Loss Of Social Support Research Articles

Evaluation of a Patient-Collected Audio Audit and Feedback Quality Improvement Program on Clinician Attention to Patient Life Context and Health Care Costs in the Veterans Affairs Health Care System

Evidence-based care plans can fail when they do not consider relevant patient life circumstances, termed contextual factors, such as a loss of social support or financial hardship. Preventing these contextual errors can reduce obstacles to effective care. To evaluate the effectiveness of a quality improvement program in which clinicians receive ongoing feedback on their attention to patient contextual factors. In this quality improvement study, patients at 6 Department of Veterans Affairs outpatient facilities audio recorded their primary care visits from May 2017 to May 2019. Encounters were analyzed using the Content Coding for Contextualization of Care (4C) method. A feedback intervention based on the 4C coded analysis was introduced using a stepped wedge design. In the 4C coding schema, clues that patients are struggling with contextual factors are termed contextual red flags (eg, sudden loss of control of a chronic condition), and a positive outcome is prospectively defined for each encounter as a quantifiable improvement of the contextual red flag. Data analysis was performed from May to October 2019. Clinicians received feedback at 2 intensity levels on their attention to patient contextual factors and on predefined patient outcomes at 4 to 6 months. Contextual error rates, patient outcomes, and hospitalization rates and costs were measured. The patients (mean age, 62.0 years; 92% male) recorded 4496 encounters with 666 clinicians. At baseline, clinicians addressed 413 of 618 contextual factors in their care plans (67%). After either standard or enhanced feedback, they addressed 1707 of 2367 contextual factors (72%), a significant difference (odds ratio, 1.3; 95% CI, 1.1-1.6; P = .01). In a mixed-effects logistic regression model, contextualized care planning was associated with a greater likelihood of improved outcomes (adjusted odds ratio, 2.5; 95% CI, 1.5-4.1; P < .001). In a budget analysis, estimated savings from avoided hospitalizations were $25.2 million (95% CI, $23.9-$26.6 million), at a cost of $337 242 for the intervention. These findings suggest that patient-collected audio recordings of the medical encounter with feedback may enhance clinician attention to contextual factors, improve outcomes, and reduce hospitalizations. In addition, the intervention is associated with substantial cost savings.

An exploratory mixed method study on the follow up status and quality of life among recurrent tuberculosis patients in South India

IntroductionAfter completion of treatment of Tuberculosis (TB), many patients can have long-term physical sequelae, which in some cases results in life-long impairment and further stigma. ObjectivesTo determine the follow up status and quality of life of post-treatment among Category 2 TB patients under RNTCP and to explore the factors affecting the Quality of Life. Material and methodsThe present study was done in urban area of Villupuram district of Tamil Nadu using Exploratory mixed methods study design. In the first phase case–control study was conducted with 100 post treatment category 2 TB patients (cases) and 100 non-TB patients (controls) matched for age and gender. The quality of life of the respondents was assessed by (WHOQOL-BREF) questionnaire (Quantitative), followed by five in-depth interviews among cases with extreme scores (Qualitative). ResultsThe mean scores of “perceived physical health” and “perceived psychological health” among cases after completion of treatment was significantly lower than the mean scores in controls. The determinants for perceived physical health were age, years of education and marital status. The determinants for psychological health were age, marital status and associated comorbidities. In-depth interview explored that major perspectives of cases affecting quality of life were side effects of drugs, loss of social support, loss of employment and psychological factors like anxiety, depression. ConclusionsHR-QOL among post treatment TB patients was reduced. Efforts should be made to counsel TB patients, family members, relatives and their workplace regarding their care, support and challenges to have a reasonable QOL.

Experts Offer Guidance on Helping Seniors Handle COVID-19 Stresses

Experts Offer Guidance on Helping Seniors Handle COVID-19 Stresses

Understanding End-User Perspectives of Mobile Pulmonary Rehabilitation (mPR): Cross-Sectional Survey and Interviews.

