"…in the middle of nowhere…" Access to, and quality of, services for autistic adults from parents' perspectives: a qualitative study

Introduction

Adequate education, employment, and services for autistic individuals contribute significantly to their and their parents' quality of life. Services and support for adults are dramatically more limited than those for children. The main purpose of this study was to explore how parents perceive factors supporting/hindering access to services, and how they assess the quality of services.

Methods

Qualitative data provided by 12 parents via a semi-structured interview with a broader focus on parental quality of life and its factors were analyzed. Their autistic children were between 20 and 34 years of age. A thematic analysis was performed on parts of the narratives on their adult periods of life.

Results

A complex pattern of parental perception of supportive and hampering factors influencing access to services unfolded. The sparsity of services/activities and reliable information on them made the space for autonomous decisions on service take highly limited. Parents have modest expectations on quality of services, evaluating them along two key aspects: a safe, positive atmosphere, and communication between parents and professionals. Other aspects of individualized autism-specific support were not or just rarely mentioned.

Discussion

Parents perceive themselves as investing a lot of effort and resources in getting some form of regular service and/or activity for their adult child. However, these parental efforts often fail, their child becoming inactive, and dependent on their presence. This suggests system-level problems with services for autistic adults in Hungary, with literature showing it is not specific to this country.

Distance-quality trade-off and choice of family planning provider in urban Pakistan

BACKGROUND

There is limited evidence between contraceptive use, availability of commodities and distance to the facility in developing countries. Distance to the facility is an essential determinant of contraceptive use. Still, women may not seek family planning services from the nearest facility and may be prepared to travel the farthest distance to receive quality family planning services.

METHODS

We analyzed women's survey data linked to health facility data and applied an alternate specific conditional logit model to examine the distance a woman is prepared to travel and the quality of services offered by facilities in urban areas in Karachi, Pakistan.

RESULTS

This study analyzed data from 336 women and 28 facilities and identified that the mean distance to the nearest facility was 0.44 km; the chosen facility was, on average, 5 km away. Women preferred facilities that offered a range of contraceptive methods and additional services provided by female healthcare providers only. Furthermore, on average, women are willing to travel a further 1.7 km for a facility that offers more family planning methods, 1.4 km for a facility that offers additional health services and 11 km for a facility that offers services delivered by female healthcare providers.

CONCLUSIONS

The findings highlight the quality measures women prioritize over distance and consider essential when choosing a family planning facility.

Data Analytics, Self-Organization, and Security Provisioning for Smart Monitoring Systems

Internet availability and its integration with smart technologies have favored everyday objects and things and offered new areas, such as the Internet of Things (IoT). IoT refers to a concept where smart devices or things are connected and create a network. This new area has suffered from big data handling and security issues. There is a need to design a data analytics model by using new 5G technologies, architecture, and a security model. Reliable data communication in the presence of legitimate nodes is always one of the challenges in these networks. Malicious nodes are generating inaccurate information and breach the user's security. In this paper, a data analytics model and self-organizing architecture for IoT networks are proposed to understand the different layers of technologies and processes. The proposed model is designed for smart environmental monitoring systems. This paper also proposes a security model based on an authentication, detection, and prediction mechanism for IoT networks. The proposed model enhances security and protects the network from DoS and DDoS attacks. The proposed model evaluates in terms of accuracy, sensitivity, and specificity by using machine learning algorithms.

University social responsibility under the influence of societal changes: Students' satisfaction and quality of services in Saudi Arabia

Universities contribute to shaping the identity of a nation with their major university social responsibility (USR) in addition to their academic purposes and corporate strategies. In Saudi Arabia with Vision 2030, universities are facing a transformation in adapting to the societal changes and implementing a socially responsible management, considering the satisfaction of their most important stakeholders (i.e., the students) and the quality of services offered to them. This study aims to explore how USR fulfills the societal changes in Saudi Arabia from the perspective of university students in addition to inspecting USR's relationships with the students' satisfaction and the quality of services offered to them. A self-report study was conducted with 350 undergraduate students in the Faculty of Social Sciences in a Social Work program at a University in the Western region of Saudi Arabia. An inside-outside (I-O) map of USR was applied to investigate the relationships among USR's aspects. The study results demonstrated a moderate level of agreement by students toward the university's fulfillment of its USR, quality of services offered to them, and their satisfaction. In contrast, the results of a regression analysis revealed that all USR aspects could explain only 13% of the students' satisfaction. Legal responsibilities, among all USR aspects, exhibited the highest influence on students' satisfaction. Gender differences existed in favor of female students' perceptions toward the university's fulfillment of its USR. The I-O map provided interesting insights to interpret the correlations among all USR aspects under the influence of societal changes that have occurred under Saudi Vision 2030.

