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Danford CA, Mooney-Doyle K, Deatrick JA, Feetham S, Gross D, Knafl KA, Kobayashi K, Moriarty H, Østergaard B, Swallow V. Building Family Interventions for Scalability and Impact. JOURNAL OF FAMILY NURSING 2024; 30:94-113. [PMID: 38629802 DOI: 10.1177/10748407241231342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Family nursing researchers are charged with addressing the conceptual and methodological underpinnings of family research when developing family-focused interventions. Step-by-step guidance is needed that integrates current science of intervention development with family science and helps researchers progress from foundational work to experimental work with policy integration. The purpose of this manuscript is to provide pragmatic, evidence-based guidance for advancing family intervention research from foundational work through efficacy testing. Guidance regarding the development of family interventions is presented using the first three of Sidani's five-stage method: (a) foundational work to understand the problem targeted for change; (b) intervention development and assessment of acceptability and feasibility; and (c) efficacy testing. Each stage of family intervention development is described in terms of process, design considerations, and policy and practice implications. Examples are included to emphasize the family lens. This manuscript provides guidance to family scientists for intervention development and implementation to advance family nursing science and inform policy.
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Affiliation(s)
| | | | | | - Suzanne Feetham
- University of Illinois Chicago, Chicago, IL USA
- Children's National Hospital, Washington, DC, USA
| | | | - Kathleen A Knafl
- The University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Helene Moriarty
- Villanova University, PA, Villanova, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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Çimke S, Yıldırım Gürkan D, Polat S. Research on Family-Centered Care in pediatric patients: A Bibliometric Analysis. J Pediatr Nurs 2024; 76:199-206. [PMID: 38479074 DOI: 10.1016/j.pedn.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study is conducted as a bibliometric analysis to determine the trends in studies related to family-centered care in children. MATERIALS AND METHODS The Web of Science database was used to collect study data. A search was conducted on Web of Science using the keywords "family-centered care", "family centered care", "family-centred care", "family centred care", "family-integrated care", "family integrated care", "patient and family centered care", "patient- and family-centered care" and "child" or "pediatric" or "pediatrics" or "child" or "newborn" or "neonatal" or "adolescent" together. The VOSviewer program was used for data analysis and visualization. The analysis included the number of publications by year, distribution by journals, most cited studies, countries with the highest publication output, most frequently used keywords, and co-authorship dimensions, presented with visual maps. RESULTS A total of 2525 studies conducted from 1980 onwards were analyzed. The analysis revealed that the initial publications related to the subject emerged in 1980, and the United States was identified as the country with the highest number of publications, based on the Web of Science database. The Journal of Pediatric Nursing: Nursing Care of Children and Families (JPN) was determined as the journal with the highest number of publications, while the journal receiving the most citations was PEDIATRICS. CONCLUSION The study found an increasing importance given to the Family-Centered Care Approach since the 1980s, with a majority of studies being descriptive in nature. It was determined that the studies were concentrated in the USA indicating a lack of global interest in the Family-Centered. PRACTICAL IMPLICATIONS Nursing researchers can build upon this study in the field of family-centered care by conducting more specific and in-depth investigations. This contributes to adding new information to the nursing literature and filling gaps in this area.
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Affiliation(s)
- Sevim Çimke
- Faculty of Health Sciences, Yozgat Bozok University, Turkey.
