scholarly journals What determines immigrant caregivers’ adherence to health recommendations from child primary care services? A grounded theory approach

2019 ◽  
Vol 20 ◽  
Author(s):  
Susana Mourão ◽  
Sónia F. Bernardes
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Grounded Theory ◽  
Primary Health Care ◽  
Health Care Professionals ◽  
Child Protection ◽  
Children's Health ◽  
Children’S Health ◽  
Theory Approach ◽  
Primary Health

AbstractAimTo investigate the diversity and specificity of the determinants of immigrant caregivers’ adherence to child primary care (CPC) health recommendations.BackgroundImmigrant caregiver’s adherence to CPC health recommendations is of utmost importance to minimize their children’s health-related vulnerabilities. Some research has been conducted on the determinants of immigrants’ access to health services, but much less is known about the determinants of their adherence to health professionals’ recommendations once they get there, especially in a primary health care context. This study contributes to bridge these gaps.MethodsInterviews and focus groups were conducted, with immigrant and non-immigrant caregivers living in Portugal (n=35), from heterogeneous socioeconomic backgrounds. Focus group and individual interview scripts were developed to explore caregivers’ understanding and use of CPC services and, particularly, their adherence to CPC recommendations. A socio-demographic questionnaire was also administered. Qualitative data were analyzed using a grounded theory methodology.Findings‘Adherence to CPC health recommendations’ is a core and multidimensional concept. Several determinants were identified at individual, interpersonal, organizational and structural levels. Some determinants were highlighted both by immigrant and non-immigrant caregivers: valuing children’s health, usefulness of recommendations, perceived health-care professionals’ competence, central role of vaccination in CPC and caregivers’ socio-economic conditions. Other determinants were specifically mentioned by immigrant caregivers: expectations about traditional versus pharmacological treatments, cultural mismatches in children’s care practices, perceived quality of Portuguese CPC services versus CPC from countries of origin. These results provide innovative theoretical and empirical contributions to the field of primary health care and, particularly, to immigrant caregivers’ adherence behaviors. Implications for research on treatment adherence in primary care contexts, the development of interventions that promote caregivers’ adherence to CPC health recommendations and for child protection will be discussed.

scholarly journals Why do they do it? A grounded theory study of the use of low-value care among primary health care physicians

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Sara Ingvarsson ◽  
Hanna Augustsson ◽  
Henna Hasson ◽  
Per Nilsen ◽  
Ulrica von Thiele Schwarz ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Grounded Theory ◽  
Primary Health Care ◽  
Health Care System ◽  
Theory Approach ◽  
Use Of Resources ◽  
Primary Health ◽  
Perceived Pressure ◽  
Care System

Abstract Background The use of low-value care (LVC) is widespread and has an impact on both the use of resources and the quality of care. However, few studies have thus far studied the factors influencing the use of LVC from the perspective of the practitioners themselves. The aim of this study is to understand why physicians within primary care use LVC. Methods Six primary health care centers in the Stockholm Region were purposively selected. Focus group discussions were conducted with physicians (n = 31) working in the centers. The discussions were coded inductively using a grounded theory approach. Results Three main reasons for performing LVC were identified. Uncertainty and disagreement about what not to do was related to being unaware of the LVC status of a practice, guidelines perceived as conflicting, guidelines perceived to be irrelevant for the target patient population, or a lack of trust in the guidelines. Perceived pressure from others concerned patient pressure, pressure from other physicians, or pressure from the health care system. A desire to do something for the patients was associated with the fact that the visit in itself prompts action, symptoms to relieve, or that patients' emotions need to be reassured. The three reasons are interdependent. Uncertainty and disagreement about what not to do have made it more difficult to handle the pressure from others and to refrain from doing something for the patients. The pressure from others and the desire to do something for the patients enhanced the uncertainty and disagreement about what not to do. Furthermore, the pressure from others influenced the desire to do something for the patients. Conclusions Three reasons work together to explain primary care physicians’ use of LVC: uncertainty and disagreement about what not to do, perceived pressure from others, and the desire to do something for the patients. The reasons may, in turn, be influenced by the health care system, but the decision nevertheless seemed to be up to the individual physician. The findings suggest that the de-implementation of LVC needs to address the three reasons from a systems perspective.

