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Mumma JM, Weaver BW, Morgan JS, Ghassemian G, Gannon PR, Burke KB, Berryhill BA, MacKay RE, Lee L, Kraft CS. Connecting pathogen transmission and healthcare worker cognition: a cognitive task analysis of infection prevention and control practices during simulated patient care. BMJ Qual Saf 2024; 33:419-431. [PMID: 38050151 PMCID: PMC11228200 DOI: 10.1136/bmjqs-2023-016230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/25/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Relatively little is known about the cognitive processes of healthcare workers that mediate between performance-shaping factors (eg, workload, time pressure) and adherence to infection prevention and control (IPC) practices. We taxonomised the cognitive work involved in IPC practices and assessed its role in how pathogens spread. METHODS Forty-two registered nurses performed patient care tasks in a standardised high-fidelity simulation. Afterwards, participants watched a video of their simulation and described what they were thinking, which we analysed to obtain frequencies of macrocognitive functions (MCFs) in the context of different IPC practices. Performance in the simulation was the frequency at which participants spread harmless surrogates for pathogens (bacteriophages). Using a tertiary split, participants were categorised into a performance group: high, medium or low. To identify associations between the three variables-performance groups, MCFs and IPC practices-we used multiblock discriminant correspondence analysis (MUDICA). RESULTS MUDICA extracted two factors discriminating between performance groups. Factor 1 captured differences between high and medium performers. High performers monitored the situation for contamination events and mitigated risks by applying formal and informal rules or managing their uncertainty, particularly for sterile technique and cleaning. Medium performers engaged more in future-oriented cognition, anticipating contamination events and planning their workflow, across many IPC practices. Factor 2 distinguished the low performers from the medium and high performers who mitigated risks with informal rules and sacrificed IPC practices when managing tradeoffs, all in the context of minimising cross-contamination from physical touch. CONCLUSIONS To reduce pathogen transmission, new approaches to training IPC (eg, cognitive skills training) and system design are needed. Interventions should help nurses apply their knowledge of IPC fluidly during patient care, prioritising and monitoring situations for risks and deciding how to mitigate risks. Planning IPC into one's workflow is beneficial but may not account for the unpredictability of patient care.
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Affiliation(s)
- Joel M Mumma
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Bradley W Weaver
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
- Office of Quality, Emory Healthcare, Atlanta, Georgia, USA
| | - Jill S Morgan
- Clinical Research, Emory University Hospital, Atlanta, Georgia, USA
- Critical Care, Emory University Hospital, Atlanta, Georgia, USA
| | | | - Paige R Gannon
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Kylie B Burke
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Brandon A Berryhill
- Department of Biology, Emory University, Atlanta, Georgia, USA
- Program in Microbiology and Molecular Genetics, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | - Rebecca E MacKay
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Lindsay Lee
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Colleen S Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
- Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Buck HG, Howland C, Stawnychy MA, Aldossary H, Cortés YI, DeBerg J, Durante A, Graven LJ, Irani E, Jaboob S, Massouh A, Oberfrank NDCF, Saylor MA, Wion RK, Bidwell JT. Caregivers' Contributions to Heart Failure Self-care: An Updated Systematic Review. J Cardiovasc Nurs 2024; 39:266-278. [PMID: 38306302 PMCID: PMC11291720 DOI: 10.1097/jcn.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
BACKGROUND A previous systematic review reporting the contributions of informal, unpaid caregivers to patient heart failure (HF) self-care requires updating to better inform research, practice, and policy. OBJECTIVE The aim of this study was to provide an updated review answering the questions: (1) What specific activities do informal caregivers of adults with HF take part in related to HF self-care? (2) Have the activities that informal caregivers of adults with HF take part in related to HF self-care changed over time? (3) What are the gaps in the science? METHODS This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, EMBASE, and Cochrane CENTRAL databases were searched. Eligible studies involved an informal, unpaid caregiver of an adult with HF as a study variable or participant. Caregiving activities were benchmarked using the theory of self-care in chronic illness. RESULTS Two thousand one hundred fifty-four research reports were identified, of which 64 met criteria. Caregivers' contributions occurred in self-care maintenance (91%), monitoring (54%), and management (46%). Activities performed directly on or to the patient were reported more frequently than activities performed for the patient. Change over time involved the 3 domains differentially. Gaps include ambiguous self-care activity descriptions, inadequate caregiving time quantification, and underrepresented self-care monitoring, supportive, and communication activities. CONCLUSIONS Newly identified caregiver-reported activities support updating the theory of self-care in chronic illness to include activities currently considered ancillary to HF self-care. Identified gaps highlight the need to define specific caregiving activities, determine task difficulty and burden, and identify caregiver self-care strategy and education needs. Exposing the hidden work of caregiving is essential to inform policy and practice.
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Hill JR, Min EE, Abebe E, Holden RJ. Telecaregiving for Dementia: A Mapping Review of Technological and Nontechnological Interventions. THE GERONTOLOGIST 2024; 64:gnad026. [PMID: 36919597 PMCID: PMC10733214 DOI: 10.1093/geront/gnad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Informal (or family) caregivers to older adults with Alzheimer's disease or other related dementias (ADRD) could greatly benefit from innovative telecaregiving systems that support caregiving from a distance. The objective of this review is to better understand (a) who is involved in telecaregiving and their experiences; (b) the interventions currently available to support ADRD telecaregiving; and (c) the outcomes measured to assess the effects of ADRD telecaregiving interventions. RESEARCH DESIGN AND METHODS A mapping review was conducted by systematically searching MEDLINE, CINAHL, Embase, and PsycINFO for all works published in English from 2002 to 2022. References of included publications were searched to identify additional empirical publications for inclusion. RESULTS Sixty-one publications (describing 48 studies and 5 nonstudy sources) were included in the review. Currently available information on the demographics, experiences, challenges, and benefits of ADRD telecaregivers is summarized. We found that interventions to support telecaregiving could be classified into 7 categories of technological interventions and 3 categories of nontechnological interventions. Empirical studies on ADRD telecaregiving interventions investigated a variety of outcomes, the most prevalent being user experience. DISCUSSION AND IMPLICATIONS We conclude that (a) the paucity of literature on telecaregiving does not allow for a comprehensive understanding of the needs and day-to-day activities of ADRD telecaregivers; (b) interventions developed to support ADRD telecaregiving may not fully meet the needs of caregivers or care recipients; and (c) there is insufficient rigorous research establishing the effects of telecaregiving interventions on key ADRD-related outcomes.
