Personal Health Services Research Articles

"Without social there is no health": Social work perspectives in multidisciplinary healthcare.

The pandemic has not just affected the health sphere: strong social effects of the emergency have added to the health risk, stressing on social relations and the deterioration of people's living conditions, and making those who are already fragile more fragile. Notwithstanding, during the emergency following the COVID-19 pandemic the attention was focused, indeed understandably, on the health aspects, widening the already existing misalignment between the health interventions and the social ones. Emergency oriented efforts and resources more toward a clinical care approach (cure) than toward support for the social and the inclusion aspects (care). Reflecting on the specific area of health care that interacts with social care (and vice versa), shows how the medicalization in managing the emergency have undermined or, at least, weakened the global approach to the person and to vulnerability profiles that should inspire the socio-healthcare integration. The aim of this review is describing the relationship between the health and social systems and the effects of the COVID-19 pandemic on it: a review of studies on the role played by social work in the health sector before and during COVID-19 pandemic emergency shows how much potential there is still to be developed for social work in the health sector that acts together with the personal health services; a care that looks at the person within his or her relationships, community resources and environmental aspects requires an investment toward integration between hospital care, social services and local communities.

Community-Based Mental Health and Substance Use Services for People Leaving Prison: Equity and Inclusion Strengths and Limitations in Specialized Service Inventory Development.

Community reentry from prison is a challenging process, especially for persons with lived and living experience of mental health concerns. Access to appropriate community-based care for those leaving prison is a key part of improving health equity for this population. Our work to develop a cross-Canada inventory of active community mental health and substance use services for criminal justice-involved persons represents a valuable example for others hoping to conduct projects that are similar in nature and scope. We describe the strengths and limitations of our health equity-informed, multi-pronged approach to service inventory development, highlighting the importance of considering and addressing search- and stakeholder-related biases. Investment of time and resources is critical to ensuring comprehensive and inclusive identification of community-based mental health services and meaningful resource development.

Privacy and Trust in pHealth - Past, Present and Future.

From beginning to today, pHealth has been a data driven service that collects and uses personal health information (PHI) for personal health services and personalized healthcare. As a result, pHealth services use intensively ICT technology, sensors, computers and mathematical algorithms. In past, pHealth applications were focused to certain health or sickness related problem, but in today they use mobile devices, wireless networks, Web-technology and Cloud platforms. In future, pHealth uses information systems that are highly distributed, dynamic, increasingly autonomous, multi-stakeholder data driven eco-system having ability to monitor anywhere person's regular life, movements and health related behaviours. Because privacy and trust are pre-requirements for successful pHealth, this development raises huge privacy and trust challenges to be solved. Researchers have shown that current privacy approaches and solutions used in pHealth do not offer acceptable level of privacy, and trust is only an illusion. This indicates, that today's privacy models and technology shall not be moved to the future pHealth. The authors have analysed interesting new privacy and trust ideas published in journals, and found that they seem to be effective but offer only a partial solution. To solve this weakness, the authors used a holistic system view to aspects impacting privacy and trust in pHealth, and created a template that can be used in planning and development future pHealth services. The authors also propose a tentative solution for future trustworthy pHealth. It combines privacy as personal property and trust as legal binding fiducial duty approaches, and uses a Blockchain-based smart contract solution to store person's privacy and trust requirements and service providers' promises.

Chronic diseases and multi-morbidity in persons experiencing homelessness: a cross-sectional study

