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Sarigiovannis P, Loría-Rebolledo LE, Foster NE, Jowett S, Saunders B. Musculoskeletal patients' preferences for care from physiotherapists or support workers: a discrete choice experiment. BMC Health Serv Res 2024; 24:1095. [PMID: 39300537 DOI: 10.1186/s12913-024-11585-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 09/12/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Delegation of clinical tasks from physiotherapists to physiotherapy support workers is common yet varies considerably in musculoskeletal outpatient physiotherapy services, leading to variation in patient care. This study aimed to explore patients' preferences and estimate specific trade-offs patients are willing to make in treatment choices when treated in musculoskeletal outpatient physiotherapy services. METHODS A discrete choice experiment was conducted using an efficient design with 16 choice scenarios, divided into two blocks. Adult patients with musculoskeletal conditions recruited from a physiotherapy service completed a cross-sectional, online questionnaire. Choice data analyses were conducted using a multinomial logit model. The marginal rate of substitution for waiting time to first follow-up physiotherapy appointment and distance from the physiotherapy clinic was calculated and a probability model was built to estimate the probability of choosing between two distinct physiotherapy service options under different scenarios. RESULTS 382 patient questionnaires were completed; 302 participants were treated by physiotherapists and 80 by physiotherapists and support workers. There was a significant preference to be seen by a physiotherapist, have more follow-up treatments, to wait less time for the first follow-up appointment, to be seen one-to-one, to see the same clinician, to travel a shorter distance to get to the clinic and to go to clinics with ample parking. Participants treated by support workers did not have a significant preference to be seen by a physiotherapist and it was more likely that they would choose to be seen by a support worker for clinic scenarios where the characteristics of the physiotherapy service were as good or better. CONCLUSIONS Findings highlight that patients treated by support workers are likely to choose to be treated by support workers again if the other service characteristics are as good or better compared to a service where treatment is provided only by physiotherapists. Findings have implications for the design of physiotherapy services to enhance patient experience when patients are treated by support workers. The findings will contribute to the development of "best practice" recommendations to guide physiotherapists in delegating clinical work to physiotherapy support workers for patients with musculoskeletal conditions.
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Affiliation(s)
- Panos Sarigiovannis
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK.
- Midlands Partnership University NHS Foundation Trust, Newcastle under Lyme, Staffordshire, ST5 2BQ, UK.
| | | | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, , Herston, Brisbane, Australia
| | - Sue Jowett
- Health Economics Unit, Institute of Applied Health Research, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Benjamin Saunders
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
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Kalocsai C, Agrawal S, de Bie L, Beder M, Bellissimo G, Berkhout S, Johnson A, McNaughton N, Rodak T, McCullough K, Soklaridis S. Power to the people? A co-produced critical review of service user involvement in mental health professions education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:273-300. [PMID: 37247126 DOI: 10.1007/s10459-023-10240-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 05/07/2023] [Indexed: 05/30/2023]
Abstract
Meaningful service user involvement in health professions education requires integrating knowledge held by "lay" people affected by health challenges into professional theories and practices. Involving service users redefines whose knowledge "counts" and implies a shift in power. Such a shift is especially significant in the mental health field, where power imbalances between health professionals and service users are magnified. However, reviews of the literature on service user involvement in mental health professional education do little to explore how power manifests in this work. Meanwhile critical and Mad studies scholars have highlighted that without real shifts in power, inclusion practices can lead to harmful consequences. We conducted a critical review to explore how power is addressed in the literature that describes service user involvement in mental health professions education. Our team used a co-produced approach and critical theories to identify how power implicitly and explicitly operates in this work to unearth the inequities and power structures that service user involvement may inadvertently perpetuate. We demonstrate that power permeates service user involvement in mental health professional education but is rarely made visible. We also argue that by missing the opportunity to locate power, the literature contributes to a series of epistemic injustices that reveal the contours of legitimate knowledge in mental health professions education and its neoliberal underpinnings. Ultimately, we call for a critical turn that foregrounds power relations to unlock the social justice-oriented transformative potential of service user involvement in mental health professions education and health professions education more broadly.
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Affiliation(s)
- Csilla Kalocsai
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Sacha Agrawal
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lee de Bie
- Centre for Clinical Ethics, Unity Health Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michaela Beder
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto, Toronto, ON, Canada
| | - Gail Bellissimo
- Independent service user educator researcher, Toronto, ON, Canada
| | - Suze Berkhout
- University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Johnson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nancy McNaughton
- Wilson Centre for Research in Education at University Health Network and University of Toronto, Toronto, ON, Canada
- Michener Institute of Education at University Health Network, Toronto, ON, Canada
| | - Terri Rodak
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kim McCullough
- Department of Social Work, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Vanstone M, Canfield C, Evans C, Leslie M, Levasseur MA, MacNeil M, Pahwa M, Panday J, Rowland P, Taneja S, Tripp L, You J, Abelson J. Towards conceptualizing patients as partners in health systems: a systematic review and descriptive synthesis. Health Res Policy Syst 2023; 21:12. [PMID: 36698200 PMCID: PMC9876419 DOI: 10.1186/s12961-022-00954-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND With the sharp increase in the involvement of patients (including family and informal caregivers) as active participants, collaborators, advisors and decision-makers in health systems, a new role has emerged: the patient partner. The role of patient partner differs from other forms of patient engagement in its longitudinal and bidirectional nature. This systematic review describes extant work on how patient partners are conceptualized and engaged in health systems. In doing so, it furthers the understanding of the role and activities of patient partners, and best practices for future patient partnership activities. METHODS A systematic review was conducted of peer-reviewed literature published in English or French that describes patient partner roles between 2000 and 2021 in any country or sector of the health system. We used a broad search strategy to capture descriptions of longitudinal patient engagement that may not have used words such as "partner" or "advisor". RESULTS A total of 506 eligible papers were identified, representing patient partnership activities in mostly high-income countries. These studies overwhelmingly described patient partnership in health research. We identified clusters of literature about patient partnership in cancer and mental health. The literature is saturated with single-site descriptive studies of patient partnership on individual projects or initiatives. There is a lack of work synthesizing impacts, facilitating factors and outcomes of patient partnership in healthcare. CONCLUSIONS There is not yet a consolidated understanding of the role, activities or impacts of patient partners. Advancement of the literature has been stymied by a lack of consistently used terminology. The literature is ready to move beyond single-site descriptions, and synthesis of existing pockets of high-quality theoretical work will be essential to this evolution.
