Priority Areas For Action Research Articles

Are National Cancer Control Indicators for patient experiences being met in regional and remote Australia? A cross-sectional study of cancer survivors who travelled for treatment

ObjectiveTo examine the health services experience of patients with cancer from regional and remote Australia using the Australian National Cancer Control Indicators (NCCI) guidelines as an assessment framework.DesignCross-sectional.SettingQueensland non-for-profit cancer...

Ending rheumatic heart disease in Australia: the evidence for a new approach.

■The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world. ■The Endgame Strategy synthesises information compiled across the 5-year lifespan of the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE). Data and results from priority research projects across several disciplines of research complemented literature reviews, systematic reviews and narrative reviews. Further, the experiences of those working in acute rheumatic fever (ARF) and RHD control and those living with RHD to provide the technical evidence for eliminating RHD in Australia were included. ■The lived experience of RHD is a critical factor in health outcomes. All future strategies to address ARF and RHD must prioritise Aboriginal and Torres Strait Islander people's knowledge, perspectives and experiences and develop co-designed approaches to RHD elimination. The environmental, economic, social and political context of RHD in Australia is inexorably linked to ending the disease. ■Statistical modelling undertaken in 2019 looked at the economic and health impacts of implementing an indicative strategy to eliminate RHD by 2031. Beginning in 2019, the strategy would include: reducing household crowding, improving hygiene infrastructure, strengthening primary health care and improving secondary prophylaxis. It was estimated that the strategy would prevent 663 deaths and save the health care system $188 million. ■The Endgame Strategy provides the evidence for a new approach to RHD elimination. It proposes an implementation framework of five priority action areas. These focus on strategies to prevent new cases of ARF and RHD early in the causal pathway from Streptococcus pyogenes exposure to ARF, and strategies that address the critical systems and structural changes needed to support a comprehensive RHD elimination strategy.

Assessing Community Contributions to Sustainable Food Systems: Dietitians Leverage Practice, Process and Paradigms

Food systems are not sustainable, and efforts to address this are paralyzed by the complex networks of food system actors and factors that interact across sectoral and geographic scales. Actions at the community level can positively contribute toward globally sustainable food systems (SFS). Assessing such contributions has two central challenges: 1) a lack of methods that support alignment between communities and across scales, balanced against the need to involve the community in developing relevant indicators; and 2) the absence of adequate, fine grained data relevant to the community. Addressing these two challenges, this paper illustrates a proposed procedure that supports community engagement with, and assessment of, their contributions. Engaged by a community of Canadian dietitians, researchers used the Delphi Inquiry method, guided by the Framework for Strategic Sustainable Development, to address the first challenge, and causal loop diagrams informed by the Cultural Adaptation Template to address the second. Indicators were developed for dietitian-identified actions and outcomes for SFS. Modeling indicator interactions provide insight into how some actions are influenced by and reinforce the value placed on SFS within the professional cultural paradigm, as well as priority areas for action and measurement. Process-oriented assessment is useful in the context of partial and subjective understandings of a dynamic system, and supports continual adjustment in action. This article offers theoretical and practical insight for community engagement in addressing some of the systemic challenges in food systems. It accommodates community-based knowledge, applies process-indicators, and emphasizes the importance of cultural paradigms as a driving force of community-level actions, and overall system change. Under current conditions, facilitating SFS literacy among dietitians can amplify adaptations for broader SFS development.

Identification of Opportunities for Applying the Circular Economy to Intensive Agriculture in Almería (South-East Spain)

The use of intensive high-yield agricultural systems has proved to be a feasible alternative to traditional systems as they able to meet the objective of guaranteeing long-term sustainability in the supply of food. In order to implement these systems, it is necessary to replace the traditional model of “extract-use-consume-dispose” with a model based on the principles of the Circular Economy (CE), optimizing the use of resources and minimizing the generation of waste. Almería has become a paradigm of this type of high-yield agricultural system, with the largest concentration of greenhouses in the world. This study analyses the opportunities that the CE can offer the intensive agriculture sector in Almería in order to obtain long-term sustainability. The results show a wide variety of alternatives, both on an agricultural exploitation level and in the case of the product packaging and wholesale centers. The priority areas of action are waste management, the prevention of product waste and the improvement in the efficiency of the use of water and energy. The principal limitations for adopting circular practices are the large investment required, the limited transfer of knowledge between the different users and the lack of sufficient support from the government and the sector.

