Barriers and Facilitators to Implementation of Virtual Reality as a Pain Management Modality in Academic, Community, and Safety-Net Settings: A Qualitative Analysis (Preprint)

2020 ◽  
Author(s):  
Urmimala Sarkar ◽  
Jane Lee ◽  
Kim Hanh Nguyen ◽  
Sarah Lisker ◽  
Courtney R Lyles
Keyword(s):  
Virtual Reality ◽  
Pain Management ◽  
Los Angeles ◽  
Qualitative Analysis ◽  
Safety Net ◽  
Academic Community ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Patient Feedback ◽  
Management Approaches

BACKGROUND Prior studies among primarily White, relatively advantaged populations show that virtual reality (VR) is an efficacious treatment modality for opioid-sparing pain management. OBJECTIVE We conducted a qualitative, theory-informed implementation science study to assess readiness for VR in safety-net settings. METHODS Using the theoretical lens of the Consolidated Framework for Implementation Research (CFIR) framework, we conducted semi-structured interviews with current VR users and non-users based in safety-net health systems (n=15). We investigated barriers and facilitators to a commercially available, previously validated VR technology platform, AppliedVR (Los Angeles, CA). We employed deductive qualitative analysis using the overarching domains of the CFIR framework and performed open, inductive coding to identify specific themes within each domain. RESULTS Interviewees deemed the VR intervention to be useful, scalable, and an appealing alternative to existing pain management approaches. Both users and non-users identified lack of reimbursement for VR as a significant challenge for adoption. Current users cited positive patient feedback, but safety-net stakeholders voiced concern that existing VR content may not be relevant or appealing to diverse patients. All respondents acknowledged the challenge of integrating and maintaining VR in current pain management workflows across a range of clinical settings, and this adoption challenge was particularly acute given resource and staffing constraints in safety-net settings. CONCLUSIONS VR for pain management holds interest for front-line pain management clinicians and leadership in safety-net health settings, but will require significant tailoring and adaption to address the needs of diverse populations. Integration into complex workflows for pain management is a significant barrier to adoption, and participants cited structural cost and reimbursement concerns as impediments to initial implementation and to scaling VR use.

scholarly journals Exploring the Patient-Provider Relationship in Older Adult Pain Management

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 945-946
Author(s):  
Sophia Sheikh ◽  
Natalie Spindle ◽  
Jennifer Brailsford ◽  
Jason Beneciuk ◽  
Monika Patel ◽  
...  
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
Older Adult ◽  
Pain Treatment ◽  
Healthcare Providers ◽  
Educational Interventions ◽  
Structured Interviews ◽  
Patient Centered ◽  
Study Objective ◽  
Management Approaches

Abstract Successful health outcomes in older patients are linked to the quality of the patient-provider relationship. Our study objective was to further understand the role of this relationship specific to pain management through perspectives from older adults and healthcare providers. Semi-structured interviews and focus groups were conducted with 9 older adults and 11 multidisciplinary healthcare providers. Transcripts were analyzed using a thematic analysis. Three main concepts emerged: (1) defining pain management goals — differences in providers and patients’ goals for pain and function, with sub-themes of realistic goal setting and a shift in pain treatment to minimize opioids as a first-line medication; (2) communication — perceived gap in providers communicating and coordinating across disciplines and with patients, with sub-themes of improving positive communication and inconsistent messaging among providers; and (3) therapeutic alliance — all parties feel that developing a relationship is built on consistent trust and open dialogue. Although providers and older adults often expressed similar perspectives, there were several areas of misalignment identified within each concept, representing areas of disconnect within the patient-provider pain management relationship. Our findings indicate providers could benefit from education on improving communication around realistic goals and patient-centered outcomes and incorporation of more holistic pain management approaches when working with older adult patients. Further study should focus on developing educational interventions to address the identified shortcomings.

scholarly journals Community Partnering for Behavioral Health Equity: Public Agency and Community Leaders’ Views of its Promise and Challenge

