1
|
Brink SM, Wortelboer HM, Hoff AFT, Emmelot CH, Visscher TLS, van Wietmarschen HA. Two-Year Results of a Five-Year Personalized Integrative Obesity Coaching Program (IBO) Based upon a Systems Health Perspective and an Evolutionary Longitudinal Study Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:807. [PMID: 38929053 PMCID: PMC11203432 DOI: 10.3390/ijerph21060807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/13/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
This study presents the outcomes of a 5-year personalized integrative coaching program for adults with obesity (body mass index BMI ≥ 30 kg/m2), based upon a systems health perspective, during the first 2 years. This longitudinal study, which had an evolutionary design, included all adults who enrolled in the program. Health-related quality of life (HRQoL) was measured with the Short Form-36 (SF-36), and physical outcomes included weight, waist circumference, aerobic capacity, lipid profile, and HbA1c. Subsequently, participants completed questionnaires (e.g., the Symptom Checlist-90 (SCL-90) and the Checklist Individual Strength (CIS)). Seventy-nine adults with a mean BMI of 39.5 kg/m2 (SD 5.3) were included. Forty-four participants completed 2 years in the program. Compared to baseline, there were significant improvements in the SF-36 subscales 'physical functioning' (MD 9.9 points, 95% CI: 2.1-17.5, p = 0.013) and 'general health perceptions' (MD 9.3 points, 95% CI 2.9-15.7, p = 0.006). Furthermore, significant improvements in physical outcomes and psychosocial questionnaires (e.g., weight loss (MD 3.5 kg, 95% CI: 1.2-5.7, p = 0.003), waist circumference (MD 5.1 cm, 95% CI: 2.4-7.8, p < 0.001), and CIS fatigue (MD 6.8, 95% CI: 3.1-10.5, p = 0.001) were observed. This study highlights the importance of a systems health perspective supporting the development of a personalized integrative coaching program for adults with obesity in a 'real-world' setting.
Collapse
Affiliation(s)
- Sander M. Brink
- Vogellanden, Center of Rehabilitation Medicine & Special Dentistry, 8001 BB Zwolle, The Netherlands; (A.F.t.H.); (C.H.E.)
| | - Heleen M. Wortelboer
- The Netherlands Organization for Applied Scientific Research (TNO), Department Work Health and Technology, 2333 BE Leiden, The Netherlands;
| | - Ard F. ten Hoff
- Vogellanden, Center of Rehabilitation Medicine & Special Dentistry, 8001 BB Zwolle, The Netherlands; (A.F.t.H.); (C.H.E.)
| | - Cornelis H. Emmelot
- Vogellanden, Center of Rehabilitation Medicine & Special Dentistry, 8001 BB Zwolle, The Netherlands; (A.F.t.H.); (C.H.E.)
| | - Tommy L. S. Visscher
- Knowledge Centre Societal Innovations, Windesheim University of Applied Sciences, 1315 RC Almere, The Netherlands;
| | | |
Collapse
|
2
|
Konsman JP. Expanding the notion of mechanism to further understanding of biopsychosocial disorders? Depression and medically-unexplained pain as cases in point. STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2024; 103:123-136. [PMID: 38157672 DOI: 10.1016/j.shpsa.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/24/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
Evidence-Based Medicine has little consideration for mechanisms and philosophers of science and medicine have recently made pleas to increase the place of mechanisms in the medical evidence hierarchy. However, in this debate the notions of mechanisms seem to be limited to 'mechanistic processes' and 'complex-systems mechanisms,' understood as 'componential causal systems'. I believe that this will not do full justice to how mechanisms are used in biological, psychological and social sciences and, consequently, in a more biopsychosocial approach to medicine. Here, I propose, following (Kuorikoski, 2009), to pay more attention to 'abstract forms of interaction' mechanisms. The present work scrutinized review articles on depression and medically unexplained pain, which are considered to be of multifactorial pathogenesis, for their use of mechanisms. In review articles on these disorders there seemed to be a range of uses between more 'abstract forms of interaction' and 'componential causal system' mechanisms. I therefore propose to expand the notions of mechanisms considered in medicine to include that of more 'abstract forms of interaction' to better explain and manage biopsychosocial disorders.
