Accessibility and System Navigation

EU-GENIE is an online tool that volunteers can use with clients. It can help them describe their support network and can link them to relevant local community resources that are tailored to the interests of the client.

EU-GENIE is a UK-developed, evidence-based online intervention aimed to support self-management for adults living with long-term health and social conditions. It was adapted for use in Canada. It is currently being tested in a sub-group of TAPESTRY clients who are enroled in Health Links. Study Objectives include: 1.      To assess the usability, acceptability, and normalization of the EU-GENIE tool in a primary care environment that is used by providers, clients and volunteers. 2.      To explore if and how EU-GENIE can function as a collaborative practice tool to improve providers’ and clients’ understanding of personal support networks, as well as linkages among primary care team members and between primary care and community-based health and social services (team-based care), within the context of Health TAPESTRY and Health Links programs. 3.      To explore if and how clients perceive the use of EU-GENIE as a tool to support attainment of their health and life goals. 4.      To explore how the size, composition and function of clients’ social networks support attainment of self-identified health goals.    Our Canadian adatped version of EU-GENIE was presented at the EU-WISE Conference, Southhampton, England. November 23, 2015. (http://eu-wise.com/wp-content/uploads/2012/12/EU-WISE-Conference-Southampton-9-R.-Valaitis-21-Nov.pdf) 

Lead:

Ruta Valaitis, Cathy Risdon, Jenny Ploeg, Anita Kothari, Lisa Dolovich, Laura Cleghorn, Anne Kennedy, Anne Rogers, Ivo Vassilev, Dale Guenter, and James Gillett

Research Funding:

• Exploring the Use of Personal Network Mapping as a Component of the TAPESTRY Program

More Information:

• Website
• Conference

The objective of this study is to evaluate the implementation and effectiveness of the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) approach in older adults.

In our program, trained volunteers visit people where they live . In these visits, they learn about what matters most to that person and their health. They also learn more about a person’s health needs. The stories people tell our volunteers are recorded and sent to their health care team using special technology. This helps the team learn more about that person’s life, health needs, goals and how they can better work together to achieve goals and meet needs.

Co-author:

Dolovich, L., Oliver, D., Lamarche, L., Agarwal, G., Carr, T., Chan, D., Cleghorn, L., Griffith, L., Javadi, D., Kastner, M., Longaphy, J., Mangin, D., Richardson, J., Papaioannou, A., Ploeg, J., Raina, P., Risdon, C., Santaguida, P.L., Straus, S., Thabane, L., Valaitis, R., Price, D.

Research Funding:

• TAPESTRY: Teams Advancing Patient Experience: Strengthening Quality

More Information:

• Publication
• Health Tapestry Website

This paper examines advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health.

We examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries. 

Co-Author:

Denise Bryant-Lukosius; Ruta Valaitis; Ruth Martin-Misener; Faith Donald; Laura Morán Peña; Linda Brousseau

Students:

1. Linda Brousseau

Research Funding:

More Information:

• Link to paper

Systems navigation services provided by a designated provider or team have the potential to address health and social disparities. We conducted an environmental scan of navigation activities in a large urban Canadian community to identify and describe: service providers who engage in systems navigation; the clients who require systems navigation support and the issues they face; activities involved; and barriers and facilitators in providing systems navigation support to clients.

 Using an online survey and convenience sampling, we recruited individuals who self-identified as community navigators or practiced systems navigation activities as part of their role. The majority of respondents (n¼145) were social workers, social services workers, or nurses. Clients of navigators struggled with mental health or addictions issues, disabilities, chronic diseases, and history of trauma or abuse. The most frequently reported activities of navigators were building professional relationships, managing paperwork, and communicating with relevant agencies or organizations. Barriers and facilitators are reported. 

Co-author:

Nancy Carter, Ruta Valaitis, Janice Feather, Laura Cleghorn, and Annie Lam

Students:

1. Janice Feather

Research Funding:

• Evaluation of a Community Nurse Navigator in a Priority Hamilton Neighbourhood

More Information:

• Link to paper

This case study describes how broker organizations supported a network of community-based services to work together to address the primary healthcare needs of recent immigrant families with young children.

