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Hernandez AL, Lingas EO, Juarez W, Villa A, Palefsky J. Using an anti-racist research framework to design studies of oral human papillomavirus and oropharyngeal cancer in San Francisco: rationale and protocol for the Health Equity and Oral Health in People living with HIV (HEOHP) qualitative study. BMJ Open 2024; 14:e091474. [PMID: 39317508 PMCID: PMC11423734 DOI: 10.1136/bmjopen-2024-091474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 08/14/2024] [Indexed: 09/26/2024] Open
Abstract
INTRODUCTION The goal of our research programme is to develop culturally appropriate patient-specific interventions for primary and secondary prevention of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) among people living with HIV (PLWH); PLWH are at a higher risk for OPC than the general population and, as with many cancers, there are disparities in OPC health outcomes by race and ethnicity. Our study incorporates an anti-racist research framework that proposes considering racism as a foundational sociocultural system that causes ill health. We expand the framework to include biases due to gender, sexual orientation, HIV status and membership in other non-dominant groups. Our research programme focuses on HPV-related OPC among people living with PLWH, and on how intersecting identities may impact an individual's experience with oral health, obtaining regular and appropriate oral healthcare, knowledge and perceptions of oral HPV infection, risk factors for OPC and HPV vaccination. METHODS AND ANALYSIS We will follow a grounded theory (GT) qualitative research methodology using focus group discussions (FGDs) to collect data. We will invite PLWH with intersecting identities to participate in one of 12-18 FGDs with 5-8 participants per group. Focus groups will be formed based on self-reported domains, including race, ethnicity, gender identity, sexual orientation and other identities that could impact oral health, such as smoking status, experience with homelessness or experience with drug use disorders. We do not know which aspects of intersecting identities are most salient to accessing oral healthcare. Using FGDs will allow us to gain this knowledge in a setting where participants can build on and reinforce shared understandings about oral healthcare. Following our GT methodology, analysis will occur concurrently with data collection, and emerging concepts or theories may result in changes to focus group guide questions. Initial focus group questions will be organised around our main objectives: (1) to identify individual, interpersonal and structural health equity factors that serve as barriers or facilitators to oral health status and care; (2) to explore knowledge and perceptions about causes, risk factors, prevention and screening for oral or OPC and (3) to elicit recommendations for improving access to regular and appropriate oral healthcare and suggestions on engaging PLWH from diverse identity groups in prevention interventions. ETHICS AND DISSEMINATION All methods and procedures were approved by the University of California, San Francisco, Institutional Review Board (approval number: 23-39307) and are in accordance with the Declaration of Helsinki of 1975, as revised in 2000. Participants are required to provide informed consent. The results of this study will be presented at scholarly meetings and published in peer-reviewed journals. In addition, a lay summary of results will be created and distributed to our participants and community through our website and social media. TRIAL REGISTRATION NUMBER NCT06055868.
