Client's Perspective Research Articles

An In-Home Withdrawal Service for individuals with low-to-moderate substance dependence: implementation and program evaluation.

Background Sonder's In-Home Withdrawal Service (IHWS) has been providing a unique home-based, multidisciplinary, wraparound withdrawal option for people with low-to-moderate levels of substance dependence since September 2019. This paper provides an evaluation of the service's overall impact on reducing substance use among clients through the delivery of this innovative service model. The evaluation explores the acceptability and feasibility of the service via client, stakeholder, and staff perspectives. Methods A mixed-method design was used to evaluate the IHWS. Descriptive analysis of quantitative data was conducted using clinical assessments from client records and online feedback surveys. Qualitative data from client, staff, and stakeholder feedback surveys were analysed thematically. Results Overall, 1166 referrals were received over the lifespan of the service, and a data set of 96 clients was included in the analysis. Self-reported measures showed that most clients decreased their substance use (89%), improved their psychological health status (75%), improved their physical health (65%), improved their quality of life (69%), and improved their understanding and ability to manage their alcohol and other drugs (AOD) use (84%). Client feedback suggests the service is providing a unique option for AOD withdrawal. Stakeholders commend the service's home-based setting, multidisciplinary and person-centred approach to care, and recommended expansion of the service to increase access for clients and reduce demand on inpatient settings. Conclusions The IHWS is having a significant impact in reducing substance use and highlights the need for increased access to holistic approaches to withdrawal. This includes pre- and post-withdrawal support and the inclusion of multidisciplinary teams, and engaging lived experience practitioners. A focus on funding primary-based services is required to meet the rising costs of tertiary-based care and to better meet the needs of consumers.

The use of practice evidence by Australian occupational therapists: Perspectives and actions.

Evidence-based practice supports clinical decision-making by using multiple sources of evidence arising from research and practice. Research evidence develops through empirical study while practice evidence arises through clinical experience, client preferences, and the practice context. Although occupational therapists have embraced the paradigm of evidence-based practice, some studies have identified limits in the availability and use of research, which can lead to reliance on other forms of evidence. This study aimed to understand how Australian occupational therapists use practice evidence, manage potential bias, and enhance trustworthiness. Potential use of a critical appraisal tool for practice evidence was also explored. A 42-item questionnaire was developed to address the study aims. It consisted of a 7-point Likert scale, ordinal and free text questions. Likert scales were collapsed into binary scales and analysed using SPSS. Ordinal data were graphed and free text responses were analysed using manifest content analysis. Most respondents (82%) indicated that practice evidence was an important informant of practice and is used alongside research evidence. Almost all respondents (98%) expressed confusion when reconciling discrepancies between research and practice evidence. There was general acknowledgement that practice evidence is prone to bias (82%), yet 92% were confident in trusting their own practice evidence. Most respondents (74.5%) undertook some measures to appraise practice evidence, and almost all respondents (90%) agreed they would refer to a critical appraisal tool that helped them evaluate practice evidence. Occupational therapists in this study routinely use practice evidence arising from their own experience, client perspectives, and their practice context to inform clinical decision-making. While they agreed that practice evidence was prone to bias and misinterpretation, they generally trusted their own practice evidence. Participants indicated they needed guidance to critically appraise their practice evidence and supported the development of a critical appraisal tool for this purpose.

Enhancing HIV treatment and support: a qualitative inquiry into client and healthcare provider perspectives on differential service delivery models in Uganda

