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Community Health Resources, Globalization, Trust in Science, and Voting as Predictors of COVID-19 Vaccination Rates: A Global Study with Implications for Vaccine Adherence. Vaccines (Basel) 2022; 10:vaccines10081343. [PMID: 36016231 PMCID: PMC9416245 DOI: 10.3390/vaccines10081343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
The COVID-19 global pandemic requires, not only an adequate supply of, but public adherence to safe and effective vaccinations. This study analyzes the human and economic resources and political and public attitudinal factors that influence widely varying country-level coronavirus vaccination rates. Using data on up to 95 countries, we found that countries’ strength of community health training and research (CHTR), education index, globalization, and vaccine supply are associated with a greater COVID-19 vaccination rate. In a separate analysis, certain political factors, and public attitudes (perceived government effectiveness, government fiscal decentralization, trust in science, and parliamentary voter turnout) predicted vaccination rates. Perceived corruption and actual freedoms (political rights and civil liberties) related to vaccination rates in prior studies were not significantly predictive when controlling for the above factors. The results confirm our prior findings on the importance of CHTR resources for increasing COVID-19 vaccination rates. They also suggest that to motivate vaccine adherence countries need, not only an adequate vaccine supply (which depends on a country having either its own resources or effective global political, social, and economic connections) and community health workforce training and research, but also a population that trusts in science, and is actively engaged in the political process.
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Rahman R, Ross A, Pinto R. The critical importance of community health workers as first responders to COVID-19 in USA. Health Promot Int 2021; 36:1498-1507. [PMID: 33569593 PMCID: PMC7928891 DOI: 10.1093/heapro/daab008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
COVID-19 has served to exacerbate existing health disparities and inequities, most—if not all—of which can be traced to the social determinants of health (SDOH) that affect specific populations and communities. Essential to health and health systems long before, community health workers are experts in addressing SDOH in community-based settings; however, they have yet to be mobilized as part of the COVID-19 response both in the US and internationally. We use data from our mixed-methods study with supervisors (n=6), Executive Directors (EDs) (n=7), and CHWs (n=90) to describe the critical role that CHWs can play to assist in response to COVID-19 using New York State's (NYS) as a case example. Building on these findings, we raise specific CHW workforce issues and propose recommendations for how to mobilize this workforce in national pandemic response efforts.
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Affiliation(s)
- Rahbel Rahman
- Graduate School of Social Service, Fordham University, New York, NY 10023, USA
| | - Abigail Ross
- Graduate School of Social Service, Fordham University, New York, NY 10023, USA
| | - Rogério Pinto
- University of Michigan School of Social Work, Ann Arbor, Michigan 48109, USA
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Asante JO, Li MJ, Liao J, Huang YX, Hao YT. The relationship between psychosocial risk factors, burnout and quality of life among primary healthcare workers in rural Guangdong province: a cross-sectional study. BMC Health Serv Res 2019; 19:447. [PMID: 31269949 PMCID: PMC6610857 DOI: 10.1186/s12913-019-4278-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/19/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Healthcare workers are often exposed to stressful working conditions at work which affect their quality of life. The study investigated the relationship between psychosocial risk factors, stress, burnout, and quality of life among primary healthcare workers in general medical practice in Qingyuan and Chaozhou cities in Guangdong province. METHOD The cross-sectional study was conducted in 108 primary health facilities including 36 community health centers (CHCs) across two developing cities in Guangdong province. A total of 873 healthcare workers completed the questionnaires. Quality of life was evaluated using The World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) and psychological risk factors were evaluated by the Copenhagen Psychosocial Questionnaire (COPSOQ). General quality of life and the quality of life domains were transformed into a score range from minimum 0 to 100 maximum. Higher scores indicated better quality of life and vice versa. Significant associations were verified using multiple regression analysis. RESULTS Poor quality of life was observed in 74.6% of healthcare workers surveyed. General poor quality of life was significantly higher among workers who reported higher burnout (Beta = - 0.331, p < 0.001). In addition, workers with high levels of burnout, unmarried workers and female workers had a higher possibility of physical health. A greater risk of poor psychological health was observed among workers with high burnout, poor sense of community and those with lower educational levels. Workers who lacked social support, those with fewer possibilities for development had increased probability of poor quality of life in the social domain. Poor quality of life in the environmental domain was observed among workers who were dissatisfied with their jobs and workers with low salaries. CONCLUSIONS Primary healthcare workers in developing cities in China have a highly demanding and strained working environment and poor quality of life. Reducing job stress and improving work conditions may ultimately improve the well-being of primary healthcare workers.
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Affiliation(s)
- Joseph Obiri Asante
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74# Zhongshan 2nd Road Building 20, Guangzhou, Guangdong People’s Republic of China
| | - Meng Jie Li
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74# Zhongshan 2nd Road Building 20, Guangzhou, Guangdong People’s Republic of China
| | - Jing Liao
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74# Zhongshan 2nd Road Building 20, Guangzhou, Guangdong People’s Republic of China
| | - Yi Xiang Huang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74# Zhongshan 2nd Road Building 20, Guangzhou, Guangdong People’s Republic of China
| | - Yuan Tao Hao
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74# Zhongshan 2nd Road Building 20, Guangzhou, Guangdong People’s Republic of China
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Rahman R, Pinto RM, Zanchetta MS, Wall MM. Delivery of Community-Based Care Through Inter-professional Teams in Brazil's Unified Health System (UHS): Comparing Perceptions Across Community Health Agents (CHAs), Nurses and Physicians. J Community Health 2018; 42:1187-1196. [PMID: 28551862 DOI: 10.1007/s10900-017-0369-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Given the shortage of medical providers and the need for medical decisions to be responsive to community needs, including lay health providers in health teams has been recommended as essential for the successful management of global health care systems. Brazil's Unified Health System (UHS) is a model for delivering community-based care through Family Health Strategy (FHS) interdisciplinary teams comprised of medical and lay health providers-Community Health Agents (CHAs), nurses, and physicians. This study aims to understand how medical and lay health providers' perceptions and attitudes could impact the delivery of community-based care. The study compares perceptions and attitudes of 168 CHAs, 62 nurses, and 32 physicians across their job context, professional capacities, professional skills, and work environment. Descriptive and bivariate analysis were performed. CHAs reported being the most efficacious amongst the providers. Physicians reported incorporating consumer-input to a lesser degree than nurses and CHAs. CHAs reported using a lesser variety of skills than physicians. A significant proportion of physicians compared to CHAs and nurses reported that they had decision-making autonomy. Providers did not report differences that lack of resources and poor work conditions interfered with their ability to meet consumer needs. This study offers technocratic perspectives of medical and lay health providers who as an inter-professional team provide community-based primary health care. Implications of the study include proposing training priorities and identifying strategies to integrate lay health providers into medical teams for Brazil's Unified Health System and other health systems that aim to deliver community-based care through inter-professional health teams.
