Cocreating a person-centred integrated care for people of low socio-economic status.

Hester Van Bommel, Tessa Van Loenen, Jako Burgers, Maria Van Den Muijsenbergh, Erik Bischoff

Keywords: low socioeconomic status, health literacy, health disparities, co-creation, design-thinking

Background:

People with low socioeconomic status (SES) often suffer from chronic diseases and low health literacy as well as social problems. A person-centred integrated-care (PC-IC) approach in general practice seems promising but should be tailored to these patients’ specific needs, expectations and capabilities.

Research questions:

Which elements in a PC-IC approach make it suited to the needs and capabilities of people with low-SES?

Method:

A recently developed PC-IC intervention was adjusted to low-SES patients using an iterative co-creation process. Participatory learning and action (PLA) techniques were used to facilitate the process. These techniques ensure meaningful and equal input of participants with different knowledge and power levels. Participants were 5 general practitioners and nurses and 4 low literate patients. Three PLA-moderated sessions took place to reach the adjusted program.

Results:

In the sessions, it was concluded that the existing PC-IC intervention appeared to be less suitable for low-SES patients as concepts, materials and questionnaires were difficult to understand. Care providers were not aware and had limited knowledge about low-SES patients who are often have limited health literacy. They reported that visual materials are helpful instead of written text or questionnaires. To support communication a visual conversation map and an easy to understand visual model of the PC-IC intervention were developed. For the healthcare providers a training for providing person-centred and integrated care to low-SES patients would be useful.

Conclusions:

To ensure an PC-IC approach can be tailored to low-SES patients, visual materials and easy to understand procedures as well as specific guidance for care providers should be developed in close collaboration with these patients.

Points for discussion:

1. Person-centered care is tailored care to the knowledge and needs of patients. However, materials and information are often too difficult to understand for many patients. How could healthcare providers communicate with all patients in an understandable way?

2. Using visual materials for all patients can be perceived as childish. How can we address this problem?

3. Increasing use of digital care (e.g., e-consultations) can increase inequity due to limited digital skills. How can we still provide person-centred care in the digital era?