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Affiliation(s)
- Jordan R Hill
- Department of Health & Wellness Design, Indiana University School of Public Health—Bloomington, Bloomington, Indiana, USA
- Indiana University Center for Aging Research, Regenstrief Institute Inc., Indianapolis, Indiana, USA
| | - Elissa E Min
- Department of Pharmacy Practice, Purdue University, West Lafayette, Indiana, USA
| | - Ephrem Abebe
- Department of Pharmacy Practice, Purdue University, West Lafayette, Indiana, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Richard J Holden
- Department of Health & Wellness Design, Indiana University School of Public Health—Bloomington, Bloomington, Indiana, USA
- Indiana University Center for Aging Research, Regenstrief Institute Inc., Indianapolis, Indiana, USA
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Qama E, Rubinelli S, Diviani N. Factors influencing the integration of self-management in daily life routines in chronic conditions: a scoping review of qualitative evidence. BMJ Open 2022; 12:e066647. [PMID: 36585140 PMCID: PMC9809267 DOI: 10.1136/bmjopen-2022-066647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Self-management of chronic diseases is regarded as dynamic experience which is always evolving and that requires constant adjustment. As unexpected and new shifts in diseases occur, patients tend to abandon acquired behaviours calling into question their sustainability over time. Developing a daily self-management routine as a response to lifestyle changes is considered to facilitate self-management performance. However, fitting self-management recommendations in one's daily life activities is a constant challenge. In this review, we describe the performance of self-management routines within daily settings in people living with chronic conditions with the aim of identifying factors that challenge its integration in daily life. DESIGN Scoping review. DATA SOURCES We searched PubMed, Web of Science, CINAHL and PsycINFO on February 2022. ELIGIBILITY CRITERIA We included qualitative studies on self-management experience, in English, with adult participants, original and peer-reviewed, and depicting the performance of self-management activities in one's own environment. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened titles and abstracts. After agreement, one reviewer screened the full text of relevant articles and extracted the data. The data were synthesised and analysed thematically. PRISMA Extension for Scoping Reviews checklist was used for reporting the steps. RESULTS Twenty-two studies were included. The thematic analysis brought up two overreaching themes. The first one is the Environment support with three subthemes: family and cultural norms; health professionals and guiding communication; and society and disease perceptions. The second theme is comprehension gap with two subthemes: reading the body and applying information. CONCLUSIONS The integration of self-management requirements in a daily routine is affected by the patients' inability to apply disease knowledge in different context and by the challenge of understanding body symptoms and predicting body reactions in advance.
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Affiliation(s)
- Enxhi Qama
- Person-centered Healthcare & Health Communication Group, Swiss Paraplegic Research, Nottwil, Switzerland
- University of Lucerne, Lucerne, Switzerland
| | - Sara Rubinelli
- Person-centered Healthcare & Health Communication Group, Swiss Paraplegic Research, Nottwil, Switzerland
- University of Lucerne, Lucerne, Switzerland
| | - Nicola Diviani
- Person-centered Healthcare & Health Communication Group, Swiss Paraplegic Research, Nottwil, Switzerland
- University of Lucerne, Lucerne, Switzerland
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Gentizon J, Fleury M, Pilet E, Büla C, Mabire C. Conceptualization and content validation of the MEDication literacy assessment of geriatric patients and informal caregivers (MED-fLAG). J Patient Rep Outcomes 2022; 6:87. [PMID: 35984575 PMCID: PMC9389474 DOI: 10.1186/s41687-022-00495-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background The assessment of patients’ medication literacy skills (i.e., abilities to access, comprehend and interact with medication-related information) is an important step in assisting clinicians to plan for appropriate care. Despite several attempts by researchers to develop measures of medication literacy, an instrument tailored to the specific needs of older adults remains a significant shortfall. Therefore, an interprofessional team that included a citizen co-researcher conceptualized a new standardised measure of medication literacy—the MEDedication Literacy Assessment of Geriatric patients and informal caregivers (MED-fLAG). MED-fLAG was designed as a three-dimensional self-reported measure of functional, interactive and critical skills. This study describes the conceptualization process and provides the results of an evaluation of MED-fLAG’s content validity, acceptability, and feasibility during a hospital stay. Methods MED-fLAG was developed in accordance with the guidance on scale development and standards for good content validity, by using the following steps: (I) conceptualization of a provisional version of MED-fLAG; (II) iterative qualitative evaluation of its content validity by older adults, informal caregivers and healthcare professionals. Results The qualitative assessment of the initial 54-item MED-fLAG was conducted in 36 participants, namely 13 home-dwelling older adults and/or informal caregivers and 23 healthcare professionals. Six rounds of revisions were performed to achieve content validity and to propose a 56-item revised MED-fLAG. Participants reported benefits of using a standardized assessment of medication literacy during a hospital stay but warned about certain limitations and prerequisites. The extent to which MED-fLAG could be integrated into discharge planning needs to be further investigated. Conclusions MED-fLAG is the first medication literacy measure tailored to the specific needs of older patients and informal caregivers. A unique feature of this measure is that it includes prescribed and non-prescribed medications, irrespective of the galenic form. Additional studies are required to evaluate the other measurement properties of MED-fLAG, and to reduce the number of items before considering its clinical application. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00495-2. On the basis of what has been written about medication literacy and the experiences of experts, we developed a new questionnaire to measure medication literacy (MED-fLAG) in older adults and/or informal caregivers. MED-fLAG was then submitted to older adults, informal caregivers and healthcare professionals to retrieve their feedback concerning the relevance, comprehensibility and exhaustiveness of the proposed items. In future, MED-fLAG will allow health professionals to evaluate medication literacy skills in older patients during hospitalization and/or in their informal caregivers when they are responsible for preparing or administering the medications, and then propose individualised support.
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Sharara SL, Arbaje AI, Cosgrove SE, Gurses AP, Dzintars K, Ladikos N, Qasba SS, Keller SC. The Voice of the Patient: Patient Roles in Antibiotic Management at the Hospital-to-Home Transition. J Patient Saf 2022; 18:e633-e639. [PMID: 34569996 PMCID: PMC8940725 DOI: 10.1097/pts.0000000000000899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our objective was to characterize tasks required for patient-performed antibiotic medication management (MM) at the hospital-to-home transition, as well as barriers to and strategies for patient-led antibiotic MM. Our overall goal was to understand patients' role in managing antibiotics at the hospital-to-home transition. METHODS We performed a qualitative study including semistructured interviews with health care workers and contextual inquiry with patients discharged home on oral antibiotics. The setting was one academic medical center and one community hospital. Participants included 37 health care workers and 16 patients. We coded interview transcripts and notes from contextual inquiry and developed themes. RESULTS We identified 6 themes involving barriers or strategies for antibiotic MM. We identified dissonance between participant descriptions of the ease of antibiotic MM at the hospital-to-home transition and their experience of barriers. Similarly, patients did not always recognize when they were experiencing side effects. Lack of access to follow-up care led to unnecessarily long antibiotic courses. Instructions about completing antibiotics were not routinely provided. However, patients typically did not question the need for the prescribed antibiotic. CONCLUSIONS There are many opportunities to improve patient-led antibiotic MM at the hospital-to-home transition. Mismatches between patient perceptions and patient experiences around antibiotic MM at the hospital-to-home transition provide opportunities for health system improvement.
