Inappropriate Services Research Articles

Male reproductive health disorders among Aboriginal and Torres Strait Islander men: a hidden problem?

To better understand help-seeking behaviours and reproductive health disorders among Aboriginal and Torres Strait Islander men. A cross-sectional mixed-methods study conducted from 1 May 2004 to 30 April 2005 of 293 Aboriginal and Torres Strait Islander men aged 18 years and over from urban, rural and remote communities in the Northern Territory and Queensland. Subscale of the International Index of Erectile Function, self-reported help-seeking behaviours for erectile dysfunction (ED) and prostate disease, thematic analysis of semi-structured interviews and focus groups. The prevalence of moderate-to-severe ED increased across age groups, from about 10% in younger men (under 35 years) to 28% in men aged 55-74 years. Moderate-to-severe ED was strongly associated with reporting a chronic condition (odds ratio [OR], 3.67) and residing in a remote area (OR, 2.94). Aboriginal and Torres Strait Islander men aged 40-59 years showed similar low levels of help-seeking behaviours compared with non-Indigenous men from a comparable population-based study. About half of the men with ED saw a doctor or received treatment for ED in each population. While prostate cancer rates were low in both studies, testing for prostate problems was less frequent in Aboriginal and Torres Strait Islander men (11.4%) than in non-Indigenous men (34.1%, P < 0.001), despite similar levels of concern about prostate cancer. Barriers to help-seeking included shame, culturally inappropriate services and lack of awareness. This study, the first to investigate reproductive health of Aboriginal and Torres Strait Islander men, found low levels of help-seeking behaviours for reproductive health disorders, with implications for missing a predictor of chronic disease and late diagnosis of prostate disease.

Service in progress

The Hyacinth Lightbourne Visiting Nursing Service in Jamaica, established in the mid-1950s with help from the Queen's Nursing Institute, brought home care to people who would otherwise have been reliant on inaccessible or inappropriate hospital services.

Iraqi primary care system in Kurdistan region: providers' perspectives on problems and opportunities for improvement.

BackgroundAs part of a comprehensive study on the primary health care system in Iraq, we sought to explore primary care providers’ perspectives about the main problems influencing the provision of primary care services and opportunities to improve the system.MethodsA qualitative study based on four focus groups involving 40 primary care providers from 12 primary health care centres was conducted in Erbil governorate in the Iraqi Kurdistan region between July and October 2010. A topic guide was used to lead discussions and covered questions on positive aspects of and current problems with the primary care system in addition to the priority needs for its improvement. The discussions were fully transcribed and the qualitative data was analyzed by content analysis, followed by a thematic analysis.ResultsProblems facing the primary care system included inappropriate health service delivery (irrational use of health services, irrational treatment, poor referral system, poor infrastructure and poor hygiene), health workforce challenges (high number of specialists, uneven distribution of the health workforce, rapid turnover, lack of training and educational opportunities and discrepancies in the salary system), shortage in resources (shortage and low quality of medical supplies and shortage in financing), poor information technology and poor leadership/governance. The greatest emphasis was placed on poor organization of health services delivery, particularly the irrational use of health services and the related overcrowding and overload on primary care providers and health facilities. Suggestions for improving the system included application of a family medicine approach and ensuring effective planning and monitoring.ConclusionsThis study has provided a comprehensive understanding of the factors that negatively affect the primary care system in Iraq’s Kurdistan region from the perspective of primary care providers. From their experience, primary care providers have a role in informing the community and policy makers about the main problems affecting this system, though improvements to the health care system must be taken up at the national level and involve other key stakeholders.

