A qualitative exploration of allied health providers' perspectives on cultural humility in palliative and end-of-life care.

BACKGROUND: Cultural factors, including religious or cultural beliefs, shape patients' death and dying experiences, including palliative and end-of-life (EOL) care preferences. Allied health providers must understand their patients' cultural preferences to support them in palliative and EOL care effectively. Cultural humility is a practice which requires allied health providers to evaluate their own values, biases, and assumptions and be open to learning from others, which may enhance cross-cultural interactions by allowing providers to understand patients' perceptions of and preferences for their health, illness, and dying. However, there is limited knowledge of how allied health providers apply cultural humility in palliative and EOL care within a Canadian context. Thus, this study describes Canadian allied health providers' perspectives of cultural humility practice in palliative and EOL care settings, including how they understand the concept and practice of cultural humility, and navigate relationships with patients who are palliative or at EOL and from diverse cultural backgrounds. METHODS: In this qualitative interpretive description study, remote interviews were conducted with allied health providers who currently or recently practiced in a Canadian palliative or EOL care setting. Interviews were audio-recorded, transcribed, and analyzed using interpretive descriptive analysis techniques. RESULTS: Eleven allied health providers from the following disciplines participated: speech-language pathology, occupational therapy, physiotherapy, and dietetics. Three themes were identified: (1) Interpreting and understanding of cultural humility in palliative and EOL care (i.e., recognizing positionality, biases and preconceived notions and learning from patients); (2) Values, conflicts, and ethical uncertainties when practicing cultural humility at EOL between provider and patient and family, and within the team and constraints/biases within the system preventing culturally humble practices; (3) The 'how to' of cultural humility in palliative and EOL care (i.e., ethical decision-making in palliative and EOL care, complexities within the care team, and conflicts and challenges due to contextual/system-level factors). CONCLUSIONS: Allied health providers used various strategies to manage relationships with patients and practice cultural humility, including intra- and inter-personal strategies, and contextual/health systems enablers. Conflicts and challenges they encountered related to cultural humility practices may be addressed through relational or health system strategies, including professional development and decision-making support.

Enabling Patients as Partners on Virtual Teams: A Scoping Review.

Developing partnerships among patients and healthcare providers improves quality of virtual care. Successful patient engagement is influenced by digital literacy. Although adults (35-64) with chronic health challenges may be motivated to use virtual services, they may not have the required skills or orientation to effectively participate on their virtual team. This scoping review aimed to identify resources available to enable adults with chronic health challenges to participate as partners on their virtual teams. Peer-reviewed and grey literature data from 2011 to 2022 were searched. A total of 432 peer-reviewed and 357 grey literature sources were retrieved and screened, and 14 and 84 sources, respectively, met the inclusion criteria. Relevant information from the sources was extracted and analyzed in duplicate and synthesized qualitatively. Key findings include (1) virtual workflow processes/frameworks, (2) 'webside manner' guidelines which emphasize "the how" as opposed to "the what" of facilitating team interactions, and (3) virtual patient support personnel. Overall, analyses suggest there are persisting gaps to be addressed in synchronous virtual care resources for adults with chronic health challenges.

Interdisciplinary trainee networks to promote research on aging: Facilitators, barriers, and next steps.

Interdisciplinary education and research foster cross disciplinary collaboration. The study of age and aging is complex and needs to be carried out by scholars from myriad disciplines, making interdisciplinary collaboration paramount. Non-formal, extracurricular, and interdisciplinary networks are increasingly filling gaps in academia's largely siloed disciplinary training. This study examines the experiences of trainees (undergraduate, graduate, and post-graduate students) who belonged to one such network devoted to interdisciplinary approaches to education and research on aging. Fifty-three trainees completed the survey. Among respondents, some faculties (e.g., Health Sciences) were disproportionately represented over others (e.g., Business, Engineering, and Humanities). Most trainees valued their participation in the interdisciplinary network for research on aging. They also valued expanding their social and professional network, the nature of which was qualitatively described in open-text responses. We then relate our findings to three types of social capital: bonding; bridging; and linking. Finally, we conclude with recommendations for the intentional design and/or refinement of similar networks to maximize value to trainees, provide the skills necessary for interdisciplinary collaboration, and foster egalitarian and representative participation therein.

