Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study

Participatory Health Cadre Model to Improve Exclusive Breastfeeding Coverage with King's Conceptual System

Objective

The purpose of this research is to develop a participatory health cadre model to enhance exclusive breastfeeding coverage through initial stages using the Imogene King model.

Methods

This study employs a mixed-methods approach with sequential exploratory designs. Qualitative research utilized in-depth interviews with informants including the head of the community health center, nutrition officers from the health center, the coordinator of Maternal and Child Health (MCH) midwives, village midwives, breastfeeding mothers, families of breastfeeding mothers, and health cadres. Quantitative research respondents consist of health cadres. The quantitative study utilizes a quasi-experimental method with a design paradigm known as the one-group pre and post-test design to measure health cadre perception on exclusive breastfeeding.

Results

This study yields elements from Imogene King that form a participatory health cadre model to enhance exclusive breastfeeding coverage, consisting of interaction, perception, communication, transaction, role, growth and development, time, and space. Transactions represent the objective integration of the health cadre participation model, as demonstrated by the behavioral shifts observed in mothers regarding breastfeeding their infants. The t-test results indicate that exclusive breastfeeding monitoring training is effective and successful in enhancing exclusive breastfeeding coverage (Sig. value = 0.000 < 0.05). In addition, the effectiveness of exclusive breastfeeding monitoring training falls within the category of good or high.

Conclusion

The research findings indicate the success of the participatory health cadre model in improving exclusive breastfeeding coverage.

Syphilis seroprevalence and associated factors: A cross-sectional study in formal female sex workers in a province of Peru

Syphilis is a sexually transmitted infection (STI) considered a public health problem that affects vulnerable and at-risk populations, such as sex workers. We designed a retrospective cross-sectional study based on the review of health evaluation records of sex workers who attended consultations to obtain comprehensive health cards at a Health Center in the Province of San Vicente de Cañete in Peru during the year 2020. We obtained sociodemographic and employment information and the RPR (rapid plasma reagin) test results to diagnose syphilis. We evaluated 220 records of sex workers with a mean age of 27.9 ± 6.9 years and the initiation of sexual relations of 16.0 ± 1.6 years, while the accumulated time they had as sex workers was 2.9 ± 2.4 years. 85.9% of those evaluated reported being heterosexual. The prevalence of syphilis was 7.3% (CI95: 4.2%-11.5%). Being a homosexual sex worker was significantly associated with syphilis (OR: 19.6; 95% CI: 4.8-80.0) compared to heterosexuals. The prevalence of syphilis presented a value similar to that reported in other Latin American and national studies, and it is evident that it is a health problem among sex workers.

Evaluating patient-reported outcome measures in Peru: a cross-sectional study of satisfaction and net promoter score using the 2016 EnSuSalud survey

BACKGROUND

Patient-reported measures attempt to quantify the value health services provide to users. Satisfaction is a common summative measure, but often has limited utility in identifying poor quality care. We compared satisfaction and the net promoter score (NPS), which was developed to help businesses quantify consumer sentiment, in a nationally representative survey in Peru. We aimed to compare NPS and satisfaction as individual ratings of care, assess the relationship of patient-reported experience ratings to these outcome measures and consider the utility of these measures as indicators of facility performance based on reliability within facilities and capacity to discriminate between facilities.

METHODS

We analysed the 2016 National Survey on User Satisfaction of Health Services, a cross-sectional outpatient exit survey. We assessed ratings by patient characteristics and compared the distributions of satisfaction and NPS categories. We tested the association of patient-reported experience measures with each outcome using multilevel ordinal logistic regression. We used intraclass correlation (ICC) from these models to predict minimum sample for reliable assessment and compared patient-reported experience measures in facilities with average satisfaction but below or above average NPS.

RESULTS

13 434 individuals rated services at 184 facilities. Satisfaction (74% satisfied) and NPS (17% reported at least 9 out of 10) were largely concordant within individuals but weakly correlated (0.37). Ratings varied by individual factors such as age and visit purpose. Most domains of patient-reported experience were associated with both outcomes. Adjusted ICC was higher for NPS (0.26 vs 0.11), requiring a minimum of 7 (vs 20) respondents for adequate reliability. Within the 70% of facilities classified as average based on satisfaction, NPS-based classification revealed systematic differences in patient-reported experience measures.

CONCLUSION

While satisfaction and NPS were broadly similar at an individual level, this evidence suggests NPS may be useful for benchmarking facility performance as part of national efforts in Peru and throughout Latin America to identify deficits in health service quality.

Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa

Background

Sexual history taking for risk behavior contributes to improving health outcomes in primary care. Giving the high numbers of people living with AIDS, every patient in South Africa should be offered an HIV test, which implies that a comprehensive sexual history must be taken.

Aim

To describe the optimal consultation process, as well as associated factors and skills required to improve disclosure of sexual health issues during a clinical encounter with a doctor in primary health care settings in North West province, South Africa.

Methods

This qualitative study, based on grounded theory, involved the video-recording of 151 consultations of adult patients living primarily with hypertension and diabetes. This article reports on the 5 consultations where some form of sexual history taking was observed. Patient consultations were analyzed thematically, which entailed open coding, followed by focused and verbatim coding using MaxQDA 2018 software. Confirmability was ensured by 2 generalist doctors, a public health specialist and the study supervisors.

Main Outcome Measure

Sexual history was not taken and patients living with sexual dysfunction were missed. If patients understand how disease and medication contribute to their sexual wellbeing, this may change their perceptions of the illness and adherence patterns.

Results

Sexual history was taken in 5 (3%) out of 151 consultations. Three themes emerged from these 5 consultations. In the patient-doctor relationship theme, patients experienced paternalism and a lack of warmth and respect. The consultation context theme included the seating arrangements, ineffective use of time, and privacy challenges due to interruptions and translators. Theme 3, consultation content, dealt with poor coverage of the components of the sexual health history.

Conclusion

Overall, sexual dysfunction in patients was totally overlooked and risk for HIV was not explored, which had a negative effect on patients’ quality of life and long-term health outcomes. The study provided detailed information on the complexity of sexual history taking during a routine consultation and is relevant to primary health care in a rural setting. Pretorius D, Couper I, Mlambo M. Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa. Sex Med 2021;9:100389.