Survey Participants Research Articles

Digital health literacy of adults with low reading and writing skills: A mixed-methods study

Abstract Background Around 12% of the adult population living in Germany have low reading and writing skills. Little is known about their digital health literacy and use of digital health technologies. The objectives of the Liter@te study were to assess the digital health literacy of adults with low reading and writing skills and to explore which digital tools they used in everyday life. Methods A cross-sectional survey (n = 96) and five focus groups (n = 39) were conducted with adults aged 18-64 years with low reading and writing skills. Digital health literacy was measured using the eHEALS scale and compared with results from a nationwide sample. Focus group participants completed a task course on digital health information and then discussed their experiences. Survey data were analyzed using descriptive statistics and logistic regression. Qualitative content analysis was applied to analyze the focus group data. Results Survey participants were on average 44 years old, 72% were female and 92% were not born in Germany. Compared to the nationwide survey, use of digital health technologies and digital health literacy were lower. In addition, use of digital health technologies was associated with higher digital health literacy. Lack of technical skills, language problems, and searching and finding health information online were most challenging for focus group participants (mean age 43 years, 87% female). Focus group participants reported that they prefer videos when searching for health information online and seek support from family members or local organizations if they cannot find a solution to their health issue. Conclusions Adults with low reading and writing skills search for health information online, but have difficulties to find the appropriate information. Interventions to promote digital health literacy are needed to ensure that persons with low reading and writing skills are not further left behind. Key messages • Adults with low language skills have a low digital health literacy. • Reading and writing requirements and lack of technical skills make it difficult for them to search health information online.

Workplace health promotion measures and use of medical services in the German Federal Armed Forces

Abstract Introduction Workplace health promotion measures (WHPM) are among recommended options for maintaining employees health, important for the German Federal Armed Forces as an employer. In order to detect associations between WHPM and health care utilization, we recorded the number of outpatient visits and hospital stays, differentiated according to gender, military or civilian activity. Methods Prospective longitudinal observational substudy with cross sectional analysis of items regarding use of medical services at T0 (6-9/2022). Analysis for T1 (2023) and T2 (2024) follow. Data were obtained with a web-based employee survey to record self-reported endpoints. A total of about 224.000 employees by the German Armed Forces were addressed. Results Survey participation rate was 10.5% (n = 23.568) of all employees in T0, 29.1% were women and 0.3% reported being diverse, 43.2% of the participants were <40 years of age. Independently of taking part in WHPM, we did not detect differences in the proportion of male soldiers receiving treatment in hospitals of the German Federal Armed Forces. Among female soldiers without WHPM, 37.5% stayed in hospitals and with WHPM 30.5%. Higher % of women (84%) than men (78%) presented to the military - or family physician (w: 81%, m: 73%), independent of participation in WHPM and assignment for civil or military. In last 4 weeks, more women (81.3%) than men (65.6%) were prescribed medication. Female employees in civilian w.p.(84.8%) took more medications than those in military w.p (77.7%). Oral contraception was used by 20% of women in both civilian and military w.p. Conclusions There are no gender differences nor difference for civilian or military employees concerning the number of days staying in hospital. More women than men recieved regular outpatient medical care and more women than men take medication regularly. *Ludwig S and Roy R share last authorship Key messages • There are no gender differences nor difference for civilian or military employees concerning the number of days staying in hospital. • More women than men recieved regular outpatient medical care and more women than men take medication regularly.

Assessing the Prospects and Risks of Delivering Sustainable Urban Development Through 3D Concrete Printing Implementation

The article presents the results of a comprehensive study of the use of 3D Concrete printing (3DCP) technology to create urban infrastructure facilities according to sustainable development principles. The work includes a study of scientific articles on the subject area under consideration, a survey of additive construction market participants, as well as an analysis and generalization of promising areas for technology development and methods for improving the quality of objects erected using 3DCP. As part of the conducted literature review, publications included in the Scopus database for the period 2015–2024 were selected for analysis using the keywords ‘Sustainable development + 3DCP’ and ‘Sustainable construction + 3DCP’. The following conclusions were made: (i) the most popular publications are review articles about the development of materials and technologies for 3DCP and (ii) the most sought-after are the studies in the field of partial application of 3DCP technology, existing equipment and materials for 3DCP, and assessment of the effectiveness and cost-effectiveness of 3DCP use. For this purpose, a questionnaire was developed consisting of three blocks: equipment and technologies; structures and materials for 3DCP; the ecology and economics of 3DCP applicability. As a result, four main risks have been identified, which represent promising areas for 3DCP development.

