Health Service Practice Research Articles

Adopting the Concept of 'Ba' and the 'SECI' Model in Developing Person-Centered Practices in Child and Adolescent Mental Health Services.

The concept of knowledge is divided into explicit and tacit knowledge; explicit knowledge refers to the knowledge that can be articulated, written and stored, while tacit knowledge refers to personal experiences, values, beliefs and emotions of an individual. By Nonaka's theory, explicit and tacit knowledge do not lie separately but interact together by interactions and relationships between human beings. Thus, the SECI model is based on the assumption that knowledge is created through the social interaction of tacit and explicit knowledge; known as knowledge conversion. The SECI model is based upon four modes of knowledge conversion; socialization, externalization, combination and internalization. 'Ba' is considered to be a shared platform for knowledge creation. 'Ba' is a shared space, be it physical, mental or a combination of both that serves as a foundation of knowledge creation. Ba involves sharing of tacit knowledge i.e. emotions, feelings, experiences and mental images. It also involves the formation of a collective relationship which is open to the sharing of practices, values, processes and culture. This concept focuses mainly on the individual as a person who holds the knowledge rather than just on the knowledge itself. It aims to create a common space to bring people together where they can dialogue to share and create knowledge. As in the relationships formed in person-centered practices, relationships formed in Ba are based on not just the sharing of objective knowledge but also on sharing values, beliefs, and emotions. It also reflects the formation of a person-centered environment as a basis for person-centered research where healthful relationships with the participants are formed. Furthermore, Ba will aid in creating a sense of connectiveness and dialogue, thus focusing on the idea that the development of new practices is done with others rather than to others. In this article we will discuss how these Eastern concepts can be adapted and used to develop person-centered practices within child and adolescent mental health services, specifically related to rehabilitation and recovery. The concepts of personhood will be discussed, followed by a reflection on current practices adopted when working with children and adolescents.

Occupational health, integrative and complementary practices in primary care, and the Covid-19 pandemic.

To identify the possible repercussions of the COVID-19 pandemic on the workers' health, the care strategies used, and the provision of Integrative and Complementary Practices in health services in the context of COVID-19. Descriptive study, with a qualitative approach, which used a focus group for data collection and content analysis according to Bardin. Eleven health professionals from the city of Registro (SP) participated and, based on the information analysis, four categories emerged: (1) Changes in work routine caused by the pandemic and the feelings they generate in health professionals; (2) Integrative and Complementary Practices as a self-care strategy in the pandemic; (3) Provision of Integrative and Complementary Practices during the pandemic; and (4) Occupational health as the focus and strategy motivator to resume the provision of Integrative and Complementary Practices in the municipality. This study allowed the identification of the impact of the pandemic, especially on workers' mental health, which influenced the search for care strategies that included the Integrative and Complementary Practices. Professionals with this training began to offer the Integrative and Complementary Practices in the service to other workers, given the interruption of their provision to the population due to the COVID-19 pandemic.

Assessment of the knowledge and practice toward male's participation during their wives' prenatal and postnatal care at King Saudi Medical City, Riyadh: KSA.

Access to skilled health care services during pregnancy, childbirth, and postnatal period for obstetric care is one of the strongest determinants of maternal and newborn health outcomes. The main objective of the present study is to assess the knowledge and practice toward male's participation during their wives' prenatal and postnatal care at King Saud Medical City. We conducted a single center, a quantitative, cross-sectional study based on a personal-interviewed structured questionnaire in 2019 adopting a stratified random sampling technique. Married men above 18 years with at least one child were interviewed using a structured questionnaire. The knowledge level was positive and moderately correlated with the practice on prenatal and postnatal care r = +0.641(P = 0.000) and was statistically significant. There was a significant difference between pregnancy intention and level of education (P = 0.000). The score of knowledge and practice increased with the increase in the number of children. Socioeconomic factor was the major determinant for men's knowledge and practice in maternal and newborn health services. In the future, studies with a large sample size are required to increase men's awareness regarding MNH issues, but should not be limited to this.

