Perception and Use of Primary Healthcare Services Among People With Cardiometabolic Diseases in Two Resource-Limited Areas in Nepal: A Mixed Methods Study

Nepal is a country in south Asia with a high burden of cardiometabolic diseases (CMDs). Strengthening primary healthcare (PHC) is a key strategy to mitigate this increasing burden and achieve universal health coverage. While previous studies in Nepal have assessed PHC use among the elderly, none have specifically explored PHC use among people with CMDs. Therefore, this mixed-methods study aimed to assess the use and perception of PHC services in Nepal among people living with CMDs for primary and secondary prevention of cardiovascular disease. We used a quantitative survey followed-up by semi-structured qualitative interviews. The sampling frame comprised five PHC facilities in Sindhuli district (rural; eastern Nepal) and five in Kailali district (urban; western Nepal), with participants selected from each facility via convenience sampling. 114 people (mean age: 54.5 ± 14.7, sex ratio 1.04) with CMDs participated in the survey. Survey data showed general dissatisfaction with PHC services. Medicine cost was rated “too expensive” by 52 and 63% of rural and urban participants, respectively. Interview data showed that perceived poor bedside manner was tied to negative perceptions of PHC quality, and vice versa. Lack of resources and excessive barriers to care was mentioned by every interviewee. In conclusion, PHC use was high but overall satisfaction relatively low. Our results suggest that bedside manner is a practical target for future research. Additionally, we identified several barriers to care, and, based on existing literature, we suggest electronic-health interventions may have potential to mitigate these challenges.

Download Full-text

Interprofessional teamwork in comprehensive primary healthcare services: Findings from a mixed methods study

Journal of Interprofessional Care ◽

10.1080/13561820.2017.1401986 ◽

2017 ◽

Vol 32 (3) ◽

pp. 274-283 ◽

Cited By ~ 5

Author(s):

Michael Bentley ◽

Toby Freeman ◽

Fran Baum ◽

Sara Javanparast

Keyword(s):

Mixed Methods ◽

Primary Healthcare ◽

Healthcare Services ◽

Mixed Methods Study ◽

Interprofessional Teamwork

Download Full-text

An Affair to Remember: A Mixed-Methods Survey Examining Therapists’ Experiences Treating Infidelity

The Family Journal ◽

10.1177/10664807211061826 ◽

2021 ◽

pp. 106648072110618

Author(s):

Taylor J. Irvine ◽

Paul R. Peluso

Keyword(s):

Mixed Methods ◽

Mixed Methods Study ◽

Personal History ◽

Future Research ◽

Present Survey ◽

Training Standards ◽

Recovery Treatment ◽

And Training

In this mixed-methods study, we analyzed data from 351 couple therapists who completed our Therapists' Experiences Treating Infidelity (TETI) survey. The present survey is a follow-up of previous iterations that examined therapists' attitudes toward infidelity and affair recovery treatment. Our TETI survey provided additional questions pertaining to therapists' personal history with affairs and perceptions on current research and training standards. Results showed that various therapist and couple factors serve to impede affair recovery treatment. Additionally, this survey revealed several similarities in therapists' attitudes from prior surveys, despite decades having passed between when the present survey and previous versions. In this article, we (a) outline findings from this mixed-methods survey, (b) discuss implications for the field, and (c) offer directions for future research.

Download Full-text

A Mixed Methods Study of Relationship Satisfaction in Parents of Children With Down Syndrome

Journal of Family Issues ◽

10.1177/0192513x211059827 ◽

2021 ◽

pp. 0192513X2110598

Author(s):

Kristen Krueger ◽

Paige Alexander ◽

Meghan Dyster ◽

Robert Steele ◽

Briana S. Nelson Goff ◽

...

Keyword(s):

Down Syndrome ◽

Mixed Methods ◽

Relationship Satisfaction ◽

National Sample ◽

Mixed Methods Study ◽

Future Research ◽

Negative Effects ◽

Children With Down Syndrome ◽

Parental Relationship ◽

And Coping

Much of the research on parents of children with intellectual and developmental disabilities (IDD) has focused on the negative effects on the couple relationship. The current study contributes to the understanding of parental relationship satisfaction in a sample of parents of children with Down syndrome (DS), through a mixed methods study that included data from a large national sample. Parents of children with DS were divided into two groups based on high and low relationship satisfaction scores, with quantitative and qualitative data analyses comparing these two groups. Results indicated differences between high relationship satisfaction and low relationship satisfaction groups on measures of hope, life satisfaction, and coping scores. Qualitative results also indicated group differences. Future research and implications for professionals working with parents of children with DS and other IDD diagnoses should include understanding the unique factors that affect interpersonal functioning.

