Levels Of Healthcare System Research Articles

App Assisted Depression Self-Management in Integrated Primary Care: A Pilot Study Exploring Patient and Provider Experiences

Abstract The integrated primary care (IPC) setting is currently the de facto institution for accessing mental healthcare among underserved populations. However, many barriers exist for these populations when seeking regular and adequate mental healthcare, including provider availability and transportation challenges. This study piloted the incorporation of mindLAMP, a mHealth app, into IPC treatment to offer a low-resource intervention designed to improve and expand access to mental healthcare for underserved patients between face-to-face visits. This study gathered data from a sample of both behavioral health providers and patients (N = 6) in IPC settings to pilot the use of the mindLAMP app among traditionally underserved patients with depression. The Patient Activation Measure and Patient Health Questionnaire were used to assess patient outcomes in addition to conducting a directed content analysis on qualitative data obtained with interviews of both patients and providers. Results from the mixed methods study design indicate that implementing this digital intervention in the IPC setting is feasible and positively experienced by both patients and providers. Perceived positive outcomes were reported by both patients and providers after incorporating the mHealth app into their mental healthcare. However, both patients and providers discussed barriers to mHealth app use that need to be addressed in order to accommodate more widespread use. Further, constraints and barriers at the provider, patient, and healthcare system levels were discussed and need to be examined further to increase the implementation of this multilevel digital intervention.

Effectiveness of training hospital management teams in tier three hospitals in Kiambu County and utilization of routine health information

Health information is essential for health decision-making at all levels of the health pyramid. This study investigated the effect of training HMTs in tier three hospitals in Kiambu County and utilization of routine health information. The study design was interventional, employing a quasi-experimental research design that guided the study in the 12 tier-three hospitals. There was an intervention cluster and a control cluster, each with six hospitals. The study adopted a census technique, and all 240 HMT members were included. The study used both qualitative and qualitative data collection techniques. Data was analysed using Fisher’s exact test for the bi-variate analysis, logistics regression to ascertain the statistical relationships, Mann-Whitney U-test to test the difference in means at baseline and end-line, Difference in Difference technique was used to establish the average treatment effect of the intervention. The study used thematic content analysis to analyse qualitative data. The County Health Management Teams and the Sub County Health Management Teams participated in the Key Informant interviews. The results revealed a significant association between the training and the odds of good utilization (A.O. R=9.01, p=0.0001). Those who received training are 9 times more likely to utilize RHI. The study concludes that, designing HIS should be based on the users’ desired needs and that the intervention was highly effective in promoting the use of the RHI among HMTs. The study recommends that Kiambu County Department of Health should provide strategies for sustaining effective utilization RHI and should provide guidelines to ensure all HMTs are trained to enable them manage hospitals better. The study recommends that; further research be conducted in the lower-level health facilities to generate recommendations appropriate for the different levels of health care systems, similar studies should be replicated in other countries to compare results and enable the drawing of triangulated policy recommendations and a follow-up study be done to determine whether the increase in utilization translates into improved health outcomes or efficiencies within the health system.

Effectiveness of socio-economic-demographic factors on utilization of routine health information among hospital management teams in tier-three hospitals in in Kiambu County, Kenya

This study investigated the effectiveness of socio-economic-demographic factors on utilization of routine health information among HMTs in tier-three hospitals in Kiambu County. The study design was interventional, employing a quasi-experimental research design that guided the study in the 12 tier-three hospitals. There was an intervention cluster and a control cluster, each with six hospitals. The study adopted a census technique, and all 240 HMT members were included. The study used both qualitative and qualitative data collection techniques. Data was analysed using Fisher’s exact test for the bi-variate analysis, logistics regression to ascertain the statistical relationships, Mann-Whitney U-test to test the difference in means at baseline and end-line, Difference in Difference technique was used to establish the average treatment effect of the intervention. The study used thematic content analysis to analyse qualitative data. The County Health Management Teams and the Sub County Health Management Teams participated in the Key Informant interviews. The results indicate that there was no statistically significant difference regarding the socio-economic-demographic factors before and after the intervention, (Mann-Whitney U-test results (U = 28333, p = 0.7851). The study concludes that, designing HIS should be based on the users’ desired needs and that the intervention was highly effective in promoting the use of the RHI among HMTs. The study recommends that Kiambu County Department of Health should provide strategies for sustaining effective utilization RHI and should provide guidelines to ensure all HMTs are trained to enable them manage hospitals better. The study recommends that; further research be conducted in the lower-level health facilities to generate recommendations appropriate for the different levels of health care systems, similar studies should be replicated in other countries to compare results and enable the drawing of triangulated policy recommendations and a follow-up study be done to determine whether the increase in utilization translates into improved health outcomes or efficiencies within the health system.

