Client Views Research Articles

Transition from homelessness to becoming housed: A qualitative study.

To explore the transitional experiences of becoming housed from homelessness. A qualitative descriptive study. Data were collected during 2017 and 2018 using a semi-structured interview method with 10 former homeless people who became housed at the time of the study. The grounded theory method was used to analyse qualitative data. 'Desire to keep a place to stretch out and lie down' was the basic social problem participants suffered during the transition from homeless to becoming housed. In addition, 'returning to the social world as a person living an ordinary life' was the basic social process that emerged as a core category. The process was divided into four phases: (1) being discarded from everyday life in the social world, (2) struggling to reconnect with society and (3) returning to the social world as a person living an ordinary life. The transition from homelessness to becoming housed is a significant experience for individuals that involves holistic changes. Community health nurses should consider their practical needs based on client views. What problem did the study address? This study explored the experiences of transitioning from homelessness to becoming housed among post-homeless individuals. What were the main findings? While moving from homelessness to becoming housed, homeless people experienced returning to the social world as a person living an ordinary life. They were also shown to go through the process of four stages. Where and on whom will the research have an impact? This study will contribute to suggesting a direction for self-reliance-based interventions among people who are homeless. Additionally, the findings will provide primary data to develop a program for social integration. No patient or public contribution.

Product Innovation and Competitiveness of Commercial Banks in Kenya

The dynamics of change in the business environment catalysed by globalization, changing consumer preferences, and a whirlwind of technological development have exerted immense pressure on commercial banks to introduce up-to-date products and services for sustainability. Product innovation has thus become a vital tool for survival and development. This study examined the influence of product innovation on the competitiveness of commercial banks in Kenya. The theory of creative destruction served as the study's guide. The study utilized a positivist research philosophy. Descriptive and correlational research designs were used. The target population consisted of 175 directors and general managers of Tier 1 commercial banks. Stratified and simple random sampling was then employed to select 122 respondents. Primary data was collected using closed and open-ended questionnaires. A pilot study was done on Equity Bank. To test validity, the study used content and construct validity. The study utilized descriptive and inferential analysis. Descriptive analysis included the use of frequencies, percentages, mean, and standard deviation, while inferential statistics employed correlation and simple linear regression analysis. Data collected from open-ended questionnaires was analysed using content analysis. The results were presented in tables. The study found that product innovation had a positive and significant influence on the competitiveness of commercial banks in Kenya (t = 0.6.438, P = 0.000). The study thus recommends that commercial banks embrace product innovation as a tool to achieve competitiveness. Product innovation should be enhanced by carrying out regular surveys, seeking client views in the development of mobile and internet product innovations, and training clients on the usage of mobile and internet banking products before onboarding.

Instructor and client views of a community falls prevention service and the impact of the COVID-19 pandemic: A qualitative exploration of a service in England.

Falls are the most common cause of injury related deaths in people over 75 years. The aim of this study was to explore the experience of providers (instructors) and service users (clients) of a fall's prevention exercise programme and the impact of the COVID-19 pandemic in Derbyshire, UK. Ten one-to-one interviews with class instructors and five focus groups with clients (n=41). Transcripts were analysed using inductive thematic analysis. Most clients were initially motivated to attend the programme to improve their physical health. All clients reported improvements in their physical health as a result of attending the classes; additional benefits to social cohesion were also widely discussed. Clients referred to the support provided by instructors during the pandemic (online classes and telephone calls) as a 'life-line'. Clients and instructors thought more could be done to advertise the programme, especially linking in with community and healthcare services. The benefits of attending exercise classes went beyond the intended purpose of improving fitness and reducing the risk of falls, extending into improved mental and social wellbeing. During the pandemic the programme also prevented feelings of isolation. Participants felt more could be done to advertise the service and increase referrals from healthcare settings.

