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Beyond the Queue: Exploring Waiting Practices in the Stories of Patients With Breast Cancer 超越排队:从乳腺癌患者的故事中探索等待的做法。
IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-17 DOI: 10.1111/hex.70086
Nada Akrouh, Rik Wehrens, Erna Scholtes, Hester van de Bovenkamp

Background

Waiting is an important topic in healthcare debates, mostly discussed in the form of waiting lists and waiting times. In this discourse, the experiential element of waiting stays hidden. Understanding the waiting experiences of patients can help to better understand healthcare waiting practices, which have a large impact on patients.

Methods

We performed a thematic analysis on 12 patients' books of women with breast cancer. We focused on the theme of waiting within these stories, through an abductive analysis.

Results

We identified three themes within the waiting practices of patients with breast cancer: (1) Thickening of time, (2) contaminated time and (3) navigating time. The theme thickening of time highlights waiting moments where time is experienced as moving at a very slow pace with intense emotional impact. The theme of contaminated time highlights the waiting processes as an ongoing component of experiencing illness. The theme of navigating time highlights patients' temporal agency, showing their waiting work in the form of strategies for dealing with practical and emotional aspects of waiting.

Discussion

The waiting experiences of patients provide insights into the burden of waiting, which is partly connected to the way healthcare services are organised and the experience of illness. Understanding these multifaceted experiences of patients helps pinpoint areas for healthcare quality improvement.

Patient or Public Contribution

The choice for the theme and approach of this research, waiting, was developed with a citizen science initiative of collecting patient stories.

背景:等待是医疗保健辩论中的一个重要话题,主要以候诊名单和等待时间的形式进行讨论。在这种讨论中,等待的体验因素被隐藏起来。了解患者的等待经历有助于更好地理解对患者有重大影响的医疗等待做法:我们对 12 本关于乳腺癌女性患者的书籍进行了主题分析。通过归纳分析,我们重点研究了这些故事中的等待主题:结果:我们在乳腺癌患者的等待实践中发现了三个主题:(1) 加厚时间;(2) 污染时间;(3) 驾驭时间。时间加厚 "这一主题强调了在等待过程中,时间以非常缓慢的速度流逝,对患者的情绪产生了强烈的影响。被污染的时间这一主题强调了等待过程是经历疾病的一个持续组成部分。驾驭时间这一主题突出了患者的时间能动性,显示了他们在等待过程中的工作,他们采取了各种策略来处理等待过程中的实际问题和情绪问题:讨论:病人的等待经历让我们了解到等待的负担,这部分与医疗服务的组织方式和疾病体验有关。了解病人这些多方面的经历有助于确定医疗质量改进的领域:本研究的主题和方法 "等待 "是通过收集病人故事的公民科学活动确定的。
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引用次数: 0
Shared Decision-Making and Body Mass Index in Australian Antenatal Care: An Exploratory OPTION12 Evaluation 澳大利亚产前护理中的共同决策和体重指数:探索性 OPTION12 评估。
IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-17 DOI: 10.1111/hex.70107
Madeline Hawke, Linda Sweet, Julie Considine

Background

Shared decision-making is recommended as a person-centred approach to decision-making in antenatal care. Little is known about the implementation of shared decision-making in antenatal care.

Objective

An exploratory study to understand how shared decision-making is implemented in antenatal clinics and whether body mass index influences maternity clinicians’ use of shared decision-making when providing antenatal care for women.

Methods

Twenty-six antenatal clinic consultations were audio-recorded with maternity clinicians and women with body mass index ≥ 35 kg/m2, and a comparison group of women with body mass index 18.5–24.9 kg/m2. Data were analysed quantitatively using the OPTION12 scale. Narrative case studies are presented to compare shared decision-making behaviour related to induction of labour.

Results

Twelve clinicians and 26 pregnant women were recruited to the study. The total scores ranged from 0 to 24, with a mean score of 9 and a median of 9.5 indicating low implementation of shared decision-making by clinicians and limited involvement of women in decision-making. No difference was observed in OPTION12 scores in decision-making for women by body mass index.

Conclusion

This study suggests that shared decision-making is limited in the antenatal clinic setting for all women, regardless of body mass index. Further research is required to confirm the findings of this exploratory study.

Patient or Public Contribution

The perspectives of women with body mass index ≥ 35 kg/m2 informed many aspects of this study including the language/terminology adopted by researchers. A consumer group reviewed the language used in the study materials, to ensure readability and avoidance of stigmatising terminology.

