Assessing delivery of the five 'As' for patient-centered counseling

The '5As' model of behavior change provides a sequence of evidence-based clinician and office practice behaviors (Assess, Advise, Agree, Assist, Arrange) that can be applied in primary care settings to address a broad range of behaviors and health conditions. Although the 5As approach is becoming more widely adopted as a strategy for health behavior change counseling, practical and standardized assessments of 5As delivery are not widely available. This article provides clinicians and researchers with alternatives for assessment of 5As implementation for both quality improvement, and for research and evaluation purposes, and presents several practical tools they may wish to use. Sample instruments for tracking delivery of the 5As and related tools that are in the public domain are provided to facilitate integration of self-management support into clinical care. We discuss the strengths and limitations of the various assessment approaches. Promising and practical measures to assess the 5As exist for both quality improvement and research purposes. Additional validation is needed on almost all current procedures, and both clinicians and researchers are encouraged to use these instruments and share the resulting data.     

The 5 R’s: An Emerging Bold Standard for Conducting Relevant Research in a Changing World

Research often fails to find its way into practice or policy in a timely way, if at all. Given the current pressure and pace of health care change, many authors have recommended different approaches to make health care research more relevant and rapid. An emerging standard for research, the “5 R’s” is a synthesis of recommendations for care delivery research that (1) is relevant to stakeholders; (2) is rapid and recursive in application; (3) redefines rigor; (4) reports on resources required; and (5) is replicable. Relevance flows from substantive ongoing participation by stakeholders. Rapidity and recursiveness occur through accelerated design and peer reviews followed by short learning/implementation cycles through which questions and answers evolve over time. Rigor is the disciplined conduct of shared learning within the specific changing situations in diverse settings. Resource reporting includes costs of interventions. Replicability involves designing for the factors that may affect subsequent implementation of an intervention or program in different contexts. These R’s of the research process are mutually reinforcing and can be supported by training that fosters collaborative and reciprocal relationships among researchers, implementers, and other stakeholders. In sum, a standard is emerging for research that is both rigorous and relevant. Consistent and bold application will increase the value, timeliness, and applicability of the research enterprise.     

Disparities Rank High in Prioritized Research,Systems and Service Delivery Needs in Missouri

Objectives: An essential function of public health is to conduct research and in Missouri, a research agenda was initiated to promote the health and well being of women and children. In 2005, a survey was emailed to 180 maternal and child health (MCH) researchers throughout the state, with 130 responding for a 72.2% response rate. These individuals were asked to select research priorities out of a list of 130 research agenda items, identify personal areas of expertise, and to recommend new research topics. Results: Results focused on identifying research priorities and research experts. The first, of the five leading research priorities, was researching disparities in terms of age, race, ethnicity, and gender, regarding sexually transmitted diseases, chronic disease, birth outcomes, prenatal care, access to care, childhood exposure to lead, immunizations and vaccinations, mental health, substance abuse, and oral health. The four remaining, of the top five specific research priorities, in order of priority, included (2) reducing barriers to health care access, (3) constructing research ecologically, (4) increasing access to oral health care for children, and (5) reducing the prevalence of children who are at-risk for being overweight. Of the 130 respondents, 83.1% reported at least one area of expertise, with a mean of 7.4 areas of expertise per respondent (range 0–41). Forty percent of the respondents reported health care access as an area of expertise, followed by school health, community development, family support, and pre/post natal care (38.5%, 36.2%, 30.0%, 28.5%, and 26.9%) respectively. Interestingly, only 17.7% of the respondents reported disparities as their area of expertise. Conclusions: The goal of moving innovations towards changes in practice can only happen when resources are available to assess innovations and communities are ready to implement those innovations. The prioritization of this MCH research agenda, prioritized by a community of MCH researchers with expertise in conducting MCH related research, is the first step towards changes in practice, ultimately leading to improvements in the health of women and children in Missouri.     