Monetary Incentives in Clinician Surveys: An Analysis and Systematic Review With a Focus on Establishing Best Practices.

Surveys involving health care providers continue to be characterized by low and declining response rates (RRs), and researchers have utilized various strategies to increase survey participation. An important approach is to employ monetary incentives to improve survey response. Using a systematic review and analyses of 100 randomized comparisons (published in 48 papers) between monetary incentives and a non-incentive condition, this paper seeks to advance the understanding of best practices for using monetary incentives in clinician surveys. These analyses show even small incentives (≤$2) to be effective in improving clinician response relative to non-incentive subgroups, with diminished returns associated with serial incremental increases above that amount up to amounts greater than $25, at which point there is an appreciable improvement, supporting the use of higher incentives in this population. Cash and direct cash equivalents (e.g., cash cards and checks) produced greater odds of survey participation compared to vouchers, lotteries and charitable contributions, with lotteries and charities being the least effective forms of monetary incentive. Survey mode, timing and ethical considerations are also addressed. Noting the challenges associated with surveying clinicians, researchers must make every effort to improve access to this difficult-to-reach population by implementing appropriate incentive-based strategies designed to improve participation rates.

GPP03 Presentation Time: 9:18 AM: Outcomes of Survey of Participants from AROI-ESTRO Gyn Teaching Courses on 3D IGABT for Cervical Cancer Conducted in India

GPP03 Presentation Time: 9:18 AM: Outcomes of Survey of Participants from AROI-ESTRO Gyn Teaching Courses on 3D IGABT for Cervical Cancer Conducted in India

Pelvic floor-related sexual functioning in the first 24 months postpartum: Findings of a large cross-sectional study.

The pelvic floor is exposed to differing stresses and trauma depending on the mode of birth. At the same time, the pelvic floor plays a crucial role in female sexual functioning (FSF). Whereby FSF encompasses different dimensions, from subjective satisfaction to physiological aspects, such as lack of pain and orgasm ability. The aim of the study presented here is to assess FSF in relationship to postpartum pelvic floor disorder based on the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), in a large convenience sample and to identify whether there is an association between mode of birth as well as perineal injuries and FSF of women up to 24 months postpartum. We conducted a cross-sectional online survey and recruited via social media women up to 24 months after birth of their last child. FSF was surveyed using the PISQ-IR. Details were also collected on all previous births and birth-related perineal trauma, as well as current breastfeeding, obesity, and socio-demographics. Multivariate models were then calculated to determine a possible association between FSF and birth mode. The data basis is the responses of 2106 survey participants within the first 24 months postpartum. Even 12-24 months postpartum, 21% of respondents are not sexually active, which burdens almost 44% of these women. With regard to mode of delivery, differences in FSF are only evident in individual dimensions of the PISQ-IR. The dimensions "Condition Impact" and "Condition Specific" were significantly associated with more impairments in sexually active respondents up to 12 months postpartum whose last mode of delivery was forceps or vacuum extraction. If a perineal tear had occurred during last birth, this was significantly associated with a lower PISQ-IR subscore in the "Condition Impact," "Condition-Specific," "Global Quality," "Partner-Related," and "Arousal" models. The low variance explanation shows that further relevant factors on female sexuality may exist. The issue of impairments in FSF following childbirth, persisting for an extended period of time, is a significant postpartum concern. Due to the very different dimensions of FSF, the influence of the mode of delivery must be considered in a differentiated way.

Association of food insecurity with the use of tobacco products and urine cotinine-measured smoking intensity: evidence from a population-based study in South Korea, 2019–2021

IntroductionThis study explored the association between food insecurity and tobacco product use and urine cotinine-measured smoking intensity.MethodsThis cross-sectional study included 13 705 adults representative of the Korean population. The 18-item...

