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Gronholm PC, Thornicroft G, Laurens KR, Evans-Lacko S. Conditional Disclosure on Pathways to Care: Coping Preferences of Young People at Risk of Psychosis. Qual Health Res 2017; 27:1842-1855. [PMID: 27909250 DOI: 10.1177/1049732316680337] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The interrelationship between stigma and help-seeking is under-researched among children and adolescents. This study explored stigma in relation to pathways to care among young people putatively in an early stage of increased risk of developing psychotic disorders. "Pathways to care" was defined as help-seeking and support from informal and formal resources, and increased risk was determined through the presence of persistent psychotic-like experiences and internalizing/externalizing psychopathology. Twenty-nine qualitative interviews were analyzed using thematic analysis. We defined the superordinate theme in these data as "conditional disclosure," a concept reflecting the rules and prerequisites that influenced how/whether participants sought help. Through parallels between these findings and established stigma theory, we examined how these conditions could be interpreted as influenced by stigma. Our findings demonstrate the influence of stigma on young people's perceptions of a range of pre-clinical symptoms, and on how they seek support for these symptoms.
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Key Words
- Western Europe, Britain
- adolescents, youth, young adults, at risk
- adolescents, youth, young adults, mental health and illness
- children, illness and disease
- community and public health
- confidentiality, privacy, disclosure
- health care, access to
- health, health promotion
- illness and disease
- prevention
- psychology, psychological issues
- qualitative
- research strategies, interviews
- research strategies, thematic analysis
- social support
- stigma
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Affiliation(s)
- Petra C Gronholm
- 1 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Graham Thornicroft
- 1 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Kristin R Laurens
- 1 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- 2 University of New South Wales, Sydney, New South Wales, Australia
- 3 Schizophrenia Research Institute, Sydney, New South Wales, Australia
- 4 Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Sara Evans-Lacko
- 1 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- 5 Personal Social Services Research Unit, London School of Economics and Political Science, London, United Kingdom
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Abstract
Thirty-five in-depth, semi-structured interviews were conducted with female, street-based, commercial sex workers in Kathmandu, Nepal. The framework of structural violence guided this study in identifying the structural context that impacts the female sex workers' lives and may cause harm to their health. Structural violence in health care was revealed through thematic analysis as (a) discrimination, (b) forced choice, and (c) limitations to health information sources. Lived experiences highlight how the sex workers engaged with structural limitations in health care access, services, and utilization. Structural violence conveys a message about who is entitled to health care and what a society emphasizes and expects regarding acceptable health behavior. Examining the structural violence highlighted how the sex workers negotiated, understood, and engaged with structural limitations in health care access, services, and utilization.
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Abstract
Only a third of people with mental disorders seek professional help. In this study, we aimed to investigate attitudes toward help-seeking among non-help-seekers drawn from a community survey in South London. We conducted qualitative interviews with 24 participants with symptoms of mental disorders. We analyzed data using thematic analysis. Participants' reasons for not seeking professional help included perceiving their problems as normal or unsuitable for professional help, negative expectations of professional help, believing informal strategies were sufficient, fearing being stigmatized for having a mental disorder and help-seeking, and self-perceptions of being strong and/or self-reliant. A small number (n = 4) had resolved their problems. Participants with unresolved mental disorders (n = 20) had more chronic stressors, particularly about finances and family relationships, and greater concerns about professional help and stigma than other participants. Potential targets for interventions to encourage help-seeking could be focused around stigma about help-seeking as well as the self-perception of being strong.
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Nicholas DB, Newton AS, Calhoun A, Dong K, deJong-Berg MA, Hamilton F, Kilmer C, McLaughlin AM, Shankar J. The Experiences and Perceptions of Street-Involved Youth Regarding Emergency Department Services. Qual Health Res 2016; 26:851-62. [PMID: 25829466 DOI: 10.1177/1049732315577605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Indexed: 05/28/2023]
Abstract
Street-involved (SI) youth comprise a substantial component of the urban homeless population. Despite being significant users of hospital emergency department (ED) services for acute and ongoing health needs, little is known about their experiences of ED care and the factors affecting their ED use. This study used a grounded theory and community-based approach to examine these issues. Focus groups and individual interviews were facilitated with 48 SI youth between ages 15 and 26 years, recruited in hospital or through community agencies serving SI youth in a major Western Canadian city. Results demonstrate that SI youth often perceived suboptimal care and experienced long waiting periods that led to many avoiding or prematurely exiting the ED. Service gaps appeared to have a negative bearing on their care and health outcomes. Findings invite a critical review of ED care processes, structures, and staff interactions in the aim of enhancing ED services to SI youth.
