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Matovelo D, Boniphace M, Singhal N, Nettel-Aguirre A, Kabakyenga J, Turyakira E, Mercader HFG, Khan S, Shaban G, Kyomuhangi T, Hobbs AJ, Manalili K, Subi L, Hatfield J, Ngallaba S, Brenner JL. Evaluation of a comprehensive maternal newborn health intervention in rural Tanzania: single-arm pre-post coverage survey results. Glob Health Action 2022; 15:2137281. [PMID: 36369729 PMCID: PMC9665093 DOI: 10.1080/16549716.2022.2137281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background In Tanzania, maternal and newborn deaths can be prevented via quality facility-based antenatal care (ANC), delivery, and postnatal care (PNC). Scalable, integrated, and comprehensive interventions addressing demand and service-side care-seeking barriers are needed. Objective Assess coverage survey indicators before and after a comprehensive maternal newborn health (MNH) intervention in Misungwi District, Tanzania. Methods A prospective, single-arm, pre- (2016) and post-(2019) coverage survey (ClinicalTrials.gov #NCT02506413) was used to assess key maternal and newborn health (MNH) outcomes. The Mama na Mtoto intervention included district activities (planning, leadership training, supportive supervision), health facility activities (training, equipment, infrastructure upgrades), and plus community health worker mobilization. Implementation change strategies, a process model, and a motivational framework incorporated best practices from a similar Ugandan intervention. Cluster sampling randomized hamlets then used ‘wedge sampling’ protocol as an alternative to full household enumeration. Key outcomes included: four or more ANC visits (ANC4+); skilled birth attendant (SBA); PNC for mother within 48 hours (PNC-woman); health facility delivery (HFD); and PNC for newborn within 48 hours (PNC-baby). Trained interviewers administered the ‘Real Accountability: Data Analysis for Results Coverage Survey to women 15–49 years old. Descriptive statistics incorporated design effect; the Lives Saved Tool estimated deaths averted based on ANC4+/HFD. Results Between baseline (n = 2,431) and endline (n = 2,070), surveys revealed significant absolute percentage increases for ANC4+ (+11.6, 95% CI [5.4, 17.7], p < 0.001), SBA (+16.6, 95% CI [11.1, 22.0], p < 0.001), PNC-woman (+9.2, 95% CI [3.2, 15.2], p = 0.002), and HFD (+17.2%, 95% CI [11.3, 23.1], p < 0.001). A PNC-baby increase (+6.1%, 95% CI [−0.5, 12.8], p = 0.07) was not statistically significant. An estimated 121 neonatal and 20 maternal lives were saved between 2016 and 2019. Conclusions Full-district scale-up of a comprehensive MNH package embedded government health system was successfully implemented over a short time and associated with significant maternal care-seeking improvements and potential for lives saved.
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Affiliation(s)
- Dismas Matovelo
- Department of Obstetrics & Gynecology, Catholic University of Health & Allied Sciences, Mwanza, Tanzania
| | - Maendeleo Boniphace
- Department of Obstetrics & Gynecology, Catholic University of Health & Allied Sciences, Mwanza, Tanzania
| | - Nalini Singhal
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alberto Nettel-Aguirre
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Centre for Health and Social Analytics, NIASRA, University of Wollongong, Wollongong, Australia
| | - Jerome Kabakyenga
- Institute of Maternal Newborn and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Eleanor Turyakira
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hannah Faye G. Mercader
- Indigenous, Local & Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sundus Khan
- Indigenous, Local & Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Girles Shaban
- Department of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Teddy Kyomuhangi
- Institute of Maternal Newborn and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Amy J. Hobbs
- Indigenous, Local & Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland, United States
| | - Kimberly Manalili
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Leonard Subi
- Department of Preventive Services, Tanzania Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sospatro Ngallaba
- Department of Community Health, Catholic University of Health & Allied Sciences, Mwanza, Tanzania
| | - Jennifer L. Brenner
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Indigenous, Local & Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Kyomuhangi T, Manalili K, Kabakyenga J, Turyakira E, Matovelo D, Khan S, Kyokushaba C, MacIntosh H, Brenner JL. Health system strengthening using a Maximizing Engagement for Readiness and Impact (MERI) Approach: A community case study. Front Public Health 2022; 10:952213. [PMID: 36504976 PMCID: PMC9727261 DOI: 10.3389/fpubh.2022.952213] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Health system strengthening initiatives in low and middle-income countries are commonly hampered by limited implementation readiness. The Maximizing Engagement for Readiness and Impact (MERI) Approach uses a system "readiness" theory of change to address implementation obstacles. MERI is documented based on field experiences, incorporating best practices, and lessons learned from two decades of maternal, newborn, and child health (MNCH) programming in East Africa. Context The MERI Approach is informed by four sequential and progressively larger MNCH interventions in Uganda and Tanzania. Intervention evaluations incorporating qualitative and quantitative data sources assessed health and process outcomes. Implementer, technical leader, stakeholder, and policymaker reflections on sequential experiences have enabled MERI Approach adaptation and documentation, using an implementation lens and an implementation science readiness theory of change. Key programmatic elements The MERI Approach comprises three core components. MERI Change Strategies (meetings, equipping, training, mentoring) describe key activity types that build general and intervention-specific capacity to maximize and sustain intervention effectiveness. The SOPETAR Process Model (Scan, Orient, Plan, Equip, Train, Act, Reflect) is a series of purposeful steps that, in sequence, drive each implementation level (district, health facility, community). A MERI Motivational Framework identifies foundational factors (self-reliance, collective-action, embeddedness, comprehensiveness, transparency) that motivate participants and enhance intervention adoption. Components aim to enhance implementer and system readiness while engaging broad stakeholders in capacity building activities toward health outcome goals. Activities align with government policy and programming and are embedded within existing district, health facility, and community structures. Discussion This case study demonstrates feasibility of the MERI Approach to support district wide MNCH programming in two low-income countries, supportive of health outcome and health system improvements. The MERI Approach has potential to engage districts, health facilities, and communities toward sustainable health outcomes, addressing intervention implementation gaps for current and emerging health needs within and beyond East Africa.