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Affiliation(s)
- Alexandra L Hernandez
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Public Health Program, Touro University California College of Education and Health Sciences, Vallejo, California, USA
| | | | - William Juarez
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Alessandro Villa
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Joel Palefsky
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Zhou C, Chen J, Tan F, Lai S, Li X, Pu K, Wu J, Dong Y, Zhao F. Relationship between self-care compliance, trust, and satisfaction among hypertensive patients in China. Front Public Health 2023; 10:1085047. [PMID: 36743158 PMCID: PMC9889937 DOI: 10.3389/fpubh.2022.1085047] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction Hypertension is a growing public health concern worldwide. It is a leading risk factor for all-cause mortality and may lead to complications such as cardiovascular disease, stroke, and kidney failure. Poor compliance of hypertensive patients is one of the major barriers to controlling high blood pressure. Compliance is not ideal among Chinese patients, and increasing patient self-care compliance with hypertension is necessary. Methods This article analyzes the status of self-care compliance, trust, and satisfaction among Chinese hypertensive patients using cross-sectional data from Zhejiang Province. We use a multi-group structural equation model (MGSEM) to compare the interrelationships across genders. Results The study's findings show that the average trust, satisfaction, and compliance scores are 3.92 ± 0.55, 3.98 ± 0.61, and 3.33 ± 0.41, respectively. Female patients exhibit higher average total scores for trust and compliance than male patients. The SEM results indicate that trust has a direct positive association with compliance [β = 0.242, 95% CI: (0.068, 0.402)] and satisfaction [β = 0.260, 95% CI: (0.145, 0.367)], while their satisfaction is not directly associated with compliance. The results of MGSEM show that trust has an indirect effect on compliance in the male group through satisfaction [β = 0.051, P < 0.05, 95% CI: (0.012, 0.116)]. In the female group, trust has a direct effect on satisfaction [β = 0.235, P < 0.05, 95% CI: (0.041, 0.406)] and compliance [β = 0.319, P < 0.01, 95% CI: (0.086, 0.574)]. Discussion This study reveals the mechanisms of self-care compliance, trust, and satisfaction among Chinese hypertensive patients. Its findings may serve as a reference for guiding primary healthcare providers to improve hypertension patients' compliance and implement gender-targeted health interventions.
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Affiliation(s)
- Chi Zhou
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China,*Correspondence: Chi Zhou ✉
| | - Jingchun Chen
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Fang Tan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sihong Lai
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xu Li
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Ke Pu
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jiahui Wu
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yin Dong
- Department of Hospital Office, The People's Hospital of Yuhuan, Taizhou, China,Yin Dong ✉
| | - Falin Zhao
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China,Falin Zhao ✉
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Harrison RE, Shyleika V, Falkenstein C, Garsevanidze E, Vishnevskaya O, Lonnroth K, Sayakci Ö, Sinha A, Sitali N, Skrahina A, Stringer B, Tan C, Mar HT, Venis S, Vetushko D, Viney K, Vishneuski R, Carrion Martin AI. Patient and health-care provider experience of a person-centred, multidisciplinary, psychosocial support and harm reduction programme for patients with harmful use of alcohol and drug-resistant tuberculosis in Minsk, Belarus. BMC Health Serv Res 2022; 22:1217. [PMID: 36180873 PMCID: PMC9523183 DOI: 10.1186/s12913-022-08525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) often concentrates in groups of people with complex health and social issues, including alcohol use disorders (AUD). Risk of TB, and poor TB treatment outcomes, are substantially elevated in people who have AUD. Médecins sans Frontières and the Belarus Ministry of Health have worked to improve treatment adherence in patients with multi-drug or rifampicin resistant (MDR/RR)-TB and harmful use of alcohol. In 2016, a person-centred, multidisciplinary, psychosocial support and harm reduction programme delivered by TB doctors, counsellors, psychiatrists, health-educators, and social workers was initiated. In 2020, we described patient and provider experiences within the programme as part of a wider evaluation. Methods We recruited 12 patients and 20 health-care workers, using purposive sampling, for in-depth individual interviews and focus group discussions. We used a participant-led, flexible, exploratory approach, enabling participants and the interviewer to shape topics of conversation. Qualitative data were coded manually and analysed thematically. As part of the analysis process, identified themes were shared with health-care worker participants to enable their reflections to be incorporated into the findings. Results Key themes related to the patients’ and practitioners experience of having and treating MDRTB with associated complex health and social issues were: fragility and despair and guidance, trust and health. Prejudice and marginalisation were global to both themes. Counsellors and other health workers built a trusting relationship with patients, enabling guidance through a multi-disciplinary approach, which supported patients to achieve their vision of health. This guidance was achieved by a team of social workers, counsellors, doctors and health-educators who provided professional and individualised help for patients’ illnesses, personal or interpersonal problems, administrative tasks, and job searches. Conclusions Patients with MDR/RR-TB and harmful use of alcohol faced complex issues during treatment. Our findings describe how person-centred, multi-disciplinary, psychosocial support helped patients in this setting to cope with these challenges and complete the treatment programme. We recommend that these findings are used to: i) inform programmatic changes to further boost the person-centred care nature of this program; and ii) advocate for this type of person-centred care approach to be rolled out across Belarus, and in contexts that face similar challenges. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08525-x.
