1
|
Benjamen J, Girard V, Jamani S, Magwood O, Holland T, Sharfuddin N, Pottie K. Access to Refugee and Migrant Mental Health Care Services during the First Six Months of the COVID-19 Pandemic: A Canadian Refugee Clinician Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105266. [PMID: 34063442 PMCID: PMC8156129 DOI: 10.3390/ijerph18105266] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 01/13/2023]
Abstract
The COVID-19 pandemic has had a major impact on the mental health of refugees and migrants. This study aimed to assess refugee clinician perspectives on mental health care during the COVID-19 pandemic, specifically access to and delivery of community mental health care services. We utilized a mixed methods design. We surveyed members of a national network of Canadian clinicians caring for refugees and migrants. Seventy-seven clinicians with experience caring for refugee populations, representing an 84% response rate, participated in the online survey, 11 of whom also participated in semi-structured interviews. We report three major themes: exacerbation of mental health issues and inequities in social determinants of health, and decreased access to integrated primary care and community migrant services. Clinicians reported major challenges delivering care during the first 6 months of the pandemic related to access to care and providing virtual care. Clinicians described perspectives on improving the management of refugee mental health, including increasing access to community resources and virtual care. The majority of clinicians reported that technology-assisted psychotherapy appears feasible to arrange, acceptable and may increase health equity for their refugee patients. However, major limitations of virtual care included technological barriers, communication and global mental health issues, and privacy concerns. In summary, the COVID-19 pandemic has exacerbated social and health inequities within refugee and migrant populations in Canada and challenged the way mental health care is traditionally delivered. However, the pandemic has provided new avenues for the delivery of care virtually, albeit not without additional and unique barriers.
Collapse
Affiliation(s)
- Joseph Benjamen
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada; (J.B.); (V.G.); (S.J.)
- C.T. Lamont Primary Care Research Centre, Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada;
| | - Vincent Girard
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada; (J.B.); (V.G.); (S.J.)
| | - Shabana Jamani
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada; (J.B.); (V.G.); (S.J.)
- C.T. Lamont Primary Care Research Centre, Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada;
| | - Olivia Magwood
- C.T. Lamont Primary Care Research Centre, Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada;
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
| | - Tim Holland
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, 1465 Brenton St, Suite 402, Halifax, NS B3J 3T4, Canada;
| | - Nazia Sharfuddin
- Department of Medicine, Faculty of Medicine, University of Alberta, 11350-83 Ave, Edmonton, AB T6G 2G3, Canada;
| | - Kevin Pottie
- C.T. Lamont Primary Care Research Centre, Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada;
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cres, Suite 200, Ottawa, ON K1G 5Z3, Canada
- Institut du Savoir Montfort, 713 Montreal Rd, Ottawa, ON K1K 0T2, Canada
- Correspondence: ; Tel.: +1-613-562-6262 (ext. 4457)
| |
Collapse
|
2
|
Craddock Lee SJ. Mixed Methods: Capturing Complexity in Family Medicine Research. Ann Fam Med 2021; 19:98-99. [PMID: 33685868 PMCID: PMC7939716 DOI: 10.1370/afm.2682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Simon J. Craddock Lee
- CORRESPONDING AUTHOR Simon J. Craddock Lee University of Texas Southwestern Medical Center 5323 Harry Hines Blvd, MSC 9066 Dallas, TX 75390-9066
| |
Collapse
|
3
|
Callejo-Black A, Wagner DV, Ramanujam K, Manabat AJ, Mastel S, Riley AR. A Systematic Review of External Validity in Pediatric Integrated Primary Care Trials. J Pediatr Psychol 2020; 45:1039-1052. [PMID: 32909603 DOI: 10.1093/jpepsy/jsaa068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/18/2020] [Accepted: 07/17/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to conduct a systematic review of external validity reporting in integrated primary care (IPC) interventions for mental health concerns. METHODS We searched Medline, CINAHL, PsycINFO, the Cochrane Center Register of Controlled Trials, and relevant literature to identify publications from 1998 to 2018 reporting on open, randomized, or quasi-randomized trials of IPC interventions that targeted child (ages 0-18 years) psychological symptoms. For each publication, we extracted the information reported in each RE-AIM domain and calculated the proportion of the total studies reviewed. RESULTS Thirty-nine publications describing 25 studies were included in the review. Publications rarely reported some indicators of external validity, including the representativeness of participants (12%), rate of adoption clinics or providers (16%), cost of implementation (8%), or evidence of maintenance (16%). Few studies reported on key pragmatic factors such as cost or organizational change processes related to implementation and maintenance. Strengths of some studies included comparisons of multiple active treatments, use of tailorable interventions, and implementation in "real world" settings. CONCLUSIONS Although IPC interventions appear efficacious under research conditions, there are significant knowledge gaps regarding the degree to which they reach and engage target recipients, what factors impact adoption and implementation of IPC interventions by clinicians, how fidelity can be maintained over time, and cost-effectiveness. Pediatric IPC researchers should embrace dissemination and implementation science methods to balance internal and external validity concerns moving forward.
Collapse
Affiliation(s)
| | - David V Wagner
- Department of Pediatrics, Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon
| | - Krishnapriya Ramanujam
- Department of Pediatrics, Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon
| | | | - Sarah Mastel
- Department of Pediatrics, Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon
| | - Andrew R Riley
- Department of Pediatrics, Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
4
|
Employer branding at armed forces: current and potential employees’ perspective. EUROPEAN JOURNAL OF TRAINING AND DEVELOPMENT 2020. [DOI: 10.1108/ejtd-03-2019-0043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Drawing from the instrumental and symbolic framework for employer branding, this study aims to explore the perception of the current and potential employees for the Indian armed forces’ employer brand.
Design/methodology/approach
The study is conducted as a mixed-method approach in the form of qualitative and quantitative phases. In the qualitative phase, online reviews of current employees were collected from glassdoor.com and analysis was conducted. While in the quantitative phase, data were collected through questionnaire from 200 potential candidates who were interested in joining the armed forces.[AQ1] Confirmatory factor analysis (CFA) for instrument validity and regression analysis, for finding significant factors, were used for data analysis.
Findings
The qualitative results indicate that the current employee's perception fits the instrumental and symbolic framework. Additionally, variables such as discrimination in positions, risk, stress, confidence and personality development were also identified. The CFA and regression analysis results were found to be significant on the instrumental dimensions – job security and task diversity and symbolic dimensions – competence.
Originality/value
The study emphasizes the important instrumental and symbolic attributes for both current and potential employees. Thus, the armed forces can use these as a base for strategy formulation regarding employer branding.
Collapse
|
5
|
Kaur N, Vedel I, El Sherif R, Pluye P. Practical mixed methods strategies used to integrate qualitative and quantitative methods in community-based primary health care research. Fam Pract 2019; 36:666-671. [PMID: 30888015 PMCID: PMC6781936 DOI: 10.1093/fampra/cmz010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mixed methods (MM) are common in community-based primary health care (CBPHC) research studies. Several strategies have been proposed to integrate qualitative and quantitative components in MM, but they are seldom well conceptualized and described. The purpose of the present review was to identify and describe practical MM strategies and combinations of strategies used to integrate qualitative and quantitative methods in CBPHC research. METHODS A methodological review with qualitative synthesis (grouping) was performed. Records published in English in 2015 were retrieved from the Scopus bibliographic database. Eligibility criteria were: CBPHC empirical study, MM research with detailed description of qualitative and quantitative methods and their integration. Data were extracted from included studies and grouped using a conceptual framework comprised of three theoretical types of MM integration, the seven combinations of these types and nine practical strategies (three per type of integration) and multiple combinations of strategies. RESULTS Among the 151 articles reporting CBPHC and MM studies retrieved, 54 (35.7%) met the inclusion criteria for this review. The included studies provided examples of the three theoretical types of MM integration, the seven combinations of these types as well as the nine practical strategies. Overall, 15 combinations of these strategies were observed. No emerging strategy was observed that was not predicted by the conceptual framework. CONCLUSIONS This review can provide guidance to CBPHC researchers for planning, conducting and reporting practical strategies and combinations of strategies used for integrating qualitative and quantitative methods in MM research.
