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Hyett N, Hutchinson M, Doyle D, Adem T, Coghill D, Harvey P, Lees C, O'Sullivan B. Rural community-centred co-planning for sustainable rural health systems. Aust J Rural Health 2024. [PMID: 38989766 DOI: 10.1111/ajr.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 06/14/2024] [Accepted: 06/22/2024] [Indexed: 07/12/2024] Open
Abstract
OBJECTIVE Sustaining rural healthcare services is challenging because of numerous systemic factors. Rural communities can inform the design of sustainable rural health models; however, further evidence of effective co-design is needed to guide implementation. The study aim was to co-design a series of place-based and evidence-informed rural health models, to improve local health system sustainability. SETTING A rural region (categorised as Modified Monash Model 5) defined by three adjoining Shires in Central and Northwest Victoria, Australia. PARTICIPANTS A health executive co-planning network led the co-design, with input and oversight from a broader cross-sector group. Healthcare professionals (n = 44) and consumers and carers (n = 21) participated in interviews, and an online survey was completed by healthcare professionals (n = 11) and consumers and carers (n = 7) to provide feedback on the preliminary results. DESIGN Community-based participatory action research was applied incorporating co-design methods and systems thinking. Data were collected through qualitative interviews followed by an online feedback survey. Mixed method data analysis (QUAL-quant) was conducted with qualitative directed content analysis of interview transcripts and quantitative descriptive analyses of survey responses to aid prioritisation. RESULTS Healthcare priorities, strengths and challenges, and proposed rural health models are described. A rural health system sustainability strategy was developed with three integrated pillars: 1. Workforce strengthening, 2. Integrated health services and 3. Innovative models of care. CONCLUSION Community-centred co-design with rural health stakeholders was effective for generating locally tailored ideas and potential health models that emulate community strengths and resources, and provide a foundation for further planning, implementation and evaluation.
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Affiliation(s)
- Nerida Hyett
- Murray PHN, Monash University, La Trobe University, Bendigo, Victoria, Australia
| | | | - Donna Doyle
- Boort District Health, Boort, Victoria, Australia
| | - Trevor Adem
- East Wimmera Health Service, Saint Arnaud, Victoria, Australia
| | - Dallas Coghill
- Inglewood & Districts Health Service, Inglewood, Victoria, Australia
| | - Pamela Harvey
- Monash Rural Health, Monash University, Bendigo, Victoria, Australia
| | - Catherine Lees
- Murray PHN, La Trobe University, Monash University, University of Melbourne, Melbourne, Victoria, Australia
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Scott RJ, Mathie E, Newman HJH, Almack K, Brady L. Commissioning and co-production in health and care services in the United Kingdom and Ireland: An exploratory literature review. Health Expect 2024; 27:e14053. [PMID: 38698629 PMCID: PMC11066417 DOI: 10.1111/hex.14053] [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: 12/12/2023] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION This exploratory literature review seeks to examine the literature around commissioning processes in the co-production of health and care services, focusing on two questions: How do health and care commissioning processes facilitate and/or pose barriers to co-production in service design and delivery? What are the contextual factors that influence these processes? METHOD A systematic search of three databases (Medline, Public Health and Social Policy and Practice) and a search platform (Web of Science) was conducted for the period 2008-2023. A total of 2675 records were retrieved. After deduplication, 1925 were screened at title and abstract level. Forty-seven reports from 42 United Kingdom and Ireland studies were included in the review. A thematic synthesis of included studies was conducted in relation to the research questions. RESULTS The review identified one overarching theme across the synthesised literature: the complexity of the commissioning landscape. Three interconnected subthemes illuminate the contextual factors that influence this landscape: commissioners as leaders of co-production; navigating relationships and the collective voice. CONCLUSION Commissioning processes were commonly a barrier to the co-production of health and care services. Though co-production was an aspiration for many commissioners, the political and economic environment and service pressures meant that it was often not fully realised. More flexible funding models, longer-term pilot projects, an increased emphasis in social value across the health and care system and building capacity for strong leadership in commissioning is needed. PATIENT AND PUBLIC CONTRIBUTION Patients and the public did not contribute to this review as it was a small piece of work following on from a completed project, with no budget for public involvement.
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Affiliation(s)
- Rebecca J. Scott
- Library and Computing ServicesUniversity of HertfordshireLondonUK
| | - Elspeth Mathie
- Health and Social Care Inclusion, Centre for Research in Public Health and Community CareUniversity of HertfordshireLondonUK
| | - Hannah J. H. Newman
- Applied Psychology, School of Life and Medical SciencesUniversity of HertfordshireLondonUK
| | - Kathryn Almack
- Family Lives and Care, Centre for Research in Public Health and Community CareUniversity of HertfordshireLondonUK
| | - Louca‐Mai Brady
- Communities, Young People and Family Lives, CRIPPAC, Centre for Research in Public Health and Community CareUniversity of HertfordshireLondonUK
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Good P, Grace R, Kaplun C, Conti J. A community-embedded approach to increasing the health literacy of Aboriginal children in a regional area: processes of co-design and local implementation. Front Public Health 2024; 12:1355603. [PMID: 38532973 PMCID: PMC10964943 DOI: 10.3389/fpubh.2024.1355603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/22/2024] [Indexed: 03/28/2024] Open
Abstract
Purpose This research explores the implementation of a child-centred, co-designed, community-embedded program called 'Young Doctors for Life' (YDFL). YDFL is designed to improve health and wellbeing outcomes for Aboriginal children in the middle childhood years. Focus is given in this paper to the processes of program adaptation of the YDFL to ensure local cultural relevance, drawing on the experiences and perspectives of children, parents, schoolteachers, and the implementation team. Method Two focus groups with program stakeholders were convened. The first group consisted of three members from the local Aboriginal implementation team, and the second group comprised two members of the program design team. Children (n = 22) and schoolteachers (n = 2) participated in semi-structured interviews. Parent survey data (n = 16) were also collected and included. The data was analysed, guided by the five elements of implementation as outlined in the Hexagon Implementation framework (Capacity; Fit; Need; Usability; Support; and Evidence), which served as a priori themes. Results YDFL provides a promising example of how programs can be adapted with and for Aboriginal communities to support child health. Successful adaptation and implementation of this program required a co-design approach engaging program designers and the local implementation team. Community collaboration was also essential to identifying and addressing local community goals and aligning new programs with local service and cultural contexts. Conclusion Health programs to support positive child outcomes are more likely to be successful when they share their focus between the risks and challenges within a community, and the positive, protective factors that can be leveraged to support children to flourish. Stakeholder engagement and community leadership are necessary to achieve meaningful program adaptation and implementation in Aboriginal communities.
