1
|
Drinkwater J, Farr M, Hickey G, Van Vliet E, Söderholm Werkö S, Klingmann I, Blackburn S. Series: Public engagement with research. Part 3: Sharing power and building trust through partnering with communities in primary care research. Eur J Gen Pract 2024; 30:2328707. [PMID: 38546448 PMCID: PMC10984225 DOI: 10.1080/13814788.2024.2328707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND This article focuses on potential strategies to support primary care researchers in working in partnership with the public and healthcare professionals. Partnership working can potentially to improve the relevance and usefulness of research and ensure better research and health outcomes. DISCUSSION We describe what we mean by partnership working and the importance of reflecting on power and building trusting relationships. To share power in partnership working, it is essential to critically reflect on the multiple dimensions of power, their manifestations, and your own power. Power can influence relationships and therefore, it is essential to build trust with partners. Next, we outline how the context of primary care research and decisions about who you work with and how to work together, are vital considerations that are imbued with power. Lastly, we suggest different ways of working in partnership to address different dimensions of power. We provide examples from primary care research across Europe regarding how to recognise, tackle, and challenge, invisible, hidden and visible power. CONCLUSION We conclude by proposing three calls to actions to encourage researchers working in primary care to consider the multiple dimensions of power and move towards partnership working. First is to use participatory methods to improve the inclusivity of your research. Second is to include patients and the public in decisions about the design, delivery and development of research and its outcomes. Third is to address various systemic and institutional barriers which hinder partnership working.
Collapse
Affiliation(s)
- Jessica Drinkwater
- Centre for Primary Care and Health Services Research, University of Manchester, United Kingdom
| | - Michelle Farr
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Gary Hickey
- Agora Digital Centre, School of Healthcare Enterprise and Innovation, University of Southampton, United Kingdom
| | | | - Sophie Söderholm Werkö
- The Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Ingrid Klingmann
- European Forum for Good Clinical Practice (EFGCP), Brussels, Belgium
| | - Steven Blackburn
- Institute of Applied Health Research, University of Birmingham, United Kingdom
| |
Collapse
|
2
|
Xiong S, Jiang W, Wang Y, Wang G, Zhang X, Hu C, Bao M, Li F, Yang J, Hou H, Peng N, Wang Q, Jiang R, Liu T, Wang J, Ma Y, Ye P, Mao L, Peiris D, Tian M. Co-designing interventions to strengthen the primary health care system for the management of hypertension and type 2 diabetes in China. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 49:101131. [PMID: 39056090 PMCID: PMC11269299 DOI: 10.1016/j.lanwpc.2024.101131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/21/2024] [Accepted: 06/16/2024] [Indexed: 07/28/2024]
Abstract
Background Policy makers and researchers are tasked with exploring ways to strengthen primary health care (PHC) to address the growing burden of non-communicable diseases (NCDs). This study aims to use a co-design approach (i.e., meaningful involvement of research end users in study planning and design) to develop PHC interventions to improve the management of hypertension and type 2 diabetes (T2DM) in four study sites in China. Methods The study adopted a three-step co-design approach, including (1) a two-round Delphi panel with health system and NCD professionals to identify prioritised health system challenges, (2) three co-design workshops (in each study site) with local health administrators, PHC providers, and residents with hypertension and/or T2DM, respectively, to develop interventions and identify factors influencing implementation, and (3) another round of co-design workshops with local health administrators to summarise findings and reach consensus. Qualitative synthesis was conducted to analyse results from the workshops. Findings Thirteen experts were involved in the two-round Delphi panel, which identified three prioritised health system challenges, including limited capacities of PHC providers, suboptimal service quality and evaluation mechanisms, and unreliable health information systems. The co-design workshops involved 116 local stakeholders in 16 sessions (four in each site), and developed three groups of interventions to address the challenges: (1) empowering PHC providers through on-the-job training for capacity building; (2) empowering patient communities through health education on healthy lifestyles and NCD self-management; and (3) empowering health administrators through local health data monitoring and strengthening governance for local PHC programs. Site-specific interventions were also considered to cater for different local contexts. Several recommendations were further identified for the implementation of these interventions, emphasising the importance of local customisation, community participation, and cross-sectoral collaborations. Interpretation By engaging multiple stakeholders in priority setting and solution generation, this study summarised several key areas for change in health workforce, service delivery, and health information. Future research should examine the effectiveness and implementation of these interventions to improve NCD management in PHC in China. Funding This study is funded by National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases funding (APP1169757) and National Natural Science Foundation of China (72074065). Shangzhi Xiong is supported by University of New South Wales tuition fee scholarship.
Collapse
Affiliation(s)
- Shangzhi Xiong
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Global Health Research Centre, Duke Kunshan University, Kunshan, China
| | - Wei Jiang
- Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Yongchen Wang
- Department of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guosheng Wang
- Academy of Arts & Design, Tsinghua University, Beijing, China
| | - Xinyi Zhang
- School of Public Health, Harbin Medical University, Harbin, China
| | - Chi Hu
- Yichang City Centre for Disease Control and Prevention, Yichang, China
| | - Mingjia Bao
- Heilongjiang Provincial Centre for Disease Control and Prevention, Harbin, China
| | - Fan Li
- Health Bureau of Wenjiang District, Chengdu, China
| | - Jiajuan Yang
- Yichang City Centre for Disease Control and Prevention, Yichang, China
| | - Huinan Hou
- Jiamusi City Centre for Disease Control and Prevention, Jiamusi, China
| | - Nan Peng
- Wenjiang District Centre for Disease Control and Prevention, Chengdu, China
| | - Qiujun Wang
- Department of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Rui Jiang
- Department of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tingzhuo Liu
- School of Public Health, Harbin Medical University, Harbin, China
| | - Jin'ge Wang
- School of Public Health, Harbin Medical University, Harbin, China
| | - Yanqiuzi Ma
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Pengpeng Ye
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Limin Mao
- Centre for Social Research in Health, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Maoyi Tian
- Department of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| |
Collapse
|
3
|
Rodriguez A, Shambhunath S, Wijesiri TID, Biazus-Dalcin C, Mc Goldrick N. Co-design of health educational materials with people experiencing homelessness and support workers: a scoping review. FRONTIERS IN ORAL HEALTH 2024; 5:1355349. [PMID: 38919732 PMCID: PMC11196637 DOI: 10.3389/froh.2024.1355349] [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: 12/13/2023] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction People experiencing homelessness are often marginalised and encounter structural barriers when seeking healthcare. Community-based oral health interventions highlighted the need of well-trained practitioners for the successful engagement of service users and behaviour change. However, a lack of adequate information and specific training has been previously reported. The adoption of inclusive approaches, such as co-design, to develop tailored and meaningful health promotion training and educational materials capable of addressing the specific needs of this group is required. Co-design entails active involvement of different groups in research processes that acknowledge participants' needs and expectations. This scoping review aims to identify the available literature on the participation of people experiencing homelessness and/or their support workers in co-designing health and oral health promotion training/educational materials, approaches adopted, and barriers and enablers to develop these materials. Methods The Joanna Briggs Institute (JBI) Scoping Review Methodology informed the development of the scoping review. The protocol was registered on the Open Science Framework. Six electronic databases (Medline (OVID), PsychInfo (OVID), Scopus, Web of Science, Applied Social Sciences Index and Abstracts (ASSIA) (ProQuest) and CINHAL) were systematically searched using MeSH terms. An extensive grey literature search, consultation with experts and hand searching of reference lists took place. Records were screened independently and in duplicate using the Rayyan Qatar Computing Research Institute (QCRI) online tool, followed by qualitative content analysis involving descriptive data coding. Results Eight studies/materials were included. Key approaches adopted to co-design, enablers and barriers were captured. The enablers were inclusivity, a safe environment for positive participation, empowerment and flexibility, the barriers were difficulty in recruiting and sustaining participation, power differentials, and limited resources. Conclusion The evidence in this area is limited. This scoping review provided foundations for further research to examine the impact of different components of the co-design process including the environment in which the co-design process is conducted. Further studies with experimental design and reported using appropriate study design frameworks detailing active components of the co-design process would strengthen the evidence base in this area.
Collapse
Affiliation(s)
- Andrea Rodriguez
- Dental Public Health, School of Dentistry, University of Dundee, Dundee, United Kingdom
| | | | | | - Camila Biazus-Dalcin
- Mother, Infant and Child Research Group (MIRU), School of Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Niall Mc Goldrick
- Dental Public Health, School of Dentistry, University of Dundee, Dundee, United Kingdom
| |
Collapse
|
4
|
Dias T, MacKay D, Canuto K, Boyle JA, D’Antoine H, Hampton D, Martin K, Phillips J, Bartlett N, Mcintyre HD, Graham S, Corpus S, Connors C, McCarthy L, Kirkham R, Maple-Brown LJ. Supporting healthy lifestyles for First Nations women and communities through co-design: lessons and early findings from remote Northern Australia. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1356060. [PMID: 38863516 PMCID: PMC11165116 DOI: 10.3389/fcdhc.2024.1356060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/24/2024] [Indexed: 06/13/2024]
Abstract
Background The period before, during, and after pregnancy presents an opportunity to reduce diabetes-related risks, which in Australia disproportionately impact Aboriginal and Torres Strait Islander women. Collaboration with Aboriginal and Torres Strait Islander women/communities is essential to ensure acceptability and sustainability of lifestyle modifications. Using a novel co-design approach, we aimed to identify shared priorities and potential lifestyle strategies. We also reflected on learnings from this approach. Methods We conducted 11 workshops and 8 interviews at two sites in Australia's Northern Territory (Central Australia and Top End), using experience-based co-design (EBCD) and incorporating principles of First Nations participatory research. Workshops/interviews explored participant' experiences and understanding of diabetes in pregnancy, contextual issues, and potential lifestyle strategies. Participants included three groups: 1) Aboriginal and Torres Strait Islander women of reproductive age (defined as aged 16-45 years); 2) Aboriginal and Torres Strait Islander community members; and 3) health/community services professionals. The study methodology sought to amplify the voices of Aboriginal women. Findings Participants included 23 women between ages 16-45 years (9 with known lived experience of diabetes in pregnancy), 5 community members and 23 health professionals. Key findings related to identified priority issues, strategies to address priorities, and reflections on use of EBCD methodology. Priorities were largely consistent across study regions: access to healthy foods and physical activity; connection to traditional practices and culture; communication regarding diabetes and related risks; and the difficulty for women of prioritising their health among competing priorities. Strategies included implementation of a holistic women's program in Central Australia, while Top End participants expressed the desire to improve nutrition, peer support and community awareness of diabetes. EBCD provided a useful structure to explore participants' experiences and collectively determine priorities, while allowing for modifications to ensure co-design methods were contextually appropriate. Challenges included the resource-intensive nature of stakeholder engagement, and collaborating effectively with services and communities when researchers were "outsiders". Conclusions A hybrid methodology using EBCD and First Nations participatory research principles enabled collaboration between Aboriginal women, communities and health services to identify shared priorities and solutions to reduce diabetes-related health risks. Genuine co-design processes support self-determination and enhance acceptability and sustainability of health strategies.
Collapse
Affiliation(s)
- Tara Dias
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Diana MacKay
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Karla Canuto
- College of Medicine and Public Health, Flinders University , Melbourne, VIC, Australia
| | - Jacqueline A. Boyle
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Heather D’Antoine
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Denella Hampton
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
- Aboriginal and Torres Strait Islander Advisory Group, Diabetes Across the Lifecourse: Northern Australia Partnership, Darwin, NT, Australia
| | - Kim Martin
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Jessica Phillips
- Women’s Cultural Hub, Mala’la Community Wellness Centre, Mala’la Aboriginal Health Corporation, Maningrida, NT, Australia
| | - Norlisha Bartlett
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - H. David Mcintyre
- Mater Research, The University of Queensland, Brisbane, QLD, Australia
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Aboriginal and Torres Strait Islander Advisory Group, Diabetes Across the Lifecourse: Northern Australia Partnership, Darwin, NT, Australia
| | - Sumaria Corpus
- Aboriginal and Torres Strait Islander Advisory Group, Diabetes Across the Lifecourse: Northern Australia Partnership, Darwin, NT, Australia
- Northern Territory Department of Health, Darwin, NT, Australia
| | | | - Leisa McCarthy
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Anyinginyi Health Aboriginal Corporation, Tennant Creek, NT, Australia
| | - Renae Kirkham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Louise J. Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, NT, Australia
| |
Collapse
|
5
|
Wyndham-West CM, Dunn JR. Housing Instability and Policy Considerations for Equitable Aging in Place in Canada. Can J Aging 2024:1-11. [PMID: 38778474 DOI: 10.1017/s0714980824000205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND In this article, we apply a gender-based analysis plus framework to research the housing experiences of older, low-income adults living and aging in Hamilton. Low-income older adults with intersectional identities are at risk of not aging in place due to marginalization and housing instability. OBJECTIVE Policy currently homogenizes the experience of aging by sidelining intersectional factors that have a bearing on aging well in place. The research aims to develop policy recommendations to address this gap. METHODS Several methods captured the housing experiences of low-income older adults, including interviews, participant observation, and arts-based techniques. FINDINGS Findings illustrate how gender and intersectional factors shape both housing trajectories and agentive practices low-income adults utilize to try to age well and in place. These strategies encompass practicing cultural citizenship, which is a claim for inclusion when excluded from mainstream ideals of aging in place. DISCUSSION We provide policy recommendations informed by participants' lived experiences aimed at promoting equitable aging in place as fundamental to full citizenship.
Collapse
Affiliation(s)
- C Michelle Wyndham-West
- Graduate Program Director, Inclusive Design and Design for Health, OCAD University, Toronto, ON, Canada
| | - James R Dunn
- Associate Dean, Faculty of Social Sciences and Professor, Health, Aging & Society, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
6
|
Hine R, Gladstone B, Reupert A, O’Dea L, Cuff R, Yates S, Silvén Hagström A, McGaw V, Foster K. StigmaBeat: Collaborating With Rural Young People to Co-Design Films Aimed at Reducing Mental Health Stigma. QUALITATIVE HEALTH RESEARCH 2024; 34:491-506. [PMID: 38029299 PMCID: PMC11080393 DOI: 10.1177/10497323231211454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Little is known about the experience and impact of intersectional stigma experienced by rural young people (15-25 years) who have a parent with mental health challenges. The StigmaBeat project employed a co-design approach to create short films to identify and challenge mental health stigma from the perspective of young people who have experienced this phenomenon. The aim of this paper is to describe the co-design methodological approach used in StigmaBeat, as an example of a novel participatory project. We describe one way that co-design can be employed by researchers in collaboration with marginalised young people to produce films aimed at reducing mental health stigma in the community. Through describing the processes undertaken in this project, the opportunities, challenges, and tensions of combining community development methods with research methods will be explored. Co-design with young people is a dynamic and engaging method of collaborative research practice capable of harnessing lived experience expertise to intervene in social issues and redesign or redevelop health services and policies. The participatory approach involved trusting and implementing the suggestions of young people in designing and developing the films and involved creating the physical and social environment to enable this, including embedding creativity, a critical element to the project's methodological success. Intensive time and resource investment are needed to engage a population that is often marginalised in relation to stigma discourse.
