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Service user, carer and provider perspectives on integrated care for older people with frailty, and factors perceived to facilitate and hinder implementation: a systematic review and narrative synthesis
- Authors:
- SADLER Euan, et al
- Journal article citation:
- PLoS ONE, 14(5), 2019, p.e0216488. Online only
- Publisher:
- Plos Publications
- Place of publication:
- San Francisco, CA
Introduction: Older people with frailty (OPF) can experience reduced quality of care and adverse outcomes due to poorly coordinated and fragmented care, making this patient population a key target group for integrated care. This systematic review explores service user, carer and provider perspectives on integrated care for OPF, and factors perceived to facilitate and hinder implementation, to draw out implications for policy, practice and research. Methods: Systematic review and narrative synthesis of qualitative studies identified from MEDLINE, CINAHL, PsycINFO and Social Sciences Citation Index, hand-searching of reference lists and citation tracking of included studies, and review of experts’ online profiles. Quality of included studies was appraised with The Critical Appraisal Skills Programme tool for qualitative research. Results: Eighteen studies were included in the synthesis. This study identified four themes related to stakeholder perspectives on integrated care for OPF: different preferences for integrated care among service users, system and service organisation components, relational aspects of care and support, and stakeholder perceptions of outcomes. Service users and carers highlighted continuity of care with a professional they could trust, whereas providers emphasised improved coordination of care between providers in different care sectors as key strategies for integrated care. This study identified three themes related to factors facilitating and hindering implementation: perceptions of the integrated care intervention and target population, service organisational factors and system level factors influencing implementation. Different stakeholder groups perceived the complexity of care needs of this patient population, difficulties with system navigation and access, and limited service user and carer involvement in care decisions as key factors hindering implementation. Providers mainly also highlighted other organisational and system factors perceived to facilitate and hinder implementation of integrated care for OPF. Conclusions: Similarities and differences in lay and professional stakeholder perspectives on integrated care for OPF and factors perceived to facilitate and hinder implementation were evident. Findings highlight the importance of addressing organisational and system level components of integrated care and factors influencing implementation for OPF. Greater attention needs to be placed on collaboratively involving service users, carers and providers to improve the co-design and implementation of integrated care programmes for this patient population. (Edited publisher abstract)
The contribution of implementation science to improving the design and evaluation of integrated care programmes for older people with frailty
- Authors:
- SADLER Euan, et al
- Journal article citation:
- Journal of Integrated Care, 27(3), 2019, pp.232-240.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to discuss three potential contributions from implementation science that can help clinicians and researchers to design and evaluate more effective integrated care programmes for older people with frailty. Design/methodology/approach: This viewpoint paper focuses on three contributions: stakeholder engagement, using implementation science frameworks, and assessment of implementation strategies and outcomes. Findings: Stakeholder engagement enhances the acceptability of interventions to recipients and providers and improves reach and sustainability. Implementation science frameworks assess provider, recipient and wider context factors enabling and hindering implementation, and guide selection and tailoring of appropriate implementation strategies. The assessment of implementation strategies and outcomes enables the evaluation of the effectiveness and implementation of integrated care programmes for this population. Research limitations/implications: Implementation science provides a systematic way to think about why integrated care programmes for older people with frailty are not implemented successfully. The field has an evidence base, including how to tailor implementation science strategies to the local setting, and assess implementation outcomes to provide clinicians and researchers with an understanding of how their programme is working. The authors draw out implications for policy, practice and future research. Originality/value: Different models to deliver integrated care to support older people with frailty exist, but it is not known which is most effective, for which individuals and in which clinical or psychosocial circumstances. Implementation science can play a valuable role in designing and evaluating more effective integrated care programmes for this population. (Edited publisher abstract)
Developing a novel peer support intervention to promote resilience after stroke
- Authors:
- SADLER Euan, et al
- Journal article citation:
- Health and Social Care in the Community, 25(5), 2017, pp.1590-1600.
- Publisher:
- Wiley
Stroke can lead to physical, mental and social long-term consequences, with the incidence of stroke increasing with age. However, there is a lack of evidence of how to improve long-term outcomes for people with stroke. Resilience, the ability to ‘bounce back’, flourish or thrive in the face of adversity improves mental health and quality of life in older adults. However, the role of resilience in adjustment after stroke has been little investigated. The purpose of this study is to report on the development and preliminary evaluation of a novel intervention to promote resilience after stroke. The study applied the first two phases of the revised UK Medical Research Council (UKMRC) framework for the development and evaluation of complex interventions: intervention development (phase 1) and feasibility testing (phase 2). Methods involved reviewing existing evidence and theory, interviews with 22 older stroke survivors and 5 carers, and focus groups and interviews with 38 professionals to investigate their understandings of resilience and its role in adjustment after stroke. The study used stakeholder consultation to co-design the intervention and returned to the literature to develop its theoretical foundations. It then developed a 6-week group-based peer support intervention to promote resilience after stroke. Theoretical mechanisms of peer support targeted were social learning, meaning-making, helping others and social comparison. Preliminary evaluation with 11 older stroke survivors in a local community setting found that it was feasible to deliver the intervention, and acceptable to stroke survivors, peer facilitators, and professionals in stroke care and research. This study demonstrates the application of the revised UKMRC framework to systematically develop an empirically and theoretically robust intervention to promote resilience after stroke. A future randomised feasibility study is needed to determine whether a full trial is feasible with a larger sample and wider age range of people with stroke. (Edited publisher abstract)
Exploring the links between spirituality and 'successful ageing'
- Authors:
- SADLER Euan, BIGGS Simon
- Journal article citation:
- Journal of Social Work Practice, 20(3), November 2006, pp.267-280.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The authors critically examine the relationship between ‘successful ageing’ and spirituality. The examination is based on a review of the literature. The authors also draw conclusions for the policy and practice implications for the care of older people.
Spiritual perspectives of Black Caribbean and White British older adults: development of a spiritual typology in later life
- Authors:
- SADLER Euan, BIGGS Simon, GLASER Karen
- Journal article citation:
- Ageing and Society, 33(3), 2013, pp.511-538.
- Publisher:
- Cambridge University Press
Spirituality is positively linked to health and well-being in later life, particularly among older adults of black ethnic groups. However, definitions of spirituality in the literature have largely been theoretically informed, rather than based on the views of older people themselves. Using in-depth interviews with 34 individuals aged between 60 and 95 years in South London, this study examines the spiritual perspectives of Black Caribbean and White British older adults. The research aimed to develop a spiritual typology to add to an understanding of the process of spirituality in later life. Findings showed that Black Caribbean older individuals mostly defined spirituality in relation to their belief in a transcendent God, whereas White British older individuals tended to draw upon a wider range of spiritual, religious or secular notions. A spirituality typology in later life captured four categories of relationship, between ‘God to self’, ‘self to God’, ‘self to universe’ and ‘self to life’. The typology highlights the central role of ethnicity in shaping spiritual perspectives in later life, and identifies the multidimensional nature of spirituality among older adults, reflecting in part a developmental process, although a process which is socially and culturally constructed. (Edited publisher abstract)