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Pearson O, Othman S, Colmer K, Ishaque S, Mejia G, Crossing S, Jesudason D, Wittert G, Zimmet P, Zoungas S, Wischer N, Morey K, Giles J, Jones S, Brown A, Kumar S. Supporting best practice in the management of chronic diseases in primary health care settings: a scoping review of training programs for Indigenous Health Workers and Practitioners. Aust J Prim Health 2024; 30:PY23124. [PMID: 38701239 DOI: 10.1071/py23124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 04/03/2024] [Indexed: 05/05/2024]
Abstract
Background To improve diabetes management in primary health care for the Aboriginal and Torres Strait Islander peoples population, training programs that are culturally and contextually relevant to the local context are required. Using a scoping review methodology, the aim of this review was to describe the characteristics of chronic disease management training programs for Aboriginal Health Workers and Practitioners, their effectiveness on knowledge and skills, and client-related outcomes, and the enablers, barriers to delivery and participation. Methods Following protocol parameters, a systematic search was conducted in relevant databases and grey literature. Two independent reviewers screened the title and abstract of each paper to determine if the study met the inclusion criteria. Results Of the 23 included studies, most were developed with stakeholders, profession facilitated and delivered by cultural facilitators. All training programs included content knowledge, two included a professional support network, four provided on-the-job support and six had follow-up support post-training. Modes of delivery ranged from didactic, storytelling and hands-on learning. Two studies reported significant improvement in participants' knowledge and confidence; one reported improvement in knowledge (12.7% increase pre-post training), and an increase in confidence in both clinical and non-clinical skills. Enablers (relevance, modes of learning, power of networking, improved knowledge, confidence and clinical practice) and barriers (adult learning capabilities, competing work-family commitments) were reported. Few studies reported on knowledge transfer into clinical practice and client-related outcomes. Conclusions Multifaceted training programs for Aboriginal health workers are well received and may improve workforce capability.
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Affiliation(s)
- Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; and University of Adelaide, Adelaide, SA 5000, Australia
| | - Shwikar Othman
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; and University of Adelaide, Adelaide, SA 5000, Australia
| | - Kate Colmer
- Flinders University, Adelaide, SA 5042, Australia
| | - Sana Ishaque
- Flinders University, Adelaide, SA 5042, Australia
| | - Gloria Mejia
- Australian Research Centre for Population Oral Health (ARCPOH), University of Adelaide, Adelaide, SA 5000, Australia
| | - Sarah Crossing
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia
| | - David Jesudason
- University of Adelaide, Adelaide, SA 5000, Australia; and Central Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Gary Wittert
- University of Adelaide, Adelaide, SA 5000, Australia; and Freemasons Centre for Male Health and Well Being, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic. 3004, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia
| | - Natalie Wischer
- National Association of Diabetes Centres, Sydney, NSW 2000, Australia
| | - Kim Morey
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; and University of Adelaide, Adelaide, SA 5000, Australia
| | - Jane Giles
- Flinders University, Adelaide, SA 5042, Australia
| | - Sara Jones
- School of Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Alex Brown
- Telethon Kids Institute, Ground Floor, 108 North Terrace, Adelaide, SA 5000, Australia; and Australian National University, Canberra, ACT 2601, Australia
| | - Saravana Kumar
- School of Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
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Mullan L, Armstrong K, Job J. Barriers and enablers to structured care delivery in Australian rural primary care. Aust J Rural Health 2023. [PMID: 36639909 DOI: 10.1111/ajr.12963] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/04/2022] [Accepted: 01/01/2023] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The primary aim of this study was to explore the barriers and enablers to structured care delivery in rural primary care, reflecting on Australian research findings. DESIGN CINAHL and Scopus databases were searched in August 2021. Inclusion criteria included English language, full-text studies, published since 2011, reporting on the barriers and enablers to the delivery of structured care within rural and remote primary care. Structured care was conceptualised as care that was organised, integrative and planned. FINDINGS A total of 435 studies were screened. Thirty-four met the inclusion criteria. Barriers to the provision of structured care related to workforce shortages, limited health care services and health care professional capacity, cultural safety and competency, limited resourcing, insufficient knowledge and education, geographical isolation, inadequate care coordination, unclear roles and responsibilities and poor health professional-patient relationships. DISCUSSION Health care system and geographical barriers and enablers encountered in rural areas are complex and multidimensional. Identification of the specific challenges to structured care delivery highlights the need for a focussed review of workforce supply and distribution challenges as well as the investigation of system integration, leadership, governance and funding reform that would be required to support rural primary care.