Download Full-text

Access to, and experiences of, healthcare services by trafficked people: findings from a mixed-methods study in England

British Journal of General Practice ◽

10.3399/bjgp16x687073 ◽

2016 ◽

Vol 66 (652) ◽

pp. e794-e801 ◽

Cited By ~ 20

Author(s):

Joanne Westwood ◽

Louise M Howard ◽

Nicky Stanley ◽

Cathy Zimmerman ◽

Clare Gerada ◽

...

Keyword(s):

Mixed Methods ◽

Healthcare Services ◽

Mixed Methods Study

Download Full-text

3361 Feasibility, Acceptability, and Appropriateness of an Insertable Vaginal Cup to Manage Urinary Incontinence Among Women with Obstetric Fistula in Ghana: A Mixed Methods Study

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.105 ◽

2019 ◽

Vol 3 (s1) ◽

pp. 44-45

Author(s):

Nessa E Ryan

Keyword(s):

Urinary Incontinence ◽

Mixed Methods ◽

Repeated Measures ◽

Obstetric Fistula ◽

Mixed Methods Study ◽

Relative Advantage ◽

Self Management ◽

Future Research ◽

Leakage Reduction ◽

The Mean

OBJECTIVES/SPECIFIC AIMS: 1. To assess feasibility (efficacy, safety, acceptability) of the menstrual cup for managing urinary incontinence among women with obstetric fistula 2. To examine pre-implementation facilitators and barriers (including appropriateness) among additional stakeholders METHODS/STUDY POPULATION: Sequential explanatory mixed methods study whereby repeated measures clinical trial results are explained by subsequent interviews with additional women with OF on coping and stigma and other stakeholders on perceptions of fistula self-management. RESULTS/ANTICIPATED RESULTS: Of the 32 patients screened, 11 were eligible (100% consent rate). At baseline, mean (±SD) leakage in ml was 63.2 (±49.2) (95% CI: 30.2-96.3) over two hours, while the mean leakage over two hours of use of the cup was 16.8 (±16.5) (95% CI: 5.7-27.9). The mean difference of 46.4 (±52.1) ml with use of the cup (95% CI: 11.4-81.4) was statistically significant (p = 0.02). With the cup, women experienced an average 61.0% (±37.4) (95% CI: 35.9-86.2) leakage reduction, a difference 10/11 users (91.0%) perceived in reduced leakage. One participant, reporting four previous surgical attempts, experienced a 78.7% leakage reduction. Acceptability was high–women could easily insert (8/11), remove (8/11), and comfortably wear (11/11) the cup and most (10/11) would recommend it. No adverse effects attributable to the intervention were observed on exam, although some women perceived difficulties with insertion and removal. Data collection tools were appropriate with slight modification advised. Interviews highlighted that women were already using various active coping and resistance strategies but lacked access to tools to support coping. Additional stakeholders reported the innovation was a simple, low-cost device that is an appropriate fit with ongoing fistula programming. Pre-implementation facilitators include the clear relative advantage to existing self-management strategies, the potential to build upon existing partnerships to implement, and a tension for change to address surgical gaps. Barriers included additional stakeholder’s perceptions of low user acceptability and appropriateness in some cases and the need for additional study data to inform decision making for practice and policy. DISCUSSION/SIGNIFICANCE OF IMPACT: The innovation is efficacious, acceptable, adds to current coping strategies, and fits within existing fistula programs. Stakeholders’ pre-implementation perceptions highlight the importance of partnerships and the need for an evidence base related to effectiveness, acceptability, and cost. Challenges to address include access to resources within these contexts (water, soap, and safe space to empty cup) and development of a culturally appropriate counseling message. Future research warranted.

Download Full-text

Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya

10.21203/rs.2.17010/v3 ◽

2020 ◽

Author(s):

Peter O. Otieno ◽

Elvis Omondi Achach Wambiya ◽

Shukri M Mohamed ◽

Martin Kavao Mutua ◽

Peter M Kibe ◽

...

