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Amoakoh HB, De Kok BC, Yevoo LL, Olde Loohuis KM, Srofenyoh EK, Arhinful DK, Koi-Larbi K, Adu-Bonsaffoh K, Amoakoh-Coleman M, Browne JL. Co-creation of a toolkit to assist risk communication and clinical decision-making in severe preeclampsia: SPOT-Impact study design. Glob Health Action 2024; 17:2336314. [PMID: 38717819 PMCID: PMC11080670 DOI: 10.1080/16549716.2024.2336314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/25/2024] [Indexed: 05/12/2024] Open
Abstract
Globally, the incidence of hypertensive disorders of pregnancy, especially preeclampsia, remains high, particularly in low- and middle-income countries. The burden of adverse maternal and perinatal outcomes is particularly high for women who develop a hypertensive disorder remote from term (<34 weeks). In parallel, many women have a suboptimal experience of care. To improve the quality of care in terms of provision and experience, there is a need to support the communication of risks and making of treatment decision in ways that promote respectful maternity care. Our study objective is to co-create a tool(kit) to support clinical decision-making, communication of risks and shared decision-making in preeclampsia with relevant stakeholders, incorporating respectful maternity care, justice, and equity principles. This qualitative study detailing the exploratory phase of co-creation takes place over 17 months (Nov 2021-March 2024) in the Greater Accra and Eastern Regions of Ghana. Informed by ethnographic observations of care interactions, in-depth interviews and focus group and group discussions, the tool(kit) will be developed with survivors and women with hypertensive disorders of pregnancy and their families, health professionals, policy makers, and researchers. The tool(kit) will consist of three components: quantitative predicted risk (based on external validated risk models or absolute risk of adverse outcomes), risk communication, and shared decision-making support. We expect to co-create a user-friendly tool(kit) to improve the quality of care for women with preeclampsia remote from term which will contribute to better maternal and perinatal health outcomes as well as better maternity care experience for women in Ghana.
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Affiliation(s)
- Hannah Brown Amoakoh
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bregje C. De Kok
- Anthropology Department, University of Amsterdam, Amsterdam, Netherlands
| | - Linda Lucy Yevoo
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital, Accra, Ghana
| | - Klaartje M. Olde Loohuis
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Emmanuel K. Srofenyoh
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital, Accra, Ghana
| | - Daniel K. Arhinful
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Kwame Adu-Bonsaffoh
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Mary Amoakoh-Coleman
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joyce L. Browne
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Marwaa MN, Guidetti S, Ytterberg C, Kristensen HK. Acceptability of two mobile applications to support cross-sectoral, person-centred and empowering stroke rehabilitation - a process evaluation. Ann Med 2024; 56:2302979. [PMID: 38466794 PMCID: PMC10930108 DOI: 10.1080/07853890.2024.2302979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 03/13/2024] Open
Abstract
AIM To evaluate the acceptability of two co-designed mobile applications Mit Sygehus [a knowledge-based solution] and Genoptræn.dk [a self-training solution] to support a cross-sectoral, person-centred and empowering stroke rehabilitation. SETTING The applications were implemented and tested throughout two stroke rehabilitation trajectories in Southern Denmark, comprising two acute, two sub-acute and two municipal stroke rehabilitation settings. METHODS, PARTICIPANTS AND ANALYSIS A process evaluation focusing on acceptability was conducted. Individual and dyadic interviews were performed with ten stroke survivors (three women and seven men, aged 50-84) with moderate stroke and seven significant others (five women and two men, aged 50-78) post-rehabilitation. A constructivist Grounded Theory analysis was used to explore what, why, when, and how the apps worked or did not work throughout the stroke rehabilitation trajectory and if adaptions were needed. RESULTS Participants found that Mit Sygehus provided adequate and sufficient knowledge and was easy to use, however, acceptability of Mit Sygehus declined throughout the rehabilitation process. Also, knowledge on 'return-to-work' and 're-gaining driver's license/permission to drive' needed to be developed. The content in Genoptræn.dk was perceived as acceptable, through content being person-centred, motivating and meaningful. Genoptræn.dk furthermore, supported the transfer between rehabilitation settings, provided a sense of progress throughout the rehabilitation process, facilitated positive habits regarding self-training, and relieved the burden on significant others. Genoptræn.dk was perceived most acceptable in the sub-acute rehabilitation setting and declined when rehabilitation continued in the municipal setting. CONCLUSION Stroke survivors and their significant others found Mit Sygehus and Genoptræn.dk acceptable to support cross-sectoral, person-centred and empowering stroke rehabilitation, however acceptability declined throughout the rehabilitation process. Further investigations are required to determine how cognitive rehabilitation can play a greater role in app-supported stroke rehabilitation and how the need for more long-term follow-up can be supported.
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Affiliation(s)
- Mille Nabsen Marwaa
- Department of Physiotherapy Education, University College Southern Denmark, Esbjerg, Denmark
- Department of Clinical Research, Center for Innovative Medical Technologies, University of Southern Denmark, Odense, Denmark
| | - Susanne Guidetti
- Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
- Geriatric Research Unit, Department of Clinical Research, University Hospital Odense, University of Southern Denmark, Odense, Denmark
| | - Hanne Kaae Kristensen
- Department of Clinical Research, Center for Innovative Medical Technologies, University of Southern Denmark, Odense, Denmark
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Khadka S, Subedi P, Indrasena BSH, Lamsal D, Aylott J. Collaborative leadership to empower nurses to implement ABCDE emergency nursing in an emergency department in Nepal. Leadersh Health Serv (Bradf Engl) 2024; 37:477-498. [PMID: 39344576 DOI: 10.1108/lhs-12-2023-0100] [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] [Indexed: 10/01/2024]
Abstract
PURPOSE Emergency medicine can save lives and in 2018 the World Health Assembly passed resolution 72.16 ensuring the role of emergency care in all health systems. With a continued global shortage of emergency physicians, with many low-medium-income countries (LMIC) still to develop emergency medicine as a speciality, the role of emergency nurses is critical to deliver the WHO Emergency Care System Framework (WHO, 2018). Emergency medicine doctors play a critical role in collaborating with nurses, in emergency medicine where nurses are often the first clinicians are often the first clinicians to interact with patients in emergency care settings, making up the majority of health-care professionals in LMIC (Mamalelala, 2024). Yet emergency nursing has yet to become established in Nepal, where nurses are often recruited to emergency departments, without having received any training in emergency or critical care treatment and management. The purpose of this paper is to outline a collaborative leadership approach to co-design an airway, breathing, circulation, disability, exposure (ABCDE) structured approach to an emergency nursing training module designed for nurses to feel empowered in the emergency department and to report on its findings. DESIGN/METHODOLOGY/APPROACH This study draws upon mixed methodology research, enrolling 30 nurses (n = 30) from an emergency department in a tertiary hospital in Nepal through three stages of the project: Stage 1: training module co-design, collaborative leadership exploring the rationale for a training module and core features of design based on the ABCDE of emergency medicine; Stage 2: quantitative data were collected to assess baseline pre- and post-intervention knowledge and follow-up knowledge assessment at 30 and 45 days; Stage 3: qualitative data were collected with 24/30 (80%) nurses to evaluate the impact and application of the nurses ABCDE learning 7 months post-training. The qualitative survey was undertaken using online Google Forms. FINDINGS Nurses were fully engaged in the co-design and collaboration of the development of an ABCDE training module which was delivered over 3 h. Full engagement was secured from all nurses in the department, and there were statistically significant advances in ABCDE emergency knowledge from the baseline, however, this knowledge began to decrease at 30 and 45 days. A follow-up qualitative survey was distributed to nurses seven months after training with an 80% return rate, which reported a range of examples of how nurses were continuing to apply their learning in practice. ORIGINALITY/VALUE This training module for emergency nurses was designed collaboratively from the "bottom up" in a tertiary hospital in Nepal, recognising the need to develop emergency nursing in the emergency department. The data revealed promising findings, while knowledge decreased from the post-training questionnaire, qualitative evidence revealed significant changes in practice, with the greatest reported change in the management of the airway. While this training module has made a difference in the quality of care provided, there is a need for a country-wide strategy in this area otherwise it is likely that such an initiative will only be developed by hospitals at a local level (Lecky, 2014). Education and training initiatives for nurses that focus on an evidence-based approach to clinical practice can bridge the workforce gap in the short term, however, the Government of Nepal must decide on establishing a recognised post-graduate sub-specialty in emergency nursing, the duration of training, who should be trained and what curriculum should be followed (Lecky, 2014).
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Affiliation(s)
- Sushil Khadka
- Department of Emergency Medicine, Chitwan Medical College, Bharatpur, Nepal
| | - Prakash Subedi
- Emergency Department, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK and QiMET Medical Institute, QiMET International Ltd, Sheffield, UK
| | - Buddhike Sri Harsha Indrasena
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK and Department of General Surgery, Provincial General Hospital, Badulla, Sri Lanka
| | - Dayaram Lamsal
- Department of Emergency Medicine, Chitwan Medical College, Bharatpur, Nepal
| | - Jill Aylott
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK and QiMET Medical Institute, QiMET International Ltd, Sheffield, UK
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Bartels SL, Stephens N, D'Andrea F, Handley M, Markaryan M, Nakakawa Bernal A, Van den Block L, de Bruin SR, Windle K, Roes M, Janssen N, Christie H, Garcia L, Teesing G, Moniz-Cook E, Graff M. Discussing methodological gaps in psychosocial intervention research for dementia: an opinion article from the INTERDEM Methodology Taskforce guided by the MRC framework. FRONTIERS IN DEMENTIA 2024; 3:1458023. [PMID: 39391708 PMCID: PMC11464461 DOI: 10.3389/frdem.2024.1458023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/29/2024] [Indexed: 10/12/2024]
Affiliation(s)
- Sara Laureen Bartels
- Department of Psychiatry and Neuropsychology and Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, Netherlands
| | - Nathan Stephens
- The Association for Dementia Studies, School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Federica D'Andrea
- The Geller Institute of Ageing and Memory, School of Medicine and Biosciences, University of West London, London, United Kingdom
| | - Melanie Handley
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - Marine Markaryan
- Department of Psychiatry and Neuropsychology and Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Lieve Van den Block
- VUB-UGent End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Simone R. de Bruin
- Research Group Living Well with Dementia, Division Health and Social Care, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Karen Windle
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom
| | - Martina Roes
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, University of Witten/Herdecke, Witten, Germany
| | - Niels Janssen
- Department of Psychiatry and Neuropsychology and Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, Netherlands
| | - Hannah Christie
- Department of Psychiatry and Neuropsychology and Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, Netherlands
- School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lesley Garcia
- School of Sociology and Social Policy, University of Nottingham, Nottingham, United Kingdom
| | | | - Esme Moniz-Cook
- Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Maud Graff
- Department of Rehabilitation, Radboudumc, Radboud University Medical Centre Nijmegen, Nijmegen, Netherlands
- Department of IQ Health, Radboudumc Alzheimer Center, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
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Bergholtz J, Wolf A, Crine V, Cleeve H, Santana MJ, Björkman I. Patient and public involvement in healthcare: a systematic mapping review of systematic reviews - identification of current research and possible directions for future research. BMJ Open 2024; 14:e083215. [PMID: 39304210 PMCID: PMC11418490 DOI: 10.1136/bmjopen-2023-083215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 08/30/2024] [Indexed: 09/22/2024] Open
Abstract
OBJECTIVES To provide an overview of patient and public involvement (PPI) in the mesolevel and macrolevel of healthcare (different from PPI in research) and identify directions for future research by mapping contexts, terminology, conceptual frameworks, measured outcomes and research gaps. DESIGN Mapping review of systematic reviews. A patient coresearcher (JB) was involved in all stages. A broad search strategy was applied to capture the variation in terminology. DATA SOURCES MEDLINE, CINAHL and PsycINFO were searched from 1 January 2001 to 5 December 2022. ELIGIBILITY CRITERIA We included systematic reviews of empirical studies focusing on PPI in the mesolevel and macrolevel of healthcare. DATA EXTRACTION AND SYNTHESIS Three independent reviewers used standardised methods to screen studies and extract data. Thematic categories were created inductively through iteration. The results were organised in narrative, visual or tabular formats. RESULTS 4419 identified records were screened. 37 systematic reviews were eligible for inclusion. Most studies were narrative syntheses (N=26). Identified context categories were PPI for healthcare quality improvement (22%), patient safety (8%), community-based initiatives (27%), peer support (16 %) and education of healthcare professionals (27%). A wide range of terms was used to discuss PPI, with community participation being the most common. 28 reviews reported on frameworks, conceptual guidance and/or policy documents. Nine different types of outcomes were identified. The research gap pointed out most frequently is the lack of studies of robust designs that allow for replication and long-term follow-up, followed by studies on cost-effectiveness and resources needed. There is a need for consensus on the use of terminology. CONCLUSIONS This mapping review sheds light on the evolving landscape of PPI in healthcare. To advance the field, future research should prioritise rigorous study designs, cost-effectiveness assessments and consensus-building efforts to create a more unified and impactful approach for PPI in healthcare.
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Affiliation(s)
- Jana Bergholtz
- Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg Institute of Health and Care Sciences, Gothenburg, Sweden
| | - Axel Wolf
- Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg Institute of Health and Care Sciences, Gothenburg, Sweden
| | - Vanessa Crine
- Department of Medical and Translational Biology, Umeå University, Umea, Sweden
| | - Helena Cleeve
- University of Gothenburg Department of Sociology and Work Science, Gothenburg, Sweden
| | - Maria-Jose Santana
- Cumming School of Medicine, University of Calgary Department of Community Health Sciences, Calgary, Alberta, Canada
- Patient Engagement Team, Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit, Calgary, Alberta, Canada
| | - Ida Björkman
- Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg Institute of Health and Care Sciences, Gothenburg, Sweden
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Wetzler SR, Wishlade T, Cates F, Kuhn I, Aiken CE. Lived experience of hypertensive disorders of pregnancy: a systematic review and meta-synthesis. Am J Obstet Gynecol MFM 2024; 6:101494. [PMID: 39299502 DOI: 10.1016/j.ajogmf.2024.101494] [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: 06/11/2024] [Revised: 08/14/2024] [Accepted: 08/25/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Hypertensive disorders are major causes of maternal and neonatal morbidity and mortality, affecting ∼10% pregnancies worldwide. OBJECTIVE Understanding the lived experience of women with hypertensive disorders during pregnancy is important to inform best practice and provide holistic care. STUDY DESIGN This is a systematic review and meta-synthesis of studies containing qualitative components relating to direct lived experience of hypertensive disorders of pregnancy. Medline via Ovid, Embase via Ovid, CINAHL via Ebsco, PsycINFO via Ebsco, Scopus, Web of Science Core Collection, and ASSIA via ProQuest were searched between database inception and June 2024. Quality assessment was performed using the Critical Appraisal Skills Programme checklist for qualitative research. Themes were labeled and organized into a framework using NVivo software. RESULTS Eighteen studies were included in the meta-synthesis. Anxiety, stress, fear and panic emerged as the most common emotional experiences during hypertensive disorders of pregnancy. Loss of control was also mentioned frequently and consistently across studies (frequency effect size 38.9% and intensity effect size 15.3%). Emotional responses to physical symptoms or lack thereof, and feelings about the impact of the complicated pregnancy on family and community also emerged as central themes associated with hypertensive disorders of pregnancy. CONCLUSION A range of emotional experiences was captured across the studies included in our meta-synthesis, some of which were observed across global settings whereas others were context-dependent. Interventions and care pathways for pregnancies affected by hypertensive disorders should aim to support women through complex emotional experiences as well as reducing morbidity and mortality.
