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Ekenes M, Oldeide O, Wehling E. Allocating municipal services to individuals with complex rehabilitation needs - a discourse analysis of individual administrative decision letters. BMC Health Serv Res 2024; 24:460. [PMID: 38609916 PMCID: PMC11015684 DOI: 10.1186/s12913-024-10972-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 04/09/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Rehabilitation is considered paramount for enhancing quality of life and reducing healthcare costs. As a result of healthcare reforms, Norwegian municipalities have been given greater responsibility for allocating rehabilitation services following discharge from hospital. Individual decision letters serve as the basis for implementing services and they have been described as information labels on the services provided by the municipality. They play an important role in planning and implementing the services in collaboration with the individual applicants. Research indicates that the implementation of policies may lead to unintended consequences, as individuals receiving municipal services perceive them as fragmented. This perception is characterised by limited user involvement and a high focus on body functions. The aim of this study was to examine how municipal decision letters about service allocation incorporate the recommendations made in the official national guideline and reflect a holistic approach to rehabilitation, coordination and user involvement for individuals with comprehensive needs. METHODS The decision letters of ten individuals with moderate to severe brain injury allocating rehabilitation services in two municipalities were examined. It was assessed whether the content was in accordance with the authorities' recommendations, and a discourse analysis was conducted using four tools adapted from an established integrated approach. RESULTS The letters primarily contained standard texts concerning legal and administrative regulations. They were predominantly in line with the official guideline to municipal service allocation. From a rehabilitation perspective, the focus was mainly on medically oriented care, scarcely referring to psychosocial needs, activity, and participation. The intended user involvement seemed to vary between active and passive status, while the coordination of services was given limited attention. CONCLUSIONS The written decision letters did fulfil legal and administrative recommendations for service allocation. However, they did not fulfil their potential to serve as a means of conveying rehabilitation issues, such as specification of the allocated services, a holistic approach to health, coordination, or the involvement of users in decision processes. These elements must be incorporated throughout the allocation process if the policies are to be implemented as intended. Findings can have international relevance for discussions between clinicians and policy makers.
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Affiliation(s)
- Maren Ekenes
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
| | - Olin Oldeide
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Eike Wehling
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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Bin Hammad MZM, Yahaya JB, Mohamed IB. A model for enterprise resource planning implementation in the Saudi public sector organizations. Heliyon 2024; 10:e24531. [PMID: 38312684 PMCID: PMC10835183 DOI: 10.1016/j.heliyon.2024.e24531] [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: 11/05/2022] [Revised: 12/13/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
Studies dedicated to user's adoption, acceptance, and use of IT have been rampant since the advent of computers and IT. Therefore, it becomes essential to assess the value of IT to organizations and to understand the determinants of such value in terms of acceptance, integration, and technology use. In this regard, Enterprise Resource Planning (ERP) adoption remains challenging for professionals and practitioners alike. Previous research neglected many vital factors, such as user involvement (participation, engagement, and resilience) and environmental factors (change management, competitiveness, and pandemic pressure). Therefore, this study aims to identify the most significant factors that influence the successful adoption of ERP and propose a conceptual model. The Technology Acceptance Model with DeLone and McLean Information Success Models were the base for the study. The findings of this study reveal a conceptual model that facilitates the successful adoption of ERP systems. Through the identification of critical factors, one factor emerged as a permanent component in the adoption process. This conceptual model provides valuable insights for organizations seeking to implement and adopt ERP systems effectively. The study's findings offer valuable insights for firms pursuing long-term economic success through ERP adoption. Understanding the influencing factors enables efficient and effective deployment. Implications are relevant to organizations, ERP vendors, and decision-makers, guiding informed decision-making and prioritizing success factors.
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Affiliation(s)
- Mohammed Zaid M Bin Hammad
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia
| | - Jamaiah Binti Yahaya
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia
| | - Ibrahim Bin Mohamed
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia
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Pedersen H, Skliarova T, Pedersen SA, Gråwe RW, Havnen A, Lara-Cabrera ML. Psychoeducation for adult ADHD: a scoping review about characteristics, patient involvement, and content. BMC Psychiatry 2024; 24:73. [PMID: 38273266 PMCID: PMC10811906 DOI: 10.1186/s12888-024-05530-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Psychosocial interventions such as psychoeducation are increasingly being used to treat adult ADHD, both as an alternative and as a supplement to pharmacotherapy. A thorough overview of the literature on psychoeducation for adult ADHD is lacking. The objectives of this scoping review were therefore to identify the characteristics of psychoeducation interventions designed for adults with ADHD, examine how the patient experience or perspective is considered during the intervention's development and implementation, determine the typical themes covered, and explore how 'psychoeducation' is defined in these interventions. METHODS A comprehensive search was performed to identify records in MEDLINE, Embase, PsycINFO, Web of Science, Cochrane CENTRAL, AMED, and ClinicalTrials.gov. Two or more reviewers were included in every step of the screening process and the final selection of included studies. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist (Supplementary Material 1) was used to report the results, and the framework developed by Arksey and O'Malley was used as a guide throughout the scoping process. RESULTS A total of 2121 records were identified through the literature search. After screening and full-text analysis, ten studies were included for final analysis. Most studies were conducted in Europe and followed a group format. Seven main themes were identified: Information about the diagnosis, treatment options, somatic health and ADHD, the insider perspective, ADHD and social life, coping and psychological skills, and ADHD and work. There was significant overlap in themes covered, but coverage of each theme varied. Themes deemed important by newer research, such as sexuality and gender-specific issues, were missing. Only one intervention involved patients in its development and implementation, and two interventions involved family members. There was variation in how psychoeducation was defined in the included studies, and the implications of this are discussed. CONCLUSION The literature on psychoeducation for adult ADHD is not ready for any systematic effect estimation. Before such estimations are conducted, a shared understanding and definition of psychoeducation are needed. The involvement of end users in the development and delivery of interventions may aid reach this goal but results from this review indicate that such practices are rare.
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Affiliation(s)
- Henrik Pedersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- Division of Psychiatry, Nidaros Community Mental Health Centre, St. Olavs University Hospital, Trondheim, Norway.
| | - Tatiana Skliarova
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sindre Andre Pedersen
- Library Section for Research Support, Data and Analysis, NTNU University Library, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Rolf W Gråwe
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Audun Havnen
- Division of Psychiatry, Nidaros Community Mental Health Centre, St. Olavs University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Mariela L Lara-Cabrera
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Division of Psychiatry, Nidelv Community Mental Health Centre, St. Olavs University Hospital, Trondheim, Norway
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García-Rayado J, Callens C. Users' involvement in digital health collaborative projects. J Health Organ Manag 2024; ahead-of-print. [PMID: 38192045 DOI: 10.1108/jhom-04-2023-0118] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE This research analyzes the roles of users in innovative digital health collaborative projects from the perspective of the user by considering three dimensions: their motivation, project activities and the support of the partnership for their effective involvement. DESIGN/METHODOLOGY/APPROACH The authors unraveled profiles of users by using a Q-methodological analysis of 24 statements and 44 service users. The statements for the three dimensions were designed according to previous models of stakeholder identification and customer participation in new product management. FINDINGS The authors obtained two profiles that advocate active participation of users, though with a different degree of involvement. One of them supports the role of users as "advisors" of users' preferences and needs, and the other indicates a higher involvement of users as "cocreators" of the innovation, with the same contribution and responsibility as the other partners. ORIGINALITY/VALUE Previous research has analyzed user involvement in digital health, as part of wider research on factors leading to the success and adoption of innovations. Moreover, previous research has analyzed user involvement in innovation projects, but without differentiating between projects carried out by an individual organization and those conducted by a partnership. This research contributes to filling this gap by revealing users' expectations about their involvement and how they think they will fit in with the dynamics of collaborative projects.
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Affiliation(s)
- Jaime García-Rayado
- Department of Accounting and Finance, Universidad de Zaragoza, Zaragoza, Spain
| | - Chesney Callens
- Department of Political Science, University of Antwerp, Antwerp, Belgium
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Abrahamsen C, Serritslev R, Myhre Jensen C. Information needs and preferences of patients with an ankle fracture: User involvement study creating an mHealth solution. Patient Educ Couns 2023; 116:107891. [PMID: 37591014 DOI: 10.1016/j.pec.2023.107891] [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] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE The aim of this study was to employ a user-driven participatory design (PD) approach to develop an mHealth solution that addresses patients' information needs after surgical or non-surgical treatment for an ankle fracture. METHODS Patients with an ankle fracture and health care professionals along the treatment pathway in both the hospital and municipality participated in four workshops (WS). RESULTS We found that patients with an ankle fracture need information on topics such as "a typical course," "bandages and assistive devices," "what can I feel," "what may I do," "what to usually worry about," "medicine," "tips and tricks," and "contact information." Moreover, patients requested diverse modes of dissemination, preferably a combination of text, timelines, pictures, animations, and videos. Alpha and beta testing of the digital platform was conducted, and content-related improvements were made. A readability analysis showed reading ease of 40.1 of 100, meaning that it should be easily understood by 15-16 year-olds. CONCLUSION Involving representatives of future users in creating this mHealth solution using PD demonstrates the benefits of creating a solution that aligns with users' needs. PRACTICE IMPLICATIONS The mHealth solution is now ready for implementation and large-scale evaluation in phase three of the overall PD study. An mHealth usability questionnaire will be employed to assess usability by future patients with surgically or non-surgically treated ankle fractures.
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Affiliation(s)
- Charlotte Abrahamsen
- Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt - University Hospital of Southern Denmark, Kolding Hospital, Denmark; Department of Regional Health, University of Southern Denmark, Odense, Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rikke Serritslev
- Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt - University Hospital of Southern Denmark, Kolding Hospital, Denmark
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Poblete L, Eriksson E, Hellström A, Glennon R. User involvement and value co-creation in well-being ecosystems. J Health Organ Manag 2023; 37:34-55. [PMID: 37787111 PMCID: PMC10596431 DOI: 10.1108/jhom-11-2022-0339] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/01/2023] [Accepted: 08/29/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE This article aims to examine how users' involvement in value co-creation influences the development and orchestration of well-being ecosystems to help tackle complex societal challenges. This research contributes to the public management literature and answers recent calls to investigate novel public service governances by discussing users' involvement and value co-creation for novel well-being solutions. DESIGN/METHODOLOGY/APPROACH The authors empirically explore this phenomenon through a case study of a complex ecosystem addressing increased well-being, focussing on the formative evaluation stage of a longitudinal evaluation of Sweden's first support centre for people affected by cancer. Following an abductive reasoning and action research approach, the authors critically discuss the potential of user involvement for the development of well-being ecosystems and outline preconditions for the success of such approaches. FINDINGS The empirical results indicate that resource reconfiguration of multi-actor collaborations provides a platform for value co-creation, innovative health services and availability of resources. Common themes include the need for multi-actor collaborations to reconfigure heterogeneous resources; actors' adaptive change capabilities; the role of governance mechanisms to align the diverse well-being ecosystem components, and the engagement of essential actors. RESEARCH LIMITATIONS/IMPLICATIONS Although using a longitudinal case study approach has revealed stimulating insights, additional data collection, multiple cases and quantitative studies are prompted. Also, the authors focus on one country but the characteristics of users' involvement for value co-creation in innovative well-being ecosystems might vary between countries. PRACTICAL IMPLICATIONS The findings of this study demonstrate the value of cancer-affected individuals, with "lived experiences", acting as sources for social innovation, and drivers of well-being ecosystem development. The findings also suggest that participating actors in the ecosystem should utilise wider knowledge and experience to tackle complex societal challenges associated with well-being. SOCIAL IMPLICATIONS Policymakers should encourage the formation of well-being ecosystems with diverse actors and resources that can help patients navigate health challenges. The findings especially show the potential of starting from the user's needs and life situation when the ambition is to integrate and innovate in fragmented systems. ORIGINALITY/VALUE The proposed model proposes that having a user-led focus on innovating new solutions can play an important role in the development of well-being ecosystems.
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Affiliation(s)
- León Poblete
- Department of Business Studies,
University of Uppsala
, Uppsala,
Sweden
- The University of Sydney Business School
, Sydney,
Australia
| | - Erik Eriksson
- Department of Technology Management and Economics
,
Chalmers University of Technology
, Gothenburg,
Sweden
| | - Andreas Hellström
- Department of Technology Management and Economics
,
Chalmers University of Technology
, Gothenburg,
Sweden
| | - Russ Glennon
- Department of Strategy
,
Enterprise and Sustainability
,
MMU Business School
,
Manchester Metropolitan University
, Manchester,
UK
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Krane V, Kaasbøll J, Kaspersen SL, Ådnanes M. 'It's not like real therapy': young people receiving child welfare services' experiences of video consultations in mental healthcare in Norway: a mixed methods approach. BMC Health Serv Res 2023; 23:949. [PMID: 37670314 PMCID: PMC10481608 DOI: 10.1186/s12913-023-09939-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Video consultations has been suggested to lower the threshold for child and adolescent mental healthcare treatment. This study explores how young people receiving child welfare services experience video consultations in child and adolescent mental healthcare. The study is part of a larger Norwegian study of access to health services for this target group. METHODS The study has a mixed methods design including qualitative interviews and a quantitative survey, with young people receiving child welfare services. The qualitative interviews included 10 participants aged 15-19. The survey included 232 participants aged 16-24 of which 36 reported having received video consultations in mental healthcare. The interviews were analysed using thematic analysis. The survey data was presented as frequencies to clarify the distribution of positive and negative perceptions of video consultation. RESULTS The results show that the participants experienced video consultations as more superficial and less binding, compared to in-person sessions. They raised concerns of the therapeutic relationship, however some found it easier to regulate closeness and distance. In the survey several reported that their relationship with the therapist got worse, and that it was much more difficult to talk on screen. Moreover, a large proportion (42%) claimed that video consultations did not fit their treatment needs overall. However, a minority of the participants found it easier to talk to the therapist on screen. CONCLUSIONS The study reveals important weaknesses and disadvantages of online therapy as experienced by young people receiving child welfare services. It is particularly worrying that their criticism involves the relational aspects of treatment, as children receiving child welfare services often have relational experiences which make them particularly sensitive to challenges in relationships. This study shows that youth involvement in decision making of video consultations in therapy has been rare. Clinicians should be aware of these young people's doubts regarding the quality of video consultations in child and adolescent mental health care. Further studies should examine how user involvement can be incorporated in video consultations in therapy and how this could improve experiences and the quality of video consultations.
