A home-based training programme improves family caregivers' oral care practices with stroke survivors: a randomized controlled trial.

OBJECTIVES: Stroke survivors experience poor oral health when discharged from the hospital to the community. The aim of this study was to evaluate the effectiveness of a home-based oral care training programme on knowledge, attitude, self-efficacy and practice behaviour of family caregivers. METHODS: A randomized controlled trial was conducted. The experimental group consisted of 48 family caregivers who received the home-based oral care training programme, and the control group consisted of 46 family caregivers who received routine oral care education. The outcomes were measured by the Knowledge of Oral Care, Attitude towards Oral Care, Self-Efficacy of Oral Care and Behaviour of Oral Care before the training programme, and at one and two months afterwards. The data were analysed using mixed model anova to determine differences in the outcomes between the two groups. RESULTS: The findings demonstrated that the intervention group had more knowledge (t = 8.80, P < 0. 001), greater self-efficacy (t = 3.53, P < 0.01) and better oral care behaviour (t = 11.93, P < 0.001) than the control group at one and two months, with statistically significant differences in oral care knowledge, self-efficacy and behaviour outcome over time. The attitude of the intervention group towards oral care practice was generally positive (mean of baseline and two month = 12.9 and 14.7), but no significant difference in attitude change between the control and intervention groups (t = 1.56, P = 0.12). The treatment interaction effect was significant for the family caregivers' behaviour of oral care at one and two months of the intervention for both groups. CONCLUSION: Our individualized home-based oral care education can achieve significant improvements in oral care knowledge and self-efficacy among family caregivers of stroke survivors, and it can sufficiently empower them to modify their oral care practices in a home-based healthcare environment.

The Influence of Demographic and Psychosocial Factors on the Intensity of pain Among Chronic Patients Receiving Home-based Nursing Care.

AIM: To determine the influence of the demographic and the psychosocial factors on the intensity of pain manifestation among the chronic ill patients. MATERIALS AND METHODS: A descriptive, cross-sectional study was carried out among 328 chronic patients under home-based nursing care in Southern State of Kerala, India, from July to August 2015. Each patient was interviewed during a scheduled home visit by a trained health professional. The translated version of the assessment tool questionnaire Medical Outcome Study-Short Form Health Survey was used for the data collection. RESULTS: Sixty-four (19.5%) out of 328 patients reported pain as one of the primary symptoms of their disease. The percentage of the patients who were suffering from pain increases with the improvements in both the educational level and the monthly income (P = 0.002 and 0.019, respectively). The social interaction with the relatives and other community members was significantly related to pain manifestation (P = 0.013). A higher degree of social interaction was associated with lower pain intensity (P = 0.019). CONCLUSION: The results of this study showed that certain demographic and psychosocial factors carry a significant level of influence on the pain manifestation and its intensity among the chronic patients. Hence, improvements in education, economic status, and psychosocial support should be considered for the management of the chronic patients.

Incorporating Paid Caregivers Into Medical Education to Enhance Medical Student Exposure to This Essential Workforce.

The implications of the COVID-19 pandemic underscored the utility of home-based health care due in part to social distancing requirements, curtailment of elective hospital procedures, and patient apprehension of the health care setting. The pandemic particularly accentuated the integral role of paid caregivers (eg, home health aides, personal care attendants, and other home care workers) in caring for patients with chronic health conditions. Given the paradigm shift toward community- and value-based health care models, paid caregivers are likely to play an even greater role as care team members. Despite the increasingly prominent role paid caregivers are assuming in health care, especially for patients who are chronically ill, in our experience as medical students, we have very little exposure to these care team members, with most interactions occurring in brief, chance encounters. Specifically, we advocate for increased medical student exposure to paid caregivers to facilitate their recognition as valuable care team members. We propose to achieve this through (1) classroom-based module learning with live paid caregivers and (2) plain language communication training to enhance reciprocal engagement.

Needs-led research: a way of employing user involvement when devising research questions on the trust model in community home-based health care services in Norway.

