scholarly journals Perceptions of Ecuadorian indigenous healers on their relationship with the formal health care system: barriers and opportunities

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Estefanía Bautista-Valarezo ◽  
Víctor Duque ◽  
Veronique Verhoeven ◽  
Jorge Mejia Chicaiza ◽  
Kristin Hendrickx ◽  
...  
Keyword(s):  
Focus Groups ◽  
Health System ◽  
Ethnic Groups ◽  
Health Beliefs ◽  
Medical Knowledge ◽  
Phenomenological Approach ◽  
Traditional Healers ◽  
Health Staff ◽  
New Paradigm ◽  
Barriers And Opportunities

Abstract Background The new paradigm of intercultural policies focuses on rethinking the common public culture. In Ecuador, the “Buen Vivir” plan seeks to incorporate the ancestral medical knowledge, experience and beliefs of traditional healers into the formal health services. This study explores views on the formal health system from the perspective of the healers belonging to the Kichwa and Shuar ethnicities in the South of Ecuador. Methods A qualitative study with a phenomenological approach was performed. Focus groups were conducted in three locations in Southern Ecuador. Shuar, Kichwa and Mestizo ethnic groups were included in the research. Results Eleven focus groups with a total of 110 participants belonging to the Shuar, Kichwa and Mestizo ethnic groups participated in the study. Six themes were created through analysis: 1) conflicts with health professionals, 2) acceptance of traditional healers, 3) respect, 4) work as a team, 5) environment and patient care, and 6) salary and recognition. Conclusion This study indicated the perceived barriers compromising respectful collaboration between health staff and traditional healers from an indigenous perspective. Power inequalities and a historically unidirectional relationship and, in addition, differences in health beliefs, seem to create misunderstandings regarding each other’s approach when faced with health and disease. However, insight in these barriers can create opportunities towards collaboration, which will have a positive effect on patient confidence in one or both systems and support continuity between traditional healers and the formal health system.

scholarly journals Early supported hospital discharge for foot disease: a co-design study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rebecca Jessup ◽  
Samantha Hanna ◽  
Jaspreet Kaur ◽  
Iman Bayat ◽  
Cassandra Bramston
Keyword(s):  
Patient Satisfaction ◽  
Focus Groups ◽  
Health System ◽  
Delphi Study ◽  
Response Rate ◽  
Average Length ◽  
Comparative Method ◽  
Health Staff ◽  
Early Supported Discharge ◽  
Foot Disease

Abstract Background There are more than 10,000 admissions each year in Australia for foot disease, with an average length of hospital stay of 26 days. Early supported discharge (ESD) has been shown to improve patient satisfaction and reduce length of stay without increasing the risk of 30-day readmissions. This research aims to gain consensus on an optimal model of early supported discharge for foot disease. Methods Three focus groups were held where preliminary components for an early discharge model, as well as inclusion and exclusion criteria, were identified with a purposefully sampled group of medical, nursing, allied health staff and consumers. Two researchers independently systematically coded focus group transcripts to identify components of an ESD model using an iterative constant comparative method. These components then formed the basis of a three phase Delphi study, with all individuals from the focus groups were invited to act as panellists. Panellists rated components for their importance with consensus established as a rating of either essential or very important by ≥80% of the panel. Results Twenty-nine experts (including 5 consumers) participated across the two study phases. Twenty-three (3 consumers) participated in the focus groups in phase one. Twenty-eight of the twenty-nine experts participated in the phase 2 Delphi. 21/28 completed round 1 of the Delphi (75% response rate), 22/28 completed round 2 (79% response rate), and 16/22 completed round 3 (72% response rate). Consensus was achieved for 17 (29%) of 58 components. These included changes to the way patients are managed on wards (both location and timeliness of care by the multidisciplinary team) and the addition of new workforce roles to improve co-ordination and management of the patients once they are at home. Conclusions A model of early supported discharge that would allow individuals to return home earlier in a way that is safe, acceptable, and feasible may result in improving patient satisfaction while reducing health system burden. Future trial and implementation of the ESD model identified in this study has the potential to make a significant contribution to the experience of care for patients and to the sustainability of the health system.

