Primary Services Research Articles

Spatiotemporal characteristics and socio-ecological drivers of ecosystem service interactions in the Dongting Lake Ecological Economic Zone

Uncovering the spatiotemporal characteristics of ecosystem services and their complex interactions is a prerequisite for managing multiple simultaneously. However, the prior research has predominantly overlooked cultural service objects and neglected the indirect socio-ecological impact pathways on ecosystem services. To delve into the dynamics and developmental trends of ecosystem alterations prior to and following the inception of an Eco-Economic Zone, this study quantitatively assessed four pivotal ecosystem services within the Dongting Lake Ecological Economic Zone spanning from 2000 to 2020. These services encompassed:crop production(CP), carbon sequestration(CS), habitat quality(HQ), and forest recreation (RS). The trade-offs and synergies between them were explored, and the driving mechanism of ecosystem services was explained based on the partial least squares-structural equation model (PLS-SEM). The results revealed that: (1) during the study timeframe, the crop production witnessed a pronounced upward trajectory, whereas the carbon sequestration, habitat quality and forest recreation remained relatively stable. Notably, the low habitat quality area (HQ ≤ 0.3) has been expanding, with a growth rate of 29.4 %; (2) the most trade-offs were observed between crop production and other ecosystem services, among which the trade-off effect between crop production and habitat quality was the strongest, with the highest average proportion of trade-off area, reaching 57.8 %. Among the six ecosystem service pairs, two are in a state of deterioration: the crop production and forest recreation, the carbon sequestration and habitat quality; (3)topographic factors were identified as the primary drivers of crop production, carbon sequestration, and habitat quality, whereas forest recreation was chiefly influenced by landscape configuration factors. Land use intensity and landscape configuration played crucial intermediary roles, with socio-economic elements adversely impacting all four ecosystem services directly, yet significantly contributed to the crop production and carbon sequestration through Suppression Effects. The research endorses the combined utilization of lake area land to improve human welfare, based on the principle of protecting the primary services of various functional sub-regions.

A study to assess the knowledge and utilization regarding services available in the primary health Centre among women residing in a selected rural community area, Udupi

The study assessed the knowledge and utilization of primary health centre services among 100 women in a rural Udupi community using descriptive research designs and a structured self-administered knowledge questionnaire. The tool's reliability and validity were tested with nursing and medicine experts. The collected data was analyzed using descriptive and inferential statistics. The study found that 84% of women had poor knowledge scores about primary health centre services, with a mean of 17.62. 100% utilized these services and practiced a balanced diet to prevent nutritional disorders. Factors like number of children had no significant association with knowledge scores, indicating partial acceptance of hypothesis H1. The study found that most women lack knowledge about primary health center services, but use them and consume balanced diets to prevent nutritional disorders.

Managerial practices for app-based primary care telemedicine service acceptance in South Africa

Purpose: This study addresses the qualitative research phase of a mixed methods study conducted to investigate patient acceptance of an app-based telemedicine service for primary care aimed at South African public health care sector patients.Design/methodology/approach: Qualitative data were collected by means of semi-structured individual interviews with patients who had exposure to an existing app-based primary care telemedicine service in South Africa named Kena Health. Thematic analysis of the qualitative data using ATLAS.ti software was conducted to identify the relevant antecedents of telemedicine service acceptance in the study’s context.Findings/results: Eight antecedents of app-based primary care telemedicine service acceptance among South African patients (who are predominantly reliant on public health care sector services to receive medical care) were identified, namely, perceived compatibility, perceived ease of use, relative advantage, price value, trust, innovativeness, privacy perception and care perception.Practical implications: To date, prior literature has not yet identified the specific antecedents that would apply to the acceptance of an app-based telemedicine service for primary care among South African individuals who are predominantly reliant on the country’s public health care system to receive medical care.Originality/value: Our study contributes to the literature by identifying which existing factors of technology acceptance apply to primary care telemedicine service acceptance, predominantly in the South African public health care sector context. Furthermore, additional antecedents of telemedicine service acceptance that have not been included in technology acceptance theory until present, that is, (positive) privacy perception and care perception are identified.

