Integrated Care Interventions Research Articles

Family Support and Type 2 Diabetes Self-management Behaviors in Underserved Latino/a/x Patients.

Latino/a/x families experience persistent Type 2 diabetes mellitus (T2DM) disparities, including higher rates of diagnosis and mortality due to disease complications than their non-Hispanic White counterparts. Though greater social support is associated with improved disease outcomes for Latino/a/x patients with diabetes, research has yet to identify the specific pathways through which social support, and specifically family support, influences self-management. This study tested a theoretical model highlighting the mechanisms and pathways linking social support and physical health. Specifically, self-efficacy and depression were tested as psychological pathways connecting family support to diabetes self-management behaviors and diabetes morbidity in Latino/a/x patients with T2DM. Data from 177 patients were analyzed using structural equation modeling. Measures included diabetes-specific family support needed and received, depressive symptoms, self-efficacy in diabetes management, diabetes self-management behaviors, health appraisal, and hemoglobin A1c. Greater diabetes-specific family support was significantly associated with more frequent engagement in diabetes self-management behaviors, both directly (p < .001) and through diabetes self-efficacy's partial mediation of this relationship (p = .013). Depression was not significantly associated with either family support (support received, p = .281; support needed, p = .428) or self-management behaviors (p = .349). Family support and diabetes self-efficacy may be important modifiable psychosocial factors to target via integrated care interventions aimed at supporting Latino/a/x patients with T2DM. Future research is needed to test empirically based, culturally adapted interventions to reduce T2DM-related health disparities in this population.

Intrinsic capacity and hospitalization among older adults: a nationally representative cross-sectional study.

Monitoring intrinsic capacity (IC) in community-dwelling older people can be potentially used to alert for adverse health outcomes. However, whether there is an association between IC and hospitalization has yet to be fully explored. This study aimed to investigate the association of the IC composite measure and its 5 domains with hospitalization in the previous year and length of hospital stay. We conducted cross-sectional analyses using data from a representative sample of community-dwelling adults (≥ 65years). We assessed the IC domains (vitality, locomotor, cognitive, sensory, and psychological) using validated self-reported information and performance tests. We calculated standardized estimated scores (z scores) for IC composite measure and domains and conducted multivariate logistic and ordinal regressions. The primary outcomes were hospitalizations in the previous year and length of hospital stay. In a sample of 5354 participants (mean age = 73 ± 6years), we found that participants with high IC composite z scores were less likely to have experienced hospitalization in the previous year (OR = 0.51; 95% CI = 0.44-0.58). Among those who were hospitalized, high IC scores were associated with short stays (OR = 0.87; 95% CI = 0.80-0.95). Cognitive and psychological domains were associated with hospitalizations, and the locomotor domain was related to length of hospital stay. The vitality domain was associated with both outcomes. IC as a composite measure was associated with previous hospitalizations and length of stay. IC can help clinicians identify older people prone to adverse outcomes, prompting preventive integrated care interventions.

Understanding adaptive tasks in cardiac rehabilitation among patients with acute myocardial infarction: a qualitative study

Background While Cardiac Rehabilitation (CR) programs have shown effectiveness in improving cardiac outcomes, there is limited understanding of how patients perceive and adapt to these interventions. Furthermore, alternative modes of delivering CR that have received positive evaluations from participants remain underexplored, yet they have the potential to enhance CR uptake. Objectives To explore the patient experience in CR programmes following Acute Myocardial Infarction (AMI) and describe their adaptive processing. Patients and Methods This qualitative study was conducted at a nationally certified centre in China between July 2021 and September 2022, encompassing three stages: in-hospital, centre-based, and home-based CR programs. Purposive sampling was used to select eligible AMI patients for in-depth semi-structured interviews. The interview outline and analytical framework were aligned with the key concepts derived from the middle-range theory of adaptation to chronic illness and the normalization process theory. The findings were reported following the Consolidated Criteria for Reporting Qualitative Research checklist. Results Forty AMI patients were recruited. Four main themes describing the process of AMI patients normalizing CR intervention were identified, including (1) experiencing CR service driving by role’s responsibilities, (2) engaging in collaborative relationship based on interpersonal trust, (3) exploring a personalized rehabilitation plan by complex integration, and (4) expecting a promised outcome to shape decision-making. Conclusion Integrated care interventions for AMI patients could benefit from a collaborative co-designed approach to ensure that CR interventions are normalized and fit into patients’ daily lives. Organizational-level CR services should align with the rehabilitation needs and expectations of patients.