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Affiliation(s)
- Phillip Good
- Transforming Early Education and Child Health (TeEACH), Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia
| | - Rebekah Grace
- Transforming Early Education and Child Health (TeEACH), Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia
| | - Catherine Kaplun
- Transforming Early Education and Child Health (TeEACH), Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia
| | - Janet Conti
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
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Kjellström S, Sarre S, Masterson D. The complexity of leadership in coproduction practices: a guiding framework based on a systematic literature review. BMC Health Serv Res 2024; 24:219. [PMID: 38368329 PMCID: PMC10873973 DOI: 10.1186/s12913-024-10549-4] [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: 04/11/2023] [Accepted: 01/03/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND As coproduction in public services increases, understanding the role of leadership in this context is essential to the tasks of establishing relational partnerships and addressing power differentials among groups. The aims of this review are to explore models of coproduction leadership and the processes involved in leading coproduction as well as, based on that exploration, to develop a guiding framework for coproduction practices. METHODS A systematic review that synthesizes the evidence reported by 73 papers related to coproduction of health and welfare. RESULTS Despite the fact that models of coleadership and collective leadership exhibit a better fit with the relational character of coproduction, the majority of the articles included in this review employed a leader-centric underlying theory. The practice of coproduction leadership is a complex activity pertaining to interactions among people, encompassing nine essential practices: initiating, power-sharing, training, supporting, establishing trust, communicating, networking, orchestration, and implementation. CONCLUSIONS This paper proposes a novel framework for coproduction leadership practices based on a systematic review of the literature and a set of reflective questions. This framework aims to help coproduction leaders and participants understand the complexity, diversity, and flexibility of coproduction leadership and to challenge and enhance their capacity to collaborate effectively.
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Affiliation(s)
- Sofia Kjellström
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, Jönköping, Sweden.
| | - Sophie Sarre
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Daniel Masterson
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, Jönköping, Sweden
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Alston L, McFayden L, Gupta TS, Payne W, Smith J. Creating a sustainable and supportive health research environment across rural and remote Australia: a call to action. Med J Aust 2023; 219 Suppl 3:S27-S30. [PMID: 37544008 DOI: 10.5694/mja2.52027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/12/2023] [Accepted: 04/28/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Laura Alston
- Deakin Rural Health, Deakin University, Geelong, VIC
| | - Lisa McFayden
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW
- Hunter Medical Research Institute, Newcastle, NSW
| | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Townsville, QLD
| | | | - James Smith
- Flinders Rural and Remote Health NT, Flinders University, Darwin, NT
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Merner B, Schonfeld L, Virgona A, Lowe D, Walsh L, Wardrope C, Graham-Wisener L, Xafis V, Colombo C, Refahi N, Bryden P, Chmielewski R, Martin F, Messino NM, Mussared A, Smith L, Biggar S, Gill M, Menzies D, Gaulden CM, Earnshaw L, Arnott L, Poole N, Ryan RE, Hill S. Consumers' and health providers' views and perceptions of partnering to improve health services design, delivery and evaluation: a co-produced qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 3:CD013274. [PMID: 36917094 PMCID: PMC10065807 DOI: 10.1002/14651858.cd013274.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Partnering with consumers in the planning, delivery and evaluation of health services is an essential component of person-centred care. There are many ways to partner with consumers to improve health services, including formal group partnerships (such as committees, boards or steering groups). However, consumers' and health providers' views and experiences of formal group partnerships remain unclear. In this qualitative evidence synthesis (QES), we focus specifically on formal group partnerships where health providers and consumers share decision-making about planning, delivering and/or evaluating health services. Formal group partnerships were selected because they are widely used throughout the world to improve person-centred care. For the purposes of this QES, the term 'consumer' refers to a person who is a patient, carer or community member who brings their perspective to health service partnerships. 'Health provider' refers to a person with a health policy, management, administrative or clinical role who participates in formal partnerships in an advisory or representative capacity. This QES was co-produced with a Stakeholder Panel of consumers and health providers. The QES was undertaken concurrently with a Cochrane intervention review entitled Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. OBJECTIVES 1. To synthesise the views and experiences of consumers and health providers of formal partnership approaches that aimed to improve planning, delivery or evaluation of health services. 2. To identify best practice principles for formal partnership approaches in health services by understanding consumers' and health providers' views and experiences. SEARCH METHODS We searched MEDLINE, Embase, PsycINFO and CINAHL for studies published between January 2000 and October 2018. We also searched grey literature sources including websites of relevant research and policy organisations involved in promoting person-centred care. SELECTION CRITERIA We included qualitative studies that explored consumers' and health providers' perceptions and experiences of partnering in formal group formats to improve the planning, delivery or evaluation of health services. DATA COLLECTION AND ANALYSIS Following completion of abstract and full-text screening, we used purposive sampling to select a sample of eligible studies that covered a range of pre-defined criteria, including rich data, range of countries and country income level, settings, participants, and types of partnership activities. A Framework Synthesis approach was used to synthesise the findings of the sample. We appraised the quality of each study using the CASP (Critical Appraisal Skill Program) tool. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. The Stakeholder Panel was involved in each stage of the review from development of the protocol to development of the best practice principles. MAIN RESULTS We found 182 studies that were eligible for inclusion. From this group, we selected 33 studies to include in the final synthesis. These studies came from a wide range of countries including 28 from high-income countries and five from low- or middle-income countries (LMICs). Each of the studies included the experiences and views of consumers and/or health providers of partnering in formal group formats. The results were divided into the following categories. Contextual factors influencing partnerships: government policy, policy implementation processes and funding, as well as the organisational context of the health service, could facilitate or impede partnering (moderate level of confidence). Consumer recruitment: consumer recruitment occurred in different ways and consumers managed the recruitment process in a minority of studies only (high level of confidence). Recruiting a range of consumers who were reflective of the clinic's demographic population was considered desirable, particularly by health providers (high level of confidence). Some health providers perceived that individual consumers' experiences were not generalisable to the broader population whereas consumers perceived it could be problematic to aim to represent a broad range of community views (high level of confidence). Partnership dynamics and processes: positive interpersonal dynamics between health providers and consumers facilitated partnerships (high level of confidence). However, formal meeting formats and lack of clarity about the consumer role could constrain consumers' involvement (high level of confidence). Health providers' professional status, technical knowledge and use of jargon were intimidating for some consumers (high level of confidence) and consumers could feel their experiential knowledge was not valued (moderate level of confidence). Consumers could also become frustrated when health providers dominated the meeting agenda (moderate level of confidence) and when they experienced token involvement, such as a lack of decision-making power (high level of confidence) Perceived impacts on partnership participants: partnering could affect health provider and consumer participants in both positive and negative ways (high level of confidence). Perceived impacts on health service planning, delivery and evaluation: partnering was perceived to improve the person-centredness of health service culture (high level of confidence), improve the built environment of the health service (high level of confidence), improve health service design and delivery e.g. facilitate 'out of hours' services or treatment closer to home (high level of confidence), enhance community ownership of health services, particularly in LMICs (moderate level of confidence), and improve consumer involvement in strategic decision-making, under certain conditions (moderate level of confidence). There was limited evidence suggesting partnering may improve health service evaluation (very low level of confidence). Best practice principles for formal partnering to promote person-centred care were developed from these findings. The principles were developed collaboratively with the Stakeholder Panel and included leadership and health service culture; diversity; equity; mutual respect; shared vision and regular communication; shared agendas and decision-making; influence and sustainability. AUTHORS' CONCLUSIONS Successful formal group partnerships with consumers require health providers to continually reflect and address power imbalances that may constrain consumers' participation. Such imbalances may be particularly acute in recruitment procedures, meeting structure and content and decision-making processes. Formal group partnerships were perceived to improve the physical environment of health services, the person-centredness of health service culture and health service design and delivery. Implementing the best practice principles may help to address power imbalances, strengthen formal partnering, improve the experiences of consumers and health providers and positively affect partnership outcomes.
