Healthcare Counseling Research Articles

Formation and Validation of the Healthy Diet Index (HDI) for Evaluation of Diet Quality in Healthcare.

Lack of tools to evaluate the quality of diet impedes dietary counselling in healthcare. We constructed a scoring for a validated food intake questionnaire, to measure the adherence to a healthy diet that prevents type 2 diabetes (T2D). The Healthy Diet Index (HDI) consists of seven weighted domains (meal pattern, grains, fruit and vegetables, fats, fish and meat, dairy, snacks and treats). We studied the correlations of the HDI with nutrient intakes calculated from 7-day food records among 52 men and 25 women, and associations of HDI with biomarkers and anthropometrics among 645 men and 2455 women. The HDI correlated inversely with total fat (Pearson’s r = −0.37), saturated fat (r = −0.37), monounsaturated fat (r = −0.37), and the glycaemic index of diet (r = −0.32) and positively with carbohydrates (r = 0.23), protein (r = 0.25), fibre (r = 0.66), magnesium (r = 0.26), iron (r = 0.25), and vitamin D (r = 0.27), (p < 0.05 for all). In the linear regression model adjusted for BMI and age, HDI is associated inversely with waist circumference, concentrations of fasting and 2-h glucose and triglycerides in men and women, total and LDL cholesterol in women, and fasting insulin in men (p < 0.05 for all). The HDI proved to be a valid tool to measure adherence to a health-promoting diet and to support individualised dietary counselling.

Development of a Scale Measuring Nurses’ Physical Activity Counseling in a Primary Care Facility: Implications for Healthcare Quality

This study constructed a scale for measuring nurses’ physical activity (PA) counseling in healthcare from the points of view of regular patients. Confirmatory factor analysis produced a two-factor solution with 7 items. The first factor extracted was “follow-up”, which accounted for a variance of 44.5% out of a total variance of 64.8% and comprises 4 items. The second factor, “PA recommendation”, accounted for a variance of 20.3% and comprises 3 items. The final scale had a good internal consistency (Cronbach's α = 0.75; factor loading ≥0.50) as well as satisfactory validity indicators.

The Development and Operation of a Home Management System during the COVID-19 Pandemic: an Experience of the Local Government (Gyeonggi-do) in South Korea

During the three the coronavirus disease 2019 (COVID-19) surges in South Korea, there was a shortage of hospital beds for COVID-19 patients, and as a result, there were cases of death while waiting for hospitalization. To minimize the risk of death and to allow those confirmed with COVID-19 to safely wait for hospitalization at home, the local government of Gyeonggi-do in South Korea developed a novel home management system (HMS). The HMS team, comprised of doctors and nurses, was organized to operate HMS. HMS provided a two-way channel for the taskforce and patients to monitor the severity of patient's condition and to provide healthcare counseling as needed. In addition, the HMS team cooperated with a triage/bed assignment team to expedite the response in case of an emergency, and managed a database of severity for real-time monitoring of patients. The HMS became operational for the first time in August 2020, initially managing only 181 patients; it currently manages a total of 3,707 patients. The HMS supplemented the government's COVID-19 confirmed case management framework by managing patients waiting at home for hospitalization due to lack of hospital and residential treatment center beds. HMS also could contribute a sense of psychological stability in patients and prevented the situation from worsening by efficient management of hospital beds and reduction of workloads on public healthcare centers. To stabilize and improve the management of COVID-19 confirmed cases, governments should organically develop self-treatment and HMS, and implement a decisive division of roles within the local governments.

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Task Sharing or Task Dumping: Counsellors Experiences of Delivering a Psychosocial Intervention for Mental Health Problems in South Africa

Given task-sharing mental health counselling to non-specialist providers is a recognised strategy to increase service capacity, ensuring that their training, supervision, and support needs are met is necessary to facilitate the sustainable delivery of a high-quality service. Using in-depth interviews, we qualitatively explored the experiences of 18 facility-based counsellors (FBCs) tasked with delivering a counselling intervention within chronic disease services offered within primary care facilities participating in the project MIND cluster randomised controlled trial. Findings show that project MIND training with a strong emphasis on role playing and skills rehearsal improved FBCs’ confidence and competence, complemented by highly structured supervision and debriefing provided by a registered counsellor, were key strategies for supporting the implementation of task-shared mental health counselling. FBCs perceived many benefits to providing mental health counselling in primary healthcare but systemic interventions are needed for sustained implementation.

