scholarly journals Development and psychometric testing of the AASPIRE Adult Autism Healthcare Provider Self-Efficacy Scale

Autism ◽  
2020 ◽  
pp. 136236132094973
Author(s):  
Christina Nicolaidis ◽  
Gavin Schnider ◽  
Junghee Lee ◽  
Dora M Raymaker ◽  
Steven K Kapp ◽  
...  
Keyword(s):  
Primary Care ◽  
Healthcare Provider ◽  
Self Efficacy ◽  
Healthcare Providers ◽  
Psychometric Testing ◽  
Community Based Participatory Research ◽  
Training Needs ◽  
Medical Issues ◽  
Adult Autism ◽  
Autistic Adults

Our objective was to develop a measure of healthcare providers’ self-efficacy in providing healthcare to autistic adults and to better understand their training needs. We used a community-based participatory research approach with academic researchers, autistic adults, supporters, and healthcare providers. We developed a one-page questionnaire which included the new 6-item self-efficacy scale, two items on how challenging and rewarding it is to provide care to autistic adults, and seven items on provider characteristics. We surveyed 143 healthcare providers from eight primary care clinics in Oregon and California, United States. Preliminary psychometric testing found the Academic Autism Spectrum Partnership in Research and Education (AASPIRE) Adult Autism Healthcare Provider Self-Efficacy Scale to have good internal consistency reliability (Cronbach’s alpha 0.87) and consist of a single factor. A priori hypothesis testing found correlations in the expected directions. Only a minority of providers reported high confidence in communicating with patients (25%); performing physical exams or procedures (43%); accurately diagnosing and treating other medical issues (40%); helping patients stay calm and comfortable during visits (38%); identifying accommodation needs (14%); and making necessary accommodations (16%). While providers need training across all aspects of care related to autism in adulthood, interventions should pay particular attention to helping providers communicate with patients and identify and make accommodations. Lay abstract The adult healthcare system is ill-prepared to provide high-quality care to autistic adults. Lack of provider training may contribute to the problem, but there are few previously tested survey instruments to guide provider training efforts. Our objective was to develop and test a measure of healthcare providers’ confidence (or “self-efficacy”) in providing healthcare to autistic adults and to use it to better understand their training needs. We used a community-based participatory research (CBPR) approach, in partnership with academic researchers, autistic adults, supporters, and healthcare providers, throughout the project. We developed a one-page questionnaire and surveyed 143 primary care providers from eight primary care clinics in Oregon and California, United States. Preliminary testing of the AASPIRE Adult Autism Healthcare Provider Self-Efficacy Scale suggests that the measure is reliable and valid. Using this scale, we found only a minority of providers reported high confidence in communicating with patients (25%); performing physical exams or procedures (43%); accurately diagnosing and treating other medical issues (40%); helping patients stay calm and comfortable during visits (38%); identifying accommodation needs (14%); and making necessary accommodations (16%). While providers need training across all aspects of care related to autism in adulthood, interventions should pay particular attention to helping providers communicate with patients, and identify and make necessary accommodations. Future research is needed to further validate this scale and to understand how to meet providers’ training needs most effectively.

scholarly journals Evaluation of an innovative tele-education intervention in chronic pain management for primary care clinicians practicing in underserved areas

2018 ◽  
Vol 25 (8) ◽  
pp. 484-492 ◽  
Author(s):  
Andrea D Furlan ◽  
Jane Zhao ◽  
Jennifer Voth ◽  
Samah Hassan ◽  
Ruth Dubin ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Nurse Practitioners ◽  
Self Efficacy ◽  
Healthcare Providers ◽  
Physician Assistants ◽  
Chronic Pain Management ◽  
Healthcare Outcomes ◽  
The Impact