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Affiliation(s)
- Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Ariane Virgona
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
- Child and Family Evidence, Australian Institute of Family Studies, Melbourne, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Cheryl Wardrope
- Clinical Governance, Metro South Hospital and Health Service, Eight Mile Plains, Australia
| | | | - Vicki Xafis
- The Sydney Children's Hospitals Network, Sydney, Australia
| | - Cinzia Colombo
- Laboratory for medical research and consumer involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Nora Refahi
- Consumer Representative, Melbourne, Australia
| | - Paul Bryden
- Consumer Representative, Caboolture, Australia
| | - Renee Chmielewski
- Planning and Patient Experience, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | | | | | | | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Susan Biggar
- Consumer Representative, Melbourne, Australia
- Australian Health Practitioner Regulation Agency (AHPRA), Melbourne, Australia
| | - Marie Gill
- Gill and Wilcox Consultancy, Melbourne, Australia
| | - David Menzies
- Chronic Disease Programs, South Eastern Melbourne Primary Health Network, Heatherton, Australia
| | - Carolyn M Gaulden
- Detroit Wayne County Authority Health Residency Program, Michigan State University, Providence Hospital, Southfield, Michigan, USA
| | | | | | - Naomi Poole
- Strategy and Innovation, Australian Commission on Safety and Quality in Health Care, Sydney, Australia
| | - Rebecca E Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Masterson S, Teljeur C, Cullinan J. Are there socioeconomic disparities in geographic accessibility to community first responders to out-of-hospital cardiac arrest in Ireland? SSM Popul Health 2022; 19:101151. [PMID: 35789763 PMCID: PMC9249950 DOI: 10.1016/j.ssmph.2022.101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/08/2021] [Accepted: 06/17/2022] [Indexed: 11/26/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Without appropriate early resuscitation interventions, the prospect of survival is limited. This means that an effective community response is a critical enabler of increasing the number of people who survive. However, while OHCA incidence is higher in more deprived areas, propensity to volunteer is, in general, associated with higher socioeconomic status. In this context, we consider whether there are socioeconomic disparities in geographic accessibility to volunteer community first responders (CFRs) in Ireland, where CFR groups have developed organically and communities self-select to participate. We use geographic information systems and propensity score matching to generate a set of control areas with which to compare established CFR catchment areas. Differences between CFRs and controls in terms of the distribution of catchment deprivation and social fragmentation scores are assessed using two-sided Kolmogorov-Smirnov tests. Overall we find that while CFR schemes are centred in more deprived and socially fragmented areas, beyond a catchment of 4 min there is no evidence of differences in area-level deprivation or social fragmentation. Our findings show that self-selection as a model of CFR recruitment does not lead to more deprived areas being disadvantaged in terms of access to CFR schemes. This means that community-led health interventions can develop to the benefit of community members across the socioeconomic spectrum and may be relevant for other countries and jurisdictions looking to support similar models within communities. Out-of-hospital cardiac arrest (OHCA) is a major cause of unexpected death. OHCA is more prevalent in deprived areas and community response is key for survival. Irish community first responders (CFRs) self-select to participate in CFR schemes. We consider if there are socioeconomic disparities in geographic access to CFRs. Self-selection does not result in deprived areas having worse access to CFR schemes.
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Smartphone activated community first responders’ experiences of out-of-hospital cardiac arrests alerts, a qualitative study. Resusc Plus 2022; 10:100246. [PMID: 35607395 PMCID: PMC9123264 DOI: 10.1016/j.resplu.2022.100246] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 01/02/2023] Open
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Buse CG, Allison S, Cole DC, Fumerton R, Parkes MW, Woollard RF. Patient- and Community-Oriented Primary Care Approaches for Health in Rural, Remote and Resource-Dependent Places: Insights for Eco-Social Praxis. Front Public Health 2022; 10:867397. [PMID: 35692331 PMCID: PMC9178183 DOI: 10.3389/fpubh.2022.867397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Accelerating ecological and societal changes require re-imagining the role of primary care and public health to address eco-social concerns in rural and remote places. In this narrative review, we searched literatures on: community-oriented primary care, patient-oriented research engagement, public health and primary care synergies, and primary care addressing social determinants of health. Our analysis was guided by questions oriented to utility for addressing concerns of social-ecological systems in rural, remote contexts characterized by a high degree of reliance on resource extraction and development (e.g., forestry, mining, oil and gas, fisheries, agriculture, ranching and/or renewables). We describe a range of useful frameworks, processes and tools that are oriented toward bolstering the resilience and engagement of both primary care and public health, though few explicitly incorporated considerations of eco-social approaches to health or broader eco-social context(s). In synthesizing the existing evidence base for integration between primary care and public health, the results signal that for community-oriented primary care and related frameworks to be useful in rural and remote community settings, practitioners are required to grapple with complexity, durable relationships, sustainable resources, holistic approaches to clinician training, Indigenous perspectives, and governance.
