Evaluation approaches to CDSM tools used in a Sharing Health Care Initiative Project

Alison Short1,2 Rebecca Taylor2,, Paul Dugdale2, Peter Nugus1,2, David Greenfield1

1 Centre for Clinical Governance, AIHI, UNSW 2 Centre for Health Stewardship, ANU

Outline of presentation

1. Overview of project and planning

2. Approaches and examples3. Take home messages

Australian Government

Department of Health and

Ageing

Evaluating the Impact of the ‘Patient as Professional

within a Network’ Tool to Self-Manage Chronic DiseaseLinked to project:

Interprofessional Learning in Primary Health Care to

Encourage Active Patient Self-Management of Chronic

Disease

Health professionals

Consumers

Community organizations

Project Overview

Aims1. To evaluate the IPL and community-of-

practice/ networking outcomes of professionals,including the patient-as-professional

2. To investigate the use of chronic disease management (CDSM) tools

3. To investigate the health literacy of the patient-as-professional

Project Overview

1. Finding the relevant information

2. Exploring the gaps and how to respond to them

3. Engaging in discussion and consultation

4. Undertaking project planning

5. Implementation & results6. Feedback and writing up

Project focus

Project planning (1)

Project planning (2)

1. Learning from literature and other researchers

2. Process evaluation3. Exploring the consumer’s

perspectives4. Exploring staff perspectives5. National surveys6. Feedback to stakeholders

Summary of approaches

Learning from literature & others

What is health literacy?

1. Basic/functional literacy 2. Communicative/interactive

literacy3. Critical health literacy

References :• Nutbeam, D. (2000). Health literacy as a public health goal: A challenge

for contemporary health education and communication strategies in the 21st century. Health Promotion International, 15, (3) 259-267.

• Peerson, A. & Saunders, M. (2009). Health literacy revisited: What do we mean and why does it matter? Health Promotion International, 24 (3), 285-296.

• Adams, R.J. (2010). Improving health outcomes with better patient understanding and education. Risk Management and Healthcare Policy, 3, 61-72.

Process evaluation

Observation, field notes attendance at relevant events

Follow-up interviews and focus groups

Review of relevant written materials

What is the Stanford Program?

Run in the ACT as the ‘Living a Healthy Life with Long-term Conditions’ course.

2 ½ hours a week for 6 weeks People of all ages with a condition lasting

longer than 6 months are encouraged to attend

Program is run by a health professional and a peer leader

Exploring consumer perspectives

MethodsFollow-up with people who had attended the

“Living a Healthy Life with Long-term Conditions” course:

158 letters (Feb09-Aug10); 53 responses (34%) 4 focus groups, 8 interviews 33 participants (M=9, F=24), including 5

carers Age range: 37-80yrs (average=59.2,

median=61) Range of chronic diseases and complex care

needs

Exploring consumer perspectives

What is it like to find the information you need to manage chronic disease? Written? Verbal? Other?

How do you use this information in discussion and interaction with others?

How do you tell what is good information, and how do you use it to make a difference for yourself and for others?

What do you think needs to change, to support understanding and information exchange about self-managing chronic disease? The role of community groups? Advocacy for

change?

Exploring consumer perspectives

Health literacy questions...

Exploring consumer perspectives

MethodsParticipants were asked about their

health literacy11 interviews and 7 focus groups50 people with chronic disease and 5

carersAged 36-83 years17 males and 38 femalesData transcribed and analysed

thematically by three researchers

Deciding which CDSM Tool to Use:MethodsSemi-structured interviews with Goulburn Valley

Health clinicians working in the field of CDSM

Participants 6 clinicians (manager CDSM, social worker, allied

health assistant, psychologist, naturopath and physiotherapist)

Length of time worked in self-management: 6 months-4 years

All participants had completed health coaching training

3 participants were Stanford Program leaders 2 participants were trained in the Flinders Program

Exploring staff perspectives

National surveySelf-Management Tools Used in Australia

Methods1. Development of a survey to

gain information about the chronic disease self-management tools used

2. Pilot testing of the survey3. Distribution of the survey to

attendees at the Australian Disease Management Association 6th Annual National Disease Management Conference pre-conference workshop

Feedback to stakeholders

MethodsKey project stakeholders interviews

Semi-structured interview guide45-60 minutes, convenient

locationSix interviews

Survey data from Health Expo 201046 completed questionnairesCommunity members (34%);

health professionals (32%)

Expectations about setting up a network need to be flexible, may not be as clearly defined as one would like

Challenges need to be addressed, e.g. organization, staffing, financial, policy support, engagement of stakeholders and sustainability.

Network needs to work from foundations of IPL, a multidisciplinary approach, working together.

Need to hold events as a focus and to promote networking activity

Needs to be a clear driver , or driving group, and adequate resources located for this.

Feedback to stakeholders

A collaborative community CDSM network

Know your context and its particular needs or limits

Plan well ahead, and in considerable detail

Make best use of existing opportunities, such as groups already gathered, such as for focus groups

Develop semi-structured questionnaires with an eye on the literature

Network and collaborate across health, academic, community organizations and consumers

About evaluation: Take home messages (1)

Revise and revise written materials – use a wide range of team members

Allow sufficient time for tasks, e.g. ethics & recruitment

Where possible, engage with others to help gather data etc.

Reassess plans of a regular basis to check that it is still realistic, and if necessary make changes

Take findings back to stakeholders

About evaluation: Take home messages (2)

Enjoy evaluating!