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Sheldon E, Ezaydi N, Desoysa L, Young J, Simmonds-Buckley M, Hind PD, Burton PC. Barriers to help-seeking, accessing and providing mental health support for medical students: a mixed methods study using the candidacy framework. BMC Health Serv Res 2024; 24:738. [PMID: 38877493 PMCID: PMC11179297 DOI: 10.1186/s12913-024-11204-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 06/13/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND The mental health of medical students is a national and international problem increasing in both demand and acuity. Medical students face barriers to accessing mental health support that is clinically effective, timely and appropriate for their needs. This mixed methods study aimed to explore experiences of these barriers and the challenges to health service delivery aligned to the Candidacy Framework. METHODS One hundred three medical students studying at The University of Sheffield completed an online survey comprising the CCAPS-34 and follow-up questions about service access and use. Semi-structured interviews with a nested sample of 20 medical students and 10 healthcare professionals explored barriers to service access and provision. A stakeholder panel of medical students and professionals met quarterly to co-produce research materials, interpret research data and identify touchpoints by pinpointing specific areas and moments of interaction between a medical student as a service user and a mental health service. RESULTS Medical students who experienced barriers to help-seeking and accessing support scored significantly higher for psychological symptoms on the CCAPS-34. Uncertainty and fear of fitness to practice processes were important barriers present across all seven stages of candidacy. The fragmented structure of local services, along with individual factors such as perceived stigma and confidentiality concerns, limited the progression of medical students through the Candidacy Framework (a framework for understanding the different stages of a person's journey to healthcare). CONCLUSION This study outlines important areas of consideration for mental health service provision and policy development to improve access to and the quality of care for medical students.
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Affiliation(s)
- Elena Sheldon
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.
- Clinical Trials Research Unit, Sheffield Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Naseeb Ezaydi
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Lauren Desoysa
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Jasmine Young
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | | | - Prof Daniel Hind
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Prof Chris Burton
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
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Vanden Bossche D, Van Poel E, Vanden Bussche P, Petré B, Ponsar C, Decat P, Willems S. Outreach work in Belgian primary care practices during COVID-19: results from the cross-sectional PRICOV-19 study. BMC PRIMARY CARE 2024; 24:283. [PMID: 38570775 PMCID: PMC10988793 DOI: 10.1186/s12875-024-02323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/22/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND General practitioners (GPs) have a vital role in reaching out to vulnerable populations during and after the COVID-19 pandemic. Nonetheless, they experience many challenges to fulfill this role. This study aimed to examine associations between practice characteristics, patient population characteristics and the extent of deprivation of practice area on the one hand, and the level of outreach work performed by primary care practices (PCPs) during the COVID-19 pandemic on the other hand. METHODS Belgian data from the international PRICOV-19 study were analyzed. Data were collected between December 2020 and August 2021 using an online survey in PCPs. Practices were recruited through randomized and convenience sampling. Descriptive statistics and ordinal logistic regression analyses were performed. Four survey questions related to outreach work constitute the outcome variable. The adjusted models included four practice characteristics (practice type, being a teaching practice for GP trainees; the presence of a nurse or a nurse assistant and the presence of a social worker or health promotor), two patient population characteristics (social vulnerability and medical complexity) and an area deprivation index. RESULTS Data from 462 respondents were included. First, the factors significantly associated with outreach work in PCPs are the type of PCP (with GPs working in a group performing more outreach work), and the presence of a nurse (assistant), social worker or health promotor. Second, the extent of outreach work done by a PCP is significantly associated with the social vulnerability of the practice's patient population. This social vulnerability factor, affecting outreach work, differed with the level of medical complexity of the practice's patient population and with the level of deprivation of the municipality where the practice is situated. CONCLUSIONS In this study, outreach work in PCPs during the COVID-19 pandemic is facilitated by the group-type cooperation of GPs and by the support of at least one staff member of the disciplines of nursing, social work, or health promotion. These findings suggest that improving the effectiveness of outreach efforts in PCPs requires addressing organizational factors at the practice level. This applies in particular to PCPs having a more socially vulnerable patient population.
