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Lambinon C, le Roux T, Eikelboom RH, Bennett RJ. Impact of adult cochlear implantation on the partner relationship: a conceptual framework informed by cochlear implant recipient and partner perceptions. Disabil Rehabil 2024:1-15. [PMID: 39225085 DOI: 10.1080/09638288.2024.2396061] [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: 09/04/2023] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE (1) To understand the impact of adult cochlear implantation on the partner relationship, as perceived by adult cochlear implant (CI) recipients and their intimate partners. (2) To generate a conceptual framework for guiding future research and clinical adult cochlear implantation interventions. METHOD Concept mapping, a participatory, mixed-method approach, was used for data collection, analysis and interpretation. Participants attended sessions to generate, sort and rate statements describing the changes in their relationship due to cochlear implantation. Participants included 15 CI recipients (mean age: 51.6 years; SD: 8.2) and 12 partners (mean age: 50.9 years; SD: 8.2). RESULTS Five concepts emerged from the data, describing changes in the partner relationship following cochlear implantation: (1) Social Interactions, (2) Partner Involvement, (3) Communication, (4) Emotional Adjustment, and (5) Relationship Intimacy. The concept Relationship Intimacy was rated the highest in positivity and importance. Findings also underscored improved social interactions, communication dynamics, and emotional adjustment. CONCLUSIONS The Relationship Intimacy cluster emerged as pivotal, highlighting its essential role in improving post-implantation relationships. CI recipients experienced enhanced autonomy, while partners' roles evolved regarding assistance and support. The diverse effects of implantation on partner relationships highlight the importance of adopting a patient- and family-centered approach to audiological intervention.
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Affiliation(s)
- Ché Lambinon
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Talita le Roux
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Robert H Eikelboom
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Ear Science Institute Australia, Subiaco, Australia
- School of Medicine, Curtin University, Perth, Australia
- Centre for Ear Sciences, The University of Western Australia, Crawley, Australia
| | - Rebecca J Bennett
- Ear Science Institute Australia, Subiaco, Australia
- School of Medicine, Curtin University, Perth, Australia
- Centre for Ear Sciences, The University of Western Australia, Crawley, Australia
- National Acoustic Laboratories, Macquarie University, Sydney, Australia
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Gentsch AT, Reed MK, Cunningham A, Chang AM, Kahn S, Kovalsky D, Doty AMB, Mills G, Hollander JE, Rising KL. "Once I take that one bite": the consideration of harm reduction as a strategy to support dietary change for patients with diabetes. BMC Endocr Disord 2024; 24:3. [PMID: 38166864 PMCID: PMC10759378 DOI: 10.1186/s12902-023-01529-6] [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: 08/24/2022] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Despite well-established guidelines to treat diabetes, many people with diabetes struggle to manage their disease. For many, this struggle is related to challenges achieving nutrition-related lifestyle changes. We examined how people with diabetes describe barriers to maintaining a healthy diet and considered the benefits of using a harm reduction approach to assist patients to achieve nutrition-related goals. METHODS This is a secondary analysis of 89 interviews conducted with adults who had type 1 or type 2 diabetes. Interviews were analyzed using a content analysis approach. Themes regarding food or diet were initially captured in a "food" node. Data in the food node were then sub-coded for this analysis, again using a content analysis approach. RESULTS Participants frequently used addiction language to talk about their relationship with food, at times referring to themselves as "an addict" and describing food as "their drug." Participants perceived their unhealthy food choices either as a sign of weakness or as "cheating." They also identified food's ability to comfort them and an unwillingness to change as particular challenges to sustaining a healthier diet. CONCLUSION Participants often described their relationship with food through an addiction lens. A harm reduction approach has been associated with positive outcomes among those with substance abuse disorder. Patient-centered communication incorporating the harm reduction model may improve the patient-clinician relationship and thus improve patient outcomes and quality-of-life while reducing health-related stigma in diabetes care. Future work should explore the effectiveness of this approach in patients with diabetes. TRIAL REGISTRATION Registered on ClinicalTrials.gov, NCT02792777. Registration information submitted 02/06/2016, with the registration first posted on the ClinicalTrials.gov website 08/06/2016. Data collection began on 29/04/2016.
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Affiliation(s)
- Alexzandra T Gentsch
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA.
| | - Megan K Reed
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Amy Cunningham
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, USA
| | - Anna Marie Chang
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
| | - Stephanie Kahn
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
| | - Danielle Kovalsky
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
- Present address: Department of Emergency Medicine, Tower Health Hospital, West Reading, USA
| | - Amanda M B Doty
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
| | - Geoffrey Mills
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, USA
| | - Judd E Hollander
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
| | - Kristin L Rising
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
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Decker-Palmer M, Klodowski D, Thompson T, Lanoue M, Messina A, Schroeder D, Barto S, Oglesby B, Frasso R. Freelisting: A Technique for Enhancing the Community Health Needs Assessment. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:201-208. [PMID: 36513364 DOI: 10.1177/2752535x221146232] [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: 12/15/2022]
Abstract
US health systems are required to conduct community health needs assessments (CHNAs). These assessments often rely solely on publicly reported disease prevalence data. The objective of this study was to identify a feasible qualitative method that can be implemented into CHNAs to confirm existing information and enhance them with new data and community narrative. Freelisting interviews were conducted in 2017 throughout a county in Pennsylvania. Individuals listed (1) things that improve health, (2) health problems, and (3) health barriers. Responses were grouped into like terms, Smith's salience index was calculated for each, subgroup variation was assessed. Community-reported health priorities were identified by salient terms juxtaposed with publicly reported disease prevalence data. 98 respondents throughout the county participated in freelisting interviews. Demographics resembled the population: median age 55, 46% female, 88% Caucasian, 9% uninsured. Salient terms that improve health included: "physical activity", "healthy eating", and "health services". Salient terms describing health problems included: "cardiovascular disease" and "spine and joint disease". Centers for Disease Control and Prevention (CDC)-reported chronic disease prevalence in the county included heart disease mortality (22% of deaths) and arthritis (26% of adults). Salient barriers to health included: "weight, physical activity, and dietary concerns", as well as "occupational concerns". This is in line with 2017 County Health Rankings related to obesity (reported 29%), however, while 10% were uninsured in the community, this was not a salient term. Freelisting can augment and inform CHNAs. In this single-county study, freelisting responses supported publicly available disease/mortality prevalence data and provided insight into community perceptions of health issues.
