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Woodward EN, Castillo AIM, True G, Willging C, Kirchner JE. Challenges and promising solutions to engaging patients in healthcare implementation in the United States: an environmental scan. BMC Health Serv Res 2024; 24:29. [PMID: 38178131 PMCID: PMC10768202 DOI: 10.1186/s12913-023-10315-y] [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: 03/08/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND One practice in healthcare implementation is patient engagement in quality improvement and systems redesign. Implementers in healthcare systems include clinical leadership, middle managers, quality improvement personnel, and others facilitating changes or adoption of new interventions. Patients provide input into different aspects of health research. However, there is little attention to involve patients in implementing interventions, especially in the United States (U.S.), and this might be essential to reduce inequities. Implementers need clear strategies to overcome challenges, and might be able to learn from countries outside the U.S. METHODS We wanted to understand existing work about how patients are being included in implementation activities in real world U.S. healthcare settings. We conducted an environmental scan of three data sources: webinars, published articles, and interviews with implementers who engaged patients in implementation activities in U.S. healthcare settings. We extracted, categorized, and triangulated from data sources the key activities, recurring challenges, and promising solutions using a coding template. RESULTS We found 27 examples of patient engagement in U.S. healthcare implementation across four webinars, 11 published articles, and seven interviews, mostly arranging patient engagement through groups and arranging processes for patients that changed how engaged they were able to be. Participants rarely specified if they were engaging a population experiencing healthcare inequities. Participants described eight recurring challenges; the two most frequently identified were: (1) recruiting patients representative of those served in the healthcare system; and (2) ensuring processes for equitable communication among all. We matched recurring challenges to promising solutions, such as logistic solutions on how to arrange meetings to enhance engagement or training in inclusivity and power-sharing. CONCLUSION We clarified how some U.S. implementers are engaging patients in healthcare implementation activities using less and more intensive engagement. It was unclear whether reducing inequities was a goal. Patient engagement in redesigning U.S. healthcare service delivery appears similar to or less intense than in countries with more robust infrastructure for this, such as Canada and the United Kingdom. Challenges were common across jurisdictions, including retaining patients in the design/delivery of implementation activities. Implementers in any region can learn from those in other places.
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Affiliation(s)
- Eva N Woodward
- VA Center for Mental Healthcare and Outcomes Research, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA.
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA.
| | - Andrea Isabel Melgar Castillo
- VA Center for Mental Healthcare and Outcomes Research, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA
- Graduate School, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
| | - Gala True
- South Central Mental Illness Research Education and Clinical Center, Southeast Louisiana Veterans Health Care System, 2400 Canal St, New Orleans, LA, 70119, USA
- Section on Community and Population Medicine, School of Medicine, Louisiana State University, 2400 Canal St (11F), New Orleans, LA, USA
| | - Cathleen Willging
- Pacific Institute for Research and Evaluation, 851 University Boulevard, Suite 101, Albuquerque, NM, 87106, USA
| | - JoAnn E Kirchner
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA
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Pérez Jolles M, Willging CE, Stadnick NA, Crable EL, Lengnick-Hall R, Hawkins J, Aarons GA. Understanding implementation research collaborations from a co-creation lens: Recommendations for a path forward. FRONTIERS IN HEALTH SERVICES 2022; 2:942658. [PMID: 36908715 PMCID: PMC10003830 DOI: 10.3389/frhs.2022.942658] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/26/2022] [Indexed: 01/18/2023]
Abstract
Increasing calls within the field of implementation science (IS) research seek to promote active engagement of diverse and often disenfranchised stakeholder voices to increase buy-in, fidelity, outcome relevance, and sustainment of evidence-based practices (EBPs). Including such voices requires cultural humility and the integration of multiple perspectives and values among organizations, groups, and individuals. However, the IS field lacks guidance for researchers on structuring collaborative approaches to promote a co-created process (i.e., synergistic approach to goal attainment). We contend that improved operationalization of co-created implementation collaborations is critical to sparking synergy and addressing differentials based on power, privilege, knowledge, and access to resources among stakeholders. These differentials can undermine future implementation and sustainment efforts if not addressed early in the research effort. An insufficient understanding of the guiding principles of co-created implementation collaborations may limit the scientific value of evaluation processes, and researchers' ability to replicate outcomes. We propose a perspective foregrounded in the concept of co-creation to guide the structuring of implementation collaboratives through five principles. We offer three case examples informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework to illustrate the application of these co-creation principles. Lastly, we offer recommendations for promoting co-creation in IS research moving forward.