Applying 'cultural humility' to occupational therapy practice: a scoping review protocol.

INTRODUCTION: Cultural humility is becoming increasingly important in healthcare delivery. Recognition of power imbalances between clients and healthcare providers is critical to enhancing cross-cultural interactions in healthcare delivery. While cultural humility has been broadly examined in healthcare, knowledge gaps exist regarding its application in occupational therapy (OT) practice. This scoping review protocol aims to: (1) describe the extent and nature of the published health literature on cultural humility, including concepts, descriptions and definitions and practice recommendations, (2) map the findings from objective one to OT practice using the Canadian Practice Process Framework (CPPF), and (3) conduct a consultation exercise to confirm the CPPF mapping and generate recommendations for the practice of cultural humility in OT. METHODS AND ANALYSIS: We will search Ovid Medline, Ovid Embase, Ovid PsycINFO, Ebsco CINAHL Plus, ProQuest ASSIA, ProQuest Sociological Abstracts, ProQuest ERIC, WHO Global Index Medicus, and Web of Science databases. Published health-related literature on cultural humility will be included. There will be no restrictions on population or article type. Following deduplication on Endnote, the search results will undergo title, abstract, and full-text review by two reviewers working independently on Covidence. Extracted data will include descriptors of the article, context, population, and cultural humility. After descriptive extraction, data describing cultural humility-related content will be descriptively and interpretively analysed using an inductive thematic synthesis approach. The data will also be mapped to OT practice through deductive coding using the CPPF. Occupational therapists and clients will be consulted to further critique, interpret and validate the mapping and generate practice recommendations. ETHICS AND DISSEMINATION: Ethics approval was not required for this scoping review protocol. We will disseminate the findings, which can enhance understanding of cultural humility in OT, facilitate cross-cultural encounters between occupational therapists and clients and improve care outcomes through publications and presentations.

mHealth Interventions to Support Caregivers of Older Adults: Equity-Focused Systematic Review.

BACKGROUND: Informal caregivers, hereafter referred to as caregivers, provide support to older adults so that they can age safely at home. The decision to become a caregiver can be influenced by individual factors, such as personal choice, or societal factors such as social determinants of health, including household income, employment status, and culture-specific gender roles. Over time, caregivers' health can be negatively affected by their caregiving roles. Although programs exist to support caregivers, the availability and appropriateness of services do not match caregivers' expressed needs. Research suggests that supportive interventions offered through mobile health (mHealth) technologies have the potential to increase caregivers' access to supportive services. However, a knowledge gap remains regarding the extent to which social determinants of health are considered in the design, implementation, and evaluation of mHealth interventions intended to support the caregivers of older adults. OBJECTIVE: This study aimed to conduct a systematic review to determine how health equity is considered in the design, implementation, and evaluation of mHealth interventions for caregivers of older adults using Cochrane Equity's PROGRESS-Plus (place of residence, race, ethnicity, culture, language, occupation, gender, religion, education, social capital, socioeconomic status-plus age, disability, and sexual orientation) framework and synthesize evidence of the impacts of the identified caregiver-focused mHealth interventions. METHODS: A systematic review was conducted using 5 databases. Articles published between January 2010 and June 2021 were included if they evaluated or explored the impact of mHealth interventions on the health and well-being of informal caregivers of older adults. mHealth interventions were defined as supportive services, for example, education, that caregivers of older adults accessed via mobile or wireless devices. RESULTS: In total, 28 articles met the inclusion criteria and were included in the review. The interventions evaluated sought to connect caregivers with services, facilitate caregiving, and promote caregivers' health and well-being. The PROGRESS-Plus framework factors were mainly considered in the results, discussion, and limitations sections of the included studies. Some PROGRESS-Plus factors such as sexual orientation, religion, and occupation, received little to no consideration across any phase of the intervention design, implementation, or evaluation. Overall, the findings of this review suggest that mHealth interventions were positively received by study participants. Such interventions have the potential to reduce caregiver burden and positively affect caregivers' physical and mental health while supporting them as caregivers. The study findings highlight the importance of making support available to help facilitate caregivers' use of mHealth interventions, as well as in the use of appropriate language and text. CONCLUSIONS: The successful uptake and spread of mHealth interventions to support caregivers of older adults will depend on creating opportunities for the inclusive involvement of a broad range of stakeholders at all stages of design, implementation, and evaluation.

