This document summarizes the findings from a research project examining community-based stroke rehabilitation outcome measures in Scotland. The project involved interviews with 34 stroke survivors and a survey of 113 rehabilitation professionals. Key findings were that stroke survivors valued participation in meaningful activities and life roles after leaving inpatient care. However, outcome measures currently used by therapists focused more on function and did not adequately capture participation or patient experience. While therapists sought measures relevant to patient goals, accessibility was a lower priority. The project aims to develop new, interactive outcome measures that encourage participation and are accessible to all stroke survivors.
This document discusses the need for person-centered care approaches in long term care settings for individuals with dementia. It outlines key concepts of person-centered care including validating individual experiences and meeting underlying needs to reduce behaviors. Effective training models like VIPS and assessments like Dementia Care Mapping are described. Barriers to implementation include staff turnover, but research shows person-centered care can improve outcomes for residents and staff.
Counselors play a critical role in helping people who are experiencing mental or emotional problems to get their lives back on track. And it is one of the treatment options for mentally ill peoples for its deal with wellness, personal growth, and career, education, and empowerment concerns. The purpose of the study is to assess the practice of counseling and its effectiveness in Jimma University Teaching Hospital (JUTH) and Amanuel Mental Health Specialized Hospital (AMHSH). It guided by mixed research design, quantitative and qualitative data about study variables was collected from 123 patients from both institutions, Qualitative data were analyzed by direct quotation according to the theme of the questions. Descriptive percentage and ANOVA analysis were used to analyze quantitative data. Descriptive statistics showed that there is a difference in the applications of counseling within the institution Analysis of ANOVA showed counseling is more effective in the treatment of depression and substance abuse. The difference in counseling provision in both institutions is also supported by qualitative analysis of the data. So, JUTH has to incorporate counseling service in the part of treatment, and AMUSH has to work on addressing a huge number of in need patients by expanding the institution.
Involvement of hub nurses in hiv policy developmentAlexander Decker
This document summarizes a study on the involvement of nurses in HIV policy development in Nyanza Province, Kenya.
1. The study found that nurses are involved in policy development at local and district levels but their involvement is still minimal at provincial and national levels. Linkages and collaborations with other organizations provided the greatest benefit.
2. Nurses perceived they were more involved in policy implementation than formulation due to lack of knowledge and skills. They also lacked confidence to participate.
3. Benefits of involvement included improved nursing care, support from workplaces, and relationships built with other health professions through collaborations. Linkages were formed with government departments, NGOs, communities, and learning institutions.
The document discusses community empowerment and its role in improving health. It defines empowerment as "an enabling process through which individuals and communities take control over their lives and their environment". It describes empowerment occurring on individual, organizational, family, and community levels. Community empowerment is the process of enhancing a community's capacity to control its own life, initiate change, mobilize resources, obtain services, and counter health risks collectively. The role of community health nurses is to identify their own power base and facilitate empowerment of individuals and communities.
3. Provide information:
- Explain clearly in simple terms
- Check understanding
- Answer questions fully and honestly
4. Support informed decision making:
- Discuss options and help weigh pros and cons
- Respect the client’s right to decide
- Offer additional help and follow up as needed
Technology-based Clinical Supervision: Extending the Reach of Clinical Superv...mikewilhelm
This document outlines an agenda and goals for a training on using technology to extend the reach of clinical supervisors. The training will familiarize clinical supervisors with research on technology-based clinical supervision and demonstrate how different technologies can be used to deliver supervision services. The agenda includes sessions on introducing TBCS, discussing barriers to accessing supervision, reviewing the benefits of TBCS, identifying ingredients for effective TBCS, demonstrating technology tools, and developing strategies to overcome barriers. The goals are for participants to better understand issues of access to supervision, how TBCS can help address problems, and gain skills in using technology for supervision.
Rehabilitation assists people with disabilities by reducing impairments and preventing complications to help them achieve optimal functioning. However, there are major gaps and challenges to providing rehabilitation services globally. Many people lack access to rehabilitation due to limited resources, specialists concentrated in cities, and long waiting lists. There is also a shortage of rehabilitation personnel worldwide. To address these issues, policies and health systems need reform, financing must be increased through partnerships, and community-based models should be used to decentralize and expand access to rehabilitation services.
This document discusses the need for person-centered care approaches in long term care settings for individuals with dementia. It outlines key concepts of person-centered care including validating individual experiences and meeting underlying needs to reduce behaviors. Effective training models like VIPS and assessments like Dementia Care Mapping are described. Barriers to implementation include staff turnover, but research shows person-centered care can improve outcomes for residents and staff.
Counselors play a critical role in helping people who are experiencing mental or emotional problems to get their lives back on track. And it is one of the treatment options for mentally ill peoples for its deal with wellness, personal growth, and career, education, and empowerment concerns. The purpose of the study is to assess the practice of counseling and its effectiveness in Jimma University Teaching Hospital (JUTH) and Amanuel Mental Health Specialized Hospital (AMHSH). It guided by mixed research design, quantitative and qualitative data about study variables was collected from 123 patients from both institutions, Qualitative data were analyzed by direct quotation according to the theme of the questions. Descriptive percentage and ANOVA analysis were used to analyze quantitative data. Descriptive statistics showed that there is a difference in the applications of counseling within the institution Analysis of ANOVA showed counseling is more effective in the treatment of depression and substance abuse. The difference in counseling provision in both institutions is also supported by qualitative analysis of the data. So, JUTH has to incorporate counseling service in the part of treatment, and AMUSH has to work on addressing a huge number of in need patients by expanding the institution.
Involvement of hub nurses in hiv policy developmentAlexander Decker
This document summarizes a study on the involvement of nurses in HIV policy development in Nyanza Province, Kenya.
1. The study found that nurses are involved in policy development at local and district levels but their involvement is still minimal at provincial and national levels. Linkages and collaborations with other organizations provided the greatest benefit.
2. Nurses perceived they were more involved in policy implementation than formulation due to lack of knowledge and skills. They also lacked confidence to participate.
3. Benefits of involvement included improved nursing care, support from workplaces, and relationships built with other health professions through collaborations. Linkages were formed with government departments, NGOs, communities, and learning institutions.
The document discusses community empowerment and its role in improving health. It defines empowerment as "an enabling process through which individuals and communities take control over their lives and their environment". It describes empowerment occurring on individual, organizational, family, and community levels. Community empowerment is the process of enhancing a community's capacity to control its own life, initiate change, mobilize resources, obtain services, and counter health risks collectively. The role of community health nurses is to identify their own power base and facilitate empowerment of individuals and communities.
