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Castellon-Lopez Y, Carson SL, Ward KT, Ramirez KD, Vo LP, Kuo T, Seeman T, Vassar SD, Trejo L, Eidem E, Aranda MP, Brown AF. Understanding the implementation and sustainability needs of evidence-based programs for racial and ethnic minoritized older adults in under-resourced communities with limited aging services. BMC Health Serv Res 2024; 24:466. [PMID: 38614988 PMCID: PMC11015605 DOI: 10.1186/s12913-024-10925-0] [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: 07/24/2023] [Accepted: 03/28/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Evidence-based programs (EBPs) for older adults effectively improve health outcomes. However, there is a limited understanding of the unique needs of service providers as they consider adopting, implementing, and maintaining programs for older minority adults in low-income communities with limited aging services. METHODS We conducted semi-structured interviews with key informants of community-based organizations (CBOs) to understand implementation and sustainability needs of CBOs within four racial and ethnically diverse Los Angeles County geographic areas. We performed thematic analysis of interview transcripts. RESULTS Interviews were conducted with representatives from 25 senior-serving agencies providing aging-related EBPs. CBO representatives reported implementing EBPs in 8 domains: Falls Prevention (68%), Mental Health (64%), Caregiver Health (48%), Chronic Disease Management (48%), Diabetes Management (36%), Arthritis Management (28%), Physical Activity (24%), and Multiple Conditions Management (8%). Themes are presented using the six domains of the Bass and Judge framework for factors impacting successful and sustained EBP implementation. CBOs in low-income and diverse communities described unique challenges with tailoring interventions based on local community context (literacy, language), cultural context, and locally available resources (technology, safe community spaces, transportation) and faced resource-intensive administrative burdens through staff turnover, data collection, sustainable funding, and networking. CONCLUSIONS Serving racial and ethnic communities has unique challenges that require tailored approaches and additional resources to ensure equitable access to EBPs for all communities. We describe suggestions for enhancing the effective adoption of EBPs among service agencies in under-resourced and diverse aging communities serving populations with aging-related health disparities.
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Affiliation(s)
- Yelba Castellon-Lopez
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA.
| | - Savanna L Carson
- Department of Medicine, Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Katherine T Ward
- Department of Medicine, Section of Geriatrics, LAC/Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Karina D Ramirez
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Lynn Phan Vo
- Department of Medicine, Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Tony Kuo
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Teresa Seeman
- Department of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Stefanie D Vassar
- Department of Medicine, Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Laura Trejo
- Los Angeles County Aging and Disabilities Department, Los Angeles, CA, USA
| | - Ellen Eidem
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - María P Aranda
- USC Edward R. Roybal Institute on Aging, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - Arleen F Brown
- Department of Medicine, Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Faussat C, Bonnin A, Hilt D, Rivière-Da Silva F, Baissin C, Michels D, Gras G, Leclerc C, Aumond C, Grammatico-Guillon L. Advantages and limits of remote consultations for HIV pre-exposure prophylaxis health pathway: ePrEP qualitative study. J Epidemiol Popul Health 2024; 72:202201. [PMID: 38523400 DOI: 10.1016/j.jeph.2024.202201] [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: 07/28/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Because of a high rate of HIV diagnosis and restricted medical access in the Centre-Val de Loire region in France , remote consultations (RC) with a community-based approach has been implemented to promote access to healthcare. Our study aimed to determine whether RC could improve access to pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) as part of the healthcare pathway associated with PrEP. MATERIALS AND METHODS A qualitative approach involving semi-structured interviews with 17 MSM and 3 physicians from specialized sexual health centres was performed, with a mean duration of interview over one hour. The research focused on the health pathway associated with PrEP, from initial awareness to ongoing prescription and follow-up. RESULTS Transitioning PrEP consultations to RC is feasible, but concerns about a potential decline in care quality compared to traditional sexual health centres follow-ups were noted. Both MSM and physicians recognized that RC could complement face-to-face approaches, especially in terms of organizational benefits. In rural areas, access to specialists through RC was seen as a partial solution, though it could be hindered by barriers in accessing laboratory testing and pharmacy services, like fear of stigmatization. More generally, distrust of medication and the difficulty of discussing sexuality with a GP were highlighted, which could limit the uptake of PrEP without access to specialists. CONCLUSIONS The initiation and uptake of PrEP among MSM are more effectively influenced by initiatives that provide information, reassurance, and facilitate initial procedures, rather than solely through RC. A strategy combining digital and community-based approaches, along with medical expertise, is recommended to increase PrEP utilization among MSM.
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Affiliation(s)
- Cathie Faussat
- Inserm Team Research U1259 MAVIVH - Morphogenèse et Antigénicitédu VIH et des Virus des Hépatites, Faculty of Medicine of Tours, Tours, France; Prevention and Public Health Department - Regional University Hospital Centre (CHRU) of Tours, Tours, France.
| | - Alicia Bonnin
- EA 7505 - EES - Education-Ethics-Health Research Team, Faculty of Medicine of Tours, Tours, France.
| | - Daniel Hilt
- AIDES Association, French non-governmental organization, Orléans & Pantin, France.
| | | | - Christine Baissin
- AIDES Association, French non-governmental organization, Orléans & Pantin, France.
| | - David Michels
- AIDES Association, French non-governmental organization, Orléans & Pantin, France; Community Research Laboratory, Coalition Plus, Pantin, France.
| | - Guillaume Gras
- Prevention and Public Health Department - Regional University Hospital Centre (CHRU) of Tours, Tours, France.
| | - Céline Leclerc
- Centre-Val de Loire Regional Health Observatory, Orléans, France.
| | - Catherine Aumond
- AIDES Association, French non-governmental organization, Orléans & Pantin, France.
| | - Leslie Grammatico-Guillon
- Inserm Team Research U1259 MAVIVH - Morphogenèse et Antigénicitédu VIH et des Virus des Hépatites, Faculty of Medicine of Tours, Tours, France; Prevention and Public Health Department - Regional University Hospital Centre (CHRU) of Tours, Tours, France.
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Khan M, Cassidy E, Parkin T, Wallace A, Carter B, Paton J, Donohue K, Mitchell S, Quin G, McNarry N, Hartley H, Bailey H, Whitehouse W, Medd R, Zahidi A, McMullan M, Bunn L. The Care and Management of Children and Young People with Ataxia Telangiectasia Provided by Nurses and Allied Health Professionals: a Scoping Review. Cerebellum 2024; 23:722-756. [PMID: 37119406 PMCID: PMC10148630 DOI: 10.1007/s12311-023-01555-z] [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] [Accepted: 03/25/2023] [Indexed: 05/01/2023]
Abstract
Ataxia telangiectasia (A-T) is a rare, multisystem progressive condition that typically presents in early childhood. In the absence of cure, people with A-T require coordinated multidisciplinary care to manage their complex array of needs and to minimize the disease burden. Although symptom management has proven benefits for this population, including improved quality of life and reduced complications, there is a need for guidance specific to the nursing and allied healthcare teams who provide care within the community. A scoping review, adopting the Joanna Briggs Institute methodology, was undertaken. It aimed to identify and map the available expertise from nursing and allied healthcare and management of children and young people with A-T ≤ 18 years of age. A rigorous search strategy was employed which generated a total of 21,118 sources of evidence, of which 50 were selected for review following screening by experts. A range of interventions were identified that reported a positive impact on A-T-related impairments, together with quality of life, indicating that outcomes can be improved for this population. Most notable interventions specific to A-T include therapeutic exercise, inspiratory muscle training, and early nutritional assessment and intervention. Further research will be required to determine the full potential of the identified interventions, including translatability to the A-T setting for evidence related to other forms of ataxia. Large gaps exist in the nursing and allied health evidence-base, highlighting a need for robust research that includes children and young people with A-T and their families to better inform and optimize management strategies.
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Affiliation(s)
- Munira Khan
- Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Tracey Parkin
- Faculty of Health, University of Plymouth, Plymouth, UK
| | | | | | - Joanne Paton
- Faculty of Health, University of Plymouth, Plymouth, UK
| | | | | | - Gemma Quin
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Nicola McNarry
- National Paediatric Ataxia Telangiectasia Clinic, Nottingham Children's Hospital, Nottingham, UK
| | - Helen Hartley
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - William Whitehouse
- National Paediatric Ataxia Telangiectasia Clinic, Nottingham Children's Hospital, Nottingham, UK
| | | | - Asma Zahidi
- Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Lisa Bunn
- Faculty of Health, University of Plymouth, Plymouth, UK.
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Gu J, Wang Q, Qiu W, Wu C, Qiu X. Chronic diseases and determinants of community health services utilization among adult residents in southern China: a community-based cross-sectional study. BMC Public Health 2024; 24:919. [PMID: 38549080 PMCID: PMC10979594 DOI: 10.1186/s12889-024-18435-8] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/26/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND The burden of chronic diseases has become a major public health concern, and high-efficiency use of community health services is essential in combating chronic diseases. This study described the status of chronic diseases in southern China and explored the determinants of health service utilization among adult residents. METHODS Data were obtained from one part of community survey data from four counties in Ganzhou City, southern China. A multistage, stratified random sampling method was used to conduct a cross-sectional survey between 2018 and 2020. Overall, 7430 valid questionnaires were collected. A lasso-linear regression analysis was performed to explore the determinants of community health service utilization. RESULTS According to the study, most participants (44.6%) reported having relatively good health, while 42.1% reported having moderate health. Chronic diseases were reported by 66.9% of the respondents. The three most prevalent self-reported chronic diseases were hypertension (22.6%), hyperlipidemia (5.9%), and diabetes (5.9%). Among residents with chronic diseases, 72.1% had one chronic disease, while the rest had multiple. Only 13.9% of residents frequently utilized community health services, while 18.9% never used them. Additionally, among residents who reported having chronic diseases, 14.1% had never attended community health services. Four categories of factors were the key determinants of community health service utilization: (1) personal characteristics, age, and sex; (2) health-related factors, such as family history, self-reported health conditions, and the number of chronic diseases; (3) community health service characteristics, such as satisfaction with and accessibility to community health services; and (4) knowledge of chronic diseases. Specifically, women tend to utilize healthcare services more frequently than men. Additionally, residents who are advanced in age, have a family history of chronic diseases, suffer from multiple chronic conditions, rate their self-reported health condition as poor, have a better knowledge about chronic diseases, have better accessibility to community health services, and have higher the satisfaction with community health services, tend to utilize them more frequently. CONCLUSIONS Given the limited healthcare resources, the government should promote the effective utilization of community health facilities as a critical community-based strategy to combat the growing threat of chronic diseases in southern China. The priority measures involve enhancing residents' access to and satisfaction with community health services and raising awareness of chronic illnesses among older individuals with poor health status.
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Affiliation(s)
- Junwang Gu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, 530021, Nanning, Guangxi, China.
- School of Public Health and Health Management, Gannan Medical University, 341000, Ganzhou, Jiangxi, China.
| | - Qi Wang
- School of Public Health and Health Management, Gannan Medical University, 341000, Ganzhou, Jiangxi, China
| | - Wei Qiu
- School of Public Health and Health Management, Gannan Medical University, 341000, Ganzhou, Jiangxi, China
| | - Chunmei Wu
- School of Public Health and Health Management, Gannan Medical University, 341000, Ganzhou, Jiangxi, China
| | - Xiaoqiang Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, 530021, Nanning, Guangxi, China.
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Nida S, Tyas ASA, Putri NE, Larasanti A, Widoyopi AA, Sumayyah R, Listiana S, Espressivo A. A systematic review of the types, workload, and supervision mechanism of community health workers: lessons learned for Indonesia. BMC Prim Care 2024; 25:82. [PMID: 38468218 PMCID: PMC10926673 DOI: 10.1186/s12875-024-02319-2] [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: 12/02/2023] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Community health workers (CHWs) have demonstrated capability to improve various health indicators, however, many programmes require support in meeting their objectives due to subpar performance and a high rate of CHW attrition. This systematic review investigated the types of CHWs, their workloads, and supervision practices that contribute to their performance in different countries. METHODS The search was carried out in November 2022 in Medline, Embase, and Neliti for studies published in Indonesian or English between 1986 and 2022 that reported public health services delivered by CHWs who live and serve the community where they live but are not considered health professionals. The findings were synthesised using a thematic analysis to assess key factors influencing the performance of CHWs. RESULTS Sixty eligible articles were included in this review. CHWs were responsible for more than two diseases (n = 35) and up to fifteen, with more than eighteen activities. Their roles covered the human life cycle, from preparation for pregnancy, care for newborns, health for children, adolescents, and productive age to elderly individuals. They were also involved in improving environmental health, community empowerment, and other social issues hindering access to health services. They carried out promotive, preventive, and curative interventions. The CHW-population ratio varied from eight to tens of thousands of people. Some CHWs did not have a clear supervision system. Challenges that were often faced by CHWs included inappropriate incentives, inadequate facilities, insufficient mentoring, and supervision, many roles, and a broad catchment area. Many studies revealed that CHWs felt overburdened and stressed. They needed help to balance their significant work and domestic tasks. CONCLUSIONS Effective planning that considered the scope of work of CHWs in proportion to their responsibilities and the provision of necessary facilities were crucial factors in improving the performance of CHWs. Supportive supervision and peer-supervision methods are promising, however, any CHW supervision required a detailed protocol. This systematic review emphasised the opportunity for CHW management system improvement in Indonesia.
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Affiliation(s)
- Sofwatun Nida
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia.
| | - Agatha Swasti Ayuning Tyas
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Nidya Eka Putri
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Ayudina Larasanti
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Aldhea Ayu Widoyopi
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Rima Sumayyah
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Saetia Listiana
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Aufia Espressivo
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
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Lee TA, Bishop J, Drover A, Midodzi WK, Twells LK. A cross-sectional study of breastfed infants referred for tongue tie assessment and frenotomy in one Canadian health region. Pediatr Investig 2024; 8:53-60. [PMID: 38516135 PMCID: PMC10951488 DOI: 10.1002/ped4.12416] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/31/2023] [Indexed: 03/23/2024] Open
Abstract
Importance Tongue tie (TT) is a condition that can cause infant feeding difficulties due to restricted tongue movement. When TT presents as a significant barrier to breastfeeding, a frenotomy may be recommended. Universally accepted diagnostic criteria for TT are lacking and wide prevalence estimates are reported. New referral processes and a Frenotomy Assessment Tool were implemented in one Canadian health region to connect breastfeeding dyads with a provider for TT evaluation and frenotomy. Objective To determine the proportion of babies with TT as well as the frequency of frenotomy. Methods This cross-sectional study included infants who initiated breastfeeding at birth and were referred for TT evaluation over a 14-month period. Data were collected retrospectively by chart review and analyzed using SPSS. Factors associated with frenotomy were examined using logistic regression. Results Two hundred and forty-one babies were referred. Ninety-two percent (n = 222) were diagnosed with TT and 66.0% (n = 159) underwent frenotomy. In the multivariate model, nipple pain/trauma, inability to latch, inability to elevate tongue, and dimpling of tongue on extension were associated with frenotomy (P < 0.05). Most referrals in our region resulted in a diagnosis of TT; however, the number of referrals was lower than expected, and of these two-thirds underwent frenotomy. Interpretation TT is a relatively common finding among breastfed infants. Future research should examine whether a simplified assessment tool containing the four items associated with frenotomy in our multivariate model can identify breastfed infants with TT who require frenotomy.
