Health Care Services In Settings Research Articles

A Classification of Cloud Services and Their Security Assessment in the Healthcare Industry

The role of cloud-based services in healthcare settings is crucial in the 21st century. This paper discusses their advantages and tools in hospitals, clinics, and diagnostic centers, categorizing existing applications and services into data storage, computing power, networking, PaaS, SaaS, data analytics, business intelligence, and project management. It also provides an in-depth analysis of security and risk assessment issues in cloud-based services, supported by case studies. Additionally, it includes a comparative risk analysis diagram of secured versus non-secured cloud systems in healthcare. Finally, the paper concludes with recommendations for future work. Key Words: Healthcare facilities, diagnostic centers, cloud services, information technology systems, security, risk analysis.

Nurses’ characteristics and spiritual care knowledge in hospital setting: A cross-sectional study

Background: The low awareness among nurses regarding the provision of spiritual services in healthcare settings results in unmet spiritual needs among patients, leading hospitals to be perceived solely as centers focusing on physical aspects. This stems from nurses’ low competence in providing spiritual care services. Objective: This study aims to analyze the correlation between nurses’ characteristics and their knowledge of spiritual care in a hospital setting. Methods: A retrospective cross-sectional study was conducted, with respondents recruited using a purposive sampling technique. Inclusion criteria included nurses working in hospitals who directly care for patients. Data were analyzed using univariate analysis (frequency and percentage) and bivariate analysis using Fisher’s exact test. Result: A total of 117 nurses participated in this study, of whom 59.8% were female, 63.25% were aged <31 years old, 77.8% were permanent workers, 57.2% had work experience < 5 years, 91.5% were Muslim, 55.6% attended workshops/seminars, and 76.9% had moderate knowledge. Workshops/seminars had a positive correlation with knowledge and were statistically significant. Conclusion: Spiritual workshops/seminars have a positive correlation and are statistically significant in enhancing nurses’ knowledge of spiritual care in a hospital setting. Therefore, there is a need to improve nurses’ spiritual care knowledge through continuing education, such as training, seminars, or workshops.

DIGIDIA-project: Experiences of video-enabled receptions for prevention of type 2 diabetes

The time of the COVID-19 epidemic emphasized the need for the development and implementation of remote receptions and digital services, as preventive work was reduced, and people decreased their in-person visits in health care due to fear of infections. In 2020, the diagnoses of type 2 diabetes (T2D) decreased, despite the fact that diabetes is known to be increasing. DIGIDIA (Promoting Digital Skills in the Low Labour Market-Driven Diabetes Patients) project aimed to respond to this need. The project focused on developing digital health competence, health literacy, and practices that enable preparation for future unforeseen events. The project recruited adults from Tampere who were at risk of T2D, had prediabetes, or recently received a diagnosis of type 2 diabetes (n=60). Participants were provided with a digital learning environment, workshops, and video-enabled receptions. This article presents the use of video reception and user experiences (n=52) in the project. The participants appreciated all organized activities. All but one participant felt that video-enabled reception suited them well. The majority of participants (87%) expressed a desire for using video reception again in health care settings. However, it was pointed out that this form of telemedicine might not be suitable for everyone, and concerns about data security were also raised. As a conclusion, citizens were ready to use video-enabled services in healthcare settings. The use of video receptions should be increased in the management of type 2 diabetes (T2D).

Barriers Affecting Breastfeeding Practices of Refugee Mothers: A Critical Ethnography in Saskatchewan, Canada.

Refugee mothers are vulnerable to cultural stereotyping and socioeconomic hardships when they migrate to a new country. This vulnerability often has a negative impact on refugee mothers' breastfeeding practices. Saskatchewan is one of the growing provinces in Canada that has a noticeable increase in refugee population with young children and limited availability of healthcare settings with baby-friendly status. Considering existing gaps in knowledge, this critical ethnographic study aimed to explore barriers that impede the breastfeeding practices of refugee mothers in Saskatchewan. After seeking ethics approval, data were collected using multiple methods, including in-depth interviews undertaken with 27 refugee mothers with young children of age range 1 day to 24 months, a review of media communications and field observations of community-based services/facilities available to refugee mothers. Findings suggest that psychosocial barriers, healthcare barriers, environmental barriers, and maternal and child health-related barriers impede the breastfeeding practices of refugee mothers in Saskatchewan. Breastfeeding practices of refugee mothers can be promoted through healthcare support, culturally appropriate services, interpretation services in healthcare settings, implementation of baby-friendly initiatives, hospital and community-based breastfeeding campaigns, and follow-up services. Collaborative efforts by healthcare settings, healthcare providers, policymakers, public health agencies, service providers, and governments are essential to support the breastfeeding practices of refugee mothers.