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Affiliation(s)
- Meredith Vanstone
- grid.25073.330000 0004 1936 8227Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada ,grid.25073.330000 0004 1936 8227Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Carolyn Canfield
- Patient Advisors Network (PAN), Toronto, ON Canada ,grid.17091.3e0000 0001 2288 9830Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Cara Evans
- grid.25073.330000 0004 1936 8227Health Policy PhD Program, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Myles Leslie
- grid.22072.350000 0004 1936 7697School of Public Policy, University of Calgary, 906 8Th Avenue S.W., Calgary, AB T2P1H9 Canada
| | | | - Maggie MacNeil
- grid.25073.330000 0004 1936 8227Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Manisha Pahwa
- grid.25073.330000 0004 1936 8227Health Policy PhD Program, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada ,grid.419887.b0000 0001 0747 0732Occupational Cancer Research Centre, Cancer Care Ontario, Ontario Health, 505 University Avenue, Toronto, ON Canada
| | - Janelle Panday
- grid.25073.330000 0004 1936 8227Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Paula Rowland
- grid.17063.330000 0001 2157 2938Wilson Centre and Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Canada 1 King’s College Circle, Toronto, ON M5S 1A8 Canada
| | - Shipra Taneja
- grid.25073.330000 0004 1936 8227Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Laura Tripp
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Jeonghwa You
- grid.25073.330000 0004 1936 8227Health Policy PhD Program, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Julia Abelson
- grid.25073.330000 0004 1936 8227Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada ,grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
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Kim EJ, Nam IC, Koo YR. Reframing Patient Experience Approaches and Methods to Achieve Patient-Centeredness in Healthcare: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9163. [PMID: 35954517 PMCID: PMC9367952 DOI: 10.3390/ijerph19159163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023]
Abstract
(1) There has been growing attention among healthcare researchers on new and innovative methodologies for improving patient experience. This study reviewed the approaches and methods used in current patient experience research by applying the perspective of design thinking to discuss practical methodologies for a patient-centered approach and creative problem-solving. (2) A scoping review was performed to identify research trends in healthcare. A four-stage design thinking process ("Discover", "Define", "Develop", and "Deliver") and five themes ("User focus", "Problem-framing", "Visualization", "Experimentation", and "Diversity"), characterizing the concept, were used for the analysis framework. (3) After reviewing 67 studies, the current studies show that the iterative process of divergent and convergent thinking is lacking, which is a core concept of design thinking, and it is necessary to employ an integrative methodology to actively apply collaborative, multidisciplinary, and creative attributes for a specific and tangible solution. (4) For creative problem-solving to improve patient experience, we should explore the possibilities of various solutions by an iterative process of divergent and convergent thinking. A concrete and visualized solution should be sought through active user interactions from various fields. For this, a specific methodology that allows users to collaborate by applying the integrative viewpoint of design thinking should be introduced.
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Affiliation(s)
- Eun-Jeong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic Medical Center, The Catholic University of Korea, Seoul 06591, Korea;
| | - Inn-Chul Nam
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 21431, Korea
| | - Yoo-Ri Koo
- Department of Service Design, Graduate School of Industrial Arts, Hongik University, Seoul 04066, Korea
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Abu-Rumman A, Al Shraah A, Al-Madi F, Alfalah T. The impact of quality framework application on patients’ satisfaction. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2022. [DOI: 10.1108/ijhrh-01-2021-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to explore if the application of the customer results criteria contained within the King Abdullah II Award for Excellence (KAIIAE) is correlated with high levels of patient satisfaction within a large hospital based in Jordan.
Design/methodology/approach
Using a mixed methodology, supported by a pragmatist theoretical approach, a satisfaction survey was conducted with patients accessing the hospital as an in-patient across a range of specialities gathering feedback about different aspects of their care. The results were compared with a self-assessment completed by different speciality teams about the existence and maturity of customer result arrangements implemented as a result of the (KAIIAE).
Findings
The findings confirmed that quality awards such as the KAIIAE can effectively be applied in a health-care setting and can help provide a framework for improving patient experience and satisfaction. A correlation was found with those specialties that self-assessed themselves more highly in terms of these arrangements and the overall levels of patient satisfaction with that specialty, suggesting that the products of working towards the KAIIAE such as establishing effective patient experience monitoring arrangements and improved learning from complaints, has a positive impact on patient satisfaction.
Originality/value
There are limited studies which focus specifically on customer results and on the use of the KAIIAE more generally. This study therefore makes a valuable contribution in adding to the debate about the strategic value of working towards formal quality improvement models and awards in health-care settings.
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Atkinson MK, Benneyan JC, Phillips RS, Schiff GD, Hunt LS, Singer SJ. Patient engagement in system redesign teams: a process of social identity. J Health Organ Manag 2021; ahead-of-print. [PMID: 34693670 DOI: 10.1108/jhom-02-2021-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Studies demonstrate how patient roles in system redesign teams reflect a continuum of involvement and influence. This research shows the process by which patients move through this continuum and effectively engage within redesign projects. DESIGN/METHODOLOGY/APPROACH The authors studied members of redesign teams, consisting of 5-10 members: clinicians, systems engineers, health system staff and patient(s), from three health systems working on separate projects in a patient safety learning lab. Weekly team meetings were observed, January 2016-April 2018, 17 semi-structured interviews were conducted and findings through a patient focus group were refined. Grounded theory was used to analyze field notes and transcripts. FINDINGS Results show how the social identity process enables patients to move through stages in a patient engagement continuum (informant, partner and active change agent). Initially, patient and team member perceptions of the patient's role influence their respective behaviors (activating, directing, framing and sharing). Subsequently, patient and team member behaviors influence patient contributions on the team, which can redefine patient and team member perceptions of the patient's role. ORIGINALITY/VALUE As health systems grow increasingly complex and become more interested in responding to patient expectations, understanding how to effectively engage patients on redesign teams gains importance. This research investigates how and why patient engagement on redesign teams changes over time and what makes different types of patient roles valuable for team objectives. Findings have implications for how redesign teams can better prepare, anticipate and support the changing role of engaged patients.
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Affiliation(s)
- Mariam Krikorian Atkinson
- Health Policy and Management, T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | | | - Russell S Phillips
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Sara J Singer
- School of Medicine, Stanford University, Stanford, California, USA
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Lasco G, Mendoza J, Renedo A, Seguin ML, Palafox B, Palileo-Villanueva LM, Amit AML, Dans AL, Balabanova D, McKee M. Nasa dugo ('It's in the blood'): lay conceptions of hypertension in the Philippines. BMJ Glob Health 2021; 5:bmjgh-2020-002295. [PMID: 32646854 PMCID: PMC7351273 DOI: 10.1136/bmjgh-2020-002295] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Understanding explanatory models is important for hypertension, a leading risk factor for cardiovascular disease and stroke. This article aims to determine what adult patients with hypertension in the Philippines attribute their condition to, how these views might be explained and what the implications are for hypertension management. Methods This is a qualitative study drawing on 71 semistructured interviews (40 initial and 31 follow-up) and four focus group discussions with patients diagnosed with hypertension. The setting was urban and rural low-income communities in the Philippines. Results Four prominent perceived causes were identified—genetics, heat, stress and diet—for what patients refer to as ‘high blood’. We propose a ‘folk physiology’ that rests on local understandings of blood and blood flow, draws from broader cultural notions of illness causation and accounts for a dynamic, non-chronic view of hypertension that in turn informs the health behaviours of those affected. Conclusions By understanding that hypertension is frequently seen not as a chronic constant condition but rather as an episodic one triggered by external influences, although in those genetically predisposed to it, it may be possible to address patient’s beliefs and thus adherence to treatment.