Studying Chinese immigrants’ spatial distribution in the Raleigh–Durham area by linking survey and commercial data using romanized names

Abstract Many population surveys do not provide information on respondents’ residential addresses, instead offering coarse geographies like zip code or higher aggregations. However, fine resolution geography can be beneficial for characterizing neighbourhoods, especially for relatively rare populations such as immigrants. One way to obtain such information is to link survey records to records in auxiliary databases that include residential addresses by matching on variables common to both files. We present an approach based on probabilistic record linkage that enables matching survey participants in the Chinese Immigrants in Raleigh–Durham Study to records from InfoUSA, an information provider of residential records. The two files use different Chinese name romanization practices, which we address through a novel and generalizable strategy for constructing records’ pairwise comparison vectors for romanized names. Using a fully Bayesian record linkage model, we characterize the geospatial distribution of Chinese immigrants in the Raleigh–Durham area of North Carolina.

Early adoption of triamcinolone acetonide suprachoroidal injection for uveitic macular edema: a physician survey

ObjectiveTo obtain physicians’ “real-world” perspectives on early experiences with triamcinolone acetonide suprachoroidal injection (SCS-TA) for treatment of patients with uveitic macular edema (UME).ResultsTwelve retina/uveitis specialists in the United States were surveyed about SCS-TA injection procedure and patient outcomes. Survey participants administered ≥ 291 SCS-TA injections to 243 patients with UME with various disease characteristics (etiologies, chronicity, and anatomical subtypes). Commonly reported reasons for SCS-TA adoption included potential for lowering the risk of steroid-associated intraocular pressure elevations versus intravitreal injections or implants (100%), potential for longer duration of action versus intravitreal steroid injections or implants (92%), and desire to use a new delivery modality (83%). Nearly all participants (92%) found injection procedure relatively easy post-training, with most (75%) procedurally comfortable after completing 2–5 injections. 58% of participants indicated that their patients gained 2–3 lines of vision by first follow-up visit, and 92% reported having patients who experienced 100–150 μm or greater reduction in central subfield thickness. Overall, 92% of participants were satisfied with SCS-TA treatment outcomes. Findings from this survey of early adopters of SCS-TA indicate that the suprachoroidal injection technique was easy to learn and resulted in favorable patient outcomes consistent with clinical trial data.

Process evaluation findings from Strong Hearts, Healthy Communities 2.0: a cardiovascular disease prevention intervention for rural women

BackgroundStrong Hearts, Healthy Communities 2.0 (SHHC-2.0) was a 24-week cardiovascular disease prevention program that was effective in improving physical activity and nutrition behaviors and clinical outcomes among women in 11 rural New York, USA towns. This study evaluated the delivery of SHHC-2.0 to prepare the intervention for further dissemination.MethodsThis process evaluation was guided by the Medical Research Council recommendations and engaged program leaders and participants (i.e., women over age 40) using quantitative and qualitative methods. The quantitative evaluation included examination of enrollment and retention data, a participant survey, and a fidelity checklist completed after classes. Descriptive and comparative statistics were used to assess implementation measures: program reach, participant attendance, dose delivered, program length, perceived effectiveness, fidelity, and participant satisfaction. The qualitative evaluation included focus groups (n = 13) and interviews (n = 4) using semi-structured guides; audio was recorded and transcripts were deductively coded and analyzed using directed content analysis and iterative categorization approaches. Comparisons across towns and between intervention and waitlist control groups were explored.ResultsAverage reach within towns was 7.5% of the eligible population (range 0.7-15.7%). Average attendance was 59.8% of sessions (range 42.0-77.4%). Average dose delivered by leaders was 86.4% of curriculum components (range 73.5-95.2%). Average session length was 51.8 ± 4.8 min across 48 sessions. Leaders’ perceived effectiveness rating averaged 4.1 ± 0.3 out of 5. Fidelity to curricular components was 81.8% (range 67.4-93.2%). Participants reported being “more than satisfied” with the overall program (88.8%) and the health benefits they obtained (72.9%). Qualitative analysis revealed that participants: (1) gained new knowledge and enjoyable experiences; (2) perceived improvements in their physical activity, nutrition, and/or health; (3) continued to face some barriers to physical activity and healthy eating, with those relating to social support being reduced; and (4) rated leaders and the group structure highly, with mixed opinions on the research elements.ConclusionsSHHC-2.0 had broad reach, was largely delivered as intended, and participants expressed high levels of satisfaction with the program and its health benefits. Our findings expand on best practices for implementing cardiovascular disease prevention programs in rural communities.Clinical trials Registrationwww.clinicaltrials.gov #NCT03059472.