EVALUATION OF COGNITIVE STRUCTURES OF HEALTH MANAGEMENT STUDENTS TOWARDS BASIC HEALTH CONCEPTS

This study was conducted to examine the cognitive structures of Health Management students from the Health Sciences Faculty regarding the concepts of "health," "disease," "physician," "hospital," and "healing." In the study, which used phenomenology design, one of the qualitative research methods, the Word Association Test (WAT), was used as a data collection tool. Fifty-five final-year Health Management students participated. The data set obtained for each concept was transferred to Excel, categorized, and a concept map was created. As a result of the frequency analysis, it was found that the concept with the highest number of repetitions for "health" was "hospital," which is the primary service provider. For the concepts of "disease" and "healing," the most frequent word was "medicine." For the concept of "hospital," the word "doctor" had the highest number of repetitions, while for the concept of "doctor," it was "stethoscope." In addition, it was observed that the students knew the concepts of "health," "disease," "physician," "hospital," and "healing."

Understanding the Scope of Acute Care Vascular Surgery at a Tertiary Academic Medical System

The restructuring of nonelective general surgery and nationwide implementation of the acute care surgery paradigm has improved patient outcomes and healthcare resource utilization. Although vascular surgery maintains one of the highest acuity rates among surgical specialties, the acute care vascular surgery (ACVS) practice model has not been widely accepted. In the present study, we investigate the scope and burden of ACVS at a tertiary academic medical system. All vascular surgical procedures performed at three hospitals comprising a large tertiary academic medical system were retrospectively queried through electronic medical records. Data were collected on procedure, acuity, timing of intervention, primary service, admission type, and total costs and charges. Patients were stratified by acuity of surgical intervention, with ACVS being defined as urgent or emergent operation. A total of 12,689 vascular surgeries were performed from 2018 to 2022. ACVS procedures comprised 22.1% of this total (n=2,803; 12.5% urgent, 9.6% emergent), with an annual burden ranging from 19.1% to 28.3%. Vascular surgeons served as primary surgeon in 91.3% of ACVS and cosurgeon in 8.7%. Fourteen separate surgical specialties requested acute vascular assistance, with the most frequently consulting specialties, including trauma or acute care surgery (ACS) (n=109, 3.9%) and cardiac surgery (n=74, 2.6%). ACVS cases were more frequently performed during after-hours (30.7% vs 11.6%) and on weekends (27.1% vs 2.0%) compared with elective vascular procedures (P<0.0001 each). The majority of ACVS cases originated from inpatient (n=2,353, 85.0%) and emergency department (n=379, 13.5%) consultations. Overall, ACVS generated $37.5 million in charges, accounting for 14% of total procedure-related charges over the study period. ACVS comprises a substantial portion of modern vascular practice and is associated with significant human and healthcare resource expenditure. These data support the development of practice models dedicated to acute vascular surgical care.

OPTimising MEDicine information handover after Discharge (OPTMED-D): protocol for development of a multifaceted intervention and stepped wedge cluster randomised controlled trial

BackgroundGeneral practitioners (GP) and community pharmacists need information about hospital discharge patients’ medicines to continue their management in the community. This necessitates effective communication, collaboration, and reliable information-sharing. However, such handover is inconsistent, and whilst digital systems are in place to transfer information at transitions of care, these systems are passive and clinicians are not prompted about patients’ transitions. There are also gaps in communication between community pharmacists and GPs. These issues impact patient safety, leading to hospital readmissions and increased healthcare costs.MethodsA three-phased, multi-method study design is planned to trial a multifaceted intervention to reduce 30-day hospital readmissions. Phase 1 is the co-design of the intervention with stakeholders and end-users; phase 2 is the development of the intervention; phase 3 is a stepped wedge cluster randomised controlled trial with 20 clusters (community pharmacies). Expected intervention components will be a hospital pharmacist navigator, primary care medication management review services, and a digital solution for information sharing. Phase 3 will recruit 10 patients per pharmacy cluster/month to achieve a sample size of 2200 patients powered to detect a 5% absolute reduction in unplanned readmissions from 10% in the control group to 5% in the intervention at 30 days. The randomisation and intervention will occur at the level of the patient’s nominated community pharmacy. Primary analysis will be a comparison of 30-day medication-related hospital readmissions between intervention and control clusters using a mixed effects Poisson regression model with a random effect for cluster (pharmacy) and a fixed effect for each step to account for secular trends.Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12624000480583p, registered 19 April 2024.

