Understanding health care in the south Caucasus: examples from Armenia

Frozen conflict in the midst of a global pandemic: potential impact on mental health in Armenian border communities

Armenia has been in a conflict with its neighbor, Azerbaijan, since 1988. Civilians in Tavush Province are regularly affected by ceasefire violations along the armed border with recent escalations further threatening the population's safety. In the midst of the COVID-19 pandemic, concerns regarding the mental health of border village residents in Armenia are prevalent. We present context-related factors of psychiatric illness, the prevalence of mental health disorders, and the state of mental health services in Armenia. We recommend directing greater attention towards the mental health status of civilians residing in conflict zones during the ongoing COVID-19 pandemic.

Public opinion about the health care system in Armenia: findings from a cross-sectional telephone survey

Background

Few studies have examined public opinion about the health care system in the former Soviet region. The objective of our study was to evaluate the population’s satisfaction with the health care system and identify factors associated with it in Armenia.

Methods

We conducted a cross-sectional telephone survey among 576 adult residents of the capital Yerevan using Random Digit Dialing technique. Simple and multivariate logistic regression explored associations between potential determinants and satisfaction.

Results

A substantial proportion of respondents (45.5%) were dissatisfied or very dissatisfied with the health system. About 49% of respondents negatively evaluated the ability of the system to provide equal access to care. About 69% of respondents thought that the responsibility for an individual’s health should be equally shared between the individual and the government or that the government’s share should be larger. The adjusted odds of satisfaction were higher among individuals with better health status, those who positively rated equal access and respect to patients in the system, those thinking that the responsibility for health should be equally shared between the individual and the government, and those who tended to trust the government.

Conclusions

This study enriched our understanding of factors that shape the population’s satisfaction with the health care system in different cultural and political environments. We recommend further exploration of public opinion about those system attributes that are not directly linked to patient experiences with care, but might be equally important for explaining the phenomenon of satisfaction.

Supplementary Information

Supplementary information accompanies this paper at 10.1186/s12913-020-05863-6.

Urban-rural differences in psychological distress in nine countries of the former Soviet Union

BACKGROUND

Studies have shown that the prevalence of mental illness can vary between urban and rural locations. This study extended research to the countries of the former Soviet Union (fSU) by assessing the association between settlement type and psychological distress and whether factors associated with psychological distress vary by settlement type.

METHODS

Data on 18,000 adults aged ≥18 years from the Health in Times of Transition (HITT) survey undertaken in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine in 2010/11 were analyzed. Settlement types were country capitals, regional capitals, cities/other urban settlements, and villages. Psychological distress was defined as the country-specific highest quintile of a composite score based on 11 questions. Logistic regression analysis with random effects was used to examine associations.

RESULTS

In a pooled country analysis, living in a smaller urban settlement or village was associated with significantly higher odds for psychological distress compared to living in the country capital. Lower social support was a strong correlate of psychological distress in all locations except capital cities.

LIMITATIONS

The psychological distress measure has not been formally validated in the study countries.

CONCLUSIONS

Lower levels of urbanicity are associated with greater psychological distress in the fSU countries. As many Western studies have linked greater urbanization to poorer mental health, this highlights the need for caution in extrapolating findings from one part of the world to others and the importance of undertaking research on the geographical correlates of mental health in different world regions.

Giving birth: the voices of Armenian women

PURPOSE AND STUDY DESIGN: The purposes of this qualitative descriptive study were to describe the perceptions of Armenian childbearing women about the meaning of giving birth and to conduct an outcomes evaluation of the Erebuni Women's Wellness Center.

METHOD

Fifteen women who had given birth to healthy term infants during the past 8 months and who received health-care services at the Erebuni Medical Center, Yerevan, Armenia participated in audiotaped interviews. Questions were asked about the meaning of their childbirth experience and their satisfaction with their health care.

RESULTS

Themes included the meaning of giving birth within the Armenian sociocultural context, enriching the family perspective across generations of Armenian families and receiving supportive quality health care.

