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Happell B, Gordon S, Hurley J, Foster K, Hazelton M, Lakeman R, Moxham L, Warner T. It takes it out of the textbook: Benefits of and barriers to expert by experience involvement in pre-registration mental health nursing education. J Psychiatr Ment Health Nurs 2024; 31:945-955. [PMID: 38509738 DOI: 10.1111/jpm.13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/22/2023] [Accepted: 02/27/2024] [Indexed: 03/22/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Service user involvement in mental health nursing education is beneficial in terms of attitudinal change to reduce stigma, clinical skill development and enhancing understandings of recovery-oriented practice. Service users as experts by experience have not been embedded within pre-registration nursing programs. Consequently, they remain limited in number, ad hoc and frequently tokenistic. Nurse academics responsible for the design and delivery of pre-registration mental health nursing curricula have a potentially important role in facilitating expert by experience involvement in mental health nursing education. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE Nurse academics teaching mental health nursing have generally favourable views about the importance of expert by experience involvement. Nurse academics experience significant barriers in supporting the implementation of academic positions for experts by experience, particularly in obtaining funding. The experts by experience could contribute to mental health nursing education does not appear to be clearly understood by nurse academics. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health services aspire to adopt a recovery-oriented approach to practice. Involving experts by experience in mental health nursing education can facilitate increased understanding and appreciation of recovery-oriented practice. Nurse academics could play an important role in supporting the implementation of experts by experience positions in nursing academia. To do so, they require an understanding of the benefits of EBE involvement in academia and the barriers that can be encountered when attempting to facilitate the implementation of such positions. Experts by experience contribute unique expertise, essential to the development of quality mental health services. Conveying this expertise through the educating the future nursing workforce in mental health is essential. ABSTRACT INTRODUCTION: Involving service users in mental health nursing education is ad hoc and minimal, despite growing evidence of its benefits. Insights and experiences of nurse academics teaching mental health to pre-registration students have been underrepresented in the research to date. AIM To seek insights and experiences of nurse academics involved in designing and delivering pre-registration mental health nursing education in Australian universities regarding involving service users in mental health nursing education. METHODS A descriptive qualitative study involving 19 nurse academics from 13 Australian universities, involved in pre-registration mental health nursing education. Data were analysed thematically. RESULTS Participants reported minimal service user involvement. Most sought an increase and identified barriers. Data analysis resulted in five identified themes: (1) value-rich, (2) resource-poor, (3) imperfect processes, (4) 'part, but not all' and (5) unrecognised worth. CONCLUSIONS Increasing meaningful involvement of service-users in mental health nursing education requires support and investment from multiple stakeholders. Nurse academics are crucial stakeholders in understanding the unique expertise service users bring. IMPLICATIONS FOR PRACTICE Service users being central to all aspects of mental health services requires their active participation in the education of health professionals. Nurse academics have an important role in realising this goal.
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Affiliation(s)
- Brenda Happell
- Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
| | - Sarah Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington South, Wellington, New Zealand
| | - John Hurley
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Mike Hazelton
- School of Nursing and Midwifery, College of Medicine, Health and Well-being, University of Newcastle, Callaghan, New South Wales, Australia
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Richard Lakeman
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Lorna Moxham
- School of Nursing, Faculty of Science, Health and Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Terri Warner
- ANU Medical School, Australian National University, Acton, New South Wales, Australia
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de Vrueh RLA, de Vlieger JSB, Orrling KM, van Rensen JML. From Innovator Result-driven to Multi-actor Impact-oriented Public-Private Partnerships: Integrating the Patient Perspective. Handb Exp Pharmacol 2024. [PMID: 39235487 DOI: 10.1007/164_2024_730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Public-Private Partnerships (PPPs) have been crucial in medicine research and development (R&D) for decades. Initially, PPPs involved private and academic innovators working in bilateral collaborations to advance pharmaceutical innovation. Later, a precompetitive open innovation environment was created, where multiple public and private innovators collaborated on mutual interests. The entry of regulators and patient interest organizations into PPPs has triggered a third shift from an innovator result-driven to a multi-actor impact-oriented partnership model. Using the second Innovative Medicines Initiative program (IMI2) as an example, this chapter focuses on the increasing roles of patient interest organizations in PPPs in roughly the last decade.Most IMI2 partnerships focused on raising awareness and sharing information tailored to patient needs (listener role) and inviting patients to share their experiences and needs (co-thinker role). Many partnerships also integrated the patient perspective by implementing patient advisory bodies (advisor role) or including patients as equal partners in steering the project (partner role). Notably, partnerships like EUPATI and PARADIGM showed that patient interest organizations can lead initiatives, especially those aiming at advancing patient engagement across the medicine R&D lifecycle (decision-maker role). While the overall impact of patient involvement in the IMI2 program is still being assessed, it has exposed many innovators and regulators to the patient perspective and created a community of patient experts with access to tools and guidelines for meaningful involvement.The PPP model continues to evolve, shifting from a treatment-only to a comprehensive diagnosis, treatment, and monitoring approach by incorporating digital and medical technology actors. This development, alongside continued patient and public integration could revolutionize the R&D and accessibility of new treatments and diagnostics.