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Affiliation(s)
- Teddy Kyomuhangi
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda,*Correspondence: Teddy Kyomuhangi
| | - Kimberly Manalili
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jerome Kabakyenga
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda,Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Eleanor Turyakira
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda,Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dismas Matovelo
- Department of Obstetrics and Gynecology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Sobia Khan
- The Center for Implementation, Toronto, ON, Canada
| | - Clare Kyokushaba
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Heather MacIntosh
- Indigenous, Local and Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer L. Brenner
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada,Indigenous, Local and Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Manalili K, Scott CM, Hemmelgarn B, O'Beirne M, Bailey AL, Haener MK, Banerjee C, Peters SP, Chiodo M, Aghajafari F, Santana MJ. Co-designing person-centred quality indicator implementation for primary care in Alberta: a consensus study. Res Involv Engagem 2022; 8:59. [PMID: 36348406 PMCID: PMC9641306 DOI: 10.1186/s40900-022-00397-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND We aimed to contribute to developing practical guidance for implementing person-centred quality indicators (PC-QIs) for primary care in Alberta, Canada. As a first step in this process, we conducted stakeholder-guided prioritization of PC-QIs and implementation strategies. Stakeholder engagement is necessary to ensure PC-QI implementation is adapted to the context and local needs. METHODS We used an adapted nominal group technique (NGT) consensus process. Panelists were presented with 26 PC-QIs, and implementation strategies. Both PC-QIs and strategies were identified from our extensive previous engagement of patients, caregivers, healthcare providers, and quality improvement leaders. The NGT objectives were to: 1. Prioritize PC-QIs and implementation strategies; and 2. Facilitate the participation of diverse primary care stakeholders in Alberta, including patients, healthcare providers, and quality improvement staff. Panelists participated in three rounds of activities. In the first, panelists individually ranked and commented on the PC-QIs and strategies. The summarized results were discussed in the second-round face-to-face group meeting. For the last round, panelists provided their final individual rankings, informed by the group discussion. Finally, we conducted an evaluation of the consensus process from the panelists' perspectives. RESULTS Eleven primary care providers, patient partners, and quality improvement staff from across Alberta participated. The panelists prioritized the following PC-QIs: 'Patient and caregiver involvement in decisions about their care and treatment'; 'Trusting relationship with healthcare provider'; 'Health information technology to support person-centred care'; 'Co-designing care in partnership with communities'; and 'Overall experience'. Implementation strategies prioritized included: 'Develop partnerships'; 'Obtain quality improvement resources'; 'Needs assessment (stakeholders are engaged about their needs/priorities for person-centred measurement)'; 'Align measurement efforts'; and 'Engage champions'. Our evaluation suggests that panelists felt that the process was valuable for planning the implementation and obtaining feedback, that their input was valued, and that most would continue to collaborate with other stakeholders to implement the PC-QIs. CONCLUSIONS Our study demonstrates the value of co-design and participatory approaches for engaging stakeholders in adapting PC-QI implementation for the primary care context in Alberta, Canada. Collaboration with stakeholders can promote buy-in for ongoing engagement and ensure implementation will lead to meaningful improvements that matter to patients and providers.
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Affiliation(s)
- Kimberly Manalili
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- Patient Engagement Platform - Alberta Strategy for Patient Oriented Research, University of Calgary, 3280 Hospital Drive NW, Cal Wenzel Precision Health Building, Calgary, AB, Canada.
| | - Catherine M Scott
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Sociology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Brenda Hemmelgarn
- Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Maeve O'Beirne
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Allan L Bailey
- Department of Family Medicine, University of Alberta, 5-16 University Terrace, 8303 112 St., Edmonton, AB, T6G 1K4, Canada
| | - Michel K Haener
- Grande Prairie Primary Care Network, 11745 105 St #104, Grande Prairie, AB, T8V 8L1, Canada
| | - Cyrene Banerjee
- Patient and Community Engagement Research Program (PaCER), University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Sue P Peters
- Health Quality Council of Alberta, 210, 811 14 St NW, Calgary, AB, T2N 2A4, Canada
| | - Mirella Chiodo
- Department of Family Medicine, University of Alberta, 5-16 University Terrace, 8303 112 St., Edmonton, AB, T6G 1K4, Canada
| | - Fariba Aghajafari
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Maria J Santana
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department Paediatrics, Alberta Children's Hospital, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
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Khan S, Kemigisha E, Turyakira E, Chaput K, Kabakyenga J, Kyomuhangi T, Manalili K, Brenner JL. Effets dramatiques des mesures de santé publique liées à la COVID-19 et de la migration inverse de masse sur la santé sexuelle et reproductive des jeunes des régions rurales de l’Ouganda. Paediatr Child Health 2022; 27:S123-S129. [PMID: 36092289 PMCID: PMC9455642 DOI: 10.1093/pch/pxab114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Les jeunes (de 10-24 ans) comptent pour presque le tiers de la population ougandaise et il est fréquemment difficile pour eux de se prévaloir de services de santé sexuelle et reproductive (SSR), l’incidence d’issues négatives en matière de SSR est en effet disproportionnellement élevée. En réponse à la COVID-19, l’Ouganda a mis en place de strictes mesures de santé publique, y compris la fermeture générale des transports collectifs, des écoles et des entreprises, ce qui a poussé les jeunes qui étudiaient et travaillaient en milieu urbain à retourner dans leur village rural. Notre étude visait à décrire qualitativement l’impact non intentionnel perçu des mesures de santé liées à la COVID-19 sur la SSR des jeunes dans deux districts ruraux. Méthodes Des groupes de consultation semi-structurée et entrevues avec intervenants clés auprès de jeunes, de parents, de leaders communautaires, de travailleurs, coordonnateurs et superviseurs de santé communautaire (TSC), de professionnels de la santé, de gestionnaires de la santé des districts et des établissements de santé et de médecins-hygiénistes expressément sélectionnés ont eu lieu afin d’examiner l’impact vécu et perçu qu’ont eues les mesures liées à la COVID-19 sur la SSR des jeunes. Les entrevues ont été enregistrées, transcrites et codées à l’aide d’une analyse thématique déductive. Résultats Quatre thèmes liés à la COVID-19 et trois sous-thèmes sont ressortis des 15 groupes de consultation et deux entrevues avec intervenants clés (n = 94). La fermeture des transports collectifs et le port obligatoire du masque ont empêché les jeunes d’obtenir des soins de SSR. La fermeture des écoles et des lieux de travail et la migration subséquente des jeunes des milieux urbains vers leur village rural ont fait exploser la demande auprès des établissements ruraux de santé mal préparés, ce qui a entravé davantage la quête de soins. Les jeunes ont rapporté craindre que leurs parents découvrent leur quête de soins de SSR, ce qui les a empêchés de le faire. Le confinement a causé des difficultés financières, l’isolement et l’entassement des familles; le mauvais traitement des jeunes, la violence sexiste et les mariages forcés ont suivi, et certains jeunes ont rapporté avoir accepté ces mariages comme un moyen d’échapper à la violence. L’inactivité et la multiplication des contacts sociaux étaient perçues comme favorisant l’activité sexuelle précoce. L’impact rapporté sur la SSR était des infections plus graves et des complications causées par le retard des soins, et une flambée des infections transmises sexuellement et des avortements. Conclusion Les mesures de santé publique liées à la COVID-19 ont fait reculer la quête de soins par les jeunes tout en augmentant les comportements risqués et les issues négatives de SSR. Il est essentiel d’investir dans la programmation en SSR auprès des jeunes afin d’inverser les effets non intentionnels de la pandémie et de reprendre notre élan vers les cibles de SSR chez les jeunes. La gestion future des pandémies doit tenir compte des disparités sociales et sanitaires et réduire les risques non intentionnels sur la SSR des jeunes présentés par les mesures de santé publique.
