1
|
Gaudine A, Parsons K, Smith-Young J. Older Adults' Experiences with Remote Care for Specialized Health Service During the COVID-19 Pandemic: A Descriptive Qualitative Study. Can J Aging 2024; 43:257-265. [PMID: 37869900 DOI: 10.1017/s0714980823000636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic necessitated a rapid uptake of remote health care services. This qualitative descriptive study was designed to gain an understanding of older adults' experiences of remote care (telephone or online video conference appointments) for specialized health services during the COVID-19 pandemic. Twenty-one older adults (ages 65 years and older; 8 men and 13 women) living in eastern Canada participated in a semi-structured telephone interview. Data were analysed using qualitative content analysis. The vast majority of older adults were overall satisfied with their remote experiences of specialist care. Advantages to remote care for specialized services included convenience, safety during the pandemic, comfort, efficiency, and ease of visit. Disadvantages included communication not as effective, feeling depersonalized or disembodied, missing the human relationship, and wanting reassurance of physical assessment. It is important that health professionals understand the disadvantages for older adults of remote care visits in order to mitigate them.
Collapse
Affiliation(s)
- Alice Gaudine
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Karen Parsons
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Joanne Smith-Young
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
| |
Collapse
|
2
|
Atchison K, Toohey AM, Ismail Z, Goodarzi Z. Understanding the Barriers to and Facilitators of Anxiety Management in Residents of Long-Term Care. Can J Aging 2024; 43:57-74. [PMID: 37665029 DOI: 10.1017/s0714980823000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Older adults, 65 years of age and older, living in long-term care (LTC) commonly experience anxiety. This study aimed to understand care providers' perspectives on the barriers to and facilitators of managing anxiety in residents of LTC. Ten semi-structured interviews with care providers in LTC were completed. Framework analysis methods were used to code, thematically analyze, designate codes as barriers or facilitators, and map the codes to the Theoretical Domains Framework. Themes were categorized as acting at the resident, provider, or system level, and were labelled as either barriers to or facilitators of anxiety care. Key barriers to anxiety care at each level were resident cognitive impairment or co-morbidities; lack of staff education, staff treatment uptake and implementation; as well as the care delivery environment and access to resources. There is a need to prioritize measurement-based care for anxiety, have increased access to non-pharmacological treatments, and have a care delivery environment that supports anxiety management to improve the care for anxiety that is delivered to residents.
Collapse
Affiliation(s)
- Kayla Atchison
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Ann M Toohey
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Brenda Strafford Centre on Aging, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
3
|
Flemons K, Cameron A, Dossett L, Helmle KE, McKeen J, Ruzycki SM. Barriers to High-quality Postoperative Glycemic Management by Surgical Teams: A Theory-informed Qualitative Analysis. Can J Diabetes 2023; 47:560-565. [PMID: 37196982 DOI: 10.1016/j.jcjd.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/24/2023] [Accepted: 05/06/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Our aim in this study was to identify the barriers to following recommendations for postoperative glycemic management among surgical team members. METHODS We conducted semistructured interviews with surgical team members guided by 2 theoretical frameworks for understanding the barriers and drivers of health-care behaviours: the Theoretical Domains Framework and the Consolidated Framework for Implementation Research. Interview data were coded deductively by 2 study team members. RESULTS Sixteen surgical team members from 7 surgical disciplines at a single hospital participated in this investigation. The most important barriers to management of postoperative hyperglycemia were knowledge of glycemic targets, belief about consequences of hyper- and hypoglycemia, available resources to manage hyperglycemia, adaptability of usual insulin regimens to complex postoperative patients, and skills to initiate insulin. CONCLUSIONS Interventions to reduce postoperative hyperglycemia are unlikely to be effective unless they use implementation science to address local barriers to high-quality management among surgical team members, including setting and systems-level barriers.
