Mapping for Conceptual Clarity: Exploring Implementation of Integrated Community-Based Primary Health Care from a Whole Systems Perspective

Abstract

Introduction:Studying implementation of integrated models of community-based primary health care requires a “whole systems” multidisciplinary approach to capture micro, meso and macro factors. However, there is, as yet, no clear operationalization of a “whole systems” approach to guide multidisciplinary research programs. Theoretical frameworks and approaches from diverse academic traditions specify different aspects of the health system in more depth. Enabling analysis across the system, when data and ideas are captured using different taxonomies, requires that we map terms and constructs across the models.Theory and methods:This paper uses concept mapping techniques to compare and contrast the theoretical frameworks and approaches used in the iCOACH project including: Ham’s Ten Characteristics of the High-Performing Chronic Care System (capturing patient/carer and provider perspectives), the Organizational Context and Capabilities for Integrating Care framework (capturing the organizational perspective), and the Health Policy Monitor framework (capturing the policy system perspective). The aim of the paper is to link concepts across different theoretical framework to guide the iCOACH study.Results:A concept map was developed that identifies 8 overarching concepts across the heuristic models. A preliminary analysis of one of these overarching concepts, care coordination, demonstrates how different perspectives will assign different meanings, values, and drivers of seemingly similar ideas. For patients and carers care coordination is about having a responsive team of health care providers. Building relationships in teams that exist within and across different organizations is essential for providers to achieve care coordination, where managers and policy makers see care coordination as being more about creating linkages and addressing systems gaps.Discussion and conclusion:This work represents a first step towards development of a fully formed conceptual framework that includes key domains, concepts, and mechanisms of implementing integrated community-based primary health care.

Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies

“…Each theory suggests a different perspective of the individual in the implementation. Our previous work in concept mapping to inform the iCOACH study has shown that drawing on different theoretical perspectives will allow for a more in-depth and varied understanding of meanings and values assigned to seemingly similar constructs [ 38 ]. Combining theoretical frameworks ensures we are not missing these varied perspectives of participants in our analysis of findings.…”

“…A table was generated mapping constructs from the theories to the domains and was agreed upon by the co-authors. We have used similar methods of concept mapping when adopting multiple theoretical frameworks [ 38 ]. Using this method, we identified four core domains: (1) characteristics of individuals adopting technology, (2) the organizational and (3) external environment , and (4) the characteristics of the technology .…”

Implementing Integrated Community-Based Primary Healthcare: Applying the iCoach-Approach to Case Selection to Denmark

“…This turned out to be an exercise of indirect case selection at the systems level. A distinct feature of the iCoach approach is that the criteria for case selection include but go beyond the system level, reflecting a ‘whole systems’ approach [44]. This is otherwise the typical level for case selections in cross-country comparative research designs [45].…”

From summative to developmental

“…Lessons learned from designing and evaluating ePRO and evaluating other complex technologies, as well as our experiences studying the implementation of international models of integrated care (Breton et al, 2017;Steele Gray, Wodchis, Baker, Carswell, Kenealy, McKillop, Breton, Parsons and Sheridan, 2018;Steele Gray, Barnsley, Gagnon, Belzile, Kenealy, Shaw, Sheridan, Wankah and Wodchis, 2018;Evans et al, 2017;McKillop et al, 2017;Kuluski et al, 2017;Shaw et al, 2017) suggest that the nuance and intricacy of leadership, personal relationships and different communication strategies is critical. These intangible qualities have been argued to be cornerstones of integrated care (Glasby, 2016).…”