Chinese Immigrant Caregivers: Understanding Their Unmet Needs and the Co-Design of an mHealth App.

BACKGROUND: Immigrant caregivers support the aging population, yet their own needs are often neglected. Mobile technology-facilitated interventions can promote caregiver health by providing easy access to self-care materials. OBJECTIVE: This study employed a design thinking framework to examine Chinese immigrant caregivers' (CICs) unmet self-care needs and co-design an app for promoting self-care with CICs. METHODS: Nineteen semi-structured interviews were conducted in conceptual design and prototype co-design phases. FINDINGS: Participants reported unmet self-care needs influenced by psychological and social barriers, immigrant status, and caregiving tasks. They expressed the need to learn to keep healthy boundaries with the care recipient and respond to emergencies. Gaining knowledge was the main benefit that drew CICs' interest in using the self-care app. However, potential barriers to use included issues of curriculum design, technology anxiety, limited free time, and caregiving burdens. DISCUSSION: The co-design process appears to be beneficial in having participants voice both barriers and preferences.

Experiences of Motivational Interviewing in Virtual Health-care Visits for Adults With Type 2 Diabetes Mellitus: A Qualitative Analysis.

OBJECTIVES: The purpose of this qualitative study is to identify barriers minimizing the effectiveness of motivational interviewing during virtual clinic encounters for individuals with type 2 diabetes based on the capability, opportunity, motivation, and behaviour (COM-B) model. METHODS: One-on-one semistructured interviews were conducted from March to June 2023, with 17 adults with type 2 diabetes (64.7% female; median age 69 years [range 47 to 83 years]) followed at St. Michael's Hospital (Toronto, Canada). Themes from transcribed interviews were identified through descriptive analysis using a grounded theory approach. RESULTS: The following main themes were identified: 1) face-to-face appointments strengthen provider-patient rapport and collaboration; 2) virtual encounters reduce patient accountability and hinder health-seeking behaviour; and 3) individuals with physical disabilities and/or low technological proficiency experience decreased provider accessibility. Protective factors that can mitigate these negative impacts include establishing rapport during in-person appointments before transitioning to virtual appointments and incorporating a video component during virtual encounters. CONCLUSIONS: Several barriers of virtual appointments currently limit the effectiveness of motivational interviewing for individuals with type 2 diabetes and make it difficult to provide person-centred care, especially by phone. However, there are protective factors that help to maintain healthy lifestyle behaviours, even after transitioning to virtual settings, and are areas for optimization moving forward.

Canadian Health Care Providers' Perspectives on Working with Older Homeless Adults in Outreach Settings.

Service providers have a unique understanding of older homeless adults' challenges and service needs. However, research on the experiences of health care providers (HCPs) who work with this population is limited. We aimed to gain a better understanding of the experiences (roles, challenges, and rewards) of HCPs who work with older homeless adults (age 50 and over) in outreach settings. We conducted individual semi-structured interviews with 10 HCPs who worked in these roles. Four themes emerged: (a) the client-provider relationship as an essential building block to HCPs' work; (b) progression of care that acknowledges the "whole person"; (c) collaboration as integral to providers' work; and (d) the importance of system navigation. Providers found their work personally and professionally fulfilling but were frustrated by system-level challenges. Findings can be used to identify strategies on how to further support providers in their roles and enhance service provision for older homeless individuals.

Co-Designing Together through Crisis: Development of a Virtual Care Guidance Document to Support Providers, Older Adults, and Caregivers.

COVID-19 has had a disproportionate and devastating impact on older adults. As health care resources suddenly shifted to emergency response planning, many health and community support services were cancelled, postponed, or shifted to virtual care. This rapid transformation of geriatric care resulted in an immediate need for practical guidance on decision making, planning and delivery of virtual care for older adults and caregivers. This article outlines the rapid co-design process that supported the development of a guidance document intended to support health and community support services providers. Data were collected through consultation sessions, surveys, and a rapid literature review, and analyzed using appropriate qualitative and quantitative methods. Although this work took place within the context of the COVID-19 pandemic, the resulting resources and lessons learned related to collective impact, co-design, population-based planning, and digital technologies can be applied more broadly.

From the voices of supervisees: A theoretical model of reflective supervision (Part II).

Empirical study of reflective supervision/consultation (RS/C) has been gaining ground over the past decade. However, much of this literature is focused on the supervisor perspective of what RS/C is, what makes it effective, and how it impacts the work of the supervisee. This paper, Part II of a two-part series, presents a theoretical model of RS/C that was developed from the perspectives and experiences of supervisees who work with infants, young children, and families and participate in either group or individual RS/C. This qualitative study built upon themes that emerged from data obtained from 50 IECMH professionals in the United States who participated in focus groups or individual interviews aimed at investigating their experiences of RS/C. Data were analyzed using a Grounded Theory approach. A developmental and ecological theoretical model of RS/C emerged from the data that includes three domains of influence - individual, relational, and contextual - on the supervisee's capacity to understand and use their experience of RS/C in their work. These novel data contribute to our understanding of RS/C from the supervisee perspective. The theoretical model provides a framework from which to investigate outcomes, train supervisors and supervisees, and advocate for RS/C within agencies and programs.