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Affiliation(s)
- Gideon Lasco
- Department of Anthropology, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines .,Development Studies Program, Ateneo de Manila University, Quezon City, Philippines
| | - Jhaki Mendoza
- Department of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Alicia Renedo
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Antonio L Dans
- Department of Medicine, University of the Philippines Manila, Manila, Philippines
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
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Marston CA, Matthews R, Renedo A, Reed JE. Working together to co-produce better health: The experience of the Collaboration for Leadership in Applied Health Research and Care for Northwest London. J Health Serv Res Policy 2021; 26:28-36. [PMID: 32486987 PMCID: PMC7734957 DOI: 10.1177/1355819620928368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To improve the provision of health care, academics can be asked to collaborate with clinicians, and clinicians with patients. Generating good evidence on health care practice depends on these collaborations working well. Yet such relationships are not the norm. We examine how social science research and health care improvement practice were linked through a programme designed to broker collaborations between clinicians, academics, and patients to improve health care - the UK National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London. We discuss the successes and challenges of the collaboration and make suggestions on how to develop synergistic relationships that facilitate co-production of social science knowledge and its translation into practice. METHODS A qualitative approach was used, including ethnographic elements and critical, reflexive dialogue between members of the two collaborating teams. RESULTS Key challenges and remedies were connected with the risks associated with new ways of working. These risks included differing ideas between collaborators about the purpose, value, and expectations of research, and institutional opposition. Dialogue between collaborators did not mean absence of tensions or clashes. Risk-taking was unpopular - institutions, funders, and partners did not always support it, despite simultaneously demanding 'innovation' in producing research that influenced practice. CONCLUSIONS Our path was made smoother because we had funding to support the creation of a 'potential space' to experiment with different ways of working. Other factors that can enhance collaboration include a shared commitment to dialogical practice, a recognition of the legitimacy of different partners' knowledge, a long timeframe to identify and resolve problems, the maintenance of an enabling environment for collaboration, a willingness to work iteratively and reflexively, and a shared end goal.
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Affiliation(s)
- Cicely A Marston
- Professor of Public Health, London School of Hygiene and Tropical Medicine, UK
| | | | - Alicia Renedo
- Assistant Professor, London School of Hygiene and Tropical Medicine, UK
| | - Julie E Reed
- Strategic Director, CLAHRC NWL, Patient and Public Engagement and Involvement Lead, National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care for Northwest London, Imperial College London, Chelsea and Westminster Hospital, UK
- Visiting Professor in Improvement Science, School of Health and Welfare, Halmstad University, Sweden
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Frahsa A, Farquet R, Bayram T, De Araujo L, Meyer S, Sakarya S, Cattacin S, Abel T. Experiences With Health Care Services in Switzerland Among Immigrant Women With Chronic Illnesses. Front Public Health 2020; 8:553438. [PMID: 33194954 PMCID: PMC7608491 DOI: 10.3389/fpubh.2020.553438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/10/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Descriptive data indicate a high burden of chronic illness among immigrant women in Switzerland. Little is known about how immigrant women with chronic illnesses experience healthcare services. This paper presents a methodological approach theoretically informed by Sen's capability approach and Levesque's framework of access to healthcare to study patient-reported experiences (PREs) of Swiss healthcare services among immigrant women with chronic conditions. Methods: We conducted 48 semi-structured qualitative interviews in Bern and Geneva with Turkish (n = 12), Portuguese (n = 12), German (n = 12), and Swiss (n = 12) women. Participants were heterogenous in age, length of stay, SES, and educational attainment, illness types and history. We also conducted semi-structured interviews with healthcare and social service providers (n = 12). Interviewed women participated in two focus group discussions (n = 15). Interviews were transcribed verbatim and analyzed using Atlas.ti software, based on Gale et al.'s framework approach. Findings informed three stakeholder dialogues in which women as well as healthcare providers and policymakers from various territorial levels participated. Results: Our methodological approach succeeded in integrating women's perspectives-from initial data collection in interviews to identify issues, focus group discussions to increase rigor, and stakeholder dialogues to develop tailored recommendations based on PREs. Discussion: This is one of the first studies in Switzerland that used PREs to research healthcare services and healthcare needs among immigrant women with chronic illnesses. This paper provides new insights on how to better understand existing challenges and potentially improve access to and quality of care.
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Affiliation(s)
- Annika Frahsa
- Institute of Sport Science, University of Tübingen, Tübingen, Germany
| | - Romaine Farquet
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Tevfik Bayram
- School of Medicine, Department of Public Health, Marmara University, Istanbul, Turkey
| | - Luna De Araujo
- Institut de Recherches Sociologiques, Université de Genève, Geneva, Switzerland
| | - Sophie Meyer
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sibel Sakarya
- School of Medicine, Department of Public Health, Koç University, Istanbul, Turkey
| | - Sandro Cattacin
- Institut de Recherches Sociologiques, Université de Genève, Geneva, Switzerland
| | - Thomas Abel
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Sandvin Olsson AB, Strøm A, Haaland-Øverby M, Fredriksen K, Stenberg U. How can we describe impact of adult patient participation in health-service development? A scoping review. PATIENT EDUCATION AND COUNSELING 2020; 103:1453-1466. [PMID: 32098746 DOI: 10.1016/j.pec.2020.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Patient participation represents a worldwide policy, but its impact lacks research. This study investigates impact of patient participation in health-service development by providing a comprehensive overview of how the literature describes it. METHOD A scoping review with a broad search strategy was conducted. The literature was examined for study characteristics, purpose for, approaches to and impact of patient participation. The data were analyzed using a thematic analysis. RESULTS The 34 included primary studies reported impacts of patient participation that were interpreted to constitute two categories: 1. The participatory process´ impact on involved patient representatives and health professionals, and the organization´s patient participation practice itself. 2. The participatory service development´s impact on the design and delivery of services regarding patients and health professionals, and the organization. CONCLUSION The literature describes a broad variation of impacts from health-service development, relevant for health professionals and patient representatives when initiating or participating in such processes. Our review provides an overview and discussion of these types of impact. PRACTICE IMPLICATIONS The findings can be of practical relevance to those aiming to develop services, quality indicators regarding effects of patient participation, or to further investigate aspects of participatory service development.
