Perspectives Of Care Providers Research Articles

Cost of illness analysis of diabetes mellitus with complications in one hospital in Surabaya

Introduction: The high prevalence and incidence of complications due to diabetes mellitus impose an economic burden on patients and society. Aim: To obtain an overview of the cost of diabetes mellitus with complications and identify the factors that affect it. Methods: This study was conducted based on the perspective of health care providers. Results: The cost of illness for diabetes mellitus with complications was IDR 2,654,047,597 and an average cost of IDR 15,688,528/patient. Diabetes mellitus type 2 with peripheral circulation complications (E11.5) had the highest average cost (IDR 34,135,284/patient). The factors that significantly influenced direct medical costs were the length of stay, class of hospitalisation, and type of complications (Charlson comorbidity index). Conclusion: The results of this study indicate that the presence of complications increases the cost of diabetes mellitus treatment.

Knowledge and perspectives of health care providers towards clients with substance abuse at Solwezi General Hospital in Solwezi District

Introduction: Substance abuse is increasingly becoming a public health threat associated with varying health and social implications. Healthcare professionals are crucial in the management of substance abuse disorders, and their knowledge and perspectives towards substance abuse clients influences the care that these clients receive. Locally, there is scanty data on the knowledge and perspectives of health care providers towards substance abuse clients in Solwezi District. Objectives: The objectives of this study were to assess knowledge and perspectives of health care providers towards substance abuse clients at Solwezi General Hospital in Solwezi District. Materials & methods: A hospital-based cross sectional study was adopted for this study. Data collection was done using a self-administered semi-structured questionnaire adapted from previous studies. The SPSS software version 20.0 for Windows was used for data analysis using descriptive statistics and the Chi-square test for inference at the 0.05 level of significance. Results: The mean age of respondents was found to be 28.76 years. A female predominance over males was noted with a ratio of close to 5:1. Seventy-seven percent of respondents were Nurses by profession (77.3%), with the majority having attained Diploma as the highest level of education (60%). Overall, knowledge of substance abuse, screening tools and interventions for substance abuse was good. Variations in respondents’ perception of which health care provider was responsible for the assessment and management of substance abuse clients were noted. Priority on substance abuse cases was found to be low in 51% of the respondents, and several barriers to effective management of substance abuse were identified including lack of knowledge (41.4%), lack of manpower (20%), lack of specialized facilities (10%) and poor patient cooperation (16%). Statistically significant associations were found between respondent’s knowledge and interest to work with substance abuse clients; as well as between respondent’s education and priority placed on substance abuse cases. Conclusion: Health care providers exhibited adequate knowledge about substance abuse. However, low priority over substance abuse cases was reported, and attributed to a number of factors. This therefore calls for more training in substance abuse, particularly assessment and management of substance abuse clients in order to optimize health services rendered to substance abuse clients. Key words: Substance abuse, Clients, Knowledge, Perspectives, Health care providers

Knowledge and perspectives of health care providers towards clients with substance abuse at Solwezi General Hospital in Solwezi District

Introduction: Substance abuse is increasingly becoming a public health threat associated with varying health and social implications. Healthcare professionals are crucial in the management of substance abuse disorders, and their knowledge and perspectives towards substance abuse clients influences the care that these clients receive. Locally, there is scanty data on the knowledge and perspectives of health care providers towards substance abuse clients in Solwezi District.Objectives: The objectives of this study were to assess knowledge and perspectives of health care providers towards substance abuse clients at Solwezi General Hospital in Solwezi District.Materials & methods: A hospital-based cross sectional study was adopted for this study. Data collection was done using a self-administered semi-structured questionnaire adapted from previous studies. The SPSS software version 20.0 for Windows was used for data analysis using descriptive statistics and the Chi-square test for inference at the 0.05 level of significance.Results: The mean age of respondents was found to be 28.76 years. A female predominance over males was noted with a ratio of close to 5:1. Seventy-seven percent of respondents were Nurses by profession (77.3%), with the majority having attained Diploma as the highest level of education (60%). Overall, knowledge of substance abuse, screening tools and interventions for substance abuse was good. Variations in respondents’ perception of which health care provider was responsible for the assessment and management of substance abuse clients were noted. Priority on substance abuse cases was found to be low in 51% of the respondents, and several barriers to effective management of substance abuse were identified including lack of knowledge (41.4%), lack of manpower (20%), lack of specialized facilities (10%) and poor patient cooperation (16%). Statistically significant associations were found between respondent’s knowledge and interest to work with substance abuse clients; as well as between respondent’s education and priority placed on substance abuse cases.Conclusion: Health care providers exhibited adequate knowledge about substance abuse. However, low priority over substance abuse cases was reported, and attributed to a number of factors. This therefore calls for more training in substance abuse, particularly assessment and management of substance abuse clients in order to optimize health services rendered to substance abuse clients.

