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Taqif H, Adisso L, Gomes Souza L, Dofara SG, Ghio SC, Rivest LP, Légaré F. Changes in intention to use an interprofessional approach to decision-making following training: a cluster before-and-after study. BMC Health Serv Res 2024; 24:437. [PMID: 38589863 PMCID: PMC11000315 DOI: 10.1186/s12913-024-10899-z] [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: 03/17/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Health professionals in home care work in interprofessional teams. Yet most training in decision support assumes a one-on-one relationship with patients. We assessed the impact of an in-person training session in interprofessional shared decision-making (IP-SDM) on home care professionals' intention to adopt this approach. METHODS We conducted a secondary analysis of a cluster stepped-wedge trial using a before-and-after study design. We collected data among home care professionals from November 2016 to February 2018 in 9 health and social services centers in Quebec, Canada. The intervention was an in-person IP-SDM training session. Intention to engage in IP-SDM pre- and post-session (dependent variable) was compared using a continuing professional development evaluation scale (CPD-Reaction) informed by the Godin's Integrated Behavioral Model for health professionals. We also assessed socio-demographic and psychosocial variables (beliefs about capabilities, beliefs about consequences, social influence and moral norm). We performed bivariate and multivariate analysis to identify factors influencing post-intervention intention. We used the STROBE reporting guidelines for observational studies to report our results. RESULTS Of 134 respondents who provided complete pairs of questionnaires (pre- and post-), most were female (90.9%), mean age was 42 (± 9.3) years and 66.9% were social workers. Mean intention scores decreased from 5.84 (± 1.19) to 5.54 (± 1.35) (Mean difference = -0.30 ± 1.16; p = 0.02). Factors associated with higher intention post-intervention were social influence (ß = 0.34, p = 0.01) and belief about capabilities (ß = 0.49, p < 0.01). CONCLUSION After in-person IP-SDM training, healthcare professionals' intention to engage in IP-SDM decreased. However, the scope of this decrease is probably not clinically significant. Due to their association with intention, beliefs about capabilities, which translate into having a sense of self-competency in the new clinical behavior, and social influences, which translate into what important others think one should be doing, could be targets for future research aiming to implement IP-SDM in home care settings.
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Affiliation(s)
- Hajar Taqif
- Department of Mathematics and Statistics, Faculty of Science and Engineering, Université Laval, Quebec City, QC, Canada
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, Quebec City, QC, Canada
| | - Lionel Adisso
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, Quebec City, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Lucas Gomes Souza
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, Quebec City, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Suélène Georgina Dofara
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, Quebec City, QC, Canada
| | - Sergio Cortez Ghio
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, Quebec City, QC, Canada
| | - Louis-Paul Rivest
- Department of Mathematics and Statistics, Faculty of Science and Engineering, Université Laval, Quebec City, QC, Canada
| | - France Légaré
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, Quebec City, QC, Canada.
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.
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Aluisio AR, Smith-Sreen J, Offorjebe A, Maina W, Pirirei S, Kinuthia J, Bukusi D, Waweru H, Bosire R, Ojuka DK, Eastment MC, Katz DA, Mello MJ, Farquhar C. Implementation and Assessment of the HIV Enhanced Access Testing in the Emergency Department (HEATED) Program in Nairobi, Kenya: A Quasi-Experimental Prospective Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.03.24305277. [PMID: 38633813 PMCID: PMC11023650 DOI: 10.1101/2024.04.03.24305277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background Persons seeking emergency injury care are often from underserved key populations (KPs) and priority populations (PPs) for HIV programming. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential to reach underserved persons. Methods This quasi-experimental prospective study evaluated implementation of the HIV Enhanced Access Testing in Emergency Departments (HEATED) at Kenyatta National Hospital ED in Nairobi, Kenya. The HEATED program was designed using setting specific data and utilizes resource reorganization, services integration and HIV sensitization to promote ED-HTS. KPs included sex workers, gay men, men who have sex with men, transgender persons and persons who inject drugs. PPs included young persons (18-24 years), victims of interpersonal violence, persons with hazardous alcohol use and those never previously HIV tested. Data were obtained from systems-level records, enrolled injured patient participants and healthcare providers. Systems and patient-level data were collected during a pre-implementation period (6 March - 16 April 2023) and post-implementation (period 1, 1 May - 26 June 2023). Additional, systems-level data were collected during a second post-implementation (period 2, 27 June - 20 August 2023). Evaluation analyses were completed across reach, effectiveness, adoption, implementation and maintenance framework domains. Results All 151 clinical staff were reached through trainings and sensitizations on the HEATED program. Systems-level ED-HTS increased from 16.7% pre-implementation to 23.0% post-implementation periods 1 and 2 (RR=1.31, 95% CI:1.21-1.43; p<0.001) with a 62.9% relative increase in HIV self-test kit provision. Among 605 patient participants, facilities-based HTS increased from 5.7% pre-implementation to 62.3% post-implementation period 1 (RR=11.2, 95%CI:6.9-18.1; p<0.001). There were 440 (72.7%) patient participants identified as KPs (5.6%) and/or PPs (65.3%). For enrolled KPs/PPs, HTS increased from 4.6% pre-implementation to 72.3% post-implementation period 1 (RR=13.8, 95%CI:5.5-28.7, p<0.001). Systems and participant level data demonstrated successful adoption and implementation of the HEATED program. Through 16-weeks post-implementation a significant increase in ED-HTS delivery was maintained as compared to pre-implementation. Conclusions The HEATED program increased ED-HTS and augmented delivery to KPs/PPs, suggesting that broader implementation could improve HIV services for underserved persons, already in contact with health systems.
