scholarly journals How can rural community-engaged health services planning achieve sustainable healthcare system changes?

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e047165
Author(s):  
Campbell Stuart Johnston ◽  
Erika Belanger ◽  
Krystal Wong ◽  
David Snadden
Keyword(s):  
Health Care ◽  
Qualitative Data ◽  
Rural Site ◽  
Secondary Outcome ◽  
Semistructured Interview ◽  
Health Providers ◽  
Snowball Sampling ◽  
Rural Healthcare ◽  
Policy Makers ◽  
Health Partnership

ObjectivesThe objectives of the Rural Site Visit Project (SV Project) were to develop a successful model for engaging all 201 communities in rural British Columbia, Canada, build relationships and gather data about community healthcare issues to help modify existing rural healthcare programs and inform government rural healthcare policy.DesignAn adapted version of Boelen’s health partnership model was used to identify each community’s Health Care Partners: health providers, academics, policy makers, health managers, community representatives and linked sectors. Qualitative data were gathered using a semistructured interview guide. Major themes were identified through content analysis, and this information was fed back to government and interviewees in reports every 6 months.SettingThe 107 communities visited thus far have healthcare services that range from hospitals with surgical programs to remote communities with no medical services at all. The majority have access to local primary care.ParticipantsParticipants were recruited from the Health Care Partner groups identified above using purposeful and snowball sampling.Primary and secondary outcome measuresA successful process was developed to engage rural communities in identifying their healthcare priorities, while simultaneously building and strengthening relationships. The qualitative data were analysed from 185 meetings in 80 communities and shared with policy makers at governmental and community levels.Results36 themes have been identified and three overarching themes that interconnect all the interviews, namely Relationships, Autonomy and Change Over Time, are discussed.ConclusionThe SV Project appears to be unique in that it is physician led, prioritises relationships, engages all of the healthcare partners singly and jointly in each community, is ongoing, provides feedback to both the policy makers and all interviewees on a 6-monthly basis and, by virtue of its large scope, has the ability to produce interim reports that have helped inform system change.

scholarly journals How can rural community-engaged health services planning affect sustainable health care system changes? - A process description and qualitative analysis of data from the Rural Coordination Centre of British Columbia’s Rural Site Visits Project

2020 ◽  
Author(s):  
C Stuart Johnston ◽  
Erika Belanger ◽  
Krystal Wong ◽  
David Snadden
Keyword(s):  
Health Care ◽  
Rural Health ◽  
Health Care System ◽  
Rural Health Care ◽  
Rural Site ◽  
Policy Makers ◽  
Health Partnership ◽  
Care Partners ◽  
System Changes ◽  
Care System

AbstractObjectivesThe objectives of the Rural Site Visit Project (SV Project) were to develop a successful model for engaging all 201 communities in rural British Columbia, Canada, build relationships and gather data about community health care issues to help modify existing rural health care programs and inform government rural health care policy.DesignAn adapted version of Boelen’s health partnership model was used to identify each community’s Health Care Partners: health providers, academics, policy makers, health managers, and community representatives. Qualitative data was gathered using a semi-structured interview guide. Major themes were identified through content analysis, and this information was fed back to the government and interviewees in reports every six months.SettingThe 107 communities visited thus far have health care services that range from hospitals with surgical programs to remote communities with no medical services at all. The majority have access to local primary care.ParticipantsParticipants were recruited from the Health Care Partner groups identified above using purposeful and snowball sampling.Primary and secondary outcome measuresA successful process was developed to engage rural communities in identifying their health care priorities, whilst simultaneously building and strengthening relationships. The qualitative data was analysed from 185 meetings in 80 communities and shared with policy makers at governmental and community levels.Results36 themes have been identified and three overarching themes that interconnect all the interviews, namely Relationships, Autonomy and Change Over Time, are discussed.ConclusionThe SV Project appears to be unique in that it is physician led, prioritizes relationships, engages all of the health care partners singly and jointly in each community, is ongoing, provides feedback to both the policy makers and all interviewees on a 6-monthly basis and, by virtue of its large scope, has the ability to produce interim reports that have helped support system change.Article SummaryThis study process has adapted Boelen’s health partnership model and is unique in that it is physician led, prioritizes relationships, engages all of the health care partners singly and jointly in each community, is ongoing, provides feedback to both the policy makers and all interviewees on a 6-monthly basis.A successful method of engaging with rural communities and building relationships and trust across multiple stakeholder groups is described that contributed to influencing positive health care system changes.As all communities in one province are being visited a picture of rural health care initiatives and challenges is highly comprehensive and therefore able to influence policy.One of the main limitations in this study is that because the interviewers were experienced health care providers, power differentials may have existed which may have introduced bias in the discussions.A potential limitation is the enormous amount of data to handle and analyze in a rigorous way, which was mitigated by having two full time analysts working together to ensure consistency with frequent meeting with the research team to consider and agree emerging themes.How can rural community-engaged health services planning affect sustainable health care system changes? – A process description and qualitative analysis of data from the Rural Coordination Centre of British Columbia’s Rural Site Visits Project

