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Ullman AJ, Gibson V, Kleidon TM, Binnewies S, Ohira R, Marsh N, McBride C, Winterbourn K, Boyte F, Cunninghame J, Roberts N, Xu GH, Takashima M, Cooke M, Rickard CM, Byrnes J, Larsen E. An mHealth application for chronic vascular access: Consumer led co-creation. J Pediatr Nurs 2024; 76:68-75. [PMID: 38364591 DOI: 10.1016/j.pedn.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Children with chronic and complex health conditions frequently need intravenous devices. The current approach to intravenous device selection, insertion, and monitoring is inconsistent, and healthcare consumers are often negatively affected by siloed health information, and poor future planning. Despite child- and family-centred care being recognised as a pillar of paediatric nursing care, limited implementation for vascular access device planning and management is evident. DESIGN AND METHODS To address this, we conducted a multi-phased approach to co-create, then evaluate, a mobile health (mHealth) application: IV Passport. Co-creation involved a prioritisation survey, followed by a Passport advisory panel consensus meeting. Following confirmation of the required content and features of the Passport, the mHealth application was designed and content validation achieved via survey. RESULTS The prioritisation survey yielded recommendations for seven features (e.g., graphical presentations of current/past devices). Content for nine device types (e.g., totally implanted ports) was suggested, each with 10 related items (e.g., insertion site). Content items for device-associated complications, future vascular access plans, and educational resources were also suggested. Following design, the application was released through Apple and Android platforms; and adapted to a paper version. Content validation was established; 100% strongly agreed the application was easy to use; 80% agreed/strongly agreed that they would recommend the Passport to others. CONCLUSION IV Passport embodies effective child- and family-centred care through consumer co-creation to empower patients and families manage vascular access devices. PRACTICE IMPLICATIONS IV Passport remains active; and can be utilised across many healthcare settings and patient populations.
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Affiliation(s)
- Amanda J Ullman
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia.
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Tricia M Kleidon
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Sebastian Binnewies
- School of Information and Communication Technology, Griffith University, Gold Coast, QLD, Australia
| | - Ryoma Ohira
- School of Information and Communication Technology, Griffith University, Gold Coast, QLD, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - Craig McBride
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | | | - Francesca Boyte
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Jacqueline Cunninghame
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Natasha Roberts
- Surgical, Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Grace Hui Xu
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Herston Infectious Disease Institute, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
| | - Emily Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
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Anaya M, Law W, Montoya HL, Moreira CM. Discharge Interventions for Limited English Proficiency Patients: A Scoping Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02003-2. [PMID: 38639867 DOI: 10.1007/s40615-024-02003-2] [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: 12/31/2023] [Revised: 03/30/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Limited English proficiency patients are required under federal law to receive language-concordant care, yet they still receive substandard discharge instructions compared to English-speaking patients. We aimed to summarize the interventions carried out to improve discharge instructions in the limited English proficiency population. METHODS We conducted a scoping review of academic and gray literature from the United States using Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols for Scoping Reviews guidelines. We searched PubMed, Embase, and CINAHL for studies to improve discharge communication. RESULTS Of the 3330 studies, 19 studies met the criteria. Core types of interventions included written interventions alone, educational interventions alone, written and educational interventions, audio and visual interventions, and other types of interventions. Even among the same core types of interventions, there were differences in types of interventions, outcomes examined, and results. DISCUSSION The majority of included interventions that studied satisfaction as an outcome measure showed improvement, while the other outcomes were not improved or worsened. More rigorous methodology and community involvement are necessary to further analyze discharge interventions for patients with limited English proficiency (LEP).
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Affiliation(s)
- Melanie Anaya
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA.