BackgroundPulmonary rehabilitation (PR) is an effective intervention for the management of people with chronic respiratory diseases, but the uptake of and adherence to PR programs is low. There is potential for mobile health (mHealth) to provide an alternative modality for the delivery of PR, overcoming many of the barriers contributing to poor attendance to current services.ObjectiveThe objective of this study was to understand the needs, preferences, and priorities of end users for the development of an adaptive mobile PR (mPR) support program.MethodsA mixed methods (qualitative and quantitative) approach was used to assess the needs, preferences, and priorities of the end users (ie, patients with chronic respiratory disorders) and key stakeholders (ie, clinicians working with patients with chronic respiratory disorders and running PR). The formative studies included the following: (1) a survey to understand the preferences and priorities of patients for PR and how mobile technology could be used to provide PR support, (2) ethnographic semistructured interviews with patients with chronic respiratory disorders to gain perspectives on their understanding of their health and potential features that could be included in an mPR program, and (3) key informant interviews with health care providers to understand the needs, preferences, and priorities for the development of an mPR support program.ResultsAcross all formative studies (patient survey, n=30; patient interviews, n=8; and key stakeholder interviews, n=8), the participants were positive about the idea of an mPR program but raised concerns related to digital literacy and confidence in using technology, access to technology, and loss of social support currently gained from traditional programs. Key stakeholders highlighted the need for patient safety to be maintained and ensuring appropriate programs for different groups within the population. Finding a balance between ensuring safety and maximizing access was seen to be essential in the success of an mPR program.ConclusionsThese formative studies found high interest in mHealth-based PR intervention and detailed the potential for an mPR program to overcome current barriers to accessing traditional PR programs. Key considerations and features were identified, including the importance of technology access and digital literacy being considered in utilizing technology with this population.

Suicide and sudden death bereavement in Australia: A longitudinal study of family members over 2 years after death.

Grief reactions change over time. However, only a limited number of studies, and none in Australia, have analysed changes in individual grief reactions longitudinally. The aim is to examine changes in grief reactions, mental health and suicidality of close family members bereaved by suicide, 6, 12 and 24 months after their loss compared with those bereaved by other forms of sudden death, adjusting for confounding factors. Participants were 142 adult family members bereaved by suicide and 63 by other sudden death, followed up at 6, 12 and 24 months in Queensland, Australia. The Grief Experience Questionnaire, Depression Anxiety Stress Scale and Beck Scale for Suicide Ideation were used as main outcomes. Mixed-effects linear and logistic regressions were utilized for statistical analyses. There were significant differences in rejection, stigmatization, shame and responsibility between the suicide and sudden death bereaved over the 2-year period, after adjusting for potential confounding factors. Rejection, stigmatization, search for explanation, somatic reactions and symptoms of depression and anxiety (Depression Anxiety Stress Scale) declined significantly over time in both groups. Rejection and somatic reactions showed group-by-time interaction effects, with a decrease in the suicide bereaved and no change in the sudden death bereaved. Loss of social support and suicidal ideation did not show a group or time effect. Although our findings confirm that there are several common dimensions to experiencing a sudden death of a family member, several differences were found between the suicide and non-suicide sudden death bereaved including significantly higher levels of rejection, stigmatization, shame and responsibility remaining in the suicide compared to sudden death bereaved 2 years after their loss. These findings should be considered in clinical practice and when designing postvention services in Australia.

Pet Loss: Understanding Disenfranchised Grief, Memorial Use, and Posttraumatic Growth

ABSTRACTThe growing body of literature exploring pet loss suggests that many bereaved pet owners experience disenfranchised grief. Disenfranchised grief occurs when a loss is unacknowledged and the bereaved are unable to express their grief. When grief is considered illegitimate, the bereaved may experience a variety of adverse psychological outcomes, including increased distress and reduced quality of life. Additionally, when grief is inhibited, the individual may be less likely to experience positive changes such as posttraumatic growth. Few studies have considered the relationship between disenfranchisement and posttraumatic growth following the loss of a companion animal. This study investigated the relationship between disenfranchised grief, memorialization, and posttraumatic growth in bereaved pet owners. Grief severity was assessed as a moderator. Using an online survey, respondents (n = 133) completed standardized measures, including the Pet Bereavement Questionnaire, the Loss of Social Support subscale from the Grief Experience Questionnaire, and the Posttraumatic Growth Inventory-Short Form (PTGI-SF). As hypothesized, there was a significant interaction between disenfranchised grief, grief severity, and posttraumatic growth, suggesting that disenfranchised grief inhibits posttraumatic growth when grief severity is high. Contrary to the hypothesis, there was no relationship between memorial quantity or type and posttraumatic growth. Overall, this study shows that disenfranchised grief can inhibit posttraumatic growth following the loss of a pet, highlighting the complicated relationship between posttraumatic growth, grief intensity, and disenfranchised grief.

