Interprofessional Educational Needs for Shared Governance of Integrated Care

Participants and Data Collection

This was a cross-sectional secondary data analysis of integrated care professionals in the community using an educational needs assessment survey. In the original study, the enrolled participants were integrated care professionals working in health and social care-related centers in 10 cities in South Korea that provided integrated care as a national pilot project. Convenience sampling is also performed. Professionals with less than 3 months of work experience were excluded. The researchers received permission from the representatives of health and social welfare centers via telephone and sent documents describing an overview of the research. The researchers sent the links to the electronic survey forms via email. Electronically informed consent was obtained from all participants. An online survey was conducted from December 2020 to January 2021, during which 210 respondents anonymously completed the survey. This convenience sample included integrated care professionals distributed across Korea and various practice settings. Only healthcare and social care professionals working in community settings were included.

Community-based integrated care professionals in South Korea collaborate to provide a range of services to meet the needs and circumstances of care recipients. The deployment of integrated care professionals in South Korea commenced in 2019. The roles of these professionals are still under development, with ongoing efforts to establish clear job descriptions, competencies, and training programs; however, research regarding this workforce remains limited. Administrators in local governments are responsible for the overall coordination of community-based integrated care, developing and implementing relevant policies, operating centers, and monitoring the performance of care providers. Care coordinators are frontline professionals, such as nurses and social workers, who work with individuals and their families to assess their unmet needs, develop care plans, and connect appropriate services in the community; health and social services providers implement direct health and social services when they are referred by care coordinators. Community health champions are peer supporters who share health messages with community residents in a friendly manner.

Measurement Tools

A study was conducted to identify competencies for integrated care using practical experience in integrated care (23), and a list of competencies was used in this study (Appendix 1). The survey asked integrated care professionals to report their opinions on which integrated care competencies are essential for their functioning by asking what is important in their job, how often they perform, and how much they want to learn, to identify their specific learning needs in integrated care practice. Although they are equipped with primary care principles from training programs, learners often encounter clinical settings that hinder their application [31]. Questioning practitioners regarding their educational needs can establish a foundation for developing practical educational programs. To understand educational needs, it is necessary to consider both the importance and performance of specific competencies. Importance refers to the degree to which it meets the purpose of the competencies, and the performance of competencies refers to how well competencies are performed. The survey questionnaires were validated by researchers and experts (seven professors of medicine, nursing, public health, and social work; two nurse practitioners; and one social worker). The questionnaire comprised items rated on a 5-point Likert scale (1 = not at all important; 5 = very important), with higher scores indicating greater importance in integrated care practice. Participants’ performance levels regarding integrated care practice were measured on a 5-point Likert scale (1 = not at all performed; 5 = performed very much), with higher scores indicating better performance in integrated care practice.

Data Analysis

SPSS software (version 22.0) was used to analyze the data. Frequency analysis was conducted to analyze the characteristics of the participants. An independent t-test was applied to the traditional importance-performance analysis method by Martilla and James (1977) [32] to determine the gap between integrated care professionals’ perceptions of the levels of importance and performance in integrated care practices. The Borich Needs Assessment Model [33] was used to identify the educational needs of integrated care professionals and their order of priority by considering the mean importance weight. To present a reference point for the order of priority, the Locus for Focus Model [34] was used to determine the number of items included in the high discrepancy, high importance (HH) quadrants. The Locus for Focus Model achieves this by plotting two key measures: the required change level, positioned on the horizontal axis, and the average difference between the required and perceived change levels, plotted on the vertical axis [34]. In this study, average performance served as the cutoff point on the horizontal axis, whereas the average difference between performance and importance was defined as the cutoff point on the vertical axis. HH was the first quadrant, and indicated the highest priority of education needs among the four quadrants; high discrepancy, low importance (HL) was the second quadrant and indicated a lower importance level than the average but a higher degree of discrepancy than the average. High-priority needs according to the Borich Needs Assessment Model were considered in the number of items, and when items from both methods corresponded, they were selected as the items with the highest priority. Items that were highly ranked in the Borich Needs Assessment Model, but were included in the HL quadrant, were selected as items of second priority.

Ethical Consideration

This study was approved by the Institutional Review Board of Chungnam National University (No.202009-SB-121-01).

Participants’ Characteristics

The demographic characteristics of the participants are presented in Table 1. They comprised 210 integrated care professionals working in integrated care facilities within the community. Most participants (66.4%) were female, with a mean age of 45.42 years and a mean length of work experience of 10.01 years. The education levels of the professionals were 61.4% with a bachelor’s degree and 22.8% with a master’s degree. Their positions were community care administrators (9.1%), care coordinators (34.9%), healthcare and social care service providers (29.5%), and community health champions (26.6%). Before participating in this study, over 70% of the professionals had not received any formal training or courses on integrated care.

