Co-creating a person-centred approach in primary care for patients with low socioeconomic status and chronic conditions: a participatory learning & action study.

Abstract

Aim: To tailor an existing Person-Centred Integrated Care (PC-IC) approach to the needs of patients with low socioeconomic status (LSES) and chronic conditions in primary care.

Background: While Disease Management Programs (DMPs) have been introduced to reduce the burden of chronic diseases, their effectiveness for patients with LSES remains uncertain due to insufficient attention to the individual context. A PC-IC approach may enhance patient outcomes by addressing patients' cultural backgrounds, values, and health literacy needs, because these factors are particularly relevant for patients with LSES.

Method: A qualitative study was conducted using three co-creation sessions with patients with LSES and chronic conditions, along with general practitioners and practice nurses, to adapt, develop, and test specific elements of the PC-IC approach. Participatory learning and action (PLA) techniques incorporating visual materials were employed to ensure meaningful engagement and input by all participants, including those with limited reading and language skills. Following these sessions, we conducted a validation check by patients on the draft materials.

Findings: In the co-creation sessions, an existing PC-IC approach was tailored to the needs of LSES patients with chronic conditions in primary care. The adapted PC-IC approach emphasized key elements as trust, being seen as a person in the social context, shared decision-making, and access to clear and easily understandable information. Existing materials needed to be adapted, resulting in a visual conversation tool. This tool covers the physical, social, and mental health domains as well as daily life, each domain with six to eight topics. It helps to get better insight into the patient's daily life, wishes, and possibilities. It maps medical and psychosocial issues and supports the patient in gaining a better understanding. The adapted PC-IC approach with the conversation tool is being presented in a training for primary care professionals.