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Affiliation(s)
- Tiffany A. Lee
- School of PharmacyMemorial University of Newfoundland (MUN)St. John'sCanada
| | - Jessica Bishop
- Faculty of MedicineMemorial University of Newfoundland (MUN)St. John'sCanada
| | - Anne Drover
- Faculty of MedicineMemorial University of Newfoundland (MUN)St. John'sCanada
| | - William K. Midodzi
- Faculty of MedicineMemorial University of Newfoundland (MUN)St. John'sCanada
| | - Laurie K. Twells
- Faculty of MedicineMemorial University of Newfoundland (MUN)St. John'sCanada
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Cross-Sudworth F, Taylor B, Kenyon S. Community postnatal care delivery in England since Covid-19: A qualitative study of midwifery leaders' perspectives and strategies. Women Birth 2024; 37:240-247. [PMID: 37903683 DOI: 10.1016/j.wombi.2023.10.006] [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: 06/22/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/01/2023]
Abstract
PROBLEM COVID-19 impacted negatively on maternity care experiences of women and staff. Understanding the emergency response is key to inform future plans. BACKGROUND Before the COVID-19 pandemic, experts highlighted concerns about UK community postnatal care, and its impact on long-term health, wellbeing, and inequalities. These appear to have been exacerbated by the pandemic. AIM To explore community postnatal care provision during and since the pandemic across a large diverse UK region. METHODS A descriptive qualitative approach. Virtual semi-structured interviews conducted November 2022-February 2023. All regional midwifery community postnatal care leaders were invited to participate. FINDINGS 11/13 midwifery leaders participated. Three main themes were identified: Changes to postnatal care (strategic response, care on the ground); Impact of postnatal care changes (staff and women's experiences); and Drivers of postnatal care changes (COVID-19, workforce issues). DISCUSSION Changes to postnatal care during the pandemic included introduction of virtual care, increased role of Maternity Support Workers, and moving away from home visits to clinic appointments. This has largely continued without evaluation. The number of care episodes provided for low and high-risk families appears to have changed little. Those requiring additional support but not deemed highest risk appear to have been most impacted. Staffing levels influenced amount and type of care provided. There was little inter-organisation collaboration in the postnatal pandemic response. CONCLUSION Changes to postnatal care provision introduced more efficient working practices. However, evaluation is needed to ensure ongoing safe, equitable and individualised care provision post pandemic within limited resources.
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Affiliation(s)
- Fiona Cross-Sudworth
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Beck Taylor
- Warwick Medical School, University of Warwick, University Road, Coventry CV4 7AL, UK
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Karuga R, Khan S, Kok M, Moraa M, Mbindyo P, Broerse J, Dieleman M. Teamwork in community health committees: a case study in two urban informal settlements. BMC Health Serv Res 2023; 23:1373. [PMID: 38062432 PMCID: PMC10702094 DOI: 10.1186/s12913-023-10370-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Community health committees (CHCs) are mechanisms for community participation in decision-making and overseeing health services in several low-and middle-income countries (LMICs). There is little research that examines teamwork and internal team relationships between members of these committees in LMICs. We aimed to assess teamwork and factors that affected teamwork of CHCs in an urban slum setting in Nairobi, Kenya. METHODS Using a qualitative case-study design, we explored teamwork of two CHCs based in two urban informal settlements in Nairobi. We used semi-structured interviews (n = 16) to explore the factors that influenced teamwork and triangulated responses using three group discussions (n = 14). We assessed the interpersonal and contextual factors that influenced teamwork using a framework for assessing teamwork of teams involved in delivering community health services. RESULTS Committee members perceived the relationships with each other as trusting and respectful. They had regular interaction with each other as friends, neighbors and lay health workers. CHC members looked to the Community Health Assistants (CHAs) as their supervisor and "boss", despite CHAs being CHC members themselves. The lay-community members in both CHCs expressed different goals for the committee. Some viewed the committee as informal savings group and community-based organization, while others viewed the committee as a structure for supervising Community Health Promoters (CHPs). Some members doubled up as both CHPs and CHC members. Complaints of favoritism arose from CHC members who were not CHPs whenever CHC members who were CHPs received stipends after being assigned health promotion tasks in the community. Underlying factors such as influence by elites, power imbalances and capacity strengthening had an influence on teamwork in CHCs. CONCLUSION In the absence of direction and support from the health system, CHCs morph into groups that prioritize the interests of the members. This redirects the teamwork that would have benefited community health services to other common interests of the team. Teamwork can be harnessed by strengthening the capacity of CHC members, CHAs, and health managers in team building and incorporating content on teamwork in the curriculum for training CHCs.
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Affiliation(s)
- Robinson Karuga
- LVCT Health, P.O. Box 19835, Nairobi, 00202, Kenya.
- Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, The Netherlands.
| | - Sitara Khan
- Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, The Netherlands
| | - Maryse Kok
- KIT Royal Tropical Institute, Mauritskade 64, 1092 AD, Amsterdam, Netherlands
| | - Malkia Moraa
- Directorate of Preventive and Promotive Health, Nairobi City County, City Hall Way, P.O Box 30075-00100, Nairobi, Kenya
| | - Patrick Mbindyo
- Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62 000, Nairobi, 00200, Kenya
| | - Jacqueline Broerse
- Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, The Netherlands
| | - Marjolein Dieleman
- KIT Royal Tropical Institute, Mauritskade 64, 1092 AD, Amsterdam, Netherlands
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Cassetti V, López-Ruiz MV, Gallego-Royo A, Egea-Ronda A, Gea-Caballero V, Aviñó Juan Ulpiano D, Baraza Cano MP, Romero Rodríguez E. [Attend, consult, involve: do we need to redefine the concept of community engagement?]. Gac Sanit 2023; 37:102344. [PMID: 38039621 DOI: 10.1016/j.gaceta.2023.102344] [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: 07/01/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To describe how a sample of people working in community health promotion projects perceive and implement community engagement approaches. METHOD Mixed qualitative-quantitative study. Data was collected through: semi-structured interviews with 10 people representing the projects, and workshops in which 53 people participated and responded to a questionnaire prepared ad hoc to identify levels of community engagement. Descriptive statistical analysis of the questionnaires and framework analysis of the interviews, observations and workshops recordings. RESULTS Although the projects are described as highly participatory, community engagement appeared mainly in the form of attending events, with few examples of consultation or community involvement. CONCLUSIONS This difference may be due to the lack of a culture of participation, both in individuals and institutions, and lack of training in community engagement. It is proposed to change the language from participation-attendance to using expressions such as consulting or involving people.
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Affiliation(s)
| | - María Victoria López-Ruiz
- Unidad de Gestión Clínica Palma del Río, Distrito Córdoba Guadalquivir, Servicio Andaluz de Salud, Palma del Río (Córdoba), España; Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España
| | - Alba Gallego-Royo
- Servicio de Medicina Preventiva, Hospital Miguel Servet, Servicio Aragonés de Salud, Zaragoza, España; Grupo de Investigación en Atención Primaria Aragón (GIIS011), IIS Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Ana Egea-Ronda
- Departamento de Salud Valencia Arnau de Vilanova-Llíria, San Antonio de Benagéber (Valencia), España.
| | - Vicente Gea-Caballero
- Facultad de Ciencias de la Salud, Valencian International University, Valencia, España; Research Group Community Health and Care, Valencian International University, Valencia, España
| | - Dory Aviñó Juan Ulpiano
- Área de Desigualdades en Salud, Fundación para la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Salud Pública), Valencia, España
| | - María Pilar Baraza Cano
- Unidad de Gestión Clínica Vicar-La Mojonera, Distrito de Atención Primaria Poniente de Almería, Servicio Andaluz de Salud, Almería, España
| | - Esperanza Romero Rodríguez
- Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España; Distrito Sanitario de Atención Primaria de Córdoba, Servicio Andaluz de Salud, Córdoba, España
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Frank M, Loh R, Everhart R, Hurley H, Hanratty R. No health without access: using a retrospective cohort to model a care continuum for people released from prison at an urban, safety net health system. Health Justice 2023; 11:49. [PMID: 37979038 PMCID: PMC10656837 DOI: 10.1186/s40352-023-00248-3] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Release from prison is characterized by discontinuity of healthcare services and results in poor health outcomes, including an increase in mortality. Institutions capable of addressing this gap in care seldom collaborate in comprehensive, data-driven transition of care planning. This study harnesses information from a data exchange between correctional facilities and community-based healthcare agencies in Colorado to model a care continuum after release from prison. METHODS We merged records from Denver Health (DH), an urban safety-net healthcare system, and the Colorado Department of Corrections (CDOC), for people released from January 1 to June 30, 2021. The study population was either (a) released to the Denver metro area (Denver and its five neighboring counties), or (b) assigned to the DH Regional Accountable Entity, or (c) assigned to the DH medical home based on Colorado Department of Healthcare Policy and Financing attribution methods. Outcomes explored were outpatient, acute care, and inpatient utilization in the first 180 days after release. We used Pearson's chi-squared tests or Fisher exact for univariate comparisons and logistic regression for multivariable analysis. RESULTS The care continuum describes the healthcare utilization at DH by people released from CDOC. From January 1, 2021, to June 30, 2021, 3242 people were released from CDOC and 2848 were included in the data exchange. 905 individuals of the 2848 were released to the Denver metro area or attributed to DH. In the study population of 905, 78.1% had a chronic medical or psychological condition. Within 180 days of release, 31.1% utilized any health service, 24.5% utilized at least one outpatient service, and 17.1% utilized outpatient services two or more times. 10.1% utilized outpatient services within the first 30 days of release. CONCLUSIONS This care continuum highlights drop offs in accessing healthcare. It can be used by governmental, correctional, community-based, and healthcare agencies to design and evaluate interventions aimed at improving the health of a population at considerable risk for poor health outcomes and death.
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Affiliation(s)
- Michael Frank
- Denver Health and Hospital Authority, Denver, CO, USA.
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Ryan Loh
- Denver Health and Hospital Authority, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rachel Everhart
- Denver Health and Hospital Authority, Denver, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hermione Hurley
- Denver Health and Hospital Authority, Denver, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rebecca Hanratty
- Denver Health and Hospital Authority, Denver, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Cam H, Wennlöf B, Gillespie U, Franzon K, Nielsen EI, Ling M, Lindner KJ, Kempen TGH, Kälvemark Sporrong S. The complexities of communication at hospital discharge of older patients: a qualitative study of healthcare professionals' views. BMC Health Serv Res 2023; 23:1211. [PMID: 37932683 PMCID: PMC10626684 DOI: 10.1186/s12913-023-10192-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Hospital discharge of older patients is a high-risk situation in terms of patient safety. Due to the fragmentation of the healthcare system, communication and coordination between stakeholders are required at discharge. The aim of this study was to explore communication in general and medication information transfer in particular at hospital discharge of older patients from the perspective of healthcare professionals (HCPs) across different organisations within the healthcare system. METHODS We conducted a qualitative study using focus group and individual or group interviews with HCPs (physicians, nurses and pharmacists) across different healthcare organisations in Sweden. Data were collected from September to October 2021. A semi-structured interview guide including questions on current medication communication practices, possible improvements and feedback on suggestions for alternative processes was used. The data were analysed thematically, guided by the systematic text condensation method. RESULTS In total, four focus group and three semi-structured interviews were conducted with 23 HCPs. Three main themes were identified: 1) Support systems that help and hinder describes the use of support systems in the discharge process to compensate for the fragmentation of the healthcare system and the impact of these systems on HCPs' communication; 2) Communication between two separate worlds depicts the difficulties in communication experienced by HCPs in different healthcare organisations and how they cope with them; and 3) The large number of medically complex patients disrupts the communication reveals how the highly pressurised healthcare system impacts on HCPs' communication at hospital discharge. CONCLUSIONS Communication at hospital discharge is hindered by the fragmented, highly pressurised healthcare system. HCPs are at risk of moral distress when coping with communication difficulties. Improved communication methods at hospital discharge are needed for the benefit of both patients and HCPs.
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Affiliation(s)
- Henrik Cam
- Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden.
- Department of Pharmacy, Uppsala University, Uppsala, Sweden.
| | - Björn Wennlöf
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
- Närvården Viksäng-Irsta, Region Västmanland, Västerås, Sweden
| | - Ulrika Gillespie
- Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Kristin Franzon
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | - Mia Ling
- Department of Pharmacy, Region Västmanland, Västerås, Sweden
| | | | - Thomas Gerardus Hendrik Kempen
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Sofia Kälvemark Sporrong
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
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12
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Wang GM, Teng MY, Yu WJ, Ren H, Cui XS. Life-space mobility among community-dwelling older persons: A scoping review. Geriatr Nurs 2023; 54:108-117. [PMID: 37722235 DOI: 10.1016/j.gerinurse.2023.08.021] [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: 07/21/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/20/2023]
Abstract
To describe and analyze the current research status of life-space mobility of the older persons in community. The literature in PubMed, Web of Science, Cochrane Library, Embase, EBSCOhost, Scopus, OpenGrey, SinoMed, CNKI, WanFang, and VIP databases was computer searched, and the time frame was build to May 23, 2023. A total of 42 literatures were included, including 35 in English and 7 in Chinese, 30 of which were cross-sectional studies. Theoretical models related to spatial mobility included the "concentric circles" model and the "cone" model. 33 literatures reported the prevalence or level of spatial mobility limitations, and 9 assessment instruments were used, The influencing factors can be divided into four categories. 9 literatures reported on the adverse effects, and 9 literatures reported on the prevention and intervention. The limitation of life-space mobility is a common and under-recognized phenomenon among the older persons in the community,with serious adverse effects, complex and diverse influencing factors.
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Affiliation(s)
- Gui-Meng Wang
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China
| | - Meng-Yuan Teng
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China
| | - Wen-Jing Yu
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China
| | - Hui Ren
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China
| | - Xiang-Shu Cui
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China.
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13
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Lindberg MS, Brattmyr M, Lundqvist J, Roos E, Solem S, Hjemdal O, Havnen A. Sociodemographic factors and use of pain medication are associated with health-related quality of life: results from an adult community mental health service in Norway. Qual Life Res 2023; 32:3135-3145. [PMID: 37338784 PMCID: PMC10522514 DOI: 10.1007/s11136-023-03461-7] [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] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Health-related quality of life (HRQoL) is an important aspect of mental health outcomes. There are few studies on HRQoL in heterogeneous patient populations seeking help at community mental health services. The aims of the study were to compare how HRQoL, measured by the EuroQol five dimensions with five levels (EQ-5D-5L), was distributed compared to other samples from national and international studies, and to explore what factors are associated with HRQoL. METHODS In a cross-sectional study, 1379 Norwegian outpatients reported their HRQoL before starting treatment. Associations with demographic variables, job status, socio-economic status, and use of pain medication were examined using multiple regression analysis. RESULTS Most of the sample, 70% to 90%, reported problems with usual activities, pain/discomfort, and anxiety/depression; 30% to 65% reported that these problems were of a moderate to extreme degree. Forty percent reported problems with mobility, and about 20% reported problems with self-care. The sample's HRQoL was considerably lower than the general population, and comparable to patient-groups from specialist mental health services. Originating from a developing country, lower level of education, lower yearly household income, being on sick leave or unemployed, and using pain medication were associated with lower HRQoL. Age, gender, and relationship status were not associated with HRQoL. This is the first study to simultaneously examine the unique contribution of these variables in one study. CONCLUSION The most impacted domains of HRQoL were pain/discomfort, anxiety/depression, and usual activities. Lower HRQoL was associated with several socio-demographic factors and use of pain medication. These findings might have clinical implications and suggest that mental health professionals should routinely measure HRQoL in addition to symptom severity, to identify areas that should be targeted to improve HRQoL.
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Affiliation(s)
- Martin Schevik Lindberg
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway.