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Affiliation(s)
- Ann Britt Sandvin Olsson
- The Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway; Center of diakonia, values and professional practice, VID Specialized University, Postboks 184 Vinderen, 0319 Oslo, Norway.
| | - Anita Strøm
- Faculty of Health Studies, VID Specialized University, Postboks 184 Vinderen, 0319 Oslo, Norway.
| | - Mette Haaland-Øverby
- The Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway.
| | - Kari Fredriksen
- The Learning and Coping Center, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway.
| | - Una Stenberg
- The Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway.
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Marston C, Arjyal A, Maskey S, Regmi S, Baral S. Using qualitative evaluation components to help understand context: case study of a family planning intervention with female community health volunteers (FCHVs) in Nepal. BMC Health Serv Res 2020; 20:685. [PMID: 32703196 PMCID: PMC7379347 DOI: 10.1186/s12913-020-05466-1] [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] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/25/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Evaluations of health interventions are increasingly concerned with measuring or accounting for 'context'. How to do this is still subject to debate and testing, and is particularly important in the case of family planning where outcomes will inevitably be influenced by contextual factors as well as any intervention effects. We conducted an evaluation of an intervention where female community health volunteers (FCHVs) in Nepal were trained to provide better interpersonal communication on family planning. We included a context-orientated qualitative component to the evaluation. Here, we discuss the evaluation findings, specifically focusing on what was added by attending to the context. We explore and illustrate important dimensions of context that may also be relevant in future evaluation work. METHODS The evaluation used a mixed methods approach, with a qualitative component which included in-depth interviews with women of reproductive age, FCHVs, and family planning service providers. We conducted iterative, thematic analysis. RESULTS The life-history fertility and contraception narratives generated from the in-depth interviews contextualised the intervention, yielding nuanced data on contraceptive choices, needs, and areas for future action. For instance, it highlighted how women generally knew about effective contraceptive methods and were willing to use them: information was not a major barrier. Barriers instead included reports of providers refusing service when women were not in the fifth day of their menstrual cycle when this was unnecessary. Privacy and secrecy were important to some women, and risked being undermined by information sharing between FCHVs and health services. The qualitative component also revealed unanticipated positive effects of our own evaluation strategies: using referral slips seemed to make it easier for women to access contraception. CONCLUSIONS Life history narratives collected via in-depth interviews helped us understand pathways from intervention to effect from the user point of view without narrowly focusing only on the intervention, highlighting possible areas for action that would otherwise have been missed. By attending to context in a nuanced way in evaluations, we can build a body of evidence that not only informs future interventions within that context, but also builds better knowledge of contextual factors likely to be important elsewhere.
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Affiliation(s)
- Cicely Marston
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | | | | | | | - Sushil Baral
- HERD International, Thapathali, Kathmandu, Nepal
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12
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Evans J, Papoulias S(C. Between funder requirements and 'jobbing scientists': the evolution of patient and public involvement in a mental health biomedical research centre - a qualitative study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:12. [PMID: 32322407 PMCID: PMC7164170 DOI: 10.1186/s40900-020-00185-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/24/2020] [Indexed: 05/16/2023]
Abstract
BACKGROUND In the UK, there has been a strong drive towards patient and public involvement (PPI) in health research. Its benefits include improvements in the quality, relevance and acceptability of research, and empowerment, self-respect and value for service users. Organisational context can significantly influence the operationalisation of PPI. Research has highlighted power asymmetries between clinicians, researchers and service users. A resistance to power sharing, tokenism and assimilation into the existing culture suggest that a consultative, technocratic form of PPI is operating within health research settings. The aim of the study was to explore the development of PPI within a London based mental health biomedical research centre (BRC) over a period of 10 years from its inception. METHODS This qualitative study compared data from 52 organisational documents and 16 semi-structured interviews with staff and service users associated with PPI within the Maudsley BRC. The data were analysed using inductive thematic analysis. Study design, data collection, analysis and write up were conducted by service user researchers. RESULTS Our analysis showed a picture of increasing activity and acceptance of PPI, its alignment with the broader BRC research agenda, progressive involvement of service users in governance, and the development of a collaborative culture in research processes. The presence of salaried service user researchers in the organisation was key to this progress. However, PPI remained localised and under resourced and there was a reluctance to change working practices which resulted in perceptions of tokenism. Service users faced conflicting expectations and were expected to assimilate rather than challenge the organisation's 'biomedical agenda'. CONCLUSIONS Service user researchers may play a key role in establishing PPI in a scientific, hierarchical research environment. Adoption of a more democratic approach to involvement would build on the good work already being done and help to transform the culture and research processes. However, such an adoption requires considerable changes to the funding and policy environment orienting health research.
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Affiliation(s)
- Joanne Evans
- Department of Psychology, King’s College London, London, SE5 8AF UK
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13
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Scheffelaar A, Bos N, Triemstra M, de Jong M, Luijkx K, van Dulmen S. Qualitative instruments involving clients as co-researchers to assess and improve the quality of care relationships in long-term care: an evaluation of instruments to enhance client participation in quality research. BMJ Open 2020; 10:e033034. [PMID: 32060154 PMCID: PMC7045080 DOI: 10.1136/bmjopen-2019-033034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/14/2019] [Accepted: 12/05/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Enhancing the active involvement of clients as co-researchers is seen as a promising innovation in quality research. The aim of this study was to assess the feasibility and usability of five qualitative instruments used by co-researchers for assessing the quality of care relationships in long-term care. DESIGN AND SETTING A qualitative evaluation was performed in three care organisations each focused on one of the following three client groups: frail older adults, people with mental health problems and people with intellectual disabilities. A total of 140 respondents participated in this study. The data comprised observations by researchers and experiences from co-researchers, clients and professionals. RESULTS Two instruments scored best on feasibility and usability and can therefore both be used by co-researchers to monitor the quality of care relationships from the client perspective in long-term care. CONCLUSIONS The selected instruments let co-researchers interview other clients about their experiences with care relationships. The study findings are useful for long-term care organisations and client councils who are willing to give clients an active role in quality improvement.
