Need For Services Research Articles

Experiences of discrimination in Finnish healthcare services

Abstract Background It has been found that foreign-born people report more discrimination than the general population. This study examines experiences of discrimination in Finnish healthcare, with a focus on individuals with a foreign background. Methods Two nationally representative cross-sectional data sets were used: MoniSuomi (n = 7838; response rate 44.1%) and Healthy Finland Surveys (n = 28154; response rate 46.3%). The outcome variable, experiences of discrimination, was predicted by means of stepwise logistic regression models covering (1) socioeconomic factors, (2) factors related to healthcare service need and use, and (3) migration-related factors. Results In healthcare services, migrants experienced discrimination more than twice as frequently as the general population (8.9% versus 3.6%, 95% CI = 8.0-9.8, 3.2-4.1). According to regression models, relevant factors were insufficient income, being female, studying as the main occupation and poor mental and physical health. Foreign background was not independently associated with discrimination. However, higher educational attainment, chronic disease, and use of occupational healthcare services increased the likelihood of experiencing discrimination only among those of foreign background and showed the opposite trend for the general population. All migration-related factors increased the risk of discrimination. Conclusions The findings underline the need for training on explaining the service system, overcoming language barriers, and working with forced migrants. The occupational healthcare workforce would particularly benefit from these interventions. The results inform the development of professionals’ training. Key messages • Migrants experience higher levels of discrimination in healthcare compared to the general population. Multiple factors explain this difference. • Healthcare professionals require training to better inform patients about the service system, to improve communication and to address the situation of forced migrants.

Large scale public health system transformation: Germany

Abstract The COVID-19 pandemic was a stress test for public health services in Germany. Decision making was complex (party lengthy and inconsistent) due to the divided responsibilities within the federal system. Some improvements on the public health system were already enacted during the pandemic. A “pandemic radar” was established to bundle up relevant infectious disease indicators with indicators of health services use. The national electronic notification and information system for infectious diseases was extended. Digital improvements were made in the public health offices. Laboratory capacity was strengthened, so was inter-science modelling to forecast pathogen spread. A nation-wide collaborative mechanism, the cloverleaf system, was introduced between regions to avoid the overburdening of hospitals. It is now established for times of excess need for inpatient services. In 2020, a 4 billion euros investment program, the “Pact of Public Health Services”, was adopted to strengthen and modernize the German public health service institutions. The pact is implemented until 2026. The human resources component is the largest. Further priorities include digitalization, improvement of the infrastructure (of designated ports and airports) for the implementation of the International Health Regulations, research and the creation of agile and resilient public health structures. Outputs so far include the establishment of more than 4800 new public health positions, the appointment of new professorships for public health services, the initiation of several research projects, and the roll-out of more than 300 digitalization projects. A new federal institute for prevention is planned. It aims to foster networking between public health services, strengthen health communication, data use, and evidence for public health services. In this process, WHO advised the federal ministry e.g. on behavioral insights; heat health action; prevention on noncommunicable diseases and others. Many public health actors have provided opinions. However, consensus building on how Germany can overcome fragmentation in public health is ongoing.

Inequalities in access to healthcare for older adults during COVID-19 pandemics in Lithuania

