Designing a Process Model of Home Care Service Delivery in Iran: A Mixed Methods Study

Document Type : Original Article

Authors

1 Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

2 Department of English Language, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran

3 Social Determinants of Health Research Center, Lorestan University of Medical Science, Khorramabad, Iran

4 Department of Community Health Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.

5 Department of Home-Based Palliative Care, ALA Cancer Prevention and Control of Charity Center (MACSA), Charity Foundation, Tehran, Iran

Abstract

Background: Considering the position of home health care in the current world, the objective of this study was to design an applied model of providing home care services in Iran.
Methods: The mixed methods approach was employed in three stages in Iran from Feb 2015 to Sep 2016. During the first phase, the qualitative method of content analysis was used. Data were collected by conducting 26 individual interviews and holding one focus group session involving 7 people. Data analysis was based on Graneheim and Lundman’s approach to content analysis.
In the second phase of the study, a literature review was carried out and at the end of this stage, a preliminary model was designed. The model was standardized in the third phase using the Delphi method with 23 participants in two rounds.
Results: Inthe first and second stages of the study, various categories emerged including patient referral, agreement, determination of the needed level of care, care plans designing, provision of comprehensive services, documentation, service monitoring,inter-professional cooperation, issuance of death certificates at home, ethical considerations, and the evaluation of services. Then, in the Delphi phase, 20 (95.2%) of the experts confirmed the structure and content of the model and its applicability.
Conclusion: The designed model can be helpful in organizing the provision of integrated and comprehensive health services to clients at home, which can be effective in improving the clients’ health and enhancing their self-care and autonomy.

Keywords


  1.  

    1. Nikbakht-Nasrabadi A, Shabany-Hamedan M. Providing healthcare services at home-a necessity in Iran: A narrative review article. Iranian Journal of Public Health. 2016;45:867-74.
    2. Genet N, Boerma W, Kroneman M, et al. Home care across Europe. Geneva: World Health Organization; 2012.
    3. Murtaugh C, Peng T, Totten A, et al. Complexity in geriatric home healthcare. Journal for Healthcare Quality. 2009;31:34-43.
    4. World Health Organization. The growing need for home health care for the elderly. Geneva: World Health Organization: 2015.
    5. World Health Organization. Solid facts: home care in Europe. Geneva: World Health Organization; 2008.
    6. Han SJ, Kim HK, Storfjell J, Kim MJ. Clinical Outcomes and Quality of Life of Home Health Care Patients. Asian Nursing Research. 2013;7:53-60.
    7. Ajlouni MT, Dawani H, Diab SM. Home Health Care (HHC) Managers Perceptions About Challenges and Obstacles that Hinder HHC Services in Jordan. Global Journal of Health Science. 2015;7:121-9.
    8. Valizadeh L, Zamanzadeh V, Saber S, Kianian T. Challenges and Barriers Faced by Home Care Centers: An Integrative Review. Medical Surgical Nursing Journal. 2018;7:e83486.
    9. Landers S, Madigan E, Leff B, et al. The Future of Home Health Care: A Strategic Framework for Optimizing Value. Home Health Care Management & Practice. 2016;28:262-78.
    10. Shahsavari H, Nasrabadi AN, Almasian M, et al. Exploration of the administrative aspects of the delivery of home health care services: a qualitative study. Asia Pacific Family Medicine. 2018;17:1.
    11. Central Office of Information for the Department of Health. Personalized Care Planning. UK: Central Office of Information for the Department of Health; 2011.
    12. Morales-Asencio JM, Gonzalo-Jiménez E, Martin-Santos FJ, et al. Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study. BMC Health Services Research. 2008;8:193.
    13. Genet N, Boerma WG, Kringos DS, et al. Home care in Europe: a systematic literature review. BMC Health Services Research. 2011;11:207.
    14. Xiao N, Long Q, Tang X, Tang S. A community-based approach to non-communicable chronic disease management within a context of advancing universal health coverage in China: progress and challenges. BMC Public Health. 2014;14:S2.
    15. World Health Organization. Noncommunicable Diseases (NCD) Country Profiles, 2018. Geneva: World Health Organization; 2018. [Cited 25 May 2019]. Available from: https://www.who.int/nmh/countries/irn_en.pdf?ua=1.
    16. Zanganeh*Baygi M, Seyedin H, Salehi M, Jafari*Sirizi M. Structural and contextual dimensions of Iranian primary health care system at local level. Iranian Red Crescent Medical Journal. 2015;17:e17222.
    17. Heydari H, Shahsavari H, Hazini A, Nikbakht*Nasrabadi A. Exploring the Barriers of Home Care Services in Iran: A Qualitative Study. Scientifica. 2016;2016.
    18. Speziale HS, Streubert HJ, Carpenter DR. Qualitative research in nursing: Advancing the humanistic imperative. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2011.
    19. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24:105-12.
    20. Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2009.
    21. Irani E, Hirschman KB, Cacchione PZ, Bowles KH. Home health nurse decision-making regarding visit intensity planning for newly admitted patients: a qualitative descriptive study. Home Health Care Services Quarterly. 2018;37:211-31.
    22. World Health Organization. Comprehensive Community and Home-Based Health Care Model. India: WHO Regional Office for South-East Asia; 2004.
    23. Stajduhar KI, Funk L, Roberts D, et al. Home care nurses’ decisions about the need for and amount of service at the end of life. Journal of Advanced Nursing. 2011;67:276-86.
    24. Scholz J, Minaudo J. Registered nurse care coordination: Creating a preferred future for older adults with multimorbidity. The Online Journal of Issues in Nursing. 2015;20:4.
    25. Curry N, Ham C. Clinical and service integration: the route to improved outcomes. London: King’s Fund; 2010.
    26. Emanuel L, Librach SL. Palliative Care. 2nd ed. Philadelphia: Saunders; 2011.