Person-centered Health Research Articles

Enactivism: a contemporary perspective of a reconceptualization of Osteopathy

Enactivism is a philosophical and scientific approach that emphasizes the role of the body and its interactions with the environment in shaping cognitive processes and subjective experiences. Meanwhile, osteopathy is a person-centered health care discipline, highlighting the structure-function interrelationship of the body and its selfregulation mechanisms. Both approaches value the body and the environment in health. Several authors have been discussing the urgent need for a reconceptualization of osteopathy and also suggesting integrate biological, psychological and social aspects. Thinking osteopathy as a Therapeutic Rationality, implies recognize its fundamental dimensions: Human Morphology, Vital Dynamics, Medical Doctrine, Diagnostic System and Therapeutic System, all integrated by a philosophical Cosmology, as the original term Medical rationality states, but also embrace a broader perspective allowing an individual and unique process of each person, reflecting the transformation of contemporary medicine to a person approach. Enactivism principles can serve as a basis for a reconceptualization of osteopathy, integrating environmental, psychological, social, and spiritual factors. Osteopathic concepts can probably be updated through the convergence between enactivism and osteopathy, promoting more meaningful and evidence-based clinical practice. Advancing in this direction requires a collaborative dialogue between researchers, health professionals and interested people, seeking an integrated understanding of the relationship between body, mind, environment and health.

'The Lost Peace': Evidencing the Syndemic Relationship between Neglected Tropical Diseases and Mental Distress in Liberia.

Neglected Tropical Diseases (NTDs) are a group of chronic infectious diseases of poverty affecting over one billion people globally. Intersections of NTDs, disability, and mental ill-health are increasingly evidenced but are rarely studied from a mixed-methods perspective. Here, we advance syndemic understandings by further assessing and contextualising the syndemic relationship between NTDs (particularly their associated disability) and mental distress in Liberia. Participatory qualitative methods, including body mapping (56 participants), social mapping (28 participants), and in-depth interviews (12) provided space for persons affected by NTDs to narrate their experiences. Simultaneously, 201 surveys explored experiences of common mental health conditions among persons affected by skin NTDs. An intersectionality approach was applied within the analysis for both qualitative and quantitative methods informed by Meyer's minority stress model, adapted for NTDs. Qualitative data was analysed thematically and gender-disaggregated, univariable and multivariable analyses were applied to survey data for the outcome measures depression (PHQ-9) and anxiety (GAD-7). Disability was associated with higher levels of depression and anxiety (p < 0.001). An interaction between disability and being a women increased incidence risk ratio of depression (p < 0.001). In alignment with qualitative findings, persons affected experienced additional generalised (financial concerns), external (experience of stigma) and internal (experience of pain and physical symptoms) minority stressors, to varying degrees, which contributed towards their mental distress, and mental health conditions. These findings were used to co-develop a syndemic-informed person-centred health system response to address the suffering associated with NTDs and mental distress, including a focus on strengthening relationships between formal and informal community health actors and the broader health system.

The Quality in Quality of Life in Parkinson's Disease: A Qualitative Meta-Synthesis.

Quality of life (QoL) is known to be impaired in people with Parkinson's disease (PwPD). Not surprisingly, a considerable effort of health interventions is aimed at maintaining or improving QoL. Yet, little is known about its determinants from a PwPD perspective to inform person-centered health care interventions. This systematic review aims to overcome this information gap by synthesizing existing evidence on factors associated with PwPD' self-perceived QoL. We searched six electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, Cochrane Library) from inception to January 2022 for eligible qualitative studies of QoL in PwPD, supplemented by citation tracking and hand searching. Study quality was assessed using the QualSyst tool. In order to characterize the determinants of QoL in PwPD, we conducted a qualitative meta-synthesis. Our analysis revealed a wide range of facilitators and barriers to QoL relating to seven overarching themes: Illness experience, health care, everyday life, social life, identity, spirituality/religion, and environment. Our systematic review reinforces the impact of symptom experience on PwPD's QoL. However, it also highlights the need to consider the non-physical dimensions of PD when assessing patients' QoL. It is therefore essential that health care professionals acknowledge the psychological, social and spiritual repercussions of PD and endeavor to respond to these concerns through a comprehensive and patient-centered strategy. Further research is needed to gain a deeper understanding of these facets of PD and to formulate successful interventions aimed at improving the QoL of PwPD.

