Positive Healthcare Experiences Research Articles

Health care experiences of mothers of children with bronchiectasis in Counties Manukau, Auckland, New Zealand

BackgroundBronchiectasis is a worsening public health problem in New Zealand. This study aimed to explore the health care experiences of mothers of children with bronchiectasis in the Counties Manukau District Health Board area of Auckland, New Zealand.MethodsSemi-structured interviews were undertaken with ten mothers of children with bronchiectasis. Data were analysed using thematic analysis.ResultsFive themes emerged: 1) Searching for answers, describing mothers’ search for a diagnosis; 2) (Dis)empowerment, describing mothers’ acquisition of knowledge, leading to empowerment; 3) Health care and relationships, describing the impact of relationships on the mother’s health care experiences; 4) A juggling act, describing the challenges of juggling health care with school, work and family; 5) Making it work, describing how mothers overcome barriers to access health care for their child.ConclusionsThe health provider-parent relationship was crucial for fostering positive health care experiences. Mothers’ acquisition of knowledge facilitated empowerment within those relationships. Additionally, mothers’ perceptions of the quality and benefit of health services motivated them to overcome barriers to accessing care. Study findings may help to improve health care experiences for parents of children with bronchiectasis if identified issues are addressed.

Experiences with skin and soft tissue infections among people who inject drugs in Philadelphia: A qualitative study

ObjectivesTo understand how people who inject drugs (PWID) experience skin and soft tissue infections (SSTI) and make decisions to seek or delay medical treatment. MethodsWe conducted semi-structured, in-depth interviews in 2015 with 19 PWID at a syringe exchange program in Philadelphia. We analyzed the data using standard qualitative techniques. ResultsPWID described adequate knowledge about SSTI, although they could not always implement knowledge about SSTI prevention due to environmental constraints. Participants reported different experiences with incident SSTI. Some sought immediate medical care at initial presentation. Most, however, waited to seek care. Previous positive and negative healthcare experiences, both in general -including stigma and withdrawal- and specific to SSTI, influenced this decision. Among those who delayed medical care, some reported self-treatment, including increased drug use for pain control, and lancing and draining their own wounds. ConclusionReducing the incidence of SSTI and promoting earlier treatment are important public health priorities. Both require ongoing attention and improvements to the environments in which PWID inject and receive care.

Health indicators and social gradient in adolescent immigrants' health risk and healthcare experiences.

Findings suggest a social gradient in which positive healthcare experiences were more common among adolescence with higher socioeconomic status for some immigrants (Russian adolescents) but not for others. The two leading health indicators were related to healthcare experiences, but as adolescent smokers were less likely to have positive healthcare experiences, proactive efforts are needed to engage this group. What is Known: • Health indicators (such as obesity) and healthcare attitudes are linked to healthcare service use among adolescents sampled from outpatient and inpatient populations. What is New: • A social gradient involving socioeconomic status and being an adolescent immigrant was found regarding risky health indicators (i.e., smoking, use of internet as the primary source of health information). • Problematic health indicators, such as smoking, is linked to less positive healthcare attitudes in apparently healthy adolescents (both immigrants and non-immigrants).

Advocacy and luck: Australian healthcare experiences following a suicide attempt

ABSTRACTHigh quality mental healthcare after a suicide attempt is a key strategy for preventing subsequent suicide attempts and deaths, yet little is known about how people navigate the healthcare system following a suicide attempt. This paper focuses on the stories told by 20 people who had attempted suicide. Five themes emerged: fitting into the healthcare system; need for advocacy; consistent care; lucky to find help; and, small kindnesses. Positive and empathetic healthcare experiences, as well as connected services, assisted the recovery of people who have attempted suicide.

Parent and staff perceptions of parental needs during a child's hospital admission to a paediatric high-dependency unit: A New Zealand study.

