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Coll-Planas L, Fuente-Vidal A, Jerez-Roig J, Karkauskienė E, Romero-Mas M, Intxaurrondo A, Caserotti P, Skjødt M, Dallmeier D, Lefebvre G, Bassinah L, Forgione D, Castro R, Minobes-Molina E, Parés-Martínez C, Blancafort Alias S, Roman-Viñas B, Socorro-Cumplido JL, Nieto-Guisado A, Sansano-Nadal O, Giné-Garriga M. Boosting enjoyment and social inclusion to increase physical activity and reduce sedentary behaviour among older adults: protocol for a feasibility study to test the JOIN4JOY approach in five European countries. BMJ Open 2024; 14:e083291. [PMID: 39067876 DOI: 10.1136/bmjopen-2023-083291] [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] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Programmes for older people aimed at increasing physical activity (PA) and reducing sedentary behaviour (SB) traditionally focus on achieving functional and health improvements. Focusing on enjoyment and social inclusion could strengthen adherence and help reach older people with social disadvantages. The aim of this study is to assess the feasibility and acceptability of the Join4Joy approach in PA programmes and its assessment tools. METHODS AND ANALYSIS A multicentric, pragmatic, pre-post feasibility study using mixed methods will be conducted. The intervention will consist of a PA programme boosting enjoyment and social inclusion, grounded on a co-creation process. Trainers will offer twelve, 1-hour weekly sessions of structured, supervised, group-based PA. Participants will be encouraged to increase activity in daily living. 144 older people will be recruited from the community and nursing homes in Spain, Denmark, Italy, Germany, and France. Additionally, participants and trainers will be invited to join virtual communities of practice to share their experiences across settings and countries. Qualitative procedures will be used to explore the acceptability of the design via interviews and focus groups with participants and trainers. Quantitative methods will be used to assess uptake, adherence, retention, reach, satisfaction, enjoyment (PACES questionnaire), physical function (e.g., Short Physical Performance Battery), quality of life (EQ-5D-5L scale), perceived improvement (Patient Global Impression of Improvement scale-I), activities of daily living (Barthel index) and SB and PA patterns (IPAQ and accelerometry). The degree and type of participation in virtual communities of practice will also be assessed. SPSS software will be used for the analysis of quantitative variables. Qualitative data will be analysed using reflective thematic analysis following Braun and Clarke (2006). ETHICS AND DISSEMINATION A favourable report by the Research Ethics Committee of UVic-UCC (282/2023) was obtained on 26 June 26th, 2023. Participation and withdrawal will be voluntary. Participants' (or their legal guardians', when necessary) written permission will be required. Results of the study will be disseminated through publication of scientific articles, presentations at sport and health-related professional conferences and congresses, as well as through social media and via the Join4Joy website. STUDY REGISTRATION ClinicalTrials.gov, NCT06100835.
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Affiliation(s)
- Laura Coll-Planas
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Andrea Fuente-Vidal
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Javier Jerez-Roig
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
- Department of Health Promotion and Rehabilitation, Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Erika Karkauskienė
- Department of Health Promotion and Rehabilitation, Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Montse Romero-Mas
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Aimar Intxaurrondo
- Fundació Salut i Envelliment (Foundation on Health and Ageing), Autonomous University of Barcelona, Barcelona, Catalunya, Spain
| | | | | | | | - Guillaume Lefebvre
- Sport Initiative et Loisir Bleu Association, Strasbourg, France
- Sport Initiative et Loisir Bleu Association, Barcelona, Spain
| | - Lucie Bassinah
- Sport Initiative et Loisir Bleu Association, Strasbourg, France
| | - Dolores Forgione
- Istituto Europeo Per Lo Sviluppo Socio Economico (ISES), Alexandria, Italy
| | - Ricard Castro
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Eduard Minobes-Molina
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Carles Parés-Martínez
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Sergi Blancafort Alias
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
- Fundació Salut i Envelliment (Foundation on Health and Ageing), Autonomous University of Barcelona, Barcelona, Catalunya, Spain
| | - Blanca Roman-Viñas
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - José Luis Socorro-Cumplido
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Ainhoa Nieto-Guisado
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Oriol Sansano-Nadal
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Maria Giné-Garriga
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna, Universitat Ramon Llull, Barcelona, Spain
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Salzer MS. Building on Recovery: Embracing Community Inclusion in Mental Health Policies and Services. Community Ment Health J 2024:10.1007/s10597-024-01309-z. [PMID: 38967842 DOI: 10.1007/s10597-024-01309-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 06/08/2024] [Indexed: 07/06/2024]
Abstract
Recovery is real and has had a transformative impact on mental health policies and services, including shifting the focus from chronicity and symptom management to the realization that individuals with mental health issues can lead meaningful lives. However, recovery has been defined, described, understood, and measured in a wide variety of ways that may account for misuses and abuses in its application and possible stagnation in its impact. It is argued that the mental health field must now build upon the strong foundations of recovery by integrating a well-established rights-oriented framework. While recovery emphasizes personal growth and hope, a rights-based perspective underscores inherent dignity, autonomy, and opportunities for acceptance and embrace in engaging in valued social roles. The addition of a rights-based framework - community inclusion, to conversations involving recovery, is aligned with the origins of recovery and how it is commonly understood, and also connects the mental health field to the dramatic positive impacts that have emerged from the longstanding centrality of this concept in the broader disability community.
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Longworth GR, de Boer J, Goh K, Agnello DM, McCaffrey L, Zapata Restrepo JR, An Q, Chastin S, Davis A, Altenburg T, Verloigne M, Giné-Garriga M. Navigating process evaluation in co-creation: a Health CASCADE scoping review of used frameworks and assessed components. BMJ Glob Health 2024; 9:e014483. [PMID: 38964878 PMCID: PMC11227756 DOI: 10.1136/bmjgh-2023-014483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/13/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Co-creation is seen as a way to ensure all relevant needs and perspectives are included and to increase its potential for beneficial effects and uptake process evaluation is crucial. However, existing process evaluation frameworks have been built on practices characterised by top-down developed and implemented interventions and may be limited in capturing essential elements of co-creation. This study aims to provide a review of studies planning and/or conducting a process evaluation of public health interventions adopting a co-creation approach and aims to derive assessed process evaluation components, used frameworks and insights into formative and/or participatory evaluation. METHODS We searched for studies on Scopus and the Health CASCADE Co-Creation Database. Co-authors performed a concept-mapping exercise to create a set of overarching dimensions for clustering the identified process evaluation components. RESULTS 54 studies were included. Conceptualisation of process evaluation included in studies concerned intervention implementation, outcome evaluation, mechanisms of impact, context and the co-creation process. 22 studies (40%) referenced ten existing process evaluation or evaluation frameworks and most referenced were the frameworks developed by Moore et al (14%), Saunders et al (5%), Steckler and Linnan (5%) and Nielsen and Randall (5%).38 process evaluation components were identified, with a focus on participation (48%), context (40%), the experience of co-creators (29%), impact (29%), satisfaction (25%) and fidelity (24%).13 studies (24%) conducted formative evaluation, 37 (68%) conducted summative evaluation and 2 studies (3%) conducted participatory evaluation. CONCLUSION The broad spectrum of process evaluation components addressed in co-creation studies, covering both the evaluation of the co-creation process and the intervention implementation, highlights the need for a process evaluation tailored to co-creation studies. This work provides an overview of process evaluation components, clustered in dimensions and reflections which researchers and practitioners can use to plan a process evaluation of a co-creation process and intervention.
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Affiliation(s)
| | - Janneke de Boer
- Department of Movement and Sports Sciences, Ghent University, Gent, Belgium
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Kunshan Goh
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Lauren McCaffrey
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Qingfan An
- Department of Community Medicine and Rehabilitation, Umeå University, Umea, Sweden
| | - Sebastien Chastin
- Department of Movement and Sports Sciences, Ghent University, Gent, Belgium
- Glasgow Caledonian University, Glasgow, UK
| | - Aaron Davis
- UniSA Creative, University of South Australia, Adelaide, South Australia, Australia
| | - Teatske Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Maite Verloigne
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Maria Giné-Garriga
- Faculty of Psychology, Education and Sport Sciences, Universitat Ramon Llull, Barcelona, Spain
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Greene Barker T, O'Higgins A, Fonagy P, Gardner F. A systematic review and meta-analysis of the effectiveness of co-designed, in-person, mental health interventions for reducing anxiety and depression symptoms. J Affect Disord 2024; 350:955-973. [PMID: 38199405 DOI: 10.1016/j.jad.2023.12.080] [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: 07/21/2023] [Revised: 12/02/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Co-design is recommended in mental health fields and has been associated with improved intervention efficacy. Despite its growing popularity, syntheses of evidence on the effectiveness of co-designed interventions are scarce, and little is known about their impact on anxiety and depression. METHODS The purpose of this systematic review and meta-analysis was to consolidate evidence on the effectiveness of in-person, co-designed mental health interventions for reducing anxiety and depression symptoms. An exhaustive search was conducted across six electronic databases (PubMed, PsycINFO, Embase, CINAHL, CENTRAL, and ProQuest) and grey literature. Criteria for inclusion comprised studies utilizing randomized or quasi-randomized methods, implementing non-digital/in-person, co-designed interventions for mental health enhancement, and assessing anxiety and/or depression. Intervention impacts were evaluated using random-effects meta-analyses. RESULTS The review identified 20 studies, with only three using the term 'co-design'. Other terminologies included 'co-developed' (n = 2), 'co-produced' (n = 2), and 'CBPR' (n = 11). Seventeen studies exhibited moderate risk of bias, while three demonstrated high risk. Meta-analyses demonstrated a moderate non-significant effect size of 0.5 (95 % CI: -0.8, 1.08; p = 0.08) on depression outcomes, and a small non-significant effect size of 0.12 (95 % CI: -0.1, 0.33; p = 0.23) on anxiety outcomes. LIMITATIONS The majority of studies lacked sufficient statistical power to detect between-group differences. Following GRADE criteria, confidence in estimates was low. CONCLUSIONS Notwithstanding widespread enthusiasm for co-design, the current evidence base is inadequate to confirm the impact of in-person, co-designed mental health interventions on anxiety and depression. More full-scale evaluation trials of higher quality are urgently needed, along with uniform terminology and measurement.
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Affiliation(s)
- Tamsin Greene Barker
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, UK; Research Department of Clinical, Educational and Health Psychology, University College London, UK.
| | - Aoife O'Higgins
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, UK; Foundations What Works Centre for Children & Families, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Frances Gardner
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, UK
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Anieto EM, Abaraogu U, Dall PM, Anieto IB, Ogbueche CM, Seenan C. Cocreators' experiences and effectiveness of cocreated interventions in improving health behaviours of adults with non-communicable diseases: a systematic review protocol. BMJ Open 2023; 13:e073153. [PMID: 37832978 PMCID: PMC10582870 DOI: 10.1136/bmjopen-2023-073153] [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: 02/24/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Improved health behaviours and help-seeking behaviour reduce morbidity and mortality from non-communicable diseases (NCDs). Compliance with the recommendations of lifestyle changes for the management of NCDs has been challenging, as patients find it difficult to change and sustain lifestyle behaviours for a long period of time. Studies have reported that cocreated interventions are promising in addressing negative health behaviours and improving health outcomes in people with NCDs; however, no conclusive evidence exists. Therefore, this review aims to evaluate cocreators' experiences and the effectiveness of cocreated interventions in improving the health behaviours of individuals with NCDs. METHODS AND ANALYSIS This review will follow the recommendations described in the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement for the synthesis of qualitative data. The following databases: Co-creation Database (https://zenodo.org/record/6773028%23.Y9h2sezP1pg), MEDLINE (via OVID), Cumulative Index to Nursing and Allied Health Literature (via EBSCO Host), EMBASE (via OVID), PsycINFO (via OVID), Scopus, Web of Science, Cochrane Library and grey literature will be searched. The identified studies will be independently screened by two reviewers to determine their eligibility. The review will target to include studies that investigated the experiences of cocreators and/or the effectiveness of cocreated interventions on the health behaviour and/or health outcomes of adults with NCDs. Two independent reviewers will also appraise the quality of the included studies, as well as data extraction. A narrative synthesis will be used to summarise the findings. Thematic synthesis and meta-analysis will be conducted for the qualitative and quantitative data, respectively. The qualitative and quantitative findings will be integrated using the parallel result convergent synthesis. ETHICS AND DISSEMINATION Ethics approval is not applicable because the review will only use data from the published studies. The findings will be disseminated through publication in peer-reviewed journals and conference presentations. PROSPERO REGISTRATION NUMBER CRD42023391746.
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Affiliation(s)
- Ebuka Miracle Anieto
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Department of Medical Rehabilitation, University of Nigeria-Enugu Campus, Enugu, Nigeria
- School of Allied Health Sciences, University of Suffolk, Ipswich, UK
| | - Ukachukwu Abaraogu
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Department of Medical Rehabilitation, University of Nigeria-Enugu Campus, Enugu, Nigeria
- School of Health and Life Sciences, University of the West of Scotland, Lanarkshire, UK
| | - Philippa Margaret Dall
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Ijeoma Blessing Anieto
- Department of Medical Rehabilitation, University of Nigeria-Enugu Campus, Enugu, Nigeria
- Department of Gerontology, Faculty of Social Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Chukwudi Martin Ogbueche
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Department of Medical Rehabilitation, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Chris Seenan
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Bonson A, Murphy D, Aldridge V, Greenberg N, Williamson V. Veterans' experiences of moral injury, treatment and recommendations for future support. BMJ Mil Health 2023:military-2022-002332. [PMID: 37192765 DOI: 10.1136/military-2022-002332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Moral injury (MI) significantly impacts the lives of many UK military veterans however, there is a lack of manualised treatment to address the needs of this population. To develop future treatments that are acceptable and well tolerated, veterans should be consulted on their experiences of existing psychological treatments and suggestions for future treatments. METHODS 10 UK military veterans were interviewed about their experiences of receiving treatment for psychological difficulties after MI, and beliefs about core components of future treatments. Thematic analysis of these interviews were conducted. RESULTS 2 superordinate themes were identified: experiences of previous mental health treatment and perceptions of the proposed treatments. Reflections on cognitive behavioural therapy were mixed, with some describing that it did not ameliorate their guilt or shame. In future treatments, focusing on values, using written letters and including therapy sessions with close companions were considered beneficial. Veterans reported that a strong rapport with therapist was key for MI treatment. CONCLUSION Findings provide a useful account of how current post-trauma treatments may be experienced by patients with MI. Although limited by sample size, the results highlight therapeutic approaches that may be helpful in future and provide important considerations for therapists treating MI.