Broker organizations were identified as pivotal for ensuring connections among network members, for supporting immigrant family access to services through their involvement with multiple providers, and for developing cultural competence capacities in the system overall. Network cohesiveness differed depending on the type of need being addressed, as did the organizations playing the role of broker. Service providers were able to extend their reach through the co-location of services in local centres and schools attended by immigrant families and their children. The study demonstrates the value of ties across service sectors facilitated by broker organizations to ensure the delivery of comprehensive services to young immigrant families challenged by an unfamiliar system of care.

Co-author:

Isaacs, S., Valaitis, R., Newbold, K.B., Black, M., & Sargeant, J.

Students:

1. Sandra Isaacs

Research Funding:

More Information:

• Publication

The three specific objectives of this study are to: (1) identify the facilitators and barriers of CM implementation in primary care clinics across Canada; (2) explain and understand the relationships between the actors, contextual factors, mechanisms and outcomes of the CM intervention; (3) identify the next steps towards CM spread in primary care across Canada.

We will conduct a multiple-case embedded mixed methods study. CM will be implemented in 10 primary care clinics in five Canadian provinces. Three different units of analysis will be embedded to obtain an in-depth understanding of each case: the healthcare system (macro level), the CM intervention in the clinics (meso level) and the individual/patient (micro level). For each objective, the following strategy will be performed: (1) an implementation analysis, (2) a realist evaluation and (3) consensus building among stakeholders using the Technique for Research of Information by Animation of a Group of Experts method. Team includes: Hudon, C., Chouinard, M.C., Aubrey-Bassler, K., Burge, F., Doucet, S., Ramsden, V.R., Brodeur, M., Bush, P.L., Couturier, Y., Dubois, M.F., Guénette, L., Légare, F., Morin, P., Poder, T.G., Poitras, M.E., Roberge, P., Valaitis, R., Bighead, S., Campbell, C., Couture, M., Davis, B., Deschenes, E., Edwards, L., Gander, S., Gauthier, G., Gauthier, P., Gibson, R.J., Godbout, J., Landry, G., Longjohn, C., Rabbitskin, B., Roy, D.A., Roy, J., Sabourin, V., Sampalli, T., Saulnier, A., Spence, C., Splane, J., Warren, M., Young, J., Pluye, P. (2018). 

co-author:

Hudon, C., Chouinard, M.C., Aubrey-Bassler, K., Burge, F., Doucet, S., Ramsden, V.R., Brodeur, M., Bush, P.L., Couturier, Y., Dubois, M.F., Guénette, L., Légare, F., Morin, P., Poder, T.G., Poitras, M.E., Roberge, P., Valaitis, R., Bighead, S., Campbell, C., Couture, M., Davis, B., Deschenes, E.,

Research Funding:

More Information:

• Link to protcol paper

The aim was to explore how an organization's trust in the cultural competency of other service providers (competence trust) can influence the effectiveness of a services network in meeting the needs of recent immigrant families.

Perceived cultural competency affected the degree of trust and collaboration within the services network when addressing the needs of recent immigrant families. Competence trust toward other providers increased the desire and commitment to work together, while lack of competence trust created avoidance. Non-government organizations were identified among the most culturally competent. The perceived positive and negative experiences of families with different providers influenced the level of trust among network members. The development of systemic cultural competences within a services network is needed in order to improve collaborations and access to services for immigrant families.

Co-author:

Isaacs, S., Valaitis, R., Newbold, K.B., Black, M., & Sargeant, J.

Students:

1. Sandra Isaacs

Research Funding:

More Information:

• Publication

This study describes the effectiveness, feasibility and effects of a volunteer program evaluation framework in primary care.