Technology-enabled knowledge translation: frameworks to promote research and practice

Knowledge translation articulates how new scientific insights can be implemented efficiently into clinical practice to reap maximal health benefits. Modern information and communication technologies can be effective tools to help in the collection, processing, and targeted distribution of information from which clinicians, researchers, administrators, policy makers in health, and the public can benefit. Effective implementation of knowledge translation through the use of information and communication technologies, or technology-enabled knowledge translation (TEKT), would benefit both the individual health professional and the health system. Successful TEKT in health requires cultivation and acceptance in the following key domains: Perceiving types of knowledge and ways in which clinicians acquire and apply knowledge in practice. Understanding the conceptual and contextual frameworks of information and communication technologies applied to health systems, particularly the push, pull, and exchange communication models. Comprehending essential issues in implementation of information and communication technologies and strategies to take advantage of emerging opportunities and overcome existing barriers. Establishing a common and widely acceptable evaluation framework in order that researchers can compare various methodologies in their rightful contexts in TEKT research and adoption. Achieving harmony and common understanding in these areas will go a long way in fostering a fertile and innovative environment to encourage research and advance understanding in this exciting domain of TEKT.     

Closing evidence gaps in general practice & family medicine. Selected Abstracts from the 92nd EGPRN Meeting – Virtual Conference, 30 April to 1 May 2021: All abstracts of the conference can be found at the EGPRN website https://www.egprn.org/page/conference-abstracts

Research in general practice covers the whole of medicine, including clinical and contextual issues. Defining the focus of research is, therefore, not easy. Knowledge and preferences of researchers and funding agencies may dominate above the real problems faced by patients and society. In addition, topic selection and prioritisation are often not coordinated, leading to duplication and research waste. A research agenda could help focus on the issues that matter most.In the Netherlands, we developed a national research agenda involving general practitioners (GPs), researchers, patients and other relevant stakeholders in healthcare. We reviewed knowledge gaps from 90 Dutch general practice guidelines and received input from 48 healthcare stakeholders to formulate research questions relevant for general practice. This resulted in a long list of 787 research questions. These were prioritised by practising GPs (n = 232) in an online survey and in an invitational conference, including GPs (n = 48) and representatives of other stakeholders in healthcare (n = 16). The prioritising procedure resulted in 24 top 10 lists of research questions categorised according to ICPC chapters and overarching themes such as person-centred care, eHealth, and organisation of care. An advisory board composed of general practice research departments representatives, the Dutch College of GPs, GP trainees, and patient organisations supported the whole process.The national research agenda provided an enormous boost in general practice research as well as in collaboration between research departments. A national general practice research programme has been launched to address the questions in the agenda. Collaboration instead of competition between research departments and institutes is encouraged within this programme. They are united in a national consortium supported by the Dutch College of GPs to facilitate collaboration between data registration networks and initiate large-scale multicentered trials.The Dutch general practice research agenda could be an example for other countries and international collaboration. Opportunities to collaborate within the EGPRN to set up an international research agenda are challenging. This could include cross-border themes such as infectious diseases, migrant care, and planetary health. A shared agenda could also increase the chances of obtaining European funding. It is time now for international collaboration in general practice research contributing to health that matters to all.

• Eur J Gen Pract. 2021; 27(1): 354–365.
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• Digital technologies: Opportunities and challenges for better, safer and more equitable primary care

2021; 27(1): 354–365. Published online 2021 Dec 13. doi: 10.1080/13814788.2021.2008352

Digital technologies: Opportunities and challenges for better, safer and more equitable primary care

Ana Luisa NevesAna Luisa NevesCenter for Health Technology and Services Research, University of Porto, Porto, PotugalFind articles by Ana Luisa NevesAuthor information Copyright and License information PMC DisclaimerCenter for Health Technology and Services Research, University of Porto, Porto, PotugalCONTACT moc.liamg@seven.asiul.anaPMC Copyright notice     

The development of a relevant and comprehensive research agenda to improve Hispanic health.

The development of an appropriate research agenda for Hispanics requires progress in three areas: (a) developing an appropriate research infrastructure, (b) increasing the availability of appropriate research instrumentation, and (c) identifying and assigning priority areas. In addition, a Latino health research agenda must identify mechanisms for increasing the number of trained Hispanic researchers and the number of Latino professional staff members at the Department of Health and Human Services. It is recommended that an Office of Hispanic Health be established within the Office of Minority Health at the Department to oversee the implementation of the recommendations made as part of the Surgeon General''s National Hispanic Health Initiative.     