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Affiliation(s)
| | | | - K M Orrling
- Foundation Lygature, Utrecht, The Netherlands
| | - J M L van Rensen
- Foundation INVOLV (formerly PGOsupport), Utrecht, The Netherlands
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Pal A, Arnet I, Elger BS, Wangmo T. Practices and Barriers in Developing and Disseminating Plain-Language Resources Reporting Medical Research Information: A Scoping Review. THE PATIENT 2024; 17:493-518. [PMID: 38878237 PMCID: PMC11343906 DOI: 10.1007/s40271-024-00700-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND The intent of plain-language resources (PLRs) reporting medical research information is to advance health literacy among the general public and enable them to participate in shared decision-making (SDM). Regulatory mandates coupled with academic and industry initiatives have given rise to an increasing volume of PLRs summarizing medical research information. However, there is significant variability in the quality, format, readability, and dissemination channels for PLRs. In this scoping review, we identify current practices, guidance, and barriers in developing and disseminating PLRs reporting medical research information to the general public including patients and caregivers. We also report on the PLR preferences of these intended audiences. METHODS A literature search of three bibliographic databases (PubMed, EMBASE, Web of Science) and three clinical trial registries (NIH, EMA, ISRCTN registry) was performed. Snowball searches within reference lists of primary articles were added. Articles with PLRs or reporting topics related to PLRs use and development available between January 2017 and June 2023 were identified. Evidence mapping and synthesis were used to make qualitative observations. Identified PLRs were quantitatively assessed, including temporal annual trends, availability by field of medicine, language, and publisher types. RESULTS A total of 9116 PLRs were identified, 9041 from the databases and 75 from clinical trial registries. The final analysis included 6590 PLRs from databases and 72 from registries. Reported barriers to PLR development included ambiguity in guidance, lack of incentives, and concerns of researchers writing for the general public. Available guidance recommendations called for greater dissemination, increased readability, and varied content formats. Patients preferred visual PLRs formats (e.g., videos, comics), which were easy to access on the internet and used short jargon-free text. In some instances, older audiences and more educated readers preferred text-only PLRs. Preferences among the general public were mostly similar to those of patients. Psychology, followed by oncology, showed the highest number of PLRs, predominantly from academia-sponsored research. Text-only PLRs were most commonly available, while graphical, digital, or online formats were less available. Preferred dissemination channels included paywall-free journal websites, indexing on PubMed, third-party websites, via email to research participants, and social media. CONCLUSIONS This scoping review maps current practices, recommendations, and patients' and the general public's preferences for PLR development and dissemination. The results suggest that making PLRs available to a wider audience by improving nomenclature, accessibility, and providing translations may contribute to empowerment and SDM. Minimizing variability among available guidance for PLR development may play an important role in amplifying the value and impact of these resources.
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Affiliation(s)
- Avishek Pal
- Institute of Biomedical Ethics, University of Basel, Bernouillistrasse 28, 4056, Basel, Switzerland.
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Bernice Simone Elger
- Institute of Biomedical Ethics, University of Basel, Bernouillistrasse 28, 4056, Basel, Switzerland
- University Center of Legal Medicine (CURML), University of Geneva, Geneva, Switzerland
| | - Tenzin Wangmo
- Institute of Biomedical Ethics, University of Basel, Bernouillistrasse 28, 4056, Basel, Switzerland
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Pal A, Klingmann I, Wangmo T, Elger B. Publishing clinical trial results in plain language: a clash of ethical principles? Curr Med Res Opin 2024; 40:493-503. [PMID: 38354123 DOI: 10.1080/03007995.2024.2308729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/18/2024] [Indexed: 02/16/2024]
Abstract
Plain language resources (PLR) are lay summaries of clinical trial results or plain language summaries of publications, in digital/visual/language formats. They aim to provide accurate information in jargon-free, and easy-to-understand language that can meet the health information needs of the general public, especially patients and caregivers. These are typically developed by the study sponsors or investigators, or by national public health bodies, research hospitals, patient organizations, and non-profit organizations. While the usefulness of PLR seems unequivocal, they have never been analyzed from the perspective of ethics. In this commentary, we do so and reflect on whether PLR are categorically advantageous or if they solve certain issues but raise new problems at the same time. Ethical concerns that PLR can potentially address include but are not limited to individual and community level health literacy, patient empowerment and autonomy. We also highlight the ethical issues that PLR may potentially exacerbate, such as fair balanced presentation and interpretation of medical knowledge, positive publication bias, and equitable access to information. PLR are important resources for patients, with promising implications for individual as well as community health. However, they require appropriate oversight and standards to optimize their potential value. Hence, we also highlight recommendations and best practices from our reading of the literature, that aim to minimize these biases.
