Client Level Research Articles

SAFE - Home Opioid Management Education (SAFE-HOME) in older adults: a naloxone awareness program for home health workers.

BackgroundOlder adults (≥65 years) have seen significant increases in opioid overdose deaths. Diversion of older adults’ opioid medication is also a contributor to opioid misuse. Naloxone, an opioid antagonist, saves lives when used for an opioid overdose, yet education on opioid overdose and naloxone access and training for older adults is limited.MethodsA prospective, interventional training program was created to educate home health workers and their older adult clients on opioid overdose and naloxone utility. The SAFE – Home Opioid Management Education (SAFE-HOME) naloxone awareness program was created to include in-person training with educational handouts around opioid risks and on the importance of naloxone. Home health workers, who provide in-home care and care coordination to older adults in rural Illinois, were trained to educate their clients with the SAFE-HOME program. Older adults were included if they were prescribed an opioid for any indication. Outcomes included change in knowledge of opioids and naloxone, home health worker perception of client knowledge level and naloxone obtainment rates following the educational intervention.ResultsThirty-five clients completed the SAFE-HOME program. The average knowledge assessment score increased from a baseline of 39.4% (SD 26.8) to 90.6% (SD 12.6, p<0.01). Most home health workers agreed their older adult clients had poor baseline knowledge of naloxone. No clients obtained naloxone due to lack of perceived need and cost barriers.ConclusionAn educational approach utilizing home health workers as client educators resulted in increased knowledge of opioid risks and naloxone utility amongst older adults.

Family Experiences and Feedback: An Examination of Attrition in Parent-Child Interaction Therapy

ABSTRACT Attrition is a significant problem in child psychotherapyand has serious implications for overall treatment effectiveness. Predictors of attrition include those at the client, therapist, and treatment levels. The current study investigated factors associated with attrition in Parent-Child Interaction Therapy (PCIT), an evidence-based parent training program for families with young children with disruptive behavior disorders. The sample of 67 caregivers were treated by 25 therapists from 19 different licensed psychiatric outpatient clinics across one state and were part of a larger study (RO1 MH09750; PI: Herschell). The effects of caregivers’ attitudes toward therapy, expectations of therapy, perceived therapist cultural competence, and commitment to treatment were examined using Binomial Logistic Regression. Therapy expectations and commitment to treatment added significantly to the model predicting attrition. Fleiss’ kappa was used to examine caregiver-therapist agreement on completion status, reasons PCIT ended, barriers to treatment experienced by families, and caregiver compliance with post-treatment therapist referrals. Results suggest low agreement across each variable, indicating that therapists may not be aware of caregiver barriers or reasons they leave PCIT prematurely. Limitations, suggestions for future research, and clinical implications are discussed.

Communication and Swallowing Disorders: The Effects of Climate Change

Purpose: The environment plays a key role in determining the health of populations, and climate change is considered to be the greatest threat to human health in the 21st century. However, despite extensive research on its increasing effects on health in general, extremely limited attention has been paid to its impact on communication and swallowing disorders (CSDs). This is surprising considering the substantial effect that the environment and climate change (air pollution, infectious diseases, and extreme weather events) have on these disorders. Method: This tutorial is written by a speech-language pathologist and audiologist to provide education and resources on the ramifications of climate change for the professions. It also offers strategies for speech-language pathologists and audiologists (SLPAs) to use and to incorporate into their practice. Results and Conclusions: The effects of climate change on the incidence, development, and exacerbation of CSDs, such as aphasia, developmental language disorders, and dysphagia, are described in detail. As health professionals, SLPAs have the trust and respect of their clients and their community; they also have a duty of care to safeguard the health of their clients. The combination of prevention, advocacy, and education roles places SLPAs in the perfect position to take action on the effects of climate change on these disorders. To fulfill these roles and to address the pressing issue of climate change, several steps, ranging from the individual client level to the global level, are provided.