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Affiliation(s)
- Sara R Wetzler
- Department of History and Philosophy of Science, University of Cambridge, Cambridge, UK (Wetzler); Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY (Wetzler).
| | - Tabitha Wishlade
- Department of Obstetrics and Gynaecology, University of Cambridge, The Rosie Hospital and NIHR Cambridge Biomedical Research Centre, Cambridge, UK (Wishlade, Aiken)
| | - Frances Cates
- Department of Liberal Arts, University of Texas at Austin (Cates)
| | - Isla Kuhn
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK (Kuhn)
| | - Catherine E Aiken
- Department of Obstetrics and Gynaecology, University of Cambridge, The Rosie Hospital and NIHR Cambridge Biomedical Research Centre, Cambridge, UK (Wishlade, Aiken)
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de Wolf-Linder S, Kramer I, Hersperger M, Schubert M, Bächi S, Stolz M, Wolverson E, Ramsenthaler C. Meaningful patient and public engagement in dissemination-embedding co-production in dementia research. FRONTIERS IN DEMENTIA 2024; 3:1426019. [PMID: 39351041 PMCID: PMC11439697 DOI: 10.3389/frdem.2024.1426019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/22/2024] [Indexed: 10/04/2024]
Abstract
Background Patient and Public Involvement and Engagement (PPIE) is still underutilised in both dementia research and corresponding dissemination activities. Aim To describe the methods, format, and lessons learned in co-creating and co-producing a dissemination strategy for a research project focused on establishing patient-centred outcome measures into routine palliative community care for persons living with dementia (PLWD) and their informal carers. Materials and methods A participatory, hybrid-format workshop was conducted to co-create the dissemination strategy with a PPIE group. A video presentation of findings and a list of prompts shared prior to the workshop were used to elicit views on dissemination strategies and knowledge translation. The workshop was followed up with a survey to consolidate the dissemination strategy. Workshop minutes and survey responses were analysed using qualitative thematic analysis. Results 22 participants from our diverse PPIE group attended the workshop. Two major themes emerged: (a) Knowledge translation: building bridges between research and practise, and (b) Collaboration and dissemination: everyone's voice is needed. Participants suggested critical changes to dissemination methods and materials. Successful knowledge translation depends on a strong evidence base. For this, materials need to be tailored to specific audiences. Everyone's voice needs to be integrated through co-production in dissemination activities by PPIE members to influence societal change. Tailored dissemination activities within a dissemination strategy were co-created spanning all phases of the research cycle. Discussion Informing and educating the public and policymakers about the needs of PLWD relies on disseminating and fostering knowledge translation throughout all phases of the research cycle.
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Affiliation(s)
- Susanne de Wolf-Linder
- School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Zürich, Switzerland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom
| | - Iris Kramer
- School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Zürich, Switzerland
| | - Martina Hersperger
- “Plattform Mäander” Foundation, Zürich, Switzerland
- Department of Health Sciences, PPIE Stakeholder Group for People With Dementia, Institute of Nursing, Winterthur, Switzerland
| | - Maria Schubert
- School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Zürich, Switzerland
| | - Sonja Bächi
- School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Zürich, Switzerland
- Department of Health Sciences, PPIE Stakeholder Group for People With Dementia, Institute of Nursing, Winterthur, Switzerland
| | - Monika Stolz
- Department of Health Sciences, PPIE Stakeholder Group for People With Dementia, Institute of Nursing, Winterthur, Switzerland
- Person Living With Dementia, Winterthur, Switzerland
| | - Emma Wolverson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom
- Dementia UK, London, United Kingdom
| | - Christina Ramsenthaler
- School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Zürich, Switzerland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom
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van Leersum CM, Jaschinski C, Bults M, van der Zwart J. Citizen involvement in research on technological innovations for health, care or well-being: a scoping review. Health Res Policy Syst 2024; 22:119. [PMID: 39223606 PMCID: PMC11367923 DOI: 10.1186/s12961-024-01152-4] [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: 11/09/2022] [Accepted: 05/20/2024] [Indexed: 09/04/2024] Open
Abstract
Citizen science can be a powerful approach to foster the successful implementation of technological innovations in health, care or well-being. Involving experience experts as co-researchers or co-designers of technological innovations facilitates mutual learning, community building, and empowerment. By utilizing the expert knowledge of the intended users, innovations have a better chance to get adopted and solve complex health-related problems. As citizen science is still a relatively new practice for health and well-being, little is known about effective methods and guidelines for successful collaboration. This scoping review aims to provide insight in (1) the levels of citizen involvement in current research on technological innovations for health, care or well-being, (2) the used participatory methodologies, and (3) lesson's learned by the researchers.A scoping review was conducted and reported in accordance with the PRISMA-ScR guidelines. The search was performed in SCOPUS in January 2021 and included peer-reviewed journal and conference papers published between 2016 and 2020. The final selection (N = 83) was limited to empirical studies that had a clear focus on technological innovations for health, care or well-being and involved citizens at the level of collaboration or higher. Our results show a growing interest in citizens science as an inclusive research approach. Citizens are predominantly involved in the design phase of innovations and less in the preparation, data-analyses or reporting phase. Eight records had citizens in the lead in one of the research phases.Researcher use different terms to describe their methodological approach including participatory design, co-design, community based participatory research, co-creation, public and patient involvement, partcipatory action research, user-centred design and citizen science. Our selection of cases shows that succesful citizen science projects develop a structural and longitudinal partnership with their collaborators, use a situated and adaptive research approach, and have researchers that are willing to abandon traditional power dynamics and engage in a mutual learning experience.
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Affiliation(s)
- Catharina Margaretha van Leersum
- Department of Science, Technology, and Policy Studies, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, The Netherlands.
- Faculty of Humanities, Open University, Heerlen, The Netherlands.
| | - Christina Jaschinski
- Technology, Health, and Care Research Group, Saxion University of Applied Sciences, Enschede, The Netherlands
| | - Marloes Bults
- Technology, Health, and Care Research Group, Saxion University of Applied Sciences, Enschede, The Netherlands
| | - Johan van der Zwart
- Department of Science, Technology, and Policy Studies, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, The Netherlands
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Wang T, Zhu H, Qian S, Giunti G, Goossens R, Melles M. Designing digital patient experiences: The digital health design framework. APPLIED ERGONOMICS 2024; 119:104289. [PMID: 38688183 DOI: 10.1016/j.apergo.2024.104289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Digital health (DH) brings considerable benefits, but it comes with potential risks. Human Factors (HF) play a critical role in providing high-quality and acceptable DH solutions. Consultation with designers is crucial for reflecting on and improving current DH design practices. OBJECTIVES We investigated the general DH design processes, challenges, and corresponding strategies that can improve the digital patient experience (PEx). METHODS A semi-structured interview study with 24 design professionals. All audio recordings were transcribed, deidentified, grammatically corrected, and imported into ATLAS.ti for data analysis. Three coders participated in data coding following the thematic analysis approach. RESULTS We identified eight DH design stages and grouped them into four phases: preparation, problem-thinking, problem-solving, and implementation. The analysis presented twelve design challenges associated with contextual, practical, managerial, and commercial aspects that can hinder the design process. We identified eight common strategies used by respondents to tackle these challenges. CONCLUSIONS We propose a Digital Health Design (DHD) framework to improve the digital PEx. It provides an overview of design deliverables, activities, stakeholders, challenges, and corresponding strategies for each design stage.
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Affiliation(s)
- Tingting Wang
- Human-Centered Design Department, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands.
| | - Haiou Zhu
- Neuroscience, Ethics & Society, Department of Psychiatry, University of Oxford, Oxford, UK; School of Design and Creative Arts, Loughborough University, Loughborough, UK
| | - Shuxian Qian
- Human-Centered Design Department, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Guido Giunti
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Clinical Medicine Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Richard Goossens
- Human-Centered Design Department, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Marijke Melles
- Human-Centered Design Department, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
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Højen AA, Lindegaard SF, Grove EL, Hansen AL, Larsen TB, Kümler T, Johnsen SP, Rolving N. Development of A structured integrated post-Pulmonary Embolism care model: The Attend-PE model. J Thromb Haemost 2024:S1538-7836(24)00437-9. [PMID: 39122195 DOI: 10.1016/j.jtha.2024.06.027] [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: 03/14/2024] [Revised: 06/05/2024] [Accepted: 06/27/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND More than 50% of patients with pulmonary embolism (PE) experience persistent functional limitations. Despite guideline recommendations for a structured integrated care model for patients with PE, consensus on an optimal follow-up strategy is lacking, and evidence is insufficient. OBJECTIVES To describe the development of a structured model for PE follow-up using coproduction methods. METHODS Coproduction of A structured integrated postPulmonary Embolism care (Attend-PE) model was conducted from October 2021 to June 2022, featuring participatory design techniques. This was combined with a stepwise approach based on Intervention Mapping to ensure that the developed model was evidence-based and theoretically grounded. RESULTS Development of the Attend-PE model included 1) a needs assessment mapping follow-up at 18 sites treating PE in Denmark; 2) definition of the overall goal and performance objectives of the Attend-PE model, based on the needs assessment in combination with a literature review; 3) coproduction of the Attend-PE model in workshops with patient representatives, healthcare professionals, and experts in the field; and 4) refinement of the structure and organization of the Attend-PE model and production of the patient education material. The Attend-PE model outlines a structured approach for in-hospital follow-up, involving group-based patient education, individual consultations, and patient-reported outcomes to assess physical and psychological well-being. The model supports a personalized posthospitalization care plan. CONCLUSION The coproduction process was successful in developing a structured follow-up model aligned with patients' needs, health provider perspectives, and existing guidelines. The Attend-PE model is currently undergoing clinical evaluation to determine its effectiveness and usability.
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Affiliation(s)
- Anette Arbjerg Højen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Stine Foged Lindegaard
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Annesofie Løvdahl Hansen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Thomas Kümler
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark; Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Nanna Rolving
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark University Hospital, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
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Morley C, Jose K, Hall SE, Shaw K, McGowan D, Wyss M, Winzenberg T. Evidence-informed, experience-based co-design: a novel framework integrating research evidence and lived experience in priority-setting and co-design of health services. BMJ Open 2024; 14:e084620. [PMID: 39122385 PMCID: PMC11404138 DOI: 10.1136/bmjopen-2024-084620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024] Open
Abstract
OBJECTIVE To describe a new co-design framework termed Evidence-informed, Experience-based Co-design (E2CD). BACKGROUND Involving consumers and clinicians in planning, designing and implementing services results in the end-product being more likely to meet the needs of end-users and increases the likelihood of their uptake and sustainability. Different forms and definitions of co-design have been described in the literature and have had varying levels of success in health service redesign. However, many fall short of including people with lived experience in all aspects of the process, particularly in setting priorities for service (re)design. In addition, health services need to deliver evidence-based care as well as care that meets the needs of users, yet few ways of integrating research evidence into co-design processes are described. This paper describes a new framework to approach co-design which addresses these issues. We believe that it offers a roadmap to address some of healthcare's most wicked problems and potentially improve outcomes for some of the most vulnerable people in our society. We use improving services for people with high healthcare service utilisation as a working example of the Framework's application. CONCLUSION Evidence-informed experience-based co-design has the potential to be used as a framework for co-design that integrates research evidence with lived experience and provides people with lived experience a central role in decision-making about prioritising and designing services to meet their needs.
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Affiliation(s)
- Claire Morley
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Kim Jose
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Sonj E Hall
- Bellberry Ltd, Eastwood, South Australia, Australia
| | - Kelly Shaw
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- KPHealth, Hobart, Tasmania, Australia
| | - Deirdre McGowan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Martina Wyss
- Primary Health Tasmania, Launceston, Tasmania, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Wannheden C, Hagman J, Riggare S, Pukk Härenstam K, Fernholm R. Safety-netting strategies for primary and emergency care: a codesign study with patients, carers and clinicians in Sweden. BMJ Open 2024; 14:e089224. [PMID: 39107019 PMCID: PMC11308890 DOI: 10.1136/bmjopen-2024-089224] [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: 05/24/2024] [Accepted: 07/19/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVES To codesign safety-netting strategies for primary and emergency care settings by integrating the experiences and ideas of patients, carers and clinicians. DESIGN A codesign process involving two focus group discussions, eight individual interviews and five workshops. All sessions were audio recorded and transcribed verbatim. Data were analysed using qualitative content analysis and reported using the Consolidated criteria for Reporting Qualitative research guidelines. SETTING Primary and emergency care in Sweden, focusing on the Stockholm region. PARTICIPANTS 7 (5 women) individuals with patient expertise, 1 (man) individual with carer expertise, 18 (12 women) individuals with clinical expertise. RESULTS Three main categories reflecting strategies for applying safety-netting were developed: first, conveying safety-netting advice, which involves understanding patient concerns, tailoring communication and using appropriate modalities for communicating; second, ensuring common understanding, which involves summarising information, asking a teach-back question and anticipating questions post consultation; and third, supporting safety-netting behaviour, which involves facilitating reconsultation, helping patients and carers to navigate the health system and explaining the care context and its purpose. CONCLUSIONS Our study highlights the collaborative nature of safety-netting, engaging both the clinician and patient, sometimes supported by carers, in an iterative process. Adding to previous research, our study also emphasises the importance of anticipating postconsultation inquiries and facilitating reconsultation.
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Affiliation(s)
- Carolina Wannheden
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Hagman
- Stockholm Health Care Services, Academic Primary Healthcare Centre, Stockholm, Sweden
| | - Sara Riggare
- Department of Women’s and Children’s Health, Participatory eHealth and Health Data Research Group, Uppsala University, Uppsala, Sweden
- Centre for Disability Studies, Uppsala University, Uppsala, Sweden
| | - Karin Pukk Härenstam
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Emergency, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Rita Fernholm
- Stockholm Health Care Services, Academic Primary Healthcare Centre, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
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Rabi S, Patton M, Santana MJ, Tang KL. Patient engagement in the development and implementation of navigation services: a scoping review protocol. BMJ Open 2024; 14:e082666. [PMID: 39097302 PMCID: PMC11298741 DOI: 10.1136/bmjopen-2023-082666] [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: 11/30/2023] [Accepted: 07/19/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION Patient navigation, a complex health intervention meant to address widespread fragmentation across the healthcare landscape, has been widely adopted internationally. This rapid uptake in patient navigation has led to a broadening of the service's reach to include those of different social positions and different health conditions. Despite the popularity and prevalence of patient navigation programmes, the extent of patient involvement and/or partnership in their construction has yet to be articulated. This scoping review will explore and describe the extent to which patients have been engaged in the development and/or implementation of patient navigation programmes to date. METHODS AND ANALYSIS This scoping review will adhere to the Arksey and O'Malley framework for conducting scoping reviews. The electronic databases MEDLINE, CINAHL, EMBASE, PsycINFO, SocINDEX and Scopus were searched in September 2023 using terms related to patient navigation and programme implementation. Inclusion criteria stipulate that the studies must: (1) include an intervention labelled as 'navigation' in a healthcare setting and (2) describe patient engagement in the design, development and/or implementation process of said patient navigation programme. To assess study eligibility, two reviewers will independently read through the titles and abstracts, followed by the full texts, of each study identified from the search strategy to determine whether they meet inclusion criteria. Reviewers will then extract data from the included studies, present descriptive study characteristics in tables, and perform qualitative content analysis. ETHICS AND DISSEMINATION This review does not require ethics approval as data will be collated exclusively from peer-reviewed articles and thesis dissertations. A manuscript summarising the results of the review will be written and submitted to a peer-reviewed journal for publication. The review will map aspects of programme development that have repeatedly utilised patient perspectives and areas where engagement has lagged. This review will also depict how patient engagement varies across programme characteristics.