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Affiliation(s)
- Avishek Pal
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Ingrid Klingmann
- European Forum for Good Clinical Practice, Brussels, Belgium
- Pharmaplex BV, Brussels, Belgium
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Bernice Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Kolade OR, Porat-Dahlerbruch J, Makhmutov R, van Achterberg T, Ellen ME. Strategies for engaging older adults and informal caregivers in health policy development: A scoping review. Health Res Policy Syst 2024; 22:26. [PMID: 38374133 PMCID: PMC10875823 DOI: 10.1186/s12961-024-01107-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Care for older adults is high on the global policy agenda. Active involvement of older adults and their informal caregivers in policy-making can lead to cost-effective health and long-term care interventions. Yet, approaches for their involvement in health policy development have yet to be extensively explored. This review maps the literature on strategies for older adults (65+ years) and informal caregivers' involvement in health policy development. METHOD As part of the European Union TRANS-SENIOR program, a scoping review was conducted using the Joanna Briggs Institute's methodology. Published and grey literature was searched, and eligible studies were screened. Data were extracted from included studies and analysed using the Multidimensional Framework for Patient and Family Engagement in Health and Healthcare. RESULTS A total of 13 engagement strategies were identified from 11 publications meeting the inclusion criteria. They were categorized as "traditional", "deliberative" and "others", adopting the World Bank's categorization of engagement methods. Older adults and informal caregivers are often consulted to elicit opinions and identify priorities. However, their involvement in policy formulation, implementation and evaluation is unclear from the available literature. Findings indicate that older adults and their informal caregivers do not often have equal influence and shared leadership in policy-making. CONCLUSION Although approaches for involving older adults and their informal caregivers' involvement were synthesized from literature, we found next to no information about their involvement in policy formulation, implementation and evaluation. Findings will guide future research in addressing identified gaps and guide policy-makers in identifying and incorporating engagement strategies to support evidence-informed policy-making processes that can improve health outcomes for older adults/informal caregivers.
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Affiliation(s)
- Opeyemi Rashidat Kolade
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, University of Leuven, KU Leuven, Kapucijnenvoer 35, 3000, Louvain, Belgium
| | - Joshua Porat-Dahlerbruch
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Rustem Makhmutov
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Theo van Achterberg
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, University of Leuven, KU Leuven, Kapucijnenvoer 35, 3000, Louvain, Belgium
| | - Moriah Esther Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Vellani S, Yous M, Rivas VM, Lucchese S, Kruizinga J, Sussman T, Abelson J, Akhtar‐Danesh N, Bravo G, Brazil K, Ganann R, Kaasalainen S. Patient and public involvement in international research: Perspectives of a team of researchers from six countries on collaborating with people with lived experiences of dementia and end-of-life. Health Expect 2024; 27:e13942. [PMID: 39102702 PMCID: PMC10748824 DOI: 10.1111/hex.13942] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Patient and public involvement (PPI) is a critical priority in research, policy, academia and advocacy organizations. PPI in dementia research is gaining momentum. However, these efforts are missing in international projects aimed at those living with advanced dementia in long-term care (LTC) homes. Additional complexities can arise in enacting PPI within the context of integration of a palliative approach to care and experiences around end-of-life in (EOL) dementia. The mySupport study involved implementing the Family Carer Decision Support (FCDS) intervention for care partners of those living with advanced dementia in LTC in six countries. RESEARCH DESIGN AND OBJECTIVE An interpretive description study was conducted to explore the perspectives of international researchers from six countries on engaging people with lived experiences of dementia and EOL care in research processes. The findings from this study informed the development of a PPI strategy and a subsequent toolkit for the FCDS intervention. FINDINGS Thirty-eight interviews were completed with project researchers: 12 from the United Kingdom, 8 from Canada, 7 from Ireland, 4 each from Italy and The Netherlands and 3 from the Czech Republic. Four broad themes describe international researchers' perspectives on advancing methods of engagement for people with lived experiences of dementia and EOL in international PPI activities: (1) Groundwork to engage in research; (2) planning for research activities is key; (3) focus on meaningful engagement and (4) having foresight for practical issues shaping PPI. DISCUSSION AND IMPLICATIONS International projects that involve PPI can present many sources of challenges. The findings in this study highlight important considerations for foundational work for incorporating PPI in international projects. Learning from world leaders and those with lived experiences in various regions can be insightful and help share tools and resources. PATIENT OR PUBLIC CONTRIBUTION PPI was envisioned as a critical part of conducting the mySupport study. The findings from this study informed the development of a PPI strategy and an international Strategic Guiding Council that included family carers of those living with advanced dementia in LTC homes in six countries. This manuscript focused on the perspectives of researchers on their engagement with people with lived experiences of dementia and EOL. The perspectives of persons with lived experiences on engaging in the mySupport research study will be reported in a forthcoming manuscript.
