Health Expectations最新文献_第4页

Optimising the PTSD Hub App Through Co-Production: Enhancing Digital Support for PTSD Management in Primary Care. 通过联合生产优化PTSD中心应用程序：加强初级保健中PTSD管理的数字支持。

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations

Pub Date : 2026-02-01 DOI: 10.1111/hex.70598

Natasha Tyler, Sarah Croke, Chloe-Nicole Low, Nicola Cassidy, Evgenia Gkintoni, Brian McMillan, Maria Panagioti

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.

背景：创伤后应激障碍（PTSD）影响大约1 / 20的个体，初级保健在早期识别和管理中起着至关重要的作用。然而，创伤后应激障碍在初级保健机构经常被诊断不足。COVID-19大流行加剧了创伤后应激障碍的发病率，导致对可获得的精神卫生服务的需求增加。虽然NICE指南推荐以创伤为重点的治疗方法，但可获得性仍然有限，这强调了在初级保健中支持管理的替代策略的必要性。目的：通过合作制作PTSD Hub应用程序（一个现有的数字资源）来优化和改进，以更好地支持初级保健环境中的PTSD患者，提高可用性、临床医生参与度和患者预后。设计与环境：采用与利益相关者合作的方法，包括有PTSD生活经历的人、非正式护理人员和初级保健专业人员。在线举办了研讨会，以收集有关如何增强PTSD Hub应用程序以更好地融入初级保健的见解。方法：进行了两次名义小组技术研讨会，以确定初级保健中PTSD护理的主要障碍，并制定改进应用程序的解决方案。参与者根据与初级保健的相关性对功能进行排名和优先级排序。结果：26名参与者参加了研讨会，代表了不同的利益相关者。确定的主要障碍包括耻辱感、临床医生时间限制以及获得创伤治疗的机会有限。解决方案包括改进症状跟踪、增强定制功能和提高临床医生的认识。结论：该研究突出了PTSD Hub应用程序在改善和支持初级保健中PTSD管理方面的潜力。未来的研究应该评估应用程序在现实世界初级保健环境中的有效性。患者和公众的贡献：患者和公众成员在整个研究过程中积极参与，采用合作生产的方式。一个由六名PTSD患者组成的生活经验咨询小组在所有阶段提供意见，包括塑造研究设计，审查参与者材料，以及为研讨会的促进提供建议。此外，26名参与者，包括有创伤后应激障碍生活经验的个人，非正式护理人员和医疗保健专业人员，参加了两个名义团体技术研讨会。生活经验研究伙伴（NC）是研究团队不可或缺的一部分，参加所有团队会议，共同主持研讨会，并为设计，分析和手稿准备做出贡献。

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引用次数: 0

Empowering Older Patients in Advance Care Planning: Evaluating MyCare™ as a Decision Support Tool 授权老年患者提前护理计划：评估MyCare™作为决策支持工具。

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations

Pub Date : 2026-01-30 DOI: 10.1111/hex.70545

Alixe Ménard, Yamini Singh, Christina Yin, Sydney Ruller, Lauren Konikoff, Jackie Kierulf, Carol Bennett, Douglas Manuel, Shane Kirkham, Daniel Kobewka

<div> <section> <h3> Background</h3> <p>Older adults with serious illness often face treatment decisions shaped by personal values, yet recognising and expressing those values in ways that guide decision-making can be challenging. This study evaluated the acceptability, usability and effectiveness of MyCare, a digital values clarification tool designed to help older adults identify and communicate their care preferences to substitute decision-makers, healthcare providers and support persons.</p> </section> <section> <h3> Methods</h3> <p>This convergent mixed-methods study explored older adults' experiences with MyCare. Acceptability was assessed using the Theoretical Framework of Acceptability survey and qualitative interviews examining perceptions of the tool's relevance and ease of use. Usability was measured with the System Usability Scale and participant feedback on navigation and clarity. Potential effectiveness was evaluated based on self-reported ability to articulate and discuss care preferences. Semi-structured interviews explored these outcomes in depth and were analysed using thematic analysis.</p> </section> <section> <h3> Results</h3> <p>A total of 15 participants (mean age = 83.5 years, SD = 7.6) were surveyed and interviewed between November 2024 and January 2025, including five dyads (one son and mother, three husband-wife pairs, and two sisters). Key themes identified included: (1) navigating autonomy and delegation in end-of-life decision-making, (2) fragmented communication, (3) influence of lived and observed experiences on care decisions, (4) fears around acceptable and unacceptable quality of life, and (5) using MyCare to promote proactive care planning. Participants reported moderate electronic health literacy, and survey results indicated high usability (SUS mean 83.2/100) and strong acceptability of MyCare, particularly in comfort, perceived value and ease of use.</p> </section> <section> <h3> Conclusions</h3> <p>MyCare demonstrated high acceptability and usability, with participants finding it effective in clarifying and communicating care preferences. It facilitated discussions about quality of life and decision-making, though challenges remain in addressing prognostic uncertainty and aligning preferences with realistic care goals. Future research should refine the tool to enhance its integration into routine healthcare settings.</p> </section> <section> <h3> Patient or Public Contribution</h3> <p>A patient partner was in

