scholarly journals Meeting the Needs of Maori with Diabetes: an Evaluation of a Nurse-Led Service

2021 ◽  
Author(s):  
◽  
Josephine Mary Elizabeth Janssen
Keyword(s):  
Health Care ◽  
Transtheoretical Model ◽  
Local Community ◽  
Diabetes Management ◽  
Service Providers ◽  
Management Support ◽  
Health Providers ◽  
Lifestyle Behaviour ◽  
Co Morbidity ◽  
Maori Health

<p>Designated Maori health service providers and specialised Maori nursing roles using "culturally appropriate" practices have been developed in New Zealand to address health disparities between Maori and non-Maori citizens. This study considers the effectiveness, from several perspectives, of a Maori nurse-led diabetes programme offered by Te Hauora O Ngati Rarua. It also identifies salient features of the experience of having diabetes and being on the programme, which consists of the combination of a six week course of group education sessions with one-to-one case management, involving health care, education and support. Programme evaluation was conducted using an embedded case study design. Seven programme participants were followed for 9-12 months, during which time multiple sources of data were accessed, including programme documents, clinical notes, laboratory results and stakeholder interviews. Client outcomes were measured in terms of physiological measures, knowledge acquisition, diabetes management and lifestyle behaviour. Some participants demonstrated improved diabetes management and lifestyle behaviour while actively engaged with the programme, but efforts tended to lapse once support was reduced. This highlighted the importance of optimising the level of long-term self-management support for clients with diabetes. High levels of co-morbidity were common and tended to complicate management. The Transtheoretical Model of Change, Chronic Care Model and Systems Theory shaped the evaluation. The study makes four important contributions to knowledge in this area: 1) it confirms the importance of Maori values and processes in "by Maori for Maori" services as they help to keep clients engaged, 2) it describes how small Maori health providers meet the needs of the local community, and 3) it identifies the value of the Maori Diabetes Nurse Educator (MDNE) role in primary health care. Thus it serves as an affirmation of the importance of the Maori Health Strategy and Maori self-determination in organising and delivering health care for Maori clients. The fourth valuable contribution is the insight gained into the dynamics of Pakeha researchers working in partnership with Maori organisations.</p>

scholarly journals Meeting the Needs of Maori with Diabetes: an Evaluation of a Nurse-Led Service

2021 ◽  
Author(s):  
◽  
Josephine Mary Elizabeth Janssen
Keyword(s):  
Health Care ◽  
Transtheoretical Model ◽  
Local Community ◽  
Diabetes Management ◽  
Service Providers ◽  
Management Support ◽  
Health Providers ◽  
Lifestyle Behaviour ◽  
Co Morbidity ◽  
Maori Health

<p>Designated Maori health service providers and specialised Maori nursing roles using "culturally appropriate" practices have been developed in New Zealand to address health disparities between Maori and non-Maori citizens. This study considers the effectiveness, from several perspectives, of a Maori nurse-led diabetes programme offered by Te Hauora O Ngati Rarua. It also identifies salient features of the experience of having diabetes and being on the programme, which consists of the combination of a six week course of group education sessions with one-to-one case management, involving health care, education and support. Programme evaluation was conducted using an embedded case study design. Seven programme participants were followed for 9-12 months, during which time multiple sources of data were accessed, including programme documents, clinical notes, laboratory results and stakeholder interviews. Client outcomes were measured in terms of physiological measures, knowledge acquisition, diabetes management and lifestyle behaviour. Some participants demonstrated improved diabetes management and lifestyle behaviour while actively engaged with the programme, but efforts tended to lapse once support was reduced. This highlighted the importance of optimising the level of long-term self-management support for clients with diabetes. High levels of co-morbidity were common and tended to complicate management. The Transtheoretical Model of Change, Chronic Care Model and Systems Theory shaped the evaluation. The study makes four important contributions to knowledge in this area: 1) it confirms the importance of Maori values and processes in "by Maori for Maori" services as they help to keep clients engaged, 2) it describes how small Maori health providers meet the needs of the local community, and 3) it identifies the value of the Maori Diabetes Nurse Educator (MDNE) role in primary health care. Thus it serves as an affirmation of the importance of the Maori Health Strategy and Maori self-determination in organising and delivering health care for Maori clients. The fourth valuable contribution is the insight gained into the dynamics of Pakeha researchers working in partnership with Maori organisations.</p>

scholarly journals Barriers and Facilitators to the Implementation of a Mobile Insulin Titration Intervention for Patients With Uncontrolled Diabetes: A Qualitative Analysis