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Affiliation(s)
- Leanne Mullan
- Western Queensland Primary Health Network, Mount Isa, Queensland, Australia.,Australian Catholic University, Banyo, Queensland, Australia
| | | | - Jennifer Job
- Centre for Health System Reform and Integration, Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia
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Integrated Primary Healthcare Opioid Tapering Interventions: A Mixed-Methods Study of Feasibility and Acceptability in Two General Practices in New South Wales, Australia. Int J Integr Care 2020; 20:6. [PMID: 33132791 PMCID: PMC7583216 DOI: 10.5334/ijic.5426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction Integrated team-based primary healthcare is well positioned to support opioid tapering for patients experiencing chronic pain. This paper describes the development, implementation and acceptability of a primary healthcare opioid tapering intervention 'Assess Inform Manage Monitor' (AIMM) at two sites. Methods AIMM involved GP advice; nurse monitoring and potential engagement with: community pharmacist; psychologist; dietitian and exercise physiologist. Individuals receiving 90 days or more of prescription opioids were eligible. Patient and provider surveys and qualitative interviews were completed. Results Of 140 eligible patients, 37 attended during the study period and were invited to participate. Patient post-intervention surveys (n = 8) and interviews (n = 6) indicated the intervention was acceptable, although the perceived value of some of the integrated team was low. GP and practice nurse support was valued. Providers (n = 4) valued team integration. Low weaning readiness was a barrier to engagement by patients and providers. Key lessons and conclusions The intervention, whilst conceptually acceptable, was not feasible in its current form. Future efforts to transition patients towards integrated care should retain the practice nurse and place more focus on understanding and reinforcing patients' readiness to wean. Greater inter-professional collaboration may also be needed. Such refinements may advance the cause of opioid reduction in primary care.
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Eassey D, Reddel HK, Ryan K, Smith L. 'It is like learning how to live all over again' A systematic review of people's experiences of living with a chronic illness from a self-determination theory perspective. Health Psychol Behav Med 2020; 8:270-291. [PMID: 34040872 PMCID: PMC8143269 DOI: 10.1080/21642850.2020.1794879] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 07/03/2020] [Indexed: 10/28/2022] Open
Abstract
Objective: To conduct a systematic review and synthesis of qualitative evidence exploring the views and experiences of people living with a chronic illness that utilised self-determination theory. Methods: We searched MEDLINE via OvidSP, PsycINFO via OvidSP, PubMed, CINAHL, EMBASE, Google Scholar, the journals Qualitative Health Research and Qualitative Research. Studies were included if they used qualitative methods, explored the subjective experiences of people living with a chronic illness and underpinned the analysis with self-determination theory. Results: From 4605 articles, six met the inclusion criteria. The synthesis culminated in a line of argument that patients endeavoured to be 'free from disease'. People's desire to live a life free from disease required nurturing their: (1) need to feel empowered (autonomy), (2) perceived ability to self-care (competence) and, (3) their need to feel a sense of belonging (relatedness). Conclusion: This review has highlighted that the majority of studies included in this review focused on the clinical aspects of managing a chronic condition and changing patient health behaviours. This suggests that there is a need for deep reflection on the current practice of caring for patients with a chronic illness. Exploring the lived experience has the potential to unravel the psychological and emotional needs of those living with a chronic illness.
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Affiliation(s)
- Daniela Eassey
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Helen K. Reddel
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Kath Ryan
- School of Pharmacy, University of Reading, Reading, UK
| | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Hunter RF, Gough A, Murray JM, Tang J, Brennan SF, Chrzanowski-Smith OJ, Carlin A, Patterson C, Longo A, Hutchinson G, Prior L, Tully MA, French DP, Adams J, McIntosh E, Xin Y, Kee F. A loyalty scheme to encourage physical activity in office workers: a cluster RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
Increasing physical activity in the workplace can provide physical and mental health benefits for employees and economic benefits for the employer through reduced absenteeism and increased productivity. However, there is limited evidence on effective behaviour change interventions in workplace settings that led to maintained physical activity. This study aimed to address this gap and contribute to the evidence base for effective and cost-effective workplace interventions.
