Health systems strengthening through person-centred care: development of a feasible and acceptable theory-based workforce approach to improve quality.
Lead Research Organisation:
King's College London
Department Name: Palliative Care and Rehabilitation
Abstract
What is the problem we want to address?
Serious illness has major effects on both the patient and family. In low and middle income countries these can be physical (such as pain and their symptoms) psychological, social (with additional stressors on income, children's school fees, stigma) and spiritual. This can affect both the wellbeing of the patient and family and their ability to access and stay in care. Health systems must address more than just the disease- they must become more "person centred". Person-centred care means that the health system is organised to meet the needs of the individual in ways that respond to their preferences, values and beliefs, offering dignity and respect. Being person-centred is seen to be a way to ensure that care services are high quality. By improving the health system through the workforce (the health care staff) the information it holds (on the individual's needs and preferences) and the way things are delivered, we can make care more person-centred.
What will we do?
In this study, we want to do some of the important initial work to inform a larger study to improve person-centredness. We will use our partnership across the UK, Zimbabwe and Uganda to find out what best person-centred care looks like from the view of patients and families facing serious illness, and very importantly from those who would be responsible for delivering (health care professionals). We will use this new information to work with health care teams to develop a strategy that is acceptable to patients and staff that can be put into practice in these countries as examples of health systems strengthening. We will also look at the best way to measure person centredness, so that when we conduct a larger study we have an accurate way to knowing if we have achieved our goals.
What will be the outputs?
The World Health Organisation has a strategy to improve person-centredness of care for all- this study will provide a practical way to deliver this from an African perspective. We will also deliver an adapted way to measure the experience of care from the patient & family perspective. Our proposed strategy will be led by the views of patients, families and health professionals- making it more likely to achieve success. We are working with health organisations in the community and with Governments to make sure that we can achieve better care through stronger health systems.
Serious illness has major effects on both the patient and family. In low and middle income countries these can be physical (such as pain and their symptoms) psychological, social (with additional stressors on income, children's school fees, stigma) and spiritual. This can affect both the wellbeing of the patient and family and their ability to access and stay in care. Health systems must address more than just the disease- they must become more "person centred". Person-centred care means that the health system is organised to meet the needs of the individual in ways that respond to their preferences, values and beliefs, offering dignity and respect. Being person-centred is seen to be a way to ensure that care services are high quality. By improving the health system through the workforce (the health care staff) the information it holds (on the individual's needs and preferences) and the way things are delivered, we can make care more person-centred.
What will we do?
In this study, we want to do some of the important initial work to inform a larger study to improve person-centredness. We will use our partnership across the UK, Zimbabwe and Uganda to find out what best person-centred care looks like from the view of patients and families facing serious illness, and very importantly from those who would be responsible for delivering (health care professionals). We will use this new information to work with health care teams to develop a strategy that is acceptable to patients and staff that can be put into practice in these countries as examples of health systems strengthening. We will also look at the best way to measure person centredness, so that when we conduct a larger study we have an accurate way to knowing if we have achieved our goals.
What will be the outputs?
The World Health Organisation has a strategy to improve person-centredness of care for all- this study will provide a practical way to deliver this from an African perspective. We will also deliver an adapted way to measure the experience of care from the patient & family perspective. Our proposed strategy will be led by the views of patients, families and health professionals- making it more likely to achieve success. We are working with health organisations in the community and with Governments to make sure that we can achieve better care through stronger health systems.
Technical Summary
Background
The Institute of Medicine describes high quality care as "safe, effective, patient-centred, efficient, timely and equitable." Person-centred care (PCC) is relevant to low and middle income country (LMIC) health systems to detect and manage socio-economic barriers to health system access and retention. Re-engineering LMIC health systems to become person-centred can improve outcomes and reduce clinic time. Within the WHO 6 Health System Buildings Blocks, Block #3 (Health Workforce) Block #5 (Information) and Block #6 (Service Delivery) could promote PCC for a stronger health system and improved quality.
Methods
Sequential mixed methods design. This 24-month study will develop a mechanism to achieve improved outcomes across 3 relevant WHO Health System Building blocks, and a valid measure of PCC. These key practical outputs will enable us to design and deliver a subsequent large scale implementation and evaluation study.
