Health Service Practice Research Articles

Understanding Mental Distress: Knowledge, Practice and Neoliberal Reform in Community Mental Health Services

Understanding Mental Distress: Knowledge, Practice and Neoliberal Reform in Community Mental Health Services

Factors influencing the recovery-oriented attitudes of nursing directors in psychiatric hospitals: A cross-sectional study in Japan.

INTRODUCTION: Recovery-oriented practices in mental health services have become a global priority. Despite their proven effectiveness, Japanese hospitals have not widely implemented such practices. This study clarified psychiatric nursing directors' recovery-oriented attitudes and factors regarding promoting recovery-oriented practices to identify methods for developing these practices in Japan. This cross-sectional study used a questionnaire survey with 250 nursing directors from 1287 Japanese psychiatric hospitals. Multivariable regression analysis assessed how socio-demographic variables and Recovery Knowledge Inventory (RKI) scores affected Recovery Attitudes Questionnaire (RAQ-7) scores. The analysis revealed that more clinical and managerial experience was associated with more negative recovery-oriented attitudes. High RKI scores, knowledge of strength, hospital size and outpatient work experience were associated with more positive recovery-oriented attitudes. Implementing recovery practices requires consideration of knowledge and experience in recovery and hospital size alongside recovery training based on a hospital's organizational structure. Although the low response rate could influence the study's generalisability, it could also indicate low interest in recovery-oriented practices among professionals. Acquiring more knowledge and experience regarding recovery promotes recovery-oriented attitudes among nursing directors. An appropriate organizational culture and consideration of hospital size are required when introducing such recovery practices.

Promoting mental health through collaboration between workplaces and occupational health services – Preliminary findings from a survey and workshop in Finland

Disability due to mental health problems places a significant burden on both society and the individual. Occupational health professionals play a key role in promoting mental health in collaboration with workplaces. Our study focused on the joint preventive mental health practices of workplaces and occupational health services (OHS). We used a multiple method approach. We gathered data in parallel from September to October 2021 through an online survey and a workshop of 102 participants. The survey was sent to 25 workplaces and their OHS (N = 25), and assessed employee perceptions of collaboration in mental health practices. We set no exclusion criteria and included all responses.We used Fisher’s Exact Test in the statistical analysis. We studied 140 comments on the means of the mental health support obtainedin theworkshop, using content analysis. The survey response rate was 78 % (N = 39). The OHS providers (N = 15) claimed that mental health support was being provided through collaboration, and 74 % (N = 24) of the workplaces agreed. Content analysis streamlined collaboration methods into six upper categories: by (1) Planning measures together, (2) Strengthening employees’ resources, (3) Discussing work ability, (4) Providing supervisors/managers with support, (5) Discussing and collaborating, and (6) Clarifying responsibilities and roles in the support of mental health. We found 55 different practices for streamlining collaboration between workplaces and OHS. We conclude that the practices to promote mental health through collaboration between workplaces and OHS require joint planning.

“It is like post-traumatic stress disorder, but in a positive sense!”: New territories of the self as inner therapeutic landscapes for youth experiencing mental ill-health

The manuscript reports on a study conducted on a youth mental health intervention, proposing a novel framework to look at the therapeutic potential of viticultural landscapes. Drawing on care studies applied to agricultural contexts, the work explores how the attention-based practice of manual grape harvest in a specific natural and social environment can produce a “therapeutic landscape of the mind”. Through ethnographic research, we investigate how the spatial and social context of the viticultural environment influences the experience of a group of young people with mental-ill health, eventually supporting their process of recovery. Findings describe how the lived experience of caring for the vines while interacting with professional winegrowers in a one-to-one relationship allows participants to explore new territories of the self. It is argued that this powerful experience is not only beneficial as it unfolds, but also at a later time. Its therapeutic potential resides in the fact that the “landscape of the mind” can be recalled by the person, while positive identities associated with it and newly discovered “ways of being” can be re-enacted. The paper furthers the reflection on place-making practices of public health services and the way they can support the identification and cultivation of enabling places, particularly for vulnerable populations (e.g. young people) that can benefit from interventions conducted in non-medical, non-stigmatizing environments. The work is the result of an interdisciplinary collaboration between a psychiatrist (designing and coordinating the intervention) and a sociologist (designing and conducting the ethnographic study).