BACKGROUND: This paper presents a user involvement process, called needs-led research, conducted as a part of a doctoral degree project aiming to explore research priorities and, ultimately, to develop a final top 10 list of questions relevant to the field of research. There is evidence of a mismatch between what user groups within a research field find relevant to study and what is actually being done. User involvement is a method that can accommodate this, and there is a growing attention and amount of research in this field based on an understanding that people who receive health care services, and their next of kin and clinicians, are uniquely positioned to contribute to research in order to understand their experiences better and improve the services. This paper presents a user involvement process in a small-scale study, referred to as needs-led research, which concerns the 'performance of the trust model in community home-based health care services'. The process was conducted as part of a doctoral degree project. METHOD: The needs-led research process is inspired by the James Lind Alliance (JLA), which focuses on bringing together service users, next of kin and clinicians on equal terms to explore research priorities. The process consisted of five-steps, each of which involved representatives from service users, next of kin and clinicians: 1) narrowing down the theme; 2) steering group meeting; 3) gathering input through a survey; 4) data processing and interim priority setting; and 5) final priority setting. RESULTS: Almost 200 participants contributed during the five steps, 294 inputs were gathered, and 35 participants voted for the top 10 list. The top 10 list is presented. CONCLUSION: This paper provides an example of how user involvement can be employed to devise research questions that are relevant for clinicians, service users, next of kin and service providers concerning the 'performance of the trust model in home-based health care'. It also outlines some strengths and limitations of the process. The needs-led research process shows that user involvement in research is feasible for developing research questions in small-scale studies. We hope that the top 10 list presented will encourage future research to address issues of importance regarding the performance of the trust model in community home-based health care services.

User involvement is a topic that has received increasing attention in research aimed at ensuring relevant and needed knowledge. It can be practised in a variety of ways, and the literature claims that there is no gold standard for how it should be done. This paper presents a user involvement process conducted autumn 2019 to spring 2020, hereby referred to as needs-led research (NLR), inspired by the James Lind Alliance (JLA). The scope of the process is the 'performance of the trust model in community home-based health care services'. The trust model is a new way of organising home-based health care services where small interdisciplinary teams work with the service users and their next of kin on tailoring the services based on the users' answers to the question 'What matters to you?'Through a five-step process, in which representatives of service users, next of kin and clinicians participated in meetings and online surveys, the goal of the NLR process was to explore research priorities and, ultimately, to develop a final top 10 list of questions relevant to the field of research. This paper describes the NLR process and discusses its strengths and limitations. We found the process to be important when identifying relevant research questions concerning a topic on which little research has been conducted, and in which we as researchers have little experience. The final top 10 list is also presented.

Home-Based Care, the Missing Link in Caring of Patients Living with HIV/AIDS and Their Family Members: A Narrative Review.

Inconsistencies between the number of patients, qualified caregivers and lack of adequate services and resources in the healthcare systems for people living with HIV/AIDS have led to the idea of providing healthcare services for this vulnerable population at home. This study aimed to review the evidence related to the Home-Based Care (HBC) programs in the context of HIV. Literature search was carried out without publication date limit through English databases of Cochrane Library, PubMed, EBSCO, Scopus, Google Scholar, Science Direct, as well as Persian databases including Magiran and SID by the end of July 2019. Out of 1312 studies retrieved from the search of databases, six guidelines and 50 articles met the eligible criteria. The results showed that the overall purpose of HBC is to create hope through providing appropriate care to help the patients and their families to maintain their independence and have the best possible quality of life. The potential benefits of HBC could be discussed in three main categories: 1) patients, including patients' satisfaction, quality of life, adherence to antiretroviral therapy, preventing mother-to-child transmission, as well as biochemical, social and psychological outcomes, 2) families, consisted of promotinon of family members' participation, enhancement of family members' awareness and provision of voluntary counseling and testing, and 3) healthcare systems, containing health care costs, workload at healthcare centers and time spent on services. Given the lessons learnt from the existing HBC programs, developing an alternative approach for providing healthcare at home in the context of HIV seems necessary and could be an agenda for action in health policy making in Iran.

Striking a balance: Health care providers' experiences with home-based, patient-centered care for older people-A meta-synthesis of qualitative studies.

OBJECTIVE: The aim of this article was to synthesize research findings about health care providers' experiences of patient-centered care in the home setting. METHODS: This is a meta-synthesis of qualitative findings using the analytical method of meta-ethnography developed by Noblit and Hare. We performed a systematic literature search in seven databases and assessed potential studies against eligibility criteria and quality. Subsequently, 10 primary studies were included for analysis. RESULTS: The core theme "being a balance artist" emerged from the synthesis, incorporating the participants' experiences when faced with conflicting and competing responsibilities and needs. Two subthemes-"balancing the older clients' needs against organizational demands" and "balancing the older clients' needs against professional standards"-further elaborated on this core theme. CONCLUSION: Health care providers' experiences indicate that organizational factors play a crucial role in shaping the conditions for patient-centered care for older people in the home setting. PRACTICE IMPLICATIONS: To motivate and facilitate health care providers to move to a more patient-centered practice, it is important to expand the values of patient-centered care beyond the clinical encounter into the organization.