BackgroundHIV/AIDS continues to be a significant contributor to illness and death, particularly in sub-Saharan Africa. In this study, we conducted a qualitative assessment to understand Client and Healthcare Provider Perspectives on Differential Service Delivery Models in Uganda. The purpose was to establish strengths and weaknesses within the services delivery models, inform policy and decision-making, and to facilitate context specific solutions.MethodsBetween February and April 2023, a qualitative cross-sectional study was utilised to gather insights from a targeted selection of individuals, including People Living with HIV (PLHIV), healthcare workers, HIV focal persons, community retail pharmacists, and various stakeholders. The data collection process included eleven in-depth interviews, nine key informant interviews, and eight focus group discussions carried out across eight districts in Central Uganda. The collected data was analyzed through inductive thematic analysis with the aid of Excel.ResultsThe various Differentiated Service Delivery Models (DSDMs), notably Community-Client-Led Drug Distribution (CCLAD), Community Drug Distribution Point (CDDP), Community Retail Pharmacy Drug Distribution Point (CRPDDP), and the facility-based Facility Based Individual Model (FBIM), were reported to have several positive impacts. These included improved treatment adherence, efficient management of antiretroviral (ARV) supplies, reduced exposure to infectious diseases, enhanced healthcare worker hospitality, minimized travel time for ART refills, stigma reduction, and decreased waiting times. Concern was raised about the lack of improvement in HIV status disclosure, opportunistic infection treatment, adherence to seasonal appointments, and sustainability due to the overreliance of the DSDMs on donor funding, suggesting potential discontinuation without funding. Doubts about health workers’ commitment surfaced. Notably, the CCLAD model displayed self-sustainability, with clients financially supporting group members to collect medicines.ConclusionCommunity-based DSDMs, such as CCLAD and CDDP, improve ART refill convenience, social support, and client experiences. These models reduce travel and waiting times, lowering infection risks. Addressing challenges and enhancing facility-based models is vital. In order to maintain funding after donor funding ends, sustainability measures like cross-subsidization can be used. If well implemented, the DSDMs have the potential to produce better or comparable ART outcomes compared to the FBIM model.

Reflections on the Collaborative Story Analysis Method to Understand Qualitative Perspectives of Indigenous Syringe Services Program Clients

Many scholars have cautioned that the use of Western research methods is problematic in studies with Indigenous communities given colonialist histories that have exploited Indigenous populations. One solution has been to utilize a Community-Based Participatory Research (CBPR) approach to enhance equity in research partnerships. Employing a CBPR approach, however, does not necessitate the inclusion of Indigenous Research Methods, an additional step that can further benefit studies with their explicit alignment with Indigenous worldviews and values. In a CBPR project aiming to understand Indigenous harm reduction clients' perspectives of barriers and facilitators to opioid use disorder treatment, our research group assembled a multidisciplinary qualitative data analysis team that included diverse tribal community members and academics. Sparse literature was available to guide the use of Indigenous Research Methods for the qualitative data analysis phase of the research. To address this gap, the aims of this process paper are: (1) to describe the implementation of the Collaborative Story Analysis method, and (2) in the Indigenous tradition of honoring and sharing stories, describe our analysis team's experiences and perceptions of implementing this Indigenous Research Method. Through a series of process discussions, the analysis team found that applying the Collaborative Story Analysis method: (1) honored relationships and story, (2) strengthened the depth of analysis, and (3) exhibited tensions when working in a dominant Western culture. Through sharing our team's experiences, the aspiration is that others can use these insights in their own consideration and implementation of an Indigenous Research Method for qualitative data analysis.

Specialist Financial Counseling for Women Affected by Domestic and Family Violence: Staff and Client Perspectives on an Australian Initiative.

This article examines staff and client perspectives on an initiative providing co-located specialist Domestic and Family Violence (DFV) financial counseling in women's legal services. An exploratory mixed-method study in five service locations captured perspectives via a client survey (n = 42), online interviews with staff (n = 15), and a review of services' progress reports. For staff and clients, integrating financial counseling into women's legal services contributed to a more comprehensive model of support which helped address the economic harms associated with violence. Findings highlight the benefits of service integration and co-location, which enabled staff to share knowledge and build capacity, and helped improve outcomes for women following violence.

A Qualitative Inquiry into Nurse-Family Partnership Black Client Perspectives.

Nurse-Family Partnership (NFP) is a home visiting program designed to improve pregnancy outcomes, child health and development, and life course outcomes for families facing socioeconomic inequalities through support and education provided by nurses to first-time mothers during pregnancy and up to 2years postpartum. Studies show that home visiting programs like NFP have positive outcomes, but attrition remains a concern which may impact the desired health equity goals. Black mothers are more likely to withdraw from the NFP program, and research is lacking regarding their experiences in home visiting programs despite facing maternal health inequities rooted in racism. The present study aimed to understand factors that influenced program continuation and provide insights for program improvement. Semi-structured qualitative interviews were conducted with 21 Black NFP clients from multiple sites. Key findings include the importance of the nurse-client relationship, access to reliable health information, and racial concordance in the nurse-client pairing. Clients valued supportive, nonjudgmental nurses who provided dependable support and education. Racially concordant partnerships were perceived as more comfortable and understanding, fostering trust and open communication. Clients also suggested that invasion of privacy during home visits and a lack of connection with their nurse could contribute to program discontinuation. Efforts to increase program retention of Black clients should focus on fostering a strong nurse-client alliance. Recommendations include increasing racial diversity in the nurse workforce, implementing a nurse-client matching system, and allowing clients to request a new nurse if needed.