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Affiliation(s)
| | - D Murphy
- Research Department, Combat Stress, Leatherhead, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - V Aldridge
- Research Department, Combat Stress, Leatherhead, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
| | - V Williamson
- King's Centre for Military Health Research, King's College London, London, UK
- Department of Experimental Psychology, Ann Watts Building, University of Oxford, Oxford, UK
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Silcock J, Marques I, Olaniyan J, Raynor DK, Baxter H, Gray N, Zaidi STR, Peat G, Fylan B, Breen L, Benn J, Alldred DP. Co-designing an intervention to improve the process of deprescribing for older people living with frailty in the United Kingdom. Health Expect 2022; 26:399-408. [PMID: 36420768 PMCID: PMC9854320 DOI: 10.1111/hex.13669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In older people living with frailty, polypharmacy can lead to preventable harm like adverse drug reactions and hospitalization. Deprescribing is a strategy to reduce problematic polypharmacy. All stakeholders should be actively involved in developing a person-centred deprescribing process that involves shared decision-making. OBJECTIVE To co-design an intervention, supported by a logic model, to increase the engagement of older people living with frailty in the process of deprescribing. DESIGN Experience-based co-design is an approach to service improvement, which uses service users and providers to identify problems and design solutions. This was used to create a person-centred intervention with the potential to improve the quality and outcomes of the deprescribing process. A 'trigger film' showing older people talking about their healthcare experiences was created and facilitated discussions about current problems in the deprescribing process. Problems were then prioritized and appropriate solutions were developed. The review located the solutions in the context of current processes and procedures. An ideal care pathway and a complex intervention to deliver better care were developed. SETTING AND PARTICIPANTS Older people living with frailty, their informal carers and professionals living and/or working in West Yorkshire, England, UK. Deprescribing was considered in the context of primary care. RESULTS The current deprescribing process differed from an ideal pathway. A complex intervention containing seven elements was required to move towards the ideal pathway. Three of these elements were prototyped and four still need development. The complex intervention responded to priorities about (a) clarity for older people about what was happening at all stages in the deprescribing process and (b) the quality of one-to-one consultations. CONCLUSIONS Priorities for improving the current deprescribing process were successfully identified. Solutions were developed and structured as a complex intervention. Further work is underway to (a) complete the prototyping of the intervention and (b) conduct feasibility testing. PATIENT OR PUBLIC CONTRIBUTION Older people living with frailty (and their informal carers) have made a central contribution, as collaborators, to ensure that a complex intervention has the greatest possible potential to enhance the experience of deprescribing medicines.
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Affiliation(s)
- Jonathan Silcock
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK,NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK
| | - Iuri Marques
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK
| | - Janice Olaniyan
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK,NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK
| | | | - Helen Baxter
- Alliance Manchester Business School, Faculty of HumanitiesUniversity of ManchesterManchesterUK
| | - Nicky Gray
- Department of Pharmacy, School of Applied SciencesUniversity of HuddersfieldHuddersfieldUK
| | | | - George Peat
- Department of Health SciencesUniversity of YorkYorkUK
| | - Beth Fylan
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK,NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK
| | - Liz Breen
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK,NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK
| | - Jonathan Benn
- NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK,School of PsychologyUniversity of LeedsLeedsUK
| | - David P. Alldred
- NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK,School of HealthcareUniversity of LeedsLeedsUK
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Carrotte E, Hopgood F, Blanchard M, Groot C, Phillips L. A New Podcast to Reduce Stigma Against People Living with Complex Mental Health Issues: A Co-Design Study (Preprint). JMIR Form Res 2022; 7:e44412. [PMID: 37145860 DOI: 10.2196/44412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Mental illness stigma refers to damaging stereotypes and emotional responses around the experience of mental health issues. Media-based interventions have the potential to reduce the public's stigmatizing attitudes by improving mental health literacy, emotional appeal, and the intimacy of address. As audio-based media facilitating storytelling, podcasts show potential for reducing stigma; however, it is unclear what features could make a podcast effective or engaging. OBJECTIVE The Co-Design and Anti-Stigma Podcast Research (CASPR) study aimed to collaborate with key target audience members to inform the development of a new podcast. This podcast primarily aims to reduce listeners' stigmatizing attitudes toward people living with complex mental health issues. METHODS This study was adapted from Experience-Based Co-Design methodology. The first part, information gathering, involved a web-based mixed methods survey with 629 Australian podcast listeners to explore their interest and concerns around podcasts. Then, a series of focus groups were held with a purposive sample of 25 participants to explore the potential benefits and challenges of the podcast format. Focus group participants included people with lived experience of complex mental health issues, media and communications professionals, health care professionals, and people interested in workplace mental health. The second part, co-design, constituted 3 meetings of a co-design committee with 10 participants drawn from the focus groups to design the podcast using brainstorming and decision-making activities. RESULTS Most survey respondents (537/629, 85.3%) indicated a willingness to listen to a podcast about experiences of mental illness stigma; participants indicated preference for semistructured episodes and a mixture of light and serious content. Focus group participants identified potential challenges with appealing to listeners, making the content emotionally resonant and engaging, and translation to listeners' attitude change. The co-design committee collaborated to achieve consensus on the focus of individual episodes: domains where stigma and discrimination are common, such as workplaces and health care settings; the structure of individual episodes: storyboards that centralize guests with lived experience, featuring explicit discussions around stigma and discrimination; and overarching content principles, including a sincere, empathetic, and hopeful tone; using plain language; having clear calls to action; and providing listener resources. CONCLUSIONS The co-design process informed a podcast design that features lived experience narratives with an explicit focus on stigma and discrimination, highlighting the realities of stigma while acknowledging progress in the space and how listeners can contribute toward social change. This study allowed for an in-depth discussion around the strengths and limitations of such a podcast according to different target audience members. The co-design committee designed key elements of a podcast that has the potential to minimize the limitations of the format while embracing the benefits of podcast-based storytelling. Once produced, the podcast will be evaluated for its impact on attitude change.
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Affiliation(s)
- Elise Carrotte
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
- Anne Deveson Research Centre, SANE, Carlton, Australia
| | - Fincina Hopgood
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
- School of Humanities, Arts, and Social Sciences, University of New England, Armidale, Australia
| | - Michelle Blanchard
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Christopher Groot
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Lisa Phillips
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
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Walter JK, Hill D, Drust WA, Lisanti A, DeWitt A, Seelhorst A, Hasiuk ML, Arnold R, Feudtner C. Intervention Codesign in the Pediatric Cardiac Intensive Care Unit to Improve Family Meetings. J Pain Symptom Manage 2022; 64:8-16. [PMID: 35339610 PMCID: PMC9189043 DOI: 10.1016/j.jpainsymman.2022.03.010] [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: 02/26/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
CONTEXT Family meetings are encouraged in the pediatric cardiac intensive care unit (CICU) with the expectation of supporting parental shared decision-making (SDM). However, they often fall short of this goal. Additionally, interprofessional team and family meetings are dominated by input from physicians, under-utilizing the skillset of the full clinical team. OBJECTIVES 1) To determine feasibility of a codesign process to optimize the preparation of the interprofessional team and parents for conducting SDM-oriented family meetings in the CICU, and 2) to describe the resulting elements of the intervention including new support documents for the team and family to prepare for the meeting, team member roles in the meeting, and optimization of communication skills. METHODS Experience-based codesign was used with CICU clinicians and parents of children hospitalized in the CICU to develop an intervention at a single institution. Sessions were audio recorded and transcribed and analyzed using modified grounded theory. Participants were surveyed about their engagement in the codesign process to assess feasibility. RESULTS Fifteen professionals and six parents enrolled in the codesign and endorsed engagement in the process and importance of the intervention elements. Participants identified the benefit of complementary parent and team preparation for family meetings noting five distinct types of meetings that occurred frequently. Documents, processes, and skills training were developed to improve interprofessional teamwork regarding shared decision making and support of parents in family meetings. CONCLUSION A codesign of an intervention with clinicians and parents in the CICU is a feasible and resulted in an intervention with broad support among clinicians in the CICU.
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Affiliation(s)
- Jennifer K Walter
- Pediatric Advanced Care Team (J.K.W., C.F.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Children's Hospital of Philadelphia Research Institute (J.K.W., D.H., W.A.D., A.L., C.F.), Philadelphia, Pennsylvania, USA.
| | - Douglas Hill
- Children's Hospital of Philadelphia Research Institute (J.K.W., D.H., W.A.D., A.L., C.F.), Philadelphia, Pennsylvania, USA
| | - William A Drust
- Children's Hospital of Philadelphia Research Institute (J.K.W., D.H., W.A.D., A.L., C.F.), Philadelphia, Pennsylvania, USA
| | - Amy Lisanti
- Children's Hospital of Philadelphia Research Institute (J.K.W., D.H., W.A.D., A.L., C.F.), Philadelphia, Pennsylvania, USA; Department of Family and Community Health (A.L.), University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Aaron DeWitt
- Division of Cardiac Critical Care Medicine (A.D., A.S.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Amanda Seelhorst
- Division of Cardiac Critical Care Medicine (A.D., A.S.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ma Luisa Hasiuk
- Department of Patient and Family Services (M.L.H.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert Arnold
- Section of Palliative Care (R.A.), University of Pittsburgh School of Medicine, Palliative and Supportive Institute UMPC Health System, Pittsburgh, Pennsylvania, USA
| | - Chris Feudtner
- Pediatric Advanced Care Team (J.K.W., C.F.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Children's Hospital of Philadelphia Research Institute (J.K.W., D.H., W.A.D., A.L., C.F.), Philadelphia, Pennsylvania, USA
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10
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Williamson V, Larkin M, Reardon T, Pearcey S, Button R, Green I, Hill C, Stallard P, Spence SH, Breen M, Mcdonald I, Ukoumunne O, Ford T, Violato M, Sniehotta F, Stainer J, Gray A, Brown P, Sancho M, Morgan F, Jasper B, Creswell C. School-based screening for childhood anxiety problems and intervention delivery: a codesign approach. BMJ Open 2022; 12:e058089. [PMID: 35728898 PMCID: PMC9214411 DOI: 10.1136/bmjopen-2021-058089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES A very small proportion of children with anxiety problems receive evidence-based treatment. Barriers to access include difficulties with problem identification, concerns about stigma and a lack of clarity about how to access specialist services and their limited availability. A school-based programme that integrates screening to identify those children who are most likely to be experiencing anxiety problems with the offer of intervention has the potential to overcome many of these barriers. This article is a process-based account of how we used codesign to develop a primary school-based screening and intervention programme for child anxiety problems. DESIGN Codesign. SETTING UK primary schools. PARTICIPANTS Data were collected from year 4 children (aged 8-9 years), parents, school staff and mental health practitioners. RESULTS We report how the developed programme was experienced and perceived by a range of users, including parents, children, school staff and mental health practitioners, as well as how the programme was adapted following user feedback. CONCLUSIONS We reflect on the mitigation techniques we employed, the lessons learnt from the codesign process and give recommendations that may inform the development and implementation of future school-based screening and intervention programmes.
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Affiliation(s)
- Victoria Williamson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Michael Larkin
- Institute for Neurodevelopment and Health, Department of Psychology, Aston University, Birmingham, UK
| | - Tessa Reardon
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Samantha Pearcey
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
| | - Roberta Button
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Iheoma Green
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Claire Hill
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | | | - Susan H Spence
- Australian Institute of Suicide Research and Prevention and School of Applied Psychology, Griffith University, Mount Gravatt, Queensland, Australia
| | - Maria Breen
- Thames Valley Clinical Trials Unit, University of Reading, Reading, UK
| | | | - Obioha Ukoumunne
- NIHR ARC South West Peninsula, University of Exeter, Heavitree Rd, Exeter, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Falko Sniehotta
- Population Health Science Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Alastair Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paul Brown
- Bransgore C Of E Primary School, Bransgore, UK
| | | | - Fran Morgan
- Square Peg (Team Square Peg CIC), London, UK
| | - Bec Jasper
- Square Peg (Team Square Peg CIC), London, UK
| | - Cathy Creswell
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
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11
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The Feasibility and Acceptability of an Experience-Based Co-Design Approach to Reducing Domestic Abuse. SOCIETIES 2022. [DOI: 10.3390/soc12030093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
One means of reducing violence against people experiencing domestic abuse is to improve the pathway which they use to access help from the police and other services. In this paper we report and reflect on a project which contributes to violence reduction via a participatory approach to service improvement, focusing on this pathway. We describe the four phases of an innovative experience-based co-design (EBCD) project, which involved collaborating with domestic abuse survivors as well as members of the police and domestic abuse organizations. We report on indicators of the acceptability and feasibility of EBCD in this context. We also reflect upon the potential of the EBCD approach for involving communities in collaborating with services to reduce domestic abuse. We discuss the conceptual and methodological implications with regard to adopting participatory and inclusive approaches in contexts where power-sharing may be difficult. We argue that EBCD has considerable potential for use in this setting and we identify several areas where insights from this project could be used to improve the future viability of any such initiatives.