Usability and utility of eHealth for physical activity counselling in primary health care: a scoping review

BackgroundPhysical activity (PA) counselling is an effective approach to promote PA in primary health care (PHC). Barriers to PA counselling in PHC include time constraints, lack of knowledge and skills of providers, and systemic barriers. Using electronic health (eHealth) has the potential to promote PA. This scoping review aimed to identify usability and utility of eHealth for tailored PA counselling introduced in PHC settings.MethodsA scoping review included primary research articles. The authors systematically searched six databases (Cochrane Library, CINAHL Complete, Embase, PubMed, Scopus and Web of Science) from the inception of the databases. The search terms consisted of three search components: intervention (PA counselling), platform (eHealth), and setting (PHC). Additional articles were included through reference lists. The inclusion criteria were research or original articles with any study designs in adult participants.ResultsOf 2501 articles after duplicate removal, 2471 articles were excluded based on the title and abstract screening and full text review. A total of 30 articles were included for synthesis. The eHealth tools had a wide range of counselling domains as a stand-alone PA domain and multiple health behaviours. The included articles presented mixed findings of usability and utility of eHealth for PA counselling among patients and providers in PHC settings. Technical problems and the complexity of the programmes were highlighted as barriers to usability. The majority of articles reported effective utility, however, several articles stated unfavourable outcomes.ConclusionseHealth has the potential to support PA counselling in PHC. Facilitators and barriers to eHealth usability should be considered and adapted to particular settings and contexts. The utility of eHealth for promoting PA among patients should be based on the pragmatic basis to optimise resources.

AN INVESTIGATION ON THE HEALTHCARE USE OF ELDERLY INDIVIDUALS IN TERMS OF SOME VARIABLES: A CROSS-SECTIONAL RESEARCH

OBJECTIVE: This study was carried out for the purpose of determining the factors that affect the usage of healthcare services by elderly individuals.MATERIAL AND METHODS: 266 elderly patients who visited a family health center between the dates of 01.02.2019 – 01.06.2019 were randomly selected, and the questionnaires were applied to those who agreed to participate in the study with the method of face-to-face interviews. Sociodemographic characteristics as age, marital status, educational level, employment status, gender, scope of health insurance, household income and chronic disease status were given as frequencies and percentages. Fisher’s exact test was used to analyze the relationships among usage of healthcare services and marital status and household income. Simple binary logistic regression analysis was used to determine which factor was a significant predictor of healthcare usage.RESULTS: It was determined that gender, perceived health status and having a chronic disease were significantly related to usage of healthcare services, while usage of healthcare services among women was 2.23 times more than that in men, and it was 3.27 times more among those with at least one chronic disease than those without.CONCLUSIONS: The data in our study may be used by healthcare policymakers and program administrators for the purpose of increasing the access to healthcare services among the elderly and especially for the sake of promotion and improvement of health campaigns. This way, it may be achieved to increase the probability of reaching healthcare counseling after being diagnosed with a chronic disease, and thus more severe complications and injuries that may occur may be prevented.

Registered Nurses’ Lived Experiences of HIV Counselling and Testing in Rural Primary Healthcare Clinics in Eastern Cape, South Africa

The increase in the global rates of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) has had far reaching effects on healthcare services around the world. The aim of the study was to explore and describe the lived experiences of registered nurses (RNs) involved in daily implementation of HIV counselling and testing (HCT) in rural primary healthcare (PHC) clinics in Eastern Cape, South Africa. The researcher used a qualitative, descriptive and contextual design. Purposive sampling was used to select the participants. A total of 19 semi-structured interviews were conducted with the RNs until data saturation was achieved. The findings revealed that the RNs experienced HCT to be overwhelming. They also showed signs of stress, frustration, despair and sadness because most of the tested clients had positive results and the number of clients testing positive was increasing. Thus, it is recommended that all professionals working with HCT should be made aware of the emotional outcomes of working in HCT services. Furthermore, it is recommended that a programme to support RNs to cope better with HCT should be developed through further research.

