Table 1
Quotes for themes and barriers identified in Category 1.
| QUOTES FOR THE THEMES | QUOTES FOR THE BARRIERS IDENTIFIED |
|---|---|
| Theme 1: Providing direct medical care Quote 1: “I do have a kind of diabetes programme with the patients. So, on a weekly basis, they come back to me to show me their blood glucose reading and also take photos of the food that they actually ate three times a week…and also they will share with me what are his activities for this past week.” (Pharmacist, female) Quote 2: “…one thing that will impact a lot is also how things are communicated [to] the patients and their family members…break down in very layman term, allowing the families to actually understand.” (Medical Social Worker, female) Theme 2: Providing psycho-emotional support Quote 3: “A lot of time I also feel that I kind of [providing] emotional support for them. Because at times they are lost, they don’t know what to do, we do give encouraging words for them to move on, and we also try to let them see what are their values in life, what are the things that they look forward to.”(Nurse, female) Quote 4: “I think apart from the eyes and ears, I think it’s really the human touch of the community partners that make the difference in their lives…So, I think all these community partners can act as a connection and their presence is their present.” (Medical Social Worker, female) | Barrier 1: Being task-oriented instead of person-centred Quote 5: “…we are pretty much task-focused. So, we go in, we want to do certain things for the patient and then, okay, that’s our duty done… a lot of times we forget to ask the patients or the residents there, what matters to them the most.” (Allied Health Professional, female) Quote 6: “Sometimes we fail to see the person as a whole… and we take them as…a person with this disease and we fail to recognize what their whole life was about…”(Community Health Operation Officer, female) Barrier 2: Inadequate resources and manpower Quote 7: “Family Service Centre can see you but they are so overworked, they are not going to see you very often. So, if you’re someone that is in real need of help, waiting for something more intense, you’re unlikely to get it.” (Occupational Therapist, male) |
Table 2
Quotes for themes and barriers identified in Category 2.
| Theme 3: Reinforcing ownership of health Quote 8: “there’s this need to actually reinforce to them that they have to take ownership over…what’s going to happen next. Like be it their rehabilitation journey or …taking ownership of their own chronic diseases.” (Physiotherapist, female) Quote 9: “They have the information, they have seen us and educated them. But somehow, we still need something to hit them so that they start changing their lifestyle. They start bouncing back from their health crisis. So, there’s another group of patients who need something else in their lives to help them bounce back.” (Dietitian, female) Theme 4: Imparting self-management knowledge and skills Quote 10: “I think as a healthcare professional, our role is actually to provide the correct information and provide resources for them… a lot of times, our touchpoint is very short, so it’s really important to actually educate the patients or family [on] how to seek help correctly, then how to go through the difficult period and how to do the maintenance outside their own home. I think that’s our main role.” (Community Nurse, female) Quote 11: “I think information is a lot when you are dealing with a new disease or health adversity and it’s like learning a new topic…a new language around this whole issue… I think the ability for her [a client] to be able to do all these information sorting, not just gathering, helped her to move on to the next step because [if] she knew what to do next, she wouldn’t confused. ” (Population Health Manager, female) Theme 5: Being navigators of community-based services and resources Quote 12: “…financial wise we can bring in our medical social workers and for the practical resource we can bring in the home personal care, Meals on Wheels, etc., because we are very knowledgeable in what are the community resources out there … we can mobilize to help these family members because if they are on their own then they really would not know that there are such resources. So we do that form of guidance to navigate the resources that are out there.” (Nurse, female) Quote 13: “…update them of the resources that are available and also linking them up to the resources and also making sure that they are taken care of…” (Nurse, male) | Barrier 3: Limited interaction time Quote 14: “there are a lot of limitations in terms of time constraint. I only have 20 minutes with the patient and then I have to somehow motivate them within 5 minutes to do exercise. So, a lot of times, the only reason that I can give that allows me to get them moving is to say, “You want to get home soon? So, once you do your exercise, you can get well, we can get you home.” So, it kind of works for more than half the patients…this very short-term goal just to get home. But I do wonder at the back of their minds whether this goal is actually what they want in terms of their health and whether there are other things that can motivate them in terms of their outlook of life and how they can continue to live their years even outside of the hospital.” (Occupational Therapist, female) Barrier 4: Restriction of eligibility criteria for financial assistance Quote 15: “Like for example, somebody who has a spinal cord injury and then he’s on a ventilator. So, needs a lot, a lot of consumables, the expenses are actually a lot, which is probably way more than the kind of money that the whole family brings in. But because their salary income is already in the higher tier, so ultimately, they are not part of the financial assessment tier already. So, this kind of people will find a lot of difficulty in getting help.” (Occupational Therapist, female) |
Table 3
Quotes for themes and barriers identified in Category 3.