We focus on conditions with high prevalence in LMIC, clinical uncertainty and prior evidence of high multidimensional needs: cancer, heart failure, and COPD.
-Objectives i & ii- qualitative in-depth interviews with patients (n=50), family caregivers (n=30) and professionals (n=30). Semi-structured topic guide data will be analysed using framework analysis, both deductive (i.e. appraise existing PCC theories) and inductive (generate new theory).
-Objective iii - design of a systems-oriented strategy. Drawing on the data from Objs i+ii, our prior work, and partner expertise we model the mechanism, intended process and outcomes. The strategy will take a multi-disciplinary approach with nurses at the centre of systems strengthening.
-Objective iv - development and validation of PCC measure.
Cognitive interviews with n=15 patients n=15 family caregivers, framework analysis and refinement of tool then validation in cross-sectional survey with n=80 patients in each of the three diagnostic groups.
The Institute of Medicine describes high quality care as "safe, effective, patient-centred, efficient, timely and equitable." Person-centred care (PCC) is relevant to low and middle income country (LMIC) health systems to detect and manage socio-economic barriers to health system access and retention. Re-engineering LMIC health systems to become person-centred can improve outcomes and reduce clinic time. Within the WHO 6 Health System Buildings Blocks, Block #3 (Health Workforce) Block #5 (Information) and Block #6 (Service Delivery) could promote PCC for a stronger health system and improved quality.
Methods
Sequential mixed methods design. This 24-month study will develop a mechanism to achieve improved outcomes across 3 relevant WHO Health System Building blocks, and a valid measure of PCC. These key practical outputs will enable us to design and deliver a subsequent large scale implementation and evaluation study.
We focus on conditions with high prevalence in LMIC, clinical uncertainty and prior evidence of high multidimensional needs: cancer, heart failure, and COPD.
-Objectives i & ii- qualitative in-depth interviews with patients (n=50), family caregivers (n=30) and professionals (n=30). Semi-structured topic guide data will be analysed using framework analysis, both deductive (i.e. appraise existing PCC theories) and inductive (generate new theory).
-Objective iii - design of a systems-oriented strategy. Drawing on the data from Objs i+ii, our prior work, and partner expertise we model the mechanism, intended process and outcomes. The strategy will take a multi-disciplinary approach with nurses at the centre of systems strengthening.
-Objective iv - development and validation of PCC measure.
Cognitive interviews with n=15 patients n=15 family caregivers, framework analysis and refinement of tool then validation in cross-sectional survey with n=80 patients in each of the three diagnostic groups.
Planned Impact
-Who might benefit from this research?
1. People living with serious illness
2. Their family members
3. Researchers
4. Policy makers
5. Clinicians
6. Funders
-How might they benefit from this research?
1. People with serious illness will benefit from the novel Africa-specific guidance on how to ensure care processes reflect the concerns and priorities of the individual. This has the potential to transform health care delivery by ensuring the health systems that serve the patient are centred around the individual.
2. Family member will benefit by ensuring that care is family-centred and that the family are seen as part of the unit of care.
3. Researchers will benefit through access to a valid measure of person-centredness for use in health systems. Health services and clinical research. They will also have access to feasible and acceptable guidance on how to strengthen health systems through person-centredness, and a theory readily adaptable to other low and middle income countries.
4. Policy makers will have access to the first African guidance on the meaning and potential practice of person centredness to achieve global policy goals.
5. Clinicians will have clear and practical guidance on the meaning and practice of person-centred care of patients and families facing serious illness.
6. Funders will benefit from this development grant as the aims and objectives will ensure a theoretically plausible, feasible, acceptable and measurable strategy is developed prior to the implementation phase.
1. People living with serious illness
2. Their family members
3. Researchers
4. Policy makers
5. Clinicians
6. Funders
-How might they benefit from this research?
1. People with serious illness will benefit from the novel Africa-specific guidance on how to ensure care processes reflect the concerns and priorities of the individual. This has the potential to transform health care delivery by ensuring the health systems that serve the patient are centred around the individual.
2. Family member will benefit by ensuring that care is family-centred and that the family are seen as part of the unit of care.
3. Researchers will benefit through access to a valid measure of person-centredness for use in health systems. Health services and clinical research. They will also have access to feasible and acceptable guidance on how to strengthen health systems through person-centredness, and a theory readily adaptable to other low and middle income countries.
