scholarly journals Healthcare professionals’ perspective on treatment burden and patient capacity in low-income rural populations: challenges and opportunities

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ruth Hardman ◽  
Stephen Begg ◽  
Evelien Spelten
Keyword(s):  
Mental Health ◽  
Chronic Disease ◽  
Health System ◽  
Low Income ◽  
Healthcare Providers ◽  
Self Management ◽  
Normalisation Process Theory ◽  
Treatment Burden ◽  
Health Providers ◽  
Patient Capacity

Abstract Background The challenges of chronic disease self-management in multimorbidity are well-known. Shippee’s Cumulative Complexity Model provides useful insights on burden and capacity factors affecting healthcare engagement and outcomes. This model reflects patient experience, but healthcare providers are reported to have a limited understanding of these concepts. Understanding burden and capacity is important for clinicians, since they can influence these factors both positively and negatively. This study aimed to explore the perspectives of healthcare providers using burden and capacity frameworks previously used only in patient studies. Methods Participants were twelve nursing and allied health providers providing chronic disease self-management support in low-income primary care settings. We used written vignettes, constructed from interviews with multimorbid patients at the same health centres, to explore how clinicians understood burden and capacity. Interviews were recorded and transcribed verbatim. Analysis was by the framework method, using Normalisation Process Theory to explore burden and the Theory of Patient Capacity to explore capacity. Results The framework analysis categories fitted the data well. All participants clearly understood capacity and were highly conscious of social (e.g. income, family demands), and psychological (e.g. cognitive, mental health) factors, in influencing engagement with healthcare. Not all clinicians recognised the term ‘treatment burden’, but the concept that it represented was familiar, with participants relating it both to specific treatment demands and to healthcare system deficiencies. Financial resources, health literacy and mental health were considered to have the biggest impact on capacity. Interaction between these factors and health system barriers (leading to increased burden) was a common and challenging occurrence that clinicians struggled to deal with. Conclusions The ability of health professionals to recognise burden and capacity has been questioned, but participants in this study displayed a level of understanding comparable to the patient literature. Many of the challenges identified were related to health system issues, which participants felt powerless to address. Despite their awareness of burden and capacity, health providers continued to operate within a single-disease model, likely to increase burden. These findings have implications for health system organisation, particularly the need for alternative models of care in multimorbidity.

scholarly journals Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e019192 ◽  
Author(s):  
Sharon Parker ◽  
Amy Prince ◽  
Louise Thomas ◽  
Hyun Song ◽  
Diana Milosevic ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Health Literacy ◽  
Healthcare Providers ◽  
Chronic Health Condition ◽  
Vulnerable Groups ◽  
Self Management ◽  
Future Research ◽  
Ehealth Literacy ◽  
Health Technologies ◽  
Vulnerable Patients

ObjectivesThe objective of this review was to assess the benefit of using electronic, mobile and telehealth tools for vulnerable patients with chronic disease and explore the mechanisms by which these impact patient self-efficacy and self-management.DesignWe searched MEDLINE, all evidence-based medicine, CINAHL, Embase and PsychINFO covering the period 2009 to 2018 for electronic, mobile or telehealth interventions. Quality was assessed according to rigour and relevance. Those studies providing a richer description (‘thick’) were synthesised using a realist matrix.Setting and participantsStudies of any design conducted in community-based primary care involving adults with one or more diagnosed chronic health condition and vulnerability due to demographic, geographic, economic and/or cultural characteristics.ResultsEighteen trials were identified targeting a range of chronic conditions and vulnerabilities. The data provided limited insight into the mechanisms underpinning these interventions, most of which sought to persuade vulnerable patients into believing they could self-manage their conditions through improved symptom monitoring, education and support and goal setting. Patients were relatively passive in the interaction, and the level of patient response attributed to their intrinsic level of motivation. Health literacy, which may be confounded with motivation, was only measured in one study, and eHealth literacy was not assessed.ConclusionsResearch incorporating these tools with vulnerable groups is not comprehensive. Apart from intrinsic motivation, health literacy may also influence the reaction of vulnerable groups to technology. Social persuasion was the main way interventions sought to achieve better self-management. Efforts to engage patients by healthcare providers were lower than expected. Use of social networks or other eHealth mechanisms to link patients and provide opportunities for vicarious experience could be further explored in relation to vulnerable groups. Future research could also assess health and eHealth literacy and differentiate the specific needs for vulnerable groups when implementing health technologies.

scholarly journals Unraveling PBF effects beyond impact evaluation: results from a qualitative study in Cameroon