scholarly journals ‘Sembur’ culture: Local wisdom in care of pregnant mother with malaria in Kupang

2020 ◽  
Vol 5 (1) ◽  
pp. 150
Author(s):  
Meyer Kapitan ◽  
Yuliana Dafroyati ◽  
Apryadno Jose Al Freadman Koa
Keyword(s):  
Pregnant Women ◽  
Health Beliefs ◽  
Local Community ◽  
Phenomenological Approach ◽  
Traditional Healers ◽  
Beliefs And Practices ◽  
Group Data ◽  
Field Notes ◽  
Health Beliefs And Practices ◽  
Depth Interviews

Malaria is one of the main public health problems in the province of East Nusa Tenggara (NTT). NTT currently ranks second in malaria cases in Indonesia after Papua. Pregnant women are a risk group, data show that pregnant women suffering from malaria complications in Kupang District is still very high due to the delay in treatment since many patients dominate the primary care of the traditional healer compared to health services. The traditional healers use herbs that are sprayed (sembur)to the patient. This action is an alternative treatment carried out by the local community because it is far from health facilities. Therefore, this study aims to determine the picture of semburculture in pregnant women suffering from malaria in Kupang Regency. This study uses qualitative techniques with a phenomenological approach. The informants were chosen by using purposive sampling and snowball approach. There were six informants, all of whom came from Kupang Regency. The data collected through depth interviews and field notes. Processing and analyzing data in the form of interview results are converted into verbatim transcripts and the results of field notes are analysed in the form of transcripts. The results of this study show three themes from all participants; (1) health beliefs and practices; (2) thoughts and feelings when conducting a sembur culture; (3) hope for a future life. This research is beneficial for maternal and child health as well as educational and service institutions.

Integrating traditional medical knowledge into mainstream healthcare in Limpopo Province

2018 ◽  
Vol 35 (5) ◽  
pp. 714-723 ◽  
Author(s):  
Jan Resenga Maluleka ◽  
Mpho Ngoepe
Keyword(s):  
Health System ◽  
Medical Knowledge ◽  
Sampling Technique ◽  
Traditional Healers ◽  
Traditional Healing ◽  
Limpopo Province ◽  
Snowball Sampling ◽  
Number Of Factors ◽  
Mainstream Healthcare ◽  
The Government

In most African states, the majority of the population depend on indigenous healing knowledge for their healthcare. This knowledge is in danger of being obliterated due to a number of factors such as it being not documented, low life expectancy where people die before transferring it to the next generation and the governments failing to incorporate it into the mainstream health system that is often overloaded. This qualitative study adopted a hermeneutic phenomenology to investigate the development of a framework to integrate knowledge of traditional healing into the mainstream healthcare system in the Limpopo province. Data were collected through interviews with traditional healers chosen through snowball sampling technique augmented by observations and analysis of legislation, notes, records and other forms of documents held by healers. Data were analysed and interpreted thematically according to the objectives of the study. The study established that indigenous medical knowledge is marginalised, and healers are not getting support from the government despite the important role they play in the national health systems. Traditional healing is not properly regulated creating a loophole for anyone to practise as a healer. A framework that points the link factors that attempt to create an understanding of how knowledge of traditional healing can be managed and integrated into the mainstream healing is proposed. It is concluded that failure to recognise traditional healing and integrate it in the mainstream health system will continue to hamstring the health system with resources in South Africa.

scholarly journals Early supported hospital discharge for foot disease: a co-design study

2021 ◽  
Author(s):  
Rebecca Jessup ◽  
Samantha Hanna ◽  
Jaspreet Kaur ◽  
Iman Bayat ◽  
Cassandra Bramston
Keyword(s):  
Patient Satisfaction ◽  
Focus Groups ◽  
Health System ◽  
Delphi Study ◽  
Response Rate ◽  
Average Length ◽  
Comparative Method ◽  
Health Staff ◽  
Early Supported Discharge ◽  
Foot Disease

