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Towards a generic conceptual framework for the evaluation of task shifting in healthcare: a scoping review and
Daisy De Bruijn-Geraets1, Monique Bessems-Beks1, Bert Vrijhoef2
1Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
Background:
Healthcare systems face urgent pressures, and task shifting offers potential solutions. However, measuring, interpreting, and comparing its effects is challenging, as outcomes depend on implementation level and context, highlighting the need for a context-sensitive and implementation-oriented framework in which different perspectives are considered.
Objective:
To develop a conceptual framework enabling comprehensive evaluation of task-shifting services and policymaking.
Methods:
The framework was developed in three steps: (1) a scoping review to identify key elements of task-shifting evaluation, including data extraction from secondary studies in English, German, or Dutch using task-shifting-related keywords and MeSH terms (PubMed/MEDLINE, Cochrane, CINAHL; June 2022-April 2024); (2) definition of structure, process, and outcome measures; and (3) classification of elements into thematic clusters within these measures, refined through consensus using a modified Nominal Group Technique.
Results:
The evaluation framework integrates structure, process, and outcome measures across four complementary perspectives: task-shifting service, patient, provider, and healthcare facility/system. The service perspective focuses on implementation, with outcomes reflecting uptake and impact. The patient perspective addresses health, shaped by care engagement and patient characteristics. The provider perspective considers professional deployment, with outcomes linked to professional well-being. Organisational/system levels set conditions for quality care, with outcomes and processes shaped by both facility- and system-bound factors.
Conclusions:
The evaluation framework provides a structured, modular basis for evaluating task shifting across multiple perspectives and informing policy. Further research should explore interdependencies between elements and the framework's applicability to other task-shifting strategies, including roles for patients, informal caregivers, and technologies.
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