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Affiliation(s)
- Sundus Khan
- Bureau de santé autochtone, locale et mondiale, école de médecine Cumming, Université de Calgary, Calgary, Alberta, Canada
| | - Elizabeth Kemigisha
- Faculté d'études interdisciplinaires, faculté de médecine, Université de science et technologie Mbarara, Mbarara, Ouganda.,Institut de santé de la mère, du nouveau-né et de l'enfant, Université de science et technologie Mbarara, Mbarara, Ouganda
| | - Eleanor Turyakira
- Institut de santé de la mère, du nouveau-né et de l'enfant, Université de science et technologie Mbarara, Mbarara, Ouganda.,Département de santé communautaire, faculté de médecine, Université de science et technologie Mbarara, Mbarara, Ouganda
| | - Kathleen Chaput
- Département d'obstétriques et de gynécologie, école de médecine Cumming, Université de Calgary, Calgary, Alberta, Canada.,Département de sciences de santé communautaire, école de médecine Cumming, Université de Calgary, Calgary, Alberta, Canada
| | - Jerome Kabakyenga
- Institut de santé de la mère, du nouveau-né et de l'enfant, Université de science et technologie Mbarara, Mbarara, Ouganda.,Département de santé communautaire, faculté de médecine, Université de science et technologie Mbarara, Mbarara, Ouganda
| | - Teddy Kyomuhangi
- Institut de santé de la mère, du nouveau-né et de l'enfant, Université de science et technologie Mbarara, Mbarara, Ouganda
| | - Kimberly Manalili
- Département de sciences de santé communautaire, école de médecine Cumming, Université de Calgary, Calgary, Alberta, Canada
| | - Jennifer L Brenner
- Bureau de santé autochtone, locale et mondiale, école de médecine Cumming, Université de Calgary, Calgary, Alberta, Canada.,Département de sciences de santé communautaire, école de médecine Cumming, Université de Calgary, Calgary, Alberta, Canada.,Département de pédiatrie, école de médecine Cumming, Université de Calgary, Calgary, Alberta, Canada
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Manalili K, Scott CM, O'Beirne M, Hemmelgarn BR, Santana MJ. Informing the implementation and use of person-centred quality indicators: a mixed methods study on the readiness, barriers and facilitators to implementation in Canada. BMJ Open 2022; 12:e060441. [PMID: 36008077 PMCID: PMC9422875 DOI: 10.1136/bmjopen-2021-060441] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To ensure optimal implementation of person-centred quality indicators (PC-QIs), we assessed the readiness of Canadian healthcare organisations and explored their perceived barriers and facilitators to implementing and using PC-QIs. DESIGN Mixed methods. SETTING AND PARTICIPANTS Representatives of Canadian healthcare delivery and coordinating organisations that guide the development and/or implementation of person-centred care (PCC) measurement. Representatives from primary care clinics and organisations from the province of Alberta, Canada also participated. METHODS We conducted a survey with representatives of Canadian healthcare organisations. The survey comprised two sections that: (1) assessed readiness for using PC-QIs, and (2) were based on the Organizational Readiness for Change Assessment tool. We summarised the survey results using descriptive statistics. We then conducted follow-up interviews with organisations representing system and clinical-level perspectives to further explore barriers and facilitators to implementing PC-QIs. The interviews were informed by and analysed using the Consolidated Framework for Implementation Research. RESULTS Thirty-three Canadian regional healthcare organisations across all 13 provinces/territories participated in the survey. Only 5 of 26 PC-QIs were considered highly feasible to implement for 75% of organisations and included: coordination of care, communication, structures to report performance, engaging patients and caregivers and overall experience. A representative sample of 10 system-level organisations and 11 primary care organisations/clinics participated in the interviews. Key barriers identified were: resources and staff capacity for quality improvement, a shift in focus to COVID-19 and health provider motivation. Facilitators included: prioritisation of PCC measurement, leadership and champion engagement, alignment with ongoing provincial strategic direction and measurement efforts, and the use of technology for data collection, management and reporting. CONCLUSIONS Despite high interest and policy alignment to use PC-QI 'readiness' to implement them effectively remains a challenge. Organisations need to be supported to collect, use and report PCC data to make the needed improvements that matter to patients.
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Affiliation(s)
- Kimberly Manalili
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Catherine M Scott
- Sociology and Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Maeve O'Beirne
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Brenda R Hemmelgarn
- University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Maria-Jose Santana
- Community Health Sciences and Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Khan S, Kemigisha E, Turyakira E, Chaput K, Kabakyenga J, Kyomuhangi T, Manalili K, Brenner JL. Dramatic effects of COVID-19 public health measures and mass reverse migration on youth sexual and reproductive health in rural Uganda. Paediatr Child Health 2022; 27:S40-S46. [PMID: 35620554 PMCID: PMC9126275 DOI: 10.1093/pch/pxab107] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/23/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction Youth (aged 10 to 24 years) comprise nearly one-third of Uganda’s population and often face challenges accessing sexual and reproductive health (SRH) services, with a disproportionately high incidence of negative SRH outcomes. Responding to COVID-19, Uganda implemented strict public health measures including broad public transportation, schooling, and business shut-downs, causing mass reverse-migration of youth from urban schools and workplaces back to rural home villages. Our study aimed to qualitatively describe the perceived unintended impacts of COVID-19 health measures on youth SRH in two rural districts. Methods Semi-structured focus group discussions (FGD) and key informant interviews (KII) with purposively selected youth, parents, community leaders, community health worker (CHW) coordinators and supervisors, health providers, facility and district health managers, and district health officers were conducted to explore lived experiences and impressions of the impacts of COVID-19 measures on youth SRH. Interviews were recorded, transcribed, and coded using deductive thematic analysis. Results Four COVID-19-related themes and three subthemes resulted from 15 FGDs and 2 KIIs (n=94). Public transportation shutdown and mandatory mask-wearing were barriers to youth SRH care-seeking. School/workplace closures and subsequent urban youth migration back to rural homes increased demand at ill-prepared, rural health facilities, further impeding care-seeking. Youth reported fear of discovery by parents, which deterred SRH service seeking. Lockdown led to family financial hardship, isolation, and overcrowding; youth mistreatment, gender-based violence, and forced marriage ensued with some youth reportedly entering partnerships as a means of escape. Idleness and increased social contact were perceived to lead to increased and earlier sexual activity. Reported SRH impacts included increased severity of infection and complications due to delayed care seeking, and surges in youth sexually transmitted infections, pregnancy, and abortion. Conclusion COVID-19 public health measures reportedly reduced youth care seeking while increasing risky behaviours and negative SRH outcomes. Investment in youth SRH programming is critical to reverse unintended pandemic effects and regain momentum toward youth SRH targets. Future pandemic management must consider social and health disparities, and mitigate unintended risks of public health measures to youth SRH.