Objectives
To determine the effectiveness and cost-effectiveness of the Physical Activity Loyalty scheme, a multicomponent intervention based on concepts similar to those that underpin a high-street loyalty card, which was aimed at encouraging habitual physical activity behaviour and maintaining increases in mean number of steps per day.
Design
A cluster randomised controlled trial with an embedded economic evaluation, behavioural economic experiments, mediation analyses and process evaluation.
Setting
Office-based employees from public sector organisations in Belfast and Lisburn city centres in Northern Ireland.
Participants
A total of 853 participants [mean age 43.6 years (standard deviation 9.6 years); 71% of participants were female] were randomly allocated by cluster to either the intervention group or the (waiting list) control group.
Intervention
The 6-month intervention consisted of financial incentives (retail vouchers), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of the workplaces allowed participants to monitor their accumulated minutes of physical activity.
Main outcome measures
The primary outcome was mean number of steps per day recorded using a sealed pedometer (Yamax Digiwalker CW-701; Yamax, Tasley, UK) worn on the waist for 7 consecutive days and at 6 and 12 months post intervention. Secondary outcomes included health, mental well-being, quality of life, work absenteeism and presenteeism, and the use of health-care resources.
Results
The mean number of steps per day were significantly lower for the intervention group than the control group [6990 mean number of steps per day (standard deviation 3078) vs. 7576 mean number of steps per day (standard deviation 3345), respectively], with an adjusted mean difference of –336 steps (95% confidence interval –612 to –60 steps; p = 0.02) at 6 months post baseline, but not significantly lower at 12 months post baseline. There was a small but significant enhancement of mental well-being in the intervention group (difference between groups for the Warwick–Edinburgh Mental Wellbeing Scale of 1.34 points, 95% confidence interval 0.48 to 2.20 points), but not for the other secondary outcomes. An economic evaluation suggested that, overall, the scheme was not cost-effective compared with no intervention. The intervention was £25.85 (95% confidence interval –£29.89 to £81.60) more costly per participant than no intervention and had no effect on quality-adjusted life-years (incremental quality-adjusted life-years –0.0000891, 95% confidence interval –0.008 to 0.008).
Limitations
Significant restructuring of participating organisations during the study resulted in lower than anticipated recruitment and retention rates. Technical issues affected intervention fidelity.
Conclusions
Overall, assignment to the intervention group resulted in a small but significant decline in the mean pedometer-measured steps per day at 6 months relative to baseline, compared with the waiting list control group. The Physical Activity Loyalty scheme was deemed not to be cost-effective compared with no intervention, primarily because no additional quality-adjusted life-years were gained through the intervention. Research to better understand the mechanisms of physical activity behaviour change maintenance will help the design of future interventions.
Trial registration
Current Controlled Trials ISRCTN17975376.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Aisling Gough
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Jennifer M Murray
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Jianjun Tang
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Sarah F Brennan
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | | | | | - Chris Patterson
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Alberto Longo
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - George Hutchinson
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - Lindsay Prior
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK
| | - David P French
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Yiqiao Xin
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
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Shand L, Higgins R, Murphy B, Jackson A. Development and validation of the healthcare providers patient-activation scale. PATIENT EDUCATION AND COUNSELING 2019; 102:1550-1557. [PMID: 30885404 DOI: 10.1016/j.pec.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/20/2019] [Accepted: 03/07/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE It has become increasingly important to assess healthcare providers' role in chronic disease self-management (CDSM) and patient activation (PA). The present study extends previous work relating to patients' behaviours by assessing healthcare providers' own behaviours in supporting PA. METHOD 50 items were generated: half assessed a PA approach; half reflected a non-patient-activation approach. 105 healthcare providers working in cardiac rehabilitation who were participants in a CDSM online training program completed the items pre- and post-training. Factor analysis determined the presence of higher order factors. Item responses pre- and post-training were compared to assess sensitivity to change. RESULTS Results indicated the presence of two factors: 'patient-activation approach' and 'non-patient-activation approach'. While both demonstrated good internal consistency, the' non-PA approach' had superior discriminatory validity and sensitivity to change. CONCLUSION Healthcare providers' beliefs about the importance of patient-activation behaviours can be measured by 40-item Healthcare Provider-Patient Activation Scale (HP-PAS). The scale could be easily converted to measure healthcare providers' actual PA behaviours. PRACTICE IMPLICATIONS The HP-PAS could be used to assess the effectiveness of clinician training for healthcare providers working in cardiac rehabilitation and other areas of CDSM. Further reliability and validity testing within other healthcare provider samples is warranted.