Older adults preferences for long-term caregivers in China: a discrete choice experiment

ObjectiveUnderstanding the preferences of old-age adults for their long-term caregivers can improve person-centred health care and the quality of long-term care (LTC). This study examines Chinese older adults’ preferences for long-term caregivers. Study designThis is a cross-sectional study. MethodsA national representative discrete choice experiment (DCE) surveyed 2031 adults aged 50–70 across 12 provinces in China. Each DCE scenario described five attributes: type of caregivers, place of LTC, contents of LTC, out-of-pocket payments, and quality of life (QoL). Preferences and the marginal willingness to pay (WTP) were derived using mixed-logit and latent class models. ResultsOlder adults displayed higher preferences for long-term caregivers who improve their QoL, incur lower out-of-pocket payments, and provide medical LTC services at home, with the maximum WTP of $22.832 per month. QoL was rated as the most important LTC factor, followed by the place of LTC and the type of caregivers. When the level of QoL improved from poor to good, respondents would be willing to pay $18.375 per month more (95% confidence interval: 16.858 to 20.137), and the uptake rate increased by 76.47%. There was preference heterogeneity among older people with different sex, education, family size, and knowledge of LTC insurance. ConclusionQoL was the most important factor in older Chinese adults' preference for caregivers. Home care and medical care from formal caregivers was preferred by older adults. We recommend training family caregivers, raising older people's awareness of LTC insurance, and guiding policymakers in developing people-oriented LTC and a multi-level LTC system.

Aging in Place and ‘The Little Things’: Prioritizing Mobile Health and Social Care in Rural Communities

ABSTRACT Older adults are more frequently wanting to age in place. Governments are seeking cost-effective and efficient methods of supporting aging populations. Older adults who want to stay in their homes for as long as possible encounter multiple barriers, including struggling to maintain their homes, inadequate levels of social and healthcare support, and the lack of financial capacity to pay for home support services. The Mobile Seniors’ Wellness Network (MSWN), a multi-disciplinary and person-centered mobile health and social support intervention study was designed to investigate and support aging in place for older adults living in rural New Brunswick, Canada. Secondary analysis of case notes and exit interviews using content analysis revealed concerns with the lack of affordable and mobile care services for vulnerable rural older adults. Older adults revealed that their needs include “the little things” rather than grand gestures or sweeping policies to age in place such as assistance with grounds and home maintenance, in addition to relational and person-centered health and social care in the home. Reliance on private service delivery and volunteer organizations can increase the likelihood that older adults will experience a breakdown of social support networks tied together loosely by friends, family, and their communities. When services are unattainable aging in place becomes an unreachable goal.

Towards Coproduction in Person Centered Medicine and Health

Towards Coproduction in Person Centered Medicine and Health

Facilitators and barriers to community-led monitoring of health programs: Qualitative evidence from the global implementation landscape.

Achieving the global HIV, tuberculosis, and malaria targets will require innovative strategies to deliver high quality and person-centered health services. Community-led monitoring (CLM) is a rapidly proliferating health systems strengthening intervention for improving healthcare services and documenting human rights violations, through social empowerment and political accountability. Driven in part by increasing financial support from donors, a growing number of countries are implementing CLM programs. This study aimed to identify early challenges and lessons learned from CLM implementation, with the aim of informing and improving the implementation of CLM programs and ultimately achieving greater impact on the delivery of services. Twenty-five CLM implementors representing 21 countries participated in an interview. Early generation of buy-in from diverse stakeholders was noted as critical for CLM success. Leveraging existing networks of service users and community organizations to implement CLM also helped to maximize program reach and resources. Uncertainty around CLM's purpose and roles among CLM stakeholders resulted in challenges to community leadership and ownership of programs. Respondents also described challenges with underfunded programs, especially advocacy components, and inflexible donor funding mechanisms. Critical capacity gaps remain around advocacy and electronic data collection and use. With the rapid expansion of CLM, this study serves as an important first step in characterizing challenges and successes in the CLM landscape. Successful implementation of CLM requires prioritizing community ownership and leadership, donor commitment to sustainable and reliable funding, and strengthened support of programs across the data collection and advocacy lifecycle.

