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Ali AZ, Wright B, Curran JA, Fawcett-Arsenault J, Newton AS. Co-designing discharge communication interventions for mental health visits to the pediatric emergency department: a mixed-methods study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:64. [PMID: 38907328 PMCID: PMC11191193 DOI: 10.1186/s40900-024-00594-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 05/31/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Discharge communication is essential to convey information regarding the care provided and follow-up plans after a visit to a hospital emergency department (ED), but it can be lacking for visits for pediatric mental health crises. Our objective was to co-design and conduct usability testing of new discharge communication interventions to improve pediatric mental health discharge communication. METHODS The study was conducted in two phases using experience-based co-design (EBCD). In phase 1 (Sep 2021 to Jan 2022), five meetings were conducted with a team of six parents and two clinicians to co-design new ED discharge communication interventions for pediatric mental health care. Thematic analysis was used to identify patterns in team discussions and participant feedback related to discharge communication improvement and the Capability, Opportunity, Motivation, Behavior (COM-B) model was used to identify strategies to support the delivery of the new interventions. After meeting five, team members completed the Public and Patient Engagement Evaluation Tool (PPEET) to evaluate the co-design experience. In phase 2 (Apr to Jul 2022), intervention usability and satisfaction were evaluated by a new group of parents, youth aged 16-24 years, ED physicians, and nurses (n = 2 of each). Thematic analysis was used to identify usability issues and a validated 5-point Likert survey was used to evaluate user satisfaction. Evaluation results were used by the co-design team to finalize the interventions and delivery strategies. RESULTS Two discharge communication interventions were created: a brochure for families and clinicians to use during the ED visit, and a text-messaging system for families after the visit. There was high satisfaction with engagement in phase 1 (overall mean PPEET score, 4.5/5). In phase 2, user satisfaction was high (mean clinician score, 4.4/5; mean caregiver/youth score, 4.1/5) with both interventions. Usability feedback included in the final intervention versions included instructions on intervention use and ensuring the text-messaging system activates within 12-24 h of discharge. CONCLUSIONS The interventions produced by this co-design initiative have the potential to address gaps in current discharge practices. Future testing is required to evaluate the impact on patients, caregivers, and health care system use after the ED visit.
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Affiliation(s)
- Amber Z Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Bruce Wright
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
- Women and Children's Health Research Institute, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
| | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | | | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
- Women and Children's Health Research Institute, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Sumner J, Ng CWT, Teo KEL, Peh ALT, Lim YW. Co-designing care for multimorbidity: a systematic review. BMC Med 2024; 22:58. [PMID: 38321495 PMCID: PMC10848537 DOI: 10.1186/s12916-024-03263-9] [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: 08/31/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The co-design of health care enables patient-centredness by partnering patients, clinicians and other stakeholders together to create services. METHODS We conducted a systematic review of co-designed health interventions for people living with multimorbidity and assessed (a) their effectiveness in improving health outcomes, (b) the co-design approaches used and (c) barriers and facilitators to the co-design process with people living with multimorbidity. We searched MEDLINE, EMBASE, CINAHL, Scopus and PsycINFO between 2000 and March 2022. Included experimental studies were quality assessed using the Cochrane risk of bias tool (ROB-2 and ROBINS-I). RESULTS We screened 14,376 reports, with 13 reports meeting the eligibility criteria. Two reported health and well-being outcomes: one randomised clinical trial (n = 134) and one controlled cohort (n = 1933). Outcome measures included quality of life, self-efficacy, well-being, anxiety, depression, functional status, healthcare utilisation and mortality. Outcomes favouring the co-design interventions compared to control were minimal, with only 4 of 17 outcomes considered beneficial. Co-design approaches included needs assessment/ideation (12 of 13), prototype (11 of 13), pilot testing (5 of 13) (i.e. focus on usability) and health and well-being evaluations (2 of 13). Common challenges to the co-design process include poor stakeholder interest, passive participation, power imbalances and a lack of representativeness in the design group. Enablers include flexibility in approach, smaller group work, advocating for stakeholders' views and commitment to the process or decisions made. CONCLUSIONS In this systematic review of co-design health interventions, we found that few projects assessed health and well-being outcomes, and the observed health and well-being benefits were minimal. The intensity and variability in the co-design approaches were substantial, and challenges were evident. Co-design aided the design of novel services and interventions for those with multimorbidity, improving their relevance, usability and acceptability. However, the clinical benefits of co-designed interventions for those with multimorbidity are unclear.