2018 ◽  
Vol 3 (2) ◽  
pp. e000693 ◽  
Author(s):  
Manuela De Allegri ◽  
Maria Paola Bertone ◽  
Shannon McMahon ◽  
Idrissou Mounpe Chare ◽  
Paul Jacob Robyn
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Low Income ◽  
Impact Evaluation ◽  
Healthcare Providers ◽  
Analytical Techniques ◽  
Demand Side ◽  
Middle Income ◽  
Implementation Processes ◽  
Heterogeneous Effects

IntroductionPerformance-based financing (PBF) has acquired increased prominence as a means of reforming health system purchasing structures in low-income and middle-income countries. A number of impact evaluations have noted that PBF often produces mixed and heterogeneous effects. Still, little systematic effort has been channelled towards understanding what causes such heterogeneity, including looking more closely at implementation processes.MethodsOur qualitative study aimed at closing this gap in knowledge by attempting to unpack the mixed and heterogeneous effects detected by the PBF impact evaluation in Cameroon to inform further implementation as the country scales up the PBF approach. We collected data at all levels of the health system (national, district, facility) and at the community level, using a mixture of in-depth interviews and focus group discussions. We combined deductive and inductive analytical techniques and applied analyst triangulation.ResultsOur findings indicate that heterogeneity in effects across facilities could be explained by pre-existing infrastructural weaknesses coupled with rigid administrative processes and implementation challenges, while heterogeneity across indicators could be explained by providers’ practices, privileging services where demand-side barriers were less substantive.ConclusionIn light of the country’s commitment to scaling up PBF, it follows that substantial efforts (particularly entrusting facilities with more financial autonomy) should be made to overcome infrastructural and demand-side barriers and to smooth implementation processes, thus, enabling healthcare providers to use PBF resources and management models to a fuller potential.

scholarly journals Experiences of Telemental Health Providers and Support Staff Serving Indigenous Patients of Northern Canada

2020 ◽  
Author(s):  
Zhida Shang ◽  
Antonia Arnaert ◽  
Yvonne Hindle ◽  
Zoumanan Debe ◽  
Geneviève Côté-Leblanc ◽  
...  
Keyword(s):  
Mental Health ◽  
Patient Care ◽  
Healthcare Providers ◽  
Indigenous Communities ◽  
Support Staff ◽  
Inpatient Unit ◽  
Telemental Health ◽  
Health Providers ◽  
Structured Interviews ◽  
Local Staff

Abstract Background: It is known that there is a high mental health burden among Indigenous communities in Northern Quebec. The use of telemental health (TMH) may be a potential solution in addressing this burden, but its use in the Northern Quebec context has never been studied. Methods: A purposive sample of eight healthcare providers and support staff comprising of an entire TMH clinic serving Indigenous patients in Northern Quebec was recruited. A qualitative descriptive approach was adopted, and semi-structured interviews were conducted, concurrent with thematic data analysis.Results: Overall, the TMH staff have a very strong sense of communication, which allows them to diligently serve the Indigenous communities, and reflect upon their own practice. On the other hand, Northern patient care at the inpatient unit is seen as a work in progress, as there exists further potential for culturally sensitive Indigenous patient care. Both the TMH clinic and the inpatient unit address the mental health gap in Northern Quebec, where local staff turnover is adversely affecting patient care. As for the delivery of the mental health care, the in-person and videoconferencing consultations have a synergistic effect, since they allow for the TMH psychiatrists to maintain both an insider and outsider identity. Finally, a comprehensive electronic medical record and further administrative reforms are desperately needed, which would increase the efficiency of all components of the TMH clinic. Conclusions: TMH is an indispensable component of Northern patient care, but there is room for further improvements, especially with regards to the inpatient unit and documentation methods. This study may have implications towards the development and improvement of telemental health in Northern Quebec.

scholarly journals “A woman’s life is tension”: A gendered analysis of women’s distress in poor urban India

2020 ◽  
pp. 136346152094783 ◽  
Author(s):  
Saloni Atal ◽  
Juliet Foster
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Low Income ◽  
Urban Poverty ◽  
Burden Of Illness ◽  
Social Representations ◽  
Empirical Studies ◽  
Health Concern ◽  
Health Providers ◽  
Shared Meanings

