Storylines of family medicine IV: perspectives on practice-lenses of appreciation

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'IV: perspectives on practice-lenses of appreciation', authors address the following themes: 'Relational connections in the doctor-patient partnership', 'Feminism and family medicine', 'Positive family medicine', 'Mindful practice', 'The new, old ethics of family medicine', 'Public health, prevention and populations', 'Information mastery in family medicine' and 'Clinical courage.' May readers nurture their curiosity through these essays.

Influences affecting decision-making regarding use of pre-exposure prophylaxis among black men who have sex with men in the USA: a systematic review and meta-synthesis

AIM

To systematically identify, evaluate, and synthesise qualitative research examining positive and negative influences affecting decision-making behaviour among black men who have sex with men (BMSM) in the USA regarding use of pre-exposure prophylaxis (PrEP).

BACKGROUND

Used correctly, PrEP is highly efficacious in preventing HIV infection and is available via healthcare services throughout the USA. BMSM are a key target population for HIV prevention services, however their engagement with these services is low. With potential barriers to access ranging from systemic to personal, a phenomenological perspective on the influences affecting individuals' decision-making is essential, helping to better understand the needs of this target population and guide development and delivery of more effective future policy and intervention services.

DESIGN

Qualitative meta-synthesis with meta-aggregation.

DATA SOURCES

The electronic databases Medline, CINAHL, APA PsycInfo, Embase and Ovid Emcare were comprehensively searched from inception to 21 January 2022.

REVIEW METHODS

Systematic identification, quality assessment and synthesis of existing qualitative research according to protocols of meta-aggregation. This included identifying salient study findings and corroborating illustrations from the data, sorting like findings into descriptive themed categories and developing transformative synthesised statements from aggregate appraisal of category findings.

RESULTS

Seventeen studies met the inclusion criteria and were assessed to be of acceptable quality. Synthesis of study data yielded 30 categories grouped under five themes: Stigma, Discrimination, Mistrust, PrEP positivity and PrEP negativity. Twelve synthesised statements were produced to provide a summary of the results and suggest improvements to the delivery of future PrEP services and interventions.

CONCLUSION

A more targeted approach focused on advocacy and ambassadorship outside of clinical settings may be more influential in positive decision-making regarding use of PrEP in BMSM populations than relying on traditional outreach methods via institutions and their representatives where stigma, mistrust and structural inequalities perpetuate.

Knowledge, attitudes and experience of physicians working in Chile toward the prescription of pre-exposure prophylaxis (PrEP): A cross-national survey

BACKGROUND

Pre-exposure prophylaxis (PrEP) involves administering antiretroviral drugs to prevent human immunodeficiency virus (HIV) infection in at-risk subjects. Chile is considered one of the countries with the highest number of new cases per year of HIV infections.

METHODS

A nationwide cross-sectional study was carried out in Chile. A questionnaire of physicians' attitudes toward the prescription of PrEP was used.

RESULTS

632 doctors responded correctly the survey. 58.5% (n = 370) were women, and median age was 34 years (IQR 25-43). 55.4% (n = 350) responded that they have never prescribed antiretrovirals for HIV-negative individuals to prevent HIV infection, and only 10.1% have prescribed PrEP. 60.8% (n = 384) mentioned having informed about the possibility of using antiretroviral post-exposure prophylaxis in case of risky sexual activity. 76.3% (n = 482) believed each institution should formulate internal protocols for administering these drugs, and 98.4% (n = 622) stated that with the currently available evidence, PrEP should be suggested to cope with the HIV pandemic.

CONCLUSION

It was concluded that knowledge, attitudes and experience toward PrEP prescribing are variable and related to patient care. However, Chile has a marked tendency in favor of this therapy, which is similar to that reported in studies worldwide.

Preferences based interventions to address the use of antibiotics without prescription: A discrete choice experiment

Background

In many countries, concerns have arisen over the population using antibiotics without consulting a physician. This practice can place patients at risk and increase antibiotic resistance in the community.