Navigating the long journey of heart failure-experiences of Māori and Pacific peoples.

Māori and Pacific peoples in Aotearoa New Zealand experience significant inequities in heart failure rates, treatment and outcomes compared to NZ Europeans. We aimed to understand the experiences of Māori and Pacific people living with heart failure as they navigated care across primary and secondary settings. This research involved a secondary analysis of data collected in a wider qualitative study investigating evidence-practice gaps of cardiovascular care experienced by Māori and Pacific people. From the wider pool of semi-structured interviews, we identified 24 people (seven Māori and 17 Pacific peoples, 23 from the North Island) living with heart failure, and applied template and framework analysis to explore their distinct experiences. Two major themes identified related to participants: 1) Condition-need for more support to understand and self-manage their heart failure condition, and 2) Journey-desire to feel well-connected to the health system in their heart failure journey. Addressing heart failure inequities for Māori and Pacific peoples requires that providers engage in clear and meaningful communication to support patient self-management. Strengthening pathways for Māori and Pacific patients and whānau (families) between primary and secondary services is required to reduce their likelihood of becoming disconnected from care.

Co-Design Model of Support for Child and Family Health Nurse Practice with Culturally and Linguistically Diverse Families

Culturally and linguistically diverse (CALD) mothers with young children face multiple inequities in accessing primary health services, such as language barriers, social isolation, low health literacy, and the availability of appropriate interpretation services. These inequities are persistent and indicate that child and family health nurse (CFHN) services, the providers of primary healthcare in many developed countries, require better support to address the needs of these families. This study engaged with CFHNs and healthcare interpreters to co-design a model of support for practice using workshops that included individual and collective brainstorming and visual representations. Transcripts of the discussion were analysed using thematic analysis. CFHNs and interpreters were able to articulate their perfect service model: a central multidisciplinary team of CFHNs, interpreters, and bilingual educators who could facilitate nurse–interpreter and nurse–interpreter–client relationships, allowing CFHNs and interpreters to do their jobs properly. This central structural component would support and be supported by rapport, trust, client choice and access, continuity of care, and cultural comfort. The study concluded that CALD mothers’ access and engagement require CFHNs to have support for their cultural comfort through the mechanism of bilingual educators and the expansion of healthcare interpreters’ role and scope in working with CFHNs in the delivery of services.

Reasons for Neonatal Presentations to Pediatric Emergency Departments in Catania: Multicentric Cross-Sectional Analysis and Exhaustive Review of the Literature.

This study aimed to characterize neonatal admissions to pediatric emergency departments (PEDs) in Catania, to analyze the primary pediatric conditions leading to these admissions, and to explore the association between the demographic characteristics of the population and the severity of their presentations. A retrospective analysis was conducted on neonates (aged <28 days) admitted to three PEDs in Catania between January 2015 and December 2019. Additionally, a comprehensive review of the literature on this topic was performed. A total of 5183 neonates presented during the study period, with a median age of 14 days at admission. The top three diagnoses were neonatal jaundice (15%), abdominal discomfort (12%), and upper airway inflammation (11%). The majority of cases were classified as non-urgent (green) at triage (59%). Overall, 1296 patients (25%) required hospitalization; 95% of those assigned a yellow triage color at admission required hospitalization. Only 33% of hospitalized patients were referred by parents, while the majority were referred by primary care pediatricians. The highest number of admissions occurred in August, while the peak in hospitalizations was in February. The majority of neonatal PED admissions are for non-acute conditions that do not require immediate medical attention. This concerning trend leads to increased workloads for PED staff, higher healthcare costs, and potential risks to neonates. Possible causes include insufficient caregiver knowledge, inadequate parental education, and suboptimal transition from hospital to primary care pediatric services.