UNDERSTANDING BARRIERS AND FACILITATORS TO HEALTH CARE PROVIDERS ASSESSING AND TREATING KNEE OSTEOARTHRITIS IN PERSONS WITH TYPE 2 DIABETES MELLITUS: A QUALITATIVE STUDY USING THE THEORETICAL DOMAINS FRAMEWORK

Purpose: Symptomatic knee osteoarthritis (OA) commonly co-exists in persons with Type 2 diabetes (T2DM) and, if left untreated, may impede diabetes self-management, including engaging in physical activity. Evidence-based therapies for OA are underutilized. Studies suggest heath care providers may pay less attention to diagnosis and management of OA in the context of other competing chronic conditions. To inform the development of an implementation intervention to improve guideline-concordant management of symptomatic knee OA in persons with T2DM, we examined the perspectives of diabetes health care providers regarding barriers and enablers to diagnosing and treating knee OA in persons with T2DM.

Barriers and Facilitators to Chronic Red Cell Transfusion Therapy in Pediatric Sickle Cell Anemia.

Background: Chronic red cell transfusion (CRCT) therapy is one of a few effective disease-modifying therapies for children with sickle cell anemia (SCA). CRCT is recommended for primary and secondary stroke prevention for at-risk children with SCA and is sometimes used for other disease-related complications. However, CRCT can be resource- and time-intensive for patients/families, providers, and organizations. This study was conducted to provide a comprehensive, multilevel examination of barriers and facilitators to transfusion therapy in children with SCA from health care provider and caregiver perspectives. Methods: A qualitative descriptive approach was used to conduct key informant interviews in a sample of 26 caregivers and 25 providers across the United States. Interviews were analyzed using directed content analysis with the Multilevel Ecological Model of Health as an initial coding framework and the constant comparison method. Results: Ten barrier themes and 10 facilitator themes emerged across all ecological levels. Themes most commonly occurred on the patient and organizational levels. Key barriers themes included Logistical Challenges, Obtaining and Maintaining Venous Access, Alloantibodies/Alloimmunization and Reactions, and Iron Overload and Adherence to Chelation Therapy. Key facilitator themes included Nursing and Non-nursing Staff Support, Positive Child/Family Experiences, Logistical Help and Social Resources, Blood Bank and Access to Blood, and Transfusion-Specific Resources. Discussion: The comprehensive understanding of multilevel barriers and facilitators to transfusion therapy, including the role of nursing, in children with SCA can inform strategies to improve CRCT for patients/families and providers and can also be applied by organizations seeking to implement transfusion services for SCA.

Evaluation of the functioning of long-term at-home nursing care in Poland from the perspective of care providers: Mixed methods study.

This study aimed to analyse and evaluate the functioning of long-term at-home nursing care (LTHNC) based on the opinions of its service providers. Long-term at-home nursing care is a form of care for patients who do not need hospital treatment but need systematic nursing care because of their health problems. LTHNC in Poland involves guaranteed care services financed from universal health insurance contributions pursuant to contracts with the National Health Fund (NHF); the program has existed since 2004. A sequential-explanatory mixed-method design was used. The study was carried out using both quantitative and qualitative research methods. A questionnaire was distributed amongst 1119 care providers (the response rate was 38.2%). The qualitative research comprised semi-structured interviews with ten care providers, namely three nurses managing LTHNC facilities and seven nurses directly providing services as part of LTHNC. The STROBE checklist was used in reporting this study. We found that the main reasons for contracting LTHNC services were the increasing demand for this form of care, financial motives and an opportunity to introduce new organisational solutions. Our study shows that LTHNC is beneficial not only for the patients, but also for the nurses who provide the care. On the one hand, LTHNC provides positive results for patients and their caregivers (family members), and on the other hand, it affords a sense of satisfaction to the nurses and contributes to the development of their professional independence. According to care providers, improving accessibility through increasing the number of contracted services as well as raising the pay for 1day of care per patient may improve the functioning of LTHNC. The results of our study are a source of information for those who organise health care and administer resources on how to improve the functioning of LTHNC.

