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Olude O, Vlassoff C, Niyikora J, Krentel A. A systematic review of participatory approaches to empower health workers in low- and middle-income countries, highlighting Health Workers for Change. Int Health 2023; 15:462-473. [PMID: 36349618 PMCID: PMC10318970 DOI: 10.1093/inthealth/ihac070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/26/2022] [Accepted: 10/21/2022] [Indexed: 07/20/2023] Open
Abstract
This systematic review assesses participatory approaches to motivating positive change among health workers in low- and middle-income countries (LMICs). The mistreatment of clients at health centres has been extensively documented, causing stress among clients, health complications and even avoidance of health centres altogether. Health workers, too, face challenges, including medicine shortages, task shifting, inadequate training and a lack of managerial support. Solutions are urgently needed to realise global commitments to quality primary healthcare, country ownership and universal health coverage. This review searched 1243 titles and abstracts, of which 32 were extracted for full text review using a published critical assessment tool. Eight papers were retained for final review, all using a single methodology, 'Health Workers for Change' (HWFC). The intervention was adapted to diverse geographical and health settings. Nine indicators from the included studies were assessed, eliciting many common findings and documenting an overall positive impact of the HWFC approach. Health workers acknowledged their negative behaviour towards clients, often as a way of coping with their own unmet needs. In most settings they developed action plans to address these issues. Recommendations are made on mainstreaming HWFC into health systems in LMICs and its potential application to alleviating stress and burnout from COVID-19.
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Affiliation(s)
| | - Carol Vlassoff
- School of Epidemiology and Public Health, University of Ottawa, Ottawa K1G 5Z3, Canada
- Bruyère Research Institute, Ottawa K1N 5C8, Canada
| | | | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa K1G 5Z3, Canada
- Bruyère Research Institute, Ottawa K1N 5C8, Canada
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Exploring behavior change techniques for reablement: A scoping review. Braz J Phys Ther 2022; 26:100401. [PMID: 35427880 PMCID: PMC9035406 DOI: 10.1016/j.bjpt.2022.100401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Reablement is a team-based person-centered health and social care model, most commonly available for community-dwelling older adults. Understanding the components of reablement and how it is delivered, received, and enacted facilitates best evidence and practice. Determining behavior change techniques (BCTs) or strategies is an important step to operationalize implementation of reablement. OBJECTIVE We conducted a scoping review of peer-reviewed literature to identify BCTs used within reablement studies. METHODS We registered our study with the Joanna Briggs Institute and conducted five database searches. Inclusion criteria were peer-reviewed studies focused on adults and older adults without significant cognitive impairment or dementia receiving reablement, and all study designs, years, and languages. We excluded studies focused on reablement for people with dementia or reablement training programs. The last search was on April 8, 2021. Two authors screened independently at Level 1 (title and abstract) and 2 (full text). Two authors adjudicated BCTs for each study, and a third author confirmed the final list. RESULTS We identified 567 studies (591 publications) and included 21 studies (44 publications) from six global locations. We identified 27 different BCTs across all studies. The three most common BCTs for reablement were goal setting (behavior), social support (unspecified), and instruction on how to perform a behavior. CONCLUSIONS We highlight some behavioral components of reablement and encourage detailed reporting to increase transparency and replication of the intervention. Future research should explore effective BCTs (or combinations of) to include within reablement to support health behavior adoption and maintenance.