Introduction Inadequate knowledge and training of healthcare providers are obstacles to effective chronic pain management. ECHO (extension for community healthcare outcomes) uses case-based learning and videoconferencing to connect specialists with providers in underserved areas. ECHO aims to increase capacity in managing complex cases in areas with poor access to specialists. Methods A pre-post study was conducted to evaluate the impact of ECHO on healthcare providers’ self-efficacy, knowledge and satisfaction. Type of profession, presenting a case, and number of sessions attended were examined as potential factors that may influence the outcomes Results From June 2014 to March 2017, 296 primary care healthcare providers attended ECHO, 264 were eligible for the study, 170 (64%) completed the pre-ECHO questionnaire and 119 completed post-ECHO questionnaires. Participants were physicians (34%), nurse practitioners (21%), pharmacists (13%) and allied health professionals (32%). Participants attended a mean of 15 ± 9.19 sessions. There was a significant increase in self-efficacy ( p < 0.0001) and knowledge ( p < 0.0001). Self-efficacy improvement was significantly higher among physicians, physician assistants and nurse practitioners than the non-prescribers group ( p = 0.03). On average, 96% of participants were satisfied with ECHO. Satisfaction was higher among those who presented cases and attended more sessions. Discussion This study shows that ECHO improved providers’ self-efficacy and knowledge. We evaluated outcomes from a multidisciplinary group of providers practicing in Ontario. This diversity supports the generalisability of our findings. Therefore, we suggest that this project may be used as a template for creating other educational programs on other medical topics.

scholarly journals Barriers to healthcare: Instrument development and comparison between autistic adults and adults with and without other disabilities

Autism ◽  
2016 ◽  
Vol 21 (8) ◽  
pp. 972-984 ◽  
Author(s):  
Dora M Raymaker ◽  
Katherine E McDonald ◽  
Elesia Ashkenazy ◽  
Martha Gerrity ◽  
Amelia M Baggs ◽  
...  
Keyword(s):  
Emotional Regulation ◽  
Short Form ◽  
Healthcare Providers ◽  
Community Based Participatory Research ◽  
Research Approach ◽  
Sensory Sensitivity ◽  
Healthcare Settings ◽  
Long Form ◽  
Barriers To Healthcare ◽  
Autistic Adults

Our objective was to use a community-based participatory research approach to identify and compare barriers to healthcare experienced by autistic adults and adults with and without other disabilities. To do so, we developed a Long- and Short-Form instrument to assess barriers in clinical and research settings. Using the Barriers to Healthcare Checklist–Long Form, we surveyed 437 participants (209 autistic, 55 non-autistic with disabilities, and 173 non-autistic without disabilities). Autistic participants selected different and greater barriers to healthcare, particularly in areas related to emotional regulation, patient-provider communication, sensory sensitivity, and healthcare navigation. Top barriers were fear or anxiety (35% (n = 74)), not being able to process information fast enough to participate in real-time discussions about healthcare (32% (n = 67)), concern about cost (30% (n = 62)), facilities causing sensory issues 30% ((n = 62)), and difficulty communicating with providers (29% (n = 61)). The Long Form instrument exhibited good content and construct validity. The items combined to create the Short Form had predominantly high levels of correlation (range 0.2–0.8, p < 0.001) and showed responsiveness to change. We recommend healthcare providers, clinics, and others working in healthcare settings to be aware of these barriers, and urge more intervention research to explore means for removing them.

scholarly journals Psychometric testing of a set of patient-reported instruments to assess healthcare interventions for autistic adults

Autism ◽  
2020 ◽  
pp. 136236132096717
Author(s):  
Christina Nicolaidis ◽  
Kelly Y Zhen ◽  
Junghee Lee ◽  
Dora M Raymaker ◽  
Steven K Kapp ◽  
...  
Keyword(s):  
Self Efficacy ◽  
Community Based Participatory Research ◽  
Internal Consistency Reliability ◽  
Healthcare Outcomes ◽  
Community Based ◽  
Healthcare Needs ◽  
Unmet Healthcare Needs ◽  
Patient Provider Communication ◽  
Autistic Adults ◽  
Healthcare Interventions

