This chapter discusses the efforts of community workers to obtain consent in local communities as a basis for taking action on issues that are affecting local people’s lives. Crucial here is that community workers resist the initial urge to settle for consensus and as a consequencelimit the possibilities for creativity, exploration and interpersonal development. Drawing on two case studies, one from Amsterdam (the Netherlands) and one from Chelsea (US), the requirements and process of acquiring consent are outlined. Consent in general refers to a form of permission to act or take action. In this chapter we consider it as a sense of approval by neighbourhood community members to engage in a collective course of action. Community workers often play a crucial part in the acquisition of community consent as they support the process of recognition of the diversity of interests, opinions and values that characterises local life. Consent is necessary for creatingsustainable local initiatives, incorporating, instead of eliminating, conflicting positions. This acknowledgement of diversity can be seen as an ethical requirement in community development practice, but also as a strategic issue for community workers. After all, without being able to obtain legitimacy for their engagement with local issues, effective community development work is impossible.This chapter focuses on neighbourhood-based community development work in geographical communities. However, similar principles apply in all forms of community development, including work with communities of interest and identity. We use the term‘community worker’ to refer to someone who takes on a facilitating and coordinating role with members of communities to build community capacity and/or bring about social change. Such workers may be paid and professionally qualified, or unpaid volunteers andactivists. They may live in the communities where they work/are active, or reside outside these areas. These circumstances influence the legitimacy of their interventions, as well as how consent is gained and consensus reached.
DOCUMENT
Aim: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse-coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design: A mixed-methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods: Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi-structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data-analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results: The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in-hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion: Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non-significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact: In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.
DOCUMENT
Background: Patient participation and goal setting appear to be difficult in daily physiotherapy practice, and practical methods are lacking. An existing patient-specific instrument, Patient-Specific Complaints (PSC), was therefore optimized into a new Patient Specific Goal-setting method (PSG). The aims of this study were to examine the feasibility of the PSG in daily physiotherapy practice, and to explore the potential impact of the new method. Methods: We conducted a process evaluation within a non-controlled intervention study. Community-based physiotherapists were instructed on how to work with the PSG in three group training sessions. The PSG is a six-step method embedded across the physiotherapy process, in which patients are stimulated to participate in the goal-setting process by: identifying problematic activities, prioritizing them, scoring their abilities, setting goals, planning and evaluating. Quantitative and qualitative data were collected among patients and physiotherapists by recording consultations and assessing patient files, questionnaires and written reflection reports. Results: Data were collected from 51 physiotherapists and 218 patients, and 38 recordings and 219 patient files were analysed. The PSG steps were performed as intended, but the ‘setting goals’ and ‘planning treatment’ steps were not performed in detail. The patients and physiotherapists were positive about the method, and the physiotherapists perceived increased patient participation. They became aware of the importance of engaging patients in a dialogue, instead of focusing on gathering information. The lack of integration in the electronic patient system was a major barrier for optimal use in practice. Although the self-reported actual use of the PSG, i.e. informing and involving patients, and client-centred competences had improved, this was not completely confirmed by the objectively observed behaviour. Conclusion: The PSG is a feasible method and tends to have impact on increasing patient participation in the goal-setting process. However, its full potential for shared goal setting has not been utilized yet. More implementation effort is needed to achieve the required behaviour change and a truly client-centred attitude, to make physiotherapists totally ready for shared goal setting.
DOCUMENT