[The experience of SERVQUAL technique application in measuring satisfaction of patients with medical services quality]

The implementation of system of quality control conforming to requirements of interstate ISO 9001 standards in in the medical organization, the important role is assigned to indicator of satisfaction of patients with quality of medical care as a feedback channel. The study purpose was to investigate satisfaction of patients with quality of medical services in medical organization rendering hospital medical care on the basis of SERVQUAL technique. The analysis of results of survey of 339 patients treated in the twenty-four-hour department of municipal hospital demonstrated rather high rating of perception of quality of rendered medical services that made up to 4.47 points according five-point scale. The application of GAP analysis technique allowed to reveal gaps between expected and real quality of received medical services by means of SQL index quality. The highest points were received for such criteria as "Sympathy" (0.61 points), "Responsiveness" (0.20 points). The satisfactory results were in case of criteria "Materiality" (-0.38 points), "Reliability (-0.43 points). The lowest points were received for criteria "Persuasiveness, confidence" (-0.69 points) that reflects inadequate orientation of hospital personnel to settle problems of patients. The study demonstrated that applying the SERVQUAL technique in assessment of quality of medical services allows to reveal the most significant factors determining satisfaction of patients. The results of survey based on the SERVQUAL technique and processed by GAP analysis are to be considered in management decision making concerning choice of correcting and preventive actions in quality management of rendering medical services at the regional level.

Inclusion of relatives in stroke rehabilitation: Perception of quality of services they received in the context of early supported discharged (ESD), in- and out-patient services

BACKGROUND

Relatives of stroke patients should be an integral part of the continuum of rehabilitation services.

OBJECTIVE

The objective was to describe their perception of the quality of the services they received in the context of early supported discharged (ESD), in- and out-patient rehabilitation services.

METHODS

Descriptive study using the Quality of Services Questionnaire for Relatives post-stroke (QSQR) completed online by relatives after the patient's discharge. It consists of 22 statements with respect to three subscales: 1) the training/instructions, 2) the information provision and 3) the organizational process of the service offer. Space is allowed for free comments and two open-ended questions. Quantitative data were analyzed descriptively, and we used a content analysis for qualitative data.

RESULTS

One-third (30/90; 33.3%) of the sample are composed of relatives aged 55 and under, with a majority (81%) of women and 51.3% of spouses. The training/instructions and information provision were perceived positively with a mean % agreement at 85.0 ± 29.6 and 84.8 ± 22.4, respectively. The mean % agreement was 91.4 ± 17.8 for the organizational process subscale. A significantly higher score (p = 0,03; Kruskal Wallis test) was found for out-patient services (n = 20) as compared to ESD (n = 29) or in-patient rehabilitation (n = 41). Qualitatively, a lack of involvement of relatives was mentioned as well as a lack of personalized information about stroke and its consequences and provision of resources available. However, communication between professionals, their availability, and their professionalism were appreciated.

CONCLUSION

Despite quantitative high scores, qualitative data allowed the identification of concrete avenues for improvement to truly and systematically include relatives in stroke rehabilitation.

How Do Public and Private Facilities Compare?

Background: Family planning (FP) is among the important interventions that reduce maternal mortality. Poor quality FP service is associated with lower services utilisation, in turn undermining the efforts to address maternal mortality. There is currently little research on the quality of FP services in the private sector in Ethiopia, and how it compares to FP services in public facilities. Methods: A secondary data analysis of two national surveys, Ethiopia Services Provision Assessment Plus Survey 2014 and Ethiopian Demographic and Health Survey 2016, was conducted. Data from 1094 (139 private, 955 public) health facilities were analysed. In total, 3696 women were included in the comparison of users’ characteristics. Logistic regression was conducted. Facility type (public vs. private) was the key exposure of interest. Results: The private facilities were less likely to have implants (Adjusted Odds Ratio (AOR) = 0.06; 95% Confidence Interval (CI): 0.03, 0.12), trained FP providers (AOR = 0.23; 95% CI: 0.14, 0.41) and FP guidelines/protocols (AOR = 0.33; 95% CI: 0.19, 0.54) than public facilities but were more likely to have functional cell phones (AOR = 8.20; 95% CI: 4.95, 13.59) and water supply (AOR = 3.37; 95% CI: 1.72, 6.59). Conclusion: This study highlights the need for strengthening both private and public facilities for public–private partnerships to contribute to increased FP use and better health outcomes.