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12
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Wilding C, Morgan D, Greenhill J, Perkins D, O'Connell ME, Bauer M, Farmer J, Morley C, Blackberry I. Web-Based Technologies to Support Carers of People Living With Dementia: Protocol for a Mixed Methods Stepped-Wedge Cluster Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e33023. [PMID: 35588366 PMCID: PMC9164093 DOI: 10.2196/33023] [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] [Received: 08/18/2021] [Revised: 02/15/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Informal carers play a significant role in supporting people living with dementia; however, carers in rural areas are often isolated, with limited access to support services. Although dementia-friendly communities provide valued support for carers, access to them is limited as they are few and geographically dispersed. Objective This study’s aim was to increase support and services for rural informal carers of people living with dementia by using information and communication technologies accessed through an integrated website and mobile app—the Verily Connect app. The objective of this protocol is to detail the research design used in a complex study that was situated in a challenging real-world setting integrating web-based and on-ground technology and communication. Therefore, it is anticipated that this protocol will strengthen the research of others exploring similar complex concepts. Methods A stepped-wedge, open-cohort cluster randomized controlled trial was conducted to implement Verily Connect across 12 rural Australian communities. The Verily Connect intervention delivered web-based, curated information about dementia, a localized directory of dementia services and support, group and individual chat forums, and peer support through videoconference. During the implementation phase of 32 weeks, Verily Connect was progressively implemented in four 8-weekly waves of 3 communities per wave. Usual care, used as a comparator, was available to carers throughout the study period. Participants and researchers were unblinded to the intervention. There were 3 cohorts of participants: carers, volunteers, and staff; participants were recruited from their communities. The primary outcome measure was perceived carer social support measured using the Medical Outcomes Study-Social Support Survey. Volunteers and staff provided feedback on their participation in Verily Connect as qualitative data. Qualitative data were collected from all cohorts of participants through interviews and focus groups. Process evaluation data were collected through interviews and memos written by research staff. Data on the costs of implementing Verily Connect were collected by the research team members and evaluated by a health economist. Results Between August 2018 and September 2019, a total of 113 participants were recruited. There were 37 (32.7%) carers, 39 (34.5%) volunteers, and 37 (32.7%) health service staff. The study was complex because of the involvement of multiple and varied communities of carers, volunteers, health service staff, and research team members originating from 5 universities. Web-based technologies were used as intervention strategies to support carers and facilitate the process of undertaking the study. Conclusions The Verily Connect trial enabled the testing and further development of a web-based approach to increasing support for carers of people living with dementia across a diverse rural landscape in Australia. This protocol provides an example of how to conduct a pragmatic evaluation of a complex and co-designed intervention involving multiple stakeholders. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12618001213235; https://tinyurl.com/4rjvrasf International Registered Report Identifier (IRRID) RR1-10.2196/33023
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Affiliation(s)
- Clare Wilding
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Wodonga, Australia
| | - Debra Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jennene Greenhill
- Faculty of Health, Southern Cross University, Bilinga, Australia.,College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Renmark, Australia
| | - David Perkins
- Centre for Rural and Remote Mental Health, The University of Newcastle, Orange, Australia.,Health Research Institute, University of Canberra, Canberra, Australia
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Michael Bauer
- Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Australia
| | - Jane Farmer
- Social Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
| | | | - Irene Blackberry
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Wodonga, Australia
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13
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Palmer VJ, Chondros P, Furler J, Herrman H, Pierce D, Godbee K, Densley K, Gunn JM. The CORE study-An adapted mental health experience codesign intervention to improve psychosocial recovery for people with severe mental illness: A stepped wedge cluster randomized-controlled trial. Health Expect 2021; 24:1948-1961. [PMID: 34350669 PMCID: PMC8628597 DOI: 10.1111/hex.13334] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Mental health policies outline the need for codesign of services and quality improvement in partnership with service users and staff (and sometimes carers), and yet, evidence of systematic implementation and the impacts on healthcare outcomes is limited. OBJECTIVE The aim of this study was to test whether an adapted mental health experience codesign intervention to improve recovery-orientation of services led to greater psychosocial recovery outcomes for service users. DESIGN A stepped wedge cluster randomized-controlled trial was conducted. SETTING AND PARTICIPANTS Four Mental Health Community Support Services providers, 287 people living with severe mental illnesses, 61 carers and 120 staff were recruited across Victoria, Australia. MAIN OUTCOME MEASURES The 24-item Revised Recovery Assessment Scale (RAS-R) measured individual psychosocial recovery. RESULTS A total of 841 observations were completed with 287 service users. The intention-to-treat analysis found RAS-R scores to be similar between the intervention (mean = 84.7, SD= 15.6) and control (mean = 86.5, SD= 15.3) phases; the adjusted estimated difference in the mean RAS-R score was -1.70 (95% confidence interval: -3.81 to 0.40; p = .11). DISCUSSION This first trial of an adapted mental health experience codesign intervention for psychosocial recovery outcomes found no difference between the intervention and control arms. CONCLUSIONS More attention to the conditions that are required for eight essential mechanisms of change to support codesign processes and implementation is needed. PATIENT AND PUBLIC INVOLVEMENT The State consumer (Victorian Mental Illness Awareness Council) and carer peak bodies (Tandem representing mental health carers) codeveloped the intervention. The adapted intervention was facilitated by coinvestigators with lived-experiences who were coauthors for the trial and process evaluation protocols, the engagement model and explanatory model of change for the trial.
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Affiliation(s)
- Victoria J. Palmer
- The Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical SchoolThe University of MelbourneParkvilleVictoriaAustralia
- The ALIVE National Centre for Mental Health Research TranslationThe University of MelbourneParkvilleVictoriaAustralia
| | - Patty Chondros
- The Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical SchoolThe University of MelbourneParkvilleVictoriaAustralia
- The ALIVE National Centre for Mental Health Research TranslationThe University of MelbourneParkvilleVictoriaAustralia
| | - John Furler
- The Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical SchoolThe University of MelbourneParkvilleVictoriaAustralia
| | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental HealthThe University of MelbourneParkvilleVictoriaAustralia
| | - David Pierce
- Department of Rural HealthThe University of MelbourneBallaratVictoriaAustralia
| | - Kali Godbee
- The Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical SchoolThe University of MelbourneParkvilleVictoriaAustralia
| | - Konstancja Densley
- The Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical SchoolThe University of MelbourneParkvilleVictoriaAustralia
- The ALIVE National Centre for Mental Health Research TranslationThe University of MelbourneParkvilleVictoriaAustralia
| | - Jane M. Gunn
- The Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical SchoolThe University of MelbourneParkvilleVictoriaAustralia
- The ALIVE National Centre for Mental Health Research TranslationThe University of MelbourneParkvilleVictoriaAustralia
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14
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Anemaat L, Palmer VJ, Copland DA, Mainstone K, Druery K, Druery J, Aisthorpe B, Binge G, Mainstone P, Wallace SJ. Using experience-based codesign to coproduce aphasia rehabilitation services: study protocol. BMJ Open 2021; 11:e047398. [PMID: 34794985 PMCID: PMC8603293 DOI: 10.1136/bmjopen-2020-047398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Aphasia is an impairment of language that occurs in 30%-40% of stroke survivors. This often chronic condition results in poor outcomes for the individual with aphasia and their family. Long-term aphasia management is limited, with few people receiving sufficient services by 6-12 months postonset. We present a protocol for the development of coproduced aphasia service elements. We will use experience-based codesign (EBCD), an approach that enables service users and providers to collaboratively develop services and care pathways. Drawing on the experiences of people with aphasia, their families and clinicians we will establish priorities for the development of new services and later work together to codesign them. METHODS AND ANALYSIS This research will be coproduced with people with aphasia (n=30-60), their families (n=30-60) and speech pathologists (n=30-60) in Queensland, Australia, using EBCD. A consumer advisory committee will provide oversight and advice throughout the research. In phase 1, we will use semistructured interviews and the nominal group technique to explore experiences and unmet needs in aphasia rehabilitation. Data will be analysed using thematic analysis and the resulting themes will be prioritised in multistakeholder focus groups. Outcomes of phase 1 will inform future research (phase 2) to codesign services. Financial costs and participant experiences of EBCD will be measured. ETHICS AND DISSEMINATION Human Research Ethics Committee approval for phase 1 has been obtained (HREC/2020/QRBW/61368). Results will be reported in peer-reviewed journal articles, presented at relevant conferences and, following EBCD suggested best practice, fed back to participants and community members at a celebratory event at completion of the project. The inclusion of service users in all stages of research will facilitate an integrated approach to knowledge translation. A summary of research findings will be made available to participating sites.
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Affiliation(s)
- Lisa Anemaat
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Victoria J Palmer
- The ALIVE National Centre for Mental Health Research Translation, The University of Melbourne, Melbourne, Victoria, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Kathryn Mainstone
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Kent Druery
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Julia Druery
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Bruce Aisthorpe
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Geoffrey Binge
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Penelope Mainstone
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
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15
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Lowe D, Ryan R, Schonfeld L, Merner B, Walsh L, Graham-Wisener L, Hill S. Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. Cochrane Database Syst Rev 2021; 9:CD013373. [PMID: 34523117 PMCID: PMC8440158 DOI: 10.1002/14651858.cd013373.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health services have traditionally been developed to focus on specific diseases or medical specialties. Involving consumers as partners in planning, delivering and evaluating health services may lead to services that are person-centred and so better able to meet the needs of and provide care for individuals. Globally, governments recommend consumer involvement in healthcare decision-making at the systems level, as a strategy for promoting person-centred health services. However, the effects of this 'working in partnership' approach to healthcare decision-making are unclear. Working in partnership is defined here as collaborative relationships between at least one consumer and health provider, meeting jointly and regularly in formal group formats, to equally contribute to and collaborate on health service-related decision-making in real time. In this review, the terms 'consumer' and 'health provider' refer to partnership participants, and 'health service user' and 'health service provider' refer to trial participants. This review of effects of partnership interventions was undertaken concurrently with a Cochrane Qualitative Evidence Synthesis (QES) entitled Consumers and health providers working in partnership for the promotion of person-centred health services: a co-produced qualitative evidence synthesis. OBJECTIVES To assess the effects of consumers and health providers working in partnership, as an intervention to promote person-centred health services. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2000 to April 2019; PROQUEST Dissertations and Theses Global from 2016 to April 2019; and grey literature and online trial registries from 2000 until September 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs of 'working in partnership' interventions meeting these three criteria: both consumer and provider participants meet; they meet jointly and regularly in formal group formats; and they make actual decisions that relate to the person-centredness of health service(s). DATA COLLECTION AND ANALYSIS Two review authors independently screened most titles and abstracts. One review author screened a subset of titles and abstracts (i.e. those identified through clinical trials registries searches, those classified by the Cochrane RCT Classifier as unlikely to be an RCT, and those identified through other sources). Two review authors independently screened all full texts of potentially eligible articles for inclusion. In case of disagreement, they consulted a third review author to reach consensus. One review author extracted data and assessed risk of bias for all included studies and a second review author independently cross-checked all data and assessments. Any discrepancies were resolved by discussion, or by consulting a third review author to reach consensus. Meta-analysis was not possible due to the small number of included trials and their heterogeneity; we synthesised results descriptively by comparison and outcome. We reported the following outcomes in GRADE 'Summary of findings' tables: health service alterations; the degree to which changed service reflects health service user priorities; health service users' ratings of health service performance; health service users' health service utilisation patterns; resources associated with the decision-making process; resources associated with implementing decisions; and adverse events. MAIN RESULTS We included five trials (one RCT and four cluster-RCTs), with 16,257 health service users and more than 469 health service providers as trial participants. For two trials, the aims of the partnerships were to directly improve the person-centredness of health services (via health service planning, and discharge co-ordination). In the remaining trials, the aims were indirect (training first-year medical doctors on patient safety) or broader in focus (which could include person-centredness of health services that targeted the public/community, households or health service delivery to improve maternal and neonatal mortality). Three trials were conducted in high income-countries, one was in a middle-income country and one was in a low-income country. Two studies evaluated working in partnership interventions, compared to usual practice without partnership (Comparison 1); and three studies evaluated working in partnership as part of a multi-component intervention, compared to the same intervention without partnership (Comparison 2). No studies evaluated one form of working in partnership compared to another (Comparison 3). The effects of consumers and health providers working in partnership compared to usual practice without partnership are uncertain: only one of the two studies that assessed this comparison measured health service alteration outcomes, and data were not usable, as only intervention group data were reported. Additionally, none of the included studies evaluating this comparison measured the other primary or secondary outcomes we sought for the 'Summary of findings' table. We are also unsure about the effects of consumers and health providers working in partnership as part of a multi-component intervention compared to the same intervention without partnership. Very low-certainty evidence indicated there may be little or no difference on health service alterations or health service user health service performance ratings (two studies); or on health service user health service utilisation patterns and adverse events (one study each). No studies evaluating this comparison reported the degree to which health service alterations reflect health service user priorities, or resource use. Overall, our confidence in the findings about the effects of working in partnership interventions was very low due to indirectness, imprecision and publication bias, and serious concerns about risk of selection bias; performance bias, detection bias and reporting bias in most studies. AUTHORS' CONCLUSIONS The effects of consumers and providers working in partnership as an intervention, or as part of a multi-component intervention, are uncertain, due to a lack of high-quality evidence and/or due to a lack of studies. Further well-designed RCTs with a clear focus on assessing outcomes directly related to partnerships for patient-centred health services are needed in this area, which may also benefit from mixed-methods and qualitative research to build the evidence base.