背景：患有严重疾病的老年人往往面临由个人价值观塑造的治疗决定，然而，以指导决策的方式认识和表达这些价值观可能具有挑战性。这项研究评估了MyCare的可接受性、可用性和有效性，MyCare是一种数字价值澄清工具，旨在帮助老年人识别并向替代决策者、医疗保健提供者和支持人员传达他们的护理偏好。方法：本融合混合方法研究探讨老年人使用MyCare的经验。可接受性是使用可接受性调查的理论框架和定性访谈来评估工具的相关性和易用性。可用性是通过系统可用性量表和参与者对导航和清晰度的反馈来衡量的。根据自我报告的表达和讨论护理偏好的能力来评估潜在的有效性。半结构化访谈深入探讨了这些结果，并使用主题分析进行了分析。结果：在2024年11月至2025年1月期间，共对15名参与者（平均年龄= 83.5岁，SD = 7.6）进行了调查和访谈，其中包括5对夫妻（1对儿子和母亲，3对夫妻和2对姐妹）。确定的关键主题包括：(1)在临终决策中导航自主和授权；(2)碎片化沟通；(3)生活和观察经验对护理决策的影响；(4)对可接受和不可接受的生活质量的恐惧；(5)使用MyCare促进积极的护理计划。参与者报告了中等程度的电子健康素养，调查结果表明MyCare的可用性高（SUS平均值为83.2/100），可接受性强，特别是在舒适度、感知价值和易用性方面。结论：MyCare表现出很高的可接受性和可用性，参与者发现它在澄清和沟通护理偏好方面是有效的。它促进了关于生活质量和决策的讨论，尽管在解决预后不确定性和使偏好与现实护理目标保持一致方面仍然存在挑战。未来的研究应完善该工具，以提高其集成到常规医疗保健设置。患者或公众贡献：一名患者伴侣从本研究开始就作为合著者和共同决策者参与了MyCare的设计和开发。他们作为患有严重疾病的人的配偶的生活经历为该工具的结构和优先事项提供了信息，以确保其与患者需求相关。在此之后，我们邀请了更多的患者作为研究参与者来提供可用性和功能的反馈。他们的见解正被用于改进和调整MyCare，以最大限度地提高其对未来患者的影响。

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引用次数: 0

Co-Designing a Peer Navigator Role to Improve Equity in Healthcare Access for Pacific Islander, Māori and Arabic Communities in Australia 共同设计同伴导航员作用，以改善太平洋岛民、Māori和澳大利亚阿拉伯社区获得医疗保健的公平性。

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations

Pub Date : 2026-01-29 DOI: 10.1111/hex.70351

Lubab Shwaita, Simone Said, Susan D. Whicker, Fan Hoak, Lizcha Kaivaha, Wadeed Salboud, Charan Stevenson, Mokhaled Mohammed, Yue Hu, Rebecca L. Jessup

Background

There is a great deal of variation in the design and delivery of the peer health navigator role, making it difficult to adapt role responsibilities into context. In this study, we aimed to co-design a bicultural peer health navigator (BPHN) role to meet the needs of culturally and linguistically diverse (CALD) people from Pacific Islander, Māori and Arabic-speaking backgrounds.

Methods

A two-phase co-design approach involving workshops with follow-up member checking via interview was used to gain insight into factors affecting patient interaction and access barriers to health services.

Results

Barriers described by participants emerged under five major themes—overcoming language barriers, improving communication, navigation and access to information, appointment reminders, and health and social services education in the community.

Conclusion

Clear tasks for the BPHN role were identified by the participants to improve accessibility and usage of healthcare services. Future work should involve feasibility testing with the support and involvement of community members, BPHNs and their supervisors and importantly health service leaders.

Patient or Public Contribution

Four of the authors were employed as bicultural peer health navigators (BPHNs) who engaged their communities to organise and conduct these workshops in their preferred language. This approach enabled an inclusive environment for the participants to share their thoughts and experiences. The proposed roles for a BPHN were generated from the workshop discussions. The BPHNs conducted the semi-structured verification interviews with the workshop participants. The thematic analysis was conducted by two of the BPHNs, with one being the primary author.