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Affiliation(s)
- Marquita Decker-Palmer
- 1889 Jefferson Center for Population Health, Johnstown, PA, USA
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
| | - David Klodowski
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Trina Thompson
- 1889 Jefferson Center for Population Health, Johnstown, PA, USA
| | - Marianna Lanoue
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
| | - Allison Messina
- Center for Health Promotion and Disease Prevention, Johnstown, PA, USA
| | - Diana Schroeder
- Center for Health Promotion and Disease Prevention, Johnstown, PA, USA
| | - Shiryl Barto
- Center for Health Promotion and Disease Prevention, Johnstown, PA, USA
| | - Billy Oglesby
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
| | - Rosemary Frasso
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
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Hudgens S, Howerter A, Keith S, Evans C, Pelletier C. Development and validation of a psoriasis treatment acceptability measure through group concept mapping. Health Qual Life Outcomes 2023; 21:83. [PMID: 37553594 PMCID: PMC10408213 DOI: 10.1186/s12955-023-02162-6] [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: 04/06/2023] [Accepted: 07/12/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Psoriasis is a common autoimmune dermatologic condition which has a pronounced negative impact on patient quality of life and disease burden. Currently, there are a number of treatments available for psoriasis, with differences in efficacy, mechanism of action, mode of administration, adverse effects, and tolerability. However, a reliable, validated patient-reported instrument to address patient expectations and of psoriasis treatment has not been developed. This project was undertaken with the aim of developing a fit-for-purpose self-reported instrument to inform patient expectations and preferences of psoriasis treatments. METHODS Two studies, both utilizing qualitative and quantitative methods, were conducted in patients within the entire spectrum of psoriasis severity. In Study 1, a group concept mapping (GCM) exercise was conducted with dermatologists and moderate-to-severe psoriasis patients to identify concepts important in the treatment of psoriasis. In Study 2, a preliminary Treatment Acceptability Questionnaire (TAQ) was developed using GCM-derived concepts from Studies 1 and 2, followed by cognitive debriefing (CD) telephone interviews of the preliminary TAQ. In Study 2, another GCM exercise was conducted with mild and newly diagnosed psoriasis patients. Psychometric analyses were performed on the TAQ to evaluate validity and reliability. RESULTS The Study 1 GCM exercise generated 43 concepts from moderate-to-severe psoriasis patients (n = 20) and dermatologists (n = 10). In Study 2, 37 GCM concepts were generated from mild and newly diagnosed psoriasis patients (n = 20). From the 2 GCM exercises, 28 concepts were selected to form the preliminary TAQ; CD interviews indicated strong understanding and relevance of TAQ items among patients with disease ranging from mild to severe. The final TAQ consisted of 20 items; psychometric analysis demonstrated strong validity and reliability of the TAQ. CONCLUSIONS The TAQ is a novel psychometrically validated patient-reported instrument to inform healthcare providers of patients' expectations of and preferences for treatment of their psoriasis and can help in shared decision making between patients and physicians.
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Affiliation(s)
- Stacie Hudgens
- Clinical Outcomes Solutions, 1820 E River Rd, Ste 220, Tucson, AZ, 85718, USA.
| | - Amy Howerter
- Clinical Outcomes Solutions, 1820 E River Rd, Ste 220, Tucson, AZ, 85718, USA
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Lin MP, Kligler SK, Friedman BW, Kim H, Rising K, Samuels-Kalow M, Eucker SA. Barriers and Best Practices for the Use of Patient-Reported Outcome Measures in Emergency Medicine. Ann Emerg Med 2023; 82:11-21. [PMID: 36682996 PMCID: PMC10293024 DOI: 10.1016/j.annemergmed.2022.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 01/21/2023]
Abstract
Patient-reported outcome measures are commonly used in clinical trials and have been incorporated into routine clinical care in select specialties but have not been widely implemented in emergency medicine research and clinical care. We describe measurement-related barriers to patient-reported outcome measure use in the emergency department; administrative and practical considerations; implications of developing novel emergency medicine-specific patient-reported outcome measures; and key considerations for the use of patient-reported outcome measures in emergency medicine research and clinical care. Despite the unique barriers of the ED environment, potential solutions include the use of ED-validated patient-reported outcome measures when available; adapting existing short-form, multidimensional patient-reported outcome measures previously validated in diverse populations, ideally using computer-adapted testing; and collecting responses during anticipated wait times. With this work, we aim to inform barriers and best practices to the use of patient-reported outcome measures in emergency medicine research and clinical care to support future, more widespread implementation of patient-reported outcome measures within emergency care. The successful adoption of patient-reported outcome measures for diverse ED patient populations within the unique constraints of the acute care environment may help researchers, clinicians, and policymakers improve the quality and patient-centeredness of acute care.
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Affiliation(s)
- Michelle P Lin
- Department of Emergency Medicine, Stanford University, Palo Alto, CA.
| | | | - Benjamin W Friedman
- Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore, Bronx, NY
| | - Howard Kim
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kristin Rising
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, PA; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA
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Simões Corrêa Galendi J, Siefen AC, Moretti DM, Yeo SY, Grüll H, Bratke G, Morganti AG, Bazzocchi A, Gasperini C, De Felice F, Blanco Sequeiros R, Huhtala M, Nijholt IM, Boomsma MF, Bos C, Verkooijen HM, Müller D, Stock S. Factors Influencing the Adoption of Magnetic Resonance-Guided High-Intensity Focused Ultrasound for Painful Bone Metastases in Europe, A Group Concept Mapping Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1084. [PMID: 36673840 PMCID: PMC9858703 DOI: 10.3390/ijerph20021084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
Magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) is an innovative treatment for patients with painful bone metastases. The adoption of MR-HIFU will be influenced by several factors beyond its effectiveness. To identify contextual factors affecting the adoption of MR-HIFU, we conducted a group concept mapping (GCM) study in four European countries. The GCM was conducted in two phases. First, the participants brainstormed statements guided by the focus prompt "One factor that may influence the uptake of MR-HIFU in clinical practice is...". Second, the participants sorted statements into categories and rated the statements according to their importance and changeability. To generate a concept map, multidimensional scaling and cluster analysis were conducted, and average ratings for each (cluster of) factors were calculated. Forty-five participants contributed to phase I and/or II (56% overall participation rate). The resulting concept map comprises 49 factors, organized in 12 clusters: "competitive treatments", "physicians' attitudes", "alignment of resources", "logistics and workflow", "technical disadvantages", "radiotherapy as first-line therapy", "aggregating knowledge and improving awareness", "clinical effectiveness", "patients' preferences", "reimbursement", "cost-effectiveness" and "hospital costs". The factors identified echo those from the literature, but their relevance and interrelationship are case-specific. Besides evidence on clinical effectiveness, contextual factors from 10 other clusters should be addressed to support adoption of MR-HIFU.