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Affiliation(s)
- Sarah Rabi
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Megan Patton
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Maria-Jose Santana
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Alberta Strategy for Patient-Oriented Research Patient Engagement Team, Edmonton, Alberta, Calgary
| | - Karen L Tang
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Medicine, University of Calgary, Calgary, Alberta, Canada
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14
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Whitmore C, Mytkolli L, Mangialardi N, Maghera J, Rudick A, Shephard K, Zazzera S, Saiva A, McQuire T, Senior P, Sherifali D, Selby P. Partnered Recruitment: Engaging Individuals With Lived Experience in the Recruitment of Co-Design Participants. Health Expect 2024; 27:e14131. [PMID: 38965808 PMCID: PMC11224126 DOI: 10.1111/hex.14131] [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: 01/31/2024] [Revised: 06/16/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Young adults with type 1 diabetes (T1D) face complex health challenges, including a heightened risk for distress. To counter this distress, there is a need to develop accessible, acceptable comprehensive care solutions that integrate diabetes and mental health care to enhance self-efficacy and counter mental health challenges in this population. OBJECTIVE To describe the engagement of individuals with lived experience of T1D and mental health challenges in the development of a recruitment strategy to support the co-design of an innovative integrated care programme. RESULTS Seven individuals with lived experience formed a Partner Advisory Council (PAC) to recruit young adults (18-29 years old) living with T1D, their friends or family and health researchers and professionals in co-design interviews (n = 19) and co-design events (n = 12). The PAC played a key role in developing a comprehensive recruitment strategy, overcoming traditional barriers and stigmas in the design of an integrated model of care. CONCLUSION Assuming the presence of mental health challenges in young adults living with T1D during recruitment had far-reaching impacts on the development of a whole-person and integrated diabetes and mental health care solution. The efficient recruitment of this sample provided invaluable insights into the nuanced challenges experienced by young adults with T1D, the individual skills developed in response to their mental health challenges and the ways that this understanding can shape future programming to support mental health, quality of life and well-being. The ongoing involvement of the PAC as co-researchers underscores the enduring impact of patient engagement in developing integrated care solutions. PATIENT OR PUBLIC CONTRIBUTION The co-design of the TECC-T1D3 model was enriched by the invaluable contributions of individuals with lived experience. This included the engagement of a diverse PAC in the recruitment of participants in co-design interviews and co-design events. PAC members actively participated in research decision-making with their insights informing a robust recruitment strategy. Beyond recruitment, PAC members continue to serve as co-researchers, shaping ongoing research and actively contributing to the TECC-T1D3 project. Six PAC members are co-authors on this manuscript.
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Affiliation(s)
- Carly Whitmore
- School of NursingMcMaster UniversityHamiltonOntarioCanada
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
| | | | - Natalie Mangialardi
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
- Diabetes Action CanadaTorontoOntarioCanada
| | - Jasmine Maghera
- Diabetes Action CanadaTorontoOntarioCanada
- Department of PharmacologyUniversity of AlbertaEdmontonAlbertaCanada
| | | | | | | | - Anika Saiva
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
| | | | - Peter Senior
- Faculty of Medicine & DentistryUniversity of Alberta, EdmontonAlbertaCanada
| | - Diana Sherifali
- School of NursingMcMaster UniversityHamiltonOntarioCanada
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
| | - Peter Selby
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
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15
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Ryan S, Maddison J, Baxter K, Wilberforce M, Birks Y, Morrissey E, Martin A, Lambat A, Bebbington P, Ziebland S, Robson L, Locock L. Understanding and using experiences of social care to guide service improvements: translating a co-design approach from health to social care. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-84. [PMID: 39264767 DOI: 10.3310/myht8970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2024]
Abstract
Background Local authorities need to find new ways of collecting and using data on social care users' experiences to improve service design and quality. Here we draw on and adapt an approach used in the healthcare improvement field, accelerated experience-based co-design, to see if it can be translated to social care. We use loneliness support as our exemplar. Objectives To understand how loneliness is understood and experienced by members of the public and characterised by social care and voluntary sector staff; to identify service improvements around loneliness support; to explore whether accelerated experience-based co-design is effective in social care; and to produce new resources for publication on Socialcaretalk.org. Design and methods Discovery phase: in-depth interviews with a diverse sample of people in terms of demographic characteristics with experience of loneliness, and 20 social care and voluntary staff who provided loneliness support. Production of a catalyst film from the public interview data set. Co-design phase: exploring whether the accelerated experience-based co-design approach is effective in one local authority area via a series of three workshops to agree shared priorities for improving loneliness support (one workshop for staff, another for people with experience of local loneliness support, and a third, joint workshop), followed by 7-monthly meetings by two co-design groups to work on priority improvements. A process evaluation of the co-design phase was conducted using interviews, ethnographic observation, questionnaires and other written material. Results Accelerated experience-based co-design demonstrated strong potential for use in social care. Diverse experiences of participants and fuzzy boundaries around social care compared to health care widened the scope of what could be considered a service improvement priority. Co-design groups focused on supporting people to return to pre-pandemic activities and developing a vulnerable passenger 'gold standard' award for taxi drivers. This work generated short-term 'wins' and longer-term legacies. Participants felt empowered by the process and prospect of change, and local lead organisations committed to take the work forward. Conclusions Using an exemplar, loneliness support, that does not correspond to a single pathway allowed us to comprehensively explore the use of accelerated experience-based co-design, and we found it can be adapted for use in social care. We produced recommendations for the future use of the approach in social care which include identifying people or organisations who could have responsibility for implementing improvements, and allowing time for coalition-building, developing trusted relationships and understanding different perspectives. Limitations COVID-19 temporarily affected the capacity of the local authority Project Lead to set up the intervention. Pandemic work pressures led to smaller numbers of participating staff and had a knock-on effect on recruitment. Staff turnover within Doncaster Council created further challenges. Future work Exploring the approach using a single pathway, such as assessing eligibility for care and support, could add additional insights into its transferability to social care. Trial registration This trial is registered as Current Controlled Trials ISRCTN98646409. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128616) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 27. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Sara Ryan
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
| | - Jane Maddison
- Social Policy Research Unit, University of York, York, UK
| | - Kate Baxter
- Social Policy Research Unit, University of York, York, UK
| | | | - Yvonne Birks
- Social Policy Research Unit, University of York, York, UK
| | - Emmie Morrissey
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
| | - Angela Martin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ahmed Lambat
- Public Involvement, LMCP Care Link, Manchester, UK
| | | | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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McKeon G, Curtis J, Rostami R, Sroba M, Farello A, Morell R, Steel Z, Harris M, Silove D, Parmenter B, Matthews E, Jamaluddin J, Rosenbaum S. Co-designing a Physical Activity Service for Refugees and Asylum Seekers Using an Experience-Based Co-design Framework. J Immigr Minor Health 2024; 26:674-688. [PMID: 38605213 PMCID: PMC11289061 DOI: 10.1007/s10903-024-01587-5] [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] [Accepted: 02/17/2024] [Indexed: 04/13/2024]
Abstract
People from refugee and asylum seeker backgrounds resettling in Australia often experience intersecting risks for poor mental and physical health. Physical activity can promote better health outcomes, however there are limited programs tailored for this population. Therefore, understanding how to support refugees and asylum seekers to engage in physical activity is crucial. This paper aims to describe how the experience-based co-design (EBCD) process was used to identify priorities for a new physical activity service for refugees and asylum seekers. Using an EBCD framework we conducted qualitative interviews and co-design workshops with service users (refugees and asylum seekers living in the community) and service providers at a community Centre in Sydney, Australia. Sixteen participants, including eight service users and eight service providers engaged in the EBCD process over 12-months. The interviews revealed common themes or 'touchpoints' including barriers and enablers to physical activity participation such as access, safety and competing stressors. Subsequent co-design focus groups resulted in the establishment of five fundamental priorities and actionable strategies; ensuring cultural and psychological safety, promoting accessibility, facilitating support to access basic needs, enhancing physical activity literacy and fostering social connection. Using EBCD methodology, this study used the insights and lived experiences of both service users and providers to co-design a physical activity service for refugees and asylum seekers which is safe, supportive, social and accessible. The results of the implementation and evaluation of the program are ongoing.
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Affiliation(s)
- Grace McKeon
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia.
- School of Population Health, University of New South Wales, Sydney, Australia.
| | - Jackie Curtis
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | - Reza Rostami
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Monika Sroba
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | | | - Rachel Morell
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | - Zachary Steel
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- St. John of God Health Care North Richmond Hospital, North Richmond, NSW, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Derrick Silove
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Belinda Parmenter
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Evan Matthews
- Centre for Health Behaviour Research South East Technological University, Waterford, Ireland
| | | | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
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Elbrink SH, Elmer SL, Hawkins MH, Osborne RH. Outcomes of co-designed communities of practice that support members to address public health issues. Health Promot Int 2024; 39:daae080. [PMID: 38989884 PMCID: PMC11237988 DOI: 10.1093/heapro/daae080] [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] [Indexed: 07/12/2024] Open
Abstract
Communities of practice are commonly used to support members in responding to public health issues. This study evaluated the outcomes of five co-designed communities of practice to determine if members' expectations were met, if knowledge sharing between members extended to knowledge translation, and if that supported members in addressing public health issues. Data were collected through an initial needs assessment, observations were made during community of practice sessions over 1 year, and qualitative interviews were conducted at the end of that year. The findings provided evidence that members' expectations were met, knowledge sharing took place within the communities of practice, and personal benefits gained supported members in advancing knowledge sharing with other members to knowledge translation outside their community of practice. Results demonstrate three outcomes of knowledge translation for members: disseminating knowledge to others, applying knowledge to make small-scale changes in practice and leveraging the knowledge to expand its reach beyond members' organizations. While the scale and speed of expanding outcomes were below initial expectations as indicated in the initial needs assessments, members remained optimistic about achieving larger-scale impacts in the future. This study showed that communities of practice achieve gradual progress rather than quick wins. Co-design supports the facilitators in meeting members' needs, which can positively contribute to members sharing knowledge and translating that knowledge to support their practice to address public health issues.
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Affiliation(s)
- Sanne H Elbrink
- School of Health Science, Centre for Global Health and Equity, Swinburne University of Technology, John Street, Hawthorn, Victoria 3122, Australia
- Durham University Business School, Durham University, Mill Hill Lane, Durham DH1 3LB, UK
| | - Shandell L Elmer
- School of Health Science, Centre for Global Health and Equity, Swinburne University of Technology, John Street, Hawthorn, Victoria 3122, Australia
- School of Nursing, College of Health and Medicine, University of Tasmania, Locked bag 1322 Newham, Launceston, Tasmania 7250, Australia
| | - Melanie H Hawkins
- School of Health Science, Centre for Global Health and Equity, Swinburne University of Technology, John Street, Hawthorn, Victoria 3122, Australia
| | - Richard H Osborne
- School of Health Science, Centre for Global Health and Equity, Swinburne University of Technology, John Street, Hawthorn, Victoria 3122, Australia
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18
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Langerman C, Forbes A, Robert G. Enhancing care in the initiation and management of insulin in older people with diabetes: A collaborative journey with older individuals and their caregivers using Experience-Based Co-Design. PLoS One 2024; 19:e0302516. [PMID: 39074147 DOI: 10.1371/journal.pone.0302516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/07/2024] [Indexed: 07/31/2024] Open
Abstract
INTRODUCTION Initiating insulin therapy in older individuals with type 2 diabetes (T2DM) poses unique challenges and requires a nuanced understanding of the age-related factors that impact safety and efficacy. This study employed Experience-Based Co-Design (EBCD) to enhance the insulin initiation and management experience for this population, emphasising a collaborative approach involving patients, caregivers, and healthcare professionals. AIM The primary aim of the research was to develop a tailored care pathway, utilising co-design and the Behaviour Change Wheel (BCW), which addressed issues specific to older adults on insulin therapy. The study sought to identify key challenges, propose practical interventions, and construct a logic model illustrating a pathway for enhanced insulin treatment experiences. METHODS An adapted EBCD process was used which integrated the Medical Research Council (MRC) Framework and BCW. The study involved thematic synthesis, video interviews, and feedback focus groups with patients, caregivers, and healthcare professionals. The 'Crazy Eights' brainstorming method, as part of the co-design workshop, generated practical solutions which informed subsequent logic model development. RESULTS Focus group findings revealed distressing insulin initiation experiences, inconsistent dietary advice, and perceived disparities in care between type 1 and type 2 diabetes. The co-design workshop identified eight key challenges, leading to proposed interventions aligned with the BCW. The logic model illustrates a pathway for older individuals undergoing insulin treatment, emphasising behaviour change among patients, caregivers, and healthcare professionals. CONCLUSION The collaborative efforts of participants contributed valuable insights in terms of the unique educational and emotional needs of patients, the importance of care continuity and of improving access to specialist services. Findings from this study can be used to inform and enhance tailored support strategies for older adults with T2DM during their insulin transition and ongoing management.
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Affiliation(s)
- Chaya Langerman
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
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Elf M, Norin L, Meijering L, Pessah-Rasmussen H, Suhonen R, Zingmark M, Kylén M. Rehabilitation at Home With the Development of a Sustainable Model Placing the Person's Needs and Environment at Heart: Protocol for a Multimethod Project. JMIR Res Protoc 2024; 13:e56996. [PMID: 39042448 PMCID: PMC11303889 DOI: 10.2196/56996] [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: 02/02/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Each year, more than 1.5 million people in Europe have a stroke, and many experience disabilities leading to activity and participation restrictions. Home-based rehabilitation is the recommended approach for stroke rehabilitation, in line with the international shift to integrated care. Despite this, rehabilitation often focuses on the person's physical functions, not the whole life situation and opportunities to live an active life. Given that rehabilitation today is often provided in the person's home, there is a need to develop new models that consider the rehabilitation process as situated in the everyday living environment of persons with stroke. This project is grounded in experiences from our ongoing research, where we study the importance of the home environment for health and participation among persons with stroke, rehabilitated at home. This research has shown unmet needs, which lead to suboptimal rehabilitation outcomes. There is a need for studies on how to use environmental resources to optimize stroke rehabilitation in the home setting. OBJECTIVE The overarching objective of the project is to develop a new practice model for rehabilitation where the needs of the person are the starting point and where the environment is considered. METHODS The project will be conducted in partnership with persons with stroke, significant others, health care professionals, and care managers. Results from a literature review will form the base for interviews with the stakeholders, followed by co-designing workshops aiming to create a new practice model. Focus groups will be held to refine the outcome of the workshops to a practice model. RESULTS This 4-year project commenced in January 2023 and will continue until December 2026. The results of the literature review are, as of April 2024, currently being analyzed. The ethics application for the interviews and co-design phase was approved in October 2023 and data collection is ongoing during spring 2024. We aim to develop a practice model with stakeholders and refine it together with care managers and decision makers. The outcome is a new practice model and implementation plan, which will be achieved in autumn 2026. CONCLUSIONS The project contributes with a prominent missing puzzle to optimize the rehabilitation process by adding a strong focus on user engagement combined with integrating different aspects of the environment. The goal is to improve quality of life and increase reintegration in society for the large group of people living with the aftermath of a stroke. By co-designing with multiple stakeholders, we expect the model to be feasible and sustainable. The knowledge from the project will also contribute to an increased awareness of the importance of the physical environment for sustainable health care. The findings will lay the foundation for future upscaling initiatives. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56996.