Objective

To evaluate individuals' preferences regarding the use of antibiotics. The study also assessed the likely effectiveness of interventions aimed at reducing inappropriate use of antibiotics.

Methods

A discrete choice experiment (DCE) was conducted in Bogotá, Colombia. The attributes were determined by a systematic literature review and four focus group sessions. The DCE included nine factors - cost, time to get attention, level of symptoms, efficacy, safety, among others- and one label -using or not antibiotics. Data analysis was carried out using a generalized multinomial logit (GMNL) model. Marginal probabilities of different sets of attributes' levels were compared to estimate the likely effectiveness of interventions.

Results

The survey was administered to 222 participants from diverse socioeconomic backgrounds. The results suggest that participants preferred not taking antibiotics and having a physician as an advisor, but the probability of inappropriate antibiotic use increased as the waiting time or the cost of receiving advice rose. The pharmacy was the preferred source of antibiotics, and participants chose the pharmacy worker (nonprofessional) as an advisor over the nurse on the phone. In the absence of any interventions aimed at reducing the use of antibiotics, approximately 47.3% of people would misuse antibiotics. This reduces to 26.5% when people perceive the efficacy of the antibiotics as low and the potential risks of self-medicating as high. An alternative model using a nursing service would likely lower inappropriate use of antibiotics.

Conclusions

Even though people prefer not using antibiotics or visiting a physician in case of disease rather than self-medicating, current access conditions might discourage them from appropriately use antibiotics. The results suggest that interventions that informing people about the risks of self-medication and the low efficacy might significantly reduce inappropriate use of antibiotics. Our results also suggest that programs that empower other health professionals to provide access to antibiotics would likely further lower inappropriate use.

Knowledge of Antibiotics Use among Lebanese Adults: A study on the influence of sociodemographic characteristics

Objectives

This study aimed to evaluate the association between sociodemographic characteristics and antibiotic knowledge in the Lebanese population.

Methods

A questionnaire-based survey was conducted in community pharmacies across all Lebanese governorates. Data were collected by well-trained pharmacists through face-to-face interviews from January until March 2017. The survey tool was adapted from a questionnaire developed by the World Health Organization. A knowledge index was computed for comparative purposes and a linear regression model was performed to assess factors associated with knowledge.

Results

A total of 623 participants were included in the analysis of this study (response rate: 90.6%). The mean antibiotic knowledge index was 12.5 ± 3.2 (minimum score: 3 and maximum score: 19). Higher knowledge score was inversely correlated with age (r = −0.118; P = 0.003), but no gender differences were reported (females: 12.6 versus males: 12.3; P = 0.191). However, statistically significant differences were found for residence type (P = 0.002), educational level (P <0.001) and total household income categories (P <0.001). The linear regression model showed a significant association between residence type and knowledge (urban versus rural: β = 0.793; P = 0.011). Furthermore, a higher knowledge index was significantly associated with a higher income combined with higher education (additive scale/β = 1.590; P = 0.025). Finally, interactions between income and age, gender and residence type were not significant.

Conclusion

Individuals residing in urban areas, with combined high income and educational levels, are more knowledgeable about antibiotics use and resistance compared to other groups. More studies are needed to assess the interaction of sociodemographic interactions with health literacy.

Public knowledge, beliefs, psychological responses, and behavioural changes during the outbreak of COVID-19 in the Middle East

Objective:

To evaluate the knowledge, believes, psychological and behavioural impact of COVID-19 on the general population in the Middle East, exploring how it impacted public lives.

Methods:

A descriptive cross-sectional online survey was sent to a convenience sample in the Middle East through social media (Facebook and WhatsApp) between 16^th of June and 30^th of June 2020. The questionnaire was designed to collect the demographic, participant’s source of information regarding COVID-19, knowledge and believes about COVID-19, the psychological consequences of COVID-19, impact of COVID-19 on participant’s behaviour. The final version of the questionnaire was further tested for content validity by experts in the field.

