1
|
Zilberstein K, Brown A, Hatcher AJ, Burton J, Gau J. Providers' experiences collaborating with child welfare workers: The good, the bad, and the impacts. Child Abuse Negl 2024; 152:106772. [PMID: 38574602 DOI: 10.1016/j.chiabu.2024.106772] [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] [Received: 11/15/2023] [Revised: 01/12/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Successful interprofessional collaborations have been identified as a potential solution to mitigate problems associated with negative outcomes for clients involved with the child welfare system. The barriers to collaborative relationships need to be better understood and effectively addressed. OBJECTIVE To understand the characteristics, barriers, and facilitators of collaborations between different types of providers and child welfare workers, as well as their impacts. PARTICIPANTS AND SETTING Mental health professionals, foster and kinship parents, legal professionals, and other providers responded to an online survey distributed in a Northeastern State of the United States of America. METHOD Participants (n = 208) completed the Quality of Collaboration with Child Welfare survey. Qualitative responses were analyzed by three coders using three levels of axial coding with constant comparison. RESULTS Participants identified different aspects of communication, relationships, and follow-through as key elements of successful collaborations, as well as the items most likely to interfere with their formation. Providers differed somewhat in how concerned they were with various aspects of collaborations in accordance with their professional roles. Barriers to successful collaborations included both individual and systemic factors which often resulted in negative outcomes. Overall, more negative experiences were offered than positive ones. CONCLUSIONS Strategies are needed to improve communication, promote positive relationships, and address systemic barriers to enhance collaboration and, in turn, improve outcomes for child welfare-involved clients.
Collapse
Affiliation(s)
| | - Adam Brown
- Silberman School of Social Work at Hunter College, NY, New York, USA.
| | | | - J Burton
- Clinical and Support Options, Northampton, MA, USA
| | - Jeff Gau
- Oregon Research Institute, Eugene, OR, USA.
| |
Collapse
|
2
|
Petagna CN, Perez S, Hsu E, Greene BM, Banner I, Bednarczyk RA, Escoffery C. Facilitators and barriers of HPV vaccination: a qualitative study in rural Georgia. BMC Cancer 2024; 24:592. [PMID: 38750439 PMCID: PMC11094994 DOI: 10.1186/s12885-024-12351-1] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccination protects against HPV-associated cancers and genital warts. Healthy People 2030 goal for HPV vaccine uptake is 80%, but as of 2021, only 58.5% of adolescents are up to date in Georgia. The purpose of the study is to assess the attitudes, vaccine practices, facilitators, and barriers to receiving the HPV vaccine in southwest Georgia. METHODS We conducted 40 semi-structured interviews in the United States from May 2020-Feburary 2022 with three different audiences (young adults, parents, and providers and public health professionals) guided by the P3 (patient-, provider-, practice-levels) Model. The audiences were recruited by multiple methods including fliers, a community advisory board, Facebook ads, phone calls or emails to schools and health systems, and snowball sampling. Young adults and parents were interviewed to assess their perceived benefits, barriers, and susceptibility of the HPV vaccine. Providers and public health professionals were interviewed about facilitators and barriers of patients receiving the HPV vaccine in their communities. We used deductive coding approach using a structured codebook, two coders, analyses in MAXQDA, and matrices. RESULTS Out of the 40 interviews: 10 young adults, 20 parents, and 10 providers and public health professionals were interviewed. Emerging facilitator themes to increase the uptake of the HPV vaccine included existing knowledge (patient level) and community outreach, providers' approach to the HPV vaccine recommendations and use of educational materials in addition to counseling parents or young adults (provider level) and immunization reminders (practice level). Barrier themes were lack of knowledge around HPV and the HPV vaccine (patient level), need for strong provider recommendation and discussing the vaccine with patients (provider level), and limited patient reminders and health education information around HPV vaccination (practice level). Related to socio-ecology, the lack of transportation and culture of limited discussion about vaccination in rural communities and the lack of policies facilitating the uptake of the HPV vaccine (e.g., school mandates) were described as challenges. CONCLUSION These interviews revealed key themes around education, knowledge, importance of immunization reminders, and approaches to increasing the HPV vaccination in rural Georgia. This data can inform future interventions across all levels (patient, provider, practice, policy, etc.) to increase HPV vaccination rates in rural communities.
Collapse
Affiliation(s)
- Courtney N Petagna
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
| | - Stephen Perez
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Erica Hsu
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Brenda M Greene
- Southwest Health District, 8-2, Division of Public Health, Georgia Department of Public Health, Albany, GA, 31710, USA
| | - Ionie Banner
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| |
Collapse
|
3
|
Mangione S. The Naming: Tell Me How You Say It, and I'll Tell You What You Think. J Gen Intern Med 2024; 39:1053-1055. [PMID: 38191975 DOI: 10.1007/s11606-023-08602-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/28/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Salvatore Mangione
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
| |
Collapse
|
4
|
Roman M, Cruz MRD, Soon R, Ma C, Chen JJ. Understanding Factors Affecting Health Providers' Perceptions of Pharmacist Roles in HPV Vaccine Administration. Hawaii J Health Soc Welf 2024; 83:92-98. [PMID: 38585287 PMCID: PMC10990833 DOI: 10.62547/rdrv2180] [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] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Human papillomavirus (HPV) is a viral infection that sexually active females and males may be exposed to in their lifetime. The HPV vaccine is highly recommended especially among children to protect them before their anticipated exposure to HPV, however, vaccination uptake in Hawai'i remains low. As of 2017, legislation allows pharmacists to vaccinate for adolescent vaccines with the potential to increase access and opportunities for patients to complete the HPV vaccine series. Physicians in Hawai'i were surveyed to examine physicians' awareness of this law, their perceptions of the role of pharmacists, and willingness to send adolescent patients to pharmacies; 137 responses were received and analyzed. Overall, 72% (n=99) of respondents were willing while 28% (n=38) were unwilling to send patients to pharmacies for vaccines. Physicians view pharmacists' role as helpful but have concerns regarding correct administration and tracking doses given. Results show potential for more physician-pharmacist collaborations through further education and trainings for pharmacists and health providers to increase physician referrals for adolescent vaccine services in pharmacies.
Collapse
Affiliation(s)
- Meliza Roman
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (MR, JJC)
| | - May Rose Dela Cruz
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai‘i at Mānoa, Honolulu, HI (MRDC)
| | - Reni Soon
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (RS)
| | - Carolyn Ma
- Daniel K. Inouye College of Pharmacy, University of Hawai‘i at Hilo, Hilo, HI (CM)
| | - John J. Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (MR, JJC)
| |
Collapse
|
5
|
Laily A, Duncan R, Gabhart KM, Nephew LD, Christy SM, Vadaparampil ST, Giuliano AR, Kasting ML. Differences in Provider Hepatitis C Virus Screening Recommendations by Patient Risk Status. Prev Med Rep 2024; 38:102602. [PMID: 38375175 PMCID: PMC10874862 DOI: 10.1016/j.pmedr.2024.102602] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 02/21/2024] Open
Abstract
Providers' recommendation is among the strongest predictors to patients engaging in preventive care. Therefore, the aim of this study was to compare providers' Hepatitis C Virus (HCV) screening recommendation quality between high-risk and average-risk patients to determine if providers are universally recommending HCV screening, regardless of risk behaviors. This cross-sectional survey of 284 Indiana providers in 2020 assessed provider characteristics, HCV screening recommendation practices (strength, presentation, frequency, timeliness), self-efficacy, and barriers to recommending HCV screening. T-test and Chi-square compared recommendation practices for high-risk and average-risk patients. Prevalence ratios were calculated for variables associated with HCV recommendation strength comparing high-risk and average-risk patients. Logistic regression analyses examined factors associated with HCV recommendation strength for high- and average-risk patients, with odds ratios. Compared to average-risk patients, high-risk patients received higher proportion of HCV recommendations that were strong (70.4 % v. 42.4 %), routine (61.9 % v. 55.6 %), frequent (37.7 % v. 28 %), and timely (74.2 % v. 54.9 %) (P-values < 0.001). Compared to average-risk patients, providers with high-risk patients had a lower percentage of giving a strong recommendation if they were nurse practitioner (PR = 0.49). For high-risk patients, providers with higher self-efficacy (aOR = 2.16;95 %CI = 0.99-4.69) had higher odds, while those with higher perceived barriers (aOR = 0.19;95 %CI = 0.09-0.39) and those with an internal medicine specialty compared to family medicine (aOR = 0.22;95 %CI = 0.08-0.57) had lower odds of giving a strong recommendation. These data suggest providers are not universally recommending HCV screening for all adults regardless of reported risk. Future research should translate these findings into multilevel interventions to improve HCV screening recommendations regardless of patient risk status.
Collapse
Affiliation(s)
- Alfu Laily
- Department of Public Health, College of Health and Human Sciences, Purdue University, 820 Mitch Daniels Blvd, West Lafayette, IN 47907, USA
| | - Robert Duncan
- Department of Human Development and Family Studies, College of Health and Human Sciences, Purdue University, 1202 West State St., West Lafayette, IN 47907, USA
| | - Kaitlyn M. Gabhart
- Department of Psychology, Vanderbilt University, 230 Appleton Pl, Nashville, TN 37203, USA
| | - Lauren D. Nephew
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 340 W 10th St., Indianapolis, IN 46202, USA
| | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Susan T. Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Monica L. Kasting
- Department of Public Health, College of Health and Human Sciences, Purdue University, 820 Mitch Daniels Blvd, West Lafayette, IN 47907, USA
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, 535 Barnhill Dr., Indianapolis, IN 46202, USA
| |
Collapse
|
6
|
Omondi GA, Both J, Ouedraogo R, Kimemia G, Juma K. "I wasn't sure it would work. I was just trying": an ethnographic study on the choice of abortion methods among young women in Kilifi County, Kenya, and Atlantique Department, Benin. Reprod Health 2023; 20:181. [PMID: 38057868 DOI: 10.1186/s12978-023-01720-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Despite the increased availability of safe abortion methods in sub-Saharan Africa, women and girls continue to use unsafe abortion methods and procedures to terminate their unwanted pregnancies, resulting in severe complications, lifelong disabilities, and death. Barriers to safe abortion methods include restrictive laws, low awareness of safe abortion methods, poverty, and sociocultural and health system barriers. Nonetheless, there is a paucity of data on the decision-making around and use of abortion methods. This paper aims to provide answers to the following questions: Which abortion methods do women and girls use and why? Who and what influences their decisions? What can we learn from their decision-making process to enhance the uptake of safe abortion methods? We focus our in-depth analysis on the rationale behind the choice of abortion methods used by women and girls in Kilifi County in Kenya and Atlantique Department in Benin. METHODS We draw on data collected as part of an ethnographic study conducted between January and August 2021 on lived experiences, social determinants, and pathways to abortion. Data were collected using repeated in-depth interviews with 95 girls and women who had a recent abortion experience. Data from the interviews were supplemented using information from key informant interviews, focus group discussions, and participant observation. Data analysis was conducted through an inductive process. RESULTS Our findings reveal that women and girls use various methods to procure abortions, including herbs, high doses of pharmaceutical drugs, homemade concoctions, medical abortion drugs, and surgical abortion methods. Procedures may involve singular or multiple attempts, and sometimes, mixing several methods to achieve the goal of pregnancy termination. The use of various abortion methods is mainly driven by the pursuit of social safety (preservation of secrecy and social relationships, avoidance of shame and stigmatization) instead of medical safety (which implies technical safety and quality). CONCLUSION Our findings reaffirm the need for comprehensive access to, and availability of, abortion-related information and services, especially safe abortion and post-abortion care services that emphasize both medical and social safety.
Collapse
Affiliation(s)
- Gladys Akinyi Omondi
- African Population Health and Research Center, Manga Cl, P.O. Box 10787, Nairobi, Kenya.
| | | | - Ramatou Ouedraogo
- African Population Health and Research Center, Manga Cl, P.O. Box 10787, Nairobi, Kenya
| | | | - Kenneth Juma
- African Population Health and Research Center, Manga Cl, P.O. Box 10787, Nairobi, Kenya
| |
Collapse
|
7
|
Luna G, Kim M, Miller R, Parekh P, Kim ES, Park SY, Abdulbaseer U, Gonzalez C, Stiehl E. Interprofessional relationships and their impact on resident hospitalizations in nursing homes: A qualitative study. Appl Nurs Res 2023; 74:151747. [PMID: 38007247 DOI: 10.1016/j.apnr.2023.151747] [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: 09/14/2022] [Revised: 08/09/2023] [Accepted: 10/24/2023] [Indexed: 11/27/2023]
Abstract
AIM The aim of this study is to explore experiences and perspectives of nurses and providers (e.g., physicians, medical directors, fellows, and nurse practitioners) on reducing preventable hospitalizations of nursing home (NH) residents in relation to interprofessional relationship and hospitalization decision-making process. BACKGROUND Preventable NH resident hospitalization continues to be a pressing public health issue. Studies show that improved interprofessional relationship may help reduce hospitalization, yet research on communication processes and interactions among different NH staff remains limited. METHODS This is a qualitative descriptive study. Two focus groups were held with fourteen nurses and thirteen in-depth, qualitative interviews were conducted with providers from two Chicagoland NHs. Focus group sessions and interviews were transcribed, coded, and analyzed for common themes based on qualitative description method. RESULTS All study participants agreed that providers have the ultimate responsibility for hospitalization decisions. However, nurses believed they could influence those decisions, depending on provider characteristics, trust, and resident conditions. Nurses and providers differed in the way they experienced and conveyed emotions, and differed in key elements affecting hospitalization decisions such as structural or environmental factors (e.g., lacking staff and equipment at the facility, poor communication between the NH and hospitals) and interpersonal factors (e.g., characteristics of effective nurses or providers and the effective interactions between them). CONCLUSIONS Interpersonal factors, including perceived competence, respect, and trust, may influence NH hospitalization decisions and be targeted for reducing preventable hospitalizations of residents.