Midwives perspectives of barriers and facilitators for the practice of promoting women's positive childbirth experience in China: A qualitative study.

Women-centered care for positive childbirth experiences is currently a global trend. However, there are some barriers to promoting women's positive childbirth experiences in practice. This study explored midwives' perspectives on the barriers and facilitators to promoting women's positive childbirth experience in practice. Qualitative semi-structured interviews were undertaken with 18 midwives in the birth unit of four tertiary care hospitals in Hefei, Anhui Province, China. Thematic analysis was used to code the interviews with deductive codes, and we organized findings according to levels of influence within the Dahlgren and Whitehead rainbow model, a socioecological model of health. Midwives reported barriers to women's positive childbirth experience were identified on four levels: individual factors included psychological barriers and childbirth expectations (micro level), social and community and organization factors included interpersonal violence, medical mistrust and obstetric violence and outcome (meso level), healthcare system factors included midwife shortage and hospital environment (macro level). Facilitators for a positive birth experience include antenatal education, community continuum of care, and respectful and understanding care. This study indicated that midwives experienced several barriers and facilitators in providing positive childbirth experience care to women in the Chinese context. The findings will help maternity care providers and policymakers develop multi-level implementation strategies at the individual, social, community, organization, and healthcare system levels.

Framework to Action: Developing and Implementing a Statewide Network to Expand Opioid Treatment Access Using SHIFT-Evidence in Texas

Background: In Texas, the expansion of access to effective treatments for opioid use disorder remains a significant public health challenge. This study aimed to demonstrate the application of the Successful Healthcare Improvement from Translating Evidence in Complex Systems (SHIFT-Evidence) framework in developing and implementing a statewide network for office-based opioid treatment (OBOT) to underserved populations. Methods: We identified systemic gaps in access to medications for opioid use disorder (MOUD) across Texas, using a targeted needs assessment of barriers and facilitators to buprenorphine prescribing. Findings were integrated into a planning template based on SHIFT-Evidence, which guided the identification of additional barriers across the health care system and iterative selection of strategies to address implementation barriers at multiple health care system levels, drawing on the Expert Recommendations for Implementing Change taxonomy. Strategies were prioritized based on feasibility and impact. To evaluate the program’s effectiveness in expanding access to MOUD, we conducted a descriptive analysis of data from the Texas Department of State Health Services’ Clinical Management for Behavioral Health Services data system to assess geographic reach and clients served within the program. Results: Applying SHIFT-Evidence provided a structured process for identifying key barriers occurring at multiple levels (patient, prescriber, and prescriber organization) and selecting tailored strategies to address each. This approach supported the successful development and expansion of an OBOT provider network, increasing access to treatment services from 6 provider organizations (10 locations) serving 52 clients in fiscal year 2019 to 23 provider organizations (48 locations) serving 1311 clients in fiscal year 2023. Conclusions: The comprehensive, multilevel approach supported by the application of SHIFT-Evidence effectively facilitated prioritization and planning to address systemic gaps across multiple health care system levels. The successful enhancement of treatment access highlights the framework’s utility in supporting improvements within complex health care systems.

Nursing Wellness in Academic and Clinical Cardiovascular and Stroke Nursing: AScientific Statement From the American Heart Association.