背景：同伴健康导航员角色的设计和交付存在很大差异，使得角色职责难以适应环境。在本研究中，我们旨在共同设计一个双文化同伴健康导航员（BPHN）角色，以满足来自太平洋岛民、Māori和阿拉伯语背景的文化和语言多样性（CALD）人群的需求。方法：采用两阶段的共同设计方法，包括研讨会和随访成员通过访谈进行检查，以深入了解影响患者互动和获得卫生服务障碍的因素。结果：参与者描述的障碍出现在五个主要主题下：克服语言障碍、改善沟通、导航和获取信息、预约提醒以及社区卫生和社会服务教育。结论：参与者确定了BPHN角色的明确任务，以改善医疗保健服务的可及性和使用率。今后的工作应包括在社区成员、bphn及其主管以及重要的保健服务领导的支持和参与下进行可行性测试。患者或公众贡献：四名作者被聘为双文化同伴健康导航员（bphn），他们让他们的社区用他们喜欢的语言组织和举办这些讲习班。这种方法为参与者提供了一个包容的环境来分享他们的想法和经验。BPHN的建议角色是从研讨会讨论中产生的。bphn对讲习班参与者进行了半结构化的验证访谈。专题分析是由两个bphn进行的，其中一个是主要作者。

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引用次数: 0

‘Until You Get the Diagnosis You're Forever in Limbo’—Parents' Experiences of Waiting for an Attention-Deficit/Hyperactivity Disorder Assessment With Child and Adolescent Mental Health Services “在你得到诊断之前，你永远处于不确定状态”——父母在儿童和青少年心理健康服务机构等待注意力缺陷/多动障碍评估的经历。

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations

Pub Date : 2026-01-28 DOI: 10.1111/hex.70569

Ellen Hedstrom, Katarzyna Kostyrka-Allchorne, Claire Ballard, Naomi James, Hannah Wright, David Daley, Cris Glazebrook, Jana Kreppner, Claire Cattel, Douglas Gordon, Natalie Gordon, Tessa Tuttlebee, Edmund Sonuga-Barke

<div> <section> <h3> Background</h3> <p>Parents in the United Kingdom seeking an assessment for attention-deficit/hyperactivity disorder (ADHD) for their child experience a significant wait before receiving an appointment with Child and Adolescent Mental Health Services (CAMHS), yet little has been written on how parents experience this period. Through qualitative interviews, we sought to understand how the period of waiting from being accepted onto a service waitlist and receiving a diagnostic assessment impacts parents and their children.</p> </section> <section> <h3> Method</h3> <p>The study was nested within a large randomised controlled trial. We conducted semi-structured interviews with 41 parents of children aged 5–11 years. 30% of parents had waited between 18 and 24 months on a CAMHS waitlist, with 10% waiting more than 2 years. Reflexive thematic analysis was used to analyse data.</p> </section> <section> <h3> Results</h3> <p>At the point of the interview, around 50% of children were still waiting for an initial assessment. Six themes reflecting parents' uncertainty around the assessment process, lack of communication from services, the importance of receiving a diagnosis, difficulty accessing support and the negative impact of waiting on mental health and education, as well as recommendations to improve communication between services and families, emerged.</p> </section> <section> <h3> Conclusion</h3> <p>Parents recognised the pressures on services to offer timely support; however, their well-being could be substantially improved by more clarity around wait times, as well as more effective signposting and support from services concerning the assessment process. This may help alleviate some of the stressors associated with their child's assessment journey, such as feeling responsible for their child's difficulties and the burden of supporting their educational needs.</p> </section> <section> <h3> Patient and Public Contribution</h3> <p>This study was nested within the OPTIMA trial, where PPI panel members provided ongoing support in various aspects of the study, including advising on participant communication, study design and data analysis. All PPI members have lived experience of having a neurodivergent child. For this study, the PPI co-produced the interview schedule and took part in transcript analysis using a thematic framework approach. To acknowledge their contributions, members of the PPI panel are included as co-authors.</p>

背景：在英国，父母在接受儿童和青少年心理健康服务（CAMHS）的预约之前，要为他们的孩子评估注意力缺陷/多动障碍（ADHD），但很少有关于父母如何经历这一时期的文章。通过定性访谈，我们试图了解从被接受进入服务候补名单到接受诊断评估的等待时间如何影响父母和他们的孩子。方法：采用大型随机对照试验。我们对41位5-11岁儿童的家长进行了半结构化访谈。30%的父母在CAMHS的等待名单上等待了18到24个月，10%的人等待了2年以上。数据分析采用自反性专题分析。结果：在访谈时，约50%的儿童仍在等待初步评估。出现了六个主题，反映了家长对评估过程的不确定性、服务机构缺乏沟通、接受诊断的重要性、难以获得支持、等待对心理健康和教育的负面影响，以及改善服务机构与家庭之间沟通的建议。结论：家长认识到服务机构提供及时支持的压力；然而，他们的福祉可以通过更明确的等待时间，以及更有效的路标和有关评估过程的服务支持而大大改善。这可能有助于减轻与孩子的评估过程相关的一些压力因素，例如对孩子的困难负责和支持他们的教育需求的负担。患者和公众贡献：该研究嵌套在OPTIMA试验中，PPI小组成员在研究的各个方面提供持续支持，包括参与者沟通、研究设计和数据分析方面的建议。所有PPI成员都有过神经分化儿童的生活经历。在本研究中，PPI共同制作了访谈时间表，并使用主题框架方法参与了文本分析。为了表彰他们的贡献，PPI小组的成员被列为共同作者。