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Affiliation(s)
- Julia Simões Corrêa Galendi
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50935 Cologne, Germany
| | - Ann-Cathrine Siefen
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50935 Cologne, Germany
| | - Debora M. Moretti
- Institute for Food and Resource Economics, Chair for Technology, Innovation Management and Entrepreneurship, University of Bonn, 53115 Bonn, Germany
| | - Sin Yuin Yeo
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
| | - Holger Grüll
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, University of Cologne, 50939 Cologne, Germany
| | - Grischa Bratke
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero, Universitaria of Bologna, 40138 Bologna, Italy
- Radiation Oncology, DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Chiara Gasperini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
| | | | - Mira Huhtala
- Department of Oncology, Turku University Hospital, University of Turku, 20521 Turku, Finland
| | - Ingrid M. Nijholt
- Department of Radiology, Isala Hospital, 8025 AB Zwolle, The Netherlands
| | - Martijn F. Boomsma
- Department of Radiology, Isala Hospital, 8025 AB Zwolle, The Netherlands
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Clemens Bos
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Helena M. Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50935 Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50935 Cologne, Germany
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Carr SE, Wearn A, Canny BJ, Carmody D, Balmer D, Celenza A, Diug B, Leech M, Wilkinson TJ. When the wheels fall off - Medical students' experiences of interrupted academic progression. MEDICAL TEACHER 2022; 44:1015-1022. [PMID: 35343860 DOI: 10.1080/0142159x.2022.2055455] [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: 06/14/2023]
Abstract
INTRODUCTION There is limited published research on medical students' perspectives of a significant interruption to their academic progression. This study sought to identify the factors that contribute to difficulties with academic progression and to understand how medical students successfully respond. METHODS This interpretive phenomenological study reports on the findings from in-depth interviews of 38 final year medical students who had experienced a significant academic interruption. RESULTS The two superordinate themes were: the factors contributing to the interruption and their experience of the interruption. Factors identified as contributing to the interruption were: workload, learning in medicine, motivation for medicine, isolation, adapting to local culture, health and external factors. Their experience of the interruption focused on stages of working through the process: 'what happened,' 'how it felt,' 'managing the failure,' 'accepting the failure' and 'making some changes.' DISCUSSION Each factor affected how the participants reacted and responded to the interruption. Regardless of the origins of the interruption, most reacted and responded in a comparable process, albeit with varying timespans. These reactions and responses were in a state of fluctuation. In order to succeed many stated they shifted their motivation from external to internal, in direct response to the interruption, resulting in changed learning behaviours. CONCLUSIONS The process of working through an interruption to academic progression for students may benefit from a model of interval debriefing, restorative academic and personal development support. Facilitation of this process could enable students to face an interruption constructively rather than as an insurmountable emotionally burdensome barrier. Medical schools could utilise these findings to implement further support strategies to reduce the number of significant academic disruptions.
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Affiliation(s)
- Sandra E Carr
- Division of Health Professions Education, The University of Western Australia, Perth, Australia
| | - Andy Wearn
- Faculty of Medical and Health Sciences, Clinical Skills Centre, The University of Auckland, Auckland, New Zealand
| | - Ben J Canny
- The University of Tasmania, Melbourne, Australia
- Monash University, Clayton, Australia
| | - Dianne Carmody
- Division of Health Professions Education, The University of Western Australia, Perth, Australia
| | - Deborah Balmer
- Faculty of Medical and Health Sciences, Clinical Skills Centre, The University of Auckland, Auckland, New Zealand
| | - Antonio Celenza
- Division of Health Professions Education, The University of Western Australia, Perth, Australia
| | | | | | - Tim J Wilkinson
- Medical School, Christchurch School of Medicine & Health Sciences, The University of Otago, Dunedin, New Zealand
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Pantha S, Jones M, Gray R. Development of a Guideline to Enhance the Reporting of Concept Mapping Research: Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127273. [PMID: 35742523 PMCID: PMC9223457 DOI: 10.3390/ijerph19127273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 02/01/2023]
Abstract
Reporting guidelines are intended to enhance the clarity and transparency of research publications. Concept mapping, a mixed-methods design, has been widely used in health research. Current reporting guidelines for mixed-methods studies are not relevant for concept mapping research. The aim of this study is to develop a reporting guideline for concept mapping research following the EQUATOR network toolkit. Guideline development is in three stages: 1. A systematic review to identify key components of reporting concept mapping research, 2. A concept mapping study involving the key stakeholder groups—researchers, methodologists, peer reviewers, journal editors, statisticians, and people who have participated in concept mapping research—to identify candidate items to include in a reporting guideline, and 3. Development of a draft reporting guideline for concept mapping research. The outcome of the research will be a reporting guideline for concept mapping research.
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Affiliation(s)
- Sandesh Pantha
- School of Nursing and Midwifery, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia; (M.J.); (R.G.)
- Correspondence:
| | - Martin Jones
- School of Nursing and Midwifery, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia; (M.J.); (R.G.)
- Department of Rural Health, University of South Australia, Whyalla Campus, Whyalla Norrie, SA 5608, Australia
- IIMPACT in Health, University of South Australia, Adelaide, SA 5000, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia; (M.J.); (R.G.)