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Affiliation(s)
- Jennifer Sumner
- Alexandra Hospital, National University Health System, Singapore, Singapore.
| | | | | | - Adena Li Tyin Peh
- Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Yee Wei Lim
- Alexandra Hospital, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Reilly M, Ali A, Doyle PF, Cotter S, Heavey L, Brain PK, Rankin PN, Mccutchan G, Redmond PP. Co-designing a recruitment strategy for lung cancer screening in high-risk individuals: protocol for a mixed-methods study. HRB Open Res 2023; 6:64. [PMID: 38911612 PMCID: PMC11190654 DOI: 10.12688/hrbopenres.13793.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 06/25/2024] Open
Abstract
Background Lung cancer is a significant cause of cancer-related mortality globally, with early detection through screening critical to improving patient outcomes. However, recruiting high-risk individuals, particularly in deprived populations, for screening remains a considerable challenge. This study aims to co-design a targeted recruitment strategy for lung cancer screening, tailored to the specific needs and experiences of high-risk individuals, in collaboration with a Patient and Public Involvement (PPI) panel and expert stakeholders in Ireland. Methods We will employ a mixed-methods design guided by the Medical Research Council (MRC) framework for developing complex interventions. Our approach will integrate systematic review findings on screening participation interventions, evaluation of the recruitment strategy's feasibility in an Irish context, and the application of behavioural science frameworks. The target population includes individuals over 55 years, either current smokers or those who quit within the last year, who reside in highly deprived areas. Conclusion This co-designed recruitment strategy will combine evidence-based research, local context understanding, and stakeholder input to develop a solution that is both scientifically robust and tailored to the target population's needs. This patient-centred approach aims to increase the potential for successful implementation of lung cancer screening programs, thereby improving early detection and patient outcomes.
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Affiliation(s)
- Maeve Reilly
- Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Ahmeda Ali
- Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Prof Frank Doyle
- Department of Health Psychology, School of Population Health, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Seamus Cotter
- Patient and Public Involvement (PPI), Irish Lung Cancer Community, Dublin, Ireland
| | - Laura Heavey
- National Screening Service, Health Service Executive (HSE), Dublin, Ireland
| | - Prof Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Prof Nicole Rankin
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grace Mccutchan
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Prof Patrick Redmond
- Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
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Ali AZ, Wright B, Curran JA, Newton AS. Review: Patient engagement in child, adolescent, and youth mental health care research - a scoping review. Child Adolesc Ment Health 2023; 28:524-535. [PMID: 36494910 DOI: 10.1111/camh.12615] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Youth and children's lived experiences are rarely considered in studies seeking to improve or evaluate their mental health care. We conducted a scoping review to identify approaches to child, adolescent, and youth engagement in mental health studies as well as study-reported barriers, constraints, and facilitators to engagement. METHOD We systematically searched six electronic databases for literature. We included studies of mental health care service design, development, or evaluation that involved engagement of children, adolescents, and/or youth with mental disorders or who intentionally self-harm. Studies could be of any design as long as patient engagement was used at any point during its design and/or conduct. Engagement could include co-designing health services/interventions and/or participating as a co-researcher. We assessed the reporting of patient engagement using the Guidance for Reporting Involvement of Patients and the Public 2 Long-Form (GRIPP2-LF) checklist and used the Experience Based Co-design (EBCD) framework to guide data extraction and analysis. RESULTS Sixteen articles were included in the review. Most studies used engagement to develop or adapt a mental health service (75%) and utilized a participatory or co-design approach (69%). Participants were namely adolescents and youth (aged 10-24 years) with some studies including young adults (up to 29 years old). Most studies followed less than 50% of the EBCD framework, and the commonly reported study barriers were related to aspects addressed in EBCD: time restrictions, recruitment, and generalizability. Frequently reported study facilitators included study methodology, youth engagement, and having a diverse participant sample. CONCLUSIONS Findings from this review suggest that the EBCD framework is not commonly used to guide patient engagement in studies of mental health care services. Future initiatives should consider following the framework to ensure meaningful evaluation and improvements to youth and children's mental health care services.
