Cramm, J.M.

A large-scale longitudinal study indicating the importance of perceived effectiveness, organizational and management support for innovative culture (Article)

2013-04-01T00:00:00Z

Teams participating in QI collaboratives reportedly enhance innovative culture in long-term care, but we currently lack empirical evidence of the ability of such teams to enhance (determinants of) innovative culture over time. The objectives of our study are therefore to explore innovative cultures in QI teams over time and identify its determinants. The study included QI teams participating between 2006 and 2011 in a national Dutch quality program (Care for Better), using an adapted version of the Breakthrough Method. Each QI team member received a questionnaire by mail within one week after the second (2-3 months post-implementation of the collaborative = T0) and final conference (12 months post-implementation = T1). A total of 859 (out of 1161) respondents filled in the questionnaire at T0 and 541 at T1 (47% response). A total of 307 team members filled in the questionnaire at both T0 and T1. We measured innovative culture, respondent characteristics (age, gender, education), perceived team effectiveness, organizational support, and management support. Two-tailed paired t-tests showed that innovative culture was slightly but significantly lower at T1 compared to T0 (12 months and 2-3 months after the start of the collaborative, respectively). Univariate analyses revealed that perceived effectiveness, organizational and management support were significantly related to innovative culture at T1 (all at p ≤ 0.001). Multilevel analyses showed that perceived effectiveness, organizational support, and management support predicted innovative culture. Our QI teams were not able to improve innovative culture over time, but their innovative culture scores were higher than non-participant professionals. QI interventions require organizational and management support to enhance innovative culture in long-term care settings.

Development and Validation of the Older Patient Assessment of Chronic Illness Care (O-PACIC) Scale After Hospitalization (Article)

2013-03-25T00:00:00Z

Objectives of this study were to develop and validate an instrument to assess older patients' experiences with integrated care delivery after hospitalization. Our study was conducted among older individuals (≥65) who had recently been discharged from a hospital. At T1, 3 months after hospital admission, 296/457 patients (65 % response) were interviewed in their homes. At T2 12 months after hospital admission, 242/436 patients (56 % response) were interviewed. Point of departure for the development of the scale was the 20-item Patient Assessment of Chronic Illness Care (PACIC), which is proven to be a valid measure to assess chronically-ill patients' assessment of integrated primary care delivery. We tested both the PACIC and new instrument by means of structural equation modeling, and examined its validity and reliability. After eliminating 10 items of the PACIC, the confirmatory factor analyses revealed good indices of fit with the 10-item Older Patient Assessment of Chronic Illness Care (O-PACIC) Scale. To estimate construct validity of the instrument, we looked at correlations between PACIC and O-PACIC scores and the satisfaction with stroke care home subscale (SASC-Home) questionnaire. Both the PACIC and O-PACIC significantly correlated with SASC-Home subscale (at p ≤ 0.001), which indicated validity. This study demonstrated that O-PACIC is a feasible, reliable and valid tool, with strong psychometric properties. We conclude that the O-PACIC is a promising instrument to evaluate integrated care delivery after hospitalization among older patients.

The experiences of neighbour, volunteer and professional support-givers in supporting community dwelling older people (Article)

2013-03-01T00:00:00Z

Public policy increasingly emphasises the importance of informal support networks to meet the needs of the ageing population. Evidence for the types of support neighbours provide to older people and how neighbours collaborate with formal support-givers is currently insufficient. Our study therefore explored (i) types of informal neighbour support and (ii) experiences of neighbours, volunteers and professionals providing support. Interviews with nine Dutch neighbour support-givers, five volunteers and 12 professionals were conducted and subjected to latent content analysis. Findings indicate that commitment occurred naturally among neighbours; along with providing instrumental and emotional support, neighbour support seems to be a matter of carefully 'watching over each other'. Neighbour support-givers, however, are often frail themselves and become overburdened; they furthermore lack support from professionals. Neighbour, volunteer and professional support-givers seem to operate in distinct, non-collaborative spheres. Findings suggest that policy-makers should consider the opportunities and limitations of neighbour and volunteer support. Professionals have an indispensable role in providing back-up and accountable, specialised support. They may be trained to adopt a visible and proactive attitude in neighbourhoods to facilitate, cooperate with and mediate between neighbour and volunteer support-givers.

The influence of organizational characteristics on employee solidarity in the long-term care sector (Article)

2013-03-01T00:00:00Z

Aim. This article is a report of a study that identifies organizational characteristics explaining employee solidarity in the long-term care sector. Background. Employee solidarity reportedly improves organizations' effectiveness and efficiency. Although general research on solidarity in organizations is available, the impact of the organizational context on solidarity in long-term care settings is lacking. Design. Cross-sectional survey. Method. The study was carried out in Dutch long-term care. A total of 313 nurses, managers and other care professionals in 23 organizations were involved. Organizational characteristics studied were centralization, hierarchical culture, formal and informal exchange of information and leadership style. The study was carried out in 2009. Findings. All organizational characteristics significantly correlated with employee solidarity in the univariate analyses. In the multivariate analyses hierarchical culture, centralization, exchange of formal and informal information and transformational leadership appears to be important for solidarity among nurses, managers and other professionals in long-term care organizations, but not transactional and passive leadership styles. Conclusion. The study increased our knowledge of solidarity among nurses, managers and other professionals in the long-term care settings. Organizational characteristics that enhance solidarity are high levels of formal and informal information exchange, less hierarchical authority, decentralization and transformational leadership styles.

Relational coordination between community health nurses and other professionals in delivering care to community-dwelling frail people (Article)

2013-03-01T00:00:00Z

Aims: The first aim of this study was to investigate whether relational coordination is higher between primary care professionals and community health nurses than among other professionals. The second aim of this study was to investigate the relationship between different levels of relational coordination and primary care professionals' satisfaction with the care delivery of community health nurses. Background: Community health nursing is based on the notion that all activities should respond to frail people's needs in a coordinated way, together with other professionals. Relational coordination is therefore important for the effective health-care delivery by these nurses. Methods: This cross-sectional study was performed among 167 professionals (n = 323, response rate 52%) who regularly worked with community health nurses. Results: The results showed a higher degree of relational coordination with community health nurses than with other primary care professionals. Multilevel analyses revealed that professionals' satisfaction with the care delivered by community health nurses was influenced positively by relational coordination. Conclusion: Enhancing relational coordination between community health nurses and other primary care professionals in the neighborhood may improve the delivery of care to community-dwelling frail people. Implications for nursing management: Comprehensive care delivery to community-dwelling frail people requires strong connections between all health and social care professionals. Community health nurses may be an important factor in strengthening these connections.