Collapse
Affiliation(s)
- Jan Pieter Konsman
- ImmunoConcEpT, CNRS UMR 5164, University of Bordeaux, 33076, Bordeaux, France.
| |
Collapse
|
3
|
Hognon L, Heraud N, Varray A, Torre K. Complex systems approaches to the adaptability of human functions and behavior in health, aging, and chronic diseases: protocol for a meta-narrative review. Syst Rev 2023; 12:122. [PMID: 37443065 PMCID: PMC10347848 DOI: 10.1186/s13643-023-02268-4] [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: 09/07/2021] [Accepted: 06/07/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Evaluating the adaptability of human functions and behavior has become a subject of growing interest due to aging populations and the increased prevalence of chronic diseases. Various research traditions, based on complex systems theories, have addressed the adaptability of human functions and behavior. However, despite the different research traditions, no review has so far compared them to provide a reliable and useful synthetic tool. Based on an adapted methodology, study objectives are to refine common and divergent traits in the way adaptability of the human functions and behavior has been studied via complex system approaches, with a special focus on aging and chronic diseases. In order to meet this objective, we will use the methodology of the meta-narrative review, and we present in this article the protocol that we will follow. METHODS The meta-narrative review explores the contrasting and complementary ways in which researchers have studied a subject in order to synthesize information and extract theoretical and applied recommendations. In order to carry out this protocol, we detail our methodology of article extraction, coding, and synthesis. We present the six main stages of our review, from the planning stage to the recommendation stage, and the way we will implement the six principles that underpin the construction of a meta-narrative review. DISCUSSION The use of a meta-narrative review methodology will yield greater visibility and comprehension of the adaptability of human functions and behavior studied via complex systems-based approaches. In a broader perspective, this paper is also geared to help future researchers carry out a meta-narrative review by highlighting the main challenges encountered and anticipated as well as elements to be taken into account before starting such a project.
Collapse
Affiliation(s)
- Louis Hognon
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France.
| | - Nelly Heraud
- Direction de la Recherche et de l'Innovation en Santé - Korian, GCS CIPS, Lodève, France
| | - Alain Varray
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| | - Kjerstin Torre
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| |
Collapse
|
4
|
Jarrett C, Baxter YC, Boch J, Carrasco C, Cobos Muñoz D, Mauro Dib K, Pessoa L, Saric J, Silveira M, Steinmann P. Deconstructing design thinking as a tool for the implementation of a population health initiative. Health Res Policy Syst 2022; 20:91. [PMID: 35986365 PMCID: PMC9389775 DOI: 10.1186/s12961-022-00892-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/25/2022] [Indexed: 12/05/2022] Open
Abstract
Background The translation of evidence-based practices and rapid uptake of innovations into global health practice is challenging. Design thinking is a consultative process involving multiple stakeholders and has been identified as a promising solution to create and apply implementation strategies in complex environments like health systems. Methods We conducted a process evaluation of a real-world example, namely an initiative to innovate hypertension screening, diagnosis and care in São Paulo, Brazil. The parameters of the evaluation were informed by a specification rubric and categorization system, recommended for the investigation of implementation strategies, and the double-diamond conceptual framework to describe and examine the strategic architecture and nature of the design thinking approach, with particular emphasis on identifying potential areas of “value-add” particular to the approach. The retrospective evaluation was performed by an independent partner who had not been involved in the setting up and implementation of the design thinking process. Results The evaluation unveiled a dense catalogue of strategically driven, mostly theoretically based, activities involving all identified health system stakeholders including patients. Narrative reconstruction illuminated the systematic and coherent nature of this approach, with different resulting actions progressively accounting for all relevant layers of the health system to engineer a broad selection of specific implementation solutions. The relevance of the identified features and the mechanics used to promote more successful implementation practices was manifested in several distinct ways: design thinking offered a clear direction on which innovations really mattered and when, as well as several new dimensions for consideration in the development of an innovation mindset amongst stakeholders. It thereby promoted relationship quality in terms of familiarity and trust, and commitment to evidence-based enquiry and action. Design thinking was also able to navigate the territory between the need for intervention “fidelity” versus “adaptation” and provide the operational know-how to face familiar implementation hurdles. Lastly, it brought a new kind of skill set to the public health stakeholders that incorporated diplomacy, multidisciplinary approaches and management sciences—skills that are considered necessary but not yet widely taught as part of public health training. Conclusions Design thinking is a sound and viable tool to use as part of an implementation strategy for engaging with health system stakeholders and successfully translating evidence-based practices and new innovations into routine practice, thereby addressing an important knowledge—practice gap and, more broadly, contributing to the strategic repertoire available to implementation science. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00892-5.
Collapse
|
5
|
Niks IMW, Veldhuis GA, van Zwieten MHJ, Sluijs T, Wiezer NM, Wortelboer HM. Individual Workplace Well-Being Captured into a Literature- and Stakeholders-Based Causal Loop Diagram. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158925. [PMID: 35897299 PMCID: PMC9331132 DOI: 10.3390/ijerph19158925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/01/2023]
Abstract
This study demonstrates an innovative approach to capture the complexity of individual workplace well-being, improving our understanding of multicausal relationships and feedback loops involved. The literature shows that a high number of interacting factors are related to individual workplace well-being. However, many studies focus on subsets of factors, and causal loops are seldomly studied. The aim of the current study was, therefore, to capture individual workplace well-being in a comprehensive conceptual causal loop diagram (CLD). We followed an iterative, qualitative, and transdisciplinary systems-thinking approach including literature search, group model building sessions, retrospective in-depth interviews with employees, and group sessions with human resource professionals, managers, job coaches, and management consultants. The results were discussed with HR and well-being officers of twelve organizations for their critical reflection on the recognizability and potential of the developed CLD. The final result, a conceptual individual workplace well-being CLD, provides a comprehensive overview of multiple, measurable key factors relating to individual workplace well-being and of the way these factors may causally interact over time, either improving or deteriorating workplace well-being. In future studies, the CLD can be translated to a quantitative system dynamics model for simulating workplace well-being scenarios. Ultimately, these simulations could be used to design effective workplace well-being interventions.