Words to find common ground for action. Bridging social and health services through concertation on accessibility to vulnerable groups in Brussels

Introduction: Linking general primary care, health and social services with non-profit organisations dedicated to vulnerable groups is the aim of an ongoing concertation process hosted by Brusano, the regional organisation aimed at fostering person-centred health and social-integrated services in Brussels.&#x0D; In the Belgian Capital, the most vulnerable people are often attended to by non-profit organisations dedicated to a specific target group or problem. These organisations are often overwhelmed, with people not moving towards general services as intended at some point. General primary care and social services remain insufficiently accessible to vulnerable people. Considering the integrated health and social policy reforms currently taking place at national and regional levels, health and social professionals felt the need to better understand each other and build common ground in order to work together and participate in the reform process. &#x0D; Targeted population and stakeholders: The targeted population is care providers from all levels of care, home helpers and social workers in all kinds of settings. End beneficiaries are vulnerable groups - e.g. migrants, sex workers, people with addictions, prisoners and former inmates, isolated persons, homeless people... - and people who are at a high risk of exclusion when facing problems mixing health and social situations – low income, precarious housing, language barriers... The premise is that if services can include such vulnerable groups, they might achieve broader accessibility for all. &#x0D; Participants: The concertation gathers professionals from multiple health sector disciplines- primary care, hospital, mental health - as well as from the social sector and dedicated non-profits. Nearly 150 professionals participate, with a mean attendance of 30 per meeting.&#x0D; Description of the initiative: In 2021-2022, the concertation resulted in an online publication, co-written by two partners, reviewed by 5 others, presented and discussed in 3 meetings, then further adjusted accordingly. The paper provides an overview of the organisation of the health and social systems, as well as a set of definitions. It acknowledges that different levels of care operate as first contact and often lack the means and skills to be fully inclusive and accessible to vulnerable groups. &#x0D; Results / Impact: Stakeholders coined a new phrase - “inclusive practices” - to fully capture the expertise of the dedicated non-profits and to bring about inclusivity in different settings through collaborations. The definitions were included in the glossary used as a reference for the upcoming Regional Health and Social Policy Plan.&#x0D; &#x0D; Learning for the international audience: Building a common language for health and social professionals, while fully recognizing the expertise of non-profits dedicated to vulnerable groups bridges the gap between health and social services. It is a step towards better integration of health and social organisations, which is a major challenge to integrated care.&#x0D; Next steps: In the coming months, the concertation process will continue identifying and supporting inclusive practices whatever the service or level of care. It will be fully part of the Regional Health and Social Integrated Plan. &#x0D; It develops as a model where a specific expertise supports services to the general population.&#x0D;

OLDER ADULT VOLUNTEERS AS MENTORS IN GERIATRIC EDUCATION

Abstract Health professions education that involves older adults has been shown to be effective in improving students’ clinical skills and attitudes towards older adults. With the goal of introducing healthcare students to geriatric care through first-hand experiences, the “Seniors Assisting in Geriatrics Education (SAGE)” Program involves older adult volunteers age 65+ in virtual person-centered health promotion visits with teams of three to four students. Through an application process, mentors are selected and receive orientation materials before visits with their assigned team. Students represent eight disciplines: dietetics, medicine, nursing, pharmacy, physical therapy, physician assistant studies, social work, and speech language pathology. Students practice basic clinical skills and screening techniques while working as a team and receiving feedback and input from their mentor. In 2022, we surveyed older adult volunteers to evaluate their mentor experience using open-ended and Likert style questions on a scale from strongly agree to strongly disagree. Survey responses (n=99) show that most mentors agreed students collaborated well (94%), health promotion topics for each visit were beneficial (83% to 85%), and they were satisfied with their SAGE experience (96%). Mentors identified opportunities for improvement related to student and mentor preparation, in-person versus online visits, and establishing rapport between mentors and teams. Results were used to enhance mentor training and engagement and to create community partnerships for recruitment and mentor diversity. By prioritizing recruitment of and training for volunteers, older adults can actively and effectively participate in meaningful educational experiences with health professions students.

