Provision Of Services Research Articles

A qualitative assessment of the role of mobile phone technology in enhancing motorcycle taxi services in Dar es Salaam, Tanzania

ABSTRACT Motorcycle taxis (MCT) have become a popular means of mobility in Sub-Saharan Africa. Information and communication technologies (ICT) have facilitated the revolution of these services. This study assesses the role of technology in the revolution of motorcycle taxis (MCT) services in Dar es Salaam, Tanzania. The study was a qualitative case study with data collected from 35 research participants. This study found that mobile phone technology is increasingly used by MCT drivers and customers to facilitate the provision and consumption of services. The technology has revolutionized the services. Even though smartphones have spread well in the country, analog phones are equally valued as they enable customers and drivers to keep in touch through phone calls and short messages. Despite the significance of the technology, various challenges were observed, including poor digital skills and increasing road accidents.

Independent Supported Housing vs institutional housing rehabilitation settings for non-homeless individuals with severe mental illness – longitudinal results from an observational study

BackgroundMost individuals with severe mental illness (SMI) strongly prefer independent living over living in an institution. Independent Supported Housing (ISH) provides housing rehabilitation for persons with SMI in their accommodations. However, most individuals who need housing rehabilitation live in institutional housing settings (housing rehabilitation as usual: HAU). We investigated which housing rehabilitation setting is effective on which variable in the long term to support service users to form an informed preference for either housing rehabilitation setting.MethodsWe conducted a two-year longitudinal observational non-inferiority study to test the effectiveness of ISH in improving participants’ social inclusion, quality of life, emotional social support, capabilities, symptom severity, functioning, service utilisation and costs. Participants were assessed at baseline and after six, twelve, and 24 months. Mixed effects models were computed to test between-group and within-group effects.ResultsThe study included 83 participants in ISH (n = 31) and HAU (n = 52) housing rehabilitation settings with a mean age of 36.2 years. Most participants were male (64%) and had a primary psychotic or schizophrenic (35%) or an affective diagnosis (24%). During the study, ISH participants significantly improved their quality of life (β = 0.54; 95% CI: 0.26 to 0.82), symptoms (β = -0.32; 95% CI: -0.60 to -0.03), and capabilities (β = 4.46; 95% CI: 0.14 to 8.77) and decreased psychiatric hospitalisations (p = 0.04). HAU participants improved their quality of life (β = 0.40; 95% CI: 0.12 to 0.69). Housing and rehabilitation support costs were almost half with ISH than with HAU.ConclusionISH has been shown to be much less expensive than HAU and was associated with several improvements like reduced psychiatric hospitalisations and improved quality of life. Therefore, our findings strongly argue for a preference-driven provision of housing rehabilitation services and to end the institutionalisation of persons with SMI.Trial registrationThe study was registered on December 04, 2018, at ClinicalTrials.gov (NCT03815604).

Blockchain Technology and Its Potential to Benefit Public Services Provision: A Short Survey

In the last few years, blockchain has emerged as a cutting-edge technology whose main advantages are transparency, traceability, immutability, enhanced efficiency, and trust, thanks to its decentralized nature. Although many people still identify blockchain with cryptocurrencies and the financial sector, it has many prospective applications beyond digital currency that can serve as use cases for which traditional infrastructures have become obsolete. Governments have started exploring its potential application to public services provision, as confirmed by the increasing number of adoption initiatives, projects, and tests. As the current public administration is often perceived as slow, bureaucratic, lacking transparency, and failing to involve citizens in decision-making processes, blockchain can establish itself as a tool that enables a process of disintermediation, which can revolutionize the way in which public services are managed and provided. In this paper, we will provide a survey of the main application areas which are likely to benefit from blockchain implementation, together with examples of practical implementations carried out by both state and local governments. Later, we will discuss the main challenges that may prevent its widespread adoption, such as government expenditure, technological maturity, and lack of public awareness. Finally, we will wrap up by providing indications on future areas of research for blockchain-based technologies.

