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Perspectives of older people and healthcare providers on implementingperson-centred care for community-dwelling older people: a systematic reviewand qualitative meta-synthesisLulu Liao 

School of Nursing, Tongji Medical College, Huazhong University of Science and Technology https://orcid.org/0000-0002-6914-6628Yilan Liu  ( yilanl2020@163.com )

Department of Nursing, Union Hospital Tongji Medical College Huazhong University of Science and TechnologyChunyan Guan 

Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyMingjiao Feng 

School of Nursing, Tongji Medical College, Huazhong University of Science and TechnologyYanjie You 

School of Nursing, Tongji Medical College, Huazhong University of Science and TechnologyYuqin Chen 

School of Nursing, Tongji Medical College, Huazhong University of Science and Technology

Systematic Review

Keywords: Person-centred care, older people, Community Care, Qualitative meta-synthesis, Systematic review

Posted Date: August 23rd, 2022

DOI: https://doi.org/10.21203/rs.3.rs-1981417/v1

License: This work is licensed under a Creative Commons Attribution 4.0 International License.   Read Full License

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Abstract

BackgroundPerson-centred care is a critical approach to improve the quality of care targeted to community-dwelling older people. The old-age care services could beprovided according to the choices, needs and preferences of the elderly. However, there have been few studies to synthesize qualitative studies and noconsensus about in�uencing factors on providing person-centred care in community. The aim of this study was to synthesize research evidence onperceptions and experiences of older people and healthcare providers on person-centred care and determine the enablers and barriers to implementing person-centred care for community-dwelling older people.

MethodsSearches were performed in PubMed, Embase, Cochrane, PsycINFO and CINAHL in published articles and were reviewed from the earliest available date toApril 2022. A quality appraisal was undertaken targeted to selected articles by the Qualitative Method Appraisal Tool. And the results from the included studieswere interpreted and synthesized through a meta-synthesis.

ResultsNine included articles were analyzed to identify 89 �ndings that were organized into 11 categories and combined into three synthesized �ndings—stakeholdercapability; opportunities in the implementation of person-centred care; motivation in the implementation of person-centred care. Summarizing these themeshelps stakeholders to identify in�uencing factors that improve the implementation of person-centred care.

ConclusionsThe �ndings of this study provide a reference for implementing successful person-centred care in the community. Improving person-centred care serviceshould develop the capability and motivation of stakeholders, and increase opportunities to build a positive environment for meaningful interactions betweencaregivers and older people.

BackgroundThe aging population is a severe problem for social development and sustainability worldwide, especially in China which has almost one-�fth of the globalpopulation aged ≥ 65 years based on the latest seventh National Census[1]. At least 150 million older people suffer from a chronic disease[2], and a growingnumber are either incapacitated or semi-incapable [3]. Generally, the aging Chinese population have displayed characteristics that can be described as 'threemore', namely more advanced age, more disability and more chronic disease. Providing high-quality old-age care and health services is urgent following theincreasing demand for services from an ageing population with more complex needs. Currently, family-based informal care is far from meeting the multi-levelneeds of older people, and formal community home care services are needed [4]. Community home care is a kind of old-age care based on the community,combining the reasonable elements of family care and institutional care, which not only embodies the core care concept of "endowment in place" but alsorealizes the combination of humanistic concept and cost-effectiveness principle [5]. Person-centred care (PCC) is foundational to providing high-quality healthcare[6]; old-age care services could be provided according to the choices, needs and preferences of the elderly. However, there had been no consensus aboutproviding PCC in the community.

The term ‘PCC’, as used in this study, is seen as an umbrella concept that covers the same meaning, such as ‘individualized-centered care’, ‘client-centeredcare’, ‘resident-focused care’, etc. The Health Foundation in the UK believes that PCC must contain four elements: providing dignity, compassion and respect;providing tailored care; supporting people to recognize and exploit their strengths and abilities; making them independent enough to live a satisfying life[7].The American Geriatrics Society panel believes that PCC requires individuals to be motivated to express their values and preferences during caregiving[8].Thus, there are different terms for PCC, but they all embody four basic care principles: wholeness, individuality, respect and empowerment. There is generalconsensus on the relevance of the person-centred view, but it is necessary to translate the PCC framework into practice [9]. Especially in community home caresettings, where the inherent isolation in home-based caring and limited professional autonomy of healthcare providers (HCPs) make it di�cult to �nd abalanced interpersonal encounter relationship with older people[10]. These problems pose huge challenges for providing high-quality care for older people tomeet their care needs.