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Affiliation(s)
- Amber Z Ali
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Bruce Wright
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Pagano N, Glasofer DR, Attia E, Ruggiero J, Eziri K, Goldstein CM, Steinglass JE. Perspectives on relapse prevention following intensive treatment of anorexia nervosa: A focus group study. Int J Eat Disord 2023; 56:1417-1431. [PMID: 37051854 PMCID: PMC10524497 DOI: 10.1002/eat.23952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Including the perspectives of individuals with lived experience of mental health issues is a critical step in research and treatment development. Focus groups with patients with a history of treatment for anorexia nervosa (AN) were conducted in anticipation of a clinical trial of Relapse Prevention and Changing Habits (REACH+). METHODS Seven female adults (23-51 years) who had previously received inpatient treatment for AN, now in remission, participated in one of two semistructured focus groups. Rapid qualitative analysis was used to examine participants' contributions and identify common topics. RESULTS Transcript analysis yielded three topics related to relapse prevention: (1) recovery aids, including a sense of agency in treatment decisions and finding new interests/passions, (2) recovery hindrances, such as lack of access to care, and (3) identification of members of support system. Aspects of REACH+ received positive feedback, such as continuity of care from the inpatient setting and the use of telehealth. Viewpoints differed with respect to the helpfulness of obtaining patient weights in treatment. The REACH+ online platform received positive comments regarding content and usability, as well as suggestions for additional content. DISCUSSION Qualitative feedback from patients with a history of AN highlighted the value of engaging patients in their own treatment decisions, as well as in treatment design and innovation. Within this small group, there were differences of opinion about treatment components, specifically weight assessment, that suggest the need for further data. User-centered design provides opportunities to improve the acceptability and, therefore, dissemination of novel treatments. PUBLIC SIGNIFICANCE Relapse prevention is a critical treatment need for patients with anorexia nervosa, as this illness too often follows a protracted course. There are challenges in both obtaining specialized care and in retaining patients in treatment. Here, patient perspectives on these challenges offer input to allow for optimization of relapse prevention treatment. Shared decision-making may be particularly valuable to support an individual's sense of agency and engagement in care.
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Affiliation(s)
- Nikki Pagano
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Deborah R. Glasofer
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Evelyn Attia
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York,
USA
| | - Julia Ruggiero
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Kelechi Eziri
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Carly M. Goldstein
- Weight Control and Diabetes Research Center, The Miriam
Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode
Island, USA
| | - Joanna E. Steinglass
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
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McKercher JP, Slade SC, Jazayeri JA, Hodge A, Knight M, Green J, Woods J, Thwaites C, Morris ME. Patient experiences of codesigned rehabilitation interventions in hospitals: a rapid review. BMJ Open 2022; 12:e068241. [PMID: 36332956 PMCID: PMC9639115 DOI: 10.1136/bmjopen-2022-068241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Codesign strengthens partnerships between healthcare workers and patients. It also facilitates collaborations supporting the development, design and delivery of healthcare services. Prior rehabilitation reviews have focused mainly on the clinical and organisational outcomes of codesign with less focus on the lived experience of rehabilitation patients. OBJECTIVE To explore patient experiences of codesigned hospital rehabilitation interventions. DESIGN Rapid review and evidence synthesis of the literature. DATA SOURCES CINAHL, MEDLINE, Embase and Cochrane were searched from 1 January 2000 to 25 April 2022. STUDY SELECTION Studies reporting patient experiences of codesigned rehabilitation interventions in hospitals. RESULTS 4156 studies were screened, and 38 full-text studies were assessed for eligibility. Seven studies were included in the final rapid review. Five out of the seven studies involved neurological rehabilitation. All eligible studies used qualitative research methods. The main barriers to codesign were related to staffing and dedicated time allocated to face-to-face patient-therapist interactions. High-quality relationships between patients and their therapists were a facilitator of codesign. Thematic synthesis revealed that codesigned rehabilitation interventions can enable a meaningful experience for patients and facilitate tailoring of treatments to align with individual needs. Personalised rehabilitation increases patient involvement in rehabilitation planning, delivery and decision-making. It also promotes positive feelings of empowerment and hope. CONCLUSION This rapid review supports the implementation of codesigned rehabilitation interventions to improve patient experiences in hospitals. PROSPERO REGISTRATION NUMBER CRD42021264547.