3. Provide information:
- Explain clearly in simple terms
- Check understanding
- Answer questions fully and honestly
4. Support informed decision making:
- Discuss options and help weigh pros and cons
- Respect the client’s right to decide
- Offer additional help and follow up as needed
Technology-based Clinical Supervision: Extending the Reach of Clinical Superv...mikewilhelm
This document outlines an agenda and goals for a training on using technology to extend the reach of clinical supervisors. The training will familiarize clinical supervisors with research on technology-based clinical supervision and demonstrate how different technologies can be used to deliver supervision services. The agenda includes sessions on introducing TBCS, discussing barriers to accessing supervision, reviewing the benefits of TBCS, identifying ingredients for effective TBCS, demonstrating technology tools, and developing strategies to overcome barriers. The goals are for participants to better understand issues of access to supervision, how TBCS can help address problems, and gain skills in using technology for supervision.
Rehabilitation assists people with disabilities by reducing impairments and preventing complications to help them achieve optimal functioning. However, there are major gaps and challenges to providing rehabilitation services globally. Many people lack access to rehabilitation due to limited resources, specialists concentrated in cities, and long waiting lists. There is also a shortage of rehabilitation personnel worldwide. To address these issues, policies and health systems need reform, financing must be increased through partnerships, and community-based models should be used to decentralize and expand access to rehabilitation services.
This document summarizes a study that explored exercise adherence and motivations in university students using mixed methods. Semi-structured interviews were conducted with 6 students and analyzed for themes around motivation, mood, and barriers to adherence. Survey data from 29 students' Exercise Motivation Inventory scores were also analyzed. Thematic analysis of interviews showed 3 major categories affecting adherence: motivation, mood, and barriers. The survey analysis found no significant results. The study concluded that motivations for adherence are diverse and all aspects of exercise experience should be considered in program design.
Living as Well as you Can for As Long as you CanBCCPA
Sit down buffet breakfast featuring keynote speaker Dr. Romayne Gallagher, Head Division of Palliative Care, Department of Family & Community Medicine, Providence Health Care; Clinical Professor, Division of Palliative Care, UBC
This document discusses using the Community Empowerment theory to address uncontrolled type 2 diabetes in urban African Americans. It notes that African Americans have higher rates of diabetes and poorer outcomes. The theory focuses on community involvement, lay health workers, and reciprocal health to empower communities and improve self-management. The document proposes that community health workers could help address barriers African Americans face in managing diabetes.
A Public Health Approach to Mental Health Care: Taking Transformation to ScaleMHTP Webmastere
This presentation was given by Kathryn Power, Director, Center for Mental Health Services at SAMHSA, at the May 13, 2008 Prevention Policy Summit. Transcript of Kathryn Power\'s opening remarks.
Seniors Quality Leap Initiative: Using Data to Drive Improvements in Resident...BCCPA
1) The document discusses using data to drive improvements in resident quality of life at Providence Health Care's residential care homes. It summarizes Providence's current residential care program and facilities.
2) It describes the Seniors Quality Leap Initiative (SQLI), a consortium of long-term care organizations that works to improve clinical quality and safety for seniors through benchmarking, testing improvement ideas, and disseminating best practices. Providence is a member of SQLI.
3) Providence has been working to improve residents' quality of life, as measured by an internationally-used survey, by identifying opportunities through SQLI like enhancing social engagement and testing various changes in its homes.
The SDHI (Social Dimensions of Health Institute) is an interdisciplinary research collaboration between the Universities of Dundee and St Andrews established in 2003. It has two main research strands: 1) the social and environmental dimensions of health, wellbeing, and service delivery; and 2) human resilience and capabilities. SDHI brings together researchers from various disciplines and departments to conduct interdisciplinary research addressing key challenges through conferences, seminars, workshops, and postgraduate support.
This document summarizes a meeting of the Hertfordshire and West Essex Sustainability and Transformation Partnership about population health management. The meeting included presentations on the national context of population health and PHM, developing PHM locally, and next steps. It discussed the role of elected members in improving health outcomes and wellbeing for residents. Attendees considered developing a population health strategy and wider determinants of health. The goal is to improve physical and mental health across the population through data-driven care that addresses health inequalities.
The Healthy Neighbors program at Yale School of Nursing aims to improve the health and lives of residents at the Church Street South apartments, a subsidized housing project near the school. The program began with annual health fairs but has expanded to include daily tutoring sessions for younger residents during the school year. Fifteen YSN students now provide tutoring and help coordinate twice-annual health education fairs. The goal is for YSN students to build relationships and gain a deeper understanding of the community's health needs.
Continuous Decision Improvement (CDI): Public Health Decision Making for Comp...Tomas J. Aragon
This document discusses Continuous Decision Improvement (CDI), a framework for improving public health decision-making processes. CDI combines principles of quality improvement with a 4-step decision-making model (Define, Design, Decide, Do) to iteratively assess and enhance how decisions are made. The goal is to achieve better health outcomes through measurable improvements in decision processes, such as increasing constructive conflict and consensus. An example is given of applying CDI principles to build trust within decision-making teams.
What offers more choice? Budgets or human rights?shibley
My talk on how best to deliver choice in English dementia strategy - through the market, e.g. personal budgets, or international law, e.g. human rights.
Understanding Personality Disorders By Tom BurnsAnsel Group Ltd
Article for the Insight Supplement of Mental Health Today Magazine July/August 2010. Tom Burns, CEO of the Ansel Group, provides an insight into this patient group and provides some messages around organising services to best meet their needs.
The document discusses behavior change and behavior change communication (BCC) strategies for targeted interventions. It states that behavior determines health risk and interventions aim to change risky behaviors to safe behaviors. BCC uses dialogue and messages to bring about behavior change at individual, community, and societal levels. Effective BCC recognizes that behavior change is a process that occurs in stages from knowledge to practice. BCC should be paired with other strategies like enabling environments and is most effective with community participation. Peer education is highlighted as a key BCC method for targeted interventions.
This study examined how people with psychosis make sense of their relationships with important others. Semi-structured interviews were conducted with participants recruited from a rehabilitation service. The results showed that participants felt connected to important others through staying in contact, receiving support, and sharing experiences that created understanding. However, having psychosis can interfere with relationships by disrupting them during hospitalization and creating a lack of understanding and stigma from others. Participants distanced themselves from others and had difficulty trusting people as a means of self-protection. The discussion concluded that relationships are important for recovery but vulnerable to changes caused by psychosis and a lack of understanding from others.