There is a growing recognition of the need for interventions to improve the healthcare of autistic adults. However, there is a dearth of validated measures to evaluate such interventions. Our objectives were to use a community-based participatory research approach to create an accessible set of patient- and proxy-reported instruments to measure healthcare outcomes and potential intervention targets in autistic adults and to assess the instruments’ psychometric characteristics, including content validity, construct validity, and internal consistency reliability. We administered a survey to 244 autistic adults recruited from 12 primary care clinics in Oregon and California, USA (194 participating directly and 50 participating via a proxy reporter). Community partners ensured items were easy to understand and captured the intended construct. The Academic Autism Spectrum Partnership in Research and Education (AASPIRE) Visit Preparedness Scale, Healthcare Accommodations Scale, and Patient–Provider Communication Scale were each found to have a single factor. The AASPIRE Health and Healthcare Self-Efficacy Scale had two factors: Individual Healthcare Self-Efficacy and Relationship-Dependent Healthcare Self-Efficacy. Both patient- and proxy-reported versions of all scales had good to excellent internal consistency reliability, with alphas ranging from 0.81 to 0.96. The scales were associated with the Barriers to Healthcare Checklist and the Unmet Healthcare Needs Checklist in the hypothesized directions. Lay Abstract Interventions to improve healthcare for autistic adults are greatly needed. To evaluate such interventions, researchers often use surveys to collect data from autistic adults (or sometimes, their supporters), but few survey measures have been tested for use with autistic adults. Our objective was to create and test a set of patient- or proxy-reported survey measures for use in studies that evaluate healthcare interventions. We used a community-based participatory research (CBPR) approach, in partnership with autistic adults, healthcare providers, and supporters. We worked together to create or adapt survey measures. Three survey measures focus on things that interventions may try to change directly: (1) how prepared patients are for visits; (2) how confident they feel in managing their health and healthcare; and (3) how well the healthcare system is making the accommodations patients feel they need. The other measures focus on the outcomes that interventions may hope to achieve: (4) improved patient–provider communication; (5) reduced barriers to care; and (6) reduced unmet healthcare needs. We then tested these measures in a survey of 244 autistic adults recruited from 12 primary care clinics in Oregon and California, USA (with 194 participating directly and 50 participating via a proxy reporter). Community partners made sure items were easy to understand and captured what was important about the underlying idea. We found the survey measures worked well in this sample. These measures may help researchers evaluate new healthcare interventions. Future research needs to assess whether interventions improve healthcare outcomes in autistic adults.

scholarly journals Long-term healthcare provider availability following large-scale hurricanes: A difference-in-differences study

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242823
Author(s):  
Sue Anne Bell ◽  
Katarzyna Klasa ◽  
Theodore J. Iwashyna ◽  
Edward C. Norton ◽  
Matthew A. Davis
Keyword(s):  
Primary Care ◽  
Healthcare Provider ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Large Scale ◽  
Healthcare Providers ◽  
County Level ◽  
Difference In Differences ◽  
Medical Specialists

Background Hurricanes Katrina and Sandy were two of the most significant disasters of the 21st century that critically impacted communities and the health of their residents. Despite the assumption that disasters affect access to healthcare, to our knowledge prior studies have not rigorously examined availability of healthcare providers following disasters. Objective The objective of this study was to examine availability of healthcare providers following large-scale hurricanes. Methods Using historical data on healthcare providers from the National Plan and Provider Enumeration System and county-level population characteristics, we conducted a quasi-experimental study to examine the effect of large-scale hurricanes on healthcare provider availability in the short-term and long-term. We separately examined availability of primary care physicians, medical specialists, surgeons, and nurse practitioners. A difference-in-differences analysis was used to control for time variant factors comparing county-level health care provider availability in affected and unaffected counties the year before Hurricanes Katrina and Sandy, to five years after each storm. Results Counties affected by Hurricane Katrina compared to unaffected locales experienced a decrease of 3.59 primary care physicians per 10,000 population (95% CI: -6.5, -0.7), medical specialists (decrease of 5.9 providers per 10,000 (95% CI: -11.3, -0.5)), and surgeons (decrease of 2.1 (95% CI: -3.8, -0.37)). However, availability of nurse practitioners did not change appreciably. Counties affected by Hurricane Sandy exhibited less pronounced changes. Changes in availability of primary care physicians, nurse practitioners, medical specialists, and surgeons were not statistically significant. Conclusion Large-scale hurricanes appear to affect availability of healthcare providers for up to several years following impact of the storm. Effects vary depending on the characteristics of the community. Primary care physicians and medical specialists availability was the most impacted, potentially having long-term implications for population health in the context of disaster recovery.