The Use of Mobile Medical Units for Populations Experiencing Homelessness in the United States: A Scoping Review.

With annual point-in-time counts indicating a rise in unsheltered homelessness in the United States, much attention has been paid to how to best provide care to this population. Mobile medical units (MMUs) have been utilized by many programs. However, little is known regarding the evidence behind their effectiveness. A scoping review is conducted of research on MMU provision of medical services for populations experiencing homelessness in the USA to examine the extent and nature of research activity, summarize available evidence, and identify research gaps in the existing literature. Following guidelines for scoping reviews, PubMed and Google Scholar were used to identify an initial 294 papers published from January 1, 1980, to May 1, 2023, using selected keywords, which were distilled to a final set of 50 studies that met eligibility criteria. Eligible articles were defined as those that pertain to the provision of healthcare (inclusive of dental, vision, and specialty services) to populations experiencing homelessness through a MMU in the United States and have been published after peer review. Of the 50 studies in the review, the majority utilized descriptive (40%) or observational methods (36%), with 4 review and 8 controlled studies and no completed randomized controlled trials. Outcome measures utilized by studies include MMU services provided (58%), patient demographics (34%), health outcomes (16%), patient-centered measures (14%), healthcare utilization (10%) and cost analysis (6%). The studies that exist suggest MMUs can facilitate effective treatment of substance use disorders, provision of primary care, and services for severe mental illness among people experiencing homelessness. MMUs have potential to provide community-based healthcare services in settings where homeless populations reside, but the paucity of randomized controlled trials indicates further research is needed to understand if MMUs are more effective than other care delivery models tailored to populations experiencing homelessness.

Parents' experiences of living with a child with cancer undergoing hematopoietic stem cell transplantation: a qualitative content analysis study.

Pediatric Hematopoietic Stem Cell Transplant (HSCT) profoundly impacts the physical, psychological, and social aspects of parents' lives. Thus, this study aimed to explore the experiences of parents living with a child with cancer who undergoes HSCT. This qualitative study involved 20 parents of children with cancer who were undergoing HSCT at a referral hospital in Iran. Purposive sampling was used to select the participants from February 2023 to November 2023. In-depth semi-structured interviews, featuring open-ended questions, were utilized for data collection. Data analysis was performed using conventional content analysis. Data analysis revealed two main themes. "Surrounded by hardships" and "Self-actualization." The first theme encompassed participants' experiences of facing difficulties in life after being aware of their child's need for HSCT. This theme consisted of four categories: "uncertainty about the child's future," "exhaustion from the child's treatment process," "worrying about the healthy child(ren)," and "helplessness." The second theme "self-actualization" included with two categories: "transformation in life's philosophy" and "acquisition of new capabilities." These categories highlighted the positive outcomes experienced by the participants following their child's HSCT. Our findings underscore the importance of healthcare providers being attuned to parents' experiences throughout their child's HSCT trajectory. It is crucial for healthcare providers to encourage parents to articulate their concerns and feelings and seek support from healthcare providers, family, and friends. The development of psychological support services in healthcare settings can facilitate tailored interventions to alleviate parents' difficulties.

Exploring challenges and improvement strategies of adolescent-friendly health services in the northwest region of Namibia: A qualitative descriptive study.

