Karen is 2 months into her PEP leave in South Africa, directing the South African Guidelines Excellence project (Project SAGE). She is primarily based at the Cochrane Centre, Medical Research Council, Cape Town, but is often found across the road in the biomechanics lab of the Stellenbosch University Physiotherapy Dept working with Prof Quinette Louw. Karen has been on a vertical learning curve since arriving, regarding South African primary care systems and players, how, when and why guideline development happens, guideline players, guideline terminology, and how guidelines are disseminated to, and used by, clinicians working in front line primary care. She is working with a small team of dedicated people, and there is a great deal of interest in the project outcomes at academic and department of health levels. Guideline development and implementation is fragmented, and the quality of this has suffered because of the lack of cohesive and agreed standards. However, because the need to get best value from every Rand spent, the focus is on getting the message ‘out there’, thus the end product of the guidelines is usually clearly and usefully presented (clear diagrams for decision-making, step by step actions, summaries of the evidence produced as recommendations and key messages). Karen will be spending the rest of her PEP leave on developing better systems for guideline writing and recommendation wording, training programs to underpin capacity building and evidence implementation. Five papers have been sent for review in the last six weeks on work to date, and the team is working on another 4 before Karen comes home in August. Now that she isn’t quite so terrified by Cape Town traffic, Karen is getting more adventurous on weekends in her tiny Chev Spark, and is thoroughly enjoying the Cape Town scenery and markets with new (and old) friends. Her wooden animal collection is growing to the point where getting them all home will be tricky. She knows she has had a bad day when she starts talking to them. The weather has been perfect so far, like Adelaide summers, and the day’s weather forecast can be made by the ‘cloud skirt’ on Table Mountain, which dominates the city.
For more information on the South African Guidelines Excellence Project, go to the SAGE website
Professor Karen Grimmer with Professor of Pharmacy, University of Durban Fatima Suleman, at the International Decision Support Meeting, in Johannesburg, about developing a South African Health Technology Assessment Unit
Shingai Machingaidze (SAGE Project officer), Dr Augustin Ntilivamunda (WHO African head HIV/AIDS section, Pretoria) and Professor Karen Grimmer
SAGE students after their week of training on clinical guidelines and the iCAHE Koala
Table Mountain at dawn, Cape Town, South Africa.
New Professional Certificate in Consumer Engagement
iCAHE has worked with the Health Consumers Alliance of South Australia (HCA) , eight health professionals and eight health consumer representatives to co-design a unique Professional Certificate in Consumer Engagement. Interested people can email Jan Kooymans (email@example.com) to receive information about the next course, scheduled to commence in July 2015.
The Certificate comprises two courses:
- Consumer Engagement – Best Evidence, Policy and Practice in Health
- Consumer Engagement – Application of Best Evidence in Health.
Consumer Engagement – Best Evidence, Policy and Practice in Health
This first comprises two full day intensives and six Journal Club sessions (two incorporated in the intensives and the other four as one hour telephone or face to face sessions). It aims to:
- Provide students with an overview of evidence and tools for consumer engagement in health service governance, policy and practice and in clinical patient care
- Enable students to design a workplace project that incorporates best practice health consumer engagement.
The course content addresses the best research and frameworks for consumer engagement in health service governance, policy and practice and shared decision making in patient care. Course participants identify evidence-based policy and practice principles, reflect on and challenge current practice and apply best evidence, and policy and practice frameworks, to a model intervention to enhance health outcomes. This first course is a pre-requisite for the second. Participants can receive a Statement of Attendance and Participation – or successfully complete the assessments and receive a Statement of Competence.
Consumer Engagement – Application of Best Evidence in Health
This course aims to provide students with a mentored process of applying their learning about evidence informed health consumer engagement in a workplace intervention and evaluating the intervention reach and impact. This is a self-directed learning project in which students use their research evidence skills and knowledge of best practice health consumer engagement to develop a successful business case for an intervention; conduct the intervention; evaluation the reach and impact; and provide a report to management, with recommendations for future consumer engagement.
On successful completion of both courses and all assessments, participants receive a Professional Certificate in Consumer Engagement.
