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Ng JY, Li SY, Cramer H. Perceptions and attitudes regarding complementary, alternative, and integrative medicine among published neurology authors: a large-scale, international cross-sectional survey. BMC Neurol 2024; 24:215. [PMID: 38914963 PMCID: PMC11194990 DOI: 10.1186/s12883-024-03661-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/30/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND While many patients with neurological disorders and conditions use complementary, alternative, and integrative medicine (CAIM), little is known about the use, perceptions, and attitudes regarding CAIM among published neurology authors. With the increasing popularity of CAIM, our objective was to assess practices, perceptions, and attitudes towards CAIM among published neurology authors. METHODS We conducted an anonymous online survey of authors who had published articles in neurology journals indexed in MEDLINE. We emailed potential participants our cross-sectional electronic survey after extracting their email addresses from one of their publications in our sample of journals. Basic descriptive statistics were drawn from quantitative data, and thematic content analysis was used to analyse qualitative data from any open-ended questions. RESULTS The survey was completed by 783 published neurology authors (1.7% response rate, 83.9% completion rate). Overall, respondents perceived CAIM to be promising in preventing, treating, and/or managing neurological diseases. Mind-body therapies received the most positive responses, indicated by over half of respondents cumulatively agreeing that they are promising (n = 368, 59.0%) and safe (n = 280, 50.3%). Whole medical systems and biofield therapy were less favourable. Most neurology clinicians reported a lack of formal (n = 211, 70.3%) and supplementary training (n = 158, 52.5%) on CAIM. Nearly half of clinicians did not feel comfortable counselling patients about CAIM therapies (n = 121, 44.5%), and over half did not feel comfortable recommending them (n = 161, 59.3%). A lack of scientific evidence for CAIM's safety and efficacy was reported as the greatest challenge to CAIM (n = 515, 92.5%). The majority of respondents believed there is value to conducting research on this topic (n = 461, 82.0%) and supported increasing allocation of research funding towards CAIM (n = 241, 58.9%). CONCLUSIONS Although many participants found CAIM to be promising to the field of neurology, the vast majority did not feel open to integrating CAIM into mainstream medical practices on account of a perceived lack of scientific evidence for its safety and efficacy. Future studies can use our findings to gather more detailed insights, improve educational resources on CAIM within neurology, as well as examine what effects a tailored CAIM education has on the perceptions and attitudes of published neurology authors towards CAIM.
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Affiliation(s)
- Jeremy Y Ng
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany.
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany.
| | - Stephanie Y Li
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Holger Cramer
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
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Dysart A, Barnett J, Harden SM. Yoga studio websites: are they an accurate first glance at the studio's mission, values, and resources? BMC Public Health 2023; 23:1622. [PMID: 37620854 PMCID: PMC10464212 DOI: 10.1186/s12889-023-16560-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/18/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Yoga, as an ancient and modern practice, increases physical, mental, emotional, spiritual, and social health. Yoga studio websites serve as a dissemination channel for studios to express their offerings, whom they employ, and whom they seek as clientele. Public health workers, physicians, researchers, and clinicians, can refer to existing studios to increase health among their patients or clients. The degree to which these websites can provide relevant information to these various stakeholder groups has yet to be defined. METHODS A pragmatic, sequential mixed-methods study was employed with quantitative data extraction, summarized as means and proportions, to score the studio websites (N = 28), and semi-structured interviews (n = 6) analyzed using the rigorous and accelerated data reduction (RADaR) technique, to confirm website content and staff intention. To explore urban and rural characteristics, yoga studios in southwest Virginia and Los Angeles were selected for inclusion. RESULTS Overall, community-based yoga studios websites included information on the type, duration, cost, and COVID mitigation strategies. The most common class duration was 60 min. Rural Southwest Virginia studios offered 8.5 classes per week whereas those in urban Los Angeles offered 24.2 classes per week. All studios used iconography and images to invite racial, ethnic, age, and body type and ability diversity. While studios in both areas specified that there were 200- and 500-hour registered yoga teachers, many of the instructor biographies did not include information on their training. Although only preliminary, the interviews (n = 6) confirmed that the websites generally represented the feel, intention, and offerings of the studio and that the primary purpose of the studio was to build relationships and ensure people felt comfortable in the space. CONCLUSION Website information was related to studio offerings and values; however, discussion with management or visiting the studio may provide a richer picture of the yoga practices offered in the space. Further suggestions for website content are provided.
