1
|
Daliri DB, Aninanya GA, Laari TT, Abagye N, Dei-Asamoa R, Afaya A. Exploring the barriers to mental health service utilization in the Bolgatanga Municipality: the perspectives of family caregivers, service providers, and mental health administrators. BMC Health Serv Res 2024; 24:278. [PMID: 38443928 PMCID: PMC10916073 DOI: 10.1186/s12913-024-10567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/05/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Mental health service utilization remains a challenge in developing countries, with numerous barriers affecting access to care. Albeit data suggest poor utilization of mental health services in the Bolgatanga Municipality in Ghana, no studies have explored the barriers to the utilization of mental health services. Therefore, this study explored the perspectives of family caregivers, service providers, and mental health service administrators on the barriers to mental health service utilization in the Bolgatanga Municipality, Ghana. METHODS A qualitative descriptive design was employed for the study. Nineteen participants were purposively sampled from two hospitals including fifteen family caregivers, two service providers, and two mental health administrators. Data were collected through individual in-depth interviews using a semi-structured interview guide. Audio-recorded interviews were transcribed verbatim and thematically analyzed using NVivo 12 pro software. RESULTS Five main themes emerged including individual-level barriers, interpersonal barriers, community-level barriers, organizational-level barriers, and policy-level barriers. At the individual level, lack of insight, poor treatment compliance, and financial challenges were prominent barriers. Interpersonal barriers included family pressure influenced by cultural and spiritual beliefs. At the community level, stigma and mental health illiteracy were identified as significant barriers. At the organizational level, barriers encompassed inadequate staffing, limited space, and staff attitudes. Policy-level barriers included the neglect of mental health in policies and the non-inclusion of mental health services in the National Health Insurance Scheme. CONCLUSION This study highlights the complexity of barriers to mental health service utilization and underscores the need for a comprehensive approach to address them. Collaborative efforts involving healthcare providers, policymakers, communities, and families are essential to mitigate these barriers. It is imperative to consider these barriers when developing strategies to improve the utilization of mental health services in Ghana.
Collapse
Affiliation(s)
- Dennis Bomansang Daliri
- Presbyterian Psychiatric Hospital, Bolgatanga, Ghana
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Gifty Apiung Aninanya
- Department of Health Services Policy Planning Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana
| | | | - Nancy Abagye
- Department of Midwifery, School of Nursing and Midwifery, University of Ghana, Legon, Ghana
| | - Richard Dei-Asamoa
- Department of Psychiatry, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Psychiatry, University of Ghana Medical School, Accra, Ghana
| | - Agani Afaya
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana.
| |
Collapse
|
2
|
McCall J, Hobbs H, Ranger C, Cameron F, Stuart H, Nelken J, Majalahti J, Urbanoski K, Kolla G, LeMaistre J, Toombs K, Herriot R, Pauly B. Prescribed safer supply during dual public health emergencies: a qualitative study examining service providers perspectives on early implementation. Subst Abuse Treat Prev Policy 2024; 19:19. [PMID: 38444035 PMCID: PMC10913403 DOI: 10.1186/s13011-024-00598-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Within North America and worldwide, drug related overdoses have increased dramatically over the past decade. COVID-19 escalated the need for a safer supply to replace unregulated substances and to reduce toxicity and overdoses. Service providers play an integral role in the delivery of safer supply but there is little empirical evidence that conceptualizes effective safer supply from their perspectives. This study explored early implementation and impacts of a safer supply program, capturing the perspectives of an interdisciplinary team of service providers on tensions and issues encountered in the development of the SAFER program. METHODS Using a community-based participatory approach, we conducted individual interviews with program providers (n = 9). The research team was composed of researchers from a local drug user organization, a local harm reduction organization, and academic researchers. The Consolidated Framework for Implementation Research (CFIR) informed the interview guide. Data was analyzed using thematic analysis. RESULTS There are six themes describing early implementation: (1) risk mitigation prescribing as context for early implementation; (2) developing SAFER specific clinical protocols; (3) accessibility challenges and program innovations; (4) interdisciplinary team and wraparound care; (5) program tensions between addiction medicine and harm reduction; (6) the successes of safer supply and future visions. CONCLUSION Early implementation issues and tensions included prescriber concerns about safer supply prescribing in a highly politicized environment, accessibility challenges for service users such as stigma, encampment displacement, OAT requirements, program capacity and costs, and tensions between addiction medicine and harm reduction. Navigating these tensions included development of clinical protocols, innovations to reduce accessibility challenges such as outreach, wraparound care, program coverage of medication costs and prescribing safer supply with/without OAT. These findings contribute important insights for the development of prescribed safer supply programs.
Collapse
Affiliation(s)
- J McCall
- University of Victoria, PO Box 1700, Stn CSC, Victoria, BC, V8W 2Y2, Canada
- Canadian Institute of Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - H Hobbs
- AVI Health and Community Services, 713 Johnson Street, Victoria, BC, V8W 1M8, Canada
- Victoria SAFER Program, 1806 Cook Street, Victoria, BC, V8W 1M8, Canada
| | - C Ranger
- AVI Health and Community Services, 713 Johnson Street, Victoria, BC, V8W 1M8, Canada
- Victoria SAFER Program, 1806 Cook Street, Victoria, BC, V8W 1M8, Canada
| | - F Cameron
- SOLID Outreach, 1056 North Park St, Victoria, BC, Canada
| | - H Stuart
- SOLID Outreach, 1056 North Park St, Victoria, BC, Canada
| | - J Nelken
- SOLID Outreach, 1056 North Park St, Victoria, BC, Canada
| | - J Majalahti
- SOLID Outreach, 1056 North Park St, Victoria, BC, Canada
| | - K Urbanoski
- University of Victoria, PO Box 1700, Stn CSC, Victoria, BC, V8W 2Y2, Canada
- Canadian Institute of Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - G Kolla
- University of Victoria, PO Box 1700, Stn CSC, Victoria, BC, V8W 2Y2, Canada
- Canadian Institute of Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - J LeMaistre
- AVI Health and Community Services, 713 Johnson Street, Victoria, BC, V8W 1M8, Canada
- Victoria SAFER Program, 1806 Cook Street, Victoria, BC, V8W 1M8, Canada
| | - K Toombs
- AVI Health and Community Services, 713 Johnson Street, Victoria, BC, V8W 1M8, Canada
- Victoria SAFER Program, 1806 Cook Street, Victoria, BC, V8W 1M8, Canada
| | - R Herriot
- Victoria SAFER Program, 1806 Cook Street, Victoria, BC, V8W 1M8, Canada
| | - Bernie Pauly
- University of Victoria, PO Box 1700, Stn CSC, Victoria, BC, V8W 2Y2, Canada.
- Canadian Institute of Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada.
| |
Collapse
|
3
|
Meherali S, Rehmani AI, Ahmad M, Adewale B, Kauser S, Lebeuf S, Benoit J, Scott SD. Impact of the COVID-19 pandemic on the sexual and reproductive health of adolescents in Alberta, Canada. Reprod Health 2023; 20:172. [PMID: 37990327 PMCID: PMC10664423 DOI: 10.1186/s12978-023-01712-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE The COVID-19 pandemic led to major service disruptions in the healthcare sector, especially regarding sexual and reproductive health services. However, the impact of the pandemic on Canadian adolescents is relatively unknown. This study aimed to investigate the impacts of the COVID-19 pandemic and associated public health measures on the sexual and reproductive health (SRH) of adolescents in Alberta, Canada. METHODS A qualitative study using an interpretive description (ID) approach and community-based participatory research principles was conducted to capture the subjective experience and perceptions of adolescents and service providers. With the collaboration of the Adolescent Advisory Group and community partners, 18 adolescents and 15 service providers were recruited for the study through purposive sampling. Findings from the qualitative interviews were analyzed using thematic analysis. RESULTS Three major themes emerged from the analysis: (1) COVID-19 SRH experience, (2) barriers to SRH, and (3) adolescent SRH strategies. Our findings highlight numerous barriers and challenges that prevented adolescents from accessing SRH education, products, and services. CONCLUSION The COVID-19 pandemic had a profound impact on the SRH and the well-being of adolescents. Our study reflects the need for diverse SRH strategies to maintain continued access to SRH resources during disruptive events, such as the pandemic.
Collapse
Affiliation(s)
- Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Amyna Ismail Rehmani
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Mariam Ahmad
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Bisi Adewale
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Samar Kauser
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Simone Lebeuf
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - James Benoit
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| |
Collapse
|
4
|
Washington-Nortey M, Anum A, Serpell Z, Xu Y. Expectations for Children with Autism Spectrum Disorders or Intellectual Disabilities in Ghana: A Comparison Between Service Providers and Parents. J Autism Dev Disord 2023:10.1007/s10803-023-06073-9. [PMID: 37530915 DOI: 10.1007/s10803-023-06073-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 08/03/2023]
Abstract
Little is known about care providers' expectations for children with autism spectrum disorders (ASD) and intellectual disabilities (ID) in Ghana. This study used group concept mapping (n = 9) and a quantitative survey (n = 128) to explore and compare service providers' and parents' expectations for children with ASD or ID. Data were analyzed using hierarchical clustering procedures and Multivariate Analysis of Variance (MANOVA). Concept mapping results revealed several expectation clusters, including independence, love and acceptance, equal social rights and opportunities, and professional and caregiver training. MANOVA results revealed significant differences between parents, teachers, and healthcare providers in their perceptions of the importance and likelihood of a child achieving these expectations. Results are discussed in reference to the cultural context, and implications are outlined.
Collapse
Affiliation(s)
| | - Adote Anum
- Department of Psychology, University of Ghana, Accra, Ghana
| | - Zewelanji Serpell
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Yaoying Xu
- Department of Counseling and Special Education, Virginia Commonwealth University, Richmond, USA
| |
Collapse
|
5
|
Sim A, Ahmad A, Hammad L, Shalaby Y, Georgiades K. Reimagining mental health care for newcomer children and families: a qualitative framework analysis of service provider perspectives. BMC Health Serv Res 2023; 23:699. [PMID: 37370152 PMCID: PMC10303766 DOI: 10.1186/s12913-023-09682-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Persistent disparities in access to mental health care for refugee and immigrant children and their families pose unique challenges to policy and practice. This study examined service provider perspectives on the barriers and opportunities for improving mental health supports for newcomer children and families in Canada. METHODS Semi-structured individual and group interviews were conducted with 33 leadership and frontline staff from 14 organizations in the health, education, settlement, and social service sectors in Hamilton, Ontario. Interview data were analyzed using the framework method. RESULTS Participants described barriers at the systems, provider, and individual and family levels that prevented newcomer families from accessing and benefiting from mental health supports. Structural barriers included inadequate services and funding, complexity of systems, cultural tensions, and, lack of prevention and early identification. Provider-level barriers included lack of representation, mental health knowledge and cultural competency, and staff shortages and burnout. Individual and family-level barriers included lack of mental health literacy, primacy of settlement needs, stigma, fear, and the high threshold for help-seeking. Participants' recommendations for "reimagining care" related to newcomer engagement, person- and family-centered care, cultural responsiveness, mental health promotion and prevention, workforce diversity and development, collaborative and integrated care, and knowledge generation and uptake. CONCLUSIONS The intersection of structural, provider, and individual/family-level barriers reduce newcomer families' access to and effectiveness of mental health supports. Reducing disparities in mental health and access to care will require a paradigm shift in the way that mental health care is conceptualized and delivered to newcomer children and families.
