Cultural Humility: A Collaborative Approach to Recruiting Patients with Deliberate Self-Harm into a Multi-Hospital Randomized Controlled Trial

Objectives: The ‘SMS SOS’ Deliberate Self-Harm (DSH) Aftercare Study was conducted in Western Sydney, Australia (October 2017 to December 2020) across three large public hospitals. During this randomized controlled trial (RCT), it was observed that knowledge exchange between key stakeholders and their ‘cultural’ perspectives (for example, Mental Health Clinicians, Lived Experience Mental Health Consultants—Patient Representatives, Administrative Officers, and Researchers) was essential to effective recruitment of patients experiencing DSH. Knowledge exchange within and between cultural groups was maximised and assessed using a communication matrix. This process, transferable to other trials engaging multiple ‘cultures’, aimed to promote the early identification of wider-team strengths as well as active management of emergent issues that would otherwise impede patient recruitment, and to maximise funding and human resources. Methods: A descriptive study was conducted with a convenience sample of team members who represented different cultures in the study. Qualitative data were elicited from a ‘know and tell’ matrix. Through an iterative process, themes were generated that encapsulated what team members needed to know from and tell to their colleagues concerning the study. Results: Factors that impacted participation in the study included clinician workload, the level of motivation/ commitment/confidence of clinicians to recruit patients, clinician-patient engagement, perception and expectations of study involvement, inter-cultural communication, and clinician training and support. The findings of this multidisciplinary consultation informed a composite model of knowledge exchange and the development of educational briefing/ orientation modules that make explicit team members’ roles and responsibilities to foster group member participation and enhance patient recruitment. Conclusions: It is incumbent upon multidisciplinary team members of large-scale studies to adopt a similar ‘knowledge exchange’ strategy early in the planning and design stage. Adoption of such a strategy has the potential to mitigate risk of delay in project timelines, improve project outcomes, and ensure the efficient use of research funding, particularly in newly established research teams within clinical settings and with members newer to formal research collaborations. Keywords: cultural humility; deliberate self-harm; engagement; participant recruitment; participatory research; randomized controlled tria

Cultural Humility: A Collaborative Approach to Recruiting Patients with Deliberate Self-Harm into a Multi-Hospital Randomized Controlled Trial

Objectives: The ‘SMS SOS’ Deliberate Self-Harm (DSH) Aftercare Study was conducted in Western Sydney, Australia (October 2017 to December 2020) across three large public hospitals. During this randomized controlled trial (RCT), it was observed that knowledge exchange between key stakeholders and their ‘cultural’ perspectives (for example, Mental Health Clinicians, Lived Experience Mental Health Consultants—Patient Representatives, Administrative Officers, and Researchers) was essential to effective recruitment of patients experiencing DSH. Knowledge exchange within and between cultural groups was maximised and assessed using a communication matrix. This process, transferable to other trials engaging multiple ‘cultures’, aimed to promote the early identification of wider-team strengths as well as active management of emergent issues that would otherwise impede patient recruitment, and to maximise funding and human resources. Methods: A descriptive study was conducted with a convenience sample of team members who represented different cultures in the study. Qualitative data were elicited from a ‘know and tell’ matrix. Through an iterative process, themes were generated that encapsulated what team members needed to know from and tell to their colleagues concerning the study. Results: Factors that impacted participation in the study included clinician workload, the level of motivation/ commitment/confidence of clinicians to recruit patients, clinician-patient engagement, perception and expectations of study involvement, inter-cultural communication, and clinician training and support. The findings of this multidisciplinary consultation informed a composite model of knowledge exchange and the development of educational briefing/ orientation modules that make explicit team members’ roles and responsibilities to foster group member participation and enhance patient recruitment. Conclusions: It is incumbent upon multidisciplinary team members of large-scale studies to adopt a similar ‘knowledge exchange’ strategy early in the planning and design stage. Adoption of such a strategy has the potential to mitigate risk of delay in project timelines, improve project outcomes, and ensure the efficient use of research funding, particularly in newly established research teams within clinical settings and with members newer to formal research collaborations. Keywords: cultural humility; deliberate self-harm; engagement; participant recruitment; participatory research; randomized controlled tria

The National Open Disclosure Pilot: evaluation of a policy implementation initiative

Objective: To determine which aspects of open disclosure "work" for patients and health care staff, based on an evaluation of the National Open Disclosure Pilot. Design, setting and participants: Qualitative analysis of semi-structured and open-ended interviews conducted between March and October 2007 with 131 clinical staff and 23 patients and family members who had participated in one or more open disclosure meetings. 21 of 40 pilot hospital sites, in New South Wales, South Australia, Victoria and Queensland, were included in the evaluation. Participating health care staff comprised 49 doctors, 20 nurses, and 62 managerial and support staff. In-depth qualitative data analysis involved mapping of discursive themes and subthemes across the interview transcripts. Results: Interviewees broadly supported open disclosure; they expressed uncertainty about its deployment and consequences, and made detailed suggestions of ways to optimise the experience, including careful pre-planning, participation by senior medical staff, and attentiveness to consumers' experience of the adverse event. Conclusion: Despite some uncertainties, the national evaluation indicates strong support for open disclosure from both health care staff and consumers, as well as a need to resource this new practice