背景:共同决策是产前护理中一种以人为本的决策方法。但人们对产前护理中共同决策的实施情况知之甚少:一项探索性研究旨在了解产前门诊如何实施共同决策,以及体重指数是否会影响产科临床医生在为产妇提供产前护理时使用共同决策:对产科临床医生和体重指数≥35 kg/m2的产妇以及体重指数为18.5-24.9 kg/m2的产妇进行了26次产前咨询录音。采用 OPTION12 量表对数据进行定量分析。通过叙述性案例研究来比较与引产相关的共同决策行为:研究共招募了 12 名临床医生和 26 名孕妇。总分从 0 分到 24 分不等,平均分为 9 分,中位数为 9.5 分,表明临床医生很少实施共同决策,妇女参与决策的程度有限。根据体重指数的不同,妇女在决策过程中的 OPTION12 得分也没有差异:本研究表明,在产前诊所环境中,无论身体质量指数如何,所有妇女的共同决策都很有限。需要进一步研究来证实这项探索性研究的结果:患者或公众的贡献:体重指数≥ 35 kg/m2 的妇女的观点为本研究提供了许多信息,包括研究人员采用的语言/术语。一个消费者团体对研究材料中使用的语言进行了审查,以确保可读性并避免使用污名化术语。
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引用次数: 0
Consumer Involvement in the Design and Development of Medication Safety Interventions or Services in Primary Care: A Scoping Review 消费者参与基层医疗机构用药安全干预或服务的设计与开发:范围综述》。
IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-17 DOI: 10.1111/hex.70092
Megan DelDot, Esther Lau, Nicole Rayner, Jean Spinks, Fiona Kelly, Lisa Nissen
<div> <section> <h3> Introduction</h3> <p>Medication-related problems remain a significant burden despite the availability of various interventions and services in primary care. Involving health care consumers to design interventions or services across health disciplines is becoming more widely used as this type of engagement reportedly leads to more accessible, acceptable and sustainable health services and quality of life. We conducted a scoping review to examine when and how consumers have been involved in the design and development of medication safety interventions or services within the primary care.</p> </section> <section> <h3> Methods</h3> <p>We searched five key databases (MEDLINE (EBSCOhost), CINAHL (EBSCOhost), PsycINFO (EBSCOhost), Embase (Elsevier) and Cochrane Library (Wiley)) for relevant articles published up to February 2024. Studies were included if they involved adult consumers (≥ 18 years), their families, carers or the wider community as stakeholders. This review only included studies where the aim was to improve safe and effective medication use, delivered exclusively in primary care. To examine consumer involvement approaches and methods we adapted a framework describing the stages of consumer involvement for the data extraction tool.</p> </section> <section> <h3> Results</h3> <p>Overall, 15 studies were included (comprising 24 articles). Codesign, experience-based codesign, coproduction and participatory action research were commonly used approaches. Meetings, interviews, surveys/questionnaires were commonly used methods. Two studies reported consumer involvement across all stages of the research study, and only one study described the consumer experience of being involved in the research process. The impact of consumer involvement on the effectiveness of these services or interventions was mixed.</p> </section> <section> <h3> Conclusion</h3> <p>The potential benefits of consumer involvement in the design and development of medication safety interventions or services may not have been fully maximised, given that genuine consumer involvement across all stages of the research study appears uncommon. More transparent and consistent reporting around the description of consumers involved, their experience of being involved and overall impact and quality of consumer participation is needed.</p> </section> <section> <h3> Patient or Public Contribution</h3> <p>This scoping review was undertaken without consumers, patients, service
导言:尽管在初级保健中提供了各种干预措施和服务,但与用药相关的问题仍然是一个沉重的负担。据报道,让医疗保健消费者参与设计跨医疗学科的干预措施或服务正得到越来越广泛的应用,因为这种参与方式能带来更方便、更可接受、更可持续的医疗服务和生活质量。我们进行了一项范围综述,研究消费者何时以及如何参与初级医疗保健中用药安全干预措施或服务的设计和开发:我们检索了五个主要数据库(MEDLINE (EBSCOhost)、CINAHL (EBSCOhost)、PsycINFO (EBSCOhost)、Embase (Elsevier) 和 Cochrane Library (Wiley))中截至 2024 年 2 月发表的相关文章。如果研究涉及成年消费者(≥ 18 岁)、其家人、照顾者或更广泛的社区利益相关者,则将其纳入研究范围。本综述仅纳入旨在改善安全有效用药的研究,且仅在基层医疗机构开展。为了考察消费者参与的方式和方法,我们在数据提取工具中采用了一个描述消费者参与阶段的框架:共纳入 15 项研究(包括 24 篇文章)。共同设计、基于经验的共同设计、共同生产和参与式行动研究是常用的方法。会议、访谈、调查/问卷是常用的方法。有两项研究报告了消费者参与研究的所有阶段,只有一项研究描述了消费者参与研究过程的体验。消费者参与对这些服务或干预措施效果的影响好坏参半:消费者参与用药安全干预措施或服务的设计与开发的潜在益处可能没有得到充分发挥,因为消费者真正参与研究的所有阶段似乎并不常见。有必要对消费者参与的描述、参与体验以及消费者参与的整体影响和质量进行更加透明和一致的报告:患者或公众的贡献:由于资源所限,本范围界定研究在没有消费者、患者、服务使用 者、护理人员或有生活经验者或公众成员参与的情况下进行。本范围界定综述由学者进行并撰写,他们与消费者和利益相关者一起进行了代码设计,并拥有药物相关问题的亲身经历。
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引用次数: 0
Co-Creation in Research: Further Reflections From the ‘Co-Creating Safe Spaces’ Project 研究中的共同创造:共同创造安全空间 "项目的进一步思考。
IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-15 DOI: 10.1111/hex.70103
Scott J. Fitzpatrick, Heather Lamb, Erin Oldman, Melanie Giugni, Cassandra Chakouch, Alyssa R. Morse, Amelia Gulliver, Erin Stewart, Stride Safe Space and Safe Haven Team, Helen T. Oni, Benn Miller, Bronwen Edwards, Kelly Stewart, Vida Bliokas, Louise A. Ellis, Fiona Shand, Alison L. Calear, Michelle Banfield

Background

Applied research using co-creation methods is rarely described or evaluated in detail. Practical evidence of co-creation processes and collaboration effectiveness is needed to better understand its complex and dynamic nature.

Methods

Using a case study design and survey method, we assessed processes of co-implementation and co-evaluation grounded in our own experiences from the Co-Creating Safe Spaces project. We examine these in the context of a published systematic framework designed to improve clarity about co-creation processes and report on how co-creation was experienced by collaborative partners.