Competitive risk strategy and entrepreneurial satisfaction among fast moving consuming goods in Nigeria during covid-19 pandemic using confirmatory factor analysis

This study examined the relationship between competitive risk and entrepreneurial satisfaction in fast moving consuming goods (FMCG) firms in Nigeria during covid-19 pandemic era. The study adopted quasi-experimental design and cross sectional design. Data were generated by quantitative and qualitative method. The employed used judgemental sampling techniques and non-proportionate stratified random sampling techniques. A total population of 6000, sample size estimate of 360 was determined using Krejcie and Morgan Table. Also, 360 copies of questionnaire were distributed to the accessible entrepreneurs’, while 329 copies were completed and retrieved. The instruments were validated with reliability above 0.7 Coefficient, using Split-Half Method to determine the internal consistency. Two research questions and two hypotheses were raised which was tested with Pearson Product Moment Correlation and KMO/Barllet’s test for the sampling adequacy for data appropriateness and sphericity respectively via SPSS 25 version. From the findings, the concept of competitive risk creates positive impact on client satisfaction. In conclusion, entrepreneurial risk cost strategy and differentiation risk strategy have significant influence on the entrepreneurial satisfaction of the FMCG firms. Based on the findings and conclusion, this study contributes to the knowledge that entrepreneurial satisfaction could be the sustaining and surviving concept to entrepreneurs if always considered in decision making during covid-19 pandemic era; while the differentiation risk cost strategy could give the FMCG firms a leading edge rather than bleeding if integrated with client satisfaction. It could be recommended that fast moving consuming goods firms should improvise entrepreneurial risk cost as strategy, because during the covid-19 pandemic the income level of client were affected in Nigeria. Hence, the entrepreneurs should employed cost advantage to domicile the FMCG markets to satisfied their client which enable them to gain large proportion of the market share ratio.

CLIENTS’ EMPIRICISM TOWARDS UPI PLATFORMS

The purpose of the study is to examine the awareness, perception and satisfaction level of clients of popular UPI platforms. Satisfied clients are the biggest promoters in today’s fast-changing competitive market. Their favourable word-of-mouth provides legitimacy, appeal, and aids in the acquisition of new clients to the business. The Unified Payment System (UPI) is designed to build a platform for cashless and transparent financial transactions by using the advantages of mobile technology. So, this study is based mostly on primary data collected from 100 samples from UPI clients in Kerala through structured questionnaire and the secondary data used only for theocratical frame. The key tools for data analysis is statistical tool like One-way ANOVA and weighted averages. Study result reveals the significant influence of educational status of the clients in their awareness of UPI platforms and its services. The study also observes the age and gender effect on the satisfaction and perception of clients. KEYWORDS: Unified Payment Interface (UPI), UPI Platforms, Client satisfaction, Client Perception, Digital inclusion.

Construction project performance: the role of client knowledge and procurement systems

PurposeThis study aims to investigate whether clients’ knowledge about construction procurement systems influence project performance objectives and the role of procurement systems on project performance objectives in South Africa.Design/methodology/approachUsing a two-round survey, 90 usable questionnaires from construction professionals in South Africa plus 3 expert clients were collected. The data were analysed using descriptive statistics – means, percentages and the analytical hierarchy process to determine the rank of client project performance criteria, while inferential statistics – Pearson product-moment correlation was used in establishing the relationship between the level of clients’ knowledge and project performance.FindingsIt was found that the common procurement systems used are traditional, followed by management-oriented and integrated procurement systems. In addition, it emerged that client’s knowledge of procurement systems shows a positive relationship with the achievement of project performance objectives. Based on these findings, it is concluded that some procurement systems being selected by clients in South Africa are inappropriately selected. This is despite the emergence of more efficient procurement systems. If procurement systems are selected based on the knowledge of the client, it will give better chances of a successful project outcome.Practical implicationsThe research suggests the need for clients to seek ways to improve their understanding or increase their knowledge of procurement systems in construction. Policymakers’ responsibilities in driving policies that will place responsibilities on clients to seek a reasonable way to improve their knowledge where possible is implied in the study.Originality/valueIt contributes to improving project performance by examining whether the level of knowledge possessed by a client influences project performance.