| | | | - Sevinç Polat
- Faculty of Health Sciences, Yozgat Bozok University, Turkey
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Moon SEJ, Hogden A, Eljiz K. Sustaining improvement of hospital-wide initiative for patient safety and quality: a systematic scoping review. BMJ Open Qual 2022; 11:bmjoq-2022-002057. [PMID: 36549751 PMCID: PMC9791458 DOI: 10.1136/bmjoq-2022-002057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Long-term sustained improvement following implementation of hospital-wide quality and safety initiatives is not easily achieved. Comprehensive theoretical and practical understanding of how gained improvements can be sustained to benefit safe and high-quality care is needed. This review aimed to identify enabling and hindering factors and their contributions to improvement sustainability from hospital-wide change to enhance patient safety and quality. METHODS A systematic scoping review method was used. Searched were peer-reviewed published records on PubMed, Scopus, World of Science, CINAHL, Health Business Elite, Health Policy Reference Centre and Cochrane Library and grey literature. Review inclusion criteria included contemporary (2010 and onwards), empirical factors to improvement sustainability evaluated after the active implementation, hospital(s) based in the western Organisation for Economic Co-operation and Development countries. Numerical and thematic analyses were undertaken. RESULTS 17 peer-reviewed papers were reviewed. Improvement and implementation approaches were predominantly adopted to guide change. Less than 6 in 10 (53%) of reviewed papers included a guiding framework/model, none with a demonstrated focus on improvement sustainability. With an evaluation time point of 4.3 years on average, 62 factors to improvement sustainability were identified and emerged into three overarching themes: People, Process and Organisational Environment. These entailed, as subthemes, actors and their roles; planning, execution and maintenance of change; and internal contexts that enabled sustainability. Well-coordinated change delivery, customised local integration and continued change effort were three most critical elements. Mechanisms between identified factors emerged in the forms of Influence and Action towards sustained improvement. CONCLUSIONS The findings map contemporary empirical factors and their mechanisms towards change sustainability from a hospital-wide initiative to improve patient safety and quality. The identified factors and mechanisms extend current theoretical and empirical knowledgebases of sustaining improvement particularly with those beyond the active implementation. The provided conceptual framework offers an empirically evidenced and actionable guide to assist sustainable organisational change in hospital settings.
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Affiliation(s)
- Sarah E J Moon
- Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia,Statewide Quality & Patient Safety Service, Department of Health Tasmania, Launceston, Tasmania, Australia
| | - Anne Hogden
- Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia,Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kathy Eljiz
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Ford JH, Gilson A. Influence of participation in a quality improvement collaborative on staff perceptions of organizational sustainability. BMC Health Serv Res 2021; 21:34. [PMID: 33413357 PMCID: PMC7791971 DOI: 10.1186/s12913-020-06026-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/17/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Sustainability capacity (SC), which is an organization's ability to implement and maintain change, is influenced by internal attributes, environmental contextual influencers, and intervention attributes. Temporal changes in staff SC perceptions, as well as the influence of quality improvement collaborative (QIC) participation, has generally not been explored. This project addresses this gap, measuring staff SC perceptions at four time points (baseline and every 9 months) for clinics participating in an intervention - the Network for the Improvement of Addiction Treatment QIC initiative (called NIATx200). METHODS A mixed linear model repeated measures analysis was applied to matched staff members (n = 908, representing 2329 total cases) across the evaluation timeframe. Three separate statistical models assessed potential predictors of SC perceptions: Time (Models I-III); NIATx200 intervention, staff job function, and tenure (Models II &III); and NIATx200 participation hours and four organizational variables (Model III). RESULTS For Model I, staff perceptions of total SC increased throughout most of the study (t1,4 = - 6.74, p < .0001; t2,4 = - 3.100, p < .036; t3,4 = - 0.23, p = ns). Model II did not change Model I's overall Time effect, but combined NIATx200 services (t = - 2.23, p = .026), staff job function (t = - 3.27, p = .001), and organizational administrators (t = - 3.50, p = .001) were also significantly associated with greater perceptions of total SC. Inclusion of additional variables in Model III demonstrated the importance of a higher participation level (t = - 3.09, p < .002) and being in a free-standing clinic (t = - 2.06, p < .04) on staff perceptions of total SC. CONCLUSION Although staff exposure to sustainability principals was minimal in NIATx200, staff perceptions about their organization's SC significantly differed over time. However, an organization's participation level in a QIC became the principal predictor of staff SC perceptions, regardless of other factors' influence. Given these findings, it is possible to develop and introduce specific sustainability content within the structure of a QIC to assess the impact on staff SC perceptions over time and the sustainment of organizational change. TRIAL REGISTRATION ClinicalTrials.gov , NCT00934141 . Registered July 6, 2009. Retrospectively registered.