Health Consumers Alliance of South Australia (HCA)
In November 2013, iCAHE entered into a partnership with HCA to work together to position consumers at the heart of health care, through research, education, information dissemination, advocacy and partnerships. To date this partnership has produced not only the professional certificate, but also a Consumer Journal Club model (see this newsletter); a Master Class in Consumer Engagement (see previous iCAHE Summer newsletter); and a number of research initiatives. iCAHE is proud to support HCA’s mission to position consumers at the heart of health care by contributing new knowledge and evidence translation in consumer engagement.
Journal Clubs and the Department of Education and Child Development
Lucylynn Lizarondo, Kobie Boshoff and Deb Kay from iCAHE have been successful in negotiating a funded agreement with DECD to run journal clubs as professional development activity for their Children Centre staff. The facilitator training commenced on the 27th of March and another training is set on the 14th of April for the second batch of facilitators. The initial uptake by staff members has been positive in anticipation of developing their skills to translate evidence into practice.
Cardiopulmonary Research Area
Team leader: Kylie Johnston
Team members: Claire Baldwin, Anna Phillips, Gisela van Kessel, Claire McEvoy.
Collaborators: Our work could not be done without our clinical and academic collaborators including
- Ms Mary Young, Dr Ral Antic , Dr Aeneas Yeo and the teams at Thoracic Medicine, Royal Adelaide Hospital.
- Prof Peter Frith (Repatriation General Hospital), A Prof Marie Williams (UniSA, School of Population Health) and Prof Alan Crockett (UniSA) who mentor and support our work.
Aim: Our research aims to improve the care of people with lung conditions. This is a broad focus and our team members are mostly physiotherapists who work in diverse settings, from acutely unwell patients in the ICU to people living with chronic lung disease in the community. We are also interested in the training of health care professionals who will care for these groups in the future.
What are we doing?: During the last 5 years our research projects have focussed on the translation of high-evidence health care recommendations to people with chronic obstructive pulmonary disease (COPD). These include pulmonary rehabilitation and multidisciplinary coordinated care at the time of transition from hospital to the community.
In 2014 projects included:
- Implementing care coordination plus early rehabilitation in high risk patients with COPD in transition from hospital to primary care. Funded by the Australian Primary Health care Research Institute this was a joint project with the Royal Adelaide Hospital and Central and Adelaide Hills Medicare Local. Results of this pilot study will be presented at the Thoracic Society of Australia and NZ (Gold Coast) in March 2015 and at the World Confederation of Physical Therapy Congress (Singapore) in May 2015. The report from this work can be found on the APHCRI website
- Patterns of physical activity and sedentary behaviour in people with COPD living in the community: This study was completed by Bachelor of Physiotherapy with Honours student Daniella Scorsonelli. This project was a joint venture with a local general practice, and Daniella graduated with the award of Honours 1.
What’s happening in 2015?
We will evaluate the use of standardised patient scenarios to develop physiotherapy student safety skills in readiness for clinical placement. This study is supported by the UniSA Teaching and Learning Development Fund and will trial a workshop using this teaching approach in the 2nd year physiotherapy course (with investigators: K Johnston, A Phillips, A Bell, S Mackintosh). We hope this approach may improve student safety skills required for practice in the acute care hospital setting.
Claire Baldwin will lead an investigation of activity levels in survivors of a critical illness at Flinders Medical Centre. This study is funded by the Physiotherapy Research Foundation and will help examine the role of activity in the recovery of very unwell patients during and after a stay in the intensive care unit.
- Katrina Li has commenced PhD studies this year exploring respiratory impairment in offspring of people with chronic obstructive pulmonary disease (COPD): potential for case finding and early intervention with supervision from Marie and Kylie.
- Physiotherapy with honours student Adrian Potter will be improving the usefulness of the 2 minute walk test in people with COPD in a study based at the Hampstead Day Rehabilitation Centre supervised by Anna and Kylie.
This year Kylie is part of a national group coordinating the writing of Australian Pulmonary Rehabilitation Guidelines, and is the SA state representative of the Lung Foundation Australia Pulmonary Rehabilitation Forum.
Check out the new Evidence-Based Practice Online page
The Evidence-Based Practice Online section of the iCAHE website has just been revamped. If you are interested in learning about evidence-based practice, this free online course provides you with an innovative and flexible means for self-directed training at a pace appropriate to your own style of learning. It offers allied health students, clinicians and academics access to resources and tutorial modules.