Impact of implementing primary care-based medication for opioid use disorder on provider and staff perceptions

Abstract Medication for opioid use disorder (MOUD) is the management of opioid use disorder (OUD) on an outpatient basis with buprenorphine or buprenorphine/naloxone (or methadone, which is limited to federally certified opioid treatment programs). Primary care practices are well poised to provide comprehensive care for patients with OUD, including provision of MOUD. The aim of this study was to assess provider and staff OUD attitudes and role perceptions before and after implementation of a MOUD clinical service line. A survey was distributed to evaluate attitudes and perceptions of patients with OUD and provision of MOUD among providers and staff in an academic family medicine clinic. Surveys were distributed in December 2020 (73% response rate), prior to a substance use disorder educational training and MOUD service line implementation, which provided patients with OUD both primary care services and management with buprenorphine/naloxone. A follow-up survey was distributed in February 2022 (69% response rate).Training and implementation of the MOUD service line demonstrated improvements in the domains of motivation (+0.63), attitudes (+0.32), satisfaction (+0.38), role support (+0.48), role adequacy (+0.39), and safety (+0.79) among surveyed participants. The change in satisfaction and safety domains was statistically significant (P &amp;lt; .05). There was no change in the role legitimacy domain.Implementation of a primary care-based MOUD service line positively affected provider and staff motivation, attitudes, satisfaction, sense of safety, role support, and adequacy when working with patients with OUD. This highlights the benefits of MOUD-specific clinical support to optimize care delivery within primary care.

Abstract A005: Addressing Moonshot limitations: High-risk racial disparities in leading cancers

Abstract Cancer remains a leading cause of death in the U.S., posing a significant public health challenge with rising incidence rates among young adults. In response, the Biden administration reignited The Cancer Moonshot initiative in 2022, aiming to reduce cancer mortality by 50% over the next 25 years. However, as there remains different mortality rates across subpopulations defined by race and ethnicity, the 50% translates into much more or less depending on the starting point for each group. Achieving this goal would require a 57.0% decrease for Black Americans, 51.9% decrease for White Americans, 21.4% for Asian Americans, 31.0% decrease for Hispanics, and 41.3% decrease for American Indian/Alaska Natives. This study examines the trends in in U.S. cancer incidence, 5-year survival, and mortality during 1992-2022 with a focus on the five leading cancers (lung, colorectal, breast, pancreas, prostate) stratified by race and ethnicity. From 2008-2020, overall cancer death rates have declined by 1.18%/year with attribution to declining lung cancer rates (-2.75%/year, 2005-2020) and anti-smoking campaigns. Estimates have been made on how to meet the Cancer Moonshot through primary, secondary, and tertiary prevention, but these rates have not factored in the different starting points nor racial disparities that exist. Progress has been heterogenous across racial/ethnic groups. Non-Hispanic Black communities continue to face excessive cancer burden compared to counterparts and have had the slowest declines in annual percent changes for mortality. To reach the Moonshot’s mortality goals in 2047, an annual decline of 1.78% across all racial and ethnic groups is needed. However, the required mortality reductions vary by cancer type and are lower for Non-Hispanic Blacks and Non-Hispanic American Indians/Alaska Natives due to inadequate access to screening and treatment. This study delineates the need for multi-level, culturally tailored interventions to improve cancer prevention, screening, and treatment accessibility. To achieve Moonshot objectives, it is imperative to increase the number of on-site patient navigators, enhance accessibility through health education and transportation services, and promote digital campaigns for primary and secondary prevention services. Despite discrepancies in interventions and policy practices, enhancing the cultural competence and holistic nature of these interventions will strengthen efforts towards health equity. These approaches can better serve high-risk groups and alleviate racial disparities in cancerous outcomes. Citation Format: Sukhmani Kaur, Rebecca Kehm, Mary Beth Terry. Addressing Moonshot limitations: High-risk racial disparities in leading cancers [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A005.

Measuring and optimizing the spatial accessibility of primary health care in remote and rural areas: a case study of Liannan Yao Autonomous County in China