4. Policy makers will have access to the first African guidance on the meaning and potential practice of person centredness to achieve global policy goals.
5. Clinicians will have clear and practical guidance on the meaning and practice of person-centred care of patients and families facing serious illness.
6. Funders will benefit from this development grant as the aims and objectives will ensure a theoretically plausible, feasible, acceptable and measurable strategy is developed prior to the implementation phase.
Organisations
- King's College London (Lead Research Organisation)
- University of Zimbabwe (Collaboration)
- Uganda Cancer Institute (Collaboration)
- Parirenyatwa Hospital (Collaboration)
- African Palliative Care Association (Collaboration)
- Mulago National Referral Hospital (Collaboration)
- Chitungwiza Municipality (Collaboration)
- Island Hospice and Healthcare (Project Partner)
| Title | Patient experience measure |
| Description | We have planned an expert meeting in Zimbabwe on 22nd March 2023 to refine and adapt the patient experience measure. Through review of literature we identified and selected 'The Picker Patient Experience Questionnaire' (PEQ). An expert meeting with be managed using both virtual (Uganda participants), and face-to-face (for Zimbabwe participants). We will refine the tool by mapping the conceptual framework from our primary data to existing tool constructs. We will refine existing and add new items using Rothrock methodological guidance on item generation, and subject this adapted patient reported experience measures to cognitive interviewing to test interpretability and completeness. We will recruit n=15 patients with serious illness (n=15 in each country). |
| Type Of Material | Physiological assessment or outcome measure |
| Year Produced | 2023 |
| Provided To Others? | No |
| Impact | Robust method to generate and revise items for measuring patient experience measure which are limited in Africa for patients with serious illness. |
| Title | Person-centred care: framework conceptual adaptation and design |
| Description | We conducted qualitative in-depth interviews with patients (n=50), family caregivers (n=30) and professionals (n=30) across Uganda and Zimbabwe. These comprised of n=5 COPD patients, n=11 cancer patients and n=10 heart failure patients in Uganda and n=5 COPD, n=10 cancer and n=10 heart failure patients in Zimbabwe. -Data collection and tools: Digitally recorded semi-structured interviews captured: barriers and facilitators to health care, expectations of care and the health system, patient/family/staff interaction, communication and information sharing, decision making, personal values regarding aspects of identity, care engagement, examples of good and bad care, preferred roles in consultations and self-management, and preferred practices for person centred care. -Data analysis: Interviews were translated where necessary and transcribed verbatim. We imported transcripts into NVIVO software and analysed using framework analysis, both deductive appraised using the existing person-centred care theory developed by Santana et al's (2018) and inductive (generate new theory from the dataset). Santana, MJ, Manalili, K, Jolley, RJ, Zelinsky, S, Lu, M. How to practice person-centred care: A conceptual framework. Health Expect. 2018; 21: 429- 440. https://doi.org/10.1111/hex.12640. |
| Type Of Material | Data analysis technique |
| Year Produced | 2022 |
| Provided To Others? | No |
| Impact | We adapted a conceptual framework for providing person-centred care for patients with serious illness (COPD, cancer and heart failure) for Uganda and Zimbabwe. The framework will be transported into other countries in Africa and other serious illnesses. |
| Description | African Palliative Care Association |
| Organisation | African Palliative Care Association |
| Country | Uganda |
| Sector | Charity/Non Profit |
| PI Contribution | As King's College London we are providing study sponsorship, provided training to all research members, processed affiliate accounts/honorary contracts such that all members of the research team have a King's email address and have access to softwares such as NVIVO. We have also trained research team on how to analyse qualitative data using NVIVO software. Members of the research team have also accessed short courses offered at King's College London for instance Good Clinical Practice. |
| Collaborator Contribution | The African Palliative Care Association is providing local leadership and coordination through the Executive Director (ED) and Research Manager who are both co-applicants in this project. The ED is a member of the steering group and provides leadership to the research manager. The research manager is ensuring that all research activities are delivered on time such as ethics application, recruitment and training of research assistants and leading data management and analysis. The research manager coordinates all research activities in Uganda and Zimbabwe. |
| Impact | Local researchers have received training on Good Clinical Practice and General Data Protection and Regulation (GDPR 2018) Research team members attend research seminar series which King's College London (KCL) hosts every 2 months virtually. Knowledge and skills on qualitative data analysis using NVivo software. Research manager has successfully provided leadership to implement research activities. N=50 patients (COPD, cancer and heart failure) have been recruited, including n=30 health professionals and n=30 family caregivers across Uganda and Zimbabwe. Research manager trained local researchers in Uganda and Zimbabwe on analysis of qualitative data, coding transcripts using NVivo. All the transcripts have been coded across Uganda and Zimbabwe. |
