Social Network Of Patients Research Articles

Post-traumatic Distress in Adults with Congenital Heart Disease: Protective Factors and Clinical Implications.

Due to various reasons explored in previous studies, adults with congenital heart disease (ACHD) are at risk of developing post-traumatic stress symptoms (PTSS). The aim of this study is to explore multiple potential psychosocial protective factors in ACHD and to understand their role in different complexities of congenital heart disease (CHD) and PTSS. This study was part of the "ABS-AHF" study, where 234 ACHD were recruited from November 2021 to August 2022 at a tertiary CHD care center. Data were collected on PTSS (PDS), resilience (RS-13), sense of coherence (SOC-L9), and social support (F-SozU K-14). The mean scores were 70.55 + / - 12.31 [21-91] for resilience, 35.83 + / - 4.81 [15-60] for sense of coherence (SOC), and 4.30 + / - 0.79 [0.93-5] for social support. SOC (OR, .91; p = .024 [.84; 9.98]) and social support (OR, .48; p = .001 [.29; 7.96]) were shown to reduce the likelihood of PTSS. Low resilience (OR, 2.40, p = .0248 [1.18; 5.18]) seems to increase this likelihood. Integrating parents and relatives early on seems to be an important protective resource. Parental support in childhood affects the development of SOC which is in line with social support related to lower PTSS. With regard to resilience and SOC, a brief and manageable screening option for personal resources is available to refer potentially vulnerable patients to specialized psychosocial care. Care offers should address coping styles and life with CHD. Offering multidisciplinary care, integrating the patient's social network, and education for patients to increase resilience and SOC might provide a way to enhance psychosocial outcomes, quality of life, and adherence in ACHD.

The relationships among family function, psychological resilience, and social network of patients with chronic disease in the community

This study aimed to examine the relationships among family function, psychological resilience, and social network of patients with chronic disease in the community and to further identify whether psychological resilience played a mediating role in the relationship between family function and social network. A cross-sectional survey including 460 convenient samples of patients with chronic disease in four Chinese communities was conducted using a general characteristics questionnaire, the Family APGAR Index, the Connor-Davidson Resilience Scale, and the Lubben Social Network Scale 6. Data were analyzed using descriptive analysis, Student's t-test, one-way ANOVA, Pearson/Spearman correlation, hierarchical multiple regression analysis, and mediation analysis using the PROCESS macro. Family function, psychological resilience, and social network were significantly related. Psychological resilience partially mediated the relationship between family function and social network. Interventions designed to enhance family function and psychological resilience may improve social network among patients with chronic disease in the community.

Profiling the patient with inflammatory bowel disease in the relationship between physical activity and partner/social network status: A post hoc patient-tailored analysis of the “BE-FIT-IBD” study

IntroductionNormal quality of life is an ultimate target in the therapeutic approach to inflammatory bowel diseases (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC) in the context of which regular physical activity (PA) is often a chimeric parameter that is not standardized in terms of quality/quantity. The study aimed to profile a sample of IBD patients about the relationship between PA-partner status and social network support. Patients and methodsA post hoc analysis of the “BE-FIT-IBD” study was set up by stratifying the data of PA with that of partner status and the support that the patient's social network (i.e., relatives, friends) provided in inciting the patient to practice regular PA. ResultsIn the 219 patients included, there was a greater tendency for patients with stable partners to view the risk of reactivation/worsening of IBD as a barrier to conducting regular PA (p<0.0001). Single patients considered PA more as a protective factor (p=0.045). Patients without a PA-supporting social network retained IBD-related treatment as a PA barrier (p=0.016) and PA as a risk for IBD complications (p=0.01), with less confidence that PA could improve the course of IBD (p<0.001). Rectal syndrome was an IBD-related barrier more represented in patients with PA-deterring social network (p<0.0001). ConclusionsThese factors are potential targets for recovering the IBD patient's adherence to regular PA.

