Eye health promotion-oriented policy statements in various national and provincial health policy documents in South Africa

Background: There are many fragmented public health policies that give directives towards various aspects of healthcare needs and implementation. However, none of these policies make specific reference to eye health promotion (EHP) as an enabler for individuals to take control of the determinants of their eye health (EH) needs.Aim: The current study sought to identify EHP messages in the various available policy documents at both national and provincial health department levels with a view to assessing awareness on the available gaps for the development of an integrated EHP policy in South Africa.Setting: The study used documents provided by the National Department of Health and those that were available online from various other provincial Departments of Health in the country.Methods: Content analysis of EH policies requested from the Directorate of Chronic Diseases, Disabilities and Geriatrics was conducted. Various other health policies that were enacted post-1994 and endorsed by the National and Provincial Departments of Health were also considered for analysis.Results: Twenty-four documents were considered for content analysis. The national guidelines on eye healthcare made reference to EH activities such as immunisation of children, vision screening of the elderly, vitamin A supplementation and maternal services to detect sexually transmitted diseases, amongst others. Of the 20 national and provincial health documents analysed, only four made reference to EH. None of these documents made any specific reference to EHP.Conclusion: Although four national guidelines contain content related to EHP, the fragmentation and lack of integration with other health policy documents may lead to eye healthcare messages not being prioritised for dissemination even where they are highly required. Also, public eye healthcare services in general will continue to lag behind as is the case in most provinces in South Africa.

URMC Universal Depression Screening Initiative: Patient Reported Outcome Assessments to Promote a Person-Centered Biopsychosocial Population Health Management Strategy

Background: Patient-reported outcomes (PROs) can promote person-centered biopsychosocial health care by measuring outcomes that matter to patients, including functioning and well-being. Data support feasibility and acceptability of PRO administration as part of routine clinical care, but less is known about its effects on population health, including detection of unmet healthcare needs. Our objectives were to examine differences in rates of clinically significant depression across sociodemographic groups and clinical settings from universal depression screens in a large health system, estimate the number of patients with untreated depression detected by screenings, and examine associations between biopsychosocial PROs—physical, psychological, and social health.Methods: We analyzed data from over 200,000 adult patients who completed depression screens—either PROMIS (Patient Reported Outcomes Measurement Information System) or PHQ-2/9—as part of routine outpatient care.Results: Depression screens were positive in 14.2% of the sample, with more positive screens among younger vs. older adults, women vs. men, non-White vs. White, and Hispanics vs. non-Hispanics. These same sociodemographic indicators, as well as completing screening in primary care (vs. specialty care) were also associated with greater likelihood of detected depression in the medical record.Discussion: Universal screening for depression symptoms throughout a large health system appears acceptable and has the potential to detect depression in diverse patient populations outside of behavioral health. Expanded delivery of PROs to include physical and social health as well as depression should be explored to develop a clinically-relevant model for addressing patients' biopsychosocial needs in an integrated fashion across the health system.

Cultural Factors and Social Changes Affecting Home Healthcare in Iran: A Qualitative Study

In Iran, home healthcare (HHC) is provided in a diverse socio-cultural context. Health professionals’ inadequate knowledge of the socio-cultural factors of the society can lead to poor quality HHC. Even so, the ways these factors influence HHC remain unclear. This study aimed to explore the effects of cultural factors and social changes on HHC in Iran. This qualitative study which follows a conventional content analysis approach was conducted in Tabriz, Iran. Eighteen individuals including nurses, home health directors, physicians, policy-makers, patients, and their families participated in the study. Participants were selected using purposive sampling. Data collection involved focus group discussion (FGD) and 16 semi-structured in-depth interviews. In order to analyze the data, Graneheim and Lundman’s techniques were used and data collection continued until saturation was reached. Five main themes emerged from the data analysis including cultural diversity issues, society’s understanding of HHC, shifting demographics affecting healthcare needs, transitioning from traditional to modern lifeways, and increasing unaffordability of healthcare. Health managers can improve the accessibility and acceptability of HHC services by identifying the socio-cultural needs of the society. Future research should develop and test patients and families’ cultural care models in the HHC setting.

