Behavioral Health Professionals Research Articles

Are you handling genital oedema confidently?

Men, women or children can suffer from oedema (swelling) of the genitalia. When differential diagnosis has excluded acute trauma or pathology and swelling remains, the condition may be diagnosed as genital lymphoedema, a chronic condition that increases the relative risk of cellulitis. Diagnosis of genital oedema is often delayed due to problems with patient and health professional behaviour, in terms of embarrassment, lack of confidence or lack of knowledge. Awareness of this condition and knowledge on how to manage it will go a long way in helping both patients and clinicians overcome the challenges of addressing genital oedema. This article describes the authors' experiences in managing genital oedema. It also briefly discusses a new international project that seeks to identify the knowledge and training that health professionals need to manage this condition more confidently.

Dietary Health-Related Risk Factors for Women in the Polish and Croatian Population Based on the Nutritional Behaviors of Junior Health Professionals

In Poland and Croatia, similarly as for a number of European countries, anemia and osteoporosis are common diet-related diseases in women, while for both the proper nutritional behaviors and preventive education are crucial. However, for the proper nutritional education there are some barriers, including those associated with an educator, his own nutritional behaviors and beliefs. The aim of the study was to assess the dietary health risk factors for women in the Polish and Croatian population based on the nutritional behaviors of junior health professionals. The study was conducted in Polish (n = 70) and Croatian (n = 80) female students of the faculties associated with public health at the universities in capital cities. Their diets were assessed based on 3-day dietary records. Nutritional value and consumption of food products, as well as the dietary risk factors for anemia and osteoporosis, were compared. While assessing the risk factors for anemia, in the Polish group, the higher intake of iron and folate, as well as vitamin B12 per 1000 kcal, was observed; and for folate, the higher frequency of inadequate intake was stated for Croatian women. While assessing the risk factors for osteoporosis, in the Polish group, compared with the Croatian, the higher intake of calcium per 1000 kcal was observed, but for vitamin D, there were no differences. Differences of the intake between the Polish and the Croatian group of junior health professionals may result in various dietary health risks for women. Based on the assessment of dietary intake, for anemia, compared to Polish women, a higher risk may be indicated for Croatian women, but for osteoporosis, similar risks may be indicated for Polish and Croatian women. Therefore, for public health, adequate nutritional education of junior health professionals is necessary.

How do clinical decision support tools used to change the behavior of health professionals affect outcomes in obese and overweight adults?

How do clinical decision support tools used to change the behavior of health professionals affect outcomes in obese and overweight adults?

Changing prescribing behaviours with educational outreach: an overview of evidence and practice

BackgroundGeneral practitioners (GPs), or family practitioners, are tasked with prescribing medications that can be harmful to the community if they are inappropriately prescribed or used (e.g. opioids). Educational programs, such as educational outreach (EO), are designed to change the behaviour of health professionals. The purpose of this study was to identify the efficacy of EO programs at changing the prescribing behaviour of GPs.MethodsThis study included an evidence and practice review, comprising a rapid review supplemented by interviews with people who are familiar with EO implementation for regulation purposes. Seven databases were searched using terms related to health professionals and prescribing. Systematic and narrative reviews published in English after 2007 were included. Non-statistical analysis was used to report intervention efficacy. Three government representatives participated in semi-structured interviews to aid in understanding the relevance of review findings to the Victorian context. Interviews were transcribed verbatim and thematically analysed for emerging themes.ResultsFourteen reviews were identified for the evidence review. Isolated (e.g. EO program delivered by itself) and multifaceted (e.g. EO program supplemented by other interventions) programs were found to change prescribing behaviours. However, limited evidence suggests that EO can successfully change prescribing behaviours specific to GPs. Isolated EO can successfully change health professional prescribing behaviours, although cheaper alternatives such as letters might be just as effective. Multifaceted EO can also successfully change health professional prescribing behaviours, especially in older adults, but it remains unclear as to what combination of interventions works best. Success factors for EO reported by government representatives included programs having practical rather than didactic foci; making EO compulsory; focussing EO on preventing adverse events; using monetary or professional development incentives; and in-person delivery.ConclusionsEducational outreach can successfully change prescribing behaviours but evidence specific to GPs is lacking. Key characteristics of EO that could optimise success include ensuring the EO program is tailored, involves practical learning and uses incentives that are meaningful to clinicians.