Results

Our study showed the interconnectedness between co-implementation and co-evaluation processes and the importance of aligning research with program processes to ensure it is responsive to emergent local needs and problems. Given relatively low levels of researcher embeddedness across sites, service champions played a pivotal role in data collection. Survey findings indicated strong support for a healthy collaboration with some concerns expressed over individual partner's areas of responsibility and ability to deliver on commitments.

Conclusion

Co-creation can be a very robust approach to translational research but is a complex endeavour. Ongoing reflexivity and attention to relational aspects support genuine collaboration and provide a foundation for addressing challenges.

Patient or Public Contribution

People with lived experience of emotional distress and/or suicidal crisis, including researchers from both academic and non-research backgrounds, service managers, peer workers, carers and advocates, were involved in this research and authored this paper.

背景:使用共同创造方法进行的应用研究很少得到详细描述或评估。为了更好地了解其复杂性和动态性,我们需要有关共同创造过程和合作效果的实际证据:方法:我们采用案例研究设计和调查方法,根据共创安全空间项目中的自身经验,对共同实施和共同评估过程进行了评估。我们在已发布的系统框架内对这些过程进行了研究,该框架旨在提高共同创造过程的清晰度,并报告合作伙伴是如何体验共同创造的:我们的研究表明了共同实施和共同评估过程之间的相互关联性,以及将研究与计划过程相结合以确保研究能够满足当地新出现的需求和问题的重要性。由于研究人员在各项目点的嵌入程度相对较低,服务倡导者在数据收集中发挥了关键作用。调查结果显示,各方大力支持健康的合作,但也有一些人对合作伙伴的责任范围和履行承诺的能力表示担忧:结论:共同创造是一种非常有效的转化研究方法,但也是一项复杂的工作。持续的反思和对关系方面的关注有助于真正的合作,并为应对挑战奠定了基础:有情绪困扰和/或自杀危机亲身经历的人,包括来自学术和非研究背景的研究人员、服务管理人员、同伴工作者、照护者和倡导者,都参与了这项研究并撰写了本文。
{"title":"Co-Creation in Research: Further Reflections From the ‘Co-Creating Safe Spaces’ Project","authors":"Scott J. Fitzpatrick,&nbsp;Heather Lamb,&nbsp;Erin Oldman,&nbsp;Melanie Giugni,&nbsp;Cassandra Chakouch,&nbsp;Alyssa R. Morse,&nbsp;Amelia Gulliver,&nbsp;Erin Stewart,&nbsp;Stride Safe Space and Safe Haven Team,&nbsp;Helen T. Oni,&nbsp;Benn Miller,&nbsp;Bronwen Edwards,&nbsp;Kelly Stewart,&nbsp;Vida Bliokas,&nbsp;Louise A. Ellis,&nbsp;Fiona Shand,&nbsp;Alison L. Calear,&nbsp;Michelle Banfield","doi":"10.1111/hex.70103","DOIUrl":"10.1111/hex.70103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Applied research using co-creation methods is rarely described or evaluated in detail. Practical evidence of co-creation processes and collaboration effectiveness is needed to better understand its complex and dynamic nature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a case study design and survey method, we assessed processes of co-implementation and co-evaluation grounded in our own experiences from the Co-Creating Safe Spaces project. We examine these in the context of a published systematic framework designed to improve clarity about co-creation processes and report on how co-creation was experienced by collaborative partners.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our study showed the interconnectedness between co-implementation and co-evaluation processes and the importance of aligning research with program processes to ensure it is responsive to emergent local needs and problems. Given relatively low levels of researcher embeddedness across sites, service champions played a pivotal role in data collection. Survey findings indicated strong support for a healthy collaboration with some concerns expressed over individual partner's areas of responsibility and ability to deliver on commitments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Co-creation can be a very robust approach to translational research but is a complex endeavour. Ongoing reflexivity and attention to relational aspects support genuine collaboration and provide a foundation for addressing challenges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient or Public Contribution</h3>\u0000 \u0000 <p>People with lived experience of emotional distress and/or suicidal crisis, including researchers from both academic and non-research backgrounds, service managers, peer workers, carers and advocates, were involved in this research and authored this paper.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"27 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hex.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Co-Design of a Facilitated Self-Management Toolkit for People With Parkinson's Disease 共同设计帕金森病患者自我管理工具包。
IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-15 DOI: 10.1111/hex.70104
Nathan Davies, Megan Armstrong, Jennifer S. Pigott, Danielle Nimmons, Joy Read, Benjamin Gardner, Bev Maydon, Anette Schrag, Kate Walters
<div> <section> <h3> Background</h3> <p>Parkinson's disease is a complex progressive neurodegenerative disease increasing globally. Self-management interventions have shown promise in improving the quality of life for people with chronic conditions. This paper aims to describe the development processes and the core components of a facilitated self-management toolkit to support people with Parkinson's disease to self-manage their condition.</p> </section> <section> <h3> Methods</h3> <p>An iterative co-design approach was adopted and included the use of systematic reviews, qualitative methods and theory to develop the Live Well with Parkinson's toolkit. A co-design group was established consisting of people with Parkinson's, family carers and health and social care experts to produce and refine an online self-management toolkit to be tested in practice. Five co-design groups were conducted alongside several phases of toolkit development.