Abstract Background Persons experiencing homelessness (PEH) suffer a high burden of chronic diseases, yet face significant barriers in accessing health services. We describe and compare chronic diseases and multi-morbidity in PEH, housing exclusion and secure housing who lacked access to regular health services in the wake of the COVID-19 pandemic in Germany. Methods Study participants were adults who sought care at clinics of the humanitarian organisation “Ärzte der Welt” in Munich, Hamburg and Berlin in 2020. The patients were categorised into three groups according to the European Typology of Homelessness and Housing Exclusion (ETHOS). We described socio-demographic characteristics, self-rated health, chronic diseases, multi-morbidity and SARS-COV-2 infections in each group. Logistic regression analysis was used to identify socio-demographic factors associated with higher odds of chronic diseases and multi-morbidity. Results Of the 695 study participants, 333 experienced homelessness, 292 housing exclusion and 70 had secure housing. 92.3 % had no or limited health insurance and 96.7% were below the poverty line. Males and EU citizens were highly represented among PEH (74.2% and 56.8% respectively). PEH had lower self-rated health (47.8%, p = 0.04), and higher rates of psychiatric illness (20.9%, p = 0.04). In adjusted analyses, being 35-49 and ≥50 years was associated with greater odds of chronic diseases (AOR= 2.33, 95% CI = 1.68-3.24; AOR=3.57, 95% CI = 2.55-5.01, respectively), while being male was associated with lower odds of multi-morbidity (AOR=0.602, 95% CI = 0.38-0.9). Of the 18 symptomatic patients tested for SARS-COV-2 infection, 15 were PEH, of whom one tested positive. Conclusions Housing was not a risk factor for chronic disease and multi-morbidity in this study. However, PEH reported poorer self-rated and psychiatric health. Strategies to improve access to health services for persons experiencing homelessness and housing exclusion are much needed in Germany. Key messages • Research to highlight the health inequity, both in access and outcomes, in persons experiencing all forms of homelessness is much needed. • This study provides data on a population disconnected from the formal healthcare system. Making such data visible is a step towards addressing the structural causes of social exclusion.

Factors influencing patients' opt-in intention of exchanging health information.

Health information exchange (HIE) exhibits tremendous benefits in improving the quality of healthcare and reducing healthcare costs. However, it also poses challenges related to data security, data privacy, patient engagement, etc. This study aimed to explore the factors affecting patients' opt-in intention to HIE by using an empirical study based on the theory of planned behavior. A Web-based survey was conducted involving 501 valid participants in China (69% validity rate). Information sensitivity and perceived HIE transparency affected the patients' opt-in intention to HIE through the mediation of perceived behavior control and trust in HIE. Information sensitivity negatively influenced perceived behavior control (-0.551, P < 0.001) and trust in HIE (-0.489, P < 0.001). Perceived transparency of HIE positively influenced perceived behavior control (0.396, P < 0.001) and trust in HIE (0.471, P < 0.001). Moreover, patients' opt-in intention to HIE can be positively affected by perceived HIE transparency (0.195, P < 0.001) and trust in HIE (0.294, P < 0.001). In addition, the moderating effect of health status was positive and significant between trust in HIE and opt-in intention to HIE but not between the perceived behavior control and opt-in intention to HIE. This study contributes to the theory of planned behavior and enriches the literature on HIE efforts. HIE administrators should design personalized health services on the basis of these different health statuses to successfully achieve patients' opt-in intention to HIE.

Access to health and rehabilitation services for persons with disabilities in Sierra Leone – focus group discussions with stakeholders

BackgroundIn Sierra Leone persons with disabilities are at higher risk of living in poverty and have poor access to a fragile healthcare and rehabilitation services. The aim was to explore stakeholders’ perceptions of access to health and rehabilitation services for persons with disabilities in Sierra Leone.MethodsSeven focus group discussions, including stakeholders working within the field of disability was conducted.ResultsThe subthemes were: continuous stigmatisation of persons with disabilities throughout life; long distances and transportation issues to access health and rehabilitation facilities; financial constraints; infrastructural barriers to healthcare and rehabilitation services and healthcare personnel’s negative attitudes and inadequate knowledge towards persons with disabilities; rehabilitation and healthcare facilities lacking materials to provide quality services; lack of specialised services and rehabilitation personnel for complex rehabilitation and the need for continuous education of new and current rehabilitation personnel.ConclusionLocal actors need to take charge and renew efforts made by international organisations by providing trained rehabilitation staff and quality rehabilitation services. Rehabilitation services need to be affordable and transportation costs covered for persons with disabilities to access healthcare and rehabilitation services. Continuous education of the public and health personnel about disability is necessary to reduce negative attitudes towards persons with disabilities.

The effects of COVID-19 on the rehabilitation of persons with aphasia: A scoping review.