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Affiliation(s)
- Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Rebecca Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | | | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Timothy A, Coetzee D, Morgan C, Kelaher M, Bailie RS, Danchin M. Using an adaptive, codesign approach to strengthen clinic-level immunisation services in Khayelitsha, Western Cape Province, South Africa. BMJ Glob Health 2021; 6:bmjgh-2020-004004. [PMID: 33762251 PMCID: PMC7993221 DOI: 10.1136/bmjgh-2020-004004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Optimal immunisation programme service delivery and childhood vaccine coverage remains an ongoing challenge in South Africa. Previous health systems approaches have made recommendations on how to address identified barriers but detailed local implementation studies are lacking. This study aimed to improve immunisation service delivery in children under 24 months in Khayelitsha, Western Cape Province using an adaptive, co-design approach to assess and improve childhood immunisation service delivery at the clinic level. METHODS A rapid, adaptive approach to identification of barriers and assessment of current childhood immunisation service delivery was developed with three clinics in Khayelitsha, Western Cape Province. This informed a short co-design process with key stakeholders and service providers to develop local interventions targeted at high priority barriers. Interventions were implemented for 4-6 months and evaluated using theory-based evaluation tools. Clinic service delivery, satisfaction and changes to clinic processes and parent engagement and knowledge were measured. RESULTS Interventions developed included weekly community immunisation education radio sessions, daily clinic health talks, immunisation education and promotion materials and service provider and parent quality checklists. Evaluation post-intervention showed improvement in parents'/guardians' knowledge about immunisation, parent engagement and service provider commitment to improvement in service quality. Radio sessions and immunisation education and communication materials were deemed most useful by parents and providers. CONCLUSION Immunisation service delivery can be strengthened using an adaptive, clinic-led assessment process which can effectively identify barriers, inform co-designed interventions and be evaluated over a short period. This approach provides a framework to guide future local participatory action research to more effectively improve childhood immunisation service delivery and other child health services in under-resourced settings.
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Affiliation(s)
- Andrea Timothy
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia .,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Coetzee
- Faculty of Health Sciences, University of Cape Town, Observatory, Western Cape, South Africa
| | - Christopher Morgan
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,JHPIEGO, Baltimore, Maryland, USA
| | - Margaret Kelaher
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ross Stewart Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Margie Danchin
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
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Mulvale G, Green J, Miatello A, Cassidy AE, Martens T. Finding harmony within dissonance: Engaging patients, family/caregivers and service providers in research to fundamentally restructure relationships through integrative dynamics. Health Expect 2021; 24 Suppl 1:147-160. [PMID: 32529748 PMCID: PMC8137493 DOI: 10.1111/hex.13063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Deeply divided ideological positions challenge collaboration when engaging youth with mental disorders, caregivers and providers in mental health research. The integrative dynamics (ID) approach can restructure relationships and overcome 'us vs them' thinking. OBJECTIVE To assess the extent to which an experience-based co-design (EBCD) approach to patient and family engagement in mental health research aligned with ID processes. METHODS A retrospective case study of EBCD data in which transitional-aged youth (n = 12), caregivers (n = 8) and providers (n = 10) co-designed prototypes to improve transitions from child to adult services. Transcripts from focus groups and a co-design event, co-designed prototypes, the resulting model, evaluation interviews and author reflections were coded deductively based on core ID concepts, while allowing for emergent themes. Analysis was based on pattern matching. Triangulation across data sources, research team, and youth and caregiver reflections enhanced rigour. FINDINGS The EBCD focus group discussions of touchpoints in experiences aligned with ID processes of acknowledging the past, by revealing the perceived identity mythos of each group, and allowing expression of and working through emotional pain. These ID processes were briefly revisited in the co-design event, where the focus was on the remaining ID processes: building cross-cutting connections and reconfiguring relationships. The staged EBCD approach may facilitate ID, by working within one's own perspective prior to all perspectives working together in co-design. CONCLUSION Researchers can augment patient engagement approaches by applying ID principles with staged integration of groups to improve relations in mental health systems, and EBCD shows promise to operationalize this.
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Affiliation(s)
- Gillian Mulvale
- DeGroote School of BusinessMcMaster UniversityHamiltonONCanada
| | - Jenn Green
- DeGroote School of BusinessMcMaster UniversityHamiltonONCanada
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18
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Williamson V, Larkin M, Reardon T, Pearcey S, Hill C, Stallard P, Spence SH, Breen M, Macdonald I, Ukoumunne O, Ford T, Violato M, Sniehotta F, Stainer J, Gray A, Brown P, Sancho M, Creswell C. Codesign and development of a primary school based pathway for child anxiety screening and intervention delivery: a protocol, mixed-methods feasibility study. BMJ Open 2021; 11:e044852. [PMID: 33879487 PMCID: PMC8061838 DOI: 10.1136/bmjopen-2020-044852] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Anxiety difficulties are among the most common mental health problems in childhood. Despite this, few children access evidence-based interventions, and school may be an ideal setting to improve children's access to treatment. This article describes the design, methods and expected data collection of the Identifying Child Anxiety Through Schools - Identification to Intervention (iCATS i2i) study, which aims to develop acceptable school-based procedures to identify and support child anxiety difficulties. METHODS AND ANALYSIS: iCATS i2i will use a mixed-methods approach to codesign and deliver a set of procedures-or 'pathway'-to improve access to evidence-based intervention for child anxiety difficulties through primary schools in England. The study will consist of four stages, initially involving in-depth interviews with parents, children, school staff and stakeholders (stage 1) to inform the development of the pathway. The pathway will then be administered in two primary schools, including screening, feedback to parents and the offer of treatment where indicated (stage 2), with participating children, parents and school staff invited to provide feedback on their experience (stages 3 and 4). Data will be analysed using Template Analysis. ETHICS AND DISSEMINATION The iCATS i2i study was approved by the University of Oxford's Research Ethics Committee (REF R64620/RE001). It is expected that this codesign study will lead on to a future feasibility study and, if indicated, a randomised controlled trial. The findings will be disseminated in several ways, including via lay summary report, publication in academic journals and presentation at conferences. By providing information on child, parent, school staff and other stakeholder's experiences, we anticipate that the findings will inform the development of an acceptable evidence-based pathway for identification and intervention for children with anxiety difficulties in primary schools and may also inform broader approaches to screening for and treating youth mental health problems outside of clinics.
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Affiliation(s)
- Victoria Williamson
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, Oxfordshire, England
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Michael Larkin
- Aston Neuroscience Institute, Department of Psychology, Aston University, Birmingham, Birmingham, UK
| | - Tessa Reardon
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, Oxfordshire, England
| | - Samantha Pearcey
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, Oxfordshire, England
| | - Claire Hill
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, UK
| | - Paul Stallard
- University of Bath, Claverton Down, Bath, Somerset, UK
| | - Susan H Spence
- Griffith University, 16 Russell Street South Bank, Brisbane, Queensland, Australia
| | - Maria Breen
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, UK
| | - Ian Macdonald
- Charlie Waller Memorial Trust, First Floor, Rear Office, Thatcham
| | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - Falko Sniehotta
- Population Health Science Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK
| | | | - Alastair Gray
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - Paul Brown
- Bransgore C Of E Primary School, Ringwood Rd, Bransgore, Christchurch, UK
| | - Michelle Sancho
- West Berkshire Council, Council Offices, Market St, Newbury, UK
| | - Cathy Creswell
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, Oxfordshire, England
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19
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Lewis M, Palmer VJ, Kotevski A, Densley K, O'Donnell ML, Johnson C, Wohlgezogen F, Gray K, Robins-Browne K, Burchill L. Rapid Design and Delivery of an Experience-Based Co-designed Mobile App to Support the Mental Health Needs of Health Care Workers Affected by the COVID-19 Pandemic: Impact Evaluation Protocol. JMIR Res Protoc 2021; 10:e26168. [PMID: 33635823 PMCID: PMC7945974 DOI: 10.2196/26168] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/10/2021] [Accepted: 02/25/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has highlighted the importance of health care workers' mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers. OBJECTIVE RMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app. METHODS The impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days. RESULTS The anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021. CONCLUSIONS The impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/26168.
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Affiliation(s)
- Matthew Lewis
- Integrated Mental Health Research Program, Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Victoria J Palmer
- Integrated Mental Health Research Program, Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Australia
| | - Aneta Kotevski
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Konstancja Densley
- Integrated Mental Health Research Program, Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Meaghan L O'Donnell
- Phoenix Australia, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Caroline Johnson
- Integrated Mental Health Research Program, Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Franz Wohlgezogen
- Centre for Workplace Leadership, Faculty of Business and Economics, The University of Melbourne, Melbourne, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Australia
| | - Kate Robins-Browne
- Integrated Mental Health Research Program, Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Luke Burchill
- Department of Medicine, The University of Melbourne, Parkville, Australia.,Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia
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20
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Slikboer R, Rehm IC, Lam S, Maloney A, Nedeljkovic M. A brief, residential peer‐support retreat for trichotillomania: A mixed methods evaluation. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Reneta Slikboer
- Department of Psychology and Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia,
| | - Imogen C. Rehm
- College of Science Engineering and Health, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia,
| | - Sandy Lam
- Department of Psychology and Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia,
| | - Alycia Maloney
- Department of Psychology and Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia,
| | - Maja Nedeljkovic
- Department of Psychology and Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia,
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21
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Lewis M, Chondros P, Mihalopoulos C, Lee YY, Gunn JM, Harvey C, Furler J, Osborn D, Castle D, Davidson S, Jayaram M, Kenny A, Nelson MR, Morgan VA, Harrap S, McKenzie K, Potiriadis M, Densley K, Palmer VJ. The assertive cardiac care trial: A randomised controlled trial of a coproduced assertive cardiac care intervention to reduce absolute cardiovascular disease risk in people with severe mental illness in the primary care setting. Contemp Clin Trials 2020; 97:106143. [PMID: 32931919 DOI: 10.1016/j.cct.2020.106143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) accounts for 40% of the excess mortality identified in people with severe mental illness (SMI). Modifiable CVD risk factors are higher and can be exacerbated by the cardiometabolic impact of psychotropic medications. People with SMI frequently attend primary care presenting a valuable opportunity for early identification, prevention and management of cardiovascular health. The ACCT Healthy Hearts Study will test a coproduced, nurse-led intervention delivered with general practitioners to reduce absolute CVD risk (ACVDR) at 12 months compared with an active control group. METHODS/DESIGN ACCT is a two group (intervention/active control) individually randomised (1:1) controlled trial (RCT). Assessments will be completed baseline (pre-randomisation), 6 months, and 12 months. The primary outcome is 5-year ACVDR measured at 12 months. Secondary outcomes include 6-month ACVDR; and blood pressure, lipids, HbA1c, BMI, quality of life, physical activity, motivation to change health behaviour, medication adherence, alcohol use and hospitalisation at 6 and 12 months. Linear mixed-effects regression will estimate mean difference between groups for primary and secondary continuous outcomes. Economic cost-consequences analysis will be conducted using quality of life and health resource use information and routinely collected government health service use and medication data. A parallel process evaluation will investigate implementation of the intervention, uptake and outcomes. DISCUSSION ACCT will deliver a coproduced and person-centred, guideline level cardiovascular primary care intervention to a high need population with SMI. If successful, the intervention could lead to the reduction of the mortality gap and increase opportunities for meaningful social and economic participation. Trial registration ANZCTR Trial number: ACTRN12619001112156.
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Affiliation(s)
- Matthew Lewis
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Patty Chondros
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Cathrine Mihalopoulos
- Deakin University, Geelong, Deakin Health Economics Unit, Faculty of Health, Australia
| | - Yong Yi Lee
- Deakin University, Geelong, Deakin Health Economics Unit, Faculty of Health, Australia; School of Public Health, The University of Queensland, Australia; Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Jane M Gunn
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Carol Harvey
- The Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia; NorthWestern Mental Health, Melbourne, Australia
| | - John Furler
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - David Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, Australia; Camden and Islington NHS Foundation Trust, NW1OPE, United Kingdom
| | - David Castle
- The Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Sandra Davidson
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Mahesh Jayaram
- The Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia; NorthWestern Mental Health, Melbourne, Australia
| | - Amanda Kenny
- College of Science, Health and Engineering, La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Australia; Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, University of Western Australia, Australia
| | - Stephen Harrap
- Department of Physiology, University of Melbourne, Australia
| | - Kylie McKenzie
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Maria Potiriadis
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Konstancja Densley
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Victoria J Palmer
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia.
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22
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Locock L, Graham C, King J, Parkin S, Chisholm A, Montgomery C, Gibbons E, Ainley E, Bostock J, Gager M, Churchill N, Dopson S, Greenhalgh T, Martin A, Powell J, Sizmur S, Ziebland S. Understanding how front-line staff use patient experience data for service improvement: an exploratory case study evaluation. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and aim
The NHS collects a large number of data on patient experience, but there are concerns that it does not use this information to improve care. This study explored whether or not and how front-line staff use patient experience data for service improvement.
Methods
Phase 1 – secondary analysis of existing national survey data, and a new survey of NHS trust patient experience leads. Phase 2 – case studies in six medical wards using ethnographic observations and interviews. A baseline and a follow-up patient experience survey were conducted on each ward, supplemented by in-depth interviews. Following an initial learning community to discuss approaches to learning from and improving patient experience, teams developed and implemented their own interventions. Emerging findings from the ethnographic research were shared formatively. Phase 3 – dissemination, including an online guide for NHS staff.
