Social Context, Self-Efficacy, and Patient-Centered Service Behavior of Medical Professionals: The Moderating Role of Achievement Motivation

Facilitators and barriers in the implementation of patient-centred care interventions among general practitioners: a systematic review protocol

BACKGROUND

Challenges in the patient-provider relationship are prevalent, underscoring the importance of patient-centred care, which is respectful and responsive to patients' needs. General practitioners (GPs), also known as family doctors, serve as gatekeepers in primary care and are well positioned to deliver this type of care. However, effectively implementing patient-centred care remains a challenge. While behaviour change interventions have been developed to enhance patient-centred care in general practices, a comprehensive understanding of the facilitators and barriers to their implementation is lacking. This review aims to examine contextual factors of implementing interventions for patient-centred care by GPs. Implementation research analyses all aspects of application, including factors influencing it, processes involved and outcomes achieved within different contexts. The review will use the updated Consolidated Framework for Implementation Research (CFIR 2.0) to analyse influential factors and the Behaviour Change Wheel (BCW) to define interventions to promote behaviour change in patient-centred care.

METHODS

This systematic literature review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of five databases (Ovid MEDLINE, CINAHL, EMBASE, Cochrane Library and Web of Science) will be conducted to identify barriers and facilitators for implementing interventions in promoting patient-centred care by GPs. The CFIR 2.0 framework will guide the categorization and synthesis of barriers and facilitators, while the BCW will be employed to define the interventions. Two independent reviewers will conduct study screening, data extraction, quality appraisal and data analysis. Any disagreements between the reviewers will be resolved through the involvement of additional reviewers.

DISCUSSION

This protocol outlines a systematic review utilizing an updated framework-based approach to identify and synthesize evidence on barriers and facilitators to implementing behaviour change interventions by GPs. The findings will provide insights into the effectiveness of these interventions in enhancing patient-centred care and will inform future research and clinical practice. This review will identify gaps and challenges in existing studies and propose strategies for the effective implementation of behavior change interventions among GPs. Additionally, it will inform clinical practice by refining behaviour change interventions to enhance the delivery of patient-centred care by GPs.

TRIAL REGISTRATION

PROSPERO: CRD42023485014.

Healthcare providers' advocacy approaches and ethical challenges in delivering healthcare to undocumented migrants: a scoping review

Delivering healthcare to undocumented migrants presents a complex challenge for healthcare providers. Integrating advocacy efforts into their daily practices can be ambiguous in practical terms, stemming from the intricate task of addressing the health needs of this population while simultaneously advocating for their health rights within the constraints imposed on them. This study seeks to consolidate findings from literature regarding the advocacy approaches employed by healthcare providers and the correlated ethical challenges. We conducted a scoping review of qualitative literature by systematically searching four databases-PubMed/Medline, Embase, Cinahl, and Cochrane Library. For developing our search strategy, we employed the PICO (Population, Intervention, Comparison, Outcome) scheme. Our analysis followed the qualitative content analysis approach proposed by Graneheim and Lundman. 30 studies were included, revealing a cumulative total of 915 healthcare providers who were interviewed. A total of 30 themes emerged comprising 14 advocacy approaches and 16 ethical challenges. Healthcare providers made a deliberate choice to engage in advocacy, responding to injustices experienced by undocumented migrants. The spectrum of advocacy initiatives varied, encompassing voluntary participation in healthcare provision, empathetic understanding, and healthcare-focused strategies. We also identified numerous correlated ethical challenges, necessitating healthcare providers to strike a balance between their eagerness to assist and their professional competence, respect the autonomy of undocumented migrants, and establish trust with them. These findings not only offer practical guidance for healthcare providers to enhance accessibility to healthcare services for undocumented migrant patients but also foster awareness of the ethical challenges that may arise in their advocacy roles.

Knowledge, attitude, and practice of healthcare professionals towards irritable bowel syndrome: a multicenter, cross-sectional study

Irritable bowel syndrome (IBS) is a disorder of the gut brain interaction (DGBI) characterized by abdominal pain and altered bowel habits, affecting approximately 10% of adult populations worldwide. Comprehending the knowledge and attitudes of healthcare professionals towards IBS may enhance patient care, leading to more accurate diagnoses and improved treatment, ultimately elevating the quality of life for IBS patients. This multicenter, cross-sectional study was conducted among healthcare professionals from 5 hospitals between June and August, 2023, utilizing a self-administered questionnaire. A total of 697 (92.1%) valid questionnaires were enrolled, with 499 (71.59%) females, and 358 (51.36%) being physicians. Their mean knowledge, attitudes, practices scores were 10.9 ± 9.57 (possible range: 0-30), 29.33 ± 3.39 (possible range: 7-35), and 35.67 ± 8.75 (possible range: 11-55), respectively. The structural equation modeling analysis demonstrated direct influence of knowledge on attitude (β = 0.195, P < 0.001) and practice (β = 0.410, P < 0.001). Additionally, attitudes were found to have a direct influence on practice (β = 0.607, P < 0.001). In addition, their KAP score varied with different gender, education, occupation, professional title, department, with families have IBS, years of work experience, and institution type (all P < 0.05). Healthcare professionals had inadequate knowledge, positive attitude and suboptimal practice towards IBS, which might be influenced by their sociodemographic characteristics.