Understanding older patients' self-management abilities: functional loss, self-management, and well-being (Article)

2013-02-01T00:00:00Z

Purpose: This study aimed to increase our understanding of self-management abilities and identify better self-managers among older individuals. Methods: Our cross-sectional research was based on a pilot study of older people who had recently been admitted to a hospital. In the pilot study, all patients (>65 years of age) who were admitted to the Vlietland hospital between June and October 2010 were asked to participate, which led to the inclusion of 456 older patients at baseline. A total of 296 patients (65% response rate) were interviewed in their homes 3 months after admission. Measures included social, cognitive, and physical functioning, self-management abilities, and well-being. We used descriptive, correlations, and multiple regression analyses. In addition, we evaluated the mediation effect of self-management abilities on well-being. Results: Social, cognitive, and physical functioning significantly correlated with self-management abilities and well-being (all p ≤ 0.001). After controlling for background characteristics, multiple regression analysis indicated that social, cognitive, and physical functioning still related to self-management abilities (β = 0.17-0.25; all p ≤ 0.001). Older people with low levels of social, cognitive, and physical functioning were worse self-managers than were those with higher levels of functioning. Conclusions: Self-management abilities mediate the relationship between social, cognitive, and physical functioning and well-being. Interventions to improve self-management abilities may help older people better deal with function losses as they age further.

The Longitudinal Relationship Between Satisfaction with Transitional Care and Social and Emotional Quality of Life Among Chronically Ill Adolescents (Article)

2013-01-28T00:00:00Z

This study aimed to identify the relationship between satisfaction with transitional care and quality of life of chronically ill adolescents over time. This longitudinal study included adolescents with type I diabetes, juvenile idiopathic arthritis (JIA), and neuromuscular disorders (NMD). At baseline 138 respondents (response rate 31 %) filled in a questionnaire and 188 about 1 year later (response rate 43 %). Analysis of variance showed that adolescents with diabetes reported the highest physical quality of life, followed in order by those with NMD and JIA (p ≤ 0.01). Adolescents with diabetes reported the highest social quality of life, followed in order by those with JIA and NMD (both at p ≤ 0.001). Univariate analyses showed that satisfaction with transitional care at T0 was significantly related to emotional and physical quality of life at T1 (both at p ≤ 0.05). At T1, satisfaction with transitional care was significantly related to the emotional, physical, and social domains of quality of life (all at p ≤ 0.001). Multiple regression analyses revealed that satisfaction with transitional care at T1 was related to emotional (β -0.20; p ≤ 0.05) and social (β -0.35; p ≤ 0.01) quality of life domains over time. This indicates that lower gap scores, which measured differences between 'best care' and 'current care,' are associated with better social and emotional quality of life in this sample of adolescents. Satisfaction with transitional care and social and emotional quality of life are related over time.

Relationships between frailty, neighborhood security, social cohesion and sense of belonging among community-dwelling older people (Article)

2012-12-03T00:00:00Z

Aim: The relationships between frailty and neighborhood social resources and neighborhood quality among community-dwelling older people are poorly understood. We therefore enquired into these associations while controlling for important individual characteristics. Methods: Our cross-sectional study included 945 out of 1440 (66% response rate) community-dwelling older people (aged ≥70 years) in Rotterdam. The sample included approximately 430 older adults per district and was proportional with respect to neighborhood and age. Potential participants were mailed questionnaires, non-respondents were first sent a reminder, then asked by telephone and finally visited at home to complete the questionnaire. Results: Age, sex, marital status and level of education varied between the frail and non-frail. A significantly larger proportion of the frail was female (64.4% vs 48.0%; P≤0.001), fewer were married (22.1% vs 48.4%; P≤0.001) and the frail were, on average, older than the non-frail (78.8 vs 76.0 years; P≤0.001). A significantly larger proportion of the frail were poorly educated (25.9% vs 18.6%; P≤0.01). Multilevel regression analyses showed that older age (P<0.001) was associated with higher likelihood of frailty and marital status (P<0.001) with lower likelihood of frailty. Feeling more secure (P<0.001) and having a stronger sense of social cohesion and neighborhood belonging (P<0.05) seemed to protect against frailty. Conclusion: The results of this study support the importance of feeling safe, social cohesion and a sense of belonging within the neighborhood. These findings could have important implications for efforts to reduce frailty of older people within communities.

The relationship between older adults' self-management abilities, well-being and depression (Article)

2012-12-01T00:00:00Z

This study aimed to identify the relationship between self-management abilities, well-being and depression. Our study was conducted among older adults (>65 years of age) who were vulnerable to loss of function after hospital discharge. Three months after hospital admission, 296/456 patients (65 % response rate) were interviewed in their homes. The 30-item Self-Management Ability Scale was used to measure six self-management abilities: taking initiative, investing in resources for long-term benefits, taking care of a variety of resources, taking care of resource multifunctionality, being self-efficacious and having a positive frame of mind. Well-being was measured with the Social Production Function (SPF) Instrument for the Level of Well-being (SPF-IL) and Cantril's ladder. The Geriatric Depression Scale was used to assess depression. Correlation analyses showed that all self-management abilities were strong indicators for well-being (p < 0.001 for all). Regression analyses revealed that investing in resources for long-term benefits, taking care of a variety of resources, taking care of resource multifunctionality and being self-efficacious were associated with well-being. While no significant relationship was found between well-being and having a positive frame of mind or taking initiative, regression analyses revealed that these self-management abilities were related to depression. Investing in resources for long-term benefits and taking care of a variety of resources were significantly related to depression. This research showed that self-management abilities are related to well-being and depression among older adults. In addition, this study identified key self-management abilities for older adults who had recently been discharged from a hospital.

