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PubMed2004

Evidence-based priority-setting: what do the decision-makers think?

OBJECTIVES: Resource scarcity dictates the need for health organisations to set priorities. Although such activity should be based, at least in part, on evidence, there are limited examples in the literature of decision-makers reflecting on their use of evidence in priority-setting. METHODS: A participatory action-research project was conducted in a single health authority in Alberta. It included in-depth interviews and focus groups with senior decision-makers both before and after development and implementation of a macro-level priority-setting framework (programme budgeting and marginal analysis, PBMA). Data were thematically coded and information on the use of evidence in priority-setting is reported. RESULTS: Barriers to the use of evidence in priority-setting identified by decision-makers included crisis-orientated management, time constraints and a lack of skills. Decision-makers suggested using a mix of 'soft' and 'hard' forms of evidence in priority-setting. Following PBMA implementation, decision-makers wanted better information on capacity to benefit, but preferred to do this pragmatically from multiple sources of information rather than using a single metric. CONCLUSION: In examining the perspectives of decision-makers in using evidence to support priority-setting, valuable information was derived which should provide insight for such processes in other jurisdictions. The main finding of a desire for pragmatic assessment of benefit is informative for those involved in both decision-making and research.

Alberta↗

PubMed2002

Walk-in clinics in Ontario. An atmosphere of tension.

OBJECTIVE: To explore family practice (FP), emergency department (ED), and walk-in clinic (WIC) physicians' perceptions and experiences regarding the effect of walk-in clinics on Ontario's health care system. DESIGN: Qualitative method of focus groups. SETTING: Hamilton, London, and Toronto, Ont. PARTICIPANTS: Sixty-three physicians participated in nine focus groups, each with four to nine participants. Family physicians, ED physicians, and WIC physicians attended separate focus groups. METHOD: Nine focus groups were conducted in three cities in Ontario. Physicians' opinions, perceptions, and experiences regarding the role and effect of WICs on Ontario's health care system were explored. Focus groups were audiotaped and comments transcribed verbatim. The qualitative data analysis program NUD*IST was used to organize the data during sequential thematic analysis. MAIN FINDINGS: Participants identified two key factors contributing to the evolution of WICs: patients' expectations for convenient health care and the perceived limited availability of family physicians. Participants thought these two related factors resulted in a gap in primary care services that WICs had filled. Throughout discussions, an atmosphere of tension permeated the focus groups. Tension seemed to arise from issues of duplication, competition, standards of practice and quality of care in WICs, the effect of environmental and personal factors on physicians' practice, and the practice philosophy adopted by WIC physicians. CONCLUSION: Both FP and ED participants acknowledged their contribution to the gap in primary care services. They appeared to attribute current problems in health care delivery to the perceived deficiencies of WICs. The outcome was a marked tension among participants.

Ambulatory Care Facilities↗

PubMed2003

The meaning of health and well-being: voices from older rural women.

INTRODUCTION: The impact of geographical location on the maintenance of older rural women's health and well-being has been largely unexamined in the research literature. Contextual explanations of environmental impact on health status have been traditionally been assigned to a narrow picture of rural life which emphasized occupational health at the expense of sociological aspects. There have been many research programs about ageing Australian people in urban areas but few concerning the older rural population. Few clues can be found as to how their needs and expectations may differ from those of their urban counterparts. The size of Australia's older population is increasing and steadily becoming feminised. Approximately 37% of these older women live outside capital cities in rural and remote areas. For those planning services for this group of older women, the influence of the rural and remote social and physical context on health and well-being must be understood and considered. METHODS: Data were collected in 2001 for this qualitative study from the five old (78-88 years), widowed rural women participants who had lived most of their lives on farms, by in-depth interviewing regarding life history, and by using personal document strategies. The life history research approach guided data collection, while thematic analysis was employed to avoid examining isolated themes. Social constructionism and socio-environmental theory of gerontology provided the philosophical boundaries to the central research question. RESULTS: While each informant's life history was unique, it was found that the informants' health and well-being were profoundly influenced by the geographical location of living on the land. CONCLUSION: This small study, which should be extended by a larger study, may be seen as a beginning step in defining health promotional activities, policy development and service programs for older rural women that are both person-centered and sensitive to their unique lifestyle.