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Baker C, Knepil G, Courtney P. The role of Qualitative research in Oral and Maxillofacial Surgery. Br J Oral Maxillofac Surg 2022; 60:910-914. [DOI: 10.1016/j.bjoms.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
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Identifying Occupational Therapy Research Priorities in Trinidad and Tobago: A Group Concept Mapping Study. Occup Ther Int 2021; 2021:9970566. [PMID: 34729058 PMCID: PMC8526263 DOI: 10.1155/2021/9970566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022] Open
Abstract
In Trinidad and Tobago, occupational therapy is an emerging profession with limitations in the number of practitioners and the scope of practice. With the development of a new Master of Science Occupational Therapy programme in the country, the profession is continuously growing. There has been an increased demand for culturally relevant research to build the occupational therapy evidence base locally. However, the narrow range of occupational therapy literature in the country makes it difficult to highlight research gaps and decipher what research areas should be prioritised to best impact occupational therapy practice at present. This group concept mapping study is aimed at identifying priority areas for occupational therapy research in Trinidad and Tobago from the perspectives of occupational therapy students and practitioners. Participants brainstormed and contributed specific research ideas they would like to see developed in the country. Individually, participants sorted these ideas into themes and rated each idea based on perceived importance and feasibility. Using the GroupWisdom™ software, multidimensional scaling and hierarchical cluster analyses were applied to the sort data to create idea clusters within a concept map. Rating values were analysed to determine priority research themes within the concept map. The resulting concept map illustrated seven research priorities: Contextualising Practitioner Development, The Realities of Emerging OT Practice, Localising Mental Health OT, Occupation and Participation of Children and Youth, School-based OT in the Local Context, OT with Special Populations, and OT Contributions to the Public Health Sector. These findings represent the research needs of the occupational therapy profession in Trinidad and Tobago and will help to focus future researchers' efforts to expand the local evidence base.
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Rising KL, Gentsch AT, Mills G, LaNoue M, Doty AMB, Cunningham A, Carr BG, Hollander JE. Patient-important outcomes to inform shared decision making and goal setting for diabetes treatment. PATIENT EDUCATION AND COUNSELING 2021; 104:2592-2597. [PMID: 33736909 DOI: 10.1016/j.pec.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/26/2021] [Accepted: 03/06/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Despite well-established treatment guidelines, diabetes is difficult to manage for many individuals. The importance of using shared decision making to optimize diabetes treatment is recognized, yet what matters most to individuals with diabetes is not well established. Our goal was to identify patients' goals and priorities for diabetes management. METHODS We engaged 141 participants through interviews and group concept mapping to identify patient-important outcomes (PIOs) for diabetes care. We generated a master list of PIOs by aggregating interview data coded to "goals" and ideas brainstormed during concept mapping, and then a patient advisory board sorted the PIOs into higher-level domains. RESULTS We identified 41 PIOs sorted into 7 broad domains: optimize daily self-care, optimize long term health, learn about diabetes, achieve measurable goals, manage medications, manage diet and best utilize medical / professional services. CONCLUSIONS Most (4/7) of PIO domains focused on personal and life goals, not medically-oriented goals. Use of these PIOs and domains may facilitate more effective SDM discussions for patients with diabetes. PRACTICE IMPLICATIONS Use of PIOs from this work can enable the empowerment of patients to voice their priorities during SDM conversations, thus facilitating development of truly individualized diabetes treatment plans.
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Affiliation(s)
- Kristin L Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA.
| | - Alexzandra T Gentsch
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA.
| | - Geoffrey Mills
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA.
| | - Marianna LaNoue
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA.
| | - Amanda M B Doty
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA.
| | - Amy Cunningham
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA.
| | - Brendan G Carr
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA.
| | - Judd E Hollander
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA.
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Cunningham AT, Arefi P, Gentsch AT, Mills GD, LaNoue MD, Doty AM, Carr BG, Hollander JE, Rising KL. Patient Markers of Successful Diabetes Management. Diabetes Spectr 2021; 34:275-282. [PMID: 34511854 PMCID: PMC8387618 DOI: 10.2337/ds20-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE For individuals with diabetes, diabetes health status may not align with A1C targets. Patients may use nonclinical targets when assessing their diabetes management success. Identifying these targets is important in developing patient-centered management plans. The purpose of this study was to identify patient markers of successful diabetes management among patients in an urban academic health system. METHODS A secondary analysis of semistructured interviews was completed with 89 adults with type 1 or type 2 diabetes. Participants had a recent diabetes-related emergency department (ED) visits or hospitalization or were primary care patients with an A1C >7.5%. Interviews were conducted to saturation. Demographic data were collected via self-report and electronic medical records. Interviews were analyzed using conventional content analysis. This analysis focused on patient perceptions of successful management coded to "measuring management success." RESULTS Although most participants cited A1C or blood glucose as a marker of successful diabetes management, they had varied understanding of these metrics. Most used a combination of targets from the following categories: 1) A1C, blood glucose, and numbers; 2) engagement in medical care; 3) taking medication and medication types; 4) symptoms; 5) diet, exercise, and weight; and 6) stress management and social support. CONCLUSION Individuals not meeting glycemic goals and/or with recent diabetes-related ED visits or hospitalizations had varied understanding of A1C and blood glucose targets. They use multiple additional markers of successful management and had a desire for management discussions that incorporate these markers. These measures should be incorporated into their care plans along with clinical targets.
