Improving the quality of self-management support in ambulatory cancer care: a mixed-method study of organisational and clinician readiness, barriers and enablers for tailoring of implementation strategies to multisites

2021 ◽  
pp. bmjqs-2020-012051
Author(s):  
Doris Howell ◽  
Melanie Powis ◽  
Ryan Kirkby ◽  
Heidi Amernic ◽  
Lesley Moody ◽  
...  
Keyword(s):  
Mixed Method ◽  
Cancer Care ◽  
Implementation Strategies ◽  
Self Management ◽  
Normalisation Process Theory ◽  
Mixed Method Study ◽  
Successful Implementation ◽  
Management Support ◽  
Specific Implementation

IntroductionImproving the quality of self-management support (SMS) for treatment-related toxicities is a priority in cancer care. Successful implementation of SMS programmes depends on tailoring implementation strategies to organisational readiness factors and barriers/enablers, however, a systematic process for this is lacking. In this formative phase of our implementation-effectiveness trial, Self-Management and Activation to Reduce Treatment-Related Toxicities, we evaluated readiness based on constructs in the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT) and developed a process for mapping implementation strategies to local contexts.MethodsIn this convergent mixed-method study, surveys and interviews were used to assess readiness and barriers/enablers for SMS among stakeholders in 3 disease site groups at 3 regional cancer centres (RCCs) in Ontario, Canada. Median survey responses were classified as a barrier, enabler or neutral based on a priori cut-off values. Barriers/enablers at each centre were mapped to CFIR and then inputted into the CFIR-Expert Recommendations for Implementing Change Strategy Matching Tool V.1.0 (CFIR-ERIC) to identify centre-specific implementation strategies. Qualitative data were separately analysed and themes mapped to CFIR constructs to provide a deeper understanding of barriers/enablers.ResultsSMS in most of the RCCs was not systematically delivered, yet most stakeholders (n=78; respondent rate=50%) valued SMS. For centre 1, 7 barriers/12 enablers were identified, 14 barriers/9 enablers for centre 2 and 11 barriers/5 enablers for centre 3. Of the total 46 strategies identified, 30 (65%) were common across centres as core implementation strategies and 5 tailored implementation recommendations were identified for centres 1 and 3, and 4 for centre 2.ConclusionsThe CFIR and CFIR-ERIC were valuable tools for tailoring SMS implementation to readiness and barriers/enablers, whereas NPT helped to clarify the clinical work of implementation. Our approach to tailoring of implementation strategies may have relevance for other studies.

scholarly journals Time to change the paradigm? A mixed method study of the preferred and potential features of an asthma self-management app

2019 ◽  
Vol 26 (2) ◽  
pp. 862-879 ◽  
Author(s):  
Chi Yan Hui ◽  
Robert Walton ◽  
Brian McKinstry ◽  
Hilary Pinnock
Keyword(s):  
Thematic Analysis ◽  
Mixed Method ◽  
Paradigm Shift ◽  
Quantitative Data ◽  
Self Management ◽  
Mixed Method Study ◽  
Management Support ◽  
Support Strategies ◽  
Patient Dependency ◽  
Purposive Sample

We explored the potential of asthma apps to support self-management and identified preferred features that enable users to live with asthma. We recruited patients from five UK practices and social media; observed their usage of our app, administered a questionnaire and interviewed a purposive sample of patients and professionals to explore preferred features. Thematic analysis of interview was synthesised with quantitative data. A total of 111 patients used our app for 3 months. We interviewed 15 patients and 16 professionals. Participants were interested in a broad range of self-management support strategies, including action plans, monitoring with feedback, allergy/weather warnings and tailor-made running coaching. Professionals wanted to integrate patients’ logs with practice records, though were concerned about data overload and risk of patient dependency. We propose a paradigm shift - from apps developed to provide features that are easy to implement technologically, to an approach in which apps are designed to deliver theoretically grounded preferred components.