- Health and Welfare, Trondheim Municipality, Trondheim, Norway.
| | - Martin Brattmyr
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Jakob Lundqvist
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Eirik Roos
- Health and Welfare, Trondheim Municipality, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
- Nidaros Community Mental Health Centre, Division of Psychiatry, St. Olav's University Hospital, Trondheim, Norway
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14
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Pola-Garcia M, Carrera Noguero AM, Astier-Peña MP, Mira JJ, Guilabert-Mora M, Cassetti V, Melús-Palazón E, Gasch-Gallén A, Benedé Azagra CB. Social Prescribing Schemes in Primary Care in Spain (EvalRA Project): a mixed-method study protocol to build an evaluation model. BMC Prim Care 2023; 24:220. [PMID: 37880601 PMCID: PMC10598937 DOI: 10.1186/s12875-023-02164-9] [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] [Received: 08/25/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Social Prescribing is a Primary Health Care service that provides people with non-clinical care alternatives that may have an impact on their health. Social Prescribing can be more or less formal and structured. Social Prescribing Schemes are formal Social Prescribing of health assets by Primary Health Care teams in coordination and follow-up of patients with providers. The emerging evidence suggests that this service can improve people's health and well-being, create value and provide sustainability for the healthcare system. However, some evaluations note that the current evidence regarding social prescribing is insufficient and needs further investigation. The EvaLRA project aims to elaborate an evaluation model of Social Prescribing Schemes in Primary Health Care based on a set of structure, process, and outcomes indicators. METHODS In the region of Aragon, the Community Health Care Strategy aims to promote the development of social prescription schemes in Primary Health Care teams. This study is divided into two stages. Stage 1: identification of primary health care teams that implement social prescribing schemes and establish a first set of indicators to evaluate social prescribing using qualitative consensus techniques with experts. Stage 2 evaluation of the relevance, feasibility and sensitivity of selected indicators after 6 and 12 months in primary health care teams. The results will provide a set of indicators considering structure, process and outcomes for social prescribing schemes. DISCUSSION Current evaluations of the application of social prescribing schemes use different criteria and indicators. A set of agreed indicators and its piloting in primary health care teams will provide a tool to evaluate the implementation of social prescription schemes. In addition, the scorecard created could be of interest to other health systems in order to assess the service and improve its information system, deployment and safety.
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Affiliation(s)
- M Pola-Garcia
- Servicio Aragonés de Salud, Zaragoza, Spain.
- Grupo GIIS011, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain.
| | - A M Carrera Noguero
- Servicio Aragonés de Salud, Zaragoza, Spain
- Grupo GIIS011, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
- Programa Actividades Comunitarias en Atención Primaria (PACAP), Sociedad Española de Medicina Familiar y Comunitaria (SEMFYC), Barcelona, Spain
| | - M P Astier-Peña
- Servicio Aragonés de Salud, Zaragoza, Spain
- Grupo GIIS011, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
- Unidad Territorial de Calidad, Dirección Territorial del Camp de Tarragona, Institut Català De La Salut, Tarragona, Spain
- FEPS, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
- Wonca World Executive Board, Brussels, Belgium
- Grupo de trabajo de Seguridad del Paciente, Sociedad Española de Medicina Familiar y Comunitaria (SEMFYC), Barcelona, Spain
| | - J J Mira
- Departmento Psicología de la Salud, Universidad Miguel Hernandez, Alicante, Spain
- Grupo de Investigación Atenea, Fundación para la Investigación Biomédica de la Comunidad Valenciana (FISABIO), Alicante, Spain
- Calité Investigación, Universidad Miguel Hernandez, Alicante, Spain
- Departamento de Salud Alicante-San Juan de Alicante, Alicante, Spain
| | - M Guilabert-Mora
- Departmento Psicología de la Salud, Universidad Miguel Hernandez, Alicante, Spain
- Calité Investigación, Universidad Miguel Hernandez, Alicante, Spain
| | - V Cassetti
- Universidad Internacional de Valencia (VIU), Valencia, Spain
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
- Indepent research, Affiliated researcher to the Unesco Chair in Global Health and Education, London, UK
| | - E Melús-Palazón
- Servicio Aragonés de Salud, Zaragoza, Spain
- Grupo GIIS011, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
- Grupo Aragonés de Investigación en Atención Primaria B21_23R, Gobierno de Aragón, Zaragoza, Spain
- Departamento de Medicina, Psiquiatría y Dermatología, Universidad de Zaragoza, Zaragoza, Spain
| | - A Gasch-Gallén
- Grupo Aragonés de Investigación en Atención Primaria B21_23R, Gobierno de Aragón, Zaragoza, Spain
- Departamento de Fisiatria y Enfermería, Universidad de Zaragoza, Zaragoza, Spain
- Grupo GIIS094, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - C B Benedé Azagra
- Servicio Aragonés de Salud, Zaragoza, Spain
- Grupo GIIS011, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
- Programa Actividades Comunitarias en Atención Primaria (PACAP), Sociedad Española de Medicina Familiar y Comunitaria (SEMFYC), Barcelona, Spain
- Grupo Aragonés de Investigación en Atención Primaria B21_23R, Gobierno de Aragón, Zaragoza, Spain
- Estrategia de Atencion Comunitaria en el Sistema de Salud de Aragon Atencion Primaria. Servicio Aragones de Salud, Departamento de Sanidad, Gobierno de Aragon, Zaragoza, Spain
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15
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Soubolsky A, Halpape K, Jorgenson D, Remillard AJ, Necyk C. Between what is and what could be: a survey of pharmacists' practices, attitudes, and beliefs in the provision of mental health care. Int J Clin Pharm 2023; 45:1192-1202. [PMID: 37682399 DOI: 10.1007/s11096-023-01633-6] [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: 06/04/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Pharmacists can have an essential role in providing care for patients with mental illness. There are gaps in the understanding of the current extent of pharmacists' involvement in caring for patients with mental illness and their readiness to effectively provide this care. AIM To describe the current practices, attitudes, and beliefs of pharmacists in providing care to individuals with mental illness, and to assess factors that may impact these practices. METHOD An electronic questionnaire was emailed to pharmacists in Saskatchewan, Canada. Likert scale questions were utilized, and data were analyzed using descriptive statistics and content analysis for free-text responses. RESULTS The response rate was 9.1% (n = 146/1596). Fewer than 20% of respondents reported they were providing the clinical services listed to most or all patients with mental illness, except for providing basic medication education (61%). Almost all agreed it is a pharmacist's role to provide all the services (61-98% for different services) and many were motivated to provide them (47-91%). The factors most frequently selected as having the greatest impact on service provision were insufficient knowledge (27%, n = 34) and competing priorities (19%, n = 24). CONCLUSION Consistent with international trends, Saskatchewan pharmacists reported low provision of clinical services for individuals with mental illness, despite a readiness to provide these services. There is an opportunity and a need to better utilize pharmacists internationally in the provision of mental health care.
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Affiliation(s)
- Amy Soubolsky
- Information Support Pharmacist RxFiles, College of Pharmacy and Nutrition, University of Saskatchewan, and Clinical Pharmacist, Saskatchewan Health Authority, Saskatoon, Canada.
| | - Katelyn Halpape
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Derek Jorgenson
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Alfred J Remillard
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Candace Necyk
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
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Grossman S, Cannuscio CC, Feuerstein-Simon R, Winston M, Agosto DE, Epstein NE, Martinez-Donate AP, Klassen AC. Public Librarian Perceptions of Assisting Immigrant Patrons: Results from a Multi-State Survey. J Community Health 2023; 48:659-669. [PMID: 36920710 DOI: 10.1007/s10900-023-01204-w] [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] [Accepted: 02/18/2023] [Indexed: 03/16/2023]
Abstract
Public libraries in the United States (U.S.) are important sources of health information. Immigrants comprise a large portion of the U.S. population, and research suggests that public libraries help immigrants adjust to life in a new country. Public libraries help immigrants access information directly related to health and provide programs that have indirect impacts on health outcomes, including learning a new language and forging social ties. The purpose of this paper was to examine perspectives from librarians related to interactions with immigrant patrons and how their library supports them in this role. Public librarians (n = 205) from two selected U.S. states completed an online survey focusing on how comfortable they were in helping immigrants with inquiries related to health and the role of the public library in supporting librarians in this endeavor. Respondents generally reported high levels of comfort interacting with immigrants, although there was limited interaction on potentially sensitive topics (i.e., immigration, health). Library staff perceived that libraries overall were not effective in meeting the needs of immigrant populations and that librarians were infrequently offered professional training related to cultural competency and diversity. The findings echo previous studies that demonstrate the need for professional development to ensure that librarians are aware of library resources available to assist immigrant patrons. Findings from this study suggest opportunities for public health professionals and public librarians to collaborate to ensure the provision of reliable resources, health information, and referrals to community-based services.
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Affiliation(s)
- Suzanne Grossman
- James Madison University, 235 Martin Luther King Jr Way, MSC 4301, Harrisonburg, VA, 22807, USA.
| | | | | | | | - Denise E Agosto
- College of Computing & Informatics, Drexel University, Pennsylvania, USA
| | - Nancy E Epstein
- Department of Community Health and Prevention, Drexel University, Pennsylvania, USA
| | | | - Ann C Klassen
- Department of Community Health and Prevention, Drexel University, Pennsylvania, USA
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17
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Kafczyk T, Hämel K. Primary mental healthcare for older people in India: between stigmatization and community orientation. Discov Ment Health 2023; 3:14. [PMID: 37861873 PMCID: PMC10501019 DOI: 10.1007/s44192-023-00040-7] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/20/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Questions of equitable access to primary mental healthcare (PMHC) for older persons in India have been examined mostly in terms of the coverage of services, although perceptions of mental health and old age and social norms at the community level should be considered in the shaping of PMHC approaches. The present qualitative study, therefore, examined how social perceptions and norms of mental health in old age are and should be considered in the design and implementation of primary healthcare approaches in India. METHODS A secondary thematic analysis of semi-structured interviews with key stakeholders (n = 14) of PMHC in India was conducted. RESULTS Four key themes emerged from the analysis, in which social perceptions and norms were discussed: (1) family participation and low threshold access to mental healthcare, (2) the position of community health workers as an important pillar of old age and mental health-sensitive community-based care, (3) the role of social cohesion and traditional values in fostering a positive and supportive community environment for old age mental health, and (4) the empowerment of communities, families and older persons through mental health education. CONCLUSIONS PMHC, with its focus on mental health promotion, could be an important anchor for combatting negative attitudes about mental health and old age. The findings presented in this study can inform age-sensitive policies and programmes for mental health in India and could inform future research on the subject.
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Affiliation(s)
- Tom Kafczyk
- School of Public Health, Department of Health Services Research and Nursing Science, Bielefeld University, Universitaetsstrasse 25, 33651, Bielefeld, Germany.
| | - Kerstin Hämel
- School of Public Health, Department of Health Services Research and Nursing Science, Bielefeld University, Universitaetsstrasse 25, 33651, Bielefeld, Germany
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18
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Hoang TN, Nguyen TP, Pham MP, Nguyen HKL, H H, Buonya YD, Le TD, Angkurawaranon C. Assessment of availability, readiness, and challenges for scaling-up hypertension management services at primary healthcare facilities, Central Highland region, Vietnam, 2020. BMC Prim Care 2023; 24:138. [PMID: 37393245 PMCID: PMC10315019 DOI: 10.1186/s12875-023-02092-8] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 06/22/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION Vietnam aims for 95% of commune health stations (CHSs) to have functional hypertension management programs by 2025. However, limited resources may impede the Central Highland region health system from achieving this goal. We assessed the availability and readiness of hypertension management services at CHSs in the Central Highland region and identified challenges to facilitate evidence-based planning. METHODS We used a mixed-methods cross-sectional design to assess hypertension management services using WHO's service availability and readiness assessment (SARA) tools in all 579 CHSs in the region, combined with twenty in-depth interviews of hypertension program focal points at communal, district, and provincial levels in all four provinces. We descriptively analyzed quantitative data and thematically analyzed qualitative data. RESULTS Hypertension management services were available at 65% of CHSs, and the readiness of the services was 62%. The urban areas had higher availability and readiness indices in most domains (basic amenities, basic equipment, and essential medicines) compared to rural areas, except for staff and training. The qualitative results showed a lack of trained staff and ambiguity in national hypertension treatment guidelines, insufficient essential medicines supply mechanism, and low priority and funding limitations for the hypertension program. CONCLUSION The overall availability and readiness for hypertension diagnosis and management service at CHSs in the Central Highland region were low, reflecting inadequate capacity of the primary healthcare facilities. Some measures to strengthen hypertension programs in the region might include increased financial support, ensuring a sufficient supply of basic medicines, and providing more specific treatment guidelines.
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Affiliation(s)
| | - Thuy Phuong Nguyen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS Australia
| | - Mai Phuong Pham
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Hue Kim Le Nguyen
- Provincial Centers for Diseases Control of Dak Lak, Dak Lak, Vietnam
| | - Hieng H
- Provincial Centers for Diseases Control of Dak Nong, Dak Nong, Vietnam
| | - Y Dech Buonya
- Provincial Centers for Diseases Control of Kon Tum, Kon Tum, Vietnam
| | - Tram Dinh Le
- Provincial Centers for Diseases Control of Gia Lai, Gai Lai, Vietnam
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
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19
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Gong AK, Yun JH, Kim IS, Yuh MA, Woo SH, Kim J, Hong S. Factors Affecting Emergency Medical Utilization After Self-harm and Effectiveness of Community-Based Suicide Prevention Provisions in Preventing Self-harm: A Nationwide Registry-Based Study in Korea. Community Ment Health J 2023; 59:942-953. [PMID: 36547814 PMCID: PMC9772591 DOI: 10.1007/s10597-022-01077-8] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
In order to formulate and implement a community-based suicide prevention program, as well as evaluate the effectiveness of these programs, it is necessary to understand the epidemiological characteristics of self-harm. Clinical data were collected from the National Emergency Department Information System (NEDIS) data panel in Korea for patients seen after self-harm episodes. Socioeconomic factors were collected from Statistics Korea. Variables representing SP provisions (SPPs) were collected from the Korea Foundation for Suicide Prevention. Increasing the number of mental health providers resulted in lower annual emergency department visit rate after self-harm (VRSH) in the entire population, as well as in both the young and elderly populations. An increase in the mental health budget led to a significant reduction in VRSHs. However, the number of suicide prevention centers did not have any significant association with the VRSH. This study also provides substantial evidence that community-based SPPs are effective in preventing self-harm.
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Affiliation(s)
- Ae Kyung Gong
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Ji Hyun Yun
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - In Soo Kim
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Min Ah Yuh
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Seon Hee Woo
- Department of Emergency Medicine, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Jinwoo Kim
- Department of Emergency Medical Service, Daejeon Health Institute of Science, 21, Chungjeong-Ro, Dong-Gu, Daejeon, 34504, Republic of Korea
| | - Sungyoup Hong
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
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20
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Dintrans PV, Valenzuela P, Castillo C, Granizo Y, Maddaleno M. Bottom-up innovative responses to COVID-19 in Latin America and the Caribbean: addressing deprioritized populations. Rev Panam Salud Publica 2023; 47:e92. [PMID: 37324197 PMCID: PMC10261555 DOI: 10.26633/rpsp.2023.92] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/02/2023] [Indexed: 06/17/2023] Open
Abstract
Objective To identify and describe innovative initiatives implemented as a response to the interruption of health services during the COVID-19 pandemic in Latin America and the Caribbean (LAC). Methods This was a descriptive study that reviewed 34 initiatives implemented during the COVID-19 pandemic in LAC to address health services needs among deprioritized groups. The review of initiatives included four phases: a call for submissions of innovative initiatives from LAC countries; a selection of initiatives that had the ability to address health services gaps and that were innovative and effective; systematization and cataloging of the selected initiatives; and a content analysis of the information collected. Data were analyzed from September to October 2021. Results The 34 initiatives show important variations regarding the target populations, the stakeholders involved, level of implementation, strategies, scope, and relevance of the innovative initiative. There was also evidence of the emergence of a bottom-up set of actions in the absence of top-down actions. Conclusion The findings of this descriptive review of 34 initiatives implemented during the COVID-19 pandemic in LAC suggest that systematizing the strategies and lessons learned has the potential to expand learning for re-establishing and improving post-pandemic health services.
