scholarly journals Barriers and potential solutions for improved surgical care for children with hernia in Eastern Uganda

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mary Margaret Ajiko ◽  
Jenny Löfgren ◽  
Solvig Ekblad
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Local Community ◽  
Surgical Care ◽  
Care Providers ◽  
Regional Referral Hospital ◽  
Surgical Conditions ◽  
And Gender ◽  
Access To Surgery ◽  
Eastern Uganda

AbstractFive billion people lack timely, affordable access to surgery. A large proportion of these are children. Qualitative research investigating the barriers to surgical care for children and ways of overcoming them is lacking. This study focused on children with hernia, a very common paediatric surgical condition for which surgery is the only effective treatment. The main aim of this qualitative study was to explore barriers to surgical care for children and identify potential solutions. Data were collected from parents of children with hernia and from health care providers at Soroti Regional Referral Hospital in eastern Uganda. Parents’ experiences, motives and barriers when accessing care were explored. The health care providers’ knowledge, perceptions and practices relating to children with hernia were investigated. The data were analysed using thematic content analysis. Traditional beliefs and gender inequality were considered major issues. Possible solutions included partnering with the local community in efforts to increase knowledge and acceptability in the community in general and by parents in particular. A formation of a surgical team dedicated to the management of children with surgical conditions was suggested as way to improve quality and increase volume of surgery for children.

scholarly journals Querying Patients With Cancer About Sexual Health and Sexual and Gender Minority Status: A Qualitative Study of Health-Care Providers

2019 ◽  
Vol 37 (6) ◽  
pp. 418-423 ◽  
Author(s):  
Elizabeth Cathcart-Rake ◽  
Jennifer M. O’Connor ◽  
Jennifer L. Ridgeway ◽  
Carmen Radecki Breitkopf ◽  
Lois J. Mc Guire ◽  
...  
Keyword(s):  
Health Care ◽  
Sexual Health ◽  
Health Care Providers ◽  
Minority Status ◽  
Care Providers ◽  
Gender Minority ◽  
Patients With Cancer ◽  
National Organizations ◽  
Sexual And Gender Minority ◽  
And Gender

Background: Although national organizations advocate that health-care providers ask patients about sexual health and sexual and gender minority status—to learn, for example, about side effects of treatment and to understand patients’ social support—these conversations often do not occur. This study explored health-care providers’ reasons for having/not having these conversations. Methods: This single-institution study recruited health-care providers from medical oncology, hematology, radiation oncology, and gynecology. Face-to-face interviews were recorded, transcribed, and analyzed qualitatively. Results: Three main themes emerged: (1) patient-centric reasons for discussing/not discussing sexual health and sexual and gender minority status (“So I think just the holistic viewpoint is important”); (2) health-care provider–centric reasons for discussing/not discussing these issues (“That’s going to take more time to talk about and to deal with…” or “I was raised orthodox, so this is not something we talk about…”; and (3) reasons that appeared to straddle both of the above themes (eg, acknowledgment of the sometimes taboo nature of these topics). Conclusion: Although many health-care providers favor talking with patients with cancer about sexual health and sexual and gender minority status, limited time, personal reluctance, and the taboo nature of these topics appear at times to hamper the initiation of these conversations.

The role of oncologic health care providers in end of life discussions for women with recurrent gynecologic or breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20543-e20543
Author(s):  
Ashley Stuckey ◽  
Katina Robison ◽  
Don S. Dizon ◽  
Michelle Rogers ◽  
Miles Ott ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
End Of Life ◽  
Health Care Providers ◽  
Institutional Review Boards ◽  
Care Providers ◽  
Provider Type ◽  
Health Care Proxy ◽  
Recurrent Cancer ◽  
And Gender