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Affiliation(s)
- Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Lizette Norin
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Louise Meijering
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, Netherlands
| | - Hélène Pessah-Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory disorders and Geriatrics, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, The Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Magnus Zingmark
- Department of Community Medicine and Rehabilitation, Umea University, Umea, Sweden
| | - Maya Kylén
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
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Potter E, Lewis C, Tilbury A, Tong J, Sipanoun P. Improving healthcare transition for young people with cancer: factors fundamental to the quality improvement journey. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:622-629. [PMID: 38954441 DOI: 10.12968/bjon.2023.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
BACKGROUND Young people receiving cancer treatment in the South Thames Children's, Teenagers' and Young Adults' Cancer Operational Delivery Network usually receive care across two or more NHS trusts, meaning transition into adult services can be challenging. AIM To develop a planned, co-ordinated approach to transition across the network that meets National Institute for Health and Care Excellence guidance recommendations for transition and the cancer service specifications. METHODS A 2-year, nurse-led quality improvement (QI) project, using the principles of experience-based co-design. OUTCOMES The QI project resulted in the development of six key principles of practice; refining and testing of a benchmarking tool; initiatives to facilitate first transition conversations; and the launch of an information hub. CONCLUSION Robust QI processes, cross-network collaboration and wide stakeholder involvement required significant resource, but enabled deeper understanding of existing pathways and processes, facilitated the establishment of meaningful objectives, and enabled the testing of interventions to ensure the project outcomes met the needs of all stakeholders.
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Affiliation(s)
- Emma Potter
- Nurse Practitioner Transition and Long Term Follow Up, The Royal Marsden NHS Foundation Trust, London; South Thames Children's, Teenagers' and Young Adults' Cancer Operational Delivery Network, London
| | | | | | - Jason Tong
- Network Manager, South Thames Children's, Teenagers' and Young Adults' Cancer Operational Delivery Network, The Royal Marsden NHS Foundation Trust, RM Partners Cancer Alliance, London
| | - Pippa Sipanoun
- Research Fellow in Transition, University of Surrey, Guildford; Lead Practice Educator-Health Inequalities, Great Ormond Street Hospital for Children NHS Foundation Trust, London; and University College London Great Ormond Street Institute of Child Health, London
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Quattrini S, Merizzi A, Caciula I, Napradean L, Azevedo MJ, Costa S, Santini S. The design and implementation of a novel music-based curriculum for dementia care professionals: The experience of SOUND in Italy, Portugal and Romania. BMC MEDICAL EDUCATION 2024; 24:668. [PMID: 38886706 PMCID: PMC11184888 DOI: 10.1186/s12909-024-05651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The positive effects of active and passive music activities on older people with dementia are well and largely documented by the literature. Nevertheless, the use of music as a non-pharmacological intervention is not so common both in private and public older people care facilities because in-home staff have no competencies for delivering such activities. Conversely, the realization and implementation of a co-designed music-based curriculum for dementia care professionals may help the diffusion of music in the older people care facilities. This study was aimed at evaluating the learning outcomes of the SOUND training, based on an original co-designed music-based curriculum for dementia care professionals and implemented in Italy, Portugal and Romania. METHODS The SOUND training study was developed through three phases: a) the co-design of the music-based curriculum for dementia care professionals, involving 55 people in the three participating countries; b) the teaching of the training curriculum to 63 dementia care professionals (29 in Italy, 17 in Portugal and 17 in Romania), delivered both in person and via a Moodle platform named Virtual Music Circle; c) the learning outcomes assessment, carried out by means of 13 self-evaluation tests, and a practical test, and the trainees' course evaluation by a questionnaire. RESULTS Most of the trainees reached the highest score in the evaluation of the theoretical competencies in the three study countries. Conversely, some practical competencies in the facilitation of music activities need to be fine-tuned. The SOUND training course was evaluated very positively in the overall structure, theoretical contents, and practical workshops by the trainees. Nevertheless, they preferred the face-to-face compared to the distance learning methodology in the three countries. CONCLUSIONS The SOUND training curriculum was effective in teaching music techniques and neurocognitive knowledge to dementia care professionals. Nevertheless, future courses should be differentiated for dementia care professionals with or without previous music knowledge and competencies. Moreover, the course is fully sustainable, because it does not require additional costs given that the curriculum is fully accessible online and it is also replicable because it trains professionals who can continue to apply the method in their working routine.
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Affiliation(s)
- Sabrina Quattrini
- Centre for Socio-Economic Research On Aging, IRCCS INRCA-National Institute of Health and Science On Aging, Ancona, Italy
| | - Alessandra Merizzi
- Centre for Socio-Economic Research On Aging, IRCCS INRCA-National Institute of Health and Science On Aging, Ancona, Italy.
| | - Ioana Caciula
- Centru de Resurse Si Formare Profesionala, Asociatia Habilitas, Bucharest, Romania
| | | | | | | | - Sara Santini
- Centre for Socio-Economic Research On Aging, IRCCS INRCA-National Institute of Health and Science On Aging, Ancona, Italy
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Santarossa S, Baber M, Hussein J, Oley C, Slangerup K, Murphy D, Kippen KE. Using action research and a community-academic partnership to understand clinical trial participation: a patient-centered perspective. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:61. [PMID: 38872195 DOI: 10.1186/s40900-024-00593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Clinical trials that are patient-centered appear to be more successful (e.g., clinical outcomes, improved communication, mutual empowerment, changed attitudes), thus, action research may be a field of importance. The current study explores the Formation and Execution of Activities phases of a community-academic partnership (CAP). METHODS Members consisted of industry stakeholders, a healthcare/academic institution, and patients/families with lived experiences as cancer survivors and/or caregivers. Retrospectively, CAP members described the facilitating and/or hindering factors present in the partnership development. A document review process was used. Field notes from three CAP meetings, which focused on understanding clinical trial participation, were analyzed using a thematic approach. RESULTS Seven facilitating and three hindering factors were present. Interpersonal (vs. operational) processes were referenced as influential facilitating factors more often. Themes that emerged included 'trials as a treatment option', 'leaving a legacy', and 'timing is critical.' CONCLUSION This study provides a patient-centered perspective on barriers/challenges of clinical trial participation and how to improve future perceptions.
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Affiliation(s)
- Sara Santarossa
- Henry Ford Health System, Department of Public Health Sciences, Patient-Engaged Research Center, Detroit, MI, USA.
| | - Michele Baber
- AstraZeneca, Inc, 1 MedImmune Way, Gaithersburg, MD, USA
| | - Janine Hussein
- Henry Ford Health System, Department of Public Health Sciences, Patient-Engaged Research Center, Detroit, MI, USA
| | - Chrystal Oley
- AstraZeneca, Inc, 1 MedImmune Way, Gaithersburg, MD, USA
| | | | - Dana Murphy
- Henry Ford Health System, Department of Public Health Sciences, Patient-Engaged Research Center, Detroit, MI, USA
| | - Karen E Kippen
- Henry Ford Health System, Department of Public Health Sciences, Patient-Engaged Research Center, Detroit, MI, USA
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Jomy J, Lin KX, Huang RS, Chen A, Malik A, Hwang M, Bhate TD, Sharfuddin N. Closing the gap on healthcare quality for equity-deserving groups: a scoping review of equity-focused quality improvement interventions in medicine. BMJ Qual Saf 2024:bmjqs-2023-017022. [PMID: 38866468 DOI: 10.1136/bmjqs-2023-017022] [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: 12/12/2023] [Accepted: 05/26/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Quality improvement (QI) efforts are critical to promoting health equity and mitigating disparities in healthcare outcomes. Equity-focused QI (EF-QI) interventions address the unique needs of equity-deserving groups and the root causes of disparities. This scoping review aims to identify themes from EF-QI interventions that improve the health of equity-deserving groups, to serve as a resource for researchers embarking on QI. METHODS In adherence with Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, several healthcare and medical databases were systematically searched from inception to December 2022. Primary studies that report results from EF-QI interventions in healthcare were included. Reviewers conducted screening and data extraction using Covidence. Inductive thematic analysis using NVivo identified key barriers to inform future EF-QI interventions. RESULTS Of 5,330 titles and abstracts screened, 36 articles were eligible for inclusion. They reported on EF-QI interventions across eight medical disciplines: primary care, obstetrics, psychiatry, paediatrics, oncology, cardiology, neurology and respirology. The most common focus was racialised communities (15/36; 42%). Barriers to EF-QI interventions included those at the provider level (training and supervision, time constraints) and institution level (funding and partnerships, infrastructure). The last theme critical to EF-QI interventions is sustainability. Only six (17%) interventions actively involved patient partners. DISCUSSION EF-QI interventions can be an effective tool for promoting health equity, but face numerous barriers to success. It is unclear whether the demonstrated barriers are intrinsic to the equity focus of the projects or can be generalised to all QI work. Researchers embarking on EF-QI work should engage patients, in addition to hospital and clinic leadership in the design process to secure funding and institutional support, improving sustainability. To the best of our knowledge, no review has synthesised the results of EF-QI interventions in healthcare. Further studies of EF-QI champions are required to better understand the barriers and how to overcome them.
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Affiliation(s)
- Jane Jomy
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ke Xin Lin
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alisia Chen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aleena Malik
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Tahara D Bhate
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Nazia Sharfuddin
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Trillium Health Partners, Mississauga, Ontario, Canada
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Ankomah SE, Fusheini A, Derrett S. 'Two heads are better than one'-exploring the experiences of Ghanaian communities on the role of patient and public participation in health system improvement. Health Policy Plan 2024; 39:603-612. [PMID: 38635419 PMCID: PMC11145915 DOI: 10.1093/heapol/czae029] [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: 06/06/2023] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 04/20/2024] Open
Abstract
Patient and Public Participation (PPP) is key to improving health systems. Yet, studies have shown that PPP implementations across many countries have been largely tokenistic. Particularly, in Ghana, whilst PPP is prioritized in national health policies and legislation, there appears to be little research focused on understanding PPP's role in health system improvement. The aim of this study, therefore, is to examine how PPP is working across the Ghanaian health system levels, as well as to understand the perspectives and experiences of participants on how PPP contributes to health system improvement. The qualitative study was undertaken in six communities in three districts in the Ashanti region of Ghana. Data were collected from semi-structured individual interviews. The selection of participants was purposive, based on their PPP-related roles. As a result, findings of this study may not reflect the experiences of others who are not directly involved in PPP initiatives. Thirty-five participants, mainly health service users and health professionals, were interviewed. Data were transcribed and analysed descriptively using Braun and Clarke's (2006) thematic analysis approach. Overall, participants noted PPP implementation was largely limited at higher health system levels (i.e. national, regional and district levels), but was functioning at the community level. PPP also improved access to health services, responsiveness to patient needs, community-health worker relationships, health-seeking behaviours, empowered healthcare users and improved health outcomes. The study, therefore, recommended the need to undertake PPP across all levels of the health system to maximize PPP's role in health system improvement. Finally, the study suggested prioritizing PPP, especially for resource-poor countries, to complement government's efforts in improving accessibility of healthcare services to many communities and also provide a more patient-centred healthcare system responsive to patients' and public needs.
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Affiliation(s)
- Samuel Egyakwa Ankomah
- Department of Preventive and Social Medicine, Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, P.O. Box GP1563, Kumasi, Ghana
| | - Adam Fusheini
- Department of Preventive and Social Medicine, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
- Center for Health Literacy and Rural Health Promotion, P.O. Box 1934, Accra, Ghana
| | - Sarah Derrett
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
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de Carvalho Corôa R, Ben Charif A, Robitaille V, G. V. Mochcovitch D, Abdoulaye Samri M, Akpo TG, Gogovor A, Blanchette V, Gomes Souza L, Kastner K, M. Achim A, McLean RKD, Milat A, Légaré F. Strategies for involving patients and the public in scaling initiatives in health and social services: A scoping review. Health Expect 2024; 27:e14086. [PMID: 38837509 PMCID: PMC11150745 DOI: 10.1111/hex.14086] [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: 12/10/2023] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Scaling in health and social services (HSS) aims to increase the intended impact of proven effective interventions. Patient and public involvement (PPI) is critical for ensuring that scaling beneficiaries' interests are served. We aimed to identify PPI strategies and their characteristics in the science and practice of scaling in HSS. METHODS In this scoping review, we included any scaling initiative in HSS that used PPI strategies and reported PPI methods and outcomes. We searched electronic databases (e.g., Medline) from inception to 5 February 2024, and grey literature (e.g., Google). Paired reviewers independently selected and extracted eligible reports. A narrative synthesis was performed and we used the PRISMA for Scoping Reviews and the Guidance for Reporting Involvement of Patients and the Public (GRIPP2). FINDINGS We included 110 unique reports out of 24,579 records. In the past 5 years, the evidence on PPI in scaling has increased faster than in any previous period. We found 236 mutually nonexclusive PPI strategies among 120 scaling initiatives. Twenty-four initiatives did not target a specific country; but most of those that did so (n = 96) occurred in higher-income countries (n = 51). Community-based primary health care was the most frequent level of care (n = 103). Mostly, patients and the public were involved throughout all scaling phases (n = 46) and throughout the continuum of collaboration (n = 45); the most frequently reported ethical lens regarding the rationale for PPI was consequentialist-utilitarian (n = 96). Few papers reported PPI recruitment processes (n = 31) or incentives used (n = 18). PPI strategies occurred mostly in direct care (n = 88). Patient and public education was the PPI strategy most reported (n = 31), followed by population consultations (n = 30). CONCLUSIONS PPI in scaling is increasing in HSS. Further investigation is needed to better document the PPI experience in scaling and ensure that it occurs in a meaningful and equitable way. PATIENT AND PUBLIC CONTRIBUTION Two patients were involved in this review. They shared decisions on review questions, data collection instruments, protocol design, and findings dissemination. REVIEW REGISTRATION Open Science Framework on 19 August 2020 (https://osf.io/zqpx7/).
