Joseph, Linju Maria (2024). An exploration of patient-held health records for improving handover communication and self-management for patients with diabetes and hypertension in outpatient settings in Kerala, India. University of Birmingham. Ph.D.
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Abstract
High-quality health systems need to optimise healthcare delivery based on the changing health needs of the population. Long-term management of non-communicable diseases (NCDs) requires patients, carers, and health care providers (HCPs) to work together for optimal results. Patient medical information is essential for all HCPs to provide quality care. Additionally, patients and carers need information for self-management. Patient-held records (PHRs) are widely used in low and middle-income countries (LMICs) such as India, to document and hand over medical information to HCPs and other HCPs or patients or carers. A previous clinical handover study in India found that handover communication was poor for patients with NCDs in outpatient settings and suggested a structured PHR for patients with NCDs.
The overall aim of this thesis was to synthesise the evidence base, explore the perceptions of patients, carers and HCPs regarding the use of PHRs and understand the factors that affect the use of PHRs for handover communication, information transfer, and self-management; that can
contribute to development or improvement of a future PHR.
In the first results chapter, evidence of the effectiveness and perceived usefulness of PHRs in LMIC is synthesised. Chapter three uses systematic reviews (SR) of PHRs for NCDs and home-based records for maternal and child health records to summarize evidence on PHRs in LMICs. Notably, the above SRs indicate limited studies evaluating PHRs for improving handover communication and self-management. Next chapter details the findings of a qualitative study among patients with diabetes and hypertension, carers, and HCPs from Kerala, India to explore their experiences with current PHRs and reports the similarities and differences in their perspectives on the use and value of current PHRs. Chapter four demonstrates that patients, carers, and HCPs use PHRs in practice; however, their perceived value of PHRs is different. Patients value the PHRs for medication procurement, while carers value them for communication during emergencies with HCPs. However, HCPs perceive PHRs as documents that aid them in clinical decision-making and preventing errors. Patients do not use PHRs for self-management, and HCPs do not use them for communicating self-management information. Chapter five reports patient navigations in the health system, HCP-patient interactions, and lack of agency over illness and overall health as contextual influences that play a role in patients' lack of engagement with PHRs. Chapter six reports a qualitative analysis of HCP data with the theoretical domains framework (TDF) to identify barriers and facilitators for HCPs to use PHRs for maintaining continuity of care in Kerala. Findings indicate that nine domains are likely to influence HCPs' in recording PHRs and communicating with patients and carers in Kerala. Chapter seven presents a plan for co-designing a PHR to be used in Kerala and proposes that an experience-based co-design (EBCD) method may improve user engagement with PHRs.
The thesis findings highlight the complexities and challenges of using PHRs in public health settings in Kerala and indicate suboptimal utilisation of current PHRs for handover communication, information transfer, and self-management. Based on these results, co-designing a PHR is proposed as a potential method to improve handover communication, information transfer, and self-management among patients with diabetes and hypertension in Kerala.
| Type of Work: | Thesis (Doctorates > Ph.D.) | |||||||||||||||
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| Award Type: | Doctorates > Ph.D. | |||||||||||||||
| Supervisor(s): |
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| Licence: | All rights reserved | |||||||||||||||
| College/Faculty: | Colleges (2008 onwards) > College of Medical & Dental Sciences | |||||||||||||||
| School or Department: | Institute of Applied Health Research | |||||||||||||||
| Funders: | None/not applicable | |||||||||||||||
| Subjects: | R Medicine > R Medicine (General) | |||||||||||||||
| URI: | http://etheses.bham.ac.uk/id/eprint/14534 |
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