Meeting the Challenge of a More Person-centered Future for US Healthcare

Developing personas to examine older adult engagement with televised direct-to-consumer advertisements: A theory based approach

Background

The average adult in the United States views up to 16 h of direct-to-consumer television advertisements (DTCA) per year, far exceeding time they spend with their primary care team. DTCAs present a unique opportunity to extend medical education beyond traditional medical settings and into the daily lives of patients. This is particularly valuable for populations with changing healthcare needs, such as older adults. As pharmaceutical companies invest in DTCAs, there is a growing need to identify what characteristics make viewers more likely to retain and act on medication information presented in DTCAs.

Objective

This paper presents a theory based approach to developing personas of older adult DTCA viewers that categorize characteristics influencing their approach to healthcare engagement.

Methods

In 2023, 25 older adult participants watched a one minute DTCA followed by a semi-structured interview. The interview guide applied concepts from the human factors engineering Communication-Human Information Processing model (C-HIP). C-HIP provided structure for both identifying personal characteristics that influence cognition and examining how these factors influence older adult's ability and desire to retain information from DTCAs. Personas were iteratively developed using qualitative analysis.

Results

The study yielded three main older adult DTCA viewing personas. These include: 1) medication averse older adults who actively avoid taking medications, 2) information seeking older adults who independently research health information to participate in shared-decision making, and 3) medication adhering older adults who prefer their provider to control decisions.

Conclusion

Constructing older adult personas provides insights into the heterogeneity among older adult approaches to engaging with health information. Each persona represents unique information priorities and personal characteristics of older adults when viewing advertisements, thus presenting a need for tailored patient-centered messaging in commercials.

Workplace health culture and trust in the occupational health office: A descriptive study of meatpacking workers

INTRODUCTION

Worker trust in employer-provided occupational health services has not been explored in essential industries, such as meatpacking. The purpose of this study was to describe workplace health culture and trust in the occupational health office and highlight meatpacking workers' experiences with the occupational health office.

METHODS

Meatpacking workers were surveyed between February 2021 and October 2022. Descriptive statistics and nonparametric tests were used to explore trust across demographic variables, including workplace health culture. Thematic analysis was used to examine the short-answer qualitative data.

RESULTS

Among workers who completed surveys (n = 731), health culture was rated low (M = 1.3 (0.73); possible range 0-3). Trust in the occupational health office was also rated low (M = 8.2 (5.06); possible range 0-20). Workers' descriptions of interactions with the occupational health office were mostly unfavorable (287 negative opinion units; 97 positive opinion units) and primarily focused on quality of care, communication, the supervisor as gatekeeper to health services, and the prioritization of company interests.

CONCLUSION

Meatpacking worker health may be improved by building worker trust in the occupational health office. Suggested strategies include enhanced communication, protection of confidentiality, prioritization of worker well-being, and promotion of a stronger health culture in plants and throughout the industry. Supporting workers without a regular healthcare provider to establish a relationship with a primary care provider of their choice is also recommended.

Trust of patients and families in mental healthcare providers and institutions: a cross-cultural study in Chennai, India, and Montreal, Canada

PURPOSE

Cross-cultural psychosis research has typically focused on a limited number of outcomes (generally symptom-related). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to fundamental treatment processes like trust. Addressing this gap, we studied two similar first-episode psychosis programs in Montreal, Canada, and Chennai, India. We hypothesized higher trust in healthcare institutions and providers among patients and families in Chennai at baseline and over follow-up.

METHODS

Upon treatment entry and at months 3, 12 and 24, trust in healthcare providers was measured using the Wake Forest Trust scale and trust in the healthcare and mental healthcare systems using two single items. Nonparametric tests were performed to compare trust levels across sites and mixed-effects linear regression models to investigate predictors of trust in healthcare providers.