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Affiliation(s)
- Chris G. Buse
- Centre for Environmental Assessment Research, University of British Columbia (Okanagan Campus), Kelowna, BC, Canada
- *Correspondence: Chris G. Buse
| | | | - Donald C. Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Margot Winifred Parkes
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Robert F. Woollard
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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De Cotta T, Knox J, Farmer J, White C, Davis H. Community co-produced mental health initiatives in rural Australia: A scoping review. Aust J Rural Health 2021; 29:865-878. [PMID: 34784085 DOI: 10.1111/ajr.12793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Inaccessibility of mental health services in rural Australia is widely reported. Community co-produced mental health and well-being initiatives could fill gaps and complement other services. OBJECTIVE This scoping review summarises findings from peer-reviewed articles to identify the key features of co-produced Australian rural mental health initiatives that engage communities in their design, delivery or evaluation processes. DESIGN Between 2009 and 2019 inclusive, 14 articles met inclusion criteria and were reviewed using Arksey and O'Malley's review methodology. FINDINGS Communities co-produced initiatives through informing, collaborating and instigating them. Some initiatives operated in specific places, for example an art gallery, while others operated across regions. Only two initiatives involved community members in multiple activities targeting prevention, early intervention, education and service accessibility; other initiatives were more focused, for example designing a new service. Over half of initiatives found were targeted at Aboriginal and Torres Strait Islander Peoples. Most articles discussed evaluation approaches, though methods were diverse. DISCUSSION Published peer-reviewed evidence about Australian rural community co-produced mental health initiatives appears scant. Evidence found suggests they generate a range of supports that could complement or mitigate for lack of, public health services. The overall lack of evidence, diversity of initiatives and inconsistent evaluation makes it difficult to assess effectiveness and which activities might be scaled-up for wider benefit. CONCLUSION Rural communities have limited resources, and evidence of what constitutes best practice in co-producing mental health services would help to avoid 'reinventing the wheel.' Greater efforts in evaluating and publishing about initiatives would be helpful.
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Affiliation(s)
- Tracy De Cotta
- Social Innovation Research Institute, Swinburne University of Technology, Hawthorn, Vic., Australia
| | - Jasmine Knox
- Social Innovation Research Institute, Swinburne University of Technology, Hawthorn, Vic., Australia
| | - Jane Farmer
- Social Innovation Research Institute, Swinburne University of Technology, Hawthorn, Vic., Australia
| | | | - Hilary Davis
- Social Innovation Research Institute, Swinburne University of Technology, Hawthorn, Vic., Australia
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Johnston CS, Belanger E, Wong K, Snadden D. How can rural community-engaged health services planning achieve sustainable healthcare system changes? BMJ Open 2021; 11:e047165. [PMID: 34649845 PMCID: PMC8522661 DOI: 10.1136/bmjopen-2020-047165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The objectives of the Rural Site Visit Project (SV Project) were to develop a successful model for engaging all 201 communities in rural British Columbia, Canada, build relationships and gather data about community healthcare issues to help modify existing rural healthcare programs and inform government rural healthcare policy. DESIGN An adapted version of Boelen's health partnership model was used to identify each community's Health Care Partners: health providers, academics, policy makers, health managers, community representatives and linked sectors. Qualitative data were gathered using a semistructured interview guide. Major themes were identified through content analysis, and this information was fed back to government and interviewees in reports every 6 months. SETTING The 107 communities visited thus far have healthcare services that range from hospitals with surgical programs to remote communities with no medical services at all. The majority have access to local primary care. PARTICIPANTS Participants were recruited from the Health Care Partner groups identified above using purposeful and snowball sampling. PRIMARY AND SECONDARY OUTCOME MEASURES A successful process was developed to engage rural communities in identifying their healthcare priorities, while simultaneously building and strengthening relationships. The qualitative data were analysed from 185 meetings in 80 communities and shared with policy makers at governmental and community levels. RESULTS 36 themes have been identified and three overarching themes that interconnect all the interviews, namely Relationships, Autonomy and Change Over Time, are discussed. CONCLUSION The SV Project appears to be unique in that it is physician led, prioritises relationships, engages all of the healthcare partners singly and jointly in each community, is ongoing, provides feedback to both the policy makers and all interviewees on a 6-monthly basis and, by virtue of its large scope, has the ability to produce interim reports that have helped inform system change.
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Affiliation(s)
| | - Erika Belanger
- Northern Node, Health Research Institute, Rural Coordination Centre of BC (RCCbc), Prince George, British Columbia, Canada
| | - Krystal Wong
- Vancouver Node, Rural Coordination Centre of BC (RCCbc), Vancouver, British Columbia, Canada
| | - David Snadden
- Family Practice, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Northern Medical Program, The University of British Columbia Faculty of Medicine, Prince George, British Columbia, Canada
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Lim S, Morris H, Pizzirani B, Kajewski D, Lee WK, Skouteris H. Evaluating hospital tools and services that were co-produced with patients: A rapid review. Int J Qual Health Care 2021; 32:231-239. [PMID: 32222757 DOI: 10.1093/intqhc/mzaa020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/04/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To describe the process and outcomes of services or products co-produced with patients in hospital settings. DATA SOURCES Database searches on Medline, CINAHL and Business Source between 2008 and 2019. STUDY SELECTION Studies that evaluate the products of co-production in hospital settings. DATA EXTRACTION Primary outcome is the individual and organizational outcomes resulting from co-production. Study characteristics, co-production process, level of engagement and intensity of engagement were also extracted. RESULTS OF DATA SYNTHESIS A total of 13 studies were included. Types of co-produced outputs were health services and care processes, tools and resources, and technology-based products, such as mobile application. Most studies engaged patients at a consultative or involvement level, with only four studies engaging patients as partners. Moderate-to-high acceptability and usability by patients and health services were reported for co-produced outputs. Organizational outcomes were also reported qualitatively as producing various positive effects, such as improved communication and diagnostic process. Positive patient outcomes were reported for co-produced outputs in qualitative (e.g. improved social support) and quantitative results (e.g. reduction of clinic wait time). No patient clinical outcomes were reported. CONCLUSION Co-produced outputs have moderate-to-high acceptability, usability or uptake. There is insufficient evidence on other organizational or patient outcomes due to the lack of reporting of outcomes in co-production. Future research should focus on the outcomes (i.e. effects on patients and health service providers), not just the output of co-production. This is critical to provide feedback to advance the knowledge and implementation of co-production.
