Discussion Of Sensitive Issues Research Articles

Outsiders, insiders, and intermediaries: village health teams\u2019 negotiation of roles to provide high quality sexual, reproductive and HIV care in Nakaseke, Uganda

BackgroundCommunity health workers, known as Village Health Teams (VHTs) in Uganda, play a central role in increasing access to community-based health services. The objective of this research is to explore tensions that may emerge as VHTs navigate multiple roles as community members and care providers particularly when providing sensitive reproductive health and HIV care.MethodsTwenty-five VHTs from a rural clinic in Uganda completed semi-structured interviews focused on experiences providing services. Interview questions focused on challenges VHTs face providing services and strategies for improving quality care. After translation from Luganda and transcription, interviews were analyzed using content analysis to identify emergent themes.ResultsMost VHTs were female (n = 16). The average age was 46, and average length of VHT work, 11 years. Analyses revealed that all VHTs capitalized upon the duality of their position, shifting roles depending upon context. Three themes emerged around VHTs’ perceptions of their roles: community insiders, professional outsiders, and intermediaries. A caregiver “insider” role facilitated rapport and discussion of sensitive issues. As community members, VHTs leveraged existing community structures to educate clients in familiar settings such as “drinking places”. However, this role posed challenges as some VHTs felt compelled to share their own resources including food and transport money. Occupying a professional outsider role offered VHTs respect. Their specialized knowledge gave them authority to counsel others on effective forms of family planning. However, some VHTs faced opposition, suspicions about their motives, and violence in this role. In balancing these two roles, the VHTs adopted a third as intermediaries, connecting the community to services in the formalized health care system. Participants suggested that additional training, ongoing supervision, and the opportunity to collaborate with other VHTs would help them better navigate their different roles and, ultimately, improve the quality of service.ConclusionsAs countries scale up family planning and HIV services using VHTs, supportive supervision and ethical dilemma training are recommended so VHTs are prepared for the challenges of assuming multiple roles within communities.

Bedside teaching: An indispensable model of patient-centred teaching in undergraduate medical education

Bedside teaching remains the most effective way of imparting competency in clinical skills in undergraduate medical education but there has been a noticeable decline in the practice of bedside teaching worldwide. This paper aims to emphasise the importance of bedside teaching, highlights the possible barriers to effective bedside teaching and equip medical teachers with the effective ways of achieving the intended goals of bedside teaching by emphasising the techniques recommended by experts in the field of medical education. Developed countries have employed the use of clinical skill centres to cushion the effect of the decline in bedside teaching, but in resource-limited countries it remains the only viable option. The advantages of bedside teaching include; learning in context, impartation of clinical skills, nurturing and development of clinical reasoning. In addition, bedside teaching provides opportunity for role modelling, professional thinking, observation of communication skills, team work and integration of communication skills, clinical skills and ethical issues in the process of patient care. Several hindrances to effective bedside teaching have been identified. These include a large student: teacher ratio, crowded lectures, improper use of logbooks, lack of preparedness and interest, increasing administrative and research works among medical teachers. The strategies recommended by experts can be categorised into three; based on the timing as; before, during and after bedside teaching. These emphasise the need for adequate preparation, setting of clear objectives before teaching, active participation, gentle correction during teaching, feedback and discussion of sensitive issues away from the patient.

Telephone focus groups in physiotherapy research: Potential uses and recommendations

The use of telephone focus groups as a research approach within health-related qualitative studies is emerging as a method of choice for some researchers. A variety of research applications of the telephone focus group method have been used within health settings over the last 10 years and have typically investigated specific health conditions, training needs, and resource development, as well as health practices and knowledge; these are all issues and contexts applicable to physiotherapy and rehabilitation research. The aim of this review is to explore the use of the telephone focus group methodology, update knowledge on its use in disciplines relevant to physiotherapy, and provide potential users with key information to conduct a telephone focus group. We advocate incorporating recent advances in telephone technology into focus group methodology for physiotherapy and rehabilitation studies, which may benefit from wider geographical representation, increased participation rates, and discussion of sensitive issues. We suggest that the telephone focus group could become a practical and valuable methodology for physiotherapy and rehabilitation researchers.

Effect of Spanish interpretation method on patient satisfaction in an urban walk-in clinic.

To examine the effect of Spanish interpretation method on satisfaction with care. Self-administered post-visit questionnaire. Urban, university-affiliated walk-in clinic. Adult, English- and Spanish-speaking patients presenting for acute care of non-emergent medical problems. Satisfaction with overall clinic visit and with 7 provider characteristics was evaluated by multiple logistic regression, controlling for age, gender, ethnicity, education, insurance status, having a routine source of medical care, and baseline health. "Language-concordant" patients, defined as Spanish-speaking patients seen by Spanish-speaking providers and English-speaking patients, and patients using AT&T telephone interpreters reported identical overall visit satisfaction (77%; P = .57), while those using family or ad hoc interpreters were significantly less satisfied (54% and 49%; P < .01 and P = .007, respectively). AT&T interpreter use and language concordance also yielded similar satisfaction rates for provider characteristics (P > .2 for all values). Compared to language-concordant patients, patients who had family members interpret were less satisfied with provider listening (62% vs 85%; P = .003), discussion of sensitive issues (60% vs 76%; P = .02), and manner (62% vs 89%; P = .005). Patients who used ad hoc interpreters were less satisfied with provider skills (60% vs 83%; P = .02), manner (71% vs 89%; P = .02), listening (54% vs 85%; P = .002), explanations (57% vs 84%; P = .02), answers (57% vs 84%; P = .05), and support (63% vs 84%; P = .02). Spanish-speaking patients using AT&T telephone interpretation are as satisfied with care as those seeing language-concordant providers, while patients using family or ad hoc interpreters are less satisfied. Clinics serving a large population of Spanish-speaking patients can enhance patient satisfaction by avoiding the use of untrained interpreters, such as family or ad hoc interpreters.

Teaching about race, gender, class and geography through fiction

Abstract Fiction is used in geography teaching with a variety of objectives. The novel Betsey Brown was used to explore the intersection of race, class and gender in urban social geography. All members of the class read the novel while a small group researched the geographical and historical contexts of the book. Use of the novel increased awareness of race and class but was less successful with gender, although it did provide a catalyst and safe forum for the discussion of sensitive issues.