Abstract Background: There are more than 10,000 admissions each year in Australia for foot disease, with an average length of hospital stay of 26 days. Early supported discharge (ESD) has been shown to improve patient satisfaction and reduce length of stay without increasing the risk of 30-day readmissions. This research aims to gain consensus on an optimal model of early supported discharge for foot disease. Methods: Three focus groups were held where preliminary components for an early discharge model, as well as inclusion and exclusion criteria, were identified with a purposefully sampled group of medical, nursing, allied health staff and consumers. Two researchers independently systematically coded focus group transcripts to identify components of an ESD model using an iterative constant comparative method. These components then formed the basis of a three phase Delphi study, with all individuals from the focus groups were invited to act as panellists. Panellists rated components for their importance with consensus established as a rating of either essential or very important by ≥80% of the panel. Results: Twenty-nine experts (including 5 consumers) participated across the two study phases. Twenty-three (3 consumers) participated in the focus groups in phase one. Twenty-eight of the twenty-nine experts participated in the phase 2 Delphi. 21/28 completed round 1 of the Delphi (75% response rate), 22/28 completed round 2 (79% response rate), and 16/22 completed round 3 (72% response rate).Consensus was achieved for 17 (29%) of 58 components. These included changes to the way patients are managed on wards (both location and timeliness of care by the multidisciplinary team) and the addition of new workforce roles to improve co-ordination and management of the patients once they are at home. Conclusions: A model of early supported discharge that would allow individuals to return home earlier in a way that is safe, acceptable, and feasible may result in improving patient satisfaction while reducing health system burden. Future trial and implementation of the ESD model identified in this study has the potential to make a significant contribution to the experience of care for patients and to the sustainability of the health system.

59. General medicine residents' perception of the mini-CEXs

2007 ◽  
Vol 30 (4) ◽  
pp. 61
Author(s):  
S. Malhotra ◽  
R. Hatala ◽  
C.-A. Courneya
Keyword(s):  
Internal Medicine ◽  
Medical Education ◽  
Focus Group ◽  
Qualitative Study ◽  
Focus Groups ◽  
General Medicine ◽  
Clinical History ◽  
Phenomenological Approach ◽  
Medical Teacher ◽  
The Impact

The mini-CEX is a 30 minute observed clinical encounter. It can be done in the outpatient, inpatient or emergency room setting. It strives to look at several parameters including a clinical history, physical, professionalism and overall clinical competence. Trainees are rated using a 9-point scoring system: 1-3 unsatisfactory, 4-6 satisfactory and 7-9 superior. Eight months after the introduction of the mini-CEX to the core University of British Columbia Internal Medicine Residents, a one hour semi-structured focus group for residents in each of the three years took place. The focus groups were conducted by an independent moderator, audio-recorded and transcribed. Using a phenomenological approach the comments made by the focus groups participants were read independently by three authors, organized into major themes. In doing so, several intriguing common patterns were revealed on how General Medicine Residents perceive their experience in completing a mini-CEX. The themes include Education, Assessment and Preparation for the Royal College of Physicians and Surgeons Internal Medicine exam. Resident learners perceived that the mini-CEX process provided insight into their clinical strengths and weaknesses. Focus group participants favored that the mini-CEX experience will benefit them in preparation, and successful completion of their licensing exam. Daelmans HE, Overmeer RM, van der Hem-Stockroos HH, Scherpbier AJ, Stehouwer CD, van der Vleuten CP. In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation. Medical Education 2006; 40(1):51-8. De Lima AA, Henquin R, Thierer J, Paulin J, Lamari S, Belcastro F, Van der Vleuten CPM. A qualitative study of the impact on learning of the mini clinical evaluation exercise in postgraduate training. Medical Teacher January 2005; 27(1):46-52. DiCicco-Bloom B, Crabtree BF. The Qualitative Research Interview. Medical Education 2006; 40:314-32.