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Kennedy MA, Hatchell KE, DiMilia PR, Kelly SM, Blunt HB, Bagley PJ, LaMantia MA, Reynolds CF, Crow RS, Maden TN, Kelly SL, Kihwele JM, Batsis JA. Community health worker interventions for older adults with complex health needs: A systematic review. J Am Geriatr Soc 2021; 69:1670-1682. [PMID: 33738803 PMCID: PMC8263299 DOI: 10.1111/jgs.17078] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/10/2021] [Accepted: 01/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES The number of older adults with complex health needs is growing, and this population experiences disproportionate morbidity and mortality. Interventions led by community health workers (CHWs) can improve clinical outcomes in the general adult population with multimorbidity, but few studies have investigated CHW-delivered interventions in older adults. DESIGN We systematically reviewed the impact of CHW interventions on health outcomes among older adults with complex health needs. We searched for English-language articles from database inception through April 2020 using seven databases. PROSPERO protocol registration CRD42019118761. SETTING Any U.S. or international setting, including clinical and community-based settings. PARTICIPANTS Adults aged 60 years or older with complex health needs, defined in this review as multimorbidity, frailty, disability, or high-utilization. INTERVENTIONS Interventions led by a CHW or similar role consistent with the American Public Health Association's definition of CHWs. MEASUREMENTS Pre-defined health outcomes (chronic disease measures, general health measures, treatment adherence, quality of life, or functional measures) as well as qualitative findings. RESULTS Of 5671 unique records, nine studies met eligibility criteria, including four randomized controlled trials, three quasi-experimental studies, and two qualitative studies. Target population and intervention characteristics were variable, and studies were generally of low-to-moderate methodological quality. Outcomes included mood, functional status and disability, social support, well-being and quality of life, medication knowledge, and certain health conditions (e.g., falls, cognition). Results were mixed with several studies demonstrating significant effects on mood and function, including one high-quality RCT, while others noted no significant intervention effects on outcomes. CONCLUSION CHW-led interventions may have benefit for older adults with complex health needs, but additional high-quality studies are needed to definitively determine the effectiveness of CHW interventions in this population. Integration of CHWs into geriatric clinical settings may be a strategy to deliver evidence-based interventions and improve clinical outcomes in complex older adults.
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Affiliation(s)
- Meaghan A. Kennedy
- New England Geriatric Research, Education, and Clinical
Center, VA Bedford Healthcare System, Bedford, MA
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kayla E. Hatchell
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Peter R. DiMilia
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | | | - Michael A. LaMantia
- Division of Geriatric Medicine, Department of Medicine,
Larner College of Medicine at The University of Vermont, Burlington, VT
| | | | - Rebecca S. Crow
- Department of Medicine, Geisel School of Medicine at
Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Geriatrics and Extended Care, Veterans Affairs Medical Center, White River Junction,
White River Junction, VT
| | - Tara N. Maden
- Analytics Institute, Dartmouth-Hitchcock Clinic, Lebanon,
NH
| | | | | | - John A. Batsis
- Division of Geriatric Medicine and Gillings School of
Global Public Health, University of North Carolina, Chapel Hill, NC
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Clotworthy A, Kusumastuti S, Westendorp RGJ. Reablement through time and space: a scoping review of how the concept of 'reablement' for older people has been defined and operationalised. BMC Geriatr 2021; 21:61. [PMID: 33446093 PMCID: PMC7809765 DOI: 10.1186/s12877-020-01958-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 11/25/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND While the field of rehabilitation has determined a common definition of professional practice, legislators and healthcare professionals in various Western countries have struggled to reach consensus about how the newer offer of 'reablement' should be organised, operationalised, and understood as a health service for older adults. International research indicates that there is confusion, ambiguity, and disagreement about the terminology and the structure of these programmes, and they may not be adequately supporting older people's self-identified goals. Could an analysis of the concept's genealogy illuminate how reablement can be more effective and beneficial in theory and in practice? METHODS We conducted a qualitative and quantitative scoping review to determine how reablement has developed through time and space. Eligible articles (N=86) had to focus on any of the defined features of current reablement programmes; there were no restrictions on study designs or publication dates. In articles published from 1947 to 2019, we identified themes and patterns, commonalities, and differences in how various countries described and defined reablement. We also performed an analysis using computer software to construct and visualise term maps based on significant words extracted from the article abstracts. RESULTS The fundamental principles of reablement have a long history. However, these programmes have undergone a widespread expansion since the mid-2000s with an intention to reduce costs related to providing long-term care services and in-home assistance to growing older populations. Despite theoretical aspirations to offer person-centred and goal-directed reablement, few countries have been able to implement programmes that adequately promote older people's goals, social involvement, or participation in their local community in a safe, culturally sensitive and adaptable way. CONCLUSIONS Reablement is meant to support older people in attaining their self-defined goals to be both more physically independent at home and socially involved in their communities. However, until legislators, health professionals, and older people can collectively reach consensus about how person-centred reablement can be more effectively implemented and supported in professional home-care practice, it will be difficult to determine a conceptual description of reablement as a service that is unique, separate, and distinct from standard rehabilitation.
