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Anantapong K, Bruun A, Walford A, Smith CH, Manthorpe J, Sampson EL, Davies N. Co-design development of a decision guide on eating and drinking for people with severe dementia during acute hospital admissions. Health Expect 2023; 26:613-629. [PMID: 36647692 PMCID: PMC10010093 DOI: 10.1111/hex.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/27/2022] [Accepted: 11/05/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Using co-design processes, we aimed to develop an evidence-based decision guide for family carers and hospital professionals to support decision-making about eating and drinking for hospital patients with severe dementia. METHODS Following a systematic review, we interviewed people with mild dementia, family carers and hospital professionals in England. We then held co-design workshops with family carers and hospital professionals. In parallel with the workshops, we used a matrix to synthesize data from all studies and to develop a decision guide prototype. The prototype was iteratively refined through further co-design workshops and discussions among researchers and Patient and Public Involvement (PPI) representatives. We conducted user testing for final feedback and to finalize the decision guide. RESULTS Most participants acknowledged the limited benefits of tube feeding and would not use or want it for someone with severe dementia. However, they found decision-making processes and communication about nutrition and hydration were emotionally demanding and poorly supported in acute hospitals. The co-design groups developed the aims of the decision guide to support conversations and shared decision-making processes in acute hospitals, and help people reach evidence-based decisions. It was designed to clarify decision-making stages, provide information and elicit the values/preferences of everyone involved. It encouraged person-centred care, best-interests decision-making and multidisciplinary team working. From user testing, family carers and hospital professionals thought the decision guide could help initiate conversations and inform decisions. The final decision guide was disseminated and is being used in clinical practice in England. CONCLUSION We used rigorous and transparent processes to co-design the decision guide with everyone involved. The decision guide may facilitate conversations about nutrition and hydration and help people reach shared decisions that meet the needs and preferences of people with severe dementia. Future evaluation is required to test its real-world impacts. PATIENT OR PUBLIC CONTRIBUTION People with mild dementia, family carers and hospital professionals contributed to the design of the decision guide through the interviews and co-design workshops. PPI members helped design study procedures and materials and prepare this manuscript.
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Affiliation(s)
- Kanthee Anantapong
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Andrea Bruun
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
| | - Anne Walford
- Family Carer, Patient and Public Involvement Panel, London, UK
| | - Christina H Smith
- Language and Cognition, Division of Psychology and Language Sciences, University College London, London, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health & Social Care Workforce, King's College London, London, UK.,NIHR Applied Research Collaboration (ARC) South London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, UK
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Meyer C, Dickins M, O’Keefe F, Hall K, Lowthian J. Risk Negotiation With People With Dementia: From Co-designed Paper Version to Implementation Preparation of an Electronic Conversation Tool. Gerontol Geriatr Med 2023; 9:23337214221149772. [PMID: 36726412 PMCID: PMC9885029 DOI: 10.1177/23337214221149772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 01/28/2023] Open
Abstract
The home care workforce provides essential support for older people with dementia to live a life of fulfillment. "Enabling Choices," an evidence-informed conversation tool, aims to negotiate risk around everyday activities between home care workers, people with dementia and their informal carers. This paper describes tool conversion into electronic format and preparation for implementation throughout a large Australian health and aged care service provider, utilizing the Implementation Framework for Aged Care (IFAC). Using codesign principles, the tool was converted from paper-based to electronic format involving frontline, operational and Information Management Services staff, and people with dementia/carers. Focus groups and interviews identified tool acceptability, feasibility, and appropriateness. For implementation preparation, the wider socio-cultural-political context was mapped, and key questions of the IFAC addressed. Environment, workflow, and training requirements were determined, and strategies for behavior change ascertained. Numerous opportunities and challenges exist for the widespread upscale of an evidence-informed tool into practice.
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Affiliation(s)
- Claudia Meyer
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia,La Trobe University, Bundoora, VIC,
Australia,Monash University, Frankston, VIC,
Australia,Flinders University, Adelaide, SA,
Australia,Claudia Meyer, Bolton Clarke Research
Institute, Level 1, 347 Burwood Highway, Forest Hill, VIC 3131, Australia.
| | - Marissa Dickins
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia,Monash University, Clayton, VIC,
Australia
| | - Fleur O’Keefe
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia
| | - Kylie Hall
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia
| | - Judy Lowthian
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia,Monash University, Clayton, VIC,
Australia,University of Queensland, St Lucia,
Australia
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Liddle J, Worthy P, Frost D, Taylor E, Taylor D. Partnering with people living with dementia and care partners in technology research and design: Reflections and recommendations. Aust Occup Ther J 2022; 69:723-741. [PMID: 36203322 PMCID: PMC10092369 DOI: 10.1111/1440-1630.12843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/15/2022] [Accepted: 09/10/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Occupational therapists may recommend and support technology use for facilitating independence, safety, wellbeing, and participation. There are high expectations for technology for people living with dementia. However, there is recognition that technologies will need to improve to deliver these expected benefits. People living with dementia have historically been excluded from direct involvement in research and design. A program of participatory research was undertaken to codesign technologies and technology research with people living with dementia and care partners. This work aims to capture the requirements, actions, and barriers experienced in forming these partnerships in technology research and design. METHODS A shared metareflection of experiences was conducted by members (5) of the research teams involved in three participatory research and technology design studies. The team comprising living experience experts, an occupational therapist, and interaction designer reflected on their experiences and derived recommendations. Key considerations for effective partnerships were drawn inductively by the authors from study experiences, materials, and reflexive discussion. FINDINGS Six core areas were identified. These were four action areas-(1) Agree on the value; (2) The time to start partnering is now; (3) Ask not assume; and (4) Push back on 'we always have'-(5) barriers and tensions, and (6) unexpected benefits. The reflections indicated that genuine partnerships and engagements were possible with living experience experts in research and design teams. These required resourcing and focussed actions to promote partnership. Despite some structural changes that encourage partnering, there are considerable barriers to this engagement; however, benefits beyond the expected ones can be realised. CONCLUSION Genuine partnerships in technology research and design with living experience experts are possible and lead to benefits for the team, research outcomes, and technologies. Recommended actions could support expansion of effective partnerships with people living with dementia and care partners as well as other partnerships in research.
