Woodward Eva N, Ball Irenia A, Willging Cathleen, Singh Rajinder Sonia, Scanlon Celia, Cluck Damon, Drummond Karen L, Landes Sara J, Hausmann Leslie R M, Kirchner JoAnn E
Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.
Front Health Serv. 2023 Jul 25;3:1124290. doi: 10.3389/frhs.2023.1124290. eCollection 2023.
Engaging service users or consumers in quality improvement or implementing a new service is important across settings and may reduce health inequities. Implementation strategies leveraging consumer engagement are neither commonly used nor robustly operationalized in implementation science. Implementers (e.g., middle managers, facilitators) want to involve consumers in implementation activities, but do not always feel confident in how to proceed. We developed a compendium of tools called Consumer Voice to guide others how to engage consumers in design/delivery of implementation strategies. Although generalizable to other settings, we developed Consumer Voice within the context of implementing suicide prevention treatments in healthcare to reach rural U.S. military veterans, as there are suicide inequities for people in rural areas.
We developed Consumer Voice using a multistep process and human-centered design methods. In between steps, a design team met to generate insights from data, and decide which prototypes to create/refine. In preliminary work, we conducted a scan of examples in healthcare of patient engagement in implementation activities and interviewed two implementation experts about preferred learning styles. In Step 1, we interviewed 26 participants with experience in community engagement, implementation, or lived experience as a rural U.S. veteran with suicidal thoughts/behavior. In Step 2, 11 implementers beta tested prototypes then share feedback in focus groups. In Step 3, we reconvened participants from prior steps to review tools and, using nominal group technique, prioritized remaining recommendations.
Consumer Voice is online, modular, and nonlinear for self-guided learning tailored to beginner, intermediate, or advanced experience with consumer engagement. Tools consist of slides, audiovisual content with written text, and templates. Findings indicated there is not one "right" way to engage consumers in implementation activities, rather that implementers wanted tools showcasing core principles for consumer engagement and practical ideas.
Consumer Voice can be used by implementers to reflect and decide on how to apply consumer engagement implementation strategies to improve equitable dissemination and uptake of evidence-based practices. Most insights generated by user data were explicitly to build trust between consumers and professionals representing institutions, which may be one component to reducing healthcare inequities.
让服务使用者或消费者参与质量改进或实施新服务在各个环境中都很重要,并且可能减少健康不平等现象。在实施科学中,利用消费者参与的实施策略既不常用,也没有得到充分的实践应用。实施者(如中层管理人员、促进者)希望让消费者参与实施活动,但对于如何推进并不总是感到自信。我们开发了一套名为“消费者之声”的工具集,以指导其他人如何让消费者参与实施策略的设计/交付。尽管该工具集可推广到其他环境,但我们是在美国农村退伍军人医疗保健领域实施自杀预防治疗的背景下开发“消费者之声”的,因为农村地区的人群存在自杀不平等问题。
我们采用多步骤流程和以人为本的设计方法开发了“消费者之声”。在各个步骤之间,一个设计团队会开会从数据中生成见解,并决定创建/完善哪些原型。在初步工作中,我们扫描了医疗保健领域患者参与实施活动的示例,并采访了两位实施专家,了解他们偏好的学习方式。在第1步中,我们采访了26名有社区参与、实施经验或有过自杀想法/行为的美国农村退伍军人生活经历的参与者。在第2步中,11名实施者对原型进行了测试,然后在焦点小组中分享反馈。在第3步中,我们重新召集了前几步的参与者来审查工具,并使用名义小组技术对其余建议进行了优先排序。
“消费者之声”是在线的、模块化的且非线性的,适用于针对消费者参与的初学者、中级或高级经验进行自我指导学习。工具包括幻灯片、带有书面文本的视听内容和模板。研究结果表明,让消费者参与实施活动没有一种“正确”的方法,而是实施者希望工具展示消费者参与的核心原则和实用想法。
实施者可以使用“消费者之声”来思考并决定如何应用消费者参与实施策略,以改善基于证据的实践的公平传播和采用。用户数据产生的大多数见解都明确指向在消费者与代表机构的专业人员之间建立信任,这可能是减少医疗保健不平等的一个因素。