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Ryan L, Wenke R, Carlini J, Weir KA, Shapiro M, Baglot N, Tobiano G, Sargeant S, Hattingh L. Exploring barriers and solutions to consumer involvement in health service research using a nominal group technique. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:72. [PMID: 38992779 PMCID: PMC11241927 DOI: 10.1186/s40900-024-00604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Consumer involvement in health research is when patients, their families and caregivers work with researchers on research projects. Despite the growing expectation for health services to facilitate the involvement of consumers in research, the practical integration of this approach is an ongoing process, with limited research conducted into how Australian health services can support this practice. This study explored consumer perspectives on the barriers and solutions to enabling consumer involvement in research within an Australian tertiary hospital and health service, and staff perspectives on the solutions to facilitating consumer involvement. A prior survey had identified barriers to consumer involvement from the staff perspective. The broad aim was to inform the development of a framework to help promote consumer involvement in research within the health service. METHODS A Nominal Group Technique (NGT) was utilised with groups comprised of health service consumers and staff. Three health consumers were co-researchers in the full life-cycle of this study and are included as authors. RESULTS Ten consumers and 14 staff participated across three sessions ranging from one to three hours. For consumers, barriers to their involvement were grouped into seven domains: (1) lack of connection with researchers/research projects, (2) low research literacy, (3) structural barriers, (4) lack of acknowledgement, (5) implementation challenges, (6) inadequate information provision, and (7) representation concerns. Solutions to enabling involvement were grouped into five domains: (1) support to connect with researchers/research projects, (2) adequate information provision, (3) incentive for involvement, (4) acknowledgement, and (5) balanced representation. Staff ideas for solutions were grouped into five domains: (1) support to connect with consumers, (2) support to involve consumers, (3) access to funds to remunerate consumers, (4) more time to involve consumers, and (5) staff training. CONCLUSION Through an NGT methodology, this study delivered a nuanced comprehension of perspectives on involving consumers in research from both health service consumers and staff. These findings serve as a foundation for identifying strategies that foster enhanced and refined relationships between consumers and researchers, advancing the collaborative landscape in health research. The findings from this project offer valuable strategies for researchers to better engage consumers in research and for consumer groups to enhance their involvement. Additionally, these insights could be used by other health services to advocate for essential resources.
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Affiliation(s)
- Laura Ryan
- Gold Coast Hospital and Health Service, Allied Health Research, Southport, QLD, 4215, Australia.
| | - Rachel Wenke
- Gold Coast Hospital and Health Service, Allied Health Research, Southport, QLD, 4215, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4226, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia
| | - Joan Carlini
- Consumer Advisory Group, Gold Coast Hospital and Health Service, Southport, QLD, 4215, Australia
- Department of Marketing, Griffith Business School, Griffith University, Gold Coast Campus, Griffith, QLD, 4111, Australia
| | - Kelly A Weir
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
- The Royal Children's Hospital Melbourne, Parkville, VIC, 3052, Australia
| | - Margaret Shapiro
- Consumer Advisory Group, Gold Coast Hospital and Health Service, Southport, QLD, 4215, Australia
| | - Noela Baglot
- Consumer Advisory Group, Gold Coast Hospital and Health Service, Southport, QLD, 4215, Australia
| | - Georgia Tobiano
- NHMRC CRE in Wiser Wound Care, Griffith University, Griffith, QLD, 4222, Australia
- Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD, 4215, Australia
| | - Sally Sargeant
- Faculty of Health, Southern Cross University, Gold Coast, Australia
| | - Laetitia Hattingh
- Gold Coast Hospital and Health Service, Allied Health Research, Southport, QLD, 4215, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Griffith, QLD, 4222, Australia
- School of Pharmacy, The University of Queensland, Queensland, QLD, 4102, Australia
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Werther L, Thorén E, Brännström J, Andersson G, Öberg M. Hearing impaired persons' experiences with the online Swedish Individualized Active Communication Education (I-ACE) program: A feasibility study. Internet Interv 2024; 36:100734. [PMID: 38524894 PMCID: PMC10958056 DOI: 10.1016/j.invent.2024.100734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Even with optimally fitted hearing aids, many individuals with hearing impairment struggle to hear in situations with difficult listening conditions. Active Communication Education (ACE) is an interactive group rehabilitation program aimed at helping people with hearing loss communicate more effectively using communication strategies to better cope with everyday life. To increase accessibility and allow more people to benefit from the ACE program, a modified individualized version was created. The purpose of this study was to examine the feasibility of providing the Swedish Individualized Active Communication Education (I-ACE) program via an online platform and to explore hearing impaired persons' experiences with the program. For five weeks, ten participants completed the Swedish I-ACE through an online platform. The participants were assigned a new chapter to complete each week and later received individual feedback on their work via the platform. The participants were asked to complete an evaluation form regarding the content and their experiences during and after completing the I-ACE. They were later interviewed to provide more detailed information on their experiences with the program. The program completion rate was 80 %. Participants found the I-ACE program to be informative and relevant but somewhat repetitive. However, only a few participants thought of the repetitiveness as negative. Few participants reported difficulties using the platform. This study indicated that it is feasible to provide the I-ACE program via an online platform and that the content of the program is informative, relevant, and comprehensible. Further research evaluating the effects of the I-ACE is warranted.
