Service User Experience Research Articles

ICT기반 스마트 피트니스 서비스 사용자 경험분석

The purpose of this study was to figure out the user experience of ICT-based smart fitness service by utilizing critical incidents technique which is the one of qualitative analysis methods. To attain the goal, ICT-based smart fitness 337 users were studied using CIT method. The analysis of the data was produced based on the observation reliability of 4 independent researchers who has sport business expert and sports management background. The results were as follows. First, according to the results of analyzing ICT-based smart fitness service users

Patient experiences of therapy for borderline personality disorder: Commonalities and differences between dialectical behaviour therapy and mentalization-based therapy and relation to outcomes.

Dialectical behaviour therapy (DBT) and mentalization-based therapy (MBT) are widely used evidence-based psychological treatments for borderline personality disorder (BPD). The study aimed to establish evidence on common and unique, and helpful and unhelpful, treatment processes. Mixed-methods. In-depth qualitative interview data on patient experiences during treatment were combined with quantitative outcome measures in 73 patients diagnosed with a personality disorder and receiving DBT or MBT. Across both DBT and MBT, accounts of learning not to react impulsively, learning to question one's thoughts and assumptions, learning to communicate more effectively, and exposure to painful emotions that may previously have been avoided were each associated with less baseline-adjusted self-harm at the end of treatment. Difficulties in interacting with other group members were more likely to be described by patients receiving MBT than DBT, whilst difficulties in the therapeutic relationship were equally common. Both of these types of difficult experience were associated with higher baseline-adjusted levels of BPD traits and emotional dysregulation, at the end of the 12-month study period. The findings identify novel evidence of common therapeutic processes across DBT and MBT that may help to reduce self-harm. The findings also highlight the potential iatrogenic effect of difficulties in the alliance with therapists or with other group members. This underscores the importance of listening to patients' voices about what they are finding difficult during therapy and working to address these relational challenges, so that the patient is able to progress and make best use of the treatment. Regardless of whether dialectical behaviour therapy or mentalization based therapy is used, helping service-users to learn not to react impulsively, to question their thoughts and assumptions, and to communicate more effectively, may be beneficial for reducing self-harm. Across both types of therapy, exposure to painful emotions is a difficult experience for service-users, but may also be beneficial for reducing self-harm, if carefully managed. Whilst service-users' experiences across both types of therapy have much in common, accounts of mentalization based therapy stand out in more often describing both helpful and unhelpful experiences of interactions with therapy group members. Service-users across both types of therapy report the benefits of learning intrapersonal mentalization skills, whilst recipients of mentalization based therapy uniquely extend this to learning interpersonal mentalization. Ruptures in the therapeutic alliance, and distressing interactions with group members, may be iatrogenic and must be carefully managed.

Families with Parental Mental Health Problems: A Systematic Narrative Review of Family‐Focused Practice

The mental health problems of parents can negatively affect their whole family. The organisational and wider context may also influence the outcomes for all involved. The aims of this systematic review were: to develop a working definition of family‐focused practice (FFP); identify the types of outcomes that are measured with a focus on service user experiences; and explore how well interventions in the included studies fit with previously established components of FFP. A comprehensive literature search of 16 databases was conducted for peer‐reviewed, primary research studies related to FFP published between 1998 and 2016. In total, 3731 articles were identified and screened by four reviewers. Of those, 40 articles met all of the inclusion criteria. The review focused on family outcomes and, consistent with previous reviews, there was a reasonable degree of consistency about the core components of FFP. An additional component, identified by this review, which was part of some interventions, was work to improve access to and engagement with community supports and services. The review concludes that there is a need for: an agreed definition of FFP; clearer links to relevant theories; a more consistent approach to measuring outcomes, including economic perspectives; and an increased strategic promotion of whole family approaches.Key Practitioner Messages There is an immediate need for an agreed definition of family‐focused practice. Relevant theory could further clarify the theories of change and anticipated outcomes. There is consistency across studies about the key components of family‐focused practice. This review suggests the inclusion of an additional component, which is practice that improves access to and engagement with community supports and services. Economic evaluations of family‐focused practice are needed. ‘There is an immediate need for an agreed definition of family‐focused practice’

