Background: There is an increasing number of patients with a chronic illness demanding primary care services. This demands for effective self-management support, including collaborative goal setting. Despite the fact that primary care professionals seem to have difficulties implementing goal setting, little information is available about the factors influencing the complexity of this process in primary care. Objective: The aim of this study was to contribute to an understanding of the complexity of selfmanagement goal setting in primary care by exploring experts’ and primary care professionals’ experiences with self-management goal setting and viewpoints regarding influencing factors. Methods: A descriptive qualitative research methodology was adopted. Two focus groups and three individual interviews were conducted (total participants n = 17). Thematic content analysis was used to analyse the data. Results: The findings were categorized into four main themes with subordinated subthemes. The themes focus around the complexity of setting non-medical goals and around professionals’ skills and attitudes to negotiate and decide about goals with patients. Furthermore, patients’ skills and attitudes for goal setting and the integration of goal setting in the time available were formulated as themes. Conclusions: Setting self-management goals in primary care, especially in family medicine, might require a shift from a medical perspective to a biopsychosocial perspective, with an increasing role set aside for the professional to coach the patient in expressing his self-management goals and to take responsibility for these goals.
Objective: To evaluate the preliminary effectiveness of a goal-directed movement intervention using a movement sensor on physical activity of hospitalized patients. Design: Prospective, pre-post study. Setting: A university medical center. Participants: Patients admitted to the pulmonology and nephrology/gastro-enterology wards. Intervention: The movement intervention consisted of (1) self-monitoring of patients' physical activity, (2) setting daily movement goals and (3) posters with exercises and walking routes. Physical activity was measured with a movement sensor (PAM AM400) which measures active minutes per day. Main measures: Primary outcome was the mean difference in active minutes per day pre- and post-implementation. Secondary outcomes were length of stay, discharge destination, immobility-related complications, physical functioning, perceived difficulty to move, 30-day readmission, 30-day mortality and the adoption of the intervention. Results: A total of 61 patients was included pre-implementation, and a total of 56 patients was included post-implementation. Pre-implementation, patients were active 38 ± 21 minutes (mean ± SD) per day, and post-implementation 50 ± 31 minutes per day (Δ12, P = 0.031). Perceived difficulty to move decreased from 3.4 to 1.7 (0-10) (Δ1.7, P = 0.008). No significant differences were found in other secondary outcomes. Conclusions: The goal-directed movement intervention seems to increase physical activity levels during hospitalization. Therefore, this intervention might be useful for other hospitals to stimulate inpatient physical activity.
Objective: To construct the underlying value structure of shared decision making (SDM) models. Method: We included previously identified SDM models (n = 40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz’s value theory to define values in SDM and to investigate value relations. Results: We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of healthcare professionals’ (HCPs) and patients’ skills [Achievement], support for a patient [Benevolence], and a good relationship between HCP and patient [Security] all facilitate patients’ autonomy [Self-Direction]. These values enable a more balanced relationship between HCP and patient and tailored decision making [Universalism]. Conclusion: SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients’ Self-Direction. Practice implications: This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients’ values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs, and HCPs when practicing.
Om de ambities te behalen zoals geformuleerd in de Sustainable Development Goals, is transdisciplinaire samenwerking nodig tussen overheden, bedrijfsleven, burgers en wetenschap. Dit vraagt om multi-stakeholderbenaderingen waarin leren van en met elkaar centraal staat. Dit onderzoeksvoorstel is een vertaalslag van bovenstaande ambitie zoals geformuleerd in samenwerking met hoger onderwijs partners in Bandung, Indonesië. Het Living Lab Upper Citarum biedt een context om onderzoek te doen binnen een bestaand Living Lab gekenmerkt door de multi-stakeholder setting en de complexiteit van duurzaam beheer van natuurlijke hulpbronnen. Het onderzoek beoogt inzicht te verkrijgen in essentiële ‘21st century skills’ voor deelnemers met faciliterende rollen in een Living Lab. De onderzoeksstrategie wil een bijdrage leveren aan de duurzaamheidsagenda van Living Labs met het ontwerpen, het ervaren, reflecteren en documenteren van praktische interventies in de lokale context. De keuze voor werken op locatie is een eerste benadering in het creëren van een realistische leerervaring voor Living Lab facilitators met diverse achtergronden en valt daarmee te beschrijven als ‘learning by doing’. De algemene onderzoekvraag is als volgt geformuleerd: Which contemporary skills and capabilities are present and which need to be developed to establish a widely shared mind set for trans- or interdisciplinary strategies so that communities and institutions in a Living Lab configuration increase their performance? De onderzoeksstrategie krijgt vorm in een ‘21st century skills exploration’ die een experimentele leerruimte biedt aan medewerkers van diverse instituten en (overheids-)organisaties die actief zijn in het Living Lab om kennis te maken met de creatieve methodes voor publieke participatie. Dit vindt vooral plaats in interactie met lokale gemeenschappen met nadruk op creatieve methodes zoals een poetry route, participatory mapping en film. Na presentatie op locatie worden de resultaten gepresenteerd tijdens een mini-symposium in Bandung.
