Healthcare consumers' and professionals' perceived acceptability of evidence‐based interventions for rural transitional care

Abstract

Background: There is a pressing need for high quality hospital-to-home transitional care in rural communities. Four evidence-based interventions (discharge planning, treatments, warning signs, and physical activity) have the potential to improve rural transitional care. However, there is limited understanding of how the perceptions of healthcare consumers and professionals compare on the acceptability of the interventions. Convergent views on intervention acceptability support implementation, whereas divergent views highlight areas requiring reconciliation prior to implementation. Aims: This study compared the acceptability of four evidence-based interventions proposed for rural transitional care, as perceived by healthcare consumers and professionals. Methods: A cross-sectional, comparative design was used. The convenience sample included 36 healthcare consumers (20 patients and 16 family caregivers) who had experienced a hospital-to-home transition in the past month and 30 healthcare professionals (29 registered nurses and one nurse practitioner) who provided transitional care in rural Ontario, Canada. Participants were presented with descriptions of the four interventions and completed an established intervention acceptability measure. Presentation of the four intervention descriptions and respective acceptability measures was randomized to control for possible order effects. The perceived overall acceptability of the interventions and their attributes (i.e., effectiveness, appropriateness, risk, and convenience) were compared using independent samples t-tests.Results: Consumer ratings were consistently higher across all four interventions in terms of overall acceptability as well as effectiveness, appropriateness, and convenience (all p's < .01; effect sizes 0.70-1.13). No significant between-group differences in perceived risk were found.Linking evidence to action: Contextual and methodological differences may account for variability in ratings, but further research is needed to explore these propositions.The results support future qualitative inquiry targeting professionals to better understand their perspectives on the effectiveness, appropriateness, and convenience of the four interventions.

Family caregivers’ perspectives on the acceptability of four interventions proposed for rural transitional care: A multi-method study

“…The scale has demonstrated internal consistency reliability (alpha > .80) [ 23 – 26 ] as well as content, discriminant [ 25 , 26 ] and factorial validity (factor loadings > .30) [ 25 ] in prior research on different health interventions and populations. In the larger study, the scale had Cronbach alphas ranging from 0.85 to 0.89 across the four interventions [ 27 ].…”

Healthcare providers’ perceived acceptability of a warning signs intervention for rural hospital-to-home transitional care: A cross-sectional study

“…Furthermore, the transition from hospital to home constitutes a marked shift from provider-driven to self-managed care for rural patients. After hospital discharge, many patients and their families find themselves managing care previously provided by nurses in hospital (e.g., watching for worsening health conditions), typically with minimal training and professional guidance [6][7][8].…”

“…In our prior research, older rural medical patients at risk for hospital readmission and their families indicated that their most pressing unmet TC need was knowing how to recognize and address the signs of worsening health conditions [6][7][8]. Evidence indicates that patients typically receive little preparation in this regard and require more education prior to discharge on whether a sign or symptom necessitates professional intervention [9].…”

“…To promote patient understanding, the intervention deploys the teach-back method, as well as educational materials that use lay language, symbols, and pictograms [22]. In our previous work, patients and their family caregivers rated the warning signs intervention as highly acceptable in preparing them to detect and respond to worsening health conditions [7], indicating that they would be very receptive to receiving it [23].…”

“…Examining their perspectives is important because, although the warning signs intervention is primarily delivered by nurses, its implementation is inherently interprofessional and often involves collaboration with other healthcare providers (HCPs) [18]. For example, if nurses and other HCPs perceive the intervention to have limited relevance, widespread adoption is unlikely [7]. Similarly, if nurses and other HCPs lack confidence in their ability to deliver the intervention, then further work can be done to help develop their knowledge and skill to competently deliver it.…”