Collapse
Affiliation(s)
- Navdeep Kaur
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Reem El Sherif
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, Canada
| |
Collapse
|
6
|
Vedel I, Kaur N, Hong QN, El Sherif R, Khanassov V, Godard-Sebillotte C, Sourial N, Yang XQ, Pluye P. Why and how to use mixed methods in primary health care research. Fam Pract 2019; 36:365-368. [PMID: 31120129 PMCID: PMC6544942 DOI: 10.1093/fampra/cmy127] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Navdeep Kaur
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Quan Nha Hong
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Reem El Sherif
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Vladimir Khanassov
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Nadia Sourial
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Xin Qiang Yang
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Riley AR, Freeman KA. Impacting Pediatric Primary Care: Opportunities and Challenges for Behavioral Research in a Shifting Healthcare Landscape. BEHAVIOR ANALYSIS (WASHINGTON, D.C.) 2019; 19:23-38. [PMID: 31206011 PMCID: PMC6567998 DOI: 10.1037/bar0000114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Behavior analysts have long recognized the potential of a partnership with pediatric medicine as an opportunity to expand the influence of behavior analysis and positively impact population health. Despite significant achievements in this domain, the impact of behavioral science on the daily practice of pediatrics has been limited. In this commentary, the authors argue that the current health care and research environments are ripe for a renewed focus on behavioral modification in pediatric primary care, with a particular emphasis on the study of high-frequency, low-intensity problems. They provide some analysis of why behavioral pediatrics has failed to gain traction in primary care, describe aspects of the current primary care practice and research landscapes that provide opportunities for an expanded portfolio of research, identify several exemplars from the behavior analytic literature that have influenced pediatric primary care or have the potential to do so, and make recommendations for producing influential data.
Collapse
Affiliation(s)
- Andrew R Riley
- Institute on Development & Disability, Department of Pediatrics, Oregon Health and Science University
| | - Kurt A Freeman
- Institute on Development & Disability, Department of Pediatrics, Oregon Health and Science University
| |
Collapse
|
8
|
Al-Ganmi AHA, Perry L, Gholizadeh L, Alotaibi AM. Behaviour change interventions to improve medication adherence in patients with cardiac disease: Protocol for a mixed methods study including a pilot randomised controlled trial. Collegian 2018. [DOI: 10.1016/j.colegn.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
9
|
Revisiting the difference between mixed methods and multimethods: Is it all in the name? ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s11135-018-0700-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
10
|
Gupta M, Bosma H, Angeli F, Kaur M, Chakrapani V, Rana M, van Schayck OC. A mixed methods study on evaluating the performance of a multi-strategy national health program to reduce maternal and child health disparities in Haryana, India. BMC Public Health 2017; 17:698. [PMID: 28893214 PMCID: PMC5594476 DOI: 10.1186/s12889-017-4706-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A multi pronged community based strategy, known as National Rural Health Mission (NRHM), was implemented from 2005-06 to 2012-13 in India to curtail maternal and child health (MCH) disparities between poor and rich, rural and urban areas, and boys and girls,. This study aimed to determine the degree to which MCH plans of NRHM implemented, and resulted in improving the MCH outcomes and reducing the inequalities. METHODS An explanatory sequential mixed methods study was conducted, first to assess the degree of implementation of MCH plans by estimating the budget utilization rates of each MCH plan, and the effectiveness of these plans by comparing demographic health surveys data conducted post (2012-13), during (2007-08) and pre- (2002-04) NRHM implementation period, in the quantitative study. Then, perceptions and beliefs of stakeholders regarding extent and effectiveness of NRHM in Haryana were explored in the qualitative study during 2013. A logistic regression analysis was done for quantitative data, and inductive applied thematic analysis for qualitative data. The findings of the quantitative and qualitative parts of study were mixed at the interpretation level. RESULTS The MCH plans, like free ambulance service, availability of free drugs and logistics, accredited social health activists were fully implemented according to the budget spent on implementing these activities in Haryana. This was also validated by qualitative study. Availability of free medicines and treatment in the public health facilities had benefitted the poor patients the most. Accredited Social Health Activists scheme was also the most appreciated scheme that had increased the institutional delivery rates. There was acute shortage of human resources in-spite of full utilization of funds allocated for this plan. The results of the qualitative study validated the findings of quantitative study of significant (p < 0.05) improvement in MCH indicators and reduction in MCH disparities between higher and lower socioeconomic groups, and rural and urban areas. CONCLUSIONS MCH plans of NRHM might have succeeded in improving the MCH outcomes and reducing the geographical and socioeconomic MCH inequalities by successfully implementing the schemes like accredited social health activists, free ambulance services, free treatment and medicines in hospitals for the poor and in rural areas.
Collapse
Affiliation(s)
- Madhu Gupta
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Room No. 130, PGIMER, Chandigarh, India
| | - Hans Bosma
- Department of Social Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Federica Angeli
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Venkatesan Chakrapani
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Room No. 130, PGIMER, Chandigarh, India
| | - Monica Rana
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Room No. 130, PGIMER, Chandigarh, India
| | - Onno C.P. van Schayck
- Department of Family Practice, CAPHRI, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
11
|
Plouvier AOA, Olde Hartman TC, de Bont OA, Maandag S, Bloem BR, van Weel C, Lagro-Janssen ALM. The diagnostic pathway of Parkinson's disease: a cross-sectional survey study of factors influencing patient dissatisfaction. BMC FAMILY PRACTICE 2017; 18:83. [PMID: 28841849 PMCID: PMC5574149 DOI: 10.1186/s12875-017-0652-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 08/09/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The diagnostic pathway of Parkinson's disease (PD) is often complicated. Experiences during this pathway can affect patients' satisfaction and their confidence and trust in healthcare providers. Although healthcare providers cannot influence the impact of the diagnosis, they can influence how patients experience the pathway. This study, therefore, aims to provide insight into PD patients' dissatisfaction with the diagnostic pathway and to describe the factors that influence it. METHODS We carried out a cross-sectional survey study among 902 patient members of the Dutch Parkinson's Disease Association, who were each asked to write an essay about their diagnostic pathway. A coding format was developed to examine the content of these essays. Inter-observer agreement on coding patient dissatisfaction was calculated using Cohen's kappa. The χ2 test and a multivariable logistic regression analysis were performed to assess the relation between dissatisfaction and sex, level of education, duration of the pathway, communication with the general practitioner (GP) and the neurologist, the number of healthcare providers involved, whether or not a second opinion had taken place (including the person who initiated it) and diagnostic delay (taking into consideration who caused the delay according to the patient). A subgroup analysis was performed to gain insight into sex-related differences. RESULTS Of all patients, 16.4% explicitly described they were dissatisfied with the diagnostic pathway, whereas 4.8% were very satisfied. The inter-observer agreement on coding dissatisfaction was κ = 0.82. The chance of dissatisfaction increased with a lower level of education, the involvement of more than one additional healthcare provider, a second opinion initiated by the patient and delay caused by a healthcare provider. When only the GP and the neurologist were involved, women were more likely to be dissatisfied than men. CONCLUSIONS PD patients' dissatisfaction with the diagnostic pathway is related to a lower level of education, a second opinion initiated by the patient and experienced diagnostic delay. GPs can positively influence patients' experiences if they are aware of these risk factors for dissatisfaction and pay extra attention to communication and shared decision making. This will contribute to a trusting therapeutic relationship that is indispensable with progression of the disease.