This study aimed to identify parents' and staff's perceptions of parents' needs during a paediatric high-dependency unit admission and the relationships between needs, socio-demographic and clinical variables and explores if these perceptions have changed. This study uses a cross-sectional descriptive correlational design, and 104 parents whose children received care and 88 staff who worked within a paediatric high-dependency unit at a tertiary hospital in New Zealand completed the Needs of Parents' Questionnaire in 2011. Parents' and staff's perceptions of the importance of needs were congruent, but differences arose between parents and staff on whether these needs were met. Parents were more likely to rate needs as having been met than staff members. Admission type, age and gender influenced parents' and staff's perceptions of parents' needs. Synergy between parent and staff satisfaction scores will be enhanced when care delivery is more closely aligned to parents' priorities for care and staff receive feedback on positive health-care experiences.

Verbal compliance-gaining strategies used by male physicians and patient healthcare experience.

This study explores male physicians' use of verbal compliance gaining strategies to encourage patients to adhere to medication regimens, lifestyle changes, or future appointments, and assesses which strategies are associated with patients' reported healthcare experiences. Five physicians from a family practice clinic in northern British Columbia, Canada, were audio-recorded while interacting with 31 patients during actual consultations. Compliance-gaining utterances were coded into five categories of strategies, while patient experience with care was assessed using a questionnaire. A number of intriguing findings emerged: direct orders were related to a more negative experience with interpersonal aspects of care, but were fairly frequently used, especially with female patients. Persuasion was the only strategy that promoted a positive patient experience, but was rarely used. However, the effect of persuasion on patient experience was no longer significant when adjusting for patients' health status. Physicians relied mostly on motivation strategies to encourage adherence, but these strategies were not related to patients' assessment of their healthcare experiences. These results suggest that the most frequently used verbal compliance gaining strategies by physicians are not always appreciated by patients. To be more effective, it is necessary to inform physicians about which compliance-gaining strategies promote a positive patient healthcare experience.

Exploring characteristics, predictors, and consequences of fear of cancer recurrence among Asian-American breast cancer survivors.

To address the fear of cancer recurrence (FCR) research gap, we used prospective data to explore FCR predictors and FCR associations with health-related quality of life among Asian-American breast cancer survivors (BCS). A total of 208 diverse Asian-American BCS completed T1 survey, and 137 completed T2 survey after 1year. Fear of cancer recurrence scores (range=0-4) were 2.01 at T1 and 1.99 at T2 reflecting low-to-moderate FCR. Scores of FCR were stable over the 1-year period (t(126)=.144, P=.886). Multiple regression analyses showed that Chinese women reported lower FCR both at T1 (t(193)=-2.92, P=.004) and T2 (t(128)=-2.56, P=.012) compared to other Asian women. Also, more positive health care experience at T1 predicted lower FCR at T2 (β=-.18, P=.041). Controlling for other covariates, greater FCR at T1 predicted poorer outcomes 1year later including lower physical (β=-.31, P<.001), emotional (β=-.37, P<.001) and functional (β=-.16, P=.044) well-being and health-related quality of life specific to breast cancer at T2 (β=-.31, P<.001). We found substantial consistencies and some divergences between our findings with Asian-American BCS and the existing literature. This prospective investigation reveals new information suggesting that Asian-American subgroup variation exists and health care system factors may influence FCR. Thus, FCR studies should consider Asian subgroupings, cultural aspects, ie, level of acculturation and health care system factors including provider-patient communication and treatment setting. Future research may benefit from contextualizing FCR within a broader distress framework to advance the science and practice of patient-centered and whole-person care.