</p> </section> <section> <h3> Results</h3> <p>An online self-management toolkit, called Live Well with Parkinson's, was developed with core aspects such as tailored information to the individual, a well-being section using an asset-based approach and problem-solving skills to create and maintain goals, symptom review and management sections and a tracker of medication, symptoms and activities/actions. A paper-based alternative version was also created for those who cannot use an online resource. The toolkit is fully manualised and facilitated by six sessions from a ‘supporter’ who is trained in behaviour change techniques. It can be shared with carers and healthcare professionals.</p> </section> <section> <h3> Conclusion</h3> <p>The toolkit is a robust and comprehensive approach to self-management of Parkinson's disease. It is evidenced based, incorporates theory and was developed with people with Parkinson's and experts in the area. The Live Well with Parkinson's toolkit has the potential to be embedded within routine healthcare, aligning with self-management policies.</p> </section> <section> <h3> Patient or Public Contribution</h3> <p>Author B.M. is our patient and public involvement (PPI) representative and author on this paper. B.M. supports a team of 15 PPI members who have contributed to the development of the toolkit. This involvement has included attending research team and steering group meetings, attending and facilitating co-designed workshops, reviewing all the toolkit information before approval and sup
背景:帕金森病是一种复杂的进行性神经退行性疾病,发病率在全球不断上升。自我管理干预措施在改善慢性病患者的生活质量方面大有可为。本文旨在描述一个促进自我管理工具包的开发过程和核心组成部分,以支持帕金森病患者自我管理病情:方法:采用迭代式共同设计方法,包括使用系统回顾、定性方法和理论来开发 "帕金森病患者健康生活 "工具包。我们成立了一个由帕金森病患者、家庭护理者以及医疗和社会护理专家组成的共同设计小组,以制作和完善在线自我管理工具包,并在实践中进行测试。在工具包开发的几个阶段,共成立了五个共同设计小组:结果:开发出了一款名为 "帕金森病患者健康生活 "的在线自我管理工具包,其核心内容包括:为个人量身定制的信息;使用基于资产的方法和解决问题的技能来创建和保持目标的健康部分;症状回顾和管理部分;以及药物、症状和活动/行动跟踪器。此外,还为那些无法使用在线资源的人制作了纸质替代版本。该工具包已完全手册化,并由一名接受过行为改变技术培训的 "支持者 "提供六节课的帮助。该工具包可与护理人员和医疗保健专业人员共享:结论:该工具包是帕金森病自我管理的一个强大而全面的方法。它以证据为基础,结合了理论,是与帕金森病患者和该领域的专家共同开发的。帕金森病患者健康生活工具包有可能被纳入常规医疗保健中,并与自我管理政策保持一致:作者B.M.是我们的患者和公众参与(PPI)代表,也是本文的作者。B.M.支持一个由15名PPI成员组成的团队,他们为工具包的开发做出了贡献。这些参与包括参加研究团队和指导小组会议、参加并主持共同设计的研讨会、在批准前审核所有工具包信息并支持用户测试。
{"title":"Co-Design of a Facilitated Self-Management Toolkit for People With Parkinson's Disease","authors":"Nathan Davies,&nbsp;Megan Armstrong,&nbsp;Jennifer S. Pigott,&nbsp;Danielle Nimmons,&nbsp;Joy Read,&nbsp;Benjamin Gardner,&nbsp;Bev Maydon,&nbsp;Anette Schrag,&nbsp;Kate Walters","doi":"10.1111/hex.70104","DOIUrl":"10.1111/hex.70104","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Parkinson's disease is a complex progressive neurodegenerative disease increasing globally. Self-management interventions have shown promise in improving the quality of life for people with chronic conditions. This paper aims to describe the development processes and the core components of a facilitated self-management toolkit to support people with Parkinson's disease to self-manage their condition.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;An iterative co-design approach was adopted and included the use of systematic reviews, qualitative methods and theory to develop the Live Well with Parkinson's toolkit. A co-design group was established consisting of people with Parkinson's, family carers and health and social care experts to produce and refine an online self-management toolkit to be tested in practice. Five co-design groups were conducted alongside several phases of toolkit development.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;An online self-management toolkit, called Live Well with Parkinson's, was developed with core aspects such as tailored information to the individual, a well-being section using an asset-based approach and problem-solving skills to create and maintain goals, symptom review and management sections and a tracker of medication, symptoms and activities/actions. A paper-based alternative version was also created for those who cannot use an online resource. The toolkit is fully manualised and facilitated by six sessions from a ‘supporter’ who is trained in behaviour change techniques. It can be shared with carers and healthcare professionals.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The toolkit is a robust and comprehensive approach to self-management of Parkinson's disease. It is evidenced based, incorporates theory and was developed with people with Parkinson's and experts in the area. The Live Well with Parkinson's toolkit has the potential to be embedded within routine healthcare, aligning with self-management policies.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Patient or Public Contribution&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Author B.M. is our patient and public involvement (PPI) representative and author on this paper. B.M. supports a team of 15 PPI members who have contributed to the development of the toolkit. This involvement has included attending research team and steering group meetings, attending and facilitating co-designed workshops, reviewing all the toolkit information before approval and sup","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"27 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hex.70104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
‘For Youth by Youth’: Distributive Leadership in Action With a Youth Codesign Team 青年的青年":与青年代码设计团队一起在行动中发挥分配式领导作用。
IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-15 DOI: 10.1111/hex.70080
Carolyn M. Melro, Caleb Brook, Reid A. Martin, Renn A. Roberts, Sophia Young, Savannah J. R. Zalik, Clifford T. Ballantyne, Amanda Neuman, Pamela Reimer

Background

Integrated youth services are an emerging delivery model in Canada that addresses siloed and fragmented youth mental health and other services. Youth engagement is viable for developing integrated youth services when purposefully built. However, it is not always clear how youth are involved in service transformation as decision-makers, and it requires an exploration of how to work with youth authentically and intentionally in the codesign process.