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Affiliation(s)
- Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, VIC 3168, Australia
| | - Heather Morris
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, VIC 3168, Australia
| | - Bengianni Pizzirani
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, VIC 3168, Australia
| | - Duncan Kajewski
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, VIC 3168, Australia
| | - Wai Kit Lee
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, VIC 3168, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, VIC 3168, Australia
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Chauhan A, Walpola RL, Manias E, Seale H, Walton M, Wilson C, Smith AB, Li J, Harrison R. How do health services engage culturally and linguistically diverse consumers? An analysis of consumer engagement frameworks in Australia. Health Expect 2021; 24:1747-1762. [PMID: 34264537 PMCID: PMC8483202 DOI: 10.1111/hex.13315] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/19/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background Engagement frameworks provide the conceptual structure for consumer engagement in healthcare decision making, but the level to which these frameworks support culturally and linguistically diverse (CALD) consumer engagement is not known. Objective This study aimed to investigate how consumer engagement is conceptualised and operationalized and to determine the implications of current consumer engagement frameworks for engagement with CALD consumers. Method Altheide's document analysis approach was used to guide a systematic search, selection and analytic process. Australian Government health department websites were searched for eligible publicly available engagement frameworks. A narrative synthesis was conducted. Results Eleven engagement frameworks published between 2007 and 2019 were identified and analysed. Only four frameworks discussed engagement with CALD consumers distinctly. Organisational prerequisites to enhance engagement opportunities and approaches to enable activities of engagement were highlighted to improve CALD consumers' active participation in decision making; however, these largely focused on language, with limited exploration of culturally sensitive services. Conclusion There is limited discussion of what culturally sensitive services look like and what resources are needed to enhance CALD consumer engagement in high‐level decision making. Health services and policy makers can enhance opportunities for engagement with CALD consumers by being flexible in their approach, implementing policies for reimbursement for participation and evaluating and adapting the activities of engagement in collaboration with CALD consumers. Patient/Public Contribution This study is part of a wider ‘CanEngage’ project, which includes a consumer investigator, and is supported by a consumer advisory group. The study was conceived with inputs from the consumer advisory group, which continued to meet regularly with the project team to discuss the methodology and emerging findings.
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Affiliation(s)
- Ashfaq Chauhan
- School of Population Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Ramesh L Walpola
- School of Population Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Holly Seale
- School of Population Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Merrilyn Walton
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carlene Wilson
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia.,School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Allan B Smith
- Centre for Oncology Education and Research Translation (CONSORT), Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia
| | - Jiadai Li
- School of Population Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Reema Harrison
- School of Population Health, UNSW Sydney, Kensington, New South Wales, Australia
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14
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Munoz SA, Bradley S. We've got what the NHS ultimately intended for us: Experiences of community engagement in rural primary care services change. Soc Sci Med 2021; 280:114033. [PMID: 34044185 DOI: 10.1016/j.socscimed.2021.114033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/22/2021] [Accepted: 05/10/2021] [Indexed: 11/15/2022]
Abstract
Policy promotes service user engagement in health services design and delivery. Various tools exist to support the engagement of citizens within health services design. We consider community engagement within the context of primary care delivery in remote and rural areas of Scotland. We present findings from three years of qualitative work with community members and healthcare professionals within five different remote and rural areas, undergoing primary care service changes. 364 interviews were carried out with community members and healthcare professionals on their experiences of, and feelings towards, the services changes. A key theme to emerge from our thematic analysis of the qualitative data is experiences of community engagement. In this paper we present our analysis of this theme. We identify different types of community engagement discourse within community and healthcare professional interviews. We illustrate these themes and, through consideration of five case study areas, demonstrate how these discourses can co-exist within the same service change process. The paper presents our sub-themes on community engagement relating to discourses of inclusion and exclusion; the role of the General Practitioner (GP); conceptualisations of the organisational role of the NHS; discourses of fear and, finally, community members understandings of what it means to be active "agents of change" (or not) within health services redesign. We argue that context is as important as method when it comes to facilitating a positive community engagement experience for citizens. Our findings have relevance to the emerging social science literature on citizen experience of public sector community engagement activities.
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Affiliation(s)
- Sarah-Anne Munoz
- Division of Rural Health and Wellbeing, Institute of Health Research and Innovation, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, UK.
| | - Sara Bradley
- Division of Rural Health and Wellbeing, Institute of Health Research and Innovation, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, UK.
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15
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Macaulay B, McHugh N, Steiner A. Public perspectives on health improvement within a remote-rural island community. Health Expect 2021; 24:1286-1299. [PMID: 33955117 PMCID: PMC8369116 DOI: 10.1111/hex.13260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/01/2021] [Accepted: 04/03/2021] [Indexed: 01/28/2023] Open
Abstract
Background Rural health outcomes are often worse than their urban counterparts. While rural health theory recognizes the importance of the social determinants of health, there is a lack of insight into public perspectives for improving rural health beyond the provision of health‐care services. Gaining insight into perceived solutions, that include and go beyond health‐ care, can help to inform resource allocation decisions to improve rural health. Objective To identify and describe shared perspectives within a remote‐rural community on how to improve rural health. Method Using Q methodology, a set of 40 statements were developed representing different perceptions of how to improve rural health. Residents of one remote‐rural island community ranked this statement set according to their level of agreement. Card‐sorts were analysed using factor analysis to identify shared points of view and interpreted alongside post‐sort qualitative interviews. Results Sixty‐two respondents participated in the study. Four shared perspectives were identified, labelled: Local economic activity; Protect and care for the community; Redistribution of resources; and Investing in people. Factors converged on the need to relieve poverty and ensure access to amenities and services. Discussion and conclusions Factors represent different elements of a multifaceted theory of rural health, indicating that ‘lay’ respondents are capable of comprehending various approaches to health improvement and perspectives are not homogenous within rural communities. Respondents diverged on the role of individuals, the public sector and ‘empowered’ community‐based organizations in delivering these solutions, with implications for policy and practice. Public Contribution Members of the public were involved in the development and piloting of the statement set.
