The necessary distinction between methodology and philosophical assumptions in healthcare research

Postcolonial theory and Canada's health care professions: bridging the gap

In recent years there have been several calls in professional and academic journals for healthcare personnel in Canada to raise the profile of postcolonial theory as a theoretical and explanatory framework for their practice with Indigenous people. In this paper I explore some of the challenges that are likely to confront those healthcare personnel in engaging with postcolonial theory in a training context. I consider these challenges in relation to three areas of conflict. First I consider conflicts around paradigms of knowledge, wherein postcolonial theory operates from a different base from most professional knowledge in health care. Second I consider conflicts of ideology, wherein postcolonial theory is largely at odds with Canada's political and popular cultures. And finally I consider issues around the question of Canada's legitimacy, which postcolonial theory puts in doubt. I suggest ways in which these conflicts might be addressed and managed in the training context, and also identify potential positive outcomes that would be enabling for healthcare personnel, and might also contribute to an improvement in Canada's relationship with its indigenous peoples.

The conceptual framework and the iterative elements of doctoral nursing research design

BACKGROUND

Conceptual frameworks are central to doctoral nursing theses; they include the pragmatic and philosophical elements of the research design and their interrelationships. While the research process may seem to stem in a straightforward, linear manner from the research question, it is a more complex iterative enterprise.

AIM

To build on Durham et al ( 2015 ) by reviewing the ostensibly static nature of research design and associated philosophical elements of the conceptual framework, reconsidering these in relation to the iterative nature of the research process, and translating these into implications for presenting the final draft of a doctoral nursing thesis.

DISCUSSION

All doctoral nursing theses will have limitations and experience difficulties. They do not follow a rigid, sequential process with a defined start and end, but progress tentatively, with the relationship between the elements of the research design and philosophical assumptions following an iterative process.

CONCLUSION

The research design element of the conceptual framework of doctoral nursing theses should reflect the iterative reality of the process and the associated interrelationships that occur.

IMPLICATIONS FOR PRACTICE

The absence in doctoral nursing theses of a full description of the philosophical and iterative processes of the research architecture and conceptual framework weakens the transparency of the research. Therefore, doctoral nursing students need to move beyond simple description of their inductive or deductive position and research design to help develop trust and confidence in their research.

Co-designing a Self-Management App Prototype to Support People With Spinal Cord Injury in the Prevention of Pressure Injuries: Mixed Methods Study

BACKGROUND

Spinal cord injury is a complex chronic health condition that requires individuals to actively self-manage. Therefore, an evidence-based, self-management app would be of value to support individuals with spinal cord injury in the prevention of pressure injuries.

OBJECTIVE

The main objectives of this study were to (1) establish a co-design approach for developing a high-fidelity prototype app for the self-management of individuals with spinal cord injury, (2) design the prototype that resulted from this process, and (3) conduct the first usability assessment of the prototype app.

METHODS

We adopted a co-design approach to develop an evidence-based app prototype. Starting from a preliminary content model (based on clinical guidelines for the prevention of pressure injuries) and three research-based user personas, we conducted an ideation workshop involving individuals with spinal cord injury and health care professionals. The ideation workshop formed the basis for two consecutive design sprints. The result of this co-design phase was an interactive app prototype. The prototype was evaluated in two rounds of usability testing (N=4 and N=15, respectively) using a combination of qualitative and quantitative methods.

RESULTS

The co-design process resulted in a high-fidelity prototype with two key components: a self-management component and a communication component. The final prototype included a combination of features to support individuals with spinal cord injury in the prevention of pressure injuries, namely a smart camera, pressure injury diary, expert consultation, reminders, and knowledge repository. Findings of the usability testing showed that most participants navigated the app fluently with little back and forth navigation and were able to successfully complete a set of assigned tasks. These positive results are supported by the average system usability score achieved (78.5/100; range 47.5-95.0) and our qualitative analysis of the semistructured interviews. Despite an overall positive evaluation of the app prototype, we identified areas for improvement (eg, inclusion of a search function).

CONCLUSIONS

Individuals with spinal cord injury often need to navigate competing interests and priorities, paired with uncertainty about the accuracy and relevance of clinical recommendations. Understanding what matters to individuals with spinal cord injury can help guide the design of behavioral interventions that are useful and acceptable to these individuals in their daily lives. This study shows that involving individuals with spinal cord injury and health care professionals in co-designing a self-management app can foster knowledge cocreation at the intersection of lived experience, medical expertise, and technical solutions.