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Affiliation(s)
- Dorien Vanden Bossche
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium.
| | - Esther Van Poel
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Pierre Vanden Bussche
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Benoit Petré
- Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Cécile Ponsar
- Academic Center of Medicine, Institute of Health and Society, UCLouvain, Brussels, Belgium
| | - Peter Decat
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Binyaruka P, Foss A, Alibrahim A, Mziray N, Cassidy R, Borghi J. Supply-side factors influencing demand for facility-based delivery in Tanzania: a multilevel analysis. HEALTH ECONOMICS REVIEW 2023; 13:52. [PMID: 37930445 PMCID: PMC10629065 DOI: 10.1186/s13561-023-00468-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Improving access to facility-based delivery care has the potential to reduce maternal and newborn deaths across settings. Yet, the access to a health facility for childbirth remains low especially in low-income settings. To inform evidence-based interventions, more evidence is needed especially accounting for demand- and supply-side factors influencing access to facility-based delivery care. We aimed to fill this knowledge gap using data from Tanzania. METHODS We used data from a cross-sectional survey (conducted in January 2012) of 150 health facilities, 1494 patients and 2846 households with women who had given births in the last 12 months before the survey across 11 districts in three regions in Tanzania. The main outcome was the place of delivery (giving birth in a health facility or otherwise), while explanatory variables were measured at the individual woman and facility level. Given the hierarchical structure of the data and variance in demand across facilities, we used a multilevel mixed-effect logistic regression to explore the determinants of facility-based delivery care. RESULTS Eighty-six percent of 2846 women gave birth in a health facility. Demand for facility-based delivery care was influenced more by demand-side factors (76%) than supply-side factors (24%). On demand-side factors, facility births were more common among women who were educated, Muslim, wealthier, with their first childbirth, and those who had at least four antenatal care visits. On supply-side factors, facility births were more common in facilities offering outreach services, longer consultation times and higher interpersonal quality. In contrast, facilities with longer average waiting times, longer travel times and higher chances of charging delivery fees had few facility births. CONCLUSIONS Policy responses should aim for strategies to improve demand like health education to raise awareness towards care seeking among less educated groups and those with higher parity, reduce financial barriers to access (including time costs to reach and access care), and policy interventions to enhance interpersonal quality in service provision.
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Affiliation(s)
- Peter Binyaruka
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania.
| | - Anna Foss
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Abdullah Alibrahim
- College of Engineering and Petroleum, Kuwait University, Kuwait City, Kuwait
| | - Nicholaus Mziray
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania
| | - Rachel Cassidy
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- KPM Center for Public Management, University of Bern, Schanzeneckstrasse 1, Bern, 3012, Switzerland
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Batchelor S, Miller ER, Lunnay B, Macdonald S, Ward PR. Revisiting Candidacy: What Might It Offer Cancer Prevention? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910157. [PMID: 34639459 PMCID: PMC8508007 DOI: 10.3390/ijerph181910157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 12/15/2022]
Abstract
The notion of candidacy emerged three decades ago through Davison and colleagues’ exploration of people’s understanding of the causes of coronary heart disease. Candidacy was a mechanism to estimate one’s own or others risk of disease informed by their lay epidemiology. It could predict who would develop illness or explain why someone succumbed to it. Candidacy’s predictive ability, however, was fallible, and it was from this perspective that the public’s reticence to adhere to prevention messages could be explained, as ultimately anybody could be ‘at-risk’. This work continues to resonate in health research, with over 700 citations of Davison’s Candidacy paper. Less explored however, is the candidacy framework in its entirety in other illness spheres, where prevention efforts could potentially impact health outcomes. This paper revisits the candidacy framework to reconsider it use within prevention. In doing so, candidacy within coronary heart disease, suicide prevention, diabetes, and cancer will be examined, and key components of candidacy and how people negotiate their candidacy within differing disease contexts will be uncovered. The applicability of candidacy to address modifiable breast cancer risk factors or cancer prevention more broadly will be considered, as will the implications for public health policy.