Collapse
Affiliation(s)
- Geraldine Luna
- Chicago Department of Public Health, 333 S State St #200, Chicago, IL 60604, United States of America.
| | - Mhinjine Kim
- University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL 60612, United States of America.
| | - Richard Miller
- University of Illinois Chicago, 2170 West Bowler Street, Chicago, IL 60612, United States of America.
| | - Pooja Parekh
- University of Illinois Chicago, 1355 S. Halsted St., Chicago, IL 60607, United States of America.
| | - Esther S Kim
- University of Illinois Chicago, 625 W Madison St., Chicago, IL 60661, United States of America.
| | - Sophia Yaejin Park
- University of Illinois Chicago, 1853 W Polk St, Chicago, IL 60612, United States of America.
| | - Ummesalmah Abdulbaseer
- University of Illinois Chicago, 1853 W Polk St, Chicago, IL 60612, United States of America.
| | - Cristina Gonzalez
- University of Illinois Chicago, 1853 W Polk St, Chicago, IL 60612, United States of America.
| | - Emily Stiehl
- University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL 60612, United States of America.
| |
Collapse
|
8
|
Bravo A, Ibañez LV, Scott S, Dick C, Carpentier P, Stone WL. Telehealth Delivery in Part C Early Intervention: Provider and Caregiver Perspectives. J Autism Dev Disord 2023; 53:4545-4559. [PMID: 36153443 PMCID: PMC9510265 DOI: 10.1007/s10803-022-05734-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Abstract
Telehealth is a promising modality for Part C early intervention (EI), services typically implemented face-to-face in home and community settings. Barriers to telehealth in EI reported prior to COVID-19 included lack of training and access to reliable internet. The abrupt telehealth shift at the onset of the pandemic did not permit a phased adoption approach. This mixed-methods study aimed to characterize perspectives of service changes resulting from the telehealth transition. Providers (n = 39) and caregivers (n = 11) completed surveys about perceptions towards the telehealth switch. All providers indicated at least one aspect of services had changed. Approximately half of caregivers reported satisfaction with services decreased and half that satisfaction remained the same. Implications for telehealth in EI beyond the pandemic are discussed.
Collapse
Affiliation(s)
- Alice Bravo
- College of Education, University of Washington, Seattle, WA, 98115, USA.
| | - Lisa V Ibañez
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Sabine Scott
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Catherine Dick
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Pascale Carpentier
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Wendy L Stone
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| |
Collapse
|
9
|
Hughes LD, Gamarel KE, Restar AJ, Sequeira GM, Dowshen N, Regan K, Kidd KM. Adolescent Providers' Experiences of Harassment Related to Delivering Gender-Affirming Care. J Adolesc Health 2023; 73:672-678. [PMID: 37589604 PMCID: PMC10568537 DOI: 10.1016/j.jadohealth.2023.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE The politicization of adolescent gender-affirming care has occurred alongside targeted harassment (e.g., threats of violence, doxing, bomb threats) of adolescent gender-affirming care providers across the United States. This study sought to explore their experiences of targeted harassment. METHODS From October to December 2022, mental and physical health gender-affirming care providers from across the United States completed a survey including open-ended questions about the kinds of harassment they experienced (i.e., method and messages of harassment) and its impact on their lives and practices. Thematic analyses were used to analyze their responses. RESULTS In total, 117 providers completed the survey and 70% shared that either they, their practice, or their institution had received threats specific to delivering gender-affirming care. The most common experiences were threats via social media or mailed letters. Several received death threats. Providers described how targeted harassment impacted their psychological well-being and required them to reassess clinic safety. Additionally, providers expressed the need for a more accurate representation of gender-affirming care in media and stronger advocacy from institutions and organizations emphasizing the importance of this care. DISCUSSION Adolescent gender-affirming care providers are experiencing targeted harassment, significantly affecting their ability to deliver care to transgender and gender-diverse adolescents and their families. Providers stressed the importance of receiving support from their institutions to ensure their safety. The ongoing sociopolitical climate related to gender-affirming care coupled with targeted harassment of those providing it will further limit access to this care.
Collapse
Affiliation(s)
- Landon D Hughes
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Arjee J Restar
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington; Department of Behavioral and Social Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Gina M Sequeira
- Department of Pediatrics, University of Washington, Seattle, Washington; Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nadia Dowshen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Gender & Sexual Development Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Katelyn Regan
- Gender & Sexual Development Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kacie M Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| |
Collapse
|
10
|
Fierro JM, Lewis MA, Brecht ML, Rachelefsky G, Feaster W, Ehwerhemuepha L, Robbins W. A pilot study to improve provider adherence to NAEPP guidelines. J Pediatr Nurs 2023; 72:113-120. [PMID: 37499439 DOI: 10.1016/j.pedn.2023.07.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
The prevalence and morbidity of Asthma in the United States has increased since the 1991 National Asthma Education and Prevention Program (NAEPP) and updated Expert Panel Report -3 (EPR-3) guidelines in 2007 were published. To improve provider adherence to the NAEPP EPR-3 guidelines Children's Hospital of Orange County (CHOC) in California integrated the HealtheIntentSM Pediatric Asthma Registry (PAR) into the electronic medical record (EMR) in 2015. METHODS A serial cross-sectional design was used to compare provider management of CHOC MediCal asthma patients before 2014 (N = 6606) and after 2018 (N = 6945) integration of the Registry with NAEPP guidelines into the EMR. Four provider adherence measures (Asthma Control Test [ACT], Asthma Action Plan [AAP], inhaled corticosteroids [ICS] and spacers) were evaluated using General Linear Mixed Models and Chi square. FINDINGS In 2018, patients were more likely to receive an ACT, (OR = 14.95, 95% CI 12.67, 17.65, p < .001), AAP (OR = 12.70, 95% CI 11.10, 14.54, p < .001), ICS (OR = 1.85, 95% CI 8.52, 14.54, p < .001) and spacer (OR = 1.45, 95% CI 1.31, 1.6, p < .001) compared to those in 2014. DISCUSSION The pilot study showed integration of the Pediatric Asthma Registry into the EMR, as a computer decision support tool that was an effective intervention to increase provider adherence to NAEPP guidelines. Ongoing monitoring and education are needed to promote and sustain provider behavioral change. Additional research to include multi-sites and decreased time between evaluation years is recommended. APPLICATION TO PRACTICE Can be used for excellent health policy decision making as a direct impact on patient care and outcomes, by improving provider adherence to the NAEPP guidelines.
Collapse
Affiliation(s)
- Joanne M Fierro
- University of California, Los Angeles, United States of America.
| | - Mary Ann Lewis
- University of California, Los Angeles, United States of America
| | | | | | - William Feaster
- Children's Hospital of Orange County, United States of America
| | | | - Wendie Robbins
- University of California, Los Angeles, United States of America
| |
Collapse
|
11
|
Lee JW, Jeong S, Han HR, Boyd CM, Perrin N, Simmons SF, Green AR, Taylor JL, Boucher HR, Szanton SL. Barriers and facilitators to deprescribing before surgery: A qualitative study of providers and older adults. Geriatr Nurs 2023; 53:135-140. [PMID: 37540907 PMCID: PMC10528381 DOI: 10.1016/j.gerinurse.2023.07.018] [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: 05/23/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Deprescribing, the collaborative process between providers and patients to streamline medication regimen, may reduce the risk of adverse events following surgery among older adults with multimorbidity. However, barriers and facilitators to deprescribing for surgery has not been explored. METHODS We conducted a qualitative study of Primary Care Providers (PCP) and patients aged 65 and older who were scheduled for surgery. We used the Theoretical Domains Framework, which informed the interview guide and analysis. RESULTS A total of 16 participants (n=8 providers, n=8 patients) were included. Themes were regarding: 1) attitudes towards deprescribing before surgery, 2) perceived benefits of deprescribing before surgery, 3) patient-provider relationship and shared decision-making, 4) hope for surgery, 5) barriers to deprescribing before surgery, and 6) preferences for deprescribing follow-up. CONCLUSION Our study findings regarding provider- and patient-related barriers and facilitators for deprescribing and desired processes before surgery may inform future deprescribing intervention targets before surgery.
Collapse
Affiliation(s)
- Ji Won Lee
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205.
| | - Suin Jeong
- Medstar Georgetown University, 3800 Reservoir Road NW, Washington, DC, 20007, USA
| | - Hae-Ra Han
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205
| | - Cynthia M Boyd
- Johns Hopkins School of Medicine, Center for Transformative Geriatric Research, 5200 Eastern Avenue, MFL Building, 3(rd) Floor, Baltimore, MD, 21224
| | - Nancy Perrin
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205
| | - Sandra Faye Simmons
- Vanderbilt Center for Quality Aging, Vanderbilt University Medical Center, Division of Geriatrics, Nashville, TN, USA; VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, TN, USA
| | - Ariel R Green
- Johns Hopkins School of Medicine, Center for Transformative Geriatric Research, 5200 Eastern Avenue, MFL Building, 3(rd) Floor, Baltimore, MD, 21224
| | - Janiece L Taylor
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205
| | - Henry R Boucher
- Medstar Union Memorial Hospital, 3333 N. Calvert St. Suite 400, Baltimore, MD, 21218
| | - Sarah L Szanton
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205
| |
Collapse
|
12
|
Vielot NA, Lane RM, Loefstedt K, Cunningham JL, Everson J, Tiller E, Johnson Patel SE, Smith JS. Acceptability and readiness to promote human papillomavirus vaccination at ages 9-10 years: a feasibility study among North Carolina clinics. Pilot Feasibility Stud 2023; 9:153. [PMID: 37653458 PMCID: PMC10470204 DOI: 10.1186/s40814-023-01379-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 07/18/2023] [Indexed: 09/02/2023] Open
Abstract
While 9-valent human papillomavirus (HPV) vaccination is approved by the US Food and Drug Administration for use in adolescents as young as age 9, providers typically recommend it at ages 11-12. Studies suggest that recommending HPV vaccination at 9 or 10 years of age could increase up-to-date vaccination by age 13, which could especially benefit rural populations with reduced access to primary health care and lower HPV vaccination coverage than urban areas. This study aimed to assess the feasibility of the age-9 recommendation of HPV vaccination in rural clinics. We conducted in-depth interviews with providers and staff from two primary care clinics in central North Carolina to understand attitudes toward recommending HPV vaccination to 9- and 10-year-olds. All interviewees agreed that HPV vaccination was important for cancer prevention and should be recommended before the onset of sexual activity, agreeing that HPV vaccination could be initiated before age 11 to improve timeliness and completion of the vaccination series. However, opinions were mixed on whether HPV vaccination should be initiated as young as 9 years old. Two key informants recruited from two university-affiliated clinics described their experiences recommending HPV vaccination to 9- and 10-year-olds, including a modified vaccination schedule that promotes HPV vaccination during routine well-child visits, prior to pubertal onset, and alongside other recommended adolescent vaccines. Age-9 recommendation and administration of HPV vaccination is possible with minimal changes to current clinical practices and could increase the convenience and acceptability of HPV vaccination in under-vaccinated settings.
Collapse
Affiliation(s)
- Nadja A Vielot
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, North Carolina, 27599, USA.
| | - Robyn M Lane
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, North Carolina, 27599, USA
| | - Kaitlyn Loefstedt
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Jason Everson
- Piedmont Health Services, Inc, Chapel Hill, North Carolina, USA
| | - Eli Tiller
- Piedmont Health Services, Inc, Chapel Hill, North Carolina, USA
| | | | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
13
|
Oluwoye O, Weeks DL, McDonell MG. An unexplored equity factor: differential beliefs and attitudes toward contingency management by providers' ethnicity. BMC Health Serv Res 2023; 23:902. [PMID: 37612684 PMCID: PMC10464444 DOI: 10.1186/s12913-023-09878-7] [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: 03/21/2023] [Accepted: 08/04/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Although considered one of the most effective interventions for substance use disorders (SUD), the widespread implementation of contingency management (CM) has remained limited. In more recent years there has been surge in the implementation of CM to address increasing rates of substance use. Prior studies at the provider-level have explored beliefs about CM among SUD treatment providers and have tailored implementation strategies based on identified barriers and training needs, to promote implementation of CM. However, there have been no implementation strategies that have actively sought to identify or address potential differences in the beliefs about CM that could be influenced by the cultural background (e.g., ethnicity) of treatment providers. To address this knowledge gap, we examined beliefs about CM among a sample of inpatient and outpatient SUD treatment providers. METHODS A cross-sectional survey of SUD treatment providers was completed by 143 respondents. The survey asked respondents about their attitudes toward CM using the Contingency Management Beliefs Questionnaire (CMBQ). Linear mixed models examined the effect of ethnicity (non-Hispanic White and Hispanic) on CMBQ subscale (general barriers, training-related barriers, CM positive-statements) scores. RESULTS Fifty-nine percent of respondents to the CMBQ self-identified as non-Hispanic White and 41% as Hispanic. Findings revealed that treatment providers who identified as Hispanic had significantly higher scores on the general barriers (p < .001) and training-related barriers (p = .020) subscales compared to the non-Hispanic White treatment providers. Post-hoc analyses identified differences in the endorsement of specific individual scale items on the general barriers (e.g., CM interventions create extra work for me) and training-related (e.g., I want more training before implementing CM) subscales. CONCLUSIONS Dissemination and implementation strategies for CM need to consider equity-related factors at the provider-level that may be associated with the adoption and uptake of CM.
