Professional Health Care Services Research Articles

Mental health challenges of recent immigrants in precarious work environments - a qualitative study.

Recent immigrants from racialized minority backgrounds and those who are not proficient in the local language are some of the most vulnerable members of society. Despite having postsecondary educational qualifications and permanent residency status, many are engaged in precarious employment. There is a scarcity of research that has explicitly focused on the work experiences and mental health challenges faced by these immigrants. Using a grounded theory approach and semi-structured face-to-face interviews, this study examined the work experiences and mental health challenges of 42 recent immigrant employees from two cities in Canada who were working in various industries and engaged in precarious employment. Eighty-one percent of the employee participants were overqualified for their jobs. Findings highlighted several ongoing mental problems that participants experienced, stemming from challenging physical and psychological workplace conditions, negative mindsets associated with their recent immigrant status, and other contextual factors and barriers. However, various coping strategies, both constructive and unconstructive, were used to address this mental distress. The study proposes a multidimensional approach to address workplace conditions to promote good mental health for these employees. This includes preventative programs for raising awareness among employers about the importance of recent immigrant employees' mental health and well-being and policy and legislation changes to ensure the employer's commitment to creating a safe and culturally friendly workplace. The approach also recommends that recent immigrant employees receive occupational health and safety training, learn about Canadian workplace norms and culture, and have access to professional healthcare services.

Exploring drivers of self-treatment with antibiotics in three agricultural communities of northern Tanzania

BackgroundAntimicrobial resistance (AMR) poses a significant global health threat, particularly in low- and middle-income countries (LMICs). Self-treatment with antibiotics, the practice of using antibiotics without professional guidance, is often considered an important contributor to the emergence and spread of AMR.MethodThis study investigated the drivers of self-treatment in three common types of agricultural communities in northern Tanzania. The research employed a comprehensive array of methods, including cross-sectional surveys (n = 790), interviews (n = 30) and observations (n = 178) targeting both antibiotic (human and animal) providers and users (patients and farmers). Qualitative interview data were analysed using a coding and association matrix, while descriptive analyses were performed on survey and observation data.ResultsSelf-treatment with antibiotics was highly prevalent in all communities. Between 41.0% (self-reported) and 60.3% (observed) of human antibiotics were obtained without a prescription and we observed that veterinary antibiotics were regularly purchased in retail shops without referral by a professional. Structural deficiencies in the healthcare system drove this practice: limited access to healthcare facilities, medication stockouts and prolonged waiting times were identified as key factors. The absence of safety nets like insurance schemes further contributed to self-medication. Retail shops offered a convenient and cost-effective alternative when antibiotics were inaccessible or unaffordable. Notably, informal networks comprising treatment vendors, friends or neighbours, as well as personal experiences played a crucial role in guiding individuals in their self-treatment decisions by providing advice on treatment choice and modalities.ConclusionsAddressing self-treatment requires a multi-faceted approach. Improving the availability and accessibility of antibiotics, enhancing healthcare services and involving retail vendors in antibiotic stewardship are essential. Structural issues like access to diagnostics and medicines must be tackled, alongside reducing barriers and incentivising individuals to use professional healthcare services. Training retail vendors to sell specific first-line antibiotics over the counter with guidance on appropriate usage should be considered. Such bottom-up interventions will enable sustainable promotion of responsible antibiotic use, mitigating AMR emergence and securing a healthier future for all.

The integrated behavioral model of mental health help seeking (IBM-HS): A health services utilization theory of planned behavior for accessing care.