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Affiliation(s)
- Pablo Villalobos Dintrans
- Programa Centro Salud PúblicaFacultad de Ciencias MédicasUniversidad de SantiagoSantiagoChilePrograma Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Santiago, Chile.
| | - Paula Valenzuela
- Independent consultantSantiagoChileIndependent consultant, Santiago, Chile
| | - Claudio Castillo
- Programa Centro Salud PúblicaFacultad de Ciencias MédicasUniversidad de SantiagoSantiagoChilePrograma Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Santiago, Chile.
| | - Yamileth Granizo
- Independent consultantSantiagoChileIndependent consultant, Santiago, Chile
| | - Matilde Maddaleno
- Programa Centro Salud PúblicaFacultad de Ciencias MédicasUniversidad de SantiagoSantiagoChilePrograma Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Santiago, Chile.
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21
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Folven KI, Tangvik RJ, Nilsen RM, Beck AM, Hetlevik Ø, Biringer E. Nutritional risk, nutrition plan and risk of death in older health care service users with chronic diseases: A register-based cohort study. Clin Nutr ESPEN 2023; 55:440-446. [PMID: 37202082 DOI: 10.1016/j.clnesp.2023.04.021] [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: 09/22/2022] [Revised: 03/15/2023] [Accepted: 04/25/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND AIMS Nutritional risk in older health care service users is a well-known challenge. Nutritional risk screening and individualised nutrition plans are common strategies for preventing and treating malnutrition. The aim of the current study was to investigate whether nutritional risk is associated with an increased risk of death and whether a nutrition plan to those at nutritional risk could reduce this potential risk of death in community health care service users over 65 years of age. METHODS We conducted a register-based, prospective cohort study on older health care service users with chronic diseases. The study included persons ≥65 years of age receiving health care services from all municipalities in Norway from 2017 to 2018 (n = 45,656). Data on diagnoses, nutritional risk, nutrition plan and death were obtained from the Norwegian Registry for Primary Health Care (NRPHC) and the Norwegian Patient Registry (NPR). We used Cox regression models to estimate the associations of nutritional risk and use of a nutrition plan with the risk of death within three and six months. Analyses were performed within the following diagnostic strata: chronic obstructive pulmonary disease (COPD), dementia, type 2 diabetes, stroke, osteoporosis and heart failure. The analyses were adjusted for age, gender, living situation and comorbidity. RESULTS Of the 45,656 health care service users, 27,160 (60%) were at nutritional risk, and 4437 (10%) and 7262 (16%) died within three and six months, respectively. Among those at nutritional risk, 82% received a nutrition plan. Health care service users at nutritional risk had an increased risk of death compared to health care service users not at nutritional risk (13% vs 5% and 20% vs 10% at three and six months). Adjusted hazard ratios (HRs) for death within six months were 2.26 (95% confidence interval (CI): 1.95, 2.61) for health care service users with COPD, 2.15 (1.93, 2.41) for those with heart failure, 2.37 (1.99, 2.84) for those with osteoporosis, 2.07 (1.80, 2.38) for those with stroke, 2.65 (2.30, 3.06) for those with type 2 diabetes and 1.94 (1.74, 2.16) for those with dementia. The adjusted HRs were larger for death within three months than death within six months for all diagnoses. Nutrition plans were not associated with the risk of death for health care service users at nutritional risk with COPD, dementia or stroke. For health care service users at nutritional risk with type 2 diabetes, osteoporosis or heart failure, nutrition plans were associated with an increased risk of death within both three and six months (adjusted HR 1.56 (95% CI: 1.10, 2.21) and 1.45 (1.11, 1.88) for type 2 diabetes; 2.20 (1.38, 3.51) and 1.71 (1.25, 2.36) for osteoporosis and 1.37 (1.05, 1.78) and 1.39 (1.13, 1.72) for heart failure). CONCLUSIONS Nutritional risk was associated with the risk of earlier death in older health care service users with common chronic diseases in the community. Nutrition plans were associated with a higher risk of death in some groups in our study. This may be because we could not control sufficiently for disease severity, the indication for providing a nutrition plan or the degree of implementation of nutrition plans in community health care.
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Affiliation(s)
- Kristin I Folven
- Department of Research and Innovation, Helse Fonna Local Health Authority, P.O. Box 2170, NO-5504 Haugesund, Norway; Centre for Nutrition, Department of Clinical Medicine, University of Bergen, P.O. Box 7804, NO-5020 Bergen, Norway.
| | - Randi J Tangvik
- Centre for Nutrition, Department of Clinical Medicine, University of Bergen, P.O. Box 7804, NO-5020 Bergen, Norway; Mohn Nutrition Research Laboratory, University of Bergen, P.O. Box 7804, NO-5020 Bergen, Norway
| | - Roy M Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, NO-5020 Bergen, Norway
| | - Anne Marie Beck
- Unit for Dieticians and Nutrition Research, Herlev and Gentofte University Hospital, DK-2730 Herlev, Denmark
| | - Øystein Hetlevik
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, P.O. Box 7804, NO-5020 Bergen, Norway
| | - Eva Biringer
- Department of Research and Innovation, Helse Fonna Local Health Authority, P.O. Box 2170, NO-5504 Haugesund, Norway
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Holton S, Wynter K, Peeters A, Georgalas A, Yeomanson A, Rasmussen B. Psychological wellbeing of Australian community health service staff during the COVID-19 pandemic: a longitudinal cohort study. BMC Health Serv Res 2023; 23:405. [PMID: 37101142 DOI: 10.1186/s12913-023-09382-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 04/09/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Hospital clinical staff have reported poor psychosocial wellbeing during the COVID-19 pandemic. Little is known about community health service staff who undertake various roles including education, advocacy and clinical services, and work with a range of clients. Few studies have collected longitudinal data. The aim of this study was to assess the psychological wellbeing of community health service staff in Australia during the COVID-19 pandemic at two time points in 2021. METHODS A prospective cohort design with an anonymous cross-sectional online survey administered at two time points (March/April 2021; n = 681 and September/October 2021; n = 479). Staff (clinical and non-clinical roles) were recruited from eight community health services in Victoria, Australia. Psychological wellbeing was assessed using the Depression, Anxiety and Stress Scale (DASS-21) and resilience using the Brief Resilience Scale (BRS). General linear models were used to measure the effects of survey time point, professional role and geographic location on DASS-21 subscale scores, adjusting for selected sociodemographic and health characteristics. RESULTS There were no significant differences in respondent sociodemographic characteristics between the two surveys. Staff's mental health declined as the pandemic continued. Adjusting for dependent children, professional role, general health status, geographic location, COVID-19 contact status and country of birth; depression, anxiety and stress scores were significantly higher for respondents in the second survey than the first (all p < 0.001). Professional role and geographic location were not statistically significantly associated with scores on any of the DASS-21 subscales. Higher levels of depression, anxiety and stress were reported among respondents who were younger, and had less resilience or poorer general health. CONCLUSIONS The psychological wellbeing of community health staff was significantly worse at the time of the second survey than the first. The findings indicate that the COVID-19 pandemic has had an ongoing and cumulative negative impact on staff wellbeing. Staff would benefit from continued wellbeing support.
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Affiliation(s)
- Sara Holton
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia.
- The Centre for Quality and Patient Safety Research in the Institute of Health Transformation, Deakin University - Western Health Partnership, St Albans, VIC, 3021, Australia.
| | - Karen Wynter
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
- The Centre for Quality and Patient Safety Research in the Institute of Health Transformation, Deakin University - Western Health Partnership, St Albans, VIC, 3021, Australia
| | - Anna Peeters
- Institute of Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | | | - Ann Yeomanson
- Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Copenhagen, Denmark
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
- The Centre for Quality and Patient Safety Research in the Institute of Health Transformation, Deakin University - Western Health Partnership, St Albans, VIC, 3021, Australia
- Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Pacella R, Nation A, Mathews B, Scott JG, Higgins DJ, Haslam DM, Dunne MP, Finkelhor D, Meinck F, Erskine HE, Thomas HJ, Malacova E, Lawrence DM, Monks C. Child maltreatment and health service use: findings of the Australian Child Maltreatment Study. Med J Aust 2023; 218 Suppl 6:S40-S46. [PMID: 37004185 PMCID: PMC10952869 DOI: 10.5694/mja2.51892] [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: 08/23/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES To examine associations between child maltreatment and health service use, both overall, by type and by the number of types of maltreatment reported. DESIGN, SETTING Cross-sectional, retrospective survey using the Juvenile Victimization Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study); computer-assisted mobile telephone interviews using random digit dialling, Australia, 9 April - 11 October 2021. PARTICIPANTS Australians aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16-24 years and 1000 respondents each from the five age groups (25-34, 35-44, 45-54, 55-64, 65 years or more). MAIN OUTCOME MEASURES Self-reported health service use during the past twelve months: hospital admissions, length of stay, and reasons for admission; and numbers of consultations with health care professionals, overall and by type. Associations between maltreatment and health service use are reported as odds ratios adjusted for age group, gender, socio-economic status, financial hardship (childhood and current), and geographic remoteness. RESULTS A total of 8503 participants completed the survey. Respondents who had experienced child maltreatment were significantly more likely than those who had not to report a hospital admission during the preceding twelve months (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.16-1.66), particularly admission with a mental disorder (aOR, 2.4; 95% CI, 1.03-5.6). The likelihood of six or more visits to general practitioners (aOR, 2.37; 95% CI, 1.87-3.02) or of a consultation with a mental health nurse (aOR, 2.67; 95% CI, 1.75-4.06), psychologist (aOR, 2.40; 95% CI, 2.00-2.88), or psychiatrist (aOR, 3.02; 95% CI, 2.25-4.04) were each higher for people who reported maltreatment during childhood. People who reported three or more maltreatment types were generally most likely to report greater health service use. CONCLUSIONS Child maltreatment has a major impact on health service use. Early, targeted interventions are vital, not only for supporting children directly, but also for their longer term wellbeing and reducing their health system use throughout life.
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Affiliation(s)
- Rosana Pacella
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
| | - Alexandra Nation
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
| | - Ben Mathews
- Queensland University of TechnologyBrisbaneQLD
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUnited States of America
| | - James G Scott
- Child Health Research Centrethe University of QueenslandBrisbaneQLD
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | - Daryl J Higgins
- Institute of Child Protection Studies, Australian Catholic UniversityMelbourneVIC
| | - Divna M Haslam
- Queensland University of TechnologyBrisbaneQLD
- The University of QueenslandBrisbaneQLD
| | - Michael P Dunne
- Queensland University of TechnologyBrisbaneQLD
- Institute for Community Health ResearchHue UniversityHue CityVietnam
| | - David Finkelhor
- Crimes against Children Research CenterUniversity of New HampshireDurhamNHUnited States of America
| | - Franziska Meinck
- University of EdinburghEdinburghUnited Kingdom
- North‐West UniversityPotchefstroomSouth Africa
| | - Holly E Erskine
- The University of QueenslandBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | - Hannah J Thomas
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | - Eva Malacova
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | | | - Claire Monks
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
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Lee J, Jang SN, Kim CS. Patterns and determinants of health and social care service needs among community-dwelling older adults. Geriatr Nurs 2023; 51:69-75. [PMID: 36921395 DOI: 10.1016/j.gerinurse.2023.02.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
AIM Using Anderson's behavioral model, we examined the patterns and determinants associated with older adults' needs for community- and institution-based care services. METHODS Participants included 411 community-dwelling older adults from the 2020 National Survey of Older Koreans. Logistic regression analyses were performed to examine factors associated with service needs among older adults. RESULTS The need was greatest for movement support services. Enabling factors (marital status, co-residence with children, receipt of financial assistance for medical expenses, social participation, and satisfaction with healthcare facilities) were associated with service needs. Long-term care beneficiary status, activities of daily living limitations, depressive symptoms, hypertension, and vision impairment were also significant factors. CONCLUSIONS Older adults with physical disabilities, depressive symptoms, and limited resources for care require prioritization in support policies to promote aging in place. Both health and social care needs should be addressed in long-term care to enhance social participation among older adults.
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Affiliation(s)
- Jakyung Lee
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea.
| | - Soong-Nang Jang
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea; Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
| | - Cheong-Seok Kim
- Department of Sociology, Dongguk University-Seoul, Seoul, Republic of Korea
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25
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Beaudoin AJ, Gagnon M, Ouellette J, Foley V, Couture M, Camden C. [Description of a Pilot Project for Pediatric Occupational Therapy in Daycare and Community Settings]. Can J Occup Ther 2023; 90:34-43. [PMID: 36069023 DOI: 10.1177/00084174221121421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Occupational therapy interventions that promote and prevent children's health and well-being aim to reduce health inequalities and foster protective factors. The purpose of this study is to describe a pilot community-based occupational therapy project for preschoolers in partnership with community organizations and childcare services. Method. A participatory action research approach was implemented with support from an advisory committee. An occupational therapist provided community-based occupational therapy services in a tiered organization model over one year. Findings. Services were offered in three tiers: 7 awareness workshops for parents and caregivers (Tier 1), 57 visits and 27 consultations in 8 community agencies (Tier 2), and 23 individual follow-ups (Tier 3). Implications. There is an opportunity to implement with community agencies and daycare settings an occupational therapy service based on community-based rehabilitation for children under 5 years of age.
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26
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Schuler BR, Collins BN, Scheuermann TS, Baishya M, Kilby L, Lepore SJ. Translating pediatric primary care best practice guidelines for addressing tobacco in the WIC system. Transl Behav Med 2023; 13:57-63. [PMID: 36434752 PMCID: PMC9972351 DOI: 10.1093/tbm/ibac079] [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] [Indexed: 11/27/2022] Open
Abstract
Tobacco smoke exposure (TSE) adversely affects child health. Intervention research on reducing childhood TSE and uptake of evidence-based smoking cessation programs has had limited reach in high-risk communities. Intervening in clinics delivering the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could address overlapping public health priorities essential for healthy child development-nutrition and smoke-free environments. The Babies Living Safe and Smokefree (BLiSS) trial addresses existing gaps by implementing and evaluating a WIC in-clinic evidence-based training based on Ask, Advise, and Refer (AAR) guidelines. WIC nutrition staff (n = 67) completed surveys pre- and post-training as part of the larger BLiSS trial. Staff sociodemographic data, knowledge, and attitudes about maternal smoking and child TSE prevention, and AAR practices in clinic were collected using self-administered surveys. Pre-post outcomes were assessed using bivariate statistics and multiple regression models. Controlling for baseline AAR-related practices and other covariates, nutrition managers were more likely to engage in post-training AAR practices than nutrition assistants. Sociodemographics and smoking status were not related to post-training AAR. Lower perceived barriers and higher reported frequency of tobacco intervention practices at baseline were associated with higher engagement in post-test AAR practices. WIC-system interventions aimed at reducing child TSE and maternal tobacco smoking may be more effective if nutrition management-level staff are involved in assessment and by addressing barriers related to TSE among nutrition assistants. Findings suggest that WIC in-clinic training may help to increase self-efficacy for staff engagement in brief screening, intervention, and referral practices.