Preliminary findings on the experiences of care for women who suffered early pregnancy losses during the COVID-19 pandemic: a qualitative study

BackgroundWomen who suffer an early pregnancy loss require specific clinical care, aftercare, and ongoing support. In the UK, the clinical management of early pregnancy complications, including loss is provided mainly through specialist Early Pregnancy Assessment Units. The COVID-19 pandemic fundamentally changed the way in which maternity and gynaecological care was delivered, as health systems moved to rapidly reconfigure and re-organise services, aiming to reduce the risk and spread of SARS-CoV-2 infection. PUDDLES is an international collaboration investigating the pandemic’s impact on care for people who suffered a perinatal bereavement. Presented here are initial qualitative findings undertaken with UK-based women who suffered early pregnancy losses during the pandemic, about how they navigated the healthcare system and its restrictions, and how they were supported.MethodsIn-keeping with a qualitative research design, in-depth semi-structured interviews were undertaken with an opportunity sample of women (N = 32) who suffered any early pregnancy loss during the COVID-19 pandemic. Data were analysed using a template analysis to understand women’s access to services, care, and networks of support, during the pandemic following their pregnancy loss. The thematic template was based on findings from parents who had suffered a late-miscarriage, stillbirth, or neonatal death in the UK, during the pandemic.ResultsAll women had experienced reconfigured maternity and early pregnancy services. Data supported themes of: 1) COVID-19 Restrictions as Impractical & Impersonal; 2) Alone, with Only Staff to Support Them; 3) Reduction in Service Provision Leading to Perceived Devaluation in Care; and 4) Seeking Their Own Support. Results suggest access to early pregnancy loss services was reduced and pandemic-related restrictions were often impractical (i.e., restrictions added to burden of accessing or receiving care). Women often reported being isolated and, concerningly, aspects of early pregnancy loss services were reported as sub-optimal.ConclusionsThese findings provide important insight for the recovery and rebuilding of health services in the post-pandemic period and help us prepare for providing a higher standard of care in the future and through any other health system shocks. Conclusions made can inform future policy and planning to ensure best possible support for women who experience early pregnancy loss.

Service provision decisions of competitive manufacturers: From service spillover perspective

This paper investigates competing manufacturers’ strategic choice of service provision in a two-level supply chain composed two manufacturers and one common retailer. Our results indicate that the strategy that two competing manufacturers provide services is always the dominant choice, and two competing manufacturers could have the highest profit in that case. But when only one of them provides services, the result is related to the potential market size, the unit service cost coefficient and the service spillover intensity. Finally, through the cost sharing and quantity competition extensions, we find the Pareto regions of cost sharing under the equilibrium strategy, and there will be multiple Nash equilibrium regions under the quantity competition.

U.S. Medical Eligibility Criteria for Contraceptive Use, 2024.

The 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by persons who have certain characteristics or medical conditions. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. MEC (CDC. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR 2016:65[No. RR-3]:1-103). Notable updates include 1) the addition of recommendations for persons with chronic kidney disease; 2) revisions to the recommendations for persons with certain characteristics or medical conditions (i.e., breastfeeding, postpartum, postabortion, obesity, surgery, deep venous thrombosis or pulmonary embolism with or without anticoagulant therapy, thrombophilia, superficial venous thrombosis, valvular heart disease, peripartum cardiomyopathy, systemic lupus erythematosus, high risk for HIV infection, cirrhosis, liver tumor, sickle cell disease, solid organ transplantation, and drug interactions with antiretrovirals used for prevention or treatment of HIV infection); and 3) inclusion of new contraceptive methods, including new doses or formulations of combined oral contraceptives, contraceptive patches, vaginal rings, progestin-only pills, levonorgestrel intrauterine devices, and vaginal pH modulator. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.

U.S. Selected Practice Recommendations for Contraceptive Use, 2024.

The 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. SPR (CDC. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR 2016;65[No. RR-4]:1-66). Notable updates include 1) updated recommendations for provision of medications for intrauterine device placement, 2) updated recommendations for bleeding irregularities during implant use, 3) new recommendations for testosterone use and risk for pregnancy, and 4) new recommendations for self-administration of injectable contraception. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.

Sexual and Reproductive Healthcare Needs of Refugee Women Exposed to Gender-Based Violence: The Case for Trauma-Informed Care in Resettlement Contexts.

