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PubMed2004

Barriers to childhood immunization: findings from a needs assessment study.

This study examines the current status of immunization among 0-3 year old children in Bakersfield and identifies barriers that prevent families from immunizing their children. A survey research design using a stratified sampling method was employed to collect data from 207 randomly selected English and Spanish speaking households having at least one child between the ages of 0-3 in Bakersfield. The findings reveal that 49% of the parents had no shot cards regarding children's immunization status. However, a significant majority of them immunized their children despite having no records. The most commonly reported consumer related barrier for late immunization was having a sick child followed by lack of parental memory and fear of side effects. The major provider-related barriers included lack of an opening for an appointment with the health care provider, limited clinic hours, and long lines in clinics. Lack of transportation was the single most systemic barrier. These findings suggest that reminder calls, increased transportation, weekend clinics and better rapport with parents can improve the immunization rates in ethnically diverse rural communities.

Adult↗
PubMed1993

Collaborative efforts: developing clinical experiences for nursing students in public sector settings.

In the present paper we described the Nurse Academic Collaboration Task Force, which was formed in 1989 by the Texas Mental Health and Mental Retardation (TXMHMR) Commissioner in order to facilitate linkages between academia and state facilities. These efforts have led to increased academic collaboration and linkage with facilities. The task force has identified areas of practice opportunities for all levels of student education programs as well as barriers to collaboration. Collaborative strategies may also lead to better nurse recruitment efforts by TXMHMR facilities. Finally, these educational experiences should prepare nurses in varied settings to provide care for individuals with mental retardation.

Communication Barriers↗
PubMed2005

Immigrants in emergency care: Swedish health care staff's experiences.

BACKGROUND: During the past few decades Sweden has developed into a multicultural society. The proportion of patients with different cultural backgrounds increases, which naturally makes new demands on health care staff. AIM: To identify whether staff in somatic and psychiatric emergency care experienced problems in the care of migrants, and if so to compare these. METHOD: The study design was explorative. Focus group interviews of 22 women and 13 men working as nurses and assistant nurses at an emergency ward, an ambulance service and a psychiatric intensive care unit were held. FINDINGS: The results showed that the main problems experienced in all wards were difficulties related to caring for asylum-seeking refugees. Some dissimilarities were revealed: unexpected behaviours in migrants related to cultural differences described by staff working in the emergency ward; migrants' refusal to eat and drink and their inactive behaviour in the psychiatric ward; and a lot of non-emergency runs by the ambulance staff because of language barriers between the emergency services centre and migrants. CONCLUSION: The main problems experienced by the health care staff were situations in which they were confronted with the need to care for asylum-seeking refugees. PRACTICE IMPLICATIONS: These emphasize the importance of support from organizational structures and national policies to develop models for caring for asylum-seeking refugees. Simple routines and facilities to communicate with foreign-language-speaking migrants need to be developed. Health care staff need a deeper understanding of individual needs in the light of migrational and cultural background.

Adaptation, Psychological↗
PubMed2004

Facilitators and barriers to improving the quality of referrals for potential oral cancer.

The quality and content of referral letters are important for prioritisation of patients who may have oral cancer. Referrals letters to the Oral Medicine Clinic at Birmingham Dental Hospital were analysed and practitioners interviewed. Whilst acceptable for general purposes, most letters did not contain sufficient information to allow effective prioritisation. Interviews disclosed a misunderstanding amongst practitioners about the way in which referrals were handled. A number of barriers to increasing the information included in letters were identified. Referral guidelines and a standardised proforma might help improve the ability of the service to operate a fast-track system.

Communication Barriers↗
PubMed2006

Breaking down barriers to breast and cervical cancer screening: a university-based prevention program for Latinas.