Collapse
Affiliation(s)
- Rochelle Hine
- Monash Rural Health, Monash University, Warragul, VIC, Australia
| | - Brenda Gladstone
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Andrea Reupert
- School of Educational Psychology and Counselling, Monash University, Warragul, VIC, Australia
| | - Lotti O’Dea
- Independent Consultant, Naarm/Collingwood, VIC, Australia
| | - Rose Cuff
- Satellite Foundation, Naarm/Collingwood, VIC, Australia
| | - Scott Yates
- School of Applied Social Sciences, De Montfort University, Leicester, UK
| | | | | | - Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, VIC, Australia
| |
Collapse
|
7
|
Janssens N, Van Wilder L, Van Hecke A, Van Hoorenbeeck K, Vanden Wyngaert K, De Smedt D, Goossens E. COCCOS study: Developing a transition program for adolescents with chronic conditions using Experience-Based Co-Design. A study protocol. PLoS One 2024; 19:e0298571. [PMID: 38578769 PMCID: PMC10997087 DOI: 10.1371/journal.pone.0298571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/25/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND During adolescence, adolescents and young adults (AYAs) are expected to transfer their care from the pediatric environment towards an adult-focused setting. To prevent an abrupt transfer of care, it is recommended to provide AYAs with chronic conditions an adequate transition program. The aim of this paper is to describe the study protocol for the development of a transition program for AYAs with common chronic conditions (COCCOS study), using the Experience-Based Co-Design (EBCD) methodology. METHODS AND ANALYSIS A qualitative, participatory study is conducted in Flanders (Belgium). Study participants are AYAs (n≥15, 14-25 years old, diagnosed with type 1 diabetes, asthma, or obesity), their families, and healthcare providers (n≥15). The study is composed of eight EBCD stages: clinical site observations, in-depth interviews, trigger film, healthcare providers' feedback event, AYAs' feedback event, joint event, co-design workshops, and a celebration event. Photovoice will take place as a starting point of EBCD. Data will be analyzed using thematic analysis. RESULTS Data collection has started in January 2023 and is expected to be completed in May 2024. As of August 2023, over 15 clinical site observations have been conducted. A total of 18 AYAs, two parents, six healthcare providers have been enrolled and a total of 20 interviews have been conducted. CONCLUSION Advancing transitional care is essential for tackling negative health outcomes. Applying the innovative participatory EBCD methodology will reveal key elements of transitional care for AYAs with common chronic conditions in the development of a person-centered transition program. PRACTICE IMPLICATIONS Study findings will apply key elements of transitional care of AYAs with chronic conditions in the development of an adequate transition program.
Collapse
Affiliation(s)
- Natwarin Janssens
- Department of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lisa Van Wilder
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Ghent University Hospital, Ghent, Belgium
| | - Kim Van Hoorenbeeck
- Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | | | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Eva Goossens
- Department of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Patient Care, Antwerp University Hospital, Antwerp, Belgium
| |
Collapse
|
8
|
Anderson‐Kittow R, Keagan‐Bull R, Giles J, Tuffrey‐Wijne I. Co-designing resources to support older people with intellectual disabilities and their families plan for parental death and transitions in care. Health Expect 2024; 27:e14000. [PMID: 38432852 PMCID: PMC10909614 DOI: 10.1111/hex.14000] [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: 06/09/2023] [Revised: 12/09/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Older people with intellectual disabilities and their families report a lack of support for planning for parental death and transitions in care. This article aims to demonstrate the process of co-designing resources to support older people with intellectual disabilities and their families to plan for the future. METHODS Following interviews and focus groups with older people with intellectual disabilities and their families, we used an adapted experience-based co-design process to develop planning ahead resources. This included a 'trigger film' summarising findings from the earlier interview study, 12 co-design workshops and a user feedback phase. RESULTS The co-design group developed a set of 102 'Planning Ahead Cards' to help families to talk about the future and prepare for meetings with social care professionals. The group made decisions about the content, format and design of resources, and how co-design workshops would run. The user feedback phase led to changes to the cards, and families and stakeholder groups suggested that they would be useful for planning ahead. CONCLUSION The Planning Ahead Cards may facilitate planning for parental death and transitions in care for older people with intellectual disabilities and their families. The co-design approach was key to ensuring that the resources were useful and accessible for families. PATIENT OR PUBLIC CONTRIBUTION People with intellectual disabilities and their families contributed to the design of the resources through the co-design workshops and feedback phase. The research team includes a research assistant with intellectual disabilities who co-facilitated co-design workshops and co-authored this article.
Collapse
Affiliation(s)
- Rebecca Anderson‐Kittow
- Faculty of Health, Science, Social Care and Education, School of NursingKingston UniversityKingston upon ThamesUK
| | - Richard Keagan‐Bull
- Faculty of Health, Science, Social Care and Education, School of NursingKingston UniversityKingston upon ThamesUK
| | - Jo Giles
- Faculty of Health, Science, Social Care and Education, School of NursingKingston UniversityKingston upon ThamesUK
| | - Irene Tuffrey‐Wijne
- Faculty of Health, Science, Social Care and Education, School of NursingKingston UniversityKingston upon ThamesUK
| |
Collapse
|
9
|
Johnston EA, Collins KE, Vicario JN, Sibthorpe C, Ireland MJ, Goodwin BC. Changes in rural caregivers' health behaviors while supporting someone with cancer: A qualitative study. Cancer Med 2024; 13:e7157. [PMID: 38572938 PMCID: PMC10993705 DOI: 10.1002/cam4.7157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/11/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE Caring for someone with cancer has a significant impact on usual routines, including caregivers' ability to maintain their own health and wellbeing. Caregivers living in rural areas face additional challenges in supporting someone with cancer, and little is known about the impact of caregiving on the health behaviors of rural caregivers. Therefore, this study explored how caring for someone with cancer affected rural caregivers' health behaviors. METHODS Through semi-structured interviews, 20 rural caregivers described changes in their health behaviors while caring for someone with cancer and the factors underlying these changes. Specific prompts were provided for diet, physical activity, alcohol, smoking, sleep, social connection and leisure, and accessing health care when needed. Interviews were audio-recorded and transcribed verbatim. Content analysis was used to identify changes in health behaviors and the factors underlying these changes. The factors identified were mapped to the socioecological framework, identifying areas for intervention across multiple levels (individual, interpersonal, organizational, community, and policy). RESULTS Rural caregivers reported both positive and negative changes to their diet, physical activity, alcohol, and smoking. Sleep, social connection and leisure, and accessing health care were negatively impacted since becoming a caregiver. CONCLUSIONS Designing interventions to address rural caregivers' coping strategies, reduce carer burden and fatigue, improve access to cooking and exercise facilities and social support while away from home, reduce the need to travel for treatment, and increase the financial support available could yield widespread benefits for supporting the health and wellbeing of rural caregivers.
Collapse
Affiliation(s)
- Elizabeth A. Johnston
- Cancer Council QueenslandFortitude ValleyQueenslandAustralia
- School of Exercise and Nutrition SciencesQueensland University of TechnologyKelvin GroveQueenslandAustralia
- Population Health ProgramQIMR Berghofer Medical Research InstituteHerstonQueenslandAustralia
| | - Katelyn E. Collins
- Cancer Council QueenslandFortitude ValleyQueenslandAustralia
- School of Psychology and WellbeingUniversity of Southern QueenslandSpringfieldQueenslandAustralia
| | | | - Chris Sibthorpe
- Cancer Council QueenslandFortitude ValleyQueenslandAustralia
| | - Michael J. Ireland
- School of Psychology and WellbeingUniversity of Southern QueenslandSpringfieldQueenslandAustralia
- Centre for Health ResearchUniversity of Southern QueenslandSpringfieldQueenslandAustralia
| | - Belinda C. Goodwin
- Cancer Council QueenslandFortitude ValleyQueenslandAustralia
- Centre for Health ResearchUniversity of Southern QueenslandSpringfieldQueenslandAustralia
- School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| |
Collapse
|
10
|
Phoenix M, Moll S, Vrzovski A, Bhaskar L, Micsinszki S, Bruce E, Mulalu L, Hossain P, Freeman B, Mulvale G, Consortium C. Advancing a collective vision for equity-based cocreation through prototyping at an international forum. Health Expect 2024; 27:e14041. [PMID: 38567877 PMCID: PMC10989061 DOI: 10.1111/hex.14041] [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: 12/06/2023] [Revised: 01/26/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Cocreation has the potential to engage people with lived and living experiences in the design and evaluation of health and social services. However, guidance is needed to better include people from equity-deserving groups (EDGs), who are more likely to face barriers to participation, experience ongoing or historical harm, and benefit from accessible methods of engagement. OBJECTIVE The aim of this international forum (CoPro2022) was to advance a collective vision for equity-based cocreation. DESIGN A participatory process of engagement in experiential colearning and arts-based creative and reflective dialogue. Visual prototypes were created and synthesised to generate a collective vision for inclusive equity-based cocreation. SETTING AND PARTICIPANTS The Forum was held at the Gathering Place by the Grand River in Ohsweken, Ontario, Canada. A total of 48 participants attended the forum. They were purposely invited and have intersecting positionalities (21 academic experts, six experience experts, 10 trainees, and 11 members of EDGs) from nine countries (Bangladesh, Botswana, Canada, England, Italy, Norway, Scotland, Singapore, Sweden). COPRO2022 ACTIVITIES: CoPro2022 was an immersive experience hosted on Indigenous land that encouraged continuous participant reflection on their own worldviews and those of others as participants openly discussed the challenges and opportunities with engaging EDGs in cocreation activities. Visual prototypes and descriptions created in small groups were informed by participants' reflections on the panel presentations at the Forum and their own experiences with equity-based cocreation. Following the event, the authorship team inductively coded themes from the prototype descriptions and met to discuss the cross-cutting themes. These informed the design of an illustrated collective vision for Equity Based Co-Creation (EqCC). RESULTS Six prototypes were cocreated by each small group to illustrate their vision for EqCC. Within these, four cross-cutting themes were identified: (i) go to where people are, (ii) nurture relationships and creativity, (iii) reflect, replenish and grow, (iv) and promote thriving and transformation. These four themes are captured in the Collective EqCC Vision to guide a new era of inclusive excellence in cocreation activities. PATIENT OR PUBLIC CONTRIBUTION Service users, caregivers, and people with lived experience were involved in leading the design of the CoPro2022 and co-led the event. This included activities at the event such as presenting, facilitating small and large group discussion, leading art-based activities, and reflecting with the team on the lessons learned. People with lived experience were involved in the analysis and knowledge sharing from this event. Several members of the research team (students and researchers) also identified as members of EDGs and were invited to draw from their personal and academic knowledge.
Collapse
Affiliation(s)
- Michelle Phoenix
- School of Rehabilitation Sciences, CanChildMcMaster UniversityHamiltonOntarioCanada
| | - Sandra Moll
- School of Rehabilitation SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Alexa Vrzovski
- Ahousaht First NationAhousatBritish ColombiaCanada
- Indigenous Project Coordinator, School of MedicineToronto Metropolitan UniversityTorontoOntarioCanada
| | - Le‐Tien Bhaskar
- Health Research Methods, Evidence, and Impact (Health Policy)McMaster UniversityHamiltonOntarioCanada
| | - Samantha Micsinszki
- School of Rehabilitation Sciences, CanChildMcMaster UniversityHamiltonOntarioCanada
| | - Emma Bruce
- School of Rehabilitation SciencesMcMaster UniversityHamiltonOntarioCanada
| | | | - Puspita Hossain
- Health Research Methods, Evidence, and Impact (Health Policy)McMaster UniversityHamiltonOntarioCanada
| | - Bonnie Freeman
- School of Social Work and Indigenous Studies DepartmentMcMaster University; Algonquin/Mohawk, Member of the Six Nations of the Grand RiverCanada
| | - Gillian Mulvale
- Health Policy and Management, DeGroote School of BusinessMcMaster UniversityHamiltonOntarioCanada
| | | |
Collapse
|
11
|
Mulvale G, Moll S, Phoenix M, Buettgen A, Freeman B, Murray-Leung L, Micsinszki SK, Mulalu L, Vrzovski A, Foisy C. Co-creating a new Charter for equitable and inclusive co-creation: insights from an international forum of academic and lived experience experts. BMJ Open 2024; 14:e078950. [PMID: 38508634 PMCID: PMC10953044 DOI: 10.1136/bmjopen-2023-078950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/04/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Co-creation approaches, such as co-design and co-production, aspire to power-sharing and collaboration between service providers and service users, recognising the specific insights each group can provide to improve health and other public services. However, an intentional focus on equity-based approaches grounded in lived experience and epistemic justice is required considering entrenched structural inequities between service-users and service-providers in public and institutional spaces where co-creation happens. OBJECTIVES This paper presents a Charter of tenets and principles to foster a new era of 'Equity-based Co-Creation' (EqCC). METHODS The Charter is based on themes heard during an International Forum held in August 2022 in Ontario, Canada, where 48 lived experience experts and researchers were purposively invited to deliberate challenges and opportunities in advancing equity in the co-creation field. RESULTS The Charter's seven tenets-honouring worldviews, acknowledging ongoing and historical harms, operationalising inclusivity, establishing safer and brave spaces, valuing lived experiences, 'being with' and fostering trust, and cultivating an EqCC heartset/mindset-aim to promote intentional inclusion of participants with intersecting social positions and differing historic oppressions. This means honouring and foregrounding lived experiences of service users and communities experiencing ongoing structural oppression and socio-political alienation-Black, Indigenous and people of colour; disabled, Mad and Deaf communities, women, 2S/LGBTQIA+ communities, people perceived to be mentally ill and other minoritised groups-to address epistemic injustice in co-creation methodologies and practice, thereby providing opportunities to begin to dismantle intersecting systems of oppression and structural violence. CONCLUSIONS Each Charter tenet speaks to a multilayered, multidimensional process that is foundational to shifting paradigms about redesigning our health and social systems and changing our relational practices. Readers are encouraged to share their reactions to the Charter, their experiences implementing it in their own work, and to participate in a growing international EqCC community of practice.