The Impact of Organizational Structure and Funding Sources on the Work and Health of Employed Caregivers in Children\u2019s Homes in Ghana

The strategies by which work is organized and carried out and the sources from which organizations obtain funding and other resources for their operations may influence employee outcomes including work performance and health. This study explored how organizational structure (dormitory vs family unit) and funding sources (government vs private) influence the work and health of individuals employed as caregivers in children’s homes in Ghana. Using qualitative research techniques we collected data from fifty-seven caregivers across three children’s homes in Ghana. We found that the structure adopted by children’s homes influence caregiver work performance by increasing work stress levels, complicating some caregivers’ ability to bond with the children and limiting the amount of time that some caregivers have to spend with their own families. These influences then exposed caregivers to physical, mental and social health risk factors including injuries from slips and falls, mental strain, and loss of social support. We also found that funding source influence the frequency of training caregivers receive, the extent of help caregivers receive with their own healthcare costs as well as the extent to which caregivers utilize international regulations like child rights principles in doing their jobs. Our findings suggest a need for stakeholder reconsideration of work design and strategizing for the homes taking into account caregiver health and well-being.

Social support under siege: An analysis of forced migration among women from the Democratic Republic of Congo

In 2016, researchers conducted a qualitative study in a mid-sized town in the United States to address gaps in research and practice related to psychosocial consequences of forced migration among women. The loss of social support and its impacts on the well-being of women are rarely addressed in refugee resettlement policy or practice overwhelmingly concerned with economic self-sufficiency. The study sought to develop theory to explain how women (n = 27) who migrated from the Democratic Republic of the Congo recreate social support post-resettlement in the United States. An interpretive approach informed by postcolonial feminist perspectives guided the grounded theory methodology. A theoretical model emerged explaining pivots in the internal and relational lives of women as social support systematically constricted over time as a result of war, displacement, and resettlement. Upon arrival to the United States, women experienced partitioned lives through changing relationships to space and time, which contributed to women being alone and impacted well-being. Converging processes propelled women towards learning to stand alone, through which women could develop a sense self-reliance, but not without internal and relational consequences. The analysis contributes to the empirical literature knowledge of how resettlement is a life altering event that sets into motion psychosocial processes with implications for well-being and health. Implications for practice and future research are discussed.

Avoidance, meaning and grief: psychosocial factors influencing engagement in HIV care

ABSTRACTAlthough the introduction of antiretroviral therapy has rendered HIV a chronic illness, inconsistent engagement in HIV care by key populations limits its public health impact. Poor engagement in care is especially prevalent among vulnerable populations with mental health and substance use disorders. Beyond structural and health system considerations, psychosocial factors may present challenges to sustained engagement. We conducted a qualitative study using in-depth interviews with 31 primarily African American, urban-based individuals, many with past or current drug use and mental disorders, living with HIV. Participants identified several psychosocial barriers that detract from their motivation to attend appointments and take medication. These included mental distress or detachment over a lack of purpose in life; denial about the need to be engaged in care; insufficient trust in the efficacy of care or the health system; deaths of loved ones leading to bereavement or loss of social support; and engagement in specific avoidance behaviors like drugs and alcohol. The study findings suggest that more comprehensive HIV care, which integrates mental health and substance abuse services in order to enhance meaning and address coping and grief, may be important. Considering these services in addition to improving the logistical components of care such as cues/reminders, accessibility, and patient-provider communication may improve intervention packages.

Czech Version of the Patient Dignity Inventory: Translation and Validation in Incurable Patients

ContextThe Patient Dignity Inventory (PDI) is a valid, reliable screening tool to assess a range of issues that have been reported to affect the sense of dignity in patients with life-limiting conditions. ObjectivesWe investigated the item characteristics, factor structure, and reliability of the Czech version of the PDI (PDI-CZ) among cancer and noncancer patients. MethodsThe PDI was translated into the Czech language following state-of-the-art criteria (a five-stage proceeding method for the translation). Two hundred thirty-nine participants completed the study (136 cancer and 103 noncancer patients). Internal consistency, test-retest reliability, and factor analysis were used for validation of the PDI-CZ. ResultsA Czech version of the PDI was obtained. The Cronbach's α for PDI-CZ was 0.92. Item 22 (not feeling supported by my health care providers) did not correlate with any other items, and it was skipped for factor analysis processing for this reason. Factor analysis resulted in a four-factor solution, accounting for 56.34% of the overall variance (factor loadings range, 0.37–0.92). The factor labels were as follows: loss of purpose of life; loss of autonomy; loss of confidence; and loss of social support (internal consistencies range, Cronbach's α 0.58–0.90). Test-retest reliability was assessed with 25 patients after two weeks. The resulting range of the Gwet's coefficient, AC1, was between 0.58 and 1.00. ConclusionThe results from the study support the reliability of the PDI-CZ and its future use in patients with incurable cancer and noncancer patients.