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Affiliation(s)
- Louise Werther
- Department of Otorhinolaryngology in Östergötland, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Elisabet Thorén
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology Clinic, Skåne University Hospital, Lund, Sweden
- Department of Clinical Science, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Jonas Brännström
- Department of Clinical Science, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Gerhard Andersson
- Department of Otorhinolaryngology in Östergötland, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Marie Öberg
- Department of Otorhinolaryngology in Östergötland, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Zhou Q, He H, Li Q, Zhao J, Wang L, Luo Z, Wang X, Chen Y. Patient and public involvement in systematic reviews: frequency, determinants, stages, barriers, and dissemination. J Clin Epidemiol 2024; 170:111356. [PMID: 38604271 DOI: 10.1016/j.jclinepi.2024.111356] [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: 11/30/2023] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES To investigate the frequency, determinants, stages, and barriers of patient and public involvement (PPI) in systematic reviews and to explore its association with the dissemination of reviews. STUDY DESIGN AND SETTING We examined systematic reviews that required the inclusion of a PPI declaration, published in The BMJ between January 1, 2015, and December 31, 2022. Multivariable analysis was used to assess the association between PPI and key variables. We investigated the association between PPI and the dissemination of reviews using Altmetric scores, citations, and full-text views. RESULTS A total of 217 systematic reviews were included, of which 56 (25.8%, 95% CI 20.0%-31.6%) included PPI, with a steady increase from 5.9% (1/17) in 2015 to 44.4% (4/35) in 2022. Of the 217 systematic reviews, 160 (73.7%) involved methodologists as co-authors. Factors significantly associated with a higher proportion of PPI included the publication year after 2019 (adjusted odds ratio [aOR] 2.46, 95% CI 1.26-4.83), the involvement of methodologist (aOR 3.08; 95% CI 1.27-7.47), and being led by researchers from high-income countries (aOR 5.47; 95% CI 1.23-24.30). Reviews that included PPI had higher Altmetric scores per month (6.6 vs 3.4, P = .002) and more monthly full-text (1048.6 vs 636.5, P < .001) and PDF (217.7 vs 129.0, P < .001) views than reviews without PPI. However, there was no difference in the monthly citations (2.2 vs 2.0, P = .365) between reviews with and without PPI. CONCLUSION The proportion of systematic reviews reporting PPI in The BMJ has increased over time, possibly due to journal policies, but it still remains at a low level. Reviews led by researchers from high-income countries or involving methodologists are associated with a higher frequency of PPI within The BMJ. Furthermore, reviews incorporating PPI within The BMJ have a higher potential for broad dissemination.
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Affiliation(s)
- Qi Zhou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou 730000, China
| | - Hongfeng He
- School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Qinyuan Li
- Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Junxian Zhao
- School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Ling Wang
- School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaohui Wang
- School of Public Health, Lanzhou University, Lanzhou 730000, China; Chinese Patient and Public Guidelines Alliance, Lanzhou, China.
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Chinese Patient and Public Guidelines Alliance, Lanzhou, China; Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Chevidence Lab of Child and Adolescent Health, Children's Hospital of Chongqing Medical University, Chongqing, China.
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Chudyk AM, Stoddard R, McCleary N, Duhamel TA, Shimmin C, Hickes S, Schultz ASH. Exploring patient and caregiver perceptions of the meaning of the patient partner role: a qualitative study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:106. [PMID: 38017570 PMCID: PMC10683322 DOI: 10.1186/s40900-023-00511-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/26/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The re-conceptualization of patients' and caregivers' roles in research from study participants to co-researchers ("patient partners") has led to growing pains within and outside the research community, such as how to effectively engage patients in research and as part of interdisciplinary teams. To support the growth of more successful research partnerships by developing a shared understanding of how patient partners conceptualize and contribute to their role, this study aimed to explore patient partners' motivations for engagement and understanding of their role. METHODS We conducted semi-structured interviews with participants (n = 13) of an online survey of activities and impacts of patient engagement in Strategy for Patient-Oriented Research projects. Eligibility criteria included being a patient partner that indicated interest in interview participation upon survey completion, the ability to read/write in English and provide informed consent. Data were analyzed thematically using an inductive, codebook thematic analysis. RESULTS Illuminating the lived/living patient and caregiver experience was central to how most patient partners conceptualized the role in terms of its definition, purpose, value, and responsibilities. Participants also identified four additional categories of motivations for becoming a patient partner and contributions that patient partners make to research that build upon and are in addition to sharing their lived/living experiences. Lastly, participants highlighted important connotations of the term patient partner, including temporal and context-specific considerations for the term "patient" and what "partner" may imply about the nature of the research relationship. CONCLUSIONS At the onset of partnership, academic researchers and patient partners must create the space necessary to discuss and understand each other's underlying motivations for partnering and their perspectives on the purpose, value, and responsibilities of the patient partner role. These early conversations should help unearth what research partners hope to get out of and feel that they are able to contribute to engaging, and in such contribute to the development of reciprocal relationships that work towards shared and valued goals. Trial registration Not applicable.
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Affiliation(s)
- Anna Maria Chudyk
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, CR3024 - 369 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada.
| | - Roger Stoddard
- Horizon Health Network, 80 Woodbridge Street, Fredericton, New Brunswick, E3B 4R3, Canada
| | - Nicola McCleary
- Ottawa Hospital Research Institute - Clinical Epidemiology Program, Room L1202, Box 711 - 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Todd A Duhamel
- Faculty of Kinesiology and Recreation Management, 212 Active Living Centre, Winnipeg, MB, R3T 2N2, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, R4012 - 351 Tache Ave, Winnipeg, MB, R2H 2A6, Canada
| | - Carolyn Shimmin
- George and Fay Yee Centre for Healthcare Innovation, 3rd floor - 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada
| | - Serena Hickes
- Translating Emergency Knowledge for Kids (TREKK) Parent Advisory Group, Children's Hospital Research Institute of Manitoba, 512E - 715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada
| | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, CR3022, 369 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada
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Lithander FE, Tenison E, Jones DA, Stocker S, Hopewell‐Kelly N, Gibson A, McGrath C. Working with public contributors in Parkinson's research: What were the changes, benefits and learnings? A critical reflection from the researcher and public contributor perspective. Health Expect 2023; 27:e13914. [PMID: 37990485 PMCID: PMC10768872 DOI: 10.1111/hex.13914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION This paper provides a critical reflection from both the researcher and public contributor (PC) perspective on the benefits and the learnings taken from involving PCs in research related to Parkinson's. APPROACH TO PATIENT AND PUBLIC INVOLVEMENT (PPI): This paper reports on how PCs shaped the design and development of the PRIME-UK research programme study materials through input into information leaflets, consent forms and other patient-facing documents used across three studies within the PRIME-UK research programme. The PRIME-UK research programme is designed to improve the quality of life of people with Parkinson's and this project included three studies: a cross-sectional study, a randomised control trial and a qualitative study. We captured these impacts using Public Involvement Impact Logs, which provide a framework allowing researchers and PCs to report on the learnings, immediate outcomes and impacts from PPI. For this project, the impact logs enabled us to provide reflections from PCs and researchers on the process of involving 'the public' in Parkinson's research. FINDINGS This paper builds on existing evidence of the range of benefits and challenges that emerge from working with patients and the public in Parkinson's research; this includes reflecting on the changes made to the study materials and benefits for the people involved. Four themes emerged from the reflections that were common to the researchers and PCs; these were the importance of providing a supportive environment; recognition of the benefit of the evaluation of the impact of PPI; acknowledgement that engagement of PPI can make a positive difference to the research process and that timely communication and the use of face-to-face communication, where available, is key. Furthermore, we demonstrate how impact logs provide a useful and straightforward tool for evaluating public involvement practices and supporting the feedback process. CONCLUSION We offer key recommendations for involving patients and the public in Parkinson's research and suggest approaches that could be implemented to capture the impacts of public involvement. PUBLIC CONTRIBUTION Public contributors (PCs) were involved in the design and development of the participant information leaflets, consent forms and other patient-facing documents used for studies within the PRIME-UK research programme. In addition, PCs evaluated their involvement using impact logs and co-authored this paper.
