254-WOMEN'S HELP-SEEKING BEHAVIOUR IN PRIMARY CARE: PHASE 1 OF A MIXED METHODS STUDY

Early identification of patients with serious infections is a clinical challenge for both medical helplines and emergency departments (ED). Serious infections might be difficult to identify as some patients present unspecific symptoms and a normal body temperature. It is therefore important to describe characteristics and help-seeking behaviour (HSB) with the aim to identify infections earlier. The study population was part of a data collection carried out between 24.01-09.02 2017, at the Emergency Medical Services Copenhagen (Medical Helpline 1813). Among 11,340 patients in contact with the Medical Helpline, we identified adult patients seen in the EDs with a diagnosis of infection (ICD-10 classification). Quantitative and qualitative (recorded voicelogs) data were extracted and a mixed methods study (convergent design) was performed. Descriptive statistics and logistic regression was used for the quantitative data strand. Thematic analysis was used for the qualitative data strand. Both data strands were integrated to describe the characteristics of the HSB of patients with infections. In total 3,614 adult patients were triaged to an ED, and 753 (20.8%) were diagnosed with infection of which 83 (11%) were hospitalized. ED patients with infection were younger (Median: 42 vs 47 years, p=<0.001), more often without comorbidity (68.5% vs 74.5%, p=0.006) and more often females (64.1% vs 53.2%, p=<0.001) compared to ED patients without infection. Hospitalized patients with infection were older (71 vs 40 years, p=<0.001), and had more comorbidity (60.2% vs 39.8%, p=<0.001) than those with infection who were not hospitalized. Fever was presented by 18 out of 32 hospitalized patients (56.3%) in the voicelogs. Some described that fever appeared with breathing difficulties, cough, and general weakness. Several patients had tried to self-manage their infection, but most calls (71.2%) were made by a close relative who was concerned. This illustrates that patients did not seek health professional help before their relatives were sufficiently concerned. Hospitalized patients with infections were older and had more comorbidity compared to the non-hospitalized patients with infections. Among hospitalized patients with infections, fever was frequently presented in 1813-calls. Characteristic like self-management and concerned relatives are important to understand the HSB of hospitalized patients with infections.

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Sexual health issues postpartum: A mixed methods study of women's help-seeking behaviour after the birth of their first baby

Midwifery ◽

10.1016/j.midw.2021.103196 ◽

2021 ◽

pp. 103196

Author(s):

Deirdre O'Malley ◽

Valerie Smith ◽

Agnes Higgins

Keyword(s):

Mixed Methods ◽

Sexual Health ◽

Help Seeking ◽

Mixed Methods Study ◽

Health Issues ◽

Help Seeking Behaviour

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An Exploratory Mixed Methods Study of Experiences of Interprofessional Teams Who Received Coaching to Simultaneously Redesign Primary Care Education and Clinical Practice

Journal of Primary Care & Community Health ◽

10.1177/21501327211023716 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110237

Author(s):

Patricia A. Carney ◽

W. Perry Dickinson ◽

Jay Fetter ◽

Eric J. Warm ◽

Brenda Zierler ◽

...

Keyword(s):

Primary Care ◽

Mixed Methods ◽

Mixed Methods Study ◽

Local Context ◽

Primary Care Residency ◽

Interprofessional Teams ◽

Coaching Relationship ◽

Team Coaching ◽

Primary Care Education ◽

Health Coaches

Introduction/Objectives: Coaching is emerging as a form of facilitation in health professions education. Most studies focus on one-on-one coaching rather than team coaching. We assessed the experiences of interprofessional teams coached to simultaneously improve primary care residency training and interprofessional practice. Methods: This three-year exploratory mixed methods study included transformational assistance from 9 interprofessional coaches, one assigned to each of 9 interprofessional primary care teams that included family medicine, internal medicine, pediatrics, nursing, pharmacy and behavioral health. Coaches interacted with teams during 2 in-person training sessions, an in-person site visit, and then as requested by their teams. Surveys administered at 1 year and end study assessed the coaching relationship and process. Results: The majority of participants (82% at end of Year 1 and 76.6% at end study) agreed or strongly agreed that their coach developed a positive working relationship with their team. Participants indicated coaches helped them: (1) develop as teams, (2) stay on task, and (3) respond to local context issues, with between 54.3% and 69.2% agreeing or strongly agreeing that their coaches were helpful in these areas. Cronbach’s alpha for the 15 coaching survey items was 0.965. Challenges included aligning the coach’s expertise with the team’s needs. Conclusions: While team coaching was well received by interprofessional teams of primary care professionals undertaking educational and clinical redesign, the 3 primary care disciplines have much to learn from each other regarding how to improve inter- and intra-professional collaborative practice among clinicians and staff as well as with interprofessional learners rotating through their outpatient clinics.

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Engaging primary care providers in managing pediatric eating disorders: a mixed methods study

Journal of Eating Disorders ◽

10.1186/s40337-020-00363-8 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Jocelyn Lebow ◽

Cassandra Narr ◽

Angela Mattke ◽

Janna R. Gewirtz O’Brien ◽

Marcie Billings ◽

...

Keyword(s):

Primary Care ◽

Eating Disorders ◽

Mixed Methods ◽

Care Setting ◽

Primary Care Setting ◽

Primary Care Providers ◽

Mixed Methods Study ◽

Evidence Based ◽

Care Providers ◽

Evidence Based Treatment

Abstract Background The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers’ perspective of challenges to identifying and managing eating disorders in the primary care setting. Methods This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. Results Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. Conclusions Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.

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Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review

BMJ Global Health ◽

10.1136/bmjgh-2020-004213 ◽

2021 ◽

Vol 6 (2) ◽

pp. e004213

Author(s):

Grace McCutchan ◽

Bahr Weiss ◽

Harriet Quinn-Scoggins ◽

Anh Dao ◽

Tom Downs ◽

...

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Cancer Treatment ◽

Help Seeking ◽

Middle Income ◽

Cancer Symptoms ◽

Middle Income Countries ◽

Help Seeking Behaviour ◽

Psychosocial Influences

IntroductionStarting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment.MethodsMixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate.ResultsOf 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments.ConclusionDue to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.

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