Results:

A total of 2,061 participants completed the survey, with the majority being females (n=1394, 67.6%), from urban areas (n=1896, 92%) and the majority were from countries of The Levant (n=1199, 58.1%), followed by the Arabian Peninsula (n=392, 19.1%), Iraq (n=300, 14.6%) and Egypt (n=138, 6.7%). Few participants (3.0%) reported to have been infected and many (n=1847, 89.6%) were committed to quarantine at home. Social media platforms were the most common sources of information (41.2%). Many (63%) believed that COVID-19 is a biological weapon and were afraid of visiting crowded places (85%). The majority avoided public facilities (86.9%) such as prayer places and believed that the news about COVID-19 made them anxious (49.5%).

Application of Remote Follow-Up Via the WeChat Platform for Patients who Underwent Congenital Cardiac Surgery During the COVID-19 Epidemic

Objective

To investigate the effect of WeChat-based telehealth services on the postoperative follow-up of children who underwent congenital heart surgery during the COVID-19 epidemic.

Methods

This study retrospectively analyzed the clinical and family data of 108 children who underwent congenital heart surgery and underwent remote follow-up via the WeChat platform from December 2019 to March 2020 in our hospital.

Results

During the follow-up period, the WeChat platform was used to refer 8 children with respiratory infection symptoms to local hospitals for treatment. Two children with poor incision healing were healed after we used the WeChat platform to guide the parents in dressing the wounds on a regular basis at home. Nutritional guidance was given via the WeChat platform to 13 patients with poor growth and development. The psychological evaluation results of the parents showed that the median (range) SDS score was 43 (34-59), and 7 parents (6.5%) were classified as depressed; the median (range) SAS score was 41 (32-58), and 12 parents (11.1%) were classified as having mild anxiety.

Conclusion

The use of WeChat-based telehealth services was effective for the remote postoperative follow-up of children who underwent congenital cardiac surgery during the COVID-19 epidemic. Providing WeChat-based telehealth services can reduce the amount of travel required for these children and their families, which is helpful for controlling and preventing the spread of COVID-19.

Patient experience with clinical pharmacist services in Travis County Federally Qualified Health Centers

Background

Positive patient experiences with care have been linked to improved health outcomes. Patient experience surveys can provide feedback about the level of patient-centered care provided by clinical pharmacists and information about how to improve services.

Objectives

Study objectives are: 1) To describe patient experience with clinical pharmacist services in a federally qualified health center (FQHC). 2) To determine if demographic or health-related factors were associated with patient experience.

Methods

This cross-sectional survey included adult patients who were English or Spanish speaking, and completed a clinical pharmacist visit in March or April 2018. Patient experience was evaluated, on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), with 10 items using four domains: pharmacist-patient interaction information provision, support for self-care, and involvement in decision making. In addition, one item was used to rate the overall experience. Demographic and health-related variables were also collected. Eligible patients completed the survey after their clinical pharmacist visit. Descriptive and inferential statistics, as well as Cronbach's alpha for scale reliability, were employed.

Results

Respondents (N=99) were 55.4 (SD=12.1) years and 53.1% were women. Overall, patients rated their experiences very high with the 10-item scale score of 4.8 (SD=0.4) out of 5 points and the overall experience rating of 4.9 (SD=0.4) out of 5 points. With the exception of race, there were no differences between patient experience and demographic and health-related variables. African Americans had significantly (p=0.0466) higher patient experience scores compared to Hispanics.

Conclusions

Patients receiving care in a FQHC highly rated their experience with clinical pharmacists. This indicates that clinical pharmacists provided a high level of patient-centered care to a diverse group.

Challenges with accessing health care for young children presumed to have malaria in the rural district of Butaleja, Uganda: a qualitative study

Objective:

A qualitative study was conducted to gain insight into challenges reported by Butaleja households during a previous household survey. Specifically, this paper discusses heads of households’ and caregivers’ perceptions of challenges they face when seeking care for their very young children with fever presumed to be malaria.