ISPCAN Jamaica 2018 (CIHRTeamSV) - Improving Health and Behavioral Outcomes a...Christine Wekerle
Improving Health and Behavioral Outcomes among Sexually Victimized Male Youth: A Qualitative Investigation Among Trauma Treatment Providers
Ashwini Tiwari, Christine Wekerle, Andrea Gonzalez (CIHRTeamSV)
Alzheimer Europe talk 2015 Dr Shibley Rahmanshibley
These are the slides for the presentation I will give this year at the Alzheimer Europe conference in Ljubljana in Slovenia. It's survey based research on the importance of clinical nursing specialists in dementia.
Continuous Decision Improvement: Decisive Leadership for Complex EnvironmentsTomas J. Aragon
This document outlines the concept of Continuous Decision Improvement (CDI) as presented by Tomas J. Aragon. It discusses CDI as a process for public health leaders to continuously improve their decision making in complex environments. The 4D Decision Process is presented as a framework for rational decision making, involving defining problems, designing alternatives, deciding on alternatives, and implementing solutions. CDI then builds on this by incorporating elements of quality improvement to continuously refine and enhance the decision making process. Examples of applying CDI to specific public health decisions are also provided.
Delivering compassionate care to older adults across the care spectrumanne spencer
This document discusses how complementary therapies can restore compassion in nursing care for older adults. It describes the background of the complementary therapy service in Claremont, which provides therapies like massage, aromatherapy and reflexology. These therapies can help reduce medications and enhance quality of life by addressing physical, emotional and spiritual needs. The role of the Clinical Nurse Specialist is to integrate these therapies into care, evaluate clients, and collaborate with staff to provide compassionate, holistic care for older adults. Complementary therapies are seen as a compassionate way to relieve suffering through touch and communication, especially for those with dementia.
The document provides an overview of a 3-day workshop on applying the International Classification of Functioning, Disability and Health (ICF) framework for interprofessional care. The workshop aims to teach participants how to use the ICF to improve patient outcomes and health systems. On Day 1, participants are introduced to the ICF and complete a case study analysis. On Day 2, teams present case studies and provide peer feedback. On Day 3, teams conduct a hospital ward round using the ICF framework. Throughout the workshop, participants engage in structured reflections and develop a proposal arguing for the ICF to encourage patient-centered care.
Recovery and recovery based approaches in mental healthSimon Bradstreet
The document provides historical context on recovery and recovery-based approaches in mental health. It discusses how long-term outcome studies in the 1990s challenged notions of chronic mental illness and fueled the development of the contemporary recovery movement. Personal recovery is characterized as a unique, non-linear process of overcoming adversity with or without symptoms. While recovery approaches have become mainstream, there are also critiques that question whether recovery has been too readily adopted as a policy goal without addressing social determinants or critically examining recovery narratives. The evidence for recovery-based interventions is mixed, and successfully moving from a social movement to implemented approaches remains challenging.
This document summarizes a study that explored exercise adherence and motivations in university students using mixed methods. Semi-structured interviews were conducted with 6 students and analyzed for themes around motivation, mood, and barriers to adherence. Survey data from 29 students' Exercise Motivation Inventory scores were also analyzed. Thematic analysis of interviews showed 3 major categories affecting adherence: motivation, mood, and barriers. The survey analysis found no significant results. The study concluded that motivations for adherence are diverse and all aspects of exercise experience should be considered in program design.
Living as Well as you Can for As Long as you CanBCCPA
Sit down buffet breakfast featuring keynote speaker Dr. Romayne Gallagher, Head Division of Palliative Care, Department of Family & Community Medicine, Providence Health Care; Clinical Professor, Division of Palliative Care, UBC
This document discusses using the Community Empowerment theory to address uncontrolled type 2 diabetes in urban African Americans. It notes that African Americans have higher rates of diabetes and poorer outcomes. The theory focuses on community involvement, lay health workers, and reciprocal health to empower communities and improve self-management. The document proposes that community health workers could help address barriers African Americans face in managing diabetes.
A Public Health Approach to Mental Health Care: Taking Transformation to ScaleMHTP Webmastere
This presentation was given by Kathryn Power, Director, Center for Mental Health Services at SAMHSA, at the May 13, 2008 Prevention Policy Summit. Transcript of Kathryn Power\'s opening remarks.
Seniors Quality Leap Initiative: Using Data to Drive Improvements in Resident...BCCPA
1) The document discusses using data to drive improvements in resident quality of life at Providence Health Care's residential care homes. It summarizes Providence's current residential care program and facilities.
2) It describes the Seniors Quality Leap Initiative (SQLI), a consortium of long-term care organizations that works to improve clinical quality and safety for seniors through benchmarking, testing improvement ideas, and disseminating best practices. Providence is a member of SQLI.
3) Providence has been working to improve residents' quality of life, as measured by an internationally-used survey, by identifying opportunities through SQLI like enhancing social engagement and testing various changes in its homes.
The SDHI (Social Dimensions of Health Institute) is an interdisciplinary research collaboration between the Universities of Dundee and St Andrews established in 2003. It has two main research strands: 1) the social and environmental dimensions of health, wellbeing, and service delivery; and 2) human resilience and capabilities. SDHI brings together researchers from various disciplines and departments to conduct interdisciplinary research addressing key challenges through conferences, seminars, workshops, and postgraduate support.
This document summarizes a meeting of the Hertfordshire and West Essex Sustainability and Transformation Partnership about population health management. The meeting included presentations on the national context of population health and PHM, developing PHM locally, and next steps. It discussed the role of elected members in improving health outcomes and wellbeing for residents. Attendees considered developing a population health strategy and wider determinants of health. The goal is to improve physical and mental health across the population through data-driven care that addresses health inequalities.
The Healthy Neighbors program at Yale School of Nursing aims to improve the health and lives of residents at the Church Street South apartments, a subsidized housing project near the school. The program began with annual health fairs but has expanded to include daily tutoring sessions for younger residents during the school year. Fifteen YSN students now provide tutoring and help coordinate twice-annual health education fairs. The goal is for YSN students to build relationships and gain a deeper understanding of the community's health needs.
Continuous Decision Improvement (CDI): Public Health Decision Making for Comp...Tomas J. Aragon
This document discusses Continuous Decision Improvement (CDI), a framework for improving public health decision-making processes. CDI combines principles of quality improvement with a 4-step decision-making model (Define, Design, Decide, Do) to iteratively assess and enhance how decisions are made. The goal is to achieve better health outcomes through measurable improvements in decision processes, such as increasing constructive conflict and consensus. An example is given of applying CDI principles to build trust within decision-making teams.