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Affiliation(s)
| | | | | | | | | | - Knut Lonnroth
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Alena Skrahina
- Republican Scientific and Practical Centre of Pulmonology and Tuberculosis (RSPCPT), Minsk, Republic of Belarus
| | | | | | | | | | - Dmitri Vetushko
- Republican Scientific and Practical Centre of Pulmonology and Tuberculosis (RSPCPT), Minsk, Republic of Belarus
| | - Kerri Viney
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,School of Public Health, The University of Sydney, Sydney, Australia
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Lauzière J, Fletcher C, Gaboury I. Cultural Safety as an Outcome of a Dynamic Relational Process: The Experience of Inuit in a Mainstream Residential Addiction Rehabilitation Centre in Southern Canada. QUALITATIVE HEALTH RESEARCH 2022; 32:970-984. [PMID: 35350939 PMCID: PMC9189595 DOI: 10.1177/10497323221087540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Few addiction treatment options are available in Arctic Canada, leading many Inuit to seek treatment programs in southern cities. We conducted a case study to understand what contributes to a culturally safe experience for Inuit in a mainstream addiction rehabilitation centre in Southern Canada. We carried out more than 700 hours of participant observation, in addition to semi-structured interviews and member-checking activities with 20 Inuit residents, 18 staff and four managers. Data were analysed using an inductive interpretative process. Throughout their journey in the program, Inuit navigated through contrasting situations and feelings that we grouped under six broad themes: having Inuit peers, having limitations imposed on one's ways of being and doing, facing ignorance and misperceptions, having conversations and dialogue, facing language barriers and being in a supportive and caring environment. This study highlights how cultural safety varies according to people, context and time, and relates to developing trustful relationships.
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Affiliation(s)
- Julie Lauzière
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Longueuil, QC, Canada
| | - Christopher Fletcher
- Département de médecine sociale et préventive, Université Laval, Quebec, QC, Canada
| | - Isabelle Gaboury
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Longueuil, QC, Canada
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Feng Y, Guan S, Xu Y, Chen W, Huang X, Wang X, Zhang M. Effects of the Two-Dimensional Structure of Trust on Patient Adherence to Medication and Non-pharmaceutical Treatment: A Cross-Sectional Study of Rural Patients With Essential Hypertension in China. Front Public Health 2022; 10:818426. [PMID: 35309202 PMCID: PMC8931731 DOI: 10.3389/fpubh.2022.818426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
In rural China, treatment adherence of patients with hypertension remains a challenge. Although early research on patient adherence has confirmed the importance of trust in doctors, the relative contribution and influence of the two-dimensional structure of trust on adherence has not been explored. Thus, this study examined the effects of patient trust in primary care physicians' (PCPs) benevolence and ability on medication adherence, dietary management, and physical activity. The data were derived from 2,533 patients at 54 primary health institutions in China (village level) from February 2017 to May 2018. Participants were assessed using the Chinese version of the Wake Forest Physician Trust Scale and the Therapeutic Adherence Subscale for Hypertensive Patients. Other information included region, gender, age, and self-rated health status. The results of multiple linear regression and structural equation modeling confirmed that patient trust in PCPs' benevolence was positively correlated with patient adherence to medication, diet management, and physical activity. Patient trust in PCPs' ability was negatively correlated with adherence to dietary management and physical activity. We concluded that interventions aimed at increasing PCP benevolence have the greatest potential to improve patient adherence to hypertension treatment. Under the country's policy of advocating to improve PCPs' diagnoses and treatment technology, it may be important to cultivate doctors' communication skills, medical ethics, and other benevolent qualities to improve patients' adherence with drug and Non-drug treatments.
