Understanding how and why upskilling programmes for unregulated care providers can support health equity in underserved communities: a realist review protocol
IntroductionFoot ulcers are one of the most devastating complications of diabetes mellitus leading to leg amputations. In Canada, systematically marginalised and racialised populations are more prone to developing foot ulcers and at higher risk of limb amputations. Shortages of regulated healthcare...
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Published in | BMJ open Vol. 13; no. 8; p. e072570 |
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Main Authors | , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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London
BMJ Publishing Group LTD
23.08.2023
BMJ Publishing Group |
Series | Protocol |
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Abstract | IntroductionFoot ulcers are one of the most devastating complications of diabetes mellitus leading to leg amputations. In Canada, systematically marginalised and racialised populations are more prone to developing foot ulcers and at higher risk of limb amputations. Shortages of regulated healthcare have hindered efforts to provide foot care. Upskilling unregulated care providers (UCPs) to deliver foot screening seems a reasonable solution to reduce limb loss. UCPs can advocate for health equity and deliver appropriate care. There is a need, however, to understand how and why an educational intervention for UCPs providing foot screening for these high-risk groups may or may not work.Methods and analysisThis realist review will follow the Realist And Meta-narrative Evidence Syntheses: Evolving Standards standards. First, we will develop an initial programme theory (PrT) based on exploratory searches and discussions with experts and stakeholders. Then, we will search MEDLINE, Embase, PsycINFO, ERIC, CINAHL and Scopus databases along with relevant sources of grey literature. The retrieved articles will be screened for studies focusing on planned educational interventions for UCPs related to diabetic foot assessment. Data regarding contexts, mechanisms and outcomes will be extracted and analysed using a realist analysis through an iterative process that includes data reviewing and consultation with our team. Finally, we will use these results to modify the initial PrT.Ethics and disseminationEthical approval is not required for this review. The main output of this research will be an evidence-based PrT for upskilling programmes for UCPs. We will share our final PrT using text, tables and infographics to summarise our results and draw insights across papers/reports. For academic, clinical, social care and educational audiences, we will produce peer-reviewed journal articles, including those detailing the process and findings of the realist review and establishing our suggestions for effective upskilling programmes.PROSPERO registration numberCRD42022369208. |
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AbstractList | INTRODUCTIONFoot ulcers are one of the most devastating complications of diabetes mellitus leading to leg amputations. In Canada, systematically marginalised and racialised populations are more prone to developing foot ulcers and at higher risk of limb amputations. Shortages of regulated healthcare have hindered efforts to provide foot care. Upskilling unregulated care providers (UCPs) to deliver foot screening seems a reasonable solution to reduce limb loss. UCPs can advocate for health equity and deliver appropriate care. There is a need, however, to understand how and why an educational intervention for UCPs providing foot screening for these high-risk groups may or may not work. METHODS AND ANALYSISThis realist review will follow the Realist And Meta-narrative Evidence Syntheses: Evolving Standards standards. First, we will develop an initial programme theory (PrT) based on exploratory searches and discussions with experts and stakeholders. Then, we will search MEDLINE, Embase, PsycINFO, ERIC, CINAHL and Scopus databases along with relevant sources of grey literature. The retrieved articles will be screened for studies focusing on planned educational interventions for UCPs related to diabetic foot assessment. Data regarding contexts, mechanisms and outcomes will be extracted and analysed using a realist analysis through an iterative process that includes data reviewing and consultation with our team. Finally, we will use these results to modify the initial PrT. ETHICS AND DISSEMINATIONEthical approval is not required for this review. The main output of this research will be an evidence-based PrT for upskilling programmes for UCPs. We will share our final PrT using text, tables and infographics to summarise our results and draw insights across papers/reports. For academic, clinical, social care and educational audiences, we will produce peer-reviewed journal articles, including those detailing the process and findings of the realist review and establishing our suggestions for effective upskilling programmes. PROSPERO REGISTRATION NUMBERCRD42022369208. Introduction Foot ulcers are one of the most devastating complications of diabetes mellitus leading to leg amputations. In Canada, systematically marginalised and racialised populations are more prone to developing foot ulcers and at higher risk of limb amputations. Shortages of regulated healthcare have hindered efforts to provide foot care. Upskilling unregulated care providers (UCPs) to deliver foot screening seems a reasonable solution to reduce limb loss. UCPs can advocate for health equity and deliver appropriate care. There is a need, however, to understand how and why an educational intervention for UCPs providing foot screening for these high-risk groups may or may not work.Methods and analysis This realist review will follow the Realist And Meta-narrative