Facilitators and hindrances in the experiences of Ugandans with and without disabilities when seeking access to microcredit schemes (Article)

2012-12-01T00:00:00Z

Purpose: This study aimed to identify facilitators and hindrances in the experiences of Ugandans with and without disabilities when seeking access to microcredit schemes. Method: Thirty-five statements were presented to 80 people, 50 of whom were disabled. Q-methodology was used to identify factors influencing access to microcredit schemes. Results: Running a business independently was solely identified by people with disabilities (PWD) as an important facilitator in accessing microcredit schemes, while relying on business skills was largely mentioned by people without disabilities. The disabled identified family-related items to be inhibiting factors. Having a group loan was ranked negatively by the disabled and ambivalently by the non-disabled. Conclusions: PWD experience different facilitators and barriers to access microcredit schemes compared to the non-disabled. PWD prefer individual loans and believe they can more successfully run a business on their own, instead of relying on family or having a group loan. Furthermore, they would benefit from microcredit schemes that take into account disability-specific circumstances. These are important findings to increase access to microcredit schemes and to let PWD benefit to the same extend from these programmes than do their non-disabled peers. Implications for Rehabilitation Research shows that people with disabilities (PWD) experience limited access to microcredit schemes than their non-disabled peers. Empirical evidence is necessary to increase our understanding of why PWD have less access to microcredit schemes, if this is different from non-disabled and identify the specific hindrances as well as supporting factors. This study showed that PWD experience different facilitators and barriers to access microcredit schemes compared to the non-disabled. PWD prefer individual loans and believe they can more successfully run a business on their own, instead of relying on family or having a group loan. Furthermore, they would benefit from microcredit schemes that take into account disability-specific circumstances.

The role of partnership functioning and synergy in achieving sustainability of innovative programmes in community care (Article)

2012-11-27T00:00:00Z

This cross-sectional study (conducted in April-May 2011) explored associations between partnership functioning synergy and sustainability of innovative programmes in community care. The study sample consisted of 106 professionals (of 244 individuals contacted) participating in 21 partnerships that implemented different innovative community care programmes in Rotterdam, The Netherlands. Partnership functioning was evaluated by assessing leadership, resources administration and efficiency. Synergy was considered the proximal outcome of partnership functioning, which, in turn, influenced the achievement of programme sustainability. On a 5-point scale of increasing sustainability, mean sustainability scores ranged from 1.9 to 4.9. The results of the regression analysis demonstrated that sustainability was positively influenced by leadership (standardised regression coefficient β=0.32; P<0.001) and non-financial resources (β=0.25; P=0.008). No significant relationship was found between administration or efficiency and programme sustainability. Partnership synergy acted as a mediator for partnership functioning and significantly affected sustainability (β=0.39; P<0.001). These findings suggest that the sustainability of innovative programmes in community care is achieved more readily when synergy is created between partners. Synergy was more likely to emerge with boundary-spanning leaders, who understood and appreciated partners' different perspectives, and could bridge their diverse cultures and were comfortable sharing ideas, resources and power. In addition, the acknowledgement of and ability to use members' resources were found to be valuable in engaging partners' involvement and achieving synergy in community care partnerships.

The care span: In the netherlands, rich interaction among professionals conducting disease management led to better chronic care (Article)

2012-11-01T00:00:00Z

Disease management programs based on the Chronic Care Model are expected to improve the quality of chronic care delivery. However, evidence to date for such improvement and how it is achieved is scarce. In 2010 and again in 2011, we surveyed professionals in twentytwo primary care practices in the Netherlands that had implemented the Chronic Care Model of disease management beginning in 2009. The responses showed that, over time, chronic illness care delivery improved to advanced levels. The gains were attributed primarily to improved relational coordination-that is, raising the quality of communication and task integration among professionals from diverse disciplines who share common objectives. These findings may have implications for other disease management efforts by collaborative care teams, in that they suggest that diverse health care professionals must be strongly connected to provide effective, holistic care.

Relational coordination promotes quality of chronic care delivery in Dutch disease-management programs (Article)

2012-10-01T00:00:00Z

BACKGROUND:: Previous studies have shown that relational coordination is positively associated with the delivery of hospital care, acute care, emergency care, trauma care, and nursing home care. The effect of relational coordination in primary care settings, such as disease-management programs, remains unknown. PURPOSE:: This study examined relational coordination between general practitioners and other professionals in disease-management programs and assessed the impact of relational coordination on the delivery of chronic illness care. METHODOLOGY:: Professionals (n = 188; response rate = 57%) in 19 disease-management programs located throughout the Netherlands completed surveys that assessed relational coordination and chronic care delivery. We used a cross-sectional study design. FINDINGS:: Our study demonstrated that the delivery of chronic illness care was positively related to relational coordination. We found positive relationships with community linkages (r = .210, p < .01), self-management support (r = .217, p < .01), decision support (r = .190, p < .01), delivery system design (r = .278, p < .001), and clinical information systems (r = .193, p < .01). Organization of the health delivery system was not significantly related to relational coordination. The regression analyses showed that even after controlling for all background variables, relational coordination still significantly affected chronic care delivery (β = .212, p ≤ .01). As expected, our findings showed a lower degree of relational coordination among general practitioners than between general practitioners and other core disease-management team members: practice nurses (M = 2.69 vs. 3.73; p < .001), dieticians (M = 2.69 vs. 3.07; p < .01), physical therapists (M = 2.69 vs. 3.06; p < .01), medical specialists (M = 2.69 vs. 3.16; p < .01), and nurse practitioners (M = 2.69 vs. 3.19; p < .001). PRACTICE IMPLICATIONS:: The enhancement of relational coordination among core disease-management professionals with different disciplines is expected to improve chronic illness care delivery.