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Affiliation(s)
- Vibeke Krane
- Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Drammen, 3007, Norway.
| | - Jannike Kaasbøll
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Research, SINTEF Digital, Trondheim, Norway
| | | | - Marian Ådnanes
- Department of Health Research, SINTEF Digital, Trondheim, Norway
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Kollewe C. [Empowerment or tokenism? Participatory research and technology development with older and old people]. Z Gerontol Geriatr 2023:10.1007/s00391-023-02215-x. [PMID: 37439853 DOI: 10.1007/s00391-023-02215-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/20/2023] [Indexed: 07/14/2023]
Abstract
Currently, many research and technology development projects with older people are described as "participatory." This literature-based article highlights patterns in current approaches to participatory research and technology development with older and old people. To this end, various strands of argumentation and historical lines of development are examined as well as the democracy-oriented model and the consumption-oriented approach to participation. This article goes on to set out the opportunities, challenges and criticisms associated with participatory projects. Finally, topics for future research and technology developments with older and old people are named and the questions which should be critically reflected upon when designing a participatory project are described.
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Affiliation(s)
- Carolin Kollewe
- Sozialwissenschaftliche Technikforschung, Fachbereich Ingenieurwissenschaften und Industriedesign, Hochschule Magdeburg-Stendal, Postfach 36 55, 39011, Magdeburg, Deutschland.
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Molewijk B, Pedersen R, Kok A, Førde R, Aasland O. Two years of ethics reflection groups about coercion in psychiatry. Measuring variation within employees' normative attitudes, user involvement and the handling of disagreement. BMC Med Ethics 2023; 24:29. [PMID: 37173770 PMCID: PMC10182617 DOI: 10.1186/s12910-023-00909-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Research on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees' attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams. METHODS We used panel data in a longitudinal design study to measure variation in survey scores from multidisciplinary employees from seven departments within three Norwegian mental health care institutions at three time points (T0-T1-T2). Mixed models were used to account for dependence of data in persons who participated more than once. RESULTS In total, 1068 surveys (from 817 employees who did and did not participate in ERG) were included in the analyses. Of these, 7.6% (N = 62) responded at three points in time, 15.5% (N = 127) at two points, and 76.8% (N = 628) once. On average, over time, respondents who participated in ERG viewed coercion more strongly as offending (p < 0.05). Those who presented a case in the ERG sessions showed lower scores on User Involvement (p < 0.001), Team Cooperation (p < 0.01) and Constructive Disagreement (p < 0.01). We observed significant differences in outcomes between individuals from different departments, as well as between different professions. Initial significant changes due to frequency of participation in ERG and case presentation in ERG did not remain statistically significant after adjustment for Departments and Professions. Differences were generally small in absolute terms, possibly due to the low amount of longitudinal data. CONCLUSIONS This study measured specific intervention-related outcome parameters for describing the impact of clinical ethics support (CES). Structural implementation of ERGs or MCDs seems to contribute to employees reporting a more critical attitude towards coercion. Ethics support is a complex intervention and studying changes over time is complex in itself. Several recommendations for strengthening the outcomes of future CES evaluation studies are discussed. CES evaluation studies are important, since-despite the intrinsic value of participating in ERG or MCD-CES inherently aims, and should aim, at improving clinical practices.
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Affiliation(s)
- Bert Molewijk
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway.
- Department of Ethics, Law and Humanities, Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Reidar Pedersen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Almar Kok
- Department of Epidemiology and Data Science and Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Aging and Later Life, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Reidun Førde
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Olaf Aasland
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Abstract
User involvement is widely recognized as best practice in the development of information technology (IT) systems. In large-scale IT projects, the involvement of users and other stakeholder groups is typically in the form of representatives, as opposed to the direct (in-person) participation characteristic for smaller projects. The potential new sharing of power that representative participation entails vis-à-vis direct stakeholder involvement, and the implications of such a shift, are an important discussion in the context of participatory design. This paper extends and adds to previous work on this subject. Drawing on stakeholder interviews conducted as part of a case study of an electronic health record implementation project in Norway, this paper seeks to describe and analyze problems that can arise with representative participation in a large-scale project. Our focus is on an observed decline of interaction between health professionals participating actively in the project and their advisory units consisting of colleagues without a formal project role. The paper describes how the project's structural arrangements might explain this decline. The paper also describes how the participating health professionals' involvement of the advisory units at regular intervals early in the project (broad involvement) was replaced by more ad hoc and competence-oriented approaches (narrow involvement). We further use the organizational structure of democracies as the basis for two analogies, (I) participants-as-political-representatives and (II) participants-as-technocrats. The observed decline in interaction between the participating health professionals and their advisory units can be seen as a transition in role from user representative to technocrat. Generalizing from the case, we suggest that (1) a project's structure strongly affects the possibilities of participating users to consult other users (e.g., non-participating colleagues) about issues concerning the design solution, (2) a project's structure conditions the role of participating users and who, or what, they represent, and (3) representative participation requires rethinking a project's structure.
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Affiliation(s)
- Øivind Klungseth Zahlsen
- Department of Computer Science, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
| | - Dag Svanæs
- Department of Computer Science, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
- Digital Design Department, The IT University of Copenhagen, Copenhagen, Denmark
| | - Yngve Dahl
- Department of Computer Science, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
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Olsson ABS, Haaland-Øverby M, Stenberg U, Slettebø T, Strøm A. Primary healthcare professionals' experience with patient participation in healthcare service development: A qualitative study. PEC Innov 2022; 1:100068. [PMID: 37213719 PMCID: PMC10194342 DOI: 10.1016/j.pecinn.2022.100068] [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] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 07/11/2022] [Accepted: 07/23/2022] [Indexed: 05/23/2023]
Abstract
Objective How healthcare professionals experience patient participation in health service development impacts its use. This participatory study explores primary healthcare professionals' perceptions of developing health services with patient representatives. Methods Four focus group interviews with primary healthcare professionals (n = 26) were conducted. We analyzed data by applying Braun and Clarke's reflexive thematic analysis. Results The healthcare professionals perceived having a complementary interprofessional relationship with the patient representatives and regarded them as colleagues. However, the professionals navigated between a position of authority and collaboration, reconciling the need for participation with its challenges, e.g., to identify the representatives' collective representation among their personal experience, to ensure a more evidence-informed result that they and their colleagues would endorse. Conclusions Regarding patient representatives as colleagues can blur the line between professionals and representatives' positions and functions and further complicate health service development. Our results indicate a need for skilled facilitators to lead the process. Innovation This study identifies issues that professionals are uncertain about when collaborating with representatives to develop primary healthcare services; difficulties that professionals must overcome to collaborate constructively with representatives. Our findings can inform healthcare professionals' education about patient participation on all levels. We have suggested topics to address.
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Affiliation(s)
- Ann Britt Sandvin Olsson
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway
- VID Specialized University, Faculty of Diakonia, Values and Professional Practice, Postboks 184 Vinderen, 0319 Oslo, Norway
- Corresponding author at: Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway.
| | - Mette Haaland-Øverby
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway
| | - Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway
- Frambu Resource Center for Rare Disorders, Sandbakkveien 18, 1404 Siggerud, Norway
| | - Tor Slettebø
- VID Specialized University, Faculty of Social Studies, Postboks 184 Vinderen, 0319 Oslo, Norway
| | - Anita Strøm
- VID Specialized University, Faculty of Health Studies, Postboks 184 Vinderen, 0319 Oslo, Norway
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Abstract
OBJECTIVE Psychiatric advance directives (PADs) are documents that allow users of mental health services to express their preferences for treatment in future mental health crises. To increase the use of PADs in psychiatric practice, it is helpful to consider how service users view PADs and the factors that facilitate or hinder PAD creation and implementation. A systematic review of the empirical literature on this topic may help inform evidence-based policy making. METHODS A systematic review concordant with PRISMA guidelines was conducted. Relevant electronic databases were searched up to July 2, 2021. Articles containing original empirical data on service users' perspectives on PADs were included. Data were analyzed thematically, tabulated, and narratively synthesized. RESULTS Fifty-three articles were identified and included. The following categories were identified: general preferences regarding factors such as legal force and revocability; benefits of PADs at the personal, treatment-related, and social levels; challenges and barriers concerning PAD creation and application; and possible and experienced facilitators of PAD creation. CONCLUSIONS Users of mental health services are highly interested in PADs and regard them as tools to improve their involvement in care. They generally prefer legally binding PADs that can be revoked only when users are competent to consent. Barriers reported by service users were mainly related to the creation and application of PADs, and support in PAD creation was the most important facilitator identified. The involvement of mental health professionals in creating PADs appears essential to realize the benefits of PADs and to reduce barriers to their use.
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Affiliation(s)
- Esther Braun
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
| | - Anne-Sophie Gaillard
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
| | - Jakov Gather
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine (all authors) and Department of Psychiatry, Psychotherapy and Preventive Medicine, Landschaftsverband Westfalen-Lippe University Hospital (Gather), Ruhr University Bochum, Bochum, Germany
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Kylén M, Slaug B, Jonsson O, Iwarsson S, Schmidt SM. User involvement in ageing and health research: a survey of researchers' and older adults' perspectives. Health Res Policy Syst 2022; 20:93. [PMID: 36050697 PMCID: PMC9438331 DOI: 10.1186/s12961-022-00894-3] [Citation(s) in RCA: 4] [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: 03/18/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND User involvement in research has rapidly increased and is often a precondition to obtain research funding. Benefits such as effectiveness and increased relevance of research are described in the literature, but the evidence to support this is weak. Little is known about ageing and health researchers' experiences and perspectives towards user involvement in research, and their attitudes towards user involvement compared to the attitudes of the users involved are largely unknown. To examine researchers' experiences and perspectives of user involvement in research on ageing and health, and to compare their attitudes towards user involvement to the attitudes of older adults in the general population. METHODS A panel study survey was used to elicit responses from researchers in ageing and health as well as from older adults (aged 60 years and older). The researcher sample (N = 64) completed the survey online, while the older adult sample (N = 881) could choose among three different options to complete the survey (online, paper format, telephone). A professional survey company collected the data. Descriptive statistics, exploratory comparisons and descriptive qualitative content analysis were used to analyse the data. RESULTS More than half (58%) of the researchers had previous experience of involving different categories of users in a wide range of research activities. The most frequent motivation for involving users was to ensure that the research produced is relevant to the target population. A majority (86%) reported benefits, and more than half (59%) described challenges. Differences in attitudes were found between researchers and older adults in the general population. CONCLUSIONS Ageing and health researchers involve users in their research to improve quality and ensure relevance, but there is no consensus among them whether users should be involved in publicly funded research. While several challenges were identified, training, institutional support and resources from funders could alleviate many of these. Findings reveal significant differences in attitudes between older adults in the general population and researchers. Further research with comparable larger samples is needed to confirm and understand the possible consequences such controversy might have and how to solve them. IRRID (International Registered Report Identifier): RR2-10.2196/17759.
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Affiliation(s)
- Maya Kylén
- Department of Health Sciences, Lund University, HSC Margaretavägen 1 B, 22240, Lund, Sweden.
| | - Björn Slaug
- Department of Health Sciences, Lund University, HSC Margaretavägen 1 B, 22240, Lund, Sweden
| | - Oskar Jonsson
- Department of Health Sciences, Lund University, HSC Margaretavägen 1 B, 22240, Lund, Sweden
| | - Susanne Iwarsson
- Department of Health Sciences, Lund University, HSC Margaretavägen 1 B, 22240, Lund, Sweden
| | - Steven M Schmidt
- Department of Health Sciences, Lund University, HSC Margaretavägen 1 B, 22240, Lund, Sweden
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Näslund H, Grim K, Markström U. User-Focused Monitoring as a Strategy for Involvement and Mental Health Service Development: An Analysis of Swedish Monitoring Reports. J Psychosoc Rehabil Ment Health 2022; 9:303-316. [PMID: 35345414 PMCID: PMC8942048 DOI: 10.1007/s40737-022-00268-6] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
User-focused monitoring (UFM) is a method of evaluating mental health services, conducted by people with lived experience of mental ill health. Research on UFM and on user involvement focused on service monitoring and evaluation is lacking. This study addresses this knowledge gap by examining UFM as a strategy for user involvement. More specifically, this study aims to synthesize patterns in UFM reports to characterize the phenomenon, as well as to further discuss negotiation processes and political opportunities in UFM. The empirical material consists of 136 Swedish UFM reports that have been analyzed in two steps: All reports were mapped according to general characteristics and a sample of 20 reports were selected to provide additional information on the method. This study has been conducted in collaboration with actors representing the user movement and municipality-based mental health services. Our analysis shows that long-term contracts between user organizations and service providers are important to create a sustainable implementation of UFM. However, strategies to protect user autonomy must be carefully considered and employed in relation to such collaborations. We further highlight the risks of a restricted focus on consumer satisfaction, and discuss the current development towards including follow-ups in the UFM process as a strategy for counteracting tokenism.