Methods:

Eleven focus groups (FGs) were carried out with household members (five with heads of households and six with household caregivers) residing in five sub-counties located across the district. Purposive sampling was used to ensure the sample represented the religious diversity and geographical distance from the peri-urban center of the district. Each FG consisted of five to six participants. The FGs were conducted at a community centre by two pairs of researchers residing in the district and who were fluent in both English and the local dialect of Lunyole. The discussions were recorded, translated, and transcribed. Transcripts were reviewed and coded with the assistance of QDA Miner (version 4.0) qualitative data management software, and analyzed using thematic content analysis.

Results:

The FG discussions identified four major areas of challenges when managing acute febrile illness in their child under the age of five with presumed malaria (1) difficulties with getting to public health facilities due to long geographical distances and lack of affordable transportation; (2) poor service once at a public health facility, including denial of care, delay in treatment, and negative experiences with the staff; (3) difficulties with managing the child’s illness at home, including challenges with keeping home-stock medicines and administering medicines as prescribed; and (4) constrained to use private outlets despite their shortcomings.

Conclusions:

Future interventions may need to look beyond the public health system to improve case management of childhood malaria at the community level in rural districts such as Butaleja. Given the difficulties with accessing quality private health outlets, there is a need to partner with the private sector to explore feasible models of community-based health insurance programs and expand the role of informal private providers.

Attitudes about and access to influenza vaccination experienced by parents of children hospitalised for influenza in Australia

INTRODUCTION

In Australia, influenza hospitalises more children than any other vaccine preventable disease does. Children aged six months or older are recommended to receive annual influenza vaccines, and pregnant women are recommended vaccination to protect infants aged up to six months. However, vaccine uptake is low. This study explored influenza vaccination knowledge and behaviours of parents of children who were hospitalised for influenza, in order to inform strategies that target barriers to uptake.

METHODS

We conducted 27 semi-structured interviews with parents/caregivers during or shortly after their child's hospitalisation for laboratory-confirmed influenza in 2017. Questions were guided by the Social Ecological Model exploring all levels of influence on vaccination uptake from the intrapersonal through to policy, via the parents' perspective. Transcripts were inductively analysed. Themes were categorised into the components of the Capability-Opportunity-Motivation-Behaviour (COM-B) model.

RESULTS

20/27 children were aged six months or older; 16/20 had not received an influenza vaccine in 2017. Mothers of 4/7 infants aged less than six months were not vaccinated in pregnancy. The themes regarding barriers to influenza vaccination were: (1) Limited Capability - misinterpretations and knowledge gaps, (2) Lack of Opportunity - inconvenient vaccination pathway, missing recommendations, absence of promotion to all, and the social norm, and (3) Missing Motivation - hierarchy of perceived seriousness, safety concerns, a preference for 'natural' ways. Though most parents, now aware of the severity of influenza, intended to vaccinate their child in future seasons, some harboured reservations about necessity and safety. When parents were asked how to help them vaccinate their children, SMS reminders and information campaigns delivered through social media, schools and childcare were suggested.

CONCLUSION

Improving parents' and providers' knowledge and confidence in influenza vaccination safety, efficacy, and benefits should be prioritised. This, together with making influenza vaccination more convenient for parents, would likely raise vaccine coverage.

The Effect of a Self-Efficacy-Enhancing Intervention on Perceived Self-Efficacy and Actual Adherence to Healthy Behaviours Among Women with Gestational Diabetes Mellitus

Objectives

This study aimed to evaluate the effectiveness of a self-efficacy-enhancing intervention (SEEI) on perceived self-efficacy and actual adherence to healthy behaviours among women with gestational diabetes mellitus (GDM).

Methods

This comparative pre-post study was conducted at the Antenatal Clinic of the Sultan Qaboos University Hospital, Muscat, Oman, between October 2016 and January 2017. A total of 90 adult Omani women with GDM were randomised to either a control group receiving standard prenatal care or a SEEI group. The SEEI group received an additional health education session and biweekly text messages to encourage adherence to healthy behaviours. All participants completed self-reported standardised questionnaires to determine perceived self-efficacy and actual adherence at baseline and after four weeks.

