Knowledge Of Available Services Research Articles

Emotional work of getting help: a qualitative analysis of caregiver-perceived barriers to responding to childhood adversity

ObjectiveTo explore caregivers’ experiences and challenges of accessing help for adversity across both health and social care sectors.DesignQualitative study design using semistructured interviews to explore how caregivers accessed services across...

Mixed Methods Evaluation of State Targeted Response to the Opioid Crisis in Ohio

Background: In 2017, the Substance Abuse and Mental Health Services Administration awarded State Targeted Response (STR) grants through the 21st Century Cures Act to help states address the opioid crisis. While there are publications that discuss how each state allocated their STR grant awards, there is a paucity of evaluations illustrating the impact of STR grant activities on clients of opioid use disorder (OUD) treatment, family members of persons living with OUD, community professionals whose work involves addressing OUD, as well as impacts on local communities. This longitudinal qualitative study assessed the impact of STR grant-funded projects on communities in Ohio particularly hard hit by the opioid epidemic. Methods: Data were collected through a mixed research methodology from November 2017 through April 2019. Epidemiologists conducted focus groups and administered surveys in 4 geographically different areas of the state. Study objectives included assessments of community messaging related to opioids, level of perceived stigma for OUD, knowledge of available services and processes for accessing them, and perception of community treatment service needs. Results: A total of 940 respondents participated in 3 cycles (6 months each) of focus groups. Key findings included increased naloxone knowledge and experience, increased proportion of persons living with OUD receiving medication-assisted treatment (MAT), and a 2.5 time increase in the number of reported positive observations of community change. While the level of perceived stigma for OUD remained consistent (moderate) throughout the study, respondents throughout cycles observed an increasing number of community approaches, such as public awareness campaigns and recovery rallies, to impart knowledge, change attitudes, and reduce stigma. Conclusion: Evaluations of STR funded activities and programs could help illustrate the value that additional funding might have over time in reducing stigma related to OUD and increasing knowledge of available treatment services in communities.

Provider perceptions of availability, accessibility, and adequacy of health and behavioral services for Latino immigrants in Philadelphia: a qualitative study

ObjectiveLatino populations in the United States are disproportionately affected by substance use, HIV/AIDS, violence, and mental health issues (SAVAME). A growing body of evidence demonstrates the syndemic nature of SAVAME and the need for integrated strategies to reduce their impact. This study sought to understand the network of SAVAME services for Latino immigrants in Philadelphia to inform future interventions for SAVAME prevention and mitigation.MethodologyKey informant interviews (N = 30) were conducted with providers working in Latino-serving organizations providing SAVAME services. Interviews were analyzed using thematic coding and grounded theory.ResultsLatino-serving providers perceived a large need for, and important limitations in the availability, accessibility, and adequacy of SAVAME services for Latino immigrants. Gaps were seen as especially acute for mental health and substance use services, partly because of insufficient funding for these services. Latino immigrants’ lack of health insurance, immigration status, limited English proficiency (LEP), stigma surrounding SAVAME issues, and limited knowledge of available services were identified as significant barriers preventing access to services. Providers noted that scarcity of well-trained, culturally competent, and ethnically concordant providers reduced the adequacy of SAVAME services for Latino immigrant clients. The small size, low levels of infrastructure, and limited capacity were reported as additional factors limiting the ability of many Latino-serving organizations to adopt a syndemic approach in the prevention and treatment of SAVAME services.ConclusionsThe results call for changes in the structure of funding streams and communitywide strategies to foster collaboration across SAVAME providers working with Latino immigrant clients.

Perceptions and attitudes of black men in a rural district of South Africa towards depression and its treatment.

