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Wurz A, Bean C, Shaikh M, Culos-Reed SN, Jung ME. From laboratory to community: Three examples of moving evidence-based physical activity into practice in Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1690-e1700. [PMID: 34623004 DOI: 10.1111/hsc.13596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 08/12/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
Physical activity (PA) is important for enhancing and sustaining people's health and well-being. Although a number of efficacious PA interventions have been developed, few have been translated from research into practice. Consequently, the knowledge-to-practice gap continues to grow, leaving many individuals unable to access evidence-based PA opportunities. This gap may be particularly relevant for those who grapple with poor health due to intrapersonal, interpersonal, cultural and system-level barriers that limit their access to evidence-based PA opportunities. Implementation efforts designed to bring research into real-world settings may bridge the knowledge-to-practice gap. Yet, cultivating quality partnerships and ensuring effectiveness, methodological rigour and scalability in real-world settings can be difficult. Furthermore, researchers seldom publish examples of how they addressed these challenges and translated their evidence-based PA opportunities into practice. Herein, we describe three cases of successful PA implementation among diverse populations: (a) individuals affected by cancer, (b) adults living with prediabetes, and (c) children from under-resourced communities. Commonalities across cases include guiding theories and frameworks, the strategies to facilitate and maintain partnerships, and scalability and sustainability plans. Practical tips and recommendations are provided to spur research and translation efforts that consider implementation from the outset, ultimately ensuring that people receive the benefits PA can confer.
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Affiliation(s)
- Amanda Wurz
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Corliss Bean
- Department of Recreation & Leisure Studies, Brock University, St. Catharines, Canada
| | - Majidullah Shaikh
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada
| | - Mary E Jung
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, Canada
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Aguilar-González A, Lou-Meda R, Chocó-Cedillos A, Moist L. Community engagement in kidney research: Guatemalan experience. BMC Nephrol 2022; 23:282. [PMID: 35962338 PMCID: PMC9373416 DOI: 10.1186/s12882-022-02891-8] [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: 02/20/2022] [Accepted: 07/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background Community engagement is essential for effective research when addressing issues important to both the community and researchers. Despite its effectiveness, there is limited published evidence concerning the evaluation of community engagement in research projects, especially in the area of nephrology. Methods We developed a community engagement program in Guatemala to address the role of hydration in chronic kidney disease of unknown origin, using five key engagement principles: 1. Local relevance and determinants of health. 2. Acknowledgment of the community. 3. Dissemination of findings and knowledge gained to all partners. 4. Usage of community partners’ input. 5. Involvement of a cyclical and iterative process in the pursuit of goals. The effectiveness of community engagement was measured by a structured questionnaire on a 5-point likert scale. This measure determined how well and how often the research team adhered to the five engagement principles. We assessed internal consistency for each set of the engagement items through Omega coefficient. Results Sixty-two community leaders completed the questionnaire. Seventy-five percent were female, with a mean age of 37 years. All 5 engagement principles scored highly on the 5-point likert scale. Every item set corresponding to an engagement principles evaluation had a Omega coefficient > 0.80, indicating a firm internal consistency for all question groups on both qualitative and quantitative scales. Conclusion Engagement of the community in the kidney research provides sustainability of the efforts and facilitates the achievements of the goals. Community leaders and researchers became a team and develop a relationship in which commitment and empowerment facilitated the participation in all aspects of the research process. This initiative could be a useful tool for researchers, especially in low-middle income countries, to start research in a community, achieve objectives in a viable form, and open opportunities to further studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02891-8.
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Affiliation(s)
- Angie Aguilar-González
- Foundation for Children With Kidney Disease -FUNDANIER-, 6 avenida 9-18 zona 10, torre 1, Oficina 804, Edificio Sixtino 2, Guatemala, 01010, Guatemala.