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA.
| | - William Law
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA
| | - Hannah L Montoya
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA
| | - Carla M Moreira
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA
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Luff D, Buscher SW, Ward VL, Ballal SA, Holden P, Pierre R, Won P, Yu EJ, Toomey SL. Understanding Racial, Ethnic, and Socioeconomic Differences in the Ambulatory Care Experience. Pediatrics 2022; 150:189912. [PMID: 36336649 DOI: 10.1542/peds.2021-056001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Racial and ethnic and socioeconomic differences in patient experience are prevalent and can negatively impact health outcomes. Our objective was to examine differences in family experience of care in the pediatric ambulatory setting. METHODS We conducted interviews with parents of patients from different demographic groups who had received care at 1 of 3 clinics at a quaternary children's hospital. Multidisciplinary team conducted inductive and deductive thematic analysis of transcribed interviews. Sentiments and recurring themes were compared within and between racial and ethnic groups, insurance status, and language. RESULTS Eighty parents were interviewed. Three primary themes were identified: (1) mitigation of system issues: parents' mixed experiences with staff or clinicians mitigating system issues impacted their overall perceptions of care; (2) pivotal role of personal interactions: clinicians' interactions positively influenced family-clinician relationships and offset negative experiences; (3) effective explanations: clinicians' clear and thorough explanations were crucial in enhancing parent confidence in care. As an overarching theme, discrimination and disrespect by staff undermined trust in care, affecting all aspects of experience. With the exception of explanations, a higher proportion of publicly-insured parents reported negative experiences across all themes compared to those with private insurance. Asian parents with public insurance had the highest proportion of interviews that were mainly negative in sentiment. CONCLUSIONS Our findings offer nuanced insights into differences in the experience of ambulatory care. Insurance status emerged as an important marker of differential perceptions of care. Our study points to areas for improvement and highlights family-clinician interactions as vital to overall positive experience.
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Affiliation(s)
- Donna Luff
- Simulator Program (SIMPeds).,Harvard Medical School, Boston, Massachusetts
| | | | - Valerie L Ward
- Office of Health Equity and Inclusion, Department of Radiology.,Harvard Medical School, Boston, Massachusetts
| | - Sonia A Ballal
- Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Sara L Toomey
- Division of General Pediatrics.,Harvard Medical School, Boston, Massachusetts
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Carandang RR, Sakamoto JL, Kunieda MK, Shibanuma A, Yarotskaya E, Basargina M, Jimba M. Effects of the maternal and child health handbook and other home-based records on mothers' non-health outcomes: a systematic review. BMJ Open 2022; 12:e058155. [PMID: 35728908 PMCID: PMC9214383 DOI: 10.1136/bmjopen-2021-058155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/17/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This review aimed to investigate the effects of the maternal and child health (MCH) handbook and other home-based records on mothers' non-health outcomes. DESIGN Systematic review. DATA SOURCES PubMed, Web of Science, CINAHL, Academic Search Complete, PsycArticles, PsycINFO, SocINDEX, CENTRAL, NHS EED, HTA, DARE, Ichuushi and J-STAGE through 26 March 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Original research articles examining home-based records and mothers' non-health outcomes published in English or Japanese across various study designs. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted relevant data and assessed the risk of bias. We assessed the certainty of evidence for each study using the Grading of Recommendations Assessment, Development, and Evaluation approach. Due to the heterogeneity of the included studies, we conducted a narrative synthesis of their findings. RESULTS Of the 4199 articles identified, we included 47 articles (20 in Japanese) in the review. Among the different types of home-based records, only the MCH handbook provided essential information about the mother-child relationship, and its use facilitated the mother-child bonding process. Mothers reported generally feeling satisfied with the use of home-based records; although their satisfaction with health services was influenced by healthcare providers' level of commitment to using these records. While home-based records positively affected communication within the household, we observed mixed effects on communication between mothers/caregivers and healthcare providers. Barriers to effective communication included a lack of satisfactory explanations regarding the use of home-based records and personalised guidance from healthcare providers. These records were also inconsistently used across different health facilities and professionals. CONCLUSIONS The MCH handbook fostered the mother-child bond. Mothers were generally satisfied with the use of home-based records, but their engagement depended on how these records were communicated and used by healthcare providers. Additional measures are necessary to ensure the implementation and effective use of home-based records. PROSPERO REGISTRATION NUMBER CRD42020166545.