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引用次数: 0

Access to Healthcare Services for the Deaf: A Scoping Review of Reviews 聋人获得医疗保健服务：综述的范围综述

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations

Pub Date : 2026-01-26 DOI: 10.1111/hex.70554

Marie-Mychèle Pratte, Magaly Brodeur, Marie-Eve Perron, Catherine Hudon

<div> <section> <h3> Background</h3> <p>Cultural and linguistic minorities are at a higher risk of poorer health, poorer health outcomes, and poorer quality of care, in part due to a lack of access to healthcare services. Inequities in access to healthcare services have been found in several Deaf populations and are associated with poorer physical and mental health outcomes.</p> </section> <section> <h3> Objective</h3> <p>This review aims to describe the breadth, scope, and nature of the literature on access to healthcare services for Deaf adults.</p> </section> <section> <h3> Methods</h3> <p>A scoping review was conducted according to Arksey and O'Malley. Ten scientific databases and grey literature were searched for reviews published between 2000 and 2025 in English, French, American Sign Language, and Quebec Sign Language. A chart form was created for extraction. Results were analyzed using narrative synthesis and the Levesque et al. conceptual framework of access to healthcare. Research priorities were identified during a deliberative workshop with members of the Deaf community in Québec, Canada.</p> </section> <section> <h3> Results</h3> <p>Eighteen reviews were included in this study. All dimensions of the conceptual framework have been explored (approachability, ability to perceive, acceptability, ability to seek, availability and accommodation, ability to reach, affordability, ability to pay, appropriateness, and ability to engage). Our analysis revealed new factors influencing access that need to be considered: cultural competence, communication barriers, sociodemographic characteristics, and technological support. We also identified that the social inclusion of the Deaf impacts multiple dimensions in a cross-sectional manner.</p> </section> <section> <h3> Conclusion</h3> <p>The Deaf face barriers to accessing healthcare services at every stage of their pathway. This review has identified several areas of access where further research is needed to address the disparities experienced by Deaf communities. There is an urgent need to involve the Deaf community in shaping the research on their access to healthcare services.</p> </section> <section> <h3> Patient or Public Contribution</h3> <p>A Deaf patient partner contributed as a co-researcher to the study design, the conduct of the review, and the interpretation of the data. This collaboratio

背景：文化和语言上的少数群体健康状况较差、健康结果较差、护理质量较差的风险较高，部分原因是缺乏获得医疗保健服务的机会。在一些聋人群体中发现了获得医疗保健服务的不公平现象，这与较差的身心健康结果有关。目的：本综述旨在描述聋成人获得卫生保健服务的文献的广度、范围和性质。方法：根据Arksey和O'Malley进行范围综述。检索了2000年至2025年间以英语、法语、美国手语和魁北克手语发表的10个科学数据库和灰色文献。为提取创建了一个图表表单。使用叙事综合和Levesque等人的医疗保健可及性概念框架对结果进行分析。在加拿大曲海贝特与聋人社区成员举行的审议讲习班上确定了研究重点。结果：本研究纳入18篇综述。概念框架的所有维度都进行了探讨（可接近性、感知能力、可接受性、寻求能力、可用性和住宿能力、达到能力、可负担性、支付能力、适当性和参与能力）。我们的分析揭示了需要考虑的影响获取的新因素：文化能力、沟通障碍、社会人口特征和技术支持。我们还发现，聋人的社会包容以横截面的方式影响着多个维度。结论：聋人在其人生道路的每个阶段都面临着获得医疗服务的障碍。本综述确定了几个需要进一步研究的领域，以解决聋人社区所经历的差异。迫切需要让聋人社区参与制定他们获得医疗保健服务的研究。患者或公众贡献：一名聋人患者作为共同研究者参与研究设计、审查的实施和数据的解释。这种合作有助于理解和解释综述的发现。

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引用次数: 0

Evaluating the Process of Patient Engagement: Insights from a Mixed-Methods Evaluation of a Cancer Center Patient Advisory Group 评估患者参与的过程：来自癌症中心患者咨询小组的混合方法评估的见解。

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations

Pub Date : 2026-01-24 DOI: 10.1111/hex.70581

Lauren Kearney, Tracy Battaglia, Karina Verma, Sara Shusterman, Michelle Hall, Gemmae Fix, Katrina Steiling