RESULTS

The study included 333 patients (Montreal = 165, Chennai = 168) and 324 family members (Montreal = 128, Chennai = 168). Across all timepoints, Chennai patients and families had higher trust in healthcare providers and the healthcare and mental healthcare systems. The effect of site on trust in healthcare providers was significant after controlling for sociodemographic characteristics known to impact trust. Patients' trust in doctors increased over follow-up.

CONCLUSION

This study uniquely focuses on trust as an outcome in psychosis, via a comparative longitudinal analysis of different trust dimensions and predictors, across two geographical settings. The consistent differences in trust levels between sites may be attributable to local cultural values and institutional structures and processes and underpin cross-cultural variations in treatment engagement and outcomes.

Primary Practice Emphasis Area and Diversity Among Board-Certified Ophthalmologists

PURPOSE

To describe the ophthalmology primary practice emphasis area by underrepresented in medicine (URiM) status using the American Board of Ophthalmology (ABO) Diplomates database.

DESIGN

Retrospective cohort study.

METHODS

The study was based on a retrospective review of the ABO database from 1992 to 2020. The datapoints recorded included age at time of graduation and at time of certification, sex/gender, self-reported race/ethnicity, year of graduation and of certification, region of practice in the United States, and the self-reported primary practice emphasis area within ophthalmology. The URiM cohort included self-identified Black, Hispanic/Latinx, American Indian and Alaska Native, and Native Hawaiian and Other Pacific Islander individuals. Statistical analysis was conducted using Pearson χ2, Student t, and Fisher exact tests.

RESULTS

A total of 575 (10.1%) ophthalmologists self-identified as URiM, vs 5132 (89.9%) as non-URiM. Diplomates who were URiM were more likely to be female and to be older at the time of ABO certification than those who were not URiM (P < .001). Over time, there was a steady decrease in the percentage of diplomates who were URiM (P < .001). There was a statistically significantly higher percentage of URiM ophthalmologists who reported glaucoma as their primary area of emphasis (P = .039) and non-URiM ophthalmologists who reported oncology, pathology, international, or genetics (P = .015), but no significant differences in the remaining subspecialties (P ≥ .123).

CONCLUSIONS

There were modest differences in reported ophthalmology primary practice emphasis areas between URiM and non-URiM ABO diplomates. Despite efforts to increase diversity in ophthalmology, the percentage of graduating URiM ABO diplomates has decreased over the past 2 decades.

Patient experiences and outcomes in a virtual healing setting: A feasibility study

RESEARCH QUESTIONS

How do participants with anxiety receiving distance healing using tuning forks, experience healing sessions? What outcomes do they spontaneously report?

THEORETICAL FRAMEWORK

Modified grounded theory, using single interviews to learn about experiences with distant sound healing.

METHODOLOGY

Standardized open-ended, qualitative interviews of 30-minute length were conducted after the intervention and analyzed using an inductive and iterative process for identifying themes, categories, and patterns in qualitative data.

CONTEXT

Single-arm, pilot feasibility study of Biofield Tuning (BT) for anxiety during the COVID-19 pandemic delivered at a distance facilitated by Zoom (without video).

SAMPLE SELECTION

A total of 15 participants were recruited to this study: 13 completed all quantitative aspects, and the 12 who completed the interviews are reported here.

DATA COLLECTION

The 30-minute qualitative interviews were designed to understand the impact of virtual BT sessions on the participant's experience, anxiety, and within the larger context of their life. The Self-Assessment of Change measured subjective shifts pre and post treatment.

ANALYSIS AND INTERPRETATION

The interviews were audio-recorded and transcribed using otter.ai. Two researchers read all the transcripts, identified key themes within the broader experience of sessions and outcomes categories, and came to consensus on key themes using a qualitative research analysis approach.

MAIN RESULTS

Participants were surprised by the degree to which they felt sensations and heard tuning fork changes. They commented on the accuracy of the healers' perceptions and comprehension of their life experiences. Participants reported positive shifts in perceptions of themselves and their surroundings, both interpersonally and in response to triggers. The patients' own words provide insight into the lived experiences of healing, and guide future research.