Nursing is an essential part of our health care system workforce. Cardiovascular and stroke nursing represents one of the largest specialty areas requiring expert knowledge and clinical proficiency to ensure safety and quality patient outcomes. To support the growth and sustainability of the various nursing roles in clinical practice, academia, and research, it is vital to attract, engage, mentor, and retain nurses. However, as the health care needs of the nation rise, staff nurses, advanced practice registered nurses, nursing educators, and nurse scientists are experiencing unprecedented demands, and individual wellness and burnout are being more closely examined at both the university and health care system levels. The goal of this scientific statement is to outline the drivers of burnout or intent to leave the profession that impact wellness specific to academic and clinical cardiovascular and stroke nursing and propose system-level interventions to mitigate and support future and current nurse clinicians, nurse educators, and nurse scientists.

Quality of life in long-term breast cancer survivors in Sub-Saharan Africa: the African Breast Cancer-Disparities in Outcomes study.

In Sub-Saharan Africa (SSA), breast cancer survivors' (BCS) quality of life (QoL) remains understudied. We compared QoL in BCS to cancer-free (CF) women across SSA settings with different levels of development, healthcare systems, ethnic compositions, and HIV prevalence. In 2022-2023, all 5 + year BCS from the African Breast Cancer-Disparities in Outcomes study and age-matched CF women from the community setting answered the WHOQOL-BREF questionnaire in Namibia, Nigeria, and Uganda. For each WHOQOL-BREF domain and general item, we estimated BCS-CF adjusted mean differences (AMD) in scores in absolute percentage points (p.p.). Overall, 862 women (BCS 357 vs. CF 505) (mean age ± SD, 57.5 ± 12.5 vs. 55.1 ± 11.2; tertiary education, 30% vs. 20%) were included. BCS reported higher/better overall QoL (AMD (95% CI) 10.65 p.p. (7.56, 13.74), i.e., ~ 40% of a change in QoL category), general health (5.84 (2.71, 8.98)), psychological (3.46 (1.43, 5.49)), social relationships (3.94 (1.25, 6.63)), and environment scores (4.27 (1.88, 6.67)) than CF women. There was no BCS-CF difference for physical health in all settings (1.52 (- 0.82, 3.87)), psychological health in Namibian Black women (0.58 (- 2.90, 4.06)), and social relationships in Nigeria (- 0.33 (- 5.81, 5.14)). BCS reported both lower energy and sexual life satisfaction than CF women. In SSA, long-term BCS have slightly better QoL than CF women except for physical health. Areas for which BCS scored lower or similar than CF women may indicate BCS' QoL issues. BCS-only studies using cancer-specific QoL questionnaires are needed to better characterize BCS' QoL in SSA.

"Don't give up, advocate for yourself": A pilot study examining healthcare experiences of people with Mayer Rokitansky Küster Hauser syndrome (MRKH).

Mayer Rokitansky Küster Hauser syndrome (MRKH) is characterized by the underdevelopment or absence of the uterus and upper vagina. Navigating healthcare interactions may present unique challenges for those with MRKH as there appears to be sparse clinical education and research available to healthcare providers. Additionally, limited research exists on the healthcare experiences of people with MRKH. This pilot study investigated the diagnostic journeys, post-diagnosis experiences, current healthcare interactions, and attitudes toward the healthcare system among individuals with MRKH. Participants with MRKH residing in the United States or Canada took part in semi-structured interviews on their MRKH-related healthcare experiences. Interview transcripts were thematically analyzed. People with MRKH conveyed that: 1) MRKH was not well known by healthcare providers and they were seldom provided with information and resources about MRKH, 2) they often needed to advocate for themselves in the healthcare system to receive adequate care, 3) sensitivity, inclusion, and knowledge from healthcare providers was invaluable, and 4) healthcare-system level barriers prohibited access to adequate care. Information and resources for MRKH patients should be age appropriate, patient-centered, trauma informed, and locally based. Providers should have access to evidence-based information and resources about MRKH, which includes knowledge of local specialist physicians, mental health specialists, pelvic health physical therapists, and other allied health professionals. Providers should also limit assumptions and use sensitive and inclusive language when communicating with patients around MRKH diagnosis, education, and development of treatment plans. Lastly, strategies for mitigating healthcare barriers should consider those with MRKH.