The impact of social norms interventions on clinical behaviour change among health workers: protocol for a systematic review and meta-analysis

BackgroundHealth workers routinely carry out clinical behaviours, such as prescribing, test-ordering or hand-washing, which impact on patient diagnoses, care, treatment and recovery. Social norms are the implicit or explicit rules that a group uses to determine values, beliefs, attitudes and behaviours. A social norms intervention seeks to change the clinical behaviour of a target health worker by exposing them to the values, beliefs, attitudes or behaviours of a reference group or person. This study aims to find out whether or not social norms interventions are effective ways of encouraging health workers to carry out desired behaviours and to identify which types of social norms intervention, if any, are most effective.MethodsA systematic review will be conducted. The inclusion criteria are a population of health professionals, a social norms intervention that seeks to change a clinical behaviour, and randomised controlled trials. Searches will be undertaken in MEDLINE, EMBASE, CINAHL, British Nursing Index, ISI Web of Science, PsycINFO and Cochrane trials. Titles and abstracts will be reviewed against the inclusion criteria to exclude any that are clearly ineligible. Two reviewers will independently screen all the remaining full texts to identify relevant papers. For studies which meet our inclusion criteria, two reviewers will extract data independently, code for behaviour change techniques and assess quality using the Cochrane risk of bias tool. The primary outcome measure will be compliance with desired behaviour. To assess the effect of social norms on the behaviour of health workers, we will perform fixed effects meta-analysis and present forest plots, stratified by behaviour change technique. We will explore sources of variation using meta-regression and may use multi-component-based network meta-analysis to explore which forms of social norms are more likely to be effective, if our data meet the necessary requirements.DiscussionThe study will provide evidence regarding the effectiveness of different methods of applying social norms to change the clinical behaviour of health professionals. We will disseminate the research to academics, health workers and members of the public and use the findings from the review to plan future research on the use of social norms with health workers.Systematic review registrationPROSPERO CRD42016045718. Future protocol changes will be clearly stated in PROSPERO.

Obstáculos no Acesso à Saúde pelos Imigrantes: Análise de Género

Enquadramento: a presença de diferentes culturas pela enorme diversidade de imigrantes em Portugal provoca alterações no comportamento dos profissionais de saúde. Objetivo: conhecer os fatores que influenciam a procura dos cuidados de saúde segundo o género dos imigrantes ucranianos na região metropolitana do Porto. Metodologia: estudo exploratório-descritivo e correlacionai com abordagem quantitativa e qualitativa. A informação foi recolhida por questionário e 11 entrevistas numa amostra de conveniência constituída por 212 imigrantes ucranianos. Resultados: evidência de dificuldades no acesso aos cuidados de saúde não se verificando diferenças significativas quanto ao género. Uma vez que as mulheres Ucranianas procuram mais os cuidados, são elas que referem mais obstáculos no acesso à saúde (comunicação ineficaz, barreira linguística, barreira cultural, diferentes interpretações dos sintomas, desarticulação entre serviços, crenças, dificuldade na conjugação de horários, custos com os tratamentos, desconhecimento dos direitos como imigrante, situação de ilegalidade, receio de descriminação). Conclusão: barreiras culturais e linguísticas e desarticulação entre serviços influenciam negativamente a procura dos cuidados. As mulheres são as maiores utilizadoras dos serviços de saúde. Os serviços devem dispor de tradutores, mediadores culturais. Espera-se que os serviços e os profissionais de saúde desenvolvam planos dirigidos aos imigrantes. Sugere-se formação que aumente a competência cultural dos profissionais.

