Sharon E. Roberts

Impact of a quality improvement program on primary healthcare in Canada: A mixed-method evaluation

PURPOSE Rigorous comprehensive evaluations of primary healthcare (PHC) quality improvement (QI) initiatives are lacking. This article describes the evaluation of the Quality Improvement and Innovation Partnership Learning Collaborative (QIIP-LC), an Ontario-wide PHC QI program targeting type 2 diabetes management, colorectal cancer (CRC) screening, access to care, and team functioning. METHODS This article highlights the primary outcome results of an external retrospective, multi-measure, mixed-method evaluation of the QIIP-LC, including: (1) matched-control pre-post chart audit of diabetes management (A1c/foot exams) and rate of CRC screening; (2) post-only advanced access survey (third-next available appointment); and (3) post-only semi-structured interviews (team functioning). RESULTS Chart audit data was collected from 34 consenting physicians per group (of which 88% provided access data). Between-group differences were not statistically significant (A1c [p=0.10]; foot exams [p=0.45]; CRC screening [p=0.77]; advanced access [p=0.22]). Qualitative interview (n=42) themes highlighted the success of the program in helping build interdisciplinary team functioning and capacity. CONCLUSION The rigorous design and methodology of the QIIP-LC evaluation utilizing a control group is one of the most significant efforts thus far to demonstrate the impact of a QI program in PHC, with improvements over time in both QIIP and control groups offering a likely explanation for the lack of statistically significant primary outcomes. Team functioning was a key success, with team-based chronic care highlighted as pivotal for improved health outcomes. Policy makers should strive to endorse QI programs with proven success through rigorous evaluation to ensure evidence-based healthcare policy and funding.

Improving chronic care through continuing education of interprofessional primary healthcare teams: a process evaluation

Abstract Process evaluations assess program structures and implementation processes so that outcomes can be accurately interpreted. This article reports the results of a process evaluation of Partnerships for Health, an initiative targeting interprofessional primary healthcare teams to improve chronic care in Southwestern Ontario, Canada. Program documentation, participant observation, and in-depth interviews were used to capture details about the program structure, implementation process, and experience of implementers and participants. Results suggest that the intended program was modified during implementation to better meet the needs of participants and to overcome participation barriers. Elements of program activities perceived as most effective included series of off-site learning/classroom sessions, practice-based/workplace information-technology (IT) support, and practice coaching because they provided: dedicated time to learn how to improve chronic care; team-building/networking within and across teams; hands-on IT training/guidance; and flexibility to meet individual practice needs. This process evaluation highlighted key program activities that were essential to the continuing education (CE) of interprofessional primary healthcare teams as they attempted to transform primary healthcare to improve chronic care.

Influence of a quality improvement learning collaborative program on team functioning in primary healthcare.

Quality improvement (QI) programs are frequently implemented to support primary healthcare (PHC) team development and to improve care outcomes. In Ontario, Canada, the Quality Improvement and Innovation Partnership (QIIP) offered a learning collaborative (LC) program to support the development of interdisciplinary team function and improve chronic disease management, disease prevention, and access to care. A qualitative study using a phenomenological approach was conducted as part of a mixed-method evaluation to explore the influence of the program on team functioning in participating PHC teams. A purposive sampling strategy was used to identify PHC teams (n = 10), from which participants of different professional roles were selected through a purposeful recruitment process to reflect maximum variation of team roles. Additionally, QI coaches working with the interview participants and the LC administrators were also interviewed. Data were collected through semistructured telephone interviews that were audiotaped and transcribed verbatim. Thematic analysis was conducted through an iterative and interpretive approach. The shared experience of participating in the program appeared to improve team functioning. Participants described increased trust and respect for each others clinical and administrative roles and were inspired by learning about different approaches to interdisciplinary care. This appeared to enhance collegial relationships, collapse professional silos, improve communication, and increase interdisciplinary collaboration. Teamwork involves more than just physically grouping healthcare providers from multiple disciplines and mandating them to work together. The LC program provided opportunities for participants to learn how to work collaboratively, and participation in the LC program appeared to enhance team functioning.

The Role of Identity Horizons in Education-to-Work Transitions: A Cross-Cultural Validation Study in Japan and the United States

This article reports on the development and construct validation of the Identity Horizons Scales, an instrument based on the identity horizons model. Participants were postsecondary students aged 18–24 years from Japan (N = 505) and the United States (N = 546). Following exploratory factor analysis and confirmatory factor analysis, a three-factor scale had adequate configural, metric, and partial scalar invariance. Evidence for construct validity was also found. Cross-cultural validity assessments suggest that the new measure can be used in both cultural contexts, and for men and women in both contexts, but that the Japanese configuration of identity horizons is more nuanced than the U.S. pattern. Implications, limitations, and future directions for research using the Identity Horizons Scales in different cultural settings are discussed.

