How can healthcare service engagement be supported for service users with complex healthcare needs?

摘要

By 2033 the number of elderly people in England and Wales is expected to exceed 16.4 million. The consequent increase in prevalence of chronic illness and demand on the health and social care services are major causes of concern for healthcare practitioners and policy-makers alike. In response, calls for greater service user autonomy, involvement, and self-care all indicate a shift away from existing paternalistic models of care to a model where service users knowledgably and competently manage their own healthcare and wellbeing. To equip healthcare professionals implement these fundamental changes, this thesis aims to capture, analyse, and articulate the process of healthcare service engagement. To investigate how healthcare services can be better designed to support healthcare engagement for service users with complex needs, this thesis conducts an empirical ethnographic study of a UK-based falls prevention service. Mixed methods were used to collect data from a wide range of sources, including twenty semi-structured interviews with healthcare professionals and service users, ninety-two surveys, referral forms, assessments, and healthcare promotional materials. The data were coded, conceptualised, and categorised to produce a grounded theory of healthcare service engagement represented in a specifically designed model. Key findings show that healthcare service engagement in the context of the chronically ill elderly needs to be understood as an interconnected, emergent, nonlinear, and situated process. It recommends that engagement should be supported in a more user-centric and personalised manner, assessing and responding to service users’ engagement needs as they emerge concurrently with the service’s pathway, integrating assessment practices within a wider healthcare context, and simplifying the existing multidisciplinary and multi-phase falls prevention pathway. Resulting from this thesis, healthcare professionals can more accurately, completely, and confidently reflect on the complex process of healthcare service engagement; better equipping the community for challenges it will face in the future.