Collapse
Affiliation(s)
- Amanda Sim
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Afreen Ahmad
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lina Hammad
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Yasmine Shalaby
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioural Neurosciences, The Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
6
|
Kourgiantakis T, Lee E, Kosar AKT, Tait C, Lau CKY, McNeil S, Craig S, Ashcroft R, Williams CC, Goldstein AL, Chandrasekera U, Sur D, Henderson JL. Youth cannabis use in Canada post-legalization: service providers' perceptions, practices, and recommendations. Subst Abuse Treat Prev Policy 2023; 18:36. [PMID: 37349741 PMCID: PMC10288694 DOI: 10.1186/s13011-023-00550-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND In 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16-24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers' perceptions, practices, and recommendations on youth cannabis use. METHODS This mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16-24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis. RESULTS The survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services. CONCLUSION Youth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms.
Collapse
Affiliation(s)
- Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
| | - Eunjung Lee
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - A Kumsal Tekirdag Kosar
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Christine Tait
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Carrie K Y Lau
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Sandra McNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Shelley Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Abby L Goldstein
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, Toronto, ON, Canada
| | - Uppala Chandrasekera
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Deepy Sur
- Ontario Association of Social Workers (OASW), Toronto, ON, Canada
| | - J L Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Department of Psychiatry, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
| |
Collapse
|
7
|
Bateman J, Egan R, Maclennan K. 'Survivorship care is one big gap': a qualitative study of post-treatment supportive care in Aotearoa New Zealand. BMC Health Serv Res 2023; 23:594. [PMID: 37291526 DOI: 10.1186/s12913-023-09580-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/18/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND This study focuses on the provision of supportive care services and programmes for cancer survivors post-treatment in Aotearoa New Zealand (NZ). It aims to aid our understanding of an often challenging and fragmented phase of cancer survivorship, and lay the groundwork for future research into the development of survivorship care in NZ. METHODS This study employed a qualitative design using semi-structured interviews with a range of healthcare providers (n = 47) involved in service provision for cancer survivors post active treatment, including supportive care providers; clinical and allied health providers; primary health providers; and Māori health providers. Data were analysed using thematic analysis. RESULTS We found that cancer survivors in NZ face a range of psycho-social and physical issues post-treatment. The provision of supportive care to meet these needs is currently fragmented and inequitable. The key barriers to improved supportive care provision for cancer survivors post-treatment include a lack of capacity and resources within the existing cancer care framework; divergent attitudes to survivorship care within the cancer care workforce; and a lack of clarity around whose responsibility post-treatment survivorship care is. CONCLUSIONS Post-treatment cancer survivorship should be established as a distinct phase of cancer care. Measures could include greater leadership in the survivorship space; the implementation of a survivorship model(s) of care; and the use of survivorship care plans; all of which could help improve referral pathways, and clarify clinical responsibility for post-treatment survivorship care.
Collapse
Affiliation(s)
- Jerram Bateman
- Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Richard Egan
- Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Karyn Maclennan
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| |
Collapse
|
8
|
Qi C, Wang Y, Qi X, Jiao Y, Que C, Chen Y. Barriers to providing internet-based home care services for urban older adults in China: a qualitative study of the service providers. BMC Geriatr 2023; 23:320. [PMID: 37221471 DOI: 10.1186/s12877-023-04028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 05/08/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Due to the increasingly aging population in China and the changes in social and family structure, older adults' care problems are becoming more and more prominent. To meet the home care needs of urban older adults, the Chinese government has launched Internet-Based Home Care Services (IBHCS). Although this model innovation can significantly relieve care problems, more and more evidence shows that there are many barriers in the process of IBHCS supply. The current literature is mostly from the perspective of the service users, and there are very few studies on the experience of service providers. METHODS In this study, we took a qualitative phenomenological approach and used semi-structured interviews to investigate service providers' daily experiences and the barriers they encounter. A total of 34 staff from 14 Home Care Service Centers (HCSCs) were included. Interviews were transcribed and analyzed using thematic analysis. RESULTS We identified the barriers that service providers encounter in IBHCS supply: (1) bureaucratic repression: unreasonable policy plans, harsh assessment, excessive paperwork, different preferences of government leaders, and obstacles caused by COVID-19 control lead to a shift of focus in their work; (2) profitability crisis in the market: high service costs, dampened effective demand, government intervention in setting prices, and parent companies' excessively high sales targets hinder the service supply process; (3) client-related challenges: the crisis of confidence, the dilemma of popularizing new technology, and communication barriers lead to rejection by older adults; (4) job dissatisfaction: low and unstable salary, heavy tasks, poor social acceptance of occupations, and lack of professional value reduce work enthusiasm. CONCLUSION We have investigated the barriers faced by service providers when providing IBHCS for urban older adults in China, providing empirical evidence in the Chinese context for the relevant literature. In order to provide IBHCS better, it is necessary to improve the institutional environment and market environment, strengthen publicity and communication, target customer needs, and adjust the working conditions of front-line workers.
Collapse
Affiliation(s)
- Caiyun Qi
- Department of social work, Shandong University, Jinan, China
| | - Yuan Wang
- Department of labor and social security, Jilin University, Qianjin Street 2699, Changchun, China.
| | - Xiaonan Qi
- Department of management, School of applied technology and health industries, Anshan Normal University, Anshan, China
| | - Yunhe Jiao
- Department of labor and social security, Jilin University, Qianjin Street 2699, Changchun, China
| | - Chuanqi Que
- department of social work, The Chinese University of Hong Kong, Hong Kong, China
| | - Yufei Chen
- Department of labor and social security, Jilin University, Qianjin Street 2699, Changchun, China
| |
Collapse
|
9
|
Olcoń K, Rambaldini-Gooding D, Degeling C. Implementation gaps in culturally responsive care for refugee and migrant maternal health in New South Wales, Australia. BMC Health Serv Res 2023; 23:42. [PMID: 36650536 PMCID: PMC9843667 DOI: 10.1186/s12913-023-09066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 01/16/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Refugee and migrant women are at higher risk of childbirth complications and generally poorer pregnancy outcomes. They also report lower satisfaction with pregnancy care because of language barriers, perceived negative attitudes among service providers, and a lack of understanding of refugee and migrant women's needs. This study juxtaposes health policy expectations in New South Wales (NSW), Australia on pregnancy and maternity care and cultural responsiveness and the experiences of maternal healthcare providers in their day-to-day work with refugee and migrant women from non-English speaking backgrounds. METHODS This study used a qualitative framework method to allow for a comparison of providers' experiences with the policy expectations. Sixteen maternal health service providers who work with refugee and migrant women were recruited from two local health districts in New South Wales, Australia and interviewed (November 2019 to August 2020) about their experiences and the challenges they faced. In addition, a systematic search was conducted for policy documents related to the provision of maternal health care to refugee and migrant women on a state and federal level and five policies were included in the analysis. RESULTS Framework analysis revealed structural barriers to culturally responsive service provision and the differential impacts of implementation gaps that impede appropriate care resulting in moral distress. Rather than being the programmatic outcome of well-resourced policies, the enactment of cultural responsiveness in the settings studied relied primarily on the intuitions and personal responses of individual service providers such as nurses and social workers. CONCLUSION Authentic culturally responsive care requires healthcare organisations to do more than provide staff training. To better promote service user and staff satisfaction and wellbeing, organisations need to embed structures to respond to the needs of refugee and migrant communities in the maternal health sector and beyond.
Collapse
Affiliation(s)
- Katarzyna Olcoń
- grid.1007.60000 0004 0486 528XSchool of Health and Society, Faculty of the Arts, Social Sciences and Humanities, The University of Wollongong, Wollongong, NSW 2522 Australia
| | - Delia Rambaldini-Gooding
- grid.1007.60000 0004 0486 528XSchool of Health and Society, Faculty of the Arts, Social Sciences and Humanities, The University of Wollongong, Wollongong, NSW 2522 Australia
| | - Chris Degeling
- grid.1007.60000 0004 0486 528XSchool of Health and Society, Faculty of the Arts, Social Sciences and Humanities, The University of Wollongong, Wollongong, NSW 2522 Australia
| |
Collapse
|
10
|
Leigh JK, Peña LD, Anurudran A, Pai A. "Are you safe to talk?": Perspectives of Service Providers on Experiences of Domestic Violence During the COVID-19 Pandemic. J Fam Violence 2023; 38:215-225. [PMID: 35068672 PMCID: PMC8759221 DOI: 10.1007/s10896-022-00359-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 05/07/2023]
Abstract
This study aimed to better understand the factors driving reported trends in domestic violence during the COVID-19 pandemic, particularly the effect of the pandemic on survivors' experiences of violence and ability to seek support. We conducted semi-structured qualitative interviews with 32 DV service providers operating in organizations across 24 U.S. cities. The majority of providers described a decrease in contact volume when shelter-in-place orders were first established, which they attributed to safety concerns, competing survival priorities, and miscommunication about what resources were available. For most organizations, this decrease was followed by an increase in contacts after the lifting of shelter-in-place orders, often surpassing typical contact counts from the pre-pandemic period. Providers identified survivors' ability to return to some aspects of their pre-pandemic lives, increased stress levels, and increased lethality of cases as key factors driving this increase. In addition, providers described several unique challenges faced by DV survivors during the pandemic, such as the use of the virus as an additional tool for control by abusers and an exacerbated lack of social support. These findings provide insight into the lived experiences driving observed trends in DV rates during COVID-19. Understanding the impact of the pandemic on survivors can help to shape public health and policy interventions to better support this vulnerable population during future crises.