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Affiliation(s)
- Shirin Vellani
- School of Nursing, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Marie‐Lee Yous
- School of Nursing, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | | | - Stephanie Lucchese
- School of Nursing, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Julia Kruizinga
- School of Nursing, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Tamara Sussman
- School of Social Work, Faculty of ArtsMcGill UniversityMontrealQuebecCanada
| | - Julia Abelson
- Department of Health Research Methods, Evidence and Impact, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Noori Akhtar‐Danesh
- School of Nursing, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Gina Bravo
- Department of Community Health Sciences, Faculty of Medicine and Health SciencesSherbrooke UniversitySherbrookeCanada
| | - Kevin Brazil
- School of Nursing and MidwiferyQueens University BelfastNorthern IrelandUK
| | - Rebecca Ganann
- School of Nursing, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Sharon Kaasalainen
- School of Nursing, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
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Rajan S, Luoma AMV, Kofke WA. Role of Fellowship Training in Furthering Innovations in Perioperative Neuroscience. J Neurosurg Anesthesiol 2024; 36:1-3. [PMID: 37922343 DOI: 10.1097/ana.0000000000000940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/28/2023] [Indexed: 11/05/2023]
Affiliation(s)
- Shobana Rajan
- Staff Anesthesiologist, Cleveland Clinic, Cleveland, OH
| | - Astri M V Luoma
- Consultant Neuroanaesthetist, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK
| | - W Andrew Kofke
- Department of Anesthesiology and Critical Care, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA
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Frey AL, Baines R, Hunt S, Kent R, Andrews T, Leigh S. Association Between the Characteristics of mHealth Apps and User Input During Development and Testing: Secondary Analysis of App Assessment Data. JMIR Mhealth Uhealth 2023; 11:e46937. [PMID: 37991822 PMCID: PMC10701645 DOI: 10.2196/46937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND User involvement is increasingly acknowledged as a central part of health care innovation. However, meaningful user involvement during the development and testing of mobile health apps is often not fully realized. OBJECTIVE This study aims to examine in which areas user input is most prevalent and whether there is an association between user inclusion and compliance with best practices for mobile health apps. METHODS A secondary analysis was conducted on an assessment data set of 1595 health apps. The data set contained information on whether the apps had been developed or tested with user input and whether they followed best practices across several domains. Background information was also available regarding the apps' country of origin, targeted condition areas, subjective user ratings, download numbers, and risk (as per the National Institute for Health and Care Excellence Evidence Standards Framework [ESF]). Descriptive statistics, Mann-Whitney U tests, and Pearson chi-square analyses were applied to the data. RESULTS User involvement was reported by 8.71% (139/1595) of apps for only the development phase, by 33.67% (537/1595) of apps for only the testing phase, by 21.88% (349/1595) of apps for both phases, and by 35.74% (570/1595) of apps for neither phase. The highest percentage of health apps with reported user input during development was observed in Denmark (19/24, 79%); in the condition areas of diabetes (38/79, 48%), cardiology (15/32, 47%), pain management (20/43, 47%), and oncology (25/54, 46%); and for high app risk (ESF tier 3a; 105/263, 39.9%). The highest percentage of health apps with reported user input during testing was observed in Belgium (10/11, 91%), Sweden (29/34, 85%), and France (13/16, 81%); in the condition areas of neurodiversity (42/52, 81%), respiratory health (58/76, 76%), cardiology (23/32, 72%), and diabetes (56/79, 71%); and for high app risk (ESF tier 3a; 176/263, 66.9%). Notably, apps that reported seeking user input during testing demonstrated significantly more downloads than those that did not (P=.008), and user inclusion was associated with better compliance with best practices in clinical assurance, data privacy, risk management, and user experience. CONCLUSIONS The countries and condition areas in which the highest percentage of health apps with user involvement were observed tended to be those with higher digital maturity in health care and more funding availability, respectively. This suggests that there may be a trade-off between developers' willingness or ability to involve users and the need to meet challenges arising from infrastructure limitations and financial constraints. Moreover, the finding of a positive association between user inclusion and compliance with best practices indicates that, where no other guidance is available, users may benefit from prioritizing health apps developed with user input as the latter may be a proxy for broader app quality.