Feature guideline- See This month’s featured guideline on the Australian Dietary guidelines
- The 13th National Rural Health Conference will be held from 24-27 May 2015 at the Darwin Convention Centre in the Northern Territory. Its theme is People, Places, Possibilities….For more information, or to register go to: http://www.ruralhealth.org.au/13nrhc/
- The Aboriginal Health Conference will be held in Perth, WA, on the 4-45 July 2015. The theme of this conference is Healthy families - healthy futures. For more information or to register go to: http://www.ruralhealthwest.com.au/professional-development/conferences-events/2015/07/04/default-calendar/aboriginal-health-conference-2015
- The 4th international conference and exhibition on occupational health and safety will be held in Toronto, Canada on the 24-25 August 2015. For more information or to register go to: http://occupationalhealth.conferenceseries.com/
- The 2015 Indigenous Allied Health Australia Conference will take place in Cairns, QLD on the 1-2nd of December, and the focus is on "allied health-stepping into action". for more information or to register go to: http://www.iahaconference.com.au/
A new book on qualitative research methodologies has been published by iCAHE researcher Dr Mandy Stanley. Published by Routledge, “Qualitative Research Methodologies for Occupational Science and Therapy” is co-edited with Dr Shoba Nayar from Auckland University of Technology and is the first time that a research methodology text has brought together occupational science and occupational therapy research. Chapters have been authored by contributors from Australia, New Zealand, Canada and Sweden including a chapter on meta-synthesis from another iCAHE member, Carolyn Murray.
Whilst written specifically for occupational scientists and occupational therapists drawing on examples of the authors’ work in those fields, it is likely that the text will be useful to other novice qualitative researchers in allied health. The book is aimed at the novice qualitative researcher level, particularly Honours or PhD students however experienced researchers will also take something away from this text.
Each chapter is dedicated to a particular methodology and follows a similar format so that readers can easily locate what they are after. A description of the methodology is provided along with a discussion of the theoretical orientation before going in to depth about sampling, data collection, analysis, rigour and ethical issues. Questions are provided to enable the reader to critique studies employing that methodology. Methodologies covered include phenomenology and grounded theory through to visual methodologies and critical discourse analysis. The concluding chapter is a transcript of a conversation about qualitative research between a number of the contributing authors.
Link to Qualitative Research Methodologies for Occupational Science and Therapy on the publisher web page: http://www.routledge.com/books/details/9780415828673/
Higher degree thesis
Congratulations to Lindy Williams who has received first-class Honours for her thesis: Investigating the Disturbance of Body Schema in Stroke. She has been commended on the quality of her thesis and the entire Honours program. Lindy was supervised by iCAHE members Michelle McDonnell and Susan Hillier and by Lorimer Moseley.
- The Benavides Cancer Institute (BCI) of the University of Santo Tomas Hospital (USTH) started the new year with two published projects contributing to their increasing research productivity output. The ‘Clinical audit of breast cancer care at the Benavides Cancer Institute, University of Santo Tomas Manila, Philippines: Part 1, methods and tools’ published with the Journal of Clinical Audit (http://www.dovepress.com/clinical-audit-of-breast-cancer-care-at-the-benavides-cancer-institute-peer-reviewed-article-CA) is authored by the BCI Breast Cancer Working Group and headed by BCI Chair, Dr Teresa Sy-Ortin MD, iCAHE’s research affiliates Dr Janine Margarita Dizon and Dr Bebet Suarez and iCAHE’s director Prof Karen Grimmer. This clinical audit of breast cancer care at BCI is a quality improvement pilot project aiming to assess and improve BCI’s services for patients with breast cancer in order to deliver the best quality and safe practice health care in the Philippines.
- ‘The evidence of effectiveness of intensity modulated radiotherapy versus two dimensional radiotherapy in the treatment of nasopharyngeal carcinoma: Meta analysis and a systematic review of the literature’ , published with the Head and Neck Journal (http://onlinelibrary.wiley.com/doi/10.1002/hed.23977/abstract) is authored by BCI Radio-Oncologists Dr Michael Mejia and Dr Jayson Co and iCAHE’s research affiliate Dr Janine Margarita Dizon. This meta –analysis compared the evidence between a more modern and expensive radiotherapy intervention compared to a conventional and less expensive intervention. This is particularly relevant to patients who are considering the cost of the intervention and aiming the best outcomes. This meta-analysis is the pioneer work amongst resident doctors at BCI who have been trained to undertake systematic reviews and meta-analyses. Of note, the meta-analysis has won the ‘Outstanding Research E-Poster’ at USTH last December 2014.