BackgroundDepression is a major contributor to the overall global burden of disease, impacting social life, family life and occupational functioning if left untreated. Despite its high prevalence and morbidity, the evidence suggests that men are hesitant to seek help, with a large percentage remaining undiagnosed. This study aimed to determine the attitudes and perceptions related to depression and its treatment amongst black men in a rural district of South Africa.MethodsThe design used was an exploratory descriptive qualitative design. Participants were selected by purposive sampling. Individual semistructured interviews were conducted, which were audio-recorded and transcribed verbatim. The data were subsequently analysed thematically to develop themes and subthemes.ResultsParticipants described depression as a psychological problem associated with lack of sleep, loneliness, feeling unwanted, increased stress, deep sadness, weight loss, forgetfulness, crying over small things and lack of concentration. Collectively, the interviews with participants showed a good understanding of the psychosocial determinants of depression but exposed a lack of awareness of its biological determinants. A large proportion (n = 13; 68.4%) of participants reported not having knowledge of available services in their area for people seeking treatment for depression. Barriers to help-seeking behaviours were fear of social stigma, fear of expressing their feelings, gender norms and stereotypes and lack of trust in others.ConclusionInterventions such as support groups and mental health awareness programmes to counteract personal perceptions may help to improve and expand the effectiveness of depression treatment. The results highlight the future need to raise awareness of depressive symptoms and expand health outreach programmes.

Scoping review: Scope of practice of nurse-led services and access to care for people experiencing homelessness.

To investigate the scope of practice of nurse-led services for people experiencing homelessness, and the influence on access to healthcare. A scoping review. On 20 November 2020, the following databases were searched: CINAHL, Embase, MEDLINE, PubMed and Scopus. Included studies focused on people experiencing homelessness aged 18 years and over, nurse-led services in any setting and described the nursing scope of practice. Studies were peer-reviewed primary research, published in English from the year 2000. Three authors performed quality appraisals using the mixed methods assessment tool. Results were synthesized and discussed narratively and reported according to the PRISMA-ScR 2020 Statement. Nineteen studies were included from the United States (n= 9), Australia (n= 4), United Kingdom (n= 4) and Canada (n= 2). The total participant sample size was n= 6303. Studies focused on registered nurses (n= 10), nurse practitioners (n= 5) or both (n= 4), in outpatient or community settings. The nursing scope of practice was broad and covered a range of skills, knowledge and attributes. Key skills identified include assessment and procedural skills, client support and health education. Key attributes were a trauma-informed approach and building trust through communication. Important knowledge included understanding the impact of homelessness, knowledge of available services and the capacity to undertake holistic assessments. Findings suggest that nurse-led care facilitated access to healthcare through building trust and supporting clients to access services. Optimized nursing scope of practice can facilitate access to healthcare for people experiencing homelessness. Key factors in enabling this include autonomy in nursing practice, organizational support and education. The broad range of skills, knowledge and attributes reported provide a foundation from which to design an educational framework to optimize the nursing scope of practice, thereby increasing access to healthcare for people experiencing homelessness.

Caregiver's Perspectives on the Healthcare Experiences of Children With Behaviour-Related Disorders.

Objective: Social Pediatrics focuses on targeting and mitigating the effects of the social determinants of health on a child’s well-being and development. Negative health outcomes have been seen in children who have faced poverty, food insecurity, inadequate housing, and traumatic events. In particular, children who come from socioeconomically disadvantaged households are more likely to develop behavioural problems. The purpose of this study is to explore the experiences of caregivers for children with a behaviour-related disorder. This includes children affected by attention, academic, and social issues (e.g. attention-deficit hyperactivity disorder, autism spectrum disorder). This study will aim to understand the strengths, barriers, and social limitations to accessing and receiving care for children with behavioural disorders. Methods: A qualitative descriptive design was used to conduct three focus groups. Of the 64 caregivers contacted, a total of 13 participants agreed to be in the study. All focus groups were analyzed using inductive thematic analysis. Results: Preliminary findings suggest that caregivers value pediatricians who spend time, communicate, and make a human connection with their patients. Barriers included physician turnover, long wait times for referrals, and a lack of knowledge regarding services and programs available in their area. Three major themes emerged from this study including (1) timeliness to care, (2) advocacy, and (3) relationship building.Conclusion: Findings suggested that caregivers valued pediatricians who spend time to make a human connection with their patients. Barriers included physician turnover, long wait times for referrals, and a lack of knowledge of available services. Caregivers who were young mothers felt an added layer of judgement when accessing the necessary care for their children. This study is important as it contributes to our knowledge on the role Social Pediatrics can play in the care of children with behaviour-related disorders.