An Energy-Efficient Clustering Routing Protocol Based on a High-QoS Node Deployment with an Inter-Cluster Routing Mechanism in WSNs

Currently, wireless sensor network (WSN) protocols are mainly used to achieve low power consumption of the network, but there are few studies on the quality of services (QoS) of these networks. Coverage can be used as a measure of the WSN’s QoS, which can further reflect the quality of data information. Additionally, the coverage requirements of regional monitoring target points are different in real applications. On this basis, this paper proposes an energy-efficient clustering routing protocol based on a high-QoS node deployment with an inter-cluster routing mechanism (EECRP-HQSND-ICRM) in WSNs. First, this paper proposes formula definitions for information integrity, validity, and redundancy from the coverage rate and introduces a node deployment strategy based on twofold coverage. Then, in order to satisfy the uniformity of the distribution of cluster heads (CHs), the monitoring area is divided into four small areas centered on the base station (BS), and the CHs are selected in the respective cells. Finally, combined with the practical application of the WSN, this paper optimizes the Dijkstra algorithm, including: (1) nonessential paths neglecting considerations, and (2) a simultaneous introduction of end-to-end weights and path weights, achieving the selection of optimal information transmission paths between the CHs. The simulation results show that, compared with the general node deployment strategies, the deployment strategy of the proposed protocol has higher information integrity and validity, as well as lower redundancy. Meanwhile, compared with some classic protocols, this protocol can greatly reduce and balance network energy consumption and extend the network lifetime.

Are reasons for care-giving related to carers' care-related quality of life and strain? Evidence from a survey of carers in England

In England, choice and control is promoted for service users in relation to social care services. Increased choice and control has also been promoted for unpaid carers, although this is still relatively underdeveloped. There is limited recognition of carers' choice in terms of the decision of whether to provide care. Alongside the promotion of choice and control, there has also been a focus on quality of life as an outcome of social care for care-recipients and their carers. Although it is known that carer choice (in terms of the decision of whether or not to provide care) is related to increased burden and poorer psychological health, there is limited evidence of the relationship between reasons for caring and care-related quality of life (CRQoL) and subjective strain in England. In this study, 387 carers were surveyed across 22 English local authorities between June 2013 and March 2014. Multiple regression analysis explored the relationship between carer-reported reasons for caring and CRQoL and strain, whilst controlling for individual characteristics (e.g. age). Reasons for caring were important predictors of CRQoL and strain. Where people were carers because social services suggested it or the care-recipient would not want help from anyone else, this was related to lower CRQoL. By contrast, where carers took on care-giving because they had time to care, this was significantly associated with better CRQoL. Carers reported greater strain where they provided care because it was expected of them. These findings are relevant to policy and practice because they indicate that, while social care systems rely on carers, the limiting of carers' choice of whether to provide care is related to worse outcomes. Increased awareness of this relationship would be beneficial in developing policy and practice that improves the QoL of care-recipients and also their carers.

Exploring health insurance services in Sudan from the perspectives of insurers

Background

It has been 20 years since the introduction of health insurance in Sudan. This study was the first one that explored health insurance services in Sudan from the perspectives of the insurers.

Methods

This was a qualitative, exploratory, interview study. The sampling frame was the list of Social Health Insurance and Private Health Insurance institutions in Sudan. Participants were selected from the four Social Health Insurance institutions and from five Private Health Insurance companies. The study was conducted in January and February 2017. In-depth individual interviews were conducted with a convenient sample of key executives from the different health insurers. Ideas and themes were identified and analysed using thematic analysis.

Results

The result showed that universal coverage was not achieved despite long time presence of Social Health Insurance and Private Health Insurance in Sudan. All participants described their services as comprehensive. All participants have good perception of the quality of the services they provide, although none of them investigated customer satisfaction. The main challenges facing Social Health Insurance are achieving universal coverage, ensuring sustainability and recruitment of the informal sector and self-employed population. Consumers' affordability of the premiums is the main obstacle for Private Health Insurance, while rising healthcare cost due to economic inflation is a challenge facing both Social Health Insurance and Private Health Insurance.

Conclusion

In spite of the presence of Social Health Insurance and Private Health Insurance in Sudan, the country is still far from achieving universal coverage. Moreover, the sustainability of health insurance is questionable. The main reasons include low governmental financial resources and lack of affordability by beneficiaries especially for Private Health Insurance. This necessitates finding solutions to improve them or trying other types of health insurance. The quality of services provided by Social Health Insurance and Private Health Insurance was described as good, but no insurance in Sudan measured customer satisfaction as yet.

