Barriers to and facilitators of a just-in-time adaptive intervention for respiratory illness in cerebral palsy: a qualitative study.
Barriers to and facilitators of a just-in-time adaptive intervention for respiratory illness in cerebral palsy: a qualitative study.
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DOI：
10.1136/bmjopen-2023-074147
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发表时间：
2023-08-17
期刊：
影响因子：
2.9
通讯作者：
中科院分区：
文献类型：
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作者：
为了了解护理人员、医疗保健专业人员和国家专家对实施及时适应性干预RE-PACT(呼吸加剧-行动和护理过渡计划)以预防严重脑瘫患者呼吸危机的看法。定性研究性学习。两个学术医疗机构的儿科综合护理方案。共有4个焦点小组与患有严重脑瘫和慢性呼吸系统疾病的儿童的照顾者一起进行，n=4与医疗保健专业人员进行，n=1与国家专家进行。参与者观看了一段概述RE-Pact的视频，其中包括行动计划、对父母信心的移动健康监测以避免住院，以及在信心较低的时候做出快速临床反应。由主持人主持的讨论引出了《消除对妇女一切形式歧视公约》设计的挑战和好处，归纳专题分析引出了执行障碍和促进者。在招募的19名照顾者中，近一半的人报告说，他们的孩子在前一年至少住院过一次。保健专业人员和国家专家(n=26)包括医生、护士、呼吸治疗师、社会工作者和研究人员。四个最重要的主题及其障碍/促进者强调了设计和人际关系与卫生系统基础设施限制相平衡的重要性。在危机情况下的干预有用性取决于设计直观和准确的行动计划，以及融入日常生活的移动健康监测工具。信任、知识、同理心和足够的临床医生能力是临床响应者-护理者关系的重要组成部分。Re-pact确定的障碍是可以解决的。脑瘫的及时适应性干预似乎非常适合满足家庭根据经验、偏好和相互竞争的需求调整干预内容的需要。
To understand caregiver, healthcare professional and national expert perspectives on implementation of a just-in-time adaptive intervention, RE-PACT (Respiratory Exacerbation-Plans for Action and Care Transitions) to prevent respiratory crises in severe cerebral palsy. Qualitative research study. Paediatric complex care programmes at two academic medical institutions. A total of n=4 focus groups were conducted with caregivers of children with severe cerebral palsy and chronic respiratory illness, n=4 with healthcare professionals, and n=1 with national experts. Participants viewed a video summarising RE-PACT, which includes action planning, mobile health surveillance of parent confidence to avoid hospitalisation and rapid clinical response at times of low confidence. Moderated discussion elicited challenges and benefits of RE-PACT’s design, and inductive thematic analysis elicited implementation barriers and facilitators. Of the 19 caregivers recruited, nearly half reported at least one hospitalisation for their child in the prior year. Healthcare professionals and national experts (n=26) included physicians, nurses, respiratory therapists, social workers and researchers. Four overarching themes and their barriers/facilitators emphasised the importance of design and interpersonal relationships balanced against health system infrastructure constraints. Intervention usefulness in crisis scenarios relies on designing action plans for intuitiveness and accuracy, and mobile health surveillance tools for integration into daily life. Trust, knowledge, empathy and adequate clinician capacity are essential components of clinical responder-caregiver relationships. RE-PACT’s identified barriers are addressable. Just-in-time adaptive interventions for cerebral palsy appear well-suited to address families’ need to tailor intervention content to levels of experience, preference and competing demands.
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