Exploring trust in (bio)medical and experiential knowledge of birth: The perspectives of pregnant women, new mothers and maternity care providers

ObjectiveTo explore women's and maternity care providers’ experiences of birth, and the roles of (bio)medical and experiential knowledge therein. Research design/settingIn-depth qualitative interviews were undertaken with pregnant women and new mothers (n = 14) as well as with a range of maternity care providers working for the National Health Service (n = 6) and privately (n = 7). FindingsTrust emerged as a key concept in women's and maternity care providers' narratives. It was found that women and maternity care providers placed trust in two key areas: trust in past experiences and trust in women's innate abilities and embodied knowledge of birth. Key conclusionsWomen and maternity care providers trust and utilise both (bio)medical and experiential forms of knowledge of birth in complex ways and the value an individual ascribes to (bio)medical and/or experiential knowledge is highly subjective, and not necessarily mutually exclusive. This destabilises the notion that (bio)medical knowledge is associated with experts and experiential knowledge is associated with ‘lay’ people, and that these two bodies of knowledge are distinct. Implications for practiceTrust is a key concept in maternity care. The predominance of biomedical models of birth risk reducing trust in the value of experiential based birth knowledges – both embodied and empathetic. Trust in experiential knowledge could help to facilitate woman-centred care by recognising women as valuable ‘knowers’ with unique insight to contribute, and not just receivers of medical knowledge. It may also help providers ‘tune-in’ with the women in their care if they allow their experiential knowledge to complement their (bio)medical knowledge.

A Thematic Analysis of Dimensions of Spiritual Care.

An overview of spiritual care studies can help reveal the dimensions of spiritual care and summarize the findings of available studies. Thus, we designed the present study based on existing studies to explain the dimensions of spiritual care. In this thematic analysis, we gathered the related articles published in Persian and English in the last 8 years (2013-2021) with the help of the keywords of Care, Support, Spirituality, Religion, Treatment, Hospice, and Palliative, and searching in electronic databases, including PubMed, Scopus, Web Of Sciences, Magiran, Islamic Science Citation (ISC), and Scientific Information Database (SID). We accurately studied 79 articles that met the inclusion criteria, and then the spiritual care components were extracted and coded, and finally, the codes were categorized as themes and sub-theme. Thematic analysis of available studies revealed that the dimensions (theme) of spiritual care include: spiritual and religious assessment, developing a structure for providing spiritual care, establishing effective and supportive communication with the patient, training the patient, answering his questions, encouraging, maintaining, and improving social communications, encouraging the patient to live happily, helping the patient to achieve peace and calmness, supporting for spiritual rituals and activities, supporting and training the patient's family, and supporting the dying patient. Spiritual care includes various and numerous dimensions. Considering the widespread dimensions of spiritual care, it seems necessary to design and plan appropriate studies to reveal other spiritual care dimensions from the perspective of patients and care providers in different cultures.

Barriers and facilitators to implementing the HEADSS psychosocial screening tool for adolescents living with HIV/AIDS in teen club program in Malawi: health care providers perspectives

BackgroundAdolescents living with HIV (ALHIV) are at high risk of experiencing mental health problems. Depression is a major contributor to the burden of HIV-related disease amongst ALHIV and is significantly linked to non-adherence to anti-retroviral therapy (ART), yet it is under-recognized. In 2015, the Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) recommended that the psychosocial screening tool Home, Education, Activities, Drugs, Sexuality, Suicide/Depression (HEADSS) be used to screen ALHIV in Malawi who were part of an adolescent antiretroviral therapy program termed “Teen Club”. However, the HEADSS tool has been substantially under-utilized. This study assessed barriers and facilitators to implementing HEADSS for ALHIV attending Teen Club Program in four selected health facilities in Malawi.MethodsWe conducted a qualitative study using semi-structured interviews at four program sites (one district hospital and one health center each in two districts) between April and May 2019. Twenty key informants were purposively selected to join this study based on their role and experiences. We used the five domains of the Consolidated Framework for Implementation Research (CFIR) to guide the development of the interview guides, analysis and interpretation of results.ResultsBarriers included inadequate planning for integration of the HEADSS approach; concerns that the HEADSS tool was too long, time consuming, lacked appropriate cultural context, and increased workload; and reports by participants that they did not have knowledge and skills to screen ALHIV using this tool. Facilitators to implementing the screening were that health care providers viewed screening as a guide to better systematic counselling, believed that screening could build better client provider relationship, and thought that it could fit into the existing work practice since it is not complex.ConclusionsA culturally adapted screening tool, especially one that can be used by non-clinicians such as lay health workers, would improve the ability to address mental health needs of ALHIV in many primary care and social service settings where resources for professional mental health staff are limited. These findings are a springboard for efforts to culturally adapt the HEADSS screening tool for detection of mental and risky behaviors among ALHIV attending ART program in Malawi.