Lost in Transition: Recommendations for transition in mental health and description of two innovative Portuguese initiatives

The process of transition from Child and Adolescent Mental Health Services to Adult Mental Health Services cannot be defined only as a process of transfer from one service to another, but as an intentional and planned process, meeting the medical, psychosocial and educational needs of patients. According to descriptions from various countries, the transition process currently lacks careful planning and execution, being experienced as an abrupt process by patients and multiple people involved in their care. This paper reflects upon transition practices in mental health services, summarising the current literature and presenting two Portuguese mental health transition projects, as examples of how the process of transition might be improved. Poorly planned transitions may contribute to an increased risk of non-adherence to treatment, loss to follow-up, and poorer health outcomes, as well as significant economic costs. Despite some general guidelines on this topic, transition protocols, if available, vary significantly across countries and regions, and no current existing model appears to fully meet the identified needs of patients in transition. In Portugal, the Semente Program in Hospital Prof. Doutor Fernando Fonseca intends to identify and intervene in the care of children of adult patients with mental health issues. The Shared Service for Teens and Young Adults, a collaboration between Centro Hospitalar Psiquiátrico de Lisboa and Hospital Dona Estefânia, incorporates some of the recommendations summarised in this paper. Better understanding and development of communication pathways, continuity, coordination of care, referral protocols, and service delivery might contribute to a more robust design of transitional mental health care, thus making it more accessible, acceptable and efficient.

Diagnosis and management of sleep disorders in shift workers, with patient informed solutions to improve health services research and practice

BackgroundThe combination of shift work and an unmanaged sleep disorder carries health and safety risks. Yet, diagnosis rates for sleep disorders are low in shift workers. The aim of this study was to understand the experience of sleep disorder diagnosis and treatment in shift workers, and consider patient informed solutions to improve access to health services. MethodsSemi-structured interviews were conducted with 16 Australian shift workers with a diagnosed sleep disorder. Patient journey mapping and reflexive thematic analysis were used to understand diagnosis and management experiences. ResultsThere were highly variable experiences with diagnosis and management, often taking >5 years to seek help from a health care provider (HCP) after noticing symptoms of a sleep disorder. Three themes were constructed, including ‘the cause of the problem’, ‘prioritising work’, and ‘(dis)satisfaction and (dis)connection’. Extent of patient and HCP awareness of sleep disorders, and a prevailing attitude of shift work being ‘the problem’ impacted diagnosis, as did organisational needs (including rostering, which had both positive and negative influences on help seeking). Relationships with HCPs were important, and living on non-standard time was both a barrier and an enabler to sleep disorder care. Participants identified the need for education and awareness, prompts and easy access to screening and referral pathways, and tailored models of care. ConclusionEducation and awareness initiatives for shift workers, their employers and HCPs, together with development of a model of care for shift workers with sleep disorders may address some of the unique barriers to diagnosis and management.

Patterns of mental health services and mood disorder disability pensions: a standard comparison of Finland’s three largest hospital districts

IntroductionMental disorders are one of the most common and disabling health conditions worldwide. There is however no consensus on the best practice of system level mental health services (MHS) provision, in order to prevent e.g. mood disorder disability pensions (DPs). We analyzed the MHS provision between Finland’s three largest hospital districts Helsinki and Uusimaa (HUS), Southwest Finland and Pirkanmaa, with known differences in mood disorder DP risk but presumably equal rates of mood disorder prevalence.MethodsWe used public MHS data analyzed with the standardized DEscription and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) mapping tool, focusing on all MHS, outpatient care provision, local services without and with gatekeeping, and centralized services. We also collected demographic data based on the European Socio-Demographic Schedule (ESDS). As a novel approach, the Gini-Simpson Diversity Index (GSDI) was calculated for the districts.ResultsEvident differences were observed regarding the districts’ MHS factors. As the hospital district with lower DP risk, HUS was characterized by the highest level of regional socioeconomic prosperity as well as high service richness and diversity. With a nationally average DP risk, Southwest Finland had the highest number of MHS personnel in full-time equivalents (FTE) per 100 000 inhabitants. Pirkanmaa, with a higher DP risk, had overall the lowest service richness and the lowest FTE of the three districts in all MHS, outpatient care and local services with gatekeeping.ConclusionsOur findings indicate that greater richness and diversity of MHS, especially in outpatient and community-based settings, may serve as indicators of a balanced, high-quality service system that is more effective in preventing mood disorder DP and meeting the different needs of the population. In addition, the need for sufficient resourcing in all MHS and outpatient services is indicated. We suggest using diversity indices to complement the measuring and reporting of regional service variation.