Key findings
Phase 1 – an analysis of staff and inpatient survey results for all 153 acute trusts in England was undertaken, and 57 completed surveys were obtained from patient experience leads. The most commonly cited barrier to using patient experience data was a lack of staff time to examine the data (75%), followed by cost (35%), lack of staff interest/support (21%) and too many data (21%). Trusts were grouped in a matrix of high, medium and low performance across several indices to inform case study selection. Phase 2 – in every site, staff undertook quality improvement projects using a range of data sources. The number and scale of these varied, as did the extent to which they drew directly on patient experience data, and the extent of involvement of patients. Before-and-after surveys of patient experience showed little statistically significant change. Making sense of patient experience ‘data’ Staff were engaged in a process of sense-making from a range of formal and informal sources of intelligence. Survey data remain the most commonly recognised and used form of data. ‘Soft’ intelligence, such as patient stories, informal comments and daily ward experiences of staff, patients and family, also fed into staff’s improvement plans, but they and the wider organisation may not recognise these as ‘data’. Staff may lack confidence in using them for improvement. Staff could not always point to a specific source of patient experience ‘data’ that led to a particular project, and sometimes reported acting on what they felt they already knew needed changing. Staff experience as a route to improving patient experience Some sites focused on staff motivation and experience on the assumption that this would improve patient experience through indirect cultural and attitudinal change, and by making staff feel empowered and supported. Staff participants identified several potential interlinked mechanisms: (1) motivated staff provide better care, (2) staff who feel taken seriously are more likely to be motivated, (3) involvement in quality improvement is itself motivating and (4) improving patient experience can directly improve staff experience. ‘Team-based capital’ in NHS settings We propose ‘team-based capital’ in NHS settings as a key mechanism between the contexts in our case studies and observed outcomes. ‘Capital’ is the extent to which staff command varied practical, organisational and social resources that enable them to set agendas, drive process and implement change. These include not just material or economic resources, but also status, time, space, relational networks and influence. Teams involving a range of clinical and non-clinical staff from multiple disciplines and levels of seniority could assemble a greater range of capital; progress was generally greater when the team included individuals from the patient experience office. Phase 3 – an online guide for NHS staff was produced in collaboration with The Point of Care Foundation.
Limitations
This was an ethnographic study of how and why NHS front-line staff do or do not use patient experience data for quality improvement. It was not designed to demonstrate whether particular types of patient experience data or quality improvement approaches are more effective than others.
Future research
Developing and testing interventions focused specifically on staff but with patient experience as the outcome, with a health economics component. Studies focusing on the effect of team composition and diversity on the impact and scope of patient-centred quality improvement. Research into using unstructured feedback and soft intelligence.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Louise Locock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Stephen Parkin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alison Chisholm
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Catherine Montgomery
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elizabeth Gibbons
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Melanie Gager
- Critical Care, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Neil Churchill
- Division of Experience, Participation and Equalities, NHS England, London, UK
| | | | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Angela Martin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John Powell
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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23
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Tang CY, Turczyniak M, Sayner A, Haines K, Butzkueven S, O'Connell HE. Adopting a collaborative approach in developing a prehabilitation program for patients with prostate cancer utilising experience-based co-design methodology. Support Care Cancer 2020; 28:5195-5202. [PMID: 32072326 DOI: 10.1007/s00520-020-05341-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Engaging patients in a prehabilitation program prior to commencement of cancer treatment is a known challenge. Utilising experience-based co-design (EBCD) methodology, this study aimed to explore the prostate cancer treatment journey from the perspectives of the patient and health professionals and collaboratively develop a prehabilitation program for patients with prostate cancer. METHODS EBCD was utilised for this study. Patients, support persons and health professionals were selectively identified and recruited from two metropolitan health services in Melbourne. Selection criteria included (i) recent clinical/patient experience with prostate cancer treatment and (ii) willingness to share positive experiences and challenges in two 2-hour face-to-face workshops. Findings from these workshops were thematically analysed to identify key themes addressing aims of the study. RESULTS Twenty participants including eight patients, one support person and 11 health professionals were recruited. Four key touchpoints were identified. All participants acknowledged positive interactions between patients and health professionals. Patients often described the journey as lonely, stressful and frustrating especially prior to commencement of treatment. A lack of a consistent approach in identifying and preparing patients with prostate cancer for treatment was identified. A structured prehabilitation program was proposed as a solution. Practical ideas to be implemented including timing of commencement, educational content and strategies to boost engagement were formulated. CONCLUSIONS The findings from the study provided practical guidance for future clinicians when implementing a prehabilitation program. Future study is required to evaluate the effectiveness of such a prehabilitation program in improving patient engagement and preparedness for prostate cancer treatment.
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Affiliation(s)
- Clarice Y Tang
- Department of Physiotherapy, Western Health, Gordon Street, Footscray, VIC, 3011, Australia.
- Department of Physiotherapy, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
- School of Allied Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Monica Turczyniak
- Department of Physiotherapy, Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - Alesha Sayner
- Department of Physiotherapy, Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - Kimberley Haines
- Department of Physiotherapy, Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - Sally Butzkueven
- Department of Cancer Services, Western Health, Furlong Road, St Albans, VIC, 3011, Australia
| | - Helen E O'Connell
- Department of Surgery, University of Melbourne, Melbourne, Australia
- Department of Urology, Western Health, St Albans, Australia
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24
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Raynor DK, Ismail H, Blenkinsopp A, Fylan B, Armitage G, Silcock J. Experience-based co-design-Adapting the method for a researcher-initiated study in a multi-site setting. Health Expect 2020; 23:562-570. [PMID: 32045087 PMCID: PMC7321746 DOI: 10.1111/hex.13028] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/04/2019] [Accepted: 12/31/2019] [Indexed: 12/18/2022] Open
Abstract
Background Experience‐based co‐design (EBCD) brings patients and staff together to co‐design services. It is normally conducted in one organization which initiates and implements the process. We used the traditional EBCD method with a number of adaptations as part of a larger research study in the British National Health Service. Methods The primary aim was to assess the feasibility and acceptability of conducting research‐initiated EBCD, to enhance intervention development prior to testing. As well as embedding the method in a research study, there were 3 further key adaptations: (a) working across primary and secondary care sectors, (b) working on multiple sites and (c) incorporating theory‐informed analysis. Results We recruited four sites (covering both primary and secondary care) and, on each site, conducted the initial traditional EBCD meetings, with separate staff and patient groups—followed by a single joint patient‐staff event, where four priority areas for co‐design were agreed. This event was driven by theory‐informed analysis, as well as the traditional trigger film of patient experiences. Each site worked on one priority area, and the four co‐design groups met over 2‐3 months to design prototype tools. A second joint event was held (not usually undertaken in single‐site EBCD) where they shared and compared outputs. The research team combined elements of these outputs to create an intervention, now being tested in a cluster randomized controlled trial. Conclusions EBCD can be successfully adapted for use across an entire patient pathway with multiple organizations and as part of a research process to identify an intervention for subsequent testing in a randomized trial. Our pragmatic approach used the patient experience to identify areas for improvement and co‐designed an intervention which directly reflected patient priorities.
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25
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Palmer VJ. The Participatory Zeitgeist in Health Care: It is Time for a Science of Participation. J Particip Med 2020; 12:e15101. [PMID: 33064092 PMCID: PMC7434075 DOI: 10.2196/15101] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/10/2019] [Accepted: 12/18/2019] [Indexed: 11/24/2022] Open
Abstract
Participation in health care is currently the zeitgeist/spirit of our times. A myriad of practices characterizes this “participatory Zeitgeist” in contemporary health care, which range from patients and professionals collaborating as partners in service delivery and treatment decision-making, to crowdsourced cures and participation in online communities, to using health apps, to involvement in health care quality improvement initiatives for systems redesign using coproduction and co-design methods. To date, patient engagement and participation in online communities and the use of apps have received a good deal of attention in participatory medicine. However, there has been a less critical examination of participation in health care planning, design, delivery, and improvement. In the face of what Thomas Kuhn called a scientific revolution, we are presented with the opportunity to re-examine some of the assumptions underpinning participation in health care and some of the emerging anomalies and weaknesses in the current science. This re-examination will allow the development of a new paradigm, a science of participation. In this science, we can systematically test, refine, and advance participation in health care to build a unifying language and theories from across the interdisciplinary fields of participatory design, medicine, and research to develop and test models to explain impacts and outcomes. A science of participation will allow the emergent and unexplained facts to be addressed in the current participatory mood of health care planning, design, delivery, and improvement.
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Affiliation(s)
- Victoria Jane Palmer
- The Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
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26
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Li F. Design and analysis considerations for cohort stepped wedge cluster randomized trials with a decay correlation structure. Stat Med 2019; 39:438-455. [PMID: 31797438 DOI: 10.1002/sim.8415] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/21/2019] [Accepted: 10/07/2019] [Indexed: 01/08/2023]
Abstract
A stepped wedge cluster randomized trial is a type of longitudinal cluster design that sequentially switches clusters to intervention over time until all clusters are treated. While the traditional posttest-only parallel design requires adjustment for a single intraclass correlation coefficient, the stepped wedge design allows multiple outcome measurements from the same cluster and so additional correlation parameters are necessary to characterize the within-cluster correlation structure. Although a number of studies have differentiated between the concepts of within-period and between-period correlations, only a few studies have allowed the between-period correlation to decay over time. In this article, we consider the proportional decay correlation structure for a cohort stepped wedge design, and provide a matrix-adjusted quasi-least squares approach to accurately estimate the correlation parameters along with the marginal intervention effect. We further develop the sample size and power procedures accounting for the correlation decay, and investigate the accuracy of the power procedure with continuous outcomes in a simulation study. We show that the empirical power agrees well with the prediction even with as few as nine clusters, when data are analyzed with matrix-adjusted quasi-least squares concurrently with a suitable bias-corrected sandwich variance. Two trial examples are provided to illustrate the new sample size procedure.
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Affiliation(s)
- Fan Li
- Department of Biostatistics, Yale University, New Haven, Connecticut.,Center for Methods in Implementation and Prevention Science, Yale University, New Haven, Connecticut
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27
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Palmer VJ, Weavell W, Callander R, Piper D, Richard L, Maher L, Boyd H, Herrman H, Furler J, Gunn J, Iedema R, Robert G. The Participatory Zeitgeist: an explanatory theoretical model of change in an era of coproduction and codesign in healthcare improvement. MEDICAL HUMANITIES 2019; 45:247-257. [PMID: 29954854 PMCID: PMC6818522 DOI: 10.1136/medhum-2017-011398] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 05/23/2023]
Abstract
Healthcare systems redesign and service improvement approaches are adopting participatory tools, techniques and mindsets. Participatory methods increasingly used in healthcare improvement coalesce around the concept of coproduction, and related practices of cocreation, codesign and coinnovation. These participatory methods have become the new Zeitgeist-the spirit of our times in quality improvement. The rationale for this new spirit of participation relates to voice and engagement (those with lived experience should be engaged in processes of development, redesign and improvements), empowerment (engagement in codesign and coproduction has positive individual and societal benefits) and advancement (quality of life and other health outcomes and experiences of services for everyone involved should improve as a result). This paper introduces Mental Health Experience Co-design (MH ECO), a peer designed and led adapted form of Experience-based Co-design (EBCD) developed in Australia. MH ECO is said to facilitate empowerment, foster trust, develop autonomy, self-determination and choice for people living with mental illnesses and their carers, including staff at mental health services. Little information exists about the underlying mechanisms of change; the entities, processes and structures that underpin MH ECO and similar EBCD studies. To address this, we identified eight possible mechanisms from an assessment of the activities and outcomes of MH ECO and a review of existing published evaluations. The eight mechanisms, recognition, dialogue, cooperation, accountability, mobilisation, enactment, creativity and attainment, are discussed within an 'explanatory theoretical model of change' that details these and ideal relational transitions that might be observed or not with MH ECO or other EBCD studies. We critically appraise the sociocultural and political movement in coproduction and draw on interdisciplinary theories from the humanities-narrative theory, dialogical ethics, cooperative and empowerment theory. The model advances theoretical thinking in coproduction beyond motivations and towards identifying underlying processes and entities that might impact on process and outcome. TRIAL REGISTRATION NUMBER: The Australian and New Zealand Clinical Trials Registry, ACTRN12614000457640 (results).