‘More than skin‐deep’: Biological essentialism in response to a distinctiveness threat in a stigmatized fan community

We investigated how group distinctiveness threats affect essentialist beliefs about group membership in a stigmatized fan community. An experiment conducted on 817 members of the fan community revealed that highly identified fans who perceived significant stigmatization were the most likely to endorse essentialist beliefs about group membership when exposed to a distinctiveness threat via comparison to a highly similar (vs. dissimilar) outgroup. These results bridge essentialism research and research on distinctiveness threat by demonstrating the mutability of group essentialism beliefs as a defensive response to distinctiveness threats. Implications for future research are discussed.

The Anthrozoomorphic Identity: Furry Fandom Members’ Connections to Nonhuman Animals

ABSTRACT We examined furry fandom members’ anthrozoomorphic identity by investigating this subcultures relationship with nonhuman animals. Using exploratory and confirmatory factor analyses and two largescale Internet and convention-based studies of furries, we developed (study 1; n=4,338) and replicated (study 2; n=1,707) the 10-item Species Connection Scale, which is a three-factor model of felt connection to animals: (1) a sense of appreciation or liking for a species, (2) a sense of spiritual or mystical connection to a species, and (3) a feeling of identification with or as another species. We then used this model to predict participants’ psychological wellbeing and tendency to attribute human-like traits and emotions to animals. The results indicated that (1) liking animals may be related to the ascription of secondary emotions to animals (supported in study 1, but not study 2), but was not associated with participant wellbeing (supported by both studies); (2) a spiritual connection to animals did not necessarily predict greater attribution of primary or secondary emotions to animals, but it was associated with greater psychological wellbeing (positive self-esteem in both studies; life satisfaction in study 1); (3) identification as an animal was strongly associated both with a tendency to avoid attributing secondary emotions to animals and negative participant wellbeing (supported by both studies). This research furthers our understanding of one subcultures’ felt connection with animals and suggests that further explorations of how connection with animals affects human welfare are warranted.

Fan and Non-Fan Recollection of Faces in Fandom-Related Art and Costumes

We compared face recognition of humans and fandom-themed characters (art and costumes) between a sample of furries (fans of anthropomorphic animal art) and non-furries. Participants viewed images that included humans, drawn anthropomorphic animals, and anthropomorphic animal costumes, and were later tested on their ability to recognize faces from a subset of the viewed images. While furries and non-furries did not differ in their recollection of human faces, furries showed significantly better memory for faces in furry-themed artwork and costumes. The results are discussed in relation to own-group bias in face recognition.

“Animals Like Us”: Identifying with Nonhuman Animals and Support for Nonhuman Animal Rights

ABSTRACT While anthropomorphizing nonhuman animals has been shown to increase identification with them and, by extension, concern for their wellbeing, little research has directly tested whether identifying with nonhuman animals is similarly associated with concern for their wellbeing. We tested hypotheses related to this premise across three cross-sectional studies. In study 1 (n = 224), we tested the hypothesis that therians—a group of people who self-identify with nonhuman animals, show greater concern for nonhuman animal rights than non-therian furries—people with a fan-like interest in media featuring anthropomorphized animal characters. In study 2 (n = 206), we further tested this hypothesis using implicit and explicit measures of identification with nonhuman animals to predict behavioral intentions to support nonhuman animal rights. In study 3 (n = 182), we tested the generalizability of our findings in a sample of undergraduate students. Taken together, the studies show that explicit, but not implicit, identification with nonhuman animals predicts greater support for their rights. The implications of these findings for research on anthropomorphism and animal rights activism are discussed, as well as the limitations of these findings and possible avenues for future research.

Identity Horizons Among Finnish Postsecondary Students : A Comparative Analysis

ABSTRACT This article examines the identity horizons of postsecondary students in Finland—a country in which social welfare provisions buffer education-to-work transitions—comparing their identity horizons to those previously reported for U.S. and Japanese students. Confirmatory factor analyses revealed scalar invariance of the Finnish version of the Identity Horizons Scales with the English and Japanese versions. Latent mean comparisons found that Finnish students had the broadest educational and work horizons, and the lowest education-to-work identity anxiety. Finnish men reported lower levels of educational horizons and higher levels of identity anxiety than Finnish women, replicating previous findings. Social class differences were also detected, with higher levels of identity anxiety and narrower educational horizons among those whose parents had no postsecondary education. Based on the apparent impacts on identity development of the different educational policies in the three countries, results are discussed in terms of policy implications supporting more effective education-to-work transitions.

The Fantasy Engagement Scale: A Flexible Measure of Positive and Negative Fantasy Engagement

ABSTRACT Despite the prevalence of fantasy activities in day-to-day life, there has been little systematic psychological research on fantasy. Existing work is scattered across numerous fantasy-related topics and are rarely viewed as a collective body of work. We propose a scale of fantasy engagement that addresses this scattered and often-contradictory literature by assessing both positive and negative aspects of fantasy engagement. Across four studies we develop and validate the Fantasy Engagement Scale, establishing its reliability, validity, and applicability to topics including well-being, escapism, and mental imagery. The results begin to reconcile contradictions in the existing research and have implications for future work on fantasy specifically and for studies of fantasy-related activities.