Collapse
Affiliation(s)
- Jenny K. Leigh
- Present Address: COVID-19 Task Force On Domestic Violence, 1629 K Street, NW #300, Washington DC, 20006 USA
- Department of Sociology, New York University, New York, NY USA
| | - Lita Danielle Peña
- Present Address: COVID-19 Task Force On Domestic Violence, 1629 K Street, NW #300, Washington DC, 20006 USA
- Institute of Psychiatry, Psychology, & Neuroscience, King’s College London, London, UK
| | - Ashri Anurudran
- Present Address: COVID-19 Task Force On Domestic Violence, 1629 K Street, NW #300, Washington DC, 20006 USA
- Harvard Medical School, Boston, MA USA
| | - Anant Pai
- Present Address: COVID-19 Task Force On Domestic Violence, 1629 K Street, NW #300, Washington DC, 20006 USA
| |
Collapse
|
11
|
Marchand K, Turuba R, Katan C, Fogarty O, Fairbank J, Tallon C, Mathias S, Barbic S. "The system always undermined what I was trying to do as an individual": identifying opportunities to improve the delivery of opioid use services for youth from the perspective of service providers in four communities across British Columbia, Canada. Addict Sci Clin Pract 2023; 18:1. [PMID: 36593469 PMCID: PMC9806820 DOI: 10.1186/s13722-022-00359-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Substance use among youth is a longstanding global health concern that has dramatically risen in the era of highly toxic and unregulated drugs, including opioids. It is crucial to ensure that youth using unregulated opioids have access to evidence-based interventions, and yet, youth encounter critical gaps in the quality of such interventions. This study aims to address these gaps by identifying opportunities to improve the quality of opioid use services from the perspective of service providers, a perspective that has received scant attention. METHODS This community-based participatory study was conducted in four communities in British Columbia (Canada), a province that declared a public health overdose emergency in 2016. Human-centered co-design workshops were held to understand service providers' (n = 41) experiences, needs, and ideas for improving the quality of youth opioid use services/treatments in their community. Multi-site qualitative analysis was used to develop overarching experiences and needs themes that were further contextualized in each local community. A blended deductive and inductive thematic analysis was used to analyze the ideas data. RESULTS Three overarching themes were identified, reflecting service providers' goals to respond to youth in a timely and developmentally appropriate manner. However, this was significantly limited by organizational and systems-level barriers, revealing service providers' priorities for intra- and inter-organizational support and collaboration and systems-level innovation. Across communities, service providers identified 209 individual ideas to address these prioritized needs and improve the quality of youth opioid use services/treatments. CONCLUSION These themes demonstrate a multi-level tension between macro-level systems and the meso-level organization of youth opioid use services, which undermine the quality of individual-level care service providers can deliver. These findings underscore the need for a coordinated multi-level response, such as developing youth-specific standards (macro-level), increasing inter-organizational activities and collaboration (meso-level), and creating programs that are specific to youths' needs (micro-level).
Collapse
Affiliation(s)
- Kirsten Marchand
- Foundry, 915-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada. .,Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Roxanne Turuba
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Christina Katan
- Canadian Centre on Substance Use and Addiction, 500-75 Albert St, Ottawa, ON K1P 5E7 Canada
| | - Oonagh Fogarty
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Jill Fairbank
- Canadian Centre on Substance Use and Addiction, 500-75 Albert St, Ottawa, ON K1P 5E7 Canada
| | | | - Steve Mathias
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Providence Health Care, 1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,Providence Research, 1190 Hornby St, Vancouver, BC V6Z 1Y6 Canada
| | - Skye Barbic
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.498725.5Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Providence Health Care, 1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,Providence Research, 1190 Hornby St, Vancouver, BC V6Z 1Y6 Canada
| |
Collapse
|
12
|
König B, Schmid H. [The future of affiliated physicians]. Urologie 2022; 61:823-828. [PMID: 35925292 DOI: 10.1007/s00120-022-01877-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
The affiliated physician is one of the oldest types of self-employed physicians who work between outpatients and inpatient sectors. The number of physicians affiliated with hospitals in Germany has been decreasing steadily in recent decades. The reasons for this decline are diverse and include political and financial problems that need to be resolved. The new political changes aimed at the expansion of out-patient services in the sense of the AOP Catalog 115 b SGB V can be a new opportunity for affiliated physicians and the departments that they are affiliated with.
Collapse
Affiliation(s)
- Bernd König
- , Eibenstr.21, 26871, Papenburg, Deutschland.
| | - Hans Schmid
- Abteilung Urologie, Helios-Klinik Wesermarsch, Nordenham, Deutschland
| |
Collapse
|
13
|
Mokitimi S, Jonas K, Schneider M, de Vries PJ. Child and adolescent mental health services in the Western Cape Province of South Africa: the perspectives of service providers. Child Adolesc Psychiatry Ment Health 2022; 16:57. [PMID: 35836277 PMCID: PMC9284743 DOI: 10.1186/s13034-022-00491-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current work in the field point to the need to strengthen child and adolescent mental health services (CAMHS) globally, and especially in low- and middle-income countries (LMICs). Policy development, planning and service provision must be relevant to the needs of stakeholders at grassroots level, and should include their perspectives. This study set out to explore the perspectives and lived experiences of service providers, including their recommendations to strengthen CAMHS in South Africa. METHODS Using focus group discussions (FGDs) and semi-structured individual interviews (SSIIs), qualitative data were collected from 46 purposefully selected multidisciplinary health service providers across the Western Cape, one of the nine provinces of South Africa. Audio-recorded data were entered into NVivo 11 (QSR), and thematic analysis was performed by two independent raters. RESULTS Results highlighted a significant lack of CAMH resources, poor intersectoral collaboration, limited access to training, absence of consistency and uniformity in service delivery, weak support for staff, and high rates of negative attitudes of staff. External factors contributing to poor CAMHS identified by service providers included poor socioeconomic circumstances, high rates of HIV/AIDS, substance use and stigma. The eight recommendations to strengthen CAMHS included a need to (1) increase CAMH staffing, (2) provide dedicated CAMHS at secondary care and child-friendly infrastructure at primary care, (3) review current service focus on number of patients seen versus quality of care provided to children, (4) formalise intersectoral collaborations, (5) increase learning opportunities for trainees, (6) employ a lead professional for CAMHS in the province, (7) increase support for staff, and (8) acknowledge staff initiatives. CONCLUSIONS Findings underlined the need for quality improvement, standardisation and scale-up of mental health services for children and adolescents in South Africa. Whilst we used the Western Cape as a 'case study', we propose that our findings may also be relevant to other LMICs. We recommend that the perspectives of service users, including children and adolescents, be sought to inform service transformation.
Collapse
Affiliation(s)
- Stella Mokitimi
- grid.7836.a0000 0004 1937 1151Division of Child and Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Kim Jonas
- grid.415021.30000 0000 9155 0024South African Medical Research Council, Cape Town, South Africa
| | - Marguerite Schneider
- grid.7836.a0000 0004 1937 1151Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Petrus J. de Vries
- grid.7836.a0000 0004 1937 1151Division of Child and Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| |
Collapse
|
14
|
Gamieldien F, Galvaan R, Myers B, Sorsdahl K. Service Providers Perspectives on Personal Recovery from Severe Mental Illness in Cape Town, South Africa: A Qualitative Study. Community Ment Health J 2022; 58:955-966. [PMID: 34671918 PMCID: PMC9187550 DOI: 10.1007/s10597-021-00904-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 10/06/2021] [Indexed: 11/29/2022]
Abstract
Severe mental illnesses (SMI) contribute significantly to the global burden of disease. In low-and-middle-income countries (LMICs), the treatment gap impacts the clinical and personal recovery of people living with an SMI. The drive to reduce this treatment gap in LMICs makes it pertinent to understand service providers' views on recovery from SMI. Semi-structured interviews and focus groups with service providers from health services and non-profit organisations in the Western Cape Province, South Africa, were conducted in this qualitative study. Seventeen participants were purposively selected, and data were thematically analysed. Three major themes emerged: delineating recovery, available services supporting recovery from SMI, and facilitators and barriers to recovery at the service level. Health services favoured clinical over personal recovery. Participants thought that many service users' personal recovery from SMI was hindered by intersecting social, economic, cultural, and political inequalities that extended beyond the influence of the health sector.
Collapse
Affiliation(s)
- Fadia Gamieldien
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa. .,Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa.
| | - Roshan Galvaan
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Faculty of Health Sciences, Curtin enAble Institute, Curtin University, Perth, WA, Australia.,Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa
| |
Collapse
|
15
|
Brooks MA, Dasgupta A, Taşğın NŞ, Meinhart M, Tekin U, Yükseker D, Kaushal N, El-Bassel N. Secondary Traumatic Stress, Depression, and Anxiety Symptoms Among Service Providers Working with Syrian Refugees in Istanbul, Turkey. J Immigr Minor Health 2022. [PMID: 35212824 DOI: 10.1007/s10903-022-01344-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
This paper examines the mental health of service providers working with Syrian refugees. Using the Professional Quality of Life framework, we hypothesize greater stress/less support from the work, person, client environment is associated with symptoms of STS, depression, and anxiety. We surveyed a sample of 104 service providers throughout Istanbul late 2018. Multivariable logistic regression examined associations between work (organizational support, caseload, supervision), person (perceived social support), client environment (trauma disclosure, percent Syrian refugees) on STS, depression, and anxiety. We found rates of moderate-to-severe STS to be 27.88%; depression 40.38%; and anxiety 29.81%. Our hypothesis was partially supported. Lower organizational support was associated with moderate-to-severe STS (aOR 0.91, 95% CI 0.84, 0.99) while lower social support with anxiety (aOR 0.89, 95% CI 0.81, 0.99). Caseload, supervision, trauma disclosure, percent refugees did not show significant associations. Organizations working with Syrian refugees may benefit from enhancing organizational support and promoting social support for staff.