Satisfaction on the university frontline services: From the lens of transacting students and employees

Client satisfaction is an influential predictor of academic life, such as services delivered with suitable standards. Thus, the study focused on determining the level of client satisfaction on the frontline services of Cagayan State University in Aparri, Philippines from the perspective of students and employees. To assess suitability, relevance, and to ensure adequate and reliable information for the evaluation of the study, the researchers adopted the descriptive- evaluative design and ascertained the level of clients’ satisfaction on the frontline services received and experienced on the campus. The study, however, was limited to the assessment of the respondents on their level of contentment only on the frontline services and providers they have encountered. The results indicated a very high level of satisfaction with which heads of offices have gained higher satisfaction ratings than that of their staff. When grouped according to the respondents’ profile, the older students rated higher the frontline services and providers than the younger ones. At the same time, regular employees have a higher level of satisfaction as compared to non-regular. The result of the study manifests students' and employees’ very high contentment with the actual performances of the frontline service providers.

Motivational Strategies Used by Exercise Professionals: A Latent Profile Analysis.

Using self-determination theory as a framework, the aim of this study was 2-fold: (1) identify different profiles of motivational strategies used by exercise professionals and (2) examine associations of these motivational profiles with work-related variables: measures, perceived job pressures, need satisfaction/frustration, and perceived exercisers' motivation. Participants were 366 exercise professionals (193 males; experience = 7.7 [5.8]y) currently working in health and fitness settings. Latent profile analysis identified a 3-profile model: (1) most need-supportive and least controlling (NS+; n = 225), (2) less need-supportive and slightly controlling (NS-; n = 42), and (3) most controlling and slightly need-supportive (mixed; n = 99). Professionals working less than 20hours per week, more experienced, and female were more likely to integrate NS+, which was also associated with higher levels of work-related need satisfaction and clients' perceived self-determination, and lower levels of job pressures and need-frustration. Conversely, NS- displayed the most maladaptive pattern of associations. The present findings highlight the importance of analyzing the correlates of different professional profiles, namely to help health and fitness organizations to provide high-quality motivational practices within an appropriate environment both for professionals and clients.

Applying behaviour change theory to understand the barriers to implementing routine outcome monitoring.

Routine outcome monitoring (ROM) is a valuable tool for monitoring client progress and pre-empting deterioration, however, there is considerable variation in how data are collected and recorded and uptake in clinical practice remains low. The aim of this study was to develop a self-report measure of practitioner attitudes to ROM in order to better understand the barriers to successful implementation in Child and Adolescent Mental Health Services (CAMHS). An anonymous survey was completed by 184 CAMHS practitioners in the United Kingdom. The survey was designed using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B). Practitioners who reported using ROM frequently in their clinical work (53%) were compared to those who used ROM infrequently (47%) across dimensions of the COM-B survey subscales. Confirmatory factor analysis confirmed the proposed four-factor structure, showing acceptable model fit, with high factor loadings and good reliability for all subscales. Frequent users of ROM exhibited significantly higher psychological capability, physical opportunity, social opportunity, and motivation, compared to infrequent users F (4, 140) = 14.76, p < .0001; Pillai's Trace = .297, partial η2 = .30. Results highlight several barriers to ROM, including the belief that there is not a strong evidence base for ROM, not receiving external training, and not discussing feedback and outcome data in supervision. In the hope of improving the successful implementation of ROM, this research provides an evidence-based tool for assessing practitioners' attitudes to ROM, which map on to intervention functions and represent targets for future implementation efforts. The value of routine outcome monitoring (ROM) as a means to measure client progress and to elevate the efficiency and quality of mental health care is well-documented in the research literature, however, uptake in practice remains relatively low. This study applied behaviour change theory to develop a psychometrically sound self-report measure of practitioners' perspectives and practices to understand the barriers to implementation in child and adolescent mental health services in the United Kingdom. The complex and multifaceted nature of the barriers to implementation requires multilevel behaviour change strategies at the client, clinician, and organisational level. Recommendations for practice include the need for integrated, multilevel strategies aimed at improving practitioners' capabilities and motivations, strong organisational leadership and a culture of data gathering and sharing, and implementation interventions, which are tailored to target local barriers.

Physiological Measurements of Stress Preceding Incidents of Challenging Behavior in People With Severe to Profound Intellectual Disabilities: Longitudinal Study Protocol of Single-Case Studies.