| | - Randall Lou-Meda
- Foundation for Children With Kidney Disease -FUNDANIER-, 6 avenida 9-18 zona 10, torre 1, Oficina 804, Edificio Sixtino 2, Guatemala, 01010, Guatemala
| | - André Chocó-Cedillos
- Foundation for Children With Kidney Disease -FUNDANIER-, 6 avenida 9-18 zona 10, torre 1, Oficina 804, Edificio Sixtino 2, Guatemala, 01010, Guatemala
| | - Louise Moist
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada.,Kidney Clinical Research Unit, London Health Sciences Centre, London, Canada
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Esmail R, Hanson HM, Holroyd-Leduc J, Niven DJ, Clement FM. Identification of knowledge translation theories, models or frameworks suitable for health technology reassessment: a survey of international experts. BMJ Open 2021; 11:e042251. [PMID: 34158291 PMCID: PMC8220529 DOI: 10.1136/bmjopen-2020-042251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Health technology reassessment (HTR) is a field focused on managing a technology throughout its life cycle for optimal use. The process results in one of four possible recommendations: increase use, decrease use, no change or complete withdrawal of the technology. However, implementation of these recommendations has been challenging. This paper explores knowledge translation (KT) theories, models and frameworks (TMFs) and their suitability for implementation of HTR recommendations. DESIGN Cross-sectional survey. PARTICIPANTS Purposeful sampling of international KT and HTR experts was administered between January and March 2019. METHODS Sixteen full-spectrum KT TMFs were rated by the experts as 'yes', 'partially yes' or 'no' on six criteria: familiarity, logical consistency/plausibility, degree of specificity, accessibility, ease of use and HTR suitability. Consensus was determined as a rating of ≥70% responding 'yes'. Descriptive statistics and manifest content analysis were conducted on open-ended comments. RESULTS Eleven HTR and 11 KT experts from Canada, USA, UK, Australia, Germany, Spain, Italy and Sweden participated. Of the 16 KT TMFs, none received ≥70% rating. When ratings of 'yes' and 'partially yes' were combined, the Consolidated Framework for Implementation Research was considered the most suitable KT TMF by both KT and HTR experts (86%). One additional KT TMF was selected by KT experts: Knowledge to Action framework. HTR experts selected two additional KT TMFs: Co-KT framework and Plan-Do-Study-Act cycle. Experts identified three key characteristics of a KT TMF that may be important to consider: practicality, guidance on implementation and KT TMF adaptability. CONCLUSIONS Despite not reaching an overall ≥70% rating on any of the KT TMFs, experts identified four KT TMFs suitable for HTR. Users may apply these KT TMFs in the implementation of HTR recommendations. In addition, KT TMF characteristics relevant to the field of HTR need to be explored further.
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Affiliation(s)
- Rosmin Esmail
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Heather M Hanson
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J Niven
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
- Department of Critical Care Medicine, Cummunity School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona M Clement
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
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Esmail R, Hanson HM, Holroyd-Leduc J, Brown S, Strifler L, Straus SE, Niven DJ, Clement FM. A scoping review of full-spectrum knowledge translation theories, models, and frameworks. Implement Sci 2020; 15:11. [PMID: 32059738 PMCID: PMC7023795 DOI: 10.1186/s13012-020-0964-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Application of knowledge translation (KT) theories, models, and frameworks (TMFs) is one method for successfully incorporating evidence into clinical care. However, there are multiple KT TMFs and little guidance on which to select. This study sought to identify and describe available full-spectrum KT TMFs to subsequently guide users. Methods A scoping review was completed. Articles were identified through searches within electronic databases, previous reviews, grey literature, and consultation with KT experts. Search terms included combinations of KT terms and theory-related terms. Included citations had to describe full-spectrum KT TMFs that had been applied or tested. Titles/abstracts and full-text articles were screened independently by two investigators. Each KT TMF was described by its characteristics including name, context, key components, how it was used, primary target audience, levels of use, and study outcomes. Each KT TMF was also categorized into theoretical approaches as process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks. Within each category, KT TMFs were compared and contrasted to identify similarities and unique characteristics. Results Electronic searches yielded 7160 citations. Additional citations were identified from previous reviews (n = 41) and bibliographies of included full-text articles (n = 6). Thirty-six citations describing 36 full-spectrum were identified. In 24 KT TMFs, the primary target audience was multi-level including patients/public, professionals, organizational, and financial/regulatory. The majority of the KT TMFs were used within public health, followed by research (organizational, translation, health), or in multiple contexts. Twenty-six could be used at the individual, organization, or policy levels, five at the individual/organization levels, three at the individual level only, and two at the organizational/policy level. Categorization of the KT TMFs resulted in 18 process models, eight classic theories, three determinant frameworks, three evaluation frameworks, and four that fit more than one category. There were no KT TMFs that fit the implementation theory category. Within each category, similarities and unique characteristics emerged through comparison. Conclusions A systematic compilation of existing full-spectrum KT TMFs, categorization into different approaches, and comparison has been provided in a user-friendly way. This list provides options for users to select from when designing KT projects and interventions. Trial registration A protocol outlining the methodology of this scoping review was developed and registered with PROSPERO (CRD42018088564).