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Affiliation(s)
- Fiona E. Lithander
- Ageing and Movement Research Group, Population Health SciencesBristol Medical School, University of BristolBristolUK
- Liggins InstituteUniversity of AucklandAucklandNew Zealand
- Department of Nutrition and DieteticsUniversity of AucklandAucklandNew Zealand
| | - Emma Tenison
- Ageing and Movement Research Group, Population Health SciencesBristol Medical School, University of BristolBristolUK
- Older People's UnitRoyal United Hospitals Bath NHS Foundation TrustBathUK
| | | | | | | | - Andy Gibson
- People in the Health West of EnglandUniversity of the West of EnglandBristolUK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West)University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
- Faculty of Health and Applied Sciences, School of Health and Social WellbeingUniversity of West EnglandBristolUK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health SciencesBristol Medical School, University of BristolBristolUK
| | - Carmel McGrath
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West)University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
- Faculty of Health and Applied Sciences, School of Health and Social WellbeingUniversity of West EnglandBristolUK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health SciencesBristol Medical School, University of BristolBristolUK
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Andersen LN, Kristensen KL, Howell CM, Rathleff MS, Fonager K, Lyng KD. What matters to people with chronic musculoskeletal pain consulting general practice? Comparing research priorities across different sectors. Scand J Pain 2023; 23:759-766. [PMID: 37694842 DOI: 10.1515/sjpain-2023-0046] [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: 04/05/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES Chronic musculoskeletal pain (CMP) is a common condition, often consulted in general practice. Our previous study identified research priorities among people with CMP using a broad recruitment strategy. It is unclear whether these research priorities reflect specific settings, including the population in general practice. Potential dissimilarities may have important implications for future research. Therefore, the study aims to explore potential differences between the previously established research priorities compared to priorities of people with CMP consulting general practice. METHODS Eighty-eight people living with CMP (51 females/37 males) from four regions of Denmark were recruited when they consulted their general practitioner. Participants were presented to an online survey and asked to prioritise predefined research themes (n=14) and research questions (n=38). The prioritisations were summarised into a Top-10 research priorities and compared the Top-10 from our previous study. RESULTS Treatment (n=57), diagnosis (n=46), cross-sectoral management (n=39) and influence on daily life (n=39) were the most selected research themes. The most prioritised research questions regarded the effectiveness of treatments and cross-sectoral management, improving diagnostic approaches and how pain affects the individuals' mental state. Four out of ten research questions aligned with our previous Top-10. CONCLUSIONS Our study identified several differences in research priorities between people living with CMP from the general population and from general practice. These findings highlight the needs for investigating how different settings influence research prioritisation. This adds important knowledge for researchers and policymakers focusing on future research within the management of CMP.
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Affiliation(s)
- Liv Nyhave Andersen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
| | | | - Clara Margrethe Howell
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Michael Skovdal Rathleff
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Damgaard Lyng
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
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Sheikhan NY, Kuluski K, McKee S, Hiebert M, Hawke LD. Exploring the impact of engagement in mental health and substance use research: A scoping review and thematic analysis. Health Expect 2023; 26:1806-1819. [PMID: 37282732 PMCID: PMC10485342 DOI: 10.1111/hex.13779] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/03/2023] [Accepted: 05/14/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND There is growing evidence demonstrating the impact of engaging people with lived experience (PWLE) in health research. However, it remains unclear what evidence is available regarding the impact of engagement specific to mental health and substance use research. METHODS A scoping review of three databases and thematic analysis were conducted. Sixty-one articles that described the impact of engagement in mental health and substance use research on either individual experiences or the research process were included. RESULTS Key topics include (a) the impact of engagement on individual experiences; (b) the impact of engagement on the research process; and (c) facilitators and barriers to impactful engagement. Studies largely focused on the perceived positive impact of engagement on PWLE (e.g., personal and professional growth, empowering and rewarding experience, feeling heard and valued), researchers (e.g., rewarding experience, deeper understanding of research topic, changes to practice), and study participants (e.g., added value, fostered a safe space). Engagement activities were perceived to improve facets of the research process, such as improvements to research quality (e.g., rigour, trustworthiness, relevance to the community), research components (e.g., recruitment), and the research environment (e.g., shifted power dynamics). Facilitators and barriers were mapped onto the lived experience, researcher, team, and institutional levels. Commonly used terminologies for engagement and PWLE were discussed. CONCLUSION Engaging PWLE-from consultation to co-creation throughout the research cycle-is perceived as having a positive impact on both the research process and individual experiences. Future research is needed to bring consistency to engagement, leverage the facilitators to engagement, and address the barriers, and in turn generate research findings that have value not only to the scientific community, but also to the people impacted by the science. PATIENT OR PUBLIC CONTRIBUTION PWLE were engaged throughout the scoping review process, including the screening phase, analysis phase, and write-up phase.
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Affiliation(s)
- Natasha Y. Sheikhan
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Kerry Kuluski
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
- Institute for Better Health, Trillium Health Partners
| | - Shelby McKee
- Centre for Addiction and Mental HealthTorontoOntarioCanada
| | | | - Lisa D. Hawke
- Centre for Addiction and Mental HealthTorontoOntarioCanada
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Bronkhorst H, van Weerden WM, Bunnik EM, Zwart H. Awe and anxiety for cancer cells: connecting scientists and patients in a holistic approach of metastasis research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:85. [PMID: 37752584 PMCID: PMC10523712 DOI: 10.1186/s40900-023-00498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/22/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Metastatic cancer is often experienced by patients as a death sentence. At the same time, translational scientists approach metastasis also as an interesting phenomenon that they try to understand and prevent. These two sides of the same coin do not mask the considerable gap that exists between the laboratory world of scientists and the life world of patients. Funding agencies nowadays increasingly demand researchers to be responsive to the values and priorities of patients and public. One approach to bridge this gap and to increase the impact of science is patient and public involvement (PPI). A concise literature review of PPI research and practice in this paper revealed that although PPI is often deployed in translational health care research, its methodology is not settled, it is not sufficiently emancipatory, and its implementation in basic and translational science is lagging behind. Here, we illustrate the practical implementation of PPI in basic and translational science, namely in the context of HOUDINI, a multidisciplinary network with the ultimate goal to improve the management of metastatic disease. METHODS This paper reports on a societal workshop that was organized to launch the holistic PPI approach of HOUDINI. During this workshop, societal partners, patients, and physicians discussed societal issues regarding cancer metastasis, and contributed to prioritization of research objectives for HOUDINI. In a later stage, the workshop results were discussed with scientists from the network to critically review its research strategy and objectives. RESULTS Workshop participants chose the development of metastasis prediction tools, effective therapies which preserve good quality of life, and non-invasive tissue sampling methods as most important research objectives for HOUDINI. Importantly, during the discussions, mutual understanding about issues like economic feasibility of novel therapies, patient anxiety for metastases, and clear communication between stakeholders was further increased. CONCLUSIONS In conclusion, the PPI workshop delivered valuable early-stage input and connections for HOUDINI, and may serve as example for similar basic and translational research projects.