Knowledge, attitudes, and beliefs related to hypertension and hyperlipidemia self-management among African-American men living in the southeastern United States

ObjectivePerceptions of illness affect cardiovascular disease (CVD) self-management. This study explores knowledge, attitudes, and beliefs regarding hypertension and hyperlipidemia management among 34 African-American men with hypertension and/or hyperlipidemia, age 40–65, living in the Southeastern United States. MethodsIn-person focus groups were conducted using semi-structured interview questions informed by the Health Belief Model (HBM). ResultsParticipants had a high level of knowledge about hypertension self-management, but less about cholesterol self-management. Perceived severity of both conditions was acknowledged, though participants perceived hypertension as more severe. Barriers to self-management included medication side effects and unhealthy dietary patterns. Facilitators included social support, positive healthcare experiences, and the value placed on family. Cultural implications highlighted the importance of food in daily life and social settings. Participants expressed how notions of masculinity affected self-management—noting the impact of feelings of vulnerability and perceived lack of control stemming from diagnosis and treatment expectations. ConclusionsThe findings highlight gaps in knowledge of hyperlipidemia versus hypertension, and the impact of cultural context and perceptions on engagement in self-management behaviors. Practice implicationsPublic health practitioners and healthcare providers serving African-American men should address cultural factors and notions of masculinity which can hinder effective disease management among this population.

A qualitative study of patient and professional perspectives of healthcare services for multiple sclerosis: implications for service development and policy.

Multiple sclerosis (MS) is a chronic degenerative condition, with heterogeneous symptoms, and an unpredictable prognosis. Previous literature suggests patients' experiences of healthcare are unsatisfactory. Primary care may play a key role in the management of people with MS (PwMS); however, provision of services for PwMS has received little focus in the primary care literature. This study aimed to explore perspectives and experiences of PwMS and healthcare professionals of UK healthcare services for MS. Semi-structured interviews were conducted with 24 PwMS, 13 Practice Nurses, 12 General Practitioners and 9 MS Specialist Nurses in northern England, between October 2012 and April 2014. Participants were purposively selected. Data were analysed thematically using constant comparative analysis. The theoretical framework of candidacy was used to interrogate data, with themes mapping onto the National Institute for Health and Care Excellence (NICE) guideline for MS. How PwMS interpreted symptoms as leading to candidacy for care dictated help-seeking. PwMS required additional support in identifying symptoms due to MS. Participants reported poor experiences of care including poor access to services, poor continuity of care and poor interpersonal interactions with perceptions of limited person-centredness. PwMS and professionals identified that MS-related disability and progression of symptoms required responsive care. Relational continuity enabled PwMS to feel understood, and professionals to holistically appraise symptoms and progression. In conclusion, continuity and patient-centredness of care are central to positive healthcare experiences for PwMS and professionals. Services need to be more accessible to ensure responsive and effective MS management. This study provides unique findings on the role of primary care for PwMS, and the relationship between findings and MS NICE guideline recommendations with implications for service delivery in the community.

Qualitative Study of Foster Caregivers' Views on Adherence to Pediatric Appointments

The current study is a qualitative investigation of how foster caregivers, primarily Latinos, view adherence to pediatric appointments. Our purpose was to identify how the child welfare system, pediatric clinics, and pediatric health providers serving foster children might promote appointment attendance. Participants in the study had a return appointment at an outpatient pediatric clinic that served only children in the child welfare system. Twenty-eight caregivers (13 related and 15 unrelated) participated in telephone interviews after the date of their scheduled pediatric appointment; 32% missed their return appointment. Semistructured interview guides included general questions about what promotes attending the pediatric appointment, what makes it difficult to attend the pediatric appointment, and how pediatric care affects the foster child. Analysis of qualitative data using content analysis identified three themes: (a) Multiple Methods to Attend Appointments, which included caregivers' organizational and problem-solving skills; (b) Positive Health Care Experiences, which consisted of caregivers' personal relationships with providers and staff members and clinic organization; and (c) Necessity of Pediatric Care, which included recognition of the need for health care, especially timely immunizations. All caregivers also reported that appointment reminders would be helpful. Unrelated caregivers said more often than related caregivers that appointment attendance was facilitated by clinic organization. Nonadherent caregivers more than attenders mentioned their need to solve problems to attend appointments or reschedule appointments. In summary, caregivers said they valued regular pediatric health care to treat their children's chronic conditions and prevent illnesses, but they acknowledged that their home lives were hectic and that attending scheduled appointments was sometimes difficult. Foster caregivers in this study identified the ideal pediatric clinic environment that encourages adherence to health care appointments. This environment is an organized clinic with easy access including parking, engaged pediatric health providers, ability to reschedule appointments when necessary, and an individualized and consistent appointment reminder system.