Transgender People's Perceptions of Medical Treatment: Implications for Providers and Loved Ones

2021 ◽  
pp. 106648072110523
Author(s):  
Nikolai Guimaoutdinov ◽  
Jane M. Tram
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Care Providers ◽  
Qualitative Data ◽  
Health Care Systems ◽  
Mental Health Providers ◽  
Health Providers ◽  
Care Providers ◽  
Health Care Barriers ◽  
Care Systems

In this study, we examine qualitative data from 73 transgender adults. We present the information our participants shared about their experiences navigating health care systems (i.e., medical health, mental health, other providers). Four themes emerged. First, participants indicated that they wanted health care providers to be more aware of transgender-specific terminology, identities, and experiences. Second, participants were concerned that health care providers blame their medical transition for unrelated health concerns. Third, participants said they did not want health care providers to probe transgender patients about their transitions. Fourth, they reported that they wanted health care providers to treat transgender patients as individuals rather than a monolith. Our research has implications for mental health providers because they benefit from understanding the health care barriers experienced by their transgender patients, in mental health and other health realms. This will allow mental health providers to better support their patients as well as bolster support from loved ones.

Health providers’ perception of quality of care for neonates in health facilities in a municipality in Southern Ghana

2016 ◽  
Vol 29 (8) ◽  
pp. 907-920 ◽  
Author(s):  
Kokui Elikplim Pomevor ◽  
Augustine Adomah-Afari
Keyword(s):  
Health Care ◽  
Neonatal Resuscitation ◽  
Neonatal Care ◽  
Health Care Facilities ◽  
Health Facilities ◽  
Health Providers ◽  
Policy Makers ◽  
Content Type ◽  
Southern Ghana

Purpose The purpose of this paper is to assess available human resources for neonatal care and their skills, in order to explore health providers’ perceptions of quality of neonatal care in health facilities in Ghana. Design/methodology/approach Data were gathered using qualitative interviews with health providers working in the maternity and paediatric wards and midwives; direct observation; and documentary review at a regional hospital, a municipal hospital and four health centres in a municipality in a region in Southern Ghana. Data were analysed using thematic framework through the process of coding in six phases to create and establish meaningful patterns. Findings The study revealed that health providers were concerned about the number of staff available, their competence and also equipment available for them to work more efficiently. Some essential equipment for neonatal care was either not available or was non-functional where it was available, while aseptic procedures were not adhered to. Moreover, personal protective equipment such as facemask, caps, aprons were not used except in the labour wards where staff had to change their footwear before entering. Research limitations/implications Limited number of health providers and facilities used, lack of exploration of parents of neonates’ perspective of quality of neonatal care in this study and other settings, including the teaching hospitals. The authors did not examine issues related to the ineffective use of IV cannulation for neonates by nurses as well as referral of neonates. Additionally, the authors did not explore the perspectives of management of the municipal and regional health directorates or policy makers of the Ministry of Health and Ghana Health Service regarding the shortage of staff, inadequate provision of medical equipment and infrastructure. Practical implications This paper suggests the need for policy makers to redirect their attention to the issues that would improve the quality of neonatal health care in health facilities in Ghana and in countries with similar challenges. Social implications The study found that the majority of nursing staff catering for sick newborns were not trained in neonatal nursing. Babies were found sleeping in separate cots but were mixed with older children. The study suggests that babies should be provided with a separate room and not mixed with older babies. Originality/value There seemed to be no defined policy framework for management of neonatal care in the country’s health care facilities. The study recommends the adoption of paediatric and neonatal care nursing as a specialty in the curricula of health training institutions. In-service trainings should encompass issues related to management of sick babies, care of preterm babies, neonatal resuscitation and intravenouscannulation, among others.