scholarly journals Why Do They Do It? A Grounded Theory Study of the Use of Low-value Care Among Primary Health Care Physicians

2020 ◽  
Author(s):  
Sara Ingvarsson ◽  
Hanna Augustsson ◽  
Henna Hasson ◽  
Per Nilsen ◽  
Ulrica von Thiele Schwarz ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Grounded Theory ◽  
Primary Health Care ◽  
Health Care System ◽  
Theory Approach ◽  
Use Of Resources ◽  
Primary Health ◽  
Perceived Pressure ◽  
Care System

Abstract Background The use of low-value care (LVC) is widespread and has an impact on both the use of resources and quality of care. However, few studies have thus far studied the factors influencing the use of LVC from the perspective of the practitioners themselves. The aim of this study is to understand why physicians within primary care use LVC. Methods Six primary health care centers in the Stockholm Region were purposively selected based on their level of prescription of three low-value lab tests (e.g., erythrocyte sedimentation rate, aspartate transaminase, vitamin D). FGDs were conducted with physicians (n = 31) working in the centers. The discussions were coded inductively using a grounded theory approach. Results Three main reasons for performing LVC were identified. Uncertainty and disagreement about what not to do was related to being unaware of the LVC status of a practice, guidelines perceived as conflicting, guidelines perceived to be irrelevant for the target patient population, or a lack of trust in the guidelines. Perceived pressure from others concerned patient pressure, pressure from other physicians, or pressure from the health care system. A desire to do something for the patients was associated with the fact that the visit in itself prompts action, symptoms to relieve, or emotions to calm. The three reasons are interdependent. Uncertainty and disagreement about what not to do have made it more difficult to handle the pressure from others and to refrain from doing something for the patients. The pressure from others and the desire to do something for the patients enhanced the uncertainty and disagreement about what not to do. Furthermore, the pressure from others influenced the desire to do something for the patients. Conclusions Three reasons work together to explain primary care physicians’ use of LVC: uncertainty and disagreement about what not to do, perceived pressure from others, and the desire to do something for the patients. The reasons may, in turn, be influenced by the health care system, but the decision nevertheless seemed to be up to the individual physician. The findings suggest that the de-implementation of LVC needs to address the three reasons from a systems perspective.

scholarly journals Why do they do it? A grounded theory study of the use of low-value care among primary health care physicians

2020 ◽  
Author(s):  
Sara Ingvarsson ◽  
Hanna Augustsson ◽  
Henna Hasson ◽  
Per Nilsen ◽  
Ulrica von Thiele Schwarz ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Grounded Theory ◽  
Primary Health Care ◽  
Health Care System ◽  
Theory Approach ◽  
Use Of Resources ◽  
Primary Health ◽  
Perceived Pressure ◽  
Care System

Abstract Background: The use of low-value care (LVC) is widespread and has an impact on both the use of resources and quality of care. However, few studies have thus far studied the factors influencing the use of LVC from the perspective of the practitioners themselves. The aim of this study is to understand why physicians within primary care use LVC. Methods: Six primary health care centers in the Stockholm Region were purposively selected. Focus group discussions were conducted with physicians (n = 31) working in the centers. The discussions were coded inductively using a grounded theory approach. Results: Three main reasons for performing LVC were identified. Uncertainty and disagreement about what not to do was related to being unaware of the LVC status of a practice, guidelines perceived as conflicting, guidelines perceived to be irrelevant for the target patient population, or a lack of trust in the guidelines. Perceived pressure from others concerned patient pressure, pressure from other physicians, or pressure from the health care system. A desire to do something for the patients was associated with the fact that the visit in itself prompts action, symptoms to relieve, or emotions to calm. The three reasons are interdependent. Uncertainty and disagreement about what not to do have made it more difficult to handle the pressure from others and to refrain from doing something for the patients. The pressure from others and the desire to do something for the patients enhanced the uncertainty and disagreement about what not to do. Furthermore, the pressure from others influenced the desire to do something for the patients. Conclusions: Three reasons work together to explain primary care physicians’ use of LVC: uncertainty and disagreement about what not to do, perceived pressure from others, and the desire to do something for the patients. The reasons may, in turn, be influenced by the health care system, but the decision nevertheless seemed to be up to the individual physician. The findings suggest that the de-implementation of LVC needs to address the three reasons from a systems perspective.

