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Aranda Z, Caamal V, Montaño M, Bernal D, Meneses S. Exploring how non-clinical factors in childbirth care shape users' experiences in public health facilities in rural Chiapas, Mexico: a qualitative study using the WHO health systems responsiveness framework. BMC Pregnancy Childbirth 2024; 24:173. [PMID: 38424565 PMCID: PMC10905866 DOI: 10.1186/s12884-024-06357-7] [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: 10/16/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Many Mexicans face barriers to receive delivery care from qualified professionals, especially indigenous and poor sectors of the population, which represent most of the population in the state of Chiapas. When access to institutional delivery care is an option, experiences with childbirth care are often poor. This underscores the need for evidence to improve the quality of services from the user's perspective. The present study was conceived with the objective of understanding how non-clinical aspects of care shape women's birthing experiences in public health institutions in Chiapas. METHODS We conducted an exploratory qualitative study. Data collection consisted in 20 semi-structured interviews to women who had delivered in a public health facility in Chiapas during the last six months prior to the interview. For the design of the interview guide we used the WHO health system responsiveness framework, which focus on the performance of the health system in terms of the extent to which it delivers services according to the "universally legitimate expectations of individuals" and focuses on the non-financial and non-clinical qualities of care. The resulting data were analyzed using thematic analysis methodology. RESULTS We identified a total of 16 themes from the data, framed in eight categories which followed the eight domains of the WHO health systems responsiveness framework: Choice of the provider and the facility, prompt attention, quality of basic amenities, access to social support, respectful treatment, privacy, involvement in decisions, and communication. We shed light on the barriers women face in receiving prompt care, aspects of health facilities that impact women's comfort, the relevance of being provided with adequate food and drink during institutional delivery, how accompaniment contributes positively to the birthing experience, the aspects of childbirth that women find important to decide on, and how providers' interpersonal behaviors affect the birthing experience. CONCLUSIONS We have identified non-clinical aspects of childbirth care that are important to the user experience and that are not being satisfactorily addressed by public health institutions in Chiapas. This evidence constitutes a necessary first step towards the design of strategies to improve the responsiveness of the Chiapas health system in childbirth care.
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Affiliation(s)
- Zeus Aranda
- Partners In Health Mexico (Compañeros En Salud), Ángel Albino Corzo, Calle Primera Pte. Sur 25, Colonia Centro, 30370 Ángel Albino Corzo, Chiapas, México.
| | - Viviana Caamal
- Partners In Health Mexico (Compañeros En Salud), Ángel Albino Corzo, Calle Primera Pte. Sur 25, Colonia Centro, 30370 Ángel Albino Corzo, Chiapas, México
| | - Mariana Montaño
- Partners In Health Mexico (Compañeros En Salud), Ángel Albino Corzo, Calle Primera Pte. Sur 25, Colonia Centro, 30370 Ángel Albino Corzo, Chiapas, México
| | - Daniel Bernal
- Escuela de Gobierno y Transformación Pública, Instituto Tecnológico y de Estudios Superiores de Monterrey, Ciudad de México, México
| | - Sergio Meneses
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, México
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Coren F, Brown MK, Ikeda DJ, Tietz D, Steinbock C, Baim-Lance A, Agins BD. Beyond tokenism in quality management policy and programming: moving from participation to meaningful involvement of people with HIV in New York State. Int J Qual Health Care 2021; 33:6068878. [PMID: 33415331 DOI: 10.1093/intqhc/mzab004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/07/2020] [Accepted: 01/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Consumer involvement in health-care policy and quality management (QM) programming is a key element in making health systems people-centered. Involvement of health-care consumers in these areas, however, remains underdeveloped and under-prioritized. When consumer involvement is actively realized, few mechanisms for assessing its impact have been developed. The New York State Department of Health (NYSDOH) embraces consumer involvement of people with HIV in QM as a guiding principle, informed by early HIV/AIDS advocacy and a framework of people-centered quality care. METHOD HIV consumer involvement is implemented statewide and informs all quality of care programming as a standard for QM in health-care organizations, implemented through four key several initiatives: (i) a statewide HIV Consumer Quality Advisory Committee; (ii) leadership and QM trainings for consumers; (iii) specific tools and activities to engage consumers in QM activities at state, regional and health-care facility levels and (iv) formal organizational assessments of consumer involvement in health-care facility QM programs. RESULTS We review the literature on this topic and place the methods used by the NYSDOH within a theoretical framework for consumer involvement. CONCLUSION We present a model that offers a paradigm for practical implementation of routine consumer involvement in QM programs that can be replicated in other health-care settings, both disease-specific and general, reflecting the priority of active participation of consumers in QM activities at all levels of the health system.