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Affiliation(s)
- Amy Clotworthy
- Department of Public Health, University of Copenhagen, Bartholinsgade 6Q, 1014, Copenhagen K, Denmark.
| | - Sasmita Kusumastuti
- Department of Public Health, University of Copenhagen, Bartholinsgade 6Q, 1014, Copenhagen K, Denmark
| | - Rudi G J Westendorp
- Department of Public Health, University of Copenhagen, Bartholinsgade 6Q, 1014, Copenhagen K, Denmark
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Hwang Y, Lee D, Kim YS. Educational Needs Associated with the Level of Complication and Comparative Risk Perceptions in People with Type 2 Diabetes. Osong Public Health Res Perspect 2020; 11:170-176. [PMID: 32864307 PMCID: PMC7442446 DOI: 10.24171/j.phrp.2020.11.4.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives This study aimed to identify the educational needs of people with type 2 diabetes according to risk perceptions and the level of severity of complications. Methods There were 177 study participants who were outpatients of the internal medicine department at a university hospital located in the Republic of Korea, who consented to participate in the survey from December 10, 2016 to February 10, 2017. The data were analyzed using descriptive statistics, Pearson correlation, ANOVA with post-hoc comparison, and multiple regression analysis. Type 2 diabetes complications were classified into 3 groups: no complications, common complications, and severe complications. Results There were statistically significant positive correlations between educational needs and comparative risk perceptions, and the level of complication and comparative risk perception. Multiple regression analysis revealed that the factor predicting educational needs of type 2 diabetes people was their comparative risk perceptions, rather than the severity of diabetes complications or sociodemographic variables. Conclusion Since risk perception is the factor that indicates the educational needs of people with type 2 diabetes, there is a need to explore factors which increase risk perception, in order to meet educational needs. The findings suggest that a more specific and individualized educational program, which focuses on each person's risk perceptions, should be developed.
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Affiliation(s)
| | - Dongsuk Lee
- College of Nursing, Kangwon National University, Chuncheon, Korea
| | - Yeon Sook Kim
- Department of Nursing, California State University, San Bernardino, California, CA, USA
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Overcash J, Ford N, Kress E, Ubbing C, Williams N. Comprehensive Geriatric Assessment as a Versatile Tool to Enhance the Care of the Older Person Diagnosed with Cancer. Geriatrics (Basel) 2019; 4:geriatrics4020039. [PMID: 31238518 PMCID: PMC6630523 DOI: 10.3390/geriatrics4020039] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/14/2019] [Accepted: 06/20/2019] [Indexed: 12/27/2022] Open
Abstract
The comprehensive geriatric assessment (CGA) is a versatile tool for the care of the older person diagnosed with cancer. The purpose of this article is to detail how a CGA can be tailored to Ambulatory Geriatric Oncology Programs (AGOPs) in academic cancer centers and to community oncology practices with varying levels of resources. The Society for International Oncology in Geriatrics (SIOG) recommends CGA as a foundation for treatment planning and decision-making for the older person receiving care for a malignancy. A CGA is often administered by a multidisciplinary team (MDT) composed of professionals who provide geriatric-focused cancer care. CGA can be used as a one-time consult for surgery, chemotherapy, or radiation therapy providers to predict treatment tolerance or as an ongoing part of patient care to manage malignant and non-malignant issues. Administrative support and proactive infrastructure planning to address scheduling, referrals, and provider communication are critical to the effectiveness of the CGA.
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Affiliation(s)
- Janine Overcash
- The College of Nursing, The Ohio State University, 1585 Neil Ave, Newton Hall, Columbus, OH 43201, USA.