State Medicaid Policy and LTC: A Multi-State Qualitative Study of Policy Influence on Caregiver Experiences

This study focuses on long-term care (LTC) state Medicaid policy and its impact on caregiver decisions and experiences. It examines respondents’ general knowledge of LTC state policies and services, challenges with navigating LTC policies and services, and decision-making pathways based on these factors. Using purposive sampling, 63 family caregivers across eight states participated in open-ended qualitative interviews (2019-2020) until thematic saturation was reached. Questions broadly examined caregivers’ experiences and decisions, focusing on decisions made around type of care setting and experiences with LTC state policy. States were selected to represent variation in Home and Community Based Service (HCBS) expenditures as a percentage of total Medicaid long-term services and support expenditures. While LTC policies and services vary significantly by state, we identified many parallels in caregiver experiences and perceptions across states, as respondents often lacked specific knowledge about LTC policies and services and how to access them. Overarching themes include LTC policy navigation challenges, distrust in state-funded LTC services and supports, and moral expectations of caregiving. To manage these challenges, caregivers employed coping strategies such utilizing informal support networks, hiring care coordination assistance, and “stretching things thin” to fill the policy and service gaps. Study findings highlight potential strategies to improve LTC services across states. There is a need to improve community trust with state services by employing transparent regulatory and evaluation procedures for LTC. Wider access to case management may improve communication and knowledge of available services to maximize benefit from HCBS expansions.

Non-use of Digital Health Consultations Among Swedish Elderly Living in the Countryside

Digital health consultations in primary care have the advantage of offering equal healthcare for people residing in the countryside. While it is gaining acceptance among young- and middle-aged people, the elderly are reluctant to use it. The aim of this study was hence to identify reasons for non-use among elderly in the countryside and describe perceived possible challenges and opportunities with digital health consultations. Semi-structured interviews were conducted with 13 persons over 65 years old residing in the Swedish countryside. There was a mistrust for services offered by private companies and their public funding, a lack of knowledge of available services, and a lack of perceived usefulness. Personal interaction and continuity was more important than time or travel conveniences, although these advantages were recognized. To prevent digital exclusion, caregivers need to offer information, encouragement, or tools for the elderly. Digital primary care also needs to offer familiarity, with continuity and personal connections.

Barriers to women\u2019s disclosure of domestic violence in health services in Palestine: qualitative interview-based study

BackgroundDomestic violence (DV) damages health and requires a global public health response and engagement of clinical services. Recent surveys show that 27% of married Palestinian women experienced some form of violence from their husbands over a 12 months' period, but only 5% had sought formal help, and rarely from health services. Across the globe, barriers to disclosure of DV have been recorded, including self-blame, fear of the consequences and lack of knowledge of services. This is the first qualitative study to address barriers to disclosure within health services for Palestinian women.MethodsIn-depth interviews were carried out with 20 women who had experienced DV. They were recruited from a non-governmental organisation offering social and legal support. Interviews were recorded, transcribed and translated into English and the data were analysed thematically.ResultsWomen encountered barriers at individual, health care service and societal levels. Lack of knowledge of available services, concern about the health care primary focus on physical issues, lack of privacy in health consultations, lack of trust in confidentiality, fear of being labelled ‘mentally ill’ and losing access to their children were all highlighted. Women wished for health professionals to take the initiative in enquiring about DV. Wider issues concerned women’s social and economic dependency on their husbands which led to fears about transgressing social and cultural norms by speaking out. Women feared being blamed and ostracised by family members and others, or experiencing an escalation of violence.ConclusionsPalestinian women’s agency to be proactive in help-seeking for DV is clearly limited. Our findings can inform training of health professionals in Palestine to address these barriers, to increase awareness of the link between DV and many common presentations such as depression, to ask sensitively about DV in private, reassure women about confidentiality, and increase awareness among women of the role that health services can play in DV.

Transitions to Postsecondary Education in Young Adults with Hemoglobinopathies: Perceptions of Patients and Staff.

Given these complexities, a multidisciplinary team in a pediatric outpatient clinic designed and implemented a standardized intervention to support AYA with hemoglobinopathies in navigating the transition to postsecondary education. A quality improvement (QI) project was initiated to support the referral of all eligible patients with hemoglobinopathies to postsecondary accessibility offices. This article will describe the development of the intervention and present key findings from qualitative interviews with patients (ages 18-19) and postsecondary accessibility office staff about the implemented resources as an initial step of an ongoing QI project. We used thematic analysis to identify themes across interviews with both groups of stakeholders. Key themes across both groups of interviews highlighted the benefits of the intervention, including (1) knowledge of available services, (2) registering early with appropriate documentation, and (3) self-advocacy. The preliminary qualitative findings validate the importance of embedding discussions about the transition to postsecondary education into routine clinic appointments for AYA with chronic health conditions. Clinical implications of this ongoing QI project for health care providers working with AYA with chronic health conditions will be shared.