Elucidating managerial, staff and client perspectives on the Speech and Language Therapy service in Malta.

Speech and language therapy (SLT) services are fundamental for communication, academic and social development. Evidence shows that demand for services is increasing, and this can adversely affect the quality of care. There are limited published studies in relation to the demand and quality of speech and language services in Malta. To elucidate the perspectives of speech-language pathologists (SLPs), service managers and parents of clients about the impact of factors pertaining to human resource development (HRD), human resource management (HRM) and the environment on the quality of the children's SLT service in western Malta. Also, to outline the beneficial strategies or recommendations to improve the quality of the service provided. A mixed-method study was used. Quantitative data provided by the Speech and Language Center (SLC) were analysed to determine demand over time using descriptive statistics. Qualitative data from one-to-one interviews using a bespoke questionnaire with managers, SLPs and parents were transcribed and analysed. Common and distinct themes in relation to the quality of services were then formulated and evaluated. Quantitative results highlighted that clients were not receiving the required number of the therapeutic sessions. In total, nine themes in relation to the quality of the SLT service were identified by parents, SLPs and managers. The factors affecting the service quality were outlined and subdivided under three branches: HRD, HRM and the environment. All factors within these subgroups are expected to enhance the quality of the service provided if they are enhanced and improved upon. Additionally, the results showed that a discrepancy between the perceived and offered SLT services was felt from the managers' and SLPs' perspectives; however, this was not felt by parents. For parents, the main concern was the availability and frequency of the therapeutic sessions provided. Insights from SLPs, managers and parents of clients highlighted the barriers and enablers of quality of service in SLT services for children. These findings can be used to improve services in Malta and other countries with similar contexts, mainly by altering time management, reducing demands and improving availability. What is already known on the subject SLT is proven to enhance a child's communication skills. Increasing demands for therapy can affect the quality of the service provided, ultimately affecting the child's progress. There is a gap in the evidence base regarding the quality of speech and language services for children in Malta and the factors which affect the quality of the service. What this study adds to the existing knowledge This is the first study of its kind in Malta. It seeks to identify the quality of SLT services for children from three different perspectives: service managers, SLPs and parents. In addition, this study investigated what affects the quality of SLT services positively or negatively. Through this study, the impeding factors were divided into three domains; HRD factors, HRM factors and environmental factors. These domains were mentioned by all three groups of participants because they affected the service negatively or positively. The main negative aspects included bad time management, high demands, and reduced availabilities and accessibilities, whilst positive aspects included improved support, relationships and the environment. What are the practical and clinical implications of this work? This study suggests reducing the managerial and administrational demands on SLPs and improving session frequency would enhance the quality of service. In relation to the three domains, the HRD factors that would enhance the quality of service are: SLPs' and parental competencies, enhancing SLPs' positive characteristics, positive attitudes and cooperation from all personas; for HRM resources the factors important for quality are strategic and risk management, workforce and recruitment; and for the environmental factors the physical environment and resources are important as they affect the service depending on their condition, that is, improved resources result in improved service. Such alterations would reduce the SLPs' demotivation and burnout due to reduced responsibilities, whilst improving accessibility and availability, ultimately enhancing the quality of the service provided.

In Search of a Good Person-to-Job Fit: Perspectives of Autistic Clients, Their Family Members, and Employers of a Pilot Autism-Specific Employment Program

In Search of a Good Person-to-Job Fit: Perspectives of Autistic Clients, Their Family Members, and Employers of a Pilot Autism-Specific Employment Program

Staff and client preferences for the design and delivery of an outcomes monitoring system in a mental health service.