A Pacific needs analysis model: a proposed methodology for assessing the needs of facility-based emergency care in the Pacific region

BackgroundEmergency care (EC) describes team-based, multidisciplinary clinical service provision, advocacy and health systems strengthening to address all urgent aspects of illness and injury for all people. In order to improve facility-based EC delivery, a structured framework is necessary to outline current capacity and future needs. This paper draws on examples of EC Needs Assessments performed at the national hospitals of three different Pacific Island Countries (PICs), to describe the development, implementation and validation of a structured assessment tool and methodological approach to conducting an EC Needs Assessment in the Pacific region.MethodsThis is a retrospective, descriptive analysis of the development of the Pacific Emergency Care Assessment (PECA) table using patient-focused principles within an EC systems framework. Tool implementation occurred through observation, literature review and interviews using a strengths-based, action-research and ethnographic methodological approach in Timor-Leste, Kiribati and the Solomon Islands. The 2014 Solomon Islands EC Needs Assessment provides the main context to illustrate and discuss the overall conduct, feasibility, validity and reliability of the PECA tool and methodological approach.ResultsIn each site, the methodological implementation enabled completion of both the PECA table and comprehensive report within approximately 6 weeks of first arriving in country. Reports synthesising findings, recommendations, priority action areas and strategies were distributed widely amongst stakeholders. Examples illustrate Face and Content, Construct and Catalytic validity, including subsequent process and infrastructure improvements triggered by the EC Needs Assessment in each site. Triangulation of information and consistency of use over time enhanced reliability of the PECA tool.Compared to other EC assessment models, the Pacific approach enabled rich data on capacity and real-life function of EC facilities. The qualitative, strengths-based method engenders long-term partnerships and positive action, but takes time and requires tailoring to a specific site.ConclusionIn PICs and other global contexts where EC resources are underdeveloped, a PECA-style approach to conducting an EC Needs Assessment can trigger positive change through high local stakeholder engagement. Testing this qualitative implementation method with a standardised EC assessment tool in other limited resource contexts is the next step to further improve global EC.

Kastamonu Karaçomak Havzasının Kentsel Gelişim Alanlarında Yeraltı Suyu Beslenimi Açısından Ekolojik Etki Değerlendirme

Araştırma kapsamında, Kastamonu Kenti‘nin kuzeyinde yer alan kentsel gelişim alanında yeraltı suyu beslenimi açısından ekolojik etkinin değerlendirilmesi hedeflenmiştir. Bu doğrultuda kentsel gelişim alanı, peyzajın fonksiyonlarından biri olan su geçirimliliği ve arazi örtüsü açısından irdelenerek, kentsel gelişimden önce ve kentsel gelişimden sonra yeraltı suyu beslenimindeki değişim seviyesinin tespit edilmesi amacı ile ekolojik etki değerlendirmesi yapılmış ve geçirimli yüzeylerdeki değişimin yeraltı suyu beslenimini etkilememesi için öneriler geliştirilmiştir. Çalışma kapsamında kullanılan yöntemler ile kentleşme ve peyzaj üzerindeki diğer müdahaleler sonucu yeraltı suyu ve su tutma kapasitesindeki olumsuz değişim ortaya konulabilmektedir. Bu çalışma, yapılacak kent planlama çalışmaları ile potansiyel müdahalelerin olası sonuçlarının öngörülmesi ve olumsuz etkilerin bertaraf edilmesine olanak sağlamaktadır. Öte yandan söz konusu olumsuzlukların planlama ve/veya uygulama sonrası araştırılması yerine, yeraltı suyu beslenimi ve yüzey akışı potansiyeli dahil, peyzaj fonksiyonu olarak ifade edilen kilit ekolojik süreçlerin irdelendiği peyzaj planlarının çok katmanlı mekânsal planlama sürecinin öncelikli eylem alanı olması önemlidir.

