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Verberne, Lisa M., Antoinette YN Schouten-van Meeteren, Diederik K. Bosman, Derk A. Colenbrander, Charissa T. Jagt, Martha A. Grootenhuis, Johannes JM van Delden, and Marijke C. Kars. "Parental experiences with a paediatric palliative care team: A qualitative study." Palliative Medicine 31, no. 10 (February 1, 2017): 956–63. http://dx.doi.org/10.1177/0269216317692682.
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Background: Parents of children with a life-limiting disease have to rely on themselves at home while adequate paediatric palliative care is lacking. In several countries, paediatric palliative care teams are introduced to ensure continuity and quality of care and to support the child and the family. Yet, little is known about how parents experience such multidisciplinary teams. Aim: To obtain insight into the support provided by a new paediatric palliative care team from the parents’ perspective. Design: An interpretative qualitative interview study using thematic analysis was performed. Setting/participants: A total of 47 single or repeated interviews were undertaken with 42 parents of 24 children supported by a multidisciplinary paediatric palliative care team located at a university children’s hospital. The children suffered from malignant or non-malignant diseases. Results: In advance, parents had limited expectations of the paediatric palliative care team. Some had difficulty accepting the need for palliative care for their child. Once parents experienced what the team achieved for their child and family, they valued the team’s involvement. Valuable elements were as follows: (1) process-related aspects such as continuity, coordination of care, and providing one reliable point of contact; (2) practical support; and (3) the team members’ sensitive and reliable attitude. As a point of improvement, parents suggested more concrete clarification upfront of the content of the team’s support. Conclusion: Parents feel supported by the paediatric palliative care team. The three elements valued by parents probably form the structure that underlies quality of paediatric palliative care. New teams should cover these three valuable elements.
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Lisy, Karolina, Jennifer Kent, Jodi Dumbrell, Helana Kelly, Amanda Piper, and Michael Jefford. "Sharing Cancer Survivorship Care between Oncology and Primary Care Providers: A Qualitative Study of Health Care Professionals’ Experiences." Journal of Clinical Medicine 9, no. 9 (September 16, 2020): 2991. http://dx.doi.org/10.3390/jcm9092991.
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Survivorship care that is shared between oncology and primary care providers may be a suitable model to effectively and efficiently care for the growing survivor population, however recommendations supporting implementation are lacking. This qualitative study aimed to explore health care professionals’ (HCPs) perceived facilitators and barriers to the implementation, delivery and sustainability of shared survivorship care. Data were collected via semi-structured focus groups and analysed by inductive thematic analysis. Results identified four overarching themes: (1) considerations for HCPs; (2) considerations regarding patients; (3) considerations for planning and process; and (4) policy implications. For HCPs, subthemes included general practitioner (GP, primary care physician) knowledge and need for further training, having clear protocols for follow-up, and direct communication channels between providers. Patient considerations included identifying patients suitable for shared care, discussing shared care with patients early in their cancer journey, and patients’ relationships with their GPs. Regarding process, subthemes included rapid referral pathways back to hospital, care coordination, and ongoing data collection to inform refinement of a dynamic model. Finally, policy implications included development of policy to support a consistent shared care model, and reliable and sustainable funding mechanisms. Based on study findings, a set of recommendations for practice and policy were developed.
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Pratesi, Alessandro. "Exploring the Emotional Experience of Same-Sex Parents by Mixing Creatively Multiple Qualitative Methods." International Journal of Qualitative Methods 11, no. 2 (April 2012): 82–101. http://dx.doi.org/10.1177/160940691201100209.
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In this paper I address some of the main challenges and benefits of doing qualitative research with a specific type of ‘informal caregivers’, i.e. those who have been thus far excluded from the conceptual category of “normal” caregivers and from normal research on informal care: same-sex parents. The research presented in this paper is an example of a qualitative, inclusive approach to studying the felt and lived experience of 33 same-sex parents. It draws on a wider study on 80 informal caregivers, who were different in terms of gender, type of care, marital status, and sexual orientation. Its aim was to offer a more inclusive interpretation and a more reliable discourse on family care and parenthood. The research objective was to gain insights into the emotional mechanisms through which the dynamics of inclusion or exclusion are interactionally and situationally constructed and/or challenged while doing care. In this paper I illustrate the mix of creative, qualitative methods I employed to explore the experiences of a group of same-sex parents living in Philadelphia (USA).
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Tajabadi, Ali, Fazlollah Ahmadi, Afsaneh Sadooghi Asl, and Mojtaba Vaismoradi. "Unsafe nursing documentation: A qualitative content analysis." Nursing Ethics 27, no. 5 (September 2, 2019): 1213–24. http://dx.doi.org/10.1177/0969733019871682.
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Background Nursing documentation as a pivotal part of nursing care has many implications for patient care in terms of safety and ethics. Objectives To explore factors influencing nursing documentation from nurses’ perspectives in the Iranian nursing context. Methods This qualitative study was carried out using a qualitative content analysis of data collected from 2018 to 2019 in two urban areas of Iran. Semi-structured interviews (n = 15), observations, and reviews of patients’ medical files were used for data collection. Ethical considerations This study was conducted in accordance with the ethical principles of research and regulations in terms of confidentiality of data, anonymity, and provision of informed consent. Findings The main theme of this study was “unsafe documentation.” Two categories, “types of errors in reporting” and “reasons of errors in reporting,” and 12 subcategories were developed indicating factors influencing nursing documentation in the Iranian nursing context. Conclusion In general, individual, organizational, and national factors affected nursing documentation in Iran. In this respect, hiring more nurses, application of reforms in the healthcare management structure, devising appropriate regulations regarding division of labor, constant education of healthcare staff, establishment of clinical governance, improvement of interpersonal relationships, development of hardware and software techniques for documentation, and provision of support should be done to improve the quality of nursing documentation. The above-mentioned suggestions can help nurses with a safe, ethical, lawful, and reliable documentation in nursing practice.
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Babaei, Sima, and Shahla Abolhasani. "Family’s Supportive Behaviors in the Care of the Patient Admitted to the Cardiac Care Unit: A Qualitative Study." Journal of Caring Sciences 9, no. 2 (June 1, 2020): 80–86. http://dx.doi.org/10.34172/jcs.2020.012.
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Introduction: A life-threatening illness can cause the involvement of family members and the imposition of psychological and physical stress on them. Certainly, the family is a very valuable resource in patient care and plays an important role in maintaining the emotional support and patient’s recovery. The aim of this study was to explain the family members’ supporting behaviors of the patient admitted to the cardiac special units. Methods: This qualitative study was performed in the cardiac special units in Isfahan. The number of participants was 20, including 5 nurses, 8 family members, and 7 patients. The data were collected through interview and observation by purposive sampling. Then, the data were analyzed by Graneheim and Lundman’s qualitative content analysis method. The study lasted 12 months. Results: Data analysis showed that family’s support can be classified into three levels, including support by the therapeutic alliance (attempts to console and reassure, restoration of selfesteem, diminishing patient’s insensitivity, commitment to the patient, and visiting the patient ), participatory information (obtaining reliable information from the nurse, active role in providing meaningful information about the patient’s prognosis), practical and instrumental support (searching for economic support resources, providing the patient with the necessary equipment, trying to do the right care taking into account the family culture). Conclusion: Understanding family’s supportive behaviors can help improve counseling and planning for quality care of patients admitted to the cardiac care units (CCUs).
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Herrijgers, Corinne, Karolien Poels, Heidi Vandebosch, Tom Platteau, Jacques van Lankveld, and Eric Florence. "Harm Reduction Practices and Needs in a Belgian Chemsex Context: Findings from a Qualitative Study." International Journal of Environmental Research and Public Health 17, no. 23 (December 4, 2020): 9081. http://dx.doi.org/10.3390/ijerph17239081.
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Chemsex is a growing public health concern, with little evidence-based care and support available. The aim of this study is to understand current risk reduction practices, and the information and care needs of gay, bisexual, and other men who have sex with men (GBMSM) who engage in chemsex. Between January and March 2020, semi structured in-depth interviews with drug-using GBMSM (n = 20) were conducted. Data were analyzed thematically. The reported preparatory measures were: deliberately scheduling chemsex sessions, and discussing preferences regarding setting and attendees. During the event, a logbook is kept to monitor drugs taken by each participant. People try to take care of each other, but this is often counteracted. Respondents highlighted needs: reliable and easily-accessible information, anonymous medical and psychological healthcare, chemsex-specific care, and a value-neutral safe space to talk about chemsex experiences. Results imply two types of users: planned and impulsive users. Adherence to intended harm reduction practices are complicated by drug effects, peer pressure, and feelings of distrust among users.
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Avent, Elizabeth S., Laura Rath, Kylie Meyer, Donna Benton, and Paul Nash. "SUPPORTING FAMILY CAREGIVERS: HOW DOES RELATIONSHIP STRAIN OCCUR IN CAREGIVING DYADS? A QUALITATIVE STUDY." Innovation in Aging 3, Supplement_1 (November 2019): S289. http://dx.doi.org/10.1093/geroni/igz038.1066.
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Abstract Family members and spouses are usually the primary caregivers for older adults. Providing direct care can be stressful, strenuous, and time-consuming for caregivers, potentially leading to frustration and anger towards care recipients. This can be detrimental to the relationship quality of the caregiving dyad. Though caregiver strain and burden have been extensively studied, there is limited information on the development of relationship strain. To explore how relationship strain occurs between caregivers and care recipients, 8 focus groups (N=62) and 8 semi-structured telephone interviews were conducted with caregivers in Los Angeles, inquiring about relationship quality with their care recipients and when frustration and anger occurs. Inductive coding was used to create coding schemas. Findings showed that most caregivers reported relationship strain occurring after taking on the caregiving role, and frustration and anger arose when providing ADLs, especially during bathing and toileting. Although these caregivers had initially experienced strain in their relationships, a recurring theme that emerged was that they developed strategies to decrease frustration and anger and improve the quality of their relationships with their care recipients. Direct communication with caregivers is important in designing a structured and effective intervention. These findings help inform an intervention for new caregivers to help them identify what can lead to relationship strain, as well as teach them reliable strategies to manage frustration and anger towards their care recipients.