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Affiliation(s)
- Mónica Pérez Jolles
- ACCORDS Dissemination and Implementation Science Program, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Cathleen E. Willging
- Pacific Institute for Research and Evaluation—Southwest Center, Beltsville, MD, United States
| | - Nicole A. Stadnick
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
- Child and Adolescent Services Research Center, San Diego, CA, United States
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, United States
| | - Erika L. Crable
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
- Child and Adolescent Services Research Center, San Diego, CA, United States
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, United States
| | | | - Jemma Hawkins
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
- Child and Adolescent Services Research Center, San Diego, CA, United States
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, United States
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Thompson AP, MacDonald SE, Wine E, Scott SD. An Evaluation of Parents' Experiences of Patient Engagement in Research to Develop a Digital Knowledge Translation Tool: Protocol for a Multi-Method Study. JMIR Res Protoc 2020; 9:e19108. [PMID: 32663147 PMCID: PMC7435679 DOI: 10.2196/19108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background The last decade has seen increasing calls for patient and public involvement in health-related research due to an ideological shift toward more equitable methods of knowledge development and an effort to increase the usability and relevance of knowledge by improving outcomes in clinical practice. Patient engagement includes simply informing patients to offering complete decision-making autonomy to individuals, groups, communities, caregivers, friends, and families who have personal experience and knowledge of a health issue. Despite the use of patient engagement methods in research, evaluation has lagged, resulting in a knowledge gap that makes it difficult to foster capacity and sustainability for patients and researchers alike since little is known about how effective patient collaborations in research are built, maintained, or improved. This study centers on pediatric functional constipation, a common condition that affects children and families. Since parents play a pivotal role in treatment, they are an optimal group to engage in improving the resources and support available to them. Objective This study aims to use patient-engagement methods to establish a research collaboration with parents to cocreate a digital knowledge translation tool for parents caring for a child with functional constipation and formally evaluate the patient engagement processes within this project to build the science of patient engagement in research. Methods Members of the parent collaborator group will be recruited from previous participants who expressed interest in the development of a digital knowledge translation tool. The group will collaborate with the research team to create a tool to address patients’ support and information needs when caring for a child with functional constipation. The parent collaborator group will then be evaluated in a multimethod study design. Data will be digitally and anonymously collected from all members of the parent collaborator group, using the validated Public and Patient Engagement Evaluation Tool (PPEET) patient questionnaire. Descriptive statistics will be used to report group characteristics and question responses. Qualitative analysis will be used to understand open-ended question responses. Specifically, directed content analysis will be used to assess themes of the Patient Engagement in Research (PEIR) Framework with a combination of deductive and inductive analyses. Findings will be integrated into the discussion if there are sufficient commonalities and inter-relationships. The final manuscript will include reporting of each element as described by the Good Reporting of a Mixed Methods Study criteria. Results Recruitment is planned for June 2020. Data collection for the evaluation of patient engagement processes will occur upon completion of the digital knowledge translation tool. The results of this study are expected to be published by the end of 2020. Conclusions This study will provide valuable information about parents’ experiences participating in child-health research and is a fundamental step in building the science of patient engagement in research. International Registered Report Identifier (IRRID) PRR1-10.2196/19108
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Affiliation(s)
| | | | - Eytan Wine