Healthy Settings: Barriers and Facilitators to a Healthy Campus Community

AbstractThis paper provides a synopsis of findings from the first two phases of a larger campus-based participatory action research study, which examines the factors that contribute to health within a university setting. Theoretical underpinnings of this study were rooted in concepts of socio-ecological thinking and healthy settings and in the Ottawa Charter and the Okanagan Charter on Health Promoting Universities. In Phase 1 (February 2016), a multidisciplinary team of student and faculty researchers used a campus survey to identify perceived facilitators and barriers to health within the university context. Participants (n = 181) included students, faculty, staff and administration. Findings from Phase 1 were used to create a second survey that itemised possible priority areas for action. In Phase 2 (April 2017), this health priorities survey was sent via the university-wide email listserv to the campus community for input. There was consensus among respondents on which areas should be prioritized for action. Areas identified include health enhancing food-environments (e.g., access to healthy food), health enhancing social environments (e.g., coping and stress management), and teaching and learning environments that support healthy living and well-being (e.g., work-life balance). The findings from Phases 1 and 2 of this study will guide student-engaged and community-driven interventions in subsequent phases of this research.

Distribución espacial de la calidad de vida relacionada a la salud infantil en la provincia de Tucumán (Argentina)

Este trabajo se propuso caracterizar la distribución espacial de la calidad de vida relacionada a la salud infantil en dos departamentos con diferente índice de bienestar de la provincia de Tucumán (Argentina). Específicamente, interesó determinar la prevalencia de niños y niñas con bajas apreciaciones de su calidad de vida relacionada a la salud y conocer sus manifestaciones territoriales, pormenorizando las diferencias urbano-rurales. Se realizó un estudio ecológico, exploratorio-descriptivo, transverso en 1647 escolares. Se administró el cuestionario internacional KIDSCREEN-52, que indaga la calidad de vida relacionada a la salud a partir de diez dimensiones; además, se desarrollaron índices espaciales. Los mapas temáticos permitieron detectar particularidades en los contextos estudiados. Se destacó que alrededor de la mitad de los niños/as evaluados/as se sintieron acosados/as y/o rechazados/as por sus pares, mientras que los sentimientos de tristeza comprometieron a uno de cada tres participantes. Los resultados de este trabajo identificaron y delimitaron zonas de actuación prioritarias, detectando problemáticas infantiles específicas que requieren especial atención. Finalmente, la cartografía resultante constituye un insumo susceptible de ser utilizado en el planeamiento territorial de la atención a la salud, mejora de la calidad de vida y reducción de las desigualdades.

The Integrated Spatial Pattern of Child Mortality during the 2012–2016 Drought in La Guajira, Colombia

The El Niño phenomenon in 2012 triggered a drought in La Guajira, Colombia that extended until 2016. In this period, the average child mortality rate in the area reached 23.4 out of 1000. The aim of this paper is to identify the integrated spatial pattern (ISP) of a single indicator in this case; child mortality. At the same time, the ISP identifies causes and priority areas for action. The socio-economic vulnerability (SEV) variables and spatial indicators related to child mortality were selected from the literature review and through meetings, workshops, and interviews with the affected community during fieldwork. Using correlation analysis and stepwise regression, the SEV variables with more accountability in child mortality during the drought were identified: Households with a monthly income of less than 100 USD, the number of people older than 65, and the number of people younger than 5 years old. Allocating weights to the SEV variables according to their degree of accountability in child mortality, its ISP has been identified. The far north of La Guajira was detected as the area most affected by child mortality and was, therefore, the priority zone for implementing actions focused on generating new sources of income.