Factorial validation of the patient assessment of chronic illness care (PACIC) and PACIC short version (PACIC-S) among cardiovascular disease patients in the Netherlands (Article)

2012-08-31T00:00:00Z

Objective: The Chronic Care Model (CCM) has achieved widespread acceptance and reflects the core elements of patient-centred care in chronic diseases such as cardiovascular diseases (CVD). In the Netherlands the extent to which CVD patients receive care congruent with the CCM is unknown. The main objectives of this study were to validate the 20-item Patient Assessment of Chronic Illness Care (PACIC) and the 11-item (PACIC-S) in the Netherlands among CVD patients and investigate the validity, reliability, and sensitivity to change of both instruments.Methods: The Dutch version of the PACIC and PACIC-S were tested among 1484 CVD patients (out of 2760; response rate 54%) enrolled in Disease Management Programmes (DMPs) at T0 and 1167 respondents (out of 2545; response rate = 46%) at T1. Five hundred-eighty-five CVD patients filled in the questionnaire at both T0 and T1. We tested the instrument by means of structural equation modeling, and examined its construct validity, reliability and sensitivity to change. Reliability of the instrument was assessed by determining the statistical coherence of the scaled items. Internal consistency of the subscales was assessed by calculating Cronbach's alphas and correlations between the PACIC and PACIC-S. We investigated the sensitivity to change of the original PACIC and the PACIC-S with paired t-tests among CVD patients in DMPs who filled in the questionnaire at both T0 and T1 (N = 585).Results: The confirmatory factor analyses revealed good indices of fit with the PACIC and PACIC-S. Internal consistency as represented by Cronbach's alphas were also good. Correlations between the PACIC and PACIC-S subscales were excellent: 0.98 at both T0 and T1. Paired t-tests results show that the PACIC and PACIC-S improved significantly over time (p < 0.01).Conclusions: The psychometric properties of the Dutch PACIC and PACIC-S were satisfactory and it is sensitive to change, rendering it a valid and reliable instrument for assessing chronic illness care among CVD patients.

The chronic care model: Congruency and predictors among patients with cardiovascular diseases and chronic obstructive pulmonary disease in the Netherlands (Article)

2012-08-07T00:00:00Z

Objective: The Chronic Care Model (CCM) achieved widespread acceptance and reflects the core elements of patient-centred care in chronic diseases such as CVD and COPD. Our aim is to assess the extent to which current care for CVD and COPD patients aligns with the CCM in Dutch healthcare practices in the early stages of implementing disease-management programs, thereby revealing possible predictors that tell us whether certain patients are more likely to receive CCM-compliant care than others. Methods: We use a cross-sectional study, addressing CVD or COPD patients from 106 primary care practices in the Netherlands. Our response rate was 53%; i.e., 2,487 of 4,681 questionnaires were returned. The Patient Assessment of Chronic Illness Care (PACIC) was used to assess compliance with CCM. Quality of life was assessed with the Short-Form 36 Health Survey (SF-36) and we used the Hospital Anxiety and Depression Scale (HADS) to assess depressive symptoms. Multilevel regression models were performed to reveal predictors of high CCM compliance. Results: With a mean (SD) of 2.77 (0.86) in CVD patients and 2.89 (0.89) in COPD patients (p = 0.002), the PACIC sum score was lower than in previous studies conducted in HMOs in the US, but similar to a European primary care setting study. The PACIC score was associated with age and depressive symptoms in both patient groups. Conclusions: Younger and less depressed patients report higher PACIC scores, indicating that their care better aligns to the CCM.

Self-management abilities, physical health and depressive symptoms among patients with cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes (Article)

2012-06-01T00:00:00Z

Objective: This study aimed to identify the predictive role of direct resources (educational level and marital status) and self-management abilities on physical health and depressive symptoms in patients with cardiovascular diseases (CVD), diabetes, or chronic obstructive pulmonary disease (COPD). Methods: Our cross-sectional questionnaire-based study included 1570 CVD patients, 917 COPD patients, and 412 patients with diabetes. Results: Physical health and depressive symptoms of COPD patients was lower than those of CVD and diabetic patients. Correlation analyses indicated that self-management abilities were strong indicators for physical health and depressive symptoms (all . p<. 0.001). This relationship was strongest for depressive symptoms. Self-management abilities were related to educational level in all groups (all . p<. 0.001). Regression analyses revealed that self-management abilities were strong predictors of physical health and depressive symptoms in all three patient groups (all . p<. 0.001). Conclusion: This research showed that self-management abilities are strong predictors of physical health and depressive symptoms. Practice implications: Interventions that improve self-management abilities may counteract a decline in physical health and depressive symptoms. Such interventions may be important tools in the prevention of the loss of self-management abilities, because they may motivate people who are not yet experiencing serious problems.

Disease-management partnership functioning, synergy and effectiveness in delivering chronic-illness care (Article)

2012-06-01T00:00:00Z

Objective: This study explored associations among disease-management partnership functioning, synergy and effectiveness in the delivery of chronic-illness care. Design: This study had a cross-sectional design. Setting and participants: The study sample consists of 218 professionals (out of 393) participating in 22 disease-management partnerships in various regions of the Netherlands. Main outcome measures: We assessed the relationships among partnership functioning, synergy and effectiveness in the delivery of chronic-illness care. Partnership functioning was assessed through leadership, resources, administration and efficiency. Synergy was considered the proximal outcome of partnership functioning, which, in turn, influenced the effectiveness of disease-management partnerships [measured with the Assessment of Chronic Illness Care (ACIC) survey instrument]. Results: Overall ACIC scores ranged from 3 to 10, indicating basic/intermediate to optimal/comprehensive delivery of chronic-illness care. The results of the regression analysis demonstrate that partnership effectiveness was positively associated with leadership (β = 0.25; P≤ 0.01), and resources (β = 0.31; P≤ 0.001). No significant relationship was found between administration, efficiency and partnership effectiveness. Partnership synergy acted as a mediator for partnership functioning and was statistically significantly associated with partnership effectiveness (β = 0.25; P≤ 0.001). Conclusion: Disease-management partnerships seemed better able to deliver higher levels of chronic-illness care when synergy is created between partners. Synergy was more likely to emerge with boundary-spanning leaders who understood and appreciated partners' different perspectives, could bridge their diverse cultures and were comfortable sharing ideas, resources and power. In addition, the acknowledgement of and ability to use members' resources are valuable in engaging partners' involvement and achieving synergy in disease-management partnerships.