Approaches to Indigenous health within interprofessional education: a scoping review protocol.

OBJECTIVE: This scoping review will explore the depth, breadth, and nature of existing literature on educational approaches to Indigenous health within interprofessional education learning activities, and provide a summary of available literature, identify gaps in the research, and recommend areas for further exploration. INTRODUCTION: Interprofessional education learning activities comprise sessions where health care learners work collaboratively to address and improve the health outcomes of a given population, such as health needs among Indigenous communities. A preliminary search for existing reviews was conducted across several databases. Published literature on Indigenous health within interprofessional education learning activities exists; however, there is no comprehensive review on this topic. INCLUSION CRITERIA: This review will consider literature on existing educational approaches to Indigenous health within interprofessional education learning activities, in particular the approaches used to teach cultural awareness, sensitivity, competency, safety, and/or humility. It will consider all forms of English-language evidence, including quantitative studies, qualitative studies, mixed-method studies, and gray literature. Participants include health care and social care professionals, educators, and students within interprofessional education learning activities. METHODS: The JBI scoping review methodology will be used to guide our research. The following databases will be searched: MEDLINE, CINAHL Plus, PsycINFO, ProQuest ASSIA, Indigenous Studies Portal, and ERIC. We will also hand search reference lists and explore gray literature. Two reviewers will screen the search results and extract included studies using data extraction forms. The data will be presented in summary tables and a narrative summary.

Older Adults' Motivations for Participating in a "Tune-Up" of Their Driving Skills: A Multi-Stakeholder Analysis.

Driver training has the potential to keep older adults safe behind-the-wheel for longer, yet there is limited evidence describing factors that influence their willingness to participate in training. Focus groups with community-dwelling older drivers (n = 23; 70-90 years) and semi-structured interviews with driving instructors (n = 6) and occupational therapists (n = 5) were conducted to identify these factors. Qualitative descriptive analyses highlighted how self-awareness of behind-the-wheel abilities in later life can influence an older adult's motivation to participate in driver training, as well as their willingness to discuss their behaviors. Collision-involvement and near-misses prompted participants to reflect on their driving abilities and their openness to feedback. Participants' preferences for learning contexts that use a strengths-based approach and validate the driving experience of older drivers, while providing feedback on behind-the-wheel performance, were raised. Older driver training initiatives that consider the needs of the aging population in their design can promote road safety and community mobility.

A Scoping Review of Environmental Factors That Impact Driving with Arthritis: Considerations for Occupational Therapy.

Using the International Classification of Functioning, Disability, and Health, this scoping review mapped environmental barriers and facilitators that can influence driving with arthritis. A search of research databases located 2445 studies from which 19 were included. The predominant diagnosis researched was rheumatoid arthritis. The most common facilitators were vehicle adaptations (e.g., supplemental mirrors, seat cushions). Barriers included a lack of knowledge among clinicians to address behind-the-wheel concerns and nonuse/abandonment of such adaptions. Results highlight key clinical and research opportunities to support drivers with arthritis.

Older driver training programs: A systematic review of evidence aimed at improving behind-the-wheel performance.