Dialysis Patients’ Social Networks and Living Donation Offers

Most living kidney donors are members of a hemodialysis patient's social network. Network members are divided into core members, those strongly connected to the patient and other members; and peripheral members, those weakly connected to the patient and other members. We identify how many hemodialysis patients' network members offered to become kidney donors, whether these offers were from core or peripheral network members, and whose offers the patients accepted. A cross-sectional interviewer-administered hemodialysis patient social network survey. Prevalent hemodialysis patients in 2 facilities. Network size and constraint, a donation from a peripheral network member. Number of living donor offers, accepting an offer. We performed egocentric network analyses for all participants. Poisson regression models evaluated associations between network measures and number of offers. Logistic regression models determined the associations between network factors and accepting a donation offer. The mean age of the 106 participants was 60 years. Forty-five percent were female, and 75% self-identified as Black. Fifty-two percent of participants received at least one living donor offer (range 1-6); 42% of the offers were from peripheral members. Participants with larger networks received more offers (incident rate ratio [IRR], 1.26; 95% CI, 1.12-1.42; P=0.001), including networks with more peripheral members (constraint, IRR, 0.97; 95% CI, 0.96-0.98; P<0.001). Participants who received a peripheral member offer had 3.6 times greater odds of accepting an offer (OR, 3.56; 95% CI, 1.15-10.8; P=0.02) than those who did not receive a peripheral member offer. A small sample of only hemodialysis patients. Most participants received at least one living donor offer, often from peripheral network members. Future living donor interventions should focus on both core and peripheral network members.

The impact of a patient's social network on emergency surgery for colon cancer.

The aim of this study was to investigate if patients with a weak social network and colon cancer are more likely to be operated as an emergency than those with a strong social network. Data from patients living in Västerbotten County, Sweden, who underwent colon cancer surgery between 2007 and 2020 were extracted from the Swedish Colorectal Cancer Registry (SCRCR). Patients identified were matched against the Västerbotten Intervention Program (VIP) and the longitudinal study Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA). These two databases include a survey that includes questions regarding quality and size of the patient's social network. Multivariable logistic regression was used for analysis. Six items from the questions on social network, and the composite variables availability of social integration (AVSI) and availability of attachment (AVAT) were analysed. Data from 801 patients were analysed. The odds ratio for emergency surgery was significantly higher for divorced patients (OR 2.01 (CI 1.03-3.91)) and for male gender (OR 1.51 (CI 1.02-2.24)). A higher OR was seen amongst those with no-one to share feelings with (OR 1.57 (CI 0.82-3.03)) or to comfort them (OR1.33 (CI 0.78-2.28)). Quantitative aspects of social life such as the number of people greater than 10 that feel relaxed at the patient's home, showed a lower OR (OR 0.71(CI 0.35-1.43)). The impact of social network on the risk for emergency surgery for colon cancer is limited. Divorced status and male gender were associated with an increased risk for emergency surgery.

Physicians' attitudes towards smartphone-based emergency response communities for anaphylaxis: Survey

ObjectivesPatients at risk of anaphylaxis are required to always carry an adrenaline auto-injector (AAI), as the first line of treatment, but their adherence is low. An Emergency Response Community (ERC) is a social network of patients who can potentially help other patients who find themselves without their medication in an emergency. ERC can be mediated by an Emergency Medical Services (EMS) agency or unmediated to provide direct patient-to-patient immediate first aid.The purpose of this research was to study physicians' attitudes towards anaphylaxis ERC (AERC). MethodsA convenience sample of 224 physicians were surveyed using an online questionnaire. Answers were analyzed using ANOVA, t-tests and ordinal regression. ResultsPositive attitudes towards an AERC found 88.4% (n = 198) see potential in the ERC and 62.9% (n = 141) think that ERC is excellent and should be implemented immediately. Fewer respondents (6.25%, n = 14) rejected the ERC completely.Respondents showed high willingness to provide patients with solicited or unsolicited advice to join an AERC (78%, n = 175 and 50%, n = 111 respectively).Physicians' opinion about the minimum age to join an AERC is an average of 15.45 years.Leading concerns are 'being left without AAI' (54.5%, n = 122), 'expired AAI' (44.2%, n = 99) and 'wrong AAI administration' (41.1%, n = 92).High support for mediated AERC (79%, n = 177) was found and mediation seems to reduce concerns among the majority (68.3%, n = 153) of respondents. ConclusionsPhysicians expressed high support for unmediated AERC. EMS mediation is preferred by the respondents and potentially lowers their concerns. Findings support the AERC approach for patients at risk of anaphylaxis. Public interest summaryPatients at risk of anaphylaxis are required to always carry an adrenaline auto-injector, as the first line of treatment, but their adherence is low. An Emergency Response Community (ERC) is a social network of patients who can potentially help other patients who find themselves without their medication in an emergency. ERC can be mediated by an Emergency Medical Services (EMS) agency or unmediated to provide direct patient-to-patient immediate first aid. The purpose of this research was to study physicians' attitudes towards anaphylaxis ERC (AERC).A convenience sample of 224 physicians were surveyed using an online questionnaire.Physicians expressed high support for unmediated AERC and high willingness to provide patients with solicited or unsolicited advice to join an AERC. EMS mediation is preferred by the respondents and potentially lowers their concerns. Leading concerns are 'being left without AAI', 'expired AAI', and 'wrong AAI administration'.