Comparing Transport Quality Perception among Different Travellers in European Cities through Co-Cluster Analysis

The quality of the transport system offered at city level constitutes an important and challenging goal for society, for local authorities, and transport operators. Therefore, appropriate evaluation of travellers’ satisfaction is required to support service performance monitoring, benchmarking, and market analysis. This aspect implies the collection of satisfaction levels for different passengers’ groups, as it could provide interesting suggestions for identifying priority areas of action. To this end, an original study aimed at understanding the main aspects affecting the common view of satisfaction among different kinds of travellers at European level is presented in this paper. A specific survey investigating how travellers perceive the quality of their journey is proposed to people living in cities characterised by different sizes. Data are then analysed through a multi-view co-clustering algorithm, an innovative machine learning technique that highlights clusters of respondents grouped according to various categories of features. Such results could be used by local authorities and transport providers to understand the specific actions to be operated to improve the quality of transport service offered in a market segmentation dimension.

313 Caring for Older Persons with Dementia in an Acute Medical Care Setting: An Exploration of Nurses’ Experiences and Perceptions

Abstract Background Presently in Ireland there are 55,000 people with dementia, with figures projected to rise to 130,000 by 2041. In acute hospitals, ensuring the provision of high standard, person-centred care for people with dementia is an essential part of policy and practice development. While nurses are key in implementing safe, effective and evidenced based care it is unclear at this moment what their experiences are, when caring for patients with dementia. It is twelve years since the last study was conducted in Ireland in a purpose-built unit for older patients so will not be reflective of an acute care setting. Therefore, it is timely to gather a current description of nurses’ experiences and perceptions in caring for patients with dementia in an acute care setting. Methods A purposeful sample of nine nurses working in an acute medical ward caring for patients with dementia participated in the study. Data was collected using semi-structured interviews, transcribed verbatim and analysed using content analysis. Results The findings are current and highlight that nurse’s display immense respect and empathy to patients with dementia and see beyond the dementia to the individuality of the person. This demonstrates positive attitudes towards these patients, despite organisational and environmental constraints. The findings further identify that staffing levels are inadequate and that nurses require specific education on dementia. Furthermore, the organisational culture and environmental design are not conducive for patients with dementia and changes need implementing in line with the Irish National Dementia Strategy and the Dementia Friendly Hospital Design Guideline. Conclusion These findings have provided a current view of nurses’ experiences and perceptions of caring for patients with dementia in an acute medical ward and support previous study findings. Strategies are now required to address these issues, with a focus on the six priority action areas from The Irish National Dementia Strategy.

(Re)Framing ocean acidification in the context of the United Nations Framework Convention on Climate Change (UNFCCC) and Paris Agreement

ABSTRACTOcean acidification is most frequently framed by the scientific community as a concurrent threat to climate change, rather than an effect of it. This separation of the two phenomena has long been deemed as a way of garnering heightened policy attention for ocean acidification rather than having it bound up in the often contested politics of climate change. This effort, however, appears to have resulted in the inadvertent placing of ocean acidification outside of the mandate of the United Nations Framework Convention on Climate Change (UNFCCC). This has created a significant gap in the global governance of this issue with no multilateral agreement understood as having jurisdiction over the mitigation of rising ocean acidity. For these reasons this paper argues that an alternative framing of ocean acidification as an effect of climate change is warranted. This would include ocean acidification in the core obligations of the Convention, thereby filling the mitigation governance gap and avoiding perverse implementation outcomes. It is contended that interpreting the UNFCCC in this way is more consistent with its objective and purpose than the existing interpretations that place ocean acidification beyond the remit of the Convention.Key policy insightsOcean acidification is best understood as an effect of climate change in the context of the UNFCCC, and therefore is included in its obligations to combat climate change and its adverse effects.An obligation to address ocean acidification has implications for the way that the provisions of the Convention, particularly on mitigation, are implemented. Mitigation activities that exacerbate ocean acidification or lead to emission reduction pathways that do not prevent dangerous acidification should be deemed inconsistent with the Convention.Protection, conservation and restoration of coastal and marine ecosystems should become a priority area for action within the UNFCCC.

