Questioning context: a set of interdisciplinary questions for investigating contextual factors affecting health decision making

A Case Study for Training Interprofessional Teams in Addressing the Social Determinants of Health in Older Adults

This case study addresses the interwoven nature of the social determinants of health, fall prevention, older adults, and home healthcare as a topic for teaching interprofessional education across professional development or academic settings. The case study challenges interprofessional learners to dissect and discuss the profile of the patient and other stakeholders, care team decisions, evidence-based research, and the considerations of significant variables on the implications for clinical reasoning and practice. Interprofessional education that includes case studies leads to the development of better skills related to clinical assessments and problem-solving. Sample facilitation questions and extensive research and resources are provided to assist those preparing to implement and facilitate the case study during an interprofessional education training session. We concluded our article by encouraging practitioners to share teaching strategies through publication so we can strengthen interprofessional education learning, as this contributes to stronger, more effective interprofessional education experiences, a need highlighted in the literature.

The Definitions and Conceptualizations of the Practice Context in the Health Professions: A Scoping Review

INTRODUCTION

Health care professionals work in different contexts, which can influence professional competencies. Despite existing literature on the impact of context on practice, the nature and influence of contextual characteristics, and how context is defined and measured, remain poorly understood. The aim of this study was to map the breadth and depth of the literature on how context is defined and measured and the contextual characteristics that may influence professional competencies.

METHODS

A scoping review using Arksey and O'Malley's framework. We searched MEDLINE (Ovid) and CINAHL (EBSCO). Our inclusion criteria were studies that reported on context or relationships between contextual characteristics and professional competencies or that measured context. We extracted data on context definitions, context measures and their psychometric properties, and contextual characteristics influencing professional competencies. We performed numerical and qualitative analyses.

RESULTS

After duplicate removal, 9106 citations were screened and 283 were retained. We compiled a list of 67 context definitions and 112 available measures, with or without psychometric properties. We identified 60 contextual factors and organized them into five themes: Leadership and Agency, Values, Policies, Supports, and Demands.

DISCUSSION

Context is a complex construct that covers a wide array of dimensions. Measures are available, but none include the five dimensions in one single measure or focus on items targeting the likelihood of context influencing several competencies. Given that the practice context plays a critical role in health care professionals' competencies, stakeholders from all sectors (education, practice, and policy) should work together to address those contextual characteristics that can adversely influence practice.

Development of a decision support tool in pediatric Differences/Disorders of Sex Development

Decisions about how best to clinically care for young children born with Disorders of Sex Development (DSD) can be challenging because some decisions are irreversible, have lasting physical and mental health effects, and are frequently made before the affected person is able to participate in decision-making. This multi-stage study involved (1) the development of a web-based decision support tool (DST) for parents of infants or young children and the clinicians caring for them; (2) the assessment of communications and decision making between DSD specialists and parents both before and after introduction of the DST; and (3) interviews with a broad range of stakeholders regarding optimizing the DST and integrating it into usual care. Experience over the course of the 3 stages of this research suggests the need for further refinement of the DST to increase acceptability to all stakeholder groups, the necessity to address misperceptions by providers that they are already accomplishing all aspects of SDM in regular care without a DST and misunderstandings by parents that decisions are unnecessary because only a single option is apparent, and to better incorporate the tool into regular clinic workflow.

Face-to-face communication between patients and family physicians in Canada: A scoping review

OBJECTIVE

Patient-provider communication is critical in primary care. Canada's unique health system, population distribution, and cultural context suggest there is value in addressing the topic in the Canadian context. We conducted a scoping review to synthesize recent Canadian literature to inform practice in primary care settings and identify research agendas for patient-provider communication in Canada.

METHODS

Using Arksey and O'Malley's framework we searched four literature databases: Medline, Web of Science, CINAHL and EMBASE. We extracted 21,932 articles published between 2010 and 2017. A total of 108 articles met the inclusion criteria. The articles were analyzed qualitatively using thematic analysis to identify major themes.

RESULTS

Four major themes were identified: information sharing, relationships, health system challenges, and development and use of communication tools.

CONCLUSION

Our review identified a need for Canadian research regarding: communication in primary care with Aboriginal, immigrant, and rural populations; the impact of medical tourism on primary care; and how to improve communication to facilitate continuity of care.

PRACTICE IMPLICATIONS

Challenges providers face in primary care in Canada include: communicating with linguistically and culturally diverse populations; addressing issues that emerge with the rise of medical tourism; a need for decision aids to improve communication with patients.

A systematic review of the psychometric properties of instruments for assessing the quality of the physical environment in healthcare

AIM

To identify instruments measuring the quality of the physical healthcare environment, describe their psychometric properties.