Interpersonal Relations Within the Context of Resource Groups for People With Severe Mental Illness: A Narrative Approach.

Objective: The resource group method intends to promote patients' agency and self-management and to organize meaningful partnerships between patients and their informal and formal support systems. The aim of this study was to enhance the understanding of interpersonal dynamics that arise within resource groups for people with severe mental illness. Insight into these unfolding processes would enable improved implementation of the resource group method so that it contributes to establishing a positive social environment, which can lead to more enduring recovery.Methodology: We performed a narrative analysis of transcripts and field notes obtained in a longitudinal, qualitative study on the resource group method. The stories of four different resource groups were reconstructed and analyzed in depth. Data included a total of 36 interviews (with patients, significant others, and mental health professionals) and 18 observations of resource group meetings.Results: The degree to which the resource group method actually contributes to recovery was based on the extent to which the existing roles of and patterns between the patient and his/her resource group members were altered. Breaking through old patterns of inequality and the joint search for a new balance in relationships proved to be crucial processes for establishing an empowering resource group. The four cases showed that it takes time, patience, and small steps back and forth to overcome the struggles and fears related to finding new ways of relating to each other. An honest and reflective atmosphere in which all participants are encouraged to participate and be curious about themselves and each other is essential for changes in interpersonal dynamics to emerge. Such changes pave the way for individuals with SMI to find their own voices and pursue their unique recovery journeys.Conclusions: The functioning of the resource group and the ability of the involved members to respond in new ways are important when working toward the patient's recovery goals. The resource group method should therefore not be considered an intervention to organize informal support for the patient, but a platform to expose and adjust the functioning of the patient's social network as a whole.

Using Patients' Social Network to Improve Compliance to Outpatient Screening Colonoscopy Appointments Among Blacks: A Randomized Clinical Trial.

Patient navigation improves colorectal cancer screening among underserved populations, but limited resources preclude widespread adoption in minority-serving institutions. We evaluated whether a patient's self-selected social contact person can effectively facilitate outpatient screening colonoscopy. From September 2014 to March 2017 in an urban tertiary center, 399 black participants scheduled for outpatient screening colonoscopy self-selected a social contact person to be a facilitator and provided the person's phone number. Of these, 201 participants (50.4%) were randomly assigned to the intervention arm for their social contact persons to be engaged by phone. The study was explained to the social contact person with details about colonoscopy screening and bowel preparation process. The social contacts were asked to assist the participants, provide support, and encourage compliance with the procedures. The social contact person was not contacted in the usual care arm, n = 198 (49.6%). We evaluated attendance to the scheduled outpatient colonoscopy and adequacy of bowel preparation. Analysis was performed by intention to treat. The social contact person was reached and agreed to be involved for 130 of the 201 participants (64.7%). No differences were found in the proportion of participants who underwent screening colonoscopy (77.3% vs 77.2%; relative risk = 1.01; 95% confidence interval: 0.91-1.12), but there was a modest increase in the proportion with adequate bowel preparation with social contact involvement (89.1% vs 80.9%; relative risk = 1.10; 95% confidence interval: 1.00-1.21). Engaging a patient's social network to serve in the role of a patient navigator did not improve compliance to outpatient screening colonoscopy but modestly improved the adequacy of bowel preparation.