Collapse
Affiliation(s)
- Gillian Mulvale
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Sandra Moll
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Phoenix
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Alexis Buettgen
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Bonnie Freeman
- Six Nations of the Grand River Territory, Ohsweken, Ontario, Canada
- School of Social Work and Indigenous Studies Department, Faculty of Social Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Louise Murray-Leung
- McMaster University, Hamilton, Ontario, Canada
- Parents for Children's Mental Health, Toronto, Ontario, Canada
| | - Samantha K Micsinszki
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Lulwama Mulalu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alexa Vrzovski
- Ahousaht First Nation, British Columbia, Canada
- School of Medicine, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Christina Foisy
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| |
Collapse
|
12
|
McGowan D, Morley C, Hansen E, Shaw K, Winzenberg T. Experiences of participants in the co-design of a community-based health service for people with high healthcare service use. BMC Health Serv Res 2024; 24:339. [PMID: 38486164 PMCID: PMC10938828 DOI: 10.1186/s12913-024-10788-5] [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: 09/26/2023] [Accepted: 02/26/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Incorporating perspectives of health consumers, healthcare workers, policy makers and stakeholders through co-design is essential to design services that are fit for purpose. However, the experiences of co-design participants are poorly understood. The aim of this study is to explore the experiences and perceptions of people involved in the co-design of a new service for people with high healthcare service utilisation. METHODS A methodology informed by the principles of grounded theory was used in this qualitative study to evaluate the experiences and perceptions of co-design participants. Participants were healthcare professionals, health managers and leaders and health consumers involved in the co-design of the new service in Tasmania, Australia. Semi-structured interviews were conducted, and data were iteratively and concurrently collected and analysed using constant comparative analysis. Audio/audio-visual recordings of interviews were transcribed verbatim. Transcripts, memos, and an audit trail were coded for experiences and perspectives of participants. RESULTS There were thirteen participants (5 health professionals, 6 health managers and leaders, and 2 health consumers). Codes were collapsed into six sub-themes and six themes. Themes were bureaucracy hinders co-design, importance of consumers and diversity, importance of a common purpose, relationships are integral, participants expectations inform their co-design experience and learning from co-design. CONCLUSION Most participants reported positive aspects such as having a common purpose, valuing relationships, and having a personal motivation for participating in co-design. However, there were factors which hindered the adaptation of co-design principles and the co-design process. Our research highlights that bureaucracy can hinder co-design, that including people with lived experience is essential and the need to consider various types of diversity when assembling co-design teams. Future co-design projects could use these findings to improve the co-design experience for participants, and ultimately the outcome for communities.
Collapse
Affiliation(s)
- Deirdre McGowan
- Menzies Institute for Medical Research University of Tasmania, Hobart, Australia.
| | - Claire Morley
- Menzies Institute for Medical Research University of Tasmania, Hobart, Australia
| | | | - Kelly Shaw
- Menzies Institute for Medical Research University of Tasmania, Hobart, Australia
- KP Health, Hobart, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research University of Tasmania, Hobart, Australia
- Primary Health Tasmania, Hobart, Australia
| |
Collapse
|
13
|
Langford R, Brockman R, Banks J, Jago R, Gillison F, Coulman K, Moore T, Nobles J. Co-designing adult weight management services: a qualitative study exploring barriers, facilitators, and considerations for future commissioning. BMC Public Health 2024; 24:778. [PMID: 38475750 DOI: 10.1186/s12889-024-18031-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Weight management services have not always benefitted everyone equally. People who live in more deprived areas, racially minoritised communities, those with complex additional needs (e.g., a physical or mental disability), and men are less likely to take part in weight management services. This can subsequently widen health inequalities. One way to counter this is to co-design services with under-served groups to better meet their needs. Using a case study approach, we explored how co-designed adult weight management services were developed, the barriers and facilitators to co-design, and the implications for future commissioning. METHODS We selected four case studies of adult weight management services in Southwest England where co-design had been planned, representing a range of populations and settings. In each case, we recruited commissioners and providers of the services, and where possible, community members involved in co-design activities. Interviews were conducted online, audio-recorded, transcribed verbatim, and analysed using thematic analysis. RESULTS We interviewed 18 participants (8 female; 10 male): seven commissioners, eight providers, and three community members involved in co-designing the services. The case studies used a range of co-design activities (planned and actualised), from light-touch to more in-depth approaches. In two case studies, co-design activities were planned but were not fully implemented due to organisational time or funding constraints. Co-design was viewed positively by participants as a way of creating more appropriate services and better engagement, thus potentially leading to reduced inequalities. Building relationships- with communities, individual community members, and with partner organisations- was critical for successful co-design and took time and effort. Short-term and unpredictable funding often hindered co-design efforts and could damage relationships with communities. Some commissioners raised concerns over the limited evidence for co-design, while others described having to embrace "a different way of thinking" when commissioning for co-design. CONCLUSIONS Co-design is an increasingly popular approach to designing health in services but can be difficult to achieve within traditional funding and commissioning practices. Drawing on our case studies, we present key considerations for those wanting to co-design health services, noting the importance of building strong relationships, creating supportive organisational cultures, and developing the evidence base.
Collapse
Affiliation(s)
- Rebecca Langford
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, BS1 2NT, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK.
| | - Rowan Brockman
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, BS1 2NT, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK
| | - Jonathan Banks
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, BS1 2NT, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK
| | - Russell Jago
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, BS1 2NT, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Oakfield House, Oakfield Grove, BS8 2BN, Bristol, UK
| | - Fiona Gillison
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, BA2 7AY, Bath, UK
| | - Karen Coulman
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, BS8 1NU, Bristol, UK
| | - Theresa Moore
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, BS1 2NT, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK
| | - James Nobles
- Health, Nutrition & Environment, Leeds Beckett University, Calverley Building, City Campus, LS1 3HE, Leeds, UK
| |
Collapse
|
14
|
Kirkham R, Puszka S, Titmuss A, Freeman N, Weaver E, Morris J, Mack S, O'Donnell V, Boffa J, Dowler J, Ellis E, Corpus S, Graham S, Scott L, Sinha AK, Connors C, Shaw JE, Azzopardi P, Brown A, Davis E, Wicklow B, Maple-Brown L. Codesigning enhanced models of care for Northern Australian Aboriginal and Torres Strait Islander youth with type 2 diabetes: study protocol. BMJ Open 2024; 14:e080328. [PMID: 38453190 PMCID: PMC10921539 DOI: 10.1136/bmjopen-2023-080328] [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: 09/27/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Premature onset of type 2 diabetes and excess mortality are critical issues internationally, particularly in Indigenous populations. There is an urgent need for developmentally appropriate and culturally safe models of care. We describe the methods for the codesign, implementation and evaluation of enhanced models of care with Aboriginal and Torres Strait Islander youth living with type 2 diabetes across Northern Australia. METHODS AND ANALYSIS Our mixed-methods approach is informed by the principles of codesign. Across eight sites in four regions, the project brings together the lived experience of Aboriginal and Torres Strait Islander young people (aged 10-25) with type 2 diabetes, their families and communities, and health professionals providing diabetes care through a structured yet flexible codesign process. Participants will help identify and collaborate in the development of a range of multifaceted improvements to current models of care. These may include addressing needs identified in our formative work such as the development of screening and management guidelines, referral pathways, peer support networks, diabetes information resources and training for health professionals in youth type 2 diabetes management. The codesign process will adopt a range of methods including qualitative interviews, focus group discussions, art-based methods and healthcare systems assessments. A developmental evaluation approach will be used to create and refine the components and principles of enhanced models of care. We anticipate that this codesign study will produce new theoretical insights and practice frameworks, resources and approaches for age-appropriate, culturally safe models of care. ETHICS AND DISSEMINATION The study design was developed in collaboration with Aboriginal and Torres Strait Islander and non-Indigenous researchers, health professionals and health service managers and has received ethical approval across all sites. A range of outputs will be produced to disseminate findings to participants, other stakeholders and the scholarly community using creative and traditional formats.
Collapse
Affiliation(s)
- Renae Kirkham
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Stefanie Puszka
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Angela Titmuss
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Department of Paediatrics, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Natasha Freeman
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Emma Weaver
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Jade Morris
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Shiree Mack
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Vicki O'Donnell
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
| | - John Boffa
- Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
| | - James Dowler
- Department of Paediatrics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Elna Ellis
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Sumaria Corpus
- Endocrine Department, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Lydia Scott
- WA Country Health Service - Kimberley, Broome, Western Australia, Australia
| | - Ashim K Sinha
- Endocrinology Department, Cairns Hospital, Cairns, Queensland, Australia
| | - Christine Connors
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Azzopardi
- Burnet Institute, Melbourne, Victoria, Australia
- National Centre for Indigenous Genomics, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Alex Brown
- National Centre for Indigenous Genomics, Australian National University, Canberra, Australian Capital Territory, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth Davis
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Brandy Wicklow
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Pediatric Endocrinology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Endocrine Department, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| |
Collapse
|
15
|
Bhui K, Joseph D, Khan N, Morrey T, Mooney R, Zahid U, Mackay T, Larkin M, Keating F, McCrone P, Upthegrove R, Griffiths SL, Edge D, Coventry PA, Arday J, Hosang GM. Experience-based Investigation and Co-design of Psychosis Centred Integrated Care Services for Ethnically Diverse People with Multimorbidity (CoPICS): study protocol. BMJ Open 2024; 14:e084121. [PMID: 38418242 PMCID: PMC10910695 DOI: 10.1136/bmjopen-2024-084121] [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: 01/09/2024] [Accepted: 01/25/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Ethnic minorities (also called racialised groups) are more likely to experience severe mental illness (SMI). People with SMI are more likely to experience multimorbidity (MM), making psychosis among racialised groups more likely to lead to MM, poor outcomes, disability and premature mortality. METHODS AND ANALYSIS This National Institute for Health and Care Research-funded study (151887) seeks to use innovative participatory methods including photovoice and biographical narrative interviews in urban and rural areas of England to assemble experience data. These data will be subjected to polytextual thematic analysis, and alongside pictures and captions, will inform an experienced-based co-design of interventions, the implementation of which will be evaluated. There will be an economic analysis and a process evaluation of the implementation. ETHICS AND DISSEMINATION This programme of work has received ethical (IRAS 322421; Newcastle North Tyneside Research Ethics Committee 23/NE/0143) and sponsor approval. The findings will be disseminated in galleries showing the creative work, as lay and academic summaries and infographics; as practice briefings for practitioners, commissioners and policy makers; peer-reviewed publications. TRIAL REGISTRATION NUMBER https://www.researchregistry.com/browse-the-registry%23home/registrationdetails/649c08111c037d0027b17d17/.
Collapse
Affiliation(s)
- Kamaldeep Bhui
- Psychiatry, University of Oxford, Oxford, UK
- Queen Mary University of London, London, UK
| | | | - Nimra Khan
- Psychiatry, University of Oxford, Oxford, UK
| | - Tara Morrey
- Psychiatry, University of Oxford, Oxford, UK
| | | | | | | | | | - Frank Keating
- Department of Social Work, Royal Holloway University of London, Egham, UK
| | | | - Rachel Upthegrove
- Department of Psychiatry, School of Psychology and College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Early Intervention Service, Forward Thinking Birmingham, Birmingham, UK
| | | | - Dawn Edge
- University of Manchester, Manchester, UK
| | | | | | | |
Collapse
|
16
|
Singh H, Benn N, Fung A, Kokorelias KM, Martyniuk J, Nelson MLA, Colquhoun H, Cameron JI, Munce S, Saragosa M, Godhwani K, Khan A, Yoo PY, Kuluski K. Co-design for stroke intervention development: Results of a scoping review. PLoS One 2024; 19:e0297162. [PMID: 38354160 PMCID: PMC10866508 DOI: 10.1371/journal.pone.0297162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/29/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Co-design methodology seeks to actively engage end-users in developing interventions. It is increasingly used to design stroke interventions; however, limited guidance exists, particularly with/for individuals with stroke who have diverse cognitive, physical and functional abilities. Thus, we describe 1) the extent of existing research that has used co-design for stroke intervention development and 2) how co-design has been used to develop stroke interventions among studies that explicitly used co-design, including the rationale, types of co-designed stroke interventions, participants involved, research methodologies/approaches, methods of incorporating end-users in the research, co-design limitations, challenges and potential strategies reported by researchers. MATERIALS AND METHODS A scoping review informed by Joanna Briggs Institute and Arksey & O'Malley methodology was conducted by searching nine databases on December 21, 2022, to locate English-language literature that used co-design to develop a stroke intervention. Additional data sources were identified through a hand search. Data sources were de-duplicated, and two research team members reviewed their titles, abstracts and full text to ensure they met the inclusion criteria. Data relating to the research objectives were extracted, analyzed, and reported numerically and descriptively. RESULTS Data sources used co-design for stroke intervention development with (n = 89) and without (n = 139) explicitly using the term 'co-design.' Among studies explicitly using co-design, it was commonly used to understand end-user needs and generate new ideas. Many co-designed interventions were technology-based (65%), and 48% were for physical rehabilitation or activity-based. Co-design was commonly conducted with multiple participants (82%; e.g., individuals with stroke, family members/caregivers and clinicians) and used various methods to engage end-users, including focus groups and workshops. Limitations, challenges and potential strategies for recruitment, participant-engagement, contextual and logistical and ethics of co-designed interventions were described. CONCLUSIONS Given the increasing popularity of co-design as a methodology for developing stroke interventions internationally, these findings can inform future co-designed studies.
Collapse
Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Natasha Benn
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Agnes Fung
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kristina M. Kokorelias
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Geriatrics Division, Sinai Health System, University Health Network, Toronto, Canada
| | - Julia Martyniuk
- Gerstein Science Information Centre, University of Toronto Libraries, University of Toronto, Toronto, Canada
| | - Michelle L. A. Nelson
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jill I. Cameron
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sarah Munce
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Marianne Saragosa
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Kian Godhwani
- Department of Psychology, University of Toronto Scarborough, Toronto, Canada
| | - Aleena Khan
- Biological Sciences, University of Toronto, Toronto, Canada
| | - Paul Yejong Yoo
- Division of Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Kerry Kuluski
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Better Health, Trillium Health Partners, Toronto, Canada
| |
Collapse
|
17
|
Graham T, Sooriah S, Chang YS, Hashimdeen S, Meydan T, Grocott P. Translating patient needs into medical device development: co-design of a photoprotection visor for Xeroderma Pigmentosum using qualitative interviews. Orphanet J Rare Dis 2024; 19:64. [PMID: 38351060 PMCID: PMC10865654 DOI: 10.1186/s13023-023-03002-y] [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: 02/01/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION People with Xeroderma Pigmentosum (XP) have a heightened sensitivity to ultraviolet radiation (UVR) and are advised to wear photoprotective clothing including a visor covering the face and neck. Photoprotective visors are homemade and predominately worn by children with decreasing frequency as age increases. To improve upon the current design and efficacy we were tasked with developing a prototype visor to meet patients' needs. METHODS Adopting a codesign methodology, patients' experiences of wearing a visor and patient and carer views of emerging prototypes were explored during interviews. A thematic analysis was conducted in parallel with data collection and themes were interpreted into design cues; desirable attributes of a visor that would counteract the negative user experiences and meet the requirements described by patients and carers. The design cues guided the iterative development of prototypes by academic engineers. RESULTS Twenty-four interviews were conducted with patients and carers. Thematic analysis resulted in the following five themes: Being safe from UVR exposure; self-consciousness; temperature effects; acoustic difficulties; and material properties. The following design cues were developed from the themes respectively; materials and design with high UVR protection; ability to customise with own headwear; ventilation to reduce steaming up; acoustic functionality to enable hearing and speech; foldable, portable, and easy to put on and take off. CONCLUSIONS It is important to understand people's experiences of using medical devices to improve their safety, efficiency and user satisfaction. The user experience themes and design cues, informed the iterative development of low fidelity visor prototypes as part of a codesign process. These design cues and responses to the prototypes are guiding commercial manufacturing and regulatory approval. The visor can then be prescribed to patients, providing an equitable service of care.