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Affiliation(s)
- Anna Dysart
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA USA
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Emary PC, Stuber KJ, Mbuagbaw L, Oremus M, Nolet PS, Nash JV, Bauman CA, Ciraco C, Couban RJ, Busse JW. Quality of Reporting Using Good Reporting of A Mixed Methods Study Criteria in Chiropractic Mixed Methods Research: A Methodological Review. J Manipulative Physiol Ther 2023; 46:152-161. [PMID: 38142381 DOI: 10.1016/j.jmpt.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/25/2023] [Accepted: 11/07/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE The purpose of this review was to examine the reporting in chiropractic mixed methods research using Good Reporting of A Mixed Methods Study (GRAMMS) criteria. METHODS In this methodological review, we searched MEDLINE, Embase, CINAHL, and the Index to Chiropractic Literature from the inception of each database to December 31, 2020, for chiropractic studies reporting the use of both qualitative and quantitative methods or mixed qualitative methods. Pairs of reviewers independently screened titles, abstracts, and full-text studies, extracted data, and appraised reporting using the GRAMMS criteria and risk of bias with the Mixed Methods Appraisal Tool (MMAT). Generalized estimating equations were used to explore factors associated with reporting using GRAMMS criteria. RESULTS Of 1040 citations, 55 studies were eligible for review. Thirty-seven of these 55 articles employed either a multistage or convergent mixed methods design, and, on average, 3 of 6 GRAMMS items were reported among included studies. We found a strong positive correlation in scores between the GRAMMS and MMAT instruments (r = 0.78; 95% CI, 0.66-0.87). In our adjusted analysis, publications in journals indexed in Web of Science (adjusted odds ratio = 2.71; 95% CI, 1.48-4.95) were associated with higher reporting using GRAMMS criteria. Three of the 55 studies fully adhered to all 6 GRAMMS criteria, 4 studies adhered to 5 criteria, 10 studies adhered to 4 criteria, and the remaining 38 adhered to 3 criteria or fewer. CONCLUSION Our findings suggest that reporting in chiropractic mixed methods research using GRAMMS criteria was poor, particularly among studies with a higher risk of bias.
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Affiliation(s)
- Peter C Emary
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada; Chiropractic Department, D'Youville University, Buffalo, New York; Private practice, Langs Community Health Centre, Cambridge, Ontario, Canada.
| | - Kent J Stuber
- Parker University Research Center, Parker University, Dallas, Texas; Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Lawrence Mbuagbaw
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada; Centre for the Development of Best Practices in Health, Yaundé, Cameroon; Division of Global Health, Stellenbosch University, Stellenbosch, South Africa; Division of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Mark Oremus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul S Nolet
- Care and Public Health Research Institute (CAPHRI) School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Jennifer V Nash
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Craig A Bauman
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
| | | | - Rachel J Couban
- Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
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DU W, WANG L, JIA M, LIANG X, LI B, ZHANG Y, LIAO X. Mixed methods research in complementary and alternative medicine: a scoping review. J TRADIT CHIN MED 2022; 42:652-666. [PMID: 35848983 PMCID: PMC9924665 DOI: 10.19852/j.cnki.jtcm.20220602.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
OBJECTIVE To update the current characteristics about the scope and quality of mixed methods research (MMR) in complementary and alternative medicine (CAM) after nearly 10 years. METHODS A 5-stage approach for conducting a scoping review was adopted. Articles published on the top 10 journals in CAM with the highest impact factor in 2020 were screened for MMR. Information of included articles were extracted, and then synthesized to illustrate the current state. Methodological quality was evaluated according to the Mixed Method Appraisal Tool (MMAT) 2018 version. RESULTS A total of 55 (55/2991, 2%) articles using mixed methods were retrieved, including 17 medical studies and 38 ethnobotanical studies. We performed an in-depth analysis on the 17 medical studies, which studied cancer, stress, pain, fatigue, exercises, mindfulness intervention, herbal medicine use, art and acupuncture. Thirteen pilot studies applied MMR to evaluate the feasibility of interventions or programs (13/17, 76%); phenomenology was inferred as the most common philosophical assumptions (13/17, 76%); the most applied type of MMR was convergent design (16/17, 94%); integration often took place at integration (12/17, 71%). Among the 16 eligible studies for quality appraisal, majority were rated as good (14/16, 88%), whereas two studies were rated as poorly described. Primarily, a poor rating was due to incomplete reporting of data analysis and citations in qualitative components; lack of confounder controlling and the sampling strategy in quantitative components; poor description of integration and justification for mixed methods. Comparing with the previous review, fewer MMR were published in 2020 in CAM, but the proportion of studies that clearly reported MMR has increased by 4 times (4%→15%). CONCLUSION CAM researchers need to realize the benefits that MMR can have on conducting further health care research. Our findings highlight that applying MMR will be helpful to understand the complex dynamics and interdisciplinary nature of complex intervention. In addition, addressing a standardized reporting criteria for MMR is recommended.