General practitioner knowledge and practice in relation to unintended pregnancy in the Grampians region of Victoria, Australia.

Abortion has been legal in the Australian state of Victoria since 2008 and medical termination of pregnancy (MTOP) available since 2012. While these developments were expected to improve Victorian rural women's access to abortion, this has not been borne out in practice. General practitioners (GPs), particularly in rural areas, are women's first point of contact when faced with an unintended pregnancy. The objective of this study was to understand rural GPs' knowledge and practice in relation to unintended pregnancy and referral for abortion, using the Grampians region of Victoria as a case study. Parts of this region, like other rural and regional areas, experience teenage pregnancy rates double the national average and more than four times that of major cities, and access to abortion services is known to be limited. Findings from the study will inform rural health service development to improve rural women's access to abortion. This article reports on the findings from a mixed methods study which explored GP knowledge, understanding and practice in relation to unintended pregnancy services in seven local government areas in the Grampians. Data were collected between April and August 2017. GPs from all practices in this region were invited to participate. A total of 84 GPs were approached, 23 (27%) completed the survey and, of these, five also took part in a semi-structured telephone interview. The quantitative survey data were analysed descriptively while the open-ended survey responses and qualitative interviews were analysed thematically. Of the GPs surveyed, 38% indicated that they 'refer to a colleague due to a conscientious objection' when women present with an unintended pregnancy. No GP always discussed telehealth medical abortion with women and only 27% said that they 'always' discussed medical abortion with women. A range of views were expressed about the adequacy and location of services, with the majority indicating services in the region were limited or inadequate. Interviews with GPs who had conscientious objections to abortion indicated that 'conscientious objection' occurred in different forms and included a range of behaviours. Rural GPs who were interested in becoming MTOP providers faced barriers such as lack of access to timely ultrasounds and surgical backup. The results indicate high levels of conscientious objection and wide variation in knowledge of services. In addition, the provision of tele-abortion and medical abortion is extremely limited in this region, even while these are considered ideal ways to address rural access to abortion. It is likely the promise of tele-abortion is far from fulfilled in the Grampians region and possibly in other rural areas in Victoria. There is a need to improve GPs' knowledge of available services and adherence to legal and professional obligations, and there are clear opportunities to achieve this, with all interview participants expressing strong support for the prevention of unintended pregnancy, and many highlighting the need for good support for women up until the point of termination.

Good training, systems and funding, not good luck: what hematologists and oncologists believe would make it easier for them to refer their cancer patients to psychosocial care.

Rates of referral of patients to psychosocial services are low in most cancer treatment centers, while rates of distress are high. The purpose of this study is to identify clinicians' barriers to referring cancer patients to psychosocial services and strategies that could increase rates of referral. A purposive sampling method ensured data were gathered in two large public teaching hospitals from seven oncologists and five hematologists with varying levels of experience, of whom five were female. Data were collected using semistructured interviews guided by the Capability, Opportunity, Motivation and Behavior model (Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide to Designing Interventions. United Kingdom: Silverback Publishing; 2014.). This helped us to identify modifiable variables associated with referral likelihood and associated evidence-based strategies using the Behavior Change Wheel. Data were analyzed using Thematic Analysis. Barriers relating to capability, opportunity, and motivation to refer to psychosocial services were identified, including lack of knowledge of available services, how to refer to them, and the types of patients who would benefit. Other barriers included the following: lack of time to discuss and refer, convoluted referral pathways, long waiting times, and fear of patient reluctance due to stigma. Respondents identified numerous strategies for overcoming barriers, including training on referral best practice, role-plays, the provision of lists of services with referral and contact details, and increasing service capacity via additional funding. Findings inform the development of acceptable, evidence-based strategies, to improve rates of referral to psychosocial services by oncologists and hematologists. Without implementation, a substantial number of people affected by cancer will continue to suffer from potentially treatable distress.