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Affiliation(s)
- Anna-Lena Frey
- Organisation for the Review of Care and Health Apps, Daresbury, United Kingdom
| | - Rebecca Baines
- Organisation for the Review of Care and Health Apps, Daresbury, United Kingdom
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Sophie Hunt
- Organisation for the Review of Care and Health Apps, Daresbury, United Kingdom
| | - Rachael Kent
- Department of Digital Humanities, King's College London, London, United Kingdom
| | - Tim Andrews
- Organisation for the Review of Care and Health Apps, Daresbury, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Simon Leigh
- Organisation for the Review of Care and Health Apps, Daresbury, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Leow MQH, Moosa AS, Salim H, Abdullah A, Lee YK, Ng CJ, Tan NC. Innovation workshop using design thinking framework and involving stakeholders to co-create ideas for management of asthma. NPJ Prim Care Respir Med 2023; 33:36. [PMID: 37925475 PMCID: PMC10625588 DOI: 10.1038/s41533-023-00357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023] Open
Affiliation(s)
| | | | - Hani Salim
- Universiti Putra Malaysia, Serdang, Malaysia
| | | | | | - Chirk Jenn Ng
- SingHealth Polyclinics, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Molloy R, Hansen A, Robinson E, D'Astoli P, Wood T, Buus N. Stakeholder perspectives on co-designing a post-registration mental health nursing curriculum: A case study. J Psychiatr Ment Health Nurs 2023. [PMID: 37822206 DOI: 10.1111/jpm.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/30/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Globally, healthcare regulatory bodies require providers of academic programs to involve service users in the design and delivery of education, yet concrete and tested directions for operationalising this are lacking. Service users' involvement in education is often passive, ad-hoc and tokenistic, with limited input at the program development level. AIM To explore the co-design processes and outcomes of a collaborative revision of an Australian post-registration mental health nursing curriculum. METHOD Using qualitative case study design, the experiences and collaborative practices of five stakeholders (one mental health service user, two carers and two academics) co-designing a post-registration mental health nursing curriculum were explored. RESULTS Commonly identified barriers to meaningful involvement were overcome through planning and collaborative execution of the group's work. Participants reported a strong sense of successful collaboration in reviewing the curriculum, trusting relationships and mutual respect. DISCUSSION While it was possible to support and augment stakeholder knowledge in the context of post-registration education, co-design processes were ultimately bound by the university's relatively inflexible bureaucratic context. IMPLICATIONS FOR PRACTICE To ensure effective stakeholder collaboration beyond classroom teaching, mental health nurse academics must prepare service users for the role, explaining the language and practices of the tertiary health education and nursing context. As part of co-design processes, organisational mandates must be explored and negotiated, and mutual clarity regarding expectations and roles must be established. A Design Thinking approach can support meaningful engagement of stakeholders in curriculum development.
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Affiliation(s)
- Renee Molloy
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Alison Hansen
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eddie Robinson
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Pauline D'Astoli
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Tandem Carers, Abbotsford, Victoria, Australia
| | - Tom Wood
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Niels Buus
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Foley K, Lunnay B, Kevin C, Ward PR. Developing a Women's Thought Collective methodology for health research: The roles and responsibilities of researchers in the reflexive co-production of knowledge. Health Expect 2023; 26:1954-1964. [PMID: 37522791 PMCID: PMC10485336 DOI: 10.1111/hex.13804] [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: 01/12/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Co-produced research holds enormous value within the health sciences. Yet, there can be a heavy focus on what research participants think, do and know; while the researcher's responsibility to explore and re/work their own knowledge or praxis tends to escape from view. This is reflected in the limited use of co-production to explore broad structural distributions of health and risk(s). We argue this missed opportunity has the potential to unfold as what Berlant calls a 'cruel optimism', where something desirable becomes an obstacle to flourishing and/or produces harm. We explore challenges to involving lay populations meaningfully in health research amidst a neoliberal cultural landscape that tends to responsibilise people with problems they cannot solve. METHODS AND FINDINGS Drawing together principles from hermeneutic and feminist philosophy, we develop a novel methodology for co-producing research about determinants of health and health risk (using a case study of alcohol consumption as an example) that centres on what researchers do, know and think during research: Women's Thought Collectives. DISCUSSION Keeping the constructed nature of social systems-because they shape ideas of value, expertise and knowledge-in view during co-produced research illuminates the potential for cruel optimisms within it. Such reflexive awareness carves out starting points for researchers to engage with how social hierarchies might (tacitly) operate during the co-production of knowledge. Our work has broad utility for diverse population groups and provides important considerations around the roles and responsibilities for reflexive co-production of knowledge at all levels of health systems. PATIENT OR PUBLIC CONTRIBUTION The development of these ideas was sparked by working with lay participants during the Women's Thought Collectives for Kristen Foley's doctoral research 2021-2023, but undertaken without their direct involvement-in accordance with the responsibilities of researchers in the reflexive co-production of knowledge. Forthcoming publications will address the outcomes and processes of this work.