Salary Benchmarking for Voice-Specialized Speech-Language Pathologists

Purpose: This study aimed to understand how salaries of voice and upper airway–specialized speech-language pathologists (SLPs) differ from medical SLPs based on prevailing wage data and to give clinicians resources to better negotiate their salary and benefits. Method: A nationwide survey of voice-specialized SLPs was disseminated via various online platforms including American Speech-Language-Hearing Association Special Interest Group 3, Instagram, voice-specialized Facebook groups, and e-mail. Data were collected via REDCap. The survey investigates SLPs' salary, benefits, experience, clinical responsibilities, and profit generated through Current Procedural Terminology codes. Two separate analyses were completed. First, annual salary, as reported by participants, was compared against annual salary, as estimated by prevailing wage data. Second, a multiple regression driver analysis was completed to identify significant predictors of wage level within our sample. Outliers in the sample were removed using the Difference in Fits procedure. Results: A total of 111 participant surveys were included for analysis. Our data demonstrate that, between participant data and prevailing wage data, salaries for voice and upper airway disorders (VUAD) SLPs are significantly higher in the West, Midwest, and Southern regions. There is no significant difference in the Northeast. Several factors proved statistically significant predictors of increased salaries including years of work ( p ≤ .0001), cost of living ( p = .0030), and work in multidisciplinary setting ( p = .0223). Conclusions: As practitioners navigate negotiations for equitable compensation, leveraging localized salary data and emphasizing the value of specialized expertise may prove instrumental. Moreover, advocating for employer-sponsored professional development opportunities and benefits can enhance the overall well-being and professional satisfaction of VUAD SLPs, ensuring optimal delivery of care within this specialized field.

Анкетирование как один из методов оценки качества образовательной деятельности в медицинском учреждении.

The article deals with the issues of training highly qualified specialists (residents) at the Federal State Budgetary Scientific Institution “Central TB Research Institute” (FSBI CTRI). Major changes in the society and development of information technologies require improvement of methods used for education and training of highly qualified specialists and set up new requirements for managing the training process, namely: the use of digital technologies, including distance learning, development of new interactive teaching methods and practicing individualized approach to training. FSBI CTRI trains specialists in the field of phthisiology, pulmonology and surgery using its clinical and laboratory facilities. Through its self-assessment procedure that is part of the accreditation monitoring of educational activities, FSBI CTRI engages the main players of the educational process into the survey aimed at improving training of highly qualified specialists. The authors of the article analyze the results of the questionnaire survey from the CTRI teachers. The data obtained during the survey helped assess the degree of satisfaction with the CTRI system of education among the survey participants, identify the main challenges of educational activities and find solutions.

Clinical implementation of advanced respiratory monitoring with esophageal pressure and electrical impedance tomography: results from an international survey and focus group discussion

