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Evaluating a novel Integrated Community of Care (ICoC) for patients from an urbanised low-income community in Singapore using the participatory action research (PAR) methodology: a study protocol
  1. Lian Leng Low1,2,
  2. Adlina Maulod3,
  3. Kheng Hock Lee1,2
  1. 1 Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
  2. 2 Department of Family Medicine, Duke-NUS Medical School, Singapore
  3. 3 Centre for Aging Research and Education, Duke-NUS Medical School, Singapore
  1. Correspondence to Dr Lian Leng Low; low.lian.leng{at}


Introduction Poorer health outcomes and disproportionate healthcare use in socioeconomically disadvantaged patients is well established. However, there is sparse literature on effective integrated care interventions that specifically target these high-risk individuals. The Integrated Community of Care (ICoC) is a novel care model that integrates hospital-based transitional care with health and social care in the community for high-risk individuals living in socially deprived communities. This study aims to evaluate the effectiveness of the ICoC in reducing acute hospital use and investigate the implementation process and its effects on clinical outcomes using a mixed-methods participatory action research (PAR) approach.

Methods and analysis This is a single-centre prospective, controlled, observational study performed in the SingHealth Regional Health System. A total of 250 eligible patients from an urbanised low-income community in Singapore will be enrolled during their index hospitalisation. Our PAR model combines two research components: quantitative and qualitative, at different phases of the intervention. Outcomes of acute hospital use and health-related quality of life are compared with controls, at 30 days and 1 year. The qualitative study aims at developing a more context-specific social ecological model of health behaviour. This model will identify how influences within one’s social environment: individual, interpersonal, organisational, community and policy factors affect people’s experiences and behaviours during care transitions from hospital to home. Knowledge on the operational aspects of ICoC will enrich our evidence-based strategies to understand the impact of the ICoC. The blending of qualitative and quantitative mixed methods recognises the dynamic implementation processes as well as the complex and evolving needs of community stakeholders in shaping outcomes.

Ethics and dissemination Ethics approval was granted by the SingHealth Centralised Institutional Review Board (CIRB 2015/2277). The findings from this study will be disseminated by publications in peer-reviewed journals, scientific meetings and presentations to government policy-makers.

Trial registration number NCT02678273

  • integrated care
  • community-based care
  • transitional care
  • low-income elderly community
  • participatory action research

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:

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  • Contributors LLL, AM and LKH conceived and designed the study. LLL and AM wrote the first draft of the paper, and all authors critically revised the paper and gave final approval for publication.

  • Competing interests None declared.

  • Ethics approval SIng Health Centralized Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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