Journal Article↗

PubMed2003

How children affect the mother/victim's process in intimate partner violence.

BACKGROUND: Witnessing intimate partner violence (IPV) causes physical and mental health problems for children. Children are one of multiple factors that a victim weighs as she manages the abusive relationship. Little has been written about how children affect the mother's decisions about the abuse or what assistance a mother wants from the children's physician in creating a nonabusive home. OBJECTIVE: To consider the role children play in their mothers' management of abusive partners. METHODS: Thirty-two mothers living in midwestern IPV shelters or participating in support groups were interviewed about their abuse stories, perceptions about the effects of the abuse on their children, and desires about IPV management in the health care setting. The interviews were audiotaped, transcribed, and analyzed by a team of researchers using thematic analysis. RESULTS: Children were an integral factor in the mothers' management of their abusive relationships. For more than half of the participants, something the children did or said catalyzed their seeking help. For some, the children's attachment to the abuser was a reason to delay seeking assistance. Based on these findings, we explored what mothers wanted from their children's physicians regarding their abusive relationships. Mothers talked about the delicate balance between education and blame, between offering help and becoming too intrusive, and between wanting the best for their children and fearing the involvement of child protective services. CONCLUSIONS: Children play an important role in mothers' management of their abusive relationships. From their children's physicians, participants wanted IPV screening and IPV resources. Some wanted the physician to educate them about how the IPV affected the children in a nonblaming manner.

Adolescent↗

PubMed2026

Factors associated with successful integration of pharmacists into residential aged care teams: A qualitative study.

BACKGROUND: Australia's Aged Care Onsite Pharmacist program aims to support quality use of medicines in residential aged care homes. This is a novel role introduced into existing teams in a complex environment. Factors associated with successful integration since implementation are currently unknown. AIM: This study aims to explore the perspectives of pharmacists and other stakeholders within aged care homes regarding successful integration of the novel aged care pharmacist service into healthcare teams. METHODS: A qualitative approach, using interpretive descriptive methodology, was used to explore perspectives. Semi-structured focus groups and interviews with pharmacists, nursing and care staff, allied health professionals, general practitioners, residents, and family members were undertaken. Data were collected via Zoom™, audio- and video-recorded, and transcribed verbatim. Two researchers undertook inductive thematic analysis to identify key themes. RESULTS: 30 participants across focus groups, focus-group interviews, interviews, and member-checking processes contributed. An overarching theme of proactivity and showing a genuine interest in others underpinned three key themes. Theme 1: Pharmacists needed to be seen, through physical presence and availability, as well as developing a distinct identity. Theme 2: Pharmacists needed to build trust, through collaboration in real time and demonstrating value. Theme 3: Pharmacists needed to develop an understanding of the aged care home environment, including social and contextual norms, as well as procedures, routines and roles. DISCUSSION: This research complements existing understandings of interprofessional collaboration and teamwork amongst healthcare professionals. Themes were interlinked; we used a sensitising framework, social cognitive theory, to present and explain the findings and interactions that can support pharmacist integration into existing teams. Aged care services should structure onboarding to prioritise early visibility, clarify roles and organisational needs, and foster in-person collaboration. Pharmacists should demonstrate proactivity and an authentic interest in all staff, residents and families.

Humans↗

PubMed2002

Introducing printed postpartum orders for measles-mumps-rubella vaccination: a qualitative study.