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Affiliation(s)
- Hilda Näslund
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Katarina Grim
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
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Lundell S, Toots A, Sönnerfors P, Halvarsson A, Wadell K. Participatory methods in a digital setting: experiences from the co-creation of an eHealth tool for people with chronic obstructive pulmonary disease. BMC Med Inform Decis Mak 2022; 22:68. [PMID: 35303895 PMCID: PMC8932463 DOI: 10.1186/s12911-022-01806-9] [Citation(s) in RCA: 4] [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: 11/04/2021] [Accepted: 03/11/2022] [Indexed: 12/22/2022] Open
Abstract
Background Using participatory methods to engage end-users in the development and design of eHealth is important to understand and incorporate their needs and context. Within participatory research, recent social distancing practice has forced a transition to digital communication platforms, a setting that warrants deeper understanding. The aim of this study was to describe the experiences of, and evaluate a digital co-creation process for developing an eHealth tool for people with chronic obstructive pulmonary disease (COPD). Methods The co-creation was guided by Participatory appreciative action and reflection, where a convenience sample (n = 17), including persons with COPD, health care professionals, relatives and a patient organization representative participated in six digital workshops. User instructions, technical equipment, and skilled support were provided if necessary. Workshops centred around different topics, with pre-recorded films, digital lectures and home assignments to up-skill participants. Process validity, experiences and ownership in the co-creation process were evaluated by repeated respondent validation, member checking, questionnaires and by assessing attendance. Data was analysed quantitatively or qualitatively as appropriate. Results The co-creators were in general satisfied with the digital format of the workshops. Mean attendance and perceived engagement in workshops was high and the experience described as enjoyable. Engagement was facilitated by up-skilling activities and discussions in small groups. Few had used digital communication previously, and feelings ranging from excitement to concern were expressed initially. Technical issues, mainly audio related, were resolved with support. At completion, skills using equipment and digital platform surpassed expectations. Few disadvantages with the digital format were identified, and advantages included reduced travel, time efficiency and reduced infection risk. Conclusions Experiences of digital co-creation were overwhelmingly positive, despite initial barriers related to computer naivety and use of digital equipment and platforms. The high level of satisfaction, engagement, attendance rates, and agreement between individual and group views suggests that a digital co-creation process is a feasible method. Several important success factors were identified, such as the provision of information and education on discussion topics in advance of workshops, as well as the smaller group discussions during workshops. The knowledge gained herein will be useful for future digital co-creation processes.
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Affiliation(s)
- Sara Lundell
- Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden.
| | - Annika Toots
- Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden
| | - Pernilla Sönnerfors
- Division of Physiotherapy, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Alexandra Halvarsson
- Division of Physiotherapy, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden
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Viksveen P, Bjønness SE, Cardenas NE, Game JR, Berg SH, Salamonsen A, Storm M, Aase K. User involvement in adolescents' mental healthcare: a systematic review. Eur Child Adolesc Psychiatry 2022; 31:1765-1788. [PMID: 34089383 PMCID: PMC9666298 DOI: 10.1007/s00787-021-01818-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/31/2021] [Indexed: 12/29/2022]
Abstract
More than one out of ten adolescents suffer from mental illness at any given time. Still, there is limited knowledge about their involvement in mental healthcare. Adolescents have the right to be involved in decisions affecting their healthcare, but limited research focuses on their engagement and decision-making. Therefore, this systematic review aims to explore the existing experiences with, the effectiveness of, and safety issues associated with user involvement for adolescents' mental healthcare at the individual and organizational level. A systematic literature review on user involvement in adolescents' mental healthcare was carried out. A protocol pre-determined the eligibility criteria and search strategies, and established guidelines were used for data extraction, critical appraisal, and reporting of results. Quantitative studies were analysed individually due to heterogeneity of the studies, while qualitative studies were analysed using thematic synthesis. A total of 31 studies were included in the review. The experiences with user involvement were reported in 24 studies with three themes at the individual level: unilateral clinician control versus collaborative relationship, capacity and support for active involvement, the right to be involved; and two themes at the organizational level: involvement outcomes relevant to adolescents' needs, conditions for optimal involvement. The effectiveness of user involvement was reported in seven studies documenting fragmented evidence related to different support structures to facilitate adolescents' involvement. The safety associated with user involvement was not reported in any studies, yet a few examples related to potential risks associated with involvement of adolescents in decision-making and as consultants were mentioned.
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Affiliation(s)
- Petter Viksveen
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
| | - Stig Erlend Bjønness
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Nicole Elizabeth Cardenas
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Faculty of Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Julia Rose Game
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Faculty of Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Siv Hilde Berg
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
| | - Anita Salamonsen
- Regional Centre for Child and Youth Mental Health and Child Welfare - North (RKBU North), Faculty of Health Sciences, UiT The Arctic University of Norway, Langnes, P.O. Box 6050, Tromsø, Norway
| | - Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Karina Aase
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
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Haak M, Ivanoff S, Barenfeld E, Berge I, Lood Q. Research as an essentiality beyond one's own competence: an interview study on frail older people's view of research. Res Involv Engagem 2021; 7:91. [PMID: 34952649 PMCID: PMC8705152 DOI: 10.1186/s40900-021-00333-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/17/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is an increased interest to make the voices of frail older people heard in research by actively involving them in research processes. Involving frail older people in research could, however, be perceived as challenging by researchers. To actively involve frail older people in research processes in a meaningful way, the knowledge about their own views on what research is must be widened and deepened. METHODS Individual interviews were conducted with 17 frail older men and women with former experience of participation in research studies. Qualitative data were analysed using content analysis. RESULTS Frail older people's views on what research means are described through the main category; An essentiality beyond one's own competence, which describes research as a complex process that is important for society but difficult to understand. This is described in the sub-categories; A driving force for societal development, A benefit when based on lived experience, A source of knowledge difficult to access and understand, and A respected job filled with responsibilities. CONCLUSION Different views on research from the perspective of frail older people show that research is viewed as a complex yet important phenomenon to frail older people. Research was also seen as a natural part in society. Research was viewed as difficult to access and understand. Thus, researchers must train themselves to communicate research findings to the public in an understandable way. To create common understandings through information and education, researchers might be better placed to involve frail older people in a meaningful way and thereby also have the possibility to develop good working practice and relationships with those involved.
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Affiliation(s)
- Maria Haak
- Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Gothenburg, Sweden.
| | - Synneve Ivanoff
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Gothenburg, Sweden
| | - Emmelie Barenfeld
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Centre for Ageing and Health - AgeCap, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Isak Berge
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Gothenburg, Sweden
| | - Qarin Lood
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Gothenburg, Sweden
- School of Nursing and Midwifery, Faculty of Health Sciences, La Trobe University, Melbourne, Australia
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Selman LE, Clement C, Douglas M, Douglas K, Taylor J, Metcalfe C, Lane JA, Horwood J. Patient and public involvement in randomised clinical trials: a mixed-methods study of a clinical trials unit to identify good practice, barriers and facilitators. Trials 2021; 22:735. [PMID: 34688304 PMCID: PMC8542312 DOI: 10.1186/s13063-021-05701-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 03/30/2021] [Accepted: 10/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background While patient and public involvement (PPI) in clinical trials is beneficial and mandated by some funders, formal guidance on how to implement PPI is limited and challenges have been reported. We aimed to investigate how PPI is approached within a UK Clinical Trials Unit (CTU)’s portfolio of randomised controlled trials, perceived barriers to/facilitators of its successful implementation, and perspectives on the CTU’s role in PPI. Methods A mixed-methods study design, involving (1) an online survey of 26 trial managers (TMs) and (2) Interviews with Trial Management Group members and public contributors from 8 case-study trials. Quantitative survey data were summarised using descriptive statistics and interview transcripts analysed thematically. Two public contributors advised throughout and are co-authors. Results (1) 21 TMs completed the survey; (2) 19 in-depth interviews were conducted with public contributors (n=8), TMs (n=5), chief investigators (n=3), PPI coordinators (n=2) and a researcher. 15/21 TMs surveyed reported that a public contributor was on the trial team, and 5 used another PPI method. 12/21 TMs reported that public contributors were paid (range £10–50/h). 5 TMs reported that training was provided for public contributors and few staff members had received any formal PPI training. The most commonly reported tasks undertaken by public contributors were the review of participant-facing materials/study documents and advising on recruitment/retention strategies. Public contributors wanted and valued feedback on changes made due to their input, but it was not always provided. Barriers to successful PPI included recruitment challenges, group dynamics, maintaining professional boundaries, negative attitudes to PPI amongst some researchers, a lack of continuity of trial staff, and the academic environment. Successful PPI required early and explicit planning, sharing of power and ownership of the trial with public contributors, building and maintaining relationships, and joint understanding and clarity about expectations/roles. CTUs have an important role to play in supporting recruitment, signposting and coordinating PPI. Conclusions While highly valuable, PPI in trials is currently variable. PPI representatives are recruited informally, may not be provided with any training and are paid inconsistently across trials. Study findings can help optimise PPI in trials and ensure researchers and public contributors are adequately supported. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05701-y.
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Affiliation(s)
- Lucy Ellen Selman
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Clare Clement
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Margaret Douglas
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Keith Douglas
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jodi Taylor
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Chris Metcalfe
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - J Athene Lane
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jeremy Horwood
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Slåtsveen RE, Wibe T, Halvorsrud L, Lund A. Needs-led research: a way of employing user involvement when devising research questions on the trust model in community home-based health care services in Norway. Res Involv Engagem 2021; 7:43. [PMID: 34158122 PMCID: PMC8218277 DOI: 10.1186/s40900-021-00291-0] [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] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND This paper presents a user involvement process, called needs-led research, conducted as a part of a doctoral degree project aiming to explore research priorities and, ultimately, to develop a final top 10 list of questions relevant to the field of research. There is evidence of a mismatch between what user groups within a research field find relevant to study and what is actually being done. User involvement is a method that can accommodate this, and there is a growing attention and amount of research in this field based on an understanding that people who receive health care services, and their next of kin and clinicians, are uniquely positioned to contribute to research in order to understand their experiences better and improve the services. This paper presents a user involvement process in a small-scale study, referred to as needs-led research, which concerns the 'performance of the trust model in community home-based health care services'. The process was conducted as part of a doctoral degree project. METHOD The needs-led research process is inspired by the James Lind Alliance (JLA), which focuses on bringing together service users, next of kin and clinicians on equal terms to explore research priorities. The process consisted of five-steps, each of which involved representatives from service users, next of kin and clinicians: 1) narrowing down the theme; 2) steering group meeting; 3) gathering input through a survey; 4) data processing and interim priority setting; and 5) final priority setting. RESULTS Almost 200 participants contributed during the five steps, 294 inputs were gathered, and 35 participants voted for the top 10 list. The top 10 list is presented. CONCLUSION This paper provides an example of how user involvement can be employed to devise research questions that are relevant for clinicians, service users, next of kin and service providers concerning the 'performance of the trust model in home-based health care'. It also outlines some strengths and limitations of the process. The needs-led research process shows that user involvement in research is feasible for developing research questions in small-scale studies. We hope that the top 10 list presented will encourage future research to address issues of importance regarding the performance of the trust model in community home-based health care services.
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Affiliation(s)
- Ruth-Ellen Slåtsveen
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130 Oslo, Norway
| | - Torunn Wibe
- Centre for Development of Institutional and Home Care Services in the City of Oslo, PO Box 435, Sentrum, 0103 Oslo, Norway
| | - Liv Halvorsrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130 Oslo, Norway
| | - Anne Lund
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130 Oslo, Norway
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Lund A, Holthe T, Halvorsrud L, Karterud D, Johannessen AF, Lovett HM, Thorstensen E, Casagrande FD, Zouganeli E, Norvoll R, Forsberg EM. Involving older adults in technology research and development discussions through dialogue cafés. Res Involv Engagem 2021; 7:26. [PMID: 33971975 PMCID: PMC8111951 DOI: 10.1186/s40900-021-00274-1] [Citation(s) in RCA: 3] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Citizen involvement is important for ensuring the relevance and quality of many research and innovation efforts. Literature shows that inadequate citizen involvement poses an obstacle during the research, development, and implementation of assistive technology. Previous studies have addressed the advantages and disadvantages of citizen engagement in health research and technology development, and there is concern about how to ensure valuable engagement to avoid situations where they don't have influence. Frail older adults are often excluded from being active partners in research projects. The overall objective of this commentary is to describe a case where dialogue cafés was used as a method for involving assisted living residents in technology discussions, elaborating on the following research question: In what ways are dialogue cafés useful for directing research and development and for engaging residents in assisted living facilities in assistive technology discussions? METHOD Six dialogue cafés with assisted living residents as participants were carried out over a period of 3 years (2016-19). Reports that were written after each café by the group leaders and rapporteurs provide the material for the analyses in this paper. RESULTS This study demonstrates an example of facilitating user involvement where the participants felt useful by contributing to research and discussions on assistive technology and where this contribution in fact directed the research and development in the overall Assisted Living Project. CONCLUSION This study demonstrated that dialogue cafés enable older residents at an assisted living facility to contribute with opinions about their needs and perspectives on assistive technologies. This negates the view of older adults as too frail to participate and demonstrates the importance of including and collaborating with older adults in research.