Abstract Background During COVID-19 pandemic, healthcare systems experienced unprecedented shock. Older adults were the most vulnerable group of Lithuanian society, facing distinctive health challenges and highest mortality rates. The aim of the study was to examine perceived inequalities and challenges in access to healthcare of Lithuanian population over 65 years old during COVID-19 pandemic. Methods Representative sample of Lithuanian population over 65 years old (1503 individuals) was involved in the anonymous questionnaire survey, performed in January, 2024. Results 22 % of respondents reported not using healthcare services during COVID-19 pandemics. Among them, 76% did not have any need for healthcare services, while 13.6% did not approach healthcare due to fear of getting infected by Covid-19, and the other 10.4% had various accessibility challenges. 15.8% reported frequent problems in registering with family doctors, and 20.0% - with the specialist appointment. There was a clear social gradient observed among those underserved: it was associated with educational level and place of residence. Those with lower education and living in smaller towns and rural areas reported more common healthcare accessibility problems. Higher education, income and better self-perceived health correlated with higher satisfaction with travel time reaching health care services and registering for the appointment (p < 0.05). Conclusions Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. Limited health care accessibility and clear social gradient could increase vulnerability of older adults, which resulted in exceptionally high mortality rates during COVID-19 pandemics. Results of the survey will be used for further development of transformative capabilities of healthcare system, responding to public health disasters and protection of the vulnerable groups of the society. Key messages • Limited health care accessibility and clear social gradient could increase vulnerability of older adults, which resulted in exceptionally high mortality rates during COVID-19 pandemics. • Results of the survey will be used for further development of transformative capabilities of healthcare system, responding to public health disasters.

Prevention of sexual exploitation of children in sport clubs and social work in Switzerland

Abstract The Convention on the Rights of the Child, ratified in 1989, provides a clear normative basis for the protection of children from violence, abuse and exploitation. Despite efforts to protect children, many children and young people are victims of sexual violence. In the extracurricular sector, clubs offer great potential for preventing sexual exploitation. However, obstacles such as the taboo nature of the topic and the clubs’ limited resources make it difficult to develop and independently implement specific prevention offers. The aim of the project was to record the activities and competencies of sports clubs, youth associations and other youth organizations in the area of prevention of sexual assault among children and adolescents in the leisure sector and to determine the need for prevention services in the canton of Zurich in Switzerland. In addition, information was obtained on the impact of existing prevention services as well as information on their further development in terms of content and organization. Together, 979 participants from sports clubs, youth associations and youth organizations (e.g. board members, coaches, leaders) as well as the parents of children who are members of these clubs were surveyed. An impact model was developed for systematic modeling, as proposed by “Health Promotion Switzerland”. The prevention of sexualized violence is seen as a very relevant topic by sports clubs, youth associations, open child and youth work and parents. However, the current implementation of prevention measures also shows that there are still barriers to implementation and room for improvement in prevention work. Participants from all areas would particularly like support with advice on how to deal with suspected cases/incidents, the provision of information materials and the creation of a protection concept. Specific ideas for the further development of prevention work were also generated and will be discussed. Key messages • The prevention of sexualized violence is seen as a very relevant topic by sports clubs, youth associations, open child and youth work and parents. • The study reveals that prevention measures are only partially implemented and identifies barriers and facilitators for improvement.

Factors that influence the need for mental health services for older adults in Europe

Abstract Background Mental health is an integral component of health, and affects close to a 100 million Europeans. Little is known about the predictors of older adult’s mental health demand among health systems in European countries. This study is based on the Andersen’s Behavior Model, that predicts that predisposing characteristics, enabling factors, and behavioral factors, influence need or demand factors of healthcare services. Aim This study has two overall objectives: (i) to investigate the determinants of older adults’ mental health services demand; and (ii) examine the relationship between predisposing characteristics, and enabling resources, with services demand. Methods Data from Wave 9, of the of the cross-national panel dataset of the Survey of Health, Ageing and Retirement in Europe (SHARE) were examined using a sample of 47, 345 older adults. Analysis: The Omnibus test was used to evaluate the fit model and Multinomial Logistics Regression were performed to test the null hypothesis that predisposing characteristics, enabling resources, and behavioral factors are not predictors of need or demand. Findings Predisposing characteristics such as gender (b=-.43, s.e.=.017, p<.001) and age (b=-1.96, s.e.=2.2, p<.001), and enabling factors such as homecare (b = 2.40, s.e.=0.1, p<.001), social support (b=-.26, s.e.=0.012, p<.001), financial support receiving (b=.51, s.e.=.086, p<.001), income (b=.09, s.e.=.009, p<.001), and behavioral factors such as use of technology are predictors of mental health services need or demand [Chi-Square= 3319.58, df = 15 and p <.001]. Implications for Policy and Practice Initiatives for the care of older adults should not only aim to increase access to care services for sub populations such as older adults with mental health but also consider enabling resources such as financial and social support and behavioral factors such as use of technology. Key messages • Demand for mental health services for older adults are influenced by predisposing, enabling and behavioral factors. • Investing in financial services, social support and technology may reduce the demand for mental health services among older adults.