- Department of Pediatrics, Division of Pediatric Gastroenterology & Nutrition, University of Alberta, Edmonton, AB, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Arnstein L, Wadsworth AC, Yamamoto BA, Stephens R, Sehmi K, Jones R, Sargent A, Gegeny T, Woolley KL. Patient involvement in preparing health research peer-reviewed publications or results summaries: a systematic review and evidence-based recommendations. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:34. [PMID: 32587753 PMCID: PMC7313171 DOI: 10.1186/s40900-020-00190-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/31/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND There are increasing calls for patient involvement in sharing health research results, but no evidence-based recommendations to guide such involvement. Our objectives were to: (1) conduct a systematic review of the evidence on patient involvement in results sharing, (2) propose evidence-based recommendations to help maximize benefits and minimize risks of such involvement and (3) conduct this project with patient authors. METHODS To avoid research waste, we verified that no systematic reviews were registered or published on this topic. We co-created, with patients, a PRISMA-P-compliant protocol. We included peer-reviewed publications reporting the effects of patient involvement in preparing peer-reviewed publications or results summaries from health research studies. We searched (9/10/2017) MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews, and secondary information sources (until 11/06/2018). We assessed the risk of bias in eligible publications and extracted data using standardized processes. To evaluate patient involvement in this project, we co-created a Patient Authorship Experience Tool. RESULTS All nine eligible publications reported on patient involvement in preparing publications; none on preparing results summaries. Evidence quality was moderate. A qualitative synthesis of evidence indicated the benefits of patient involvement may outweigh the risks. We have proposed 21 evidence-based recommendations to help maximize the benefits and minimize the risks when involving patients as authors of peer-reviewed publications. The recommendations focus on practical actions patient and non-patient authors can take before (10 recommendations), during (7 recommendations) and after (4 recommendations) manuscript development. Using the Patient Authorship Experience Tool, both patient and non-patient authors rated their experience highly. CONCLUSIONS Based on a systematic review, we have proposed 21 evidence-based recommendations to help maximize the benefits and minimize the risks of involving patients as authors of peer-reviewed publications.
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Affiliation(s)
- Lauri Arnstein
- Envision the Patient – Envision Pharma Group, Suite 5.11, 5th Floor, 1 Lyric Square, London, W6 0NB UK
| | - Anne Clare Wadsworth
- Envision the Patient – Envision Pharma Group, Suite 5.11, 5th Floor, 1 Lyric Square, London, W6 0NB UK
- Alligent EU – Envision Pharma Group, Wilmslow, UK
| | - Beverley Anne Yamamoto
- Osaka University, Osaka, Japan
- Hereditary Angioedema Japan (Registered NPO), Hyogo, Japan
- Hereditary Angioedema International (Registered NPO/Charity), Fairfax City, VA USA
| | - Richard Stephens
- Consumer Forum, National Cancer Research Institute, London, UK
- Research Involvement and Engagement, London, UK
| | - Kawaldip Sehmi
- International Alliance of Patients’ Organizations, London, UK
| | | | | | | | - Karen L. Woolley
- Envision the Patient – Envision Pharma Group, Suite 5.11, 5th Floor, 1 Lyric Square, London, W6 0NB UK
- ProScribe KK – Envision Pharma Group, Tokyo, Japan
- University of Queensland, Brisbane, Queensland Australia
- University of the Sunshine Coast, Maroochydore DC, Queensland Australia
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Harrison JD, Anderson WG, Fagan M, Robinson E, Schnipper J, Symczak G, Hanson C, Carnie MB, Banta J, Chen S, Duong J, Wong C, Auerbach AD. Patient and Family Advisory Councils (PFACs): Identifying Challenges and Solutions to Support Engagement in Research. THE PATIENT 2018; 11:413-423. [PMID: 29392529 PMCID: PMC11034744 DOI: 10.1007/s40271-018-0298-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim was to describe barriers to patient and family advisory council (PFAC) member engagement in research and strategies to support engagement in this context. METHODS We formed a study team comprising patient advisors, researchers, physicians, and nurses. We then undertook a qualitative study using focus groups and interviews. We invited PFAC members, PFAC leaders, hospital leaders, and researchers from nine academic medical centers that are part of a hospital medicine research network to participate. All participants were asked a standard set of questions exploring the study question. We used content analysis to analyze data. RESULTS Eighty PFAC members and other stakeholders (45 patient/caregiver members of PFACs, 12 PFAC leaders, 12 hospital leaders, 11 researchers) participated in eight focus and 19 individual interviews. We identified ten barriers to PFAC member engagement in research. Codes were organized into three categories: (1) individual PFAC member reluctance; (2) lack of skills and training; and (3) problems connecting with the right person at the right time. We identified ten strategies to support engagement. These were organized into four categories: (1) creating an environment where the PFAC members are making a genuine and unique contribution; (2) building community between PFAC members and researchers; (3) best practice activities for researchers to facilitate engagement; and (4) tools and training. CONCLUSION Barriers to engaging PFAC members in research include patients' negative perceptions of research and researchers' lack of training. Building community between PFAC members and researchers is a foundation for partnerships. There are shared training opportunities for PFAC members and researchers to build skills about research and research engagement.