Methods

This study reflects on the development of HOMEBASE, a network of integrated youth service delivery in Saskatchewan, Canada, and documents the process of actively and authentically engaging with youth through distributive leadership in the codesign process.

Findings

Youth are actively and eagerly willing to participate in the codesign process of developing integrated services when there is a shared responsibility, and they are authentically involved and informed within the decision-making process. This requires time to form trust, build relationships and provide youth with low-pressure environments to foster healthy debates.

Conclusion

By utilizing a distributive leadership approach, the Youth Codesign Team has been engaged in various levels of decision-making. By following these guiding principles, policymakers, youth development workers and researchers can engage youth in meaningful ways to improve the design and development of integrated care.

Patient or Public Contribution

Five youths from the HOMEBASE Provincial Youth Co-Design Team collaborated in writing this article based on their experiences of being engaged at varying levels of decision-making in a distributive leadership approach to building integrated youth services.

背景:在加拿大,青少年综合服务是一种新兴的服务模式,可以解决青少年心理健康和其他服务各自为政的问题。在有目的的情况下,青少年参与对于发展青少年综合服务是可行的。然而,青少年作为决策者如何参与服务转型并不总是很清楚,这就需要探索如何在代码设计过程中真实、有意地与青少年合作:本研究反映了加拿大萨斯喀彻温省青年综合服务网络 HOMEBASE 的发展情况,并记录了通过分配式领导在代码设计过程中积极、真实地与青年合作的过程:研究结果:如果有共同的责任,而且青年能够真实地参与决策过程并了解相关信息,那么青年就会积极、热切地愿意参与制定综合服务的代码设计过程。这需要时间来形成信任、建立关系,并为青年提供低压环境,以促进健康的辩论:通过采用分配式领导方法,青年规划设计小组参与了各级决策。通过遵循这些指导原则,政策制定者、青年发展工作者和研究人员可以让青年以有意义的方式参与进来,以改善综合护理的设计和发展:来自 "HOMEBASE "省级青年共同设计小组的五位青年根据他们参与不同层面决策的经验合作撰写了这篇文章。
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引用次数: 0
The Symphony of Consumer Partnering and Clinical Governance: An Organizational Review Using the RE-AIM Framework 消费者合作与临床治理的交响乐:使用 RE-AIM 框架进行组织审查。
IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-13 DOI: 10.1111/hex.70095
Jodie Nixon, Emily Steel, Warren Stubbs, Amber Williamson, Javed Khan, Phillip Carswell, Anne Coccetti
<div> <section> <h3> Introduction</h3> <p>Partnering with Consumers in healthcare systems is now widely accepted and mandated in many countries. Despite this acceptance, there is minimal information regarding the best practice of how to successfully establish systems to embed this practice into healthcare systems.</p> </section> <section> <h3> Methods</h3> <p>This evaluation used the RE-AIM implementation framework to retrospectively analyse data from a 3-year timeline to review the events relating to the transition of Consumer Partnering into a Clinical Governance Unit. Data was sourced via Phase 1 – a focus group to establish a 3-year timeline of events, enablers and barriers, and Phase 2 – a quantitative and qualitative semi-structured interview to review systems that had been developed to support embedding partnering with consumers into Clinical Governance.</p> </section> <section> <h3> Results</h3> <p>Five primary enablers and five barriers to successfully embedding a Consumer Partnering Team into a Clinical Governance Unit were identified. Enablers included Executive sponsorship and ownership of the value of partnering with consumers, Executive leadership influence on local area uptake, an organization-wide network, valuing via remuneration, and a centralized orientation and onboarding programme for Consumer Partners. Barriers included skills and attitudes of committee chairs, the size of the Directorate (smaller local areas can be easier to influence change), patient feedback data requires interpretation to be useful, staff turnover can reduce the relationships with Consumer Partners, and financial insecurity is a barrier to implementation and maintenance.</p> </section> <section> <h3> Conclusions</h3> <p>This article described how an Australian Health Service embedded a Consumer Partnering Team into a Clinical Governance Unit to ensure that partnering became business as usual practice. Enablers, barriers, and unintended consequences can be used as learnings for other organizations to develop a similar approach.</p> </section> <section> <h3> Patient or Public Contribution</h3> <p>Two Consumer Partners with lived experience of the health service, and members of the organizations committee structures are part of the evaluation team. As team members, the consumers participated as equal contributors in evaluation design, analysis of the focus group and interview data, and contribution to the writing and review of the manuscript. Two Consumer Par