Collapse
Affiliation(s)
- Tanya Graham
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Sangeeta Sooriah
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
- Healthwatch Camden, 85-87 Bayham Street, London, NW1 0AG, UK
| | - Yan-Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
| | - Shaikh Hashimdeen
- University of Wales Trinity Saint David, Centre for Advanced Batch Manufacture (CBM), Waterfront, Innovation Quarter Campus, Heol Ynys, Kings Road, Swansea, SA1 8EW, UK
- Cardiff School of Engineering, Cardiff University, Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
| | - Turgut Meydan
- Cardiff School of Engineering, Cardiff University, Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
| | - Patricia Grocott
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
| |
Collapse
|
18
|
Kehoe M, Whitehead R, de Boer K, Meyer D, Hopkins L, Nedeljkovic M. A qualitative evaluation of a co-design process involving young people at risk of suicide. Health Expect 2024; 27:e13986. [PMID: 38343139 PMCID: PMC10859657 DOI: 10.1111/hex.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Co-design is becoming common practice in the development of mental health services, however, little is known about the experience of such practices, particularly when young people are involved. OBJECTIVE The aim of this study was to conduct a process evaluation of the co-design which was undertaken for the development of an intervention for youth and adolescents at risk of suicide. This paper briefly outlines the co-design process undertaken during a COVID-19 lockdown and then focuses on a qualitative evaluation of the experience of taking part in a co-design process. SETTING AND PARTICIPANTS The evaluation involved young consumers of a public youth mental health service, their carers/parents and service delivery staff who had taken part in the co-design process. METHOD This study used follow-up semistructured interviews with the co-design participants to explore their experience of the co-design process. Inductive thematic analysis was used to draw out common themes from the qualitative data. RESULTS It was found that despite the practical efforts of the project team to minimise known issues in co-design, challenges centred around perceptions regarding power imbalance, the need for extensive consultation and time constraints still arose. DISCUSSION Despite these challenges, the study found that the co-design provided a human-centred, accessible and rewarding process for young people, parents and staff members, leaving them with the feeling that they had made a worthwhile contribution to the design of the new service, as well as contributing to changing practice in service design. CONCLUSION With sensitivity and adaptation to usual practice, it is possible to include young people with suicidal ideation, their parents/carers and professional staff in a safe and effective co-design process. PATIENT AND PUBLIC CONTRIBUTION The authors would like to thank and acknowledge the young people with a lived experience and their carers who participated in the co-design process and research evaluation component of this study. We also wish to thank the clinical staff, peer workers and family peer workers who participated in this research.
Collapse
Affiliation(s)
- Michelle Kehoe
- Department of Occupational TherapyMonash UniversityClaytonAustralia
- Alfred HealthMelbourneAustralia
| | | | - Kathleen de Boer
- Centre for Mental Health and Brain ScienceSwinburne UniversityHawthornAustralia
| | - Denny Meyer
- Centre for Mental Health and Brain ScienceSwinburne UniversityHawthornAustralia
| | - Liza Hopkins
- Alfred Mental and Addiction HealthMelbourneAustralia
| | - Maja Nedeljkovic
- Centre for Mental Health and Brain ScienceSwinburne UniversityHawthornAustralia
| |
Collapse
|
19
|
Green J. Debate: Responses to commentaries - neurodiversity, autism and healthcare. Child Adolesc Ment Health 2024; 29:99-100. [PMID: 38102943 DOI: 10.1111/camh.12691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Jonathan Green
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre, Royal Manchester Children's Hospital, Manchester, UK
| |
Collapse
|
20
|
Opozda MJ, Galdas PM, Watkins DC, Smith JA. Intersecting identities, diverse masculinities, and collaborative development: Considerations in creating online mental health interventions that work for men. Compr Psychiatry 2024; 129:152443. [PMID: 38113813 DOI: 10.1016/j.comppsych.2023.152443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023] Open
Abstract
Online mental health interventions have received attention for their potential to bypass barriers that stop men from seeking mental health help from a health professional. However, emerging data suggest that men's use of online mental health interventions is low, and when used, early attrition is common. In this commentary, we hypothesise that men's common lack of engagement with online mental health interventions may reflect limited attention being paid to the needs and preferences of potential users during their development. We outline a series of considerations that we believe are important to advance the development of acceptable, effective online mental health interventions for men: (1) men's diverse and intersecting characteristics, circumstances, and needs; (2) centring positive, progressive masculinities; and (3) listening to, learning from, and working in partnership with men to develop interventions. We also examine how existing online mental health interventions targeting men have engaged with these considerations. Keywords: men, male, mental health, e-mental health, digital health, online interventions.
Collapse
Affiliation(s)
- Melissa J Opozda
- College of Medicine and Public Health, Flinders University, Darwin, Australia; Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia.
| | - Paul M Galdas
- Department of Health Sciences, University of York, York, UK
| | - Daphne C Watkins
- School of Social Work, National Centre for Institutional Diversity, University of Michigan, Ann Arbor, USA
| | - James A Smith
- College of Medicine and Public Health, Flinders University, Darwin, Australia
| |
Collapse
|
21
|
Giosa JL, Kalles E, McAiney C, Oelke ND, Aubrecht K, McNeil H, Habib-Perez O, Holyoke P. Co-designing action-oriented mental health conversations between care providers and ageing Canadians in the community: a participatory mixed-methods study protocol. BMJ Open 2024; 14:e079653. [PMID: 38296303 PMCID: PMC10831463 DOI: 10.1136/bmjopen-2023-079653] [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: 09/07/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION The mental health of ageing Canadians is a growing concern, particularly post-pandemic. Older adults face systemic ageism and mental health stigma as pervasive barriers to seeking needed mental health support, care and treatment within health and social care systems. These barriers are exacerbated when service providers focus on physical healthcare needs or lack the skills and confidence to talk about and/or address mental health during routine visits. This study aims to co-design and test an evidence-based approach to mental health conversations at the point-of-care in home and community settings with older adults, family and friend caregivers and health and social care providers that could facilitate help-seeking activities and care access. METHODS AND ANALYSIS A participatory mixed-methods study design will be applied, guided by a Working Group of experts-by-experience (n=30). Phase 1 engages ageing Canadians in four online workshops (n=60) and a national survey (n=1000) to adapt an evidence-based visual model of mental health for use with older adults in home and community care. Phase 2 includes six co-design workshops with community providers (n=90) in rural and urban sites across three Canadian provinces to co-design tools, resources and processes for enabling the use of the adapted model as a conversation guide. Phase 3 involves pilot and feasibility testing the co-designed conversations with older adult clients of providers from Phase 2 (n=180). ETHICS AND DISSEMINATION Phases 1 and 2 of this study have received ethics clearance at the University of Waterloo (ORE #44187), University of British Columbia (#H22-02306) and St. Francis Xavier University (#26075). While an overview of Phase 3 is included, details will rely on Phase 2 outcomes. Knowledge mobilisation activities will include peer-reviewed publications, conference presentations, webinars, newsletters, infographics and policy briefs. Interested audiences may include community organisations, policy and decision-makers and health and social care providers.
Collapse
Affiliation(s)
- Justine L Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- SE Research Centre, Saint Elizabeth Health Care, Markham, Ontario, Canada
| | - Elizabeth Kalles
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- SE Research Centre, Saint Elizabeth Health Care, Markham, Ontario, Canada
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Nelly D Oelke
- School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
- Rural Coordination Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Katie Aubrecht
- Department of Sociology, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Heather McNeil
- SE Research Centre, Saint Elizabeth Health Care, Markham, Ontario, Canada
| | - Olinda Habib-Perez
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul Holyoke
- SE Research Centre, Saint Elizabeth Health Care, Markham, Ontario, Canada
| |
Collapse
|
22
|
Clifton S, Bray E, Dong S, McCabe R, Siddall P. Co-design of an intervention exploring meaning and purpose after spinal cord injury. Disabil Rehabil 2024:1-10. [PMID: 38258447 DOI: 10.1080/09638288.2023.2300655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Rebuilding a strong sense of meaning and purpose following trauma is a vital contributor to post-traumatic growth and adapting well to a spinal cord injury. This project aimed to develop an intervention that used the concept of post-traumatic growth to foster a stronger sense of meaning and purpose in people with a spinal cord injury. METHODS Using participatory action research methodology, the intervention was designed in an iterative process with health professionals and people with lived experience of spinal cord injury. We developed a ten-week online group program and delivered two pilot programs to 13 participants. We used their feedback to further refine the program before finalisation. RESULTS A participatory action research approach resulted in a positive intervention well received by participants and consumer organisations. Feedback suggests the intervention shows promise for improvements in functional and psychosocial outcomes and has long-term viability. CONCLUSIONS The project successfully developed and delivered a novel program that uses the concept of post-traumatic growth to foster a stronger sense of meaning and purpose. Further implementation of the program with larger numbers will allow for evaluation of the program's effectiveness.
Collapse
Affiliation(s)
- Shane Clifton
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Camperdown, Australia
| | - Emily Bray
- Spinal Cord Injuries Australia, Sydney, Australia
| | - Skye Dong
- Melanoma Institute Australia, Wollstonecraft, Australia
| | | | - Philip Siddall
- Hammondcare, Sydney, Australia
- Sydney Medical School-Northern, The University of Sydney, Camperdown, Australia
| |
Collapse
|
23
|
Reitzel M, Letts L, Lennon C, Lasenby-Lessard J, Novak-Pavlic M, Di Rezze B, Phoenix M. Co-designing solutions to enhance access and engagement in pediatric telerehabilitation. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1293833. [PMID: 38178897 PMCID: PMC10765520 DOI: 10.3389/fresc.2023.1293833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024]
Abstract
Introduction Prior to the COVID-19 pandemic, children's therapy appointments provided by Ontario's publicly-funded Children's Treatment Centre (CTCs) primarily occurred in-person. With COVID-19 restrictions, CTCs offered services via telerehabilitation (e.g., video, phone), which remains a part of service delivery. CTC data shows that families experience barriers in attending telerehabilitation appointments and may need supports in place to ensure service accessibility. Our study aimed to co-design innovative solutions to enhance access and engagement in ambulatory pediatric telerehabilitation services. This manuscript reports the co-design process and findings related to solution development. Methods This research project used an experience based co-design (EBCD) approach, where caregivers, clinicians and CTC management worked together to improve experience with telerehabilitation services. Interview data were collected from 27 caregivers and 27 clinicians to gain an in-depth understanding of their barriers and successes with telerehabilitation. Next, 4 interactive co-design meetings were held with caregivers, clinicians and CTC management to address priorities identified during the interviews. Using qualitative content analysis, data from the interviews and co-design meetings were analyzed and findings related to the solutions developed are presented. Findings Four topics were identified from the interview data that were selected as focii for the co-design meetings. Findings from the co-design meetings emphasized the importance of communication, consistency and connection (the 3C's) in experiences with telerehabilitation. The 3C's are represented in the co-designed solutions aimed at changing organizational processes and generating tools and resources for telerehabilitation services. Discussion The 3C's influence experiences with telerehabilitation services. By enhancing the experience with telerehabilitation, families will encounter fewer barriers to accessing and engaging in this service delivery model.
Collapse
Affiliation(s)
- Meaghan Reitzel
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- KidsAbility Centre for Child Development, Waterloo, ON, Canada
| | - Lori Letts
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Cynthia Lennon
- KidsAbility Centre for Child Development, Waterloo, ON, Canada
| | - Jennifer Lasenby-Lessard
- Parent Partner, Waterloo, ON, Canada
- Psychology Department, University of Guelph, Guelph, ON, Canada
| | - Monika Novak-Pavlic
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Briano Di Rezze
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Michelle Phoenix
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| |
Collapse
|
24
|
Garrett A, Jauregui J. Beyond Opening Doors: Valuing Community Voices While Rethinking Curricular Design. J Grad Med Educ 2023; 15:726-727. [PMID: 38045945 PMCID: PMC10686654 DOI: 10.4300/jgme-d-23-00811.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Alexander Garrett
- Alexander Garrett, MD, is a Medical Education Research Fellow, Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA; and
| | - Joshua Jauregui
- Joshua Jauregui, MD, is Associate Professor, Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
25
|
Singh H, Fulton J, Mirzazada S, Saragosa M, Uleryk EM, Nelson MLA. Community-Based Culturally Tailored Education Programs for Black Communities with Cardiovascular Disease, Diabetes, Hypertension, and Stroke: Systematic Review Findings. J Racial Ethn Health Disparities 2023; 10:2986-3006. [PMID: 36508135 PMCID: PMC10645635 DOI: 10.1007/s40615-022-01474-5] [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: 09/28/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Community-based culturally tailored education (CBCTE) programs for chronic diseases may reduce health disparities; however, a synthesis across chronic diseases is lacking. We explored (1) the characteristics and outcomes of CBCTE programs and (2) which strategies for culturally appropriate interventions have been used in CBCTE programs, and how they have been implemented. METHODS A systematic review was conducted by searching three databases to identify empirical full-text literature on CBCTE programs for Black communities with cardiovascular disease, hypertension, diabetes, or stroke. Studies were screened in duplicate, then data regarding study characteristics, participants, intervention, and outcomes were extracted and analyzed. Cultural tailoring strategies within programs were categorized using Kreuter and colleagues' framework. RESULTS Of the 74 studies, most were conducted in the USA (97%) and delivered in one site (53%; e.g., church/home). CBCTE programs targeted diabetes (65%), hypertension (30%), diabetes and hypertension (1%), cardiovascular disease (3%), and stroke (1%). Reported program benefits included physiological, medication-related, physical activity, and literacy. Cultural tailoring strategies included peripheral (targeted Black communities), constituent-involving (e.g., community informed), evidential (e.g., integrated community resources), linguistic (e.g., delivered in community's dialect/accent), and sociocultural (e.g., integrated community members' religious practices). CONCLUSIONS CBCTE programs may have beneficial outcomes, but a small sample size limited several. The strategies identified can be adopted by programs seeking to culturally tailor. Future interventions should clearly describe community members' roles/involvement and deliver programs in multiple locations to broaden reach. TRIAL REGISTRATION PROSPERO CRD42021245772.
Collapse
Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada.
- KITE, Toronto Rehabilitation Institute, University Health Network, 520 Sutherland Drive, Toronto, ON, Canada.