Self-efficacy in nurse entrepreneurs: A concept analysis

BACKGROUND

Nursing entrepreneurship represents an important opportunity for the nursing profession to address population health challenges and improve health care access. Although nurse entrepreneurs can be agents of change, the role of self-efficacy, as a determinant of nurses' success in business, is under-studied conceptually and in research.

PURPOSE

This paper presents an in-depth concept analysis and model of self-efficacy within the context of the nurse entrepreneur role.

METHODS

We used Walker and Avant's concept analysis methodology.

DISCUSSION

A systematic understanding of self-efficacy in nurse entrepreneurs provides insights into how it may influence their judgments and actions. Our analysis sets the stage for research on how self-efficacy in nurse entrepreneurs impacts success in the nursing business.

CONCLUSION

A conceptual model of self-efficacy in nurse entrepreneurs can guide their development through education and networking activities that incorporate experiential components to improve leadership and managerial skills for success in the health care business.

Latent profiles of ethical climate and nurses' service behavior

BACKGROUND

Hospital ethical climate has important implications for clinical nurses' service behavior; however, the relationships are complicated by the fact that five types of ethical climate (caring, law and code, rules, instrumental, and independence) can be combined differently according to their level and shape differences. Recent developments in person-centered methods (e.g., latent profile analysis (LPA)) have helped to address these complexities.

AIM

From a person-centered perspective, this study explored the distinct profiles of hospital ethical climate and then examined the relationships of the profiles with clinical nurses' service behavior (both in-role and extra-role service behavior).

RESEARCH DESIGN

A quantitative study was conducted using cluster random sampling. Latent profile analysis and binary coded hexadecimal (BCH) analysis were conducted using Mplus 8.2.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 871 clinical nurses in China were surveyed using the Ethical Climate Scale and Nurses' Service Behavior Questionnaire.

ETHICAL CONSIDERATIONS

Ethical approval was obtained from the IRB of the First Affiliated Hospital of Jinan University (No. KY-2020-090).

RESULTS

A four-profile hospital ethical climate model provided the best fit for the data. The four different profiles not only varied in level, but also in shape: high normative and low egoism (45.8%), high ethical climate (19.9%), low ethical climate (3.6%), and moderate ethical climate (30.8%). These profiles differentially predicted clinical nurses' overall, in-role, and extra-role service behaviors.

CONCLUSIONS

The results reveal new insights into the nature of hospital ethical climate and how different clinical nurses in these profiles can be best managed to accomplish different forms of service behavior.

The influence of achievement motivation on college students’ employability: A chain mediation analysis of self-efficacy and academic performance

Employability of college students has been attached great importance by higher education institutions, employers, and governments because college graduates are the strategic human resource for the sustainable growth of universities, organizations, and countries across the world. It is also receiving growing attention from academic community. This study aimed to examine the psychological mechanism that impacts college students’ employability. It adopted an empirical approach by collecting data from 646 final-year students from 9 universities in the mainland of China. SPSS 25.0 was used for description, correlation, and regression analysis. AMOS 24.0 was utilized for path analysis. Model 6 Bootstrap method of PROCESS Version 3.5 was adopted for mediation analysis. The results showed that achievement motivation positively predicted self-efficacy, academic performance, and employability among undergraduates. Participants’ self-efficacy did not significantly impact their employability or play a mediating role in the relationship between achievement motivation and employability, while academic performance was a significant mediator of this association. Self-efficacy and academic performance served as chain mediators in the prediction of achievement motivation on college students’ employability. After controlling gender and family residence, achievement motivation still had significant and positive impact on employability of college students. This research made several noteworthy contributions to the existing studies on college students’ employability and provided insight for practitioners in strengthening their employability through these psychological constructs.

Mediating Role of Psychological Capital in the Relationship Between Social Support and Self-Neglect Among Chinese Community-Dwelling Older Adults

Objectives

Self-neglect in older adults has become an important public health issue and is associated with negative health outcomes and increased morbidity and mortality. Social support has been recognized as a prominent predictor of self-neglect, but the underlying mechanism is unclear. This study aims to investigate and illustrate the associations among social support, psychological capital, and self-neglect.

Methods

This study used a cross-sectional convenience sampling design. A total of 511 older adults were recruited in Chinese communities. Spearman’s correlation coefficient and hierarchical multiple regression analysis were performed to assess the influencing factors of self-neglect. A structural equation model was applied to test the hypothesized mediation model.

Results

Social support and psychological capital were found to be negatively related to self-neglect. Social support and psychological capital explained 5.1 and 11.9% of the incremental variances of older adults’ self-neglect, respectively. Psychological capital acts as a mediator between social support and self-neglect.

Conclusion

Self-neglect among older adults is a rising problem in China. Social support and higher psychological capital could decrease the risk of self-neglect in older adults. It is crucial to improve social networks and facilitate psychological interventions to reduce such self-neglect.