Collapse
Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99202, USA.
| | - Douglas L Weeks
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99202, USA
| | - Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99202, USA
| |
Collapse
|
14
|
Smith L, Williams RM, Whealan J, Windels A, Anderson ED, Parikh V, Breece CJ, Puran N, Shepherd AK, Geronimo M, Luta G, Adams-Campbell L, Taylor KL. Development and Evaluation of Brief Web-Based Education for Primary Care Providers to Address Inequities in Lung Cancer Screening and Smoking Cessation Treatment. J Cancer Educ 2023; 38:1296-1303. [PMID: 36637713 PMCID: PMC10754418 DOI: 10.1007/s13187-023-02262-3] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
Annual lung cancer screening (LCS) is recommended for individuals at high risk for lung cancer. However, primary care provider-initiated discussions about LCS and referrals for screening are low overall, particularly among Black or African Americans and other minoritized racial and ethnic groups. Disparities also exist in receiving provider advice to quit smoking. Effective methods are needed to improve provider knowledge about LCS and tobacco-related disparities, and to provide resources to achieve equity in LCS rates. We report the feasibility and impact of pairing a self-directed Lung Cancer Health Disparities (HD) Web-based course with the National Training Network Lung Cancer Screening (LuCa) course on primary care providers' knowledge about LCS and the health disparities associated with LCS. In a quasi-experimental study, primary care providers (N = 91) recruited from the MedStar Health System were assigned to complete the LuCa course only vs. the LuCa + HD courses. We measured pre-post-LCS-related knowledge and opinions about the courses. The majority (60.4%) of providers were resident physicians. There was no significant difference between groups on post-test knowledge (p > 0.05). However, within groups, there was an improvement in knowledge from pre- to post-test (LuCa only (p = 0.03); LuCa + HD (p < 0.001)). The majority of providers (81%) indicated they planned to improve their screening and preventive practices after having reviewed the educational modules. These findings provide preliminary evidence that this e-learning course can be used to educate providers on LCS, smoking cessation, and related disparities impacting patients.
Collapse
Affiliation(s)
- Laney Smith
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue NW, Suite 300, Washington, D.C., 20007‑2401, USA
| | - Randi M Williams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue NW, Suite 300, Washington, D.C., 20007‑2401, USA.
| | - Julia Whealan
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue NW, Suite 300, Washington, D.C., 20007‑2401, USA
| | - Allison Windels
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Eric D Anderson
- Department of Interventional Pulmonology, Georgetown University Medical Center, Washington, D.C., USA
| | | | - Chavalia Joan Breece
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Namita Puran
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, D.C., USA
| | - Andrea K Shepherd
- Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA
| | | | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, D.C., 20007, USA
| | - Lucile Adams-Campbell
- Office of Minority Health and Health Disparities Research, Georgetown University Medical Center, Washington, D.C., 20007, USA
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue NW, Suite 300, Washington, D.C., 20007‑2401, USA
| |
Collapse
|
15
|
Abdi I, Bolsewicz K, Bullivant B, Marques MD, Steffens MS. Understanding the factors that influence communication about COVID-19 vaccines with patients: Perspectives of Australian immunisation providers. Vaccine X 2023; 14:100304. [PMID: 37091729 PMCID: PMC10108559 DOI: 10.1016/j.jvacx.2023.100304] [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: 12/22/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023] Open
Abstract
Background COVID-19 immunisation providers have been at the forefront of the pandemic, and their ability to communicate effectively with patients is key to encouraging COVID-19 vaccine acceptance and uptake. This study explored providers' perspectives on the factors influencing communication with patients about COVID-19 vaccines. Methods We used an explanatory-sequential mixed-methods approach to conduct the study between December 2021 and March 2022. Phase I involved a cross-sectional survey with immunisation providers in New South Wales (n = 341; 189 general practitioners, 118 nurses and 34 pharmacists), followed by Phase II: semi-structured, in-depth qualitative interviews (n = 19; 10 nurses, 9 pharmacists). We generated descriptive results for the survey. We analysed the qualitative data thematically using an inductive approach. Results Almost half of survey participants reported communicating often with people who were hesitant about COVID-19 vaccines (49 %; 166/341), however, 21 % (71/341) reported inadequate time to address concerns during consultations. Interview participants reported communication challenges, including time constraints, difficulties addressing and eliciting patient concerns, and keeping up to date with changing information. Conversely, interview participants reported that easy access to government information resources, time to learn about COVID-19 vaccines proactively, knowing about and being able to use tailored strategies to support Aboriginal and Torres Strait Islander and CALD patients were helpful when communicating with patients. Conclusions Immunisation providers play an important role in patient vaccine acceptance and uptake. Our findings indicate that whilst providers were largely confident in their interactions with patients, further communication support would strengthen providers' skills in communicating with patients who have questions and concerns about COVID-19 vaccines.
Collapse
Affiliation(s)
- Ikram Abdi
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Katarzyna Bolsewicz
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Bianca Bullivant
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Mathew D Marques
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Maryke S Steffens
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
16
|
Yu JRT, Shuaib U, Mate KKV, Kaur H, Sonneborn C, Hogue O, Morrison J, Yu XX. Identifying misconceptions and knowledge gaps in functional neurological disorders among emergency care providers. J Clin Neurosci 2023; 114:81-88. [PMID: 37329664 DOI: 10.1016/j.jocn.2023.06.008] [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: 02/15/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Functional Neurologic Disorders (FND) are a common but heterogeneous group of disabling conditions. The Emergency Department (ED) is an important venue for care and referral as it is often the first point of contact when patients with FND are faced with a crisis or exacerbation of symptoms. METHODS ED providers (n = 273) practicing in the Cleveland Clinic Foundation Northeast Ohio network were invited to participate through secure web application electronic surveys. Data were collected on practice profiles, knowledge, attitudes, management of FND, and awareness of available resources for FND. RESULTS Sixty providers completed the survey (22% response rate; n = 50 ED physicians, 10 advanced care providers) with 95.0% (n = 57) reporting a lack of understanding about FND. The terms Psychogenic Nonepileptic Seizures and stress induced/stress related disease were used by 60.0% (n = 36) and 58.3% (n = 35) respectively. Ninety percent (n = 53) rated their experience with managing FND patients as at least more difficult. Eighty- five percent (n = 51) agreed with "rule out others" and 60% (n = 36) agreed with "caused by psych stress". Eighty six percent (n = 50) believe that there is a difference between FND from malingering. Only one respondent was familiar with any FND resources and 79% (n = 47) reported the need for FND specific educational materials. CONCLUSION This survey revealed major gaps in knowledge, inaccurate perceptions, and management that differs from the current standard of care among ED providers caring for patients with FND. Educational opportunities are needed to guide diagnosis and evidence-based treatment to optimize management of patients with FND.
Collapse
Affiliation(s)
- Jeryl Ritzi T Yu
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States
| | - Umar Shuaib
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States
| | - Kedar K V Mate
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Department of Musculoskeletal Oncology, Mayo Clinic, Arizona, United States
| | - Harpreet Kaur
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States
| | - Claire Sonneborn
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, OH, United States
| | - Olivia Hogue
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, OH, United States
| | - James Morrison
- Emergency Services Institute & Respiratory Institute, Cleveland Clinic, OH, United States
| | - Xin Xin Yu
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States.
| |
Collapse
|
17
|
Brotherton JM, McDermott T, Smith MA, Machalek DA, Shilling H, Prang KH, Jennett C, Nightingale C, Zammit C, Pagotto A, Rankin NM, Kelaher M. Implementation of Australia's primary human papillomavirus (HPV) cervical screening program: The STakeholders Opinions of Renewal Implementation and Experiences Study. Prev Med Rep 2023; 33:102213. [PMID: 37223565 PMCID: PMC10201842 DOI: 10.1016/j.pmedr.2023.102213] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/25/2023] Open
Abstract
In this study, we aimed to document stakeholders' experiences of implementing Australia's renewed National Cervical Screening Program. In December 2017, the program changed from 2nd yearly cytology for 20-69 year olds to 5 yearly human papillomavirus (HPV) screening for women 25-74 years. We undertook semi-structured interviews with key stakeholders including government, program administrators, register staff, clinicians and health care workers, non-government organisations, professional bodies, and pathology laboratories from across Australia between Nov 2018 - Aug 2019. Response rate to emailed invitations was 49/85 (58%). We used Proctor et al's (2011) implementation outcomes framework to guide our questions and thematic analysis. We found that stakeholders were evenly divided over whether implementation was successful. There was strong support for change, but concern over aspects of the implementation. There was some frustration related to the delayed start, timeliness of communication and education, shortcomings in change management, lack of inclusion of Aboriginal and Torres Strait Islander people in planning and implementation, failure to make self-collection widely available, and delays in the National Cancer Screening Register. Barriers centred around a perceived failure to appreciate the enormity of the change and register build, and consequent failure to resource, project manage and communicate effectively. Facilitators included the good will and dedication of stakeholders, strong evidence base for change and the support of jurisdictions during the delay. We documented substantial implementation challenges, offering learnings for other countries transitioning to HPV screening. Sufficient planning, significant and transparent engagement and communication with stakeholders, and change management are critical.
Collapse
Affiliation(s)
- Julia M.L. Brotherton
- Formerly Employed at the Australian Centre for the Prevention of Cervical Cancer, Victoria, Australia
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Tracey McDermott
- Formerly Employed at the Australian Centre for the Prevention of Cervical Cancer, Victoria, Australia
| | - Megan A. Smith
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, New South Wales, Australia
| | - Dorothy A. Machalek
- Centre for Women’s Infectious Diseases, Royal Women’s Hospital Melbourne, Victoria, Australia
- Kirby Institute, University of NSW, New South Wales, Australia
| | - Hannah Shilling
- Centre for Women’s Infectious Diseases, Royal Women’s Hospital Melbourne, Victoria, Australia
| | - Khic-Houy Prang
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Chloe Jennett
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, New South Wales, Australia
| | - Claire Nightingale
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Claire Zammit
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Amy Pagotto
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, New South Wales, Australia
| | - Nicole M. Rankin
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Margaret Kelaher
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| |
Collapse
|
18
|
Davis TL, Mittal M, Oragwu AC, Wang MQ, Boekeloo BO. Examining HIV Diagnosis and Linkage to PrEP Prescription Among Members at An Integrated Health System in the Southeast United States. AIDS Behav 2023; 27:796-805. [PMID: 36097086 DOI: 10.1007/s10461-022-03812-4] [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] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
Pre-Exposure Prophylaxis (PrEP) is a priority method for preventing HIV infection. This study's aims were threefold: (1) identify characteristics of members of a large health maintenance organization, Kaiser Permanente Georgia (KPGA), associated with HIV infection, (2) identify which member characteristics associated with HIV were also associated with PrEP prescription, and (3) identify which HIV-associated characteristics were associated with under- or over-prescribing of PrEP. Analysis of variables from the electronic medical record revealed that age, race, gender, mental health diagnosis, STI diagnosis, and sexual orientation were independently associated with HIV diagnosis. The same characteristics were independently associated with PrEP prescription except for race. Persons identifying as Black or unknown race, women, and/or heterosexual; and who had an STI diagnosis and/or illicit drug use had lower odds of being prescribed PrEP than of having an HIV diagnosis. The implications of these findings for improving physician identification of candidates for PrEP prescription are discussed.
Collapse
Affiliation(s)
- Teaniese L Davis
- Center for Health Research, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Mona Mittal
- Department of Family Science, University of Maryland School of Public Health, College Park, MD, USA
| | - Adanna C Oragwu
- Clinical Pharmacy , Kaiser Permanente Georgia, Atlanta, GA, USA.,Global Medical Affairs, Gilead Sciences, Foster City, CA, USA
| | - Min Qi Wang
- Department of Behavioral and Community Health, University of Maryland School of Public Health, 4200 Valley Dr, 20742. 301-405-2463, College Park, MD, USA
| | - Bradley O Boekeloo
- Department of Behavioral and Community Health, University of Maryland School of Public Health, 4200 Valley Dr, 20742. 301-405-2463, College Park, MD, USA.
| |
Collapse
|
19
|
Fentem A, Riordan R, Doroshenko C, Li X, Kasson E, Banks D, Winograd RP, Cavazos-Rehg P. Impact of the COVID-19 pandemic on burnout and perceived workplace quality among addiction treatment providers. Addict Sci Clin Pract 2023; 18:5. [PMID: 36670445 PMCID: PMC9854021 DOI: 10.1186/s13722-023-00361-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/17/2021] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This study examines the impact of the COVID-19 pandemic on work satisfaction, work-related stress, and perceived work quality among substance use treatment providers to better understand challenges faced among this group during the pandemic. METHODS Participants of this study were 91 addiction treatment providers (e.g., therapists, physicians, community support specialists, administrative staff) recruited from various treatment facilities (e.g., inpatient and outpatient settings). Mixed method analyses were conducted to assess self-reported burnout, sources of work-related stress, and perceived work quality during the pandemic. Responses from providers reporting COVID-19 related decreases in work quality were compared to responses from providers who reported their quality of work had increased or remained the same. RESULTS Results demonstrated half of providers (51%) reported their quality of work had decreased. This perceived decrease in quality of work was associated with higher levels of emotional exhaustion (M = 17.41 vs. M = 12.48, p = 0.002), workplace stress (M = 42.80 vs. M = 30.84, p = 0.001), as well as decreased enjoyment of work (83% vs. 51%, p = 0.001) and decreased personal accomplishment (M = 20.64 vs. M = 23.05 p = 0.001). Qualitative investigations further illustrated that increased hours, changes in work schedules, work-life balance challenges, difficulties with client communication, and increased client needs were contributing factors increasing stress/burnout and decreasing perceived work quality. CONCLUSIONS Addiction treatment providers experience high levels of burnout and workplace stress. Additionally, many individuals perceived a decrease in their quality of work during the COVID-19 pandemic. Addiction treatment facility administration should address these challenges to support the well-being of clinical staff and the clients they serve both during and after the COVID-19 pandemic.