Immunization coverage of 12\u201323\u2009months old children and its associated factors in Minjar-Shenkora district, Ethiopia: a community-based study

BackgroundChildhood vaccinations have been shown to be effective in protecting children against vaccine-preventable diseases. The systematic investigation of the causes of incomplete immunization is critical for the full immunization and develop health system interventions to improve immunization coverage. To date, no community-based immunization coverage assessment study was conducted in Minjar-shenkora district. Therefore, the aim of this study was to assess the immunization coverage and its factors among 12–23 months old children in Minjar-shenkora district, Ethiopia.MethodsCommunity-based cross-sectional study was conducted from September to November 2017. A total of 566 children aged 12–23 months and their mothers/caregivers were successfully interviewed using structured and pre-tested questionnaire. A stratified sampling technique was employed. Study participants were selected systematically. Data were entered into Epi data version 3.1 and exported into SPSS version 21 for analysis. Logistic regression analyses were done. A significant association was declared at a p-value less than 0.05.ResultsThree fourth (75.6%) of 12–23 months old children were fully vaccinated. Incorrect appointment date (46.4%), the experience of child sickness with previous vaccination (35.2%) and disrespectful behavior of health professionals (14.3%) were the most common reasons cited by mothers/caregivers for incomplete vaccination of children. Being unmarried (AOR = 3.52, CI = 2.61, 9.15), not being a member of health development army (AOR = 3.31, CI = 2.01, 11.65) and traveling time greater than two hours on foot (AOR = 2.46, CI = 5.01, 17.18) were predictors of incomplete immunization.ConclusionsChild immunization coverage was still below the governmental plan of 90% in 2020. Being unmarried, not being a member of health development army and traveling time greater than two hours on foot were predictors of incomplete immunization. Strengthen health development army programmatic interventions in the community will improve child vaccination completion in the district. The issue of long travel time should be addressed by increasing the number of new vaccination sites/clusters in the district.

Online patient feedback: a cross-sectional survey of the attitudes and experiences of United Kingdom health care professionals

ObjectivesOnline patient feedback is a growing phenomenon but little is known about health professional attitudes and behaviours in relation to it. We aimed to identify the characteristics, attitudes and self-reported behaviours and experiences of doctors and nurses towards online feedback from their patients or their carers.MethodsWe conducted a cross-sectional self-completed online questionnaire of 1001 registered doctors and 749 nurses and midwives involved in direct patient care in the United Kingdom.ResultsJust over a quarter (27.7% or 277/1001) of doctors and 21% (157/749) of nurses were aware that patients/carers had provided online feedback about an episode of care in which they were involved, and 20.5% (205/1001) of doctors and 11.1% (83/749) of nurses had experienced online feedback about them as an individual practitioner. Feedback on reviews/ratings sites was seen as more useful than social media feedback to help improve services. Both types of feedback were more likely to be seen as useful by nurses compared with doctors and by hospital-based professionals compared with those based in community settings. Doctors were more likely than nurses to believe that online feedback is unrepresentative and generally negative in tone. The majority of respondents had never encouraged patients/carers to leave online feedback.ConclusionsDespite enthusiasm from health policymakers, many health care professionals have little direct experience of online feedback, and rarely encourage it, as they view it as unrepresentative and with limited value for improving the quality of health services. The difference in opinion between doctors and nurses has the potential to disrupt any use of online patient feedback. The findings have implications for policy and practice in how online patient feedback is solicited and acted upon.

Can nudge-interventions address health service overuse and underuse? Protocol for a systematic review

IntroductionNudge-interventions aimed at health professionals are proposed to reduce the overuse and underuse of health services. However, little is known about their effectiveness at changing health professionals’ behaviours in relation...

Improving behavioral health workforce supply and needs estimates using active surveillance data.