scholarly journals Reporting of noise-induced hearing loss: perceptions of primary health care professionals

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Gonçalves ◽  
H Pedroso ◽  
J Areosa
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Hearing Loss ◽  
Primary Health Care ◽  
Health Care Professionals ◽  
Health Concern ◽  
Noise Induced Hearing Loss ◽  
Care Network ◽  
Primary Health ◽  
Health Care Network

Abstract Background Worldwide, workers' health is still a Public Health concern, given the high number of hazardous occupational activities, as well as workers affected by work-related diseases. Among these diseases, occupational Noise-Induced Hearing Loss-NIHL is considered the second commonest occupational disease, and in Brazil, its reporting is compulsory. However, occupational diseases are usually underreported, hindering the knowledge of their actual magnitude, and the elaboration of prevention-oriented public policies. Objective To analyze the perception and knowledge of Primary Health Care professionals in Curitiba-Parana State, Brazil, on the compulsory NIHL reporting. Methods quantitative and qualitative approach conducted in three steps: analysis of a series of NIHL case histories reported in the official database between 2007 and 2018; application of a questionnaire to Primary Health Care Network professionals; collective interview with Primary Health Care Network nurses, speech therapists and doctors. Results NIHL reporting evidenced 82 cases, 67 (81.7%) among males, age ranging 50-64 years, 10 (12.2%) had complete high school level, 27 (32.9%) were formally employed, and 12 (14.6%) worked in the processing industry. Regarding the result of the applied questionnaire among the Primary Health Care professionals, 48 (68.7%) stated that they were prepared to identify workers' health problems, to 33 (68.7%) professionals, guidance to reassure users' comprehensive care is more important than the compulsory reporting, 21 (43.7%) claimed that they were qualified to identify NIHL cases, and 25 (52.1%) did not report the cases. Difficulties in reporting NIHL cases are: not understanding their flow, being afraid of the legal implications, which may generate difficulties in requesting audiometric testing, not having the management support, etc. Conclusions Most health care professionals are knowledgeable on NIHL, but they do not report the suspected cases due to lack of guidance. Key messages Primary care health professionals does not consider occupational health as part of the service to be provided. Primary care services are not prepared to establish the relationship between the injury and the job.

scholarly journals Patient Safety in Primary Health Care in a Brazilian municipality

2021 ◽  
Vol 31 (4) ◽  
Author(s):  
Marcelo Pereira da Rocha ◽  
Ingrid Soares Viana ◽  
Iago Freitas Vieira
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Patient Safety ◽  
Content Analysis ◽  
Primary Health Care ◽  
Health Care Professionals ◽  
Family Health ◽  
Qualitative Approach ◽  
Exploratory Research ◽  
Primary Health

Abstract The adoption of safe practices by health services drives out health harms and preventable deaths at all levels of health care. This study aimed to understand how patient safety actions are organized in the conception of primary health care professionals in a municipality in the state of Bahia. exploratory research, with a qualitative approach, was performed through in person and online interviews with two Nurses and three Dental Surgeons, with broad knowledge of the researched matter and working in traditional primary care and Family Health teams. Data were analyzed through content analysis. It was perceived that knowledge of the researched topic was insufficient and that there was a need for the matter to become part of the teams’ discussion agenda. The reports point out that, in the interviewees’ view, actions related to patient safety are not yet implemented in the researched location. It was identified the need for structuring actions aimed at preventing adverse events and institutionalizing safety in health care.

scholarly journals Atuação dos profissionais de educação física na atenção primária à saúde

2017 ◽  
Vol 15 (2) ◽  
pp. 105-113
Author(s):  
Joel Carlos Valcanaia Ferreira ◽  
Joel Saraiva Ferreira
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Physical Education ◽  
Health Care Professionals ◽  
Private Higher Education ◽  
Education Professionals ◽  
Department Of Health ◽  
Primary Health ◽  
Intervention Context

