1
|
Lin J, Yang D, Zhao X, Xie L, Xiong K, Hu L, Xu Y, Yu S, Huang W, Gong N, Liang X. The action logic of the older adults about health-seeking in South Rural China. BMC Public Health 2023; 23:2487. [PMID: 38087231 PMCID: PMC10714459 DOI: 10.1186/s12889-023-17314-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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The Chinese government has invested significant resources to build many rural healthcare stations. However, in the face of convenient medical paths and accessible medical resources, the utilization rate of health services for older adults in rural areas is surprisingly low. This study explored why health-seeking behavior among older adults in rural China was not active. METHODS Data were collected through participatory rural appraisal (PRA) with 108 participants in 12 villages in southern China. Daily schedule and social and resource mapping were employed to outline the range of activities and the routine of the older adults, as well as in-depth interviews to understand the logic of their healthcare choices. Data collected were analyzed by content analysis. RESULTS Three themes were generated: (1) perceptions of health status (being healthy or sick): the rural older adults used the ability to handle routine chores as a measure of health status; (2) prioritization of solving symptoms over curing diseases: the older adults preferred the informal self-medication to cope with diseases, as long as there were no symptoms and no pain; (3) 'unpredictable' troubles: they tended to favor the 'optimal' solution of keeping their lives in order rather than the best medical treatment options. CONCLUSION This study showed that the medical practices of the rural elderly were profoundly influenced by their perceptions of health and their life experiences. In the face of diseases, they tended to keep their lives in order, preferring self-treatment practices that address symptoms or selectively following medical advice rather than medical and science-based clinical solutions. In the future, the construction of rural health care should focus on changing the 'inaccessibility' of healthcare resources at the subjective level of the rural elderly and develop culturally adaptable health education.
Collapse
Affiliation(s)
- Jianqiang Lin
- State Key laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Department of Ophthalmology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dan Yang
- Department of Endodontics, Stomatological Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xinyu Zhao
- State Key laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Liqiong Xie
- State Key laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Kun Xiong
- State Key laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lei Hu
- School of Nursing, Jinan University, Guangzhou, China
| | - Yue Xu
- State Key laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - ShanShan Yu
- State Key laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wenyong Huang
- State Key laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Ni Gong
- School of Nursing, Jinan University, Guangzhou, China.
| | - Xiaoling Liang
- State Key laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
2
|
Li JJ, Yang XY, Zhang HJ, Yin DQ, Zhang JT, Cui JW, Han JD, Ma Y, Jia HX. The Psychosomatic Traits of "People with the Five Elements in Traditional Chinese Medicine": A Qualitative Study. Biomed Environ Sci 2023; 36:1068-1078. [PMID: 38098326 DOI: 10.3967/bes2023.136] [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: 04/09/2023] [Accepted: 08/21/2023] [Indexed: 12/18/2023]
Abstract
Objective To identify the representative attributes of the five elements of a person with a qualitative methodology and provide the basis for the clinical diagnosis and treatment of "people with the five elements in traditional Chinese medicine (TCM)." Methods Data collected from the literature review, two sessions of brainstorming of experts with related experience in "people with the five elements in TCM" from October 2020 to December 2020, and six rounds of in-depth interviews with 30 participants who had various attributes of the five elements from March 2021 to October 2021 were analyzed. Triangulation was used in this study, and theming and synthesizing were used to analyze the data. Results A total of 31 experts and 30 interviewees participated in this study. The median age of the experts and interviewees were 48.0 and 38.5 years, respectively; 51.66% and 54.8% of experts and interviewees, respectively, were men. The descriptors of facial diagrams of "people with the five elements in TCM" were complexion, shape, distribution state of facial bones, convergence trend of facial muscles, and facial expression. A theoretical model of "people with the five elements in TCM" was shaped based on these findings. Conclusion The study suggests a possibility for bridging the gap between personality and bodily state, identifying an avenue for personality research from the perspective of TCM.
Collapse
Affiliation(s)
- Jia Jia Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China;Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100088, China
| | - Xin Yu Yang
- School of Life Sciences, Peking University, Beijing 100871, China
| | - Hong Jun Zhang
- The First Hospital Affiliated to Beijing University of Chinese Medicine, DongZhimen Hospital, Beijing 100700, China
| | - Dong Qing Yin
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China;Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100088, China
| | - Jin Tao Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Jing Wen Cui
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China;Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100088, China
| | - Jing Dong Han
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Yan Ma
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Hong Xiao Jia
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China;Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100088, China
| |
Collapse
|
3
|
Russell LE, Tse J, Bowie J, Richardson CR, Trubek A, Maruthur N, Wolfson JA. Cooking behaviours after Diabetes Prevention Program (DPP) participation among DPP participants in Baltimore, MD. Public Health Nutr 2023; 26:2492-2497. [PMID: 37271725 DOI: 10.1017/s1368980023001106] [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: 06/06/2023]
Abstract
OBJECTIVE The Diabetes Prevention Program (DPP) is a widely implemented 12-month behavioural weight loss programme for individuals with prediabetes. The DPP covers nutrition but does not explicitly incorporate cooking skills education. The objective of the current study is to describe food and cooking skills (FACS) and strategies of recent DPP participants. DESIGN Photo-elicitation in-depth interviews were conducted from June to August, 2021. SETTING Baltimore, MD, USA. PARTICIPANTS Thirteen Black women who participated in DPP. RESULTS The DPP curriculum influenced participants' healthy cooking practices. Many participants reported shifting from frying foods to air-frying and baking foods to promote healthier cooking and more efficient meal preparation. Participants also reported that their participation in DPP made them more mindful of consuming fruits and vegetables and avoiding foods high in carbohydrates, fats, sugars and Na. With respect to food skills, participants reported that they were more attentive to reading labels and packaging on foods and assessing the quality of ingredients when grocery shopping. CONCLUSIONS Overall, participants reported changing their food preferences, shopping practices and cooking strategies to promote healthier eating after completing the DPP. Incorporating hands-on cooking skills and practices into the DPP curriculum may support sustained behaviour change to manage prediabetes and prevent development of type 2 diabetes among participants.
Collapse
Affiliation(s)
- Lauren E Russell
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
| | - Jillian Tse
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD21205, USA
| | - Janice Bowie
- Johns Hopkins Bloomberg School of Public Health, Department of Health Behavior and Society, Baltimore, MD, USA
| | | | - Amy Trubek
- University of Vermont, Department of Nutrition and Food Sciences, Burlington, VT, USA
| | - Nisa Maruthur
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Julia A Wolfson
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD21205, USA
- University of Michigan School of Public Health, Department of Health Management and Policy, Ann Arbor, MI, USA
| |
Collapse
|
4
|
Anyango C, Goicolea I, Namatovu F. Women with disabilities' experiences of intimate partner violence: a qualitative study from Sweden. BMC Womens Health 2023; 23:381. [PMID: 37474929 PMCID: PMC10360297 DOI: 10.1186/s12905-023-02524-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/02/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Intimate Partner Violence (IPV) is a prevalent form of gender-based violence affecting one in three women globally. It is also a preventable cause of ill-health, disability, and death. Current research suggests that women with disabilities are at a significantly higher risk of experiencing violence throughout their lifetime. They are almost twice as likely to experience violence compared to men with disabilities or men and women without disabilities. Additionally, they experience higher rates of all types of violence. This increased vulnerability may be due to factors related to disability such as dependence on others for support, mistrust, and social and physical isolation. Although there is existing research on IPV against women in general, there is limited knowledge on IPV against women with disabilities. To address this gap in knowledge, this study aimed to explore women with disabilities' perceptions and experiences of being victims/survivors of IPV in Sweden. METHODS This was a qualitative study conducted through in-depth interviews with eleven women with disabilities. The participants were aged eighteen years upwards. The collected data was analyzed using reflexive thematic analysis with a constructivist epistemological standpoint. RESULTS We developed four themes. Theme one: "multiple abuse by multiple abusers, over time," describes the participants' experiences of various types of violence from different perpetrators for prolonged periods. Theme two: "psychological abuse-harmful, but neglected and difficult to prove," explains how women with disabilities' perceive psychological abuse as harmful, but not given the same level of seriousness as physical violence. It also expresses the difficulties they encountered in providing tangible evidence to prove instances of psychological abuse. Theme three: "abuse does not end with separation," highlights how abuse can continue beyond separation/divorce. Theme four: "surviving abusive relationships" describes the different and evolving ways the participants used to navigate their abusive relationships. CONCLUSIONS Women with disabilities face all forms of abuse. They find it challenging to prove psychological abuse, and the system is inadequate in addressing its harm. The abuse also continues after separation or divorce. The support system should consider the needs of women with disabilities who experience violence, both during and after the abusive relationship. Service providers should be better equipped to detect and handle all types of IPV, especially psychological abuse.
Collapse
Affiliation(s)
- Cartrine Anyango
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
- Centre for Demographic and Ageing Research (CEDAR), Umeå University, Umeå, Sweden.
| | - Isabel Goicolea
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Fredinah Namatovu
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Centre for Demographic and Ageing Research (CEDAR), Umeå University, Umeå, Sweden
| |
Collapse
|
5
|
Halverson CM, Penwell HL, Francomano CA. Clinician-associated traumatization from difficult medical encounters: Results from a qualitative interview study on the Ehlers-Danlos Syndromes. SSM Qual Res Health 2023; 3:100237. [PMID: 37426705 PMCID: PMC10328215 DOI: 10.1016/j.ssmqr.2023.100237] [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] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Patients with hypermobile Ehlers Danlos Syndrome often experience psychological distress resulting from the perceived hostility and disinterest of their clinicians. We conducted 26 in-depth interviews with patients to understand the origins of this trauma and how it could be addressed in practice. We found that the cumulative effects of numerous negative encounters lead patients to lose trust in their healthcare providers and the healthcare system, and to develop acute anxiety about returning to clinic to seek further care. We describe this as clinician-associated traumatization. Ultimately, our interviewees described the result of this traumatization as worse - but preventable - health outcomes.
Collapse
Affiliation(s)
- Colin M.E. Halverson
- Center for Bioethics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anthropology, Indiana University, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
| | - Heather L. Penwell
- Center for Bioethics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Clair A. Francomano
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
6
|
Rhee ES, Kim HS. Understanding the Dynamics of Online Social Support Among Postpartum Mothers in Online Communities. Matern Child Health J 2023; 27:690-697. [PMID: 36781692 DOI: 10.1007/s10995-023-03594-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Despite previous attempts to identify types of social support among postpartum mothers, researchers have overlooked how and why postpartum mothers seek and offer social support as well as the dynamics of participation in online communities. OBJECTIVE AND METHODS The objective of the current study was to explore possible answers through grounded theory approach of interviews with 24 mothers who have experienced postpartum depression and psychological distress. RESULTS The primary motivation to join the community was a desire for connectedness and reassurance. Initially engaged to seek information, users began to share not only informational and tangible support, but also emotional and esteem support as they gained comfort with their membership in these groups. CONCLUSION Findings suggest that affirming normalcy while coping with postpartum distress is an integral part of the social support shared among postpartum mothers. Moreover, the findings indicated that to maximize the sustainability as well as the effectiveness of online communities for postpartum mothers, motivating silent users to participate and reciprocate is crucial.
Collapse
Affiliation(s)
- E Soo Rhee
- Department of Mass Communication, Towson University, 8000 York Rd, Towson, MD, 21252, USA.
| | - Hyang-Sook Kim
- Department of Mass Communication, Towson University, 8000 York Rd, Towson, MD, 21252, USA
| |
Collapse
|
7
|
Dopelt K, Davidovitch N, Davidov N, Plot I, Boas H, Barach P. "As if we are branded with the mark of Cain": stigma, guilt, and shame experienced by COVID-19 survivors in Israel - a qualitative study. Curr Psychol 2023:1-14. [PMID: 36684454 PMCID: PMC9838295 DOI: 10.1007/s12144-023-04241-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
Stigma is associated with harmful health outcomes, and it fuels social and health inequalities. It can undermine social cohesion and encourage social exclusion of groups, which may contribute to secrecy about disease symptoms, avoidance of disease testing and vaccination, and further spread of a contagious illness. Stigmatization is a social process set to exclude those who are perceived to be a potential source of disease and may pose a threat to effective interpersonal and social relationships. In this qualitative study, we delved into the stigmatization experiences of twenty COVID-19 recovered patients during the COVID-19 first wave, using in-depth semi-structured interviews conducted during November 2020. Using thematic analysis, we found that the process of stigmatization was all-encompassing, from the stage of diagnosis throughout the duration of the disease and the recovery phases. On the basis of the data, we hypothesized that stigma is a significant public health concern, and effective and comprehensive interventions are needed to counteract the damaging and insidious effects during infectious disease pandemics such as COVID-19, and reduce infectious disease-related stigma. Interventions should address provision of emotional support frameworks for the victims of stigmatization and discrimination that accompany the COVID-19 pandemic and future pandemics. This study was conducted in the early days of the COVID-19 pandemic, when uncertainty about the disease was high and fear of contamination fueled high levels of stigmatization against those who became ill with Covid-19.