e20543 Background: Advance care planning (ACP) is an important topic for women with metastatic or recurrent cancer. Unfortunately, data suggest ACP is often not discussed at health care visits. Because patients with metastatic or recurrent cancer are incurable, the issue of end of life (EOL) is one faced by patients and providers. This study evaluates how often oncologic health care providers initiate EOL conversations with their patients. Methods: Eligible patients included women with metastatic or recurrent gynecologic or breast cancer of ≥3 month’s duration in an academic women’s oncology program. Interviews were conducted by research staff. Clinical characteristics and documentation of EOL decisions were obtained through chart reviews. Data were analyzed using SAS v.9.3. Multivariate logistic regression was used to model the association of EOL discussions with ACP. The study was approved by the hospital and university Institutional Review Boards. Results: 200 women were enrolled; 64% had stage III-IV cancer at diagnosis. The majority was white (91%) with a mean age of 60 (range 35-82). A total of 638 providers were identified (mean: 3.2 providers per patient; 57% female). Health care provider type and gender were not associated with EOL discussions. Only 49 women (25%) recalled an EOL conversation with at least one provider which appeared to correspond to the low proportion of people with documented ACP. Only 42 (22%) had an advanced directive (AD) and 29 (15%) a health care proxy (HCP) in the chart. Having an EOL conversation with at least one provider was not associated with a chart-documented AD (OR=1.6, 95% CI=0.7-3.6) or HCP (OR=1.8, 95% CI=0.7-4.5). The time since recurrence was shorter for those reporting EOL conversations (1.7 vs. 3.1 years, p=.0274). Conclusions: In this study, oncologic health care providers infrequently initiated EOL discussions with their patients with metastatic or recurrent cancer. More concerning, patient recollection of an EOL discussion with a provider was not associated with chart-documented ACP. Further studies evaluating the factors limiting EOL discussions as well as studies testing interventions to improve provider documentation of the ACP are warranted.

scholarly journals Teaching Health-Care Providers to Query Patients With Cancer About Sexual and Gender Minority (SGM) Status and Sexual Health

2019 ◽  
Vol 36 (6) ◽  
pp. 533-537 ◽  
Author(s):  
Elizabeth J. Cathcart-Rake ◽  
Carmen Radecki Breitkopf ◽  
Judith Kaur ◽  
Jennifer O’Connor ◽  
Jennifer L. Ridgeway ◽  
...  
Keyword(s):  
Health Care ◽  
Sexual Health ◽  
End Of Life ◽  
Health Care Providers ◽  
Position Statement ◽  
Care Providers ◽  
Related Data ◽  
Patients With Cancer ◽  
And Gender ◽  
American Society

End of life is difficult for all patients but sexual and gender minorities (SGM) are prone to isolation and loneliness, especially if their SGM status is unknown or unaccepted. In oncology clinics, where goals of care discussions about end of life are integral and frequent, querying patients about their SGM status and sexual health is of particular importance. The American Society of Clinical Oncology recently released a position statement that called for greater focus on SGM populations with the goal of reducing and eventually eliminating disparities in cancer care within this group. An important first step in addressing such disparities is learning how best to train cancer health-care providers to ask patients about their SGM status and about sexual health in general. This article summarizes the mandate for understanding cancer issues in SGM populations and the dearth of cancer-related data within this group. This article also describes an ongoing 3-part study intended to build a mini curriculum with the goal of helping cancer health-care providers to ask patients with cancer about SGM status and to ask all patients with cancer about sexual health issues. The results of this ongoing study could potentially improve end-of-life care for subgroups of patients.

scholarly journals Practice, Perceived Barriers and Motivating factors to medical-incident reporting: A cross-section survey of health care providers at Mbarara Regional Referral Hospital, Southwestern Uganda.

2020 ◽  
Author(s):  
Naome Turyahabwe ◽  
James Mwesigwa ◽  
Christine Atuhairwe ◽  
Ivan Mugisha Taremwa
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Health Care Providers ◽  
Incident Reporting ◽  
Referral Hospital ◽  
Perceived Barriers ◽  
P Value ◽  
Motivating Factors ◽  
Care Providers ◽  
Regional Referral Hospital