Collapse
Affiliation(s)
- Annette O A Plouvier
- Department of Primary and Community Care, Radboud university medical center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud university medical center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Olga A de Bont
- Department of Primary and Community Care, Radboud university medical center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sjoerd Maandag
- Department of Primary and Community Care, Radboud university medical center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology and Parkinson Center Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care, Radboud university medical center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.,Department Health Services Research and Policy, Australian National University, Canberra, Australia
| | - Antoine L M Lagro-Janssen
- Department of Primary and Community Care, Radboud university medical center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
12
|
Amorin-Woods LG, Parkin-Smith GF, Nedkoff L, Fisher C. Critique of a practice-based pilot study in chiropractic practices in Western Australia. Chiropr Man Therap 2016; 24:38. [PMID: 27729973 PMCID: PMC5046802 DOI: 10.1186/s12998-016-0117-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/01/2016] [Indexed: 01/30/2023] Open
Abstract
Background Practice-based data collection can offer insight into the nature of chiropractic practice and contribute to resolving the conundrum of the chiropractic profession’s role in contemporary healthcare, subsequently informing care service policy. However, there is little formal data available about chiropractic practice to inform decision-makers about the nature and role of chiropractic within the context of a modern multidisciplinary healthcare context in Australia, particularly at a local and regional level. Methods This was a mixed-methods data transformation model (qualitative to quantitative) pilot study the purpose of which was to provide a critique of the research design and collect data from a selected sample of chiropractic practices in Western Australia, with a view to offer recommendations related to the design, feasibility and implementation of a future confirmatory study. Results A narrative critique of the research methods of this pilot study is offered in this paper covering: (a) practice and patient recruitment, (b) enrollment of patients, (c) data collection methods, (d) acceptability of the study methods, (e) sample size calculations, and (f) design critique. Conclusions The result of this critique provides a sensible sample size estimate and recommendations as to the design and implementation of a future confirmatory study. Furthermore, we believe that a confirmatory study is not only feasible, but indeed necessary, with a view to offer meaningful insight into chiropractic practice in Western Australia. Trial registration ACTRN12616000434493 Australian New Zealand Clinical Trials Registry (ANZCTR). Registered 5 April 2016. First participant enrolled 01 July 2014, retrospectively registered. Electronic supplementary material The online version of this article (doi:10.1186/s12998-016-0117-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lyndon G Amorin-Woods
- School of Health Professions (Discipline of Chiropractic) Murdoch University, Perth, Western Australia Australia ; Murdoch University Chiropractic Clinic, South Street Campus, 90 South Street, Murdoch, Western Australia 6150 Australia
| | - Gregory F Parkin-Smith
- General Practice and Emergency Medicine Registrar, Busselton, Western Australia 6160 Australia
| | - Lee Nedkoff
- School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, 35 Stirling Highway (M431), Crawley, Perth, Western Australia 6009 Australia
| | - Colleen Fisher
- School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, 35 Stirling Highway (M431), Crawley, Perth, Western Australia 6009 Australia
| |
Collapse
|
13
|
Rooks RN, Ford CD. Family Health History and Behavioral Change among Undergraduate Students: A Mixed Methods Study. Health (London) 2016. [DOI: 10.4236/health.2016.84034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
14
|
Merolli M, Gray K, Martin-Sanchez F, Mantopoulos S, Hogg M. Using Social Media While Waiting in Pain: A Clinical 12-Week Longitudinal Pilot Study. JMIR Res Protoc 2015; 4:e101. [PMID: 26254245 PMCID: PMC4705018 DOI: 10.2196/resprot.4621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/20/2015] [Accepted: 07/10/2015] [Indexed: 01/06/2023] Open
Abstract
Background Chronic pain places an enormous burden on health care systems. Multidisciplinary pain management services are well documented as an effective means to improve patient outcomes. However, waiting lists to access these services are long and outcomes deteriorate. Innovative solutions such as social media are gaining attention as a way to decrease this burden and improve outcomes. It is a challenge to design research that demonstrates whether social media are acceptable to patients and clinically effective. Objective The aim was to conduct a longitudinal pilot study to understand what aspects of research design are key to the success of running a larger-scale study of social media use in the clinical management of chronic pain. Methods A 12-week study examined social media use by patients on the waiting list for the Royal Melbourne Hospital Pain Management Service. Selected social media resources were suggested for use by patients waiting for an appointment at the clinic. Patients filled out measures for pain interference and pain self-efficacy before and after the study. Follow-up was conducted at monthly intervals via telephone semistructured interviews to discuss engagement and garner individual perceptions towards social media use. A social media-use instrument was also administered as part of the after-study questionnaire. Results Targeted recruitment refined 235 patient referrals to 138 (58.7%) suitable potential participants. Contact was made with 84 out of 138 (60.9%) patients. After a further exclusion of 54 out of 84 (64%) patients for various reasons, this left 30 out of 84 (36%) patients fitting the inclusion criteria and interested in study participation. A final study cohort of 17 out of 30 (57%) was obtained. Demographics of the 17 patients were mixed. Low back pain was the primary condition reported as leading to chronic pain. Semistructured interviews collected data from 16 out of 17 (94%) patients who started the trial, and at final follow-up 9 out of 17 (53%) patients completed questionnaires. Low specificity of the resources to one’s condition and time poorness may have been barriers to engagement. Conclusions Results suggest that with refinements, this study design can be implemented successfully when conducting a larger social media study. At present, comment cannot be made on what effect using social media can have on patients on hospital waiting lists, nor whether those who use social media while waiting in pain achieve better outcomes from eventual participation in a chronic pain program. Long-term follow-up should be included in future studies to answer this. Future research should focus on multicenter randomized controlled trials, involving patients in the intervention design for improved participation and outcomes and for evidence to be sound.
Collapse
Affiliation(s)
- Mark Merolli
- Health and Biomedical Informatics Centre, The University of Melbourne, Melbourne, Australia.
| | | | | | | | | |
Collapse
|
15
|
Monaghan T. A critical analysis of the literature and theoretical perspectives on theory-practice gap amongst newly qualified nurses within the United Kingdom. NURSE EDUCATION TODAY 2015; 35:e1-e7. [PMID: 25862073 DOI: 10.1016/j.nedt.2015.03.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 02/28/2015] [Accepted: 03/10/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This critical analysis of the literature examines the factors and theoretical perspectives contributing to the theory-practice gap for newly qualified nurses within the United Kingdom. This article aspires to inform, guide and promote effective nursing education both academically and practically. DESIGN A systematic search strategy was conducted to identify relevant literature covering the period of 2000-2014, to include only contemporary theoretical perspectives coinciding with the dearth of contemporary literature post Project 2000. DATA SOURCES The literature was systematically investigated utilising nursing research databases, the Cumulative Index of Nursing and Allied Health Literature, Allied and Complementary Medicine, the U.S. National Library of Medicine and Internurse. REVIEW METHODS To satisfy the search criteria only articles conducted within the United Kingdom and written in the English language were included. Only literature including nurses and newly qualified nurses were included. To identify relevant literature a series of key words were utilised. RESULTS Systematic review of the literature revealed that newly qualified nurses feel unprepared for practice, lacking confidence in their own abilities. It was also felt by newly qualified nurses that not enough time was dedicated to the production of clinical skills during their training. The use of preceptorship programmes was found to reduce the transitional stress associated with becoming a qualified nursing practitioner. CONCLUSIONS Despite the increasing research being undertaken in the area of theory-practice gap there is still a need for nursing educators, practice areas and regulatory bodies to invest further in research. The effects of preceptorship and simulation exercises in particular require more research to provide regulatory bodies with enough evidence to make an informed decision as to whether their use should be mandatory.
Collapse
|
16
|
Plouvier AOA, Olde Hartman TC, van Weel C, Bloem BR, Lagro-Janssen ALM. Transitions in Parkinson's disease in primary care: protocol of a longitudinal mixed methods study. BMJ Open 2015; 5:e007171. [PMID: 26038355 PMCID: PMC4458602 DOI: 10.1136/bmjopen-2014-007171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Parkinson's disease affects many aspects of the lives of patients and their relatives. Patients must adapt continuously to disabilities that necessitate changes in (medical) support, such as domestic adjustments, involvement of (non)professional caregivers or admission to hospital. Such changes mark a transition: a transfer of a patient between levels or locations of care. Transitions are likely to be multifold and complex, given that Parkinson's disease care extends across all echelons of healthcare. Patients and relatives are vulnerable during a transition, which imposes risks for their safety and quality of life. Guidance by the general practitioner, who knows the preferences of the patient, can help to overcome challenges associated with a transition. However, patient-centred primary care requires insight into the transitions patients with Parkinson's disease encounter. We aim to examine these transitions and the way patients, relatives and general practitioners experience them and cope with them. Moreover, we will study the patients' expectations of their general practitioner during a transition and the general practitioners' views on their role. METHODS AND ANALYSIS A longitudinal mixed methods study will be conducted, using qualitative research methods combined with quantitative data as a validated questionnaire on quality of life. Patients will be asked to make a video diary every 2 weeks for a period of 1 year. Once they encounter a transition, patients and their general practitioners will be interviewed to identify causes and consequences of the transition. The verbatim transcripts of the videos and interviews will be analysed according to the principles of constant comparative analysis. ETHICS AND DISSEMINATION Ethical approval was not needed according to Dutch legislation. Informed consent of patients, relatives and general practitioners will be obtained. We will disseminate the results in peer-reviewed journals, at research conferences and on the website of the Dutch Parkinson's Disease Association.
Collapse
Affiliation(s)
- Annette O A Plouvier
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
- Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia
| | - Bastiaan R Bloem
- Department of Neurology, Parkinson Center Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Antoine L M Lagro-Janssen
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| |
Collapse
|
17
|
Hampson C, Smith SJ. Helping occupational performance through engagement: A service evaluation of a programme for informal carers of people with dementia. Br J Occup Ther 2015. [DOI: 10.1177/0308022614563941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Statement of context The Helping Occupational Performance through Engagement programme is a series of workshops which aim to equip informal caregivers with the skills and knowledge they require to engage a person with dementia in meaningful daily occupations. Reflection on practice Following the initial implementation of the programme, a service evaluation was carried out to establish whether these aims were being met. The evaluation took a mixed methods approach, combining questionnaire and focus group data obtained from participants of the programme. Implications for practice Results demonstrated that whilst in general the programme is fulfilling its aims, further evaluation is required to establish the long-term impact of the programme.
