Title

Background

Inter-professional education (IPE) occurs when two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. In the context of population ageing, IPE plays an important role in preparing the health workforce to deliver care for older people. WHO recognizes IPE as a necessary step in preparing a collaborative health workforce capable of responding to local health needs. In addition to strong political commitment to promoting the welfare of older people, workforce development may help integrate social and health care services to progressively ensure universal health coverage in the Philippines and Viet Nam as they undergo rapid population ageing.

Goal

To develop a competency-based IPE programme for health and social care workers in the Philippines, which can be adapted for use in Viet Nam and other low- and middle-income countries to better integrate health and social services.

Methods

1. Analysis of the Philippines National Demographic Health Survey (2003-2017) and of the Community Elderly Survey in Hue, Viet Nam (2018) to determine the characteristics and needs of people 60 years and older.
2. Review of the existing curricula and professional training programmes based on IPE related to the care of older people in Japan, Philippines, and Viet Nam, and a global literature review of the reliability and validity of evaluation tools, enablers and barriers, and mechanisms and initiatives for IPE, based on research published between 2008 and 2018.
3. In-depth interviews and focus group discussions involving 348 health and social care workers (i.e., doctors, nurses, rehabilitation therapists, social workers, nursing assistants, community health workers, caregivers, etc.) directly involved in the care of older adults from selected primary health care centres, hospitals (i.e., public and private), nursing homes, and faith-based care centres in the Philippines and Viet Nam (174 participants in each country); and meetings with local experts and public officials to identify gaps between knowledge and practice of interprofessional collaboration.
4. Used the evidence obtained from the secondary data analysis, document reviews and qualitative research to develop a three-day training programme with scenario-based case methods and task-based group work modules and piloted the training programme with hospital workers and community health workers in Tagaytay and Marikina municipalities.
5. Evaluation of the training programme piloted in the Philippines using a randomized control design with community health workers (n=42 in intervention group and n=39 in control group), and a pre-and-post-test design with hospital workers (n=40). Evaluation tools included Attitudes Toward Health Care Teams Scale (ATHCTS), Coordinated Activities Evaluation Scale (CAES), Readiness on Inter-Professional Learning Scale (RIPLS), and Facts on Aging Quiz (FAQ).

Results

1. The qualitative research findings revealed that interprofessional collaboration tends to occur only on an ad hoc and inconsistent basis. Participants attributed this to a confluence of barriers at the personal level (i.e., power differences and hierarchy, disengagement and neglect, and unfamiliarity with other professions’ services and competencies, existing cultural background intricacies), organizational level (i.e., resource bottlenecks), and particularly systemic levels (i.e., fragmented geriatric care system).
2. The pilot intervention study showed a statistically significant improvement in attitudes among community health workers in the intervention group, which was sustained for 6 months after the training (ATHCTS score at pre-test 78.4, at 6 months after training 84.7, p<0.001). Statistically significant improvements in attitudes and coordination were observed among hospital workers immediately after the training (ATHCTS score at pre-test 88.9, on last day of training 98.4, p<0.001; CAES score at pre-test 25.6, on last day of training 29.7, p<0.001).

Global implications

Countries are striving to better respond to the health needs of populations as they age. Strengthening human resources is a critical component of this effort. The training programme developed through this study showed that in-service interprofessional education improves attitudes and care-coordination performance towards the delivery of integrated care for the growing number of older people.

Local implications

The training materials developed in this study are partly based on curriculum previously developed in Japan. These materials could inform the development of similar training programmes in the Kansai region to strengthen its human resources to respond to the needs of older persons. In turn, experiences from the Kansai region could be relevant for other countries facing the challenges of responding to the needs of older adults.

Research products

Published papers:

Nakamura, K., Siongco, K.L.L., Moncatar, T.R.T. et al. In-service training programme for health and social care workers in the Philippines to strengthen interprofessional collaboration in caring for older adults: a mixed-methods study. Health Res Policy Sys 20 (Suppl 1), 111 (2022). https://doi.org/10.1186/s12961-022-00914-2

Siongco KLL, Nakamura K, Seino K, Moncatar TRT, Tejero LMS, De La Vega SAF, et al. Improving community health workers’ attitudes toward collaborative practice in the care of older adults: an in-service training intervention trial in the Philippines. Int J Environ Res Public Health2021;18:9986. https://doi.org/10.3390/ijerph18199986

Moncatar TRT, Nakamura K, Siongco KLL, Seino K, Carlson R, Canila CC, Javier RS, Lorenzo FME. Interprofessional collaboration and barriers among health and social workers caring for older adults: a Philippine case study.Hum Resour Health 2021;19:52.https://doi.org/10.1186/s12960-021-00568-1

Han TDT, Nakamura K, Seino K, Duc VNH, Vo TV. Do communication patterns affect the association between cognitive impairment and hearing loss among older adults in Vietnam? Int J Environ Res Public Health 2021;18:1603.https://doi.org/10.3390/ijerph18041603

