Improving immunization uptake rates among Gypsies, Roma and Travellers: a qualitative study of the views of service providers

ABSTRACT Background Gypsies, Roma and Travellers are at risk of low uptake of routine immunizations. Interventions to improve uptake in these communities are seldom evaluated. As part of a qualitative study exploring barriers and facilitators to immunization uptake in Travellers, we report service provider (SP) perspectives. Methods We interviewed immunization SPs working with six Traveller communities across four UK cities. Participants included frontline staff and those with strategic or commissioning roles. Semi-structured interviews explored perceived attitudes of Travellers to vaccinations, local service delivery, and opportunities and challenges to improving uptake. Audio-recordings were transcribed, analyzed thematically and mapped to a socio-ecological model of health. Results 39 SPs participated. Four overarching themes were identified: building trusting relationships between SPs and Travellers; facilitating attendance at appointments; improving record keeping and monitoring and responding to local and national policy change. Travellers were perceived as largely supportive of immunizations, though system and organizational processes were recognized barriers to accessing services. Conclusions Findings were broadly consistent across Traveller groups and settings. The barriers identified could often be addressed within existing infrastructure, though require system or policy change. Development of a culturally competent system appears important to enable equity in access to immunizations for Travellers.

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What makes an optimal delivery for PrEP against HIV: A qualitative study in MSM

International Journal of STD & AIDS ◽

10.1177/09564624211060824 ◽

2022 ◽

pp. 095646242110608

Author(s):

Janice Y. C. Lau ◽

Ngai-Sze Wong ◽

Krystal C. K. Lee ◽

Tsz-Ho Kwan ◽

Grace C. Y. Lui ◽

...

Keyword(s):

Qualitative Study ◽

Service Providers ◽

Effective Means ◽

Qualitative Assessment ◽

Theory Approach ◽

Service Model ◽

Structured Interviews ◽

Sexually Transmitted ◽

Ethnic Chinese ◽

Sex With Men

Background Pre-exposure prophylaxis (PrEP) is an effective means of HIV prevention for men who have sex with men (MSM), a key population whose engagement is crucial for achieving effective public health outcomes. An optimal service model would be important in planning the implementation of PrEP in places where such service has not been established. Methods A qualitative study was conducted to delineate the attributes of an optimal PrEP service model for MSM in Hong Kong, a city where no formal PrEP programs existed. Twenty purposively sampled MSM who were enrollees of two pilot PrEP projects participated in the semi-structured interviews promoting story-telling. The coded data were thematically analyzed following Grounded Theory approach, focusing on uncovering a typology of the essential attributes of an optimal PrEP service model, and the reasons for such preferences. Results Participating MSM were all ethnic Chinese and aged 26 to 52 years. All had received PrEP from pilot projects in conjunction with periodic screening of sexually transmitted infections (STI), HIV antibody, and plasma creatinine. Four major themes emerged as regards the attributes of a preferred PrEP service: (i) comprehensiveness of HIV/STI and safety monitoring; (ii) convenient unitary service; (iii) stigma-free PrEP access and protecting confidentiality; and (iv) affordable price. Whereas regular provision of PrEP was acceptable to MSM, unaffordability and related stigma were the anticipated challenges for potential service providers. Conclusions The qualitative assessment of MSM’s preference for PrEP service delivery has yielded important information on the many facets of a desirable service model.

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Evaluation of a sitting light volleyball intervention to adults with physical disabilities: Qualitative study using social–ecological approach

10.21203/rs.2.15889/v2 ◽

2020 ◽

Author(s):

Ka Man Leung ◽

Pak-Kwong Chung ◽

William Chu

Keyword(s):