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Affiliation(s)
- Sima L Sharara
- From the Division of Infectious Diseases, Department of Medicine
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Holden RJ, Abebe E, Russ-Jara AL, Chui MA. Human factors and ergonomics methods for pharmacy research and clinical practice. Res Social Adm Pharm 2021; 17:2019-2027. [PMID: 33985892 PMCID: PMC8603214 DOI: 10.1016/j.sapharm.2021.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Human factors and ergonomics (HFE) is a scientific and practical human-centered discipline that studies and improves human performance in sociotechnical systems. HFE in pharmacy promotes the human-centered design of systems to support individuals and teams performing medication-related work. OBJECTIVE To review select HFE methods well suited to address pharmacy challenges, with examples of their application in pharmacy. METHODS We define the scope of HFE methods in pharmacy as applications to pharmacy settings, such as inpatient or community pharmacies, as well as medication-related phenomena such as medication safety, adherence, or deprescribing. We identify and present seven categories of HFE methods suited to widespread use for pharmacy research and clinical practice. RESULTS Categories of HFE methods applicable to pharmacy include work system analysis; task analysis; workload assessment; medication safety and error analysis; user-centered and participatory design; usability evaluation; and physical ergonomics. HFE methods are used in three broad phases of human-centered design and evaluation: study; design; and evaluation. The most robust applications of HFE methods involve the combination of HFE methods across all three phases. Two cases illustrate such a comprehensive application of HFE: one case of medication package, label, and information design and a second case of human-centered design of a digital decision aid for medication safety. CONCLUSIONS Pharmacy, including the places where pharmacy professionals work and the multistep process of medication use across people and settings, can benefit from HFE. This is because pharmacy is a human-centered sociotechnical system with an existing tradition of studying and analyzing the present state, designing solutions to problems, and evaluating those solutions in laboratory or practice settings. We conclude by addressing common concerns about the implementation of HFE methods and urge the adoption of HFE methods in pharmacy.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Center for Aging Research, Regenstrief Institute, Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA.
| | - Ephrem Abebe
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Alissa L Russ-Jara
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Michelle A Chui
- Social & Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
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Glass JE, Matson TE, Lim C, Hartzler AL, Kimbel K, Lee AK, Beatty T, Parrish R, Caldeiro RM, Garza McWethy A, Curran GM, Bradley KA. Approaches for Implementing App-Based Digital Treatments for Drug Use Disorders Into Primary Care: A Qualitative, User-Centered Design Study of Patient Perspectives. J Med Internet Res 2021; 23:e25866. [PMID: 34255666 PMCID: PMC8293157 DOI: 10.2196/25866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/11/2021] [Accepted: 05/04/2021] [Indexed: 01/23/2023] Open
Abstract
Background Digital interventions, such as websites and smartphone apps, can be effective in treating drug use disorders (DUDs). However, their implementation in primary care is hindered, in part, by a lack of knowledge on how patients might like these treatments delivered to them. Objective This study aims to increase the understanding of how patients with DUDs prefer to receive app-based treatments to inform the implementation of these treatments in primary care. Methods The methods of user-centered design were combined with qualitative research methods to inform the design of workflows for offering app-based treatments in primary care. Adult patients (n=14) with past-year cannabis, stimulant, or opioid use disorder from 5 primary care clinics of Kaiser Permanente Washington in the Seattle area participated in this study. Semistructured interviews were recorded, transcribed, and analyzed using qualitative template analysis. The coding scheme included deductive codes based on interview topics, which primarily focused on workflow design. Inductive codes emerged from the data. Results Participants wanted to learn about apps during visits where drug use was discussed and felt that app-related conversations should be incorporated into the existing care whenever possible, as opposed to creating new health care visits to facilitate the use of the app. Nearly all participants preferred receiving clinician support for using apps over using them without support. They desired a trusting, supportive relationship with a clinician who could guide them as they used the app. Participants wanted follow-up support via phone calls or secure messaging because these modes of communication were perceived as a convenient and low burden (eg, no copays or appointment travel). Conclusions A user-centered implementation of treatment apps for DUDs in primary care will require health systems to design workflows that account for patients’ needs for structure, support in and outside of visits, and desire for convenience.
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Affiliation(s)
- Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Theresa E Matson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Catherine Lim
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, United States
| | - Kilian Kimbel
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Rebecca Parrish
- Kaiser Permanente Washington Mental Health & Wellness Services, Renton, WA, United States
| | - Ryan M Caldeiro
- Kaiser Permanente Washington Mental Health & Wellness Services, Renton, WA, United States
| | - Angela Garza McWethy
- Kaiser Permanente Washington Mental Health & Wellness Services, Renton, WA, United States
| | - Geoffrey M Curran
- University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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Holden RJ, Carayon P. SEIPS 101 and seven simple SEIPS tools. BMJ Qual Saf 2021; 30:901-910. [PMID: 34039748 PMCID: PMC8543199 DOI: 10.1136/bmjqs-2020-012538] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/11/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | - Pascale Carayon
- Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Cadel L, Cimino SR, Rolf von den Baumen T, James KA, McCarthy L, Guilcher SJT. Medication Management Frameworks in the Context of Self-Management: A Scoping Review. Patient Prefer Adherence 2021; 15:1311-1329. [PMID: 34163148 PMCID: PMC8216068 DOI: 10.2147/ppa.s308223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/29/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Many individuals take multiple prescribed and unprescribed medications, also known as polypharmacy, which can be problematic. Improving medication self-management is important; however, most medication management frameworks focus on adherence and limit the integration of the core components of self-management. Therefore, the objective of this scoping review was to identify what is reported in the literature on medication management frameworks or models within the context of self-management. METHODS Electronic databases (Medline, Embase, CINAHL and Cochrane Library) and grey literature (healthcare and government organization websites) were searched for articles that described a framework or model developed or adapted for medication management, included components of self-management and was published from January 2000 to January 2020. During the screening of titles and abstracts, 5668 articles were reviewed, 5242 were excluded and 426 were then assessed at the full-text level. Thirty-nine articles met the eligibility criteria and were included in the review. RESULTS About half of the frameworks were newly developed (n=20), while the other half were adapted from, or applied, a previous model or framework (n=19). The majority of frameworks focused on medication adherence and most of the self-management domains were categorized as medical management, followed by emotional and role management. CONCLUSION Medication self-management is a complex process and often impacts multiple areas of an individual's life. It is important for future frameworks to incorporate a comprehensive, holistic conceptualization of self-management that is inclusive of the three self-management domains - medical, emotional and role management.