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Affiliation(s)
- Samantha Batchelor
- Discipline of Public Health, Flinders University, Adelaide 5001, Australia; (S.B.); (E.R.M.); (B.L.)
| | - Emma R. Miller
- Discipline of Public Health, Flinders University, Adelaide 5001, Australia; (S.B.); (E.R.M.); (B.L.)
| | - Belinda Lunnay
- Discipline of Public Health, Flinders University, Adelaide 5001, Australia; (S.B.); (E.R.M.); (B.L.)
| | - Sara Macdonald
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Paul R. Ward
- Discipline of Public Health, Flinders University, Adelaide 5001, Australia; (S.B.); (E.R.M.); (B.L.)
- Correspondence:
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Pfister A, Koschmieder N, Wyss S. Limited access to family-based addiction prevention services for socio-economically deprived families in Switzerland: a grounded theory study. Int J Equity Health 2020; 19:194. [PMID: 33115492 PMCID: PMC7594279 DOI: 10.1186/s12939-020-01305-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background Families living in poor socio-economic circumstances, already confronted with social and health inequalities, are often not reached by family-based addiction prevention services. Besides quantitative models and health literacy approaches, qualitative research is lacking that could shed light on the exact circumstances and processes that lead to hindered addiction prevention service uptake by these families. Drawing on the concept of candidacy, we therefore reconstructed how socio-economically deprived parents and their (pre) adolescent children in the German-speaking part of Switzerland (non-)identified their candidacy for family-based addiction prevention services. Methods Following grounded theory, we collected and analysed data in an iterative-cyclical manner using theoretical sampling and theoretical coding techniques. Sixteen families with children aged 10–14 years were interviewed in depth (parent/s and child separately). All but one family lived below the at-risk-of-poverty threshold. Results Socio-economically deprived families’ modes of recognizing and handling problems in everyday life were found to be core phenomena that structure the process towards (non) identification of candidacy for family-based addiction prevention services. Four modes anchored within socio-demographic resources were found: Families with mode A perceived their current life situation as existentially threatening and focused daily coping on the main pressing problem. Others (mode B) perceived prevalent multiple problems as normal (now); problems were normalized, often not recognized as such. In mode C families, problems were pragmatically recognized at a low threshold and pragmatically dealt with, mostly within the family. In mode D families, problems were constantly produced and dealt with early by the worried and anxious parents monitoring their child. From modes D to A, vulnerability increased concerning non-identification of candidacy for family-based addiction prevention services. Further, thematic relevance of addiction prevention, past experience with offers, integration in systems of assistance, strategies to protect the family, and families’ search for information influenced whether identification of candidacy took place. Conclusions Socio-economically deprived families differ in modes of problem construction and handling in everyday life; this differently opens up or closes routes to family-based addiction prevention. Addiction prevention practice should build on a bundle of diverse strategies for outreach to these families, stressing especially interventions on the structural and environmental level. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-020-01305-1.
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Affiliation(s)
- Andreas Pfister
- Institute of Social Management, Social Policy and Prevention, School of Social Work, Lucerne University of Applied Sciences and Arts, Werftestrasse 1, Postfach 2945, CH-6002, Lucerne, Switzerland.