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Affiliation(s)
- Victoria Jane Palmer
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Wayne Weavell
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rosemary Callander
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Donella Piper
- Business School, University of New England, Armidale, New South Wales, Australia
| | - Lauralie Richard
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of General Practice and Rural Health, Dunedin School of Medicine, The University of Otago, Dunedin, New Zealand
| | - Lynne Maher
- Ko Awatea, Health System Innovation and Improvement, Counties Manukau Health, Auckland, New Zealand
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Hilary Boyd
- Strategy, Participation and Improvement Group, Auckland District Health Board, Auckland, New Zealand
| | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Furler
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Gunn
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rick Iedema
- Centre for Team Based Practice and Learning in Health Care, Health Schools, King's College London, London, UK
| | - Glenn Robert
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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28
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Lowe D, Merner B, Graham-Wisener L, Walsh L, Hill S. The effects of consumers and health providers working in partnership as an intervention for the promotion of person-centred health services. Hippokratia 2019. [DOI: 10.1002/14651858.cd013373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Dianne Lowe
- La Trobe University; Centre for Health Communication and Participation, School of Psychology and Public Health; Bundoora VIC Australia 3086
| | - Bronwen Merner
- La Trobe University; Centre for Health Communication and Participation, School of Psychology and Public Health; Bundoora VIC Australia 3086
| | | | - Louisa Walsh
- La Trobe University; Centre for Health Communication and Participation, School of Psychology and Public Health; Bundoora VIC Australia 3086
| | - Sophie Hill
- La Trobe University; Centre for Health Communication and Participation, School of Psychology and Public Health; Bundoora VIC Australia 3086
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29
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Abstract
To use experience-based co-design to identify the key design requirements of a peer support model for critical care survivors; understand the use of the experience-based co-design method from clinician, patients, and family perspectives. Design Using experience-based co-design, qualitative data about participants' preferences for a peer support model were generated via workshops. Participants' perspectives of experience-based co-design were evaluated with focus groups. Setting University-affiliated hospital in Melbourne, Australia. Subjects Snowball sampling was used to recruit clinicians from across the care spectrum (ICU-community); critical care survivors and nominated family members were recruited using convenience sampling. Measurements and Main Results Consensus on a peer support model was reached through the experience-based co-design process, with the following key themes: 1) socialization and group cohesion; 2) management of potential risks; and 3) individualized needs of patients and families. Evaluation of participants' perspectives of the experience-based co-design method identified five key themes: 1) participation as a positive experience; 2) emotional engagement in the process; 3) learning from patients and family members; 4) feeling heard; and 5) practical challenges of experience-based co-design and readiness to participate. Conclusions Experience-based co-design was a feasible approach to developing a peer support model for use with critical care survivors and was well received by participants. Future testing of the co-designed peer support model in a pilot randomized controlled trial will enhance understanding of peer support in critical care and the use of experience-based co-design as a design methodology.
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30
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Giné-Garriga M, Sandlund M, Dall PM, Chastin SFM, Pérez S, Skelton DA. A Novel Approach to Reduce Sedentary Behaviour in Care Home Residents: The GET READY Study Utilising Service-Learning and Co-Creation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E418. [PMID: 30717105 PMCID: PMC6388363 DOI: 10.3390/ijerph16030418] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 01/20/2023]
Abstract
The GET READY study aimed to integrate service-learning methodology into University degrees by offering students individual service opportunities with residential care homes, to co-create the best suited intervention to reduce the sedentary behaviour (SB) of residents throughout the day, with researchers, end-users, care staff, family members and policymakers. Eight workshops with care home residents and four workshops with care staff, relatives and policymakers, led by undergraduate students, were audiotaped, transcribed verbatim and analysed with inductive thematic analysis to understand views and preferences for sustainable strategies to reduce SB and increase movement of residents. Perspectives about SB and movement in care homes highlighted four subthemes. Assets for decreasing SB included three subthemes, and suggestions and strategies encapsulated four subthemes. There is a need to include end-users in decision making, and involve care staff and relatives in enhancing strategies to reduce SB among residents if we want sustainable changes in behaviour. A change in the culture at a policymaker and care staff's level could provide opportunities to open care homes to the community with regular activities outside the care home premises, and offer household chores and opportunities to give residents a role in maintaining their home environment.
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Affiliation(s)
- Maria Giné-Garriga
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
- Department of Physical Activity and Sport Sciences, Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, Císter 34, 08022 Barcelona, Spain.
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Umeå University, 901 87 Umeå, Sweden.
| | - Philippa M Dall
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
| | - Sebastien F M Chastin
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
- Department of Movement and Sport Science, Ghent University, St. Pietersnieuwstraat 33, 9000 Ghent, Belgium.
| | - Susana Pérez
- Department of Physical Activity and Sport Sciences, Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, Císter 34, 08022 Barcelona, Spain.
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
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31
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Treichler EBH, Li F, O'Hare M, Evans EA, Johnson JR, Spaulding WD. Psychosocial and functional contributors to personal recovery in serious mental illness. J Ment Health 2019; 28:427-435. [PMID: 30661426 DOI: 10.1080/09638237.2018.1521932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Although recovery-oriented services have been conceptualized to improve personal recovery, related research often focuses on measures of clinical recovery. Identifying the relationships between personal recovery, clinical recovery, and psychosocial variables will inform service components and outcome measurement in recovery-oriented services. Aims: This study sought to determine the connection between personal recovery and two sets of potential contributors: psychosocial variables (i.e., empowerment, resilience, and consumer involvement) and functional indicators of clinical recovery. Method: These relationships were examined by analyzing survey data collected from 266 consumers who are receiving public mental health services in the United States. Results: Empowerment, resilience and psychological involvement were associated with personal recovery. Clinical recovery did not uniquely contribute to personal recovery once psychosocial factors were accounted for. Interactions revealed that the relationship between psychological involvement and personal recovery was stronger for those who had been recently hospitalized, and for those with relatively greater resilience. Conclusions: Results indicate that personal recovery is an essential outcome measure for recovery-oriented services that cannot be replaced by clinical recovery outcome measurement. Additionally, empowerment, resilience, and consumer involvement are key components of recovery, which suggests that services and outcome measures should prioritize incorporation of these constructs.
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Affiliation(s)
- Emily B H Treichler
- a VISN 22 Mental Illness Research, Education, & Clinical Center, VA San Diego Healthcare System , San Diego , CA , USA.,b Department of Psychiatry , University of California , San Diego , CA , USA
| | - Feiyu Li
- c Department of Psychology , University of Nebraska-Lincoln , Lincoln , NE , USA
| | - Mary O'Hare
- d Disability Rights Nebraska , Lincoln , NE , USA
| | - Eric A Evans
- d Disability Rights Nebraska , Lincoln , NE , USA
| | - J R Johnson
- c Department of Psychology , University of Nebraska-Lincoln , Lincoln , NE , USA.,d Disability Rights Nebraska , Lincoln , NE , USA
| | - William D Spaulding
- c Department of Psychology , University of Nebraska-Lincoln , Lincoln , NE , USA
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32
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Mulvale G, Moll S, Miatello A, Robert G, Larkin M, Palmer VJ, Powell A, Gable C, Girling M. Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration. Health Expect 2019; 22:284-297. [PMID: 30604580 PMCID: PMC6543156 DOI: 10.1111/hex.12864] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/29/2018] [Accepted: 12/11/2018] [Indexed: 11/30/2022] Open
Abstract
Background Codesign has the potential to transform health and other public services. To avoid unintentionally reinforcing existing inequities, better understanding is needed of how to facilitate involvement of vulnerable populations in acceptable, ethical and effective codesign. Objective To explore citizens’ involvement in codesigning public services for vulnerable groups, identify challenges and suggest improvements. Design A modified case study approach. Pattern matching was used to compare reported challenges with a priori theoretical propositions. Setting and participants A two‐day international symposium involved 28 practitioners, academics and service users from seven countries to reflect on challenges and to codesign improved processes for involving vulnerable populations. Intervention studied Eight case studies working with vulnerable and disadvantaged populations in three countries. Results We identified five shared challenges to meaningful, sustained participation of vulnerable populations: engagement; power differentials; health concerns; funding; and other economic/social circumstances. In response, a focus on relationships and flexibility is essential. We encourage codesign projects to enact a set of principles or heuristics rather than following pre‐specified steps. We identify a set of principles and tactics, relating to challenges outlined in our case studies, which may help in codesigning public services with vulnerable populations. Discussion and conclusions Codesign facilitators must consider how meaningful engagement will be achieved and how power differentials will be managed when working with services for vulnerable populations. The need for flexibility and responsiveness to service user needs may challenge expectations about timelines and outcomes. User‐centred evaluations of codesigned public services are needed.
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Affiliation(s)
| | - Sandra Moll
- McMaster University, Burlington, Ontario, Canada
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33
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Eines TF, Angelo E, Vatne S. Discourse analysis of health providers' experiences using service design. Nurs Open 2019; 6:84-92. [PMID: 30534397 PMCID: PMC6279718 DOI: 10.1002/nop2.191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 06/15/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Municipal healthcare organizations are facing increasing challenges to developing more cost-effective organizations and services, particularly in nursing homes. The background for this article is an attempt in this concern; implementing service design in a nursing home. AIM The aim of the study is to explore nurses and nurse assistants' experiences using service design in a nursing home. DESIGN A qualitative design was applied. METHOD Data were collected through focus group interviews with 17 nurses and nurse assistants in 2015. Thematic discourse analysis was conducted to analyse their discussed experiences. RESULTS The employees had positive attitudes towards incorporating a service design approach that focused on the patients' needs, which thus encouraged creative solutions and promoted employee involvement. The study shows that involving service designers and employees in the entire process, from planning to implementation of new and innovative solutions, requires closer collaboration between the service designers, managers, and employees to achieve the final goal. We consider that the results of this study will be of relevance to the future development of health care and nursing in nursing homes.
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Affiliation(s)
| | - Elin Angelo
- Norwegian University of Science and TechnologyTrondheimNorway
| | - Solfrid Vatne
- Molde University CollegeSpecialised University in LogisticsMoldeNorway
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34
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The codesign of an interdisciplinary team-based intervention regarding initiating palliative care in pediatric oncology. Support Care Cancer 2018; 26:3249-3256. [PMID: 29627863 DOI: 10.1007/s00520-018-4190-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Children with advanced cancer are often not referred to palliative or hospice care before they die or are only referred close to the child's death. The goals of the current project were to learn about pediatric oncology team members' perspectives on palliative care, to collaborate with team members to modify and tailor three separate interdisciplinary team-based interventions regarding initiating palliative care, and to assess the feasibility of this collaborative approach. METHODS We used a modified version of experience-based codesign (EBCD) involving members of the pediatric palliative care team and three interdisciplinary pediatric oncology teams (Bone Marrow Transplant, Neuro-Oncology, and Solid Tumor) to review and tailor materials for three team-based interventions. Eleven pediatric oncology team members participated in four codesign sessions to discuss their experiences with initiating palliative care and to review the proposed intervention including patient case studies, techniques for managing uncertainty and negative emotions, role ambiguity, system-level barriers, and team communication and collaboration. RESULTS The codesign process showed that the participants were strong supporters of palliative care, members of different teams had preferences for different materials that would be appropriate for their teams, and that while participants reported frustration with timing of palliative care, they had difficulty suggesting how to change current practices. CONCLUSIONS The current project demonstrated the feasibility of collaborating with pediatric oncology clinicians to develop interventions about introducing palliative care. The procedures and results of this project will be posted online so that other institutions can use them as a model for developing similar interventions appropriate for their needs.
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35
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How do we incorporate patient views into the design of healthcare services for older people: a discussion paper. BMC Oral Health 2018; 18:61. [PMID: 29625597 PMCID: PMC5889523 DOI: 10.1186/s12903-018-0513-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/16/2018] [Indexed: 12/19/2022] Open
Abstract
Background Across the European Union costs for the treatment of oral disease is expected to rise to €93 Billion by 2020 and be higher than those for stroke and dementia combined. A significant proportion of these costs will relate to the provision of care for older people. Dental caries severity and experience is now a major public health issue in older people and periodontal disease disproportionately affects older adults. Poor oral health impacts on older people’s quality of life, their self-esteem, general health and diet. Oral health care service provision for older people is often unavailable or poor, as is the standard of knowledge amongst formal and informal carers. The aim of this discussion paper is to explore some of the approaches that could be taken to improve the level of co-production in the design of healthcare services for older people. Main text People’s emotional and practical response to challenges in health and well-being and the responsiveness of systems to their needs is crucial to improve the quality of service provision. This is a particularly important aspect of care for older people as felt, expressed and normative needs may be fundamentally different and vary as they become increasingly dependent. Co-production shifts the design process away from the traditional ‘top-down’ medical model, where needs assessments are undertaken by someone external to a community and strategies are devised that encourage these communities to become passive recipients of services. Instead, an inductive paradigm of partnership working and shared leadership is actively encouraged to set priorities and ultimately helps improve the translational gap between research, health policy and health-service provision. Discussion The four methodological approaches discussed in this paper (Priority Setting Partnerships, Discrete Choice Experiments, Core Outcome Sets and Experience Based Co-Design) represent an approach that seeks to better engage with older people and ensure an inductive, co-produced process to the research and design of healthcare services of the future. These methods facilitate partnerships between researchers, healthcare professionals and patients to produce more responsive and appropriate public services for older people.
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36
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Hall AE, Bryant J, Sanson-Fisher RW, Fradgley EA, Proietto AM, Roos I. Consumer input into health care: Time for a new active and comprehensive model of consumer involvement. Health Expect 2018; 21:707-713. [PMID: 29512248 PMCID: PMC6117488 DOI: 10.1111/hex.12665] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2017] [Indexed: 11/28/2022] Open
Abstract
Background To ensure the provision of patient‐centred health care, it is essential that consumers are actively involved in the process of determining and implementing health‐care quality improvements. However, common strategies used to involve consumers in quality improvements, such as consumer membership on committees and collection of patient feedback via surveys, are ineffective and have a number of limitations, including: limited representativeness; tokenism; a lack of reliable and valid patient feedback data; infrequent assessment of patient feedback; delays in acquiring feedback; and how collected feedback is used to drive health‐care improvements. Objectives We propose a new active model of consumer engagement that aims to overcome these limitations. This model involves the following: (i) the development of a new measure of consumer perceptions; (ii) low cost and frequent electronic data collection of patient views of quality improvements; (iii) efficient feedback to the health‐care decision makers; and (iv) active involvement of consumers that fosters power to influence health system changes.