Delivered relative dose intensity in adolescent and young adult germ cell tumours in England: Assessment of data quality and consistency from clinical trials compared to national cancer registration data.

Adolescent and young adults (AYA) with germ cell tumours (GCT) have poorer survival rates than children and many older adults with the same cancers. There are several likely contributing factors to this, including the treatment received. The prognostic benefit of intended dose intensity is well documented in GCT from trials comparing regimens. However, evidence specific to AYA is limited by poor recruitment of AYA to trials and dose delivery outside trials not being well examined. We examined the utility of cancer registration data and a clinical trials dataset to investigate the delivery of relative dose intensity (RDI) in routine National Health Service practice in England, compared to within international clinical trials. Linked data from the Cancer Outcomes and Services Dataset (COSD) and the Systemic Anti-Cancer Therapy (SACT) dataset, and data from four international clinical trials were analysed. Survival over time was described using Kaplan-Meier estimation; overall, by age category, International Germ-Cell Cancer Collaborative Group (IGCCCG) classification, stage, tumour subtype, primary site, ethnicity and deprivation. Cox regression models were used to determine the fully adjusted effect of RDI on mortality risk. The quality of both datasets was critically evaluated and clinically enhanced. RDI was found to be well maintained in all datasets with higher RDIs associated with improved survival outcomes. Real-world data demonstrated several strengths, including population coverage and inclusion of sociodemographic variables and comorbidity. It is limited in GCT however, by the poor completion of data items enabling risk classification of patients and a higher proportion of missing data.

Developing sustainable service user involvement practices in mental health services in Sweden: the "Userinvolve" research program protocol.

The purpose of this paper is to outline the protocol for the research program "UserInvolve," with the aim of developing sustainable, service user involvement practices in mental health services in Sweden. This protocol outlines the knowledge gap and aim of the UserInvolve-program. It further provides an overview of the research infrastructure, with specific focus on the organization and management of the program as well as the design of the six underlying research projects. These six research projects form the core of the UserInvolve-program and will be carried out during a six-year period (2022-2027). The projects are focused on examining articulations of experiential knowledge in user collectives, on four specific user involvement interventions (shared decision-making, peer support, user-focused monitoring, and systemic involvement methods) and on developing theory and method on co-production in mental health research and practice. The knowledge gained through the co-production approach will be disseminated throughout the program years, targeting service users, welfare actors and the research community. Based on these research activities, our impact goals relate to strengthening the legitimacy of and methods for co-production in the mental health research and practice field.

Higher education student perceptions regarding the practice of telemental health services in Kingdom of Saudi Arabia.

To study higher education student perceptions regarding the practice of telemental health services in Saudi Arabia. The study conducted a cross-sectional descriptive design through an online self-administered survey. The targeted number of responses was set to at least 385 convenience-sample students who were enrolled in different degree programs at the selected university for the Spring 2022 semester. Data collection was done during March 2022. The sample population was 401 eligible responses. Most respondents Most respondents were from Riyadh (39.15%), females (66.33%), single (64.83%) at the time of data collection. Forty-five percent of participants did not use any telemental health services in the past. Moreover, 34.41% of the participants reported that they preferred to use mixed methods of mental services that combined face-to-face and distanced interactions. Telemental services that can be provided based on students' perceptions were consultations (75.81%), followed by education and promotion (64.33%). Almost half of the participants reported that the internet and culture are among the factors that have shaped their perceptions of telemental health in Saudi Arabia, while the least important factor was their experience with providers. The current study showed that the higher education students perceived telemental health positively and were willing to use telemental health in the future; in addition, the most essential technologies related to telemental health services were videoconferences, audio-visuals, and telephones.