Outcome monitoring can support the delivery of quality service that meets the needs of clients, clinicians and services. However, few studies have examined client or staff perspectives on the design and implementation of outcomes monitoring within a service. Implementation of outcomes monitoring requires understanding the preferences and expectations of relevant stakeholders. Informed by the Consolidated Framework for Implementation Research, this study aimed to investigate the preferences and priorities of relevant staff, clients and family members to inform the design and implementation of an effective outcomes monitoring system in the context of a mental health service for military veterans and their families. Twenty-nine staff participated across five online focus groups, including clinical staff, peer workers, policy staff and supervisors. Ten clients participated in online or telephone semi-structured interviews. Thematic analysis was used to develop themes from the data. Clients and staff agreed that outcomes monitoring should cover more than symptoms, particularly by incorporating functional outcomes. Assessing mental health over time was considered a valuable tool for supporting treatment processes and providing actionable information. Challenges identified by clients and staff included the need for efficient processes, ensuring measures are relevant and acceptable, and maintaining client privacy. The ability to personalise data collection and have a streamlined, responsive system were key attributes of a quality outcomes monitoring framework. Findings suggest that an effective outcome monitoring framework should be client-led, tailored to the individual's needs, and provide feedback on progress. Outcomes monitoring should also be efficient, accessible and allow for safe information sharing.

Marriage and Divorce: A Qualitative Study from the Perspective of Iranian Academic Experts, Counselors, and Clients

ABSTRACT Over the recent few years, divorce rates have increased steadily, and marriage rates have decreased in Iran, which highlights the necessity to study. Obviously, the unidimensional study is insufficient due to the complex nature of the issue. Therefore, the qualitative study was conducted through the grounded theory approach and a purposeful and theoretical sampling method and data collection through triangulation, including semi-structured interviews with academic experts, counselors, and young adult clients. The data were analyzed in a cyclical process using open, axial, and selective coding. Macro factors are not only known as the causes of marriage reduction and divorce increase; they also play a role as a double pressure of marital conflicts and some micro factors such as addiction and violence. Accordingly, in addition to considering the micro and macro factors, necessary to pay attention to their impacts and influence on each other systemically.

Client perspectives on creating supportive sexual health environments for people with persistent anxiety: a qualitative study

ObjectivesWe sought to explore sexual health service clients’ perspectives, preferences and suggestions for how to better address or alleviate anxiety among clients of sexual health services (eg, sexually transmitted infection...

Perceived Change Processes in Dialectical Behaviour Therapy From the Perspective of Clients With a Diagnosis or Traits of Borderline Personality Disorder: A Systematic Literature Review.

To synthesise qualitative research on individuals diagnosed with (or reportedly showing traits of) borderline pattern personality disorder who underwent dialectical behaviour therapy, aiming to comprehend their perceptions of change processes and the therapy's effects. A comprehensive literature search was conducted across multiple online databases and grey literature sources. Papers were quality appraised using an adapted version of the Critical Appraisal Skills Programme tool. A metaethnographic approach was employed during the synthesis. Eleven studies met criteria for inclusion in the review. The main themes identified through the synthesis process were the impact of DBT, the supportive structure and the 1:1 therapy component. The synthesis uncovered the importance of various processes within DBT that patients perceived as active ingredients for their change. Many of these processes aligned with proposed theoretical processes of change and quantitative research on DBT's effectiveness.

Yoga as an adjunct treatment for eating disorders: a qualitative enquiry of client perspectives

BackgroundThis qualitative enquiry explores the experiences and perspectives of individuals with an eating disorder (ED) regarding their perceptions of yoga as an adjunct intervention to psychotherapy. It also explores the feasibility, acceptability, and safety of yoga from their perspectives.MethodsThis study used a practice-based evidence framework and employed semi-structured interviews with 16 females with an ED. Participants were asked about their perspectives on the use of yoga as an adjunct intervention in ED recovery, perceived risks and what factors supported or hindered engagement. Thematic template analysis was used.ResultsThree topic areas were elaborated. The first included participants’ perceptions of how yoga enhanced their ED recovery. The second included how and when participants came to find yoga in their ED recovery. The final topic explored factors that supported participants with ED to engage in yoga. These resulted in the development of guiding principles to consider when designing a yoga intervention for EDs.ConclusionsThis study adds further to the emerging evidence that yoga can bring complementary benefits to ED recovery and provides a biopsychosocial-spiritual framework for understanding these. Findings provide an understanding of how yoga programs can be adapted to improve safety and engagement for people with an ED. Yoga programs for people with EDs should be co-designed to ensure that the physical, social, and cultural environment is accessible and acceptable.