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Affiliation(s)
- Anne Lund
- Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130 Oslo, Norway
| | - Torhild Holthe
- Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130 Oslo, Norway
| | - Liv Halvorsrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130 Oslo, Norway
| | - Dag Karterud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130 Oslo, Norway
| | | | | | - Erik Thorstensen
- Oslo Metropolitan University, Work Research Institute, PO Box 4, St. Olavs Plass, 0130 Oslo, Norway
| | - Flávia Dias Casagrande
- Faculty of Technology, Art, and Design, Department of Mechanical, Electronics, and Chemical Engineering, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130 Oslo, Norway
| | - Evi Zouganeli
- Faculty of Technology, Art, and Design, Department of Mechanical, Electronics, and Chemical Engineering, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130 Oslo, Norway
| | - Reidun Norvoll
- Oslo Metropolitan University, Work Research Institute, PO Box 4, St. Olavs Plass, 0130 Oslo, Norway
| | - Ellen Marie Forsberg
- Oslo Metropolitan University, Work Research Institute, PO Box 4, St. Olavs Plass, 0130 Oslo, Norway
- NORSUS Norwegian Institute for Sustainability Research, Stadion 4, 1671 Kråkerøy, Norway
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Baumgardt J, Schwarz J, Bechdolf A, Nikolaidis K, Heinze M, Hamann J, Holzke M, Längle G, Richter J, Brieger P, Kilian R, Timm J, Hirschmeier C, Von Peter S, Weinmann S. Implementation, efficacy, costs and processes of inpatient equivalent home-treatment in German mental health care (AKtiV): protocol of a mixed-method, participatory, quasi-experimental trial. BMC Psychiatry 2021; 21:173. [PMID: 33781237 PMCID: PMC8008509 DOI: 10.1186/s12888-021-03163-9] [Citation(s) in RCA: 10] [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] [Received: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Over the last decades, many high-income countries have successfully implemented assertive outreach mental health services for acute care. Despite evidence that these services entail several benefits for service users, Germany has lagged behind and has been slow in implementing outreach services. In 2018, a new law enabled national mental health care providers to implement team-based crisis intervention services on a regular basis, allowing for different forms of Inpatient Equivalent Home Treatment (IEHT). IEHT is similar to the internationally known Home Treatment or Crisis Resolution Teams. It provides acute psychiatric treatment at the user's home, similar to inpatient hospital treatment in terms of content, flexibility, and complexity. METHODS/DESIGN The presented naturalistic, quasi-experimental cohort study will evaluate IEHT in ten hospitals running IEHT services in different German regions. Within a multi-method research approach, it will evaluate stakeholders' experiences of care, service use, efficacy, costs, treatment processes and implementation processes of IEHT from different perspectives. Quantitative surveys will be used to recruit 360 service users. Subsequently, 180 service users receiving IEHT will be compared with 180 matched statistical 'twins' receiving standard inpatient treatment. Assessments will take place at baseline as well as after 6 and 12 months. The primary outcome is the hospital re-admission rate within 12 months. Secondary outcomes include the combined readmission rate, total number of inpatient hospital days, treatment discontinuation rate, quality of life, psycho-social functioning, job integration, recovery, satisfaction with care, shared decision-making, and treatment costs. Additionally, the study will assess the burden of care and satisfaction with care among relatives or informal caregivers. A collaborative research team made up of researchers with and without lived experience of mental distress will conduct qualitative investigations with service users, caregivers and IEHT staff teams to explore critical ingredients and interactions between implementation processes, treatment processes, and outcomes from a stakeholder perspective. DISCUSSION By integrating outcome, process and implementation research as well as different stakeholder perspectives and experiences in one study, this trial captures the various facets of IEHT as a special form of home treatment. Therefore, it allows for an adequate, comprehensive evaluation on different levels of this complex intervention. TRIAL REGISTRATION Trial registrations: 1) German Clinical Trials Register (DRKS), DRKS000224769. Registered December 3rd 2020, https://www.drks.de/drks_web/setLocale_EN.do ; 2) ClinicalTrials.gov, Identifier: NCT0474550 . Registered February 9th 2021.
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Affiliation(s)
- Johanna Baumgardt
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany.
| | - Julian Schwarz
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany
- ORYGEN, National Center of Excellence of Youth Mental Health, University of Melbourne, Melbourne, Australia
- Department for Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Konstantinos Nikolaidis
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Johannes Hamann
- kbo-Isar Amper Klinikum, Region München, Munich, Germany
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Martin Holzke
- Center for Psychiatry Suedwuerttemberg, Department of Psychiatry I, Ulm University, Ravensburg, Weissenau, Germany
| | - Gerhard Längle
- Center for Psychiatry Suedwuerttemberg, Zwiefalten, Germany
- Gemeinnützige GmbH für Psychiatrie Reutlingen (PP.rt), Academic Hospital of Tuebingen University, Reutlingen, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Department of Medicine of the Tuebingen University, Tuebingen, Germany
| | - Janina Richter
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Department of Medicine of the Tuebingen University, Tuebingen, Germany
| | - Peter Brieger
- kbo-Isar Amper Klinikum, Region München, Munich, Germany
| | - Reinhold Kilian
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | | | - Constance Hirschmeier
- Department for Psychiatry and Psychotherapy, Charité University Hospital Berlin, Berlin, Germany
| | - Sebastian Von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Stefan Weinmann
- Psychiatric Hospital and Rehabilitation Unit, Rudolf-Sophien-Stift, Stuttgart, Germany
- University Psychiatric Hospital Basel, Basel, Switzerland
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22
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Fern LA, Greenwood M, Smith S, Brand S, Coleman N, Stark DP, Murray MJ. Pre-Implementation Assessment of the Acceptability of Using Circulating microRNAs for Follow-Up of Malignant Germ-Cell Tumors. Clin Genitourin Cancer 2021; 19:381-387. [PMID: 33846102 DOI: 10.1016/j.clgc.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/07/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND MicroRNAs from the miR-371~373 and miR-302/367 clusters, particularly miR-371a-3p, are promising biomarkers for blood-based diagnosis and disease monitoring of malignant germ cell tumors (GCTs) and are nearing clinical implementation. These biomarkers have superior sensitivity and specificity compared with current markers alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). We explored patient acceptability of using circulating microRNAs to replace multiple serial computed tomography (CT) scans in malignant GCT follow-up. PATIENTS AND METHODS Two workshops involved interactive presentations and focus groups. Discussions were digitally recorded and transcribed verbatim. Qualitative thematic analysis of transcripts identified the key themes. RESULTS Prior to the workshops, potential participants expressed concern about the adoption of new blood tests due to personal experiences of the limitations of existing (AFP/HCG) markers. Twelve males (22-57 years of age; currently, 26-59 years of age) with a malignant GCT diagnosis participated; all were in follow-up. Three had experienced recurrence. Participants had cumulative exposure of between 1 and 15 CT scans. Data saturation was reached at the second workshop; five themes emerged underpinning preference for microRNA testing versus CT scans: (1) increased sensitivity and safety, (2) reduced financial costs, (3) reduced time for testing and results, (4) practicalities, and (5) reduced anxiety. However, some participants perceived an increased diagnostic capacity of CT scans versus blood testing. CONCLUSION This first user consultation of circulating microRNA testing for future malignant GCT follow-up suggests high acceptability with potential patient and healthcare system benefits.
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Affiliation(s)
- Lorna A Fern
- Oncology Division, University College London Hospitals NHS Foundation Trust, London, UK; National Cancer Research Institute Teenage and Young Adult and Germ Cell Research Group, London, UK.
| | | | - Shievon Smith
- Department of Medical Oncology, St Bartholomew's Hospital, London, UK
| | - Susan Brand
- It's in the Bag Charity, Bristol Haematology and Oncology Centre, Bristol, UK
| | | | - Daniel P Stark
- National Cancer Research Institute Teenage and Young Adult and Germ Cell Research Group, London, UK; Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
| | - Matthew J Murray
- National Cancer Research Institute Teenage and Young Adult and Germ Cell Research Group, London, UK; Department of Pathology, University of Cambridge, Cambridge, UK; Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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23
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Berge I, Barenfeld E, Dahlin-Ivanoff S, Haak M, Lood Q. Challenging oneself on the threshold to the world of research - frail older people's experiences of involvement in research. BMC Geriatr 2020; 20:410. [PMID: 33069211 PMCID: PMC7568390 DOI: 10.1186/s12877-020-01817-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/31/2019] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background User involvement of people outside academia in research is argued to increase relevance of research for society and to empower the involved lay persons. Frail older people can be a hard to reach group for research and thus an underrepresented group in research. There is a lack of knowledge how collaboration with frail older people should be best performed. Therefore, the aim of this study was to explore frail older people’s experiences of involvement in research. Methods In this study we have invited people, 75 years of age or older screened as physically frail and who have previously participated in a study as data sources, to share their experiences by intensive interviewing. Data was collected and analysed in parallel inspired by a constructivist grounded theory approach. Results The results demonstrate how frail older people have different incentives, how their context of ageing and the unusual position of being involved in research altogether influenced how, where and in what way they wished to be involved in research. This is described in three categories: Contributing to making a difference for oneself and others, Living a frail existence and Being on somebody else’s turf. The categories compose the core category, Challenging oneself on the threshold to the world of research, which symbolises the perceived distance between the frail older people themselves and the research world, but also the challenges the frail older people could go through when choosing to be involved in research. Conclusions Frail older people have a varied capacity to participate in research, but in what way and how is difficult to know before they have been involved in the process of research. Our results advocate that it is problematic to exclude frail older people a priori and that there is a potential for new perspectives and knowledge to be shaped in the encounter and in the relationship between the researcher and the frail older person. For research to be able to cater for frail older people’s needs of health services, their voices need to be heard and taken into consideration.
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Affiliation(s)
- Isak Berge
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Gothenburg, Sweden.
| | - Emmelie Barenfeld
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Synneve Dahlin-Ivanoff
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Gothenburg, Sweden
| | - Maria Haak
- Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Qarin Lood
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Gothenburg, Sweden.,School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
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24
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Hulbaek M, Knutz E, Ebbesen NT, Primdahl J, Nielsen JB, Birkelund R. Pelvic organ prolapse and treatment decisions- developing an online preference-sensitive tool to support shared decisions. BMC Med Inform Decis Mak 2020; 20:265. [PMID: 33059668 PMCID: PMC7565805 DOI: 10.1186/s12911-020-01264-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/30/2019] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Female patients with pelvic organ prolapse and clinicians need to take decisions regarding treatment that are often unpredictable in relation to how they impact the future everyday lives of the patients. This study formed the developmental phase of a larger study to develop and test an online tool to support shared decision-making. Methods Patients, health care professionals and other stakeholders participated in the development and evaluation process of this tool. The collected data was generated from observational studies, exploratory interviews with prompt cards and workshops with end users from four Danish gynecology outpatient clinics. Results Content analysis led to important themes. For the patients three themes emerged: 1) how the impact of symptoms on everyday life affected the need for relief, 2) their bodily perception and sex life and 3) their worries about the future. For clinicians the different symptoms and their severity was a main theme. Conclusions This article provides an overall description and discussion of the development methodology. It demonstrates how user involvement informed the prototyping process and how patients’ preferences were included in the final prototype. Whether the tool actually increases SDM, remains to be tested in a pilot feasibility study.
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Affiliation(s)
- Mette Hulbaek
- Department of Gynecology & Obstetrics, Hospital of Southern Jutland, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Eva Knutz
- Department of Design & Communication, University of Southern Denmark, Kolding, Denmark
| | - Niels Teglhus Ebbesen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, Denmark.,Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Jesper Bo Nielsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Regner Birkelund
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
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25
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Sandvin Olsson AB, Strøm A, Haaland-Øverby M, Fredriksen K, Stenberg U. How can we describe impact of adult patient participation in health-service development? A scoping review. Patient Educ Couns 2020; 103:1453-1466. [PMID: 32098746 DOI: 10.1016/j.pec.2020.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Patient participation represents a worldwide policy, but its impact lacks research. This study investigates impact of patient participation in health-service development by providing a comprehensive overview of how the literature describes it. METHOD A scoping review with a broad search strategy was conducted. The literature was examined for study characteristics, purpose for, approaches to and impact of patient participation. The data were analyzed using a thematic analysis. RESULTS The 34 included primary studies reported impacts of patient participation that were interpreted to constitute two categories: 1. The participatory process´ impact on involved patient representatives and health professionals, and the organization´s patient participation practice itself. 2. The participatory service development´s impact on the design and delivery of services regarding patients and health professionals, and the organization. CONCLUSION The literature describes a broad variation of impacts from health-service development, relevant for health professionals and patient representatives when initiating or participating in such processes. Our review provides an overview and discussion of these types of impact. PRACTICE IMPLICATIONS The findings can be of practical relevance to those aiming to develop services, quality indicators regarding effects of patient participation, or to further investigate aspects of participatory service development.