What offers more choice? Budgets or human rights?shibley
My talk on how best to deliver choice in English dementia strategy - through the market, e.g. personal budgets, or international law, e.g. human rights.
Understanding Personality Disorders By Tom BurnsAnsel Group Ltd
Article for the Insight Supplement of Mental Health Today Magazine July/August 2010. Tom Burns, CEO of the Ansel Group, provides an insight into this patient group and provides some messages around organising services to best meet their needs.
The document discusses behavior change and behavior change communication (BCC) strategies for targeted interventions. It states that behavior determines health risk and interventions aim to change risky behaviors to safe behaviors. BCC uses dialogue and messages to bring about behavior change at individual, community, and societal levels. Effective BCC recognizes that behavior change is a process that occurs in stages from knowledge to practice. BCC should be paired with other strategies like enabling environments and is most effective with community participation. Peer education is highlighted as a key BCC method for targeted interventions.
This study examined how people with psychosis make sense of their relationships with important others. Semi-structured interviews were conducted with participants recruited from a rehabilitation service. The results showed that participants felt connected to important others through staying in contact, receiving support, and sharing experiences that created understanding. However, having psychosis can interfere with relationships by disrupting them during hospitalization and creating a lack of understanding and stigma from others. Participants distanced themselves from others and had difficulty trusting people as a means of self-protection. The discussion concluded that relationships are important for recovery but vulnerable to changes caused by psychosis and a lack of understanding from others.
ISPCAN Jamaica 2018 (CIHRTeamSV) - Improving Health and Behavioral Outcomes a...Christine Wekerle
Improving Health and Behavioral Outcomes among Sexually Victimized Male Youth: A Qualitative Investigation Among Trauma Treatment Providers
Ashwini Tiwari, Christine Wekerle, Andrea Gonzalez (CIHRTeamSV)
Alzheimer Europe talk 2015 Dr Shibley Rahmanshibley
These are the slides for the presentation I will give this year at the Alzheimer Europe conference in Ljubljana in Slovenia. It's survey based research on the importance of clinical nursing specialists in dementia.
Continuous Decision Improvement: Decisive Leadership for Complex EnvironmentsTomas J. Aragon
This document outlines the concept of Continuous Decision Improvement (CDI) as presented by Tomas J. Aragon. It discusses CDI as a process for public health leaders to continuously improve their decision making in complex environments. The 4D Decision Process is presented as a framework for rational decision making, involving defining problems, designing alternatives, deciding on alternatives, and implementing solutions. CDI then builds on this by incorporating elements of quality improvement to continuously refine and enhance the decision making process. Examples of applying CDI to specific public health decisions are also provided.
Delivering compassionate care to older adults across the care spectrumanne spencer
This document discusses how complementary therapies can restore compassion in nursing care for older adults. It describes the background of the complementary therapy service in Claremont, which provides therapies like massage, aromatherapy and reflexology. These therapies can help reduce medications and enhance quality of life by addressing physical, emotional and spiritual needs. The role of the Clinical Nurse Specialist is to integrate these therapies into care, evaluate clients, and collaborate with staff to provide compassionate, holistic care for older adults. Complementary therapies are seen as a compassionate way to relieve suffering through touch and communication, especially for those with dementia.
The document provides an overview of a 3-day workshop on applying the International Classification of Functioning, Disability and Health (ICF) framework for interprofessional care. The workshop aims to teach participants how to use the ICF to improve patient outcomes and health systems. On Day 1, participants are introduced to the ICF and complete a case study analysis. On Day 2, teams present case studies and provide peer feedback. On Day 3, teams conduct a hospital ward round using the ICF framework. Throughout the workshop, participants engage in structured reflections and develop a proposal arguing for the ICF to encourage patient-centered care.
Recovery and recovery based approaches in mental healthSimon Bradstreet
The document provides historical context on recovery and recovery-based approaches in mental health. It discusses how long-term outcome studies in the 1990s challenged notions of chronic mental illness and fueled the development of the contemporary recovery movement. Personal recovery is characterized as a unique, non-linear process of overcoming adversity with or without symptoms. While recovery approaches have become mainstream, there are also critiques that question whether recovery has been too readily adopted as a policy goal without addressing social determinants or critically examining recovery narratives. The evidence for recovery-based interventions is mixed, and successfully moving from a social movement to implemented approaches remains challenging.
This study explored community stroke rehabilitation therapists' use of outcome measures in Scotland. A survey of 113 therapists found that the most commonly used measures were the Berg Balance Scale, Tinetti Balance and Gait scales for physical therapists, the Rivermead Behavioural Memory Test and Barthel Index for occupational therapists, and the Therapy Outcome Measure and Frenchay Aphasia Screening Test for speech and language therapists. The top reasons for selecting measures were that they are relevant to patients' goals, easy to use, and sensitive to change. However, over a third of therapists were dissatisfied with the relevance of available measures to patients. The study highlights tensions between best practice and constraints like financial barriers to using measures.
The Interprofessional Team Immersion (IPTI) offers students across 13 health professions opportunities to apply their skills in cross-professional communication, teamness, and patient-centered engagement. The experience is characterized by high stakes cases carefully designed to cultivate an atmosphere conducive to rapid teambuilding and compassionate patient care. Within a safe learning environment, faculty and students acquire understanding of roles and responsibilities as well as skills to manage complex cases. This presentation will describe and demonstrate the rationale, design, and implementation of IPTI over a three-year period. Findings suggest significant increase in IPTI students’ perceptions of cooperation, resource sharing and communication skills for team-based practice. Programmatic evaluation substantiates the value students place on practicing interprofessional clinical skills before and while in their clinical-community rotations. Debriefing sessions with standardized patients enhanced students’ knowledge and appreciation for patient engagement and shared decision-making culminating for some in scholarly products. In total, findings provide beneficial insight for other interprofessional educational and collaborative practice initiatives taking place at the University and in the community. Learn more about IPEC at University of New England ipec(at)une(dot)edu or follow us on Twitter @UNEIPE
July 2017 EdgeTalks - A new mandate to support community actionNHS Horizons
This document discusses the importance of "people powered" or asset-based approaches to health and wellbeing. It notes that while modern medicine is powerful, many still live with long-term conditions, so these approaches are important. Evidence shows that approaches like shared decision making, personalized care planning, and peer support can improve outcomes. The presenter argues that health professionals should partner with people and communities, focus on what matters to them, and promote individual wellbeing through practices like better conversations and collaboration. Embracing these approaches in their own work could make a big difference.