Collapse
Affiliation(s)
- Andrea Fentem
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Raven Riordan
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Christine Doroshenko
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Xiao Li
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Erin Kasson
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Devin Banks
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121 USA
| | - Rachel P. Winograd
- grid.266757.70000000114809378Missouri Institute of Mental Health, University of Missouri St. Louis, 43 Benton Court, St. Louis, MO 63121 USA
| | - Patricia Cavazos-Rehg
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| |
Collapse
|
20
|
Vranda MN, Janardhana N, Kumar CN. Development of preparedness to respond to intimate partner violence scale among mental health professionals. J Neurosci Rural Pract 2023; 14:98-102. [PMID: 36891117 PMCID: PMC9945028 DOI: 10.25259/jnrp-2022-4-31] [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: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Violence against women has been associated with serious health and mental health consequences. Health-care professionals play an important role in screening and providing care and support to victims of intimate partner violence (IPV) in the hospital setting. There is no culturally relevant tool to assess the mental health professional (MHP) preparedness to screen for partner violence in the clinical setting. This research aimed towards developing and standardizing scale to measure MHP preparedness and perceived skills in responding to IPV in the clinical setting. Materials and Methods The scale was field tested with 200 subjects using consecutive sampling at a tertiary care hospital. Results The exploratory factor analysis resulted in five factors constituting 59.2% of the total variance. The internal consistency Cronbach alpha 0.72 for the final 32-item scale was highly reliable and adequate. Conclusion The final version of the Preparedness to Respond to IPV (PR-IPV) scale measures MHP PR-IPV in the clinical setting. Further, the scale can be used to evaluate the outcome of IPV interventions in different settings.
Collapse
Affiliation(s)
- Mysore Narasimha Vranda
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Navaneetham Janardhana
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | |
Collapse
|
21
|
Aslanyan L, Arakelyan Z, Atanyan A, Abrahamyan A, Karapetyan M, Sahakyan S. Primary healthcare providers challenged during the COVID-19 pandemic: a qualitative study. BMC Prim Care 2022; 23:310. [PMID: 36463103 PMCID: PMC9719166 DOI: 10.1186/s12875-022-01923-4] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Primary healthcare (PHC) providers are widely acknowledged for putting the most efficient and long-lasting efforts for addressing community health issues and promoting health equity. This study aimed to explore PHC providers' experiences with coronavirus pandemic preparedness and response in Armenia. METHODS We applied a qualitative study design using semi-structured in-depth interviews and structured observation checklists. Study participants were recruited using theoretical and convenience sampling techniques throughout Armenia. Inductive conventional content analysis was utilized to analyze the in-depth interviews. Nineteen in-depth interviews were conducted with 21 participants. Observations took place in 35 PHC facilities. The data collected during the observations was analyzed using the "SPSS22.0.0.0" software. RESULTS Five main themes of primary healthcare providers' experiences were drawn out based on the study findings: 1) the gap in providers' risk communication skills; 2) uneven supply distributions; 3) difficulties in specimen collection and testing processes; 4) providers challenged by home visits; 5) poor patient-provider relationships. The results revealed that primary care providers were affected by uneven supply distribution throughout the country. The lack of proper laboratory settings and issues with specimen collection were challenges shaping the providers' experiences during the pandemic. The study highlighted the health systems' unpreparedness to engage providers in home visits for COVID-19 patients. The findings suggested that it was more challenging for healthcare providers to gain the trust of their patients during the pandemic. The study results also underlined the need for trainings to help primary care providers enhance their risk communication expertise or assign other responsible bodies to carry out risk communication on PHC providers' behalf. CONCLUSION The study discovered that PHC providers have a very important role in healthcare system's preparedness and response to handle public health emergencies such as the COVID-19 pandemic. Based on the findings the study team recommends prioritizing rural PHC development, ensuring appropriate supply distributions, developing comprehensive protocols on safe home visits and specimen collection and testing processes, and trainings PHC providers on risk communication, patient-centeredness, as well as proper use of personal protective equipment.
Collapse
Affiliation(s)
- Lusine Aslanyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Zaruhi Arakelyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Astghik Atanyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Arpine Abrahamyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Manya Karapetyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| |
Collapse
|
22
|
Quinn K, John S, Hirshfield S, Algiers O, O'Neil A, Petroll A, Walsh J. Challenges to meeting the HIV care needs of older adults in the rural South. SSM Qual Res Health 2022; 2:100113. [PMID: 36620181 PMCID: PMC9815493 DOI: 10.1016/j.ssmqr.2022.100113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
People living with HIV in rural parts of the Southern United States face poor outcomes along the HIV care continuum. Additionally, over half of people with diagnosed HIV are age 50 and older. Older adults living with HIV in the rural South often have complex health and social needs associated with HIV, aging, and the rural environment. Research is needed to understand what support organizations and clinics need in providing care to this population. This qualitative study examines the challenges health and social service providers face in caring for older patients living with HIV. In 2020-2021, we interviewed 27 key informants who work in organizations that provide care to older adults with HIV in the seven states with high rural HIV burden: Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina. Our findings highlight how racism and poverty; culture, politics, and religion; and a lack of healthcare infrastructure collectively shape access to HIV care for older adults in the South. Rural health and social service providers need structural-level changes to improve their care and services.
Collapse
Affiliation(s)
- K.G. Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - S.A. John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - S. Hirshfield
- SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY, 11203, United States
| | - O. Algiers
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - A. O'Neil
- Institute for Health and Equity, Medical College of Wisconsin, 8701 W. Watertown Plank Road, Wauwatosa, WI, 53226, United States
| | - A.E. Petroll
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - J.L. Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| |
Collapse
|
23
|
Stokes B, Fraser E, Kriegel L, Oluwoye O. Exploring Provider Perspectives on Implementing Coordinated Specialty Care: A Qualitative Study. Community Ment Health J 2022; 58:1321-1328. [PMID: 35091877 PMCID: PMC8799406 DOI: 10.1007/s10597-022-00939-5] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/21/2021] [Indexed: 12/02/2022]
Abstract
This study aimed to explore clinician roles and experiences related to the implementation and sustainability of coordinated specialty care (CSC) programs for first episode psychosis. Qualitative interviews were conducted with 20 CSC providers and team members, recruited from five CSC programs. Using a semi-structured guide, interviews explored experiences with the delivery of CSC in the context of community-based outpatient mental health agencies and the challenges with implementation. Interviews were audio recorded, transcribed, and analyzed using thematic analysis. Themes were parsed into two overarching categories, provider, and organizational-level factors, and further distilled into subthemes which interacted with one another to form an interacting web of barriers to successful programmatic implementation for CSC programs. Study findings have important implications for development of future policy for financing mental health agencies, the creation of additional materials, supports for the model, and hiring and retention of staff for future implemented CSC programs.
Collapse
Affiliation(s)
- Bryony Stokes
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.,Department of Human Development, Washington State University, Pullman, WA, USA.,Washington State Center for Excellence in Early Psychosis, Seattle, WA, USA
| | - Elizabeth Fraser
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.,Washington State Center for Excellence in Early Psychosis, Seattle, WA, USA
| | - Liat Kriegel
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA. .,Washington State Center for Excellence in Early Psychosis, Seattle, WA, USA.
| |
Collapse
|
24
|
Smith J, Schachter A, Banay R, Zimmerman E, Vargas A, Sellman A, Kamanga A. Promoting respectful maternity care using a behavioral design approach in Zambia: results from a mixed-methods evaluation. Reprod Health 2022; 19:141. [PMID: 35725476 PMCID: PMC9208205 DOI: 10.1186/s12978-022-01447-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background Respectful maternity care (RMC) has been elevated in the global discourse, however, instances of disrespect and abuse remain prevalent. While several studies have highlighted promising approaches to promote RMC, this body of literature is still limited and few approaches have been scaled outside the initial study sites. Building on formative research conducted through a behavioral science lens, we sought to develop and test evidence-based, low-cost solutions to promote RMC which would be well-positioned for scale-up. Our study highlights the effectiveness of the solution package on provider provision of respectful care and client satisfaction, as well as intermediary outcomes and behavioral mechanisms. Methods A quasi-experimental evaluation, informed by the behavioral design approach, was completed to test the effectiveness of a 5-component solution package in Chipata, Zambia. Quantitative surveys were collected from health facility providers and postpartum clients at baseline and endline in intervention and comparison facilities. Additional qualitative interviews were conducted with health facility providers and postpartum clients at endline. We also conducted interviews with health facility in-charges and observed labor and delivery practices at intervention facilities over the course of implementation. Results Evidence suggested that at endline, clients at implementation facilities were less likely to experience disrespect and abuse compared to clients at comparison facilities (ß = − 0.15 p = 0.01). Clients at intervention facilities were more likely to request pain management compared to clients at comparison facilities (ß = 0.33, p = 0.003). The solutions were simple for providers to implement and were easily integrated into existing services by providers during labor and delivery. Providers at intervention facilities also described the pain management toolkit as helpful in expanding the types of pain management techniques used during labor. Conclusions The results of this small-scale study act as a proof of concept, demonstrating that the behavioral design approach can lead to solutions that show potential for impact. In other settings where providers face similar barriers to providing RMC, an adaptation of this solution package might lead to similarly positive results. Given the global scale of disrespectful care, these low-cost solutions hold promise for improving the quality of care women receive during labor and delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01447-1. Instances of disrespect and abuse during childbirth are prevalent around the world, particularly in low-resource settings. Few interventions have been designed and evaluated in these settings and even fewer in Southern Africa. This study aimed to understand the effects of a behaviorally informed intervention on the provision of respectful maternity care. We performed an evaluation of a health facility-based intervention, in Chipata District, Zambia. The study included quantitative and qualitative surveys with health care providers and women who recently delivered, as well as health facility observations and qualitative interviews with health facility supervisors. Our results show that clients who delivered at a facility where our intervention took place had a decreased likelihood of experiencing disrespect and abuse and an increased provision of pain management support. Our findings suggest that facility-based approaches informed by behavioral science have the potential to increase provision of respectful care and decrease the prevalence of mistreatment in low-resource settings. A large-scale evaluation of these interventions across settings could contribute valuable evidence around low-cost solutions to promote respectful maternity care.
Collapse
|
25
|
Shayo EH, Kivuyo S, Seeley J, Bukenya D, Karoli P, Mfinanga SG, Jaffar S, Van Hout MC. The acceptability of integrated healthcare services for HIV and non-communicable diseases: experiences from patients and healthcare workers in Tanzania. BMC Health Serv Res 2022; 22:655. [PMID: 35578274 PMCID: PMC9112557 DOI: 10.1186/s12913-022-08065-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, the prevalence of non-communicable diseases (NCDs) has risen sharply amidst a high burden of communicable diseases. An integrated approach to HIV and NCD care offers the potential of strengthening disease control programmes. We used qualitative methods to explore patients' and care-providers' experiences and perspectives on the acceptability of integrated care for HIV-infection, diabetes mellitus (DM), and hypertension (HT) in Tanzania. METHODS A qualitative study was conducted in selected health facilities in Dar es Salaam and Coastal regions, which had started to provide integrated care and management for HIV, DM, and HT using a single research clinic for patients with one or more of these conditions. In-depth interviews were held with patients and healthcare providers at three time points: At enrolment (prior to the patient receiving integrated care, at the mid-line and at the study end). A minimum of 16 patients and 12 healthcare providers were sampled for each time point. Observation was also carried out in the respective clinics during pre- and mid-line phases. The Theoretical Framework of Acceptability (TFA) underpinned the structure and interpretation of the combined qualitative and observational data sets. RESULTS Patients and healthcare providers revealed a positive attitude towards the integrated care delivery model at the mid-line and at study end-time points. High acceptability was related to increased exposure to service integration in terms of satisfaction with the clinic setup, seating arrangements and the provision of medical care services. Satisfaction also centred on the patients' freedom to move from one service point to another, and to discuss the services and their own health status amongst themselves. Adherence to medication and scheduling of clinic appointments appeared central to the patient-provider relationship as an aspect in the provision of quality services. Multi-condition health education, patient time and cost-saving, and detection of undiagnosed disease conditions emerged as benefits. On the other hand, a few challenges included long waiting times and limited privacy in lower and periphery health facilities due to infrastructural limitations. CONCLUSION The study reveals a continued high level of acceptability of the integrated care model among study participants in Tanzania. This calls for evaluation in a larger and a comparative study. Nevertheless, much more concerted efforts are necessary to address structural challenges and maximise privacy and confidentiality.