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Affiliation(s)
- Ann Britt Sandvin Olsson
- The Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway; Center of diakonia, values and professional practice, VID Specialized University, Postboks 184 Vinderen, 0319 Oslo, Norway.
| | - Anita Strøm
- Faculty of Health Studies, VID Specialized University, Postboks 184 Vinderen, 0319 Oslo, Norway.
| | - Mette Haaland-Øverby
- The Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway.
| | - Kari Fredriksen
- The Learning and Coping Center, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway.
| | - Una Stenberg
- The Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway.
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26
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Laterra A, Callahan T, Msiska T, Woelk G, Chowdhary P, Gullo S, Mwale PM, Modi S, Chauwa F, Kayira D, Kalua T, Wako E. Bringing women's voices to PMTCT CARE: adapting CARE's Community Score Card© to engage women living with HIV to build quality health systems in Malawi. BMC Health Serv Res 2020; 20:679. [PMID: 32698814 PMCID: PMC7376699 DOI: 10.1186/s12913-020-05538-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/11/2019] [Accepted: 07/13/2020] [Indexed: 11/19/2022] Open
Abstract
Background Coverage of prevention of mother-to-child transmission of HIV (PMTCT) services has expanded rapidly but approaches to ensure service delivery is patient-centered have not always kept pace. To better understand how the inclusion of women living with HIV in a collective, quality improvement process could address persistent gaps, we adapted a social accountability approach, CARE’s Community Score Card© (CSC), to the PMTCT context. The CSC process generates perception-based score cards and facilitates regular quality improvement dialogues between service users and service providers. Methods Fifteen indicators were generated by PMTCT service users and providers as part of the CSC process. These indicators were scored by each population during three sequential cycles of the CSC process which culminates in a sharing of scores in a collective meeting followed by action planning. We aggregated these scores across facilities and analyzed the differences in first and last scorings to understand perceived improvements over the course of the project (z-test comparing the significance of two proportions; one-tailed p-value ≤ .05). Data were collected over 12 months from September 2017 to August 2018. Results Fourteen of the fifteen indicators improved over the course of this project, with eight showing statistically significant improvement. Out of the indicators that showed statistically significant improvement, the majority fell within the control of local communities, local health facilities, or service providers (7 out of 8) and were related to patient or user experience and support from families and community members (6 out of 8). From first to last cycle, scores from service users’ and service providers’ perspectives converged. At the first scoring cycle, four indicators exhibited statistically significant differences (p-value ≤ .05) between service users and service providers. At the final cycle there were no statistically significant differences between the scores of these two groups. Conclusions By creating an opportunity for mothers living with HIV, health service providers, communities, and local government officials to jointly identify issues and implement solutions, the CSC contributed to improvements in the perceived quality of PMTCT services. The success of this model highlights the feasibility and importance of involving people living with HIV in quality improvement and assurance efforts. Trial registration Trial registration: ClincalTrials.gov NCT04372667 retrospectively registered on May 1st 2020.
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Affiliation(s)
- Anne Laterra
- CARE USA, 151 Ellis Street NE, Atlanta, GA, USA.
| | - Tegan Callahan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Godfrey Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, D.C, USA
| | | | - Sara Gullo
- Independent consultant, Atlanta, GA, USA
| | | | - Surbhi Modi
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Felluna Chauwa
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Dumbani Kayira
- Centers for Disease Control and Prevention, Lilongwe, Malawi
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27
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Halvorsen K, Dihle A, Hansen C, Nordhaug M, Jerpseth H, Tveiten S, Joranger P, Ruud Knutsen I. Empowerment in healthcare: A thematic synthesis and critical discussion of concept analyses of empowerment. Patient Educ Couns 2020; 103:1263-1271. [PMID: 32164960 DOI: 10.1016/j.pec.2020.02.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/05/2020] [Accepted: 02/12/2020] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The objective of this study is to shed light on common characteristics revealed in concept analyses of empowerment to contribute to further understanding. A further objective is to discuss how the perspective of healthcare service users appeared in the concept analyses. METHODS The review was performed by systematically searching Medline, CINAHL, EMBASE, PsycINFO and ERIC. The search yielded 255 abstracts, which were reduced by relevance and critical appraisal to the 12 concept analyses included. The analysis process involved thematic synthesis as described by Thomas and Harden. RESULTS The synthesis led to 13 descriptive themes structured according to antecedents, attributes and consequences of empowerment. The synthesis revealed how sparsely the question of equality and power in the relation between health professionals and healthcare service users is addressed. DISCUSSION To a great extent empowerment is viewed as a helping process of making patients act differently, rather than redistribution of power. For groups that are particularly vulnerable to oppression, questions of power are of severe importance. PRACTICE IMPLICATIONS As user participation is a growing discourse in health policy, health professionals need education to develop and address dimensions of power and reciprocity in empowering relations between users and themselves.
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Affiliation(s)
- Kristin Halvorsen
- Faculty of Health Sciences, Institute of Nursing and health Promotion, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, N-0130 Oslo, Norway.
| | - Alfhild Dihle
- Faculty of Health Sciences, Institute of Nursing and health Promotion, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, N-0130 Oslo, Norway.
| | - Camilla Hansen
- Faculty of Health Sciences, Institute of Nursing and health Promotion, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, N-0130 Oslo, Norway.
| | - Marita Nordhaug
- Faculty of Health Sciences, Institute of Nursing and health Promotion, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, N-0130 Oslo, Norway.
| | - Heidi Jerpseth
- Faculty of Health Sciences, Institute of Nursing and health Promotion, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, N-0130 Oslo, Norway.
| | - Sidsel Tveiten
- Faculty of Health Sciences, Institute of Nursing and health Promotion, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, N-0130 Oslo, Norway.
| | - Pål Joranger
- Faculty of Health Sciences, Institute of Nursing and health Promotion, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, N-0130 Oslo, Norway.
| | - Ingrid Ruud Knutsen
- Faculty of Health Sciences, Institute of Nursing and health Promotion, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, N-0130 Oslo, Norway.
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28
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Coulman KD, Nicholson A, Shaw A, Daykin A, Selman LE, Macefield R, Shorter GW, Cramer H, Sydes MR, Gamble C, Pick ME, Taylor G, Lane JA. Understanding and optimising patient and public involvement in trial oversight: an ethnographic study of eight clinical trials. Trials 2020; 21:543. [PMID: 32552907 PMCID: PMC7302397 DOI: 10.1186/s13063-020-04495-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/10/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Trial oversight is important for trial governance and conduct. Patients and/or lay members of the public are increasingly included in trial oversight committees, influenced by international patient and public involvement (PPI) initiatives to improve the quality and relevance of research. However, there is a lack of guidance on how to undertake PPI in trial oversight and tokenistic PPI remains an issue. This paper explores how PPI functions in existing trial oversight committees and provides recommendations to optimise PPI in future trials. This was part of a larger study investigating the role and function of oversight committees in trials facing challenges. METHODS Using an ethnographic study design, we observed oversight meetings of eight UK trials and conducted semi-structured interviews with members of their trial steering committees (TSCs) and trial management groups (TMGs) including public contributors, trial sponsors and funders. Thematic analysis of data was undertaken, with findings integrated to provide a multi-perspective account of how PPI functions in trial oversight. RESULTS Eight TSC and six TMG meetings from eight trials were observed, and 66 semi-structured interviews conducted with 52 purposively sampled oversight group members, including three public contributors. PPI was reported as beneficial in trial oversight, with public members contributing a patient voice and fulfilling a patient advocacy role. However, public contributors were not always active at oversight meetings and were sometimes felt to have a tokenistic role, with trialists reporting a lack of understanding of how to undertake PPI in trial oversight. To optimise PPI in trial oversight, the following areas were highlighted: the importance of planning effective strategies to recruit public contributors; considering the level of oversight and stage(s) of trial to include PPI; support for public contributors by the trial team between and during oversight meetings. CONCLUSIONS We present evidence-based recommendations to inform future PPI in trial oversight. Consideration should be given at trial design stage on how to recruit and involve public contributors within trial oversight, as well as support and mentorship for both public contributors and trialists (in how to undertake PPI effectively). Findings from this study further strengthen the evidence base on facilitating meaningful PPI within clinical trials.
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Affiliation(s)
- K D Coulman
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.
| | - A Nicholson
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - A Shaw
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - A Daykin
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - L E Selman
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - R Macefield
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - G W Shorter
- Centre for Improving Health Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, BT9 5BN, UK
| | - H Cramer
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, WC1J 6JL, UK
- MRC London Hub for Trial Methodology Research, London, UK
| | - C Gamble
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3BX, UK
| | - M E Pick
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - G Taylor
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - J A Lane
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
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29
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De Freitas C, Massag J, Amorim M, Fraga S. Involvement in maternal care by migrants and ethnic minorities: a narrative review. Public Health Rev 2020; 41:5. [PMID: 32280558 PMCID: PMC7137324 DOI: 10.1186/s40985-020-00121-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/30/2020] [Accepted: 03/16/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Guidelines for improving the quality of maternal health services emphasise women's involvement in care. However, evidence about migrant and ethnic minorities' preferences for participation in maternal care remains unsystematised. Understanding these populations' experiences with and preferred forms of involvement in care provision is crucial for imbuing policies and guidelines with sensitivity to diversity and for implementing people-centred care. This paper presents a narrative synthesis of empirical studies of involvement in maternal health care by migrants and ethnic minorities based on four key dimensions: information, communication, expression of preferences and decision-making. METHODS Studies indexed in PubMed and Scopus published until December 2019 were searched. Original quantitative, qualitative and mixed methods studies written in English and reporting on migrant and ethnic minority involvement in maternal care were included. Backward reference tracking was carried out. Three researchers conducted full-text review of selected publications. RESULTS In total, 22 studies met the inclusion criteria. The majority of studies were comparative and addressed only one or two dimensions of involvement, with an emphasis on the information and communication dimensions. Compared to natives, migrants and ethnic minorities were more likely to (1) lack access to adequate information as a result of health care staff's limited time, knowledge and misconceptions about women's needs and preferences; (2) report suboptimal communication with care staff caused by language barriers and inadequate interpreting services; (3) be offered fewer opportunities to express preferences and to have preferences be taken less into account; and (4) be less involved in decisions about their care due to difficulties in understanding information, socio-cultural beliefs and previous experiences with care provision less attuned with playing an active role in decision-making and care staff detracting attitudes. CONCLUSION Constraints to adequate and inclusive involvement in maternal care can hinder access to quality care and result in severe negative health outcomes for migrant and ethnic minority women. More research is needed into how to tailor the dimensions of involvement to migrant and ethnic minorities' needs and preferences, followed by provision of the resources necessary for effective implementation (e.g. sufficient time for consultations, optimal interpreter systems, health care staff training).
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Affiliation(s)
- Cláudia De Freitas
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Centre for Research and Studies in Sociology, University Institute of Lisbon (ISCTE-IUL), Lisbon, Portugal
| | - Janka Massag
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal
| | - Mariana Amorim
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal
| | - Sílvia Fraga
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Abstract
BACKGROUND User involvement, based on respect and carried out through dialogue, has been shown to lead to increased self-respect, self-confidence and positive identity. In Sweden, the Social Service Act requires that interventions be designed and implemented together with the individual concerned. The basic criterion for social support is prolonged severe mental illness (usually at least 6 months), with no criteria for specific diagnosis or institutional history. The most common form of social support is 'support in daily living', a community care intervention for people aged 18 years or older who have their own homes and living arrangements. AIM This article aims to deepen our understanding of user involvement at the individual level in the provision of an ongoing social work intervention. What elements of user involvement can be found in users' and support workers' descriptions of helpful support in daily living? METHOD Qualitative interviews were conducted with 18 users, who had experienced support in daily living as helpful, and 16 interviews with the users' support workers. RESULTS Three major, interconnected themes emerged: Constant dialogue; Framing the flexibility, in relation to formalized intervention plans and regulations; The importance of 'small things', decisions concerning daily life. CONCLUSION Both users and support workers described user involvement at the individual, micro-level to be an integral part of helpful support in daily living. It was possible to create a space for dialogue and co-creation in which users were involved in formulating and deciding the contents of their support at an informal level, to influence their own everyday lives. While a formal framework of rules, restrictions and plans surrounds meetings between users and professionals, a facilitating factor may be the absence of too detailed plans and regulations, leaving trust to users and professionals and their capacity to manage most of the choices they have to make.