BackgroundPopularity of electrical impedance tomography (EIT) and esophageal pressure (Pes) monitoring in the ICU is increasing, but there is uncertainty regarding their bedside use within a personalized ventilation strategy. We aimed to gather insights about the current experiences and perceived role of these physiological monitoring techniques, and to identify barriers and facilitators/solutions for EIT and Pes implementation.MethodsQualitative study involving (1) a survey targeted at ICU clinicians with interest in advanced respiratory monitoring and (2) an expert focus group discussion. The survey was shared via international networks and personal communication. An in-person discussion session on barriers, facilitators/solutions for EIT implementation was organized with an international panel of EIT experts as part of a multi-day EIT meeting. Pes was not discussed in-person, but we found the focus group results relevant to Pes as well. This was confirmed by the survey results and four additional Pes experts that were consulted.ResultsWe received 138 survey responses, and 26 experts participated in the in-person discussion. Survey participants had diverse background [physicians (54%), respiratory therapists (19%), clinical researchers (15%), and nurses (6%)] with mostly > 10 year ICU experience. 84% of Pes users and 74% of EIT users rated themselves as competent to expert users. Techniques are currently primarily used during controlled ventilation for individualization of PEEP (EIT and Pes), and for monitoring lung mechanics and lung stress (Pes). EIT and Pes are considered relevant techniques to guide ventilation management and is helpful for educating clinicians; however, 57% of EIT users and 37% of Pes users agreed that further validation is needed. Lack of equipment/materials, evidence-based guidelines, clinical protocols, and/or the time-consuming nature of the measurements are main reasons hampering Pes and EIT application. Identified facilitators/solutions to improve implementation include international guidelines and collaborations between clinicians/researcher and manufacturers, structured courses for training and use, easy and user-friendly devices and standardized analysis pipelines.ConclusionsThis study revealed insights on the role and implementation of advanced respiratory monitoring with EIT and Pes. The identified barriers, facilitators and strategies can serve as input for further discussions to promote the development of EIT-guided or Pes-guided personalized ventilation strategies.

What Motivates Students to Study Intermediate and Advanced Level Japanese at Australian Universities?

ABSTRACT This article discusses the results of a survey (N = 148) distributed in August 2021 to Australia-based Universities offering Intermediate and Advanced level Japanese. The survey was designed to understand what motivates students to continue their Japanese language studies to the upper levels and the impact of the COVID-19 associated switch to online learning on their motivation. The content of 23 online interviews is also addressed. The discussion includes details of the metadata which shows that most survey participants are domestic students and more than half speak a language in addition to English. Dörnyei’s L2 Motivational Self System (L2MSS) framework was used to analyse the motivational data and the results show that most students are self-motivated and committed to their Japanese language studies. They derive motivation from various sources, such as their positive learning experience, ‘Ideal Japanese self-image’, and interest in Japanese culture including J-Pop products. Less than half of participants perceived the COVID-19 associated switch to online to have affected their motivation and this includes two who experienced increased motivation. The findings show that Intermediate and Advanced level students have a strong sense of a future self who will use the language in their careers, for leisure, and with others.

Societal Discrimination, Vigilance, and Patient-Provider Relationships Among Perinatal Women: A Mixed Methods Study.

In the United States, maternal mortality is high and patterned by race and socioeconomic status (SES). Patient-provider relationships and societal discrimination have been separately associated with poor maternal outcomes, but it is not clear how such mechanisms may be interrelated. Thus, the present study investigates how societal experiences of discrimination are associated with and manifest in patient-provider relationship quality among perinatal women. The study uses a mixed methods design with an explanatory-sequential approach. First, a path analysis using structural equation modeling of a cross-sectional representative survey of 244 perinatal women in Kalamazoo County, Michigan, was conducted. Second, a thematic qualitative analysis was conducted of focus groups composed of survey participants (n = 34). In the quantitative analyses, race and SES were associated with experiences of societal discrimination in the expected directions (race: b, 1.87; SE, 0.58; P =.001; SES: b, 2.18; SE, 0.60; P <.001), discrimination positively predicted vigilant behaviors (b, 0.81; SE, 0.15; P <.001), and more vigilant behaviors predicted worse patient-provider relationship quality (b, 0.18; SE, 0.07; P <.001). In the qualitative findings, we found detailed accounts linking provider discrimination, vigilance, and patient-provider relationships among focus groups composed of only women of color (n = 9). Overall, the quantitative analyses find support for the conceptual model showing race and SES are associated with societal discrimination, which is associated with vigilant behaviors and, in turn, quality of patient-provider relationships. The qualitative analyses provide preliminary evidence for how these pathways manifest in care settings and demonstrate the importance of establishing trust in patient-provider relationships, especially among women of color.