Client Views of Contingency Management in Gambling Treatment: A Thematic Analysis

Low levels of treatment access and poor retention among those with gambling problems suggests a need to improve treatment. Contingency management (CM) is a behavioural intervention involving the identification of target behaviours and the provision of incentives when targets are met. There exists a substantial evidence base for CM increasing abstinence and attendance in substance misuse treatment, but this has not been widely extended to gambling treatment setting. This study sought to explore the views of clients about CM for the treatment of problematic and disordered gambling. We conducted semi-structured interviews with 25 gambling treatment clients who were, or had previously been, engaged in treatment in Great Britain. Participants were provided with an explanation of CM, two hypothetical scenarios, and two structured questionnaires to facilitate discussion. Thematic analysis was used to interpret findings. Some participants felt that clients could manipulate CM while in treatment to obtain money to gamble, and that mechanisms of CM could trigger recovering clients into relapse. Participants also identified potential benefits of CM to achieve treatment goals, by enhancing motivation and engagement while in treatment, and helping bring people into treatment earlier. Gambling treatment clients broadly supported the use of incentives for treatment. CM is seen as a facilitator of extended engagement in treatment, and an encouragement for clients to make progress in the treatment process.

Survival Politics: Regime Security and Alliance Design on the Korean Peninsula

Abstract What determines states’ willingness to institutionalize alliances? Contrary to conventional emphasis on system-level conditions, we argue that states pay close attention to the domestic political consequences of institutionalizing alliances. This is particularly true for unequal allies. Client regimes are disproportionately sensitive to alliance design, as it affects patron allies’ ability to influence their military, distribute finance and arms, and legitimate preferred political groups. Two factors—power consolidation and political compatibility—determine whether the client views alliance institutionalization as complementary or conflictual with regime survival. The divergent alliance designs North and South Korea chose after the Korean War support our argument. An unresolved power consolidation process forced Kim Il-Sung to refuse formalizing the wartime alliance with the PRC, and Kim concluded a minimal treaty in 1961 after consolidating his power. In contrast, rapid consolidation left Rhee Syngman little to fear from continuing the highly institutionalized wartime alliance arrangement with the United States, which accepted his authority in the south. Our findings have important implications for alliance design, intra-alliance politics, and civil–military relations. Diseño de alianzas y seguridad del régimen de la política de supervivencia en la península de Corea

Professor Kees van der Heijden: Commentary on Rowland and Spaniol (2021)

AbstractWorking with Kees as his apprentice scenario planner, I have been fortunate to have participated in many scenario workshops, both on the Strathclyde MBA program and with organizations. Alongside these workshops, I am also very privileged to have been an assistant to Kees on a number of scenario projects with organizations in a range of countries. I have learned many things in the time spent with Kees, and consider his book, “Scenarios: The Art of Strategic Conversation” to be the definitive field guide to the art and craft of scenario planning, albeit there have been a plethora of books on the subject since. The objective of this commentary is to discuss from a practical perspective, three things I have learned from my years of experience with Kees which have proved useful in my scenario work with client organizations, namely the elicitation of client views and insights, the value of the “Business Idea” and the scenario development timescale

Dispute Resolution Choices for Property Settlement in Australia: Client Views on the Advantages and Disadvantages of Family Dispute Resolution and Legal Pathways

Although many separating Australian couples make their own arrangements for property division, evidence suggests over 40% nominate either Family Dispute Resolution (FDR), lawyers or courts as their main pathway to settlement. Whereas it is compulsory to attempt FDR in parenting matters, this is not so for property matters. This paper examines client perspectives on property dispute resolution methods using interviews with 112 prospective FDR clients. Some proceeded to joint FDR and some did not, or proceeded for parenting matters only. Thematic analysis highlights the perceived benefits and disadvantages of FDR, compared to using lawyers or going to court, for property matters. We explore issues relating to the cost and character of each process, including implications for post‐separation relationships. Often the initial motivation for choosing FDR was that of avoiding the legal alternatives, which were considered costlier, stressful and/or more acrimonious. After the fact, FDR participants could also identify advantages of the mediation process itself. We conclude that affordability and conflict mitigation are important to clients when choosing and evaluating pathways to property settlement. Those opting to use lawyers instead often wanted more guidance with regard to outcomes, or considered legal pathways more authoritative.