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Affiliation(s)
| | | | | | - Kathryn Dong
- University of Alberta, Edmonton, Alberta, Canada
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Patel N, Jones P, Adamson V, Spiteri M, Kinmond K. Chronic Obstructive Pulmonary Disease Patients' Experiences of an Enhanced Self-Management Model of Care. Qual Health Res 2016; 26:568-577. [PMID: 25711841 DOI: 10.1177/1049732315573013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is debilitating and costly. Self-management is championed to empower individuals to better manage their condition and also to efficiently utilize health resources. As a multi-disciplinary team, we conducted focus group research with individuals living with COPD who were participating in a longitudinal study to use an electronic "diary" to monitor, record, and transmit their own health status, plus receiving regular nurse visits. The main aims of the focus groups were to investigate how far individuals embraced the electronic diary and experienced it as an aid to the self-management of their condition. We also looked at the importance of the nurse visits to the process. Thematic analysis revealed that patients responded positively to the use of technology (the electronic diary), including psychological benefits of perceived support offered by the remote symptom surveillance. Findings also showed patients' increased awareness and monitoring of personal symptoms together with an improved understanding of disease self-management. Nurse support emerged as an important "human" factor in the process. In addition, a reduction in hospital admission was observed, thus reducing costs to the health service.
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Affiliation(s)
- Neil Patel
- University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
| | - Pauline Jones
- University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
| | - Vikki Adamson
- University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
| | - Monica Spiteri
- University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
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Hole RD, Evans M, Berg LD, Bottorff JL, Dingwall C, Alexis C, Nyberg J, Smith ML. Visibility and Voice: Aboriginal People Experience Culturally Safe and Unsafe Health Care. Qual Health Res 2015; 25:1662-74. [PMID: 25583958 DOI: 10.1177/1049732314566325] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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] [Indexed: 05/22/2023]
Abstract
In Canada, cultural safety (CS) is emerging as a theoretical and practice lens to orient health care services to meet the needs of Aboriginal people. Evidence suggests Aboriginal peoples' encounters with health care are commonly negative, and there is concern that these experiences can contribute to further adverse health outcomes. In this article, we report findings based on participatory action research drawing on Indigenous methods. Our project goal was to interrogate practices within one hospital to see whether and how CS for Aboriginal patients could be improved. Interviews with Aboriginal patients who had accessed hospital services were conducted, and responses were collated into narrative summaries. Using interlocking analysis, findings revealed a number of processes operating to produce adverse health outcomes. One significant outcome is the production of structural violence that reproduces experiences of institutional trauma. Positive culturally safe experiences, although less frequently reported, were described as interpersonal interactions with feelings visibility and therefore, treatment as a "human being."
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Affiliation(s)
- Rachelle D Hole
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Mike Evans
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Lawrence D Berg
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Joan L Bottorff
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Carlene Dingwall
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Carmella Alexis
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Jessie Nyberg
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Michelle L Smith
- The University of British Columbia, Kelowna, British Columbia, Canada
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Abstract
Despite an urgent need for mental health care among U.S. service members returning from deployments to Iraq and Afghanistan, many veterans do not receive timely or adequate treatment. We used photovoice methods to engage veterans in identifying barriers to utilizing mental health services. Veterans described how key aspects of military culture and identity, highly adaptive during deployment, can deter help-seeking behavior and hinder recovery. Veterans' photographs highlighted how mental health symptoms and self-coping strategies operated as barriers to care. Many veterans' photos and stories revealed how negative health care encounters contributed to avoidance and abandonment of treatment; some veterans described these experiences as re-traumatizing. Visual methods can be a powerful tool for engaging recent war veterans in research. In particular, community-based participatory research approaches, which have rarely been used with veterans, hold great promise for informing effective interventions to improve access and enhance provision of patient-centered care for veterans.