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Affiliation(s)
- Hildert Bronkhorst
- Erasmus School of Philosophy, Erasmus University Rotterdam (EUR), Rotterdam, The Netherlands
| | - Wytske M. van Weerden
- Department of Experimental Oncology, Erasmus Medical Centre (Erasmus MC), Rotterdam, The Netherlands
| | - Eline M. Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus Medical Centre (Erasmus MC), Rotterdam, The Netherlands
| | - Hub Zwart
- Erasmus School of Philosophy, Erasmus University Rotterdam (EUR), Rotterdam, The Netherlands
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Fredriksson M, Modigh A. Public involvement in the Swedish health system: citizen dialogues with unclear outcomes. BMC Health Serv Res 2023; 23:947. [PMID: 37667356 PMCID: PMC10478364 DOI: 10.1186/s12913-023-09947-x] [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: 04/18/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND In systems with representative democracy, there is a growing consensus that citizens should have the possibility to participate in decisions that affect them, extending beyond just voting in national or local/regional elections. However, significant uncertainty remains regarding the role of public involvement in decision-making, not least in healthcare. In this article, we focus on citizen dialogues (CDs) in a health system that is politically governed and decentralised. The aim of the study was to evaluate the functioning of citizen dialogues in the Swedish health system in terms of representation, process, content, and outcomes. METHODS This study was conducted using a qualitative case design focusing on CDs at the regional level in Sweden. The regional level is politically elected and responsible for funding and provision of healthcare. The data consist of public documents describing and evaluating the CDs and interviews, which were analysed drawing on a modified version of the Abelson et al. analytical framework for evaluating public involvement in healthcare. RESULTS Some CDs were an attempt to counteract political inequality by inviting groups that are less represented, while others aimed to increase legitimacy by reducing the distance between policymakers and citizens. The results from the CDs-which were often held in the beginning of a potential policy process-were often stated to be used as input in decision-making, but how was not made clear. Generally, the CDs formed an opportunity for members of the public to express preferences (on a broad topic) rather than developing preferences, with a risk of suggestions being too unspecific to be useful in decision-making. The more disinterested public perspective, in comparison with patients, reinforced the risk of triviality. A need for better follow-up on the impact of the CDs on actual decision-making was mentioned as a necessary step for progress. CONCLUSIONS It is unclear how input from CDs is used in policymaking in the politically governed regions responsible for healthcare in Sweden. The analysis points to policy input from CDs being too general and a lack of documentation of how it is used. We need to know more about how much weight input from CDs carry in relation to other types of information that politicians use, and in relation to other types of patient and public involvement.
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Affiliation(s)
- Mio Fredriksson
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Postal address: Box 564, Uppsala, 751 22 Sweden
| | - Anton Modigh
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Postal address: Box 564, Uppsala, 751 22 Sweden
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De Freitas Lopes AC, Novaes HMD, De Soárez PC. Does patient and public involvement impact public health decision-making? A 10 year retrospective analysis of public consultation in Brazil. Health Res Policy Syst 2023; 21:72. [PMID: 37438823 DOI: 10.1186/s12961-023-01018-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/14/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND The aim of this work is to characterize the processes associated with patient and public involvement (PPI) in the form of public consultations (PC) during the first 10 years of operation of the National Committee for Health Technology Incorporation in the Unified Health System (Conitec) of Brazil, and to identify factors associated with changes in Conitec's recommendations following these PC. METHODS This cross-sectional study analysed all processes related to the adoption of technologies that took place in Brazil between 2012 and 2021 based on technical reports and self-reported information collected from PC participants. A multiple logistic regression model identified factors associated with changes in Conitec's recommendations following PC. RESULTS A total of 479 technical reports were published, of which 83% (n = 400) were submitted to PC. Demands were made mainly by applicants from the government (n = 262; 55%), regarding the adoption of medicines (n = 366; 76%), in which context neoplasms and infectious diseases were the most frequent indications (n = 66; 14% for each). A total of 264 (55%) processes resulted in a final recommendation in favour of introducing the technology. Over the period of 10 years, 196 483 contributions were received in response to PC. The largest volume of contributions was made by patients and their families or representatives (n = 99 082; 50%), females (122 895; 67%), white individuals (129 165; 71%) and individuals between the ages of 25 and 59 years (145 364; 80%). Alteration of the preliminary recommendation occurred in 13% (n = 53) of the PC, with a higher proportion of recommendations being altered from 2017 onwards. Increased participation by patients had a significant impact on the alteration of the preliminary recommendation (odds ratio 3.87, 95% CI 1.33-13.35, p = 0.02). CONCLUSIONS Increased engagement of patients and their families and caregivers in PC was associated with changing the preliminary recommendation of Conitec about the adoption of technologies into the public health system in Brazil.
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Affiliation(s)
- Ana Carolina De Freitas Lopes
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo 455, Cerqueira Cesar, São Paulo, SP, 01246903, Brazil.