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Affiliation(s)
- Wanqing DU
- 1 Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
- 2 Center for Evidence-based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
- 3 Xiyuan School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Liuding WANG
- 1 Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Min JIA
- 1 Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Xiao LIANG
- 1 Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Bo LI
- 4 Department of Clinical Epidemiology, Beijing Traditional Chinese Medicine Hospital, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China
| | - Yunling ZHANG
- 1 Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
- Prof. ZHANG Yunling, Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing100091, China. , Telephone: +86-15201084286; +86-17888805760
| | - Xing LIAO
- 2 Center for Evidence-based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
- Prof. LIAO Xing, Center for Evidence-based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
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Emary PC, Stuber KJ, Mbuagbaw L, Oremus M, Nolet PS, Nash JV, Bauman CA, Ciraco C, Couban RJ, Busse JW. Risk of bias in chiropractic mixed methods research: a secondary analysis of a meta-epidemiological review. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2022; 66:7-20. [PMID: 35655699 PMCID: PMC9103633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To examine the risk of bias in chiropractic mixed methods research. METHODS We performed a secondary analysis of a meta-epidemiological review of chiropractic mixed methods studies. We assessed risk of bias with the Mixed Methods Appraisal Tool (MMAT) and used generalized estimating equations to explore factors associated with risk of bias. RESULTS Among 55 eligible studies, a mean of 62% (6.8 [2.3]/11) of MMAT items were fulfilled. In our adjusted analysis, studies published since 2010 versus pre-2010 (adjusted odds ratio [aOR] = 2.26; 95% confidence interval [CI], 1.39 to 3.68) and those published in journals with an impact factor versus no impact factor (aOR = 2.21; 95% CI, 1.33 to 3.68) were associated with lower risk of bias. CONCLUSION Our findings suggest opportunities for improvement in the quality of conduct among published chiropractic mixed methods studies. Author compliance with the MMAT criteria may reduce methodological bias in future mixed methods research.
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Affiliation(s)
- Peter C. Emary
- Department of Health Research Methods, Evidence and Impact, McMaster University
- Chiropractic Department, D’Youville University
- Private Practice
| | - Kent J. Stuber
- Department of Graduate Education and Research, Canadian Memorial Chiropractic College
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, St. Joseph’s Healthcare-Hamilton
- Centre for the Development of Best Practices in Health, Yaundé, Cameroon
- Division of Global Health, Stellenbosch University, South Africa
| | - Mark Oremus
- Department of Health Research Methods, Evidence and Impact, McMaster University
- School of Public Health Sciences, University of Waterloo
| | - Paul S. Nolet
- Department of Graduate Education and Research, Canadian Memorial Chiropractic College
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Craig A. Bauman
- Department of Family Medicine, McMaster University
- The Centre for Family Medicine Family Health Team, Kitchener, Ontario
| | | | - Rachel J. Couban
- Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Jason W. Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University
- Department of Anesthesia, McMaster University
- Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
- Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada
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Emary PC, Stuber KJ, Mbuagbaw L, Oremus M, Nolet PS, Nash JV, Bauman CA, Ciraco C, Couban RJ, Busse JW. Quality of reporting in chiropractic mixed methods research: a methodological review protocol. Chiropr Man Therap 2021; 29:35. [PMID: 34526065 PMCID: PMC8442283 DOI: 10.1186/s12998-021-00395-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/07/2021] [Indexed: 01/20/2023] Open
Abstract
Background Mixed methods designs are increasingly used in health care research to enrich findings. However, little is known about the frequency of use of this methodology in chiropractic research, or the quality of reporting among chiropractic studies using mixed methods.
Objective To quantify the use and quality of mixed methods in chiropractic research, and explore the association of study characteristics (e.g., authorship, expertise, journal impact factor, country and year of publication) with reporting quality.
Methods We will conduct a systematic search of MEDLINE, EMBASE, CINAHL, and the Index to Chiropractic Literature to identify all chiropractic mixed methods studies published from inception of each database to December 31, 2020. Articles reporting the use of both qualitative and quantitative methods, or mixed qualitative methods, will be included. Pairs of reviewers will perform article screening, data extraction, risk of bias with the Mixed Methods Appraisal Tool (MMAT), and appraisal of reporting quality using the Good Reporting of A Mixed Methods Study (GRAMMS) guideline. We will explore the correlation between GRAMMS and MMAT scores, and construct generalized estimating equations to explore factors associated with reporting quality. Discussion This will be the first methodological review to examine the reporting quality of published mixed methods studies involving chiropractic research. The results of our review will inform opportunities to improve reporting in chiropractic mixed methods studies. Our results will be disseminated in a peer-reviewed publication and presented publicly at conferences and as part of a doctoral thesis. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-021-00395-0.
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Affiliation(s)
- Peter C Emary
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. .,Chiropractic Department, D'Youville College, Buffalo, NY, USA. .,Private Practice, Cambridge, ON, Canada.