This article introduces the integrated behavioral model of mental health help seeking (IBM-HS), a theoretical model for understanding the constructs (e.g., systemic, predisposing, and enabling factors; mental health literacy; illness perceptions; perceived need; stigma; shame; perceived benefits, motivation) that influence people's decision making around seeking professional mental health care and their ultimate access to formal treatment. The IBM-HS is a help-seeking-specific adaptation of the empirically supported integrated behavioral model and integrative model, which are themselves evolutions of the theory of planned behavior and theory of reasoned action. The IBM-HS posits that help-seeking determinants (e.g., structural forces; cultural influences; past help-seeking experience; evaluated need; mental health perceptions, knowledge, and skills; social support) influence help-seeking beliefs (i.e., outcome beliefs, experiential beliefs, beliefs about others' expectations, beliefs about others' behavior, logistical beliefs), which in turn determine their respective help-seeking mechanisms (i.e., attitude, perceived norm, personal agency). These mechanisms collectively influence help-seeking intention, which drives prospective help-seeking behavior, subject to the moderating effects of determinants. Finally, prospective behavior has reciprocal feedback loop effects on certain determinants and beliefs. This article describes the need for the IBM-HS, the model's constructs and their interrelations, measurement considerations, and how the model can be used by scholarly and applied users to systematically understand people's intention to seek professional mental health care services and what helps or hinders them from utilizing this care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Analisis Kualitas Pelayanan Kesehatan di Puskesmas Porong Kabupaten Sidoarjo

Public service is crucial for fulfilling community basic needs, particularly in healthcare. Puskesmas Porong, a healthcare institution in Sidoarjo District, serves as the primary focus of this study. With a vision to provide quality and professional healthcare services to the community, Puskesmas Porong plays a pivotal role as the primary healthcare center in Porong Subdistrict. Despite adequate facilities including 46 inpatient beds and coverage of 10 surrounding villages, challenges persist. High patient influx poses significant issues such as long waiting times for services, attributed to insufficient staff and resources. Moreover, limited community participation in providing feedback is a concern, hindering the identification of issues and optimal solutions for healthcare service improvement.This qualitative research aims to analyze healthcare service quality at Puskesmas Porong, employing interviews with key stakeholders including the head of the health center, medical staff, administrative personnel, and patients. Additionally, observation and documentation methods were utilized to gather comprehensive data on service provision, patient satisfaction, and facility conditions. Results reveal that while operational procedures are generally adhered to, discrepancies exist between management perceptions and patient experiences. Patients highlight shortcomings in BPJS utilization, medical equipment adequacy, and diagnostic accuracy, underscoring the need for targeted improvements to enhance service quality and community trust.

IoT Based Medical Assessor and Predictor for HealthCare Solutions

Abstract: The introduction of cutting-edge, intelligent medical equipment into the virtual doctor system is orchestrating a remarkable transformation within community healthcare. Research in the healthcare sector has unveiled promising developments in extending human lifespan. However, obtaining healthcare services in remote areas remains a formidable challenge as patients often have to endure long journeys for treatment. The incorporation of IoT technology offers a viable solution by allowing real-time monitoring of vital signs through sensors like heart rate, Spo2, temperature, B.P and ECG sensors, measuring pulse rate, blood oxygen levels, body temperature, and blood pressure, respectively and applying different machine learning algorithms to predict the condition of the patient and suggest some precautions & medications. The reliability of the collected data is assured, and ThingSpeak software transmits this data to the cloud, enabling the delivery of professional healthcare services to those in need. Notably, statistics reveal that in India, the doctor-to-patient ratio stands at 1:854, underscoring the crucial role of this technology in addressing healthcare requirements in rural communities.

Understanding Men's Lived Experience of Mental Distress Through Metaphors.

The use of tailored language, which involves a clinician's ability to adapt communication styles and employ accessible terms and concepts, has long been touted as key to engaging men with mental health services. Metaphors are one communication device that can provide men with ways through which to meaningfully express themselves and communicate their mental distress experiences. Using qualitative photovoice research, the current study examined how New Zealand-based men (n = 21) communicatively constructed their meaning of mental distress through metaphors. Analysis of interview data was used to derive three metaphor groupings men consistently drew on to articulate their lived experiences: metaphors of emotions (darkness and weight), metaphors of survival (battle and entity), and metaphors of disembodiments (debility and entrapment). The findings highlight the power of metaphors as a tool for men in communicating their experiences of mental distress and are valuable for health professionals to contemplate across an array of contexts. The implications and importance of a metaphor-enriched perspective for engaging men in professional health care settings and services are discussed.