Implementing a COVID-19 vaccination outreach service for people experiencing homelessness.

In 2021, the Australian government implemented a population wide COVID-19 vaccination program. People experiencing homelessness faced challenges accessing vaccines and many were not being reached. By reorienting vaccination services to include assertive outreach strategies, a Brisbane-based non-profit health care team successfully administered 2065 COVID-19 vaccinations to homeless and precariously housed people. This study examines insights from stakeholders delivering the service and perspectives of clients who received a vaccine. Semi-structured interviews with five stakeholders and a survey of 63 clients involved in the Micah Projects COVID-19 vaccination program are reported. Client survey questions covered demographic characteristics, and motivations and hesitancies around vaccination. Stakeholder interviews were inductively analysed and quantitative survey data were exported into SPSS (IBM V27) and analysed using descriptive statistics. The Micah Projects team initiated 220 pop-up vaccination clinics and worked closely with Aboriginal and Torres Strait Islander communities. Downsizing and mobilising the service engaged greater numbers of people sleeping rough and Aboriginal and Torres Strait Islander people. Clients' decisions to vaccinate were often spontaneous, driven by immediate availability and motivated by a desire to stay healthy and protect the community. Tailoring vaccination programs to include assertive outreach strategies effectively reduces barriers for people experiencing homelessness. Community embeddedness, trust, flexibility and cultural safety are critical elements for success. SO WHAT?: People experiencing homelessness are motivated to vaccinate. Reorientating health services to remove structural barriers and build the supportive environments needed to work through vaccine hesitancies are critical elements to ensure equitable access and promote health.

The Lawlessness of Loss: Poetry and Autoethnographic Writing as Therapy in Grief and Loss.

This study seeks to locate and evaluate 'poetry therapy' as a form of therapeutic method for use by practitioners of humanistic psychotherapy especially when used in responding to the traumas associated with grief and loss. Following an initial survey of the literature, the study will explore some examples of the use of poetry therapy for grief, with an especial qualitative focus upon the insights to be gained from first-hand autoethnographic accounts. The study undertakes a literature review which also includes some consideration of peer-reviewed autoethnographic explorations authored by theorists and practitioners of psychotherapy in order to identify what additional insights, if any, may be gained from accessing these personal accounts of process. In particular, the humanist perspective upon grief should be tempered with pragmatism so as to avoid regarding poetry as a reductive sentimentalising of trauma: encountering loss may be seen as experiencing subjection to a 'lawless' world. The study confirms the use of poetry therapy and autoethnographic writing has significant utility and potential, whilst recognising the challenges for empirical confirmation, the need for practitioners to be sensitive to the nuances of the source materials and the subtlety of appropriate application for different client perspectives and groups.

Client and stakeholder perceptions of a novel, nurse practitioner-led alcohol and other drug ambulatory withdrawal service.

Despite recommendations for ambulatory withdrawal programs appearing in many contemporary alcohol and other drug treatment guidelines, to date there have been few studies exploring such programs from client and service stakeholder perspectives. The aim of this study was to explore both individual and service stakeholder perceptions of a nurse practitioner-led ambulatory withdrawal service on the Gold Coast, Queensland, Australia. Data were obtained from three groups: clinicians with knowledge of the service (n = 6); relatives of clients who had used the service (n = 2); and clients who had used the service (n = 10) using a Qualitative Descriptive design. Saldaña's (Saldaña, The coding manual for qualitative researchers. 2013) structural coding framework was used to analyse and code data into themes, with the study reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (Tong et al. Int J Qual Health Care 2017;19:349-57). Participants noted advantages of the nurse practitioner-led ambulatory withdrawal service, including rapid availability of admission to the service and a person-centred approach. Compared with other ambulatory withdrawal options, clients valued the ability to remain in their own environment, however participants suggested greater follow-up after withdrawal, with the potential of a home visiting service for greater client engagement and treatment retention. Findings provide evidence to suggest that nurse practitioner-led ambulatory withdrawal services are an acceptable option for a proportion of clients who need rapid access to services when they wish to make changes to their alcohol and/or other drug use. Furthermore, they can provide person-centred care for comorbid physical and mental ill health occurring in addition to psychosocial issues associated with alcohol and/or other drug use.

