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Fix GM, Kaitz J, Herbst AN, Wiener RS, Crocker D, Miano D, Barker AM. Practical Strategies for Co-design: The Case of Engaging Patients in Developing Patient-Facing Shared-Decision Making Materials for Lung Cancer Screening. J Patient Exp 2024; 11:23743735241252247. [PMID: 38855653 PMCID: PMC11162119 DOI: 10.1177/23743735241252247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Co-design provides a meaningful way to engage patients in research. However, there is limited practical guidance. We used our co-design project to identify strategies for other researchers. An ethnographic case study design was used. Data included participant observation of co-design meetings, meeting minutes, analytic fieldnotes, qualitative patient interviews, and research team member self-reflections. Additionally, we got external feedback. We analyzed data iteratively. Our team included 5 patients and 6 researchers. We identified 3 strategies to include patients in co-design: (1) Deliberately build the team, from recruiting patients to specifying roles. (2) Tailor the meeting format to thoughtfully use patients' time and expertise. (3) Disrupt traditional hierarchies, to empower patients to actively participate. Researchers seeking to include patients as team members should consider: team composition and roles, leveraging meeting formats to optimize contributions and purposefully creating a culture of collaboration, so patient expertise informs the end product. Our work provides practical guidance for researchers to incorporate patient expertise in the co-design process and meaningfully involve them in their work.
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Affiliation(s)
- Gemmae M. Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jenesse Kaitz
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
- Sleep Medicine, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Abigail N. Herbst
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, USA
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Dave Crocker
- Veteran Consultant Network, CHOIR Bedford Veteran Consultant Network, Bedford, MA, USA
| | - Dani Miano
- Methodist Healthcare System, San Antonio, TX, USA
| | - Anna M. Barker
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
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Rattray NA, Natividad D, Spontak K, Kukla M, Do ANL, Danson L, Frankel RM, True G. Learning from women veterans who navigate invisible injuries, caregiving, and reintegration challenges. BMC Womens Health 2023; 23:665. [PMID: 38082289 PMCID: PMC10714493 DOI: 10.1186/s12905-023-02815-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND As women comprise a greater proportion of military service members, there is growing recognition of how their experiences in the early phase of military to civilian transitions have an important influence on their health and reintegration outcomes. Qualitative accounts of women veterans can inform programs that support transitioning service members. OBJECTIVES We examined narratives of civilian reintegration among women veterans to understand their experiences of adjusting to community life while coping with mental health challenges. METHODS/PARTICIPANTS We interviewed 16 post-911 era women who were within 5 years of separating from military service and developed a case study based on three participants. MAIN APPROACH Interviews were audio-recorded and transcribed verbatim. Inductive thematic analysis was conducted to establish categories about reintegration. Immersion/crystallization techniques were used to identify exemplary cases that illustrated salient themes. KEY RESULTS Women veterans identified establishing a future career direction, drawing on social support, and navigating health care services as major factors influencing how they adjusted to civilian life. In addition, participants also highlighted the navigation of complex and intersecting identities (i.e., wife, mother, employee, friend, veteran, patient, etc.), further magnified by gender inequalities. These women performed emotional labor, which is often rendered invisible and oriented toward their family and loved ones, while simultaneously monitoring self-care activities. During the early period of reintegration, they described how they felt marginalized in terms of accessing healthcare compared to their military spouses and male veteran peers. CONCLUSIONS Our case study suggests that there are key gaps in addressing healthcare and readjustment needs for women servicemembers, a high priority VA group, as they transition into post-military life. It is important to consider innovative ways to address specific needs of women in veteran-focused policies and programs.
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Affiliation(s)
- Nicholas A Rattray
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA.
- Regenstrief Institute, Inc, Indianapolis, IN, USA.
- Indiana University School of Medicine, Indianapolis, USA.