10.2196/13906 ◽  
2019 ◽  
Vol 7 (7) ◽  
pp. e13906 ◽  
Author(s):  
Erin Rogers ◽  
Sneha R Aidasani ◽  
Rebecca Friedes ◽  
Lu Hu ◽  
Aisha T Langford ◽  
...  
Keyword(s):  
Health Care ◽  
Text Messaging ◽  
Diabetes Management ◽  
Unmet Need ◽  
Health Care Facilities ◽  
Future Research ◽  
Management Support ◽  
Implementation Climate ◽  
Time Saving ◽  
Provider Perceptions

Background In 2016, a short message service text messaging intervention to titrate insulin in patients with uncontrolled type 2 diabetes was implemented at two health care facilities in New York City. Objective This study aimed to conduct a qualitative evaluation assessing barriers to and the facilitators of the implementation of the Mobile Insulin Titration Intervention (MITI) program into usual care. Methods We conducted in-depth interviews with 36 patients enrolled in the MITI program and the staff involved in MITI (n=19) in the two health care systems. Interviews were transcribed and iteratively coded by two study investigators, both inductively and deductively using a codebook guided by the Consolidated Framework for Implementation Research. Results Multiple facilitator themes emerged: (1) MITI had strong relative advantages to in-person titration, including its convenience and time-saving design, (2) the free cost of MITI was important to the patients, (3) MITI was easy to use and the patients were confident in their ability to use it, (4) MITI was compatible with the patients’ home routines and clinic workflow, (5) the patients and staff perceived MITI to have value beyond insulin titration by reminding and motivating the patients to engage in healthy behaviors and providing a source of patient support, and (6) implementation in clinics was made easy by having a strong implementation climate, communication networks to spread information about MITI, and a strong program champion. The barriers identified included the following: (1) language limitations, (2) initial nurse concerns about the scope of practice changes required to deliver MITI, (3) initial provider knowledge gaps about the program, and (4) provider perceptions that MITI might not be appropriate for some patients (eg, older or not tech-savvy). There was also a theme that emerged during the patient and staff interviews of an unmet need for long-term additional diabetes management support among this population, specifically diet, nutrition, and exercise support. Conclusions The patients and staff were overwhelmingly supportive of MITI and believed that it had many benefits and that it was compatible with the clinic workflow and patients’ lives. Initial implementation efforts should address staff training and nurse concerns. Future research should explore options for integrating additional diabetes support for patients.

scholarly journals Health Care Experiences of Transgender Binary and Nonbinary University Students

2019 ◽  
Vol 47 (1) ◽  
pp. 59-97 ◽  
Author(s):  
Abbie E. Goldberg ◽  
Katherine A. Kuvalanka ◽  
Stephanie L. Budge ◽  
Madeline B. Benz ◽  
JuliAnna Z. Smith
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Graduate Students ◽  
Undergraduate Students ◽  
Service Providers ◽  
Health Providers ◽  
Gender Identities ◽  
Health Care Experiences ◽  
Health Service Providers ◽  
Nonbinary Gender

An increasing number of young adults identify with nonbinary gender identities. Yet health providers and therapists often lack understanding of such identities. In this mixed-methods study of 506 transgender undergraduate and graduate students, most of whom (75%) had nonbinary gender identities, we aimed to understand participants’ mental health and health care experiences, and factors related to misgendering and less affirming treatment by providers. Eighty-five percent of participants reported mental health challenges, and named fear of violence and nonsupport as distal stressors. Experiences with therapists and health providers were mixed. Salient features of negative interactions were invalidation, avoidance, or overemphasis in regard to participants’ nonbinary identities. Participants viewed counseling services as more affirming than health services. Nonbinary students reported more misgendering by therapists and health providers, and less trans-affirming care by health service providers, compared to binary students. Undergraduate students reported more misgendering by therapists and health providers than graduate students.