Collapse
Affiliation(s)
- Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Nadav Davidovitch
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Nikol Davidov
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Ira Plot
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Hagai Boas
- Department of Politics and Governance, Ben Gurion University of the Negev, Beer Sheva, Israel
- The Van Leer Jerusalem Institute, Jerusalem, Israel
| | - Paul Barach
- Thomas Jefferson University, Philadelphia, PA USA
| |
Collapse
|
8
|
Morales GI, Lee S, Bradford A, De Camp A, Tandoc EC. Exploring vaccine hesitancy determinants during the COVID-19 pandemic: An in-depth interview study. SSM Qual Res Health 2022; 2:100045. [PMID: 35128519 PMCID: PMC8800497 DOI: 10.1016/j.ssmqr.2022.100045] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 04/23/2023]
Abstract
On January 20, 2020, the CDC reported its first case of the novel coronavirus in the United States. Almost a year and a half after the first COVID-19 vaccine was given in the U.S., efforts to vaccinate individuals in the hopes of achieving herd immunity continue. Despite the amounts of scientific breakthroughs to create and disseminate the vaccines, people continue to express hesitancy. Existing research has explored vaccine hesitancy through survey data, restricting an in-depth understanding for why people remain hesitant. As a result, this research aimed to understand in-depth reasons for vaccine hesitancy as well as what finally got those who, although hesitant, went through with getting inoculated. In addition, we also wanted to know how the vaccine hesitant received information about the vaccine. Using in-depth interviews, we identified key elements that influenced vaccine hesitancy which include social pressure to not get vaccinated and lack of trust in the healthcare system. We also identified reasons why vaccine hesitant individuals ultimately decided to receive the COVID-19 vaccine. These reasons included becoming informed, getting back to normal, and societal pressure. Finally, we sought to understand what served as venues for COVID-19 information and those were media sources like traditional news outlets/legacy media (e.g., TV) and digital/social media, and interpersonal sources like family, friends, and co-workers. In revealing these factors through in-depth interviews, we show how complex vaccine hesitancy is and the elements public health practitioners need to take into consideration when constructing vaccine-related information/messages.
Collapse
|
9
|
Björkmark M, Nynäs P, Koskinen C. "Living Between Two Different Worlds": Experiences of Leaving a High-Cost Religious Group. J Relig Health 2022; 61:4721-4737. [PMID: 34405314 PMCID: PMC9569318 DOI: 10.1007/s10943-021-01397-1] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
The aim of this interdisciplinary study is to gain a comprehensive understanding of individuals' subjective experiences after leaving a high-cost religious group and how these experiences have affected their lives. In-depth interviews were done with 18 participants who had left different religious communities in Finland. The interviews were analysed through a thematic analysis. The results show that religious disaffiliation is a life change that may affect an individual's life in profound ways. Life after being a member of a high-cost group may involve experiences of fear, guilt, sorrow, pain, loss and even suffering on an existential level. These experiences can have serious implications for one's well-being and health. However, life after religious disaffiliation also includes many positive aspects, such as experiences of joy, freedom, relief, gratitude and empowerment.
Collapse
Affiliation(s)
- Maria Björkmark
- Department of Caring Science, Åbo Akademi University, Vaasa, Finland.
- Centria University of Applied Sciences, Talonpojankatu 2, 67100, Kokkola, Finland.
| | - Peter Nynäs
- Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turku, Finland
| | - Camilla Koskinen
- Department of Caring and Ethics, University of Stavanger, Stavanger, Norway
| |
Collapse
|
10
|
Øgård-Repål A, Berg RC, Skogen V, Fossum M. "They make a difference": a qualitative study of providers' experiences of peer support in outpatient clinics for people living with HIV. BMC Health Serv Res 2022; 22:1380. [PMID: 36411443 PMCID: PMC9676711 DOI: 10.1186/s12913-022-08810-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although the life expectancy of people living with HIV has increased, they are still often disconnected from society through stigma and discrimination. Peer support has been found to increase social support. Given the limited research on peer support from the providers' perspective, this study explored how peer supporters experience their roles and contributions in outpatient clinics (OPCs). Additionally, healthcare professionals' perceptions of working with peer supporters in OPCs were examined. METHODS: This qualitative study included purposively selected peer supporters (n = 10) and healthcare professionals (n = 5) from five OPCs in Norway in 2020. In-depth interviews and focus group discussions were conducted in Norwegian or English, using interview guides. Interview transcripts were analysed in NVivo 12 using reflexive and collaborative thematic analysis. RESULTS The results show that peer supporters experience mutual support through emotional and honest interactions. Further, the peer supporters found it essential to negotiate with the service users about their preconception of HIV, confront their views through dialogue, and replicate positive experiences by being credible role models. The participants expressed that integrating peer support in the OPCs' usual care processes increased the prospect of equitable services. Quality of peer support and role clarity were identified as critical components. The results demonstrate that emotional and honest conversations promote support between peers and that peer supporters identify a need for a reframed understanding of HIV by modelling plausible alternative interpretations and coping experiences. CONCLUSIONS This study contributes to knowledge on how peer support can meet the needs of people living with HIV. Incorporating people living with HIV in the co-production and distribution of healthcare services may improve the knowledge and perspectives in healthcare services. However, the skill standards of peer supporters should be addressed when implementing peer support in usual care.
Collapse
Affiliation(s)
- Anita Øgård-Repål
- grid.23048.3d0000 0004 0417 6230Centre for Caring Research, Department of Health and Nursing Science, University of Agder, Southern Norway, Grimstad, Aust-Agder, Norway
| | - Rigmor C. Berg
- grid.418193.60000 0001 1541 4204Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway ,grid.10919.300000000122595234Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Vegard Skogen
- grid.10919.300000000122595234Institute for Clinical Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Department of Infectious Diseases, Medical Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Mariann Fossum
- grid.23048.3d0000 0004 0417 6230Centre for Caring Research, Department of Health and Nursing Science, University of Agder, Southern Norway, Grimstad, Aust-Agder, Norway
| |
Collapse
|
11
|
Rudolph J, Tan S, Crawford J, Butler-Henderson K. Perceived quality of online learning during COVID-19 in higher education in Singapore: perspectives from students, lecturers, and academic leaders. Educ Res Policy Pract 2022; 22:171-191. [PMID: 38625351 PMCID: PMC9668702 DOI: 10.1007/s10671-022-09325-0] [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] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/25/2022] [Indexed: 10/19/2023]
Abstract
The COVID-19 pandemic has significantly affected the higher education sector in Singapore. Existing tertiary studies seeking to understand the intraperiod response to COVID-19 often focus on single institutions, jurisdictions or stakeholder groups. This study is the first in-depth qualitative multi-stakeholder examination of the higher education environment in Singapore during the COVID-19 pandemic. It explored the perceptions of the quality of digital pedagogy during COVID-19, how universities have adapted because of the pandemic, and how leaders, teaching staff and students have been affected by the management and educational changes via 13 semi-structured interviews across six Singapore higher education institutions. Through purposive sampling, we explore current stakeholder perceptions, structural education changes, and personal learning and teaching impacts of COVID-19. Applying Braun and Clarke's approach to thematic analysis, we inductively uncovered four major themes: the Singapore government's approach to COVID-19 and its effects on delivery; academic leadership approaches; education technology; and well-being. This article is critical as a key foundation to understand how Singapore is responding with unique geopolitical differences. We discuss the practical implications of our research for current university faculty and students during and beyond the pandemic, and outline opportunities for future research.
Collapse
Affiliation(s)
| | - Shannon Tan
- Kaplan Higher Education Singapore, Singapore, Singapore
| | | | | |
Collapse
|
12
|
van Paassen P, Dijkstra M, Peay HL, Rokx C, Verbon A, Reiss P, Prins JM, Henderson GE, Rennie S, Nieuwkerk PT, de Bree GJ. Perceptions of HIV cure and willingness to participate in HIV cure-related trials among people enrolled in the Netherlands cohort study on acute HIV infection. J Virus Erad 2022; 8:100072. [PMID: 35769632 DOI: 10.1016/j.jve.2022.100072] [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: 03/28/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/22/2022] Open
Abstract
Background People who initiate antiretroviral therapy (ART) during acute HIV infection are potential candidates for HIV cure-related clinical trials, as early ART reduces the size of the HIV reservoir. These trials, which may include ART interruption (ATI), might involve potential risks. We explored knowledge and perception of HIV cure and willingness to participate in cure-related trials among participants of the Netherlands Cohort Study on Acute HIV infection (NOVA study), who started antiretroviral therapy immediately after diagnosis of acute HIV infection. Methods We conducted 20 in-depth qualitative interviews with NOVA study participants between October-December 2018. Data were analyzed thematically, using inductive and iterative coding techniques. Findings Most participants had limited knowledge of HIV cure and understood HIV cure as complete eradication of HIV from their bodies. HIV cure was considered important to most participants, mostly due to the stigma surrounding HIV. More than half would consider undergoing brief ATI during trial participation, but only one person considered extended ATI. Viral rebound and increased infectiousness during ATI were perceived as large concerns. Participants remained hopeful of being cured during trial participation, even though they were informed that no personal medical benefit was to be expected. Interpretation Our results highlight the need for thorough informed consent procedures with assessment of comprehension and exploration of personal motives prior to enrollment in cure-related trials. Researchers might need to moderate their expectations about how many participants will enroll in a trial with extended ATI.
Collapse
|
13
|
Ock M, Pyo J, Jo MW, Herdman M, Luo N. Perceptions of the General Public About Health-related Quality of Life and the EQ-5D Questionnaire: A Qualitative Study in Korea. J Prev Med Public Health 2022; 55:213-225. [PMID: 35677995 PMCID: PMC9201084 DOI: 10.3961/jpmph.22.151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/29/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this qualitative study was to investigate how members of the general public in Korea interpret the concept of health, and which dimensions of health are most important to them. We also explored their perceptions of the EuroQoL 5-Dimension (EQ-5D), including the EuroQoL visual analogue scale (EQ-VAS). METHODS We conducted face-to-face, in-depth interviews with 20 individuals from the general population, using a semi-structured interview guide. Content analysis was performed with verbatim transcripts and field notes to identify codes and categorize them according to their similarities and associations. RESULTS In total, 734 different codes were derived and classified into 4 categories. Participants cited the importance of both the mental and physical aspects of health, although they emphasized that the physical aspects appeared to play a larger role in their conceptualization of health. Participants noted that the EQ-5D has the advantage of being composed of 5 dimensions that are simple and contain both physical and mental areas necessary to describe health. However, some of them mentioned the need to add more dimensions of mental health and social health. Participants showed great satisfaction with the visually well-presented EQ-VAS. However, participants opined that the EQ-VAS scores might not be comparable across respondents because of different ways of responding to the scale. CONCLUSIONS While physical health is a fundamental aspect of health, mental and social aspects are also important to Koreans. The content of the EQ-5D broadly matched the attributes of health considered important by Koreans.
Collapse
Affiliation(s)
- Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.,Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeehee Pyo
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.,Department of Preventive Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| |
Collapse
|
14
|
Øgård-Repål A, Berg RC, Skogen V, Fossum M. Peer support in an outpatient clinic for people living with human immunodeficiency virus: a qualitative study of service users' experiences. BMC Health Serv Res 2022; 22:549. [PMID: 35468797 PMCID: PMC9036816 DOI: 10.1186/s12913-022-07958-8] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although human immunodeficiency virus (HIV) has become a manageable condition with increasing life expectancy, people living with HIV (PLHIV) are still often isolated from society due to stigma and discrimination. Peer support provides one avenue for increased social support. Given the limited research on peer support from the perspective of PLHIV, this study explored their experiences of peer support organised by healthcare professionals in an outpatient clinical setting. METHODS The study used a qualitative, descriptive research design for an in-depth understanding of peer support provided to PLHIV in the context of outpatient clinics. Healthcare professionals contributed to the recruitment of 16 participants. We conducted in-depth interviews about participants' experiences of peer support, and performed a directed content analysis of the data. Further, we sorted the data into pre-determined categories. RESULTS The pre-determined categories constituted attachment, social integration, an opportunity for nurturance, reassurance of worth, reliable alliance, and guidance. The identified themes were: gained emotional support, disclosure behaviour allowed garnering of emotional support, non-disclosure promoted the need to meet a peer, experienced a sense of belonging, activated an opportunity for mutual support, means to re-establish belief in one's own worth, perceived a positive affirmation of disease management, facilitated dialogue about disease management, the outpatient clinic as a safe place, and a setting for flexible, individualised support. CONCLUSIONS This study highlights the peer support experiences of PLHIV in the context of outpatient clinics. The participants' experiences align with previous findings, showing that peer support contributes to mutual emotional support between peers. This is particularly important in cultures of non-disclosure where PLHIV experience intersectional stigma. Additionally, our results show outpatient clinics to be supportive surroundings for facilitating peer support, ensuring confidentiality in peer support outreach. Therefore, peer support contributes positively to individualising outpatient clinic services to meet the changing needs of PLHIV.