Community perceptions of a biopsychosocial model of integrated care in the health center: the case of 4 health districts in South Kivu, Democratic Republic of Congo

SummaryBackgroundBiopsychosocial care is one of the approaches recommended in the health system by the WHO. Although efforts are being made on the provider side to implement it and integrate it into the health system, the community dynamic also remains to be taken into account for its support. The objective of this study is to understand the community's perceptions of the concept of integrated health care management according to the biopsychosocial approach (BPS) at the Health Center of a Health District and its evaluation in its implementation.MethodsThis cross-sectional study was done in six Health Areas belonging to four Health Districts in South Kivu, DRC. We conducted 15 semi-directive individual interviews with 9 respondents selected by convenience, including 6 members of the Development Committees of the Health Areas, with whom we conducted 12 interviews and 3 patients met in the health centers. The adapted Normalization MeAsure Development (NoMAD) tool, derived from the Theory of the Normalization Process of Complex Interventions, allowed us to collect data from November 2017 to February 2018, and then from November 2018 to February 2019. After data extraction and synthesis, we conducted a thematic analysis using the NoMAD tool to build a thematic framework. Six themes were grouped into three categories.ResultsInitially, community reports that the BPS approach of integrated care in the Health Centre is understood differently by providers; but then, through collective coordination and integrated leadership within the health care team, the approach becomes clearer. The community encouraged some practices identified as catalysts to help the approach, notably the development of financial autonomy and mutual support, to the detriment of those identified as barriers. According to the community, the BPS model has further strengthened the performance of health workers and should be expanded and sustained. ConclusionsThe results of our study show the importance of community dynamics in the care of biopsychosocial situations by providers. The barriers and catalysts to the mechanism, both community-based and professional, identified in our study should be considered in the process of integrating the biopsychosocial model of person-centered health care.

Health System Enablers and Barriers to Continuity of Care for First Nations Peoples Living with Chronic Disease.

Failings in providing continuity of care following an acute event for a chronic disease contribute to care inequities for First Nations Peoples in Australia, Canada, and Aotearoa (New Zealand). A rapid narrative review, including primary studies published in English from Medline, Embase, PsycINFO, and Cochrane Central, concerning chronic diseases (cancer, cardiovascular disease, chronic kidney disease, diabetes, and related complications), was conducted. Barriers and enablers to continuity of care for First Nations Peoples were explored considering an empirical lens from the World Health Organization framework on integrated person-centred health services. Barriers included a need for more community initiatives, health and social care networks, and coaching and peer support. Enabling strategies included care adapted to patients' cultural beliefs and behavioural, personal, and family influences; continued and trusting relationships among providers, patients, and caregivers; and provision of flexible, consistent, adaptable care along the continuum. The support and co-creation of care solutions must be a dialogical participatory process adapted to each community. Health and social care should be harmonised with First Nations Peoples' cultural beliefs and family influences. Sustainable strategies require a co-design commitment for well-funded flexible care plans considering coaching and peer support across the lifespan.

Exploring patient perspectives: A qualitative inquiry into healthcare perceptions, experiences and satisfaction in Lebanon.

Patient perspectives have received increasing importance within health systems over the past four decades. Measures of patient experience and satisfaction are commonly used. However, these measures do not capture all the information that is available through engaging with patients. An improved understanding of the various types of patient perspectives and the distinctions between them is needed. The lack of such knowledge limits the usefulness of including patient perspectives as components within pay-for-performance initiatives. This study aimed to explore patient perspectives on hospital care in Lebanon. It also aimed to contribute insights that may improve the national pay-for-performance initiative and to the knowledge on engaging patients towards person-centered health systems. We conducted a qualitative study using focus group discussions with persons recently discharged after hospitalization under the coverage of the Lebanese Ministry of Public Health. This study was implemented in 2017 and involved 42 participants across eight focus groups. Qualitative content analysis was used to analyze the information provided by participants. Five overall themes supported by 17 categories were identified, capturing the meaning of the participants' perspectives: health is everything; being turned into second class citizens; money and personal connections make all the difference; wanting to be treated with dignity and respect; and tolerating letdown, for the sake of right treatment. The most frequently prioritized statement in a ranking exercise regarding patient satisfaction was regular contact with the patient's doctor. Patient perspectives include more than what is traditionally incorporated in measures of patient satisfaction and experience. Patient valuing of health and their perceptions on each of the health system, and access and quality of care should also be taken into account. Hospital pay-for-performance initiatives can be made more responsive through a broader consideration of these perspectives. More broadly, health systems would benefit from wider engagement of patients. We propose a framework relating patient perspectives to value-based healthcare and health system performance.