Integrated Care Models for Older Adults with Depression and Physical Comorbidity: A Scoping Review.

Multimorbidity is a growing challenge in the care for older people with mental illness. To address both physical and mental illnesses, integrated care management is required. The purpose of this scoping review is to identify core components of integrated care models for older adults with depression and physical comorbidity, and map reported outcomes and implementation strategies. PubMed, EMBASE, CINAHL and Cochrane Library were searched independently by two reviewers for studies concerning integrated care interventions for older adults with depression and physical comorbidity. We used the SELFIE framework to map core components of integrated care models. Clinical and organisational outcomes were mapped. Thirty-eight studies describing thirteen care models were included. In all care models, a multidisciplinary team was involved. The following core components were mainly described: continuity, person-centredness, tailored holistic assessment, pro-activeness, treatment interaction, individualized care planning, and coordination tailored to complexity of care needs. Twenty-seven different outcomes were evaluated, with more attention given to clinical than to organisational outcomes. The core components that comprise integrated care models are diverse. Future studies should focus more on implementation aspects of the intervention and describe financial parts, e.g., the cost of the intervention for the healthcare user, more transparently.

Barriers and enablers of integrated care in the UK: a rapid evidence review of review articles and grey literature 2018-2022.

Integrated care refers to person-centered and coordinated, health and social care, and community services. Integrated care systems are partnerships of organizations that deliver health and care services which were placed on a statutory footing in England, April 2022. Due to the need for fast, accessible, and relevant evidence, a rapid review was conducted according to World Health Organization methods to determine barriers and enablers of integrated care across the United Kingdom, 2018-2022. Nine databases were searched for review articles reporting evaluation of integrated care interventions involving medical (clinical and diagnostic) and nonmedical (public health services and community-based or social care/person-centred care) approaches, quality checked with the Critical Appraisal Skills Program qualitative checklist. OpenGrey and hand searches were used to identify grey literature, quality checked with the Authority, Accuracy, Coverage, Objectivity, Date, and Significance checklist. Thirty-four reviews and 21 grey literature reports fitted inclusion criteria of adult physical/mental health outcomes/multiple morbidities. Thematic analysis revealed six themes (collaborative approach; costs; evidence and evaluation; integration of care; professional roles; service user factors) with 20 subthemes including key barriers (cost effectiveness; effectiveness of integrated care; evaluation methods; focus of evidence; future research; impact of integration) and enablers (accessing care; collaboration and partnership; concept of integration; inter-professional relationships; person-centered ethos). Findings indicated a paucity of robust research to evaluate such interventions and lack of standardized methodology to assess cost effectiveness, although there is growing interest in co-production that has engendered information sharing and reduced duplication, and inter-professional collaborations that have bridged task-related gaps and overlaps. The importance of identifying elements of integrated care associated with successful outcomes and determining sustainability of interventions meeting joined-up care and preventive population health objectives was highlighted.

Integrated care models for older adults with depression and physical multimorbidity: a scoping review