Territory: meanings produced by primary care nurses

Know the meaning of territory from the perspective of primary care nurses. An exploratory-descriptive study with a qualitative approach was conducted in ten primary healthcare units located in the city of Boa Vista, Roraima, Brazil. The social group consisted of eight permanent municipal employees who are nurses. Data collection took place from December 2022 to February 2023 through semi-structured interviews. The audio recordings amounted to approximately one hour and twenty minutes, which were transcribed manually and analyzed according to Bardin's theoretical framework. The meanings related to territory from the perspective of nurses working in primary care were organized into three thematic categories, namely: territory understood as the area of coverage for professional healthcare services, territory seen as a meeting place for healthcare professionals with priority groups, and territory interpreted as a space for care management. The meanings regarding territory have been decoded as the geographical space for the activities of the primary healthcare team professionals. Territory as the care location for priority groups, with emphasis on children, pregnant women, elderly individuals diagnosed with hypertension and diabetes, bedridden patients, migrants, individuals with disabilities, disadvantaged and vulnerable groups. Finally, (re)recognized as the place where action planning, organization of healthcare practices, service coordination, primary team supervision, and care evaluation take place.

Perspectives of telemedicine-based services among family caregivers of patients with end-of-life cancer: a qualitative study in mainland China

BackgroundDespite being driven by a strong sense of duty and familial obligation, providing care for patients nearing the end of life poses challenges for family caregivers. Telemedicine has rapidly gained traction as a transformative approach to healthcare delivery, offering an array of benefits that could be particularly valuable in end-of-life care. However, research on the perspectives of telemedicine-based services among family caregivers of patients with end-of-life cancer is limited. Therefore, this study aims to explore the perspectives and preferences of telemedicine-based services among family caregivers of patients with end-of-life cancer and provide a framework for developing and executing a tailored telemedicine-based end-of-life care program that addresses the unique needs of family caregivers in mainland China.MethodA descriptive phenomenological approach was used. Family caregivers were selected using purposive sampling at a tertiary cancer hospital. One-on-one semi-structured interviews were conducted with the participants from November to December 2022. Colaizz’s method was used to analyze the interviews.ResultsFourteen participants participated in interviews. Three themes and ten subthemes were identified: motivation to receive telemedicine services (relief from the burden of home care; access to professional health care services), supportive care needs for telemedicine services (support for symptom management; negative emotional adjustment; death education; daily life care guidance), and functional expectations of telemedicine service platforms (ease of use; real-time online guidance and response; personalized automatic reminder; targeted matching push of health knowledge).ConclusionFamily caregivers expressed interest in telemedicine-based services and identified various care needs before receiving telemedicine services. The findings of this study can help policymakers and healthcare providers develop more effective and culturally appropriate telemedicine-based service programs that can better support family caregivers of end-of-life cancer patients.

Working conditions of the kinesiologists working in the Atacama region in the context of the COVID-19 pandemic

Introduction: The social-health crisis generated by the COVID-19 pandemic highlights the importance of attending to the working conditions of health personnel in order to provide for risks at work. Kinesiologists had a frontline role during the pandemic which led to the modification of their activities and at the same time increased hiring of these professionals in health care services. Objective: To understand the working conditions of kinesiologists working in the Atacama region, in northern Chile, during the COVID-19 pandemic. Method: The qualitative study is based on the naturalistic paradigm, the tendency used is the grounded theory with a systematic design of Strauss and Corbin J. With two levels of open and axial analysis. Twenty semi-structured interviews were carried out with kinesiologists, ten women and ten men. Results: The analysis allowed establishing eight predominant categories: poor working conditions, poor employment conditions, attitudes and feelings, professionalism, facilitators of working conditions, relevance of the professional role, good employment conditions and lack of knowledge of concepts of employment and working conditions. Conclusion: The working conditions of kinesiologists are deficient, the informal contractual situation stands out and without access to social security, constituting an element of precarious employment and exposure to psychosocial risks as predominant elements of working conditions that are important to address to ensure the safety and quality of care services through the professionals who provide care