Using mHealth to Increase Treatment Utilization Among Recently Incarcerated Homeless Adults (Link2Care): Protocol for a Randomized Controlled Trial

BackgroundThere is a significant revolving door of incarceration among homeless adults. Homeless adults who receive professional coordination of individualized care (ie, case management) during the period following their release from jail experience fewer mental health and substance use problems, are more likely to obtain stable housing, and are less likely to be reincarcerated. This is because case managers work to meet the various needs of their clients by helping them to overcome barriers to needed services (eg, food, clothing, housing, job training, substance abuse and mental health treatment, medical care, medication, social support, proof of identification, and legal aid). Many barriers (eg, limited transportation, inability to schedule appointments, and limited knowledge of available services) prevent homeless adults who were recently released from incarceration from obtaining available case management, crisis management, substance abuse, and mental health services.ObjectiveThe aim of the Link2Care study is to assess the effectiveness of a smartphone app for increasing case management and treatment service utilization, and in turn reduce homelessness and rearrest. The goals of this research are to (1) assess the impact of an innovative smartphone app that will prompt and directly link recently incarcerated homeless adults to community-based case management services and resources and (2) utilize in-person and smartphone-based assessments to identify key variables (eg, alcohol or drug use, social support, psychological distress, and quality of life) that predict continued homelessness and rearrest.MethodsHomeless adults (N=432) who enroll in a shelter-based Homeless Recovery Program after release from the Dallas County Jail will be randomly assigned to one of the three treatment groups: (1) usual case management, (2) usual case management plus smartphone, and (3) usual case management with a study-provided smartphone that is preloaded with an innovative case management app (smartphone-based case management). Those assigned to smartphone-based case management will receive smartphones that prompt (twice weekly) connections to shelter-based case managers. The app will also offer direct links to case managers (available during normal business hours) and crisis interventionists (available 24 hours a day, 7 days a week) with the touch of a button.ResultsRecruitment began in the spring of 2018, and data collection will conclude in 2021.ConclusionsThis research represents an important step toward integrated service connection and health care service provision for one of the most underserved, high need, and understudied populations in the United States.Trial RegistrationClinicalTrials.gov NCT03399500; https://clinicaltrials.gov/ct2/show/NCT03399500 (Archived by WebCite at http://www.webcitation.org/6zSJwdgUS)Registered Report IdentifierRR1-10.2196/9868

Implementation of eMental Health care: viewpoints from key informants from organizations and agencies with eHealth mandates

BackgroundThe use of technology such as computers, tablets, and smartphones to improve access to and the delivery of mental health care (eMental Health care) is growing worldwide. However, despite the rapidly expanding evidence base demonstrating the efficacy of eMental Health care, its implementation in clinical practice and health care systems remains fragmented. To date, no peer-reviewed, key-informant studies have reported on the perspectives of decision-makers concerned with whether and how to implement eMental Health care.MethodsFrom September to November 2015, we conducted 31 interviews with key informants responsible for leadership, policy, research, and/ or information technology in organizations influential in the adoption of technology for eMental Health care. Deductive and inductive thematic analyses of transcripts were conducted using the Behavior Change Wheel as an organizing framework. Frequency and intensity effect sizes were calculated for emerging themes to further explore patterns within the data.ResultsKey informant responses (n = 31) representing 6 developed countries and multiple organizations showed consensus on common factors impacting implementation: individual and organizational capacities (e.g., computer literacy skills [patients and providers], knowledge gaps about cyber security, limited knowledge of available services); motivational drivers of technology-based care (e.g., extending care, data analytics); and opportunities for health systems to advance eMental Health care implementation (e.g., intersectoral research, rapid testing cycles, sustainable funding). Frequency effect sizes showed strong associations between implementation and credibility, knowledge, workflow, patient empowerment, electronic medical record (EMR) integration, sustained funding and intersectoral networks. Intensity effect sizes showed the highest concentration of statements (>10% of all comments) related to funding, credibility, knowledge gaps, and patient empowerment.ConclusionThis study provides previously unavailable information about key informant perspectives on eMental Health care implementation. The themes that emerged, namely the need to intensify intersectoral research, measure/monitor readiness to implement, define cost-utility benchmarks, raise awareness about available technologies, and test assumptions that ‘proven’ technologies will be easily integrated can inform the design and evaluation of eMental Health care implementation models.