Objective: Multimorbidity, the coexistence of multiple chronic conditions occurring in one person at the same time, where one is not a known complication of the other, is a growing challenge in the care for older people with mental illness. In order to address both physical and mental illnesses in older people, integrated care management is required. The purpose of this scoping review was to provide a comprehensive overview of integrated care models for older adults (60+) with depression and physical multimorbidity. We identified the core components of the examined integrated care models and mapped the reported outcomes and implementation strategies.&#x0D; Methods and analysis: We followed the methodology of Arksey and O’Malley’s. MEDLINE, EMBASE, CINAHL and Cochrane Library were searched independently by two reviewers from inception to May 2022. Studies composed in English or Dutch concerning integrated care interventions for older adults with major depression and physical multimorbidity were included. We used the micro-level SELFIE framework to map the core concepts of integrated care models. Outcomes were divided in person-centered and service themes.&#x0D; Results: After title and abstract and subsequent full-text screening, 38 studies were included describing 13 different care models. The majority (n=21) were randomized controlled trials, followed by observational studies (n=6), study protocols (n=5), qualitative studies (n=4), and feasibility studies (n=2). Studies were conducted in the North-America (n=28), Europe (n=6), Asia (n=3) and Australia (n=1). In all care models, a multidisciplinary team with a care coordinator was involved. Also treatment interaction, continuity of care, individualized care planning, tailored holistic assessment and self-management support were elements of all care models. Informal care giver involvement and shared decision making were less often described as core elements. Discrepancy was detected in the information systems and technology that different care models used. Only seven care models reported on financial aspects of the intervention, e.g. the reimbursement on participation or the provision of financial incentives.&#x0D; A total of 32 different outcomes were evaluated in the primary studies. Patient outcomes, e.g. functional status and depression symptoms, are well described by all care models. In contrast, little attention is paid to service outcomes such as emergency department visits or therapy attendance. Only two studies briefly described the implementation strategies used in the study.&#x0D; Conclusion: The core elements that comprise integrated care models are diverse. Future studies should focus more on implementation aspects of the intervention and describe financial parts, e.g. the cost of the intervention for the healthcare user, more transparently.&#x0D; Key words: Collaborative care, integrated care, psychosomatic medicine, geriatric psychiatry, care models

Workshop launch of the IJIC Thematic issue on scale-up of integrated care interventions for chronic diseases in three diverse settings.

Chronic diseases – such as Type 2 Diabetes (T2D) and hypertension (HTN) – are on the rise globally, regardless of country income levels. A vast range of policy initiatives and interventions stimulates principles of integrated care – to prevent and manage T2D and HTN. These integrated care interventions, shown to be effective in small-scale settings, whilst mostly not technically nor medically complex, tend to be organizationally challenging: they require system changes and coordinated actions from different actors and institutions to achieve maximal effect.&#x0D; The global challenges common to many health systems call for an analysis across contexts. Through reciprocal learning of new avenues towards integrated care between different projects and contexts, we aim to increase the understanding of the relationships between context, intervention, implementation and impact. The ‘Scaling up an integrated care package for diabetes and hypertension for vulnerable people in Cambodia, Belgium &amp; Slovenia (SCUBY; https://scuby.eu)’ project funded by the European Commission), aims to address the above-cited challenges through roadmaps to scale-up clearly defined, evidence-based, integrated care interventions. These interventions, comprising of (a) early detection and diagnosis, (b) treatment in primary care services, (c) health education, (d) self-management support to patients and caregivers, and (e) collaboration between caregivers, compose an ‘integrated care package’ (ICP). The project implements and evaluates the scale-up of the ICP in purposively selected types of health systems: a developing health system in a lower middle-income country (Cambodia); a centrally steered health system in a high-income country (Slovenia); and a publicly funded highly privatized health-care health system in a high-income country (Belgium). Country-specific scale-up strategies are co-developed and implemented together with a wide range of stakeholders, including policy makers, health care professionals, community groups and patients (organizations). The ensuing evaluation assesses changes in the structure, process and outcomes of care. A three-dimensional framework evaluates scale-up along three axes: (1) increase in population coverage; (2) expansion of the ICP; and (3) integration of the ICP into the health system referring to the degree to which governance arrangements, organization, financing and service delivery allow the ICP to be adopted and diffused in the health system.&#x0D; The SCUBY project aims to provide guidance for scaling-up practices of integrated care interventions through a compilation of articles in a thematic issue in the International Journal of Integrated Care with a focus on chronic diseases in a variety of contexts. The aims of this workshop will be: 1) to provide an overview of the present state of the art of research of scale-up of integrated care; 2) to launch the thematic issue; and 3) to reflect and exchange with researchers, policy makers and beneficiaries.&#x0D; Session organization: Part 1) Bird’s eye on the research landscape (Viktoria Stein, 10 min). Part 2) Launch: Presenting the special issue and contributions to the field (Kerstin Klipstein-Grobusch, 15 min). Part 3) Panel discussion with 6 people (2 SCUBY researchers, 2 policy makers, 2 beneficiaries, led by Jason Yap, 45 min). Part 4) Open interaction with audience and synthesis (workshop leader, 15 min).