scholarly journals Deprescribing conversations: a closer look at prescriber–patient communication

2018 ◽  
Vol 9 (12) ◽  
pp. 687-698 ◽  
Author(s):  
Justin P. Turner ◽  
Claude Richard ◽  
Marie-Thérèse Lussier ◽  
Marie-Eve Lavoie ◽  
Barbara Farrell ◽  
...  
Keyword(s):  
Primary Care ◽  
Content Analysis ◽  
Proton Pump Inhibitor ◽  
Healthcare Provider ◽  
Descriptive Analysis ◽  
Healthcare Providers ◽  
Provider Communication ◽  
Care Practices ◽  
Primary Care Practices

Background: Little is known about the initiation, style and content of patient and healthcare provider communication around deprescribing. We report the findings from a content analysis of audio-recorded discussions of proton pump inhibitor (PPI) and benzodiazepine deprescribing in primary care. Methods: Participants were healthcare providers ( n = 13) from primary care practices ( n = 3) and patients aged ⩾65 ( n = 24) who were chronic users of PPIs or benzodiazepines. The EMPOWER educational brochures were distributed prior to ( n = 15) or after ( n = 9) the patient’s usual healthcare provider appointment. Conversations were audio-recorded and coded using MEDICODE to analyze who initiated different themes, whether they followed a monologue or dialogue style, and to what extent the thematic content addressed issues pertaining to: ‘dosage/instructions,’ ‘medication action and efficacy,’ ‘risk/adverse effects,’ ‘attitudes/emotions,’ ‘adherence’ and ‘follow up.’ Descriptive analysis of the conversations was performed with comparison between patients who received the EMPOWER brochure before or after their appointments. Results: Patients were mostly women (67%) with a mean age of 74 ± 6 years. For PPI users, prior education resulted in a greater proportion of themes initiated by patients (44% versus 17%) and maintaining dialogue-style conversations (48% versus 28%). Among benzodiazepine users, conversation initiation (52% versus 47%) and conversation style was similar between both groups. The content of deprescribing conversations for PPIs revealed that patients and their healthcare providers focused less on ‘dosage/instructions,’ and more on the ‘medication action and efficacy’ and the necessity for ‘follow up.’ Conversations about stopping benzodiazepines were more likely to stagnate on the ‘if’ rather than the ‘how.’ Conclusion: The initiation, style and content of the conversations varied between PPI and benzodiazepine users, suggesting that healthcare providers will need to tailor deprescribing conversations accordingly.

Information delivery in prenatal genetic counseling

2010 ◽  
Vol 20 (2) ◽  
pp. 243-259 ◽  
Author(s):  
Olga Zayts ◽  
M. Agnes Kang
Keyword(s):  
Hong Kong ◽  
Healthcare Provider ◽  
Healthcare Providers ◽  
Information Delivery ◽  
Video Data ◽  
Prenatal Genetic Counseling ◽  
Joint Activity ◽  
Medical Issues ◽  
New Information ◽  
Patient’S Experience