Determinants of Unmet Healthcare Needs During the Final Stage of the COVID-19 Pandemic: Insights From a 21-Country Online Survey

ObjectivesDuring the COVID-19 pandemic, essential health services experienced significant disruptions, impacting preventive and chronic care across the world.MethodsUtilizing the Pandemic Recovery Survey (PRS), conducted online with Facebook’s Active User Base across 21 countries between March and May 2023, this cross-sectional study identifies the magnitude of and key factors associated with unmet preventive and chronic care needs during the late stage of the COVID-19 pandemic.ResultsApproximately 28.2% of respondents reported unmet preventive care needs, and 42.1% experienced unmet chronic care needs, with key determinants including food insecurity (aOR 1.94, 95% CI 1.81–2.07 for preventive services; aOR 1.85, 95% CI 1.68–2.03 for existing conditions) and distrust in health professionals (aOR 1.09, 95% CI 1.03–1.15 for preventive services; aOR 1.53, 95% CI 1.41–1.66 for existing conditions).ConclusionThe findings underscore a widespread unmet need for health services, highlighting the impact of social determinants and trust in health professionals on service disruption. The results suggest that pandemic recovery efforts should focus on the most affected groups to bridge health disparities and ensure an equitable recovery.

Unmet health needs during COVID-19 pandemic in Serbia

Abstract Background The COVID-19 pandemic made health care access more difficult. This study provides insight into significant individual factors associated with unmet needs in 2021 in Serbia. Methods The study is a secondary analysis of SILC data, conducted on a sample of 13,855 respondents aged 16 + (source: Statistical Office of the Republic of Serbia). The outcome variable is self-reported unmet need for physician service in last 12 months (yes/no). Multivariate logistic regression is used to identify factors significantly related to unmet needs. Demographic, socioeconomic factors and health needs, which have been found to be significant for outcome in univariate logistic regression, are entered in final analysis. Results It was shown that age, marital, employment status, income and health needs were significant factors for unmet needs. Compared to 16-24 age group, aged 65+ were more likely to report unmet needs, OR = 3.5(CI = 2.1-5.6); for 45-64 years old OR = 3.4(CI = 2.1-5.3); for 25-44 OR = 2.0(CI = 1.3-3.1). Separated/divorced had higher odds for unmet needs than married ones, OR = 1.4(CI = 1.2-1.8); as well as unemployed, OR = 1.4(CI = 1.2-1.6), and retired, OR = 1.2(CI = 1.0-1.5), than employed. Those from the 1st quintile, based on equalized disposable household income, were more likely to report unmet need compared to the 5th quintile, OR = 1.8(CI = 1.5-2.1). A gradient across all quintiles was proven (for 2nd quintile OR = 1.6(CI = 1.3-1.9), for 3rd OR = 1.4(CI = 1.1-1.7), for 4th OR = 1.3(CI = 1.1-1.5)). Compared to participants with very good/good health, those who perceive own health as very poor/poor had 3 times higher odds (CI = 2.5-3.5) to report unmet need; for those with average health OR = 1.7(CI = 1.5-1.9). Suffering from chronic illness increases odds 2.2 times (CI = 1.9-2.5). Conclusions The highest probability for unmet needs was established across most vulnerable groups, which is significant for preparing for future public health crises and preventing increase in health inequalities during them. Key messages • During the pandemic,there was a higher probability of unmet health needs among the most vulnerable groups. • Strategies need to be put in place to prevent health inequalities deepening in a future crisis.