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Affiliation(s)
- Sundus Khan
- Indigenous, Local & Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Elizabeth Kemigisha
- Faculty of Interdisciplinary Studies, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.,Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Eleanor Turyakira
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kathleen Chaput
- Department of Obstetrics and Gynecology, 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
| | - Jerome Kabakyenga
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Teddy Kyomuhangi
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kimberly Manalili
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Brenner
- Indigenous, Local & Global Health Office, 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.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Manalili K, Lorenzetti DL, Egunsola O, O'Beirne M, Hemmelgarn B, Scott CM, Santana MJ. The effectiveness of person-centred quality improvement strategies on the management and control of hypertension in primary care: A systematic review and meta-analysis. J Eval Clin Pract 2022; 28:260-277. [PMID: 34528338 DOI: 10.1111/jep.13618] [Citation(s) in RCA: 2] [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: 04/08/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of person-centred quality improvement strategies on the management and control of adults with hypertension in primary care. METHODS A systematic review and meta-analysis was conducted using the Medline, Cochrane Central Register for Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature, and APA PsycINFO databases (January 1980 to March 2020). Randomized controlled trials that evaluated person-centred quality improvement strategies for the management and control of essential hypertension among adults ( ≥ 18 years) in primary care were included. Random effects models were used to estimate weighted mean differences (WMD) for the change in systolic and diastolic blood pressures (SBP, DBP) from baseline; risk ratios (RR) were calculated for the proportion of participants achieving target blood pressures, for each quality improvement strategy assessed. A qualitative review of the implementation details of the interventions was conducted to identify common components of interventions that were effective in improving blood pressure outcomes. RESULTS Eight studies were included (total of 5654 patients). Findings favour use of person-centred quality improvement interventions over usual care (RR = 1.23 [95% CI: 1.01; 1.48]) for improving blood pressure outcomes. Self-management (RR = 1.43 [95% CI: 1.23; 1.65]) had the greatest effects on blood pressure targets. Clinician education resulted in the greatest SBP reduction (WMD:6.09 mmHg [95% CI: 2.32; 9.85]), while patient education and patient reminder systems (both WMD:4.86 mmHg [95% CI: 0.88; 8.83]) saw the most improvements in DBP. While interventions varied in their strategy implementation, common features of effective interventions included tailored communication with patients, use of health information technology, and multidisciplinary collaboration. CONCLUSION Person-centred quality improvement strategies were effective in improving blood pressure outcomes. Further research is needed regarding the context of implementing interventions to provide greater insight into the components of a person-centred quality improvement intervention most effective in improving hypertension outcomes.
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Affiliation(s)
- Kimberly Manalili
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Health Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Oluwaseun Egunsola
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maeve O'Beirne
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine M Scott
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Sociology, University of Calgary, Calgary, Alberta, Canada
| | - Maria J Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department Paediatrics, University of Calgary, Calgary, Alberta, Canada
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Hobbs AJ, Manalili K, Turyakira E, Kabakyenga J, Kyomuhangi T, Nettel-Aguirre A, Kyokushaba C, Rwandekeye P, Brenner JL. Five-year Retention of Volunteer Community Health Workers in Rural Uganda: A Population-Based Retrospective Cohort. Health Policy Plan 2021; 37:483-491. [PMID: 34922343 PMCID: PMC9006062 DOI: 10.1093/heapol/czab151] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/30/2021] [Accepted: 12/17/2021] [Indexed: 11/24/2022] Open
Abstract
Community health workers (CHWs) effectively improve maternal, newborn and child health (MNCH) outcomes in low-to-middle-income countries. However, CHW retention remains a challenge. This retrospective registry analysis evaluated medium-term retention of volunteer CHWs in two rural Ugandan districts, trained during a district-wide MNCH initiative. From 2012 to 2014, the Healthy Child Uganda partnership facilitated district-led CHW programme scale-up. CHW retention was tracked prospectively from the start of the intervention up to 2 years. Additional follow-up occurred at 5 years to confirm retention status. Database analysis assessed CHW demographic characteristics, retention rates and exit reasons 5 years post-intervention. A multivariable logistic regression model examined 5-year retention-associated characteristics. Of the original cohort of 2317 CHWs, 70% were female. The mean age was 38.8 years (standard deviation, SD: 10.0). Sixty months (5 years) after the start of the intervention, 84% of CHWs remained active. Of those exiting (n = 377), 63% reported a ‘logistical’ reason, such as relocation (n = 96), new job (n = 51) or death (n = 30). Sex [male, female; odds ratio (OR) = 1.53; 95% confidence interval (CI): 1 · 20–1 · 96] and age group (<25 years, 30–59; OR = 0.40; 95% CI: 0.25–0.62) were significantly associated with 5-year retention in multivariable modelling. Education completion (secondary school, primary) was not significantly associated with retention in adjusted analyses. CHWs in this relatively large cohort, trained and supervised within a national CHW programme and district-wide MNCH initiative, were retained over the medium term. Importantly, high 5-year retention in this intervention counters findings from other studies suggesting low retention in government-led and volunteer CHW programmes. Encouragingly, findings from our study suggest that retention was high, not significantly associated with timing of external partner support and largely not attributed to the CHW role i.e. workload and programme factors. Our study showcases the potential for sustainable volunteer CHW programming at scale and can inform planners and policymakers considering programme design, including selection and replacement planning for CHW networks.