| | - Nikola Koschmieder
- Institute of Social Management, Social Policy and Prevention, School of Social Work, Lucerne University of Applied Sciences and Arts, Werftestrasse 1, Postfach 2945, CH-6002, Lucerne, Switzerland
| | - Sabrina Wyss
- Institute of Social Management, Social Policy and Prevention, School of Social Work, Lucerne University of Applied Sciences and Arts, Werftestrasse 1, Postfach 2945, CH-6002, Lucerne, Switzerland
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Høj SB, Jacka B, Minoyan N, Artenie AA, Bruneau J. Conceptualising access in the direct-acting antiviral era: An integrated framework to inform research and practice in HCV care for people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:11-23. [PMID: 31003825 DOI: 10.1016/j.drugpo.2019.04.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/22/2019] [Accepted: 04/01/2019] [Indexed: 12/17/2022]
Abstract
As direct-acting antiviral (DAA) therapy costs fall and eligibility criteria are relaxed, people who inject drugs (PWID) will increasingly become eligible for HCV treatment. Yet eligibility does not necessarily equate to access. Amidst efforts to expand treatment uptake in this population, we seek to synthesise and clarify the conceptual underpinnings of access to health care for PWID, with a view to informing research and practice. Integrating dominant frameworks of health service utilisation, care seeking processes, and ecological perspectives on health promotion, we present a comprehensive theoretical framework to understand, investigate and intervene upon barriers and facilitators to HCV care for PWID. Built upon the concept of Candidacy, the framework describes access to care as a continually negotiated product of the alignment between individuals, health professionals, and health systems. Individuals must identify themselves as candidates for services and then work to stake this claim; health professionals serve as gatekeepers, adjudicating asserted candidacies within the context of localised operating conditions; and repeated interactions build experiential knowledge and patient-practitioner relationships, influencing identification and assertion of candidacy over time. These processes occur within a complex social ecology of interdependent individual, service, system, and policy factors, on which other established theories provide guidance. There is a pressing need for a deliberate and nuanced theory of health care access to complement efforts to document the HCV 'cascade of care' among PWID. We offer this framework as an organising device for observational research, intervention, and implementation science to expand access to HCV care in this vulnerable population. Using practical examples from the HCV literature, we demonstrate its utility for specifying research questions and intervention targets across multiple levels of influence; describing and testing plausible effect mechanisms; and identifying potential threats to validity or barriers to research translation.
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Affiliation(s)
- Stine Bordier Høj
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada.
| | - Brendan Jacka
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Nanor Minoyan
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada; École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, H3N 1X9, Canada
| | - Andreea Adelina Artenie
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada; École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, H3N 1X9, Canada
| | - Julie Bruneau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada; Département de Médicine Familiale et Médecine d'Urgence, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada.
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Nkosi B, Seeley J, Ngwenya N, Mchunu SL, Gumede D, Ferguson J, Doyle AM. Exploring adolescents and young people's candidacy for utilising health services in a rural district, South Africa. BMC Health Serv Res 2019; 19:195. [PMID: 30922372 PMCID: PMC6438017 DOI: 10.1186/s12913-019-3960-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We use the 'candidacy framework' to describe adolescents' and young people's (AYP) experiences of health services in a rural KwaZulu-Natal district, South Africa. METHODS A qualitative approach was used including group discussions, in-depth and key informant interviews with a purposive sample of AYP (n = 70), community leaders (n = 15), school health teams (n = 10), and health service providers (n = 6). RESULTS Findings indicate tacit understanding among AYP that they are candidates for general health services. However, HIV stigma, apprehensions and misconceptions about sexual and reproductive health, and socio-cultural views which disapprove of AYP pre-marital sex undermine their candidacy for sexual and reproductive services. CONCLUSION Consideration and understanding of the vulnerabilities and reasons AYP exclude themselves will inform interventions to address their health needs. AYP's participation in the design of health services will increase their acceptability and encourage uptake of services.
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Affiliation(s)
- Busisiwe Nkosi
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
| | - Janet Seeley
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Nothando Ngwenya
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
| | - S. Lerato Mchunu
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
| | - Dumile Gumede
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
| | - Jane Ferguson
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Aoife M. Doyle
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Oryema P, Babirye JN, Baguma C, Wasswa P, Guwatudde D. Utilization of outreach immunization services among children in Hoima District, Uganda: a cluster survey. BMC Res Notes 2017; 10:111. [PMID: 28241865 PMCID: PMC5327539 DOI: 10.1186/s13104-017-2431-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 02/15/2017] [Indexed: 11/29/2022] Open
Abstract
Background The global vaccine action plan 2011–2020 was endorsed by 194 states to equitably extend the benefits of immunization to all people. However, gaps in vaccination coverage remain in developing countries such as Uganda. One of the strategies used to tackle existing inequities is implementation of outreach immunization services to deliver services to those with poor geographical access. However, reports of inconsistent use of these services prevail; therefore understanding the factors associated with use of these services is critical for improving service delivery. This study examined the factors associated with utilization of outreach immunization services among children aged 10–23 months in Hoima District, Uganda. Results Overall, 87.4% (416/476) of the children had ever utilized outreach immunization services. Of these, 3.6% (15/416) had completed their entire immunization schedules from outreach immunization sessions. Use of outreach services was associated with reports that the time of outreach sessions was convenient [adjusted odds ratio (AOR) 2.9, 95% confidence interval (CI) 1.32–6.51], community mobilization was done prior to outreach sessions (AOR 4.9, 95% CI 1.94–12.61), the caretaker knew the benefits of childhood immunizations (AOR 2.1, 95% CI 1.30–4.42), and the caretaker was able to name at least four vaccine preventable diseases (AOR 3.0, 95% CI 1.13–7.88). Conclusions Utilization of outreach immunization services in Hoima District was high but reduced with subsequent vaccine doses. Therefore, strategies targeted at retaining service users for the entire immunization schedule need to be developed and implemented. Such strategies could include health education emphasizing the benefits of childhood immunization.