Collapse
Affiliation(s)
- Elizabeth H. Shayo
- grid.416716.30000 0004 0367 5636National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Sokoine Kivuyo
- grid.416716.30000 0004 0367 5636National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Janet Seeley
- grid.415861.f0000 0004 1790 6116MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Dominic Bukenya
- grid.415861.f0000 0004 1790 6116MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Peter Karoli
- grid.416716.30000 0004 0367 5636National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Sayoki Godfrey Mfinanga
- grid.416716.30000 0004 0367 5636National Institute for Medical Research, Dar es Salaam, Tanzania
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine, Liverpool, UK
| | - Shabbar Jaffar
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine, Liverpool, UK
| | | |
Collapse
|
26
|
Born J, Frank C. The relative impact of barriers to care among military health services personnel: exploring differences using context specific scenarios. BMC Health Serv Res 2022; 22:607. [PMID: 35524306 PMCID: PMC9074225 DOI: 10.1186/s12913-022-07850-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/25/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Military health care providers often under access both physical and mental health care, yet research has predominantly focused on barriers to mental health care. This study explored a comprehensive set of barriers using hypothetical scenarios to quantify barrier impact on access to both mental and physical health care. Methods Canadian military health services personnel (N = 1033) completed one of two electronic surveys (assessing either physical health or other mental health barriers) that captured participant’s demographics, health, endorsement of barriers, intent to seek care, and whether the respondent would access care in different health scenarios (pneumonia, back injury, depression and post-traumatic stress disorder). Logistic regression was used to calculate odds of not accessing care (versus accessing care) for each of the four health scenarios. Results All barrier factors independently predicted increased odds of not accessing care for all four scenarios. When entered into an adjusted model none of the barrier factors significantly predicted accessing care in the physical health scenarios. Staffing and workload resources and Treatment preferences (e.g., self-treat) were significant predictors of accessing care in the mental health scenarios. Weak general intentions to access care was the strongest predictors of not accessing care across all four scenarios. Conclusions The impact of barriers on hypothetical care-seeking behaviour differs depending on the context for which one is accessing care, with access to resources and preference to self-treat driving mental health care seeking. Intent appears to be the most impactful predictor of accessing care potentially mediating the effect of other barrier types on care seeking. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07850-5.
Collapse
Affiliation(s)
- Jennifer Born
- Director General Military Personnel Research and Analysis, Department of National Defence, National Defence Headquarters, 101 Colonel By Drive, Ottawa, ON, K1A 0K2, Canada.
| | - Christine Frank
- Director General Military Personnel Research and Analysis, Department of National Defence, National Defence Headquarters, 101 Colonel By Drive, Ottawa, ON, K1A 0K2, Canada
| |
Collapse
|
27
|
Weng R, Zhang C, Wen L, Luo Y, Ye J, Wang H, Li J, Ning N, Huang J, Chen X, Cai Y. Chlamydia-related knowledge, opinion to opportunistic testing, and practices of providers among different sexually transmitted infections related departments in hospitals in Shenzhen city, China. BMC Health Serv Res 2022; 22:601. [PMID: 35509056 PMCID: PMC9067339 DOI: 10.1186/s12913-022-08012-3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Chlamydia trachomatis (CT) infection could lead to seriously adverse outcomes if left untreated. This study aimed to determine CT-related knowledge, opinion to testing, and practices of providers among different sexually transmitted infections (STI) related departments in hospitals in Shenzhen city, China, and also to explore the differences in these responses. MATERIALS AND METHODS From 1st April 2018 to 15th April 2018, a cross-sectional study was conducted in Shenzhen and 64 of 66 hospitals agreed to participate in this study. In the hospital sites, all the providers from the department of obstetrics and gynecology, department of dermatology and venereology, department of urology, and anorectal surgical department were recruited. A structured paper-based questionnaire was used to obtain data on CT-related information. RESULTS A total of 355 providers from 64 hospitals participated in the current study. Compared to providers from the department of dermatology and venereology, those from the department of obstetrics and gynecology (OR = 0.31, 95% CI 0.16-0.62), department of urology (OR = 0.32, 95% CI 0.16-0.65), and anorectal surgical department (OR = 0.25, 95% CI 0.09-0.71) were less likely to identify that "Be in a long-term mutually monogamous relationship with a partner who has been tested and has negative STI test results." is an appropriate way for a sexually active person to reduce risk of getting CT. Also, those from the department of obstetrics and gynecology (OR = 0.45, 95% CI 0.23-0.87) were less likely to identify that "Use latex condoms the right way every time you have sex" is another appropriate way. A high proportion of providers agreed that all sexually active patients attending to their department should be screened regularly (77.1%), and they are willing to offer opportunistic CT screening (96.0%). Only 11.4% of respondents correctly identified that the appropriate time frame of the CT retesting is three months. CONCLUSIONS Providers among STI-related departments in hospitals showed a very high willingness to offer opportunistic CT screening. However, this study showed important gaps in providers' knowledge and practices in China, targeted training in CT-related knowledge and practice is urgently needed.
Collapse
Affiliation(s)
- Rongxing Weng
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, China
| | - Chunlai Zhang
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, China
| | - Lizhang Wen
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, China
| | - Yiting Luo
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, China
| | - Jianbin Ye
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, China
| | - Honglin Wang
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, China
| | - Jing Li
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, China
| | - Ning Ning
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, China
- Shantou University Medical College, Shantou, 515000, China
| | - Junxin Huang
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, China
| | - Xiangsheng Chen
- Chinese Academy of Medical Sciences & Peking Union Medical College Institute of Dermatology, Nanjing, China
- National Center for STD Control, China Center for Disease Control and Prevention, Nanjing, China
| | - Yumao Cai
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, China.
| |
Collapse
|
28
|
Ford JH, Jolles SA, Heller D, Langenstroer M, Crnich C. There and back again: the shape of telemedicine in U.S. nursing homes following COVID-19. BMC Geriatr 2022; 22:337. [PMID: 35436869 PMCID: PMC9015887 DOI: 10.1186/s12877-022-03046-y] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Telemedicine use in nursing homes (NHs) expanded during the COVID-19 pandemic. The objectives of this study were to characterize plans to continue telemedicine among newly adopting NHs and identify factors limiting its use after COVID-19. Methods Key informants from 9 Wisconsin NHs that adopted telemedicine during COVID-19 were recruited. Semi-structured interviews and surveys were employed to identify participant perceptions about the value of telemedicine, implementation challenges encountered, and plans and barriers to sustaining its delivery after COVID-19. Directed content analysis and a deductive thematic approach using the Systems Engineering Initiative for Patient Safety (SEIPS) model was used during analyses. Quantitative and qualitative data were integrated to identify participant views on the value of telemedicine and the tools and work system enhancements needed to make telemedicine easier and more effective. Results All participating NHs indicated a preference to continue telemedicine after COVID-19. Urgent assessments of resident change-in-condition and cognitively based sub-specialty consultations were identified as the encounter types most amenable to telemedicine. Reductions in resident off-site encounters and minimization of resident therapy interruptions were identified as major benefits of telemedicine. Twelve work system enhancements needed to better sustain telemedicine were identified, including improvements to: 1) equipment/IT infrastructure; 2) scheduling; 3) information exchange; and 4) telemedicine facilitators. Discussion NHs that adopted telemedicine during COVID-19 wish to continue its use. However, interventions that enhance the integration of telemedicine into NH and off-site clinic work systems require changes to existing regulations and reimbursement models to sustain its utilization after COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03046-y.
Collapse
Affiliation(s)
- James H Ford
- Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin, 777 Highland Ave, Madison, WI, 53705, USA.
| | - Sally A Jolles
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Dee Heller
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | | | - Christopher Crnich
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA.,William S. Middleton VA Hospital, Madison, WI, USA
| |
Collapse
|
29
|
Wikström L, Schildmeijer K, Nylander EM, Eriksson K. Patients' and providers' perspectives on e-health applications designed for self-care in association with surgery - a scoping review. BMC Health Serv Res 2022; 22:386. [PMID: 35321707 PMCID: PMC8944084 DOI: 10.1186/s12913-022-07718-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/02/2022] [Indexed: 11/11/2022] Open
Abstract
Background Before and after major surgery, access to information in a user-friendly way is a prerequisite for patients to feel confident in taking on the responsibility for their surgical preparation and recovery. Several e-health applications have been developed to support patients perioperatively. The aim of this review was to give an overview of e-health applications designed for self-care associated with surgery by providing a scoping overview of perspectives from providers and patients. Methods We searched the following data sources to identify peer-reviewed quantitative and qualitative studies published between 2015 and 2020: CINAHL, Google Scholar, MEDLINE, PsycInfo, Web of Science, and Scopus. After identifying 960 titles, we screened 638 abstracts, of which 72 were screened in full text. Protocol register: 10.17605/OSF.IO/R3QND. Results We included 15 studies which met our inclusion criteria. Data from several surgical contexts revealed that the most common self-care actions in e-health applications were preoperative preparations and self-assessments of postoperative recovery. Motivational factors for self-care were information, combined with supportive reminders and messages, and chat features. Although there was great variance in research designs and technical solutions, a willingness to engage with and adhere to e-health seemed to increase patients’ self-care activities and thereby accelerate return to work and normal activities. In addition, the need for physical visits seemed to decrease. Even though age groups were not primarily studied, the included studies showed that adult patients of any age engaged in surgical self-care supported by e-health. The providers’ perspectives were not found. Conclusions E-health applications supporting perioperative self-care indicated a positive impact on recovery. However, experiences of healthcare professionals delivering e-health associated with surgery are missing. Additionally, studies based on patients’ perspectives regarding willingness, adherence, and motivation for self-care supported by e-health are sparse. A need for studies examining the supporting role of e-health for self-care in the surgical context is therefore needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07718-8.
Collapse
Affiliation(s)
- Lotta Wikström
- School of Health and Welfare, Jönköping University, Jönköping, Sweden. .,Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden. .,Department of Nursing Science, School of Health and Welfare, Lotta Wikström, Jönköping University, Box 1026, 551 11, Jönköping, Sweden.
| | | | | | - Kerstin Eriksson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden
| |
Collapse
|
30
|
Nyenhuis SM, Kahwash B, Cooke A, Gregory KL, Greiwe J, Nanda A. Recommendations for Physical Activity in Asthma: A Work Group Report of the AAAAI Sports, Exercise, and Fitness Committee. J Allergy Clin Immunol Pract 2022; 10:433-443. [PMID: 34844909 DOI: 10.1016/j.jaip.2021.10.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/27/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
Regular physical activity not only improves general health but also can positively impact asthma outcomes, such as control and quality of life. Despite this, many asthma patients do not engage in regular physical activity because they mistakenly believe that they should restrict exercise participation. Health care providers have an opportunity to influence the physical activity levels of their patients during regular office visits. Nonetheless, health care providers often overlook physical activity counseling as an adjunct to pharmacological therapy in asthma patients, and in particular, overlook physical activity counseling. Some providers who acknowledge the benefits of physical activity report being unaware how to approach a conversation with patients about this topic. To address these issues, members of the Sports, Exercise, and Fitness Committee of the American Academy of Allergy, Asthma, and Immunology (AAAAI) performed a focused literature search to identify and evaluate the effects of physical activity in patients with asthma. The purpose of this report is to summarize the evidence for physical activity's impact on asthma patients' disease control, pulmonary function, and overall well-being. Several subpopulations of patients with asthma, including children, adolescents, and older adults, are considered individually. In addition, this report offers practical recommendations for clinicians, including how to identify and overcome barriers to counseling, and methods to incorporate physical activity counseling into asthma treatment practice.
Collapse
Affiliation(s)
- Sharmilee M Nyenhuis
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Ill.
| | - Basil Kahwash
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Andrew Cooke
- Lake Allergy, Asthma, and Immunology, Tavares, Fla
| | - Karen L Gregory
- Oklahoma Allergy and Asthma Clinic, Oklahoma City, Okla, and Georgetown University School of Nursing and Health Studies, Washington, DC
| | - Justin Greiwe
- Bernstein Allergy Group, Inc, Cincinnati, Ohio; Division of Immunology/Allergy Section, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
31
|
Kyrou D, Vrontaras N, Karamanidou C. Going above and beyond: a qualitative study on the experiences and perspectives of HIV healthcare providers in Greece. BMC Health Serv Res 2021; 21:1358. [PMID: 34930281 PMCID: PMC8686363 DOI: 10.1186/s12913-021-07380-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background This study concerns the experiences and perceptions of healthcare providers (HCPs) in Greece, as they respond to the changing health and psychosocial needs of people living with HIV (PLHIV) in unfavorable conditions, within a healthcare system encumbered by a decade of austerity measures. Methods To this end, semi-structured interviews were conducted with 20 HCPs in six HIV units throughout Greece. The data were analyzed employing reflexive thematic analysis, under a critical realist approach. Results Three main themes were generated from the analysis of the data: 1) Care Beyond Medicine, 2) Compensating System Barriers Towards Optimized Care and 3) Role Appraisal. According to HCPs’ perspectives, 1) their role extends beyond medicine, as they provide care for vulnerable groups and respond to their psychosocial difficulties. 2) Struggling to overcome structural barriers, HCPs often manage to provide privileged care to PLHIV. 3) In doing so, they become excessively involved. Despite the fulfillment experienced, HCPs often feel invalidated by the hospital setting, and frustrated, when they cannot manage to respond to the pressing needs of PLHIV. Conclusions HCPs are forced to pull together their personal resources in order to coordinate care and respond to PLHIV’s psychosocial difficulties and health issues, as there is no formal model of coordination of care for PLHIV in Greece. Considering these findings, the development of case management protocols and integrated care pathways in Greece is being proposed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07380-6.