BackgroundClients with severe to profound intellectual disabilities (SPID) and challenging behavior (CB) and the professional caregivers that support them are vulnerable to high stress levels, which negatively impact their well-being and the quality of care. CB is thought to result from an increase in the intensity and frequency of clients’ stress experiences. In turn, staff members experience stress in dealing with this behavior, and stressed staff members might behave in ways that increase clients’ stress levels, contributing to the origin and maintenance of CB. Research into these dyadic interactions between clients and staff is scarce for people with SPID, especially in real-life situations. The barriers of studying stress in this population include clients’ difficulties in communicating stress experiences and the lack of an objective continuous measure of stress.ObjectiveThis paper presents a protocol for studying patterns of physiological stress in 15 client-caregiver dyads in the 30 minutes preceding incidents of CB compared to control periods without CB and the interplay between the stress levels of clients and professional caregivers.MethodsWe will conduct 15 single-case studies to assess patterns of physiological stress in dyads of clients with SPID and professional caregivers prior to CB in several Dutch residential institutes. Client-caregiver dyads will wear the Empatica E4 wristband for 20 sessions of 3 to 8 hours without interruptions of daily routines while caregivers report clients’ CB. The physiological measures obtained will be electrodermal activity (microsiemens) and heart rate (beats per minute). A multilevel model with repeated measures at the incident level nested within the person level will be applied, employing separate models for electrodermal activity and heart rate to compare stress levels in the 30 minutes prior to incidents with control epochs. Covariates in the models include movement, temperature, and gender. In addition, cross-recurrence quantification analyses will be performed to study the synchronization between the stress levels of clients and professional caregivers.ResultsThe Ethics Committee of the Radboud University (NL-number: NL71683.091.19) approved the study on February 12, 2020. In total, 15 organizations have declared their commitment to participate in the study. The first result is expected in the spring of 2022.ConclusionsStudy results will demonstrate whether changes in patterns of electrodermal activity and heart rate are apparent in the 30 minutes preceding an incident of CB compared to baseline levels when the client does not engage in CB. The synchronization between caregivers’ and clients’ physiological stress levels will be explored with cross-recurrence quantification analyses. Insights into the physiological stress levels of clients and caregivers may contribute to a reduction of CB and an improvement of both clients’ and caregivers’ safety and well-being.International Registered Report Identifier (IRRID)DERR1-10.2196/24911

Nursing Care to Meet Fluid and Electrolyte Needs of Chronic Kidney Disease Patient

Background : Chronic Kidney Failure (CKD) is a kidney function disorder that occurs gradually, cannot be recovered, and describes a decrease in urine production which results in an accumulation of fluid in the body. This can disrupt their fluid and electrolyte balance. In this regard, in Indonesia there are still many phenomena of non-compliance with fluid monitoring that occur. If this is left unchecked, it will result in a condition of overload or excess fluid in the patient. Fluid management is needed to fulfill the patient's fluid and electrolyte needs, so that changes in body weight and the results of the calculation of fluid balance can be controlled and become an illustration of meeting these needs. Purpose : to explain nursing care to meet fluid and electrolyte needs in chronic kidney disease patients. Methods : nursing care was carried out on patients with a diagnosis of chronic kidney disease who have impaired fluid and electrolyte requirements. The nursing intervention used to overcome this problem was fluid management. Data were collected from interviews and observations and further analysis was carried out. Results : After three days nursing intervention, the results showed that the client's level of shortness of breath decreased, the blood pressure level was close to normal, fluid calculation close to balance, and the client's weight seemed stable. Conclusion : fluid management was effective for monitoring fluid intake and output of chronic kidney disease patient.

Awareness of Basic Cardiopulmonary Resuscitation (CPR) and Related Factors in Patients Referred to Shahidzadeh Hospital in Behbahan: A Study in Southwestern Iran