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Affiliation(s)
- Rahbel Rahman
- Department of Social Work, Binghamton University, Binghamton, NY, USA.
| | | | | | - Melanie M Wall
- Department of Biostatistics, Columbia University, 722 West 168th St., New York, NY, 10032, USA
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Pinto RM, Spector AY, Witte SS, Filippone P, Choi CJ, Wall M. Training in Evidence-Based Practices Increases Likelihood to Integrate Different HIV Prevention Services with Substance-Using Clients. SOCIAL WORK IN PUBLIC HEALTH 2018; 33:202-214. [PMID: 29488860 PMCID: PMC6079518 DOI: 10.1080/19371918.2018.1438326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Providers of social and public health services ("providers") often use HIV prevention strategies with substance-using clients to decrease HIV transmission and infection. This article examines factors that facilitate providers' use of select HIV-prevention strategies. Sample comprises 379 providers from 36 agencies in New York City. OUTCOMES sexual risk assessments; risk reduction counseling; condom demonstration; and referrals to HIV testing. PREDICTORS training; job satisfaction; staff collaboration. The authors used multilevel logistic regression and linear multilevel models. HIV prevention training was associated with increased performance of each outcome. The odds of conducting several outcomes were higher for providers trained in evidence-based interventions. Staff collaboration and job satisfaction were associated with provision of multiple outcomes. This study shows training and collaboration/satisfaction as significantly influencing providers to use prevention strategies. Providers ought to be trained in multiple modalities, and agencies ought to prioritize collaborative environments that promote job satisfaction.
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Affiliation(s)
- Rogério M Pinto
- a School of Social Work , University of Michigan-Ann Arbor , Ann Arbor , Michigan , USA
| | - Anya Y Spector
- b Stella and Charles Guttman Community College , New York , NY , USA
| | - Susan S Witte
- c School of Social Work , Columbia University , New York , NY , USA
| | - Prema Filippone
- c School of Social Work , Columbia University , New York , NY , USA
| | - C Jean Choi
- d Division of Biostatistics , New York State Psychiatric Institute , New York , NY , USA
- e Department of Psychiatry, Division of Biostatistics , Columbia University , New York , NY , USA
| | - Melanie Wall
- d Division of Biostatistics , New York State Psychiatric Institute , New York , NY , USA
- e Department of Psychiatry, Division of Biostatistics , Columbia University , New York , NY , USA
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Parry C, Carney T, Petersen Williams P. Reducing substance use and risky sexual behaviour among drug users in Durban, South Africa: Assessing the impact of community-level risk-reduction interventions. SAHARA J 2017; 14:110-117. [PMID: 28969490 PMCID: PMC5639608 DOI: 10.1080/17290376.2017.1381640] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Alcohol and other drug (AOD) use is increasingly recognised as having a direct and indirect effect on the transmission of human immunodeficiency virus (HIV). However, there is evidence to suggest that drug- and sex-related HIV risk-reduction interventions targeted at drug users within drug treatment centres or via community outreach efforts can lead to positive health outcomes. This study aimed to test whether a community-level intervention aimed at AOD users has an impact on risky AOD use and sexual risk behaviour. In 2007, in collaboration with a local non-governmental organisation (NGO) in Durban, an initiative was begun to implement a number of harm reduction strategies for injection and non-injection drug users. The NGO recruited peer outreach workers who received intensive initial training, which was followed by six-monthly monitoring and evaluation of their performance. Participants had to be 16 years of age or older, and self-reported alcohol and/or drug users. Peer outreach workers completed a face-to-face baseline questionnaire with participants which recorded risk behaviours and a risk-reduction plan was developed with participants which consisted of reducing injection (if applicable) and non-injection drug use and sex-related risks. Other components of the intervention included distribution of condoms, risk-reduction counselling, expanded access to HIV Testing Services, HIV/sexually transmitted infection care and treatment, and referrals to substance abuse treatment and social services. At follow-up, the baseline questionnaire was completed again and participants were also asked the frequency of reducing identified risk behaviours. Baseline information was collected from 138 drug users recruited into the study through community-based outreach, and who were subsequently followed up between 2010 and 2012. No injection drug users were reached. The data presented here are for first contact (baseline) and the final follow-up contact with the participants. There were no decreases in drug use practices such as use of cannabis, heroin, cocaine and Ecstasy after the intervention with drug users; however, there was a significant reduction in alcohol use following the intervention. While there was a substantial increase in the proportion of participants using drugs daily as opposed to more often, the reduction in the frequency of drug use was not statistically significant. Following the intervention, drug users had significantly fewer sexual partners, but there were no significant differences following the intervention with regard to frequency of sex or use of condoms. Substance use in general and during sex was, however, decreased. While the findings were mixed, the study shows that it is possible to provide HIV risk-reduction services to a population of substance users who are less likely to receive services through community outreach, and provide risk-reduction information, condoms and condom demonstration and other services. More intensive interventions might be needed to have a substantial impact on substance use and substance use-related HIV risk behaviours.