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Affiliation(s)
- Bobby Macaulay
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Neil McHugh
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Artur Steiner
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
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16
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Metelmann C, Metelmann B, Kohnen D, Brinkrolf P, Andelius L, Böttiger BW, Burkart R, Hahnenkamp K, Krammel M, Marks T, Müller MP, Prasse S, Stieglis R, Strickmann B, Thies KC. Smartphone-based dispatch of community first responders to out-of-hospital cardiac arrest - statements from an international consensus conference. Scand J Trauma Resusc Emerg Med 2021; 29:29. [PMID: 33526058 PMCID: PMC7852085 DOI: 10.1186/s13049-021-00841-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
Background Over the past decade Smartphone-based activation (SBA) of Community First Responders (CFR) to out-of-hospital cardiac arrests (OHCA) has gained much attention and popularity throughout Europe. Various programmes have been established, and interestingly there are considerable differences in technology, responder spectrum and the degree of integration into the prehospital emergency services. It is unclear whether these dissimilarities affect outcome. This paper reviews the current state in five European countries, reveals similarities and controversies, and presents consensus statements generated in an international conference with the intention to support public decision making on future strategies for SBA of CFR. Methods In a consensus conference a three-step approach was used: (i) presentation of current research from five European countries; (ii) workshops discussing evidence amongst the audience to generate consensus statements; (iii) anonymous real-time voting applying the modified RAND-UCLA Appropriateness method to adopt or reject the statements. The consensus panel aimed to represent all stakeholders involved in this topic. Results While 21 of 25 generated statements gained approval, consensus was only found for 5 of them. One statement was rejected but without consensus. Members of the consensus conference confirmed that CFR save lives. They further acknowledged the crucial role of emergency medical control centres and called for nationwide strategies. Conclusions Members of the consensus conference acknowledged that smartphone-based activation of CFR to OHCA saves lives. The statements generated by the consensus conference may assist the public, healthcare services and governments to utilise these systems to their full potential, and direct the research community towards fields that still need to be addressed. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00841-1.
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Affiliation(s)
- Camilla Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany.
| | - Bibiana Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany
| | - Dorothea Kohnen
- zeb.business school, Steinbeis University Berlin, Münster, Germany
| | - Peter Brinkrolf
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany
| | - Linn Andelius
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | | | - Klaus Hahnenkamp
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany
| | - Mario Krammel
- Emergency Medical Service Vienna, Vienna, Austria.,PULS Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Tore Marks
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany
| | - Michael P Müller
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josefskrankenhaus, Freiburg im Breisgau, Germany
| | | | - Remy Stieglis
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bernd Strickmann
- Emergency Medical Service, City and District of Gütersloh, Gütersloh, Germany
| | - Karl Christian Thies
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany.,Klinik für Anaesthesiologie, EvKB, Universitätsklinikum OWL der Universitaet Bielefeld, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Germany
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17
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Sustainable Urban Community Development: A Case Study from the Perspective of Self-Governance and Public Participation. SUSTAINABILITY 2020. [DOI: 10.3390/su12020617] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
(1) Background: There is a global trend to stimulate sustainable urbanization by updating the hardware of the built environment with green technologies. However, simply greening the city hardware does not ensure a sustainable urban system. In reality, urban communities, as cells of the city, play a crucial role in the sustainable development of the entire city. (2) Methods: This paper conducts a case study by investigating a community in Taipei with semi-structured interviews and other first-hand data. It examines how self-organization, voluntary groups, and the public participation of community members has successfully institutionalized a governing system for the sustainable development of communities; (3) Results: This paper identifies the major actors and mechanisms underpinning the sustainable development of urban communities with a case study in Taipei. The establishment of this more cost-effective form of community governance will possibly provide more benefits to community members; (4) Conclusions: This case study will shed light on the sustainable development of urban community in many other cities, offering possible pathways and epitome for self-organization of urban community in the coming era. Its cost-effective institutional design contributes greatly to sustainable community development, partly solving the current failure to promote urban sustainability.
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Farmer J, Bigby C, Davis H, Carlisle K, Kenny A, Huysmans R. The state of health services partnering with consumers: evidence from an online survey of Australian health services. BMC Health Serv Res 2018; 18:628. [PMID: 30097008 PMCID: PMC6086055 DOI: 10.1186/s12913-018-3433-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 07/30/2018] [Indexed: 11/29/2022] Open
Abstract
Background Involving consumers in producing health services is mandated in many countries. Evidence indicates consumer partnerships lead to improved service design, quality and innovation. Involving participants from minority groups is crucial because poor understanding of distinctive needs affects individuals’ service experiences and outcomes. Few studies consider service compliance with consumer partnering requirements or inclusion of minority group participants. Methods An online survey structured by domains of the Australian National Safety and Quality in Health Service Standards (NSQHS, 2013), was conducted. Questions covered consumer partnering in service planning, management and evaluation plus patient care design and inclusion of consumers from minority groups. Approximately 1200 Australian hospital and day surgery services were identified and 447 individual email addresses were identified for staff leading consumer partnerships. Quantitative data were analysed using SPSS. Qualitative responses, managed in NVivo, were analysed thematically. Frequencies were produced to indicate common activities and range of activities within question domains. Results Comprehensive responses were received from 115 services (25.7%), including metropolitan and non-metropolitan, private and public service settings. Most respondents (95.6%) “partnered with consumers to develop or provide feedback on patient information”. Regarding inclusion of participants from minority groups, respondents were least likely to specifically include those from socially disadvantaged backgrounds (23.6%). Public health services were more likely than private services to engage with consumers. Conclusions The survey is the first to include responses about consumer partnering from across Australia. While many respondents partner with consumers, it is clear that more easily-organised activity such as involvement in existing committees or commenting on patient information occurs more commonly than involvement in strategy or governance. This raises questions over whether strategic-level involvement is too difficult or unrealistic; or whether services simply lack tools. Minority views may be missed where there is a lack of specific action to include diversity. Future work might address why services choose the activities we found and probe emerging opportunities, such as using social media or online engagement. Electronic supplementary material The online version of this article (10.1186/s12913-018-3433-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jane Farmer
- Social Innovation Research Institute, Swinburne University of Technology, John Street, Hawthorn, Melbourne, Australia.