The need for equitable access to primary healthcare services in the current global context has attracted widespread attention, prompting nations to continuously enhance their grassroots medical service levels. In response, China launched the "Healthy China" initiative, which prioritizes the enhancement of national health as a core goal of the healthcare system and uses this opportunity to deepen reforms aimed at strengthening primary care. However, in remote and rural areas, the optimization of medical resource allocation and the achievement of balanced service development remain critical challenges owing to limited resources. This study selected Liannan Yao Autonomous County, which is situated in the northwestern corner of Guangdong Province, as a case study due to its remote mountainous location, underdeveloped economy, and minority region characteristics. Through field research and interviews, this study thoroughly explored the needs of both supply and demand, factoring in elements such as the service capability of healthcare facilities and residents' travel thresholds to enhance the two-step floating catchment area model, thus making it more applicable to remote villages. By integrating electric bikes and cars, which are the primary means of transportation in rural areas, this study conducted a thorough analysis and comparison of the accessibility of medical services in Liannan Yao Autonomous County (Liannan County) . The results reveal significant disparities in healthcare accessibility, an uneven distribution of medical resources, and varying impacts of transportation conditions and facility service capabilities on accessibility. Notably, the study revealed that improving transportation conditions alone has limited effects in rural areas; the key lies in balancing medical service capabilities and the rationality of overall layouts. From the perspectives of equity and efficiency, this study employs the equitable coverage model and the efficiency-driven model to construct two scenarios, comparing accessibility changes in Liannan County under both conditions and proposing strategies to improve the spatial layout of local healthcare facilities. This research not only deepens the understanding of healthcare service accessibility in rural areas but also provides a scientific basis for optimizing resource allocation and enhancing primary medical services, offering valuable guidance and reference for Liannan County and other similar rural regions.

The lived experience of parents of children with disabilities as service users: A transformative learning theory perspective.

The study sought to examine the content and processes that characterize the lived experiences of parents of children with disabilities as service users. The study employed a qualitative approach, utilizing the photovoice methodology to explore formative experiences derived from participants' lived experiences. A total of 24 participants were interviewed; 19 were parents of children with autism and five were parents of children with other disabilities. The database was analyzed by content analysis. Four central themes were identified: (1) interactions with services and their representatives; (2) challenges embodied in the parents' lived experiences as service users; (3) translation into action: expanding the parental role; and (4) policy changing. Research findings emphasize the fact that as the child's primary caregiver, parents of children with disabilities should be treated as primary service users themselves. Services providing care and support for children with disabilities should consider parents' lived experience-based knowledge when designing and planning services. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Study of Factors Contributing to the Nutritional Status of Elderly People Receiving Home Care.

(1) Background: Nutrition is a critical aspect of health and well-being in the elderly population, as physiological changes associated with aging can impact nutrient utilization and dietary needs. The aim of this study was the assessment of nutritional screening and associated factors among community-dwelling elderly people. (2) Methods: This study is the first phase of an intervention trial of people aged 65 years and over who received primary health services and resided in the municipality of Archanes Asterousia in Crete, Greece. Nutritional risk was assessed using the Mini Nutritional Assessment. Diet-related factors were analyzed, including health status (oral hygiene, depression, cognitive decline, impaired functioning, quality of life), social factors (educational attainment, marital status, type of work before 60 years), and lifestyle factors (smoking, drinking, diet). (3) Results: A total of 730 elderly people were evaluated (males, 31.5%), with an average age (±SD) of 76.83 (±6.68) years. MNA was found to have a statistically significant connection with assessment of oral hygiene, mental state, Charlson comorbidity, functional independence (assessed with the Barthel scale), and quality of life. The exception was geriatric depression (GDS), with which no statistically significant association was found (p > 0.05). Nutritional risk analysis revealed 379 participants (51.9%) to be adequately nourished, 205 (28.1%) to be at risk of malnutrition, and 146 (20.0%) to be malnourished. (4) Conclusions: These results clearly demonstrated the key factors that contribute to the nutritional screening of elderly people and need to be addressed by health authorities and social services.

A Model for Developing Academic Leadership of Teachers in the 21st Century Under the Office of Primary Educational Service Area in Thailand

This research aimed to present a model for developing the academic leadership of teachers in the 21st century under the Office of Primary Educational Service Area. This study used an integrated research method divided into two phases. Phase One aimed to study the current state of academic leadership of teachers in the 21st century under the Office of the Primary Educational Service Area. The sample group of this phase included 335 educational institution administrators, teachers, and heads of the academic department at schools under the jurisdiction of the Primary Educational Service Area Office Government Inspection Area 14, derived from stratified random sampling and three exemplary educational institutions. Phase Two aimed at creating a model for developing teachers&amp;rsquo; academic leadership in the 21st century under the Office of the Primary Educational Service Area. The sample group of this phase consisted of 12 experts for a focus group meeting, obtained from purposive sampling. The research tools used were questionnaires, interviews, and evaluation forms. Data were analyzed to investigate average, standard deviation, and content analysis. The research results showed that the current overall condition in every aspect was practiced at a high level. In addition, there were five academic leadership development models for teachers in the 21st century under the Primary Educational Service Area Office: principles of the model; objectives of the model; methods of operation of the model; evaluation of the model, and conditions for success of the model. The models were appropriate and the overall feasibility was high.