导言:在许多国家,医疗保健系统中与消费者建立合作伙伴关系已被广泛接受和强制执行。尽管已被接受,但关于如何成功建立系统将这一做法纳入医疗系统的最佳做法的信息却少之又少:本次评估采用 RE-AIM 实施框架,对 3 年时间内的数据进行回顾性分析,以回顾与消费者伙伴计划向临床治理部门过渡有关的事件。数据来源包括:第一阶段--焦点小组,以确定 3 年间的事件、促进因素和障碍;第二阶段--定量和定性半结构式访谈,以回顾为支持将消费者合作嵌入临床治理而开发的系统:结果:确定了成功将消费者合作团队纳入临床治理单位的五个主要促进因素和五个障碍。有利因素包括:行政人员对与消费者建立伙伴关系的价值的支持和所有权、行政领导对地方区域采纳情况的影响、全组织范围的网络、通过薪酬给予的重视,以及为消费者合作伙伴提供的集中指导和入职培训计划。障碍包括委员会主席的技能和态度、总局的规模(较小的地方区域可能更容易影响变革)、患者反馈数据需要解释才能发挥作用、人员流动会减少与消费者合作伙伴的关系,以及财政不稳定是实施和维护的障碍:本文介绍了澳大利亚卫生服务机构如何将消费者合作伙伴团队嵌入临床治理部门,以确保合作伙伴关系成为常规做法。促进因素、障碍和意外后果可作为其他组织开发类似方法的借鉴:患者或公众的贡献:评估小组中有两名具有医疗服务生活经验的消费者伙伴和组织委员会成员。作为团队成员,消费者以平等的身份参与了评估设计、焦点小组和访谈数据的分析,以及手稿的撰写和审阅。两名具有医疗服务生活经验的消费者伙伴和委员会成员参与了焦点小组和访谈。
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引用次数: 0
Delivery of Supported Self-Management in Primary Care Asthma Reviews: Insights From the IMP2ART Programme 在初级保健哮喘审查中提供支持性自我管理:IMP2ART 计划的启示。
IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-12 DOI: 10.1111/hex.70100
Emma Kinley, Hilary Pinnock, Liz Steed, Kirstie McClatchey
<div> <section> <h3> Background</h3> <p>Supported self-management (SSM) for asthma reduces the risk of asthma attacks and improves asthma control and quality of life. SSM optimally includes patient-centred communication and behaviour change support, however, the extent to which this occurs in routine primary care is unclear. This project was nested within the IMPlementing IMProved Asthma self-management as RouTine (IMP<sup>2</sup>ART) programme; a UK-wide trial evaluating an implementation strategy (including healthcare professional (HCP) training on behaviour change strategies and patient-centred care) to improve support for asthma self-management.</p> </section> <section> <h3> Objective</h3> <p>To provide an understanding of how healthcare professionals deliver SSM in UK clinical practice; through assessing time spent on SSM strategies, how and to what extent patient-centred care and behaviour change discussions are delivered, and to explore whether factors such as mode of review or implementation support influence delivery.</p> </section> <section> <h3> Design, Setting and Participants</h3> <p>We conducted an observational study using video-recordings of 12 HCPs delivering routine face-to-face and telephone asthma reviews (<i>n</i> = 64) in a sample of general practices participating in the IMP<sup>2</sup>ART trial (implementation <i>n</i> = 4; control <i>n</i> = 6). Analytical methods included: ALFA Toolkit Multi-Channel Video Observation (to code and quantify tasks undertaken); the Patient-Centred Observation Form; and The Behaviour Change Counselling Index (to assess patient-centeredness and behaviour change counselling used by HCPs).</p> </section> <section> <h3> Results</h3> <p>HCPs mostly spent time during routine asthma reviews discussing: an individual's asthma condition and management (average of 27.8% of consultation time); collaboratively reviewing and completing a personalised asthma action plan (6.3%) and training for practical self-management activities (5.4%). Areas of patient-centred care delivery and behavioural discussions included: creating and maintaining relationships, discussing asthma action plans and medication reconciliation. Professionals in IMP<sup>2</sup>ART implementation group practices delivered more SSM strategies. Comparison of face-to-face and remote consultations found no significant differences in HCP delivery of SSM.</p> </section> <section> <h3> Conclusions</h3> <p>HCPs in UK primary care spent half the time
背景:哮喘的支持性自我管理(SSM)可降低哮喘发作的风险,改善哮喘控制和生活质量。自我管理的最佳方式包括以患者为中心的沟通和行为改变支持,但在常规初级保健中的应用程度尚不清楚。该项目嵌套在 "IMP2ART"(IMP Implementing IMProved Asthma self-management as RouTine)计划中;该计划是一项英国范围内的试验,旨在评估一种实施策略(包括医疗保健专业人员(HCP)行为改变策略培训和以患者为中心的护理),以改善对哮喘自我管理的支持:通过评估自我管理策略所花费的时间、以患者为中心的护理和行为改变讨论的实施方式和程度,了解医护人员如何在英国临床实践中实施自我管理,并探讨审查模式或实施支持等因素是否会影响实施:我们对参与 IMP2ART 试验的全科诊所样本(实施样本 4 个;对照样本 6 个)中 12 名保健医生进行常规面对面和电话哮喘复查(样本数 = 64)的录像进行了观察研究。分析方法包括ALFA工具包多通道视频观察(对所执行的任务进行编码和量化);以患者为中心的观察表;行为改变咨询指数(评估以患者为中心的情况和保健医生使用的行为改变咨询):在常规哮喘复查中,医疗保健人员大多会花时间讨论:个人哮喘状况和管理(平均占就诊时间的 27.8%);合作审查和完成个性化哮喘行动计划(6.3%)以及实际自我管理活动培训(5.4%)。以患者为中心的护理服务和行为讨论领域包括:建立和维护人际关系、讨论哮喘行动计划和药物调节。IMP2ART实施小组中的专业人员提供了更多的自我管理策略。对面对面咨询和远程咨询进行比较后发现,医疗保健人员在提供 SSM 方面没有明显差异:结论:英国初级医疗保健机构的专业人员在面对面和远程哮喘复查中都花费了一半的时间来实施 SSM,这表明两种实施方式都是可以接受的。与对照组相比,在IMP2ART实施组实践中进行的复查显示了更多的行为改变和合作性SSM策略:英国哮喘应用研究中心(AUKCAR)的患者和公众参与计划成员全程参与,包括项目构思、对面向参与者的文件提供反馈以及讨论研究结果的影响。
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引用次数: 0
Through Their Eyes: Using Photovoice to Capture the Capacity-Building Journey of Long Covid Patient Experts 通过他们的眼睛:使用摄影 "选择"(Photovoice)来捕捉长期病患专家的能力建设历程。
IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-11 DOI: 10.1111/hex.70094
Nabil Natafgi, Katie Parris, Erin Walker, Tracey Gartner, Jeanette Coffin, Ariana Mitcham, Luis Sanchez Ferrer, Maushmi K. Patel, Haley Wymbs, Ann Blair Kennedy