Activity resumption after acquired brain injury: the influence of the social network as described by social workers

Purpose To understand how the social network of patients with acquired brain injury facilitates or hinders resumption of their activities, such as social and leisure activities, and how this affects patients’ well-being and quality of life. Methods Thematic analysis was applied to 70 narratives about family members, friends, neighbors and colleagues helping or hindering patients in resuming their activities. The narratives were derived from social workers with extensive experience with brain-injured patients and their social networks. Results The narratives show that an available, understanding and well-informed network enhances activity resumption by being inclusive and encouraging patients to develop their skills. This is in line with earlier studies based on patients’ experiences. Whereas the patient-based studies emphasize that being unsupportive or overprotective hinders patients from resuming their activities, this study also shows that preventing patients from meeting others or placing too-high demands results in activity loss, social isolation and reduced well-being and quality of life. Conclusions Several social network factors play a role in activity resumption, well-being, and quality of life of after brain injury. Early after the brain injury, rehabilitation professionals should work with patients’ family members, friends, and others and educate them about how to provide adequate support. IMPLICATIONS FOR REHABILITATION Since the patient’s social network is an important determinant of activity resumption, rehabilitation professionals should analyze its features soon after brain injury, such as whether patients have an understanding network that encourages them and includes them in their activities. Since especially close network members tend to be protective of or place high demands on the patient, rehabilitation professionals should explain to them the importance of activity resumption for the patient’s wellbeing and the adverse effects of being overprotective or over-demanding. Rehabilitation professionals should include other network members, such as friends or colleagues, in the rehabilitation process and educate them about how to support patients in resuming their activities.

Patients' experiences and social support needs following the diagnosis and initial treatment of acute leukemia - A qualitative study.

This study explores how newly diagnosed patients with acute leukemia (AL) experience the diagnosis and the initial treatment, and their need and preferences for social support. Explorative semi-structured individual interviews were carried out in patients with AL (n = 18) four to sixteen weeks post diagnosis. Thematic analysis was used to analyze the qualitative interview data. Identified themes were 1) Jolted by the diagnosis, and subtheme Loss of personal autonomy; 2) Restoring normality in everyday life, and subtheme Facing a new social identity; and 3) A lifeline of hope. Being newly diagnosed with AL was experienced as traumatic, which negatively affected personal autonomy and everyday life. There was a pressing need to restore a sense of normality in everyday life while managing a new social identity as a cancer patient. Social support from family, friends and other patients were invaluable and experienced as an important lifeline. Receiving a life threatening diagnose and undergoing chemotherapeutic treatment had a negative impact on everyday life which required re-establishing daily life activities. This increased the need for social support which had a distinct role in facilitating the patients' coping strategy. It is important to support and strengthen the patient's social network from the time of diagnosis. Future studies should examine the feasibility and benefit of experienced-based social support from peers (former patients) to patients with AL.

The social networks of New Zealand patients with multimorbidity and the work of those nominated as their ‘significant supporters’: An exploratory study

Social networks are informal relationships often with social ties and voluntary or mandatory obligations that can positively support a patient with multimorbidity. This exploratory study sought insights into the social networks of New Zealand people with multimorbidity and also the work of those nominated as providing significant support. Ten participants were recruited from general practice as part of an education programme in which health professional students discussed living with multimorbidity and completed a social network template together with patients. Each patient nominated an individual from their social network whom they considered provided significant support. A researcher interviewed each supporter about their experience of providing support, and their view of the patient's social network. Significant supporters included three classified as 'lay' supporters (sister, wife and daughter) and seven classified as 'professional' supporters (exercise physiologist, general practitioners, nurse, medical specialists). The activities described by supporters was classified according to Vassilev et al.'s expansion of Corbin and Strauss's 1985 classification of work in chronic illness, including the categories of "illness," "everyday" and "emotional" work. Irrespective of whether supporters were lay or professional, they gave examples of each category. While this is expected of lay supporters, it is not expected of professional supporters who are typically viewed as undertaking illness work. Lay supporters described a complex array of activities sometimes impacting on their own personal well-being, making them more akin to meeting the formal definition of being a carer, while professional supports gave objective yet professionally invested descriptions. The work of lay and professional supporters is complementary in the provision of support for those with multimorbidity. Consideration should be given to the role of lay supporters and to their own needs if they are to be able to sustain their support work with patients.