Satisfaction with care as a quality-of-life predictor for stroke patients and their caregivers (Article)

2012-01-09T00:00:00Z

Purpose: We sought to identify indicators associated with the quality of life (QoL) of stroke patients and caregivers. Methods: The cross-sectional study was conducted at nine Dutch stroke service facilities involving 251 stroke patients and their caregivers. We used the EuroQol (EQ-5D) and Satisfaction with Stroke Care questionnaires, and included the variables (1) disability at hospital admission, (2) length of hospital stay, (3) demographic data, and (4) caregivers' relationship with stroke patients. The Actor-Partner (patient-caregiver) Interdependence Model (APIM) was used to examine dependence between patients' and caregivers' QoL scores through dyad membership. Results: Patients' age was significantly related to their QoL, and caregivers' age and educational level were significantly related to their QoL. Patients' disability on hospital admission and length of stay were associated with patients' QoL, and their disability on admission was related to caregivers' QoL. No relationship was found between length of stay and caregivers' QoL. Satisfaction with care was associated with both patients' and caregivers' QoL. Conclusions: The APIM distinguished the different roles of patients and caregivers while acknowledging the interdependence of their QoL scores. Satisfaction with care was identified as important indicator of stroke patients' and caregivers' QoL.

Longitudinal study of parents' impact on quality of life of children and young adults with intellectual disabilities (Article)

2012-01-01T00:00:00Z

Background Earlier research has distinguished five domains of Quality of life (QoL) for people with ID: material well-being, development and activity, physical well-being, social well-being, and emotional well-being. We investigated parents' perspectives on these domains and QoL for children and young adults with ID and hypothesized that parents' well-being would be a predictive factor in QoL of their children with ID. Methods Our longitudinal study administered questionnaires to parents at T0(n=147) and T1(n=108). The inclusion criteria were: (i) the child's age 0-24years and (ii) the child's intellectual disability (IQ<70 or IQ<85 in combination with behavioural problems). Results Social well-being of parents (P≤0.001), changes in parents' social well-being (P≤0.01) and changes in children's social well-being (P≤0.05) were strong predictors of QoL for children with ID. Emotional well-being of children with ID (P≤0.01), changes in children's emotional well-being (P≤0.01) and changes in emotional well-being of parents (P≤0.05) also predicted QoL of children with ID. Material well-being of parents, and health, development and activity of the children were not predictors. Conclusion Our study revealed that predictors of QoL in children and young adults with ID occurred in the following domains: physical well-being (children), social well-being (parents and children) and emotional well-being (parents and children).

The importance of relational coordination for integrated care delivery to older patients in the hospital (Article)

2012-01-01T00:00:00Z

Aim: This study investigated relational coordination among professionals providing healthcare to hospitalized older patients and assessed its impact on integrated care delivery. Background: Previous studies have shown that relational coordination is positively associated with the delivery of acute, emergency and trauma care. The effect of relational coordination in integrated care delivery to hospitalized older patients remains unknown. Methods: This cross-sectional study was part of an examination of integrated care delivery to hospitalized older patients. Data were collected using questionnaires distributed to hospital professionals (192 respondents; 44% response rate). Results: After controlling for demographic variables, regression analyses showed that relational coordination was positively related to integrated care delivery (β = 0.20; P ≤ 0.05). Relational coordination was lower among professionals in the same discipline, and higher between nurses and others than between medical specialists and others. Relational coordination and integrated care delivery were significantly higher in geriatrics than in other units (both P ≤ 0.001). Conclusions: The enhancement of relational coordination among healthcare professionals is positively associated with integrated care delivery to older patients. Implications for nursing management: Relational coordination should be improved between medical specialists and others and higher levels of relational coordination and integrated care delivery should be achieved in all hospital units.

Access to livelihood assets among youth with and without disabilities in South Africa: Implications for health professional education (Article)

2012-01-01T00:00:00Z

Purpose. This study compared access to 5 livelihood assets among disabled and non-disabled youth, to inform health professionals on inequities related to disability and to monitor the transformation agenda aimed at creating an inclusive society. Methods. Fieldworkers interviewed 989 youth (18 - 35 years; 523 (52.9%) disabled youth (DY), 466 (47.1%) non-disabled youth (NDY)) at 9 sites in 5 South African provinces. Descriptive statistics were used to describe demographic characteristics and livelihood assets. Chi-squared and t-tests were used for comparisons. Results. Doctors at hospitals and nurses at clinics are health professionals most frequently seen. Far fewer DY than NDY attended and completed school. Unemployment was markedly more common among DY than among NDY. Barriers to accessing employment for DY were poor health and lack of skills development, and a lack of job opportunities for NDY. Both groups received the same amount of support from immediate household members, but significantly more NDY received support from extended family, friends, partners, and neighbours. They spent significantly more time engaging in all free-time activities. NDY reported more access to bathrooms, phone, and newspapers, as well as public services and the business sector. Participation and access were limited for both groups because of inaccessible public transport. Conclusion. This paper shows that DY have a greater struggle to access livelihood assets than non-disabled peers. The Disability Studies Academic Programme at the University of Cape Town is an initiative that seeks to take specific focused action with disability organisations in order to address the inequities faced by disabled youth to ensure their inclusion in development to the same degree as their non-disabled peers.

The Importance of Neighborhood Social Cohesion and Social Capital for the Well Being of Older Adults in the Community (Article)

2012-01-01T00:00:00Z

We aimed to investigate whether social capital (obtaining support through indirect ties such as from neighbors) and social cohesion (interdependencies among neighbors) within neighborhoods positively affect the well being of older adults. Design and Methods: This crosssectional study included 945 of 1,440 (66% response rate) independently living older adults (aged !70 years) in Rotterdam. We fitted a hierarchical random effects model to account for the hierarchical structure of the study design: 945 older adults (Level 1) nested in 72 neighborhoods (Level 2). Results: Univariate analyses showed that being born in the Netherlands, house ownership, education, income, social capital of individuals, neighborhood security, neighborhood services, neighborhood social capital, and neighborhood social cohesion were significantly related to the well being of older adults. Multilevel analyses showed that social capital of individuals, neighborhood services, neighborhood social capital, and neighborhood social cohesion predicted the well being of older adults. Single and poor older adults reported lower well being than did better off and married older adults. However, the effects of marital status and income were mediated by neighborhood services, social capital, and social cohesion. Neighborhood services, social capital, and social cohesion may act as buffer against the adverse effects of being single and poor on the well being of older adults. Implications: The results of this study support the importance of social capital of individuals, as well as social capital within the neighborhood and social cohesion within the neighborhood for well being of older adults. The well being of older adults may also be enhanced through the improvement of quality of neighborhood services.

