1
|
Valaitis R, Longaphy J, Ploeg J, Agarwal G, Oliver D, Nair K, Kastner M, Avilla E, Dolovich L. Health TAPESTRY: co-designing interprofessional primary care programs for older adults using the persona-scenario method. BMC Fam Pract 2019; 20:122. [PMID: 31484493 PMCID: PMC6727539 DOI: 10.1186/s12875-019-1013-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/22/2019] [Indexed: 11/24/2022]
Abstract
Background Working with patients and health care providers to co-design health interventions is gaining global prominence. While co-design of interventions is important for all patients, it is particularly important for older adults who often experience multiple and complex chronic conditions. Persona-scenarios have been used by designers of technology applications. The purpose of this paper is to explore how a modified approach to the persona-scenario method was used to co-design a complex primary health care intervention (Health TAPESTRY) by and for older adults and providers and the value added of this approach. Methods The persona-scenario method involved patient and clinician participants from two academically-linked primary care practices. Local prospective volunteers and community service providers (e.g., home care services, support services) were also recruited. Persona-scenario workshops were facilitated by researchers experienced in qualitative methods. Working mostly in homogenous pairs, participants created a fictitious but authentic persona that represented people like themselves. Core components of the Health TAPESTRY intervention were described. Then, participants created a story (scenario) involving their persona and an aspect of the proposed Health TAPESTRY program (e.g., volunteer roles). Two stages of analysis involved descriptive identification of themes, followed by an interpretive phase to extract possible actions and products related to ideas in each theme. Results Fourteen persona-scenario workshops were held involving patients (n = 15), healthcare providers/community care providers (n = 29), community service providers (n = 12), and volunteers (n = 14). Fifty themes emerged under four Health TAPESTRY components and a fifth category - patient. Eight cross cutting themes highlighted areas integral to the intervention. In total, 414 actions were identified and 406 products were extracted under the themes, of which 44.8% of the products (n = 182) were novel. The remaining 224 had been considered by the research team. Conclusions The persona-scenario method drew out feasible novel ideas from stakeholders, which expanded on the research team’s original ideas and highlighted interactions among components and stakeholder groups. Many ideas were integrated into the Health TAPESTRY program’s design and implementation. Persona-scenario method added significant value worthy of the added time it required. This method presents a promising alternative to active engagement of multiple stakeholders in the co-design of complex interventions. Electronic supplementary material The online version of this article (10.1186/s12875-019-1013-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ruta Valaitis
- School of Nursing, McMaster University, HSC 3N25,1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
| | - Jennifer Longaphy
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, Ontario, L8P 1H6, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, HSC 3N25,1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, Ontario, L8P 1H6, Canada
| | - Doug Oliver
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, Ontario, L8P 1H6, Canada
| | - Kalpana Nair
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, Ontario, L8P 1H6, Canada
| | - Monika Kastner
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M6, Canada
| | - Ernie Avilla
- Department of Medicine, Division of Clinical Immunology & Allergy, HSC 3V47, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, Ontario, L8P 1H6, Canada
| |
Collapse
|
2
|
Dolovich L, Oliver D, Lamarche L, Agarwal G, Carr T, Chan D, Cleghorn L, Griffith L, Javadi D, Kastner M, Longaphy J, Mangin D, Papaioannou A, Ploeg J, Raina P, Richardson J, Risdon C, Santaguida PL, Straus S, Thabane L, Valaitis R, Price D. A protocol for a pragmatic randomized controlled trial using the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) platform approach to promote person-focused primary healthcare for older adults. Implement Sci 2016; 11:49. [PMID: 27044360 PMCID: PMC4820854 DOI: 10.1186/s13012-016-0407-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/12/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Healthcare systems are not well designed to help people maintain or improve their health. They are generally not person-focused or well-coordinated. The objective of this study is to evaluate the effectiveness of the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) approach in older adults. The overarching hypothesis is that using the Health TAPESTRY approach to achieve better integration of the health and social care systems into a person's life that centers on meeting a person's health goals and needs will result in optimal aging. METHODS/DESIGN This is a 12-month delayed intervention pragmatic randomized controlled trial. The study will be performed in Hamilton, Ontario, Canada in the two-site McMaster Family Health Team. Participants will include 316 patients who are 70 years of age or older. Participants will be randomized to the Health TAPESTRY approach or control group. The Health TAPESTRY approach includes intentional, proactive conversations about a person's life and health goals and health risks and then initiation of congruent tailored interventions that support achievement of those goals and addressing of risks through (1) trained volunteers visiting clients in their homes to serve as a link between the primary care team and the client; (2) the use of novel technology including a personal health record from the home to link directly with the primary healthcare team; and (3) improved processes for connections, system navigation, and care delivery among interprofessional primary care teams, community service providers, and informal caregivers. The primary outcome will be the goal attainment scaling score. Secondary outcomes include self-efficacy for managing chronic disease, quality of life, the participant perspective on their own aging, social support, access to health services, comprehensiveness of care, patient empowerment, patient-centeredness, caregiver strain, satisfaction with care, healthcare resource utilization, and cost-effectiveness. Implementation processes will also be evaluated. The main comparative analysis will take place at 6 months. DISCUSSION Evidence of the individual elements of the Health TAPESTRY platform has been shown in isolation in the previous research. However, this study will better understand how to best integrate them to maximize the system's transformation of person-focused, primary care for older adults. TRIAL REGISTRATION ClinicalTrials.gov NCT02283723.
Collapse
Affiliation(s)
- Lisa Dolovich
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada.
| | - Doug Oliver
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
- McMaster Family Health Team, Hamilton, Canada
| | - Larkin Lamarche
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
- McMaster Family Health Team, Hamilton, Canada
| | - Tracey Carr
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | - David Chan
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | - Laura Cleghorn
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
- School of Nursing, McMaster University, Hamilton, Canada
| | - Lauren Griffith
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Dena Javadi
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | - Monika Kastner
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Jennifer Longaphy
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | | | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Canada
| | - Parminder Raina
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Cathy Risdon
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
- McMaster Family Health Team, Hamilton, Canada
| | - P Lina Santaguida
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Sharon Straus
- Institute of Health Management and Policy, University of Toronto, Toronto, Canada
| | - Lehana Thabane
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Ruta Valaitis
- School of Nursing, McMaster University, Hamilton, Canada
| | - David Price
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
- McMaster Family Health Team, Hamilton, Canada
| |
Collapse
|