Implementation of an intersectoral outreach and community nursing care intervention with refugees in Quebec: A protocol study

To establish and assess an intersectoral local network focused on the roles of registered nurses and primary healthcare nurse practitioners to ensure the continuity of care and service pathways for refugees in Quebec. Developmental evaluation with a mixed methodology. The qualitative component will include: (1) a document review; (2) observations of participants during meetings of different governance structures; (3) semi-structured interviews with key actors (n=40; 20/neighbourhood interventions); and (4) focus groups with end users of the services (refugees) (n=4; 6 to 8 participants per group). The quantitative component will be based on: (1) a data sheet on health and social interventions for refugees users filled in by registered nurses, primary healthcare nurse practitioners and physicians and (2) data analysis of the clinical-administrative database since 2012. This study received funding in June 2019 and Research Ethics Committee approval was granted in July 2020. In Quebec, refugee vulnerability is exacerbated by the lack of integration of existing resources and the lack of access to care and continuity of services. To address these issues, an integrated local network for refugees must be developed. Additionally, we will explore the role of registered nurses and their collaboration with primary healthcare nurse practitioners. This study will provide recommendations on how to optimize the scopes of practice of registered nurses and primary healthcare nurse practitioners, adapt care and services and develop a local intersectoral network to better meet the complex needs of refugees. It will evaluate the use and the appreciation of new services for targeted populations (neighbourhoods and refugees) and aim to improve the accessibility, continuity and user experience of all health services for those populations.

Towards Equitable Health Care Access: Community Participatory Research Exploring Unmet Health Care Needs of Homeless Individuals.

Community and health services often overlook health care needs of persons experiencing homelessness, which leads to deterioration in health and increased utilization of emergency services. Since homeless people are underrepresented in health service research, little is known about their unmet health care needs, particularly in smaller cities where resources are limited. This community-based participatory research explored the experiences of small-city homeless service users (HSUs) with unmet health care needs and community service providers (CSPs) who work with them to determine barriers to health care access affecting them. Structured interviews were conducted with 65 HSUs and 15 CSPs in interior British Columbia, Canada. These interviews were audio-recorded, and the retrieved data were analyzed thematically. The three themes uncovered included: a lack of access to health care and risk of stigma, a lack of trust and fear of discrimination, and a need for community navigation and social support. The findings indicate that HSUs do not receive equitable care and face challenges in accessing appropriate and timely foot care, which contributes to increased foot-related emergency visits, loss of trust in the health care system, and disabilities due to worsening foot conditions. Various social determinants of health also impact HSUs, such as low socioeconomic status, lack of housing, decreased social support, unhealthy behaviors, and inequitable access to health services. By collaborating with HSUs, community and health services need to develop innovative outreach programs that provide better community resources as the first step toward equitable access to health care.

Mental Health Service User and Worker Experiences of Psychosocial Support Via Telehealth Through the COVID-19 Pandemic: Qualitative Study.