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Affiliation(s)
- Paul Oryema
- School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Juliet N Babirye
- School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Charles Baguma
- School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Peter Wasswa
- African Field Epidemiology Network (AFENET), P.O. Box 12874, Kampala, Uganda.
| | - David Guwatudde
- School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
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Burström B, Marttila A, Kulane A, Lindberg L, Burström K. Practising proportionate universalism - a study protocol of an extended postnatal home visiting programme in a disadvantaged area in Stockholm, Sweden. BMC Health Serv Res 2017; 17:91. [PMID: 28129751 PMCID: PMC5273844 DOI: 10.1186/s12913-017-2038-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In spite of a well-developed welfare system in Sweden, there are important health divides between residential areas in Stockholm county, with shorter life expectancy in disadvantaged areas. These socioeconomic and health divides also affect children. Extra efforts and organized collaboration by different authorities are required to meet the greater needs of children growing up in these areas. METHODS/DESIGN This article reports on the programme logic and evaluation design of an extended postnatal home visiting programme in collaboration between child health services and social services in the Rinkeby area, Stockholm, Sweden, where a large proportion are recent immigrants and more than 50% are at-risk of poverty. The intervention consists of five extra home visits when the child is aged between 2-15 months, jointly by a child health nurse and a social service parental advisor, offered to all parents of first-born children attending Rinkeby child health centre. Parents of first-born children attending child health centres in neighboring areas serve as controls. The evaluation will use a mixed methods approach, including participant observation, in-depth interviews, interviews using structured questionnaires, review and analysis of child health records and records of health care utilization. DISCUSSION The intervention has so far been very positively received by the parents (95% participation rate), who seem to perceive that they actually benefit from participating, and also from staff in child health services and social services who find this approach to be in line with their professional intentions. The staff members interviewed also appreciate the inter-professional collaboration. The intervention has sparked activities also in other sectors (the local library, the open child day care centre) of the local area. The timing of the intervention, at the start of the child's life, may be well suited to support parents in reorienting themselves and finding a positive parenting role, to the benefit of the development of the child. The intervention may be seen as a concrete example of "proportionate universalism", as a strategy to reduce inequalities in health - applying a universal intervention with increased intensity in groups that have a greater need for it. TRIAL REGISTRATION The study was retrospectively registered (11 August 2016) in the ISRCTN registry ( ISRCTN11832097 DOI: 10.1186/ISRCTN11832097 ).
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Affiliation(s)
- Bo Burström
- Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, SE 171 77, Sweden. .,Stockholm County Council Health Services, Stockholm, Sweden.