Previous studies show that supply of behavioral health professionals in rural areas is inadequate to meet the need. Measuring shortage using licensure data on psychiatrists is a common approach. Although inexpensive, the licensure data have many limitations. An alternative is to implement an active surveillance system, which uses licensure data in addition to active data collection to obtain timely and detailed information. Nebraska Health Professions Tracking Service (HPTS) data were used to examine differences in workforce supply estimates between the passive (licensure data only) and active (HPTS data) surveillance systems. The impact of these differences on the designation of psychiatric professional shortage areas has been described. Information regarding the number of psychiatrists, advanced practice registered nurses and physician assistants specializing in psychiatry was not available from the licensure database, unlike HPTS. Using licensure data versus HPTS data to estimate workforce, the counts of professionals actively practicing in psychiatry and behavioral health were overestimated by 24.1-57.1%. Ignoring work status, the workforce was overestimated by 10.0-17.4%. Providers spent 54-78% of time seeing patients. Based on primary practice location, 87% of counties did not have a psychiatrist and 9.6% were at or above the Health Professional Shortage Area designation ratio of psychiatrists to population. Enumeration methods such as ongoing surveillance, in addition to licensure data, curtails the issues and improves identification of shortage areas and future behavioral workforce related planning and implementation strategies.

Health professional beliefs, knowledge, and concerns surrounding medicinal cannabis - A systematic review.

BackgroundThe number of jurisdictions allowing access to medicinal cannabis has been steadily increasing since the state of California introduced legislation in 1996. Although there is a high degree of legislative heterogeneity across jurisdictions, the involvement of a health professional is common among all. This places health professionals at the forefront of therapy, yet no systematic review of literature has offered insight into the beliefs, knowledge, and concerns of health professionals regarding medicinal cannabis.MethodsUsing a predetermined study protocol, PubMed, EMBASE, PsycINFO, CINAHL, and Scopus databases were searched for studies indexed up to the 1st August 2018. Pre-defined inclusion and exclusion criteria were applied uniformly. Screening for relevancy, full-text review, data extraction, and risk of bias were completed by two independent investigators. Risk of bias was assessed using CASP criteria (qualitative) and a modified domain-based risk assessment tool (quantitative).ResultsOf the 15,775 studies retrieved, 106 underwent full-text review and of these, 26 were included. The overall risk of bias was considered low across all included studies. The general impression was that health professionals supported the use of medicinal cannabis in practice; however, there was a unanimous lack of self-perceived knowledge surrounding all aspects of medicinal cannabis. Health professionals also voiced concern regarding direct patient harms and indirect societal harms.ConclusionThis systematic review has offered a lens through which to view the existing literature surrounding the beliefs, knowledge, and concerns of health professionals regarding medicinal cannabis. These results are limited, however, by the implicit common-sense models of behaviour utilised by the included studies. Before strategies can be developed and implemented to change health professional behaviour, a more thorough understanding of the factors that underpin the delivery of medicinal cannabis is necessary.

Disaster mental health in higher education: A review.

Disaster mental health (DMH), also referred to as disaster behavioral health, and crisis intervention more broadly, is a significant, yet relatively nonstandardized response system in the United States. Higher education can play a critical role in shifting understanding of DMH, its place within emergency management, and skills building among students. With the increased need for qualified DMH practitioners growing, the academy is uniquely positioned to train students as they become our future responders. Movement toward standardized curriculum and certification programs within schools of social work and emergency management can alleviate lack of knowledge and training as well as better prepare emergency managers and behavioral health professionals to respond to the emotional and mental wellbeing of those impacted by disasters (natural or human-caused).

Review article: A primer for clinical researchers in the emergency department: Part VIII. Implementation science: An introduction.

New research findings may not lead to change in practice, or a change at the front line may be delayed by years. A number of terms have been used to describe efforts and strategies to speed a change in evidence-based practice, such as: implementation science, knowledge translation, research translation and others. In contrast to traditional clinical research, implementation science generally aims to understand and change health professional behaviour to promote evidence uptake as opposed to attempting to change patient behaviour. There are now theoretical frameworks and evolving evidence providing guidance how to change clinician behaviour and, specifically, emerging evidence on how to achieve this in the emergency setting. This review will provide an introduction to implementation science and illustrate how to target evidence practice gaps using ED examples.