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Affiliation(s)
- C.D.H. Parry
- PhD Psychology, is the Director of the Alcohol, Tobacco and Other Drug Research Unit at the South African Medical Research Council, Cape Town, South Africa
- Extraordinary Professor at the Department of Psychiatry, University of Stellenbosch, Tygerberg, South Africa
| | - T. Carney
- PhD Psychiatry & Mental Health, is a Senior Scientist at the Alcohol, Tobacco and Other Drug Research Unit, at the South African Medical Research Council, Cape Town, South Africa
- Honorary Lecturer at the Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - P. Petersen Williams
- PhD Public Health & Family Medicine, is a Senior Scientist at the Alcohol, Tobacco and Other Drug Research Unit, at the South African Medical Research Council, Cape Town, South Africa
- Honorary Research Associate at the Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Grossman-Kahn R, Schoen J, Mallett JW, Brentani A, Kaselitz E, Heisler M. Challenges facing community health workers in Brazil's Family Health Strategy: A qualitative study. Int J Health Plann Manage 2017; 33:309-320. [PMID: 28940668 DOI: 10.1002/hpm.2456] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 08/16/2017] [Indexed: 11/12/2022] Open
Abstract
Community health worker (CHW) programs are implemented in many low- and middle-income countries such as Brazil to increase access to and quality of care for underserved populations; CHW programs have been found to improve certain indicators of health, but few studies have investigated the daily work of CHWs, their perspectives on what both helps and hinders them from fulfilling their roles, and ways that their effectiveness and job satisfaction could be increased. To examine these questions, we observed clinic visits, CHW home visits, and conducted semistructured interviews with CHWs in 7 primary care centers in Brazil-2 in Salvador, Bahia, and 5 in São Paulo, SP-in which CHWs are incorporated into the work of all primary care health teams. In addition to enhancing communication between the medical system and the community, CHWs consider their key roles to be helping persuade community members to seek medical care and increasing health professionals' awareness of the social conditions affecting their patients' health. Key obstacles that CHWs face include failure to be fully integrated into the primary care team, inability to follow-up on identified health needs due to limited resources, as well as community members' lack of understanding of their work and undervaluing of preventative medicine. Increased training, better incorporation of CHWs into clinic flow and decision making, and establishing a clear community awareness of the roles and value of CHWs will help increase the motivation and effectiveness of CHWs in Brazil.
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Affiliation(s)
| | - Julia Schoen
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Alexandra Brentani
- Department of Pediatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Elizabeth Kaselitz
- University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, Ann Arbor Veterans' Affairs (VA) Healthcare System, Ann Arbor, Michigan, USA
| | - Michele Heisler
- Center for Clinical Management Research, Ann Arbor Veterans' Affairs (VA) Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Santos CGD, Sabidó M, Leturiondo AL, Ferreira CDO, da Cruz TP, Benzaken AS. Development, validation and testing costs of an in-house real-time PCR assay for the detection of Chlamydia trachomatis. J Med Microbiol 2017; 66:312-317. [PMID: 28141509 DOI: 10.1099/jmm.0.000443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To improve the screening of Chlamydia trachomatis(C. trachomatis) in Brazil, an accurate and affordable method is needed. The objective of this study was to develop and assess the performance and costs of a new in-house real-time PCR (qPCR) assay for the diagnosis of C. trachomatis infection. METHODOLOGY Asymptomatic women aged 14-25 years who attended primary health services in Manaus, Brazil, were screened for C. trachomatis using the Digene Hybrid Capture II CT-ID (HCII CT-ID) DNA test. A subset of cervical specimens were tested using an in-house qPCR and a commercial qPCR, ArtusC. trachomatis Plus RG PCR 96 CE (Artus qPCR) kit, as a reference test. A primer/probe based on the sequence of cryptic plasmid (CP) was designed. An economic evaluation was conducted from the provider's perspective. RESULTS The primers were considered specific for C. trachomatis because they did not amplify any product from non-sexually transmitted bacterial species tested. Overall, 292 specimens were tested by both the commercial kit (Artus qPCR) and the in-house qPCR. Of those, one resulted in no amplification and was excluded from the analysis. The sensitivity, specificity, and positive and negative predictive values of the in-house qPCR were 99.5 % [95 % confidence interval (CI): 97.1-100], 95.1 % (95 % CI: 89-98.4), 97.4 % (95 % CI: 94-99.1) and 99.0 % (95 % CI: 94.5-100), respectively. The cost per case of C. trachomatis was £0.44 ($0.55) for HCII CT-ID, £1.16 ($1.45) for Artus qPCR and £1.06 ($1.33) for in-house qPCR. CONCLUSION We have standardized an in-house qPCR to detect cervical C. trachomatis targeting CP. The in-house qPCR showed excellent accuracy and was more affordable than the commercial qPCR kit.
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Affiliation(s)
- Camila Gurgel Dos Santos
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil.,Fundação Alfredo da Matta, Manaus, Amazonas, Brazil
| | - Meritxell Sabidó
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil.,TransLab, Departament of Medical Sciences, Universitat de Girona, Catalunya, Spain.,CIBER de Epidemiologia y Salud Pública, CIBERESP, Spain
| | | | | | | | - Adele Schwartz Benzaken
- Fundação Alfredo da Matta, Manaus, Amazonas, Brazil.,Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil.,Departamento de IST, Aids e Hepatites Virais, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
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Rahman R, Pinto RM, Wall MM. HIV Education and Welfare Services in Primary Care: An Empirical Model of Integration in Brazil's Unified Health System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030294. [PMID: 28335444 PMCID: PMC5369130 DOI: 10.3390/ijerph14030294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022]
Abstract
Integration of health education and welfare services in primary care systems is a key strategy to solve the multiple determinants of chronic diseases, such as Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS). However, there is a scarcity of conceptual models from which to build integration strategies. We provide a model based on cross-sectional data from 168 Community Health Agents, 62 nurses, and 32 physicians in two municipalities in Brazil’s Unified Health System (UHS). The outcome, service integration, comprised HIV education, community activities (e.g., health walks and workshops), and documentation services (e.g., obtainment of working papers and birth certificates). Predictors included individual factors (provider confidence, knowledge/skills, perseverance, efficacy); job characteristics (interprofessional collaboration, work-autonomy, decision-making autonomy, skill variety); and organizational factors (work conditions and work resources). Structural equation modeling was used to identify factors associated with service integration. Knowledge and skills, skill variety, confidence, and perseverance predicted greater integration of HIV education alongside community activities and documentation services. Job characteristics and organizational factors did not predict integration. Our study offers an explanatory model that can be adapted to examine other variables that may influence integration of different services in global primary healthcare systems. Findings suggest that practitioner trainings to improve integration should focus on cognitive constructs—confidence, perseverance, knowledge, and skills.