scholarly journals Barriers and Facilitators to the Implementation of a Mobile Insulin Titration Intervention for Uncontrolled Diabetes Patients: A Qualitative Analysis (Preprint)

2019 ◽  
Author(s):  
Erin Rogers ◽  
Sneha R Aidasani ◽  
Rebecca Friedes ◽  
Lu Hu ◽  
Aisha T. Langford ◽  
...  
Keyword(s):  
Health Care ◽  
Text Messaging ◽  
Diabetes Management ◽  
Health Care Systems ◽  
Unmet Need ◽  
Future Research ◽  
Management Support ◽  
Implementation Climate ◽  
Time Saving ◽  
Care Systems

BACKGROUND In 2016, a text-messaging intervention to titrate insulin in patients with uncontrolled type 2 diabetes was implemented at two health care systems in New York City. OBJECTIVE This study conducted a qualitative evaluation assessing barriers to, and facilitators of, implementation of the mobile insulin titration intervention (called “MITI”) into usual care. METHODS We conducted in-depth interviews with patients enrolled in the MITI program (N=36) and staff involved in MITI (N=19) at the two health care systems. Interviews were transcribed and iteratively coded by two study investigators both inductively and deductively using a codebook guided by the Consolidated Framework for Implementation Research. RESULTS Multiple facilitator themes emerged: 1) MITI had strong relative advantages to in-person titration including its convenience and time-saving design; 2) the free cost of MITI was important to patients; 3) MITI was easy to use and patients were confident in their ability to use MITI; 4) MITI was compatible with patients’ home routines and clinic workflow; 5) patients and staff perceived MITI to have value beyond insulin titration by reminding and motivating patients to engage in healthy behaviors and providing a source of patient support; and 6) implementation in clinics was made easy by having a strong implementation climate, communication networks to spread information about MITI, and a strong program champion. Barriers identified included: 1) language limitations; 2) initial nurse concerns about scope of practice changes required to deliver MITI; 2) initial provider knowledge gaps about the program; and 3) provider perceptions that MITI may not be appropriate for some patients (e.g., older, not tech-savvy). There was also a theme that emerged during patient and staff interviewees of an unmet need for longer-term, additional diabetes management support among this population, specifically diet, nutrition and exercise support. CONCLUSIONS Patients and staff were overwhelmingly supportive of MITI, believed it had many benefits and believed it was compatible with the clinic workflow and patient’s lives. Initial implementation efforts should address staff training and nurse concerns. Future research should explore options for integrating additional diabetes support for patients.

scholarly journals Implementing COVID-19 Surveillance Through Inter-Organizational Coordination: A Qualitative Study of Three Cities in Colombia

2021 ◽  
Author(s):  
Simon Turner ◽  
Carolina Segura ◽  
Natalia Niño
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Services ◽  
Disease Surveillance ◽  
Service Providers ◽  
Health Planning ◽  
Insurance Companies ◽  
Health Providers ◽  
Structured Interviews ◽  
Coordination Strategies