Differences in the association of subjective wellbeing measures with health, socioeconomic status, and social conditions among residents of an Eastern Cape township (Article)

2012-01-01T00:00:00Z

The use of variably self-reported measures of wellbeing may produce differing outcomes. This study examined the differences in association with health, socioeconomic status, and social conditions (marital status, social capital) of two widely used cognitive subjective wellbeing measurements: Cantril’s ladder and Diener’s five-item Satisfaction with Life Scale. Methods: A stratified sampling design was used to collect data from representative households in the 20 neighborhoods of Rhini, a deprived suburb of Grahamstown in the Eastern Cape province of South Africa. Correlation and stepwise multiple regression analyses investigated differences in the associations between wellbeing and health, demographics, socioeconomic status, and social conditions determined by the three measurements. Results: We found that the multiple-item satisfaction with life scale elicited more discriminating responses that took into account a broader range of life domains. This scale reported more significant relationships between subjective wellbeing and health, socioeconomic status, and social conditions. Cantril’s ladder produced a narrower range of career-like comparisons. The direction of association between measures of wellbeing and socioeconomic characteristics never changed according to the measures used. Conclusions: Policy-makers, researchers, and practitioners using these instruments should be aware of the differences between single- and multiple-item wellbeing measures, and recognize that the choice of instrument will affect the life domains found to be associated with wellbeing.

The potential for integrated care programmes to improve quality of care as assessed by patients with COPD: early results from a real-world implementation study in The Netherlands (Article)

2012-01-01T00:00:00Z

Objective: We investigated whether patients with chronic obstructive pulmonary disease (COPD) who were enrolled in disease-management programmes (DMPs) felt that they received a better quality of care than non-enrolled COPD patients. Methods: Our cross-sectional study was performed among patients (n=665) enrolled in four DMPs in the Netherlands. We also evaluated COPD patients (n=227) not enrolled in such programmes. Patients’ assessment of chronic-illness care (PACIC) was measured with a 20-item questionnaire. The instrument had five pre-defined domains: patient activation (three items), delivery-system/practice design (three items), goal setting/tailoring (five items), problem solving/contextual (four items), and follow-up/coordination (five items). Results: The mean overall PACIC score (scale: 1–5) of enrolled DMP patients was 2.94, and that of non-enrolled DMP patients was 2.73 (p≤0.01). Differences in the same direction were found in the subscales of patient activation (p≤0.01), delivery-system/practice design (p≤0.001), and problem solving/contextual (p≤0.001). Conclusions: Our results suggest that even in the early stages of implementation, DMPs for COPD may significantly improve care.

Development and validation of a short version of the Partnership Self-Assessment Tool (PSAT) among professionals in Dutch disease-management partnerships (Article)

2011-07-04T00:00:00Z

Background: The extent to which partnership synergy is created within quality improvement programmes in the Netherlands is unknown. In this article, we describe the psychometric testing of the Partnership Self-Assessment Tool (PSAT) among professionals in twenty-two disease-management partnerships participating in quality improvement projects focused on chronic care in the Netherlands. Our objectives are to validate the PSAT in the Netherlands and to reduce the number of items of the original PSAT while maintaining validity and reliability. Methods. The Dutch version of the PSAT was tested in twenty-two disease-management partnerships with 218 professionals. We tested the instrument by means of structural equation modelling, and examined its validity and reliability. Results: After eliminating 14 items, the confirmatory factor analyses revealed good indices of fit with the resulting 15-item PSAT-Short version (PSAT-S). Internal consistency as represented by Cronbach's alpha ranged from acceptable (0.75) for the 'efficiency' subscale to excellent for the 'leadership' subscale (0.87). Convergent validity was provided with high correlations of the partnership dimensions and partnership synergy (ranged from 0.512 to 0.609) and high correlations with chronic illness care (ranged from 0.447 to 0.329). Conclusion: The psychometric properties and convergent validity of the PSAT-S were satisfactory rendering it a valid and reliable instrument for assessing partnership synergy and its dimensions of partnership functioning.

Development and validation of a short version of the Assessment of Chronic Illness Care (ACIC) in Dutch Disease Management Programs (Article)

2011-07-04T00:00:00Z

Background: In the Netherlands the extent to which chronically ill patients receive care congruent with the Chronic Care Model is unknown. The main objectives of this study were to (1) validate the Assessment of Chronic Illness Care (ACIC) in the Netherlands in various Disease Management Programmes (DMPs) and (2) shorten the 34-item ACIC while maintaining adequate validity, reliability, and sensitivity to change.Methods: The Dutch version of the ACIC was tested in 22 DMPs with 218 professionals. We tested the instrument by means of structural equation modelling, and examined its validity, reliability and sensitivity to change.Results: After eliminating 13 items, the confirmatory factor analyses revealed good indices of fit with the resulting 21-item ACIC (ACIC-S). Internal consistency as represented by Cronbach's alpha ranged from 'acceptable' for the 'clinical information systems' subscale to 'excellent' for the 'organization of the healthcare delivery system' subscale. Correlations between the ACIC and ACIC-S subscales were also good, ranging from .87 to 1.00, indicating acceptable coverage of the core areas of the CCM. The seven subscales were significantly and positively correlated, indicating that the subscales were conceptually related but also distinct. Paired t-tests results show that the ACIC scores of the original instrument all improved significantly over time in regions that were in the process of implementing DMPs (all components at p < 0.0001).Conclusion: We conclude that the psychometric properties of the ACIC and the ACIC-S are good and the ACIC-S is a promising alternate instrument to assess chronic illness care.

Validation of the Caregivers' Satisfaction with Stroke Care Questionnaire: C-SASC hospital scale (Article)

2011-06-01T00:00:00Z

To date, researchers have lacked a validated instrument to measure stroke caregivers' satisfaction with hospital care. We adjusted a validated patient version of satisfaction with hospital care for stroke caregivers and tested the 11-item caregivers' satisfaction with hospital care (C-SASC hospital scale) on caregivers of stroke patients admitted to nine stroke service facilities in the Netherlands. Stroke patients were identified through the stroke service facilities; caregivers were identified through the patients. We collected admission demographic data from the caregivers and gave them the C-SASC hospital scale. We tested the instrument by means of structural equation modeling and examined its validity and reliability. After the elimination of three items, the confirmatory factor analyses revealed good indices of fit with the resulting eight-item C-SASC hospital scale. Cronbach's α was high (0.85) and correlations with general satisfaction items with hospital care ranged from 0.594 to 0.594 (convergent validity). No significant relations were found with health and quality of life (divergent validity). Such results indicate strong construct validity. We conclude that the C-SASC hospital scale is a promising instrument for measuring stroke caregivers' satisfaction with hospital stroke care.

