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Development of a Peer Support Model Using Experience-Based Co-Design to Improve Critical Care Recovery.

ABSTRACT: To use experience-based co-design to identify the key design requirements of a peer support model for critical care survivors; understand the use of the experience-based co-design method from clinician, patients, and family perspectives. Design:Using experience-based co-design, qualitative data about participants' preferences for a peer support model were generated via workshops. Participants' perspectives of experience-based co-design were evaluated with focus groups. Setting:University-affiliated hospital in Melbourne, Australia. Subjects:Snowball sampling was used to recruit clinicians from across the care spectrum (ICU-community); critical care survivors and nominated family members were recruited using convenience sampling. Measurements and Main Results:Consensus on a peer support model was reached through the experience-based co-design process, with the following key themes: 1) socialization and group cohesion; 2) management of potential risks; and 3) individualized needs of patients and families. Evaluation of participants' perspectives of the experience-based co-design method identified five key themes: 1) participation as a positive experience; 2) emotional engagement in the process; 3) learning from patients and family members; 4) feeling heard; and 5) practical challenges of experience-based co-design and readiness to participate. Conclusions:Experience-based co-design was a feasible approach to developing a peer support model for use with critical care survivors and was well received by participants. Future testing of the co-designed peer support model in a pilot randomized controlled trial will enhance understanding of peer support in critical care and the use of experience-based co-design as a design methodology.

SUBMITTER: Haines KJ

PROVIDER: S-EPMC7063862 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Development of a Peer Support Model Using Experience-Based Co-Design to Improve Critical Care Recovery.

Haines Kimberley J KJ Holdsworth Clare C Cranwell Kathryn K Skinner Elizabeth H EH Holton Sara S MacLeod-Smith Belinda B Bates Samantha S Iwashyna Theodore J TJ French Craig C Booth Sarah S Carmody Jacki J Henningham Lucy L Searle Grey G Shackell Melina M Maher Lynne L

Critical care explorations 20190322 3

To use experience-based co-design to identify the key design requirements of a peer support model for critical care survivors; understand the use of the experience-based co-design method from clinician, patients, and family perspectives.<h4>Design</h4>Using experience-based co-design, qualitative data about participants' preferences for a peer support model were generated via workshops. Participants' perspectives of experience-based co-design were evaluated with focus groups.<h4>Setting</h4>Univ ...[more]

PMID: 32166251

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Project description:BackgroundDespite the increasing use of mobile health (mHealth) services, such as mHealth apps or SMS text messaging services, that support the patient self-management of chronic conditions, many existing mHealth services lack theoretical guidance. In addition, although often the target audience for requirement acquisition at the initial mHealth app design stage, it is a common challenge for them to fully conceptualize their needs for mHealth services that help self-manage chronic conditions.ObjectiveThis study proposes a novel co-design approach with the initial requirements for mHealth services proposed by clinicians based on their experiences in guiding patients to self-manage chronic conditions. A design case is presented to illustrate our innovative approach to designing an mHealth app that supports the self-management of patients with obesity in their preparation for elective surgery.MethodsWe adopted a clinician-led co-design approach. The co-design approach consisted of the following four cyclic phases: understanding user needs, identifying an applicable underlying theory, integrating the theory into the prototype design, and evaluating and refining the prototype mHealth services with patients. Expert panel discussions, a literature review, intervention mapping, and patient focus group discussions were conducted in these four phases.ResultsIn stage 1, the expert panel proposed the following three common user needs: motivational, educational, and supportive needs. In stage 2, the team selected the Social Cognitive Theory to guide the app design. In stage 3, the team designed and developed the key functions of the mHealth app, including automatic push notifications; web-based resources; goal setting and monitoring; and interactive health-related exchanges that encourage physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. Push notifications were designed in response to a patient's risk level, as informed by the person's response to a baseline health survey. In stage 4, the prototype mHealth app was used to capture further requirements from patients in the two focus group discussions. Focus group participants affirmed the potential benefits of the app and suggested more requirements for the function, presentation, and personalization needs. The app was improved based on these suggestions.ConclusionsThis study reports an innovative co-design approach that was used to leverage the clinical experiences of clinicians to produce the initial prototype app and the approach taken to allow patients to effectively voice their needs and expectations for the mHealth app in a focus group discussion. This approach can be generalized to the design of any mHealth service that aims to support the patient self-management of chronic conditions.