Strategies to advancing digital health equity: perspectives from underserved groups

Abstract Digital Health Technologies (DHTs) are revolutionizing healthcare. However, there is a lack of demonstrable health benefits across all populations. To advance digital health equity, we explored the perspectives of underserved groups on strategies to support digital inclusivity. Participants belonged to two or more CLEARS (Culture (ethnicity, language, religion), Limiting conditions (visual or hearing), low Educational attainment, older Age, Residence (rural, deprived or no fixed address), low Socioeconomic status) groups. This framework encompassed sociodemographic factors associated with digital exclusion and recognizes the role of intersectionality.(1) Twenty-nine individuals participated in focus groups (n = 4) or interviews (n = 11) and shared their perspectives on the barriers to DHTs, innovative ideas to improve inclusivity, and perceived feasibility of implementing changes. An inductive reflective thematic analysis was used to analyze the transcripts, assisted by N-Vivo. Participants experienced fragmented communication with healthcare providers when using DHTs, explaining how they received a no-reply SMS message asking them to confirm an appointment via a link but were unable to access the link. Current solutions to overcoming such barriers included using non-digital routes (e.g., visiting a pharmacy) or calling non-emergency healthcare services. Many participants expressed the need for DHT support services to be implemented to provide educational support and access to devices. However, some participants raised concerns about the financial strain this might place on healthcare systems. Future research should evaluate the feasibility of implementing different DHTs support services across different settings to advance digital health equity. (1)Wilson et al. (2023). Strategies to develop, design, implement and support digital health equity in key underserved groups: protocol for a systematic review. Alzheimer’s & Dementia. Key messages • Strategies to mitigating digital exclusion within healthcare should be designed with underserved groups. • Future research should evaluate the feasibility of implementing different DHTs support services across different settings to advance digital health equity.

Evaluation of specific offers for mothers with mental stress

Abstract Background As part of the Austrian early intervention programme ‘Frühe Hilfen’, specific interventions (a psychotherapeutic short-term intervention and a therapeutic group) were implemented in some regions. An evaluation was carried out to gain general insights into the need for and benefits of psychosocial services as well as in-depth information on the benefits of the two selected services. The results of the project should also enable further conclusions/recommendations for appropriate services. Methods Mixed-methods approach: qualitative (focus groups, individual interviews, online surveys, participant observation) and quantitative (screening questionnaires) instruments involving a large number of relevant stakeholders and actors. Data analysis: content-structuring qualitative content analysis according to Kuckartz; descriptive analysis of the screening questionnaires. Results The analysis revealed a great need for specific psychosocial services for this target group as well as a high level of satisfaction with the psychosocial services utilised. However, all respondents pointed out barriers to the utilisation of psychosocial services. The evaluation results show that the two specific services make an important contribution to improving the well-being of mothers with mental health problems. Both services largely reach their target group well and, thanks to their focus, contribute to the well-being of mothers with mental health problems. The effectiveness of the service is underpinned by the fact that all participants perceive a reduction in mental stress and notice a reduction in stress during the screenings. Conclusions Based on the evaluation results, it is generally recommended that low-threshold, free and needs-based services be established or expanded. In addition, there is a need for more educational and public relations work on psychosocial stress/diseases and more information on support services. Key messages • There is a great need for psychosocial support among mothers. • The high level of satisfaction with the services evaluated indicates that more such services are needed to support families.