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Affiliation(s)
- Kristen Foley
- Research Centre for Public Health, Equity and Human FlourishingTorrens University AustraliaAdelaideAustralia
| | - Belinda Lunnay
- Research Centre for Public Health, Equity and Human FlourishingTorrens University AustraliaAdelaideAustralia
| | - Catherine Kevin
- College of Humanities and Social ScienceFlinders UniversityAdelaideAustralia
| | - Paul R. Ward
- Research Centre for Public Health, Equity and Human FlourishingTorrens University AustraliaAdelaideAustralia
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Bronkhorst H, van Weerden WM, Bunnik EM, Zwart H. Awe and anxiety for cancer cells: connecting scientists and patients in a holistic approach of metastasis research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:85. [PMID: 37752584 PMCID: PMC10523712 DOI: 10.1186/s40900-023-00498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/22/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Metastatic cancer is often experienced by patients as a death sentence. At the same time, translational scientists approach metastasis also as an interesting phenomenon that they try to understand and prevent. These two sides of the same coin do not mask the considerable gap that exists between the laboratory world of scientists and the life world of patients. Funding agencies nowadays increasingly demand researchers to be responsive to the values and priorities of patients and public. One approach to bridge this gap and to increase the impact of science is patient and public involvement (PPI). A concise literature review of PPI research and practice in this paper revealed that although PPI is often deployed in translational health care research, its methodology is not settled, it is not sufficiently emancipatory, and its implementation in basic and translational science is lagging behind. Here, we illustrate the practical implementation of PPI in basic and translational science, namely in the context of HOUDINI, a multidisciplinary network with the ultimate goal to improve the management of metastatic disease. METHODS This paper reports on a societal workshop that was organized to launch the holistic PPI approach of HOUDINI. During this workshop, societal partners, patients, and physicians discussed societal issues regarding cancer metastasis, and contributed to prioritization of research objectives for HOUDINI. In a later stage, the workshop results were discussed with scientists from the network to critically review its research strategy and objectives. RESULTS Workshop participants chose the development of metastasis prediction tools, effective therapies which preserve good quality of life, and non-invasive tissue sampling methods as most important research objectives for HOUDINI. Importantly, during the discussions, mutual understanding about issues like economic feasibility of novel therapies, patient anxiety for metastases, and clear communication between stakeholders was further increased. CONCLUSIONS In conclusion, the PPI workshop delivered valuable early-stage input and connections for HOUDINI, and may serve as example for similar basic and translational research projects.
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Affiliation(s)
- Hildert Bronkhorst
- Erasmus School of Philosophy, Erasmus University Rotterdam (EUR), Rotterdam, The Netherlands
| | - Wytske M. van Weerden
- Department of Experimental Oncology, Erasmus Medical Centre (Erasmus MC), Rotterdam, The Netherlands
| | - Eline M. Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus Medical Centre (Erasmus MC), Rotterdam, The Netherlands
| | - Hub Zwart
- Erasmus School of Philosophy, Erasmus University Rotterdam (EUR), Rotterdam, The Netherlands
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Krysinska K, Ozols I, Ross A, Andriessen K, Banfield M, McGrath M, Edwards B, Hawgood J, Kõlves K, Ross V, Pirkis J. Active involvement of people with lived experience of suicide in suicide research: a Delphi consensus study. BMC Psychiatry 2023; 23:496. [PMID: 37434145 DOI: 10.1186/s12888-023-04973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 06/21/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND The importance and value of involvement of people with lived experience of suicide has been recognized in suicide research and prevention. Nonetheless, clear guidance on research collaboration and co-production is lacking. This study aimed to address this gap by developing a set of guidelines on active involvement of people with lived experience of suicide in suicide studies., i.e., conducting research with or by people with lived experience, rather than to, about or for them. METHODS The Delphi method was used to determine statements on best practice for the active involvement of people with lived experience of suicide in suicide research. Statements were compiled through a systematic search of the scientific and grey literature, and reviewing qualitative data from a recent related study conducted by the authors. Two expert panels: people with lived experience of suicide (n = 44) and suicide researchers (n = 29) rated statements over three rounds of an online survey. Statements endorsed by at least 80% of panellists of each panel were included in the guidelines. RESULTS Panellists endorsed 96 out of 126 statements in 17 sections covering the full research cycle from deciding on the research question and securing funding, to conducting research and disseminating and implementing outcomes. Overall, there was a substantial level of agreement between the two panels regarding support from research institutions, collaboration and co-production, communication and shared decision making, conducting research, self-care, acknowledgment, and dissemination and implementation. However, panels also disagreed on specific statements regarding representativeness and diversity, managing expectations, time and budgeting, training, and self-disclosure. CONCLUSIONS This study identified consensus recommendations on active involvement of people with lived experience of suicide in suicide research, including co-production. Support from research institutions and funders, and training on co-production for researchers and people with lived experience, are needed for successful implementation and uptake of the guidelines.