Telephonic assesment of consumer satisfaction of telephonic case management of cancer patients.

80 Background: Feedback provided by customers/consumers has become an established means of assessing the quality of goods and services. The Optum division of UnitedHealth Group maintains two telephonic case management programs for cancer patients to support quality and cost effective care: Cancer Resource Services (CRS) and the Cancer Support Program (CSP). In each case, the purpose of the telephonic intervention is to provide support, education, and, when appropriate, steerage to one of our contracted Centers of Excellence (COEs). Methods: In this report, we provide satisfaction data collected during 2014 from surviving patients whose cases were closed or reached their 1-year anniversary in these case management programs. These telephonic surveys were conducted by a contracted third party. Results: For CRS, 363 members were contacted and surveys were completed; for CSP, 400 were contacted and completed. Average age was 61 (CRS) and 57 years (CSP). 61% were women. Sixty-two % of the CRS patients were treated at a COE as were 59% of the CSP patients. For CRS members, 90% experienced a positive health care experience (satisfied or very satisfied); for CSP, 94%. Quality of life was improved in 51% for CRS and 65% for CSP. For all four of these measures, there was a statistically significant (p &lt; 0.05) improvement compared with the survey data from 2013. There was 96% overall satisfaction with the program for both CRS and CSP, while overall satisfaction with the nurse/case manager was 96% (CRS) and 98% (CSP). 96% (CRS) and 94% (CSP) are likely to recommend these services to others while 97% and 91% are likely to use these services again if needed. Positive comments outweighed suggestions for improvement. The most common suggestion for improvement was to expand the availability of these services. Conclusions: We conclude that our members with cancer are benefiting from the experience of telephonic case management by our experienced oncology nurse/case managers who are, in turn, assisted by our associated staff of social workers and medical directors.

Exploring Healthcare Experiences of Transgender Individuals.

Purpose: It has been widely noted that existing healthcare systems do not always function effectively for the transgender population. Despite existing healthcare barriers, however, transgender individuals have been shown to have positive healthcare experiences. This study explored a cohort of transgender individuals who had positive healthcare experiences, and those who were involved in creating a positive healthcare experience for transgender individuals.Methods: A single case study was conducted, which included 10 interviews with transgender individuals, healthcare providers, and friends/family/significant others of transgender individuals. Data were analyzed through thematic analysis.Results: Seven key themes emerged within macro levels (large-scale system), meso levels (local/interpersonal), and micro levels (individual/internal) of healthcare system support. At a macro level, few system strengths were shown, with hope for change in the future. On a meso level, both external supports and informal networking emerged as key factors in positive healthcare experiences. At the micro level, self-navigation, characteristics for success, and personal strategy development were important for achieving positive experiences.Conclusion: Factors that contribute to positive healthcare experiences for transgender individuals were outlined in this study, showing that meso and micro level support compensate for large-scale healthcare system deficits.

Conflict and Care

Israel has provided immediate healthcare to Syrian children, civilians and fighters since early 2013 despite being in an official state of war with Syria since 1973. We present qualitative findings from a larger mixed-methods phenomenological study to understand how the geopolitical and social history of Israel and Syria influences healthcare providers and Syrian patient caregivers in northern Israel. Theories of humanization and cognitive dissonance guided this study and frame the beliefs and experiences of healthcare providers who treated wounded Syrians in Israeli hospitals. Findings indicate healthcare providers and Syrian caregivers adjusted their beliefs to allow for positive healthcare experiences. Qualitative analysis revealed two major themes: supportive and hindering systemic elements contributing to the healthcare provider-patient-caregiver relationship. Internal psychological developments, contextual factors, and relational processes influenced humanization of the other within the relationship. This study illuminates unique ethical and humanitarian demands relevant for healthcare workers and those with whom they interact.