Integrated care for people and families living with Parkinson's, Huntington's and Multiple Sclerosis: A systematic review

People living with long term neurological conditions have complex needs that demand coordination of care across different health and social care sectors, however there is uncertainty in how to deliver integrated care and its impact on people.&#x0D; Our research is focused on patients and caregivers living with long term neurological conditions, specifically with Parkinson’s disease (PD), Multiple Sclerosis (MS) and Huntington’s Disease (HD).&#x0D; We developed the review questions and interpreted the results of the review with a patient and public involvement group composed of people with lived experience of long term conditions. The group identified three important problems with their care: fragmentation (services are not joined-up missing important needs), duplication (repetition of assessments) and lack of continuity (changes in staff and difficulty in knowing who to contact). These areas prompted us to identify the key characteristics of successful integrated care programmes in the literature and which benefits were brought to people.&#x0D; We undertook a systematic review of the literature searching CINAHL, Cochrane, Embase, PsycINFO, Medline, Web of Science and Google Scholar of all published studies (from Jan 1, 2000 to Sep 30, 2021) testing multisectoral integrated care interventions in people living with PD, MS and HD. Articles published in English, Portuguese, Spanish and German were considered. We supplemented this with snowballing technique, hand and grey literature searches. Evidence was graded for strength (or certainty) for each outcome measure.&#x0D; Our review identified 15 papers across 5 countries and a total of 2095 patients and caregivers were included. Analysis indicated that multisectoral integrated care programmes can improve people’s access to resources and patients’ mood (by reducing depression). UK studies indicated improvements in patients’ quality of life, although the international literature was inconclusive. To date, few programmes considered benefits for caregivers; studies that did, reported no differences or even a decline on caregivers’ outcomes. Evidence identified was inconsistent or limited regarding all other outcomes reported. Overall, the literature has a limited consideration of effects on people living with PD and MS, namely, needs being met and continuity of care; to date, no empirical research has focussed on people living with HD. Successful programmes for people with PD and MS were characterised by four facilitating factors:&#x0D; • Expert knowledge&#x0D; • Multi-sectoral care coordination&#x0D; • Care continuity&#x0D; • Person-centred approach&#x0D; Hindering factors were related to logistics for care delivery, such as issues with data access and care transition between different providers.&#x0D; To date, limited evidence exists to support the benefits of multisectoral integrate care programmes from the perspective of patients and caregivers. By focusing on metrics that do not reflect people’s experiences and how well people’s needs are being met, the true impact of these programmes is lost, and with it, the opportunity to advise policies for best service delivery in practice.&#x0D; Future studies should investigate integrated care from the perspective of patients and caregivers, to measure impact at user-level. This is relevant across all conditions. Furthermore, more research is needed in vulnerable groups and people living with rare complex conditions such as HD.

Social workers are key to addressing social determinants of health in integrated care settings

ABSTRACT Social workers play an important role in assessing social determinants of health (SDH) and providing behavioral health services in integrated care settings. Evidence suggests that integrated care interventions improve quality of life and other patient outcomes. However, the ambiguous role of social workers on the interdisciplinary team, the lack of protocol in SDH screening and intervention, and restrictions due to healthcare reimbursement limit social workers’ ability to intervene. Future directions include standardizing integrated care models, evaluating integrated care’s efficacy to address SDH, incorporating SDH into interprofessional training including role clarification and reimbursing for SDH assessment and intervention.

Assessing tenant health amid social housing redevelopment: lessons from a pilot project.

