Dataset Information

Identifying Opportunities, and Motivation to Enhance Capabilities, Influencing the Development of a Personalized Digital Health Hub Model of Care for Hip Fractures: Mixed Methods Exploratory Study.

ABSTRACT:

Background

Most older people after a hip fracture injury never return to their prefracture status, and some are admitted to residential aged care facilities. Advancement of digital technology has helped in optimizing health care including self-management and telerehabilitation.

Objective

This study aims to understand the perspectives of older patients with hip fracture and their family members and residential aged caregivers on the feasibility of developing a model of care using a personalized digital health hub.

Methods

We conducted a mixed methods study in South Australia involving patients aged 50 years and older, their family members, and residential aged caregivers. Quantitative data analysis included basic demographic characteristics, and access to digital devices was analyzed using descriptive statistics. Spearman rank-order correlation was used to examine correlations between the perceived role of a personalized digital health hub in improving health and the likelihood of subsequent use. Findings from qualitative analysis were interpreted using constructs of capability, opportunity, and motivation to help understand the factors influencing the likelihood of potential personalized digital health hub use.

Results

This study recruited 100 participants-55 patients, 13 family members, and 32 residential aged caregivers. The mean age of the patients was 76.4 (SD 8.4, range 54-88) years, and 60% (33/55) of the patients were female. Approximately 50% (34/68) of the patients and their family members had access to digital devices, despite less than one-third using computers as part of their occupation. Approximately 72% (72/100) of the respondents thought that personalized digital health hub could improve health outcomes in patients. However, a moderate negative correlation existed with increasing age and likelihood of personalized digital health hub use (Spearman ρ=-0.50; P<.001), and the perceived role of the personalized digital health hub in improving health had a strong positive correlation with the likelihood of personalized digital health hub use by self (Spearman ρ=0.71; P<.001) and by society, including friends and family members (Spearman ρ=0.75; P<.001). Most patients (54/55, 98%) believed they had a family member, friend, or caregiver who would be able to help them use a personalized digital health hub. Qualitative analysis explored capability by understanding aspects of existing knowledge, including willingness to advance digital navigation skills. Access could be improved through supporting opportunities, and factors influencing intrinsic motivation were considered crucial for designing a personalized digital health hub-enabled model of care.

Conclusions

This study emphasized the complex relationship between capabilities, motivation, and opportunities for patients, their family members, and formal caregivers as a patient networked unit. The next stage of research will continue to involve a cocreation approach followed by iterative processes and understand the factors influencing the development and successful integration of complex digital health care interventions in real-world scenarios.

SUBMITTER: Yadav L

PROVIDER: S-EPMC8587193 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BackgroundA recent paradigm shift has led to an explicit focus on enhancing health equity through equity-oriented dissemination and implementation (D&I) research. However, the integration and bidirectional learning across these two fields is still in its infancy and siloed. This exploratory study aimed to examine participants' perceived capabilities, opportunities, and motivations to conduct equity-oriented D&I research.MethodsWe conducted an exploratory cross-sectional survey distributed online from December 2020 to April 2021. Participants were recruited at either D&I or health disparities-oriented conferences, meetings, through social media, or personal outreach via emails. Informed by the Capability, Opportunity, and Motivation Model (COM-B), the survey queried respondents about different aspects of engaging in and conducting equity-oriented D&I research. All analyses were conducted in SPSS Version 27.0.ResultsA total of 180 participants responded to the survey. Most participants were women (81.7%), white (66.1%), academics (78.9%), and faculty members (53.9%). Many reported they were advanced (36.7%) or advanced beginners (27.8%) in the D&I field, and a substantial proportion (37.8%) reported being novice in D&I research that focused on health equity. Participants reported high motivation (e.g., 62.8% were motivated to apply theories, models, frameworks for promoting health equity in D&I research), but low capability to conduct equity-oriented D&I research (e.g., 5% had the information needed for promoting health equity in D&I research). Most participants (62.2%) reported not having used measures to examine equity in their D&I projects, and for those who did use measures, they mainly used individual-level measures (vs. organizational- or structural-level measures). When asked about factors that could influence their ability to conduct equity-oriented D&I research, 44.4% reported not having the skills necessary, and 32.2% stated difficulties in receiving funding for equity-oriented D&I research.ConclusionsStudy findings provide empirical insight into the perspectives of researchers from different backgrounds on what is needed to conduct equity-oriented D&I research. These data suggest the need for a multi-pronged approach to enhance the capability and opportunities for conducting equity-oriented D&I work, such as: training specifically in equity-oriented D&I, collaboration between D&I researchers with individuals with expertise and lived experience with health equity research, funding for equity-oriented D&I research, and recognition of the value of community engaged research in promotion packages.