A situational construal approach to healthcare experiences

BackgroundThe Situational Construal Model proposes that characteristics of persons and situations interact to influence construal of situations and resultant behavior. We apply this framework to the study of healthcare experiences in two studies. MethodsIn Study 1, mTurk users (N = 670) read vignettes of positive, neutral, or negative healthcare experiences, described their construal of the vignette, and completed individual difference measures. In Study 2, mTurk users (N = 292) recalled a recent healthcare visit and reported individual differences, visit characteristics, and outcomes following the visit. ResultsAcross both studies, personality was related to the valenced construal of healthcare experiences. In Study 2, patient and visit characteristics predicted situational construal and self-reported visit outcomes, and situational construal statistically mediated relationships between patient and visit characteristics and outcomes. ConclusionsThe current work supports the application of the Situational Construal Model to healthcare situations and demonstrates the importance of both person and situation variables for understanding key healthcare outcomes.

How Patients Perceive Their Doctors’ Communication

By emphasizing the value of health professionals’ communication skills in creating positive health care experiences, researchers have tended to study health communication as an interpersonal encounter. Interactions in the health context, though, are inherently intergroup. Using the language and social psychology approach, this study emphasizes those intergroup features of health communication. We used mixed methods and applied communication accommodation theory and the willingness to communicate construct to the health context. Participants in Canada and Australia ( N = 371) were asked about their perceptions of their health consultations. Multiple regression analyses revealed that health communication competence was the best predictor of patient willingness to communicate. Differences between patients’ accounts of positive and negative health care experiences were clearly differentiated by their perceptions of the health professionals’ communication strategies. The potential effects of these strategies on patient participation are discussed.

The perceptions of homeless people regarding their healthcare needs and experiences of receiving health care.

To understand the perspective of the homeless about their healthcare encounters and how their experiences of receiving healthcare influence their health-seeking behaviour. A phenomenological study was undertaken because of the increasing levels of homelessness in the United Kingdom. Most of the current literature is American or Canadian. An interpretive phenomenological inquiry. An opportunistic sample of fourteen single homeless adults was recruited from one male hostel and one non-residential day centre. Data collection was done in 2013. Semi-structured audio-recorded interviews were conducted one-to-one. Colaizzi's method for data analysis was used. Three major themes were identified. Expressed Health Need, Healthcare Experiences and Attitudes to health care. Health problems are recognized by the homeless but the need for intervention is not always prioritised. Obstacles in access to health care in the UK are both perceived (attitudes towards the homeless; previous bad experience) and actual (difficulty in registering with a general practitioner, difficulty travelling to services, being forced to move to new area). Some homeless people feel that they are treated with prejudice and receive substandard care. Positive healthcare experiences were also reported. Positive and negative healthcare encounters can profoundly affect the homeless. Address apparent inconsistency of care; promote greater interdisciplinary communication and referrals to homeless services from prisons and hospitals; increase the availability of intermediate services; reduce obligation of homeless to move area; research experiences of homeless families.

Abstract B86: “The doctor supported me by telling me exactly what she was doing”: Health care experiences of African American women following an abnormal mammogram