Evidence based practice in occupational health services – A survey study with Finnish occupational health physicians and occupational health nurses

Evidence based practice in occupational health services – A survey study with Finnish occupational health physicians and occupational health nurses

An Overview of the History and Development of Health Services Management Education, Training, and Practice in Saudi Arabia: Calling for Change

The purpose of this article is to outline the history and development of health, services, management, training, and practice in Saudi Arabia and provide suggestions for enhancement of the development of the profession. A comprehensive descriptive needs assessment was conducted retrospectively through direct observation, online websites, interviews, and a review of existing documents from government agencies. Conducting a series of studies on the type and number of candidates required in this industry is essential for shaping the structure of education in health services management.

Implementation and dissemination of home and community-based interventions for informal caregivers of people living with dementia: a systematic scoping review protocol

IntroductionAgeing in place, supported by formal home and community services and informal caregivers, is the most used long-term care option for people with dementia (PwD). Informal caregivers are inundated by...

The evolution of IS/IT in health care in last decades

The evolution of knowledge and information has changed the practices of health services over the years. The use of Information systems (IS), with the underlying Information Technology (IT), plays a vital role in managing medical information and associated resources, always to provide a better quality of health care. IS/IT is increasingly developing globally, with new features and tasks greatly expanded, leaving paper records and voluminous files behind. The ubiquitous information and computing resources increasingly allow the sharing of all types of data between various entities. New IS/IT will have to be thought to correspond to the new types of monitoring and analysis of biomedical data. This work intends to explore the IS/IT in health and its evolution over the last few years.

A systematic review and meta-analysis of women's satisfaction with skilled delivery care and the associated factors in Ethiopia.

Evidence of variation in maternity health service practices has increased the government’s interest in quantifying and advancing the quality of institutional delivery care in the developing world, including Ethiopia. Therefore, we conducted a systematic review and meta-analysis to update and provide more representative data on women’s satisfaction with skilled delivery care and the associated factors in Ethiopia. This systematic review and meta-analysis followed the Preferred Reporting Items 2015 guideline. We searched PubMed/Medline, SCOPUS, Embase, Web of Science, and Google Scholar electronic databases for all 36 included studies. The pooled prevalence of women’s satisfaction with skilled delivery care and the associated factors were estimated using a random-effects model. Subgroup analysis and meta-regression were performed to identify the source of heterogeneity. Furthermore, publication bias was checked using eggers and funnel plots. All statistical analyses were performed using STATA version 14.0 software. The pooled prevalence of women’s satisfaction with skilled delivery care was 67.31 with 95% confidence interval (60.18–74.44). Wanted pregnancy (adjusted odds ratio = 2.86, 95% confidence interval: (2.24–3.64)), having a plan to deliver at a health facility (adjusted odds ratio = 2.09, 95% confidence interval: (1.42–3.09)), access to ambulance service (adjusted odds ratio = 1.52, 95% confidence interval: (1.00–2.31)), waiting time < 15 min (adjusted odds ratio = 3.66, 95% confidence interval: (2.51–5.33)), privacy assured (adjusted odds ratio = 3.94, 95% confidence interval: (2.23–6.94)), short duration of labour < 12 hr (adjusted odds ratio = 2.55, 95% confidence interval: (1.58–4.12)), proper labour pain management (adjusted odds ratio = 3.01, 95% confidence interval: (1.46–6.22)), and normal newborn outcome (adjusted odds ratio = 3.94, 95% confidence interval: (2.17–7.15)) were associated with women’s satisfaction. Almost two-thirds of women were satisfied with skilled delivery care. In comparison, the remaining one-third were not satisfied with the care. The quality of intrapartum care, unwanted pregnancy, lack of ambulance services, prolonged duration of labour, poor labour pain management, and complicated newborn outcome were factors affecting women’s satisfaction with skilled delivery care in Ethiopia. Therefore, strategies need to be developed to increase the satisfaction level by considering the abovementioned factors during routine delivery care.