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Affiliation(s)
- James H Ford
- University of Wisconsin - Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, USA.
| | - Aaron Gilson
- University of Wisconsin - Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, USA
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Lennox L, Linwood-Amor A, Maher L, Reed J. Making change last? Exploring the value of sustainability approaches in healthcare: a scoping review. Health Res Policy Syst 2020; 18:120. [PMID: 33050921 PMCID: PMC7556957 DOI: 10.1186/s12961-020-00601-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
Background Numerous models, tools and frameworks have been produced to improve the sustainability of evidence-based interventions. Due to the vast number available, choosing the most appropriate one is increasingly difficult for researchers and practitioners. To understand the value of such approaches, evidence warranting their use is needed. However, there is limited understanding of how sustainability approaches have been used and how they have impacted research or practice. This review aims to consolidate evidence on the application and impact of sustainability approaches in healthcare settings. Methods A systematic scoping review was designed to search for peer-reviewed publications detailing the use of sustainability approaches in practice. A 5-stage framework for scoping reviews directed the search strategy, and quality assessment was performed using the Mixed Method Appraisal Tool. Searches were performed through electronic citation tracking and snowballing of references. Articles were obtained through Web of Science, PubMed and Google Scholar. Six outcome variables for sustainability were explored to ascertain impact of approaches. Results This review includes 68 articles demonstrating the application of sustainability approaches in practice. Results show an increase in the use of sustainability approaches in peer-reviewed studies. Approaches have been applied across a range of healthcare settings, including primary, secondary, tertiary and community healthcare. Approaches are used for five main purposes, namely analysis, evaluation, guidance, assessment and planning. Results outline benefits (e.g. improved conceptualisation of sustainability constructs and improved ability to interpret sustainability data) and challenges (e.g. issues with approach constructs and difficulty in application) associated with using a sustainability approach in practice. Few articles (14/68) reported the sustainability outcome variables explored; therefore, the impact of approaches on sustainability remains unclear. Additional sustainability outcome variables reported in retrieved articles are discussed. Conclusions This review provides practitioners and researchers with a consolidated evidence base on sustainability approaches. Findings highlight the remaining gaps in the literature and emphasise the need for improved rigour and reporting of sustainability approaches in research studies. To guide future assessment and study of sustainability in healthcare settings an updated list of sustainability outcome variables is proposed. Trial Registration This review was registered on the PROSPERO database CRD 42016040081 in June 2016.
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Affiliation(s)
- L Lennox
- National Institute for Health Research, Applied Research Collaboration North West London. Imperial College London, 369 Fulham Road, SW10 9NH, London, United Kingdom.
| | - A Linwood-Amor
- Ministry of Health, Environment, Culture and Housing, George Town, Grand Cayman KY1-9000, Cayman Islands
| | - L Maher
- Ko Awatea Health System Innovation and Improvement, Middlemore Hospital, 100 Hospital Road, Otahuhu, New Zealand
| | - J Reed
- Julie Reed Consultancy, 27 Molasses House, London, SW113TN, United Kingdom
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Armstrong M, Champagne J, Mortimer DS. Department of Veterans Affairs Polytrauma Rehabilitation Centers: Inpatient Rehabilitation Management of Combat-Related Polytrauma. Phys Med Rehabil Clin N Am 2018; 30:13-27. [PMID: 30470417 DOI: 10.1016/j.pmr.2018.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Traumatic brain injury (TBI) is one of the signature injuries of Operation Iraqi Freedom and Operation Enduring Freedom. To ensure that rehabilitation care needs of veterans and active duty servicemembers with TBI and polytrauma injuries were met, the Department of Veterans Affairs (VA) established the Polytrauma System of Care (PSC) in 2005. The 5 VA Polytrauma Rehabilitation Centers provide tertiary, acute inpatient rehabilitation for the PSC. Interdisciplinary treatment teams of multiple rehabilitation disciplines provide the complex, patient-centered care to achieve maximum benefit. After discharge, veterans and servicemembers with TBI and polytrauma receive lifelong support and care through the PSC.
