Experience In Primary Health Care Research Articles

Using diaries to explore the work experiences of primary health care nursing managers in two South African provinces

BackgroundSouth Africa is on the brink of another wave of major health system reforms that underscore the centrality of primary health care (PHC). Nursing managers will play a critical role in these reforms.ObjectiveThe aim of the study was to explore the work experiences of PHC clinic nursing managers through the use of reflective diaries, a method hitherto under-utilised in health systems research in low- and middle-income countries.DesignDuring 2012, a sub-set of 22 PHC nursing managers was selected randomly from a larger nurses’ survey in two South African provinces. After informed consent, participants were requested to keep individual diaries for a period of 6 weeks, using a clear set of diary entry guidelines. Reminders consisted of weekly short message service reminders and telephone calls. Diary entries were analysed using thematic content analysis. A diary feedback meeting was held with all the participants to validate the findings.ResultsFifteen diaries were received, representing a 68% response rate. The majority of respondents (14/15) were female, each with between 5 and 15 years of nursing experience. Most participants made their diary entries at home. Diaries proved to be cathartic for individual nursing managers. Although inter-related and not mutually exclusive, the main themes that emerged from the diary analysis were health system deficiencies; human resource challenges; unsupportive management environment; leadership and governance; and the emotional impact of clinic management.ConclusionsDiaries are an innovative method of capturing the work experiences of managers at the PHC level, as they allow for confidentiality and anonymity, often not possible with other qualitative research methods. The expressed concerns of nursing managers must be addressed to ensure the success of South Africa's health sector reforms, particularly at the PHC level.

Importance of community engagement in primary health care: the case of Afghan refugees.

Refugees can experience problems accessing and utilising Australian primary health care services, resulting in suboptimal health outcomes. Little is known about the impact of their pre-migration health care experiences. This paper demonstrates how the Afghan pre-migration experiences of primary health care can affect engagement with Australian primary care services. It considers the implications for Australian primary health care policy, planning and delivery. This paper is based on the international experiences, insights and expert opinions of the authors, and is underpinned by literature on Afghan health-seeking behaviour. Importantly, Afghanistan and Australia have different primary health care strategies. In Afghanistan, health care is predominantly provided through a community-based outreach approach, namely through community health workers residing in the local community. In contrast, the Australian health care system requires client attendance at formal health service facilities. This difference contributes to service access and utilisation problems. Community engagement is essential to bridge the gap between the Afghan community and Australian primary health care services. This can be achieved through the health sector working to strengthen partnerships between Afghan individuals, communities and health services. Enhanced community engagement has the potential to improve the delivery of primary health care to the Afghan community in Australia.

Patient-reported confidence in primary healthcare: are there disparities by ethnicity or language?

ObjectiveTo examine whether confidence in primary healthcare (PHC) differs among ethnic–linguistic groups and which PHC experiences are associated with confidence.DesignA cross-sectional study where patient surveys were administered using random digit...

Primary Health Care Experiences of Hispanics with Serious Mental Illness: A Mixed-Methods Study

This mixed-methods study examines the primary health care experiences of Hispanic patients with serious mental illness. Forty patients were recruited from an outpatient mental health clinic. Participants reported a combination of perceived discrimination and stigmatization when receiving medical care. They rated the quality of chronic illness care as poor and reported low levels of self-efficacy and patient activation. These indicators were positively associated with how patients viewed their relationships with primary care providers. A grounded model was developed to describe the structural, social, and interpersonal processes that shaped participants' primary care experiences.

Mothers’ perceptions of primary health-care providers: thematic analysis of responses to open-ended survey questions

General practitioners and maternal, child and family health nurses have a central role in postpartum primary health care for women and their infants. Positive client-provider relationships are particularly important for women experiencing mental health problems or unsettled infant behaviour. However, little is known about their experiences of postnatal primary health care. The study aimed to describe views of postnatal primary health care among women completing a residential early parenting programme and to identify potential strategies to enhance provider-patient interactions. Participants (n=138) were women admitted with their infants to a private or a public early parenting service in Melbourne, Australia. Women completed a detailed self-report survey, including open-ended questions about experiences of primary health-care services, and a structured psychiatric interview to diagnose anxiety and depression. Survey responses were analysed thematically. Womens' experiences of primary health care were influenced by their perceptions of provider competence and the quality of interactions. While similar positive characteristics of doctor and nurse care were valued, medical and nursing practices were judged in different ways. Women described GPs who listened, understood and were thorough as providing good care, and maternal, child and family health nurses were valued for providing support, advice and encouragement. Threats to therapeutic relationships with doctors included feeling rushed during consultations, believing that GPs were not mental health-care providers and the clinician not being 'good' with the infant; with nurses, problems included feeling judged or given advice that was inconsistent or lacked an evidence-base. Postpartum primary health care will be improved by unhurried consultations, empathic recognition, encouragement, evidence-informed guidance and absence of criticism.