| | - Nikki Ford
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Elizabeth Kress
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Caitlin Ubbing
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Nicole Williams
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
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Perales J, Reininger BM, Lee M, Linder SH. Participants' perceptions of interactions with community health workers who promote behavior change: a qualitative characterization from participants with normal, depressive and anxious mood states. Int J Equity Health 2018; 17:19. [PMID: 29402278 PMCID: PMC5800056 DOI: 10.1186/s12939-018-0729-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 01/16/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Interventions that promote healthier lifestyles among Latinos often involve community health workers (CHWs). CHWs can effectively advocate for healthier lifestyles and may be pivotal in addressing such mental health conditions as depression and anxiety. The goal of this study was to characterize the relationship dynamics between Latino participants and CHWs, from the participant's perspective. We aimed to determine if CHW-delivered community interventions effected behavior change, especially among participants who reported anxiety and depression. METHODS Semi-structured interviews were conducted with a purposive sample of 28 Latino participants that was based on a mental health scoring strata. Participants completed a lifestyle intervention that included multiple home visits from CHWs to promote physical activity and healthful food choice. Interviews were conducted in the participant's preferred language (English or Spanish). Transcribed interviews were analyzed using a grounded theory approach until concept saturation was achieved. RESULTS The sample was primarily female (82%), lower socioeconomic status (64%), and mean age of 50 years. Participants discussed the rapport building and professionalism of CHWs as a feature that facilitated strong, positive relationships and lifestyle behavior changes. Participants described how CHWs patterned their change approaches, which were similar to commonly used therapeutic techniques in the treatment of anxiety and depression. While anxiety and depression were described as having an impact on behavior change, most, but not all, participants who reported negative mood states said that the CHW relationship helped in changing that state to some extent. CONCLUSIONS Participants' perceptions indicated that positive personal changes were influenced by CHWs. Only participants who reported consistently poor scores for depression, anxiety or both reported negative or neutral experiences with the CHWs. This study lends qualitative support to the use of CHWs as extenders of care, particularly in areas that have a shortage of primary and mental health care providers.
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Affiliation(s)
- Joseph Perales
- La Clínica - Casa del Sol, 1501 Fruitvale Ave, Oakland, California, 94601, USA
| | - Belinda M Reininger
- UT Health School of Public Health in Brownsville, Division of Health Promotion & Behavioral Sciences and Hispanic Health Research Center, One West University Blvd, Brownsville, TX, 78520, USA. .,Michael & Susan Dell Center for Healthy Living, UT School of Public Health, Austin Regional Campus, University of Texas Administration Building (UTA), 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA. .,University of Texas Health Science Center at Houston, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA.
| | - MinJae Lee
- University of Texas Health Science Center at Houston, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA.,University of Texas Health Science Center at Houston, Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA
| | - Stephen H Linder
- UT Health School of Public Health, Institute for Health Policy, Division of Management, Policy and Community Health, 6410 Fannin, Houston, TX, 77030, USA
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Lawn S, Westwood T, Jordans S, Zabeen S, O'Connor J. Support workers can develop the skills to work with complexity in community aged care: An Australian study of training provided across aged care community services. GERONTOLOGY & GERIATRICS EDUCATION 2017; 38:453-470. [PMID: 26908178 DOI: 10.1080/02701960.2015.1116070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Enhancing support workers' (SW) role is timely given increasing demands on human and financial health care resources. This article presents outcomes of a program, delivered to 140 participants from five community aged care providers in Australia, designed to enhance knowledge, skills, and confidence of community aged care SWs, building their practical skills in understanding, recognizing, and responding to complexity. Evaluation training modules on communication, complexity, behavior change, and chronic condition self-management support involved pre/post surveys with SWs and their supervisors. SWs reported greater awareness, skills, and confidence in working with complexity, reinforcing the value of their existing practices and skills. Coordinators reported greater appreciation of SWs' skills, and greater awareness of gaps in SWs' support and supervision needs. Educators, policy makers, and services should account for these contributions, given growing fiscal restraint and focus on reablement and consumer-directed care.
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Affiliation(s)
- Sharon Lawn
- a Flinders Human Behaviour and Health Research Unit , Flinders University , Adelaide , South Australia , Australia
| | - Tania Westwood
- b Service Planning and Primary Health , Southern Adelaide Local Health Network , Adelaide , South Australia , Australia
| | - Sarah Jordans
- c Office for the Ageing , SA Health , Adelaide , South Australia , Australia
| | - Sara Zabeen
- a Flinders Human Behaviour and Health Research Unit , Flinders University , Adelaide , South Australia , Australia
| | - Julianne O'Connor
- d Transition Care Services , Southern Adelaide Local Health Network , Adelaide , South Australia , Australia
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