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Affiliation(s)
- Michael Armstrong
- Department of Physical Medicine and Rehabilitation, Minneapolis VA Health Care System, University of Minnesota, 1 Veterans Drive (117), Minneapolis, MN 55417, USA.
| | - Julie Champagne
- Polytrauma Transitional Rehabilitation, Minneapolis VA Health Care System, 1 Veterans Drive (117), Minneapolis, MN 55417, USA
| | - Diane Schretzman Mortimer
- Department of Physical Medicine and Rehabilitation, Polytrauma Network Site, Minneapolis VA Health Care System, 1 Veterans Drive (117), Minneapolis, MN 55417, USA
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Family Needs on an Inpatient Brain Injury Rehabilitation Unit: A Quantitative Assessment. J Head Trauma Rehabil 2018; 33:228-236. [DOI: 10.1097/htr.0000000000000390] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Context Matters: Team and Organizational Factors Associated with Reach of Evidence-Based Psychotherapies for PTSD in the Veterans Health Administration. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:904-918. [PMID: 28597238 PMCID: PMC5640758 DOI: 10.1007/s10488-017-0809-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Evidence-based psychotherapies for PTSD are often underused. The objective of this mixed-method study was to identify organizational and clinic factors that promote high levels of reach of evidence-based psychotherapies for PTSD 10 years into their dissemination throughout the Veterans Health Administration. We conducted 96 individual interviews with staff from ten outpatient PTSD teams at nine sites that differed in reach of evidence-based psychotherapies for PTSD. Major themes associated with reach included clinic mission, clinic leader and staff engagement, clinic operations, staff perceptions, and the practice environment. Strategies to improve reach of evidence-based psychotherapies should attend to organizational and team-level factors.
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Moriarty H, Winter L, Short TH, True G. Exploration of Factors Related to Depressive Symptomatology in Family Members of Military Veterans With Traumatic Brain Injury. JOURNAL OF FAMILY NURSING 2018; 24:184-216. [PMID: 29848196 DOI: 10.1177/1074840718773470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Traumatic brain injury (TBI) is a family affair, affecting those with the injury and their families. Psychological distress, often measured as depression or depressive symptoms, is highly prevalent among family members. Predictors of depression in family members of civilians with TBI have been examined, but predictors of depression in family members of military veterans have received very little research attention and are poorly understood. To address the knowledge gap, this study explored factors related to depressive symptoms in family members of veterans in the United States, using an ecological framework. Baseline data from 83 family members were used. Family members with higher caregiver burden, presence of a veteran with posttraumatic stress disorder (PTSD), and greater financial difficulty experienced significantly more depressive symptoms. Findings suggest that efforts to support family members and decrease their depression should aim to reduce caregiver burden and financial difficulty, and help family members cope with veteran PTSD and TBI. Family-focused interventions are needed.