Social cognitive theory is an interpersonal theory that aims to understand individual and group behavior and identify methods to modify behavior. It focuses on reciprocal determinism between personal factors, behavior, and the environment. Key concepts include observational learning, reinforcement, self-efficacy, and expectations. Diffusion of innovation theory examines how innovations spread through social systems via communication channels over time. It considers characteristics of innovations and adopter categories. Community organization theory aims to help community groups identify problems, mobilize resources, and implement strategies through consensus, capacity building, and task orientation.
This document describes the development of a Poststroke Checklist (PSC) to standardize follow-up care for stroke survivors. An international panel of experts identified common long-term poststroke problems and developed a draft checklist. A Delphi method consensus process was used with experts to refine the checklist. The final PSC assesses 11 key problems, including mobility, pain, and incontinence. It links patient responses to appropriate referrals to address problems and improve quality of life outcomes for stroke survivors. The goal is to provide a simple, evidence-based tool for use in primary care settings during long-term poststroke follow-up.
This document provides an overview of a public and patient engagement training session hosted by Community & Voluntary Action Tameside (CVAT) and Healthwatch Tameside. The training covered frameworks for assessing the scope and impact of proposals in order to determine the appropriate level of public engagement. Participants worked through case studies to practice applying the frameworks. They considered questions around understanding impact, identifying stakeholders, and planning evaluation. The goal was to equip participants with tools for meaningful public involvement in health and social care projects.
The document describes two research projects presented at a workshop on collaborative research. The first project aims to understand the experiences of carers of people with personality disorders and inform the development of a national carers' strategy. The second project explores understandings of recovery from the perspective of people with personality disorders living in the community. Both projects involve collaboration between service users, carers, academics and clinicians. Participants at the workshop worked in groups to develop sample research project titles and questions.
Exercise programs for people with dementia: What's the evidence?Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of exercise programs for people with dementia. Click here for access to the audio recording: https://youtu.be/jC8HhC2XFrE
Dorothy Forbes, Professor, Faculty of Nursing, University of Alberta, Edmonton led the session and presented findings from her latest Cochrane review:
Forbes, D., Forbes, S. C., Blake, C. M., Thiessen, E. J., & Forbes, S. (2015). Exercise programs for people with dementia. Cochrane Database of Systematic Reviews, 2015(4), CD006489.
As the population ages, the number of people suffering with dementia will also rise. Not only will this affect quality of life of people with dementia but will also increase the burden of family caregivers, community care, and residential care services. Exercise interventions have been identified as a potential way of reducing or delaying the progression of dementia and its symptoms. This review examines two questions: do exercise programs for older people with dementia improve cognition, activities of daily living (ADLs), challenging behaviour, depression, and mortality in older people with dementia? and; do exercise programs for older people with dementia have an indirect impact on family caregivers' burden, quality of life, and mortality?
The document summarizes a webinar on supporting staff wellbeing in the women and girls sector. The webinar covered topics like what influences staff wellbeing, supporting staff through reflective practice, self-care techniques like breathing exercises, and trauma-informed support. It provided an agenda, discussed concepts like containment and reflective practice, considerations for leadership, and referenced additional resources on topics like vicarious trauma, the RESPECT self-care model, and system psychodynamics.
Information interventions for injury recovery: a reviewAlex Collie
This presentation reports the results of a systematic review of information based interventions for injury recovery. It was presented at the Canadian Association for Research on Work and Health (CARWH) conference in 2012. The study has since been published in the Journal of Rehabilitation Medicine. A link to the study is here:
http://www.ncbi.nlm.nih.gov/pubmed/22674232
This presentation developed by Michelle Constable and Jim McManus, explores how health psychology can help the work of Environmental Health Officers and was part of an introductory workshop for the Environmental Health Profession organised by the Beds and Herts Branch of the Chartered Institute of Environmental Health
This community health assessment in Little Village, Chicago used participatory qualitative inquiry methods including focus groups, interviews, and oral histories to understand health issues from a community perspective. The assessment employed a community-based participatory research approach with academic and community partners collaborating throughout the process. Qualitative data analysis was an iterative process that engaged community stakeholders in developing codes, analyzing findings, and disseminating results. Key findings from the inquiry included stress from parenting, migration, occupation, and fear as major health concerns, as well as barriers to healthy coping. The participatory methods enhanced understanding of complex health issues and promoted meaningful relationships between partners.
This document provides an overview of recovery from mental illness presented by various speakers. It discusses historical views that lacked hope in recovery and modern concepts of recovery as a personal journey involving growth, strengths, and functioning despite symptoms. Recovery principles emphasize hope, meaning defined by the individual, self-management, social inclusion, and identity separate from illness. Treatment focuses on well-being rather than just symptoms and is a collaborative process where the individual directs their care and goals. The residential program described offers a recovery-focused environment over 3-6 months to build skills and independence.
Stages of Change & Reactance in Group WorkJane Gilgun
This document discusses stages of change and reactance in group work. It summarizes the stages of change model, which developed from research on smoking cessation and may apply to other issues. The stages are precontemplation, contemplation, preparation, action, and maintenance. It also discusses the common factors model and how relationships, motivation, capacities, skills and techniques, and external factors influence change. Reactance is defined as a response to threatened behaviors and can block change. Maintaining change requires attention to relationships and external environments to feel understood, connected, and safe.
Community engagement in public health interventions for disadvantaged groups:...Health Evidence™
Health Evidence hosted a 60 minute webinar examining the effectiveness of community engagement in public health interventions for disadvantaged groups. Click here for access to the audio recording for this webinar: https://youtu.be/tUZ-u7QbMCY.
Alison O'Mara-Eves, Senior Researcher, University College London, EPPI-Centre and Ginny Brunton, Senior Health Researcher, University College London, EPPI-Centre presented findings from their review:
O'Mara-Eves A., Brunton G., Oliver S., Kavanagh J., Jamal F., & Thomas J. (2015). The effectiveness of community engagement in public health interventions for disadvantaged groups: A meta-analysis . BMC Public Health, 15, 129.
Community engagement is becoming an increasingly popular component included in the development and implementation of public health interventions. Involved community members take on roles that range from merely being informed, to being consulted, to collaborating or leading on the design, delivery and evaluation of public health strategies. This review examines the use of public health interventions with a community engagement component, particularly for its use in reducing health inequities among disadvantaged populations. Findings of the review suggest community engagement in public health interventions has an effect on several health outcomes, including health behaviours and self-efficacy. This webinar will examine the effectiveness and components of public health interventions that include community engagement and the impact on health outcomes.