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Affiliation(s)
- James D Harrison
- Division of Hospital Medicine, University of California San Francisco, 533 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Wendy G Anderson
- Division of Hospital Medicine, University of California San Francisco, 533 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Maureen Fagan
- Center for Patients and Families, Brigham and Women's Hospital, Boston, MA, USA
| | - Edmondo Robinson
- Department of Medicine, Christiana Care Health System, Wilmington, DE, USA
| | - Jeffrey Schnipper
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Gina Symczak
- Intensive Care Unit Patient and Family Advisory Council, University of California San Francisco, San Francisco, CA, USA
| | - Catherine Hanson
- University of Michigan Local Patient and Stakeholder Council, Ann Arbor, MI, USA
| | - Martha B Carnie
- Center for Patients and Families, Brigham and Women's Hospital, Boston, MA, USA
| | - Jim Banta
- Intensive Care Unit Patient and Family Advisory Council, University of California San Francisco, San Francisco, CA, USA
| | - Sherry Chen
- Division of Hospital Medicine, University of California San Francisco, 533 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Jonathan Duong
- Division of Hospital Medicine, University of California San Francisco, 533 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Celene Wong
- Center for Patients and Families, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew D Auerbach
- Division of Hospital Medicine, University of California San Francisco, 533 Parnassus Avenue, San Francisco, CA, 94143, USA
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Pérez Jolles M, Martinez M, Garcia SJ, Stein GL, Thomas KC. Involving Latina/o parents in patient-centered outcomes research: Contributions to research study design, implementation and outcomes. Health Expect 2017; 20:992-1000. [PMID: 28177564 PMCID: PMC5600244 DOI: 10.1111/hex.12540] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Comparative effectiveness research (CER) is supported by policymakers as a way to provide service providers and patients with evidence-based information to make better health-care decisions and ultimately improve services for patients. However, Latina/o patients are rarely involved as study advisors, and there is a lack of documentation on how their voices contribute to the research process when they are included as collaborators. OBJECTIVES The purpose of this article was to contribute to the literature by presenting concrete contributions of Latina/o parent involvement to study design, implementation and outcomes in the context of a CER study called Padres Efectivos (Parent Activation). METHODS Researchers facilitated a collaborative relationship with parents by establishing a mentor parent group. The contributions of parent involvement in the following stages of the research process are described: (i) proposal development, (ii) implementation of protocols, (iii) analysis plan and (iv) dissemination of results. RESULTS Mentor parents' contributions helped tailor the content of the intervention to their needs during proposal, increased recruitment, validated the main outcome measure and added two important outcome measures, emphasized the importance of controlling for novice treatment status and developed innovative dissemination strategies. CONCLUSIONS Mentor parents' guidance to the researchers has contributed to reaching recruitment goals, strengthened the study protocol, expanded findings, supported broad ownership of study implications and enriched the overall study data collection efforts. These findings can inform future research efforts seeking an active Latino parent collaboration and the timely incorporation of parent voices in each phase of the research process.
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Affiliation(s)
- Mónica Pérez Jolles
- Suzanne Dworak‐Peck School of Social WorkUniversity of Southern CaliforniaLos AngelesCAUSA
- Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Maria Martinez
- Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - San Juanita Garcia
- Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Gabriela L. Stein
- Psychology DepartmentUniversity of North Carolina at GreensboroGreensboroNCUSA
| | - Mentor Parent Group Members
- Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kathleen C. Thomas
- Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Health Policy and ManagementUniversity of North Carolina at Chapel HillChapel HillNCUSA
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