A large number of studies about the implementation of PCC in hospitals and nursing homes have been reported, with relatively few studies taking place incommunity home setting, indicating a research disparity in this important �eld of study between acute care hospitals, long-term institutions and community[11–13]. The research to date has focused on the effectiveness of PCC, but few on the key factors for implementing PCC targeted to older people incommunity home care. In light of this, this article explores the critical factors for implementing PCC in the community research domain. Studies have shownthat HCPs acquire PCC assessment and care skills primarily through their own intuitive and trial-and-error processes, with little educational or institutional help[14, 15]. Community doctors have highlighted the importance of their own personal resources and developing relationships with older people in shaping thePCC provided [16]. Due to the complexity of interventions and the range of results, it is di�cult to draw accurate conclusions about the in�uencing factors ofPCC interventions implemented in the community home care.

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PCC has been promoted as the cornerstone of high-quality care [17]. A challenging task and topic of increasing interest within healthcare are improvingcommunity home care quality while reducing cost [18]. Qualitative research offers great advantages for an in-depth understanding of the PCC experiences ofdifferent populations in the community. This type of research plays a crucial role in providing evidence for the signi�cance, feasibility and acceptability ofimplementing PCC interventions for community health professionals, home-based caregivers, and older people. Despite �nding a relatively large number ofbasic research in this area, a systematic evaluation of enablers and barriers to implementing PCC in the community elderly care has not yet been reported [19–21]. The COM-B model (Capacity, Opportunity, motivation-behavior model) has been widely used in the medical �eld to explain and guide a variety ofbehavioral interventions, which can comprehensively and systematically understand the in�uencing factors in the process of behaviour change [22]. The aimof this study was to gain insight into perspectives of older people and HCPs on PCC for community-dwelling older people and to identify the enablers andbarriers to successful implementation based on the COM-B model.

MethodsResearch design

This systematic review with qualitative meta-synthesis was guided by the guidelines of Joanna Briggs Institute [23]. To identify published or ongoing projectsrelevant to the topic, a systematic review and meta- synthesis were carried out by searching Procedure PROSPERO (https://www.crd.york.ac.uk/prospero/).When seeking a greater understanding of stakeholders' experiences with PCC interventions, especially when the aim is to include speci�c groups such as olderpeople in the community, qualitative research is better suited and even required than quantitative research. This review was registered with PROSPERO(CRD42022314924).

Search strategy

The search strategy aimed to identify peer-reviewed published studies. We conducted a broad bibliographic search using the CINAHL, PubMed, Ovid Embase,Cochrane, and PsycINFO from the earliest available date to April 2022. The research was not limited to the English language. A three-step search strategy wasused to locate the literature in this systematic review. First, two researchers will undertake an initial limited search of CINAHL and PubMed, followed by astructured analysis of text words contained in titles, and of index terms used to describe the article. With this initial step, we will ensure that our searchstrategy is su�ciently sensitive, precise, and speci�c in terms of our research objectives and the population, concepts, and context of interest. A secondextensive search, we will undertake a structured search using all identi�ed keywords and index terms. Lastly, the reference lists of all included articles will besearched manually for additional sources. The initial search included the key search terms of person-centred care, patient-centered care, older people, andcommunity care. Details of the full search strategy are provided in Appendix .

Eligibility criteria and study selection

To ensure the correct identi�cation and selection of relevant studies, we developed the inclusion/exclusion criteria to aid the selection of appropriate papers.The inclusion criteria of the systematic review are outlined below: a). all of the included studies were qualitative or mixed methods studies; b). the context wascommunity home caring institutions, providing professional home healthcare visits. Hospitals or nursing homes were excluded; c). the focus was on thatstakeholders’ experiences of participating in PCC interventions programs, including but not limited to older people over the age of 60, health professionals,family caregivers. These health professionals may have been working in any sector in community health services institution. As a primary focus of thesystematic review was the perspectives of older people and HCPs on PCC interventions, studies using quantitative methods to analyze data were excluded.