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Affiliation(s)
- Roberta de Carvalho Corôa
- VITAM—Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐NationaleQuebec CityQuebecCanada
- Unité de soutien au système de santé apprenant QuébecQuebec CityQuebecCanada
- Faculty of MedicineUniversité LavalQuebec CityQuebecCanada
| | | | | | - Diogo G. V. Mochcovitch
- VITAM—Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐NationaleQuebec CityQuebecCanada
| | | | - Talagbe Gabin Akpo
- Faculty of Business AdministrationUniversité LavalQuebec CityQuebecCanada
- Institut National de la Recherche ScientifiqueUniversité LavalQuebec CityQuebecCanada
| | - Amédé Gogovor
- VITAM—Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐NationaleQuebec CityQuebecCanada
- Unité de soutien au système de santé apprenant QuébecQuebec CityQuebecCanada
- Faculty of MedicineUniversité LavalQuebec CityQuebecCanada
| | - Virginie Blanchette
- VITAM—Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐NationaleQuebec CityQuebecCanada
- Department of Human Kinetics and Podiatric MedicineUniversité du Québec à Trois‐RivièresTrois‐RivièresQuebecCanada
| | - Lucas Gomes Souza
- VITAM—Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐NationaleQuebec CityQuebecCanada
- Faculty of MedicineUniversité LavalQuebec CityQuebecCanada
| | | | - Amélie M. Achim
- VITAM—Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐NationaleQuebec CityQuebecCanada
- Faculty of MedicineUniversité LavalQuebec CityQuebecCanada
- CERVO Brain Research CentreQuebec CityQuebecCanada
| | - Robert K. D. McLean
- International Development Research CentreOttawaOntarioCanada
- Faculty of Medicine and Health SciencesStellenbosch UniversityStellenboschWestern CapeSouth Africa
| | - Andrew Milat
- School of Public HealthUniversity of SydneySydneyNew South WalesAustralia
- Sydney Health PartnersSydneyNew South WalesAustralia
| | - France Légaré
- VITAM—Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐NationaleQuebec CityQuebecCanada
- Unité de soutien au système de santé apprenant QuébecQuebec CityQuebecCanada
- Faculty of MedicineUniversité LavalQuebec CityQuebecCanada
- Centre de Recherche du CHU de Québec ‐ Université LavalQuebec CityQuebecCanada
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Anemaat L, Palmer VJ, Copland DA, Binge G, Druery K, Druery J, Mainstone K, Aisthorpe B, Mainstone P, Wallace SJ. Qualitative Exploration of Speech Pathologists' Experiences and Priorities for Aphasia Service Design: Initial Stage of an Experience-Based Co-Design Project to Improve Aphasia Services. Health Expect 2024; 27:e14105. [PMID: 38879788 PMCID: PMC11180296 DOI: 10.1111/hex.14105] [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: 01/11/2024] [Revised: 03/13/2024] [Accepted: 05/26/2024] [Indexed: 06/19/2024] Open
Abstract
INTRODUCTION AND AIMS Stroke survivors with aphasia (impaired language/communication) have poor outcomes and gaps in the clinical implementation of best practice contribute to this. Little is known, however, about speech pathologist perspectives on the touchpoints (key moments shaping experiences) in the clinical care pathway that have the greatest impact on service delivery nor how this varies by geographical location. We explored the experiences of speech pathologists who provide aphasia services to establish priorities for improvement and design. METHODS AND ANALYSIS This is the initial experience gathering and priority identification stage of an experience-based co-design (EBCD) project. Speech pathologists were recruited from 21 geographically diverse Hospital and Health Services in Queensland, Australia. Speech pathologists working in acute, rehabilitation and community services shared positive and negative experiences of delivering aphasia care in interviews and focus groups. Experiential data were analysed using qualitative thematic analysis to determine touchpoints. Priorities for service design were identified using an adapted nominal group technique. RESULTS Speech pathologists (n = 62) participated in 16 focus groups and nine interviews and shared 132 experiences of delivering aphasia care. Providing care in teams with poor awareness of the impacts of aphasia was identified as a key challenge, as poor patient-provider communication was perceived to increase risk of adverse outcomes for patients. Speech pathologists identified areas for improvement related to their own professional needs (e.g., greater access to clinical supervision); collaborative health care (e.g., better coordination and interdisciplinary care to increase therapy time); and the service context and environment (e.g., psychological services able to support diverse communication needs). CONCLUSIONS Speech pathologist delivery of aphasia services could be improved through increased access to clinical supervision, opportunities for peer debriefing and interdisciplinary care. Priorities for service design varied by geographical location and included: education to support care transitions (remote areas), improved referral pathways and service linkage (regional areas) and dedicated aphasia staffing (metropolitan areas). PATIENT OR PUBLIC CONTRIBUTION A consumer advisory committee comprising people with aphasia (n = 3, authors K.M., K.D. and B.A.), their significant others (n = 2, authors J.D. and P.M.), and a Cultural Capability Officer (author G.B.) guided this research. The team: (1) reviewed participant information; (2) co-designed surveys and workshop resources; (3) copresented research outcomes and contributed to publications. Research questions and study design (e.g., analysis methods and assessment measures) were developed by the research team (authors L.A., V.J.P., D.A.C. and S.J.W.).
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Affiliation(s)
- Lisa Anemaat
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research AllianceThe University of Queensland and Metro North HealthAustralia
| | - Victoria J. Palmer
- The ALIVE National Centre for Mental Health Research TranslationThe University of MelbourneMelbourneAustralia
| | - David A. Copland
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research AllianceThe University of Queensland and Metro North HealthAustralia
| | - Geoffrey Binge
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
| | - Kent Druery
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
| | - Julia Druery
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
| | - Kathryn Mainstone
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
| | - Bruce Aisthorpe
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
| | - Penelope Mainstone
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
| | - Sarah J. Wallace
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research CentreThe University of QueenslandHerstonAustralia
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Scheibl F, Boots L, Eley R, Fox C, Gracey F, Harrison Dening K, Oyebode J, Penhale B, Poland F, Ridel G, West J, Cross JL. Adapting a Dutch Web-Based Intervention to Support Family Caregivers of People With Dementia in the UK Context: Accelerated Experience-Based Co-Design. JMIR Form Res 2024; 8:e52389. [PMID: 38776139 PMCID: PMC11153978 DOI: 10.2196/52389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Around 700,000 family caregivers provide unpaid care for 900,000 people living with dementia in the United Kingdom. Few family caregivers receive support for their own psychological needs and funding for community respite services has declined. These trends are seen across Europe as demographic and budgetary pressures have intensified due to public spending cuts arising from the 2008 financial crisis and the COVID-19 pandemic. The World Health Organization has prioritized the need to expand the provision of support for caregivers and families of people with dementia by 2025. Web-based interventions have the potential for development as they require modest investment and can be accessed by family caregivers at home. Further cost benefits can be realized by adapting existing interventions with demonstrated effectiveness for new contexts. This paper reports initial findings from the CareCoach study, which is adapting Partner in Balance (PiB), a web-based coaching intervention developed in the Netherlands, for family caregivers in the United Kingdom. OBJECTIVE This study aims to work with unpaid family caregivers and staff in adapting the Dutch web-based support tool PiB to improve its acceptability and usability for use in the United Kingdom. METHODS Accelerated Experience-Based Co-Design (AEBCD) was used with caregivers, staff, and core stakeholders. Interviews, workshops, and stakeholder consultations were conducted. Data were analyzed iteratively. Recommendations for the redesign of PiB for use across the United Kingdom were adjudicated by the study Adaptation Working Party. RESULTS Sixteen caregivers and 17 staff took part in interviews. Thirteen caregivers and 17 staff took part in workshops. Most (n=26) participants were White, female, and retired. All except 4 caregivers (2 male and 2 female) found the PiB's offer of web-based self-help learning acceptable. Caregivers identified complexity and lack of inclusivity in some wording and video resources as problematic. The staff took a stronger perspective on the lack of inclusivity in PiB video resources. Staff and caregivers coproduced new inclusive wording and recommended creating new videos to adapt PiB for the UK context. CONCLUSIONS AEBCD methods facilitated the engagement of caregivers and staff and advanced the adaptation of the PiB complex intervention. An important addition to the AEBCD method in this process was the work of an Adaptation Working Party, which adjudicated and agreed to new wording where this could not be established in consultation with caregivers and staff. TRIAL REGISTRATION ISRCTN Registry ISRCTN12540555; https://doi.org/10.1186/ISRCTN12540555.
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Affiliation(s)
- Fiona Scheibl
- Institute of Applied Health Research, College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - Lizzy Boots
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Ruth Eley
- Together Everyday in Dementia, Liverpool, United Kingdom
| | | | - Fergus Gracey
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | | | - Jan Oyebode
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
| | - Bridget Penhale
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Fiona Poland
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Gemma Ridel
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, United Kingdom
| | - Juniper West
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, United Kingdom
| | - Jane L Cross
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
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Yu K, Jiang H, Liu M, Wu S, Jordan-Marsh M, Chi I. Chinese Immigrant Caregivers: Understanding Their Unmet Needs and the Co-Design of an mHealth App. Can J Aging 2024:1-8. [PMID: 38757195 DOI: 10.1017/s0714980824000187] [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] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Immigrant caregivers support the aging population, yet their own needs are often neglected. Mobile technology-facilitated interventions can promote caregiver health by providing easy access to self-care materials. OBJECTIVE This study employed a design thinking framework to examine Chinese immigrant caregivers' (CICs) unmet self-care needs and co-design an app for promoting self-care with CICs. METHODS Nineteen semi-structured interviews were conducted in conceptual design and prototype co-design phases. FINDINGS Participants reported unmet self-care needs influenced by psychological and social barriers, immigrant status, and caregiving tasks. They expressed the need to learn to keep healthy boundaries with the care recipient and respond to emergencies. Gaining knowledge was the main benefit that drew CICs' interest in using the self-care app. However, potential barriers to use included issues of curriculum design, technology anxiety, limited free time, and caregiving burdens. DISCUSSION The co-design process appears to be beneficial in having participants voice both barriers and preferences.
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Affiliation(s)
- Kexin Yu
- NIA-Layton Aging and Alzheimer's Disease Center, and Oregon Center for Aging & Technology, Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, USA
| | - Haojun Jiang
- Tourism and Social Administration College, Nanjing Xiaozhuang University, Nanjing, China
| | - Mandong Liu
- Research Institute of Social Development, Southwestern University of Finance and Economics, Sichuan, China
| | - Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, USA
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Maryalice Jordan-Marsh
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, USA
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Chouliara N, Cameron T, Ballard-Ridley S, Fisher RJ, Kettlewell J, Kidd L, Luxton L, Pomeroy V, Stockley RC, Thomas S, Gordon AL. Investigating the Implementation of Community-Based Stroke Telerehabilitation in England; A Realist Synthesis Study Protocol. Healthcare (Basel) 2024; 12:1027. [PMID: 38786437 PMCID: PMC11120767 DOI: 10.3390/healthcare12101027] [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: 03/29/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Telerehabilitation (TR) shows promise as a method of remote service delivery, yet there is little guidance to inform implementation in the context of the National Health Service (NHS) in England. This paper presents the protocol for a realist synthesis study aiming to investigate how TR can be implemented to support the provision of high-quality, equitable community-based stroke rehabilitation, and under what conditions. Using a realist approach, we will synthesise information from (1) an evidence review, (2) qualitative interviews with clinicians (n ≤ 30), and patient-family carer dyads (n ≤ 60) from three purposively selected community stroke rehabilitation services in England. Working groups including rehabilitation professionals, service-users and policy-makers will co-develop actionable recommendations. Insights from the review and the interviews will be synthesised to test and refine programme theories that explain how TR works and for whom in clinical practice, and draw key messages for service implementation. This protocol highlights the need to improve our understanding of TR implementation in the context of multidisciplinary, community-based stroke service provision. We suggest the use of a realist methodology and co-production to inform evidence-based recommendations that consider the needs and priorities of clinicians and people affected by stroke.
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Affiliation(s)
- Niki Chouliara
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham NG7 2TU, UK
| | - Trudi Cameron
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham NG7 2TU, UK
| | | | | | - Jade Kettlewell
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
| | - Lisa Kidd
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow G4 0BA, UK;
| | - Leanna Luxton
- Northampton General Hospital NHS Trust, Northampton NN1 5BD, UK;
| | - Valerie Pomeroy
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK;
| | - Rachel C. Stockley
- School of Nursing and Midwifery, University of Central Lancashire, Lancashire PR1 2HE, UK;
| | - Shirley Thomas
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
| | - Adam L. Gordon
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham NG7 2TU, UK
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Avent ML, Franks W, Redmond A, Allen MJ, Naicker S. Developing an intervention package to optimise the management of vancomycin therapy using theory informed co-design. Res Social Adm Pharm 2024; 20:498-505. [PMID: 38365521 DOI: 10.1016/j.sapharm.2024.01.012] [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: 12/06/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Optimising the management of vancomycin by achieving target therapeutic concentrations early during therapy has been associated with reduced mortality and morbidity. Despite the availability of guidelines and training, the management of vancomycin remains suboptimal. OBJECTIVES The primary outcome was the development of interventions and associated implementation strategies to optimise the management of vancomycin therapy. This paper describes how co-design process was used to build a theory informed intervention package, which was implemented across a wide range of in-patient hospital settings in Queensland, Australia. METHODS This multiple methods study was conducted in four phases: 1) a baseline audit to identify the nature of the problem and associated determinants informed by stakeholder interviews 2) mapping these findings to the Theoretical Domains Framework (TDF) to identify behavioural correlates and modifiers 3) prioritising the behavioural modifiers and associated implementation strategies to inform a protype of the intervention in a series of co-design sessions and 4) implementing and evaluating the intervention package. The study was conducted across the four teaching hospitals in a large Queensland Hospital and Health Service across multiple healthcare disciplines namely nurses, doctors, and pharmacists. This intervention package was subsequently implemented across Queensland Health with the support of the local champions under the guidance of the steering group. RESULTS Clinicians identified that a multifaceted intervention package and training which can be tailored to the health-care professional disciplines, would be best suited to shift clinician behaviour to align with guidelines. The findings from the co-design process aligned with theory-informed intervention package. Each of the intervention strategies varied in their frequency and popularity of use. CONCLUSIONS The use of theory-informed and participatory approach assisted with the intervention development process and aligned the intervention content with the priorities of stakeholders. The TDF provided a structured process for developing intervention content which is both acceptable and useful to stakeholders and may improve the management of vancomycin.
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Affiliation(s)
- M L Avent
- Queensland Statewide Antimicrobial Stewardship Program, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia.
| | - W Franks
- Department of Pharmacy, Metro North Hospital and Health Service, Brisbane, Australia
| | - A Redmond
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - M J Allen
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Australia
| | - S Naicker
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Australia
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Turuba R, Katan C, Marchand K, Brasset C, Ewert A, Tallon C, Fairbank J, Mathias S, Barbic S. Weaving community-based participatory research and co-design to improve opioid use treatments and services for youth, caregivers, and service providers. PLoS One 2024; 19:e0297532. [PMID: 38635804 PMCID: PMC11025903 DOI: 10.1371/journal.pone.0297532] [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: 05/15/2023] [Accepted: 12/30/2023] [Indexed: 04/20/2024] Open
Abstract
Integrating the voices of service users and providers in the design and delivery of health services increases the acceptability, relevance, and effectiveness of services. Such efforts are particularly important for youth opioid use treatments and services, which have failed to consider the unique needs of youth and families. Applying community-based participatory research (CBPR) and co-design can facilitate this process by contextualizing service user experiences at individual and community levels and supporting the collaborative design of innovative solutions for improving care. However, few studies demonstrate how to effectively integrate these methods and engage underserved populations in co-design. As such, this manuscript describes how our team wove CBPR and co-design methods to develop solutions for improving youth opioid use treatments and services in Canada. As per CBPR methods, national, provincial, and community partnerships were established to inform and support the project's activities. These partnerships were integral for recruiting service users (i.e., youth and caregivers) and service providers to co-design prototypes and support local testing and implementation. Co-design methods enabled understanding of the needs and experiences of youth, caregivers, and service providers, resulting in meaningful community-specific innovations. We used several engagement methods during the co-design process, including regular working group meetings, small group discussions, individual interviews and consultations, and feedback grids. Challenges involved the time commitment and resources needed for co-design, which were exacerbated by the COVID-19 pandemic and limited our ability to engage a diverse sample of youth and caregivers in the process. Strengths of the study included youth and caregiver involvement in the co-design process, which centered around their lived experiences; the therapeutic aspect of the process for participants; and the development of innovations that were accepted by design partners.