| | - Diana Natividad
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
| | - Katrina Spontak
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
- University of Indianapolis, Indianapolis, USA
| | - Marina Kukla
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
- Department of Psychology, Indiana-University-Purdue University, Indianapolis, USA
| | - Ai-Nghia L Do
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
| | - Leah Danson
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
- University of Indianapolis, Indianapolis, USA
| | - Richard M Frankel
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, USA
| | - Gala True
- South Central MIRECC, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
- Section of Community and Population Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA
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Cannedy S, Dyer KE, Oishi A, Fenwick KM, Olmos-Ochoa TT, Luger TM, Gideonse TK, Cheney AM, Canelo I, Yano EM, Hamilton AB. Managers' and Leaders' Perceptions of Sexual and Gender-Based Public Harassment in the Veterans Health Administration. Womens Health Issues 2022; 32:395-401. [PMID: 35277335 DOI: 10.1016/j.whi.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Managers and leaders have a critical role to play in sexual and gender-based harassment prevention within organizations. Although the Veterans Health Administration has committed to eliminating harassment through national directives and training programs, it is unclear how aware local-level managers and leaders are about public harassment at their facilities and how they perceive sexual and gender-based harassment. We examined middle managers' and leaders' views about whether harassment is perceived as a problem locally, and what policies and procedures (if any) are in place to address public harassment. METHODS We conducted 69 semistructured telephone interviews with middle managers and facility leaders before implementation of an evidence-based quality improvement project designed to improve delivery of comprehensive women's health care. Transcripts were coded using the constant comparative method and analyzed for overarching themes. RESULTS Perceptions of the prevalence of sexual and gender-based public harassment varied among middle managers and leaders. A little more than one-half of respondents were unaware of facility-level policies and procedures to address public harassment between patients. To decrease patient-to-patient harassment, both groups generally supported the creation of separate clinical spaces for women. However, middle managers also stated that education was needed to change patient harassing behavior, which they tied to male military culture. CONCLUSIONS Aligning divergent perspectives of what constitutes sexual and gender-based harassment and how to address it is a necessary step towards tackling harassment at the local level. Managers and leaders should continue to assess environments of care and share findings widely among employees and leadership to improve awareness and inform a unified response.
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Affiliation(s)
- Shay Cannedy
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California.
| | - Karen E Dyer
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
| | - Anneka Oishi
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
| | - Karissa M Fenwick
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
| | - Tanya T Olmos-Ochoa
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
| | | | - Theodore K Gideonse
- Department of Health, Society, and Behavior, UCI Program in Public Health, Irvine, California
| | - Ann M Cheney
- Department of Social Medicine, Population, and Public Health, UC Riverside School of Medicine, Riverside, California
| | - Ismelda Canelo
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
| | - Elizabeth M Yano
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California; Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, California
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Women Veterans' Perspectives on How to Make Veterans Affairs Healthcare Settings More Welcoming to Women. Womens Health Issues 2020; 30:299-305. [DOI: 10.1016/j.whi.2020.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/04/2020] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
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Dyer KE, Potter SJ, Hamilton AB, Luger TM, Bergman AA, Yano EM, Klap R. Gender Differences in Veterans’ Perceptions of Harassment on Veterans Health Administration Grounds. Womens Health Issues 2019; 29 Suppl 1:S83-S93. [DOI: 10.1016/j.whi.2019.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 04/27/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
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Dodds CD, Kiernan MD. Hidden Veterans: A Review of the Literature on Women Veterans in Contemporary Society. ACTA ACUST UNITED AC 2019. [DOI: 10.1177/1054137319834775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christina D. Dodds
- Department of Social Work, Northumbria University, Newcastle upon Tyne, UK
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Klap R, Darling JE, Hamilton AB, Rose DE, Dyer K, Canelo I, Haskell S, Yano EM. Prevalence of Stranger Harassment of Women Veterans at Veterans Affairs Medical Centers and Impacts on Delayed and Missed Care. Womens Health Issues 2019; 29:107-115. [DOI: 10.1016/j.whi.2018.12.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022]
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Eichler M, Smith-Evans K. Gender in Veteran reintegration and transition: a scoping review. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2018. [DOI: 10.3138/jmvfh.2017-0004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Maya Eichler
- Department of Political and Canadian Studies and Department of Women's Studies, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Kimberley Smith-Evans
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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Cheney AM, Newkirk CN, Nekhavhambe VM, Rotondi MB, Hamilton A. Effects of social and spatial contexts on young latinas' methamphetamine use initiation. J Ethn Subst Abuse 2017; 17:32-49. [PMID: 29035155 DOI: 10.1080/15332640.2017.1362721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this article, we examine methamphetamine (meth) use initiation as influenced by Latinas' social positions within institutions (e.g., family and economy). We conducted ethnographic fieldwork in five women's residential substance use treatment facilities in Los Angeles County with women who considered meth to be their primary drug of choice. Using an urban ethnographic framing, we demonstrate the effects of low-income young Latinas' spatial- and social-context rendered vulnerability to abuse and neglect, and the resulting emotional distress, on meth use initiation. When considering pathways to substance use intervention for vulnerable Latina girls and women, clinicians, researchers, and policy makers need to understand substance use pathways as dynamic processes to cope with psychosocial stress while living in communities with easy access to illicit substances such as methamphetamine.
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Affiliation(s)
- Ann M Cheney
- a University of California , Riverside , California
| | | | | | | | - Alison Hamilton
- c University of California , Los Angeles , California.,d VA Greater Los Angeles Healthcare System , Los Angeles , California
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