Building public trust and confidence in secondary use of health data for healthcare improvement and research: a qualitative study pre-protocol

Background Secondary use of health data provides opportunities to drive improvements in healthcare provision, personalised medicine, comparative effectiveness research, health services innovation, and policy and practice. However, secondary data use requires compliance with relevant legislation, implementation of technical safeguards, ethical data management, and respect for data sharers. Existing evidence suggests widespread support for secondary use of health data among the public, which co-exists with concerns about privacy, confidentiality and misuse of data. Balancing the protection of individuals’ rights against the use of their health data for societal benefits is of vital importance, and trust underpins this process. The study protocol explores how to build public trust and confidence in the secondary use of health data through all key stakeholder groups in Ireland, towards developing a culture that promotes a safe and trustworthy use of data. Methods This study will adopt a qualitative cross-sectional approach conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research COREQ guidelines. Participants in the study will include academics and researchers; healthcare professionals, data protection, ethics and privacy experts and data controllers; pharmaceutical industry and patients and public. Purposive and convenience sampling techniques will be utilised to recruit the participants, and data will be collected utilizing focus groups that may be supplemented with semi-structured interviews. Data will be coded by themes using reflexive thematic analysis (TA) and collective intelligence (CI) will be convened post-analysis to explore the preliminary findings with the participants. Ethics and Dissemination Ethical approval was obtained from the Royal College of Surgeons in Ireland Research Ethics Committee (REC202208013). Final data analysis and dissemination is expected by Q1 2024. Findings will be disseminated through peer-reviewed journal publications, presentations at relevant conferences, and other academic, public and policy channels. Lay summaries will be designed for Public and Patient Involvement (PPI) contributors and general public.

보건·복지 공무원의 역량 강화를 위한 교육적 요구도 분석

The purpose of this study is to analyze the educational needs of health and welfare officialswho have changed after COVID-19 to strengthen their competencies and improve their practicalwork skills. To fulfill the purpose of the study, 30 educational needs were identified throughthe analysis of previous studies and FGIs with 12 health and welfare officials organized byposition. Based on these, a questionnaire was created and sent to health and welfare officialsthrough an online platform to receive responses, with a total of 240 participants. The collecteddata was analyzed using the Borich Needs Formula and The Locus for Focus Model, and theeight areas with overlapping factors among the priorities derived from both methods werepresented as the top priorities. The top priority educational needs identified were digitalcompetencies, communication skills tailored to subject characteristics,, understanding andpracticing health and welfare services, disaster and crisis command and management in localcommunities, integrated practices in health and welfare services, counseling techniques foraddressing grievances, understanding and mediating inter-organizational conflict, andself-leadership. These results can be used as a basis for establishing an educational system todevelop the capacity of health and welfare officials and improve their professionalism.

Principles for secondary traumatic stress-responsive practice: An expert consensus approach.

Though research on secondary traumatic stress (STS) has greatly increased in the past decade, to date the field lacks a coherent set of guiding principles for practice that behavioral health providers and organizations can use to mitigate the occurrence and impact of STS. As such it is important to identify effective strategies, grounded in research and professional experience, to reduce the occurrence and impact of STS among behavioral health professionals and organizations. We conducted a four-stage modified Delphi survey. Thirty-one international STS experts were invited to participate, with a minimum of 19 responding in each round. Thematic analysis was conducted on qualitative data, which was incorporated into revisions of the principles. Consensus was achieved on 14 principles, seven targeted at individual professionals, and seven targeted at organizations. This is the first effort to delineate principles for practice intended to reduce the occurrence and impact of STS in individual and organizational practice in behavioral health services. The principles are intended to inform best practices for individuals and organizations providing services to persons and communities who have experienced trauma and thereby improve the quality and effectiveness of services to traumatized populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Assessment of knowledge, attitude, and practice of public primary school teachers on school health programme in Bende Local Government Area of Abia State, Nigeria

Background: The National School Health Policy recommends School Based Committee for schools which is responsible for the implementation of school health programmes (SHP). There are not enough medical doctors to deliver healthcare services in the primary schools hence teachers are looked upon to assist in healthcare delivery in schools. Teachers are in a vantage position to facilitate health among school-aged children. Children spend greater part of their time in school and have opportunity to regularly receive instructions in healthy living from their teachers. Methodology: This was a descriptive cross-sectional study conducted in 34 public primary schools in Bende Local Government Area (LGA), Abia State. All the primary school teachers (320) in the LGA were studied. Data were collected using pre-tested self-administered questionnaire. Data were analysed using SPPSS version 26 and presented in frequency tables. Chi-square was used to test association between categorical variables. P<0.05 was taken as statistically significant. Results: Ages of the participants were positively skewed with a mean value of 39.5±6.793 and a skewness of 0.136. From the findings, 204(63.7%) had good knowledge, 124 (38.7%) had positive attitude and 150 (46.9%) had good practice to school health services. There were statistically significant differences between socio-demographic characteristics and good knowledge and positive attitudes. There was statistically significant difference between socio-demographic characteristics and practice of school health services except marital status with a p-value of 0.108. Conclusion: The participants had good knowledge but negative attitude and poor practice of school health services. There may be need for training intervention studies in school health services to upgrade teachers’ knowledge, attitude and practice. There should be a legislation in the state and country requiring prospective teachers to obtain a diploma in school health services before engaging in teaching profession.