Collapse
Affiliation(s)
- Anita Øgård-Repål
- Centre for Caring Research- Southern Norway, Department of Health and Nursing Science, University of Agder, Grimstad, Aust-Agder, Norway.
| | - Rigmor C Berg
- Divison of Health Services, Norwegian Institute of Public Health, Oslo, Norway.,Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Vegard Skogen
- Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Infectious Diseases, Medical Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Mariann Fossum
- Centre for Caring Research- Southern Norway, Department of Health and Nursing Science, University of Agder, Grimstad, Aust-Agder, Norway
| |
Collapse
|
15
|
Gultekin B, Demir S, Gunduz MA, Cura F, Ozer L. The logistics service providers during the COVID-19 pandemic: The prominence and the cause-effect structure of uncertainties and risks. Comput Ind Eng 2022; 165:107950. [PMID: 35043031 PMCID: PMC8757651 DOI: 10.1016/j.cie.2022.107950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/12/2021] [Accepted: 01/10/2022] [Indexed: 05/04/2023]
Abstract
Uncertainties and risks play a central role in creating vulnerabilities for logistics service operations. Over the years, Logistic Service Providers (LSPs) have learned how to ensure resilience to confront uncertainties and risks triggered by adverse events. However, quite unlike any seen in recent times, the COVID-19 pandemic brings about unavoidable uncertainties and risks for the logistics industry. Yet, there is no common approach to contextualize how they interact together. We incorporate an empirical research design and make a threefold contribution: first, we identify uncertainties and risks that LSPs encounter during the COVID-19 pandemic and investigate their prominence. Second, we unveil intertwined schemes of afore-identified uncertainties and risks and augment the understanding of their cause-effect structure. Third, we provide an uncertainty and risk assessment guideline for LSPs affected by threats emerging from unforeseeable crises. In this study, we combine qualitative work and the fuzzy DEMATEL method. Qualitative thematic analysis of in-depth interviews reveals the most important uncertainties (COVID-19 measures, employee welfare, forecast horizon, demand change, and government regulations) and risks (COVID-19 risk, delivery delays, supply chain disruptions, financial failure, and product returns) for LSPs. The fuzzy DEMATEL method shows that COVID-19 measures and COVID-19 risk are highly prominent and influence other factors. The results indicate that demand change, government regulations, and supply chain disruptions are net causers, and employee welfare, financial failure, forecast horizon, delivery delays, and product returns are net receivers. Distinctly, employee welfare is the most affected factor, empirically confirming that major risks for LSPs are related to the human factor. More investigation in our results suggests that supply chain disruptions and demand change, two factors triggered by the COVID-19 pandemic, influence financial failure and forecast horizon, two factors associated with operational performance.
Collapse
Affiliation(s)
- Beyza Gultekin
- Hacettepe University, Department of Business Administration, 06800 Ankara, Turkey
| | - Sercan Demir
- Harran University, Department of Industrial Engineering, 63000 Sanliurfa, Turkey
| | - Mehmet Akif Gunduz
- KTO Karatay University, Department of International Trade and Logistics, 42020 Konya, Turkey
| | - Fatih Cura
- KTO Karatay University, Department of International Trade and Logistics, 42020 Konya, Turkey
| | - Leyla Ozer
- Hacettepe University, Department of Business Administration, 06800 Ankara, Turkey
| |
Collapse
|
16
|
Hayun Y, Ben-Dror A, Schreuer N, Eshel Y, Ad-El D, Olshinka A. Camp "Sababa" (awesome) - The world of children with burns. Burns 2022; 48:413-419. [PMID: 34001386 DOI: 10.1016/j.burns.2021.04.017] [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: 07/11/2020] [Revised: 03/21/2021] [Accepted: 04/18/2021] [Indexed: 12/14/2022]
Abstract
AIMS Camp "Sababa" operates in Israel through the Burn Advocate Network of New Jersey, to help children with burn injuries cope with consequences of injury. The study assessed adolescents' perceptions of their participation in the camp, and its effect on their self-esteem and quality of life. METHODS Ten adolescents from diverse cultural backgrounds attended Camp "Sababa" in 2017. All the participants and parents signed an informed consent form, responded to a demographics questionnaire, and participated in in-depth interviews and focus groups. Phenomenological analysis revealed three themes, reflecting the chronological sequence of rehabilitation: (1) coping with emotional and physical scars, (2) formulating coping strategies, (3) belonging to a group, and (4) implications of camp experience. RESULTS Social participation engendered a feeling of safety and trust, enabling adolescents to share their burn experiences, and thus cope better with the physical and emotional challenges of their injuries. Participation in camp activities strengthened their confidence and social bonding; and their return to typical adolescent behaviour while at camp, and ultimately in the community. CONCLUSIONS The positive results suggest that burn camps should be part of the rehabilitation process of adolescents with burn injury, with emphasis on challenging, age-appropriate activities, and peer group participation.
Collapse
Affiliation(s)
- Yehiel Hayun
- Department of Plastic Surgery & Burns, Rabin Medical Center, Petah Tikva 4941492 Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Anat Ben-Dror
- Occupational Therapy Unit, Schneider Children's Medical Center of Israel, Petah Tikva 4920235 Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Schreuer
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 31905, Israel
| | - Yuliana Eshel
- Occupational Therapy Unit, Schneider Children's Medical Center of Israel, Petah Tikva 4920235 Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dean Ad-El
- Department of Plastic Surgery & Burns, Rabin Medical Center, Petah Tikva 4941492 Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Olshinka
- Department of Plastic Surgery & Burns, Rabin Medical Center, Petah Tikva 4941492 Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Plastic Surgery & Burns Unit, Schneider Children's Medical Center of Israel, Petah Tikva 4920235 Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
17
|
Nyongesa MK, Nasambu C, Mapenzi R, Koot HM, Cuijpers P, Newton CRJC, Abubakar A. Psychosocial and mental health challenges faced by emerging adults living with HIV and support systems aiding their positive coping: a qualitative study from the Kenyan coast. BMC Public Health 2022; 22:76. [PMID: 35022012 PMCID: PMC8756635 DOI: 10.1186/s12889-021-12440-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/17/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa, there is little data on the challenges faced by young people living with HIV transitioning into adult life. Adapting the socio-ecological framework, this qualitative study investigated the challenges faced by emerging adults living with HIV from a rural Kenyan setting. Additionally, the study explored support systems that aid positive coping among these young adults. METHODS In April 2018, in-depth interviews were conducted with a convenience sample of 22 young adults living with HIV (12 females), 18-24 years old, from rural Kilifi, coast of Kenya. Data were analyzed thematically using NVIVO 11 software. RESULTS Young adults living with HIV from this setting face various challenges at different levels of the social ecosystem. At the individual level, key challenges they reported included acceptance of HIV positive status, antiretroviral adherence, economic burden associated with access to healthcare, building an intimate relationship, mental health problems, and HIV status disclosure. At the family level, death of parents, poverty, and being unaccepted were the commonly mentioned challenges. At the community level, socialization difficulties and long waiting time at the HIV clinic were highlighted. HIV stigma and discrimination were frequently reported across the different levels. Economic independence, social support (from families, friends, organizations, healthcare providers and peer meetings), and reliance on spirituality aided positive coping among these young adults amidst the challenges of living with HIV. CONCLUSIONS In this rural setting, emerging adults living with HIV face various challenges at the individual, family, and community level, some of which are cross-cutting. Our findings underscore the need for designing multi-level youth-friendly interventions that can address modifiable challenges encountered by emerging adults living with HIV in this and similar settings. Such interventions should incorporate appropriate context-specific support structures that may help these young people smoothly transit into adult life.
Collapse
Affiliation(s)
- Moses K Nyongesa
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya.
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Carophine Nasambu
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
| | - Rachael Mapenzi
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
| | - Hans M Koot
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charles R J C Newton
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Amina Abubakar
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| |
Collapse
|
18
|
Ho ES, Parsons JA, Davidge KM, Clarke HM, Wright FV. Shared decision making in youth with brachial plexus birth injuries and their families: A qualitative study. Patient Educ Couns 2021; 104:2586-2591. [PMID: 33766450 DOI: 10.1016/j.pec.2021.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/15/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The objective of this study is to elucidate the decision-making experiences of youth with brachial plexus birth injuries who face preference-sensitive decisions regarding treatment options for a persistent elbow contracture. METHODS Transcripts, research-created drawings, and field notes from in-depth interviews with 5 young adults and 14 youth-parent dyads, and 15 participant observation sessions of families and clinicians in the clinic setting were deductively and inductively coded and thematically analyzed. RESULTS Youth's shared decision making was influenced by relational processes with their clinicians and parents. Youth's trust in their clinicians' recommendations for pursuing treatment and pressure from their parents to pursue or continue rehabilitation treatment affected how their voices were expressed and heard. Parental emotional adjustment to the birth injury played a role in parental perceptions of what was deemed their youth's best interest in the shared decision. CONCLUSIONS The decision-making experiences of youth with brachial plexus birth injury illustrate the complexity of paediatric preference-sensitive decisions and the significance of social and emotional factors on these shared decisions. PRACTICE IMPLICATIONS Opportunity for youth to express their voice without external pressure during shared decision making is needed to make well-informed decisions based on their own values. Interventions such as decision coaching and decision support tools may help youth and parents to formally identify and discuss these relational processes.
Collapse
Affiliation(s)
- Emily S Ho
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.
| | - Janet A Parsons
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Kristen M Davidge
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Howard M Clarke
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - F Virginia Wright
- Department of Physical Therapy, University of Toronto, Toronto, Canada; Bloorview Research Institute, Toronto, Canada
| |
Collapse
|
19
|
Savelli CJ, Simpson J, Mateus C. Exploring the Experiences of Members of the International Food Safety Authorities Network: An Interpretative Phenomenological Analysis. J Food Prot 2021; 84:1683-1697. [PMID: 34086917 DOI: 10.4315/jfp-21-171] [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: 04/20/2021] [Accepted: 06/01/2021] [Indexed: 11/11/2022]
Abstract
ABSTRACT The International Food Safety Authorities Network (INFOSAN) is a global network of national food safety authorities from 190 countries, managed jointly by the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) that aims to facilitate the rapid exchange of information during food safety incidents. A three-phase study of INFOSAN was launched in 2019 to characterize and examine the network as a functional community of practice and determine its value systematically and rigorously from its members' perspectives. The first two phases of the study involved analyzing the INFOSAN Community Website and surveying of all of its members. The main objective of this third and final phase of the study was to understand the experiences of a small group of INFOSAN members as they relate to various dimensions of membership. A qualitative methodology was used to provide a deeper understanding of members' experiences and supplement the results from the first two quantitative study phases. Interviews were conducted with 10 INFOSAN members from 10 geographic regions, transcribed verbatim, and analyzed using interpretative phenomenological analysis. The results offer an understanding of INFOSAN members' experiences in the context of what participation in this global network means to them and relate to five themes concerning trust, learning, health protection, sense of community, and future potential. The findings suggest that focusing on outreach to sustain personal interest, training to improve technical capacity, and advocacy to obtain political buy-in are ways in which the INFOSAN Secretariat could enable participation and create value at the individual, organizational, and national level, respectively. Such engagement could translate into more effective international communication during urgent food safety incidents and fewer cases of foodborne illness worldwide. HIGHLIGHTS
Collapse
Affiliation(s)
- Carmen Joseph Savelli
- World Health Organization, Nutrition and Food Safety, Avenue Appia 20, 1211, Geneva, Switzerland.,Faculty of Health and Medicine, Division of Health Research, Lancaster University, Bailrigg, Lancaster LA1 4YW, UK
| | - J Simpson
- Faculty of Health and Medicine, Division of Health Research, Lancaster University, Bailrigg, Lancaster LA1 4YW, UK
| | - C Mateus
- Faculty of Health and Medicine, Division of Health Research, Lancaster University, Bailrigg, Lancaster LA1 4YW, UK
| |
Collapse
|
20
|
Talmor I. Implementing a multi-criteria decision-making approach to a new party's election campaign - A case study. MethodsX 2021; 8:101328. [PMID: 34430236 PMCID: PMC8374358 DOI: 10.1016/j.mex.2021.101328] [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: 01/31/2021] [Accepted: 03/25/2021] [Indexed: 10/31/2022] Open
Abstract
During pre-election campaigns, parties make great efforts to persuade constituents to vote for them. Usually, new parties have smaller budgets and fewer resources than veteran parties. In particular, the more heterogeneous the party's electorate, the more critical the issue of resource allocation is. This paper presents a method to allocate new party's campaign advertising resources efficiently to maximize its voters. The model developed uses Pareto principle and multi-criteria approach and integrates party's confidential data together with an official open-to-all data. The model produced clear and unbiased results, and these advantages made it effective and user-friendly for the strategic team and campaign managers. We implemented the model on a specific new party during the intensive political period before the April 2019 elections in Israel.•This paper analyses the issue of allocating new party's campaign advertising resources efficiently to maximize its voters.•Our model integrates Pareto principle with multi-criteria decision-making approach and uses the party's confidential data together with official open to all state data.•The model produced clear and unbiased results, and these advantages made it effective and user-friendly for the strategic team and campaign managers.