Collapse
|
16
|
Sedgewick JR, Ali A, Badea A, Carr T, Groot G. Service providers' perceptions of support needs for Indigenous cancer patients in Saskatchewan: a needs assessment. BMC Health Serv Res 2021; 21:848. [PMID: 34419035 PMCID: PMC8380380 DOI: 10.1186/s12913-021-06821-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/26/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In Saskatchewan, Canada, Indigenous cancer care services at the municipal, provincial, and federal levels are intended to improve quality care but can result in a complex, fragmented, and multi-jurisdictional health care system. A multi-phase needs assessment project was initiated to document Indigenous cancer care needs. Guided by Indigenous patient partners, clinicians, academics, and policy makers, the present study reflects a needs assessment of Indigenous cancer supports from the perspectives of cancer care service providers. METHODS Qualitative data were collected through three focus groups with 20 service providers for cancer patients and their families at three Saskatchewan cities. Participants included chemotherapy and radiation nurses, social workers, a patient navigator, dieticians, and practicum students. A semi-structured interview guide was used to conduct the sessions to allow for freedom of responses. Data were recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS Service providers' perspectives were categorized into five themes: 1) addressing travel-related issues, 2) logistical challenges, 3) improvements to Indigenous-specific health care supports, 4) cultural sensitivity in health care, and 5) consistency in care. Supports provided differed for the two Indigenous groups, First Nations and Métis. Service providers made recommendations regarding how needs could be met. They saw language translation providers and Elder supports as important. Recommendations for improving travel were for medical taxis to include breaks so that passengers may alleviate any uncomfortable side effects of their cancer treatment. Further, Indigenous-specific accommodations were recommended for those requiring medical travel. These recommendations aligned with supports that are available in four other Canadian provinces. CONCLUSIONS These results identified gaps in supports and outlined recommendations to address barriers to cancer care from the perspectives of service providers. These recommendations may inform evidence-based health system interventions for Indigenous cancer patients and ultimately aim to improve cancer care services, quality of life, and health outcomes of Indigenous patients throughout their cancer journey.
Collapse
Affiliation(s)
- Jennifer R Sedgewick
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Anum Ali
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Andreea Badea
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Tracey Carr
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Gary Groot
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
| |
Collapse
|
17
|
Goodridge D, Roger KS, Walsh CA, PausJenssen E, Cewick M, Liepert C. Service providers' use of harm reduction approaches in working with older adults experiencing abuse: a qualitative study. BMC Geriatr 2021; 21:398. [PMID: 34193077 PMCID: PMC8242276 DOI: 10.1186/s12877-021-02328-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although abuse experienced by older adults is common and expected to increase, disclosure, reporting and interventions to prevent or mitigate abuse remain sub-optimal. Incorporating principles of harm reduction into service provision has been advocated as a strategy that may improve outcomes for this population. This paper explores whether and how these principles of harm reduction were employed by professionals who provide services to older adults experiencing abuse. METHODS Thematic analysis of qualitative interviews with 23 professionals providing services to older adults experiencing abuse across three Western provinces of Canada was conducted. Key principles of harm reduction (humanism, incrementalism, individualism, pragmatism, autonomy, and accountability without termination) were used as a framework for organizing the themes. RESULTS Our analysis illustrated a clear congruence between each of the six harm reduction principles and the approaches reflected in the narratives of professionals who provided services to this population, although these were not explicitly articulated as harm reduction by participants. Each of the harm reduction principles was evident in service providers' description of their professional practice with abused older adults, although some principles were emphasized differentially at different phases of the disclosure and intervention process. Enactment of a humanistic approach formed the basis of the therapeutic client-provider relationships with abused older adults, with incremental, individual, and pragmatic principles also apparent in the discourse of participants. While respect for the older adult's autonomy figured prominently in the data, concerns about the welfare of the older adults with questionable capacity were expressed when they did not engage with services or chose to return to a high-risk environment. Accountability without termination of the client-provider relationship was reflected in continuation of support regardless of the decisions made by the older adult experiencing abuse. CONCLUSIONS Harm reduction approaches are evident in service providers' accounts of working with older adults experiencing abuse. While further refinement of the operational definitions of harm reduction principles specific to their application with older adults is still required, this harm reduction framework aligns well with both the ethical imperatives and the practical realities of supporting older adults experiencing abuse.
Collapse
Affiliation(s)
- Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - Kerstin Stieber Roger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | - Marina Cewick
- Faculty of Education, University of Manitoba, Winnipeg, Canada
| | - Carla Liepert
- Faculty of Social Work, University of Calgary, Calgary, Canada
| |
Collapse
|
18
|
Rogers HJ, Hogan L, Coates D, Homer CSE, Henry A. Cross Cultural Workers for women and families from migrant and refugee backgrounds: a mixed-methods study of service providers perceptions. BMC Womens Health 2021; 21:222. [PMID: 34044833 PMCID: PMC8161620 DOI: 10.1186/s12905-021-01368-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022]
Abstract
Background Women from migrant and refugee backgrounds who live in high-income countries are at increased risk of adverse perinatal outcomes, including mental health issues, preterm birth and maternal and infant mortality. There is a need to implement and evaluate models of care to meet their specific needs in order to improve health outcomes, their experiences of care, and overcome barriers to access. In Sydney, Australia, a unique model of care was implemented to support women and families from migrant and refugee backgrounds to access health and community-based services through the continuum of pregnancy to the early parenting period. This model of care is known as the Cross Cultural Workers (CCWs) in Maternity and Child and Family Health Service (the CCW Service). The aim of this study was to explore the perceptions of service providers regarding the CCW Service and identify recommendations for improvement. Methods A mixed-methods study was conducted consisting of surveys and face to face semi-structured interviews. Service providers were recruited from hospital-based maternity and community-based services. Survey data were analysed descriptively. Interviews were analysed using qualitative content analysis. Results Sixty-nine service providers completed surveys and 19 were interviewed. The CCW Service was highly regarded by service providers who perceived it to be critical in improving care for women from migrant and refugee backgrounds. The overarching theme from the interviews was the ability of the CCW Service to act as a ‘bridge to health’ through the provision of culturally responsive care. There were three main categories; supporting access to health and community-based services, improving the healthcare experience, and organisational factors, including part-time hours, capacity, heavy workloads and confusion/lack of clarity regarding the CCW role, which affected CCWs’ capacity to optimally support service providers in providing culturally responsive care. These limitations meant CCWs were not able to meet demand, and fully operationalise the model. Conclusion Service providers perceived the CCW model to be a culturally responsive model of care tailored to the needs of women and families from migrant and refugee backgrounds, that reduces barriers to access, and has the potential to improve perinatal outcomes, and women's experience and satisfaction with care. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01368-4.
Collapse
Affiliation(s)
- Helen J Rogers
- Child, Youth and Family Services, South Eastern Sydney Local Health District, Sydney, NSW, 2010, Australia. .,School of Women's and Children's Health, University of NSW (UNSW), Sydney, NSW, 2052, Australia.
| | - Lily Hogan
- School of Women's and Children's Health, University of NSW (UNSW), Sydney, NSW, 2052, Australia
| | - Dominiek Coates
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Caroline S E Homer
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia.,Maternal and Child Health, Burnet Institute, Melbourne, VIC, 3004, Australia
| | - Amanda Henry
- School of Women's and Children's Health, University of NSW (UNSW), Sydney, NSW, 2052, Australia.,Department of Women's and Children's Health, St George Hospital, Sydney, NSW, 2217, Australia.,Australia Global Women's Health Program, The George Institute for Global Health, Sydney, NSW, 2042, Australia
| |
Collapse
|
19
|
Lee GK, Curtiss SL, Kuo HJ, Chun J, Lee H, Nimako DD. The Role of Acceptance in the Transition to Adulthood: A Multi-Informant Comparison of Practitioners, Families, and Youth with Autism. J Autism Dev Disord 2021; 52:1444-1457. [PMID: 33942187 DOI: 10.1007/s10803-021-05037-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
This study investigated the role of acceptance during the transition process among autistic young adults, parents, and practitioners. Six focus groups were run and thematic analysis was used to identify four themes: Youth on the autism spectrum discussed transition as a time where Self-Advocacy and Self-Acceptance were salient. Both youth and parents discussed the Lack of Understanding and Acceptance they experience. Particularly, youth highlighted the lack of understanding of sensory needs and parents underscored the lack of understanding by medical professionals. In contrast, practitioners highlighted the presence of Community Openness. Both practitioners and parents discussed Finding Personal Support through Acceptance. Self-acceptance and acceptance of autism are imperative for autistic young adults and families to achieve well-being.
Collapse
Affiliation(s)
- Gloria K Lee
- Department of Counseling, Educational Psychology & Special Education, Michigan State University, 620 Farm Lane, East Lansing, MI, 48824, USA.
| | - Sarah L Curtiss
- College of Education and Human Development, University of Delaware, 25 N. College Avenue, Newark, DE, 19716, USA
| | - Hung Jen Kuo
- Department of Counseling, Educational Psychology & Special Education, Michigan State University, 620 Farm Lane, East Lansing, MI, 48824, USA
| | - Jina Chun
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, 1000 Bascom Mall, Madison, WI, 53706, USA
| | - Heekyung Lee
- Department of Counseling, Educational Psychology & Special Education, Michigan State University, 620 Farm Lane, East Lansing, MI, 48824, USA
| | - Danielle D Nimako
- Department or Counselor Education, Emporia State University, 1601 State Street, Emporia, KS, 66801, USA
| |
Collapse
|
20
|
Raifman S, Baum SE, White K, Hopkins K, Ogburn T, Grossman D. Perspectives on self-managed abortion among providers in hospitals along the Texas-Mexico border. BMC Womens Health 2021; 21:132. [PMID: 33784993 PMCID: PMC8008213 DOI: 10.1186/s12905-021-01281-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/12/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Following self-managed abortion (SMA), or a pregnancy termination attempt outside of the formal health system, some patients may seek care in an emergency department. Information about provider experiences treating these patients in hospital settings on the Texas-Mexico border is lacking. METHODS The study team conducted semi-structured interviews with physicians, advanced practice clinicians, and nurses who had experience with patients presenting with early pregnancy complications in emergency and/or labor and delivery departments in five hospitals near the Texas-Mexico border. Interview questions focused on respondents' roles at the hospital, knowledge of abortion services and laws, perspectives on SMA trends, experiences treating patients presenting after SMA, and potential gaps in training related to abortion. Researchers conducted interviews in person between October 2017 and January 2018, and analyzed transcripts using a thematic analysis approach. RESULTS Most of the 54 participants interviewed said that the care provided to SMA patients was, and should be, the same as for patients presenting after miscarriage. The majority had treated a patient they suspected or confirmed had attempted SMA; typically, these cases required only expectant management and confirmation of pregnancy termination, or treatment for incomplete abortion. In rare cases, further clinical intervention was required. Many providers lacked clinical and legal knowledge about abortion, including local resources available. CONCLUSIONS Treatment provided to SMA patients is similar to that provided to patients presenting after early pregnancy loss. Lack of provider knowledge about abortion and SMA, despite their involvement with SMA patients, highlights a need for improved training.