- Departamento de Gestão e Incorporação de Tecnologias em Saúde, Ministry of Health, Esplanada dos Ministérios, Bloco G, Brasilia, Brazil.
| | - Hillegonda Maria Dutilh Novaes
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo 455, Cerqueira Cesar, São Paulo, SP, 01246903, Brazil
| | - Patrícia Coelho De Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo 455, Cerqueira Cesar, São Paulo, SP, 01246903, Brazil
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Qu Z, Oedingen C, Bartling T, Krauth C, Schrem H. Systematic review on the involvement and engagement of patients as advisers for the organisation of organ transplantation services. BMJ Open 2023; 13:e072091. [PMID: 37164468 PMCID: PMC10173988 DOI: 10.1136/bmjopen-2023-072091] [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] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES This systematic review aims to derive practical lessons from publications on patient involvement and engagement in the organisation of organ transplantation services. DESIGN This systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Inclusion criteria for the analysis of publications in English cited in the databases PubMed and Web of Science until 6 December 2022 required that patients participated as advisers in the organisation of organ transplantation services. Quality assessment was performed using the Guidance for Reporting Involvement of Patients and the Public (GRIPP) 2 small form and the Critical Appraisal Skills Programme (CASP) tool for the assessment of the risks of bias. RESULTS Deployed search strings identified 2263 records resulting in a total of 11 articles. The aims and strategies, deployed methods, observed effects, observed barriers and proposed improvements for the future varied vastly. All reported that well-developed programmes involving and engaging patients at an organisational level provide additional benefits for patients and foster patient-centred care. Lessons learnt include: (1) to empower patients, the information provided to them should be individualised to prioritise their needs; (2) financial as well as organisational resources are important to successfully implement patient involvement and engagement; (3) systematic feedback from patients in organisational structures to health providers is required to improve clinical workflows and (4) the consideration of ethical issues and the relationship between investigators and participating patients should be clarified and reported. CONCLUSIONS Actionable management recommendations could be derived. The quantitative impact on clinical outcome and economic clinical process improvements remains to be investigated. Study quality can be improved using the GRIPP 2 guidance and the CASP tool. PROSPERO REGISTRATION NUMBER CRD42022186467.
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Affiliation(s)
- Zhi Qu
- Transplant Center, Hannover Medical School, Hannover, Germany
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Carina Oedingen
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
- Center for Health Economics Research Hannover (CHERH), Hannover Medical School, Hannover, Germany
| | - Tim Bartling
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
- Center for Health Economics Research Hannover (CHERH), Hannover Medical School, Hannover, Germany
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
- Center for Health Economics Research Hannover (CHERH), Hannover Medical School, Hannover, Germany
| | - Harald Schrem
- General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
- Transplant Center Graz, Medical University Graz, Graz, Austria
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Chambers RL, Pask S, Higginson IJ, Barclay S, Murtagh FE, Sleeman KE. Inclusion of palliative and end of life care in health strategies aimed at integrated care: a documentary analysis. HEALTH OPEN RESEARCH 2023; 4:19. [PMID: 36987529 PMCID: PMC7614372 DOI: 10.12688/amrcopenres.13079.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: In England, Integrated Care Systems have been established to improve integration of care, as part of the NHS Long Term Plan. For people near the end of life, palliative care can improve integration of care. We aimed to understand whether and how palliative and end of life care was included in Integrated Care System strategies, and to consider priorities for strengthening this. Methods: Documentary analysis of Integrated Care System (ICS) strategies, using summative content analysis, was performed. Google searches were used to identify NHS Trust, Clinical Commissioning Group or ICS websites. We searched these websites to identify strategies. Key terms were used to identify relevant content. Themes were mapped onto an adapted logic model for integrated care. Results: 23 Integrated Care System strategy documents were identified. Of these, two did not mention any of the key terms, and six highlighted palliative and end of life care as either a priority, area of focus, or an ambition. While most (19/23) strategies included elements that could be mapped onto the adapted logic model for integrated care, the thread from enablers and components, to structures, processes, outcomes, and impact was incomplete. Conclusions: Greater prioritisation of palliative and end of life care within recently established Integrated Care Systems could improve outcomes for people near the end of life, as well as reduce reliance on acute hospital care. Integrated Care Systems should consider involving patients, the public and palliative care stakeholders in the ongoing development of strategies. For strategies to be effective, our adapted logic model can be used to outline how different components of care fit together to achieve defined outcomes and impact.
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Affiliation(s)
- Rachel L. Chambers
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, SE5 9PJ, UK
| | - Sophie Pask
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, SE5 9PJ, UK
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fliss E.M. Murtagh
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, SE5 9PJ, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Katherine E. Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, SE5 9PJ, UK
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
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13
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Shahid A, Lalani IN, Rosgen BK, Sept BG, Longmore S, Parsons Leigh J, Stelfox HT, Fiest KM. A scoping review of methods to measure and evaluate citizen engagement in health research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:72. [PMID: 36496455 PMCID: PMC9737710 DOI: 10.1186/s40900-022-00405-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/29/2022] [Indexed: 05/20/2023]
Abstract
BACKGROUND Citizen engagement, or partnering with interested members of the public in health research, is becoming more common. While ongoing assessment of citizen engagement practices is considered important to its success, there is little clarity around aspects of citizen engagement that are important to assess (i.e., what to look for) and methods to assess (i.e., how to measure and/ or evaluate) citizen engagement in health research. METHODS In this scoping review, we included peer-reviewed literature that focused primarily on method(s) to measure and/or evaluate citizen engagement in health research. Independently and in duplicate, we completed title and abstract screening and full-text screening and extracted data including document characteristics, citizen engagement definitions and goals, and methods to measure or evaluate citizen engagement (including characteristics of these methods). RESULTS Our search yielded 16,762 records of which 33 records (31 peer-reviewed articles, one government report, one conference proceeding) met our inclusion criteria. Studies discussed engaging citizens (i.e., patients [n = 16], members of the public [n = 7], service users/consumers [n = 4], individuals from specific disease groups [n = 3]) in research processes. Reported methods of citizen engagement measurement and evaluation included frameworks, discussion-based methods (i.e., focus groups, interviews), survey-based methods (e.g., audits, questionnaires), and other methods (e.g., observation, prioritization tasks). Methods to measure and evaluate citizen engagement commonly focused on collecting perceptions of citizens and researchers on aspects of citizen engagement including empowerment, impact, respect, support, and value. DISCUSSION AND CONCLUSION We found that methods to measure and/or evaluate citizen engagement in health research vary widely but share some similarities in aspect of citizen engagement considered important to measure or evaluate. These aspects could be used to devise a more standardized, modifiable, and widely applicable framework for measuring and evaluating citizen engagement in research. PATIENT OR PUBLIC CONTRIBUTION Two citizen team members were involved as equal partners in study design and interpretation of its findings. SYSTEMATIC REVIEW REGISTRATION Open Science Framework (10.17605/OSF.IO/HZCBR).
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Inara N Lalani
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brianna K Rosgen
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shelly Longmore
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Dalhousie University, Halifax, NS, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Alberta Health Services, Calgary, AB, Canada.