- Temerty Faculty of Medicine, Rehabilitation Science Institute, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada.
| | - Joseph Fulton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, 10 Overlea Blvd, Toronto, ON, Canada
| | - Sofia Mirzazada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada
| | - Marianne Saragosa
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, Canada
| | | | - Michelle L A Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, 10 Overlea Blvd, Toronto, ON, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, Canada
| |
Collapse
|
26
|
Aggarwal M, Katz A, Kokorelias KM, Wong ST, Aghajafari F, Ivers NM, Martin-Misener R, Aubrey-Bassler K, Breton M, Upshur REG, Kwong JC. What are effective vaccine distribution approaches for equity-deserving and high-risk populations during COVID-19? Exploring best practices and recommendations in Canada: protocol for a mixed-methods multiple case codesign study. BMJ Open 2023; 13:e072238. [PMID: 37940159 PMCID: PMC10632871 DOI: 10.1136/bmjopen-2023-072238] [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: 01/26/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION The WHO has stated that vaccine hesitancy is a serious threat to overcoming COVID-19. Vaccine hesitancy among underserved and at-risk communities is an ongoing challenge in Canada. Public confidence in vaccine safety and effectiveness and the principles of equity need to be considered in vaccine distribution. In Canada, governments of each province or territory manage their own healthcare system, providing an opportunity to compare and contrast distribution strategies. The overarching objective of this study is to identify effective vaccine distribution approaches and advance knowledge on how to design and implement various strategies to meet the different needs of underserved communities. METHODS AND ANALYSIS Multiple case studies in seven Canadian provinces will be conducted using a mixed-methods design. The study will be informed by Experience-Based CoDesign techniques and theoretically guided by the Socio-Ecological Model and the Vaccine Hesitancy Matrix frameworks. Phase 1 will involve a policy document review to systematically explore the vaccine distribution strategy over time in each jurisdiction. This will inform the second phase, which will involve (2a) semistructured, in-depth interviews with policymakers, public health officials, researchers, providers, groups representing patients, researchers and stakeholders and (2b) an analysis of population-based administrative health data of vaccine administration. Integration of qualitative and quantitative data will inform the identification of effective vaccine distribution approaches for various populations. Informed by this evidence, phase 3 of the study will involve conducting focus groups with multiple stakeholders to codesign recommendations for the design and implementation of effective vaccine delivery strategies for equity-deserving and at-risk populations. ETHICS AND DISSEMINATION This study is approved by the University of Toronto's Health Sciences Research Ethics Board (#42643), University of British Columbia Behavioural Research Ethics Board (#H22-01750-A002), Research Ethics Board of the Nova Scotia Health Authority (#48272), Newfoundland and Labrador Health Research Ethics Board (#2022.126), Conjoint Health Research Ethics Board, University of Calgary (REB22-0207), and University of Manitoba Health Research Board (H2022-239). The outcome of this study will be to produce a series of recommendations for implementing future vaccine distribution approaches from the perspective of various stakeholders, including equity-deserving and at-risk populations.
Collapse
Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alan Katz
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Family Medicine, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristina Marie Kokorelias
- Rehabiliation Sciences Institute, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St. John's, Newfoundland, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Ross E G Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
27
|
Munce SE, Steele Gray C, Pomeroy BC, Bayley M, Kokorelias KM, Luong D, Biddiss E, Cave T, Bragge P, Chew-Graham CA, Colquhoun H, Dadich A, Dainty KN, Elliott M, Feng P, Goldhar J, Hamilton CB, Harvey G, Kastner M, Kothari A, Langley J, Jeffs L, Masterson D, Nelson MLA, Perrier L, Riley J, Sellen K, Seto E, Simpson R, Staniszewska S, Srinivasan V, Straus SE, Tricco AC, Kuluski K. Development of the Preferred Components for Co-Design in Research Guideline and Checklist: Protocol for a Scoping Review and a Modified Delphi Process. JMIR Res Protoc 2023; 12:e50463. [PMID: 37902812 PMCID: PMC10644195 DOI: 10.2196/50463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/17/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND There is increasing evidence that co-design can lead to more engaging, acceptable, relevant, feasible, and even effective interventions. However, no guidance is provided on the specific designs and associated methods or methodologies involved in the process. We propose the development of the Preferred Components for Co-design in Research (PRECISE) guideline to enhance the consistency, transparency, and quality of reporting co-design studies used to develop complex health interventions. OBJECTIVE The aim is to develop the first iteration of the PRECISE guideline. The purpose of the PRECISE guideline is to improve the consistency, transparency, and quality of reporting on studies that use co-design to develop complex health interventions. METHODS The aim will be achieved by addressing the following objectives: to review and synthesize the literature on the models, theories, and frameworks used in the co-design of complex health interventions to identify their common elements (components, values or principles, associated methods and methodologies, and outcomes); and by using the results of the scoping review, prioritize the co-design components, values or principles, associated methods and methodologies, and outcomes to be included in the PRECISE guideline. RESULTS The project has been funded by the Canadian Institutes of Health Research. CONCLUSIONS The collective results of this project will lead to a ready-to-implement PRECISE guideline that outlines a minimum set of items to include when reporting the co-design of complex health interventions. The PRECISE guideline will improve the consistency, transparency, and quality of reports of studies. Additionally, it will include guidance on how to enact or enable the values or principles of co-design for meaningful and collaborative solutions (interventions). PRECISE might also be used by peer reviewers and editors to improve the review of manuscripts involving co-design. Ultimately, the PRECISE guideline will facilitate more efficient use of new results about complex health intervention development and bring better returns on research investments. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50463.
Collapse
Affiliation(s)
- Sarah Ep Munce
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | | | - Mark Bayley
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristina Marie Kokorelias
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sinai Health and University Health Network, Geriatrics, Toronto, ON, Canada
| | - Dorothy Luong
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Elaine Biddiss
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | | | - Peter Bragge
- Monash Sustainable Development Institute Evidence Review Service, BehaviourWorks Australia, Monash University, Clayton Campus, Melbourne, Victoria, Australia
| | - Carolyn A Chew-Graham
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Newcastle, United Kingdom
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ann Dadich
- School of Business, Western Sydney University, Sydney, Australia
| | - Katie N Dainty
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
| | | | - Patrick Feng
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Ontario College of Art & Design University, Toronto, ON, Canada
| | - Jodeme Goldhar
- International Foundation for Integrated Care, Toronto, ON, Canada
| | - Clayon B Hamilton
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Gillian Harvey
- Design Studies, Department of Art & Design, University of Alberta, Edmonton, AB, Canada
| | - Monika Kastner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
| | - Anita Kothari
- School of Health Studies, Western University, London, ON, Canada
| | - Joe Langley
- Lab4Living, Sheffield Hallam University, Sheffield, United Kingdom
| | - Lianne Jeffs
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Daniel Masterson
- Jönköping Academy for Improvement of Health and Welfare Sweden, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Michelle LA Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Laure Perrier
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - John Riley
- Ontario Strategy for Patient-Oriented Research SUPPORT Unit, Toronto, ON, Canada
| | - Kate Sellen
- Ontario College of Art & Design University, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
| | - Robert Simpson
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health and Wellbeing, University of Glasgow, Scotland, United Kingdom
| | - Sophie Staniszewska
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Vasanthi Srinivasan
- Ontario Strategy for Patient-Oriented Research SUPPORT Unit, Toronto, ON, Canada
| | - Sharon E Straus
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - Andrea C Tricco
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University School of Nursing, Queen's University, Kingston, ON, Canada
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| |
Collapse
|
28
|
Pettersson S, Klompstra L, Jirwe M, Jaarsma T. Developing a Culturally Appropriate Tool to Support Self-Care in Migrants with Type 2 Diabetes - A Co-Design Study. Patient Prefer Adherence 2023; 17:2557-2567. [PMID: 37854029 PMCID: PMC10581012 DOI: 10.2147/ppa.s426908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Migrants, especially from the Middle East, experience poorer health outcomes and face greater difficulties in accessing healthcare compared to native populations and there is a need for culturally appropriate education for this vulnerable group. The purpose of this study is to describe the process of developing a culturally appropriate tool to support self-care in migrants with type 2 diabetes. Methods In this Co-design study, a tool for supporting self-care in migrants with type 2 diabetes was developed. Migrant patients with type 2 diabetes, healthcare providers and researchers participated in the process, which was based on six elements; engage, plan, explore, develop, decide and change. From February 2021 to December 2022, idea groups were conducted, and a tool was developed through brainstorming, prioritizing and prototyping. Results In total, 14 migrant patients, ten health care providers and four researchers participated in the Co-design process. The patients wished to receive information about type 2 diabetes self-care behaviour in their own languages. The healthcare providers asked for clear instructions on where to guide their patients regarding reliable information about diabetes in the patient's own language. All participants agreed that information can be presented in different formats, either: text (paper or online), audio-visual via recorded videos and/or lectures and pictures. Discussion The Co-design process led to several important insights and experiences related to the importance of diverse cultural backgrounds. When conducting a Co-design study with end-users as stakeholders, it is significant that the stakeholders have a diverse background in experiences, both as patients as well as those who deliver or implement the health service. In this study it was of great importance to include patients with diverse backgrounds regarding; gender, age, health literacy, occupation, years living in Sweden and duration of diabetes.
Collapse
Affiliation(s)
- Sara Pettersson
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| | - Leonie Klompstra
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| | - Maria Jirwe
- Red Cross University College, Department of Health Sciences, Huddinge, Sweden
| | - Tiny Jaarsma
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| |
Collapse
|
29
|
Voorheis P, Petch J, Pham Q, Kuluski K. Maximizing the value of patient and public involvement in the digital health co-design process: A qualitative descriptive study with design leaders and patient-public partners. PLOS DIGITAL HEALTH 2023; 2:e0000213. [PMID: 37878566 PMCID: PMC10599516 DOI: 10.1371/journal.pdig.0000213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/25/2023] [Indexed: 10/27/2023]
Abstract
Digital health interventions have enormous potential to support patients and the public in achieving their health goals. Nonetheless, many digital health interventions are failing to effectively engage patients and the public. One solution that has been proposed is to directly involve patients and the public in the design process of these digital health interventions. Although there is consensus that involving patients and the public in collaborative design is valuable, design teams have little guidance on how to maximize the value of their collaborative design work. The main objective of this study was to understand how the value of patient and public involvement in digital health design can be maximized, from the perspective of design leaders and patient-public partners. Using a qualitative descriptive methodology, we conducted semi-structured interviews with 19 design leaders and 9 patient-public partners. Interviewees agreed that involving patients and the public was valuable, however, they questioned if current collaborative methods were optimized to ensure maximal value. Interviewees suggested that patient and public collaborative design can add value through four different mechanisms: (1) by allowing the design process to be an empowering intervention itself, (2) by ensuring that the digital health intervention will be effectively engaging for users, (3) by ensuring that the digital health intervention will be seamlessly implemented in practice, and (4) by allowing patient-public collaborations extend beyond the initial product design. Overall, interviewees emphasized that although collaborative design has historically focused on improving the digital health product itself, patients and the public have crucial insights on implementation planning as well as how collaborative design can be used as its own empowering intervention. The results of this paper provide clarity about the ways that patient and public collaborative design can be made more valuable. Digital health design teams can use these results to be more intentional about their collaborative design approaches.
Collapse
Affiliation(s)
- Paula Voorheis
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Canada
| | - Jeremy Petch
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Canada
- Division of Cardiology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Quynh Pham
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, Canada
- Telfer School of Management, University of Ottawa, Ottawa, Canada
| | - Kerry Kuluski
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| |
Collapse
|
30
|
McGeown H, Potter L, Stone T, Swede J, Cramer H, Horwood J, Carvalho M, Connell F, Feder G, Farr M. Trauma-informed co-production: Collaborating and combining expertise to improve access to primary care with women with complex needs. Health Expect 2023; 26:1895-1914. [PMID: 37430474 PMCID: PMC10485347 DOI: 10.1111/hex.13795] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION Health, social care, charitable and justice sectors are increasingly recognising the need for trauma-informed services that seek to recognise signs of trauma, provide appropriate paths to recovery and ensure that services enable people rather than retraumatise. Foundational to the development of trauma-informed services is collaboration with people with lived experience of trauma. Co-production principles may provide a useful framework for this collaboration, due to their emphasis on lived experience, and intent to address power imbalances and promote equity. This article aims to examine trauma-informed and co-production principles to consider the extent to which they overlap and explore how to tailor co-production approaches to support people who have experienced trauma. METHODS Bridging Gaps is a collaboration between women who have experienced complex trauma, a charity that supports them, primary care clinicians and health researchers to improve access to trauma-informed primary care. Using co-production principles, we aimed to ensure that women who have experienced trauma were key decision-makers throughout the project. Through reflective notes (n = 19), observations of meetings (n = 3), interviews with people involved in the project (n = 9) and reflective group discussions on our experiences, we share learning, successes and failures. Data analysis followed a framework approach, using trauma-informed principles. RESULTS Co-production processes can require adaptation when working with people who have experienced trauma. We emphasise the need for close partnership working, flexibility and transparency around power dynamics, paying particular attention to aspects of power that are less readily visible. Sharing experiences can retrigger trauma. People conducting co-production work need to understand trauma and how this may impact upon an individual's sense of psychological safety. Long-term funding is vital to enable projects to have enough time for the establishment of trust and delivery of tangible results. CONCLUSIONS Co-production principles are highly suitable when developing trauma-informed services. Greater consideration needs to be given as to whether and how people share lived experiences, the need for safe spaces, honesty and humility, difficult dynamics between empowerment and safety and whether and when blurring boundaries may be helpful. Our findings have applicability to policy-making, funding and service provision to enable co-production processes to become more trauma-informed. PUBLIC CONTRIBUTION Bridging Gaps was started by a group of women who have experienced complex trauma, including addiction, homelessness, mental health problems, sexual exploitation, domestic and sexual violence and poverty, with a general practitioner (GP) who provides healthcare to this population, alongside a support worker from the charity One25, a charity that supports some of the most marginalised women in Bristol to heal and thrive. More GPs and healthcare researchers joined the group and they have been meeting fortnightly for a period of 4 years with the aim of improving access to trauma-informed primary care. The group uses co-production principles to work together, and we aim to ensure that women who have experienced trauma are key decision-makers throughout our work together. This article is a summary of our learning, informed by discussion, observations and interviews with members of the group.
Collapse
Affiliation(s)
- Helen McGeown
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Lucy Potter
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Tracey Stone
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | | | - Helen Cramer
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | | | - Jeremy Horwood
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | | | | | - Gene Feder
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Michelle Farr
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| |
Collapse
|
31
|
Gris F, D’Amen B, Lamura G, Paciaroni L, Socci M, Melchiorre MG. Personalized Technological Support for Informal Caregivers of Older People with Dementia: A Co-Design Approach Involving Potential End Users and Healthcare Professionals in Three Focus Groups in Italy. Healthcare (Basel) 2023; 11:2640. [PMID: 37830677 PMCID: PMC10572801 DOI: 10.3390/healthcare11192640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
Informal/family caregivers (ICs) of older people with dementia (PwD) can suffer from depression and burnout. However, digital solutions can potentially provide innovative ways to facilitate care provision. The aim of this study was to analyze the opinions of end users (EUs), i.e., PwD aged 65 years and over and their ICs and healthcare professionals (HPs), on the use of digital technology to support care activities. Qualitative data were collected during the co-design phase of the European project "DemiCare-Personalized support for informal caregivers of people with dementia". This study focused on the Italian context and included two PwD, three ICs, and seven HPs. Three focus groups were held in April-June 2022. Qualitative data were analyzed using MaxQDA 2020 software. Seven thematic areas were identified: daily activities, care tasks, information needs, support received, relationship with and expectations from technology, functionality of the DemiCare integrated system, and ethical issues. Smart devices seemed to be received positively by ICs and HPs, although older PwD seemed to have difficulty accepting the technology. Overall, despite the low number of participants, it seems important and potentially effective to consider the needs and preferences of PwD during exploratory co-design to allow social interactions with them. This study was not registered.