Results

At baseline, there were no significant differences between the control and SEEI groups in mean scores for perceived self-efficacy (122.9 ± 19.9 versus 118.2 ± 19.5; P = 0.26) or actual adherence to healthy behaviours (3.1 ± 1.2 versus 3.2 ± 1.0; P = 0.23). However, after four weeks, there was a significant positive difference between the SEEI and control groups in terms of pre-post change in scores for both perceived self-efficacy (9.9 ± 19.6 versus -1.8 ± 17.6; P <0.05) and actual adherence to healthy behaviours (1.5 ± 1.1 versus 0.4 ± 0.8; P <0.01).

Conclusion

The SEEI was found to significantly improve perceived self-efficacy and actual adherence to healthy behaviours among a group of Omani women with GDM.

Pain management in hospitals: patients' satisfaction and related barriers

Background:

Suboptimal pain control has been frequently reported in healthcare settings and documented to negatively impact patients’ health. Patients’ perception regarding pain management may influence their satisfaction regarding treatment.

Objectives:

This study focuses on the assessment of patients’ satisfaction regarding pain therapy and defining patient-related barriers for its implication.

Methods:

A cross-sectional study was conducted in two tertiary care hospitals from April till July 2017. A face-to face interview questionnaire was filled regarding pain scores and patients’ attitudes regarding pain management. Both medical and post-surgical adult patients with all types of pain were eligible to participate. A descriptive analysis of patient satisfaction and perceptions regarding pain management was done.

Results:

Results from 183 participants with a mean age of 49 (SD=17.33) revealed that pain was their main reason for hospitalization (71.6% of the cases). Numeric pain scores were recorded only in 14.2% of the patient medical files. Pain intensity documentation by healthcare professionals was found in 41.5% of the cases, and 7.7% of the patients had to wait for more than 30 minutes before getting the pain medication. Around 85% of the patients were satisfied with their pain management. Patients’ barriers to effective pain therapy were mainly fear of adverse effects, addiction, and additional costs (p<0.05).

Conclusions:

Pain remains a prevalent problem that requires more efforts for improvement. Our study can effectively serve as a start for larger studies where barriers to pain management can be assessed as an independent variable affecting pain management practice.

Stress underestimation and mental health literacy of depression in Japanese workers: A cross-sectional study

Appropriately estimating stress levels in daily life is important for motivating people to undertake stress-management behaviors or seek out information on stress management and mental health. People who exhibit high stress underestimation might not be interested in information on mental health, and would therefore have less knowledge of it. We investigated the association between stress underestimation tendency and mental health literacy of depression (i.e., knowledge of the recognition, prognosis, and usefulness of resources of depression) in Japanese workers. We cross-sectionally surveyed 3718 Japanese workers using a web-based questionnaire on stress underestimation, mental health literacy of depression (vignettes on people with depression), and covariates (age, education, depressive symptoms, income, and worksite size). After adjusting for covariates, high stress underestimation was associated with greater odds of not recognizing depression (i.e., choosing anything other than depression). Furthermore, these individuals had greater odds of expecting the case to improve without treatment and not selecting useful sources of support (e.g. talk over with friends/family, see a psychiatrist, take medication, see a counselor) compared to those with moderate stress underestimation. These relationships were all stronger among males than among females. Stress underestimation was related to poorer mental health literacy of depression.

Assessment of health seeking behaviour and self-medication among general public in the state of Penang, Malaysia

Background:

Patients’ behaviour in making decisions regarding health is currently changing from passive recipients to recipients who play an active role in taking action to control their health and taking self-care initiatives.

Objectives:

This study was conducted to evaluate the health seeking behaviour among general public and its associated factors; and to evaluate the medicine taking behaviour in public and the practice of self-medication.