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Kallon II, Colvin CJ, Trafford Z. A qualitative study of patients and healthcare workers' experiences and perceptions to inform a better understanding of gaps in care for pre-discharged tuberculosis patients in Cape Town, South Africa. BMC Health Serv Res 2022; 22:128. [PMID: 35093053 PMCID: PMC8801106 DOI: 10.1186/s12913-022-07540-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/13/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Many people diagnosed with Mycobacterium tuberculosis (TB) in tertiary and district hospitals in South Africa do not arrive at their primary care clinic for continued care after they are discharged from the hospital. This loss to follow up is a major, ongoing problem for public health in South Africa, and contributes to drug-resistant TB strains. The objective of this paper was to explore patients' experiences and perceptions of diagnosis and treatment before their discharge from hospital. We use a framework known as patient-centred care to illustrate how these patient narratives point to lapses in these principles within the hospital system, and to show how such lapses may contribute to loss to follow up and inconsistent TB care. METHODS We employed a qualitative study using semi-structured interviews to investigate patient and healthcare workers' experiences and perceptions of TB care in two Western Cape hospitals. We purposefully sampled 17 patients, 10 healthcare workers, and two key informant policy makers, all of whom had relevant experiences and insights. Data collection was done between October 2015 and February 2017. Data were analysed using Miles and Huberman's qualitative analysis framework. RESULTS Hospitals did not achieve patient-centred care. Newly diagnosed patients were provided with inadequate TB education, diseased-focused approaches were favoured over patient-focused approaches, and there was limited engagement with patients to understand their needs and feelings during the critical period between diagnosis and discharge. Consequently, some patients felt anxious prior to their discharge from hospital. Coupled with their overwhelming socio-economic barriers and complex family situations, some patients felt hopeless and powerless as they prepared for discharge. Finally, there was a lack of patient-provider partnership due to problems including healthcare workers' time constraints and heavy workloads, which detracted from a focus on patients' needs and feelings. CONCLUSIONS Improving the three intersecting elements of patient-centred care (health education, engaging with patients' needs and feelings, and shared decision-making) has the potential to positively influence patients' continuity of care for TB in South Africa. It would be helpful to also proactively address how patients plan to stay connected to care, on treatment, and supported, in light of their family situation or socio-economic circumstances. Detailed and unique pre-discharge counselling for each patient may be valuable in this regard.
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Affiliation(s)
- Idriss I Kallon
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
| | - Christopher J Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Virginia, USA
- Department of Epidemiology, Brown University, Providence, USA
| | - Zara Trafford
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Psychology Department, Stellenbosch University, Stellenbosch, South Africa
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Pietersen E, Anderson K, van der Heijden YF. Public health and hospital-based nursing intersection: Case study of drug-resistant tuberculosis patients. Public Health Nurs 2022; 39:170-179. [PMID: 34990027 DOI: 10.1111/phn.13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Public health nurses (PHN) are key partners in continuity of care for drug-resistant tuberculosis (DR-TB) patients. We examined complexities in DR-TB care transition between community- and hospital-based care. DESIGN We conducted a case study using medical record data. Four patients were purposively selected to illustrate intersectional complexities in DR-TB care transition involving PHN. RESULTS Case A (HIV negative male) received PHN care at a community-based facility 124 km from Cape Town. Cases B, C, and D (males living with HIV) received PHN community-based care, averaging 25 km from the hospital. Treatment failed in cases A, B, and C; they subsequently died. Case D was cured. All cases were granted leave of absence at least once while hospitalized. None returned when expected mainly due to lack of transport funds. PHN played critical roles regarding patients' return by conducting home visits, interacting with relatives, and assisting emergency officers to transport patients back to the hospital. PHN supported relatives to endure protracted patient hospitalizations. CONCLUSION The role of PHN in continuity of DR-TB care in low-middle income countries is unambiguous. PHN are key partners in the DR-TB care cascade, namely facilitating retention in care between hospital and community-based care. Effective DR-TB control relies on effective partnerships among healthcare personnel, patients, and their families.