Project description:BackgroundPerinatal (during pregnancy and up until one year after birth) depression is one of the most common medical complications of pregnancy and is a major public health issue. The common early detection method to identify depression is to systematically administer depression screens to patients during their usual care clinic encounters. This study investigates how prenatal patients perceive depression screening and how screening informs their treatment to meet the specific needs of different racial and ethnic groups within both community and health care settings.MethodsBetween June 2019 and August 2019, semi-structured in-depth interviews were conducted to explore participants' experiences of depression screening with the Edinburgh Postnatal Depression Scale (EPDS). Perinatal women (N = 29) consented to participate in-depth, one-on-one qualitative interviews. Trained patient-researchers (n = 6), women who had previously experienced a perinatal mental health problem, were trained as research team members and facilitated the interviews alongside a research assistant. All interviews were recorded and transcribed verbatim. Data was analyzed with the use of Nvivo12. Thematic network analysis was used to analyze the data.ResultsThrough the in-depth patient engaged qualitative interviews this study uncovered several specific motivators and behaviors related to perinatal depression screening. Using directed content analysis, several themes within a COM-B frame emerged and could be reduced to themes and further divided into two different stages: the depression screening stage and the post-screening stage.ConclusionsThe results of this qualitative study provide information for health care providers to improve, adjust, and assess the process of conducting perinatal depression screening among women. The data also provide information for health care facilities to identify a better screening tool and develop and measure their screening process. These findings are essential to design comprehensive patient-centered screening protocols given the increase in state and federal policies urging universal depression screening.

Project description:BackgroundVarious nerve blocks with local anaesthetic agents have been used to reduce pain after hip fracture and subsequent surgery. This review was published originally in 1999 and was updated in 2001, 2002, 2009 and 2017.ObjectivesThis review focuses on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anaesthesia for hip fracture surgery. We undertook the update to look for new studies and to update the methods to reflect Cochrane standards.Search methodsFor the updated review, we searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8), MEDLINE (Ovid SP, 1966 to August week 1 2016), Embase (Ovid SP, 1988 to 2016 August week 1) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO, 1982 to August week 1 2016), as well as trial registers and reference lists of relevant articles.Selection criteriaWe included randomized controlled trials (RCTs) involving use of nerve blocks as part of the care provided for adults aged 16 years and older with hip fracture.Data collection and analysisTwo review authors independently assessed new trials for inclusion, determined trial quality using the Cochrane tool and extracted data. When appropriate, we pooled results of outcome measures. We rated the quality of evidence according to the GRADE Working Group approach.Main resultsWe included 31 trials (1760 participants; 897 randomized to peripheral nerve blocks and 863 to no regional blockade). Results of eight trials with 373 participants show that peripheral nerve blocks reduced pain on movement within 30 minutes of block placement (standardized mean difference (SMD) -1.41, 95% confidence interval (CI) -2.14 to -0.67; equivalent to -3.4 on a scale from 0 to 10; I2 = 90%; high quality of evidence). Effect size was proportionate to the concentration of local anaesthetic used (P < 0.00001). Based on seven trials with 676 participants, we did not find a difference in the risk of acute confusional state (risk ratio (RR) 0.69, 95% CI 0.38 to 1.27; I2 = 48%; very low quality of evidence). Three trials with 131 participants reported decreased risk for pneumonia (RR 0.41, 95% CI 0.19 to 0.89; I2 = 3%; number needed to treat for an additional beneficial outcome (NNTB) 7, 95% CI 5 to 72; moderate quality of evidence). We did not find a difference in risk of myocardial ischaemia or death within six months, but the number of participants included was well below the optimal information size for these two outcomes. Two trials with 155 participants reported that peripheral nerve blocks also reduced time to first mobilization after surgery (mean difference -11.25 hours, 95% CI -14.34 to -8.15 hours; I2 = 52%; moderate quality of evidence). One trial with 75 participants indicated that the cost of analgesic drugs was lower when they were given as a single shot block (SMD -3.48, 95% CI -4.23 to -2.74; moderate quality of evidence).Authors' conclusionsHigh-quality evidence shows that regional blockade reduces pain on movement within 30 minutes after block placement. Moderate-quality evidence shows reduced risk for pneumonia, decreased time to first mobilization and cost reduction of the analgesic regimen (single shot blocks).

Project description:This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five countries of the European Union plus Sweden (EU6). In 2017, new fragility fractures in the EU6 are estimated at 2.7 million with an associated annual cost of €37.5 billion and a loss of 1.0 million quality-adjusted life years.IntroductionOsteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fractures, which in turn, represent the main consequence of the disease. This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five EU countries and Sweden (designated the EU6).MethodsA series of metrics describing the burden and management of fragility fractures were defined by a scientific steering committee. A working group performed the data collection and analysis. Data were collected from current literature, available retrospective data and public sources. Different methods were applied (e.g. standard statistics and health economic modelling), where appropriate, to perform the analysis for each metric.ResultsTotal fragility fractures in the EU6 are estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; a 23% increase. The resulting annual fracture-related costs (€37.5 billion in 2017) are expected to increase by 27%. An estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures. The current disability-adjusted life years (DALYs) per 1000 individuals age 50 years or more were estimated at 21 years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. The treatment gap (percentage of eligible individuals not receiving treatment with osteoporosis drugs) in the EU6 is estimated to be 73% for women and 63% for men; an increase of 17% since 2010. If all patients who fracture in the EU6 were enrolled into fracture liaison services, at least 19,000 fractures every year might be avoided.ConclusionsFracture-related burden is expected to increase over the coming decades. Given the substantial treatment gap and proven cost-effectiveness of fracture prevention schemes such as fracture liaison services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are appropriately assessed and treated.