Disclosure of physical, emotional and sexual child abuse, help-seeking and access to abuse response services in two South African Provinces

Physical, emotional and sexual child abuse are major problems in South Africa. This study investigates whether children know about post-abuse services, if they disclose and seek services, and what the outcomes of help-seeking behaviour are. It examines factors associated with request and receipt of services. Confidential self-report questionnaires were completed by adolescents aged 10–17 (n = 3515) in South Africa. Prevalence of frequent (>weekly) physical abuse was 7.4%, frequent emotional abuse 12.4%, and lifetime contact sexual abuse 9.0%. 98.6% could name one suitable confidante or formal service for abuse disclosure, but only 20.0% of abuse victims disclosed. Of those, 72% received help. Most common confidantes were caregivers and teachers. Of all abuse victims, 85.6% did not receive help due to non-disclosure or inactivity of services, and 14.4% received help: 4.9% from formal health or social services and 7.1% through community vigilante action. Emotional abuse, sexual abuse and female gender were associated with higher odds of help-seeking. While children in South Africa showed high knowledge of available services, access to and receipt of formal services among abused children was low. Notably fewer children received help from formal services than through community vigilante action. Urgent action is needed to improve service access for child abuse victims.

Reproductive Health Services: Barriers to Use Among College Students.

The objective of the current study was to explore demographic, financial, and psychosocial barriers associated with the use/non-use of reproductive health (RH) services. The sample included 212 college students (60 % female) aged 18-19 from a Northern California public university. In October, 2014, students took an on-line survey with questions on knowledge, access, barriers, and use of different RH services and settings. Findings indicated that college students were more likely to visit a primary care setting and/or school-based setting for their RH care. Sexual intercourse was the strongest correlate of having received RH care in the past year, followed by gender, social disapproval, and knowledge of available services. Analyses stratified by gender found a similar pattern among females. However, the only significant predictor among males was knowledge of available services. These finding highlight universities as uniquely positioned to reduce perceived barriers to accessing RH services by making use of technology, promoting health and wellness centers, and providing/adding sexual and reproductive information to general education classes.

General Practitioners' Views About an Orthopaedic Clinical Assessment Service

General practitioners' (GP) views about orthopaedic clinical assessment services (OCAS) managed by physiotherapists in the NHS have seldom been sought, yet GPs are likely to be key referrers to such a service. This study aims to review GP views about an OCAS and how they believed the service could be improved. Fifteen consenting GPs were interviewed utilizing semi-structured interviews and a standardized topic guide. Interviews were recorded, transcribed and analysed for emergent themes. Interviews were analysed sequentially by date performed until saturation. Themes were discussed, and disagreements evaluated until agreement was found between the two main authors. The third author then analysed randomly selected interview transcripts and found no additional themes. The study found GPs refer to specialist services, including this OCAS, because of wait times, locality, patient experience, GP experience and knowledge of available services. No GP identified they knew all possible orthopaedic referral routes. GPs saw OCAS as another referral choice for patients suffering orthopaedic pathologies. GPs identified some difficulty in understanding the different services including the various professional roles involved. To assist with their understanding, they described requesting advertising of the different services and the clinicians involved or streamlining of services by provider services. Further detailed research addressing the limitations in this research design is indicated to investigate GP's thoughts and behaviours in relation to referral patterns especially as GPs in the UK took on commissioning for services from April 2013.

An internet survey of emotional health, treatment seeking and barriers to accessing mental health treatment among Chinese-speaking international students in Australia

The present internet survey examined the demographic characteristics of Chinese-speaking international students in Australia, psychological distress levels as measured by the Kessler-10 (K-10) Item scale, help-seeking history and preferences, as well as treatment barriers. Of the 144 respondents, 54% reported high psychological distress (mean K-10 score = 23.96; SD = 9.03). However, only 9% of those who were highly distressed reported they had sought mental health services in the past year. While the majority preferred help from informal social networks, they tended to favour mental health services over traditional culture-specific forms of help. Common barriers to accessing mental health services reported by respondents with high psychological distress included costs or transportation concerns, limited knowledge of available services, time constraints, the perception that symptoms were not severe enough to warrant treatment, language difficulties and lack of knowledge of symptoms of psychological distress. Although the majority preferred face-to-face treatments over internet treatments, a considerable percentage of respondents were willing to try either treatment modality. Chinese-speaking international students are a high risk group for developing psychological distress, yet they tend to underuse mental health services. Education about the effectiveness of face-to-face and online treatments may increase treatment seeking by this population.