Digital Learning and Work Readiness among Marginalized Women

In the era of information communication and technology, all aspects of human life are influenced by ICT. In general, the aim of this research is to identify the readiness of marginalized youth in relation to the use of ICT (knowledge, attitudes, and preferences) in the workplace. The research was conducted in three marginalized communities in three provinces in Indonesia, namely 1) Kalibaru in North Jakarta, 2) Getasan in Semarang Regency, Central Java, and 3) Sekotong in West Lombok, West Nusa Tenggara. This research applies a quantitative approach by conducting a household survey and a youth survey, and a qualitative approach by conducting a series of focus group discussions. The household survey participants were 220 families, and in the youth survey, the participants were 220 youth aged 18-29 years. Questionnaires are used in household and youth surveys. For FGD, an FGD protocol was developed. The results of this research indicate that youth unemployment is considered an important policy in Indonesia. Certification for internships is important to recognize the qualifications and skills of the employees trained and mentored in the company. In addition, considering the limited number of job opportunities in the market, the intense competition, and the limited skills and education of marginalized young people, it seems important to encourage young people to become entrepreneurs. Data obtained from the field shows that only one-third of the participants in this study had attended vocational courses or training provided by any training provider. One of the reasons is that the distance between where they live and the training location is far, while transportation costs are not covered by the training provider. Apart from that, parents also forbid teenagers, especially girls, from going far outside the village to take part in job training. This study shows that young people understand the existence of differences in gender treatment in the workplace. The difference lies in the position of the worker, the regulations, and the salary/wages given to the worker.Men are expected to have higher positions, heavier work responsibilities, and higher salaries/wages than women. There are also gendered jobs, such as sewing and hairdressing for women, while technical jobs are reserved for men. The causes of this segregation are largely rooted in a patriarchal culture that places men as superior. This research shows that the participants have gadgets to communicate with each other. However, only a few of them use sophisticated gadgets to carry out online trading, which can be caused by a lack of knowledge and skills in digital trading and marketing, as well as online management and supply chains. This means that people have sophisticated gadgets just to communicate on social media and play games just to fill their time. They do not use it for economic activities.

Pain Management in Knee Osteoarthritis: Insights from an Exploratory Online Survey of Italian Patients and Physicians.

In Italy, knee osteoarthritis (KOA) accounts for over 5 million prevalent cases and requires long-term multidisciplinary management. The most frequent KOA symptom is pain. The aim of the survey is to provide a national overview of the current management of moderate-to-severe pain associated with KOA from both clinicians' and patients' perspectives. An exploratory qualitative survey was conducted in Italy between July and October 2023. The survey participants were members of four national scientific societies and two patient associations who were invited to participate via email and given an online questionnaire. Questions included a mix of single and multiple responses and scalar items. In total, 1473 clinicians and 150 patients with KOA completed the questionnaire. Patients rated knee pain as both the most burdensome symptom and the most frequent reason for treatment dissatisfaction and seeking consultation. One in two patients declared that they were unsatisfied/little satisfied with the current prescribed analgesic treatments. The clinicians surveyed preferentially prescribed intra-articular hyaluronic acid, oral non-steroidal anti-inflammatory drugs/paracetamol, non-pharmacological intervention, and intra-articular corticosteroids. The clinicians' selection of analgesic therapy often failed to adequately meet patients' expectations for pain relief. Our findings highlight the current unmet needs of patients with KOA in Italy and call for new approaches to effectively optimize the management of KOA-associated pain.

International survey of people living with chronic conditions (PaRIS survey): effects of general practitioner non-participation on the representativeness of the Norwegian patient data

