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PubMed1998

Critical reflections on the politics of need: implications for public health.

This paper presents a case for an underlying language of need consistent with public health's commitment to social justice. After examining the problem of human need as it has been conceptualised historically, this paper argues that the problems of needs--a central concern in the modern welfare state--are inherently political. Two ways of conceptualizing need which have dominated the recent discourse on need--namely a therapeutic language of need and rights talk--are examined and found to be unsatisfactory in capturing the sense in which needs and their definition and arbitration are central to the life of the community. What is required for public health is a language of need which speaks to the reciprocity and interdependence which characterise community; such a language is to be found in a "moral economy of interdependence". The paper concludes by discussing what a moral economy of interdependence, as a language of need consistent with the aims of public health, might look like.

Canada↗
PubMed2003

Substance abuse treatment need among older adults in 2020: the impact of the aging baby-boom cohort.

BACKGROUND: There is concern that as the baby boom population ages in the US, there will be a substantial increase in the number of older adults needing treatment for substance abuse problems. To address this concern, projections of future treatment need for older adults (defined as age 50 and older) were made. METHODS: Using data from the National Household Survey on Drug Abuse, regression models including predictors of treatment need in 2000 and 2001 were developed. Treatment need was defined as having a DSM-IV alcohol or illicit drug use disorder in the past year. Regression parameters from these models were applied to the projected 2020 population to obtain estimates of the number of older adults needing treatment in 2020. RESULTS: The number of older adults in need of substance abuse treatment is estimated to increase from 1.7 million in 2000 and 2001 to 4.4 million in 2020. This is due to a 50 percent increase in the number of older adults and a 70 percent increase in the rate of treatment need among older adults. CONCLUSIONS: The aging baby boom cohort will place increasing demands on the substance abuse treatment system in the next two decades, requiring a shift in focus to address the special needs of an older population of substance abusers. There is also a need to develop improved tools for measuring substance use and abuse among older adults.

Aged↗
PubMed2002

Essential information and support needs of family caregivers.

The purpose of this study was to identify essential information and support needs of family caregivers for individuals with Alzheimer's disease or a related dementia, and to examine the relationship between caregiver characteristics and needs. Caregivers (n=128, response rate=49.4%) returned a survey detailing information needs, support needs, and personal information. The need for information concerning diagnosis/treatment and legal/financial issues was more important than general information about the disease. Specifically, information about health plan coverage was most important. Experienced caregivers also needed legal/financial information, as well as support. Female caregivers rated needs related to support as significantly more important than male caregivers. Practitioners should realize that caregivers may have different information and support needs and these needs may change throughout the caregiving experience.

Adult↗
PubMed1998

Evaluation of an innovative program to address the health and social service needs of drug-using women with or at risk for HIV infection.

Drug-using women with or at risk for HIV infection have many competing unmet needs, especially for social services, drug treatment, and medical care. High-risk drug-using women were recruited through street outreach, at needle exchange sites, a prison, and local community based organizations in New Haven, Connecticut for a study of the service needs of out-of-treatment drug users and the ability of an interactive case management intervention (ICM) to address those needs. These women were administered baseline and follow-up interviews to identify their health and social service needs and the degree to which these needs were resolved. The women who chose to enroll in the interactive case management intervention (n = 38) did not differ demographically nor in their HIV risk behaviors from those not receiving case management (n = 73). Provision of ICM was most successful in meeting needs for supportive mental health counseling, basic services, and long term housing. The impact of interactive case management was less evident for the acquisition of medical and dental services, which were accessed comparably by women not receiving the intervention. Overall, the women who enrolled in the ICM intervention showed a significant decrease in the number of unmet service needs as compared to those who did not enroll. Multiple contacts were required by the case manager to establish trust and to resolve the unmet service needs of these high-risk women. Women with or at risk for HIV infection can be effectively engaged in an ICM intervention in order to meet their multiple unmet service needs, although such interventions are time-and-labor intensive.

Adult↗
PubMed1998

A study to determine how needs assessment is being used to improve health.