BackgroundDuring the COVID-19 pandemic, we saw telehealth rapidly become the primary way to receive mental health care. International research has validated many of the benefits and challenges of telehealth known beforehand for specific population groups. However, if telehealth is to assume prominence in future mental health service delivery, greater understanding of its capacity to be used to provide psychosocial support to people with complex and enduring mental health conditions is needed.ObjectiveWe focused on an Australian community-managed provider of psychosocial intervention and support. We aimed to understand service user and worker experiences of psychosocial support via telehealth throughout the COVID-19 pandemic.MethodsThis study was jointly developed and conducted by people with lived experience of mental ill health or distress, mental health service providers, and university-based researchers. Semistructured interviews were conducted between August and November 2020 and explored participant experiences of receiving or providing psychosocial support via telehealth, including telephone, text, and videoconferencing. Qualitative data were analyzed thematically; quantitative data were collated and analyzed using descriptive statistics.ResultsService users (n=20) and workers (n=8) completed individual interviews via telephone or videoconferencing platform. Service users received psychosocial support services by telephone (12/20, 60%), by videoconferencing (6/20, 30%), and by both telephone and videoconferencing (2/20, 10%). Of note, 55% (11/20) of service user participants stated a future preference for in-person psychosocial support services, 30% (6/20) preferred to receive a mixture of in-person and telehealth, and 15% (3/20) elected telehealth only. Two meta-themes emerged as integral to worker and service user experience of telehealth during the pandemic: (1) creating safety and comfort and (2) a whole new way of working. The first meta-theme comprises subthemes relating to a sense of safety and comfort while using telehealth; including trusting in the relationship and having and exercising choice and control. The second meta-theme contains subthemes reflecting key challenges and opportunities associated with the shift from in-person psychosocial support to telehealth.ConclusionsOverall, our findings highlighted that most service users experienced telehealth positively, but this was dependent on them continuing to get the support they needed in a way that was safe and comfortable. While access difficulties of a subgroup of service users should not be ignored, most service users and workers were able to adapt to telehealth by focusing on maintaining the relationship and using choice and flexibility to maintain service delivery. Although most research participants expressed a preference for a return to in-person psychosocial support or hybrid in-person and telehealth models, there was a general recognition that intentional use of telehealth could contribute to flexible and responsive service delivery. Challenges to telehealth provision of psychosocial support identified in this study are yet to be fully understood.

The ambulance service advanced practitioner's role in supporting care homes: a qualitative study of care staff experiences

Background/Aims The demand from care homes on NHS services continues to rise, with little evidence of ambulance service contribution in this area. The Yorkshire Ambulance Service provides an advanced practitioner model to support care homes in Sheffield, as an alternative to calling 999. This study investigated the experiences and needs of the care home staff who use the ambulance service advanced practitioner model. Methods This qualitative study conducted semi-structured, face-to-face interviews with 19 staff members from 10 different care home settings. Thematic analysis using a combination of NVivo and manual coding was undertaken. Results The three key themes from the interviews were variations in service demand, the service user's expectations and experience, and benefits to residents. Participants reported that good community services reduced the need to call 999, empowering carers to support residents to remain in the community. Conclusions Care homes require comprehensive services that meet their needs. The advanced practitioner model provided by the ambulance service supports this, preventing unnecessary 999 calls and fitting with other community service provision.

Service users experience of psychological interventions in primary care settings: A qualitative meta-synthesis.

Primary care mental health services play a crucial role in public mental health by providing local and accessible psychological interventions that meet individuals' needs. Despite growing research investigating service users' perspectives of psychological interventions, a qualitative systematic review in this context is not available. The present meta-synthesis collates the existing articles and gives a thematic synthesis of qualitative studies on service users' experience of psychological interventions in primary care. Multiple databases (CINAHL, EMBASE, PsychINFO, MEDLINE, and Cochrane Library) were searched for published qualitative studies of service users' experiences of psychological interventions delivered in primary care. Articles were included if they met inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme tool. All types of psychological interventions were considered across model and delivery format (e.g., face-to-face, computerised programmes, and group). NVIVO was used to code the dataset and themes were extracted following thematic synthesis. Twenty-two studies were included. Four analytical themes and 10 subthemes emerged. The identified themes were as follows: (1) 'Access and Acceptability: facilitators and barriers', (2) 'Structural aspects'; (3) 'Therapeutic process' and (4) 'Outcomes'. A model of interrelationships between themes is proposed. Findings suggest several 'essential ingredients' across psychological interventions and modalities. The crucial role of relational factors, the importance of assessing service users' perceptions of treatment features (e.g., remote delivery) and of tailoring the intervention to their needs were emphasised. Results also suggest involving service users more in discussions and decisions about psychological interventions offered might enhance access, acceptability, and engagement. Recommendations for practice and research are provided.

Covid-19 and Families With Parental Mental Illness: Crisis and Opportunity.