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Affiliation(s)
- Rahbel Rahman
- Department of Social Work, Community of College and Public Affairs, Binghamton University, 67 Washington St, Binghamton, NY 13902, USA.
| | - Rogério M Pinto
- School of Social Work, University of Michigan, 1080 S University Ave, Ann Arbor, MI 48109, USA.
| | - Melanie M Wall
- Department of Biostatistics, Columbia University, 722 West 168th St. New York, NY 10032, USA.
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Ghesquiere AR, Pinto RM, Rahman R, Spector AY. Factors Associated with Providers' Perceptions of Mental Health Care in Santa Luzia's Family Health Strategy, Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010033. [PMID: 26703644 PMCID: PMC4730424 DOI: 10.3390/ijerph13010033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/02/2015] [Accepted: 11/05/2015] [Indexed: 11/17/2022]
Abstract
Brazil has a unique mental health care system, characterized by universal coverage delivered by interdisciplinary teams both in the community and in specialized centros de atenção psicossocial (CAPS-psychosocial care centers). Provision of patient-centered mental health care is an important principle of Brazilian mental health care, but this topic has not been well-studied. We analyzed data from a cross-sectional survey of 151 community health workers (CHWs), nurses, and physicians in Santa Luzia, Minas Gerais State, Brazil. Chi-squares, t-tests and multivariate regression analyses examined differences in socio-demographics, caseload, engagement in evidence-based practices (EBPs), and transdisciplinary collaboration between providers who reported providing high levels of patient-centered mental health care and those who did not. In multivariate regression models, components of transdisciplinary collaboration were significantly associated with providers' perceptions of patient-centered mental health care (p < 0.05). CHWs were also significantly more likely to report providing patient-centered care than physicians and nurses. EBP engagement and sociodemographics were not associated with perceptions. Results suggest that training efforts to improve patient-centered mental health care in Brazil could build upon CHWs' skills and focus on transdisciplinary collaboration. Findings may inform practice in other countries with similar health care systems.
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Affiliation(s)
- Angela R Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, 2180 Third Ave, New York, NY 10035, USA.
| | - Rogerio M Pinto
- School of Social Work, University of Michigan, Room 3792 SSWB, 1080 S. University Ave., Ann Arbor, MI 48109, USA.
| | - Rahbel Rahman
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA.
| | - Anya Y Spector
- New York City Department of Health and Mental Hygiene, 42-09 28th St, Long Island City, NY 11101, USA.
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Martins AMEDBL, Haikal DS, Souza JGS, Sá MABD, Ferreira EFE, Pordeus IA. Access to information on how to avoid oral health problems among elderly persons registered with the Family Health Strategy. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2015. [DOI: 10.1590/1809-9823.2015.14186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives : To identify the level of access to information regarding how to prevent oral health problems among the elderly, and verify if such levels were higher among members of households registered with the Family Health Strategy Program. Methods : An analytic cross-sectional study was conducted of a probabilistic complex sample of elderly (65-74 years old) members of the population of a large city. The level of access was estimated with adjustment for the design effect, as well as the magnitudes of association. Descriptive, bivariate and logistic regression (OR/CI95%) analysis was performed. Variables related to personal determinants, health services, health-related behavior and health outcomes were considered. Results : Of the 490 participants, 53.4% reported they had access to information about how to prevent oral health problems. This access was higher among elderly persons living in a household registered with the Family Health Strategy Program (2.04/1.14-3.67), and who had at least five years of schooling (2.53/1.67-3.83), regularly used dental services (1.84/1.07-3.17), did not smoke either now or in the past (1.79/1.13-2.82), did not suffer from chronic diseases (2.14/1.34-3.42) and had not suffered social impacts because of their oral health conditions (1.77/1.08-2.91). Conclusion : Most of the elderly persons had access to information about how to prevent oral health problems, with such access being greater among those registered with the Family Health Strategy Program.
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Puett C, Alderman H, Sadler K, Coates J. 'Sometimes they fail to keep their faith in us': community health worker perceptions of structural barriers to quality of care and community utilisation of services in Bangladesh. MATERNAL & CHILD NUTRITION 2015; 11:1011-22. [PMID: 23941290 PMCID: PMC6860328 DOI: 10.1111/mcn.12072] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Community health workers (CHWs) have strong potential to extend health and nutrition services to underserved populations. However, CHWs face complex challenges when working within weak health systems and among communities with limited abilities to access and utilise CHW services. It is crucial to understand these challenges to improve programme support mechanisms. This study describes the results of qualitative investigations into CHW perceptions of barriers to quality of care among two groups of workers implementing community case management of acute respiratory infection, diarrhoea and severe acute malnutrition in southern Bangladesh. We explored systemic barriers to service delivery, pertaining to communities and health systems, which limited the usefulness and effectiveness of CHW services. Focus group discussions (n = 10) were conducted in March 2010. Discussions were analysed for themes related to CHWs' work challenges. Findings highlight several perceived barriers to effective service provision, including community poverty constraining uptake of recommended practices, irregular supplies of medicine from the health facility and poor quality of care for CHW referrals sent there. This study further documents interactions between demand-side and supply-side constraints including the influence of health system resource constraints on community trust in CHW services, and the influence of community resource constraints on the utilisation and effectiveness of CHW services. By documenting service delivery challenges from the perspective of the frontline workers themselves, this article contributes evidence to help identify appropriate support mechanisms for these workers, in order to develop scalable and sustainable CHW programmes in countries with under-resourced public health care infrastructure.