What exposure do student nurses have to primary health care and community nursing during the New Zealand undergraduate Bachelor of Nursing programme?

A research project to examine the theoretical and practical exposure student nurses have to Primary Health Care (PHC) and community nursing in their undergraduate programme was undertaken in New Zealand (NZ). Providing quality clinical placements for health care students is acknowledged as a major challenge for tertiary institutions. In order to reflect the current shift in health care delivery from hospital to community settings, one such challenge is to ensure students receive appropriate theoretical programme content and clinical experience in PHC and community settings. The project consisted of a review of relevant international literature, and a questionnaire sent to all NZ tertiary institutions providing a Bachelor of Nursing (BN). Findings included a variable understanding of the concept of PHC, a lack of appropriate PHC placements across the country, competition for student placements in PHC, and professional organisation requirements for student supervision impacting on placement availability. Innovations identified to increase PHC placements comprised the establishment of Dedicated Education Units (DEUs), curriculum revision, and final year PHC placements offered only to students targeting PHC settings on registration. Study recommendations involve establishing a regional rather than a local approach to managing clinical placements, increasing professional governance support and reviewing clinical placement funding.

Priorities for young adults when accessing UK primary care: literature review

This literature review focuses on what matters to young adults when they access primary care services in the United Kingdom. Patients' access to and experience of primary care services differs across age groups. Existing research has largely focused on the needs and experiences of children, adolescents, and adults. There is some evidence to suggest the views of young adults (aged 18-25 years) that may differ from the views of other age groups, and research has not previously reported specifically on the views of this group of the population. The literature was reviewed to identify the views and priorities of young UK adults regarding primary healthcare provision, and furthermore, to identify those related topics that would benefit from further research. Relevant academic publications and grey literature published from 2000 onwards was reviewed and synthesised. We identified and reported emerging themes that were of importance to young adults in respect of the UK primary care provision. A total of 19 papers met our inclusion criteria. Young adults access primary care services less frequently than other age groups; this may be because of their experience of primary care throughout childhood and adolescence. Five aspects of primary care provision emerged as being of importance to young adults--the accessibility and availability of services, the confidentiality of health-related information, issues relating to communication with healthcare professionals, continuity of care, and behaviours and attitudes expressed towards young adults by healthcare professionals. There is a lack of focus of current research on the expectations, needs, and primary healthcare experiences of young adults. Young adults may hold views that are distinct from other age groups. Further research is needed to better understand the needs of a young adult population as their needs may impact the future use of services.

The Practice of Telehealth by Nurses: An Experience in Primary Healthcare in Brazil

In Brazil, in order to train the Family Health Strategy teams, the Health Ministry implemented the Brazil Telehealth Program to provide health support and permanent health education. In Pernambuco, the Telehealth Center Network of Pernambuco (RedeNUTES) offers telehealth services to 80 municipalities, supporting 154 Family Health Strategy teams. The goal of this article is to present a profile of nurses' participation in the telehealth services developed by RedeNUTES. This article is a descriptive study of the actions taken by nurses in tele-education and in the telesupport environment, covering the period from the beginning of 2009 to the end of 2010. Three-hundred forty-nine Web conferences in tele-education, which included nurses both as lecturers and as members of the audience, were analyzed. The median average number of participants was 50 per course during the 2-year period. The participation in the training courses, among the higher-education professionals, was mainly composed of nurses. In telesupport, nurses participated as teleconsultants, answering questions received by electronic forms and by remote Web conference consultations. The most popular categories found in the requests for second opinion, submitted by nursing professionals, were obstetrics, gynecology, and pediatrics. We conclude that nurses have participated in telehealth services as members of the audience, as lecturers, and as teleconsultants. We also consider that the active participation of nurses could bring benefits to the quality of the telehealth services provided to the community. These practices could help predict how healthcare will look like in the next few years.