Abuse of Power on Managing the Health Care Services Policy for the Indonesian National Army Forces and its Implication on Marginalized Soldier’s Health

This research aims to understand the abuse of power on managing the health service policy and its implication that is very significant in reducing marginalized soldiers’ health due at the ontological level and sociological level. The problem is very interesting to be analyzed by conducting a qualitative research method based on public policy theory, abuse of power theory, and health services theory. Data were collected through in-depth interviews, observation, and documentation related to managing the health service policy cases in Indonesia. Data were analyzed by using interactive models are data reduction, data display, data verification, and supported by triangulation. The results were based on ontological level and sociological level using public policy perspective and power perspective for improving health service policy and practice for The Indonesian Army Forces. Vision and mission of public policy on managing health service policy are needed for providing information to stakeholders related, regarding the regulations and sanctions in health service policy. This result provides inputs for making better regulation on health service policy in Indonesia for state agencies as public officials and practitioners.

Study of Elders’ Health Status and Perception about Old Age

The health status of elders and elders’ perception regarding old age in a community is an important issue in a society. The present study aims to assess the health status and perception of old age of elderly population of Nijgadh Municipality. A descriptive cross-sectional study has been carried out among 204 elders taken from the community through simple random sampling method. The data were collected through face to face structured interview schedule in 2021. The descriptive and inferential statistical analysis of the collected data showed that the about 20 percent elders had got good status of health but remaining (about 80%) of them were suffering from some kinds of health complications. Similarly, more than 73 percent of elders felt their life more problematic. This study measured significant variation (p&lt;0.05) of level of health status with only three socio-demographic variables (age, caste, and feeling of helplessness among the variables (gender, age groups, caste, living with or without spouse, literacy status, and feeling helplessness. Furthermore, this study measured significant variation (p&lt;0.05) of perception about old age of elderly population with only three socio-demographic variable (age, caste, and feeling of helpless) among the variables (gender, age groups, caste, living with or without spouse, literacy status, and feeling helplessness). Based on the study, it can be said that age, caste, and feeling of helplessness status of elderly population were the major factors for creating variations in health status and perceptions of elderly life. The policies, programs, and community effort are needed for managing regular health service practice. Similarly, all the community members must be serious for keeping elders happy by managing their requirement with love which may require collective action from social, health and justice sectors.

Personal recovery and its challenges in forensic mental health: systematic review and thematic synthesis of the qualitative literature.

There has been a call for a framework to guide recovery-oriented practices in forensic mental health services. This study aims to examine personal recovery and its challenges in forensic mental health settings in relation to the established framework for personal recovery in mental illness: connectedness, hope, identity, meaning and empowerment (CHIME). This study is an updated and expanded systematic review and thematic synthesis of the qualitative literature. A systematic search of six electronic databases (Web of Science, Medline, PsycINFO, CINAHL, EMBASE and SocIndex) was carried out in January 2019, using the terms [Recover*] AND [Forensic OR Secure] AND [Patient* OR Offend* OR Service User*]. Only studies that included service user's own perceptions and were published from 2014 onward were included in the review. Data were examined with thematic synthesis and subsequently analysed in relation to the CHIME framework. Twenty-one studies were included in the review. Findings suggest that some adjustments to the original CHIME framework are needed for it to be more relevant to forensic populations, and that an additional recovery process regarding feeling safe and being secure (safety and security) could be added to CHIME, providing the CHIME-Secure framework (CHIME-S). Specific challenges and barriers for forensic recovery were identified and found to represent the opposite of the recovery processes defined by CHIME (e.g. hopelessness). We present the CHIME-S as a framework for the personal recovery processes of forensic mental health service users. The CHIME-S may guide the recovery-oriented work of forensic mental health services.

