Unraveling the role of client-professional communication in adolescent psychosocial care

Cliëntgerichte communicatie is essentieel voor kwalitatief goede jeugdhulp Dit proefschrift onderstreept het belang van cliëntgerichte communicatie in de psychosociale zorg voor adolescenten met emotionele en gedragsproblemen. Cliëntgericht communiceren betekent dat hulpverleners hun communicatie afstemmen op de behoeften van individuele cliënten. Jongeren en hun ouders hebben verschillende communicatiebehoeften en wanneer hulpverleners daar niet aan tegemoetkomen heeft dat een negatieve invloed op de uitkomsten van het zorgproces. Jongeren die de communicatie anders ervaren dan zij zouden willen, participeren minder en leren minder en hun problemen nemen minder af dan bij jongeren van wie de ervaringen wel overeenkomen met wat zij belangrijk vinden. Dit proefschrift laat ook zien dat hulpverleners specifieke en doelgerichte communicatiestrategieën hanteren. Om positief gedrag van cliënten te bekrachtigen kunnen zij bijvoorbeeld een specifieke communicatiestrategie gebruiken waarbij zij een compliment combineren met een motivatie voor het geven van dat compliment. Ook beschikken hulpverleners over verschillende strategieën om te reageren op ‘ik weet het niet’ – antwoorden van jongeren. Dit type antwoord wordt in professionele handboeken wel beschreven als niet-coöperatief gedrag dat vermeden moet worden. Hulpverleners gaan echter ook op andere manieren met deze antwoorden om. Soms gebruiken zij deze zelfs als een startpunt voor een therapeutische interventie om, samen met de cliënt, te komen van een staat van ‘niet weten’ naar een staat van ‘weten’. De bevindingen van dit onderzoek hebben implicaties voor praktijk, onderwijs en beleid. Communicatie die beter op de cliënt is afgestemd blijkt samen te hangen met positievere uitkomsten in de psychosociale zorg voor adolescenten. Dat biedt kansen voor betere zorg voor een kwetsbare groep jeugdigen

Development of the GeriatrICS, an ICF-based and person-centred assessment tool for evaluation of health-related problems in community-living older adults

Introduction: Ideally, older adults should receive person-centred care and support that meets their individual needs and wishes, taking all relevant health-related problems into account. The International Classification of Functioning, Disability and Health ICF might offer a basis for identification of these problems as it provides a unified language for evaluation of functioning and disability associated with someone’s health status. ICF Core Sets have been developed to describe the spectrum of disabilities of specific patient populations. Therefore, aim of this study was to develop a valid Geriatric ICF Core Set GeriatrICS reflecting all relevant health-related problems of community-living older adults without dementia. Methods: This study consisted of two sub-studies: 1 a written Delphi study to select ICF categories, and 2 assessing content validity in a cross-sectional study. For the Delphi study, a representative panel of experts older adults and non-medical experts on health-related problems due to ageing was constituted. Panel members had to select second-level categories from the ICF-classification relevant to community-living, non-demented older adults 75+, and had to reach consensus on this selection. For the validation study, older adults frail or with complex care needs were visited by a case manager district nurse or social worker who used the initial GeriatrICS as an assessment tool. Older adults had to rate all categories on a scale ranging from 0 no problem to 10 complete problem. Content validity of a category was guaranteed if ≥10% indicated a problem with that category. Results: 41 Delphi panel members obtained consensus in two rounds on 30 ICF-categories. Next, 267 older adults participated in the validation study. All categories met the criterion for content validity except for d530 Toileting. The final GeriatrICS consists of 29 categories: fourteen Body Functions categories, nine Activities and Participation categories and six Environmental Factors categories. Discussions and conclusions: This study resulted in a valid ICF Core Set GeriatrICS including 29 ICF categories representing the most relevant health-related problems among community-living older adults without the diagnosis of dementia. The GeriatrICS included categories from all ICF components, showing that older people’s health is a multidimensional construct. Compared to commonly used, profession-based tools, the GeriatrICS is unique as it is a population-based, cross-domain tool. Therefore, the GeriatrICS is a good starting point for the delivery of person-centred and integrated care. Lessons learned: The GeriatrICS may be used in person-centred and integrated care practice as an assessment tool, in order to tailor care and support to the needs of older adults. Analysis and interpretation of an older adult’s outcomes, and translation into an appropriate care plan, requires highly competent and experienced professionals. Limitations: Older adults with dementia or cognitive impairments may have been included in the validation study since dementia was not an exclusion criterion. Impact on the results is expected to be trivial as case managers were experienced interviewers and a partner or family member participated in the assessment in case of cognitive problems. Suggestions for future research: Future research should investigate the health-related problems of older adults with dementia and robust older adults