Analysis of morbidity with poisonings with ethanol and surrogate alcohols in irkutsk region between 2010 and 2017

Aim. Poisonings with ethanol and surrogate alcohols are preventable causes of morbidity and mortality posing a serious threat to population health. The aim of the study was to analyze the dynamics of the incidence of acute poisoning with ethyl and surrogate alcohols in the Irkutsk region for the period from 2010 to 2017, and to discuss it in the context of the regional and federal policy aimed at regulation of the alcohol - containing products. Materials and methods. The data of the statistical reporting form No. 12-15 “Information on the results of toxicological monitoring” in the Irkutsk region for the period from 2010 to 2017, the data of the Federal State Statistics Service RosStat on the incidence of acute chemical poisoning, and on incidence of acute poisoning with ethyl alcohol and surrogate alcohols were analyzed. Subsequent interpretation of the results in the context of the regional and federal alcohol control policy has been performed. Results. In the Irkutsk region, during the analyzed period of time there was observed a high incidence of acute poisonings with ethanol and surrogate alcohols with territorial differences within the region, and with positive dynamics of reduction of incidence by 38.7% in 2017 in comparison to 2010. Poisonings with ethanol occupy a leading place in the structure of the incidence in comparison with poisoning with other alcohols. The Irkutsk region was ranked 9th among all other subjects of the Russian Federation in 2017 by level of morbidity with alcohol poisonings. Among all cases of poisonings the proportion of the adult working age population was 89.1%, males - 77%, and unemployed population - 57.8%, which suggests that these categories of population are under the highest risk of acute poisoning with ethanol and surrogate alcohols. Conclusion. Strengthening control over the illegal distribution of ethyl alcohol and alcohol - containing products, especially in the territories situated along the Federal highways is seen as a priority area for action. Control of distribution of alcohols between 2010 and 2017 on the territory of the Irkutsk region allowed reducing incidence of poisonings by 38.7%. To maintain the positive dynamics of reducing morbidity and mortality from acute poisoning of alcohol etiology, to preserve the labor potential of the population of the Irkutsk region, it is necessary to further strengthen and reinforce control measures at the regional level.

Understanding the tele-coupling mechanism of urban food-energy-water nexus: Critical sources, nodes, and supply chains

With the increasing urbanization but growing resource scarcities, the securing provision of fundamental resources as food, energy and water (FEW) has become a unique challenge for urban sustainability. This is not only because of continuous demand of resource imports from different regions for urban areas, but also due to the complex interrelationships among FEW systems. In such context, exploring the interactions between FEW resources and economic activities when investigating FEW provisions to meet urban demand through trade is very essential to find effective policy intervention points and priority areas for actions. This paper investigates external binding FEW resource flows with internal certain interlinkages driven by final demand of Beijing city at different nodes along their supply chains, by combing structural path analysis and multi-regional input-output model of China 2010. The results show that the key source regions present overall neighborhood pattern that Hebei, Inner Mongolia, Anhui, Jiangsu, and Shandong near Beijing are the five leading contributors of tran-regional FEW provisions. The top 20 nexus paths are identified and the most important nexus pathways start with the other services in Beijing. Besides this, the critical supply chains appear divergent directions for FEW flows, driven by food, construction and agriculture industries respectively. Moreover, the key nodes mainly concentrate on less developed regions and energy-related sectors. For example, non-metal products manufacturing in Hebei, petroleum refining and coking in Heilongjiang, and coal mining and washing in Inner Mongolia have larger impacts on all of FEW flows across the supply chains. These results are very informative to targeting our efforts to address the urban FEW nexus issue both from the perspective of supply side and demand side.

A Critical Assessment of the EU Circular Economy Action Plan in the Light of the Access to Finance for Circular Economy Projects

As sustainability concerns advocate for a rapid deployment of circular economy, preserving and recovering the so-called ‘critical raw materials’ and minimising plastics waste, the European Commission issued an EU action plan for the Circular Economy in 2015 with two subsequent reports on its implementation. The focus of the action plan has been threefold: product design, facilitating durability of the products and waste management, while determining five priority areas of action and highlighting the need for financing the transition to a more circular economy. The latter has been seen as an accelerator for the deployment of circular economy, mentioned in the framework of creation of new circular business models and in the waste management framework. While it has been repeatedly highlighted that there is a need for extensive financing (an estimated EUR 320 billion by 2025) for a systemic transition to circular economy to come about (with estimated combined benefits of such shift of EUR 500 billion), the focus of the report has been on providing such finance in the current ‘business as usual’ framework, advocating for higher investment in such transition by the EU, without a comparative assessment of the current private financial market frameworks and their role in such transition. The present article critically assesses the action plan’s lack of focus on the access-to-finance as critical for the transition to a more circular economy outside of the public finance.