Abstract Background : Medical-incident reporting (MIR) ensures patient safety and delivery of quality of care by minimizing unintentional harm among health care providers. We explored medical-incident reporting practices, perceived barriers and motivating factors among health care providers at Mbarara Regional Referral Hospital (MRRH). Methods : We conducted a cross-sectional descriptive study on 158 health provider at Mbarara Regional Referral Hospital (MRRH), Western Uganda. Data was gathered using a structured questionnaire and analyzed with SPSS. The chi-square was used to determine factors associated with MIR at MRRH. Results : The results showed that there was no formal incident reporting structure. However the medical-incidences identified were: medication errors (89.9%), diagnostic errors (71.5%), surgical errors (52.5%) and preventive error (47.7%). The motivating factors of MIR were: establishment of a good communication system, instituting corrective action on the reported incidents and reinforcing health workers knowledge on MIR (p-value 0.004); presence of effective organizational systems like: written guidelines, practices of open door policy, no blame approach, and team work were significantly associated with MIR (p-value 0.000). On the other hand, perceived barriers to MIR were: lack of knowledge on incidents and their reporting, non-existence of an incident reporting team and fear of being punished (p value 0.669). Conclusion : Medical Incident Reporting at MRRH was sub-optimal. Therefore setting up an incident management team and conducting routine training MIR among health care workers will increase patient safety.

Barriers and Facilitators to PrEP Initiation and Adherence Among Transgender and Gender Non-Binary Individuals in Southern California

2020 ◽  
Vol 32 (6) ◽  
pp. 472-485
Author(s):  
C. Wei-Ming Watson ◽  
Elizabeth Pasipanodya ◽  
Micah J. Savin ◽  
Eric E. Ellorin ◽  
Katya C. Corado ◽  
...  
Keyword(s):  
Health Care ◽  
Los Angeles ◽  
Health Care Providers ◽  
Barriers And Facilitators ◽  
Care Providers ◽  
Financial Barriers ◽  
In Trans ◽  
And Gender ◽  
Prep Awareness ◽  
Exposure Prophylaxis

While transgender and gender non-binary (trans/nb) individuals are disproportionately affected by HIV, pre-exposure prophylaxis (PrEP) uptake remains low in this underserved population. We conducted four focus groups with 37 trans/nb individuals in San Diego and Los Angeles to assess barriers and facilitators of PrEP usage. Transcripts were coded for qualitative themes. Although overall PrEP awareness was high, participants reported limited knowledge and misinformation about PrEP. Barriers to PrEP use included: structural access (e.g., discrimination from health care providers, lack of trans-inclusive services, financial barriers), mental health struggles limiting ability to access PrEP, and concerns about potential side effects, drug-drug interactions with hormone therapy, and lack of other STI protection. Facilitators of PrEP usage included: increased PrEP availability, prior experience taking daily medications, and motivation to have active and healthy lives without fear of contracting HIV. Addressing both structural and psychosocial/behavioral factors in trans-affirming health care environments is crucial to designing inclusive, effective PrEP interventions.

scholarly journals Cross-Cultural Validation Into Filipino of the Consumer Assessment of Health-Care Providers and Systems Surgical Care Survey (S-CAHPS)

2020 ◽  
Vol 7 (6) ◽  
pp. 1136-1143
Author(s):  
Gian Carlo S Torres ◽  
John Rey B Macindo
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Surgical Care ◽  
Cross Cultural ◽  
Culturally Appropriate ◽  
Care Providers ◽  
Surgical Experience ◽  
Care Survey ◽  
Consumer Assessment ◽  
Cultural Validation

Surgical experience is increasingly being recognized; however, Consumer Assessment of Health-Care Providers and Systems Surgical Care Survey (S-CAHPS), the tool for surgical experience, is available in English and Spanish only. To measure surgical experience among Filipinos, a culturally appropriate version should be validated. This study culturally adapted the S-CAHPS into Filipino. A five-step cross-cultural validation study was conducted. Language experts conducted forward translation, back translation, and panel reconciliation. Pretesting included content validation and pretesting of the Filipino S-CAHPS. Field testing involved 55 purposively selected postoperative patients who completed a 3-part survey from March to July 2018. The English S-CAHPS was reduced to 34 items to account cultural variations, yielding an item content validity index (I-CV) of 1.00. One-sample t test and Bland–Altman plots showed good linguistic equivalence. Correlation coefficients were ≥0.30, suggestive of good conceptual equivalence. Cronbach’s alpha values were 0.83 and 0.85 indicative of good reliability. The Filipino S-CAHPS showed acceptable psychometric properties. It is a valid and culturally appropriate instrument to measure surgical experience among Filipinos which can be utilized for quality improvement measures on both practice and policy levels.

