Urban Primary Health Care Centre Research Articles

Validity and reliability of the Turkish version of the Hill–Bone compliance to high blood pressure therapy scale for use in primary health care settings

Objectives: To assess the validity and reliability of the Turkish version of the Hill–Bone compliance to high blood pressure therapy scale for use in primary care in Turkey. Methods: To develop a Turkish version of the scale, it was translated into Turkish then back-translated into English. The final version was used in a survey in two urban primary health care centers in Izmir, Turkey. For assessing the validity of Turkish scale, we performed factor analysis to test construct validity. Reliability was assessed by calculating the Cronbach's alpha as a measure of internal consistency. Results: Factor analysis revealed a three–factor structure representing unintentional medication non-adherence; intentional medication non-adherence; and salt intake adherence. Percentages of explained variance were 33.3%, 14.6% and 11.2% respectively. When forcing a two-factor structure we found salt intake and medication adherence clusters. Cronbach's alpha was 0.72 and 0.83 for medication adherence and whole scale, respectively.Conclusion: The Turkish Hill–Bone scale presented a factor structure consistent with the original scale, had a high level of internal consistency. It can be used for assessing hypertension patients’ compliance in Turkish primary care settings.

The influence of HIV/AIDS on the practice of primary care nurses in Jordan: Rhetoric and reality

The role of nurses in raising community awareness about HIV/AIDS is well-reported. However, little is known about the practice of Jordanian nurses and the role they play in the prevention and control of HIV/AIDS. This interpretive ethnographic study sought to illuminate the role of primary care nurses and examine the influence of HIV/AIDS on their practice. The study was undertaken in Jordan in three rural and three urban primary health-care centres. Data collection included participant observation, key informant interviews and document analysis. These data informed the development of descriptive ethnographic accounts that allowed for the subsequent identification of common and divergent themes reflective of factors recognized as influencing the practice of the nurse participants. The findings indicate that the rhetoric offered by all levels of administration and endorsed in policy is not reflective of the reality of practice. Poor resources and educational preparation, a limited nursing skill mix and access to professional development, lack of nursing leadership and role models, cultural beliefs and geographic isolation are factors that reduced the capacity of the primary care nurses to raise awareness and, therefore, influence the prevention and control of HIV/AIDS.

Jordan’s vulnerability: A population at risk of HIV/AIDS

This paper describes the findings of an ethnographic study that sought to explore the influence of HIV/AIDS on the practice of primary care nurses in Jordan. The study was undertaken in three (3) rural and three (3) urban comprehensive primary health care centres. Data collection included participant observation, key informant interviews, field notation and document analysis. These data informed the development of descriptive ethnographic accounts that allowed for the subsequent identification of common and divergent themes reflective of factors recognized as influencing the practice of nurses.The findings indicate that the ability of the nurses to raise awareness and therefore reduce the spread of HIV/AIDS is unrealistic. Data shows that the population is at risk because the nurses’ knowledge and skill base is inadequate and the health care facilities are crippled by limited human and physical resources. Poor management and the lack of localised leadership are also factors identified as contributing to the vulnerability of Jordanians.Enhanced commitment from the Ministry of Health and the senior nursing administration in Jordan is required if the comprehensive primary health care centres are to meet expectations and improve health outcomes of the population. Funding must be directed to improve the infrastructure of the comprehensive primary health care centres and adequate concurrent funds provided for the purchase of non-capital items. It is crucial that support be made available to up-skill the nursing staff and superior recruitment and retention initiatives implemented to address the current nursing shortages.

Finnish women's experiences of antenatal care

Objective: to explore and describe women's experiences of antenatal care.Design: semi-structured interviews, dialogical interviews and non-participant observation in two phases both during and after pregnancy were analysed according to Colaizzi's phenomenological method.Setting: four maternity clinics in one rural and one urban primary health care centre and one outpatient maternity clinic at a central hospital in Finland.Participants: in the first phase a purposive sample of nine women were interviewed at 36 weeks gestation, three weeks, three months and two and a half years after birth. In the second phase, data were collected for further breadth and depth and 31 women, who were going through different stages of pregnancy, delivery and the puerperium participated. Data were collected by means of interviews supplemented by non-participatory observation. In the total sample of 40 Finnish women, one half was primigravidae and the other half multigravidae.Findings: a main thread running through the women's experiences of antenatal care were their needs and wishes that concerned the health of the unborn baby, but also the health and dignity of themselves and their family. The pregnant women wanted to share their pregnancy and childbirth story in a confident relationship based on humaneness and interest in a peaceful atmosphere. They needed protection safeguarded through scientifically based and humane surveillance, and professional competence was expected. They wanted to continuously participate in the new situations through knowledge in dialogues and they wanted to involve their family in the care on their own terms. The childbirth preparation groups had an important multidimensional role in the care.Implications for practice: the findings challenge the antenatal care that so far has been focused on the physical health, the needs of the primigravida and a blurred family perspective. The family perspective implies knowing both the pregnant woman and her partner in terms of the pregnancy, the birth and a new parenthood. Humane, scientifically based perinatal care can be developed by innovations from these findings, especially considering the multidimensional role of the parent groups.