Collapse
Affiliation(s)
- Irene M. W. Niks
- Department Work, Health & Technology, The Netherlands Organization for Applied Scientific Research (TNO), 2301 DA Leiden, The Netherlands; (M.H.J.v.Z.); (N.M.W.)
- Correspondence:
| | - Guido A. Veldhuis
- Department Defense, Safety & Security, The Netherlands Organization for Applied Scientific Research (TNO), 2509 JG The Hague, The Netherlands;
| | - Marianne H. J. van Zwieten
- Department Work, Health & Technology, The Netherlands Organization for Applied Scientific Research (TNO), 2301 DA Leiden, The Netherlands; (M.H.J.v.Z.); (N.M.W.)
| | - Teun Sluijs
- Department Microbiology and Systems Biology, The Netherlands Organization for Applied Scientific Research (TNO), 3700 AJ Zeist, The Netherlands; (T.S.); (H.M.W.)
| | - Noortje M. Wiezer
- Department Work, Health & Technology, The Netherlands Organization for Applied Scientific Research (TNO), 2301 DA Leiden, The Netherlands; (M.H.J.v.Z.); (N.M.W.)
| | - Heleen M. Wortelboer
- Department Microbiology and Systems Biology, The Netherlands Organization for Applied Scientific Research (TNO), 3700 AJ Zeist, The Netherlands; (T.S.); (H.M.W.)
| |
Collapse
|
6
|
Kusch M, Labouvie H, Schiewer V, Talalaev N, Cwik JC, Bussmann S, Vaganian L, Gerlach AL, Dresen A, Cecon N, Salm S, Krieger T, Pfaff H, Lemmen C, Derendorf L, Stock S, Samel C, Hagemeier A, Hellmich M, Leicher B, Hültenschmidt G, Swoboda J, Haas P, Arning A, Göttel A, Schwickerath K, Graeven U, Houwaart S, Kerek-Bodden H, Krebs S, Muth C, Hecker C, Reiser M, Mauch C, Benner J, Schmidt G, Karlowsky C, Vimalanandan G, Matyschik L, Galonska L, Francke A, Osborne K, Nestle U, Bäumer M, Schmitz K, Wolf J, Hallek M. Integrated, cross-sectoral psycho-oncology (isPO): a new form of care for newly diagnosed cancer patients in Germany. BMC Health Serv Res 2022; 22:543. [PMID: 35459202 PMCID: PMC9034572 DOI: 10.1186/s12913-022-07782-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background The annual incidence of new cancer cases has been increasing worldwide for many years, and is likely to continue to rise. In Germany, the number of new cancer cases is expected to increase by 20% until 2030. Half of all cancer patients experience significant emotional and psychosocial distress along the continuum of their disease, treatment, and aftercare, and also as long-term survivors. Consequently, in many countries, psycho-oncological programs have been developed to address this added burden at both the individual and population level. These programs promote the active engagement of patients in their cancer therapy, aftercare and survivorship planning and aim to improve the patients' quality of life. In Germany, the “new form of care isPO” (“nFC-isPO”; integrated, cross-sectoral psycho-oncology/integrierte, sektorenübergreifende Psycho-Onkologie) is currently being developed, implemented and evaluated. This approach strives to accomplish the goals devised in the National Cancer Plan by providing psycho-oncological care to all cancer patients according to their individual healthcare needs. The term “new form of care" is defined by the Innovation Fund (IF) of Germany's Federal Joint Committee as “a structured and legally binding cooperation between different professional groups and/or institutions in medical and non-medical care”. The nFC-isPO is part of the isPO project funded by the IF. It is implemented in four local cancer centres and is currently undergoing a continuous quality improvement process. As part of the isPO project the nFC-isPO is being evaluated by an independent institution: the Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Germany. The four-year isPO project was selected by the IF to be eligible for funding because it meets the requirements of the federal government's National Cancer Plan (NCP), in particular, the “further development of the oncological care structures and quality assurance" in the psycho-oncological domain. An independent evaluation is required by the IF to verify if the new form of care leads to an improvement in cross-sectoral care and to explore its potential for permanent integration into the German health care system. Methods The nFC-isPO consists of six components: a concept of care (C1), care pathways (C2), a psycho-oncological care network (C3), a care process organization plan (C4), an IT-supported documentation and assistance system (C5) and a quality management system (C6). The two components concept of care (C1) and care pathways (C2) represent the isPO clinical care program, according to which the individual cancer patients are offered psycho-oncological services within a period of 12 months after program enrolment following the diagnosis of cancer. The remaining components (C3-C6) represent the formal-administrative aspects of the nFC-isPO that are intended to meet the legally binding requirements of patient care in the German health care system. With the aim of systematic development of the nFC-isPO while at the same time enabling the external evaluators to examine its quality, effectiveness and efficiency under conditions of routine care, the project partners took into consideration approaches from translational psycho-oncology, practice-based health care research and program theory. In order to develop a structured, population-based isPO care program, reference was made to a specific program theory, to the stepped-care approach, and also to evidence-based guideline recommendations. Results The basic version, nFC-isPO, was created over the first year after the start of the isPO project in October 2017, and has since been subject to a continuous quality improvement process. In 2019, the nFC-isPO was implemented at four local psycho-oncological care networks in the federal state North Rhine-Westphalia, in Germany. The legal basis of the