Evidence Syntheses: Evolving Standards standards. First, we will develop an initial programme theory (PrT) based on exploratory searches and discussions with experts and stakeholders. Then, we will search MEDLINE, Embase, PsycINFO, ERIC, CINAHL and Scopus databases along with relevant sources of grey literature. The retrieved articles will be screened for studies focusing on planned educational interventions for UCPs related to diabetic foot assessment. Data regarding contexts, mechanisms and outcomes will be extracted and analysed using a realist analysis through an iterative process that includes data reviewing and consultation with our team. Finally, we will use these results to modify the initial PrT.Ethics and dissemination Ethical approval is not required for this review. The main output of this research will be an evidence-based PrT for upskilling programmes for UCPs. We will share our final PrT using text, tables and infographics to summarise our results and draw insights across papers/reports. For academic, clinical, social care and educational audiences, we will produce peer-reviewed journal articles, including those detailing the process and findings of the realist review and establishing our suggestions for effective upskilling programmes.PROSPERO registration number CRD42022369208. |
Author | Cobbing, Saul Abdulwasi, Munira Rac, Valeria E Hassan, Samah Bartley, Nicola Cheung, Hei-Ching Kristy Hodges, Brian David Gray, Catharine Marie Woods, Nicole N Leake, Patti Etherington, Andrea Anderson, Melanie |
AuthorAffiliation | 11 Department of Physiotherapy , University of KwaZulu-Natal , Durban , South Africa 10 Department of Physical Therapy , University of Toronto , Toronto , Ontario , Canada 1 The Institute of Education Research , University Health Network , Toronto , Ontario , Canada 2 University Health Network , Toronto , Ontario , Canada 6 Toronto Health Economics and Technology Assessment (THETA) Collaborative , Toronto Health Economics and Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN) , Toronto , Ontario , Canada 7 Diabetes Action Canada , CIHR SPOR Network , Toronto , Ontario , Canada 9 Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada 5 Institute of Health Policy, Management, and Evaluation (IHPME) , Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada 12 Wilson Centre , University Health Network , Toronto , Ontario , Canada 13 Library and Information Services , University Health Networ |
AuthorAffiliation_xml | – name: 12 Wilson Centre , University Health Network , Toronto , Ontario , Canada – name: 7 Diabetes Action Canada , CIHR SPOR Network , Toronto , Ontario , Canada – name: 5 Institute of Health Policy, Management, and Evaluation (IHPME) , Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada – name: 10 Department of Physical Therapy , University of Toronto , Toronto , Ontario , Canada – name: 8 Temerty Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada – name: 2 University Health Network , Toronto , Ontario , Canada – name: 11 Department of Physiotherapy , University of KwaZulu-Natal , Durban , South Africa – name: 3 The Michener Institute of Education , University Health Network , Toronto , Ontario , Canada – name: 9 Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada – name: 13 Library and Information Services , University Health Network , Toronto , Ontario , Canada – name: 1 The Institute of Education Research , University Health Network , Toronto , Ontario , Canada – name: 6 Toronto Health Economics and Technology Assessment (THETA) Collaborative , Toronto Health Economics and Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN) , Toronto , Ontario , Canada – name: 4 Program for Health System and Technology Evaluation , Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN) , Toronto , Ontario , Canada |
Author_xml | – sequence: 1 givenname: Samah orcidid: 0000-0003-2526-4515 surname: Hassan fullname: Hassan, Samah – sequence: 2 givenname: Valeria E surname: Rac fullname: Rac, Valeria E – sequence: 3 givenname: Brian David surname: Hodges fullname: Hodges, Brian David – sequence: 4 givenname: Patti surname: Leake fullname: Leake, Patti – sequence: 5 givenname: Saul surname: Cobbing fullname: Cobbing, Saul – sequence: 6 givenname: Catharine Marie surname: Gray fullname: Gray, Catharine Marie – sequence: 7 givenname: Nicola surname: Bartley fullname: Bartley, Nicola – sequence: 8 givenname: Andrea surname: Etherington fullname: Etherington, Andrea – sequence: 9 givenname: Munira surname: Abdulwasi fullname: Abdulwasi, Munira – sequence: 10 givenname: Hei-Ching Kristy surname: Cheung fullname: Cheung, Hei-Ching Kristy – sequence: 11 givenname: Melanie orcidid: 0000-0001-9786-1656 surname: Anderson fullname: Anderson, Melanie – sequence: 12 givenname: Nicole N surname: Woods fullname: Woods, Nicole N |
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Snippet | IntroductionFoot ulcers are one of the most devastating complications of diabetes mellitus leading to leg amputations. In Canada, systematically marginalised... INTRODUCTIONFoot ulcers are one of the most devastating complications of diabetes mellitus leading to leg amputations. In Canada, systematically marginalised... Introduction Foot ulcers are one of the most devastating complications of diabetes mellitus leading to leg amputations. In Canada, systematically marginalised... |
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SubjectTerms | Amputation Canadians Costs Diabetes Diabetes and Endocrinology Foot diseases Health disparities Intervention Leg ulcers Patients Shortages Social exclusion Socioeconomic factors |
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Title | Understanding how and why upskilling programmes for unregulated care providers can support health equity in underserved communities: a realist review protocol |
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