Using a co-design process to develop an integrated model of care for delivering self-management intervention to multi-morbid COPD people in rural Nepal

Abstract

Background People with chronic obstructive pulmonary disease (COPD) in Nepal are not receiving adequate support to self-manage their chronic conditions, and primary health care can play a key role in the effective management of these. In this study, we aimed to develop a model of care, using a co-design approach, for delivering evidence-based biomedical and psycho-social care to support self-management for people with multi-morbid COPD in rural Nepal. Methods A co-design approach, guided by the five stages of the design thinking model, was used for this study. Layering on “empathize” and “define” phases, we ideated a model of care that was further refined in a “prototype” stage, which included a series of consultative meetings and a 1-day co-design workshop with stakeholders. This co-design process involved a wide range of stakeholders from Nepal, including people with COPD and their families, community representatives, local government representatives, primary care practitioners, community health workers, policymakers, state-level government representatives and academics. Results Through our co-design approach, a model of integrated care for delivering evidence-based biomedical and psycho-social care to support self-management for people with multi-morbid COPD was designed. The integrated model of care included: screening of the community members aged > 40 years or exhibiting symptoms for COPD and management of symptomatic patients within primary health care, establishing referral pathways for severe cases to and from secondary/tertiary-level health care and establishing a community-based support system. It involved specific roles for community health workers, patients and their caregivers and community representatives. It was built on existing services and programmes linking primary health care centres and tertiary-level health facilities. Conclusion The co-design approach is different from the currently dominant approach of rolling out models of care, which were designed elsewhere with minimal community engagement. In our study, the co-design approach was found to be effective in engaging various stakeholders and in developing a model of care for rural Nepal. This grassroots approach is more likely to be acceptable, effective and sustainable in rural Nepal. Further research is required to test the effectiveness of an integrated model of care in delivering self-management support for people with multi-morbid COPD in rural Nepal.

Analyzing the Implementation of Policies and Guidelines for the Prevention and Management of Type 2 Diabetes at Primary Health Care Level in Nepal

“…The overall findings of the study suggest the need for developing context-specific cost-effective intervention approaches to prevention and control of NCDs including diabetes. Further, co-designing approach ( 45 ) could be adopted that will address the concerns of all stakeholders and design the people centered interventions that could be scalable to primary care level across the country.…”

Older adults with non-communicable chronic conditions and their health care access amid COVID-19 pandemic in Bangladesh: Findings from a cross-sectional study

“…The current pandemic provides us with an opportunity to evaluate our existing practices to deliver essential health care services during emergencies to the most vulnerable groups and strengthen national emergency preparedness system. Engagement of both private and public healthcare institutions along with other stakeholders in health service design [47] would be essential design people centred care model to maintain access to basic health services (such as screening, medical check-ups, and pharmacy services) during the emergency and beyond. Decision makers should also design the strategies that can address the needs of the older adults with non-communicable disease to provide basic health care services required for maintaining good health at the community level through primary health care approach.…”

Preventing Drift through Continued Co-Design with a First Nations Community: Refining the Prototype of a Tiered FASD Assessment

“…The findings in this study confirm the need for continuous co-design and strong, genuine relationships with the community to prevent drift back to dominant cultural ways when implementing health services with and for First Nations communities. Continuous co-design and stakeholder engagement throughout the life of a co-designed project has offered checks and balances for ensuring outcomes were community- rather than expert-focused, demonstrating positive outcomes in other studies [ 35 , 36 ]. Brief and limited co-design sessions at the start of a project, or committees that involve community members, but do not engage in consistent co-design throughout the implementation stages, can lead to issues in achieving desired outcomes [ 37 ].…”