Food Safety Education Needs of High-School Students: Leftovers, Lunches, and Microwaves.

We explored priority areas of food safety education needed by high-school students within Ontario, Canada. We analyzed transcripts from semistructured interviews with 20 experts in food safety, food safety education in youth, and high-school education in Ontario. Inductive thematic analysis was used to identify priority food safety education needs. We identified 4 priority action areas for food safety education targeting students: how to safely do the things they typically do with food; how to keep themselves and their kitchens clean and safe; how microorganisms grow and how they can result in foodborne disease; and how to keep food out of the "danger zone" 4°C to 60°C (40° F to 140° F). The results indicate that students need specific education around the use of microwaves, consumption of convenience meals, preparing and handling foods at school events, and safe transportation of food for lunches, school trips, and sporting events. High-school students need food safety education specific to their usual interactions with food, including the foods, tools, and settings students regularly encounter. Delivery of food safety education should emphasize sequences of safe food-handling behaviors for specific food interactions, such as reheating a meal in the microwave, rather than traditional food safety concepts, such as temperature abuse.

БЛОКЧЕЙН ЯК КАТАЛІЗАТОР ТРАНСФОРМАЦІЇ БІЗНЕС-ПРОЦЕСІВ У СТРАХУВАННІ

На сьогодні у страховому секторі технологія блокчейн перебуває на етапі інноваційної активації, а спектр можливих додатків і можливостей її застосування ще не вивчений. Метою статті є переосмислення традиційних страхових бізнес-процесів у контексті інноваційних технологій та аналіз перспектив їх трансформації. Дослідження присвячено саме страховому сектору, оскільки серед 80 нових, але реальних можливостей використання технології блокчейн, майже чверть — у страхуванні. Блокчейн у поєднанні зі смартконтрактами може позитивно трансформувати усі внутрішні процеси страховиків (від залучення клієнтів, андерайтингу до запобігання шахрайству) і навіть дозволити компаніям виходити на нові ринки з новими продуктами, дає можливості вирішувати проблеми, пов’язані з надмірною централізацією, непрозорістю та відмиванням грошей у страховій сфері. Однак ці можливості в основному визначатимуться тим, чи буде ринок використовувати технологію, чи ні.Окреслено можливості та потенціал застосування технології блокчейн у страховому секторі фінансового ринку, виділено сильні та слабкі сторони технології, виявлено ключові переваги, які дає блокчейн для кожного з основних (операційних) бізнес-процесів страховика: створення і продаж страхового продукту, введення даних про клієнта/оцінка ідентичності, оцінка ризиків/обчислення премій, обслуговування клієнтів, урегулювання збитків, управління активами. Зроблено висновок, що на сьогодні українським страховим компаніям важливо шляхом створення прототипних рішень поступово набувати необхідних компетенцій та оцінювати, як блокчейн буде впливати на наявну страхову бізнес-модель і наскільки ця технологія буде прийнята персоналом і клієнтами. Страховики можуть почати діяти, фокусуючи увагу на трьох напрямах: інноваційний ландшафт, власні пріоритетні напрями діяльності та можливі операційні моделі.

Conservation or politics? Australia's target to kill 2 million cats

AbstractThe Australian Government's 5‐year Threatened Species Strategy contains four priority action areas and associated targets. Here, we argue that the well‐publicized target to cull 2 million feral cats has a weak scientific basis because: (1) reliable estimates of Australia's cat population size did not exist when the target was set; (2) it is extremely difficult to measure progress (numbers of cats killed) in an accurate, reliable way; and, most importantly, (3) the cull target is not explicitly linked to direct conservation outcomes (e.g., measured increases in threatened species populations). These limitations mean that the cull target fails to meet what would be considered best practice for pest management. The focus on killing cats runs the risk of distracting attention away from other threats to biodiversity, most prominent of which is widespread, ongoing habitat loss, which has been largely overlooked in the Threatened Species Strategy. The culling target is a highly visible symbol of a broader campaign around feral cat research and management in Australia, rather than a direct indicator of conservation action and success. We are concerned that progress toward the 2 million target could be misinterpreted as progress toward conserving threatened species, when the link between the two is not clear.