Hillier S, Maarten I, Dominic T. 2015. Assessing Proprioception A Systematic Review of Possibilities. Neurorehabilitation and neural repair. 1-17: 1545968315573055.
Machotka Z., Perraton L., Grimmer K. 2015. Clinical Guidelines in Sports Medicine: Am I Reading a Guideline or a Consensus Statement: What’s the Difference? Does it Matter?The Internet Journal of Allied Health Sciences and Practice. Vol. 13 No1.
Galea SL, Lee M, English C, Ada L. 2015 Sedentary Versus active behaviour in people after stroke. Physical Therapy Reviews. Vol 20:1-7
Thomas S, Mackintosh S. 2014 Use of the Theoretical Domains Framework to Develop an Intervention to Improve Physical Therapist Management of the Risk of Falls after Discharge. Physical Therapy. Vol 94:11 1660-1675
Ortin TS, Mejia M, Dizon JM, Grimmer KA, Gonzalez-Suarez CB, Bacorro W, Co J, Caguioa P, Calma C, Regala E, Baldivia K, Yolo R, Morales K, Sanchez J, Malilay R, Tabangay-Lim MI, Que J, Bautista J. 2014. Clinical Audit of Breast Cancer Care at the Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines. Part 1, methods and tools. Clinical Audit. 2015:7 1-12
Co J, Mejia M, Dizon JM. The Evidence of Effectiveness of Intensity Modulated Radiotherapy versus Two Dimensional Radiotherapy in the Treatment of Nasopharyngeal Carcinoma: Meta-Analysis and a Systematic Review of the Literature. Head and Neck. DOI: 10.1002/hed.23977
Gonzalez-Suarez M, Dones V, Grimmer-Somers K, Thoirs K, Milanese S, Atlas A. Radial nerve measurements in non-symptomatic upper extremities of Filipinos: A cross sectional studyMuscle and Nerve 2015 Jan 17. doi: 10.1002/mus.24574. [Epub ahead of print]
Widago I, Pratt N, Russell M, Roughead L. How common is frailty in older Australians? Australian Journal on Ageing (In press)
Luker, J, Bernhardt J, Grimmer K, Edwards I. A Qualitative Exploration of Discharge Destination as an Outcome or a Driver of Acute Stroke Care. BMC Health Services Research. 2014 14:193
Lynch EA, Luker J, Cadilhac D, Hillier S. Rehabilitation assessments for patients with stroke in Australian hospitals do not always reflect the patients' rehabilitation requirements. Archives of Physical Medicine and Rehabilitation. (In press) http://dx.doi.org/10.1016/j.apmr.2014.12.009
Baldwin C, Bersten A. Myopathic characteristics in septic mechanically ventilated patients. Current Opinion in Clinical Nutrition and Metabolic Care. (In press)
Bernhardt J, English C, Johnson L, Cumming T. Early mobilization after stroke. Early Adoption but Limited Evidence. Stroke AHA. DOI:10.1161/STROKEAHA.114.007434
Hodgson C, Stiller K, Needham D, Tipping C, Harrold M, Baldwin C, Bradley S, Berney S, Caruana R, Elliott D, Green M, Haines K, Higgins A, Kaukonen K, Leditschke I, Nichels M, Paratz J, Patman S, Skinner E, Young P, Zanni J, Denehy L, Webb S. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults.Critical Care. Hodgson et al. Critical Care (2014) 18:658DOI 10.1186/s13054-014-0658-y
Gonzalez-Suarez C, Dizon R, Grimmer K, Estrada M, Liao L, Malleta A, Tan M, Marfil V, Versales C, Suarez J, So K, Uyehara E. Protocol for audit of current Filipino practice in rehabilitation of stroke inpatients. Journal of Multidisciplinary Healthcare. J Multidiscip Healthc. 2015 Mar 2;8:127-38. doi: 10.2147/JMDH.S61813. eCollection 2015
Book: Nayar, S., & Stanley, M. (Eds.) (2015). Qualitative research methodologies for occupational science and therapy. London: Routledge.