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Murugesu, Laxsini, Olga C. Damman, Marloes E. Derksen, Danielle R. M. Timmermans, Ank de Jonge, Ellen M. A. Smets, and Mirjam P. Fransen. "Women’s Participation in Decision-Making in Maternity Care: A Qualitative Exploration of Clients’ Health Literacy Skills and Needs for Support." International Journal of Environmental Research and Public Health 18, no. 3 (January 27, 2021): 1130. http://dx.doi.org/10.3390/ijerph18031130.
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Shared decision-making requires adequate functional health literacy (HL) skills from clients to understand information, as well as interactive and critical HL skills to obtain, appraise and apply information about available options. This study aimed to explore women’s HL skills and needs for support regarding shared decision-making in maternity care. In-depth interviews were held among women in Dutch maternity care who scored low (n = 10) and high (n = 13) on basic health literacy screening test(s). HL skills and perceived needs for support were identified through thematic analysis. Women appeared to be highly engaged in the decision-making process. They mentioned searching and selecting general information about pregnancy and labor, constructing their preferences based on their own pre-existing knowledge and experiences and by discussions with partners and significant others. However, women with low basic skills and primigravida perceived difficulties in finding reliable information, understanding probabilistic information, constructing preferences based on benefit/harm information and preparing for consultations. Women also emphasized dealing with uncertainties, changing circumstances of pregnancy and labor, and emotions. Maternity care professionals could further support clients by guiding them towards reliable information. To facilitate participation in decision-making, preparing women for consultations (e.g., agenda setting) and supporting them in a timely manner to understand benefit/harm information seem important.
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Mselle, Lilian, Nathanael Sirili, Amani Anaeli, and Siriel Massawe. "Understanding barriers to implementing referral procedures in the rural and semi-urban district hospitals in Tanzania: Experiences of healthcare providers working in maternity units." PLOS ONE 16, no. 8 (August 26, 2021): e0255475. http://dx.doi.org/10.1371/journal.pone.0255475.
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Introduction Maternal and perinatal deaths occurring in low and middle income countries could be prevented with timely access to maternal and new-born care. In order to increase access to maternal and child health services, a well-functioning referral system that allows for continuity of care across different tiers of healthcare is required. A reliable healthcare system, with adequate numbers of skilled staff, resources and mechanisms, is critical to ensuring that access to care is available when the need arises. Material and methods This descriptive, qualitative study design was used to explore barriers to implementing a reliable referral system. Twelve individual qualitative interviews were conducted with health care providers working in rural and semi-urban district hospitals in the Northern, Western, Eastern and Southern zones of Tanzania. Thematic analysis guided analysis of data. Results Three (3) main and interconnected themes were abstracted from the data relating to participants’ experiences of referring women with obstetric complications to adequate obstetric care. These were: 1. Adhering to a rigid referral protocol; 2. Completing the referral of women to an adequate health facility and 3. Communicating the condition of the woman with obstetric complications between the referring and receiving facilities. Conclusion Because of referral regulations, assistant medical officers were unable to make referral decisions even when they felt that a referral was needed. The lack of availability of hospital transport as well as the lack of a reliable feedback mechanism, prohibited effective referrals of patients. The Ministry of Health should revise the referral protocol to allow all clinicians to provide referrals, including assistant medical officers- who make up the majority of clinical staff in rural health care facilities. A mechanism to ensure effective communication between the referral facility and the tertiary care hospital should be instituted for quality and continuity of care. Furthermore, health care facilities should put aside budget for fuelling the ambulance for effective referrals.
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Donaghy, Eddie, Helen Atherton, Victoria Hammersley, Hannah McNeilly, Annemieke Bikker, Lucy Robbins, John Campbell, and Brian McKinstry. "Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care." British Journal of General Practice 69, no. 686 (June 3, 2019): e586-e594. http://dx.doi.org/10.3399/bjgp19x704141.
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BackgroundPeople increasingly communicate online, using visual communication mediums such as Skype and FaceTime. Growing demands on primary care services mean that new ways of providing patient care are being considered. Video consultation (VC) over the internet is one such mode.AimTo explore patients’ and clinicians’ experiences of VC.Design and settingSemi-structured interviews in UK primary care.MethodPrimary care clinicians were provided with VC equipment. They invited patients requiring a follow-up consultation to an online VC using the Attend Anywhere web-based platform. Participating patients required a smartphone, tablet, or video-enabled computer. Following VCs, semi-structured interviews were conducted with patients (n = 21) and primary care clinicians (n = 13), followed by a thematic analysis.ResultsParticipants reported positive experiences of VC, and stated that VC was particularly helpful for them as working people and people with mobility or mental health problems. VCs were considered superior to telephone consultations in providing visual cues and reassurance, building rapport, and improving communication. Technical problems, however, were common. Clinicians felt, for routine use, VCs must be more reliable and seamlessly integrated with appointment systems, which would require upgrading of current NHS IT systems.ConclusionThe visual component of VCs offers distinct advantages over telephone consultations. When integrated with current systems VCs can provide a time-saving alternative to face-to-face consultations when formal physical examination is not required, especially for people who work. Demand for VC services in primary care is likely to rise, but improved technical infrastructure is required to allow VC to become routine. However, for complex or sensitive problems face-to-face consultations remain preferable.
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Sass, Rachelle, Juli Finlay, Krista Rossum, Kaytlynn V. Soroka, Michael McCormick, Arlene Desjarlais, Hans Vorster, et al. "Patient, Caregiver, and Provider Perspectives on Challenges and Solutions to Individualization of Care in Hemodialysis: A Qualitative Study." Canadian Journal of Kidney Health and Disease 7 (January 2020): 205435812097071. http://dx.doi.org/10.1177/2054358120970715.
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Background: Clinical settings often make it challenging for patients with kidney failure to receive individualized hemodialysis (HD) care. Individualization refers to care that reflects an individual’s specific circumstances, values, and preferences. Objective: This study aimed to describe patient, caregiver, and health care professional perspectives regarding challenges and solutions to individualization of care in people receiving in-center HD. Design: In this multicentre qualitative study, we conducted focus groups with individuals receiving in-center HD and their caregivers and semi-structured interviews with health care providers from May 2017 to August 2018. Setting: Hemodialysis programs in 5 cities: Calgary, Edmonton, Winnipeg, Ottawa, and Halifax. Participants: Individuals receiving in-center HD for more than 6 months, aged 18 years or older, and able to communicate in English were eligible to participate, as well as their caregivers. Health care providers with HD experience were recruited using a purposive approach and snowball sampling. Methods: Two sequential methods of qualitative data collection were undertaken: (1) focus groups and interviews with HD patients and caregivers, which informed (2) individual interviews with health care providers. A qualitative descriptive methodology guided focus groups and interviews. Data from all focus groups and interviews were analyzed using conventional content analysis. Results: Among 82 patients/caregivers and 31 health care providers, we identified 4 main themes: session set-up, transportation and parking, socioeconomic and emotional well-being, and HD treatment location and scheduling. Particular challenges faced were as follows: (1) session set-up: lack of preferred supplies, machine and HD access set-up, call buttons, bed/chair discomfort, needling options, privacy in the unit, and self-care; (2) transportation and parking: lack of reliable/punctual service, and high costs; (3) socioeconomic and emotional well-being: employment aid, finances, nutrition, lack of support programs, and individualization of treatment goals; and (4) HD treatment location and scheduling: patient displacement from their usual spot, short notice of changes to dialysis time and location, lack of flexibility, and shortages of HD spots. Limitations: Uncertain applicability to non-English speaking individuals, those receiving HD outside large urban centers, and those residing outside of Canada. Conclusions: Participants identified challenges to individualization of in-center HD care, primarily regarding patient comfort and safety during HD sessions, affordable and reliable transportation to and from HD sessions, increased financial burden as a result of changes in functional and employment status with HD, individualization of treatment goals, and flexibility in treatment schedule and self-care. These findings will inform future studies aimed at improving patient-centered HD care.
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Marzuki, Nanis S., Elizabeth Yohmi, Eveline Nainggolan, Badriul Hegar, Hanifah Oswari, and I. Gusti Ayu Nyoman Partiwi. "Breastfeeding practices in mothers: a qualitative study." Paediatrica Indonesiana 54, no. 1 (February 28, 2014): 35. http://dx.doi.org/10.14238/pi54.1.2014.35-41.
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Background Despite the WHO and UNICEF recorrunendations, the well-known breastfeeding benefits, and the efforts to promote and support breastfeeding; exclusive breastfeeding by Indonesian mothers remains low and contributes to high infant mortality rates.Objective To elucidate the fac tors that influence mothers' choices for infant feedingMethods This qualitative study was conducted as part of a nationwide survey. The study included 36 in-depth interviews of mothers with infants aged 0-11 months, and health care professionals, including general practitioners, pediatricians, and midwives. This study was performed between 0 cto ber - November 2 0 l 0 in both rural and urban areas of 4 provinces in Indon esia.Results We found that most mothers intended to breastfeed and had positive perceptions of breastfeeding. However, mothers faced many challenges in the practice of exclusive and proper breastfeeding. Additionally, the perceived definition of exclusive breastfeeding varied among the participants, leading to n on-exclusive breastfeeding attitudes. The most frequent reasons for mothers to introduce additional milk formula or food were the perception of an inadequate milk supply, infant dissatisfaction or fu ssiness after feeding. Different perceptions were also demonstrated in different regions and the varying levels of socioeconomic status. Health care practitioners (HCPs) were the most reliable source for giving adequate information, but unfortunately, they were not easily accessible and provided inconsistent information. Consequently, closely-related family members were the major contributors of information to a mother'schoice of infant feeding; because they were easily accessible.Conclusion Factors influencing mothers in their breastfeeding practices are their basic knowledge, demographic and socioeconomic status, as well as the availability of support from closelyrelatedfamily members, friends, and HCPs.
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Brookes-Howell, Lucy, Emma Thomas-Jones, Janine Bates, Marie-Jet Bekkers, Curt Brugman, Elinor Coulman, Nick Francis, et al. "Challenges in managing urinary tract infection and the potential of a point-of-care test guided care in primary care: an international qualitative study." BJGP Open 3, no. 2 (April 2, 2019): bjgpopen18X101630. http://dx.doi.org/10.3399/bjgpopen18x101630.