Collapse
Affiliation(s)
- Kristin Flemons
- W21C, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anna Cameron
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lesly Dossett
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Karmon E Helmle
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Julie McKeen
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shannon M Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
4
|
Bird M, Cerutti S, Jiang Y, Srugo SA, de Groh M. Implementation of the CANRISK Tool: A Qualitative Exploration Among Allied Health Professionals in Canada. Can J Diabetes 2021; 46:118-125. [PMID: 34334307 DOI: 10.1016/j.jcjd.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/28/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Launched in 2011 by the Public Health Agency of Canada, the Canadian Diabetes Risk Questionnaire (CANRISK) is a self-assessment tool validated in a Canadian sample, but its uptake has never been assessed. We sought to determine the level of current use of the CANRISK tool, identify common facilitators and barriers to its use and recommend future improvements. METHODS Ten professional allied health organizations across Canada were contacted for in-depth interviews. Contextual content and thematic analysis were used to analyze the qualitative data set. RESULTS According to allied health professionals, the tool is widely used, appealing and needed, and is being used for risk screening and health promotion. Respondents also identified the need to provide support and next steps for users identified as high risk. Still, several barriers to implementation were found, including readability, offensive or confusing language and difficulty ascertaining body measurements. CONCLUSIONS The CANRISK is a valuable diabetes risk assessment tool in Canada, particularly for allied health organizations.
Collapse
Affiliation(s)
- Madeleine Bird
- Social Determinants of Health Division, Public Health Agency of Canada, Montréal, Québec, Canada; Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada
| | - Stephanie Cerutti
- Ontario Regional Office, Public Health Agency of Canada, Toronto, Ontario, Canada
| | - Ying Jiang
- Applied Research Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Sebastian A Srugo
- Applied Research Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Margaret de Groh
- Applied Research Division, Public Health Agency of Canada, Ottawa, Ontario, Canada.
| |
Collapse
|
5
|
Egunsola O, Dowsett LE, Diaz R, Brent MH, Rac V, Clement FM. Diabetic Retinopathy Screening: A Systematic Review of Qualitative Literature. Can J Diabetes 2021:S1499-2671(21)00032-0. [PMID: 33814308 DOI: 10.1016/j.jcjd.2021.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Diabetic retinopathy is a common microvascular complication that leads to vision loss. Despite national and international organizations developing guidelines for diabetic retinopathy screening, patients with diabetes remain unscreened. Our aim was to understand facilitators and barriers influencing diabetic retinopathy screening attendance and to examine factors that promote program success. METHODS MEDLINE, Embase, PsycINFO and CINAHL from inception until September 23, 2019 were used for data collection. Studies were included if they were original qualitative research articles, included adults >18 years of age and assessed diabetic retinopathy screening programs or retinopathy screening as a component of a general diabetes care program. A "best-fit" framework synthesis methodology was used for this analysis. RESULTS Twenty-nine articles involving 1,433 participants were identified. Six themes of barriers to, and facilitators of, diabetic retinopathy screening were identified, including access to screening, knowledge and information sharing, training and skills competency, service delivery, cultural competency and psychological factors. Cost and competing interests were common barriers to access; lack of knowledge about screening services was also a frequently reported barrier. Both patients and providers identified the need for improved service delivery, especially the referral and follow-up process. Providers recognized the need for additional training, patients enumerated several psychological barriers to screening uptake and cultural considerations were believed to be important, particularly among indigenous communities. CONCLUSIONS To improve screening uptake, the identified challenges must be addressed while also reinforcing the facilitators. Furthermore, program administrators could model new and unsuccessful screening programs after the successful ones while also considering local peculiarities.
Collapse
|
6
|
Marshall J, Birriel PC, Baker E, Olson L, Agu N, Estefan LF. WIDENING THE SCOPE OF SOCIAL SUPPORT: THE FLORIDA MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAM. Infant Ment Health J 2018; 39:595-607. [PMID: 30074249 DOI: 10.1002/imhj.21737] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is designed to support pregnant women and families in developing skills and utilizing resources necessary to promote their children's physical, social, and emotional development. Little evaluation attention has focused on large-scale, public policy driven home-visiting programs. Social support provision is a critical component of a successful home-visiting program; therefore, there is a need to better understand participants' perceptions of social support provided to them in this context. Forty-five home-visiting participants from five Florida MIECHV programs completed semistructured telephone interviews. Participants discussed their experiences with the MIECHV program, including descriptions of their interactions with home visitors. Content analysis revealed that participants experienced multilayered social support from home-visiting staff. Families needed and received substantial emotional, instrumental, informational, and appraisal support at the individual level. This support was embedded within and strengthened by the strategies and activities of the home-visiting model of service provision. Results highlight the powerful opportunity home visiting offers as a method of service delivery within the larger system of care to increase social support in families experiencing high risk for negative maternal and child health outcomes. Implications for policy and practice are discussed.