This document discusses the development of measures to assess community participation and environmental factors that influence participation for people with disabilities. It presents three talks:
1. Developing a measure of community participation after rehabilitation, which describes developing items to measure participation and testing them in various populations. Two constructs were identified: involvement in life situations and control over participation.
2. Feasuring the feasibility of measuring community participation after rehabilitation discharge, which evaluated using computer-adapted testing to measure participation over phone and internet with rehabilitation patients. Completion rates were similar for both modes.
3. Developing environmental factor measures for people with traumatic brain injury, stroke and spinal cord injury, which discusses efforts to create measures of environmental factors that
Evidence-Informed Guidelines for Recreation Therapy programs to Enhance the M...BCCPA
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2. About the Project
• Funded by the Chief Scientist Office
• 18 month duration
• Project start date: 1st February 2012
• End date: 31st July 2013
• Scotland-wide project
• Project team
• Dr Thilo Kroll, University of Dundee (Principal Investigator)
• Dr Helen Moore, University of Dundee
• Dr Jacqui Morris, University of Dundee
• Dr Frederike Van Wijck, Glasgow Caledonian University
• Professor James Law, University of Newcastle
• Dr Lisa Salisbury, University of Edinburgh
• John Dennis, NHS Greater Glasgow and Clyde
3. Project Rationale
• UK policy indicates that stroke rehabilitation needs to be
evidence-based, equitable and patient-centred and
outcome measurement must reflect these values.
• However, converging evidence indicates a gap between UK
policy and clinical practice in terms of stroke outcome
assessment.
• People who had a stroke have mostly NOT been consulted
on the relevance (usefulness and appropriateness) and
accessibility (ability to complete the measure) of outcome
measures that are used in community stroke rehabilitation.
• Community-based rehabilitation professionals may
currently use measures that do not necessarily reflect
patient priorities and accessibility requirements.
4. Function Participation
Impairment
- Muscle
weakness
- Paralysis
- Walking
difficulty
Participation restriction
- Getting in and out of
office buildings
- Accessible
transportation
- Lack of adapted
exercise equipment
Time
Inpatient stroke rehabilitation Community-based rehabilitation
Person X Environment
Measures
5. Accessibility of Outcome
Measures
• Accessibility: Can service users actively take part in outcome
assessments?
• Little is known about acceptability of outcome measures to service
users in terms of language, design and suitability.
• A review of 30 studies on stroke-specific patient reported outcome
measures showed only 5 had addressed acceptability
(Salter, Jutai, Zettler, Moses, Foley & Teasell, 2008).
• Inclusivity of outcome measures is poorly understood.
6. Project Aims
• Enable people with stroke to contribute to the
development of outcome measures in community based
rehabilitation
• Examine the rationale for the choice of outcome
measures that are currently used by community based
rehabilitation professionals
• Developing key recommendations for improving
outcome assessment after stroke
7. Research Plan – 3 Phases
• Phase 1 – Service user exploration
• Interviews with people after stroke who are community-dwelling and
currently/recently engaged in community rehabilitation (Explore
relevance and accessibility)
• Phase 2 – Rehabilitation professional’s current practice exploration
• Web-based survey with senior rehabilitation professionals
(Physiotherapists, Occupational therapists, Speech and Language
therapists) across all Scottish health boards.
• In-depth phone interviews (Explore use of outcome measures)
• Phase 3 – synthesis workshop
• Half –day workshop bringing together rehabilitation professionals
and stroke survivors (Determine priorities and way forward)
8. Phase 1: Service User
Interviews
• Research Question:
“Which are the most relevant outcomes that
people with stroke want to achieve through
community-based rehabilitation, and what are
the requirements for ensuring that the process of
outcome assessment is sufficiently inclusive?”
9. Who did we interview?
◦ One-off interviews with 34 people after stroke who were
currently or were recently engaged in community stroke
rehabilitation
◦ 6 interviews used Talking Mats™
Service users from 8 health boards took part
Fife, Grampian, Tayside, Lanarkshire, Lothian, Highland, Dumfries
and Galloway, GGC.
19 males, 15 females
16 under 65s, 17 over 65s (1 age unrecorded)
11 were 0-6 months post stroke, 12 were 7-12 months post
stroke and 7 were 12+ months post stroke
Phase 1: Service User Participants
10. • What matters? (relevance)
• We asked people:
• what matters to you in your life?
• what do you most want to get out of your
rehabilitation?
• How should what matters be captured? (accessibility)
• We asked people:
• about how therapists looked at how they were
getting on in their rehabilitation?
• for their suggestions on how they would like people
to look at how they are getting on.
Phase 1: Interview Topic Guide
11. Phase 1: Results
• Audio recordings of the 28 non-Talking Mats interviews were
transcribed and coded using Framework Analysis (Ritchie &
Spencer, 1994).
• 90 areas of importance to life and 55 rehabilitation goals were
identified by service users.
• 74 of 90 life importance areas (82.2%) and 41 of 55 rehab
goals (74.5%) could be mapped onto the 9 ICF activities and
participation domains.
12. ICF Activity and Participation
Domains
1. Self Care (9 excerpts coded)
• e.g. caring for appearance, losing weight
“Res: I do sunbeds […] My next-door neighbour actually came to the door last week with
a letter that went through her letterbox and she said sorry is Raymond in? I said
what, it’s me. Oh I didn’t know.. didn’t notice me. I think that was a good thing” (male
stroke survivor, age 45, 0-6 months post stroke)
2. Mobility (56 excerpts coded)
• e.g. walking, moving around in different locations, driving
3. Interpersonal Interaction and Relationships (56 excerpts coded)
• e.g. family relationships, informal social relationships
“Int: What’s important to you?
Res: My two boys. Definitely. They come first.” (female stroke survivor, age 64, more than
12 months post stroke)
4. General Tasks and Demands (3 excerpts coded)
• e.g. undertaking a single task, carrying out a daily routine
13. ICFActivityand ParticipationDomains(2)
5. Community, Civic and Social life (51 excerpts coded)
• e.g. recreation and leisure
6. Domestic life (31 excerpts)
• e.g. shopping, preparing meals, doing housework
7. Communication (6 excerpts)
• e.g. Speaking, Conversation
“My speech is obviously affected, that’s obvious, even I see it, I can see it what I am saying, I
come to speak to somebody, blur blur that sort, I try to keep it going. That is trying to keep
it low for the person I am speaking to. I mean it’s difficult. When I speak I try to speak
properly. That’s for the person and pretending to, that doesn’t mean pretending.. But I like
the person to understand what I am saying”. (Male stroke survivor, age 64, 7-12 months
post stroke)
8. Learning and Applying knowledge (14 excerpts)
• e.g. reading, writing, calculations
9. Major Life Areas
• e.g. work, education, voluntary work (25 excerpts)
14. Items not mapped onto the ICF
• 16/90 areas of importance and 14/55 rehab goals could not be mapped
onto the ICF activities and participation domains.