Collapse
Affiliation(s)
- Francesca Gris
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, 60124 Ancona, Italy; (F.G.); (G.L.); (M.G.M.)
| | - Barbara D’Amen
- Italian National Institute of Statistics—ISTAT, Via Cesare Balbo 39, 00184 Rome, Italy
| | - Giovanni Lamura
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, 60124 Ancona, Italy; (F.G.); (G.L.); (M.G.M.)
| | - Lucia Paciaroni
- Neurology Unit, Centre for Cognitive Disorders and Dementias, IRCCS INRCA—National Institute of Health and Science on Ageing, 60129 Ancona, Italy;
| | - Marco Socci
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, 60124 Ancona, Italy; (F.G.); (G.L.); (M.G.M.)
| | - Maria Gabriella Melchiorre
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, 60124 Ancona, Italy; (F.G.); (G.L.); (M.G.M.)
| |
Collapse
|
32
|
Adams C, Walpola R, Schembri A, Harrison R. The HUSH Project: Using codesign to reduce sleep disruptions for patients in hospital. Health Expect 2023; 27:e13881. [PMID: 37740911 PMCID: PMC10768860 DOI: 10.1111/hex.13881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/09/2023] [Accepted: 09/16/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Poor quality sleep in hospitals may be problematic for patients, negatively impacting their recovery and wellbeing. This project aimed to investigate the effectiveness of codesign in addressing key issues affecting sleep disruption in the healthcare setting. METHODS Codesign with patients, staff and consumer representatives was conducted in an acute metropolitan tertiary public hospital in Sydney, Australia. Through a four-stage process, a multimodal intervention to address and reduce the impact of sleep disruptions among hospital inpatients was created. Pre- and post-intervention evaluation was used to determine changes in patient-reported sleep disruption. RESULTS 'The HUSH Project' (Help Us Support Healing) intervention resulted from the codesign process, which included the provision of HUSH Sleep Packs (with earplugs, eye masks and herbal tea), patient information resources, and ward-based Sleep Champions. Survey data from 210 patients revealed a statistically significant decrease in patient-reported noise disturbances for patients in shared rooms following the 4-week intervention period of the HUSH program. CONCLUSION The HUSH Project demonstrated that a novel multimodal intervention may be valuable in reducing sleep disruption in hospitals. These findings also indicate the benefits of using codesign methodology to support improvement projects that seek to enhance patient experiences of care. PATIENT OR PUBLIC CONTRIBUTION This project utilised codesign methodology, which involved significant contributions from patients and consumer representatives, from research conceptualisation into intervention design, implementation and project evaluation.
Collapse
Affiliation(s)
- Corey Adams
- Australian Institute of Health Innovation (AIHI)Macquarie UniversitySydneyAustralia
| | - Ramesh Walpola
- School of Population HealthUniversity of New South Wales (UNSW)SydneyAustralia
- School of Health SciencesUniversity of New South Wales (UNSW)SydneyAustralia
| | | | - Reema Harrison
- Australian Institute of Health Innovation (AIHI)Macquarie UniversitySydneyAustralia
| |
Collapse
|
33
|
Kim KK, McGrath SP, Solorza JL, Lindeman D. The ACTIVATE Digital Health Pilot Program for Diabetes and Hypertension in an Underserved and Rural Community. Appl Clin Inform 2023; 14:644-653. [PMID: 37201542 PMCID: PMC10431973 DOI: 10.1055/a-2096-0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/16/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Community health centers and patients in rural and agricultural communities struggle to address diabetes and hypertension in the face of health disparities and technology barriers. The stark reality of these digital health disparities were highlighted during the coronavirus disease 2019 pandemic. OBJECTIVES The objective of the ACTIVATE (Accountability, Coordination, and Telehealth in the Valley to Achieve Transformation and Equity) project was to codesign a platform for remote patient monitoring and program for chronic illness management that would address these disparities and offer a solution that fit the needs and context of the community. METHODS ACTIVATE was a digital health intervention implemented in three phases: community codesign, feasibility assessment, and a pilot phase. Pre- and postintervention outcomes included regularly collected hemoglobin A1c (A1c) for participants with diabetes and blood pressure for those with hypertension. RESULTS Participants were adult patients with uncontrolled diabetes and/or hypertension (n = 50). Most were White and Hispanic or Latino (84%) with Spanish as a primary language (69%), and the mean age was 55. There was substantial adoption and use of the technology: over 10,000 glucose and blood pressure measures were transmitted using connected remote monitoring devices over a 6-month period. Participants with diabetes achieved a mean reduction in A1c of 3.28 percentage points (standard deviation [SD]: 2.81) at 3 months and 4.19 percentage points (SD: 2.69) at 6 months. The vast majority of patients achieved an A1c in the target range for control (7.0-8.0%). Participants with hypertension achieved reductions in systolic blood pressure of 14.81 mm Hg (SD: 21.40) at 3 months and 13.55 mm Hg (SD: 23.31) at 6 months, with smaller reductions in diastolic blood pressure. The majority of participants also reached target blood pressure (less than 130/80). CONCLUSION The ACTIVATE pilot demonstrated that a codesigned solution for remote patient monitoring and chronic illness management delivered by community health centers can overcome digital divide barriers and show positive health outcomes for rural and agricultural residents.
Collapse
Affiliation(s)
- Katherine K. Kim
- MITRE Corporation, Health Innovation Center, McLean, Virginia, United States
- Department of Public Health Sciences, Division of Health Informatics, University of California Davis, School of Medicine, Sacramento, California, United States
| | - Scott P. McGrath
- CITRIS and the Banatao Institute, University of California Berkeley, Berkeley, California, United States
| | - Juan L. Solorza
- Livingston Community Health, Livingston, California, United States
| | - David Lindeman
- CITRIS and the Banatao Institute, University of California Berkeley, Berkeley, California, United States
| |
Collapse
|
34
|
Cheek C, Hayba N, Richardson L, Austin EE, Francis Auton E, Safi M, Ransolin N, Vukasovic M, De Los Santos A, Murphy M, Harrison R, Churruca K, Long JC, Hibbert PD, Carrigan A, Newman B, Hutchinson K, Mitchell R, Cutler H, Holt L, Braithwaite J, Gillies D, Salmon PM, Walpola RL, Zurynski Y, Ellis LA, Smith K, Brown A, Ali R, Gwynne K, Clay-Williams R. Experience-based codesign approach to improve care in Australian emergency departments for complex consumer cohorts: the MyED project protocol, Stages 1.1-1.3. BMJ Open 2023; 13:e072908. [PMID: 37407042 DOI: 10.1136/bmjopen-2023-072908] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Emergency department (ED) care must adapt to meet current and future demands. In Australia, ED quality measures (eg, prolonged length of stay, re-presentations or patient experience) are worse for older adults with multiple comorbidities, people who have a disability, those who present with a mental health condition, Indigenous Australians, and those with a culturally and linguistically diverse (CALD) background. Strengthened ED performance relies on understanding the social and systemic barriers and preferences for care of these different cohorts, and identifying viable solutions that may result in sustained improvement by service providers. A collaborative 5-year project (MyED) aims to codesign, with ED users and providers, new or adapted models of care that improve ED performance, improve patient outcomes and improve patient experience for these five cohorts. METHODS AND ANALYSIS Experience-based codesign using mixed methods, set in three hospitals in one health district in Australia. This protocol introduces the staged and incremental approach to the whole project, and details the first research elements: ethnographic observations at the ED care interface, interviews with providers and interviews with two patient cohorts-older adults and adults with a CALD background. We aim to sample a diverse range of participants, carefully tailoring recruitment and support. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Western Sydney Local Health District Human Research Ethics Committee (2022/PID02749-2022/ETH02447). Prior informed written consent will be obtained from all research participants. Findings from each stage of the project will be submitted for peer-reviewed publication. Project outputs will be disseminated for implementation more widely across New South Wales, Australia.
Collapse
Affiliation(s)
- Colleen Cheek
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Nema Hayba
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Lieke Richardson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Francis Auton
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mariam Safi
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Natália Ransolin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Matthew Vukasovic
- Department of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Aaron De Los Santos
- Department of Emergency Medicine, Blacktown and Mount Druitt Hospital, Blacktown, New South Wales, Australia
| | - Margaret Murphy
- Department of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Bronwyn Newman
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Henry Cutler
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Leanne Holt
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Donna Gillies
- NDIS Quality and Safeguards Commission, Penrith, New South Wales, Australia
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Ramesh Lahiru Walpola
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kylie Smith
- Emergency Care Institute, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Anthony Brown
- Western Sydney University, Penrith, New South Wales, Australia
| | - Reza Ali
- Department of Emergency Medicine, Blacktown and Mount Druitt Hospital, Blacktown, New South Wales, Australia
| | - Kylie Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
35
|
Crooks J, Flemming K, Shulman C, Hudson B. Opportunities and challenges in involving people with lived experience of inclusion health as co-researchers in palliative and end of life research: a rapid review and thematic synthesis. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:25. [PMID: 37081580 PMCID: PMC10116696 DOI: 10.1186/s40900-023-00436-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Co-research is a collaborative approach to research, promoting involvement of individuals with lived experience of a research area as experts by experience. Recently, the importance of co-research within palliative and end of life care (PEoLC) has been highlighted, yet few recommendations exist regarding best practice for involving inclusion health groups (i.e., groups that are socially excluded, typically experiencing multiple disadvantages that contribute to poor health outcomes). AIMS To identify and synthesise qualitative literature outlining barriers and facilitators for involving four inclusion health groups (individuals with lived experience of: homelessness, substance use disorder, incarceration or exchanging sex for money) in PEoLC research, from the perspectives of both the researchers and individuals with lived experience. METHODS This report is a rapid review with thematic synthesis methodology. Three electronic databases were searched (2012-30th August 2022). Thematic synthesis was used to generate themes across qualitative studies. RESULTS Three qualitative studies were eligible for inclusion. Two involved individuals with lived experience of incarceration, and one lived experience of homelessness. No papers outlined best-practice guidance for co-research; all offered reflections on the co-research process. Challenges for involvement included: facilitating appropriate reimbursement; overcoming stigma; fear of tokenism; pre-conceived views and the emotional burden of research. Successes and benefits included: advanced level of insight, a two-way learning opportunity and relatability of lived experience co-researchers. CONCLUSIONS This review did not identify any best-practice guidance for co-production of PEoLC research with inclusion health groups. There are few, good quality, qualitative studies offering insight into challenges and facilitators for lived experience co-researcher involvement. Further research and formal policy development is required to produce formal best-practice guidance to support safe, impactful inclusion in PEoLC research. It is important that researchers work together with people who have lived experience of the topic they are researching. Palliative care is specialised medical care for people living with a terminal illness. There is some collaboration between researchers and people with lived experience in palliative and end-of-life care research. However, some groups of people have been excluded. This includes people experiencing homelessness, or people with drug or alcohol addictions. This review aimed to understand what works and what doesn't work when involving four excluded groups in palliative and end-of-life research. These groups were people experiencing homelessness, those who had spent time in prison, people with drug or alcohol disorders, and people who exchanged sex for money. This review used a shortened methodology, which allowed it to be done quickly. Three online academic databases (Medline, PubMed, PsychINFO) were searched for research projects: three papers were included in the review. No clear guidance for working with these groups was found. Analysis identified themes across papers. Challenges for collaboration included: appropriate payment methods; overcoming stigma; fear of being talked down to,; assumptions made before meeting people, and the potential of becoming upset. Successes and benefits included: better understanding of the research topic, the opportunity to learn from one another, and how research participants could relate to lived experience co-researchers. There are few, good quality papers, but more research is needed to produce guidance to support safe, impactful collaboration.
Collapse
Affiliation(s)
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Caroline Shulman
- Pathway, London, UK
- Healthy London Partnership, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Briony Hudson
- Research and Policy, Marie Curie, London, UK
- Pathway, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| |
Collapse
|
36
|
O'Grady HK, Bhimani Z, Dalziel S, Dolanjski B, Sandhu G, Santos M, Smith K, Murthy S, Marshall JC, Kho ME. Co-designing and pilot testing an infographic to support patients/families through the REMAP-CAP consent process: a mixed-methods study protocol. Pilot Feasibility Stud 2023; 9:58. [PMID: 37055859 PMCID: PMC10098229 DOI: 10.1186/s40814-023-01290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Informed consent is critical to the ethical conduct of clinical research and requires understanding of a trial including its purpose, process, potential risks and benefits, and alternatives to participation. This can be challenging for complex trials, such as platform trials, and in high-stress environments, such as the intensive care unit (ICU). REMAP-CAP (randomized, embedded, multifactorial, adaptive platform trial for community-acquired pneumonia) is a platform trial which studies treatments for ICU patients with community-acquired pneumonia, including COVID-19. Patient/family partners (PFP) identified challenges during the REMAP-CAP consent process. METHODS This is a patient-centred co-design study to refine and test an infographic to supplement current REMAP-CAP consent documents. Infographic prototypes were developed by patients, substitute decision-makers (SDMs), and researchers with lived experience in the ICU or with ICU research. We will apply a two-phase exploratory sequential, mixed-methods research design. In phase 1, we will conduct focus groups with ICU patients, SDMs, and research coordinators (RCs). We will use inductive content analysis to inform infographic refinement, to be pilot tested in phase 2. Phase 2 is a prospective study within a trial (SWAT) at ≤ 5 REMAP-CAP sites. We will collect self-reported data from patients/SDMs and RCs. The primary outcome is feasibility (eligible consent encounters, receipt of infographic, consent to follow-up, completion of follow-up surveys). Data will be integrated to understand if/how quantitative results build upon the qualitatively informed infographic. DISCUSSION Phase 1 results will be used to co-design an infographic, directly informed by the perspectives of patients, SDMs, and RCs involved in ICU research consent discussions. Results from phase 2 will determine the feasibility of infographic implementation in REMAP-CAP consent encounters. These feasibility data will inform a larger SWAT to evaluate our consent infographic. If successful, use of a co-designed infographic to support REMAP-CAP consent documents may improve the experience of consent for patients, SDMs, and RCs. TRIAL REGISTRATION The Northern Ireland Hub for Trials Methodology Research SWAT Repository (SWAT no. 176).