scholarly journals Building capacity for implementation—the KT Challenge

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Agnes T. Black ◽  
Marla Steinberg ◽  
Amanda E. Chisholm ◽  
Kristi Coldwell ◽  
Alison M. Hoens ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Health Care Professionals ◽  
Qualitative Data ◽  
Practice Change ◽  
Evidence Based ◽  
Science Literature ◽  
Health Care Settings ◽  
Improvement Programs ◽  
The Impact

Abstract Background The KT Challenge program supports health care professionals to effectively implement evidence-based practices. Unlike other knowledge translation (KT) programs, this program is grounded in capacity building, focuses on health care professionals (HCPs), and uses a multi-component intervention. This study presents the evaluation of the KT Challenge program to assess the impact on uptake, KT capacity, and practice change. Methods The evaluation used a mixed-methods retrospective pre-post design involving surveys and review of documents such as teams’ final reports. Online surveys collecting both quantitative and qualitative data were deployed at four time points (after both workshops, 6 months into implementation, and at the end of the 2-year funded projects) to measure KT capacity (knowledge, skills, and confidence) and impact on practice change. Qualitative data was analyzed using a general inductive approach and quantitative data was analyzed using non-parametric statistics. Results Participants reported statistically significant increases in knowledge and confidence across both workshops, at the 6-month mark of their projects, and at the end of their projects. In addition, at the 6-month check-in, practitioners reported statistically significant improvements in their ability to implement practice changes. In the first cohort of the program, of the teams who were able to complete their projects, half were able to show demonstrable practice changes. Conclusions The KT Challenge was successful in improving the capacity of HCPs to implement evidence-based practice changes and has begun to show demonstrable improvements in a number of practice areas. The program is relevant to a variety of HCPs working in diverse practice settings and is relatively inexpensive to implement. Like all practice improvement programs in health care settings, a number of challenges emerged stemming from the high turnover of staff and the limited capacity of some practitioners to take on anything beyond direct patient care. Efforts to address these challenges have been added to subsequent cohorts of the program and ongoing evaluation will examine if they are successful. The KT Challenge program has continued to garner great interest among practitioners, even in the midst of dealing with the COVID-19 pandemic, and shows promise for organizations looking for better ways to mobilize knowledge to improve patient care and empower staff. This study contributes to the implementation science literature by providing a description and evaluation of a new model for embedding KT practice skills in health care settings.

scholarly journals An interview study to determine the experiences of cellulitis diagnosis amongst health care professionals in the UK

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e034692
Author(s):  
Mitesh Patel ◽  
Siang Ing Lee ◽  
Nick J Levell ◽  
Peter Smart ◽  
Joe Kai ◽  
...  
Keyword(s):  
Clinical Features ◽  
Clinical Experience ◽  
Lower Limb ◽  
Health Care Professionals ◽  
Secondary Outcome ◽  
Snowball Sampling ◽  
Acute Medicine ◽  
Common Diagnosis ◽  
The Uk ◽  
National Networks

ObjectivesTo explore healthcare professionals (HCPs) experiences and challenges in diagnosing suspected lower limb cellulitis.SettingUK nationwide.Participants20 qualified HCPs, who had a minimum of 2 years clinical experience as an HCP in the national health service and had managed a clinical case of suspected cellulitis of the lower limb in the UK. HCPs were recruited from departments of dermatology (including a specialist cellulitis clinic), general practice, tissue viability, lymphoedema services, general surgery, emergency care and acute medicine. Purposive sampling was employed to ensure that participants included consultant doctors, trainee doctors and nurses across the specialties listed above. Participants were recruited through national networks, HCPs who contributed to the cellulitis priority setting partnership, UK Dermatology Clinical Trials Network, snowball sampling where participants helped recruit other participants and personal networks of the authors.Primary and secondary outcomesPrimary outcome was to describe the key clinical features which inform the diagnosis of lower limb cellulitis. Secondary outcome was to explore the difficulties in making a diagnosis of lower limb cellulitis.ResultsThe presentation of lower limb cellulitis changes as the episode runs its course. Therefore, different specialties see clinical features at varying stages of cellulitis. Clinical experience is essential to being confident in making a diagnosis, but even among experienced HCPs, there were differences in the clinical rationale of diagnosis. A group of core clinical features were suggested, many of which overlapped with alternative diagnoses. This emphasises how the diagnosis is challenging, with objective aids and a greater understanding of the mimics of cellulitis required.ConclusionCellulitis is a complex diagnosis and has a variable clinical presentation at different stages. Although cellulitis is a common diagnosis to make, HCPs need to be mindful of alternative diagnoses.