<div> <section> <h3> Background</h3> <p>Patient engagement is associated with improved care quality, better health outcomes, increased trust and satisfaction, and reduced costs. Patient engagement is recommended in cancer care. Patient advisory groups (PAGs) are a commonly used approach for engaging patients. However, more evidence is needed to understand how effectively PAGs support meaningful engagement, what factors shape that engagement, and how their contributions align with program goals. This study used a mixed-methods approach to evaluate patient engagement within a PAG supporting an oncology quality improvement initiative.</p> </section> <section> <h3> Methods</h3> <p>The Oncology Equity Alliance (OEA), a quality improvement initiative to improve care coordination and reduce time to treatment, established a PAG to engage patients throughout the initiative. We conducted a mixed-method evaluation of PAG engagement. Focus groups with PAG members and qualitative interviews with OEA team members were rapidly analyzed to identify engagement successes and challenges, and to determine engagement principles to focus on for survey evaluation. Perceptions of PAG engagement were assessed via surveys of PAG members and OEA team members, using selected items from the Research Engagement Survey Tool (REST). Surveys were analyzed descriptively and according to the REST scoring scheme.</p> </section> <section> <h3> Results</h3> <p>Focus groups (<i>n</i> = 2) and interviews (<i>n</i> = 3) identified key facilitators that supported engagement including deliberate coordination, mutual respect, a sense of belonging, and co-learning. Engagement was also positively impacted by members' motivations for joining the PAG and practical and logistical considerations. Challenges included PAG members' desire for greater understanding of the project's impact, more agenda setting, and ongoing education about OEA core components. This qualitative data informed the selection of engagement principles of focus for quantitative evaluation using REST. A total of 80% of PAG members (<i>n</i> = 10) felt very engaged, with the degree of engagement corresponding to cooperation and collaboration domains; however, for individual survey items, an average of 20% of responses were marked by PAG members as “not applicable.”</p> </section> <section> <h3> Conclusion</h3> <p>This mixed-method evaluation found strong alignment between program goals and PAG member engagement, highlighted effective strategies, and identified addressable challenges. As patient engagement becomes more common in

背景：患者参与与提高护理质量、改善健康结果、增加信任和满意度以及降低成本相关。癌症治疗建议患者参与。患者咨询小组（PAGs）是吸引患者的常用方法。然而，需要更多的证据来理解pag如何有效地支持有意义的参与，是什么因素塑造了这种参与，以及他们的贡献如何与项目目标相一致。本研究采用混合方法评估PAG中支持肿瘤质量改进计划的患者参与情况。方法：肿瘤学公平联盟（OEA）是一个质量改进倡议，旨在改善护理协调和缩短治疗时间，建立了一个PAG，让患者参与整个倡议。我们对PAG接触情况进行了混合方法评估。对PAG成员的焦点小组和OEA团队成员的定性访谈进行了快速分析，以确定参与的成功和挑战，并确定调查评估的重点参与原则。通过对PAG成员和OEA团队成员的调查，使用研究参与调查工具（REST）中的选定项目，评估PAG参与的看法。根据REST评分方案对调查结果进行描述性分析。结果：焦点小组（n = 2）和访谈（n = 3）确定了支持参与的关键促进因素，包括深思熟虑的协调、相互尊重、归属感和共同学习。成员加入PAG的动机以及实际和后勤方面的考虑也对参与度产生了积极影响。挑战包括PAG成员希望更好地理解项目的影响，更多的议程设置，以及关于OEA核心组件的持续教育。这些定性数据为使用REST进行定量评估的重点参与原则的选择提供了信息。共有80%的PAG成员（n = 10）感到非常投入，投入程度与合作和协作领域相对应；然而，就个别调查项目而言，PAG成员平均有20%的回复被标记为“不适用”。结论：这种混合方法的评估发现项目目标和PAG成员参与之间有很强的一致性，突出了有效的策略，并确定了可解决的挑战。随着患者参与在癌症治疗中变得越来越普遍，应用这些经验对于推进有意义的、以人为本的项目至关重要。患者贡献：本文介绍了对PAG的评价。除了作为研究的参与者，患者咨询小组的成员还参与了成员检查，以验证研究结果，确保解释反映了他们的经验和观点。

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引用次数: 0

User Involvement in Transition Care in Virtual 4-Party Meetings: A Qualitative Study 虚拟四方会议中过渡关怀的用户参与：一项定性研究。

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations

Pub Date : 2026-01-24 DOI: 10.1111/hex.70566

Ditte Høgsgaard, Janet Froulund Jensen, Heidi Myglegård Andersen

Background

Older adults with multimorbidity often experience fragmented transitional care between the hospital, primary care, and municipal services. Insufficient communication and limited user involvement can compromise safety, satisfaction, and continuity. To address these challenges, a structured cross-sectoral intervention, the Virtual 4-Party Meeting (V4M), was developed to enhance patient and family involvement in discharge planning.

Aim

To explore how older adults with multimorbidity and their relatives experienced involvement in transitional care through V4M.