Part III: Recovery-Oriented Practices in Community Mental Health and Substance Abuse Services: A Meta-Synthesis

In recent decades, recovery-oriented practice has become the major approach in mental health and substance abuse care, especially in community mental health and substance abuse services. Various models of recovery-oriented practice have come to form the basis of the integration of this approach in service settings. The study aims to elucidate the characteristics of recovery-oriented practice as experienced by participants in the practice. The method used was a qualitative meta-synthesis that integrated the findings from thirty-four empirical papers published by one research group. Four meta-themes were developed: (a) helping and supporting, (b) collaborating and relating, (c) identity integration in practice, and (d) generating hope through nurturing and helping. These themes emphasize the value of relationships and connectedness, contextuality, and resources that can be mobilized in practice. The results emphasize the need to incorporate the elements in the four major themes as “working capital” for practitioners to realize recovery-oriented practice. The concepts of personal, social, and economic capital as working capital are elaborated, drawing from the meta-themes as the basis for recovery-oriented practice in mental health and substance abuse services.

Cultural competence in multi-family psychoeducation groups: The experiences of Russian-speaking immigrant mothers of adults with severe mental illness.

The successful integration of cultural competence with evidence-based practices in mental health services is still limited for particular cultural populations. The current study explored culturally adapted family psychoeducation intervention for immigrants from the former Soviet Union (FSU) in Israel who care for a family member with severe mental illness (SMI). Semi-structured in-depth interviews were conducted with 18 immigrant mothers about their experience of taking part in Russian-speaking multi-family psychoeducation groups (MFPGs). Qualitative content analysis revealed five salient processes and changes that participants attributed to their engagement in the intervention: 1) from a language barrier to utilization of and satisfaction with services; 2) from a lack of information to acquiring new mental health knowledge; 3) from harboring a family secret to exposure and sharing; 4) from social isolation to cultural belonging and support; 5) from families blurring boundaries to physical and emotional separation. The results showed that these changes-linguistic, cognitive, emotional, socio-cultural and relational-improved family coping and recovery. Implications for cultural adaptation of family psychoeducation for Russian-speaking immigrants are discussed.

Implementing individual placement and support (IPS): the experiences of employment specialists in the early implementation phase of IPS in Northern Norway. The IPSNOR study

BackgroundFor decades there has been a continuous increase in the number of people receiving welfare benefits for being outside the work force due to mental illness. There is sufficient evidence for the efficacy of Individual Placement and Support (IPS) for gaining and maintaining competitive employment. Yet, IPS is still not implemented as routine practice in public community mental health services. Knowledge about implementation challenges as experienced by the practitioners is limited. This study seeks to explore the experiences of the front-line workers, known as employment specialists, in the early implementation phase.MethodsQualitative data were collected through field notes and five focus group interviews. The study participants were 45 IPS employment specialists located at 14 different sites in Northern Norway. Transcripts and field notes were analysed by thematic analyses.ResultsWhile employment specialists are key to the implementation process, implementing IPS requires more than creating and filling the role of the employment specialist. It requires adjustments in multiple organisations. The new employment specialist then is a pioneer of service development. Some employment specialists found this a difficult challenge, and one that did not correspond to their expectations going into this role. Others appreciated the pioneering role. IPS implementation also challenged the delegation of roles and responsibilities between sectors, and related legal frameworks related to confidentiality and access. The facilitating role of human relationships emphasised the importance of social support which is an important factor in a healthy work environment. Rural areas with long distances and close- knit societies may cause challenges for implementation.ConclusionThe study provides increased understanding on what happens in the early implementation phase of IPS from the employment specialists’ perspective. Results from this study can contribute to increased focus on job satisfaction, turnover and recruitment of employment specialists, factors which have previously been shown to influence the success of IPS. The greatest challenge for making “IPS efficacy in trials” become “IPS effectiveness in the real world” is implementation, and this study has highlighted some of the implementation issues.

Research and Scholarly Methods: Pragmatic Clinical Trials.

AbstractPragmatic clinical trials (PCTs) have received increased attention within health services and pharmacy practice research due to their ability to test interventions in the real world, with emphasis on implementation and scalability in diverse practice environments. The purpose of this article is to introduce the PCT research design to health service and pharmacy practice researchers, followed by considerations and recommendations for conducting successful PCT research. It is organized into three parts, including a definition of PCTs, the process of selecting a PCT design, and general considerations and recommendations of PCTs. We conclude with the applications and trends in the use of PCTs in pharmacy research.