This paper assesses literature regarding the sexual and reproductive healthcare (SRH) needs of resettled refugee women who experienced gender-based violence (GBV) and trauma-informed care (TIC) principles utilized among SRH service providers. A systematic search identified relevant studies published between 2000 and 2021; no articles found reflected both SRH and TIC principles among refugee women. The search was therefore separated into two aims: to review the literature about SRH needs for refugee women in resettlement countries who experienced GBV (Aim 1) and to examine the use of TIC principles in SRH care among women who experienced GBV (Aim 2). Thematic analysis of the articles identified key themes. Twenty-six articles were included in the analysis across both aims (Aim 1 = 8, Aim 2 = 18). Aim 1 articles shared three factors shaping the SRH needs of resettled refugee women: the centrality of violence and trauma; structural barriers to SRH care; and actions, practices, and resources for service providers. Aim 2 articles illustrated seven key principles of TIC used in SRH service provision, such as empowerment; trauma-specific services and integrated care; connection; safety; collaboration; identity culture and context; and trustworthiness. Resettled refugee women's experiences of violence necessitate trauma-informed SRH health care. While there is limited peer-reviewed literature regarding TIC-SRH care for refugee women, the findings regarding the SRH needs of refugee women and the findings regarding the implementation of TIC in SRH collectively frame recommendations for how SRH can be infused with TIC. An example from practice, in the form of the Refugee Women's Health Clinic, is included as an exemplar of TIC SRH principles in action for the health of resettled refugee women who have survived gendered violence.

Treatment outcomes of the e-Health in the elderly: A systematic review

Introduction: the E-Health, is a relevant service provision since the SARS-Cov-2 pandemic, when it became a patient care alternative, however, few studies have evidenced the treatment outcomes of this tool in elderly people. Objectives: to analyze the treatment outcomes of telemedicine in the elderly. Methods: a systematic review was carried out according to six stages. The PubMed, CINAHL and Science Direct databases were used. Experimental studies between 2017 and 2022 were included. All references were exported to the EndNote manager. The methodological quality was analyzed using the Mixed Method Appraisal Tools (MMAT) checklist. The deductive thematic analysis of the data was based on the Model for Assessment of Telemedicine Applications (MAST). Results: out of a total of 2 628 articles identified and 10 included. Of the total number of studies analyzed, two of them used a digital platform, two by telephone follow-up, four mixed telemedicine interventions and two by tele-rehabilitation. According to the evaluation of the methodological quality of the studies, five of them met all the criteria and five studies met more than 80 % of the criteria. Conclusions: mixed e-Health tools improve treatment outcomes in the psychosocial perspective in the older adult. Future studies should delve into other aspects of the impact of treatment outcomes of other digital tools used in health for this age group, such as somatic, physical, and cultural aspects

Exploring Musculoskeletal Injuries Among Informal and Formal Carers of People With Dementia.

Carers of people with dementia manually handle the care recipients (eg, repetitive lifting, transferring, and pulling) as part of the care service, increasing the musculoskeletal injury risk to themselves. We aimed to determine the prevalence of musculoskeletal injuries among informal and formal carers of people with dementia and the perceived associated risk factors. Primary carers of people with dementia (26 males and 141 females) from Dementia Care Centers and Home Care programs completed a questionnaire providing information about (a) the carers' and their care recipients' characteristics, (b) musculoskeletal symptoms (via the Nordic Musculoskeletal Questionnaire) and related aspects, and (c) the caregiving activities exposing the carers to risk of musculoskeletal injury. Our results showed that 69.7% of informal and 86.7% of formal carers reported having more than 1 musculoskeletal injury, while 63.1% and 61.5%, respectively, reported having a musculoskeletal injury in the last year. Lower back had the highest injury prevalence (>10% for both groups). The 2 carer groups were not different in any of the variables. Our results reinforce calls for education and support of carers, regardless of their formal status, to enable injury-free and prolonged service provision.

Extending mechanical thrombectomy service provision to 24/7: a break-even analysis

