The vicious cycle of distrust: Access, quality, and efficiency within a post-communist mental health system

Historical origins of corruption in the Romanian public health system - path dependency and contagion effect

BACKGROUND

In this paper, we estimate the long-lasting influence of the former Habsburg Empire's border on the territory of Romania, specifically on the prevalence of corrupt behaviour and practices in health services.

METHODS

Employing microdata from the 2016 Life in Transition Survey and applying ordered probit regression, we explore the hypothesis that the geographical proximity of respondents' residences to the former imperial border-restricting the analysis within a bandwidth of 50 km, 75 km or even 100 km on either side - significantly influences current individual tendencies towards corrupt behaviour.

RESULTS

The results indicate that individuals in Transylvania living in the immediate vicinity of the former border of the Habsburg Empire (no more than 75 km away) show a higher propensity towards corrupt behaviours, similar to those from Moldova and Wallachia who reside in the same bandwidth but to the east of the former historical border. Interestingly, on one hand, after a series of tests with various relevant factors, the contagion effect is observed from right to left, meaning from those in Moldova and Wallachia towards those in Transylvania, and not the other way around as might be expected based on other previous studies. On the other hand, individuals living more than 75 kms west of the former historical border show clear reluctance to engage in informal payments and gift-giving when interacting with the public health system as patients.

CONCLUSION

By rigorously controlling for various variables that comprehensively show different legacies of the communist regime, our results confirm the persistence of these influences across different bandwidths, thereby corroborating the hypothesis of path dependence influenced by the former Habsburg Empire.

The experience of seeking and accessing help from mental health services among young people of Eastern European backgrounds: A qualitative interview study

OBJECTIVES

Most lifetime mental health problems (MHP) start before the age of 25. Yet young people-particularly those of minority backgrounds-often do not seek or access professional help. In the UK, young people of Eastern European (EE) backgrounds represent a large minority group; however, little is known about their experiences of MHP and help-seeking. In this study, we aim to understand the help-seeking process from the perspectives of EE young people.

DESIGN

We used a qualitative study design with semi-structured individual interviews. The results were analysed using reflexive thematic analysis.

METHOD

Twelve young people (18-25 years) of EE backgrounds, living in Oxfordshire, UK, took part. All participants had experienced a severe MHP and were identified in the community.

RESULTS

EE young people's experiences of MHP and help-seeking were driven by a sense of being caught between different cultures and simultaneously needing to navigate the potentially contrasting expectations of both cultures. This process was reinforced or tempered by the perceived continuing influence of young people's families, that is, families with more open views about MHP made it easier for young people to navigate through the process of help-seeking. Young people's internalised cultural and familial beliefs about MHP affected their decision-making when experiencing difficulties, their levels of trust in services, and perceived sense of resourcefulness and ability to cope.

CONCLUSIONS

Recognising and responding to the cultural tension that young people of EE backgrounds may experience can help us to develop more accessible and inclusive mental health services.

Understanding patient barriers and facilitators to uptake of lung screening using low dose computed tomography: a mixed methods scoping review of the current literature

BACKGROUND

Targeted lung cancer screening is effective in reducing mortality by upwards of twenty percent. However, screening is not universally available and uptake is variable and socially patterned. Understanding screening behaviour is integral to designing a service that serves its population and promotes equitable uptake. We sought to review the literature to identify barriers and facilitators to screening to inform the development of a pilot lung screening study in Scotland.

METHODS

We used Arksey and O'Malley's scoping review methodology and PRISMA-ScR framework to identify relevant literature to meet the study aims. Qualitative, quantitative and mixed methods primary studies published between January 2000 and May 2021 were identified and reviewed by two reviewers for inclusion, using a list of search terms developed by the study team and adapted for chosen databases.

RESULTS

Twenty-one articles met the final inclusion criteria. Articles were published between 2003 and 2021 and came from high income countries. Following data extraction and synthesis, findings were organised into four categories: Awareness of lung screening, Enthusiasm for lung screening, Barriers to lung screening, and Facilitators or ways of promoting uptake of lung screening. Awareness of lung screening was low while enthusiasm was high. Barriers to screening included fear of a cancer diagnosis, low perceived risk of lung cancer as well as practical barriers of cost, travel and time off work. Being health conscious, provider endorsement and seeking reassurance were all identified as facilitators of screening participation.

CONCLUSIONS

Understanding patient reported barriers and facilitators to lung screening can help inform the implementation of future lung screening pilots and national lung screening programmes.

Students' values, professional socialization and the mental gap of corporate social responsibility perceptions

This paper examines how values and professional socialization in business schools impact the formulation of students' contextualized view of social responsibility. We propose the empirical concept of a mental gap between the existing and the wished-for level of a business school's corporate social responsibility and estimate it empirically by using a sample of business school students from Central and South East Europe. Results show that students wish their business schools to reduce their current orientation toward economic outcomes and focus on environmental and social responsibilities. We interpret those empirical results in terms of the students' wish to balance achieving economic prosperity and enjoyment of life with the prosocial outcomes of their education. New student generations' perception of corporate social responsibility is not shaped by the professional socialization patterns but rather by the own perceptions, which can be influenced by experiential approaches to academic teaching and learning. Based on these empirical results, implications for academic practice and future research are explored.