| | - Anneli Marttila
- Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, SE 171 77, Sweden.,Stockholm County Council Health Services, Stockholm, Sweden
| | - Asli Kulane
- Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, SE 171 77, Sweden
| | - Lene Lindberg
- Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, SE 171 77, Sweden.,Stockholm County Council Health Services, Stockholm, Sweden
| | - Kristina Burström
- Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, SE 171 77, Sweden.,Stockholm County Council Health Services, Stockholm, Sweden.,Department of Learning, Informatics, Management and Ethics, Health Outcomes and Economic Evaluation Research Group, Karolinska Institutet, Stockholm, Sweden
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Hoon E, Pham C, Beilby J, Karnon J. Unconnected and out-of-sight: identifying health care non-users with unmet needs. BMC Health Serv Res 2017; 17:80. [PMID: 28122546 PMCID: PMC5264445 DOI: 10.1186/s12913-017-2019-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/16/2017] [Indexed: 11/29/2022] Open
Abstract
Background While current debates on how to deliver sustainable health care recognise socio-economic dimensions to health service use, attention has focussed on how to reduce demand for services. However, the measures of demand may not account for a subgroup of the population who to date have remained out of sight because they do not access health services. This study aimed to describe the characteristics of individuals who self-reported having fair or poor health but did not use health services. Methods Data from the 2010 LINKIN health census survey (n = 7895) and the 2013 HILDA National Panel Survey (n = 13,609) were analysed focussing on the population who self-reported their overall health status as fair or poor. Simple and multivariable logistic regression modelling examined characteristics associated with a lack of health services use. The outcome measure of interest was no health service use in the previous 12 months and co-variables included demographic and socioeconomic indicators, health-related quality of life, having no health condition and health risk factors. Results Overall 21% of LINKIN respondents reported their overall health as fair or poor compared to 18% in the HILDA dataset. In LINKIN, 4.4% of those reporting fair or poor health, reported not using any health service provider in the past 12 months. Similarly, 4.5% of HILDA respondents were non-users. When adjusted for multiple co-variables, unemployment (aOR 3.24, 95% CI 1.28-8.17), educational level at Year 10 or below (aOR 1.94, 95% CI 1.02-3.70) and smoking (aOR 2.67, 95% CI 1.38-5.17) were significantly associated with non-use for the LINKIN data, as did lack of health conditions (aOR 0.18, 95% CI 0.08-0.41). The HILDA regression analyses indicated the same directions of association between equivalent variables and lack of health service use, with the exception of educational level. Conclusions In line with recent assertions on real denominators in health need, this study describes those people rarely included in the population at risk and the potential for systematic bias towards the overestimation of the effectiveness of interventions. This study informs current policy debates and planning, including how we connect with hard-to-reach populations and how this sub-group might be more appropriately included when measuring effectiveness of health policies and programs.
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Affiliation(s)
- Elizabeth Hoon
- School of Public Health, Mail Drop DX 650 171, The University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Clarabelle Pham
- School of Public Health, Mail Drop DX 650 171, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Justin Beilby
- School of Public Health, Mail Drop DX 650 171, The University of Adelaide, Adelaide, SA, 5005, Australia.,Torrens University, GPO Box 2025, Adelaide, SA, 5001, Australia
| | - Jonathan Karnon
- School of Public Health, Mail Drop DX 650 171, The University of Adelaide, Adelaide, SA, 5005, Australia
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11
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Chinn D, Abraham E. Using 'candidacy' as a framework for understanding access to mainstream psychological treatment for people with intellectual disabilities and common mental health problems within the English Improving Access to Psychological Therapies service. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:571-582. [PMID: 27097932 DOI: 10.1111/jir.12274] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/09/2015] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The Improving Access to Psychological Therapies (IAPT) service was established to address common mental health problems among the English population in a timely manner in order to counter the social and economic disadvantage accompanying such difficulties. Using the concept of candidacy, we examined how the legitimacy of claims by people with intellectual disabilities to use this service is facilitated or impeded. METHOD We used a sequential mixed methods design. We completed 21 interviews with a range of stakeholders, including people with intellectual disabilities and their carers. Themes from the interviews were used to design an online survey questionnaire that was returned by 452 staff from IAPT and specialist intellectual disability services. RESULTS Using the candidacy framework, we noted that eligibility and access to IAPT were achieved through dynamic and iterative processes of negotiation involving people with intellectual disabilities and their supporters on one side and IAPT staff and service structures on the other. Barriers and facilitators were apparent throughout the seven dimensions of candidacy (identification, navigation, permeability of services, appearances, adjudications, offers and resistance and operating conditions) and were linked to discourses relating to the character and purpose of IAPT and specialist intellectual disability services. CONCLUSIONS Opportunities exist for some people with intellectual disabilities to assert their candidacy for IAPT input, although there are barriers at individual, professional, organisational and structural levels. More attention needs to be paid to how principles of inclusiveness are operationalised within IAPT teams and to the mental health facilitation role of specialist intellectual disability staff.