Directions in Implementation Research Methods for Behavioral and Social Science

There is a growing interest, by researchers, policymakers, and practitioners, in evidence-based policy and practice. As a result, more dollars are being invested in program evaluation in order to establish ??what works,?? and in some cases, funding is specifically tied to those programs found to be effective. However, reproducing positive effects found in research requires more than simply adopting an evidence-based program. Implementation research can provide guidance on which components of an intervention matter most for program impacts and how implementation components can best be implemented. However, while the body of rigorous research on effective practices continues to grow, research on implementation lags behind. To address these issues, the Administration for Children and Families and federal partners convened a roundtable meeting entitled, Improving Implementation Research Methods for Behavioral and Social Science, in the fall of 2010. This special section of the Journal of Behavioral Health Services & Research includes papers from the roundtable and highlights the role implementation science can play in shedding light on the difficult task of taking evidence-based practices to scale.     

Beyond Knowledge Transfer: A Model of Knowledge Integration in a Clinical Setting

Current conceptualizations of knowledge transfer reinforce the notion of a linear process between researchers and clinicians, who are seen as operating separately with different agenda. This paper uses a case study to illustrate a dynamic model of knowledge integration involving integrated and interdependent relationships among researchers, clinicians, and decision-makers. We believe the principles of this model are more likely to lead to effective use of research evidence in clinical practice.     

Cognitive apprenticeship in health sciences education: a qualitative review

Cognitive apprenticeship theory emphasizes the process of making expert thinking “visible” to students and fostering the cognitive and meta-cognitive processes required for expertise. The purpose of this review was to evaluate the use of cognitive apprenticeship theory with the primary aim of understanding how and to what extent the theory has been applied to the design, implementation, and analysis of education in the health sciences. The initial search yielded 149 articles, with 45 excluded because they contained the term “cognitive apprenticeship” only in reference list. The remaining 104 articles were categorized using a theory talk coding scheme. An in depth qualitative synthesis and review was conducted for the 26 articles falling into the major theory talk category. Application of cognitive apprenticeship theory tended to focus on the methods dimension (e.g., coaching, mentoring, scaffolding), with some consideration for the content and sociology dimensions. Cognitive apprenticeship was applied in various disciplines (e.g., nursing, medicine, veterinary) and educational settings (e.g., clinical, simulations, online). Health sciences education researchers often used cognitive apprenticeship to inform instructional design and instrument development. Major recommendations from the literature included consideration for contextual influences, providing faculty development, and expanding application of the theory to improve instructional design and student outcomes. This body of research provides critical insight into cognitive apprenticeship theory and extends our understanding of how to develop expert thinking in health sciences students. New research directions should apply the theory into additional aspects of health sciences educational research, such as classroom learning and interprofessional education.     

Social marketing: Should it be used to promote evidence-based health information?

The implementation of public health knowledge is a complex process; researchers focus on organizational barriers but generally give little attention to the format and validity of relevant information. Primary and secondary papers and practice guidelines should represent valid and relevant sources of knowledge for clinicians and others involved in public health. However, this information is usually targeted at researchers rather than practitioners; it is often not completely intelligible, does not explain what it really adds to existing knowledge or which clinical/organizational context to place it in, and often lacks 'appeal' for those who are less informed. Moreover, this information is sometimes founded on biased research, shaped by sponsors to give scientific plausibility to market-driven messages. A "social marketing" approach can help public health researchers make evidence-based information clear and appealing. The validity and relevance of this information can be explained to target readers in light of their own knowledge levels and in terms of how this information could help their practice. In this paper we analyse the barriers to knowledge transfer that are often inherent in the format of the information, and propose a more user-friendly, enriched and non-research-article format.     

Ethics of participation and social inclusion of older persons in research: lessons learned from the COVID-19 pandemic in Singapore

Effectively addressing the coronavirus disease 2019 (COVID-19) pandemic caused by the new pathogen requires continuous generation of evidence to inform decision-making. Despite an unprecedented amount of research occurring globally, the need to identify gaps in knowledge and prioritize a research agenda that is linked to public health action is indisputable. The WHO South-East Asia Region (SEAR) is likely to have region-specific research needs. We aimed to identify a priority research agenda for guiding the regional and national response to the COVID-19 pandemic in SEAR countries. An online, anonymous research prioritization exercise using recent WHO guidance was conducted among the technical staff of WHO’s country and regional offices engaged with the national COVID-19 response during October 2020. They were each asked to contribute up to five priority research ideas across seven thematic areas. These research ideas were reviewed, consolidated and scored by a core group on six parameters: regional specificity, relevance to the COVID-19 response, feasibility within regional research capacity, time to availability for decision-making, likely impact on practice, and promoting equity and gender responsiveness. The total scores for individual suggestions were organized in descending order, and ideas in the upper tertile were considered to be of high priority. A total of 203 priority research ideas were received from 48 respondents, who were primarily research and emergency response focal points in country and regional offices. These were consolidated into 78 research ideas and scored. The final priority research agenda of 27 items covered all thematic areas—health system (n=10), public health interventions (n=6), disease epidemiology (n=5), socioeconomic and equity (n=3), basic sciences (n=1), clinical sciences (n=1) and pandemic preparedness (n=1). This exercise, a part of WHO’s mandate to “shape the research agenda”, can help build a research roadmap ensuring efficient use of limited resources. This prioritized research agenda can act as a catalyst for Member States to accelerate research that could impact the COVID-19 response in SEAR.     