Provider perspectives of barriers and facilitators to the transition from pediatric to adult care: a qualitative descriptive study using the COM-B model of behaviour

Abstract Objectives Transition of care can be a complex process that involves multiple providers working together across the pediatric and adult health care system to support youth. The shift from a primarily family-centred approach to a patient-centred approach that emphasizes more personal responsibility for health care management can be challenging for youth, caregivers and providers to navigate. Despite the importance of transition, there is a lack of evidence about the best practices and types of interventions that support the transition of care process from the perspective of both pediatric and adult health care providers. An exploration of barriers and facilitators is a critical first step to identifying important behavioural determinants for designing and implementing evidence-based interventions. As such, the purpose of this study was to identify the barriers and facilitators to the transition of care from the perspective of pediatric and adult health care providers. Methods A qualitative descriptive design was used to conduct semi-structured interviews guided by the COM-B Model of Behaviour – a theoretical model that suggests that for any behaviour to occur there must be a change in one or more of the following domains: capability, opportunity and/or motivation. The study took place in the province of Nova Scotia, Canada and focused on three common conditions: Inflammatory Bowel Disease, Diabetes, and Juvenile Idiopathic Arthritis. Participants were recruited through stratified purposeful and convenience sampling and all interviews were conducted virtually on Zoom. Interviews were audio-recorded, transcribed verbatim and imported into NVivo Qualitative Data Software for analysis. Data were first analyzed using directed content analysis, guided by the COM-B model, then further examined using inductive thematic analysis to identify barriers and facilitators within the three domains. Results In total, 26 health care providers participated in this study (pediatric, n=13, adult n=13) including a mix of adult and pediatric physicians, nurses, and allied health care professionals. The participants identified primarily as female (n=19.73%) and had a range of years of experience (3–39, mean = 14.84). We identified a range of interconnected barriers and facilitators across each of the COM-B Model of Behaviour domains such as, degree of formalized training (capability), facilitation and coordination responsibilities (opportunity), collaboration across providers (opportunities), securing attachment to adult care system (motivation) and time (opportunity). Findings were categorized by three overarching themes: (1) Knowledge and Skills to Support Transition of Care; (2) Navigation Role for Youth and Caregivers; and (3) System Coordination. Conclusions By using the COM-B Model of Behaviour, we identified key barriers and facilitators that intersect to influence the transition of care process. These findings will be used to inform and adapt initiatives and interventions in Nova Scotia to improve the transition experience, as well as may be transferrable to other jurisdictions.

Home-Based Palliative Care Team Perspectives on Challenges in Patient Referral and Enrollment

ContextAs funding for home-based palliative care continues to expand, there is an increasing need to understand barriers to patient referral to and acceptance of home-based palliative care. ObjectivesThe aim of this study was to elicit perspectives of home-based palliative care administrators and providers on barriers encountered in identification, referral, and enrollment of patients eligible for home-based palliative care. MethodsWe conducted a qualitative study employing focus groups of nine home-based palliative care agencies across California. Focus groups were audio-recorded and transcribed. Using thematic analysis, researchers independently coded the transcripts and identified themes from the codes. ResultsA total of 25 HBPC staff participated in the nine focus groups. Participants included both clinicians (n = 17) and administrators (n = 8). Our analysis revealed 13 themes that fit under four major thematic categories: 1) lack of formal payment structures (few HBPC payors and variation in payment and services among payors), 2) agency structure barriers (limitations of electronic medical records and multiple lines of business), 3) patient- and family-level barriers (misconceptions and/or lack of palliative care knowledge, uninformed of the referral and/or no warm hand-off, reluctance to have strangers in the home, overwhelmed with health issues and related services, HBPC service refusal/unresponsive to outreach), and 4) physician-level barriers (misconceptions and/or lack of palliative care knowledge, variability in HBPC payment and services, lack of time, patient ownership). ConclusionHBPC providers identified a myriad of barriers that preclude patient access to HBPC. With growing provision of HBPC services, greater efforts to overcome these barriers are needed.