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Affiliation(s)
- Alix E Hall
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia
| | - Rob W Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia
| | - Elizabeth A Fradgley
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia.,Hunter Cancer Research Alliance, Waratah, NSW, Australia
| | - Anthony M Proietto
- Hunter Cancer Research Alliance, Waratah, NSW, Australia.,Cancer Services and Cancer Network, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Ian Roos
- Youth Research Centre, Melbourne Graduate School of Education, University of Melbourne, Parkville, Vic., Australia
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37
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Clarke D, Jones F, Harris R, Robert G. What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings? A rapid evidence synthesis. BMJ Open 2017; 7:e014650. [PMID: 28701409 PMCID: PMC5734495 DOI: 10.1136/bmjopen-2016-014650] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Co-production is defined as the voluntary or involuntary involvement of users in the design, management, delivery and/or evaluation of services. Interest in co-production as an intervention for improving healthcare quality is increasing. In the acute healthcare context, co-production is promoted as harnessing the knowledge of patients, carers and staff to make changes about which they care most. However, little is known regarding the impact of co-production on patient, staff or organisational outcomes in these settings. AIMS To identify and appraise reported outcomes of co-production as an intervention to improve quality of services in acute healthcare settings. DESIGN Rapid evidence synthesis. DATA SOURCES Medline, Cinahl, Web of Science, Embase, HMIC, Cochrane Database of Systematic Reviews, SCIE, Proquest Dissertation and Theses, EThOS, OpenGrey; CoDesign; The Design Journal; Design Issues. STUDY SELECTION Studies reporting patient, staff or organisational outcomes associated with using co-production in an acute healthcare setting. FINDINGS 712 titles and abstracts were screened; 24 papers underwent full-text review, and 11 papers were included in the evidence synthesis. One study was a feasibility randomised controlled trial, three were process evaluations and seven used descriptive qualitative approaches. Reported outcomes related to (a) the value of patient and staff involvement in co-production processes; (b) the generation of ideas for changes to processes, practices and clinical environments; and (c) tangible service changes and impacts on patient experiences. Only one study included cost analysis; none reported an economic evaluation. No studies assessed the sustainability of any changes made. CONCLUSIONS Despite increasing interest in and advocacy for co-production, there is a lack of rigorous evaluation in acute healthcare settings. Future studies should evaluate clinical and service outcomes as well as the cost-effectiveness of co-production relative to other forms of quality improvement. Potentially broader impacts on the values and behaviours of participants should also be considered.
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Affiliation(s)
- David Clarke
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, Bradford, UK
| | - Fiona Jones
- Faculty of Health Social Care and Education, St George's University of London, London, UK
| | - Ruth Harris
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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38
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Richard L, Piper D, Weavell W, Callander R, Iedema R, Furler J, Pierce D, Godbee K, Gunn J, Palmer VJ. Advancing engagement methods for trials: the CORE study relational model of engagement for a stepped wedge cluster randomised controlled trial of experience-based co-design for people living with severe mental illnesses. Trials 2017; 18:169. [PMID: 28388937 PMCID: PMC5385022 DOI: 10.1186/s13063-017-1878-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 03/06/2017] [Indexed: 11/17/2022] Open
Abstract
Background Engagement is essential in trials research but is rarely embedded across all stages of the research continuum. The development, use, effectiveness and value of engagement in trials research is poorly researched and understood, and models of engagement are rarely informed by theory. This article describes an innovative methodological approach for the development and application of a relational model of engagement in a stepped wedge designed cluster randomised controlled trial (RCT), the CORE study. The purpose of the model is to embed engagement across the continuum of the trial which will test if an experience-based co-design intervention improves psychosocial recovery for people affected by severe mental illness. Methods The model was developed in three stages and used a structured iterative approach. A context mapping assessment of trial sites was followed by a literature review on recruitment and retention of hard-to-reach groups in complex interventions and RCTs. Relevant theoretical and philosophical underpinnings were identified by an additional review of literature to inform model development and enactment of engagement activities. Results Policy, organisational and service user data combined with evidence from the literature on barriers to recruitment provided contextual information. Four perspectives support the theoretical framework of the relational model of engagement and this is organised around two facets: the relational and continuous. The relational facet is underpinned by relational ethical theories and participatory action research principles. The continuous facet is supported by systems thinking and translation theories. These combine to enact an ethics of engagement and evoke knowledge mobilisation to reach the higher order goals of the model. Conclusions Engagement models are invaluable for trials research, but there are opportunities to advance their theoretical development and application, particularly within stepped wedge designed studies where there may be a significant waiting period between enrolment in a study and receipt of an intervention.
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Affiliation(s)
- Lauralie Richard
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 200, Berkeley Street, Melbourne, VIC, 3052, Australia.,The Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Donella Piper
- School of Health, University of New England, Armidale, Australia
| | - Wayne Weavell
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 200, Berkeley Street, Melbourne, VIC, 3052, Australia
| | - Rosemary Callander
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 200, Berkeley Street, Melbourne, VIC, 3052, Australia
| | - Rick Iedema
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - John Furler
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 200, Berkeley Street, Melbourne, VIC, 3052, Australia
| | - David Pierce
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Kali Godbee
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 200, Berkeley Street, Melbourne, VIC, 3052, Australia
| | - Jane Gunn
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 200, Berkeley Street, Melbourne, VIC, 3052, Australia
| | - Victoria J Palmer
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 200, Berkeley Street, Melbourne, VIC, 3052, Australia.
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Blackwell RWN, Lowton K, Robert G, Grudzen C, Grocott P. Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes. Int J Nurs Stud 2017; 68:83-94. [PMID: 28095347 DOI: 10.1016/j.ijnurstu.2017.01.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 01/05/2017] [Accepted: 01/09/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Increasing use of emergency departments among older patients with palliative needs has led to the development of several service-level interventions intended to improve care quality. There is little evidence of patient and family involvement in developmental processes, and little is known about the experiences of - and preferences for - palliative care delivery in this setting. Participatory action research seeking to enable collaborative working between patients and staff should enhance the impact of local quality improvement work but has not been widely implemented in such a complex setting. OBJECTIVES To critique the feasibility of this methodology as a quality improvement intervention in complex healthcare settings, laying a foundation for future work. SETTING an Emergency Department in a large teaching hospital in the United Kingdom. METHODS Experience-based Co-design incorporating: 150h of nonparticipant observation; semi-structured interviews with 15 staff members about their experiences of palliative care delivery; 5 focus groups with 64 staff members to explore challenges in delivering palliative care; 10 filmed semi-structured interviews with palliative care patients or their family members; a co-design event involving staff, patients and family members. FINDINGS the study successfully identified quality improvement priorities leading to changes in Emergency Department-palliative care processes. Further outputs were the creation of a patient-family-staff experience training DVD to encourage reflective discussion and the identification and application of generic design principles for improving palliative care in the Emergency Department. There were benefits and challenges associated with using Experience-based Co-design in this setting. Benefits included the flexibility of the approach, the high levels of engagement and responsiveness of patients, families and staff, and the impact of using filmed narrative interviews to enhance the 'voice' of seldom heard patients and families. Challenges included high levels of staff turnover during the 19 month project, significant time constraints in the Emergency Department and the ability of older patients and their families to fully participate in the co-design process. CONCLUSION Experience-based Co-design is a useful approach for encouraging collaborative working between vulnerable patients, family and staff in complex healthcare environments. The flexibility of the approach allows the specific needs of participants to be accounted for, enabling fuller engagement with those who typically may not be invited to contribute to quality improvement work. Recommendations for future studies in this and similar settings include testing the 'accelerated' form of the approach and experimenting with alternative ways of increasing involvement of patients/families in the co-design phase.
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Affiliation(s)
- Rebecca Wright Née Blackwell
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, JCMB, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Karen Lowton
- Department of Sociology, University of Sussex, Freeman Building, Falmer, Brighton, BN1 9RH, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, JCMB, 57 Waterloo Road, London, SE1 8WA, UK
| | - Corita Grudzen
- Ronald O. Perelman Department of Emergency Medicine, Associate Professor of Emergency Medicine and Population Health, NYU School of Medicine, USA
| | - Patricia Grocott
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, JCMB, 57 Waterloo Road, London, SE1 8WA, UK
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Dieterich M, Irving CB, Bergman H, Khokhar MA, Park B, Marshall M. Intensive case management for severe mental illness. Cochrane Database Syst Rev 2017; 1:CD007906. [PMID: 28067944 PMCID: PMC6472672 DOI: 10.1002/14651858.cd007906.pub3] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Intensive Case Management (ICM) is a community-based package of care aiming to provide long-term care for severely mentally ill people who do not require immediate admission. Intensive Case Management evolved from two original community models of care, Assertive Community Treatment (ACT) and Case Management (CM), where ICM emphasises the importance of small caseload (fewer than 20) and high-intensity input. OBJECTIVES To assess the effects of ICM as a means of caring for severely mentally ill people in the community in comparison with non-ICM (caseload greater than 20) and with standard community care. We did not distinguish between models of ICM. In addition, to assess whether the effect of ICM on hospitalisation (mean number of days per month in hospital) is influenced by the intervention's fidelity to the ACT model and by the rate of hospital use in the setting where the trial was conducted (baseline level of hospital use). SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (last update search 10 April 2015). SELECTION CRITERIA All relevant randomised clinical trials focusing on people with severe mental illness, aged 18 to 65 years and treated in the community care setting, where ICM is compared to non-ICM or standard care. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials, assessed quality, and extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses.We performed a random-effects meta-regression analysis to examine the association of the intervention's fidelity to the ACT model and the rate of hospital use in the setting where the trial was conducted with the treatment effect. We assessed overall quality for clinically important outcomes using the GRADE approach and investigated possible risk of bias within included trials. MAIN RESULTS The 2016 update included two more studies (n = 196) and more publications with additional data for four already included studies. The updated review therefore includes 7524 participants from 40 randomised controlled trials (RCTs). We found data relevant to two comparisons: ICM versus standard care, and ICM versus non-ICM. The majority of studies had a high risk of selective reporting. No studies provided data for relapse or important improvement in mental state.1. ICM versus standard careWhen ICM was compared with standard care for the outcome service use, ICM slightly reduced the number of days in hospital per month (n = 3595, 24 RCTs, MD -0.86, 95% CI -1.37 to -0.34,low-quality evidence). Similarly, for the outcome global state, ICM reduced the number of people leaving the trial early (n = 1798, 13 RCTs, RR 0.68, 95% CI 0.58 to 0.79, low-quality evidence). For the outcome adverse events, the evidence showed that ICM may make little or no difference in reducing death by suicide (n = 1456, 9 RCTs, RR 0.68, 95% CI 0.31 to 1.51, low-quality evidence). In addition, for the outcome social functioning, there was uncertainty about the effect of ICM on unemployment due to very low-quality evidence (n = 1129, 4 RCTs, RR 0.70, 95% CI 0.49 to 1.0, very low-quality evidence).2. ICM versus non-ICMWhen ICM was compared with non-ICM for the outcome service use, there was moderate-quality evidence that ICM probably makes little or no difference in the average number of days in hospital per month (n = 2220, 21 RCTs, MD -0.08, 95% CI -0.37 to 0.21, moderate-quality evidence) or in the average number of admissions (n = 678, 1 RCT, MD -0.18, 95% CI -0.41 to 0.05, moderate-quality evidence) compared to non-ICM. Similarly, the results showed that ICM may reduce the number of participants leaving the intervention early (n = 1970, 7 RCTs, RR 0.70, 95% CI 0.52 to 0.95,low-quality evidence) and that ICM may make little or no difference in reducing death by suicide (n = 1152, 3 RCTs, RR 0.88, 95% CI 0.27 to 2.84, low-quality evidence). Finally, for the outcome social functioning, there was uncertainty about the effect of ICM on unemployment as compared to non-ICM (n = 73, 1 RCT, RR 1.46, 95% CI 0.45 to 4.74, very low-quality evidence).3. Fidelity to ACTWithin the meta-regression we found that i.) the more ICM is adherent to the ACT model, the better it is at decreasing time in hospital ('organisation fidelity' variable coefficient -0.36, 95% CI -0.66 to -0.07); and ii.) the higher the baseline hospital use in the population, the better ICM is at decreasing time in hospital ('baseline hospital use' variable coefficient -0.20, 95% CI -0.32 to -0.10). Combining both these variables within the model, 'organisation fidelity' is no longer significant, but the 'baseline hospital use' result still significantly influences time in hospital (regression coefficient -0.18, 95% CI -0.29 to -0.07, P = 0.0027). AUTHORS' CONCLUSIONS Based on very low- to moderate-quality evidence, ICM is effective in ameliorating many outcomes relevant to people with severe mental illness. Compared to standard care, ICM may reduce hospitalisation and increase retention in care. It also globally improved social functioning, although ICM's effect on mental state and quality of life remains unclear. Intensive Case Management is at least valuable to people with severe mental illnesses in the subgroup of those with a high level of hospitalisation (about four days per month in past two years). Intensive Case Management models with high fidelity to the original team organisation of ACT model were more effective at reducing time in hospital.However, it is unclear what overall gain ICM provides on top of a less formal non-ICM approach.We do not think that more trials comparing current ICM with standard care or non-ICM are justified, however we currently know of no review comparing non-ICM with standard care, and this should be undertaken.