| Theme 6: Strengthening family support Quote 16: “Because if they are fighting at home, then…like the first thing is to kind of stop the fight. And then… it’s just really helping to link the pieces together and help everybody to be on the same page and like, “Okay, we’re starting at the same point. This is what your dad means. Okay, your daughter didn’t mean that but this is what she actually means.” and things like that.” (Allied Health Professional, female) Quote 17: “…he [an alcoholic man] wanted to get the support from the family members… So, we start to do some family dynamic to approach one by one and encourage them to have a communication in a way that maybe “he needs you”. Actually patient himself also requests that, “If a family member starts to motivate me to quit drinking, I’m more willingly to quit.” So, we encourage the elder son to participate in the conversation…I can see his condition become much more better. The amount of alcohol he drinks is gradually reduced compared to last time…his physical well-being was definitely better than before.” (Nurse, male) Theme 7: Cultivating collaborative inter-organisational bonds Quote 18: “For our Family Service Centre, we work very closely with a hospital. I think they have also extensively reached out to us…at different level… we start to go out together to do home visits to our clients to reach out to work on challenging cases. And also their MSWs and our social workers are also meeting for case conferences. We are also trying to bring in…tele health check in our centres. So, I think there’s a lot more collaboration [at] different levels.” (Social Worker, male) Quote 19: “We need to look at the bridge…And how can we shape this bridge in a way that it becomes more accessible for the community member to be able to cross in-between instead of making them run to five different places.” (Manager of a social care organisation, female) Theme 8: Initiating community-based support collectives Quote 20: “we’re thinking of building this community that is resilient to [be] able to thrive, able to manage with their own internal community support. So, to do that, I think we have to build the community. Not by us, but the community builds the community itself. We’ll just be facilitators…now we have this local area coordinators that we’re putting into the communities. So, through these local coordinators… we hope that we can help to pull the people together so that the community will be able to flourish and go into community building where they are able to provide the support needed within the community. (Population Health Director, female) Quote 21: “… the thing that we’re advocating and teaching and like trying to bring more people in is asset-based community development…so I would definitely advocate for us taking a backseat as a healthcare worker and really just creating and providing the opportunities for the communities to rise up to what they can do. So, [it] diminishes our presence eventually and get ourselves out of their lives as long as you know that they can be independent rather than creating reliance on [the] system and resulting in more workload for us.” (Population Health Manager, female) | Barrier 5: Lack of a centralised system and streamlined integration Quote 22: “I think we need to have a common platform whereby we are able to communicate so [as] to provide more seamless care for patients. And also, having said that, the patient also [have] clearer picture like who’s in the picture, who is actually doing what for me.” (Nurse, male) Quote 23: “Not very systematic and… there’s no central coordination or case management in the community for such things. Like for example, I can have a patient who requires several services… we probably don’t know each other is actually helping the patient… we don’t share the same system…a lot of things are blinded from the provider’s side… So, currently the systems are still quite…fragmented in a way.” (Allied Health Professional, female) Barrier 6: Tendency of a more self-focused orientation Quote 24: “I think it’s the Singapore culture, with the new and younger generation, that might block some of these from being organic developing on its own.” (Medical Social Worker, female) |