Primary health care in Italy: from medical behaviour to teamwork

Primary health care represents an essential area in relation to health protection: its purposes are, on the one hand, health promotion, on the other hand the possibility to resort only if necessary to hospital care. In the novel National Collective Agreement, new teamwork forms of organization are introduced; for example, the obligatory Territorial Functional Aggregation: an organizational Unit which general practitioners and general paediatricians join to. The article by Scala et al. (see page 17), about an experience of primary health care, focuses the necessity to plan new organizational forms of work for teams oriented to realize efficient and effective answers to population needs: the phases of the activities in équipe are analysed, lingering on lights and shadows of the team.

Child injury surveillance that guides interventions: the Beijing primary healthcare experience

ObjectivesTo provide feedback to guide injury prevention interventions and to test the feasibility of integrating injury surveillance into the existing primary healthcare service for children under 6 years of age.DesignThis...

Perceptions of unmet healthcare needs: what do Punjabi and Chinese-speaking immigrants think? A qualitative study

BackgroundUnmet healthcare needs - the difference between healthcare services deemed necessary to deal with a particular health problem and the actual services received - is commonly measured by the question, "During the past 12 months, was there ever a time when you felt that you needed healthcare, but you didn't receive it?" In 2003, unmet needs were reported by 10% of immigrants in Canada, yet, little is known specifically about Chinese- or Punjabi-speaking immigrants' perceptions and reporting of unmet needs. Our study examined: 1) How are unmet healthcare needs conceptualized among Chinese- and Punjabi-speaking immigrants? 2) Are their primary healthcare experiences related to their unmet healthcare needs?MethodsTwelve focus groups (6 Chinese, 6 Punjabi; n = 78) were conducted in Chinese or Punjabi and socio-demographic and health data were collected. Thematic analysis of focus group data examined the perceptions of unmet needs and any relationship to primary healthcare experiences.ResultsOur analysis revealed two overarching themes: 1) defining an unmet healthcare need and 2) identifying an unmet need. Participants had unmet healthcare needs in relation to barriers to accessing care, their lack of health system literacy, and when the health system was less responsive than their expectations.ConclusionsAsking whether someone ever had a time when they needed healthcare but did not receive it can either underestimate or overestimate unmet need. Measuring unmet need using single items is likely insufficient since more detail in a revised set of questions could begin to clarify whether the reporting of an unmet need was based on an expectation or a clinical need. Who defines what an unmet healthcare need is depends on the context (insured versus uninsured health services, experience in two or more healthcare systems versus experience in one healthcare system) and who is defining it (provider, patient, insurer).

Fonoaudiologia e Núcleos de Apoio à Saúde da Família: conceitos e referências

Visando dar subsídios à análise do trabalho do fonoaudiólogo na Atenção Básica, mais especificamente nos Núcleos de Apoio à Saúde da Família (NASF), este artigo realizou revisão da literatura sobre o tema abordado usando ferramentas de busca do Medline, SciELO e o LILACS, por intermédio da pesquisa avançada simultânea de base de dados da Biblioteca Virtual em Saúde (BVS), da Bireme. Procurou-se resgatar um pouco da história da Fonoaudiologia no SUS e dar ênfase à importância da Estratégia de Saúde da Família relacionada ao serviço de Fonoaudiologia nos NASFs. A pesquisa realizada aponta que a atuação da Fonoaudiologia dentro do sistema de saúde é bastante extensa, perpassando diferentes níveis de assistência, o que requer o desenvolvimento de distintas tecnologias de trabalho em saúde. As ações desenvolvidas pelos NASFs exigem, necessariamente, a atuação de equipes interdisciplinares, implicadas em processos de trabalho transdisciplinar e na criação/invenção de dispositivos terapêuticos. A análise das experiências de atuação da Fonoaudiologia na Atenção Básica, na Saúde da Família e, mais recentemente, nos NASFs, merece ser acompanhada e avaliada de perto para que se possa avançar na produção e sistematização de práticas de cuidado à saúde que respondam às necessidades da população e que sejam capazes de enfrentar os graves efeitos dos distúrbios de linguagem, voz, motricidade oral e audição. Desta forma conclui-se que se faz necessário o monitoramento e sistematização dos limites e potencialidades deste modelo, visando seu aprimoramento e apropriação do mesmo, como estratégia de atenção integral, de inserção da Fonoaudiologia no SUS.