| Start Year | 2020 |
| Description | Chitungwiza hospital |
| Organisation | Chitungwiza Municipality |
| Country | Zimbabwe |
| Sector | Public |
| PI Contribution | We have provided honorary contracts to researchers at King's. They have access to short courses, IT, Library resources. |
| Collaborator Contribution | Provided a room for patient, caregivers and health professionals qualitative interviews Ethics approval and site access to the participants. |
| Impact | COPD, heart failure and cancer patients have been recruited. Caregivers of patients with COPD, heart failure and cancer were also recruited including healthcare professionals working with these patients. |
| Start Year | 2020 |
| Description | Mulago National Referral and Teaching Hospital Kiruddu. |
| Organisation | Mulago National Referral Hospital |
| Country | Uganda |
| Sector | Hospitals |
| PI Contribution | We are working with Mulago referral hospital and a site co-investigator/lead at this facility. We have provided an honorary contract to the site lead and he attends research seminar series hosted at King's College London virtually, short courses such as Good Clinical Practice and General Data Protection and Regulation (GDPR 2018). |
| Collaborator Contribution | Provides leadership and support to research team who are collecting data at the facility including ensuring that research activities are implemented following appropriate ethical standards for example consenting, recruitment, data collection and management. |
| Impact | Researchers and the site lead attended training on Good Clinical Practice and General Data Protection and Regulation (2018). They have received a certificate for each training attended. We have recruited n=6 COPD patients, n=5 family caregivers and health professionals at this facility. |
| Start Year | 2020 |
| Description | Parirenyatwa hospital |
| Organisation | Parirenyatwa Hospital |
| Country | Zimbabwe |
| Sector | Hospitals |
| PI Contribution | We trained research assistants who are collecting data at Parirenyatwa hospital. We have also provided King's College London honorary contracts with access to King's IT facilities, training courses and software. |
| Collaborator Contribution | They have provide a room which research assistants use to engage patients. They have provided ethics approval and access to the clinic to recruit patients. |
| Impact | COPD, heart failure and cancer patients were recruited Health professionals recruited Family caregivers recruited |
| Start Year | 2020 |
| Description | Uganda Cancer Institute |
| Organisation | Uganda Cancer Institute |
| Country | Uganda |
| Sector | Hospitals |
| PI Contribution | We are working with the Uganda Cancer Institute and a site co-investigator/lead at this facility. We have provided honorary contract to site co-investigator and has access to King's College London softwares, short courses/training for example Good Clinical Practice, General Data Protection and Regulation (2018) and attends research seminar series hosted virtually by King's College London. |
| Collaborator Contribution | The site co-investigator is a point of contact for our local research team. He provides leadership and support to researchers and ensures that all research activities (consenting, recruitment, data collection, and management) are implemented following appropriate ethical procedures. Cancer patients, their family caregivers and health professionals have been recruited at this facility. |
| Impact | We have recruited n=8 cancer patients and n=5 caregivers/family members and n=5 health professionals at this facility. The site lead and researchers have honorary contract with King's College London, have attended short courses/training on Good Clinical Practice and General Data Protection and Regulation (2018). |
| Start Year | 2020 |
| Description | University of Zimbabwe and Island hospice and healthcare |
| Organisation | University of Zimbabwe |
| Country | Zimbabwe |
| Sector | Academic/University |
| PI Contribution | Our team engaged University of Zimbabwe Clinical Trials Research Centre (UZ-CTRC) and Island Hospice and Healthcare (IHH) to work with us on this project in Zimbabwe. King's College London has provided affiliate accounts to all members of the research team in Zimbabwe. They are accessing short courses and training offered by King's College London such as Good Clinical Practice, General Data Protection and Regulation (GDPR 2018). Our research team also provided training to UZ-CTRC and IHH research staff on qualitative research methods. We have also provided access to softwares such as NVivo, SPSS and Stata for qualitative and quantitative data analysis and Endnote for managing references. King's will also provide data for MSc students to use for secondary data analysis. We have provided training in qualitative data analysis and the team has coded transcripts. Towards the end 2021, we introduced research seminar series where we invite academics to present on a research topic to members of the research. We developed a time sheet for these seminars which take place every two months (last Thursday for that month). So far we have had three seminars: 1) Health outcomes measurements which was presented by Dr Jane Bates who is a country lead in Malawi, 2) Theory of Change which was presented by two external academics: Professor Crick Lund from King's College London and Dr Lindsay Farrant from University of Cape Town, 3) Intervention Development which was presented by Professor Richard Harding. Other topics to be presented are 4) Qualitative data analysis 5) Process evaluation and 6) Clinical trials in palliative care. So far feedback from all the participants has been positive. Researchers are also completing training logs after training highlighting what they have learned from the seminar and how they will use the knowledge in their work. |