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Affiliation(s)
- Chloe Puett
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - Harold Alderman
- International Food Policy Research Institute (IFPRI)Washington, DCUSA
| | - Kate Sadler
- Feinstein International CenterTufts UniversityMedfordMassachusettsUSA
| | - Jennifer Coates
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
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14
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Martins AMEDBL, Barreto SM, dos Santos-Neto PE, de Sá MAB, Souza JGS, Haikal DS, Ferreira e Ferreira E, Pordeus IA. Greater access to information on how to prevent oral cancer among elderly using primary health care. CIENCIA & SAUDE COLETIVA 2015; 20:2239-53. [PMID: 26132263 DOI: 10.1590/1413-81232015207.15272014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 11/15/2014] [Indexed: 11/22/2022] Open
Abstract
Educative actions are an important component of health promotion in Brazil's primary healthcare program, the Family Health Strategy (FHS). The efficacy of these actions is evidenced by compliance with healthy behaviors and in the reduction of rates of mortality and morbidity. The objective of this study was to identify whether access to information regarding the prevention of oral cancer is greater among elders whose residences are registered with the FHS. SPSS® was utilized to obtain estimates that were corrected for sample design, considering the magnitude of the associations between access to such information with personal determinants, the use and cost of healthcare, health-related behaviors and health outcomes. 58.9% of the 492 participating elders reported having access to such information. We verified that there was a greater chance for access among residents of houses registered by the FHS; those with greater per capita income (2.01/1.183.43); non-smokers (2.00/1.16-3.46); those that realized oral self-examination (6.35/3.46-11.64); and those that did not perceive discomfort in the mouth, head or neck (2.06/1.02-4.17). Access was greater among residents of homes registered by the FHS. Personal determinants of health, health-related behaviors and health outcomes are influenced or influence access to information regarding the prevention and management of oral diseases.
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Affiliation(s)
| | - Sandhi Maria Barreto
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil
| | - Pedro Eleutério dos Santos-Neto
- Departamento de Odontologia, Centro de Ciências Básicas e da Saúde, Universidade Estadual de Montes Claros, Montes Claros, MG, Brasil,
| | - Maria Aparecida Barbosa de Sá
- Departamento de Odontologia, Centro de Ciências Básicas e da Saúde, Universidade Estadual de Montes Claros, Montes Claros, MG, Brasil,
| | | | - Desireé Sant'Ana Haikal
- Departamento de Odontologia, Centro de Ciências Básicas e da Saúde, Universidade Estadual de Montes Claros, Montes Claros, MG, Brasil,
| | - Efigenia Ferreira e Ferreira
- Departamento de Odontopediatria e Ortodontia, Faculdade de Odontologia, Universidade Federal de Minas Gerais, Brasil
| | - Isabela Almeida Pordeus
- Departamento de Odontopediatria e Ortodontia, Faculdade de Odontologia, Universidade Federal de Minas Gerais, Brasil
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Correa AAF, Pignatari ACC, da Silveira M, Mingone RCC, de Sales Oliveira VG, Fortaleza CMCB. Small hospitals matter: insights from the emergence and spread of vancomycin-resistant enterococci in 2 public hospitals in inner Brazil. Diagn Microbiol Infect Dis 2015; 82:227-33. [DOI: 10.1016/j.diagmicrobio.2015.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 03/12/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
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Melo DG, de Paula PK, de Araujo Rodrigues S, da Silva de Avó LR, Germano CMR, Demarzo MMP. Genetics in primary health care and the National Policy on Comprehensive Care for People with Rare Diseases in Brazil: opportunities and challenges for professional education. J Community Genet 2015; 6:231-40. [PMID: 25893505 PMCID: PMC4524835 DOI: 10.1007/s12687-015-0224-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/25/2015] [Indexed: 01/21/2023] Open
Abstract
As discoveries regarding the genetic contribution to disease have grown rapidly, health care professionals are expected to incorporate genetic and genomic perspectives into health education and practice. Genetic competencies common to all health professionals have been identified by the US National Coalition for Health Professional Education in Genetics (NCHPEG), which defined the knowledge, skills, and attitudes required to achieve these competencies. The aim of this study is to analyze genetic competencies of primary health care professionals in Brazil. It is a descriptive survey study, whereby doctors, nurses, and dentists were invited to participate by answering a questionnaire including 11 issues based on competencies established by the NCHPEG. Data were presented as percentages. Differences between groups of participants were assessed by the Fisher exact test, with the level of significance set at p < 0.05. Results showed that concerning knowledge, about 80 % of the participants recognized basic genetics terminology, but practitioners had difficulty in identifying patterns of inheritance. Regarding clinical skills, practitioners were able to recognize facial dysmorphias and identify situations where referral of patients to specialists was necessary. Nevertheless, there were challenges in the process of valuing and gathering information about family history. Regarding attitudes, 68.9 % of the participants thought about the comprehensiveness of care but faced challenges in counselling parents. The results of this study may contribute to developing an ongoing education program for primary health care professionals, leading to a strategy to overcome the challenges of including genetics in the Brazilian Unified Health System.