• 11 rehab goals relating to ‘body function’ domains of the ICF were
identified: e.g. balance, strength, coordination, arm functioning.
• 10 areas of importance and 3 rehab goals reflected issues surrounding
‘dealing with life after stroke’
Independence confidence getting back to normal
worrying less adjusting life to stroke
Getting self together not wanting to feel sorry for self
Taking life at a reasonable pace spontaneity in participating
15. Talking Mats Interviews
• 6 participants with aphasia (4 male, 2
female, mean age 62, range 32-75 y) took part in
Talking Mats interviews.
16. Talking Mats Interviews:
Results
• Factors identified as important to participants
after stroke in the wider interview study were
endorsed by participants with aphasia.
• All 6 participants rated being able to get
around, self-care and relationships with
others as being important to them.
• The least important items were being able to
multi-task and driving. Each was rated as
important by one participant only.
Communication, using the phone and writing
messages were important for most but not all
participants.
17. Stroke survivors interviewed had limited views on how what
matters should be captured.
What seems most important is that measurement should be a
positive experience for service users that:
◦ is encouraging
◦ shows progress
12 excerpts from 8 respondents (out of 28) indicated some
areas of outcome measurement that they felt were negative.
Some ways of measuring how service users are getting on:
◦ were hard for stroke survivors to complete
◦ were confusing as they were not culturally relevant
◦ risked making people feel like they were being judged
How should what matters be captured?
18. Stroke survivor views
INT: “So, how do you find it when people are watching you
doing things round the house? How is that for you?
RES: Very stressful, because you’re just wondering are they
going to say something that I’m not doing right or if I’m
not coping with it will they send me back to hospital or
something like that. That’s one of my worst fears, being
sent back to hospital or being sent in to some place that
is not my own home. I would really stress out about
that”. (Female stroke survivor, 67, 0-6 months post
stroke)
19. Summary of Phase 1
• Participation in meaningful activities and life roles are what matter
most to people once they are back home. Beyond function to
meaning
• The ICF domains of activity and participation are a useful resource
for mapping community rehabilitation goals
• Adjusting to life with stroke is another area of importance to service
users.
• For outcome measurement to be relevant to service users it must
address participation
• What is captured should provide encouragement to service users
and should be culturally relevant and accessible
20. Phase 2: Therapist Current
Practice Exploration
Research Questions:
• “Which outcome measures do rehabilitation
professionals currently use in multi-disciplinary
community-based stroke rehabilitation settings –
and why?”
• “Does the use of outcome measures differ based
on geographic location and practice
characteristics such as location, model and case
mix?”
21. • Web survey
• 13 (out of 14 Scottish NHS Health
Boards - Western Isles no
response)
• n=113 (55 Physiotherapists; 39
Occupational Therapists; 23
Speech and Language Therapists)
• 8 accessible rural; 31 accessible
small town; 31 large urban area;
30 other urban; 2 remote area; 11
remote small town
• 31 up to 5 years of experience
with stroke; 24 up to 10 years; 19
up to 15 years; 39 more than 15
years
22. • Addenbrooke’s Cognitive Examination (ACE-R)
• Barthel Index
• Berg Balance Scale (BBS)
• Nine Hole Peg Test (NHPT) or other pegs
• Rivermead Behavioural Memory Test (RBMT)
• Rivermead Perceptual Assessment Battery (RPAB)
• Ten Metre Walk Test (10MWT)
• Therapy Outcome Measure (TOM)
• Timed Up & Go Test (TUG)
• Tinetti - balance / Tinetti - gait
Top 10 (Top 3) Outcome
Measures (mentioned by more
than 20 therapists)
23. • Addenbrooke’s Cognitive Examination (ACE-R)
• Barthel Index
• Berg Balance Scale (BBS) PT
• Nine Hole Peg Test (NHPT) or other pegs
• Rivermead Behavioural Memory Test (RBMT) OT
• Rivermead Perceptual Assessment Battery (RPAB) OT
• Ten Metre Walk Test (10MWT)
• Therapy Outcome Measure (TOM) SLT
• Timed Up & Go Test (TUG)
• Tinetti - balance / Tinetti - gait
Top 3 Outcome Measures by
profession
24. 5 main reasons for choosing the
measure
1. They are relevant to patients’ goals (61.9%)
2. They are easy to use (53.4%)
3. There is a good evidence base for using the instrument
(50.8%)
4. They are sensitive to change in patient performance
(48.3%)
5. They are specific to the outcomes being measured
(45.8%)
25. Relevance to Patient Goals and
Accessibility
• Despite relevance to patients’ goals being the
primary driver in outcome measure
selection, only 13.6% of therapists endorsed
‘the measure elicits the views of patients’
as within their top 5 reasons for selecting
outcome measures.
• Accessibility was within the top 5 reasons for
selecting an outcome measure for only 8.5% of
respondents and a measure being aphasia
friendly was within the top 5 reasons for
selection for 2.5% of respondents.
26. 5 main purposes for the
measure
• To assess functional change in the patient
• To plan treatment
• To identify what the patient’s goals are
• To enable the patient to see progress
• To provide feedback to the patient/family
members/team
27. Satisfaction with outcome
measures
• When asked about satisfaction with the
range of measures available, 37.5% of
respondents expressed dissatisfaction with
the relevance of the range of measures
available.
“Outcome measures are not patient-centred, and are
rarely a reflection of the patient's goals. They tend to be
prescriptive and focus on what a patient can or cannot
do, rather than what they need or want to be able to do”
(SLT)
28. What is NOT in current measures
• Community / outdoor mobility
• Psychological adaptation rather than functional gains
• Fatigue
• Aphasia friendly measures
• Driving
• Community integration
• Meaningful activity and quality of life
• Level of carer support
• Participation in society
• Small but meaningful changes
• Patient’s everyday needs / impact on daily lives
• Return to work
• Experience ‘measures’
29. Therapist Interviews
• 13 therapists (5 PTs, 4 OTs, 4 SLTs) took part in 30
minute follow-up phone interviews to explore views
on outcome measurement in more depth.
• Tension for therapists between best practice and
realities of financial and service constraints, lack of
time and environmental barriers to using measures.