Trust of patients and families in mental healthcare providers and institutions: A cross-cultural study in Chennai, India and Montreal, Canada

Purpose

Cross-cultural psychosis research has typically focused on a limited number of outcomes (generally symptom-related). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to fundamental treatment processes like trust. Addressing this gap, we studied two similar first-episode psychosis programs in Montreal, Canada and Chennai, India. We hypothesized higher trust in healthcare institutions and providers among patients and families in Chennai at baseline and over follow-up.

Methods

Upon treatment entry and at months 3, 12 and 24, trust in healthcare providers was measured using the Wake Forest Trust scale and trust in the healthcare and mental healthcare systems using two single items. Non-parametric tests were performed to compare trust levels across sites and mixed-effects linear regression models to investigate predictors of trust in healthcare providers.

Results

The study included 333 patients (Montreal=165, Chennai=168) and 324 family members (Montreal=128, Chennai=168). Across all timepoints, Chennai patients and families had higher trust in healthcare providers and the healthcare and mental healthcare systems. The effect of site on trust in healthcare providers was significant after controlling for sociodemographic characteristics known to impact trust. Patients' trust in doctors increased over follow-up.

Conclusion

This study uniquely focuses on trust as an outcome in psychosis, via a comparative longitudinal analysis of different trust dimensions and predictors, across two geographical settings. The consistent differences in trust levels between sites may be attributable to local cultural values and institutional structures and processes and underpin cross-cultural variations in treatment engagement and outcomes.

Pursuing Pharmacoequity: Determinants, Drivers, and Pathways to Progress

The United States pays more for medical care than any other nation in the world, including for prescription drugs. These costs are inequitably distributed, as individuals from underrepresented racial and ethnic groups in the United States experience the highest costs of care and unequal access to high-quality, evidence-based medication therapy. Pharmacoequity refers to equity in access to pharmacotherapies or ensuring that all patients, regardless of race and ethnicity, socioeconomic status, or availability of resources, have access to the highest quality of pharmacotherapy required to manage their health conditions. Herein the authors describe the urgent need to prioritize pharmacoequity. This goal will require a bold and innovative examination of social policy, research infrastructure, patient and prescriber characteristics, as well as health policy determinants of inequitable medication access. In this article, the authors describe these determinants, identify drivers of ongoing inequities in prescription drug access, and provide a framework for the path toward achieving pharmacoequity.

Interprofessional Collaborative Relationship-Building Model in Action in Primary Care: A Secondary Analysis

Introduction

Team-based care has been integrated into primary care (PC) across Canada because it improves patient safety, effectiveness, efficiency, person-centredness, and equity. However, this integration in and of itself may not lead to improved patient care without effective interpersonal relationships amongst team members. Currently, teams have few tools to guide the development of collaborative relationships. The Interprofessional Collaborative Relationship-building Model (ICRB) was developed to be a tool for understanding the stages of development of the interprofessional team's relationship-building.

Purpose

This qualitative secondary data analysis illuminates a PC team's experiences of their developing interprofessional relationships with occupational therapists and physical therapists who joined the PC team.

Method

Eleven team member interviews of one primary care team from a family medicine teaching clinic affiliated with a training university and the health region in central Canada were analyzed using secondary data analysis. The team included family physicians (n = 4), nurses (n = 2), a social worker (n = 1), a mental health counselor (n = 1), occupational therapists (n = 2), and a physical therapist (n = 1). We used the ICRB for directed content analysis using the phased approach that includes the three main steps of data preparation, data organization and data presentation.

Results

This team experienced the ICRB stages of Looking For Help, Fitting-In, and Growing Reciprocity thereby learning about one another to better understand what OT and PT may bring to the PC setting. However, contrary to the ICRB, co-location, was the context within which the collaborative relationship-building took place rather than a distinct developmental stage. Although team members did experience some level of Growing Reciprocity, this developing team had not yet established collaborative leadership processes. As the ICRB originally posited, communication and patient focus facilitated all stages of the relationship-building process and helped the team develop shared values and role clarity that establish how different team members contribute to improving quality care.