The COVID-19 emergency has affected us all, but not equally. Families where parents have mental illness (PMI) are potentially at increased risk, but little is known about how they or their support services managed under lockdown/restrictions. We harnessed our existing partnerships with adult and child mental health services in the Republic of Ireland (RoI) and Northern Ireland (NI) to investigate the qualitative experiences of service users and families in coping during the first COVID-19 lockdown (March–May 2020), and how services were supporting them. Semi-structured phone/online interviews were conducted with 22 clinicians/managers (12 from RoI; 10 from NI) who provided information from their caseloads (~155 families with PMI). Sixteen family members (10 from RoI, 6 from NI) were also interviewed. Data were analysed using standard thematic analysis. Sixty percent of families reported improved mental health, primarily due to respite from daily stresses and the “normalisation” of mental distress in the general population. Approximately 30%, typically with more severe/enduring mental illness, reported additional challenges, and mental distress including: unmanageable child behaviours; fear of relapse/hospitalisation; financial difficulties; absence of child care; and a lack of routines. Service provision varied considerably across regions. The experiences within this case study highlight unique opportunities to address the multiple stresses of pre-emergency daily living. We also highlight how mental health services and governments might become more “pandemic ready” to more effectively support vulnerable families, including addressing service overload issues, optimising the use of digital technologies, and providing in-person contact and social supports where required.

Advancing recovery education for people experiencing housing instability: A qualitative analysis of service user and provider perspectives in Canada.

The recovery paradigm is increasingly being adopted within mental health services internationally, to support a process of personal change for affected individuals, with the aim of living a satisfying, hopeful, contributing life within the limitations of mental illness. In efforts to assist the process of recovery, Recovery Education Centres (REC), offering recovery supports through education rather than traditional service models, have been widely implemented; there is limited evidence to date with respect to the experiences and outcomes of disadvantaged populations, such as people experiencing homelessness, with recovery education. This study used qualitative methods to explore the perspectives and experiences of service users and providers of the Supporting Transitions and Recovery (STAR) Learning Centre in Toronto, Canada, focused on supporting the process of recovery for individuals with histories of homelessness. Between July 2017 and June 2018, semistructured interviews with 20 service users, one key informant, and a focus group comprising eight current and former REC staff and volunteers were conducted to explore opportunities to better tailor the curriculum, and key programmatic features, to the needs of the population. Interviews were analysed using inductive thematic analysis. Most participants described favourable experiences with the REC and suggested adding more challenging course content (n=10) and increasing delivery options (n=8), highlighting the diversity of participant needs. Others described the importance of improving accessibility through geographic expansion, offering transit subsidies, and using innovative media. In addition, the importance of delivering more courses in partnership with community partners, to maximise reach and impact, was also highlighted (n=15). This study underscores the importance of engaging service users and providers, including peers, in ongoing adaptations to best serve the target populations. The expertise and lived experience of these key stakeholders offer a unique lens, supporting the process of recovery, through co-production of curriculum content and joint program planning and improvements. Findings can inform REC development for disadvantaged populations and potentially enhance recovery outcomes for those experiencing multiple barriers to recovery.

What treatment outcomes matter most? A Q-study of outcome priority profiles among youth with lived experience of depression

Interest in youth perspectives on what constitutes an important outcome in the treatment of depression has been growing, but limited attention has been given to heterogeneity in outcome priorities, and minority viewpoints. These are important to consider for person-centred outcome tracking in clinical practice, or when conducting clinical trials targeting specific populations. This study used Q-methodology to identify outcome priority profiles among youth with lived experience of service use for depression. A purposive sample of 28 youth (aged 16–21 years) rank-ordered 35 outcome statements by importance and completed brief semi-structured interviews eliciting their sorting rationales. By-person principal component analysis was used to identify outcome priority profiles based on all Q-sort configurations. Priority profiles were described and interpreted with reference to the qualitative interview data. Four distinct outcome priority profiles were identified: “Relieving distress and experiencing a happier emotional state”; “Learning to cope with cyclical distressing emotional states”; “Understanding and processing distressing emotional states”; and “Reduced interference of ongoing distressing emotional states with daily life”. All four profiles prioritised improvements in mood and the ability to feel pleasure but differed in the level of importance assigned to learning coping skills, processing experiences, and the reduced interference of depression with life and identity. As part of a person-centered approach to care delivery, care providers should routinely engage young people in conversation and shared decision-making about the types of change they would like to prioritise and track during treatment, beyond a common core of consensus outcomes.