Infection Control and Prevention Strategies in Dental Practices during the Covid-19 Pandemic

The coronavirus-19 (COVID-19) pandemic caused by Coronavirus is causing severe acute respiratory infections. The profession of dental health service workers must know the proper infection prevention and control. The profession of dental health care workers in low-middle-income countries is at odds with developed countries in facing the challenges of a lack of personal protective equipment (PPE) and infrastructure constraints. This study aims to determine infection prevention and control strategies in dental health service practices during the Covid-19 pandemic in lower middle countries. The method used in this paper is a systematic literature review method and is analyzed according to inclusion and exclusion criteria, carried out by reviewing journals traced from international databases published between 2019 and 2021. Researchers conducted a search for data sources from the Pubmed and Mendeley databases. Search for articles in 2019-2021. There are 20 journals that fall into the criteria. The results showed that during the Covid-19 pandemic, infection prevention and control measures were needed in dental service practices in middle- and lower-income countries. Dental treatment procedures should be carried out with cross infection prevention and control in accordance with procedures and guidelines such as; patient screening, pre-treatment, treatment, post-treatment, and prevention in the dental health service practice room Keywords: COVID-19, Dental, infection prevention and protection, middle- and lower-income countries.

Building readiness for inclusive practice in mainstream health services: A pre-inclusion framework to deconstruct exclusion

Across the globe, people are not equitably included or respected by health services. This results in some people being ‘hardly reached’ and having less access to safe and appropriate care. While some health services have adopted specific agendas to increase inclusion, these services can struggle to implement such strategies because the underlying reasons for exclusion have not been addressed. This calls for preparation prior to implementation of inclusion approaches that deconstructs discourses and practices of exclusion. This paper presents a pre-inclusion framework that seeks to deconstruct exclusion in health services. Authors developed this framework from action research in four ‘mainstream’ regional health services in southeast Australia over five years. Research identified dominant discourses of exclusion among staff in these services. The study also identified common experiences of residents hardly reached by these services. Following, a range of change activities were undertaken within these services to deconstruct exclusion. Researchers also kept journals, reflected on their impact, and identified lessons learned from trying to deconstruct exclusion. Triangulating these analyses, researchers developed an interdisciplinary framework that weaves together Foucauldian theory on power/discourse with continuous quality improvement processes to embed cultural humility and voices of the hardly reached in health care. The framework outlines five foundational concepts (power as productive, deconstruction, use of continuous quality improvement processes, cultural humility and voices of service users), followed by six principles (a journey, expect resistance, whole of service approach, make visible the reasons for change, we are all cultural beings and people centred care) and six actions undertaken within health services (commitment, assessment of exclusion, action plans, structural change, reflective discussions and engagement). Until such approaches to deconstruct exclusion are implemented, inclusive agendas are likely to be ineffective.

Role of organisational factors on uptake and implementation of the B.strong brief intervention training program in Queensland Indigenous primary health care services.

The B.strong Program was an Indigenous health worker brief intervention (BI) training program delivered in Queensland from 2017-2020. This study examines the organisational factors of participating Indigenous primary health care (PHC) services that impacted on B.strong's uptake and implementation in those services. Semi-structured interviews were conducted from 2019-2020 with 20 B.strong Program trainees and four health service managers from eight purposively sampled Queensland PHC services, and one Queensland Department of Health manager, to examine their perceptions of uptake and implementation of the B.strong Program. The Consolidated Framework for Implementation Research was used as a framework for the evaluation. Data analysis was conducted using NVivo 11. Although strong PHC service support was evident for the uptake of face-to-face workshop training, it was not available to support trainees to complete online modules or for ongoing BI delivery to clients. Key organisational factors associated with both program uptake and implementation of BIs in PHC services were leadership engagement and implementation climate. Within these themes, embedding B.strong into operational practices of health services, having policies, processes and consistent administrative support to facilitate implementation, and addressing gaps in knowledge and skills of health workers were identified as needing to be improved. The study identified the lack of application of continuous quality improvement (CQI) processes to BIs at these health services as a barrier to effective implementation. The study supports the establishment of BI specific CQI initiatives inhealth services and supports better engagement with organisational leadership in BI training to ensure their ongoing support of both the training and implementation of BI.