Understanding and addressing the stigma of mental illness with ethnic minority communities

Higher income societies have moved from institutional to community-based care for people experiencing mental illness. However, stigma and discrimination persists and undermines help-seeking, recovery and life chances. Mental illness prevalence is higher amongst communities that face multiple prejudices and disadvantages within society, including Black and minority ethnic communities who may experience migration trauma, racism, acculturation and adverse social circumstances. This study examines beliefs, stigma and the effectiveness of existing national mental health campaigns with Pakistani, Indian and Chinese heritage communities in Scotland, UK, using community based participatory research. Community organisers were trained and supported to co-facilitate focus groups with 87 people using a range of languages. Whilst diversity within and between communities was apparent, important trends emerged. People with mental illness experience high levels of stigma from communities. Families experience significant associated stigma. This shame combines with culturally inappropriate services to reduce help-seeking from mental health services, friends and families. Existing anti-stigma campaigns have failed to reach or engage with communities due to a combination of practical issues such as the use of inappropriate language, imagery and media, but also due to assuming western medical concepts of illness. Participants suggested a new model for national campaigns placing greater emphasis upon community development, cultural events, positive contact and dialogue with families, faith leaders and youth groups. National anti-stigma programmes must develop more effective partnerships with communities or risk magnifying existing inequalities. Despite a range of national programmes to address stigma towards people with mental illness, it remains as the major barrier to social inclusion for people with mental illness living in communities. Stigma is particularly severe if people have a mental illness and are also economically disadvantaged or face multiple stigmas. By adopting community based participatory research (CBPR) approaches with three Black and ethnic minority communities in Scotland, this study makes the case that stigma can only be understood and effectively addressed with reference to its socio-cultural context.

Understanding and addressing the stigma of mental illness with ethnic minority communities

Higher income societies have moved from institutional to community-based care for people experiencing mental illness. However, stigma and discrimination persists and undermines help-seeking, recovery and life chances. Mental illness prevalence is higher amongst communities that face multiple prejudices and disadvantages within society, including Black and minority ethnic communities who may experience migration trauma, racism, acculturation and adverse social circumstances. This study examines beliefs, stigma and the effectiveness of existing national mental health campaigns with Pakistani, Indian and Chinese heritage communities in Scotland, UK, using community based participatory research. Community organisers were trained and supported to co-facilitate focus groups with 87 people using a range of languages. Whilst diversity within and between communities was apparent, important trends emerged. People with mental illness experience high levels of stigma from communities. Families experience significant associated stigma. This shame combines with culturally inappropriate services to reduce help-seeking from mental health services, friends and families. Existing anti-stigma campaigns have failed to reach or engage with communities due to a combination of practical issues such as the use of inappropriate language, imagery and media, but also due to assuming western medical concepts of illness. Participants suggested a new model for national campaigns placing greater emphasis upon community development, cultural events, positive contact and dialogue with families, faith leaders and youth groups. National anti-stigma programmes must develop more effective partnerships with communities or risk magnifying existing inequalities. Despite a range of national programmes to address stigma towards people with mental illness, it remains as the major barrier to social inclusion for people with mental illness living in communities. Stigma is particularly severe if people have a mental illness and are also economically disadvantaged or face multiple stigmas. By adopting community based participatory research (CBPR) approaches with three Black and ethnic minority communities in Scotland, this study makes the case that stigma can only be understood and effectively addressed with reference to its socio-cultural context.

Retention of allied health professionals in rural New South Wales: a thematic analysis of focus group discussions

BackgroundUneven distribution of the medical workforce is globally recognised, with widespread rural health workforce shortages. There has been substantial research on factors affecting recruitment and retention of rural doctors, but little has been done to establish the motives and conditions that encourage allied health professionals to practice rurally. This study aims to identify aspects of recruitment and retention of rural allied health professionals using qualitative methodology.MethodsSix focus groups were conducted across rural NSW and analysed thematically using a grounded theory approach. The thirty allied health professionals participating in the focus groups were purposively sampled to represent a range of geographic locations, allied health professions, gender, age, and public or private work sectors.ResultsFive major themes emerged: personal factors; workload and type of work; continuing professional development (CPD); the impact of management; and career progression. ‘Pull factors’ favouring rural practice included: attraction to rural lifestyle; married or having family in the area; low cost of living; rural origin; personal engagement in the community; advanced work roles; a broad variety of challenging clinical work; and making a difference. ‘Push factors’ discouraging rural practice included: lack of employment opportunities for spouses; perceived inadequate quality of secondary schools; age related issues (retirement, desire for younger peer social interaction, and intention to travel); limited opportunity for career advancement; unmanageable workloads; and inadequate access to CPD. Having competent clinical managers mitigated the general frustration with health service management related to inappropriate service models and insufficient or inequitably distributed resources. Failure to fill vacant positions was of particular concern and frustration with the lack of CPD access was strongly represented by informants.ConclusionsWhile personal factors affecting recruitment and retention of allied health study participants were similar to doctors, differences also existed. Allied health professionals were attracted by advanced work roles in a context of generalist practice. Access to CPD and inequitable resource distribution were strong ‘push’ factors in this group. Health policy based on the assumption of transferability between professions may be misguided.