implementation is a contract for "special care" with the German statutory health insurance funds according to state law (§ 140a SCB V; Social Code Book V for the statutory health insurance funds). Besides the accompanying external evaluation by the IMVR, the nFC-isPO is subjected to quarterly internal and cross-network quality assurance and improvement measures (internal evaluation) in order to ensure continuous quality improvement process. These quality management measures are developed and tested in the isPO project and are to be retained in order to ensure the sustainability of the quality of nFC-isPO for later dissemination into the German health care system. Discussion Demands on quality, effectiveness and cost-effectiveness of in the German health care system are increasing, whereas financial resources are declining, especially for psychosocial services. At the same time, knowledge about evidence-based screening, assessment and intervention in cancer patients and about the provision of psychosocial oncological services is growing continuously. Due to the legal framework of the statutory health insurance in Germany, it has taken years to put sound psycho-oncological findings from research into practice. Ensuring the adequate and sustainable financing of a needs-oriented, psycho-oncological care approach for all newly diagnosed cancer patients, as required by the NCP, may still require many additional years. The aim of the isPO project is to develop a new form of psycho-oncological care for the individual and the population suffering from cancer, and to provide those responsible for German health policy with a sound basis for decision-making on the timely dissemination of psycho-oncological services in the German health care system. Trial registration The study was pre-registered at the German Clinical Trials Register (https://www.drks.de/DRKS00015326) under the following trial registration number: DRKS00015326; Date of registration: October 30, 2018.
Collapse
Affiliation(s)
- Michael Kusch
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany.
| | - Hildegard Labouvie
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Vera Schiewer
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Natalie Talalaev
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Jan C Cwik
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Sonja Bussmann
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Lusine Vaganian
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Alexander L Gerlach
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Antje Dresen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Natalia Cecon
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Sandra Salm
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Theresia Krieger
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Holger Pfaff
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Clarissa Lemmen
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Lisa Derendorf
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Christina Samel
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Anna Hagemeier
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Bernd Leicher
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Gregor Hültenschmidt
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Jessica Swoboda
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Peter Haas
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Anna Arning
- Krebsgesellschaft Nordrhein-Westfalen E.V, Düsseldorf, Germany
| | - Andrea Göttel
- Krebsgesellschaft Nordrhein-Westfalen E.V, Düsseldorf, Germany
| | | | - Ullrich Graeven
- Krebsgesellschaft Nordrhein-Westfalen E.V, Düsseldorf, Germany
| | - Stefanie Houwaart
- House of the Cancer Patient Support Associations of Germany, Bonn, Germany
| | - Hedy Kerek-Bodden
- House of the Cancer Patient Support Associations of Germany, Bonn, Germany
| | - Steffen Krebs
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Christiana Muth
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | | | - Marcel Reiser
- PIOH Köln - Praxis Internistischer Onkologie Und Hämatologie, Cologne, Germany
| | - Cornelia Mauch
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | | | | | | | | | | | | | | | | | | | | | | | - Jürgen Wolf
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| |
Collapse
|
7
|
Kuipers T, van de Pas R, Krumeich A. Is the healthcare provision in the Netherlands compliant with universal health coverage based on the right to health? A narrative literature review. Global Health 2022; 18:38. [PMID: 35366916 PMCID: PMC8976435 DOI: 10.1186/s12992-022-00831-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
Universal health coverage, as one of the targets of the Sustainable Development Goals, is the access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost. It is a practical expression of the concern for health equity and the right to health, and a goal for all countries. This review is a novel attempt to explore the healthcare provision in the Netherlands as an expression of universal health coverage based on the right to health. The study adopted a narrative review approach using a framework that consists of 10 universal health coverage indicators which are derived from seven human rights principles. The techno-economic approach to healthcare provision by the Dutch state achieves a healthcare system where most of the population is covered for most of the services for most of the costs. The Dutch state complies with its minimum core obligations, while less attention is paid to participatory decision making and non-discrimination principles. However, with the fiscal sustainability of healthcare provision showing erosion, basing healthcare policy on values based on human rights principles might prevent a regressive policy.