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Affiliation(s)
- Débora Gusmão Melo
- Department of Medicine, Federal University of São Carlos, Rod. Washington Luís (SP-310), Km 235, Campus da UFSCar, 13565-905, São Paulo, Brazil,
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Factors Associated with Low Levels of HIV Testing among Men Who Have Sex with Men (MSM) in Brazil. PLoS One 2015; 10:e0130445. [PMID: 26098559 PMCID: PMC4476690 DOI: 10.1371/journal.pone.0130445] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/20/2015] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to assess risk factors associated with low levels of HIV testing among MSM recruited through respondent driven sampling (RDS) in Brazil. Of 3,617 participants, 48.4% had never tested previously for HIV. A logistic model indicated that younger age, lower socioeconomic class, education, poor HIV/AIDS knowledge, no history of cruising, and having been tested during the study were characteristics independently associated with low levels of previous HIV testing. The HIV testing rate among MSM in Brazil is still low in spite of the availability of a large number services providing universal and free access to HIV/AIDS diagnosis and treatment. To respond to low utilization, the authors propose a higher priority for testing for key populations such as MSM, expanded education, expanding testing sites and a welcoming and nonjudgmental environment in health services.
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Spector AY, Pinto RM, Rahman R, da Fonseca A. Implementation of Brazil's "family health strategy": factors associated with community health workers', nurses', and physicians' delivery of drug use services. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 26:509-15. [PMID: 25599595 DOI: 10.1016/j.drugpo.2014.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 11/28/2014] [Accepted: 12/07/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Brazil's "family health strategy" (ESF), provides primary care, mostly to individuals in impoverished communities through teams of physicians, nurses, and community health workers (CHWs). ESF workers are called upon to offer drug use services (e.g., referrals, counseling) as drug use represents an urgent public health crisis. New federal initiatives are being implemented to build capacity in this workforce to deliver drug use services, yet little is known about whether ESF workers are providing drug use services already. Guided by social cognitive theory, this study examines factors associated with ESF workers' provision of drug use services. METHODS Cross-sectional surveys were collected from 262 ESF workers (168 CHWs, 62 nurses, and 32 physicians) in Mesquita, Rio de Janeiro State and Santa Luzia, Minas Gerais State. OUTCOME VARIABLE provision of drug-use services. PREDICTORS capacity to engage in evidence-based practice (EBP), resource constraints, peer support, knowledge of EBP, and job title. Logistic regression was used to determine relative influence of each predictor upon the outcome. RESULTS Thirty-nine percent reported providing drug use services. Younger workers, CHWs, workers with knowledge about EBP and workers that report peer support were more likely to offer drug use services. Workers that reported resource constraints and more capacity to implement EBP were less likely to offer drug use services. CONCLUSION ESF workers require education in locating, assessing and evaluating the latest research. Mentorship from physicians and peer support through team meetings may enhance workers' delivery of drug use services, across professional disciplines. Educational initiatives aimed at ESF teams should consider these factors as potentially enhancing implementation of drug use services. Building ESF workers' capacity to collaborate across disciplines and to gain access to tools for providing assessment and treatment of drug use issues may improve uptake of new initiatives.
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Affiliation(s)
- Anya Y Spector
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 722 West 168th Street, Room 307, New York, NY 10032, United States.
| | - Rogério M Pinto
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, United States
| | - Rahbel Rahman
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, United States
| | - Aline da Fonseca
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, United States
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Kawasaki R, Sadamori T, Ferreira de Almeida T, Akiyoshi M, Nishihara M, Yoshimura T, Ohnishi M. Reactions of community members regarding community health workers' activities as a measure of the impact of a training program in Amazonas, Brazil. J Rural Med 2014; 10:7-19. [PMID: 26380586 PMCID: PMC4571745 DOI: 10.2185/jrm.2890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022] Open
Abstract
Objectives: The aim of this study was to evaluate the impact of community
health worker (CHW) training on recognition and satisfaction regarding the performance of
CHWs among members of the community in Amazonas, Brazil, which is a resource-poor area
underserved with regard to medical health-care accessibility. Methods: Baseline and endline surveys concerning recognition and
satisfaction with respect to CHW performance among members of the community were conducted
by interview using a questionnaire before and after implementation of a program to
strengthen community health projects in Manicoré, Amazonas, Brazil. One of the components
of the project was CHW refresher training, which focused on facilitating adequate use of
health-care services and providing primary health care, including health guidance. The
baseline survey was performed in February 2004 at the beginning of the project, and the
endline survey was performed in February 2006 at the end of the project. There were 82 and
120 CHWs working in Manicoré at the times of the baseline and endline surveys,
respectively. Statistical analysis was performed to determine the significance of changes
in experience with CHW activities, expected functions of CHWs, and satisfaction regarding
the performance of CHWs between the baseline and endline surveys. In addition, qualitative
analysis was conducted to evaluate the acceptability, feasibility, and sustainability of
CHW refresher training. Results: Overall recognition and level of satisfaction regarding CHW
performance among members of the community were improved from the baseline to the endline
survey, regardless of type of residential area, such as town and/or remote area. Members
of the community came to not expect CHWs to “provide strong medicine” (P
< 0.001) and “provide injections” (P < 0.001), and came to
appreciate “go to hospital with a sick person” (P = 0.031) as a function
and role of CHWs. Conclusions: The results of the present study indicated that steady
approaches to motivate and support CHWs in resource-limited settings could improve
performance of CHWs and satisfaction of people in the community regarding the activities
of CHWs to sustain their health.
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Affiliation(s)
- Ryoko Kawasaki
- Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | | | | | - Megumi Akiyoshi
- The Hirayama Ikuo Volunteer Center, Waseda University, Japan
| | - Mika Nishihara
- Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Toshiro Yoshimura
- Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Mayumi Ohnishi
- Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Pinto RM, Spector AY, Witte SS, Gilbert L. Systematizing planning and formative phases of HIV prevention research: Case studies from Brazil, Mongolia, and Kazakhstan. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2014; 1:137-144. [PMID: 25489495 PMCID: PMC4257476 DOI: 10.1007/s40609-014-0020-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES International Community Based Participatory Research (CBPR) is vulnerable to contextual, political, and interpersonal issues that may hamper researchers' abilities to develop and sustain partnerships with local communities. This paper responds to a call for systematizing CBPR practices and to the urgent need for frameworks with potential to facilitate partnership-building between researchers and communities in both "developed" and "developing" countries. METHODS Using three brief case examples, each from a different context, with different partners and varied research questions, we demonstrate how to apply the International Participatory Research Framework (IPRF). RESULTS IPRF consists of triangulated procedures (steps and actions) that can facilitate known participatory outcomes: 1) community-defined research goals, 2) capacity for further research, and 3) policies and programs grounded in research. CONCLUSIONS We show how the application of this model is particularly helpful in the planning and formative phases of CBPR. Other partnerships can use this framework in its entirety or aspects thereof, in different contexts. Further evaluation of how this framework can help other international partnerships, studying myriad diseases and conditions, should be a focus of future international CBPR.