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BackgroundLittle is known about clinicians’ experiences of using a point-of-care test (POCT) to inform management of urinary tract infection (UTI) in general practice.AimTo explore experiences of using the Flexicult test to inform management of UTI and views on requirements for an optimal POCT to inform successful implementation.Design & settingTelephone interviews with 35 primary care clinicians and healthcare professionals in Wales, England, Spain, and the Netherlands, who had participated in a trial of the Flexicult POCT for UTI based on urine culture.MethodThematic analysis of semi-structured interviews.ResultsMost primary care clinicians interviewed agreed on the need for a POCT in UTI management, and that the Flexicult POCT delivered quicker results than laboratory results used in usual care, reassured patients, boosted their confidence in decision-making, and reminded them about antibiotic stewardship. However, clinicians also reported difficulties in interpreting results, limitations on when the Flexicult could be used, and concerns that testing all patients would strain care delivery and prolong patient discomfort when delaying decisions until a non-rapid POCT result was available. An optimal POCT would produce more rapid results, and be reliable and easy to use. Uptake into routine care would be enhanced by: clear guidance on which patients should be tested; training for interpreting ‘grey area’ results; reiterating that even ‘straightforward’ cases might be better managed with a test; clear messages about stopping unnecessary antibiotics versus completing a course; and better self-management strategies to accompany implementation of delayed, or non-prescription of, antibiotics.ConclusionPrimary care clinicians believe that POCT tests could play a useful role in the management of UTI and gave clear recommendations for successful implementation.
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Beales, Darren, David Carolan, Joshua Chuah-Choong, Sarah Hammond, Eimear O’Brien, Eileen Boyle, Sonia Ranelli, David Holthouse, Tim Mitchell, and Helen Slater. "Exploring peoples’ lived experience of complex regional pain syndrome in Australia: a qualitative study." Scandinavian Journal of Pain 21, no. 2 (January 6, 2021): 393–405. http://dx.doi.org/10.1515/sjpain-2020-0142.
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Abstract Objectives Complex regional pain syndrome (CRPS) is a persistent pain condition which is often misunderstood and poorly managed. Qualitative studies are needed to explore the lived experience of the condition and to better understand patient perspectives on their management experiences and needs. The aim of this study was to explore the lived experience of CRPS in Australia, including exploration of their perceptions of care and advice received from healthcare professionals. Methods A qualitative study with individual in-depth semi-structured, face-to-face interviews was performed (n=15, 80% female, average time elapsed since diagnosis 3.8 years). Qualitative data were analysed using an inductive thematic analysis approach. Results Four main themes with associated subthemes were identified, representing the participants’ journey: (1) Life Changing Impact of CRPS (Subthemes: Impact on self, Impact on others); (2) Variable Experiences of Care (Subthemes: Helpful experiences of care, Unhelpful experiences of care); (3) Making Sense of CRPS (Subthemes: Knowledge and understanding, Dealing with unpredictability); and (4) Perceptions on Lessons Learned from Living with CRPS (Subthemes: Acceptance was an important part of the journey, Trial and error was necessary to find an individual way forward, Coping strategies). Conclusions The themes identified align to and expand on prior qualitative research findings in people with CRPS. It highlights the challenges people face related to their personal self, their close relationships and their social and work roles. It highlights the difficulties these people have in finding reliable, trust-worthy information. These findings suggest that healthcare professionals may benefit from education about how to better support people with CRPS, including helping people to navigate to the right care. Engaging people with CRPS in the development of educational resources should be a future research goal. It is recommended that patient perspectives are incorporated into the development of care pathways for CRPS.
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PATEL, VIKRAM, and MARTIN PRINCE. "Ageing and mental health in a developing country: who cares? Qualitative studies from Goa, India." Psychological Medicine 31, no. 1 (January 2001): 29–38. http://dx.doi.org/10.1017/s0033291799003098.
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Background. While there is a growing body of epidemiological evidence on the prevalence of mental illnesses in late-life in developing countries, there is limited data on cultural perceptions of mental illnesses and care arrangement for older people.Method. This qualitative study used focus group discussions with older people and key informants to investigate the status of older people and concepts of late-life mental health conditions, particularly dementia and depression, in Goa, India.Results. Vignettes of depression and dementia were widely recognized. However, neither condition was thought to constitute a health condition. Dementia was construed as a normal part of ageing and was not perceived as requiring medical care. Thus, primary health physicians rarely saw this condition in their clinical work, but community health workers frequently recognized individuals with dementia. Depression was a common presentation in primary care, but infrequently diagnosed. Both late-life mental disorders were attributed to abuse, neglect, or lack of love on the part of children towards a parent. There was evidence that the system of family care and support for older persons was less reliable than has been claimed. Care was often conditional upon the child's expectation of inheriting the parent's property. Care for those with dependency needs was almost entirely family-based with little or no formal services. Unsurprisingly, fear for the future, and in particular ‘dependency anxiety’ was commonplace among older Goans.Conclusions. There is a need to raise awareness about mental disorders in late-life in the community and among health professionals, and to improve access to appropriate health care for the elderly with mental illness. The study suggests directions for the future development of locally appropriate support services, such as involving the comprehensive network of community health workers.
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Gil-Lacruz, Marta, and Ana Isabel Gil-Lacruz. "Health Attributions and Health Care Behavior Interactions in a Community Sample." Social Behavior and Personality: an international journal 38, no. 6 (July 1, 2010): 845–58. http://dx.doi.org/10.2224/sbp.2010.38.6.845.
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In this article we examine the influence of a number of psychosocial variables on health attributions and the use of the health care system. The study sample consisted of 1,032 participants, who were representative of a stratified suburban community in Spain. Home-based interviews were conducted to identify participants' main health improvement resources. Most answers were related to health attitudes concerning behavior, the health services available to participants, or other external agents. Qualitative and quantitative strategies were employed and results showed that age and health perception were the most reliable predictors of these attitudes. Social variables were found to play an important role in the explanation of participants' beliefs and medical consultation behaviors.
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Bassett, Chris, Jane Bassett, and Judith Tanner. "The Importance of Research in Nursing Practice." British Journal of Perioperative Nursing (United Kingdom) 13, no. 1 (January 2003): 30–31. http://dx.doi.org/10.1177/175045890301300104.
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Current, valid and reliable research is becoming more and more important in modern healthcare practice. Patients and their families’ expectations are increasing and they, quite rightly, expect their nursing care to be the very best available. Over the next five issues, this series will explore the following areas: • The value of research in nursing • What is research? • Qualitative and quantitative research • Reading and critiquing research • Implementing research in practice
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Hauffman, Anna, Sven Alfonsson, Helena Igelström, and Birgitta Johansson. "Experiences of Internet-Based Stepped Care in Individuals With Cancer and Concurrent Symptoms of Anxiety and Depression: Qualitative Exploration Conducted Alongside the U-CARE AdultCan Randomized Controlled Trial." Journal of Medical Internet Research 22, no. 3 (March 30, 2020): e16547. http://dx.doi.org/10.2196/16547.
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Background Individuals with newly diagnosed cancer may experience impaired health in several aspects and often have a large need for information and support. About 30% will experience symptoms of anxiety and depression, with varying needs of knowledge and support. Despite this, many of these patients lack appropriate support. Internet-based support programs may offer a supplement to standard care services, but must be carefully explored from a user perspective. Objective The purpose of this study was to explore the participants’ perceptions of the relevance and benefits of an internet-based stepped care program (iCAN-DO) targeting individuals with cancer and concurrent symptoms of anxiety and depression. Methods We performed a qualitative study with an inductive approach, in which we used semistructured questions to interview 15 individuals using iCAN-DO. We analyzed the interviews using content analysis. Results The analysis found 17 subcategories regarding the stepped care intervention, resulting in 4 categories. Participants described the need for information as large and looked upon finding information almost as a survival strategy when receiving the cancer diagnosis. iCAN-DO was seen as a useful, reliable source of information and support. It was used as a complement to standard care and as a means to inform next of kin. Increased knowledge was a foundation for continued processing of participants’ own feelings. The optimal time to gain access to iCAN-DO would have been when being informed of the diagnosis. The most common denominator was feeling acknowledged and supported, but with a desire for further adaptation of the system to each individual’s own situation and needs. Conclusions Users saw the internet-based stepped care program as safe and reliable and used it as a complement to standard care. Similar interventions may gain from more personalized contents, being integrated into standard care, or using symptom tracking to adjust the contents. Offering this type of program close to diagnosis may provide benefits to users. Trial Registration ClincalTrials.gov NCT-01630681; https://clinicaltrials.gov/ct2/show/NCT01630681
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Kovaleva, Mariya A., Melinda Higgins, Bonnie Mowinski Jennings, Mi-Kyung Song, Carolyn K. Clevenger, Patricia C. Griffiths, and Kenneth W. Hepburn. "THE INTEGRATED MEMORY CARE CLINIC AS A HEALTHCARE NETWORK." Innovation in Aging 3, Supplement_1 (November 2019): S559. http://dx.doi.org/10.1093/geroni/igz038.2067.
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Abstract The Integrated Memory Care Clinic (IMCC) at Emory Healthcare is a patient-centered medical home led by advanced practice registered nurses (APRNs) who provide dementia and primary care. This presentation describes the experiences of persons living with dementia and their caregivers during their first year at the IMCC, through the lens of the IMCC as a healthcare network. Forty-two caregivers were evaluated in three survey-based assessments over nine months. Twelve caregivers completed qualitative interviews about their experience at the IMCC. Severity of depression and delusions and total symptom severity improved significantly for persons living with dementia. Caregivers described their sense of belonging to the IMCC healthcare team and valued direct telephone access to APRNs. By enhancing care access and engaging clients in their care, the IMCC serves as a reliable and professional healthcare network for patient-caregiver dyads who often receive suboptimal dementia care in mainstream healthcare.
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Dowell, Jo A., and Zulayka Ruiz. "Visto, Pero No Escuchado: A Qualitative Arm of a Mixed-Methods Study of Puerto Rican Children With Asthma." Hispanic Health Care International 18, no. 3 (January 7, 2020): 150–57. http://dx.doi.org/10.1177/1540415319899105.