OBJECTIVE: After introducing printed postpartum orders at our centre, we observed a large increase in measles-mumps-rubella (MMR) vaccination of susceptible women. The objective of this study was to ascertain factors responsible for the success of our approach and to identify potential obstacles so as to facilitate the implementation of similar policies at other hospitals. METHODS: For this qualitative study, taped semi-structured interviews were carried out with physicians, nurses, and a ward clerk regarding their views on postpartum MMR vaccination and on various aspects of implementing a printed postpartum order sheet that included MMR vaccination of susceptible women. Interviews were transcribed and the responses classified by theme. Thematic analysis was used to identify strengths and weaknesses of this approach. RESULTS: Following implementation of printed postpartum orders that included MMR vaccination of susceptible women, the proportion of eligible women vaccinated increased from 12.1 to 81.7% (risk ratio 6.8, 95% confidence interval [CI] 3.3, 13.7). While the physician and nursing staff broadly supported this initiative, we identified the need for changes in obstetrical care and documentation: most importantly, a comprehensive protocol with supporting information and guidelines should be provided for postpartum nurses; and a system must be in place to ensure that the completed antenatal record, including screening test results, be available in the expected hospital of delivery by the late second trimester. CONCLUSION: Previously undocumented claims that standing orders for postpartum MMR vaccination will increase the rate of vaccination of susceptible women have now been substantiated at one centre. Nevertheless, careful infrastructure and systems changes are required to ensure implementation of such orders.

Female↗

PubMed1999

The relationship between expectations and satisfaction: a qualitative study of patients' experiences of surgery for gynaecological cancer.

It is important that a patient perspective is introduced to the identification and measurement of the outcomes of health care. The aim of this study was to use qualitative methods to examine the presence or absence of expectations prior to the experience of health care and the relationship between expectations, satisfaction and dissatisfaction in a group of women undergoing surgery in a large teaching hospital. Nineteen women with a diagnosis of gynaecological cancer were interviewed on two occasions, before and after surgery. A thematic analysis was undertaken. The results suggest that there is not a clear relationship between expectations and satisfaction. Women had different levels of expectations about different types of care and different aspects of care. Unfulfilled expectations did not lead to less satisfaction. The women were able to express satisfaction either with the care overall or with specific aspects of care, as well as being able to distinguish aspects of care with which they were dissatisfied.

Journal Article↗

PubMed2005

End-of-life care and African Americans: voices from the community.

BACKGROUND: In 1997, the Institute of Medicine called for reform, improved quality and expanded research in end-of-life care. Yet little empirical information about preferences of African Americans has been documented. A community-campus partnership was formed to guide a needs assessment related to end-of-life care in a Southern, urban, African American community. This paper presents focus group findings related to end-of-life and palliative care. METHODS: A qualitative design of multiple-meeting focus groups was used to explore experiences, preferences, needs, and feelings expressed by family members with at least one relative who had died in a hospital (group 1) or at home (group 2). Sessions were taped and transcribed; themes were identified using systematic analytic procedures. RESULTS: Thematic analysis revealed key concerns related to health care provider communications about end-of-life care and dying. Positive communications empowered and showed respect for patients and family members and recognized the importance of their spiritual beliefs; informed them about resources available to assist dying at home; and, for patients dying in the hospital, treated them with nurturing, compassion, and diligent monitoring of the patient's medical status and needs. Other themes related to end-of-life care issues include preparation, planning, and access. A table of quotes from participants is available from the corresponding author. CONCLUSIONS: Findings suggest important clinical implications for clinicians and other health professionals. These voices from the community remind us of the heterogeneity in needs and preferences and challenge us to listen and tailor communication to each patient and their families.

Black or African American↗

PubMedDate not supplied

Attitudes of Chinese parents toward the oral health of their children with caries: a qualitative study.

PURPOSE: The purpose of this study was to investigate Chinese parents' beliefs and perspectives regarding extensive caries (EC), oral care habits, and dental treatment. An overview of qualitative research methods is provided. METHODS: In this qualitative study, 20 in-depth interviews were conducted with parents of children diagnosed with EC. Parents lived in a major metropolitan area, and many were newly immigrated. Parents who accepted or refused dental treatment for their children under general anesthesia or sedation were included. Transcribed interviews were analyzed using standard thematic analysis. RESULTS: Negative themes were: (1) fear of dental anesthesia and its adverse effects; (2) parents' own lack of dental education as children; (3) lack of social support in seeking dental treatment; (4) inadequate knowledge of oral hygiene; and (5) cultural beliefs that did not support the preservation of the primary dentition. Positive themes were: (1) trust in the providers and in Western medicine; and (2) satisfaction with outcomes of dental treatment. CONCLUSIONS: Several factors were found that could contribute to a higher rate of EC in this population. Providers can benefit from this study by anticipating what practices and attitudes are common in this community. Earlier intervention and delivery of culturally sensitive care can prevent or delay progression of this dental disease.