Collapse
Affiliation(s)
- Dimitrios Kyrou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 6th km Charilaou-Thermi Road, 57001, Thessaloniki, Greece.
| | - Nikolaos Vrontaras
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 6th km Charilaou-Thermi Road, 57001, Thessaloniki, Greece
| | - Christina Karamanidou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 6th km Charilaou-Thermi Road, 57001, Thessaloniki, Greece
| |
Collapse
|
32
|
Yizengaw MA, Mustofa SY, Ashagrie HE, Zeleke TG. Prevalence and factors associated with work-related musculoskeletal disorder among health care providers working in the operation room. Ann Med Surg (Lond) 2021; 72:102989. [PMID: 34849216 PMCID: PMC8608889 DOI: 10.1016/j.amsu.2021.102989] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 09/05/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background Work-related musculoskeletal disorder is a major and frequently underappreciated problem on people, countries, healthcare services, and society as a whole. Not only have detrimental health impacts, but it had considerable damage on healthcare services and costs. Objective The aim of this study was to determine the prevalence and factors associated with work-related musculoskeletal diseases among health care providers working in the operating room of University of Gondar comprehensive specialized hospital and Tibebe Ghion comprehensive specialized hospital, North West Ethiopia, 2021. Method Institution-based cross-sectional study was conducted on 394 healthcare providers. Purposive sampling was used to select the study participants. Data were collected through a self-administer questionnaire using the standard Nordic Musculoskeletal Questionnaire. Descriptive statistics and bivariate logistic regression were done to identify factors associated with work-related musculoskeletal disorders. Variables with P-value≤ 0.05 with 95% confidence interval in a multivariate model were taken as statistically significant. Finally, AOR with 95% confidence interval at a P-value<0.05 was reported. Result The prevalence of work-related musculoskeletal disorder among study participants was 64.2% with 95% CI: (59.4, 69.0). In multivariate logistic regression analysis; working overtime [AOR:1.74; 95% CI (1.05, 2.86)], previous history of MSD [AOR:6.85; 95%CI:(1.91, 22.7)], being diploma holder [AOR:5.27; 95% CI (1.12, 24.68)], being 1st degree holder [AOR:2.65; 95% CI (1.11, 6.28)], absence of assistance during procedures [AOR:1.73; 95% CI (1.02, 2.85)], and working in night shifts [AOR:1.72; 95% CI (1.08, 2.74)] were significantly associated with work related musculoskeletal disease among health care providers working in operation room. Conclusion A high proportion of hospital care providers working in the operation room reported MSD at different body parts. Lower back pain was the most often complained. Working overtime, not having assistance during procedures, educational status (diploma and 1st degree holder), and working at night shifts were statistically significant associated with musculoskeletal disorders.
Collapse
Key Words
- AOR, Adjusted Odds Ratio
- Associated
- BMI, Body Mass Index
- CI, Confidence Interval
- COR, Crude Odds Ratio
- Disorders
- ETB, Ethiopian Birr
- Health
- MSP, Musculoskeletal Pain
- Musculoskeletal
- OR, Operation Room
- Prevalence
- Providers
- SPSS, Statistical Package for Social Sciences
- TGCSH, Tibebe Ghion Comprehensive Specialized Hospital
- UOGCSH, University of Gondar Comprehensive Specialized Hospital
- WRMSD, Work Related Musculoskeletal Disease
Collapse
|
33
|
Hughes LD, Kidd KM, Gamarel KE, Operario D, Dowshen N. "These Laws Will Be Devastating": Provider Perspectives on Legislation Banning Gender-Affirming Care for Transgender Adolescents. J Adolesc Health 2021; 69:976-982. [PMID: 34627657 PMCID: PMC9131701 DOI: 10.1016/j.jadohealth.2021.08.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/14/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The standards of care for transgender and gender diverse youth (TGDY) experiencing gender dysphoria are well-established and include gender-affirming medical interventions. As of July 2021, 22 states have introduced or passed legislation that bans the provision of gender-affirming medical care to anyone under the age of 18 even with parent or guardian consent. The purpose of this study is to understand what providers who deliver gender-affirming medical care to TGDY think about this legislation. METHODS In March 2021, we recruited participants via listservs known to be frequented by providers of gender-affirming medical care. Eligible participants were over the age of 18, currently working as a physician, nurse practitioner, or physician's assistant, and providing gender-affirming care to TGDY under the age of 18 in the U.S. RESULTS We analyzed the responses of 103 providers from all 50 states and DC. Most participants identified as white (77%), cisgender women (70%), specializing in pediatric care (52%). The most salient theme, described by nearly all participants, was the fear that legislation banning gender-affirming care would lead to worsening mental health including increased risk for suicides among TGDY. Other themes included the politicization of medical care, legislation that defies the current standards of care for TGDY, worsening discrimination toward TGDY, and adverse effects on the providers. CONCLUSIONS Providers of gender-affirming care overwhelmingly opposed legislation that bans gender-affirming care for TGDY citing the severe consequences to the health and well-being of TGDY along with the need to practice evidence-based medicine without fear.
Collapse
Affiliation(s)
- Landon D Hughes
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
| | - Kacie M Kidd
- Department of Pediatrics, West Virginia University School of Medicine, 1 Medical Center Dr, Morgantown, West Virginia
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Nadia Dowshen
- Colonial Penn Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
34
|
Caplon A, Alexander KA, Kershaw T, Willie TC. Assessing Provider-, Clinic-, and Structural-Level Barriers and Recommendations to Pre-Exposure Prophylaxis (PrEP) Uptake: A Qualitative Investigation Among Women Experiencing Intimate Partner Violence, Intimate Partner Violence Service Providers, and Healthcare Providers. AIDS Behav 2021; 25:3425-3436. [PMID: 33974167 DOI: 10.1007/s10461-021-03297-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
Intimate partner violence (IPV) relates to HIV susceptibility and acquisition. Existing research examined barriers to pre-exposure prophylaxis (PrEP) uptake among women but few studies assess uptake and delivery among IPV service providers, along with provider-, clinic-, and structural-level barriers. We conducted 34 semi-structured interviews with PrEP-eligible cisgender heterosexual women experiencing IPV, Reproductive Health providers, PrEP providers, and IPV service providers in Northeast US. Systems theory was used to examine barriers from individuals who either work closely with or are part of the population. The framework method was used to draw descriptive and explanatory conclusions. Findings suggest limited knowledge for Reproductive Health and IPV Service Providers. Providers often did not feel equipped to discussed PrEP in visits or focused efforts solely on safety. Expanding PrEP awareness is necessary and marketing should include women. Future research should investigate how providers can work collaboratively across sectors to ensure women receive comprehensive trauma-informed care.
Collapse
Affiliation(s)
- Amy Caplon
- Division of Cancer Control and Populations Sciences, National Cancer Institute, 9606 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Kamila A Alexander
- Department of Community - Public Health Nursing, Johns Hopkins School of Nursing, Baltimore, MD, 21205, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| |
Collapse
|
35
|
Zimba CC, Akiba CF, Matewere M, Thom A, Udedi M, Masiye JK, Kulisewa K, Go VFL, Hosseinipour MC, Gaynes BN, Pence BW. Facilitators, barriers and potential solutions to the integration of depression and non-communicable diseases (NCDs) care in Malawi: a qualitative study with service providers. Int J Ment Health Syst 2021; 15:59. [PMID: 34116699 PMCID: PMC8196431 DOI: 10.1186/s13033-021-00480-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/07/2020] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Integration of depression services into infectious disease care is feasible, acceptable, and effective in sub-Saharan African settings. However, while the region shifts focus to include chronic diseases, additional information is required to integrate depression services into chronic disease settings. We assessed service providers’ views on the concept of integrating depression care into non-communicable diseases’ (NCD) clinics in Malawi. The aim of this analysis was to better understand barriers, facilitators, and solutions to integrating depression into NCD services. Methods Between June and August 2018, we conducted nineteen in-depth interviews with providers. Providers were recruited from 10 public hospitals located within the central region of Malawi (i.e., 2 per clinic, with the exception of one clinic where only one provider was interviewed because of scheduling challenges). Using a semi structured interview guide, we asked participants questions related to their understanding of depression and its management at their clinic. We used thematic analysis allowing for both inductive and deductive approach. Themes that emerged related to facilitators, barriers and suggested solutions to integrate depression assessment and care into NCD clinics. We used CFIR constructs to categorize the facilitators and barriers. Results Almost all providers knew what depression is and its associated signs and symptoms. Almost all facilities had an NCD-dedicated room and reported that integrating depression into NCD care was feasible. Facilitators of service integration included readiness to integrate services by the NCD providers, availability of antidepressants at the clinic. Barriers to service integration included limited knowledge and lack of training regarding depression care, inadequacy of both human and material resources, high workload experienced by the providers and lack of physical space for some depression services especially counseling. Suggested solutions were training of NCD staff on depression assessment and care, engaging hospital leaders to create an NCD and depression care integration policy, integrating depression information into existing documents, increasing staff, and reorganizing clinic flow. Conclusion Findings of this study suggest a need for innovative implementation science solutions such as reorganizing clinic flow to increase the quality and duration of the patient-provider interaction, as well as ongoing trainings and supervisions to increase clinical knowledge. Trial registration This study reports finding of part of the formative phase of “The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building—A Clinic-Randomized Trial of Strategies to Integrate Depression Care in Malawi” registered as NCT03711786
Collapse
Affiliation(s)
| | - Christopher F Akiba
- Gillings School of Global and Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | | | - Annie Thom
- Malawi Ministry of Health, Lilongwe, Malawi
| | | | | | | | | | | | | | | |
Collapse
|
36
|
John SA, Walsh JL, Pleuhs B, Wesche R, Quinn KG, Petroll AE. Tailored HIV Pre-exposure Prophylaxis (PrEP) Intervention Needs from a Latent Class Analysis Among U.S. Healthcare Providers. AIDS Behav 2021; 25:1751-60. [PMID: 33216244 DOI: 10.1007/s10461-020-03105-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
Interventions are needed to expand HIV pre-exposure prophylaxis (PrEP) prescribing practices among healthcare providers, but research classifying providers to determine tailored intervention needs is lacking. Providers reported demographics, factors related to HIV treatment and prevention experience, and PrEP-related factors such as knowledge and community protection beliefs via online survey. Latent class analysis grouped providers with similar patterns of HIV prevention- and treatment-related care and tested for associations with demographics and PrEP-related factors. Three distinct classes of providers emerged: (1) PrEP naïve, (2) PrEP aware, and (3) PrEP prescribers. Providers with lower community protection beliefs and staff capacity were more likely to be classified as PrEP naïve compared to aware (ps < 0.05). Providers with concerns about PrEP-related tasks and staff capacity were more likely to be classified as PrEP aware compared to prescribers (ps < 0.05). PrEP-naïve providers could benefit from continuing education, whereas PrEP-aware providers might benefit from capacity building and prescribing optimization interventions.
Collapse
|
37
|
Faro JM, Mattocks KM, Mourao D, Nagawa CS, Lemon SC, Wang B, Cutrona SL, Sadasivam RS. Experiences and perceptions of referrals to a community-based physical activity program for cancer survivors: a qualitative exploration. BMC Health Serv Res 2021; 21:358. [PMID: 33865384 PMCID: PMC8052851 DOI: 10.1186/s12913-021-06365-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/08/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Physical activity rates in cancer survivors continue to be low despite the known benefits and availability of evidence-based programs. LIVESTRONG at the Y is a national community-based physical activity program offered cost-free to cancer survivors, though is underutilized. We explored perceptions and experiences of staff and participating survivors to better understand program awareness, referrals and participation. METHODS LIVESTRONG at the Y program staff [directors (n = 16), instructors (n = 4)] and survivors (n = 8) from 8 United States YMCAs took part in 30-min semi-structured phone interviews between March-May 2019. Interviews were digitally recorded, transcribed, and evaluated using a thematic analysis approach. RESULTS Program staff themes included: 1) Program awareness should be further developed for both the general public and medical providers; 2) Strong relationships with medical providers increased program referrals; 3) Electronic referral systems between providers and LIVESTRONG would help to streamline the referral process; and 4) Bi-directional communication between program staff and medical providers is key to providing patient progress updates. Survivor themes included: 1) Survivors trust their medical team and the information they provide about physical activity; 2) Providers need to incorporate an action plan and referrals for survivors to be active once treatments are completed; and 3) Personal experiences of those who participated in LIVESTRONG resonate with survivors and increase participation. CONCLUSIONS LIVESTRONG staff reported the need for an integrated electronic referral system and bi-directional communication with providers about participant progress. Survivors want physical activity education, electronic referrals and follow-up from their healthcare team, coupled with peer support from other survivors. Cancer care provider knowledge and electronic referrals during and after treatment may expedite and increase participation in this community-based program.