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Introduction: Communication among health care providers, caregivers, and children with asthma is challenging and sometimes may exclude the child. This may result in delay in recognizing and responding appropriately to asthma symptoms. The purpose was to conduct focus groups among Puerto Rican children with asthma on communication with their health care provider about their asthma symptoms. Method: The qualitative arm (focus groups) of a mixed-method explanatory sequential study that was used to view communication with their health care provider through the lens of a group of Puerto Rican children. The sample included Puerto Rican children ages 8 to 12 years with asthma ( N = 23). The goal was to develop a child illness representation questionnaire. Results: The perspective of children with asthma provided enriched information to influence the development of instrument subscale on communication. The children were often not heard during a clinical visit. Most of the children express fear of their health care provider. Conclusions: Although this was a small sample, there were indications that children would like to opportunity to tell the story about their experience with having asthma. Further research will lead to the next step toward developing and computing a reliable measure that includes the child in a discussion during a clinical visit.
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Khalil, Rehana, Zahid Naeem, Allah Bachayo Rajar, and Uroosa Talib. "A pragmatic perspective on mental disorders by psychiatrists of Karachi, Pakistan: A qualitative study." Journal of Shifa Tameer-e-Millat University 3, no. 1 (August 9, 2020): 34–41. http://dx.doi.org/10.32593/jstmu/vol3.iss1.93.
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Introduction: There is an alarming rise in mental health problems in Pakistan, due to various reasons including genetic vulnerability. There is a paucity of reliable and updated data on mental illnesses in Pakistan.
Objective: The main objective of our study was to explore the perspective of psychiatrists on frequency of mental disorders, their related factors and expected recovery from mental illnesses in a Psychiatric Care and Rehabilitation center of Karachi, Pakistan.
Methodology: This qualitative study was conducted at the Karwan-e-Hayat Psychiatric Care and Rehabilitation center, Karachi, Pakistan from Dec 2019 to April 2020. Seventeen study participants were recruited through purposive sampling and data was collected through in-depth interviews. Qualitative thematic analysis of content was done though generation of a coding scheme.
Results: Analysis of the interview transcripts revealed two main themes related to psychiatrists’ views about mental disorders in Pakistan; (1) Contributing and consequential correlates of mental disorders (2) Effective therapeutic strategies and recovery rate from mental disorders.
Conclusion: Our study concluded that mental disorders are increasing with high proportion of psychosis and schizophrenia cases in Pakistan. The productive young age group and male gender are most commonly affected. The factors associated with mental disorders include lower socio-economic status, Low-literacy, divorce, exposure to traumatic events like violence and political turmoil, and sleep disturbances. The recovery rate from mental disorders is promising with integrative approach including pharmacological, psychosocial and care management strategies.
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Chayati, Nur, Christantie Effendy, and Setyopranoto Setyopranoto. "QUALITY INDICATORS FOR STROKE PATIENTS AT HOME-BASED CARE SETTING: A REVIEW." Jurnal Kesehatan Komunitas 5, no. 3 (December 31, 2019): 118–23. http://dx.doi.org/10.25311/keskom.vol5.iss3.372.
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Background: One method to identify the level of performance is using quality of care indicators. Even though many quality indicators of health care have been announced, those which specify in home care services are limited in that none of them describe the stroke patients’ condition. The purposes of this study are to determine through systematic literature review what methods can be used to assess the quality of home care that patients received and to identify what components can be used as a determinant of the quality of home care services.
Method: Google Scholar, EBSCO, ProQuest and PubMed database websites were searched for articles and information.
Results: The method that was used is a qualitative study using a literature review with quantitative analysis of a previously accepted research instrument with a questionnaire that has been widely available and considered reliable. The researchers identified thematic differentiation in grouping the quality indicators used by those articles, however most of them are classified as outcome indicators, one as process indicator, and none as structure or input indicator. Overall quality indicators in home care that are used by the three articles are based on the Home Care Quality Indicators Instrument (HCQIs).
Conclusions: Several studies discussed home care quality indicators but no articles specifically analyze home care provision for stroke patients. Further research is needed to clarify the components indicators for stroke patients and more importantly, these indicators should be valid, and reliable.
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Lin, Jianqiang, Ni Gong, Qianzhong Cao, Yijing Zhou, Yitingxue Cai, Guangming Jin, Charlotte Aimee Young, Jing Yang, Yiyao Wang, and Danying Zheng. "What hinders congenital ectopia lentis patients’ follow-up visits? A qualitative study." BMJ Open 10, no. 3 (March 2020): e030434. http://dx.doi.org/10.1136/bmjopen-2019-030434.
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ObjectivesThe aim of our study is to give insight into congenital ectopia lentis (CEL) patients’ care-seeking behaviour and explore the factors affecting their follow-up visits.DesignCross-sectional study; in-depth and face-to-face semistructured interview.SettingA large-scale ophthalmology hospital in China.Participants35 patients with CEL and their parents from May 2017 to August 2017.Main outcome measuresThemes and categories. The interviews were audio-recorded, transcribed verbatim, coded and analysed using grounded theory. Data collection was closed when new themes did not emerge in subsequent dialogues.ResultsThe factors affecting the timely visits included insufficient awareness of CEL, shame on hereditary disease, lack of effective doctor–patient communication, lack of reliable information online and daily stressors.ConclusionContinuing medical education of severe and rare disease, reforming the pattern of medical education, constructing an interactive platform of the disease on the internet and improving healthcare policy are effective ways to improve the diagnosis and treatment status of CEL in China.
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Skillman, Megan, Caitlin Cross-Barnet, Rachel Friedman Singer, Christina Rotondo, Sarah Ruiz, and Adil Moiduddin. "A Framework for Rigorous Qualitative Research as a Component of Mixed Method Rapid-Cycle Evaluation." Qualitative Health Research 29, no. 2 (September 3, 2018): 279–89. http://dx.doi.org/10.1177/1049732318795675.
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As federal, state, and local governments continue to test innovative approaches to health care delivery, the ability to produce timely and reliable evidence of what works and why it works is crucial. There is limited literature on methodological approaches to rapid-cycle qualitative research. The purpose of this article is to describe the advantages and limitations of a broadly applicable framework for in-depth qualitative analysis placed within a larger rapid-cycle, multisite, mixed-method evaluation. This evaluation included multiple cycles of primary qualitative data collection and quarterly and annual reporting. Several strategies allowed us to be adaptable while remaining rigorous; these included planning for multiple waves of qualitative coding, a hybrid inductive/deductive approach informed by a cross-program evaluation framework, and use of a large team with specific program expertise. Lessons from this evaluation can inform researchers and evaluators functioning in rapid assessment or rapid-cycle evaluation contexts.
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Eden, Rebekah, Andrew Burton-Jones, James Grant, Renea Collins, Andrew Staib, and Clair Sullivan. "Digitising an Australian university hospital: qualitative analysis of staff-reported impacts." Australian Health Review 44, no. 5 (2020): 677. http://dx.doi.org/10.1071/ah18218.
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Objective This study aims to assist hospitals contemplating digital transformation by assessing the reported qualitative effects of rapidly implementing an integrated eHealth system in a large Australian hospital and determining whether existing literature offers a reliable framework to assess the effects of digitisation. Methods A qualitative, single-site case study was performed using semistructured interviews supplemented by focus groups, observations and documentation. In all, 92 individuals across medical, nursing, allied health, administrative and executive roles provided insights into the eHealth system, which consisted of an electronic medical record, computerised decision support, computerised physician order entry, ePrescribing systems and wireless device integration. These results were compared against a known framework of the effects of hospital digitisation. Results Diverse, mostly positive, effects were reported, largely consistent with existing literature. Several new effects not reported in literature were reported, namely: (1) improvements in accountability for care, individual career development and time management; (2) mixed findings for the availability of real-time data; and (3) positive findings for the secondary use of data. Conclusions The overall positive perceptions of the effects of digitisation should give confidence to health services contemplating rapid digital transformation. Although existing literature provides a reliable framework for impact assessment, new effects are still emerging, and research and practice need to shift towards understanding how clinicians and hospitals can maximise the benefits of digital transformation. What is known about the topic? Hospitals outside the US are increasingly becoming engaged in eHealth transformations. Yet, the reported effects of these technologies are diverse and mixed with qualitative effects rarely reported. What does this paper add? This study provides a qualitative assessment of the effects of an eHealth transformation at a large Australian tertiary hospital. The results provide renewed confidence in the literature because the findings are largely consistent with expectations from prior systematic reviews of impacts. The qualitative approach followed also resulted in the identification of new effects, which included improvements in accountability, time management and individual development, as well as mixed results for real-time data. In addition, substantial improvements in patient outcomes and clinician productivity were reported from the secondary use of data within the eHealth systems. What are the implications for practitioners? The overall positive findings in this large case study should give confidence to other health services contemplating rapid digital transformation. To achieve substantial benefits, hospitals need to understand how they can best leverage the data within these systems to improve the quality and efficiency of patient care. As such, both research and practice need to shift towards understanding how these systems can be used more effectively.
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Gholamnejad, Hanieh, Ali Darvishpoor Kakhki, Fazlollah Ahmadi, and Camelia Rohani. "Development and Psychometric Evaluation of the Elderly Hypertension Self-Care Index." Journal of Nursing Measurement 27, no. 3 (December 1, 2019): 418–32. http://dx.doi.org/10.1891/1061-3749.27.3.418.
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PurposeThis study was done to develop and evaluate the psychometric properties of the Elderly Hypertension Self-Care Index.MethodsThis was an exploratory mixed method study. Items were developed through conducting a qualitative study with conventional content analysis approach and comprehensively reviewing the existing literature. Then, the developed index was assessed for face, content, and construct validity as well as reliability.ResultsAnalyses identified four themes of self-care: intelligent acceptance, self-actualization in the pass of the disease, effective supporters, and destructive constraints. Exploratory factor analysis revealed that only 28 items were appropriate which were loaded on six factors, accounting for 45.035% of the total variance of hypertension self-care. Cronbach's alpha and test–retest intraclass correlation coefficients of the index were 0.80 and 0.96, respectively.ConclusionThe Elderly Hypertension Self-Care Index showed that it is a valid and reliable index in the elderly health context; and can be used for self-care assessment among elderly people with hypertension.
