a standard set of outcome measures for non-specific low back pain in Dutch primary care physiotherapy practices: a Delphi study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1550-1564. [PMID: 31004195 DOI: 10.1007/s00586-019-05962-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/22/2019] [Accepted: 03/24/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop a clinical standard set of outcome measures that are accepted for relevance and feasibility by stakeholders and useful for (a) interaction between patient and the professional, e.g. shared decision-making in goal-setting, monitoring and feedback based on outcomes, (b) internal quality improvement, and (c) external transparency in patients with non-specific low back pain (NSLBP) in primary care physical therapy. METHODS We used a consensus-driven modified RAND-UCLA Delphi method in seven steps with panellists (patients, representatives of patient and physiotherapy associations, researchers, policy makers, health insurers): (1) literature search, (2) first online survey, (3) patient interviews, (4) an experts meeting, (5) a consensus meeting, (6) second online survey, and (7) final approval of an advisory board. Steps 1-4 resulted in potential outcome measures. In the consensus meeting after discussion panellists voted for inclusion per measure. In the second online survey the final standard set was rated on relevance and feasibility on a 9-point Likert scale; when the median score was ≥ 7, the standard set was accepted and finally approved. RESULTS Thirteen draft outcome measures were rated and discussed, and finally, six outcome measures were accepted. The standard set includes the Quebec Back Pain Disability Scale, Oswestry Disability Index, Patient-Specific Functional Scale, Numeric Pain Rating Scale, Global Perceived Effect (GPE-DV), and the STarT Back Screening Tool (SBT). CONCLUSION This study presents a standard set of outcome measures for patients with NSLBP in primary care physiotherapy accepted for relevance and feasibility by stakeholders. The standard set is currently used in daily practice and tested on validity and reliability in a pilot study. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- A C Verburg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
| | - S A van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - H Kiers
- Institute for Human Movement Studies, Utrecht University of Applied Sciences, Utrecht, The Netherlands
- Association for Quality in Physical Therapy (SKF), Zwolle, The Netherlands
| | - M W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - P J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| |
Collapse
|