Using Human-Centered Design to Improve Serious Illness Care for Older Adults with Advanced Dementia

ContextOlder adults with advanced dementia increasingly receive potentially non-beneficial, high-intensity life-sustaining treatments and goal-discordant care in the United States. Interventions to address this issue have shown limited success. ObjectivesTo use human-centered design (HCD) with clinicians caring for older adults with advanced dementia to develop intervention ideas to reduce high-intensity, goal-discordant treatments near the end of life. MethodsWe used the first two steps of HCD, inspiration, and ideation, to understand clinicians’ perspectives regarding challenges in providing goal-concordant care for older adults with advanced dementia and to generate intervention ideas. In inspiration, we conducted in-depth interviews with clinicians caring for older adults with advanced dementia. We analyzed interviews using thematic analysis to identify themes and insights, which we synthesized into design opportunities using HCD. In ideation, we completed structured brainstorming sessions with study investigators, physicians, and designers to generate ideas for interventions at different healthcare system levels. ResultsDuring inspiration, we developed seven themes about clinicians’ experiences providing serious illness care for older adults with advanced dementia. We identified six instances where two or more themes were in tension. We synthesized these tensions into five insight statements capturing clinicians’ key challenges, which we reframed as three design opportunities. Brainstorming sessions conducted as part of ideation generated 132 solution ideas for these three opportunities, with participants selecting nine for testing. ConclusionThe HCD process generated ideas at multiple healthcare system levels to address an enduring challenge in serious illness care by involving clinicians, researchers, and designers in intervention design.

Management of detected syphilis in pregnancy adheres to guideline recommendations, but the crisis of congenital syphilis persists.

Infectious syphilis among women of reproductive age continues to rise in many countries including Australia, with a resultant increase in congenital syphilis. In response, new guidelines for management of syphilis in pregnancy were published in Queensland, Australia in 2018. This study evaluates the management of women diagnosed with syphilis in pregnancy in South-East Queensland (SEQ) after release of this guideline. This retrospective review of notification data identified women in SEQ who had a positive syphilis serology during pregnancy, without evidence of adequate treatment prior to the pregnancy, between January 2019 and December 2021 inclusive. Maternal demographics and pregnancy details including syphilis staging, testing and management were extracted, with management assessed against the 2018 Queensland syphilis in pregnancy guideline. Of the 42 women identified, 79% were diagnosed in the first or second trimester, 69% had early-stage syphilis at the time of diagnosis and 86% were asymptomatic at the time of diagnosis. All, including the eight (19%) Aboriginal and/or Torres Strait Islander women identified, completed stage-appropriate treatment with penicillin, 83% completed treatment four weeks prior to delivery and 60% achieved a four-fold reduction in rapid plasma reagin at time of delivery. Our findings suggest compliance with syphilis in pregnancy management recommendations has improved in SEQ since release of the 2018 guidelines. However, congenital syphilis rates continue to rise; further initiatives addressing barriers to timely testing and management of syphilis in pregnancy are urgently needed at both healthcare system levels and for individual women.

Abstract 4136846: Sex Differences in Hypertension Diagnosis among Young Adults

Background: Young adults, especially men, may experience delays in diagnosis of hypertension, which subsequently affect timely treatment and control of high blood pressure (BP). Question: Compared with young adult women, how soon are young adult men diagnosed with hypertension after having high BPs during clinical encounters? Aim: To estimate the time to first diagnosis of hypertension in young adult men and women, and to identify factors associated with a delayed diagnosis of hypertension. Methods: Using electronic health records, we identified adults aged 18-39 years with systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, based on average of three consecutive separate outpatient BPs within two years of each other, between 2009-2016 from Kaiser Permanente Southern California. We followed them from the third qualifying BP until hypertension diagnosis, membership disenrollment, end of study (12/31/2019), or death, whichever occurred first. We used the cumulative incidence function and Cox proportional hazards models to estimate the time to first diagnosis of hypertension and identify factors associated with diagnosis. Results: Among 2,443 young adults (mean age 31 years, 57% men) with high BP, 37% were diagnosed with hypertension during a median of 5.9 years. Compared with women, a lower percentage of men were diagnosed with hypertension (30% vs 47%) and men received their diagnoses later (median time to diagnosis: 2.3 vs 1.4 years) ( Figure ). Among the total population, 19% of men and 12% of women did not have follow-up BP measures within one year following their third qualifying high BP. Among those diagnosed, 80% initiated with antihypertensive medications within one year following their diagnosis. Factors associated with a delayed diagnosis of hypertension included being male, younger, having lower systolic or diastolic BP, a lower body mass index, and the absence of dyslipidemia or (pre)diabetes. Conclusion: This study highlights that young adult men are at a higher risk of delayed hypertension diagnosis, emphasizing the need for healthcare system level interventions to improve the recognition, diagnosis, and treatment of hypertension in this population.