Collapse
|
8
|
Developing a Personalized Integrative Obesity-Coaching Program: A Systems Health Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020882. [PMID: 35055703 PMCID: PMC8775850 DOI: 10.3390/ijerph19020882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 02/05/2023]
Abstract
Current obesity management strategies are failing to achieve sustainable and favorable long-term results. We propose a more personalized, dynamic, and systemic perspective on the interactions of key determinants and coaching advice on obesity. The aim of this study was to use a systems view on overweight, complexity science, and a transdisciplinary process to develop a five-year personalized integrative obesity-coaching and research program. Managers, medical specialists, clinical psychologists, dieticians, physical- and psychomotor therapists, and lifestyle coaches aligned their perspectives and objectives with experts in systems thinking and systems biology. A systems health model of obesity was used to identify the causal relations of variables with the most influence on obesity. The model helped to align and design a personalized integrative obesity-coaching program and to identify the key variables to monitor the progress and to adjust the personalized program, depending on the goals and needs of the participant. It was decided to use subtyping of participants by a systems biologist, based on traditional Chinese medicine symptoms, as a novel method to personalize the intervention. The collaborative transdisciplinary approach based upon a systems view on obesity was successful in developing a personalized and adaptive five-year obesity-coaching and research program.
Collapse
|
9
|
Burdett T, Inman J. Person-centred integrated care with a health promotion/public health approach: a rapid review. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-02-2021-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PurposeDue to the need for the development of person-centred integrated models of care with a population health approach, this paper explored contemporary literature in this arena.Design/methodology/approachA systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Papers included in this review focused upon person-centred integrated care and a health promotion/public health approach (January 2018–October 2020). Papers were excluded due to not being written in English, not fitting the age criteria and not being peer reviewed.FindingsEight studies met the inclusion criteria and three overarching themes were identified with regards to person-centred integrated care as a health promotion/public health approach: Core components; Development, implementation, and evaluation of models of care and relationship to population health and wellbeing outcomes.Research limitations/implicationsThe need for person-centred integrated care as a health promotion/public health approach, to enhance population health and well-being outcomes requires further research to continue to develop, implement and evaluate models of care.Originality/valueThe international scope of this contemporary review brought together the three concepts of person-centred integrated care and public health, exploring the translation of policy into practice (WHO, 2016). The juxtaposition of public health approaches in the background/consequential or foreground/active agent demonstrates how promotion, prevention and population health can be re-valued in integrated people-centred health services (WHO, 2016).
Collapse
|
10
|
Carpenter LJ, Bautovich A, Sharma S, Gatsi M, Wand APF. The development of pathways for responding to patient complexity in a liaison psychiatry setting. Australas Psychiatry 2021; 29:256-260. [PMID: 32640835 DOI: 10.1177/1039856220937648] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aims were to develop and operationalise a method of identifying patients at increased risk of adverse outcomes due to clinical and systems complexity within consultation-liaison psychiatry (CLP), and to formalise escalation processes for enhanced input with targeted clinical and organisational support. METHODS The literature pertaining to methods for identifying and responding to complexity in general hospital settings was reviewed. An Escalation Tool operationalising the identification of complexity and response pathways was devised and tested. Feedback on the face validity and utility guided refinement. RESULTS Two established tools that assess complexity, INTERMED and the Patient-Centred Accreditation method (PCAM) and a novel 'episode complexity' screening method, were identified and informed the development of a tool for identifying and responding to complexity, which was then piloted. The tool was deemed useful, notwithstanding variability in scoring. CONCLUSIONS The Escalation Tool combined elements of existing measures to identify complexity in general hospital inpatients and guide pathways for action. It was well received and considered feasible for implementation, with local adaptation according to available resources.