BackgroundThe impact of the Coronavirus disease 2019 (COVID-19) pandemic was more pronounced on the well-being of persons with disabilities, especially in low- and middle-income countries. There is documented evidence of the rippling effects of COVID-19 on persons with disabilities. However, not much is known about the impact of COVID-19 on the rehabilitation of persons with aphasia.ObjectiveThe scoping review explores how COVID-19 affected the rehabilitation of persons living with aphasia.MethodA scoping review was conducted using Arksey and O’Malley’s framework. A search was conducted on Science Direct, PubMed, Medline, Scopus, ProQuest and Google Scholar, to identify relevant studies published between 2019 and 2022. Data were analysed using thematic analysis.ResultsMost studies regarding the effects of COVID-19 on persons living with aphasia were conducted in the United Kingdom. Five themes emerged from the data, namely, (1) negative impact on rehabilitative care, (2) telehealth and its limitations, (3) impact on social participation, (4) compromised caregiver involvement and (5) mental health challenges.ConclusionsFindings highlight the need for healthcare professionals to pursue innovative ways in which aphasia rehabilitation and conversational support programmes can be made accessible to persons with aphasia, despite the limitations brought about by a pandemic. Telerehabilitation programmes need to be tailored to the needs of persons with aphasia if they are to be successful. This study highlights the importance and need for the prioritisation of mental health services for persons with aphasia and their caregivers during a pandemic.

Construction of IPA decision model for diabetes prevention and control based on economy and importance

Objective: To determine the priority of diabetes prevention and control measures in the perspective of the economy and importance, and provide theoretical support for guiding relevant departments to implement measures based on actual economic level. Methods: An online survey was conducted on the importance, feasibility and implementation of major chronic disease prevention and control measures in 488 national demonstration areas for comprehensive chronic disease prevention and control. The content of the survey was divided into individual and group levels, with 10 dimensions and 44 measures, to obtain the scores of the economy and importance. IPA model was used to divide the dimension index of diabetes prevention and control into quadrants. The standardized factor load coefficient of the second-order confirmatory factor analysis was used to determine the priority of dimension index in the same quadrant. The priority of prevention and control measures in each dimension was determined by the discriminant parameter of project response theory. Results: The mean scores of economy and importance were 66.50 and 89.94, respectively, and the matrix was divided into four quadrants. The first quadrant was the "highest priority" with high importance and economy, including medical insurance and family doctors, health education, high-risk detection and intervention, patient management and community action. The second quadrant was characterized as high importance but low economy, which was the priority for improvement, including only one dimension of complication screening. The third quadrant was the lowest priority due to low importance and economy, including personal health service evaluation and follow-up, environmental support, diabetes co-infection prevention and glycemic policy. The last quadrant had low importance but high economy, which was the second improvement level. The priority measures in different quadrants were: (1) the highest priority: blood lipid control, occupational site, prevention and control work plan, blood glucose testing, family doctor contract service; (2) the priority improvement: annual neuropathy screening; (3)the lowest priority: universal access to risk scoring, healthy eating, healthy dining innovations and tuberculosis screening. Conclusion: IPA model can be used to construct a decision-making model for diabetes prevention and control and determine the priority of corresponding measures.

Coordination of health and rehabilitation services for person with disabilities in Sierra Leone – a stakeholders’ perspective

Purpose To explore stakeholders’ perceptions of the coordination of health and rehabilitation services for persons with disabilities in Sierra Leone. Materials and methods A qualitative study including seven focus group discussions with health, rehabilitation, and disability organisations stakeholders in Sierra Leone. Content analysis was used for data analysis. Results One theme emerged; poor governance in implementing disability policies, healthcare, and rehabilitation services, which included seven subthemes: insufficient implementation of healthcare policies for persons with disabilities; changes, lack of coordination and communication between ministries governing disability policies and rehabilitation services; need for accurate disability data and clinical record keeping; absence of funds and poor political priority to healthcare and rehabilitation services; continuous support for non-governmental organisations (NGOs) to provide healthcare and rehabilitation service delivery; lack of coordination between different healthcare and rehabilitation service providers and calling for increasing persons with disabilities capacity for greater inclusion in society. Conclusions Increasing governmental prioritisation, and ensuring coordination and trust between donors, NGOs, and governmental programmes were keys for sustainable health and rehabilitation services. Stakeholders need to ensure national coverage and equally distributed health and rehabilitation services. Including rehabilitation services and assistive technology in the Free Healthcare Initiative would contribute to implementing the Disability Act. Implications for rehabilitation Political prioritisation of persons with disability (PWD) need to increase to provide national coverage and equally distributed health and rehabilitation services for PWD. To ensure access to rehabilitation services and access to basic assistive technology for PWD, the government of Sierra Leone could agree on basic rehabilitation services and a priority list of assistive devices to be distributed through rehabilitation centres and funded by the Free Health Care Initiative programme or the Sierra Leone health insurance scheme. To increase access to health services for PWD, the government of Sierra Leone could ensure inclusion of PWD in the Free Health Care Initiative programme. The government, donors, and organisations providing or funding health and rehabilitation services for PWD need to mobilise and coordinate resources better and be mutually held accountable to maximise the benefits of PWD resources.