Choice processes and satisfaction with care according to parents of children and young adults with intellectual disability in the Netherlands (Article)

2011-06-01T00:00:00Z

Background Despite the expressed desire for access to information on care providers and increased availability of this information, the use of available information falls short of expectations. We lack research on the decision-making processes and on how these processes are influenced. A study that employs "real-life" decisions is necessary. Methods Our experimental study design established the effects of providing decision-support information only (services/quality indicators) and providing a combination of information and personal decision-making support (counselling/peer meetings) on the choice process and satisfaction with care. Results These forms of support affected the choice process, but did not affect satisfaction with care. Decision-support information combined with personal decision-making support led to less frequent switching of care providers and to more satisfaction with choice information. Parents make limited use of online decision-support information, but did use decision counselling. Conclusion This population is better supported with an intensified personal approach rather than through the current generic approach using websites.

Psychological well-being of caregivers of children with intellectual disabilities: Using parental stress as a mediating factor (Article)

2011-06-01T00:00:00Z

Parental stress has been identified as a major affecter of caregivers' psychological well-being and a risk increaser for unwillingly placing children with disabilities in the care of others. Recognition of effective means to ease caregiving burdens must guide policymaking and will help to provide better and tailored support and intervention for the children. This study aims to characterize caregivers of children with intellectual disabilities who are about to seek outside support and care and to identify the conditions under which psychological well-being and parental stress are affected using parental stress as a mediating factor. We found that parental stress and the child's depressive feelings strongly affected psychological well-being. We also found an indirect relation of restricted caregiver social activities through parental stress. To protect psychological well-being of caregivers, support services should address depressive feelings among children with intellectual disabilities, facilitate caregivers' social activity, and reduce stress.

The relationship between (stigmatizing) views and lay public preferences regarding tuberculosis treatment in the Eastern Cape, South Africa (Article)

2011-01-18T00:00:00Z

Background: Tuberculosis (TB) and human immune virus/acquired immune deficiency syndrome (HIV/AIDS) stigmas affect public attitudes toward TB treatment and policy. This study examined 'stigmatizing' ideas and the view that 'TB patients should line-up in the chronic illness queue' in relation to preferences and attitudes toward TB treatment. Methods: Data were gathered through a survey administered to respondents from 1,020 households in Grahamstown. The survey measured stigmatization surrounding TB and HIV/AIDS, and determined perceptions of respondents whether TB patients should queue with other chronically ill patients. Respondents selected support and treatment options they felt would benefit TB patients. Statistical analysis identified the prevalence of TB and HIV/AIDS stigmas. Logistic regression analyses explored associations between stigmatizing ideas, views regarding TB patients in the chronic illness queue, and attitudes toward support and treatment. Results: Respondents with TB stigmatizing ideas held positive attitudes toward volunteer support, special TB queues, and treatment at clinics; they held negative attitudes toward temporary disability grants, provision of information at work or school, and treatment at the TB hospital. Respondents who felt it beneficial for TB patients to queue with other chronically ill patients conversely held positive attitudes toward provision of porridge and disability grants, and treatment at the TB hospital; they held negative attitudes toward volunteer support, special TB queues, information provision at work or school, and treatment at clinics. Conclusion: These results showed that two varying views related to visibility factors that expose patients to stigmatization (one characterized by TB stigma, the other by the view that TB patients should queue with other chronically ill patients) are associated with opposing attitudes and preferences towards TB treatment. These opposing attitudes complicate treatment outcomes, and suggest that complex behaviors must be taken into account when designing health policy.

Evaluation of a large scale implementation of disease management programmes in various Dutch regions: A study protocol (Article)

2011-01-12T00:00:00Z

Background. Disease management programmes (DMPs) have been developed to improve effectiveness and economic efficiency within chronic care delivery by combining patient-related, professional-directed, and organisational interventions. The benefits of DMPs within different settings, patient groups, and versions remain unclear. In this article we propose a protocol to evaluate a range of current DMPs by capturing them in a single conceptual framework, employing comparable structure, process, and outcome measures, and combining qualitative and quantitative research methods. Methods. To assess DMP effectiveness a practical clinical trial will be conducted. Twenty-two disease management experiments will be studied in various Dutch regions consisting of a variety of collaborations between organisations and/or professionals. Patient cohorts include those with cardiovascular diseases, chronic obstructive pulmonary disease, diabetes, stroke, depression, psychotic diseases, and eating disorders. Our methodological approach combines qualitative and quantitative research methods to enable a comprehensive evaluation of complex programmes. Process indicators will be collected from health care providers' data registries and measured via physician and staff questionnaires. Patient questionnaires include health care experiences, health care utilisation, and quality of life. Qualitative data will be gathered by means of interviews and document analysis for an in depth description of project interventions and the contexts in which DMPs are embedded, and an ethnographic process evaluation in five DMPs. Such a design will provide insight into ongoing DMPs and demonstrate which elements of the intervention are potentially (cost)-effective for which patient populations. It will also enable sound comparison of the results of the different programmes. Discussion. The study will lead to a better understanding of (1) the mechanisms of disease management, (2) the feasibility, and cost-effectiveness of a disease management approach to improving health care, and (3) the factors that determine success and failure of DMPs. Our study results will be relevant to decision makers and managers who confront the challenge of implementing and integrating DMPs into the health care system. Moreover, it will contribute to the search for methods to evaluate complex healthcare interventions.