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Affiliation(s)
- Aukelien Scheffelaar
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Nanne Bos
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Mattanja Triemstra
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | | | - Katrien Luijkx
- Tranzo Academic Centre for Transformation in Care and Welfare, Tilburg University, Tilburg, The Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Nic Giolla Easpaig B, Arnolda G, Tran Y, Bierbaum M, Lamprell K, Delaney GP, Liauw W, Chittajallu R, Winata T, Ward RL, Currow DC, Olver I, Karnon J, Westbrook J, Braithwaite J. What is multidisciplinary cancer care like in practice? a protocol for a mixed-method study to characterise ambulatory oncology services in the Australian public sector. BMJ Open 2019; 9:e031179. [PMID: 31601594 PMCID: PMC6797275 DOI: 10.1136/bmjopen-2019-031179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION An understanding of the real-world provision of oncology outpatient services can help maintain service quality in the face of escalating demand and tight budgets, by informing the design of interventions that improve the effectiveness or efficiency of provision. The aims of this study are threefold. First, to develop an understanding of cancer services in outpatient clinics by characterising the organisation and practice of multidisciplinary care (MDC). Second, to explore the key areas of: (a) clinical decision-making and (b) engagement with patients' supportive needs. Third, to identify barriers to, and facilitators of, the delivery of quality care in these settings. METHODS AND ANALYSIS A suite of mixed-methods studies will be implemented at six hospitals providing cancer outpatient clinics, with a staged roll-out. In Stage One, we will examine policies, use unstructured observations and undertake interviews with key health professionals to characterise the organisation and delivery of MDC. In Stage Two, observations of practice will continue, to deepen our understanding, and to inform two focused studies. The first will explore decision-making practices and the second will examine how staff engage with patients' needs; both studies involve interviews, to complement observation. As part of the study of supportive care, we will examine the implications of an introduction of patient-reported measures (PRMs) into care, adding surveys to interviews before and after PRMs roll-out. Data analysis will account for site-specific and cross-site issues using an adapted Qualitative Rapid Appraisal, Rigorous Analysis approach. Quantitative data from clinician surveys will be statistically analysed and triangulated with the related qualitative study findings. ETHICS AND DISSEMINATION Ethical approval was granted by South Eastern Sydney Local Health District Human Research Ethics Committee (no. 18/207). Findings will be shared with participating hospitals and widely disseminated through publications and presentations.
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Affiliation(s)
- Bróna Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Klay Lamprell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Geoffrey P Delaney
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia
- University of New South Wales South Western Sydney Clinical School, Liverpool, New South Wales, Australia
| | - Winston Liauw
- Saint George Hospital Saint George Cancer Care Centre, Kogarah, New South Wales, Australia
- Saint George Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Renuka Chittajallu
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn L Ward
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - David C Currow
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Ian Olver
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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15
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Patient-centered care factors and access to care: a path analysis using the Andersen behavior model. Public Health 2019; 171:41-49. [DOI: 10.1016/j.puhe.2019.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/19/2019] [Accepted: 03/29/2019] [Indexed: 11/21/2022]
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Matthews R, Papoulias C(S. Toward Co-productive Learning? The Exchange Network as Experimental Space. FRONTIERS IN SOCIOLOGY 2019; 4:36. [PMID: 33869359 PMCID: PMC8022628 DOI: 10.3389/fsoc.2019.00036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/04/2019] [Indexed: 05/22/2023]
Abstract
Policy around patient and public involvement (PPI) in the production, design and delivery of health services, and research remains difficult to implement. Consequently, in the UK and elsewhere, recent years have seen a proliferation of toolkits, training, and guidelines for supporting good practice in PPI. However, such instruments rarely engage with the power asymmetries shaping the terrain of collaboration in research and healthcare provision. Toolkits and standards may tell us little about how different actors can be enabled to reflect on and negotiate such asymmetries, nor on how they may effectively challenge what count as legitimate forms of knowledge and expertise. To understand this, we need to turn our attention to the relational dynamic of collaboration itself. In this paper we present the development of the Exchange Network, an experimental learning space deliberately designed to foreground, and work on this relational dynamic in healthcare research and quality improvement. The Network brings together diverse actors (researchers, clinicians, patients, carers, and managers) for structured "events" which are not internal to particular research or improvement projects but subsist at a distance from these. Such events thus temporarily suspend the role allocation, structure, targets, and other pragmatic constraints of such projects. We discuss how Exchange Network participants make use of action learning techniques to reflect critically on such constraints; how they generate a "knowledge space" in which they can rehearse and test a capacity for dialogue: an encounter between potentially conflictual forms of knowledge. We suggest that Exchange Network events, by explicitly attending to the dynamics and tensions of collaboration, may enable participants to collectively challenge organizational norms and expectations and to seed capacities for learning, as well as generate new forms of mutuality and care.
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Affiliation(s)
- Rachel Matthews
- National Institute for Health Research (NIHR), Collaboration for Leadership and Applied Health Research and Care (CLAHRC) for Northwest London, Imperial College London, London, United Kingdom
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17
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Uhre J. The dialogic construction of patient involvement in patient-centred neurorehabilitation. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2018. [DOI: 10.4081/qrmh.2018.7792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper explores how the practice of patient involvement in neurorehabilitation is constructed in tension-riddled professional narratives. I adopt dialogic communication theory to focus on how involvement is constructed across different roles and voices. My analysis is based on an action research project that uses a dialogical communication perspective and participatory methods to explore patient-centred care through the eyes of healthcare professionals. I argue that patient involvement is constructed as a demanding process that requires memory, presence, communicative abilities and temporal understanding of personal needs. These requirements are not explicit in the situated institutionalized practices. As well, I show how the available involvement strategies are laced with taken for granted characteristics, which fall short in the situation that arises when patients do not have the ability to participate or play the role of an active patient. The findings in this paper contribute to the growing literature on patient-centred healthcare by empirically investigating how the discursive configuration of patient, health professional and institutional practices intertwine in producing certain inherent expectations, habits and taken for granted perspectives in care delivery. I also suggest that the findings can usefully be incorporated into patient-centred care design and organizational strategies in order to take into account both the patient, relatives and healthcare professionals as vital for creating a patient-centred practice, organization and professional environment.
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18
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Riediger ND, Bombak AE, Mudryj A, Bensley J, Ankomah S. A systematic search and qualitative review of reporting bias of lifestyle interventions in randomized controlled trials of diabetes prevention and management. Nutr J 2018; 17:83. [PMID: 30193589 PMCID: PMC6129007 DOI: 10.1186/s12937-018-0390-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/20/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Scholars have documented presumptions regarding the relationships between diet, exercise, weight, and type 2 diabetes. However, it is unclear to what extent researchers contribute to these presumptions, and how often these relationships are thoroughly delineated within the context of randomized controlled trials (RCTs). Thus, the aim was to conduct a systematic search and qualitative, thematic analysis of RCTs focusing on lifestyle interventions for diabetes prevention or management, to examine how researchers discuss body weight in 1) the rationale and design of their RCTs; and 2) their presentation and interpretation of their findings. METHODS We completed an electronic search for records published between 2007 and November 2016. Selection criteria included: RCTs with a follow-up period of ≥12 months; adult participants with type 2 diabetes/pre-diabetes; lifestyle interventions classified as dietary, exercise, and/or behavioural; primary outcomes of incident diabetes and complications, mortality, cardiovascular disease, and quality of life; and secondary outcomes of glycemic control and blood pressure. Nineteen articles were identified for inclusion and subject to thematic content analysis. RESULTS Obesity and weight loss figured prominently in the rationale and outcomes of the majority of the articles, despite intentional exclusion of "weight loss" and "obesity" as search terms. There was ambiguity over whether weight loss was classified as inclusive to the intervention, an outcome, or a measure of adherence. Results revealed that authors frequently engaged in "spin reporting" by pooling data from intervention and control groups to test the relationship between weight lost and outcomes and in their presentation of results. CONCLUSIONS Researchers need to be aware of their biases and assumptions regarding body weight in designing, analyzing, and interpreting lifestyle interventions for diabetes prevention and management.