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Affiliation(s)
- Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Stephanie R Cimino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- St. John’s Rehab, Sunnybrook Health Sciences Centre, North York, Ontario, Canada
| | | | - Kadesha A James
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Lisa McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Correspondence: Sara JT Guilcher Leslie Dan Faculty of Pharmacy, 144 College Street, Room 604, Toronto, ON, M5S 3M2, CanadaTel + 1-416-946-7020 Email
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Holden RJ, Abebe E. Medication transitions: Vulnerable periods of change in need of human factors and ergonomics. APPLIED ERGONOMICS 2021; 90:103279. [PMID: 33049545 PMCID: PMC7606579 DOI: 10.1016/j.apergo.2020.103279] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 06/06/2023]
Abstract
We present a novel view of transitions from the lens of patient ergonomics (the "science of patient work"), which posits that patients and other non-professionals perform effortful work towards health-related goals. In patient work transitions, patients experience changes in, for example, health, task demands, work capacity, roles and responsibilities, knowledge and skills, routines, needs and technologies. Medication transitions are a particularly vulnerable type of patient work transitions. We describe two cases of medication transitions-new medications and medication deprescribing-in which the patient work lens reveals many accompanying changes, vulnerabilities, and opportunities for human factors and ergonomics.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Ephrem Abebe
- Purdue University College of Pharmacy, West Lafayette, IN, USA
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12
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Holden RJ, Daley CN, Mickelson RS, Bolchini D, Toscos T, Cornet VP, Miller A, Mirro MJ. Patient decision-making personas: An application of a patient-centered cognitive task analysis (P-CTA). APPLIED ERGONOMICS 2020; 87:103107. [PMID: 32310109 DOI: 10.1016/j.apergo.2020.103107] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 12/21/2019] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
Personas can be used to understand patterns of variation in patients' performance of cognitive work, particularly self-care decision making. In this study, we used a patient-centered cognitive task analysis (P-CTA) to develop self-care decision-making personas. We collected data from 24 older adults with chronic heart failure and 14 support persons, using critical incident and fictitious scenario interviews. Qualitative analyses produced three personas but revealed that individuals exemplify different personas across situations. The Rule-Following persona seeks clear rules, exercises caution under uncertainty, and grounds actions in confidence in clinician experts. The Researching persona seeks information to gain better understanding, invents strategies, and conducts experiments independently or with clinicians. The Disengaging persona does not actively seek rules or information and does not attempt to reduce uncertainty or conduct experiments. We discuss the situational nature of personas, their use in design, and the benefits of P-CTA for studying patient decision making.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., USA.
| | - Carly N Daley
- Department of BioHealth Informatics, IUPUI School of Informatics and Computing, USA; Parkview Mirro Center for Research and Innovation, Parkview Health, USA
| | | | - Davide Bolchini
- Department of Human-Centered Computing, IUPUI School of Informatics and Computing, USA
| | - Tammy Toscos
- Parkview Mirro Center for Research and Innovation, Parkview Health, USA
| | - Victor P Cornet
- Parkview Mirro Center for Research and Innovation, Parkview Health, USA; Department of Human-Centered Computing, IUPUI School of Informatics and Computing, USA
| | - Amy Miller
- Department of Radiology Oncology, Indiana University School of Medicine, USA
| | - Michael J Mirro
- Parkview Mirro Center for Research and Innovation, Parkview Health, USA
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13
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Petrescu-Prahova M, Osterhage K, Taylor JO, Painter I, Choi Y, Turner AM. Older Adult Health-Related Support Networks: Implications for the Design of Digital Communication Tools. Innov Aging 2020; 4:igaa020. [PMID: 32665982 PMCID: PMC7325148 DOI: 10.1093/geroni/igaa020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives Digital communication tools facilitate the provision of health-related social support to older adults. However, little is known about what design features make such tools most useful and feasible. The purpose of this study was to describe health-related social support networks of older adults and outline recommendations for the design of tools that facilitate the giving and receiving of support. Research Design and Methods We collected data through validated instruments and semistructured qualitative interviews with 88 older adults. We calculated descriptive statistics for the quantitative data and analyzed qualitative data using directed content analysis. Results Health-related support networks described by our sample of generally healthy older adults varied in size from 0 to 10 members. Some networks did not include any family members, and others did not include any friends. Seventy-four percent of network members lived in the same state as the older adult participant, but only 15% of them lived with the participant. Emotional support was the main type of health-related support provided, followed by instrumental, informational, and appraisal support. Discussion and Implications Health-related support networks of older adults are varied and complex. Our results suggest that digital communication tools to promote and leverage support from network members should facilitate the involvement of friends and family regardless of their physical location, allow for the transparent allocation of concrete tasks to prevent overburdening any one network member, and facilitate sharing of personal health information with family and friends while ensuring privacy and autonomy.
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Affiliation(s)
| | - Katie Osterhage
- Department of Family Medicine, School of Medicine, University of Washington, Seattle
| | - Jean O Taylor
- Department of Health Services, School of Public Health, University of Washington, Seattle
| | - Ian Painter
- Department of Health Services, School of Public Health, University of Washington, Seattle
| | - Yong Choi
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento
| | - Anne M Turner
- Department of Health Services, School of Public Health, University of Washington, Seattle.,Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle
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14
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A Structural Equation Model of Gratitude, Self-efficacy, and Medication Adherence in Patients With Stage B Heart Failure. J Cardiovasc Nurs 2020; 35:E18-E24. [PMID: 32649372 DOI: 10.1097/jcn.0000000000000721] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Consistent self-care slows the progression of heart failure (HF). Gratitude, the practice of appreciating the positive aspects of life, may influence self-efficacy, which in turn is known to improve self-care. However, little is known about the relationships among gratitude, self-efficacy, and medication adherence in HF. OBJECTIVE The aim of this study was to test a model to determine if self-efficacy mediates the relationship between gratitude and medication adherence in asymptomatic patients with HF. METHOD This is a secondary analysis of data from a prospective observational study. Data were analyzed using a structural equation model to examine associations between gratitude, cardiac-specific self-efficacy, and medication adherence in 153 patients with HF. Gratitude, self-efficacy, and medication adherence were assessed using the Gratitude Questionnaire-6, Cardiac Self-efficacy Scale-Maintain Function Subscale, and the Morisky Medication Adherence Scale, respectively. RESULTS Patient mean (SD) age was 66 (11) years, and 95% of the participants were men. Patients were primarily white (79%), black (12%), or Asian (6%). Gratitude exerted an indirect effect on medication adherence through self-efficacy (b = 0.16; P < .05). Gratitude was positively related to self-efficacy (b = 0.50; P < .05), and self-efficacy was positively related to medication adherence (b = 0.31; P < .05). The model fit was acceptable (comparative fit index = 0.92, Tucker-Lewis index = 0.90, root-mean-square error of approximation = 0.08). CONCLUSION In this study, we found evidence that self-efficacy was a mechanism through which gratitude was associated with medication adherence in asymptomatic patients with HF, suggesting a way to improve self-care nonpharmacologically. Future work will examine whether gratitude intervention results in improved self-care.