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Affiliation(s)
- Amy J Hobbs
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW., Calgary, Alberta, T2N 4Z6, Canada
| | - Kimberly Manalili
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW., Calgary, Alberta, T2N 4Z6, Canada
| | - Eleanor Turyakira
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Jerome Kabakyenga
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Teddy Kyomuhangi
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Alberto Nettel-Aguirre
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW., Calgary, Alberta, T2N 4Z6, Canada.,Centre for Health and Social Analytics, National Institute for Applied Statistics Research Australia, SMAS, University of Wollongong, Wollongong, NSW, 2520 Australia
| | - Clare Kyokushaba
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Polar Rwandekeye
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Jennifer L Brenner
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW., Calgary, Alberta, T2N 4Z6, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW., Calgary, Alberta, T3B 6A8, Canada
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Manalili K, Siad FM, Antonio M, Lashewicz B, Santana MJ. Codesigning person-centred quality indicators with diverse communities: A qualitative patient engagement study. Health Expect 2021; 25:2188-2202. [PMID: 34854190 PMCID: PMC9615079 DOI: 10.1111/hex.13388] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Effective engagement of underrepresented communities in health research and policy remains a challenge due to barriers that hinder participation. Our study had two objectives: (1) identify themes of person‐centred care (PCC) from perspectives of diverse patients/caregivers that would inform the development of person‐centred quality indicators (PC‐QIs) for evaluating the quality of PCC and initiatives to improve PCC and (2) explore innovative participatory approaches to engage ethnocultural communities in qualitative research. Methods Drawing on participatory action research methods, we partnered with a community‐based organization to train six ‘Community Brokers’ from the Chinese, Filipino, South Asian, Latino‐Hispanic, East African and Syrian communities, who were engaged throughout the study. We also partnered with the provincial health organization to engage their Patient and Family Advisory, who represented further aspects of diversity. We conducted focus group discussions with patients/caregivers to obtain their perspectives on their values, preferences and needs regarding PCC. We identified themes through our study and engaged provincial stakeholders to prioritize these themes for informing the development of PC‐QIs and codesign initiatives for improving PCC. Results Eight focus groups were conducted with 66 diverse participants. Ethnocultural communities highlighted themes related to access and cost of care, language barriers and culture, while the Patient and Family Advisory emphasized patient and caregiver engagement. Together with provincial stakeholders, initiatives were identified to improve PCC, such as codesigning innovative models of training and evaluation of healthcare providers. Conclusion Incorporating patient and community voices requires addressing issues related to equity and understanding barriers to effective and meaningful engagement. Patient or Public Contribution Patient and public engagement was central to our research study. This included partnership with a community‐based organization, with a broad network of ethnocultural communities, as well as the provincial health service delivery organization, who both facilitated the ongoing engagement of diverse patients/caregiver communities throughout our study including designing the study, recruiting participants, collecting and organizing data, interpreting findings and mobilizing knowledge. Drawing from participatory action research methods, patients and the public were involved in the codesign of the PC‐QIs and initiatives to improve PCC in the province based on the findings from our study.
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Affiliation(s)
- Kimberly Manalili
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Fartoon M Siad
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Bonnie Lashewicz
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maria J Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Murembe N, Kyomuhangi T, Manalili K, Beinempaka F, Nakazibwe P, Kyokushaba C, Tibanyendera B, Brenner JL, Turyakira E. Context matters in understanding the vulnerability of women: perspectives from southwestern Uganda. ACTA ACUST UNITED AC 2021; 79:4. [PMID: 33413655 PMCID: PMC7791671 DOI: 10.1186/s13690-020-00523-x] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022]
Abstract
Background Vulnerability at the individual, family, community or organization level affects access and utilization of health services, and is a key consideration for health equity. Several frameworks have been used to explore the concept of vulnerability and identified demographics including ethnicity, economic class, level of education, and geographical location. While the magnitude of vulnerable populations is not clearly documented and understood, specific indicators, such as extreme poverty, show that vulnerability among women is pervasive. Women in low and middle-income countries often do not control economic resources and are culturally disadvantaged, which exacerbates other vulnerabilities they experience. In this commentary, we explore the different understandings of vulnerability and the importance of engaging communities in defining vulnerability for research, as well as for programming and provision of maternal newborn and child health (MNCH) services. Methodology In a recent community-based qualitative study, we examined the healthcare utilization experiences of vulnerable women with MNCH services in rural southwestern Uganda. Focus group discussions were conducted with community leaders and community health workers in two districts of Southwestern Uganda. In addition, we did individual interviews with women living in extreme poverty and having other conventional vulnerability characteristics. Findings and discussion We found that the traditional criteria of vulnerability were insufficient to identify categories of vulnerable women to target in the context of MNCH programming and service provision in resource-limited settings. Through our engagement with communities and through the narratives of the people we interviewed, we obtained insight into how nuanced vulnerability can be, and how important it is to ground definitions of vulnerability within the specific context. We identified additional aspects of vulnerability through this study, including: women who suffer from alcoholism or have husbands with alcoholism, women with a history of home births, women that have given birth only to girls, and those living on fishing sites. Conclusion Engaging communities in defining vulnerability is critical for the effective design, implementation and monitoring of MNCH programs, as it ensures these services are reaching those who are most in need.
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Affiliation(s)
- Neema Murembe
- Department of Human Development and Relational Sciences, Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Teddy Kyomuhangi
- Healthy Child Uganda, Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kimberly Manalili
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Florence Beinempaka
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Primrose Nakazibwe
- Department of Human Development and Relational Sciences, Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Clare Kyokushaba
- Healthy Child Uganda, Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Basil Tibanyendera
- Department of Education Foundations, Faculty of Education, University of Saint Joseph Mbarara, Mbarara, Uganda
| | - Jennifer L Brenner
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Eleanor Turyakira
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
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Santana MJ, Manalili K, Zelinsky S, Brien S, Gibbons E, King J, Frank L, Wallström S, Fairie P, Leeb K, Quan H, Sawatzky R. Improving the quality of person-centred healthcare from the patient perspective: development of person-centred quality indicators. BMJ Open 2020; 10:e037323. [PMID: 33122312 PMCID: PMC7597468 DOI: 10.1136/bmjopen-2020-037323] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE International efforts are being made towards a person-centred care (PCC) model, but there are currently no standardised mechanisms to measure and monitor PCC at a healthcare system level. The use of metrics to measure PCC can help to drive the changes needed to improve the quality of healthcare that is person centred. OBJECTIVE To develop and validate person-centred care quality indicators (PC-QIs) measuring PCC at a healthcare system level through a synthesis of the evidence and a person-centred consensus approach to ensure the PC-QIs reflect what matters most to people in their care. METHODS Existing indicators were first identified through a scoping review of the literature and an international environmental scan. Focus group discussions with diverse patients and caregivers and interviews with clinicians and experts in quality improvement allowed us to identify gaps in current measurement of PCC and inform the development of new PC-QIs. A set of identified and newly developed PC-QIs were subsequently refined by Delphi consensus process using a modified RAND/UCLA Appropriateness Method. The international consensus panel consisted of patients, family members, community representatives, clinicians, researchers and healthcare quality experts. RESULTS From an initial 39 unique evidence-based PC-QIs identified and developed, the consensus process yielded 26 final PC-QIs. These included 7 related to structure, 16 related to process, 2 related to outcome and 1 overall global PC-QI. CONCLUSIONS The final 26 evidence-based and person-informed PC-QIs can be used to measure and evaluate quality incorporating patient perspectives, empowering jurisdictions to monitor healthcare system performance and evaluate policy and practice related to PCC.