Doctors' health: stigma and the professional discomfort in seeking help

SummaryI describe the needs for and impediments in provision of psychological support services for doctors. Morbidity and the resistance in the profession to addressing their own health needs are discussed. I also explore the principles of bespoke services for doctors, with particular emphasis on overcoming stigma and facilitating therapeutic engagement. I argue that triage is an inappropriate service model of care for doctors.

Treating criminal behavior: Is the bang worth the buck?

Andrews and colleagues showed that the principles of Risk-Need-Responsivity (RNR) effectively reduced recidivism. The purpose of this study was to advance Andrews and colleagues’ work by examining whether correctional services that adhered to RNR were more expensive than services that did not adhere to RNR. Articles included in the Andrews et al. (1990) meta-analysis of correctional services were gathered and reevaluated based upon a coding process which emphasized the maximum cost of service provision. Results indicated that appropriate correctional services (services that adhered to RNR) were not significantly more expensive than inappropriate correctional services (services that did not adhere to RNR) or traditional criminal sanctions. Also indicated was a practical cost difference between appropriate and inappropriate correctional services, where inappropriate correctional services had increased costs, possibly because of increased time of service provision. The implications of these findings for policy and correctional administrative decision making with regard to offender treatment are discussed.

Judging a patient's decision to seek emergency healthcare: clues for managing increasing patient demand

In recent years, the concept of an 'inappropriate' emergency department or ambulance user has arisen. This discussion paper explores definition and measurement of inappropriate emergency healthcare utilisation, and the effect on demand. A comprehensive literature review of published articles was conducted. Exploration of the definitions of 'inappropriate' emergency healthcare utilisation identified two patient cohorts; emergency healthcare utilisation by those who are not experiencing a health emergency, and those who do not seek emergency healthcare who should. Several position papers from Australian and international sources emphasised the patient's right to access emergency healthcare when they feel the need, and the responsibility of emergency healthcare workers to provide treatment to all patients. Differences between medical classifications of urgency based on physiological measures are contrasted with patient-based determination of urgency, which is defined by psychosocial factors. This literature review raises questions about patients' understanding of the role of emergency healthcare services in an emergency. This has implications for determining the patient's point of access to the health system in an acute health event, and offers an opportunity to selectively educate patients and carers to change help-seeking behaviours to suit the health system resources and moderate patient demand.

ラオス国首都ビエンチャンにおける公園の整備状況と利用実態に関する研究

Lao PDR is a landlocked country located in the middle of Indochina. Vientiane Capital, which is the capital city of Lao PDR, has an area of 3,920km2 and its population was 795,000 in 2009. It has high economic and demographic growth potential. It is thus quite likely that the urban area would rapidly expand toward the suburbs, creating the problem of urban sprawl with bad living conditions and inappropriate social services. In this study, it was carried out to make clear current conditions of urban parks in Vientiane Capital with conducting a park counting survey and a park interview survey. According to the study, it is clear that there are only 9 urban parks with a total area of 20.6ha in Vientiane Capital. Considering the population volume, the parks area seems to be quite less. Additionally, definition of “urban park” as one of the urban infrastructure facilities is not regulated in any relevant laws, therefore, any vision and target volume of urban parks have not been formulated so far. Following this study, it is required that studies conduct more in developing countries especially in Asia to grasp current conditions of urban parks for aiming of establishment of sustainable city and of export of Japanese knowledge and skills related to urban parks.

