Family Participation in Bangladesh Hospital Care

Family Caregiver Participation in Hospital Care in a Tertiary Hospital in Bangladesh: a Mixed Methods Study

This mixed methods study aims to understand family care participation in the adult medicine wards of Chattogram Medical College Hospital, Bangladesh. The main questions it aims to answer, from the perspective of the patient, family caregiver, nurse, doctor, ward assistant, and hospital administrator, are:

1. What is the role of the family caregiver in hospital care?
2. What is the perceived effect of family participation in hospital care?
3. What are the barriers and facilitators experienced in family participation?
4. What are suggestions for family participation interventions?

These questions will be answered with three study arms:

1. A prospective observational cohort (population: patients and family caregivers)
2. A time and motion study (population: nurses and doctors)
3. Interviews and focus group discussions (population: patients, family caregivers, nurses, doctors, ward assistants, and hospital administrators)

Study Overview

• Status: Completed
• Conditions: Hospitalized Patients

• Study Type: Observational
• Enrollment (Actual): 353

Contacts and Locations

Study Locations

• Bangladesh
  • Chattogram, Bangladesh
    • Chattogram Medical College Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

This study includes the patients, family caregivers, nurses, doctors, ward assistants, and hospital administrators admitted/caring/working on the general medicine wards of Chattogram Medical College Hospital.

Description

Prospective Observational Cohort

• Inclusion Criteria

  • Population
  • Patient: Admitted to the ward (in-patient)
  • Family caregiver: caregiver providing care at the bedside of the patient on the ward
  • Environment: Admitted to medicine wards 13, 14 or 16 of Chattogram Medical College Hospital
  • Admission time: Admitted in the last 48 hours
  • Adult: ≥18 years

• Exclusion criteria

  • Admission time: Planned discharge or transfer within the first 24 hours of admission
  • Child: <18 years
  • Previously enrolled in this study arm
  • No consent given

Time and Motion

• Inclusion Criteria

  • Population: Nurses and doctors
  • Environment: Working in the medicine wards 13, 14 or 16 of Chattogram Medical College Hospital

• Exclusion Criteria

  • Population: <6 months work experience on wards 13, 14 or 16 of CMCH
  • Previously enrolled in this study arm
  • No consent given

Qualitative (interviews and focus group discussions)

• Inclusion Criteria

  • Population
  • Patient: Admitted to the ward (in-patient)
  • Family caregiver: Caregiver providing care at the bedside of the patient on the ward
  • Health workers: Nurses, doctors and ward assistants
  • Hospital administrator: Managers and professors
  • Environment
  • Patient: Admitted to medicine wards 13, 14 or 16 of CMCH
  • Family caregiver: Caring for their relative on wards 13, 14 or 16 of CMCH
  • Health worker: Working on wards 13, 14 or 16 of CMCH
  • Hospital administrator: Responsible for care delivery on wards 13, 14 or 16 of CMCH

• Exclusion Criteria

  • Population
  • Patient: Unconscious or unable to participate in a conversation
  • Family caregiver: Unable to leave the patient for reasons of safety
  • Health worker: <6 months of work experience on wards 13, 14 or 16 of CMCH
  • Hospital administrator: <6 months in a management role for wards 13, 14 or 16 of CMCH
  • Admission time
  • Patient: Admitted <48 hours
  • Family caregiver: <8 cumulative hours present at patient bedside in last 48 hours
  • Child: <18 years
  • Previously enrolled in this study arm
  • No consent given

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort
Prospective Observational Cohort; Patient and family caregiver dyads will be recruited for a prospective cohort observation for at least 24 hours and a maximum of seven days. At inclusion, baseline and self-reported data from admission until inclusion will be collected. After inclusion, data will be collected every 24 hours on self-reported outcomes of the last 24 hours. Patients and family caregiver dyads will be followed until discharge, transfer to another department, death or a maximum of seven days of follow-up. If dyads stay longer than seven days, daily follow-up is ended and they are called once 14 days later to collect outcome data.
Time and Motion; Nurses and doctors will be recruited for time-and-motion observations by a trained non-participant observer during their shift on the medicine ward. Observers will use a REDCap to record where, what, for how long and how health workers perform tasks and interactions during their shifts. Observations will take place in sets of two hours each. Approximate equal amounts of observations will be done on all medicine wards. Observations will occur on different days of the week, at different shifts during the day, and at different times during a shift to collect data from different care contexts. Baseline data of the shift is recorded at the start of the observation.
Qualitative; The qualitative arm of the study involves interviews and focus group discussions with patients, family caregivers, nurses, doctors and hospital administrators. The FGDs and interviews will be performed in Bengali by a local researcher experienced in qualitative research. An interview guide is used to define themes for the conversations, however, the interviewer is encouraged to follow the flow of the conversation by changing the order of topics or asking additional questions. The main themes of the interview guide are (1) the role of family participation in hospital care, (2) the perceived effect of family participation, (3) the barriers and facilitators for family participation in hospital care, and (4) the opportunities for improving family caregiver participation in hospital care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The role of family participation in hospital care	The role of family participation will be described with data from: Prospective observational cohort: patient baseline characteristics, family caregiver baseline characteristics, care characteristics during follow-up (for example: tasks performed, number of caregivers present, hours caregiver is present), end of follow-up status (example: discharged, transferred, death).; Interviews and FDG: with patients, family caregivers, nurses, doctors, ward assistants, and hospital administrators.	During admission to the general medicine ward
The perceived effect of family participation in hospital care	The perceived effect of family participation will be described with data from: Time and motion: division of work time of nurses and doctors, time spend interacting with patients and family caregivers.; Interviews and FDG: with patients, family caregivers, nurses, doctors, ward assistants, and hospital administrators.	During admission to the general medicine ward
The barriers and facilitators of family participation in hospital care	The barriers and facilitators of family participation will be described with data from: Prospective observational cohort: patient baseline characteristics, family caregiver baseline characteristics, care characteristics during follow-up (for example: tasks performed, number of caregivers present, hours caregiver is present), end of follow-up status (example: discharged, transferred, death).; Time and motion: division of work time of nurses and doctors, time spend interacting with patients and family caregivers.; Interviews and FDG: with patients, family caregivers, nurses, doctors, ward assistants, and hospital administrators.	During admission to the general medicine ward
The intervention suggestions for family participation in hospital care	The barriers and facilitators of family participation will be described with data from: 1. Interviews and FDG: with patients, family caregivers, nurses, doctors, ward assistants, and hospital administrators.	During admission to the general medicine ward

Collaborators and Investigators

• Sponsor: Michele van Vugt
• Collaborators: Mahidol Oxford Tropical Medicine Research Unit; Amsterdam UMC, location AMC; Chattogram Medical College Hospital; Asian University for Women

Study record dates

Study Major Dates

• Study Start (Actual): September 26, 2023
• Primary Completion (Actual): November 27, 2023
• Study Completion (Actual): November 27, 2023

Study Registration Dates

• First Submitted: October 7, 2024
• First Submitted That Met QC Criteria: October 7, 2024
• First Posted (Estimated): October 9, 2024

Study Record Updates

• Last Update Posted (Estimated): October 9, 2024
• Last Update Submitted That Met QC Criteria: October 7, 2024
• Last Verified: October 1, 2024

More Information

Terms related to this study

• Keywords: Family; Qualitative; Observational; Cohort; Adult; Hospital; Care; Bangladesh; Prospective; Family caregivers; Mixed method; Time and Motion
• Other Study ID Numbers: FPBDMM

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Data can be requested from the research group.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No