Collapse
Affiliation(s)
- Sarah Raifman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
| | - Sarah E Baum
- Ibis Reproductive Health, 1736 Franklin St, Suite 600, Oakland, CA, 94612, USA
| | - Kari White
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Stop D3500, TX, 78712, Austin, USA
| | - Kristine Hopkins
- Population Research Center, The University of Texas at Austin, 305 E. 23rd St. Stop G1800, Austin, TX, 78712-1699, USA
| | - Tony Ogburn
- University of Texas Rio Grande Valley, 2102 Treasure Hill Blvd, Harlingen, TX, 78550, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
| |
Collapse
|
21
|
Antunes AAM, Vaz DV. Family-Centered practice in a Brazilian rehabilitation network service. Braz J Phys Ther 2021; 25:544-551. [PMID: 33722507 DOI: 10.1016/j.bjpt.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/13/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Family-centered practice (FCP) is widely accepted as a best practice in pediatric rehabilitation. However, its implementation in Brazil is incipient, and systematic documentation of the extent to which it has been achieved is not available. OBJECTIVES To determine parents' and service providers' perceptions of family-centeredness and specific areas in need of improvement in four rehabilitation hospitals. METHODS A total of 107 caregivers and 89 service providers responded to the Measure of Processes of Care-20 (MPOC-20) and the Measure of Processes of Care for Service providers (MPOC-SP), respectively. The MPOC questionnaires evaluate FCP from the point of view of parents and rehabilitation professionals. Domain scores within each questionnaire were compared with Kruskal-Wallis and Mann-Whitney tests. MPOC items with low scores (from 1-4 out of 7 by 33% or more of respondents) were considered to indicate weaknesses in service delivery. RESULTS Median MPOC-20 scores varied from 5.2 (4.7, 5.8) (Providing General Information) to 7.0 (6.0, 7.0) (Enabling and Partnership). The Providing General Information scores were significantly lower than those of other domains (p < 0.003). The MPOC-SP scores varied from 4.8 (4.0, 5.8) (Providing General Information) to 6.1 (5.8, 6.6) (Treating People Respectfully). Scores for Treating People Respectfully were significantly higher (p < 0.0001) and Providing General Information scores significantly lower (p < 0.0001) than those of the other domains. Most items with high percentages of low scores were from the domain Providing General Information. CONCLUSION Except for Providing General Information, the results indicated that services implement FCP "to a fairly great extent," comparing favorably to international data. Provision of information can be improved.
Collapse
Affiliation(s)
- Ana Amélia Moraes Antunes
- Rehabilitation Sciences Graduate Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Physical Therapist, Rede Sarah de Hospitais de Reabilitação, Belo Horizonte, MG, Brazil
| | - Daniela Virgínia Vaz
- Departament of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
| |
Collapse
|
22
|
Tiwari A, Smith S, Wekerle C, Kimber M, Jack SM, MacMillan H, Gonzalez A. Trauma services for youth victims of sexual abuse- does one size fit all? A qualitative study among service providers in Ontario, Canada. Child Abuse Negl 2021; 112:104903. [PMID: 33412414 DOI: 10.1016/j.chiabu.2020.104903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite a range of interventions available to treat mental health symptoms experienced by youth with a history of child sexual abuse (CSA), limited empirical work has examined practitioner delivery of these interventions in real-world practice. OBJECTIVE This paper aimed to qualitatively explore the delivery of trauma-based interventions in community settings in Ontario, Canada. PARTICIPANTS AND SETTINGS Using qualitative description, a purposeful sample of service providers (N = 51; 92 % female) were recruited from nine community-based organizations located in Southern Ontario, Canada providing psychotherapeutic trauma-based interventions to youth with a history of child sexual abuse. METHODS Semi-structured one-on-one (n = 17), joint (n = 3) and focus group (n = 5) interviews elicited provider descriptions of their strategies and approaches for addressing trauma-related symptoms in this population. Data were interpreted using conventional content analyses. RESULTS Eclectic delivery of interventions and multifactorial decision-making processes were identified as core elements of treatment planning and intervention delivery among providers. Eclectic treatment was described to involve the consideration of four core elements (provider judgement; youth voice; youth characteristics; and clinical team discussion) of intervention and three key principles (meeting youth needs; providing client-centered care; addressing safety and stability). CONCLUSIONS Research capable of characterizing the efficacy of client-centered, eclectic approaches to treat symptoms experienced by youth with a history of CSA is needed.
Collapse
Affiliation(s)
- Ashwini Tiwari
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, Administration, B3, 100 West 5th, Hamilton, ON L8N 3K7 Canada.
| | - Savanah Smith
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4L8, Canada.
| | - Christine Wekerle
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4L8, Canada.
| | - Melissa Kimber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, Administration, B3, 100 West 5th, Hamilton, ON L8N 3K7 Canada.
| | - Susan M Jack
- School of Nursing, McMaster University 1280 Main Street West, Hamilton, Ontario L8S4L8, Canada.
| | - Harriet MacMillan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, Administration, B3, 100 West 5th, Hamilton, ON L8N 3K7 Canada.
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, Administration, B3, 100 West 5th, Hamilton, ON L8N 3K7 Canada.
| |
Collapse
|
23
|
Kenu A, Kenu E, Bandoh DA, Aikins M. Factors that promote and sustain the use of traditional, complementary and integrative medicine services at LEKMA hospital, Ghana, 2017: an observational study. BMC Complement Med Ther 2021; 21:14. [PMID: 33407386 PMCID: PMC7788857 DOI: 10.1186/s12906-020-03185-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background About 70% of Ghanaians depend on traditional, complementary and integrative medicine (TCIM) practices for primary healthcare needs. It was therefore integrated into mainstream healthcare delivery system by the Ministry of Health in September 2012. LEKMA hospital was one of the institutions for piloting TCIM services. We assessed factors that promote the usage and sustainability of TCIM services within the formal healthcare system. Methods We conducted a cross-sectional study from April–June 2017 at the LEKMA hospital, Accra, Ghana. Patients and managers of TCIM clinic were interviewed. Data was collected through qualitative and quantitative approaches. We defined usage of TCIM as its current use, and sustainability as structures in place to run TCIM services. For assessing usage, a five-point Likert scale was used to assess five domain areas via exit interviews. Managers were assessed on the sustainability of TCIM services through in-depth interviews. Likert scales responses were analysed quantitatively using descriptive tertile statistics. Thematic analysis was used for qualitative analysis. Results Overall, 72.7% (40/55) of the clients showed a high preference for TCIM usage and 80.0% (4/5) of the managers valued it as partially sustainable. Eighty per cent (44/55) of patients indicated that the location of TCIM services and availability of visible directional signs influenced the good usage; 84% (46/55) of the patients agreed that the usage of TCIM was influenced by their perceived effectiveness. Managers indicated that human resources for providing services was a challenge and TCIM integration into the operations of the hospital needed to be improved. Conclusion We observed a high preference for usage of TCIM among users at LEKMA hospital. The general belief in the potency, perceived effectiveness, location and availability of TCIM services are key determinants of the high preference for usage of TCIM. Provision of TCIM services in its current form is partially sustainable from the managers’ perspective. We recommend that the Ministry of Health ensures the availability of staff and create awareness of TCIM services among the general populace.
Collapse
Affiliation(s)
- Angela Kenu
- School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Ernest Kenu
- School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana. .,Ghana Field Epidemiology and Laboratory Training Program (GFELTP), Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
| | - Delia Akosua Bandoh
- Ghana Field Epidemiology and Laboratory Training Program (GFELTP), Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Moses Aikins
- School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.,Health Economics, Systems and Policy Research Group (HESPRG), Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| |
Collapse
|
24
|
Ogbuabor DC. Through service providers' eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-Eastern Nigeria. BMC Infect Dis 2020; 20:206. [PMID: 32143584 PMCID: PMC7060534 DOI: 10.1186/s12879-020-4944-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/02/2020] [Indexed: 01/06/2023] Open
Abstract
Background Well-functioning health systems are essential to achieving global and national tuberculosis (TB) control targets. This study examined health system factors affecting implementation of TB control programme from the perspectives of service providers. Methods The study was conducted in Enugu State, South-eastern Nigeria using qualitative, cross-sectional design involving 23 TB service providers (13 district TB supervisors and 10 facility TB focal persons). Data were collected through in-depth, semi-structured interviews using a health system dynamic framework and analysed thematically. Results Stewardship from National TB Control Programme (NTP) improved governance of TB control, but stewardship from local government was weak. Government spending on TB control was inadequate, whereas donors fund TB control. Poor human resources management practices hindered TB service delivery. TB service providers have poor capacity for data management because changes in recording and reporting tools were not matched with training of service providers. Drugs and other supplies to TB treatment centres were interrupted despite the use of a logistics agency. Poor integration of TB into general health services, weak laboratory capacity, withdrawal of subsidies to community volunteers and patent medicine vendors, poorly funded patient tracking systems, and ineffectual TB/HIV collaboration resulted in weak organisation of TB service delivery. Conclusion Health systems strengthening for TB control service must focus on effective oversight from NTP and local health system; predictable domestic resource mobilisation through budgets and social health insurance; training and incentives to attract and retain TB service providers; effective supply and TB drug management; and improvements in organization of service delivery.
Collapse
Affiliation(s)
- Daniel Chukwuemeka Ogbuabor
- Department of Health Administration and Management, University of Nigeria Enugu Campus, Enugu, Enugu State, Nigeria. .,Department of Health Systems and Policy, Sustainable Impact Resource Agency, Enugu, Enugu State, Nigeria.
| |
Collapse
|
25
|
Abstract
This study addressed the predictors of service providers' use of a multi-level evidence-based program (EBP). Of the 92 trained providers participating in the study, 67 (72.8%) used the EBP at least once. A multidimensional index of the amount of usage (MUI) was created using three indicators. Providers' self-efficacy and the amount of training they had received predicted their amount of usage. The community to which the providers belonged was also associated with their amount of usage. The findings underline the importance of studying many indicators of usage in implementation research and considering both provider-level and broader contextual variables as determinants of the use of EBPs.