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Affiliation(s)
- Elize Pietersen
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Kim Anderson
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Yuri F van der Heijden
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, USA.,Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA.,The Aurum Institute, Johannesburg, South Africa
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Arakelyan S, Jailobaeva K, Dakessian A, Diaconu K, Caperon L, Strang A, Bou-Orm IR, Witter S, Ager A. The role of trust in health-seeking for non-communicable disease services in fragile contexts: A cross-country comparative study. Soc Sci Med 2021; 291:114473. [PMID: 34662762 PMCID: PMC8689406 DOI: 10.1016/j.socscimed.2021.114473] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 12/01/2022]
Abstract
Non-communicable diseases (NCDs) disproportionately affect people living in fragile contexts marked by poor governance and health systems struggling to deliver quality services for the benefit of all. This combination can lead to the erosion of trust in the health system, affecting health-seeking behaviours and the ability of individuals to sustain their health. In this cross-country multiple-case study, we analyse the role of trust in health-seeking for NCD services in fragile contexts. Our analysis triangulates multiple data sources, including semi-structured interviews (n = 102) and Group Model Building workshops (n = 8) with individuals affected by NCDs and health providers delivering NCD services. Data were collected in Freetown and Makeni (Sierra Leone), Beirut and Beqaa (Lebanon), and Morazán, Chalatenango and Bajo Lempa (El Salvador) between April 2018 and April 2019. We present a conceptual model depicting key dynamics and feedback loops between contextual factors, institutional, interpersonal and social trust and health-seeking pathways. Our findings signal that firstly, the way health services are delivered and experienced shapes institutional trust in health systems, interpersonal trust in health providers and future health-seeking pathways. Secondly, historical narratives about public institutions and state authorities' responses to contextual fragility drivers impact institutional trust and utilisation of services from public health institutions. Thirdly, social trust mediates health-seeking behaviour through social bonds and links between health systems and individuals affected by NCDs. Given the repeated and sustained utilisation of health services required with these chronic diseases, (re)building and maintaining trust in public health institutions and providers is a crucial task in fragile contexts. This requires interventions at community, district and national levels, with a key focus on promoting links and mutual accountability between health systems and communities affected by NCDs.
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Affiliation(s)
- Stella Arakelyan
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK.
| | - Kanykey Jailobaeva
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Arek Dakessian
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Karin Diaconu
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Lizzie Caperon
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Alison Strang
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Ibrahim R Bou-Orm
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Sophie Witter
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Alastair Ager
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK.
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Law S, Seepamore B, Oxlade O, Sikhakhane N, Dawood H, Chetty S, Padayatchi N, Menzies D, Daftary A. Acceptability, feasibility, and impact of a pilot tuberculosis literacy and treatment counselling intervention: a mixed methods study. BMC Infect Dis 2021; 21:449. [PMID: 34006254 PMCID: PMC8132373 DOI: 10.1186/s12879-021-06136-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background There is a need for innovative strategies to improve TB testing uptake and patient retention along the continuum of TB care early-on in treatment without burdening under-resourced health systems. We used a mixed methods approach to develop and pilot test a tuberculosis literacy and counselling intervention at an urban clinic in KwaZulu Natal, South Africa, to improve TB testing uptake and retention in tuberculosis care. Methods We engaged in discussions with clinic staff to plan and develop the intervention, which was delivered by senior social work students who received one-week training. The intervention included: 1) group health talks with all patients attending the primary clinic; and 2) individual counselling sessions, using motivational interviewing techniques, with newly diagnosed tuberculosis patients. We compared social work students’ tuberculosis knowledge, attitudes, and practices before and after their training. We assessed the change in number of tuberculosis diagnostic tests performed after implementation via an interrupted time series analysis with a quasi-Poisson regression model. We compared pre- and post-intervention probabilities of treatment initiation and completion using regression analyses, adjusting for potential baseline confounders. We conducted focus groups with the students, as well as brief surveys and one-on-one interviews with patients, to assess acceptability, feasibility, and implementation. Results During the study period, 1226 individuals received tuberculosis