Despite global agreements on adolescents' sexual and reproductive health and rights, access to and the utilisation of these services by the adolescents remain underutilised in low and middle-income countries. The aim of the study was to explore challenges and improvement strategies of adolescent-friendly health services in the northwest of Namibia. This study employed a qualitative approach utilising an explorative strategy. Semi-structured interviews were used to collect the data. Fifteen nurses were selected using a convenience sampling technique. The interviews were audio recorded, transcribed verbatim and the data were analysed using thematic analysis. The data analysis led to the emergence of the following three themes: Challenges affecting the delivery of Adolescent Friendly Health Services, Challenges affecting participation of adolescent to AFHS and strategies to improve the provision of adolescent-friendly health services. Findings from this study revealed several barriers reportedly faced by adolescents in accessing AFHS as including a lack of comprehensive sexual reproductive health (SRH) services in many healthcare facilities, a lack of trained staff, unfavourable environments for adolescents, a lack of information about the services provided, and recruitment of providers who are not friendly to young people and adolescents. This study findings may lead to an improvement in the provision of such services in healthcare settings. The study can lead to an improvement in the provision of adolescent-friendly services in health care settings. It can help the Ministry of Health and Social Services, along with its agencies, to formulate strategies that can be used to mitigate the challenges d in the provision of adolescent-friendly services.

The practice of pregnancy options counseling in social service and healthcare settings in the United States: a systematic literature review

ABSTRACT Introduction The purpose of this systematic literature was to summarize the literature on pregnancy options counseling for women and patients who experience an unintended pregnancy across healthcare and social service settings. Methods We conducted a systematic literature review using the PRISMA Checklist. Following the literature search of 8 electronic databases, we used a three-stage search process to screen articles for inclusion. Results A total of 20 peer-reviewed articles met the inclusion criteria for this study. Half (n = 10) of the articles reviewed were empirical studies utilizing quantitative or qualitative methodology while the other half (n = 10) were conceptual or non-empirical. The articles affirmed a shared definition of pregnancy options counseling, but terminology differences were noted over time. Lastly, variations of intervention practices appeared across practice settings, with referral practice variations being the most notable. Conclusion Pregnancy options counseling practices varied across settings, suggesting patients who received this intervention may not have accessed equitable or ethical care.

A quantitative and qualitative analysis of a medication health literacy workshop for newly and recently arrived refugees

AbstractIntroductionRefugees entering the United States are often unfamiliar with the healthcare system and have different medication beliefs. Since 2016, pharmacy students and faculty have been conducting medication literacy workshops to improve knowledge of medications for newly arriving refugees.ObjectivesThe primary study objective was to measure the newly arriving refugees' medication knowledge after a one‐time educational workshop.MethodsThis was a retrospective quantitative and qualitative evaluation. Participants engaged in a student‐led 90‐min educational workshop utilizing interpreters, translated materials, and demonstrations. Topics included medical definitions, information on getting sick, medication use, and label reading. A translated, postworkshop evaluation included 22 questions grouped into the following categories: demographics (n = 4), medication use (n = 7), label reading (n = 6), access (n = 3), and cultural beliefs (n = 2). Three optional, free‐response questions regarding overall workshop feedback were included. Quantitative data was analyzed utilizing descriptive statistics. Thematic analysis was used to analyze qualitative data. Two independent coders reviewed each free‐response question and discussed any discrepancies for consensus. The study team developed key themes based on the codes.ResultsTwenty‐one workshops were conducted with 419 participants from 42 countries. Correct responses were highest for medication beliefs (84%), label reading (78%), access (74%), and medication use (73%). Prescription label reading ability was high (86%), while preventative medicine understanding was lower (34%). Three major learning themes developed, including (1) Cultural differences impact medication habits, (2) Knowing provider roles and how to access different services in healthcare settings was important, and (3) Understanding how to read a label was useful. Researchers found that demonstrations were helpful in participants' learning and that additional education on prevention and specific disease states would be useful.ConclusionNewly and recently arrived refugees were able to correctly identify basic medication health information through a medication literacy workshop. Additional classes exploring other topics, including preventative medicine and medications, should be considered.

Supporting rehabilitation practice for COVID-19 recovery: a descriptive qualitative analysis of allied health perspectives.