2018 ◽  
Vol 28 (Supp) ◽  
pp. 397-406 ◽  
Author(s):  
Elizabeth Bromley ◽  
Chantal Figueroa ◽  
Enrico G. Castillo ◽  
Farbod Kadkhoda ◽  
Bowen Chung ◽  
...  
Keyword(s):  
Los Angeles ◽  
Behavioral Health ◽  
Health Systems ◽  
Safety Net ◽  
Relationship Building ◽  
Health Improvement ◽  
System Transformation ◽  
Structured Interviews ◽  
Community Based ◽  
Public Agency

Objective: To understand potential for multi-sector partnerships among com­munity-based organizations and publicly funded health systems to implement health improvement strategies that advance health equity.Setting: In 2014, the Los Angeles County (LAC) Board of Supervisors approved the Health Neighborhood Initiative (HNI) that aims to: 1) improve coordination of health services for behavioral health clients across safety-net providers within neighborhoods; and 2) address social determinants of health through community-driven, public agency sponsored partnerships with community-based organizations.Design: Key stakeholder interviewing dur­ing HNI planning and early implementation to elicit perceptions of multi-sector partner­ships and innovations required for partner­ships to achieve system transformation and health equity.Participants: Twenty-five semi-structured interviews with 49 leaders from LAC health systems, community-based organizations; and payers.Main Outcomes Means: Grounded the­matic analysis of interview data.Results: Leaders perceived partnerships within and beyond health systems as transformative in their potential to: improve access, value, and efficiency; align priori­ties of safety-net systems and communities; and harness the power of communities to impact health. Leaders identified trust as critical to success in partnerships but named lack of time for relationship-building, limitations in service capacity, and ques­tions about sustainability as barriers to trust-building. Leaders described the need for procedural innovations within health systems that would support equitable part­nerships including innovations that would increase transparency and normalize infor­mation exchange, share agenda-setting and decision-making power with partners, and institutionalize partnering through training and accountability.Conclusions: Leaders described improv­ing procedural justice in public agencies’ relationships with communities as key to effective partnering for health eq­uity.Ethn Dis.2018;28(Suppl 2):397-406; doi:10.18865/ed.28.S2.397.

A design contribution to the entrepreneurial experience

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Juan David ROLDAN ACEVEDO ◽  
Ida TELALBASIC
Keyword(s):  
Product Development ◽  
Qualitative Analysis ◽  
Design Research ◽  
Recent Literature ◽  
Early Stage ◽  
Entrepreneurial Activity ◽  
Value Proposition ◽  
Structured Interviews ◽  
User Centric ◽  
Constant Growth

In recent history, different design approaches have been entering fields like management and strategy to improve product development and service delivery. Specifically, entrepreneurship has adopted a user-centric mindset in methodologies like the business canvas model and the value proposition canvas which increases the awareness of the users’ needs when developing solutions. What happens when a service design approach is used to understand the entrepreneurs’ experience through the creation of their startups? Recent literature suggests that entrepreneurial activity and success is conditioned by their local entrepreneurship ecosystem. This study investigates the Entrepreneurship Ecosystem of Medellín, Colombia - an ecosystem in constant growth but that lacks qualitative analysis. The sample consists of 12 entrepreneurs in early-stage phase. The data was gathered with two design research methods: Cultural Probes and Semi-structured interviews. The analysis of the information collected facilitated the development of 4 insights about the entrepreneurs and an experience map to visualise and interpret their journey to create a startup. The results of this study reflected the implications of the ecosystem, the explanation of the users’ perceptions and awareness and propose a set of ideas to the local government to improve the experience of undertaking a startup in Medellín.

scholarly journals The Importance of Perceived Relevance: A Qualitative Evaluation of Patient’s Perceptions of Value and Impact Following a Low-Intensity Group-Based Pain Management Program

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 46
Author(s):  
Joshua W. Pate ◽  
Elizabeth Tran ◽  
Seema Radhakrishnan ◽  
Andrew M. Leaver
Keyword(s):  
Pain Management ◽  
Qualitative Evaluation ◽  
Management Program ◽  
Structured Interviews ◽  
Patient Beliefs ◽  
Pain Management Program ◽  
Westmead Hospital ◽  
Group A ◽  
Perceived Relevance ◽  
Beliefs And Attitudes