Client, caregiver, volunteer, and therapist views on a voluntary supported group exercise programme for older adults with dementia

BackgroundExisting group exercise programmes, or other services offered to maintain physical activity levels, are typically not developed specifically for older adults with dementia. The aim of this study was to gain knowledge about perceptions of a newly developed volunteer supported group exercise programme for older adults with dementia, and any barriers that may have affected participation and compliance.MethodsSeven (six face-to-face and one by email) interviews were conducted with (i) older adults and volunteers participating in a pilot 12-week group exercise programme, (ii) caregivers, and (iii) therapists leading the group sessions. Interview transcriptions were systemised by use of NVivo 8 and analysed by use of Systematic Text Condensation method.ResultsThe theme “building relationships” represents the reason why attending this group was important for the participants. The findings suggest that how we organize exercise groups is important, with some sort of extra support, to ensure that persons will begin and continue to participate in new activities outside their homes.ConclusionsThis study showed that it is possible to involve home-dwelling persons with cognitive decline and dementia in group exercise sessions. The role of building relationships was the major factor for successful participation. Providing support and ensuring motivation for persons attending the group outside their homes was essential, both for them and their caregivers. Service providers should not underestimate the importance of building relationships between persons involved in service offers.

Client views of counselor directives （指导）: A qualitative study in china

ABSTRACTIn order to understand client views of counselor’ use of directives, we conducted in-depth interviews with nine clients immediately after they completed a session at a university counseling center in China. The results, derived by using Consensus Qualitative Research (CQR), revealed that participants generally expected counselors to give directives, reported having received them, and felt good after receiving them. In addition, clients perceived some non-directive counselor interventions as being directives. Clients felt discontented when they did not receive as many directives as they wanted and when they received directives that did not fit their needs. Clients indicated that they would implement only those directives that they anticipated would have a clear benefit and would not implement those that seemed difficult to do. The results shed light on outcomes related to directives, conditions needed for directives to be implemented, mechanisms by which directives lead to positive change, and client feelings after receiving counselor directives, all within the context of the Chinese culture. One implication of the results is that training programs need to focus on training how to use directives when working with Chinese clients.

Abstinence or controlled drinking – a five-year follow-up on Swedish clients reporting positive change after treatment for substance use disorders

Purpose The purpose of this paper is to investigate how clients – five years after completing treatment interventions endorsing abstinence – view abstinence and the role of Alcoholics Anonymous (AA) in their recovery process. Design/methodology/approach Interviews with 40 clients were conducted shortly after them finishing treatment and five years later. All the interviewees had attended treatment programmes based on the 12-step philosophy, and they all described abstinence as crucial to their recovery process in an initial interview. Findings At follow-up, the majority remained abstinent. For many, attending AA meetings was still important – some described attending as a routine, whereas others stressed that the meetings were crucial for remaining abstinent. For those who reported controlled drinking (CD), this was described either as a natural step in their recovery process or as associated with worries and self-doubts. Research limitations/implications The results suggest the importance of offering interventions with various treatment goals and that clients choosing CD as part of their sustained recovery would benefit from support in this process, both from peers and professionals. Originality/value There are heterogeneous views on the possibilities of CD after recovery from substance use disorder both in research and in treatment systems. This study on client views on abstinence versus CD after treatment advocating total abstinence can contribute with perspectives on this ongoing discussion.

Life Is a Stage: Autistic Perspectives on Neurotypicality.

