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Qualitative research
Research
Capturing the experiences of patients across multiple complex interventions: a meta-qualitative approach
  1. Fiona Webster1,
  2. Jennifer Christian2,
  3. Elizabeth Mansfield2,
  4. Onil Bhattacharyya1,3,
  5. Gillian Hawker2,
  6. Wendy Levinson2,
  7. Gary Naglie2,
  8. Thuy-Nga Pham1,4,
  9. Louise Rose5,
  10. Michael Schull2,6,
  11. Samir Sinha6,
  12. Vicky Stergiopoulos7,8,
  13. Ross Upshur1,9,
  14. Lynn Wilson1
  15. on behalf of the BRIDGES Collaborative
  1. 1Department of Family and Community Medicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
  4. 4South East Toronto Family Health Team, Toronto East General Hospital, Toronto, Ontario, Canada
  5. 5Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital, Toronto, Ontario, Canada
  6. 6Health System Planning & Evaluation Research Program, Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
  7. 7Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
  8. 8Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  9. 9Bridgepoint Health, Bridgepoint Collaboratory for Research and Innovation, Toronto, Ontario, Canada
  1. Correspondence to Dr Fiona Webster; Fiona.Webster{at}utoronto.ca

Abstract

Objectives The perspectives, needs and preferences of individuals with complex health and social needs can be overlooked in the design of healthcare interventions. This study was designed to provide new insights on patient perspectives drawing from the qualitative evaluation of 5 complex healthcare interventions.

Setting Patients and their caregivers were recruited from 5 interventions based in primary, hospital and community care in Ontario, Canada.

Participants We included 62 interviews from 44 patients and 18 non-clinical caregivers.

Intervention Our team analysed the transcripts from 5 distinct projects. This approach to qualitative meta-evaluation identifies common issues described by a diverse group of patients, therefore providing potential insights into systems issues.

Outcome measures This study is a secondary analysis of qualitative data; therefore, no outcome measures were identified.

Results We identified 5 broad themes that capture the patients’ experience and highlight issues that might not be adequately addressed in complex interventions. In our study, we found that: (1) the emergency department is the unavoidable point of care; (2) patients and caregivers are part of complex and variable family systems; (3) non-medical issues mediate patients’ experiences of health and healthcare delivery; (4) the unanticipated consequences of complex healthcare interventions are often the most valuable; and (5) patient experiences are shaped by the healthcare discourses on medically complex patients.

Conclusions Our findings suggest that key assumptions about patients that inform intervention design need to be made explicit in order to build capacity to better understand and support patients with multiple chronic diseases. Across many health systems internationally, multiple models are being implemented simultaneously that may have shared features and target similar patients, and a qualitative meta-evaluation approach, thus offers an opportunity for cumulative learning at a system level in addition to informing intervention design and modification.

  • QUALITATIVE RESEARCH
  • PRIMARY CARE
  • MENTAL HEALTH

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2015-007664

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