Being more than “just a bog-standard knee”: the role of person-centred practice in physiotherapy: a narrative inquiry

Purpose The aim of this study was to understand how physiotherapeutic encounters were experienced over time by one service user and the extent to which the encounters were person-centred. Methods This narrative inquiry study had one participant purposively sampled due to their extensive experience of physiotherapy in healthcare systems in the United Kingdom. Data were collected through interviews and analysed using Clandinin and Connelly’s three-dimensional framework. Results Time-related aspects of physiotherapeutic encounters were noted in the evolutionary journey of physiotherapy practice. Personal and social aspects were evident in the words and attitude of the physiotherapists. The influence of place was noted in the role that external forces and the environment played in shaping how physiotherapy was experienced. Conclusions These narratives remind physiotherapists and healthcare providers to reflect on the role they play in shaping the experience of service users and whether those experiences are considered to be person, therapist, or institution centred. Those training pre-registration physiotherapy students need to consider giving students the opportunity to develop and reflect on their philosophy of practice early in the curriculum to enhance the experience of service users in the long-term. IMPLICATIONS FOR REHABILITATION It is important for therapists to consider preconceived ideas of what a service user may want, and to listen to them as unique people, with a future journey ahead of them to understand what is truly important to them. Physiotherapists need to reflect on the role they play and the words they use in shaping the experience of care for service users, and whether this is perceived as being person or therapist centred. Physiotherapists who are more person-centred in practice were better placed to promote self-management of long-term conditions. Providing pre-registration physiotherapists with the opportunity to develop their own value-based philosophy of practice during training may enhance the experiences of their service users in the future.

"You Can't Work with My People If You Don't Know How to": Enhancing Transfer of Care from Hospital to Primary Care for Aboriginal Australians with Chronic Disease.

Indigenous Australians experience significantly poorer health compared to other Australians, with chronic disease contributing to two-thirds of the health gap. We report on an evaluation of an innovative model that leverages mainstream and Aboriginal health resources to enable safe, supported transfer of care for Aboriginal adults with chronic conditions leaving hospital. The multisite evaluation was Aboriginal-led and underpinned by the principles of self-determination and equity and Indigenous research protocols. The qualitative study documented processes and captured service user and provider experiences. We found benefits for patients and their families, the hospital and the health system. The new model enhanced the patient journey and trust in the health service and was a source of staff satisfaction. Challenges included staff availability, patient identification and complexity and the broader issue of cultural safety. Critical success factors included strong governance with joint cultural and clinical leadership and enduring relationships and partnerships at the service delivery, organisation and system levels. A holistic model of care, bringing together cultural and clinical expertise and partnering with Indigenous community organisations, can enhance care coordination and safety across the hospital–community interface. It is important to consider context as well as specific program elements in design, implementation and evaluation.

Evaluation of service quality and user experience on credit card application using e-SERVQUAL model and usability testing

One of the emerging fields of a startup business is financial technology, also known as fintech. Fintech is divided into several sectors, namely payment, aggregator, lending, crowdfunding, and other online financial transactions. The study was conducted at an Indonesia fintech aggregatorthat became the first e-commerce marketplace for financial products such as credit cards, insurance, and loans. The data showed that 53.6% of the number of application submissions came from the credit card category but there was a decrease of 22.8% in 2019. The purpose of this study is to evaluate the service quality and user experiences from credit card submissions in a mobile application to improve the platform to fit the customer’s needs. Service quality evaluation is done using the e-SERVQUAL modelwith efficiency, system availability, fulfillment, privacy, responsiveness, compensation, contact as its dimensions. The results found that 13 variables need to be improved by the company. Evaluation of user experience done by usability testing method by considering the dimensions of learnability, effectiveness, efficiency, and satisfaction. Based on the Pareto diagram, there 21 failuresthat need to be prioritized. User satisfaction obtained using the System Usability Scale (SUS) is 44.5 which is categorized in the OK category. Design of improvement is done using the House of Quality method and 10 technical requirements need to be developed. After giving a proposal using a prototype, the re-test was done, and user satisfaction increase to 70.4.