The Narrative-Based Evolution of a Stakeholder-Engaged Research Team

Millions of people worldwide have experienced abrupt and traumatic disruption in the flow of their personal life story as a result of stroke and the onset of aphasia. For each one who survives and embarks on the journey toward recovery, their unique and evolving narrative yields gems of wisdom borne of the experience. This wisdom is shared with others through interpersonal narrative exchange and engagement, which foster biographical coherence and provide sources of hope to others on the path toward a productive and fulfilling life. This case study illustrates how a biography-based approach to stakeholder-engaged research merges personal stories in three ways. First, the case illustrates how the personal and professional stories of the candidate research team members merged to form the team through networking over time. Second, the biography-based approach led the team to identify the written personal accounts of 259 people living with aphasia as the raw data set for their research, with the intended goal of mining gems of practical wisdom from these written biographical works. Third, the case illustrates how the biography-based approach draws on the personal stories of in-hospital experiences of research team members with aphasia to prospectively hone the initial research focus. Specifically, the team will tap the collective voice within the written accounts to evaluate the in-hospital experiences of people with aphasia. The ultimate goal will be to catalyze participatory action, in collaboration with transdisciplinary health care providers, to advance responsive, person-centered health care. The authors address challenges and priorities in stakeholder-engaged research team development, the importance of honing a research focus, and the identification of research dissemination venues. Oral and written accounts of life with aphasia offer a timeless and potentially rich source of wisdom that can be tapped through the process of stakeholder-engaged research.

Struggling to Keep up and Have a Good Life: A Qualitative Study of Living with Impaired Balance Control Due to Multiple Sclerosis.

To explore and describe the experiences of people with multiple sclerosis (MS) living with impaired balance control and how balance impairment can be managed in everyday life. A qualitative design was used. Data was collected through semi-structured interviews. Transcripts were analyzed using qualitative inductive content analysis. Sixteen participants (12 women) with MS and variation in level of balance control were interviewed. Age ranged between 35 and 64years, and overall MS-disability ranged between 2.0 (mild) and 5.5 (moderate) according to the Expanded Disability Status Scale. Five main categories emerged: balance is an automatic skill that now requires attention; contributors to balance impairment; burdens of balance impairment; management of balance impairment; and negotiation between capacity and ambition for continuing the good life. Body functions emphasized as central to keeping balance were somatosensory-motor functions, vision, and management of fatigue. Day-to-day variation in capacity and being in stimuli-rich environments were conditions highlighted as impacting balance. The main categories yielded the overarching theme of being restrained by impaired balance control and struggling to keep up. Participants with MS described balance impairment as balance no longer being an automatic skill and having an adverse impact on everyday life. A strong effort was shown to not let shortcomings control and determine quality of life. To manage limitations and restrictions and to move forward in the struggle to keep up a good life, an extensive toolbox of strategies aiming to minimize the impact of balance impairment was used to maintain quality of life. This study highlights the importance of person-centered health care in MS, with increased awareness of the individual perspective of how balance impairment is perceived. The person-centered focus increases both quality and efficiency in therapy since it involves the individual's thoughts of a life where participation in valued activities is less restricted.

Mapping young people's journeys through mental health services: A prospective longitudinal qualitative study protocol.

Mental ill health is a major health risk for young people. There is unmet need for mental health assessment and treatment across Australia despite significant investment in government-funded plans to cover mental health and youth-oriented services. Understandings of mental health care for young people are impeded by a lack of longitudinal research. Without this research, it is difficult to understand how services do or do not support the recovery of young people over time. This project will analyse the healthcare journeys of young people aged 16-25 years experiencing their first episode of mental ill health for which they have sought GP support, over 12 months in the Australian Capital Territory. The study team will recruit up to 25 diverse young people and their general practitioners (GPs), and conduct four qualitative semi-structured interviews over 12 months with each participant. GP interviews will explore their role in the mental health care and care coordination for the young person. Interviews with young people will explore experiences and perceptions of navigating the health system, and the supports and resources they engaged with during the 12-month period. In between interviews, young people will be asked to keep a record of their mental health care experiences, through their choice of media. Participant-produced materials will also form the basis for interviews, providing stimuli to discuss the lived experience of care. Through analysing the narratives of both young people and their GPs, the study will establish how young people understand value in mental health care delivery. The study will use longitudinal qualitative mapping of healthcare journeys to identify key barriers and enablers to establishing effective, person-centred health care for young people with mental ill health.