Design and implementation of a Type-2 hybrid, prospective randomized trial of opioid agonist therapies integration into primary care clinics in Ukraine

IntroductionUkraine has high HIV prevalence, concentrated among people who inject drugs (PWID), mostly of opioids. Maintenance on opioid agonist therapies (OAT) is the most effective evidence-based treatment for opioid use disorder. As PWID experience high morbidity and mortality from preventable and treatable non-communicable diseases, international agencies recommend integrating OAT into primary care centers (PCC). MethodsA randomized, type-2 hybrid implementation trial was carried out to compare outcomes of OAT integration in PCC to OAT delivery at specialty treatment centers (STC) – standard-of-care. Tele-education supporting PCC providers in managing OAT, HIV, tuberculosis and non-communicable diseases along with pay-for-performance incentives were used to facilitate implementation. Consenting patients underwent 1:2 randomization to either STC or PCC. Quality health indicators (QHIs), a composite percentage of recommended primary and specialty services accessed by patients (blood/urine tests, cancer screenings, etc.), were defined as efficacy outcomes and were assessed by participant self-report at baseline and every 6 months over 24 months and electronic chart reviews after the completion of the follow-up. The primary outcome is defined as the difference in composite QHI scores at 24 months, in which a repeated measures likelihood-based mixed model with missing at random assumptions will be used. Providers at PCC completed surveys at baseline, 12 and 24 months to assess implementation outcomes including changes in stigma and attitudes towards OAT and PWID. Preliminary resultsAmong the 1459 participants allocated to STC (N = 509) or PCC (N = 950), there were no differences in clinical and demographic characteristics. Self-reported prevalences were available for HIV (42 %), HCV (57 %), and prior tuberculosis (17 %). Study retention at 6, 12, 18, and 24 months was as 91 %, 85 %, 80 %, and 74 %, respectively. ConclusionPWID have a high prevalence of medical comorbidities and integrating OAT into primary care settings has the potential to improve the health of PWID. Findings from this study can help guide implementation of integrated care in Ukraine and throughout similar low-resource, high-burden countries in the Eastern European and Central Asian region.

Risk factors and trajectories of self-harm, neurodevelopmental disorders, and mental health conditions in pupils Educated in Other Than At School (EOTAS) in Wales: a retrospective nationwide electronic cohort study

Objective and ApproachPupils ‘Educated in Other Than At School’ (EOTAS) are some of the most vulnerable learners, who, for reasons such as mental health or behavioural difficulties, do not attend a mainstream school. We linked population data from Education Wales (EDUW) between 2010-19 to primary and secondary healthcare records. Individuals included in the EOTAS dataset aged from 7 to 18 years were identified as cases. Controls were pseudo-randomly selected based on equivalent age distribution. We used regression approach to compare characteristics of EOTAS pupils with controls and evaluate their risks of self-harm and mental health conditions before and after being in EOTAS provision. ResultsBeing male, high deprivation levels, and previous records childhood maltreatment, self-harm, and mental health conditions resulted in higher odds of being in EOTAS provision. Female in EOTAS provision entered at a later age, and with higher proportion of co-morbidities. Pupils in EOTAS provision had increased incidence of self-harm and mental health conditions from one year after entering EOTAS provision up to 24 years of age than controls with similar characteristics. ConclusionsAn important proportion of pupils in EOTAS provision are from the most deprived areas in Wales, with complex life trajectories, social, emotional, and mental health needs. ImplicationsEOTAS provision is not sufficient to attend the social, emotional, and mental health needs of their pupils. Long-term support and a better integration with social care, primary and specialist mental health services is required.

Pengaruh Kedisiplinan, Lingkungan Kerja, dan Motivasi terhadap Kinerja Pegawai pada Kantor Pelayanan Pajak Pratama Bandung Tegallega

This study aims to find out and analyze how much the influence of discipline has a significant effect on employee performance at the Bandung Tegallega Primary Tax Service Office. The population of this study is 75 employees of the Bandung Tegallega Primary Tax Service Office. To meet the number of samples, the sampling method in the field uses random sampling techniques. The researcher determined a sample of 75 respondents who were employees of the Bandung Pratama Tax Service Office. As a result, the work motivation of employees is still in the sufficient category, so it needs to be improved so that the performance of employees who are also in the sufficient category can increase. Discipline and Work Environment are classified as good and need to be maintained. Discipline, Work Environment, and Work Motivation each have a significant positive effect on Employee Performance, with Discipline and Work Environment making a major contribution to improving Performance. Overall, these three variables affect Employee Performance by 82%, while the remaining 18% is influenced by other factors that are not studied.