Collapse
Affiliation(s)
| | - Alison Bautovich
- Department of Consultation-Liaison Psychiatry, Prince of Wales Hospital, Australia.,School of Psychiatry, University of New South Wales, Australia
| | - Swapnil Sharma
- Department of Consultation-Liaison Psychiatry, Prince of Wales Hospital, Australia.,School of Psychiatry, University of New South Wales, Australia
| | - Mike Gatsi
- Eastern Suburbs Mental Health, Australia
| | - Anne Pamela Frances Wand
- Department of Consultation-Liaison Psychiatry, Prince of Wales Hospital, Australia.,School of Psychiatry, University of New South Wales, Australia
| |
Collapse
|
11
|
Laukka E, Pölkki T, Heponiemi T, Kaihlanen AM, Kanste O. Leadership in Digital Health Services: Protocol for a Concept Analysis. JMIR Res Protoc 2021; 10:e25495. [PMID: 33538702 PMCID: PMC7892283 DOI: 10.2196/25495] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Due to the rapid digitalization of health care, leadership is becoming more complex. Leadership in digital health services is a term that has been used in the literature with various meanings. Conceptualization of leadership in digital health services is needed to deliver higher quality digital health services, update existing leadership practices, and advance research. Objective The aim of this study is to outline a concept analysis that aims to clarify and define the concept of leadership in digital health services. Methods The concept analysis will be performed using the Walker and Avant model, which involves eight steps: concept selection, determination of aims, identification of uses, determination of defining attributes, construction of a model case, construction of additional cases, identification of antecedents and consequences, and definition of empirical referents. A scoping literature search will be performed following the search protocol for scoping reviews by the Joanna Briggs Institute to identify all relevant literature on leadership in digital health services. Searches will be conducted in 6 scientific databases (CINAHL, MEDLINE, Scopus, ProQuest, Web of Science, and the Finnish database Medic), and unpublished studies and gray literature will be searched using Google Scholar, EBSCO Open Dissertations, and MedNar. Results An initial limited search of MEDLINE was undertaken on October 19, 2020, resulting in 883 records. The results of the concept analysis will be submitted for publication by July 2021. Conclusions A robust conceptualization of leadership in digital health services is needed to support research, leadership, and education. The concept analysis model of Walker and Avant will be used to meet this need. As leadership in digital health services appears to be an interprofessional and intersectoral collaboration, defining this concept may also facilitate collaboration between professionals and sectors. The concept analysis to be conducted will also expand our understanding of leadership in digital health services. International Registered Report Identifier (IRRID) PRR1-10.2196/25495
Collapse
Affiliation(s)
- Elina Laukka
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Health and Social Service System Research, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tarja Pölkki
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Tarja Heponiemi
- Health and Social Service System Research, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anu-Marja Kaihlanen
- Health and Social Service System Research, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Outi Kanste
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| |
Collapse
|
12
|
A Proof-of-Concept System Dynamics Simulation Model of the Development of Burnout and Recovery Using Retrospective Case Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165964. [PMID: 32824546 PMCID: PMC7459661 DOI: 10.3390/ijerph17165964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 01/05/2023]
Abstract
The phenomenon of burnout is a complex issue, which despite major efforts from researchers and organizations remains hard to prevent. The current literature highlights an increasing global prevalence of employees that are dealing with burnout. What has been largely missing is a more systemic, dynamic, and personal perspective on the interactions of the key determinants of burnout. Burnout can be seen as the outcome of a complex system involving feedback loops between individual mental models, individual behavior, and external social influences. Understanding the feedback loops involved may enable employees and organizations to intervene in burnout trajectories early and effectively. System dynamics (SD) modeling is a methodology that can describe the structure and behavior of a complex system. The current paper describes the development of an SD model of burnout. First, an expert- and literature-informed causal loop diagram (CLD) of burnout is developed. Then, a novel approach is developed to collect personal retrospective scenario data. Finally, the CLD and data are translated into a quantitative SD model. The potential of the SD model is illustrated by simulating the behavior of three realistic personas during the onset of and recovery from burnout. The process of development of an SD model of burnout is presented and the strengths and limitations of the approach are discussed.
Collapse
|
13
|
Protective and Risk Factors for Adolescent Substance Use in Spain: Self-Esteem and Other Indicators of Personal Well-Being and Ill-Being. SUSTAINABILITY 2020. [DOI: 10.3390/su12155962] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although self-esteem has traditionally been considered as an important correlate of psychosocial adjustment, some empirical studies have found a positive relationship between some domains of self-esteem and drug use among adolescents. The present study analyzes self-esteem and other adjustment personal indicators as protective or risk factors for substance use. Participants were 644 Spanish adolescents aged 12–17 years. Substance use (cigarettes, alcohol, marijuana, and other illicit drugs), multidimensional self-esteem (academic, social, emotional, family, and physical), and other indicators of adolescents’ well-being and ill-being (psychological problems, behavior problems, and parenting) were measured. We observed, on the one hand, that substance use had a significant negative relationship with academic, family, and physical self-esteem. On the other hand, we also observed a significant positive relationship between drug use and social self-esteem. However, this significant relationship disappeared after statistically controlling for sex and age, using both partial correlation analyses and covariance analysis. Interestingly, beyond the importance of each factor related to drugs, prevention science should first of all be able to identify whether the main psychological variables (e.g., social or physical self-esteem) are risk or protective factors for drug use.