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Affiliation(s)
- Helene Moriarty
- 1 Villanova University, Villanova, PA, USA
- 2 Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Laraine Winter
- 2 Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | | | - Gala True
- 4 Tulane University, New Orleans, Louisiana, USA
- 5 South Central Mental Illness Research, Education and Clinical Center, Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA
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Malec JF, Van Houtven CH, Tanielian T, Atizado A, Dorn MC. Impact of TBI on caregivers of veterans with TBI: Burden and interventions. Brain Inj 2017; 31:1235-1245. [DOI: 10.1080/02699052.2016.1274778] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- James F. Malec
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
- Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
- Emeritus Professor of Psychology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Adrian Atizado
- DAV National Service & Legislative Headquarters, Washington, DC, USA
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Stevens LF, Pickett TC, Wilder Schaaf KP, Taylor BC, Gravely A, Van Houtven CH, Friedemann-Sánchez G, Griffin JM. The Relationship between Training and Mental Health among Caregivers of Individuals with Polytrauma. Behav Neurol 2015; 2015:185941. [PMID: 26770015 PMCID: PMC4685074 DOI: 10.1155/2015/185941] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/23/2015] [Accepted: 10/27/2015] [Indexed: 11/23/2022] Open
Abstract
This was a hypothesis-generating exploration of relationships between caregiver training during TBI/polytrauma rehabilitation and caregiver mental health. In this cross-sectional study, 507 informal caregivers to US service members with TBI who received inpatient rehabilitation care in a Veterans Affairs' Polytrauma Rehabilitation Center from 2001 to 2009 completed a retrospective, self-report survey. Embedded in the survey were measures of caregiver mental health, including the National Institutes of Health's Patient Reported Outcome Measurement Information System (PROMIS) Anxiety and Depression Short Forms, the Rosenberg Self-Esteem scale, and the Zarit Burden Short Form. Though no groups endorsed clinical levels, mental health symptoms varied by caregiver training category (Trained, Not Trained, and Did Not Need Training). Caregivers who did not receive training on how to navigate healthcare systems endorsed higher depression and burden and lower self-esteem than those who did. Caregivers who did not receive training in supporting their care recipients' emotions endorsed higher anxiety, depression, and burden and lower self-esteem than those who did. Analyses also suggested a different association between training and mental health based on caregivers' relationship to the care recipient and the intensity of care recipient needs. Potential hypotheses for testing in future studies raised by these findings are discussed.
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Affiliation(s)
- Lillian Flores Stevens
- Hunter Holmes McGuire VAMC, Psychology Section (116B), 1201 Broad Rock Boulevard, Richmond, VA 23249, USA
- Departments of Psychology, Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Treven C. Pickett
- Hunter Holmes McGuire VAMC, Psychology Section (116B), 1201 Broad Rock Boulevard, Richmond, VA 23249, USA
- Departments of Psychology, Psychiatry, Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Kathryn P. Wilder Schaaf
- Hunter Holmes McGuire VAMC, Psychology Section (116B), 1201 Broad Rock Boulevard, Richmond, VA 23249, USA
- Departments of Psychology, Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Brent C. Taylor
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, 1 Veterans Drive (152/Building 9), Minneapolis, MN 55417, USA
| | - Amy Gravely
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, 1 Veterans Drive (152/Building 9), Minneapolis, MN 55417, USA
| | - Courtney Harold Van Houtven
- Center for Health Services Research in Primary Care, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA
| | - Greta Friedemann-Sánchez
- Humphrey School of Public Affairs, University of Minnesota, 267 Humphrey Center, 301 19th Avenue S., Minneapolis, MN 55455, USA
| | - Joan M. Griffin
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, 1 Veterans Drive (152/Building 9), Minneapolis, MN 55417, USA
- Mayo Clinic, Department of Health Sciences Research, Division of Health Care Policy and Research, Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, USA