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Affiliation(s)
- Roxanne Turuba
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christina Katan
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Kirsten Marchand
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | | | - Alayna Ewert
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Corinne Tallon
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Jill Fairbank
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Steve Mathias
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
- Providence Research, Vancouver, British Columbia, Canada
| | - Skye Barbic
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
- Providence Research, Vancouver, British Columbia, Canada
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Okeny PK, Pittalis C, Monaghan CF, Brugha R, Gajewski J. Dimensions of patient-centred care from the perspective of patients and healthcare workers in hospital settings in sub-Saharan Africa: A qualitative evidence synthesis. PLoS One 2024; 19:e0299627. [PMID: 38626224 PMCID: PMC11020865 DOI: 10.1371/journal.pone.0299627] [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: 12/24/2022] [Accepted: 02/14/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION The United States Institute of Medicine defines patient centred care (PCC), a core element of healthcare quality, as care that is holistic and responsive to individual needs. PCC is associated with better patient satisfaction and improved clinical outcomes. Current conceptualizations of PCC are mainly from Europe and North America. This systematic review summarises the perceived dimensions of PCC among patients and healthcare workers within hospitals in sub-Saharan Africa (SSA). METHODS Without date restrictions, searches were done on databases of the Web of Science, Cochrane Library, PubMed, Embase, Global Health, and grey literature, from their inception up to 11th August 2022. Only qualitative studies exploring dimensions or perceptions of PCC among patients, doctors and/or nurses in hospitals in (SSA) were included. Review articles and editorials were excluded. Two independent reviewers screened titles and abstracts, and conducted full-text reviews with conflicts resolved by a third reviewer. The CASP (critical appraisal skills program) checklist was utilised to assess the quality of included studies. The framework synthesis method was employed for data synthesis. RESULTS 5507 articles were retrieved. Thirty-eight studies met the inclusion criteria, of which 17 were in the specialty of obstetrics, while the rest were spread across different fields. The perceived dimensions reported in the studies included privacy and confidentiality, communication, shared decision making, dignity and respect, continuity of care, access to care, adequate infrastructure and empowerment. Separate analysis of patients' and providers' perspective revealed a difference in the practical understanding of shared-decision making. These dimensions were summarised into a framework consisting of patient-as-person, access to care, and integrated care. CONCLUSION The conceptualization of PCC within SSA was largely similar to findings from other parts of the world, although with a stronger emphasis on access to care. In SSA, both relational and structural aspects of care were significant elements of PCC. Healthcare providers mostly perceived structural aspects such as infrastructure as key dimensions of PCC. TRIAL REGISTRATION PROSPERO Registration number CRD42021238411.
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Affiliation(s)
- Paul K. Okeny
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Surgery, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Chiara Pittalis
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Celina Flocks Monaghan
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ruairi Brugha
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jakub Gajewski
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Lichtenstein Liljeblad K, Kopp Kallner H, Brynhildsen J, Kilander H. Women's experiences of postpartum contraceptive services when elective caesarean section is the method of birth: a qualitative study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024; 50:107-113. [PMID: 38365455 DOI: 10.1136/bmjsrh-2023-202046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The unmet need for postpartum contraception is a global challenge. Postpartum placement of an intrauterine device (IUD) within 48 hours of vaginal delivery is available in many settings worldwide, but is not routinely practised in Sweden. To improve contraceptive services and facilitate the informed choice of IUD placement at the time of a caesarean section (CS), we performed this study to identify and describe women's experiences of contraceptive services before, during and after an elective CS. METHODS A qualitative design and methodology was used. We interviewed 20 women aged 28-42 years who underwent elective CS in Sweden. Interviews were analysed using reflexive thematic analysis. RESULTS The three main themes found were (1) receptivity to contraceptive counselling in the context of CS, (2) communication and decision-making about postpartum contraception before CS and (3) lack of support and guidance to receive contraceptive services before and after CS. The participants described readiness and interest regarding postpartum contraception. They prefered counselling from around 25 weeks of gestation. Despite this finding, antenatal communication and contraceptive decision-making seemed rare. Participants reported a lack of support and guidance which necessitated a need by women to navigate the contraceptive services themselves in order to receive information about contraception before CS and to receive postpartum support. CONCLUSIONS Antenatal contraceptive counselling including information about IUD placement during CS was appreciated and welcomed by women with elective CS as their birth method. Most of the women whom we interviewed would prefer to receive contraception counselling on postpartum use during the second half of their pregnancy.
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Affiliation(s)
- Karin Lichtenstein Liljeblad
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Karolinska Institute, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Karolinska Institute, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics and Gynecology, Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, School of Medical Sciences, Faculty of Health and Medicine, Örebro University, Örebro, Sweden
| | - Helena Kilander
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Women's and Children's Health, Karolinska Institute and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden
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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.
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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
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Berglund M, Andersson S, Kjellsdotter A. A feeling of not being alone - Patients' with COPD experiences of a group-based self-management education with a digital website: A qualitative study. Nurs Open 2024; 11:e2153. [PMID: 38641867 PMCID: PMC11031618 DOI: 10.1002/nop2.2153] [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: 12/06/2021] [Revised: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024] Open
Abstract
AIM To describe patients' with chronic obstructive pulmonary disease (COPD) experiences of group-based self-management education with a digital website. DESIGN A qualitative approach with a phenomenologicalmethod. Patients participating in an earlier study, with self-experience of COPD as a special competence, were involved as research partners at the design of this study. METHODS Eleven individual and two group interviews with five participants in each group were conducted. RESULTS Group-based self-management education with a digital website supports learning. Sharing experiences with others in similar situations creates security and reduces the feeling of being alone. Based on questions and discussion in the group, and through self-reflection, general information is transformed into useful knowledge and understanding of one's own situation. COPD information on the website provides an opportunity to gain knowledge continuously based on needs that contributes to learning. This research has demonstrated that adapting learning activities to individual learning styles increases sustainability of learning. Sharing experiences reduces feelings of loneliness. It is therefore important to create spaces for sharing experiences and in-depth reflection that support learning over time.
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Affiliation(s)
- Mia Berglund
- School of Health SciencesSkövde UniversitySkövdeSweden
| | - Susanne Andersson
- FoU‐centrum Skaraborg ‐ R&D Centre SkaraborgRegion Västra GötalandSkövdeSweden
- Department of Health SciencesUniversity WestTrollhättanSweden
| | - Anna Kjellsdotter
- School of Health SciencesSkövde UniversitySkövdeSweden
- Research and Development CentreSkaraborg HospitalSkövdeSweden
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Shaller D, Nembhard I, Matta S, Grob R, Lee Y, Warne E, Evans R, Dicello D, Colon M, Polanco A, Schlesinger M. Assessing an innovative method to promote learning from patient narratives: Findings from a field experiment in ambulatory care. Health Serv Res 2024; 59:e14245. [PMID: 37845082 PMCID: PMC10915476 DOI: 10.1111/1475-6773.14245] [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] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE To assess whether an online interactive report designed to facilitate interpretation of patients' narrative feedback produces change in ambulatory staff learning, behavior at the individual staff and practice level, and patient experience survey scores. DATA SOURCES AND SETTING We studied 22 ambulatory practice sites within an academic medical center using three primary data sources: 333 staff surveys; 20 in-depth interviews with practice leaders and staff; and 9551 modified CG-CAHPS patient experience surveys augmented by open-ended narrative elicitation questions. STUDY DESIGN We conducted a cluster quasi-experimental study, comparing 12 intervention and 10 control sites. At control sites, narratives were delivered free-form to site administrators via email; at intervention sites, narratives were delivered online with interactive tools for interpretation, accompanied by user training. We assessed control-versus-intervention site differences in learning, behavior, and patient experience scores. DATA COLLECTION Staff surveys and interviews were completed at intervention and control sites, 9 months after intervention launch. Patient surveys were collected beginning 4 months pre-launch through 9 months post-launch. We used control-versus-intervention and difference-in-difference analyses for survey data and thematic analysis for interview data. PRINCIPAL FINDINGS Interviews suggested that the interface facilitated narrative interpretation and use for improvement. Staff survey analyses indicated enhanced learning from narratives at intervention sites (29% over control sites' mean of 3.19 out of 5 across eight domains, p < 0.001) and greater behavior change at staff and practice levels (31% and 21% over control sites' means of 3.35 and 3.39, p < 0.001, respectively). Patient experience scores for interactions with office staff and wait time information increased significantly at intervention sites, compared to control sites (3.7% and 8.2%, respectively); however, provider listening scores declined 3.3%. CONCLUSIONS Patient narratives presented through structured feedback reporting methods can catalyze positive changes in staff learning, promote behavior change, and increase patient experience scores in domains of non-clinical interaction.
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Affiliation(s)
| | - Ingrid Nembhard
- Health Care Management Department, The Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sasmira Matta
- Health Care Management Department, The Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Rachel Grob
- Center for Patient Partnerships, Department of Family Medicine and Community HealthUniversity of WisconsinMadisonWisconsinUSA
| | - Yuna Lee
- Department of Health Policy and Management, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Emily Warne
- Center for Patient Partnerships, Department of Family Medicine and Community HealthUniversity of WisconsinMadisonWisconsinUSA
| | | | | | - Maria Colon
- New York‐Presbyterian HospitalNew YorkNew YorkUSA
| | | | - Mark Schlesinger
- Department of Health Policy and Management, School of Public HealthYale UniversityNew HavenConnecticutUSA
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Perry AE, Baker H, Aboaja A, Wilson L, Morris S. Co-production and adaptation of a prison-based problem-solving workbook to support the mental health of patients housed within a medium- and low-secure forensic service. Health Expect 2024; 27:e13997. [PMID: 38400622 PMCID: PMC10891435 DOI: 10.1111/hex.13997] [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: 10/09/2023] [Revised: 12/19/2023] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Problem-solving skills (PSS) help to provide a systematic approach to dealing with and managing complex problems. The overall aim of this study was to assess the acceptability and feasibility of developing and adapting a prison-based PSS workbook for adults within a medium- and low-secure hospital. METHOD We used the Medical Research Council framework in our participatory mixed methods study incorporating an adapted survey (to identify what types of problems people experience in secure hospitals), a series of three interactive workshops (to co-produce two case study examples for a workbook) and we gathered feedback from patients and hospital staff on the acceptability and feasibility of the workbook. Data from the survey were used to inform the case study examples, and the feedback from patients and hospital staff was descriptively summarised and the results consolidated. RESULTS In total, 82 (51%) patients took part in the survey; 22 patients and 49 hospital staff provided feedback on the workbook. The survey results indicated that patients regularly experience problems while in the hospital. Patients reported problems relating to restrictions of freedom and boredom. The workshops produced two case studies for the workbooks, with mainly positive patient and staff feedback. More work is required to improve the visual representation of the characters in the case studies, the amount and content of the language and the mechanism of the intervention delivery. CONCLUSION The adaptation process proved acceptable and feasible to both patients and staff. The co-production methodology for the workbook and feedback from patients and staff was an effective way of iteratively refining the materials to ensure that they were both meaningful and acceptable to staff and patients. Subsequent work is required to develop the workbook and evaluate the feasibility of the intervention delivery, recruitment rates, uptake and adherence to the PSS using a randomised controlled trial. PATIENT OR PUBLIC CONTRIBUTION At each stage of the project consultation with patients and/or hospital staff was involved.
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Affiliation(s)
- Amanda E. Perry
- Department of Health SciencesUniversity of YorkYorkFulfordUK
| | - Heather Baker
- Tees Esk and Wear Valleys NHS Foundation TrustDarlingtonWest ParkUK
| | - Anne Aboaja
- Tees Esk and Wear Valleys NHS Foundation TrustDarlingtonWest ParkUK
| | - Lindsey Wilson
- Tees Esk and Wear Valleys NHS Foundation TrustDarlingtonWest ParkUK
| | - Sarah Morris
- Tees Esk and Wear Valleys NHS Foundation TrustDarlingtonWest ParkUK
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Loeliger J, Francis J, Kiss N, Stewart J, Chandler S, Donohoe K, Hughes V, Swan W, Kaegi K, Elliott A, McIntosh R. Enhancing the provision of cancer nutrition information to support care through experience-based co-design: a mixed-methods study. Support Care Cancer 2024; 32:257. [PMID: 38556587 DOI: 10.1007/s00520-024-08453-y] [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: 05/21/2023] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Nutrition is essential within cancer care, yet patient and carer access to nutrition care and information is variable. This study aimed to (1) investigate patient and carer access and perceptions, and health professional views and practices, relating to cancer nutrition information and care; and (2) co-design interactive resources to support optimal nutrition care. METHODS Patients and carers completed a survey regarding access to nutrition care and information. Seven multidisciplinary health service teams were invited to participate in a survey and focus group to assess barriers and enablers in nutrition practices. Focus groups were recorded, transcribed and thematically analyzed. Eligible patients, carers, and health professionals were invited to four virtual workshops utilizing experience-based co-design methods to identify nutrition priority areas and design resources. Workshop participant acceptability of the resources was measured. RESULTS Of 104 consumer survey respondents (n = 97 patients, n = 7 carers), 61% agreed that it "took too much time to find evidence-based nutrition and cancer information", and 46% had seen a dietitian. Thirty-four of 38 health professionals completed the survey and 30 participated in a focus group, and it was identified the greatest barriers to delivering nutrition care were lack of referral services, knowledge or skill gaps, and time. Twenty participants (n = 10 patients and carers, n = 10 health professionals) attended four workshops and co-designed a suite of 46 novel resources rated as highly acceptable. CONCLUSION Improved communication, training, and availability of suitable resources could improve access to and support cancer nutrition information and care. New, co-designed cancer nutrition resources were created and deemed highly acceptable to patients, carers, and health professionals.
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Affiliation(s)
- Jenelle Loeliger
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
- School of Exercise and Nutrition Sciences, Deakin University, Deakin, VIC, Australia.
| | - Jill Francis
- School of Health Sciences, University of Melbourne, Parkville, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, 3010, Australia
- Department of Health Services Research & Implementation Science, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, VIC, Australia
| | - Jane Stewart
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | | | | | - Vanessa Hughes
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Wendy Swan
- Nutrition & Dietetics, Goulburn Valley Health, Shepparton, VIC, Australia
| | - Kate Kaegi
- Nutrition Department, Austin Health, Heidelberg, VIC, Australia
| | - Andrea Elliott
- Nutrition and Dietetics Department, Alfred Health, Melbourne, VIC, Australia
| | - Rebecca McIntosh
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
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Sion KYJ, Heerings M, Blok M, Scheffelaar A, Huijg JM, Westerhof G, Pot AM, Luijkx K, Hamers JPH. How Stories Can Contribute Toward Quality Improvement in Long-Term Care. THE GERONTOLOGIST 2024; 64:gnad084. [PMID: 37392446 PMCID: PMC10943509 DOI: 10.1093/geront/gnad084] [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] [Received: 03/22/2023] [Indexed: 07/03/2023] Open
Abstract
It is important to evaluate how residents, their significant others, and professional caregivers experience life in a nursing home to improve quality of care based on their needs and wishes. Narratives are a promising method to assess this experienced quality of care as they enable a rich understanding, reflection, and learning. In the Netherlands, narratives are becoming a more substantial element within the quality improvement cycle of nursing homes. The added value of using narrative methods is that they provide space to share experiences, identify dilemmas in care provision, and provide rich information for quality improvements. The use of narratives in practice, however, can also be challenging as this requires effective guidance on how to learn from this data, incorporation of the narrative method in the organizational structure, and national recognition that narrative data can also be used for accountability. In this article, 5 Dutch research institutes reflect on the importance, value, and challenges of using narratives in nursing homes.