Collapse
Affiliation(s)
- Émilie Charest
- École de Psychologie, Université Laval, 2325 rue des Bibliothèques, Pavillon F.-A.-Savard, 11e étage, Québec, QC, G1V 0A6, Canada
| | - Marie-Hélène Gagné
- École de Psychologie, Université Laval, 2325 rue des Bibliothèques, Pavillon F.-A.-Savard, 11e étage, Québec, QC, G1V 0A6, Canada.
| |
Collapse
|
26
|
Mutisya R, Wambua J, Nyachae P, Kamau M, Karnad SR, Kabue M. Strengthening integration of family planning with HIV/AIDS and other services: experience from three Kenyan cities. Reprod Health 2019; 16:62. [PMID: 31138271 PMCID: PMC6538540 DOI: 10.1186/s12978-019-0715-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Kenya has made remarkable progress in integrating a range of reproductive health services with HIV/AIDS services over the past decade. This study describes a sub-set of outcomes from the Bill & Melinda Gates Foundation (BMGF)-funded Jhpiego-led Kenya Urban Reproductive Health Initiative (Tupange) Project (2010–2015), specifically addressing strengthening family planning (FP) integration with a range of primary care services including HIV testing and counselling, HIV care services, and maternal, newborn and child care. Methods A cross-sectional study was conducted between August and October 2013 in the cities of Mombasa, Nairobi and Kisumu in Kenya to assess the level of FP integration across six other service delivery areas (antenatal care clinic, maternity wards, postnatal care clinic, child welfare clinic, HIV testing and counseling (HTC) clinics, HIV/AIDS services in comprehensive care clinics). The variables of interest were level of integration, provider knowledge, and provider skills. Routine program monitoring data on workload was utilized for sampling, with additional data collected and analyzed from twenty health facilities selected for this study, along with client exit interviews. Descriptive analysis and Chi-square/ Fishers Exact tests were done to explore relationships between variables of interest. Results Integration of FP occurred in all the five service areas to varying degrees. Service provider FP knowledge in four service delivery areas (HTC clinic, antenatal clinic, postnatal clinic, and child welfare clinic) increased with increasing levels of integration. Forty-seven percent of the clients reported that time spent accessing FP services in the HTC clinic was reasonable. However, no FP knowledge was reported from service providers in HIV/AIDS comprehensive care clinics in all levels of integration despite observed provision of counseling and referral for FP services. Conclusions Integration of FP services in other primary care service areas including HTC clinic can be enhanced through targeted interventions at the facility. A holistic approach to address service providers’ capacity and attitudes, ensuring FP commodity security, and creating a supportive environment to accommodate service integration is necessary and recommended. Additional studies are necessary to identify ways of enhancing FP integration, particularly with HIV/AIDS care services. Electronic supplementary material The online version of this article (10.1186/s12978-019-0715-8) contains supplementary material, which is available to authorized users.
Collapse
|
27
|
Li L, Liang LJ, Lin C, Feng N, Cao W, Wu Z. An intervention to improve provider-patient interaction at methadone maintenance treatment in China. J Subst Abuse Treat 2019; 99:149-155. [PMID: 30797387 DOI: 10.1016/j.jsat.2019.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study evaluated an intervention aiming to improve methadone maintenance therapy (MMT) service providers' interaction with their patients in China. METHODS Sixty-eight MMT clinics were randomized to either an intervention or a control condition. Providers in the intervention group attended three group training sessions to enhance their communication skills. Trained providers were encouraged to practice the taught communication skills through provider-initiated individual sessions with their patients. A total of 418 service providers completed assessments from baseline to 24-month. Linear mixed-effects regression models were used to compare self-reported short-term and sustained improvement in provider-patient interaction between the intervention and the control conditions. RESULTS The intervention group service providers perceived significantly greater short-term and sustained improvement in provider-patient interaction compared to the control group service providers (estimated difference (±SE): 1.20 (0.24) and 1.35 (0.33), respectively; p-values < 0.0001). Providers' baseline job satisfaction was significantly associated with a greater perceived improvement in provider-patient interaction for both periods (reg. coef. (±SE): 0.02 (0.01) and 0.04 (0.01) for short-term and sustained periods, respectively; p-values < 0.01). CONCLUSION Study findings suggest that the intervention could be beneficial for improving perceived provider-patient interaction in MMT programs. Service providers' job satisfaction should be addressed in training programs for the improvement of provider-patient interaction.
Collapse
Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
| | - Li-Jung Liang
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Nan Feng
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Wei Cao
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
| |
Collapse
|
28
|
Janda M, Horsham C, Koh U, Gillespie N, Vagenas D, Loescher LJ, Curiel-Lewandrowski C, Hofmann-Wellenhof R, Peter Soyer H. Evaluating healthcare practitioners' views on store-and-forward teledermoscopy services for the diagnosis of skin cancer. Digit Health 2019; 5:2055207619828225. [PMID: 30792879 PMCID: PMC6376520 DOI: 10.1177/2055207619828225] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/13/2019] [Indexed: 12/02/2022] Open
Abstract
Objective The aim of the study is to evaluate healthcare practitioners’ views on and
satisfaction with (i) digital image acquisition and storage and (ii)
store-and-forward teledermoscopy services for the diagnosis of skin cancer
in their clinical practice. Methods An online survey was conducted among 59 healthcare practitioners (GPs
(n=17), dermatologists (n=22),
dermatology registrars (n=18), a dermatology research
fellow (n=1) and a plastic surgeon (n=1))
to assess usability of digital image acquisition and storage for when the
imaging process is conducted by the healthcare practitioners themselves, or
by their patients. The study identifies the enablers and barriers of this
emerging mode of medical practice. A thematic analysis was used to extract
key themes from open-ended responses, which involved identifying themes and
patterns within and across participants. Results Thirty-four healthcare practitioners (58%) had previously used a mobile
dermatoscope within their practice. Participants most appreciated its use in
their practice for lesion monitoring (59%) and record keeping (39%).
Challenges reported were the increased time to support the additional
workload (45%), technical issues (33%) and cost of equipment (27%).
Practitioners were unsure (36%) or did not advocate teledermoscopy for
direct-to-consumer use (41%). Only 23% supported the use of
direct-to-consumer teledermoscopy. Conclusion While most practitioners are receptive to mobile teledermoscopy, there was
less support for patient-initiated use, whereby the patient controls the
imaging process. As technology improves rapidly it is important to evaluate
practitioners’ acceptance and satisfaction of evolving telehealth services,
moving forward with models of practice where healthcare practitioners and
other healthcare providers will feel comfortable engaging in telehealth
services.
Collapse
Affiliation(s)
- Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Uyen Koh
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicole Gillespie
- UQ Business School, The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lois J Loescher
- Colleges of Nursing and Public Health, The University of Arizona, Tucson, Arizona, United States of America
| | | | | | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| |
Collapse
|
29
|
Li L, Wu Z, Liang LJ, Lin C, Luo S, Cao X, Hsieh J, Rou K. An intervention trial targeting methadone maintenance treatment providers to improve clients' treatment retention in China. Drug Alcohol Depend 2019; 194:143-150. [PMID: 30445272 PMCID: PMC6413495 DOI: 10.1016/j.drugalcdep.2018.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Service providers including doctors, nurses, and other healthcare professionals play an essential role in methadone maintenance treatment (MMT). This study evaluated the impact of an intervention targeting MMT providers on their clients' treatment retention. METHODS This study was conducted in 68 MMT clinics in five provinces of China with 36 clients randomly selected from each clinic. The clinics were randomized to intervention or control condition. The MMT CARE intervention started with group sessions to enhance providers' communication skills. The trained providers were encouraged to conduct individual sessions with clients to promote treatment engagement. The outcomes, which include client retention (main outcome) and their reception of provider-delivered individual sessions (process outcome), were measured over a 24-month period. RESULTS Significantly fewer intervention clients dropped out from MMT than control clients during the study period (31% vs. 41%; p < 0.0001). Dropout hazard was significantly lower in the intervention condition compared to the control condition (HR = 0.71, 95% CI: 0.57, 0.89). More intervention clients had individual sessions than control clients (93% vs. 70%; p < 0.0001). Having individual sessions was associated with a significantly lower dropout hazard (HR = 0.30, 95% CI: 0.23, 0.40). The intervention clients had a significantly lower dropout hazard than the control clients if they started the individual sessions during the first six months (HR = 0.68, 95% CI: 0.51, 0.90). CONCLUSIONS The MMT CARE intervention focusing on provider capacity building has demonstrated efficacy in reducing clients' treatment dropout. This study sheds light on MMT service improvement in China and other global community-based harm reduction programs.
Collapse
Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
| | - Li-Jung Liang
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Sitong Luo
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Xiaobin Cao
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
| | - Julie Hsieh
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Keming Rou
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
| |
Collapse
|
30
|
Puri MC, Maharjan M, Pearson E, Pradhan E, Dhungel Y, Khadka A, Shah IH. Delivering postpartum family planning services in Nepal: are providers supportive? BMC Health Serv Res 2018; 18:948. [PMID: 30522481 PMCID: PMC6282334 DOI: 10.1186/s12913-018-3777-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 11/28/2018] [Indexed: 11/18/2022] Open
Abstract
Background Health service providers play a key role in addressing women’s need for pregnancy prevention, especially during the postpartum period. Yet, in Nepal, little is known about their views on providing postpartum family planning (PPFP) services and postpartum contraceptive methods such as immediate postpartum intra-uterine devices (PPIUD). This paper explores the perspectives of different types of providers on PPFP including PPIUD, their confidence in providing PPFP services, and their willingness to share their knowledge and skills with colleagues after receiving PPFP and PPIUD training. Methods In-depth interviews were conducted with 14 obstetricians/gynecologists and nurses from six tertiary level public hospitals in Nepal after they received PPFP and PPIUD training as part of an intervention aimed at integrating PPFP counseling and insertion into routine maternity care services. The interviews were audio recorded, transcribed, and analyzed using a thematic approach. Results Providers identified several advantages of PPFP, supported the provision of such services, and were willing to transfer their newly acquired skills to colleagues in other facilities who had not received PPFP and PPIUD training. However, many providers identified several supply-side and training-related barriers to providing high quality PPFP services, such as, (i) lack of adequate human resources, particularly a FP counselor; (ii) work overload; (iii) lack of private space for counseling; (iv) lack of IUDs and information, education and counseling materials; and (v) lack of support from hospital management. Conclusions Providers appeared to be motivated to deliver quality PPFP services and transfer their knowledge to colleagues but identified several barriers which prevented them from doing so. Future efforts to improve provision of quality PPFP services should address the barriers identified by providers. Electronic supplementary material The online version of this article (10.1186/s12913-018-3777-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mahesh C Puri
- Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal.