Conclusions

The context of co-location with a patient focus and open communication facilitated the team's development with the occupational therapists and physical therapist. Collaborative leadership is a worthy goal for future research and clinical focus as it has implications for improving overall patient quality care and team member work satisfaction.

Role of Infodemics on Social Media in the Development of People’s Readiness to Follow COVID-19 Preventive Measures

Unparalleled levels of misinformation have contributed to widespread misunderstandings about the nature of the coronavirus, its cure and preventative measures. Misinformation crosses borders rapidly with the help of social media, and this phenomenon is constantly increasing. Thus, the current study proposes a research framework to explore how citizens’ trust in government and social media influences their readiness to follow COVID-19 preventive measures. Additionally, the role of a health infodemic was explored in perceptions and relationships among factors influencing an individual’s readiness to follow COVID-19 preventive measures with data collected from 396 participants in Taiwan. The findings indicate citizens’ trust in social media (TRSM), attitude (ATT), perceived benefit (PBT), personal innovativeness, and how peer referents positively influence their readiness. However, the relationship between citizens’ trust in the government (TRGT) and their readiness to follow COVID-19 preventive measures (INT) is not statistically significant. The current study also explores the negative moderating effect of health infodemics on the relationship between TRSM and INT, TRGT and INT, ATT and INT, PBT and INT. Thus, the Taiwanese government must consider the current study’s findings to develop attractively, informed, and evidence-based content, which helps its citizens improve their health literacy and counter the spread of misinformation.

Assessing dental student perceptions after engaging in a longitudinal interprofessional education curriculum: A preliminary study

PURPOSE/OBJECTIVES

Baseline IPE perceptions for dental students were gathered prior to the implementation of a 2-year formalised IPE curriculum at a US institution. The goal was to establish a baseline of student perceptions and, in the future, continue to track student IPE perception data with IPE engagement as one measure of outcomes. The purpose of this paper is to analyse two dental student cohort perceptions of IPE after engaging in a 2-year longitudinal curriculum.

METHODS

First- and second-year students were required to participate in a 2-year IPE curriculum. As a requirement of the curriculum, students were asked to complete a validated IPE assessment, the Student Perceptions of Interprofessional Clinical Education-Revised instrument, version 2 (SPICE-R2). Students completed the SPICE-R2 survey, using a retrospective pretest/post-test design, after engaging in the 2-year curriculum.

RESULTS

Sixty-four students in cohort 2017 and 70 students in cohort 2018 completed the entire SPICE-R2. Statistically significant positive changes (p < .05) were found in both dental student cohorts after engagement in the 2-year longitudinal IPE curriculum.

CONCLUSION(S)

A longitudinal IPE curriculum has the potential to impact student IPE perceptions. Additional longitudinal multi-institutional research is needed to determine best practices in delivery and learning.

Blockchain for Increased Trust in Virtual Health Care: Proof-of-Concept Study

BACKGROUND

Health care systems are currently undergoing a digital transformation that has been primarily triggered by emerging technologies, such as artificial intelligence, the Internet of Things, 5G, blockchain, and the digital representation of patients using (mobile) sensor devices. One of the results of this transformation is the gradual virtualization of care. Irrespective of the care environment, trust between caregivers and patients is essential for achieving favorable health outcomes. Given the many breaches of information security and patient safety, today's health information system portfolios do not suffice as infrastructure for establishing and maintaining trust in virtual care environments.

OBJECTIVE

This study aims to establish a theoretical foundation for a complex health care system intervention that aims to exploit a cryptographically secured infrastructure for establishing and maintaining trust in virtualized care environments and, based on this theoretical foundation, present a proof of concept that fulfills the necessary requirements.