O objetivo do estudo foi analisar as características sociodemográficas e econômicas dos profissionais de Educação Física atuantes na Atenção Primária à Saúde no município de Campo Grande - MS. A distribuição dos profissionais na rede municipal de saúde foi fornecida pela Secretaria Municipal de Saúde. Para obter as informações junto aos profissionais, utilizou-se de questionário autoaplicável elaborado especificamente para o presente estudo. Os resultados indicaram que 61% dos profissionais de Educação Física com vínculo funcional com a Secretaria Municipal de Saúde Pública de Campo Grande - MS atuavam na Atenção Primária. Os profissionais são maioria do sexo masculino (54%), predominância de casados (82%), faixa etária de 30 a 39 anos (73%), renda mensal de até três salários mínimos (73%), formação em Educação Física (Licenciatura Plena) (54%), concluída há mais de 10 anos (82%), majoritariamente em instituições privadas de ensino superior (73%), concursados no serviço público (91%), com jornada de serviço semanal de 40 horas (91%), atuantes há mais de três anos da Atenção Primária à Saúde (82%). Concluiu-se que as características sociodemográficas e econômicas revelaram que os PEF detém estabilidade funcional, com experiência na área de atuação e formação condizente com o contexto de intervenção.ABSTRACT. The work of physical education professionals on primary health care. The goal of this study was to analyze the sociodemographic and economical characteristics of the physical education professionals working with Primary Health Care in the municipality of Campo Grande - MS. The data were initially collected with the management of municipal department of health, in order to identify the distribution of professionals in the municipal health network and, later, with the Primary Health Care professionals themselves. In order to obtain the information from the professionals, it was used a self-applicable questionnaire devised specifically for this study. The results showed that 61% of the physical education professionals functionally linked to the municipal department of public health of Campo Grande-MS worked with primary care, which represented a coverage of approximately 30% of supply of physical activities on that level of health care. The evaluated professionals presented a sociodemographic profile with a majority of males (54%), prevalently married (82%), in the age group between 30 and 39 years old (73%), with a monthly income of up to three minimum wages (73%), with a full licentiateship in Physical Education (54%), concluded over 10 years ago (82%), mostly in private higher education institutions (73%), with public service tender (91%), with a 40-hour workweek (91%), working with primary care for over three years (82%). It was concluded that the sociodemographic and economical characteristics showed that the Physical Education professionals have functional tenure, with experience in the area of work and training in line with the intervention context.

Multidisciplinary collaboration in primary care: through the eyes of patients

2013 ◽  
Vol 19 (3) ◽  
pp. 190 ◽  
Author(s):  
Lynn H. Cheong ◽  
Carol L. Armour ◽  
Sinthia Z. Bosnic-Anticevich
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Chronic Illness ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Primary Health Care System ◽  
Structured Interviews ◽  
Multidisciplinary Collaboration ◽  
Primary Health

Managing chronic illness is highly complex and the pathways to access health care for the patient are unpredictable and often unknown. While multidisciplinary care (MDC) arrangements are promoted in the Australian primary health care system, there is a paucity of research on multidisciplinary collaboration from patients’ perspectives. This exploratory study is the first to gain an understanding of the experiences, perceptions, attitudes and potential role of people with chronic illness (asthma) on the delivery of MDC in the Australian primary health care setting. In-depth semi-structured interviews were conducted with asthma patients from Sydney, Australia. Qualitative analysis of data indicates that patients are significant players in MDC and their perceptions of their chronic condition, perceived roles of health care professionals, and expectations of health care delivery, influence their participation and attitudes towards multidisciplinary services. Our research shows the challenges presented by patients in the delivery and establishment of multidisciplinary health care teams, and highlights the need to consider patients’ perspectives in the development of MDC models in primary care.