Asian↗

PubMed2006

User involvement in healthcare technology development and assessment: structured literature review.

PURPOSE: Medical device users are one of the principal medical device technology stakeholders. The involvement of users in medical device technology development and assessment is central to meet their needs. This study aims to examine this issue. DESIGN/METHODOLOGY/APPROACH: A structured review of the literature published from 1980 to 2005 in peer-reviewed journals was carried out from a social science perspective to investigate user involvement practice in the development and assessment of medical device technologies. This was followed by a qualitative thematic analysis. FINDINGS: Medical device users include clinicians, patients, carers and others. Different kinds of medical devices are developed and assessed by user involvement. The user involvement occurs at different stages of the medical device technology lifecycle and the degree of user involvement is in the order of: design > testing and trials > deployment > concept stages. The methods most commonly used for capturing users' perspectives are usability tests, interviews and questionnaire surveys. RESEARCH LIMITATIONS/IMPLICATIONS: The relevant engineering, medical and nursing literature, which might have been useful, was not reviewed. However, useful findings emerge that apply to health care generally. ORIGINALITY/VALUE: This study shows that medical device users are not homogeneous but heterogeneous in several aspects, such as needs, skills and working environments. This is an important consideration for incorporating users' perspectives in medical device technologies.

Community Participation↗

PubMed2005

Cutting across boundaries: a case study using feminist praxis to understand the meanings of self-harm.

Deliberate self-harm predominantly occurs in women under the age of 30 years. This qualitative case study using feminist methods explored the experiences of three women who each had a long history of self-harming behaviour. Psychoanalytical concepts are used to explore the meaning of the conflicts that these women experience. Emergent themes include: great expectations, I speak but no one hears, sexual naivety meets sexual violence, and redrawing the sexual map. This thematic analysis helps facilitate an insight into what these women are trying to communicate, and provides guidance for mental health professionals to more effectively respond to the challenges of working with women who self-harm.

Adolescent↗

PubMed2006

German ambulatory care physicians' perspectives on clinical guidelines - a national survey.

BACKGROUND: There has been little systematic research about the extent to which German physicians accept or reject the concept and practice of a) clinical practice guidelines (CPG) and b) evidence based medicine (EBM)The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice. METHODS: Structured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Likert scale). 511 office-based general practitioners and specialists. Main outcome measures were the application of Clinical Practice Guidelines in daily practice, preference for sources of guidelines and degree of knowledge and acceptance of EBM. In the data analysis Pearson's correlation coefficient was used for explorative analysis of correlations. The comparison of groups was performed by Student's t-test. Chi2 test was used to investigate distribution of two or more categorical variables. RESULTS: Of the total study population 55.3% of physicians reported already using guidelines in the treatment of patients. Physicians in group practices (GrP) as well as general practitioners (GP) agreed significantly more with the usefulness of guidelines as a basis for patient care than doctors in single practices (SP) or specialists (S) (Student's t-test mean GP 2.57, S 2.84, p < 0.01; mean GrP 2.55, SP 2.80, p < 0.05). 33.1% of the participants demonstrated a strong rejection to the application of guidelines in patient care. Acceptance of guidelines from a governmental institution was substantially lower than from physician networks or medical societies (36.2% vs. 53.4% vs. 62.0%). 73.8% of doctors interpret EBM as a combination of scientific research and individual medical knowledge; 80% regard EBM as the best basis for patient care. CONCLUSION: Despite a majority of physicians accepting and applying CPGs a large group remains that is critical and opposed to the utilization of CPGs in daily practice and to the concept of EBM in general. Doctors in single practice and specialists appear to be more critical than physicians in group practices and GPs. Future research is needed to evaluate the willingness to acquire necessary knowledge and skills for the promotion and routine application of CPGs.