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Affiliation(s)
- Rogério M Pinto
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027
| | - Anya Y Spector
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, 722 West 168 Street room 307, New York, NY 10032
| | - Susan S Witte
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027
| | - Louisa Gilbert
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027
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21
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Teles MAB, Barbosa MR, Vargas AMD, Gomes VE, Ferreira EFE, Martins AMEDBL, Ferreira RC. Psychosocial work conditions and quality of life among primary health care employees: a cross sectional study. Health Qual Life Outcomes 2014; 12:72. [PMID: 24884707 PMCID: PMC4122097 DOI: 10.1186/1477-7525-12-72] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/07/2014] [Indexed: 12/02/2022] Open
Abstract
Background Workers in Primary Health Care are often exposed to stressful conditions
at work. This study investigated the association between adverse
psychosocial work conditions and poor quality of life among Primary
Health Care workers. Methods This cross-sectional study included all 797 Primary Health Care workers
of a medium-sized city, Brazil: doctors, nurses, nursing technicians and
nursing assistants, dentists, oral health technicians, and auxiliary
oral hygienists, and community health workers. Data were collected by
interviews. Quality of life was assessed using the WHOQOL-BREF; general
quality of life, as well as the physical, psychological, social and
environmental domains were considered, with scores from 0 to 100. Higher
scores indicate a better quality of life. Poor quality of life was
defined by the lowest quartiles of the WHOQOL score distributions for
each of the domains. Adverse psychosocial work conditions were
investigated by the Effort-Reward Imbalance model. Associations
were verified using multiple logistic regression. Results Poor quality of life was observed in 117 (15.4%) workers. Workers with
imbalanced effort-reward (high effort/low reward) had an increased
probability of general poor quality of life (OR = 1.91;
1.07–3.42), and in the physical (OR = 1.62;
1.02–2.66), and environmental (OR = 2.39;
1.37–4.16) domains; those with low effort/low reward demonstrated
a greater probability of poor quality of life in the social domain
(OR = 1.82; 1.00–3.30). Workers with overcommitment at
work had an increased likelihood of poor quality of life in the physical
(OR = 1.55, 1.06–2.26) and environmental
(OR = 1.69; 1.08–2.65) domains. These associations
were independent of individual characteristics, job characteristics,
lifestyle, perception of general health, or psychological and biological
functions. Conclusions There is an association between adverse psychosocial work conditions and
poor quality of life among Primary Health Care workers.
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Affiliation(s)
| | | | | | | | | | | | - Raquel Conceição Ferreira
- Federal University of Minas Gerais, 6627 Antônio Carlos Avenue, Pampulha, Belo Horizonte, MG, Brazil.
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Brazilian community health agents and qualitative primary healthcare information. Prim Health Care Res Dev 2014; 16:235-45. [DOI: 10.1017/s146342361400019x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AimThe aim of this study was to explore female community health agents’ views about the value of recording qualitative information on contextual health issues they observe during home visits, data that are not officially required to be documented for the Brazilian System of Primary Healthcare Information.BackgroundThe study was conducted in community primary healthcare centres located in the cities of Araçatuba and Coroados (state of São Paulo) and Rio de Janeiro (state of Rio de Janeiro), Brazil.MethodsThe design was a qualitative, exploratory study. The purposeful sampling criteria were being female, with a minimum of three years of continuous service in the same location. Data collection with 62 participants was conducted via 11 focus groups (in 2007 and 2008). Audio files were transcribed and submitted to the method of thematic analysis. Four themes guided the analysis: working with qualitative information and undocumented observation; reflecting on qualitative information; integrating/analysing quantitative and qualitative information; and information-sharing with agents and family health teams. In 2010, 25 community health agents verified the final interpretation of the findings.FindingsParticipants valued the recording of qualitative, contextual information to expand understanding of primary healthcare issues and as an indicator of clients’ improved health behaviour and health literacy. While participants initiated the recording of additional health information, they generally did not inform the family health team about these findings. They perceived that team members devalued this type of information by considering it a reflection of the clientele’s social conditions or problems beyond the scope of medical concerns. Documentation of qualitative evidence can account for the effectiveness of health education in two ways: by improving preventative care, and by amplifying the voices of underprivileged clients who live in poverty to ensure the most appropriate and best quality primary healthcare for them.
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Vasan A, Anatole M, Mezzacappa C, Hedt-Gauthier BL, Hirschhorn LR, Nkikabahizi F, Hagenimana M, Ndayisaba A, Cyamatare FR, Nzeyimana B, Drobac P, Gupta N. Baseline assessment of adult and adolescent primary care delivery in Rwanda: an opportunity for quality improvement. BMC Health Serv Res 2013; 13:518. [PMID: 24344805 PMCID: PMC3878570 DOI: 10.1186/1472-6963-13-518] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 12/04/2013] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND As resource-limited health systems evolve to address complex diseases, attention must be returned to basic primary care delivery. Limited data exists detailing the quality of general adult and adolescent primary care delivered at front-line facilities in these regions. Here we describe the baseline quality of care for adults and adolescents in rural Rwanda. METHODS Patients aged 13 and older presenting to eight rural health center outpatient departments in one district in southeastern Rwanda between February and March 2011 were included. Routine nurse-delivered care was observed by clinical mentors trained in the WHO Integrated Management of Adolescent & Adult Illness (IMAI) protocol using standardized checklists, and compared to decisions made by the clinical mentor as the gold standard. RESULTS Four hundred and seventy consultations were observed. Of these, only 1.5% were screened and triaged for emergency conditions. Fewer than 10% of patients were routinely screened for chronic conditions including HIV, tuberculosis, anemia or malnutrition. Nurses correctly diagnosed 50.1% of patient complaints (95% CI: 45.7%-54.5%) and determined the correct treatment 44.9% of the time (95% CI: 40.6%-49.3%). Correct diagnosis and treatment varied significantly across health centers (p = 0.03 and p = 0.04, respectively). CONCLUSION Fundamental gaps exist in adult and adolescent primary care delivery in Rwanda, including triage, screening, diagnosis, and treatment, with significant variability across conditions and facilities. Research and innovation toward improving and standardizing primary care delivery in sub-Saharan Africa is required. IMAI, supported by routine mentorship, is one potentially important approach to establishing the standards necessary for high-quality care.