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Affiliation(s)
- D Chinn
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - E Abraham
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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12
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Lhussier M, Carr SM, Forster N. A realist synthesis of the evidence on outreach programmes for health improvement of Traveller Communities. J Public Health (Oxf) 2015; 38:e125-32. [PMID: 26232206 PMCID: PMC4894485 DOI: 10.1093/pubmed/fdv093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Improving the health of Traveller Communities is an international public health concern but there is little evidence on effective interventions. This study aimed to explain how, for whom and in what circumstances outreach works in Traveller Communities. Methods A realist synthesis was undertaken. Systematic literature searches were conducted between August and November 2011. Grey literature was sought and key stakeholders were involved throughout the review process. Iterative steps of data extraction, analysis and synthesis, followed by additional searches were undertaken. Results An explanatory framework details how, why and in what circumstances participation, behaviour change or social capital development happened. The trust status of outreach workers is an important context of outreach interventions, in conjunction with their ability to negotiate the intervention focus. The higher the outreach worker's trust status, the lower the imperative that they negotiate the intervention focus. A ‘menu’ of reasoning mechanisms is presented, leading to key engagement outcomes. Conclusions Adopting a realist analysis, this study offers a framework with explanatory purchase as to the potential of outreach to improve health in marginalized groups.
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Affiliation(s)
- M Lhussier
- Department of Public Health and Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Coach Lane Campus East (H012), Newcastle upon Tyne NE7 7XA, UK Fuse, the Centre for Translational Research in Public Health, UK
| | - S M Carr
- Department of Public Health and Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Coach Lane Campus East (H012), Newcastle upon Tyne NE7 7XA, UK Fuse, the Centre for Translational Research in Public Health, UK Faculty of Health, Federation University, Australia
| | - N Forster
- Department of Public Health and Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Coach Lane Campus East (H012), Newcastle upon Tyne NE7 7XA, UK Fuse, the Centre for Translational Research in Public Health, UK
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13
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Ellis N, Gidlow C, Cowap L, Randall J, Iqbal Z, Kumar J. A qualitative investigation of non-response in NHS health checks. ACTA ACUST UNITED AC 2015; 73:14. [PMID: 25825674 PMCID: PMC4377903 DOI: 10.1186/s13690-015-0064-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/24/2015] [Indexed: 11/28/2022]
Abstract
Background Improving uptake of NHS Health Checks has become a priority in England, but there is a lack of data on the perceptions of programme non-attenders. This study aimed to explore how non-attenders of NHS Health Checks perceive the programme, identify reasons for non-attendance and inform strategies to improve uptake. Method This qualitative study involved individuals registered at four general practices in Stoke-on-Trent, UK, who had not taken up their invitation to a NHS Health Check. Semi-structured face-to-face and telephone interviews were audio-recorded and transcribed verbatim for Thematic Analysis. Results Interviews were completed with 19 males and 22 females (mean age 52.9 ± 8.5 years), who were socio-demographically representative of the non-attender population. Four main themes identified related to: the positive perception of the Health Check concept among non-attenders; the perceived lack of personal relevance; ineffective invitation method and appointment inconvenience were common barriers; previous experience of primary care can influence uptake. Conclusions Fundamental requirements for improving uptake are that individuals recognise the personal relevance of Health Checks and that attendance is convenient. Incorporating more sophisticated and personalised risk communication as part of the invitation could increase impact and promote candidacy. Flexibility and convenience of appointments should be considered by participating general practices.