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Affiliation(s)
- Amy T. Cunningham
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Corresponding author: Amy T. Cunningham,
| | - Pouya Arefi
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Alexzandra T. Gentsch
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Geoffrey D. Mills
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Marianna D. LaNoue
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Amanda M.B. Doty
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Brendan G. Carr
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Judd E. Hollander
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Kristin L. Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Construction of a conceptual framework for assessment of health-related quality of life in calves with respiratory disease. Animal 2021; 15:100191. [PMID: 33640293 DOI: 10.1016/j.animal.2021.100191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Bovine respiratory disease (BRD) is one of the most prevalent diseases affecting beef and dairy calves worldwide, with implications for lifetime productivity, antimicrobial use and animal welfare. Our objective was to construct a conceptual framework for assessment of health-related quality of life (HRQL) in calves with respiratory disease, based on indicators suitable for direct pen-side visual observation. Health-related quality of life measures aim to evaluate the subjective experience of the animal rather than any related pathology. A conceptual framework graphically represents the concepts to be measured and the potential relationships between them. A multistage, mixed method approach involving diverse data sources, collection methods and stakeholders was applied to promote comprehensiveness, understanding and validity of findings. A scoping review was conducted to identify, characterize and collate evidence of behavioural indicators of BRD. The indicators identified were mapped against the principal attributes of five prominent animal welfare assessment frameworks to appraise their correspondence with different characterizations of the dimensions of welfare. Forty-two semi-structured, individual, qualitative interviews with a purposeful sample of experienced veterinarians and stockpersons from UK, USA and Canada elicited in-depth descriptions of the visual observations of HRQL they make in diagnosing and assessing the response to treatment of calves with BRD. Verbatim interview transcripts were examined using inductive thematic analysis. Respondents provided insights and understanding of indicators of HRQL in BRD such as interaction with feed source, hair coat condition, specific characteristics of eye appearance, eye contact, rumen fill and stretching (pandiculation). In an on-farm pilot study to assess the value of potential HRQL behavioural indicators, there was a moderate positive correlation between behaviour and clinical scores (rs = 0.59) across the 5 days preceding veterinary treatment for BRD. Interestingly, the behaviours evaluated were observed a median of 1.0 (interquartile range: 1.0-3.5) days before clinical indicators used in the scoring system. The proposed conceptual framework for assessment of HRQL features 23 putative indicators of HRQL distributed across two interrelated domains - clinical signs and behavioural expressions of emotional well-being. It has potential applications to inform the development of new HRQL measures such as structured questionnaires and automated sensor technologies.
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Singer BA, Keith S, Howerter A, Doll H, Pham T, Mehta R. A Study Comparing Patient and Clinician Perspectives of Treatments for Multiple Sclerosis via Group Concept Mapping. Patient Prefer Adherence 2021; 15:975-987. [PMID: 34012257 PMCID: PMC8126969 DOI: 10.2147/ppa.s297052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/09/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Clinicians treating multiple sclerosis (MS) should consider patient preferences when making treatment decisions. An online mixed-methods approach to elicit patient-centered concepts, group concept mapping (GCM), was used to generate statements reflecting the patient experience in relapsing-remitting MS and identify the most important patient-centered outcomes from patient and clinician perspectives. PATIENTS AND METHODS Twenty patients and 12 MS specialists in the United States provided statements describing what an ideal treatment would do to improve symptoms and daily functioning. Statements were sorted by participants into meaningful domains and rated on importance on an 11-point scale. RESULTS Sixty-four unique statements supporting 6 domains of clustered concepts were generated. Patient and clinician ratings of importance were highly correlated (r=0.82); however, patients rated the domains of Activities of Daily Living, Prevent & Cure, and Address Symptoms as highest in importance, whereas clinicians rated Prevent & Cure, Safe & Effective, and Activities of Daily Living as highest in importance. Statements rated above the domain mean by both patients and clinicians included "Improve cognitive function" and "Improve motor function" in the Activities of Daily Living domain and "Help with memory issues" and "Help preserve cognition" in the Address Symptoms domain. The statement "Improve short term memory" was 1 of 3 statements rated above the domain mean by patients but below the domain mean by clinicians. CONCLUSION High levels of agreement of concept importance were found between patients and MS specialists, although certain domains and statements were rated more highly by one group. Overall, concepts such as cognitive function, physical and emotional functioning, and activities of daily living were perceived as having great importance for treatment outcomes versus symptom-focused outcomes like gait or tingling sensations. This comprehensive concept model for the MS patient experience can be used for further development of patient-centered outcome measures in MS treatment.
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Affiliation(s)
- Barry A Singer
- The MS Center for Innovations in Care, Missouri, Baptist Medical Center, St. Louis, MO, USA
| | - Shannon Keith
- Clinical Outcomes Assessment,Clinical Outcomes Solutions, Chicago, IL, USA
- Correspondence: Shannon Keith Clinical Outcome Assessments, Clinical Outcomes Solutions, 53 W Jackson Blvd, Suite 1150, Chicago, IL, 60604, USATel +1 312 465 2443 Email
| | - Amy Howerter
- Quantitative Science,Clinical Outcomes Solutions, Tucson, AZ, USA
| | - Helen Doll
- Quantitative Science,Clinical Outcomes Solutions, Tucson, AZ, USA
| | - Timothy Pham
- US HEOR, Bristol Myers Squibb, Princeton, NJ, USA
| | - Rina Mehta
- US HEOR, Bristol Myers Squibb, Princeton, NJ, USA
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15
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Wilson R, Small J. Care Staff Perspectives on Using Mobile Technology to Support Communication in Long-Term Care: Mixed Methods Study. JMIR Nurs 2020; 3:e21881. [PMID: 34406973 PMCID: PMC8373373 DOI: 10.2196/21881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Long-term care (LTC) homes provide 24-hour care for people living with complex care needs. LTC staff assist older adults living with chronic conditions such as Alzheimer disease, related dementias, and stroke, which can cause communication disorders. In addition to the complex cognitive challenges that can impact communication, further difficulties can arise from cultural-language differences between care staff and residents. Breakdowns in caregiver-resident communication can negatively impact the delivery of person-centered care. Recent advances in mobile technology, specifically mobile devices (tablets and smartphones) and their software apps, offer innovative solutions for supporting everyday communication between care staff and residents. To date, little is known about the care staff's perspectives on the different ways that mobile technology could be used to support communication with residents. OBJECTIVE This study aims to identify care staff's perspectives on the different ways of using devices and apps to support everyday communication with adults living in LTC homes and the priority care areas for using mobile technology to support communication with residents. METHODS This descriptive study employed concept mapping methods to explore care staff's perspectives about ways of using mobile technology with residents and to identify the usefulness, practicality, and probable uses of mobile technology to support communication in priority care areas. Concept mapping is an integrated mixed methods approach (qualitative and quantitative) that uses a structured process to identify priority areas for planning and evaluation. In total, 13 care staff from a single LTC home participated in this study. Concept mapping includes 2 main data collection phases: (1) statement generations through brainstorming and (2) statement structuring through sorting and rating. Brainstorming took place in person in a group session, whereas sorting and rating occurred individually after the brainstorming session. Concept mapping data were analyzed using multidimensional scaling and cluster analysis to generate numerous interpretable data maps and displays. RESULTS Participants generated 67 unique statements during the brainstorming session. Following the sorting and rating of the statements, a concept map analysis was performed. In total, 5 clusters were identified: (1) connect, (2) care management, (3) facilitate, (4) caregiving, and (5) overcoming barriers. Although all 5 clusters were rated as useful, with a mean score of 4.1 to 4.5 (Likert: 1-5), the care staff rated cluster 2 (care management) as highest on usefulness, practicality, and probable use of mobile technology to support communication in LTC. CONCLUSIONS This study provided insight into the viewpoints of care staff regarding the different ways mobile technology could be used to support caregiver-resident communication in LTC. Our findings suggest that care management, facilitating communication, and overcoming barriers are 3 priority target areas for implementing mobile health interventions to promote person-centered care and resident-centered care.