Collapse
Affiliation(s)
- Caroline Hampson
- Clinical Specialist Occupational Therapist, Lancashire Care NHS Foundation Trust, Burnley, UK
| | - Sarah Jane Smith
- Senior Lecturer and Head of Education Programmes, School of Dementia Studies, University of Bradford, Bradford, UK
| |
Collapse
|
18
|
Increasing access to fresh produce by pairing urban farms with corner stores: a case study in a low-income urban setting. Public Health Nutr 2015; 18:2770-4. [PMID: 25649045 DOI: 10.1017/s1368980015000051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Our objective was to pilot collaborations between two urban farms with two corner stores to increase access to fresh produce in low-income neighbourhoods. DESIGN We conducted a pre-post evaluation of two farm-store collaborations using quantitative distribution and sales data. Using semi-structured interviews, we qualitatively assessed feasibility of implementation and collaboration acceptability to farmers and storeowners. SETTING Low-income urban neighbourhoods in Baltimore, MD, USA in 2012. SUBJECTS Pair #1 included a 0·25 acre (0·1 ha) urban farm with a store serving local residents and was promoted by the neighbourhood association. Pair #2 included a 2 acre (0·8 ha) urban farm with a store serving bus commuters. RESULTS Produce was delivered all nine intervention weeks in both pairs. Pair #1 produced a significant increase in the mean number of produce varieties carried in the store by 11·3 (P<0·01) and sold 86 % of all items delivered. Pair #2 resulted in a non-significant increase in the number of produce varieties carried by 2·2 (P=0·44) and sold 63 % of all items delivered. CONCLUSIONS Our case study suggests that pairing urban farms with corner stores for produce distribution may be feasible and could be a new model to increase access to fruits and vegetables among low-income urban neighbourhoods. For future programmes to be successful, strong community backing may be vital to support produce sales.
Collapse
|
19
|
Krist AH, Aycock RA, Etz RS, Devoe JE, Sabo RT, Williams R, Stein KL, Iwamoto G, Puro J, Deshazo J, Kashiri PL, Arkind J, Romney C, Kano M, Nelson C, Longo DR, Wolver S, Woolf SH. MyPreventiveCare: implementation and dissemination of an interactive preventive health record in three practice-based research networks serving disadvantaged patients--a randomized cluster trial. Implement Sci 2014; 9:181. [PMID: 25500097 PMCID: PMC4269965 DOI: 10.1186/s13012-014-0181-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 11/24/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Evidence-based preventive services for early detection of cancer and other health conditions offer profound health benefits, yet Americans receive only half of indicated services. Policy initiatives promote the adoption of information technologies to engage patients in care. We developed a theory-driven interactive preventive health record (IPHR) to engage patients in health promotion. The model defines five levels of functionality: (1) collecting patient information, (2) integrating with electronic health records (EHRs), (3) translating information into lay language, (4) providing individualized, guideline-based clinical recommendations, and (5) facilitating patient action. It is hypothesized that personal health records (PHRs) with these higher levels of functionality will inform and activate patients in ways that simpler PHRs cannot. However, realizing this vision requires both technological advances and effective implementation based upon clinician and practice engagement. METHODS/DESIGN We are starting a two-phase, mixed-method trial to evaluate whether the IPHR is scalable across a large number of practices and how its uptake differs for minority and disadvantaged patients. In phase 1, 40 practices from three practice-based research networks will be randomized to add IPHR functionality to their PHR versus continue to use their existing PHR. Throughout the study, we will engage intervention practices to locally tailor IPHR content and learn how to integrate new functions into their practice workflow. In phase 2, the IPHR to all nonintervention practices to observe whether the IPHR can be implemented more broadly (Scalability). Phase 1 will feature an implementation assessment in intervention practices, based on the RE-AIM model, to measure Reach (creation of IPHR accounts by patients), Adoption (practice decision to use the IPHR), Implementation (consistency, fidelity, barriers, and facilitators of use), and Maintenance (sustained use). The incremental effect of the IPHR on receipt of cancer screening tests and shared decision-making compared to traditional PHRs will assess Effectiveness. In phase 2, we will assess similar outcomes as phase 1 except for effectiveness. DISCUSSION This study will yield information about the effectiveness of new health information technologies designed to actively engage patients in their care as well as information about how to effectively implement and disseminate PHRs by engaging clinicians. TRIAL REGISTRATION ClinicalTrials.gov: NCT02138448.
Collapse
Affiliation(s)
- Alex H Krist
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Rebecca A Aycock
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Rebecca S Etz
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Jennifer E Devoe
- />OCHIN, Portland, OR, Oregon
- />Department of Family Medicine, Oregon Health & Science University, Portland, OR, Oregon
- />Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, Oregon
| | - Roy T Sabo
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
- />Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Robert Williams
- />Department of Family Medicine, University of New Mexico, Albuquerque, NM Mexico
| | - Karen L Stein
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Gary Iwamoto
- />Department of Internal Medicine, University of New Mexico, Albuquerque, NM Mexico
| | | | - Jon Deshazo
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Paulette Lail Kashiri
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
| | | | - Crystal Romney
- />Department of Family Medicine, University of New Mexico, Albuquerque, NM Mexico
| | - Miria Kano
- />Department of Family Medicine, University of New Mexico, Albuquerque, NM Mexico
| | | | - Daniel R Longo
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Susan Wolver
- />Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Steven H Woolf
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
- />Center on Society and Health, Virginia Commonwealth University, Richmond, VA, Virginia
| |
Collapse
|
20
|
Birt L, Emery JD, Prevost AT, Sutton S, Walter FM. Psychological impact of family history risk assessment in primary care: a mixed methods study. Fam Pract 2014; 31:409-18. [PMID: 24728773 PMCID: PMC5926455 DOI: 10.1093/fampra/cmu012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Routine family history risk assessment for chronic diseases could enable primary care practitioners to efficiently identify at-risk patients and promote preventive management strategies. OBJECTIVES To investigate patients' understanding and responses to family history risk assessment in primary care. METHOD A mixed methods study set in 10 Eastern England general practices. Participants in a family history questionnaire validation study were triaged into population or increased risk for four chronic diseases (type 2 diabetes, cardiovascular disease, breast cancer, colorectal cancer). Questionnaires completed immediately prior to the family history consultation (baseline) and 4 weeks later (follow-up) assessed the psychological impact, including State-Trait Anxiety Inventory scores. Semi-structured interviews explored the meaning participants gave to their personal familial disease risk. RESULTS Four hundred and fifty-three participants completed both baseline and follow-up questionnaires and 30 were interviewed. At follow-up, there was no increase in anxiety among either group, or differences between the groups [difference in mean change 0.02, 95% confidence interval -2.04, 2.08, P = 0.98]. There were no significant changes over time in self-rated health in either group. At follow-up, participants at increased risk (n = 153) were more likely to have recent changes to behaviour and they had stronger intentions to make changes to diet (P = 0.001), physical activity (P = 0.006) and to seek further information in the future than those at population risk (n = 300; P < 0.001). Using qualitative analysis, five themes were developed representing ways in which participants gave meaning to familial disease risk ('Being reassured', 'Controlling risk', 'Dealing with it later', 'Beyond my control', 'Disbelieving the risk'). The meanings they attributed to increased risk appeared to shape their intention to undertake behaviour change. CONCLUSION Routine assessment for familial risk of chronic diseases may be undertaken in primary care without causing anxiety or reducing self-rated health. Patient responses to family history risk assessment may inform promotion of preventive management strategies.
Collapse
Affiliation(s)
- Linda Birt
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK,
| | - Jon D Emery
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK, General Practice and Primary Care Academic Centre, University of Melbourne, Parkville VIC 3010, Australia, School of Primary Aboriginal and Rural Health Care, University of Western Australia, Crawley WA 6009, Australia
| | - A Toby Prevost
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK, King's College London, Department of Primary Care and Public Health Sciences, Capital House, London, UK and
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK, General Practice and Primary Care Academic Centre, University of Melbourne, Parkville VIC 3010, Australia, School of Primary Aboriginal and Rural Health Care, University of Western Australia, Crawley WA 6009, Australia
| |
Collapse
|
21
|
Glasgow RE, Kurz D, Dickman JM, Osuna D, Strycker L, King DK. Linking internet-based diabetes self-management to primary care: lessons learned and implications for research translation and practice implementation. Transl Behav Med 2013; 2:313-21. [PMID: 24073131 DOI: 10.1007/s13142-012-0109-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There has been little discussion of or research on the key translational issue of how to integrate patient self-management programs across multiple primary care clinics within an HMO. The purpose of this study was to summarize our experiences and lessons learned in trying to integrate information from a web-based diabetes self-management program into primary care and the electronic health record (EHR). We describe plans, implementation, adaptations made, and data on patient and physician reactions to the My Path diabetes self-management program provided to 331 adult primary care patients. Mixed methods results revealed that, despite the availability of a state-of-the-art EHR, the intervention was not well integrated into primary care. Information from health-promotion and disease management programs, even within the same organization and with advanced EHR systems, is challenging to integrate into busy primary care.