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Affiliation(s)
- Ashwin Vasan
- Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda and Boston, USA
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Department of Medicine, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, USA
| | - Manzi Anatole
- Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda and Boston, USA
- University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda
| | - Catherine Mezzacappa
- Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda and Boston, USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, USA
| | - Bethany L Hedt-Gauthier
- Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda and Boston, USA
- University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, USA
| | - Lisa R Hirschhorn
- Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda and Boston, USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | | | | | | | - Felix R Cyamatare
- Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda and Boston, USA
| | | | - Peter Drobac
- Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda and Boston, USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Neil Gupta
- Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda and Boston, USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, USA
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Akhtar-Danesh N, Valaitis R, O'Mara L, Austin P, Munroe V. Viewpoints about collaboration between primary care and public health in Canada. BMC Health Serv Res 2013; 13:311. [PMID: 23945461 PMCID: PMC3765372 DOI: 10.1186/1472-6963-13-311] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 08/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there is a global movement toward health system integration and collaboration, little is known about values, beliefs, and attitudes towards collaboration between stakeholders in public health (i.e. promotion, protection, and prevention with vulnerable groups and/or at the population level) and primary care (i.e., family practices, nurse-led clinics). The purpose of this study was to explore viewpoints of key stakeholders regarding primary care (PC) and public health (PH) collaboration in Canada. METHODS We used Q-methodology to identify common viewpoints held by participants who attended a national meeting in Canada in 2010 to discuss PC and PH collaboration. The study was conducted in two phases. In Phase 1 a Q-sample, a Q-sort table, and a short demographic questionnaire were developed which were used in Phase 2 for data collection. The Q-sorts then were analysed to identify the salient factors and consensus statements. RESULTS In total, 25 multidisciplinary individuals including researchers, policy-makers, directors, managers, and practitioners (e.g., nurses, family physicians, dietitians) participated. Using a by-person factor analysis, three factors (salient viewpoints) emerged. Factors were named based on their distinguishing statements as follows: a) System Driven Collaborators, b) Cautious Collaborators, and c) Competent Isolationists. System Driven Collaborators strongly believed that a clear mandate from the top is needed to enable PH, PC and the rest of the health system to effectively work together and that people in different branches in the Ministry/ Ministries have to strongly believe in collaboration, actively support it, and develop directed policies to foster organizations work together. Cautious Collaborators strongly supported the idea of having better consciousness-raising about what collaborations might be possible and beneficial, and also reflecting on the collaborations already in place. The Competent Isolationists strongly believed that it is necessary for PC and PH sectors to spend time to ensure that both parties clearly understand the differences between their roles. They believe that physicians, nurses, and social workers will not see the value in collaboration because they lack inter-professional educational programs. CONCLUSIONS Different viewpoints are held by stakeholders around PC and PH collaboration which have the potential to influence the success of collaborations. Understanding and managing these differences is important to assist change management processes required to build and maintain strong PC and PH collaborations.
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Pinto RM, Spector AY, Yu G, Campbell ANC. Transdisciplinary collaboration and endorsement of pharmacological and psychosocial evidence-based practices by medical and psychosocial substance abuse treatment providers in the United States. DRUGS-EDUCATION PREVENTION AND POLICY 2013; 20:408-416. [PMID: 26778896 DOI: 10.3109/09687637.2013.783792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To examine the relative contribution of providers' professional affiliation (medical vs. non-medical), involvement in research, and training needs for associations with endorsement of the following evidence-based practices (EBPs): (1) pharmacological - buprenorphine treatment and (2) psychosocial - Cognitive Behavioural Therapy (CBT). METHODS Secondary analysis from a 2008 survey of a national sample (n = 571) of substance abuse treatment providers (medical, social workers, psychologists and counsellors) affiliated with the United States National Institute on Drug Abuse's National Drug Abuse Treatment Clinical Trials Network. Multivariate linear regression models to analyze cross-sectional survey data. FINDINGS Results demonstrated that medical providers and providers with previous research involvement more strongly endorsed the effectiveness of buprenorphine over CBT. Compared to medical providers, psychosocial providers more strongly endorsed CBT. There was a positive association between needing training in rapport with patients and endorsement of buprenorphine and a negative association with CBT. There was a positive association between needing training in behavioural management and needs assessment and endorsement of CBT. CONCLUSIONS Results underscore the importance of providers' involvement in research and the need for training medical and non-medical providers in practice areas that can purposely enhance their use of pharmacological and psychosocial EBPs.
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Affiliation(s)
- Rogério M Pinto
- Department of Social Work, Columbia University, New York City, NY, USA
| | - Anya Y Spector
- Department of Social Work, Columbia University, New York City, NY, USA; New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York City, NY, USA
| | - Gary Yu
- Department of Social Work, Columbia University, New York City, NY, USA
| | - Aimee N C Campbell
- New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York City, NY, USA
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VanderEnde D. Enhancing the Use of Evidence-Based Practice With Patient Feedback. Am J Public Health 2013; 103:e3. [DOI: 10.2105/ajph.2012.301176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Daniel VanderEnde
- The author is with the Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, GA
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