Qualitative Study ◽

Psychological Health ◽

Ecological Model ◽

Physical Disabilities ◽

Structured Interviews ◽

Intervention Programme ◽

Social Ecological ◽

Physical And Psychological Health ◽

The Government ◽

Community Facilities

Abstract Background: This study was part of a 15-week sitting light volleyball (SLVB) intervention programme which examined the effectiveness of the intervention on physical and psychological attributes of adults with physical disabilities (PWPD) in Hong Kong. SLVB was a new sport, combing Paralympic volleyball and light volleyball. Gaining an in-depth understanding of the perceptions and experiences of PWPD in the SLVB intervention is critical to further develop SLVB as a PA intervention and sport. Using a social–ecological model (SEM), (a) the participants’ experiences regarding the intervention were assessed and (b) the suitability and feasibility of the SLVB intervention to PWPD were qualitatively examined. Methods: Twenty participants (mean age = 53.52 years standard deviation (SD = 9.02), 60% female participants; 25% had at least a college degree) attended our semi-structured interviews. Results: Using content analysis, their experiences at the individual or intrapersonal level (physical and psychological health, enjoyment, novelty, competence autonomy); interpersonal levels (socialization, teamwork, social support); organizational and community levels (perceived sport venue environment, venue accessibility, safety, dissemination of information, and community facilities); and policy level (resources allocation by the government) were obtained. The participants also commented on the suitability and feasibility of the SLVB intervention for PWPD, contents and coaching, modified rules, duration of session and scheduling, and number of participants and coaches. Conclusion: This qualitative study identified several themes for engaging PWPD in SLVB, and demonstrated that adopting a multilevel approach to intervention in SLVB has positive outcomes to participants. In general, SLVB is suitable and feasible to PWPD. The study contributes to an in-depth understanding of the experiences among PWPD in the SLVB intervention, which is very critical to the further development of SLVB in terms of a PA intervention and sport.

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Challenges of the Relative Value Unit Experience in Iran: A Qualitative Study

10.53350/pjmhs211551249 ◽

2021 ◽

Vol 15 (5) ◽

pp. 1249-1255

Author(s):

S. Forootan ◽

S. Hajebrahimi ◽

B. Najafi ◽

A. Janati

Keyword(s):

Qualitative Study ◽

Service Providers ◽

Health Sector ◽

Active Role ◽

Structured Interviews ◽

Group Discussions ◽

Provider Behavior ◽

Income Disparities ◽

Relative Value ◽

Data Content

Background: The Relative Value Unit (RVU) is a value scale and plays a key role in the physician reimbursement system. The health sector has faced challenges such as providers’ dissatisfaction, income disparities, and reduced service quality which is said to be due to improper RVUs. Always there are debates about it. This study aims to identify the challenges of the RVU experience in Iran from the perspective of the service providers, payers and, policymakers. Methods: This qualitative study was conducted in 2020. Data were collected from November 2019 to February 2020. Thirty experts participated in the study and were categorized into four groups: insurance organizations’ managers, surgeons, health economists, and health policymakers. Focus Group Discussions and semi-structured interviews were held to collect data. Content analysis was conducted to analyze data. Results: According to the expert, the challenges of RVU in Iran are classified into five scopes. Financial, payment, macro-organization, regulation, and persuasion scope. Each scope’s result was categorized into main themes and relevant sub-themes. Conclusions: The RVU has an important impact on the health system, provider behavior, and even patients. Paying attention to required infrastructures, decision- makers’ conflict of interests, decrease the Ministry of Health and Medical Education’s authority, and expanding the active role of involved organizations to increase their commitment to the successful implantation of RVU is necessary. Keywords: Relative Value Unit, Challenge, Expert opinion, Qualitative study, Iran.

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Healthcare inequities and barriers to access for homeless individuals: a qualitative study in Barcelona (Spain)

International Journal for Equity in Health ◽

10.1186/s12939-021-01409-2 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Andrés Cernadas ◽

Ángela Fernández

Keyword(s):

Qualitative Study ◽

Health Services ◽

Healthcare Workers ◽

Service Providers ◽

Universal Access ◽

Healthcare Services ◽

Medical Professional ◽

Homeless Population ◽

Public Health Services ◽

Structured Interviews

Abstract Background In Spain, homeless individuals have lower perceived quality of health than the rest of the population and their life expectancy is 30 years lower than the national average. While the Spanish health system provides universal access and coverage, homeless individuals do not access or use public care enough to maintain their health. The objective of this study is to determine if homeless individuals can access public health services in conditions of equality with the rest of the population, as established in healthcare legislation, and to better understand the causes of observed inequalities or inequities of access. Methods A detailed qualitative study was carried out in the city of Barcelona (Spain) from October 2019 to February 2020. A total of nine open and in-depth interviews were done with homeless individuals along with seven semi-structured interviews with key informants and two focus groups. One group was composed of eight individuals who were living on the street at the time and the other consisted of eight individuals working in healthcare and social assistance. Results The participants indicated that homeless individuals tend to only access healthcare services when they are seriously ill or have suffered some kind of injury. Once there, they tend to encounter significant barriers that might be 1) administrative; 2) personal, based on belief that that will be poorly attended, discriminated against, or unable to afford treatment; or 3) medical-professional, when health professionals, who understand the lifestyle of this population and their low follow-through with treatments, tend towards minimalist interventions that lack the dedication they would apply to other groups of patients. Conclusions The conclusions derived from this study convey the infrequent use of health services by homeless individuals for reasons attributable to the population itself, to healthcare workers and to the entire healthcare system. Accordingly, to reduce inequities of access to these services, recommendations to healthcare service providers include adapting facilities to provide more adequate care for this population; increasing sensitivity/awareness among healthcare workers; developing in situ care systems in places where the homeless population is most concentrated; and establishing healthcare collaboration agreements with entities that work with this population.