Impacto de la violencia doméstica sobre la salud reproductiva y neonatal

Domestic violence can have an important influence on mother and child health. To assess the consequences of remote and actual, emotional or physical, domestic violence on the reproductive and newborn health in pregnant women. A longitudinal epidemiological observation from an Urban Primary Health Care Center from Valdivia, Chile, in 1998. Two cohorts were studied: Pregnant women that experienced domestic violence (index group) and pregnant women not exposed to domestic violence (control group). Women were followed during pregnancy and at labor. The newborn was also assessed. The index group had a higher relative risk (RR) for impending abortion (RR 1.44, 95% confidence interval (CI): 1.07-1.93), hypertensive syndrome of pregnancy (RR 1.5, 95% CI: 1.18-1.96), intrahepatic cholestasis (RR 1.5, 95% CI: 1.1-1.94). Women that experienced violence during pregnancy had a higher risk of urinary tract infection (RR 2.88, 95% CI: 1.28-6.43), intrauterine growth retardation (RR 3.7, 95% CI: 1.77-7.93) and intrahepatic cholestasis. Newborns from the index group had lower weight, size and gestational age. Domestic violence is associated with hypertension during pregnancy and intrauterine growth retardation. The incorporation of bio-psychological evaluation and monitoring systems could attenuate the consequences of domestic violence.

Primary health care patients’ knowledge about diabetes in the United Arab Emirates

This study defined the baseline level of knowledge about diabetes and the perceived effectiveness of sources of diabetes information in an urban primary health care centre in Al-Ain. A validated questionnaire was administered to 300 randomly chosen adult patients with diabetes. Patient knowledge about diabetes was directly related to their level of general education. Written and electronic media, and contact with a nurse or doctor were effective sources of education on diabetes while "conversation with significant others", dietician or pharmacist were not effective. Nurse- or doctor-centred education appears to be an effective choice for future programmes to provide information to patients with diabetes.

HIV Prevention in Single, Urban Women: Condom-Use Readiness

To understand women's readiness to use condoms and their perceived pros and cons for condom use. Comparative, descriptive design guided by the Transtheoretical Model. Data were collected at two urban primary health care centers in western New York. 364 single urban women with steady (main) or other (casual, concurrent, multiple, new) sexual partners. Most participants were young (mean age of 27 years), economically disadvantaged women of color. Each participant completed an anonymous questionnaire that included items for the stage of change algorithm, decisional balance of the pros and cons of condom use, sexual history, and HIV risk information. Most women were in the early stages of change (not intending to use condoms), but those with other partners were further along in the stages of change for condom use than those with steady partners. The pros or advantages of condom use differed for these women depending on partner type. The change in the balance between the pros and cons occurred as theoretically predicted for women with steady and other partners. Effectiveness of HIV prevention interventions for women may be enhanced if they are tailored to both readiness to change and partner type.

The meanings of pain: an exploration of women's descriptions of symptoms

A grounded theory study with repeated semi-structured interviews was conducted to explore the meaning of the illness experiences of women patients, impaired by biomedically undefined musculoskeletal pain. Twenty female patients were recruited at an urban primary health care centre in northern Sweden, where two of the researchers work as family physicians. In this paper we focus on considerations of patient pain and analyze the findings from aspects linking together body, gender, and society. Four categories of symptom description were identified: bodily presentations, explanatory models, consequences of pain for the patient's activities, and consequences for her self-perception. The bodily symptoms signaled loss of control. The explanatory models consisted of physical damage and strain injuries, but were also psychological and self-blaming. The consequences of pain were described as negative consequences for the women's everyday life that challenged their self-perception as women. The participants' search and need for legitimization of their illness experiences, and the expectations placed on doctors as legitimizing agents was evident. To achieve the desired shared understanding in consultations, doctors must be aware of and consider not only physical signs and symptoms, but also the patients' gendered concerns and psycho-social circumstances.

An Urban Nurse-Managed Primary Health Care Center: Health Promotion in Action

An Urban Nurse-Managed Primary Health Care Center: Health Promotion in Action

“How could I even think of a job?” - Ambiguities in working life in a group of female patients with undefined musculoskeletal pain

Objective - To explore the meaning of working life for a group of women sick-listed because of undefined, musculoskeletal pain disorders.Design - Repeated thematic interviews, analysed qualitatively according to grounded theory.Setting and participants - Twenty female patients, impaired by biomedically undefined pain and musculoskeletal disorders, were successively recruited at an urban primary health care centre in northern Sweden.Main findings - There were discrepancies between work aspirations and work experiences concerning economic maintenance, social interaction, and personal recognition. The women had low-income jobs in fields threatened by redundancy, such as cleaning, care, and service. Family considerations had a strong impact on organization and priorities in paid work. In a situation of pain and sick leave, family orientation strengthened and work aspirations declined. Social and personal recognition was sought in the unpaid duties at home, and economic refuge in ‘the state as supporter’.Implications - To understand women with undefined musculoskeletal pain as patients, we must also understand their aspirations and experiences as workers, mothers, and spouses. ‘Family considerations’, ‘diminishing paid work’, and ‘the state as supporter’ are important concepts for understanding the women's sick role process.