Cannabinoids use in critically ill ventilated patients: A qualitative study using Q methodology

Initiatives such as the Epilepsy Learning Healthcare System continue to advocate for standardized care and shared outcome data. Therefore, the current project aim was to gather information from epilepsy healthcare professionals, behavioral health professionals in particular, regarding their behavioral health and cognitive screening practices in pediatric patients with epilepsy. Information obtained will be used to assist in the development of new educational programs and platforms in the American Epilepsy Society (AES) and to inform the development of guidelines for behavioral healthcare of patients with pediatric epilepsy.Twenty-five AES members representing 25 unique epilepsy programs across the United States participated in the survey. Findings are described in terms of three focus areas: (1) Systems, (2) Assessment, and (3) Intervention. Over 80% of respondents surveyed reported that they do conduct formal screenings, most commonly to determine if further evaluation is indicated (81%), inform treatment decisions (57.1%), and for developmental surveillance (33.3%). Assessment methods were fairly evenly split between nonstandardized informal questions (50%) and evidence-based broadband measures, with the Behavior Assessment System for Children (BASC), 2nd or 3rd Editions (40%) most commonly used. If behavioral health concerns are identified, referrals are often made for psychotherapy (48% in-house; 80% community-based), psychiatry (68% in-house; 48% community-based), and cognitive testing (88% neuropsychological testing; 36% for psychoeducational testing). Thirty-two percent refer for psychotropic medication management.According to this survey, a number of epilepsy centers and clinics incorporate behavioral health screening; however, there is significant variability in assessments/measures used, who is administering them, and their purpose in the trajectory of treatment. These findings emphasize the need for standardization across centers in order to most effectively provide comprehensive care for youth with epilepsy.

Primary health care nurses attitude towards people with severe mental disorders in Addis Ababa, Ethiopia: a cross sectional study

BackgroundNegative attitude and discriminatory behavior of health professionals constitute a major obstacle in psychiatric care and have been pointed out as a key issue in working with mental illness. Understanding about the attitude of nurses is crucial for quality and holistic care of psychiatric services and essential for the successful integration of mental health into primary health care. However, there is a paucity of study to examine the attitude of primary health care nurses towards severe mental disorder in Ethiopia. Therefore, this study aimed to assess the attitude of primary health care nurses and its associated factors towards people with severe mental illness in Addis Ababa.MethodsInstitutional based cross-sectional study was conducted among nurses working at primary health care in Addis Ababa from May to June, 2018. Multistage sampling technique was used to select 634 participants. A structured self-administered questionnaire was used. Data were coded and entered into EPIDATA 3.1 and exported to SPSS version 20 for analysis. Bivariate and multivariate binary logistic regression analysis was used to identify factors associated with attitudes of nurses in primary health care. The level of significance was declared at P-value < 0.05 with 95% confidence interval.ResultsA total of 610 respondents were included in the study with a response rate of 96.2%. The mean age of participants was 28.6 ± 5.9 (SD) years and the prevalence of negative attitude was 48.2%. Multiple logistic regression models revealed that respondents who have diploma [AOR = 3.09, CI (1.20–7.95)], work experience of < 5 years [AOR = 4.49, CI (2.37–8.49)], respondents who didn’t took mh-Gap training [AOR = 4.92, CI (3.05–7.95)] and poor knowledge about mental illness [AOR = 2.84, CI (1.82–4.44) were associated with negative attitude towards people with severe mental illness.ConclusionNearly half of the participants have negative attitude towards people with severe mental disorders. Therefore, evidence based and contextualized models are warranted to mitigate negative attitudes of primary health care nurses.

Factors Associated with Parents' Adherence to Different Types of Exercises in Home Programs for Children with Disabilities.