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Affiliation(s)
- Rosmin Esmail
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D14A Teaching and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Alberta Health Services, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Heather M Hanson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D14A Teaching and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Alberta Health Services, Calgary, Alberta, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D14A Teaching and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Alberta Health Services, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sage Brown
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D14A Teaching and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Health Technology Assessment Unit, University of Calgary, Calgary, Alberta, Canada
| | - Lisa Strifler
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Niven
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D14A Teaching and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Alberta Health Services, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona M Clement
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D14A Teaching and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada. .,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada. .,Health Technology Assessment Unit, University of Calgary, Calgary, Alberta, Canada.
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Steenkamer B, Baan C, Putters K, van Oers H, Drewes H. Population health management guiding principles to stimulate collaboration and improve pharmaceutical care. J Health Organ Manag 2018; 32:224-245. [PMID: 29624140 PMCID: PMC5925855 DOI: 10.1108/jhom-06-2017-0146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/06/2017] [Accepted: 01/10/2018] [Indexed: 11/17/2022]
Abstract
Purpose A range of strategies to improve pharmaceutical care has been implemented by population health management (PHM) initiatives. However, which strategies generate the desired outcomes is largely unknown. The purpose of this paper is to identify guiding principles underlying collaborative strategies to improve pharmaceutical care and the contextual factors and mechanisms through which these principles operate. Design/methodology/approach The evaluation was informed by a realist methodology examining the links between PHM strategies, their outcomes and the contexts and mechanisms by which these strategies operate. Guiding principles were identified by grouping context-specific strategies with specific outcomes. Findings In total, ten guiding principles were identified: create agreement and commitment based on a long-term vision; foster cooperation and representation at the board level; use layered governance structures; create awareness at all levels; enable interpersonal links at all levels; create learning environments; organize shared responsibility; adjust financial strategies to market contexts; organize mutual gains; and align regional agreements with national policies and regulations. Contextual factors such as shared savings influenced the effectiveness of the guiding principles. Mechanisms by which these guiding principles operate were, for instance, fostering trust and creating a shared sense of the problem. Practical implications The guiding principles highlight how collaboration can be stimulated to improve pharmaceutical care while taking into account local constraints and possibilities. The interdependency of these principles necessitates effectuating them together in order to realize the best possible improvements and outcomes. Originality/value This is the first study using a realist approach to understand the guiding principles underlying collaboration to improve pharmaceutical care.
