Darwich Adam S, Boström Anne-Marie, Guidetti Susanne, Raghothama Jayanth, Meijer Sebastiaan
Division of Health Informatics and Logistics, Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Huddinge, Stockholm, Sweden.
Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden.
JMIR Hum Factors. 2023 Jun 30;10:e42283. doi: 10.2196/42283.
Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use.
The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems.
The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods.
The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements "workload" and "distress" were important determinants of home care staff health, provision, and quality of care.
The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored.
由于人口老龄化，家庭护理面临着日益增长的需求。在提供家庭护理方面已发现若干挑战，例如需要支持以及根据个人需求定制支持。以目标为导向的干预措施，如恢复能力训练，可能为其中一些挑战提供解决方案。恢复能力训练方法旨在适应疾病并重新学习日常生活技能，已发现其可提高与健康相关的生活质量，同时减少服务使用。
本研究的目的是描述与家庭护理人员工作量、家庭护理使用者需求和满意度以及恢复能力训练方法相关的家庭护理系统变量（要素）及其关系（联系）。这是为了研究以个人为中心的恢复能力训练方法等改进措施和干预措施对家庭护理服务提供、工作量、工作相关压力、家庭护理使用者体验及其他组织因素的影响。主要重点是瑞典的家庭护理和由税收资助的全民福利系统。
该研究采用混合方法，通过与护理、职业治疗、老龄化及恢复能力训练方法等学术医疗科学研究专家进行参与式方法构建因果循环图。该方法辅以理论模型和科学文献。所构建的模型由同一组专家和实证证据进行验证。最后，对模型进行定性分析和模拟分析。
最终的因果循环图包括压力、家庭护理人员、家庭护理使用者、组织、家庭护理使用者的社会支持网络以及社会层面等类别中的要素和联系。该模型能够定性描述文献中观察到的干预结果。分析提出了有待改进的要素以及相关研究干预措施的潜在影响。例如，“工作量”和“困扰”要素是家庭护理人员健康、护理提供和护理质量的重要决定因素。
所构建的模型可能有助于在家庭护理改进背景下进行假设形成、研究设计和讨论。进一步的工作将纳入更广泛的利益相关者群体以降低偏差风险。将探索转化为定量模型。
