Health Expectations最新文献

Background: Post-traumatic stress disorder (PTSD) affects approximately 1 in 20 individuals, with primary care playing a crucial role in early identification and management. However, PTSD is frequently underdiagnosed in primary care settings. The COVID-19 pandemic has exacerbated the incidence of PTSD, leading to an increased demand for accessible mental health services. While NICE guidelines recommend trauma-focused therapies, access remains limited, underscoring the need for alternative strategies to support management within primary care.

Aim: To optimise and refine through co-production the PTSD Hub app, an existing digital resource, to better support individuals with PTSD in primary care settings, improving usability, clinician engagement, and patient outcomes.

Design & setting: A co-production approach was employed with stakeholders, including people with lived experience of PTSD, informal carers, and primary care professionals. Workshops were held online to gather insights on how to enhance the PTSD Hub app for better integration into primary care.

Method: Two Nominal Group Technique workshops were conducted to identify key barriers to PTSD care in primary care and generate solutions for improving the app. Participants ranked and prioritised features based on relevance to primary care.

Results: Twenty-six participants attended the workshops, representing a diverse mix of stakeholders. Key barriers identified included stigma, clinician time constraints, and limited access to trauma-focused therapies. Solutions included improving symptom tracking, enhancing customisation features, and raising clinician awareness.

Conclusion: The study highlights the potential of the PTSD Hub app in improving and supporting PTSD management in primary care. Future research should evaluate the app's effectiveness in real-world primary care settings.

Patient and public contribution: Patients and members of the public were actively involved throughout this study using a co-production approach. A lived experience advisory panel of six individuals with PTSD provided input at all stages, including shaping the study design, reviewing participant materials, and advising on workshop facilitation. Additionally, 26 participants, comprising individuals with lived experience of PTSD, informal carers, and healthcare professionals, contributed to two Nominal Group Technique workshops. A lived experience research partner (NC) was an integral part of the research team, attended all team meetings, co-facilitated workshop sessions and contributed to design, analysis and manuscript preparation.

Background: Measuring patient experiences has become a key initiative for improving healthcare quality worldwide. Since patient experiences are inherently shaped by sociocultural context and healthcare system structures, developing locally relevant measurement tools is crucial for reflecting patients' needs and expectations. South Korea has developed a patient experience questionnaire for hospital inpatient care within its National Health Insurance system through a systematic process involving patient engagement. In outlining the development process of the questionnaire, this study assesses its psychometric properties, focusing on validity and reliability.

Methods: The Patient Experience Assessment (PXA) questionnaire was developed through a three-phase process: (1) item generation via a literature review and qualitative research with patient and caregiver groups, (2) expert review using the Delphi method, and (3) validity and reliability testing through a pilot test. After stakeholder feedback, the current version of PXA includes 21 items across 6 domains. Psychometric properties were assessed using data from 629 inpatients in four general hospitals, split into two subsamples for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to ensure robust construct validation. Internal consistency was assessed using Cronbach's alpha.

Results: The PXA questionnaire includes globally recognised patient-centred themes while addressing unique issues that matter to patients in the Korean healthcare system. EFA identified a four-factor structure: (1) Information, dignity, and autonomy; (2) Communication with nurses; (3) Communication with doctors; and (4) Hospital environment. CFA confirmed this structure, demonstrating high convergent validity (standardised loadings > 0.70) and satisfactory model fit (CFI and TLI > 0.950, RMSEA = 0.036, SRMR = 0.046). The instrument showed excellent reliability (Cronbach's alpha: total = 0.95; subscales = 0.89-0.93).

Conclusion: The PXA questionnaire, currently being implemented in South Korea, demonstrates robust psychometric properties. This work also exemplifies the process of developing a locally relevant patient experience questionnaire, grounded in global knowledge on patient-centred care.

Patient or public contribution: Patients and caregivers participated in focus group discussions during PXA development. Their opinions directly informed the identification of culturally specific patient experience dimensions relevant to the Korean healthcare system. These findings emphasise engaging target patient populations in developing locally relevant patient experience instruments.