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Affiliation(s)
- Natalie D. Riediger
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, 407 Human Ecology Building, Winnipeg, MB R3T 2N2 Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Andrea E. Bombak
- Department of Sociology, Faculty of Arts, University of New Brunswick, Fredericton, NB Canada
| | - Adriana Mudryj
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Jackson Bensley
- School of Health Sciences, Community Health Division, Central Michigan University, Mt Pleasant, MI USA
| | - Samuel Ankomah
- School of Health Sciences, Community Health Division, Central Michigan University, Mt Pleasant, MI USA
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Melder A, Burns P, Mcloughlin I, Teede H. Examining 'institutional entrepreneurship' in healthcare redesign and improvement through comparative case study research: a study protocol. BMJ Open 2018; 8:e020807. [PMID: 30082347 PMCID: PMC6078238 DOI: 10.1136/bmjopen-2017-020807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Healthcare service redesign and improvement has become an important activity that health system leaders and clinicians realise must be nurtured and mastered, if the capacity issues that constrain healthcare delivery are to be solved. However, little is known about the critical success factors that are essential for sustaining and scaling up improvement initiatives. This situation limits the impact of these initiatives and undermines the general standing of redesign and improvement activity within healthcare systems. The conduct of the doctoral research detailed in this study protocol will be nested within a broader parent study that seeks to address this problem by drawing on the theory of 'institutional entrepreneurship'. The doctoral research will apply this idea to understanding the capacities and capabilities required at the organisation level to bring about transformational change in healthcare services. METHODS AND ANALYSIS The parent study is predominantly qualitative, is multilevel in nature and has been codesigned with five partner healthcare organisations. The focus is a sector-wide attempt in an Australian state jurisdiction to transfer new redesign and improvement knowledge into the public healthcare system. The doctoral research will focus on the implementation of the sector-wide approach in one healthcare service in the jurisdiction. This research involves interviews with project team members and stakeholders involved in two improvement initiatives undertaken by the health service. It will involve interviews with redesign and improvement leaders and senior managers responsible for the overall health service improvement approach. The methods will also include immersive fieldwork, interviews and focus groups. Appropriate methods for coding and thematic extraction will be applied to the qualitative data. ETHICS AND DISSEMINATION Ethical approval has been granted by the health service and Monash University Human Research Ethics Committee. Dissemination will be facilitated via academic publication, industry reports and workshops and dissemination events as part of the broader project.
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Affiliation(s)
- Angela Melder
- Monash Centre for Health Research and Implementation, Monash Univeristy, Clayton, Victoria, Australia
- Centre For Clinical Effectiveness, Monash Health, Melbourne, Victoria, Australia
| | - Prue Burns
- Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Ian Mcloughlin
- Department of Management, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Helena Teede
- Endocrinology and Diabetes Units, Monash Health, Melbourne, Victoria, Australia
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Fiorio CV, Gorli M, Verzillo S. Evaluating organizational change in health care: the patient-centered hospital model. BMC Health Serv Res 2018; 18:95. [PMID: 29422045 PMCID: PMC5806258 DOI: 10.1186/s12913-018-2877-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 01/23/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND An increasing number of hospitals react to recent demographic, epidemiological and managerial challenges moving from a traditional organizational model to a Patient-Centered (PC) hospital model. Although the theoretical managerial literature on the PC hospital model is vast, quantitative evaluations of the performance of hospitals that moved from the traditional to the PC organizational structure is scarce. However, quantitative analysis of effects of managerial changes is important and can provide additional argument in support of innovation. METHODS We take advantage of a quasi-experimental setting and of a unique administrative data set on the population of hospital discharge charts (HDCs) over a period of 9 years of Lombardy, the richest and one of the most populated region of Italy. During this period three important hospitals switched to the PC model in 2010, whereas all the others remained with the functional organizational model. This allowed us to develop a difference-in-difference analysis of some selected measures of efficiency and effectiveness for PC hospitals focusing on the "between-variability" of the 25 major diagnostic categories (MDCs) in each hospital and estimating a difference-in-difference model. RESULTS We contribute to the literature that addresses the evaluation of healthcare and hospital change by providing a quantitative estimation of efficiency and effectiveness changes following to the implementation of the PC hospital model. Results show that both efficiency and effectiveness have significantly increased in the average MDC of PC hospitals, thus confirming the need for policy makers to invest in new organizational models close to the principles of PC hospital structures. CONCLUSIONS Although an organizational change towards the PC model can be a costly process, implying a rebalancing of responsibilities and power among hospital personnel (e.g. medical and nursing staff), our results suggest that changing towards a PC model can be worthwhile in terms of both efficacy and efficiency. This evidence can be used to inform and sustain hospital managers and policy makers in their hospital design efforts and to communicate the innovation advantages within the hospital organizations, among the personnel and in the public debate.
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Affiliation(s)
- Carlo V. Fiorio
- Irvapp-FBK, Via Santa Croce 77, Trento, 38122 Italy
- Universitá degli Studi di Milano, Via Conservatorio, 7, Milano, 20121 Italy
- Dondena Centre, Bocconi University, Via Rontgen, 1, Milano, 20136 Italy
| | - Mara Gorli
- Universitá Cattolica del Sacro Cuore, Largo Gemelli, 1, Milano, 20123 Italy
- CERISMAS, Centro di Ricerche e Studi in Management Sanitario c/o Universitá Cattolica del Sacro Cuore, Via Necchi 7, Milano, 20123 Italy
| | - Stefano Verzillo
- European Commission, Joint Research Centre**, Via E. Fermi, 2749, Ispra (VA), 21027 Italy
- CRISP - Interuniversity Research Centre on Public Services, Universitá degli Studi di Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, Milano, 20126 Italy
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de Freitas C, dos Reis V, Silva S, Videira PA, Morava E, Jaeken J. Public and patient involvement in needs assessment and social innovation: a people-centred approach to care and research for congenital disorders of glycosylation. BMC Health Serv Res 2017; 17:682. [PMID: 28950866 PMCID: PMC5615629 DOI: 10.1186/s12913-017-2625-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 09/18/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Public and patient involvement in the design of people-centred care and research is vital for communities whose needs are underserved, as are people with rare diseases. Innovations devised collectively by patients, caregivers, professionals and other members of the public can foster transformative change toward more responsive services and research. However, attempts to involve lay and professional stakeholders in devising community-framed strategies to address the unmet needs of rare diseases are lacking. In this study, we engaged with the community of Congenital Disorders of Glycosylation (CDG) to assess its needs and elicit social innovations to promote people-centred care and research. METHODS Drawing on a qualitative study, we conducted three think tanks in France with a total of 48 participants, including patients/family members (n = 18), health care professionals (n = 7), researchers (n = 7) and people combining several of these roles (n = 16). Participants came from 20 countries across five continents. They were selected from the registry of the Second World Conference on CDG through heterogeneity and simple random sampling. Inductive and deductive approaches were employed to conduct interpretational analysis using open, axial and selective coding, and the constant-comparison method to facilitate the emergence of categories and core themes. RESULTS The CDG community has unmet needs for information, quality health care, psychosocial support and representation in decision-making concerned with care and research. According to participants, these needs can be addressed through a range of social innovations, including peer-support communities, web-based information resources and a CDG expertise platform. CONCLUSION This is one of the few studies to engage lay and professional experts in needs assessment and innovation for CDG at a global level. Implementing the innovations proposed by the CDG community is likely to have ethical, legal and social implications associated with the potential donation of patients' clinical and biological material that need to be assessed and regulated with involvement from all stakeholders. To promote people-centred care for the CDG community, and increase its participation in the governance of care and research, it is necessary to create participatory spaces in which the views of people affected by CDG can be fully expressed.