A Study on the Nanotechnology Researchers’ Information Needs and Information Retrieval Behavior

The purpose of this project is to study the nanotechnology researchers’ information needs and information retrieval behavior. Its Methodology is questionnaire survey. Research instrument was a researcher-made questionnaire whose reliability was calculated through Cronbach α (α= 0,914) and whose content validity was analyzed and approved through expert opinions.1225 researchers in nanotechnology are included as the research population out of whom 291 researchers, based on Krejcie and Morgan table, were selected using cluster random sampling method. Out of distributed questionnaires (500), 243 of them (84% of the sample) were returned completed. Statistical analyses were carried out in SPSS and Excel environments. The results of research indicate that, 69.7 % researchers mainly use articles, 58.8 % of them e-journals, and a few of them use bibliographies as formal sources. Their ideal type of resource is e-resources. Their motives to use information are mainly conducting research projects and updating their field-related information. Academic centers are where they usually refer to address their information needs. The major problems to access information are inappropriate internet services and lack of access to certain data bases due to subscription issues.

Factors Associated With the Overuse or Underuse of Health Care Services Among Medical Aid Beneficiaries in Korea

Purpose: To compare and contrast demographic characteristics and health care service utilization between overusers and underusers of health care services and to identify factors associated with the overuse or underuse of health care services among the medical aid beneficiaries in Korea. Methods: Secondary data analysis was performed using health care costs and medical aid case management progress data. Data on demographic characteristics, health-related quality of life (HRQoL), and inappropriate health care service user category (overuse or underuse) were provided by the Medical-Aid Case Management Center of Korea, and heath care service reimbursement data were provided by the Korea National Health Insurance Corporation (NHIC). Data on 22,697 beneficiaries were used for analysis, and logistic regression analysis was conducted to examine factors that are associated with overuse and underuse of health care services. Results: The study results revealed that older individuals, women, unemployed individuals, type 1 medical aid beneficiaries, and those with higher education and disabilities were more likely to belong to the overuse group, but urban residents, compared to metropolitan residents, and those with higher HRQoL were more likely to belong to the underuse group (p < .05). Conclusions: Understanding factors associated with the overuse or underuse of health care services may help to provide tailored case management services to improve the HRQoL of the beneficiaries and optimize their use of health care services. Clinical Relevance: Promoting appropriate use of health care services may enhance clients' quality of life and preserve resources for other essential services for medical aid beneficiaries.

Consumer choices of international mountaineering holiday: A perspective of Slovak mountaineering market towards Slovak tourism providers

The main purpose of this study was to critically analyze consumer choices of Slovak mountaineersfor purchasing international mountaineering holiday from Slovak outbound travel agencies/tour-operators. To increase the probability of the respondents’ geographic, age and gender varieties,qualitative questionnaires were distributed among 80 respondents using the method of clustersampling. The preferences of mountaineering holiday arrangement of the analysed market werefound to be through personal communication with Slovak travel intermediaries, which was perceivedmore safe and time-saving then independent purchase or/and purchase through international travelintermediaries. An individually tailored holiday was preferred as it provides safety andsimultaneously satisfies the desired elements of freedom and independence. The main issuesregarding the provided services by the Slovak outbound travel agencies/tour-operators have beenrelated to lack of mountaineering expertise and an inappropriate service delivery.

Rapid change, climate adversity and the next 'big dry': older farmers' mental health.

