Tuberculosis care for migrant patients in Portugal: a mixed methods study with primary healthcare providers

Abstract Background We have shown that Ethiopian primary healthcare providers refer only half of the severely sick children who, according to guidelines, should get an urgent referral. Frequently parents of referred ill children don’t bring their children to the next level. We aimed to describe the referral of severely ill Ethiopian children based on primary healthcare register reviews and explore health care providers’ and parents’ perceptions regarding factors that hinder or enhance referral. Methods A mixed-methods study was conducted in 11 districts and a town administration of the Hadiya zone in Ethiopia’s Southern region from May to June 2019. Data collection included interviews and focus group discussions with healthcare providers, key informant interviews with parents of sick children who had been referred, and reviewing registers of sick children treated during the last 12 months at health posts and health centres. We analysed the association between healthcare providers’ and sick children’s characteristics and providers’ compliance with referral guidelines for sick children 0–59 months old. Content analysis was undertaken to explore the perceived factors that influenced referral and adherence to referral from providers’ and parents’ perspectives. Results Healthcare providers did not refer nearly half of the severely ill children that should have been referred, according to guidelines. Providers who had received in-service training on child healthcare were more likely to adhere to referral guidelines. The severity of the child’s illness and mobile phone communication and transport availability were perceived to be positively associated with adherence to referral guidelines. Lack of knowledge of treatment guidelines and skills, and high health worker workload, were among the factors perceived to be linked to lower adherence to guidelines. The healthcare providers considered parents of referred sick children as having low compliance with the referral advice. In contrast, parents had the opinion that compliance with a referral for sick children was high. Perceived awareness of severity of the child’s illness, ability to afford referral costs, and availability of transport or ambulance services were perceived to motivate parents to take their children to the referral facility. Traditional illness perceptions, lack of confidence in the referral site’s medical care, and a long distance were perceived to hurdle caregivers’ referral compliance. Conclusions We found that the healthcare providers’ adherence to referral guidelines was not optimal. Care providers and parents had divergent opinions on parents’ compliance with referral advice. Factors related to the health system, family economy, and available ambulance services influence whether care providers and parents pursued severely ill children’s referral. Adequate referral of sick children is an aspect of primary healthcare quality that is essential to avoid unnecessary under-five deaths.

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Risk perception on the labour ward: A mixed methods study

Journal of Patient Safety and Risk Management ◽

10.1177/25160435211002428 ◽

2021 ◽

Vol 26 (2) ◽

pp. 56-63

Author(s):

Claire McCarthy ◽

Sarah Meaney ◽

Marie Rochford ◽

Keelin O’Donoghue

Keyword(s):

Mixed Methods ◽

Lived Experience ◽

Healthcare Providers ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Daily Basis ◽

Mixed Methods Study ◽

Structured Interviews ◽

Staff Support ◽

Staff Wellbeing

Healthcare providers commonly experience risky situations in the provision of maternity care, and there has been increased focus on the lived experience in recent years. We aimed to assess opinions on, understanding of and behaviours of risk on the LW by conducting a mixed methods study. Staff working in a LW setting completed a descriptive questionnaire-based study, followed by qualitative structured interviews. Statistical analysis was performed with SPSS on quantitative data and thematic analysis performed on qualitative data. Nearly two thirds of staff (64%; 73/114) completed the questionnaire, with 56.2% (n = 47) experiencing risk on a daily basis. Experiencing risk evoked feelings of apprehension (68.4%; n = 50) and worry (60.2%; n = 44) which was echoed in the qualitative work. Structured clinical assessment was utilised in risky situations, and staff described “ going on autopilot” to manage these situations. A large number of respondents reflected on their provision of care following an adverse event (87.7%; n = 64). Debriefing was mentioned as an important practice following such events by all respondents. This study describes the negative terminology prevailing in emergency obstetric care. These experiences can have a profound impact on staff. Risk reduction strategies and the provision of increased staff support and training are crucial to improve staff wellbeing in stressful scenarios.