El estudio empírico de la supervisión/consulta con reflexión (RS/C) ha estado ganando terreno en la pasada década. Sin embargo, la mayoría de estas publicaciones se enfocan en la perspectiva del supervisor acerca de lo que RS/C es, lo que la hace eficaz y qué impacto tiene en el trabajo del supervisado. Este ensayo, Parte II de una serie de dos partes, presenta un modelo teórico de RS/C que se desarrolló a partir de las perspectivas y experiencias de los supervisados que trabajan con infantes, niños pequeños y familias y participan en RS/C de grupo o individual. Este estudio cualitativo tuvo como base los temas que surgieron de datos obtenidos de cincuenta profesionales de IECMH en los Estados Unidos, quienes participaron en grupos de enfoque o entrevistas individuales dirigidas a investigar sus experiencias de RS/C. La información se analizó usando un acercamiento de Teoría Fundamentada. De la información surgió un modelo teorético de desarrollo y ecológico de RS/C que incluye tres dominios de influencia - individual, relacional y contextual - sobre la capacidad de los supervisados de comprender y usar sus experiencias de RS/C en el trabajo. Esta novedosa información contribuye a nuestro conocimiento de RS/C desde la perspectiva del supervisado. El modelo teórico provee un marco de trabajo desde el cual se investigan los resultados, se entrenan los supervisores y supervisados, y se aboga por la inclusión de RS/C dentro de agencias y programas.

Les études empiriques de la supervision / consultation réflexive (RS/C pour reprendre l'anglais) a gagné du terrain ces dix dernières années. Cependant beaucoup de ces recherches sont focalisées sur la perspective du superviseur de ce qu'est la RS/C, ce qui rend la rend efficace, et comment elle influence le travail de la personne supervisée. Cet article, la deuxième partie d'une série en deux parties, présente un modèle théorique de la RS/C qui a été développé à partir des perspectives et des expériences de personnes supervisées travaillant avec des nourrissons, de jeunes enfants et des familles et participant à soit une RS/C de groupe ou individuelle. Cette étude qualitative s'est bâtie sur des thèmes ayant émergé de données obtenues de cinquante professionnels de la santé mentale du nourrisson et de la petite enfance se trouvant aux Etats-Unis qui ont participé à des groupes de discussion ou à des entretiens individuels destinés à enquêter sur leurs expériences de la RS/C. Les données ont été analysées en utilisant une approche de Théorie Ancrée. Un modèle théorique développemental et écologique de RS/C a émergé des données, incluant trois domaines d'influence - individuel, relationnel, et contextuel - sur la capacité de la personne supervisée à comprendre et à utiliser ses expériences de la RS/C dans le travail. Ces nouvelles données contribuent à notre compréhension de la RS/C du point de vue de la personne supervisée. Le modèle théorique offre une structure à partir de laquelle on peut faire des recherches sur les résultats, former les superviseurs et les personnes supervisées, et se faire les avocats de la RS/C au sein des agences et des programmes.

From the voices of supervisees: What is reflective supervision and how does it support their work? (Part I).

Reflective supervision/consultation (RS/C) is a relationship for learning that embraces reflection and reflective practice strategies. It is considered best practice within the infant and early childhood mental health (IECMH) field. Based on research with supervisors, essential components of RS/C have been operationalized and used to develop evaluative tools. Little is known, however, about the essential components that supervisees find most useful. This paper, part I of a two-part series, describes the essential components that supervisees identify as fundamental and ways they believe their work is supported by participation in RS/C. Fifty IECMH professionals located in the United States who received RS/C participated in focus groups or individual interviews. Data were analyzed using a Grounded Theory approach. Essential components of RS/C from the supervisee perspective included supervisee feelings of safety, the development of trust, holding a non-judgmental stance, being available and present, and consistency and predictability. Additionally, supervisees identified outcomes of RS/C that included components of professional wellness, personal growth, and infant and family engagement. This study adds the supervisee's voice to the identification and operationalization of essential RS/C components and elucidates outcomes of RS/C that supervisees view as connected to their professional role.