Development and maturation of the occupational health services research field in the United States over the past 25 years: Challenges and opportunities for the future.

Work is an important social determinant of health; unfortunately, work-related injuries remain prevalent, can have devastating impact on worker health, and can impose heavy economic burdens on workers and society. Occupational health services research (OHSR) underpins occupational health services policy and practice, focusing on health determinants, health services, healthcare delivery, and health systems affecting workers. The field of OHSR has undergone tremendous expansion in both definition and scope over the past 25 years. In this commentary, focusing on the US, we document the historical development and evolution of OHSR as a research field, describe current doctoral-level OHSR training, and discuss challenges and opportunities for the OHSR field. We also propose an updated definition for the OHSR field: Research and evaluation related to the determinants of worker health and well-being; to occupational injury and illness prevention and surveillance; to healthcare, health programs, and health policy affecting workers; and to the organization, access, quality, outcomes, and costs of occupational health services and related health systems. Researchers trained in OHSR are essential contributors to improvements in healthcare, health systems, and policy and programs to improve worker health and productivity, as well as equity and justice in job and employment conditions. We look forward to the continued growth of OHSR as a field and to the expansion of OHSR academic training opportunities.

Effects of Telephone Consultation on Safety, Service Use, Patient Satisfaction, and Workload: Systematic Review and Meta-Analysis of Randomized Trials.

Objective: Telephone consultation (TC) is widely used for its easy access and convenience. This review aimed to assess the effects of TC including triage on safety, service use, patient satisfaction, and health professionals' workload to inform directions for future health service practice. Methods: CENTRAL, MEDLINE, Embase, CINAHL, ProQuest Dissertation & Theses (Health & Medicine), ClinincalTrials.gov, and International Clinical Trial Registry Platform were searched on April 7, 2022. The included were randomized controlled trials that compared TC with standard (face-to-face [F2F]) management or that by another group of call advisers. Cochrane methods were used to select eligible studies, assess the risk of bias, estimate summary effect measure, and grade evidence certainty. Meta-analysis was performed on important outcomes with moderate- or high-quality evidence. Results: Eight studies were included involving 40,002 participants. TC could increase call resolution-proportion of callers' concerns being addressed by telephone advice alone (two studies; high certainty) and reduce F2F contacts with doctors for the first consultation (two studies, moderate certainty) compared with standard management or TC by doctors. None of included studies reported increases in adverse events, including all-cause mortality, acute and emergency department visit, and hospitalization. There was inadequate evidence regarding the effects of TC on patient satisfaction and length of consultation. Conclusion: The findings support the benefits of TC on improving call resolution and reducing F2F contacts with doctors on the day of first management for regular day service; and TC by nurses can provide better effects than that by doctors for out-of-hours service.

Fostering equitable change in health services: Using critical reflexivity to challenge dominant discourses in low back pain care in Australia.

Justice and equity-focused practices in health services play a critical but overlooked role in low back pain (LBP) care. Critical reflexivity - the ability to examine and challenge power relations, and broader social issues embedded in everyday life - can be a useful tool to foster practices that are more socially just. No research has yet explored this approach in back pain health services. This study sought to understand how clinicians construct LBP in relation to broader socio-cultural-political aspects of care and explore if those constructions changed when clinicians engaged with critically reflexive dialogues with researchers. Using critical discourse analysis methods, this qualitative study explored institutionalised patterns of knowledge in the construction of LBP care. We conducted 22 critically reflexive dialogues with 29 clinicians from two health services in Australia - a private physiotherapy clinic and a public multidisciplinary pain clinic. Our analyses suggested that clinicians and services often constructed LBP care at an individual level. This dominant individualistic discourse constrained consideration of justice-oriented practices in the care of people with LBP. Through dialogues, discursive constructions of LBP care expanded to incorporate systems and health service workplace practices. This expansion fostered more equitable clinical and service practices - such as assisting patients to navigate health care systems, considering patients' socioeconomic circumstances when developing treatment plans, encouraging staff discussion of possible systemic changes to enhance justice, and fostering a more inclusive workplace culture. Although such expansions faced challenges, incorporating broader discourses enabled recommendations to address LBP care inequities. Critical reflexivity can be a tool to foster greater social justice within health services. By expanding constructions of LBP care beyond individuals, critical reflexive dialogues can foster discussion and actions towards more equitable workplace cultures, services and systems.