Abstract 4137768: Evaluation of Therapeutic Intensification for Uncontrolled Hypertension Using Different Sources of Electronic Health Records

Background: Healthcare system level interventions to monitor therapeutic intensification for uncontrolled blood pressure (BP) may address potential therapeutic inertia, however, the best methods to evaluate therapeutic intensification using different sources of electronic health records are unknown. Question: To what extent do medication orders and pharmacy data provide comparable or distinct evaluations of therapeutic intensification? Methods: We identified adults with uncontrolled hypertension (systolic BP ≥140 or diastolic BP ≥90 mm Hg) in an outpatient encounter (index) from Kaiser Permanente Southern California in 2018. We included patients with new antihypertensive medication orders at the index encounter. We calculated therapeutic intensification score (TIS), a proportional measure of prescribed daily dose to maximum recommended daily dose of antihypertensive medications using two data sources: (1) medication orders including dose, directions for use, discontinuation order; (2) pharmacy fill data including strength, days’ supply, and quantity within 14 days after the index. Therapeutic intensification was determined by comparing the new dose at index and the previous dose [delta TIS (new dose – previous dose) >0]. Differences in TIS and the percentage of concordance using two methods were compared using descriptive statistics. Results: We included 75,935 patients with medication orders at the index encounter. Using medication order data, 84% increased the dose of antihypertensive medications with a median TIS (25 th , 75 th ) of 0.25 (0.13, 0.50). Among the total, 80% (n=61,485) filled their prescriptions. Among those who filled their prescriptions, 84% and 85% increased the dose using medication order and pharmacy data, respectively, with 95% concordance between the two methods. Mean (SD) differences in dose change was -0.06 (0.55) between the two methods ( p <0.001). Conclusion: A large portion of patients with uncontrolled BP failed to fill their new prescriptions, underscoring the value of utilizing medication order data to evaluate therapeutic intensification. For those who filled prescriptions, only minimal differences were observed between the evaluations using medication orders and pharmacy data.

A "silent storm": uncovering the escalating crisis in mental healthcare for children and adolescents in Slovenia during and after the COVID-19 pandemic.

Our aim was to assess the burden of children and adolescents' mental health problems on the Slovenian outpatient healthcare system before, during and after the pandemic. In a retrospective analysis of healthcare indicators from 2008 to 2023, we analysed data from the National Institute of Public Health. Key domains included initial visits for mental and behavioural disorders (MBDs) to primary care for the population aged 0-19; the number of referrals to an initial assessment with a child and adolescent psychiatrist (CAP) at the secondary level for the population aged 0-17 along with the corresponding waiting times; and the number of urgent referrals for the population aged 0-17 to emergency mental health centres at the tertiary level. The calculations included rates per 1000 people. Descriptive statistics and diagrams were used to compare the data. Segmented linear regression analysis (SLR) was conducted on the primary healthcare data to identify the distinct temporal point indicating an increase. Comparing the average rates of the 2020-2022 period to those of the 2018-2019 period, there was a 20% increase in initial visits to primary care, a 23% increase in the referral rate to a CAP at the secondary level, and a 41% increase to the tertiary level of care. In secondary care, a four- to sevenfold increase in waiting times for the initial CAP assessment was observed between 2019 and 2023. The incidence of initial visits to primary healthcare services for MBD increased from 2008 to 2019 (average annual growth rate of 4.5%). The average annual growth rate for the 2020-2022 period tripled to 13.9%. The SLR showed that the trend of accelerating growth could have begun in 2017 for the 0-5 age group and possibly for the 15-19 age group as well. After the initial decline in 2020, all levels of the Slovenian healthcare system faced an increased burden of MBD in children and adolescents from 2021 to 2022 compared to pre-pandemic levels. Nevertheless, a portion of this increase aligns with longitudinal growing trends from 2008 onwards. Tackling the crisis requires urgent national action, significant improvement in organization, and investments in mental health.