OBJECTIVE: To determine how needs assessment is being used in Health Authorities and General Practice. DESIGN: A postal survey of a one in two sample of Scottish GPs, semistructured interviews with selected health authority executives and a random sample of GPs. SUBJECTS: Nine hundred and sixty-five GPs (54% of those sent the postal questionnaire), 47 randomly selected GP practices and 36 selected health authority (called health boards in Scotland) executives. RESULTS: In health authorities, a view of commissioning/planning emerged with three components: (1) planning (including needs assessment); (2) leadership; and (3) strong relationships with stakeholders. Health authority executives believed that GP involvement is one of several vital components but doubted the commitment of all but a few GPs to the planning process. GPs welcomed enhanced influence but feared increases in workload and admitted to a lack of training in the skills required for needs assessment. Health authority executives aspired to place needs assessment at the centre of planning but admitted that, at present, cost and volume issues predominate. Most GPs were not involved in needs assessment and argued that it is not part of a GPs core activity. National needs assessment documents were well received by health authorities but made little or no impact on GPs. CONCLUSIONS: Needs assessment will have little involvement from primary care until there are changes in the attitudes and skills of the majority of GPs. Fundamental changes are required in health authority priorities and practice if their rhetoric about needs assessment is to be turned into reality. The role of needs assessment could be enhanced but this will only happen if it can be shown to lead to improved health outcomes while addressing the financial pressures that currently dominate the agenda.

Attitude of Health Personnel↗
PubMed1997

Met and unmet nursing care needs in men with prostate cancer. An explorative study. Part II.

Men with prostate cancer (n = 11) were interviewed during an in-patient period at a urological clinic, about their experiences of met and unmet needs from health professionals. Their perception of quality of life and sense of coherence were also assessed. The findings were analysed from a phenemenological-hermeneutic perspective and interpreted within the concept of transition. It was interpreted that objective functional health needs were mostly met by health professionals and subjective existential needs were mostly not met. The analysis revealed patients as passive or active receivers of care. Passive receivers were explicitly and implicitly stating unmet needs, or explicitly stating satisfaction with nursing care at the same time as implicitly contradicting, referring to their needs as bagatelles, unimportant, whereas active receivers talked about their needs explicitly with the staff and did not state implicit unmet needs. This suggests that nurses need to be aware of and have sensitive ears to undertones in statements and actively seek for patients' needs. The most important nursing care areas seemed to be to provide solutions to physical problems together with staff support including information, and acting to increase confidence in staff and staff availability. This encourages patient, wives and families, in cooperation, towards a healthy exit of transition.

Aged↗
PubMed2003

Reports of information and support needs of daughters and sisters of women with breast cancer.

The aim of this study was to describe the information and support needs of women who have primary relatives with breast cancer. The Information and Support Needs Questionnaire (ISNQ) was developed and revised from previous qualitative and pilot studies. The ISNQ addressed concepts of the importance of, and the degree to which, 29 information and support needs related to breast cancer had been met. The study sample consisted of 261 community-residing women who had mothers, sisters, or a mother and sister(s) with breast cancer. Data were collected using a mailed survey. In addition to the ISNQ, additional items addressed family and health history, breast self-care practices, perception of the impact of the relative's breast cancer and other variables. Also included were established and well-validated measures of anxiety and depression. The findings document women's priority information and support needs. The information need most frequently identified as very important was information about personal risk of breast cancer. Other highly rated needs addressed risk factors for breast cancer and early detection measures. Generally, the women perceived that their information and support needs were not well met. These findings illuminate needs of women for more information and support when they have close family relatives with breast cancer and opportunities for primary care providers to assist women in addressing their needs.

Adult↗
PubMed2001

Evaluating the self-assessed support needs of women with breast cancer.