Collapse
Affiliation(s)
- Irit Talmor
- Western Galilee College, Sir Harry Solomon School of Management, Akko, Israel
| |
Collapse
|
21
|
Dangerfield F, Ball K, Dickson-Swift V, Thornton LE. Understanding regional food environments: A qualitative exploration of food purchasing behaviour. Health Place 2021; 71:102652. [PMID: 34392056 DOI: 10.1016/j.healthplace.2021.102652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022]
Abstract
The characteristics of regional food environments differ from those of urban food environments, however, the importance of these characteristics in shaping food purchasing behaviours is unclear. Using a qualitative descriptive approach, how regional adults use and perceive their food environment and the factors that determine their food purchasing behaviour were explored. Semi-structured in-depth interviews were undertaken with thirteen regional-dwelling Australian adults. Findings suggest regional residents consider a range of factors beyond proximity to home, in deciding where to purchase food. Knowing how people use their food environment will inform contextually-appropriate policy recommendations and interventions to improve regional food environments and healthy purchasing behaviours.
Collapse
|
22
|
Verhage M, Thielman L, de Kock L, Lindenberg J. Coping of Older Adults in Times of COVID-19: Considerations of Temporality Among Dutch Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 76:e290-e299. [PMID: 33423054 PMCID: PMC7928596 DOI: 10.1093/geronb/gbab008] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Globally, mitigation measures during the coronavirus disease 2019 (COVID-19) pandemic have focused on protecting older adults. Earlier disaster studies have shown the importance of including older peoples' voices to prevent secondary stressors, yet these voices have received little attention during this pandemic. Here, we explore how Dutch older adults view this crisis and cope with measures to contribute to our understanding of coping of older adults in general and during disaster situations more specifically. METHOD Qualitative study using semistructured telephone interviews with 59 diverse older adults aged 54-95 throughout the Netherlands. RESULTS Older adults typify this crisis as ungraspable, disrupting their daily and social lives. Despite filling their lives with activities, they experience loss or lack of purpose. They try to follow measures to decrease infection risk and gain control, and use problem- and emotion-focused coping strategies. Emotion-focused strategies used were interpreting their personal vulnerability, self-enhancing comparisons, acceptance, and distraction. In the latter 2 strategies, the temporary nature of measures was emphasized. DISCUSSION Older adults describe this crisis consistently with earlier findings from disaster studies. They use known coping strategies, but emphasize the duration in relation to their expectation of temporality. This underscores a dynamic, processual approach toward coping that incorporates temporal dimensions such as duration and order. Our findings stress the importance of acknowledging heterogeneity among older adults and adjusting communication about mitigation measures to decrease insecurity and increase resonance. This may make COVID-19 mitigation measures more manageable and age-responsible and allow older adults to start living again.
Collapse
Affiliation(s)
- Miriam Verhage
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands
| | - Lucia Thielman
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
- Faculty of Behavioural and Movement Sciences, Educational Studies, Vrije Universiteit, Amsterdam, The Netherlands
| | - Lieke de Kock
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
| | - Jolanda Lindenberg
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands
| |
Collapse
|
23
|
Ekwunife OI, Ofomata CJ, Okafor CE, Anetoh MU, Kalu SO, Ele PU, Eleje GU. Cost-effectiveness and feasibility of conditional economic incentives and motivational interviewing to improve HIV health outcomes of adolescents living with HIV in Anambra State, Nigeria. BMC Health Serv Res 2021; 21:685. [PMID: 34247604 PMCID: PMC8272893 DOI: 10.1186/s12913-021-06718-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/12/2021] [Accepted: 06/25/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. METHOD A cost-effectiveness analysis from the healthcare provider's perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. RESULT The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients' acceptance of the intervention was very high. CONCLUSION The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1-3 times per annum. Patients' acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. TRIAL REGISTRATION This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network ( PACTR201806003040425 ).
Collapse
Affiliation(s)
| | | | - Charles Ebuka Okafor
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia.
| | - Maureen Ugonwa Anetoh
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Prince Udegbunam Ele
- Division of Respiratory Medicine, Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - George Uchenna Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| |
Collapse
|
24
|
Baysak E, Yorguner N, Kandemir G, Denizman IA, Akvardar Y. Is early marriage practice a problem for women living in Istanbul? A qualitative study. Arch Womens Ment Health 2021; 24:243-50. [PMID: 32901363 DOI: 10.1007/s00737-020-01067-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
Early marriages (EM) adversely affect women's physical and mental health, education, and social status. The current study aimed to analyze effects of EM through the thoughts, experiences, and suggestions of women who were married under the age of eighteen in Istanbul, Turkey, and the key informants (e.g., social worker, psychologist, obstetrician) who have encountered EM. In-depth interviews were conducted with fifteen women who were married before age 18, recruited from psychiatry outpatient department and eleven key informants. Thematic analysis was used. Low educated, poor family environment with domestic violence and neglect of children, loss of parents, lack of access to education, and traditional social structure were stated as causes for EM. Families' attitudes about EM were characterized as their daughter's reputation would be tarnished which implied the daughter's premarital relationships would be perceived as immoral by community. All women experienced traditional, aggressive rituals for the first night of marriage, husbands were mostly insensitive, and coercive resulting a traumatic experience. Women were subjected to physical, sexual, psychological, and emotional violence; most of them were socially isolated after marriage with restrictions imposed by their spouses and spouses' family that limited communication with their loved ones. The women generally felt unprepared for adult sexual life and motherhood. In order to prevent EM, raising parents' awareness about EM, supporting girls' education, and enforcing legitimate regulations were recommended. Early marriages violate human rights, cause negative consequences for health both physically and mentally, and deepen social inequality for women. All the participants suggested a better functioning legislative arrangement. The male dominated society that legitimizes child marriages and other harmful traditional practices should be addressed.
Collapse
|
25
|
Imchen T. Beyond cancer: a reflection on the narratives of nasopharyngeal carcinoma patients in Nagaland. Support Care Cancer 2021; 29:5839-46. [PMID: 33754197 DOI: 10.1007/s00520-021-06155-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
In the Three-year Report of the Population-Based Cancer Registries: 2012-2014 published by the Indian Council of Medical Research (ICMR 2016) [11], the incidence of nasopharyngeal carcinoma (NPC) in Nagaland has been ranked as the highest in the country and the second-highest globally next to China. With the paucity of literature and very few studies done on the high incidence of NPC among the Nagas in Nagaland, the present study was undertaken to understand and examine the experiences and perceptions of patients diagnosed with NPC and efforts were made to draw on their experiences with cancer care treatment through the thematic analysis of the ten in-depth interviews conducted. The patient's experiences with anxiety, fear, and distress due to NPC, its impact on the reconstruction of self, the coping mechanisms they develop in the form of resilience, personal attributes of hope and optimism, and the impact of religion and prayers in helping them deal with their disease are discussed in the paper.
Collapse
|
26
|
Mehta RV, Sreenivasa MA, Mathew M, Girard AW, Taneja S, Ranjan S, Ramakrishnan U, Martorell R, Ryan PB, Young MF. A mixed-methods study of pesticide exposures in Breastmilk and Community & Lactating Women's perspectives from Haryana, India. BMC Public Health 2020; 20:1877. [PMID: 33287778 PMCID: PMC7720549 DOI: 10.1186/s12889-020-09966-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population growth which has resulted in a need for increased crop yields to sustain food security, in addition to the effects of climate change, have led to the widespread use of chemical pesticides. The indiscriminate use of pesticides has in turn led to contamination of the environment, food commodities and bioaccumulation in human tissues, particularly in agrarian regions of India including the northern state of Haryana. METHODS We conducted a pilot screening study to investigate the presence of organochlorine, organophosphate, and pyrethroid pesticides in breastmilk samples (n = 75) from Haryana, India. Pesticide analyses were conducted using gas chromatography mass spectrometry (GC-MS) for OC and OP pesticides and GC-electron capture detector for pyrethroids. The study was complemented by a qualitative evaluation of maternal and community perceptions, knowledge, attitudes and practices associated with pesticide use and risk of exposure (n = 30 in-depth interviews; n = 9 focus group discussions). RESULTS Analysis of breastmilk showed the presence of p,p'-dichlorodiphenyltrichloroethane (DDT) and p,p'-dichlorodiphenyldichloroethylene (DDE) in 4% (range: CONCLUSIONS In our small sample, breastmilk pesticide concentrations were low and did not pose a risk to infants. Based on the persistent nature of many organic pollutants and reported widespread use, we recommend more comprehensive and longitudinal investigation of upstream pesticide contamination in the food supply and exposures among mothers and children. TRIAL REGISTRATION CTRI/2017/01/007636 , Date Registered: 06/01/2017. CTRI website: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=17249&EncHid=&modid=&compid=%27,%2717249det%27.
Collapse
Affiliation(s)
- Rukshan V. Mehta
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA USA
- Rollins School of Public Health, Emory University, Claudia Nance Rollins Building, 5th Floor, 1518 Clifton Road, Atlanta, GA 30329 USA
| | - M. A. Sreenivasa
- Council for Scientific and Industrial Research – Central Food Technological Research Institute, Mysuru, India
| | - Mathen Mathew
- Council for Scientific and Industrial Research – Central Food Technological Research Institute, Mysuru, India
| | - Amy Webb Girard
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA USA
- The Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Sunita Taneja
- Society for Applied Studies, Centre for Health Research and Development, New Delhi, India
| | - Samriddhi Ranjan
- Society for Applied Studies, Centre for Health Research and Development, New Delhi, India
| | - Usha Ramakrishnan
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA USA
- The Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Reynaldo Martorell
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA USA
- The Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - P. Barry Ryan
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Melissa F. Young
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA USA
- The Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| |
Collapse
|
27
|
Chen-Sankey JC, Broun A, Duarte DA, Ajith A, Jewett B, Smiley SL, Mead-Morse EL, Guy MC, Choi K. Exploring changes in cigar smoking patterns and motivations to quit cigars among black young adults in the time of COVID-19. Addict Behav Rep 2020; 12:100317. [PMID: 33364325 PMCID: PMC7752713 DOI: 10.1016/j.abrep.2020.100317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/14/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has disproportionately impacted the Black/African American communities in the U.S. The objective of this study is to understand the change in cigar smoking patterns and motivations to quit cigars during the COVID-19 pandemic among Black young adult cigar smokers. METHODS During May-June 2020, in-depth telephone interviews were conducted to investigate cigar (i.e., large cigars, cigarillos, filtered cigars, and blunts) smoking behaviors during the pandemic among self-identified, non-Hispanic Black/African American young adult cigar smokers (n = 40; ages 21-29). Interviews were audio-recorded, transcribed verbatim, and coded separately by three coders. Thematic analysis was used to assess thematic patterns arising from the interviews. RESULTS Most participants reported smoking cigarillos and blunts in higher frequency and quantity to cope with COVID-19-induced stress, anxiety, loneliness, and boredom due to economic losses and physical isolation. Some also reported contextual changes in cigarillo and blunt smoking, including smoking around the clock, smoking immediately after waking up, and smoking an entire cigarillo or blunt in one setting. Very few participants reported motivations to quit cigars during the pandemic. Perceiving higher risks of progressed COVID-19 outcomes did not prompt participants' increased motivations for quitting cigars. CONCLUSIONS Black young adults in this study increasingly smoked cigarillos and blunts during the COVID-19 pandemic, mainly attributed to daily life stressors. Participants did not have increased motivations for quitting cigars to reduce COVID-19-related risks. Promoting contextually appropriate healthy coping and cigar smoking cessation may minimize COVID-19-related health consequences of cigar smoking and reduce health disparities among Black young adults.
