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Pahwa M, Cavanagh A, Vanstone M. Key Informants in Applied Qualitative Health Research. QUALITATIVE HEALTH RESEARCH 2023; 33:1251-1261. [PMID: 37902082 PMCID: PMC10666509 DOI: 10.1177/10497323231198796] [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] [Indexed: 10/31/2023]
Abstract
Identifying and recruiting key informants is a widely used sampling strategy in applied qualitative health research. Key informants were first conceptualized within ethnography, but there is little methodological guidance about how to use this technique outside of that research tradition. The objective of this article is to offer practical suggestions about how existing methods for data collection with key informants could be translated to methodologies commonly used in applied qualitative health research. This article delineates how key informants could be conceptualized and sampled and how data sufficiency can be approached. The article prompts deeper consideration of the politics of representation and epistemic power that are inherent to the use of key informants in applied qualitative health research.
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Affiliation(s)
- Manisha Pahwa
- Health Policy PhD Program, McMaster University, Hamilton, ON, Canada
- Occupational Cancer Research Centre, Cancer Care Ontario, Ontario Health, Toronto, ON, Canada
| | - Alice Cavanagh
- Health Policy PhD Program, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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Majidi SA, Fakoorfard Z, Safarmohammadi H, Kazemnezhad Leily E. The Relationship between Moral Intelligence and Patient Safety Culture in Nurses. J Caring Sci 2023; 12:241-247. [PMID: 38249999 PMCID: PMC10799267 DOI: 10.34172/jcs.2023.30501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/09/2021] [Indexed: 01/23/2024] Open
Abstract
Introduction Ethical issues are among the first concerns and important issues in the daily care of nurses, so that nurses always try to maintain and observe them in order to provide better and more basic care to patients. Moral intelligence (MI) can provide a framework for the proper functioning of nurses. The main purpose of this study was to determine the relationship between patient safety culture and the MI of nurses working in hospitals in Iran, Guilan province. Methods In the present study which was descriptive and correlational research, the sample was 400 nurses from Iran. Data were collected by a standardized and modified questionnaire "Hospital Survey on Patient Safety Culture (HSOPSC)", and "Lennick & Kiel's Moral Intelligence Scale". The collected data were analyzed by Spearman correlation and Friedman test via SPSS software version 13. Results The findings of the study showed that the relationship between the patient safety culture and MI, was significant, and the total MI score (P<0.0001 and r=0.30). Conclusion There is a positive correlation between MI of nurses and patient safety culture. Therefore, planning to increase the MI of nurses can lead to improve patients' safety culture.
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Affiliation(s)
- Seyed Ali Majidi
- Department of Nursing & Midwifery, Rasht Branch, Islamic Azad University, Rasht, Iran
| | - Zeinab Fakoorfard
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamideh Safarmohammadi
- Poursina Education & Treatment Center, Guilan University of Medical Sciences, Guilan, Iran
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Whyle EB, Olivier J. Towards an Explanation of the Social Value of Health Systems: An Interpretive Synthesis. Int J Health Policy Manag 2021; 10:414-429. [PMID: 32861236 PMCID: PMC9056134 DOI: 10.34172/ijhpm.2020.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/15/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Health systems are complex social systems, and values constitute a central dimension of their complexity. Values are commonly understood as key drivers of health system change, operating across all health systems components and functions. Moreover, health systems are understood to influence and generate social values, presenting an opportunity to harness health systems to build stronger, more cohesive societies. However, there is little investigation (theoretical, conceptual, or empirical) on social values in health policy and systems research (HPSR), particularly regarding the capacity of health systems to influence and generate social values. This study develops an explanatory theory for the 'social value of health systems.' METHODS We present the results of an interpretive synthesis of HPSR literature on social values, drawing on a qualitative systematic review, focusing on claims about the relationship between 'health systems' and 'social values.' We combined relational claims extracted from the literature under a common framework in order to generate new explanatory theory. RESULTS We identify four mechanisms by which health systems are considered to contribute social value to society: Health systems can: (1) offer a unifying national ideal and build social cohesion, (2) influence and legitimise popular attitudes about rights and entitlements with regard to healthcare and inform citizen's understanding of state responsibilities, (3) strengthen trust in the state and legitimise state authority, and (4) communicate the extent to which the state values various population groups. CONCLUSION We conclude that, using a systems-thinking and complex adaptive systems perspective, the above mechanisms can be explained as emergent properties of the dynamic network of values-based connections operating within health systems. We also demonstrate that this theory accounts for how HPSR authors write about the relationship between health systems and social values. Finally, we offer lessons for researchers and policy-makers seeking to bring about values-based change in health systems.