The supportive care needs of women experiencing gynaecological cancer: a Western Australian cross-sectional study

BackgroundWomen diagnosed with gynaecological cancer experience supportive care needs that require care provision to reduce the impact on their lives. International evidence suggests supportive care needs of women with gynaecological cancer are not being met and provision of holistic care is a priority area for action. Knowledge on gynaecological cancer supportive care needs is limited, specifically comparison of needs and cancer gynaecological subtype.Our aim was to identify supportive care needs of Western Australian women experiencing gynaecological cancer, their satisfaction with help and explore associations between participant’s demographic characteristics and identified needs.MethodsA cross-sectional design incorporating a modified version of the Supportive Care Needs Survey – short form (SCNS-SF34) assessed 37 supportive care needs under five domains in conjunction with demographic data. Three hundred and forty three women with gynaecological cancer attending a tertiary public referral hospital completed the survey over 12 months. Statistical analysis was performed using the R environment for statistical computing. A linear regression model was fitted with factor scores for each domain and demographic characteristics as explanatory variables.ResultsThree hundred and three women (83%) identified at least one moderate or high level supportive care need. The five highest ranked needs were, ‘being informed about your test results as soon as feasible’ (54.8%), ‘fears about cancer spreading’ (53.7%), ‘being treated like a person not just another case’ (51.9%), ‘being informed about cancer which is under control or diminishing (that is, remission)’ (50.7%), and ‘being adequately informed about the benefits and side-effects of treatments before you choose to have them’ (49.9%). Eight of the top ten needs were from the ‘health system and information’ domain. Associations between supportive care items and demographic variables revealed ‘cancer type’, and ‘time since completion of treatment’ had no impact on level of perceived need for any domain.ConclusionsWestern Australian women with gynaecological cancer identified a high level of supportive care needs. The implementation of a supportive care screening tool is recommended to ensure needs are identified and care is patient-centred. Early identification and management of needs may help to reduce the burden on health system resources for managing ongoing needs.

Exploring barriers to the use of formal maternal health services and priority areas for action in Sidama zone, southern Ethiopia

BackgroundIn 2015 the maternal mortality ratio for Ethiopia was 353 per 100,000 live births. Large numbers of women do not use maternal health services. This study aimed to identify factors influencing the use of maternal health services at the primary health care unit (PHCU) level in rural communities in Sidama zone, south Ethiopia in order to design quality improvement interventions.MethodsWe conducted a qualitative study in six woredas in 2013: 14 focus group discussions (FGDs) and 44 in-depth interviews with purposefully selected community members (women, male, traditional birth attendants, local kebele administrators), health professionals and health extension workers (HEWs) at PHCUs. We digitally recorded, transcribed and thematically analysed the interviews and FGDs using Nvivo. The ‘three delay model’ informed the analytical process and discussion of barriers to the use of maternal health services.ResultsLack of knowledge on danger signs and benefits of maternal health services; cultural and traditional beliefs; trust in TBAs; lack of decision making power of women, previous negative experiences with health facilities; fear of going to an unfamiliar setting; lack of privacy and perceived costs of maternal health services were the main factors causing the first delay in deciding to seek care. Transport problems in inaccessible areas were the main contributing factor for the second delay on reaching care facilities. Lack of logistic supplies and equipment, insufficient knowledge and skills and unprofessional behaviour of health workers were key factors for the third delay in accessing quality care.ConclusionsUse of maternal health services at the PHCU level in Sidama zone is influenced by complex factors within the community and health system. PHCUs should continue to implement awareness creation activities to improve knowledge of the community on complications of pregnancy and benefits of maternal health services. The health system has to be responsive to community’s cultural norms and practices. The mangers of the woreda health office and health centres should take into account the available budgets; work on ensuring the necessary logistics and supplies to be in place at PHCU.