Background: Given that the golden time to rescue a patient with cardiac arrest is only a few minutes, and since many deaths occur before the patient arrives at the medical center, if those present at the scene are familiar with basic resuscitation, they can perform resuscitation, Prevent the death of the person. Due to the importance of measuring the level of knowledge of individuals, this study was conducted to determine the level of knowledge about basal cardiopulmonary resuscitation in patients referred to Shahidzadeh Hospital in Behbahan in 2020. Materials and Methods: This cross-sectional descriptive study was performed on patients referred to Shahidzadeh Hospital in Behbahan in the first quarter of 2020 by available sampling method. The data collection tool was a researcher-made questionnaire of basic cardiopulmonary resuscitation with face validity and reliability was 0.71. Data were analyzed using SPSS 20 software and independent t-test, ANOVA, and Pearson correlation coefficient. Results: This study was performed on 169 patients with a mean age of 25/12±57/34 patients referred to the hospital. The mean knowledge of these people was 69/2±12/4 which indicates poor knowledge in the field of resuscitation. People with higher education and people who had obtained information in this regard during their studies, had a statistically significant better knowledge than others (p 0.05). Conclusion: The results showed that the level of clients' awareness of cardiopulmonary resuscitation is low and special attention should be paid to increasing the awareness of these strata in the macro programs of the health network and the health care system. Also, using strategies such as using new classes and educational tools can be very effective and raise the level of awareness of these people. It is also suggested that this study be performed in the clients of health centers and other related factors be examined.

Effects of Aerobic Exercise on Fasting Blood Glucose and Blood Pressure Levels of Diabetic-Hypertensive Clients at a Diabetes Clinicin Accra, Ghana

Background: Hypertension and diabetes are associated with an increased risk of cardiovascular diseases. Effective interventions are therefore relevant in reducing the morbidity and mortality associated with hypertension and diabetes. We set out to determine the effect of aerobic exercise on type-2 diabetic-hypertensive clients at a diabetes clinic in Accra.Method: Twenty-one participants were recruited from the National Diabetes Management and Research Center in Korle-Bu in Accra.Participants undertook 30 minutes of aerobic exercise comprising, warm up, ergonomic cycling and cool down, three times a week for a period of eight weeks. Fasting blood glucose and blood pressure levels were measured and changes with respect to exercise were analysed. The mixed model ANOVA was used to test for the differences in the weekly blood pressure and blood glucose levels while the paired t-test was used to compare the baseline and final readings of blood pressure and blood glucose levels. Pearson’s correlation test was used to determine the relationship between age and change in blood pressure and blood glucose levels after eight weeks of exercise.Results: Mean systolic blood pressure reduced from 142mmHg to 135mmHg while the mean diastolic blood pressure also reduced from 89mmHg to 84mmHg post exercises. The baseline and eighth week post exercise average blood glucose level were 8.0 mmol/L and 5.2 mmol/L respectively. There were significant differences in baseline and week eight systolic (p = 0.0017), and diastolic (p = 0.006) blood pressure as well as blood glucose (p=0.0027) levels. There was also a significant positive correlation between age and change in blood glucose level (p = 0.036).Conclusion: Aerobic exercise reduces the fasting blood glucose level and blood pressure in type-2 diabetic-hypertensives. Diabetic-hypertensives should therefore be encouraged to participate in aerobic exercises.

A Digital Platform for Facilitating Personalized Dementia Care in Nursing Homes: Formative Evaluation Study.

BackgroundCare personalization is key to the well-being of people with dementia according to person-centered care. With the development of the internet of things, a large quantity of personal data can be collected securely and reliably, which has the potential to facilitate care personalization for people with dementia. Yet, there are limited assistive technologies developed for this purpose, and the user acceptance of assistive technologies is low in nursing homes. Therefore, through a data-enabled design approach, a digital platform was developed for helping the care team in a nursing home to personalize dementia care, specifically in the management of behavioral and psychological dementia symptoms.ObjectiveThis study aimed to evaluate the digital platform in a real-life context with potential users from the following two aspects: (1) to explore if the digital platform could help with generating insights on the current state of each person with dementia and (2) to gather feedback on the digital platform from the care team.MethodsThe digital platform was deployed in the nursing home for 7 weeks and the data collected were visualized and presented to the care team via the digital platform. The visualizations were analyzed by the researchers for pattern detection. Meanwhile, the care team was asked to examine the visualizations and were interviewed for the following: (1) if any insights and actions were generated from the examination, (2) the usefulness of the digital platform, and (3) the improvements they would like to see.ResultsThe data collected on the digital platform demonstrated its potential for pattern detection. Insights were generated by the care team and categorized into “client level,” “ward level,” and “team level.” The corresponding actions taken by the care team were classified into “investigation” and “implementation.” User acceptance varied across the care team, and three aspects of improvement for the digital platform were identified.ConclusionsBy evaluating the digital platform, this study gained insights on applying data-enabled design for personalizing dementia care; besides, it offers future researchers some recommendations on how to integrate assistive technologies in the nursing home context.