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Affiliation(s)
- Eleanor Beth Whyle
- Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Schoemaker CG, van Loon J, Achterberg PW, den Hertog FRJ, Hilderink H, Melse J, Vonk RAA, van Oers H. Four normative perspectives on public health policy-making and their preferences for bodies of evidence. Health Res Policy Syst 2020; 18:94. [PMID: 32831080 PMCID: PMC7446163 DOI: 10.1186/s12961-020-00614-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 08/03/2020] [Indexed: 01/03/2023] Open
Abstract
Calls for evidence-informed public health policy-making often ignore that there are multiple, and often competing, bodies of potentially relevant evidence to which policy-makers have recourse in identifying policy priorities and taking decisions. In this paper, we illustrate how policy frames may favour the use of specific bodies of evidence. For the sixth Dutch Public Health Status and Foresight report (2014), possible future trends in population health and healthcare expenditure were used as a starting point for a deliberative dialogue with stakeholders to identify and formulate the most important societal challenges for the Dutch health system. Working with these stakeholders, we expanded these societal challenges into four normative perspectives on public health. These perspectives can be regarded as policy frames. In each of the perspectives, a specific body of evidence is favoured and other types of evidence are neglected. Crucial outcomes in one body may be regarded as irrelevant from other perspectives. Consequently, the results of research from a single body of evidence may not be helpful in the policy-making processes because policy-makers need to account for trade-offs between all competing interests and values. To support these policy processes, researchers need to combine qualitative and quantitative methodologies to address different outcomes from the start of their studies. We feel it is time for the research community to re-politicise the idea of evidence use and for policy-makers to demand research that helps them to account for all health-related policy goals. This is a prerequisite for real evidence-informed policy-making.
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Affiliation(s)
- Casper G Schoemaker
- National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands.
| | - Jeanne van Loon
- Ministry of Education, Culture and Science, Rijnstraat 50, 2515 XP, Den Haag, The Netherlands
| | - Peter W Achterberg
- National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
| | - Frank R J den Hertog
- National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
| | - Henk Hilderink
- National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
| | - Johan Melse
- National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
| | - Robert A A Vonk
- The Council for Health and Society, Parnassusplein 5, 2511 VX, Den Haag, The Netherlands
| | - Hans van Oers
- Ministry of Health, Welfare and Sport, Parnassusplein 5, 2511 VX, Den Haag, The Netherlands
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The Public Health Status and Foresight report 2014: Four normative perspectives on a healthier Netherlands in 2040. Health Policy 2019; 123:252-259. [DOI: 10.1016/j.healthpol.2018.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/04/2018] [Accepted: 10/22/2018] [Indexed: 11/22/2022]
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Wang L, Grignon M, Perry S, Chen XK, Ytsma A, Allin S, Gapanenko K. The Determinants of the Technical Efficiency of Acute Inpatient Care in Canada. Health Serv Res 2018; 53:4829-4847. [PMID: 29665053 DOI: 10.1111/1475-6773.12861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the technical efficiency of acute inpatient care at the pan-Canadian level and to explore the factors associated with inefficiency-why hospitals are not on their production frontier. DATA SOURCES/STUDY SETTING Canadian Management Information System (MIS) database (CMDB) and Discharge Abstract Database (DAD) for the fiscal year of 2012-2013. STUDY DESIGN We use a nonparametric approach (data envelopment analysis) applied to three peer groups (teaching, large, and medium hospitals, focusing on their acute inpatient care only). The double bootstrap procedure (Simar and Wilson 2007) is adopted in the regression. DATA COLLECTION/EXTRACTION METHODS Information on inpatient episodes of care (number and quality of outcomes) was extracted from the DAD. The cost of the inpatient care was extracted from the CMDB. PRINCIPAL FINDINGS On average, acute hospitals in Canada are operating at about 75 percent efficiency, and this could thus potentially increase their level of outcomes (quantity and quality) by addressing inefficiencies. In some cases, such as for teaching hospitals, the factors significantly correlated with efficiency scores were not related to management but to the social composition of the caseload. In contrast, for large and medium nonteaching hospitals, efficiency related more to the ability to discharge patients to postacute care facilities. The efficiency of medium hospitals is also positively related to treating more clinically noncomplex patients. CONCLUSIONS The main drivers of efficiency of acute inpatient care vary by hospital peer groups. Thus, the results provide different policy and managerial implications for teaching, large, and medium hospitals to achieve efficiency gains.