| | - Kent J Stuber
- Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare-Hamilton, Hamilton, ON, Canada.,Centre for the Development of Best Practices in Health, Yaundé, Cameroon.,Division of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Mark Oremus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Paul S Nolet
- Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.,Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Jennifer V Nash
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Craig A Bauman
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,The Centre for Family Medicine Family Health Team, Kitchener, ON, Canada
| | - Carla Ciraco
- Chiropractic Department, D'Youville College, Buffalo, NY, USA
| | - Rachel J Couban
- Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Anesthesia, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada.,Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, ON, Canada
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Xu N, Lv A, Li T, Li X, Huang M, Su Y. Experiences of healthcare providers during the coronavirus pandemic and its impact on them: protocol for a mixed-methods systematic review. BMJ Open 2021; 11:e043686. [PMID: 33637546 PMCID: PMC7918807 DOI: 10.1136/bmjopen-2020-043686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Frontline healthcare providers are redeployed to areas outside their clinical expertise and assigned high-loading workload to address the surge of patients with each coronavirus outbreak. Their importance in crisis is not in doubt. However, they experienced considerable physical distress and psychological stressors, even leading to psychological illness and infection in this environment. There is an urgent need to accurately, comprehensively and objectively understand their experiences, perceptions and current situation of burnout, post-traumatic stress disorder (PTSD), anxiety, depression, insomnia and coronavirus infection. Therefore, this protocol is to conduct a mixed-methods systematic review to summarise the evidence on the experiences of healthcare providers and impacts of the coronavirus on their psychological status and infection during the pandemics. METHODS Published studies on experience, perspective, impact, burnout, PTSD, anxiety, depression, insomnia, and infection of healthcare providers with SARS, Middle East respiratory syndrome and COVID-19, and written in English and Chinese will be accepted. Databases (MEDLINE, EMBASE, CENTRAL, Web of Science, PubMed, Psychology Information, WanFang and SinoMed) from inception until 30 July 2020 will be searched. Two reviewers will select, screen, extract data and assess the risk of bias independently. Risk of bias of results will be using the Mixed-Methods Appraisal Tool. Using a convergent integrated approach on qualitative/quantitative studies, we will synthesise qualitative and quantitative data separately. The incidence and number of cases about burnout, PTSD, anxiety, depression, insomnia and coronavirus infection among medical staff will be extracted. Then we will transform quantitative data to synthesise narrative findings. This protocol will be reported per the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. ETHICS AND DISSEMINATION Ethical assessment is not required due to the nature of the proposed systematic review. Findings of our research will be disseminated at conferences related to this field and through publication in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42020198506.
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Affiliation(s)
- Na Xu
- Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - AiLi Lv
- Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - TianZi Li
- Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - XiaoFeng Li
- Tongji University Tenth People's Hospital, Shanghai, China
| | - Mei Huang
- Department of Nursing, Air Force Medical University, Xi' an, ShaanXi, China
| | - Yan Su
- Health Science Center, Xi'an Jiaotong University, Xi'an, China
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A Methodological Review of Mixed Methods Research in Palliative and End-of-Life Care (2014-2019). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113853. [PMID: 32485830 PMCID: PMC7312170 DOI: 10.3390/ijerph17113853] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 01/26/2023]
Abstract
Mixed methods research has been increasingly recognized as a useful approach for describing and explaining complex issues in palliative care and end-of-life research. However, little is known about the use of this methodology in the field and the ways in which mixed methods studies have been reported. The purpose of this methodological review was to examine the characteristics, methodological features and reporting quality of mixed methods articles published in palliative care research. The authors screened all articles published in eight journals specialized in palliative care between January 2014 and April 2019. Those that reported a mixed methods study (n = 159) were included. The Good Reporting of a Mixed Methods Study (GRAMMS) criteria were used to assess reporting quality. Findings showed that 57.9% of the identified studies used a convergent design and 82.4% mentioned complementarity as their main purpose for using a mixed methods approach. The reporting quality of the articles generally showed a need for improvement as authors usually did not describe the type of mixed methods design used and provided little detail on the integration of quantitative and qualitative methods. Based on the findings, recommendations are made to improve the quality of reporting of mixed methods articles in palliative care.
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Senzon SA. The Chiropractic Vertebral Subluxation Part 1: Introduction. JOURNAL OF CHIROPRACTIC HUMANITIES 2018; 25:10-21. [PMID: 31019417 PMCID: PMC6472118 DOI: 10.1016/j.echu.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/15/2018] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The objective of this article is to present a rationale for the need of a history of chiropractic vertebral subluxation (CVS) theory based on primary sources. DISCUSSION There is a dichotomy in the chiropractic profession around subluxation terminology, which has many facets. The literature around this topic spans social, economic, cultural, and scientific questions. By developing a rationale for a historical perspective of CVS theory, including the tracking of the historical development of ideas throughout the profession, a foundation for future discourse may emerge. CONCLUSIONS By using primary sources, ideas in chiropractic on the development of CVS theory are proposed. This introduction presents a basis for the need of a history of CVS theory and suggests how this work may be used to further philosophical dialogs in chiropractic.
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Affiliation(s)
- Simon A. Senzon
- Corresponding author: Simon A. Senzon, MA, DC, 218 E. Chestnut Street, Asheville, NC 28801. Tel.: +1 828 251 0815.