• Tension between tailoring measures to patient-
relevant goals and outcomes and ‘standardisation’
(choosing the same functional measure for
everyone)
30. Summary of Phase 2
• The findings show that practice, in line with policy, is shifting
towards greater patient-centredness in rehabilitation, with
relevance being a key factor in selecting outcome measures.
• Despite relevance being a key factor in selecting outcome
measures, over a third of therapists were dissatisfied with the
range of measures available in terms of relevance to their
patients. Therapists rarely felt that selecting measures which
elicit patient viewpoints was most important.
• What therapists feel is missing in outcome measures is what
service users report as being important to them.
• The findings highlight a gap between UK policy and practice in
terms of inclusiveness, with accessibility of outcome measures
not being a key factor in outcome measure selection.
31. Phase 3 – Synthesis Workshop
• 5 service users who took part in phase 1 of the project
• 8 community rehab therapists (PT, OT, SLT)
• Purpose of workshop
• Present initial findings for group discussion
• SUs and therapists rate importance of statements generated from
analysis
• Establish priorities moving forwards
• Method
• Presented statements generated from answers to ‘what is important
to you?’ in service user interviews
• Participants asked to rate the importance of statements 1-5 scale
• List of potential priorities provided to participants along with 3 fake
notes - $200, $100, $50. Asked to place these next to their priorities
32.
33.
34. Top 3 outcome measurement
priorities by ‘monetary investment’
• Be relevant to stroke survivors goals
• Encourage stroke survivors to reach their therapy goals
• Engage all stroke survivors irrespective of disability
35. Conclusions
• Participation in meaningful life roles/activities and experience
of life after stroke are what matters most to service users once
they have left the inpatient setting
• Complex picture for therapist’s current practice
• Functional measures most used
• Relevance to patients goals is of key importance
• Accessibility not a major priority
• Tension between what therapists want to do/are allowed to do
• Priorities for ways forward are outcome measures that are
relevant, provide opportunities for encouragement and are
accessible
36. What next…
• Creation of new measures in line with what’s meaningful in the
community in terms of participation/dealing with life after stroke as:
1. Not many participation measures in existence
2. Not validated
3. Not used routinely – functional measures dominate
• Measures should not be generic pencil/paper
• Interactive
• Accessible
• Centred around providing motivation and/or encouragement
• Smart measures – adaptable without losing rigour
• Discussion to be had in policy terms
• Reduce pressure in terms of what needs reporting to managers
• Acceptance of reporting more subjective, informal measures which capture
patient experience
• Primary training/CPD on experiential and participation aspects of recovery
and measuring these
Editor's Notes
Hi, my name is Helen Moore and I am the Research Associate on the project ‘Measuring outcomes in community-based stroke rehabilitation: enhancing inclusion and participation’ at the University of Dundee. Today I am here to provide an overview of this project on which we have been working over the last 18 months, rationale, methodology, findings and where to next. I will talk for about 30 minutes of the webinar which will leave half the time at the end for questions and discussion but please feel free to ask questions as we go and please let me know if you can’t hear anything I am saying.
Outcome measurement is an important area within community stroke rehabilitation. However, people who have had a stroke have mostly not been consulted on the relevance and accessibility of outcome measures that are used in community stroke rehabilitation
To go into this in a little more detail. First, thinking about the issue of relevance. A globally accepted conceptual framework for rehabilitation practice and research is the International Classification of Functioning, Disability and Health (WHO-ICF). This biopsychosocial framework has moved the focus of health care from aetiology to impact. It positions functioning and participation in life roles along a continuum that is influenced by personal and environment factors. After a stroke, rehabilitation goals tend to shift along the patient journey; in the acute stage, they mainly reflect impairment and activity limitation constructs of the ICF. Following hospital discharge, participation (i.e. life roles, e.g. interpersonal relationships, education, employment) in the wider community becomes more important.although there are numerous validated stroke outcome measures, a comprehensive reviewdemonstrates that the majority are biased towards impairment and activity limitation, whilst there is a dearth of measures in the participation domain. Stroke-specific measures that do address activities and participation are mostly limited to the ‘mobility’ category. Additionally, a review of Patient Reported Outcome Measures (PROM) for stroke also shows that only a small proportion of the nine stroke-specific PROMs include items on social functioning.
Furthermore, little is known about acceptability of PROMs to patients (i.e. the extent to which an instrument is appropriate in terms of language, design, and suitable given the patient’s health status); of the 30 studies on stroke-specific outcome measures, only 5 had addressed some aspect of acceptability. This was often measured in terms of the amount of missing data, or the number of people indicating they needed assistance, suggesting that the inclusivity of PROMs is poorly understood. Thus, ‘patient-reported’ measures do not necessarily reflect (a) patient choice, (b) appropriateness in terms of usability/accessibility of the measure. Consequently, PROMS may (a) ignore personally relevant outcome domains and areas and (b) exclude people with adaptation needs (e.g. people with communication impairments
The aims of this project are to improve the quality and impact of community-based stroke rehabilitation based on service user informed and ICF framed recommendations for clinical practice regarding outcome measurement. These aims will be achieved by:enabling people with stroke to contribute to the development of outcome assessments in community-based rehabilitation that are aligned with their priorities (research phase 1);examining the rationale for selection of outcomes currently in use by rehabilitation professionals in community rehabilitation (research phase 2);synthesising and disseminating key recommendations for enhancing outcome assessment for community-dwelling stroke survivors (research phase 3).
6 participants used Talking Mats. People were receiving a range of input – PT, OT, SLT
So what did we ask people about? UK policy states that services must be patient centred. Community rehabilitation should therefore be addressing goals and achieving outcomes that are of personal relevance to service users. So we wanted to find out what was important to service users. What is personally relevant? So we asked people…(slide)
4 areas of health domains in ICFBody structures (e.g. structure of the brain)Body function (e.g. muscle power)Activities and participation (e.g. walking)Environment (e.g. immediate family)
If we consider the 9 activity and participation domains of the ICF in turn.
This study used Talking Mats™ 1, a communication framework and speech therapy support tool, which represents discussion topics pictorially as symbols placed along a visual scale on a mat. Talking Mats were used to adapt the format of interviews previously conducted with a larger group of stroke participants without aphasia.All participants were asked: what is important to you in your life?Symbols were generated on the basis of previous responses from project intervieweesSymbols were placed on one mat with a 3-point top-scale,composed of ‘Important’, ‘I’m not sure’ and ‘Not important’ ratings.Participants were encouraged to add their own symbols whilst generating the mat if issues that were important to them were not included in the pre-prepared symbols selection.