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15
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Yin K, Jung J, Coiera E, Laranjo L, Blandford A, Khoja A, Tai WT, Phillips DP, Lau AYS. Patient Work and Their Contexts: Scoping Review. J Med Internet Res 2020; 22:e16656. [PMID: 32484449 PMCID: PMC7298639 DOI: 10.2196/16656] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/04/2020] [Accepted: 03/29/2020] [Indexed: 12/19/2022] Open
Abstract
Background Having patients self-manage their health conditions is a widely promoted concept, but many patients struggle to practice it effectively. Moreover, few studies have analyzed the nature of work required from patients and how such work fits into the context of their daily life. Objective This study aimed to review the characteristics of patient work in adult patients. Patient work refers to tasks that health conditions impose on patients (eg, taking medications) within a system of contextual factors. Methods A systematic scoping review was conducted using narrative synthesis. Data were extracted from PubMed, Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO, including studies from August 2013 to August 2018. The included studies focused on adult patients and assessed one or more of the following: (1) physical health–related tasks, (2) cognitive health–related tasks, or (3) contextual factors affecting these tasks. Tasks were categorized according to the themes that emerged: (1) if the task is always visible to others or can be cognitive, (2) if the task must be conducted collaboratively or can be conducted alone, and (3) if the task was done with the purpose of creating resources. Contextual factors were grouped according to the level at which they exert influence (micro, meso, or macro) and where they fit in the patient work system (the macroergonomic layer of physical, social, and organizational factors; the mesoergonomic layer of household and community; and the microergonomic triad of person-task-tools). Results In total, 67 publications were included, with 58 original research articles and 9 review articles. A variety of patient work tasks were observed, ranging from physical and tangible tasks (such as taking medications and visiting health care professionals) to psychological and social tasks (such as creating coping strategies). Patient work was affected by a range of contextual factors on the micro, meso, or macro levels. Our results indicate that most patient work was done alone, in private, and often imposing cognitive burden with low amounts of support. Conclusions This review sought to provide insight into the work burden of health management from a patient perspective and how patient context influences such work. For many patients, health-related work is ever present, invisible, and overwhelming. When researchers and clinicians design and implement patient-facing interventions, it is important to understand how the extra work impacts one’s internal state and coping strategy, how such work fits into daily routines, and if these changes could be maintained in the long term.
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Affiliation(s)
- Kathleen Yin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Joshua Jung
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Liliana Laranjo
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Ann Blandford
- UCL Interaction Centre, University College London, London, United Kingdom
| | - Adeel Khoja
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Wan-Tien Tai
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Daniel Psillakis Phillips
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia.,UCL Interaction Centre, University College London, London, United Kingdom
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16
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Jolliff AF, Hoonakker P, Ponto K, Tredinnick R, Casper G, Martell T, Werner NE. The desktop, or the top of the desk? The relative usefulness of household features for personal health information management. APPLIED ERGONOMICS 2020; 82:102912. [PMID: 31430599 PMCID: PMC7366289 DOI: 10.1016/j.apergo.2019.102912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 06/21/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
Sixty percent of the US population manages at least one chronic illness. For these patients, personal health information management (PHIM) is an integral part of daily life, and largely occurs within the home. However, the way in which the home supports PHIM has not been systematically investigated. The present study examined how members of the diabetic population use features of the home environment to support PHIM. Participants (N = 60) explored a simulated home environment, the VR CAVE, and identified the most useful features for performing three examples of PHIM tasks. The computer was perceived as the most useful feature for PHIM. However, perceived usefulness of features varied based on the PHIM task performed and the rooms in which features appeared. We conclude that a detailed study of the affordances of features is necessary to ease the burden of managing chronic illness, particularly diabetes mellitus, in the sociotechnical system of the home.
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Affiliation(s)
- Anna F Jolliff
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI, 53706, USA; Department of Counseling Psychology, University of Wisconsin-Madison, USA.
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, USA; Wisconsin Institute for Discovery, Madison, WI, USA
| | - Kevin Ponto
- Wisconsin Institute for Discovery, Madison, WI, USA; School of Human Ecology, University of Wisconsin-Madison, USA
| | | | - Gail Casper
- Wisconsin Institute for Discovery, Madison, WI, USA; School of Nursing, University of Wisconsin-Madison, USA
| | - Thomas Martell
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI, 53706, USA
| | - Nicole E Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI, 53706, USA
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17
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Holden RJ, Cornet VP, Valdez RS. Patient ergonomics: 10-year mapping review of patient-centered human factors. APPLIED ERGONOMICS 2020; 82:102972. [PMID: 31654954 DOI: 10.1016/j.apergo.2019.102972] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 07/01/2019] [Accepted: 10/02/2019] [Indexed: 05/09/2023]
Abstract
Patient ergonomics is the application of human factors or related disciplines to study and improve patients' and other non-professionals' performance of effortful work activities in pursuit of health goals. We performed a mapping review of 212 full-text patient ergonomics publications in two conference proceedings, 2007-2017. The review revealed a robust and growing body of literature on patient ergonomics, particularly in the areas of aging and chronic disease, tools and technologies, and evaluations of patient-centered interventions on outcomes such as usability, user acceptance, and performance. Findings highlighted gaps deserving future research, including research with understudied populations such as children, informal caregivers, networks and collectives (groups), and marginalized populations; on topics such as health promotion and transitions of care; and using longitudinal and experimental study designs. The growth of patient-centeredness in general and of patient ergonomics in particular compel other more focused reviews, new primary research, and developing a roadmap for future patient ergonomics research.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc, USA.
| | - Victor P Cornet
- Department of Human-Centered Computing, IUPUI School of Informatics and Computing, USA
| | - Rupa S Valdez
- Department of Public Health Sciences, University of Virginia School of Medicine, USA
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18
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Keller SC, Cosgrove SE, Arbaje AI, Chang RHE, Krosche A, Williams D, Gurses AP. Roles and Role Ambiguity in Patient- and Caregiver-Performed Outpatient Parenteral Antimicrobial Therapy. Jt Comm J Qual Patient Saf 2019; 45:763-771. [PMID: 31447376 PMCID: PMC6823133 DOI: 10.1016/j.jcjq.2019.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Complicated medical therapies traditionally performed in acute care hospitals are increasingly moving to the home, requiring patients and informal caregivers to perform complicated medical tasks. For example, in outpatient parenteral antimicrobial therapy (OPAT), patients and caregivers perform antimicrobial infusions and venous catheter care. The objective of this study was to characterize patient understanding of patient, caregiver, and health care worker roles in OPAT and barriers to fulfilling these roles, with the goal of understanding how to best support patients and their caregivers. METHODS A qualitative study using 40 semistructured telephone interviews and 20 contextual inquiries of patients and caregivers performing OPAT tasks was performed. Eligible participants were discharged from two academic medical centers on OPAT. Interview transcripts and notes from contextual inquiry were coded based on a human factors engineering model. RESULTS Four main roles are described: communicator, advocate, learner-trainer, and lay health care worker doing "high-skilled tasks." Patients and caregivers experienced role ambiguity about OPAT task performance at the time of hospital discharge. Patients noted that their health care workers experienced role ambiguity as well, particularly regarding who was managing their care. Patients and caregivers used role transitions to achieve workload management, in which patients and caregivers transitioned OPAT tasks or non-OPAT tasks from one person to another. CONCLUSION Clear delineation of roles in complicated home-based medical therapies and training of all who may perform these tasks could improve the safety and quality of home-based care.