| | - Manju Maharjan
- Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal
| | | | | | - Yasaswi Dhungel
- Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal
| | - Aayush Khadka
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Iqbal H Shah
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
31
|
Adebiyi BO, Mukumbang FC, Cloete LG, Beytell AM. Exploring service providers' perspectives on the prevention and management of fetal alcohol spectrum disorders in South Africa: a qualitative study. BMC Public Health 2018; 18:1238. [PMID: 30400900 PMCID: PMC6220472 DOI: 10.1186/s12889-018-6126-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/16/2018] [Indexed: 11/19/2022] Open
Abstract
Background Fetal alcohol spectrum disorder (FASD) is among the leading causes of developmental and intellectual disabilities in individuals. Although efforts are being made toward the prevention and management of FASD in South Africa, the prevalence remains high. The sustained high prevalence could be attributed to several factors, including the lack of policy for a coordinated effort to prevent, diagnose and manage FASD nationally. In this study, our aim was to explore the perspectives of service providers (health and allied professionals, teachers, social workers) on the prevention and management of FASD towards developing a guideline to inform policy. Method Guided by the exploratory qualitative research design, we purposively sampled relevant service providers in the field of FASD prevention and management for focus group discussions. Nine of these discussions were conducted with to eight participants per discussion session. The discussants were asked various questions on the current and required interventions and practices for the prevention and management of FASD. Following the Framework Method, data were transcribed verbatim and analysed using the thematic content analysis approach. Results Our findings show that aspects of the prevention and management of alcohol-related conditions are present in various policies. However, there is no clear focus on coordinated, multi-sectoral efforts for a more comprehensive approach to the prevention and management of FASD. The participants recognized the need for specific requirements on broad-based preventive awareness programs, training and support for parents and caregivers, inclusive education in mainstream schools and training of relevant professionals. Conclusion Comprehensive and coordinated prevention and management programs guided by a specific policy could improve the prevention and management of FASD. Policy formulation demonstrates commitment from the government, highlights the importance of the condition, and elaborates on context-specific prevention and management protocols. Electronic supplementary material The online version of this article (10.1186/s12889-018-6126-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Babatope O Adebiyi
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, 7535, South Africa.
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, 7535, South Africa
| | - Lizahn G Cloete
- Division of Occupational Therapy, University of Stellenbosch, Stellenbosch, South Africa
| | - Anna-Marie Beytell
- Department of Social Work, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
32
|
Abstract
BACKGROUND Methadone maintenance treatment (MMT) programs have expanded rapidly in China during the last decade. However, variance in service providers' practice may have an impact on the quality of care received by the patients. This study examined Chinese service providers' adherence to the MMT protocol and its associated factors. METHODS The study used baseline data from a randomized intervention trial implemented in MMT clinics in five provinces of China. The data were collected from January 2012 to August 2013. A total of 418 service providers from 68 MMT clinics participated in the study. Demographic and job-related characteristics were collected. The providers' adherence to the MMT protocol, MMT knowledge, negative attitudes towards people who use drugs (PWUD), and perceived institutional support were assessed. RESULTS The average adherence score was 36.7 ± 4.3 (out of 9-45). Fewer providers adhered to the protocol items where communications with patients or families were required. After controlling for potential confounders, adherence to the MMT protocol was positively associated with perceived institutional support (standardized β = 0.130; p = 0.0052), and negatively associated with prejudicial attitudes towards PWUD (standardized β = -0.357; p < 0.0001). Reception of national-level MMT training was not associated with higher level of adherence to protocol. CONCLUSION The findings suggest the potential benefits of providing institutional support to MMT providers to enhance their level of adherence to the MMT protocol. Intervention effort is needed to reduce negative attitudes towards PWUD among MMT service providers to achieve greater consistency with best-practice recommendations.
Collapse
Affiliation(s)
- Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Chiao-Wen Lan
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Keming Rou
- National Center for AIDS Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, China
| |
Collapse
|
33
|
Asefa A, Bekele D, Morgan A, Kermode M. Service providers' experiences of disrespectful and abusive behavior towards women during facility based childbirth in Addis Ababa, Ethiopia. Reprod Health 2018; 15:4. [PMID: 29304814 PMCID: PMC5756390 DOI: 10.1186/s12978-017-0449-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background Disrespect and abuse (D&A) of women during childbirth by the attending staff in health facilities has been widely reported in many countries. Although D&A in labor rooms is recognized as a deterrent to maternal health service utilization, approaches to defining, classifying, and measuring D&A are still at an early stage of development. This study aims to enhance understanding of service providers’ experiences of D&A during facility based childbirth in health facilities in Addis Ababa. Methods A facility based cross-sectional study was conducted in August 2013 in one hospital and three health centers. A total of 57 health professionals who had assisted with childbirth during the study period completed a self-administered questionnaire. Service providers’ personal observations of mistreatment during childbirth and their perceptions of respectful maternity care (RMC) were assessed. Data were entered into and analyzed using SPSS version 16 software. Results The majority (83.7%) of participants were aged <30 years (mean = 27.25 ± 5.45). Almost half (43.9%) were midwives, and 77.2% had less than five years experience as a health professional. Work load was reported to be very high by 31.6% of participants, and 28% rated their working environment as poor or very poor. Almost half (50.3%) of participants reported that service providers do not generally obtain women’s consent prior to procedures. One-quarter (25.9%) reported having ever witnessed physical abuse (physical force, slapping, or hitting) in their health facility. They also reported observing privacy violations (34.5%), and women being detained against their will (18%). Violations of women’s rights were self-reported by 14.5% of participants. More than half (57.1%) felt that they had been disrespected and abused in their work place. The majority of participants (79.6%) believed that lack of respectful care discourages pregnant women from coming to health facilities for delivery. Conclusions The study findings indicate that most service providers from these facilities had witnessed disrespectful practices during childbirth, and recognized that such practices have negative consequences for service utilization. These findings can help decision makers plan for interventions to improve RMC taking account of the provider perspective.
Collapse
Affiliation(s)
- Anteneh Asefa
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, P.O.Box 70, Hawassa, Ethiopia. .,Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 5, 333 Exhibition Street, Melbourne, 3000, Australia.
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, P.O.Box 143079, Addis Ababa, Ethiopia
| | - Alison Morgan
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 5, 333 Exhibition Street, Melbourne, 3000, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 5, 333 Exhibition Street, Melbourne, 3000, Australia
| |
Collapse
|
34
|
Poínhos R, Oliveira BMPM, van der Lans IA, Fischer ARH, Berezowska A, Rankin A, Kuznesof S, Stewart-Knox B, Frewer LJ, de Almeida MDV. Providing Personalised Nutrition: Consumers' Trust and Preferences Regarding Sources of Information, Service Providers and Regulators, and Communication Channels. Public Health Genomics 2017; 20:218-228. [PMID: 29050032 DOI: 10.1159/000481357] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 09/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Personalised nutrition has potential to revolutionise dietary health promotion if accepted by the general public. We studied trust and preferences regarding personalised nutrition services, how they influence intention to adopt these services, and cultural and social differences therein. METHODS A total of 9,381 participants were quota-sampled to be representative of each of 9 EU countries (Germany, Greece, Ireland, Poland, Portugal, Spain, the Netherlands, the UK, and Norway) and surveyed by a questionnaire assessing their intention to adopt personalised nutrition, trust in service regulators and information sources, and preferences for service providers and information channels. RESULTS Trust and preferences significantly predicted intention to adopt personalised nutrition. Higher trust in the local department of health care was associated with lower intention to adopt personalised nutrition. General practitioners were the most trusted of service regulators, except in Portugal, where consumer organisations and universities were most trusted. In all countries, family doctors were the most trusted information providers. Trust in the National Health Service as service regulator and information source showed high variability across countries. Despite its highest variability across countries, personal meeting was the preferred communication channel, except in Spain, where an automated internet service was preferred. General practitioners were the preferred service providers, except in Poland, where dietitians and nutritionists were preferred. The preference for dietitians and nutritionists as service providers highly varied across countries. CONCLUSION These results may assist in informing local initiatives to encourage acceptance and adoption of country-specific tailored personalised nutrition services, therefore benefiting individual and public health.
Collapse
Affiliation(s)
- Rui Poínhos
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Khanlou N, Haque N, Sheehan S, Jones G. "It is an Issue of not Knowing Where to Go": Service Providers' Perspectives on Challenges in Accessing Social Support and Services by Immigrant Mothers of Children with Disabilities. J Immigr Minor Health 2015; 17:1840-7. [PMID: 25376126 DOI: 10.1007/s10903-014-0122-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In Canada little is known about the challenges immigrant mothers of children with disabilities encounter in accessing formal and informal social support. This paper presents the perspectives of service providers on the mothers’ challenges. Data was collected from 27 service providers in Toronto, Canada in 2012 through in-depth interviews. The interview guide was informed by published literature on families of children with special needs. Level one analyses entailed descriptive analyses; and level two consisted of applying House’s 4 domains of social support to organize the themes. Following House’s domains, challenges to (1) Structural support, (2) Instrumental support, (3) Emotional support, and (4) Perception of support were identified. Among providers who work with families of children with disabilities there is recognition of the mothers’ particular challenges in light of their immigration status. Language and communication are significant barriers for immigrant mothers in accessing social support.
Collapse
|
36
|
Ala-Nikkola T, Sadeniemi M, Kaila M, Saarni S, Kontio R, Pirkola S, Joffe G, Oranta O, Wahlbeck K. How size matters: exploring the association between quality of mental health services and catchment area size. BMC Psychiatry 2016; 16:289. [PMID: 27520368 PMCID: PMC4983042 DOI: 10.1186/s12888-016-0992-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/03/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The diversity of mental health and substance abuse services (MHS) available to service users is seen as an indicator of the quality of the service system. In most countries MHS are provided by a mix of public, private and third sector providers. In Finland, officially, the municipalities are responsible for organizing the services needed, but the real extent and roles of private and third sector service providers are not known. Our previous study showed that the catchment area population size was strongly associated with diversity of mental health services. It is not known whether this was due to some types of services or some provider types being more sensitive to the size effect than others. The aim of this study was to investigate the association between area population size and diversity of mental health services, i.e. which types of services and which service providers' contributions are sensitive to population size. METHODS To map and classify services, we used the ESMS-R. The diversity of services was defined as the count of main types of care. Providers were classified as public, private or third sectors. RESULTS The diversity of outpatient, residential and voluntary services correlated positively with catchment area population size. The strongest positive correlation between the size of population and services available was found in third sector activities followed by public providers, but no correlation was found for diversity of private services. The third sector and public corporations each provided 44 % of the service units. Third sector providers produced all self-help services and most of the day care services. Third sector and private companies provided a significant part (59 %) of the residential care service units. CONCLUSIONS Significant positive correlations were found between size of catchment area population and diversity of residential, outpatient and voluntary services, indicating that these services concentrate on areas with larger population bases. The third sector seems to significantly complement the public sector in providing different services. Thus the third sector be needs to be functionally integrated with other MHS services to achieve a diversified and integrated service system.