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Babatunde OO, Dawson S, Brammar J, Parton L, Dziedzic K, Adebajo AO. Patient and public involvement in implementation of evidence-based guidance for musculoskeletal conditions: a scoping review of current advances and gaps. BMC Rheumatol 2022; 6:84. [PMID: 36273226 PMCID: PMC9588238 DOI: 10.1186/s41927-022-00310-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/05/2022] [Indexed: 12/02/2022] Open
Abstract
Advances in musculoskeletal (MSK) research have been successfully curated into widely endorsed evidence-based recommendations and guidelines. However, there continues to exist significant variations in care and quality of care, and the global health and socio-economic burdens associated with MSK conditions continues to increase. Limited accessibility, and applicability of guideline recommendations have been suggested as contributory factors to less than adequate guideline implementation. Since patient and public involvement (PPI) is being credited with increasing relevance, dissemination and uptake of MSK research, the success of guidelines implementation strategies may also be maximised through increasing opportunities for PPI input. We therefore conducted a scoping review of literature to explore PPI in implementation of evidence-based guidance for MSK conditions. A comprehensive search was used to identify relevant literature in three databases (Medline, Embase, Cinahl) and two large repositories (WHO, G-IN), supplemented by grey literature search. Eligibility was determined with criteria established a priori and narrative synthesis was used to summarise PPI activities, contexts, and impact on implementation of MSK related evidence-based guidance across ten eligible studies (one from a low-and middle-income country LMIC). A prevalence of low-level PPI (mainly consultative activities) was found in the current literature and may partly account for current experiences of significant variations and quality of care for MSK patients. The success of PPI in MSK research may be lessened by the oversight of PPI in implementation. This has implications for both high- and low-resource healthcare systems, especially in LMICs where evidence is limited. Patient and public partnership for mobilising knowledge, maximising guideline uptake, and bridging the research-practice gap particularly in low resource settings remain important and should extend beyond PPI in research and guideline dissemination activities only. This review is a clarion call to stakeholders, and all involved, to transform PPI in MSK research into real world benefits through implementation approaches underpinned by patient and public partnerships. We anticipate that this will enhance and drive quality improvements in MSK care with patients and for patients across health and care settings.
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Affiliation(s)
| | - Shoba Dawson
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - June Brammar
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, ST6 7AG, UK
| | - Linda Parton
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Krysia Dziedzic
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Adewale O Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
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15
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Fujio K, Inomata T, Fujisawa K, Sung J, Nakamura M, Iwagami M, Muto K, Ebihara N, Nakamura M, Okano M, Akasaki Y, Okumura Y, Ide T, Nojiri S, Nagao M, Fujimoto K, Hirosawa K, Murakami A. Patient and public involvement in mobile health-based research for hay fever: a qualitative study of patient and public involvement implementation process. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:45. [PMID: 36056430 PMCID: PMC9437402 DOI: 10.1186/s40900-022-00382-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Smartphones are being increasingly used for research owing to their multifunctionality and flexibility, and crowdsourced research using smartphone applications (apps) is effective in the early detection and management of chronic diseases. We developed the AllerSearch app to gather real-world data on individual subjective symptoms and lifestyle factors related to hay fever. This study established a foundation for interactive research by adopting novel, diverse perspectives accrued through implementing the principles of patient and public involvement (PPI) in the development of our app. METHODS Patients and members of the public with a history or family history of hay fever were recruited from November 2019 to December 2021 through a dedicated website, social networking services, and web briefing according to the PPI Guidebook 2019 by the Japan Agency for Medical Research and Development. Nine opinion exchange meetings were held from February 2020 to December 2021 to collect opinions and suggestions for updating the app. After each meeting, interactive evaluations from PPI contributors and researchers were collected. The compiled suggestions were then incorporated into the app, establishing an active feedback loop fed by the consistently interactive infrastructure. RESULTS Four PPI contributors (one man and three women) were recruited, and 93 items were added/changed in the in-app survey questionnaire in accordance with discussions from the exchange meetings. The exchange meetings emphasized an atmosphere and opportunity for participants to speak up, ensuring frequent opportunities for them to contribute to the research. In March 2020, a public website was created to display real-time outcomes of the number of participants and users' hay-fever-preventative behaviors. In August 2020, a new PPI-implemented AllerSearch app was released. CONCLUSIONS This study marks the first research on clinical smartphone apps for hay fever in Japan that implements PPI throughout its timeline from research and development to the publication of research results. Taking advantage of the distinct perspectives offered by PPI contributors, a step was taken toward actualizing a foundation for an interactive research environment. These results should promote future PPI research and foster the establishment of a social construct that enables PPI efforts in various fields.
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Affiliation(s)
- Kenta Fujio
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takenori Inomata
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan.
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Kumiko Fujisawa
- Department of Public Policy, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Jaemyoung Sung
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
| | - Masahiro Nakamura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kaori Muto
- Department of Public Policy, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Urayasu Hospital, Juntendo University, Chiba, Japan
| | - Masahiro Nakamura
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mitsuhiro Okano
- Department of Otorhinolaryngology, International University of Health and Welfare, Narita, Japan
| | - Yasutsugu Akasaki
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuichi Okumura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takuma Ide
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Masashi Nagao
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
- Department of Orthopedic Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
- School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Keiichi Fujimoto
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
| | - Kunihiko Hirosawa
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Chudyk AM, Stoddard R, McCleary N, Duhamel TA, Shimmin C, Hickes S, Schultz ASH. Activities and impacts of patient engagement in CIHR SPOR funded research: a cross-sectional survey of academic researcher and patient partner experiences. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:44. [PMID: 36038887 PMCID: PMC9423700 DOI: 10.1186/s40900-022-00376-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/09/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND Knowledge about the specific engagement activities pursued and associated impacts of patient engagement in research in Canada remains nascent. This study aimed to describe engagement activities and perceived impacts of projects funded by the Strategy for Patient-Oriented Research (SPOR). METHODS This was a cross-sectional online survey of academic researchers and patient partners engaging in projects funded through 13 SPOR funding calls (2014-2019). Patient engagement activities and impacts were measured using a self-developed survey. Thematic analysis was used to describe engagement activities and impacts. RESULTS 66 of 511 academic researchers and 20 of 28 patient partners contacted completed the survey and were included in analyses. Respondents reported that patient partners were engaged in seven types of activities across the research cycle: (a) sharing experiences/giving advice, (b) identifying the research focus/methods, (c) developing/revising aspects of the project, (d) conducting research activities, (e) study participation, (f) presenting on behalf of the project, and (g) other grant development or knowledge translation activities. Engagement was associated with six different types of impacts related to knowledge, outputs, or directions being (a) created, (b) moulded, (c) confirmed, or (d) chosen/prioritized, (e) perceived success of the research, and (f) minimal/negative impacts on the research. CONCLUSIONS This study presents information on different ways that patient partners were engaged in SPOR-funded research and the potential impacts of these activities. This knowledge base is imperative to the future of patient engagement in research, including the planning and evaluation of future studies that engage patients as active shapers of research.