Changes in health, lifestyle, and wellbeing of children with type 1 diabetes and their parents during the pandemic

ObjectiveThe COVID-19 pandemic restrictions have substantially affected people’s health and rapidly changed their daily routines. This is a prospective study that investigated the impact of the pandemic on primary school children with Type 1 diabetes and their parents during the first lockdown in Kuwait.MethodsA questionnaire battery related to mental health, well-being, and lifestyle was administered at baseline in Summer 2019 (face-to-face, at a diabetes outpatient clinic) and at follow-up during lockdown in Summer 2020 (via telephone, in adherence with COVID-19 restrictions). Data were collected for 70 dyads with children aged 9–12 years.ResultsSignificant differences were found in most scores for both children and parents. Their mental health worsened to a higher level of depression, anxiety, stress, and a poor level of wellbeing. The average scores on the follow-up tests fell within a clinical range on these measures. Significant differences in their lifestyle, compared to before the lockdown, included decreased levels of physical activity and lower healthy core nutritional intake.ConclusionsOur findings indicate that the COVID-19 lockdown has had a significant psychological and possibly physiological impact on children with Type 1 diabetes and their parents. We conclude that there is a need for mental health support services focusing on these groups. Although full lockdown restrictions will have stopped in the past year, post-pandemic stressors may be expected to continue to adversely affect this cohort.

Informing Psychosocial Care for Young Couples Coping with Early-Onset Breast Cancer: A Cross-Sectional Examination of Unmet Service Needs and Their Association with Psychological Distress in the First Year Post-Diagnosis.

Objective: Young women diagnosed with breast cancer report greater psychological and physical morbidity than both older women and healthy peers. Similarly, young partners experience elevated cancer-related distress. Psychosocial oncology programs are not frequently attuned to the needs of young adult patients and may exclude their social networks. This marks a critical gap in psychosocial care delivery. The study investigated unmet service needs, psychological distress, and care preferences of young couples managing breast cancer in the first year post-diagnosis. Methods: Forty dyads (n = 80) of women aged 18-45 and their partners completed measures of anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and a service use questionnaire adapted from previously published Adolescent and Young Adult (AYA) literature. The resulting 25 items assessed perceived care needs and service utilization across three domains: informational, emotional/supportive, and practical issues. Descriptive statistics, cross-tabulations, and bivariate correlations were computed. Actor and partner effects of unmet needs on mental health outcomes were investigated with generalized estimating equations (GEE). Results: Patients and partners were in their late thirties, mostly non-Hispanic White, married, highly educated, and employed. Approximately 60% of patients and 43%-66% of partners presented one or more unmet service needs, which correlated with greater distress. Unmet needs about information related to exercise, recurrence, nutrition, and symptom management were prevalent. Unmet supportive service needs of both patients and partners included age-appropriate programs, sexual health, and family counseling. Women reported practical needs for work/school accommodations, integrative care, financial issues and health coverage; while financial concerns, health insurance, and caregiving demands were priorities for partners. Conclusion: Young couples facing early-onset breast cancer experience large proportions of unmet service needs. These challenges were exacerbated by the lack of developmentally targeted psychosocial programs pertaining to informational, supportive, and practical care needs. Enhancing providers' understanding of the psychosocial issues affecting young couples' well-being, and the implementation of systematic procedures to detect and respond to their distress, is urgently needed.