METHODS

This work applies the following framework for the design and evaluation of complex intervention research within health care: a review of the literature and expert consultation for technology forecasting. A proof of concept was developed by following the principles of design science and requirements engineering.

RESULTS

This study determined and defined the crucial functional and nonfunctional requirements and principles for enhancing trust between caregivers and patients within a virtualized health care environment. The cornerstone of our architecture is an approach that uses blockchain technology. The proposed decentralized system offers an innovative governance structure for a novel trust model. The presented theoretical design principles are supported by a concrete implementation of an Ethereum-based platform called VerifyMed.

CONCLUSIONS

A service for enhancing trust in a virtualized health care environment that is built on a public blockchain has a high fit for purpose in Healthcare 4.0.

The Birth Education Starts Today Video on Birth Care Options: Evaluation With University Students

Despite evidence indicating that midwife-attended birth is safe and satisfactory, few U.S. families have credentialed midwives as their birth care providers. In the context of person-centered health care and improving maternity care, we evaluated how an author-constructed video featuring evidence and personal narratives on midwifery care affected attitudes and care preferences/intentions for a hypothetical future birth among university students who had not become parents. Students (114 women, 30 men) completed care attitude and preference items before and after viewing the video. Significant (p < .001) changes indicated significantly improved attitudes toward midwives and out-of-hospital birth and related preferences. We discuss the educational framework of the video and plans to determine whether short-term effects translate into care-seeking behavior across diverse populations.

Trust towards nurses who care for haemodialysis patients: a cross-sectional study

BACKGROUND

Trust is widely acknowledged as the main component of relationships between patients and nurses.

AIMS

Considering the importance of building trust in the patient-nurse relationship especially in vulnerable patients such as patients undergoing haemodialysis, this study was carried out to assess the trust of these patients towards nurses in the haemodialysis unit and to explore its relationship with some characteristics of the patients.

METHODS

In this cross-sectional study, a total of 180 patients undergoing maintenance haemodialysis were selected using random sampling method. Data were collected by trust in nurses (TNS) scale. The collected data were analysed by SPSS (ver.21) software using anova, independent t-test and Pearson's correlation coefficient.

RESULTS

The mean score of patients' trust in nurses was 23.82, showing a high level of trust towards nurses. The lowest score (with a mean score of 4.17) was related to the providing of accurate information by nurses about the disease. Pearson's correlation coefficient indicated a positive significant relationship between the age and patient's trust (r = 0.17, p > 0.05), and there was a negative relationship between the mean score of trust and the mean of interdialytic weight gain (r = 0.57, p > 0.05).

CONCLUSIONS

Although the patient trust towards nurses was high in this study, there were some deficiencies in certain items especially in the provision of information and education to the patients. Education of specialised courses for nurses and empowering them to provide a high quality care to the patients on dialysis could help to increase the patents' trust.

Developing the Learning about Midwives and Birth Settings Video for Teaching About Birth Care Options

BACKGROUND

U.S. women's reports have indicated misconceptions about midwifery care and related birth options, yet these care approaches are associated with healthy birth outcomes. From the perspective of person-centered care, we aimed to address existing knowledge gaps on midwifery care by creating an accessible learning tool help inform future parents and community educators of evidence-based birth care options.

METHOD

Applied action research (AR) principles to develop a learning tool for public use. We conducted focus groups with nulliparous young adults who were university students, those who were nonstudent community members, and medical professionals to build content. We collected pre–post viewing data on knowledge, attitudes, and future behavioral intentions with university and community samples.

RESULTS

Our resultant 17-minute video contains content in three areas: (a) narratives from midwives, (b) narratives from parents, (c) information on midwives' credentialing and scope of care, birth settings, and safety studies. Evaluation data indicated that the video positively influenced viewers' related knowledge, attitudes, and future behavioral intentions.