English C, Bernhardt J, Crotty M, Esterman A, Segal L, Hillier S. 2015 Circuit class therapy or seven-day week therapy for increasing rehabilitation intensity of therapy after stroke (CIRCUIT): a randomized controlled trial. International Journal of Stroke. doi: 10.1111/ijs.12470. [Epub ahead of print] Abstract
Gomersall S, Norton K, Maher C, English C. 2015 In search of lost time: When people undertake a new exercise program, where does the time come from? A randomized controlled trial. Journal of Science and Medicine in Sport. Volume 18, Issue 1, Pages 43–48 Abstract
Farewell to Khushnum Pastakia
We recently farewelled our friend and colleague Khushnum Pastakia, who has taken a flying leap to work as a physiotherapist at The House of Dancing Water, a Macau-based circus. A farewell morning tea was held for Khushnum before she left in early March. Khushnum completed her Bachelor of Physiotherapy in India, at the Maharashtra University of Health Sciences, in 2005. Working in a sports clinic cemented her passion for musculoskeletal physiotherapy, leading Khushnum to Australia, where she undertook a Masters of Manual and Sports Physiotherapy here at the University of South Australia, completing the program in 2009, and being awarded the Maria Hammond prize for overall academic achievement in her final year.
Khushnum has been with iCAHE as a research assistant since 2010, pairing this with clinical work as a physiotherapist. Her work at the centre included primary and secondary research for a broad range of projects. Her practical nature, critical mind and team player attitude all contributed to her being highly valued as a skilled and supportive member of the research team. We will miss Khushnum’s presence and contribution to the centre, but know that this next step is an exciting one for her, and wish her all the best as she takes on life in ‘The City of Dreams’!
The iCAHE team, March 2015
Congratulations to Louise Wiles
Dr Louise Wiles has successfully applied for the Early Career Researcher (ECR) Development Program in 2015. The ECR Development Program is aimed at academic staff seeking opportunities for strategic career planning and skill development in the area of academic research, and who are within the first five years of their research careers after graduating with a PhD. Louise will be attending a series of monthly sessions on a range of topics, engage in discussions with experienced researchers, and receive individual mentoring on establishing a successful academic career.
iCAHE Journal Clubs
Further information: iCAHEjournalclub@unisa.edu.au
What does iCAHE Journal Club do?
iCAHE Journal Clubs (JCs) provide a sustainable way to enable a group of people to learn about and apply evidence-informed practice relevant to them. iCAHE JCs offer a supportive environment where participants can increase their knowledge of research methodologies, share experiences and discuss current practice with colleagues, whilst focusing on translating research evidence into their everyday practice.
The unique iCAHE JC model was developed as the result of research, which identified accessing and appraising literature as a major barrier to sharing and improving practice. In iCAHE JCs, researchers from the iCAHE team undertake the searching and critical appraisal. This means JC participants learn about evidence-based practice principles and processes as well as investigation of their particular issues and questions.
JCs validate current practice
‘The evidence from research offers some support to our current model of care (home based supervised exercise programs); the interventions described in the article are very similar to the approach taken here and supports our current clinical practice’
JCs identify development needs
‘Our staff needs to be educated about the importance of the following: promotion of restorative care principles, and encouraging a service-wide wellness approach’
JCs identify implementation barriers
'The research illustrated the cost implications to patients/family (e.g. Gluten-free diet was found to have positive impact on autism-related behaviour; however, this could increase food bills, which in turn would place greater financial burden on families)'
JCs frame future strategies
‘Following discussion of research evidence, journal club members identified important variables that need to be integrated into their client system (mood of the client, extent of carer burden, noting when a person is especially isolated); journal club members recommended a ‘one stop’ phone in point to ensure clients get in contact with the services they needed; Domiciliary Care needs to consider how the CDC (consumer directed care) approach might be incorporated into existing services or if new models of flexible care need to be developed’.
Update on iCAHE JCs
We are currently supporting over 30 JCs. JC groups have expanded beyond the original allied health practitioner focus to now include health consumer representatives and education and early childhood development groups.
The 2015 Journal Club Training Program has been reviewed and updated, based on feedback from previous JC participants.
The Starter Training Module now streamlines the JC theory component and has an additional section on facilitation. This includes the opportunity to hear from other JC facilitators and to participate in a ‘mock’ Journal Club to experience how one can operate.