Health and social burdens of people living in an economically and health-deprived area (Doctoral Thesis)

2010-12-14T00:00:00Z

To be poor is by definition to have less of the good things in life, including health and longevity. Obtaining equal access to care is a major step in improving health, however, improved access to health services is only part of the solution for advancing health, avoiding illnesses and enhancing well-being. Th e fact remains that people at the bottom of society are faced with the worst living conditions and report the worst health outcomes. Regardless the country these poor people live in, what type of health insurance they have or do not have, and the level of health care they receive, they still have the worst health of all. These disparities cannot be explained by biological differences. The World Health Organization holistically viewed the social determinants of health, concluding that global health and illness follow a social gradient; lower socioeconomic positions are consistently correlated with poorer health. Th ese avoidable health inequalities arise because of the circumstances in which people are born, live, work, and age, including the adequacy of health care systems. Th e conditions in which people live and die are, in turn, shaped by social and economic forces. Together, the structural determinants and conditions of daily life constitute the socioeconomic determinants of health. These are responsible for a major part of health inequities between and within countries, and constitute one form of social injustice. Global action focused on the socioeconomic determinants of health is necessary to achieve health equity. Since neighbourhoods and communities are amendable to intervention, they are the most appropriate social levels at which to improve the health of populations. Most human development programs seek as a primary goal to improve the subjective well-being of those most aff ected by poverty. In 2000, 189 countries signed the United Nations Millennium Declaration, which set eight Millennium Development Goals (MDGs) to be achieved by 2015. Th ese MDGs aim to decrease poverty, inequality and improve health and subjective well-being; the latter is increasingly recognized as an important additional source for the evaluation of broad societal and economic development. Communities and neighbourhoods with high levels of subjective well-being are essential for health equity. An accumulating body of knowledge has shown that subjective well-being is a strong predictor of physical health and longevity, spurring growing interest in this factor.

Improving subjective well-being of the poor in the Eastern Cape (Article)

2010-10-01T00:00:00Z

This study investigated the effects of income, health, social capital, marital status, employment, education and crime experience on subjective well-being within a poor community in the Eastern Cape of South Africa. It appeared that higher income is associated with higher subjective well-being and that social capital serves as an important subjective well-being predictor in all income groups. Efforts must be made to ensure that countries do not develop economically at the expense of other aspects of life important for well-being in the very poor, such as social capital.

Patient views on determinants of compliance with tuberculosis treatment in the Eastern Cape, South Africa: An application of Q-methodology (Article)

2010-07-06T00:00:00Z

Background: Tuberculosis (TB) constitutes one-quarter of all avoidable deaths in developing countries. In the Eastern Cape, South Africa, TB is a public health problem of epidemic proportion. Poor compliance and frequent interruption to treatment are associated with increased transmission rates, morbidity, and costs to TB control programs. This study explored determinants of (non-)compliance from the patients perspective. Methods: Semi-structured interviews were conducted with patients (33 treatment compliers and 34 treatment non-compliers) and 14 community health workers from local community clinics and the hospital in the township of Grahamstown, Eastern Cape, South Africa. Q-methodology was used. Patients rank ordered 32 opinion statements describing determinants of treatment compliance fromthe TB adherencemodel. By-person factor analysis was used to explore patterns in the rankings of statements by compliers and non-compliers. These patterns were interpreted and described as patient views on determinants of compliance with treatment. Patients and community health workers selected the top five determinants of compliance and non-compliance. Results: Compliers believed that completing treatment would cure them of B. Economic prospects were crucial for compliance. Compliers felt that the support of the government disability grant helped with compliance. Noncompliers believed that stigmatization had the greatest impact on noncompliance, together with the burden of disease, the arrangements involved ith receiving treatment, restrictions accompanying treatment, and the association of TB with HIV/AIDS infection. Conclusions: Stigmatization makes TB a 'social disease'. Individual motivation and self-efficacy appear to have a considerable effect on compliance, but, for non-compliers, the general lack of job prospects and being able to provide for themselves or their family also makes TB very much an 'economic disease'.

TB treatment initiation and adherence in a South African community influenced more by perceptions than by knowledge of tuberculosis (Article)

2010-03-08T00:00:00Z

Background. Tuberculosis (TB) is a global health concern. Inadequate case finding and case holding has been cited as major barrier to the control of TB. The TB literature is written almost entirely from a biomedical perspective, while recent studies show that it is imperative to understand lay perception to determine why people seek treatment and may stop taking treatment. The Eastern Cape is known as a province with high TB incidence, prevalence and with one of the worst cure rates of South Africa. Its inhabitants can be considered lay experts when it comes to TB. Therefore, we investigated knowledge, perceptions of (access to) TB treatment and adherence to treatment among an Eastern Cape population. Methods. An area-stratified sampling design was applied. A total of 1020 households were selected randomly in proportion to the total number of households in each neighbourhood. Results. TB knowledge can be considered fairly good among this community. Respondents' perceptions suggest that stigma may influence TB patients' decision in health seeking behavior and adherence to TB treatment. A full 95% of those interviewed believe people with TB tend to hide their TB status out of fear of what others may say. Regression analyses revealed that in this population young and old, men and women and the lower and higher educated share the same attitudes and perceptions. Our findings are therefore likely to reflect the actual situation of TB patients in this population. Conclusions. The lay experts' perceptions suggests that stigma appears to effect case holding and case finding. Future interventions should be directed at improving attitudes and perceptions to potentially reduce stigma. This requires a patient-centered approach to empower TB patients and active involvement in the development and implementation of stigma reduction programs.

How employment support and social integration programmes are viewed by the intellectually disabled (Article)

2009-06-01T00:00:00Z

Background: Supported employment is intended to facilitate and promote participation and integration of intellectually disabled citizens in society. This study investigated their view of the programme. Methods: Q-methodology was used. Eighteen respondents with a mild intellectual disability rank-ordered 22 statements representing five main aspects of supported employment. The data were factor-analysed to group respondents according to their views. Q-methodology was a feasible approach that facilitated in-depth conversations with respondents with a mild intellectual disability in a playful manner. Results: Two views onthe impact of supported employment on social integration were observed: 'Work as participation' and 'work as structure'. The first placed greater value on participation, task variety, belonging, and feeling appreciated; the second placed greater value on working independently, clear working agreements, and friendly co-workers. The views indicate two distinct approaches to effecting a positive relationship between supported employment and social integration. Conclusion: From the perspective of people with an intellectual disability supported employment contributes to self-development and has a positive effect on well-being, albeit in different ways for the individual groups. © 2009 The Authors. Journal compilation