Predictive Association of Low- and High-Fidelity Supported Employment Programs with Multiple Outcomes in a Real-World Setting: A Prospective Longitudinal Multi-site Study

PurposeThe individual placement and support (IPS) model of supported employment is a leading evidence-based practice in community mental health services. In Japan, individualized supported employment that is highly informed by the philosophy of the IPS model has been implemented. While there is a body of evidence demonstrating the association between program fidelity and the proportion of participants gaining competitive employment, the association between fidelity and a wider set of vocational and individual outcomes has received limited investigation. This study aimed to assess whether high-fidelity individualized supported employment programs were superior to low-fidelity programs in terms of vocational outcomes, preferred job acquisition, and patient-reported outcome measures (PROMs).MethodsA prospective longitudinal study with 24-month follow-up analyzed 16 individualized supported employment programs. The Japanese version of the individualized Supported Employment Fidelity scale (JiSEF) was used to assess the structural quality of supported employment programs (scores: low-fidelity program, ≤ 90; high-fidelity program, ≥ 91). Job acquisition, work tenure, work earnings, job preference matching (e.g., occupation type, salary, and illness disclosure), and PROMs such as the INSPIRE and WHO-Five Well-being index were compared between groups.ResultsThere were 75 and 127 participants in the low-fidelity group (k = 6) and high-fidelity group (k = 10), respectively. The high-fidelity group demonstrated better vocational outcomes than the low-fidelity group, i.e., higher competitive job acquisition (71.7% versus 38.7%, respectively, adjusted odds ratio (aOR) = 3.6, p = 0.002), longer work tenure (adjusted mean difference = 140.8, p < 0.001), and better match for illness disclosure preference (92.6% versus 68.0%, respectively, aOR = 5.9, p = 0.003). However, we found no differences between groups in other preference matches or PROM outcomes.ConclusionHigh-fidelity individualized supported employment programs resulted in good vocational outcomes in a real-world setting. However, enhancing service quality to increase desired job acquisition and improve PROMs will be important in the future.Clinical Trial RegistrationUMIN000025648

Effects of the first COVID-19 lockdown on quality and safety in mental healthcare transitions in England.

The COVID-19 pandemic forced the rapid implementation of changes to practice in mental health services, in particular transitions of care. Care transitions pose a particular threat to patient safety. This study aimed to understand the perspectives of different stakeholders about the impact of temporary changes in practice and policy of mental health transitions as a result of coronavirus disease 2019 (COVID-19) on perceived healthcare quality and safety. Thirty-four participants were interviewed about quality and safety in mental health transitions during May and June 2020 (the end of the first UK national lockdown). Semi-structured remote interviews were conducted to generate in-depth information pertaining to various stakeholders (patients, carers, healthcare professionals and key informants). Results were analysed thematically. The qualitative data highlighted six overarching themes in relation to practice changes: (a) technology-enabled communication; (b) discharge planning and readiness; (c) community support and follow-up; (d) admissions; (e) adapting to new policy and guidelines; (f) health worker safety and well-being. The COVID-19 pandemic exacerbated some quality and safety concerns such as tensions between teams, reduced support in the community and increased threshold for admissions. Also, several improvement interventions previously recommended in the literature, were implemented locally. The practice of mental health transitions has transformed during the COVID-19 pandemic, affecting quality and safety. National policies concerning mental health transitions should concentrate on converting the mostly local and temporary positive changes into sustainable service quality improvements and applying systematic corrective policies to prevent exacerbations of previous quality and safety concerns.