La supervisión/consulta con reflexión (RS/C) es una relación para el aprendizaje (Fenichel, 1992) que abarca la reflexión y las estrategias de reflexión en la práctica. La misma es considerada como una de las buenas prácticas dentro del campo de la salud mental del infante y la temprana niñez (IECMH). Con base en la investigación con supervisores, los componentes esenciales de RS/C han sido puestos en operación y usados para desarrollar herramientas de evaluación. Sin embargo, poco se sabe acerca de los componentes esenciales que los supervisados ven como los más útiles. Este ensayo, primera parte de una serie de dos partes, describe los componentes esenciales que los supervisados identifican como fundamentales y las maneras como ellos creen que su trabajo es apoyado por la participación en RS/C. Cincuenta profesionales de IECMH que recibieron RS/C participaron en grupos de enfoque o entrevistas individuales. Se analizaron los datos usando un acercamiento de la Teoría Fundamentada. Entre los componentes esenciales de RS/C desde la perspectiva del supervisado se incluyen los sentimientos de seguridad del supervisado, el desarrollo de la confianza, el mantener una actitud imparcial, estar disponible y presente, y consistencia y previsibilidad. Adicionalmente, los supervisados identificaron resultados de RS/C que incluyen componentes de bienestar profesional, crecimiento personal, así como la participación del infante y la familia. Este estudio agrega la voz del supervisado a la identificación y funcionamiento de los componentes esenciales de RS/C y dilucida resultados de RS/C que los supervisados ven como conectados con su papel profesional.

La supervision / consultation réflexive (RS/C pour reprendre l'anglais) est une relation d'apprentissage (Fenichel, 1992) qui embrasse la réflexion et des stratégies de pratique réflective. Elle est considérée comme étant la meilleure pratique au sein du domaine de la santé mentale du nourrisson et de la petite enfance. A partir des recherches avec des superviseurs les composants essentiels de la RS/C ont été opérationnalisés et utilisés pour développer des outils évaluatifs. On sait peu de choses, cependant, sur les composants essentiels que les personnes supervisées estiment être les plus utiles. Cet article, la première partie d'une série de deux parties, décrit les composants essentiels que les personnes supervisées identifient comme étant fondamentaux et les manières dont ils estiment que leur travail est soutenu par la participation à la RS/C. Cinquante professionnels de la santé mentale du nourrisson et de la petite enfance se trouvant aux Etats-Unis et ayant reçu la RS/C ont participé à des groupes de discussion ou à des entretiens individuels. Les données ont été analysées en utilisant une approche de Théorie Ancrée. Les composants essentiels à la RS/C du point de vue des personnes supervisées ont inclus le sentiment de sûreté de la personne supervisée, le développement de la confiance, le fait de ne pas juger, le fait d'être disponible et présent, ainsi que la cohérence et la prévisibilité. De plus les personnes supervisées ont identifié des résultats de la RS/C qui ont inclus des composants de bien-être professionnel, d'épanouissement personnel et d'engagement avec le nourrisson et la famille. Cette étude ajoute la voix de la personne supervisée à l'identification et à l'opérationnalisation des composants essentiels de la RS/C et élucide les résultats de la RS/C que les personnes supervisées considèrent comme étant lié à leur rôle professionnel.

A SHARP Response: Developing COVID-19 Research Aims in Partnership with the Seniors Helping as Research Partners (SHARP) Group.

COVID-19 has disproportionally impacted older adults, and has highlighted many issues, including extreme deficiencies in Canadian long-term care homes and gaps in home and community care services for older adults. In recent years, there has been a push towards better patient and family engagement in health system research, and with the onset of the pandemic, engaging older adults in research and policy planning is more important than ever. In this article, we describe the Seniors Helping as Research Partners (SHARP) approach to engagement with older adults as an example of how partnerships that engage older adults in the development of research aims and processes can help to ensure that future research meets the needs of older adults. SHARP members highlighted a number of areas for future COVID-19 research such as improvements to long-term care, enhancing access to home and community care, and a focus on aging and social isolation.

"I Had Nobody to Represent Me": How Perceptions of Diabetes Health-Care Providers' Age, Gender and Ethnicity Impact Shared Decision-Making in Adults With Type 1 and Type 2 Diabetes.

OBJECTIVES: Our aim in this study was to investigate how patients' perceptions of their diabetes health-care providers' (HCP) age, gender and ethnicity impact shared decision-making using the Theory of Planned Behaviour. METHODS: Adult participants receiving diabetes care at community sites, primary care or specialty clinics participated in semistructured, one-on-one interviews conducted from November 2018 to January 2019. Responses were transcribed and qualitatively analyzed for emergent themes using statistical software (NVivo version 9). RESULTS: We conducted 28 interviews with participants 34 to 81 years of age. The following themes were identified: 1) participants' gestalt of their diabetes HCP was strongly gender dependent 2) there was a hidden preference for Caucasian HCPs, 3) age evoked a less defensive response with regard to shared decision-making and 4) degree of trust in self and in their diabetes HCP directed participants' readiness to be part of the shared decision-making. CONCLUSIONS: Participants' narrative experiences strongly suggest that they view their diabetes HCPs through a gendered and racialized lens.