We searched relevant databases and grey literature, retrieving 4,240 papers. All search results were imported into EndNote X9 software. A total of 3,379 articleswere identi�ed after removing duplicates. Two trained reviewers independently screened the titles and abstracts following the inclusion and exclusion criteria,3,255 papers were deleted. Of the 124 articles that met the inclusion criteria remaining, 114 were excluded after full-text review assessment and 10 met theeligibility criteria. The quality appraisal revealed that nine included articles were of high quality and one with poor quality was deleted. Figure 1 shows theresults of the search and screening strategies. Articles were independently screened by two researchers, and there were no disagreements.

Quality assessment

Studies were assessed for quality using the Joanna Briggs Institute (JBI) qualitative research appraisal tool [24]. Original studies had to score more than �veassessment criteria in order to be selected in this review synthesis. On each item was answer-able by either “yes” (1 point), “no” (0 point), “not application” (0point) or “unclear” (0 points). To avoid possible biases, lower-quality studies were excluded [25, 26]. One of the original studies [27] received only �ve scores inthe quality assessment process due to lack of adequate details and was therefore excluded from this review (Appendix ). Any disagreements were resolvedafter discussion between the two reviewers or following consultation with a third reviewer on the team. The quality assessment of the full text papers includedin the review is reported in Table 1. 

Data extraction and synthesis

All included papers in the systematic review were analyzed independently by two authors. Relevant details for each study were extracted from papers using astandardized data extraction tool from Joanna Briggs Institute Qualitative Assessment and Review Instrument JBI-QARI . The �ndings are extracted verbatimfrom the studies, as are the illustrative quotes usually recorded verbatim from the participants. Findings were graded in accordance with the reader's level ofcon�dence in the �ndings based on the published data. Each article was critically appraised by two reviewers independently and attributed a level of credibilityto each one. The JBI-QARI qualitative criteria has three levels of credibility: unequivocal (U) —relates to �ndings that are matter of fact, beyond reasonabledoubt; credible (C)—relates to �ndings that are plausible interpretations of the primary data within the theoretical framework; and unsupported (Un)—relates to�ndings that are unsupported by the data. There were no disagreements between the reviewers in this process. Based on the similarity of meanings, those

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�ndings were combined to form different categories, these categories were then subjected to a meta-synthesis to generate comprehensive synthesised�ndings by meta-aggregation [28]. A systematic process of data organization and synthesis was led by the �rst author. In the case of a disagreement, afterconsulting the primary literature, a group discussion to reach an agreement will be held. 

We will assess the �nal synthesised �ndings based on the JBI approach for rating con�dence of synthesised qualitative �ndings (ConQual) to determine thecon�dence level [29]. The summary of �ndings table was created by using the following major elements, including population, phenomena of interest, context,synthesised �nding, type of research, and the �nal ConQual scores. 

ResultsCharacteristics of the studies

Nine research studies met the eligibility criteria for inclusion in the meta-synthesis, all of which were qualitative studies. The methods applied in the ninearticles were mainly one-to-one interviews and focus group interviews. The articles are spread over time (from 2006 to 2022), mostly concentrated in 2018-2022. Among the nine papers, three were from Canada, two were from Australia, and four were from Ireland, United Kingdom, Netherlands, and America,respectively. The contexts of the studies were mainly community living or residential settings for older people. The study participants were diverse, includingregistered nurses, voluntary staffs, case managers, older people, family/friend caregivers, and clinicians. Further detailed results of the included studies arepresented in Appendix . 

Meta-synthesis of qualitative data

We extracted a total of 89 �ndings from the nine included studies, all of which were unequivocal. Those �ndings were aggregated into 12 categories based onthe similarity of meanings, which were then meta-aggregated into three synthesised �ndings (Table 2). The study �ndings are listed in Appendix IV and theresults of the meta-synthesis process are shown in Appendix V.