Collapse
Affiliation(s)
- Heather K O'Grady
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Zahra Bhimani
- St. Michael's Hospital Unity Health Toronto, Toronto, Ontario, Canada
| | - Sandra Dalziel
- St. Michael's Hospital Unity Health Toronto, Toronto, Ontario, Canada
| | - Barbara Dolanjski
- St. Michael's Hospital Unity Health Toronto, Toronto, Ontario, Canada
| | - Gyan Sandhu
- St. Michael's Hospital Unity Health Toronto, Toronto, Ontario, Canada
| | - Marlene Santos
- St. Michael's Hospital Unity Health Toronto, Toronto, Ontario, Canada
| | - Kathy Smith
- St. Michael's Hospital Unity Health Toronto, Toronto, Ontario, Canada
| | - Srinivas Murthy
- Faculty of Medicine, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - John C Marshall
- St. Michael's Hospital Unity Health Toronto, Toronto, Ontario, Canada
| | - Michelle E Kho
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
- Physiotherapy Department, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| |
Collapse
|
37
|
Ostojic K, Paget S, Martin T, Dee-Price BJ, McIntyre S, Smithers Sheedy H, Mimmo L, Burnett H, Scott T, Berg A, Masi A, Scarcella M, Calderan J, Azmatullah S, Mohamed M, Woodbury M, Wilkinson A, Zwi K, Dale R, Eapen V, Lingam R, Strnadová I, Woolfenden S. Codesigning a social prescribing pathway to address the social determinant of health concerns of children with cerebral palsy and their families in Australia: a protocol for a mixed-methods formative research study. BMJ Open 2023; 13:e066346. [PMID: 37024248 PMCID: PMC10083805 DOI: 10.1136/bmjopen-2022-066346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Social determinants of health (SDH) are contributors to health inequities experienced by some children with cerebral palsy and pose barriers to families engaging with complex and fragmented healthcare systems. There is emerging evidence to support 'social prescribing' interventions that systematically identify SDH concerns and refer patients to non-medical social care support and services to address their needs. To date, social prescribing has not been trialled specifically for children with neurodevelopmental disabilities, including cerebral palsy, in Australia. This study aims to codesign a social prescribing programme to address SDH concerns of children with cerebral palsy and their families who attend one of the three tertiary paediatric rehabilitation services in New South Wales, Australia. METHODS AND ANALYSIS This is a qualitative multi-site study conducted at the three NSW paediatric hospitals' rehabilitation departments using a codesign approach. Children aged 12-18 years with cerebral palsy, parents/caregivers of children (aged 0-18 years) with cerebral palsy, and clinicians will be involved in all stages to codesign the social prescribing programme. The study will consist of three components: (1) 'what we need', (2) 'creating the pathways' and (3) 'finalising and sign off'. This project is overseen by two advisory groups: one group of young adults with cerebral palsy and one group of parents of young people with cerebral palsy. The study will be guided by the biopsychosocial ecological framework, and analysis will follow Braun and Clark's thematic approach. ETHICS AND DISSEMINATION The study protocol was approved by the human research ethics committee of the Sydney Children's Hospitals Network. This codesign study will inform a future pilot study of feasibility and acceptability, then if indicated, a pilot clinical trial of efficacy. We will collaborate with all project stakeholders to disseminate findings and undertake further research to build sustainable and scalable models of care. TRIAL REGISTRATION NUMBER ACTRN12622001459718.
Collapse
Affiliation(s)
- Katarina Ostojic
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Simon Paget
- Kids Rehab, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tanya Martin
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
| | - Betty-Jean Dee-Price
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hayley Smithers Sheedy
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Laurel Mimmo
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
- Nursing Research Unit, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Heather Burnett
- John Hunter Children's Hospital, Hunter Region Mail Centre, New South Wales, Australia
| | - Timothy Scott
- Rehab2Kids, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Alison Berg
- Kids Rehab, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Anne Masi
- School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michele Scarcella
- Aboriginal Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Jack Calderan
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Sheikh Azmatullah
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Masyitah Mohamed
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Mackenzie Woodbury
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Alunya Wilkinson
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen Zwi
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
- Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Russell Dale
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Kids Neuroscience Centre, Kids Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Valsamma Eapen
- School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Iva Strnadová
- School of Education, University of New South Wales, Sydney, New South Wales, Australia
- Disability Innovation Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
- Community Paediatrics Research Group, Institute for Women, Children and Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| |
Collapse
|
38
|
Bullen J, Hill-Wall T, Anderson K, Brown A, Bracknell C, Newnham EA, Garvey G, Waters L. From Deficit to Strength-Based Aboriginal Health Research-Moving toward Flourishing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5395. [PMID: 37048008 PMCID: PMC10094537 DOI: 10.3390/ijerph20075395] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
Aboriginal Australians have a fundamental human right to opportunities that lead to healthy and flourishing lives. While the impact of trauma on Aboriginal Australians is well-documented, a pervasive deficit narrative that focuses on problems and pathology persists in research and policy discourse. This narrative risks further exacerbating Aboriginal disadvantage through a focus on 'fixing what is wrong' with Aboriginal Australians and the internalising of these narratives by Aboriginal Australians. While a growing body of research adopts strength-based models, limited research has sought to explore Aboriginal flourishing. This conceptual paper seeks to contribute to a burgeoning paradigm shift in Aboriginal research, seeking to understand what can be learned from Aboriginal people who flourish, how we best determine this, and in what contexts this can be impactful. Within, we argue the case for a new approach to exploring Aboriginal wellbeing that integrates salutogenic, positive psychology concepts with complex systems theory to understand and promote Aboriginal wellbeing and flourishing. While deeper work may be required to establish the parameters of a strength-based, culturally aligned Aboriginal conceptualisation of positive psychology, we suggest the integration of Aboriginal and Western methodologies offers a unique and potent means of shifting the dial on seemingly intractable problems.
Collapse
Affiliation(s)
- Jonathan Bullen
- EnAble Institute, Curtin University, Perth, WA 6102, Australia
- Telethon Kids Institute, Perth, WA 6009, Australia;
| | - Trish Hill-Wall
- EnAble Institute, Curtin University, Perth, WA 6102, Australia
| | - Kate Anderson
- Faculty of Medicine, The School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Alex Brown
- Telethon Kids Institute, Perth, WA 6009, Australia;
- National Centre for Indigenous Genomics, The John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Clint Bracknell
- School of Languages and Cultures, The University of Queensland, St. Lucia, QLD 4067, Australia
| | - Elizabeth A. Newnham
- EnAble Institute, Curtin University, Perth, WA 6102, Australia
- School of Population Health, Curtin University, Perth, WA 6102, Australia
- FXB Center for Health and Human Rights, Harvard University, Boston, MA 02115, USA
| | - Gail Garvey
- Faculty of Medicine, The School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Lea Waters
- Centre for Wellbeing Science, Melbourne Graduate School of Education, The University of Melbourne, Parkville, VIC 3101, Australia
| |
Collapse
|
39
|
Anantapong K, Bruun A, Walford A, Smith CH, Manthorpe J, Sampson EL, Davies N. Co-design development of a decision guide on eating and drinking for people with severe dementia during acute hospital admissions. Health Expect 2023; 26:613-629. [PMID: 36647692 PMCID: PMC10010093 DOI: 10.1111/hex.13672] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/27/2022] [Accepted: 11/05/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Using co-design processes, we aimed to develop an evidence-based decision guide for family carers and hospital professionals to support decision-making about eating and drinking for hospital patients with severe dementia. METHODS Following a systematic review, we interviewed people with mild dementia, family carers and hospital professionals in England. We then held co-design workshops with family carers and hospital professionals. In parallel with the workshops, we used a matrix to synthesize data from all studies and to develop a decision guide prototype. The prototype was iteratively refined through further co-design workshops and discussions among researchers and Patient and Public Involvement (PPI) representatives. We conducted user testing for final feedback and to finalize the decision guide. RESULTS Most participants acknowledged the limited benefits of tube feeding and would not use or want it for someone with severe dementia. However, they found decision-making processes and communication about nutrition and hydration were emotionally demanding and poorly supported in acute hospitals. The co-design groups developed the aims of the decision guide to support conversations and shared decision-making processes in acute hospitals, and help people reach evidence-based decisions. It was designed to clarify decision-making stages, provide information and elicit the values/preferences of everyone involved. It encouraged person-centred care, best-interests decision-making and multidisciplinary team working. From user testing, family carers and hospital professionals thought the decision guide could help initiate conversations and inform decisions. The final decision guide was disseminated and is being used in clinical practice in England. CONCLUSION We used rigorous and transparent processes to co-design the decision guide with everyone involved. The decision guide may facilitate conversations about nutrition and hydration and help people reach shared decisions that meet the needs and preferences of people with severe dementia. Future evaluation is required to test its real-world impacts. PATIENT OR PUBLIC CONTRIBUTION People with mild dementia, family carers and hospital professionals contributed to the design of the decision guide through the interviews and co-design workshops. PPI members helped design study procedures and materials and prepare this manuscript.
Collapse
Affiliation(s)
- Kanthee Anantapong
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Andrea Bruun
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
| | - Anne Walford
- Family Carer, Patient and Public Involvement Panel, London, UK
| | - Christina H Smith
- Language and Cognition, Division of Psychology and Language Sciences, University College London, London, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health & Social Care Workforce, King's College London, London, UK.,NIHR Applied Research Collaboration (ARC) South London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, UK
| |
Collapse
|
40
|
Singh DR, Sah RK, Simkhada B, Darwin Z. Potentials and challenges of using co-design in health services research in low- and middle-income countries. Glob Health Res Policy 2023; 8:5. [PMID: 36915174 PMCID: PMC10009993 DOI: 10.1186/s41256-023-00290-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 03/05/2023] [Indexed: 03/16/2023] Open
Abstract
Co-design with people having poor access to health services and fragile health systems in low- and middle-income countries can be momentous in bringing service users and other stakeholders together to improve the delivery and utilisation of health services. There is ample of evidence from high-income countries regarding how co-design can translate available evidence into developing acceptable, feasible, and adaptable health solutions in different settings. However, there is limited literature on co-design in health research in the context of low- and middle-income countries. Therefore, it is crucial to understand how knowledge about collaborative working can be translated into policy and practice in the context of low- and middle-income countries. Thus, this paper discusses the concept of co-design, co-production, and co-creation in health and the potentiality and challenges of using co-design in health services research in low- and middle-income countries. Despite the challenges, the co-design research has considerable potential to encourage the meaningful engagement of service users and other stakeholders in developing, implementing, and evaluating real-world solutions in low- and middle-income countries. It is essential to balance power dynamics in a co-design process through mutual recognition and respect, participant diversity, and reciprocity and flexibility in sharing. The inclusive and collaborative approach to working is complex due to existing rigid hierarchical structures, socio-cultural beliefs, political interference and working practices. However, this could be minimised by developing transparent terms of reference that reflect the value and benefits of equal partnership in particular co-design work.
Collapse
Affiliation(s)
- Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.
| | - Rajeeb Kumar Sah
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Bibha Simkhada
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Zoe Darwin
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| |
Collapse
|
41
|
Brijnath B, Navarro Medel C, Antoniades J, Gilbert AS. Culturally Adapting Evidence on Dementia Prevention for Ethnically Diverse Communities: Lessons Learnt from co-design. Clin Gerontol 2023; 46:155-167. [PMID: 35894749 DOI: 10.1080/07317115.2022.2101968] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES 40% of dementia cases can be prevented by addressing 12 lifestyle factors. These risk factors have increased presence in ethnic minorities, yet dementia prevention messages have not reached these communities. This article investigates the experience of co-designing a dementia prevention animated film with 9 ethnic groups in Australia. METHODS Evidence-based recommendations were adapted through an iterative process involving workshops with a stakeholder advisory committee and nine focus groups with 104 participants from the Arabic-, Hindi-, Tamil-, Cantonese-, Mandarin-, Greek-, Italian-, Spanish-, and Vietnamese-speaking communities. Data were analyzed using the Normalization Process Theory. RESULTS Cultural adaptation involves consideration of the mode of delivery, imagery and tone of the resource being developed; ensuring cultural adequacy; anticipating the need of the end-users; and managing linguistic challenges associated with working across multiple languages. CONCLUSIONS Learnings from this co-design process offer valuable insights for researchers and program developers who work with ethnic minority groups. CLINICAL IMPLICATIONS • Adaptation across cultures and languages is a negotiation not a consensus building exercise• Linguistic adaptation requires consideration of the education levels, and linguistic and intergenerational preferences of community members• Co-designing across multiple languages and cultures risks "flattening out" key aspects of cultural specificity.
Collapse
Affiliation(s)
- Bianca Brijnath
- Division of Social Gerontology, National Ageing Research Institute
- School of Social Sciences, University of Western Australia
| | | | - Josefine Antoniades
- Division of Social Gerontology, National Ageing Research Institute
- School of Public Health and Preventive Medicine, Monash University
| | - Andrew S Gilbert
- Division of Social Gerontology, National Ageing Research Institute
- Department of Social Inquiry, La Trobe University
| |
Collapse
|
42
|
Cunningham C, O'Donoghue G, Cosgrave S, Sands T, Leacy B, Markievicz I, Monaghan A, Shields N. Gym staff perspectives on disability inclusion: a qualitative study. Disabil Rehabil 2023; 45:441-448. [PMID: 35191365 DOI: 10.1080/09638288.2022.2036826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To explore gym staff perspectives on the inclusion of people with disability in the gym setting. MATERIALS AND METHODS Semi-structured interviews were conducted with 16 staff at four urban gym facilities, exploring perspectives on disability inclusion. An interpretive descriptive approach was adopted with reflexive thematic analysis of interview data and subsequent mapping of themes to the socioecological model. RESULTS Consistent with the socioecological model, the themes identified were "people with disability benefit from participation in gym settings" (personal); "positive interactions with people with disability" (interpersonal); "managing expectations of other gym users" (interpersonal); "inclusion is supported by a positive ethos, staff training and accessible facilities" (organisational); "people with disability lack awareness of inclusive exercise opportunities" (community); "desire to increase collaboration with healthcare professionals" (community); "access to transport can facilitate gym attendance" (community) and "local gym policy" (policy). CONCLUSION Although an overall ethos of inclusion was apparent, areas identified for enhancement were: awareness of gym services in the community; inter-sectoral collaboration with healthcare and disability organisations; comprehensive disability inclusion training; transport systems and accessibility; engaging people with disability in gym service planning. Implications for rehabilitationGym staff value collaboration with healthcare and rehab professionals to support inclusion of people with disability in exercise.Standardised disability inclusion training for gym staff is recommended.Individuals with disability should be empowered to contribute to the development of inclusive gym facilities and services.Rehab professionals have a role to play in raising awareness and advocating for inclusive exercise opportunities.
Collapse
Affiliation(s)
- Caitríona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Grainne O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Sinead Cosgrave
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Tiarna Sands
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Brendan Leacy
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Igor Markievicz
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Andrew Monaghan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Nora Shields
- Department of Physiotherapy, La Trobe University, Melbourne, Australia
| |
Collapse
|
43
|
Robinson S, Foley K, Moore T, Valentine K, Burton J, Marshall A, O’Donnell M, Brebner C. Prioritising Children and Young People with Disability in Research About Domestic and Family Violence: Methodological, Ethical and Pragmatic Reflections. JOURNAL OF FAMILY VIOLENCE 2023; 38:1-14. [PMID: 36743687 PMCID: PMC9883126 DOI: 10.1007/s10896-023-00496-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/30/2022] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
Purpose The perspectives of children and young people with disability who experience domestic and family violence are under-researched, impeding the development of approaches that meet their needs. Knowledge gaps stem from the layered discursive positioning of disability, childhood/youth, or domestic and family violence in addition to the methodological, ethical and pragmatic complexity of research needed to understand their priorities and be attuned to their lived experience. This article explores methodological, ethical and practical challenges to centring their voices in research about domestic and family violence. Method A conceptual framework of feminist disability theory and intersectionality informed our co-designed research, across three phases: (1) quantitative large-scale data linkage and case file analysis; (2) qualitative research with children and young people, their families and service providers and (3) stakeholder engagement workshops. Results We reflect on how our research was able to prioritise the contextual agency of children and young people with disability, ways it could not, and other constraints. Conclusion Children and young people with disability experiencing domestic and family violence hold an expert and unique vantage point on what happens to them. Amplifying their priorities for directing policy and organisational change requires more of researchers in terms of methods, but also more flexibility in how projects are funded to enable creativity and innovation. We call for collective attention to frameworks for supported decision-making and child ethics to progress inclusive research which recognises the importance of participation for children and young people with disability.