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Affiliation(s)
- Freda Coren
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | | | - Daniel J Ikeda
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Daniel Tietz
- New York State Department of Health, AIDS Institute, 90 Church Street, New York, NY 10007, USA
| | - Clemens Steinbock
- New York State Department of Health, AIDS Institute, 90 Church Street, New York, NY 10007, USA
| | - Abigail Baim-Lance
- Veterans Health Administration James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - Bruce D Agins
- University of California, San Francisco Institute for Global Health Sciences 550 16th Street, Third Floor, San Francisco, CA 94158, USA
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Fusco F, Marsilio M, Guglielmetti C. Co-production in health policy and management: a comprehensive bibliometric review. BMC Health Serv Res 2020; 20:504. [PMID: 32503522 PMCID: PMC7275357 DOI: 10.1186/s12913-020-05241-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 04/19/2020] [Indexed: 12/25/2022] Open
Abstract
Background Due to an increasingly elderly population, a higher incidence of chronic diseases and higher expectations regarding public service provision, healthcare services are under increasing strain to cut costs while maintaining quality. The importance of promoting systems of co-produced health between stakeholders has gained considerable traction both in the literature and in public sector policy debates. This study provides a comprehensive map of the extant literature and identifies the main themes and future research needs. Methods A quantitative bibliometric analysis was carried out consisting of a performance analysis, science mapping, and a scientific collaboration analysis. Web of Science (WoS) was chosen to extract the dataset; the search was refined by language, i.e. English, and type of publication, i.e. journal academic articles and reviews. No time limitation was selected. Results The dataset is made up of 295 papers ranging from 1994 to May 2019. The analysis highlighted an annual percentage growth rate in the topic of co-production of about 25%. The articles retrieved are split between 1225 authors and 148 sources. This fragmentation was confirmed by the collaboration analysis, which revealed very few long-lasting collaborations. The scientific production is geographically polarised within the EU and Anglo-Saxon countries, with the United Kingdom playing a central role. The intellectual structure consists of three main areas: public administration and management, service management and knowledge translation literature. The co-word analysis confirms the relatively low scientific maturity of co-production applied to health services. It shows few well-developed and central terms, which refer to traditional areas of co-production (e.g. public health, social care), and some emerging themes related to social and health phenomena (e.g. the elderly and chronic diseases), the use of technologies, and the recent patient-centred approach to care (patient involvement/engagement). Conclusions The field is still far from being mature. Empirical practices, especially regarding co-delivery and co-management as well as the evaluation of their real impacts on providers and on patients are lacking and should be more widely investigated.
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Affiliation(s)
- Floriana Fusco
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122, Milan, Italy
| | - Marta Marsilio
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122, Milan, Italy.
| | - Chiara Guglielmetti
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122, Milan, Italy
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Palumbo R, Annarumma C, Manna R, Musella M, Adinolfi P. Improving quality by involving patient. The role of health literacy in influencing patients’ behaviors. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1620458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Rocco Palumbo
- Department of Management & Innovation Systems, University of Salerno, Salerno, Italy
| | - Carmela Annarumma
- Department of Management & Innovation Systems, University of Salerno, Salerno, Italy
| | - Rosalba Manna
- Department of Business and Quantitative Studies, University of Naples ‘Parthenope’, Naples, Italy
| | - Marco Musella
- Department of Management & Innovation Systems, University of Salerno, Salerno, Italy
| | - Paola Adinolfi
- Department of Management & Innovation Systems, University of Salerno, Salerno, Italy
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Baim-Lance A, Tietz D, Lever H, Swart M, Agins B. Everyday and unavoidable coproduction: exploring patient participation in the delivery of healthcare services. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:128-142. [PMID: 30084113 DOI: 10.1111/1467-9566.12801] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The financial and capacity pressures facing healthcare systems call for new strategies to deliver high-quality, efficient services. 'Coproduction' is a concept gaining recognition as an approach to create patient partnerships that enable better functioning healthcare systems. Yet, this framing obscures coproduction's 'everyday and unavoidable' character, already part of healthcare service delivery. This paper aims to understand these everyday and unavoidable dimensions of coproduced healthcare services by drawing upon thematic and process analyses of a 15-month ethnography of 45 patients in three HIV clinics in New York. A 'health practices' approach guided exploring patients' activities, their effects on clinical processes, and the conditions surrounding their performances. By constructing a typology of activity types - Building, Accepting, and Objecting - and tracing patients' descriptions of activity performances, the paper shows how coproduction is forged by making and relying upon clinic-based relationships, and for patients also with a broader human community. These dynamics reveal how patients' bodily and temporal understandings are brought into and shape coproduced services. From these insights, we recommend that healthcare practitioners incorporate into their coproduction analytic methods and perspectives to engage patients as capable and aware individuals, who can support clinic efficiencies while producing new delivery possibilities.