Experiences of parents of children with special needs at school entry: a mixed method approach

BACKGROUND

The transition from pre-school to kindergarten can be complex for children who need special assistance due to mental or physical disabilities (children with 'special needs'). We used a convergent mixed method approach to explore parents' experiences with service provision as their children transitioned to school.

METHODS

Parents (including one grandparent) of 37 children aged 4 to 6 years completed measures assessing their perceptions of and satisfaction with services. Semi-structured interviews were also conducted with 10 parents to understand their experience with services.

RESULTS

Post transition, parents reported lower perceptions of services and decreased satisfaction than pre-transition. The following themes emerged from the qualitative data: qualities of services and service providers, communication and information transfer, parent advocacy, uncertainty about services, and contrasts and contradictions in satisfaction. The qualitative findings indicate that parents were both satisfied and concerned with aspects of the post-transition service provision.

CONCLUSIONS

While the quantitative results suggested that parents' experience with services became less positive after their children entered school, the qualitative findings illustrated the variability in parents' experiences and components of service provision that require improvements to facilitate a successful school entry.

Evaluation of the Quality of Health Service Providers: The Iranian People Perspective 2014

INTRODUCTION

Quality is the center of attention in all service providing organizations that are effective in promoting satisfaction of patients who are referred to medical centers. The aim of this study was to investigate the quality of health service providers in a case study of Qazvin, Iran, in 2014.

METHODS

This descriptive study was conducted on 1,002 people who were residents of Qazvin Province (Iran) in 2014. The people were selected randomly from the population of the study area. The main variables studied were education, perceptions, expectations, and gaps in service quality. The data collection tool was the standard Servequal questionnaire. To determine the reliability of the research tool, we used Cronbach's Alpha coefficient and the test-retest method. Statistical analyses were conducted using SPSS and the ANOVA test.

RESULTS

The mean age of people included in the study was 32 ± 9.9 years, and the average waiting time to receive services was 73 ± 47 minutes. Hospitals and doctors' offices had the highest quality gap of -1.420 ± 0.82 and -1.01 ± 0.75, respectively. The service quality gaps in medical centers, health providers of rural area, and health providers of urban area were -0.883 ± 0.67, -0.882 ± 0.83, and -0.804 ± 0.62, respectively. There was a significant relationship between peoples' perceptions and expectations concerning the quality of health services and their educational levels.

CONCLUSION

The higher gaps in quality in hospitals and in doctors' offices require more attention. Managers and policy makers should consider developing and implementing plans to reduce these gaps in quality and to promote better health services in these two sectors.

Nurses' Perspectives on Patient Satisfaction and Expectations: An International Cross-Sectional Multicenter Study With Implications for Evidence-Based Practice

BACKGROUND

Addressing patient expectations is necessary to achieve high satisfaction. However, few data are available on nurses' perceptions and performance with respect to patient expectations and satisfaction.

OBJECTIVES

This international multicenter study aimed to: (a) evaluate nurses' attitudes and performance with respect to patient satisfaction and expectations, and (b) identify predictors of nurses' inquiry of patients' satisfaction at the point of discharge.

METHODS

A questionnaire examining attitudes and performance toward patient satisfaction and expectations was developed and validated. Nurses at four academic hospitals in the United States, the United Kingdom, Israel, and Denmark were surveyed.

RESULTS

A total of 536 nurses participated in the study (response rate 85.3%). Nurses expressed positive attitudes toward activities related to patient satisfaction and expectations, endorsing the importance of talking with patients about their satisfaction status (91.6%) and their expectations (93.2%). More than half of the responders (51.8%) claimed to have responded to the status of patient satisfaction or dissatisfaction (Israel: 25%; United States: 54.9%; United Kingdom: 61.7%; Denmark: 69.9%; p < .001). However, only 12.1% stated that they routinely ask patients about their level of satisfaction, with nurses in the United States (18.3%) and Denmark (17.5%) more likely to ask compared to nurses in the United Kingdom (7.4%) and Israel (6.3%; p = .001). Adjusted logistic regression identified four significant predictors (p < .05) of nurses' inquiry about patients' satisfaction: "Responding to patient's satisfaction status" (OR: 3.1; 95% CI: 1.7-5.8); "Documenting patient's satisfaction status" (OR: 2.8; 95% CI: 1.6-5.1); "Asking routinely about expectations" (OR: 5.4; 95% CI: 3-9.7); and "Responded to expectations during the past month" (OR: 4.3; 95% CI: 1.9-9.4).