Sexual risk-taking among young Swedish men testing for STI

Objectives This study investigates sexual risk-taking among young men testing for sexually transmitted infections (STI). Sampling method 452 participants (aged 18–30) completed surveys concerning their backgrounds, sexual risk-taking, and experience with STI. Results Over one-third had used alcohol during their last sexual encounter, one-fifth were reluctant to use condoms due to concerns about erection difficulties, 14.7% had experienced sexual coercion and one-fifth reported having had contracted the most common STI, chlamydia trachomatis (CT). Older participants (aged 25–30) were more reluctant to use condoms because of erection worries and to report having had CT. Immigrant men reported more unprotected sex while men who have sex with men (MSM) were more exposed to sexual coercion than others, but less likely to use alcohol when having sex. Conclusions There are important differences in sexual risk-taking within the group of young men testing for sexually transmitted infections which need to be taken into account in developing effective counselling and promotion strategies in sexual and reproductive health care. Further research on young men’s sexual risk-taking is needed to broaden understanding of factors associated with young men’s sexual health.

Family Medicine Clerkship Teaching About Contraception: Meeting a Need.

Introduction: Women’s healthcare including preventive care, obstetric care, and family planning and counseling are important medical education topics that student physicians frequently encounter during their Family Medicine Clerkship in medical training; however, despite its brief emphasis, many students feel underprepared to counsel patients in a clinical setting. With this in mind, a case-based curriculum focused on women’s health was developed for students enrolled in the Family Medicine Clerkship.Methods: During the 2018-2019 academic year, 127 students on the Family Medicine Clerkship at the Florida International University Herbert Wertheim College of Medicine (HWCOM) participated in three two-hour sessions on the topics of adolescent preventive health care, obstetric care, and contraceptive counseling. These sessions incorporated cases, role-play activities, and pre-session readings. An optional, anonymous, paper-based pre-session survey of Likert-type questions was administered prior to the first session and a post-session survey of Likert-type questions was given following the final session. IRB exemption was obtained.Results: The pre-session survey showed that 41.67% of students agreed or strongly agreed that they were confident in their ability to perform female contraceptive counseling. After the sessions, 92.68% of students agreed or strongly agreed that the case addressing contraceptive counseling was of clinical value to their learning needs. Conclusion: Given that less than half of the students felt confident in their counseling abilities prior to these sessions, this curriculum is potentially addressing an unmet educational need. Students found this session to be relevant, indicating that a case-based discussion curriculum that incorporates both pre-session reading materials and role-play interactions may be a promising educational approach.

Hubungan Pengetahuan Dan Sikap Ibu Hamil Dengan Kejadian Mual Muntah Pada Kehamilan Trimester Pertama Di Poskesdes Ampalu Kota Pariaman Bidan Helfiati, Amd. Keb.

Nausea, vomiting in pregnancy is physiological that occurs in the first trimester, which starts 6 weeks after the first day of the last menstrual period, and disappears 6-12 weeks later. The report shows that almost 50-90% of pregnant women experience it. Nausea, vomiting if not treated can cause severe dehydration until poisoning occurs. The purpose of this study was to link the knowledge and attitudes of pregnant women with the occurrence of nausea and vomiting in the first trimester of pregnancy in the Poskesdes Ampalu Midwife Helfiati, Amd. Keb. The study was conducted in July 2019. This type of research is analytic survey research with a cross-sectional design. The population in this study were all pregnant women who visited Helfiati Amd.Keb polindes as many as 40 pregnant women with a total sampling technique. Data were analyzed by univariate and bivariate by computerized statistical tests using SPSS Ver. 17 with a significance level α = 0.05 and a degree of confidence of 95%. The results of the univariate analysis showed that 52.5% of mothers experienced nausea, vomiting, 62.5% of low-knowledge mothers and 42.5% of mothers were negative about how to deal with nausea and vomiting. there is a significant relationship between knowledge (p = 0,000) and attitude (p = 0,000) with the incidence of nausea and vomiting in the first trimester of pregnancy in the Poskesdes Ampalu Midwife Helfiati, Amd.Keb 2019. The results of this study can be concluded that there is a significant relationship between knowledge and attitude with the occurrence of nausea, vomiting. With this research it is expected that health workers provide IEC services and improve health care counseling in an effort to increase the knowledge of pregnant women about how to cope with nausea, and also expect mothers to be more active in seeking information about physiological complaints during pregnancy, especially how to deal with nausea vomiting by following counseling activities held by health workers so that in the future more knowledge from mothers.