diagnostic testing and 163 patients started tuberculosis treatment, of whom 84 (51.5%) received individual counselling. The number of diagnostic tuberculosis tests performed increased by 1.36 (95%CI 1.23–1.58) times post-intervention, adjusting for background calendar trend. Probabilities of TB treatment initiation and treatment completion increased by 10.1% (95%CI 1.5–21.3%) and 4.4% (95%CI -7.3-16.0%), respectively. Patients found the counselling sessions alleviated anxiety and increased treatment self-efficacy. Social work students felt the clinic staff were collaborative and highly supportive of the intervention, and that it improved patient engagement and adherence. Conclusions Engaging clinic staff in the development of an intervention ensures buy-in and collaboration. Education and counselling before and early-on in tuberculosis treatment can increase tuberculosis testing and treatment uptake. Training junior social workers can enable task-shifting in under-resourced settings, while addressing important service gaps in tuberculosis care. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06136-1.
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Affiliation(s)
- Stephanie Law
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,McGill International TB Centre, Research Institute of the McGill University Health Centre, 1001 rue Decarie, Montreal, Quebec, H4A 3J1, Canada.
| | - Boitumelo Seepamore
- School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, 238 Mazisi Kunene Rd, Glenwood, Durban, 4041, South Africa
| | - Olivia Oxlade
- McGill International TB Centre, Research Institute of the McGill University Health Centre, 1001 rue Decarie, Montreal, Quebec, H4A 3J1, Canada
| | - Nondumiso Sikhakhane
- CAPRISA- MRC HIV-TB Treatment and Pathogenesis Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa
| | - Halima Dawood
- CAPRISA- MRC HIV-TB Treatment and Pathogenesis Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa.,Department Medicine, Infectious Disease Unit, Greys Hospital, The Msunduzi, Town Hill, Pietermaritzburg, 3201, South Africa
| | - Sheldon Chetty
- East Boom Community Healthcare Centre, 541 Boom Street, Pietermaritzburg, 3201, South Africa
| | - Nesri Padayatchi
- CAPRISA- MRC HIV-TB Treatment and Pathogenesis Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa
| | - Dick Menzies
- McGill International TB Centre, Research Institute of the McGill University Health Centre, 1001 rue Decarie, Montreal, Quebec, H4A 3J1, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, Quebec, H3A 1A2, Canada
| | - Amrita Daftary
- CAPRISA- MRC HIV-TB Treatment and Pathogenesis Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa.,School of Global Health and Dahdaleh Institute of Global Health Research, York University, 88 The Pond Rd, North York, ON, M3J 2S5, Canada
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Lau LL, Hung N, Dodd W, Lim K, Ferma JD, Cole DC. Social trust and health seeking behaviours: A longitudinal study of a community-based active tuberculosis case finding program in the Philippines. SSM Popul Health 2020; 12:100664. [PMID: 33015308 PMCID: PMC7522854 DOI: 10.1016/j.ssmph.2020.100664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction Social trust is an important driver of health seeking behaviours and plays a particularly important role for diseases that have a high degree of stigma associated with them, such as tuberculosis (TB). Individuals experiencing poverty also face additional social and financial barriers in accessing care for TB. We examined an active case finding (ACF) initiative embedded in a program targeting those living in poverty (Transform) implemented by International Care Ministries (ICM), a Philippine-based non-governmental organization (NGO), and analyzed how different forms of social trust may affect the initial uptake of ACF. Methods Program monitoring data and a cross-sectional survey conducted at the beginning of Transform included six dimensions of social trust: satisfaction with family life, satisfaction with friendships, and level of trust in relatives, neighbours, pastor or religious leader, and local government officials. Amongst individuals suspected of having TB who received referrals post-screening, multilevel modelling examined the effects of social trust on rural health unit (RHU) attendance. Results Among the subset of 3350 individuals who received TB screening in 51 communities, 889 (26.5%) were symptom positive and required referral to the RHU, but only 24.1% of those who received referrals successfully attended the RHU. Multilevel regression analysis showed that for each unit increase on the Likert scale in baseline level of family satisfaction and level of trust in relatives, the odds of attending an RHU was 1.03 times (95% CI: 0.99, 1.07) and 1.06 times greater (95% CI: 1.00, 1.11), respectively, independent of other factors. Conclusion These results suggest that social trust in family members could play a valuable role in addressing stigma and rejection, both cited as barriers to higher screening rates. It is recommended that ACF programs that target TB, or other diseases that are stigmatized, prioritize trust-building as an important component of their intervention. Role of social trust on health clinic attendance among extreme poor examined. Effect of five relationship types in supporting tuberculosis testing explored. Trust in family relationships predicted greater health clinic testing. Health interventions for stigmatized diseases should prioritize trust-building.