Synthesised �nding 1: Stakeholder capability 

It is crucial to recognize that stakeholder capability affects the implementation of PCC interventions. Communication skills and professional competence canbe improved through providing tailored training education. Furthermore, older people and their caregivers should be encouraged in decision-making.

Trust and mutual communication are the cornerstones around which a humanistic care team is built; it should be done with understanding and respect andwithout regard for hierarchy. A person-centred communication style involves active or re�ective listening that is advantageous to drive behaviour change. 

I asked, like, he asked me questions and he doesn't focus with me. There's no that connection…between you. Like he has to listen to you �rst, but he's on thecomputer like “uh huh. What happened to you? — Uh huh”. I don't want that. Like, I want, like, personal connection. He has to understand me. What's my pain…and they don't look. Manalili, K et al.,2021, p.8

Communication can be number one no matter who you’re looking after. (McKenzie and Brown,2021, P.278)

Older people generally lack decision-making capabilities, and it is believed that competence in making decisions encourages personnel to participate moreenthusiastically in decision-making processes.

And I said was there ever, was there any way that I could have somebody help me with my grocery shopping? And he said 'Oh, yes, you, they have this, uh, yougive them a list and they go out and shop and they bring it back and, uh, you pay for it.' But that's not helping with my grocery shopping, that is just groceryshopping. (Giosa, J et al., 2021, P.8)

Yaa, so, being a valued member of the care team, and to be treated as a human being, versus just this patient… cause I had a lot of experience withthat. (Manalili, K et al.,2021, P.9)

Meanwhile, HCPs in the community should develop care plan by combining experience with research literature. And the community managers should carry outtargeted training to improve professional competence about PCC.

It’s a combination of your academic study on that person, your professionalism in getting to know that person. But really and truly it is your day-to-day work,working with that person on a physical, intellectual and intimate level. (Doody, C et al., 2013, P.1118)

I have probably psychoanalyzed a lot of the experiences that I’ve been through to learn from my mistakes. (Narayan MC and Mallinson RK, 2022, P.5)

Synthesised �nding 2: Opportunities in the implementation of person-centred care

It is essential to note that opportunities are important factors in�uencing the implementation of PCC, including support from work environment resources,collaboration and multidisciplinary teamwork. And communication helps to establish a climate of trust and respect and facilitates making shared decisions.Financial and time constraints posed barriers to conducting the PCC interventions.

The workplace support (physical and cultural) is especially important to convince stakeholders if a person-centred approach is to be supported. Availableresources (human and �scal) and reasonable workload impact the implementation of PCC and, in particular, the choice of intervention methods.

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One of the very huge issues affecting community nursing right now is financial compensation. I mean, you work in a hospital, you do pretty much the samething you do out here – [but] you get paid more for it [if you work in the hospital] and it’s a hard thing to convince people that it’s worth coming to thecommunity for personal reward rather than financial [remuneration]. (Brown, D et al., 2006, P.164)

Reinforcing multidisciplinary teams and collaboration are seen as an important part at PCC program. Older people with chronic diseases often need support inmultiple domains, and also facilitate providing continuity of care for them over time.

One of the greatest barriers is the lack of understanding of person- centeredness. People think that the nurses are the only people to be person-centred buteverybody from the maintenance man, cook, household staff and the team all have to be person-centred. (Doody, C et al., 2013, P.1117)

Establishing a trusting and respectful relationship is seen as key to promote a good social environment. The person-centred approach that guidedcommunication might be crucial in creating trust between older people, family caregivers, health professionals. Signi�cant time spent deliberately buildingtrust and rapport, through which health outcomes are achieved, makes sense for the implementation of PCC programmes.

Caring doctors took participants seriously and were not dismissive, unlike doctors whose attitude was uhum, right, sure as they were writing the prescription.Caring doctors were responsive: He interacted with me, at my level. . . he treated me like a sentient, sensible, intelligent woman. . . looking at a situation andhim recognising what his responses and reactions needed to be, he was not dismissive, he was engaged. (Gillespie, H et al., 2018, P.1060)

it is important because it’s also a part of building a relationship of trust. Clients apparently like the social aspect, having a nice time. Well, I do think that this isan important component, but it’s certainly not my main reason for coming. (Uittenbroek, R. J et al., 2018, P.6)

Time constraints are averse to implementing successful PCC programmes. This could be partly due to a lack of health staff and bureaucratic overload (lack ofa whole service approach, staff turnover, sharp targets and complex procedures). The situation resulted in high work pressure, overtime, and reduced quality ofcare. This condition can cause stressful work environments, burnout, and decreased quality of care.