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Affiliation(s)
- Lyndel Shand
- Australian Centre for Heart Health, Melbourne, Victoria, Australia; Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Rosemary Higgins
- Australian Centre for Heart Health, Melbourne, Victoria, Australia; Faculty of Health, Deakin University, Burwood, Victoria, Australia; Department of Physiotherapy, University of Melbourne, Victoria, Australia
| | - Barbara Murphy
- Australian Centre for Heart Health, Melbourne, Victoria, Australia; Faculty of Health, Deakin University, Burwood, Victoria, Australia; Department of Psychology, University of Melbourne, Victoria, Australia.
| | - Alun Jackson
- Australian Centre for Heart Health, Melbourne, Victoria, Australia; Faculty of Health, Deakin University, Burwood, Victoria, Australia; Centre on Behavioural Health, Hong Kong University, Hong Kong
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7
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Zhang P, Gao J, Wang Y, Sun Q, Sun X. Effect of chronic disease self-management program on the quality of life of HIV-infected men who have sex with men: An empirical study in Shanghai, China. Int J Health Plann Manage 2019; 34:1055-1064. [PMID: 31364209 DOI: 10.1002/hpm.2874] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The HIV/AIDS epidemic rages on in China, particularly among men who have sex with men (MSM). MSM with HIV/AIDS also tend to have poorer quality of life than other members of the population. A major contributor to these issues is the huge gap between the increasing demand of MSM for medical services and the availability of such services; their current needs cannot be met only with the services of the Chinese Center for Disease Control and Prevention. The aim of the present study was to examine the quality of life of MSM with HIV/AIDS in Shanghai, as well as determine whether it is influenced by chronic disease self-management (CDSM). METHODS We conducted a pre-post study to evaluate the effect of CDSM on participants' quality of life. Four hundred twenty participants were assigned to either the CDSM group (n = 210) or the control group (n = 210). We collected data on quality of life (using the Medical Outcomes Study HIV Health Survey [MOS-HIV]) and various psychological and behavioral variables via interviewer-administered questionnaires. RESULTS The physical and mental health summary scores of the MOS-HIV were 53.7 and 49.9, respectively. The CDSM group showed a significant improvement in quality of life and a significant decrease in the proportion of participants with anxiety symptoms (from 38.6% to 22.6%). Furthermore, the frequency of condom use increased from 43.3% to 47.3%. CONCLUSION MSM with HIV generally had low quality of life in Shanghai. The CDSM program might help promote the quality of life of MSM while helping them practice healthy behaviors.
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Affiliation(s)
- Peng Zhang
- School of Clinical Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jing Gao
- School of Clinical Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yanmei Wang
- Department of Nursing, Shanghai Gongli Hospital, Second Military Medical University, Shanghai, China
| | - Qiao Sun
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Xiaoming Sun
- School of Public Health, Fudan University, Shanghai, China.,Pudong Institute for Health Development, Shanghai, China
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8
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Gagnon MP, Attieh R, Dunn S, Grandes G, Bully P, Estabrooks CA, Légaré F, Roch G, Ouimet M. Development and Content Validation of a Transcultural Instrument to Assess Organizational Readiness for Knowledge Translation in Healthcare Organizations: The OR4KT. Int J Health Policy Manag 2018; 7:791-797. [PMID: 30316227 PMCID: PMC6186488 DOI: 10.15171/ijhpm.2018.17] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/13/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Implementing effective interventions in healthcare requires organizations to be ready to support change. This study aimed to develop, adapt transculturally, and assess the content and face validity of the Organizational Readiness for Knowledge Translation (OR4KT) tool. The OR4KT was designed to measure the readiness of healthcare organizations to implement evidence-informed change across a variety of services.