Stress among UK consultant urologists and factors influencing when they leave full-time NHS practice

Objective: The UK medical workforce is in crisis. The number of surgeons in National Health Service (NHS) practice has decreased, partly because newly qualified doctors withdraw from the workforce, and partly because of the early retirement of experienced surgeons. The reasons for urological trainee loss are largely known, but stress factors influencing the retirement of consultants before state pension age (SPA) are not. Methods: An online survey of the consultant membership of the British Association of Urological Surgeons was carried out over a 12-week period starting in September 2020. Information was sought regarding stresses at work and home, together with factors affecting retirement decisions. Data analysis was performed if > 90% of questions were complete. Results: Overall, 36.5% of 1374 invitees completed the survey. Workplace-based issues were the main causes of stress: on-call, an unsupportive working environment, complaint handling and poor relations with hospital managers were predominant factors which were exacerbated by punitive taxation. Experienced urologists ameliorated these factors by reducing their contracted activity, increasing part-time working and, ultimately, retiring before SPA. Conclusions: Workplace-based factors are associated with stress reported by consultant urologists. Alleviation of stressor factors, especially those related to on-call activity, should be explored to reduce the erosion of the senior workforce. Level of evidence: Not applicable

Enhancing Traditional Health Services: Empowering Holistic Care Clinic

Traditional Health Service Development: Enhancing Knowledge and Skills for Holistic Care Clinic. This study aims to improve the knowledge and skills of Pimpinan Cabang Aisyiyah (PCA) Jambangan Surabaya members in providing traditional health services at Klinik Aisyiyah Holistic Care. The program includes training in acupressure and marketing and financial management. Twelve participants from PCA Jambangan attended the training and registered with the Indonesian Association of Acupressure Practitioners (P3AI) to undergo competency tests and obtain necessary permits from the Surabaya Health Department for practicing traditional health services at the clinic. The implementation coincided with the PCA Jambangan's musycab launching. The successful completion of the program resulted in the issuance of the clinic's operational permit and the availability of qualified human resources to provide complementary health services to the community.
 Highlight:
 
 
 Empowering traditional health practitioners: The study focuses on enhancing the knowledge and skills of PCA Jambangan members to provide effective traditional health services at Klinik Aisyiyah Holistic Care.
 
 
 Training in complementary therapies: The program includes specialized training in acupressure, enabling participants to offer holistic care options to the community.
 
 
 Obtaining necessary permits: Participants undergo competency tests and secure permits from the Surabaya Health Department, ensuring legal practice of traditional health services at the clinic.
 
 
 Keyword: Traditional Health Services, Holistic Care Clinic, Knowledge Enhancement, Skills Development, Acupressure Training

Enhancing Traditional Health Services: Empowering Holistic Care Clinic

Traditional Health Service Development: Enhancing Knowledge and Skills for Holistic Care Clinic. This study aims to improve the knowledge and skills of Pimpinan Cabang Aisyiyah (PCA) Jambangan Surabaya members in providing traditional health services at Klinik Aisyiyah Holistic Care. The program includes training in acupressure and marketing and financial management. Twelve participants from PCA Jambangan attended the training and registered with the Indonesian Association of Acupressure Practitioners (P3AI) to undergo competency tests and obtain necessary permits from the Surabaya Health Department for practicing traditional health services at the clinic. The implementation coincided with the PCA Jambangan's musycab launching. The successful completion of the program resulted in the issuance of the clinic's operational permit and the availability of qualified human resources to provide complementary health services to the community.
 Highlight:
 
 
 Empowering traditional health practitioners: The study focuses on enhancing the knowledge and skills of PCA Jambangan members to provide effective traditional health services at Klinik Aisyiyah Holistic Care.
 
 
 Training in complementary therapies: The program includes specialized training in acupressure, enabling participants to offer holistic care options to the community.
 
 
 Obtaining necessary permits: Participants undergo competency tests and secure permits from the Surabaya Health Department, ensuring legal practice of traditional health services at the clinic.
 
 
 Keyword: Traditional Health Services, Holistic Care Clinic, Knowledge Enhancement, Skills Development, Acupressure Training