On-Line Algorithms of Stride-Parameter Estimation for in-Shoe Motion-Sensor System

We propose two on-line algorithms for stride parameter estimation for an in-shoe motion-sensor system (IMS) system: one for on-line stride segmentation based on stable foot-flat detection using foot-sole angle and the other for a three-dimensional zero-velocity-update for accurate stride parameterization. We developed a small and lightweight IMS device, which consists of an inertial measurement unit, micro control unit, and peripheral electrical components, integrated with an insole so that it can be placed inside a shoe at the arch of the foot. Stride parameters, i.e., stride length, walking speed, foot height, circumduction, peak foot sole angle in the dorsiflexion and plantarflexion directions, and toe-in <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$/$ </tex-math></inline-formula> out angle, that characterize a user’s foot motion are estimated. We recruited 30 healthy participants and evaluated the precision of our IMS system by comparing the stride parameters calculated with this system with those acquired from a motion-capture system. The results indicate the precision of the system in terms of the root mean square error for stride length of 0.069 m, walking speed of 0.094 <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\text{m}/\text{s}$ </tex-math></inline-formula> , foot height of 1.5 cm, circumduction of 1.0 cm, peak foot-sole angle in the dorsiflexion of 3.3 deg. and in the plantarflexion directions of 5.9 deg., and toe-in <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$/$ </tex-math></inline-formula> out angle of 2.5 deg. Our IMS system has good precision regarding all parameters and high reliability and promises to contribute to personal health and wellness services and solutions by serving as a powerful and practical tool for objective gait assessment in real-world contexts.

Clouds Proportionate Medical Data Stream Analytics for Internet of Things-Based Healthcare Systems

Internet of Things (IoT) assisted healthcare systems are designed for providing ubiquitous access and recommendations for personal and distributed electronic health services. The heterogeneous IoT platform assists healthcare services with reliable data management through dedicated computing devices. Healthcare services' reliability depends upon the efficient handling of heterogeneous data streams due to variations and errors. A Proportionate Data Analytics (PDA) for heterogeneous healthcare data stream processing is introduced in this manuscript. This analytics method differentiates the data streams based on variations and errors for satisfying the service responses. The classification is streamlined using linear regression for segregating errors from the variations in different time intervals. The time intervals are differentiated recurrently after detecting errors in the stream's variation. This process of differentiation and classification retains a high response ratio for healthcare services through spontaneous regressions. The proposed method's performance is analyzed using the metrics accuracy, identification ratio, delivery, variation factor, and processing time.

Using stakeholders’ experiences to redesign health services for persons living with heart failure: a case study protocol in a Swedish cardiac care setting

IntroductionClinical guidelines promote recognising persons with heart failure (referred to as PWHF) as coproducers of their own care. Coproduction of healthcare—involving PWHF, families and professionals in care processes—aims to promote...