Collapse
|
14
|
Bontemps-Hommen MCML, Vosman FJH, Baart AJ. The multiple faces of practical wisdom in complex clinical practices: An empirical exploration. J Eval Clin Pract 2020; 26:1034-1041. [PMID: 30793447 DOI: 10.1111/jep.13119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/23/2019] [Accepted: 01/31/2019] [Indexed: 01/10/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES In recent publications, attention has been drawn to the importance of practical wisdom in order to ensure good, individually attuned care in complex clinical practices. However, what remains insufficiently elucidated is how practical wisdom emerges in the workplace. This study aims to describe manifestations of practical wisdom in medical practices within a general hospital. It also seeks to clarify the interruptions that can be considered as triggers for the emergence of practical wisdom. Furthermore, we searched for figurations, which possibly elicit or constrain the emergence of practical wisdom. METHODS We used 10 thick descriptions of very distinct patient cases to carry out an explorative qualitative heuristic in-depth analysis. RESULTS These varied cases enabled us to describe diverse manifestations of practical wisdom; in addition, we were able to discern 10 different "interruptions" that triggered practical wisdom, and finally, we hypothesize that certain infrastructural figurations might facilitate the manifestation of practical wisdom. CONCLUSIONS We found that practical wisdom frequently emerged in unexpected and diverse guises in these clinical practices, although the "interruptions" that we discovered did not automatically trigger practical wisdom. We have investigated the figurations mentioned only to a limited degree. More empirical research is needed to make the philosophical concept of practical wisdom better manageable for clinical practices and to gain better understanding of the figurations that elicit or obstruct its manifestation.
Collapse
Affiliation(s)
| | - Frans J H Vosman
- Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Andries J Baart
- Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
| |
Collapse
|
15
|
Complex systems, part I: why 42 is rarely, if ever, the ultimate answer. Br J Oral Maxillofac Surg 2020; 58:225-230. [PMID: 31987681 DOI: 10.1016/j.bjoms.2019.12.013] [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: 09/13/2019] [Accepted: 12/31/2019] [Indexed: 11/23/2022]
Abstract
We describe the different categories of systems and systems thinking, and illustrate why almost all clinical interactions constitute simultaneously complex and complicated systems, so-called "wicked systems". We also discuss why they are not amenable to quantitative analysis. With the use of comparisons and illustrations we show some of the problems that reductionist metrics create, and support concerns regarding quantitative fallacy. The systematic correlation of data in medicine was one of the earliest achievements of the discipline. Recently, however, the overwhelming bias towards an evidence base, which relies almost entirely on randomised controlled trials, has created a reductionist view that often excludes important aspects of medicine and, in particular, surgery. We must now move away from thinking that is controlled by the "tyranny of metrics" to embrace complex-systems thinking, and work across disciplines. We outline the arguments for this and give clinical examples from oral and maxillofacial surgery.
Collapse
|
16
|
Martin CM. Complex adaptive systems approaches in health care-A slow but real emergence? J Eval Clin Pract 2018; 24:266-268. [PMID: 29589876 DOI: 10.1111/jep.12878] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 11/30/2022]
|
17
|
van Ommen B, Wopereis S, van Empelen P, van Keulen HM, Otten W, Kasteleyn M, Molema JJW, de Hoogh IM, Chavannes NH, Numans ME, Evers AWM, Pijl H. From Diabetes Care to Diabetes Cure-The Integration of Systems Biology, eHealth, and Behavioral Change. Front Endocrinol (Lausanne) 2018; 8:381. [PMID: 29403436 PMCID: PMC5786854 DOI: 10.3389/fendo.2017.00381] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 12/26/2017] [Indexed: 12/23/2022] Open
Abstract
From a biological view, most of the processes involved in insulin resistance, which drives the pathobiology of type 2 diabetes, are reversible. This theoretically makes the disease reversible and curable by changing dietary habits and physical activity, particularly when adopted early in the disease process. Yet, this is not fully implemented and exploited in health care due to numerous obstacles. This article reviews the state of the art in all areas involved in a diabetes cure-focused therapy and discusses the scientific and technological advancements that need to be integrated into a systems approach sustainable lifestyle-based healthcare system and economy. The implementation of lifestyle as cure necessitates personalized and sustained lifestyle adaptations, which can only be established by a systems approach, including all relevant aspects (personalized diagnosis and diet, physical activity and stress management, self-empowerment, motivation, participation and health literacy, all facilitated by blended care and ehealth). Introduction of such a systems approach in type 2 diabetes therapy not only requires a concerted action of many stakeholders but also a change in healthcare economy, with new winners and losers. A "call for action" is put forward to actually initiate this transition. The solution provided for type 2 diabetes is translatable to other lifestyle-related disorders.
