Being Uncertain: Rural-Living Cardiac Patients' Experience of Seeking Health Care

Exploring barriers to accessing health care services by young women in rural settings: a qualitative study in Australia, Canada, and Sweden

BACKGROUND

The aim of this study is to explore young rural women's perceived barriers in accessing healthcare services with a focus on the interrelation between three marginalization criteria: age (youth), gender (female), and place of residence (rural areas) in Australia, Canada, and Sweden.

METHODS

Using a qualitative interpretive approach, we conducted semi-structured in-depth interviews with 31 young women aged 18 to 24 in selected rural communities. Data collection took place from May 2019 to January 2021, and the qualitative data were analyzed using NVivo software.

RESULTS

Self-perceived barriers for access to healthcare services among young women living in rural and remote areas encompass various challenges across individual, institutional, and structural levels. Individual barriers include limited knowledge about available health services, negative attitudes toward healthcare, psychological discomfort when seeking assistance, and economic affordability issues. Institutional challenges involve limited healthcare resources, gender insensitivity among providers, judgmental attitudes from healthcare staff, inadequate time management of services, and a lack of privacy and confidentiality within facilities. Structural barriers further compound these issues through socio-cultural and gender norms, insufficient coverage of universal health insurance, low budget allocations for health facilities in rural and small urban areas, and the geographic distance to healthcare providers. Addressing these multifaceted barriers is crucial to improving healthcare access for rural population.

CONCLUSIONS

Appropriate strategies and policies must be introduced to promote access to healthcare services in rural and remote areas even in most high-`income countries.

Experiences and challenges of acute coronary syndrome patients in care provision: a qualitative systematic review

BACKGROUND

Coronary artery disease including acute coronary syndrome (ACS) constitutes the most common cause of death in people with cardiovascular disease. Prompt diagnosis and early initiation of treatment significantly impact on patient outcomes. Positive patient experience with their initial care is linked to positive clinical outcomes.

OBJECTIVE

This qualitative review aimed to investigate patients' experience of care provision and the challenges faced by them during their different stages of care following an ACS.

METHODS

Searches of four databases - MEDLINE, Embase, CINAHL and PsychINFO - were conducted from inception until July 13, 2022, and were limited to English-language publications. Assessment of methodological quality of studies was performed using the Jonna Briggs Institute (JBI) qualitative assessment and review instrument. Data were extracted using the standardised data extraction tool from JBI. Data synthesis following the JBI approach of meta-aggregation was performed. The level of confidence for each synthesised finding was established based on ConQual.

RESULTS

Overall, from 578 records, 10 studies were included with 39 findings extracted from the included studies. The main synthesised findings were the need to provide tailored information and appropriate management at different stages of care, and that timely management and trust in health care workers are associated with greater patient satisfaction and more positive experiences.

CONCLUSION

Patients with an ACS experience many challenges during different stages of their care. Clinicians should be aware of the challenges they face and provide tailored information to patients that is appropriate for their different stages of management in order to best optimise patient experience and improve patient outcomes.

Behind the Silence of the Professional Classroom in Universities: Formation of Cognition-Practice Separation among University Students-A Grounded Theory Study in China

Classroom silence is a negative form of classroom performance that is particularly prominent in the Chinese learner population. Existing research has mainly explored the silence phenomenon among Chinese university students in two types of learning contexts: overseas university classrooms and foreign language classrooms at local universities, without focusing on the Chinese undergraduates' reticence in courses mediated by native language at domestic universities. However, the last type is the most common habitat for Chinese university students' learning in higher education. Therefore, a sample of Chinese undergraduates majoring in education (n = 394) was recruited to determine the mechanisms of silence formation in professional classrooms. This study was based on grounded theory and in-depth interviews, and the recorded material was processed using NVivo 12. After a series of steps including open coding, axial coding, selective coding, and theoretical saturation testing, the core feature of the phenomenon of silence in professional classrooms of Chinese university students majoring in education was found to be the separation of students' cognition and speaking practice. Then, a theoretical model of the formation and development of the phenomenon of classroom silence in professional classrooms of these undergraduates was constructed. The study showed that these university students had professional perceptions of classroom silence and displayed strong opposition to it, but they continued to maintain silent classroom behavior under the combined influence of individual characteristics, classroom experience, and learning adjustment. Following this, implications for existing research and suggestions for future practice are discussed.

Rural patients' experience of education, surveillance, and self-care support after heart disease related hospitalisation: a qualitative study

People living in rural Iceland have a higher rate of cardiovascular risk factors and healthcare utilisation compared to people in urban areas.The aim of this qualitative study was to explore the experiences of people with coronary heart disease, living in rural Iceland regarding patient education, surveillance, and self-care support. The participants (N = 14, age 52‒79 years, 8 male), were interviewed 6 to 12 months after hospital discharge following a cardiac event (in 2018‒2019). Systematic text-condensation was used for analysis. The findings were categorised into three main themes: Education and support describes inadequate patient education and support from health-care professionals after discharge from hospitaland how the internet was the main information source supplemented with spouse's and family support. Local healthcare services describe thelack of and importance of access to health-care professionals, stable services, and underutilisation of telemedicine and primary healthcare in the local area, and Self-care behaviour describes the lack of professional support with lifestyle changes and how the participants manage self-care as well as their attitudes towards the disease.The results indicate that access to continuous healthcare services and person-centred support focusing on prevention strategies are widely impaired in rural areas in Iceland.