Developing a Prenatal Nutrition Tool: A Process of Evidence, Collaboration, and Consultation.

The Prenatal Nutrition Tool was created for care providers that work with pregnant clients and aims to support focused conversations on nutrition topics that influence maternal and infant health outcomes. A systematic 9-step product development process that combined findings from the literature with perspectives of nutrition experts and care providers was used to develop the tool. The results of a literature review and a modified Delphi Process (to obtain expert opinion) laid the foundation for the tool content. The final tool incorporated client feedback. More specifically, client feedback helped to refine tool questions. The tool consists of 2 parts: a questionnaire (written survey) and a conversation guide. The questionnaire covers 4 key themes (pregnancy weight gain, multivitamins, life circumstances, overall food intake) in 13 questions. The conversation guide utilizes public health nutrition guidance documents to lead care providers in focused discussions with clients. The tool is not intended to be a screening tool for medical conditions or replace an in-depth prenatal nutrition assessment. The tool can be accessed by any care provider in Canada on the Alberta Health Services website at Prenatal Nutrition Tool | Alberta Health Services.

Cost-effectiveness of whole-exome sequencing in progressive neurological disorders of children.

To clarify the diagnostic utility and the cost-effectiveness of whole-exome sequencing (WES) as a routine early-diagnostic tool in children with progressive neurological disorders. Patients with infantile-onset severe neurological diseases or childhood-onset progressive neurological disorders were prospectively recruited to this WES study, in the pediatric neurology clinic at Helsinki University Hospital during 2016-2018. A total of 48 patients underwent a singleton WES. A control group of 49 children underwent traditional diagnostic examinations and were retrospectively collected from the hospital records. Their use of health care services, related to the diagnostic process, was gathered. Incremental cost-effectiveness ratio (ICER) per additional diagnosis was calculated from the health care provider perspective. Bootstrapping methods were used to estimate the uncertainty of cost-effectiveness outcomes. WES provided a better diagnostic yield (38%) than diagnostic pathway that did not prioritize WES in early diagnosis (25%). WES outperformed other diagnostic paths especially when made early, within one year of first admission (44%). Cost-effectiveness in our results are conservative, affected by WES costs during 2016-18. WES is an efficient and cost-effective diagnostic tool that should be prioritized in early diagnostic path of children with progressive neurological disorders. The progressively decreasing price of the test improves cost-effectiveness further.

Spiritual Experience in Dementia From the Health Care Provider Perspective: Implications for Intervention

Spiritual care seeks to counter negative outcomes from spiritual distress and is notably needed in dementia. Such care needs disease-appropriate customization. Employing “cognitive apprenticeship” theory’s focus on learning from contrast, we explored spiritual needs salient within dementia as related to other disease states; we aimed to inform future dementia-focused spiritual care design. Accordingly, we conducted semi-structured qualitative interviews with 24 providers who serve older adults inclusive of persons with dementia. We sampled participants purposively by discipline (chaplains, nursing staff, social workers, activities professionals) and religious tradition (for chaplains). Our interview guide inquired about the nature of spiritual needs in dementia and stakeholders’ roles in addressing them. Hybrid inductive/deductive thematic analysis was employed. A thematic structure emerged with two themes: 1) spiritual experience in dementia compared to other medical conditions (sub-themes: the salience of (a) fear; (b) loss of self; (c) dementia’s progressive and incurable nature; (d) dementia’s impact on accessing faith); and 2) the need for spiritual intervention at the mild stage of dementia (sub-themes: (a) awareness in mild dementia and its influence on spiritual distress; (b) a window of opportunity). These findings pointed to possibilities for the “what” of spiritual needs and the “who” and “when” of implementing spiritual care. Implications included the imperative for dementia-specific spiritual assessment tools, interventions targeting fear and loss early in the disease, and stakeholder training. Researchers should study the “how” of dementia-appropriate spiritual care given recipients’ cognitive and linguistic challenges. Conjointly, these efforts could promote the spiritual well-being of persons with dementia worldwide.