Tailored JC Facilitator Training packages are now available. These focus on aspects such as continuing professional development; professional performance management; developing health policies; and quality improvement. The aim of this series is to build upon current facilitator’s capabilities and provide them with the knowledge and tools to further refine their Journal Clubs to best meet their needs.
Interested facilitators – and people interested in becoming a JC facilitator, can contact us at: iCAHEjournalclub@unisa.edu.au
JC Critical appraisals
The critical appraisals prepared for JCs by iCAHE researchers are published on our website (www.unisa.edu.au/cahe). The following critical appraisal, along with the article appraised, give an indication of the nature of the debate, discussion and learning that can be covered in iCAHE JCs.
Smith SG, Curtis LM, Wardle J, von Wagner C, Wolf MS (2013) Skill Set or Mind Set? Associations between Health Literacy, Patient Activation and Health. PLoS ONE 8(9): e74373. doi:10.1371/journal.pone.0074373
Link to the iCAHE Critical Appraisal Summary of the Smith et al. 2013 article.
Tips to running a successful Journal Club
Many people ask us about what makes a successful Journal Club, so we thought we would share with you our top tips for getting the most out of your Journal Club in 2015.
- Identify central aims/ objectives that the Journal Club considers important. This can be done via hard copy surveys or survey monkey – have a few options and people can vote.
- Once the survey results have been collated, refine these areas of interest to one or two central aims/objectives which your Journal Club would like to achieve. If the collated results have too many areas this may be a time to take it back to the group to vote on one or two main aims/ objectives. From these main aims, as a club you will be able to design a series of journal club questions around the central aim(s)/question(s).
- Email a reminder and a ‘teaser’ about what the upcoming Journal Club meeting will be focussing on.
- Newsletter highlights are a great way to attract other staff at your organisation to get involved and to be able to share the fantastic work you are involved in – and of course to share the interesting things you are finding out through being involved in a Journal Club.
- Having the facilities to include rural and remote staff in your organisation is a big plus. Using Skype, videoconferencing or teleconferencing facilities is a great way to build your Journal Club community. It will increase your attendance, allow you to network within or across organisations and allow for different perspectives to be discussed.
- Food – I don’t think that this step to success needs any explaining… everybody loves food!
iCAHE would like to acknowledge Lauren Woodford (Occupational Therapist, Central Adelaide Local Health Network) and the Central Adelaide Palliative Care Service’s Journal Club for their exceptional work and commitment to evidenced-based practice, and thank them for providing many of these tips on conducting a successful journal club.
We would love to hear your top tips for getting the most out of your Journal Club. Please email us on iCAHEjournalclub@unisa.edu.au with your top tips.
The Journal Club Process
- Complete the getting started checklist and forward it to iCAHEjournalclub@unisa.edu.au
- Identify the group facilitator.
- Arrange for the facilitator to attend iCAHE JC Facilitator Stater Pack Training
- Get started.
iCAHE staff can assist you to begin your meetings even before your have a trained Facilitator.
Work through the JC process (click here to view the JC process). As you will see in the diagram, the first step involves the development of a clinical scenario or a topic (clinical question) by the JC members. Once you have a topic, this is refined using what we call “PICO” framework. For a definition of PICO (or navigate to find another framework PECOT) please see the iCAHE glossary of terms. For more examples of clinical scenarios and PICOs which have been used by current journal clubs for their meetings, you may refer to the critical appraisal summaries uploaded on our website.
As facilitator of the journal club, you are expected to submit (via email) the clinical scenario and PICO 3-4 weeks prior to your scheduled meeting. As soon as iCAHE receive your PICO, we will run a search to find the most relevant research evidence to address your clinical question. iCAHE will send you relevant abstracts and you have to decide which one is most applicable to your practice. When you have selected the article, I will send you the publication as well as the critical appraisal tool (click here for an example of a critical appraisal tool), which you need to distribute to the members ideally a week before the meeting. The questions in the critical appraisal tool will serve as points for discussion during the journal club meeting. iCAHE will appraise the article and send the appraisal summary in time for the meeting.
