Current evidence for designing self-management support for underserved populations: an integrative review using the example of diabetes.

AIMS: With numerous and continuing attempts at adapting diabetes self-management support programmes to better account for underserved populations, its important that the lessons being learned are understood and shared. The work we present here reviews the latest evidence and best practice in designing and embedding culturally and socially sensitive, self-management support programmes. METHODS: We explored the literature with regard to four key design considerations of diabetes self-management support programmes: Composition - the design and content of written materials and digital tools and interfaces; Structure - the combination of individual and group sessions, their frequency, and the overall duration of programmes; Facilitators - the combination of individuals used to deliver the programme; and Context - the influence and mitigation of a range of individual, socio-cultural, and environmental factors. RESULTS: We found useful and recent examples of design innovation within a variety of countries and models of health care delivery including Brazil, Mexico, Netherlands, Spain, United Kingdom, and United States of America. Within Composition we confirmed the importance of retaining best practice in creating readily understood written information and intuitive digital interfaces; Structure the need to offer group, individual, and remote learning options in programmes of flexible duration and frequency; Facilitators where the benefits of using culturally concordant peers and community-based providers were described; and finally in Context the need to integrate self-management support programmes within existing health systems, and tailor their various constituent elements according to the language, resources, and beliefs of individuals and their communities. CONCLUSIONS: A number of design principles across the four design considerations were identified that together offer a promising means of creating the next generation of self-management support programme more readily accessible for underserved communities. Ultimately, we recommend that the precise configuration should be co-produced by all relevant service and patient stakeholders and its delivery embedded in local health systems.

Implementing Community-Created Self-Management Support Tools in Primary Care Practices: Multimethod Analysis From the INSTTEPP Study.

PURPOSE: With one-half of Americans projected to be living with at least one chronic condition before 2020, enhancing patient self-management support (SMS) may improve health-related behaviors and clinical outcomes. Routine SMS implementation in primary care settings is difficult. Little is known about the practice conditions required for successful implementation of SMS tools. METHODS: Four primary care practice-based research networks (PBRNs) recruited 16 practices to participate in a boot camp translation process to adapt patient-centered SMS tools. Boot camp translation sessions were held over a 2-month period with 2 patients, a clinician, and a care manager from each practice. Qualitative case comparison and qualitative comparative analysis were used to examine practice conditions needed to implement SMS tools. The Consolidated Framework for Implementation Research guided data collection and analysis. RESULTS: Four different practice conditions affected the implementation of new SMS tools: functional practice organization; system that enables innovation and change; presence of a visible, activated champion; and synergy and alignment of SMS changes with other work. Qualitative comparative analysis suggested that it was necessary to have an enabling system, a visible champion, and synergy for a practice to at least minimally implement the SMS tools. Sufficiency testing, however, failed to show robust consistency to satisfactorily explain conditions required to implement new SMS tools. CONCLUSIONS: To implement tailored self-management support tools relatively rapidly, the minimum necessary conditions include a system that enables innovation and change, presence of a visible champion, and alignment of SMS changes with other work; yet, these alone are insufficient to ensure successful implementation.

How to Translate Self-Management Support Tools Into Clinical Practice: A Report From the INSTTEPP Trial and Meta-LARC Consortium.

PURPOSE: Patient self-management is an inevitable part of the work of being a patient, and self-management support (SMS) has become increasingly important in chronic disease management. However, the majority of SMS resources available in the Agency for Healthcare Research and Quality SMS Resource Library were developed without explicit collaboration between clinicians and patients. METHODS: Translation of SMS tools derived from the library into primary care practices occurred utilizing boot camp translation in four different practice-based research networks (PBRNs). The typical model of boot camp translation was adapted for the purpose of the Implementing Networks' Self-management Tools Through Engaging Patients and Practices (INSTTEPP) study to develop SMS tools for implementation in the participating practices. Clinicians, clinic staff members, and patients were involved throughout the translation process. Existing resources from the SMS library were reviewed and adapted by each boot camp translation group to create tools unique to the patients in each network. RESULTS: There was no preexisting resource within the library that was deemed suitable for implementation without modification. Each network adapted tools from the SMS library to create different products. Common themes emerged from each network's translation process that highlighted the importance of patient engagement in the translation process. Boot camp translation, in conjunction with PBRNs, can be implemented to adapt SMS tools for implementation in member practices. CONCLUSIONS: Boot camp translation with a combination of practices and patients can be implemented to facilitate a process of local adaptation that improves the local applicability of SMS tools in primary care clinics.

On-farm broiler welfare assessment and associated training

Around the world, people who care for animals as stock keepers, stockmen, farmers, producers are placed in a position where they can greatly influence the quality of life of the animals they manage. This is particularly true in broiler chickens, where large numbers of animals can be cared for by comparatively small numbers of people. There is an international progression to start to assess poultry welfare on farm by looking at the animals themselves using (Animal Based Measures ABMs) rather than by looking exclusively at the resources provided (space, light heat, litter material - Resource Based Measures RBM's). In general, the areas being assessed are: Are the animals properly fed and supplied with water? Are the animals properly housed? Are the animals healthy? Can the animals express a range of behaviours and emotional states? Different types of organisations are starting to use ABM's - Government inspection bodies - for example state veterinary staff, Research institutes - wishing to use standardized assessment methods for research, Animal Welfare NGO's, Farm assurance companies and Legislators. The WelfareQualityNetwork® (WQN) http://www.welfarequality.net/everyone has described ABM's which address twelve health and welfare criteria and has tested them on a large number of farms across Europe. Some examples from this assessment scheme are described.

On-farm broiler welfare assessment and associated training

Around the world, people who care for animals as stock keepers, stockmen, farmers, producers are placed in a position where they can greatly influence the quality of life of the animals they manage. This is particularly true in broiler chickens, where large numbers of animals can be cared for by comparatively small numbers of people. There is an international progression to start to assess poultry welfare on farm by looking at the animals themselves using (Animal Based Measures ABMs) rather than by looking exclusively at the resources provided (space, light heat, litter material - Resource Based Measures RBM's). In general, the areas being assessed are: Are the animals properly fed and supplied with water? Are the animals properly housed? Are the animals healthy? Can the animals express a range of behaviours and emotional states? Different types of organisations are starting to use ABM's - Government inspection bodies - for example state veterinary staff, Research institutes - wishing to use standardized assessment methods for research, Animal Welfare NGO's, Farm assurance companies and Legislators. The WelfareQualityNetwork® (WQN) http://www.welfarequality.net/everyone has described ABM's which address twelve health and welfare criteria and has tested them on a large number of farms across Europe. Some examples from this assessment scheme are described.(AU)