Assessment of first-phase COVID-19 pandemic in Europe using hierarchical clustering based on principal components analysis

<p>It is of great interest for researchers to assess the COVID-19 pandemic in Europe. Grouping of COVID-19-affected regions is an effective way to monitor and optimize planning to combat the disease. This paper applied hierarchical clustering based on principal components analysis (HCPCA) to COVID-19 data from affected European countries. Considering several attribute indices, we obtained a new set of indicators using principal components analysis to aggregate and reduce the dimension of attribute indices of affected countries. Further, we obtained groups of affected countries subject to their similarity using hierarchical clustering to the reduced observations of new attributes indices of these countries. This study aims to group European countries with similar epidemic severity using some presumed attribute indices. The study is limited up to 24 May 2020, to assess if the outputs of the study could help governments, administrators, World Health Organization (WHO), healthcare service professionals, and other decision-makers to optimize their policies and plan their regulations in the country level requirements so that transmission of infections, deaths, critical conditions of patients could be minimized. For this purpose, we used hierarchical clustering using principal components analysis to obtain better clusters of countries with similar epidemic severity.</p>

Providing healthcare outside working hours: moral and legal aspects

It would often be in the public interest for persons with special knowledge, including the so-called liberal profession-als, to exercise their skills voluntarily, as long as a need for their services arises: for example, a healthcare practitionerwould provide treatment to anyone in need of emergency care, architects would act as soon as there is a mention ofa crack in the load-bearing wall of an apartment building and judges would judge a court on holidays if need arises.But the legal duty to act can be demanded from those who are legally assigned this task only. For all the stakeholders,legal certainty in healthcare is an issue of major importance. To contribute to this aspect, this study aims to detect thelegal and ethical framework of the medical practitioner’s obligation to provide treatment outside of working hours. Thescientific literature, case-law, legal acts and court judgements were studied; the analytic, doctrinal, comparative andmodelling methods were applied; the general legal norm interpretation methods were used. The authors conclude thatoutside of working hours, medical practitioners are exempt from their legal responsibilities, are guided by moral normsand general citizens’ obligations only and have the right to refuse to provide professional healthcare services. Theinconsistency among legal scholars and legal and medical practitioners concerning the duties of healthcare profes-sionals during their rest time was detected. The recommendations are proposed to ensure legal certainty and achieveconsentaneity among the stakeholders.

Development and initial validation of the addressing client needs with social determinants of health scale (ACN: SDH)

BackgroundThe purpose of this study was to validate a scale that can be used by healthcare service professionals, healthcare systems, educators, and researchers to assess health service professionals’ social determinants of health (SDOH) competency; with competency defined as their knowledge, awareness-biases, skills, and actual preparedness to address SDOH challenges.MethodsAn Exploratory Factor Analysis (EFA) was conducted with a sample of 220 health service professionals, and 6 factors were identified. A Confirmatory Factor Analysis (CFA) was conducted with 303 health service professionals and the 6-factor solution was supported, with 22 items.ResultsThe reliability estimates for the 6 factors are as follows: Factor 1, Action Toward Addressing SDOH (a = .85); Factor 2, SDOH Knowledge (a = .94); Factor 3, Negative Attitude toward Addressing SDOH (a = .79); Factor 4, Systemic Accountability (a = .81); Factor 5, School Preparation (a = .86); and Factor 6, Perception of the Cause of SDOH (a = .94).ConclusionThe ACN:SDH scale is the first validated measure that can be used to systematically appraise health service professionals’ SDOH competency.