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Affiliation(s)
- Maria-Jose Santana
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Alberta Strategy for Patient-oriented Research, Calgary, Alberta, Canada
| | - Kimberly Manalili
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sandra Zelinsky
- Alberta Strategy for Patient-oriented Research, Calgary, Alberta, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Susan Brien
- Health Quality Ontario, Toronto, Ontario, Canada
| | | | - Jenny King
- Picker Institute Europe, Oxford, Oxfordshire, UK
| | - Lori Frank
- RAND Corporation, Arlington, Virginia, USA
| | - Sara Wallström
- Center for Person Centered Care, Gothenburg, Sweden
- University of Gothenburg, Gothenburg, Sweden
| | - Paul Fairie
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kira Leeb
- Victorian Agency for Health Information, Melbourne, Victoria, Australia
| | - Hude Quan
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Richard Sawatzky
- Trinity Western University School of Nursing, Langley, British Columbia, Canada
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Manalili K, Santana MJ. Using implementation science to inform the integration of electronic patient-reported experience measures (ePREMs) into healthcare quality improvement: description of a theory-based application in primary care. Qual Life Res 2020; 30:3073-3084. [PMID: 32715388 DOI: 10.1007/s11136-020-02588-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Collecting and monitoring the information from patients through patient-reported experience measures (PREMs) about the quality of care they receive is important for tracking changes in healthcare quality, stimulate innovation, and enhance person-centred care. The objective of this theoretical paper is to discuss the use of implementation science theories, models, and frameworks to inform and evaluate the integration of the electronic collection of PREMs (ePREMs) in healthcare quality improvement for primary care in Canada. METHODS To assess potential knowledge-to-practice gaps in implementing ePREMs in primary care in Alberta, the overarching implementation model that will be used is the Knowledge to Action Cycle. An integrated knowledge translation approach will ensure ongoing engagement of key stakeholders (e.g. primary care providers, patients) throughout the study. ePREM implementation will be informed by the identification of barriers and facilitators to implementation using the Consolidated Framework for Implementation Research (CFIR). The CFIR brings an organizational perspective providing an opportunity to explore the intervention characteristics, the context of implementation, individual factors, and the processes that influence implementation of ePREMs in healthcare. Identified barriers and facilitators to ePREM implementation will be mapped to evidence-based implementation strategies and prioritized by stakeholders. The RE-AIM framework will be used to guide the evaluation of ePREM implementation outcomes after six months of implementation by assessing Reach, Effectiveness, Adoption, Implementation, and Maintenance (sustainability). DISCUSSION Consultations with stakeholders affirm the importance of using integrated knowledge translation approaches and the need to better understand how to integrate ePREMs in primary care. Using an implementations science approach, this study can provide guidance for mitigating important ePREM implementation challenges and promote the successful uptake and use of ePREMs for quality improvement in healthcare.
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Affiliation(s)
- Kimberly Manalili
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Teaching Research and Wellness Building, Calgary, AB, Canada
| | - Maria J Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Teaching Research and Wellness Building, Calgary, AB, Canada. .,Strategy for Patient-Oriented Research, Patient Engagement Platform, Alberta, Canada. .,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Ahmed S, Djurkovic A, Manalili K, Sahota B, Santana MJ. A qualitative study on measuring patient-centered care: Perspectives from clinician-scientists and quality improvement experts. Health Sci Rep 2019; 2:e140. [PMID: 31890898 PMCID: PMC6920695 DOI: 10.1002/hsr2.140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/18/2019] [Accepted: 09/27/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND AIMS Patient-centered care (PCC) benefits patients, health-care providers, and health-care systems by providing delivery of care that addresses patient values and needs while improving provider experiences, and by decreasing health-care expenditure. To improve PCC, health-care systems need to measure it. Recently, we developed a PCC framework that is evidence based and patient informed. The purpose of this study was to gather the perspective of clinician-scientists and quality improvement experts regarding the PCC domains included in the framework. Their perspectives were used to refine these domains, which ultimately will inform the development of PCC quality indicators. METHODS Participants were recruited via expert and snowball sampling. Semi-structured interviews were conducted with clinician-scientists and quality improvement experts from Canada, the United States, and the United Kingdom from October 2017 to January 2018. With the use of an interview guide developed using the PCC framework, interviews were audio recorded and transcribed for a thematic analysis using NVivo qualitative data analysis software. Inductive thematic analysis was used to identify themes and subthemes. RESULTS Sixteen semi-structured interviews were conducted, which included four clinician-scientists and 12 quality improvement experts. Twelve of the participants were from Canada, three from the United Kingdom, and one from the United States. From the thematic analysis, three major themes were identified: (a) measurability of PCC, (b) practical considerations for implementing measurement, and (c) policy and practice implications. Participants discussed barriers and recommendations to improve and increase the clarity of the PCC domains in health system reporting, resulting in several future directions to refine and target specific PCC domains. CONCLUSION Clinician-scientists and quality improvement experts provided key recommendations for the measurement of PCC. The perspectives of key stakeholders in PCC measurement will inform strategies for the implementation and uptake of patient-centered quality indicators in health-care systems. The views of these key experts can lay the foundation for the development of standardized measures of PCC, to ensure monitoring and improvement of PCC.