Methods

A qualitative hermeneutic design was applied. Eleven patients ( + 65 years) and their relatives participated in semi-structured interviews immediately after V4M and again 14 days post-discharge. Data were analyzed using Braun and Clarke's reflexive thematic analysis within a Gadamerian hermeneutic framework.

Results

Three themes emerged: (1) Bridges between Systems. V4M reduced fragmentation and improved coordination through shared dialog; (2) A Relational Space of Alignment, the meetings created emotional safety and supported patient autonomy and relational understanding; and (3) Involvement and Responsibility are deeply interconnected. Meaningful involvement occurred when accountability was shared between patients, relatives, and professionals.

Conclusion

V4M provided an effective model for integrating user involvement into transitional care by combining structural coordination with relational engagement. Patients and relatives felt acknowledged, informed, and reassured when professionals gained a clearer sense of shared responsibility. The study highlights that genuine user involvement depends on both emotional recognition and concrete accountability mechanisms across sectors.

Patient or Public Contribution

Older adults with multimorbidity and their relatives contributed to the development of the V4M intervention. In this study, patients and relatives participated as interviewees but were not involved in data analysis or manuscript preparation.

背景：患有多种疾病的老年人通常在医院、初级保健和市政服务之间经历零散的过渡护理。不充分的沟通和有限的用户参与会损害安全性、满意度和连续性。为了应对这些挑战，开发了一种结构化的跨部门干预，即虚拟四方会议（V4M），以加强患者和家庭对出院计划的参与。目的：探讨多病老年人及其亲属通过V4M参与过渡性照护的情况。方法：采用定性解释学设计。11例患者（65岁以上）及其家属在V4M术后立即和出院后14天再次参加了半结构化访谈。数据分析采用了Braun和Clarke在伽达美尔解释学框架内的反身性主题分析。结果：出现了三个主题：(1)系统之间的桥梁。V4M通过共享对话减少了碎片，提高了协调性；(2)关系空间的一致性，会议创造了情感安全，支持患者自主和关系理解；(3)参与和责任是紧密相连的。当病人、家属和专业人员共同承担责任时，就会产生有意义的参与。结论：V4M通过结构协调与关系参与相结合，为过渡性护理整合用户介入提供了有效的模型。当专业人员获得更清晰的共同责任意识时，患者和家属感到被认可、知情和放心。该研究强调，真正的用户参与取决于跨部门的情感认可和具体问责机制。患者或公众贡献：患有多种疾病的老年人及其亲属为V4M干预的发展做出了贡献。在本研究中，患者和亲属作为访谈对象参与，但不参与数据分析和稿件准备。

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引用次数: 0

Turning to Service Users for the Understanding of Current and Future Mental Health Services in the Development Process of Research and Practice: A Qualitative Study 转向服务使用者了解当前与未来心理健康服务发展过程的研究与实践：一项质性研究。

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations

Pub Date : 2026-01-24 DOI: 10.1111/hex.70574

Emmy Nilsson, Carina Tjörnstrand, Daniel Lindqvist, Jenny Wetterling, Annika Lexén, Ulrika Bejerholm

<div> <section> <h3> Background</h3> <p>A person-centred and recovery-oriented approach is an integral part of modern mental health services founded on the experiential knowledge of service users. Their reflections as experts, grounded in their unique experience as service users, play a significant role in developing and improving the existing care. Experiential knowledge is therefore a means to enhance the relevance of research, inform the development of care, and bridge research and practice.</p> </section> <section> <h3> Aim</h3> <p>To understand service users' experiences of their current mental health services and explore reflections on the Flexible Assertive Community Treatment (FACT) model and its role in future practice.</p> </section> <section> <h3> Methods</h3> <p>A total of 17 experts participated in individual and dyadic in-depth interviews. A reflexive thematic analysis was performed on the participants' experiences of current mental health services and on their reflections on a vignette describing an integrative, recovery-oriented care and support model—FACT.</p> </section> <section> <h3> Results</h3> <p>The analysis resulted in three themes. The first theme, ‘Losing value and credibility as a person when becoming a service user’, reflected participants' experiences of being reduced to the signs and symptoms of their mental health problems. The second theme, ‘Navigating through the mental health maze’, describes participants view on the current mental health services, while the last theme, ‘Involving service users in their care and support would be empowering’, holds participants' views on the importance of greater involvement in future service design and delivery.</p> </section> <section> <h3> Conclusions</h3> <p>These results underscore the necessity for enhanced collaboration to empower and provide inclusive, tailored care and support, which the participants emphasised as essential for the future of mental health services. The participants reflected on certain structural concepts, such as hierarchy, caring culture, and financial strains, prior to the implementation of FACT, which need to be addressed before an adaptation of integrative, recovery-oriented care and support models.</p> </section> <section> <h3> Public and Service User Contribution</h3> <p>The study planning and process involved stakeholders, including user organisatio