<div> <section> <h3> Background</h3> <p>Long Covid, characterised by persistent symptoms following the coronavirus disease 2019 (COVID-19) infection, significantly impacts the quality of life. Engaging patients in research and care through participatory methods can enhance a shared understanding of illness and improve the relevance of research.</p> </section> <section> <h3> Objective</h3> <p>We define Patient Experts (PEs) as persons (including patients, caregivers and providers) who have completed a series of training sessions on team building, research methods and communication at the Patient Engagement Studio, University of South Carolina (PES USC). This study explores the use of photovoice to document the experiences and capacity-building journey of Long Covid PEs within PES USC.</p> </section> <section> <h3> Methods</h3> <p>The study employed photovoice within the COVID-19-Focused Virtual Patient Engagement Studio (CoVIP Studio). PEs submitted photographs and narratives at two distinct time points. Among the 18 PEs who participated in the project, 47 photos were collected during the training, and 31 were collected at the project's conclusion. Thematic analysis was conducted to capture changes in patient perspectives and engagement.</p> </section> <section> <h3> Results</h3> <p>Initial themes identified were “Hope through Community,” “Collaborative Education and Research” and “Strength and Endurance.” By the project's end, themes had evolved to “Working as a Team to Share and Acquire Knowledge,” “Enhanced Confidence in the Future of Care” and “Perseverance and Progress.” These findings highlight the transformative impact of patient engagement and the utility of photovoice in documenting longitudinal shifts in patient perspectives.</p> </section> <section> <h3> Conclusion</h3> <p>Photovoice effectively engaged Long Covid patients and captured their evolving roles and perceptions as PEs. The study underscores the value of patient-led participatory methods in enhancing the relevance and applicability of clinical research, advocating for their broader adoption to improve patient-centred care and research outcomes.</p> </section> <section> <h3> Patient or Public Contribution</h3> <p>A CoVIP Studio stakeholder advisory board (CoVIP SAB) guided the co-development and implementation of this project. The CoVIP SAB comprised nine members with complementa
背景:冠状病毒病2019(COVID-19)感染后症状持续存在的长Covid严重影响了患者的生活质量。通过参与式方法让患者参与到研究和护理中来,可以增强对疾病的共同理解,提高研究的相关性:我们将患者专家(PEs)定义为在南卡罗来纳大学患者参与工作室(PES USC)完成一系列关于团队建设、研究方法和沟通培训课程的人(包括患者、护理人员和医疗服务提供者)。本研究探讨了如何利用摄影oice 记录南卡罗来纳大学患者参与工作室内的长科维德 PE 的经历和能力建设历程:本研究在以 COVID-19 为重点的虚拟患者参与工作室(CoVIP Studio)中使用了摄影舆论。患者在两个不同的时间点提交照片和叙述。在参与项目的 18 名 PE 中,培训期间收集了 47 张照片,项目结束时收集了 31 张照片。我们进行了主题分析,以捕捉患者观点和参与度的变化:最初确定的主题是 "社区带来的希望"、"合作教育与研究 "和 "力量与耐力"。到项目结束时,主题已发展为 "团队合作,分享和获取知识"、"增强对未来护理的信心 "和 "坚持不懈,不断进步"。这些发现凸显了患者参与的变革性影响,以及摄影舆论在记录患者观点纵向转变方面的实用性:Photovoice 有效地吸引了 Long Covid 患者的参与,并捕捉到了他们作为 PE 不断变化的角色和看法。这项研究强调了以患者为主导的参与式方法在提高临床研究的相关性和适用性方面的价值,倡导更广泛地采用这些方法来改善以患者为中心的护理和研究成果:CoVIP 工作室利益相关者咨询委员会(CoVIP SAB)为该项目的共同开发和实施提供了指导。CoVIP SAB 由九名具有互补技能和专业知识的成员组成,其中包括三名患者、三名为 COVID-19 患者提供护理的临床医生以及三名在以患者为中心的研究、COVID-19 和/或患者参与方面具有专长并与患者作为共同研究者开展合作的研究人员。委员会对项目的设计和实施、照片选择提示的改进和传播策略的制定都做出了贡献。此外,一名积极参与项目各个阶段的 PE 参与了本文的撰写,并成为本文的共同作者。所有项目活动都有患者和/或护理人员参与,他们都有 Long Covid 的亲身经历。
{"title":"Through Their Eyes: Using Photovoice to Capture the Capacity-Building Journey of Long Covid Patient Experts","authors":"Nabil Natafgi,&nbsp;Katie Parris,&nbsp;Erin Walker,&nbsp;Tracey Gartner,&nbsp;Jeanette Coffin,&nbsp;Ariana Mitcham,&nbsp;Luis Sanchez Ferrer,&nbsp;Maushmi K. Patel,&nbsp;Haley Wymbs,&nbsp;Ann Blair Kennedy","doi":"10.1111/hex.70094","DOIUrl":"10.1111/hex.70094","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Long Covid, characterised by persistent symptoms following the coronavirus disease 2019 (COVID-19) infection, significantly impacts the quality of life. Engaging patients in research and care through participatory methods can enhance a shared understanding of illness and improve the relevance of research.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We define Patient Experts (PEs) as persons (including patients, caregivers and providers) who have completed a series of training sessions on team building, research methods and communication at the Patient Engagement Studio, University of South Carolina (PES USC). This study explores the use of photovoice to document the experiences and capacity-building journey of Long Covid PEs within PES USC.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The study employed photovoice within the COVID-19-Focused Virtual Patient Engagement Studio (CoVIP Studio). PEs submitted photographs and narratives at two distinct time points. Among the 18 PEs who participated in the project, 47 photos were collected during the training, and 31 were collected at the project's conclusion. Thematic analysis was conducted to capture changes in patient perspectives and engagement.