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Affiliation(s)
- Brittany R Schuler
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Taneisha S Scheuermann
- Department of Population Health, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mona Baishya
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Linda Kilby
- N.O.R.T.H., Inc—Philadelphia WIC Program, Philadelphia, PA, USA
| | - Stephen J Lepore
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
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Ridgeway JL, Gerdes EOW, Dodge A, Liedl CP, Juntunen MB, Sundt WJS, Glasgow A, Lampman MA, Fink AL, Severson SB, Lin G, Sampson RR, Peterson RP, Murley BM, Klassen AB, Luke A, Friedman PA, Buechler TE, Newman JS, McCoy RG. Community paramedic hospital reduction and mitigation program: study protocol for a randomized pragmatic clinical trial. Trials 2023; 24:122. [PMID: 36805692 PMCID: PMC9940335 DOI: 10.1186/s13063-022-07034-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/16/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND New patient-centered models of care are needed to individualize care and reduce high-cost care, including emergency department (ED) visits and hospitalizations for low- and intermediate-acuity conditions that could be managed outside the hospital setting. Community paramedics (CPs) have advanced training in low- and high-acuity care and are equipped to manage a wide range of health conditions, deliver patient education, and address social determinants of health in the home setting. The objective of this trial is to evaluate the effectiveness and implementation of the Care Anywhere with Community Paramedics (CACP) program with respect to shortening and preventing acute care utilization. METHODS This is a pragmatic, hybrid type 1, two-group, parallel-arm, 1:1 randomized clinical trial of CACP versus usual care that includes formative evaluation methods and assessment of implementation outcomes. It is being conducted in two sites in the US Midwest, which include small metropolitan areas and rural areas. Eligible patients are ≥ 18 years old; referred from an outpatient, ED, or hospital setting; clinically appropriate for ambulatory care with CP support; and residing within CP service areas of the referral sites. Aim 1 uses formative data collection with key clinical stakeholders and rapid qualitative analysis to identify potential facilitators/barriers to implementation and refine workflows in the 3-month period before trial enrollment commences (i.e., pre-implementation). Aim 2 uses mixed methods to evaluate CACP effectiveness, compared to usual care, by the number of days spent alive outside of the ED or hospital during the first 30 days following randomization (primary outcome), as well as self-reported quality of life and treatment burden, emergency medical services use, ED visits, hospitalizations, skilled nursing facility utilization, and adverse events (secondary outcomes). Implementation outcomes will be measured using the RE-AIM framework and include an assessment of perceived sustainability and metrics on equity in implementation. Aim 3 uses qualitative methods to understand patient, CP, and health care team perceptions of the intervention and recommendations for further refinement. In an effort to conduct a rigorous evaluation but also speed translation to practice, the planned duration of the trial is 15 months from the study launch to the end of enrollment. DISCUSSION This study will provide robust and timely evidence for the effectiveness of the CACP program, which may pave the way for large-scale implementation. Implementation outcomes will inform any needed refinements and best practices for scale-up and sustainability. TRIAL REGISTRATION ClinicalTrials.gov NCT05232799. Registered on 10 February 2022.
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Affiliation(s)
- Jennifer L. Ridgeway
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Erin O. Wissler Gerdes
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Andrew Dodge
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | | | | | - Wendy J. S. Sundt
- Research Services – Clinical Trials Office, Mayo Clinic, Rochester, MN USA
| | - Amy Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Michelle A. Lampman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Angela L. Fink
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | - Sara B. Severson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | - Richard R. Sampson
- Department of Family Medicine, Mayo Clinic Health System - Northland, Barron, WI USA
| | - Robert P. Peterson
- Division of Hospital Internal Medicine, Mayo Clinic Health System - Northland, Barron, WI USA
| | | | - Aaron B. Klassen
- Department of Emergency Medicine, Mayo Clinic Ambulance, Rochester, MN USA
| | - Anuradha Luke
- Department of Emergency Medicine, Mayo Clinic Ambulance, Rochester, MN USA
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | | | - James S. Newman
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Rozalina G. McCoy
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
- Mayo Clinic Ambulance, Rochester, MN USA
- Department of Medicine, Division of Community Internal Medicine, Geriatrics, and Palliative Care, Rochester, MN USA
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28
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Rousham EK, Nahar P, Uddin MR, Islam MA, Nizame FA, Khisa N, Akter SMS, Munim MS, Rahman M, Unicomb L. Gender and urban-rural influences on antibiotic purchasing and prescription use in retail drug shops: a one health study. BMC Public Health 2023; 23:229. [PMID: 36732727 PMCID: PMC9896778 DOI: 10.1186/s12889-023-15155-3] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/11/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Few studies have reported antibiotic purchases from retail drug shops in relation to gender in low and middle-income countries (LMICs). Using a One Health approach, we aimed to examine gender dimensions of antibiotic purchases for humans and animals and use of prescriptions in retail drug shops in Bangladesh. METHODS We conducted customer observations in 20 drug shops in one rural and one urban area. Customer gender, antibiotic purchases, and prescription use were recorded during a four-hour observation (2 sessions of 2 hours) in each shop. We included drug shops selling human medicine (n = 15); animal medicine (n = 3), and shops selling both human and animal medicine (n = 2). RESULTS Of 582 observations, 31.6% of drug shop customers were women. Women comprised almost half of customers (47.1%) in urban drug shops but only 17.2% of customers in rural drug shops (p < 0.001). Antibiotic purchases were more common in urban than rural shops (21.6% versus 12.2% of all transactions, p = 0.003). Only a quarter (26.0%) of customers who purchased antibiotics used a prescription. Prescription use for antibiotics was more likely among women than men (odds ratio (OR) = 4.04, 95% CI 1.55, 10.55) and more likely among urban compared to rural customers (OR = 4.31 95% CI 1.34, 13.84). After adjusting for urban-rural locality, women remained more likely to use a prescription than men (adjusted OR = 3.38, 95% CI 1.26, 9.09) but this was in part due to antibiotics bought by men for animals without prescription. Customers in drug shops selling animal medicine had the lowest use of prescriptions for antibiotics (4.8% of antibiotic purchases). CONCLUSION This study found that nearly three-quarters of all antibiotics sold were without prescription, including antibiotics on the list of critically important antimicrobials for human medicine. Men attending drug shops were more likely to purchase antibiotics without a prescription compared to women, while women customers were underrepresented in rural drug shops. Antibiotic stewardship initiatives in the community need to consider gender and urban-rural dimensions of drug shop uptake and prescription use for antibiotics in both human and animal medicine. Such initiatives could strengthen National Action Plans.
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Affiliation(s)
- Emily K. Rousham
- grid.6571.50000 0004 1936 8542School of Sport, Exercise and Health Sciences, Loughborough University, LE11 3TU Loughborough, Leicestershire, UK
| | - Papreen Nahar
- grid.12082.390000 0004 1936 7590Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton and Hove, UK
| | - Mohammad Rofi Uddin
- grid.414142.60000 0004 0600 7174Environmental Interventions Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Aminul Islam
- grid.30064.310000 0001 2157 6568Paul G. Allen School for Global Health, Washington State University, Pullman, WA USA
| | - Fosiul Alam Nizame
- grid.414142.60000 0004 0600 7174Environmental Interventions Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nirnita Khisa
- Tarum Development Organization, Rangamati, Bangladesh
| | - S. M. Salim Akter
- grid.414142.60000 0004 0600 7174Environmental Interventions Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Saeed Munim
- grid.414142.60000 0004 0600 7174Environmental Interventions Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahbubur Rahman
- grid.414142.60000 0004 0600 7174Environmental Interventions Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Leanne Unicomb
- grid.414142.60000 0004 0600 7174Environmental Interventions Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Cooper JB, Scotti A, Carr ML. Implementing medicare education for medication access: A review of the literature using the RE-AIM framework. Res Social Adm Pharm 2023; 19:16-27. [PMID: 36085121 PMCID: PMC10187529 DOI: 10.1016/j.sapharm.2023.04.047] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/24/2022] [Accepted: 08/14/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND The rising cost of medications has a disproportionate effect on community-dwelling older adults despite policy changes designed to improve medication access. Medicare insurance counseling provided by pharmacists, including individualized plan comparison and enrollment assistance, improves medication adherence and health care utilization, yet only 15% of community dwelling older adults report using a pharmacy or pharmacist for Medicare information. To determine what information is available to inform expanding implementation of pharmacy as a resource for Medicare insurance counseling, a systematic review of published studies using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was conducted. METHODS Articles meeting inclusion criteria were identified through a literature search using PubMed and GoogleScholar; 27 pharmacy Medicare insurance counseling studies were identified representing 13 unique programs in clinical, community outreach, and community pharmacy settings. Each article was coded by two researchers using the RE-AIM Coding Sheet for Publications and the extent of RE-AIM dimension reporting was determined using descriptive statistics at the program level. Discussions were used to arrive at coding consensus and concordance was measured with Krippendorff's alpha. RESULTS Across all studies (15 quasi experimental, 10 analytical case reports, and 2 case reports) more than half of the programs reported framework component dimensions for Reach (69%), Adoption (58%), Implementation (54%), and Maintenance (54%), and fewer than half reported comprehensively on Effectiveness (44%). Ten studies in 7 of 13 programs reported estimated out-of-pocket cost savings. Two studies measured patient-centered outcomes: medication adherence by proportion of days covered (PDC) and health care utilization by hospital admissions and emergency department visits. Gaps in the external validity of pharmacy Medicare education programs were identified including staff participation rates, methods to identify participating settings and program costs. CONCLUSIONS Based on this review, current research on pharmacy Medicare education is insufficient to guide broad implementation. Additional studies are needed to determine how Medicare education integrating pharmacists and pharmacies can be implemented to address cost-related non-adherence for community dwelling older adults.
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Affiliation(s)
- Julie B Cooper
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, 1 University Parkway, High Point, NC, 27268, United States.
| | - Alice Scotti
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, 1 University Parkway, High Point, NC, 27268, United States.
| | - Megan L Carr
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, 1 University Parkway, High Point, NC, 27268, United States.
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Pola-Garcia M, Domínguez García M, Gasch-Gallén Á, Lou Alcaine ML, Enríquez Martín N, Benedé Azagra CB. [Implementation of a social prescribing protocol in Aragon's primary care teams]. Aten Primaria 2022; 54:102496. [PMID: 36308979 PMCID: PMC9614823 DOI: 10.1016/j.aprim.2022.102496] [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: 07/07/2022] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To analyze the implementation of social prescribing guideline in primary care Aragón. DESIGN Observational, descriptive, cross-sectional study. LOCATION One hundred twenty-three primary care teams of Aragón. PARTICIPANTS Social prescribing made with the protocol «Recomendación Activos - AP» of electronic health record of primary care Aragón from September 2018 to March 2021. MAIN MEASUREMENTS The most relevant variables of the protocol were described: age, sex, province, health sector, basic health area, health problem, aspect to be enhanced, asset for health recommended, type of professional, degree of assistance, satisfaction and improvement. RESULTS The protocol was used 2109 times, 1482 recommendations were made and 428 follow-ups were performed. The use of the protocol increased progressively until March 2020. A total of 1431 people received one recommendation and 51 received more than one recommendation. The average age of the beneficiaries was 67.9years. 74.8% of recommendations were addressed to women. Diagnoses related to social and psychological problems were the most frequently recommended, and the physical sphere was the aspect most promoted. Most social prescribing was linked to physical activity and resources for the promotion of personal autonomy. More than 90% of the people regularly attended the activity, the average satisfaction was 4.8 (0/5) and the degree of improvement 4.3 (0/5). CONCLUSIONS The implementation of asset for health recommended within the Aragon community care strategy is working, however, some aspects need to be reviewed. It is necessary to continue generating evidence to be able to adapt and make this process more efficient.
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Affiliation(s)
- Marina Pola-Garcia
- Centro de Salud Almozara, Sector Zaragoza II, Servicio Aragonés de Salud, Zaragoza, España,Grupo GIIS011, Instituto de Investigación Sanitaria de Aragón, Zaragoza, España,Autor para correspondencia.
| | - Marta Domínguez García
- Grupo GIIS011, Instituto de Investigación Sanitaria de Aragón, Zaragoza, España,Centro de Salud Calatayud Sur, Sector Calatayud, Servicio Aragonés de Salud, Calatayud, Zaragoza, España,Grupo de Investigación en Atención Primaria B21_20R, Gobierno de Aragón, Zaragoza, España,Programa Actividades Comunitarias en Atención Primaria de Aragón (PACAP Aragón), Sociedad Aragonesa Medicina Familiar y Comunitaria (SAMFYC), Zaragoza, España
| | - Ángel Gasch-Gallén
- Grupo de Investigación en Atención Primaria B21_20R, Gobierno de Aragón, Zaragoza, España,Departamento de Fisiatría y Enfermería, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, España,Grupo GIIS094, Instituto de Investigación Sanitaria de Aragón, Zaragoza, España
| | - María Luz Lou Alcaine
- Grupo GIIS011, Instituto de Investigación Sanitaria de Aragón, Zaragoza, España,Dirección General de Asistencia Sanitaria, Departamento de Sanidad, Gobierno de Aragón, Zaragoza, España
| | - Natalia Enríquez Martín
- Unidad de Calidad y Seguridad, Servicio Aragonés de Salud, Departamento de Sanidad, Gobierno de Aragón, Zaragoza, España
| | - Carmen Belén Benedé Azagra
- Grupo GIIS011, Instituto de Investigación Sanitaria de Aragón, Zaragoza, España,Grupo de Investigación en Atención Primaria B21_20R, Gobierno de Aragón, Zaragoza, España,Programa Actividades Comunitarias en Atención Primaria de Aragón (PACAP Aragón), Sociedad Aragonesa Medicina Familiar y Comunitaria (SAMFYC), Zaragoza, España,Centro de Salud Canal Imperial, Sector Zaragoza II, Servicio Aragonés de Salud, Zaragoza, España
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Johansson-Pajala RM, Alam M, Gusdal A, Heideken Wågert PV, Löwenmark A, Boström AM, Hammar LM. Anxiety and loneliness among older people living in residential care facilities or receiving home care services in Sweden during the COVID-19 pandemic: a national cross-sectional study. BMC Geriatr 2022; 22:927. [PMID: 36456904 PMCID: PMC9714409 DOI: 10.1186/s12877-022-03544-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/19/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Older people were subjected to significant restrictions on physical contacts with others during the COVID-19 pandemic. Social distancing impacts older people's experiences of anxiety and loneliness. Despite a large body of research on the pandemic, there is little research on its effects on older people in residential care facilities (RCF) and in home care services (HCS), who are the frailest of the older population. We aimed to investigate the effect of the first wave of the COVID-19 pandemic in March-May 2020 on experiences of anxiety and loneliness among older people living in RCF or receiving HCS and the impact of the progression of the pandemic on these experiences. METHODS A retrospective cross-sectional design using data from the national user satisfaction survey (March - May 2020) by the Swedish National Board of Health and Welfare. Survey responses were retrieved from 27,872 older people in RCF (mean age 87 years) and 82,834 older people receiving HCS (mean age 84 years). Proportional-odds (cumulative logit) model was used to estimate the degree of association between dependent and independent variables. RESULTS Loneliness and anxiety were more prevalent among the older persons living in RCF (loneliness: 69%, anxiety: 63%) than those receiving HCS (53% and 47%, respectively). Proportional odds models revealed that among the RCF and HCS respondents, the cumulative odds ratio of experiencing higher degree of anxiety increased by 1.06% and 1.04%, respectively, and loneliness by 1.13% and 1.16%, respectively, for 1% increase in the COVID-19 infection rate. Poor self-rated health was the most influential factor for anxiety in both RCF and HCS. Living alone (with HCS) was the most influential factor affecting loneliness. Experiences of disrespect from staff were more strongly associated with anxiety and loneliness in RCF than in HCS. CONCLUSION Older people in RCF or receiving HCS experienced increasing levels of anxiety and loneliness as the first wave of the pandemic progressed. Older people' mental and social wellbeing should be recognized to a greater extent, such as by providing opportunities for social activities. Better preparedness for future similar events is needed, where restrictions on social interaction are balanced against the public health directives.