Comparing the Experiences of Parturient Women With Remifentanil Analgesia and Elective Cesarean Section and Providing Improver Strategies: A Sequential Explanatory Mixed Method Study

2021 ◽  
Author(s):  
rana dousti ◽  
Sevil Hakimi ◽  
Hojjat Pourfathi ◽  
Roghayeh Nourizadeh ◽  
Niloufar sattarzadeh jahdi
Keyword(s):  
Cesarean Section ◽  
Mixed Method ◽  
Elective Cesarean Section ◽  
Mixed Method Study ◽  
Quality Of Data ◽  
Sequential Approach ◽  
Private Hospitals ◽  
Elective Cesarean ◽  
The City

Abstract Background Identifying methods that can effectively and safely improve the childbirth experience and are tailored to mothers' needs are of crucial importance. The current study aimed to compare experiences of parturient women with remifentanil analgesia and elective cesarean section and providing improver strategies for women living in the city of Tabriz, Iran.MethodsThis is a mixed-method study with an explanatory sequential approach. The first stage is quantitative and longitudinal. The study population is all parturient women who will give birth by elective C-section or vaginal painless delivery using remifentanil in private hospitals of the city of Tabriz in 2020-2021. All mothers are free to choose either method. Participants will be selected from all private hospitals using the convenience sampling technique proportioned to the number of eligible women in each hospital. Participants will be followed up to 30 days after delivery to complete the Edinburgh Postpartum Depression questionnaire. The second stage is a qualitative study aimed at exploring the perceptions of parturient women who had either elective C-section or painless delivery (using remifentanil), including factors related to labor experiences. Data will be collected by semi structured interviews with new mothers and important others (if needed).In the third stage, a mixed study will be performed to provide strategies for improving labor experiences. we will use an explanatory Sequential approach in order to increase the accuracy and quality of data and to use the findings to evaluate different methods of delivery.DiscussionBy comparing the experience of parturient women receiving Remifentanil analgesia and elective C-section, evidence-based improving strategies using a culturally sensitive approach can be provided. Presentation of the results obtained from this study using the mixed method may help in better understanding the issue. Also, the obtained results can be used to enhance the quality of midwifery care to be examined by health policymakers and planners.Trial registrationThis study is approved by the ethics committee of the Tabriz University of Medical Sciences (code: IR.TBZMED.REC.1399. 521). Besides, it's evaluated by relevant refers.

scholarly journals Quality of Life in Family Caregivers of Adolescents with Depression in China: A Mixed-Method Study

2020 ◽  
Vol Volume 14 ◽  
pp. 1317-1327
Author(s):  
Yinying Zhang ◽  
Min Yang ◽  
Xin Guo ◽  
Qiongni Chen
Keyword(s):  
Quality Of Life ◽  
Family Caregivers ◽  
Mixed Method ◽  
Mixed Method Study

A Mixed-Method Study to Explore Patients' Perspective of Self-Management Tasks in the Early Phase after Kidney Transplant

2014 ◽  
Vol 24 (1) ◽  
pp. 8-18 ◽  
Author(s):  
Gabriela Schmid-Mohler ◽  
Petra Schäfer-Keller ◽  
Anja Frei ◽  
Thomas Fehr ◽  
Rebecca Spirig
Keyword(s):  
Kidney Transplant ◽  
Mixed Method ◽  
Early Phase ◽  
Self Management ◽  
Mixed Method Study ◽  
Patients Perspective

scholarly journals Proactive Health Support: Exploring Face-to-Face Start-Up Sessions Between Participants and Registered Nurses at the Onset of Telephone-Based Self-Management Support

2020 ◽  
Vol 7 ◽  
pp. 233339362093002
Author(s):  
Susanne Winther ◽  
Mia Fredens ◽  
Marie Brund Hansen ◽  
Kirstine Skov Benthien ◽  
Camilla Palmhøj Nielsen ◽  
...  
Keyword(s):  
Registered Nurses ◽  
Large Scale ◽  
Self Management ◽  
Management Support ◽  
Continuous Contact ◽  
Face To Face ◽  
Start Up ◽  
Health Support ◽  
The Relationship