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Affiliation(s)
- Katya Y J Sion
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands
- Living-Lab in Ageing and Long-Term Care, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Marjolijn Heerings
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Marije Blok
- Leyden Academy on Vitality and Ageing, Leiden, Zuid-Holland, The Netherlands
- Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Aukelien Scheffelaar
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
| | - Johanna M Huijg
- Leyden Academy on Vitality and Ageing, Leiden, Zuid-Holland, The Netherlands
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Gerben Westerhof
- Department Psychology, Health and Technology, University of Twente, Enschede, Overijssel, The Netherlands
| | - Anne Margriet Pot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Optentia, North-West University, Vanderbijlpark, Gauteng, South Africa
| | - Katrien Luijkx
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
| | - Jan P H Hamers
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands
- Living-Lab in Ageing and Long-Term Care, Maastricht University, Maastricht, Limburg, The Netherlands
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Marshall KH, Pincus HA, Tesson S, Lingam R, Woolfenden SR, Kasparian NA. Integrated psychological care in pediatric hospital settings for children with complex chronic illness and their families: a systematic review. Psychol Health 2024; 39:452-478. [PMID: 35635028 DOI: 10.1080/08870446.2022.2072843] [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] [Received: 09/08/2021] [Revised: 03/07/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To synthesize and critically evaluate evidence on the effectiveness of integrated psychological care models for children with complex chronic illness within pediatric hospital settings and provide recommendations for successful implementation. DESIGN Six electronic databases (Medline, Cochrane, Embase, PsycINFO, Scopus, CINAHL) were systematically searched for English language studies including families of children aged 0-17 years with complex chronic illness. Eligible studies reported on psychology or neuropsychology screening, assessment, intervention, or services provided within a pediatric hospital setting. RESULTS Fifteen studies were identified for review; nine assessed a psychological service, five examined psychosocial screening, and one examined a neuropsychology service. Three studies demonstrated the effectiveness of integrated psychological services in improving child or parent physical, psychological, or behavioral health outcomes. Uptake of psychosocial screening was high (84-96%), but only 25-37% of children or families identified as 'at-risk' engaged with on-site psychology services. Integrated psychological services offering consultations at the same time and location as the child's medical visit reported the highest rates of uptake (77-100%). CONCLUSIONS The available evidence supports co-location of child medical and psychological services. A more consistent and comprehensive approach to the assessment of patient- and caregiver-reported outcomes and implementation effectiveness is recommended.
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Affiliation(s)
- Kate H Marshall
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Harold A Pincus
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
- Irving Institute for Clinical and Translational Research, Columbia University and New York‑Presbyterian Hospital, New York, NY, USA
| | - Stephanie Tesson
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Susan R Woolfenden
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
- Sydney Institute for Women, Children and their Families, Sydney local health District, Sydney, NSW, Australia
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Khopekar F, Nabi S, Shiva M, Stewart M, Rajendran B, Nabi G. Cost-effectiveness of quality improvement intervention to reduce time between CT-detection and ureteroscopic laser fragmentation in acute symptomatic ureteric stones management. World J Urol 2024; 42:144. [PMID: 38478078 PMCID: PMC10937764 DOI: 10.1007/s00345-023-04694-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/25/2023] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To prospectively assess clinical and cost effectiveness of emergency ureteroscopic laser fragmentation of urinary stones causing symptoms or obstruction. PATIENTS AND METHODS 100 consecutive patients with an average (median) age 55.6 (57.5) years and average (median) stone size of 8.2 mm (± 7 mm) between October 2018 and December 2021 who underwent emergency ureteroscopy and laser fragmentation formed the study cohort as part of a clinical service quality improvement. Primary outcome was single procedure stone-free rate and cost-effectiveness. The secondary outcomes were complications, re-admission and re-intervention. A decision analysis model was constructed to compare the cost-effectiveness of emergency ureteroscopy with laser fragmentation (EUL) and emergency temporary stenting followed by delayed ureteroscopy with laser fragmentation (DUL) using our results and success rates for modelling. RESULTS Single procedure stone-free rates (SFR) for EUL and DUL were 85%. The re-intervention rate, re-admission and complication rates of the study cohort (EUL) were 9%, 18%, and 4%, respectively, compared to 15%, 20%, and 5%, respectively for the control cohort (DUL). The decision analysis modelling demonstrated that the EUL treatment option was more cost-efficient, averting £2868 (€3260) per patient for the UK health sector. Total cost of delayed intervention was £7783 (€8847) for DUL in contrast to £4915 (€5580) for EUL. CONCLUSIONS Implementation of quality improvement project based on a reduction in CT detection-to-laser fragmentation time interval in acute ureteric obstruction or symptoms caused by stones had similar clinical effectiveness compared to delayed ureteroscopic management, but more cost-effective.
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Affiliation(s)
| | - Soha Nabi
- University of Aberdeen, Aberdeen, UK
| | | | | | | | - Ghulam Nabi
- Ninewells Hospital, Dundee, UK.
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, Dundee, DD1 9SY, UK.
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Kirby P, Lai H, Horrocks S, Harrison M, Wilson D, Daniels S, Calvo RA, Sharp DJ, Alexander CM. Patient and Public Involvement in Technology-Related Dementia Research: Scoping Review. JMIR Aging 2024; 7:e48292. [PMID: 38437014 PMCID: PMC10949132 DOI: 10.2196/48292] [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: 04/18/2023] [Revised: 09/12/2023] [Accepted: 01/17/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Technology-related research on people with dementia and their carers often aims to enable people to remain living at home for longer and prevent unnecessary hospital admissions. To develop person-centered, effective, and ethical research, patient and public involvement (PPI) is necessary, although it may be perceived as more difficult with this cohort. With recent and rapid expansions in health and care-related technology, this review explored how and with what impact collaborations between researchers and stakeholders such as people with dementia and their carers have taken place. OBJECTIVE This review aims to describe approaches to PPI used to date in technology-related dementia research, along with the barriers and facilitators and impact of PPI in this area. METHODS A scoping review of literature related to dementia, technology, and PPI was conducted using MEDLINE, PsycINFO, Embase, and CINAHL. Papers were screened for inclusion by 2 authors. Data were then extracted using a predesigned data extraction table by the same 2 authors. A third author supported the resolution of any conflicts at each stage. Barriers to and facilitators of undertaking PPI were then examined and themed. RESULTS The search yielded 1694 papers, with 31 (1.83%) being analyzed after screening. Most (21/31, 68%) did not make clear distinctions between activities undertaken as PPI and those undertaken by research participants, and as such, their involvement did not fit easily into the National Institute for Health and Care Research definition of PPI. Most of this mixed involvement focused on reviewing or evaluating technology prototypes. A range of approaches were described, most typically using focus groups or co-design workshops. In total, 29% (9/31) described involvement at multiple stages throughout the research cycle, sometimes with evidence of sharing decision-making power. Some (23/31, 74%) commented on barriers to or facilitators of effective PPI. The challenges identified often regarded issues of working with people with significant cognitive impairments and pressures on time and resources. Where reported, the impact of PPI was largely reported as positive, including the experiences for patient and public partners, the impact on research quality, and the learning experience it provided for researchers. Only 4 (13%) papers used formal methods for evaluating impact. CONCLUSIONS Researchers often involve people with dementia and other stakeholders in technology research. At present, involvement is often limited in scope despite aspirations for high levels of involvement and partnership working. Involving people with dementia, their carers, and other stakeholders can have a positive impact on research, patient and public partners, and researchers. Wider reporting of methods and facilitative strategies along with more formalized methods for recording and reporting on meaningful impact would be helpful so that all those involved-researchers, patients, and other stakeholders-can learn how we can best conduct research together.
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Affiliation(s)
- Pippa Kirby
- Department of Therapies, Imperial College Healthcare NHS Trust, London, United Kingdom
- UK Dementia Research Institute, Care Research and Technology Centre (UK DRI CR&T), London, United Kingdom
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Helen Lai
- UK Dementia Research Institute, Care Research and Technology Centre (UK DRI CR&T), London, United Kingdom
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Sophie Horrocks
- UK Dementia Research Institute, Care Research and Technology Centre (UK DRI CR&T), London, United Kingdom
- Helix Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Matthew Harrison
- UK Dementia Research Institute, Care Research and Technology Centre (UK DRI CR&T), London, United Kingdom
- Helix Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Danielle Wilson
- UK Dementia Research Institute, Care Research and Technology Centre (UK DRI CR&T), London, United Kingdom
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Sarah Daniels
- UK Dementia Research Institute, Care Research and Technology Centre (UK DRI CR&T), London, United Kingdom
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Rafael A Calvo
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - David J Sharp
- UK Dementia Research Institute, Care Research and Technology Centre (UK DRI CR&T), London, United Kingdom
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Caroline M Alexander
- Department of Therapies, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Briggs J, Kostakis I, Meredith P, Dall'ora C, Darbyshire J, Gerry S, Griffiths P, Hope J, Jones J, Kovacs C, Lawrence R, Prytherch D, Watkinson P, Redfern O. Safer and more efficient vital signs monitoring protocols to identify the deteriorating patients in the general hospital ward: an observational study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-143. [PMID: 38551079 DOI: 10.3310/hytr4612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Background The frequency at which patients should have their vital signs (e.g. blood pressure, pulse, oxygen saturation) measured on hospital wards is currently unknown. Current National Health Service monitoring protocols are based on expert opinion but supported by little empirical evidence. The challenge is finding the balance between insufficient monitoring (risking missing early signs of deterioration and delays in treatment) and over-observation of stable patients (wasting resources needed in other aspects of care). Objective Provide an evidence-based approach to creating monitoring protocols based on a patient's risk of deterioration and link these to nursing workload and economic impact. Design Our study consisted of two parts: (1) an observational study of nursing staff to ascertain the time to perform vital sign observations; and (2) a retrospective study of historic data on patient admissions exploring the relationships between National Early Warning Score and risk of outcome over time. These were underpinned by opinions and experiences from stakeholders. Setting and participants Observational study: observed nursing staff on 16 randomly selected adult general wards at four acute National Health Service hospitals. Retrospective study: extracted, linked and analysed routinely collected data from two large National Health Service acute trusts; data from over 400,000 patient admissions and 9,000,000 vital sign observations. Results Observational study found a variety of practices, with two hospitals having registered nurses take the majority of vital sign observations and two favouring healthcare assistants or student nurses. However, whoever took the observations spent roughly the same length of time. The average was 5:01 minutes per observation over a 'round', including time to locate and prepare the equipment and travel to the patient area. Retrospective study created survival models predicting the risk of outcomes over time since the patient was last observed. For low-risk patients, there was little difference in risk between 4 hours and 24 hours post observation. Conclusions We explored several different scenarios with our stakeholders (clinicians and patients), based on how 'risk' could be managed in different ways. Vital sign observations are often done more frequently than necessary from a bald assessment of the patient's risk, and we show that a maximum threshold of risk could theoretically be achieved with less resource. Existing resources could therefore be redeployed within a changed protocol to achieve better outcomes for some patients without compromising the safety of the rest. Our work supports the approach of the current monitoring protocol, whereby patients' National Early Warning Score 2 guides observation frequency. Existing practice is to observe higher-risk patients more frequently and our findings have shown that this is objectively justified. It is worth noting that important nurse-patient interactions take place during vital sign monitoring and should not be eliminated under new monitoring processes. Our study contributes to the existing evidence on how vital sign observations should be scheduled. However, ultimately, it is for the relevant professionals to decide how our work should be used. Study registration This study is registered as ISRCTN10863045. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/05/03) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 6. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Jim Briggs
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, Portsmouth, UK
| | - Ina Kostakis
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, Portsmouth, UK
| | - Paul Meredith
- Research Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Julie Darbyshire
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Stephen Gerry
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | | | - Jo Hope
- Health Sciences, University of Southampton, Southampton, UK
| | - Jeremy Jones
- Health Sciences, University of Southampton, Southampton, UK
| | - Caroline Kovacs
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, Portsmouth, UK
| | | | - David Prytherch
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, Portsmouth, UK
| | - Peter Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Oliver Redfern
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Sumner J, Ng CWT, Teo KEL, Peh ALT, Lim YW. Co-designing care for multimorbidity: a systematic review. BMC Med 2024; 22:58. [PMID: 38321495 PMCID: PMC10848537 DOI: 10.1186/s12916-024-03263-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The co-design of health care enables patient-centredness by partnering patients, clinicians and other stakeholders together to create services. METHODS We conducted a systematic review of co-designed health interventions for people living with multimorbidity and assessed (a) their effectiveness in improving health outcomes, (b) the co-design approaches used and (c) barriers and facilitators to the co-design process with people living with multimorbidity. We searched MEDLINE, EMBASE, CINAHL, Scopus and PsycINFO between 2000 and March 2022. Included experimental studies were quality assessed using the Cochrane risk of bias tool (ROB-2 and ROBINS-I). RESULTS We screened 14,376 reports, with 13 reports meeting the eligibility criteria. Two reported health and well-being outcomes: one randomised clinical trial (n = 134) and one controlled cohort (n = 1933). Outcome measures included quality of life, self-efficacy, well-being, anxiety, depression, functional status, healthcare utilisation and mortality. Outcomes favouring the co-design interventions compared to control were minimal, with only 4 of 17 outcomes considered beneficial. Co-design approaches included needs assessment/ideation (12 of 13), prototype (11 of 13), pilot testing (5 of 13) (i.e. focus on usability) and health and well-being evaluations (2 of 13). Common challenges to the co-design process include poor stakeholder interest, passive participation, power imbalances and a lack of representativeness in the design group. Enablers include flexibility in approach, smaller group work, advocating for stakeholders' views and commitment to the process or decisions made. CONCLUSIONS In this systematic review of co-design health interventions, we found that few projects assessed health and well-being outcomes, and the observed health and well-being benefits were minimal. The intensity and variability in the co-design approaches were substantial, and challenges were evident. Co-design aided the design of novel services and interventions for those with multimorbidity, improving their relevance, usability and acceptability. However, the clinical benefits of co-designed interventions for those with multimorbidity are unclear.
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Affiliation(s)
- Jennifer Sumner
- Alexandra Hospital, National University Health System, Singapore, Singapore.
| | | | | | - Adena Li Tyin Peh
- Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Yee Wei Lim
- Alexandra Hospital, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Lawless MT, Archibald MM, Ambagtsheer RC, Pinero de Plaza MA, Kitson AL. My Wellbeing Journal: Development of a communication and goal-setting tool to improve care for older adults with chronic conditions and multimorbidity. Health Expect 2024; 27:e13890. [PMID: 37830439 PMCID: PMC10726145 DOI: 10.1111/hex.13890] [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: 06/17/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Chronic conditions and multimorbidity, the presence of two or more chronic conditions, are increasingly common in older adults. Effective management of chronic conditions and multimorbidity in older adults requires a collaborative and person-centred approach that considers the individual's goals, preferences and priorities. However, ensuring high-quality personalised care for older adults with multimorbidity can be challenging due to the complexity of their care needs, limited time and a lack of patient preparation to discuss their personal goals and preferences with their healthcare team. OBJECTIVE To codesign a communication and goal-setting tool, My Wellbeing Journal, to support personalised care planning for older adults with chronic conditions and multimorbidity. DESIGN We drew on an experience-based codesign approach to develop My Wellbeing Journal. This article reports on the final end-user feedback, which was collected via an online survey with older adults and their carers. SETTING AND PARTICIPANTS Older adults with chronic conditions, multimorbidity and informal carers living in Australia. Personalised care planning was considered in the context of primary care. RESULTS A total of 88 participants completed the online survey. The survey focused on participants' feedback on the tool in terms of effectiveness, efficiency, satisfaction and errors encountered. This feedback resulted in modifications to My Wellbeing Journal, which can be used during clinical encounters to facilitate communication, goal setting and progress tracking. DISCUSSION AND CONCLUSIONS Clinicians and carers can use the tool to guide discussions with older adults about their care planning and help them set realistic goals that are meaningful to them. The findings of this study could be used to inform the development of recommendations for healthcare providers to implement person-centred, goal-oriented care for older adults with chronic conditions and multimorbidity. PATIENT OR PUBLIC CONTRIBUTION Older adults living with chronic conditions and multimorbidity and their carers have contributed to the development of a tool that has the potential to significantly enhance the experience of personalised care planning. Their direct involvement as collaborators has ensured that the tool is optimised to meet the standards of effectiveness and usability.