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Affiliation(s)
- Anna Maria Chudyk
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, CR3024 - 369 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada.
| | - Roger Stoddard
- Horizon Health Network, 80 Woodbridge Street, Fredericton New Brunswick, E3B 4R3, Canada
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Room L1202, 501 Smyth Road, Box 711, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Todd A Duhamel
- Faculty of Kinesiology and Recreation Management, 212 Active Living Centre, Winnipeg, MB, R3T 2N2, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Canada
| | - Carolyn Shimmin
- George and Fay Yee Centre for Healthcare Innovation, 3rd floor - 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada
| | - Serena Hickes
- Translating Emergency Knowledge for Kids (TREKK) Parent Advisory Group, Children's Hospital Research Institute of Manitoba, 512E - 715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada
| | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, CR3022 - 369 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada
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17
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Dave MG, Chudyk AM, Oravec N, Kent DE, Duhamel TA, Schultz AS, Arora RC. Putting patient value first: Using a modified nominal group technique for the implementation of enhanced recovery after cardiac surgery recommendations. JTCVS OPEN 2022; 12:306-314. [PMID: 36590723 PMCID: PMC9801247 DOI: 10.1016/j.xjon.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 01/04/2023]
Abstract
Objective In 2019, the Society for Enhanced Recovery After Cardiac Surgery (ERAS-CS) published perioperative guidelines to optimize the care of patients undergoing cardiac surgery. For centers with limited capacity, a sequential approach to the implementation of the full guidelines may be more feasible. Therefore, we aimed to explore the priority of implementation of the ERAS-CS guideline recommendations from a patient and caregiver perspective. Methods Using a modified nominal group technique, individuals who previously underwent cardiac surgery and their caregivers ranked ERAS-CS recommendations within 3 time points (ie, preoperative, intraoperative, and postoperative) and across 2 to 3 voting rounds. Final round rankings (median, mean and first quartile) were used to determine relative priorities. Results Seven individuals (5 patients and 2 caregivers) participated in the study. Patient engagement tools (2, 2.29, and 1.50), surgical site infection reduction (2, 1.67, and 1.25), and postoperative systematic delirium screening (1, 2.43, and 1.00) were the top-ranked ERAS-CS recommendations in the preoperative, intraoperative, and postoperative time points, respectively. Conclusions Exploration of patient and caregiver priorities may provide important insights to guide the healthcare team with clinical pathway development and implementation. Further study is needed to understand the impact of the integration of patient and caregiver values on effective and sustainable clinical pathway implementation.
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Affiliation(s)
- Mudra G. Dave
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada,Cardiac Sciences Manitoba, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Anna M. Chudyk
- St Boniface Research Centre, Health Services & Structural Determinants of Health Research, Winnipeg, Manitoba, Canada,College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nebojša Oravec
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David E. Kent
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada,Cardiac Sciences Manitoba, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Todd A. Duhamel
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada,Institute of Cardiovascular Sciences, Alberchtsen Research Centre, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Annette S.H. Schultz
- St Boniface Research Centre, Health Services & Structural Determinants of Health Research, Winnipeg, Manitoba, Canada,College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rakesh C. Arora
- Cardiac Sciences Manitoba, St Boniface Hospital, Winnipeg, Manitoba, Canada,Institute of Cardiovascular Sciences, Alberchtsen Research Centre, St Boniface Hospital, Winnipeg, Manitoba, Canada,Section of Cardiac Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada,Address for reprints: Rakesh C. Arora, MD, PhD, IH Asper Clinical Research Institute, St Boniface Hospital, CR3015–369 Taché Ave, Winnipeg, MB, Canada R2H 2A6.
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Building from Patient Experiences to Deliver Patient-Focused Healthcare Systems in Collaboration with Patients: A Call to Action. Ther Innov Regul Sci 2022; 56:848-858. [PMID: 35854183 PMCID: PMC9356929 DOI: 10.1007/s43441-022-00432-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
Abstract
Patients’ experiences of their diagnosis, condition, and treatment (including the impact on their lives), and their experiences surrounding expectations of care, are becoming increasingly important in shaping healthcare systems that meet the evolving needs and priorities of different patient communities over time; this is an ongoing goal of all healthcare stakeholders. Current approaches that capture patient experiences with data are fragmented, resulting in duplication of effort, numerous requests for information, and increased patient burden. Application of patient experience data to inform healthcare decisions is still emerging and there remains an opportunity to align diverse stakeholders on the value of these data to strengthen healthcare systems. Given the collective value of understanding patient experiences across multiple stakeholder groups, we propose a more aligned approach to the collection of patient experience data. This approach is built on the principle that the patients’ experiences are the starting point, and not just something to be considered at the end of the process. It must also be based on meaningful patient engagement, where patients are collaborators and decision makers at each step, thereby ensuring their needs and priorities are accurately reflected. The resulting data and evidence should be made available for all stakeholders, to inform their decision making and healthcare strategies in ways that meet patient priorities. We call for multi-stakeholder collaboration that will deliver healthcare systems and interventions that are better centered around and tailored to patient experiences, and that will help address patients’ unmet needs.
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The Your Rheum story: involvement of young people in rheumatology research. BMC Rheumatol 2022; 6:43. [PMID: 35787300 PMCID: PMC9253258 DOI: 10.1186/s41927-022-00273-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/29/2022] [Indexed: 11/15/2022] Open
Abstract
Until recently, young people too often fell into the gaps between services due to restrictive age criteria. Furthermore, their voice was too infrequently heard or was represented by proxies in the form of their caregivers or by adults recalling their youth. The lack of young person involvement in adolescent health research including the arena of paediatric and adolescent chronic disease has been highlighted in current literature. However, the involvement of young people at all stages of health research, from priority setting through to dissemination, is widely advocated. Furthermore, such involvement is considered to be important ethically and, most important of all, has been called for by young people themselves. Young people have clear views about research and these views potentially enhance our understanding of how young people form opinions about research. These opinions in turn informs researchers how to best engage young people (including recruitment and retention) in research. Such involvement of young people ensures that research questions, project methodologies and/or interventions are truly resonant with their lives. This paper describes the development of a national youth advisory group in UK rheumatology, an important addition to the evolving evidence base to support the involvement of young people in rheumatology research. The paper is written with two young people who are members of this group, providing them with an opportunity to learn more about a key component of research—writing papers for publication.
