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Fadzil F, Idris IB, Kamal Nor N, Ismail J, Mohd Tamil A, Mohamad Noh K, Khamis N, Ahmad NA, Othman S, Ismail R. Missed Appointments at a Child Development Centre and Barriers to Access Special Needs Services for Children in Klang Valley, Malaysia: A Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010325. [PMID: 35010584 PMCID: PMC8751213 DOI: 10.3390/ijerph19010325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/24/2021] [Accepted: 12/25/2021] [Indexed: 05/25/2023]
Abstract
Attending appointments is vital for children with special needs, as such appointments involve long-term interdisciplinary care to ensure continuity of care and improve health and well-being. This study was performed to determine the prevalence of missed clinic appointments and identify the factors among those who have ever missed appointments and barriers of access to children's special needs services at the Child Development Centre (CDC) at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Moreover, suggestions for improvement from the caregivers' perspectives were explored. This is an explanatory sequential mixed methods study among caregivers of children with developmental disabilities aged up to 17 years old. Of 197 caregivers, 62 (31.5%) had missed clinic appointments. Forgetfulness was the most frequently cited reason. The bi-variable analysis showed significant differences in missed appointment rates by gender of caregivers and duration of follow-up. The final logistic regression model demonstrated that, when combined with the effect of being a male caregiver as an independent variable, follow-up duration of more than 6 years increased 2.67 times the risk of missing an appointment. Caregivers' perceived barriers were transportation, caregiver, child and healthcare services factors. Policies and strategic plans should be focused on key findings from these factors to improve appointment adherence and accessibility to services for children with special needs.
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Affiliation(s)
- Fariza Fadzil
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (F.F.); (A.M.T.)
- Family Health Development Division, Public Health Department, Ministry of Health Malaysia, Complex E, Precinct 1, Putrajaya 62590, Malaysia; (S.O.); (R.I.)
| | - Idayu Badilla Idris
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (F.F.); (A.M.T.)
| | - Norazlin Kamal Nor
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (N.K.N.); (J.I.)
| | - Juriza Ismail
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (N.K.N.); (J.I.)
| | - Azmi Mohd Tamil
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (F.F.); (A.M.T.)
| | - Kamaliah Mohamad Noh
- Faculty of Medicine, University of Cyberjaya, Persiaran Bestari, Cyber 11, Cyberjaya 63000, Malaysia;
| | - Noraziani Khamis
- Institute for Health Management, Ministry of Health Malaysia, Setia Murni U13/52, Section U13, Setia Alam, Shah Alam 40170, Malaysia;
| | - Noor Ani Ahmad
- Institute for Public Health, Ministry of Health Malaysia, Setia Murni U13/52, Section U13, Setia Alam, Shah Alam 40170, Malaysia;
| | - Salimah Othman
- Family Health Development Division, Public Health Department, Ministry of Health Malaysia, Complex E, Precinct 1, Putrajaya 62590, Malaysia; (S.O.); (R.I.)
| | - Rohana Ismail
- Family Health Development Division, Public Health Department, Ministry of Health Malaysia, Complex E, Precinct 1, Putrajaya 62590, Malaysia; (S.O.); (R.I.)
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MacKenzie L, Bedggood J, Csiernik R. The Impact of Weather on a Canadian Post-Secondary Walk-In Counseling Program. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2019. [DOI: 10.1080/87568225.2019.1687386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Laura MacKenzie
- Schulich Interfaculty Program in Public Health, Western University, London, Ontario, Canada
| | - Joanna Bedggood
- Manager of Student Wellness, King’s University College, London, Ontario, Canada
| | - Rick Csiernik
- School of Social Work, King’s University College, London, Ontario, Canada
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Schoeman JC, Swanepoel DW, van der Linde J. Developmental screening: predictors of follow-up adherence in primary health care. Afr Health Sci 2017; 17:52-61. [PMID: 29026377 DOI: 10.4314/ahs.v17i1.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The importance of early identification for infants and young children with developmental delays is well established. Poor follow-up on referrals, however, undermines the effectiveness of early intervention programmes. OBJECTIVES To identify factors, including text message reminders, that influence follow-up adherence for early intervention after developmental screening in primary health care. A secondary objective surveyed reasons for follow-up default. METHODS The PEDS tools were used to screen 247 high-risk children. A risk assessment questionnaire was completed with caregivers whose children were referred for speech-language and/or occupational therapy (n=106, 43%). A quasi-experimental correlational study was employed to identify risk factors for defaulting on appointments. A thematic analysis of telephonic interviews was also employed to determine reasons for follow-up defaults. RESULTS Follow-up adherence was 17%. Participants who were never married, divorced or widowed were 2.88 times more likely to attend a follow-up appointment than those who were married or living together (95%, CI 0.97-8.63). Text message reminders did not improve follow-up. More than half (58%) of participants who defaulted on appontments could be reached for telephonic interviews. Interviews showed that 87% of participants were unconcerned about their child's development. Other reasons for defaulting were employment, logistical issues, other responsibilities and forgetfulness. CONCLUSION Follow-up adherence for early intervention services following a positive primary health care screen was poor. Increased awareness and education regarding the importance of development for educational success is needed.