Standardization of Shared Electric Kickboard Service Process Using Service Blueprint

개인용 이동수단으로만 주로 활용되던 퍼스널 모빌리티 사업에 공유서비스를 결합한 분야인 공유 모빌리티 서비스의 시장은 점차 증가하고 있다. 공유 모빌리티와 관련된 사건 및 사고 역시 증가하며 이에 대한 정책의 개선방안도 제안되고 있다. 서비스의 이용에 대한 문제는 꾸준히 증가하고 있지만, 관련 선행연구 및 논의는 부족한상황이다. 이에 본 연구에서는 공유 모빌리티 중 가장 주목받는 전동킥보드를 주제로 공유서비스에 대한 연구를 진행하였다. 첫째, 공유 전동킥보드 관련 온라인 뉴스기사들에 대하여 크롤링 기법을 활용하여 우리나라의 기존 공유 킥보드 서비스 및 시장이 우선적으로 고려해야 할 사항을 살펴보고, 둘째, 서비스 사용자의 경험적 측면에서 분석하여 공유 전동킥보드 서비스의 새로운 청사진(service blueprint)을 제안하려 한다. 공유 킥보드에 대한 뉴스를 시계열의 형태로 빈도 분석하여 빈도가 높은 단어들을 알아보고, 추출된 상위 키워드를 고려한 공유 전동킥보드의 새로운 서비스 청사진을 제공하고자 한다. 공유 전동킥보드의 서비스 청사진을제안하여 소비자에게 동일한 서비스와 안전한 품질의 서비스를 제공하여 사용자 만족도를 개선하는 것에 목적이있다. 이를 위해, 크롤링 빈도분석 결과를 바탕으로 서비스를 분석하고 기존의 공유 전동 스쿠터 서비스 청사진에 F 포인트(사용자 인증, 탑승, 하차, 반납)를 중심으로 서비스 개선안을 도출하였으며, 이를 활용하여 새로운공유 전동 스쿠터 서비스 청사진을 제안하였다. 본 논문은 공유 전동킥보드의 이용상 문제를 서비스 청사진을 통해 현황 분석하여 서비스 표준화를 제안한다는점에서 의의가 있다. 개선된 서비스 청사진을 통하여 사용자 중심의 서비스 표준화를 시도하고, 이를 통해 성장가능성이 있는 공유 모빌리티 서비스 산업의 생태계 발전에 기여하고자 한다.The market for shared mobility services, which combines personal mobility businesses with shared services, is gradually expanding. As incidents and accidents related to shared mobility services are also on the rise, policy improvement measures are being suggested as well. Despit e the fact that issues regarding the use of such services are steadily on the rise, related prior research and discussion are lacking. Thus a research on sharing services with electric scooters, the most anticipated shared mobility service, as the subject was conducted. First, some factors that the Korean electric scooter services and market must consider will be taken into account by indexing online news articles through crawling. Second, a new service blueprint for shared electric scooter services through analyzing the experiences of service users will be proposed. This paper seeks to provide a new service blueprint for shared electric scooter services through a frequency analysis on news articles about shared electric scooters in the form of a time series. By using these keywords, we provide a blueprint for the new service of shared electric kickboard. The purpose lies in improving user satisfaction by providing consistent service and ensured safety, enabled through a service blueprint for shared electric scooters. analyze existing services based on frequency analysis results from crawling data and drew a service improvement plan centered around an F point(user identification, boarding, dismounting, return), and applied our findings on a new service blueprint for shared electric scooter services. This study holds its significance in that it suggests a standardization of services by means of a situation analysis on issues that arise from using shared electric scooters. The improved service blueprint aims to attempt user-centered service standardization and to contribute to the development of the ecosystem of the shared mobility service industry that holds potential for growth.

Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users' Views.

Shared decisionmaking (SDM) is a recommended health communication approach in mental health settings. Yet, implementation of SDM in psychiatric consultations discussing medication management is challenging. Insufficient attention has been given to examine the views of both clinicians and service users together about the experiences of SDM in psychiatric medication management. The purpose of this paper is to examine the views of service users, community psychiatric nurses, and psychiatrists about enablers and barriers of SDM. A thematic analysis of 30 semi structured interviews with service users, psychiatrists, and community psychiatric nurses, in a community mental health team in the UK, was conducted. A service user advisory group was involved in all phases of the research cycle, including data collection, analysis, and dissemination. The results offer a detailed contextualized account of how medication decisions are made. For psychiatrists and service user participants SDM is seen as a way of enhancing service users' engagement in and control over treatment decisions. While psychiatrists value the transactional benefits of SDM, service user participants and psychiatric nurses conceptualize SDM as a long-term endeavor embedded within therapeutic partnerships. For service users these partnerships mitigate acknowledged problems of feeling unable to be fully involved during times of crisis. This study identified a range of barriers and facilitators to SDM concerning psychiatric medications from the lived experience of service users and the professional experience of clinicians. Furthermore, it indicates new potential intervention points to support SDM in psychiatric medication decisions.

The use of coproduction to inform an evidence-based service delivery model for mental health service users with complex needs

AimsCo-production recognises that people who use social care services (and their families) and third sector organisations within community settings have knowledge and experience that can be used to help make services better for services users and those who care for them. This study shares the coproduction that took place in the design of a mixed methods study that aims to understand: the profile and history of service users currently defined as having complex needs; the decision-making processes by clinicians that lead to these individuals entering this complex group; service users and carers experience of service use; and, the associated costs. This study involves a comprehensive evaluation that aims to inform an evidence-based service delivery model for mental health service users with complex needs.MethodA study stakeholder group, including clinicians, academics, service users, housing associations, health economists, and statisticians was formed from the outset to inform the mixed methods design, combining quantitative (in-depth analysis of patient records and economic evaluation) and qualitative (written medical notes and in-depth interviews with service users, carers, and clinicians) methods. The study included five components: (1) a quantitative description and analysis of the demographic clinical characteristics of the patient group; (2) an economic evaluation of direct medical costs, direct non-medical costs, and indirect costs for each patient; (3) semi-structured interviews about patients and carers experiences; (4) data from components 1-3 was used to co-produce vignettes jointly with the stakeholders group; and, (5) semi-structured interviews about clinical decision-making by clinicians in relation to this patient group by using the vignettes as example case studies.ResultCoproduction took place at each stage of the study, including the design, development of data collection tools, data analysis and formation of the vignettes required for stage five. The results demonstrated how co-production and multiagency working have been evident throughout the process of designing the study, the continuous engagement throughout the analysis, dissemination and implementation of the findings.ConclusionThe findings support the application of the core principles of co-production in the design, set-up and implementation of research within an NHS Trust as demonstrable by the acceptability and collaborative working within the study. The study's key outcomes were to: examine the resource use and cost impact associated with alternative care pathways to the NHS and other sectors of the economy (including social care); explore patient health and non-health outcomes associated with alternative care pathways; and, gain an understanding of a complex service user group and how decisions are made in their treatment to inform how services are delivered in the future and made more person-centred and consistent.

Evaluating service user & carer experience of videoconferencing software during COVID-19 pandemic