61 The HEADS-ED under 6: Validation of a mental health and developmental screening and triage tool

Abstract Background The HEADS-ED screening and triage tool was developed for children 6 years to young adults as a communimetric mental health (MH) and addictions screener to help clinicians identify and communicate areas of need and recommended clinical care. Few clinician-administered tools identify both MH and developmental needs in young children under 6. From a review of milestone tools and in consultation with paediatricians, psychiatrists, and family physicians, the HEADS-ED Under 6 is a MH and developmental screening and triage tool that was developed to screen and flag functional impairment and action required in several areas, including: Home & caregivers, Eating & sleeping, Activities & peers, Development /speech/language/motor, Safety, Emotions & behaviours and Discharge & current resources (see http://heads-ed.com for more background and access to both tools available in English and French). Objectives Our objectives were to examine: 1) feasibility of implementing the new HEADS-ED Under 6 screening and triage tool in community and hospital settings, 2) clinical utility of the tool to assist with clinical decision making, and 3) validity of the tool against a comprehensive assessment. Design/Methods We conducted two implementation and validation studies to examine uptake of the tool and how the tool assists in clinical referral decisions to more specialized and intensive services at 2 sites. For our initial validation study, we piloted and validated the tool at a community MH agency in Ontario for children under the age of 6 from November 2019- March 2021 (N=566). For our cross-validation study, we examined how the tool was implemented within a regional coordinated access service housed in a paediatric hospital in Ontario from June 2021- August 2023 (N=589). Results For our initial validation study, the HEADS-ED Under 6 was widely used by intake workers (95%, N = 536/566) to communicate children’s MH and developmental needs (Figure 1) and assisted in recommending services of varying intensity. The tool showed good concordance with the InterRAI Early Years assessment in similar domains requiring no action (61.1% to 81.6%), requiring action but not immediate (49.2% to 88.0%) and requiring immediate action (66.7% to 100%) for children under 4 years old (p's <.001). Three clinical domains (Eating & sleeping, Development/speech/language/motor, and Emotions & behaviours) also independently predicted an urgent care recommendation (p's < .001). For our cross-validation study, the tool was used for all 589 intake appointments, and 96.4% (N = 568/589) had a level of need documented. HEADS-ED Under 6 clinical domains (.24-.38) and total scores (.52) were significantly correlated with level of need (p<.001). Higher HEADS-ED Under 6 total scores helped intake workers decide on more intense services based on level of need (p<.001; Figure 2). ROC analyses (AUC = .807, SE = 68.5% sensitivity, 79.5% specificity) confirmed a total score of 6 or above helped triage to more targeted and intense services. Conclusion The HEADS-ED Under 6 is a brief, straight-forward, and valid screening and triage tool that can be used by intake workers, physicians, and paediatricians to guide their interview in several areas of MH and development, communicate the severity of the child’s MH and developmental needs, and assist with determining level of need for services. When a HEADS-ED Under 6 total score reaches ≥6, clinicians should advocate for more intensive services when making MH service referrals.

"Running on goodwill and fairydust" - Midwives' experiences of facilitating and delivering local breastfeeding support via Facebook groups: A qualitative descriptive study.

Facebook groups providing breastfeeding support are widespread. Some are created and/or facilitated by midwives, but little is known about their motivations or experiences. The present study aimed to examine how midwives involved in providing breastfeeding support via local Breastfeeding support Facebook (BSF) groups perceive the value of this provision and their experiences of creating these services and engaging with mothers online. Participants were recruited through Facebook advertising and snowballing techniques. UK registered midwives with experience of providing breastfeeding support via Facebook groups were eligible. Semi-structured interviews were conducted using Microsoft Teams/Zoom with nine midwives between July and September 2021. Reflexive thematic analysis was conducted. Three themes, each with three subthemes, were identified: (1) Imperatives and Value; (2) Goodwill & Lack of Resources; and (3) Community of Practice. Theme 1 described groups as necessary for meeting current mothers' needs and improving low breastfeeding rates. Theme 2 highlighted that BSF groups rely on voluntary work by midwives and peer supporters, with sustainability and recognition of their efforts being major concerns. Theme 3 showed that BSF groups function as communities of practice, offering social learning opportunities and benefits for midwives. Midwives became involved in delivering online support motivated by a belief in the value of this provision, but acted as volunteers and felt unsupported by wider services. This has impacts for the sustainability of this provision regardless of its value. However, midwives reported significant benefits from involvement. Thus, there is a need for services to provide additional guidance and investment.

How COVID-19 pandemic and Ukrainian crisis shaped mental health services for medical students in Poland?

