Understanding care navigation by older adults with multimorbidity: mixed-methods study using social network and framework analyses

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dc.contributor.authorVos, Jolien
dc.contributor.authorGerling, Kathrin
dc.contributor.authorLinehan, Conor
dc.contributor.authorSiriwardena, Aloysius N.
dc.contributor.authorWindle, Karen
dc.date.accessioned2019-07-16T15:23:41Z
dc.date.available2019-07-16T15:23:41Z
dc.date.issued2018-11-14
dc.description.abstractBackground: Health and social care systems were designed to be used primarily by people with single and acute diseases. However, a growing number of older adults are diagnosed with multiple long-term conditions (LTCs). The process of navigating the intricacies of health and social care systems to receive appropriate care presents significant challenges for older people living with multiple LTCs, which in turn can negatively influence their well-being and quality of life. Objective: The long-term goal of this work is to design technology to assist people with LTCs in navigating health and social care systems. To do so, we must first understand how older people living with LTCs currently engage with and navigate their care networks. No published research describes and analyses the structure of formal and informal care networks of older adults with multiple LTCs, the frequency of interactions with each type of care service, and the problems that typically arise in these interactions. Methods: We conducted a mixed-methods study and recruited 62 participants aged ≥55 years who were living in England, had ≥2 LTCs, and had completed a social network analysis questionnaire. Semistructured interviews were conducted with roughly a 10% subsample of the questionnaire sample: 4 women and 3 men. On average, interviewees aged 70 years and had 4 LTCs. Results: Personal care networks were complex and adapted to each individual. The task of building and subsequently navigating one’s personal care network rested mainly on patients’ shoulders. It was frequently the patients’ task to bridge and connect the different parts of the system. The major factor leading to a satisfying navigation experience was found to be patients’ assertive, determined, and proactive approaches. Furthermore, smooth communication and interaction between different parts of the care system led to more satisfying navigation experiences. Conclusions: Technology to support care navigation for older adults with multiple LTCs needs to support patients in managing complex health and social care systems by effectively integrating the management of multiple conditions and facilitating communication among multiple stakeholders, while also offering flexibility to adapt to individual situations. Quality of care seems to be dependent on the determination and ability of patients. Those with less determination and fewer organization skills experience worse care. Thus, technology must aim to fulfill these coordination functions to ensure care is equitable across those who need it.en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleide11054en
dc.identifier.citationVos, J., Gerling, K., Linehan, C., Siriwardena, A.N. and Windle, K., 2018. Understanding Care Navigation by Older Adults With Multimorbidity: Mixed-Methods Study Using Social Network and Framework Analyses. JMIR Aging, 1(2):e11054. DOI:10.2196/11054en
dc.identifier.doi10.2196/11054en
dc.identifier.eissn1438-8871
dc.identifier.endpage12en
dc.identifier.issn1439-4456
dc.identifier.issued2en
dc.identifier.journaltitleJMIR Agingen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/8176
dc.identifier.volume1en
dc.language.isoenen
dc.publisherJMIR Publicationsen
dc.relation.urihttps://aging.jmir.org/2018/2/e11054/
dc.rights© Jolien Vos, Kathrin Gerling, Conor Linehan, Aloysius N Siriwardena, Karen Windle. Originally published in JMIR Aging (http://aging.jmir.org), 14.11.2018. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Aging, is properly cited. The complete bibliographic information, a link to the original publication on http://aging.jmir.org, as well as this copyright and license information must be included.en
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en
dc.subjectCare navigationen
dc.subjectLong-term conditionsen
dc.subjectMultimorbidityen
dc.subjectOlder adultsen
dc.subjectSocial network analysisen
dc.titleUnderstanding care navigation by older adults with multimorbidity: mixed-methods study using social network and framework analysesen
dc.typeArticle (peer-reviewed)en
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