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Affiliation(s)
- Karolina Krysinska
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | | | - Anna Ross
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Michelle Banfield
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Martina McGrath
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Jacinta Hawgood
- The Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Kairi Kõlves
- The Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Victoria Ross
- The Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Lee-Foon NK, Smith M, Greene SM, Kuluski K, Reid RJ. Positioning patients to partner: exploring ways to better integrate patient involvement in the learning health systems. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:51. [PMID: 37430380 PMCID: PMC10334670 DOI: 10.1186/s40900-023-00459-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023]
Abstract
Globally, health systems are increasingly striving to deliver evidence based care that improves patients', caregivers' and communities' health outcomes. To deliver this care, more systems are engaging these groups to help inform healthcare service design and delivery. Their lived experiences-experiences accessing and/or supporting someone who accesses healthcare services-are now viewed by many systems as expertise and an important part of understanding and improving care quality. Patients', caregivers' and communities' participation in health systems can range from healthcare organizational design to being members of research teams. Unfortunately, this involvement greatly varies and these groups are often sidelined to the start of research projects, with little to no role in later project stages. Additionally, some systems may forgo direct engagement, focusing solely on patient data collection and analysis. Given the benefits of active patient, caregiver and community participation in health systems on patient health outcomes, systems have begun identifying different approaches to studying and applying findings of patient, caregiver and community informed care initiatives in a rapid and consistent fashion. The learning health system (LHS) is one approach that can foster deeper and continuous engagement of these groups in health systems change. This approach embeds research into health systems, continuously learning from data and translating findings into healthcare practices in real time. Here, ongoing patient, caregiver and community involvement is considered vital for a well functioning LHS. Despite their importance, great variability exists as to what their involvement means in practice. This commentary examines the current state of patient, caregiver and community participation in the LHS. In particular, gaps in and need for resources to support their knowledge of the LHS are discussed. We conclude by recommending several factors health systems must consider in order to increase participation in their LHS. Systems must: (1) assess patients', caregivers and community understanding of how their feedback are used in the LHS and how collected data are used to inform patient care; (2) review the level and extent of these groups' participation in health system improvement activities; and (3) examine whether health systems have the workforce, capacity and infrastructure to nurture continuous and impactful engagement.
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Affiliation(s)
- Nakia K. Lee-Foon
- Institute for Better Health, Trillium Health Partners, 100 Queensway West, Clinical and Administrative Building, 6th Floor, Mississauga, ON L5B 1B8 Canada
| | | | | | - Kerry Kuluski
- Institute for Better Health, Trillium Health Partners, 100 Queensway West, Clinical and Administrative Building, 6th Floor, Mississauga, ON L5B 1B8 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Robert J. Reid
- Institute for Better Health, Trillium Health Partners, 100 Queensway West, Clinical and Administrative Building, 6th Floor, Mississauga, ON L5B 1B8 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6 Canada
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Tanay MA, Diez de Los Rios de la Serna C, Boland V, Lopes AMDS, Wingfield K, Chircop D, Dornan M, Suchodolska G, Yıldız Aytaç G, Kurt B, Colomer-Lahiguera S. Patient and public involvement in research: Reflections and experiences of doctoral cancer nurse researchers in Europe. Eur J Oncol Nurs 2023; 64:102351. [PMID: 37290166 DOI: 10.1016/j.ejon.2023.102351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/23/2023] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Early career researchers lack guidance about patient and public involvement (PPI). The overall aim of the study was to explore the knowledge and experiences of using PPI in research among doctoral students who are registered nurses. METHODS This qualitative study included findings generated from reflective essays and focus groups involving ten registered cancer nurses who are undertaking doctoral research. The study has two stages of data collection. Participants initially wrote a reflective essay using a set of guiding questions to structure a response which was subsequently analysed. Two focus groups were then conducted to provide further insight into the themes identified in the reflective essays. Reflective thematic analysis was used to identify, name, and define the final themes. RESULTS There were ten participants from seven countries and were at various stages of their doctoral study. Analysis of data from reflective essays (n = 10) and focus groups (n = 2) identified four themes namely, (a) evolving recognition and appreciation of PPI, (b) embracing PPI and impact on doctoral studies, (c) the influence of the research environment, and (d) the need to empower doctoral students to integrate PPI in their research journey. CONCLUSION Participants reported differing experiences of PPI awareness showing disparity in guidance about PPI for junior researchers across Europe. We recommend provision of early PPI training for doctoral students to support and encourage involvement of patients and the public in their research. Opportunities for sharing PPI experiences to help improve PPI culture in research environments that support doctoral students should be explored.