ObjectiveThe study aimed to explore the perspective of healthcare workers on the resources they need to provide quality rehabilitation for people recovering from coronavirus disease 2019 (COVID-19) infection.MethodsA descriptive qualitative approach using reflexive thematic analysis was employed. Focus groups and interviews were performed with nine healthcare workers (one intensive care unit physiotherapist, one respiratory therapist and seven occupational therapists) with experience treating patients recovering from COVID-19 infection within hospital and in the community. Verbatim transcripts were coded and analysed for themes.ResultsHealthcare workers perceive an urgent need for resources about recovery from COVID-19 infection to support quality care. They particularly want detailed guidance about potential trajectories of recovery, and what should be expected over time for people with long COVID. Many observed that this group of patients had higher oxygen requirement and experienced slower recovery than others with serious respiratory conditions. Supports for quality care do exist but were not perceived as sufficient by participants. They want any new resources developed to be accessible, quick to access and targeted to specific healthcare worker roles and services settings. Participants identified several barriers to accessing practice supports, including the time poor nature of health care and financial costs to both patients and healthcare workers.ConclusionHealthcare workers perceive an urgent need for the development of resources to support quality rehabilitation for people recovering from COVID-19 infection, to support best outcomes for this group of patients. Any resources developed must consider identified barriers to their access and use to maximise their impact.

Exploring barriers to the use of trust translation services by pharmacy staff

Abstract Introduction 4.1 million people in England and Wales do not speak English as a first language.1 Whilst representing only 7.1% of the population, data suggests this cohort face greater barriers to effective healthcare than native English speakers. One study found they experience twice the rate of medication errors.2 One solution is the use of translation services in healthcare settings. However, national evidence shows service underutilisation.2 Research cites long waiting times, loss of phone connection and translator lack of familiarity with National Health Service (NHS) as contributors.3 Anecdotal data suggests underutilisation of services at Oxford Road Campus (ORC) of Manchester University Foundation Trust (MFT). 18% of ORC patients are not native English speakers, meaning there is a potential risk to patient outcomes if translation services are underutilised. Aim To explore the barriers pharmacy staff at ORC of MFT face when accessing the local translation service for patients; where its use would be appropriate and/or beneficial. Methods A literature search was conducted regarding use of translation services by healthcare staff and existing barriers to use. An interview proforma was formulated using the literature findings, existing questionnaires, discussions with a University of Manchester research Pharmacist and the group’s aims and objectives. The questions were formulated into the Qualtrics XMTM software. Data was collected using structured interviews to increase capture of qualitative data. The target audience was Trust pharmacy staff with patient contact. The sampling technique was opportunistic and captured 45 respondents. Quantitative data was analysed through Microsoft Excel, whilst qualitative data was analysed using thematic grouping. No ethical approval was required as this was a service evaluation. Results 97.8% of respondents had encountered at least one patient without English as a first language. Of these, 100% were aware of trust translation services, despite only 7% of staff having received training. Only 25% of participants reported the trust translation service was their primary method for translation. Preferred methods of overcoming language barriers were use of relatives/next of kin or a multilingual staff member. The most reported barriers in order of frequency were time, ease of access and preferring alternative methods. Some participants who had never used the service reported concerns over the accuracy of translation and high costs of the service. 78% of respondents indicated that they would use the service if barriers were rectified. When asked about features of an ideal service, exact waiting times, use without a PIN and dedicated ward phones were the most popular responses. Discussion/Conclusion Results obtained show numerous barriers to service use and accessibility. Of note, several staff who reported barriers had never used the service. These perceived barriers often related to factually incorrect views of the service such as cost and accuracy of translation. Thus, training for staff in conjunction with improvements to the service would increase utilisation of the translation service and therefore patient safety. One imitation of our project was that no data exists on number of patient facing staff so it is not possible to quantify the percentage of staff captured.