Towards an AIDS-free generation by 2030: how are South African children, adolescents, caregivers and health care workers coping with HIV?

2021 ◽  
pp. 008124632199217
Author(s):  
Yogan Pillay
Keyword(s):  
Health Care ◽  
Children And Adolescents ◽  
South African ◽  
Health Care Workers ◽  
Policy Makers ◽  
Number Of Children ◽  
Key Stakeholders ◽  
Care Workers ◽  
Free Generation ◽  
Living With Hiv

We are committed to an AIDS free generation by 2030 – nine short years away. This article reflects on the global and South African data on new infections, total number of children and adolescents living with HIV as well as data on vertical transmission. The article includes the voices of key stakeholders in the quest to end HIV in children so that lessons from their experiences can be used by policy makers in strengthening services.

scholarly journals Community pharmacy as a setting for public health nutrition action: Australian nutritionists’ perspectives

2014 ◽  
Vol 18 (10) ◽  
pp. 1864-1872 ◽  
Author(s):  
Judith H Maher ◽  
John Lowe ◽  
Roger Hughes
Keyword(s):  
Public Health ◽  
Health Care ◽  
Community Pharmacy ◽  
Qualitative Data ◽  
Infant Nutrition ◽  
Public Health Nutrition ◽  
Structured Interviews ◽  
Nutrient Supplementation ◽  
Practice Experience ◽  
In Pregnancy

AbstractObjectiveTo explore public health nutritionists’ perceptions of nutrition and its place in community pharmacy (CP) presently and into the future; and to explore perceived opportunities, feasibility and scope of public health nutrition (PHN) interventions in CP, with a focus on maternal and infant nutrition.DesignQualitative data were gathered through semi-structured interviews and drew on hermeneutics as the theoretical framework for analysis and interpretation.SettingQueensland, Australia.SubjectsPublic health nutritionists, identified through purposive, criterion sampling, were chosen due to (i) their role as potential stakeholders, (ii) their knowledge and emphasis on nutrition and (iii) their practice experience.ResultsOpportunities for PHN action focused primarily on actions relating to early nutrient supplementation in pregnancy and breast-feeding protection and promotion. Opportunities in CP were constrained by practitioners’ perception of (i) conflict between health care and commercial interests in CP, (ii) problematic practices in CP and (iii) values and motivations of practitioners and other stakeholders in the CP sector. Strategies were suggested to improve practices and enhance the setting from a PHN perspective. Participants suggested both collaborative and regulatory approaches to achieve settings-based changes, identifying the need for these to coexist for effective outcomes.ConclusionsPublic health nutritionists suggest that opportunities for PHN action are constrained by perceived conflicted interests and that consumers need to be adequately protected from the influence of commercial interests. PHN action in this setting needs adequate reflection on evidence as well as ethics ensuring that practices are ‘for the good’ of mothers and infants.

“We Got to Do Better”: Interactions Between School Counselors and Black Male Student-Athletes

2021 ◽  
Vol 25 (1_part_4) ◽  
pp. 2156759X2110400
Author(s):  
Paul C. Harris ◽  
Miray D. Seward ◽  
Renae D. Mayes ◽  
Liana Elopre ◽  
Ellie Wengert
Keyword(s):  
Critical Race Theory ◽  
School Counselors ◽  
Black Male ◽  
School Counselor ◽  
Student Athletes ◽  
Male Student ◽  
Semistructured Interview ◽  
Snowball Sampling ◽  
Black Male Student ◽  
Prior Experiences

This qualitative study explores the perspectives and experiences of Black male student-athletes with particular focus on their interactions with school counselors. It draws on nine participants selected through purposive and snowball sampling techniques. The Black male participants were current or former student-athletes at the high school and Division I levels. We developed and analyzed the semistructured interview questions through the lens of critical race theory. Using deductive data analysis techniques, we identified key factors that appear to shape interactions between Black male student-athletes and school counselors, including the perception of the school counselor role, a village of support, and prior experiences with school counselors. The results of this study have implications for school counselor practice, policy, and research.

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