The mental health of medical students is a crucial concern in contemporary medical education. This manuscript reports the availability and shape of psychological support for medical students in Poland in the backdrop of the COVID-19 pandemic and the Ukrainian crisis. A survey comprising 10 questions was distributed to 22 medical schools in Poland, with a 59% response rate. The findings reveal that psychological support programs are predominantly managed by internal university units. Funding sources vary, with some universities utilizing internal budgets and others leveraging European funds or external projects. The support modalities are primarily hybrid, catering to student preferences. Limitations exist in the number of consultations, although some universities provide extended support based on student needs. Assistance is offered in multiple languages, with additional programs like stress-reduction workshops and mindfulness training being available in several universities. A notable increase in demand for psychological support post-COVID-19 was reported, with some universities establishing their programs during or after the pandemic. The commentary highlights the rising need for mental health services among medical students and underscores the importance of flexible, inclusive, and well-funded support. The effective functioning of these programs aligns with the broader objective of fostering a resilient and emotionally balanced healthcare workforce.

Unlocking mental well-being: The role of workplace social support and organisational justice in the public service

Research purpose: This study sought to determine the relationship between public service employee’s mental health accounting for the role of organisational justice and workplace social support.Motivation for the study: Calls exist to understand issues of mental health within the confines of the organisation.Research approach/design and method: A survey approach utilising a convenience sample of 289 public service employees as respondents was utilised. The location of the study was the Eastern Cape province, South Africa.Main findings: The findings show that workplace social support has a direct and positive relationship with employee mental health. Organisational justice has no significant relationship with employee mental health. Workplace social support was found to fully mediate the relationship between organisational justice and employee mental health.Practical/managerial implications: Strategies can be put in place that inform the promotion of mental health with the public service. These include the need for support services to promote mental health to address organisational issues that impede the pathway of such interventions.Contribution/value-add: The findings proffer useful precursors to interventions that address the challenge of mental health.

Understanding Tinnitus Clinical Care in the Veterans Health Administration and Department of Defense: Overview of Survey Results.

In 2021, the Veterans Health Administration (VHA) and Department of Defense (DOD) Tinnitus Working Group conducted a survey of DOD and VHA clinicians to evaluate clinical services provided for tinnitus. The online survey included a mix of multiple-choice and open-ended questions. Respondents included VHA and DOD health care providers in audiology, otolaryngology, mental health, and primary care, as well as DOD hearing conservation technicians. Quantitative and qualitative methods were used to analyze the data. A total of 669 providers responded to this combined survey. Results indicated that compared to DOD and VHA providers in other fields, audiologists tended to be more confident and more aware of their role in tinnitus management. In terms of confidence and scope of practice, DOD mental health care providers were the group least familiar with tinnitus care. Other results explored herein include barriers to tinnitus care, facilitators for progressive tinnitus management programs, interventions and patient materials offered, new patient materials wanted, and respondents' preferred information sources and training methods. Survey results indicated that more directed education and support are needed to increase DOD and VHA clinicians' awareness of the need for tinnitus services and their roles in providing that care. https://doi.org/10.23641/asha.27229215.

"I don't feel fully prepared": a qualitative study of recently graduated students' mental health experiences of the transition out of university.

This study aimed to better understand the mental health experiences of students as they prepared to transition out of university. Participants included 18 recently graduated students from a Canadian university. Virtual one-on-one semi-structured qualitative interviews were conducted and analyzed following the protocol for content analysis and using QSR NVivo. Four main themes were identified, including: distress and feelings of doubt, the importance of connections, the impact of the COVID-19 pandemic, and experiences with mental health service use. Participants discussed feeling pressured to succeed and a fear of failure, uncertainty and unpreparedness for next steps, the importance of connections to peers and professors, a lack of motivation and feeling 'unfinished' due to the COVID-19 pandemic response, and the need for flexible and accessible mental health services to address immediate and longer-term needs. Results have implications for better support of students as they prepare for graduation.