scholarly journals Qualitative study using interviews and focus groups to explore the current and potential for antimicrobial stewardship in community pharmacy informed by the Theoretical Domains Framework

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e025101 ◽  
Author(s):  
Leah Ffion Jones ◽  
Rebecca Owens ◽  
Anna Sallis ◽  
Diane Ashiru-Oredope ◽  
Tracey Thornley ◽  
...  
Keyword(s):  
Focus Groups ◽  
Community Pharmacy ◽  
Antimicrobial Stewardship ◽  
Self Care ◽  
Intervention Development ◽  
Theoretical Domains Framework ◽  
Community Pharmacists ◽  
Pharmacy Staff ◽  
Barriers And Opportunities ◽  
The Impact

ObjectivesCommunity pharmacists and their staff have the potential to contribute to antimicrobial stewardship (AMS). However, their barriers and opportunities are not well understood. The aim was to investigate the experiences and perceptions of community pharmacists and their teams around AMS to inform intervention development.DesignInterviews and focus groups were used to explore the views of pharmacists, pharmacy staff, general practitioners (GPs), members of pharmacy organisations and commissioners. The questioning schedule was developed using the Theoretical Domains Framework which helped inform recommendations to facilitate AMS in community pharmacy.Results8 GPs, 28 pharmacists, 13 pharmacy staff, 6 representatives from pharmacy organisations in England and Wales, and 2 local stakeholders participated.Knowledge and skills both facilitated or hindered provision of self-care and compliance advice by different grades of pharmacy staff. Some staff were not aware of the impact of giving self-care and compliance advice to help control antimicrobial resistance (AMR). The pharmacy environment created barriers to AMS; this included lack of time of well-qualified staff leading to misinformation from underskilled staff to patients about the need for antibiotics or the need to visit the GP, this was exacerbated by lack of space. AMS activities were limited by absent diagnoses on antibiotic prescriptions.Several pharmacy staff felt that undertaking patient examinations, questioning the rationale for antibiotic prescriptions and performing audits would allow them to provide more tailored AMS advice.ConclusionsInterventions are required to overcome a lack of qualified staff, time and space to give patients AMS advice. Staff need to understand how self-care and antibiotic compliance advice can help control AMR. A multifaceted educational intervention including information for staff with feedback about the advice given may help. Indication for a prescription would enable pharmacists to provide more targeted antibiotic advice. Commissioners should consider the pharmacists’ role in examining patients, and giving advice about antibiotic prescriptions.

American Indian Behavioral Health Treatment Preferences as Perceived by Urban Indian Health Program Providers

2021 ◽  
pp. 104973232110578
Author(s):  
Andrew Pomerville ◽  
Anna Kawennison Fetter ◽  
Joseph P. Gone
Keyword(s):  
Focus Groups ◽  
American Indian ◽  
Behavioral Health ◽  
Cultural Values ◽  
The United States ◽  
Treatment Preferences ◽  
Health Staff ◽  
Indian Health ◽  
Urban Indian ◽  
Therapy Room

Behavioral health services specifically targeted for ethnoracial clients are typically tailored to the specific needs and preferences of these populations; however, little research has been done with American Indian clients specifically. To better understand how clinicians handle provision of treatment to this population, we interviewed 28 behavioral health staff at six Urban Indian Health Programs in the United States and conducted focus groups with 23 staff at five such programs. Thematic analysis of transcripts from these interviews and focus groups suggests that these staff attempt to blend and tailor empirically supported treatments with American Indian cultural values and practices where possible. Simultaneously, staff try to honor the client’s specific preferences and needs and to encourage clients to seek cultural practices and connection outside of the therapy room. In so doing staff members were acutely aware of the limitations of the evidence base and the lack of research with American Indian clients.