Online psychological support in the COVID‐19 era: Social representations, trust and perceived effectiveness from the perspectives of clients and professionals

Online psychological support in the COVID‐19 era: Social representations, trust and perceived effectiveness from the perspectives of clients and professionals

Client perspectives on the support provided for the management of diabetes mellitus in dogs and cats

Background: Literature suggests that owners of pets with diabetes mellitus are not adequately supported by veterinary professionals to manage their pet's condition. Quality of life assessments for diabetic pets in practice often focus on the animal's clinical signs and overlook owner feedback. Aims: To investigate client perspectives on how having a dog or cat with diabetes mellitus affects pet and owner quality of life, the challenges faced and management options available, and how support could be improved. Methods: A questionnaire was designed using the online tool ‘NoviSurvey’ and completed by UK-based owners. Results: Out of the 99 valid responses, 26% of participants disagreed that their veterinary practice supported them with their pet's diabetes mellitus. Results showed that diabetes mellitus is perceived to have a significant effect on quality of life of not only the pet with the disease but also the owner who is managing it. Conclusions: The effects of having a pet with diabetes mellitus on quality of life are being overlooked by the veterinary profession. Online support groups are an important platform for these owners to connect but should not be their primary source of advice because of a lack of veterinary support. Registered veterinary nurses are well placed to carry out regular quality of life assessments and provide evidence-based advice during clinics.

User and service provider assessment of technology readiness of library commons in selected universities in Ghana

PurposeThis study assessed the technology readiness of library commons in selected universities in Ghana from the perspectives of both clients and service providers.Design/methodology/approachA sample survey research design was used to carry out the study, and the study consisted of quantitative and qualitative approaches. The data were collected from 157 of the 430 commons’ users and six library directors/commons librarians, using a questionnaire and an interview schedule respectively. The quantitative data were analysed using descriptive statistics and inferential analysis with SPSS Ver. 22, and structural equation modelling with AMOS Ver. 23.FindingsThe study found significant relationships between the availability of learning resources and users' experience, use and satisfaction with the commons. Additionally, there were significant relationships between the readiness of the commons, users' perceptions and their satisfaction levels. The library/commons managers identified key preparedness issues, including inadequate planning and poor space allocation. Furthermore, the study revealed negative feelings among library/commons managers, such as insecurity, resistance and low confidence.Practical implicationsThe academic libraries in Ghana should evaluate their commons following the findings of this study, and use other readiness implementation tools to identify and address the gaps in their implementation of the commons.Originality/valueThis study was based on the opinions of the users and operators of the commons and focused primarily on technology-related factors. However, it is essential to evaluate other readiness factors, such as change and services, and institutional factors, using frameworks such as Hess and Ostrom’s (2005) Institutional Development Framework, to provide complementary results that can guide better implementation of the commons and improve the quality of services.

What matters to you? A mixed-method evaluation of goal setting and attainment within reablement from a client perspective

Background Goal setting is an essential component of reablement programmes. At the same time it is also an important aspect in the evaluation of reablement from the perspective of clients. Objectives As part of the TRANS-SENIOR project, this research aims to get an in-depth insight of goal setting and goal attainment within reablement services from the perspective of the older person. Material and methods A convergent mixed methods design was used, combining data from electronic care files, and completed Canadian Occupational Performance Measure (COPM) forms with individual interviews. Results In total, 17 clients participated. Participants’ meaningful goals mainly focused on self-care, rather than leisure or productivity. This mattered most to them, since being independent in performing self-care tasks increased clients’ confidence and perseverance. Regarding goal attainment, a statistically significant and clinically relevant increase in self-perceived performance and satisfaction scores were observed. Conclusion Although most goals focused on self-care, it became apparent that these tasks matter to participants, especially because these often precede fundamental life goals. Significance Reablement can positively contribute to goal setting and attainment of clients and may contribute to increased independence. However, effectiveness, and subsequently long-term effects, are not yet accomplished and should be evaluated in future research.