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Affiliation(s)
- Adam R. Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, USA
| | | | - Agatha Offorjebe
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, USA
| | | | | | - John Kinuthia
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Daniel K. Ojuka
- Department of Surgery, University of Nairobi Faculty of Health Sciences, Nairobi, Kenya
| | - McKenna C. Eastment
- Department of Global Health, University of Washington, Seattle, US
- Department of Medicine, University of Washington, Seattle, US
| | - David A. Katz
- Department of Global Health, University of Washington, Seattle, US
| | - Michael J. Mello
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, US
- Department of Medicine, University of Washington, Seattle, US
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Jeyakumar T, Karsan I, Williams B, Fried J, Kane G, Ambata-Villanueva S, Bennett A, McMahon GT, Paton M, Williams N, Younus S, Wiljer D. Paving the Way Forward for Evidence-Based Continuing Professional Development. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 44:53-57. [PMID: 37079386 DOI: 10.1097/ceh.0000000000000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
ABSTRACT Continuing professional development (CPD) fosters lifelong learning and enables health care providers to keep their knowledge and skills current with rapidly evolving health care practices. Instructional methods promoting critical thinking and decision making contribute to effective CPD interventions. The delivery methods influence the uptake of content and the resulting changes in knowledge, skills, attitudes, and behavior. Educational approaches are needed to ensure that CPD meets the changing needs of health care providers. This article examines the development approach and key recommendations embedded in a CE Educator's toolkit created to evolve CPD practice and foster a learning experience that promotes self-awareness, self-reflection, competency, and behavioral change. The Knowledge-to-Action framework was used in designing the toolkit. The toolkit highlighted three intervention formats: facilitation of small group learning, case-based learning, and reflective learning. Strategies and guidelines to promote active learning principles in CPD activities within different modalities and learning contexts were included. The goal of the toolkit is to assist CPD providers to design educational activities that optimally support health care providers' self-reflection and knowledge translation into their clinical environment and contribute to practice improvement, thus achieving the outcomes of the quintuple aim.
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Affiliation(s)
- Tharshini Jeyakumar
- Ms. Jeyakumar: Education Specialist, Digital Education, University Health Network, Toronto, Ontario, Canada. Ms. Karsan: Digital Education Analyst, Digital Education, University Health Network, Toronto, Ontario, Canada. Dr. Williams: Clinical Program Director, Professional Renewal Center, Clinical Associate Professor, Department of Psychiatry, School of Medicine, University of Kansas, and Director of Education, Wales Behavioral Assessment, Lawrence, KS. Ms. Fried: Chair of the Strategic Affairs Committee, a Member of the Board of Directors and the Executive Committee, Society for Academic Continuing Medical Education, Los Angeles, CA. Dr. Kane: Professor Emeritus, Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA. Ms. Ambata-Villanueva: Manager, Digital Education, University Health Network, Toronto, Ontario, Canada.Ms. Bennett: Public Health Teaching Faculty and Student Outreach Coordinator at Nova Southeastern University's Dr. Kiran C. Patel College of Osteopathic Medicine, Ft.Lauderdale, FL. Dr. McMahon: President and CEO, Accreditation Council for Continuing Medical Education, Chicago, IL. Dr. Paton: Education Research Coordinator for Continuing Professional Development, Temerty Faculty of Medicine and a PhD Candidate in the Department of Leadership, Higher, and Adult Education, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada. Mr. Williams: Practice Manager, Professional Renewal Center® and CME Administrator for Wales Behavioral Assessment, Lawrence, KS. Ms. Younus: Research Associate, Digital Education, University Health Network, Toronto, Ontario, Canada. Dr. Wiljer: Executive Director, Education Technology and Innovation, University Health Network, and Professor, Institute of Health Policy, Management and Evaluation & Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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