Healthiness and sustainability of food service in healthcare settings in Germany

Abstract Background Current dietary patterns threaten individual and planetary health. Healthcare settings can set a positive example for dietary change, but data on the quality of food they offer is scarce. The aim of our study was to assess the environmental footprint and nutritional quality of food service in hospitals and nursing homes in Germany. Methods We collected 6-12 months of food procurement data and all available meal plans from three nursing homes and two hospitals in Germany. Procured food items were categorized into 50 food groups (e.g., potatoes, beef, apples), and the environmental footprint was calculated (i.e., land use, greenhouse gas (GHG) emissions, acidification, eutrophication, and water use) using life-cycle analysis factors based on a recent meta-analysis. Lunches from a representative week were broken down into their constituent ingredients and analyzed for adherence to the Planetary Health Diet (PHD) using an established dietary index (PHDI). Results Preliminary analysis of one nursing home and one hospital showed that animal-source foods (ASF) accounted for 70% of overall GHG emissions and land use and 76% of water use, primarily from beef, pork, milk, and cheese. Among plant-based foods, coffee disproportionately contributed to the environmental footprint. Red meat accounted for 30-45% of lunch calories consumed (13-25% of weight) and potatoes accounted for 20-24% of calories (31-35% of weight), whereas vegetables and legumes combined accounted for 11-15% of calories (33-35% of weight). Nursing home meals achieved 61 and hospital meals 71 out of 150 points on the PHDI. Conclusions Healthcare institutions in Germany have poor adherence to the PHD, with up to two-thirds of calories derived from red meat and potatoes. Unsurprisingly, ASF account for the majority of the institutions’ environmental food footprint. Policies to make healthcare foodservice more environmentally sustainable while ensuring nutritional adequacy are urgently needed. Key messages • Foodservice in German hospitals and nursing homes is neither healthy nor environmentally sustainable. • Policies are needed to improve healthcare food service for individual and planetary health.

Experiences and Beliefs on Tobacco Use, Cessation in India: A Qualitative Study.

Almost 80% of global tobacco usage is concentrated in low- and-middle-income countries (LMICs) like India. Added to this, there is dearth of dedicated tobacco cessation specialist services in healthcare settings in these regions. Identification of challenges in the delivery of cessation interventions and understanding the experiences of tobacco users will aid in formulating successful quit strategies. This qualitative study in India aimed to understand the perspectives of tobacco-using patients in healthcare facilities regarding tobacco use and cessation. This qualitative study was conducted in urban and rural areas of four study sites, two each in the North and South India. Using purposive sampling, patients who were tobacco users were selected from healthcare facilities. The interviews were transcribed, coded and organised into themes. Analysis was done using NVivo 10 software. A total of 22 in-depth interviews were conducted on participants aged 23 to 80 years who were either current or past tobacco users. A majority of the participants were aware of their increased health risks associated with tobacco consumption and had attempted quitting; however, barriers such as peer influence, formed habit, certain cultural barriers and the addictive nature of nicotine prevented them from successfully quitting. Familial and peer support, the government's role in spreading public awareness, and limiting the sale of tobacco were stated as facilitators for tobacco cessation. The findings of this study point out that despite awareness of the perils of tobacco among smokers, there are various barriers and beliefs related to tobacco use and cessation. These findings would prove advantageous for policy-makers to implement and promote addiction treatment programmes for successful tobacco cessation efforts. In order to optimise strategies, policies must be well informed by ongoing dialogue between the public, service providers and policy-makers.

A quality improvement approach to improving recognition of Māori tamariki (children) and assessing barriers to culturally responsive care in a paediatric ward setting.

Health inequity persists in Aotearoa (New Zealand) and internationally amongst most indigenous peoples. To address these health inequities, countries need to contend with the ramifications of entrenched historical, cultural and systemic failures. Within Aotearoa part of the solution to rectifying persistent health inequities lies in shifting everyday healthcare practices towards a more culturally responsive, patient-centred approach that utilises Māori knowledge and principles. Although the need for culturally responsive services in healthcare settings is clearly evident, most practitioners struggle with the challenge of creating a culturally safe environment. Further to these challenges, there are issues related to accurate recognition of ethnicity within the time constraints of an overwrought hospital environment. Within this environment, the correct identification of ethnicity is a fundamental step in the process of moving towards culturally responsive and more inclusive care. The research was concerned with indigenous Māori patients being consistently and correctly identified so that they might receive culturally appropriate interaction and treatment. The research specifically focused on the impact of introducing a customised sticker prompt on the front cover of clinical notes of Māori tamariki (children) to assist with correct ethnicity identification. Surveys were conducted on the paediatric ward over a 3-week period, prior to and during the intervention to evaluate the effect of the customised stickers. This study sought to (1) assess the efficacy of a sticker to improve recognition of Māori tamariki (children), (2) examine key barriers to identifying ethnicity and (3) identify wider impacts of a sticker prompt on clinical practice. Results showed wide ranging positive impacts on clinical practice and culturally responsive care. Sixty-four per cent of participants indicated that the stickers were a useful tool to improve identification of Māori tamariki. Respondents reported increased accuracy of identifying patients by ethnicity, as well as improved awareness of existing ethnicity documentation, and increased engagement regarding cultural needs and ethnicity. This study identified that sticker prompts are a useful tool for healthcare workers to improve recognition and awareness of ethnicity and to increase dialogue around cultural needs. The stickers led to increased consideration of the wider elements of holistic wellbeing and therefore improved culturally responsive care for Māori tamariki.