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Affiliation(s)
- Mary Anne Tanay
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, United Kingdom.
| | | | - Vanessa Boland
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - André Manuel Da Silva Lopes
- Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne, Lausanne University Hospital, Switzerland
| | - Karen Wingfield
- School of Healthcare Sciences, Cardiff University, United Kingdom
| | - Daren Chircop
- School of Health Sciences, University of Southampton, United Kingdom
| | - Mark Dornan
- Institute of Nursing and Health Research, Ulster University, United Kingdom
| | - Grażyna Suchodolska
- Department of Oncology & Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Gülşah Yıldız Aytaç
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Turkey
| | - Berna Kurt
- Faculty of Nursing, Internal Medicine Nursing Department, Hacettepe University, Turkey
| | - Sara Colomer-Lahiguera
- Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne, Lausanne University Hospital, Switzerland
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Hospodková P, Gilíková K, Barták M, Marušáková E, Tichopád A. Opportunities and Threats of the Legally Facilitated Performance-Based Managed Entry Agreements in Slovakia: The Early-Adoption Perspective. Healthcare (Basel) 2023; 11:healthcare11081179. [PMID: 37108013 PMCID: PMC10138524 DOI: 10.3390/healthcare11081179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Slovakia has adopted an amendment to Act No. 363/2011, regulating, among other things, drug reimbursement and is undergoing a significant change in the availability of innovative treatments for patients. High expectations are associated with arrangements related to performance-based managed entry agreements. Opinions and positions towards this change appear to be inconsistent, and for the further application of the law in practice and when setting up the main implementation processes, it is necessary to understand the positions and opinions of the individual actors who are involved in the PB-MEA process. The interviews were conducted in the period from 20 May to 15 August 2022 around the same time as the finalisation of the amendment to Act No. 363/2011 and its adoption. A roughly one-hour open interview was conducted on a sample of 12 stakeholders in the following groups: representatives of the Ministry of Health, health-care providers, pharmaceutical companies and others, including a health insurance company. The main objective was to qualitatively describe the perception of this topic by key stakeholders in Slovakia. The responses were analysed using MAXQDATA 2022 software to obtain codes associated with key expressions. We identified three main strong top categories of expressions that strongly dominated the pro-management interviews with stakeholders: legislation, opportunities and threats. Ambiguity and insufficient coverage of the new law, improved availability of medicinal products and threats associated with data, IT systems and potentially unfavourable new reimbursement schemes were identified as key topics of each of the said top categories, respectively. Among individual sets of respondents, there is frequent consensus on both opportunities and threats in the area of implementing process changes in PB-MEA. For the successful implementation of the law in practice, some basic threats need to be removed, among which in particular is insufficient data infrastructure.
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Affiliation(s)
- Petra Hospodková
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
| | - Klára Gilíková
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
| | - Miroslav Barták
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
| | - Elena Marušáková
- Department of Public Health, Faculty of Health and Social Work, Trnava University, 917 01 Trnava, Slovakia
| | - Aleš Tichopád
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
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Pereira MG, Pedras S, Louro A, Lopes A, Vilaça M. Stress reduction interventions for patients with chronic diabetic foot ulcers: a qualitative study into patients and caregivers' perceptions. J Foot Ankle Res 2023; 16:3. [PMID: 36747299 PMCID: PMC9901134 DOI: 10.1186/s13047-022-00592-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/24/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The present study aimed to assess the perceptions of patients with chronic diabetic foot ulcers (DFUs) and their family caregivers regarding the impact of two stress reduction interventions on DFU and psychological wellbeing. The intervention included progressive muscle relaxation and hypnosis sessions. METHODS This study used a qualitative exploratory design and included individual interviews with eight patients with chronic DFUs and six family caregivers, using a semi-structured interview guide. Transcript analysis employed thematic content analysis. RESULTS Four key themes common to patients and their caregivers were found: 1) perspectives regarding the intervention; 2) intervention effectiveness; 3) perceived importance of psychology in the DFU treatment; and 4) emotional consequences associated with DFUs. Although themes were common to both intervention groups, sub-themes from the last two themes differed for patients that received muscle relaxation versus those who received hypnosis. CONCLUSION Patients and caregivers reported perceived benefits from both interventions, regarding DFU healing and emotional wellbeing. Patients who received hypnosis and their caregivers also reported lasting effects. Participants suggested that psychological interventions such as stress reduction interventions could be included in the DFU standard treatment as an adjuvant to the clinical protocol for DFU treatment, preferably offered early on, when patients begin treatment at the diabetic foot consultation.
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Affiliation(s)
- M. Graça Pereira
- grid.10328.380000 0001 2159 175XPsychology Research Centre (CIPsi), University of Minho, Braga, Portugal ,grid.10328.380000 0001 2159 175XSchool of Psychology, Department of Applied Psychology, University of Minho, Campus de Gualtar, Braga, 4710-057 Portugal
| | - Susana Pedras
- grid.5808.50000 0001 1503 7226Angiology & Vascular Surgery Department, Centro Hospitalar Universitário Porto (CHUP), Porto, Portugal
| | - André Louro
- grid.10328.380000 0001 2159 175XHealth & Family Research Group, Psychology Research Centre (CIPsi), University of Minho, Braga, Portugal
| | - Alberto Lopes
- Portuguese Association of Clinical Hypnosis and Hypnoanalysis (APHCH), Porto, Portugal
| | - Margarida Vilaça
- grid.10328.380000 0001 2159 175XPsychology Research Centre (CIPsi), University of Minho, Braga, Portugal
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