"What else can we do?"-Provider perspectives on treatment-resistant depression in late life.

Treatment-resistant depression in late-life (TRLLD) is common. Perspectives of primary care providers (PCPs) and psychiatrists treating TRLLD could give insights into the challenges and potential solutions for managing this condition. To identify perspectives of providers who treat TRLLD, we conducted a qualitative descriptive study using semi-structured interviews with providers treating older adults with TRLLD in five locations across North America (i.e., Los Angeles, New York City, Pittsburgh, St. Louis, and Toronto). We conducted semi-structured interviews with 50 care providers (24 primary care providers [PCPs], 22 psychiatrists, and 4 depression care managers). Interviews elicited providers' perspectives on treatment options for TRLLD, including treatment within the primary care setting and referral to psychiatry, and sought suggestions for improvement. We identified four themes. (1) Treating TRLLD takes an emotional toll on providers; (2) existing psychiatric services are inadequate to meet the needs of patients with TRLLD, mainly because of lack of access; (3) PCPs often attempt to treat TRLLD, even when they are not comfortable doing so; and (4) to better meet the needs of patients with TRLLD, providers recommend integrated care models involving PCPs, psychiatrists, and psychotherapists, potentially made more feasible by the growth of telehealth. Findings from these qualitative interviews show the challenges in providing care for TRLLD. These findings can guide knowledge dissemination to psychiatrists, PCPs, policy-makers, and other stakeholders involved in the mental health system. They can also inform structural changes to clinical practice that may increase the implementation of the best treatment strategies across settings to improve long-term outcomes for TRLLD.

Exploring the perspectives of primary care providers on use of the electronic Patient Reported Outcomes tool to support goal-oriented care: a qualitative study

BackgroundDigital health technologies can support primary care delivery, but clinical uptake in primary care is limited. This study explores enablers and barriers experienced by primary care providers when adopting new digital health technologies, using the example of the electronic Patient Reported Outcome (ePRO) tool; a mobile application and web portal designed to support goal-oriented care. To better understand implementation drivers and barriers primary care providers’ usage behaviours are compared to their perspectives on ePRO utility and fit to support care for patients with complex care needs.MethodsThis qualitative sub-analysis was part of a larger trial evaluating the use of the ePRO tool in primary care. Qualitative interviews were conducted with providers at the midpoint (i.e. 4.5–6 months after ePRO implementation) and end-point (i.e. 9–12 months after ePRO implementation) of the trial. Interviews explored providers’ experiences and perceptions of integrating the tool within their clinical practice. Interview data were analyzed using a hybrid thematic analysis and guided by the Technology Acceptance Model. Data from thirteen providers from three distinct primary care sites were included in the presented study.ResultsThree core themes were identified: (1) Perceived usefulness: perceptions of the tool’s alignment with providers’ typical approach to care, impact and value and fit with existing workflows influenced providers’ intention to use the tool and usage behaviour; (2) Behavioural intention: providers had a high or low behavioural intention, and for some, it changed over time; and (3) Improving usage behaviour: enabling external factors and enhancing the tool’s perceived ease of use may improve usage behaviour.ConclusionsMultiple refinements/iterations of the ePRO tool (e.g. enhancing the tool’s alignment with provider workflows and functions) may be needed to enhance providers’ usage behaviour, perceived usefulness and behavioural intention. Enabling external factors, such as organizational and IT support, are also necessary to increase providers’ usage behaviour. Lessons from this study advance knowledge of technology implementation in primary care.Trial registrationClinicaltrials.gov Identified NCT02917954. Registered September 2016, https://www.clinicaltrials.gov/ct2/show/study/NCT02917954

Perspectives of health care providers regarding the levonorgestrel-releasing intrauterine system

Objectives The aims of the study were to assess the number of insertions per month of the 52 mg levonorgestrel-releasing intrauterine system (LNG-IUS) and gauge the knowledge and opinions of health care providers with regard to some of its characteristics and the reasons why women liked using the method. Methods An online questionnaire survey was conducted between January and July 2021 at the University of Campinas, Brazil. The survey comprised physicians and nurses from centres that had requested and received donated devices. Results A total of 65 health care providers answered the questionnaire (41 physicians and 24 nurses). The main misconceptions were related to insertion after an ectopic pregnancy: 60/65 (92.3%) answered that users with previous ectopic pregnancy must have frequent follow-up. Wrong answers were also given on the occurrence of acne (37/65, 56.9%) and depression (32/65, 49.2%). Participants reported that the LNG-IUS was highly effective (100%), long-acting (93.9%) and an appropriate method for controlling uterine bleeding (90.8%) and that it had few side effects (86.2%). Conclusion Our study suggests that health care providers from centres that requested and received LNG-IUS donations, even though they reported adequate knowledge about the device, still had misconceptions with regard to its clinical management.