Association of a Patient's Type of Insurance With Preventive Service Delivery.

Introduction Chronic disease or death associated with chronic disease is often avoidable with proper interventions, including preventive services in healthcare settings. However, preventive service delivery rates by physicians are low. This study examined the association between preventive services and the type of patient insurance, as well as the association between the duration of an office visit and the type of patient insurance. Methods A retrospective observational cohort study was conducted using multivariate logistic regression. Pooled data on physician office-based visits from the 2011-2016 and 2018 National Ambulatory Medical Care Survey (NAMCS) were used in this analysis. The main measures observed were the odds of providing preventive services as they related to the type of patient insurance. Preventive measures assessed were those recommended by the United States Preventive Services Task Force with an A or B grade, applicable to most adults 18-64. Additionally, the mean office visit duration was analyzed based on the type of insurance. Results The odds of receiving cervical cancer screenings and tobacco smoking cessation screenings were 47% (p <0.01) and 31% (p =0.10) lower with Medicaid than private insurance, respectively. The odds of receiving blood pressure screenings and cervical cancer screenings were 43% (p =0.01) and 62% (p <0.01) lower in uninsured office visits compared to private insurance, respectively. Compared to private insurance, Medicaid and uninsured visits were 2.68 minutes and 1.97 minutes shorter in duration, respectively (p <0.05). Conclusions An association was found between the type of patient's insurance and the odds of providing preventive services. If the aim of healthcare is to improve the incidence of chronic disease or death associated with chronic disease, preventive services should be provided regardless of insurance type.

Discrimination Experienced by Women Living with HIV and AIDS Accessing Reproductive Health Services

Women with disclosed HIV status experience different barriers and are stigmatized and discriminated against in health services. The sexual and reproductive health of women living with HIV is critical when compared to those who are not living with HIV. Discriminatory behaviour in health settings decreases the morale of women and limits the care of their health. Women living with HIV hide their status because of fear of discrimination, which puts the health personnel at high risk of transmission. The goal of this study was to learn more about the reasons for and types of discrimination faced by HIV-positive women seeking reproductive health services in healthcare settings. The researcher found three significant findings. To begin with, pre-existing social attitudes, perceptions, and information regarding women with HIV are at the foundation of stigma and discrimination in healthcare settings. Second, the forms of stigma and prejudice that WLHIV perceived or experienced differed from each other, regardless of which service under reproductive health they sought. Finally, due to such discrimination, WLHIV refuses to disclose their HIV status, delaying or avoiding seeking medical help, experiencing emotional stress, and having low self-esteem.

Expectations of the Ontario Healthcare System following the Implementation of Ontario Health Teams

With the arrival of Ontario Health Teams (OHTs), healthcare providers, clinicians and patients seek to witness the efficacy of an integrated care model. OHTs are built on the concept of healthcare integration, coordinated care, shared fiscal and clinical accountabilities between multiple healthcare service providers, as well as bridging the gaps between the clinical, social and health promotional aspects of care delivery. This meta-narrative review seeks to examine, compare and determine the efficacy of the integrated care model using cross-sectional studies from around the world to see how integrated care effects health related outcomes. The efficacy of the model will be determined by evaluating the abilities of other integrated care models to reduce healthcare expenditures, improve coordination of care between healthcare service providers, bolster patient satisfaction and health outcomes, minimise emergency and life-threatening cases, lower emergency hospital admission rates as well as provide a comprehensive set of healthcare services including biomedical, mental and social supports. For future applications, this study could be used as a guideline to highlight areas of improvement in integrated care models, as well as to evaluate benefits of existing models and determine best approaches forward.