INTRODUCTION: Age- and health-related changes, alongside declines in driving confidence and on-road exposure, have been implicated in crashes involving older drivers. Interventions aimed at improving behind-the-wheel behavior are diverse and their associated impact remains unclear. This systematic review examined evidence on older driver training with respect to (1) road safety knowledge; (2) self-perceived changes in driving abilities; and (3) behind-the-wheel performance. Method Nine databases were searched for English-language articles describing randomized controlled trials (RCTs) and non-RCTs of driver training interventions aimed at those aged 55+ who did not have medical or other impairments that precluded licensure. Quality appraisals were conducted using Cochrane's Risk of Bias Tool (RoB) and Risk Of Bias In Non-randomized Studies - of Interventions tool (ROBINS - I). [PROSPERO; registration no. CRD42018087366]. Results Twenty-five RCTs and eight non-RCTs met the inclusion criteria. Interventions varied in their design and delivery where classroom-based education, or a combination of classroom-based education with on-road feedback, improved road safety knowledge. Training tailored to individual participants was found to improve self-perceived and behind-the-wheel outcomes, including crashes. Conclusions Interventions comprised of tailored training can improve knowledge of road safety, changes to self-perception of driving abilities, and improved behind-the-wheel performance of older drivers. Future research should compare modes of training delivery for this driver population to determine the optimal combinations of off- and/or on-road training. Practical applications Training programs aimed at older drivers should be supported by theory and research evidence. By conducting comparative trials with a sufficient sample size alongside well-defined outcomes that are designed in accordance with reporting guidelines, the most effective approaches for training older drivers will be identified.

Blended face-to-face and online/computer-based education approaches in chronic disease self-management: A critical interpretive synthesis.

OBJECTIVE: To review the literature on chronic disease self-management programs that blend face-to-face and online/computer-based education design and delivery. METHODS: A critical interpretive synthesis was conducted. Studies that described blended chronic disease self-management programs were reviewed. Two reviewers performed independent database searches, eligibility screening, and data extraction. Findings were synthesized using a conceptual mapping process. RESULTS: Twelve articles were included in the final review. Studies focused on patients with diagnoses of diabetes, asthma, and chronic obstructive pulmonary disorder. Factors influencing the design and delivery of programs focused on patient characteristics (such as disease prognosis, time since diagnosis, social determinants of health, health literacy, and proficiency with online/computer-based technologies). CONCLUSIONS: Blended learning self-management programs should consider the suitability of programs in light of health conditions and patient characteristics. Individual patient needs can be identified through clinician-driven assessments, including collaborative goal setting and the selection of pertinent educational tools. PRACTICE IMPLICATIONS: When considering the design and delivery of chronic disease self-management education programs, healthcare providers should consider three factors: 1) patient characteristics, 2) learning perspectives, and 3) design technology options that best meet patient abilities, clinician expertise, and administrative capacity.

Identifying real and perceived barriers to therapeutic education programs for individuals with inflammatory arthritis.

Therapeutic Education Programs (TEPs) grounded in self-management principles have been shown to improve quality of life of patients with chronic conditions and reduce patient-related healthcare costs. Though these programs are becoming more readily available, patients often experience barriers in participating. This study sought to identify barriers faced by inflammatory arthritis (IA) patients in attending a TEP and understand how patients overcame perceived barriers. A mixed-method study design was used. Questionnaires were distributed to individuals with IA who were invited to attend a TEP between 2010 and 2013. Respondents were those that chose not to attend (group A), individuals who attended ≤4 of 10 sessions (group B), individuals who attended ≥5 of 10 sessions prior to May 2013 (group C), and individuals who attended ≥5 of 10 sessions from June 2013 to November 2013 (group D). Individuals in group D were also invited to participate in focus groups to discuss how they had overcome perceived barriers. Real barriers identified by individuals in groups A and B included time, distance, and cost associated with attendance. Individuals who overcame perceived barriers (groups C and D) discussed strategies they used to do so. Aspects of the overall program experience and access to clinic and program also contributed to patients being able to overcome barriers. Time, distance, and cost are external barriers that prevented individuals from utilizing self-management education opportunities. These barriers were overcome if and when individuals had resources available to them. Readiness for behavior change also influenced commitment to participate in the program.