This paper examines the interactional accomplishment of information delivery in the context of prenatal genetic counselling (PGC) in Hong Kong. We argue that information delivery is structured as a joint activity between the healthcare provider and the patient, and the structure of the talk takes into account the patient’s experience and knowledge of medical issues. The healthcare provider ‘taps into’ the patient’s knowledge and experience by using what we call ‘initial inquiries’ as a means of introducing potentially new information. We define initial inquiries as a type of question-response sequence that initiates the speaker’s future action of information delivery. In this way, the information delivery is constructed as a joint activity and healthcare providers can also ‘tailor’ the information according to each individual patient. This study is part of a larger on-going interactional study of PGC based on video data recorded in a Prenatal Diagnostics and Counselling Department of one Hong Kong hospital between 2005 and 2008 and comprises more than 17 hours of recordings. We use a conversation analytic approach to examine the interactional organization of talk used in the accomplishment of information delivery.

scholarly journals Patientens delaktighet i val av vårdgivare. En litteratur review

2018 ◽  
Vol 14 (1) ◽  
Author(s):  
Madeleine Nilsson ◽  
Lillemor Lindwall ◽  
Jan Nilsson ◽  
Ingrid From
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Literature Review ◽  
Patient Care ◽  
Healthcare Provider ◽  
Healthcare Providers ◽  
Health Problems ◽  
Caring Relationships

The idea behind care choice is that healthcare providers would be more responsive to patients’ health problems and needs and in doing so compete with increased quality and that patients should be able to choose from this. The question is how patients choose a healthcare provider by themselves. The aim was to describe what affected when patients chose healthcare providers. A literature review was carried out. The results showed that patients’ choice of healthcare providers depended on the following three themes: their own care experiences, caring relationships with staff and service provided by caregivers. The underlying idea of care choice is competition based on quality of care, but the results show that patients make their choices based on other factors as described in the result and therefore improvement can be achieved if focus is placed on being responsive for patient care needs.patient participation; primary care; caring needs; qualtiy of care; care choice; caring sciencepasientdeltakelse; primæromsorg; omsorgsbehov; kvalitet på omsorg; omsorg valg; omsorgsfull vitenskap 

scholarly journals Citizen advisory groups for the creation and improvement of decision aids: experience from two Swiss centers for primary care

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kevin Selby ◽  
Regula Cardinaux ◽  
Beatrice Metry ◽  
Simone de Rougemont ◽  
Janine Chabloz ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Aids ◽  
Community Based Participatory Research ◽  
Lung Cancer Screening ◽  
Target Population ◽  
Advisory Groups ◽  
Patient Decision ◽  
The Creation ◽  
Meeting Transcripts ◽  
The University

Abstract Background Guidelines for patient decision aids (DA) recommend target population involvement throughout the development process, but developers may struggle because of limited resources. We sought to develop a feasible means of getting repeated feedback from users. Methods Between 2017 and 2020, two Swiss centers for primary care (Lausanne and Bern) created citizen advisory groups to contribute to multiple improvement cycles for colorectal, prostate and lung cancer screening DAs. Following Community Based Participatory Research principles, we collaborated with local organizations to recruit citizens aged 50 to 75 without previous cancer diagnoses. We remunerated incidental costs and participant time. One center supplemented in-person meetings by mailed paper questionnaires, while the other supplemented meetings using small-group workshops and analyses of meeting transcripts. Results In Lausanne, we received input from 49 participants for three DAs between 2017 and 2020. For each topic, participants gave feedback on the initial draft and 2 subsequent versions during in-person meetings with ~ 8 participants and one round of mailed questionnaires. In Bern, 10 participants were recruited among standardized patients from the university, all of whom attended in-person meetings every three months between 2017 and 2020. At both sites, numerous changes were made to the content, appearance, language, and tone of DAs and outreach materials. Participants reported high levels of satisfaction with the participative process. Conclusions Citizen advisory groups are a feasible means of repeatedly incorporating end-user feedback during the creation of multiple DAs. Methodological differences between the two centers underline the need for a flexible model adapted to local needs.