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Affiliation(s)
- Rose-Marie Johansson-Pajala
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden
| | - Moudud Alam
- grid.411953.b0000 0001 0304 6002School of Information and Engineering/Statistics, Dalarna University, Falun, Sweden
| | - Annelie Gusdal
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden
| | - Petra von Heideken Wågert
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden
| | - Annica Löwenmark
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden
| | - Anne-Marie Boström
- grid.4714.60000 0004 1937 0626Division of Nursing, Department of Neurobiology, Care Science and Society Karolinska Institute, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden ,grid.4714.60000 0004 1937 0626R&D unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Lena Marmstål Hammar
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden ,grid.4714.60000 0004 1937 0626Division of Nursing, Department of Neurobiology, Care Science and Society Karolinska Institute, Stockholm, Sweden ,grid.411953.b0000 0001 0304 6002School of Health and Welfare, Dalarna University, Falun, Sweden
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Domínguez García M, Pola-García M, Oliván Blázquez B, Lahoz Bernad I, Lou Alcaine ML, Benedé Azagra CB. [Analysis of community agendas in primary care and factors associated with their implementation]. Gac Sanit 2022; 37:102257. [PMID: 36347170 DOI: 10.1016/j.gaceta.2022.102257] [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] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe the community agendas created by the Aragonese Primary Care Teams (PCT), to analyze the characteristics of said PCT, and to explore factors related to their implementation. METHOD Descriptive observational study of the community agendas and the Aragonese PCT that have created them since the implementation of the Aragonese Community Care Strategy (ACCS) in 2016 until March 2021. Bivariate and multivariate analysis of the characteristics of these PCT that have created the agenda with respect to those who have not developed it. RESULTS 75 of the 123 Aragonese PCT (61%) have created the community agenda. 74.7% of them also have an active Health Council. 45 of the 75 agendas are of the advanced type, with 41 PCT that had carried out the zone health diagnosis and 28 PCT that made asset recommendations. It was observed how the creation of the community agenda is related to being a PCT belonging to a semi-urban basic health zone (odds ratio [OR]: 3.02; 95% confidence interval [95% CI]: 1.22-7.47; p=0.017) and that at least one professional would have received specific training (OR: 5.29; 95% CI: 1.09-25.72; p=0.039). CONCLUSIONS The community agenda is a tool that supports the development of community care for PCT. The training provided by the ACCS has been shown to be key to the development of the agendas, and this work must continue, with special emphasis on the PCT belonging to rural or urban basic health zones, since they are the ones that are experiencing the greatest difficulties.
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Affiliation(s)
- Marta Domínguez García
- Servicio Aragonés de Salud, Zaragoza, España; Grupo GIIS011, Instituto Investigación Sanitaria Aragón, Zaragoza, España; Grupo Aragonés de Investigación en Atención Primaria B21_20R, Gobierno de Aragón, Zaragoza, España
| | - Marina Pola-García
- Servicio Aragonés de Salud, Zaragoza, España; Grupo GIIS011, Instituto Investigación Sanitaria Aragón, Zaragoza, España
| | - Bárbara Oliván Blázquez
- Grupo GIIS011, Instituto Investigación Sanitaria Aragón, Zaragoza, España; Grupo Aragonés de Investigación en Atención Primaria B21_20R, Gobierno de Aragón, Zaragoza, España; Departamento de Psicología y Sociología, Universidad de Zaragoza, Zaragoza, España.
| | | | - María Luz Lou Alcaine
- Grupo GIIS011, Instituto Investigación Sanitaria Aragón, Zaragoza, España; Dirección General de Asistencia Sanitaria, Departamento de Sanidad, Gobierno de Aragón, Zaragoza, España
| | - Carmen Belén Benedé Azagra
- Servicio Aragonés de Salud, Zaragoza, España; Grupo GIIS011, Instituto Investigación Sanitaria Aragón, Zaragoza, España; Grupo Aragonés de Investigación en Atención Primaria B21_20R, Gobierno de Aragón, Zaragoza, España
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Egea-Ronda A, Niclos-Esteve M, Ródenas A, Verdeguer M, Cassetti V, Herrero C, Soler JM, Paredes-Carbonell JJ. [Theory of change implemented in the program to promote physical activity "La Ribera Camina"]. Gac Sanit 2022; 36:546-552. [PMID: 35584981 DOI: 10.1016/j.gaceta.2022.02.012] [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] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To develop a theory of change of a program to promote physical activity in eleven health districts, in order to improve its design and plan its evaluation. METHOD Four focus groups were carried out, to develop a participatory theory of change, to identify the expected changes (long, medium and short term) of "La Ribera Camina" program, according to the following stakeholders: primary healthcare professionals, local government representatives and community members. A thematic analysis was used to identify the actions to be taken to achieve these changes, as well as the difficulties and facilitators to enhance the sustainability of the program. RESULTS The identified changes were classified into four themes: 1) changes in physical and social health (improved physical condition, healthy habits, self-esteem and perceived well-being); 2) organizational and relational changes (better coordination between institutions); 3) specific changes to the program (incorporation of more "assets" and local associations, especially male participants, more trails and schedules); and 4) changes in the environment (improved trails' infrastructures and safety). CONCLUSIONS The theory of change allows to identify and classify the changes that are expected, the actions to be carried out and the links between elements of the program. This will serve as the basis for its evaluation. This methodology could be applied to other programs interested in incorporating intersectorality and community engagement in their design and evaluation.
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Affiliation(s)
- Ana Egea-Ronda
- Departament de Salut València Arnau de Vilanova-Llíria, San Antonio de Benagéber, Valencia, España
| | | | - Amparo Ródenas
- Centre de Salut Pública Alzira, FISABIO, Alzira, Valencia, España
| | - Mariví Verdeguer
- Departament de Salut de La Ribera, FISABIO, Alzira, Valencia, España
| | - Viola Cassetti
- Affiliated researcher, UNESCO Chair in Global Health and Education, Valencia, España
| | - Carlos Herrero
- Departament de Salut de La Ribera, FISABIO, Alzira, Valencia, España
| | - José M Soler
- Departament de Salut de La Ribera, FISABIO, Alzira, Valencia, España; Derpartament d'Estadística i Investigació Operativa Aplicada i Qualitat, Universitat Politècnica de Valencia, Valencia, España
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徐 菱, 惠 淼, 朱 树, 杨 照, 李 梦, 杨 宏, 郑 茜, 吕 继, 杨 莉. [Chronic kidney disease in community: Current state for screening and management]. Beijing Da Xue Xue Bao Yi Xue Ban 2022; 54:1056. [PMID: 36241251 PMCID: PMC9568408 DOI: 10.19723/j.issn.1671-167x.2022.05.036] [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] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To understand the current state and problem of screening and management of chronic kidney disease (CKD) in the community, and to explore the improving strategies. METHODS We established a community-CKD integrated data science platform based on medical information from 79 community health centers, in Xicheng District, Beijing. Patients who referred to 79 community health centers from 21 June 2015 to 20 November 2021 were retrospectively included in this study using the CKD data platform. The monitoring of the indicator of kidney injury, risk factor control, medicine use and device configuration in community were assessed in the study. RESULTS In the study, 70.6% of the population were identified with high risk of CKD in the total 374 498 individuals who referred to the community health centers. Hypertension (62.3%), coronary heart disease (43.3%) and diabetes (30.4%) were the most common risk factors in high-risk CKD population. Only 17.2% of the patients with high risk of CKD were screened for kidney injury including at least one serum creatine (Scr) or albuminuria test, among which 10 992 (24.2%) individuals were defined as CKD. 22.7% (11 338/49 908) of the total patients with kidney screening in community were defined as CKD, of whom, 42.6% and 46.1% were identified by estimated glomerular filtration rate (eGFR) < 60 mL/(min·1.73 m2) and abnormalities of urinary proteins, respectively. The overall CKD detection rate in the community was 5.2% (19 299/374 498), and the miss-diagnosis rate of CKD was 38.1%. Of the 79 community health centers, 13 (16.5%) were equipped with ACR testing device, and eGFR was reported directly in 66 (83.5%) centers. Altogether 60.3% and 99.7% of the community CKD patients achieved glucose control and blood pressure control, respectively, and 59.3% of the CKD patients who had proteinuria was treated with renin-angiotensin-aldosterone system (RAAS) inhibitors. CONCLUSION High-risk CKD population account for a substantial proportion of patients who refer to the community. Early screening, prevention and management of CKD in the community are of great importance to improve the prognosis and decrease the burden of CKD. It's essential to establish a screening and monitoring system, strengthen standardized management and clinician training for improving the ability of CKD management in the community.
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Affiliation(s)
- 菱忆 徐
- 北京大学第一医院肾内科,北京大学肾脏疾病研究所,卫生部肾脏疾病重点实验室,慢性肾脏病防治教育部重点实验室(北京大学),中国医学科学院免疫介导肾病诊治创新单元,北京 100034Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
- 社区智慧健康管理和人工智能应用联合实验室,北京 100034Joint Laboratory of Community Intelligent Health Management, Beijing 10034, China
| | - 淼 惠
- 北京大学第一医院肾内科,北京大学肾脏疾病研究所,卫生部肾脏疾病重点实验室,慢性肾脏病防治教育部重点实验室(北京大学),中国医学科学院免疫介导肾病诊治创新单元,北京 100034Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
- 社区智慧健康管理和人工智能应用联合实验室,北京 100034Joint Laboratory of Community Intelligent Health Management, Beijing 10034, China
| | - 树宏 朱
- 社区智慧健康管理和人工智能应用联合实验室,北京 100034Joint Laboratory of Community Intelligent Health Management, Beijing 10034, China
- 北京市西城区智慧健康研究中心,北京 100053Health Intelligence Research Center of Beijing Xicheng District, Beijing 100053, China
| | - 照 杨
- 北京大学第一医院肾内科,北京大学肾脏疾病研究所,卫生部肾脏疾病重点实验室,慢性肾脏病防治教育部重点实验室(北京大学),中国医学科学院免疫介导肾病诊治创新单元,北京 100034Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
- 社区智慧健康管理和人工智能应用联合实验室,北京 100034Joint Laboratory of Community Intelligent Health Management, Beijing 10034, China
| | - 梦蕊 李
- 北京大学第一医院肾内科,北京大学肾脏疾病研究所,卫生部肾脏疾病重点实验室,慢性肾脏病防治教育部重点实验室(北京大学),中国医学科学院免疫介导肾病诊治创新单元,北京 100034Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
- 社区智慧健康管理和人工智能应用联合实验室,北京 100034Joint Laboratory of Community Intelligent Health Management, Beijing 10034, China
| | - 宏宇 杨
- 北京大学第一医院肾内科,北京大学肾脏疾病研究所,卫生部肾脏疾病重点实验室,慢性肾脏病防治教育部重点实验室(北京大学),中国医学科学院免疫介导肾病诊治创新单元,北京 100034Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
- 社区智慧健康管理和人工智能应用联合实验室,北京 100034Joint Laboratory of Community Intelligent Health Management, Beijing 10034, China
| | - 茜子 郑
- 北京大学第一医院肾内科,北京大学肾脏疾病研究所,卫生部肾脏疾病重点实验室,慢性肾脏病防治教育部重点实验室(北京大学),中国医学科学院免疫介导肾病诊治创新单元,北京 100034Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
- 社区智慧健康管理和人工智能应用联合实验室,北京 100034Joint Laboratory of Community Intelligent Health Management, Beijing 10034, China
| | - 继成 吕
- 北京大学第一医院肾内科,北京大学肾脏疾病研究所,卫生部肾脏疾病重点实验室,慢性肾脏病防治教育部重点实验室(北京大学),中国医学科学院免疫介导肾病诊治创新单元,北京 100034Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
- 社区智慧健康管理和人工智能应用联合实验室,北京 100034Joint Laboratory of Community Intelligent Health Management, Beijing 10034, China
| | - 莉 杨
- 北京大学第一医院肾内科,北京大学肾脏疾病研究所,卫生部肾脏疾病重点实验室,慢性肾脏病防治教育部重点实验室(北京大学),中国医学科学院免疫介导肾病诊治创新单元,北京 100034Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
- 社区智慧健康管理和人工智能应用联合实验室,北京 100034Joint Laboratory of Community Intelligent Health Management, Beijing 10034, China
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Aristide C, Bullington BW, Kuguru M, Sundararajan R, Nguyen NT, Lambert VJ, Mwakisole AH, Wamoyi J, Downs JA. Health providers' perspectives on contraceptive use in rural Northwest Tanzania: A qualitative study. Contracept X 2022; 4:100086. [PMID: 36324829 PMCID: PMC9618975 DOI: 10.1016/j.conx.2022.100086] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 07/29/2022] [Accepted: 09/23/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives In Tanzania, contraceptive use is limited, particularly in rural communities and even among women who would like to delay childbearing. This paper aims to present health providers' perspectives on populations seeking contraception and barriers that could be addressed to increase access to and uptake of contraception, given their interface with large portions of their communities. Study Design We conducted 18 in-depth interviews with providers stationed at health dispensaries in six rural villages in northwest Tanzania. Two investigators independently coded interviews using a stepwise process to achieve consensus on prevalent topics. Results Three topics emerged from our analysis: (1) nature of clients seeking contraception; (2) barriers to uptake of contraception; and (3) the role of secrecy in obtaining and using contraception. Health providers reported that married women with children were the most frequent users of contraception, alongside some single women, men, sex workers, and students. Barriers to contraception included lack of supplies and trained staff, misconceptions and fears, stigma, and unsupportive partners. Providers observed that contraception was often used secretly. They reported surreptitious visits and described clients' preferential use of discreet methods. Providers respected and supported clients' desires to keep visits confidential. Conclusion Our data suggest maintaining high stocks of discreet contraceptive methods and deploying more trained staff to dispensaries could increase availability and access to contraceptives. At the community level, more education campaigns are warranted to address barriers, especially those related to stigma. Implications Our work highlights the need for additional contraceptive methods that are easy to administer and discreet for women who must maintain secrecy. Future studies of the effectiveness of interventions and new contraceptives should obtain healthcare providers' perspectives, as they can provide important insights to service provision.