Response to intervention services for preschool children with developmental language disorder: Opinions of school and health care service professionals and managers

Background. Children with developmental language disorder (DLD) are less prepared for school than typically developing children and are therefore at risk for academic, social, and behavioral difficulties when they enter school. To support these children, early family-centered intervention is recommended. However, access to effective care remains an issue. Researchers have therefore suggested to reconsider the place of individual specialized intervention within a broader systemic response to intervention (RTI) framework. The aim of this study is to explore the opinions of professionals and managers working with children aged 0–5 with language difficulties on strategies to better support their school readiness. Specifically, it explores the facilitators and barriers to school readiness in children with DLD as well as strategies to better prepare them for school. Finally, it examines how an RTI model can provide a framework for services to preschool children with DLD. Methods. Two focus groups were conducted with 15 professionals and managers in the health care and school systems in the province of Quebec (Canada). The interviews were analyzed using an analytical questioning strategy. Results. Five key elements in service delivery were deemed essential in supporting school readiness of children with language difficulties: (1) maximizing community initiatives, (2) training and supporting partners, (3) supporting change in practice, (4) offering flexible services adapted to children's needs, and (5) implementing mechanisms to ensure service continuity and information transfer between agencies. These key elements are conceptualized within the RTI model. Conclusion. The five key elements identified in this study should be part of an intervention model in order to optimize service organization and better support school readiness for children with DLD.

The Seeking Mental Health Care model: prediction of help-seeking for depressive symptoms by stigma and mental illness representations

BackgroundOnly about half the people with depression seek professional health care services. To constitute the different predictors and associating variables of health care utilisation, we model the process and aim to test our hypothesised Seeking Mental Health Care Model. The model includes empirical influences on the help-seeking process to predict actual behaviour and incorporates superordinate (stigma, treatment experiences) as well as intermediate attitudinal variables (continuum and causal beliefs, depression literacy and self-efficacy).MethodAll variables are examined in an online study (baseline, three- and six-month follow-up). The sample consisted of adults with depressive symptoms (PHQ-9 sum score ≥ 8), currently not receiving mental health care treatment. To examine the prediction of variables explaining help-seeking behaviour, a path model analysis was carried out (lavaan package, software R).ResultsAltogether, 1368 participants (Mage = 42.38, SDage = 15.22, 65.6% female) were included, 983 participating in at least one follow-up. Model fit was excellent (i.e., RMSEA = 0.059, CFI = 0.989), and the model confirmed most of the hypothesised predictions. Intermediary variables were significantly associated with stigma and experiences. Depression literacy (ß = .28), continuum beliefs (ß = .11) and openness to a balanced biopsychosocial causal model (ß = .21) significantly influenced self-identification (R2 = .35), which among the causal beliefs and self-efficacy influenced help-seeking intention (R2 = .10). Intention (ß = .40) prospectively predicted help-seeking behaviour (R2 = .16).ConclusionThe Seeking Mental Health Care Model provides an empirically validated conceptualisation of the help-seeking process of people with untreated depressive symptoms as a comprehensive approach considering internal influences. Implications and open questions are discussed, e.g., regarding differentiated assessment of self-efficacy, usefulness of continuum beliefs and causal beliefs in anti-stigma work, and replication of the model for other mental illnesses.Trial registrationGerman Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111–1264-9954. Registered 16 February 2021.

The Influences of Open Access of Online Health Information on Patient Compliance to Professional Healthcare Providers Prescription in Kasangati Town Council, Wakiso District Uganda

Globally the health sector has witnessed disruptive transformation of how information is; generated, analyzed and shared using Information Communication Technologies (ICT). There is limited understanding on how patient’s access of online health information influences their desire to seek professional healthcare services or their adherence to professional healthcare service providers prescription/advise. Thus, the aim of this study was to investigate the influence that online health information has on patients’ compliance to professional healthcare service provider’s case management plans in Kasangati Town Council, Wakiso District, Uganda. Results show that, availability of internet, accessibility and availability of information and desire to gain deeper understanding are some of key factors that influence patients to access online health information. The study further revealed that access to online health information reinforces patient desired to seek professional care services and adhere to a case management plan provided by the health workers in addition to improving patient awareness and participation in management of their health.

Causing harm but doing good: Recognizing and overcoming the burden of necessary evil enactment in healthcare service professions.