Professional interventions for autistic people often encourage the development of neurotypical behavior. However, the pressure to appear or behave neurotypically has been associated with negative mental health outcomes. Consequently, autistic perspectives on the concept of neurotypicality are a critical area for empirical research. As a follow-up to a prior study on perceptions of autism, the present study examined the concept of neurotypicality as represented in 39 online video logs authored by YouTubers who self-identified as autistic. The study aimed to understand autistic perspectives on neurotypicality to guide professional service provision toward practices that support overall well-being. Consistent with procedures frequently implemented within narrative inquiry, we identified three exemplary videos that presented salient and consistent narratives about neurotypicality. We submitted transcripts of these three videos to inductive thematic analysis to establish their distinctive features and hence the features of the narratives they embodied. Afterward, we used the distinctive features of the exemplary videos to deductively analyze the remaining 36 videos in the data set. The three exemplary videos presented features that related to three divergent narratives about neurotypicality that were supported by the data set as a whole: neurotypicality as (1) an achievement; (2) a masquerade; and (3) a curse. These three narratives differed sharply in regard to the desirability and feasibility of neurotypical conduct. Across all narratives, neurotypical behavior was associated with significant effort. Implications for professionals serving the autism community include the need to be prepared to offer clients different narratives about neurotypical behavior, as presented in writings and media authored by autistic individuals. A second implication concerns the need to align intervention and educational goals with a client's views and values. Finally, independent of the goals established between professionals and clients, the former must monitor the stress and effort associated with the enactment of neurotypicality and make changes accordingly. Why was this study done?: Professionals often want to help autistic clients to behave like people who are not autistic (often called neurotypicals). However, we do not know much about how people on the autism spectrum feel about the idea of neurotypicality. In this study, we analyzed 39 videos from YouTubers who identified as autistic to learn more about what they think of neurotypicality.What was the purpose of this study?: Our goal was to learn directly from autistic individuals and to help professionals (e.g., psychologists and speech-language therapists) to provide better services to the autistic community.What did the researchers do?: We chose three of the videos that were good examples of different ways of thinking about neurotypicality. We analyzed the three videos to identify their unique features. Then we identified examples of those features in the other 36 videos in our data set.What were the results of the study?: We identified three ways of thinking about neurotypicality: neurotypicality as (1) an achievement; (2) a masquerade or theatrical performance; and (3) a curse. These ways of thinking about neurotypicality differed mostly in regard to the extent to which neurotypicality was desired and considered possible. A shared characteristic was that neurotypical behavior required a lot of effort from autistic individuals.What do these findings add to what was already known?: The findings of our study highlight the effort associated with neurotypical behavior and the connection between neurotypical behavior and mental health. The study can help professionals to better understand what behaving neurotypically feels like for autistic individuals. It also has the potential to increase discussions about neurotypicality by amplifying the autistic voices that are still underrepresented in scientific studies.What are potential weaknesses in the study?: The ways of thinking about neurotypicality that we identified in our data may not be representative of all the autistic community because most of the vloggers in our data were white males who identified with Asperger's syndrome. Also, our study included only videos recorded in English and uploaded to YouTubeTM between 2005 and 2015. Future studies should include individuals from all areas of the autism spectrum and more recent data presented in more varied formats and languages.How will these findings help autistic adults now or in the future?: The findings of our study suggest that professionals who serve the autistic community should be able to share with others different views of neurotypicality, help clients work toward goals that are important to them, and monitor signs of stress caused by the effort to behave neurotypically. This should in turn positively impact the quality of services provided to the autistic community and with it the overall well-being of people on the autism spectrum.

Antenatal contraception counselling and provision of contraception after delivery for first-time young mothers enrolled with a Family Nurse Partnership programme

ObjectiveTo evaluate antenatal contraceptive counselling and provision of postpartum contraception on contraceptive choices of first-time teenage mothers enrolled with a Family Nurse Partnership (FNP) programme.DesignHealth service research evaluation.PopulationCohort of FNP...

Integrating Smoking Cessation Care into a Medically Supervised Injecting Facility Using an Organizational Change Intervention: A Qualitative Study of Staff and Client Views.

Background: Clients accessing supervised injecting facilities (SIFs) smoke at high rates. An SIF piloted an organizational change intervention to integrate smoking cessation care as routine treatment. This study aims to explore staff acceptability, perceived facilitators, and perceived barriers to implementing six core components of an organizational change intervention to integrate smoking cessation care in an SIF. Staff and client views on the acceptability, facilitators, and barriers to the provision of smoking cessation care were also examined. Methods: This paper presents findings from the qualitative component conducted post-intervention implementation. Face-to-face semi-structured staff interviews (n = 14) and two client focus groups (n = 5 and n = 4) were conducted between September and October 2016. Recruitment continued until data saturation was reached. Thematic analysis was employed to synthesise and combine respondent views and identify key themes. Results: Staff viewed the organizational change intervention as acceptable. Commitment from leadership, a designated champion, access to resources, and the congruence between the change and the facility’s ethos were important facilitators of organizational change. Less engaged staff was the sole barrier to the intervention. Smoking cessation care was deemed suitable. Key facilitators of smoking cessation care included: Written protocols, ongoing training, and visually engaging information. Key barriers of smoking cessation care included: Lack of access to nicotine replacement therapy (NRT) outside of business hours, practical limitations of the database, and concerns about sustainability of NRT. Conclusion: This study develops our understanding of factors influencing the implementation of an organisational change intervention to promote sustainable provision of smoking cessation care in the SIF setting.