AIMS OF THE STUDY: The first aim of the study was to identify the self-assessed support needs of women with breast cancer at various points of illness and, secondly, to establish if these needs formed clusters which could provide the basis for developing a standardized scale of needs for use by breast care teams in the evaluation of care. BACKGROUND: It has been found that support given to women with breast cancer has a positive effect upon their reactions to the illness and may even prolong their survival. Given that breast cancer affects a large number of women it is obviously important that those affected receive, in addition to the best available medical treatment, the type of support that best meets their needs. This study aimed to provide information on the impact of breast cancer and the need for various types of support by examining women's own assessment of their needs at different stages of their illness. DESIGN AND METHODS: A purposive sample of 12 women with a diagnosis of breast cancer was selected in one health authority in England, United Kingdom (UK). Women selected represented a wide age range (between 26 and 58), were married or in long-term cohabiting relationships and were at different points on the illness trajectory. Women were invited to take part in a semi-structured interview about their experiences of breast cancer. The data from these interviews were analysed using the software package Qualitative Solutions and Research, Nonnumerical Data Indexing, Searching and Theorizing (QSR*NUDIST). Following this content analysis, a questionnaire was formulated which divided statements into seven categories: diagnosis, treatment, support, femininity and body image, family and friends, information and after care, to be rated on a Likert scale ranging from "of no importance" to "extremely important". Questionnaire data were analysed by means of a one-way analysis of variance (for three independent variables) or t-test for two independent variables. Results. The questionnaire was sent to 971 women and achieved a response rate of 50.4%. The mean score for statements of need reached the level of point 4 on the Likert scale (important) with three exceptions: having professional help with family problems and domestic upheaval, coping with feelings of anger and dealing with the question "why me?" CONCLUSION: With the above three exceptions, women experienced a high level of need associated with a diagnosis of breast cancer. Studies of this kind should enable resources to be targeted to areas of highest need.

Adult↗
PubMed2002

The relationship between maternal needs and priorities in a neonatal intensive care environment.

AIM: The aim of this study was to investigate the nature and organization of maternal needs and priorities in a neonatal unit. BACKGROUND: The relationship between maternal needs and priorities appears to be an under studied area in neonatal nursing. METHODS: A quantitative survey was carried out based on 209 mothers with premature infants. Two self-assessment schedules were used: critical care maternal needs inventory (J. Leske, Heart and Lung 15, 27-42) and a ranking scale. The data were analysed with multivariate analysis. FINDINGS: Data analysis revealed clear priorities in maternal needs. In particular the need for accurate infant related information was a priority for 93% of the mothers. Good communication practices with professionals were also valued. The mothers displayed altruistic behaviour, and self-related needs took second place. It is proposed that maternal needs demonstrate a hierarchical organization. CONCLUSION: It is important for nurses to consider the individual needs of the mothers, simply because the satisfaction of these needs is essential for maternal well-being.

Communication↗
PubMed2002

Unmet nursing care needs of home-based disabled patients.

BACKGROUND: In Taiwan, family members care for 80-90% of disabled people, but most have no professional training or knowledge of care for the disabled. Therefore, the adequacy of care received by the disabled needs to be assessed. AIMS: To evaluate the unmet nursing care needs of physically disabled patients and determine the relevant factors. METHODS: All 322 subjects were over 18 years of age, had a Barthel Index of less than 80 and became disabled 2 years prior to the commencement of this study. All subjects were outpatients of hospitals in central Taiwan and were contacted by phone to schedule an interview. Based on activity of daily living (ADL) scores, patients were divided into three groups: complete dependency, severe dependency and moderate dependency. After training, nurses evaluated the patients' ADL and completed the 20-item Assessment of Nursing Activity (ANA) questionnaire. Based on the ANA, subjects' unmet needs and caregivers' knowledge requirements were assessed. FINDINGS: The results showed the mean number of unmet needs was approximately five. Percentage of unmet needs was 44.8%. For complete dependency patients, the unmet needs score of patients and the needs score of caregiver's knowledge was highest, followed by the severe dependency group, and the moderate dependency group. Based on multiple linear regression, the factors that affected unmet need were as follows: age of patient, ADL score, education level of the caregivers, average daily duration of care and need of caregiving knowledge. Our findings indicate that the provision of counseling and educational support for family caregivers is required to promote quality of care for the disabled.

Activities of Daily Living↗
PubMed2002

Comparison of user assessed needs for care between psychiatric inpatients and supported community residents.