Methods: Based on systematic reviews of the literature, a Delphi exercise, and expert consultation, we first generated an initial pool of items. Second, we developed and assessed content validity of the pilot OR4KT questionnaire in English. Third, we created French and Spanish versions using a sequential forward and backward translation approach, and transcultural adaptation by a consensus process. Finally, we conducted pilot studies in three contexts – the Basque country region (Spain), and the provinces of Québec and Ontario (Canada) – where 30 experts assessed the face validity of the three versions of OR4KT.
Results: We selected 59 items, grouped in 6 dimensions (organizational climate, context, change content, leadership, organizational support, and motivation) for the final English version of OR4KT. Translation and transcultural adaptation did not identify any content or language problems. Our findings indicate that the English, French and Spanish versions of OR4KT are linguistically equivalents and have high face validity. Only minor revisions to the wording of some items were recommended.
Conclusion: The OR4KT holds promise as a measure of readiness for knowledge translation (KT) in healthcare organizations. The validity and reliability of the three versions of the OR4KT will be assessed in real-life contexts of implementation of evidence-based changes in healthcare
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Affiliation(s)
- Marie-Pierre Gagnon
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Québec, QC, Canada.,Department of Nursing Sciences, Université Laval, Québec, QC, Canada
| | - Randa Attieh
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Québec, QC, Canada.,Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Sandra Dunn
- CRED Research Centre - École Supérieure des Affaires, Beirut, Lebanon.,CHEO Research Institute, Centre for Practice Changing Research Building, Ottawa, ON, Canada
| | - Gonzalo Grandes
- Better Outcomes Registry & Nerwork (BORN) Ontario, Ottawa, ON, Canada.,Primary Care Research Unit of Bizkaia - Osakidetza, Basque Health Service, Bilbao, Spain
| | - Paola Bully
- Better Outcomes Registry & Nerwork (BORN) Ontario, Ottawa, ON, Canada.,Primary Care Research Unit of Bizkaia - Osakidetza, Basque Health Service, Bilbao, Spain
| | | | - France Légaré
- Faculty of Nursing and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Geneviève Roch
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Québec, QC, Canada.,Department of Nursing Sciences, Université Laval, Québec, QC, Canada
| | - Mathieu Ouimet
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Québec, QC, Canada.,Department of Family Medicine, Université Laval, Québec, QC, Canada
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Entwistle VA, Cribb A, Owens J. Why Health and Social Care Support for People with Long-Term Conditions Should be Oriented Towards Enabling Them to Live Well. HEALTH CARE ANALYSIS 2018; 26:48-65. [PMID: 27896539 PMCID: PMC5816130 DOI: 10.1007/s10728-016-0335-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When (the promotion of) support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling ‘partnership working’; run the risk of undermining patients’ self-evaluative attitudes (and then of failing to notice that as harmful); limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live (and die) well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people (both generally and more specifically) for living well, help keep the importance of disease control in perspective, recognize social influences on people’s values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice.
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Affiliation(s)
- Vikki A Entwistle
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK.
| | - Alan Cribb
- School of Education, Communication and Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, UK
| | - John Owens
- School of Education, Communication and Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, UK
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10
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Gustavsson C, Nordlander J, Söderlund A. Activity and life-role targeting rehabilitation for persistent pain: feasibility of an intervention in primary healthcare. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1426784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Catharina Gustavsson
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- Department of Physiotherapy, School of Health, Care and Social Welfare, Västerås, Sweden
- School of Education, Health and Social Studies, Hogskolan Dalarna, Falun, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | | | - Anne Söderlund
- Department of Physiotherapy, School of Health, Care and Social Welfare, Västerås, Sweden
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Figueiredo S, Mayo NE, Thomas A. Future Rehabilitation Professionals' Intentions to Use Self-Management Support: Helping Students to Help Patients. Physiother Can 2017; 69:73-80. [PMID: 28154447 DOI: 10.3138/ptc.2015-68e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: We evaluated whether education in self-management support (SMS) increases future clinicians' intentions to use a new way of delivering rehabilitation services. Methods: A convenience sample of 10 students took a 5-week theoretical course, followed by 6 weeks spent assessing patients, establishing treatment plans, and monitoring their performance by telephone. Focus groups were held before and after the educational modules, with deductive mapping of themes to the Theory of Planned Behaviour and inductive analysis of additional themes. Results: Five themes and 22 subcategories emerged from the deductive-inductive focus group content analysis. After participating in the educational modules, students reported gaining knowledge about SMS and highlighted the lack of similar preparation during their academic courses. Nonetheless, they were hesitant to adopt SMS. Conclusion: Future clinicians gained knowledge and skills after being exposed to SMS courses, but their intention to adopt SMS in their future daily practice remained low. We also noted a lack of formal training in SMS in the academic setting. The findings from this study support incorporating SMS training into the curriculum, but to increase students' intention to use SMS as part of patient care, training may need to be in more depth than it was in the modules we used.