Collapse
Affiliation(s)
- Julia C. Chen-Sankey
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, United States
| | - Aaron Broun
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, United States
| | - Danielle A. Duarte
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, United States
| | - Aniruddh Ajith
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, United States
| | - Bambi Jewett
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, United States
| | - Sabrina L. Smiley
- University of Southern California, Keck School of Medicine, Department of Preventive Medicine, United States
| | | | - Mignonne C. Guy
- Virginia Commonwealth University, College of Humanities & Sciences, Department of African American Studies, United States
| | - Kelvin Choi
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, United States
| |
Collapse
|
28
|
Kiriazova T, Go VF, Hershow RB, Hamilton EL, Sarasvita R, Bui Q, Lancaster KE, Dumchev K, Hoffman IF, Miller WC, Latkin CA. Perspectives of clients and providers on factors influencing opioid agonist treatment uptake among HIV-positive people who use drugs in Indonesia, Ukraine, and Vietnam: HPTN 074 study. Harm Reduct J 2020; 17:69. [PMID: 32998731 PMCID: PMC7528574 DOI: 10.1186/s12954-020-00415-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/13/2020] [Accepted: 09/16/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Opioid agonist treatment (OAT) is an effective method of addiction treatment and HIV prevention. However, globally, people who inject drugs (PWID) have insufficient OAT uptake. To expand OAT access and uptake, policymakers, program developers and healthcare providers should be aware of barriers to and facilitators of OAT uptake among PWID. METHODS As a part of the HPTN 074 study, which assessed the feasibility of an intervention to facilitate HIV treatment and OAT in PWID living with HIV in Indonesia, Ukraine, and Vietnam, we conducted in-depth interviews with 37 HIV-positive PWID and 25 healthcare providers to explore barriers to and facilitators of OAT uptake. All interviews were audio-recorded, transcribed, translated into English, and coded in NVivo for analysis. We developed matrices to identify emergent themes and patterns. RESULTS Despite some reported country-specific factors, PWID and healthcare providers at all geographic locations reported similar barriers to OAT initiation, such as complicated procedures to initiate OAT, problematic clinic access, lack of information on OAT, misconceptions about methadone, financial burden, and stigma toward PWID. However, while PWID reported fear of drug interaction (OAT and antiretroviral therapy), providers perceived that PWID prioritized drug use over caring for their health and hence were less motivated to take up ART and OAT. Motivation for a life change and social support were reported to be facilitators. CONCLUSION These results highlight a need for support for PWID to initiate and retain in drug treatment. To expand OAT in all three countries, it is necessary to facilitate access and ensure low-threshold, financially affordable OAT programs for PWID, accompanied with supporting interventions. PWID attitudes and beliefs about OAT indicate the need for informational campaigns to counter misinformation and stigma associated with addiction and OAT (especially methadone).
Collapse
Affiliation(s)
- Tetiana Kiriazova
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, 27, Kyiv, 04050 Ukraine
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina At Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599 USA
| | - Rebecca B. Hershow
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina At Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599 USA
| | - Erica L. Hamilton
- Science Facilitation Department, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC 27701 USA
| | - Riza Sarasvita
- Dr. Cipto Mangunkusumo National Central General Hospital, University of Indonesia, Jalan Pangeran Diponegoro No.71, Salemba, Senen, Jakarta Pusat, Daerah Khusus Ibukota, Jakarta, 10430 Indonesia
| | - Quynh Bui
- UNC Project Vietnam, Yen Hoa Health Clinic, Lot E2, Duong Dinh Nghe Street, Cau Giay District, Hanoi, Vietnam
| | - Kathryn E. Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, 300-D Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Kostyantyn Dumchev
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, 27, Kyiv, 04050 Ukraine
| | - Irving F. Hoffman
- Division of Infectious Diseases, School of Medicine, The University of North Carolina At Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC 27599 USA
| | - William C. Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, 300-D Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Carl A. Latkin
- Department of Health, Behavior, and Society, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| |
Collapse
|
29
|
Mendez-Luck CA, Anthony KP, Guerrero LR. Burden and Bad Days Among Mexican-Origin Women Caregivers. J Gerontol B Psychol Sci Soc Sci 2020; 75:1719-1730. [PMID: 31420678 DOI: 10.1093/geronb/gbz102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/08/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This article examines the construct of burden and the use of coping strategies among Mexican-origin caregivers of older adults. METHODS In-depth semistructured interviews were conducted with 44 Mexican-origin women caregivers living in the East Los Angeles area. Audio files were transcribed and analyzed in Atlas.ti V7.1.8. Data were analyzed using a grounded theory approach. RESULTS Caregivers did not typically talk about caregiving as a burden per se; they used other terms for burden that resonated with their experiences. Caregivers viewed caregiving difficulty in physical and emotional terms as it related to specific caregiving circumstances and situations. Caregivers used a variety of coping strategies to get through bad days, including reframing stressful situations to make sense of their circumstances. DISCUSSION Findings shed light on the mixed results found in the literature on Latino caregiving burden. Results suggest that Mexican-origin women caregivers have a more nuanced experience of caregiving burden than has been found in prior literature. Results also suggest research using traditional measures of burden may not fully capture situational and cultural distinctions to the extent Mexican-origin caregivers ascribe other language to represent difficult caregiving experiences.
Collapse
|
30
|
Urbaniak A, Falk K, Heusinger J. Navigating care in rural areas: Strategies employed by older adults with continuing care needs and their impact on social exclusion. Health Place 2020; 66:102423. [PMID: 32916385 DOI: 10.1016/j.healthplace.2020.102423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 07/07/2020] [Accepted: 08/14/2020] [Indexed: 11/19/2022]
Abstract
The literature recognizes the great diversity of care arrangements among rural-dwelling older people. However, little is known about the complex relationships between spatial, social and infrastructural characteristics of place and the strategies that older people develop to navigate care. Even less is known about how navigating care impacts social exclusion from the perspective of older adults themselves. To fill this gap, in this secondary analysis we draw on data from twenty-one in-depth interviews from two studies conducted in rural environments in Germany and Poland. We identify three main strategies of navigating care in the rural environment: adaptation to circumstances, making use of the environment, and shaping circumstances. We present details from four cases that exemplify how strategies are interconnected with characteristics of place. The relationships between place and navigating care in rural environments is discussed with reference to the overall level of social exclusion experienced by rural-dwelling older adults with continuing care needs.
Collapse
Affiliation(s)
- Anna Urbaniak
- Irish Centre for Social Gerontology, Institute for Lifecourse and Society, National University of Ireland, Galway, H91C7DK, Galway, Ireland; Institut für Soziologie, Universität Wien, Rooseveltplatz 2, 1090, Wien, Austria.
| | - Katrin Falk
- Institut für Gerontologische Forschung e.V., Torstraße 178, 10115, Berlin, Germany
| | - Josefine Heusinger
- Institut für Gerontologische Forschung e.V., Torstraße 178, 10115, Berlin, Germany
| |
Collapse
|
31
|
Conkova N, Vullnetari J, King R, Fokkema T. "Left Like Stones in the Middle of the Road": Narratives of Aging Alone and Coping Strategies in Rural Albania and Bulgaria. J Gerontol B Psychol Sci Soc Sci 2020; 74:1492-1500. [PMID: 30346616 DOI: 10.1093/geronb/gby127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/03/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We explore and compare older adults' lived experiences and coping strategies in two postcommunist countries-Albania and Bulgaria. Wholesale youth outmigration and economic and institutional regional decline have led to decaying rural areas where older adults become "abandoned." Aging alone, as couples or widowed, they are socially marginalized and in constant search for coping mechanisms which enable them to survive. METHODS We adopt a social-psychology theoretical framework which distinguishes between problem-focused and emotion-focused coping. Data include 28 in-depth interviews with older residents and participant observation in selected rural areas of the two countries. RESULTS In both countries, rural social isolation is expressed as a lack of close family ties-mainly due to the removal through outmigration of children and grandchildren-and detachment from society at large. The most prevalent coping mechanism consists of practical and emotional support from non-kin ties, especially neighbors. Remittances help to resolve material needs, especially in Albania, where most rural young people migrate abroad. In both settings, a range of emotion-focused coping strategies were identified, including perceptions of decreased needs, lowered expectations about relationships, and satisfaction at the achievements of the younger generations. DISCUSSION Similarities between research findings in Albania and Bulgaria reflect their shared political and institutional history. Although few, differences relate to a combination of contrasting migration and cultural patterns. In both settings problem- and emotion-focused adaptive strategies are overlapping, and successful aging efforts seem to be of a communal rather than an individualistic nature.
Collapse
Affiliation(s)
- Nina Conkova
- Department of Public Administration and Sociology, Erasmus University Rotterdam, The Netherlands.,Leyden Academy on Vitality and Ageing, The Netherlands
| | - Julie Vullnetari
- Geography and Environmental Sciences, University of Southampton, UK
| | - Russell King
- Sussex Centre for Migration Research, University of Sussex, UK
| | - Tineke Fokkema
- Department of Public Administration and Sociology, Erasmus University Rotterdam, The Netherlands.,Netherlands Interdisciplinary Demographic Institute (NIDI-KNAW), University of Groningen, The Netherlands
| |
Collapse
|
32
|
Harrison JAK, Thomson R, Banda HT, Mbera GB, Gregorius S, Stenberg B, Marshall T. Access to health care for people with disabilities in rural Malawi: what are the barriers? BMC Public Health 2020; 20:833. [PMID: 32487088 PMCID: PMC7268500 DOI: 10.1186/s12889-020-08691-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/24/2019] [Accepted: 04/13/2020] [Indexed: 02/06/2023] Open
Abstract
Background People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside a mobility or sensory impairment, on health care accessibility is explored. Methods Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Short Set (WGSS) questions, were recruited. The WGSS questions concern a person’s ability in core functional domains (including seeing, hearing and moving), and a score of 3 indicates ‘a lot of difficulty’ whilst 4 means ‘cannot do at all’. People with cognitive impairments were not included in this study. All who were selected for the study participated in an individual in-depth interview and full recordings of these were then transcribed and translated. Results Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Attitudinal factors were explored and, whilst unfavourable health seeking behaviour was found to act as an access barrier for some participants, community and health care workers’ attitudes towards disability were not reported to influence health care accessibility in this study. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision.
Collapse
Affiliation(s)
| | - Rachael Thomson
- Collaboration for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hastings T Banda
- Research for Equity And Community Health (REACH) Trust, Lilongwe, Malawi
| | - Grace B Mbera
- Research for Equity And Community Health (REACH) Trust, Lilongwe, Malawi
| | - Stefanie Gregorius
- Collaboration for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Tim Marshall
- School for Policy Studies, University of Bristol, Bristol, UK
| |
Collapse
|
33
|
Zhou Q, Chen H, Younger KM, Cassidy TM, Kearney JM. "I was determined to breastfeed, and I always found a solution": successful experiences of exclusive breastfeeding among Chinese mothers in Ireland. Int Breastfeed J 2020; 15:47. [PMID: 32434576 PMCID: PMC7240908 DOI: 10.1186/s13006-020-00292-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/14/2019] [Accepted: 05/13/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The prevalence of exclusive breastfeeding for at least 4 months was previously found to be very low among Chinese immigrants in Ireland, at 5.8% (Zhou et al., Front Public Health 6:351, 2018). This study investigates the successful experiences of Chinese mothers living in Ireland who exclusively breastfeed for between four and 6 months. METHODS Participants were recruited from the sample of the Ireland Chinese Mother Survey. Qualitative in-depth interviews were conducted with fourteen participants in their homes or public places. RESULTS A content analysis revealed that various factors contributed to a successful experience of exclusive breastfeeding among the group of Chinese immigrant mothers, including strong self-determination; appropriate physical conditions; awareness of the benefits of exclusive breastfeeding; a lack of time constraints; and family, professional and policy support. The barriers that the mothers faced included the difficulty of balancing breastfeeding and employment, infant health issues, language barriers, an inability to consume the traditional Chinese postpartum diet and a lack of public breastfeeding facilities. Measures taken to overcome these barriers included seeking family support, resting during the lactation period, and pumping breast milk to feed from a bottle when outside the home. CONCLUSIONS This study highlights unique factors affecting exclusive breastfeeding among Chinese mothers in Ireland, which may be useful to health care professionals working with Chinese immigrant women internationally.