To trial methods for a future longitudinal study to: a) assess how the redevelopment of a large social housing estate affects the health of tenants; and b) act on health needs identified throughout the redevelopment. Type of program or service: Self-reported health assessment with referral to community-based link worker. Participants recruited from the tenant population completed (online or face-to-face) a health questionnaire covering self-reported health status and behaviours, housing conditions, sense of community, and demographics. Those identified as being at moderate/high risk of psychological distress and/or alcohol use disorder were contacted by a community-based link worker, who connected them with health/human services as appropriate. A total of 24 tenants were recruited for the pilot study against a target sample size of 50. The health questionnaire and referral process worked as expected, with no issues reported. This pilot study successfully trialled methods for: a) assessing tenants' health; and b) referring those identified as being likely to have unmet health service needs to a community-based link worker, leveraging existing collaborations between academics, the local health district and community groups. Fewer tenants than expected, and none aged younger than 35 years, participated in the survey. Furthermore, the substantial number of suspicious/fraudulent responses was not anticipated. Recruitment and data collection approaches must be reviewed to address these issues if this study is to be scaled up. Although only a pilot project, we connected several tenants who had unmet health needs with a health service. While it is impossible to generalise from our small sample, the number of referrals (one-quarter of participants) indicates a potentially large unmet need for health services in the community. It highlights the importance of link workers or other person-centred integrated care interventions in social housing populations.

Correlating Access to Primary Medical Care and Veterinary Care Providers: A Novel Application of Spatial Gravity Modelling.

Increasingly, health professionals are recognizing the need for a more holistic, or One Health, approach to wellness. Companion animals share the lives and homes of many Americans, and yet little research exists on the intersection of disparities of access to veterinary care and access to human health care. This research aims to fill that gap by exploring the use of a spatial model that identifies the relationship of supply and demand while also considering reductions as a function of travel time to a care facility. Four counties in Alabama were analyzed at the census tract level to determine the supply of primary care physicians and veterinary care providers. This research provides a unique application of the Enhanced Two-Step Floating Catchment Area model by independently examining access to each type of care and then comparing both access supply values at the census level. Results indicated a statistically significant positive relationship between access to both types of care, implying areas with lower access to primary care have concomitantly low access to veterinary care. Implications for practice include the introduction of this methodological approach, identification of future parameter specification research to improve the approach, and identification of an area of significant concern in the One Health framework. Further, the results can inform solution strategies such as offering integrated care interventions for both humans and their companion animal household members with direct use for policymakers aimed at increasing equitable access to health care across the One Health spectrum.

The impact of nurse-led nonpharmacological multidisciplinary holistic nursing care on fatigue patients receiving hemodialysis: a randomized, parallel-group, controlled trial

BackgroundFatigue is a symptom characterized by an elevated prevalence in patients undergoing hemodialysis, which may cause extreme mental and muscular debilitation, significantly influencing social interaction, life quality and well-being. However, the significance of fatigue to patients undergoing hemodialysis has not been recognized yet, and prevention and management of fatigue in this population have not been thoroughly investigated. Additionally, previous studies mainly focused on muscular fatigue, while mental fatigue has been seldom discussed. This study aims to investigate the interaction between nurses and multidisciplinary of nonpharmacological integrated care interventions (NICIs) and assess the impact of fatigue on patients undergoing hemodialysis.MethodsThe integrative nonpharmacological care interventions in this study included walking, motivational interviewing (MI) and health education regarding behavioral self-management. A single-center randomized controlled trial was conducted in the dialysis center of the nephrological department in a tertiary affiliated hospital of medical university from January to June 2019. A total of 118 patients were selected and randomly divided into the intervention group (IG) and the control group (CG). Four patients dropped out during the study, and 114 patients were enrolled for the eventual analysis. The 60 patients in the IG received routine nursing combined with integrated care interventions, while the 54 patients in the CG received routine nursing only. This study lasted for six months.ResultsThe experimental group exhibited significant reductions of overall fatigue (2.26 vs. 0.48), mental fatigue (1.41 vs. 0.54), muscular fatigue (2.13 vs. 0.75), and some biochemical indicators (e.g., serum urea) (P<0.05), compared with the CG.ConclusionsNurses and multidisciplinary teams have been demonstrated to play a key role and interplay function in chronic disease management. Hence, the nurse-led multidisciplinary NICIs significantly alleviated total fatigue (muscular fatigue and mental fatigue) and improved other parameters.Trial registrationChiCTR-IOR-16008621 (March 18, 2016)

Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study

IntroductionHealthcare fragmentation, a main cause for delay in cancer diagnosis and treatment, contributes to high mortality in Latin America (LA), particularly among disadvantaged populations. This research focuses on integrated care...