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Affiliation(s)
| | - Susan C Slade
- Department of Physiotherapy, Monash University, Clayton, Victoria, Australia
| | | | - Anita Hodge
- Healthscope Limited, Melbourne, Victoria, Australia
| | - Matthew Knight
- The Victorian Rehabilitation Centre, Glen Waverley, Victoria, Australia
| | - Janet Green
- School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Jeffrey Woods
- ARCH, La Trobe University, Melbourne, Victoria, Australia
| | - Claire Thwaites
- ARCH, La Trobe University, Melbourne, Victoria, Australia
- The Victorian Rehabilitation Centre, Glen Waverley, Victoria, Australia
| | - Meg E Morris
- ARCH, La Trobe University, Melbourne, Victoria, Australia
- The Victorian Rehabilitation Centre, Glen Waverley, Victoria, Australia
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Bird M, McGillion M, Chambers EM, Dix J, Fajardo CJ, Gilmour M, Levesque K, Lim A, Mierdel S, Ouellette C, Polanski AN, Reaume SV, Whitmore C, Carter N. A generative co-design framework for healthcare innovation: development and application of an end-user engagement framework. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:12. [PMID: 33648588 PMCID: PMC7923456 DOI: 10.1186/s40900-021-00252-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/15/2021] [Indexed: 05/31/2023]
Abstract
Background Continual improvements to health systems, products, and services are necessary for improvements in health. However, many of these improvements are not incorporated into everyday practice. When designing new health systems, products, and services, involving members of the healthcare community and the public with personal healthcare experience can help to make sure that improvements will be useful and relevant to others like them. Methods Together with healthcare workers and family members with healthcare experience, we developed and applied a step-by-step guide to involving those with personal experience in the design of health system improvements. Results Our guide has three phases- 'Pre-Design', 'Co-Design', and 'Post-Design'. This paper describes each of these phases and illustrates how we applied them to our own project, which is to use virtual healthcare methods to improve care for children with chronic healthcare conditions and their families. In our own work, we found that healthcare workers and family members with personal healthcare experiences were able to use their knowledge and creativity to help us imagine how to improve care for children with chronic healthcare conditions and their families. We have created action items from these family member- and healthcare worker-identified needs, which we will use to shape our virtual healthcare system. Conclusions This paper may be useful for those seeking to involve members of the healthcare community and the public in the creation of better healthcare systems, products, and services. Background Challenges with the adoption, scale, and spread of health innovations represent significant gaps in the evidence-to-practice cycle. In the health innovation design process, a lack of attention paid to the needs of end-users, and subsequent tailoring of innovations to meet these needs, is a possible reason for this deficit. In the creative field of health innovation, which includes the design of healthcare products, systems (governance and organization mechanisms), and services (delivery mechanisms), a framework for both soliciting the needs of end-users and translating these needs into the design of health innovations is needed. Methods To address this gap, our team developed and applied a seven-step methodological framework, called A Generative Co-Design Framework for Healthcare Innovation. This framework was developed by an interdisciplinary team that included patient partners. Results This manuscript contributes a framework and applied exemplar for those seeking to engage end-users in the creative process of healthcare innovation. Through the stages of 'Pre-Design', 'Co-Design', and 'Post-Design', we were able to harness the creative insights of end-users, drawing on their experiences to shape a future state of care. Using an expository example of our own work, the DigiComp Kids project, we illustrate the application of each stage of the Framework. Conclusions A Generative Co-Design Framework for Healthcare Innovation provides healthcare innovators, applied health science researchers, clinicians, and quality improvement specialists with a guide to eliciting and incorporating the viewpoints of end-users while distilling practical considerations for healthcare innovation and design.
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Affiliation(s)
- M. Bird
- School of Nursing, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8 Canada
| | - M. McGillion
- School of Nursing, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8 Canada
| | | | - J. Dix
- VON Canada, 2315 St. Laurent Blvd, Suite 100, Ottawa, ON K1G 4J8 Canada
| | - C. J. Fajardo
- Ontario Health (OTN), 438 University Avenue, Suite 200, Toronto, ON M5G 2K8 Canada
| | - M. Gilmour
- D’Youville College, Patricia H. Garman School of Nursing, Buffalo, USA
| | - K. Levesque
- School of Nursing, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8 Canada
| | - A. Lim
- Department of Pediatrics, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8 Canada
| | - S. Mierdel
- Ontario Health (OTN), 438 University Avenue, Suite 200, Toronto, ON M5G 2K8 Canada
| | - C. Ouellette
- School of Nursing, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8 Canada
| | - A. N. Polanski
- McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8 Canada
| | - S. V. Reaume
- DigiComp Kids, Hamilton, Canada
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON N2L 3G1 Canada
| | - C. Whitmore
- School of Nursing, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8 Canada
| | - N. Carter
- School of Nursing, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8 Canada
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