| | - Christine Bigby
- Living with Disability Research Centre, La Trobe University, Bundoora, Melbourne, Australia
| | - Hilary Davis
- Living with Disability Research Centre, La Trobe University, Bundoora, Melbourne, Australia.,Centre for Social Impact, Swinburne University of Technology, John Street, Hawthorn, Melbourne, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Townsville, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, QLD, Townsville, Australia
| | - Amanda Kenny
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Richard Huysmans
- Raven Consulting Group, Unit 4, 62 Wattletree Road, Armadale Vic, Melbourne, 3143, Australia
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19
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Volunteer First Responders for Optimizing Management of Mass Casualty Incidents. Disaster Med Public Health Prep 2018; 13:287-294. [DOI: 10.1017/dmp.2018.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjectiveRapid response to a trauma incident is vital for saving lives. However, in a mass casualty incident (MCI), there may not be enough resources (first responders and equipment) to adequately triage, prepare, and evacuate every injured person. To address this deficit, a Volunteer First Responder (VFR) program was established.MethodsThis paper describes the organizational structure and roles of the VFR program, outlines the geographical distribution of volunteers, and evaluates response times to 3 MCIs for both ambulance services and VFRs in 2000 and 2016.ResultsWhen mapped, the spatial distribution of VFRs and ambulance stations closely and deliberately reflects the population distribution of Israel. We found that VFRs were consistently first to arrive at the scene of an MCI and greatly increased the number of personnel available to assist with MCI management in urban, suburban, and rural settings.ConclusionsThe VFR program provides an important and effective life-saving resource to supplement emergency first response. Given the known importance of rapid response to trauma, VFRs likely contribute to reduced trauma mortality, although further research is needed in order to examine this question specifically. (Disaster Med Public Health Preparedness. 2019;13:287–294)
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20
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Carlisle K, Farmer J, Taylor J, Larkins S, Evans R. Evaluating community participation: A comparison of participatory approaches in the planning and implementation of new primary health-care services in northern Australia. Int J Health Plann Manage 2018; 33:704-722. [PMID: 29658139 DOI: 10.1002/hpm.2523] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 03/03/2018] [Accepted: 03/06/2018] [Indexed: 11/10/2022] Open
Abstract
Community participation is increasingly seen as a prerequisite for more acceptable and sustainable health services. It is difficult to evaluate the extent of participation in health planning and implementation of services, and there are limited tools available to assist in evaluating such processes. Our paper reports on community participation as part of the implementation of 2 primary health programs in regional north Queensland, Australia. We define community participation as collective involvement of people, including consultation, from a community of place or interest in aspects of health service development. We pragmatically evaluate and compare the extent of participation by using a framework developed by Rifkin and colleagues in 1988 and subsequently refined. Data collected from the implementation of each program were analyzed and ranked on a spidergram against 5 process indicators: needs assessment, leadership, resource mobilization, management, and organization. Community participation was found to vary across the programs but was most extensive in both programs in identifying need and potential solutions. Both programs demonstrated high levels of integration of the implementation of health programs with preexisting community structures. Involving local communities in genuine opportunities in managing the programs and mobilizing resources was more challenging. Key differences emerged in the people involved in the programs, the settings and frameworks used to facilitate implementation. We conclude that Rifkin's process indicators are a useful starting point for assessing community participation, particularly for health planners who are required to include participatory approaches when planning and implementing services. We suggest areas that require further consideration.
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Affiliation(s)
- Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Jane Farmer
- Centre for Social Impact, Swinburne University, Melbourne, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
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21
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Phung VH, Trueman I, Togher F, Ørner R, Siriwardena AN. Perceptions and experiences of community first responders on their role and relationships: qualitative interview study. Scand J Trauma Resusc Emerg Med 2018; 26:13. [PMID: 29402312 PMCID: PMC5800091 DOI: 10.1186/s13049-018-0482-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community First Responders (CFRs) are lay volunteers who respond to medical emergencies. We aimed to explore perceptions and experiences of CFRs in one scheme about their role. METHODS We conducted semi-structured interviews with a purposive sample of CFRs during June and July 2016 in a predominantly rural UK county. Interviews were transcribed verbatim and analysed using the Framework method, supported by NVivo 10. RESULTS We interviewed four female and 12 male adult CFRs aged 18-65+ years with different levels of expertise and tenures. Five main themes were identified: motivation and ongoing commitment; learning to be a CFR; the reality of being a CFR; relationships with statutory ambulance services and the public; and the way forward for CFRs and the scheme. Participants became CFRs mainly for altruistic reasons, to help others and put something back into their community, which contributed to personal satisfaction and helped maintain their involvement over time. CFRs valued scenario-based training and while some were keen to access additional training to enable them to attend a greater variety of incidents, others stressed the importance of maintaining existing abilities and improving their communication skills. They were often first on scene, which they recognised could take an emotional toll but for which they found informal support mechanisms helpful. Participants felt a lack of public recognition and sometimes were undervalued by ambulance staff, which they thought arose from a lack of clarity over their purpose and responsibilities. Although CFRs perceived their role to be changing, some were fearful of extending the scope of their responsibilities. They welcomed support for volunteers, greater publicity and help with fundraising to enable schemes to remain charities, while complementing the role of ambulance services. DISCUSSION CFR schemes should consider the varying training, development and support needs of staff. CFRs wanted schemes to be complementary but distinct from ambulance services. Further information on outcomes and costs of the CFR contribution to prehospital care is needed. CONCLUSION Our findings provide insight into the experiences of CFRs, which can inform how the role might be better supported. Because CFR schemes are voluntary and serve defined localities, decisions about levels of training, priority areas and targets should be locally driven. Further research is required on the effectiveness, outcomes, and costs of CFR schemes and a wider understanding of stakeholder perceptions of CFR and CFR schemes is also needed.
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Affiliation(s)
- Viet-Hai Phung
- Community and Health Research Unit (CaHRU), School of Health & Social Care, University of Lincoln, Lincoln, LN5 7AY, UK
| | - Ian Trueman
- School of Health & Social Care, University of Lincoln, Lincoln, LN5 7AY, UK
| | - Fiona Togher
- Community and Health Research Unit (CaHRU), School of Health & Social Care, University of Lincoln, Lincoln, LN5 7AY, UK
| | - Roderick Ørner
- Community and Health Research Unit (CaHRU), School of Health & Social Care, University of Lincoln, Lincoln, LN5 7AY, UK
| | - Aloysius Niroshan Siriwardena
- Community and Health Research Unit (CaHRU), School of Health & Social Care, University of Lincoln, Lincoln, LN5 7AY, UK.