Physical Activity Counseling in Primary Care in Germany-An Integrative Review.

Physical activity counseling in primary health care is regarded as a useful complementary preventive and therapeutic measure and is advocated by leading public health institutions. This integrative review summarizes the available data on physical activity counseling in primary care in Germany. A systematic literature search in various databases (peer reviewed and grey literature) was carried out for quantitative and qualitative studies on physical activity counseling and use of “Exercise on Prescription”. The 25 studies included show a very high methodological diversity and, in some cases, considerable risks of bias, with limited comparability across studies. Counseling was provided in all studies by physicians. They report frequent physical activity counseling, which is partly confirmed and partly refuted by patient data. The use of “Exercise on Prescription” is at a very low level. Information on the frequency of physical activity counseling in Germany varies depending on data source and is sometimes contradictory. Our review provides a synthesis of various perspectives on routine physical activity counseling in primary care in Germany. Future studies using standardized and validated instruments in representative samples are needed to further knowledge on counseling and to be able to establish trends in prevalence. Strengthening the topics of physical activity and health and physical activity counseling in medical curriculum is strongly recommended.

Pregnant Women with Obesity Have Unique Perceptions About Gestational Weight Gain, Exercise, and Support for Behavior Change.

Prepregnancy obesity and excessive gestational weight gain (GWG) pose health risks to woman and fetus, yet gestational weight management interventions are largely unsuccessful. Little research examines the perceptions of women with obesity about weight gain and exercise. Although women with obesity have different body habitus and life experiences, most studies combine overweight and obese women into one group. We conducted 3 focus groups with pregnant women with obesity to determine perceptions of GWG, exercise, and a proposed behavioral intervention. Seventeen women participated in the focus groups including 6 at a birth center and 11 at a federally qualified health center. A key finding was that women with obesity felt stigmatized and perceived pregnancy as a refuge from fat shaming. Participants viewed risks associated with excessive GWG as exaggerated and instead deemed self-assessments of how they feel and look as more reliable measures of maternal and fetal health. Participants reported that quality rather than quantity of food promotes pregnancy health and that restrained eaters put their fetuses at risk. Knowledge gaps emerged related to dissatisfaction with counseling about weight gain guidelines. Although physical activity was endorsed, participants voiced safety concerns about exercise during pregnancy and instead favored walking and routine daily activity. Goal setting, positive messaging, and positive reinforcement were identified as favorable aspects of the proposed behavioral intervention. Pregnant women with obesity share other pregnant women's perceptions about weight gain and exercise in pregnancy but also have unique perceptions. Pregnant women with obesity in this study reported feeling stigmatized and fearful of being shamed by their health care providers but paradoxically eager for guidance. The findings offer implications for health care counseling and GWG interventions for this population.

Preventative health screening community events, a mechanism to target minority ethnic populations in improving primary care utilisation to improve health outcomes.

Preventative medicine has become a central focus in primary care provision, with greater emphasis on education and access to health care screening. The Department of Health reports existing health inequalities and inequalities in access within ethnic minority groups. Studies assessing the value of community engagement in primary care have reported variable outcomes in term of subsequent service utilisation. To consider the benefit of community-based health screening checks to improve access and health outcomes in minority ethnic groups. An open community health screening event (n = 43), to allow targeted screening within an ethnic minority population. Screening included BP, BMI, BM and cholesterol. Results were interpreted by a healthcare professional and counselling was provided regarding relevant risk factors. Post-event feedback was gathered to collate participant opinion and views. Seventy-nine per cent of participants were from ethnic minority backgrounds: 64% were overweight or obese and 53% of participants were referred to primary care for urgent review following abnormal findings. All those referred would not have accessed healthcare without the event referral. All (100%) participants believed it improved health education and access to health care. This study clearly demonstrates the value of targeted community-led screening and education events in public health promotion. There was a significant benefit in providing community-based screening. There is a need for a longitudinal analysis to determine the impact on health outcomes and long-term access to healthcare provision.