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Hirschl, Michael M., Harald Herkner, Anton N. Laggner, Christer Sylvén, Gundars Rasmanis, Paul O. Collinson, Willie Gerhardt, et al. "Analytical and Clinical Performance of an Improved Qualitative Troponin T Rapid Test in Laboratories and Critical Care Units." Archives of Pathology & Laboratory Medicine 124, no. 4 (April 1, 2000): 583–87. http://dx.doi.org/10.5858/2000-124-0583-aacpoa.
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Abstract Objective.—To evaluate the performance of a visual troponin T rapid test in the hands of nontraditionally trained personnel of 2 critical care units in comparison to 3 laboratories. Methods.—Method comparisons of the troponin T rapid test versus cardiac troponin T enzyme-linked immunosorbent assay were performed with 804 samples from 510 patients with suspected acute coronary syndromes. Cross-reactivity with skeletal troponin T was studied up to 5000 μg/L. Results.—Laboratories and critical care units obtained comparable results in the analytical cutoff of the test (0.11 and 0.10 μg/L) and in the diagnostic sensitivities in the detection of acute myocardial infarction (96% and 93% after 8 hours) and of high-risk patients with unstable angina pectoris (100% and 100%). Different percentages of false-positive results (0.2% and 3%) were found, which may reflect different objectives and strategies in these hospital units. The cross-reactivity with skeletal troponin T was less than 0.01%. Conclusions.—The troponin T rapid test gives reliable results not only when used by laboratory personnel experienced in the execution of analytical methods, but also in the hands of nurses and physicians working in clinical units outside the laboratory.
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Cleary, Paul D. "Satisfaction May Not Suffice!: A Commentary on ‘a Patient's Perspective’." International Journal of Technology Assessment in Health Care 14, no. 1 (1998): 35–37. http://dx.doi.org/10.1017/s0266462300010503.
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AbstractThere are inherent limitations in using assessments of patient satisfaction to make inferences about the quality of medical care. Such evaluations tend to be subjective, subject to reporting biases, and difficult to interpret when they are being used to motivate and guide quality improvement efforts. Newer methods of eliciting both reports and ratings from consumers, such as the Consumer Assessment of Health Plans (CAHPS) project, can provide reliable, valid, interpretable, and actionable data about selected aspects of health care. The use of these methods and continued use of new qualitative methods, such as cognitive interviewing, should allow us to continue increasing the prominence of consumer-based information in quality assessment and improvement efforts.
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Hoffmann, Mariell, Michel Wensing, Frank Peters-Klimm, Joachim Szecsenyi, Mechthild Hartmann, Hans-Christoph Friederich, and Markus W. Haun. "Perspectives of Psychotherapists and Psychiatrists on Mental Health Care Integration Within Primary Care Via Video Consultations: Qualitative Preimplementation Study." Journal of Medical Internet Research 22, no. 6 (June 18, 2020): e17569. http://dx.doi.org/10.2196/17569.
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Background Many patients with mental disorders remain untreated. Video-based mental health care demonstrates comparable effectiveness to face-to-face treatments and is a promising mode for delivering specialized care within primary care. Nevertheless, professionals struggle with implementing video consultations in their daily practice. Specifically, little is known about mental health specialists’ acceptance of mental health video consultations in routine practice. The PROVIDE (ImPROving cross-sectoral collaboration between primary and psychosocial care: An implementation study on VIDEo consultations) project aims to improve cross-sectoral collaboration between primary and psychosocial care through implementing video consultations in primary care. To increase the uptake of video consultations, it is crucial to account for necessary prerequisites and to tailor interventions to the needs of the target group prior to implementation. Objective The aim of this study was to explore the acceptance of video consultations embedded in primary care from the perspectives of mental health specialists in Germany. Methods We conducted a qualitative, exploratory, preimplementation study in urban and rural counties. We conducted three semistructured focus groups with 11 mental health specialists. We used qualitative content analysis combining an inductive-deductive approach, applying the Tailored Implementation in Chronic Diseases (TICD) framework to the text material, which comprises individual health professional factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; social, political, and legal factors; and guideline factors. Results Against the background of long waiting times and a shortage of mental health specialists, especially in rural areas, participants valued video consultations as a potential means to improve access to mental health care. With respect to the TICD framework domains, the participants most often discussed individual health professional factors, followed by patient factors. All participants highlighted the importance of a trusting relationship between the patient and the therapist and doubted whether such a relationship could be established through video consultations (11/11, 100%). However, participants considered mental health specialist video consultations to be particularly suited for patients in rural areas, those with impaired mobility, and those who may otherwise remain untreated (6/11, 55%). Most participants expected video consultations to help the aforementioned patient groups avoid tedious searching for an available therapist and save on travel time and, therefore, improve access to specialized care for patients (7/11, 64%). Moreover, the participants expected video consultations to improve collaboration with the family physician (6/11, 55%). Finally, participants identified organizational aspects, such as reliable scheduling, the duration of the individual consultation (9/11, 82%), and reimbursement conditions (7/11, 67%), as key drivers for the acceptance and adoption of the model. Conclusions While mental health specialists expect video consultations to improve access to specialized care for some patients, they consistently wonder whether such consultations can establish a trusting patient-therapist relationship. When implementing video consultations, these concerns should be addressed by training providers in managing technology-based treatment settings, with extra consideration for fostering the patients’ and therapists’ engagement. Trial Registration German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one
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Rome, Sunny Harris, and Miriam Raskin. "Transitioning Out of Foster Care." Youth & Society 51, no. 4 (February 1, 2017): 529–47. http://dx.doi.org/10.1177/0044118x17694968.
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Youth aging out of foster care are at particular risk for negative outcomes including school dropout, homelessness, poverty, unemployment, substance abuse, health and mental health problems, and victimization. Yet we know little about how, when, and why these youth find themselves on a downward trajectory. This qualitative, phenomenological study—conducted in partnership with four public child welfare agencies—examined the lived experience of 19 youth during their first year after exiting foster care. The authors used monthly, contemporaneous interviews to explore domains including housing, employment, education, and relationships with trusted adults. Although outcomes in employment were poorest, participants’ experience in all domains was characterized by frequent changes and instability. Adverse events began immediately and many youth were unsure how to navigate the system to get help. Yet youth who were successful in one domain were more likely to be successful in others. Risk factors included having four or more foster care placements, being on probation, accumulating fines, and losing government assistance. Protective factors included living with an adult who shares the rent and maintains a positive, consistent presence; being a full-time student; receiving educational and housing subsidies; having reliable means of transportation and communication; and maintaining the same job throughout the transitional year. Despite facing significant obstacles, the youth demonstrated resilience and optimism as they contemplated their futures. Recommendations include providing specialized services that target youth as they exit the system, and emphasizing stability rather than self-sufficiency.
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Burke, Lauren, Jamie Kirkham, Janine Arnott, Victoria Gray, Matthew Peak, and Michael W. Beresford. "The transition of adolescents with juvenile idiopathic arthritis or epilepsy from paediatric health-care services to adult health-care services: A scoping review of the literature and a synthesis of the evidence." Journal of Child Health Care 22, no. 3 (January 21, 2018): 332–58. http://dx.doi.org/10.1177/1367493517753330.
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Young people with long-term health conditions (LTCs) can face challenges when making the transition to adult health services. This paper sought to identify studies that assess and explore transitional care for young people with LTCs. Two conditions were used as exemplars: juvenile idiopathic arthritis (JIA) and epilepsy. A scoping review of the literature was conducted by using search terms to search for papers in English between 2001 and 2016 concerning transitional care on four databases. Qualitative papers were reviewed and synthesized using thematic analysis. Quantitative papers using health outcomes were also synthesized. Twenty-eight papers were selected for review. Despite the wealth of literature concerning aspects of transitional care that are key to a successful transition for young people with JIA or epilepsy, there is a paucity of outcomes that define ‘successful’ transition and consequently a lack of reliable research evaluating the effectiveness of transitional care interventions to support young people moving to adult health services.
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Miller, D. M., and A. Palm. "Comparison in Spontaneous Ventilation of the Maxima with the Humphrey ADE Breathing System and between Four Methods for Detecting Rebreathing." Anaesthesia and Intensive Care 23, no. 3 (June 1995): 296–301. http://dx.doi.org/10.1177/0310057x9502300305.
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An enclosed efferent, afferent reservoir breathing system (Maxima, Life Air Pty Ltd), being valveless, was compared to a simple afferent reservoir system (Humphrey ADE, A mode), having a valve, by assessing fresh gas flow (V̇F) requirements, with respect to ventilation (V̇E), that prevents rebreathing in volunteers, awake and breathing spontaneously. The results are recorded in terms of the quotient V̇F/V̇E associated with the onset of rebreathing. At the same time four clinical methods for assessing rebreathing were evaluated from the perspective of suitability for practical application during anaesthesia. No significant difference was found in the VF requirements between the ADE and Maxima breathing systems with respective values obtained for the quotient VF/VE of 0.80 and 0.77. Our findings showed that the method of sampling carbon dioxide (CO2) at the outflow of the efferent limb of the patient connector (eliminated CO2 method) in both afferent reservoir systems provided the highest flow rate and most reliable indication for detecting potential or actual rebreathing, when attempting to minimize VF. It provides no additional deadspace or resistance to gas flow, and has the advantage of being the only qualitative method that is reliable for the purpose of detecting the onset of rebreathing.
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Kelly, Ayano, Fiona Niddrie, David J. Tunnicliffe, Andrea Matus Gonzalez, Camilla Hanson, Ivy Jiang, Gabor Major, Davinder Singh-Grewal, Kathleen Tymms, and Allison Tong. "Patients’ attitudes and experiences of transition from paediatric to adult healthcare in rheumatology: a qualitative systematic review." Rheumatology 59, no. 12 (May 15, 2020): 3737–50. http://dx.doi.org/10.1093/rheumatology/keaa168.