We’re only touching the tip of the iceberg in relation to person-centredness. We do our utmost in choice, in documentation, in family involvement, but we wouldneed ten times more staff to do what possibly could be done for each service user to fulfil their dreams, we do the best we can with person centeredness at thecore. (Doody, C et al., 2013, P.1117)

Synthesised �nding 3: Motivation in the implementation of person-centred care

Motivation includes re�exive and automatic motivation, which guide the oneself to produce positive or negative emotions towards behavioral goals in PCCprogrammes through increasing knowledge and experiences. The resilient attitude of care professionals, especially proactive caring belief, facilitated theparticipation of all stakeholders in the process of person-centred care. Factors impeding implementation included lack of self-re�ection, unclear responsibilityfor rewarding and accountability, and pre-existing ways of providing tailored personal health care.

The managers facilitate self-directed learning and encourage self-re�ection using critical thinking skills, which are bene�cial to gaining insight into theirbeliefs, values, and attitudes from both a cognitive and emotional perspective. 

I have probably psychoanalyzed a lot of the experiences that I’ve been through to learn from my mistakes” (Narayan MC and Mallinson RK, 2022, P.5)

The health professionals and family caregivers should consider proactive and compassionate caring as the heart of the practice, treat the older people withdignity and respect as an individual.

Actually, whenever I go to doctor, they call me by name. Once [they] call me by my name I feel close, attached to them. Otherwise, I'm going to feel bad. myrelationship with my doctor is really good. (Manalili, K et al., 2021, P.8)

Strengthening rewards and accountability mechanisms are facilitators to implementing effective PCC. Some managers stated that the role of case managersand patients' rights should be clari�ed. 

Doing the right thing is quality, right thing is a standard. So, if you are diagnosed with particular disease for a patient, then you have to do the right things, whatyou need to do, so quality, in my opinion he's doing the right things. (Manalili, K et al., 2021, P.10)

In the PCC programme, having a resilient, optimistic attitude and positive beliefs toward self-management of older people is a vital step in the direction of theiractivation. The stakeholders can side-step the barriers with a resilient attitude that allows them to embrace the positive aspects.

I make it work for me and for the patient. And I can make it work for the agency as well. I’m not afraid to think out of the box, change the way I do things. I amalways thinking is there something that I could do differently to be more successful” (Narayan MC and Mallinson RK, 2022, P.6)

ConQual ‘Summary of Findings’

The CERQual approach provides transparent assessment and explanations of what level of con�dence should be assigned to individual review �ndings [25].The ConQual Scores and the summary of the synthesised �ndings are shown in Appendix . The ConQual Scores was moderate for three synthesised �ndings,where were downgraded one level due to dependability limitation issues. All �ndings are unequivocal, so the credibility of all included studies remainsunchanged.

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DiscussionThis systematic review provided a comprehensive picture of the perspectives of older people and HCPs on PCC in community home care based on theavailable literature. We derived three key synthesised �ndings from our global synthesis: stakeholder capability, opportunities in the implementation of PCC,motivation in the implementation of PCC. These �ndings identi�ed a broad range of barriers and facilitators to implement effective PCC programmes incommunity setting. No previous systematic review has synthesised qualitative data regarding these in�uence factors. In the context of quality improvement,this review provides a timely overview regarding the current evidence related to PCC interventions, considering the waste of medical resources, we shouldprovide safe and continuous person-centred case management medical services in accordance with older people needs.