Siongco KLL, Nakamura K, Seino K. Reduction in inequalities in health insurance coverage and healthcare utilization among older adults in the Philippines after mandatory national health insurance coverage: trend analysis for 2003–2017.Environmental Health and Preventive Medicine2020;25:17.doi.org/10.1186/s12199-020-00854-9

Vo THM, Nakamura K, Seino K, Nguyen HTL, Vo TV. Fear of falling and cognitive impairment in elderly with different social support levels: findings from a community survey in Central Vietnam. BMC Geriatrics 2020;20:141. doi.org/10.1186/s12877-020-01533-8

Moncatar TR, Nakamura K, Siongco KLL, Rahman M, Seino K. Prevalence and determinants of self-reported injuries among community-dwelling older adults in the Philippines: A 10-year pooled analysis. Int J Environ Res Public Health 2020;17:4372. doi.org/10.3390/ijerph17124372

Moncatar TR, Nakamura K, Rahman M, Seino K. Health status and health facility utilization of community-dwelling elderly living alone in the Philippines: A nationwide cross-sectional study. Health 2019;11:1554-72. doi.org/10.4236/health.2019.1111117s

Manuscripts under review:

Nakamura K, Siongco KL, Moncatar TRT, Tejero LM, Vega SA, Bonito S, Javier R, Tsutsui T, Tri HTD, Vo MTH, Tashiro Y, Al-Sobaihi S, Seino K, Vo TV, Lorenzo FM, Canila CC. In-service training programme for health and social care workers in the Philippines to strengthen interprofessional collaboration in caring for older adults: a mixed methods study. – Health Research Policy and Systems. Supplement issue.

Vo MTH, Nakamura K, Seino K, Moncatar TRT, Han TDT, Siongco KLL, Tashiro Y, Vo TV. Can collaboration among health and social care workers help overcome geriatric care challenges? A qualitative case study in Central Vietnam. – Health and Social Care in the Community.

Conference Presentations:

In-service inter professional training program for geriatric care. Seino K, Nakamura K, Siongco KL, Moncatar TJR, Canila C, Javier R, Lorenzo FM, Takano T. 79th Annual Meeting of Japanese Society of Public Health, October 2020, Kyoto, Japan, J Jpn Soc Public Health, 67 (10 suppl.), 2020.

Determinants of collaboration for elderly care in a low-resource context. Moncatar TJR, Nakamura K, Siongco KL, Seino K, Canila C, Javier R, Lorenzo FM, Takano T. 79th Annual Meeting of Japanese Society of Public Health, October 2020, Kyoto, Japan, J Jpn Soc Public Health, 67 (10 suppl.), 2020.

Improvement in attitudes toward collaboration in the Philippine healthcare setting. Siongco KLL, Nakamura K, Moncatar TJR, Canila C, Javier R, Lorenzo FM, Seino K, Takano T. 79th Annual Meeting of Japanese Society of Public Health, October 2020, Kyoto, Japan, J Jpn Soc Public Health, 67 (10 suppl.), 2020.

Hearing impairment and cognitive function among older adults in Viet Nam. Han TDT, Nakamura K, Seino K, Vo MTH, Vo VT, Takano T. 79th Annual Meeting of Japanese Society of Public Health, October 2020, Kyoto, Japan, J Jpn Soc Public Health, 67 (10 suppl.), 2020.

Association between living alone and fear of falling among Vietnamese elderly. Vo MTH, Nakamura K, Seino K, Han TDT, Vo VT, Takano T. 79th Annual Meeting of Japanese Society of Public Health, October 2020, Kyoto, Japan, J Jpn Soc Public Health, 67 (10 suppl.), 2020.

Workforce development to improve quality health and social care services for older adults in ASEAN countries. Nakamura K. 7th International Health Literacy Conference, Nov 2019, Ho Chi Minh City, Vietnam

Does residence of Filipino elderly living alone affects non-communicable disease and health facility use? Moncatar TJR, Nakamura K, Siongco KL, Seino K, Rahman M, Canila C, Lorenzo FM, Takano T. 78th Annual Meeting of Japanese Society of Public Health, October 2019, Kochi, Japan, J Jpn Soc Public Health, 66 (10 suppl.) 598, 2019.

Predictors of type of health facility use among elderly in the Philippines. Siongco KLL, Nakamura K, Moncatar TJR, Canila C, Lorenzo FM, Seino K, Takano T. 78th Annual Meeting of Japanese Society of Public Health, October 2019, Kochi, Japan, J Jpn Soc Public Health, 66 (10 suppl.) 191, 2019.

Instrumental activities of daily living of the elderly in the central Viet Nam. Han TDT, Nakamura K, Vo MTH, Seino K, Vo VT, Takano T. 78th Annual Meeting of Japanese Society of Public Health, October 2019, Kochi, Japan, J Jpn Soc Public Health, 66 (10 suppl.) 263, 2019.

Cognitive impairment and fear of falling among Vietnamese older adults. Vo MTH, Nakamura K, Han TDT, Vo VT, Seino K, Takano T. 78th Annual Meeting of Japanese Society of Public Health, October 2019, Kochi, Japan, J Jpn Soc Public Health, 66 (10 suppl.) 597, 2019.