Collapse
Affiliation(s)
- Qianling Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.
| | - Haoyue Chen
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Katherine M Younger
- School of Biological and Health Sciences, Technological University Dublin, Kevin Street, Dublin 8, Ireland
| | - Tanya M Cassidy
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin 9, Ireland
| | - John M Kearney
- School of Biological and Health Sciences, Technological University Dublin, Kevin Street, Dublin 8, Ireland
| |
Collapse
|
34
|
Naanyu V, Ruff J, Goodrich S, Spira T, Bateganya M, Toroitich-Ruto C, Otieno-Nyunya B, Siika AM, Wools-Kaloustian K. Qualitative exploration of perceived benefits of care and barriers influencing HIV care in trans Nzoia, Kenya. BMC Health Serv Res 2020; 20:355. [PMID: 32334601 PMCID: PMC7183649 DOI: 10.1186/s12913-020-05236-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/06/2019] [Accepted: 04/17/2020] [Indexed: 01/13/2023] Open
Abstract
Background Substantial efforts have been made to ensure people living with HIV (PLHIV) are linked to and retained in care but many challenges deter care utilization. We report perceived benefits of seeking HIV care and barriers to HIV care that were identified through a formative assessment conducted to advise the development of an alternative care model to deliver antiretroviral treatment therapy (ART) in Trans Nzoia County, Kenya. Methods Data were collected in 2015 through key informant interviews (KIIs), in-depth interviews (IDIs), and focus group discussions (FGDs). The study involved 55 participants of whom 53% were female. Ten KIIs provided community contextual information and viewpoints on the HIV epidemic in Trans Nzoia County while 20 PLHIV (10 male and 10 female) participated in IDIs. Twenty-five individuals living with HIV participated in four FGDs - two groups for men and two for women. Key informants were purposively selected, while every third patient above 18 years at the Kitale HIV Clinic was invited to share their HIV care experience through IDIs or FGDs. Trained research assistants moderated all sessions and audio recordings were transcribed and analyzed thematically. Results Findings showed that PLHIV in Trans Nzoia County used both conventional and complementary alternative care for HIV; however, public health facilities were preferred. Popular perceived benefits of adopting care were relief from symptoms and the chance to live longer. Benefits of care uptake included weight gain, renewed energy, and positive behavior change. Individual-level barriers to HIV care included lack of money and food, use of alternative care, negative side effects of ART, denial, and disclosure difficulties. At the community level, stigma, limited social support for conventional HIV treatment, and poor means of transport were reported. The health system barriers were limited supplies and staff, long distance to conventional HIV care, and unprofessional providers. Conclusions Diverse individual, community and health system barriers continue to affect HIV care-seeking efforts in Kenya. Appreciation of context and lived experiences allows for development of realistic care models.
Collapse
Affiliation(s)
- V Naanyu
- Department of Health Policy and Management, School of Public Health, College of Health Science, Moi University, Eldoret, Kenya.
| | - J Ruff
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - S Goodrich
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - T Spira
- Division of Global HIV &TB, United States Centers for Disease Control & Prevention (CDC), Atlanta, GA, USA
| | - M Bateganya
- Division of Global HIV &TB, United States Centers for Disease Control & Prevention (CDC), Atlanta, GA, USA
| | | | | | - A M Siika
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - K Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
35
|
Guerrero LR, Mendez-Luck CA. Overcoming a Bad Day: a Qualitative Look into the Dementia Caregiving Experiences of Mexican-Origin Women in East Los Angeles. J Cross Cult Gerontol 2020; 34:373-384. [PMID: 31134464 DOI: 10.1007/s10823-019-09373-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/29/2022]
Abstract
The number of Latinos with Alzheimer's disease (AD) is projected to more than double by 2030. Yet, the current literature is lagging on Alzheimer's caregiving among Latinos. This study explores how Mexican origin women experience dementia caregiving, and the coping strategies they use to manage their caregiving situations. Nine women were identified as caregivers of a family member with AD or dementia from a larger study on caregiving. Interviews with them were collected and subsequently analyzed using a modified grounded theory approach to reduce the data to identify thematic content. All but one participant described caregiving as "tiring," "wearing," or "hard." They reported suffering from stress, insomnia, nervousness, migraines, and/or depression because of their caregiving experiences. Participants engaged in various coping strategies to help combat the perceived negative consequences of their caregiving experiences. The most commonly reported strategies were various forms of distraction, and meditation or prayer. The Mexican origin women in this study experience faced two types of interpersonal challenges related to dementia caregiving: changes in the care receiver's personality and behaviors, and physical care needs. They engaged in various coping to strategies to address the difficulties of their situation. This study provides formative research for identifying research questions and topics of examination in the future.
Collapse
Affiliation(s)
- Lourdes R Guerrero
- David Geffen School of Medicine at UCLA Medicine, Geriatrics, BOX 951687, 2339 PVUB, Los Angeles, CA, 90095-1687, USA.
| | - Carolyn A Mendez-Luck
- College of Public Health & Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR, 97331, USA
| |
Collapse
|
36
|
Choi Y, Oketch SY, Adewumi K, Bukusi E, Huchko MJ. A Qualitative Exploration of Women's Experiences with a Community Health Volunteer-Led Cervical Cancer Educational Module in Migori County, Kenya. J Cancer Educ 2020; 35:36-43. [PMID: 30368651 PMCID: PMC6920575 DOI: 10.1007/s13187-018-1437-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 06/08/2023]
Abstract
Detection and treatment of human papillomavirus (HPV) and cervical precancer through screening programs is an effective way to reduce cervical cancer deaths. However, high cervical cancer mortality persists in low- and middle-income countries. As screening programs become more widely available, it is essential to understand how knowledge about cervical cancer and perceived disease risk impacts screening uptake and acceptability. We evaluated women's experiences with a cervical cancer education strategy led by community health volunteers (CHVs) in Migori County, Kenya, as part of a cluster randomized controlled trial of cervical cancer screening implementation strategies. The educational modules employed simple language and images and sought to increase understanding of the relationship between HPV and cervical cancer, the mechanisms of self-collected HPV testing, and the importance of cervical cancer screening. Modules took place in three different contexts throughout the study: (1) during community mobilization; (2) prior to screening in either community health campaigns or health facilities; and (3) prior to treatment. Between January and September 2016, we conducted in-depth interviews with 525 participants to assess their experience with various aspects of the screening program. After the context-specific educational modules, women reported increased awareness of cervical cancer screening and willingness to screen, described HPV- and cervical cancer-related stigma and emphasized the use of educational modules to reduce stigma. Some misconceptions about cervical cancer were evident. With effective and context-specific training, lay health workers, such as CHVs, can help bridge the gap between cervical cancer screening uptake and acceptability.
Collapse
Affiliation(s)
- Yujung Choi
- Duke Global Health Institute, Box 90519, 310 Trent Drive, Durham, NC, 27708, USA.
| | - Sandra Y Oketch
- Center for Microbiology Research, Kenya Medical Research Institute, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
| | - Konyin Adewumi
- Duke Global Health Institute, Box 90519, 310 Trent Drive, Durham, NC, 27708, USA
| | - Elizabeth Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Washington, P.O. Box 356460, Seattle, WA, 98195, USA
| | - Megan J Huchko
- Duke Global Health Institute, Box 90519, 310 Trent Drive, Durham, NC, 27708, USA
- Department of Obstetrics and Gynecology, Duke University, 201 Trent Dr., 203 Baker House, Durham, NC, 27710, USA
| |
Collapse
|
37
|
Malede A, Aemero M, Gari SR, Kloos H, Alemu K. Barriers of persistent long-lasting insecticidal nets utilization in villages around Lake Tana, Northwest Ethiopia: a qualitative study. BMC Public Health 2019; 19:1303. [PMID: 31619208 PMCID: PMC6796332 DOI: 10.1186/s12889-019-7692-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/08/2019] [Accepted: 09/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Malaria remains a major public health problem in Ethiopia. The use of LLINs is an effective approach to reducing transmission. Persistent use of LLINs is determined by numerous factors. Quantitative studies have assessed LLIN ownership and utilization, but the behavioral, socio-cultural, socioeconomic and net distribution contexts that impact their use have not been examined in depth. This study aimed to explore barriers of persistent LLIN use among communities around Lake Tana. Methods Twenty-three community residents who owned LLINs (15) or not (8) during the study period and 38 key informants were interviewed from April to June 2017. Phenomenological study was employed to explore the local contexts and factors that influence persistent use of LLINs. Individuals were purposefully selected to capture different views. Community residents were selected based on their permanent residence and LLIN use experience. Key informants were health extension workers, local leaders, students, and health professionals. The data were managed using QSR International NVivo Version 10 software and coded, and themes were identified. Results Killing ability of nets against arthropods other than mosquitoes reportedly made use of LLINs a favored malaria prevention method despite their ineffectiveness after 3 months. Conical nets were preferred due to their compatibility with varied sleeping structures. Numerous factors influenced persistent use, notably erroneous perceptions about LLINs, malaria and mosquitoes; bedbug infestation; inconvenience; unintended uses; distribution problem of nets; and socio-cultural and economic factors. Unintended uses were often associated with local needs and seldom linked with social issues and deficiencies in information about malaria and LLINs. Collateral benefits were considered important, principally in terms of disinfestation of bedbugs. Conclusions Non-persistent LLIN use was associated with inconvenient bed net design and early damage; non-potency of the insecticide against other arthropods; facilitation of bedbug infestation; unintended uses; wrong perceptions about malaria, mosquitoes, and LLINs; and inadequate follow-up regarding LLINs utilization. Distribution of conical nets and provision of adequate information on LLINs and malaria may promote persistent use. Using an insecticide that also kills arthropods other than mosquitoes may reduce unintended uses and increase persistent use.
Collapse
Affiliation(s)
- Asmamaw Malede
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Mulugeta Aemero
- Department of Medical Parasitology, School of Biomedical & Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Sirak Robele Gari
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
38
|
Satalkar P, Shaw D. How do researchers acquire and develop notions of research integrity? A qualitative study among biomedical researchers in Switzerland. BMC Med Ethics 2019; 20:72. [PMID: 31619226 PMCID: PMC6796439 DOI: 10.1186/s12910-019-0410-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/29/2018] [Accepted: 09/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Structured training in research integrity, research ethics and responsible conduct of research is one strategy to reduce research misconduct and strengthen reliability of and trust in scientific evidence. However, how researchers develop their sense of integrity is not fully understood. We examined the factors and circumstances that shape researchers’ understanding of research integrity. Methods This study draws insights from in-depth, semi-structured interviews with 33 researchers in the life sciences and medicine, representing three seniority levels across five research universities in Switzerland. Results The results of this study indicate that early education, moral values inculcated by the family and participation in team sports were the earliest influences on notions of honesty, integrity and fairness among researchers. Researchers’ personality traits, including degree of ambition and internal moral compass, were perceived as critical in determining the importance they attributed to conducting research with high ethical standards. Positive and negative experiences in early research life also had a significant impact on their views regarding research integrity. Two thirds of the study participants had not received any formal training in research integrity. Their awareness of training opportunities at their institutions was also limited. Conclusion Age-appropriate development of honesty and integrity starts as early as primary education. Research integrity training should be offered from the bachelors level and continue throughout the entire professional life of researchers. Although these courses may not imbue researchers with integrity itself, they are essential to improving the research culture, reinforcing integrity norms, and discouraging researchers who lack personal integrity from engaging in research misconduct.
Collapse
Affiliation(s)
- Priya Satalkar
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| |
Collapse
|
39
|
Mutenherwa F, Wassenaar DR, de Oliveira T. Ethical issues associated with HIV molecular epidemiology: a qualitative exploratory study using inductive analytic approaches. BMC Med Ethics 2019; 20:67. [PMID: 31590695 PMCID: PMC6781327 DOI: 10.1186/s12910-019-0403-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 06/01/2018] [Accepted: 08/30/2019] [Indexed: 11/30/2022] Open
Abstract
Background HIV molecular epidemiology is increasingly recognized as a vital source of information for understanding HIV transmission dynamics. Despite extensive use of these data-intensive techniques in both research and public health settings, the ethical issues associated with this science have received minimal attention. As the discipline evolves, there is reasonable concern that existing ethical and legal frameworks and standards might lag behind the rapid methodological developments in this field. This is a follow-up on our earlier work that applied a predetermined analytical framework to examine the perspectives of a sample of scientists from the fields of epidemiology, public health, virology and bioethics on key ethical issues associated with HIV molecular epidemiology in HIV network research. Methods Fourteen in-depth interviews were conducted with scientists from the fields of molecular epidemiology, public health, virology and bioethics. Inductive analytical approaches were applied to identify key themes that emerged from the data. Results Our interviewees acknowledged the potential positive impact of molecular epidemiology in the fight against HIV. However, they were concerned that HIV phylogenetics research messages may be incorrectly interpreted if not presented at the appropriate level. There was consensus that HIV phylogenetics research presents a potential risk to privacy, but the probability and magnitude of this risk was less obvious. Although participants acknowledged the social value that could be realized from the analysis of HIV genetic sequences, there was a perceived fear that the boundaries for use of HIV sequence data were not clearly defined. Conclusions Our findings highlight distinct ethical issues arising from HIV molecular epidemiology. As the discipline evolves and HIV sequence data become increasingly available, it is critical to ensure that ethical standards keep pace with biomedical advancements. We argue that the ethical issues raised in this study, whether real or perceived, require further conceptual and empirical examination.