Preliminary Study on a Novel Protocol for Improving Familiarity with a Lower-Limb Robotic Exoskeleton in Able-Bodied, First-Time Users

Lower-limb exoskeletons have been created for different healthcare needs, but no research has been done on developing a proper protocol for users to get accustomed to moving with one. The user manuals provided also do not include such instructions. A pre-test was conducted with the TWIN (IIT), which is a lower-limb exoskeleton made for persons with spinal cord injury. In the pre-test, two healthy, able-bodied graduate students indicated a need for a protocol that can better prepare able-bodied, first-time users to move with an exoskeleton. TWIN was used in this preliminary study and nine users were divided to receive a tutorial or no tutorial before walking with the exoskeleton. Due to COVID-19 regulations, the study could only be performed with healthy, young-to-middle-aged lab members that do not require walking support. The proposed protocol was evaluated with the System Usability Scale, NASA Raw Task Load Index, and two custom surveys. The members who received the tutorial found it easy to follow and helpful, but the tutorial seemed to come at a price of higher perceived mental and physical demands, which could stem from the longer testing duration and the need to constantly recall and apply the things learned from the tutorial. All results presented are preliminary, and it is recommended to include biomechanical analysis and conduct the experiment with more participants in the future. Nonetheless, this proof-of-concept study lays groundwork for future related studies and the protocol will be adjusted, applied, and validated to patients and geriatric users.

A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination personnel

Introduction & Importance: Effective, patient-centered care coordination has been shown to improve outcomes for children with special healthcare needs (CSHCN), who often have complex, long-term involvement with multiple service providers. Traumatic brain injury (TBI) can result in long-term physical, intellectual, social, and emotional disabilities that persist long after acute treatment. Yet, even though it is a chronic condition, TBI remains an area with scarce standardization and research surrounding the complex, long-term care coordination need in this population. The purpose of this scoping review is to summarize current research on outcomes in CSHCN after implementation of care coordinators, whether individual or teams, to inform future research for youth with TBI. Methods: OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination and CSHCN. Results: 31 articles met inclusion criteria. Outcomes for children and families were grouped into 5 major categories: healthcare utilization, cost of care, disease status, parent and child quality of life, and healthcare satisfaction and perception of care. Discussion: Implementation of care coordinators, whether in the form of individuals, dyads, or teams, resulted in overall positive outcomes for CSHCN and their families across all 5 major outcome domains. Future research should be focused on the efficacy of care coordinators differing in profession, qualifications, and educational attainment specifically for the unique needs of children with TBI. Additionally, the application of care coordination within medical homes should be further investigated to increase proactive, preventative care of children with TBI and further reduce reactive, need-based treatment only.

An Overview of an Undergraduate Diversity MCH Pipeline Training Program: USF’s Train-A-Bull

Purpose To describe an undergraduate pipeline training program (PTP) designed to guide underrepresented minorities (URM) trainees into MCH-related health professions, ultimately contributing to a diverse maternal and child health (MCH) workforce that can improve health outcomes for all women/mothers, children, and their families, including fathers and children with special healthcare needs. Description Three cohorts with 35 total undergraduate trainees were recruited to participated in the 2 years USF MCH PTP program where they were mentored, trained, guided, and supported by program faculty/staff. Students were recruited early in their education track, and the program was individually tailored based on trainees’ educational discovery stages. Key program components included seminars, summer institutes, public health courses, mentorship, internship, experiential learning opportunities, and professional networking opportunities. Assessment The majority of the undergraduate participants were diverse URMs including Hispanic/Latino (37.1%), Black/African American (31.4%), Asian (20%), and American Indian/Alaskan Native (5.7%) trainees. Out of all the cohorts, 51.4% were first-generation college students and 74.3% had economic hardships (i.e., PELL Grant, FAFSA). Resulting from the program, all cohorts increased in educational discovery stages, one-third enrolled in health-related graduate studies and half joined the MCH workforce. Conclusion Recruitment in pipeline programs should be intentional and meet students where they are in their education discovery stage. The use of educational discovery stages within a pipeline program are useful in both tailoring curriculum to individuals’ needs and assessment of progression in career decision-making. Mentoring from program staff remains an important component for pipeline programs.