| Collaborator Contribution | Our partners have provided us with links to study sites such as Chitungwiza and Parirenyatwa hospitals including Island Hospice and Healthcare which provides services to patients with serious illness. Our partners prepared protocol for local ethics approval from the Zimbabwe Medical Research Council and administrative clearance from study sites. Furthermore, they have engaged clinical specialists working with patients with serious illness such as chest physicians, lung specialists, oncologists to help with identification and recruitment of study participants. The local team collected data: qualitative interviews with patients and family caregivers and health professionals. The team is transcribed and translated (where applicable) interviews. The team has managed data using NVivo software, and coded the transcripts. |
| Impact | 1.Training on Good Clinical Practice and General Data Protection and Regulation (GDPR 2018) 2. Training on qualitative research methods, data collection and management. 3. Knowledge and skills in transcribing qualitative interviews 4. Knowledge and skills in analysing qualitative data such as coding using Nvivo software. 5. Sharing of information and ideas through research seminar series. 6. The following stakeholder participants have been recruited in Zimbabawe: Patients (n=5 COPD, n=10 cancer and n=10 heart failure), family caregivers n=15 (n=5 for each disease condition) and n=15 health professionals (n=5 each working with COPD, cancer and heart failure) patients. |
| Start Year | 2020 |
| Description | Intervention Development |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was our third research seminar presentation and was delivered by Professor Richard Harding. The presented was on Intervention development. Richard outlined the process on developing complex interventions in palliative care using the MRC framework and shared experiences on how he has used this framework to develop a complex palliative care intervention (Treatment Outcomes in palliative care for patients with HIV in Kenya) including active ingredients and mechanism of action. Richard also outlined the revised version of the MRC framework. This meeting attracted audience from King's College London n=2, Ghana n=4, Malawi n=4 , Uganda N=6 and Zimbabwe n=10. Participants stated that they found the talk very informative, for instance some of them stated that even though they know or have heard about MRC framework and complex interventions, they do not have experience on how to use it. This was an important lesson to participants since part of this project involves developing an intervention for the elderly people with multi-morbidity. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Patient and Public Engagement |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | We held two focus group discussions with cancer patients (PPI and engagement). The aim of the focus groups were to discuss how cancer patients want to be engaged in research, why they should be engaged and what challenges and barriers they experience and how we can manage these. There were n= 8 men and 8 women cancer patients who attended the focus groups. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Patient group workshop |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | A workshop was held with research and ethics regulators following an engagement with cancer patients regarding how patient-centred research can be conducted. This workshop discussed findings from the focus groups and how ethics regulators can ensure that patient participants wishes and views are taken into consideration when reviewing protocols for ethics approval for example patient to be represented on ethics committees, The ethics committee agreed to have a patient representative on the committee (Uganda national council and Uganda national council for science and technology) Formation of groups: patients will be trained on how to engage commissioners, policy makers, health workers to empower them to use their voice effectively in research. We had n=11 stakeholders who attended the workshop: n=4 research and ethics regulators, n=3 patients, n=3 civil society, n=1 media/journalist. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Patient group workshop |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Workshop with policy makers, commissioners and patients was held where research data findings from focus groups with cancer patients were presented. The purpose was to disseminate findings from the patients engagement workshop and to develop and action plan for engaging patients meaningly in the research which informs their care. A total of n=15 attended the event: n=4 were patients, n=4 were commissioners, n=3 were members of civil society, n=2 health professionals, n=1 media/journalist and n=1 community representative. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Research Seminar series: Health Outcome Measurements |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | The project lead in Malawi, Dr Jane Bates presented on 'Health Outcome Measurements'. This is part of the research seminar series which we introduced in 2021. This was the first event and was held on Thursday 28th October 2021. King's college London hosted the event virtually using Zoom platform. We had participants from Zimbabwe/Island hospices and healthcare n=12, Uganda/African Palliative Care Association n=6, Ghana/College of Physicians and Kwame Nkrumah University of Science and Technology n=8, Malawi/College of Medicine n=3 and King's College London n=2. The objectives of this session were: Define health outcomes according to WHO Why use outcomes in research Examples of patient reported outcomes and patient reported experience measures in palliative care Challenges of using outcome measures in palliative care This session was thought provoking and the audience shared experiences using outcome measures in research and clinical practice. Most participants reported using the African Palliative Care Outcome Scales (APOS) and the Quality of Life (EQ5D) measure. There was a debate on choice of using the APOS (validated in Africa), scored on a Likert scale 0-5 or the Integrated palliative care outcome measure (validated in the UK), scored on a Likert scale 0-4. Jane Bates shared her experiences using the UK version because the African version was not easy to administer in Malawi, participants could only chose either 0 or 5 option (they could not chose any score between 0 and 5). This was interesting because the audience from Africa thought it would have been appropriate to use the African version. There was also a discussion about the African Integrated measure which is currently undergoing validation using datasets from Sudan and Zimbabwe. The team will use the lessons learnt to develop a measure for calculating costs of palliative care services, which is the next phase of this project. |
| Year(s) Of Engagement Activity | 2021 |
| Description | The role of research and innovations in improving 'Patient-Centred Care |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | An expert panel discussion aimed to disseminate best practices for patient and public involvement and engagement in people with serious health related suffering. This was a hybrid event hosted by African Palliative Care Association (APCA) in Kampala, Uganda on 11th March 2023. The group agreed that APCA should train university students on person-centred care and public involvement in research. This will be done through the 'Patient Centred Care Movement'. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Theory of Change |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Professor Click Lund and Dr Lindsay Farrant (who are our collaborators in another project on health systems strengthening in sub-Saharan Africa) presented on Theory of Change (ToC). The main aim of this session was to share knowledge and experiences on how to design a ToC workshop. Click covered what ToC is, it's elements and the process of preparing and delivering a ToC workshop. Lindsay presented on practical example of ToC which she delivered for her project in South Africa (facilitation, venue, delegates, process map and ToC map). The meeting was held virtually using Zoom platform on 25th November 2021. This was the second research seminar for this project. We had n=3 from King's College London, n=6 from Uganda, n=3 from Malawi, n=3 from Ghana and n=12 from Zimbabwe. It was a thought proving meeting, the experiences shared by Crick and Lindsay have informed the planning to our ToC workshops to be delivered in Malawi, Ghana and Zimbabwe (which are some expected outputs from this project). We are planning the first ToC workshop in Malawi from 28-30th March 2022. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Theory of Change workshops |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | We held a theory of change work with Stakeholders to develop a logic model for the person-centred care framework for patients living with serious illness. The workshop was held on 27th August 2022 at Metsu hotel in Uganda. 25 people attended which included patients, family caregivers, NGO representatives, Ministry of health, and academia. We developed a logic model which outlines what patients and families with COPD, heart failure and cancer need, the challenges they experience and pathway to impact. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Theory of change workshop |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | A "Theory of Change" workshop was held in Harare/Zimbabwe following the MRC guidance on Process Evaluation of Complex Intervention, and 'Theory of Change', drawing on Patient and Public Involvement (patients and families), clinical and advocacy organisations, palliative care specialities Ministry. These components formed contextual barriers and facilitators (environment, skills policy), intended population, components, intended and outcomes and pathways to impact. In total 27 people attended the meeting. |
| Year(s) Of Engagement Activity | 2022 |