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Initial themes identified were “Hope through Community,” “Collaborative Education and Research” and “Strength and Endurance.” By the project's end, themes had evolved to “Working as a Team to Share and Acquire Knowledge,” “Enhanced Confidence in the Future of Care” and “Perseverance and Progress.” These findings highlight the transformative impact of patient engagement and the utility of photovoice in documenting longitudinal shifts in patient perspectives.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Photovoice effectively engaged Long Covid patients and captured their evolving roles and perceptions as PEs. The study underscores the value of patient-led participatory methods in enhancing the relevance and applicability of clinical research, advocating for their broader adoption to improve patient-centred care and research outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Patient or Public Contribution&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A CoVIP Studio stakeholder advisory board (CoVIP SAB) guided the co-development and implementation of this project. The CoVIP SAB comprised nine members with complementa","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"27 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Community-Driven Health Promotion: Evaluation of a Rural Microgrant Program 社区驱动的健康促进:农村小额赠款计划评估。
IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-10 DOI: 10.1111/hex.70098
Michele Conlin, Dorothy McLaren, Evelien Spelten, Sean MacDermott
<div> <section> <h3> Introduction</h3> <p>Microgrants for health promotion have the potential to engage communities in designing and implementing place-based interventions to improve health and social outcomes. However, the evidence base around microgrants for health promotion is limited. This study presents the evaluation of a health service-funded microgrant program for health promotion in rural Australia.</p> </section> <section> <h3> Methods</h3> <p>The evaluation framework was developed through a participatory approach and involved collaborative logic model building and co-prioritized evaluation questions with health service staff and grant recipients. Evaluation questions focused on participation, short-term outcomes, and the perceived value of program activities. Qualitative methods (reflexive thematic analysis) were used to answer the evaluation questions. Data sources included semi-structured interviews with grantees (<i>n</i> = 11) and the health service's health promotion team (<i>n</i> = 4), electronic field notes kept by the health promotion team (<i>n</i> = 50 documents), electronic progress reports completed by grantees (<i>n</i> = 6) and information and feedback forums (<i>n</i> = 2).</p> </section> <section> <h3> Results</h3> <p>Since the program's inception in 2019, the health service has received 22 grant applications of which 15 were approved and 14 disbursed. Evaluation results show that grantees were community members with multiple roles, often with previous experience in applying for grants. Expected outcomes have been partially met, especially with regard to the program's aim of community empowerment. The most notable impact was the enhancement of participants' perception of and relationship with the health promotion team, as well as the creation of opportunities for community members such as exposure to art and bridging of social groups.</p> </section> <section> <h3> Conclusion</h3> <p>Microgrants represent a feasible way to increase health opportunities and foster community participation in the planning and delivery of health promotion programs. The key program activities identified and suggested improvements can help guide program replication and adaptation by other small organizations.</p> </section> <section> <h3> Public Contribution</h3> <p>Community members who had previously received a health service grant were invited to participate in collaborative workshops and follow-up surveys to codesign the grant program evalu
导言:用于促进健康的小额赠款有可能让社区参与设计和实施基于地方的干预措施,以改善健康和社会成果。然而,有关小额赠款促进健康的证据基础十分有限。本研究介绍了对澳大利亚农村地区卫生服务资助的健康促进小额赠款计划的评估:方法:评估框架是通过参与式方法制定的,包括与卫生服务人员和赠款接受者合作建立逻辑模型和共同确定评估问题的优先次序。评估问题主要集中在参与度、短期成果以及对计划活动价值的认识上。采用定性方法(反思性专题分析)来回答评估问题。数据来源包括与受资助者(n = 11)和卫生服务部门健康促进团队(n = 4)的半结构化访谈、健康促进团队保存的电子现场笔记(n = 50份文件)、受资助者完成的电子进度报告(n = 6)以及信息和反馈论坛(n = 2):自该计划于 2019 年启动以来,卫生服务部门共收到 22 份赠款申请,其中 15 份获得批准,14 份已发放。评估结果显示,受资助者都是身兼多职的社区成员,通常都有申请资助的经验。预期成果已部分实现,特别是在该计划的社区赋权目标方面。最显著的影响是提高了参与者对健康促进团队的认识,改善了他们与健康促进团队的关系,同时也为社区成员创造了机会,如接触艺术和沟通社会群体:小额赠款是增加健康机会、促进社区参与健康促进计划的规划和实施的可行方法。确定的主要计划活动和提出的改进建议有助于指导其他小型组织复制和调整计划:公众贡献:邀请曾经获得过健康服务补助金的社区成员参加合作研讨会和后续调查,共同设计补助金项目评估框架,共同确定评估问题的优先次序,并指导结果的传播计划。
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引用次数: 0
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Health Expectations
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