Urinary albumin excretion rate and its determinants after 6 years in non-insulin-dependent diabetic patients

The present study was undertaken to clarify the progression of urinary albumin excretion rate (UAER) in non-insulin-dependent diabetic (NIDD) patients 6 years after diagnosis, and to elucidate the risk factors of nephropathy. This is a population-based controlled (baseline) cohort study. The prospective evaluation utilized the diabetic patients as internal controls. The setting was an urban primary health care centre. Main outcome measures were the UAER-24 h and fractional urinary albumin excretion rate (FAC) and their relation to mean blood pressure, haemoglobin Alc, fasting serum insulin and cholesterol and renal size. UAER (mg/24 h) was increased (geometric mean, quartile 1 and 3) in the diabetic patients at baseline, compared to the non-diabetic control subjects; 21 (10 and 33) versus 12 (8 and 15), P = 0.0001 (Wilcoxon's rank test). The UAER-24 h was not increased in diabetic subjects at follow-up; 24 (7 and 49) P = 0.3791 versus diabetic subjects at baseline. Eighteen per cent of normoalbuminuric (UAER < 30mg/24 h) patients developed microalbuminuria (UAER = 30-300 mg/24 h) and 3% clinical nephropathy (UAER > 300 mg/24 h). Of the microalbuminuric subjects 19% progressed to clinical nephropathy, 46% remained microalbuminuric and 35% remitted to normoalbuminuria. Serum insulin concentration, after assessment of confounding factors, measured at the baseline predicted the UAER for all diabetic subjects at follow-up in multiple linear regression analysis in an independent and significant way (P = 0.01). Serum insulin concentration (P = 0.034) and diuretic therapy (P = 0.050) at baseline independently predicted the outcome of the categorical variable progressor/nonprogressor (n = 22/86) based on the UAER-24 h at baseline and at follow-up. Progression of the UAER during the first 6 years is found among approximately every fifth NIDD subject who develops either microalbuminuria (from normoalbuminuria) or clinical nephropathy (from microalbuminuria). The role of serum insulin (insulin resistance) or some factor associated with it, is suggestive in the genesis of kidney disease.

Talking at work--professional advice-seeking at primary health care centres.

To describe professional advice- and information-seeking at primary health care (PHC) centres. Prospective cross-sectional data collection using semi-structured interviews. Statistical analysis of association between team-based and centralized organization, profession and pattern of advice-seeking. 4 urban PHC centres in Ostergötland County, Sweden. 199 PHC centre staff members (25 doctors, 70 nurses, 49 nurses' aides, 12 medical laboratory technologists, 24 secretaries, 19 physiotherapists). Nine (4%) staff members did not participate in the study (4 doctors, 3 nurses, 1 nurses' aide, and 1 secretary). Number of staff using an advice source. For organizational advice, PHC centre managers were consulted at the centrally organized PHC centres, while staff at centres using team organization more often consulted outside sources. Having no one to ask for advice on patient communication was more common in the centralized organization. Regarding medical advice, only nurses' aides differed by consulting their own profession rather than doctors. For patient communication problems, the professions shared an intra-professional advice pattern. The PHC centre staff maintain parallel overlapping networks of professional advice-seeking. The observed networks can also be seen to answer simultaneous demands from patients, the local health care administration, social services and professional authorities. Straightforward ways to develop the professional communication at PHC centres would be to visualize these multiple dependencies and to support their optimal function in the organization.

Somatization and the recognition of depression and anxiety in primary care.

The authors examined the effect of patients' style of clinical presentation on primary care physicians' recognition of depression and anxiety. The subjects were 685 patients attending family medicine clinics on self-initiated visits. They completed structured interviews assessing presenting complaints, self-report measures of symptoms and hypochondriacal worry, the Diagnostic Interview Schedule (DIS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Physician recognition was determined by notation of any psychiatric condition in the medical chart over the ensuing 12 months. The authors identified three progressively more persistent forms of somatic presentations, labeled "initial," "facultative," and "true" somatization. Of 215 patients with CES-D scores of 16 or higher, 80% made somatized presentations; of 75 patients with DIS-diagnosed major depression or anxiety disorder, 76% made somatic presentations. Among patients with DIS major depression or anxiety disorder, somatization reduced physician recognition from 77%, for psychosocial presenters, to 22%, for true somatizers. The same pattern was found for patients with high CES-D scores. In logistic regression models education, seriousness of concurrent medical illness, hypochondriacal worry, and number of lifetime medically unexplained symptoms each increased the likelihood of recognition, while somatized presentations decreased the rate of recognition. While physician recognition of psychiatric distress in primary care varied widely with different criteria for recognition, the same pattern of reduction of recognition with increasing level of somatization was found for all criteria. In contrast, hypochondriacal worry and medically unexplained somatic symptoms increased the rate of recognition.