Case Studies: Person-Centered Health Coaching in People With Negative Social Determinants of Health

Social determinants of health are the conditions in the environment that influence health outcomes, such as housing, transportation, and neighborhoods. In this report, we examine 3 cases of participants with social risk factors who participated in a health coaching intervention study. The study was a science-based, nurse health coaching model provided to older adult participants in a Midwestern state designed to equip and empower them to achieve and maintain their health and optimum function to support independent living at home. The program was an 8-week virtual coaching method using weekly, 30-minute, 2-way video coaching sessions with participants. For each of the 3 cases, we describe the patterns of engagement, early and later health goals as coaching progressed, and the types of outcomes achieved. From these case studies, we illustrate how social determinants may affect the types of goals, processes, and potential outcomes achieved by participants of health coaching programs. From these insights, we propose directions in health policy and services and future research considerations.

Contribution of Pharmaceutical Care to Person-centered Health Care and the Safety of Pharmacotherapy for Hospitalized Older Individuals in Brazil: An Investigative Single-arm Intervention Trial.

Adverse drug events (ADE) and medication errors (ME) provide large numbers of victims. Older people are more susceptible to these events, due to the continuing search for several chronic degenerative disease treatments. The Third Global Patient Safety Challenge announced the objective of reducing unnecessary polypharmacy, encouraging deprescription, and aiming to ensure the prescription of medications in an appropriate manner, based on the best evidence and taking into account the individual factors of people. To evaluate whether Pharmaceutical Care (PC), when inserted in a geriatric ward and the context of person-centered health care, cooperates with the safety of pharmacotherapy in older individuals in Brazil. This is an investigative, single-arm, preliminary study. individuals aged ≥60 years and admitted to the geriatric ward between August 2019 to January 2020. The PC (with the practice of pharmacotherapeutic follow-up, medication reconciliation, and pharmacotherapy review) was made available to identify ADE and ME, as well as the associated factors and clinical outcomes, were analyzed. 60 participants were included. It was found that, on hospital admission, 93.3% of them were polymedicated and 86.7% had a history of using potentially inappropriate medications (PIM). ADE and ME were detected in 43 individuals (71.7%) and, in total, 115 incidents were identified, with drugs that act on the nervous system associated with them (31.9%). Acceptance of the PC's recommendations reached the rate of 85.2%. Polypharmacy (p=0.03) and the presence of multiple diseases (p=0.03) had an effect on the presentation of ADE and ME. The number of medications in use decreased in the comparison between admission and hospital discharge (p<0.0001). This investigative study indicated that ADE and ME are linked to the polypharmacy in use at the beginning of hospitalization. On the other hand, we showed that the PC (inserted in the multidisciplinary team) contributed to the deprescribing of medications at hospital discharge. Therefore, the PC can provide improvements in this scenario.

The Development, Deployment, and Evaluation of the CLEFT-Q Computerized Adaptive Test: A Multimethods Approach Contributing to Personalized, Person-Centered Health Assessments in Plastic Surgery.