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Affiliation(s)
- Sabrina Figueiredo
- Faculty of Medicine, School of Physical and Occupational Therapy; Division of Clinical Epidemiology
| | - Nancy E Mayo
- Faculty of Medicine, School of Physical and Occupational Therapy; Division of Clinical Epidemiology; Department of Geriatrics, Faculty of Medicine
| | - Aliki Thomas
- Faculty of Medicine, School of Physical and Occupational Therapy; Centre for Medical Education, Faculty of Medicine, McGill University; Centre for Interdisciplinary Research in Rehabilitation, Jewish Rehabilitation Hospital, Montreal
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Currin M, Patterson S, McGhee H, Kuipers P. Embedding Socio-Behavioral Frameworks in Community Rehabilitation: Evaluation of a Service Change Program. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2016. [DOI: 10.1080/02703181.2016.1267294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Michelle Currin
- Community Adult Rehabilitation Service, Metro South Hospital and Health Service, Logan Central, Queensland, Australia
| | - Sarah Patterson
- Community Adult Rehabilitation Service, Metro South Hospital and Health Service, Logan Central, Queensland, Australia
| | - Hannah McGhee
- Community Adult Rehabilitation Service, Metro South Hospital and Health Service, Logan Central, Queensland, Australia
| | - Pim Kuipers
- Centre for Functioning & Health Research, Metro South Hospital and Health Service, Logan Central, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Logan, Queensland, Australia
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Rawal LB, Wolfe R, Riddell M, Dunbar JA, Li H, Oldenburg B. Utilisation of general practitioner services and achievement of guideline targets by people with diabetes who joined a peer-support program in Victoria, Australia. Aust J Prim Health 2015; 21:205-13. [PMID: 24618400 DOI: 10.1071/py13178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 01/21/2014] [Indexed: 12/16/2022]
Abstract
This paper describes the use of general practitioner (GP) services and achievement of guideline targets by 285 adults with type 2 diabetes in urban and regional areas of Victoria, Australia. Anthropometric and biomedical measures and responses to a self-administered questionnaire were collected. Findings indicate that almost all participants had visited a GP and had had their hypoglycated haemoglobin (HbA1c) measured in the past 6 months; less than one-third had visited a practice nurse. Fifty per cent achieved a HbA1c target of 7.0%; 40%, a total cholesterol ≤ 4.00 mmol/L; 39%, BP Systolic ≤ 130 mmHg; 51%, BP Diastolic ≤ 80 mmHg; 15%, body mass index ≤ 25 kg/m2; and 34% reported a moderately intense level of physical activity, that is, ≥ 30 min, 5 days a week. However, 39% of individuals achieved at least two targets and 18% achieved at least three of these guideline targets. Regional participants were more likely to report having a management plan and having visited a practice nurse, but they were less likely to have visited other health professionals. Therefore, a more sustained effort that also includes collaborative care approaches is required to improve the management of diabetes in Australia.