War and Children

War and Children

Prevention of Functional Decline by Reframing the Role of Nursing Homes?

Institutionalization is generally a consequence of functional decline driven by physical limitations, cognitive impairments, and/or loss of social supports. At this stage, intervention to reverse functional losses is often too late. To be more effective, geriatric medicine must evolve to intervene at an earlier stage of the disability process. Could nursing homes (NHs) transform from settings in which many residents dwell to settings in which the NH residents and those living in neighboring communities benefit from staff expertise to enhance quality of life and maintain or slow functional decline? A task force of clinical researchers met in Toulouse on December 2, 2015, to address some of these challenges: how to prevent or slow functional decline and disabilities for NH residents and how NHs may promote the prevention of functional decline in community-dwelling frail elderly. The present article reports the main results of the Task Force discussions to generate a new paradigm.

Development of the Transition Shock Scale for Newly Graduated Nurses

The purpose of this study was to develop a scale to assess the transition shock experienced by newly graduated nurses, and test the validity and reliability of the scale. The initial items were identified through a review of literature and in-depth interviews with nine newly graduated nurses. Content validation of the items was evaluated by five nurse professors and three nurses. Participants were 269 newly graduated nurses who worked at six acute care hospitals in Busan, Ulsan, and Yangsan, South Korea. Data were analyzed using item analysis, exploratory and confirmatory factor analysis, criterion related validity, and internal consistency. The final scale consisted of 18 items and six factors (conflict between theory and practice, overwhelming workload, loss of social support, shrinking relationship with co-workers, confusion in professional nursing values, and incongruity in work and personal life), which explained 71.3% of the total variance. The six subscale model was validated by confirmatory factor analysis. Cronbach's alpha for the total items was. 89. Convergent validity was evaluated by analyzing total correlation with burnout (r=.71, p<.001) and turnover intention (t=5.84, p<.001). This scale can be used in the development of nursing interventions to reduce the transition shock experienced by newly graduated nurses.

Anxiety About Aging in University Students Comparisons by Gender

The aim of this research was to compare the profiles of anxiety about aging in Mexican university students to aging. The total sample was of 1669 subjects; 851 women and 818 men with a mean age of 20.53 years (SD = 2.82) and 20.89 years (SD = 2.03) respectively. The approach adopted in the research is framed within a quantitative approach with a descriptive survey design. The results of the multivariate analysis of variance followed by analyzes of univariate variance, are the ones who show higher levels of anxiety to the fear of loss of social support and autonomy, while men manifest higher levels of anxiety as to contact with the elderly. The differences between men and women regarding anxiety about aging, suggest that in designing any intervention that aims to reduce this anxiety must be taken into account gender variable. Future research should replicate these findings in larger samples.

Terapia assistida por animais e sua influência nos níveis de pressão arterial de idosos institucionalizados

A terapia assistida por animais (TAA) é utilizada como instrumento no tratamento de doenças, com diversos efeitos benéficos em paciente psiquiátricos, hospitalizados, idosos, dentre outros. A TAA objetiva promover o bem-estar, saúde emocional, física, social e cognitiva, sendo o animal o principal agente da terapia, que funciona como ponte de ligação entre o tratamento e o paciente. A institucionalização do idoso ocorre, geralmente, após ocorrência de alterações físicas, cognitivas, doenças agudas ou crônicas, perda do cônjuge ou filho, perda de apoios sociais, pobreza, gerando dependência na realização das atividades da vida diária e locomoção. Trata-se de estudo clínico experimental controlado, realizado em uma casa de repouso em Vila Velha, ES, com o objetivo de avaliar a influencia da TAA na pressão arterial de idosos hipertensos institucionalizados. Participaram do estudo 25 idosos. As variáveis utilizadas no trabalho foram TAA (independente), variação de Pressão Arterial (dependente) e idade (controle). Foram realizadas sessões de TAA semanalmente com a duração de 1 hora e a pressão arterial foi aferida com uso de esfigmomanômetro antes e após a cada sessão durante 4 meses. Observou-se melhor controle dos níveis pressóricos além da promoção de momentos de alegria e relaxamento da amostra representativa do grupo de idosos institucionalizados.