BackgroundComprehensive stroke centres across England have developed investment proposals, showing the estimated increases in mechanical thrombectomy (MT) treatment volume that would justify extending the standard hours to a 24/7 service provision. These investment proposals have been developed taking a financial accounting perspective, that is by considering the financial revenues from tariff income. However, given the pressure put on local health authorities to provide value for money services, an affordability question emerges. That is, at what additional MT treatment volume the additional treatment costs are offset by the additional health economic benefits, that is quality-adjusted life years (QALYs) and societal cost savings, generated by administering MT compared to standard care.MethodsA break-even analysis was conducted to identify the additional MT treatment volume required. The incremental hospital-related costs associated with the 24/7 MT extension were estimated using information and parameters from four relevant business cases. The additional societal cost savings and health benefits were estimated by adapting a previously developed Markov chain-based model.ResultsThe additional hospital-related annual costs for extending MT to a 24/7 service were estimated at a mean of £3,756,818 (range £1,847,387 to £5,092,788). On average, 750 (range 246 to 1,571) additional eligible stroke patients are required to be treated with MT yearly for the proposed 24/7 service extension to be affordable from a health economic perspective. Overall, the additional facility and equipment costs associated with the 24/7 extension would affect this estimate by 20%.ConclusionsThese findings support the ongoing debate regarding the optimal levels of MT treatment required for a 24/7 extension and respective changes in hospital organisational activities. They also highlight a need for a regional-level coordination between local authorities and hospital administrations to ensure equity provision in that stroke patients can benefit from MT and that the optimal MT treatment volume is reached. Future studies should contemplate reproducing the presented analysis for different health service provision settings and decision making contexts.

Nurses' perception of epidural services in a Johannesburg academic setting.

Labour pain is associated with detrimental maternal and foetal physical and psychological effects. Labour analgesia is a basic right for all women and labour epidural analgesia has been accepted as the gold standard for providing such, with reported improvement in patient satisfaction. In South Africa, studies have shown that labour epidural rates are low. At an academic hospital in Johannesburg, a 24-h labour epidural service combined with an awareness campaign and educational programme (LEAP) was initiated with the aim of improving labour epidural rates. Results showed a short-lived uptake with a subsequent decline. This study explored the experiences of labour ward nursing staff regarding the labour epidural service at this academic hospital including perceived limitations and possible recommendations regarding improving service provision. A qualitative, descriptive and exploratory study was conducted. Purposive sampling was used with semistructured, audio-recorded individual interviews, thematic analysis was performed using Braun and Clarke's six-phase approach. The key theme is required education and supervision of epidural insertion (see page 3), management of childbirth and challenges related to epidural service provision. A positive sentiment was expressed by the participants; however, deficiencies in the service such as shortages of experienced personnel, work constraints and insufficient training may be affecting service sustainability. Further studies are recommended to form guidance towards the development and implementation of interventions to improve service delivery.Contribution:Provision of continual training and increased staffing of healthcare personnel will help improve the sustainability of the labour epidural service.

Public libraries’ role in supporting Ukrainian refugees: A focus on Hungary and Poland

The Russian invasion of Ukraine in February 2022 led to Europe’s largest displacement of people since World War II, with significant substantial numbers of Ukrainian refugees seeking shelter in neighbouring countries. International research attests to the crucial roles public libraries can play in the reception and integration of refugees. However, diverse professional and geographical contexts and sociopolitical landscapes in which libraries work to support refugee reception and integration processes, necessitate ongoing and renewed focus on the topic. Therefore, this study examines how public libraries in Hungary and Poland responded to the influx of Ukrainian refugees, investigating their roles, programmes and partnerships. Using mixed methods, the study analyses previously unexamined 2018 questionnaire results and conducts 12 subsequent interviews with library staff. Findings reveal that libraries addressed a spectrum of user needs falling into three broad phases. Initially, they focussed on primary needs during the first phase, transitioning to settlement-related needs in the second phase. Variances between Poland and Hungary emerged during this phase, with Hungary primarily serving transient refugees and those with Hungarian backgrounds, while Poland saw a higher number of refugees of Ukrainian background settling. In the final phase, libraries emphasized literacy, integration and cultural support, aligning with reading and collection-oriented services. Service provision was characterized by nontraditional services in the first phase, non-collection-oriented services in the second phase and collection-oriented services in the third phase, with information provision central to all three phases. The study underscores public libraries’ role in addressing community needs, rooted in their core values of inclusivity and community engagement. However, their effectiveness hinges on inclusion in community-level efforts, awareness among new groups and securing economic and political support. Further research is warranted to explore library services to refugees globally amid increasing global migration and to understand the experiences of refugees using library services.