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Affiliation(s)
- Rozanne Wilson
- School of Audiology and Speech Sciences, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Jeff Small
- School of Audiology and Speech Sciences, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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Donohoe J, O'Rourke M, Hammond S, Stoyanov S, O'Tuathaigh C. Strategies for Enhancing Resilience in Medical Students: a Group Concept Mapping Analysis. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:427-431. [PMID: 32124407 DOI: 10.1007/s40596-020-01208-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/12/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Research has consistently shown that medical students have greater rates of stress and mental-ill health in comparison with non-medical students. The objective of this study was to investigate the resilience strategies employed by medical students in an Irish medical school to inoculate themselves against the deleterious effects of stress on health and wellbeing. METHODS Group concept mapping was utilized incorporating qualitative and quantitative methodologies. The stages undertaken by year 3 students at an Irish medical school involved brainstorming/idea generation, categorization, and rating of resilience strategies students employed to manage stress during medical school. The data was analyzed utilizing The Concept System® software through multidimensional scaling and hierarchical clustering. RESULTS Categories of resilience strategies employed included "friends and family," "de-stress through exercise/sport," "extra-curricular non-medical activities," "self-enabled distraction," "organization," and "enhancing emotional and mental wellbeing." Students rated spending time with "friends and family" to be most effective when seeking to relieve stress, whereas students rated "de-stressing through exercise/sport" as being of greatest importance in relation to inclusion in a resilience-based intervention. Students recognized the value of incorporating strategies to enhance emotional and mental wellbeing into a resilience-promoting program. "Self-enabled distraction" rated poorly on both scales. CONCLUSIONS Strategies rated by students to be important to incorporate in a stress reduction management program are accessible, are feasible, and can be implemented into the medical curriculum.
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Affiliation(s)
| | | | | | - Slavi Stoyanov
- Open University of the Netherlands, Heerlen, The Netherlands
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17
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Cunningham AT, Gentsch AT, Doty AMB, Mills G, LaNoue M, Carr BG, Hollander JE, Rising KL. "I had no other choice but to catch it too": the roles of family history and experiences with diabetes in illness representations. BMC Endocr Disord 2020; 20:95. [PMID: 32590965 PMCID: PMC7318544 DOI: 10.1186/s12902-020-00580-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/19/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A family history of diabetes and family members' experiences with diabetes may influence individuals' beliefs and expectations about their own diabetes. No qualitative studies have explored the relationship between family history and experiences and individuals' diabetes illness representations. METHODS Secondary data analysis of 89 exploratory, semi-structured interviews with adults with type 1 or type 2 diabetes seeking care in an urban health system. Participants had a recent diabetes-related ED visit/hospitalization or hemoglobin A1c > 7.5%. Interviews were conducted until thematic saturation was achieved. Demographic data were collected via self-report and electronic medical record review. Interviews were audio-recorded, transcribed, and coded using a conventional content analysis approach. References to family history and family members' experiences with diabetes were analyzed using selected domains of Leventhal's Common Sense Model of Self-Regulation. RESULTS Participants cited both genetic and behavioral family history as a major cause of their diabetes. Stories of relatives' diabetes complications and death figured prominently in their discussion of consequences; however, participants felt controllability over diabetes through diet, physical activity, and other self-care behaviors. CONCLUSIONS Findings supported an important role of family diabetes history and experience in development of diabetes illness representations. Further research is needed to expand our understanding of the relationships between these perceptions, self-management behaviors, and outcomes. Family practice providers, diabetes educators and other team members should consider expanding assessment of current family structure and support to also include an exploration of family history with diabetes, including which family members had diabetes, their self-care behaviors, and their outcomes, and how this history fits into the patient's illness representations.
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Affiliation(s)
- Amy T Cunningham
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Suite 401, Philadelphia, PA, 401, USA.
| | - Alexzandra T Gentsch
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite, Philadelphia, PA, 300, USA
| | - Amanda M B Doty
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite, Philadelphia, PA, 300, USA
| | - Geoffrey Mills
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Suite, Philadelphia, PA, 401, USA
| | - Marianna LaNoue
- College of Population Health, Thomas Jefferson University, 901 Walnut Street, 10th floor, Philadelphia, PA, USA
| | - Brendan G Carr
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite, Philadelphia, PA, 300, USA
| | - Judd E Hollander
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite, Philadelphia, PA, 300, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite, Philadelphia, PA, 300, USA
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Kiran T, Wells D, Okrainec K, Kennedy C, Devotta K, Mabaya G, Phillips L, Lang A, O'Campo P. Patient and caregiver priorities in the transition from hospital to home: results from province-wide group concept mapping. BMJ Qual Saf 2020; 29:390-400. [PMID: 31907325 DOI: 10.1136/bmjqs-2019-009993] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients and caregivers often face significant challenges when they are discharged home from hospital. We sought to understand what influenced patient and caregiver experience in the transition from hospital to home and which of these aspects they prioritised for health system improvement. METHODS We conducted group concept mapping over 11 months with patients-and their caregivers-who were admitted to a hospital overnight in the last 3 years in Ontario, Canada and discharged home. Home included supportive housing, shelters and long-term care. Participants responded to a single focal prompt about what affected their experience during the transition. We summarised responses in unique statements. We then recruited participants to rate each statement on a five-point scale on whether addressing this gap should be a priority for the health system. The provincial quality agency recruited participants in partnership with patient, community and healthcare organisations. Participation was online, in-person or virtual. RESULTS 736 participants provided 2704 responses to the focal prompt. Unique concepts were summarised in 52 statements that were then rated by 271 participants. Participants rated the following three statements most highly as a gap that should be a priority for the health system to address (in rank order): 'Not enough publicly funded home care services to meet the need', 'Home care support is not in place when arriving home from hospital' and 'Having to advocate to get enough home care'. The top priority was consistent across multiple subgroups. CONCLUSIONS In a country with universal health insurance, patients and caregivers from diverse backgrounds consistently prioritised insufficient public coverage for home care services as a gap the health system should address to improve the transition from hospital to home.