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A Randomized Controlled Trial to Evaluate the Veterans' In-home Program for Military Veterans With Traumatic Brain Injury and Their Families: Report on Impact for Family Members. PM R 2015; 8:495-509. [PMID: 26514790 DOI: 10.1016/j.pmrj.2015.10.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/14/2015] [Accepted: 10/18/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) creates many challenges for families as well as for patients. Few intervention studies have considered both the needs of the person with TBI and his or her family and included both in the intervention process. To address this gap, we designed an innovative intervention for veterans with TBI and families-the Veterans' In-home Program (VIP)-targeting veterans' environment, delivered in veterans' homes, and involving their families. OBJECTIVES To determine whether the VIP is more effective than standard outpatient clinic care in improving family members' well-being in 3 domains (depressive symptoms, burden, and satisfaction) and to assess its acceptability to family members. DESIGN In this randomized controlled trial, 81 dyads (veteran/family member) were randomly assigned to VIP or an enhanced usual care control condition. Randomization occurred after the baseline interview. Follow-up interviews occurred 3-4 months after baseline, and the interviewer was blinded to group assignment. SETTING Interviews and intervention sessions were conducted in veterans' homes or by telephone. PARTICIPANTS A total of 81 veterans with TBI recruited from a Veterans Affairs (VA) polytrauma program and a key family member for each participated. Of the 81 family members, 63 completed the follow-up interview. INTERVENTION The VIP, guided by the person-environment fit model, consisted of 6 home visits and 2 telephone calls delivered by occupational therapists over a 3- to 4-month period. Family members were invited to participate in the 6 home sessions. MAIN OUTCOME MEASURES Family member well-being was operationally defined as depressive symptomatology, caregiver burden, and caregiver satisfaction 3-4 months after baseline. Acceptability was operationally defined through 3 indicators. RESULTS Family members in the VIP showed significantly lower depressive symptom scores and lower burden scores when compared to controls at follow-up. Satisfaction with caregiving did not differ between groups. Family members' acceptance of the intervention was high. CONCLUSIONS VIP represents the first evidence-based intervention that considers both the veteran with TBI and the family. VIP had a significant impact on family member well-being and thus addresses a large gap in previous research and services for families of veterans with TBI.
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Ford JH, Alagoz E, Dinauer S, Johnson KA, Pe-Romashko K, Gustafson DH. Successful Organizational Strategies to Sustain Use of A-CHESS: A Mobile Intervention for Individuals With Alcohol Use Disorders. J Med Internet Res 2015; 17:e201. [PMID: 26286257 PMCID: PMC4642385 DOI: 10.2196/jmir.3965] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 06/08/2015] [Accepted: 07/16/2015] [Indexed: 02/03/2023] Open
Abstract
Background Mobile health (mHealth) services are growing in importance in health care research with the advancement of wireless networks, tablets, and mobile phone technologies. These technologies offer a wide range of applications that cover the spectrum of health care delivery. Although preliminary experiments in mHealth demonstrate promising results, more robust real-world evidence is needed for widespread adoption and sustainment of these technologies. Objective Our aim was to identify the problems/challenges associated with sustained use of an mHealth addiction recovery support app and to determine strategies used by agencies that successfully sustained client use of A-CHESS. Methods Qualitative inquiry assessed staff perceptions about organizational attributes and strategies associated with sustained use of the mobile app, A-CHESS. A total of 73 interviews of clinicians and administrators were conducted. The initial interviews (n=36) occurred at the implementation of A-CHESS. Follow-up interviews (n=37) occurred approximately 12 and 24 months later. A coding scheme was developed and Multiuser NVivo was used to manage and analyze the blinded interview data. Results Successful strategies used by treatment providers to sustain A-CHESS included (1) strong leadership support, (2) use of client feedback reports to follow up on non-engaged clients, (3) identify passionate staff and incorporate A-CHESS discussions in weekly meetings, (4) develop A-CHESS guidelines related to client use, (5) establish internal work groups to engage clients, and (6) establish a financial strategy to sustain A-CHESS use. The study also identified attributes of A-CHESS that enhanced as well as inhibited its sustainability. Conclusions Mobile apps can play an important role in health care delivery. However, providers will need to develop strategies for engaging both staff and patients in ongoing use of the apps. They will also need to rework business processes to accommodate the changes in communication frequency and style, learn to use app data for decision making, and identify financing mechanisms for supporting these changes.
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Affiliation(s)
- James H Ford
- University of Wisconsin - Madison, Center for Health Systems Research and Analysis, Madison, WI, United States.
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