Stakeholder capability is one of the essential components affecting the successful implementation of PCC programmes. Enhancing the person-centredcommunication skill of HCPs and decision-making capabilities among older people were cornerstones for implementing PCC in community. Older people'svalues and preferences are incorporated with the expertise and knowledge of their treating teams through shared decision-making [30]. This PCC interventionwill require older people to clearly express their needs and preferences in order to be translated into professional expectations and actions as person-centredoutcomes [31]. However, it is noteworthy that there is a �ne line between negotiating over goals with the older people and persuading them to accept tailoredgoals [32]. Therefore, care service should pay attention to fostering best practice in mutual communication and construct the appropriate social relationshipsbetween the older people, family caregivers and health professionals, in order to improve quality care and meet their needs. In addition, it would be also usefulto provide evidence-based training by combining experience with research literature to enhance professional competence for HCPs [14, 33]. The evidencewhich is currently available on PCC interventions do not be necessarily used in daily clinical practice [34]. Professional trainings should be designed tointegrate theory knowledge with practice wisdom. In the process of training, highlight the practicability of theoretical knowledge, such as explaining morecases in caring; The teaching mode should also be mentee-oriented, rather than the traditional mentor-dominated, so as to further improve trainees' self-thinking and adaptability [35, 36].

Most challenges and obstacles exist in the �eld of opportunity. The review has shown that establishing multidisciplinary teamwork and collaborationmechanisms will be essential to truly implementing individualized care plans as a person-centred innovation in practice. According to the plan-do-check-act(PDCA) cycling management mode, multidisciplinary teamwork and dynamic self-monitoring management are important link for continuous qualityimprovement [37]. Other studies have also drawn similar conclusion. For example, Chenoweth and Wu et al. [38, 39] also found that collaboration betweendepartments and team members were favorable for fostering a positive environment for meaningfulness interactions between caregivers and older people. ALack of trusting relationships and time constraints are barriers for successfully implementing PCC in daily practice. The Institute of Medicine (IOM) putforward the "PCC" is the medical staff take the elderly in care as equal partners rather than the recipient, establish a trustful and respectful relationship witholder people and their families, to ensure them get education and support they need, and develop effective care plans [40]. The essence of time constraints issigni�cantly understaffed, re�ected in lower HCPs to the elderly ratios. At present, the main family caregivers are the spouse, the next children and otherrelatives, and the last nanny. But they lack essential knowledge regarding PCC interventions. It is clear that traditional family informal care does not su�ce tomeet the multi-level care needs of older people, which highlights the need for community home care services [4]. With the increase of health needs andworkloads in complexity, the low sta�ng ratios further increases work burden and time pressure [41]. It has been suggested that training to improve the qualityof caregivers can make up for the shortage of caregivers [42]. Overall, an adequate supply of resources is more conducive to PCC interventions, theinfrastructure of healthcare organizations and the positive environment enable older people to experience relative well-being [43].

Recognizing motivation is a necessary component for successful PCC programme implementation. We identify several in�uencing factors that related to the‘re�ective motivation’ component of the COM-B model, including positive self-re�ection, proactive caring as the heart of the practice, strengthening rewardsand empowerment mechanisms, and possessing resilient optimistic attitude towards PCC. By fostering caregivers' practical and re�ective skills, they are ableto adapt to changes in unforeseen circumstances through critical thinking. Ennis expressed that critical thinking aims to determine our beliefs and actions. Itis the ability to evaluate, analyse and synthesize information outside the self, which is of crucial importance to all supervision [44]. Based on theoretical ModelJean Watson’s theory of human caring, human care is the core and essence of caring practice. Each individual is treated as a whole, their rights are respectedand treated equally, and self-identity of care recipients is supported [45]. The managers could be appropriately authorized to HCPs and homecare workers,create a fair, caring, and rule-oriented ethical atmosphere, and establish a �rm and reasonable reward-and-punishment mechanism [46]. Empowerment(knowledge, competence, values, impact) and establishing reward and punishment mechanism are important for promoting the likelihood of sustained leanefforts and improving the desired health outcomes [47].

Qualitative research emphasizes subjectivity and individuality, and meta-synthesis is a systematic review of original qualitative research, which can interpretthe phenomenon more comprehensively, promote people-oriented caring, and re�ect the humanistic, social and ethical characteristics of caring services. Inthis way, it is possible to integrate the in�uencing factors in the person/patient/client centred care practices of older people across different communities,cultures and countries. Another strength is that the evidence in this review comes from the views of multiple stakeholders such as older people, healthprofessionals and family caregivers, so a range of views was collected. Due to the majority of studies do not present a statement locating the researcherculturally or theoretically, the included literature is primarily considered to have moderate dependability.