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Affiliation(s)
- Naomi Ellis
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK
| | - Christopher Gidlow
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK
| | - Lisa Cowap
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK
| | - Jason Randall
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK
| | - Zafar Iqbal
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK ; Stoke-on-Trent City Council Public Health Directorate, Civic Centre, Glebe Street, Stoke-on-Trent, ST4 1HH UK
| | - Jagdish Kumar
- Havering Public Health, Mercury House, 12th Floor, Mercury Gardens, Romford, Essex RM1 3DW UK
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Carr SM, Lhussier M, Forster N, Goodall D, Geddes L, Pennington M, Bancroft A, Adams J, Michie S. Outreach programmes for health improvement of Traveller Communities: a synthesis of evidence. PUBLIC HEALTH RESEARCH 2014. [DOI: 10.3310/phr02030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Susan M Carr
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Monique Lhussier
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Natalie Forster
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Deborah Goodall
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Lesley Geddes
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Mark Pennington
- Department of Health Services Research and Policy, London School of Health & Tropical Medicine, London, UK
| | - Angus Bancroft
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Jean Adams
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Susan Michie
- Division of Psychology and Language Sciences, University College London, London, UK
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15
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Opportunistic community-based health checks. Public Health 2014; 128:582-4. [PMID: 24916427 DOI: 10.1016/j.puhe.2014.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 11/24/2022]
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16
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López-Entrambasaguas OM, Fernández-Sola C, Granero-Molina J. Perception of HIV Prevention Programs Among Ayoreo Sex Workers in Bolivia. J Transcult Nurs 2014; 26:458-65. [DOI: 10.1177/1043659614526254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Ayoreo population constitutes one of Bolivia’s most vulnerable ethnic groups in terms of HIV/AIDS. Being a woman, indigenous, and a sex worker signifies belonging to a high-risk group. The aim of this study is to explore the Ayoreo sex workers’ and health agents’ perceptions of HIV/AIDS prevention programs in order to identify variables that could influence their success or failure. This study used an ethnographic methodology that included participant observation and semistructured interviews. In the data collection, participant observation and semistructured interviews with sex workers and key informants were conducted. Three themes emerged from the inductive data analysis: health prevention efforts, cultural inadequacy of prevention programs, and the eventuality of interventions. We conclude that nursing can develop culturally-adequate HIV/AIDS prevention interventions and programs as well as promote health within these populations.
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Dryden R, Williams B, McCowan C, Themessl-Huber M. What do we know about who does and does not attend general health checks? Findings from a narrative scoping review. BMC Public Health 2012; 12:723. [PMID: 22938046 PMCID: PMC3491052 DOI: 10.1186/1471-2458-12-723] [Citation(s) in RCA: 152] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 08/24/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND General and preventive health checks are a key feature of contemporary policies of anticipatory care. Ensuring high and equitable uptake of such general health checks is essential to ensuring health gain and preventing health inequalities. This literature review explores the socio-demographic, clinical and social cognitive characteristics of those who do and do not engage with general health checks or preventive health checks for cardiovascular disease. METHODS An exploratory scoping study approach was employed. Databases searched included the British Nursing Index and Archive, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE), EMBASE, MEDLINE, PsycINFO and the Social Sciences Citation Index (SSCI). Titles and abstracts of 17463 papers were screened; 1171 papers were then independently assessed by two researchers. A review of full text was carried out by two of the authors resulting in 39 being included in the final review. RESULTS Those least likely to attend health checks were men on low incomes, low socio-economic status, unemployed or less well educated. In general, attenders were older than non-attenders. An individual's marital status was found to affect attendance rates with non-attenders more likely to be single. In general, white individuals were more likely to engage with services than individuals from other ethnic backgrounds. Non-attenders had a greater proportion of cardiovascular risk factors than attenders, and smokers were less likely to attend than non-smokers. The relationship between health beliefs and health behaviours appeared complex. Non-attenders were shown to value health less strongly, have low self-efficacy, feel less in control of their health and be less likely to believe in the efficacy of health checks. CONCLUSION Routine health check-ups appear to be taken up inequitably, with gender, age, socio-demographic status and ethnicity all associated with differential service use. Furthermore, non-attenders appeared to have greater clinical need or risk factors suggesting that differential uptake may lead to sub-optimal health gain and contribute to inequalities via the inverse care law. Appropriate service redesign and interventions to encourage increased uptake among these groups is required.
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Affiliation(s)
- Ruth Dryden
- Social Dimensions of Health Institute, 11 Airlie Place, University of Dundee, Dundee, UK
| | - Brian Williams
- Nursing, Midwifery & Allied Health Professions Research Unit, Iris Murdoch Building, University of Stirling, Stirling, UK
| | - Colin McCowan
- Division of Population Health Sciences, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
| | - Markus Themessl-Huber
- Social Dimensions of Health Institute, 11 Airlie Place, University of Dundee, Dundee, UK
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