Mixed Methods Study of Teaming Up for Community Health Simulation Intervention
Background: To improve health outcomes, the social determinants of health (SDoH) need to be integrated throughout prelicensure education, with experiential learning to aid in transferring theory to practice. Interprofessional education (IPE) is vital because a multifaceted, team-based approach is needed for complex SDoH. A 3-day IPE simulation intervention, Teaming Up for Community Health (TUCH), was designed to provide experiential learning on team-based care to address SDoH.
Methodology: A 2-group quasi-experimental design was used to evaluate students’ interprofessional teamwork socialization, valuing, and attitudes, and their empathy and commitment to addressing poverty and SDoH. Students participated in INTRAprofessional teams (nursing students–comparison group) or INTERprofessional teams (nursing and social work students–intervention group). TUCH Day 1 included team building and a video simulation, Day 2 was a poverty simulation, and Day 3 was an unfolding simulation with standardized patients: escape room to telehealth encounter to clinic visit. Surveys were completed pre-/post-TUCH and 2-months later. Data was analyzed for 85 nursing students using Mixed Model Analysis of Variance; analysis of social work student data was not completed due to low enrollment (1 student/group). Focus groups were conducted to examine nursing and social work students’ perceptions of the value of TUCH.
Results: Interprofessional Socialization and Valuing Scale (ISVS-21) scores significantly improved and remained elevated for both groups. Attitudes Toward Health Care Teams Scale (ATHCTS)-Quality of Care Delivery score improved for the intervention group only and was significantly higher than the comparison group. Undergraduate Perceptions of Poverty Tracking Survey (UPPTS) scores showed heightened empathy and commitment to addressing SDoH at baseline, with few significant improvements. Thematic analysis revealed four themes: Better understanding of community care, Must address SDoH, Teamwork is important to practice, and Learning is enhanced by engaging and applying.
Conclusion: Attitudes towards team-based care improved after participating in INTERprofessional teams, while interprofessional socialization and values improved after both INTRA- and INTER-professional learning. Outcomes related to SDoH did not show improvement likely because students were already highly empathetic and committed; however, qualitative findings revealed better confidence for addressing SDoH in clinical practice.
Implications: Results suggest curricula include both intra- and inter-professional simulations. Further study of enhancing teamwork outcomes through a combination of intra- and inter-professional simulations is recommended. A major aim of TUCH was to improve ability to address SDoH with team-based care, but a measurement tool was not located. Future education and research should go beyond addressing empathy and seek to improve self-confidence and performance.