Abstract Introducing comprehensive surveillance is recommended as an urgent public health measure to control and mitigate the spread of COVID-19 worldwide. However, its implementation has proven challenging as it requires inter-organizational coordination among multiple health care stakeholders. The purpose of this study was to examine the role of soft and hard mechanisms in the implementation of inter-organizational coordination strategies for COVID-19 surveillance within Colombia, drawing on evidence from the cities of Bogotá, Cali and Cartagena. The study used a case study approach to understand the perspectives of local and national authorities, insurance companies and health providers in the implementation of inter-organizational coordination strategies for COVID-19 surveillance. 81 semi-structured interviews were conducted between June and November 2020. The data was analysed by codes and categorized using New NVivo software. The study identified inter-organizational coordination strategies that were implemented to provide COVID-19 surveillance in the three cities. Both soft (e.g. trust and shared purpose) and hard mechanisms (e.g. formal agreements and regulations) acted as mediators for collaboration and helped to address existing structural barriers in the provision of health services. The findings suggest that soft and hard mechanisms contributed to promoting change among health care system stakeholders and improved inter-organizational coordination for disease surveillance. The findings contribute to evidence regarding practices to improve coordinated surveillance of disease, including the roles of new forms of financing and contracting between insurers and public and private health service providers, logistics regarding early diagnosis in infectious disease, and the provision of health services at the community level regardless of insurance affiliation. Our research provides evidence to improve disease surveillance frameworks in fragmented health systems contributing to public health planning and health system improvement.

scholarly journals 'It's whanaungatanga and all that kind of stuff': Maori cancer patients’ experiences of health services

2013 ◽  
Vol 5 (4) ◽  
pp. 308 ◽  
Author(s):  
Tania Slater ◽  
Anna Matheson ◽  
Cheryl Davies ◽  
Huia Tavite ◽  
Triny Ruhe ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Services ◽  
Continuity Of Care ◽  
Cancer Care ◽  
Health Providers ◽  
Primary Health ◽  
Practical Support ◽  
Maori Health ◽  
The Impact

INTRODUCTION: There are unacceptable ethnic differences in cancer survival in Aotearoa/New Zealand. For people with cancer, quality of life and survival are shaped by access to care, but research on Maori access to, and through, cancer care is limited. Internationally, research has shown that primary care plays an important role in providing patient-centred, holistic care and information throughout the cancer care journey. Additionally, Maori health providers provide practical support and facilitate access to all levels of health care. Here we describe the cancer journeys of Maori patients and whanau and identify factors that may facilitate or inhibit access to and through cancer care services. METHODS: Twelve Maori patients affected by cancer and their whanau (family) in the lower North Island took part in face-to-face semi-structured interviews exploring their experiences of cancer screening, diagnosis, treatment, survival and palliative care. FINDINGS: Three key areas were identified that impacted upon the cancer care journey: the experience of support; continuity of care; and the impact of financial and geographic determinants. CONCLUSION: Primary care plays a key role in support and continuity of care across the cancer journey. Alongside interpersonal rapport, a long-term relationship with a primary health provider facilitated a more positive experience of the cancer care journey, suggesting that patients with a ‘medical home’ are happier with their care and report less problems with coordination between services. Positive, longstanding relationships with general practitioners and Maori health providers assisted patients and whanau with the provision and understanding of information, alongside practical support. KEYWORDS: Cancer; family; health services, indigenous; Maori health; primary health care cancer

scholarly journals Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes

2008 ◽  
Vol 32 (2) ◽  
pp. 330 ◽  
Author(s):  
Peter W Harvey ◽  
John N Petkov ◽  
Gary Misan ◽  
Jeffrey Fuller ◽  
Malcolm W Battersby ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Disease ◽  
Planning Process ◽  
Self Management ◽  
Service Utilisation ◽  
Management Support ◽  
Health Providers ◽  
Management Skills ◽  
Health Related ◽  
Health Related Behaviour

The Sharing Health Care SA chronic disease selfmanagement (CDSM) project in rural South Australia was designed to assist patients with chronic and complex conditions (diabetes, cardiovascular disease and arthritis) to learn how to participate more effectively in the management of their condition and to improve their self-management skills. Participants with chronic and complex conditions were recruited into the Sharing Health Care SA program and offered a range of education and support options (including a 6-week peer-led chronic disease self-management program) as part of the Enhanced Primary Care care planning process. Patient self-reported data were collected at baseline and subsequent 6-month intervals using the Partners in Health (PIH) scale to assess selfmanagement skill and ability for 175 patients across four data collection points. Health providers also scored patient knowledge and self-management skills using the same scale over the same intervals. Patients also completed a modified Stanford 2000 Health Survey for the same time intervals to assess service utilisation and health-related lifestyle factors. Results show that both mean patient self-reported PIH scores and mean health provider PIH scores for patients improved significantly over time, indicating that patients demonstrated improved understanding of their condition and improved their ability to manage and deal with their symptoms. These results suggest that involvement in peer-led selfmanagement education programs has a positive effect on patient self-management skill, confidence and health-related behaviour.