The aim of the present study was to compare user assessed needs for care for psychiatric patients in inpatient settings with that of residents in supported community residences. The Camberwell Assessment of Need was administered to 75 patients and residents in different housing settings. Residents in supported community settings had more needs for care (8.1), than patients in inpatient settings (5.8), partly because of differences in duration of illness. A greater proportion of those living in supported community residences reported needs in the areas of psychotic symptoms, accommodation, food, daytime activities, sexual expression and looking after the home. There were no differences in numbers of unmet needs. Relatives and friends provided emotional and social support predominantly in the areas of company and psychological distress. In conclusion, living in supported community residences does not imply more unmet needs, or less adequate response to needs from services, despite a greater number of needs being reported. In some areas of need, relatives and friends play an important role in the provision of support.

Adolescent↗
PubMed2003

The universal, situational, and personal needs of cancer patients and their main carers.

The importance of psychosocial factors in the cancer journey for both patients and their carers has been recognised in UK health policy. The aim of this paper is to consider--(1) which needs are regarded as important by patients and their carers; (2) which are the unmet needs of patients and their carers. The study focuses on the responses of 233 paired cancer patients and their carers derived from a cross-sectional questionnaire survey in three health authorities in North West England. The majority of patient-carer pairs expressed the importance of having good relationships with health-care professionals and receiving good-quality information. These can be identified as "universal" needs. A minority of patient-carer pairs expressed the importance of other kinds of needs. These items were mainly to do with managing daily life, emotions, and social identity and can be identified as "situational" or "personal" needs. Where there were discrepancies between patients and carers, patients were likely to identify more needs as important. In contrast, carers have more unmet needs, reflecting their comparative neglect. Broadly, "universal" needs are being met, but "situational" and "personal" needs, particularly among carers, are relatively unmet and require greater attention on the part of nurses and primary care professionals.

Adult↗
PubMed2000

To what extent are the needs of severely disabled people met by community rehabilitation services? A follow-up study.

PURPOSE: To evaluate which needs of disabled people would be met over a one year follow-up period and to examine which factors would be predictive of identifying those people who had more needs met from those who had fewer needs met. METHOD: A follow-up study of a cohort of community dwelling disabled people (aged 16-65) from two NHS Health Districts in Southern England with contrasting patterns of rehabilitation provision, who had participated in a cross-sectional interview study one year previously which had assessed their met and unmet needs. The Southampton Needs Assessment Questionnaire was used to examine needs. Disability was evaluated with the OPCS Disability and Severity Scales and perceived health status with the SF-36. RESULTS: Participation rate at follow-up was 92 %. Of the 300 baseline unmet needs reported by 69 of the 77 participants 33% had been met at follow-up. People whose disability had increased more and/or whose mental health status had improved more had greater percentages of their baseline needs met. There was a non-significant trend for smaller percentages of baseline needs to be met in Basingstoke than in Southampton. CONCLUSIONS: At ground level, disabled people's views were taken into account, to some extent, in the provision of rehabilitation services. This input should be made at a higher level, in the overall shaping of services.

Adolescent↗
PubMed2006

Construct and criterion validities of the Service Need Assessment Profile (SNAP): a measure of support for people with disabilities.

BACKGROUND: The Service Need Assessment Profile (SNAP) measures individual functional needs in areas of daily living. It produces a support profile, detailing the time allocations for staff support to assist in each area of need. The Supports Intensity Scale (SIS) is a support needs assessment scale designed to provide an objective measure of a person's need for support in medical, behavioural, and life activities. SIS can be used for individualised support planning, clinical judgements regarding support needs, resource allocation and financial planning. The Inventory for Client and Agency Planning (ICAP) assesses adaptive and maladaptive behaviours and gathers additional information to determine type and amount of special assistance that people with disabilities need. METHOD: This study evaluated the construct and criterion validities of SNAP in relation to the SIS and ICAP, using assessment data from 114 individuals with a range of disabilities and levels of severity. RESULTS: Construct and criterion validities were supported for the SNAP by high correlations with SIS, ICAP, and staff estimates of support needs and by its capacity to discriminate between sub-groups in expected ways. CONCLUSIONS: The results provide support for the use of SNAP as a support needs instrument.

Activities of Daily Living↗
PubMed2000

Interrater reliability of the Camberwell Assessment of Need Short Appraisal Schedule.