Consumer involvement in health research: a review and research agenda

The involvement of consumers in health research is now Department of Health policy within the UK. Despite the existence of policy directives, there is a dearth of knowledge on the effects of such involvement. This paper critically reviews the state of our knowledge on this issue, and maps out a research agenda with the aim of stimulating systematic, empirical inquiry into consumer involvement in health research. The paper discusses definitions of 'the consumer'; considers why consumer involvement is believed to be important to health research; traces the development of the policy; analyses the epistemological and methodological implications of the policy; discusses the various levels of consumer involvement in research; and outlines the objections to the policy that have been put forward by clinicians and researchers. Four questions were identified during the review as being in need of theoretical and empirical attention: (1) how can consumer involvement in health research be further conceptualised? (2) how and why does consumer involvement influence health research? (3) how can the influence of consumers in health research be measured and evaluated? and (4) what factors are associated with 'successful' consumer involvement in health research?     

Transforming Patient-Centered Care: Development of the Evidence Informed Decision Making through Engagement Model

BackgroundIn response to the passage of the Affordable Care Act in the United States, clinicians and researchers are critically evaluating methods to engage patients in implementing evidence-based care to improve health outcomes. However, most models on implementation only target clinicians or health systems as the adopters of evidence. Patients are largely ignored in these models. A new implementation model that captures the complex but important role of patients in the uptake of evidence may be a critical missing link.DiscussionThrough a process of theory evaluation and development, we explore patient-centered concepts (patient activation and shared decision making) within an implementation model by mapping qualitative data from an elective induction of labor study to assess the model's ability to capture these key concepts. The process demonstrated that a new, patient-centered model for implementation is needed. In response, the Evidence Informed Decision Making through Engagement Model is presented. We conclude that, by fully integrating women into an implementation model, outcomes that are important to both the clinician and patient will improve.ConclusionsIn the interest of providing evidence-based care to women during pregnancy and childbirth, it is essential that care is patient centered. The inclusion of concepts discussed in this article has the potential to extend beyond maternity care and influence other clinical areas. Utilizing the newly developed Evidence Informed Decision Making through Engagement Model provides a framework for utilizing evidence and translating it into practice while acknowledging the important role that women have in the process.     

Understanding the Context of Health for Persons With Multiple Chronic Conditions: Moving From What Is the Matter to What Matters

PURPOSE

An isolated focus on 1 disease at a time is insufficient to generate the scientific evidence needed to improve the health of persons living with more than 1 chronic condition. This article explores how to bring context into research efforts to improve the health of persons living with multiple chronic conditions (MCC).

METHODS

Forty-five experts, including persons with MCC, family and friend caregivers, researchers, policy makers, funders, and clinicians met to critically consider 4 aspects of incorporating context into research on MCC: key contextual factors, needed research, essential research methods for understanding important contextual factors, and necessary partnerships for catalyzing collaborative action in conducting and applying research.

RESULTS

Key contextual factors involve complementary perspectives across multiple levels: public policy, community, health care systems, family, and person, as well as the cellular and molecular levels where most research currently is focused. Needed research involves moving from a disease focus toward a person-driven, goal-directed research agenda. Relevant research methods are participatory, flexible, multilevel, quantitative and qualitative, conducive to longitudinal dynamic measurement from diverse data sources, sufficiently detailed to consider what works for whom in which situation, and generative of ongoing communities of learning, living and practice. Important partnerships for collaborative action include cooperation among members of the research enterprise, health care providers, community-based support, persons with MCC and their family and friend caregivers, policy makers, and payers, including government, public health, philanthropic organizations, and the business community.

CONCLUSION

Consistent attention to contextual factors is needed to enhance health research for persons with MCC. Rigorous, integrated, participatory, multimethod approaches to generate new knowledge and diverse partnerships can be used to increase the relevance of research to make health care more sustainable, safe, equitable and effective, to reduce suffering, and to improve quality of life.     