Collapse
Affiliation(s)
- Taina Ala-Nikkola
- University of Helsinki and Helsinki University Hospital, Psychiatry, Välskärinkatu 12, FI-00029, Helsinki, Finland. .,Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270, Helsinki, Finland.
| | - Minna Sadeniemi
- Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270 Helsinki, Finland ,Department of Social Services and Health Care, City of Helsinki, FI-00099 Helsinki, Finland ,Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, FI-00029 Helsinki, Finland
| | - Minna Kaila
- Department of Public Health, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, FI-000014 Helsinki, Finland
| | - Samuli Saarni
- Turku University Central Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
| | - Raija Kontio
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, FI-00029 Helsinki, Finland
| | - Sami Pirkola
- University of Tampere and Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-33014 Tampere, Finland
| | - Grigori Joffe
- University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, FI-00029 Helsinki, Finland
| | - Olli Oranta
- Turku University Central Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
| | - Kristian Wahlbeck
- Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270 Helsinki, Finland
| |
Collapse
|
37
|
Hmone MP, Dibley MJ, Li M, Alam A. A formative study to inform mHealth based randomized controlled trial intervention to promote exclusive breastfeeding practices in Myanmar: incorporating qualitative study findings. BMC Med Inform Decis Mak 2016; 16:60. [PMID: 27260252 PMCID: PMC4893226 DOI: 10.1186/s12911-016-0301-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background Undernutrition is a major concern for Myanmar children with low exclusive breastfeeding rate (24%). A formative study was conducted to explore the perceptions and practices relating to exclusive breastfeeding, and barriers and facilitators to using mobile communications for exclusive breastfeeding counselling. The results inform the design of a randomized control trial to promote exclusive breastfeeding practices among Myanmar mothers. Methods We conducted twenty in-depth interviews with pregnant women and accompanying family members attending an antenatal clinic at the Central Women’s Hospital, Yangon, seven key-informant interviews and one focus group discussion with fifteen service providers such as nurses, doctors, managers and staff from the National Nutrition Centre, Department of Health, United Nations Children’s Fund International and National Non-Government Organizations and Ooredoo, a private mobile company. Results Widespread practices of feeding water, honey, infant formula and semi-solid food were reported to be existed in the community before the child reaches four months, mostly influenced by grandmothers from both sides. All couples knew breast milk was good for baby and intended to breastfeed, though limited understanding of the term exclusive breastfeeding was reported. Perception that breast milk alone was not sufficient to provide all nutrients needed for the first six months of baby’s life, mother had insufficient milk supply or breast problems, mother’s back to work and grandmothers’ influence emerged as barriers to breastfeed exclusively for six months. All women knew how to make basic phone calls, majority could read mobile text message in Burmese and possess mobile phones while a few of them shared phones with their husbands. All couples preferred to receive text messages 2–3 times per week in the evening. Institutional staff suggested messages to be simple, easily understandable and culturally appropriate. Perceived barriers included limited mobile network coverage, affordability of mobile handset and phone bills, literacy and community familiarity with text messages. All respondents welcomed the idea of planned intervention. Conclusion We incorporated findings to develop messages and determine the modality, inclusion criteria and tailored with gestation and child age, to be delivered in the randomized controlled trial intervention.
Collapse
Affiliation(s)
- Myat Pan Hmone
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Michael J Dibley
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Mu Li
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Ashraful Alam
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia
| |
Collapse
|
38
|
Aoun SM, Deas K, Kristjanson LJ, Kissane DW. Identifying and addressing the support needs of family caregivers of people with motor neurone disease using the Carer Support Needs Assessment Tool. Palliat Support Care 2017; 15:32-43. [PMID: 27173737 DOI: 10.1017/S1478951516000341] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Family caregivers of people with motor neurone disease (MND) experience adverse health outcomes as a result of their caregiving experience. This may be alleviated if their support needs are identified and addressed in a systematic and timely manner. The objective of the present study was to assess the feasibility and relevance of the Carer Support Needs Assessment Tool (CSNAT) in home-based care during the period of caregiving from the perspectives of the family caregivers of people with MND and their service providers. METHOD The study was conducted during 2014 in Western Australia. Some 30 family caregivers and 4 care advisors participated in trialing the CSNAT intervention, which involved two visits from care advisors (6-8 weeks apart) to identify and address support needs. The feedback from family caregivers was obtained via telephone interviews and that of care advisors via a self-administered questionnaire. RESULTS A total of 24 caregivers completed the study (80% completion rate) and identified the highest support priorities as "knowing what to expect in the future," "knowing who to contact if concerned," and "equipment to help care." The majority found that this assessment process adequately addressed their needs and gave them a sense of validation, reassurance, and empowerment. Care advisors advocated the CSNAT approach as an improvement over standard practice, allowing them to more clearly assess needs, to offer a more structured follow-up, and to focus on the caregiver and family. SIGNIFICANCE OF RESULTS The CSNAT approach for identifying and addressing family caregivers' support needs was found to be relevant and feasible by MND family caregivers and care advisors. The tool provided a formal structure to facilitate discussions with family caregivers and thus enable needs to be addressed. Such discussions can also inform an evidence base for the ongoing development of services, ensuring that new and improved services are designed to meet the explicit needs of the family caregivers of people with a motor neurone disease.
Collapse
|
39
|
Bennett L, Bergin M, Wells JS. The social space of empowerment within epilepsy services: The map is not the terrain. Epilepsy Behav 2016; 56:139-48. [PMID: 26874865 DOI: 10.1016/j.yebeh.2015.12.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/04/2015] [Accepted: 12/30/2015] [Indexed: 11/20/2022]
Abstract
Empowerment is now seen as an integral component of holistic practice and service design in healthcare, particularly as it relates to the improvement of quality of life for people with epilepsy. However, the literature suggests that empowerment is a neglected and poorly understood concept by service users and providers alike within epilepsy services. Conceptual ambiguity is a further impediment to its understanding and implementation. Bearing this in mind, a clear definition of empowerment is needed in order to realistically recognize, encourage, and prioritize empowerment as a service design philosophy. Therefore, this paper undertakes a concept analysis of empowerment with reference to epilepsy services. Results indicate that empowerment demands a transformation of consciousness and a readiness to act on this transformation in order to allow people to gain personal power and autonomy over their own life, including the self-management of their condition. With this in mind, a critical reflection on the 'micro' and 'macro' levels of power that exist within epilepsy services is warranted with reference to theoretical principles. In this context although the map is not the terrain, we argue that an educational intervention guided by critical social theory principles has the potential to encourage an understanding of empowerment and 'holds the key' to future advances for its implementation within epilepsy services.
Collapse
|
40
|
Laar AK, Amankwa B, Asiedu C. Prevention-of-Mother-To-Child-Transmission of HIV Services in Sub-Saharan Africa: A Qualitative Analysis of Healthcare Providers and Clients Challenges in Ghana. Int J MCH AIDS 2014; 2:244-9. [PMID: 27621979 PMCID: PMC4948151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Developed by the World Health Organization (WHO) and partners, the correct adaptation and implementation of the global guidelines on prevention of mother-to-child transmission (PMTCT) of HIV is critical. This study explored the challenges that health workers face implementing WHO's PMTCT guidelines, and the experiences of HIV-positive clients receiving these services. METHODS We interacted with 14 health professionals, and 16 PMTCT clients through in-depth interviews. Four of seven PMTCT sites within the Accra Metropolis were purposively included. Interviews were tape-recorded, transcribed, analyzed, and then sorted into themes. RESULTS Health workers had challenges translating PMTCT guidelines into useful messages for their clients. Their counselling was often prescriptive. Counselors identified inadequate in-service training as a key reason for their out-dated and inconsistent messages. HIV-positive clients exhibited general knowledge about the importance of doing exclusive breast-feeding for the first six months of life. Clients had confidence in antiretroviral for PMTCT. However, deeply rooted socio-cultural practices and the attitudes of counselors remain challenges to clients. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS Counselors require refresher training which addresses, among other things, long-held socio-cultural practices. Publicizing these challenges will prod policy makers and program implementers to develop strategies that address the challenges both locally and globally.
Collapse
Affiliation(s)
- Amos Kankponang Laar
- Department of Population, Family, and Reproductive Health, School of Public Health, Legon, GHANA
| | | | | |
Collapse
|
41
|
Li L, Liang LJ, Lin C, Wu Z, Wen Y. Individual attitudes and perceived social norms: Reports on HIV/AIDS-related stigma among service providers in China. Int J Psychol 2012; 44:443-50. [PMID: 20090857 DOI: 10.1080/00207590802644774] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined HIV/AIDS-related stigma among Chinese service providers by comparing their personal attitudes toward people living with HIV/AIDS with their perception of social norms related to people living with HIV/AIDS. We randomly selected three provincial hospitals, four city/prefecture hospitals, 10 county hospitals,18 township health clinics, and 54 village clinics from Yunnan, China. Doctors and nurses were randomly sampled proportionally to the doctor–nurse ratio of each hospital or clinic. Lab technicians were over-sampled in order to include an adequate representation in the analysis. A total of 1,101 service providers participated in a voluntary,anonymous survey where demographic characteristics, individual attitude and perceived social norms toward people living with HIV/AIDS, discrimination intent at work, general prejudicial attitude and knowledge on HIV/AIDS were measured. A majority of the sample demonstrated a similarity between their personal views and what they thought most people in society believe. Multiple logistic regressions revealed that participants who were younger or reported personal contact with people living with HIV/AIDS were significantly more likely to report personal attitudes toward the population that were more liberal than their perceived social norms. Holding a more liberal personal attitude toward people living with HIV/AIDS than perceived social norms was significantly and negatively related to the level of discrimination intent at work, perceived discrimination at interpersonal level and the level of general prejudicial attitude toward people living with HIV/AIDS. Results underscored the importance of understanding social norms and personal attitudes in studying HIV-related stigma and called for the incorporation of existing human capital into future HIV stigma reduction programs.
Collapse
Affiliation(s)
- Li Li
- University of California at Los Angeles, Los Angeles,CA, USA.
| | | | | | | | | |
Collapse
|