Treating chronic health conditions consumes a significant portion of the health care resource. Two–thirds of UK hospital admissions consist of people with chronic conditions (Singh, 2005). To date, health management has tended to focus on service redesign, rather than focusing on the patients, as a way to facilitate improved outcomes and control costs. Typically, these management approaches are premised on the patient as a consumer/end user. An alternative view to the patient being a consumer is that of the patient being a co–producer of the service. Co–production recognises the client (patient) as a resource, in that value cannot easily be created or delivered, unless the patient actively contributes to the service (Alford, 1998). Patients gain health value when they are well and are independent of the health care system and its costs. Health care organisations gain economic value, when chronic patients require less health care. This thesis examines co–production, in the context of contemporary patient involvement and heath services management. ‘Knowing the People Planning’ (KPP), an innovative health management method, is evaluated for its patient management co–production potential. KPP is based on ten key features of service provision. Four of the key features relate to the patient, whilst the remaining six features relate to the organisation. It is the management of these patient and organisation features that better facilitates chronic long-term mental health patients as co–producers. The empirical findings, from this evaluation of KPP provide evidence for the efficacy of co–productive health management theory and practice. Patient health value and health care organisation economic value are created, when both the organisation and the patient co–produce the health service. KPP was initially implemented by eight of New Zealand’s 21 District Health Boards. Socio-ecological action research methodology was used to evaluate KPP — by taking a ‘people-in-environments’ approach. The evaluation covers fourteen action research cycles for 2,021 chronic long-term patients over four years. Measurements include the amount of time these long-term patients spent in hospital and employment rates. The integration of the action research cycles, using the socio-ecological method supported the generation of (what I have called) ‘co–productive health management theory’. Analyses of secondary data, across organisational and patient domains, supplement the action research findings, in order to assess for confounding factors. The organisation outcomes relate to costs and staff turnover. Patient outcomes relate to service utilisation measures, for approximately 60,000 adult patients per year, who access New Zealand’s secondary mental health services. A pivotal finding of this research was that, as the rate of patients with treatment plans increased from 50% to 90%, inpatient bed use decreased by 26%. However, increased funding for mental health services had only a minor impact on decreasing inpatient bed use. Patient employment rates increased, whilst the number of patients who required access to general practitioners and changes to their housing situation, decreased. The patient management co–production view offers a significant opportunity for health care managers and researchers to significantly improve both patient and organisation value. Co–production views the patient as a resource, who contributes to her/his health outcome, rather than a person who simply consumes services. The better patients can co–produce their health outcome the better their health, and the lower their demand for health services.

Background: Play is the child’s natural world. According to psychoanalytical studies, play has an important role in children’s development, and the absence of play during a child’s life could lead to severe pathological implications. Based on this theory and being aware that physiotherapy treatment programs could be long lasting, tiresome and lacking motivation for children, this literature review presents a perspective regarding the integration of play within physiotherapy programs and examines the physical and emotional outcomes during this integration. Aim: To investigate the outcomes of integrating play in physiotherapy for children with chronic health conditions. Method: The research strategy for this review was a thorough search of peer-reviewed articles in the databases CINAHL and AMED which include articles from the fields of allied and complementary medicine, as well as the database Scope Med. Participants were children with chronic health conditions, ranging from 2-18 years old. In the term ‘play’ virtual reality and video game activities were included due to the lack of research. In addition, articles from a previous literature review conducted by the author were also included in the present paper. Results: The focus of researchers on children with CP and the lack of evidence for children with other health conditions, the persistence of physiotherapists to assess mainly physical outcomes and not emotional needs of children, and the measurement tools used for this purpose are presented. Conclusions: For children with chronic health conditions who attend physiotherapy sessions, play could serve as a mediate and an appropriate developmental approach in order to achieve physical and emotional changes. There is a need for physiotherapists to balance physical and emotional needs, and have a more ‘human’ relationship, rather than a ‘bodily’ - strict professional relationship with children. Although the information presented in this review is not considered as sufficient to draw conclusions, it could serve as a first step for researchers to study this integration in greater depth, and to focus on children with conditions other than CP.

The main purpose of this study was to explore the influence of social support and self-efficacy on the physical activity beliefs and behaviours of participants in a peer-mentoring intervention embedded in a community-based exercise program. A second purpose was to explore social support, self-efficacy, and perceived barriers and facilitators to exercise program adherence for study participants within the community-based exercise program setting. Participants (N=10, plus 6 mentors) were adults with chronic health conditions living in a low-income neighbourhood. Intervention (n=4) and comparison (n=6) groups completed self-report measures of physical activity, social support, and barrier self-efficacy at baseline, 6-weeks, and 12-weeks. Interviews were used post-intervention to explore the impact of peer mentoring, perceived social support and self-efficacy within the exercise setting, and barriers and facilitators to physical activity for study participants. Intervention participants showed greater exercise program adherence than comparison participants at 6-weeks. Qualitative findings suggest the peer mentoring intervention increased motivation and sense of obligation to adhere to the exercise program, and provided vicarious learning opportunities that may have indirectly influenced exercise program adherence for intervention and mentor participants. Findings also suggest that the exercise program was highly influential to participants’ social support and self-efficacy beliefs. Multiple barriers and facilitators to physical activity were reported. Overall, the current study supports the use of peer mentoring as an intervention strategy in combination with additional strategies to promote exercise program adherence in the study population. Practical implications are discussed in relation to the promotion of exercise program adherence in older adults with chronic health conditions participating in a community-based exercise program in a low-income neighbourhood. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2011-09-29 10:44:19.343

Background: The selection of a developmental time metric is useful in understanding causal processes that underlie cognitive change, and for the identification of potential moderators of cognitive decline. We examined various conceptualizations of developmental time (e.g., chronological age, measurement occasion, time-in-study, and time-to-attrition), and moderators of cognitive decline that are associated with CNS functioning (e.g., intraindividual variability and chronic health conditions). Methods: Participants were 304 community-dwelling Caucasian older adults (208 women and 96 men), aged 64 to 92 (M = 74.02, SD = 5.95) in a longitudinal study. HLM models were fit to examine patterns and moderators of cognitive change. Results: Time-to-attrition was associated with significant cognitive decline. Greater intraindividual variability, a behavioural indicator of CNS deficits, was associated with impaired performance on executive functioning and episodic memory measures. Conclusions: Our findings underscore the importance of selecting an appropriate time metric in order to address the possible causal mechanisms underlying the association between cognitive loss and selective attrition (i.e., CNS integrity).

No description available.

The purpose and aims of this qualitative descriptive study were to describe how past experiences with research (including communication, information, values and support) may contribute to research fatigue among youth and parents of youth with HIV, CF, and T1D. Eighteen parents and youth were purposively recruited from outpatient subspecialty clinics at a major academic medical center. They took part in qualitative interviews, completed a demographics form, and the Decisional Conflict Scale. Youth participants also completed the Erikson Psychosocial Stage Inventory. Two major themes emerged: blurred lines and hope for the future. Research fatigue was not found in this sample. Results point to challenges with informed consent in settings where research and clinical care are integrated, and suggest that protective factors allow for continued participation without excess burden on youth and parents. Strategies to minimize research fatigue and support engagement in research are offered.