Commentary: Adverse experiences in psychiatric hospitals might be the cause of some postdischarge suicides.

In this article, the authors comment on "Postdischarge Suicide: A Psychodynamic Understanding of Subjective Experience and Its Importance in Suicide Prevention," by Schechter, Goldblatt, Ronningstam, Herbstman, and Maltsberger (Bulletin of the Menninger Clinic, 2016, volume 80, pp. 80-96). Suicide after discharge from psychiatric hospitals is an enduring and serious problem. Consideration needs to be given to the possibility that adverse experiences associated with hospitalization, experiences such as trauma, stigma, and loss of social support, might precipitate some suicides after discharge.

Stigma and need for care in individuals who hear voices.

Voice hearing experiences, or auditory verbal hallucinations, occur in healthy individuals as well as in individuals who need clinical care, but news media depict voice hearing primarily as a symptom of mental illness, particularly schizophrenia. This article explores whether, and how, public perception of an exaggerated association between voice hearing and mental illness might influence individuals' need for clinical care. A narrative literature review was conducted, using relevant peer-reviewed research published in the English language. Stigma may prevent disclosure of voice hearing experiences. Non-disclosure can prevent access to sources of normalizing information and lead to isolation, loss of social support and distress. Internalization of stigma and concomitantly decreased self-esteem could potentially affect features of voices such as perceived voice power, controllability, negativity and frequency, as well as distress. Increased distress may result in a decrease in functioning and increased need for clinical care. The literature reviewed suggests that stigma has the potential to increase need for care through many interrelated pathways. However, the ability to draw definitive conclusions was constrained by the designs of the studies reviewed. Further research is needed to confirm the findings of this review.

Development of the Sport Injury Anxiety Scale

ABSTRACTThe purpose of this research was to develop a measure of sport injury anxiety (SIA), defined as the tendency to make threat appraisals in sport situations where injury is seen as possible and/or likely. The Sport Injury Anxiety Scale (SIAS) was developed in three stages. In Stage 1, expert raters evaluated items to determine their adequacy. In Stage 2, 491 collegiate athletes completed the preliminary SIAS. Results of an exploratory factor analysis (EFA) revealed a reliable scale with seven subscales, including anxiety associated with: (a) loss of athleticism, (b) being perceived as weak, (c) experiencing pain, (d) loss of social support, (e) letting down important others, (f) reinjury, and (g) having an impaired self-image. Confirmatory factor analyses (CFAs) supported a shortened scale and the multidimensional and hierarchical structure of SIAS scores. In Stage 3, 284 collegiate athletes completed the 21-item SIAS and other measures. Analyses supported the construct validity of the SIAS.

International Students’ Perspectives on the Importance of Obtaining Social Support from Host National Students

&lt;p class="apa"&gt;Students pursuing studies in a foreign land experience a disruption or loss of familiar support networks that function as powerful coping mechanisms in times of stress. Loss of social support has been associated with negative consequences such as depression, anxiety and loneliness. Researchers have categorized social support as emotional, practical, informational and in the form of social companionship. This study reports the findings of a study involving undergraduate international students pursuing their first degrees in four research universities in Malaysia. Using the quantitative methodology, a total of 400 questionnaires were distributed to international undergraduates with a return of 318 questionnaires. Results showed that many international students desired frequent social support from host national students in all four categories. Suggestions are made to institutions of higher learning to create a more supportive and conducive environment for intercultural contact in line with the efforts of internationalization.&lt;/p&gt;

Migrant families as effective buffers against discrimination: The perceived work–care conflict and household conditions of mothers

Summary Past social work studies on discrimination perceived by immigrants mainly concerned the negative impacts of social dislocation on the immigrants, such as their loss of social support, devaluation of education and work skills, and acculturative stress. Important features of family efficacy, notably the immigrant’s perceived control over the work–care management and household conditions are yet to be considered in any conceptual model of perceived discrimination. Findings The present study tested both the social dislocation and family efficacy models for 372 Chinese migrant mothers living in low-income communities of Hong Kong. While path analyses supported both models, the family efficacy model had substantially higher power in explaining perceived discrimination. Application Implications for social service practitioners and policy advocates to promote the life chances of poor migrant mothers are discussed.