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Culturally Appropriate Training for Remote Australian Aboriginal Health Workers: Evaluation of an Early Child Development Training Intervention. J Dev Behav Pediatr 2015; 36:503-11. [PMID: 26263420 DOI: 10.1097/dbp.0000000000000200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to design, implement, and evaluate training in early childhood development (ECD) and in the use of a culturally adapted developmental screening tool, for remote Australian Aboriginal Health Workers (AHWs) and other remote health practitioners. METHOD A case-study evaluation framework was adopted. Two remote Australian Aboriginal health services were selected as case-study sites. Materials review, semistructured interviews, posttraining feedback surveys, and workplace observations contributed to the evaluation, guided by Guskey's 5-level education evaluation model. RESULTS Remote health practitioners (including AHWs and Remote Area Nurses) and early childhood staff from the sites participated in a customized 2½ day training workshop focusing on the principles of ECD and the use of the culturally adapted Ages and Stages Questionnaire, third edition. Consistent with adult learning theories and recommendations from the literature regarding culturally appropriate professional development methods in this context, the workshop comprised interactive classroom training, role-plays, and practice coaching in the workplace, including booster training. The qualitative findings demonstrated that mode of delivery was effective and valued by participants. The workshop improved practitioners' skills, knowledge, competence, and confidence to identify and manage developmental difficulties and promote child development, evidenced on self-report and workplace clinical observation. CONCLUSION The findings suggest that the practical, culturally appropriate training led to positive learning outcomes in developmental practice for AHWs and other remote health practitioners. This is an important finding that has implications in other Indigenous contexts, as effective training is a critical component of any practice improvement intervention. Further research examining factors influencing practice change is required.
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Cotugno JD, Ferguson M, Harden H, Colquist S, Stack AA, Zimmerman JI, Russell AW, Ball LE, Hickman IJ. "I wish they could be in my shoes": patients' insights into tertiary health care for type 2 diabetes mellitus. Patient Prefer Adherence 2015; 9:1647-55. [PMID: 26604714 PMCID: PMC4655948 DOI: 10.2147/ppa.s91214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Insightful accounts of patient experience within a health care system can be valuable for facilitating improvements in service delivery. OBJECTIVE The aim of this study was to explore patients' perceptions and experiences regarding a tertiary hospital Diabetes and Endocrinology outpatient service for the management of type 2 diabetes mellitus (T2DM). METHOD Nine patients participated in discovery interviews with an independent trained facilitator. Patients' stories were synthesized thematically using a constant comparative approach. RESULTS Three major themes were identified from the patients' stories: 1) understanding T2DM and diabetes management with subthemes highlighting that specialist care is highly valued by patients who experience a significant burden of diabetes on daily life and who may have low health literacy and low self confidence; 2) relationships with practitioners were viewed critical and perceived lack of empathy impacted the effectiveness of care; and 3) impact of health care systems on service delivery with lack of continuity of care relating to the tertiary hospital model and limitations with appointment bookings negatively impacting on patient experience. DISCUSSION The patients' stories suggest that the expectation of establishing a productive, ongoing relationship with practitioners is highly valued. Tertiary clinics for T2DM are well placed to incorporate novel technological approaches for monitoring and follow-up, which may overcome many of the perceived barriers of traditional service delivery. CONCLUSION Investing in strategies that promote patient-practitioner relationships may enhance effectiveness of treatment for T2DM by meeting patient expectations of personalized care. Future changes in service delivery would benefit from incorporating patients as key stakeholders in service evaluation.
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Affiliation(s)
- Jacqueline D Cotugno
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Maree Ferguson
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Annabelle A Stack
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Jane I Zimmerman
- Department of Diabetes & Endocrinology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Anthony W Russell
- Department of Diabetes & Endocrinology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Lauren E Ball
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia
- The Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Correspondence: Ingrid J Hickman, Department of Nutrition and Dietetics, Ground Floor, Building 15, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD 4102, Australia, Tel +61 7 3176 5588, Fax +61 7 3176 5619, Email
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Solberg HS, Steinsbekk A, Solbjør M, Granbo R, Garåsen H. Characteristics of a self-management support programme applicable in primary health care: a qualitative study of users' and health professionals' perceptions. BMC Health Serv Res 2014; 14:562. [PMID: 25380808 PMCID: PMC4229612 DOI: 10.1186/s12913-014-0562-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/24/2014] [Indexed: 11/17/2022] Open
Abstract
Background Development of more self-management support programmes in primary health care has been one option used to enhance positive outcomes in chronic disease management. At present, research results provide no consensus on what would be the best way to develop support programmes into new settings. The aim of the present study was therefore to explore users’ and health professionals’ perceptions of what would be the vital elements in a self - management support programme applicable in primary health care, how to account for them, and why. Methods Four qualitative, semi-structured focus group interviews were conducted in Central Norway. The informants possessed experience in development, provision, or participation in a self-management support programme. Data was analysed by the Systematic Text Condensation method. Results The results showed an overall positive expectation to the potential benefits of development of a self-management support programme in primary health care. Despite somewhat different arguments and perspectives, the users and the health professionals had a joint agreement on core characteristics; a self-management support programme in primary health care should therefore be generic, not disease specific, and delivered in a group- based format. A special focus should be on the everyday- life of the participants. The most challenging aspect was a present lack of competence and experience among health professionals to moderate self-management support programmes. Conclusions The development and design of a relevant and applicable self-management support programme in primary health care should balance the interests of the users with the possibilities and constraints within each municipality. It would be vital to benefit from the closeness of the patients’ every-day life situations. The user informants’ perception of a self-management support programme as a supplement to regular medical treatment represented an expanded understanding of the self-management support concept. An exploring approach should be applied in the development of the health professionals’ competence in practice. The effect of a self-management support programme based on the core characteristics found in this study needs to be evaluated.