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Can live music therapy reduce distress and pain in children with burns after wound care procedures? A randomized controlled trial. Burns 2018; 44:823-833. [PMID: 29395407 DOI: 10.1016/j.burns.2017.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Burn wound care procedures are very painful and lead to distress. Live music therapy has shown beneficial effects on distress and pain in specific pediatric patient populations. In this study we measured whether live music therapy has beneficial effects in terms of less distress and pain in children with burns after wound care procedures. METHODS This randomized assessor-blinded controlled trial (RCT) took place at the burns unit of the Red Cross War Memorial Children's Hospital, Cape Town, South Africa. It included newly admitted inpatients between the ages of 0 and 13 years undergoing their first or second wound care procedures. Excluded were children with a hearing impairment or low level of consciousness. The intervention group received one live music therapy session directly after wound care in addition to standard care. The control group received standard care only. The primary outcome was distress measured with the Observational Scale of Behavioral Distress-revised (OSBD-r). The secondary outcome was pain measured with the COMFORT-behavioral scale (COMFORT-B). In addition, in children older than 5 years self-reported distress with the validated Wong-Baker scale (FACES) and pain with the Faces Pain Scale-Revised (FPS-R) were measured. Patients in both groups were videotaped for three minutes before wound care; during the music therapy or the control condition; and for two minutes thereafter. Two researchers, blinded to the study condition, independently scored the OSBD-r and the COMFORT-B from the video footage before and after music therapy. RESULTS We included 135 patients, median age 22.6 months (IQR 15.4-40.7 months). Change scores did not significantly differ between the intervention and the control groups for either distress (p=0.53; d=0.11; 95% CI -0.23 to 0.45) or pain (p=0.99; d=0.04; 95% CI -0.30 to 0.38). Self-reported distress in a small group of children (n=18) older than 5 years indicated a significant reduction in distress after live music therapy (p=0.05). CONCLUSIONS Live music therapy was not found effective in reducing distress and pain in young children after burn wound care. Older children might be more responsive to this intervention.
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Themes Underlying Australian General Practitioner Views towards Chiropractic and Osteopathy: An Assessment of Free Text Data from a Cross-Sectional Survey. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:2786106. [PMID: 29552080 PMCID: PMC5820586 DOI: 10.1155/2018/2786106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/23/2017] [Accepted: 12/12/2017] [Indexed: 12/31/2022]
Abstract
The Australian chiropractic and osteopathic professions underwent a period of significant transformation between 1960 and 2000. This resulted in an improvement in the views held by the medical profession towards the two professions. However, a recent survey of Australian general practitioners (GPs) reported that a number of GPs still hold negative views towards chiropractors and osteopaths. This paper examines these views from the perspective of critical realism and explores the generative mechanisms that can influence the willingness of health practitioners to collaborate over patient care. A qualitative analysis of open-ended responses to a survey of 630 Australian GPs was conducted. Unfavourable attitudes of GPs towards chiropractors and osteopaths included perceived lack of safety, efficacy, and inadequacy of training, despite chiropractic's and osteopathy's reliance on the same evidence base and similar training to those of other manual therapy professions such as physiotherapy. These attitudes may be underpinned by the professional biases against chiropractic and osteopathy that continue to marginalise the professions within the Australian healthcare system. Continued investment in the research base for chiropractic and osteopathic practice is required, along with raising the awareness of GPs about the education and skills of chiropractors and osteopaths.
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Piil K, Jakobsen J, Christensen K, Juhler M, Guetterman T, Fetters M, Jarden M. Needs and preferences among patients with high-grade glioma and their caregivers - A longitudinal mixed methods study. Eur J Cancer Care (Engl) 2018; 27:e12806. [DOI: 10.1111/ecc.12806] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/30/2017] [Indexed: 12/16/2022]
Affiliation(s)
- K. Piil
- The University Hospitals Center for Health Research (UCSF), Center for Integrated Rehabilitation of Cancer Patients (CIRE) and Finsen Center; Copenhagen Denmark
- Department of Neurosurgery; The University Hospital of Copenhagen; Copenhagen Denmark
| | - J. Jakobsen
- Neuroscience Center; The University Hospital of Copenhagen; Copenhagen Denmark
| | - K.B. Christensen
- Department of Public Health; Section of Biostatistics; University of Copenhagen; Copenhagen Denmark
| | - M. Juhler
- Department of Neurosurgery; The University Hospital of Copenhagen; Copenhagen Denmark
- Department of Clinical Medicine; Section of Neurology, Psychiatry and Sensory Sciences; The University of Copenhagen; Copenhagen Denmark
| | - T.C. Guetterman
- Department of Family Medicine; The University of Michigan; Ann Arbor MI USA
| | - M.D. Fetters
- Department of Family Medicine; The University of Michigan; Ann Arbor MI USA
| | - M. Jarden
- The University Hospitals Center for Health Research (UCSF), Center for Integrated Rehabilitation of Cancer Patients (CIRE) and Finsen Center; Copenhagen Denmark
- Faculty of Health and Medical Sciences; Department of Public Health; University of Copenhagen; Copenhagen Denmark
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Emmert M, Meszmer N, Jablonski L, Zinth L, Schöffski O, Taheri-Zadeh F. Public release of hospital quality data for referral practices in Germany: results from a cluster-randomised controlled trial. HEALTH ECONOMICS REVIEW 2017; 7:33. [PMID: 28952136 PMCID: PMC5615085 DOI: 10.1186/s13561-017-0171-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/22/2017] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To evaluate the impact of different dissemination channels on the awareness and usage of hospital performance reports among referring physicians, as well as the usefulness of such reports from the referring physicians' perspective. DATA SOURCES/STUDY SETTING Primary data collected from a survey with 277 referring physicians (response rate = 26.2%) in Nuremberg, Germany (03-06/2016). STUDY DESIGN Cluster-randomised controlled trial at the practice level. Physician practices were randomly assigned to one of two conditions: (1) physicians in the control arm could become aware of the performance reports via mass media channels (Mass Media, [Formula: see text]=132, [Formula: see text]=147); (2) physicians in the intervention arm also received a printed version of the report via mail (Mass and Special Media, [Formula: see text]=117; [Formula: see text]=130). PRINCIPAL FINDINGS Overall, 68% of respondents recalled hospital performance reports and 21% used them for referral decisions. Physicians from the Mass and Special Media group were more likely to be aware of the performance reports (OR 4.16; 95% CI 2.16-8.00, p < .001) but not more likely to be influenced when referring patients into hospitals (OR 1.73; 95% CI 0.72-4.12, p > .05). On a 1 (very good) to 6 (insufficient) scale, the usefulness of the performance reports was rated 3.67 (±1.40). Aggregated presentation formats were rated more helpful than detailed hospital quality information. CONCLUSIONS Hospital quality reports have limited impact on referral practices. To increase the latter, concerns raised by referring physicians must be given more weight. Those principally refer to the underlying data, the design of the reports, and the lack of important information.
