Whitelaw Sandy, Vijay Devi, Clark David
School of Social and Environmental Sustainability, University of Glasgow, Dumfries Campus, Bankend Road, Dumfries, DG1 4ZL, UK.
Department of Organizational Behavior, Indian Institute of Management Calcutta, Kolkata, India.
Palliat Care Soc Pract. 2024 Oct 7;18:26323524241287223. doi: 10.1177/26323524241287223. eCollection 2024.
The World Health Organization Astana Declaration of 2018 sees primary healthcare as key to universal health coverage and gives further support to the goal of building sustainable models of community palliative care. Yet evaluating the benefits of such models continues to pose methodological and conceptual challenges.
To explore evaluation issues associated with a community-based palliative care approach in Kerala, India.
An illuminative case study using a rapid evaluation methodology.
Qualitative interviews, documentary analysis and observations of home care and community organising.
We appraise a community palliative care programme in Kerala, India, using three linked 'canvases' of enquiry: (1) 'complex' multi-factorial community-based interventions and implications for evaluation; (2) 'axiological' orientations that foreground values in any evaluation process and (3) the status of evaluative evidence in postcolonial contexts. Three values underpinning the care process were significant: heterogeneity, voice and decentralisation. We identify 'objects of interest' related to first-, second- and third-order outcomes: (1) individuals and organisations; (2) unintended targets outside the core domain and (3) indirect, distal effects within and outside the domain.
We show how evaluation of palliative care in complex community circumstances can be successfully accomplished when attending to the significance of community care values.
世界卫生组织2018年《阿斯塔纳宣言》将初级卫生保健视为全民健康覆盖的关键，并进一步支持建立可持续社区姑息治疗模式的目标。然而，评估此类模式的益处仍然面临方法和概念上的挑战。
探讨印度喀拉拉邦基于社区的姑息治疗方法相关的评估问题。
采用快速评估方法的阐释性案例研究。
定性访谈、文献分析以及对家庭护理和社区组织的观察。
我们使用三个相互关联的“调查框架”对印度喀拉拉邦的一个社区姑息治疗项目进行评估：（1）“复杂的”多因素社区干预措施及其对评估的影响；（2）在任何评估过程中突出价值观的“价值论”取向；（3）后殖民背景下评估证据的地位。支撑护理过程的三个价值观具有重要意义：异质性、话语权和权力下放。我们确定了与一阶、二阶和三阶结果相关的“利益对象”：（1）个人和组织；（2）核心领域之外的意外目标；（3）该领域内外的间接、远期影响。
我们展示了在关注社区护理价值观的重要性时，如何成功完成复杂社区环境中姑息治疗的评估。