Collapse
Affiliation(s)
- Russell E Glasgow
- Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd., Room 6144, Rockville, MD 20852 USA
| | | | | | | | | | | |
Collapse
|
22
|
olde Hartman TC, van Rijswijk E, van Dulmen S, van Weel-Baumgarten E, Lucassen PLBJ, van Weel C. How patients and family physicians communicate about persistent medically unexplained symptoms. A qualitative study of video-recorded consultations. PATIENT EDUCATION AND COUNSELING 2013; 90:354-360. [PMID: 21482059 DOI: 10.1016/j.pec.2011.02.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 02/22/2011] [Accepted: 02/23/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To study doctor-patient interaction styles in consultations with patients presenting persistent medically unexplained symptoms (MUS) and to study on which stages of the consultation patients and doctors focus within the available time. METHODS exploratory, qualitative analysis of transcripts of 20 videotaped consultations between family physicians (FP) and persistent MUS patients. RESULTS Patients presented many symptoms in a rather unstructured way. However, FPs hardly used structuring techniques such as agenda setting and summarizing. Patients with persistent MUS got much opportunity to tell their story, but the reasons for encounter, their beliefs and concerns were not discussed in a structured manner. Although consultations were focused on these issues, mostly patients themselves initiated discussion of their ideas, concerns and expectations. FPs' extensive explanations of the origin of the symptoms often did not take patients' beliefs and concerns into account. CONCLUSIONS Due to patients' multiple symptom presentation and the absence of FPs' structuring techniques, consultations of persistent MUS patients proceed rather unfocused. However, patients got ample opportunity to tell their story. PRACTICE IMPLICATIONS Persistent MUS patients might benefit from structured consultations focused on the exploration of the reason for encounter.
Collapse
Affiliation(s)
- Tim C olde Hartman
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
23
|
Bourke-Taylor H, Pallant JF, Law M, Howie L. Predicting mental health among mothers of school-aged children with developmental disabilities: the relative contribution of child, maternal and environmental factors. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1732-40. [PMID: 22699247 DOI: 10.1016/j.ridd.2012.04.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 04/14/2012] [Accepted: 04/16/2012] [Indexed: 05/26/2023]
Abstract
AIM Many mothers of children with developmental disabilities are known to experience high levels of stress, and compromised mental health. Research is crucial to better understand and assist mothers with compromised mental health, and ultimately better service families raising and supporting a child with a disability. METHOD Data were collected using cross sectional mail-out survey with follow up phone call. Instruments included the Short Form 36 version 2 (SF-36v2) and instruments that measured maternal, child and environmental factors. Descriptive statistics examined characteristics of participants. Correlation, t-tests, and multiple regression analyses were used to identify factors associated with mothers' mental health. RESULTS Mothers (N=152) cared for a school-aged child (aged 5-18 years) with high care needs and developmental disabilities including autism spectrum disorder (n=94); cerebral palsy (n=29); attention deficit hyperactivity disorder (n=19). Factors associated with maternal mental health included the child's psychosocial health (r=.36) and challenging behaviour (r=-.33); maternal empowerment (r=.40); maternal participation in health promoting activities (r=.43); and the child's unmet service needs (r=-.29). The strongest predictors of maternal mental health in this cross sectional study were maternal participation in healthy activity and empowerment, the child's emotional functioning and unmet service needs. CONCLUSION This study identified maternal factors as the most important influence on self reported mental health among this sample of mothers. Findings suggest that service changes that provide mothers with information about their own health and need for health enhancing activities, as well as education that empowers mothers to manage and master their child's disability and needs, may contribute to maternal mental health and well being.
Collapse
Affiliation(s)
- Helen Bourke-Taylor
- Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University-Peninsula Campus, PO Box 527, Frankston, Victoria 3199, Australia.
| | | | | | | |
Collapse
|
24
|
Mixed methods analysis of participant attrition in the nurse-family partnership. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2012; 13:219-28. [PMID: 22562646 DOI: 10.1007/s11121-012-0287-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Participant attrition is a major influence on the effectiveness of evidence-based interventions. Assessing predictors of participant attrition and nurse and site characteristics associated with it could lay a foundation for increasing retention and engagement. We examined this issue in the national expansion of the Nurse-Family Partnership, an evidence-based program of prenatal and infancy home visiting for low-income, first-time mothers, their children, and families. Using a mixed methods approach, we examined participant, nurse, and site predictors of participant attrition and completed home visits. We used mixed multivariate regression models to identify participant, nurse, program, and site predictors of addressable attrition and completed home visits during pregnancy and the first year of the child's life for 10,367 participants at 66 implementation sites. We then conducted semi-structured interviews with nurse home visitors and supervisors at selected sites with the highest (N = 5 sites) and lowest (N = 6 sites) rates of participant addressable attrition and employed qualitative methods to synthesize themes that emerged in nurses' descriptions of the strategies they used to retain participants. Mothers who were younger, unmarried, African American, and visited by nurses who ceased employment had higher rates of attrition and fewer home visits. Hispanic mothers, those living with partners, and those employed at registration had lower rates of attrition. Those who were living with partners and employed had more home visits. Nurses in high retention sites adapted the program to their clients' needs, were less directive, and more collaborative with them. Increasing nurses' flexibility in adapting this structured, evidence-based program to families' needs may increase participant retention and completed home visits.
Collapse
|
25
|
Nash C, Martindale R, Collins D, Martindale A. Parameterising expertise in coaching: past, present and future. J Sports Sci 2012; 30:985-94. [PMID: 22568585 DOI: 10.1080/02640414.2012.682079] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Research into expertise is increasing across a number of domains pertinent to sport. Whilst this increase is particularly apparent in coaching, a key question is how to identify an expert coach? Accordingly, this paper draws upon existing studies into expert coaches to address this issue; in particular, the criteria used to select expert coaches for research purposes and the methods used in expert coach research. Based on these data, we contend that the elements of expertise are not fully reflected within currently accepted criteria which, in turn, results in expert coaching research not necessarily identifying the appropriate individuals to study. The paper concludes with recommendations for more rigorous criteria for selecting expert coaches and highlights the associated implications for the future training and development of expert coaches.
Collapse
|
26
|
Pownall JD, Jahoda A, Hastings RP. Sexuality and sex education of adolescents with intellectual disability: mothers' attitudes, experiences, and support needs. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2012; 50:140-154. [PMID: 22642968 DOI: 10.1352/1934-9556-50.2.140] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Few studies have considered families' views about adolescents' sexual development. The authors compared attitudes and behaviors of mothers of young people with (n = 30) and without intellectual disability (n = 30). Both groups placed similar importance on dealing with their children's developing sexuality and were similarly confident in doing so. Mothers of young people with intellectual disability held more cautious attitudes about contraception, readiness to learn about sex, and decisions about intimate relationships. Mothers expressed concerns about their children with intellectual disability and sexual vulnerability. They had also spoken about fewer sexual topics with their children and began these discussions when their children were older. The findings can inform more sensitive supports and materials to help families deal with the sexual development of their offspring.
Collapse
|
27
|
Bourke-Taylor H, Howie L, Law M, Pallant JF. Self-reported mental health of mothers with a school-aged child with a disability in Victoria: a mixed method study. J Paediatr Child Health 2012; 48:153-9. [PMID: 21470330 DOI: 10.1111/j.1440-1754.2011.02060.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This research investigated the mental health of mothers of school-aged children with disabilities in Victoria, Australia. METHODS A mixed method triangulation design model was used to investigate the mental health of mothers (n= 152) of school-aged children with developmental disabilities. Self-reported medical history and completion of the Short Form Health Survey Version 2 were used to collect data via mail-out survey and follow-up phone interview. RESULTS Mothers reported subjective mental health two standard deviations below other Australians and higher rates of depression and anxiety that other Australian women and the adult population in general. Half of participants reported that their health affected their ability to provide the care that their child needed, and half experienced frequent interrupted sleep secondary to the care of their child with a disability. Significantly poorer mental health was reported by mothers with a pre-school-aged child as well as a child with a disability (P < 0.001), mothers with more than one child with a disability (P= 0.038), mothers of children with autism spectrum disorder (ASD) (P= 0.026), and mothers who recognised that their health affected care giving (P < 0.001). CONCLUSIONS The reported mental health of participants in this study indicates that further attention is needed to action health strategies to support mothers of children with disabilities. Health programs and policy that will identify mothers in need of assistance, as well as management strategies that will adequately support mental wellness in mothers is required in Australia.
