Article Figures & Data
Tables
Assessment What are person’s values and goals with respect to this health issue?
What resources are locally available? Is there opportunity to access them? How convenient are they? What is the price?
What personal, family, or community factors help or hinder using those resources?
Intervention What is the functional goal? Is there an opportunity to achieve the function in another way?
What personal, family, or community assets can be leveraged to increase opportunity?
Can the social context be addressed through community action or advocacy?
How easy is it to get to a grocery store for food shopping? Are fresh fruits and vegetables for sale where you usually shop for food? Can you afford to buy fresh fruits and vegetables? Is there a place where you can grow food in your yard or your neighborhood? Do you have time to fix your own meals? Do you have family who can help you fix meals? At home, are you free to eat the foods that doctors or dietitians have said you should eat? Do you have the chance to be physically active? It is convenient for you to be physically active several days a week? Is being physically active a daily part of your job? Do you have time each day to be physically active? Do you have convenient places to be physically active outside [indoors]? Do you have safe places to be physically active outside [indoors]? Can you afford to join a health or fitness club where you can exercise? Do other people help free your time to be physically active? Does your spouse/partner make it easier for you to be physically active? Are there people to help watch your kids while you exercise? Do you have other duties [such as caring for a parent] that make it hard to be physically active?
Additional Files
The Article in Brief
Capability and Clinical Success
Robert L. Ferrer , and colleagues
Background Better outcomes for chronic diseases are hard to achieve because success depends on factors outside the control of the health care system, including patients� ability to mange their health behaviors and chronic diseases. Social and environmental factors influence patients' self-management of chronic diseases, but there is not yet a systematic clinical response to these barriers. The �capability� framework, defined as the real opportunity to achieve a desired lifestyle, offers an approach for addressing social determinants in practice, as well as planning and evaluating community responses to chronic illness.
What This Study Found Because it focuses attention on the conditions that constrain opportunity and how opportunity emerges from the interaction between personal resources and social environment, the capability framework has the potential to expand the informational basis for making clinical assessments, illuminating areas where patients� knowledge and motivation may be constrained by difficult circumstances. By focusing on external and internal supports, the capability framework can potentially augment the effectiveness of self-management and empowerment strategies. It may also help to more efficiently manage health behaviors and chronic disease by prospectively identifying patients who are at high risk of failing to change key behaviors.
Implications
Annals Journal Club:
Sep/Oct 2010
The Capability Framework
The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1How it Works
In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Comments: Submit a response.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/AJC/.
CURRENT SELECTION
Article for Discussion
- Ferrer RL, Carrasco AV. Capability and clinical success. Ann Fam Med. 2010;8(5):454-460.
Discussion Tips
This article is different from most Annals Journal Club selections. A theory piece, it provides a framework for us to see differently problems that often seem intractable from a narrower clinical perspective.Discussion Questions
- What problem(s) are addressed by this article?
- How well does the opening case represent challenging patients in your setting? How responsive is your practice to the needs and opportunities presented by such patients?
- Do the article�s sections on epidemiological context, the disconnect between process and outcome improvements, and environmental barriers to healthy behaviors bring to mind shortcomings of your practice or health care system situation?
- How well does the capability framework reflect your life and clinical experience? Does this framework help you to see avenues to work on problems that previously seemed outside the bounds of your vision or clinical competence?
- How well grounded in literature or experience does this theory appear, as articulated in the article?
- What holes do you see in this framework?
- What are the implications of the framework for patient-centered care?
- Can you use Tables 1 and 2 to apply the framework to improve your care of a challenging patient you have seen this week?
- How might you develop practice systems and community partnerships to support application of the capability framework? What support already exists where you are?
- What policy implications are suggested by this theory?
- What research opportunities does this theory suggest? How might a participatory research approach 2 be used to pursue these opportunities?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals journal club: It�s time to get RADICAL. Ann Fam Med. 2006;4(3):196-197. http://annfammed.org/cgi/content/full/4/3/196.
- Macaulay AC, Commanda LE, Freeman WL, et al. Participatory research maximises community and lay involvement. BMJ. 1999;319(7212):774-778.
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