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Affiliation(s)
- Lincoln L.H. Lau
- Dalla Lana School of Public Health, University of Toronto, Canada
- International Care Ministries Foundation Inc, Philippines
- School of Public Health and Health Systems, University of Waterloo, Canada
- Corresponding author. Unit 2001 Antel Global Corporate Center Julia Vargas Ave Ortigas Center Pasig City NCR Philippines.
| | - Natalee Hung
- International Care Ministries Foundation Inc, Philippines
| | - Warren Dodd
- School of Public Health and Health Systems, University of Waterloo, Canada
| | - Krisha Lim
- International Care Ministries Foundation Inc, Philippines
| | | | - Donald C. Cole
- Dalla Lana School of Public Health, University of Toronto, Canada
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11
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Carter J, Friedland JS, Kirwan DE, Nathavitharana RR. Translating scientific discoveries during pandemics: ensuring equity for people affected by COVID-19 and tuberculosis. ERJ Open Res 2020; 6:00562-2020. [PMID: 33204676 PMCID: PMC7659031 DOI: 10.1183/23120541.00562-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/01/2020] [Indexed: 12/15/2022] Open
Abstract
The #COVID19 pandemic has emphasised major global health inequities: this editorial argues lessons learnt from TB must remind us of the gaps in the research agenda that must be addressed to ensure that scientific advances are equitably disseminated https://bit.ly/3bTZHS3.
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Affiliation(s)
- Jessica Carter
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Jon S. Friedland
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Daniela E. Kirwan
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Ruvandhi R. Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Boston, MA, USA
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12
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Klem NR, Smith A, O'Sullivan P, Dowsey MM, Schütze R, Kent P, Choong PF, Bunzli S. What Influences Patient Satisfaction after TKA? A Qualitative Investigation. Clin Orthop Relat Res 2020; 478:1850-1866. [PMID: 32732567 PMCID: PMC7371044 DOI: 10.1097/corr.0000000000001284] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/14/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient satisfaction is a common measure of the success of an orthopaedic intervention. However, there is poor understanding of what satisfaction means to patients or what influences it. QUESTIONS/PURPOSES Using qualitative study methodology in patients undergoing TKA, we asked: (1) What does it mean to be satisfied after TKA? (2) What factors influence satisfaction levels after TKA? METHODS People in a hospital registry who had completed 12-month follow-up questionnaires and were not more than 18 months post-TKA at the time of sampling were eligible (n = 121). To recruit a sample that provided insight into a range of TKA experiences, we divided eligible candidates on the registry into quadrants based on their responder status and satisfaction level. A responder was an individual who experienced a clinically meaningful change in pain and/or function on the WOMAC according to the Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria. Individuals were considered satisfied unless they indicated somewhat dissatisfied or very dissatisfied for one or more of the four items on the Self-Administered Patient Satisfaction Scale. From the resulting quadrants: responder satisfied, nonresponder satisfied, nonresponder dissatisfied, responder dissatisfied, we identified men and women with a range of ages and invited them to participate (n = 85). The final sample (n = 40), consisted of 10 responder satisfied, nine nonresponder satisfied, eight nonresponder dissatisfied, and 13 responder dissatisfied; 71% were women, with a mean age of 71 ± 7 years and a mean time since TKA surgery of 17 ± 2 months (range 13 to 25 months). Interview transcripts were analyzed