Pelaksanaan Pelayanan Kesehatan Penyandang Disabilitas: Perspektif Fiqih Siyasah

Article 12 Sub C of Law Number 8 of 2016 concerning Health Services for Persons with Disabilities is present by giving responsibility to the government for the right to health services for persons with disabilities. As explained in Article 12 of Law Number 8 of 2016 namely: "That persons with disabilities have the right to obtain equality and opportunity for safe, quality, and affordable health services". Persons with disabilities are also citizens of the Republic of Indonesia who in the 1945 Constitution are guaranteed to have the same position, rights, obligations and roles as other citizens. Inpatient Puskesmas Katibung South Lampung is a health center that has the widest working area compared to other health centers in Katibung, South Lampung. So the Katibung Inpatient Health Center, South Lampung, plays an important role in providing health services for all people in the working area of the health center, without exception for people with disabilities. The formulation of the research problem is how to the right to health services for persons with disabilities from the fiqh siyasah perspective at the Katibung Inpatient Health Center. This study aims to determine how the implementation of the fulfillment of the right to health services for persons with disabilities in the fiqh siyasah perspective at the Katibung Inpatient Health Center. As for this writing, using field research methods means that this research is carried out by going directly to the field that will be the object of research. Sources of data used in this study are secondary data such as books, journals, government publications and primary data such as observations and interviews, so as to obtain primary data it is clear that a population and sample are needed in this study. The total population in this study was 159 people and took a sample of 10 people using purposive sampling technique. In this study, it was revealed that health services for persons with disabilities were still not fully fulfilled due to the absence of information and data collection, stigmatization and socio-cultural factors.

Addressing the complex substance use and mental health needs of people leaving prison: Insights from developing a national inventory of services in Canada.

Internationally, transitions from prison to the community are often precarious experiences for people who are living with substance use and mental health concerns. In Canada, a continuing opioid overdose crisis and overlapping challenges related to the COVID-19 pandemic have generated urgency for scaling up community-based services that can meet the complex substance use and mental health needs of people leaving prison. In this commentary, we reflect on our experience with and knowledge gained by developing a national inventory of substance use and mental health services for criminal justice-involved persons who are re-entering the community. We learned that there is a scarcity of such community-based services specific to criminal justice-involved populations and a glaring lack of information about culturally safe and appropriate supports. Stakeholders from organisations across Canada identified that communities need a comprehensive array of low-barrier services, inclusive of harm reduction and substance use treatment services, to meet the diverse needs of people leaving prison. We recommend building greater investment in and awareness of community-driven, local programs, as well as enhancing efforts to engage people with lived and living experience in service design and provision. We also briefly describe a few programs to highlight examples of how to operationalise the themes that we observed to emerge while developing a national inventory of community-based substance use and mental health services for criminal justice-involved persons.

Stakeholder perspectives on an integrated package of care for lower limb disorders caused by podoconiosis, lymphatic filariasis or leprosy: A qualitative study.

Lower limb disorders including lymphoedema create a huge burden for affected persons in their physical and mental health, as well as socioeconomic and psychosocial consequences for them, their families and communities. As routine health services for the integrated management and prevention of lower limb disorders are still lacking, the 'Excellence in Disability Prevention Integrated across Neglected Tropical Diseases' (EnDPoINT) study was implemented to assess the development and delivery of an integrated package of holistic care-including physical health, mental health and psychosocial care-within routine health services for persons with lower limb disorders caused by podoconiosis, lymphatic filariasis and leprosy. This study was part of the first of three phases within EnDPoINT, involving the development of the integrated care package. Focus group discussions and key informant interviews were undertaken with 34 participants between January-February 2019 in Awi zone, Ethiopia, in order to assess the draft care package's feasibility, acceptability and appropriateness. Persons affected by lower limb disorders such as lymphoedema experience stigma, exclusion from families, communities and work as well as physical and financial hardship. Beliefs in disease causation inhibit affected persons from accessing care. Ignorance was a barrier for health care providers as well as affected persons. Training and education of affected persons, communities and caregivers is important in improving care access. It also requires time, space, materials and financial resources. Both top-down and grass roots input into service development are key, as well as collaboration across stakeholders including charities, community leaders and "expert patients". This study highlighted the need for the EnDPoINT integrated care package and provided suggestions for solutions according to its three aspects of integrated care (integration into routine care; integration of mental health and psychosocial care; and integration of care across the three diseases), thereby giving support for its feasibility, acceptability and appropriateness.

Description of drugs prescribed for hormone therapy in specialized health services for transsexual and transvestite persons in Rio Grande do Sul, Brazil, 2020.