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Abstract Objectives We aimed to describe patients’ attitudes and experiences of transition from paediatric to adult healthcare in rheumatology to inform patient-centred transitional care programmes. Methods We searched MEDLINE, EMBASE, PsycINFO and CINAHL to August 2019 and used thematic synthesis to analyse the findings. Results From 26 studies involving 451 people with juvenile-onset rheumatic conditions we identified six themes: a sense of belonging (comfort in familiarity, connectedness in shared experiences, reassurance in being with others of a similar age, desire for normality and acceptance); preparedness for sudden changes (confidence through guided introductions to the adult environment, rapport from continuity of care, security in a reliable point of contact, minimizing lifestyle disruptions); abandonment and fear of the unknown (abrupt and forced independence, ill-equipped to hand over medical information, shocked by meeting adults with visible damage and disability, vulnerability in the loss of privacy); anonymous and dismissed in adult care (deprived of human focus, sterile and uninviting environment, disregard of debilitating pain and fatigue); quest for autonomy (controlled and patronized in the paediatric environment, liberated from the authority of others, freedom to communicate openly); and tensions in parental involvement (overshadowed by parental presence, guilt of excluding parents, reluctant withdrawal of parental support). Conclusion Young people feel dismissed, abandoned, ill-prepared and out of control during transition. However, successful transition can be supported by preparing for changes, creating a sense of belonging and negotiating parental involvement and autonomy. Incorporating patient-identified priorities into transitional services may improve satisfaction and outcomes in young people with juvenile-onset rheumatic conditions.
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LaVecchia, Christina M., Victor M. Montori, Nilay D. Shah, and Rozalina G. McCoy. "Values informing the development of an indicator of appropriate diabetes therapy: qualitative study." BMJ Open 10, no. 12 (December 2020): e044395. http://dx.doi.org/10.1136/bmjopen-2020-044395.
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ObjectivesDespite increasing focus on individualised diabetes management, current diabetes quality measures are based on meeting generic haemoglobin A1c thresholds and do not reflect considerations of clinical complexity, hypoglycaemic susceptibility or treatment burden. Our team observed a multidisciplinary stakeholder panel tasked with informing an appropriate diabetes therapy indicator (ADTI) and analysed their deliberations, seeking to understand what constitutes appropriate diabetes therapy and how it can be captured using an operational quality indicator. We focused specifically on factors the panel valued in an ideal indicator, how they defined appropriateness and how they thought an indicator of appropriateness could be operationalised.DesignQualitative study examining Delphi panel deliberations as it iteratively refined the ADTI.Participants and methodsThe 12-member panel was comprised of clinicians (endocrinology, primary care, geriatrics), pharmacists, nurses, researchers, and representatives of public and private health plans. It met for four teleconference calls and deliberated asynchronously using semi-structured questionnaires following each call to develop the ADTI. These semistructured questionnaires, as well as the meeting minutes, were then analysed using an inductive thematic approach.ResultsWe identified three themes in panellist discussions that represented the core value systems underpinning the indicator and its formation: (1) promoting individualised, evidence-based and equitable care; (2) balancing autonomy and prescriptiveness in clinical decision-making; and (3) ensuring an accurate, reliable and practical indicator. These three principles were operationalised into definitions of treatment intensity and clinical complexity, and yielded an indicator that participants judged both fair and effective.ConclusionsBetter understanding of what multidisciplinary stakeholders perceive as appropriate diabetes management can help develop quality indicators that are patient-centred, evidence-based, equitable and pragmatic across a range of clinical settings.
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Högberg, Cecilia, Ulf Gunnarsson, Stefan Jansson, Hans Thulesius, Olof Cronberg, and Mikael Lilja. "Diagnosing colorectal cancer in primary care: cohort study in Sweden of qualitative faecal immunochemical tests, haemoglobin levels, and platelet counts." British Journal of General Practice 70, no. 701 (November 2, 2020): e843-e851. http://dx.doi.org/10.3399/bjgp20x713465.
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BackgroundColorectal cancer (CRC) diagnostics are challenging in primary care and reliable diagnostic aids are desired. Qualitative faecal immunochemical tests (FITs) have been used for suspected CRC in Sweden since the mid-2000s, but evidence regarding their effectiveness is scarce. Anaemia and thrombocytosis are both associated with CRC.AimTo evaluate the usefulness of qualitative FITs requested for symptomatic patients in primary care, alone and combined with findings of anaemia and thrombocytosis, in the diagnosis of CRC.Design and settingA population-based cohort study using electronic health records and data from the Swedish Cancer Register, covering five Swedish regions.MethodPatients aged ≥18 years in the five regions who had provided FITs requested by primary care practitioners from 1 January 2015 to 31 December 2015 were identified. FIT and blood-count data were registered and all CRC diagnoses made within 2 years were retrieved. Diagnostic measurements were calculated.ResultsIn total, 15 789 patients provided FITs (four different brands); of these patients, 304 were later diagnosed with CRC. Haemoglobin levels were available for 13 863 patients, and platelet counts for 10 973 patients. Calculated for the different FIT brands only, the sensitivities for CRC were 81.6%–100%; specificities 65.7%–79.5%; positive predictive values 4.7%–8.1%; and negative predictive values 99.5%–100%. Calculated for the finding of either a positive FIT or anaemia, the sensitivities increased to 88.9–100%. Adding thrombocytosis did not further increase the diagnostic performance.ConclusionQualitative FITs requested in primary care seem to be useful as rule-in tests for referral when CRC is suspected. A negative FIT and no anaemia indicate a low risk of CRC.
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Vanhaecht, Kris, Karel De Witte, Roeland Depreitere, Ruben Van Zelm, Leentje De Bleser, Karin Proost, and Walter Sermeus. "Development and validation of a care process self-evaluation tool." Health Services Management Research 20, no. 3 (August 1, 2007): 189–202. http://dx.doi.org/10.1258/095148407781395964.
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Clinical pathways are used as a method of organizing care processes. Although they are used worldwide, the concept remains unclear, with little understanding of what exactly is being implemented. A recent systematic review revealed that, although a tool exists to score the instrumental qualities of clinical pathways, no tools are available to assess how the clinical pathway influences the process of care. These tools are needed for a better understanding of the impact of clinical pathways on the length of hospital stay and patient outcomes. In this study, a Care Process Self-Evaluation Tool (CPSET), based on the clinical pathway concept, for assessing the organization of the process of care has been developed and tested. Qualitative and quantitative methods, involving 885 professionals and patients, were used in the development and validation. The CPSET is a valid and reliable 29-item instrument for assessing how the process of care is organized. The CPSET has five subscales: patient-focused organization, coordination of care, communication with patients and family, cooperation with primary care and monitoring/follow-up of the care process. The CPSET can be used in the audit and accreditation of care processes and will help managers and clinicians to understand better how care processes are organized.
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Müller, Julia, Charlotte Ullrich, and Regina Poss-Doering. "Beyond Known Barriers—Assessing Physician Perspectives and Attitudes Toward Introducing Open Health Records in Germany: Qualitative Study." Journal of Participatory Medicine 12, no. 4 (November 6, 2020): e19093. http://dx.doi.org/10.2196/19093.
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Background Giving patients access to their medical records (ie, open health records) can support doctor-patient communication and patient-centered care and can improve quality of care, patients’ health literacy, self-care, and treatment adherence. In Germany, patients are entitled by law to have access to their medical records. However, in practice doing so remains an exception in Germany. So far, research has been focused on organizational implementation barriers. Little is known about physicians’ attitudes and perspectives toward opening records in German primary care. Objective This qualitative study aims to provide a better understanding of physicians’ attitudes toward opening records in primary care in Germany. To expand the knowledge base that future implementation programs could draw from, this study focuses on professional self-conception as an influencing factor regarding the approval for open health records. Perspectives of practicing primary care physicians and advanced medical students were explored. Methods Data were collected through semistructured guide-based interviews with general practitioners (GPs) and advanced medical students. Participants were asked to share their perspectives on open health records in German general practices, as well as perceived implications, their expectations for future medical records, and the conditions for a potential implementation. Data were pseudonymized, audiotaped, and transcribed verbatim. Themes and subthemes were identified through thematic analysis. Results Barriers and potential advantages were reported by 7 GPs and 7 medical students (N=14). The following barriers were identified: (1) data security, (2) increased workload, (3) costs, (4) the patients’ limited capabilities, and (5) the physicians’ concerns. The following advantages were reported: (1) patient education and empowerment, (2) positive impact on the practice, and (3) improved quality of care. GPs’ professional self-conception influenced their approval for open records: GPs considered their aspiration for professional autonomy and freedom from external control to be threatened and their knowledge-based support of patients to be obstructed by open records. Medical students emphasized the chance to achieve shared decision making through open records and expected the implementation to be realistic in the near future. GPs were more hesitant and voiced a strong resistance toward sharing notes on perceptions that go beyond clinical data. Reliable technical conditions, the participants’ consent, and a joint development of the implementation project to meet the GPs’ interests were requested. Conclusions Open health record concepts can be seen as a chance to increase transparency in health care. For a potential future implementation in Germany, thorough consideration regarding the compatibility of GPs’ professional values would be warranted. However, the medical students’ positive attitude provides an optimistic perspective. Further research and a broad support from decision makers would be crucial to establish open records in Germany.
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van Braak, Marije, Mechteld Visser, Marije Holtrop, Ilona Statius Muller, Jettie Bont, and Nynke van Dijk. "What motivates general practitioners to change practice behaviour? A qualitative study of audit and feedback group sessions in Dutch general practice." BMJ Open 9, no. 5 (May 2019): e025286. http://dx.doi.org/10.1136/bmjopen-2018-025286.
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ObjectivesAdopting an attributional perspective, the current article investigates how audit and feedback group sessions contribute to general practitioners’ (GPs) motivation to change their practice behaviour to improve care. We focus on the contributions of the audit and feedback itself (content) and the group discussion (process).MethodsFour focus groups, comprising a total of 39 participating Dutch GPs, discussed and compared audit and feedback of their practices. The focus groups were analysed thematically.ResultsAudit and feedback contributed to GPs’ motivation to change in two ways: by raising awareness about aspects of their current care practice and by providing indications of the possible impact of change. For these contributions to play out, the audit and feedback should be reliable and valid, specific, recent and recurrent and concern GPs’ own practices or practices within their own influence sphere. Care behaviour attributed to external, uncontrollable or unstable causes would not induce change. The added value of the group is twofold as well: group discussion contributed to GPs’ motivation to change by providing a frame of reference and by affording insights that participants would not have been able to achieve on their own.ConclusionsIn audit and feedback group sessions, both audit and feedback information and group discussion can valuably contribute to GPs’ motivation to change care practice behaviour. Peer interaction can positively contribute to explore alternative practices and avenues for improvement. Local or regional peer meetings would be beneficial in facilitating reflection and discussion. An important avenue for future studies is to explore the contribution of audit and feedback and small-group discussion to actual practice change.