"We can move forward": challenging historical inequity in public health research in Solomon Islands

Background  

In resource-poor countries, such as Solomon Islands, the research agenda on health is often dominated by researchers from resource-rich countries. New strategies are needed to empower local researchers to set directions for health research. This paper presents a process which seeks to enable a local and potentially more equitable research agenda at a remote hospital in Solomon Islands.     

Lessons Learned and Challenges Ahead: Report from the OCHIN Safety Net West Practice-based Research Network (PBRN)

Introduction: We recently completed a strategic planning process to better understand the development of our 5-year-old practice-based research network (PBRN) and to identify gaps between our original vision and current progress. Although many of our experiences are not new to the PBRN community, our reflections may be valuable for those developing or reshaping PBRNs in a changing health care environment. Lessons Learned: We learned about the importance of (1) shared vision and commitment to a unique patient population; (2) strong leadership, mentorship, and collaboration; (3) creative approaches to engaging busy clinicians and bridging the worlds of academia and community practice; and (4) harnessing data from electronic health records and navigating processes related to data protection, sharing, and ownership. Challenges Ahead: We must emphasize research that is timely, relevant, and integrated into practice. One model supporting this goal involves a broader partnership than was initially envisioned for our PBRN-one that includes clinicians, researchers, information architects, and quality improvement experts partnering to develop an innovation center. This center could facilitate development of relevant research questions while also addressing "quick-turnaround" needs. CONCLUSIONS: Gaps remain between our PBRN's initial vision and current reality. Closing these gaps may require future creativity in building partnerships and finding nontraditional funding sources.     

It's all about relationships: A qualitative study of health researchers' perspectives of conducting interdisciplinary health research

Background  

Interdisciplinary research has been promoted as an optimal research paradigm in the health sciences, yet little is known about how researchers experience interdisciplinarity in practice. This study sought to determine how interdisciplinary research was conceptualized and operationalized from the researcher's perspective and to better understand how best to facilitate interdisciplinary research success.     

Moving from intersection to integration: public health law research and public health systems and services research

Context: For three decades, experts have been stressing the importance of law to the effective operation of public health systems. Most recently, in a 2011 report, the Institute of Medicine recommended a review of state and local public health laws to ensure appropriate authority for public health agencies; adequate access to legal counsel for public health agencies; evaluations of the health effects and costs associated with legislation, regulations, and policies; and enhancement of research methods to assess the strength of evidence regarding the health effects of public policies. These recommendations, and the continued interest in law as a determinant of health system performance, speak to the need for integrating the emerging fields of Public Health Law Research (PHLR) and Public Health Systems and Services Research (PHSSR). Methods: Expert commentary. Findings: This article sets out a unified framework for the two fields and a shared research agenda built around three broad inquiries: (1) the structural role of law in shaping the organization, powers, prerogatives, duties, and limitations of public health agencies and thereby their functioning and ultimately their impact on public health (“infrastructure”); (2) the mechanisms through which public health system characteristics influence the implementation of interventional public health laws (“implementation”); and (3) the individual and system characteristics that influence the ability of public health systems and their community partners to develop and secure enactment of legal initiatives to advance public health (“innovation”). Research to date has laid a foundation of evidence, but progress requires better and more accessible data, a new generation of researchers comfortable in both law and health research, and more rigorous methods. Conclusions: The routine integration of law as a salient factor in broader PHSSR studies of public health system functioning and health outcomes will enhance the usefulness of research in supporting practice and the long‐term improvement of system performance.     

Social scientists and patient safety: Critics or contributors?

Patient safety has been high on the national and international agenda in healthcare for almost a decade. It is proving to be a tough problem; tough in cultural, technical, clinical, and psychological terms and because of its massive scale and heterogeneity. While many of the challenges and problems of patient safety are social and organisational, few social scientists are involved in patient safety. Clinicians and clinical researchers are for the most part open to other perspectives, but that they may not fully appreciate the potential contribution of the social sciences. Social scientists can, for instance, assist in drawing attention to the need to take an account of the social and cultural context of patient safety interventions, by drawing on narratives and stories to illuminate organisational processes and by encouraging greater use of ethnographic and observational research. However, if social scientists are to have a real impact they need to do more than simply offer critiques of patient safety and move to active engagement with clinicians and patient safety researchers.