Improving self-management of health through an eHealth application:an action-based study among older adults living in the community

Introduction: Older adults living at home benefit from self-management support to stay healthy for as long as possible. An eHealth application could be a solution to meet older adults’ individual supportive needs. The aim of this study was to identify quality criteria for eHealth applications targeting personalized access to self-management support of health from a community-living older adult’s perspective. The study is conducted as part of the EU-supported CONNECARE research and the NFU program eHealth.Methods: We designed an action-based study using focus groups, individual interviews, and questionnaires among robust, community-living older adults participating in Embrace, a person-centred and integrated service in the Netherlands. The study was designed in three phases. The results of each phase led to an improved version of the quality criteria underlying the eHealth application, which was used as input for the next phase of development. In the first phase, twelve older adults participated in two focus groups that gathered twice. The majority was male n=8 and participants were between the age of 76 and 85. Participants were asked about their needs concerning physical activity, nutrition, and social activity in their daily lives, and the support of a potential eHealth application. Based on a first list of quality criteria resulting from these focus groups, a self-management application prototype was developed. In the second phase, seven participants male: n=6 tested the prototype and individual interviews were conducted, resulting in a second version of the quality criteria. Focus group discussions were audio-recorded and interviews were video-recorded. All data were transcribed verbatim and then analyzed and coded into key issues and themes. Results of the first two phases are now used to further develop and improve the self-management application. The third phase concerns evaluation research in which robust older adults living at home n=40, 75 years and older will use the application in their daily lives. Evaluation will involve quantitative and qualitative measures, resulting in a final list of quality criteria.Results: A list of quality criteria for eHealth applications has been established based on the first two phases of the study. Quality criteria concern accessibility, functionalities, navigation, readability, trust and privacy.Discussions: Study results provide insight into quality criteria needed to design, build and implement an eHealth application targeting personalized access to self-management support of health from the older adults’ perspective.Conclusions: An eHealth application targeting older adults’ self-management should be easy to use, personalized, and beneficial for the person using it.Lessons learned: For a successful eHealth application it is essential to actively involve potential end users at all stages of the developmental process. Traditional research methods have to be adapted to successfully study the quality of an eHealth application.Limitations: Participants were all relatively healthy older adults with at least an interest in ICT early adopters, frail older adults were excluded.Suggestions for future research: Viewpoints of care providers and more vulnerable older adults, for example people with complex care needs, low health literacy, or different ethnicity should be addressed

Results of a cross-sectional study on health-related problems of community-living older adults using the GeriatrICS, an ICF-based assessment tool