Routine use of patient-reported outcome measures (PROMs) and computerized adaptive tests (CATs) may improve care in a range of surgical conditions. However, most available CATs are neither condition-specific nor coproduced with patients and lack clinically relevant score interpretation. Recently, a PROM called the CLEFT-Q has been developed for use in the treatment of cleft lip or palate (CL/P), but the assessment burden may be limiting its uptake into clinical practice. We aimed to develop a CAT for the CLEFT-Q, which could facilitate the uptake of the CLEFT-Q PROM internationally. We aimed to conduct this work with a novel patient-centered approach and make source code available as an open-source framework for CAT development in other surgical conditions. CATs were developed with the Rasch measurement theory, using full-length CLEFT-Q responses collected during the CLEFT-Q field test (this included 2434 patients across 12 countries). These algorithms were validated in Monte Carlo simulations involving full-length CLEFT-Q responses collected from 536 patients. In these simulations, the CAT algorithms approximated full-length CLEFT-Q scores iteratively, using progressively fewer items from the full-length PROM. Agreement between full-length CLEFT-Q score and CAT score at different assessment lengths was measured using the Pearson correlation coefficient, root-mean-square error (RMSE), and 95% limits of agreement. CAT settings, including the number of items to be included in the final assessments, were determined in a multistakeholder workshop that included patients and health care professionals. A user interface was developed for the platform, and it was prospectively piloted in the United Kingdom and the Netherlands. Interviews were conducted with 6 patients and 4 clinicians to explore end-user experience. The length of all 8 CLEFT-Q scales in the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set combined was reduced from 76 to 59 items, and at this length, CAT assessments reproduced full-length CLEFT-Q scores accurately (with correlations between full-length CLEFT-Q score and CAT score exceeding 0.97, and the RMSE ranging from 2 to 5 out of 100). Workshop stakeholders considered this the optimal balance between accuracy and assessment burden. The platform was perceived to improve clinical communication and facilitate shared decision-making. Our platform is likely to facilitate routine CLEFT-Q uptake, and this may have a positive impact on clinical care. Our free source code enables other researchers to rapidly and economically reproduce this work for other PROMs.

Mental health symptoms among homeless shelter residents during COVID-19 lockdown in Tshwane, South Africa.

In order to contain the spread of COVID-19 in South Africa during the national state of emergency, the Gauteng Department of Social Development established temporary shelters and activated existing facilities to provide basic needs to street-homeless people in Tshwane, which facilitated primary health care service-delivery to this community. This study aimed to determine and analyse the prevalence of mental health symptoms and demographic characteristics among street-homeless people living in Tshwane's shelters during lockdown. Homeless shelters set up in Tshwane during level 5 of the COVID-19 lockdown in South Africa. A cross-sectional, analytical study was conducted using a Diagnostic and Statistical Manual of Mental Disorders (DSM-5)-based questionnaire that looked at 13 mental health symptom domains. Presence of moderate-to-severe symptoms were reported among the 295 participants as follows: substance use 202 (68%), anxiety 156 (53%), personality functioning 132 (44%), depression 85 (29%), sleep problems 77 (26%), somatic symptoms 69 (23%), anger 62 (21%), repetitive thoughts and behaviours 60 (20%), dissociation 55 (19%), mania 54 (18%), suicidal ideation 36 (12%), memory 33 (11%) and psychosis 23 (8%). A high burden of mental health symptoms was identified. Community-oriented and person-centred health services with clear care-coordination pathways are required to understand and overcome the barriers street-homeless people face in accessing health and social services.Contribution: This study determined the prevalence of mental health symptoms within the street-based population in Tshwane, which has not previously been studied.

Evaluation of a modernized supported housing intervention for individuals who experience severe and persistent mental illness in Ontario, Canada.

Supported housing approaches that include case management and increased opportunities for independence and personal autonomy for people who are living with severe and persistent mental illness (SPMI) have been found to help reduce hospitalizations and use of the emergency department. What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. This study uncovered that individuals experiencing SPMI who lived in supported housing used more primary health care and specialist physician services, in the year following transition to this housing arrangement. The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual residents, including increasing access to both primary health care and specialist services. This is important for nursing practice, as the findings of the study show that supported housing arrangements for people experiencing SPMI may assist in better supporting their complex health care needs. INTRODUCTION: Supported housing for people who are living with severe and persistent mental illness (SPMI) has been found to help reduce hospitalizations and use of the emergency department. What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. The aim of this study was to compare the use of health services use of individuals with SPMI, before and after transition to the new supported housing program. Using health care administrative databases, a pre-post cohort study was conducted examining the health system use of residents who transitioned from custodial to supported housing arrangements between 2017 and 2019. Individuals with SPMI used more primary health care and specialist physician services after transition to the supported housing model. The results suggest that a supported housing model may be associated with increased usage of outpatient person-centred health services in people experiencing SPMI. The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual. This is important for nursing practice, as the findings of the study show that supported housing arrangements may assist in better supporting complex health care needs of individuals.