Autism and the “I-Who-Feels”

Sela-Smith referred to the phenomenological experience of the individual as the “I-who-feels.” This article discusses the implications for mental health practitioners of using the approach that J. F. T. Bugental called presence to actively explore the lived experience of psychotherapy clients with autism spectrum disorder. For clients experiencing diverse ways of what Heidegger termed being-in-the-world, this approach is especially relevant from a social justice standpoint. It allows the space for the client’s lived experience—as opposed to the stringent clinical etiology of mental health symptoms—to be acknowledged, valued, and given a voice. This approach can transcend beyond the container of the psychotherapy room and affect how the client views and appreciates the benefits, and sometimes the adversities, that come with diverse ways of being. Autism spectrum disorder, in particular, presents unique challenges to being-in-the-world and the ability to communicate one’s lived experience; attendees will leave with a better understanding of the phenomenology of the condition. Discussion will also focus on the implications and social justice ramifications of exploring lived experience in this population.

Clinician and client views of utilising early supported discharge services

Background/Aims:To explore the beliefs and attitudes of potential referrers and referrees regarding the possible utilisation of early supported discharge (ESD) prior to hospital discharge.Methods:Semi-standardised one-to-one interviews were conducted with nine consultants and ten dyads, comprising inpatients and corresponding treating staff members involved in referral of these patients to ESD. Content analysis was completed to identify key themes and to group the data into categories.Results:Rehabilitation consultants reported safety and the ability to manage at home were the primary considerations in ESD referral decision making. Most patients were extremely likely to agree to referral to ESD. Four main categories were identified in the responses from the patient/staff dyads, which were summarised as: positive and negative aspects of ESD, and barriers and enablers to early discharge. Patients were only willing to return home with ESD once they were ambulant in some capacity. Staff identified considerably more potential disadvantages, and fewer benefits than patients with regard to early discharge. However, there was no indication that staff beliefs had a negative influence on patient views regarding their participation in ESD.Conclusions:Patients and staff generally approved of ESD services; however, staff may need to place greater consideration on advantages, such as the potential emotional and mental benefits that some patients associate with returning home sooner with ESD.

English

The world is changing very fast toward cultural pluralism. It is predicted that most of the societies will be more diverse in 21st century. Cultural differences denied for centuries in therapeutic interventions are no more acceptable. Multicultural counseling and therapy are in fact a strong trend in response to this urgent need. That is the reason for multiculturalism to be considered the fourth force in psychology. All counseling and therapy issues and interventions are somewhat cross-cultural. How a client views the world is important insofar as it contrasts with the counselor’s. Many Eastern and Western cultures are considered different according to different perspectives. Family as a powerful social institution is the matrix of cultural identity of its members. In recent years, culture turned to occupy a key position in family therapy. Couples have learned to identify with cultural values and biases of their own families throughout their childhood. Family counselors and therapists as well as all their counterparts need to develop activities and intervention techniques to counteract these biases. Development of multiculturalism transformed how many therapists think and work with families. This article deals with cultural issues and dementions of counseling and therapy East and West, with more emphasis on couples and families. Key words: Multiculturalism, Counseling, Marriage and Family Issues.

Client and provider views on access to care for substance-using American Indians: perspectives from a Northern Plains urban clinic.

In addition to disparities in rates of substance use problems, American Indians (AIs) report multiple barriers to receiving treatment services. The present study utilized intake questionnaire data and focus groups to gain perspectives from 152 clients (65% male, 35% female; mean age 30 years) and 6 female providers on access to treatment for Northern Plains AIs in an urban, non-Native program. AI clients acknowledged the need for treatment more often than did substance users in general, but faced greater resource barriers. Both clients and providers offered specific recommendations for improving access to substance use treatment for AI populations in the Northern Plains.

