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Developing a global practice-based framework of person-centred care from primary data: a cross-national qualitative study with patients, caregivers and healthcare professionals

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Alessandra Giusti, Panate Pukrittayakamee, Ghadeer Alarja, Lindsay Farrant, Joy Hunter, Olona Mzimkulu, Liz Gwyther, Nokuzola Williams, Kamonporn Wannarit, Lana Abusalem, Sawsan Alajarmeh, Waleed Alrjoub, Lakkana Thongchot, Satit Janwanishstaporn, Adib Edilbi, Ruba Al-Ani, Omar Shamieh, Ping Guo, Kennedy Bashan Nkhoma, Sridhar Venkatapuram & 1 more Richard Harding

Original languageEnglish
Article numbere008843
JournalBMJ Global Health
Volume7
Issue number7
DOIs
Accepted/In press21 May 2022
Published13 Jul 2022

Bibliographical note

Funding Information: This research was partly funded by the National Institute of Health Research (NIHR) Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa, King’s College London (GHRU 16/136/54) using UK aid from the UK Government to support global health research. The research was also partly conducted through the R4HC-MENA programme funded by the UK Research and Innovation Global Challenges Research Fund (Official Development Assistance). The first author was additionally partly funded by Funds for Graduate Women (FfGW) (GA-00937). The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders played no part in the conduct of this research. Funding Information: This project funded by National Institute of Health Research (NIHR) Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa, King’s College London (GHRU 16/136/54). R4HC-MENA programme funded by the UK Global Challenges Research Fund (Official Development Assistance) (ES/P010962/1). Funds for Graduate Women (FfGW) (GA-00937) Publisher Copyright: ©

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King's Authors

Abstract

INTRODUCTION: Person-centred care (PCC) is internationally recognised as a critical component of high-quality healthcare. However, PCC evolved in a few high-income countries and there are limited data exploring this concept across the vast majority of countries which are low- and middle-income. This study aimed to appraise and adapt a PCC model across three serious physical conditions in three middle-income countries and generate an evidence-based framework and recommendations for globally relevant PCC.

METHODS: Cross-national, cross-sectional qualitative study. In depth, semistructured interviews conducted with: advanced cancer patients in Jordan (n=50), their caregivers (n=20) and healthcare professionals (HCPs) (n=20); chronic obstructive pulmonary disease patients in South Africa (n=22), their caregivers (n=19) and HCPs (n=22); heart failure patients in Thailand (n=14), their caregivers (n=10) and HCPs (n=12). Data were analysed using framework analysis. Santana et al's PCC model (2018) and Giusti et al's systematic review (2020) were used to construct an a priori coding frame for deductive analysis, with additional inductive coding for coding that did not fit the frame.

RESULTS: The findings both reveal specific practical actions that contribute towards delivering PCC and highlight new cross-national domains of person-centredness: interdependency and collectivism; bringing care into the home and community; equity and non-discrimination; addressing health and illness within the context of limited resources; and workforce well-being.

CONCLUSION: The data suggest that PCC requires particular structural features of the healthcare system to be in place, such as professional education in PCC values and partnerships with community-based workers. These structures may better enable PCC processes, including tailored information sharing and providing genuine opportunities for patients to do the things that matter to them, such as making informed care decisions and sustaining social relationships. PCC must also accommodate a collectivist perspective and support the well-being of the workforce.

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