Collapse
|
7
|
Helmle KE, Edwards AL, Kushniruk AW, Borycki EM. Qualitative Evaluation of the Barriers and Facilitators Influencing the Use of an Electronic Basal Bolus Insulin Therapy Protocol to Improve the Care of Adult Inpatients With Diabetes. Can J Diabetes 2018; 42:459-464.e1. [PMID: 29395845 DOI: 10.1016/j.jcjd.2017.10.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/26/2017] [Accepted: 10/26/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES A qualitative evaluation of the perceived impact of a new evidence-informed electronic basal bolus insulin therapy order set on clinical workflow and practice, and exploration of potential barriers and facilitators to electronic basal bolus insulin order set uptake and use in acute care facilities for various acute care team members. METHODS We conducted 9 semistructured focus groups with multidisciplinary nursing staff (n=22), resident trainees (n=24) and attending physicians (n=23) involved in the delivery of inpatient diabetes care at 3 adult acute care facilities. The domains of inquiry included impact on workload, perceived impact on patient care and discipline-specific barriers and facilitators to use, including care-providers' needs, comfort and competencies, contributions from the clinical environment and efficacy of communication. The interviews were transcribed and analyzed using a content analysis approach. RESULTS Several major themes emerged from the focus group discussions, including impact of education, information technology/user interface, workflow, organizational issues and practices, and perceived outcomes. Barriers and facilitators were identified relating to each theme. CONCLUSIONS The outcomes highlight the complex interplay between educational, organizational and technical themes and the significance of employing a systemic approach to support the implementation of electronic inpatient glycemic-management protocols within complex social organizations.
Collapse
Affiliation(s)
- Karmon E Helmle
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Alun L Edwards
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andre W Kushniruk
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
| | - Elizabeth M Borycki
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
8
|
Abstract
Prephysical activity screening is important for older adults' participating in physical activity. Unfortunately, many older adults face barriers to exercise participation and thus, may not complete proper physical activity screening. The purpose of this project was to conduct a thematic analysis of perceptions and experiences of community-dwelling older adults regarding prephysical activity screening (i.e., Get Active Questionnaire (GAQ) and a standardized exercise stress test). A convenience sample of adults (male n = 58, female n = 54) aged 75 ± 7 years living in the City of London, Ontario, Canada, was used. Participants completed a treadmill stress test and the GAQ at a research laboratory for community-based referrals. One week later, participants completed the GAQ again and were asked questions by a research assistant about their perceptions of the screening process. Thematic analysis of the responses was conducted. The results indicated that older adults view physical activity screening as acceptable, but not always necessary. Also, the experiences expressed by this sample of older adults indicated that physical activity screening can contribute to continued confidence (through reassurance) and can contribute to increased motivation (through yearly fitness results) in exercise participation. In conclusion, older adults may perceive screening as supportive in exercise adoption, if screening is simple, convenient, and supports older adults' motivation and confidence to exercise.
Collapse
Affiliation(s)
- Liza Stathokostas
- a Faculty of Health Sciences, School of Kinesiology, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Andrea F M Petrella
- a Faculty of Health Sciences, School of Kinesiology, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Wendy Blunt
- b Centre for Studies in Family Medicine, Department of Family Medicine, University of Western Ontario, London, ON N6G 2M1, Canada
| | - Robert J Petrella
- a Faculty of Health Sciences, School of Kinesiology, University of Western Ontario, London, ON N6A 3K7, Canada.,b Centre for Studies in Family Medicine, Department of Family Medicine, University of Western Ontario, London, ON N6G 2M1, Canada
| |
Collapse
|