A public health value-based healthcare paradigm for HIV

Background HIV patients face considerable acute and chronic healthcare needs and battling the HIV epidemic remains of the utmost importance. By focusing on health outcomes in relation to the cost of care, value-based healthcare (VBHC) proposes a strategy to optimize quality of care and cost-efficiency. Its implementation may provide an answer to the increasing pressure to optimize spending in healthcare while improving patient outcomes. This paper describes a pragmatic value-based healthcare framework for HIV care. Methods A value-based HIV healthcare framework was developed during a series of roundtable discussions bringing together 16 clinical stakeholder representatives from the Belgian HIV reference centers and 2 VBHC specialists. Each round of discussions was focused on a central question translating a concept or idea to the next level of practical implementation: 1) how can VBHC principles be translated into value-based HIV care drivers; 2) how can these value-based HIV care divers be translated into value-based care objectives and activities; and 3) how can value-based HIV care objectives and activities be translated into value-based care indicators. Value drivers were linked to concrete objectives and activities using a logical framework approach. Finally, specific, measurable, and acceptable structure, process and outcomes indicators were defined to complement the framework. Results Our framework identifies 4 core value areas where HIV care would benefit most from improvements: Prevention, improvement of the cascade of care, providing patient-centered HIV care and sustaining a state-of-the-art HIV disease management context. These 4 core value areas were translated into 12 actionable core value objectives. For each objective, example activities were proposed. Indicators are suggested for each level of the framework (outcome indicators for value areas and objectives, process indicators for suggested activities). Conclusions This framework approach outlines how to define a patient- and public health centered value-based HIV care paradigm. It proposes how to translate core value drivers to practical objectives and activities and suggests defining indicators that can be used to track and improve the framework’s implementation in practice.

Continuity of care for children with special healthcare needs during the COVID-19 pandemic

ABSTRACT Objective: To describe the continuity of care for children with special healthcare needs during the COVID-19 pandemic through the perception of their caregivers in the Northeast of Brazil. Methods: Qualitative descriptive-exploratory research carried out between June and September 2020, in a municipality in the Northeast of Brazil. Eleven caregivers participated through semi-structured interviews conducted at home. The data were submitted to thematic content analysis. Results: The social isolation period and the suspension of health services affected the continuity of care, configuring the category “Implications of the COVID-19 pandemic for the continuity of care”. Caregivers expressed fear of children contracting the coronavirus, characterizing the category “Fears and uncertainties of the COVID-19 pandemic in view of the vulnerability of children with special healthcare needs”. Final considerations: Caregivers’ reports revealed problems in the continuity of care for the studied cohort. Therefore, health care practices must be rethought in times of pandemic.

Contextualizing Healthcare Needs of the Transgender Community in Kerala

Kerala witnessed a transformation in recent times in the case of social acceptance of the transgender community. Participation in HIV/AIDS projects gave them some social recognition. There was a turning point in the situation when the Supreme Court judgement came in 2014 on National Legal Service Authority vs Government of India. It started to formulate policies and welfare schemes to support the transgender community. Following this, the Kerala government drafted the Transgender Policy in 2015. The present situation is much improved. Yet there is not much improvement in healthcare services. There is no protocol or guidelines for treatment, which may result in practice without quality assurance and high cost. This chapter is an attempt to review the situation of the transgender community in Kerala before and after the transgender policy to look into achievements and gaps in security measures, including healthcare access.