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Affiliation(s)
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands
- Australia Ear Science Institute Australia, Subiaco, Australia
| | - Jeannie van der Linde
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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Bigna JJR, Noubiap JJN, Plottel CS, Kouanfack C, Koulla-Shiro S. Factors associated with non-adherence to scheduled medical follow-up appointments among Cameroonian children requiring HIV care: a case-control analysis of the usual-care group in the MORE CARE trial. Infect Dis Poverty 2014; 3:44. [PMID: 25671122 PMCID: PMC4322435 DOI: 10.1186/2049-9957-3-44] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/12/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A better understanding of why HIV-exposed/infected children fail to attend their scheduled follow-up medical appointments for HIV-related care would allow for interventions to enhance the delivery of care. The aim of this study was to determine characteristics of the caregiver-child dyad (CCD) associated with children's non-adherence to scheduled follow-up medical appointments in HIV programs in Cameroon. METHODS We conducted a case-control analysis of the usual-care group of CCDs from the MORE CARE trial, in which the effect of mobile phone reminders for HIV-exposed/infected children in attending follow-up appointments was assessed from January to March 2013. For this study, the absence of a child at their appointment was considered a case and the presence of a child at their appointment was defined as a control. We used three multivariate binary logistic regression analyses. The best-fit model was the one which had the smallest chi-square value with the Hosmer-Lemeshow test (HLχ²). Magnitudes of associations were expressed by odds ratio (OR), with a p-value <0.05 considered as statistically significant. RESULTS We included 30 cases and 31 controls. Our best-fit model which considered the sex of the adults and children separately (HL χ²=3.5) showed that missing scheduled medical appointments was associated with: lack of formal education of the caregiver (OR 29.1, 95% CI 1.1-777.0; p=0.044), prolonged time to the next appointment/follow-up (OR [1 week increase] 1.4, 95% CI 1.03-2.0; p=0.032), and being a female child (OR 5.2, 95% CI 1.2-23.1; p=0.032). One model (HLχ²=10.5) revealed that woman-boy pairs adhered less to medical appointments compared to woman-girl pairs (OR 4.9, 95% CI 1.05-22.9; p=0.044). Another model (HLχ²=11.1) revealed that man-boy pairs were more likely to attend appointments compared to woman-girl pairs (OR 0.23, 95% CI 0.06-0.93; p=0.039). There were no statistical associations for the ages of the children or the caregivers, the study sites, or the HIV status (confirmed vs. suspected) of the children. CONCLUSION The profile of children who would not attend follow-up medical appointments in an HIV program was: a female, with a caregiver who has had no formal education, and with a longer follow-up appointment interval. There is a possibility that female children are favored by female caregivers and that male children are favored by male caregivers when they come to medical care.
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Affiliation(s)
- Jean Joel R Bigna
- />Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon
- />Faculty of Medicine, University of Montpellier 1, Montpellier, France
- />Preventing Mother to Child Transmission Unit, Goulfey District Hospital, Goulfey, Cameroon
| | | | - Claudia S Plottel
- />Department of Medicine, New York University Langone Medical Center, New York, USA
| | - Charles Kouanfack
- />Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon
- />Accredited Treatment Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Sinata Koulla-Shiro
- />Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon
- />Infectious Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
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