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Evaluation of a sitting light volleyball intervention: a social-ecological approach

10.21203/rs.2.15889/v1 ◽

2019 ◽

Author(s):

Ka Man Leung ◽

Pak-Kwong Chung ◽

William Chu

Keyword(s):

Qualitative Study ◽

Ecological Model ◽

Self Regulation ◽

Community Setting ◽

Well Being ◽

Organizational Level ◽

Structured Interviews ◽

Intervention Programme ◽

Social Ecological ◽

The Government

Abstract Background This study was part of a 15-week sitting light volleyball (SLVB) intervention programme which examined the effectiveness of the intervention on physical and psychological attributes of people with physical disabilities (PWPD) in Hong Kong. Gaining an in-depth understanding of the perceptions and experiences of PWPD in the SLVB intervention is critical to further develop SLVB as a PA intervention and sport. This qualitative study explored and examined the association between the SLVB intervention elements and outcomes. Methods Using a social–ecological model (SEM), the participants’ experiences regarding the intervention were assessed and the suitability and feasibility of the SLVB intervention elements were examined. Twenty participants (mean age = 53.52 years standard deviation (SD = 9.02), 60% female participants; 25% had at least a college degree) attended our semi-structured interviews. Results Using thematic analysis, their experiences at the individual or intrapersonal level (improved health and well-being, enjoyment, novelty, competence autonomy, and self-regulation when playing SLVB); relationship or interpersonal levels (teamwork, social support, socialization, and communication); perceived environment level (comfort, privacy, spaciousness, and accessibility concerns); community or organizational level (safety, dissemination of information, and community facilities); and policy level (resources allocation by the government) were obtained. The participants also commented on the suitability of the SLVB intervention for PWPD, contents and coaching, modified rules, duration of session and scheduling, and number of participants and coaches. Conclusion This qualitative study identified several primary drivers and barriers for engaging PWPD in SLVB, and demonstrated that adopting a multilevel approach to our SLVB intervention has positive outcomes. Our results can facilitate the development of the experiential aspects of SLVB and indicate the suitability and feasibility of organizing SLVB-related activities in a community setting in the future.

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Cultivating social occupations, spaces, and networks: service providers’ perspectives on enabling immigrants’ social participation

Cadernos Brasileiros de Terapia Ocupacional ◽

10.1590/2526-8910.ctoao2184 ◽

2021 ◽

Vol 29 ◽

Author(s):

Suzanne Huot ◽

Jaqueline Brower ◽

Alex Tham ◽

Atieh Razavi Yekta

Keyword(s):

Qualitative Study ◽

Economic Integration ◽

Thematic Analysis ◽

Social Participation ◽

Service Providers ◽

Community Organizations ◽

Occupational Therapists ◽

Social Identities ◽

Canadian Society ◽

Structured Interviews

Abstract Introduction Immigrants may experience many barriers to social participation within host societies. Immigrants’ integration into Canadian society is supported through government-funded services. Objective In the present study, we explored the perspectives of service providers working in community organizations regarding their role in enabling immigrants’ social participation through occupations in British Columbia, Canada. Method Representatives from twenty different organizations providing services to the community participated in a constructivist qualitative study aiming to uncover aspects shaping opportunities for occupational participation provided for immigrants. Results Drawing on semi-structured interviews and using thematic analysis, we identified three main themes relating to cultivating social occupations, spaces, and networks. Findings illustrate that service providers’ cultivation of these opportunities can support immigrants’ desired social roles and social identities, further enabling their participation in receiving societies. Conclusion Emphasis upon supporting socio-economic integration into society appears to limit a client-centred approach to developing opportunities for social participation through occupation. Implications for occupational therapists and scientists are discussed.