Collapse
Affiliation(s)
- Helen Bourke-Taylor
- Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, Australia.
| | | | | | | |
Collapse
|
28
|
Stange KC. Refocusing knowledge generation, application, and education: raising our gaze to promote health across boundaries. Am J Prev Med 2011; 41:S164-9. [PMID: 21961659 PMCID: PMC4079111 DOI: 10.1016/j.amepre.2011.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 06/06/2011] [Accepted: 06/08/2011] [Indexed: 10/17/2022]
Affiliation(s)
- Kurt C Stange
- Case Western Reserve University, Department of Family Medicine, Cleveland, Ohio 44106, USA.
| |
Collapse
|
29
|
Arnault DS, Fetters MD. RO1 Funding for Mixed Methods Research: Lessons learned from the Mixed-Method Analysis of Japanese Depression Project. JOURNAL OF MIXED METHODS RESEARCH 2011; 5:309-329. [PMID: 25419196 PMCID: PMC4240524 DOI: 10.1177/1558689811416481] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Mixed methods research has made significant in-roads in the effort to examine complex health related phenomenon. However, little has been published on the funding of mixed methods research projects. This paper addresses that gap by presenting an example of an NIMH funded project using a mixed methods QUAL-QUAN triangulation design entitled "The Mixed-Method Analysis of Japanese Depression." We present the Cultural Determinants of Health Seeking model that framed the study, the specific aims, the quantitative and qualitative data sources informing the study, and overview of the mixing of the two studies. Finally, we examine reviewer's comments and our insights related to writing mixed method proposal successful for achieving RO1 level funding.
Collapse
Affiliation(s)
| | - Michael D. Fetters
- University of Michigan Department of Family Medicine 1018 Fuller St Ann Arbor, Michigan 48104-1213 Tel. 734-998-7120 X 341 Fax 734-998-7335
| |
Collapse
|
30
|
Melanson M, Grossberndt A, Klowak M, Leong C, Frost EE, Prout M, Le Dorze JA, Gramlich C, Doupe M, Wong L, Esfahani F, Gomori A, Namaka M. Fatigue and cognition in patients with relapsing multiple sclerosis treated with interferon β. Int J Neurosci 2011; 120:631-40. [PMID: 20942577 DOI: 10.3109/00207454.2010.511732] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Fatigue and cognitive deficits are common symptoms affecting patients with multiple sclerosis. METHODS The effects of interferon beta on fatigue and cognitive deficits were assessed in 50 patients with relapsing multiple sclerosis (recruited at a single center). The pre-treatment assessments were performed on visits 1 and 2 (Months 0 and 3). Patients started treatment with subcutaneous interferon beta-1a or beta-1b, or intramuscular interferon beta-1a at Month 3, with reassessment at visits 3 and 4 (6 and 12 months, respectively). Co-primary endpoints were change in fatigue (Modified Fatigue Impact Scale) and change in cognition (Brief Repeatable Battery of Neuropsychological Tests) from pre-treatment to visits 3 and 4. Follow-up data were obtained for 40 patients. RESULTS The pre-treatment demographic and disease characteristics did not differ between groups. Improvements in fatigue levels were reported for patients receiving subcutaneous interferon beta-1a versus patients in the intramuscular interferon beta-1a group (p = .04) and in the interferon beta-1b group (p = .09). Improvements were also reported in five out of 17 cognitive indices for all the treatment groups. CONCLUSION The data suggest that interferon beta may reduce fatigue and cognitive deficits in patients with relapsing multiple sclerosis. Larger, randomized, and controlled studies are required to confirm our findings.
Collapse
Affiliation(s)
- Maria Melanson
- Multiple Sclerosis Clinic Health Sciences Centre, Winnipeg, Manitoba, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Bourke-Taylor H, Howie L, Law M. Barriers to maternal workforce participation and relationship between paid work and health. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2011; 55:511-520. [PMID: 21385261 DOI: 10.1111/j.1365-2788.2011.01407.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Families of children with disabilities experience extra financial strains, and mothers are frequently unable to participate in paid work because of caregiving obligations. METHODS A mailed survey and follow-up phone calls were used to gather data about mother's health, workforce participation and barriers to inclusion in the workplace (n = 152). Verbatim reports of issues that hindered workforce participation were analysed qualitatively to derive themes. Maternal health-related quality of life (HRQoL) was measured using the Short Form Health Survey Version 2 (SF-36v2). Norm-based conversions were used to compare HRQoL between working and non-working mothers and to compare to population norms. RESULTS Eighty-two per cent of mothers in the sample wanted and needed to work for pay but indicated over 300 issues that prevent their work participation. Data analysis revealed 26 common issues which prevent work participation. These issues fit into three main categories: mother-related reasons (28%), child-related reasons (29%) and service limitations (43%). Mothers who worked (n = 83) reported significantly better HRQoL than mothers who did not work (n = 69) on five of the eight SF-36v2 dimensions and overall mental health. CONCLUSIONS Compared to other working Australians, mothers in this study had higher education yet reported poorer health, lower family income and lower workforce participation. Respondents reported that service system limitations were the main barriers to participation in the paid workforce. Investigation of service changes such as increased respite care, availability of outside hours school care, improved professional competency and family-centred services is recommended in order to improve maternal participation in paid work.
Collapse
Affiliation(s)
- H Bourke-Taylor
- Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University-Peninsula Campus, Frankston, Victoria, Australia.
| | | | | |
Collapse
|
32
|
Kreps GL. Methodological diversity and integration in health communication inquiry. PATIENT EDUCATION AND COUNSELING 2011; 82:285-291. [PMID: 21353965 DOI: 10.1016/j.pec.2011.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 01/17/2011] [Indexed: 05/30/2023]
Abstract
Research on health communication is complicated by myriad individual, organizational, and societal factors that influence health-related decisions and behaviors, making it difficult to control for secular trends (uncontrolled social and environmental influences) that affect health care and health promotion practices. Sophisticated research on health communication must take into account the numerous situational, psychological, and societal factors to fully examine the often hidden dynamics of health care and health promotion. This essay examines major research challenges, strategies, and opportunities for making sense of the complexities of health communication processes, recommending the power of methodological diversity and integration for health research.
Collapse
Affiliation(s)
- Gary L Kreps
- Center for Health and Risk Communication, George Mason University, Fairfax, VA 22030-4444, USA.
| |
Collapse
|
33
|
Knops AM, Storm-Versloot MN, Mank APM, Ubbink DT, Vermeulen H, Bossuyt PMM, Goossens A. Factors influencing long-term adherence to two previously implemented hospital guidelines. Int J Qual Health Care 2010; 22:421-9. [PMID: 20716551 DOI: 10.1093/intqhc/mzq038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE AND SETTING After successful implementation, adherence to hospital guidelines should be sustained. Long-term adherence to two hospital guidelines was audited. The overall aim was to explore factors accounting for their long-term adherence or non-adherence. DESIGN AND PARTICIPANTS A fluid balance guideline (FBG) and body temperature guideline (BTG) were developed and implemented in our hospital in 2000. Long-term adherence was determined retrospectively based on data from patient files. Focus groups were launched to explore nurses' perceptions of barriers and facilitators regarding long-term adherence. The predominant themes from the nurses' focus groups were posed to clinicians in questionnaires. RESULTS Nurses involved in the FBG (overall adherence 100%) stated that adherence has immediate advantages in terms of safety and a gain in time. Nurses and oncologists acted unanimously which was thought to enhance adherence. On the other hand, opinions differed on the BTG within the nursing teams and medical staff (overall adherence 50%). Although the guideline discourages routine postoperative body temperature measurements, temperature should be measured according to the guideline in a considerable number of cases due to changes in patient characteristics since the year 2000. Therefore, adherence was judged to be rather complex. CONCLUSIONS To secure adherence to hospital guidelines after their successful implementation, guidelines should preferably be comprehensive in terms of being applicable to the majority of the patients in that particular setting and to the most common clinical situations. All healthcare professionals involved should be aware of its immediate benefits for themselves or to their patients.
Collapse
Affiliation(s)
- A M Knops
- Department of Quality Assurance and Process Innovation, Academic Medical Center, Room A3-503, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
34
|
Stange KC, Nutting PA, Miller WL, Jaén CR, Crabtree BF, Flocke SA, Gill JM. Defining and measuring the patient-centered medical home. J Gen Intern Med 2010; 25:601-12. [PMID: 20467909 PMCID: PMC2869425 DOI: 10.1007/s11606-010-1291-3] [Citation(s) in RCA: 335] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The patient-centered medical home (PCMH) is four things: 1) the fundamental tenets of primary care: first contact access, comprehensiveness, integration/coordination, and relationships involving sustained partnership; 2) new ways of organizing practice; 3) development of practices' internal capabilities, and 4) related health care system and reimbursement changes. All of these are focused on improving the health of whole people, families, communities and populations, and on increasing the value of healthcare. The value of the fundamental tenets of primary care is well established. This value includes higher health care quality, better whole-person and population health, lower cost and reduced inequalities compared to healthcare systems not based on primary care. The needed practice organizational and health care system change aspects of the PCMH are still evolving in highly related ways. The PCMH will continue to evolve as evidence comes in from hundreds of demonstrations and experiments ongoing around the country, and as the local and larger healthcare systems change. Measuring the PCMH involves the following: Giving primacy to the core tenets of primary care. Assessing practice and system changes that are hypothesized to provide added value Assessing development of practices' core processes and adaptive reserve. Assessing integration with more functional healthcare system and community resources. Evaluating the potential for unintended negative consequences from valuing the more easily measured instrumental features of the PCMH over the fundamental relationship and whole system aspects. Recognizing that since a fundamental benefit of primary care is its adaptability to diverse people, populations and systems, functional PCMHs will look different in different settings. Efforts to transform practice to patient-centered medical homes must recognize, assess and value the fundamental features of primary care that provide personalized, equitable health care and foster individual and population health.
