Department of Rural Health, 'The Chalet', University of Melbourne, Docker Street, Wangaratta 3677, Victoria, Australia.
Department of Rural Health, 'Dunvegan', University of Melbourne, 806 Mair Street, Ballarat, VIC, 3350, Australia.
BMC Health Serv Res. 2022 Aug 10;22(1):1019. doi: 10.1186/s12913-022-08411-6.
People residing in rural areas have higher rates of skin cancer and face barriers to accessing care. Models of skin cancer care addressing the specific needs of rural communities and overcoming specific challenges are required, but literature is scarce. This study aimed to describe the elements of a nurse-led skin cancer model in rural Victoria using qualitative methodology and programme logic to inform implementation and ongoing sustainability.
Qualitative descriptive design. Semi-structured interviews were conducted with key stakeholders involved in the skin cancer model, namely health service executive management, clinical staff, and administration staff. Interviews were audio-recorded and transcribed verbatim. Transcripts were thematically analysed independently by two researchers before themes were compared and refined. A programme logic model was developed to organise themes into contextual elements, inputs, activities and anticipated outcomes; it was also used as a visual tool to aid discussions with key stakeholders. Member checking of the logic model occurred to verify interpretation. This programme logic model will be refined throughout the implementation phase, and again after three years of service delivery.
Eight stakeholders participated in interviews. Thematic analysis identified three major themes: the influence of the local rural context, the elements of the model, and "making it happen'. These major themes and accompanying sub-themes were mapped to the programme logic model by contextual elements (rural locale, health service access barriers, burden of disease), key inputs (promotion, human resources including appropriate nurse training and leadership) and 'making it happen' (governance including referral pathways, flexible and sustained funding, and partnerships). The anticipated outcomes identified include skin cancer care delivered locally, timely access, career development for nurses, and decreased skin cancer burden.
An initiative that is place-based and community driven in response to consumer demand addresses key system barriers to earlier detection of skin cancers. It is anticipated to result in flow-on reductions in skin cancer disease burden. Programme logic was useful to both describe the initiative and as a visual tool for discussions, with the potential to inform wider health service efforts to address system barriers and bottlenecks.
居住在农村地区的人们皮肤癌发病率更高，并且在获得医疗方面面临障碍。需要建立针对农村社区特定需求并克服特定挑战的皮肤癌护理模式，但目前文献匮乏。本研究旨在使用定性方法和方案逻辑描述维多利亚农村地区的护士主导型皮肤癌模型的要素，以为实施和持续可持续性提供信息。
定性描述性设计。对参与皮肤癌模型的主要利益相关者（即卫生服务执行管理层、临床工作人员和行政工作人员）进行了半结构式访谈。访谈内容进行了录音并逐字记录。两名研究人员独立对转录本进行了主题分析，然后对主题进行了比较和完善。制定了方案逻辑模型，将主题组织成背景要素、投入、活动和预期结果；它也被用作与主要利益相关者进行讨论的可视化工具。在整个实施阶段以及服务提供三年后，将对逻辑模型进行成员检查以验证解释。
八名利益相关者参加了访谈。主题分析确定了三个主要主题：当地农村背景的影响、模型的要素和“使之成为现实”。这些主要主题和伴随的子主题通过背景要素（农村环境、卫生服务获取障碍、疾病负担）、关键投入（包括宣传、人力资源，包括适当的护士培训和领导力）和“使之成为现实”（包括转诊途径、灵活和持续的资金以及伙伴关系的治理）映射到方案逻辑模型。确定的预期结果包括在当地提供皮肤癌护理、及时获得护理、护士的职业发展以及皮肤癌负担的降低。
该倡议是针对消费者需求的基于地点和社区驱动的举措，旨在解决早期发现皮肤癌的关键系统障碍。预计将对皮肤癌疾病负担的减少产生连锁反应。方案逻辑不仅有助于描述该倡议，而且还可以作为讨论的可视化工具，有潜力为更广泛的卫生服务工作提供信息，以解决系统障碍和瓶颈。