Performance objectives for non-structural elements

The recent earthquakes in New Zealand have raised awareness of the seismic vulnerability of non-structural elements and the costly consequences when non-structural elements perform poorly. Impacts on business continuity due to the damage of non-structural elements has been identified as a major cost and disruption issue in recent earthquakes in New Zealand, as well as worldwide. Clearly improvements in performance of non-structural elements under earthquake loads will yield benefits to society.
 This paper explores the intended and expected performance objectives for non-structural elements. Possible historic differences in performance objective expectations for non-structural elements between building services engineers, fire engineers and structural engineers are discussed. Wider construction industry expectations are explored along with our experience of client and regulatory authority views.
 The paper discusses the application and interpretation of the New Zealand earthquake loadings Standard NZS1170.5:2004 for the design of non-structural elements including possible differences in interpretation between building services, structural and fire engineers leading to confusion around the expected performance of non-structural elements under different limit states. It is based on the experience of several of the authors as members of the Standards committee for NZS1170.5:2004.
 The paper concludes by discussing changes to NZS1170.5:2004 the authors have proposed as members of the NZS1170.5 Standards committee to clarify and address the identified issues. These changes clarify the classification of parts, requirements for consideration earthquake imposed deformations, parts supported on ledges, potential falling of parts, the combination of fire and earthquake loads, and the requirement for parts to be designed for both serviceability and ultimate limit states along with the effective introduction of a serviceability limit state for parts for occupational continuity.

Sexual health-related information delivery - are patient information leaflets still relevant?

Background Patient information leaflets (PILs) are widely utilised within publically funded sexual health clinics to deliver sexual health-related information (SHRI); however, their continued value to clients in the era of social media is unclear. This study aimed to evaluate clients' opinions on three newly developed PILs and examine client views on other forms of SHRI delivery. An anonymous self-administered questionnaire was completed by clients attending the Western Sydney Sexual Health Centre (WSSHC) in 2012. High-risk population (HRP) vs non-high-risk population (non-HRP) views on PILs vs alternative methods of SHRI delivery were analysed by using Mann-Whitney U, Wilcoxon, McNemar and χ(2) tests. Over half (210/315; (67%)) of the consecutive clients from a culturally diverse population completed the survey. Sex workers (SW) and young people (YP) were significantly likely to have a high school education than non-HRP (P<0.039 and P<0.032). Overall, PILs, a clinic website and the Sexual Health Information Link (SHIL), a state-wide website and telephone line, were ranked significantly higher as a means of SHRI delivery on a Likert scale than newer technologies including Facebook (P<0.001), email (P<0.001), mobile phone applications (P<0.001), TVs in waiting rooms (P<0.001) and business cards (P<0.001). There was no significant difference in opinion between HRP and non-HRP. This study provides evidence for the ongoing use of PILs to deliver SHRI to clinic attendees, in conjunction with other forms of SHRI delivery such as websites and SHIL. Novel methods may require additional consumer engagement and a greater understanding of specific population's needs.

Evaluation of NHS Health Checks provided by community pharmacies.

Background Community pharmacy is a potentially useful, easily accessed provider of NHS Health Checks. Little published work has reported outcomes or sought views of pharmacy Health Check attenders. This evaluation assessed findings of pharmacy Health Checks plus subsequent attendance after referral to general practices and obtained client views. Methods Mixed methods including: data abstraction from Health Check and practice records, questionnaire to all attenders and interviews with sample of questionnaire respondents. Results Data from 190 pharmacy Health Checks, performed in four pharmacies, showed that the majority of attenders (58%) were female, 53% white, with 80% aged under 55. Seventy five per cent had at least one modifiable cardiovascular risk factor, 8% had a cardiovascular disease risk score of ?20%, 30% were referred to their practice for further tests/consultation, but only half of these attended. Lifestyle advice was offered to 74% and referral for support with changing lifestyle accepted by 20%. Survey respondents (66) were unrepresentative and fewer had modifiable risk factors. Many indicated that making lifestyle changes and their views on pharmacy Health Checks were positive, particularly reflecting accessibility. Conclusions Pharmacy NHS Health Checks reach people with modifiable risk factors, identify those requiring further investigation and refer appropriately. Greater emphasis and encouragement are required to act on referrals if Health Checks are to maximize benefits.