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Affiliation(s)
- Tara Kiran
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada .,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Ontario Health, Quality Business Unit (formerly Health Quality Ontario), Toronto, Ontario, Canada
| | - David Wells
- Ontario Health, Quality Business Unit (formerly Health Quality Ontario), Toronto, Ontario, Canada
| | - Karen Okrainec
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carol Kennedy
- Ontario Health, Quality Business Unit (formerly Health Quality Ontario), Toronto, Ontario, Canada
| | - Kimberly Devotta
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gracia Mabaya
- Ontario Health, Quality Business Unit (formerly Health Quality Ontario), Toronto, Ontario, Canada
| | - Lacey Phillips
- Ontario Health, Quality Business Unit (formerly Health Quality Ontario), Toronto, Ontario, Canada
| | - Amy Lang
- Ontario Health, Quality Business Unit (formerly Health Quality Ontario), Toronto, Ontario, Canada
| | - Patricia O'Campo
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Kiran T, Wells D, Okrainec K, Kennedy C, Devotta K, Mabaya G, Phillips L, Lang A, O'Campo P. Patient and caregiver experience in the transition from hospital to home - brainstorming results from group concept mapping: a patient-oriented study. CMAJ Open 2020; 8:E121-E133. [PMID: 32127383 PMCID: PMC7055492 DOI: 10.9778/cmajo.20190009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Improving the quality of care for patients who return home after a hospital stay is an international priority; however, few jurisdictions have engaged broadly with patients and caregivers to understand what most affects their experience transitioning home. We performed Ontario-wide group concept mapping, beginning with a brainstorming phase, to understand patient and caregiver priorities in the transition. METHODS We used group concept mapping to engage patients and caregivers who had lived experience transitioning from hospital to home in Ontario in the previous 3 years. We report on the first phase, brainstorming, conducted over 10 weeks beginning Jan. 11, 2018 via an online survey or facilitated group discussion. Participants responded to a single focal prompt: "When leaving the hospital for home, some thing(s) that affected the experience were: ____." The study team identified recurrent concepts and overarching themes. Patients and caregivers informed the study design, recruitment and data interpretation. RESULTS In all, 665 people (263 patients [39.5%], 352 caregivers [52.9%] and 50 people who were both patient and caregiver [7.5%]) participated in brainstorming online, and 71 people participated in 1 of 8 group discussions. Participants identified 6 key areas affecting their experience of transition from hospital to home: home and community care, the discharge process, medical follow-up after discharge, medications, patient and caregiver education, and the kindness and caring of the health care team in hospital. Most notable were challenges with the timeliness, sufficiency, reliability and consistency of publicly funded home care services. INTERPRETATION Patients and caregivers from across Ontario noted a range of issues affecting their experience transitioning from hospital to home, particularly the quality and sufficiency of publicly funded home care. Our findings will be used to inform a provincial quality standard on the transition from hospital to home.
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Affiliation(s)
- Tara Kiran
- Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), Institute of Health Policy, Management and Evaluation (Kiran) and Dalla Lana School of Public Health (Devotta, O'Campo), University of Toronto; Centre for Urban Health Solutions (Kiran, Devotta, O'Campo), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Ontario Health (Quality Business Unit) (Kiran, Wells, Kennedy, Mabaya, Phillips, Lang); Department of Medicine (Okrainec), University Health Network and University of Toronto, Toronto, Ont.
| | - David Wells
- Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), Institute of Health Policy, Management and Evaluation (Kiran) and Dalla Lana School of Public Health (Devotta, O'Campo), University of Toronto; Centre for Urban Health Solutions (Kiran, Devotta, O'Campo), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Ontario Health (Quality Business Unit) (Kiran, Wells, Kennedy, Mabaya, Phillips, Lang); Department of Medicine (Okrainec), University Health Network and University of Toronto, Toronto, Ont
| | - Karen Okrainec
- Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), Institute of Health Policy, Management and Evaluation (Kiran) and Dalla Lana School of Public Health (Devotta, O'Campo), University of Toronto; Centre for Urban Health Solutions (Kiran, Devotta, O'Campo), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Ontario Health (Quality Business Unit) (Kiran, Wells, Kennedy, Mabaya, Phillips, Lang); Department of Medicine (Okrainec), University Health Network and University of Toronto, Toronto, Ont
| | - Carol Kennedy
- Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), Institute of Health Policy, Management and Evaluation (Kiran) and Dalla Lana School of Public Health (Devotta, O'Campo), University of Toronto; Centre for Urban Health Solutions (Kiran, Devotta, O'Campo), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Ontario Health (Quality Business Unit) (Kiran, Wells, Kennedy, Mabaya, Phillips, Lang); Department of Medicine (Okrainec), University Health Network and University of Toronto, Toronto, Ont
| | - Kimberly Devotta
- Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), Institute of Health Policy, Management and Evaluation (Kiran) and Dalla Lana School of Public Health (Devotta, O'Campo), University of Toronto; Centre for Urban Health Solutions (Kiran, Devotta, O'Campo), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Ontario Health (Quality Business Unit) (Kiran, Wells, Kennedy, Mabaya, Phillips, Lang); Department of Medicine (Okrainec), University Health Network and University of Toronto, Toronto, Ont
| | - Gracia Mabaya
- Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), Institute of Health Policy, Management and Evaluation (Kiran) and Dalla Lana School of Public Health (Devotta, O'Campo), University of Toronto; Centre for Urban Health Solutions (Kiran, Devotta, O'Campo), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Ontario Health (Quality Business Unit) (Kiran, Wells, Kennedy, Mabaya, Phillips, Lang); Department of Medicine (Okrainec), University Health Network and University of Toronto, Toronto, Ont
| | - Lacey Phillips
- Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), Institute of Health Policy, Management and Evaluation (Kiran) and Dalla Lana School of Public Health (Devotta, O'Campo), University of Toronto; Centre for Urban Health Solutions (Kiran, Devotta, O'Campo), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Ontario Health (Quality Business Unit) (Kiran, Wells, Kennedy, Mabaya, Phillips, Lang); Department of Medicine (Okrainec), University Health Network and University of Toronto, Toronto, Ont
| | - Amy Lang
- Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), Institute of Health Policy, Management and Evaluation (Kiran) and Dalla Lana School of Public Health (Devotta, O'Campo), University of Toronto; Centre for Urban Health Solutions (Kiran, Devotta, O'Campo), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Ontario Health (Quality Business Unit) (Kiran, Wells, Kennedy, Mabaya, Phillips, Lang); Department of Medicine (Okrainec), University Health Network and University of Toronto, Toronto, Ont
| | - Pat O'Campo
- Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), Institute of Health Policy, Management and Evaluation (Kiran) and Dalla Lana School of Public Health (Devotta, O'Campo), University of Toronto; Centre for Urban Health Solutions (Kiran, Devotta, O'Campo), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Ontario Health (Quality Business Unit) (Kiran, Wells, Kennedy, Mabaya, Phillips, Lang); Department of Medicine (Okrainec), University Health Network and University of Toronto, Toronto, Ont
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Mills GD, LaNoue M, Gentsch AT, Doty AMB, Cunningham A, Nord G, Rising KL. Patient experience and challenges in group concept mapping for clinical research. J Patient Rep Outcomes 2019; 3:54. [PMID: 31418089 PMCID: PMC6695458 DOI: 10.1186/s41687-019-0147-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background and objective Group concept mapping (GCM) is a research method that engages stakeholders in generating, structuring and representing ideas around a specific topic or question. GCM has been used with patients to answer questions related to health and disease but little is known about the patient experience as a participant in the process. This paper explores the patient experience participating in GCM as assessed with direct observation and surveys of participants. Methods This is a secondary analysis performed within a larger study in which 3 GCM iterations were performed to engage patients in identifying patient-important outcomes for diabetes care. Researchers tracked the frequency and type of assistance required by each participant to complete the sorting and rating steps of GCM. In addition, a 17-question patient experience survey was administered over the telephone to the participants after they had completed the GCM process. Survey questions asked about the personal impact of participating in GCM and the ease of various steps of the GCM process. Results Researchers helped patients 92 times during the 3 GCM iterations, most commonly to address software and computer literacy issues, but also with the sorting phase itself. Of the 52 GCM participants, 40 completed the post-GCM survey. Respondents averaged 56 years of age, were 50% female and had an average hemoglobin A1c of 9.1%. Ninety-two percent (n = 37) of respondents felt that they had contributed something important to this research project and 90% (n = 36) agreed or strongly agreed that their efforts would help others with diabetes. Respondents reported that the brainstorming session was less difficult when compared with sorting and rating of statements. Discussion Our results suggest that patients find value in participating in GCM. Patients reported less comfort with the sorting step of GCM when compared with brainstorming, an observation that correlates with our observations from the GCM sessions. Researchers should consider using paper sorting methods and objective measures of sorting quality when using GCM in patient-engaged research to improve the patient experience and concept map quality.
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Affiliation(s)
- Geoffrey D Mills
- Department of Family and Community Medicine, Thomas Jefferson University, 833 Chestnut Street, Suite 301, Philadelphia, PA, 19107, USA.
| | - Marianna LaNoue
- Department of Family and Community Medicine, Thomas Jefferson University, 833 Chestnut Street, Suite 301, Philadelphia, PA, 19107, USA.,College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexzandra T Gentsch
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Amanda M B Doty
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Amy Cunningham
- Department of Family and Community Medicine, Thomas Jefferson University, 833 Chestnut Street, Suite 301, Philadelphia, PA, 19107, USA
| | - Garrison Nord
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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LaNoue M, Gentsch A, Cunningham A, Mills G, Doty AMB, Hollander JE, Carr BG, Loebell L, Weingarten G, Rising KL. Eliciting patient-important outcomes through group brainstorming: when is saturation reached? J Patient Rep Outcomes 2019; 3:9. [PMID: 30714080 PMCID: PMC6360192 DOI: 10.1186/s41687-019-0097-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Group brainstorming is a technique for the elicitation of patient input that has many potential uses, however no data demonstrate concept saturation. In this study we explore concept saturation in group brainstorming performed in a single session as compared to two or three sessions. METHODS Fifty-two predominately African American adults patients with moderately to poorly controlled Diabetes Mellitus participated in three separate group brainstorming sessions as part of a PCORI-funded group concept mapping study examining comparing methods for the elicitation of patient important outcomes (PIOs). Brainstorming was unstructured, in response to a prompt designed to elicit PIOs in diabetes care. We combined similar brainstormed responses from all three sessions into a 'master list' of unique PIOs, and then compared the proportion obtained at each individual session, as well as those obtained in combinations of 2 sessions, to the master list. RESULTS Twenty-four participants generated 85 responses in session A, 14 participants generated 63 in session B, and 14 participants generated 47 in session C. Compared to the master list, the individual sessions contributed 87%, 76%, and 63% of PIOs. Session B added 3 unique PIOs not present in session A, and session C added 2 PIOs not present in either A or B. No single session achieved >90% saturation of the master list, but all 3 combinations of 2 sessions achieved > 90%. CONCLUSIONS Single sessions elicited only 63-87% of the patient-important outcomes obtained across all three sessions, however all combinations of two sessions elicited over 90% of the master list, suggesting that 2 sessions are sufficient for concept saturation. TRIAL REGISTRATION NCT02792777 . Registered 2 June 2016.
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Affiliation(s)
- Marianna LaNoue
- College of Population Health and Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St., suite 401, Philadelphia, PA 19107 USA
| | - Alexzandra Gentsch
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, USA
| | - Amy Cunningham
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, USA
| | - Geoffrey Mills
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, USA
| | - Amanda M. B. Doty
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, USA
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, USA
| | - Brendan G. Carr
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, USA
| | - Larry Loebell
- Voicing Outcomes Important for Care (VOICe) Study, Patient and Key Stakeholder Advisory Board (PAKSAB) member, Philadelphia, PA USA
| | - Gail Weingarten
- Voicing Outcomes Important for Care (VOICe) Study, Patient and Key Stakeholder Advisory Board (PAKSAB) member, Philadelphia, PA USA
| | - Kristin L. Rising
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, USA
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