OBJECTIVE: Australian mental health policy aims to introduce evidence-based practice within a community care approach. This aim requires reliable measures that can be used by a wide variety of professionals. The interrater reliability of the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) was assessed under routine conditions. METHOD: Three interviewer-observer dyads assessed the needs of 14 inpatients and 18 day patients of a psychiatric rehabilitation unit in New South Wales, Australia. RESULTS: Agreement on the identification of an area of need was high. However, agreement was higher on patient ratings than on staff ratings. Correlations on staff ratings of met needs were also moderate (r = 0.53), suggesting discrepancies in rating the level of need. CONCLUSION: Differences in staff ratings may be attributed to ambiguity in the definition of need and levels of need and/or the sources of information used by the rater making the assessment. An approach to establishing an operational definition of need is suggested, and an increase in the number of levels of need is recommended. Implications for Australian mental health policy are noted.

Adult↗
PubMed1997

A longitudinal study on subjective and objective orthodontic treatment need.

The purpose of the study was to analyse changes in professionally-defined need and self-perceived need between the ages of 12-20 years. In 1985, occlusion and perceived need for treatment were recorded in 306 12-year-olds (born 1973) living in five communes in Finnmark, the most northern part of Norway. In 1993-94, 271 of the individuals were traced through the Norwegian Central Person Register and invited in letters to attend a clinical examination and an interview. A total of 80 individuals responded, with a mean age of 20.7 years. Professionally-defined need was assessed according to the Need for Orthodontic Treatment Index (NOTI) which is used by the Norwegian Health Insurance System for reimbursement of treatment costs. Change in category of need between 12-20 years was used as a measurement of health gain. Perceived need was measured by the individuals' responses to a question about desire for treatment. Individuals who received treatment (n = 22) showed an improvement in occlusion (health gain) corresponding on average to one category of need. The occlusal status of the untreated individuals was unchanged. All the individuals that desired treatment at 12 years of age (n = 15) did not want treatment at 20, and they were satisfied with their dental arrangement. Most of these individuals had received treatment, but a few with minor malocclusions had at age 12 been informed about the small objective need and refrained from treatment. All the individuals that wanted treatment at 20 years of age, 29 per cent of the total sample, had not desired treatment at 12 years of age. The results underline the importance of information and education during orthodontic counselling of potential patients.

Adolescent↗
PubMed2002

A simple tool to evoke physicians' real training needs.

Commonly used methods for identifying the training needs of general practitioners do not enable the real needs felt during interviews with patients during office visits to be detected. In this study, the authors evaluate how physicians' use of a personal-office-visit diary affects the level of specificity of their expressed training needs. In 1999, the authors carried out a controlled intervention trial using a random sample of 1,038 general practitioners from a region of France, randomized to intervention and control groups. The practitioners in the intervention group were asked to identify their training needs using a personal-office-visit diary. The level of specificity for their expressed needs was compared with that of the expressed needs of the practitioners in the control group. The use of the diary was associated with a significantly higher level of specificity in the training needs identified by the general practitioners who participated. Independent of the intervention, practitioners under 40 years of age, those in urban practice, and those who were members of a continuing medical education (CME) association expressed their training needs with higher specificity. The personal-office-visit diary would seem to be a simple, inexpensive, and useful tool for more specifically identifying training needs, which could help establish more appropriate and better-targeted training programs. However, it should be assessed further by those involved in CME for general practitioners.

Adult↗
PubMed1994

Child disability and family needs in the People's Republic of China.

As developing countries have made progress in their efforts to reduce child mortality, there is an increasing need to address the prevention and reduction of childhood disability. The People's Republic of China has built on its success in primary health care and is extending its attention to identifying the scope of needs of individuals with disabilities. The focus of this exploratory study was to identify the nature of child and family needs among Chinese families with disabled children. A sample of 101 families from two settings (urban and rural) responded to the Family Needs Survey describing their life with a child with disabilities. The findings revealed that information was a pressing need for Chinese families. Financial help and locating a doctor were the other major expressed needs. Our discussion suggests that the type of child impairment and the setting may be factors related to variability in expressed needs. Of interest was the fact that, while some needs may be culture specific, the pattern of needs was consistent with other cultures as well.

Activities of Daily Living↗