There is a lack of knowledge with regard to the adherence to different types of exercises prescribed for children with disabilities. The aim was to examine parents’ adherence to prescriptions of different types of home exercises; to identify associated factors related to the parents, the children and the environment, and to assess the relative influence of the behaviour of health professionals. Parents (393) were recruited from 18 early intervention centres. A cross-sectional survey using a self-reported questionnaire was used to examine whether three types of exercises (“flexibility exercises”, “neuromotor development training” and “body mechanics and postural stabilisation”) were prescribed in their home programs; if the child had received exercises according to a prescription; and items related to the parents, child, environment, and health professionals. The adherence rates were different among the types of exercises. Parents with low perception of barriers and high self-efficacy had a higher adherence to neuromotor development training and postural stabilization, whereas parents with a high level of knowledge increased their odds of adherence to flexibility exercises. Health professionals’ behaviour had a distinct influence on the adherence to different exercises. This study suggests the need to specifically consider the types of exercises prescribed in the management of adherence to home programs.

Multidisciplinary Teaming: Enhancing Collaboration through Increased Understanding.

In an effort to provide clarity about the unique contributions of several professions within the context of multidisciplinary treatment, we reviewed the definitions, philosophical underpinnings, and national requirements pertaining to both scopes of practice (i.e., model licensing acts, legislation, and regulatory boards) and training (i.e., task lists, accreditation standards and course requirements, and exam blueprints) of 4 behavioral health professions. The professions we selected (behavior analysis, psychology, speech-language pathology, and occupational therapy) are likely to provide treatment alongside one another and often to the same clients. In a review of documents pertaining to scopes of practice and training for each profession, we found overlapping content. However, the similarities between professions diminished when we reviewed more specific guidelines such as learning objectives, educational requirements (i.e., coursework), supervised clinical experience (e.g., internships), and national examinations. This was especially true when considering each profession's underlying approach to treatment (i.e., philosophical underpinnings) and, hence, service activities. We discuss our findings in light of service overlap and make a call for greater collaboration between professions, as related to the separate content knowledge and expertise of professionals in each field and the impact on client outcomes.

Barriers to and facilitators of health services utilisation by refugees in resettlement countries: an overview of systematic reviews.

Objective The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries. Methods An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool. Results Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals. Conclusions Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups. What is known about the topic? Refugee health after resettlement is poor, yet health service use is low. What does this paper add? Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals' knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified. What are the implications for practitioners? The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees.

Palliative Care in Solomon Islands

This Discussion Paper presents the findings of initial research into palliative care in Solomon Islands. This research sought to explore the current palliative care policy and service landscape in Solomon Islands, existing strengths to expand upon, and opportunities for future action and research. The result here is the first published exploration of palliative care in Solomon Islands. Following a literature review, data collection involved documentary analysis and interviews with policy-makers, health professionals and other community stakeholders. All interviewees agreed that there is a need to pay more attention to palliative care in Solomon Islands. Key areas for future action include: supporting health professionals to have difficult conversations with people about their prognosis and what to expect during the dying process; training for health professionals in pain assessment and management; improving systems and guidelines, particularly referral systems and access to morphine; and expanding support for families caring for loved ones dying at home. Future research opportunities exist in understanding: families’ and patients’ needs; cultural approaches to care-giving, pain and death; the role of traditional healers; how to increase health literacy; the costs and savings associated with palliative care provision; and the knowledge, attitudes and behaviours of health professionals. An examination of the opiate analgesic system is a pressing research priority. We conclude with recommendations for donors regarding how they could support future action and research.

Teaching Note—Implementation of Online Client Simulation to Train and Assess Screening and Brief Intervention Skills

ABSTRACTGiven the workforce shortage of adequately trained behavioral health professionals, schools of social work are ideally positioned to teach empirically supported treatments for preventing and reducing substance use, specifically, screening and brief interventions. Traditionally, opportunities to practice screening and brief intervention skills occur in classes and field placements; however, these opportunities are limited by class time, placement setting, and multiple demands placed on field instructors. Online client simulation has potential to address these limitations as an asynchronous training and assessment tool. This article details the integration of online interactive client simulation technology in advanced-level master of social work curricula. Drawing on longitudinal pre- and postdata, we present a preliminary analysis of changes in students’ screening and brief intervention skills.