Healthcare providers’ knowledge of standard precautions at the primary healthcare level in Saudi Arabia

The aim of this study was to assess knowledge of standard precautions (SPs) and infection control by healthcare workers (HCWs) at the primary healthcare level in Al-Hassa, and to define possible correlates that influence such knowledge. All HCWs at primary healthcare centres in Al-Hassa were targeted for the survey. A self-administered questionnaire was designed and pre-tested. The data gathered covered basic knowledge of components of SPs and infection control including objectives, hand hygiene, personal protective equipment, sharps disposal, environmental sanitation and care of healthcare providers. Attitudes pertaining to implementation of SPs and training needs were also assessed. Knowledge deficits of components of SPs were demonstrated, especially those related to hand hygiene, sharps disposal, management of sharps injuries and environmental cleaning. Misconceptions were identified in the management of HCWs after exposure to patients with communicable diseases and following sharps injuries. Age of providers, speciality and previous on-the-job training did not influence the knowledge of the participants. Female gender, holding a postgraduate degree and >5 years of experience in primary healthcare were positive correlates to the knowledge score. Lack of resources and training opportunities, and excessive workload were the most frequent factors cited by HCWs for not implementing SPs during routine tasks. The level of knowledge of SPs by HCWs in primary healthcare in Al-Hassa is low. Current training and medical and nursing school curricula should therefore be revised.

The dynamics of community and NGO partnership: primary health care experiences in rural Mali

Utilizing ethnographic research methods, this case study examines the experiences of an NGO-sponsored health care program in rural Mali. The findings indicate that while, in principle, the organization operates from an alternative development base, it has been unable to decentralize the decision-making process and facilitate community dialogue and participation. Numerous problems resulted, including superficial forms of local participation, lack of community ownership, non-remuneration of health workers and midwives, inadequate training, and ultimately, limited program gains. The analyses highlight the complexity and dynamic nature of health program implementation in a developing context, and suggest several factors important to project success. These include drawing on diverse local perspectives, promoting broad-based participation, and providing culturally appropriate ways to include all community members, particularly women.

Multidisciplinary Practice Experience of Nursing Faculty and Their Collaborators for Primary Health Care in Korea

This study aimed to describe the range of participation of nursing faculty members and their collaborators in multidisciplinary primary health care in Korea and to analyze facilitators, benefits, barriers, and learned lessons. An exploratory descriptive research design was utilized. A total of 13 nursing faculty members and 13 multidisciplinary collaborators were interviewed face to face using a brief questionnaire and semi-structured interview guide. Descriptive statistics, comparative analysis, and content analysis were used for data analysis. About 43% of the nursing faculty had multidisciplinary primary health care experience. Facilitators included a government-funded research/demonstration project, personal belief and expertise in primary health care, and well-delineated role boundaries. Benefits included improved quality of life, more convenient community life, meeting multifaceted needs of community residents, and enhanced research activities. Barriers were lack of teamwork; territoriality and self-protective behaviors; lack of insight into primary health care among stakeholders; nurses undervaluing their work; and the rigid bureaucratic system of public health centers. Learned lessons were the importance of teamwork and its synergistic benefits, the importance of conducting clinically relevant research, having the government's support in the improvement of public health, developing health policies through multidisciplinary primary health care (M-D PHC) work, and respecting each other's territory and expertise. Teamwork should be included in all health professions' curricula, and nursing clinical practicums should include primary health care in all specialty areas. More faculties should engage in multidisciplinary primary health care. The benefits of a multidisciplinary approach to primary health care outweigh the difficulties experienced by multidisciplinary team members. The findings of this study may be useful for future multidisciplinary primary health care work worldwide.