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Affiliation(s)
- Li Wang
- McMaster University, Hamilton, ON, Canada
| | | | - Sheril Perry
- Canadian Institute for Health Information, Ottawa, ON, Canada
| | - Xi-Kuan Chen
- Canadian Institute for Health Information, Toronto, ON, Canada
| | - Alison Ytsma
- Canadian Institute for Health Information, Toronto, ON, Canada
| | - Sara Allin
- Canadian Institute for Health Information, Toronto, ON, Canada
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Wong ST, MacDonald M, Martin-Misener R, Meagher-Stewart D, O’Mara L, Valaitis RK. What systemic factors contribute to collaboration between primary care and public health sectors? An interpretive descriptive study. BMC Health Serv Res 2017; 17:796. [PMID: 29191182 PMCID: PMC5709916 DOI: 10.1186/s12913-017-2730-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Purposefully building stronger collaborations between primary care (PC) and public health (PH) is one approach to strengthening primary health care. The purpose of this paper is to report: 1) what systemic factors influence collaborations between PC and PH; and 2) how systemic factors interact and could influence collaboration. METHODS This interpretive descriptive study used purposive and snowball sampling to recruit and conduct interviews with PC and PH key informants in British Columbia (n = 20), Ontario (n = 19), and Nova Scotia (n = 21), Canada. Other participants (n = 14) were knowledgeable about collaborations and were located in various Canadian provinces or working at a national level. Data were organized into codes and thematic analysis was completed using NVivo. The frequency of "sources" (individual transcripts), "references" (quotes), and matrix queries were used to identify potential relationships between factors. RESULTS We conducted a total of 70 in-depth interviews with 74 participants working in either PC (n = 33) or PH (n = 32), both PC and PH (n = 7), or neither sector (n = 2). Participant roles included direct service providers (n = 17), senior program managers (n = 14), executive officers (n = 11), and middle managers (n = 10). Seven systemic factors for collaboration were identified: 1) health service structures that promote collaboration; 2) funding models and financial incentives supporting collaboration; 3) governmental and regulatory policies and mandates for collaboration; 4) power relations; 5) harmonized information and communication infrastructure; 6) targeted professional education; and 7) formal systems leaders as collaborative champions. CONCLUSIONS Most themes were discussed with equal frequency between PC and PH. An assessment of the system level context (i.e., provincial and regional organization and funding of PC and PH, history of government in successful implementation of health care reform, etc) along with these seven system level factors could assist other jurisdictions in moving towards increased PC and PH collaboration. There was some variation in the importance of the themes across provinces. British Columbia participants more frequently discussed system structures that could promote collaboration, power relations, harmonized information and communication structures, formal systems leaders as collaboration champions and targeted professional education. Ontario participants most frequently discussed governmental and regulatory policies and mandates for collaboration.
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Affiliation(s)
- Sabrina T. Wong
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall, T161, Vancouver, Canada
- Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, Canada
| | - Marjorie MacDonald
- School of Nursing, University of Victoria, HSD B220, 3800 Finnerty Road, Victoria, BC V8P 5C2 Canada
| | - Ruth Martin-Misener
- Dalhousie University, Room G26, Forrest Bldg., 5869 University Avenue, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Donna Meagher-Stewart
- Dalhousie University, Room G26, Forrest Bldg., 5869 University Avenue, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Linda O’Mara
- School of Nursing Health Sciences Center Room 3N25E, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Ruta K. Valaitis
- School of Nursing Health Sciences Center Room 3N25E, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
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Mettler T, Vimarlund V. All that Glitters is not Gold: Six Steps Before Selecting and Prioritizing e-Health Services. J Med Syst 2017; 41:154. [PMID: 28852918 DOI: 10.1007/s10916-017-0801-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/21/2017] [Indexed: 11/30/2022]
Abstract
Since the market for e-health applications is constantly growing, it is getting an ever more complex endeavor to select and prioritize the right service offering given a particular situation. In examining the extant literature, it was revealed that little emphasis is actually placed on how to analyze contextual or environmental factors prior to the selection and prioritization of e-health services. With this paper, we therefore propose a formative framework consisting of six fundamental yet very pragmatic steps that may support decision makers in identifying the most important contextual pre-requisites that e-health services need to fulfill in order to be considered as effective for their environment to be implemented.
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Affiliation(s)
- Tobias Mettler
- Swiss Graduate School of Public Administration, University of Lausanne, Rue de la mouline 28, 1022, Chavannes-près-Renens, Switzerland.
| | - Vivian Vimarlund
- Department of Computer and Information Science, Linköping University, Ingång 29C Campus Valla, 58183, Linköping, Sweden
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