背景：以人为本和以康复为导向的方法是建立在服务使用者经验知识基础上的现代精神卫生服务的一个组成部分。他们作为专家的思考，基于他们作为服务使用者的独特经验，在发展和改进现有护理方面发挥了重要作用。因此，经验知识是提高研究相关性的一种手段，为护理的发展提供信息，并在研究和实践之间架起桥梁。目的：了解服务使用者对当前心理健康服务的体验，探讨对灵活自信社区治疗（FACT）模式的思考及其在未来实践中的作用。方法：对17名专家进行单独和双组深度访谈。对参与者目前的精神卫生服务经历和他们对描述综合的、以康复为导向的护理和支持模式- fact的小插图的思考进行了反思性专题分析。结果：分析得出三个主题。第一个主题是“当成为服务使用者时，作为一个人失去了价值和信誉”，反映了参与者被贬低为心理健康问题的迹象和症状的经历。第二个主题是“在精神健康迷宫中导航”，描述了与会者对当前精神健康服务的看法，而最后一个主题是“让服务使用者参与他们的照顾和支持将赋予权力”，表达了与会者对更多参与未来服务设计和提供的重要性的看法。结论：这些结果强调了加强协作的必要性，以增强能力并提供包容的、量身定制的护理和支持，与会者强调这对精神卫生服务的未来至关重要。在实施FACT之前，参与者反思了某些结构概念，如等级制度、关怀文化和财政压力，这些概念需要在适应综合的、以康复为导向的护理和支持模式之前解决。公共和服务用户贡献：研究规划和过程涉及利益攸关方，包括用户组织、瑞典精神卫生伙伴关系（NSPH）、sk及其姊妹组织LIBRA sk，以及精神卫生服务的管理人员和专业人员。其中一名作者有自己的精神疾病经历，对数据分析和稿件的定稿做出了很大的贡献，两名作者有亲属经历。

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引用次数: 0

Best Practice Principles to Work With Consumer Representatives on Patient Safety Investigation Teams 在患者安全调查小组中与消费者代表合作的最佳实践原则。

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations

Pub Date : 2026-01-23 DOI: 10.1111/hex.70543

Yinghua Yu, Charlotte J. Molloy, Lorelle Bowditch, Mia Bierbaum, Liat Watson, Jennifer Morris, Zoe Fernance, Jenny Berrill, Duncan Brown, Matthew Ames, Peter D. Hibbert

<div> <section> <h3> Introduction</h3> <p>Consumer representatives (CRs), individuals with lived experience and other consumer advisers and volunteers, play an increasing role in advancing consumer-oriented healthcare. Some health services have begun integrating CRs into patient safety investigation teams with the aim of ensuring patient and family perspectives are incorporated into the process. Recent empirical research has begun to shed light on the perceptions and experiences of CRs in these roles. Built on these insights, this paper proposes a set of best practice principles for the effective engagement of CRs in patient safety investigations.</p> </section> <section> <h3> Methods</h3> <p>This study adopted a qualitative approach, drawing on data collected through interviews with 11 CRs and 10 focus groups with health service staff from Victoria, Australia. A co-design workshop was conducted with an advisory committee of six consumers from four Australian jurisdictions. Thematic analysis was employed to analyse the data and identify key themes.</p> </section> <section> <h3> Results</h3> <p>Four high-level themes emerged: (1) formalise the CR role, including the implementation of a standardised recruitment process with defined professional and personal selection criteria to ensure an appropriate fit for the role, as well as appropriate remuneration and considerations for inclusion and equity; (2) investigation team-level support, providing structured training for CRs, chairs and other team members to consider the team dynamics and interactions as a whole. Form buddy/mentorship programmes to ensure consistent engagement and support processes; (3) organisational integration, embedding the CR role within the organisational structure, including dedicated escalation pathways, ongoing evaluation and feedback mechanisms for continuous improvement of the role; (4) system-wide cultural shift, promoting the recognition and valuing CRs through committed leadership, legislative support and awareness building at all levels of the organisational hierarchy, and developing a shared pool of trained CRs.</p> </section> <section> <h3> Conclusion</h3> <p>The paper proposes best practice principles to optimise the engagement of CRs on patient safety investigation teams.</p> </section> <section> <h3> Patient or Public Contribution</h3> <p>Eleven individuals with experience as CRs on patient safety investigation teams were interviewed. Additionally, six consumers from