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Affiliation(s)
- Gala True
- Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Khary K Rigg
- University of South Florida, Tampa, Florida, USA
| | - Anneliese Butler
- Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Abstract
Help seeking is known to be a complex and difficult journey for people who self-injure. In this article, we explore the process of help seeking from the perspective of a group of people living in Northern Ireland with a history of self-injury. We conducted 10 semistructured interviews and employed a grounded theory approach to data analysis. We created two major categories from the interview transcript data: (a) "involution of feeling," which depicts participants' perspectives on barriers to help seeking; and (b) "to be treated like a person," in which participants communicate their experiences of help seeking. The findings pose important implications for policy, practice, theory, and future research, including the need to increase the uptake of follow-up care among people who arrive at hospitals as a result of self-injury, self-harm, or suicidal behaviors.
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Affiliation(s)
- Maggie Long
- University of Ulster, Jordanstown Campus, Newtownabbey, United Kingdom
| | | | - Anne Tracey
- University of Ulster, Magee Campus, Derry, United Kingdom
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Fried J, Harris B, Eyles J, Moshabela M. Acceptable care? Illness constructions, healthworlds, and accessible chronic treatment in South Africa. Qual Health Res 2015; 25:622-635. [PMID: 25829509 PMCID: PMC4390520 DOI: 10.1177/1049732315575315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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] [Indexed: 05/30/2023]
Abstract
Achieving equitable access to health care is an important policy goal, with access influenced by affordability, availability, and acceptability of specific services. We explore patient narratives from a 5-year program of research on health care access to examine relationships between social constructions of illness and the acceptability of health services in the context of tuberculosis treatment and antiretroviral therapy in South Africa. Acceptability of services seems particularly important to the meanings patients attach to illness and care, whereas-conversely-these constructions appear to influence what constitutes acceptability and hence affect access to care. We highlight the underestimated role of individually, socially, and politically constructed healthworlds; traditional and biomedical beliefs; and social support networks. Suggested policy implications for improving acceptability and hence overall health care access include abandoning patronizing approaches to care and refocusing from treating "disease" to responding to "illness" by acknowledging and incorporating patients' healthworlds in patient-provider interactions.
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Affiliation(s)
- Jana Fried
- Coventry University, Coventry, West Midlands, United Kingdom
| | - Bronwyn Harris
- University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - John Eyles
- University of the Witwatersrand, Johannesburg, Gauteng, South Africa McMaster University, Hamilton, Ontario, Canada
| | - Mosa Moshabela
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Wesson HKH, Stevens KA, Bachani AM, Mogere S, Akungah D, Nyamari J, Masasabi Wekesa J, Hyder AA. Trauma systems in Kenya: a qualitative analysis at the district level. Qual Health Res 2015; 25:589-599. [PMID: 25563630 DOI: 10.1177/1049732314562890] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Injury is a leading cause of death and disability in low- and middle-income countries. Kenya has a particularly high burden of injuries, accounting for 88.4 deaths per 100,000 population. Despite recent attempts to prioritize injury prevention in Kenya, trauma care systems have not been assessed. We assessed perceptions of formal and informal district-level trauma systems through 25 qualitative semi-structured interviews and 16 focus group discussions with Ministry of Health officials, district hospital administrators, health care providers, police, and community members. We used the principles of theoretical analysis to identify common themes of prehospital and hospital trauma care. We found prehospital care relied primarily on "good Samaritans" and police. We described hospital care in terms of human resources, infrastructure, and definitive care. The interviewers repeatedly emphasized the lack of hospital infrastructure. We showed the need to develop prehospital care systems and strengthen hospital trauma care services.
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Affiliation(s)
- Hadley K H Wesson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Kent A Stevens
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | | | | | | | | | | | - Adnan A Hyder
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Abstract
In this study we explored the factors that affect assistive technology (AT) provision within the Navajo Nation using a qualitative approach to inquiry. Focus groups were held in which AT users discussed their awareness of AT and their need for, use of, and satisfaction with AT devices and services. Twenty-eight individuals who used wheelchairs, orthotics or prosthetics, hearing aids, communication aids, vision aids, and other AT participated in one of seven focus groups. Seven AT providers discussed the facilitators and barriers that affect AT provision. The findings revealed six themes common to both stakeholder groups and two additional themes for AT users. The central theme for AT users centered on (not) feeling understood; the central theme for AT providers revolved around the processes, activities, and roles the providers engaged in at times for different clients. Activities to increase awareness and to promote successful AT provision and satisfaction with AT devices were proposed.