by looking for factors in the participants' narrative that appeared to underscore their level of satisfaction and attaching inductive (data-derived, rather than a priori derived) codes to relevant sections of text. Coded data from participants who reported high and low levels of satisfaction were compared/contrasted and emerging patterns were mapped into a conceptual model. Recruitment continued until no new information was uncovered in data analysis of subsequent interviews, signalling to the researchers that further interviews would not change the key themes identified and data collection could cease. RESULTS In those with high satisfaction levels, satisfaction was conceptualized as an improvement in pain and function. In those with low satisfaction levels, rather than an improvement, satisfaction was conceptualized as completely resolving all symptoms and functional limitations. In addition, we identified three pathways through which participants reached different levels of low and high satisfaction: (1) The full-glass pathway, characterized by no or minimal ongoing symptoms and functional deficits, which consistently led to high levels of satisfaction; (2) the glass-half-full pathway, characterized by ongoing symptoms and functional limitations, which led to high satisfaction; and (3) the glass-half-empty pathway, also characterized by ongoing symptoms and functional limitations, which led to low satisfaction levels. The latter two pathways were mediated by three core mechanisms (recalibration, reframing valued activities, and reconceptualization) influenced either positively or negatively by (1) a persons' thoughts and feelings such as optimism, self-efficacy, pain catastrophizing, external locus of control; and (2) social and contextual factors such as fulfilment of social roles, therapeutic alliance, lack of family/social support. CONCLUSIONS This qualitative study suggests that for preoperative patients in whom unrealistically high hopes for complete symptom resolution and restoration of functional capacity persists, it may be appropriate to direct them away from TKA due to the risk of low satisfaction. For postoperative patients troubled by ongoing symptoms or functional limitations, clinicians may improve levels of satisfaction by targeting the three core mechanisms (recalibration, reframing valued activities, and reconceptualization) through addressing modifiable negative thoughts and feelings in interventions such as psychology or psychotherapy; and negative social and contextual factors by promoting a strong therapeutic alliance and engagement in community activities. Given that these factors may be identifiable preoperatively, future research is needed to explore if and how addressing them preoperatively may improve satisfaction post-TKA. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Nardia-Rose Klem
- N.-R. Klem, A. Smith, P. O'Sullivan, R. Schütze, P. Kent, Curtin University, Bentley, Western Australia, Australia
| | - Anne Smith
- N.-R. Klem, A. Smith, P. O'Sullivan, R. Schütze, P. Kent, Curtin University, Bentley, Western Australia, Australia
| | - Peter O'Sullivan
- N.-R. Klem, A. Smith, P. O'Sullivan, R. Schütze, P. Kent, Curtin University, Bentley, Western Australia, Australia
| | - Michelle M Dowsey
- M. M. Dowsey, P. F. Choong, S. Bunzli, The University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Robert Schütze
- N.-R. Klem, A. Smith, P. O'Sullivan, R. Schütze, P. Kent, Curtin University, Bentley, Western Australia, Australia
| | - Peter Kent
- N.-R. Klem, A. Smith, P. O'Sullivan, R. Schütze, P. Kent, Curtin University, Bentley, Western Australia, Australia
- P. Kent, University of Southern Denmark, Odense, Denmark
| | - Peter F Choong
- M. M. Dowsey, P. F. Choong, S. Bunzli, The University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Samantha Bunzli
- M. M. Dowsey, P. F. Choong, S. Bunzli, The University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
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