Review Paper: Gender Competencies in the Medical Curriculum: Addressing Gender Bias in Medicine

2009 ◽  
Vol 21 (4) ◽  
pp. 359-376 ◽  
Author(s):  
Yut-Lin Wong
Keyword(s):  
Health Care ◽  
Gender Bias ◽  
Health Care Providers ◽  
Curriculum Reform ◽  
Medical Curriculum ◽  
Gender Inequalities ◽  
Care Providers ◽  
Inequalities In Health ◽  
Medical Curricula ◽  
And Gender

Gender inequalities in health and gender bias in medicine are interrelated challenges facing health care providers and educators. Women and girls are disadvantaged in accessing health care because of their low social status and unequal treatment in medical care. Gender bias has long been inherent in clinical practice, medical research, and education. This can be traced to the medical curriculum that shapes the perceptions, attitudes, and behavior of the future doctor. The author advocates medical curricula change to address gender inequalities in health and gender bias in medicine. She analyses the reasons for integration of gender competencies in the medical curriculum, discusses what gender competencies are, and reviews ways to in-build gender competencies and their assessment. Efforts to change and gender sensitize medical curricula in developed and developing countries are also reviewed. The review hopes to contribute to strategic medical curriculum reform, which would lead to gender-sensitive health services and equity in health.

scholarly journals Socio-Cultural and Gender-Based Issues that Shape Sexuality of Emerging Adults in Nigeria: A Qualitative Approach

2021 ◽  
Author(s):  
Olufemi Adetutu ◽  
Sola Asa ◽  
Bola Solanke ◽  
AbdulRahman Azeez Aroke ◽  
David Okunlola
Keyword(s):  
Health Care ◽  
Emerging Adults ◽  
Health Care Providers ◽  
Sexual And Reproductive Health ◽  
Sexual Relationships ◽  
Health Providers ◽  
Care Providers ◽  
Individual Agency ◽  
Gender Based ◽  
And Gender

Abstract Background Socio-cultural and gender-based issues influence sexuality of emerging adults. These gender-based issues worsen sexual health outcomes of emerging adults in studies outside Nigeria. Some of these issues are male dominance in sexual relationships, health care providers’ bias in attending to sexual health needs of emerging adults and age disparate sexual relationships. Studies have reported that males dominate females in sexual relationship largely in part owing to masculinity tendencies. Also, health care providers view emerging adults as randy when seeking information on sexual and reproductive health care services. Added to these is age disparate sexual relationships. Older men engage in exchanged sex while younger females are unable to negotiate condom. All these speak to gender and social inequality in sexual relationships are largely undocumented in Nigeria. Method This study collected information purposively using a qualitative inquiry. Thirty (30) in-depth interviews (IDIs), six (6) Focus Group Discussions (FGDs) and Eighteen (18) Key Informant Interviews (KIIs) were conducted across the three main ethnic groups in Nigeria. Result Narratives and interviews showed nuanced discourses of all these gendered issues. Males dominated females in sexual relationships through suppression to negotiate condom, diminished females’ individual agency, and engagement in multiple sexual partnerships. Females endured domination of males in sexual relationships to sustain relationships. Also, health providers were biased and indifferent in providing sexual and reproductive health services to emerging adults. This study showed poor socio-economic status makes older men to exploit and take advantage of younger females in sexual relationships. Wide age difference and the notion of fulfilling their side in a paid sexual intercourse made younger females unable to negotiate condom. Conclusion Gender-based issues and socio-cultural norms diminished individual agency of emerging adults, especially females, achieving positive sexuality. Policies that dispel socio-cultural and gendered norms in sexual relationships should be encouraged, including increased awareness on sex education to parents and children, skill acquisitions and empowerment programmes for emerging adults and capacity building of health providers to improve provision of SRH needs of emerging adults.

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