Office-Based Screening for Sexually Transmitted Infections in Adolescents.

Almost 1 in 4 adolescents have a sexually transmitted infection (STI). These infections are preventable through safe sexual practices and routine screening. Pediatricians are the first line of clinical care for adolescents and are well positioned to offer sexual and reproductive health care counseling and services to their patients; yet, there is a paucity of sexual health screening provided at routine health supervision visits. This article addresses the epidemiology of STIs in adolescents, reviews the evidence of current clinical practice, presents recommended STI screening from government and medical agencies, and offers strategies to address barriers to providing care for adolescents and for sexual health screening in primary care.

Outcomes of neonates born at &lt;26 weeks gestational age who receive extensive cardiopulmonary resuscitation compared with airway and breathing support

To evaluate outcomes of preterm infants <26 weeks gestational age (GA) following postdelivery extensive cardiopulmonary resuscitation (ECPR) compared with airway and breathing support (ABS). Retrospective review of Canadian Neonatal Network data during January 2010 to December 2016. The primary outcome was death or severe morbidity (intraventricular hemorrhage ≥grade 3 or periventricular leucomalacia, retinopathy of prematurity ≥stage 3, bronchopulmonary dysplasia, or necrotizing enterocolitis). Among 3633 infants analyzed, 433 (11.9%) received ECPR. In multivariable analysis, death or severe morbidity was higher in the ECPR versus ABS group [adjusted odds ratio 2.26 (95% confidence interval 1.49, 3.43)]. The majority of the difference was due to increased mortality, which occurred mostly during the first week of life. These data from a recent cohort of infants near the limits of viability may be useful for prognostication for health care providers and counseling of parents.

Adolescent and Parent Knowledge, Attitudes, and Perceptions of Harm of Household Controlled Medications

Introduction: Adolescents learn knowledge, attitudes, and behaviors from their parents, yet little is known about how these attributes are associated with management of household controlled prescription medications. We aimed to assess adolescent and parent: 1) knowledge and attitudes regarding household controlled medications, including previous healthcare counseling; 2) perceptions of harm of medication misuse and diversion; and 3) potential associations of these attributes with household management. Methods: This was a cross-sectional study with paired data using brief, online, confidential surveys of adolescents and parents via an adolescent medicine clinic associated with a large academic center. Eligible adolescents were aged 12–18 years old with at least one controlled prescription medication in the home. Data collection and analysis occured in 2017–2018. Results: Of the 243 adolescent-parent dyads, many adolescents and parents had: low knowledge (15%; 6%), risky attitudes (31%; 32%), received healthcare counseling on safe management of controlled medications (30%; 96%), and low perceived harm of adolescent diversion (39%; 49%). Parents practicing unsafe household management were 2.4 (95% CI = 1.3, 4.3) times as likely to have risky attitudes. Adolescents with families practicing unsafe medication management were 3.7 (95% CI = 1.1, 10.4) times as likely to have low perceptions of harm from diversion. Conclusions: Many adolescents and parents have low knowledge, risky attitudes, and low perceptions of harm of adolescent diversion, some of which are associated with unsafe household medication management. Providers should aim to utilize interventions to improve these attributes for adolescents and parents to enhance safe household medication management.

Exploring professional issues: the psychosocial component of genetic counseling in genomic healthcare.

Aim: To determine UK genetic counselors' (UKGCs) opinion regarding 'the psychosocial component of the UKGC remit in the new genomics era'. Methods: Facilitated discussions at a national conference (2016) using interactive methodologies (58 participants). Results: UKGCs recognized the rapid rate of change emerging with advances in genomic science. Change will be required to the UKGC remit and the roles, rules, relationships and responsibilities that underpin it (29 topics identified). UKGCs supported their 'unique selling point'; integrating knowledge and the explicit focus on psychosocial aspects of genomic healthcare. By 2019, some of the aspirations have been achieved. Conclusion: UKGCs should proactively position themselves to capitalize on the challenges and opportunities of genomic healthcare to maximize patient benefit.

Perceived need and barriers to adolescent mental health care: agreement between adolescents and their parents.