INTRODUCTION: The lower rate of utilization of mammography and cervical cancer screening observed for Latinas in the United States has been attributed to cultural, economic, and linguistic barriers they may encounter. METHODS: A screening program was implemented offering cancer prevention education plus breast and cervical cancer screening to Latinas, as well as all necessary follow-up care, at no cost to the participant. RESULTS: In the first 6 years of this project, a total of 928 screening visits occurred; 53% were participants who had returned at least once for additional annual screening. Ninety-one percent of participants preferred speaking in Spanish to their health care providers; however, only 2% identified a primary care provider and 5% stated they had health care insurance. The participant characteristics and results of initial evaluation, as well as necessary follow-up studies, are presented. CONCLUSIONS: By removing economic concerns and by providing care and education through bilingual staff in a culturally sensitive environment, some of the barriers to cancer screening for Latinas were overcome. The success of the program is reflected by a high rate of return for additional annual screening by our participants.

Adult↗
PubMedDate not supplied

Research subjects with limited English proficiency: ethical and legal issues.

In this article, we examine Institutional Review Board (IRB) policies, international guidelines, and federal regulations and guidance for dealing with Limited English Proficiency (LEP) research subjects. We show that federal and international guidance concerning this topic is insufficient, and there is considerable variation in IRB policies. While some IRBs have thorough and useful policies, others do not. Many IRBs do not provide researchers and IRB member with answers to several important questions relating to language barriers in research. We recommend that federal agencies, international organizations, IRBs, and researchers take steps to fill in the gaps in guidance and policy to help insure that LEP populations will receive equitable and ethical treatment in research.

Communication Barriers↗
PubMed1995

AIDS prevention with adolescents.

Prevention of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) among adolescents is increasingly recognized as an important public health priority. Sexual risk acts associated with HIV/AIDS transmission (unprotected sexual intercourse with multiple partners of unknown serostatus) are typically initiated by late adolescence, with many youths engaging in sexual relations earlier. Despite being well informed about HIV/AIDS and having positive attitudes toward HIV/AIDS prevention, adolescents have not changed their behavior in response to the pandemic. AIDS-prevention programs must be tailored to consider stereotypic sex roles, gay youths' sexual orientation, and substance abuse. Intensive prevention programs focusing on helping youths perceive HIV as a problem, motivate them to act safely, and implement safe acts by acquiring coping skills, access to condoms and health care, and identifying individual barriers to implementing safe acts have successfully reduced adolescents' risk acts. However, avenues for broad-scale dissemination of such programs or alternative models to change youths' behaviors must be identified.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Women at risk of coronary heart disease experience barriers to diagnosis and treatment: a qualitative interview study.

OBJECTIVE: To explore barriers in the health service to diagnosis and treatment experienced by women at increased risk of coronary heart disease (CHD). DESIGN: Qualitative study using semi-structured interviews. SETTING: Norway. SUBJECTS: Twenty women diagnosed with heterozygous familial hypercholesterolemia (FH) recruited through a lipid clinic. RESULTS: Women reported three specific barriers related to diagnosis and treatment of CHD. They had to struggle to take a cholesterol test; they experienced that their risk was being downplayed by doctors; and that their symptoms of CHD were misinterpreted when they consulted doctors for evaluation and treatment. CONCLUSION: Stereotyping CHD as a man's disease may result in barriers to diagnosis and treatment for women. Doctors should ask the patient about the family history of CHD if a concern about heart disease is on the patient's agenda.

Adolescent↗
PubMed2005

Determinants of treatment adherence in ethnically diverse, economically disadvantaged patients with rheumatic disease.