Consumer knowledge and availability of maternal and child health services: a challenge for achieving MDG 4 and 5 in Southeast Nigeria

BackgroundReducing child mortality and improving maternal health occupies a prominent space in the Millennium Development Goals (MDGs), and it has been noted that some reductions have taken place, but not enough. If consumers know what and where services are available, they may be motivated to use them. This study therefore evaluated consumers’ knowledge about available maternal and child health services and where these services can be obtained in the study area. Although knowledge of available health services does not translate to utilization of these services, this study is important as knowledge of available health services can prompt the informed use of services. The study determined the consumers’ knowledge about available Maternal and Child Health services and where these services are available.MethodsThe study was a cross-sectional research design. The sample for the study consisted of a total of 450 women of child bearing age selected from the 20 political wards that make up Ezeagu Local Government Area. The 20 political wards constituted 20 clusters (cluster sampling technique) i.e. one cluster per political ward. Simple random sampling method by balloting was used to select five (5) wards out of the 20 political wards. Finally, a total of 90 women of childbearing age were selected from each of the five wards (clusters) using simple random method.ResultsThe study showed that majority of the women (37.3%) were between 36-45 years, married [49.5%], had more than five children [21.6%], hold at least SSCE [23.7%], and were farmers and Christians [32.3% and 81.8%] respectively. Maternal health services available are mainly antenatal [57%] and delivery services [54.3%]. Other available services are described at the results section. In the same vein, immunization [63.8%] was the most available child health service in the area. Both Maternal and Child Health services were available mainly at public and private hospitals [53.6% and 52.3% for maternal services; 56.1% and 53.9% respectively for child health services] respectively [see result section for details].ConclusionsAvailable Maternal and Child Health services known to mothers in the study area were not encouraging, and these are structurally contextual. ANC and delivery services for mothers, and immunization for children were found to be available as indicated by at least more than half of the respondents. The women knew that these services were available mostly in public and private hospitals which should constitute referral points instead of the health centers that offer primary care at community level. Knowledge of available services is important for consumers to make use of the services. Awareness programmes should be targeted more on the consumers if the MDG 4 and 5 must be reached by 2015. This suggests that the women in the study area do not use primary health care services adequately, and may be incurring huge indirect costs and at the same time travel too far to obtain primary care. This is therefore quite challenging for reducing child mortality and improving maternal health in southeast Nigeria. Knowledge of available services is important for consumers to make use of the services. Awareness programmes should be targeted more on the consumers if the MDG 4 and 5 must be reached by 2015.

Persistent and delayed effects of a psycho-educational program for family caregivers at disclosure of dementia diagnosis in a relative: a six-month follow-up study

Abstract Background: Disclosure of a relative’s dementia diagnosis marks the family member’s official entry into the caregiver role, yet caregivers seldom receive support at this early stage in order to facilitate transition. This study (2008–2011) sought to evaluate whether positive effects observed at completion of a psycho-educational program persisted and whether any delayed effects emerged six months later. Methods: French-speaking primary caregivers of relatives diagnosed with dementia in the past nine months were recruited at memory clinics in Quebec (Canada). The 97 participants were blindly assessed using standardized measures before randomization to the experimental or the control group and were evaluated at program completion and six months later on outcomes associated with a healthy role transition. Results: Compared with controls, caregivers in the experimental group at both time points were better able to plan for the future care needs of their relative (p=0.05), made greater use of the coping strategy of reframing (p=0.05), experienced less psychological distress (p=0.05), had better knowledge of available services (those with low and moderate knowledge at baseline (p=0.001 and p=0.01, respectively) and tended to be more efficacious in their caregiver role (p=0.06). No persistent effect regarding preparedness or confidence in dealing with caregiving was observed, and no delayed effect was observed for stress-management coping strategies or informal support family conflicts. Conclusions: Intervention at career onset is key to fostering a healthy caregiver role transition. Greater emphasis should be placed on developing skills concerning non-significant outcomes. This trial was not registered.