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Affiliation(s)
- Christine Aristide
- Center for Global Health, Weill Cornell Medicine, New York City, NY, USA
- Corresponding author.
| | - Brooke W. Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Natalie T. Nguyen
- Center for Global Health, Weill Cornell Medicine, New York City, NY, USA
| | | | | | - Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| | - Jennifer A. Downs
- Center for Global Health, Weill Cornell Medicine, New York City, NY, USA
- Department of Medicine, Bugando Medical Center, Mwanza, Tanzania
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36
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Vardoulakis S, Matthews V, Bailie RS, Hu W, Salvador‐Carulla L, Barratt AL, Chu C. Building resilience to Australian flood disasters in the face of climate change. Med J Aust 2022; 217:342-345. [PMID: 35717626 PMCID: PMC9795877 DOI: 10.5694/mja2.51595] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/23/2022] [Accepted: 05/04/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Sotiris Vardoulakis
- National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraACT,Healthy Environments And Lives (HEAL) National Research NetworkAustralia
| | - Veronica Matthews
- Healthy Environments And Lives (HEAL) National Research NetworkAustralia,University Centre for Rural Health, University of SydneyLismoreNSW
| | - Ross S Bailie
- Healthy Environments And Lives (HEAL) National Research NetworkAustralia,University of SydneySydneyNSW
| | - Wenbiao Hu
- Healthy Environments And Lives (HEAL) National Research NetworkAustralia,Queensland University of TechnologyBrisbaneQLD
| | - Luis Salvador‐Carulla
- Healthy Environments And Lives (HEAL) National Research NetworkAustralia,Health Research InstituteUniversity of CanberraCanberraACT
| | - Alexandra L Barratt
- Healthy Environments And Lives (HEAL) National Research NetworkAustralia,University of SydneySydneyNSW
| | - Cordia Chu
- Healthy Environments And Lives (HEAL) National Research NetworkAustralia,Centre for Environment and Population HealthGriffith UniversityBrisbaneQLD
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Væver MS, Krogh MT, Stuart AC, Madsen EB, Haase TW, Egmose I. Understanding Your Baby: protocol for a controlled parallel group study of a universal home-based educational program for first time parents. BMC Psychol 2022; 10:223. [PMID: 36138482 PMCID: PMC9502638 DOI: 10.1186/s40359-022-00924-3] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Infant mental health represents a significant public health issue. The transition to parenthood provides optimal opportunities for supporting parenting competence. Especially parental mentalization, i.e. the caregiver’s ability to notice and interpret the child’s behavior in terms of mental states, is important in infancy where the caregiver-infant communication is based solely on the infant’s behavioral cues.
Methods This study evaluates the efficacy of the intervention Understanding Your Baby (UYB) compared to Care As Usual (CAU) in 10 Danish municipalities. UYB aims at promoting parental competence in new parents by supporting them in noticing their infants’ behavioral cues and interpreting them in terms of mental states. Participants will be approximately 1,130 singletons and their parents. Inclusion criteria are first-time parents, minimum 18 years old, living in one of the 10 municipalities, and registered in the Danish Civil Registration Register (CPR). Around 230 health visitors deliver the UYB as part of their routine observation of infant social withdrawal in the Danish home visiting program. During an interaction between the health visitor and the infant, the health visitor articulates specific infant behaviors and helps the caregivers interpret these behaviors to mental states. The study is a controlled parallel group study with data obtained at four time points in two phases: First in the control group receiving the publicly available postnatal care (CAU), secondly in the intervention group after UYB implementation into the existing postnatal services. The primary outcome is maternal competence. Secondary measures include paternal competence, parental stress, parental mentalizing, and infant socioemotional development. Analysis will employ survey data and data from the health visitors’ register.
Discussion Results will provide evidence regarding the efficacy of UYB in promoting parenting competences. If proved effective, the study will represent a notable advance to initiating the UYB intervention as part of a better infant mental health strategy in Denmark. Conversely, if UYB is inferior to CAU, this is also important knowledge in regard to promoting parenting competence and infant mental health in a general population.
Trial registrationhttps://ClinicalTrials.gov with ID no. NCT03991416. Registered at 19 June 2019—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03991416 Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00924-3.
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Affiliation(s)
- Mette Skovgaard Væver
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, Building 03-2-216, 1353, Copenhagen K, Denmark.
| | - Marianne Thode Krogh
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, Building 03-2-216, 1353, Copenhagen K, Denmark
| | - Anne Christine Stuart
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, Building 03-2-216, 1353, Copenhagen K, Denmark
| | - Eva Back Madsen
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, Building 03-2-216, 1353, Copenhagen K, Denmark
| | - Tina Wahl Haase
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, Building 03-2-216, 1353, Copenhagen K, Denmark
| | - Ida Egmose
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, Building 03-2-216, 1353, Copenhagen K, Denmark
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Carter AJE, Harrison M, Goldstein J, Arab M, Jensen J, Houde K, Urquhart R. Providing palliative care at home aligns with the professional identity of paramedics: a qualitative study of paramedics and palliative health care providers. CAN J EMERG MED 2022; 24:751-759. [PMID: 36117240 DOI: 10.1007/s43678-022-00369-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 07/29/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND An innovative program, 'Paramedics Providing Palliative Care at Home,' was implemented in Nova Scotia, Canada in 2015. Roles like this are part of an evolving professional identity; role discordance or lack of clarity not only hinders professionalization but may impair the wellbeing, and career longevity of paramedics. This study explored the alignment of providing palliative support at home with paramedic professional identity. METHODS Qualitative description was employed, with thematic analysis of focus groups with paramedics and palliative health care providers. Recruitment posters were sent through the professional college (paramedics) and program managers (health care providers). Focus groups followed a semi-structured guide, discussing understanding of and experiences with the role and its alignment with professional identity. Challenges to paramedic palliative support and fit with professional identify were explored. Thematic content analysis was ongoing while focus groups were being conducted, until no new codes were found. Codes were combined, sorted into categories, and ultimately, agreed-upon themes. Saturation of themes was reached. RESULTS Eleven paramedics and twenty palliative health care providers participated. Four themes reflected paramedic's expanded role: (1) patient centeredness and job satisfaction with provision of palliative support, (2) a bridging role, (3) paramedic as advocate and educator, (4) provision of psychosocial support. Four themes reflected paramedic's professional identity: (1) evolution of paramedicine as a skilled clinical profession, (2) helping people and communities, (3) paramedic skill set aligns with work in palliative care, and (4) changing paramedic mindset. CONCLUSION Paramedics and palliative health care providers highlighted the provision of palliative care as part of a positive growth of paramedicine as a health profession, and a good fit with professional identity. Novel roles like this are important in the evolution of our health care system faced with increasing pressures to get the right care with the right provider at the right time.
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Affiliation(s)
- Alix J E Carter
- Emergency Health Services Nova Scotia, Halifax, Canada. .,Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada. .,Nova Scotia Health Authority, Halifax, Canada.
| | - Michelle Harrison
- Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, Canada
| | - Judah Goldstein
- Emergency Health Services Nova Scotia, Halifax, Canada.,Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, Canada
| | | | - Jan Jensen
- Emergency Health Services Nova Scotia, Halifax, Canada.,Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, Canada
| | | | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
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Leong YY, Hamzah E, McCarthy S, Lim ZN. Providing End-of-Life Care in the Community: What Are the Challenges in Malaysia? J Hosp Palliat Care 2022; 25:133-137. [PMID: 37674906 PMCID: PMC10179988 DOI: 10.14475/jhpc.2022.25.3.133] [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] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 09/08/2023]
Abstract
A 72-year-old woman with metastatic lung cancer to bone and brain and with left external iliac vein thrombosis was under the care of a community palliative care provider. She experienced an acute pain crisis due to acute limb ischemia of the left lower limb. Goals-of-care discussions were held with the patient and her family; she prioritized symptom control and end-of-life care at home. The family and patient were aware of her short prognosis. Her complex pain was managed by the community palliative team, and her family was empowered to give subcutaneous injections. We illustrate a case showing the importance of community health services with palliative care support in providing symptom management and support to patient and family caregivers throughout the course of a life-limiting illness. It also highlights family caregivers' potential psychological distress in delivering subcutaneous injections in terminal care for a patient at home.
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Affiliation(s)
- Yoke Yeng Leong
- Community Palliative Care, Hospis Malaysia, Kuala Lumpur, Malaysia
| | - Ednin Hamzah
- Community Palliative Care, Hospis Malaysia, Kuala Lumpur, Malaysia
| | - Sylvia McCarthy
- Community Palliative Care, Hospis Malaysia, Kuala Lumpur, Malaysia
| | - Zee Nee Lim
- Community Palliative Care, Hospis Malaysia, Kuala Lumpur, Malaysia
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Satué de Velasco E, Gayol Fernández M, Eyaralar Riera MT, Magallón Botaya R, Abal Ferrer F. [Impact of the pandemic on primary care. SESPAS Report 2022]. Gac Sanit 2022; 36 Suppl 1:S30-S35. [PMID: 35781145 PMCID: PMC9244614 DOI: 10.1016/j.gaceta.2022.05.004] [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] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022]
Abstract
La pandemia de COVID-19, que dura ya más de 2 años, ha tensionado la atención primaria (AP) de salud hasta una preocupante situación actual de saturación y agotamiento. La COVID-19 es una enfermedad infecciosa comunitaria que, debido al gran número de casos (alrededor de 10 millones declarados en enero de 2022), ha requerido un esfuerzo extraordinario de atención de los casos leves y de detección precoz de los casos potencialmente graves por parte de los centros de salud. Desafortunadamente, no se ha realizado hasta ahora una evaluación global de las actuaciones que permita aprender de esta nueva experiencia. Se describe en este artículo el impacto en la AP de las distintas fases por las que ha discurrido la pandemia. Se proponen soluciones para reforzar los criterios centrales que permiten mantener la AP como fundamento del estado de derecho, la longitudinalidad, la resolutividad, la accesibilidad y la coordinación y continuidad asistencial mediante el aporte de recursos y competencias a la AP. Se concluye que la AP debe seguir siendo la base del sistema sanitario y recuperar o reivindicar aquellas competencias y recursos que siempre debieron estar ubicadas en este nivel de atención.
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Affiliation(s)
- Eduardo Satué de Velasco
- Farmacia Comunitaria, Maella (Zaragoza), España; Red Española de Atención Primaria (REAP), España
| | - Manuel Gayol Fernández
- Red Española de Atención Primaria (REAP), España; Enfermería de Área Sanitaria VI, SESPA Asturias, Arriondas, España
| | | | - Rosa Magallón Botaya
- Red Española de Atención Primaria (REAP), España; Medicina Familiar y Comunitaria, Centro de Salud de Arrabal, Zaragoza, España.
| | - Francisco Abal Ferrer
- Red Española de Atención Primaria (REAP), España; Medicina Familiar y Comunitaria, Centro de Salud de Siero Sariego, Carbayín Alto (Asturias), España
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Wang H, Chu L, Li D, Zhou F, Wang Z, Sui G, Zeng Y, Cao Y. A more convenient prognostic scoring system for early evaluation of chest pain. Am J Emerg Med 2022; 57:207-209. [PMID: 35123839 DOI: 10.1016/j.ajem.2022.01.025] [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] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Hongxia Wang
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Department of General Practice, People's Hospital of Deyang City, Deyang, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Lili Chu
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Dongze Li
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Fating Zhou
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Zhiyuan Wang
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Guo Sui
- Department of General Practice, People's Hospital of Deyang City, Deyang, China
| | - Yi Zeng
- Department of General Practice, People's Hospital of Deyang City, Deyang, China
| | - Yu Cao
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China.
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Jirapramukpitak T, Jaisin K, Supanya S, Takizawa P. Effectiveness of a community health worker-led case management programme to improve outcomes for people with psychotic disorders in Thailand: a one-year prospective cohort study. BMC Psychiatry 2022; 22:247. [PMID: 35395746 PMCID: PMC8991661 DOI: 10.1186/s12888-022-03888-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 03/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intensive case management (ICM) programmes for psychotic patients are effective in improving outcomes, but often unfeasible in resource-poor settings, as they typically require extensive human resources and expertise. We developed and evaluated the effectiveness of a less intensive case management program (LICM), led by community health workers, on one-year social functioning and service use. METHODS A prospective cohort study was conducted on patients aged 18 and above residing in a hospital catchment area. Outcomes were compared between LICM (n = 64) and non-LICM participants (n = 485). A counterfactual framework approach was applied to assess causal effects of the LICM on outcomes. The programme effectiveness was analyzed by augmented-inverse probability of treatment weighting (AIPW) to estimate potential outcome mean (POM) and average treatment effect (ATE). Outcomes were employment status and use of emergency, inpatient and outpatient services. Analyses were stratified by the number of previous psychotic relapse (≤ 1, > 1) to assess heterogeneity of treatment effect on those in an early and later stages of psychotic illness. RESULTS In the early-stage cohort, the likelihood of being employed at one year post-baseline was significantly greater in LICM participants than non-LICM participants (ATE 0.10, 95%CI 0.05-0.14, p < 0.001), whereas service use of all types, except outpatient, was not significantly different between the two groups. In the later-stage cohort, the likelihoods of employment between the two groups at post-baseline were similar (ATE -0.02, 95%CI -0.19-0.15, p = 0.826), whereas service use of all types was significantly higher in LICM participants. CONCLUSION LICM in a setting where community mental services are scarce may benefit those at an early stage of psychotic illness, by leading to better social functioning and no higher use of unscheduled services at the end of the programme, possibly through their better prognosis and medication adherence. A more intensive case management model may be appropriate for those in a later stage of the illness.
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Affiliation(s)
- Tawanchai Jirapramukpitak
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand. .,Centre of Excellence in Applied Epidemiology, Thammasat University, Pathumthai, Thailand. .,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Kankamol Jaisin
- grid.10223.320000 0004 1937 0490Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suttha Supanya
- grid.477945.c0000 0004 0622 0215Department of Mental Health, Ministry of Public Health, Somdet Chaopraya Institute of Psychiatry, Bangkok, Thailand
| | - Patcharapim Takizawa
- grid.20515.330000 0001 2369 4728Department of Global Public Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki Japan
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Lo SHS, Chau JPC, Lam SKY, Saran R. Understanding the priorities in life beyond the first year after stroke: Qualitative findings and non-participant observations of stroke survivors and service providers. Neuropsychol Rehabil 2022; 33:794-820. [PMID: 35261329 DOI: 10.1080/09602011.2022.2049827] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ABSTRACTLong-term unmet health needs are associated with a lower quality of life in stroke survivors. Survivors' priorities in living their lives and health professionals' recognition influence survivors' perceptions of their needs. From the perspectives of survivors and service providers, this study investigated survivors' long-term priorities for continuing their lives after stroke. A qualitative study was conducted with a convenience sample of 40 stroke survivors and a purposive sample of 11 providers who had worked with survivors for more than five years and were currently managers of community-based stroke care services or leaders of volunteer groups. Following the survivors' interviews, non-participant observations of a random day's activities were conducted. Data were transcribed verbatim. Survivors' and providers' data were analyzed separately and then together thematically. Five themes emerged: healing the mind in order to move forward, optimizing adaptations and maintaining physical function, living a safe and cost-effective life, returning to work, and giving back to society. Community-based services can be improved to offer more at-home, technology-supported psychological and self-management interventions, barrier-free and one-stop services, and opportunities for employment and volunteering. It would be worthwhile to invest in conducting public education to promote social inclusion and strengthening collaboration between academic and community organizations.
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Affiliation(s)
- Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Simon Kwun Yu Lam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ravneet Saran
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Abstract
OBJECTIVES Health and social care navigation services provide support for people with long-term conditions. Such services are available in the New Zealand (NZ) context. However little is known nationally or internationally about clients' experience of engaging with such services. This study aimed to describe client perspectives of engaging with a health and social care navigation service in a NZ metropolitan city. METHODS The manager and navigators of the service recruited clients who were previous users of the service. We individually interviewed nine clients (F = 7; M = 2; aged between 30-80 years) in their homes. Many of the participants reported social isolation, and some were without regular income. We transcribed interviews verbatim and analysed data thematically. RESULTS There was one overall theme: Restoration of my essence or being (in the Māori language, wairua), and sense of belonging (turangawaewae) through a regenerative approach developed in partnership between the navigator and the client. Thus, participants felt renewed and validated as human beings. DISCUSSION Enabling clients to feel re-valued as human beings captures the concept of personhood whereby a person has capability and capacity for life choices. We suggest enabling a client to feel valued assists in development of self-determination and consequently improved health and well-being.