Collapse
Affiliation(s)
- Farirai Mutenherwa
- School of Applied Human Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville, Pietermaritzburg, 3209, South Africa. .,KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Douglas R Wassenaar
- School of Applied Human Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville, Pietermaritzburg, 3209, South Africa
| | - Tulio de Oliveira
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Global Health, University of Washington, Seattle, USA.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| |
Collapse
|
40
|
Maxwell AE, Young S, Moe E, Bastani R, Wentzell E. Understanding Factors that Influence Health Care Utilization Among Mixtec and Zapotec Women in a Farmworker Community in California. J Community Health 2019; 43:356-365. [PMID: 28975501 DOI: 10.1007/s10900-017-0430-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 11/25/2022]
Abstract
This paper examines health care utilization among indigenous immigrants from Oaxaca, Mexico, who have settled in a farmworker community in southern California. In 2016, two trained Spanish-Mixteco and Spanish-Zapoteco bi-lingual interviewers conducted in-depth interviews with 44 indigenous women residing in Oxnard, California on issues that affect health care utilization. Interviews were conducted in Mixteco, Zapoteco and Spanish and were coded to identify structural, cultural, and provider-related barriers to health care utilization. Five bi-lingual Spanish-Mixteco indigenous interpreters employed at local clinics were also interviewed. Many women reported lack of health insurance, inability to pay, language barriers, long waiting times, rushed encounters with providers, and seeking western medical care only after home remedies did not work. However, several women were able to access routine health care services, often with support from indigenous interpreters employed at clinics. Interviews with five interpreters found that they provided assistance with interpretation during medical encounters and appointment making. They also educated patients about upcoming exams, identified low-cost services and insurance programs available to patients, assisted with paperwork and occasionally educated physicians on behalf of their patients. In addition to addressing barriers to health care access our findings suggest the importance of identifying and leveraging community assets, such as indigenous navigators, when developing programs for such underserved communities. Our findings can inform best practice in settings that provide health care to indigenous populations and may also apply to settings that provide health care to other immigrant communities that have very limited familiarity and contact with western health care.
Collapse
Affiliation(s)
- Annette E Maxwell
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Sandra Young
- Mixteco/Indigena Community Organizing Project, PO Box 20543, Oxnard, CA, 93034, USA
| | - Emily Moe
- Department of Anthropology, University of Iowa, Iowa City, IA, USA
| | - Roshan Bastani
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA
| | - Emily Wentzell
- Department of Anthropology, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
41
|
Bukenya D, Mayanja BN, Nakamanya S, Muhumuza R, Seeley J. What causes non-adherence among some individuals on long term antiretroviral therapy? Experiences of individuals with poor viral suppression in Uganda. AIDS Res Ther 2019; 16:2. [PMID: 30665440 PMCID: PMC6340167 DOI: 10.1186/s12981-018-0214-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 07/21/2018] [Accepted: 12/10/2018] [Indexed: 12/28/2022] Open
Abstract
Background Antiretroviral therapy (ART) use by people living with HIV reduces HIV transmission, morbidity, mortality, and improves quality of life. Good ART adherence is required to achieve these benefits. We investigated how the environmental, social, economic and behavioural experiences of people living with HIV with poor viral suppression could explain their non-adherence to long term ART. Methods This qualitative cross-sectional study was conducted in Uganda between September 2015 and April 2016. Thirty individuals on ART for 5 years or more (10 on first line and 20 on second line), with poor viral suppression, were randomly selected from a cohort of people living with HIV on ART. In-depth interviews about ART; awareness, adherence counselling, obstacles to daily adherence and regimen switches were conducted. Emerging themes from the interviews transcripts and field notes were identified and thematic content analysis done. Participants’ consent, compensation, confidentiality and study ethical approvals were ensured. Results We found that poor adherence to long term ART was due to: travel for work or social activities, stigma, receiving little or no continuous ART adherence education, alcohol consumption and use of alternative ‘HIV cure’ medicines. Other reasons included; ART side effects, treatment fatigue, belief that long-term ART or God can ‘cure HIV’, and food security. Conclusions Achieving optimal ART benefits requires continuous provision of ART adherence education to individuals on long term ART. This helps them overcome the challenges related to living with HIV: worries of food insecurity, alcohol misuse, economic hardship, and beliefs in HIV cures and use of unproven alternative HIV treatments. People living with HIV who travel require adherence support and larger quantities of ART refills to cover their time away.
Collapse
|
42
|
Ayoub JJ, Abiad M, Forman MR, Honein-AbouHaidar G, Naja F. The interaction of personal, contextual, and study characteristics and their effect on recruitment and participation of pregnant women in research: a qualitative study in Lebanon. BMC Med Res Methodol 2018; 18:155. [PMID: 30497391 PMCID: PMC6267028 DOI: 10.1186/s12874-018-0616-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 04/05/2018] [Accepted: 11/14/2018] [Indexed: 01/05/2023] Open
Abstract
Background Declining participation rates are impeding health research. Little is known about factors influencing the decision to participate in low- and middle-income countries (LMIC). Therefore, this paper reports on the various individual factors and their with contextual factors in influencing participation in research among pregnant women and the recommendations to enhance their recruitment in Lebanon. Methods This study used a qualitative research design drawing on focus groups and in-depth interviews. The Theoretical Domain Framework guided data collection and analysis. The three participant groups included: Group 1-Pregnant women (n = 25) attending public pre-natal events and antenatal clinics in Beirut; Group 2-Pregnant women (n = 6) already enrolled in the ongoing Mother and Infant Nutritional Assessment birth cohort study; Group 3-Key informants (n = 13) including health care workers involved in recruiting pregnant women. Conversations were audio recorded, transcribed, translated into English, and thematically analyzed. Results Three main factors influencing participation were revealed, with each factor encompassing several sub-themes: (1) personal factors (altruism, self-confidence, personal interest in the topic, previous understanding of the nature and purpose of research, education level, and previous research experience), (2) contextual factors (societal factors, family and friends), and (3) study characteristics (burden of the study, ethical considerations, incentives, and research interpersonal skills and physician endorsement to participate). The results suggested a dynamic interaction among the identified factors, forming two intersecting axes, with a four-quadrant configuration. The y- and x-axes represented personal factors and contextual factors, respectively. Individuals positioned on the lower-left quadrant were the least likely to participate; those on the upper-right quadrant were the most likely to participate; while those on the upper-left and lower-right quadrants were indecisive. Study characteristics seemed to affect the decision of pregnant women to participate situated in any of the four quadrants. Specific recommendations to improve participation were also identified. Conclusions Our findings suggested an interaction of personal factors, contextual factors, and study characteristics affecting subjects’ participation. This interaction integrates factors into a novel dynamic framework that could be used in future studies. The recommendations identified may help improve participation of pregnant women in health research hence enhancing the quality and generalizability of research findings in LMIC. Electronic supplementary material The online version of this article (10.1186/s12874-018-0616-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jennifer J Ayoub
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - May Abiad
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Michele R Forman
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | | | | | - Farah Naja
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.
| |
Collapse
|
43
|
Podmore B, Hutchings A, Durand MA, Robson J, Konan S, van der Meulen J, Lynch R. Comorbidities and the referral pathway to access joint replacement surgery: an exploratory qualitative study. BMC Health Serv Res 2018; 18:754. [PMID: 30285847 PMCID: PMC6171304 DOI: 10.1186/s12913-018-3565-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/31/2018] [Accepted: 09/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background Variation in access to joint replacement surgery has been widely reported but less attention has been given to the impact of comorbidities on the patient journey to joint replacement surgery. There is a lack of consensus amongst healthcare professionals and commissioners about how patients with comorbidities should be referred or selected for joint replacement surgery. It is therefore important to understand the views of healthcare professionals on the management, referral and selection of patients with comorbidities for joint replacement surgery. Methods An exploratory qualitative study involving semi-structured interviews with 20 healthcare professionals in England across the referral pathway to joint replacement surgery. They were asked to talk about their experiences of referring and selecting patients with comorbidities for joint replacement surgery. The interviews were audio-recorded and transcribed verbatim. Data analysis followed a thematic analysis approach based on the principles of grounded theory. Results In general, the presence of comorbidities was not seen as a barrier to being referred or selected for joint replacement but was seen as a challenge to manage the patients’ journey across the referral pathway. Each professional group, concentrated on different aspects of the patients’ condition which appeared to affect how they managed patients with comorbidities. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the professionals believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. Conclusions At the clinician-level, comorbidities were not perceived as a barrier to accessing joint replacement surgery but at the pathway-level, it may create an implicit barrier such that patients with comorbidities may get ‘lost’ to the system. Further study is needed to explore the roles and responsibilities of professionals across the current orthopaedic referral pathway which may be less suitable for patients with comorbidities. Electronic supplementary material The online version of this article (10.1186/s12913-018-3565-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Bélène Podmore
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. .,Clinical Effectiveness Unit, The Royal College of Surgeons of England, England, UK.
| | - Andrew Hutchings
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, England, UK
| | - Mary-Alison Durand
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - John Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sujith Konan
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, England, UK
| | - Rebecca Lynch
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| |
Collapse
|
44
|
Rehnström Loi U, Lindgren M, Faxelid E, Oguttu M, Klingberg-Allvin M. Decision-making preceding induced abortion: a qualitative study of women's experiences in Kisumu, Kenya. Reprod Health 2018; 15:166. [PMID: 30285768 PMCID: PMC6171301 DOI: 10.1186/s12978-018-0612-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 01/31/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022] Open
Abstract
Background Unwanted pregnancies and unsafe abortions are prevalent in regions where women and adolescent girls have unmet contraceptive needs. Globally, about 25 million unsafe abortions take place every year. In countries with restrictive abortion laws, safe abortion care is not always accessible. In Kenya, the high unwanted pregnancy rate resulting in unsafe abortions is a serious public health issue. Gaps exist in knowledge regarding women’s decision-making processes in relation to induced abortions in Kenya. Decision-making is a fundamental factor for consideration when planning and implementing contraceptive services. This study explored decision-making processes preceding induced abortion among women with unwanted pregnancy in Kisumu, Kenya. Methods Individual face-to-face in-depth interviews were conducted with nine women aged 19–32 years old. Women who had experienced induced abortion were recruited after receiving post-abortion care at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) or Kisumu East District Hospital (KDH) in Kisumu, Kenya. In total, 15 in-depth interviews using open-ended questions were conducted. All interviews were tape-recorded, transcribed and coded manually using inductive content analysis. Results Respondents described their own experiences regarding decision-making preceding induced abortion. This study shows that the main reasons for induced abortion were socio-economic stress and a lack of support from the male partner. In addition, deviance from family expectations and gender-based norms highly influenced the decision to have an abortion among the interviewed women. The principal decision maker was often the male partner who pressed for the termination of the pregnancy indirectly by declining his financial or social responsibilities or directly by demanding termination. In some cases, the male partner controlled decision-making by arranging an unsafe abortion without the woman’s consent. Strategic choices regarding whom to confide in were employed as protection against abortion stigma. This contributed to a culture of silence around abortion and unwanted pregnancy, a factor that made women more vulnerable to complications. Conclusions The findings suggest that financial, social and gender-based dependencies influence women’s agency and perceived options in decision-making regarding abortion.