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Affiliation(s)
- Michael T. Lawless
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Mandy M. Archibald
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
- Helen Glass Centre for NursingCollege of NursingWinnipegManitobaCanada
| | | | | | - Alison L. Kitson
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
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Juel A, Berring LL, Erlangsen A, Larsen ER, Buus N. Sense of psychological ownership in co-design processes: A case study. Health Expect 2024; 27:e13886. [PMID: 37890859 PMCID: PMC10726143 DOI: 10.1111/hex.13886] [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: 05/12/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Service users are increasingly participating in health research. Although collaborative research is assumed to give users a sense of psychological ownership, little is known about the specific psychosocial processes through which ownership develops and is displayed. The present study yields insight into a process in which service users, researchers and a website designer collaborated to design a website. AIM The aim of this study was to explore how participants developed and displayed feelings of ownership during a collaborative process to design a website. METHODS A case study design was adopted by which audio recordings were subjected to thematic analysis and interpreted by drawing on the concept of psychological ownership. FINDINGS A sense of psychological ownership of the website design process emerged in two distinct and overlapping phases. In the first phase, 'sense of ownership during the early design phase', only researchers and the website designer displayed a sense of ownership, which was facilitated by the research context preceding the collaborative workshops. In the second phase, 'sense of ownership during the collaborative design phase', service users gradually started to develop parallel feelings of ownership that were facilitated by workshop design activities. These activities enabled service users to increasingly control the process, to invest themselves in the process and to gain intimate knowledge of the process and its outcome. Service users' sense of ownership was displayed in their statements about the website and its elements. CONCLUSION Participants engaged in codesign processes may develop a sense of psychological ownership at different speeds because of contextual factors. It is important to take this into account as it may complicate the formation of egalitarian work groups. PATIENT AND PUBLIC CONTRIBUTION Parents of children with suicidal behaviour and a counsellor participated as service users in a website design process.
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Affiliation(s)
- Anette Juel
- Psychiatric Research UnitPsychiatry Region ZealandSlagelseDenmark
- Mental Health Centre CopenhagenDanish Research Institute for Suicide PreventionHellerupDenmark
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Lene L. Berring
- Psychiatric Research UnitPsychiatry Region ZealandSlagelseDenmark
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Annette Erlangsen
- Mental Health Centre CopenhagenDanish Research Institute for Suicide PreventionHellerupDenmark
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Center of Mental Health ResearchThe Australian National UniversityCanberraAustralian Capital TerritoryAustralia
- Copenhagen Research Center for Mental HealthMental Health Centre CopenhagenHellerupDenmark
| | - Erik R. Larsen
- Translational Neuropsychiatry Unit, Department of Clinical MedicineAarhus UniversityAarhus NuDenmark
| | - Niels Buus
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and HealthMonash UniversityClaytonVictoriaAustralia
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Aworinde J, Evans CJ, Gillam J, Ramsenthaler C, Davies N, Ellis‐Smith C. Co-design of the EMBED-Care Framework as an intervention to enhance shared decision-making for people affected by dementia and practitioners, comprising holistic assessment, linked with clinical decision support tools: A qualitative study. Health Expect 2024; 27:e13987. [PMID: 38343168 PMCID: PMC10859658 DOI: 10.1111/hex.13987] [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: 08/31/2023] [Revised: 01/17/2024] [Accepted: 01/27/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Shared decision-making intends to align care provision with individuals' preferences. However, the involvement of people living with dementia in decision-making about their care varies. We aimed to co-design the EMBED-Care Framework, to enhance shared decision-making between people affected by dementia and practitioners. METHODS A theory and evidence driven co-design study was conducted, using iterative workshops, informed by a theoretical model of shared decision-making and the EMBED-Care Framework (the intervention) for person-centred holistic palliative dementia care. The intervention incorporates a holistic outcome measure for assessment and review, linked with clinical decision-support tools to support shared decision-making. We drew on the Medical Research Council (MRC) guidance for developing and evaluating complex interventions. Participants included people with dementia of any type, current or bereaved family carers and practitioners. We recruited via established dementia groups and research and clinical networks. Data were analysed using reflexive thematic analysis to explore how and when the intervention could enhance communication and shared decision-making, and the requirements for use, presented as a logic model. RESULTS Five co-design workshops were undertaken with participants comprising people affected by dementia (n = 18) and practitioners (n = 36). Three themes were generated, comprising: (1) 'knowing the person and personalisation of care', involving the person with dementia and/or family carer identifying the needs of the person using a holistic assessment. (2) 'engaging and considering the perspectives of all involved in decision-making' required listening to the person and the family to understand their priorities, and to manage multiple preferences. (3) 'Training and support activities' to use the Framework through use of animated videos to convey information, such as to understand the outcome measure used to assess symptoms. CONCLUSIONS The intervention developed sought to enhance shared decision-making with individuals affected by dementia and practitioners, through increased shared knowledge of individual priorities and choices for care and treatment. The workshops generated understanding to manage disagreements in determining priorities. Practitioners require face-to-face training on the intervention, and on communication to manage sensitive conversations about symptoms, care and treatment with individuals and their family. The findings informed the construction of a logic model to illustrate how the intervention is intended to work.
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Affiliation(s)
- Jesutofunmi Aworinde
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
| | - Catherine J. Evans
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
- Sussex Community NHS Foundation TrustBrightonUK
| | - Juliet Gillam
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
| | - Christina Ramsenthaler
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
- Department of Health SciencesZurich University of Applied Sciences (ZHAW)WinterthurSwitzerland
- Hull York Medical School, Wolfson Palliative Care Research CentreUniversity of HullHullEngland
| | - Nathan Davies
- Research Department of Primary Care and Population HealthCentre for Aging Population Studies, University College LondonLondonUK
| | - Clare Ellis‐Smith
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
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Chow AJ, Saad A, Al‐Baldawi Z, Iverson R, Skidmore B, Jordan I, Pallone N, Smith M, Chakraborty P, Brehaut J, Cohen E, Dyack S, Gillis J, Goobie S, Greenberg CR, Hayeems R, Hutton B, Inbar‐Feigenberg M, Jain‐Ghai S, Khangura S, MacKenzie JJ, Mitchell JJ, Moazin Z, Nicholls SG, Pender A, Prasad C, Schulze A, Siriwardena K, Sparkes RN, Speechley KN, Stockler S, Taljaard M, Teitelbaum M, Trakadis Y, Van Karnebeek C, Walia JS, Wilson K, Potter BK. Family-centred care interventions for children with chronic conditions: A scoping review. Health Expect 2024; 27:e13897. [PMID: 39102737 PMCID: PMC10837485 DOI: 10.1111/hex.13897] [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: 06/30/2023] [Revised: 09/08/2023] [Accepted: 10/10/2023] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Children with chronic conditions have greater health care needs than the general paediatric population but may not receive care that centres their needs and preferences as identified by their families. Clinicians and researchers are interested in developing interventions to improve family-centred care need information about the characteristics of existing interventions, their development and the domains of family-centred care that they address. We conducted a scoping review that aimed to identify and characterize recent family-centred interventions designed to improve experiences with care for children with chronic conditions. METHODS We searched Medline, Embase, PsycInfo and Cochrane databases, and grey literature sources for relevant articles or documents published between 1 January 2019 and 11 August 2020 (databases) or 7-20 October 2020 (grey literature). Primary studies with ≥10 participants, clinical practice guidelines and theoretical articles describing family-centred interventions that aimed to improve experiences with care for children with chronic conditions were eligible. Following citation and full-text screening by two reviewers working independently, we charted data covering study characteristics and interventions from eligible reports and synthesized interventions by domains of family-centred care. RESULTS Our search identified 2882 citations, from which 63 articles describing 61 unique interventions met the eligibility criteria and were included in this review. The most common study designs were quasiexperimental studies (n = 18), randomized controlled trials (n = 11) and qualitative and mixed-methods studies (n = 9 each). The most frequently addressed domains of family-centred care were communication and information provision (n = 45), family involvement in care (n = 37) and access to care (n = 30). CONCLUSION This review, which identified 61 unique interventions aimed at improving family-centred care for children with chronic conditions across a range of settings, is a concrete resource for researchers, health care providers and administrators interested in improving care for this high-needs population. PATIENT OR PUBLIC CONTRIBUTION This study was co-developed with three patient partner co-investigators, all of whom are individuals with lived experiences of rare chronic diseases as parents and/or patients and have prior experience in patient engagement in research (I. J., N. P., M. S.). These patient partner co-investigators contributed to this study at all stages, from conceptualization to dissemination.
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Affiliation(s)
- Andrea J. Chow
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Ammar Saad
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Zobaida Al‐Baldawi
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Ryan Iverson
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | | | | | | | - Maureen Smith
- Canadian Organization for Rare DisordersOttawaOntarioCanada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern OntarioOttawaOntarioCanada
- Department of PediatricsUniversity of OttawaOttawaOntarioCanada
| | - Jamie Brehaut
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Eyal Cohen
- Department of PediatricsUniversity of Toronto/Hospital for Sick ChildrenTorontoOntarioCanada
| | - Sarah Dyack
- Department of PediatricsDalhousie UniversityHalifaxNova ScotiaCanada
| | | | - Sharan Goobie
- Department of PediatricsDalhousie UniversityHalifaxNova ScotiaCanada
| | - Cheryl R. Greenberg
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegManitobaCanada
| | - Robin Hayeems
- Child Health Evaluative SciencesUniversity of Toronto/Hospital for Sick ChildrenTorontoOntarioCanada
| | - Brian Hutton
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Michal Inbar‐Feigenberg
- Division of Clinical & Metabolic GeneticsHospital for Sick ChildrenTorontoOntarioCanada
- Department of PediatricsUniversity of TorontoTorontoOntarioCanada
| | - Shailly Jain‐Ghai
- Department of Medical GeneticsUniversity of AlbertaEdmontonAlbertaCanada
| | - Sara Khangura
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Jennifer J. MacKenzie
- Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
- Department of MedicineQueen's UniversityKingstonOntarioCanada
| | | | - Zeinab Moazin
- Newborn Screening Ontario, Children's Hospital of Eastern OntarioOttawaOntarioCanada
| | - Stuart G. Nicholls
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Amy Pender
- McMaster Children's HospitalHamiltonOntarioCanada
| | - Chitra Prasad
- Department of PediatricsWestern UniversityLondonOntarioCanada
| | - Andreas Schulze
- Department of Biochemistry and Department of PediatricsUniversity of TorontoTorontoOntarioCanada
- Clinical and Metabolic GeneticsHospital for Sick ChildrenTorontoOntarioCanada
| | - Komudi Siriwardena
- Department of Medical GeneticsUniversity of AlbertaEdmontonAlbertaCanada
| | | | - Kathy N. Speechley
- Departments of Pediatrics and Epidemiology and BiostatisticsWestern UniversityLondonOntarioCanada
| | | | - Monica Taljaard
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | | | | | - Clara Van Karnebeek
- Departments of Pediatrics and Human GeneticsEmma Center for Personalized Medicine, Amsterdam UMCAmsterdamThe Netherlands
| | | | - Kumanan Wilson
- Department of PediatricsUniversity of OttawaOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
- Bruyère Research InstituteOttawaOntarioCanada
| | - Beth K. Potter
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
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Bogaert K, Regge MD, Vermassen F, Eeckloo K. Engaging healthcare professionals and patient representatives in the development of a quality model for hospitals: a mixed-method study. Int J Qual Health Care 2024; 36:mzad116. [PMID: 38183266 DOI: 10.1093/intqhc/mzad116] [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: 07/28/2023] [Revised: 12/03/2023] [Accepted: 12/30/2023] [Indexed: 01/07/2024] Open
Abstract
Top-down and externally imposed quality requirements can lead to improvement but do not seem as sustainable as intended. There is a need for a quality model that intrinsically motivates healthcare professionals to contribute to quality and safe care in hospitals. This study shows how a quality model that matches the identity and the quality vision of the organization was developed. A multimethod design with three phases was used in the development of the model at a large teaching hospital in Belgium. In the first phase, 14 focus groups and 19 interviews with staff members were conducted to obtain an overview of the quality and safety challenges, complemented by a plenary discussion with the members of the patient advisory council. In the second phase, the challenges that had been captured were further assessed using a hospital-wide survey for all hospital staff. Finally, a newly established quality review board (with internal and external stakeholders) critically evaluated the input of Phases 1 and 2 and defined the basic quality standards to be implemented in the hospital. A first evaluation 2 years after the implementation was conducted based on (i) patients' perceptions of quality of care and patient safety by publicly available indicators collected in 2016, 2019, and 2022 and (ii) staff experiences and perceptions regarding the acceptability of the new model gathered through (grouped) interviews and an open questionnaire. The quality model consists of eight broad themes, including norms for the hospital staff (n = 27), sustained with quality systems (n = 8), and organizational support (n = 6), with aid from adequate management and leadership (n = 6). The themes were converted into 46 standards. These should be supported within a safe, efficient, and caring work environment. The new model was launched in the hospital in June 2021. The evaluation shows a significant difference in quality and safety on different dimensions as perceived by hospitalized patients. The perceived added value of the participatory model is a better fit with the needs of employees and the fact that the model can be adjusted to the specific context of the different hospital departments. The lack of hard indicators is seen as a challenge in monitoring quality and safety. The participation of various stakeholders inside and outside the organization in defining the quality challenges resulted in the creation of a participatory quality model for the hospital, which leads towards a better-supported quality policy in the hospital.
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Affiliation(s)
| | - Melissa De Regge
- Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, Ghent B-9000, Belgium
- Faculty of Economics and Business Administration, Department of Marketing, Innovation and Organisation, Ghent University, Tweekerkenstraat 2, Ghent B-9000, Belgium
| | - Frank Vermassen
- Management Department & Department of Vascular Surgery, Ghent University Hospital, Corneel Heymanslaan 10, Ghent B-9000, Belgium
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, Ghent B-9000, Belgium
| | - Kristof Eeckloo
- Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, Ghent B-9000, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Corneel Heymanslaan 10, Ghent B-9000, Belgium
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50
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Hunt DF. Power of saying 'I Don't Know': psychological safety and participatory strategies for healthcare leaders. BMJ LEADER 2024:leader-2023-000906. [PMID: 38233121 DOI: 10.1136/leader-2023-000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/01/2024] [Indexed: 01/19/2024]
Abstract
As healthcare systems grow increasingly complex and integrate with other services and sectors, creating complex patient pathways, this inevitably leads to additional layers within a system. Consequently, high-tier leaders become progressively detached from the inner workings of the systems in which they operate. Several barriers exist that may deter a leader from embracing uncertainty and acknowledging the limits of their expertise in these systems. These barriers range from personal insecurities about perception to organisational stigmas that compound these concerns through expectations of infallible leadership. In this article, I draw on my experience as an embedded researcher and someone who has taught leadership in healthcare settings to examine the importance of leadership vulnerability, considering not only for the leaders themselves but also for fostering a learning and innovative culture within the organisation. I focus on two fundamental tenets: psychological safety and participatory approaches to innovation. In addition, I offer practical considerations for embracing vulnerability and discuss the ensuing benefits. Given the rapidly evolving complexities in healthcare and paradigm-shifting innovations, such as the integration of digital solutions, this article serves as a call to action. It urges leaders to embrace uncertainty, encourage participation and venture into the unknown.
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Affiliation(s)
- David Francis Hunt
- Department of Psychology, University of Exeter, Exeter, UK
- Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, Oxford, UK
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