Utilizing SBIRT as a Framework for Transforming How We Think About Prevention and Early Intervention for Youth and Young Adults

Utilizing SBIRT as a Framework for Transforming How We Think About Prevention and Early Intervention for Youth and Young Adults

A mixed-methods feasibility study of Nyamekela4Care: An intervention to support improved quality of care among service providers in low-resource settings

BackgroundIn South Africa, health and care service providers (SPs) face many interconnected challenges at work, including inadequate training and supervision and high levels of burnout. Nyamekela4Care (N4C) was developed as an integrated intervention for SP teams, to support their ability to provide high-quality care through providing a structure for operating regular team meetings that includes training, empathic skills development, administration, case sharing and self-care. We aimed to determine the feasibility, acceptability, and preliminary effectiveness of the N4C intervention as a support package for SPs in resource-constrained settings. MethodsThis study utilized a mixed-methods, repeated measures design. Purposive sampling was used to recruit 42 SPs from two healthcare service settings in South Africa where teams of primary care clinic staff work together with home-visiting community health workers from community-based organisations. Data were collected across three timepoints. Self-report data were collected directly from participants at all timepoints, alongside qualitative interviews, investigating participants’ wellbeing, work satisfaction, work-related knowledge, and acceptability of N4C. A repeated measures ANOVA was applied to the data to test the preliminary effectiveness of N4C. Qualitative interview data were analysed using a thematic analysis approach to identify pertinent themes in the data. ResultsThe N4C intervention was found to be acceptable, with low uptake of the intervention at one site limiting interpretation of its feasibility. Qualitative data demonstrated that the intervention resulted in improved collaboration between organisations; improved capacity to practice self-care in certain cases; and improved work-related knowledge. Quantitative data identified a significant increase in work-related knowledge, but no significant differences for any other outcomes. The success of implementation may have been impeded by contextual factors such as uncertainty regarding contractual agreements for staff, staff attrition, lack of commitment and skill of some of the operational leadership and the small number of N4C meetings held. ConclusionWhile participants noted improvements in work-related knowledge, self-care and intersectoral collaboration as benefits of the intervention, the implementation of N4C, particularly at one site, limited our ability to assess its feasibility and impact. Further areas for quality of care intervention research are discussed.

General practitioners\u2019 experiences in consultations with foreign language patients after the introduction of a user\u2019s fee for professional interpretation: a qualitative interview study

BackgroundIn 2018, an amendment to the Danish Health Care Act was passed making it a requirement for patients not proficient in Danish to pay for interpretation services in health care settings. Thereafter there has been a drastic decline in the use of professional interpreters, especially in general practice. We aimed to investigate the experiences of general practitioners (GPs) in establishing an understanding with these patients in consultations, without the presence of a professional interpreter.MethodsThe study was qualitative, based on semi-structured interviews with nine purposively selected GPs. Analysis was by interpretative phenomenological analysis.ResultsThe GPs said that after the amendment was passed, the patients chose to almost exclusively use family members or friends as ad hoc interpreters, or they attended consultations with no interpreter present at all. The GPs experienced that the use of family interpreters caused specific problems, due to both their relationship with the patient and their lack of professional interpretation skills. If no mediator was present the GPs perceived the establishment of understanding as extremely challenging. This was particularly the case if patients had chronic conditions, mental or psychosocial problems or if cultural barriers were present. According to the GPs, the challenges were not exclusively restricted to a lack of language translation, but could also involve intertwined cultural barriers or social problems. The impairment in mutual understanding had different consequences, and led to poorer treatment at many levels in health care. The lack of access to a professional interpreter also presented the GP with ethical and legal dilemmas.ConclusionsThe GPs experienced that the changes in interpretation provision for patients in health care had led to professional interpretation being almost absent from general practice settings for patients subject to the fee. This led to several communication challenges, insufficient understanding in consultations, and poorer treatment of these, often very vulnerable, patients. The situation could, however, also involve the risk of epistemic injustice. The GPs experienced the situation as very unsatisfactory; it both comprised their ability to exercise their professionalism and their ethical obligations and restricted their legal rights.