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Affiliation(s)
- Martin Emmert
- School of Business and Economics, Health Services Management, University of Erlangen-Nuremberg, Lange Gasse 20 90403 Nuremberg, Nuremberg, Germany
| | - Nina Meszmer
- School of Business and Economics, Health Services Management, University of Erlangen-Nuremberg, Lange Gasse 20 90403 Nuremberg, Nuremberg, Germany
| | - Lisa Jablonski
- School of Business and Economics, Health Services Management, University of Erlangen-Nuremberg, Lange Gasse 20 90403 Nuremberg, Nuremberg, Germany
| | - Lena Zinth
- School of Business and Economics, Health Services Management, University of Erlangen-Nuremberg, Lange Gasse 20 90403 Nuremberg, Nuremberg, Germany
| | - Oliver Schöffski
- School of Business and Economics, Health Services Management, University of Erlangen-Nuremberg, Lange Gasse 20 90403 Nuremberg, Nuremberg, Germany
| | - Fatemeh Taheri-Zadeh
- Media, Information and Design Department of Information and Communication, University of Applied Sciences and Arts, Hannover, Germany
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Emmert M, Sauter L, Jablonski L, Sander U, Taheri-Zadeh F. Do Physicians Respond to Web-Based Patient Ratings? An Analysis of Physicians' Responses to More Than One Million Web-Based Ratings Over a Six-Year Period. J Med Internet Res 2017; 19:e275. [PMID: 28747292 PMCID: PMC5550732 DOI: 10.2196/jmir.7538] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/21/2017] [Accepted: 06/02/2017] [Indexed: 11/13/2022] Open
Abstract
Background Physician-rating websites (PRWs) may lead to quality improvements in case they enable and establish a peer-to-peer communication between patients and physicians. Yet, we know little about whether and how physicians respond on the Web to patient ratings. Objective The objective of this study was to describe trends in physicians’ Web-based responses to patient ratings over time, to identify what physician characteristics influence Web-based responses, and to examine the topics physicians are likely to respond to. Methods We analyzed physician responses to more than 1 million patient ratings displayed on the German PRW, jameda, from 2010 to 2015. Quantitative analysis contained chi-square analyses and the Mann-Whitney U test. Quantitative content techniques were applied to determine the topics physicians respond to based on a randomly selected sample of 600 Web-based ratings and corresponding physician responses. Results Overall, physicians responded to 1.58% (16,640/1,052,347) of all Web-based ratings, with an increasing trend over time from 0.70% (157/22,355) in 2010 to 1.88% (6377/339,919) in 2015. Web-based ratings that were responded to had significantly worse rating results than ratings that were not responded to (2.15 vs 1.74, P<.001). Physicians who respond on the Web to patient ratings differ significantly from nonresponders regarding several characteristics such as gender and patient recommendation results (P<.001 each). Regarding scaled-survey rating elements, physicians were most likely to respond to the waiting time within the practice (19.4%, 99/509) and the time spent with the patient (18.3%, 110/600). Almost one-third of topics in narrative comments were answered by the physicians (30.66%, 382/1246). Conclusions So far, only a minority of physicians have taken the chance to respond on the Web to patient ratings. This is likely because of (1) the low awareness of PRWs among physicians, (2) the fact that only a few PRWs enable physicians to respond on the Web to patient ratings, and (3) the lack of an active moderator to establish peer-to-peer communication. PRW providers should foster more frequent communication between the patient and the physician and encourage physicians to respond on the Web to patient ratings. Further research is needed to learn more about the motivation of physicians to respond or not respond to Web-based patient ratings.