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Affiliation(s)
- Amanda Wilkinson
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Janel Atlas
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Katrina Nelson
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Hilda Mulligan
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Rodríguez-Gallego I, Strivens-Vilchez H, Agea-Cano I, Marín-Sánchez C, Sevillano-Giraldo MD, Gamundi-Fernández C, Berná-Guisado C, Leon-Larios F. Breastfeeding experiences during the COVID-19 pandemic in Spain:a qualitative study. Int Breastfeed J 2022; 17:11. [PMID: 35193625 PMCID: PMC8861604 DOI: 10.1186/s13006-022-00453-0] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/26/2022] [Indexed: 12/17/2022] Open
Abstract
Background The pandemic caused by COVID-19 has affected reproductive and perinatal health both through the infection itself and, indirectly, as a consequence of changes in medical care, social policy or social and economic circumstances. The objective of this study is to explore the impact of the pandemic and of the measures adopted on breastfeeding initiation and maintenance. Methods A qualitative descriptive study was conducted by means in-depth semi-structured interviews, until reaching data saturation. The study was conducted between the months of January to May 2021. Participants were recruited by midwives from the Primary Care Centres of the Andalusian provinces provinces of Seville, Cádiz, Huelva, Granada, and Jaén. The interviews were conducted via phone call and were subsequently transcribed and analysed by means of reflexive inductive thematic analysis, using Braun and Clarke’s thematic analysis. Results A total of 30 interviews were conducted. Five main themes and ten subthemes were developed, namely: Information received (access to the information, figure who provided the information), unequal support from the professionals during the pandemic (support to postpartum hospitalization, support received from Primary Health Care during the postpartum period), social and family support about breastfeeding (support groups, family support), impact of confinement and of social restriction measures (positive influence on breastfeeding, influence on bonding with the newborn), emotional effect of the pandemic (insecurity and fear related to contagion by coronavirus, feelings of loneliness). Conclusion The use of online breastfeeding support groups through applications such as WhatsApp®, Facebook® or Instagram® has provided important breastfeeding information and support sources. The main figure identified that has provided formal breastfeeding support during this period was that of the midwife. In addition, the social restrictions inherent to the pandemic have exerted a positive effect for women in bonding and breastfeeding, as a consequence of the increase in the time spent at their homes and in the family nucleus co-living. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00453-0.
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Affiliation(s)
- Isabel Rodríguez-Gallego
- Maternal-fetal Clinical Management Unit, Genetics and Reproduction, Virgen del Rocío University Hospital, Red Cross Nursing University Centre, University of Seville, Seville, Spain.
| | | | - Irene Agea-Cano
- Obstetrics and Gynecology, San Juan de la Cruz Hospital, Jaén, Spain
| | | | | | | | | | - Fatima Leon-Larios
- Nursing Department, School of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
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Xing B, Liang G, Zhang J, Zhang J, Jiang Z, Miao Q. Qualitative assessment of the intention of Chinese community health workers to implement advance care planning using theory of planned behavior. BMC Palliat Care 2021; 20:187. [PMID: 34886846 PMCID: PMC8662910 DOI: 10.1186/s12904-021-00885-1] [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: 06/16/2021] [Accepted: 11/22/2021] [Indexed: 01/10/2023] Open
Abstract
Background The aging population coupled with progressive medical technology has increased the demand for improved quality of end-of-life in China. However, implementation of an advance care planning (ACP) program in mainland China is still in its infancy owing to the significant influence of filial piety in Chinese culture. Research on implementation of ACP program among community health workers (CHWs) is limited. The current study sought to explore the willingness of CHWs to implement ACP based on the theory of planned behavior (TPB) and provide a reference for promotion of ACP in Chinese communities. Methods Phenomenological qualitative study using semi-structured face-to-face interviews. Interviews were audio-recorded. Colaizzi’s method was used for data analysis. The study received ethical approval and all participants provided written consent. Results Thirteen CHWs from 3 community health service centers (CHSCs) in Hangzhou, Zhejiang Province, China were interviewed. Through the analysis of the interview content, we determined that most CHWs have a supportive attitude towards the implementation of ACP, the reasons for which are as follows: relieve suffering of patients and respect their medical autonomy; relieve economic and psychological burden on family members; promote development of community palliative care. However, some CHWs believe that the implementation of ACP will lead to doctor-patient disputes and medical risks. CHWs reported that the support of patients and their families, community lawyers, psychosocial professionals, and CHSCs senior managers helped them to implement ACP. In addition, they indicated that the improvement of doctor-patient communication ability, the improvement of community medical environment, the support of government policy, and the training of CHWs were the promoting factors influencing their implementation of ACP. The hindrance factors include insufficient allocation of community health human resources, imperfect ACP legislation in China, and deep-rooted traditional culture. Conclusion Findings demonstrated that Chinese CHWs tend to support the implementation of ACP, but their willingness to implement is affected by different factors. CHSCs should actively organize standardized ACP training and comprehensively consider community medical environment, organizational norms, and human resources in implementation of ACP. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00885-1.
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Affiliation(s)
- Bingyu Xing
- Division of Health Sciences, Hangzhou Normal University, Room 405, Building No.9 in Shenyuan, No.2318 of Yuhangtang Rd, Yuhang District, Hangzhou, 311121, China
| | - Guanmian Liang
- Nursing Department, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, China
| | - Jing Zhang
- Division of Health Sciences, Hangzhou Normal University, Room 405, Building No.9 in Shenyuan, No.2318 of Yuhangtang Rd, Yuhang District, Hangzhou, 311121, China
| | - Jinsheng Zhang
- Division of Health Sciences, Hangzhou Normal University, Room 405, Building No.9 in Shenyuan, No.2318 of Yuhangtang Rd, Yuhang District, Hangzhou, 311121, China
| | - Zhizhi Jiang
- Kaixuan Street Community Health Service Center, Hangzhou, 310000, China
| | - Qunfang Miao
- Division of Health Sciences, Hangzhou Normal University, Room 405, Building No.9 in Shenyuan, No.2318 of Yuhangtang Rd, Yuhang District, Hangzhou, 311121, China.
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Fernàndez-López L, Klavs I, Conway A, Kustec T, Serdt M, Baros S, Staneková DV, Lemsalu L, Wawer I, Wysocki P, Casabona J. Recommendations for collection and integration of community-based testing and linkage to care data into national surveillance, monitoring and evaluation systems for HIV, viral hepatitis and sexually transmitted infections: results from the INTEGRATE Joint Action. BMC Infect Dis 2021; 21:794. [PMID: 34517821 PMCID: PMC8438807 DOI: 10.1186/s12879-021-06499-5] [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] [Received: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND National testing strategy, including monitoring and evaluation, is critical in responding to HIV, sexually transmitted infections, and viral hepatitis. Community-based voluntary counselling and testing contributes to early HIV diagnoses among key populations. Countries providing community-based testing, should integrate some core data on testing and linkage to care in these services into national surveillance and monitoring and evaluation systems. This study aimed to support the integration of community-based voluntary counselling and testing data into respective national surveillance and M&E systems for those infections. METHODS Preliminary consensus on indicators for the integration of community-based voluntary counselling and testing data into respective national surveillance and monitoring and evaluation systems was reached. Pilot studies were conducted in Estonia, Poland, Serbia, Slovakia, Slovenia and Spain. After pilot activities were implemented, the final consensus on indicators was reached. An analysis of the facilitators and barriers faced during pilot studies was conducted to inform the final recommendations for implementation. RESULTS The minimum set of six indicators to be integrated into national surveillance and monitoring and evaluation systems were: number of tests, number of clients tested, reactivity rate for tests and clients, positivity (active infection) rates for tests and clients, linkage to care rates for clients with reactive and/or positive test result, proportion of all new diagnoses in a country with first reactive test result at community-based voluntary counselling and testing service. Seven additional indicators were identified. Each indicator should be disaggregated by key population, sex and age group. A list of 10 recommendations for the collection and integration of community-based voluntary counselling and testing data into national surveillance and monitoring and evaluation systems for HIV, sexually transmitted infections and viral hepatitis was identified. CONCLUSIONS Integration of some community-based voluntary counselling and testing monitoring and evaluation data into national surveillance and monitoring and evaluation systems in all pilot countries was achieved. The recommendations will support such integration in other European countries. European Centre for Prevention and Control of Diseases included questions from the minimum list of indicators into their Dublin Declaration questionnaire 2020 to contribute to evidence based community testing policies in European countries.
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Affiliation(s)
- Laura Fernàndez-López
- Health Department, Generalitat de Catalunya, Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Badalona, Spain.
- Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain.
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.
| | - Irena Klavs
- National Institute of Public Health, Trubarjeva 2, Ljubljana, Slovenia
| | - Anna Conway
- Health Department, Generalitat de Catalunya, Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Badalona, Spain
- Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Tanja Kustec
- National Institute of Public Health, Trubarjeva 2, Ljubljana, Slovenia
| | - Mojca Serdt
- National Institute of Public Health, Trubarjeva 2, Ljubljana, Slovenia
| | - Sladjana Baros
- Institute of Public Health of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia
| | | | - Liis Lemsalu
- Department of Drug and Infectious Diseases Epidemiology, National Institute for Health Development, Tallinn, Estonia
| | - Iwona Wawer
- National AIDS Centre, The Agency of the Ministry of Health, Warsaw, Poland
| | - Piotr Wysocki
- National AIDS Centre, The Agency of the Ministry of Health, Warsaw, Poland
| | - Jordi Casabona
- Health Department, Generalitat de Catalunya, Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Badalona, Spain
- Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Univ Autonoma de Barcelona, Badalona, Spain
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Fernàndez-López L, Baros S, Niedźwiedzka-Stadnik M, Staneková DV, Rosińska M, Simic D, Jovanoic V, Hábeková M, Takáčová M, Wawer I, Wysocki P, Conway A, Klavs I, Casabona J. Integration of community-based testing data into national HIV surveillance in Poland, Serbia and Slovakia within the framework of INTEGRATE project. BMC Infect Dis 2021; 21:800. [PMID: 34517839 DOI: 10.1186/s12879-021-06498-6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community-based voluntary counselling and testing contributes to early HIV diagnoses among key populations. Testing data from such decentralized services is however often not standardized nor linked to national surveillance systems. This study aimed to support the integration of community testing data into respective national surveillance and monitoring and evaluation systems for those infections. We present results from three national pilots, focused on improved data collection and transfer. METHODS Within the Joint Action INTEGRATE different pilot activities were planned and implemented according to the local context. In Slovakia, standardised data collection tools were implemented in three community testing services. The data generated was used to calculate the proposed indicators. In Poland, positive test results from the community testing database were linked to the national case-based surveillance database using confirmatory test number, to improve the completeness of behavioural data in the national database. In Serbia, voluntary counselling and testing forms were improved enabling identification of community-based testing. A system to generate unique client identifiers was initiated in the National registry of HIV cases to monitor linkage to care. RESULTS All three sites were able to estimate most of the agreed indicators. In Slovakia during the study period 675 people were tested for HIV, 410 for hepatitis C and 457 for syphilis, with reactivity rates of 0.4, 2.5 and 1.8%, respectively. For HIV, 66.7% of reactive cases were confirmed and linked to care. In Poland, 28.9% of the community testing sites' records were linked to the national surveillance database (and accounted for 14.3% of all new diagnoses registered here during 2017-2018). Reactivity rate ranged between 1.9% and 2.1%. In Serbia, 80 persons were tested at community sites, from which two had a reactive HIV test result. By linking unique client identifiers from voluntary counselling and testing and National Registry of HIV cases databases, linkage to care within a two-month period was observed for one of two people with reactive HIV test result. CONCLUSIONS Pilot activities in the three countries demonstrate that integration of community-based testing data into surveillance systems is feasible and can help improve national surveillance data by providing key information.
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Cramer RL, McLachlan HL, Shafiei T, Amir LH, Cullinane M, Small R, Forster DA. Women's experiences of infant feeding support: Findings from a cross-sectional survey in Victoria, Australia. Women Birth 2021; 34:e505-e513. [PMID: 34420765 DOI: 10.1016/j.wombi.2020.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/09/2020] [Revised: 09/16/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate new mothers' experiences of infant feeding support. DESIGN A postal survey developed for this study was sent to all new mothers in ten local government areas in Victoria, Australia when their baby was six months of age. Questions explored infant feeding methods, feeding support services, and experiences of infant feeding support. This survey made up one component of the Supporting breastfeeding In Local Communities (SILC) cluster randomised controlled trial. FINDINGS 997/4127 women (24%) completed the survey between 15 April 2013 and 31 July 2013. Women received infant feeding support from multiple sources, including professionals, family members, and peers. Overall, 88% reported receiving adequate infant feeding support. Women who reported not receiving adequate infant feeding support were less likely to be giving any breast milk at six months compared to those reporting adequate support (OR = 0.59; 95% CI 0.40, 0.88). Adjusting for breastfeeding intention and parity did not alter the association (Adj. OR = 0.60; 95% CI 0.40, 0.90). Women were most satisfied when they received accessible, available, consistent professional infant feeding support provided in a non-judgemental and reassuring way. Women were dissatisfied when there were barriers restricting access to support, or when they received conflicting advice or support that made them feel guilty, pressured or judged. KEY CONCLUSIONS Regardless of infant feeding method, women wanted accessible, non-judgemental support. Given that receiving adequate support was associated with more breast milk feeding at six months, care providers should ensure accessible infant feeding support is available to all new mothers.
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Affiliation(s)
- Rhian L Cramer
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Health, Federation University Australia, Mount Helen, VIC 3350, Australia.
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia. https://www.twitter.com/touransh
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia. https://www.twitter.com/Lisa_H_Amir
| | - Meabh Cullinane
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia. https://www.twitter.com/mbcullinane
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia. https://www.twitter.com/small_rhonda
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
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50
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Plourde-Léveillé L, Fraser S. Vers une décolonisation des ressources de soins et services sociaux : les travailleurs communautaires locaux au Nunavik. Can J Public Health 2021; 112:676-684. [PMID: 33825135 PMCID: PMC8225724 DOI: 10.17269/s41997-020-00461-9] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES According to the World Health Organization, discrepancies in health statistics reflect unequal access to resources. The Truth and Reconciliation Commission of Canada calls for an increase in the number of Indigenous workers within health and social services. The involvement of local community workers is essential to ensure the cultural security of care and the decolonization of services. This article presents the role played by these workers in the expansion of mental health services and social interventions in Nunavik, the contextual considerations that influence their practice and their place within professional teams. METHODS A thematic analysis was conducted on semi-structured interviews done in 2016 with 60 Inuit and non-Inuit individuals working in the broad field of health and social services in Nunavik. RESULTS The integration of local community workers is perceived to bring several benefits, including the improvement of interventions and unique learning opportunities. However, several factors hinder this collaboration, such as clarity of mandates, access to pre-requisite training and diplomas, recognition of local knowledge, and staff turnover. More flexibility and support after hiring would allow for the service structure to be adapted to the complex reality of Nunavik. CONCLUSION This article adds to the body of literature highlighting the importance of collaboration with local community workers. The decolonization of services necessarily involves redesigning structures in order to recognize their contribution and to give a place to local knowledge.
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Affiliation(s)
- Léa Plourde-Léveillé
- Département de psychologie, Université du Québec à Montréal, 100 rue Sherbrooke, Montréal, Québec, H2X 3P2, Canada.
- Centre de recherche et d'intervention sur le suicide, enjeux éthiques et pratiques de fin de vie (CRISE), Université du Québec à Montréal, C.P. 8888, Succ. Centre-Ville, Montréal, Québec, H3C 3P8, Canada.
| | - Sarah Fraser
- Département de psychoéducation, Université de Montréal, C. P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du centre Sud-de-l'Île de Montréal, Montréal, Québec, Canada
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