Methods: In the first phase, qualitative research was conducted to better understand collaboration in a psychiatric hospital (previously published). In the second phase a local hospital level committee from the same hospital was created to act on the qualitative research and create a set of recommendations to improve collaborative practice at the hospital for the hospital. Some of these recommendations were implemented, where feasible and the outcomes discussed. These recommendations were then sent to a nationwide Delphi panel. These committees consisted of healthcare staff of various professions, patients and carers.
Results: The Delphi panel reached consensus after three rounds. The recommendations include ways to improve collaborative problem solving and decision making in the hospital, ways to improve the autonomy and relatedness of patients, carers and staff and ways to improve the levels of resources (e.g. skills training in staff, allowing people with lived experience of mental disorder to contribute).
Conclusions: This study showed that the Delphi method is a feasible method of developing recommendations and guidelines in Malaysia and allowed a wider range of stakeholders to contribute than traditional methods of developing guidelines and recommendations.Trial registration Registered in the National Medical Research Register, Malaysia, NMRR-13-308-14792.
METHODS: A shared decision-making scale was developed using a qualitative research derived model and refined using Rasch and factor analysis. The scale was used by staff in the hospital for four consecutive years (n = 152, 121, 119 and 121) and by two independent patients' and carers' samples (n = 223 and 236).
RESULTS: Respondents had difficulty determining what constituted a decision and the scale was redeveloped after first use in patients and carers. The initial focus on shared decision-making was changed to shared problem-solving. Two factors were found in the first staff sample: shared problem-solving and shared decision-making. The structure was confirmed on the second patients' and carers' sample and an independent staff sample consisting of the first data-points for the last three years. The shared problem-solving and decision-making scale (SPSDM) demonstrated evidence of convergent and divergent validity, internal consistency, measurement invariance on longitudinal data and sensitivity to change.
CONCLUSIONS: Shared problem-solving was easier to measure than shared decision-making in this context.
PRACTICE IMPLICATIONS: Shared problem-solving is an important component of collaboration, as well as shared decision-making.
AIMS: To better understand collaboration between and within these systems and create a theoretical framework for system development.
METHOD: A total of 26 focus groups and 27 individual interviews were undertaken with patients, carers, psychiatric hospital staff, primary care and district hospital staff, religious and traditional healers, community leaders, non-governmental organisation workers, and school and college counsellors. Grounded theory methods were used to analyse the data and create a theory of collaboration.
RESULTS: Three themes both defined and enabled collaboration: (a) collaborative behaviours; (b) motivation towards a common goal or value; and (c) autonomy. Three other enablers of collaboration were identified: (d) relatedness (for example trusting, understanding and caring about the other); (e) resources (competence, time, physical resources and opportunities); and (f) motivation for collaboration (weighing up the personal costs versus benefits of acting collaboratively).
CONCLUSIONS: The first three themes provided a definition of collaboration in this context: 'two or more parties working together towards a common goal or value, while maintaining autonomy'. The main barriers to collaboration were lack of autonomy, relatedness, motivation and resources, together with the potential cost of acting collaboratively without reciprocation. Finding ways to change these structural, cultural and organisational features is likely to improve collaboration in this system and improve access to care and outcomes for patients.
METHODS: Thirty-four polymorphisms in 26 genes were typed by mass spectrometry in 422 patients undergoing endoscopy (162 Chinese, 113 Indian and 87 Malay controls and 60 Chinese GC cases). Patients were assessed for evidence of H. pylori infection. Odds ratios (OR) and confidence intervals (CI) were obtained using logistic regression models.
RESULT: The prevalence of 16 polymorphisms varied significantly among the ethnicities. In the Chinese subgroup, nominally significant associations were shown between (i) EBBR2+1963G (rs1801200) and H. pylori infection (per-allele OR: 0.48, 95% CI 0.23, 0.98, P = 0.04), (ii) PTGS2-1195G (rs689466) and an increased risk of GC on adjusting for H. pylori status (OR: 1.53, 95% CI 0.99, 2.37, P = 0.05), and (iii) IL1B-1473C (rs1143623) and a decreased risk of GC (OR: 0.64, 95% CI 0.41, 0.99, P = 0.05). Borderline significant associations were seen between IL2-330G (rs2069762) (OR 1.45, 95% CI 0.95, 2.15, P = 0.06) and IL13-1111T (rs1800925) (OR 0.65, 95% CI 0.42, 1.01, P = 0.06) and H. pylori infection.
CONCLUSION: These findings contribute to the understanding of the genetic variation between ethnicities, which may influence H. pylori susceptibility and the outcome of infection.
MATERIALS: Focus group and individual interviews with patients, carers, healthcare staff, religious authorities, traditional healers and community members.
DISCUSSION: Four stages of help seeking were identified: (1) noticing symptoms and initial labelling, (2) collective decision-making, (3) spiritual diagnoses and treatment and (4) psychiatric diagnosis and treatment.
CONCLUSION: Spiritual diagnoses have the advantage of being less stigmatising, giving meaning to symptoms, and were seen to offer hope of cure rather than just symptom control. Patients and carers need help to integrate different explanatory models into a meaningful whole.