Educational Needs in Core Integrated Care Competencies

This study administered 19 items derived from the core competencies of integrated care to all the integrated care professionals. The average importance and performance scores for the competencies and educational needs are presented in Table 2. No. 5 (working collaboratively across integrated care settings to improve professionals’ and community residents’ experience of care) was the most important competency according to the respondents, with a score of 4.35 ± 0.77 (mean ± standard deviation), and was also the most-performed competency, with a score of 3.84 ± 0.99. The highest educational needs score was analyzed using the Borich Needs Assessment Model for Item 16 (utilizing information and communication technology [ICT] appropriately for integrated care), and the second highest was for Item 15 (collaboratively working with multidisciplinary professionals). However, according to the Locus for Focus Model, no. 16 appeared in the HL quadrant, whereas nos. 15 and 5 appeared in the HH quadrant (Figure 1).

Figure 1

Educational Needs in the Community-Care Competencies of Administrators

Twenty items derived from community-care administrator competencies in integrated care were administered to the community-care administrators. The average importance and performance scores for competencies and educational needs are presented in Table 3. Item 8 (building effective working relationships with other professionals working in public or private institutions) was the most important skill according to the respondents, with a score of 4.18 ± 0.80. Item 19 (planning finance, budget, and business, and monitoring the cost-effective use of finance and resources) was the most performed skill, with a score of 3.86 ± 0.99. The highest educational needs score analyzed using the Borich Needs Assessment Model was for no. 3 (developing policies relevant to integrated care based on circumstances and problems in the community), and the second highest was for no. 8. According to the Locus for Focus Model, no. 1 (identifying high-priority needs related to healthcare and social welfare in the community), no. 2 (identifying healthcare and social welfare problems in the community), and nos. 3 and 8 appeared in the HH quadrant (Figure 2).

Figure 2

Educational Needs in the Competencies of Care Coordinators

Thirteen items derived from community-care coordinator competencies in integrated care were administered to community-care coordinators. The average importance and performance scores for the competencies and educational needs are presented in Table 4. No. 7 (referring to community residents with health care and social welfare needs to adequate services) was the most important skill according to the respondents, with a score of 4.21 ± 0.79, and was the most-performed skill, with a score of 3.83 ± 0.92. The highest educational needs score analyzed using the Borich Needs Assessment Model was for no. 7, and the second highest was for no. 8 (identifying community residents’ satisfaction with received services). According to the Locus for Focus Model, no. 4 (determining patients’ comprehensive needs accurately), no. 5 (contributing to developing care plans to meet individuals’ health and social care needs), and nos. 7 and 9 (monitoring the quality of services to meet the quality standards and requirements) appeared in the HH quadrant (Figure 3).

Figure 3

Educational Needs in the Competencies of Healthcare and Social Care Service Providers

Thirteen items derived from community-care service providers’ competencies in integrated care were administered to community-care service providers. The average importance and performance scores for the competencies and educational needs are presented in Table 5. Item 9 (helping community residents confront emergencies or crises) was the most important competency according to the respondents, with a score of 4.58 ± 0.62. Item 1 (identifying the health and social care needs of community residents to provide person-centered services) was the most performed competency, with a score of 4.01 ± 0.84. The highest educational needs score analyzed using the Borich Needs Assessment Model was for no. 3 (promoting local services effectively), and the second highest was for no. 2 (planning local services based on the needs of community residents). According to the Locus for Focus Model, no. 2, no. 3, no. 8 (undertaking training and development of the workforce providing services), and no. 9 appeared in the HH quadrant (Figure 4).

Figure 4

Educational Needs in the Competencies of Community Health Champions

Twelve items derived from the competencies of community health champions in integrated care were administered to community residents who worked as community health champions. The average importance and performance scores for the competencies and educational needs are presented in Table 6. Item 1 (identifying health and social care-related problems of community residents) was the most important competency according to the respondents, with a score of 4.14 ± 0.77. Item 7 (participating in decision-making relevant to health and social care needs) was the most performed competency, with a score of 3.63 ± 0.95. The highest educational needs score analyzed using the Borich Needs Assessment Model was for Item 1, and the second highest was for Item 4 (understanding the importance of participating in the integrated care process). According to the Locus for Focus Model, no. 1, no. 8 (playing a leading role when designing health- and social-related business plans for community residents), and no. 9 (cooperating with community-based organizations/institutions for integrated care) appeared in the HH quadrant (Figure 5).

Figure 5

Strengths and Limitations

The need for integrated care is increasing owing to the aging population. The increasing demand for person-centered care for the elderly necessitates integrated medical, nursing, and social service models. Working together can provide comprehensive and coordinated care tailored to each individual’s unique needs and preferences. This study investigated the educational needs of integrated care professionals based on their competencies. This further enables evidence-based education program designs and allows learners to apply their knowledge practically. The study also included a core professional group comprising community health champions who needed to be included in integrated care in community settings. This would provide an opportunity to train peer supporters, who are also community residents, as experts to facilitate public participation in the integrated care process. However, this study had several limitations. First, it was conducted in one country, and specific cultural or political characteristics may have affected the results. Future studies should include multiple countries to compare these differences. Selection bias may have affected the validity and generalizability of our findings to a broader population. The sample was drawn from integrated care professionals in several cities in South Korea who agreed to participate in this study. Moreover, the number of participants in the community-care administrator group was relatively small because they were public officers working in public centers.