Please contact the journal club team at iCAHEjournalclub@unisa.edu.au - we would love to hear from you!
iCAHE JC for consumer representatives
Since 2007 iCAHE has been supporting allied health practitioners in Australia organise and implement a structured journal club as a vehicle for promoting evidence-based practice in allied health. In 2014, as recognition of the integral role of consumer engagement in health care, iCAHE and the Health Consumers Alliance (HCA) of South Australia (hcasa.asn.au) undertook a project to see if the same journal club model would benefit and support the work of trained health consumer representatives.
The intention was to keep consumer representatives informed of the current best evidence on effective strategies for engaging and representing consumers at different areas of health care: governance and policy, services and individual care. Prior to the establishment of the consumer JC, iCAHE consulted with a range of consumer representatives to determine whether this approach is appropriate, relevant and sustainable for consumer representatives. A summary of themes which emerged from the consultation is outlined below:
Based on findings from the consultation, a journal club framework was implemented which consisted of an initial training session (Session 1) and a block of three sessions (Sessions 2-4) on a range of topics. Nine consumer representatives agreed to pilot-test the journal club framework.
Session 1: The training session focussed on evidence-based practice and framing well-structured questions relevant to practice. At the end of the training, the pilot group identified a topic/question for each of the three sessions, which were submitted to iCAHE researchers who then executed a search strategy to identify the most relevant research evidence. The group also nominated a member to act as a facilitator (i.e. liaison between the pilot group and iCAHE).
Sessions 2-4: The sessions were organised fortnightly and co-facilitated by a researcher from iCAHE and a Senior Consumer Engagement Officer from HCA. For every session, iCAHE provided the research publication and plain language summary to the facilitator for dissemination to all journal club members one week prior to the scheduled meeting. On the day, the members discussed the article not only in the context of the results but how it may influence their work as consumer representatives and what can be learnt from it.
An independent researcher from iCAHE followed up with journal club members after the last session to explore the impact of journal club in supporting consumer advocacy and representation. Individual interviews were undertaken with journal club members who consented to participate. Overall, there was an agreement that the journal club concept was a good initiative and that the idea of using good quality research evidence in informing consumer advocacy was invaluable. One of the participants commented:
Certainly the one that I attended, it was really good. Which are really true research papers and journal documents? I think I found that very interesting because, you know, I’ve been at things where you say, “How many have they researched?” It might only be 20 people and you wonder about the documents and validation of that. I thought that session that told us how to really tell, you know, the difference. That was very helpful and I really would like more in depth on that.
When asked about the usefulness of research findings discussed during journal club meetings, one of the participants said:
One of the papers we discussed was around the working together of health practitioners and patients to plan diets for those who had had gastrectomy due to stomach cancer. One of our participants communicated this study to some of the clinical leaders and said “What are we doing in South Australia about working with cancer consumers and dietary planning because this study shows if you do that there’d be better adherent to what are correct diets once you’ve had operations” and things, and the actual leader wrote back saying “Yes, this is really important to take note of and we need to be mindful of what we’re doing”. So you could see that was a direct example of someone actually using that evidence to ask a question around their committee and who they are in networks with. So that was great.
While the participants recognised the value of journal club, they also identified challenges and opportunities to improve its implementation. For example, one of the participants mentioned that, in order to improve participation and commitment, journal club organisers explicitly acknowledge and inform participants about the culture shift from purely personal experience and storytelling to rigorous research.
We’re talking about a big culture shift in the way consumer advocates think about themselves and do their work and I think it’s a big culture shift to go from personal experience and individual storytelling and anecdote; it’s a big jump from that to rigorous research. And having said that, it may have been in terms of improving this sort of exercise in future for the organisers to actually explicitly acknowledge that and explicitly talk about how the individual story and experience will either be put to one side for the purpose of enquiring in a more systematic and rigorous way or how the individual story could help, you know, be harnessed to frame the question but with a preparedness to leave the individual story aside and focus on the evidence.
The participants agreed that it might be more useful for consumer representatives if the topics or questions are specific to their agenda (specific local consumer groups for example, a group of renal patients) and what their actual interests are, rather than engaging in general discussions about consumer engagement which are not always viewed as relevant to their role.
I think it was a hard call for a group of desperately interested advocates on different kinds of things in different parts of the city to engage with questions that they may not have seen as relevant or interesting to their role.
The pilot evaluation of the journal club suggests that a journal club approach is likely to be used by consumer representatives to guide their practice. In keeping with the co-design approach to the project, the findings from this evaluation will be used to refine the structure and process of the current journal club model.