scholarly journals “Satanism is witchcraft’s younger sibling”: Changing perceptions of natural and supernatural anaemia causality in Malawian children

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250661
Author(s):  
Sarah Svege ◽  
Thandile Nkosi-Gondwe ◽  
Siri Lange
Keyword(s):  
Health Beliefs ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Treatment Options ◽  
Age Groups ◽  
Traditional Healers ◽  
Sub Saharan Africa ◽  
Local Health ◽  
Traditional Treatment ◽  
Poor Nutrition

In countries of sub-Saharan Africa, many children are admitted to hospital with severe forms of anaemia. The late hospital admissions of anaemic children contribute significantly to child morbidity and mortality in these countries. This qualitative study explores local health beliefs and traditional treatment practices that may hinder timely seeking of hospital care for anaemic children. In January of 2019, nine focus group discussions were conducted with 90 participants in rural communities of Malawi. The participants represented four groups of caregivers; mothers, fathers, grandmothers and grandfathers of children under the age of five. The Malawian medical landscape is comprised of formal and informal therapeutic alternatives–and this myriad of modalities is likely to complicate the healthcare choices of caregivers. When dealing with child illness, many participants reported how they would follow a step-by-step, ‘multi-try’ therapeutic pathway where a combination of biomedical and traditional treatment options were sought at varying time points depending on the perceived cause and severity of symptoms. The participants linked anaemia to naturalistic (malaria, poor nutrition and the local illnesses kakozi and kapamba), societal (the local illness msempho) and supernatural or personalistic (witchcraft and Satanism) causes. Most participants agreed that anaemia due to malaria and poor nutrition should be treated at hospital. As for local illnesses, many grandparents suggested herbal treatment offered by traditional healers, while the majority of parents would opt for hospital care. However, participants across all age groups claimed that anaemia caused by witchcraft and Satanism could only be dealt with by traditional healers or prayer, respectively. The multiple theories of anaemia causality combined with extensive use of and trust in traditional and complementary medicine may explain the frequent delay in admittance of anaemic children to hospital.

scholarly journals Drinking Carling Out of Stella Glasses: People and Place in the Missing Middle

2021 ◽  
Vol 5 ◽  
Author(s):  
Kathryn McEwan
Keyword(s):  
Young People ◽  
Focus Groups ◽  
Social Mobility ◽  
Phenomenological Approach ◽  
Housing Estate ◽  
Structured Interviews ◽  
Private Housing ◽  
The Uk ◽  
Qualitative Phenomenological ◽  
Missing Middle

As trends of social and economic change allow precarity to inch into the lives of those who may have been more accustomed to security (Standing, 2011, 2014), this paper addresses the response of some young people who are caught “betwixt and between” in potentially liminal states (Turner, 1967). Those whose families have undertaken intra- or intergenerational social mobility and who have made a home in a place, Ingleby Barwick in Teesside, that seems to be of them and for them—an in-between place that is seen as “not quite” middle or working class. This paper draws data from a research project that adopted a qualitative phenomenological approach to uncover the meaning of experiences for participants. Methods included focus groups and semi-structured interviews through which 70 local people contributed their thoughts, hopes, concerns, and stories about their lives now and what they aspire to for the future. Places, such as the large private housing estate in the Northeast of England on which this research was carried out, make up significant sections of the UK population, yet tend to be understudied populations, often missed by a sociological gaze attracted to extremes. It was anticipated that in Ingleby Barwick, where social mobility allows access to this relatively exclusive estate, notions of individualism and deservingness that underlie meritocratic ideology (Mendick et al., 2015; Littler, 2018) would be significant, a supposition borne out in the findings. “Making it” to Ingleby was, and continues to be, indicative to many of meritocratic success, making it “a moral place for moral people” (McEwan, 2019). Consequently, the threat then posed by economic precarity, of restricting access to the transitions and lifestyles that create the “distinction” (Bourdieu, 1984) required to denote fit to this place, is noted to be very real in a place ironically marked by many outside it as fundamentally unreal.

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