Keyword(s):

Primary Care ◽

Primary Healthcare ◽

Associated Factors ◽

Healthcare Services ◽

Urban Slums ◽

Public Facility ◽

Health Coverage ◽

Ordinal Logistic Regression Analysis ◽

Access To Primary Care ◽

Female Headed Households

Abstract Background: Access to primary healthcare is crucial for the delivery of Kenya’s universal health coverage policy. However, disparities in healthcare have proved to be the biggest challenge for implementing primary care in poor-urban resource settings. In this study, we assessed the level of access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. Methods: The data were drawn from the Lown scholars’ study of 300 randomly selected households in Viwandani slums (Nairobi, Kenya), between June and July 2018. Access to primary care was measured using Penchansky and Thomas’ model. Access index was constructed using principal component analysis and recorded into tertiles with categories labeled as poor, moderate, and highest. Generalized ordinal logistic regression analysis was used to determine the factors associated with access to primary care. The adjusted odds ratios (AOR) and 95 percent confidence intervals were used to interpret the strength of associations. Results: The odds of being in the highest access tertile versus the combined categories of lowest and moderate access tertile were 3.5 times higher for males than female-headed households (AOR 3.05 [95% CI 1.47-6.37]; p<.05). Households with an average quarterly out-of-pocket healthcare expenditure of ≥$30 had significantly lower odds of being in the highest versus combined categories of lowest and moderate access tertile compared to those spending ≤ $5.(AOR 0.36 [95% CI 0.18-0.74]; p<.05). Households that sought primary care from private facilities had significantly higher odds of being in the highest versus combined categories of lowest and moderate access tertiles compared to the public facilities (AOR 6.64 [95% CI 3.67-12.01]; p<.001). Conclusion: In Nairobi slums in Kenya, living in a female-headed household, seeking care from a public facility, and paying out of pocket for healthcare are significantly associated with low access to primary care. Therefore, the design of the UHC program in this setting should prioritize quality improvement in public health facilities and focus on policies that encourage economic empowerment of female-headed households to improve access to primary healthcare

Download Full-text

Patients’ Experiences of Engagement with Healthcare Services Following a High-Risk Self-Harm Presentation to a Hospital Emergency Department: A Mixed Methods Study

Archives of Suicide Research ◽

10.1080/13811118.2020.1779153 ◽

2020 ◽

pp. 1-21

Author(s):

Grace Cully ◽

Dorothy Leahy ◽

Frances Shiely ◽

Ella Arensman

Keyword(s):

Emergency Department ◽

Mixed Methods ◽

High Risk ◽

Healthcare Services ◽

Mixed Methods Study ◽

Hospital Emergency Department ◽

Hospital Emergency ◽

Self Harm

Download Full-text

Perceived barriers of tobacco dependence treatment: a mixed-methods study among primary healthcare physicians in Armenia

Primary Health Care Research & Development ◽

10.1017/s1463423618000828 ◽

2018 ◽

Vol 20 ◽

Cited By ~ 3

Author(s):

Arusyak Harutyunyan ◽

Armine Abrahamyan ◽

Varduhi Hayrumyan ◽

Varduhi Petrosyan

Keyword(s):

Smoking Cessation ◽

Mixed Methods ◽

Primary Healthcare ◽

Quantitative Data ◽

Tobacco Dependence ◽

Mixed Methods Study ◽

Perceived Barriers ◽

Smoking Cessation Counseling ◽

Tobacco Dependence Treatment ◽

Smoking Cessation Services

AbstractBackgroundDespite compelling evidence that physicians play a prominent role in smoking cessation, most smokers do not receive the recommended smoking cessation counseling.AimTo identify perceived barriers that hinder primary healthcare physicians (PHPs) from providing smoking cessation treatment to patients in Armenia.MethodsA sequential exploratory mixed-methods study was conducted among PHPs from two Armenian cities (Yerevan and Gyumri). We implemented qualitative phase through focus group discussions (FGDs) using a semi-structured guide. For the subsequent quantitative phase, the data were collected through cross-sectional survey. A directed deductive content analysis technique was used to analyze the FGDs and questionnaires were analyzed descriptively. Following the data collection (March 2015–May 2016) and descriptive analysis, the qualitative and quantitative data sets were merged by drawing quantitative data onto qualitative categories.FindingsOverall, 23 PHPs participated in five FGDs and 108 participants completed the survey. Three main categories of barriers were identified: physician-based, patient-based, and system-based barriers. The main physicians-based barriers were insufficient knowledge and inadequate training on tobacco-dependence treatment. Lack of patients’ motivation to quit, poor compliance with the treatment, patients’ withdrawal symptoms were identified as patient-based disincentives. System-based barriers included lack of reimbursement for providing smoking cessation counseling, high price and low availability of smoking cessation medications. Most of the qualitative descriptions were confirmed by quantitative findings.ConclusionsTargeted interventions are needed to address barriers that limited PHPs’ involvement in providing smoking cessation services in Armenia. There is an urgent need to enhance PHPs’ knowledge and skills in delivering smoking cessation counseling, to increase patients’ demand for smoking cessation services, and to ensure availability and affordability of smoking cessation services in Armenia.

Download Full-text