DIMENSIONAL VALIDITY OF THE INVENTORY OF ETHICAL PROBLEMS IN PRIMARY HEALTH CARE IN THE CONTEXT OF CHILDREN'S HEALTH

2021 ◽  
Vol 30 ◽  
Author(s):  
Deisy Vital dos Santos ◽  
Kátia Santana Freitas ◽  
Darci de Oliveira Santa Rosa ◽  
Elma Lourdes Campos Pavone Zoboli ◽  
Juliana de Oliveira Freitas Miranda
Keyword(s):  
Health Care ◽  
Factor Analysis ◽  
Primary Health Care ◽  
Internal Consistency ◽  
Children's Health ◽  
Children’S Health ◽  
Validity And Reliability ◽  
Ethical Problems ◽  
Cronbach's Alpha ◽  
Primary Health

ABSTRACT Objective: to assess the dimensional validity and reliability of the Inventory of Ethical Problems in Primary Health Care adapted to the children's health context. Method: a cross-sectional study with 101 nurses from the Family Health Strategy Units in a city of the Brazilian Northeast region. Data collection was carried out between May 2016 and June 2017. Construct validity was assessed by means of exploratory factor analysis and reliability by verifying internal consistency using Cronbach's alpha coefficient. Results: the factor analysis revealed the multidimensionality of the Inventory of Ethical Problems in Primary Health Care-Children's Health. It consisted of 19 items, distributed into 4 factors: Factor 1 - Organization of the health system; Factor 2 - Professional Ethics; Factor 3 - Teamwork; and Factor 4 - Parents (or guardians) autonomy expression. Overall internal consistency by Cronbach's alpha and for the factors was moderate to satisfactory. Conclusion: factor analysis revealed that the inventory has a multidimensional structure with 4 factors. The study showed evidence of validity and reliability that recommends the application of the IPE-APS to the context of children's health.

scholarly journals Lessons Learned From a Living Lab on the Broad Adoption of eHealth in Primary Health Care (Preprint)

2017 ◽  
Author(s):  
Ilse Catharina Sophia Swinkels ◽  
Martine Wilhelmina Johanna Huygens ◽  
Tim M Schoenmakers ◽  
Wendy Oude Nijeweme-D'Hollosy ◽  
Lex van Velsen ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Professionals ◽  
World View ◽  
Small Range ◽  
Policy Makers ◽  
Research Institutes ◽  
Primary Health ◽  
Living Lab

BACKGROUND Electronic health (eHealth) solutions are considered to relieve current and future pressure on the sustainability of primary health care systems. However, evidence of the effectiveness of eHealth in daily practice is missing. Furthermore, eHealth solutions are often not implemented structurally after a pilot phase, even if successful during this phase. Although many studies on barriers and facilitators were published in recent years, eHealth implementation still progresses only slowly. To further unravel the slow implementation process in primary health care and accelerate the implementation of eHealth, a 3-year Living Lab project was set up. In the Living Lab, called eLabEL, patients, health care professionals, small- and medium-sized enterprises (SMEs), and research institutes collaborated to select and integrate fully mature eHealth technologies for implementation in primary health care. Seven primary health care centers, 10 SMEs, and 4 research institutes participated. OBJECTIVE This viewpoint paper aims to show the process of adoption of eHealth in primary care from the perspective of different stakeholders in a qualitative way. We provide a real-world view on how such a process occurs, including successes and failures related to the different perspectives. METHODS Reflective and process-based notes from all meetings of the project partners, interview data, and data of focus groups were analyzed systematically using four theoretical models to study the adoption of eHealth in primary care. RESULTS The results showed that large-scale implementation of eHealth depends on the efforts of and interaction and collaboration among 4 groups of stakeholders: patients, health care professionals, SMEs, and those responsible for health care policy (health care insurers and policy makers). These stakeholders are all acting within their own contexts and with their own values and expectations. We experienced that patients reported expected benefits regarding the use of eHealth for self-management purposes, and health care professionals stressed the potential benefits of eHealth and were interested in using eHealth to distinguish themselves from other care organizations. In addition, eHealth entrepreneurs valued the collaboration among SMEs as they were not big enough to enter the health care market on their own and valued the collaboration with research institutes. Furthermore, health care insurers and policy makers shared the ambition and need for the development and implementation of an integrated eHealth infrastructure. CONCLUSIONS For optimal and sustainable use of eHealth, patients should be actively involved, primary health care professionals need to be reinforced in their management, entrepreneurs should work closely with health care professionals and patients, and the government needs to focus on new health care models stimulating innovations. Only when all these parties act together, starting in local communities with a small range of eHealth tools, the potential of eHealth will be enforced.

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