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Affiliation(s)
- Sara C. Keller
- Division of Infectious Diseases, Department of Medicine; Associate Faculty, Armstrong Institute for Patient Safety and Quality, Anesthesiology and Critical Care Medicine; Johns Hopkins University School of Medicine, Baltimore
| | - Sara E. Cosgrove
- Division of Infectious Diseases, Department of Medicine; Faculty, Armstrong Institute for Patient Safety and Quality, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Alicia I. Arbaje
- Medicine, Director of Transitional Care Research, Center for Transformative Geriatrics Research, Division of Geriatric Medicine and Gerontology, Department of Medicine; Johns Hopkins University School of Medicine, and Faculty, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | | | - Amanda Krosche
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine
| | - Deborah Williams
- Division of Quality Management, Johns Hopkins Home Care Group, Baltimore
| | - Ayse P. Gurses
- Armstrong Institute for Patient Safety and Quality, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine; Associate Professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
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19
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Daley C, Al-Abdulmunem M, Holden RJ. Knowledge among patients with heart failure: A narrative synthesis of qualitative research. Heart Lung 2019; 48:477-485. [PMID: 31227224 DOI: 10.1016/j.hrtlng.2019.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/15/2019] [Accepted: 05/18/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients' knowledge of heart failure (HF) is integral to improved outcomes. However, the HF literature has not adequately explored the nature of patients' knowledge of HF as part of their lived experience. OBJECTIVES We aimed to characterize the nature of patients' knowledge of HF, in the context of living with the disease. METHODS We conducted a narrative synthesis of qualitative studies that addressed patients' knowledge of HF. Studies were systematically searched and retrieved from MEDLINE, CINAHL, PsycINFO and PsycARTICLES databases. Findings were synthesized using an iterative coding process carried out by multiple analysts and reported following Enhancing Transparency in the Reporting of Qualitative Health Research (ENTREQ) criteria. RESULTS Analysis of 73 eligible articles produced five themes: the content that comprises HF knowledge; development of HF knowledge over time; application of HF knowledge for decision making; communication of information between clinicians and patients; and patients' experience of knowledge. CONCLUSION The nature of patients' knowledge of HF is both explicit and implicit, dynamic, and personal. This multidimensional model of knowledge-in-context calls for equally multidimensional research and intervention design.
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Affiliation(s)
- Carly Daley
- Department of BioHealth Informatics, IUPUI, Indianapolis, IN, USA; Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA.
| | | | - Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA.
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20
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Lin YK, Lin M, Chen H. Do Electronic Health Records Affect Quality of Care? Evidence from the HITECH Act. INFORMATION SYSTEMS RESEARCH 2019. [DOI: 10.1287/isre.2018.0813] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Yu-Kai Lin
- Center for Process Innovation, Department of Computer Information Systems, J. Mack Robinson College of Business, Georgia State University, Atlanta, Georgia 30303
| | - Mingfeng Lin
- Information Technology Management, Scheller College of Business, Georgia Institute of Technology, Atlanta, Georgia 30308
| | - Hsinchun Chen
- Department of Management Information Systems, Eller College of Management, University of Arizona, Tucson, Arizona 85721
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21
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Yin K, Harms T, Ho K, Rapport F, Vagholkar S, Laranjo L, Coiera E, Gershuny J, Lau AYS. Patient work from a context and time use perspective: a mixed-methods study protocol. BMJ Open 2018; 8:e022163. [PMID: 30580259 PMCID: PMC6307620 DOI: 10.1136/bmjopen-2018-022163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Self-management is widely promoted but less attention is focused on the work required from patients. To date, many individuals struggle to practise self-management. 'Patient work', a concept that examines the 'work' involved in self-management, is an approach to understanding the tasks, effort, time and context from patient perspective. The purpose of our study is to use a novel approach combining non-obstructive observations via digital devices with in-depth qualitative data about health behaviours and motivations, to capture the full range of patient work experienced by people with type 2 diabetes and chronic comorbidities. It aims to yield comprehensive insights about 'what works' in self-management, potentially extending to populations with other chronic health conditions. METHODS AND ANALYSIS This mixed-methods observational study involves a (1) prestudy interview and questionnaires, (2) a 24-hour period during which participants wear a camera and complete a time-use diary, and a (3) poststudy interview and study feedback. Adult participants living with type 2 diabetes with at least one chronic comorbidity will be recruited using purposive sampling to obtain a balanced gender ratio and of participants using insulin and those using only oral medication. Interviews will be analysed using thematic analysis. Data captured by digital devices, diaries and questionnaires will be used to analyse the duration, time, context and patterns of health-related behaviours. ETHICS AND DISSEMINATION The study was approved by the Macquarie University Human Research Ethics Committee for Medical Sciences (reference number 5201700718). Participants will carry a wallet-sized card that explains the purpose of the study to third parties, and can remove the camera at any stage. Before the poststudy interview begins, participants will view the camera images in private and can delete any images. Should any images be used in future publications or presentations, identifying features such as human faces and names will be obscured.
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Affiliation(s)
- Kathleen Yin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Teresa Harms
- Department of Sociology, Centre for Time Use Research, University of Oxford, Oxford, UK
- Planning and Transport Research Centre, Business School, University of Western Australia, Perth, Western Australia, Australia
| | - Kenneth Ho
- Faculty of Medical and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sanjyot Vagholkar
- Faculty of Medical and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Liliana Laranjo
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan Gershuny
- Department of Sociology, Centre for Time Use Research, University of Oxford, Oxford, UK
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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22
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Werner NE, Jolliff AF, Casper G, Martell T, Ponto K. Home is where the head is: a distributed cognition account of personal health information management in the home among those with chronic illness. ERGONOMICS 2018; 61:1065-1078. [PMID: 29402181 PMCID: PMC7909619 DOI: 10.1080/00140139.2018.1435910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 01/23/2018] [Indexed: 06/07/2023]
Abstract
Managing chronic illness requires personal health information management (PHIM) to be performed by lay individuals. Paramount to understanding the PHIM process is understanding the sociotechnical system in which it frequently occurs: the home environment. We combined distributed cognition theory and the patient work system model to investigate how characteristics of the home interact with the cognitive work of PHIM. We used a 3D virtual reality CAVE that enabled participants who had been diagnosed with diabetes (N = 20) to describe how they would perform PHIM in the home context. We found that PHIM is distinctly cognitive work, and rarely performed 'in the head'. Rather, features of the physical environment, tasks, people, and tools and technologies present, continuously shape and are shaped by the PHIM process. We suggest that approaches in which the individual (sans context) is considered the relevant unit of analysis overlook the pivotal role of the environment in shaping PHIM. Practitioner Summary: We examined how Personal Health Information Management (PHIM) is performed in the homes of diabetic patients. We found that approaches to studying cognition that focus on the individual, to the exclusion of their context, overlook the pivotal role of environmental, social, and technological features in shaping PHIM.