Health literacy and changes in pattern of drug use among participants at the Stockholm Needle Exchange Program during the COVID-19 pandemic

Background and aimsPeople who inject drugs may be particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to underlying health problems, stigma and social vulnerabilities. Harm reduction services, including needle exchange programs (NEP), have been subjected to varying degrees of disruption in the world, especially in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Compared to responses in other countries, Sweden’s initial strategy toward limiting the spread and impact of COVID-19 was less restrictive to its citizens with no imposed general societal lockdown. In this study, we investigate changes in drug use patterns, utilization of NEP associated health services, COVID-19 health literacy and the prevalence of SARS-CoV-2 antibodies among NEP clients in Stockholm during the COVID-19 pandemic.MethodsNEP visits and services provided (needles/syringes, HIV and hepatitis C tests and treatment, naloxone distributed) and overall mortality among NEP clients between January 1 and October 31, 2020, were used for trend analyses in comparison with corresponding 2019 data. Between July 27 and October 2, 2020, NEP clients (n = 232) responded to a 27 item COVID-19 Health Literacy Questionnaire. SARS CoV-2 IgG antibody tests (n = 779) were performed between June 15 and October 31, 2020.ResultsDuring the COVID-19 pandemic number of clients, client visits, naloxone distribution and HCV tests remained stable compared to 2019, while distribution of needles/syringes increased (p < 0.0001); number of HIV tests and HCV treatments decreased (p < 0.05); and mortality decreased (< 0.01). Overall, the level of health literacy concerning transmission routes and protective measures was high. SARS-CoV-2 antibody prevalence was 5.4% (95% CI 4.0–7.2).ConclusionsThe Stockholm NEP managed to maintain a high level of clients and services during the pandemic. In general, COVID-19 health literacy was adequate and the overall SARS-CoV-2 antibody prevalence was low compared to the general population, which highlights a need for prioritized and targeted COVID-19 vaccination among PWID.

Coping Ability Relationship With Anxiety Levels Of Chronic Kidney Failure Clients Undergoing Hemodialysis

Mental Health is a condition in which an individual can develop physically, mentally, spiritually, and socially so that the individual realizes his own abilities, can overcome pressures, can work productively and is able to contribute to his community (Mental Health Act 18 of 2014). One of the psychosocial problems that many people experience in daily life is anxiety. A person who has an anxiety problem can have an effect on his physical and mental. The purpose of this study is to find out the Relationship of Coping Ability With Anxiety Levels Of Chronic Kidney Failure Clients Undergoing Hemodialysis. The research method used is by Cross-Sectional approach. The research was conducted in the Hemodialysis room of RS Pelni Jakarta with a total of 30 response sampling using simple random sampling. Statistical test results show p 1.0 &gt; 0.05 means that there is no meaningful relationship between anxiety levels and coping strategies in patients undergoing hemodialysis. conclusion and advice are that hospitals can carry out health counseling activities on anxiety management and coping strategies in patients undergoing hemodialysis.

Mental health in HIV prevention and care: A qualitative study of challenges and facilitators to integration in Vietnam