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Affiliation(s)
- Rogie Royce Carandang
- Department of Community and Global Health, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Public Health Sciences, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Jennifer Lisa Sakamoto
- Department of Community and Global Health, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Mika Kondo Kunieda
- Department of Community and Global Health, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
- Faculty of Policy Management, Keio University, Fujisawa-shi, Kanagawa, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Ekaterina Yarotskaya
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Milana Basargina
- Department of Neonatal Pathology, National Medical Research Center for Children's Health, Moscow, Russian Federation
| | - Masamine Jimba
- Department of Community and Global Health, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
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Doyle C. The importance of supportive relationships with general practitioners, hospitals and pharmacists for mothers who 'give medicines' to children with severe and profound intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:29-49. [PMID: 32815761 DOI: 10.1177/1744629520951003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A purposeful sample of 15 mothers of children with severe and profound intellectual disabilities participated in this hermeneutic phenomenological study through interviews and completion of a diary. The aim of the study was to explore mothers' lived experience of 'giving medicines' to children with severe and profound intellectual disabilities. Findings yielded multiple themes, one of which gave insight into the importance of supportive relationships with health professionals. The general practitioner (GP), hospital and pharmacist are key in providing supportive elements to mothers' daily role. Having the support of a helpful GP was key in helping mothers cope on a daily basis for child related queries on illness, getting prescriptions or seeking advice. Accessibility to the hospital and avoiding the emergency department with their child was recommended. The pharmacist was central to the daily activities relating to 'giving medicines' and a good relationship resulted in a happier mother.
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Affiliation(s)
- Carmel Doyle
- School of Nursing and Midwifery, 214057Trinity College, Dublin, Ireland
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Ward VL, Tennermann NW, Chuersanga G, Melvin P, Milstein ME, Finkelstein JA, Garvin MM, Wood LJ, Rauscher NA, Laussen PC, Leichtner AM, Emans SJ, Churchwell KB. Creating a health equity and inclusion office in an academic pediatric medical center: priorities addressed and lessons learned. Pediatr Radiol 2022; 52:1776-1785. [PMID: 35229182 PMCID: PMC8885314 DOI: 10.1007/s00247-022-05283-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 11/21/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over the last two decades, medical schools and academic health centers have acknowledged the persistence of health disparities in their patients and the lack of diversity in their faculty, leaders and extended workforce. We established an Office of Health Equity and Inclusion (OHEI) at our pediatric academic medical center after a thorough evaluation of prior diversity initiatives and review of faculty development data. OBJECTIVE To describe the lessons learned at a pediatric academic medical center in prioritizing and implementing health equity, diversity and inclusion (EDI) initiatives in creating the OHEI. MATERIALS AND METHODS We reviewed internal administrative data and faculty development data, including data related to faculty who are underrepresented in medicine, to understand the role of our EDI initiatives in the strategic priorities addressed and lessons learned in the creation of the OHEI. RESULTS The intentional steps taken in our medical center's strategic approach in the creation of this office led to four important lessons to improve pediatric health equity: (1) board, senior executive and institutional prioritization of EDI initiatives; (2) multi-specialty and interprofessional collaboration; (3) academic approach to EDI programmatic development; and (4) intentionality with accountability in all EDI initiatives. CONCLUSION The key lessons learned during the creation of an Office of Health Equity and Inclusion can provide guidance to other academic health centers committed to implementing institutional priorities that focus their EDI initiatives on the improvement of pediatric health equity.
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Affiliation(s)
- Valerie L Ward
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA.