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Affiliation(s)
- Nicole E. Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Virtual Environments Group, Wisconsin Institutes for Discovery, Madison, WI, USA
| | - Anna F. Jolliff
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Gail Casper
- Virtual Environments Group, Wisconsin Institutes for Discovery, Madison, WI, USA
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Thomas Martell
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin Ponto
- Virtual Environments Group, Wisconsin Institutes for Discovery, Madison, WI, USA
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI, USA
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23
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Taylor JO, Hartzler AL, Osterhage KP, Demiris G, Turner AM. Monitoring for change: the role of family and friends in helping older adults manage personal health information. J Am Med Inform Assoc 2018; 25:989-999. [PMID: 29726993 PMCID: PMC7646862 DOI: 10.1093/jamia/ocy037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Although family and friends (FF) often play a significant support role in the health of older adults (OA), we know little about their role in personal health information management (PHIM). To address this gap and inform the design of PHIM tools, we describe the work, needs, and barriers of FF in the context of PHIM for OAs. Methods We conducted semi-structured telephone interviews with 52 FF identified by OA as being important in their health and PHIM. We analyzed interview transcripts for themes about FF information work, barriers, and support needs. Results FF play a supportive role in OA health maintenance, medical encounters, decision making, and daily activities. Monitoring, the ongoing process of seeking information related to the OA status, emerged as a key activity comprised of 3 phases: detection, interpretation, and action. Barriers to monitoring included OA choices and constraints, FF constraints, and difficulty with technological tools, resources, health information exchange between providers, social network dynamics, and physical distance. Conclusions FF frequently monitor for change in OA well-being, seeking up-to-date information to facilitate support of OA PHIM. Health information technology tools designed for FF can support all phases of monitoring by providing: (1) timely and granular levels of access to OA health information as the OA ages; (2) tailored health education for FF that is based on OA clinical data; and (3) networking platforms that integrate delegation, volunteering, and relevant resources, along with tools to facilitate support of OA appointment calendars and medication management. Such tools could reduce the burden of PHIM for OA and their loved ones.
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Affiliation(s)
- Jean O Taylor
- Northwest Center for Public Health Practice, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
| | - Katie P Osterhage
- Northwest Center for Public Health Practice, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anne M Turner
- Northwest Center for Public Health Practice, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
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24
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Mickelson RS, Holden RJ. Medication management strategies used by older adults with heart failure: A systems-based analysis. Eur J Cardiovasc Nurs 2018; 17:418-428. [PMID: 28901787 PMCID: PMC7728464 DOI: 10.1177/1474515117730704] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Older adults with heart failure use strategies to cope with the constraining barriers impeding medication management. Strategies are behavioral adaptations that allow goal achievement despite these constraining conditions. When strategies do not exist, are ineffective or maladaptive, medication performance and health outcomes are at risk. While constraints to medication adherence are described in literature, strategies used by patients to manage medications are less well-described or understood. AIM Guided by cognitive engineering concepts, the aim of this study was to describe and analyze the strategies used by older adults with heart failure to achieve their medication management goals. METHODS This mixed methods study employed an empirical strategies analysis method to elicit medication management strategies used by older adults with heart failure. Observation and interview data collected from 61 older adults with heart failure and 31 caregivers were analyzed using qualitative content analysis to derive categories, patterns and themes within and across cases. RESULTS Data derived thematic sub-categories described planned and ad hoc methods of strategic adaptations. Stable strategies proactively adjusted the medication management process, environment, or the patients themselves. Patients applied situational strategies (planned or ad hoc) to irregular or unexpected situations. Medication non-adherence was a strategy employed when life goals conflicted with medication adherence. The health system was a source of constraints without providing commensurate strategies. CONCLUSIONS Patients strived to control their medication system and achieve goals using adaptive strategies. Future patient self-mangement research can benefit from methods and theories used to study professional work, such as strategies analysis.
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Affiliation(s)
- Robin S. Mickelson
- Vanderbilt School of Nursing, Vanderbilt University, Nashville, TN, United States
- Department of Veterans Affairs, Tennessee Valley Healthcare System Nashville, TN
| | - Richard J. Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, United States
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Holden RJ, Srinivas P, Campbell NL, Clark DO, Bodke KS, Hong Y, Boustani MA, Ferguson D, Callahan CM. Understanding older adults' medication decision making and behavior: A study on over-the-counter (OTC) anticholinergic medications. Res Social Adm Pharm 2018; 15:53-60. [PMID: 29559218 DOI: 10.1016/j.sapharm.2018.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/29/2018] [Accepted: 03/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Older adults purchase and use over-the-counter (OTC) medications with potentially significant adverse effects. Some OTC medications, such as those with anticholinergic effects, are relatively contraindicated for use by older adults due to evidence of impaired cognition and other adverse effects. OBJECTIVE To inform the design of future OTC medication safety interventions for older adults, this study investigated consumers' decision making and behavior related to OTC medication purchasing and use, with a focus on OTC anticholinergic medications. METHODS The study had a cross-sectional design with multiple methods. A total of 84 adults participated in qualitative research interviews (n = 24), in-store shopper observations (n = 39), and laboratory-based simulated OTC shopping tasks (n = 21). Simulated shopping participants also rank-ordered eight factors on their importance for OTC decision making. RESULTS Findings revealed that many participants had concerns about medication adverse effects, generally, but were not aware of age-related risk associated with the use of anticholinergic medications. Analyses produced a map of the workflow of OTC-related behavior and decision making as well as related barriers such as difficulty locating medications or comparing them to an alternative. Participants reported effectiveness, adverse effects or health risks, and price as most important to their OTC medication purchase and use decisions. A persona analysis identified two types of consumers: the habit follower, who frequently purchased OTC medications and considered them safe; and the deliberator, who was more likely to weigh their options and consider alternatives to OTC medications. CONCLUSION A conceptual model of OTC medication purchase and use is presented. Drawing on study findings and behavioral theories, the model depicts dual processes for OTC medication decision making - habit-based and deliberation-based - as well as the antecedents and consequences of decision making. This model suggests several design directions for consumer-oriented interventions to promote OTC medication safety.