The mental health of women living in poverty is a growing public health concern, particularly in India where the burden of illness is compounded by critical shortages in mental health providers and fragmented services. This was an exploratory study which sought to examine low-income women’s perceptions of mental illness and its management in the context of urban poverty in India. This research was prompted by the lack of empirical studies documenting how women in marginalized sections of society understand mental illness. Data were collected through a combination of 10 focus group discussions and two individual interviews with a total of 63 women residing in low-income areas of Mumbai. Social representations theory was used to explore shared meanings of mental illness among women in this setting. Thematic analysis of the data showed that women use the expression “tension” to talk about mental illness. Tension was described both as an ordinary part of life and a condition having its origins in more profound gender-related stressors, particularly pressures surrounding motherhood, chronic poverty and domestic conflict. Approaches to managing tension were pluralistic and focused on the resumption of social roles. Findings are consistent with other studies in similar cultural contexts, suggesting a shared, transnational character to women’s distress and the need for scholarship on women’s mental health in low-income settings to be more attuned to gendered forms of marginalization.

Strengthening mental health services in Sierra Leone: perspectives from within the health system

2020 ◽  
Vol 35 (6) ◽  
pp. 657-664
Author(s):  
Jessica J Fitts ◽  
Fatmata Gegbe ◽  
Mark S Aber ◽  
Daniel Kaitibi ◽  
Musa Aziz Yokie
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Care ◽  
Health System ◽  
Sierra Leone ◽  
Low Income ◽  
Health Initiatives

Abstract Though mental and substance use disorders are a leading cause of disability worldwide, mental health systems are vastly under-resourced in most low- and middle-income countries and the majority of people with serious mental health needs receives no formal treatment. Despite international calls for the integration of mental health into routine care, availability of outpatient mental health services and integration of mental health into the broader healthcare system remain weak in many countries. Efforts to strengthen mental healthcare systems must be informed by the local context, with attention to key health system components. The current study is a qualitative analysis of stakeholder perspectives on mental health system strengthening in one low-income country, Sierra Leone. It utilizes locally grounded knowledge from frontline healthcare providers to identify constraints and opportunities for strengthening mental health care within each component of the health system. In-depth semi-structured interviews were conducted with 43 participants including doctors, nurses, community health workers, mental health advocates, mental health specialists, and traditional healers recruited from the Bo, Moyamba and Western Area Urban Districts. Interview transcripts were content-coded in NVivo using both a priori and emergent codes and aggregated into broader themes, utilizing the World Health Organization Health Systems Framework. Participants described an extremely limited system of mental health care, with constraints and obstacles within each health system component. Participants identified potential strategies to help overcome these constraints. Findings reinforce the importance of factors outside of the healthcare system that shape the implementation of mental health initiatives, including pervasive stigma towards mental illness, local conceptualizations of mental illness and an emphasis on traditional treatment approaches. Implications for mental health initiatives in Sierra Leone and other low-income countries include a need for investment in primary care clinics to support integrated mental health services and the importance of engaging communities to promote the utilization of mental health services.

Improving the seniors’ transition from hospital to the community: a case for intensive geriatric service workers

2016 ◽  
Vol 29 (1) ◽  
pp. 149-163 ◽  
Author(s):  
Carrie A. McAiney ◽  
Loretta M. Hillier ◽  
Janice Paul ◽  
Jane McKinnon Wilson ◽  
Anna Tersigni Phelan ◽  
...  
Keyword(s):  
Health System ◽  
Healthcare Providers ◽  
Preliminary Evidence ◽  
Community Services ◽  
Self Management ◽  
Care Providers ◽  
Service Worker ◽  
Chart Audit ◽  
Care Plans ◽  
Geriatric Service

ABSTRACTBackground:Limited continuity of care, poor communication between healthcare providers, and ineffective self-management are barriers to recovery as seniors transition back to the community following an Emergency Department (ED) visit or hospitalization. The intensive geriatric service worker (IGSW) role is a new service developed in southern Ontario, Canada to address gaps for seniors transitioning home from acute care to prevent rehospitalization and premature institutionalization through the provision of intensive support and follow-up to ensure adherence to care plans, facilitate communication with care providers, and promote self-management. This study describes the IGSW role and provides preliminary evidence of its impact on clients, caregivers and the broader health system.Methods:This mixed methods evaluation included a chart audit of all clients served, tracking of the achievement of goals for IGSW involvement, and interviews with clients and caregivers and other key informants.Results:During the study period, 632 clients were served. Rates of goal achievement ranged from 25%–87% and in cases where achieved, the extent of IGSW involvement mostly exceeded recommendations. IGSWs were credited with improving adherence with treatment recommendations, increasing awareness and use of community services, and improving self-management, which potentially reduced ED visits and hospitalizations and delayed institutionalization.Conclusions:The IGSW role has the potential to improve supports for seniors and facilitate more appropriate use of health system resources, and represents a promising mechanism for improving the integration and coordination of care across health sectors.