Pandemic COVID-19 as a challenge for telemedicine in the Czech Republic.

The COVID-19 Pandemic contributed to accelerating the process of using information and communication technologies and digital technologies in healthcare management and delivery within healthcare systems. At that time, the Czech healthcare system faced the same problems as other European systems and struggled with a temporary limitation of direct provision of healthcare services. It was solved by switching to telemedicine. The Czech healthcare system used telemedicine to a minimal extent until then. Despite adopting the law on healthcare digitisation, it is still one of the countries with a lower level of digitisation of healthcare processes. The article presents the results of an exploratory expert investigation focused on the implementation and development of telemedicine in the Czech Republic. The conducted research aimed to identify problems related to the implementation of telemedicine in practice, place them in the broader framework of the healthcare system and structure them, propose possible solutions, and identify the future challenges of telemedicine in the Czech Republic. We based our study on the results of a three-phase QUAL-QUAN-QUAL research. Data collection in the first phase took the form of individual semi-structured interviews with patients (25) with practical experience in the field of telemedicine, followed by the second quantitative phase of the questionnaire survey with patients (650). The third qualitative phase included semi-structured interviews with experts (17) with practical experience in telemedicine. The introduction and expansion of telemedicine require several fundamental changes. These include adjustments to the legislative environment and changes to the technological infrastructure, organisation of care and work. Several barriers have been identified at the healthcare system level, healthcare providers, healthcare professionals and patients.

Burnout and Turnover Among Veterans Health Administration Primary Care Providers From Fiscal Years 2017-2021.

We examined how individual-level turnover among Veterans Health Administration primary care providers (PCPs) from fiscal years 2017 to 2021 was associated with health care system-level burnout and turnover intent. Burnout among PCPs has been well documented in recent studies, but less is known about the potential relationship between burnout and turnover. We identified a national cohort of 6444 PCPs (physicians, nurse practitioners, and physician assistants) in 129 Veterans Health Administration health care systems in the first quarter of fiscal year 2017 and tracked their employment status for 20 quarters. PCP employment data on turnover were linked to annual health care system-level employee survey data on burnout, turnover intent, and other covariates. We performed logistic regression to estimate the impact of health care system-level burnout and turnover intent on individual PCP turnover, controlling for individual and health care system-level covariates and adjusting for clustering at the health care system level. Median health care system-level burnout ranged from 42.5% to 52.0% annually, and turnover among PCPs ranged from 6.3% to 8.4% (mean = 7.0%; SD = 0.9%). Separation from employment was higher among employees at health care systems with the highest burnout (odds ratio =1.14; 95% CI = 1.01-1.29) and turnover intent (OR = 1.18; 95% CI = 1.03-1.35). PCPs in health care systems with high burnout are more likely to separate from employment. Policymakers and administrators seeking to improve retention should consider system-level interventions to address organizational drivers of burnout.

Barriers and facilitators to cervical cancer screening among under- and neverscreened women in Flanders, Belgium – a qualitative study on community and healthcare providers’ perspectives

BackgroundCervical cancer is detectable and preventable in premalignant stages. In 2013, a population-based cervical cancer screening (CCS) programme was set up in Flanders (Belgium) promoting screening by means of sending reminder letters. Yet, in 2021, only a CCS coverage of 63.6% has been reached, which is just a bare increase since the implementation of the programme (62.7% in 2013) (Jaarrapport 2022, Centrum voor Kankeropsporing (CvKO), 2022; Jaarrapport 2015, Centrum voor Kankeropsporing (CvKO), 2015).ObjectivesTo explore the characteristics of under- and neverscreened women in Flanders and to gain a better understanding of the barriers that prevent these women from attending CCS as well as factors that may facilitate CCS uptake.MethodsTwelve in-depth interviews and six focus group discussions were conducted with gynaecologists, general practitioners, community health workers and stakeholders providing support to women belonging to potentially underscreened population groups. Reported barriers and facilitators were subsequently classified using the Socio-Ecological Model (SEM). Finally, a causal loop diagram was constructed to visualise the dynamic interrelations among the barriers and facilitators.ResultsStakeholders and healthcare professionals confirm the vulnerability for cervical cancer screening in women with a substance use disorder and women with a migration background. The participation in screening among female sex workers is contingent upon their specific work environment. The group of never- or underscreened women is very heterogeneous and includes many women who are either unaware of CCS or have other priorities. A lack of focus on prevention is the most commonly reported barrier at the healthcare system level. Increasing awareness about cervical cancer (screening) and creating more opportunities for healthcare workers to offer prevention services are the primary facilitators.ConclusionTo improve screening participation in Flanders, different screening strategies tailored to a diversity of women are needed.