Managing Primary Care Using Patient Satisfaction Measures

Our study aimed to identify which attributes of a primary healthcare experience have the most impact on patient satisfaction as well as which aspects of each attribute are most significant in patients' response to the services they receive. The three attributes examined in this study were access, staff care, and physician care. Analyses of the aspects of each attribute controlled for age, gender, and race. Data used in this study were obtained through a survey questionnaire with random sampling, resulting in the sample size of 8,465. The psychometric properties of the questionnaire were also examined and showed appropriate reliability and validity. The multiple regression analysis showed that among the three attributes, physician care was most influential, closely followed by staff care, with access having much less influence. Further analyses revealed that specific aspects of each attribute were more influential on patient satisfaction. Within the physician care attribute, patients were found to be rational consumers who were looking for surrogate indicators of correct diagnosis and treatment options among the measures available to them. They were much less likely to be influenced by so-called bedside manner. Within the staff care attribute, willingness and compassionate behaviors of staff and prompt service were most important. Within the access attribute, patients sought caring interaction with appointment personnel. After considering the findings, we discuss possible actions for healthcare managers.

Identifying HIV/AIDS primary care development needs

This paper reports a study aimed at identifying the primary health care experiences of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Malaysia. The rationale behind the study was to enable informed action for developing more responsive and effective primary care. Reports such as from the World Health Organisation forecast sharp escalations in the incidence of HIV/AIDS in Malaysia and the Asia-Pacific region within the next few years. With sparse information on the course of infection on the local population and an understanding of health care needs of those afflicted, health services would be ill-prepared for projected increases. Semi-structured interviews were conducted with a convenience sample of 99 patients attending two major HIV/AIDS clinics in Malaysia. Several gaps in care provision were highlighted, such as with treatment/consultation facilities and availability and accessibility of information. What is also evident is that there are a number of good support services available but not well publicized to those in need of them. That includes health professionals who could be making appropriate referrals. The lack of communications and inter-professional working appears to be part of the problem. The findings provide baseline data and preliminary insights to government and other service providers towards advancing, optimizing and refining existing policies and infrastructure. Although the availability of a number of primary care facilities have been identified, the study indicates the need for more effective co-ordinated efforts with clear leadership to pull together scarce resources towards the aim of some degree of seamless primary care provision. It is suggested that nurses would be well placed for such a role in view of the nature of their education and training that helps prepare them for the multi-faceted role.

Assessing community healthcare needs: lessons from Africa.

This article describes participatory approaches to needs assessments for community profiling in developing countries. It reviews the literature on compiling community profiles, provides an insight into conducting these in developing countries, and draws out lessons for those contemplating community profiling in the UK. The author's experience of primary health care in Africa shows that involving communities in the collection and analysis of data improves the value and quality of information, and the appropriateness of the programmes that result.

Physical Therapists' Emotional Expressions in Interviews about Factors Important for Interaction with Patients

Interactions between patients and physiotherapists have been studied by various researchers. Some results indicate that physiotherapists have an awareness of underlying emotions, but often respond only on an intellectual level. It seems that verbally expressed emotions may be important for interaction between physiotherapists and patients during treatment. Aim The aim of this study was to investigate how many and what verbally expressed emotions physiotherapists state during interviews between physiotherapists and patients. Method The study was a qualitative case study with cross-case analysis according to Shepard et al (1993) and Merriam (1988). Ten informants participated, all of them 'experts in interaction with patients', women, Swedish-speaking, and with at least five years' experience in primary health care. The physiotherapists' emotions were categorised according to Tomkins (1984) and Izard (1977) in the categories of interest/excitement, surprise/startle, enjoyment/joy, sadness, anger/rage, fear/terror, shame/humiliation, contempt and disgust. Results Positive emotions such as interest and joy were expressed most often in the interviews, in situations where physiotherapy had been successful, as joyful contacts with colleagues, or in situations where humour was used as a therapeutic instrument. Surprise, sadness and anger were expressed more seldom and contempt or disgust were not expressed at all in the interviews. Conclusion Verbal expressions of emotions in treatment situations in physiotherapy practice should be promoted more emphatically. This may start a reflective process in both patients and physiotherapists and deepen the understanding of the interaction. (Less)

Is it a healthy experience? what primary care offers people with learning disabilities

The 1995 Department of Health’s strategy document on the health of the nation for people with learning disability argues strongly that they should have access to the full range of NHS services. Members of the Community Team in Bolton used local experience of primary health care to improve access to such services. Here Duncan Mitchell and Stephanie Pickup explain the team’s findings