Azevedo Salomé, Guede-Fernández Federico, von Hafe Francisco, Dias Pedro, Lopes Inês, Cardoso Nuno, Coelho Pedro, Santos Jorge, Fragata José, Vital Clara, Semedo Helena, Gualdino Ana, Londral Ana
Value for Health CoLAB, Lisbon, Portugal.
Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal.
Front Digit Health. 2022 Dec 7;4:1006447. doi: 10.3389/fdgth.2022.1006447. eCollection 2022.
COVID-19 increased the demand for Remote Patient Monitoring (RPM) services as a rapid solution for safe patient follow-up in a lockdown context. Time and resource constraints resulted in unplanned scaled-up RPM pilot initiatives posing risks to the access and quality of care. Scalability and rapid implementation of RPM services require social change and active collaboration between stakeholders. Therefore, a participatory action research (PAR) approach is needed to support the collaborative development of the technological component while simultaneously implementing and evaluating the RPM service through critical action-reflection cycles.
This study aims to demonstrate how PAR can be used to guide the scalability design of RPM pilot initiatives and the implementation of RPM-based follow-up services.
Using a case study strategy, we described the PAR team's (nurses, physicians, developers, and researchers) activities within and across the four phases of the research process (problem definition, planning, action, and reflection). Team meetings were analyzed through content analysis and descriptive statistics. The PAR team selected ex-ante pilot initiatives to reflect upon features feedback and participatory level assessment. Pilot initiatives were investigated using semi-structured interviews transcribed and coded into themes following the principles of grounded theory and pilot meetings minutes and reports through content analysis. The PAR team used the MoSCoW prioritization method to define the set of features and descriptive statistics to reflect on the performance of the PAR approach.
The approach involved two action-reflection cycles. From the 15 features identified, the team classified 11 as must-haves in the scaled-up version. The participation was similar among researchers (52.9%), developers (47.5%), and physicians (46.7%), who focused on suggesting and planning actions. Nurses with the lowest participation (5.8%) focused on knowledge sharing and generation. The top three meeting outcomes were: improved research and development system (35.0%), socio-technical-economic constraints characterization (25.2%), and understanding of end-user technology utilization (22.0%).
The scalability and implementation of RPM services must consider contextual factors, such as individuals' and organizations' interests and needs. The PAR approach supports simultaneously designing, developing, testing, and evaluating the RPM technological features, in a real-world context, with the participation of healthcare professionals, developers, and researchers.
在封锁背景下，新冠疫情增加了对远程患者监测（RPM）服务的需求，以作为安全随访患者的快速解决方案。时间和资源限制导致计划外扩大RPM试点项目，给医疗服务的可及性和质量带来风险。RPM服务的可扩展性和快速实施需要社会变革以及利益相关者之间的积极协作。因此，需要一种参与式行动研究（PAR）方法来支持技术组件的协同开发，同时通过关键的行动反思循环来实施和评估RPM服务。
本研究旨在展示如何使用PAR来指导RPM试点项目的可扩展性设计以及基于RPM的随访服务的实施。
采用案例研究策略，我们描述了PAR团队（护士、医生、开发者和研究人员）在研究过程的四个阶段（问题定义、规划、行动和反思）内及跨阶段的活动。通过内容分析和描述性统计对团队会议进行分析。PAR团队选择事前试点项目以反思功能反馈和参与度评估。使用半结构化访谈对试点项目进行调查，访谈转录后按照扎根理论原则编码为主题，并通过内容分析对试点会议记录和报告进行分析。PAR团队使用MoSCoW优先级排序方法来定义功能集，并使用描述性统计来反思PAR方法的性能。
该方法涉及两个行动反思循环。从确定的15个功能中，团队将11个归类为扩大版本中的必备功能。研究人员（52.9%）、开发者（47.5%）和医生（46.7%）的参与度相似，他们专注于提出和规划行动。参与度最低的护士（5.8%）专注于知识共享和知识生成。会议的前三大成果是：改进研发系统（35.0%）、社会技术经济约束特征描述（25.2%）以及对最终用户技术使用的理解（22.0%）。
RPM服务的可扩展性和实施必须考虑背景因素, 如个人和组织的利益及需求。PAR方法支持在现实环境中，在医疗专业人员、开发者和研究人员的参与下，同时设计、开发、测试和评估RPM技术功能。