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Idenfors, Hans, Gunnar Kullgren, and Ellinor Salander Renberg. "Professional Care as an Option Prior to Self-Harm." Crisis 36, no. 3 (May 2015): 179–86. http://dx.doi.org/10.1027/0227-5910/a000310.
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Abstract. Background: Deliberate self-harm (DSH) is a growing problem among young people and is a major risk factor for suicide. Young adults experiencing mental distress and suicidal ideation are reluctant to seek help, requiring new strategies to reach this group. Aims: The present study explored young people's views of professional care before first contact for DSH, and factors that influenced the establishing of contact. Method: Interviews with 10 young individuals, shortly after they had harmed themselves, were analyzed using qualitative content analysis. Results: The participants emphasized the importance of receiving more knowledge on where to turn, having different help-seeking options, and receiving immediate help. Family and friends were vital for support and making health care contact. The quality of the professional contact was stressed. Several reasons for not communicating distress were mentioned. Two themes were identified: "A need for a more flexible, available and varied health care" and "A struggle to be independent and yet being in need of reliable support." Conclusion: These findings suggest that easy and direct access to professional help is a decisive factor for young people experiencing psychological problems and that health services must find new ways of communicating information on seeking mental health help.
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Voss, Sarah, Kim Kirby, Janet Brandling, and Jonathan Benger. "OP6 A qualitative study on conveyance decision-making during emergency call outs to people with dementia: The HOMEWARD project." Emergency Medicine Journal 36, no. 10 (September 24, 2019): e4.2-e4. http://dx.doi.org/10.1136/emermed-2019-999abs.6.
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ObjectivesAmbulance staff are increasingly required to make complex decisions as to whether they should convey a patient to hospital or ‘see and treat’ at the scene. Dementia can be a significant barrier to the assessment of pain and injury. However, to our knowledge no research has specifically examined the process of decision-making by ambulance staff in relation to people with dementia. This qualitative study was designed to investigate the factors influencing the decision-making process during ambulance calls to older people with dementia.MethodsThis qualitative study used a combination of observation, interview and document analysis, to investigate the factors influencing the decision-making process during ambulance calls to older people with dementia. A researcher worked alongside ambulance crews in the capacity of observer and recruited eligible patients to participate in case studies. Data were collected from observation notes of decision-making during the incident, patient care records and post incident interviews with participants, and analysed thematically.ResultsFour main themes emerged from the data concerning the way that paramedics make decisions in people with dementia: Physical Condition; the key factor influencing paramedics’ decision-making was the physical condition of the patient. Cognitive Capacity; most of the participants preferred not to remove patients with a diagnosis of dementia from surroundings familiar to them, unless they deemed it absolutely essential. Patient Circumstances; this included the patient’s medical history and the support available to them. Professional Influences; paramedics also drew on other perspectives to inform their decision-making.ConclusionThe preference for avoiding unnecessary conveyance for patients with dementia, combined with difficulties in obtaining an accurate patient medical history and assessment, mean that decision-making can be especially challenging. Further research is needed to find reliable ways of assessing patients and accessing information to support conveyance decisions for ambulance calls to people with dementia.
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Laureij, Lyzette T., Leonieke J. Breunis, Regine P. M. Steegers-Theunissen, and Ageeth N. Rosman. "Identifying the Needs for a Web-Based Postpartum Platform Among Parents of Newborns and Health Care Professionals: Qualitative Focus Group Study." JMIR Formative Research 4, no. 5 (May 26, 2020): e16202. http://dx.doi.org/10.2196/16202.
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Background During the turbulent postpartum period, there is an urgent need by parents for support and information regarding the care for their infant. In the Netherlands, professional support is provided during the first 8 days postpartum and for a maximum of 8 hours a day. This care is delivered by maternity care assistants (MCAs). Despite the availability of this extensive care, a majority of women prefer to make use of a lesser amount of postpartum care. After this period, access to care is less obvious. Where parents are automatically offered care in the first 8 days after birth, they must request care in the period thereafter. To compensate for a possible gap in information transfer, electronic health (eHealth) can be a valuable, easily accessible addition to regular care. Objective We explored the needs and preferred content by new parents and health care professionals of a web-based platform dedicated to the postpartum period and identified barriers and facilitators for using such a platform. Methods We conducted 3 semistructured focus groups among (1) parents of newborns, (2) MCAs, and (3) clinicians and administrators in maternity care. A topic list based on a framework designed for innovation processes was used. Thematic content analysis was applied. Results In the focus group for parents, 5 mothers and 1 male partner participated. A total of 6 MCAs participated in the second focus group. A total of 5 clinicians and 2 administrators—a member of a stakeholder party and a manager of a maternity care organization—participated in the third focus group. All user groups underlined that a platform focusing on the postpartum period was missing in current care, especially by parents experiencing a gap following the intensive care ending after the first week of childbirth. Parents indicated that they would perceive a postpartum platform as a proper source of reliable information on topics regarding breastfeeding, growth, and developmental milestones, but also as a tool to support them in seeking care with appropriate professionals. They also emphasized the need to receive personalized information and the opportunity to ask questions via the platform. MCAs acknowledged added value of providing additional information on topics that they address during the early postpartum period. MCAs as well as clinicians and administrators would guide parents to such a platform for additional support. All user groups experienced disadvantages of using an authentication procedure and filling out extra questionnaires to receive tailored information. Conclusions Our research shows that parents of newborns, MCAs, and clinicians and administrators foresee the additional value of a web-based postpartum platform for at least the whole postpartum period. The platform should be easily accessible and personalized. Content on the platform should contain information regarding breastfeeding, growth, and developmental milestones. A chat function with professionals could be considered as an option.
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Saunders, K. E. A., A. C. Bilderbeck, J. Price, and G. M. Goodwin. "Distinguishing bipolar disorder from borderline personality disorder: A study of current clinical practice." European Psychiatry 30, no. 8 (October 21, 2015): 965–74. http://dx.doi.org/10.1016/j.eurpsy.2015.09.007.
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AbstractBackgroundDiagnosing mental illness is a central role for psychiatrists. Correct diagnosis informs both treatment and prognosis, and facilitates accurate communication. We sought to explore how psychiatrists distinguished two common psychiatric diagnoses: bipolar disorder (BD) and borderline personality disorder (BPD).MethodsWe conducted a qualitative study of psychiatrists to explore their practical experience. We then sought to validate these results by conducting a questionnaire study testing the theoretical knowledge and practical experience of a large number of UK psychiatrists. Finally we studied the assessment process in NHS psychiatric teams by analysing GP letters, assessments by psychiatrists, and assessment letters.ResultsThere was broad agreement in both the qualitative and questionnaire studies that the two diagnoses can be difficult to distinguish. The majority of psychiatrists demonstrated in survey responses a comprehensive understanding DSM-IV-TR criteria although many felt that these criteria did not necessarily assist diagnostic differentiation. This scepticism about diagnostic criteria appeared to strongly influence clinical practice in the sample of clinicians we observed. In only a minority of assessments were symptoms of mania or BPD sufficiently assessed to establish the presence or absence of each diagnosis.ConclusionClinical diagnostic practice was not adequate to differentiate reliably BD and BPD. The absence of reliable diagnostic practice has widespread implications for patient care, service provision and the reliability of clinical case registries.
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Ojha, Gita Jyoti, and Ruchi Nagar Buckshee. "Developing a Self-Report Tool to Measure Functional Limitation in Children Aged 7-12 Years with Physical Dysfunction." International Journal of Research and Review 8, no. 8 (August 17, 2021): 377–84. http://dx.doi.org/10.52403/ijrr.20210852.
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Objective: To develop a self-report questionnaire to measure functional limitation in children aged 7- 12 years with physical dysfunction. Study design: Methodological research design Method: The study was conducted in phases: drafting of the questionnaire, content validation, pilot testing, revision of the questionnaire, field testing and test-retest reliability. A total of 66 items were generated through a review of the literature and interviews of twenty five children, their parents and health-care professionals. Qualitative and quantitative content validation through expert review and item reduction resulted in a 59-item questionnaire which was pilot tested on a sample of 10 children with physical dysfunction. With further inputs the questionnaire was revised. Thus, the final questionnaire with 60 items in two versions (a child and a caregiver’s version) in both Hindi and English was developed. Results: Qualitative review and Content validity was established for the Children’s Functional Limitation Scale. The questionnaire demonstrated high internal consistency (Cronbach’s alpha=0.91), moderate agreement between parents and children (weighted kappa= 0.718) and good test-retest reliability (weighted kappa=0.88). Conclusion: “Children’s Functional Limitation Scale” is a valid and reliable tool for documenting difficulties perceived by children with physical dysfunction. Also, the study demonstrates ability of children to reliably report their limitations. Keywords: Functional limitation, Activities of Daily living, Self-Report, Questionnaire, Children with physical dysfunctions
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Menon, Shailaja, Daniel Murphy, Hardeep Singh, Ashley N. Meyer, and Dean Sittig. "Workarounds and Test Results Follow-up in Electronic Health Record-Based Primary Care." Applied Clinical Informatics 07, no. 02 (April 2016): 543–59. http://dx.doi.org/10.4338/aci-2015-10-ra-0135.