<p><span style="color: #1c1d1e; font-family: 'Open Sans', icomoon, sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">Volunteers support health and social care worldwide, yet there is little research on integrating these unpaid community members into primary care. ‘Health Teams Advancing Patient Experience, Strengthening Quality through Health Connectors for Diabetes Management’ (Health TAPESTRY‐HC‐DM) integrates volunteer ‘health connectors’ into a community‐ and primary care‐based program supporting client self‐management in Hamilton, Canada. Volunteers supported clients through goal setting, motivation, education and connections to community resources and primary care. This study aimed to create and apply a volunteer program evaluation framework to explore: (a) volunteer training effectiveness (learning online content, in‐person training, self‐efficacy in role tasks, training overall); (b) feasibility of program implementation (process measures, reflections on client encounters, understanding of volunteer roles/responsibilities, client perspectives on volunteer program); and (c) effects of volunteering on volunteers (health outcomes, self‐efficacy, value of volunteering). A concurrent triangulation, mixed‐methods design was used. Data were collected in 2016, sources included: volunteer online training quizzes, focus groups, self‐efficacy survey, Veterans RAND 12‐Item (VR‐12) survey, in‐person training feedback forms and narratives of client visits; client interviews; and quantitative implementation data. Quantitative data analysis included descriptive statistics, paired samples<span>&nbsp;</span></span><em style="box-sizing: border-box; color: #1c1d1e; font-family: 'Open Sans', icomoon, sans-serif; font-size: 16px; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-style: initial; text-decoration-color: initial;">t</em><span style="color: #1c1d1e; font-family: 'Open Sans', icomoon, sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;"><span>&nbsp;</span>tests, and effect size (Cohen's<span>&nbsp;</span></span><em style="box-sizing: border-box; color: #1c1d1e; font-family: 'Open Sans', icomoon, sans-serif; font-size: 16px; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-style: initial; text-decoration-color: initial;">d</em><span style="color: #1c1d1e; font-family: 'Open Sans', icomoon, sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">). Qualitative data used descriptive thematic analysis. Nineteen volunteers and 12 clients participated in this evaluation. Findings demonstrate the volunteer program evaluation framework in action. Online training increased knowledge. In‐person training received largely positive evaluations. Self‐efficacy was high post‐training and higher after volunteering. VR‐12 sub‐scale means increased descriptively. Volunteers understood themselves as healthcare system connectors, feeling fulfilled with their contributions and learning new skills. They identified barriers including not having the resources and skills of healthcare professionals. Clients found volunteers were a major program strength, appreciating their company and regular goals follow‐up. Using a volunteer program evaluation framework generated rich and comprehensive data demonstrating the feasibility of bringing volunteers into primary care.</span></p>

https://onlinelibrary.wiley.com/doi/abs/10.1111/hs:

Lisa Dolovich, Jessica Gaber, Ruta Valaitis, Jenny PLoeg, Doug Oliver, Julie Richardson, Dee Mangin, Fiona Paeascandalo, & Gina Agarwal

Research Funding:

• TAPESTRY: Teams Advancing Patient Experience: Strengthening Quality

More Information:

• Link to paper

This paper fills a gap in knowledge to reveal what is known about motivators and factors influencing implementation and maintenance of patient navigation programs in primary care that link patients to community-based health and social services. It also reports on outcomes from these studies to help identify gaps in research that can inform future studies.

This scoping literature review involved: i) electronic database searches; ii) a web site search; iii) a search of reference lists from literature reviews; and, iv) author follow up. It included papers from Canada, the United States, the United Kingdom, Australia, New Zealand, and/or Western Europe published between January 1990 and June 2013 if they discussed navigators or navigation programs in primary care settings that linked patients to community-based health and social services.   Of 34 papers, most originated in the United States (n = 29) while the remainder were from the United Kingdom, Canada and Australia. Motivators for initiating navigation programs were to: a) improve delivery of health and social care services; b) support and manage specific health needs or specific population needs, and; c) improve quality of life and wellbeing of patients. Eleven factors were found to influence implementation and maintenance of these patient navigation programs. These factors closely aligned with the Diffusion of Innovation in Service Organizations model, thus providing a theoretical foundation to support them. Various positive outcomes were reported for patients, providers and navigators, as well as the health and social care system, although they need to be considered with caution since the majority of studies were descriptive.

First Author:

Ruta K. Valaitis; Nancy Carter; Annie Lam; Jennifer Nicholl; Janice Feather; Laura Cleghorn

Students:

1. Jennifer Nicholl
2. Janice Feather

Research Funding:

• Evaluation of a Community Nurse Navigator in a Priority Hamilton Neighbourhood

More Information:

• Link to paper

Invited Working Group Member: Ontario’s Ministry of Health and Long-term Care Primary Health Care Planning Group: Working Group 2: Strengthening Primary Care Access. The report was completed August 2011.

The membership of the working group was diverse and reflective of the many stakeholders and jurisdictions involved in primary care access in Ontario. Experts were drawn from across the province of Ontario including healthcare practitioners, Aboriginal health experts, researchers, administrators and policymakers participated in the Improving Access in Primary Care Working Group.