BACKGROUND

The physical healthcare environment is regarded as a quality factor for health care. To facilitate evidence-based design there is a need for valid and usable instruments that can evaluate the design of the healthcare environment.

DESIGN

Systematic psychometric review.

DATA SOURCES

A systematic literature search in Medline, CINAHL, Psychinfo, Avery index and reference lists of eligible papers (1990-2016).

REVIEW METHOD

Consensus based standards for selection of health measurement instruments guidelines were used to evaluate psychometric data reported.

RESULTS

Twenty-three instruments were included. Most of the instruments are intended for healthcare environments related to the care of older people. Many of the instruments were old, lacked strong, contemporary theoretical foundations, varied in the extent to which they had been used in empirical studies and in the degree to which their validity and reliability had been evaluated.

CONCLUSIONS

Although we found many instruments for measuring the quality of the physical healthcare environment, none met all of our criteria for robustness. Of the instruments, The Multiphasic environmental assessment procedure, The Professional environment assessment protocol and The therapeutic environment screening have been used and tested most frequently. The Perceived hospital quality indicators are user centred and combine aspects of the physical and social environment. The Sheffield care environment assessment matrix has potential as it is comprehensive developed using a theoretical framework that has the needs of older people at the centre. However, further psychometric and user-evaluation of the instrument is required.

Indirect effects of contextual factors on patients' consultations with healthcare professionals about health information found online

Background

E-health users are encouraged to consult healthcare professionals about the health information they found online because it facilitates e-health users to participate in an informed decision-making process with healthcare professionals on treatment options. However, few studies have examined the path of how e-health users consult healthcare professionals about the health information. Using psychological empowerment, which claims that empowering individuals requires understanding contextual factors that interact with the individuals’ intrapsychic factors, this study tested a hypothesis: the contextual factors play an indirect role between patients’ perceived poor health and their consultations with healthcare professionals about the health information found online, holding predisposing factors constant.

Methods

The data were collected from the Health Information National Trends Survey and used a subsample of e-health users who used healthcare services during the past year. The subsample (N = 2,297) was analyzed using structural equation modeling (SEM).

Results

The SEM analysis supported the hypothesized indirect model. Meanwhile, patients with low socioeconomic statuses tended to score high in the outcome measurement of the contextual factors; however, they tended not to consult professionals.

Conclusions

It is important to acknowledge contextual factors, which encompass communication and relational aspects as well as the process and outcomes of treatments, when empowering e-health users to use e-health tools meaningfully and become empowered in caring for their own health. Particularly, those with low income and education levels were the less powered or powerless patients: they tended not to be competent in having a voice and discussing the health information that they found online with professionals.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1713-y) contains supplementary material, which is available to authorized users.

Shared decision making in designing new healthcare environments-time to begin improving quality

BACKGROUND

Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments.

DISCUSSION

This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed. We suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users' perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.

Cardiac rehabilitation and the therapeutic environment: the importance of physical, social, and symbolic safety for programme participation among women

AIM

To report an exploration of the multidimensionality of safety in cardiac rehabilitation programmes as perceived by women who were enrolled in the Women's Cardiovascular Health Initiative in Toronto, Canada.

BACKGROUND

Cardiovascular disease is the leading cause of death among women. Although cardiac rehabilitation is clinically effective, significantly fewer women than men participate in available programmes. The literature identifies factors affecting women's cardiac rehabilitation participation, and provides possible explanations for this gender disparity. Although safety is mentioned among the barriers to women's cardiac rehabilitation participation, the extent to which safety contributes to programme participation, completion, and maintenance remains under-explored in the cardiac rehabilitation literature.

DESIGN

We conducted an exploratory qualitative study to examine the role safety and place play for women engaged in cardiac prevention and rehabilitation at the Women's Cardiovascular Health Initiative. Methods.  From 2005-2006, 14 participants engaged in semi-structured, qualitative interviews lasting 30-90 minutes. Discussions addressed women's experiences at the Women's Cardiovascular Health Initiative. Interview transcripts were analysed using thematic analysis.

FINDINGS

Three themes were developed: 'Safety', which was sub-categorized according to physical, social, and symbolic interpretations of safety, 'searching for a sense of place', and 'confidence and empowerment'.

CONCLUSION

Feeling physically, socially, and symbolically safe in one's cardiac rehabilitation environment may contribute to programme adherence and exercise maintenance for women. Focusing on comprehensive notions of safety in future cardiac rehabilitation research could offer insight into why many women do not maintain an exercise regimen in currently structured cardiac rehabilitation and community programmes.