Necessary evils - defined as acts that cause physical, psychological, or emotional harm to victims but are for the greater good of either the victim or society - are an everyday occurrence in the healthcare industry across the globe and across healthcare service professions. Healthcare professionals are tasked with behaviors that result in pain and suffering (e.g. nurses providing shots to patients; oncologists communicating cancer diagnoses) for the betterment of their patients and stakeholders. Although these behaviors are professionally mandated, they can also be cognitively and psychologically taxing for enactors. The current conceptual paper explores the undesired effects of performing necessary evils and proposes various actions through which healthcare organizations can reduce the negative repercussions of necessary evil enactment on healthcare service professionals.

Conversations and Reactions Around Severe Hypoglycemia (CRASH) Study: Results From People With Diabetes and Caregivers in the United States.

A survey was conducted in eight countries to examine conversations around, and experiences and treatments during, severe hypoglycemia among people with diabetes and caregivers of people with diabetes. This article reports a subgroup analysis from the United States involving 219 people with diabetes and 210 caregivers. Most respondents (79.7%) did not use professional health care services during their most recent severe hypoglycemic event, and 40.3% did not report the event to their health care providers at a subsequent follow-up visit. Hypoglycemic events left respondents feeling scared (70.9%), unprepared (42.7%), and helpless (46.9%). These clinically important psychosocial impacts on people with diabetes and caregivers underscore the need for conversations about hypoglycemia prevention and management.

The Soteria model: implementing an alternative to acute psychiatric hospitalization in Israel

ABSTRACT Background Since 2016, Soteria homes have been operating in Israel. In this report we describe the implementation of the model. Methods Data for 486 residents staying in one of three Soteria homes from 2016 through 2020 are presented. The model, and necessary modifications, are discussed. Results The majority of the residents in the Soteria homes suffered from psychotic (41.3%) or bipolar disorder (20.9%) and were of a mean age of 34.5 (SD = 12.83). While operating according to the principles of Soteria, adaptations had to be made. The homes used professional staff as well as companions. Accepting a wide range of residents exposed the home to situations of violent behaviour which required adjustment in admission policy. Work with insurers limited the possible length of stay. Financial constraints expanded the home capacity to 10 residents, while limiting work shifts to 12 hours. Cultural considerations led to the establishment of single-gender homes. Discussion Soteria homes can be a viable component of publicly-funded mental health care systems. The implementation of the Soteria model can provide important lessons for the future development of a professional and humane mental health care service – not as an alternative, but as an integral part of the system.

Studying intraprofessional and interprofessional learning processes initiated by an educational intervention applying a qualitative design with multimethod approach: a study protocol

IntroductionInterprofessional collaboration in education and practice has been highlighted as a premise for providing good care. Both the intraprofessional and interprofessional impacts have bearing on healthcare professionals’ performance and learning....

The benefits and challenges of established peer support programmes for patients, informal caregivers, and healthcare providers.

Peer support programmes that provide services for various health conditions have been in existence for many years; however, there is little study of their benefits and challenges. Our goal was to explore how existing peer support programmes help patients with a variety of health conditions, the challenges that these programmes meet, and how they are addressed. We partnered with 7 peer support programmes operating in healthcare and community settings and conducted 43 semi-structured interviews with key informants. Audiorecordings were transcribed and qualitative analysis was conducted using grounded theory methods. Peer support programmes offer informational and psychosocial support, reduce social isolation, and connect patients and caregivers to others with similar health issues. These programmes provide a supportive community of persons who have personal experience with the same health condition and who can provide practical information about self-care and guidance in navigating the health system. Peer support is viewed as different from and complementary to professional healthcare services. Existing programmes experience challenges such as matching of peer supporter and peer recipient and maintaining relationship boundaries. They have gained experience in addressing some of these challenges. Peer support programmes can help persons and caregivers manage health conditions but also face challenges that need to be addressed through organizational processes. Peer support programmes have relevance for improving healthcare systems, especially given the increased focus on becoming more patient-centred. Further study of peer programmes and their relevance to improving individuals' well-being is warranted.