Abstract Purpose. The diagnostic and therapeutic delays African American women experience following an abnormal mammogram are well-documented and may partially contribute to racial disparities in late stage diagnosis and survival. Previous literature has suggested inadequate provider-patient communication may contribute to delayed care and subsequent attitudes and behaviors regarding breast cancer care. Nevertheless, little research has characterized the specific communication needs African American women have following an abnormal mammogram experience. Objective. We describe themes regarding positive and challenging healthcare experiences following an abnormal mammogram result among a small sample of African American women. Methods. Through multiple clinics and community advocates, we recruited a convenience sample of 30 African American women who had received an abnormal mammogram within the previous four years. Qualitative, semi-structured interviews focused on challenging and positive aspects of healthcare interactions following the abnormal mammogram experience (e.g., “What were some ways you felt the doctor and staff supported you?”). Data were analyzed using principles of grounded theory. Results. Several salient themes concerning health communication emerged from our exploratory study. African American women often emphasized their confidence in their ability to act on health information during the abnormal mammogram experience (“When you do the follow-up, you get to ask”). Staff responses to proactive approaches were negative and positive for different women. Negative social interactions with staff included perceived disrespect (“I was actually disappointed with the receptionist…she had a little attitude”) and healthcare distrust concerning withheld information (“I would call them on the phone and…fuss at them about different things that I had found out that were not true or that were available that they did not tell me.”). African American women with positive experiences noted direct communication (“They didn't try to hide anything. They were out front.”; “I feel the doctor supported me by telling me exactly what she was doing.”) and detailed information (“They told me what they were going to do. They told me how to prepare.”). Additionally, women noted the importance of personalism. Women who were less satisfied with follow-up care noted lack of empathy (“They were robots…They're like a tape recording. It's not individualized or personal.”). Conversely, satisfied women mentioned familiarity with patients (“Well they knew my history, so that really made me feel comfortable”) and empathy (“I have doctors who care. They are concerned about this, so they want me to follow-up”; “They talked to you, comforted you.”). Conclusions: Our findings parallel a broader body of literature concerning inadequate patient-provider interactions and culturally specific communication needs of African American populations. The current study further suggests the importance of providing African Americans an active role during care, including direct, professional, and comprehensive communicative styles. Interpersonal support and “whole patient” approaches are also highly valued for this patient population. Emergent themes from this study have direct implications for clinicians and future interventions to increase early breast cancer detection for African American women. Citation Format: Yamile Molina, Sarah H. Hohl, Bridgette Hempstead, Jacci Thompson-Dodd, Rachel C. Malen, Beti Thompson, Rachel M. Ceballos. “The doctor supported me by telling me exactly what she was doing”: Health care experiences of African American women following an abnormal mammogram. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B86. doi:10.1158/1538-7755.DISP13-B86

The ABCs of caring for sexual assault patients

The ABCs of caring for sexual assault patients

Patient evaluation of hospital outcomes: an analysis of open-ended comments from extreme clusters in a national survey

ObjectivesA recent study identified patients in six distinct response groups based on their evaluations of outcomes related to overall satisfaction, malpractice and benefit of treatment. This study validates the response...

Healthcare experiences of gender diverse Australians: a mixed-methods, self-report survey

BackgroundTo date the healthcare experiences of gender diverse Australians have received little attention. Previous international research indicates a range of both negative and positive healthcare experiences amongst this diverse population, with negative experiences being those most frequently reported.MethodAn online survey was designed to examine the healthcare experiences of gender diverse Australians. The survey included Likert scales asking participants to rate their mental and physical health, and their experiences with psychiatrists, general practitioners and surgeons (in terms of perceived comfort, discrimination and information provision). Open-ended questions provided the opportunity for participants to further elaborate on their experiences. Data were collected between June 2012 and July 2013. Quantitative data analysis was conducted utilising SPSS 17.0, including ANCOVAs and correlations to examine the relationships between variables. Qualitative data were coded by the authors in terms of negative or positive responses and the validity of ratings were assessed utilising Cohen's kappa.Results110 people assigned male at birth (MAAB) and 78 people assigned female at birth (FAAB) completed two separate surveys. All identified as gender diverse as defined in this paper. 70% of participants had accessed a psychiatrist. Participants MAAB rated their experiences with psychiatrists more highly than participants FAAB. 80% of participants had accessed a general practitioner. Comfort with, and respect from, general practitioners were both positively correlated with mental health, whilst discrimination was negatively correlated with mental health. 42.5% of participants had undertaken sex-affirming surgery. Those who had such surgery reported higher levels of physical and mental health than those who had not undertaken surgery. Participants MAAB reported more positive experiences of surgery than did participants FAAB.ConclusionsFindings highlight the need for increased education of medical practitioners in regards to engaging with gender diverse clients.