Adult↗

PubMedDate not supplied

Impact of the Leading an Empowered Organisation programme.

AIM: To evaluate the impact of the Leading an Empowered Organisation (LEO) programme on the role of grade G nurses and their multidisciplinary colleagues in one NHS trust. The LEO programme encourages and promotes leadership skills among NHS staff. METHOD: A purposive sample of four grade G nurses, one from each of the hospital's four clinical divisions, was included. Each grade G nurse, and his or her matron, nominated eight colleagues for interview. The final sample comprised four grade G nurses and 32 of their colleagues. Data were analysed using the principles of thematic analysis described by Attride-Stirling (2001). FINDINGS: The LEO programme improved the grade G nurses' approach to their work in relation to competence, communication strategies, problem solving, risk taking, leadership and management style. Factors that affected the grade G nurses' implementation of the LEO principles included: relationships, personality, experience, work context, staffing levels, autonomy and authority. CONCLUSION: This study provided insight into how the grade G nurses applied the principles of the LEO programme in their daily work. Their ability to apply the LEO principles was both restricted and assisted by the culture in which they worked. A partnership between theory and practice is needed. This finding has implications for the LEO programme and the need for it to be implicit in the local working philosophy, that is, the context in which its principles are to be used. This is so that the working context and people within it are intimately engaged with the individual undertaking the course.

Attitude of Health Personnel↗

PubMed2006

Comparing the use of indigenous knowledge with classification and ordination techniques for assessing the species composition and structure of vegetation in a tropical forest.

Identification of groups that are similar in their floristic composition and structure (habitat types) is essential for conservation and forest managers to allocate high priority areas and to designate areas for reserves, refuges, and other protected areas. In this study, the use of indigenous knowledge for the identification of habitat types in the field was compared against an ecological characterization of habitat types, including their species composition obtained by using classification and ordination techniques for a tropical landscape mosaic in a rural Mayan area of Quintana Roo, Mexico. Plant diversity data calculated from 141 sampled sites chosen randomly on a vegetation class's thematic map obtained by multispectral satellite image classification were used for this propose. Results indicated high similarity in the categorization of vegetation types between the Mayan classification and those obtained by cluster and detrended correspondence analysis. This suggests that indigenous knowledge has a practical use and can be comparable to that obtained by using science-based methods. Finally, identification and mapping of vegetation classes (habitat types) using satellite image classification allowed us to discriminate significantly different species compositions, in such a way that they can provide a useful mechanism for interpolating diversity values over the entire landscape.

Biodiversity↗

PubMed2004

Using student nurses as teachers in inquiry-based learning.

BACKGROUND: Traditionally, teaching in nurse education colleges and universities in the United Kingdom (UK) has relied substantially on didactic, large group, teacher-led approaches. Emerging literature identifies a shift towards student-centred learning in a variety of formats, such as problem- and enquiry-based learning. These approaches require students to take greater responsibility for both their own learning and that of others. Internationally, and in a number of academic educational disciplines, use of peer-assisted learning, supplemental instruction and peer tutoring as curriculum initiatives has aided improvement in student retention and academic performance. There is, however, a paucity of literature exploring the use of undergraduate student nurses as peer teachers. AIM: To explore the viability of using student nurses as teachers in an inquiry-based nursing curriculum and to ascertain the value students place on this teaching and learning method. METHOD: The first phase of the study involved observation of 'parallel resource sessions': teacher-led sessions that addressed a theoretical component of the curriculum. In the second phase, student feedback of these sessions to their peers was observed. This was followed by focus group interviews (with a total of 240 participants), which were analysed using thematic analysis. FINDINGS: The findings suggest that student nurses were uncomfortable with being used as teachers, often questioned the intrinsic worth of this approach as a developmental tool, and considered the responsibility for teaching the content of parallel resource sessions to lie with nurse educators. CONCLUSION: Nurse educators must continue to explore innovative approaches to improve both student nurses' experience and their fitness for practice. The strategy of using student nurses as teachers may be appropriate in some circumstances but requires further research, considerable support and continual evaluation.