引言：消费者代表（CRs），具有实际经验的个人和其他消费者顾问和志愿者，在推进面向消费者的医疗保健方面发挥着越来越大的作用。一些保健服务机构已开始将社区评估纳入患者安全调查小组，目的是确保将患者和家属的观点纳入这一进程。最近的实证研究已经开始揭示在这些角色的责任代表的看法和经验。基于这些见解，本文提出了一套最佳实践原则，使cr有效参与患者安全调查。方法：本研究采用定性方法，通过对澳大利亚维多利亚州11名CRs和10个卫生服务人员焦点小组的访谈收集数据。与来自澳大利亚四个司法管辖区的六名消费者组成的咨询委员会共同举办了一个设计讲习班。采用主题分析来分析数据并确定关键主题。结果：出现了四个高层次的主题：(1)使企业社会责任角色正规化，包括实施标准化的招聘流程，其中包含明确的专业和个人选择标准，以确保角色的合适性，以及适当的薪酬和包容性和公平性考虑；(2)调查团队层面的支持，为客服人员、主席和其他团队成员提供结构化的培训，以考虑团队动态和整体互动。形成伙伴/师友计划，以确保持续的参与和支持过程；(3)组织整合，将企业社会责任角色嵌入到组织结构中，包括专门的升级途径、持续的评估和反馈机制，以持续改进该角色；(4)全系统的文化转变，通过致力于领导、立法支持和各级组织的意识建设，促进对企业责任人员的认可和重视，并建立一个共享的培训过的企业责任人员库。结论：本文提出了最佳实践原则，以优化cr在患者安全调查小组中的参与。患者或公众贡献：采访了11位在患者安全调查小组中具有CRs经验的个人。此外，来自澳大利亚四个司法管辖区的六位消费者——研究资助消费者咨询委员会的成员和本文的共同作者——合作进行了研究设计，为数据解释和写作做出了贡献，并与研究团队合作制定了建议的最佳实践原则。

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引用次数: 0

Reducing the ‘Silence Between Sessions’: A Qualitative Study on Youth and Professionals' Perspectives on Digital Tools for Suicide Prevention 减少“会议之间的沉默”：青少年和专业人士对预防自杀的数字工具的看法的定性研究。

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations

Pub Date : 2026-01-23 DOI: 10.1111/hex.70572

Elise Carrotte, India Bellairs-Walsh, Sarah Hetrick, Jo Robinson, Eleanor Bailey

Introduction

Despite academic and clinical interest in digital suicide prevention tools (‘digital tools’), challenges persist related to their integration into existing care pathways. The objective of this study was to understand how young people and professionals use and perceive digital tools for the management of suicidal thoughts and/or self-harming behaviours.

Methods

This qualitative study involved interviews with young people aged 18–25 with lived experience of suicidal thoughts and/or self-harming behaviours (n = 8), and with clinical or research expertise in youth suicide and digital interventions (n = 9). Interview transcripts were analysed using reflexive thematic analysis.

Results

The analysis generated three main themes: (1) bridging the gaps in support, (2) user experience while navigating suicidal thoughts or crisis, and (3) digital tool implementation: expectation versus reality. Further, sub-themes were: (i) unique suicide prevention opportunities inherent to digital tools, (ii) complexity of digital risk management, (iii) privacy considerations around a stigmatised topic, and (iv) (perceived) low uptake by young people.

Conclusion

Digital tools that are user-friendly, adaptable, and personalised may enable tailored and timely support for the prevention and management of suicide and self-harm. Nonetheless, poor user experience, organisational buy-in, and difficulties managing suicide risk data outside clinical environments pose challenges to effective implementation, scale-up, and sustained engagement. Participatory methods, such as co-design, may help address these issues.

Patient or Public Contribution

Young people with lived experience of suicidal thoughts and/or self-harming behaviours, and who had used digital tools for suicide prevention purposes, were participants in this study. Study processes were reviewed by Orygen's Youth Research Council prior to study commencement.

导读：尽管学术和临床对数字自杀预防工具（“数字工具”）感兴趣，但与它们融入现有护理途径相关的挑战仍然存在。本研究的目的是了解年轻人和专业人士如何使用和感知数字工具来管理自杀念头和/或自我伤害行为。方法：本定性研究包括对18-25岁有自杀想法和/或自残行为经历的年轻人（n = 8）以及在青少年自杀和数字干预方面具有临床或研究专业知识的年轻人（n = 9）进行访谈。访谈记录使用反身性主题分析进行分析。结果：分析产生了三个主要主题：(1)弥合支持差距；(2)在处理自杀念头或危机时的用户体验；(3)数字工具实施：期望与现实。此外，子主题是：(i)数字工具固有的独特自杀预防机会，（ii）数字风险管理的复杂性，（iii）围绕污名化话题的隐私考虑，以及（iv）（感知）年轻人的低接受度。结论：用户友好、适应性强和个性化的数字工具可以为预防和管理自杀和自我伤害提供量身定制和及时的支持。然而，糟糕的用户体验、组织支持以及在临床环境之外管理自杀风险数据的困难，对有效实施、扩大规模和持续参与构成了挑战。共同设计等参与性方法可能有助于解决这些问题。患者或公众贡献：本研究的参与者是有过自杀念头和/或自残行为的年轻人，他们使用数字工具来预防自杀。在研究开始之前，研究过程由Orygen青年研究委员会审查。

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