Human factors and ergonomics approaches have been successfully applied to study and improve the work performance of healthcare professionals. However, there has been relatively little work in “patient-engaged human factors,” or the application of human factors to the health-related work of patients and other nonprofessionals. This study applied a foundational human factors tool, the systems model, to investigate the barriers to self-care performance among chronically ill elderly patients and their informal (family) caregivers. A Patient Work System model was developed to guide the collection and analysis of interviews, surveys, and observations of patients with heart failure (n=30) and their informal caregivers (n=14). Iterative analyses revealed the nature and prevalence of self-care barriers across components of the Patient Work System. Person-related barriers were common and stemmed from patients’ biomedical conditions, limitations, knowledge deficits, preferences, and perceptions as well as the characteristics of informal caregivers and healthcare professionals. Task barriers were also highly prevalent and included task difficulty, timing, complexity, ambiguity, conflict, and undesirable consequences. Tool barriers were related to both availability and access of tools and technologies and their design, usability, and impact. Context barriers were found across three domains—physical-spatial, social-cultural, and organizational—and multiple “spaces” such as “at home,” “on the go,” and “in the community.” Barriers often stemmed not from single factors but from the interaction of several work system components. Study findings suggest the need to further explore multiple actors, context, and interactions in the patient work system during research and intervention design, as well as the need to develop new models and measures for studying patient and family work.
Human factors/ergonomics recognizes work as embedded in and shaped by levels of social, physical, and organizational context. This study investigates the contextual or macroergonomic factors present in the health-related work performed by patients. We performed a secondary content analysis of findings from three studies of the work of chronically ill patients and their informal caregivers. Our resulting consolidated macroergonomic patient work system model identifies seventeen factors across physical, social, and organizational domains and household and community levels. These factors are illustrated with examples from the three studies and discussed as having positive, negative, or varying effects on health and health behavior. We present three brief case studies to illustrate how macroergonomic factors combine across domains and levels to shape performance in expected and unexpected ways. Findings demonstrate not only the importance of context for patients’ health-related activities but also specific factors to consider in future research, design, and policy efforts.
Objective
To pilot a sociotechnical systems-based instrument that assesses the prevalence
and nature of self-care barriers among patients presenting to the emergency department
(ED) with acute heart failure.
Methods
A semi-structured instrument for measuring self-reported self-care barriers was
developed and administered by ED clinicians and non-clinician researchers to 31 ED
patients diagnosed with acute heart failure. Responses were analyzed using descriptive
statistics and qualitative content analysis. Feasibility was assessed by examining
participant cooperation rates, instrument completion times, item nonresponse, and data
yield.
Results
Of 47 distinct self-care barriers assessed, a median of 15 per patient were
indicated as “sometimes” or “often” present. Thirty-four
specific barriers were reported by over 25% of patients and nine were reported by over
50%. The sources of barriers included the person, self-care tasks, tools and
technologies, and organizational, social, and physical contexts. Seven of the top ten
most prevalent barriers were related to patient characteristics and the next three to
the organizational context (e.g., life disruptions). A preliminary feasibility
assessment found few item nonresponses or comprehension difficulties, good cooperation,
high data yield from both closed- and open-ended items, but opportunities to reduce
median administration time and variability.
Conclusions
An instrument assessing self-care barriers from multiple system sources can be
feasibly implemented in the ED. Further research is required to modify the instrument
for widespread use and evaluate its implementation across institutions and cultural
contexts. Self-care barriers measurement can be one component of broader inquiry into
the distributed health-related “work” activity of patients, caregivers,
and clinicians.
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