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Affiliation(s)
- Jacki Liddle
- The Florence Project, School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Queensland, Australia
| | - Peter Worthy
- The Florence Project, School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Queensland, Australia
| | - Dennis Frost
- The Florence Project, School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Queensland, Australia
| | - Eileen Taylor
- The Florence Project, School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Queensland, Australia
| | - Dubhglas Taylor
- The Florence Project, School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Queensland, Australia
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Effendy C, Margaretha SEPM, Probandari A. The Utility of Participatory Action Research in the Nursing Field: A Scoping Review. Creat Nurs 2022; 28:54-60. [PMID: 35173063 DOI: 10.1891/cn-2021-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Participatory action research (PAR) is a method of inquiry that promotes a collaborative approach to knowledge creation. This article examined areas of research interest that included PAR methods, highlighting the areas of improvement that such approaches might offer to researchers and scientists in the nursing field. Among the 20 included studies, participatory concepts are more likely used to direct research design than to select participants. About two-thirds of the studies reviewed used PAR principles in designing projects. Although only a few research collaborative efforts involved partners in selecting participants, 70% involved participants in data gathering. Participatory approaches to data processing and interpretation were found in over 60% of articles assessed across all content categories. Approximately half of the studies included suggestions for participatory implementation approaches; a quarter discussed participatory ways to disseminate results. The findings demonstrate how researchers are incorporating PAR principles into a variety of areas of nursing research. Promises to fully include participants and promises of reciprocal benefit are essential in order to pursue meaningful PAR.
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LaMonica HM, Davenport TA, Roberts AE, Hickie IB. Understanding Technology Preferences and Requirements for Health Information Technologies Designed to Improve and Maintain the Mental Health and Well-Being of Older Adults: Participatory Design Study. JMIR Aging 2021; 4:e21461. [PMID: 33404509 PMCID: PMC7817357 DOI: 10.2196/21461] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/28/2022] Open
Abstract
Background Worldwide, the population is aging rapidly; therefore, there is a growing interest in strategies to support and maintain health and well-being in later life. Although familiarity with technology and digital literacy are increasing among this group, some older adults still lack confidence in their ability to use web-based technologies. In addition, age-related changes in cognition, vision, hearing, and perception may be barriers to adoption and highlight the need for digital tools developed specifically to meet the unique needs of older adults. Objective The aim of this study is to understand the use of technology by older adults in general and identify the potential barriers to and facilitators of the adoption of health information technologies (HITs) to support the health and well-being of older adults to facilitate implementation and promote user uptake. In addition, this study aims to co-design and configure the InnoWell Platform, a digital tool designed to facilitate better outcomes for people seeking mental health services, to meet the needs of adults 50 years and older and their supportive others (eg, family members, caregivers) to ensure the accessibility, engagement, and appropriateness of the technology. Methods Participants were adults 50 years and older and those who self-identified as a supportive other (eg, family member, caregiver). Participants were invited to participate in a 3-hour participatory design workshop using a variety of methods, including prompted discussion, creation of descriptive artifacts, and group-based development of user journeys. Results Four participatory design workshops were conducted, including a total of 21 participants, each attending a single workshop. Technology use was prevalent, with a preference indicated for smartphones and computers. Factors facilitating the adoption of HITs included personalization of content and functionality to meet and be responsive to a consumer’s needs, access to up-to-date information from reputable sources, and integration with standard care practices to support the relationship with health professionals. Concerns regarding data privacy and security were the primary barriers to the use of technology to support mental health and well-being. Conclusions Although HITs have the potential to improve access to cost-effective and low-intensity interventions at scale for improving and maintaining mental health and well-being, several strategies may improve the uptake and efficacy of technologies by the older adult community, including the use of co-design methodologies to ensure usability, acceptability, and appropriateness of the technology; support in using and understanding the clinical applications of the technology by a digital navigator; and ready availability of education and training materials.
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Affiliation(s)
- Haley M LaMonica
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | | | - Anna E Roberts
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
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Rathnayake S, Moyle W, Jones C, Calleja P. Co-design of an mHealth application for family caregivers of people with dementia to address functional disability care needs. Inform Health Soc Care 2020; 46:1-17. [DOI: 10.1080/17538157.2020.1793347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sarath Rathnayake
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Department of Nursing, University of Peradeniya, Kandy, Sri Lanka
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Cindy Jones
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Pauline Calleja
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
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