[Memorandum IV: Theoretical and Normative Grounding of Health Services Research]

Application of Andersen's behavioural model of health services use: a scoping review with a focus on qualitative health services research

INTRODUCTION

Qualitative methods have become integral in health services research, and Andersen's behavioural model of health services use (BMHSU) is one of the most commonly employed models of health service utilisation. The model focuses on three core factors to explain healthcare utilisation: predisposing, enabling and need factors. A recent overview of the application of the BMHSU is lacking, particularly regarding its application in qualitative research. Therefore, we provide (1) a descriptive overview of the application of the BMHSU in health services research in general and (2) a qualitative synthesis on the (un)suitability of the model in qualitative health services research.

METHODS

We searched five databases from March to April 2019, and in April 2020. For inclusion, each study had to focus on individuals ≥18 years of age and to cite the BMHSU, a modified version of the model, or the three core factors that constitute the model, regardless of study design, or publication type. We used MS Excel to perform descriptive statistics, and applied MAXQDA 2020 as part of a qualitative content analysis.

RESULTS

From a total of 6319 results, we identified 1879 publications dealing with the BMSHU. The main methodological approach was quantitative (89%). More than half of the studies are based on the BMHSU from 1995. 77 studies employed a qualitative design, the BMHSU was applied to justify the theoretical background (62%), structure the data collection (40%) and perform data coding (78%). Various publications highlight the usefulness of the BMHSU for qualitative data, while others criticise the model for several reasons (eg, its lack of cultural or psychosocial factors).

CONCLUSIONS

The application of different and older models of healthcare utilisation hinders comparative health services research. Future research should consider quantitative or qualitative study designs and account for the most current and comprehensive model of the BMHSU.

[Educational Programmes in Health Services Research in Germany: Current State and Future Perspectives]

Ziel der Studie Ziel dieser Untersuchung war es, die derzeit akkreditierten Versorgungsforschungsstudiengänge in Deutschland im Hinblick auf ihre Strukturdaten und Inhalte zu analysieren.

Methodik Im Rahmen eines deskriptiven qualitativen Designs wurden die aktuellen Studienverlaufspläne, die Modulhandbücher und die Steckbriefe akkreditierter Masterstudiengänge der Versorgungsforschung inhaltsanalytisch ausgewertet.

Ergebnisse Die 6 analysierten Studiengänge zeigen sich hinsichtlich ihrer strukturellen Merkmale und lehr-lerninhaltlichen Ausrichtung in den wesentlichen Punkten als homogen. Ziel aller Studiengänge ist es, fach- und disziplinübergreifende personale und soziale Kompetenzen zu fördern, um Versorgungsbedarfe im Gesundheitswesen zu identifizieren, Innovationen der Versorgung zu entwickeln, zu initiieren, zu evaluieren und kritisch zu reflektieren.

Schlussfolgerungen Trotz ähnlicher Lehr-Lerninhalte bestehen spezifische Ausrichtungen, für die sich die Studierenden vor dem Hintergrund ihrer individuellen Präferenzen entscheiden können. Diese Ergebnisse könnten unter Berücksichtigung aktueller Diskurse und weiterer Erkenntnisse als Grundlage für Empfehlungen zur Entwicklung eines Kerncurriculums dienen.

[DNVF Memorandum Health Services Research in Oncology]

Health services research in oncology deals with all situations which cancer patients face. It looks at the different phases of care, i. e. prevention / early detection, prehabilitation, diagnostics, therapy, rehabilitation and palliative care as well as the various actors, including those affected, the carers and self-help. It deals with healthy people (e. g. in the context of prevention / early detection), patients and cancer survivors. Due to the nature of cancer and the existing care structures, there are a number of specific contents for health services research in oncology compared to general health services research while the methods remain essentially identical. This memorandum describes the subject, illustrates the care structures and identifies areas of health services research in oncology. This memorandum has been prepared by the Oncology Section of the German Network for Health Services Research and is the result of intensive discussions.

[Sectoral interface-an opportunity for health services research?]

The request for increased outpatient care is currently widely discussed in healthcare debates. With that, the sectoral interface (outpatient/hospital) is receiving greater attention, which provides an incentive for better cooperation and coordination of all healthcare providers. This also marks an opportunity to establish new cross-sectoral structures-also for research. The definitions of cross-sectoral care and the research content need to be in a standardized and consolidated manner. The provision of treatment data along the entire patent's path remains essential for health services research. In this context, the cross-sectoral interface could be regarded as fragile in that it is particularly sensitive to disruptions. The current increasing digitalization can also be seen as an opportunity to minimize the loss of information through the further development of cross-sectoral structures and to improve patient care, while simultaneously making a contribution to research across sectoral borders.

[The Junior Research Academy 2017 of the German Research Foundation (DFG) - Promotion of Young Researchers in Health Services]

The fourth Junior Research Academy in Health Services Research was once again funded by the German Research Foundation (DFG) in 2017. The academy was initiated by the Centre for Health and Society (chs) in Düsseldorf with the participation of the Centre for Health Services Research Cologne (ZVFK), the Research Centre for Health Communication and Health Services Research (CHSR) of the Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy of the University Hospital Bonn, the Interdisciplinary Centre for Health Services Research (IZVF) in Witten and the Institute for Health Services Research and Clinical Epidemiology (IVE) of the University Marburg. The aims of the Junior Research Academy are for imparting skills in the development and elaboration of innovative project ideas, to increase the number of proposals from the field of health services research to the DFG, to strengthen basic research within health services research in Germany and to network the scientific community. Young researchers from all over Germany were eligible to apply for participation by submitting an application in the form of a research proposal. A total of 83 applications were received. The 21 most promising applicants (14 women and 7 men) were selected in a 2-stage review process; 20 of these completed the Junior Research Academy program. After a one-day preparatory workshop, the preparation and review of a sample application, an academy week and a finalisation phase, all applications were submitted to the DFG on time. Of these proposals, 9 were funded. The first alumni meeting of the DFG Junior Research Academy took place in Düsseldorf in July 2019.

[Urolithiasis research-big data and artificial intelligence : How we can use the new structures of the medical informatics initiative of the Federal Ministry of Education and Research]

BACKGROUND

The digital transformation of society has a tremendous impact on both medicine and healthcare. The generation and processing of continuously growing amounts of digital data can be used to facilitate new approaches in research, particularly for healthcare research of common diseases such as urolithiasis.

OBJECTIVE

Presentation of the design of the German medical informatics initiative (MI-I) and the resulting possibilities for healthcare research in the field of urolithiasis.

RESULTS

For a meaningful utilization patient data must be readily available for research purposes and suitable methods for the analysis, interpretation and utilization must be developed. The aim of the German MI‑I is to make patient data collected during hospitalization available for research. The formation of so-called data integration centers will create a digital network that will facilitate the utilization and exchange of data between institutions. Advanced artificial intelligence algorithms will be used for analysis of the immense amounts of data. In May 2019 the German Federal Ministry of Education and Research boosted funding for the set-up of a digital nationwide registry on urolithiasis where the data foundation is to be generated based on the digital infrastructure of the MI‑I. The registry is intended to answer questions from the three relevant areas: "impact of the disease on individuals and society" (e.g. limitations in the quality of life and ability to work, treatment costs), "identification of further risk factors" (e.g. personalized medicine, especially taking account of lifestyle and nutrition, development of a risk score) and "evaluation of various treatment approaches" (which is the best treatment for an individual patient?).