A qualitative study of abortion care providers’ perspectives on telemedicine medical abortion provision in the context of COVID-19

BackgroundTelemedicine for medical abortion care was rapidly introduced in Great Britain in response to the COVID-19 pandemic. A growing body of literature demonstrates that telemedicine abortion care is safe, effective...

Quality of care in public sector family planning services in KwaZulu-Natal, South Africa: a qualitative evaluation from community and health care provider perspectives

BackgroundQuality of care is a multidimensional concept that forms an integral part of the uptake and use of modern contraceptive methods. Satisfaction with services is a significant factor in the continued use of services. While much is known about quality of care in the general public health care service, little is known about family planning specific quality of care in South Africa. This paper aims to fill the gap in the research by using the Bruce-Jain family planning quality of care framework.MethodsThis formative qualitative study was conducted in South Africa, Zambia, and Kenya to explore the uptake of family planning and contraception. The results presented in this paper are from the South African data. Fourteen focus group discussions, twelve with community members and two with health care providers, were conducted along with eight in-depth interviews with key informants. Thematic content analysis using the Bruce-Jain Quality of Care framework was conducted to analyse this data using NVIVO 10.ResultsFamily planning quality of care was defined by participants as the quality of contraceptive methods, attitudes of health care providers, and outcomes of contraceptive use. The data showed that women have limited autonomy in their choice to either use contraception or the method that they might prefer. Important elements that relate to quality of care were identified and described by participants and grouped according to the structural or process components of the framework. Structure-related sub-themes identified included the lack of technically trained providers; integration of services that contributed to long waiting times and mixing of a variety of clients; and poor infrastructure. Sub-themes raised under the process category included poor interpersonal relations; lack of counselling/information exchange, fear; and time constraints. Neither providers nor users discussed follow up mechanisms which is a key aspect to ensure continuity of contraceptive use.ConclusionUsing a qualitative methodology and applying the Bruce-Jain Quality of Care framework provided key insights into perceptions and challenges about family planning quality of care. Identifying which components are specific to family planning is important for improving contraceptive outcomes. In particular, autonomy in user choice of contraceptive method, integration of services, and the acceptability of overall family planning care was raised as areas of concern.

Potential interventions to support HCV treatment uptake among HIV co-infected people in Canada: Perceptions of patients and health care providers.

Increasing direct-acting antiviral (DAA) treatment uptake is key to eliminating HCV infection as a public health threat in Canada. People living with human immunodeficiency virus (HIV) and hepatitis C (HCV) co-infection face barriers to HCV treatment initiation. We sought to identify interventions that could support HCV treatment initiation based on patient and HCV care provider perspectives. Eleven people living with HIV with a history of HCV infection and 12 HCV care providers were recruited for this qualitative descriptive study. Participants created ranked-ordered lists of potential interventions during nominal groups (n = 4) and individual interviews (n = 6). Following the nominal group technique, transcripts and intervention lists underwent thematic analysis and ranking scores were merged to create consolidated and prioritized lists from patient and provider perspectives. Patient participants identified a total of eight interventions. The highest-ranked interventions were multidisciplinary clinics, HCV awareness campaigns and patient education, nurse- or pharmacist-led care, peer involvement, and more and better-prepared health professionals. Provider participants identified 11 interventions. The highest-ranked were mobile outreach, DAA initiation at pharmacies, a simplified process of DAA prescription, integration of primary and specialist care, and patient-centred approaches. Participants proposed alternatives to hospital-based specialist HCV care, which require increasing capacity for nurses, pharmacists, primary care providers, and peers to have more direct roles in HCV treatment provision. They also identified the need for structural changes and educational initiatives. In addition to optimizing HCV care, these interventions might result in broader benefits for the health of HIV-HCV co-infected people.