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Affiliation(s)
- Betty Steenkamer
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilberg, The Netherlands
| | - Caroline Baan
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilberg, The Netherlands
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kim Putters
- Department of Health Care Governance, Institute for Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- The Netherlands Institute for Social Research, The Hague, The Netherlands
| | - Hans van Oers
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilberg, The Netherlands
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Hanneke Drewes
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Schmidt B, Watt K, McDermott R, Mills J. Assessing the link between implementation fidelity and health outcomes for a trial of intensive case management by community health workers: a mixed methods study protocol. BMC Health Serv Res 2017; 17:490. [PMID: 28716135 PMCID: PMC5512738 DOI: 10.1186/s12913-017-2320-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 05/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background Better systems of care are required to address chronic disease in Indigenous people to ensure they can access all their care needs. Health research has produced evidence about effective models of care and chronic disease strategies to address Indigenous health, however the transfer of research findings into routine clinical practice has proven challenging. Complex interventions, such as those related to chronic disease, have many components that are often poorly implemented and hence rarely achieve implementation fidelity. Implementation fidelity is “the degree to which programs are implemented as intended by the program developer”. Knowing if an intervention was implemented as planned is fundamental to knowing what has contributed to the success of an intervention. Methods The aim of this study is to adapt the implementation fidelity framework developed by Keith et al. and apply it to the intervention implemented in phase 1 of the Getting Better at Chronic Care in North Queensland study. The objectives are to quantify the level of implementation fidelity achieved during phase 1 of the study, measure the association between implementation fidelity and health outcomes and to explore the features of the primary health care system that contributed to improved health outcomes. A convergent parallel mixed methods study design will be used to develop a process for assessing implementation fidelity. Information collected via a questionnaire and routine data generated during phase 1 of the study will be used to explain the context for the intervention in each site and develop an implementation fidelity score for each component of the intervention. A weighting will be applied to each component of the intervention to calculate the overall implementation score for each participating community. Statistical analysis will assess the level of association between implementation fidelity scores and health outcomes. Discussion Health services research seeks to find solutions to social and technical problems to improve health outcomes. The development of a tool and methodology for assessing implementation fidelity in the Indigenous primary health care context will help address some of the barriers to the translation of research into practice. Trial registration ACTRN12610000812099: 29.9.2010
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Affiliation(s)
- Barbara Schmidt
- University of South Australia, Adelaide, Australia. .,James Cook University, Cairns, Australia.
| | | | - Robyn McDermott
- University of South Australia, Adelaide, Australia.,James Cook University, Cairns, Australia
| | - Jane Mills
- James Cook University, Cairns, Australia
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Liddy C, Johnston S, Nash K, Irving H, Davidson R. Implementation and evolution of a regional chronic disease self-management program. Canadian Journal of Public Health 2016; 107:e194-e201. [PMID: 27526218 DOI: 10.17269/cjph.107.5126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 04/27/2016] [Accepted: 01/30/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To establish a comprehensive, community-based program to improve and sustain self-management support for individuals with chronic diseases and complement office-based strategies to support behaviour change. PARTICIPANTS Health service delivery organizations. SETTING The Champlain Local Health Integration Network (LHIN), a health district in Eastern Ontario. INTERVENTION We created Living Healthy Champlain (LHC), a regional organization providing peer leader training and coordination for the group Stanford Chronic Disease Self-Management Program (CDSMP); skills training and mentorship in behaviour change approaches for health care providers; and support to organizations to integrate self-management support into routine practice. We used the RE-AIM framework to evaluate the overall program's impact by exploring its reach, effectiveness, adoption, implementation and maintenance. OUTCOME A total of 232 Stanford CDSMP sessions (63 during the pilot project and 169 post-pilot) have been held at 127 locations in 24 cities across the Champlain LHIN, reaching approximately 4,000 patients. The effectiveness of the service was established through ongoing evidence reviews, a focus group and a pre-post utilization study of the pilot. LHC trained over 300 peer volunteers to provide the Stanford CDSMP sessions, 98 of whom continue to activelyhost workshops. An additional 1,327 providers have been trained in other models of self-management support, such as Health Coaching and Motivational Interviewing. Over the study period, LHC grew from a small pilot project to a regional initiative with sustainable provincial funding and was adopted by the province as a model for similar service delivery across Ontario. CONCLUSION A community-based self-management program working in partnership with primary care can be effectively and broadly implemented in support of patients living with chronic conditions.