Adolescent↗

PubMed2004

Recovery from fibromyalgia - previous patients' own experiences.

PURPOSE: To explore what patients that had completely recovered from fibromyalgia (FM) experienced as being important for their recovery. METHODS: Five women, aged between 37 and 49 were interviewed individually. The interviews were aimed at finding out about the recovery process and the women's daily lives at the time of the interview and before and after their diagnosis, with a special emphasis on social relationships and obligations. The interviews were analysed by qualitative thematic content analysis. RESULTS: These five women reported that they recovered irrespective of specific treatment. The study shows that resistance to the unpleasantness of the sick role and the stigmatization associated with the uncertain nature of the FM diagnosis promoted recovery. Instead of adapting their activities to pain, they used pain as a warning signal of too much stress in life. This significantly developed their ability to alter their life goals and everyday obligations. At the same time they managed to maintain a social role they considered to be consistent with their self-image. CONCLUSIONS: Patients can recover from FM. The information from these informants suggests that to struggle against a role of chronic patient and keep up with their social obligations and goals were of great importance.

Adult↗

PubMed2006

The response of general practitioners to the threat of violence in their practices: results from a qualitative study.

BACKGROUND: Violence directed towards GPs has been recognized as a significant problem in the UK. In Australian urban general practice, no study has previously examined this topic. OBJECTIVE: The objective of this study was to investigate the responses of Australian urban GPs to experiences of violence and to perceptions of risk of violence. METHODS DESIGN: A qualitative study of data collected from two sources-focus group discussions and qualitative questionnaire responses. Focus group discussions were audiotaped and transcribed. Questionnaires offered the opportunity for respondents to make qualitative comments. The focus group transcripts and qualitative questionnaire responses were coded independently by members of the research team and subjected to thematic analysis. SETTING: Three urban Divisions of General Practice in New South Wales, Australia. SUBJECTS: Focus groups were conducted with male and female GPs comprising a range of ages, socio-economic practice catchments and practice structures. Questionnaires were distributed to all GPs in the three divisions. RESULTS: The GPs in this study perceived themselves as being at significant risk of occupational violence. Despite responses to violence being largely ad hoc and uncoordinated, a coherent schema of GPs' responses to the threat of violence is apparent in the data. This has been characterized as encompassing primary, secondary and tertiary responses, and reflects a continuum of proactive to reactive responses. CONCLUSION: The findings will have implications for further research and for policy in the area.

After-Hours Care↗

PubMed2004

Socio-cultural influences on Chinese women's attendance for cervical screening.

BACKGROUND: Compared with other countries, Hong Kong has a relatively high rate of cervical cancer. Much of this morbidity should be avoidable with cervical screening, but uptake rates for screening in Hong Kong are low. In programmes to promote cervical screening attendance, it is essential that aspects of the socio-cultural system be taken into account to provide appropriate preventive health strategies. AIM: This paper outlines an investigation of the cultural and social factors contributing to Chinese women's attendance for cervical screening. METHOD: A mixed methods design was employed, combining and comparing two data sets. The initial data set was drawn from 10 focus groups involving both screened and unscreened Chinese women (n = 54). The second data set was drawn from a total population of Hong Kong doctors, and involved face-to-face semi-structured interviews (n = 28). RESULTS: Thematic analysis of the data from women indicated that the social factors of cost, educational base, knowledge of risk, the social value of early detection and cultural issues such as modesty and embarrassment contributed to screening attendance. The doctors perceived a cultural tendency towards fatalism, as well as seeing the gender, interpersonal and interprofessional skills of the practitioner to be important in influencing levels of Chinese women's shyness and discomfort, and hence affecting attendance. The lay and practitioner data sets varied in the perceptions of women's pain, embarrassment and risk factors. CONCLUSION: Programmes providing services for Chinese women need to ensure that the philosophy of the staff and the approach and materials used are culturally relevant. Recommendations are that nurses equipped with relevant social and cultural knowledge of population groups should have a central role in health promotion and screening services.

Adult↗