Background and objectives: Limited evidence exists exploring perceptions of which aspects of a pain management program are perceived as valuable and impactful. The aim of this study was to explore patient beliefs about which aspects of a pain management program were valued and/or had perceived impact. Materials and Methods: One-on-one structured interviews were conducted with 11 adults three months after their completion of the Spark Pain Program at Westmead Hospital, Sydney, Australia. Concepts in the transcripts were inductively identified and explored, utilizing thematic analysis to better understand their relevance to the study aim. Results: Four themes emerged: (1) “The program overall was positive, but…”; (2) “I valued my improved knowledge and understanding of pain, but…”; (3) “I valued the stretching/relaxation/pacing/activity monitoring”; and (4) “I valued being part of a supportive and understanding group”. Participants reported that they liked being treated as an individual within the group. A lack of perceived personal relevance of key messages was identified in some participants; it appears that patients in pain programs must determine that changes in knowledge, beliefs, and attitudes are personally relevant in order for the changes to have a significant impact on them. Conclusions: This study provides new insights into aspects of a pain management program that were perceived as valuable and impactful, areas that “missed the mark”, and hypotheses to guide the implementation of service delivery and program redesign.

Purchasing Power and Self-Determination: Social Worker Perspectives

2021 ◽  
Author(s):  
Charlotte Bailey ◽  
Debbie Plath ◽  
Alankaar Sharma
Keyword(s):  
Decision Making ◽  
Social Work ◽  
Social Workers ◽  
Work Practice ◽  
Social Work Practice ◽  
Self Determination ◽  
Purchasing Power ◽  
Service Users ◽  
Structured Interviews ◽  
Management Approaches

Abstract The international policy trend towards personalised budgets, which is designed to offer people with disabilities purchasing power to choose services that suit them, is exemplified in the Australian National Disability Insurance Scheme (NDIS). This article examines how the ‘purchasing power’ afforded to service users through individualised budgets impacts on social work practice and the choice and self-determination of NDIS service users. Social workers’ views were sought on the alignment between the NDIS principles of choice and control and social work principles of participation and self-determination and how their social work practice has changed in order to facilitate client access to supports through NDIS budgets and meaningful participation in decision-making. A survey was completed by forty-five social workers, and in-depth semi-structured interviews were conducted with five of these participants. The findings identify how social workers have responded to the shortfalls of the NDIS by the following: interpreting information for clients; assisting service users to navigate complex service provision systems; supporting clients through goal setting, decision-making and implementation of action plans; and adopting case management approaches. The incorporation of social work services into the NDIS service model is proposed in order to facilitate meaningful choice and self-determination associated with purchasing power.

scholarly journals The PROMISES study: a mixed methods approach to explore the acceptability of salivary progesterone testing for preterm birth risk among pregnant women and trained frontline healthcare workers in rural India

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040268
Author(s):  
Danielle Ashworth ◽  
Pankhuri Sharma ◽  
Sergio A Silverio ◽  
Simi Khan ◽  
Nishtha Kathuria ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Barriers And Facilitators ◽  
Rural India ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Thematic Framework

IntroductionIndia has an overall neonatal mortality rate of 28/1000 live births, with higher rates in rural India. Approximately 3.5 million pregnancies in India are affected by preterm birth (PTB) annually and contribute to approximately a quarter of PTBs globally. Embedded within the PROMISES study (which aims to validate a low-cost salivary progesterone test for early detection of PTB risk), we present a mixed methods explanatory sequential feasibility substudy of the salivary progesterone test.MethodsA pretraining and post-training questionnaire to assess Accredited Social Health Activists (ASHAs) (n=201) knowledge and experience of PTB and salivary progesterone sampling was analysed using the McNemar test. Descriptive statistics for a cross-sectional survey of pregnant women (n=400) are presented in which the acceptability of this test for pregnant women is assessed. Structured interviews were undertaken with ASHAs (n=10) and pregnant women (n=9), and were analysed using thematic framework analysis to explore the barriers and facilitators influencing the use of this test in rural India.ResultsBefore training, ASHAs’ knowledge of PTB (including risk factors, causes, postnatal support and testing) was very limited. After the training programme, there was a significant improvement in the ASHAs’ knowledge of PTB. All 400 women reported the salivary test was acceptable with the majority finding it easy but not quick or better than drawing blood. For the qualitative aspects of the study, analysis of interview data with ASHAs and women, our thematic framework comprised of three main areas: implementation of intervention; networks of influence and access to healthcare. Qualitative data were stratified and presented as barriers and facilitators.ConclusionThis study suggests support for ongoing investigations validating PTB testing using salivary progesterone in rural settings.