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Affiliation(s)
- Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada, 43 Bruyère Street, Annex E, Room 106, K1N 5C8. .,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Sharon Johnston
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada, 43 Bruyère Street, Annex E, Room 106, K1N 5C8.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kate Nash
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada, 43 Bruyère Street, Annex E, Room 106, K1N 5C8
| | - Hannah Irving
- Care of the Elderly Research Program, Bruyère Research Institute, Ottawa, ON, Canada
| | - Rachel Davidson
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada, 43 Bruyère Street, Annex E, Room 106, K1N 5C8
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Liddy C, Johnston S, Guilcher S, Irving H, Hogel M, Jaglal S. Impact of a chronic disease self-management program on healthcare utilization in eastern Ontario, Canada. Prev Med Rep 2015; 2:586-90. [PMID: 26844122 PMCID: PMC4721386 DOI: 10.1016/j.pmedr.2015.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study aims to examine patients' patterns of health care utilization before and after participation in a Chronic Disease Self-Management Program (CDSMP). We conducted a pre-post study using health care administrative data from 186 individuals in the Ottawa region who participated in our CDSMP between September 2009 and January 2011. We collected the number of general practitioner/specialist visits, planned/unplanned emergency department visits, and hospitalizations, measured 6 months and 1 year before and after participation in the CDSMP. Multivariate analysis was performed to identify associations between patient characteristics and pre-post CDSMP health care utilization. CDSMP participation showed no effect on number of physician visits, hospitalizations, or emergency department visits. Individuals with > 5 chronic conditions were more likely to visit a physician and the emergency department following the CDSMP than those with 1 chronic condition. Among individuals > 61 years of age, those with the marital status widowed were more likely to visit their physician and the emergency department following the CDSMP than married individuals. To conclude, the CDSMP appeared not to decrease health care utilization. Low baseline utilization rates, short-term follow-ups, and a relatively healthy patient population may have contributed to the program's low impact. We examine patients' health care use before and after a self-management program. Patients complete six workshops teaching chronic disease self-management skills. The program does not appear to decrease health care utilization. Several factors (e.g. low baseline usage, high patient health) may reduce impact.
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Affiliation(s)
- Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyere St, Annex E, Ottawa, Ontario K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 43 Bruyere Street (Floor 3JB), Ottawa, Ontario K1N 5C8, Canada
| | - Sharon Johnston
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyere St, Annex E, Ottawa, Ontario K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 43 Bruyere Street (Floor 3JB), Ottawa, Ontario K1N 5C8, Canada
| | - Sara Guilcher
- Canadian Population Health Initiative, Canadian Institute for Health Information, 4110 Yonge Street, Suite 300, Toronto, Ontario M2P 2B7, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Hannah Irving
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyere St, Annex E, Ottawa, Ontario K1N 5C8, Canada
| | - Matthew Hogel
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyere St, Annex E, Ottawa, Ontario K1N 5C8, Canada
| | - Susan Jaglal
- Toronto Rehabilitation Institute-University Health Network, 7-504, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada; Institute for Clinical Evaluative Sciences, University of Toronto, 155 College Street, Suite 424, Toronto, Ontario M5T 3M6, Canada
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The perceptions and perspectives of patients and health care providers on chronic diseases management in rural South Africa: a qualitative study. BMC Health Serv Res 2015; 15:143. [PMID: 25880727 PMCID: PMC4399424 DOI: 10.1186/s12913-015-0812-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 03/23/2015] [Indexed: 11/29/2022] Open
Abstract
Background Preventive health care represents the future for health care delivery in South Africa to improve management of chronic diseases as this has been implemented for some time in several countries to tackle the increasing burden of chronic diseases. Individual person’s health is unique, as they move in and out of chronic and acute health care phases, there is need to integrate chronic and acute care constructs to improve continuity of care and maximize health and improve wellbeing. The aim of this study was to determine the perceptions and perspectives of chronic patients’ and nurses regarding chronic disease management in terms of barriers, facilitators and their experiences. Methods To meet our aim we used qualitative methods involving the collection of information by means of focus group discussions in Dikgale Health and Demographic Surveillance System (HDSS). All data was recorded, transcribed verbatim and analysed using data-driven thematic analysis. Results Our study showed that chronic disease patients have a first contact with health care professionals at the primary health care level in the study area. The main barriers mentioned by both the health care workers and chronic disease patients are lack of knowledge on chronic diseases, shortage of medication and shortage of nurses in the clinics which causes patients to wait for a long periods in a clinic. Health care workers are poorly trained on the management of chronic diseases. Lack of supervision by the district and provincial health managers together with poor dissemination of guidelines has been found to be a contributing factor to lack of knowledge in nurses among the clinics within the study area. Both patients and nurses mentioned the need to involve community health workers and traditional healers and integrate their services in order to early detect and manage chronic diseases in the community. Conclusions Nurses and chronic disease patients mentioned similar barriers to chronic disease management. Concerted action is needed to strengthen the delivery of medications at the clinics, improve the chronic disease knowledge for both nurses and patients by conducting in-service trainings or workshops, increase the involvement of community health workers and establish a link (through formal referral system) with traditional healers.
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