ConclusionUsing the COM-B model as the theoretical framework, this study comprehensively and systematically analyzed the barriers and promoters of theimplementation of PCC for community-dwelling older people. Three themes identi�ed in the study are: stakeholder capability, opportunity in the PCC, andmotivation in the PCC. Taking the above factors as the entry point, targeted interventions should be taken to improve the practical level of PCC. 

Implications for research

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There are eleven implications for research that were found. Each of the recommendations from the review is provided in Appendix and has been assigned alevel of Recommendation based on guidelines from the Joanna Briggs Institute [48]. Three grades of Recommendation are used Grade "A" (strongRecommendation), Grade "B" (intermediate Recommendation) and Grade "C” (weak Recommendation). Findings can strengthen the evidence on implementingperson-centred care programmes in community. It is necessary assess the capabilities and skills of person-centered communication, decision-making andinformation processing, provide a platform to support change at the individual and environmental level. And there is a need to research to focus on designing,developing, and implementing training and education programs about PCC in community.

AbbreviationsHCPsHealthcare providersPCCPerson-centred CareCOM-B modelCapacity, Opportunity, motivation-behavior modelJBIJoanna Briggs InstituteConQualCon�dence of synthesised qualitative �ndingsPDCAthe plan-do-check-actIOMthe Institute of Medicine

DeclarationsEthics approval and consent to participate

No ethical approval and consent to participate was required for this paper.

Consent for publication

Not applicable

Availability of data and materials’ statement

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

No con�ict of competing interest has been declared by the authors. 

Funding

This study is granted by 2020 scienti�c research project of Chinese Nursing Association. Grant Number: ZHKY202006.

Authors’ contributions

Study design: LLL, GCY. Data analysis: LLL, GCY, FMJ. Manuscript writing: LLL, GCY. Manuscript revisions: all authors.

Acknowledgement

Not applicable

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TablesTable1. Quality assessment of included studiestion Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Scorewn et al. (2006) U Y Y Y Y N N Y Y Y 7dy et al. (2013) U Y Y Y Y N N Y Y Y 7espie et al. (2018) Y Y Y Y Y Y Y Y Y Y 10enbroek et al. (2018) U Y Y Y Y Y N Y Y Y 8sa et al. (2021) U Y Y Y Y Y N Y Y Y 9nalili et al. (2021) Y Y Y Y Y Y Y Y Y Y 10Kenzie and Brown (2020) U Y Y Y Y Y Y Y Y Y 9Kenzie and Brown (2021) U Y Y Y Y U U Y Y Y 7ayan and Mallinson (2022) Y Y Y Y Y Y Y Y Y Y 10

 

 

Table 2. Themes of Meta-synthesis

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Synthesizedfindings

category Brownet al,2006

Doodyetal,2013

Gillespieetal,2018

Uittenbroeket al,2018

Giosaetal,2021

Manalilietal,2021

McKenzieandBrown,2020

McKenzieandBrown,2021

Narayan andMallinson,20

Stakeholdercapability

Lack of person-centeredcommunication skill

  

  

√   

√ √   

√   

Lack of decision-making capabilities 

√ √   

  

√ √ √   

  

Training andeducation

  

√   

√   

  

  

  

√

Opportunitiesin theimplementationof person-centred care

workplace support √ √   

  

√ √   

  

√

Multidisciplinaryteamwork andcollaboration

√ √   

√ √ √   

  

  

Trustful andrespectfulrelationship

√   

√ √ √   

  

  

√

Time constraints   

√ √   

  

√   

  

√

Motivation intheimplementationof person-centred care

Encourage self-reflection usingcritical thinking skills

  

√ √ √ √   

√   

√

Proactive andcompassionate caringas the heart of thepractice

√ √   

  

  

√ √ √ √

Strengthen rewardsand empowermentmechanisms

√   

  

√   

√   

  

  

Resilient optimisticattitude towardsperson-centred care

  

  

  

√   

  

√ √ √

 

Figures

Figure 1

PRISMA �owchart of literature in the search process

Supplementary Files

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