High-cost users still came to hospitals during the COVID-19 pandemic during first wave data in Thailand: secondary data analysis

BackgroundThe phenomenon of high-cost users (HCUs) in health care occurs when a small proportion of patients account for a large proportion of health care expenditures. By understanding this phenomenon during the COVID-19 pandemic, tailored interventions can be provided to ensure that patients receive the care they need and reduce the burden on the health system.ObjectivesThis study aimed to determine (1) whether the HCUs phenomenon occurred during the pandemic in Thailand by exploring the pattern of inpatient health expenditures over time from 2016 to 2021; (2) the patient characteristics of HCUs; (3) the top 5 primary diagnoses of HCUs; and (4) the potential predictors associated with being an HCU.MethodsThe secondary data analysis was conducted via inpatient department (IPD) e-Claim data from the National Health Security Office for the Universal Coverage Scheme, which provides health care to ~ 80% of the Thai population. Health care expenditure over time was calculated, and the characteristics of the population were examined via descriptive analysis. Multinomial logistic regression was applied to explore the potential predictors associated with being an HCU.ResultsThe characteristics of HCUs remained relatively the same from 2016 to 2021. In terms of the proportion of male (55%) to female patients (45%), the age ranged from 55 to 57 years, with an estimated 8-day length of hospital stay and 7 admissions per year, and the average health care cost per patient was ≥ USD 2,860 (100,000 THB). The low-cost users (LCUs) group (the bottom 50% of the population), had more female patients (55%), a younger age ranging from 27 to 33 years, a 3-day length of stay, 1‒2 admissions per year, and a lower average health care cost per patient, which was less than USD 315 (≤ 11,000 THB).ConclusionThe HCUs phenomenon still existed even with limited health care accessibility or lockdown measures implemented during the COVID-19 pandemic. This finding could indicate the uniqueness of the need for health services by HCUs, which differ from those of other population groups. By understanding the trends of health care utilization and expenditure, along with potential predictors associated with being an HCU, policies can be introduced to ensure the appropriate allocation of health resources to the right people in need of the right care during future pandemics.

"I Needed to be That Voice": A Multi-Party Study of the Healthcare and Social Service Experiences and Needs of Transgender and Gender-diverse Older Adults in Canada.

The social contexts of transgender and gender-diverse (TGD) older adults remain under-examined. In this qualitative study, which involved six virtual focus groups with a total of 21 participants inclusive of TGD adults ages 50+, service providers, and community advocates, we sought to examine the healthcare and social service experiences and needs of TGD older adults in Canada. Drawing theoretically on critical gerontology and intersectionality, and methodologically on interpretive description, we examined the perspectives of different participant groups to develop insight into TGD older adults' issues and priorities in the context of their engagements with systems of care. Our findings revealed the role of histories of marginalization, precarity, contemporary sources of intersectional oppression, and resistance in shaping the experiences of this population, while also highlighting community-driven ground-up activities to address evolving needs. Drawing on this conceptualization, we explored the implications of our research for ongoing inquiry, policy, and practice.

When library cares: mining insights from LibQUAL+ to determine university students’ priorities

PurposeThis study aims to evaluate students' satisfaction with university library services in southern Punjab, Pakistan, emphasizing their perspective on service quality (SQ).Design/methodology/approachA LibQUAL+® survey with 22 core items was conducted within university settings using convenience sampling. In total, 345 usable responses were returned through Google Forms. Data analysis involved descriptive statistics, ordinal logistic regression test, Pearson and Deviance statistics and chi-square test to assess the satisfaction status of library users.FindingsThe study found that libraries generally meet SQ standards. However, there were minor gaps in information control (IC) and library as place (LP).Practical implicationsThe study provides library administrators with actionable insights to enhance services, encouraging stakeholders to adopt optimal library practices for heightened efficiency and user satisfaction.Social implicationsIt highlights the crucial role of libraries in shaping future societal progress by emphasizing the need for elevated user services. Librarians can use this knowledge to modify their planning and take impactful initiatives that align with the evolving needs of their users.Originality/valueWhile many studies have utilized LibQUAL, this research is unique for its focus on addressing university library services in underdeveloped regions facing economic challenges. It attempts to fill the information gap by offering a transferable approach for strategic priorities in similar settings.