DISCUSSION AND CLINICAL IMPLICATIONS

This research is an example of an international collaborative work conducted with the American International Health Alliance (AIHA) who established women's wellness centres in Eastern Europe in conjunction with United States Agency for International Development. Outcomes data is very important in order to ensure the quality of health care provided. Clinical personnel found evaluative data were helpful in improving services to women and newborns. Because of dramatic socioeconomic situation in Armenia and many changes that have happened in their health care over the past 18 years, it is important to document the outcomes of AIHA partnership programmes in improving the health of childbearing women and their families. Listening to the voices of Armenian childbearing women is essential to guide health-care initiatives.

Primary health care facility performance assessment in Armenia

Purpose

The purpose of this study is to focus on the performance of select facilities in Lori and Shirak provinces in Armenia in Spring 2008. This is in response to the deterioration of the primary healthcare sector in Armenia.

Design/methodology/approach

The performance assessment focused on the status of several performance indicators, both current and as recalled for 2006. The interviewer‐administered questionnaire addressed access to care, provider relations with community and clients, environment, management, and primary and secondary prevention at the facilities. For each domain, a summative score that ranged from 0 to 3 was computed and a mean score for each facility derived.

Findings

The project has had significant positive impact on facilities' performance. Access to care scores increased from 2.0 in 2006 to 2.5 in 2008; provider relations with community improved from 1.1 to 1.4; environment scores improved from 1.3 to 1.9, facility management improved from 1.4 to 1.7; and prevention efforts increased from 1.3 to 1.9. The overall mean facility score increased from 1.4 to 1.8. Although the scores for small rural clinics increased, their scores were lower than the scores for other facility types.

Originality/value

In the chronic absence of administrative surveillance data, this paper provides valuable information on the status of primary healthcare services in Armenian provinces. It demonstrates the value of interviewer‐administered performance assessments in obtaining data across project sites when internal monitoring of progress is unavailable.

Patient satisfaction with primary care in Armenia: good rating of bad services?

The study assessed the level of patient satisfaction at selected primary health-care facilities in Lori and Shirak provinces of Armenia. Self-administered questionnaires were distributed to 684 recent clients at primary health-care facilities. The majority of patients were satisfied with their provider (mean satisfaction score of 1.75 out of maximum 2). Most patients (89.0%) would visit the same provider again, and would recommend the provider to friends (85.6%). Satisfaction with other aspects of care, including waiting time, accessibility of services, confidentiality and cleanliness of the facility, was also high (mean score of 1.70 out of 2). Seventy-eight percent of respondents considered the care they received to be ‘excellent’ or ‘good’. The less educated and those in rural areas were more likely to be satisfied with the provider's quality. Despite the fundamental problems now challenging the Armenian primary health-care sector, patient satisfaction remains high. Given the high level of reported satisfaction, more focused satisfaction research tools and alternative approaches to patient assessments of care are needed to inform quality improvement in the Armenian setting.

Evaluation of "magnet journey to nursing excellence program" in Russia and Armenia

OBJECTIVE

To provide an outcomes-evaluation of an intervention to strengthen professional nursing practice in Russian and Armenian hospitals.

DESIGN

The Nursing Quality Improvement Initiative using the ANCC Forces of Magnetism to develop professional nurse practice was implemented in four hospitals in Russia and Armenia. Cross-sectional survey data were collected at two time points from 840 nurses in Wave 1 and 859 nurses in Wave 2. Comparisons were undertaken between targeted units in each hospital compared to nontargeted units, and each hospital served as its own control in surveys that took place in years 1 and 3 of the demonstration.

METHODS

Descriptive information on nurse samples was derived from survey items. Changes in characteristics of nurse practice environments, nurse-reported patient care quality, and nurse burnout in Russia and Armenia, overall and separately for targeted and nontargeted units, were tested using chi-square statistics and difference of means tests.

FINDINGS

Practice environment features such as nurses' involvement in hospital affairs, better collegial relationships with physicians, more support for nursing care from administrators, and continuity of nursing care improved after the intervention. Resource adequacy indicators did not change over the demonstration period. Changes in indicators of patient care quality were favorable, though differences in changes in targeted and nontargeted units were equivocal.

CONCLUSIONS

Changes consistent with evolving professional nursing practice were associated with program implementation. Forces of magnetism appear to have the same potential for transforming nursing practice in countries with fewer resources as in wealthier Western countries.

CLINICAL RELEVANCE

Magnet Recognition, an evidence-based best practice for improving the nursing-care environment developed in Western countries, was feasible to implement in countries with transitioning economies, limited resources, and truncated professional nursing education.