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A Family-Focused Intervention for Parental Mental Illness: A Practitioner Perspective

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.783161 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mairead Furlong ◽

Christine Mulligan ◽

Sharon McGarr ◽

Siobhan O'Connor ◽

Sinead McGilloway

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Illness ◽

Qualitative Study ◽

Child Protection ◽

Service Providers ◽

Controlled Trial ◽

Parental Mental Illness ◽

Structured Interviews ◽

Mental Health Settings

Background: Parental mental illness (PMI) is common and can lead to children developing mental disorders. Family Talk (FT) is a well-known and widely implemented intervention designed to reduce the risk of transgenerational psychopathology. However, given the research to practise “gap,” very little qualitative research, to date, has investigated practitioner experiences in implementing FT. This study aimed to explore the practitioner-perceived barriers and facilitators to the implementation and sustainability of FT within mainstream mental health settings.Methods: This qualitative study was nested within a randomised controlled trial (RCT) of Family Talk [N = 86 families (139 parents, 221 children)] within 15 adult (AMHS), child (CAMHS), primary care mental health, and child protection sites in Ireland. Semi-structured interviews and focus groups were undertaken with a purposive sample of clinicians (n = 31) and managers (n = 10), based on their experiences of implementing FT. Interview data were transcribed verbatim, analysed using constructivist grounded theory, and informed by Fixsen's implementation science framework.Results: Service providers highlighted a number of benefits for approximately two thirds of families across different diagnoses and mental health settings (AMHS/CAMHS/primary care). Sites varied in their capacity to embed FT, with key enablers identified as acquiring managerial and organisational support, building clinician skill, and establishing interagency collaboration. Implementation challenges included: recruitment difficulties, stresses in working with multiply-disadvantaged families, disruption in delivery due to the COVID-19 global pandemic, and sustainability concerns (e.g., perceived fit of FT with organisational remit/capacity, systemic and cultural barriers to change).Conclusion: This study is only the second qualitative study ever conducted to explore practitioner experiences in implementing FT, and the first conducted within the context of an RCT and national research programme to introduce family-focused practise (FFP) for families living with PMI. The findings illuminate the successes and complexities of implementing FFP in a country without a “think family” infrastructure, whilst highlighting a number of important generalisable lessons for the implementation of FT, and other similar interventions, elsewhere.

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Promoting inter-organisational knowledge sharing: A qualitative evaluation of England’s Global Digital Exemplar and Fast Follower Programme

PLoS ONE ◽

10.1371/journal.pone.0255220 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255220

Author(s):

Susan Hinder ◽

Kathrin Cresswell ◽

Aziz Sheikh ◽

Bryony Dean Franklin ◽

Marta Krasuska ◽

...

Keyword(s):

Knowledge Sharing ◽

Information Sharing ◽

Service Providers ◽

National Policy ◽

Qualitative Evaluation ◽

Structured Interviews ◽

Informal Knowledge ◽

Health Service Providers ◽

Diverse Data ◽

Directional Learning

Background The Global Digital Exemplar (GDE) Programme was designed to promote the digitisation of hospital services in England. Selected provider organisations that were reasonably digitally-mature were funded with the expectation that they would achieve internationally recognised levels of excellence and act as exemplars (‘GDE sites’) and share their learning with somewhat less digitally-mature Fast Follower (FF) sites. Aims This paper explores how partnerships between GDE and FF sites have promoted knowledge sharing and learning between organisations. Methods We conducted an independent qualitative longitudinal evaluation of the GDE Programme, collecting data across 36 provider organisations (including acute, mental health and speciality), 12 of which we studied as in-depth ethnographic case studies. We used a combination of semi-structured interviews with programme leads, vendors and national policy leads, non-participant observations of meetings and workshops, and analysed national and local documents. This allowed us to explore both how inter-organisational learning and knowledge sharing was planned, and how it played out in practice. Thematic qualitative analysis, combining findings from diverse data sources, was facilitated by NVivo 11 and drew on sociotechnical systems theory. Results Formally established GDE and FF partnerships were perceived to enhance learning and accelerate adoption of technologies in most pairings. They were seen to be most successful where they had encouraged, and were supported by, informal knowledge networking, driven by the mutual benefits of information sharing. Informal networking was enhanced where the benefits were maximised (for example where paired sites had implemented the same technological system) and networking costs minimised (for example by geographical proximity, prior links and institutional alignment). Although the intervention anticipated uni-directional learning between exemplar sites and ‘followers’, in most cases we observed a two-way flow of information, with GDEs also learning from FFs, through informal networking which also extended to other health service providers outside the Programme. The efforts of the GDE Programme to establish a learning ecosystem has enhanced the profile of shared learning within the NHS. Conclusions Inter-organisational partnerships have produced significant gains for both follower (FF) and exemplar (GDE) sites. Formal linkages were most effective where they had facilitated, and were supported by, informal networking. Informal networking was driven by the mutual benefits of information sharing and was optimised where sites were well aligned in terms of technology, geography and culture. Misalignments that created barriers to networking between organisations in a few cases were attributed to inappropriate choice of partners. Policy makers seeking to promote learning through centrally directed mechanisms need to create a framework that enables networking and informal knowledge transfer, allowing local organisations to develop bottom-up collaboration and exchanges, where they are productive, in an organic manner.