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SummaryElectronic health records (EHRs) have potential to facilitate reliable communication and follow-up of test results. However, limitations in EHR functionality remain, leading practitioners to use workarounds while managing test results. Workarounds can lead to patient safety concerns and signify indications as to how to build better EHR systems that meet provider needs.To understand why primary care practitioners (PCPs) use workarounds to manage test results by analyzing data from a previously conducted national cross-sectional survey on test result management.We conducted a secondary data analysis of quantitative and qualitative data from a national survey of PCPs practicing in the Department of Veterans Affairs (VA) and explored the use of workarounds in test results management. We used multivariate logistic regression analysis to examine the association between key sociotechnical factors that could affect test results follow-up (e.g., both technology-related and those unrelated to technology, such as organizational support for patient notification) and workaround use. We conducted a qualitative content analysis of free text survey data to examine reasons for use of workarounds.Of 2554 survey respondents, 1104 (43%) reported using workarounds related to test results management. Of these 1028 (93%) described the type of workaround they were using; 719 (70%) reported paper-based methods, while 230 (22%) used a combination of paper- and computer-based workarounds. Primary care practitioners who self-reported limited administrative support to help them notify patients of test results or described an instance where they personally (or a colleague) missed results, were more likely to use workarounds (p=0.02 and p=0.001, respectively). Qualitative analysis identified three main reasons for workaround use: 1) as a memory aid, 2) for improved efficiency and 3) for facilitating internal and external care coordination.Workarounds to manage EHR-based test results are common, and their use results from unmet provider information management needs. Future EHRs and the respective work systems around them need to evolve to meet these needs.
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Loban, Ekaterina, Cathie Scott, Virginia Lewis, and Jeannie Haggerty. "Measuring partnership synergy and functioning: Multi-stakeholder collaboration in primary health care." PLOS ONE 16, no. 5 (May 28, 2021): e0252299. http://dx.doi.org/10.1371/journal.pone.0252299.
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In primary health care, multi-stakeholder partnerships between clinicians, policy makers, academic representatives and other stakeholders to improve service delivery are becoming more common. Literature on processes and approaches that enhance partnership effectiveness is growing. However, evidence on the performance of the measures of partnership functioning and the achievement of desired outcomes is still limited, due to the field’s definitional ambiguity and the challenges inherent in measuring complex and evolving collaborative processes. Reliable measures are needed for external or self-assessment of partnership functioning, as intermediate steps in the achievement of desired outcomes. We adapted the Partnership Self-Assessment Tool (PSAT) and distributed it to multiple stakeholders within five partnerships in Canada and Australia. The instrument contained a number of partnership functioning sub-scales. New sub-scales were developed for the domains of communication and external environment. Partnership synergy was assessed using modified Partnership Synergy Processes and Partnership Synergy Outcomes sub-scales, and a combined Partnership Synergy scale. Ranking by partnership scores was compared with independent ranks based on a qualitative evaluation of the partnerships’ development. 55 (90%) questionnaires were returned. Our results indicate that the instrument was capable of discriminating between different levels of dimensions of partnership functioning and partnership synergy even in a limited sample. The sub-scales were sufficiently reliable to have the capacity to discriminate between individuals, and between partnerships. There was negligible difference in the correlations between different partnership functioning dimensions and Partnership Synergy sub-scales. The Communication and External Environment sub-scales did not perform well metrically. The adapted partnership assessment tool is suitable for assessing the achievement of partnership synergy and specific indicators of partnership functioning. Further development of Communication and External Environment sub-scales is warranted. The instrument could be applied to assess internal partnership performance on key indicators across settings, in order to determine if the collaborative process is working well.
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Searle, Aidan, Emma Ranger, Jez Zahra, Byron Tibbitts, Angie Page, and Ashley Cooper. "Engagement in e-cycling and the self-management of type 2 diabetes: a qualitative study in primary care." BJGP Open 3, no. 2 (April 16, 2019): bjgpopen18X101638. http://dx.doi.org/10.3399/bjgpopen18x101638.
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BackgroundPhysical activity (PA) is important in the management of type 2 diabetes (T2DM), however many people find it difficult to implement and/or sustain in the self-management of the condition. Electrically assisted cycling (e-cycling) may be viewed as a means of self-management in which effort is invested to balance the interplay of lifestyle factors and disease progression.AimTo explore engagement with an e-cycling intervention conducted with adults with T2DM.Design & settingProspective qualitative interview study with adults in central Bristol (UK) and surrounding suburbs, in the context of the self-management of T2DM in primary care.MethodInterviews were conducted with 20 individuals with T2DM (42–70 years, 11 male, 9 female) prior to their participation in a 20-week e-cycling intervention. Post-intervention interviews were conducted with 18 participants (11 male, 7 female). Interviews were transcribed verbatim and inductive thematic analysis was undertaken.ResultsParticipants were aware that PA contributed to the management of their diabetes. Engagement with e-cycling was viewed as both an acceptable and a social lifestyle intervention. Furthermore, participants were unhappy with the volume of medication used to manage their diabetes and e-cycling fostered autonomy in the management of T2DM. GPs and practice nurses were regarded as an important source of reliable information, and were considered to be best placed to talk about interventions to increase PA.ConclusionE-cycling is viewed as an acceptable form of PA to aid the self-management of T2DM. E-cycling may support people with T2DM to reduce their medication intake and in turn foster greater autonomy in managing the condition. The findings have implications for the role of primary care health professionals in supporting both patients and significant others in adoption of e-cycling.
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Ellington, Kelly. "Web-Based Perinatal Education for the New Obstetrical Patient: A Quality Improvement Project." Journal of Perinatal Education 27, no. 2 (2018): 115–20. http://dx.doi.org/10.1891/1058-1243.27.2.115.
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Mixed-methods quality improvement project improved the new obstetrical perinatal education curriculum by cultivating reliable delivery of evidenced-based initiatives linked to successful pregnancy. The web-based format enhanced family-centered care in a teaching format in the comfort of the home. The identification of at-risk populations resulted in improved referral for cell-free fetal DNA screening. A qualitative approach assessed overall provider satisfaction with web-based teaching. The patient survey identified barriers for noncompletion of web-based content. Quantitative data identified completion rate, high-risk populations for referral for advanced screening, and provider satisfaction with web-based curriculum content in a teaching platform linked to the provider’s website.
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Kozlov, Elissa, Brian D. Carpenter, and Thomas L. Rodebaugh. "Development and validation of the Palliative Care Knowledge Scale (PaCKS)." Palliative and Supportive Care 15, no. 5 (December 27, 2016): 524–34. http://dx.doi.org/10.1017/s1478951516000997.
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ABSTRACTObjective:The purpose of this study was to develop a reliable and valid scale that broadly measures knowledge about palliative care among non-healthcare professionals.Method:An initial item pool of 38 true/false questions was developed based on extensive qualitative and quantitative pilot research. The preliminary items were tested with a community sample of 614 adults aged 18–89 years as well as 30 palliative care professionals. The factor structure, reliability, stability, internal consistency, and validity of the 13-item Palliative Care Knowledge Scale (PaCKS) were assessed.Results:The results of our study indicate that the PaCKS meets or exceeds the standards for psychometric scale development.Significance of results:Prior to this study, there were no psychometrically evaluated scales with which to assess knowledge of palliative care. Our study developed the PaCKS, which is valid for assessing knowledge about palliative services in the general population. With the successful development of this instrument, new research exploring how knowledge about palliative care influences access and utilization of the service is possible. Prior research in palliative care access and utilization has not assessed knowledge of palliative care, though many studies have suggested that knowledge deficits contribute to underutilization of these services. Creating a scale that measures knowledge about palliative care is a critical first step toward understanding and combating potential barriers to access and utilization of this life-improving service.
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Demirchyan, Anahit, and Dzovinar Melkom Melkomian. "Main Barriers to Optimal Breastfeeding Practices in Armenia: A Qualitative Study." Journal of Human Lactation 36, no. 2 (June 20, 2019): 318–27. http://dx.doi.org/10.1177/0890334419858968.
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Background In 2015, the median duration of exclusive breastfeeding was 2.2 months in Armenia, and only 15% of 4–5-month-old children were exclusively breastfed, indicating an issue with breastfeeding knowledge and practices. Research aim To identify the main barriers to optimal breastfeeding practices in Armenia. Methods We used qualitative research methods via focus group discussions and in-depth interviews with four groups of providers from different levels of care, and mothers of young children, from Yerevan city and two provinces, Lori and Shirak. Overall, eight in-depth interviews and 13 focus group discussions were conducted with a total of 99 participants. Qualitative content analysis was applied, with elements of both inductive and deductive approaches. Results We identified two main categories of barriers to optimal breastfeeding—systemic barriers and knowledge deficiencies. The main themes within systemic barriers were lack of skilled breastfeeding support services and low motivation of providers—mainly related to inadequate recognition of their role in breastfeeding counseling and low remuneration. The main knowledge-related barriers were insufficient counseling of mothers, lack of reliable information sources about infant feeding, and misconceptions among both mothers and providers. Conclusion Optimal breastfeeding is crucial for the best start to an infant’s life; however, there were a number of barriers to optimal breastfeeding practices in Armenia. Our findings and recommendations could help policymakers apply effective strategies for improving breastfeeding rates in Armenia. Considering the similar historical backgrounds of the post-Soviet countries, our findings could also be applicable to other Commonwealth of Independent States countries.
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Kheir, Abdelmoneim E., Ghada A. Jobara, Kamal M. Elhag, and Mohamed Z. Karar. "Qualitative C-reactive protein as a marker of neonatal sepsis in a tertiary neonatal unit in Sudan." Healthcare in Low-resource Settings 1, no. 2 (October 9, 2013): 21. http://dx.doi.org/10.4081/hls.2013.e21.
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Sepsis is one of the most common causes of morbidity and mortality in newborns. Diagnosis of neonatal sepsis may be difficult because clinical presentations are often non-specific. The aim of this study was to evaluate the role of qualitative C-reactive protein in the diagnosis of neonatal sepsis, and examine the correlation between C-reactive protein, blood culture and risk factors for sepsis. This was a prospective study, conducted in the Neonatal Intensive Care Unit at Soba University Hospital, Sudan. A total of seventy babies with a clinical diagnosis of sepsis were included. Chi square test was used to determine the association between C-reactive protein and risk factors for sepsis and also the association between C-reactive protein and blood culture. Blood culture was positive in 41.4% of babies, and C-reactive protein was positive in 58% of babies with positive blood culture. There was significant association between C-reactive protein results and blood culture (P=0.00). In conclusion, we can assume that Creactive protein is a reliable diagnostic marker of neonatal sepsis, especially in developing communities with poor resources.