Methods:

A cross-sectional study was undertaken among general public in Penang Island, Malaysia. A convenience sampling of 888 participants successfully completed the survey. Self-administered questionnaires were distributed among the residents in the north east of Penang Island.

Results:

This study showed that most of the participants chose to consult the physician when they experience any health problems (66.7%), followed by self-medication (20.9%). The first action for consulting the physician was significantly predicted by Malay respondents and retired people (OR 3.05, 95% CI 1.04-8.89). The prevalence of self-medication was 54%. The practice of self-medication was significantly associated with Chinese participants, educated people, people with alone living status and people with more self-care orientation.

Conclusion:

Increasing the awareness of the public about the rational choice of getting medical assistance is a very important issue to control their health. A health education program is needed to increase the awareness about the use of medicines among the general public and to enable them to make the right decisions relating to health problems.

A multimedia campaign to improve back beliefs in patients with non-specific low back pain: a process evaluation

BACKGROUND

Low back pain (LBP) is one of the most prevalent and costly disorders worldwide. To reduce its burden in the Netherlands, implementation of a multidisciplinary guideline for LBP was supported by a multifaceted eHealth campaign for patients with LBP. The current study aims 1) to evaluate whether the implementation strategy was performed as planned; 2) to assess the feasibility, barriers and facilitators of the patient based eHealth campaign; 3) to gain insight into the satisfaction and experiences of patients with various ethnic backgrounds with the implementation strategy and to make a comparison between them; and 4) to explore the association between exposure to and satisfaction with the implementation strategy.

METHODS

This process evaluation was performed using the Linnan and Steckler framework, and used a mixed methods approach for data collection and analysis. The relationship between satisfaction of patients and exposure to the strategy was statistically examined. Semi-structured interviews were analysed using qualitative data analysis methods.

RESULTS

Two hundred and fourteen patients participated in the quantitative, and 44 in the qualitative analysis. Most were female and had a high level of education. Many patients did not use the campaign at all or only once, and those that did rated it as reasonable. Patient satisfaction with the campaign increased significantly with an increase in its use. Qualitative analysis showed that four main themes played a role in campaign rating and use: satisfaction with intervention components, perceived benefits of the intervention, usage of the intervention, and satisfaction with the medium used.

CONCLUSION

This process evaluation showed that the eHealth campaign was used only by a small proportion of patients with non-specific LBP. It seemed that the campaign was offered to the patients too late, that the lay-out of the campaign did not meet patient needs, and that healthcare providers rarely discussed the campaign with their patients, while involvement of those providers seemed to improve trustworthiness of the campaign and increase its usage. It is important to invest effort into healthcare providers to motivate patients to use eHealth intervention and to tailor strategies better to the needs of users.

TRIAL REGISTRATION

Netherlands Trial Register (NTR): NTR4329 . Registered December 20th, 2013.

Psychometric properties of the Belief about Medicines Questionnaire (BMQ) in the Maltese language

BACKGROUND

Investigating beliefs about medicines has been of interest over the past years, with studies aiming to better understand theoretical reasons behind development of such beliefs.

OBJECTIVE

This study aimed to produce a culturally and contextually appropriate version of the Beliefs about Medicines Questionnaire (BMQ) in the Maltese language and to assess its psychometric properties.

METHODS

Medication beliefs were evaluated using the BMQ which is divided into two sections: BMQ-General (sub-scales: Overuse and Harm, 4 items per sub-scale) and BMQ-Specific (sub-scales: Necessity and Concerns, 5 items per sub-scale). Following translation/back translation, the Maltese version of the BMQ was applied to patients having asthma, diabetes, cardiovascular disease or depression who attended out-patients' clinics at the main state general hospital in Malta between June and September 2013. Cronbach's alpha coefficient, alpha, was used to determine internal consistency of the BMQ and Principal Component Analysis using Varimax rotation with Kaiser normalisation was carried out to analyse component loading of the items on the respective sub-scales.