Digital Teaching Supervision Model of Educational Supervisors under the Office of Primary Educational Service Area in Northeastern Region

This research aimed to: 1) Investigate the effectiveness of digital teaching guidance provided by educational supervisors affiliated with the Northeastern Primary Education Area Office. 2) Develop a model for digital teaching guidance by educational supervisors under the Northeastern Primary Education Service Area Office. 3) Evaluate the feasibility and benefits of the proposed model. The research consisted of three phases: Phase 1: Investigating the effectiveness of digital teaching guidance by educational supervisors, based on relevant documents, research, and interviews with a purposively sampled group of 30 individuals demonstrating outstanding practices (Best Practice). Phase 2: Developing a model for digital teaching guidance by educational supervisors and evaluating the model&amp;rsquo;s suitability through a seminar involving 7 experts, using the Connoisseurship approach. Phase 3: Evaluating the feasibility and benefits of the digital teaching guidance model by educational supervisors. The sample group comprised 50 educational supervisors affiliated with the Northeastern Primary Education Service Area Office, selected through multi-stage random sampling. Statistical analysis used in the study included mean, percentage, and standard deviation. The research findings revealed that: 1. Effective digital teaching guidance by educational supervisors consists of four key processes: 1) Analysis of context, 2) Development of teaching guidance plans, 3) Observation of teaching practices, and 4) Reflection on outcomes. Each process involved problem analysis, needs identification, collaborative planning, and the systematic use of digital tools and online social media aligned with the teaching guidance process. The effectiveness of teaching guidance was evaluated through the assessment of teachers&amp;rsquo; knowledge, understanding, and learning management abilities, collaboratively determined and facilitated through an online Professional Learning Community (PLC). 2. The developed model comprises five components: 1) Principles and concepts, 2) Objectives, 3) Core content of the model, including the four-step digital teaching guidance process, 4) Implementation guidelines, and 5) Success conditions. The model&amp;rsquo;s suitability was assessed at the highest level. 3. In the feasibility and benefits assessment, the overall evaluation indicated the highest level of feasibility and benefits.

A qualitative study of negative sociocultural experiences of accessing primary health care services among Africans from refugee backgrounds in Australia: implications for organisational health literacy

BackgroundPrimary health care is the first point of contact for patients from refugee backgrounds in the Australian health system. Sociocultural factors, including beliefs and value systems, are salient determinants of health literacy and access to primary health care services. Although African refugees in Australia have diverse sociocultural backgrounds, little is known about the influence of sociocultural factors on their experiences of accessing primary health care services. Guided by the theoretical framework of access to health care, this study examined from the perspective of African refugees how culturally and religiously conditioned, constructed and bound health beliefs, knowledge and practices influence their experiences of access to, acceptance and use of primary health care services and information in Australia.MethodsThis exploratory, qualitative study involved 19 African refugees from nine countries living in New South Wales, Australia. Semi-structured interviews were conducted and recorded using Zoom software. The interviews were transcribed verbatim and analysed using a bottom-up thematic analytical approach for theme generation.ResultsFour main themes were identified. The themes included: participants' experiences of services as inaccessible and monocultural and providing information in a culturally unsafe and insensitive manner; the impact of the clinical care environment; meeting expectations and needs; and overcoming access challenges and reclaiming power and autonomy through familiar means. The findings generally support four dimensions in the access to health care framework, including approachability, acceptability, availability and accommodation and appropriateness.ConclusionAfrican refugees experience significant social and cultural challenges in accessing primary health care services. These challenges could be due to a lack of literacy on the part of health services and their providers in servicing the needs of African refugees. This is an important finding that needs to be addressed by the Australian health care system and services. Enhancing organisational health literacy through evidence-informed strategies in primary health systems and services can help reduce disparities in health access and outcomes that may be exacerbated by cultural, linguistic and religious differences.