On the same page: Co-designing the logic model of a telehealth service for children in rural and remote Australia

Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model: A Sequential Explanatory Mixed-Methods Study

BACKGROUND

In recent decades, medical supervision of the labor and delivery process has expanded beyond its boundaries to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. So far, the policies and programs of the Ministry of Health to reduce medical interventions and cesarean section rates have not been successful. Therefore, the current study aims to be conducted with the purpose of "Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model".

METHODS/DESIGN

The current study is a mixed-methods sequential explanatory design by using the MAP-IT model includes 5 steps: Mobilize, Assess, Plan, Implement, and Track, providing a framework for planning and evaluating public health interventions in a community. It will be implemented in three stages: The first phase of the research will be a cross-sectional descriptive study to determine the attitudes and preferences towards establishing a midwifery-led birthing center focusing on midwives and women of childbearing age by using two researcher-made questionnaires to assess the participants' attitudes and preferences toward establishing a midwifery-led birthing center. Subsequently, extreme cases will be selected based on the participants' average attitude scores toward establishing a midwifery-led birthing center in the quantitative section. In the second stage of the study, qualitative in-depth interviews will be conducted with the identified extreme cases from the first quantitative phase and other stakeholders (the first and second steps of the MAP-IT model, namely identifying and forming a stakeholder coalition, and assessing community resources and real needs). In this stage, the conventional qualitative content analysis approach will be used. Subsequently, based on the quantitative and qualitative data obtained up to this stage, a midwifery-led birthing center program based on the third step of the MAP-IT model, namely Plan, will be developed and validated using the Delphi method.

DISCUSSION

This is the first study that uses a mixed-method approach for designing a midwife-led maternity care program based on the MAP-IT model. This study will fill the research gap in the field of improving midwife-led maternity care and designing a program based on the needs of a large group of pregnant mothers. We hope this program facilitates improved eligibility of midwifery to continue care to manage and improve their health easily and affordably.

ETHICAL CODE

IR.MUMS.NURSE.REC. 1403. 014.

Community-based participatory-research through co-design: supporting collaboration from all sides of disability

BACKGROUND

As co-design and community-based participatory research gain traction in health and disability, the challenges and benefits of collaboratively conducting research need to be considered. Current literature supports using co-design to improve service quality and create more satisfactory services. However, while the 'why' of using co-design is well understood, there is limited literature on 'how' to co-design. We aimed to describe the application of co-design from start to finish within a specific case study and to reflect on the challenges and benefits created by specific process design choices.

METHODS

A telepractice re-design project has been a case study example of co-design. The co-design was co-facilitated by an embedded researcher and a peer researcher with lived experience of disability. Embedded in a Western Australian disability organisation, the co-design process included five workshops and a reflection session with a team of 10 lived experience and staff participants (referred to as co-designers) to produce a prototype telepractice model for testing.

RESULTS

The findings are divided into two components. The first describes the process design choices made throughout the co-design implementation case study. This is followed by a reflection on the benefits and challenges resulting from specific process design choices. The reflective process describes the co-designers' perspective and the researcher's and organisational experiences. Reflections of the co-designers include balancing idealism and realism, the value of small groups, ensuring accessibility and choice, and learning new skills and gaining new insights. The organisational and research-focused reflections included challenges between time for building relationships and the schedules of academic and organisational decision-making, the messiness of co-design juxtaposed with the processes of ethics applications, and the need for inclusive dissemination of findings.

CONCLUSIONS

The authors advocate that co-design is a useful and outcome-generating methodology that proactively enables the inclusion of people with disability and service providers through community-based participatory research and action. Through our experiences, we recommend community-based participatory research, specifically co-design, to generate creative thinking and service design.

Acceptability of a Multimodal Telerehabilitation Intervention for Children Ages 3-8 Years with Motor Difficulties: Results of a Qualitative Study

PURPOSE

The purpose of this study is to explore the acceptability of a telerehabilitation intervention provided to parents of children with motor difficulties.

MATERIAL AND METHODS

Sixteen parents of children were purposefully recruited to participate in semi-structured interviews aimed at assessing the acceptability of the telerehabilitation intervention. Interviews were analyzed thematically.

RESULTS

All participants described evolving acceptability associated with their interactions with the web platform. The opportunities generated, suitability in relation to families' values and perceived effects positively impacted acceptability. The understanding and consistency of intervention delivery, the child's level of involvement, the associated parental burden of the intervention and the therapeutic alliances created also affected acceptability.

CONCLUSION

Our study findings support the acceptability of a telerehabilitation intervention for families of children with motor difficulties. Telerehabilitation seems to be more acceptable to families with children without suspected or confirmed diagnoses.