Mental disorders cause high burden in adolescents, but adolescents often underutilise potentially beneficial treatments. Perceived need for and barriers to care may influence whether adolescents utilise services and which treatments they receive. Adolescents and parents are stakeholders in adolescent mental health care, but their perceptions regarding need for and barriers to care might differ. Understanding patterns of adolescent-parent agreement might help identify gaps in adolescent mental health care. A nationally representative sample of Australian adolescents aged 13-17 and their parents (N = 2310), recruited between 2013-2014, were asked about perceived need for four types of adolescent mental health care (counselling, medication, information and skill training) and barriers to care. Perceived need was categorised as fully met, partially met, unmet, or no need. Cohen's kappa was used to assess adolescent-parent agreement. Multinomial logistic regressions were used to model variables associated with patterns of agreement. Almost half (46.5% (s.e. = 1.21)) of either adolescents or parents reported a perceived need for any type of care. For both groups, perceived need was greatest for counselling and lowest for medication. Identified needs were fully met for a third of adolescents. Adolescent-parent agreement on perceived need was fair (kappa = 0.25 (s.e. = 0.01)), but poor regarding the extent to which needs were met (kappa = -0.10 (s.e. = 0.02)). The lack of parental knowledge about adolescents' feelings was positively associated with adolescent-parent agreement that needs were partially met or unmet and disagreement about perceived need, compared to agreement that needs were fully met (relative risk ratio (RRR) = 1.91 (95% CI = 1.19-3.04) to RRR = 4.69 (95% CI = 2.38-9.28)). Having a probable disorder was positively associated with adolescent-parent agreement that needs were partially met or unmet (RRR = 2.86 (95% CI = 1.46-5.61)), and negatively with adolescent-parent disagreement on perceived need (RRR = 0.50 (95% CI = 0.30-0.82)). Adolescents reported most frequently attitudinal barriers to care (e.g. self-reliance: 55.1% (s.e. = 2.39)); parents most frequently reported that their child refused help (38.7% (s.e. = 2.69)). Adolescent-parent agreement was poor for attitudinal (kappa = -0.03 (s.e. = 0.06)) and slight for structural barriers (kappa = 0.02 (s.e. = 0.09)). There are gaps in the extent to which adolescent mental health care is meeting the needs of adolescents and their parents. It seems important to align adolescents' and parents' needs at the beginning and throughout treatment and to improve communication between adolescents and their parents. Both might provide opportunities to increase the likelihood that needs will be fully met. Campaigns directed towards adolescents and parents need to address different barriers to care. For adolescents, attitudinal barriers such as stigma and mental health literacy require attention.

The contraceptive and reproductive history and planning goals of trans-masculine adults: a mixed-methods study

ObjectivesThis study aims to identify factors associated with the reproductive planning of trans-masculine adults. Study designBetween 2015 and 2016, providers enrolled 150 trans-masculine adults in a sexual health study assessing sociodemographics, social support, gender affirmation, sexual partnering, and reproductive history and planning. A brief clinical interview assessed contraceptive use and concerns. Bivariate and multivariable logistic regression analyses examined associations between participant characteristics and three outcomes: current contraceptive use, lifetime pregnancy history and reproductive planning. ResultsOverall, 37.3% are currently using contraceptives; 5.3% have been pregnant; and 20.0% plan to have biological children (9.3% plan to become pregnant; 12.0% plan to use their oocytes with a surrogate). Participants are less likely to use contraceptives if they are students vs. not, have socially affirmed their gender vs. not and have a partner vs. are single. Greater number of sexual partners is associated with the increased odds of contraceptive use. Further, as social support increases, the odds of having been pregnant decreases. Participants with a nonbinary gender identity are more likely to want to become pregnant than those with a binary gender identity, whereas those who have socially affirmed their gender are less likely to want to become pregnant than those who had not. Finally, participants of color more commonly planned to use their oocytes with a surrogate than white participants. ConclusionSociodemographic, gender affirmation, social support and sexual partner factors are associated with contraceptive use and reproductive history among trans-masculine patients. ImplicationsHealthcare providers must be aware of the diverse reproductive histories and pregnancy goals of trans-masculine individuals in order to provide comprehensive reproductive healthcare counseling and provision. More research is needed to better understand contraception and reproduction desires in trans-masculine individuals.