To describe the drugs prescribed for hormone treatment as part of the transsexualization process in health facilities providing specialized care for transsexual and transvestite persons in the state of Rio Grande do Sul, Brazil. This was a descriptive study based on data collected in health facilities between May and September 2020 using the instrument developed by the researchers. The survey covered all seven services in the state. Antiandrogen drugs and spironolactone were prescribed for transsexuals and transvestites women in all services. Only one service did not prescribe cyproterone. All health facilities prescribed estrogen-based drugs, although with differences in the route of administration. In the case of transsexuals men, all services prescribed androgens to be administered via the intramuscular route. The study indicates which drugs are prescribed and their diversity, ratifying the need to produce information for the implementation of equity policies in the Brazilian National Health System.

Community participation differences between Black and White adults with serious mental illness.

Promoting community participation is a core goal of behavioral health services for persons with serious mental illness (SMI) regardless of their racial/ethnic background. While practitioners are trained to respect diversity and culture, little is known about how racial/ethnic minorities participate in their communities during the recovery process. This is especially true for Black adults, who are disproportionately represented in current services. This study sought to compare differences in community participation experiences and interests between Black and White adults with SMI. Secondary data (n = 799) were analyzed from studies involving Black and White adults with SMI using the Temple University Community Participation Measure. Regression analyses were conducted to identify potential differences in four areas: amount of participation in a variety of community activities; number of activities participants deemed important; number of important activities actually performed; and the percentage of important activities performed as much as desired (i.e., sufficiency). Compared to White adults, Black adults had greater amounts of community participation overall and in a number of specific community activities (e.g., worship, visiting park/recreation center). Black adults also reported more community activities as important and were more likely to engage in their important activities. Relative to White adults, results suggest that Black adults with SMI were interested in and engaged more in social activities-potentially enhancing their sense of group solidarity and personal mental health recovery. Accordingly, practitioners should be aware of, and attend to, possible racial/ethnic differences in community participation, and its possible role in promoting or hindering recovery across diverse populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Help-seeking behaviours for mental health in higher education

ABSTRACT Researchers have studied help-seeking behaviours regarding students’ mental health, highlighting their reluctance when in higher education. This study aimed to identify the facilitators and barriers to formal and informal sources of help-seeking for mental health difficulties in students based in the UK. Data from 304 participants (82% females) was explored using quantitative self-report methods. The results indicated that help-seeking behaviours were related with living arrangements, sexuality and age: Commuter students were more likely to seek help from their personal tutor compared to those living on campus. Students who identified as Lesbian, Gay, Bisexual, Queer, Questioning and Transitioning (LGBTQQ) were more likely to engage with off-campus services than non-LGBTQQ students and young people were more likely to seek informal support from family and friends compared to older students. In contrast, the findings show that student help-seeking behaviours were related with a sense of belonging and ethnicity: As students sense of belonging to their university increased, so did their help-seeking behaviour. Black, Asian or Minority Ethnic (BAME) students were more likely to engage with professional services from personal tutors and mental health services in comparison to White students, who were more likely to seek help from their peers. Findings highlighted the importance of creating effective programmes that encourage students to discuss mental health and improve help-seeking behaviours.

Social Insurance as Health Care System Financing in Pakistan: Is it a Solution to all Healthcare related Problems?

Social health insurance based financing is one of the many mechanisms for collecting and pooling the funds to health services, along with tax-financing, private health insurance, community insurance, and out of pocket. It should not be considered the only solution for health system financing, and it is not always raising additional funding for health system.1 A health system is the organization of persons, institutions, and resources that deliver health care services to fulfill the health needs of the populations. A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes the efforts carried out for improving determinants of health.2 A health system includes public sector facilities and private facilities, which deliver preventive, curative and personal health services. It also includes behaviour change programs, vector-control campaigns, health insurance system, inter-sectoral coordination and legislation. The goals for health system include providing good health for its citizens, being responsiveness to the expectations of the population it serves, and fair funding services. The achievements towards these is based on how a health system carries out following key functions; provision of health care services, resource generation, financing, and stewardship.1

Quality Management in Healthcare System; where we stand?

Quality Management in Healthcare System; where we stand?