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Affiliation(s)
- Kim D Reisinger
- San Francisco State University, San Francisco, California, USA
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Drolet M, Savard J, Benot J, Arcand I, Savard S, Lagacé J, Lauzon S, Dubouloz CJ. Health services for linguistic minorities in a bilingual setting: challenges for bilingual professionals. Qual Health Res 2014; 24:295-305. [PMID: 24549410 DOI: 10.1177/1049732314523503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We explore in this qualitative research the challenges faced by bilingual health and social services professionals in a Canadian bilingual setting, as well as the strategies used to overcome them. Eight focus groups were conducted with a total of 43 bilingual Francophone professionals who offered services in French in 21 health and social service organizations in eastern Ontario, Canada. We highlight linguistic issues affecting a minority Francophone clientele, the shortage of services in French, and organizational issues within these agencies. The solutions that the professionals adopt for better serving the clients and overcoming these challenges focus on adapting services from linguistic angles. In the long term, such an enhanced approach can affect staff well-being. Ensuring access to services for linguistic minority populations and the active offer of same should not rest solely on the shoulders of such professionals, but rather on organizational strategies.
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Abstract
In this study, I examined how people with serious mental illness defined and prioritized their service needs when released from jail and how these service priorities shaped the sequencing of help-seeking activities after their release. Data included ethnographic observations and interviews with the staff and clients of a mental health reentry program and responses to an open-ended questionnaire that was given to the program's clients (N = 115). Sixty-three percent of the clients identified housing and 35% identified financial assistance as one of their two most important service needs, whereas only 12% selected treatment services. These service priorities reflect a hierarchy in help-seeking activities postrelease in which clients' access to treatment services was predicated on their ability to first find sustainable economic and material support. I conclude that reentry programs need to have the resources required to meet both the basic and treatment needs of people with serious mental illness leaving jail.
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Abstract
The main purpose of this article is to examine the understanding and experience of health and health care among rural-to-urban migrants in China, and to explain the impact of the internal factors of migrants themselves and the external factors of their social environment. Understanding the perceptions and consciousness of health issues among migrants is crucial to prevention, intervention, and other health-related measures for the migrant population in China, but this has rarely been explored in studies. On the basis of a case study of a migrant community in Beijing, I explore the migrants' understandings of health and health care and analyze factors in the social environment, including exclusion from the social system and the possibility of health participation, exclusion from social relation networks, obstructed channels of health maintenance, and exclusion of crowd psychology, which impact heavily on their health understanding and health behavior. I argue that the internal and the external factors are linked together closely and interact as reciprocal causation. However, the migrants should not be seen as primarily responsible, because their poor understanding of health mainly results from the socioeconomic environment in which they live and work.
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Affiliation(s)
- Yan Li
- 1Shandong University, Jinan, China
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Abstract
Female sex workers in Russia have been particularly vulnerable to recent social, political, and economic changes. In this article, we describe the facilitators and barriers for sex workers receiving health care services in St. Petersburg, Russia. We conducted observations at medical institutions and nongovernmental organizations and in-depth interviews with 29 female sex workers. We identified the following barriers: poverty, not having documents, lack of anonymity in testing, and the official registration system. We identified the following facilitators: intervention by family members, social connections within the health care system, and referral services from a nongovernmental organization. Our findings indicate a need for reassessing policies and designing programs that better facilitate the use of health care services for the most vulnerable populations. This should include the expansion of support systems and outreach services designed to help female sex workers navigate the health care system.
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Abstract
I present the findings from a study that explored the experiences and decision making of street-involved women navigating the health care system. Data were drawn from a larger qualitative study situated in a western Canadian inner-city neighborhood that examined the health-management strategies of street-involved women with a history of crack cocaine use. Data were collected over a 17-month period and included ethnographic methods of participant observation, group interviews (n = 57), and in-depth interviews (n = 10). Inductive thematic analysis derived two major themes: power and punishment, and organization and delivery of care. The themes illustrate how women's experiences and decision making were located within a nexus of power relations that operated across women's shared social location as downtown eastsiders. Implications of the findings are discussed in relation to supporting women's efforts and improving health outcomes.
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Affiliation(s)
- Vicky Bungay
- University of British Columbia School of Nursing, T201-2211 Wesbrook Mall, Vancouver, British Columbia, Canada.
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