AimsTo evaluate service user and carer experience of use of videoconferencing software (Microsoft Teams) during MDT meetings.To identify specific areas for improvementTo make changes based on these recommendationsMethod2 surveys were distributed to inpatients and their carers on a functional Older Adults inpatient ward (n = 21), including quantitative and qualitiative questions. The results from these were compiled, and on review, mutliple recommendations for improvement were made.Result90% of service users find it helpful to have family present over videoconferencing software during their MDT meetings, and 91% of carers feel involved and able to contribute when they do join in this way81% of carers have the technology available at home to use such software, but only 55% of them feel confident using it. 73% need more information on its use.60% of carers referenced poor staff skills with software as a barrier to its use, and 60% referenced poor organisation of meetings2 service users raised issue with the size of a small laptop screen not allowing them to see who was actually present over MS Teams, although none were concerned with issues around confidentiality and the use of such softwareSeveral service users, carers and members of community teams identified poor sound quality as an issue, both when joining over the software, and when present in the room.ConclusionWidespread use of videoconferencing software such as MS Teams is likely to continue beyond the end of the COVID-19 pandemic. Through discussion with the ward team, the IT department, the training department, and the local council, multiple changes were made to the service, as below. These form a recommended list of areas for improvement in other services.Availability of videoconferencing equipment (in addition to laptop)Dedicated videoconferencing microphone/speaker to improve sound qualityDisplay screenWebcamOrganisation of meetingsDesignating a chairperson to admit and introduce all participantsDesignating a meeting organiser to invite all necessary participantsStaff skillsLocal audit of staff familiarity with softwareIntroduction of mandatory training for staff on use of softwareCarer skills & access to equipmentInformation and support available from well-trained staffLiaison with other organisations including council and third sector about availablity of equipment loans and training for carers

Exploring the experiences of completing outcome measure questionnaires for service users at Newham CAMHS

This study explores the experiences of service users completing outcome measure questionnaires (OM’s) in a CAMHS service. The study utilises a mixed methods framework with a sample of N=12 participants (6 young people and 6 mothers). Themes emerging were (1) Autonomy (2) Communication (3) Safe space (4) Efficiency vs Accuracy. Responses suggest that participants felt OM’s are an important part of their care, however expressed the need for more collaborative working with clinicia,ns. Participants felt OM’s were quick and efficient however some identified need for more in depth questions. Lastly participants identified the need for a safe space when completingOM’s. The study provides suggestions to overcome barriers to completing OM for service users (SU’s) in a CAMHS service.

Service user experience of remote consultations during COVID-19 in an older adult community mental health setting

AimsThe COVID-19 pandemic has had a significant effect on our ability to communicate face-to-face with patients freely. Similar to other medical specialities and general practice (1), to continue providing a service for our service users, we employed other means of communication including telephone and video consultations (although face-to-face consultations were available for high clinical concern and/or identified risk). We set out to explore the acceptability of remote consultation for service users of an older adult (>65 years) Community Mental Health Team (CMHT).Reference: BMJ 2020;371:m3945MethodA total of 34 service users were selected randomly from the CMHT caseload (9% of total 372 caseload). 4 clinicians were involved in collecting data between July and October 2020. We used our trust's (East London Foundation Trust) standard questionnaire on patient satisfaction and contacted individuals by telephone to complete the survey.ResultFor both questions of ‘I felt listened to by the team’ and ‘I feel I have been given enough information regarding my care’ 17 (50%) responders ‘agreed’ with this statement and an additional 13 (38%) ‘strongly agreed’ (total of 88%). For the statement ‘I feel involved in decisions about my care’ 16 (47%) responders ‘agreed’ and a further 11 (32%) responders ‘strongly agreed’ with this statement. The statement ‘The professionals involved in my care talk to each other and we all work as a team’ had 15 (44%) responders ‘agree’ and 13 (38%) responders ‘strongly agree’. When asked ‘If you experienced telephone/video sessions, were these helpful?’ 31 responders said ‘yes’.ConclusionOverall most responders agreed or strongly agreed that they felt listened to, were given enough information about their care, felt involved in decisions about their care and that they worked as a team with the professionals involved in their care. 91% of responders felt that the video/telephone sessions had been helpful. These data have provided reassurance that telemedicine methods were a useful substitute for face-to-face consultations during the early stages of the pandemic. However this was a small scale study. This study cannot tell us about the experience after the initial 6 months of the pandemic, how often it would be optimal for people have face to face reviews, or whether satisfaction with telemedicine altered over a longer period. We were also not able to tell whether the experience varied for those who had less robust and longstanding relationships with their clinicians.