Collapse
Affiliation(s)
- Jamie M Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA.
| | - Kristin M Mattocks
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
| | - Dalton Mourao
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA
| | - Catherine S Nagawa
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA
| | - Stephenie C Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA
| |
Collapse
|
38
|
Schalet BD, Reise SP, Zulman DM, Lewis ET, Kimerling R. Psychometric evaluation of a patient-reported item bank for healthcare engagement. Qual Life Res 2021; 30:2363-2374. [PMID: 33835412 DOI: 10.1007/s11136-021-02824-2] [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: 03/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Healthcare engagement is a core measurement target for efforts to improve healthcare systems. This construct is broadly defined as the extent to which healthcare services represent collaborative partnerships with patients. Previous qualitative work operationalized healthcare engagement as generalized self-efficacy in four related subdomains: self-management, collaborative communication, health information use, and healthcare navigation. Building on this work, our objective was to establish a healthcare engagement instrument that is sufficiently unidimensional to yield a single score. METHOD We conducted cognitive interviews followed by a nation-wide mail survey of US Veteran Administration (VA) healthcare users. Data were collected on 49 candidate healthcare engagement items, as well as measures of self-efficacy for managing symptoms, provider communication, and perceived access. Items were subjected to exploratory bifactor, statistical learning, and IRT analyses. RESULTS Cognitive interviews were completed by 56 patients and 9552 VA healthcare users with chronic conditions completed the mail survey. Participants were mostly white and male but with sizable minority participation. Psychometric analyses and content considerations reduced the item pool to 23 items, which demonstrated a strong general factor (OmegaH of .89). IRT analyses revealed a high level of reliability across the trait range and little DIF across groups. Most health information use items were removed during analyses, suggesting a more independent role for this domain. CONCLUSION We provide quantitative evidence for a relatively unidimensional measure of healthcare engagement. Despite developed with VA healthcare users, the measure is intended for general use. Future work includes short-form development and validation with other patient groups.
Collapse
Affiliation(s)
- Benjamin D Schalet
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA.
| | - Steven P Reise
- Department of Psychology, University of California, San Diego, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, USA
| | - Eleanor T Lewis
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, USA
| | - Rachel Kimerling
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, USA.,Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, USA
| |
Collapse
|
39
|
Kochhar S, Dubé E, Graham J, Jee Y, Memish ZA, Menning L, Nohynek H, Salmon D, Top KA, MacDonald NE. COVID-19 vaccine safety questions and answers for healthcare providers (CONSIDER). Vaccine 2021; 39:2504-2505. [PMID: 33836897 PMCID: PMC7983421 DOI: 10.1016/j.vaccine.2021.03.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Sonali Kochhar
- Department of Global Health, University of Washington, Seattle, United States; Global Healthcare Consulting, India.
| | - Eve Dubé
- Quebec National Institute of Public Health, Canada; Laval University, Canada
| | | | - Youngmee Jee
- GSPA, Seoul National University, Republic of Korea; Special Representative for Health Diplomacy, Korea Foundation, Republic of Korea
| | - Ziad A Memish
- Research and Innovation Center, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Lisa Menning
- WHO HQ Department of Immunization, Vaccines, and Biologicals, Geneva, Switzerland
| | - Hanna Nohynek
- Deputy Head of Unit, Finnish Institute for Health and Welfare THL, Finland
| | - Daniel Salmon
- Institute for Vaccine Safety, Johns Hopkins University School of Public Health, United States
| | - Karina A Top
- Pediatrics and Community Health & Epidemiology, Dalhousie University, Canada
| | | |
Collapse
|
40
|
Jiang C, Larbi O, Feyes D, Wang GM, Momotaz H, Li M, Daunov K, Daly B, Mazanec S, Rodgers-Melnick S, Rolfe S, Tamburro N, Hooper MW, Hobson S, Lee RT. A survey of cancer patients, caregivers, and providers regarding familiarity, importance, and utilization of supportive and integrative oncology services. Support Care Cancer 2021; 29:5777-85. [PMID: 33740131 DOI: 10.1007/s00520-021-06081-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/17/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Supportive and integrative oncology services aim to improve the quality of life of cancer patients. This study characterizes the views of these services among cancer patients, caregivers, and providers at a comprehensive cancer center. METHODS A cross-sectional survey was administered in 2017-2018. The survey asked about participants' familiarity, perceived importance, use, accessibility, and barriers to 19 supportive and integrative oncology services using a Likert scale. Data were analyzed using the Kruskal-Wallis test and a proportional odds regression model. RESULTS A total of 976 surveys were obtained (604 patient surveys, 199 caregiver surveys, 173 provider surveys). Patients were mostly female (56.3%), ≥60 years old (59.4%), and Caucasian (66%). Providers were an even distribution of nurses, physicians, and advanced practice providers. Patients felt social work and nutrition services were the most familiar (36.4% and 34.8%) and the most important (46.3% and 54.5%). Caregivers were also most familiar with those two services, but felt that nutrition and learning resources were most important. Social work and nutrition were easiest to access and used the most by both patients and providers. There was a positive correlation between accessibility and perceived importance. Being unaware was the most common barrier identified by patients (38.4%), providers (67.1%), and caregivers (33.7%). CONCLUSION Social work and nutrition services were most familiar to respondents, and also generally the most important, accessible, and utilized. Lack of awareness was the most common barrier cited and suggests that increased efforts to educate patients and providers about other services available are needed.
Collapse
|
41
|
Pudasainee-Kapri S. Providers' Adherence to Evidence-Based Asthma Guidelines in Pediatric Primary Care. J Pediatr Nurs 2021; 57:18-24. [PMID: 33212342 DOI: 10.1016/j.pedn.2020.09.020] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Regardless of existence of National asthma guidelines, adherence to major elements of guidelines among providers is suboptimal. The nonadherence contributes to poor clinical outcomes and quality of life of asthma patients. PURPOSE This project aims to improve the standard of care of asthma patients with increased providers' adherence to asthma guidelines through provider education, and implementation of practice guidelines and evidence-based resources. METHODS A pre-post implementation retrospective design was adopted along with the provision of provider education sessions and implementation of pediatric asthma management practice guidelines and asthma resources in the pediatric practice in Southern, New Jersey. Data were collected via retrospective chart review among 41 patients four-months pre-implementation and 38 patients three months post-implementation to assess the improvement of providers' adherence to seven elements of asthma guidelines. Descriptive statistics and chi-square tests were computed to evaluate providers' adherence. RESULTS Results showed improvement from pre- to post-implementation in utilization of six of the seven key elements of guidelines among providers that include, the assessment and documentation of asthma control (4.9% to 39.5%), medication adherence (20% to 87.5%), medication delivery technique (7.3% to 18.4%), environmental triggers (14.6% to 44.7%), asthma action plan (4.9% to 28.9%), and follow-up visits (48.8% to 76.3%). In addition, the chi-square test showed a significant association between environmental triggers assessment from baseline to post-implementation, χ2 (1, n = 79) = 4.29, p = .038. CONCLUSION Providing necessary resources and provider-focused education demonstrated a positive change in promoting best practice and facilitating providers' adherence.
Collapse
|
42
|
Koltai DC, Smith CE, Cai GY, Ratliff O, Kakooza-Mwesige A, Najjuma JN, Muhindo R, Rukundo GZ, Teuwen DE, Kayanja A, Kalubi P, Haglund MM, Fuller AT. Healthcare provider perspectives regarding epilepsy care in Uganda. Epilepsy Behav 2021; 114:107294. [PMID: 32763023 DOI: 10.1016/j.yebeh.2020.107294] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Epilepsy is the most common chronic neurological disorder in the world and imposes a large economic burden on global healthcare systems, especially in low-income settings and rural areas as is found in sub-Saharan Africa (SSA). Despite the high epilepsy prevalence, there are no systematic descriptions of healthcare provider (HCP) perceptions and needs in managing people with epilepsy (PWE) in Uganda. Identifying these perceptions and needs is crucial for understanding community priorities, thereby enhancing the development of culturally sensitive communications, interventions, and research approaches. METHODS In this qualitative study, we used semistructured interview guides to conduct focus group discussions that explored the perspectives of 32 providers of epilepsy care from health facilities around Mbarara, Uganda. Our sample included nonspecialized general physicians (n = 3), medical residents (n = 8), medical clinical officers (n = 3), psychiatric clinical nurses (n = 6), medical nurses and nursing assistants (n = 9), and other providers (n = 3), who were loosely grouped into discussion groups based on level or type of training. Self-assessed proficiency ratings were also administered to gain a better understanding of participants' confidence in their training, preparedness, and capabilities regarding epilepsy care. Thematic analysis of the focus group transcripts was conducted to ascertain commonly occurring themes about perceptions and challenges in epilepsy care. RESULTS Our analyses identified nine major themes that dominated the perspectives of the study participants: care management, medications, diagnostics, HCP training, human resources, location, patient education, social support, and community knowledge and beliefs. Proficiency ratings prioritized areas of confidence as knowledge related to referrals, psychosocial impacts, and seizure neurophysiology. Areas of need were revealed as knowledge of diagnostic tools and antiepileptic drug (AED) regimens. CONCLUSIONS Our findings delineate the perspectives of providers caring for PWE, with consistent recognition of challenges centering around resource augmentation, infrastructure strengthening, and education. Participants emphasized the urgent need to augment these resources to address limitations in medication types and access, trained human resources, and diagnostic tools. They overwhelmingly recognized the need for infrastructure strengthening to address human, diagnostic, medicinal, and capital resource limitations that place undue burden on patients with epilepsy and physicians. Providers indicated a clear desire to learn more about different diagnostic tools and medical management practices, potentially through continuing education, specialized training, or more intentional in-school diagnostic preparation. They also advocated for the powerful influence of patient and family education and clearly articulated the need for community sensitization and support. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
Collapse
Affiliation(s)
- Deborah C Koltai
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC, Box 3119, Trent Drive, Durham, NC, USA.
| | - Caleigh E Smith
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Grace Y Cai
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Olivia Ratliff
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda; Department of Paediatrics and Child Health, Mulago National Referral Hospital, Pediatric Neurology Unit, Kampala, Uganda
| | - Josephine N Najjuma
- Mbarara University of Science and Technology Department of Nursing, Plot 8 - 18 Kabale Road, PO Box 1410, Mbarara, Uganda; Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Rose Muhindo
- Mbarara Regional Referral Hospital, Mbarara, Uganda; Mbarara University of Science and Technology, Department of Medicine, Plot 8 - 18 Kabale Road, PO Box 1410, Mbarara, Uganda
| | - Godfrey Z Rukundo
- Mbarara University of Science and Technology, Department of Psychiatry, Faculty of Medicine, Plot 8 - 18 Kabale Road, PO Box 1410, Mbarara, Uganda
| | - Dirk E Teuwen
- UCB, Allée de la recherche 60, 1070 Brussels, Belgium
| | - Adrian Kayanja
- Mbarara Regional Referral Hospital, Mbarara, Uganda; Mbarara University of Science and Technology, Department of Medicine, Plot 8 - 18 Kabale Road, PO Box 1410, Mbarara, Uganda
| | - Peter Kalubi
- Mbarara University of Science and Technology, Department of Paediatrics and Child Health, Plot 8 - 18 Kabale Road, P. O Box 1410, Mbarara, Uganda
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA
| | - Anthony T Fuller
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA
| |
Collapse
|
43
|
John SA, Quinn KG, Pleuhs B, Walsh JL, Petroll AE. HIV Post-Exposure Prophylaxis (PEP) Awareness and Non-Occupational PEP (nPEP) Prescribing History Among U.S. Healthcare Providers. AIDS Behav 2020; 24:3124-3131. [PMID: 32300991 PMCID: PMC7508835 DOI: 10.1007/s10461-020-02866-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 10/24/2022]
Abstract
Non-occupational post-exposure prophylaxis (nPEP) has been clinically recommended since 2005. HIV providers and non-HIV providers (n = 480) practicing within above-average HIV prevalence ZIP codes of the 10 U.S. cities with greatest overall HIV prevalence participated in a cross-sectional survey between July 2014 and May 2015. Providers were asked about their awareness of post-exposure prophylaxis (PEP) and nPEP prescribing experience for patients with potential sexual exposures to HIV, which we coded into a PEP prescribing cascade with three categories: (1) PEP unaware, (2) PEP aware, no nPEP prescribing experience, and (3) nPEP prescribing experience. Overall, 12.5% were unaware of PEP, 43.5% were aware but hadn't prescribed nPEP, and 44.0% had prescribed nPEP for potential sexual exposures to HIV. Fewer providers practicing in the U.S. South had ever prescribed nPEP compared to providers in other regions (χ2= 39.91, p < 0.001). HIV providers, compared to non-HIV providers, were more likely to be classified in the nPEP prescription group compared to the PEP aware without nPEP prescription group (RRR = 2.96, p < 0.001). PrEP prescribers, compared to those PrEP unaware, were more likely to be classified in the nPEP prescription group compared to PEP aware without nPEP prescription group (RRR = 12.49, p < 0.001).
Collapse
Affiliation(s)
- Steven A John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA.
| | - Katherine G Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
| | - Benedikt Pleuhs
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
| | - Jennifer L Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
| | - Andrew E Petroll
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
| |
Collapse
|
44
|
Etiaba E, Manzano A, Agbawodikeizu U, Ogu U, Ebenso B, Uzochukwu B, Onwujekwe O, Ezumah N, Mirzoev T. "If you are on duty, you may be afraid to come out to attend to a person": fear of crime and security challenges in maternal acute care in Nigeria from a realist perspective. BMC Health Serv Res 2020; 20:903. [PMID: 32993630 PMCID: PMC7525946 DOI: 10.1186/s12913-020-05747-9] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/18/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Maternal and Child Health is a global priority. Access and utilization of facility-based health services remain a challenge in low and middle-income countries. Evidence on barriers to providing and accessing services omits information on the role of security within facilities. This paper explores the role of security in the provision and use of maternal health services in primary healthcare facilities in Nigeria. METHODS Study was carried out in Anambra state, Nigeria. Qualitative data were initially collected from 35 in-depth interviews and 24 focus groups with purposively identified key informants. Information gathered was used to build a programme theory that was tested with another round of interviews (17) and focus group (4) discussions. Data analysis and reporting were based on the Context-Mechanism-Outcome heuristic of Realist Evaluation methodology. RESULTS The presence of a male security guard in the facility was the most important security factor that facilitated provision and uptake of services. Others include perimeter fencing, lighting and staff accommodation. Lack of these components constrained provision and use of services, by impacting on behaviour of staff and patients. Security concerns of facility staff who did not feel safe to let in people into unguarded facilities, mirrored those of pregnant women who did not utilize health facilities because of fear of not being let in and attended to by facility staff. CONCLUSION Health facility security should be key consideration in programme planning, to avert staff and women's fear of crime which currently constrains provision and use of maternal healthcare at health facilities.