scholarly journals Family Physician’s and Primary Care Team’s Perspectives on Supporting Family Caregivers in Primary Care Networks

2021 ◽  
Vol 18 (6) ◽  
pp. 3293
Author(s):  
Jasneet Parmar ◽  
Sharon Anderson ◽  
Marjan Abbasi ◽  
Saeed Ahmadinejad ◽  
Karenn Chan ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Caregivers ◽  
Healthcare Providers ◽  
Family Physicians ◽  
Care Team ◽  
Primary Care Team ◽  
Caregiver Support ◽  
Team Members ◽  
Primary Care Teams ◽  
Support Family

Background. Research, practice, and policy have focused on educating family caregivers to sustain care but failed to equip healthcare providers to effectively support family caregivers. Family physicians are well-positioned to care for family caregivers. Methods. We adopted an interpretive description design to explore family physicians and primary care team members’ perceptions of their current and recommended practices for supporting family caregivers. We conducted focus groups with family physicians and their primary care team members. Results. Ten physicians and 42 team members participated. We identified three major themes. “Family physicians and primary care teams can be a valuable source of support for family caregivers” highlighted these primary care team members’ broad recognition of the need to support family caregiver’s health. “What stands in the way” spoke to the barriers in current practices that precluded supporting family caregivers. Primary care teams recommended, “A structured approach may be a way forward.” Conclusion. A plethora of research and policy documents recommend proactive, consistent support for family caregivers, yet comprehensive caregiver support policy remains elusive. The continuity of care makes primary care an ideal setting to support family caregivers. Now policy-makers must develop consistent protocols to assess, and care for family caregivers in primary care.

scholarly journals What is stopping us? An implementation science study of kangaroo care in British Columbia’s neonatal intensive care units

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Coutts ◽  
Alix Woldring ◽  
Ann Pederson ◽  
Julie De Salaberry ◽  
Horacio Osiovich ◽  
...  
Keyword(s):  
Intensive Care ◽  
Healthcare Provider ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Healthcare Providers ◽  
Neurodevelopmental Outcomes ◽  
Kangaroo Care ◽  
Optimal Care ◽  
Barriers And Enablers ◽  
Provider Beliefs

Abstract Background The goal of the Neonatal Intensive Care Unit (NICU) is to provide optimal care for preterm and sick infants while supporting their growth and development. The NICU environment can be stressful for preterm infants and often cannot adequately support their neurodevelopmental needs. Kangaroo Care (KC) is an evidence-based developmental care strategy that has been shown to be associated with improved short and long term neurodevelopmental outcomes for preterm infants. Despite evidence for best practice, uptake of the practice of KC in resource supported settings remains low. The aim of this study was to identify and describe healthcare providers’ perspectives on the barriers and enablers of implementing KC. Methods This qualitative study was set in 11 NICUs in British Columbia, Canada, ranging in size from 6 to 70 beds, with mixed levels of care from the less acute up to the most complex acute neonatal care. A total of 35 semi-structured healthcare provider interviews were conducted to understand their experiences providing KC in the NICU. Data were coded and emerging themes were identified. The Consolidated Framework for Implementation Research (CFIR) guided our research methods. Results Four overarching themes were identified as barriers and enablers to KC by healthcare providers in their particular setting: 1) the NICU physical environment; 2) healthcare provider beliefs about KC; 3) clinical practice variation; and 4) parent presence. Depending on the specific features of a given site these factors functioned as an enabler or barrier to practicing KC. Conclusions A ‘one size fits all’ approach cannot be identified to guide Kangaroo Care implementation as it is a complex intervention and each NICU presents unique barriers and enablers to its uptake. Support for improving parental presence, shifting healthcare provider beliefs, identifying creative solutions to NICU design and space constraints, and the development of a provincial guideline for KC in NICUs may together provide the impetus to change practice and reduce barriers to KC for healthcare providers, families, and administrators at local and system levels.

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