RESULTS

The Maltese version of the BMQ showed acceptable internal consistency for the harm scale (alpha=0.56), the necessity scale (alpha=0.73) and the concerns scale (alpha=0.66), however the overuse scale gave poor internal consistency (alpha=0.48) due to the item on natural remedies which posed some difficulty in the Maltese sample. The final solution for Principal Component Analysis yielded a four-factor structure representing the 4 sub-scales of the BMQ, with results being comparable to previous studies out in different languages.

CONCLUSION

The Maltese version of the BMQ was found to have acceptable psychometric properties for the beliefs about medicines in the Maltese population.

[Design and Validation of a Questionnaire on Vaccination in Students of Health Sciences, Spain]

OBJECTIVE

Immunization rates among medicine and nursing students -and among health professional in general- during hospital training are low. It is necessary to investigate the causes for these low immunization rates. The objective of this study was to design and validate a questionnaire for exploring the attitudes and behaviours of medicine and nursing students toward immunization of vaccine-preventable diseases.

METHODS

An instrument validation study. The sample included 646 nursing and medicine students at University of Oviedo, Spain. It was a non-ramdom sampling. After the content validation process, a 24-item questionnaire was designed to assess attitudes and behaviours/behavioural intentions. Reliability (ordinal alpha), internal validity (exploratory factor analysis by parellel analysis), ANOVA and mediational model tests were performed.

RESULTS

Exploratory factor analysis yielded two factors which accounted for 48.8% of total variance. Ordinal alpha for the total score was 0.92. Differences were observed across academic years in the dimensions of attitudes (F5.447=3.728) and knowledge (F5.448=65.59), but not in behaviours/behavioural intentions (F5.461=1.680). Attitudes demonstrated to be a moderating variable of knowledge and attitudes/behavioural attitudes (Indirect effect B=0.15; SD=0.3; 95% CI:0.09-0.19).

CONCLUSIONS

We developed a questionnaie based on sufficient evidence of reliability and internal validity. Scores on attitudes and knowledge increase with the academic year. Attitudes act as a moderating variable between knowledge and behaviours/behavioural intentions.

Perspectives of People Living with HIV on Access to Health Care: Protocol for a Scoping Review

Background

Strategies to improve access to health care for people living with human immunodeficiency virus (PLHIV) have demonstrated limited success. Whereas previous approaches have been informed by the views of health providers and decision-makers, it is believed that incorporating patient perspectives into the design and evaluations of health care programs will lead to improved access to health care services.

Objective

We aim to map the literature on the perspectives of PLHIV concerning access to health care services, to identify gaps in evidence, and to produce an evidence-informed research action plan to guide the Living with HIV program of research.

Methods

This scoping review includes peer-reviewed and grey literature from 1946 to May 2014 using double data extraction. Variations of the search terms “HIV”, “patient satisfaction”, and “health services accessibility” are used to identify relevant literature. The search strategy is being developed in consultation with content experts, review methodologists, and a librarian, and validated using gold standard studies identified by those stakeholders. The inclusion criteria are (1) the study includes the perspectives of PLHIV, (2) study design includes qualitative, quantitative, or mixed methods, and (3) outcome measures are limited to patient satisfaction, their implied needs, beliefs, and desires in relation to access to health care. The papers are extracted by two independent reviewers, including quality assessment. Data is then collated, summarized, and thematically analyzed.

Results

A total of 12,857 references were retrieved, of which 326 documents were identified as eligible in pre-screening, and 64 articles met the inclusion criteria (56% qualitative studies, 38% quantitative studies and 6% mixed-method studies). Only four studies were conducted in Canada. Data synthesis is in progress and full results are expected in June, 2016.

Conclusions

This scoping review will record and characterize the extensive body of literature on perspectives of PLHIV regarding access to health care. A literature repository will be developed to assist stakeholders, decision-makers, and PLHIV in developing and implementing patient-oriented health care programs.