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Affiliation(s)
- Martin Emmert
- Institute of Management, School of Business and Economics, Health Services Management, Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany
| | - Lisa Sauter
- Institute of Management, School of Business and Economics, Health Services Management, Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany
| | - Lisa Jablonski
- Institute of Management, School of Business and Economics, Health Services Management, Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany
| | - Uwe Sander
- Media, Information and Design, Department of Information and Communication, University of Applied Sciences and Arts, Hannover, Germany
| | - Fatemeh Taheri-Zadeh
- Media, Information and Design, Department of Information and Communication, University of Applied Sciences and Arts, Hannover, Germany
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Brooks AT, Krumlauf M, Fryer CS, Beck KH, Yang L, Ramchandani VA, Wallen GR. Critical Transitions: A Mixed Methods Examination of Sleep from Inpatient Alcohol Rehabilitation Treatment to the Community. PLoS One 2016; 11:e0161725. [PMID: 27571353 PMCID: PMC5003361 DOI: 10.1371/journal.pone.0161725] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/10/2016] [Indexed: 12/02/2022] Open
Abstract
Aims This prospective, repeated measures study utilized a convergent parallel mixed methods approach to assess sleep experiences among individuals who were alcohol-dependent undergoing inpatient detoxification and treatment at a clinical research facility across the transition periods associated with the rehabilitation process: the initial adjustment to becoming an inpatient and the transition from inpatient to outpatient status. Methods This study included individual semi-structured interviews and quantitative measures relating to psychological distress, sleep quality, daytime sleepiness, and sleep-related beliefs and behavior (n = 33; 66.7% male). Interviews were conducted and questionnaires were administered within one week of participants’ scheduled discharge date and again four to six weeks post-discharge when they returned for a follow-up visit (or via phone). Results Participants self-reported significant sleep disturbances at both study time points. Of those participants with valid data at both time points (n = 28), there were no significant changes in mean scores from pre- to post-discharge with the exception of self-efficacy for sleep (SE-S) being significantly higher post-discharge. Preliminary qualitative findings suggested differences between those with ongoing sleep disturbances, those whose sleep disturbances had resolved, and those with no sleep disturbances at either time point. Conclusions This analysis highlights individual variation in sleep throughout the process of inpatient treatment and transition to outpatient aftercare in individuals with alcohol dependence. Collecting quantitative and qualitative data concurrently and combining emerging themes from qualitative data with quantitative analyses allowed for a more thorough examination of this relatively novel area of research and provided information that can be utilized to inform future behavioral sleep interventions.
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Affiliation(s)
- Alyssa Todaro Brooks
- National Institutes of Health Clinical Center, Bethesda, Maryland, United States of America
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, United States of America
- * E-mail:
| | - Michael Krumlauf
- National Institutes of Health Clinical Center, Bethesda, Maryland, United States of America
| | - Craig S. Fryer
- University of Maryland School of Public Health, Department of Behavioral and Community Health, College Park, Maryland, United States of America
| | - Kenneth H. Beck
- University of Maryland School of Public Health, Department of Behavioral and Community Health, College Park, Maryland, United States of America
| | - Li Yang
- National Institutes of Health Clinical Center, Bethesda, Maryland, United States of America
| | - Vijay A. Ramchandani
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, United States of America
| | - Gwenyth R. Wallen
- National Institutes of Health Clinical Center, Bethesda, Maryland, United States of America
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Stuber KJ, Langweiler M, Mior S, McCarthy PW. Assessing patient-centered care in patients with chronic health conditions attending chiropractic practice: protocol for a mixed-methods study. Chiropr Man Therap 2016; 24:15. [PMID: 27162609 PMCID: PMC4860769 DOI: 10.1186/s12998-016-0095-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 04/01/2016] [Indexed: 12/30/2022] Open
Abstract
Background The management of chronic health conditions increasingly requires an organized, coordinated, and patient-centered approach to care. The Chronic Care Model (CCM) has been adopted in primary care to improve care delivery for those with chronic health conditions. Chiropractors manage chronic health conditions; however, little is known if such care is patient-centered. The primary aim of this study is to determine to what extent chiropractic patients with chronic health conditions perceive their care is patient-centred. We will assess concordance with the CCM using the Patient Assessment of Chronic Illness Care (PACIC) survey in study patients. We will also explore perception of how patient-centered the care provided by chiropractors is for those with chronic health conditions according to patients and chiropractors. Methods/design We will use a sequential mixed methods design with quantitative priority. In the quantitative component patients will complete a written questionnaire providing sociodemographic, health status, and health care interaction information, all of which will serve as the independent variables. Patients will also complete a modified version of the PACIC; the average overall score will be the dependent variable. In the qualitative component semi-structured interviews and focus groups with patients and chiropractors will be conducted. A pilot study will be conducted to determine if the modified PACIC will perform adequately in measuring concordance with the CCM for chiropractic care. Pilot testing will also allow for assessment of the interview and focus groups guides. Variables found to be significantly associated will be included in a multivariate linear regression analysis to identify significant predictors of the dependent variable. Qualitative data will be analyzed using an inductive thematic analysis to provide meaning to the quantitative results. Discussion There is a paucity of research describing the extent to which chiropractic care for patients with chronic health conditions is concordant with the CCM. This study will examine this relationship and the perceptions and experiences of patients and chiropractors regarding how patient-centered chiropractic care is for these patients.