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Affiliation(s)
- Abigail Baim-Lance
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Daniel Tietz
- New York State Department of Health AIDS Institute, New York, NY, USA
| | | | | | - Bruce Agins
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
- University of California, San Francisco Institute for Global Health Sciences, San Francisco, CA, USA
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Nemec M, Kolar T, Rusjan B. Online communities as a new source of exploring patient dissatisfaction. J Health Organ Manag 2018; 32:962-979. [PMID: 30468413 DOI: 10.1108/jhom-03-2018-0104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to analyse whether internet forums are an appropriate source for identification of causes of dissatisfaction of patients with non-medical aspects of healthcare services. DESIGN/METHODOLOGY/APPROACH Based on the guidelines of netnography qualitative research the authors identify relevant posts or comments on selected online forums in which web users show their dissatisfaction with healthcare services. Five popular Slovenian forums representing different interest communities have been chosen and 42 forums' topics have been reviewed. FINDINGS Online communities have an important role in exploring patient dissatisfaction. Through content analysis comments were coded into meaningful categories and subcategories. RESEARCH LIMITATIONS/IMPLICATIONS Some comments were more explicit, while others have provided general and looser reasons for dissatisfaction, and in such cases coding and content analysis of comments was more difficult. PRACTICAL IMPLICATIONS Contents expressed within online communities are helpful in designing improvement activities since they enable determination of concrete relevant measures aiming at eliminating and preventing the established causes of discontent, such as instituting new policies, introducing training programs, determining desired changes in culture. ORIGINALITY/VALUE Usefulness of the netnography as a qualitative method of research is confirmed through confirmation that causes of dissatisfaction of Slovenian patients, which have been identified in the authors research are similar to those identified in previous research in the field of patient satisfaction conducted in Slovenia. Results constitute a new form of researching patient dissatisfaction and expose the specific causes of patient dissatisfaction with healthcare services in Slovenia.
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Affiliation(s)
- Maja Nemec
- Faculty of Economics, University of Ljubljana , Ljubljana, Slovenia
| | - Tomaž Kolar
- Faculty of Economics, University of Ljubljana , Ljubljana, Slovenia
| | - Borut Rusjan
- Faculty of Economics, University of Ljubljana , Ljubljana, Slovenia
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Yang Y, Perkins DR, Stearns AE. Barriers and Facilitators to Treatment Engagement Among Clients in Inpatient Substance Abuse Treatment. QUALITATIVE HEALTH RESEARCH 2018; 28:1474-1485. [PMID: 29683040 DOI: 10.1177/1049732318771005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is a call for drawing on client voice to provide a rich, nuanced understanding of factors influencing substance treatment engagement as to maximizing treatment benefits. We interviewed 60 clients in a short-term inpatient substance treatment program and examined facilitators and barriers to treatment engagement. Thematic analysis yielded four themes, including perceived treatment needs, trust and counselor rapport, peer inspiration, and organizational factors. Perceived treatment needs serve as both a facilitator and a barrier wherein the acknowledgment of needs led to greater treatment engagement whereas a lack of perceived needs hindered treatment engagement. The establishment of trust and counselor rapport and peer inspiration facilitated treatment engagement. Clients rated several organizational factors including a lack of treatment provision, gender-responsive treatment and infrastructure, and ineffective communication with nonclinical staff as barriers to treatment engagement. Clinical implications include enhancing treatment motivation and counselor rapport, establishing gender-responsive treatment programs, and providing trainings for staff.
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Affiliation(s)
- Yang Yang
- 1 University of Louisiana at Lafayette, Lafayette, Louisiana, USA
| | - David R Perkins
- 1 University of Louisiana at Lafayette, Lafayette, Louisiana, USA
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