Budget Control on Capital Project Delivery in Samburu County Government

Purpose: This study aimed to evaluate the effects of budget control on delivery of capital project delivery in Samburu County-Kenya. Methodology: This study examined the effect of budget control procedures on the completion of capital projects using a descriptive research design. A total of 52 employees who were department heads and routinely took part in the budgeting process, belonging to the J, K, and L job groups, comprise the research sample. To effectively represent the intricate dynamics at work and to offer insightful information about how budget control affects the efficacy and efficiency of capital project delivery within the framework of the Samburu County Government, data was provided in linear regression models. Findings: The findings of this study can assist county governments in better understanding the factors that affect county budget management systems and performance as well as what needs to be changed to enhance the aforementioned budget performance. The findings can also be helpful to academics while looking into how budgetary control affects the provision of public services. Finally, it may offer politicians and other decision-makers new insights into the delivery of capital projects and the management of public resources. The study's results demonstrated that budget control significantly impacted capital project delivery in Samburu County, accounting for 77.3% of the variance with P ˂ 0.05. Unique Contribution to Theory, Practice and Policy: The study investigated how capital project delivery and budget control interact using the agency theory. Kenyan county governments and legislators should tighten budget control to address issues. The primary finding of the study was that counties can accomplish their financial and quantitative objectives with the aid of budget control. Additionally, it can help the county meet its goals, identify the operating activity items in the budgets, and fortify the relevant accounting structures.

The influence of unstable coalition governments in Gauteng metropolitan municipalities

Background: Coalition governments involve multiple political parties uniting to govern because of the absence of a majority party in the council following electoral outcomes. In South Africa, coalitions have become much more common since the 2016 and 2021 local government elections.Aim: This study investigates the implications of unstable coalition governments on municipal administration within the Gauteng metropolitan municipalities.Setting: The study focused on the City of Tshwane, Ekurhuleni, and the City of Johannesburg metropolitan municipalities in the Gauteng Province of South Africa.Methods: Employing a qualitative approach with a case study design, this research draws upon secondary sources and employs thematic analysis for a comprehensive examination of data.Results: The findings underscore that unstable coalition governments exert multifaceted effects on municipal administration in Gauteng. Firstly, they erode the foundational principles of democratic and accountable governance. Secondly, the instability adversely affects the provision of essential services. Thirdly, the process of budget formulation and approval is compromised. Fourthly, the precarious nature of political coalitions jeopardises creating a safe and healthy municipal environment and contributes to hung councils. Fifthly, municipal human resource practices are negatively influenced, alongside challenges in effectively managing municipal funds.Conclusion: There is a critical need for government and municipalities to institute effective legislation and policies addressing the challenges associated with unstable coalition governments in order to foster stability, promoting democratic values and ensuring efficient municipal administration within the Gauteng metropolitan context.Contribution: The study makes key recommendations for improving municipal administration under coalition councils in South Africa’s metros.

Mangrove ecology guiding the use of mangroves as nature‐based solutions

Abstract Mangroves are implemented as nature‐based solutions (NbS) for coastal protection, climate change mitigation (carbon sequestration) and other services. They play a core role in providing benefits for biodiversity, livelihoods and human well‐being. Ecological research has informed the use of mangroves as NbS, but failure of NbS projects has often been due to misconceptions about mangrove ecology and the limited use of the wide range of ecological knowledge available. Enhanced knowledge of the spatial and temporal variation in ecological processes, and differentiation among mangrove tree species and assemblages (including fauna and microbial communities) in the provision of ecosystem functions and services, will support successful use of mangroves as NbS. Knowledge of mangrove responses to the interacting pressures of climate change and human uses of the coastal zone will support resilient NbS projects. Synthesis. The success of mangroves as NbS can be improved with increased incorporation of knowledge of the ecology of mangrove plants, animals and microbes and by sharing and co‐producing knowledge within mangrove societies.

Investigate-Design-Practice-Reflect: An Iterative Community-Engaged Action Process to Improve Population Health

BackgroundCommunity-based coalitions are a common strategy for community engagement efforts targeting the improvement of a variety of population health outcomes. The typical processes that coalitions follow to organize efforts include steps that are sequential, slow, and time intensive. These processes also limit local decision-making to the selection of evidence-based policies or programs.MethodsWe present a process control theory-based Community Action Process, Investigate-Design-Practice-Reflect (IDPR), where community hubs (i.e., coalitions) organize agile efforts in a non-sequential, rapid, and efficient manner to harness local assets and data to make decisions regarding the provision and production of population health services. Using qualitative methods, we illustrate and analyze the use of IDPR in a one community case study as part of Wellscapes, a Type 3-hybrid implementation-effectiveness community randomized controlled trial to improve children’s population health physical activity.ResultsWe found community members followed the IDPR Community Action Process to rapidly design, organize, deliver, and receive feedback on a community-based, children’s population physical activity prototype, an afterschool Play-in-the-Park opportunity for all children.DiscussionFollowing IDPR afforded the community coalition timely learning through feedback within a process that coordinated decisions regarding what community services met community needs (provision decisions) and how to organize the production of the population health services (production decisions).