Lung Cancer Stigma across the Social Network: Patient and Caregiver Perspectives.

To examine the personal experiences of people with lung cancer and their caregivers and how stigma is manifested throughout a patient's social network. A qualitative thematic analysis of interviews with28 patients with lung cancer and their caregivers wasconducted. Telephone interviews were conducted andtranscribed verbatim. Data analysis was guided by contemporary stigma theory. Patients and caregivers reported feeling high levelsof felt stigma and concomitant psychological distress in response to the diagnosis of lung cancer. Three overarching themes emerged: the nexus of lung cancer and smoking, moralization, and attacking the link between lung cancer and smoking. Stigma was inevitably linked to smoking, and this formed the hub around which the other themes were organized. Caregivers reported feeling invisible and noted a lack of support systems for families and caregivers. In addition, there was evidence that caregivers experienced stigma by association as members of the patients' close networks. Both groups responded ambivalently to stigmatizing antismoking advertisements. The qualitative analysis demonstrated the complex interplay of the social and personal domains in the experience and outcomes of stigma in lung cancer. There isa significant potential for caregivers of patients with lungcancer to experience exacerbations of psychosocial distress as a consequence of widely shared negative viewsabout lung cancer and its prognosis. It remains forresearchers and practitioners to incorporate such complexity in addressing stigma and psychosocial distress in both patients and caregivers.

Layperson's knowledge and perceptions of irritable bowel syndrome as potential barriers to care.

The aim of this study was to describe the layperson's knowledge and perceptions regarding the aetiology, pathogenesis, prevalence, medical evaluation, diagnosis and treatment of irritable bowel syndrome. Diagnosis acceptance and adherence to treatment is influenced by the views of the patient's social networks. Little is known how these networks influence those with irritable bowel syndrome. Cross-sectional study of two-hundred four laypersons, ages 18-80years without an irritable bowel syndrome diagnosis. Data were collected May 2016-March 2017. Laypersons without a diagnosis of IBS self-reported their knowledge and perceptions about IBS. Participants were able to identify many symptoms associated with irritable bowel syndrome however held misconceptions regarding the development of irritable bowel syndrome as noted by the endorsement of genetics, environment and diet or alcohol/smoking behaviours as specific causes. Further misconceptions held included the belief that irritable bowel syndrome was associated with an increased risk for the development of colon cancer and inflammatory bowel disease. Contrary to current guidelines, many thought a gastroenterologist was the only person appropriate to diagnose irritable bowel syndrome and objective testing, such as colonoscopy, was necessary to establish a diagnosis. Laypersons have an understanding of the symptoms associated with IBS; however, hold numerous misconceptions regarding the aetiology, role of the healthcare provider, necessary testing and risks associated with irritable bowel syndrome. These misconceptions are inconsistent with current guidelines and practices. Establishing partnerships and educating social networks in addition to patients may enhance outcomes for those with IBS.

Using Patientsʼ Social Network to Improve Compliance to Outpatient Screening Colonoscopy Appointments Among Blacks: A Randomized Controlled Trial

