Characteristics of the studies using realist evaluation to assess interventions that address psychosocial healthcare issues in older adults: a scoping review

OBJECTIVES

Interventions to address psychosocial healthcare issues in older adults are increasing. Realist evaluation (RE) helps us understand how these interventions work for their issues. It is significant to obtain implications for further developing such research. We aimed to identify the characteristics of studies using RE to assess interventions that address psychosocial healthcare issues in older adults by mapping relevant literature.

DESIGN

Scoping review.

DATA SOURCES

MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, Cochrane Library, ICHUSHI (a Japanese database) and Google Scholar were used for searches between 5 January 2022 and 4 January 2024.

ELIGIBILITY CRITERIA

(1) Showing that most of the participants were older adults or their stakeholders; (2) stating in the research background or aim sections that the target interventions aimed at addressing older adults' psychosocial healthcare issues and (3) using RE to assess these interventions.

DATA EXTRACTION

Data on country of origin, type of research, study design, qualitative data collection and analysis methods, desirable items for RE and intervention aims and purposes were extracted and summarised using descriptive statistics.

RESULTS

Fifty-four studies were analysed. Most studies were conducted in the UK (54.5%). Mixed methods were used in 28 studies (51.9%), while only qualitative methods were used in 25 studies (46.2 %). Fourteen intervention aims and purposes were identified: improving dementia care, avoiding emergency admissions, preventing social isolation and promoting family involvement in the care of older adults.

CONCLUSION

RE is useful for promoting an understanding of how interventions work for addressing psychosocial healthcare issues in older adults. RE also promotes the updating of plausible theories that lead to improving interventions. Our findings show the implications of managing time and resources to address the challenge of RE's time and resource intensiveness and carefully considering the data collection methods to reduce burdens on older adults.

Care needs of adults with spinal trauma in the prehospital and hospital setting from the perspective of patient care team: A qualitative research

BACKGROUND

Appropriate care of patients with definite spinal cord injury or at risk of it in the prehospital and hospital stages requires comprehensive planning in the health system. It is also the requirement of any successful program to explain the needs from the perspective of its stakeholders. Thus, this study aimed to discover the care needs of adults with spinal trauma in prehospital and hospital settings from the perspective of the patient care team.

MATERIALS AND METHODS

This qualitative study was conducted with the participation of urban and rural prehospital emergency personnel and emergency departments of educational and therapeutic hospitals affiliated to Isfahan, Tehran, Shiraz, Kermanshah, Ahvaz, and Yasuj Universities of Medical Sciences, through conducting 36 in-depth semi-structured interviews from September to December 2021. Using purposive sampling method, the participants were selected considering the maximum variation. The data saturation was reached after conducting interviews and group discussions with 36 subjects. Data were analyzed using conventional content analysis approach. Lundman and Graneheim approach were used for the study rigour. Data were simultaneously analyzed using MAXQDA software version 10.

RESULT

During the data analysis, two themes of prehospital care with two main categories (emergency care and management of secondary complications of spinal trauma) and hospital care with two main categories (emergency care and management of secondary complications of spinal trauma) emerged.

CONCLUSION

Emergency care and management of secondary complications of spinal cord injury in the prehospital and hospital stages can affect treatment results, improve quality of life, and reduce mortality rate, secondary injuries, and healthcare costs. Thus, identification of the care needs of the adults with spinal trauma from the perspective of the patient care team can help the authorities to plan appropriate interventions.

Comparison of Palliative Knowledge and Self-Efficacy Expectation of German Paramedics Between a Rural and an Urban Structured Emergency Medical Service Area

OBJECTIVE(S)

Differences in the German emergency medical service (EMS) can be seen in the countryside in contrast to the city with regard to travel distances to hospitals and in the access routes of EMS-physicians. In order to investigate the success of establishment of palliative crisis cards associated with training and the rural and urban EMS structures, two urban and two rural EMS areas were compared using the Paramedic Palliative Care Test (PARPACT). Methods: The PARPACT includes test items on palliative knowledge (PK, maximum score: 15 points) and palliative self-efficacy expectations (PSE, maximum score: 18 points), as well as items on palliative attitudes in dealing with palliative care patients. We used a 4-point Likert-type scale. For data analysis, nonparametric tests (χ-test and Mann-Whitney U test) were used in addition to descriptive analysis (frequencies, means, medians, standard deviations, and ranges). Results: In total, 291 out of 750 ambulance or EMS personnel participated in the voluntary survey. Rural ambulance or EMS personnel answered the PK-questions correctly more often on average (mean: 11.19, SD: 1.85) than urban ambulance or EMS personnel (mean: 9.18, SD: 2.39; Mann-Whitney U test: U=5040.000, P=.001). In addition, ambulance or EMS personnel with the highest level of training (3-year-trained paramedics) performed better in PK (mean: 10.38, SD: 2.31) than less intensively training ambulance or EMS personnel (mean: 9.58, SD: 2.43; Mann-Whitney U-test: U=8446.500, P=.004). In terms of PSE, rural ambulance or EMS personnel also achieved higher mean PSE-scores (mean: 12.55, SD: 2.60) than urban ambulance or EMS personnel (mean: 9.77, SD: 3.41; Mann-Whitney U-test: U=5148.500, P=.001). Conclusions: Better training in the EMS is associated with improved PK compared to less qualified nonphysician EMS staff. The establishment of palliative crisis cards and the structures in the city alone do not lead to improved knowledge and PSE.