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Affiliation(s)
- Sadia Ahmed
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Andrea Djurkovic
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Kimberly Manalili
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Balreen Sahota
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Student Accessibility Services, Student and Enrolment ServicesUniversity of CalgaryCalgaryAlbertaCanada
| | - Maria J. Santana
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Paediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
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Santana MJ, Ahmed S, Lorenzetti D, Jolley RJ, Manalili K, Zelinsky S, Quan H, Lu M. Measuring patient-centred system performance: a scoping review of patient-centred care quality indicators. BMJ Open 2019; 9:e023596. [PMID: 30617101 PMCID: PMC6326310 DOI: 10.1136/bmjopen-2018-023596] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The shift to the patient-centred care (PCC) model as a healthcare delivery paradigm calls for systematic measurement and evaluation. In an attempt to develop patient-centred quality indicators (PC-QIs), this study aimed to identify quality indicators that can be used to measure PCC. METHODS Design: scoping review. DATA SOURCES studies were identified through searching seven electronic databases and the grey literature. Search terms included quality improvement, quality indicators, healthcare quality and PCC. Eligibility Criteria: articles were included if they mentioned development and/or implementation of PC-QIs. DATA EXTRACTION AND SYNTHESIS extracted data included study characteristics (country, year of publication and type of study/article), patients' inclusion in the development of indicators and type of patient populations and point of care if applicable (eg, in-patient, out-patient and primary care). RESULTS A total 184 full-text peer-reviewed articles were assessed for eligibility for inclusion; of these, 9 articles were included in this review. From the non-peer-reviewed literature, eight documents met the criteria for inclusion in this study. This review revealed the heterogeneity describing and defining the nature of PC-QIs. Most PC-QIs were presented as PCC measures and identified as guidelines, surveys or recommendations, and therefore cannot be classified as actual PC-QIs. Out of 502 ways to measure PCC, only 25 were considered to be actual PC-QIs. None of the identified articles implemented the quality indicators in care settings. CONCLUSION The identification of PC-QIs is a key first step in laying the groundwork to develop evidence-based PC-QIs. Research is needed to continue the development and implementation of PC-QIs for healthcare quality improvement.
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Affiliation(s)
- Maria-Jose Santana
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sadia Ahmed
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lorenzetti
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Health Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Rachel J Jolley
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kimberly Manalili
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sandra Zelinsky
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mingshan Lu
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
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15
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Doktorchik C, Manalili K, Jolley R, Gibbons E, Lu M, Quan H, Santana MJ. Identifying Canadian patient-centred care measurement practices and quality indicators: a survey. CMAJ Open 2018; 6:E643-E650. [PMID: 30563920 PMCID: PMC6298869 DOI: 10.9778/cmajo.20170143] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient-centred quality indicators allow health care systems to monitor and evaluate patient-centred care practices and identify gaps in health care quality. Our objective was to determine whether Canadian provinces and territories measure patient-centred care, identify patient-centred quality indicators currently being used and compare patient-centred care practices and measurement in Canada to those of health care systems in other countries. METHODS An online survey was developed to collect data on demographic characteristics, patient-centred care practices, and indicators used at quality improvement organizations and health care authorities. The survey was conducted with quality improvement leads in Canada and 4 other countries. Content analysis methods were used to analyze and report the data. Patient-centred quality indicators were identified and categorized according to the Donabedian framework (structure, process, outcome). RESULTS The survey had a response rate of 47/67 (70%) and a completion rate of 58/60 (97%). We obtained completed surveys from 12 of the 13 provinces and territories in Canada. Respondents from most provinces indicated their organization used patient-centred care measures to inform practices. Respondents in only 4 provinces/territories reported using patient-centred quality indicators, for a total of 61 unique indicators. Most indicators used across Canada assessed aspects of care related to the Donabedian components of process and outcome. Findings for Canada were comparable to those for Sweden, England, Australia and New Zealand, where many measures are still in development. INTERPRETATION This study provided greater insight into patient-centred care measurement across Canada, Sweden, England, Australia and New Zealand and helped us to identify patient-centred quality indicators currently in use. These results will inform the development of a standard set of patient-centred quality indicators for implementation by health care organizations to improve the quality of health care.
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Affiliation(s)
- Chelsea Doktorchik
- Departments of Community Health Sciences (Doktorchik, Manalili, Jolley, Quan, Santana) and Economics (Lu), University of Calgary, Calgary, Alta.; Health Services Research Unit (Gibbons), Nuffield Department of Population Health, University of Oxford, UK
| | - Kimberly Manalili
- Departments of Community Health Sciences (Doktorchik, Manalili, Jolley, Quan, Santana) and Economics (Lu), University of Calgary, Calgary, Alta.; Health Services Research Unit (Gibbons), Nuffield Department of Population Health, University of Oxford, UK
| | - Rachel Jolley
- Departments of Community Health Sciences (Doktorchik, Manalili, Jolley, Quan, Santana) and Economics (Lu), University of Calgary, Calgary, Alta.; Health Services Research Unit (Gibbons), Nuffield Department of Population Health, University of Oxford, UK
| | - Elizabeth Gibbons
- Departments of Community Health Sciences (Doktorchik, Manalili, Jolley, Quan, Santana) and Economics (Lu), University of Calgary, Calgary, Alta.; Health Services Research Unit (Gibbons), Nuffield Department of Population Health, University of Oxford, UK
| | - Mingshan Lu
- Departments of Community Health Sciences (Doktorchik, Manalili, Jolley, Quan, Santana) and Economics (Lu), University of Calgary, Calgary, Alta.; Health Services Research Unit (Gibbons), Nuffield Department of Population Health, University of Oxford, UK
| | - Hude Quan
- Departments of Community Health Sciences (Doktorchik, Manalili, Jolley, Quan, Santana) and Economics (Lu), University of Calgary, Calgary, Alta.; Health Services Research Unit (Gibbons), Nuffield Department of Population Health, University of Oxford, UK
| | - Maria J Santana
- Departments of Community Health Sciences (Doktorchik, Manalili, Jolley, Quan, Santana) and Economics (Lu), University of Calgary, Calgary, Alta.; Health Services Research Unit (Gibbons), Nuffield Department of Population Health, University of Oxford, UK
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Abstract
OBJECTIVES The purpose of this study was to identify patient-centred quality indicators (PC-QI) and measures for measuring cultural competence in healthcare. DESIGN Scoping review. SETTING All care settings. SEARCH STRATEGY A search of CINAHL, EMBASE, MEDLINE, PsycINFO, Social Work Abstracts and SocINDEX, and the grey literature was conducted to identify relevant studies. Studies were included if they reported indicators or measures for cultural competence. We differentiated PC-QIs from measures: PC-QIs were identified as a unit of measurement of the performance of the healthcare system, which reflects what matters to patients and families, and to any individual that is in contact with healthcare services. In contrast, measures evaluate delivery of patient-centred care, in the form of a survey and/or checklist. Data collected included publication year and type, country, ethnocultural groups and mention of quality indicator and/or measures for cultural competence. RESULTS The search yielded a total of 786 abstracts and sources, of which 16 were included in the review. Twelve out of 16 sources reported measures for cultural competence, for a total of 10 measures. Identified domains from the measures included: physical environment, staff awareness of attitudes and values, diversity training and communication. Two out of 16 sources reported PC-QIs for cultural competence (92 structure and process indicators, and 48 outcome indicators). There was greater representation of structure and process indicators and measures for cultural competence, compared with outcome indicators. CONCLUSION Monitoring and evaluating patient-centred care for ethnocultural communities allows for improvements to be made in the delivery of culturally competent healthcare. Future research should include development of PC-QIs for measuring cultural competence that also reflect cultural humility, and the involvement of ethnocultural communities in the development and implementation of these indicators.