Happy times, careers and happenstance in UK psychiatry: time, timeliness, timelessness, eternity and contemporality.

To address some challenges facing psychiatrists today we discuss issues of happenstance and fulfilment in psychiatric careers through some of the record and reflections of four psychiatrists since the 1950s. We trace the changes in psychiatry attendant to the transition from the welfare to the neoliberal state and=its contemporary postmodern culture. We highlight the crucial importance of political-cultural as well as technological developments in determining psychiatric service management and provision, and clinical practice and career outcomes. In the light of this impact, in a global era that some highly respected authorities consider in apocalyptic terms, we advocate for the incorporation of training in political awareness and activism in the psychiatric curriculum and practice. We suggest that this is necessary for social justice and patient welfare and that it will help safeguard psychiatric professionalism, conscience and self-esteem.

Age of Autism Spectrum Disorder Diagnosis and Patient-Centered Medical Home Components.

Early diagnosis of autism spectrum disorder (ASD) in children facilitates the provision of services and enhances opportunities for improving functioning via intervention. To date, limited studies have examined whether age of ASD diagnosis is associated with components of care of the patient-centered medical home (PCMH), a model of health care that emphasizes centralized, accessible, and coordinated care. The objective of the current study was to evaluate the associations between components of the PCMH and age of ASD diagnosis while controlling for associated clinical and socio-demographic factors, in a national sample of children 17years and younger with ASD. The present study was a cross-sectional, observational study. Participants were caregivers of 1,193 children ages with ASD from the 2020 National Survey of Children's Health (NSCH). Hierarchical multiple linear regression analysis was run with age of ASD diagnosis as the criterion variable in two regression models. The binary composite medical home proxy variable was investigated as well as the five individual medical home components (usual source of care, personal doctor or nurse, family-centered care, care coordination, able to obtain referrals when needed). In the first regression analysis, the overall PCMH proxy variable was significantly correlated with the age of ASD diagnosis (standardized beta coefficient = -.08; p < .01). Of the five components of the PCMH assessed in the second regression model, only usual source of sick care was significantly associated with the age of ASD diagnosis (standardized beta coefficient = -.11; p < .01). Having a usual source of sick care may be an important factor in receiving an earlier ASD diagnosis for children and adolescents.

Factors critical for the successful delivery of telehealth to rural populations: a descriptive qualitative study

BackgroundThe use of telehealth has proliferated to the point of being a common and accepted method of healthcare service delivery. Due to the rapidity of telehealth implementation, the evidence underpinning this approach to healthcare delivery is lagging, particularly when considering the uniqueness of some service users, such as those in rural areas. This research aimed to address the current gap in knowledge related to the factors critical for the successful delivery of telehealth to rural populations.MethodsThis research used a qualitative descriptive design to explore telehealth service provision in rural areas from the perspective of clinicians and describe factors critical to the effective delivery of telehealth in rural contexts. Semi-structured interviews were conducted with clinicians from allied health and nursing backgrounds working in child and family nursing, allied health services, and mental health services. A manifest content analysis was undertaken using the Framework approach.ResultsSixteen health professionals from nursing, clinical psychology, and social work were interviewed. Participants mostly identified as female (88%) and ranged in age from 26 to 65 years with a mean age of 47 years. Three overarching themes were identified: (1) Navigating the role of telehealth to support rural healthcare; (2) Preparing clinicians to engage in telehealth service delivery; and (3) Appreciating the complexities of telehealth implementation across services and environments.ConclusionsThis research suggests that successful delivery of telehealth to rural populations requires consideration of the context in which telehealth services are being delivered, particularly in rural and remote communities where there are challenges with resourcing and training to support health professionals. Rural populations, like all communities, need choice in healthcare service delivery and models to increase accessibility. Preparation and specific, intentional training for health professionals on how to transition to and maintain telehealth services is a critical factor for delivery of telehealth to rural populations. Future research should further investigate the training and supports required for telehealth service provision, including who, when and what training will equip health professionals with the appropriate skill set to deliver rural telehealth services.