Collapse
Affiliation(s)
- Enyi Etiaba
- Department of Health Administration and Management, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria. .,Health Policy Research Group, Department of Pharmaco-therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, 11.20 Social Sciences Building, Leeds, UK
| | - Uju Agbawodikeizu
- Health Policy Research Group, Department of Pharmaco-therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.,Department of Social Work, Faculty of Social Sciences, University of Nigeria, Nsukka, Nigeria
| | - Udochukwu Ogu
- Health Policy Research Group, Department of Pharmaco-therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Bassey Ebenso
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Benjamin Uzochukwu
- Health Policy Research Group, Department of Pharmaco-therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.,Department of Community Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Obinna Onwujekwe
- Department of Health Administration and Management, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.,Health Policy Research Group, Department of Pharmaco-therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Nkoli Ezumah
- Health Policy Research Group, Department of Pharmaco-therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Tolib Mirzoev
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| |
Collapse
|
45
|
Gagnon M, Guta A, Payne A. "Setting people up for success and then failure" - health care and service providers' experiences of using prize-based contingency management. Subst Abuse Treat Prev Policy 2020; 15:71. [PMID: 32928275 PMCID: PMC7491156 DOI: 10.1186/s13011-020-00316-z] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/09/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Over the last 50 years, there has been a growing interest in and use of contingency management (CM) for people who use substances. Yet, despite showing some level of efficacy (albeit only short-term) and being praised by researchers as beneficial and cost-saving, it continues to be underutilized by health care and service providers. Why that is remains unclear. METHODS Recognizing a gap, we conducted a targeted analysis of a larger set of qualitative interviews conducted on the experience of health care and service providers with incentives (including prize-based CM) (n = 25). RESULTS Four themes were identified during the analysis: 1) The specificities of prize-based CM, 2) The role of providers in administering prize-based CM, 3) The positive and negative impact on the relationship, and 4) The ethical concerns arising from prize-based CM. Overall, our findings are consistent with existing literature and suggest that providers are wary of using prize-based CM because they tend to value effort over success, support over reward, honesty over deceit, and certainty over probability and variability. CONCLUSION Our analysis offers additional insights into the experiences of providers who use prize-based CM and possibly some indications as to why they may not wish to work with this type of incentive. The question raised here is not whether there is enough evidence on the effectiveness of prize-based CM, but rather if this type of incentive is appropriate and ethical when caring for people who use substances.
Collapse
Affiliation(s)
- Marilou Gagnon
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada.
| | - Adrian Guta
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, ON, N9A 0C5, V6T2B5, Canada
| | - Alayna Payne
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| |
Collapse
|
46
|
Eaton CK, Beachy S, McLean KA, Nicolais CJ, Bernstein R, Sáez-Clarke E, Quittner AL, Riekert KA. Misunderstandings, misperceptions, and missed opportunities: Perspectives on adherence barriers from people with CF, caregivers, and CF team members. Patient Educ Couns 2020; 103:1587-1594. [PMID: 32098744 DOI: 10.1016/j.pec.2020.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/24/2020] [Accepted: 02/15/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To identify differences in perspectives of people with cystic fibrosis (PwCF) and caregivers versus healthcare providers on adherence barriers. Mismatched perspectives may lead to miscommunication and missed opportunities to reduce barriers and improve CF outcomes. METHODS PwCF, caregivers, and CF providers completed audio-taped, semi-structured interviews about adherence barriers. Interviews were transcribed and coded for themes. Themes were reviewed to identify when PwCF-caregiver perspectives differed from providers'. RESULTS Participants included 14 adolescents with CF (mean age = 15.89 years, 64 % female, 71 % Caucasian), 14 adults with CF (mean age = 30.03 years, 64 % female, 57 % Caucasian), 29 caregivers (76 % female; 72 % Caucasian), and 42 providers. Four barriers were identified that could generate miscommunication between PwCF-caregivers and providers: Tired = Fatigued/Sleepy versus Tired = Burnout, Vacation and Travel, Knowledge and Skills About CF Regimen, and Daily Habits or Routines. PwCF and caregivers used similar words as providers, but conceptualized barriers differently. PwCF and caregivers discussed barriers pragmatically, however, providers viewed certain barriers more abstractly or unidimensionally, or did not discuss them. CONCLUSIONS PwCF-caregivers and providers may not align in how they discuss barriers, which may contribute to miscommunication about adherence challenges. PRACTICE IMPLICATIONS Patient-centered communication strategies may enhance providers' understandings of PwCF-caregiver perspectives on barriers and facilitate adherence interventions.
Collapse
Affiliation(s)
- Cyd K Eaton
- The Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA.
| | - Sara Beachy
- The Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Katherine A McLean
- Rush University Medical Center, Department of Pediatrics, Chicago, IL, USA
| | | | - Ruth Bernstein
- University of Miami, Department of Psychology, Coral Gables, FL, 33124, USA
| | | | | | - Kristin A Riekert
- The Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| |
Collapse
|
47
|
Granade CJ, Parker Fiebelkorn A, Black CL, Lutz CS, Srivastav A, Bridges CB, Ball SW, Devlin RG, Cloud AJ, Kim DK. Implementation of the Standards for adult immunization practice: A survey of U.S. Health care providers. Vaccine 2020; 38:5305-12. [PMID: 32586760 DOI: 10.1016/j.vaccine.2020.05.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 01/10/2023]
Abstract
The revised Standards for Adult Immunization Practice ("Standards"), published in 2014, recommend routine vaccination assessment, strong provider recommendation, vaccine administration or referral, and documentation of vaccines administered into immunization information systems (IIS). We assessed clinician and pharmacist implementation of the Standards in the United States from 2016 to 2018. Participating clinicians (family and internal medicine physicians, obstetricians-gynecologists, specialty physicians, physician assistants, and nurse practitioners) and pharmacists responded using an internet panel survey. Weighted proportion of clinicians and pharmacists reporting full implementation of each component of the Standards were calculated. Adjusted prevalence ratio (APR) estimates of practice characteristics associated with self-reported implementation of the Standards are also presented. Across all medical specialties, the percentages of clinicians and pharmacists implementing the vaccine assessment and recommendation components of the Standards were >80.0%. However, due to low IIS documentation, full implementation of the Standards was low overall, ranging from 30.4% for specialty medicine to 45.8% in family medicine clinicians. The presence of an immunization champion (APR, 1.40 [95% confidence interval {CI}, 1.26 to 1.54]), use of standing orders (APR, 1.41 [95% CI, 1.27 to 1.57]), and use of a patient reminder-recall system (APR, 1.39 [95% CI, 1.26 to 1.54]) were positively associated with adherence to the Standards by clinicians. Similar results were observed for pharmacists. Nonetheless, vaccination improvement strategies, i.e., having standing orders in place, empowering an immunization champion, and using patient recall-reminder systems were underutilized in clinical settings; full implementation of the Standards was inconsistent across all health care provider practices.
Collapse
|
48
|
Das J, Daniels B, Ashok M, Shim EY, Muralidharan K. Two Indias: The structure of primary health care markets in rural Indian villages with implications for policy. Soc Sci Med 2020; 301:112799. [PMID: 32553441 PMCID: PMC9188269 DOI: 10.1016/j.socscimed.2020.112799] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 06/26/2019] [Revised: 11/22/2019] [Accepted: 01/11/2020] [Indexed: 11/13/2022]
Abstract
We visited 1519 villages across 19 Indian states in 2009 to (a) count all health care providers and (b) elicit their quality as measured through tests of medical knowledge. We document three main findings. First, 75% of villages have at least one health care provider and 64% of care is sought in villages with 3 or more providers. Most providers are in the private sector (86%) and, within the private sector, the majority are ‘informal providers' without any formal medical training. Our estimates suggest that such informal providers account for 68% of the total provider population in rural India. Second, there is considerable variation in quality across states and formal qualifications are a poor predictor of quality. For instance, the medical knowledge of informal providers in Tamil Nadu and Karnataka is higher than that of fully trained doctors in Bihar and Uttar Pradesh. Surprisingly, the share of informal providers does not decline with socioeconomic status. Instead, their quality, along with the quality of doctors in the private and public sector, increases sharply. Third, India is divided into two nations not just by quality of health care providers, but also by costs: Better performing states provide higher quality at lower per-visit costs, suggesting that they are on a different production possibility frontier. These patterns are consistent with significant variation across states in the availability and quality of medical education. Our results highlight the complex structure of health care markets, the large share of private informal providers, and the substantial variation in the quality and cost of care across and within markets in rural India. Measuring and accounting for this complexity is essential for health care policy in India. In 2010, the average Indian village had 3.2 primary healthcare providers. Of these, 86% were in the private sector and 68% had no formal medical training. In richer states, the share of informal providers did not decrease—quality improved. In high-performing states, quality was higher and per-patient costs were lower. The density and variation of health market cost and quality has policy implications.
Collapse
Affiliation(s)
- Jishnu Das
- Georgetown University, Washington, DC, USA; Centre for Policy Research, New Delhi, India.
| | | | - Monisha Ashok
- Center for Innovation and Impact, Global Health Bureau, USAID, USA
| | | | | |
Collapse
|
49
|
Funchess T, Bradwell MW, McLeod ST, Blackwell E, Kolbo JR, Zhang L, Ismail OH. Racial Disparities in Reproductive Healthcare among Parous and Nulliparous Women in Mississippi. J Racial Ethn Health Disparities 2021; 8:304-14. [PMID: 32495305 DOI: 10.1007/s40615-020-00783-x] [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] [Received: 03/18/2020] [Revised: 05/16/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Long-standing racial disparities exist in reproductive healthcare and have been associated with negative health outcomes among minority women. This study aimed to analyze the racial disparities in reproductive healthcare among Mississippi women, particularly as it related to contraception access, usage, setting, provider type, and payer. METHODS A two-stage stratified probability design was employed - 95 of the 1500 licensed childcare facilities across the state were randomly selected, and then two to three classrooms were randomly selected within each facility. The children were the means to obtaining a weighted sample of parous women of childbearing age (15-44). Once a parous woman completed the study, she could invite a nulliparous friend of similar age, race, and socioeconomic background to also participate in the study. RESULTS Racial disparities were found in the reproductive healthcare of both the parous and nulliparous groups. Overall, black women were less likely to receive services from an obstetrics and gynecology. Parous and nulliparous black women were more likely to receive their reproductive healthcare at the health department and less likely to use the most effective methods of contraception. CONCLUSION Low use of the most effective methods of contraception, despite high levels of general contraceptive use and high insurance coverage, hints at additional barriers to full access for black women in Mississippi. More equitable access to effective family planning counseling and contraception can have meaningful impact on the lives of black women in our state.
Collapse
|
50
|
Smith J, Banay R, Zimmerman E, Caetano V, Musheke M, Kamanga A. Barriers to provision of respectful maternity care in Zambia: results from a qualitative study through the lens of behavioral science. BMC Pregnancy Childbirth 2020; 20:26. [PMID: 31918682 PMCID: PMC6953303 DOI: 10.1186/s12884-019-2579-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/05/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Recently, a growing body of literature has established that disrespect and abuse during delivery is prevalent around the world. This complex issue has not been well studied through the lens of behavioral science, which could shed light on the psychological dimensions of health worker behavior and how their micro-level context may be triggering abuse. Our research focuses on the behavioral drivers of disrespect and abuse in Zambia to develop solutions with health workers and women that improve the experience of care during delivery. METHODS A qualitative study based on the behavioral design methodology was conducted in Chipata District, Eastern Province. Study participants included postpartum women, providers (staff who attend deliveries), supervisors and mentors, health volunteers, and birth companions. Observations were conducted of client-provider interactions on labor wards at two urban health centers and a district hospital. In-depth interviews were audio recorded and English interpretation from these recordings was transcribed verbatim. Data was analyzed using thematic analysis and findings were synthesized following the behavioral design methodology. RESULTS Five key behavioral barriers were identified: 1) providers do not consider the decision to provide respectful care because they believe they are doing what they are expected to do, 2) providers do not consider the decision to provide respectful care explicitly since abuse and violence are normalized and therefore the default, 3) providers may decide that the costs of providing respectful care outweigh the gains, 4) providers believe they do not need to provide respectful care, and 5) providers may change their mind about the quality of care they will provide when they believe that disrespectful care will assist their clinical objectives. We identified features of providers' context - the environment in which they live and work, and their past experiences - which contribute to each barrier, including supervisory systems, visual cues, social constructs, clinical processes, and other features. CONCLUSIONS Client experience of disrespectful care during labor and delivery in Chipata, Zambia is prevalent. Providers experience several behavioral barriers to providing respectful maternity care. Each of these barriers is triggered by one or more addressable features in a provider's environment. By applying the behavioral design methodology to the challenge of respectful maternity care, we have identified specific and concrete contextual cues that targeted solutions could address in order to facilitate respectful maternity care.
Collapse
|