LINKING EVIDENCE TO ACTION

These findings warrant further investigation, potentially into the nurses' work environments or educational programs, to better understand why nurses' positive attitudes toward patient satisfaction and expectations do not result in actively asking patients about their satisfaction level and what should be done to improve nurses' performance. Healthcare organizations and policy makers should develop and support structured programs to address patient expectations and improve patient satisfaction during hospitalization.

Global Nursing Issues and Development: Analysis of World Health Organization Documents

PURPOSE

To analyze World Health Organization (WHO) documents to identify global nursing issues and development.

DESIGN

Qualitative content analysis.

METHODS

Documents published by the six WHO regions between 2007 and 2012 and with key words related to nurse/midwife or nursing/midwifery were included. Themes, categories, and subcategories were derived. The final coding reached 80% agreement among three independent coders, and the final coding for the discrepant coding was reached by consensus.

FINDINGS

Thirty-two documents from the regions of Europe (n = 19), the Americas (n = 6), the Western Pacific (n = 4), Africa (n = 1), the Eastern Mediterranean (n = 1), and Southeast Asia (n = 1) were examined. A total of 385 units of analysis dispersed in 31 subcategories under four themes were derived. The four themes derived (number of unit of analysis, %) were Management & Leadership (206, 53.5), Practice (75, 19.5), Education (70, 18.2), and Research (34, 8.8).

CONCLUSIONS

The key nursing issues of concern at the global level are workforce, the impacts of nursing in health care, professional status, and education of nurses. International alliances can help advance nursing, but the visibility of nursing in the WHO needs to be strengthened.

CLINICAL RELEVANCE

Organizational leadership is important in order to optimize the use of nursing competence in practice and inform policy makers regarding the value of nursing to promote people's health.

Priority strategies for India's family planning programme

Strategies to accelerate progress of India's family planning programme are discussed and the importance of improving the quality and reach of services to address unmet contraceptive need by providing method choice is emphasized. Although there is a growing demand for both limiting and spacing births, female sterilisation, is the dominant method in the national programme and use of spacing methods remains very limited. Fertility decline has been slower in the empowered action group (EAG) states which contribute about 40 per cent of population growth to the country and also depict gloomy statistics for other socio-development indicators. It is, therefore, important to intensify efforts to reduce both fertility and mortality in these states. arationale has been provided for implementing integrated programmes using a gender lens because the lack of women's autonomy in reproductive decision-making, compounded by poor male involvement in sexual and reproductive health matters, is a fundamental issue yet to be addressed. The need for collaboration between scientists developing contraceptive technologies and those implementing family planning services is underscored. If contraceptive technologies are developed with an understanding of the contexts in which they will be delivered and an appreciation of end-users' needs and perspectives, they are more likely to be accepted by service providers and used by clients.

Are we satisfied with the follow-up of hypertensive and chronic kidney disease patients in outpatient clinics?

Hypertension and chronic kidney disease constitute major health problems as they are associated with increased morbidity and mortality. Large-scale clinical trials, have emphasized the need of a strict blood pressure and early recognition of kidney disease to reduce the complications. However, the rate of hypertension control seems to be low, the prevalence of hypertension and chronic kidney disease steadily increases, indicating a gap in the management of those patients. This is due either to a poor organization of the health care system or a defective patient-physician communication. This review will try to identify possible errors in the management of hypertensive and renal failure patients in outpatient clinics and to propose ways to improve prevention and control of hypertension and chronic kidney diseases in our population.

Analysis of the continuity of services from the viewpoint of clinical files in the perspective of quality improvement

Purpose

Theory

Methods

Results and conclusions

Factors influencing patients' utilization of primary health care providers in saudi arabia

OBJECTIVE

To determine the factors that significantly discriminate between Ministry of Health (MOH) and private primary health care patients in Riyadh City, Saudi Arabia.

METHODOLOGY

Through a self-administered questionnaire, data were collected from 408 randomly selected patients in five MOH primary health care centers and five private dispensaries. Data collection was conducted from February 15 to March 15, 1998. Two-group stepwise discriminant analysis was utilized in analyzing the data.

RESULTS

Seven of the 33 factors were found to be statistically significant in discriminating between MOH and private patients. These factors were: (1) source of payment, (2) availability of other sources of income, (3) distance between residence and Primary Health Care (PHC) provider, (4) education, (5) preference for similar-gender doctors, (6) preference for Saudi doctors, and (7) perceived quality of medical staff.

CONCLUSION

The study notes that PHC providers cannot control the sociodemographic characteristics of patients. Therefore, policy makers should focus on ensuring that PHC facilities have enough male and female doctors. Furthermore, the quality of the medical staff of these facilities should be upgraded to improve the overall quality of the services they provide. The conduct of further studies related to the utilization of health care providers is also recommended.