Strengthening Primary Care Access:

Primary Health Care Working Group

Research Funding:

More Information:

• Strengthening Primary Care Access

We conducted a scoping literature review following established methods to explore the existing evidence on system navigation in primary care. To be included, studies had to be published in English between 1990 and 2013, and include a navigator or navigation process in a primary care setting that involves the community- based social services beyond the health care system. We make an important contribution to the literature by highlighting navigation models that address both health and social service navigation. T

Co-Author:

Nancy Carter, Ruta K. Valaitis, Annie Lam, Janice Feather, Jennifer Nicholl and Laura Cleghorn

Students:

1. Jennifer Nicholl
2. Janice Feather

Research Funding:

• Evaluation of a Community Nurse Navigator in a Priority Hamilton Neighbourhood

More Information:

• Link to paper

To address increasing pressures for cancer survivorship care, provincial cancer agencies have introduced new models of post-treatment follow-up involving earlier transition of cancer survivors back to primary care (PC) providers. It is unknown how nurses in PC settings have responded to this practice change. The purpose of this qualitative descriptive study was to examine registered nurses' (RNs) perspectives of the strengths, gaps, barriers and opportunities for optimizing nursing roles in the delivery of cancer survivorship care within PC settings.

Participants completed a demographical questionnaire and semi-structured, in-depth telephone interview. Data collection and analysis were conducted concurrently. Data were analyzed using content analysis approaches. The sample included 18 RNs working in diverse PC settings across Ontario. Participants' involvement in cancer survivorship care was limited, but it could be categorized into the following three themes: care coordination and system navigation, emotional support and facilitating access to community resources. Individual, practice setting and PC team factors influenced nurses' involvement in cancer survivorship care. To the best of our knowledge, this is the first Canadian study to examine RN roles in PC settings related to cancer survivorship care. There is wide variability and opportunity to enhance RNs' roles and involvement in cancer survivorship care.

Co-Author:

Lindsay Yuille, Denise Bryant-Lukosius, Ruta Valaitis & Lisa Dolovich

Students:

1. Lindsay Yuille

Research Funding:

More Information:

• Link to publication

The goal of the Aging, Community and Health Research Unit (ACHRU) is to promote optimal aging at home for older adults with multimorbidity (≥2 chronic conditions) and to support their family/friend caregivers. This protocol paper reports the rationale and plan for this patient-oriented, cross-jurisdictional research program.

BACKGROUND: The goal of the Aging, Community and Health Research Unit (ACHRU) is to promote optimal aging at home for older adults with multimorbidity (≥2 chronic conditions) and to support their family/friend caregivers. This protocol paper reports the rationale and plan for this patient-oriented, cross-jurisdictional research program. OBJECTIVES: The objectives of the ACHRU research program are (i) to codesign integrated and person-centered interventions with older adults, family/friend caregivers, and providers; (ii) to examine the feasibility of newly designed interventions; (iii) to determine the intervention effectiveness on Triple Aim outcomes: health, patient/caregiver experience, and cost; (iv) to examine intervention context and implementation barriers and facilitators; (v) to use diverse integrated knowledge translation (IKT) strategies to engage knowledge users to support scalability and sustainability of effective interventions; and (vi) to build patient-oriented research capacity. DESIGN: The research program was informed by the Knowledge-to-Action Framework and the Complexity Model. Six individual studies were conceptualized as integrated pieces of work. The results of the three initial descriptive studies will inform and be followed by three pragmatic randomized controlled trials. IKT and capacity building activities will be embedded in all six studies and tailored to the unique focus of each study. CONCLUSIONS: This research program will inform the development of effective and scalable person-centered interventions that are sustainable through interagency and intersectoral partnerships with community-based agencies, policy makers, and other health and social service agencies. Implementation of these interventions has the potential to transform health-care services and systems and improve the quality of life for older adults with multimorbidity and their caregivers.

Co-author:

Markle-Reid, M., Ploeg, J., Valaitis, R., Duggleby, W., Fisher, K., Fraser, K., Ganann, R., Griffith, L., Gruneir, A., McAiney, C., and Williams, A. for the Aging, Community and Health Research Unit Team

Research Funding:

More Information:

• Link to paper