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Affiliation(s)
- Marina Dieterich
- Azienda USL Toscana Nord OvestDepartment of PsychiatryLivornoItaly
| | - Claire B Irving
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthUniversity of Nottingham Innovation Park, Triumph RoadNottinghamUKNG7 2TU
| | - Hanna Bergman
- Enhance Reviews LtdCentral Office, Cobweb buildingsThe Lane, LyfordWantageUKOX12 0EE
| | - Mariam A Khokhar
- University of SheffieldOral Health and Development15 Askham CourtGamston Radcliffe RoadNottinghamUKNG2 6NR
| | - Bert Park
- Nottinghamshire Healthcare NHS TrustAMH Management SuiteHighbury HospitalNottinghamUKNG6 9DR
| | - Max Marshall
- The Lantern CentreUniversity of ManchesterVicarage LaneOf Watling Street Road, FulwoodPrestonLancashireUK
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Enticott JC, Shawyer F, Brophy L, Russell G, Fossey E, Inder B, Mazza D, Vasi S, Weller PJ, Wilson-Evered E, Edan V, Meadows G. The PULSAR primary care protocol: a stepped-wedge cluster randomized controlled trial to test a training intervention for general practitioners in recovery-oriented practice to optimize personal recovery in adult patients. BMC Psychiatry 2016; 16:451. [PMID: 27998277 PMCID: PMC5168875 DOI: 10.1186/s12888-016-1153-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/01/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND General practitioners (GPs) in Australia play a central role in the delivery of mental health care. This article describes the PULSAR (Principles Unite Local Services Assisting Recovery) Primary Care protocol, a novel mixed methods evaluation of a training intervention for GPs in recovery-oriented practice. The aim of the intervention is to optimize personal recovery in patients consulting study GPs for mental health issues. METHODS The intervention mixed methods design involves a stepped-wedge cluster randomized controlled trial testing the outcomes of training in recovery-oriented practice, together with an embedded qualitative study to identify the contextual enablers and challenges to implementing recovery-oriented practice. The project is conducted in Victoria, Australia between 2013 and 2017. Eighteen general practices and community health centers are randomly allocated to one of two steps (nine months apart) to start an intervention comprising GP training in the delivery of recovery-oriented practice. Data collection consists of cross-sectional surveys collected from patients of participating GPs at baseline, and again at the end of Steps 1 and 2. The primary outcome is improvement in personal recovery using responses to the Questionnaire about the Process of Recovery. Secondary outcomes are improvements in patient-rated measures of personal recovery and wellbeing, and of the recovery-oriented practice they have received, using the INSPIRE questionnaire, the Warwick-Edinburgh Mental Well-being Scale, and the Kessler Psychological Distress Scale. Participant data will be analyzed in the group that the cluster was assigned to at each study time point. Another per-protocol dataset will contain all data time-stamped according to the date of intervention received at each cluster site. Qualitative interviews with GPs and patients at three and nine months post-training will investigate experiences and challenges related to implementing recovery-oriented practice in primary care. DISCUSSION Recovery-oriented practice is gaining increasing prominence in mental health service delivery and the outcomes of such an approach within the primary care sector for the first time will be evaluated in this project. If findings are positive, the intervention has the potential to extend recovery-oriented practice to GPs throughout the community. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry ( ACTRN12614001312639 ). Registered: 8 August 2014.
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Affiliation(s)
- Joanne C. Enticott
- Southern Synergy, Department of Psychiatry, Monash University, 126 Cleeland St, Dandenong, VIC Australia ,Royal District Nursing Service Institute, 31 Alma Rd, St Kilda, VIC Australia
| | - Frances Shawyer
- Southern Synergy, Department of Psychiatry, Monash University, 126 Cleeland St, Dandenong, VIC Australia
| | - Lisa Brophy
- Mind Australia, Heidelberg, VIC Australia ,Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC Australia
| | - Grant Russell
- School of Primary Health Care, Monash University, Notting Hill Campus, Victoria, Australia ,Southern Academic Primary Care Research Unit, Monash University, Notting Hill, Victoria, Australia
| | - Ellie Fossey
- School of Primary Health Care, Monash University Peninsula Campus, Frankston, VIC Australia
| | - Brett Inder
- Department of Econometrics and Business Statistics, Monash University, Melbourne, VIC Australia
| | - Danielle Mazza
- School of Primary Health Care, Monash University, Notting Hill Campus, Victoria, Australia
| | - Shiva Vasi
- School of Primary Health Care, Monash University, Notting Hill Campus, Victoria, Australia ,Southern Academic Primary Care Research Unit, Monash University, Notting Hill, Victoria, Australia
| | | | | | - Vrinda Edan
- Southern Synergy, Department of Psychiatry, Monash University, 126 Cleeland St, Dandenong, VIC Australia
| | - Graham Meadows
- Southern Synergy, Department of Psychiatry, Monash University, 126 Cleeland St, Dandenong, VIC, Australia. .,Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia. .,Monash Health, Melbourne, VIC, Australia.
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Goeman D, Comans T, Enticott JC, Renehan E, Beattie E, Kurrle S, Koch S. Evaluating the Efficacy of the "Support for Life" Program for People with Dementia and Their Families and Carers' to Enable Them to Live Well: A Protocol for a Cluster Stepped Wedge Randomized Controlled Trial. Front Public Health 2016; 4:245. [PMID: 27843893 PMCID: PMC5086896 DOI: 10.3389/fpubh.2016.00245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/18/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction Assistance provided to support people living with dementia and carers is highly valued by them. However, current support systems in Australia are disjointed, inaccessible to all, poorly coordinated, and focus on dysfunction rather than ability. Support workers for people with dementia are in short supply, and there is little consistency in their roles. To address this large service gap and unmet need, we have developed an evidence-based optimized model of holistic support for people with dementia and their carers and families. This article describes the “Support for Life” model intervention. Methods A stepped wedge cluster randomized controlled trial will be conducted over 3 years across three Australian states. One hundred participants with dementia and/or their carers/family members will be randomly selected from community health center client lists in each state to receive either the dementia “Support for Life” intervention (Group A) or routine care (Group B). Group A participants will have access to the intervention from year 1. Group B participants will continue to receive usual care and will not be denied information on dementia or dementia services in year 1. In year 2, Group B participants will have access to the intervention. A highly trained expert dementia support worker will provide the “Support for Life” intervention, which is a flexible, individually tailored, holistic support that is relationship-centered, focused on enablement as opposed to dysfunction, and facilitate participants’ continued engagement in their community and the workforce. Additionally, dementia education, information resources, advocacy, and practical support to navigate and access dementia services and health care will be provided. The mode of support will include face to face, telephone, and internet interaction on an “as needed basis” for 12 months. The primary hypothesis is that the intervention will improve the quality of life of people with dementia and the health and well-being of carers/family through facilitating the continuation and enhancement of regular daily activities. Secondary hypotheses will examine other health and service usage outcomes. The outputs will also include a health economic analysis to investigate the costs (and savings) of any associated reduction in unnecessary health services use and delay in accessing permanent residential aged care. Trial registration number Australian and New Zealand Clinical Trials Registry: ACTRN12616000927426p.
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Affiliation(s)
- Dianne Goeman
- Royal District Nursing Service Ltd., RDNS Institute, St. Kilda, VIC, Australia; Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Tracy Comans
- Metro North Hospital and Health Service District, Brisbane, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | | | - Emma Renehan
- Royal District Nursing Service Ltd., RDNS Institute , St. Kilda, VIC , Australia
| | - Elizabeth Beattie
- Dementia and Collaborative Research Centre (DCRC), School of Nursing, Queensland University of Technology , Brisbane, QLD , Australia
| | - Susan Kurrle
- NHMRC Cognitive Decline Partnership Centre (CDPC), Sydney Medical School - Northern, Hornsby Ku-ring-gai Hospital, The University of Sydney , Sydney, NSW , Australia
| | - Susan Koch
- Royal District Nursing Service Ltd., RDNS Institute , St. Kilda, VIC , Australia
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Barker D, McElduff P, D'Este C, Campbell MJ. Stepped wedge cluster randomised trials: a review of the statistical methodology used and available. BMC Med Res Methodol 2016; 16:69. [PMID: 27267471 PMCID: PMC4895892 DOI: 10.1186/s12874-016-0176-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous reviews have focussed on the rationale for employing the stepped wedge design (SWD), the areas of research to which the design has been applied and the general characteristics of the design. However these did not focus on the statistical methods nor addressed the appropriateness of sample size methods used.This was a review of the literature of the statistical methodology used in stepped wedge cluster randomised trials. METHODS Literature Review. The Medline, Embase, PsycINFO, CINAHL and Cochrane databases were searched for methodological guides and RCTs which employed the stepped wedge design. RESULTS This review identified 102 trials which employed the stepped wedge design compared to 37 from the most recent review by Beard et al. 2015. Forty six trials were cohort designs and 45 % (n = 46) had fewer than 10 clusters. Of the 42 articles discussing the design methodology 10 covered analysis and seven covered sample size. For cohort stepped wedge designs there was only one paper considering analysis and one considering sample size methods. Most trials employed either a GEE or mixed model approach to analysis (n = 77) but only 22 trials (22 %) estimated sample size in a way which accounted for the stepped wedge design that was subsequently used. CONCLUSIONS Many studies which employ the stepped wedge design have few clusters but use methods of analysis which may require more clusters for unbiased and efficient intervention effect estimates. There is the need for research on the minimum number of clusters required for both types of stepped wedge design. Researchers should distinguish in the sample size calculation between cohort and cross sectional stepped wedge designs. Further research is needed on the effect of adjusting for the potential confounding of time on the study power.
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Affiliation(s)
- D Barker
- School of Medicine and Public Health, Faculty of Health, CCEB, HMRI Building, Level 4 West, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - P McElduff
- School of Medicine and Public Health, Faculty of Health, CCEB, HMRI Building, Level 4 West, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - C D'Este
- School of Medicine and Public Health, Faculty of Health, CCEB, HMRI Building, Level 4 West, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, 0200, Australia
| | - M J Campbell
- Medical Statistics Group, ScHARR, University of Sheffield, Sheffield, UK
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Kapur N, Ibrahim S, While D, Baird A, Rodway C, Hunt IM, Windfuhr K, Moreton A, Shaw J, Appleby L. Mental health service changes, organisational factors, and patient suicide in England in 1997-2012: a before-and-after study. Lancet Psychiatry 2016; 3:526-34. [PMID: 27107805 DOI: 10.1016/s2215-0366(16)00063-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/29/2016] [Accepted: 02/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research into which aspects of service provision in mental health are most effective in preventing suicide is sparse. We examined the association between service changes, organisational factors, and suicide rates in a national sample. METHODS We did a before-and-after analysis of service delivery data and an ecological analysis of organisational characteristics, in relation to suicide rates, in providers of mental health care in England. We also investigated whether the effect of service changes varied according to markers of organisational functioning. FINDINGS Overall, 19 248 individuals who died by suicide within 12 months of contact with mental health services were included (1997-2012). Various service changes related to ward safety, improved community services, staff training, and implementation of policy and guidance were associated with a lower suicide rate after the introduction of these changes (incidence rate ratios ranged from 0·71 to 0·79, p<0·0001). Some wider organisational factors, such as non-medical staff turnover (Spearman's r=0·34, p=0·01) and incident reporting (0·46, 0·0004), were also related to suicide rates but others, such as staff sickness (-0·12, 0·37) and patient satisfaction (-0·06, 0·64), were not. Service changes had more effect in organisations that had low rates of staff turnover but high rates of overall event reporting. INTERPRETATION Aspects of mental health service provision might have an effect on suicide rates in clinical populations but the wider organisational context in which service changes are made are likely to be important too. System-wide change implemented across the patient care pathway could be a key strategy for improving patient safety in mental health care. FUNDING The Healthcare Quality Improvement Partnership commissions the Mental Health Clinical Outcome Review Programme, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, on behalf of NHS England, NHS Wales, the Scottish Government Health and Social Care Directorate, the Northern Ireland Department of Health, Social Services and Public Safety, and the States of Jersey and Guernsey.
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Affiliation(s)
- Nav Kapur
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Manchester Mental Health and Social Care Trust, Manchester, UK.
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - David While
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Alison Baird
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Cathryn Rodway
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Isabelle M Hunt
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Kirsten Windfuhr
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Adam Moreton
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Jenny Shaw
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Castelnuovo G, Pietrabissa G, Cattivelli R, Manzoni GM, Molinari E. Not Only Clinical Efficacy in Psychological Treatments: Clinical Psychology Must Promote Cost-Benefit, Cost-Effectiveness, and Cost-Utility Analysis. Front Psychol 2016; 7:563. [PMID: 27242562 PMCID: PMC4860399 DOI: 10.3389/fpsyg.2016.00563] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/05/2016] [Indexed: 01/17/2023] Open
Affiliation(s)
- Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Roberto Cattivelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Faculty of Psychology, eCampus UniversityNovedrate, Italy
| | - Enrico Molinari
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
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Cooper K, Gillmore C, Hogg L. Experience-based co-design in an adult psychological therapies service. J Ment Health 2015; 25:36-40. [DOI: 10.3109/09638237.2015.1101423] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Springham N, Robert G. Experience based co-design reduces formal complaints on an acute mental health ward. BMJ QUALITY IMPROVEMENT REPORTS 2015; 4:bmjquality_uu209153.w3970. [PMID: 26734433 PMCID: PMC4693090 DOI: 10.1136/bmjquality.u209153.w3970] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/11/2015] [Indexed: 11/30/2022]
Abstract
An acute mental health triage ward at Oxleas NHS Foundation Trust was attracting high levels of formal service user and family complaints. The Trust used experience based co-design to examine the issues and redesign procedures. This resulted in an immediate eradication of formal complaints for a period of 23 months. This paper describes two outcomes: firstly, the successful adaptations made to the experience based co-design methodology from its origins in physical care, in order to ensure it was safe and effective in an acute mental health setting; and, secondly, the changes made to the ward as a result of this quality improvement intervention.
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Affiliation(s)
- Neil Springham
- Oxleas NHS Foundation Trust and Kings College London, UK (respectively)
| | - Glenn Robert
- Oxleas NHS Foundation Trust and Kings College London, UK (respectively)
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