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Affiliation(s)
- Kent Jason Stuber
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario Canada ; Faculty of Life Sciences and Education, University of South Wales, Treforest, Wales
| | - Mark Langweiler
- Faculty of Life Sciences and Education, University of South Wales, Treforest, Wales
| | - Silvano Mior
- Canadian Memorial Chiropractic College, Toronto, Ontario Canada
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Fogarty S, Smith CA. Evaluating research information on practitioner websites describing the use of acupuncture as an adjunct to IVF. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2015.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cremers AL, de Laat MM, Kapata N, Gerrets R, Klipstein-Grobusch K, Grobusch MP. Assessing the consequences of stigma for tuberculosis patients in urban Zambia. PLoS One 2015; 10:e0119861. [PMID: 25806955 PMCID: PMC4373828 DOI: 10.1371/journal.pone.0119861] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/17/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Stigma is one of the many factors hindering tuberculosis (TB) control by negatively affecting hospital delay and treatment compliance. In Zambia, the morbidity and mortality due to TB remains high, despite extended public health attempts to control the epidemic and to diminish stigma. STUDY AIM To enhance understanding of TB-related stigmatizing perceptions and to describe TB patients' experiences of stigma in order to point out recommendations to improve TB policy. METHODS We conducted a mixed method study at Kanyama clinic and surrounding areas, in Lusaka, Zambia; structured interviews with 300 TB patients, multiple in-depth interviews with 30 TB patients and 10 biomedical health workers, 3 focus group discussions with TB patients and treatment supporters, complemented by participant observation and policy analysis of the TB control program. Predictors of stigma were identified by use of multivariate regression analyses; qualitative analysis of the in-depth interviews, focus group discussions and participant observation was used for triangulation of the study findings. RESULTS We focused on the 138/300 patients that described TB-related perceptions and attitudes, of whom 113 (82%) reported stigma. Stigma provoking TB conceptions were associated with human immunodeficiency virus (HIV)-infection, alleged immoral behaviour, (perceived) incurability, and (traditional) myths about TB aetiology. Consequences of stigma prevailed both among children and adults and included low self-esteem, insults, ridicule, discrimination, social exclusion, and isolation leading to a decreased quality of life and social status, non-disclosure, and/or difficulties with treatment compliance and adherence. Women had significantly more stigma-related problems than men. CONCLUSIONS The findings illustrate that many TB patients faced stigma-related issues, often hindering effective TB control and suggesting that current efforts to reduce stigma are not yet optimal. The content and implementation of sensitization programs should be improved and more emphasis needs to be placed on women and children.
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Affiliation(s)
- Anne Lia Cremers
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Myrthe Manon de Laat
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nathan Kapata
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- The National TB/Leprosy Control Programme, Lusaka, Zambia
- University of Zambia—University College London (UNZA-UCL) program, Lusaka, Zambia
| | - Rene Gerrets
- Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Epidemiology, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Peter Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Ketelaar NABM, Faber MJ, Elwyn G, Westert GP, Braspenning JC. Comparative performance information plays no role in the referral behaviour of GPs. BMC FAMILY PRACTICE 2014; 15:146. [PMID: 25160715 PMCID: PMC4161854 DOI: 10.1186/1471-2296-15-146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 08/15/2014] [Indexed: 02/06/2023]
Abstract
Background Comparative performance information (CPI) about the quality of hospital care is information used to identify high-quality hospitals and providers. As the gatekeeper to secondary care, the general practitioner (GP) can use CPI to reflect on the pros and cons of the available options with the patient and choose a provider best fitted to the patient’s needs. We investigated how GPs view their role in using CPI to choose providers and support patients. Method We used a mixed-method, sequential, exploratory design to conduct explorative interviews with 15 GPs about their referral routines, methods of referral consideration, patient involvement, and the role of CPI. Then we quantified the qualitative results by sending a survey questionnaire to 81 GPs affiliated with a representative national research network. Results Seventy GPs (86% response rate) filled out the questionnaire. Most GPs did not know where to find CPI (87%) and had never searched for it (94%). The GPs reported that they were not motivated to use CPI due to doubts about its role as support information, uncertainty about the effect of using CPI, lack of faith in better outcomes, and uncertainty about CPI content and validity. Nonetheless, most GPs believed that patients would like to be informed about quality-of-care differences (62%), and about half the GPs discussed quality-of-care differences with their patients (46%), though these discussions were not based on CPI. Conclusion Decisions about referrals to hospital care are not based on CPI exchanges during GP consultations. As a gatekeeper, the GP is in a good position to guide patients through the enormous amount of quality information that is available. Nevertheless, it is unclear how and whether the GP’s role in using information about quality of care in the referral process can grow, as patients hardly ever initiate a discussion based on CPI, though they seem to be increasingly more critical about differences in quality of care. Future research should address the conditions needed to support GPs’ ability and willingness to use CPI to guide their patients in the referral process.
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Affiliation(s)
- Nicole A B M Ketelaar
- Radboud university medical center, Scientific Institute for Quality of Healthcare 114, P,O, Box 9101, 6500, HB, Nijmegen, The Netherlands.
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Weeks J. Institute for Integrative Health in $1-Million Grant to Explore Nature's Effect on Wounded Warriors … plus more. Integr Med (Encinitas) 2014; 13:18-20. [PMID: 26770087 PMCID: PMC4684124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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