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Affiliation(s)
- Richard J Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing - Indianapolis, IN, USA; Indiana University Center for Aging Research (IUCAR), Regenstrief Institute, Inc. - Indianapolis, IN, USA.
| | - Preethi Srinivas
- Indiana University Center for Aging Research (IUCAR), Regenstrief Institute, Inc. - Indianapolis, IN, USA
| | - Noll L Campbell
- Indiana University Center for Aging Research (IUCAR), Regenstrief Institute, Inc. - Indianapolis, IN, USA; Purdue University College of Pharmacy - Lafayette, IN, USA
| | - Daniel O Clark
- Indiana University Center for Aging Research (IUCAR), Regenstrief Institute, Inc. - Indianapolis, IN, USA; Indiana University School of Medicine - Indianapolis, IN, USA
| | - Kunal S Bodke
- Indiana University Center for Aging Research (IUCAR), Regenstrief Institute, Inc. - Indianapolis, IN, USA
| | - Youngbok Hong
- Indiana University Center for Aging Research (IUCAR), Regenstrief Institute, Inc. - Indianapolis, IN, USA; Indiana University Herron School of Art and Design - Indianapolis, IN, USA
| | - Malaz A Boustani
- Indiana University Center for Aging Research (IUCAR), Regenstrief Institute, Inc. - Indianapolis, IN, USA; Indiana University School of Medicine - Indianapolis, IN, USA; Indiana University Center for Health Innovation and Implementation Science, Indiana CTSI - Indianapolis, IN, USA
| | - Denisha Ferguson
- Indiana University Center for Aging Research (IUCAR), Regenstrief Institute, Inc. - Indianapolis, IN, USA
| | - Christopher M Callahan
- Indiana University Center for Aging Research (IUCAR), Regenstrief Institute, Inc. - Indianapolis, IN, USA; Indiana University School of Medicine - Indianapolis, IN, USA
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Heiden SM, Holden RJ, Alder CA, Bodke K, Boustani M. Human factors in mental healthcare: A work system analysis of a community-based program for older adults with depression and dementia. APPLIED ERGONOMICS 2017; 64:27-40. [PMID: 28610811 PMCID: PMC5535802 DOI: 10.1016/j.apergo.2017.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/16/2017] [Accepted: 05/03/2017] [Indexed: 06/07/2023]
Abstract
Mental healthcare is a critical but largely unexplored application domain for human factors/ergonomics. This paper reports on a work system evaluation of a home-based dementia and depression care program for older adults, the Aging Brain Care program. The Workflow Elements Model was used to guide data collection and analysis of 59 h of observation, supplemented by key informant input. We identified four actors, 37 artifacts across seven types, ten action categories, and ten outcomes including improved health and safety. Five themes emerged regarding barriers and facilitators to care delivery in the program: the centrality of relationship building; the use of adaptive workarounds; performance of duplicate work; travel and scheduling challenges; and communication-related factors. Findings offer new insight into how mental healthcare services are delivered in a community-based program and key work-related factors shaping program outcomes.
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Affiliation(s)
- Siobhan M Heiden
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Richard J Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA; Indiana University Center for Aging Research (IU CAR), Indianapolis, IN, USA.
| | - Catherine A Alder
- Indiana University Center for Aging Research (IU CAR), Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA
| | - Kunal Bodke
- Indiana University Center for Aging Research (IU CAR), Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA
| | - Malaz Boustani
- Indiana University Center for Aging Research (IU CAR), Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA; Eskenazi Health, Indianapolis, IN, USA
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Mickelson RS, Holden RJ. Capturing the Medication Management Work System of Older Adults Using a Digital Diary Method. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1541931213601622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Human Factors and Ergonomics (HFE) has the potential to transform the lives of older adults by helping them better manage their health and disease. Older adults are often beset with multiple chronic illnesses and struggle to manage complex medication regimens. Non-adherence, errors, and poor outcomes are common. New research shows that patients’ health-related activities constitute an effortful, goal-driven type of work called patient work. HFE can play a major role in the study and improvement of patient work performance but current HFE methods are not fully suitable. This is in part because patient work is variable and takes place in home and community settings dissimilar to those commonly studied by healthcare HFE researchers. The objective of this study was to perform a work systems analysis of the medication management work of older adults with heart failure by adapting a method more suitable for the study of patient work. This qualitative longitudinal study used an innovative digital diary data collection method. Fifteen older adults with heart failure made medication-related multimedia recordings over a one-week period followed by an interview. These data were content analyzed according to the Patient Work System model. Results identified 6 organizational (70 instances), 7 task (45 instances), 7 tool (31 instances), 6 patient (31 instances), 4 social (21 instances), and 2 physical work system factors (10 instances). Patient medication performance suffered from a lack of care coordination and integration. Organizational tools such as mail order delivery facilitated access, but many patients devised tools and strategies to address other barriers. The study concluded that there is a need to design task-relevant tools to support and optimize the patients’ medication management work systems.
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Affiliation(s)
| | - Richard J. Holden
- BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA
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Cornet V, Voida S, Holden RJ. Activity Theory Analysis of Heart Failure Self-Care. MIND, CULTURE, AND ACTIVITY 2017; 25:22-39. [PMID: 31105419 PMCID: PMC6519742 DOI: 10.1080/10749039.2017.1372785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The management of chronic health conditions such as heart failure is a complex process emerging from the activity of a network of individuals and artifacts. This article presents an Activity Theory-based secondary analysis of data from a geriatric heart failure management study. Twenty-one patients' interviews and clinic visit observations were analyzed to uncover eight configurations of roles and activities involving patients, clinicians, and others in the sociotechnical network. For each configuration or activity pattern, we identify points of tension and propose guidelines for developing interventions for future computer-supported healthcare systems.
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Affiliation(s)
- Victor Cornet
- Indiana University–Purdue University, Indianapolis (IUPUI)
| | | | - Richard J. Holden
- Indiana University–Purdue University, Indianapolis (IUPUI)
- Indiana University Center for Aging Research, Regenstrief Institute, Inc
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Srinivas P, Cornet V, Holden R. Human factors analysis, design, and evaluation of Engage, a consumer health IT application for geriatric heart failure self-care. INTERNATIONAL JOURNAL OF HUMAN-COMPUTER INTERACTION 2016; 33:298-312. [PMID: 30429638 PMCID: PMC6231419 DOI: 10.1080/10447318.2016.1265784] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Human factors and ergonomics (HFE) and related approaches can be used to enhance research and development of consumer-facing health IT systems, including technologies supporting the needs of people with chronic disease. We describe a multiphase HFE study of health IT supporting self-care of chronic heart failure by older adults. The study was based on HFE frameworks of "patient work" and incorporated the three broad phases of user-centered design: study or analysis; design; and evaluation. In the study phase, data from observations, interviews, surveys, and other methods were analyzed to identify gaps in and requirements for supporting heart failure self-care. The design phase applied findings from the study phase throughout an iterative process, culminating in the design of the Engage application, a product intended for continuous use over 30 days to stimulate self-care engagement, behavior, and knowledge. During the evaluation phase, we identified a variety of usability issues through expert heuristic evaluation and laboratory-based usability testing. We discuss the implications of our findings regarding heart failure self-care in older adults and the methodological challenges of rapid translational field research and development in this domain.
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Affiliation(s)
- Preethi Srinivas
- Indiana University Center for Aging Research (IUCAR),
Regenstrief Institute, Inc. – Indianapolis, IN, USA
| | - Victor Cornet
- Indiana University School of Informatics and Computing
– Indianapolis, IN, USA
| | - Richard Holden
- Indiana University Center for Aging Research (IUCAR),
Regenstrief Institute, Inc. – Indianapolis, IN, USA
- Indiana University School of Informatics and Computing
– Indianapolis, IN, USA
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