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Affiliation(s)
- David Matscheck
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | | | - Alain Topor
- Department of Social Work, Stockholm University, Stockholm, Sweden
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Salemonsen E, Førland G, Hansen BS, Holm AL. Understanding beneficial self-management support and the meaning of user involvement in lifestyle interventions: a qualitative study from the perspective of healthcare professionals. BMC Health Serv Res 2020; 20:88. [PMID: 32024505 PMCID: PMC7003436 DOI: 10.1186/s12913-020-4951-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/30/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In light of the high prevalence of overweight and obesity among adults and the subsequent stigmatization and health consequences, there is a need to develop effective interventions to support lifestyle change. The literature supports the key role of healthcare professionals (HPs) in facilitating self-management through lifestyle interventions for those with chronic conditions. However, there is a lack of knowledge about how HPs practice self-management support (SMS) and user involvement for persons afflicted by overweight or obesity in lifestyle interventions in primary care Healthy Life Centres (HLC). The aim of this study was to explore how HPs provide SMS and what user involvement implies for HPs in HLCs. METHODS An interpretative exploratory design, using qualitative thematic analysis of data from two focus group interviews with ten HPs from eight different HLCs, was conducted. RESULTS The analysis resulted in one overall theme; A partnership based on ethical awareness, non-judgemental attitude, dialogue and shared responsibility, comprising four interrelated themes: 1) Supporting self-efficacy, self-worth and dignity through an attitude of respect, acknowledgement and generosity, 2) Promoting self-belief and self-perceived health, 3) Collaborating and sharing responsibility, and 4) Being flexible, adjusting and sharing time. CONCLUSION HPs in HLCs see service users as equal partners in a collaboration based on shared responsibility, acknowledgement and generosity. In order to help, their practice involves a heightened level of ethical awareness, including a non-judgemental attitude and dialogue. HPs in HLCs have something to teach us about ethical acting and helping persons who are struggling with overweight or obesity to change their lifestyle and regain dignity. They seem to see the service users' existential needs and have learned the art of meeting the other in her/his most vulnerable situation i.e., seeking help for a "wrong lifestyle". It may be time to highlight the need for SMS and user involvement to focus on shared responsibility in partnership rather than personal responsibility. More research is required to explore the conditions for such practice.
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Affiliation(s)
- Elin Salemonsen
- Department of Health and Caring Science, Western Norway University of Applied Sciences, Faculty of Health and Social Sciences, Bjørnsons gate 45, 5528 Haugesund, Norway
- University of Stavanger, Faculty of Health Sciences, Kjell Arholmsgate 39, 4021 Stavanger, Norway
| | - Georg Førland
- Department of Health and Caring Science, Western Norway University of Applied Sciences, Faculty of Health and Social Sciences, Bjørnsons gate 45, 5528 Haugesund, Norway
| | - Britt Sætre Hansen
- University of Stavanger, Faculty of Health Sciences, Kjell Arholmsgate 39, 4021 Stavanger, Norway
| | - Anne Lise Holm
- Department of Health and Caring Science, Western Norway University of Applied Sciences, Faculty of Health and Social Sciences, Bjørnsons gate 45, 5528 Haugesund, Norway
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Bjønness S, Viksveen P, Johannessen JO, Storm M. User participation and shared decision-making in adolescent mental healthcare: a qualitative study of healthcare professionals' perspectives. Child Adolesc Psychiatry Ment Health 2020; 14:2. [PMID: 31988656 PMCID: PMC6969458 DOI: 10.1186/s13034-020-0310-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/07/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Most mental health problems occur in adolescence. There is increasing recognition of user participation and shared decision-making in adolescents' mental healthcare. However, research in this field of clinical practice is still sparse. The objective of this study was to explore healthcare professionals' perspectives on user participation, and opportunities for shared decision-making in Child and Adolescent Mental Health Service (CAMHS) inpatient units. METHODS Healthcare professionals at CAMHS inpatient units participated in three focus group interviews. Fifteen participants with experience with user participation and shared decision-making were recruited from five hospitals in Norway. RESULTS Five themes emerged: (1) involvement before admission; (2) sufficient time to feel safe; (3) individualized therapy; (4) access to meetings where decisions are made; and (5) changing professionals' attitudes and practices. CONCLUSION User participation and shared decision-making require changes in workplace culture, and routines that allow for individualized mental health services that are adapted to adolescents' needs. This calls for a flexible approach that challenges clinical pathways and short-stay hospital policies. The results of this study may inform further work on strengthening user participation and the implementation of shared decision-making.Trial registration Norwegian Regional Committees for Medical and Health Research Ethics, reference number 2017/1195.
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Affiliation(s)
- Stig Bjønness
- Centre for Resilience in Healthcare (SHARE), Department for Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Petter Viksveen
- Centre for Resilience in Healthcare (SHARE), Department for Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Department for Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Marianne Storm
- Department for Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Kroner DG, Morgan RD, Mills JF, Maeda K. Risk assessment tool floundering? Let's ask the client to self-predict. Int J Law Psychiatry 2020; 68:101541. [PMID: 32033705 DOI: 10.1016/j.ijlp.2020.101541] [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] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/25/2019] [Accepted: 12/31/2019] [Indexed: 06/10/2023]
Abstract
Self-prediction by criminal justice involved clients has not been typically implemented in risk assessment procedures, yet clients have unique self-knowledge that may add to the assessment of risk. The Transition Inventory is an eight scale self-prediction measure that addresses areas that are a precursor to antisocial and criminal activity (e.g., "Drugs or alcohol will be a problem for me"). The Transition Inventory was administered to 131 paroled clients (primary drug-related offenses), 104 of whom were of minority/ethnic status. Predictive validity was demonstrated by the Transition Inventory incrementally predicting supervision failure. Individual scale construct validity was demonstrated by predicting later assessed corresponding measures, with the Leisure scale having the most robust predictive relationship. Self-prediction may promote greater predictability and stronger client engagement in the assessment process.
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Affiliation(s)
- Daryl G Kroner
- Southern Illinois University Carbondale, Department of Criminology & Criminal Justice, Faner Hall - Mail Code 4504, Southern Illinois University Carbondale, 1000 Faner Drive, Carbondale, IL 62901-4328, United States of America.
| | - Robert D Morgan
- Texas Tech University, Lubbock, TX 79409-2051, United States of America
| | - Jeremy F Mills
- Carleton University, Loeb B550, 1125 Colonel By Drive, Ottawa K1S 5B6, Canada
| | - Kanu Maeda
- Southern Illinois University Carbondale, Department of Criminology & Criminal Justice, Faner Hall - Mail Code 4504, Southern Illinois University Carbondale, 1000 Faner Drive, Carbondale, IL 62901-4328, United States of America
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Tollefsen TK, Neumer SP, Berg-Nielsen TS. "What matters to you?": A randomized controlled effectiveness trial, Using Systematic Idiographic Assessment as an intervention to Increase Adolescents' perceived control of their mental health. J Adolesc 2019; 78:53-61. [PMID: 31835096 DOI: 10.1016/j.adolescence.2019.11.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Over the last decades, many Western countries have seen an increase in mental health difficulties in the adolescent population. Among Norwegian adolescents, internalizing symptoms are most prevalent, and 10%-38% of adolescents seek out primary health care services for mental health problems. This study examined whether an idiographic measure designed for adolescents called Assert, which uses variables individually selected by the adolescents, could improve user involvement, locus of control, mental health, and quality of life. METHODS This study conducted a randomized controlled effectiveness trial using Assert in primary healthcare. A community sample of 150 Norwegian adolescents aged 12-23 years (M = 16.2; SD = 2.2) were randomized to the Assert or control group. Of the participants 27 (18%) were male. The adolescents and 52 counsellors from primary healthcare services responded to online questionnaires. Of the counselors, 92.8% were female and trained in the use of systematic idiographic assessment. RESULTS Adolescents who used Assert scored significantly lower on external LoC, attributing less of their mental health improvement to chance, fate, or luck. However, the intervention showed no effect on the symptoms of mental health, QoL, or user involvement. CONCLUSIONS Using Assert in primary healthcare may enhance adolescents' sense of being able to influence their life circumstances and mental health by allowing them more control of their treatment. However, this approach might not be successful in reducing symptoms.
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Affiliation(s)
- Thomas Kristian Tollefsen
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Norway; University of Oslo, Norway.
| | - Simon-Peter Neumer
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Norway
| | - Turid Suzanne Berg-Nielsen
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Norway; Norwegian University of Science and Technology, Trondheim, Norway
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Best P, McConnell T, Davidson G, Badham J, Neill RD. Group based video-conferencing for adults with depression: findings from a user-led qualitative data analysis using participatory theme elicitation. Res Involv Engagem 2019; 5:40. [PMID: 31844555 PMCID: PMC6896757 DOI: 10.1186/s40900-019-0173-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Accessing support services for depression has been historically difficult given the societal stigma that exists regarding the condition. Recent advances in digital technologies continue to be postulated as a potential panacea yet the results from research trials have been mixed with a range of effect sizes. METHODS This article offers a different perspective by presenting a panel of end users (co-researchers) with qualitative interview data (n = 8) taken from a feasibility RCT of a group based video-conferencing service for depressed adults. The co-researcher panel were introduced to a new method of participatory data analysis known as Participatory Theme Elicitation (PTE). This method involves using network analysis techniques to create groupings and visual diagrams in order to support the generation of themes and minimise scientific researcher input/influence. RESULTS Co-researchers reported that while VC based interventions appeared convenient, accessible and relatively low cost - additional training and support should be offered to improve uptake and retention. In addition, co-researchers suggested that further exploration is needed regarding the level of self-awareness one feels in a group based VC environment and whether this facilitates disclosure (through disinhibition) or increases anxiety. CONCLUSION The findings presented here appear to support existing (researcher and academic-led) literature in the field as well as suggest new areas for investigation. By presenting data generated solely by co-researchers, this article also adds to the evidence surrounding participatory analysis methods - particularly the growing need for robust approaches that are accessible and less time-consuming than those currently available. TRIAL REGISTRATION NUMBER NCT03288506 (Clinicaltrials.gov) 20th Sept 2017 https://clinicaltrials.gov/ct2/show/NCT03288506.
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Affiliation(s)
- Paul Best
- School of Social Sciences Education and Social Work. 6 College Park, Queen’s University Belfast, Belfast, UK
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Royal Victoria Hospital, Queen’s University Belfast, Belfast, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
| | - Tracey McConnell
- School of Social Sciences Education and Social Work. 6 College Park, Queen’s University Belfast, Belfast, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
| | - Gavin Davidson
- School of Social Sciences Education and Social Work. 6 College Park, Queen’s University Belfast, Belfast, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
| | - Jennifer Badham
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Royal Victoria Hospital, Queen’s University Belfast, Belfast, UK
| | - Ruth D. Neill
- School of Social Sciences Education and Social Work. 6 College Park, Queen’s University Belfast, Belfast, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
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Wells B, Beeston AV, Bradley E, Brown GJ, Crook H, Kurtić E. Talking in Time: The development of a self-administered conversation analysis based training programme for cochlear implant users. Cochlear Implants Int 2019; 20:255-265. [PMID: 31234737 DOI: 10.1080/14670100.2019.1625185] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Training software to facilitate participation in conversations where overlapping talk is common was to be developed with the involvement of Cochlear implant (CI) users. Methods: Examples of common types of overlap were extracted from a recorded corpus of 3.5 hours of British English conversation. In eight meetings, an expert panel of five CI users tried out ideas for a computer-based training programme addressing difficulties in turn-taking. Results: Based on feedback from the panel, a training programme was devised. The first module consists of introductory videos. The three remaining modules, implemented in interactive software, focus on non-overlapped turn-taking, competitive overlaps and accidental overlaps. Discussion: The development process is considered in light of feedback from panel members and from an end of project dissemination event. Benefits, limitations and challenges of the present approach to user involvement and to the design of self-administered communication training programmes are discussed. Conclusion: The project was characterized by two innovative features: the involvement of service users not only at its outset and conclusion but throughout its course; and the exclusive use of naturally occurring conversational speech in the training programme. While both present practical challenges, the project has demonstrated the potential for ecologically valid speech rehabilitation training.
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Affiliation(s)
- Bill Wells
- a Department of Human Communication Sciences , University of Sheffield , Sheffield , UK
| | - Amy V Beeston
- b Department of Computer Science , University of Sheffield , Sheffield , UK
| | - Erica Bradley
- c Department of Neurotology , Sheffield Teaching Hospitals NHS Trust , Sheffield , UK
| | - Guy J Brown
- b Department of Computer Science , University of Sheffield , Sheffield , UK
| | - Harriet Crook
- c Department of Neurotology , Sheffield Teaching Hospitals NHS Trust , Sheffield , UK
| | - Emina Kurtić
- a Department of Human Communication Sciences , University of Sheffield , Sheffield , UK
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Brooks H, Lovell K, Bee P, Fraser C, Molloy C, Rogers A. Implementing an intervention designed to enhance service user involvement in mental health care planning: a qualitative process evaluation. Soc Psychiatry Psychiatr Epidemiol 2019; 54:221-233. [PMID: 30267112 DOI: 10.1007/s00127-018-1603-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 06/07/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental health interventions. A randomised controlled trial of a user- and carer-informed training package in the United Kingdom to enhance SDM in care planning in secondary mental health care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, carer, mental health professional and organisational levels. METHODS A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental health service users, carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically. RESULTS The process evaluation demonstrated that despite buy-in from those delivering care planning in mental health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention. CONCLUSIONS Future aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of health care relationships and include elements which seek to address these directly.