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Farmer J, Carlisle K, Dickson-Swift V, Teasdale S, Kenny A, Taylor J, Croker F, Marini K, Gussy M. Applying social innovation theory to examine how community co-designed health services develop: using a case study approach and mixed methods. BMC Health Serv Res 2018; 18:68. [PMID: 29386012 PMCID: PMC5793380 DOI: 10.1186/s12913-018-2852-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background Citizen participation in health service co-production is increasingly enacted. A reason for engaging community members is to co-design services that are locally-appropriate and harness local assets. To date, much literature examines processes of involving participants, with little consideration of innovative services are designed, how innovations emerge, develop and whether they sustain or diffuse. This paper addresses this gap by examining co-designed initiatives through the lens of social innovation – a conceptualisation more attuned to analysing grassroots innovation than common health services research approaches considering top-down, technical innovations. This paper considers whether social innovation is a useful frame for examining co-designed services. Methods Eighty-eight volunteer community-based participants from six rural Australian communities were engaged using the same, tested co-design framework for a 12-month design and then 12-month implementation phase, in 24 workshops (2014–16). Mixed, qualitative data were collected and used to formulate five case studies of community co-designed innovations. A social innovation theory, derived from literature, was applied as an analytical frame to examine co-design cases at 3 stages: innovation growth, development and sustainability/diffusion. Results Social innovation theory was found relevant in examining and understanding what occurred at each stage of innovation development. Innovations themselves were all adaptations of existing ideas. They emerged due to local participants combining knowledge from local context, own experiences and exemplars. External facilitation brought resources together. The project provided a protective niche in which pilot innovations developed, but they needed support from managers and/or policymakers to be implemented; and to be compatible with existing health system practices. For innovations to move to sustainability/diffusion required political relationships. Challenging existing practice without these was problematical. Conclusions Social innovation provides a useful lens to understand the grassroots innovation process implied in community participation in service co-design. It helps to show problems in co-design processes and highlights the need for strong partnerships and advocacy beyond the immediate community for new ideas to thrive. Regional commissioning organisations are intended to diffuse useful, co-designed service innovations. Efforts are required to develop an innovation system to realise the potential of community involvement in co-design.
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Affiliation(s)
- Jane Farmer
- Social Innovation Research Institute, Swinburne University, John Street, Hawthorn, Melbourne, 3122, Australia.
| | - Karen Carlisle
- College of Medicine & Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | | | - Simon Teasdale
- Public Policy and Organisations, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland
| | - Amanda Kenny
- Rural Nursing, La Trobe Rural Health School, La Trobe University, Edwards Road, Bendigo, VIC, 3550, Australia
| | - Judy Taylor
- James Cook University, Townsville, QLD, 4811, Australia
| | - Felicity Croker
- College of Medicine & Dentistry, James Cook University, Cairns, QLD, Australia
| | - Karen Marini
- Community Engagement, Murray Primary Health Network, Rowan Street, Bendigo, 3551, Australia
| | - Mark Gussy
- Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Edwards Road, Bendigo, VIC, 3550, Australia
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Hyett N, Kenny A, Dickson-Swift V. Re-imagining occupational therapy clients as communities: Presenting the community-centred practice framework. Scand J Occup Ther 2018; 26:246-260. [DOI: 10.1080/11038128.2017.1423374] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nerida Hyett
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Amanda Kenny
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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Phung VH, Trueman I, Togher F, Orner R, Siriwardena AN. Community first responders and responder schemes in the United Kingdom: systematic scoping review. Scand J Trauma Resusc Emerg Med 2017. [PMID: 28629382 PMCID: PMC5477292 DOI: 10.1186/s13049-017-0403-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Community First Responder (CFR) schemes support lay people to respond to medical emergencies, working closely with ambulance services. They operate widely in the UK. There has been no previous review of UK literature on these schemes. This is the first systematic scoping review of UK literature on CFR schemes, which identifies the reasons for becoming a CFR, requirements for training and feedback and confusion between the CFR role and that of ambulance service staff. This study also reveals gaps in the evidence base for CFR schemes. Methods We conducted a systematic scoping review of the published literature, in the English language from 2000 onwards using specific search terms in six databases. Narrative synthesis was used to analyse article content. Results Nine articles remained from the initial search of 15,969 articles after removing duplicates, title and abstract and then full text review. People were motivated to become CFRs through an altruistic desire to help others. They generally felt rewarded by their work but recognised that the help they provided was limited by their training compared with ambulance staff. There were concerns about the possible emotional impact on CFRs responding to incidents. CFRs felt that better feedback would enhance their learning. Ongoing training and support were viewed as essential to enable CFRs to progress. They perceived that public recognition of the CFR role was low, patients sometimes confusing them with ambulance staff. Relationships with the ambulance service were sometimes ambivalent due to confusion over roles. There was support for local autonomy of CFR schemes but with greater sharing of best practice. Discussion Most studies dated from 2005 and were descriptive rather than analytical. In the UK and Australia CFRs are usually lay volunteers equipped with basic skills for responding to medical emergencies, whereas in the US they include other emergency staff as well as lay people. Conclusion Opportunities for future research include exploring experiences and perceptions of patients who have been treated by CFRs and other stakeholders, while also evaluating the effectiveness and costs of CFR schemes.
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Affiliation(s)
- Viet-Hai Phung
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK
| | - Ian Trueman
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK
| | - Fiona Togher
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK
| | - Roderick Orner
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK
| | - A Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK.
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Pitchforth E, Nolte E, Corbett J, Miani C, Winpenny E, van Teijlingen E, Elmore N, King S, Ball S, Miler J, Ling T. Community hospitals and their services in the NHS: identifying transferable learning from international developments – scoping review, systematic review, country reports and case studies. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05190] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BackgroundThe notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential.ObjectivesThis study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care.MethodsA multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland.ResultsThe evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented.LimitationsThe use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth.ConclusionsAt a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s).FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Emma Pitchforth
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Ellen Nolte
- European Observatory on Health Systems and Policies, London School of Economics and Political Science and London School of Hygiene & Tropical Medicine, London, UK
| | - Jennie Corbett
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Céline Miani
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Eleanor Winpenny
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Edwin van Teijlingen
- Department of Human Sciences and Public Health, University of Bournemouth, Bournemouth, UK
| | - Natasha Elmore
- Cambridge Centre for Health Services Research (CCHSR), Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | - Sarah Ball
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Joanna Miler
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Tom Ling
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
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