DISCUSSION

Our iterative developmental process yielded a learning tool responsive to viewer input on communicating about nonnormative, safe birth care options. Initial data indicated promise of positively influencing viewers' attitudes and behavioral intentions toward midwife-attended birth in- and out-of-hospital. Future plans include publicly releasing the video and assessing long-term learning impact with initial study samples.

Application of Doctor-Nurse-Patient Integration Management Mode in Patients with Endometriosis

BACKGROUND

To investigate the effect of applying doctor-nurse-patient integration management mode to patients with endometriosis (EMT).

METHODS

A total of 160 patients with EMT from the Department of Neurology of The Fifth Affiliated Hospital Sun Yat-Sen University from January 2017 to October 2017 were selected. They were divided into control group and experimental group according to the time sequence of hospitalization, with 80 patients in each group. The traditional nursing management mode was implemented in the control group, and doctor-nurse-patient integration mode was implemented in the experimental group. The psychological status, quality of life, and satisfaction of the 2 groups of patients were compared one year after surgery.

RESULTS

The anxiety and depression scores in the observation group were (41.89±7.50) and (42.40±7.40) points, respectively, and those in the control group were (57.55±9.68) and (55.00±9.35) points, respectively. The differences between the two groups were statistically significant (t=-11.44, -9.42, P<0.05). The improvement rate of quality of life (sleep, work and sexual life) in the observation group was 87.5%, which was higher than that in the control group (63.8%). The difference between the 2 groups was statistically significant (U=583, P<0.01). The satisfaction rate in the observation group was 90.00%, which was higher than that in the control group (78.75%) (U=592.00, P< 0.01).

CONCLUSION

The doctor-nurse-patient integration management mode can effectively improve the negative psychological status and quality of life of patients with EMT and improve patient satisfaction, which is worth popularizing.

Trust in the health care professional and health outcome: A meta-analysis

Objective

To examine whether patients’ trust in the health care professional is associated with health outcomes.

Study selection

We searched 4 major electronic databases for studies that reported quantitative data on the association between trust in the health care professional and health outcome. We screened the full-texts of 400 publications and included 47 studies in our meta-analysis.

Data extraction and data synthesis

We conducted random effects meta-analyses and meta-regressions and calculated correlation coefficients with corresponding 95% confidence intervals. Two interdependent researchers assessed the quality of the included studies using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

Results

Overall, we found a small to moderate correlation between trust and health outcomes (r = 0.24, 95% CI: 0.19–0.29). Subgroup analyses revealed a moderate correlation between trust and self-rated subjective health outcomes (r = 0.30, 0.24–0.35). Correlations between trust and objective (r = -0.02, -0.08–0.03) as well as observer-rated outcomes (r = 0.10, -0.16–0.36) were non-significant. Exploratory analyses showed a large correlation between trust and patient satisfaction and somewhat smaller correlations with health behaviours, quality of life and symptom severity. Heterogeneity was small to moderate across the analyses.

Conclusions

From a clinical perspective, patients reported more beneficial health behaviours, less symptoms and higher quality of life and to be more satisfied with treatment when they had higher trust in their health care professional. There was evidence for upward bias in the summarized results. Prospective studies are required to deepen our understanding of the complex interplay between trust and health outcomes.

Teaching University Students About Evidence-Based Perinatal Care: Effects on Learning and Future Care Preferences

U.S. university students hold generally medicalized views on childbirth, which contrast with evidence indicating that low-intervention birth is safest for most. Therefore, intentional efforts are needed to educate childbearing populations on perinatal care evidence. Toward that aim, this study involved teaching university students in an introductory class (N = 50) about evidence-based perinatal care. Students completed a "future birth plan" and an essay on how their learning affected care preferences. Analyses revealed that students selected evidence-based care components up to 100 times more frequently than what the national data indicate they are used. Students based care selections on evidence, costs, and personal views. Their interest in physiologic birth has important implications for advancing education on perinatal care, practice, and policy.