Effectiveness of community-based multidisciplinary integrated care for older people: a protocol for a systematic review

IntroductionThe increasing number of older adults with multiple complex care needs has placed increased pressure on healthcare systems internationally to reorientate healthcare delivery. For many older adults, their first point...

The effect of an integrated care intervention of multidisciplinary mental health treatment and employment services for trauma-affected refugees: study protocol for a randomised controlled trial

BackgroundThe complexity of past trauma and ongoing post-migration stressors challenges the existing mental health treatment for trauma-affected refugees. Therefore, interventions are needed to accommodate these complex challenges in mental health treatment. This study examines the effect of an add-on integrated care intervention compared to treatment as usual (TAU) for trauma-affected refugees in a randomised controlled trial (RCT).MethodsThe study is carried out at a Danish outpatient clinic and will include 197 treatment-seeking refugees with post-traumatic stress disorder (PTSD) who are unemployed and affiliated with municipal employment services. Mental health TAU comprises 10 sessions with a medical doctor (pharmacological treatment and psychoeducation) and 16–20 sessions with a psychologist (manual-based cognitive behavioural therapy) for a period of 8 to 12 months. The add-on intervention strengthens coordination between mental health treatment and employment interventions with three cross-sectoral collaborative meetings during the mental health treatment. The integrated care intervention draws attention to the bidirectional impact of mental health problems and post-migration stressors and focuses on cross-sectoral shared plans. The primary outcome is functioning, measured by WHODAS 2.0, the interviewer-administered 12-item version, with secondary outcomes measuring quality of life, mental health symptoms, and post-migration stressors.DiscussionThe RCT is novel in intervention design for trauma-affected refugees and will bring forward new perspectives and knowledge of integrated care interventions for trauma-affected refugees. The integrated care intervention is expected to reduce post-migration stressors that negatively affect the treatment of trauma-related mental health problems, thereby improving preconditions for enhanced treatment outcomes. The intervention builds on existing practices in the Danish healthcare and employment sectors, which ensures high scalability and sustainability for future practices.Trial registrationClinicalTrials.gov Identifier: NCT04244864, registered 28 January 2020. Protocol version: 17 September 2022, version 2.

The effects of multi-disciplinary integrated care on healthcare utilization: Evidence from a natural experiment in the UK.

Better integration is a priority for most international health systems. However, multiple interventions are often implemented simultaneously, making evaluation difficult and providing limited evidence for policy makers about specific interventions. We evaluate a common integrated care intervention, multi-disciplinary group (MDG) meetings for discussion of high-risk patients, introduced in one socio-economically deprived area in the UK in spring 2015. Using data from multiple waves of the national GP Patient Survey and Hospital Episode Statistics, we estimate its effects on primary and secondary care utilization and costs, health status and patient experience. We use triple differences, exploiting the targeting at people aged 65years and over, parsing effects from other population-level interventions implemented simultaneously. The intervention reduced the probability of visiting a primary care nurse by three percentage points and decreased length of stay by 1day following emergency care admission. However, since planned care use increased, overall costs were unaffected. MDG meetings are presumably fulfilling public health objectives by decreasing length of stay and detecting previously unmet needs. However, the effect of MDGs on health system cost is uncertain and health remains unchanged. Evaluations of specific integrated care interventions may be more useful to public decision makers facing budget constraints.

Impact of multimorbidity and complex multimorbidity on mortality among older Australians aged 45 years and over: a large population-based record linkage study

ObjectivesMultimorbidity (MM, co-occurrence of two or more chronic conditions) and complex multimorbidity (CMM, three or more chronic conditions affecting three or more different body systems) are used in the assessment...