Introduction: Blacks suffer a disproportionately higher burden from colorectal cancer in the United States in part due to suboptimal screening uptake. Although the use of patient navigators has been shown to improve healthcare delivery to underserved populations, this service is typically reserved for patients with cancer diagnosis because of limited resources in minority serving institutions. Aim: To determine whether a patient's self-selected social contact person can effectively facilitate the uptake of scheduled outpatient screening colonoscopy in the typical role of a patient navigator. Methods: Of 410 patients who self-selected a social contact person and provided the person's phone number, 207 (50.5%) were randomly assigned to the intervention arm and their social contact person was contacted by phone. The study was explained to the person with details about colonoscopy screening including bowel preparation process. The social contacts were asked to assist the patient, provide support and encourage compliance with the scheduled procedure. A brochure on colonoscopy screening was also mailed to the social contact person. The primary outcomes were compliance with the outpatient colonoscopy and the adequacy of bowel preparation assessed during the colonoscopy. Analysis was performed by intention to treat. Results: Overall, the social contact person was reached and agreed to be involved in 122/207 (58.9%). No differences were found between the patients in the social contact group and control group in the proportion who underwent screening colonoscopy. There was a non-significant increase in the proportion with adequate bowel preparation with social contact involvement (Table).Table: Table. Social network engagement and compliance with screening colonoscopyConclusion: Engaging a patient's social network to serve in the role of a patient navigator is not an effective strategy to improve compliance to outpatient cancer screening colonoscopy among underserved blacks. Minority serving institutions should invest in sustainable models to support patient navigation for colorectal cancer screening to improve compliance. Clinical trial registration: NCT02464618 The study was funded by the National Institute of Diabetes and Digestive Diseases and Kidney (NIDDK) grant number: R21DK100875.

Social networks of patients with multimorbidity: a qualitative study of patients' and supporters' views.

INTRODUCTION Multimorbidity impacts on patients' health and wellbeing, but relationships experienced within social networks can support people to live well. AIM This study sought to elicit the views of New Zealanders with multimorbidity about their social networks and the views of their nominated supporters. METHODS Ten patients with multimorbidity and their nominated supporters each independently recorded their views of the patient's social network on a five-concentric-circle template, indicating supporting role and importance to each patient. Sets of patients' and nominated supporters' templates were compared followed by comparing matched pairs of patient-supporter templates. Nominated supporters' views about the patients' networks and why they were nominated were collated. RESULTS Three patients nominated family members as supporters and seven nominated health professionals. Nominated family members identified a greater range of supporters than nominated health professionals. Nominated family members perceived that they played an integral role, whereas health professionals were less comfortable viewing relationships with patients in this way. Family members were not surprised to be nominated as supporters, and some described a considerable burden of care. Health professionals described themselves as coordinators of support and having positive relationships with patients. DISCUSSION Patients with multimorbidity have rich and diverse social networks. They view partners, family and health professionals as providing significant support. Family members are more aware of their role and have a deeper understanding of other network members than health professionals. Further research is needed on the use of social networks in clinical practice to support the health and wellbeing of those with multimorbidity.

Factoren die de keuze van patiënten voor zorgaanbieders in europese en noord-amerikaanse landen bepalen

Introduction: Since the introduction of a market oriented structure in public health care patients are expected to make informed choices between health care providers. However, it is still unclear what patients base their decisions on. The objective of this literature study is to identify the personal, healthcare provider-related, logistic and financial factors which determine the patients’ choice for certain healthcare providers. More specifically, only determinants of choice for surgical hospital care in European and North-American countries are studied. Method: Articles were mainly derived from the Pubmed, Medline and Google Scholar databases. Search terms used were patient choice, provider, physician and hospital. Furthermore, 3 additional articles were provided by the supervisors and 8 articles were included by backwards referencing. After inclusion, the articles were analyzed by the simple approach. Results: 27 articles were taken into account for analyses. Personal factors that influence the patient´s choice for a certain provider are age, race, medical condition, educational level, earlier experiences and the advice of people in the social network of patients. Furthermore, provider related factors which often came forward were the expertise of staff, the number of services offered, reputation and the quality of care provided. Moreover, the type of organization and the size of hospitals have an impact on the choice. Important logistic aspects are the distance to the hospital, the waiting time before treatment and the travel options. Financial aspects which are considered in advance of choosing are the costs of treatment, the costs of travelling and the personal expenses. Conclusion: It can be concluded that many factors determine the patient’s choice. However, it is difficult to indicate the importance of all the factors found because often combinations of factors or interactions between factors determine the patient’s choice.