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Nicole W Tennermann
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
| | - Geeranan Chuersanga
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
| | - Patrice Melvin
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA, USA
| | - Maxine E Milstein
- Office of Faculty Development, Boston Children's Hospital, Boston, MA, USA
| | - Jonathan A Finkelstein
- Harvard Medical School, Boston, MA, USA
- Program for Patient Safety and Quality, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Michele M Garvin
- Office of General Counsel, Boston Children's Hospital, Boston, MA, USA
| | - Laura J Wood
- Nursing and Patient Care Operations, Boston Children's Hospital, Boston, MA, USA
| | - Nina A Rauscher
- Department of Health Affairs, Boston Children's Hospital, Boston, MA, USA
| | - Peter C Laussen
- Harvard Medical School, Boston, MA, USA
- Department of Health Affairs, Boston Children's Hospital, Boston, MA, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Alan M Leichtner
- Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Division of Gastroenterology, Boston Children's Hospital, Boston, MA, USA
- Department of Education, Boston Children's Hospital, Boston, MA, USA
| | - S Jean Emans
- Harvard Medical School, Boston, MA, USA
- Office of Faculty Development, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Kevin B Churchwell
- Harvard Medical School, Boston, MA, USA
- Office of the CEO and President, Boston Children's Hospital, Boston, MA, USA
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Stephen JM, Zoucha R. Spanish Speaking, Limited English Proficient Parents whose Children are Hospitalized: An Integrative Review. J Pediatr Nurs 2020; 52:30-40. [PMID: 32163844 DOI: 10.1016/j.pedn.2020.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022]
Abstract
PROBLEM Children of non-English speakers are at risk for health disparities. Little is known about the experiences of Spanish speaking parents with limited English proficiency (LEP) whose children are hospitalized. The purposes of this integrative review were to explore what is known and to identify gaps in the literature about the experiences of Spanish speaking parents with LEP whose children are hospitalized. ELIGIBILITY CRITERIA Whittemore and Knafl's (2005) integrative review method guided the process. Studies addressed Spanish speaking parents of hospitalized children in the United States. SAMPLE A final sample consisted of 36 quantitative and qualitative research studies published from 1994 to 2018; located through a search of CINAHL, Pubmed, and Scopus. RESULTS Language services were inconsistent although mandated by standards and laws. Parents experienced mixed emotions related to care. Emergency departments in large, urban cities were the most common care settings. Differences in care outcomes and safety risks for children of Spanish speaking parents existed; however, findings were inconsistent. Only three of the 36 studies addressed nursing care. CONCLUSIONS Research design and quality varied. Parents valued communication in their language. Nurses are the primary healthcare provider in the hospital setting but few studies explored parents' experiences associated with nursing care. No studies explored parents' experiences with their child's hospitalization in the context of culture. IMPLICATIONS Future research is needed to explore the cultural values, beliefs, and experiences of Spanish speaking parents with LEP and the role of nurses and to inform culturally congruent nursing care, research, and policy.
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Mahadevan S, Broaddus-Shea ET. How Should Home-Based Maternal and Child Health Records Be Implemented? A Global Framework Analysis. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:100-113. [PMID: 32234843 PMCID: PMC7108936 DOI: 10.9745/ghsp-d-19-00340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/22/2020] [Indexed: 11/18/2022]
Abstract
Our assessment of home-based record use in low- and middle-income countries indicated that the implementation process consists of 8 interdependent components involving policy makers, funders, and end users—health care workers, pregnant women, and the parents/caregivers of children. Successful implementation can result in improved maternal and child health outcomes and more efficient use of government and donor investments. Background: A home-based record (HBR) is a health document kept by the patient or their caregivers, rather than by the health care facility. HBRs are used in 163 countries, but they have not been implemented universally or consistently. Effective implementation maximizes both health impacts and cost-effectiveness. We sought to examine this research-to-practice gap and delineate the facilitators and barriers to the effective implementation and use of maternal and child health HBRs especially in low- and middle-income countries (LMICs). Methods: Using a framework analysis approach, we created a framework of implementation categories in advance using subject expert inputs. We collected information through 2 streams. First, we screened 69 gray literature documents, of which 18 were included for analysis. Second, we conducted semi-structured interviews with 12 key informants, each of whom had extensive experience with HBR implementation. We abstracted the relevant data from the documents and interviews into an analytic matrix. The matrix was based on the initial framework and adjusted according to emergent categories from the data. Results: We identified 8 contributors to successful HBR implementation. These include establishing high-level support from the government and ensuring clear communication between all ministries and nongovernmental organizations involved. Choice of appropriate contents within the record was noted as important for alignment with the health system and for end user acceptance, as were the design, its physical durability, and timely redesigns. Logistical considerations, such as covering costs sustainably and arranging printing and distribution, could be potential bottlenecks. Finally, end users' engagement with HBRs depended on how the record was initially introduced to them and how its importance was reinforced over time by those in leadership positions. Conclusions: This framework analysis is the first study to take a more comprehensive and broad approach to the HBR implementation process in LMICs. The findings provide guidance for policy makers, donors, and health care practitioners regarding best implementation practice and effective HBR use, as well as where further research is required.