Collapse
Affiliation(s)
- Sally Robinson
- College of Nursing and Health Sciences, Flinders University, PO Box 2100, Adelaide, SA, 5001 South Australia
| | - Kristen Foley
- College of Nursing and Health Sciences, Flinders University, PO Box 2100, Adelaide, SA, 5001 South Australia
| | - Tim Moore
- Australian Catholic University, Melbourne, Australia
| | | | - Jala Burton
- College of Nursing and Health Sciences, Flinders University, PO Box 2100, Adelaide, SA, 5001 South Australia
| | - Amy Marshall
- College of Nursing and Health Sciences, Flinders University, PO Box 2100, Adelaide, SA, 5001 South Australia
| | - Melissa O’Donnell
- Centre for Child Protection, University of South Australia, Adelaide, South Australia
| | - Chris Brebner
- College of Nursing and Health Sciences, Flinders University, PO Box 2100, Adelaide, SA, 5001 South Australia
| |
Collapse
|
44
|
Anderson K, Gall A, Butler T, Ngampromwongse K, Hector D, Turnbull S, Lucas K, Nehill C, Boltong A, Keefe D, Garvey G. Development of Key Principles and Best Practices for Co-Design in Health with First Nations Australians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:147. [PMID: 36612467 PMCID: PMC9819583 DOI: 10.3390/ijerph20010147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND While co-design offers potential for equitably engaging First Nations Australians in findings solutions to redressing prevailing disparities, appropriate applications of co-design must align with First Nations Australians' culture, values, and worldviews. To achieve this, robust, culturally grounded, and First Nations-determined principles and practices to guide co-design approaches are required. AIMS This project aimed to develop a set of key principles and best practices for co-design in health with First Nations Australians. METHODS A First Nations Australian co-led team conducted a series of Online Yarning Circles (OYC) and individual Yarns with key stakeholders to guide development of key principles and best practice approaches for co-design with First Nations Australians. The Yarns were informed by the findings of a recently conducted comprehensive review, and a Collaborative Yarning Methodology was used to iteratively develop the principles and practices. RESULTS A total of 25 stakeholders participated in the Yarns, with 72% identifying as First Nations Australian. Analysis led to a set of six key principles and twenty-seven associated best practices for co-design in health with First Nations Australians. The principles were: First Nations leadership; Culturally grounded approach; Respect; Benefit to community; Inclusive partnerships; and Transparency and evaluation. CONCLUSIONS Together, these principles and practices provide a valuable starting point for the future development of guidelines, toolkits, reporting standards, and evaluation criteria to guide applications of co-design with First Nations Australians.
Collapse
Affiliation(s)
- Kate Anderson
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
| | - Alana Gall
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore 2480, Australia
| | - Tamara Butler
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
| | | | | | | | | | | | - Anna Boltong
- Cancer Australia, Sydney 2010, Australia
- Kirby Institute, UNSW Medicine, The University of New South Wales, Kensington 2052, Australia
| | | | - Gail Garvey
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
| |
Collapse
|
45
|
Butler T, Gall A, Garvey G, Ngampromwongse K, Hector D, Turnbull S, Lucas K, Nehill C, Boltong A, Keefe D, Anderson K. A Comprehensive Review of Optimal Approaches to Co-Design in Health with First Nations Australians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316166. [PMID: 36498237 PMCID: PMC9735487 DOI: 10.3390/ijerph192316166] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/12/2023]
Abstract
BACKGROUND Australia's social, structural, and political context, together with the continuing impact of colonisation, perpetuates health care and outcome disparities for First Nations Australians. A new approach led by First Nations Australians is required to address these disparities. Co-design is emerging as a valued method for First Nations Australian communities to drive change in health policy and practice to better meet their needs and priorities. However, it is critical that co-design processes and outcomes are culturally safe and effective. Aims: This project aimed to identify the current evidence around optimal approaches to co-design in health with First Nations Australians. METHODS First Nations Australian co-led team conducted a comprehensive review to identify peer-reviewed and grey literature reporting the application of co-design in health-related areas by and with First Nations Australians. A First Nations Co-Design Working Group (FNCDWG) was established to guide this work and team.A Collaborative Yarning Methodology (CYM) was used to conduct a thematic analysis of the included literature. RESULTS After full-text screening, 99 studies were included. Thematic analysis elicited the following six key themes, which included 28 practical sub-themes, relevant to co-design in health with First Nations Australians: First Nations Australians leadership; Culturally grounded approach; Respect; Benefit to First Nations communities; Inclusive partnerships; and Evidence-based decision making. CONCLUSION The findings of this review provide a valuable snapshot of the existing evidence to be used as a starting point to guide appropriate and effective applications of co-design in health with First Nations Australians.
Collapse
Affiliation(s)
- Tamara Butler
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
| | - Alana Gall
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore 2480, Australia
| | - Gail Garvey
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
| | | | | | | | | | | | - Anna Boltong
- Cancer Australia, Sydney 2010, Australia
- Kirby Institute, UNSW Medicine, The University of New South Wales, Kensington 2052, Australia
| | | | - Kate Anderson
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
| |
Collapse
|
46
|
Ells LJ, Ashton M, Li R, Logue J, Griffiths C, Torbahn G, Marwood J, Stubbs J, Clare K, Gately PJ, Campbell-Scherer D. Can We Deliver Person-Centred Obesity Care Across the Globe? Curr Obes Rep 2022; 11:350-355. [PMID: 36272056 PMCID: PMC9589792 DOI: 10.1007/s13679-022-00489-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This article discusses what person-centred care is; why it is critically important in providing effective care of a chronic, complex disease like obesity; and what can be learnt from international best practice to inform global implementation. RECENT FINDINGS There are four key principles to providing person-centred obesity care: providing care that is coordinated, personalised, enabling and delivered with dignity, compassion and respect. The Canadian 5AsT framework provides a co-developed person-centred obesity care approach that addresses complexity and is being tested internationally. Embedding person-centred obesity care across the globe will require a complex system approach to provide a framework for healthcare system redesign, advances in people-driven discovery and advocacy for policy change. Additional training, tools and resources are required to support local implementation, delivery and evaluation. Delivering high-quality, effective person-centred care across the globe will be critical in addressing the current obesity epidemic.
Collapse
Affiliation(s)
- Louisa J Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK.
| | | | - Rui Li
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Jennifer Logue
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Claire Griffiths
- Obesity Institute, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Gabriel Torbahn
- Department of Pediatrics, Paracelsus Medical University, Klinikum Nürnberg, Universitätsklinik Der Paracelsus Medizinischen Privatuniversität Nürnberg, Nuremberg, Germany
| | - Jordan Marwood
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - James Stubbs
- School of Psychology, University of Leeds, Leeds, UK
| | - Ken Clare
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
- , Obesity UK, Leeds, UK
| | - Paul J Gately
- , Obesity UK, Leeds, UK
- Obesity Institute, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- MoreLife UK Ltd, Leeds, UK
| | - Denise Campbell-Scherer
- Physician Learning Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| |
Collapse
|
47
|
Mistry SK, Harris E, Harris MF. Learning from a codesign exercise aimed at developing a navigation intervention in the general practice setting. Fam Pract 2022; 39:1070-1079. [PMID: 35365997 DOI: 10.1093/fampra/cmac020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In this study, we aimed to describe and evaluate the codesign of an intervention in general practice setting to help address navigation problems faced by the patients from the culturally and linguistically diverse (CALD) community in Australia. METHODS An experience-based codesign (EBCD) methodology was adopted using the Double Diamond design process. Two codesign workshops were conducted online with 13 participants including patients, their caregivers, health service providers, researchers, and other stakeholders. Workshops were audio-recorded, transcribed, and thematically analyzed. RESULTS The codesign participants identified several navigation problems among CALD patients such as inadequate health literacy, cultural and language barriers, and difficulties with navigating health and social services. They believed that bilingual community navigators (BCNs; lay health workers from the same language or cultural background) could help them address these problems. However, this depended on BCNs being trained and supervised, with a clear role definition and manageable workloads, and not used as an interpreter. In undertaking the codesign process, we found that pre-workshop consultations were useful to ensure engagement, especially for consumers who participated more actively in group activities with service providers after these and their own separate small group discussions during the workshop. CONCLUSION Overall, participants identified that BCNs could offer help in addressing the problems faced by the CALD patients in accessing care in general practice setting. The codesign process provided new insights into the navigation problems faced by CALD patients in accessing care and collaboratively developed a strategy for further testing and evaluation.
Collapse
Affiliation(s)
- Sabuj K Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Botany Street, Kensington, NSW 2052, Australia
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Botany Street, Kensington, NSW 2052, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Botany Street, Kensington, NSW 2052, Australia
| |
Collapse
|
48
|
Micsinszki SK, Tanel NL, Kowal J, King G, Menna-Dack D, Chu A, Phoenix M. Codesigning simulations and analyzing the process to ascertain principles of authentic and meaningful research engagement in childhood disability research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:60. [PMID: 36352487 PMCID: PMC9645736 DOI: 10.1186/s40900-022-00398-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Including youth with disabilities and their families as partners in childhood disability research is imperative but can be challenging to do in an authentic and meaningful way. Simulation allows individuals to learn in a controlled environment and provides an opportunity to try new approaches. The objectives of the research study were to (1) codesign a suite of simulations and facilitation resources and understand how stakeholders engaged in the codesign process; and (2) describe the principles of authentic and meaningful research engagement as identified by stakeholders. METHODS Interdisciplinary stakeholder groups, including youth with disabilities, parents, researchers, and trainees, codesigned simulation training videos by developing shared storylines about challenges with research engagement that were then performed and digitally recorded with standardized patient actors. Two forms of data were collected: (1) observations via field notes and video recordings were analyzed to understand the codesign process; and (2) interviews were analyzed to understand principles of authentic and meaningful engagement. RESULTS Four simulation training videos were developed, and topics included: (1) forming a project team; (2) identifying project objectives and priorities; (3) reviewing results; and (4) navigating concerns about knowledge translation. Thirteen participants participated in the simulation codesign; nine of whom consented to be observed in the codesign process and seven who completed follow up interviews. We identified two themes about authentic and meaningful engagement in research: (1) whether the invitation to engage on a project was authentic and meaningful or was extended to 'tick a box'; and (2) whether there were authentic and meaningful opportunities to contribute (e.g., valued contributions aligned with people's lived experience, skills, and interests) or if they only served as a 'rubber stamp'. Communication and expectations tied the 'tick box' and 'rubber stamp' themes together and underlie whether engagement was authentic and meaningful. CONCLUSIONS For research engagement to be authentic and meaningful, researchers and families need to set clear expectations, build rapport, have tangible supports, use clear communication, and build time and space to work together. Future work will explore the utility of the simulations and whether they improve knowledge and attitudes about authentic and meaningful engagement in research.
Collapse
Affiliation(s)
- Samantha K Micsinszki
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada.
- Bloorview Research Institute, Toronto, ON, Canada.
| | | | - Julia Kowal
- Bloorview Research Institute, Toronto, ON, Canada
| | - Gillian King
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
- Bloorview Research Institute, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Dolly Menna-Dack
- Bloorview Research Institute, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Angel Chu
- Bloorview Research Institute, Toronto, ON, Canada
| | - Michelle Phoenix
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
- Bloorview Research Institute, Toronto, ON, Canada
| |
Collapse
|
49
|
It is a relay not a sprint! Evolving co-design in a digital and virtual environment: neighbourhood services for elders. GLOBAL PUBLIC POLICY AND GOVERNANCE 2022. [PMCID: PMC9632595 DOI: 10.1007/s43508-022-00053-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is an emerging body of research on the co-design of public services, including co-design with vulnerable adults. However, what has been less explored has been the impact of digital technology and virtual environments upon the co-design process in this context. This paper analyses the contingencies of virtual co-design through a case study of a project to develop supportive local communities for vulnerable elderly people. This project was initially planned to use traditional co-design methods within a face-to-face environment, in the context of the local public service ecosystem. The CoVid-19 pandemic made this impossible. Consequently, an innovative approach to co-design was developed that shifted the process from a face-to-face to a virtual environment. This exploratory paper reports and evaluates this approach and its implications for the future of the theory and practice of the co-design of public services for vulnerable adults. Theoretically the paper evolves a model of co-design in a virtual space that is embedded within a public service ecosystem framework of value creation. At a practice level, the paper provides insight into the strategic and operational management of co-creation in a virtual space. It evolves the ‘Relay’ model of asynchronous co-creation across time and considers it key contingencies.
Collapse
|
50
|
Liddle J, Worthy P, Frost D, Taylor E, Taylor D. Partnering with people living with dementia and care partners in technology research and design: Reflections and recommendations. Aust Occup Ther J 2022; 69:723-741. [PMID: 36203322 PMCID: PMC10092369 DOI: 10.1111/1440-1630.12843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/15/2022] [Accepted: 09/10/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Occupational therapists may recommend and support technology use for facilitating independence, safety, wellbeing, and participation. There are high expectations for technology for people living with dementia. However, there is recognition that technologies will need to improve to deliver these expected benefits. People living with dementia have historically been excluded from direct involvement in research and design. A program of participatory research was undertaken to codesign technologies and technology research with people living with dementia and care partners. This work aims to capture the requirements, actions, and barriers experienced in forming these partnerships in technology research and design. METHODS A shared metareflection of experiences was conducted by members (5) of the research teams involved in three participatory research and technology design studies. The team comprising living experience experts, an occupational therapist, and interaction designer reflected on their experiences and derived recommendations. Key considerations for effective partnerships were drawn inductively by the authors from study experiences, materials, and reflexive discussion. FINDINGS Six core areas were identified. These were four action areas-(1) Agree on the value; (2) The time to start partnering is now; (3) Ask not assume; and (4) Push back on 'we always have'-(5) barriers and tensions, and (6) unexpected benefits. The reflections indicated that genuine partnerships and engagements were possible with living experience experts in research and design teams. These required resourcing and focussed actions to promote partnership. Despite some structural changes that encourage partnering, there are considerable barriers to this engagement; however, benefits beyond the expected ones can be realised. CONCLUSION Genuine partnerships in technology research and design with living experience experts are possible and lead to benefits for the team, research outcomes, and technologies. Recommended actions could support expansion of effective partnerships with people living with dementia and care partners as well as other partnerships in research.
Collapse
Affiliation(s)
- Jacki Liddle
- The Florence Project, School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Queensland, Australia
| | - Peter Worthy
- The Florence Project, School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Queensland, Australia
| | - Dennis Frost
- The Florence Project, School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Queensland, Australia
| | - Eileen Taylor
- The Florence Project, School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Queensland, Australia
| | - Dubhglas Taylor
- The Florence Project, School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Queensland, Australia
| |
Collapse
|