Social skills, social networks and psychological well-being of patiens with spinal cord injury

The paper presents information concerning the relations between the subjective evaluation of social skills, parameters of the social network and the factors determining psychological well-being ofpatients with spinal cord injury sequellae (SCIS). Thus, one of the focuses of the diagnostic and therapeutic work of a clinical psychologist and psychotherapist in the rehabilitation hospital environment becomes as well a subjective assessment by SCIS patients of their own social skills, as the development of these skills, contributing to the expansion of the social network, which is a resource for the provision ofpsychological wellbeing ofpatients. This testifies not only to the need for correction of the emotional state ofpatients, but also the necessity of specific psychotherapeutic interventions. Such interventions should be aimed at the increasing in the level of communication skills which are useful for the formation of new social relationships and the development of the social network of patients (group forms of training, support groups, chat forums, etc.).

Making house calls increases living donor inquiries and evaluations for blacks on the kidney transplant waiting list.

Blacks receive live donor kidney transplant (LDKT) less often than patients of all other races. We evaluated the effectiveness of educational interventions in removing barriers to LDKT for blacks. Patients were randomized to three interventions in which health educator(s) delivered an intervention to (a) the patient and his/her guests in the patient's home (house calls [HC], n=54), (b) clusters of patients and their guests in the transplant center (group based [GB], n=49), and (c) the individual patient alone in the transplant center (individual counseling [IC], n=49). At the 2-year endpoint, 15% (n=8), 8% (n=4), and 6% (n=3) of HC, GB, and IC patients, respectively, received LDKT (P=0.30). Patients in the HC group were more likely than patients in the GB and IC groups to have at least one donor inquiry (82% vs. 61% vs. 47%, P=0.001) and evaluation (65% vs. 39% vs. 27%, P<0.001). Patients in the HC group also were more likely to have higher knowledge, fewer concerns, and higher willingness to talk to others about donation 6 weeks after intervention. These findings underscore the importance of including the patient's social network in LDKT education and the potential of the HC intervention to reduce racial disparity in LDKT rates.

Stigmatization on the way to recovery in mental illness - the factors associated with social functioning

Persons with mental disorders often experience stigmatization. There is a number of social factors that may affect the process of recovery and at the same time, in certain circumstances, could be a source of stigma. Mentally ill may find strength in themselves to fight against the disease or the opposite - can internalize the negative attitudes of the society and become self-stigmatized. The patient's family, on the one hand, is often the only source of social support, on the other hand, can experience a destructive influence of courtesy-stigma. Mentally ill have to face social reluctance which is reinforced by stereotypical media coverage of mental disorders. The social network of patients is poor and often limited to a family system. Negative views about persons diagnosed with mental illness are most visible in the labour market. Patients experience many types of discrimination at work,have lower employment rates and lower mean wages than healthy ones. Structural discrimination is a form of stigma which is revealed in underfunded and inefficient system of mental health care. All the social factors mentioned above are necessary for recovery (positive stimulation of functioning), but can also increase stigma and become a significant barrier in the recovery of psychiatric patients. This paper highlights the complex and ambiguous nature of the relationship between social factors and the recovery of the mentally ill basing on the data from the literature.

Family members’ experiences of the use of interpreters in healthcare

The aim was to explore adults' experiences of their family members' use of interpreters in health-care encounters. Language barriers are a major hindrance for migrants to receive appropriate healthcare. In a foreign country, family members often need support in care of migrant patients. No previous studies focusing on adult family members' experiences of the use of interpreters in healthcare have been found. A purposive sample of 10 adult family members with experiences of the use of interpreters in health-care encounters. Data were collected between May and September 2009 by focus-group interviews and analysed with qualitative analysis according to a method described for focus groups. Three categories emerged from the analysis: (1) Experiences of the use of professional interpreters, (2) Experiences of being used as an interpreter and (3) Experiences of what needs to be improved when using interpreters. The main findings showed no agreement in family members' experiences; interpretation should be individually and situationally adapted. However, when family members acted as interpreters, their role was to give both practical and emotional support, and this led to both positive and negative emotions. Use of simple language, better collaboration in the health-care organization and developing the interpreters' professional attitude could improve the use of professional interpreters. The type of interpreter, mode of interpretation and patient's preferences should be considered in the interpretation situation. In order to achieve high-quality healthcare, health-care professionals need to organize a good interpretation situation case-by-case, choose the appropriate interpreters with the patient in focus and cooperate with members of the patient's social network.