Does the development of strategic readiness represent a response to the relationship of strategic competencies and the healthcare information system? Evidence from private hospitals in Jordan

This study introduces a model designed to improve the strategic readiness of private hospitals in Amman by incorporating strategic competencies as an independent variable and using a healthcare information system as a mediator. Targeting private hospitals with over 140 beds, the research included a population of 3263 employees across various managerial levels. Data collection methods involved interviews and electronic questionnaires, resulting in a sample size of 344. Statistical analyses comprised exploratory and confirmatory factor analysis, structural equation modeling, and hypothesis testing with SMART PLS 3.3.3 software. The results indicated medium levels of both strategic competencies and healthcare information systems, while strategic readiness was found to be low. Nevertheless, the proposed model showed a direct positive effect of strategic competencies on strategic readiness, with the healthcare information system acting as a significant partial mediator. Evaluation metrics included the arithmetic mean, standard deviation, and path analysis. This model surpasses traditional methods by effectively linking strategic competencies and information systems to enhance strategic readiness, providing a strong framework for improving hospital responses to crises and dynamic changes. The study suggests focusing on enhancing and developing strategic competencies and integrating a comprehensive healthcare information system to optimize hospital operations and increase readiness.

Clinical Data Flow in Botswana Clinics: Protocol for a Mixed-Methods Assessment.

Botswana has made significant investments in its health care information infrastructure, including vertical programs for child health and nutrition, HIV care, and tuberculosis. However, effectively integrating the more than 18 systems in place for data collection and reporting has proved to be challenging. The Botswana Health Data Collaborative Roadmap Strategy (2020-24) states that "there exists parallel reporting systems and data is not integrated into the mainstream reports at the national level," seconded by the Botswana National eLearning strategy (2020), which states that "there is inadequate information flow at all levels, proliferation of systems, reporting tools are not synthesized; hence too many systems are not communicating." The objectives of this study are to (1) create a visual representation of how data are processed and the inputs and outputs through each health care system level; (2) understand how frontline workers perceive health care data sharing across existing platforms and the impact of data on health care service delivery. The setting included a varied range of 30 health care facilities across Botswana, aiming to capture insights from multiple perspectives into data flow and system integration challenges. The study design combined qualitative and quantitative methodologies, informed by the rapid assessment process and the technology assessment model for resource limited settings. The study used a participatory research approach to ensure comprehensive stakeholder engagement from its inception. Survey instruments were designed to capture the intricacies of data processing, sharing, and integration among health care workers. A purposive sampling strategy was used to ensure a wide representation of participants across different health care roles and settings. Data collection used both digital surveys and in-depth interviews. Preliminary themes for analysis include perceptions of the value of health care data and experiences in data collection and sharing. Ethical approvals were comprehensively obtained, reflecting the commitment to uphold research integrity and participant welfare throughout the study. The study recruited almost 44 health care facilities, spanning a variety of health care facilities. Of the 44 recruited facilities, 27 responded to the surveys and participated in the interviews. A total of 75% (112/150) of health care professionals participating came from clinics, 20% (30/150) from hospitals, and 5% (8/150) from health posts and mobile clinics. As of October 10, 2023, the study had collected over 200 quantitative surveys and conducted 90 semistructured interviews. This study has so far shown enthusiastic engagement from the health care community, underscoring the relevance and necessity of this study's objectives. We believe the methodology, centered around extensive community engagement, is pivotal in capturing a nuanced understanding of the health care data ecosystem. The focus will now shift to the analysis phase of the study, with the aim of developing comprehensive recommendations for improving data flow within Botswana's health care system. DERR1-10.2196/52411.