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Healthcare Providers’ Perceptions on the Timing of Initial Advance Care Planning Discussions in Japan: a Mixed-Methods Study

Journal of General Internal Medicine ◽

10.1007/s11606-020-06524-4 ◽

2021 ◽

Author(s):

Jun Miyashita ◽

Ayako Kohno ◽

Sayaka Shimizu ◽

Motohiro Kashiwazaki ◽

Noriki Kamihiro ◽

...

Keyword(s):

Mixed Methods ◽

Advance Care Planning ◽

Healthcare Providers ◽

Mixed Methods Study ◽

Care Planning ◽

Advance Care

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The ISTSS/Rand Guidelines on Mental Health Training of Primary Healthcare Providers for Trauma-Exposed Populations in Conflict-Affected Countries

Journal of Traumatic Stress ◽

10.1002/jts.20094 ◽

2006 ◽

Vol 19 (1) ◽

pp. 5-17 ◽

Cited By ~ 16

Author(s):

David Eisenman ◽

Stevan Weine ◽

Bonnie Green ◽

Joop de Jong ◽

Nadine Rayburn ◽

...

Keyword(s):

Mental Health ◽

Primary Healthcare ◽

Healthcare Providers ◽

Mental Health Training ◽

Health Training ◽

Primary Healthcare Providers

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Evidence-based intrapartum practice and its associated factors at a tertiary teaching hospital in the Philippines, a descriptive mixed-methods study.

10.21203/rs.2.16741/v4 ◽

2020 ◽

Author(s):

Chisato Masuda ◽

Shirley Kristine Ferolin ◽

Ken Masuda ◽

Chris Smith ◽

Mitsuaki Matsui

Keyword(s):

Mixed Methods ◽

Associated Factors ◽

Healthcare Providers ◽

The Philippines ◽

Mixed Methods Study ◽

Evidence Based ◽

Factors Associated ◽

Second Stage ◽

Assisted Delivery ◽

Fundal Pressure

Abstract Background Evidenced-based practice is a key component of quality care. However, studies in the Philippines have identified gaps between evidence and actual maternity practices. This study aims to describe the practice of evidence-based intrapartum care and its associated factors, as well as exploring the perceptions of healthcare providers in a tertiary hospital in the Philippines. Methods A mixed-methods study was conducted, which consisted of direct observation of intrapartum practices during the second and third stages, as well as semi-structured interviews and focus group discussions with care providers to determine their perceptions and reasoning behind decisions to perform episiotomy or fundal pressure. Univariate and multivariate logistic regression were used to analyse the relationship between observed practices and maternal, neonatal, and environmental factors. Qualitative data were parsed and categorised to identify themes related to the decision-making process. Results A total of 170 deliveries were included. Recommended care, such as prophylactic use of oxytocin and controlled cord traction in the third stage, were applied in almost all the cases. However, harmful practices were also observed, such as intramuscular or intravenous oxytocin use in the second stage (14%) and lack of foetal heart rate monitoring (57%). Of primiparae, 92% received episiotomy and 31% of all deliveries received fundal pressure. Factors associated with the implementation of episiotomy included primipara (adjusted Odds Ratio [aOR] 62.3), duration of the second stage of more than 30 minutes (aOR 4.6), and assisted vaginal delivery (aOR 15.0). Factors associated with fundal pressure were primipara (aOR 3.0), augmentation with oxytocin (aOR 3.3), and assisted delivery (aOR 4.8). Healthcare providers believe that these practices can prevent laceration. The rate of obstetric anal sphincter injuries (OASIS) was 17%. Associated with OASIS were assisted delivery (aOR 6.0), baby weights of more than 3.5 kg (aOR 7.8), episiotomy (aOR 26.4), and fundal pressure (aOR 6.2). Conclusions Our study found that potentially harmful practices are still conducted that contribute to the occurrence of OASIS. The perception of these practices is divergent with current evidence, and empirical knowledge has more influence. To improve practices the scientific evidence and its underlying basis should be understood among providers.

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