scholarly journals Community Clinic in Bangladesh: Empowering women through utilization and participation

2021 ◽  
Vol 16 (2) ◽  
pp. 54-64
Author(s):  
Baizid Khoorshid Riaz ◽  
Sk Akhtar Ahmad ◽  
Md Ziaul Islam ◽  
Liaquat Ali
Keyword(s):  
Health Care ◽  
Local Community ◽  
Service Providers ◽  
Development Program ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Community Members ◽  
Cross Sectional ◽  
Face To Face ◽  
Community People

Background: Community Clinics (CC) has been established to provide basic healthcare services at the doorstep of the community people in Bangladesh. Besides health care, government has taken a development program through CC to improve maternal health care with an aim to reduce the maternal mortality. This study was an attempt to find out the role of community women in the utilization and participation of CC management. Methods: This cross-sectional study was carried out in 32 randomly selected CCs from 16 randomly selected districts. A total of 63 service providers, 2238 service users (patients) and 3285 community members were included as the respondents of this study. For data collection respondents were interviewed face to face by using a pretested questionnaire. Results: The majority of the service providers of the CC were from the local community, and a higher proportion of them were female (52.4%). The providers provided healthcare services both in CC and at community level. A total of 2238 patients visited the 32 studied CCs per day for getting treatment and significantly a higher proportion of them were female (71.2%). Most of the patients (83.0%) expressed satisfaction with the services provided in the CCs and most of them were female (83.8%). Of the total 3285 respondents, 60.3% were the women from the catchment communities. The activities of the CC were known by all of them (98.3%) and they participated in the management of CC. Conclusions: The study revealed that because of utilization and participation in the management of CC, the women became an imperative person in the community, thus empowering them in healthcare development.

Impact of California Safe Patient Handling Legislation: Health Care Workers’ Perspectives

2021 ◽  
Vol 69 (3) ◽  
pp. 124-133
Author(s):  
Soo-Jeong Lee ◽  
Laura Stock ◽  
Victoria Michalchuk ◽  
Kelsie Adesoye ◽  
Kathleen Mullen
Keyword(s):  
Health Care ◽  
San Francisco ◽  
Health Care Workers ◽  
Qualitative Content Analysis ◽  
Management Support ◽  
Patient Handling ◽  
Safe Patient Handling ◽  
Care Workers ◽  
Policies And Programs ◽  
Safe Practices

Background: Musculoskeletal injuries from patient handling are significant problems among health care workers. In California, legislation requiring hospitals to implement safe patient handling (SPH) programs was enacted in 2011. This qualitative study explored workers’ experiences and perceptions about the law, their hospital’s SPH policies and programs, patient handling practices, and work environment. Methods: Three focus groups were conducted with 21 participants (19 nurses and 2 patient handling specialists) recruited from 12 hospitals located in the San Francisco Bay Area and San Joaquin Valley. Qualitative content analysis was used for data analysis. Results: Multiple themes emerged from diverse experiences and perceptions. Positive perceptions included empowerment to advocate for safety, increased awareness of SPH policies and programs, increased provision of patient handling equipment and training, increased lift use, and improvement in safety culture. Perceived concerns included continuing barriers to safe practices and lift use such as difficulty securing assistance, limited availability of lift teams, understaffing, limited nursing employee input in the safety committee, blaming of individuals for injury, increased workload, and continuing injury concerns. Participants indicated the need for effective training, sufficient staffing, and management support for injured workers. Conclusions/Application to Practice: This study identified improvements in hospitals’ SPH programs and practices since the passage of California’s SPH law, as well as continuing challenges and barriers to safe practices and injury prevention. The findings provide useful information to understanding the positive impacts of the SPH law but also notes the potential limitations of this legislation in the view of health care workers.

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