Health System Interactions Research Articles

Validity of a questionnaire measuring the world health organization concept of health system responsiveness with respect to perinatal services in the Dutch obstetric care system.

BackgroundThe concept of responsiveness, introduced by the World Health Organization (WHO), addresses non-clinical aspects of health service quality that are relevant regardless of provider, country, health system or health condition. Responsiveness refers to “aspects related to the way individuals are treated and the environment in which they are treated” during health system interactions. This paper assesses the psychometric properties of a newly developed responsiveness questionnaire dedicated to evaluating maternal experiences of perinatal care services, called the Responsiveness in Perinatal and Obstetric Health Care Questionnaire (ReproQ), using the eight-domain WHO concept.MethodsThe ReproQ was developed between October 2009 and February 2010 by adapting the WHO Responsiveness Questionnaire items to the perinatal care context. The psychometric properties of feasibility, construct validity, and discriminative validity were empirically assessed in a sample of Dutch women two weeks post partum.ResultsA total of 171 women consented to participation. Feasibility: the interviews lasted between 20 and 40 minutes and the overall missing rate was 8%. Construct validity: mean Cronbach’s alphas for the antenatal, birth and postpartum phase were: 0.73 (range 0.57-0.82), 0.84 (range 0.66-0.92), and 0.87 (range 0.62-0.95) respectively. The item-own scale correlations within all phases were considerably higher than most of the item-other scale correlations. Within the antenatal care, birth care and post partum phases, the eight factors explained 69%, 69%, and 76% of variance respectively. Discriminative validity: overall responsiveness mean sum scores were higher for women whose children were not admitted. This confirmed the hypothesis that dissatisfaction with health outcomes is transferred to their judgement on responsiveness of the perinatal services.ConclusionsThe ReproQ interview-based questionnaire demonstrated satisfactory psychometric properties to describe the quality of perinatal care in the Netherlands, with the potential to discriminate between different levels of quality of care. In view of the relatively small sample, further testing and research is recommended.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0622-1) contains supplementary material, which is available to authorized users.

The patient’s voice: an exploratory study of the impact of a group self-management support program

BackgroundGiven the potential value of self-management support programs for people with chronic diseases, it is vital to understand how they influence participants’ health attitudes and behaviours. The Stanford Chronic Disease Self-Management Program (CDSMP), the most well-known and widely studied such program, is funded in many provinces and jurisdictions throughout Canada. However, there is little published evidence on its impact in the Canadian health-care system. We studied participants’ reactions and perceived impacts of attending the Stanford program in one Ontario health region so we could assess its value to the health region. The study asked: What are participants’ reactions and perceived impacts of attending the Stanford CDSMP?MethodsThis mixed methods exploratory study held four focus groups approximately one year after participants attended a Stanford program workshop. At the beginning of each session, participants filled out a survey on the type and frequency of community and health resources used for their self-management. During the sessions, a moderator guided the discussion, asking about such things as long-term impact of the program on their lives and barriers to self-management of their chronic conditions.ResultsParticipants perceived diverse effects of the workshop: from having a profound impact on one area to affecting all aspects of their lives. A change in physical activity patterns was the most prominent behaviour change, noted by over half the participants. Other recurrent effects included an improved sense of social connection and better coping skills. Barriers to self-management were experienced by almost all participants with several dominant themes emerging including problems with the health system and patient-physician interaction. Participants reported a wide variety of resources used in their self-management, and in some cases, an increase in use was noted for some resources.ConclusionsSelf-management support is, at its core, a complex and patient-centred concept, so a diversity of outcomes to match the diversity of participants should be expected. As these interventions move into different target populations and communities, it is essential that we continue to explore through multiple research methods, the effects, and their meaning to participants, ensuring the optimal investment of resources for the very individuals these interventions aim to serve.

Issues in Serving the Forensic Client

In the course of a study of a team model of intensive case management for people with serious mental illness who are homeless and leaving Philadelphia jails, several issues regarding the interaction of mental health and jail systems have arisen. Among these issues are continuity of care in an unpredictable jail system, extensive involvement of family members in the charges brought against clients, and the use of legal sanctions toward therapeutic outcomes. This article discusses these issues both as they have appeared in the literature and as they have affected the progress of the study. Implications for community mental health system interactions with jails in serving forensic clients are explored.

Boundary spanners: A key component for the effective interactions of the justice and mental health systems.

Rarely are issues at the interface of the justice and mental health systems framed in system terms. Just how useful this perspective can be is demonstrated by the concept ofboundary spanners. This term has been in the organizational literature for 20 years to define positions that link two or more systems whose goals and expectations are at least partially conflicting. Boundary spanning positions are illustrated here by examples from a jail diversion program in Multnomah County Jail (Portland, Oregon), a community forensic program in Palm Beach County (Florida), and the Oregon Psychiatric Security Review Board which monitors persons acquitted by reason of insanity. To date, almost no research on boundary spanning positions in criminal justice-mental health system interactions has been conducted. This article concludes that a vigorous pursuit of such an agenda should be initiated because this concept, as part of a systems approach to justice-mental health problems, is highly promising.

Legal and mental health system interactions: Major developments and research needs

During the past two decades there has been in the United States a veritable profusion of professional and scientific literature dealing with various issues at the interface of the legal and mental health systems. Several new journals, literally scores of books, and several hundred journal articles and research reports have appeared. The above literature in very large measure reflects the many developments that have taken place in the law (legislative enactments, major court decisions, and administrative regulations), related public policies, and programs. In fact, it has only been within the past 15 years that Mental Health Law has emerged as a new and rapidly growing field of specialization. Greatly increased attention and interest have also been shown in the areas of forensic psychiatry, forensic psychology, related mental health disciplines, and in the behavioral and social sciences. The following is an alphabetical listing of some of the most relevant journals that have started publication during the last 15 years: Bulletin of the American Academy of Psychiatry and Law, Criminal Justice and Behavior, International Journal of Law and Psychiatry, Journal of Psychiatry and Law, Law and Human Behavior, Law and Psychology Review, Law & Society Review, and Mental Disability Law Reporter. This list does not, of course, include the many older professional journals and law reviews that continue to publish large numbers of relevant articles. It might also be noted here that, reflecting the aforementioned developments, since 1968 the Center for Studies of Crime and Delinquency (National Institute of Mental Health) has had a program priority in the area of law and mental health interactions. During this period the Center has sponsored many research and training projects, and numerous resulting publications have appeared (see, e.g., Brodsky & Smitherman, in press; Grisso, 1980, 1981; Hiday, 1977a, 1977b; Elwork et al., in press; Schwitzgebel, 1974; Steadman & Cocozza, 1974; Steadman, 1979; Thornberry & Jacoby, 1979). The Center has also published several items relevant to the law and mental health area in its

The use of Metro-Apex in health administration and planning education and training.

Metro-Apex is a computerized gaming-simulation designed to give practitioners and students an understanding of the environment of health care delivery systems. The exercise allows participants to explore the interaction of health roles and the health system's interaction with the larger community system. Originally developed as an air pollution control exercise, it has evolved to be a game about communities and how they operate. In 1972, the Department of Health, Education, and Welfare funded the Center for Multidisciplinary Educational Exercises (COMEX), of the University of Southern California to modify Metro-Apex for use with health service planners, health care administrators, and students in programs leading to these positions. The game runs in several rounds of from three to eight hours for groups of from 40 to 120 persons. Used in both educational and training settings, Metro-Apex is found to be a flexible addition to the health educator's tools.