OBJECTIVE: To explore the determinants of adherence to medical recommendations, including drug therapy and appointment-keeping, among ethnically diverse and economically disadvantaged patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). METHODS: Patients with RA and SLE were identified through chart review and were invited to participate in focus groups to examine their attitudes and beliefs regarding adherence to treatment and medical appointments. Eight focus groups (4 RA, 4 SLE) were conducted, with a total of 40 participants (22 SLE patients and 18 RA patients). Transcripts were analyzed using grounded theory techniques and qualitative analysis software to facilitate coding interpretation. RESULTS: The majority of participants reported experiencing difficulty in adhering to their treatment at least occasionally. Both SLE and RA patients reported similar barriers to treatment adherence: fear of side effects, financial problems, difficulty in navigating the public health system, and perceived treatment inefficacy. RA and SLE patients also revealed barriers to appointment keeping, including difficulties in scheduling, financial costs, transportation, and functional impairment limiting their ability to attend the clinic. CONCLUSION: Patients' perceptions of and experiences with the health system, physicians, medication effectiveness, and side effects influence their adherence to treatment and other medical recommendations. Strategies to improve adherence could include the following: attempting to modify patients' beliefs and perceptions regarding medication effectiveness, promoting realistic expectations about risk/benefit ratios, and improving access to health care by reducing barriers that limit the interaction between patients and the health system.

Adult↗
PubMed2000

Social barriers to a theoretical neuroscience.

Social rather than scientific barriers are impeding neuroscience theory. There are plenty of experimental data and mathematical methods to develop a rigorous, mathematical theory in neuroscience. However, structural mathematical efforts are being suffocated by the requirement to produce numbers immediately. Also theoretical development is tied too closely to one experimental group. The social barriers can be addressed by: (1) judging theory by structural accuracy rather than numerical output; (2) recognizing mathematical theory (not just computational modeling) as a method for producing insight into neurobiological phenomena; (3) funding fundamental theoretical neuroscience and (4) recognizing theoretical neuroscientists as neuroscientists.

Attitude↗
PubMed2003

Discussing STIs: doctors are from Mars, patients from Venus.

BACKGROUND: Primary care plays an important role in promoting sexual health, but in this setting counselling regarding sexually transmitted infections (STIs) is rarely performed and often inadequate. OBJECTIVE: Our aim was to identify and quantify the barriers physicians encounter in discussing STIs with their patients. METHODS: A postal questionnaire-based survey was carried out in a random sample of 200 primary care physicians in Antwerp, Belgium. RESULTS: The response rate was 68%. Among the 122 respondents, only 44.3% provide some form of counselling (asking about sexual history, informing about safe sex or informing about STIs) regularly, at least once a week. Major barriers are language and comprehension problems (for 74.2% of respondents), ethnic differences (68.4%), insufficient training (69.4%), lack of time (60.8%), presence of the patient's partner (89.2%) or mother (94.2%), first contact with a patient (60.8%), fear of embarrassing the patient (30.6%) and a patient without genital complaints (71.4%). About half of the GPs fail to counsel an asymptomatic patient with obvious STI risk, and as many give no safe sex advice in a first contraception consultation. CONCLUSIONS: Physicians have many and various barriers to discussing STIs with their patients. Features of contemporary STI counselling and solutions to its problems are discussed. Education of health care providers should be given priority.

Adult↗
PubMed2002

Association between parents' preferences and perceptions of barriers to vaccination and the immunization status of their children: a study from Pediatric Research in Office Settings and the National Medical Association.