IntroductionGlobally, men who have sex with men (MSM) experience a disproportionate burden of mental health issues. While HIV service providers may possess the skills and relationships to provision mental health and psychosocial support (MHPSS) to this population, task-sharing models that integrate MHPSS into HIV contexts remain limited. The aim of this study was to explore the sociodemographic, psychological, and structural factors operant at the client and HIV service provider levels that shape MHPSS access and burden among MSM and opportunities for integration in Vietnam. MethodsBetween June and August 2018, semi-structured interviews were conducted with 20 MSM and 13 service providers at out-patient clinics (OPCs) and community-based organizations (CBOs) in Hanoi, Vietnam. Interviews explored participants’ understandings of and experiences with the signs, causes, and appropriate treatments for mental health concerns; and perceived barriers to MHPSS integration in HIV contexts. Data were coded thematically and analyzed in MAXQDA. ResultsMost MSM did not view their mental distress as constituting illness or as warranting clinical attention. Specifically, terms like “mental illness” were often associated with being “crazy” or immoral, while symptoms of distress were interpreted as having to do with everyday difficulties associated with being MSM and/or HIV-positive. Due to mental health stigma, MSM were reluctant to access services while service providers were similarly reluctant to query about needs. Few service providers knew where to refer patients for MHPSS, and none had done so previously. Most service providers reported lacking the human capital, expertise, and funding to address MHPSS needs. ConclusionsOur findings suggest that aside from mental health stigma, future integration strategies must address competing demands and incentivization structures, limitations in existing mental health infrastructure and funding, misperceptions around MHPSS needs and symptoms, and opportunities to streamline MHPSS with existing CBO activities to strengthen community wellbeing.

PENGARUH TERAPI KOGNITIF DAN TERAPI PSIKOEDUKASI KELUARGA TERHADAP TINGKAT ANSIETAS KLIEN KANKER

Introduction: Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells that can lead to death. The physical impact caused by cancer will affect a person's psychological condition, causing psychosocial problems. Purpose: This study aims to determine the effect of cognitive therapy and family psychoeducation therapy on the anxiety level of cancer clients at the Regional General Hospital (RSUD) Dr. Hi. Abdul Moeloek, Lampung Province. Methods: This study used a quasi-experimental design with pre-post test control group with a total sample of 35 people for each group. The instrument used was hamilton anxiety rating scale (HARS). The analytical test used was repeated ANOVA test and independent t-test. Results: The results showed that cancer client anxiety decreased significantly (p value &lt;0.05) after receiving nurse nursing action, but after being given cognitive therapy and family psychoeducation therapy, it decreased significantly than after receiving nurse nursing action. Conclusion: The implication of this research is that cognitive therapy and family psychoeducation therapy reduce the anxiety level of cancer clients, so that the hospital can add interventions related to psychosocial problems, especially for cancer clients who experience anxiety at the Regional General Hospital (RSUD) Dr. Hi. Abdul Moeloek, Lampung Province.

The effect of audit partners’ workload compression on audit quality across Europe

The effect of audit partners’ workload compression on audit quality has received extensive attention. Prior literature presents mixed results in different audit market settings such as US, China and Australia. But little is known in the European audit market. Under the same audit market setting, using different methodologies also leads to inconsistent results. For example, studies using the OLS regression might show contradictory findings with that using the partner fixed effect model. To fill the evidence gap in EU, we study the data from 16 European countries spanning years 2010 through 2019. We first apply the OLS regression and partner fixed effect model, and then we use multilevel model to reconcile the inconsistent results due to different methodologies. We highlight the use of the multilevel model to address data dependence issues and contextualize the results from client level to partner level. Our aim is to test the association between EU audit partners’ workload compression and audit quality. Our findings suggest that higher workload compression is associated with longer audit report lag, more earnings manipulation, and higher cost of capital. We hope to raise regulators’ awareness of consequences of audit partners’ workload compression.

Disruptive Social Work: Forms, Possibilities and Tensions

Abstract In recent years, a growing literature has rediscovered radical social work and the various forms it takes. In these debates, a key concept that has been developed and deployed is ‘resistance’. Studies provide growing evidence for the myriad ways in which social workers engage in resistance activities as part of their everyday practice. However, most of these studies portray resistance as an individualised activity and overlook the role of clients in such activities. Drawing on the concept of ‘disruptive power’, this article makes the case for what it terms ‘disruptive social work’, which involves collective resistance activities that disrupt institutions and social relations of everyday life to create meaningful change. After providing a definition of disruptive social work, the article suggests that this practice can be carried out at two levels. At the professional level, social workers occupy an important structural position that allows them to disrupt the workings of the social service system. At the client level, social workers can help their differently positioned clients develop a sense of their own disruptive power and activate it. Examples of disruptive social work are presented throughout the article. It concludes by highlighting the practical and ethical challenges this practice poses for social workers today.