Collapse
Affiliation(s)
- Kurt C Stange
- Family Medicine, Epidemiology & Biostatistics, Sociology and Oncology, Case Western Reserve University, 10900 Euclid Ave, LC 7136, Cleveland, OH 44106, USA.
| | | | | | | | | | | | | |
Collapse
|
35
|
Jones RM, Devers KJ, Kuzel AJ, Woolf SH. Patient-reported barriers to colorectal cancer screening: a mixed-methods analysis. Am J Prev Med 2010; 38:508-16. [PMID: 20409499 PMCID: PMC2946825 DOI: 10.1016/j.amepre.2010.01.021] [Citation(s) in RCA: 233] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Revised: 11/09/2009] [Accepted: 01/11/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND Barriers experienced by patients influence the uptake of colorectal cancer (CRC) screening. Prior research has quantified how often patients encounter these challenges but has generally not revealed their complex perspective and experience with barriers. PURPOSE This mixed-methods study was conducted to understand current perspectives on CRC screening. METHODS A two-part, mixed-methods study was conducted of primary care patients recruited from Virginia Ambulatory Care Outcomes Research Network practices. First, in June-July 2005 a survey was mailed to 660 patients aged 50-75 years posing an open-ended question about "the most important barrier" to CRC screening. Second, beginning in October 2005, seven gender- and largely race-specific focus groups involving 40 patients aged 45-75 years were conducted. Beginning in October 2005, survey verbatim responses were coded and quantitatively analyzed and focus group transcripts were qualitatively analyzed. RESULTS Responses to the open-ended survey question, answered by 74% of respondents, identified fear and the bowel preparation as the most important barriers to screening. Only 1.6% of responses cited the absence of physician advice. Focus group participants cited similar issues and other previously reported barriers, but their remarks exposed the intricacies of complex barriers, such as fear, lack of information, time, the role of physicians, and access to care. Participants also cited barriers that have little documentation in the literature, such as low self-worth, "para-sexual" sensitivities, fatalism, negative past experiences with testing, and skepticism about the financial motivation behind screening recommendations. CONCLUSIONS Mixed-methods analysis helps to disaggregate the complex nuances that influence patient behavior. In the present study, patients explained the web of influences on knowledge, motivation, and ability to undergo CRC screening, which clinicians and policymakers should consider in designing interventions to increase the level of screening.
Collapse
Affiliation(s)
- Resa M Jones
- Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
| | | | | | | |
Collapse
|
36
|
Jaén CR, Crabtree BF, Palmer RF, Ferrer RL, Nutting PA, Miller WL, Stewart EE, Wood R, Davila M, Stange KC. Methods for evaluating practice change toward a patient-centered medical home. Ann Fam Med 2010; 8 Suppl 1:S9-20; S92. [PMID: 20530398 PMCID: PMC2885721 DOI: 10.1370/afm.1108] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 12/16/2009] [Accepted: 01/19/2010] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Understanding the transformation of primary care practices to patient-centered medical homes (PCMHs) requires making sense of the change process, multilevel outcomes, and context. We describe the methods used to evaluate the country's first national demonstration project of the PCMH concept, with an emphasis on the quantitative measures and lessons for multimethod evaluation approaches. METHODS The National Demonstration Project (NDP) was a group-randomized clinical trial of facilitated and self-directed implementation strategies for the PCMH. An independent evaluation team developed an integrated package of quantitative and qualitative methods to evaluate the process and outcomes of the NDP for practices and patients. Data were collected by an ethnographic analyst and a research nurse who visited each practice, and from multiple data sources including a medical record audit, patient and staff surveys, direct observation, interviews, and text review. Analyses aimed to provide real-time feedback to the NDP implementation team and lessons that would be transferable to the larger practice, policy, education, and research communities. RESULTS Real-time analyses and feedback appeared to be helpful to the facilitators. Medical record audits provided data on process-of-care outcomes. Patient surveys contributed important information about patient-rated primary care attributes and patient-centered outcomes. Clinician and staff surveys provided important practice experience and organizational data. Ethnographic observations supplied insights about the process of practice development. Most practices were not able to provide detailed financial information. CONCLUSIONS A multimethod approach is challenging, but feasible and vital to understanding the process and outcome of a practice development process. Additional longitudinal follow-up of NDP practices and their patients is needed.
Collapse
Affiliation(s)
- Carlos Roberto Jaén
- Department of Family & Community Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Despite the use of quantitative and qualitative data in trauma research and therapy, mixed methods studies in this field have not been analyzed to help researchers designing investigations. This discussion begins by reviewing four core characteristics of mixed methods research in the social and human sciences. Combining these characteristics, the authors focus on four select mixed methods designs that are applicable in trauma research. These designs are defined and their essential elements noted. Applying these designs to trauma research, a search was conducted to locate mixed methods trauma studies. From this search, one sample study was selected, and its characteristics of mixed methods procedures noted. Finally, drawing on other mixed methods designs available, several follow-up mixed methods studies were described for this sample study, enabling trauma researchers to view design options for applying mixed methods research in trauma investigations.
Collapse
Affiliation(s)
- John W Creswell
- Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE 68502, USA.
| | | |
Collapse
|
38
|
Nagel T, Robinson G, Condon J, Trauer T. Approach to treatment of mental illness and substance dependence in remote Indigenous communities: Results of a mixed methods study. Aust J Rural Health 2009; 17:174-82. [DOI: 10.1111/j.1440-1584.2009.01060.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
39
|
Galvin R, Cusack T, Stokes E. To what extent are family members and friends involved in physiotherapy and the delivery of exercises to people with stroke? Disabil Rehabil 2009; 31:898-905. [DOI: 10.1080/09638280802356369] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
40
|
Ruffin MT, Creswell JW, Jimbo M, Fetters MD. Factors influencing choices for colorectal cancer screening among previously unscreened African and Caucasian Americans: findings from a triangulation mixed methods investigation. J Community Health 2009; 34:79-89. [PMID: 19082695 DOI: 10.1007/s10900-008-9133-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We investigated factors that influence choice of colorectal cancer (CRC) screening test and assessed the most- and least-preferred options among fecal occult blood testing (FOBT), flexible sigmoidoscopy, colonoscopy, and double contrast barium enema among adults with varied race, gender, and geographic region demographics. Mixed methods data collection consisted of 10 focus group interviews and a survey of the 93 focus group participants. Participants were >or=50 years of age and reported not having been screened for colorectal cancer in the last ten years. Analyses examined differences by race, gender, and geographic location. Participants had modest knowledge about CRC and there were fewer correct answers to knowledge questions by African Americans. Participants recognized value of early detection, and identified health symptoms and their doctor's recommendation as influential for obtaining CRC screening. They chose colonoscopy and FOBT as the most preferred tests, while barium enema was least preferred. The analysis revealed intra-group variations in preference, though there were no significant differences by race, gender, or location. Openness of discussing this sensitive topic, lack of knowledge about colorectal cancer and screening costs, and diversity of preferences expressed within study groups suggest the importance of patient-physician dialogue about colorectal cancer screening options. New approaches to promoting colorectal cancer screening need to explore methods to facilitate patients establishing and expressing preferences among the screening options.
Collapse
Affiliation(s)
- Mack T Ruffin
- Department of Family Medicine, University of Michigan Health System, Ann Arbor, MI 48104-1213, USA.
| | | | | | | |
Collapse
|
41
|
Nagel TM, Thompson C, Robinson G, Condon J, Trauer T. Two-way approaches to Indigenous mental health literacy. Aust J Prim Health 2009. [DOI: 10.1071/py08052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study was designed to provide important new information about relapse prevention in Indigenous 1 people with chronic mental illness. It aimed to explore Indigenous mental health promotion with Aboriginal mental health workers (AMHW) in order to develop strategies for effective mental health intervention. The research was conducted in three remote Indigenous communities in the top end of the Northern Territory with AMHW. Assessment, psycho-education, and care-planning resources were developed with local AMHW through exploration of local Indigenous perspectives of mental health promotion. Qualitative research methods and an ethnographic approach were used to elicit information, and data included key informant interviews, participant observation, music, photography and story telling. The study confirms that Indigenous people in remote communities prefer to use story telling and local language, local artwork and local music to convey health information. It also confirms that family and local practitioners are key cultural informants and that indirect, holistic and ‘two-way’ messages are preferred.