Barriers and facilitators to the implementation of social robots for older adults and people with dementia: a scoping review

Background

Psychosocial issues, such as social isolation and loneliness among older adults and people with dementia, continue to pose challenges with a rapidly aging population worldwide. Social robots are a rapidly emerging field of technology, developed to help address the psychosocial needs of this population. Although studies have reported positive findings regarding their psychosocial benefits, their implementation in real-world practice remains a challenge. Nevertheless, little is known about the factors affecting their implementation. The purpose of this review is to provide a systematic overview of the barriers and facilitators affecting the implementation of social robots for older adults and people with dementia.

Method

The Arksey and O’Malley approach with methodological enhancement by Levac et al. was used to guide the conduct of this review. Seven electronic databases were searched. In addition, hand searching and backward citation tracing was conducted. Three independent reviewers were involved in the screening and data charting process. Findings were synthesised and categorised into the five domains outlined in the Consolidated Framework of Implementation Research (CFIR).

Results

A total of 53 studies were included in the final review. Most of the included studies were based in participants’ homes and in care facilities. Barriers and facilitators were mapped onto 18 constructs in the five domains of the CFIR. The most frequently cited barriers were mapped to the constructs within the domain of “Intervention characteristics”, where issues such as the complexity of using the technology and technical obstacles impeded implementation. Most facilitators were mapped onto the domain “Patient needs and resources”. Overall, existing research are disproportionately focused on the internal validity (i.e. characteristics) of social robots, and there is significantly less research investigating their external validity, such as organisational or wider contextual factors that can affect their implementation in real-world practice.

Conclusion

This review has identified and synthesised the breadth of evidence on the barriers and facilitators to the implementation of social robots for older adults and people with dementia. Future research should pay more attention to investigating the contextual factors, using an implementation framework, to identify barriers and facilitators to guide the implementation of social robots.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02277-9.

Behavioral Health Emergencies Encountered by Community Paramedics: Lessons from the Field and Opportunities for Skills Advancement

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Experiential education enhancing paramedic perspective and interpersonal communication with older patients: a controlled study

BACKGROUND

Paramedics are required to provide care to an aging population with multidimensional and complex issues. As such educators need to prepare undergraduate paramedics to recognise, assess and manage a broad range of psychosocial care and support issues beyond somatic conditions. Experiential educational interventions with older people provide realistic and contextualised experience which can improve the provision of holistic patient focused care.

METHODS

This was a single institution controlled before-after study with parallel groups, conducted in Australia in 2017. It was designed to compare the effectiveness of an educational program related to older people (intervention), verses no intervention (control) on paramedic student attitudes, knowledge and behavior with older patients.

RESULTS

A total of 124 second year paramedic students were included in this study; 60 in the intervention and 64 in the control group. Their demographics and Time 1 baseline results were homogeneous. Both groups showed improvement in communication skills with real older patients (p < 0.001, η² = 0.41) and (p < 0.001, η² = 0.35). The intervention group showed greater improvements in the 'understands the patient's perspective' element for both the self-assessment (p < 0.001) and the clinician assessment (p = 0.01). Multiple linear regression Model 1 found gender (β = - 0.25; p = 0.01) was the best predictor of clinician-assessed communication, with females having higher scores. Knowledge and attitudes remained relatively unchanged for both groups.

CONCLUSIONS

As the first study to observe, measure and report on the interpersonal communication skills of paramedic student's with 'real' older patients we can report that these skills were from fair to good at baseline and improved from good to very good post the intervention. Overall improvement was notably better in the 'understanding the patients perspective element' for the intervention group who had conducted one-one visits with an older person.

Psychosocial Support Issues Affecting Older Patients: A Cross-sectional Paramedic Perspective

This research aimed to gain an understanding of the psychosocial support needs of older patients in the out-of-hospital setting from the perspective of paramedics. Specifically, we investigate if and how paramedics are able to meet the needs of older adults, and the barriers preventing them from achieving this. This study was a cross-sectional study utilizing a sequential design with both quantitative and qualitative methodologies. All participants agreed or strongly agreed that older patients have needs beyond the physical and that they would like to do more for older patients. Paramedics discussed that psychosocial support issues are rarely in isolation and straightforward but were often coupled with broader, longer term physical health and social support issues. They would like to be able to do more for patients but feel hamstrung by lack of time, resources, and know-how.

A Critical Analysis of Debates Around Mental Health Calls in the Prehospital Setting

Paramedics, health care workers who assess and manage health concerns in the prehospital setting, are increasingly providing psychosocial care in response to a rise in mental health call volume. Observers have construed this fact as “misuse” of paramedic services, and proposed as solutions better triaging of patients, better mental health training of paramedics, and a greater number of community mental health services. In this commentary, we argue that despite the ostensibly well-intentioned nature of these solutions, they shift attention and accountability away from relevant public policies, as well as from broader economic, social, and political determinants of mental health, while placing responsibility on those requiring services or, at best, on the health care system. We also argue that the perspective of paramedics, who are exposed to, and interact with, individuals in their everyday environments, has the potential to inform a better, structural and critical, understanding of the factors driving the rise in psychosocial crises in the first place. Finally, we suggest that a greater engagement with the political and social determinants of mental health would lead to preventing, rather than primarily reacting to, these crises after the fact.