OBJECTIVES: To assess the association between parents' perceptions of various barriers to vaccination and their preferences regarding specific strategies designed to reduce missed vaccination opportunities and the immunization status of their children and to estimate the overall contribution of the perception of barriers on underimmunization among children who are vaccinated in pediatricians' offices. METHODS: As part of a nationwide study on the immunization status of children followed by practicing pediatricians, parents of children who were 8 to 35 months of age and seen consecutively at 177 participating practice sites completed a survey on health beliefs regarding the vaccination process. In addition to demographic information, parents were asked to identify the most difficult thing about obtaining immunizations, as well as their preferences regarding the maximum number of vaccine injections that should be administered to their child at 1 visit and for receiving a needed immunization during an office visit for a mild illness. Immunization data on study children were abstracted from the practice medical record, and specific survey responses for each parent were compared with the immunization status of his or her child at 8 months of age using chi2 tests. For parental health beliefs associated with immunization status by bivariate analyses, the relative risks for underimmunization and population-attributable risk percentages of each belief were calculated after potentially confounding variables were adjusted for. RESULTS: Immunization data were collected on 13 520 children; 13 516 parents responded to at least 1 question regarding vaccination health beliefs. Two thirds of the responding parents indicated that their child should receive no more than 2 immunizations at 1 visit. However, there was no difference in the preferred maximum number of vaccines between parents of children who were fully immunized at 8 months of age and those of underimmunized children. Similarly, there was no difference in a stated preference for receiving a needed immunization during an illness visit. Overall, 74% of respondents indicated that there was "nothing" difficult about obtaining vaccines for their children. The most commonly cited barrier was concern about the side effects of vaccines, identified by 22.6% of parents. However, this barrier was not associated with immunization status. Each of the remaining barriers-including the confusing vaccination schedule, expense of vaccines, the inconvenience of the vaccination process, having a child who was often too ill to receive vaccines, religious objections, and other identified barriers-was statistically associated with immunization status, with adjusted relative risks for underimmunization ranging from 1.42 to 3.04. However, because each of these barriers was identified as important by <5% of parents, the population-attributable risk percentage for each was < or =2.5%. Overall, it was estimated that parental perception of barriers associated with immunization status accounts for 8.0% of the underimmunization observed among children who are vaccinated in the offices of primary care pediatricians. CONCLUSIONS: Parental preferences regarding vaccination practices designed to reduce missed opportunities were not associated with the immunization status of their children. Although several barriers to vaccination were associated with immunization status, individual barriers were identified by a small minority of parents. Overall, parental perceptions of barriers to vaccination do not seem to be a significant cause of underimmunization in this population of children.

Attitude to Health↗
PubMed1985

The health of Indians in Canadian cities: a challenge to the health care system.

It is well known that Canadian native people living on reserves have high morbidity and mortality rates, but less is known about the health of those who migrated to urban centres. Several studies have shown that these people have high rates of mental health problems, specific diseases, injuries, infant death and hospital admission. In addition, there is evidence that cultural differences create barriers to their use of health care facilities. The low socioeconomic status, cultural differences and discrimination that they find in cities are identified as the primary blocks to good health and adequate health care. More epidemiologic studies need to be done to identify health problems, needs and barriers to health care. Federal, provincial and civic governments along with the appropriate departments of faculties of medicine should begin working with native organizations to improve the health of native people living in Canada's cities.

Adult↗
PubMed2002

Teaching Spanish to pediatric emergency physicians: effects on patient satisfaction.

BACKGROUND: Language barriers are known to negatively affect patient satisfaction. OBJECTIVE: To determine whether a course of instruction in medical Spanish for pediatric emergency department (ED) physicians is associated with an increase in satisfaction for Spanish-speaking-only families. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION: Nine pediatric ED physicians completed a 10-week medical Spanish course. Mock clinical scenarios and testing were used to establish an improvement in each physician's ability to communicate with Spanish-speaking-only families. Before (preintervention period) and after (postintervention period) the course, Spanish-speaking-only families cared for by these physicians completed satisfaction questionnaires. Professional interpreters were equally available during both the preintervention and postintervention periods. MAIN OUTCOME MEASURES: Responses to patient family satisfaction questionnaires. RESULTS: A total of 143 Spanish-speaking-only families completed satisfaction questionnaires. Preintervention (n = 85) and postintervention (n = 58) cohorts did not differ significantly in age, vital signs, length of ED visit, discharge diagnosis, or self-reported English proficiency. Physicians used a professional interpreter less often in the postintervention period (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.16-0.71). Postintervention families were significantly more likely to strongly agree that "the physician was concerned about my child" (OR, 2.1; 95% CI, 1.0-4.2), "made me feel comfortable" (OR, 2.6; 95% CI, 1.1-4.4), "was respectful" (OR, 3.0; 95% CI, 1.4-6.5), and "listened to what I said" (OR, 2.9; 95% CI, 1.4-5.9). CONCLUSIONS: A 10-week medical Spanish course for pediatric ED physicians was associated with decreased interpreter use and increased family satisfaction.