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Values, principles, strategies, and frameworks underlying patient and public involvement in health technology assessment and guideline development: a scoping review. Int J Technol Assess Health Care 2022; 38:e46. [PMID: 35655444 DOI: 10.1017/s0266462322000289] [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] [Indexed: 11/07/2022]
Abstract
The importance of patient and public involvement (PPI) is recognized by agencies involved in health technology assessment (HTA) and guideline development. However, a comprehensive overview of the underlying PPI principles, values, strategies, and frameworks is lacking. This scoping review aimed to summarize the available evidence on principles, values, frameworks, and strategies underpinning PPI carried out by agencies involved in HTA and guideline development. A total of twelve records were included, of which four referred to guidelines and eight to HTA. Overall, this review demonstrated a lack of consistency in the definition and application of the concepts of values and principles to PPI in the context of guideline development and HTA. There was significant overlap between values and principles, with some broad themes emerging, such as representation, transparency, relevance, equity, fairness, and reconciling different types of knowledge. Frameworks were typically based on the stages of guideline development or HTA, despite heterogeneity in how stages were labeled and described. Strategies were also mapped to the stages of guideline development and HTA and varied substantially depending on the context and setting. Both strategies and frameworks demonstrated patients and the public can be involved, albeit to a variable extent, throughout the stages of guideline development and HTA. However, frameworks often failed to explicitly link the values and principles with the HTA and guideline development stages through actionable PPI strategies. Further research is warranted to better understand the values, principles, and frameworks underpinning PPI in guideline development and HTA.
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Shahid A, Rosgen BK, Krewulak KD, Lorenzetti DL, Foster N, Sept BG, Leigh JP, Stelfox HT, Fiest KM. Incorporating and evaluating citizen engagement in health research: a scoping review protocol. Syst Rev 2021; 10:260. [PMID: 34583771 PMCID: PMC8480041 DOI: 10.1186/s13643-021-01812-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Citizen engagement in research is an emerging practice that involves members of the general public in research processes such as priority setting, planning, decision-making, research conduct, implementation, evaluation, and dissemination. Engaging citizens in research, particularly health research, increases the relevance of study findings, minimizes waste by facilitating stewardship over resources, and builds public trust in the research. While several existing frameworks guide the application of citizen engagement principles to health research, it is unclear how citizen engagement can be utilized to maximize benefits and minimize risks and challenges in health research. To address the gaps in knowledge around citizen engagement in health research, we propose a scoping review to synthesize the state of knowledge on methods to incorporate and evaluate citizen engagement in research. A protocol is presented in this manuscript. METHODS The methodology for our scoping review is guided by Arksey and O' Malley's framework for scoping reviews, and additional recommendations by Levac and colleagues. We will include peer-reviewed and gray literature that report on citizen engagement in health research (including biomedical, clinical, health systems and services, and social, cultural, environmental and population health) and report method(s) to conduct, measure, or evaluate citizen engagement. We will systematically search electronic databases (MEDLINE, EMBASE, CINAHL, JSTOR, PsycINFO, Scopus, and Science Direct) from inception onwards and search relevant organizations' websites for additional studies, frameworks, and reports on citizen engagement. Title and abstract and full-text citations will be screened independently and in duplicate. Data will be extracted independently and in duplicate, including document characteristics, citizen engagement definitions and goals, and outcomes of citizen engagement (e.g., barriers, facilitators). DISCUSSION This review will synthesize the definitions, goals, methods, outcomes, and significance of citizen engagement in health research, as well as any potential barriers, facilitators, and challenges outlined in existing literature. The findings will provide an evidence-based foundation for developing new or improved guidance for citizen engagement in health research. Overall, we anticipate that our scoping review will be a preliminary step to meaningful engagement of citizens in research and strengthen the relationship between the scientific community and the public through transparency and collaboration. SYSTEMATIC REVIEW REGISTRATION Open Science Framework https://osf.io/hzcbr .
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Brianna K Rosgen
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Diane L Lorenzetti
- Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Health Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Nadine Foster
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.,Dalhousie University, Halifax, Nova Scotia, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.,Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada. .,Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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22
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Abilkaiyr N, Sabyr N, Tazhiyeva A, Satybaldin A. Comparative analysis of primary health care indicators security standing in Belgium and Norway: Lessons from readiness to COVID-19. J Med Life 2021; 14:816-822. [PMID: 35126753 PMCID: PMC8811665 DOI: 10.25122/jml-2021-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022] Open
Abstract
The research aims to suggest the most enabling indicator of COVID-19 resistance in Belgium and Norway by studying the dynamics of staff and bed security indicators of the primary health care sector. The research methodology comprises Organization for Economic Cooperation and Development (OECD) statistical analysis of staff and bed security indicators. The reason for choosing Belgium and Norway for comparative analysis regarding the readiness to face the COVID-19 pandemic in terms of staff and bed security is because Belgium is leading by the highest level and Norway is leading by the lowest level of morbidity and mortality per 1 million population. The study revealed that the greatest enabler of the primary health care system efficiency in terms of resistance to COVID-19 is primary health care staff security. The analysis clearly shows that the number of beds is not paramount for the effectiveness of the healthcare system and primary health care. The COVID-19 pandemic has exposed the deficiencies and weaknesses of primary health care systems of all countries of the world. The research results suggest that Belgium and other countries focus on the education of nurses and therapists. The significance of the research results is that they prove that the main factor of the effectiveness of the primary health care system is its human resources. This information is useful for improving health systems in many countries around the world.
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Affiliation(s)
- Nazerke Abilkaiyr
- Department of Epidemiology, Biostatistics and Evidence-Based Medicine, Al-Farabi Kazakh National University, Almaty, Republic of Kazakhstan,Corresponding Author: Nazerke Abilkaiyr, Department of Epidemiology, Biostatistics and Evidence-Based Medicine, Al-Farabi Kazakh National University, 050040, 71 Al-Farabi Ave., Almaty, Republic of Kazakhstan. E-mail:
| | - Nursymbat Sabyr
- Faculty of Economics, L.N. Gumilyov Eurasian National University, Nur-Sultan, Republic of Kazakhstan
| | | | - Azimkhan Satybaldin
- Institute of Economics, Science Committee of the Ministry of Education of the Republic of Kazakhstan, Almaty, Republic of Kazakhstan
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