Evaluation of the Chronic Disease Self-Management Program With Low-Income, Urban, African American Older Adults

2008 ◽  
Vol 25 (4) ◽  
pp. 193-202 ◽  
Author(s):  
Molly A. Rose ◽  
Christine Arenson ◽  
Pamela Harrod ◽  
Robyn Salkey ◽  
Abbie Santana ◽  
...  
Keyword(s):  
Older Adults ◽  
African American ◽  
Chronic Disease ◽  
Low Income ◽  
Management Program ◽  
Self Management ◽  
African American Older Adults

My health, myself: a qualitative study on motivations for effective chronic disease self-management among community dwelling adults

2020 ◽  
Vol 37 (6) ◽  
pp. 839-844
Author(s):  
Muhammad Danial Hadi ◽  
Yongxing Patrick Lin ◽  
Ee-Yuee Chan
Keyword(s):  
Chronic Disease ◽  
Chronic Diseases ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Good Health ◽  
Community Dwelling ◽  
Self Control ◽  
Self Management ◽  
Management Support ◽  
Healthcare Provision

Abstract Background Chronic diseases continue to be a significant cause of morbidity and mortality despite modifiable risk factors. This suggests that current primary healthcare provision needs to delve beyond patient education, to understand the motivators that drive patients to undertake chronic disease self-management. Understanding these motivations within the context of a multi-cultural community can facilitate tailored support for chronic disease self-management. Objectives To explore the motivations behind effective chronic disease self-management in community dwelling adults in Singapore. Methods A qualitative descriptive study was carried out in five clinics in a large medical centre. Twelve participants who were assessed to be optimally managing their chronic diseases were recruited using purposive sampling. Individual in-depth interviews were conducted until data saturation, with data thematically analysed. Results Three salient themes emerged from the data. Firstly, ‘Regaining self-control, avoiding complications’ describes the participants’ journey towards personal mastery in self-management, as well as a fear of debilitating complications resulting in their desire for good health. Secondly, ‘Preserving social identities and roles’ illustrates how participants yearn to maintain their pre-existing roles and functions through maintenance of their health. Finally, ‘Accessing proximal support systems’ highlights resources and supports surrounding the participants that encourage continued chronic disease self-management. Within each theme, specific motivators and challenges encountered by participants in their self-management journey were discussed. Conclusions Findings can prompt primary healthcare providers to leverage on the patients’ life goals and social roles in chronic disease self-management support. This may empower patients to engage in self-management and strengthen primary care provision.

scholarly journals Enablers and barriers to clinical leadership in the labour ward of district hospitals in KwaZulu-Natal, South Africa

BMJ Leader ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. 75-80
Author(s):  
Solange Mianda ◽  
Anna Silvia Voce
Keyword(s):  
Health System ◽  
Low Income ◽  
Clinical Skills ◽  
Healthcare Providers ◽  
Theory Approach ◽  
Dynamic Interactions ◽  
Clinical Leadership ◽  
District Hospitals ◽  
Kwazulu Natal ◽  
Labour Ward

Introduction and backgroundLike many health systems in low-income and middle-income countries, the South African health system has failed to decrease both maternal and perinatal mortality significantly, especially in district hospitals. Inappropriately trained healthcare providers and poor clinical leadership are repeatedly linked to healthcare providers’ preventable factors contributing to most maternal and perinatal deaths. Clinical skills of healthcare providers have been largely addressed, while clinical leadership remained neglected. One strategy implemented recently to support clinical leadership is the introduction of District Clinical Specialist Teams (DCSTs). Clinical leadership in the labour ward of district hospitals in KwaZulu-Natal (KZN) is conceptualised as an emergent phenomenon arising from dynamic interactions in the labour ward and the broader health system, converging to attain optimal patient care.AimTo evaluate the enablers and barriers to clinical leadership in the labour ward of district hospitals.MethodIterative data collection and analysis, following the Corbin and Strauss grounded theory approach, was applied. In-depth interviews were carried out with the midwifery members of the DCSTs in KZN. The emergent enablers and barriers to clinical leadership were presented and discussed at a workshop with broader midwifery representation, leading to a final classification of enablers and barriers to clinical leadership.Results and conclusionEnablers and barriers to clinical leadership arise as a result of emergent dynamic interactions within the labour ward and the broader health system, located at policy, organisational, team and individual healthcare provider levels, with the policy context as the overriding factor framing the implementation of clinical leadership.

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