To describe the experiences of older farmers in the face of prolonged drought and rapid change. Content analysis of issues and priorities raised in semi-structured community forums. Rural centres in NSW. One hundred and fifty older farmers, their families, Industry and Investment NSW, rural financial and mental health services, the Country Women's Association and other non-government agencies. Five public forums organised under the Rural Adversity Mental Health Program. Prolonged drought caused pressures on farmers that compounded the usual stresses of farming and of ageing. These were experienced in the context of rapid social and industry change, fuel price volatility and the insidious threat of climate change. Three main themes were articulated: loss, government compliance pressures and difficulties accessing and/or inappropriate services. Older farmers felt an overwhelming sense of loss: of profitability and professional success, community status, physical well-being and comfort, the ability to participate in the modern world and, above all, of relationships (partners, children and friends moving away). They interpreted government compliance requirements as evidence of community and government loss of trust in famers. They resisted using the few mental health services that might be available, fearing being labelled as 'crazy' and discouraged by the culturally inappropriate way in which services were offered. Older farmers would benefit from joint services related to health and well-being simultaneously with modern business management offered in trusted, comfortable settings.

Village savings and loans: A pathway to financial inclusion for Africa's poorest households

For Africa's poorest and most marginalized households, few financial institutions exist to serve them, and where institutions do exist they generally have inappropriate products and services. To address the issue of financial inclusion and reach poorer clients, CARE began promoting a savings-led microfinance model, called Village Savings and Loans Associations (VSLAs). The VSLA model is based on the belief that for the extremely poor, particularly women, the best approach is to begin by building their financial assets and skills through savings rather than debt. Through participation in a VSLA members can diversify their activities, plant additional crops and even add new income-generating activities. At the same time, they are able to save and borrow in ways that allow them to smooth cyclical household consumption patterns. Now more than ever before, we see VSLAs as an important, and often necessary, rung on the ladder of financial inclusion.

Indigenous cultural training for health workers in Australia.

Culturally inappropriate health services contribute to persistent health inequalities. This article reviews approaches to indigenous cultural training for health workers and assesses how effectively they have been translated into training programmes within Australia. CINAHL PLUS, MEDLINE, Wiley InterScience, ATSIHealth and ProQuest. The review focuses on the conceptual and empirical literature on indigenous cultural training for health workers within selected settler-colonial countries, together with published evaluations of such training programmes in Australia. Data extraction Information on conceptual models underpinning training was extracted descriptively. Details of authors, year, area of investigation, participant group, evaluation method and relevant findings were extracted from published evaluations. Six models relevant to cultural training were located and organized into a conceptual schema ('cultural competence, transcultural care, cultural safety, cultural awareness, cultural security and cultural respect'). Indigenous cultural training in Australia is most commonly based on a 'cultural awareness' model. Nine published evaluations of Australian indigenous cultural training programmes for health workers were located. Of the three studies that assessed change at multiple points in time, two found positive changes. However, the only study to include a control group found no effect. This review shows that the evidence for the effectiveness of indigenous cultural training programmes in Australia is poor. Critiques of cultural training from indigenous and non-indigenous scholars suggest that a 'cultural safety' model may offer the most potential to improve the effectiveness of health services for indigenous Australians.

Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient

In the United States, the incidence rate of new or recurrent stroke is approximately 795 000 per year, and stroke prevalence for individuals over the age of 20 years is estimated at 6.5 million.1 Mortality rates in the first 30 days after stroke have decreased because of advances in emergency medicine and acute stroke care. In addition, there is strong evidence that organized postacute, inpatient stroke care delivered within the first 4 weeks by an interdisciplinary healthcare team results in an absolute reduction in the number of deaths.2,3 Despite these positive achievements, stroke continues to represent the leading cause of long-term disability in Americans: An estimated 50 million stroke survivors worldwide currently cope with significant physical, cognitive, and emotional deficits, and 25% to 74% of these survivors require some assistance or are fully dependent on caregivers for activities of daily living (ADLs).4,5 Notwithstanding the substantial progress in acute stroke care over the past 15 years, the focus of stroke medical advances and healthcare resources has been on acute and subacute recovery phases, which has resulted in substantial health disparities in later phases of stroke care. Additionally, healthcare providers (HCPs) are often unaware of not only patients’ potential for improvement during more chronic recovery phases but also common issues that stroke survivors and their caregivers experience. Furthermore, even with evidence that documents neuroplasticity potential regardless of age and time after stroke,6 the mean lifetime cost of ischemic stroke (which accounts for 87% of all strokes) in the United States is an estimated $140 000 (for inpatient, rehabilitation, and follow-up costs), with 70% of first-year stroke costs attributed to acute inpatient hospital care1; therefore, fewer financial resources appear to be dedicated to providing optimal care during the later phases of stroke recovery. Because there remains a …