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Affiliation(s)
- Cláudia de Freitas
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Institutional address 1: Rua das Taipas 135, 4050-600, Porto, Portugal
- Centre for Research and Studies in Sociology - University Institute of Lisbon, Porto, Portugal
- Institutional address 2: Avenida das Forças Armadas, 1649-026, Lisbon, Portugal
| | - Vanessa dos Reis
- Founder of the Portuguese Association for CDG (APCDG), Porto, Portugal
- Institutional address: Rua Manuel da Fonseca 46, 2820-389, Almada, Portugal
| | - Susana Silva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Institutional address 1: Rua das Taipas 135, 4050-600, Porto, Portugal
| | - Paula A. Videira
- Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal
- Institutional address: Glycoimmunology group Lab 3.19 - Departamento Ciências da Vida (Ed Departamental), Faculdade de Ciências e Tecnologia, 2829-516 Caparica, Portugal
| | - Eva Morava
- School of Medicine, Tulane University, New Orleans, USA
- Institutional address: Hayward Genetics Center SL#31, Tulane University Medical School, 1430 Tulane Ave, New Orleans, LA 70112 USA
| | - Jaak Jaeken
- Department of Pediatrics, Center for Metabolic Disease, University Hospital Gasthuisberg, Leuven, Belgium
- Institutional Address: Herestraat 49, 3000, Leuven, Belgium
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Mackintosh N, Rance S, Carter W, Sandall J. Working for patient safety: a qualitative study of women's help-seeking during acute perinatal events. BMC Pregnancy Childbirth 2017; 17:232. [PMID: 28716050 PMCID: PMC5513134 DOI: 10.1186/s12884-017-1401-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/03/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Women and their relatives can play an important role in early detection and help seeking for acute perinatal events. Recent UK reports indicate that patient-professional partnership in 'working for safety' can be difficult to achieve in practice, sometimes with catastrophic consequences. This research explored the experiences of women and relatives who had experienced early warning signs about their condition and sought help in escalating care. METHODS Secondary analysis of case study data which included qualitative interviews with 22 women purposively sampled on account of experiencing a step up in care and 4 of their relatives from two NHS Trusts in England during 2010. Analysis focused on the type of safety work participants engaged in, and the opportunities and challenges reported by women and family members when negotiating safety at home and in hospital. RESULTS Women and relatives took on a dual responsibility for self-diagnosis, self-care and seeking triage, whilst trying to avoid overburdening stretched services. Being informed, however, did not necessarily enable engagement from staff and services. The women's narratives highlighted the work that they engaged in to build a case for clinical attention, the negotiations that took place with health care professionals and the strategies women and partners drew on (such as objective signs and symptoms, use of verbal insistence and repetition) to secure clinical help. For some women, the events left them with a lasting feeling that their concerns had been disregarded. Some described a sense of betrayal and loss of trust in an institution they believed had failed to care for them. CONCLUSION The notion of 'safety partnerships' which suggests a sense of equality and reciprocity was not borne out by our data, especially with regards to the experiences of teenage women. To enable women and families to secure a rapid response in clinical emergencies, strategies need to move beyond the provision of patient information about warning signs. Effective partnerships for safety may be supported by system level change such as improved triage, continuity of care, self-referral pathways and staff training to address asymmetries of power that persist within the health system.
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Affiliation(s)
- Nicola Mackintosh
- SAPPHIRE Group, Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 7RH UK
| | - Susanna Rance
- Institute for Health and Human Development, University of East London, London, UK
| | - Wendy Carter
- Division of Women’s Health, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Jane Sandall
- Division of Women’s Health, Faculty of Life Sciences and Medicine, King’s College London, London, UK
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van Mol MMC, Boeter TGW, Verharen L, Kompanje EJO, Bakker J, Nijkamp MD. Patient- and family-centred care in the intensive care unit: a challenge in the daily practice of healthcare professionals. J Clin Nurs 2017; 26:3212-3223. [DOI: 10.1111/jocn.13669] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Margo MC van Mol
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
| | - Trudi GW Boeter
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
| | | | - Erwin JO Kompanje
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
| | - Jan Bakker
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
- Division of Pulmonary, Allergy, and Critical Care Medicine; Department of Medicine; Columbia University Medical Center; New York NY USA
| | - Marjan D Nijkamp
- Faculty of Psychology and Educational Sciences; Open University of the Netherlands; Heerlen the Netherlands
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24
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Roy NT, Ulrich EE. Quantifying the relationship between patient characteristics and involvement in developing and implementing a treatment plan. DRUG HEALTHCARE AND PATIENT SAFETY 2017; 9:1-8. [PMID: 28144164 PMCID: PMC5248929 DOI: 10.2147/dhps.s107065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Improving the patient-physician relationship through patient involvement in the care may lead to improved patient safety and better health outcomes. There exists a gap in knowledge in identifying factors that affect self-reported patient involvement in individualized treatment plans. The objectives of this study were to 1) describe patients’ perceptions of their involvement in the creation and implementation of their treatment plans and 2) determine if patient involvement varied by medical condition or demographic characteristics. Methods This study was a cross-sectional analysis of data from the “Quality of Care” module of the 2008 Health and Retirement Study (HRS). The individuals of HRS surveys were older than 50 years. One-way analyses of variance were conducted to determine differences between patient characteristics and involvement in creating a treatment plan. A linear regression was conducted to determine predictors of the summed involvement score. Results Average summed scores for each domain (shared decision-making, counseling, and follow-up) and overall involvement scores were ~50%. Linear regression showed that being non-White, older age, and diagnosed with a psychiatric condition or diabetes were predictors of increased self-reported involvement in the development and communication of a patient’s treatment plan. Conclusion Age, race, and having diabetes or a psychiatric condition were the major predictors affecting patient involvement in care, although overall involvement in care was low for all groups. Practice implications Patient involvement in care was lower than expected and should be further studied to determine the effects of involvement on health outcomes.