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Requirements and Incentives for Implementation of Pharmaceutical Strategic Purchasing in Iranian Health System: A Qualitative Study

Global Journal of Health Science ◽

10.5539/gjhs.v9n1p163 ◽

2016 ◽

Vol 9 (1) ◽

pp. 163 ◽

Cited By ~ 6

Author(s):

Peivand Bastani ◽

Leila Doshmangir ◽

Mahnaz Samadbeik ◽

Rassoul Dinarvand

Keyword(s):

Qualitative Study ◽

Service Providers ◽

Analysis Data ◽

Health Coverage ◽

Structured Interviews ◽

Framework Analysis ◽

Reimbursement Mechanisms ◽

Strategic Purchasing ◽

System A ◽

Insurance Reimbursement

PURPOSE: According to the importance of strategic purchasing as a prerequisite for overall access and universal health coverage, this study was conducted to explore requirements and incentives for implementation of pharmaceutical strategic purchasing in the Iranian health system.METHODS: This was a qualitative study conducted through content analysis with an inductive approach applying a five-stage framework analysis. Data analysis was started right after transcribing each interview applying MAXQDA10. Data was saturated after 32 semi-structured interviews with experts. These key informants were selected purposefully and through snowball sampling.RESULTS: The findings are categorized under three main themes: “Payment Mechanisms to Service Providers”, “Insurance Reimbursement Mechanisms” and “Rules and Regulations”, and eight related subthemes.CONCLUSIONS: According to the importance of incentive interventions in pharmaceutical strategic purchasing, it is necessary to pay close attention to pharmaceutical price, realistic and fair premiums and appropriate contracts with suppliers, along with estimation a reasonable profit margin for pharmaceutical suppliers and the appropriate reimbursement mechanisms as the most significant incentives for increasing access to pharmaceuticals and implementing strategic purchasing.

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Perceived occupational stressors among emergency medical service providers: a qualitative study

BMC Emergency Medicine ◽

10.1186/s12873-021-00430-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ali Afshari ◽

Seyed Reza Borzou ◽

Farshid Shamsaei ◽

Eesa Mohammadi ◽

Leili Tapak

Keyword(s):

Content Analysis ◽

Qualitative Study ◽

Service Providers ◽

Care Quality ◽

Critical Conditions ◽

Continuous Exposure ◽

Occupational Stressors ◽

Structured Interviews ◽

Emergency Medical ◽

Conventional Content Analysis

Abstract Introduction Emergency medical services (EMS) providers are at continuous exposure to occupational stressors which negatively affect their health and professional practice. This study explored perceived occupational stressors among EMS providers. Methods This qualitative study was conducted from December 2019 to April 2020 using conventional content analysis. Sixteen EMS providers were purposively selected from EMS stations in Hamadan, Iran. Semi-structured interviews (with length of 45–60 min) were held for data collection. Data were analyzed through Graneheim and Lundman’s conventional content analysis approach. Findings Data analysis resulted in the development of two themes, namely critical conditions of EMS provision, and personal and professional conflicts. The six categories of these two themes were complexity of patients’ clinical conditions, interruption of EMS provision, health hazards, interpersonal problems, interprofessional interactions, and legal conflicts. Conclusion Besides the stress associated with emergency patient care, EMS providers face many different occupational stressors. EMS managers can use the findings of the present study to develop strategies for reducing occupational stress among EMS providers and thereby, improve their health and care quality.

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