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Stoneman A, Atkinson D, Davey M, Marley JV. Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services. BMC Health Serv Res 2014; 14:481. [PMID: 25288282 PMCID: PMC4282197 DOI: 10.1186/1472-6963-14-481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Management of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. We have previously demonstrated that diabetes monitoring and outcomes can be improved and maintained over a 10-year period at Derby Aboriginal Health Service (DAHS). While continuous quality improvement (CQI) has been shown to improve service delivery rates and clinical outcome measures, the process of interpreting audit results and developing strategies for improvement is less well described. This paper describes the evaluation of care of patients with type 2 diabetes mellitus (T2DM) and features of effective CQI in ACCHSs in the remote Kimberley region of north Western Australia. Methods Retrospective audit of records for Aboriginal and Torres Strait Islander primary care patients aged ≥15 years with a confirmed diagnosis of T2DM at four Kimberley ACCHSs from 1 July 2011 to 30 June 2012. Interviews with health service staff and focus group discussions with patients post audit. Main outcome measures: diabetes care related activities, clinical outcome measures and factors influencing good diabetes related care and effective CQI. Results A total of 348 patients from the four ACCHSs were included in the study. Clinical care activities were generally high across three of the four health services (at least 71% of patients had cholesterol recorded, 89% blood pressure, 84% HbA1c). Patients from DAHS had lower median cholesterol levels (4.4 mmol/L) and the highest proportion of patients meeting clinical targets for HbA1c (31% v 16% ACCHS-3; P = 0.02). Features that facilitated good care included clearly defined staff roles for diabetes management, support and involvement of Aboriginal Health Workers, efficient recall systems, and well-coordinated allied health services. Effective CQI features included seamless and timely data collection, local ownership of the process, openness to admitting deficiencies and willingness to embrace change. Conclusions Well-designed health care delivery and CQI systems, with a strong sense of ownership over diabetes management led to increased service delivery rates and improved clinical outcome measures in ACCHSs. Locally run CQI processes may be more responsive to individual health services and more sustainable than externally driven systems.
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Affiliation(s)
- Alice Stoneman
- Launceston Clinical School, University of Tasmania, Locked Bag 1377, Launceston, TAS 7250, Australia.
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Serfontein S, Mash RJ. Views of patients on a group diabetes education programme using motivational interviewing in South African primary care: a qualitative study. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2013.10874395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- S Serfontein
- Division of Family Medicine and Primary Care, Stellenbosch University
| | - RJ Mash
- Division of Family Medicine and Primary Care, Stellenbosch University
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Boström E, Isaksson U, Lundman B, Lehuluante A, Hörnsten Å. Patient-centred care in type 2 diabetes - an altered professional role for diabetes specialist nurses. Scand J Caring Sci 2013; 28:675-82. [DOI: 10.1111/scs.12092] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/24/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Eva Boström
- Department of Nursing; Umeå University; Umeå Sweden
| | - Ulf Isaksson
- Department of Nursing; Umeå University; Umeå Sweden
| | | | | | - Åsa Hörnsten
- Department of Nursing; Umeå University; Umeå Sweden
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