Considering User Experience and Behavioral Approaches in the Design of mHealth Interventions for Atrial Fibrillation: Systematic Review.

Atrial fibrillation (AF) is a leading chronic cardiac disease associated with an increased risk of stroke, cardiac complications, and general mortality. Mobile health (mHealth) interventions, including wearable devices and apps, can aid in the detection, screening, and management of AF to improve patient outcomes. The inclusion of approaches that consider user experiences and behavior in the design of health care interventions can increase the usability of mHealth interventions, and hence, hopefully, yield an increase in positive outcomes in the lives of users. This study aims to show how research has considered user experiences and behavioral approaches in designing mHealth interventions for AF detection, screening, and management; the phases of designing complex interventions from the UK Medical Research Council (MRC) were referenced: namely, identification, development, feasibility, evaluation, and implementation. Studies published until September 7, 2022, that examined user experiences and behavioral approaches associated with mHealth interventions in the context of AF were extracted from multiple databases. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were used. A total of 2219 records were extracted, with only 55 records reporting on usability, user experiences, or behavioral approaches more widely for designing mHealth interventions in the context of AF. When mapping the studies onto the phases of the UK MRC's guidance for developing and evaluating complex interventions, the following was found: in the identification phase, there were significant differences between the needs of patients and health care workers. In the development phase, user perspectives guided the iterative development of apps, interfaces, and intervention protocols in 4 studies. Most studies (43/55, 78%) assessed the usability of interventions in the feasibility phase as an outcome, although the data collection tools were not designed together with users and stakeholders. Studies that examined the evaluation and implementation phase entailed reporting on challenges in user participation, acceptance, and workflows that could not be captured by studies in the previous phases. To realize the envisaged human behavior intended through treatment, review results highlight the scant inclusion of behavior change approaches for mHealth interventions across multiple levels of sociotechnical health care systems. While interventions at the level of the individual (micro) and the level of communities (meso) were found in the studies reviewed, no studies were found intervening at societal levels (macro). Studies also failed to consider the temporal variation of user goals and feedback in the design of long-term behavioral interventions. In this systematic review, we proposed 2 contributions: first, mapping studies to different phases of the MRC framework for developing and evaluating complex interventions, and second, mapping behavioral approaches to different levels of health care systems. Finally, we discuss the wider implications of our results in guiding future mHealth research.

‘Pain free if I ever will be’: lived experience of workers seeking care for pain attributed to musculoskeletal disorders

BackgroundPain attributed to musculoskeletal disorders are a significant hinderance to work ability and economic growth, especially in developing countries. Quality of life and lived experience of workers with musculoskeletal disorders have not been explored enough to determine whether person-centred care is provided. There is a wealth of evidence for using the biomedical approach in the management of workers with musculoskeletal disorders, which has proved ineffective in reducing absenteeism and symptoms experienced by workers. The purpose of this study was to explore the lived experience of workers seeking care for musculoskeletal disorders and how their pain attitudes and beliefs influenced their experience.MethodsA qualitative approach with thematic analysis was used. Purposive sampling was used to recruit six participants for semi-structured interviews. All participants were either experiencing pain attributed to a musculoskeletal disorder or had received care for a musculoskeletal disorder.ResultsPain attitudes and beliefs of workers with a musculoskeletal disorder and healthcare professionals greatly influenced the care and recovery process of musculoskeletal disorders. There is a primary biomedical lens informing care of workers with musculoskeletal disorders received. Workers expect healthcare professionals to explore their concerns further, but the focus of care for most participants was their presenting complaint. There is also a need for the autonomy of workers to be preserved, and communication between healthcare professionals and workers with musculoskeletal disorders needs to improve.ConclusionsMany stakeholders are involved in the recovery process from musculoskeletal disorders. There is a need for a biopsychosocial informed practice to improve return-to-work (RTW) in workers with musculoskeletal disorders. Change is needed at all healthcare system levels to reduce the negative experiences of workers and maladaptive pain beliefs that is associated with persisting symptoms and extended absenteeism.