Project description:INTRODUCTION:This study will evaluate the effectiveness of an innovative peer support programme. The programme incorporates leadership training, mentorship, recognition and reward systems for peer support workers, and supportive/reminder text messaging for patients discharged from acute (hospital) care. We hypothesise that patients enrolled in the peer support system plus daily supportive/reminder text messages condition will achieve superior outcomes in comparison to other groups. METHODS AND ANALYSIS:This is a prospective, rater-blinded, four-arm randomised controlled trial. 180 patients discharged from acute psychiatric care in Edmonton, Alberta, Canada will be randomised to one of four conditions: (1) enrolment in a peer support system; (2) enrolment in a peer support system plus automated daily supportive/reminder text messages; (3) enrolment in automated daily supportive/reminder text messages alone; or (4) treatment as usual follow-up care. Patients in each group will complete evaluation measures (eg, recovery, general symptomatology and functional outcomes) at baseline, 6 months and 12months. Patient service utilisation data and clinician-rated measures will also be used to gauge patient progress. Patient data will be analysed with descriptive statistics, repeated measures and correlational analyses. The peer support worker experience will be captured using qualitative methods. ETHICS AND DISSEMINATION:The study will be conducted in accordance with the Declaration of Helsinki (Hong Kong Amendment) and Good Clinical Practice (Canadian Guidelines). The study has received ethical clearance from the Health Ethics Research Board of the University of Alberta (Ref # Pro00078427) and operational approval from our regional health authority (AHS- (PRJ) #35293). All participants will provide informed consent prior to study inclusion. The results will be disseminated at several levels, including patients/peer supports, practitioners, academics/researchers, and healthcare organisations. TRIAL REGISTRATION NUMBER:NCT03404882; Pre-results.

Project description:BackgroundPharmacogenetics can impact patient care and outcomes through personalizing the selection of medicines, resulting in improved efficacy and a reduction in harmful side effects. Despite the existence of compelling clinical evidence and international guidelines highlighting the benefits of pharmacogenetics in clinical practice, implementation within the National Health Service in the United Kingdom is limited. An important barrier to overcome is the development of IT solutions that support the integration of pharmacogenetic data into health care systems. This necessitates a better understanding of the role of electronic health records (EHRs) and the design of clinical decision support systems that are acceptable to clinicians, particularly those in primary care.ObjectiveExplore the needs and requirements of a pharmacogenetic service from the perspective of primary care clinicians with a view to co-design a prototype solution.MethodsWe used ethnographic and think-aloud observations, user research workshops, and prototyping. The participants for this study included general practitioners and pharmacists. In total, we undertook 5 sessions of ethnographic observation to understand current practices and workflows. This was followed by 3 user research workshops, each with its own topic guide starting with personas and early ideation, through to exploring the potential of clinical decision support systems and prototype design. We subsequently analyzed workshop data using affinity diagramming and refined the key requirements for the solution collaboratively as a multidisciplinary project team.ResultsUser research results identified that pharmacogenetic data must be incorporated within existing EHRs rather than through a stand-alone portal. The information presented through clinical decision support systems must be clear, accessible, and user-friendly as the service will be used by a range of end users. Critically, the information should be displayed within the prescribing workflow, rather than discrete results stored statically in the EHR. Finally, the prescribing recommendations should be authoritative to provide confidence in the validity of the results. Based on these findings we co-designed an interactive prototype, demonstrating pharmacogenetic clinical decision support integrated within the prescribing workflow of an EHR.ConclusionsThis study marks a significant step forward in the design of systems that support pharmacogenetic-guided prescribing in primary care settings. Clinical decision support systems have the potential to enhance the personalization of medicines, provided they are effectively implemented within EHRs and present pharmacogenetic data in a user-friendly, actionable, and standardized format. Achieving this requires the development of a decoupled, standards-based architecture that allows for the separation of data from application, facilitating integration across various EHRs through the use of application programming interfaces (APIs). More globally, this study demonstrates the role of health informatics and user-centered design in realizing the potential of personalized medicine at scale and ensuring that the benefits of genomic innovation reach patients and populations effectively.

Project description:BackgroundPeer support is an emotional, social, and practical help provided by nonprofessionals to assist others in sustaining health behaviors. Peer support is valued in recovery-oriented models of mental health and is becoming increasingly implemented at the organizational level. Text messaging is a relatively low-cost, high-impact, and easily scalable program that uses existing technology, is devoid of geographic barriers, and is easily accessible to end users.ObjectiveThis study aims to evaluate the effectiveness of an innovative peer support system plus a supportive text messaging program on the recovery of discharged patients from acute psychiatric care.MethodsThis prospective, rater blinded, controlled observational study included 181 patients who were discharged from acute psychiatric care. Patients were randomized to one of four conditions: treatment as usual (follow-up care), daily supportive text messages only, peer support only, or peer support plus daily supportive text messages. A standardized self-report measure of recovery (Recovery Assessment Scale [RAS]) was completed at baseline, 6 weeks, 3 months, and 6 months. Descriptive analysis, one-way analysis of variance, and repeated measures multivariate analysis of covariance were used to examine the changes in the RAS among the study groups and over the follow-up time points.ResultsA total of 65 patients completed the assessments at each time point. For the overall sample, higher scores were found for the peer support plus text message condition compared with the text message only and treatment as usual condition on several scales (ie, willingness to ask for help and personal confidence and hope) and total score on the RAS, after 6 months of intervention.ConclusionsPeer support plus supportive text messaging seems to result in improved recovery compared with other interventions. It may be advisable to incorporate the two interventions as part of routine practice for patients with psychiatric disorders upon hospital discharge.

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Development of a Peer Support Model Using Experience-Based Co-Design to Improve Critical Care Recovery.

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Development of a Peer Support Model Using Experience-Based Co-Design to Improve Critical Care Recovery.

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