Adult↗
PubMedDate not supplied

Barriers to and facilitators for newborn resuscitation in Malawi, Africa.

Newborn resuscitation is a key component of efforts to reduce neonatal morbidity and mortality. This article reports the findings of focus groups conducted to explore the barriers and facilitators present for obstetric nurse providers in a central urban hospital in Malawi regarding the training and provision of neonatal resuscitation. All obstetric nurse providers in this setting participated in focus groups; these groups identified 4 themes: 1) confidence in their skills in assessing newborns and recognizing the need for resuscitation, 2) a lack of resources, 3) facilitators who would enable them to introduce resuscitation, and 4) solutions to the current problems. Resource shortages and barriers to providing care included availability of staff, equipment, and supplies; labor ward geography; ethical dilemmas; and the lack of standard protocols regarding newborn resuscitation. Facilitators were professional experience and the critical load of deliveries performed. Solutions to barriers included small resource additions as well as long-term policy changes. With standard policy and protocols, experienced, confident nurses could overcome the barriers to providing newborn resuscitation. This group identified ways to change systems to decrease infant mortality, thereby improving the health and quality of life of women receiving care in Malawi.

Attitude of Health Personnel↗
PubMed2002

Recommendations for nursing requirements at a field hospital, based on the Israel Defense Forces field hospital at the earthquake disaster in Turkey--August 1999.

On the 17th of August 1999, an earthquake of 7.4 magnitude on the Richter Scale struck the Marmara region in Turkey causing a massive casualties event with an estimated 2,680 deaths and 5,300 injuries just at the city of Adapazari alone. A field hospital was set up by the Israel Defense Forces at Adapazari in order to provide temporary medical services until regular medical forces recovered. The aim of the paper is to overview the requirements of the nursing staff at a field hospital based on our experience and analysis of the nursing activity at the field hospital at Adapazari. The methods implemented include interviewing all nurses and many of the doctors who took part in the field hospital as well as a review of medical literature about disasters. We found an inverted nurse:phycisian ratio of 1:1.77, as opposed to a 2.5-3:1 ratio in regular civilian hospitals. The nurses in our field hospital had to work longer and more intensive shifts than in a regular hospital. They had to overcome language barriers and cultural differences, and faced difficult hygiene conditions. Our overview analysis of results brought up several recommendations. Firstly, although it is not possible to predictthe number and types of casualties, it is necessary to provide an adequate number of nurses (1-1.5:1 nurse:physician ratio). Furthermore, the nurses should be specialized and rotated as needed. Secondly, the language and cultural barriers should not be undermined despite the abundance of translators. Finally, the hygiene status in a field hospital requires management by nurses with active participation of all members.

Communication Barriers↗
PubMedDate not supplied

Programmatic barriers to providing culturally competent end-of-life care.

Despite many efforts to increase access to end-of-life care, culturally diverse groups are still not being served. Interviews of 22 hospice and palliative care program directors in one southeastern state indicated that directors overestimated how well programs are doing in meeting the needs of diverse groups but were very interested in implementing cultural diversity training for their staff Those who were more concerned about such issues had recruited more diverse volunteers into their programs. The presence of diverse staff or volunteers predicted a more diverse patient population. A number of efforts were underway to develop cultural competence and provide culturally competent care. Several directors reported no efforts in this direction, however Directors described programmatic barriers and resources needed. The authors concluded that directors should provide leadership in their agencies in welcoming diversity. Implications for further research and work within the larger end-of-life care field are discussed.

Attitude of Health Personnel↗