Rethinking early intervention rehabilitation services for children with motor difficulties: engaging stakeholders in the conceptualization of telerehabilitation primary care

PURPOSE

Rehabilitation services for children with mild motor difficulties are limited. Telehealth could be a novel avenue through which to provide these services. With the input of various stakeholder groups, this study aimed to develop a logic model for a new primary care telerehabilitation intervention and to identify influencing implementation factors.

METHODS AND MATERIALS

A participatory research design was used. A logic model, developed in consultation with five healthcare managers, was discussed with four stakeholder groups. Focus groups were conducted with clinicians (n = 9), pediatric healthcare managers (n = 5), and technology information consultants (n = 2), while parents (n = 4) were interviewed to explore their perceptions of the proposed intervention, and factors influencing implementation. Transcribed discussions were analyzed using reflexive thematic analysis.

RESULTS

Stakeholders supported the delivery of telerehabilitation services for children with mild motor difficulties. Although agreement was generated for each logic model component, important recommendations were voiced related to service relevance and sustainability, parent and community capacity building, and platform dependability, security, and support. Identified factors influencing the implementation encompassed consumer, provider, technological, systemic and contextual barriers and facilitators. Strategies to address them were also suggested.

CONCLUSION

This study demonstrates the value of, and a process to engage stakeholders in the designing of pediatric telerehabilitation services and its implementation.IMPLICATIONS FOR PRACTICEPediatric telerehabilitation service are complex interventions which operate in complicate systems.Designing telerehabilitation services with stakeholders is recommended, yet how to do so often not clear.This study demonstrated that the development of a logic model can provide a systematic framework to helps guide the co-design process with stakeholders.Resulting recommendation underscored a broader vision for the intervention and identified crucial factors and strategies required for its successful implementation and sustainability.

Logical model of telenursing program of a high complexity oncology care center

OBJECTIVE

To develop the logical model of the Alô Enfermeiro program aiming at elucidating the existing structure, activities carried out, and expected results, allowing the program implementation systematic evaluation.

METHOD

This is an evaluative study with a qualitative approach. The development of the logical model was based on systematic methodologies, constituted from the analysis of institutional documents, literature review, search for essential elements that supported the implementation of the program, and the participation of stakeholders for discussion and validation of the data obtained.

RESULTS

It was possible to define the macro problem that gave rise to the program, establish the definition of the Program Alô Enfermeiro, target audience, general and specific objectives, as well as to structure the necessary components, such as inputs and activities, indicating the expected results in the short, medium, and long term. The logical model allowed the identification of the Alô Enfermeiro Program evaluation question, directed to the evaluation of results.

CONCLUSION

The logical model developed allowed the comprehension of the program structure, the interaction among the activities carried out and the expected results of the "Alô Enfermeiro".

Maternal and Child Health Nursing education before and during COVID-19: An exploratory descriptive study

Background

Major disruptions to higher education during COVID-19 resulted in a rapid shift to online learning and associated adaptations to teaching and assessment practices, including for postgraduate programs requiring practical skill development such as nursing and midwifery. Educator perspectives of this transition have not been widely studied.

Purpose

This qualitative descriptive study aimed to describe Australian postgraduate Maternal, Child and Family Health nurse educators' perceptions of COVID-19 impacts on student knowledge of theory and practice, and lessons learned through their responses.

Method

Semi-structured interviews were reflexively thematically analyzed.

Results

All participants recognized struggles, opportunities and innovations within three key themes: “We've learned how to be flexible”: Grappling with COVID-safe teaching and assessment; “Chat rooms and Zoomland”: Learning in a virtual community; and “We've had a few struggles”: Clinical placement tensions. Educators described a sense of uncertainty, increased flexibility, opportunities for change and new ways of connecting. They adapted by developing new online resources and broadening clinical practicum and assessment requirements to address new practice approaches including telehealth.

Conclusions

Rapidly changing practice requirements and concerns about risk of disease transfer between workplace and placement venues restricted placement opportunities. Educators learned and incorporated new skills and strategies into their teaching, while aiming to meet professional expectations and maintain quality of education. Some strategies are likely to be maintained for future education programs.

Modelo lógico do programa de telenfermagem de um centro de assistência de alta complexidade em oncologia

RESUMO Objetivo: Desenvolver o modelo lógico do programa Alô Enfermeiro com o intuito de elucidar a estrutura existente, atividades realizadas e resultados esperados, possibilitando a avaliação sistemática da implementação do programa. Método: Trata-se de uma pesquisa avaliativa de abordagem qualitativa. O desenvolvimento do modelo lógico foi embasado em metodologias sistemáticas, constituídas a partir da análise dos documentos institucionais, revisão da literatura, busca por elementos essenciais que fundamentaram a implementação do programa, e a participação dos stakeholders para discussão e validação dos dados obtidos. Resultados: Foi possível definir o macroproblema que deu origem ao programa, estabelecer a definição do Programa Alô Enfermeiro, público-alvo, objetivos geral e específicos, além de estruturar os componentes necessários, como insumos e atividades, indicando os resultados esperados em curto, médio e longo prazo. O modelo lógico permitiu a identificação da pergunta avaliativa do Programa Alô Enfermeiro, direcionada à avaliação de resultados. Conclusão O modelo lógico desenvolvido possibilitou a compreensão da estrutura do programa, da interação entre as atividades realizadas e os resultados esperados do “Alô Enfermeiro”.