Collapse
|
42
|
|
43
|
Cardiac Rehabilitation Coordinators' Perceptions of Patient-Related Barriers to Implementing Cardiac Evidence-Based Guidelines. J Cardiovasc Nurs 2008; 23:449-57. [DOI: 10.1097/01.jcn.0000317450.64778.a0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
44
|
Olde Hartman T, Hassink-Franke L, Dowrick C, Fortes S, Lam C, van der Horst H, Lucassen P, van Weel-Baumgarten E. Medically unexplained symptoms in family medicine: defining a research agenda. Proceedings from WONCA 2007. Fam Pract 2008; 25:266-71. [PMID: 18596048 DOI: 10.1093/fampra/cmn041] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Medically unexplained symptoms (MUSs) are frequently presented in primary care. Unfortunately, knowledge of these patients and/or symptoms in primary care is still limited. Available research comes mainly from Europe and North America, while the perspectives of cultures such as Africa, Asia and South America are relatively unknown. To bring cultural perspectives together, a symposium and workshop on MUS in primary care was held at the WONCA World Conference 2007 in Singapore. OBJECTIVE Main goals of this symposium and workshop-apart from presenting ongoing research and bringing together experts in MUS-were to detect knowledge gaps in MUS and to establish priorities in MUS research. This publication focuses on the proposed research agenda. METHODS Using a nominal group technique, we generated research topics and set priorities. Research topics were grouped into research themes. RESULTS Participants' (66 researchers and GPs from 29 nationalities) most important research topics were 'formulating a broadly accepted definition of MUS', 'finding a strategy to recognize MUS better and at an earlier stage', 'studying the value of self-management and empowerment in patients with MUS' and 'finding predictors to decide which strategy will best help the individual patient with MUS'. Priorities in research themes of MUS are as follows: (i) therapeutic options for patients with MUS and (ii) problems in consultations with these patients. CONCLUSIONS More research on MUS in primary care is needed to improve the consultations with and management of these patients. Internationally primary care conferences are excellent for exchanging ideas and formulating central issues of research.
Collapse
Affiliation(s)
- Tc Olde Hartman
- Department of Family Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Mendlinger S, Cwikel J. Spiraling between qualitative and quantitative data on women's health behaviors: a double helix model for mixed methods. QUALITATIVE HEALTH RESEARCH 2008; 18:280-93. [PMID: 18216346 DOI: 10.1177/1049732307312392] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A double helix spiral model is presented which demonstrates how to combine qualitative and quantitative methods of inquiry in an interactive fashion over time. Using findings on women's health behaviors (e.g., menstruation, breast-feeding, coping strategies), we show how qualitative and quantitative methods highlight the theory of knowledge acquisition in women's health decisions. A rich data set of 48 semistructured, in-depth ethnographic interviews with mother-daughter dyads from six ethnic groups (Israeli, European, North African, Former Soviet Union [FSU], American/Canadian, and Ethiopian), plus seven focus groups, provided the qualitative sources for analysis. This data set formed the basis of research questions used in a quantitative telephone survey of 302 Israeli women from the ages of 25 to 42 from four ethnic groups. We employed multiple cycles of data analysis from both data sets to produce a more detailed and multidimensional picture of women's health behavior decisions through a spiraling process.
Collapse
|
46
|
Solberg LI. Improving medical practice: a conceptual framework. Ann Fam Med 2007; 5:251-6. [PMID: 17548853 PMCID: PMC1886486 DOI: 10.1370/afm.666] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 09/28/2006] [Accepted: 10/03/2006] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this article is to produce a relatively simple conceptual framework for guiding and studying practice improvement. METHODS I summarize the lessons from my experience with a variety of quality improvement research studies during the last 30 years, supplemented with relevant literature from both medicine and other industries about the issues associated with successful quality improvement. RESULTS My experience suggests that organizational leadership with an urgent vision for change, ability to manage the change process, and selection of systematic changes capable of fulfilling the vision are each critical for successful quality improvement. Published literature from other industries emphasizes the importance of a goal-directed change process managed by leaders who recognize the need to engage their employees and other leaders in a disciplined but flexible way that accommodates external and internal factors and uses teams and group learning. It also suggests the importance of organizational context and the level of external and internal barriers and facilitators for change. The resulting model proposes that priority, change process, and care process content are necessary for measurable improvements in quality of care and patient outcomes, although internal and external barriers must also be attended to and addressed. CONCLUSION This framework may provide a guide to those in the front lines of care who would like to make the care transformations that are needed to greatly improve care. It may also be helpful to those who are developing or testing interventions and recruiting medical practices for such change efforts.
Collapse
Affiliation(s)
- Leif I Solberg
- HealthPartners Research Foundation, Minneapolis, Minn 55440, USA.
| |
Collapse
|
47
|
Handley MA, Hall C, Sanford E, Diaz E, Gonzalez-Mendez E, Drace K, Wilson R, Villalobos M, Croughan M. Globalization, binational communities, and imported food risks: results of an outbreak investigation of lead poisoning in Monterey County, California. Am J Public Health 2007; 97:900-6. [PMID: 17395841 PMCID: PMC1854874 DOI: 10.2105/ajph.2005.074138] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2005] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Although the burden of lead poisoning has decreased across developed countries, it remains the most prevalent environmental poison worldwide. Our objective was to investigate the sources of an outbreak of lead poisoning in Monterey County, California. METHODS An investigation in 3 county health department clinics in Monterey County, California, was conducted between 2001 and 2003 to identify risk factors for elevated blood lead levels (> or = 10 microg/dL) among children and pregnant women. RESULTS The prevalence of elevated blood lead levels was significantly higher in 1 of the 3 clinics (6% among screened children and 13% among prenatal patients). Risk factors included eating imported foods (relative risk [RR]=3.4; 95% confidence interval [CI]=1.2, 9.5) and having originated from the Zimatlan area of Oaxaca, Mexico, compared with other areas of Oaxaca (RR=4.0; 95% CI=1.7, 9.5). Home-prepared dried grasshoppers (chapulines) sent from Oaxaca were found to contain significant amounts of lead. CONCLUSIONS Consumption of foods imported from Oaxaca was identified as a risk factor for elevated blood lead levels in Monterey County, California. Lead-contaminated imported chapulines were identified as 1 source of lead poisoning, although other sources may also contribute to the observed findings. Food transport between binational communities presents a unique risk for the importation of environmental hazards [corrected]
Collapse
Affiliation(s)
- Margaret A Handley
- Department of Family Medicine and Community Medicine, University of California, San Francisco 94110, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Ramchandani P. What are parents for? Child Care Health Dev 2007; 33:115-6. [PMID: 17291313 DOI: 10.1111/j.1365-2214.2007.00736.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
49
|
Katerndahl D, Crabtree B. Creating innovative research designs: the 10-year Methodological Think Tank case study. Ann Fam Med 2006; 4:443-9. [PMID: 17003146 PMCID: PMC1578651 DOI: 10.1370/afm.549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Addressing important but complex research questions often necessitates the creation of innovative mixed methods designs. This report describes an approach to developing research designs for studying important but methodologically challenging research questions. METHODS The Methodological Think Tank has been held annually in conjunction with the Primary Care Research Methods and Statistics Conference in San Antonio since 1994. A group of 3 to 4 methodologists with expertise balanced between quantitative and qualitative backgrounds is invited by the think tank coordinators to serve on a 2-day think tank to discuss a research question selected from those submitted in response to a call for proposals. During the first half-day, these experts explore the content area with the investigator, often challenging beliefs and assumptions. During the second half-day, the think tank participants systematically prune potential approaches until a desirable research method is identified. RESULTS To date, the most recent 7 think tanks have produced fundable research designs, with 1 being funded by a K award and 4 by R01 grants. All participating investigators attributed much of their success to think tank participation. Lessons learned include (1) the importance of careful selection of participating methodologists, (2) all think tank communities of inquiry must go through 4 stages of development from pseudocommunity to community, and (3) the critical importance of listening by the investigator. CONCLUSION Researchers and academic departments could use this process locally to develop innovative research designs.
Collapse
Affiliation(s)
- David Katerndahl
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, Tex 78229, USA.
| | | |
Collapse
|
50
|
“Since You’re Asking. . . ”: Free Text Commentaries in an Epidemiological Study of Low Back Pain Consulters in Primary Care. ACTA ACUST UNITED AC 2006. [DOI: 10.1007/s11135-005-2071-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|