Table 1 Key barriers and proposed solutions identified from the PEARL and modified Hanlon Method priority setting exercise
Identified barriers | Proposed solutions | ||||
|---|---|---|---|---|---|
8P domain | Barrier | “Importance” ranking | Goals of possible next actions and solution/s? | Stakeholder domains (PCOS Clinic operations/health service stakeholders/external stakeholders) | Predicted intensity of work to be undertaken? (high, moderate, low) |
Procedures (consultations and referral process) | ART is promoted as 1st line treatment by physicians | Not a top priority | NA | NA | NA |
Very short consultation period may hinder proper patient decision-making | 5 | Redesign lifestyle management information package to enable clinicians to provide information to patients within a short amount of time. Utilise allied health within the same session? | PCOS clinic operations | High | |
Expectations of using drugs as 1st line treatment | Not a top priority | NA | NA | NA | |
Lag period for lifestyle advice | 2 | Redesign operational protocols for patient management and flow. Utilise operations research methods? | PCOS clinic operations | Moderate | |
Policies (government and hospitals) | Ministry of health (MOH) co-funding scheme for ART in public hospitals | Not a top priority | NA | NA | NA |
Place (SG) | Patients can choose multiple providers for ART | Not a top priority | NA | NA | NA |
“Kiasu” culturea | Not a top priority | NA | NA | NA | |
Cultural factors making healthy lifestyles more difficult to sustain | Not a top priority | NA | NA | NA | |
Convenience factors make sustainability of a healthy lifestyle difficult | 4 | Develop more consistent and coordinated stakeholder collaboration in the lifestyle programme, redesign lifestyle management programme and utilise IT-enabled ‘quantified self’ tools to encourage uptake and sustainability | Health service stakeholders, external stakeholders | High | |
Clinicians believe that patients have limited time and priority for healthy lifestyle | 3 | Develop more consistent and coordinated stakeholder collaboration in the lifestyle programme, redesign lifestyle management programme and utilise IT-enabled ‘quantified self’ tools to encourage uptake and sustainability | Health service stakeholders, external stakeholders | High | |
Product (lifestyle management programme) | Variability in delivering lifestyle management for PCOS women | 1 | Develop more consistent and coordinated stakeholder collaboration in the lifestyle programme, redesign lifestyle management programme and utilise IT-enabled ‘quantified self’ tools to encourage uptake and sustainability | PCOS clinic operations, health service stakeholders | High |
Enforcement and support of lifestyle management is weak | 1 | Develop more consistent and coordinated stakeholder collaboration in the lifestyle programme, redesign lifestyle management programme and utilise IT-enabled ‘quantified self’ tools to encourage uptake and motivation | PCOS clinic operations, health service stakeholders | High | |
People (programme capacity) | Low capacity for supporting lifestyle management programmes | 1 | Develop more consistent and coordinated stakeholder collaboration in the lifestyle programme, redesign lifestyle management programme and utilise IT-enabled ‘quantified self’ tools to encourage uptake and motivation | PCOS clinic operations, health service stakeholders | High |
Lack of customised support for women | 3 | Redesign lifestyle management programme and utilise IT-enabled ‘quantified self’ tools to encourage uptake and motivation | PCOS clinic operations, health service stakeholders | High | |
Processes (integration) | No collaboration with health promotion board (HPB) to promote healthier lifestyles for improving fertility | 3 | Explore and design a collaborative programme for lifestyle management for women with PCOS at a national level | Health service stakeholders, external stakeholders | Low |
No collaboration between KKH IVF clinic and the SGH lifestyle clinic to facilitate lifestyle management | 1 | Explore and design a collaborative programme for lifestyle management for women with PCOS at a health service level | Health service stakeholders | Moderate | |
No clear coordination process between physicians and allied health staff at KKH to enhance lifestyle management programmes | 1 | Redesign operational protocols for patient management and flow. Utilise operations research methods? | PCOS clinic operations, Health service stakeholders | Low | |
No collaboration between KKH IVF clinic and polyclinics to facilitate lifestyle management | 1 | Explore and design a collaborative programme for lifestyle management for women with PCOS at a health service and community level | Health service stakeholders | Moderate | |
Promotion | Clinicians believe patients want medical procedures as 1st line treatments in SG, rather than lifestyle or other ‘non-invasive’ factors | Not a top priority | NA | NA | NA |
Lifestyle management is delivered within an IVF clinic setting | Not a top priority | NA | NA | NA | |
Poor promotion of lifestyle management | Not a top priority | NA | NA | NA | |
Price | Clear financial outlays communicated for ART/IVF treatment | Not a top priority | NA | NA | NA |
Unclear financial outlays for lifestyle management | Not a top priority | NA | NA | NA | |
Patients to evaluate the cost-benefits of immediate ART vs lifestyle management | Not a top priority | NA | NA | NA | |