Informing telehealth service delivery for cardiovascular disease management: exploring the perceptions of rural health professionals

Objective To explore the perceptions of rural health professionals who use telehealth services for cardiovascular health care, including the potential role of telehealth in enhancing services for this patient group. Methods Semi-structured interviews were conducted with ten rural health professionals across a range of disciplines, including medicine, nursing and allied health. All study participants were based in the same rural region in New South Wales, Australia. Results Participant responses emphasised the importance of including rural communities in ongoing dialogue to enhance telehealth services for cardiovascular care. Divergent expectations about the purpose of telehealth and unresolved technology issues were identified as factors to be addressed. Rural health professionals highlighted the importance of all stakeholders coming together to overcome barriers and enhance telehealth services in a collaborative manner. Conclusion This study contributes to an evolving understanding of how health professionals based in regional Australia experience telehealth services. Future telehealth research should proceed in collaboration with rural communities, supported by policy that actively facilitates the meaningful inclusion of rural stakeholders in telehealth dialogue. What is known about the topic? Telehealth is frequently discussed as a potential solution to overcome aspects of rural health, such as poor outcomes and limited access to services compared with metropolitan areas. In the context of telehealth and cardiovascular disease (CVD), research that focuses on rural communities is limited, particularly regarding the experiences of these communities with telehealth. What does this paper add? This paper offers insight into how telehealth is experienced by rural health professionals. The paper highlights divergent expectations of telehealth's purpose and unresolved technological issues as barriers to telehealth service delivery. It suggests telehealth services may be enhanced by collaborative approaches that engage multiple stakeholder groups. What are the implications for practitioners? The use and development of telehealth in rural communities requires a collaborative approach that considers the views of rural stakeholders in their specific contexts. To improve telehealth services for people living with CVD in rural communities, it is important that rural stakeholders have opportunities to engage with non-rural clinicians, telehealth developers and policy makers.

Scaling up perioperative medicine for older people undergoing surgery (POPS) services; use of a logic model approach

Perioperative medicine for older people undergoing surgery (POPS) services are gaining traction, in acknowledgment of the poorer outcomes experienced by older surgical patients. In response to the NHS' growing focus on scaling innovation, a logic model of the POPS service at Guy's and St Thomas' NHS Foundation Trust was developed to articulate a founding centre's experience. The logic model was applied as a means of service evaluation and to guide implementation of a new POPS service at a district general trust. This is a novel study within the field of perioperative medicine for older people, interlinking implementation science theory to achieve meaningful clinical results and describe the lessons learnt during the process. Future work will include validation of this logic model to facilitate national POPS scale-up.

The medium, the message and the measure: a theory-driven review on the value of telehealth as a patient-facing digital health innovation

By what measure should a policy maker choose between two mediums that deliver the same or similar message or service? Between, say, video consultation or a remote patient monitoring application (i.e. patient-facing digital health innovations) and in-person consultation? To answer this question, we sought to identify measures which are used in randomised controlled trials. But first we used two theories to frame the effects of patient-facing digital health innovations on - 1) transaction costs (i.e. the effort, time and costs required to complete a clinical interaction); and 2) process outcomes and clinical outcomes along the care cascade or information value chain, such that the 'value of information' (VoI) is different at each point in the care cascade or value chain. From the trials, we identified three categories of measures: outcome (process or clinical), satisfaction, and cost. We found that although patient-facing digital health innovations tend to confer much of their value by altering process outcomes, satisfaction, and transaction costs, these measures are inconsistently assessed. Efforts to determine the relative value of and choose between mediums of service delivery should adopt a metric (i.e. mathematical combination of measures) that capture all dimensions of value. We argue that 'value of information' (VoI) is such a metric - it is calculated as the difference between the 'expected utility' (EU) of alternative options. But for patient-facing digital health innovations, 'expected utility' (EU) should incorporate the probability of achieving not only a clinical outcome, but also process outcomes (depending on the innovation under consideration); and the measures of utility should include satisfaction and transaction costs; and also changes in population access to services, and health system capacity to deliver more services, which may result from reduction in transaction costs.