Health Provider Perceptions Research Articles

Using contraceptives to delay first birth: a qualitative study of individual, community and health provider perceptions in southern Tanzania

BackgroundYoung adolescents and unmarried women in low and middle income countries face challenges in accessing family planning services. One factor likely to limit contraceptive use is the attitude and opinion of local stakeholders such as community leaders and health workers. Much of the existing evidence on this topic focuses on women who have already started childbearing. Using primary qualitative data, we explored individual, community and health provider’s perceptions about using modern contraceptives to delay the first birth in a high fertility setting.MethodsA descriptive qualitative study was conducted in Tandahimba district in southern Tanzania between December 2014 and March 2015. We conducted 8 focus group discussions with men and women and 25 in-depth interviews (18 with women, 4 with family planning service providers and 3 with district-level staff). Participants were purposively sampled. Data transcripts were managed and coded using Nvivo 11 software and we employed a thematic framework analysis.ResultsThree main themes emerged about using modern contraceptives to delay first birth: (1) the social and biological status of the woman (2) the type of contraceptive and (3) non-alignment among national policies for adolescents. Use of modern contraceptives to delay first birth was widely acceptable for women who were students, young, unmarried and women in unstable marriage. But long-acting reversible methods such as implants and intrauterine devices were perceived as inappropriate methods for delaying first birth, partly because of fears around delayed return to fecundity, discontinuation once woman’s marital status changes and permanently limiting future fertility. The support for use of modern contraceptives to delay a first pregnancy was not unanimous. A small number of participants from both rural and urban areas did not approve the use of contraceptive methods before the birth of a first baby at all, not even for students. There was lack of clarity and consistency on the definition of ‘young’ and that had direct implications for access, autonomy in decision-making, confidentiality and consent for young people.ConclusionsWomen who wish to delay their first birth face challenges related to restrictions by age and method imposed by stakeholders in accessing and provision of modern contraceptives. There is a need for a clearly communicated policy on minimum age and appropriate method choice for delayers of first birth.

The influence of patient readiness on implementation of evidence-based PTSD treatments in Veterans Affairs residential programs.

Mental health provider perceptions of patient readiness for trauma-focused evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD) have been found to impact outpatient care in the Department of Veterans Affairs (VA). One hundred and 72 mental health directors and providers from 36 VA residential PTSD treatment programs completed qualitative interviews regarding implementation of two EBTs, Prolonged Exposure (PE), and Cognitive Processing Therapy (CPT). Perceptions of patients' "readiness" for PE and CPT, including how to define and assess this construct and how it influences implementation of these EBTs, were discussed. Patient readiness was identified as having three components: psychological and psychiatric stability, general readiness to change, and specific skills to manage trauma-focused EBTs (e.g., distress tolerance, affect regulation skills). Providers indicated that some patients who are deemed not ready are either screened out prior to entry or helped to get ready prior to or during their residential stay. Providers expressed difficulties predicting who is actually ready and described what they saw as differences between readiness for PE as compared with CPT. The concept of readiness for trauma-focused EBTs impacted admission and access to services in the programs. Future research directions, such as empirically measuring readiness and formally assessing veterans' perceptions of and willingness to participate in these EBTs, are considered. (PsycINFO Database Record

Oral Health Provider Perceptions of Dental Therapists and Oral Health Equity in the Southeastern United States

Oral Health Provider Perceptions of Dental Therapists and Oral Health Equity in the Southeastern United States Purpose: A growing need for oral health care is challenged by the maldistribution of oral health providers and lack of opportunity to access oral health care in the current system among underserved populations. Emerging workforce models, such as dental therapists, is one option for improving oral health equity and promoting access across racial/ethnic and socio-demographic groups while addressing those who suffer from disparate lack of access. The purpose of this study is to investigate existing dental workforce perspectives in several southeastern states about emerging workforce models, specifically dental therapists, as a first step in moving toward workforce diversity and oral health equity. Procedures: Sixteen dental clinicians participated in focus group research. Findings: Open coding and the constant comparative method was used to analyze the data. Five themes emerged. Conclusions: The findings showed that participants held exclusionary and contradictory attitudes toward providing care to marginalized and underserved groups, questioned whether dental therapists had the training and skill to practice certain procedures and were most concerned about maintaining their own economic security. Findings were characterized by an absence of cultural competency and a resistance to intellectual inquisitiveness. Dialogue about how to address oral health inequity for the poor and underserved was given scant attention. These findings raise serious concerns as to whether dentists will become collaborative with other sectors of society to remedy the social policies that lead to oral health disparities and are willing to address the inequitable pain and suffering among those without access to oral health care.

