Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Office of Research Services and School of Business, MacEwan University, Edmonton, Alberta, Canada.
BMC Health Serv Res. 2023 Mar 14;23(1):248. doi: 10.1186/s12913-023-09191-3.
As people live longer, they are at increased risk for chronic diseases and disability. Self-management is a strategy to improve health outcomes and quality of life of those who engage in it. This study sought to gain a better understanding of the factors, including digital technology, that affect public health policy on self-management through an analysis of government policy in the most populous and multicultural province in Canada: Ontario. The overarching question guiding the study was: What factors have influenced the development of healthcare self-management policies over time?
Archival research methods, combining document review and evaluation, were used to collect data from policy documents published in Ontario. The documents were analyzed using the READ approach, evaluated using a data extraction table, and synthesized into themes using the model for health policy analysis.
Between January 1, 1985, and May 5, 2022, 72 policy documents on self-management of health were retrieved from databases, archives, and grey literature. Their contents largely focussed on self-management of general chronic conditions, while 47% (n = 18/72) mention diabetes, and 3% (n = 2/72) focussed solely on older adults. Digital technologies were mentioned and were viewed as tools to support self-management in the context of healthcare delivery and enhancing healthcare infrastructure (i.e., telehealth or software in healthcare settings). The actors involved in the policy document creation included mostly Ontario government agencies and departments, and sometimes expert organizations, community groups and engaged stakeholders. The results suggest that several factors including pressures on the healthcare system, hybrid top-down and bottom-up policymaking, and political context have influenced the nature and implementation timing of self-management policy in Ontario.
The policy documents on self-management of health reveal a positive evolution of the content discussed over time. The changes were shaped by an evolving context, both from a health and political perspective, within a dynamic system of interactions between actors. This research helps understand the factors that have shaped changes and suggests that a critical evidence-based approach on public health policy is needed in understanding processes involved in the development of healthcare self-management policies from the perspective of a democratic governing system.
随着人们寿命的延长，他们患慢性病和残疾的风险增加。自我管理是一种改善参与其中的人的健康结果和生活质量的策略。本研究旨在通过分析加拿大人口最多和文化最多元化的省份安大略省的政府政策，更好地了解影响自我管理公共卫生政策的因素，包括数字技术。指导这项研究的首要问题是：随着时间的推移，哪些因素影响了医疗保健自我管理政策的发展？
采用档案研究方法，结合文件审查和评估，从安大略省发布的政策文件中收集数据。使用 READ 方法分析文件，使用数据提取表进行评估，并使用健康政策分析模型将其综合为主题。
1985 年 1 月 1 日至 2022 年 5 月 5 日，从数据库、档案和灰色文献中检索到 72 份关于健康自我管理的政策文件。它们的内容主要集中在一般慢性病的自我管理上，而 47%（n=18/72）提到糖尿病，3%（n=2/72）仅关注老年人。数字技术被提及，并被视为医疗保健提供和增强医疗保健基础设施（即医疗保健环境中的远程医疗或软件）中支持自我管理的工具。参与政策文件创建的行为者主要包括安大略省政府机构和部门，有时还包括专家组织、社区团体和参与的利益相关者。结果表明，包括医疗保健系统压力、混合自上而下和自下而上的决策制定以及政治背景在内的几个因素影响了安大略省自我管理政策的性质和实施时间。
健康自我管理政策文件揭示了所讨论内容随时间的积极演变。这些变化是由一个不断变化的背景塑造的，从健康和政治的角度来看，都是在一个由行为者之间的互动构成的动态系统中。这项研究有助于了解影响变化的因素，并表明需要从民主治理体系的角度，对公共卫生政策采取批判性的循证方法，以了解医疗保健自我管理政策制定过程中涉及的因素。