Access to and experience of child and adolescent mental health services: barriers to children and young people with learning disabilities and their families

Despite laudable intentions and evidence of progress, significant barriers remain in relation to the access to and experiences of child and adolescent mental health services (CAMHS). This article draws on the findings of a literature review and reports a number of barriers and their impact on children and young people with learning disabilities. Children and young people with learning disabilities are at a disproportionate risk of experiencing mental health problems yet access and experience of CAMHS can be highly uneven. Families are often unclear about how to access mental health services and what services are available. Such information and knowledge‐related barriers are particularly significant for certain minority ethnic groups. Barriers related to the CAMHS workforce mix, skills and staff attitudes can also mean that skills required for working with people with both mental health conditions and learning disabilities can be lacking. At a macro level, systems‐related barriers include a lack of joint commissioning and planning, unclear care pathways, the lack of a single point of referral, difficult transition to adult mental health services and a lack of inappropriate services.

Health and Safety in Small Workplaces: Refocusing Upstream

Small workplaces have particular injury risks and are enduringly difficult for the occupational health and safety (OHS) system to reach. This paper puts forward an "upstream" perspective on OHS in small workplaces that moves beyond the attributes of the workplace and those who work there. The paper draws on and synthesizes ideas and findings from emerging upstream OHS research, our own empirical investigations in Ontario and Quebec, and our collected research experience in small workplace health. Upstream structures and processes (regulations, policies, services, interventions, professional practices) are often misaligned with the conditions of work and social relations of small workplaces. Key upstream factors include regulatory exemption, subcontracting, unionization levels, the changing character of small enterprise, joint management, service and inspection constraints, competing institutional accountabilities, institutional orientation to large business, and inappropriate service and policy. Misalignment of the OHS system with the nature and practical realities of small workplaces can undermine prevention and the management of ill health and injury. To address such misalignments, the paper calls for: 1) restructuring of data collection and consultation processes to increase the visibility, voice and credibility of small workplaces; 2) "audits" of OHS-related legislation, policy and interventions to assess and address implications for small workplaces; 3) reflection on current terms and concepts that render workers invisible and capture poorly the essence and (increasing) diversity of these workplaces; and 4) extension of the upstream gaze to the global level.

Getting to “No”

Physicians need strategies for addressing patient requests for medically inappropriate tests and treatments. We examined communication processes that physicians use to deal with patient requests of questionable appropriateness. Data come from audio-recorded visits and postvisit questionnaires of standardized patient visits to primary care offices in Sacramento and San Francisco, California, and Rochester, New York, from May 2003 to May 2004. Investigators performed an iterative review of visit transcripts in which patients requested, but did not receive, an antidepressant prescription. Measurements include qualitative analysis of strategies for communicating request denial. The relationship between strategies and satisfaction reports in postvisit questionnaires was examined using the Fisher exact test. Standardized patients requested antidepressants in 199 visits; the antidepressants were not prescribed in 88 visits (44%), 84 of which were available for analysis. In 53 of 84 visits (63%), physicians used 1 or more of the following 3 strategies that explicitly incorporated the patient perspective: (1) exploring the context of the request, (2) referring to a mental health professional, and (3) offering an alternative diagnosis. Twenty-six visits (31%) involved emphasis on biomedical approaches: prescribing a sleep aid or ordering a diagnostic workup. In 5 visits (6%), physicians rejected the request outright. Standardized patients reported significantly higher visit satisfaction when approaches relying on the patient perspective were used to deny the request (P = .001). Strategies for saying no may be used to communicate appropriate care plans, to reduce provision of medically inappropriate services, and to preserve the physician-patient relationship. These findings should be considered in the context of physician education and training in light of increasing health care costs.