Proactive Health Support (PaHS) is a large-scale intervention in Denmark carried out by registered nurses (RNs) who provide self-management support to people at risk of hospital admission to enhance their health, coping, and quality of life. PaHS is initiated with a face-to-face session followed by telephone conversations. We aimed to explore the start-up sessions, including if and how the relationship between participants and RNs developed at the onset of PaHS. We used an ethnographic design including observations and informal interviews. Data were analyzed using a phenomenological–hermeneutical approach. The study showed that contexts such as hospitals and RNs legitimized the intervention. Face-to-face communication contributed to credibility, just as the same RN throughout the intervention ensured continuity. We conclude that start-up sessions before telephone-based self-management support enable a trust-based relationship between participants and RNs. Continuous contact with the same RNs throughout the session promoted participation in the intervention.

scholarly journals A Causal Relationship of Home Care Services on the Quality of Life among Survivors of Stroke in Thailand

2021 ◽  
Vol 18 (5) ◽  
Author(s):  
Patoomthip ADUNWATANASIRI ◽  
Siriorn SINDHU ◽  
Napaporn WANITKUN ◽  
Chukiat VIWATWONGKASEM
Keyword(s):  
Quality Of Life ◽  
Home Care ◽  
Functional Status ◽  
Home Care Services ◽  
Self Management ◽  
Stroke Survivors ◽  
Management Support ◽  
Policy Makers ◽  
Care Services

Survivors of stroke suffer impairments associated with a complex need of care from healthcare services after being discharged from hospital and returning home, and these impairments affect the quality of their lives. This cross-sectional study, aimed at evaluating the pathways linking home care services, patient factors, and quality of life (QOL), was carried out by conducting interviews and questionnaires with stroke survivors at their homes. Simple random sampling was used to select the settings for data collection, and multi-stage sampling was used to select the samples. In all, 317 stroke survivors admitted to 13 hospitals in rural and urban setting were selected for participation in the study. The data obtained were analyzed by using Structural Equation Modeling (SEM). The hypothetical model demonstrated a good fit (chi-square = 15.299, df = 9, p = 0.083, GFI = 0.98, CFI = 0.98, RMSEA = 0.047). Statistically significant explanatory variables for the home care service had a direct effect on perceived self-management support, functional status, and QOL (β = 0.39, 0.12 and 0.11, respectively), while number of community supporters had a significant positive indirect effect on QOL through functional status (β = 0.13). The variables accounted for 56 % of the variance in QOL. This finding could be used by policy makers to make important policy development in home care services and help improve health outcomes. In particular, it is also recommended that policy makers push for policies that encompass self-management support and community support groups among stroke survivors in community settings.

Oral language development among Mandarin learners in Chinese homestays

2018 ◽  
Vol 3 (1) ◽  
pp. 32-57
Author(s):  
Wenhao Diao ◽  
Anne Donovan ◽  
Margaret Malone
Keyword(s):  
Mixed Method ◽  
Oral Language ◽  
Learning Experience ◽  
Oral Proficiency ◽  
Mixed Method Study ◽  
Oral Language Development ◽  
American Students ◽  
Host Families

Abstract This mixed-method study describes the oral Mandarin development of 25 American students living in Chinese homestays, and how it may relate to the ways they respond to opportunities for interaction with their host families. While scholars have begun to examine students’ Mandarin development during their sojourns in China, there is little research regarding changes in their holistic oral proficiency and how such changes may be related to the quality of interaction they have with their interlocutors. The results of this study show robust gains in proficiency ratings of their oral performances over the course of one semester. A case study of two purposefully selected student performances – one who demonstrated the most prominent proficiency gains and the other who showed no gains – reveals differences in the ways they respond to opportunities for interaction. These findings provide suggestions on ways to best facilitate students’ learning experience while living with host families.

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