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Affiliation(s)
- Natalie T Roy
- Department of Pharmaceutical, Biomedical, and Administrative Sciences, College of Pharmacy and Health Sciences, Drake University, Des Moines, IA, USA
| | - Erin E Ulrich
- Department of Pharmaceutical, Biomedical, and Administrative Sciences, College of Pharmacy and Health Sciences, Drake University, Des Moines, IA, USA
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25
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Abstract
Patients are increasingly expected to take a more involved role in research. Funding for some projects now requires incorporating patients' viewpoints or involvement in research processes. While intended to achieve commendable goals, it is important to critically assess the means used to achieve these aims. Presently, there may be issues of valuing only certain epistemologies, failing to evaluate existing programs and their impacts, marginalizing less "engaged" patients, and promoting only tokenism. These are areas that require exploration and reflection before assuming that patient engagement approaches are sufficient or the only means of incorporating patient perspectives into research.
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Affiliation(s)
| | - Heather M Hanson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Seniors Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
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26
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Rowland P, McMillan S, McGillicuddy P, Richards J. What is “the patient perspective” in patient engagement programs? Implicit logics and parallels to feminist theories. Health (London) 2016; 21:76-92. [DOI: 10.1177/1363459316644494] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Public and patient involvement (PPI) in health care may refer to many different processes, ranging from participating in decision-making about one’s own care to participating in health services research, health policy development, or organizational reforms. Across these many forms of public and patient involvement, the conceptual and theoretical underpinnings remain poorly articulated. Instead, most public and patient involvement programs rely on policy initiatives as their conceptual frameworks. This lack of conceptual clarity participates in dilemmas of program design, implementation, and evaluation. This study contributes to the development of theoretical understandings of public and patient involvement. In particular, we focus on the deployment of patient engagement programs within health service organizations. To develop a deeper understanding of the conceptual underpinnings of these programs, we examined the concept of “the patient perspective” as used by patient engagement practitioners and participants. Specifically, we focused on the way this phrase was used in the singular: “the” patient perspective or “the” patient voice. From qualitative analysis of interviews with 20 patient advisers and 6 staff members within a large urban health network in Canada, we argue that “the patient perspective” is referred to as a particular kind of situated knowledge, specifically an embodied knowledge of vulnerability. We draw parallels between this logic of patient perspective and the logic of early feminist theory, including the concepts of standpoint theory and strong objectivity. We suggest that champions of patient engagement may learn much from the way feminist theorists have constructed their arguments and addressed critique.
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27
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Østergaard LR, Bjertrup PJ, Samuelsen H. "Children get sick all the time": A qualitative study of socio-cultural and health system factors contributing to recurrent child illnesses in rural Burkina Faso. BMC Public Health 2016; 16:384. [PMID: 27164827 PMCID: PMC4863333 DOI: 10.1186/s12889-016-3067-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/29/2016] [Indexed: 11/22/2022] Open
Abstract
Background In Burkina Faso, the government has implemented various health sector reforms in order to overcome financial and geographical barriers to citizens’ access to primary healthcare throughout the country. Despite these efforts, morbidity and mortality rates among children remain high and the utilization of public healthcare services low. This study explores the relationship between mothers’ intentions to use public health services in cases of child sickness, their social strategies and cultural practices to act on these intentions and the actual services provided at the primary health care facilities. Focusing on mothers as the primary caregivers, we follow their pathways from the onset of symptoms through their various attempts of providing treatment for their sick children. The overall objective is to discuss the interconnectedness of various factors, inside and outside of the primary health care services that contribute to the continuing high child morbidity and mortality rates. Methods The study is based on ethnographic fieldwork, including in-depth interviews and follow-up interviews with 27 mothers, informal observations of daily-life activities and structured observations of clinical encounters. Data analysis took the form of thematic analysis. Results and discussion Focusing on the mothers’ social strategies and cultural practices, three forms of responses/actions have been identified: home-treatment, consultation with a traditional specialist, and consultation at the primary health care services. Due to their accumulated vulnerabilities, mothers shift pragmatically from one treatment to another. However, the sporadic nature of their treatment-seeking hinders them in obtaining long-term solutions and the result is recurrent child illnesses and relapses over long periods of time. The routinization of the clinical encounter at rural dispensaries furthermore fails to address these complexities of children’s illnesses. Conclusions The analysis of case studies, interviews and observations shows how mothers in a rural area struggle and often fail to receive care at public healthcare facilities. Health service delivery could be organized in a manner that responds better to the needs of these mothers in terms of both access and retention.
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Affiliation(s)
- Lise Rosendal Østergaard
- Department of Anthropology, University of Copenhagen, Øster Farimagsgade 5, DK-1353, Copenhagen K, Denmark.
| | - Pia Juul Bjertrup
- Department of Anthropology, University of Copenhagen, Øster Farimagsgade 5, DK-1353, Copenhagen K, Denmark
| | - Helle Samuelsen
- Department of Anthropology, University of Copenhagen, Øster Farimagsgade 5, DK-1353, Copenhagen K, Denmark
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28
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Swinglehurst D, Emmerich N, Maybin J, Park S, Quilligan S. Confronting the quality paradox: towards new characterisations of 'quality' in contemporary healthcare. BMC Health Serv Res 2015; 15:240. [PMID: 26092245 PMCID: PMC4473825 DOI: 10.1186/s12913-015-0851-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/24/2015] [Indexed: 12/05/2022] Open
Abstract
This editorial introduces the special Biomed Central cross-journal collection The Many Meanings of 'Quality' in Healthcare: Interdisciplinary Perspectives, setting out the context for the development of the collection, and presenting brief summaries of all the included papers in three broad themes 1) the practices of assuring quality in healthcare 2) giving 'space to the story' 3) addressing moral complexity in the clinic, the classroom and the academy. The editorial concludes with reflections on some of the key messages that emerge from the papers which are relevant to policymakers and practitioners who seek to improve the quality of healthcare.
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Affiliation(s)
- Deborah Swinglehurst
- Centre for Primary Care and Public Health, Queen Mary, University of London, London, UK.
| | - Nathan Emmerich
- School of Politics, International Studies & Philosophy, Queen's University Belfast, Belfast, UK.
| | - Jo Maybin
- Policy Directorate, The King's Fund, London, UK.
| | - Sophie Park
- Department of Primary Care & Population Health, Institute of Epidemiology & Health, University College London, London, UK.
| | - Sally Quilligan
- Clinical and Communication Skills Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
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