An exploratory study of the patient experience of pharmacist supplementary prescribing in a secondary care mental health setting

BACKGROUND

Management of chronic disease has become an increasing challenge to the National Health Service in the United Kingdom. The introduction of supplementary prescribing was seen as a possible mechanism to address the needs of this patient group. Individuals with mental illness were considered particularly suitable for management in this way.

OBJECTIVE

To explore the views and experiences of patients with mental illness on being managed by a pharmacist supplementary prescriber in a secondary care outpatient setting.

METHODS

A study of patient experiences utilising semi-structured interviews and self-completion diaries was adopted. Eleven patients participated in the study. Data were analysed utilising code and retrieve, and content analysis respectively.

RESULTS

Patients valued the increased accessibility to, and continuity of, their prescriber compared with their experience of other healthcare professionals. Patients reported they were able to trust the pharmacist's knowledge of medication, were provided with sufficient information regarding reasons for treatment and side effects, and felt that they had an active role in decisions concerning their healthcare.

CONCLUSIONS

This exploratory study showed that patients had positive views of being managed by a supplementary prescriber. However, it should be noted that the number of participants was small. It is therefore important that further, more wide ranging research is conducted to evaluate pharmacist prescribing within mental health settings.

Reasons for Consultation among Patients attending Primary Healthcare Centres in Oman

OBJECTIVES

Pathways to care or care-seeking, which translate into healthcare utilisation, have been investigated in many parts of the world, but there is a dearth of studies in the Arabian Gulf. The aim of this study was to examine the characteristics of attendees at primary healthcare centres in northern Oman and their reasons for visiting.

METHODS

Face-to-face interviews were conducted with 676 participants attending 12 primary healthcare centres between June and July 2006. The catchment area was selected to represent the population structure in Oman. The 12-item questionnaire was read to every fifth eligible patient entering each healthcare centre for a routine appointment. Analyses were conducted using univariate statistics.

RESULTS

About a third (n = 200; 29.6%) of the participants had a history of chronic illness; 231 (34%) were on regular medications; 211 (31%) were taking part in health education programmes; 130 (19%) were open to complementary medicine. The majority of the participants mentioned physician's advice (n = 570; 84%) as the strongest reason for seeking consultation. Conversely, physician's advice was strongly related to particular demographic factors.

CONCLUSION

This observational study identified some characteristics and reasons for visiting healthcare facilities in northern Oman. These are discussed within the context of prevailing sociocultural factors. The implications for the prevention and detection of ill health in Oman are also discussed.

Balancing risk versus benefit: the elderly patient's perspective on warfarin therapy

Warfarin therapy is underused in the target at-risk elderly population. Clinicians perceive that older patients are reluctant to use this therapy, however the perspective of patients or their carers has yet to be explored.

Objective:

To explore in-depth the perspectives of elderly patients and/or their carers regarding the use of warfarin therapy.

Method:

A qualitative study, using semi-structured group interviews was undertaken. The audio-taped discussions were transcribed verbatim, then thematically analysed to identify emergent themes. Group discussions were conducted at a major Sydney teaching hospital, over a 2-month period. Individuals aged 65 years or older (and/or their carers) who were using long-term (6 months) warfarin therapy were recruited by voluntary response to study flyers.

Results:

17 patients and carers (mean age 77.2 SD=7.5 years) participated in one of two focus groups. Five core themes emerged regarding warfarin therapy: inadequate knowledge and understanding about it, patients/carers variable experience of information provision, cycle of reactions to being on it, issues in its practical management, and the spectrum of experiences with it. Overall, participants were very accepting of the therapy, describing a high level of compliance, despite initial fears and anxieties, and a relative lack of knowledge. Patients felt somewhat abandoned in their management of warfarin due to the lack of ongoing support services in the community, and inadequate information provision.

Conclusions:

Elderly patients and their carers appear to be quite accepting of warfarin therapy, in contrast to the perceptions of health care professionals. More effort is needed, however, in terms of information provision, particularly in the form of community-based services, to assist patients in the long-term management of warfarin.