Collapse
Affiliation(s)
- Ulrika Rehnström Loi
- Department of Public Health Sciences/IHCAR, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Matilda Lindgren
- Department of Public Health Sciences/IHCAR, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Elisabeth Faxelid
- Department of Public Health Sciences/IHCAR, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Monica Oguttu
- College of Health Sciences, School of Nursing Sciences, University of Nairobi, Nairobi, Kenya.,Kisumu Medical Education Trust (KMET), Kisumu, Kenya
| | - Marie Klingberg-Allvin
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Högskolegatan 2, 791 31, Falun, Sweden
| |
Collapse
|
45
|
Rombach M, Bitsch V, Kang E, Ricchieri F. Comparing German and Italian food banks: Actors' knowledge on food insecurity and their perception of the interaction with food bank users. Br Food J 2018; 120:2425-2438. [PMID: 30581195 PMCID: PMC6289091 DOI: 10.1108/bfj-11-2017-0626] [Citation(s) in RCA: 2] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/09/2018] [Accepted: 03/17/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE The purpose of this paper is to investigate food bank actors' knowledge of food insecurity in Germany and in Italy, as well as interactions between food bank actors and food bank users. The study builds on a knowledge framework from an educational context and applies it to food banks. DESIGN/METHODOLOGY/APPROACH The study uses a qualitative research approach. In all, 22 in-depth interviews were recorded, transcribed and analyzed through inductive qualitative content analysis. FINDINGS German and Italian food bank actors interviewed had at least situational knowledge on food insecurity. Some actors of the Italian food bank also showed procedural knowledge. Interactions between food bank personnel and users were affected by feelings of gratitude, shame, anger and disappointment. ORIGINALITY/VALUE The study explores food bank personnel's knowledge on food insecurity, which appears to be a knowledge gap, even though many prior studies were dedicated to food banks and food insecurity. The study contributes to knowledge systematization to provide best practice recommendations for volunteer-user interaction, and suggests how food bank managers and volunteers' knowledge can be improved.
Collapse
Affiliation(s)
- Meike Rombach
- Chair of Economics of Horticulture and Landscaping, Technical University of Munich, Munich, Germany
| | - Vera Bitsch
- Chair of Economics of Horticulture and Landscaping, Technical University of Munich, Munich, Germany
| | - Eunkyung Kang
- Chair of Economics of Horticulture and Landscaping, Technical University of Munich, Munich, Germany
| | - Francesco Ricchieri
- Chair of Economics of Horticulture and Landscaping, Technical University of Munich, Munich, Germany
| |
Collapse
|
46
|
Stuij M. 'Physical activity, that's a tricky subject.' Experiences of health care professionals with physical activity in type 2 diabetes care. BMC Health Serv Res 2018; 18:297. [PMID: 29685135 PMCID: PMC5914058 DOI: 10.1186/s12913-018-3102-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 09/27/2017] [Accepted: 04/08/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Based on a growing body of epidemiological and biomedical studies, physical activity (PA) is considered a cornerstone in type 2 diabetes treatment. However, it is also a practice embedded in daily life and, as such, may produce certain frictions as a topic in health care. The aim of this article is to give in-depth insight into experiences of health care professionals with the delivery of PA counselling to people with type 2 diabetes. METHODS This study is based on in-depth interviews with 24 Dutch professionals providing care to people with type 2 diabetes. They were asked to tell about their experiences with PA in different roles, both in their professional and personal lives. The interviews were audio-recorded and transcribed verbatim. Data analysis followed a narrative approach with not only a focus on what was told, but also on how this was constructed in interaction with the interviewer, the cultural resources that were drawn on and inconsistencies or alternatives that were presented. This narrative focus was used to explore how professionals made sense of their experiences with PA counselling within the wider sociocultural context. RESULTS While the professionals view PA as a foundation of type 2 diabetes treatment, they experience it to be a tricky subject. Two main areas of tension were identified: (1) the understanding of patient behaviour; and (2) professionals' views on responsibilities, both on their responsibilities as professionals and their notions on who is responsible for behaviour change. CONCLUSIONS Health care professionals providing PA counselling to people with type 2 diabetes have to navigate between possibilities within the diabetes care framework, options for an embedding of PA in the patient's lifeworld, and the professionals' opinions on and experiences with PA and healthy living from their own lifeworld. This makes PA a complex topic of care.
Collapse
Affiliation(s)
- Mirjam Stuij
- Department of Medical Humanities, APH Research Institute, VU University medical centre, De Boelelaan 1089a, 1081, HV, Amsterdam, the Netherlands.
- Mulier Institute, Herculesplein 269, 3584, AA, Utrecht, the Netherlands.
| |
Collapse
|
47
|
Leavy B, Berntsson J, Franzén E, Skavberg Roaldsen K. Perceptions of balance and falls following a supervised training intervention - a qualitative study of people with Parkinson's disease. Disabil Rehabil 2017; 41:934-940. [PMID: 29265899 DOI: 10.1080/09638288.2017.1417498] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To explore perceptions of balance and falls among people with mild to moderate Parkinson's disease 3 - 12 months following participation in supervised balance training. MATERIALS AND METHODS This qualitative study used in-depth individual interviews for data collection among 13 people with Parkinson's disease. Interviews were systematically analyzed using qualitative content analysis with an inductive approach. RESULTS Three main themes arose: Falls - avoided and intended highlights the wide spectrum of fall perceptions, ranging from worse-case scenario to undramatized events; Balance identity incorporates how gradual deterioration in balance served as a reminder of disease progression and how identifying themselves as "aware not afraid" helped certain participants to maintain balance confidence despite everyday activity restriction; Training as treatment recounts how participants used exercise as disease self-management with the aim to maintain independence in daily life. Interpretation of the underlying patterns of these main themes resulted in the overarching theme Training as treatment when battling problems with balance and falls. CONCLUSIONS Whereas certain participants expressed a fear of falling which they managed by activity restriction, others described being confident in their balance despite avoidance of balance-challenging activities. Training was used as treatment to self-manage disease-related balance impairments in order to maintain independence in daily life. Implication for Rehabilitation People with Parkinson's disease require early advice about the positive effects of physical activity as well as strategies for self-management in order to ease the psychological and physical burden of progressive balance impairment. Fear of falling should be investigated alongside activity avoidance in this group in order to provide a more accurate insight into the scope of psychological concerns regarding balance and falls in everyday life. Certain people with Parkinson's disease define their balance according to activities they continue to participate in, while others who express fear-related activity avoidance require help to adapt balance-challenging activities in order to maintain balance confidence and avoid physical inactivity.
Collapse
Affiliation(s)
- Breiffni Leavy
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Huddinge , Sweden.,b Stockholms Sjukhem Foundation , Stockholm , Sweden
| | - Johan Berntsson
- c Karolinska University Hospital, Function Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function , Stockholm , Sweden
| | - Erika Franzén
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Huddinge , Sweden.,b Stockholms Sjukhem Foundation , Stockholm , Sweden.,c Karolinska University Hospital, Function Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function , Stockholm , Sweden
| | - Kirsti Skavberg Roaldsen
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Huddinge , Sweden.,d Department of Research , Sunnaas Rehabilitation Hospital , Oslo , Norway.,e Faculty of Health Sciences, Department of Physiotherapy , Oslo and Akershus University College of Applied Sciences , Oslo , Norway
| |
Collapse
|
48
|
Kirkman M, Apicella C, Graham J, Hickey M, Hopper JL, Keogh L, Winship I, Fisher J. Meanings of abortion in context: accounts of abortion in the lives of women diagnosed with breast cancer. BMC Womens Health 2017; 17:26. [PMID: 28381301 PMCID: PMC5382471 DOI: 10.1186/s12905-017-0383-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 03/24/2016] [Accepted: 03/30/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A breast cancer diagnosis and an abortion can each be pivotal moments in a woman's life. Research on abortion and breast cancer deals predominantly with women diagnosed during pregnancy who might be advised to have an abortion. The other-discredited but persistent-association is that abortions cause breast cancer. The aim here was to understand some of the ways in which women themselves might experience the convergence of abortion and breast cancer. METHODS Among 50 women recruited from the Australian Breast Cancer Family Study and interviewed in depth about what it meant to have a breast cancer diagnosis before the age of 41, five spontaneously told of having or contemplating an abortion. The transcripts of these five women were analysed to identify what abortion meant in the context of breast cancer, studying each woman's account as an individual "case" and interpreting it within narrative theory. RESULTS It was evident that each woman understood abortion as playing a different role in her life. One reported an abortion that she did not link to her cancer, the second was relieved not to have to abort a mid-treatment pregnancy, the third represented abortion as saving her life by making her cancer identifiable, the fourth grieved an abortion that had enabled her to begin chemotherapy, and the fifth believed that her cancer was caused by an earlier abortion. CONCLUSIONS The women's accounts illustrate the different meanings of abortion in women's lives, with concomitant need for diverse support, advice, and information.
Collapse
Affiliation(s)
- Maggie Kirkman
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Carmel Apicella
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jillian Graham
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
| | - Martha Hickey
- School of Medicine, The University of Melbourne, Melbourne, Australia
| | - John L. Hopper
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Louise Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ingrid Winship
- School of Medicine, The University of Melbourne, Melbourne, Australia
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
49
|
Abstract
OBJECTIVES Despite extensive research into the determinants of electronic nicotine delivery system (ENDS) uptake, few studies have examined the psychosocial benefits ENDS users seek and experience. Using a consumer ritual framework, we explored how ENDS users recreated or replaced smoking practices, and considered implications for smoking cessation. DESIGN In-depth interviews; data analysed using thematic analysis. SETTING Dunedin, New Zealand. PARTICIPANTS 16 young adult ENDS users (age M=21.4, SD=1.9; 44% female). RESULTS Participants reported using different ENDS to achieve varying outcomes. Some used 'cigalikes' to recreate a physically and visually similar experience to smoking; they privileged device appearance over nicotine delivery. In contrast, others used personally crafted mods to develop new rituals that differentiated them from smokers and showcased their technical expertise. Irrespective of the device they used, several former smokers and dual users of cigarettes and ENDS experienced strong nostalgia for smoking attributes, particularly the elemental appeal of fire and the finiteness of a cigarette. Non-smoking participants used ENDS to maintain social connections with their peers. CONCLUSIONS Participants used ENDS to construct rituals that recreated or replaced smoking attributes, and that varied in the emphasis given to device appearance, nicotine delivery, and social performance. Identifying how ENDS users create new rituals and the components they privilege within these could help promote full transition from smoking to ENDS and identify those at greatest risk of dual use or relapse to cigarette smoking.
Collapse
Affiliation(s)
- Janet Hoek
- Department of Marketing, University of Otago, Dunedin, New Zealand
| | - Johannes Thrul
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - Pamela Ling
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
50
|
Masiye F, Mayosi B, de Vries J. "I passed the test!" Evidence of diagnostic misconception in the recruitment of population controls for an H3Africa genomic study in Cape Town, South Africa. BMC Med Ethics 2017; 18:12. [PMID: 28202021 PMCID: PMC5311841 DOI: 10.1186/s12910-017-0175-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/13/2016] [Accepted: 02/08/2017] [Indexed: 11/26/2022] Open
Abstract
Background Advances in genetic and genomic research have introduced challenges in obtaining informed consent for research in low and middle-income settings. However, there are only few studies that have explored challenges in obtaining informed consent in genetic and genomic research in Africa and none in South Africa. To start filling this gap, we conducted an empirical study to investigate the efficacy of informed consent procedures for an H3Africa genomic study on Rheumatic Heart Disease (RHDGen) at the University of Cape Town in South Africa. The main aim of the study was to understand ethical challenges in obtaining informed consent in the RHDGen study. Methods We used a qualitative study methodology involving in-depth interviews and participant observations. Our study participants were RHDGen cases (patients), healthy controls and research staff involved in the recruitment of RHDGen cases and controls. In total, we conducted 32 in-depth interviews with RHDGen cases and controls, 2 in-depth interviews with research staff and 57 direct observations of the consent procedures of RHDGen cases and controls. The interviews were conducted in English, audio-recorded and transcribed verbatim. Data were analyzed using thematic content analysis. The study was conducted in 3 sites within Cape Town, South Africa. Results Most healthy controls joined the RHDGen study in order to be screened for rheumatic heart disease (diagnostic misconception). A majority of RHDGen cases decided to join the RHDGen study because of therapeutic misconception. Conclusion The ethical challenges that impacted on obtaining informed consent in the RHDGen study were complex. In this study, the main challenges were diagnostic misconception among RHDGen controls and therapeutic misconception among RHDGen cases.
Collapse
Affiliation(s)
- Francis Masiye
- Department of Medicine, University of Cape Town, Faculty of Health Sciences, Cape Town, South Africa. .,University of Malawi College of Medicine, School of Public Health, Centre for Bioethics in Eastern and Southern Africa (CEBESA), Private Bag 360, Chichiri, Blantyre, Malawi.
| | - Bongani Mayosi
- Department of Medicine, University of Cape Town, Faculty of Health Sciences, Cape Town, South Africa
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Faculty of Health Sciences, Cape Town, South Africa
| |
Collapse
|