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Affiliation(s)
- Sruthi Mahadevan
- University College London Medical School; Royal Free London NHS Foundation Trust, London, UK.
| | - Elena T Broaddus-Shea
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Magwood O, Kpadé V, Afza R, Oraka C, McWhirter J, Oliver S, Pottie K. Understanding women's, caregivers', and providers' experiences with home-based records: A systematic review of qualitative studies. PLoS One 2018; 13:e0204966. [PMID: 30286161 PMCID: PMC6171900 DOI: 10.1371/journal.pone.0204966] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 09/15/2018] [Indexed: 11/19/2022] Open
Abstract
Mothers, caregivers, and healthcare providers in 163 countries have used paper and electronic home-based records (HBRs) to facilitate primary care visit. These standardized records have the potential to empower women, improve the quality of care for mothers and children and reduce health inequities. This review examines experiences of women, caregivers and providers with home-based records for maternal and child health and seeks to explore the feasibility, acceptability, affordability and equity of these interventions. We systematically searched MEDLINE, MEDLINE In-Process, MEDLINE Ahead of Print, Embase, CINAHL, ERIC, and PsycINFO for articles that were published between January 1992 and December 2017. We used the CASP checklist to assess study quality, a framework analysis to support synthesis, and GRADE-CERQual to assess the confidence in the key findings. Of 7,904 citations, 19 studies met our inclusion criteria. In these studies, mothers, caregivers and children shared HBR experiences in relation to maternal and child health which facilitated the monitoring of immunisations and child growth and development. Participants' reports of HBRs acting as a point of commonality between patient and provider offer an explanation for their perceptions of improved communication and patient-centered care, and enhanced engagement and empowerment during pregnancy and childcare. Healthcare providers and nurses reported that the home-based record increased their feeling of connection with their patients. Although there were concerns around electronic records and confidentiality, there were no specific concerns reported for paper records. Mothers and other caregivers see home based records as having a pivotal role in facilitating primary care visits and enhancing healthcare for their families. The records' potential could be limited by users concerns over confidentiality of electronic home-based records, or shortcomings in their design. Health systems should seize the opportunity HBRs provide in empowering women, especially in the contexts of lower literacy levels and weak health care delivery systems.
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Affiliation(s)
- Olivia Magwood
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Victoire Kpadé
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Ruh Afza
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | | | | | - Sandy Oliver
- Department of Social Science, University College London, London, United Kingdom
- University of Johannesburg, Johannesburg, South Africa
| | - Kevin Pottie
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
- Departments of Family Medicine & Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
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Northway R, Rees S, Davies M, Williams S. Hospital passports, patient safety and person-centred care: A review of documents currently used for people with intellectual disabilities in the UK. J Clin Nurs 2017; 26:5160-5168. [PMID: 28881074 DOI: 10.1111/jocn.14065] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To review hospital passports currently in use for people with intellectual disabilities in the UK and to make recommendations for practice. BACKGROUND Hospital passports have been introduced internationally to address communication barriers that may limit access to appropriate health care for people with intellectual disabilities. They are viewed as promoting patient safety and person-centred care but their format may vary, they are not always used appropriately, and hence, their effectiveness may be limited. DESIGN Qualitative content analysis. METHODS Sixty hospital passports in use in the UK were reviewed against a coding frame by two members of the research team. Areas of interest included key patient and primary care information, support network details, consent and capacity, support required in relation to activities of daily living, length of the document and completion details. Results were entered into Excel. RESULTS Considerable variation was found between documents in terms of terminology, length and format. Most included information regarding communication and support needs although some omitted important information such as allergies, risk assessment and need for reasonable adjustments. CONCLUSIONS Considerable variation exists between current hospital passports, which may limit their effectiveness: key information required may not be included and/or it may not be easy to locate. Greater standardisation of documents is required, but this process should include input from all key stakeholders. RELEVANCE TO CLINICAL PRACTICE Internationally nurses provide care for people with intellectual disabilities and others with communication difficulties. Hospital passports are one way of enhancing safety and person-centred care, need to be accessed and used as a basis for care planning. However, variation in format may limit this effectiveness and nurses should work with others to develop a more standardised approach, which better meets the needs of all stakeholders.
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Affiliation(s)
- Ruth Northway
- School of Care Sciences, University of South Wales, Pontypridd, UK
| | - Stacey Rees
- School of Care Sciences, University of South Wales, Pontypridd, UK
| | - Michelle Davies
- Llanfrechfa Grange, Aneurin Bevan University Health Board, Llanfrechfa, Cwmbran, UK
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