Crisis and mental health of working women: risk factors and integrated care interventions based on organizational, individual, and institutional partnership

PurposeCrises can weigh heavily on individuals' mental health. COVID-19 is a crisis that has shaken humanity, plunging it into a great wave of fear, ambiguity and uncertainty, due to its novelty and rapid spread, as well as lethality. Mental health disparities between women and men have widened as a result of this pandemic. Stress factors have multiplied, especially among working women, making them more psychologically vulnerable than they were before this pandemic and easy prey to psychological distress. This emphasized the importance of having integrated care interventions that take into consideration the organizational context, with gendered lenses. This paper discusses the relationship between COVID-19 and psychological distress among women in the workforce. It presents the main sources of stress and addresses integrated care interventions that can help to prevent psychological distress among women.Design/methodology/approachThis paper is a viewpoint and critique of the recent literature.FindingsInterventions based on a partnership between employers, employees, and government, including health and social services are needed to prevent mental health problems among women in the workplace that can result from crises. In this case, a gendered approach as well as an optimization of the use of new technologies should be favored.Originality/valueThere is little focus on the development of integrated care approaches to address psychological distress among working women in times of crisis and beyond. This paper helps to expand the scope of integrated care to work-related mental health research by exploring the impact of an unprecedented health crisis on a vulnerable group that suffers from disparities in mental health. It also provides insights into preventive interventions, built upon an integrated care approach, based on a tripartite partnership between working women, employing organizations, and governmental institutions, facilitated by the integration of new technologies. By doing this, the author aims to contribute to the prevention of mental health issues that can result from this crisis.

Understanding the Experience of Service Users in an Integrated Care Programme for Obesity and Mental Health: A Qualitative Investigation of Total Wellbeing Luton.

Obesity is a complex public health issue with multiple contributing factors. The emphasis on joined care has led to the development and implementation of a number of integrated care interventions targeting obesity and mental health. The purpose of this study was to examine user experience in an integrated care programme for obesity and mental health in Luton, UK. Semi-structured interviews were conducted with a purposeful sample of service users (N = 14). Interview transcripts were analysed using thematic analysis. Analysis of the interviews identified six main themes for understanding service users’ experiences of integrated care: (1) ‘A user-centered system’, (2) ‘Supports behaviour change’, (3) ‘Valued social support’, (4) ‘Communication is key’, (5) ‘Flexible referral process’, and (6) ‘Positive impact on life’. These themes describe how the service is operated, evidence perceived value service users place on social support in behavior change intervention, and address which service areas work well and which require improvement. The findings of these interviews have offered a significant contribution to understanding what service users value the most in an integrated healthcare setting. Service users value ongoing support and being listened to by healthcare professionals, as well as the camaraderie and knowledge acquisition to support their own behaviour change and promote self-regulation following their participation in the programme.

Factors associated with frailty in kidney transplant recipients: A cross-sectional study.

Frailty is prevalent in kidney transplant recipients and associated with multiple health care challenges. The association between frailty and outcomes has been extensively studied in kidney transplant recipients, but the status of frailty and its associated factors are not well studied, hindering efforts to develop strategies to improve care and reduce frailty. To identify the factors that are associated with frailty in kidney transplant recipients comprehensively. The associated factors of frailty were explored by a cross-sectional study of 185 kidney transplant recipients. Data were collected using the general information questionnaire, the Charlson comorbidity index, the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, the Connor-Davidson Resilience Scale, the Perceived Social Support Scale and the Tilburg Frailty Indicator. Data were analyzed using the multiple linear regression analysis. A total of 75 (40.5%) kidney transplant recipients were assessed as frail by Chinese TFI. Age (β = 0.228), time post-transplant (β = 0.055), sleep quality (β = 0.224) and psychological resilience (β = -0.038) entered the final multiple regression equation and accounted for 41.8% of the total frailty variation (R2 = 0.418, F = 21.31, p < 0.05). Frailty was common among kidney transplant recipients. Old age, long time after transplantation, poor sleep quality and low psychological resilience were main associated factors for frailty. Integrated care interventions are therefore needed for this vulnerable population to prevent or delay frailty.