Collapse
Affiliation(s)
- Ben van Ommen
- Netherlands Organization for Applied Scientific Research (TNO), Department of Microbiology and Systems Biology, Leiden, Netherlands
| | - Suzan Wopereis
- Netherlands Organization for Applied Scientific Research (TNO), Department of Microbiology and Systems Biology, Leiden, Netherlands
| | - Pepijn van Empelen
- Netherlands Organization for Applied Scientific Research (TNO), Department of Child Health, Leiden, Netherlands
| | - Hilde M. van Keulen
- Netherlands Organization for Applied Scientific Research (TNO), Department of Child Health, Leiden, Netherlands
| | - Wilma Otten
- Netherlands Organization for Applied Scientific Research (TNO), Department of Child Health, Leiden, Netherlands
| | - Marise Kasteleyn
- Leiden University Medical Center (LUMC), Department of Public Health and Primary Care, Leiden, Netherlands
| | - Johanna J. W. Molema
- Netherlands Organization for Applied Scientific Research (TNO), Department of Work Health Technology, Leiden, Netherlands
| | - Iris M. de Hoogh
- Netherlands Organization for Applied Scientific Research (TNO), Department of Microbiology and Systems Biology, Leiden, Netherlands
| | - Niels H. Chavannes
- Leiden University Medical Center (LUMC), Department of Public Health and Primary Care, Leiden, Netherlands
| | - Mattijs E. Numans
- Leiden University Medical Center (LUMC), Department of Public Health and Primary Care, Leiden, Netherlands
| | - Andrea W. M. Evers
- Department of Health, Medical and Neuropsychology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | - Hanno Pijl
- Leiden University Medical Center (LUMC), Department of Internal Medicine, Leiden, Netherlands
| |
Collapse
|
18
|
Combining Theory-Driven Evaluation and Causal Loop Diagramming for Opening the 'Black Box' of an Intervention in the Health Sector: A Case of Performance-Based Financing in Western Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091007. [PMID: 28869518 PMCID: PMC5615544 DOI: 10.3390/ijerph14091007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 08/25/2017] [Accepted: 09/01/2017] [Indexed: 02/08/2023]
Abstract
Increased attention on "complexity" in health systems evaluation has resulted in many different methodological responses. Theory-driven evaluations and systems thinking are two such responses that aim for better understanding of the mechanisms underlying given outcomes. Here, we studied the implementation of a performance-based financing intervention by the Belgian Technical Cooperation in Western Uganda to illustrate a methodological strategy of combining these two approaches. We utilized a systems dynamics tool called causal loop diagramming (CLD) to generate hypotheses feeding into a theory-driven evaluation. Semi-structured interviews were conducted with 30 health workers from two districts (Kasese and Kyenjojo) and with 16 key informants. After CLD, we identified three relevant hypotheses: "success to the successful", "growth and underinvestment", and "supervision conundrum". The first hypothesis leads to increasing improvements in performance, as better performance leads to more incentives, which in turn leads to better performance. The latter two hypotheses point to potential bottlenecks. Thus, the proposed methodological strategy was a useful tool for identifying hypotheses that can inform a theory-driven evaluation. The hypotheses are represented in a comprehensible way while highlighting the underlying assumptions, and are more easily falsifiable than hypotheses identified without using CLD.
Collapse
|
19
|
Shen L, Ye B, Sun H, Lin Y, van Wietmarschen H, Shen B. Systems Health: A Transition from Disease Management Toward Health Promotion. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1028:149-164. [PMID: 29058221 DOI: 10.1007/978-981-10-6041-0_9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
To date, most of the chronic diseases such as cancer, cardiovascular disease, and diabetes, are the leading cause of death. Current strategies toward disease treatment, e.g., risk prediction and target therapy, still have limitations for precision medicine due to the dynamic and complex nature of health. Interactions among genetics, lifestyle, and surrounding environments have nonnegligible effects on disease evolution. Thus a transition in health-care area is urgently needed to address the hysteresis of diagnosis and stabilize the increasing health-care costs. In this chapter, we explored new insights in the field of health promotion and introduced the integration of systems theories with health science and clinical practice. On the basis of systems biology and systems medicine, a novel concept called "systems health" was comprehensively advocated. Two types of bioinformatics models, i.e., causal loop diagram and quantitative model, were selected as examples for further illumination. Translational applications of these models in systems health were sequentially discussed. Moreover, we highlighted the bridging of ancient and modern views toward health and put forward a proposition for citizen science and citizen empowerment in health promotion.
Collapse
Affiliation(s)
- Li Shen
- Center for Systems Biology, Soochow University, No.1 Shizi Street, Suzhou, Jiangsu, 215006, China
| | - Benchen Ye
- Center for Systems Biology, Soochow University, No.1 Shizi Street, Suzhou, Jiangsu, 215006, China
| | - Huimin Sun
- Collaborative Innovation Center of Sustainable Forestry in Southern China of Jiangsu Province, Nanjing Forestry University, Nanjing, 210037, China
| | - Yuxin Lin
- Center for Systems Biology, Soochow University, No.1 Shizi Street, Suzhou, Jiangsu, 215006, China
| | | | - Bairong Shen
- Center for Systems Biology, Soochow University, No.1 Shizi Street, Suzhou, Jiangsu, 215006, China.
| |
Collapse
|