Introduction: Ideally, older adults should receive person-centred care and support that meets their individual needs and wishes, taking all relevant health-related aspects into account. A first step towards that goal is to gain insight into their health-related problems. For that purpose, a person-centred ICF Core Set for community-living older adults, the GeriatrICS, was developed. The objectives of this study were to assess the prevalence and severity of health-related problems in community-living older adults, and to assess the differences between subgroups of older adults: those with complex care needs, frail and robust older adults. Methods: A cross-sectional study was conducted among older adults receiving person-centred and integrated care and support from Embrace, a person-centred and integrated service. Older adults with complex care needs n=163 and frail older adults n=104 were interviewed by case managers, who assessed the older adults using the GeriatrICS. Robust older adults n=274 received a questionnaire version of the GeriatrICS. All older adults had to rate the items on a scale ranging from 0 no problem to 10 complete problem. We examined data per item in terms of prevalence of problems and severity. Differences in prevalence between subgroups was tested using Chi-square tests and differences in severity were tested using Mann-Whitney U tests. Results: Mean age of participants n=541 was 80.7 years SD 4.4, 56% was female, and 51% had a lower educational level.Preliminary analyses showed that, overall, the most prevalent and severe problems were related to the clusters Mobility, Mental Functions and Physical Health. For example, prevalence of Mobility-related problems: Complex care needs 52.0%, Frail 55.6% and Robust 43.6%, and severity: Complex care needs 1.9, Frail 2.4 and Robust 1.0. Although prevalence was comparable among frail older adults and those with complex care needs, results showed a trend in higher severity scores for frail participants. Robust older adults also showed health-related problems e.g. Physical Health: prevalence 33.8%, severity 0.8, but less frequent and less severe compared to participants with complex care needs 45.7%, 1.5 and frail participants 47.1%, 1.8. Discussions and conclusions: We assessed health-related problems due to ageing using the GeriatrICS in a community-sample of older adults. Frail older adults and those with complex care needs showed the highest prevalence of problems, but frail participants experienced them as more severe. Besides, robust older adults already showed health-related problems, indicating the need for prevention. Lessons learned: Prevention of health-related problems in older adults is necessary and should also be targeted at robust older adults.Results suggest that using the GeriatrICS could be a good starting point for the development of person-centred, proactive and preventive care and support programs. Limitations: We may have to deal with common method bias, due to the difference in assessment methods interview by a case manager versus a questionnaire version. However, in both situations, the assessment was self-reported because the older adults had to indicate the severity of their problems. Suggestions for future research: Future studies should examine the concurrent validity of both assessment methods using the GeriatrICS

Patient Perspectives to Inform a Health Literacy Educational Program:A Systematic Review and Thematic Synthesis of Qualitative Studies

Patient-centred care is tailored to the needs of patients and is necessary for better health outcomes, especially for individuals with limited health literacy (LHL). However, its implementation remains challenging. The key to effectively address patient-centred care is to include perspectives of patients with LHL within the curricula of (future) healthcare providers (HCP). This systematic review aimed to explore and synthesize evidence on the needs, experiences and preferences of patients with LHL and to inform an existing educational framework. We searched three databases: PsychInfo, Medline and Cinahl, and extracted 798 articles. One-hundred and three articles met the inclusion criteria. After data extraction and thematic synthesis, key themes were identified. Patients with LHL and chronic diseases encounter multiple problems in the care process, which are often related to a lack of person-centeredness. Patient perspectives were categorized into four key themes: (1) Support system; (2) Patient self-management; (3) Capacities of HCPs; (4) Barriers in healthcare systems. “Cultural sensitivity” and “eHealth” were identified as recurring themes. A set of learning outcomes for (future) HCPs was developed based on our findings. The perspectives of patients with LHL provided valuable input for a comprehensive and person-centred educational framework that can enhance the relevance and quality of education for (future) HCPs, and contribute to better person-centred care for patients with LHL

Long-term advantages of person-centred and integrated care:results of a longitudinal study on Embrace

Introduction: Embrace1 is a population-based, person-centred, and integrated care service for community-living older adults that combines the Chronic Care Model with risk profiles based on a population health management model. A multidisciplinary Elderly Care Team organizes and evaluates care and support, with intensity depending on an older adult’s risk profile. Embrace has been implemented since 2012 and showed positive outcomes after 12 months regarding patient outcomes, quality of care, and costs. Aim of this study was to assess the long-term outcomes, overall and by risk profile. Methods: We performed a longitudinal study on patient outcomes, quality of care, and costs, with evaluation of change after 12, 24, and 36 months compared to baseline. Results: In total, 1308 older adults participated in the study mean age 80.7 years SD 4.6, 55% female, 57% low educational level. The risk profile distribution changed after 12 and 24 months, with an increase in frail participants Robust 66% vs 39% after 24 months, Frail 17% vs 41%, Complex care needs 18% vs 20%. Overall, general health EQ-VAS remained stable across measurement moments. Quality of life ‘compared to the year before’ SF-36 was stable after 12 months, and decreased after 24 months p=0.026, ES=0.12 and 36 months p0.001, ES=0.61. Discussion and conclusion: Overall, long-term outcomes of Embrace for the older adults are beneficial, particularly for older adults with complex care needs. It seems that Embrace has halted the declining trends in general health and well-being associated with ageing, as well as the related costs increase. Lessons learned: Implementation of Embrace among frail older adults can be improved. Limitations: The lack of a control group. Suggestions for future research: Further research should focus on preventive en proactive support programs for older adults