Social accountability for maternal health services in Muanda and Bolenge Health Zones, Democratic Republic of Congo: a situation analysis.

BackgroundThe Democratic Republic of the Congo is one of the countries in Sub-Saharan Africa with the highest maternal mortality ratio estimated at 846 deaths per 100,000 live births. Innovative strategies such as social accountability are needed to improve both health service delivery and utilization. Indeed, social accountability is a form of citizen engagement defined as the ‘extent and capability of citizens to hold politicians, policy makers and providers accountable and make them responsive to their needs.’ This study explores existing social accountability mechanisms through which women’s concerns are expressed and responded to by health providers in local settings.MethodsAn exploratory study was conducted in two health zones with purposively sampled respondents including twenty-five women, five men, five health providers, two health zone officers and eleven community stakeholders. Data on women’s voice and oversight and health providers’ responsiveness were collected using semi-structured interviews and analysed using thematic analysis.ResultsIn the two health zones, women rarely voiced their concerns and expectations about health services. This reluctance was due to: the absence of procedures to express them, to the lack of knowledge thereof, fear of reprisals, of being misunderstood as well as factors such as age-related power, ethnicity backgrounds, and women’s status.The means most often mentioned by women for expressing their concerns were as individuals rather than as a collective. They did not use them instead; instead they looked to intermediaries, mostly, trusted health providers, community health workers and local leaders. Their perceptions of health providers’ responsiveness varied. For women, there were no mechanisms for oversight in place. Individual discontent with malpractice was not shown to health providers. In contrast, health providers mentioned community health workers, health committee, and community based organizations as formal oversight mechanisms. All respondents recognized the lack of coalition around maternal health despite the many local associations and groups.ConclusionsSocial accountability is relatively inexistent in the maternal health services in the two health zones. For social accountability to be promoted, efforts need to be made to create its mechanisms and to open the local context settings to dialogue, which appears structurally absent.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1176-6) contains supplementary material, which is available to authorized users.

Provider Perceptions of the Social Work Environment and the State of Pediatric Care in a Downsized Urban Public Academic Medical Center

The author's purpose through this study was to document and analyze health provider perceptions of their social work environment and the state of pediatric care at Los Angeles County King/Drew Hospital and Medical Center in 2000, after the restructuring and downsizing of the hospital and its community clinics. The research results showed nurses and physicians reporting that both the quality of pediatric care and the provider social work environment were poor. Negative factors in the social work environment included: low employee morale, poorly staffed clinical teams, lack of professional autonomy, perceptions of low quality of care for pediatric patients, and interpersonal issues of poor communication and collaboration among providers. Providers also perceived a non-supportive work environment, sense of powerlessness, poor quality of work, lack of goal clarity from leadership, lack of fairness in leadership behavior, and an organizational leadership that is abandoning its core mission and values, thereby making it difficult for providers to carry out their professional functions. The author's findings in this study suggest a relationship between intra-role conflict, social employment environment and quality of care at King/Drew Medical Center in 2000. Lessons for practice are presented.

Comparison of Parental and Health provider perceptions of illness severity, communications and attitudes towards decision making in a Neonatal Intensive Care Unit

Comparison of Parental and Health provider perceptions of illness severity, communications and attitudes towards decision making in a Neonatal Intensive Care Unit

Comparison of Parental and Health Provider Perceptions of Communications and Treatment Decision Making in the Neonatal Intensive Care Unit (NICU) ♦ 154

AIMS/METHODS: To better understand the dynamics of parental communication and involvement in treatment withdrawal decisions in the NICU, we compared parental and health provider perceptions of communications and attitudes toward treatment decision making, and followed them over time. Using self-report questionnaires, we simultaneously surveyed parents of infants meeting study criteria for being at risk of treatment withdrawal ( 6 days old, or for whom participation was not agreed to by the neonatologist, were excluded. A repeat mailed questionnaire was administered to parents 6 weeks later. Response rates: parents 66% (23/35 infants), health providers (physicians, nurses, social workers) 70%(70/100).