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Affiliation(s)
- Helen Brooks
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Eleanor Rathbone Building, Liverpool, UK.
| | - Karina Lovell
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Penny Bee
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Claire Fraser
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Christine Molloy
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Anne Rogers
- NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
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Locock L, Kirkpatrick S, Brading L, Sturmey G, Cornwell J, Churchill N, Robert G. Involving service users in the qualitative analysis of patient narratives to support healthcare quality improvement. Res Involv Engagem 2019; 5:1. [PMID: 30788147 PMCID: PMC6318884 DOI: 10.1186/s40900-018-0133-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/29/2018] [Indexed: 05/16/2023]
Abstract
PLAIN ENGLISH SUMMARY Patient or user involvement in health research is well-established but is often limited to advising on research questions and design, leaving researchers to collect and analyse 'data' (which in this paper means written copies of interviews with patients about their experiences). We were working with sets of interviews with 1) young people with depression and 2) people with experiences of stroke. We were looking for key themes that it would be useful for the NHS to know about, and we developed short films which healthcare staff can use to think about how to make care more patient-centred. We wanted to see what user involvement in this analysis would bring, and how best to achieve it practically.After the researcher team had analysed the interviews, we ran two one-day workshops with people with relevant experience as a patient/service user or carer. We gave them some brief training in how to analyse interviews and how they might be used for improving the quality of care. Then we looked at extracts from the interviews, and discussed whether people could see the same themes as the researcher.People identified similar themes to the researcher, but also identified new details the researcher had missed. However, they felt reading large amounts of text was not the best way to use their time and experience. Instead they recommended that a better approach would be for a researcher to meet with a group of users at the start of analysis, to discuss what to look out for. ABSTRACT Background Patient or user involvement in health research is a well-established principle. However, involvement is often limited to advising on research questions and design, leaving researchers to complete data collection and analysis. Involvement in data analysis is one of the most challenging, least well-explored aspects of involvement. Qualitative interview data forms high volumes of rich, complex material which can be daunting to work with.Analysing narrative interviews with patients is central to a patient-centred quality improvement method called experience-based co-design. The analysis identifies 'touchpoints' - key moments of healthcare experiences - and leads to the production of a 'trigger film' to spark codesign discussions between patients and staff. We wanted to see what user involvement in this analysis would bring, and how best to achieve it. Methods As part of a wider secondary analysis study to create new trigger films, we re-analysed interview transcripts on experiences of young people with depression and experiences of stroke. We then ran two workshops with people with relevant lived experience, working with extracts from the same materials after brief training. Results People involved in the workshops identified similar themes to the researcher, but also brought some new insights. While they engaged easily with the materials selected, we under-estimated how much time it would take people to work through these. Discussion and sharing experiences and perspectives were highly valued in the first workshop. In the second workshop, we therefore started with group discussion, based on people's own experience, of what they thought the touchpoints would be, and later viewed a draft trigger film together to see how it compared. Conclusions Those involved felt that while analysing transcripts was possible in small quantities, it was not best use of their time. We suggest that conversation, rather than data, is at the heart of user involvement in analysis. One way to retain the value of lived experience in the analytic process, without over-burdening people with data, is to elicit user reflections on their experience at the start of analysis, and use this as a guide to direct both researcher and service user attention during the remainder of the process.
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Affiliation(s)
- Louise Locock
- Health Services Research Unit, University of Aberdeen (Formerly University of Oxford), Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD Scotland
| | - Susan Kirkpatrick
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG England
| | - Lucy Brading
- Institute of Psychology Health and Society/North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, L69 3GL England
| | | | - Jocelyn Cornwell
- Point of Care Foundation, 3rd Floor, CAN Mezzanine 7–14 Great Dover Street London SE1 4RY, London, England
| | - Neil Churchill
- Experience, Participation and Equalities, NHS England, Quarry House, Quarry Hill, Leeds, LS2 7UE England
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, James Clerk Maxwell Building, 57 Waterloo Rd, London, SE1 8WA England
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Jewell A, Pritchard M, Barrett K, Green P, Markham S, McKenzie S, Oliver R, Wan M, Downs J, Stewart R. The Maudsley Biomedical Research Centre (BRC) data linkage service user and carer advisory group: creating and sustaining a successful patient and public involvement group to guide research in a complex area. Res Involv Engagem 2019; 5:20. [PMID: 31205751 PMCID: PMC6558776 DOI: 10.1186/s40900-019-0152-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/20/2019] [Indexed: 05/17/2023]
Abstract
BACKGROUND Patient and Public Involvement (PPI) in health and social care research has been shown to improve the quality and relevance of research. PPI in data linkage research is important in ensuring the legitimacy of future health informatics initiatives, but remains sparse and under-developed. This article describes the setting up and evaluation of a service user and carer advisory group with the aim of providing feedback and advice to researchers developing or making use of database linkages in the field of mental health. AIM The aim of this study is to describe the creation and formative evaluation of the service user and carer advisory group after a trial period of 12 months. METHOD Six individuals were recruited to the group all of whom had personal experience of mental illness. A formative evaluation was conducted after a trial period of 12 months. RESULTS Evaluation revealed that the group succeeded in promoting dialogue between service users/carers and researchers. Factors that contributed to the success of the group's first year included the opportunity it provided for researchers to involve service users and carers in their projects, the training provided to group members, and the openness of researchers to receiving feedback from the group. CONCLUSION The group encourages the incorporation of PPI in data linkage research which helps to ensure the legitimacy of data linkage practices and governance systems whilst also improving the quality and relevance of the research being conducted using linked data.
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Affiliation(s)
- Amelia Jewell
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Megan Pritchard
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Patrick Green
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sarah Markham
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Roger Oliver
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Maria Wan
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Johnny Downs
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Romsland GI, Milosavljevic KL, Andreassen TA. Facilitating non-tokenistic user involvement in research. Res Involv Engagem 2019; 5:18. [PMID: 31183162 PMCID: PMC6551868 DOI: 10.1186/s40900-019-0153-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/22/2019] [Indexed: 05/12/2023]
Abstract
BACKGROUND With the increase in user activism in the Western societies in recent years, there has also been an increase in promoting user involvement in research. Hence, is necessary to address the danger of tokenism, a false appearance of inclusiveness, in user involvement, as well as to explore methods for promoting active user involvement. Using a Norwegian research project on the rehabilitation processes following traumatic injuries organised via user involvement, this study reviews ways in which to avoid tokenism in user involvement and how to instead stimulate active user engagement in research. METHODS The analysis employs an ethnographic approach using participant observations from real life settings involving user involvement during the five years research process. The empirical material includes 472 pages of transcribed audio recordings from meetings between researchers and collaborators discussing personal experiences with traumatic injuries, and 340 pages of documents on the project's involvement process. This empirical material was examined by thematic analysis, involving processes such as decontextualising, flagging and re-contextualising. RESULTS Two main categories of facilitation emerged as promoting non-tokenistic, active user involvement in research: 1) defining the collaborative arena, (i.e. the setting of collaboration) which entails preparing for participation and promoting active involvement, and 2) designing for research counselling, which involves gathering user perspectives and valuing criticism. Taking into account the existing asymmetric relationships between researchers and collaborators, enabling more evenly distributed power dynamics also proved to be essential. CONCLUSIONS To achieve active participation that is relevant to the collaborators, two interconnected yet analytically independent themes should be considered: the collaborative arena and counselling. Both prove crucial for curbing power imbalance and stimulating the involvement process. The study indicates that non-tokenistic involvement should be anchored in the respect for participants and their ability to make contributions. This analysis can help researchers who seek active engagement and non-tokenistic involvement in research to find methods for facilitating and organising participation in their fields.
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Affiliation(s)
- Grace Inga Romsland
- Sunnaas Rehabilitation Hospital, Bjørnemyrveien, NO-1450 Nesoddtangen, Norway
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, PO Box 4 St. Olavs plass, NO-0130 Oslo, Norway
| | - Kate Louise Milosavljevic
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, PO Box 4 St. Olavs plass, NO-0130 Oslo, Norway
| | - Tone Alm Andreassen
- Centre for the study of professions (SPS), OsloMet - Oslo Metropolitan University, PO Box 4 St. Olavs plass, NO-0130 Oslo, Norway
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Laitila M, Nummelin J, Kortteisto T, Pitkänen A. Service users' views regarding user involvement in mental health services: A qualitative study. Arch Psychiatr Nurs 2018; 32:695-701. [PMID: 30201197 DOI: 10.1016/j.apnu.2018.03.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 10/02/2017] [Revised: 01/27/2018] [Accepted: 03/11/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Service user involvement is emphasised in many strategies, plans and declarations globally. However, in practice, service user involvement is not always achieved and remains at a tokenistic level. OBJECTIVES To explore the views of service users on user involvement in mental health service. DESIGN Explorative descriptive study design. SETTING The study was conducted in one psychiatric hospital and in two mental health organisations in western Finland. METHODS The data was generated through three focus group interviews and analysed with qualitative content analysis. RESULTS User involvement means that people using mental health services are respected, listened to and can act in co-operation with professionals so than they feel that they can influence their own care and treatment. The participants articulated concrete factors that promote or inhibit user involvement. Service user involvement can be enhanced by strengthening service users´ position, by developing the mental health care system and by specific training for professionals. CONCLUSIONS The views of service users in this study concerning the realisation of user involvement and the factors promoting and preventing it were realistic. They are basic elements of patient-centred care and of all human interaction. Our participants described service user involvement in their own care and treatment. They emphasised the need to have more information, and wanted to be more involved in decision-making about their own care and treatment. They called for better care planning and co-ordination as one way to increase service user involvement. These also have implications for mental health services at the system level.
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Affiliation(s)
- Minna Laitila
- Hospital District of South Ostrobothnia, Hanneksenrinne 7, 60220 Seinäjoki, Finland.
| | - Jalmiina Nummelin
- Hospital District of Kanta-Hame, Ahvenistontie 20, 13530 Hämeenlinna, Finland.
| | - Tiina Kortteisto
- Tampere University Hospital, Department of Internal Medicine, Teiskontie 35, 33521 Tampere, Finland.
| | - Anneli Pitkänen
- Administration Centre, Pirkanmaa Hospital District, Teiskontie 35, 33521 Tampere, Finland.
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Brooks H, James K, Irmansyah I, Keliat BA, Utomo B, Rose D, Colucci E, Lovell K. Exploring the potential of civic engagement to strengthen mental health systems in Indonesia (IGNITE): a study protocol. Int J Ment Health Syst 2018; 12:49. [PMID: 30159023 PMCID: PMC6109339 DOI: 10.1186/s13033-018-0227-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 08/14/2018] [Indexed: 01/02/2023] Open
Abstract
Background Indonesia has the highest rate of years of life lost to disability or early death from Schizophrenia than any other country in the world. More than 90% of people with mental illness do not get any treatment and tens of thousands of people with psychosis are illegally detained (‘pasung’) in the family home. Civic engagement, a core part of the recent World Health Organisation global strategy, has the potential to address some of these challenges through the development of person-centered models of care. The aim of the study is to develop a testable systems level, culturally appropriate, civic engagement framework for use in Jakarta and Bogor, Indonesia to strengthen local mental health services. Methods A mixed methods study underpinned by a realist approach will be undertaken across four phases in two study sites in Indonesia (Jakarta and Bogor). Phase 1 will explore the use of civic engagement across South East Asia by conducting a systematic review of existing evidence. By surveying 300 mental health professionals, phase 2 will identify the stakeholders, the sources of collaboration and the evidence used by professionals in decision making within local mental health systems and identify potential opportunities for civic engagement within the system. In order to explore the potential use of civic engagement within Indonesian mental health services and identify priorities for a culturally appropriate framework, phase 3 will undertake two focus groups with participants with experience of psychosis or caring for someone with psychosis (n = 20–30). Professionals and other key decision makers in a range of roles across the system at a national (n = 5) and local level (n = 10–15/site) will also take part in semi-structured interviews. Phase 4 will co-produce a civic engagement framework for use in Indonesia by synthesising evidence from phases 1–3 collaboratively with key stakeholders. Discussion Civic engagement is a potential way in which health services in low and middle income countries can address the burden of mental health conditions through the development of person-centred models of care. However, such approaches are underexplored in Indonesia. This study will work with local stakeholders to design a testable civic engagement framework for use in mental health services in Indonesia. Electronic supplementary material The online version of this article (10.1186/s13033-018-0227-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helen Brooks
- 1Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Karen James
- Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston and St Georges, London, UK
| | - I Irmansyah
- 3National Institute of Health Research and Development, Jakarta, Indonesia.,Marzoeki Mahdi Hospital, Bogor, Indonesia
| | | | | | - Diana Rose
- 7Department of Health Services Research, Kings College London, London, UK
| | | | - Karina Lovell
- 9Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Larsson I, Staland-Nyman C, Svedberg P, Nygren JM, Carlsson IM. Children and young people's participation in developing interventions in health and well-being: a scoping review. BMC Health Serv Res 2018; 18:507. [PMID: 29954392 PMCID: PMC6027768 DOI: 10.1186/s12913-018-3219-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [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: 06/23/2016] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Greater interest is being shown in participatory approaches, especially in research on interventions that concern children and young people's health and well-being. Although participatory approaches have user involvement in common, they differ in terms of the explicit guidance on how to actually involve and engage children and young people in health research. The aim of this scoping review was to systematically map recent research involving children and young people in the development of interventions targeting issues of health and well-being. METHODS An interpretative scoping literature review based on: a scientific literature search in (health and social science) databases, reference lists, a manual search in key journals and contact with existing networks was conducted. A total of 4458 references were identified through the literature search, of which 41 studies published between 2000 and 2017 were included in the review. The target population was children and young people under 25 years old. Level of participation was categorized according to Shier's Pathways to Participation Model. RESULTS The review showed that participatory approaches were most often used in the development of interventions in school settings and in community and healthcare settings and on issues concerning support in lifestyle or in managing illness or disease. The level of participation varied from children and young people taking part just as active informants, through stages of greater participation both in quantitative and qualitative terms, to children and young people becoming an active agent involved as a co-researcher where the research process was shaped by views of a higher level of mutuality. Most of the studies were categorised at a medium level and only three studies were judged to involve the children and young people at the highest level. CONCLUSIONS This scoping review showed that work remains in enabling children and young people to influence the development of interventions targeting health and well-being. In relation to level of sustainability in the interventions, it is relevant that goals, strategies and processes are formulated by those who can gain from the interventions. Participatory approaches aiming for a higher level of participation where children and young people work together with the researchers in partnerships are thus warranted.
