Coproducing and Implementing Person-Centered Key Performance Indicators in Ambulatory Cancer Nursing

Using data from mHealth apps to inform person-centred practice: A discussion paper

BACKGROUND

mHealth applications (apps) are tools that can enhance research by efficiently collecting and storing large amounts of data. However, data collection alone does not lead to change. Innovation and practice change occur through utilisation of evidence. The volume of data collected raises questions regarding utilisation of data by nurses and midwives, and how data from mHealth apps can be used to improve person-centred practice. There is limited empirical evidence and a lack of direction from global health authorities to guide nurses and midwives in this area.

AIM

To describe strategies for nurses and midwives that could enhance the effective use of data generated by mHealth apps to inform person-centred practice. The purpose of this paper is to stimulate reflection and generate actions for data utilisation when using mHealth apps in nursing research and practice.

METHODS

This discussion paper has been informed by current evidence, the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, and research experience as part of doctoral study.

FINDINGS

Before engaging in data collection using mHealth apps, nurses and midwives would benefit from considering the nature of the evidence collected, available technological infrastructure, and staff skill levels. When collecting data and interpreting results, use of a team approach supported by engaged leadership and external facilitation is invaluable. This provides support to operate apps, and more importantly use the data collected to inform person-centred practice.

CONCLUSIONS

This paper addresses the limited available evidence to guide nurses and midwives when using mHealth apps to collect and use data to inform practice change. It highlights the need for appropriate technology, external facilitative support, engaged leadership, and a team approach to collect meaningful evidence using mHealth apps. Clinicians, leaders, and researchers can apply the strategies provided to enhance the use of mHealth apps and ensure translation of evidence into practice.

Development and optimisation of a mobile app (iMPAKT) for improving person-centred practice in healthcare settings: A multi-methods evaluation study

Objective

To develop and optimise an app (iMPAKT) for improving implementation and measurement of person-centred practice in healthcare settings.

Methods

Two iterative rounds of testing were carried out based on cognitive task analysis and qualitative interview methods. The System Usability Scale (SUS) was also used to evaluate the app. Quantitative data on task completion and SUS scores were evaluated descriptively, with thematic analysis performed on qualitative data. The MoSCoW prioritisation system was used to identify key modifications to improve the app.

Results

Twelve participants took part (eight health professionals and four patient and public involvement representatives). Views on design and structure of the app were positive. The majority of the 16 tasks undertaken during the cognitive task analysis were easy to complete. Mean SUS scores were 73.5/100 (SD: 7.9; range = 60-92.5), suggesting good overall usability. For one section of the app that transcribes patients speaking about their experience of care, a non-intuitive user interface and lack of transcription accuracy were identified as key issues influencing usability and acceptability.

Conclusions

Findings from the evaluation were used to inform iterative modifications to further develop and optimise the iMPAKT App. These included improved navigational flow, and implementation of an updated artificial intelligence (AI) based Speech-To-Text software; allowing for more accurate, real-time transcription. Use of such AI-based software represents an interesting area that requires further evaluation. This is particularly apparent in relation to potential for large-scale collection of data on person-centred measures using the iMPAKT App, and for assessing initiatives designed to improve patient experience.

The experience of staff utilizing data to evaluate and improve person-centred practice: An action research study

AIM

Explore how nurses and midwives use patient experience data collected from a mobile health app to influence the development of person-centred practice.

DESIGN

Participatory action research, underpinned by the Person-Centred Nursing Framework and Practice Development principles.

METHODS

Six clinical units in a large health district engaged in three action cycles from 2018 to 2020 using a mobile health app. Nursing/midwifery staff on the units (N = 177) utilized data collected via the app to evaluate and improve person-centred practice. A pre-post survey using the PCPI-S was conducted to evaluate staff perceptions of person-centredness. Data from the surveys (n = 101 in 2018 and n = 102 in 2020) and 17 semi-structured interviews were used to understand the influence working with these data had on person-centred practice. The Guidelines for Best Practices in the Reporting of Participatory Action Research have been used to report this study.

RESULTS

Improvements in person-centred practice were noted across both data sets. There was a statistically significant increase in two domains of the PCPI-S in the independent t-test and across all three domains in the paired t-test results. Thematic analysis resulted in the identification of six themes: Getting everyone on board, once we understood, keeping on track, there's a person in the bed, knowing you're doing a good job and improving over time.

CONCLUSION

Engaging with the data collected from the app in a facilitated and collaborative way results in increases in person-centredness.

IMPACT

This study provides insight into how nurses and midwives used data from a mHealth app to evaluate and improve person-centred practice. Utilizing the data generated by the app resulted in increased person-centredness amongst staff and changes to practice and culture. Nursing and midwifery teams who are supported to engage with patient experience data in an action-oriented way will see person-centred practice improvements, affecting patients and staff.

CONTACT-Patient-Centred Care Questionnaire to assess care for patients treated with oral anticancer drugs: Development and psychometric validation

OBJECTIVE

Instruments to measure quality of patient-centred care (PCC) for the rapidly growing population of patients treated with oral anticancer drugs (OACD) are lacking. The aim of this study was to develop a valid and reliable instrument to assess PCC in the context of OACD.

METHODS

The CONTACT-Patient-Centred Care Questionnaire (CONTACT-PCCQ) was developed based on a validated set of key elements (KEs) for patient-centred education and counselling in patients taking OACD, and face validity was evaluated by means of cognitive interviews. In 16 Belgian hospitals, adult patients treated with OACD were asked to complete the questionnaire. Construct validity was investigated through exploratory factor analyses (EFAs) and internal consistency of the subscales was examined using Cronbach's alpha.

RESULTS

The initial 86-item instrument was completed by 464 patients. Each EFA confirmed the a priori PCC-based structure of the subscales. However, EFA revealed more than one factor for two of the subscales. Therefore, multiple subsections within these subscales were created. Based on factor loadings and item content, six items were removed. This resulted in a final 80-item instrument with seven subscales and five subsections. Cronbach's alpha for the subscales and subsections ranged between 0.732 and 0.918, which implies adequate internal consistency.

CONCLUSION

A final instrument with 80 items divided into seven subscales, covering all six dimensions of PCC, was obtained. The CONTACT-PCCQ has acceptable psychometric properties, supporting its use as a measure to assess care experiences of patients treated with OACD.