BackgroundThe International Survey of People living with Chronic Conditions (OECD-PaRIS survey), aims to systematically gather patient-reported experiences (PREMs) and - outcomes (PROMs) and potential predictors for these outcomes for persons with chronic conditions as well as information from professionals about health care provided. In such patient surveys, the advantages of a multilevel (nested) approach in which patients are sampled ‘within providers’ need to be balanced against the potential for bias if patient populations from participating GPs significantly differ from those of non-participating GPs. The objective was to assess the effects of general practitioner (GP) non-participation on the representativeness of the Norwegian patient data of the International Survey of People living with Chronic Conditions (OECD-PaRIS survey).MethodsTo test all aspects of the first main PaRIS survey, it was preceded by a field trial which this paper reports on the Norwegian part of. For the Norwegian part of the field trial in 2022, we randomly sampled and surveyed 75 GPs and 125 patients 45 years and older for each GP, regardless of whether their GP were also participating in the study. GPs were sampled from a national register that included all GPs. The surveys were primarily digital, but we sent postal questionnaires to non-digital patients and non-responding digital patients. We compared GP and patient characteristics as well as patient-reported experiences and outcomes according to GP participation status in bivariate analysis, supplemented with multiple linear regressions with PREMs/PROMs as dependent variables and participation status as independent adjusting for significant patient factors.Results17 of 75 sampled GPs participated (22.7%), of which 993 of 2,015 patients responded (49.3%). 3,347 of 7,080 patients of non-responding GPs answered (47.3%). Persons with chronic conditions from participating GPs reported significantly better patient-centred coordinated care (p = 0.017), overall experiences with the GP office the last 12 months (p = 0.004), mental well-being (p = 0.039) and mental health (p = 0.013) than patients from non-participating GPs. The raw differences between participating and non-participating GPs on patient-reported experiences and – outcomes varied from 1.5 to 2.9 points on a 0-100 scale, and from 2.2 to 3.0 after adjustment for case-mix.ConclusionsThe Norwegian field trial indicates that estimates based on participants in the PaRIS survey may modestly overestimate patient-reported experiences and -outcomes at the aggregated level and the need for more research within and across countries to identify and address this potential bias.

Perceptions of surgery in Nicaragua: A cross-sectional survey study within the surgery for the people project.

Barriers to medical care include lack of proper infrastructure and equipment; however, cultural barriers to care and poorly perceived quality of care, especially surgical care, can also negatively impact a patient's utilization of healthcare services. This study used patient-survey data from three unique municipalities in Nicaragua to examine pre-hospital barriers to care, including previous experience with healthcare, and how those experiences impact patient perceptions of surgery and care-seeking behavior. Surveys were administered in Siuna, Rosita, and Bonanza, Nicaragua between July 2019 and September 2020. Survey participants were aged 18-years or older that live in communities served by the Ministry of Health. The surveys were open response and multiple-choice format. Surveys included questions about structural/cultural/financial barriers to care, communication barriers, and knowledge of healthcare services. Data was managed using REDCap tools and analysis was completed using R. Individuals that previously visited a health post were significantly more likely to have a positive perception of surgery compared to those who had not (OR = 1.4) (p = 0.019). This finding remained significant after adjustment for education, age, and municipality. However, previous hospital visits did not have a significant impact on perception of surgery. Individuals with higher transportation costs reported a negative perception of surgery (40.4%), as well as those who used private transportation (29.1%) (p<0.001). Participants that reported travel obstacles were 2.64 times as likely to have a positive perception of surgery (p<0.001), even when adjusted for all demographics except site. These findings suggest that individuals who previously interacted with only lower-level healthcare environments were significantly more likely to have a positive perception of surgery. Counterintuitive findings show that access to public transport, transportation costs >2USD, and cell-phone usage increased negative perception of surgery. This study demonstrates the complexity of variables that impact perceptions of healthcare services while highlighting areas of focus for future targeted investments.

The effect of results-based motivating system on metabolic risk factors of non-communicable diseases: A field trial study.

Non-communicable diseases can be controlled and managed by reducing their associated metabolic risk factors. In this study, a set of intervention packages were designed to reduce the prevalence of three common metabolic risk factors (hypertension, hyperlipidemia, and obesity and overweight) in the community by motivating non-physician health workers. A field trial study was conducted in 4 districts of Iran. Thirty-two community health centers were randomly selected. A survey of 30 to 70-year-old was conducted to measure baseline metabolic risk factors. The intervention packages focused on improving hypertension, hyperlipidemia, obesity and overweight. The interventions included goal-setting, evidence-based education, operational planning, and incentive payments for non-physician health workers. A second survey to measure the final metabolic risk factors was performed after one year. The difference-in-difference method was used to evaluate the effectiveness of the intervention packages. The average age of participants in both surveys was 49 years. The interventions had statistically significant effects only on decreasing the prevalence of overweight and obesity. The package with all the interventions except pay-for-performance decreased the odds of overweight and obesity to 0.57 (95% CI: 0.34, 0.95). Involving non-physician health workers and having action plans based on the health needs of the covered population can decrease obesity and overweight in the community. However, longer trials are needed to observe the effects on hypertension and hyperlipidemia.