scholarly journals Organizational Change Management in Higher Education through the Lens of Executive Coaches

2021 ◽  
Vol 11 (6) ◽  
pp. 269
Author(s):  
Dimitrios Vlachopoulos
Keyword(s):  
Higher Education ◽  
Organizational Change ◽  
Change Management ◽  
Academic Community ◽  
Structured Interviews ◽  
Organizational Change Management ◽  
Executive Coaches ◽  
Leadership In Higher Education ◽  
Education Leaders ◽  
Higher Education Leaders

This study investigated perceptions of organizational change management among executive coaches working with British higher-education leaders and factors that make leaders effective when managing change. This basic qualitative research used semi-structured interviews with eight executive coaches selected through purposeful sampling. As main challenges to efficient, inclusive change management, participants mentioned leaders’ lack of a strategic vision or plan, lack of leadership and future leader development programs, and lack of clarity in decision-making. They recognized that leaders’ academic and professional profiles are positively viewed and said that, with coaching and support in leadership and strategic planning, these people can inspire the academic community and promote positive change. Additional emphasis was given to the role of coaching in the development of key soft skills (honesty, responsibility, resiliency, creativity, proactivity, and empathy, among others), which are necessary for effective change management and leadership in higher education. The paper’s implications have two aspects. First, the lessons of the actual explicit content of the coaches’ observations (challenges to efficient change management and views of leaders); second, the implications of these observations (how coaching can help and what leaders need).

Abstract 090: Armenian Ethnicity: An Independent Risk Factor for Positive Exercise Treadmill Tests

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Ara H Rostomian ◽  
Daniel Sanchez ◽  
Jonathan Soverow
Keyword(s):  
Risk Factors ◽  
Los Angeles ◽  
Multivariate Logistic Regression Analysis ◽  
Safety Net ◽  
The United States ◽  
World Health ◽  
Limited Information ◽  
Safety Net Hospital ◽  
Exercise Treadmill ◽  
History Of

Background: Several studies have examined the risk of cardiovascular disease (CVD) among larger racial and ethnic groups such as Hispanics and African-Americans in the United States, but limited information is available on smaller subgroups such as Armenians. According to the World Health Organization, Armenia ranks eighth in CVD rates among all countries however it is unclear if Armenian immigrants living in the US have the same high rates of disease. This study examined whether being of Armenian descent increased the risk of having a positive exercise treadmill test (ETT) among patients treated at a safety net hospital in Los Angeles County. Methods: Data on patients who received an ETT from 2008-2011 were used to conduct a retrospective analysis of the relationship between Armenian ethnicity and ETT result as a surrogate measure for CVD. A multivariate logistic regression analysis was used to estimate the odds ratios (OR) for having a positive ETT among Armenians relative to non-Armenians, adjusting for the following pre-specified covariates: gender, age, diabetes, hypertension, hyperlipidemia, smoking, family history of coronary artery disease (CAD), and patient history of CAD. Results: A total of 5,297 patients, ages 18 to 89, were included. Of these, 13% were Armenian and 46% were male, with an average age of 53 years. Armenians had higher odds of having a positive ETT than non-Armenians (Crude OR=1.30, p=0.037, CI:1.02,1.66). After adjusting for CV risk factors, Armenians were still significantly more likely to have a positive ETT than non-Armenians (OR=1.33, p=0.029, CI:1.03,1.71). CAD (OR 2.02, p<0.001, CI:1.38,2.96), and hyperlipidemia (OR=1.31, p=0.008, CI:1.07,1.60) were also significantly associated with a positive ETT. Conclusion: Armenians have a higher likelihood of having a positive ETT than non-Armenians. This relationship appears to be independent of traditional CV risk factors and suggests a role for cultural and/or genetic influences.

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