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Affiliation(s)
- Sadia Ahmed
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fartoon M Siad
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kimberly Manalili
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Vic Lantion
- Ethno-Cultural Council of Calgary, Calgary, Alberta, Canada
| | - Mingshan Lu
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maria-Jose Santana
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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17
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Abstract
BACKGROUND Globally, health-care systems and organizations are looking to improve health system performance through the implementation of a person-centred care (PCC) model. While numerous conceptual frameworks for PCC exist, a gap remains in practical guidance on PCC implementation. METHODS Based on a narrative review of the PCC literature, a generic conceptual framework was developed in collaboration with a patient partner, which synthesizes evidence, recommendations and best practice from existing frameworks and implementation case studies. The Donabedian model for health-care improvement was used to classify PCC domains into the categories of "Structure," "Process" and "Outcome" for health-care quality improvement. DISCUSSION The framework emphasizes the structural domain, which relates to the health-care system or context in which care is delivered, providing the foundation for PCC, and influencing the processes and outcomes of care. Structural domains identified include: the creation of a PCC culture across the continuum of care; co-designing educational programs, as well as health promotion and prevention programs with patients; providing a supportive and accommodating environment; and developing and integrating structures to support health information technology and to measure and monitor PCC performance. Process domains describe the importance of cultivating communication and respectful and compassionate care; engaging patients in managing their care; and integration of care. Outcome domains identified include: access to care and Patient-Reported Outcomes. CONCLUSION This conceptual framework provides a step-wise roadmap to guide health-care systems and organizations in the provision PCC across various health-care sectors.
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Affiliation(s)
- Maria J. Santana
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Kimberly Manalili
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Rachel J. Jolley
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Sandra Zelinsky
- Patient PartnerStrategy for Patient‐oriented Research, Methods and Development PlatformAlbertaABCanada
| | - Hude Quan
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Mingshan Lu
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Department of EconomicsUniversity of CalgaryCalgaryABCanada
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18
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Ludwick T, Turyakira E, Kyomuhangi T, Manalili K, Robinson S, Brenner JL. Supportive supervision and constructive relationships with healthcare workers support CHW performance: Use of a qualitative framework to evaluate CHW programming in Uganda. Hum Resour Health 2018; 16:11. [PMID: 29439743 PMCID: PMC5812047 DOI: 10.1186/s12960-018-0272-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND While evidence supports community health worker (CHW) capacity to improve maternal and newborn health in less-resourced countries, key implementation gaps remain. Tools for assessing CHW performance and evidence on what programmatic components affect performance are lacking. This study developed and tested a qualitative evaluative framework and tool to assess CHW team performance in a district program in rural Uganda. METHODS A new assessment framework was developed to collect and analyze qualitative evidence based on CHW perspectives on seven program components associated with effectiveness (selection; training; community embeddedness; peer support; supportive supervision; relationship with other healthcare workers; retention and incentive structures). Focus groups were conducted with four high/medium-performing CHW teams and four low-performing CHW teams selected through random, stratified sampling. Content analysis involved organizing focus group transcripts according to the seven program effectiveness components, and assigning scores to each component per focus group. RESULTS Four components, 'supportive supervision', 'good relationships with other healthcare workers', 'peer support', and 'retention and incentive structures' received the lowest overall scores. Variances in scores between 'high'/'medium'- and 'low'-performing CHW teams were largest for 'supportive supervision' and 'good relationships with other healthcare workers.' Our analysis suggests that in the Bushenyi intervention context, CHW team performance is highly correlated with the quality of supervision and relationships with other healthcare workers. CHWs identified key performance-related issues of absentee supervisors, referral system challenges, and lack of engagement/respect by health workers. Other less-correlated program components warrant further study and may have been impacted by relatively consistent program implementation within our limited study area. CONCLUSIONS Applying process-oriented measurement tools are needed to better understand CHW performance-related factors and build a supportive environment for CHW program effectiveness and sustainability. Findings from a qualitative, multi-component tool developed and applied in this study suggest that factors related to (1) supportive supervision and (2) relationships with other healthcare workers may be strongly associated with variances in performance outcomes within a program. Careful consideration of supervisory structure and health worker orientation during program implementation are among strategies proposed to increase CHW performance.
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Affiliation(s)
- Teralynn Ludwick
- School of Public Health, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3 Canada
| | - Eleanor Turyakira
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O BOX 1410 Mbarara, Uganda
| | - Teddy Kyomuhangi
- Maternal, Newborn, and Child Health Institute, Mbarara University of Science and Technology, P.O BOX 1410 Mbarara, Uganda
| | - Kimberly Manalili
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4 Canada
| | - Sheila Robinson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4 Canada
| | - Jennifer L. Brenner
- Pediatrics, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4 Canada
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19
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Abstract
INTRODUCTION The concept of patient-centred care (PCC) is changing the way healthcare is understood, accepted and delivered. The Institute of Medicine has defined PCC as 1 of its 6 aims to improve healthcare quality. However, in Canada, there are currently no nationwide standards in place for measuring and evaluating healthcare from a patient-centred approach. In this paper, we outline our scoping review protocol to systematically review published and unpublished literature specific to patient-centred quality indicators that have been implemented and evaluated across various care settings. METHODS AND ANALYSIS Arksey and O'Malley's scoping review methodology framework will guide the conduct of this scoping review. We will search electronic databases (MEDLINE, EMBASE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Social Work Abstracts, Social Services Abstracts), grey literature sources and the reference lists of key studies to identify studies appropriate for inclusion. 2 reviewers will independently screen all abstracts and full-text studies for inclusion. We will include any study which focuses on quality indicators in the context of PCC. All bibliographic data, study characteristics and indicators will be collected and analysed using a tool developed through an iterative process by the research team. Indicators will be classified according to a predefined conceptual framework and categorised and described using qualitative content analysis. ETHICS AND DISSEMINATION The scoping review will synthesise patient-centred quality indicators and their characteristics as described in the literature. This review will be the first step to formally identify what quality indicators have been used to evaluate PCC across the healthcare continuum, and will be used to inform a stakeholder consensus process exploring the development of a generic set of patient-centred quality indicators applicable to multiple care settings. The results will be disseminated through a peer-reviewed publication, conference presentations and a one-day stakeholder meeting.
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Affiliation(s)
- Rachel J Jolley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Kimberly Manalili
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mingshan Lu
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maria J Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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