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Affiliation(s)
- Ingrid Larsson
- School of Health and Welfare, Halmstad University, Box 823, S-30118, Halmstad, Sweden.
| | - Carin Staland-Nyman
- School of Health and Welfare, Halmstad University, Box 823, S-30118, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Box 823, S-30118, Halmstad, Sweden
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Box 823, S-30118, Halmstad, Sweden
| | - Ing-Marie Carlsson
- School of Health and Welfare, Halmstad University, Box 823, S-30118, Halmstad, Sweden
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Kylberg M, Haak M, Iwarsson S. Research with and about user participation: potentials and challenges. Aging Clin Exp Res 2018; 30:105-8. [PMID: 28361466 DOI: 10.1007/s40520-017-0750-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/10/2017] [Indexed: 11/19/2022]
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Ryhl C. Simulating Disability in Universal Design Teaching: A Critique - Abandoning Try-It-Yourself in Teaching Universal Design in Architecture. Stud Health Technol Inform 2018; 256:572-578. [PMID: 30371417] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Blindfolding people and providing them with white cane or placing them in a manual wheelchair for 20-60 minutes is a much used and classic exercise when teaching architects and other professionals the basics of user needs related to disability. This method, called try-it-yourself, is the most prevalent method where universal design in taught in the Nordic region. While the exercise is often praised for ensuring an effective 'eye-opening' outcome, the ethical aspects, the absence of the users themselves or the possibilities of alternative methods for teaching user needs appear to be non-existing. The article is based on literature studies and 1:1 experience gained from our Master program in universal design, where the try-it-yourself exercise is analyzed and discussed. The article argues that the exercise, as opposed to its original intention, appears to increase disability stigma and ethical dilemmas. Hence, it needs to be challenged as the prevalent exercise used for teaching universal design and accessibility. The article also discusses alternative methods for teaching user needs. Furthermore, the article discusses the tacit cultural acceptance of the exercise, as well as the ethical dilemmas in the non-existing debate of what is actually being tried-yourself in the exercise. The article also presents possible reasons for the significant absence of an open critical debate about the pros and cons of the exercise, as it is being used non-critically in the Nordic region.
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Affiliation(s)
- Camilla Ryhl
- Danish Building Research Institute, Aalborg University, Copenhagen, Denmark
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Best P, Badham J, Corepal R, O’Neill RF, Tully MA, Kee F, Hunter RF. Network methods to support user involvement in qualitative data analyses: an introduction to Participatory Theme Elicitation. Trials 2017; 18:559. [PMID: 29169378 PMCID: PMC5701364 DOI: 10.1186/s13063-017-2289-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 10/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While Patient and Public Involvement (PPI) is encouraged throughout the research process, engagement is typically limited to intervention design and post-analysis stages. There are few approaches to participatory data analyses within complex health interventions. METHODS Using qualitative data from a feasibility randomised controlled trial (RCT), this proof-of-concept study tests the value of a new approach to participatory data analysis called Participatory Theme Elicitation (PTE). Forty excerpts were given to eight members of a youth advisory PPI panel to sort into piles based on their perception of related thematic content. Using algorithms to detect communities in networks, excerpts were then assigned to a thematic cluster that combined the panel members' perspectives. Network analysis techniques were also used to identify key excerpts in each grouping that were then further explored qualitatively. RESULTS While PTE analysis was, for the most part, consistent with the researcher-led analysis, young people also identified new emerging thematic content. CONCLUSIONS PTE appears promising for encouraging user led identification of themes arising from qualitative data collected during complex interventions. Further work is required to validate and extend this method. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02455986 . Retrospectively Registered on 21 May 2015.
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Affiliation(s)
- Paul Best
- School of Social Sciences, Education and Social Work, Queen’s University, Belfast, UK
| | - Jennifer Badham
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, UK
| | - Rekesh Corepal
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, UK
| | - Roisin F. O’Neill
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, UK
| | - Mark A. Tully
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, UK
| | - Frank Kee
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, UK
| | - Ruth F. Hunter
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, UK
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Mackintosh N, Rance S, Carter W, Sandall J. Working for patient safety: a qualitative study of women's help-seeking during acute perinatal events. BMC Pregnancy Childbirth 2017; 17:232. [PMID: 28716050 PMCID: PMC5513134 DOI: 10.1186/s12884-017-1401-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/03/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Women and their relatives can play an important role in early detection and help seeking for acute perinatal events. Recent UK reports indicate that patient-professional partnership in 'working for safety' can be difficult to achieve in practice, sometimes with catastrophic consequences. This research explored the experiences of women and relatives who had experienced early warning signs about their condition and sought help in escalating care. METHODS Secondary analysis of case study data which included qualitative interviews with 22 women purposively sampled on account of experiencing a step up in care and 4 of their relatives from two NHS Trusts in England during 2010. Analysis focused on the type of safety work participants engaged in, and the opportunities and challenges reported by women and family members when negotiating safety at home and in hospital. RESULTS Women and relatives took on a dual responsibility for self-diagnosis, self-care and seeking triage, whilst trying to avoid overburdening stretched services. Being informed, however, did not necessarily enable engagement from staff and services. The women's narratives highlighted the work that they engaged in to build a case for clinical attention, the negotiations that took place with health care professionals and the strategies women and partners drew on (such as objective signs and symptoms, use of verbal insistence and repetition) to secure clinical help. For some women, the events left them with a lasting feeling that their concerns had been disregarded. Some described a sense of betrayal and loss of trust in an institution they believed had failed to care for them. CONCLUSION The notion of 'safety partnerships' which suggests a sense of equality and reciprocity was not borne out by our data, especially with regards to the experiences of teenage women. To enable women and families to secure a rapid response in clinical emergencies, strategies need to move beyond the provision of patient information about warning signs. Effective partnerships for safety may be supported by system level change such as improved triage, continuity of care, self-referral pathways and staff training to address asymmetries of power that persist within the health system.
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Affiliation(s)
- Nicola Mackintosh
- SAPPHIRE Group, Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 7RH UK
| | - Susanna Rance
- Institute for Health and Human Development, University of East London, London, UK
| | - Wendy Carter
- Division of Women’s Health, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Jane Sandall
- Division of Women’s Health, Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Abstract
Purpose - Patient involvement in the design and improvement of health services is increasingly recognized as an essential part of patient-centred care. Yet little research, and no measurement tool, has addressed the organizational impacts of such involvement. The paper aims to discuss these issues. Design/methodology/approach - The authors developed and piloted the scoresheet for tangible effects of patient participation (STEPP) to measure the instrumental use of patient input. Its items assess the magnitude of each recommendation or issue brought forward by patients, the extent of the organization's response, and the apparent degree of patient influence on this response. In collaboration with teams (staff) from five involvement initiatives, the authors collected interview and documentary data and scored the STEPP, first independently then jointly. Feedback meetings and a "challenges log" supported ongoing improvement. Findings - Although researchers' and teams' initial scores often diverged, the authors quickly reached consensus as new information was shared. Composite scores appeared to credibly reflect the degree of organizational impact, and were associated with salient features of the involvement initiatives. Teams described the STEPP as easy to use and useful for monitoring and accountability purposes. The tool seemed most suitable for initiatives in which patients generated novel, concrete recommendations; less so for broad public consultations of which instrumental use was not a primary goal. Originality/value - The STEPP is a promising, first-in-class tool with potential usefulness to both researchers and practitioners. With further research to better establish its reliability and validity, it could make a valuable contribution to full mixed-methods evaluation of patient involvement.
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Affiliation(s)
- Sara A Kreindler
- Community Health Sciences, University of Manitoba, Winnipeg, Canada AND Health Systems Performance Platform, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada
| | - Ashley Struthers
- Evaluation Platform, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada
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Andreassen T, Weiderpass E, Nicula F, Suteu O, Itu A, Bumbu M, Tincu A, Ursin G, Moen K. Controversies about cervical cancer screening: A qualitative study of Roma women's (non)participation in cervical cancer screening in Romania. Soc Sci Med 2017; 183:48-55. [PMID: 28460211 DOI: 10.1016/j.socscimed.2017.04.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/23/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
Romania has Europe's highest incidence and mortality of cervical cancer. While a free national cervical cancer-screening programme has been in operation since 2012, participation in the programme is low, particularly in minority populations. The aim of this study was to explore Roma women's (non)participation in the programme from women's own perspectives and those of healthcare providers and policy makers. We carried out fieldwork for a period of 125 days in 2015/16 involving 144 study participants in Cluj and Bucharest counties. Fieldwork entailed participant observation, qualitative interviewing and focus group discussions. A striking finding was that screening providers and Roma women had highly different takes on the national screening programme. We identified four fundamental questions about which there was considerable disagreement between them: whether a free national screening programme existed in the first place, whether Roma women were meant to be included in the programme if it did, whether Roma women wanted to take part in screening, and to what degree screening participation would really benefit women's health. On the background of insights from actor-network theory, the article discusses to what degree the programme could be said to speak to the interest of its intended Roma public, and considers the controversies in light of the literature on patient centred care and user involvement in health care. The paper contributes to the understanding of the health and health-related circumstances of the largest minority in Europe. It also problematizes the use of the concept of "barriers" in research into participation in cancer screening, and exemplifies how user involvement can potentially help transform and improve screening programmes.
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Affiliation(s)
- Trude Andreassen
- Cancer Registry of Norway, Oslo, Norway; Institute of Health and Society, University of Oslo, Norway.
| | - Elisabete Weiderpass
- Cancer Registry of Norway, Oslo, Norway; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Florian Nicula
- The Oncology Institute "Prof. Dr. Ion Chiricuţă" of Cluj-Napoca, Romania
| | - Ofelia Suteu
- The Oncology Institute "Prof. Dr. Ion Chiricuţă" of Cluj-Napoca, Romania; "Iuliu Haţieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andreea Itu
- The Oncology Institute "Prof. Dr. Ion Chiricuţă" of Cluj-Napoca, Romania
| | - Minodora Bumbu
- The Oncology Institute "Prof. Dr. Ion Chiricuţă" of Cluj-Napoca, Romania
| | - Aida Tincu
- "Iuliu Haţieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway; Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Kåre Moen
- Institute of Health and Society, University of Oslo, Norway
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Høstgaard AMB, Bertelsen P, Nøhr C. Constructive eHealth evaluation: lessons from evaluation of EHR development in 4 Danish hospitals. BMC Med Inform Decis Mak 2017; 17:45. [PMID: 28427407 PMCID: PMC5397829 DOI: 10.1186/s12911-017-0444-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Information and communication sources in the healthcare sector are replaced with new eHealth technologies. This has led to problems arising from the lack of awareness of the importance of end-user involvement in eHealth development and of the difficulties caused by using traditional summative evaluation methods. The Constructive eHealth evaluation method (CeHEM) provides a solution to these problems by offering an evaluation framework for supporting and facilitating end-user involvement during all phases of eHealth development. The aim of this paper is to support this process by sharing experiences of the eHealth evaluation method used in the introduction of electronic health records (EHR) in the North Denmark Region of Denmark. It is the first time the fully developed method and the experiences on using the CeHEM in all five phases of a full lifecycle framework is presented. METHODS A case study evaluation of the EHR development process in the North Denmark Region was conducted from 2004 to 2010. The population consisted of clinicians, IT professionals, administrators, and vendors. The study involved 4 hospitals in the region. Data were collected using questionnaires, observations, interviews, and insight gathered from relevant documents. RESULTS The evaluation showed a need for a) Early involvement of clinicians, b) The best possible representation of clinicians, and c) Workload reduction for those involved. The consequences of not providing this were a lack of ownership of decisions and negative attitudes towards the clinical benefits related to these decisions. Further, the result disclosed that by following the above recommendations, and by providing feedback to the 4 actor groups, the physicians' involvement was improved. As a result they took ownership of decisions and gained a positive attitude to the clinical benefits. CONCLUSIONS The CeHEM has proven successful in formative evaluation of EHR development and can point at important issues that need to be taken care of by management. The method provides a framework that takes care of feedback and learning during eHealth development. It can thus support successful eHealth development in a broader context while building on a well-known success factor: end-user involvement in eHealth development.
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Affiliation(s)
- Anna Marie Balling Høstgaard
- Department of Health Science and Technology, Aalborg University, Niels Jernesvej 14, 9220, Aalborg Øst, Aalborg, Denmark
| | - Pernille Bertelsen
- Department of Planning, Danish Centre for Health Informatics, Aalborg University, Vestre Havnepromenade 5, Aalborg, Denmark
| | - Christian Nøhr
- Department of Planning, Danish Centre for Health Informatics, Aalborg University, Vestre Havnepromenade 5, Aalborg, Denmark
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