Whether and how people reach care.
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1201 to 1225 of 2,047Gender dynamics affecting maternal health and health care access and use in Uganda.
Despite its reduction over the last decade, the maternal mortality rate in Uganda remains high, due to in part a lack of access to maternal health care. In an effort to increase access to care, a quasi-experimental trial using vouchers was implemented in Eastern Uganda between 2009 and 2011. Findings from the trial reported a dramatic increase in pregnant women's access to institutional delivery. Sustainability of such interventions, however, is an important challenge. While such interventions are able to successfully address immediate access barriers, such as lack of financial resources and transportation, they are reliant on external resources to sustain them and are not designed to address the underlying causes contributing to women's lack of access, including those related to gender. In an effort to examine ways to sustain the intervention beyond external financial resources, project…
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The outcomes of health-promoting communities: being active eating well initiative-a community-based obesity prevention intervention in Victoria, Australia.
Objective: The aim of this study is to evaluate the impact of the Health-Promoting Communities: Being Active Eating Well (HPC:BAEW, 2007-2010) initiative, which comprised community-based multi-component interventions adapted to community context in five separate communities. The intervention aimed to promote healthy eating, physical activity and stronger, healthier communities.
Methods: A mixed method and multilevel quasi-experimental evaluation of the HPC:BAEW initiative captured process, impact and outcome data. The evaluation involved both cross-sectional (children and adolescents) and longitudinal designs (adults) with data collected pre- and post-intervention in intervention (n=2408 children and adolescents from 18 schools, n=501 adults from 22 workplaces) and comparison groups (n=3163 children and adolescents from 33 schools, n=318 adults from seven workplaces). Anthropometry, obes…
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Integrating Mental Health and HIV Services in Zimbabwean Communities: A Nurse and Community-led Approach to Reach the Most Vulnerable.
Alcohol use and depression negatively impact adherence, retention in care, and HIV progression, and people living with HIV (PLWH) have disproportionately higher depression rates. In developing countries, more than 76% of people with mental health issues receive no treatment. We hypothesized that stepped-care mental health/HIV integration provided by multiple service professionals in Zimbabwe would be acceptable and feasible. A three-phase mixed-method design was used with a longitudinal cohort of 325 nurses, community health workers, and traditional medicine practitioners in nine communities. During Phase 3, 312 PLWH were screened by nurses for mental health symptoms; 28% were positive. Of 59 PLWH screened for harmful alcohol and substance use, 36% were positive. Community health workers and traditional medicine practitioners screened 123 PLWH; 54% were positive for mental health symptom…
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Nipp RD, El-Jawahri A, Moran SM, D'Arpino SM, Johnson PC, Lage DE, Wong RL, Pirl WF, Traeger L, Lennes IT, Cashavelly BJ, Jackson VA, Greer JA, Ryan DP, Hochberg EP, Temel JS (2017)MEDLINE-indexed journal, not yet read by usCancer173 citations The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer.
Background: Patients with advanced cancer often experience frequent and prolonged hospitalizations; however, the factors associated with greater health care utilization have not been described. We sought to investigate the relation between patients' physical and psychological symptom burden and health care utilization.
Methods: We enrolled patients with advanced cancer and unplanned hospitalizations from September 2014-May 2016. Upon admission, we assessed physical (Edmonton Symptom Assessment System [ESAS]) and psychological symptoms (Patient Health Questionnaire 4 [PHQ-4]). We examined the relationship between symptom burden and healthcare utilization using linear regression for hospital length of stay (LOS) and Cox regression for time to first unplanned readmission within 90 days. We adjusted all models for age, sex, marital status, comorbidity, education, time since advanced cancer d…
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Effectiveness of a 10-week group program based on Dialectical Behaviour Therapy skills among patients with personality and mood disorders: findings from a pilot study.
Objectives: Community mental health services are often required to manage people experiencing repeated crises. Personality disorders are not uncommon, accounting for up to one-third of such presentations. These patients are often difficult to treat, leading to a revolving-door phenomenon. This study evaluated the effectiveness of a pilot intervention in reducing psychological symptoms and distress, and examined the impact of the intervention on mental health service utilization.
Methods: A pre- versus post-treatment evaluation was conducted of the effectiveness of a 10-week group psychological intervention based on Dialectical Behaviour Therapy skills, conducted in a regional Australian community mental health service with patients diagnosed with either Cluster B personality disorder or a mood disorder.
Results: Of those who completed the program ( N = 38 patients), 84% were female, with…
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Using a co-production prioritization exercise involving South Asian children, young people and their families to identify health priorities requiring further research and public awareness.
Objectives: To facilitate South Asian (SA) families and health-care professionals (HCPs) participation in a prioritization exercise to co-produce child health research and public awareness agendas.
Design: A three-stage process was adopted involving the following: (i) systematic literature review, (ii) HCP scoping survey and (iii) focus groups of SA adolescents and families. A Punjabi- and Urdu-speaking community facilitator moderated focus groups. A British Sign Language interpreter assisted in the hard of hearing group. Concordant and discordant themes between HCPs and SAs were identified.
Setting: National survey of HCPs. Leicestershire for SA families.
Participants: A total of 27 HCPs and 35 SAs. SAs varied by descent, age (16-74), UK stay length (3-57 years) religion and disability.
Results: Ranked by submission frequency in the survey, HCPs prioritized (i) public awareness on obesi…
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The relationship between health locus of control, depression, and sociodemographic factors and amount of time breast cancer patients wait before seeking diagnosis and treatment.
Background: In the Federation of Bosnia and Herzegovina, the prevalence and incidence of breast cancer has been increasing, and the national programme of early prevention, administered locally, is sporadic and without quality assurance. While many factors may influence women's decision to adopt prevention-oriented behaviours regarding breast cancer, this study has emphasised the importance of sociodemographic factors, psychological factors and mental wellbeing.
Subjects and methods: Participants in the study were all patients who, during one year, were admitted for the first time for diagnosis and treatment in the biggest Clinical hospitals of the Herzegovina-Neretva region Patients were divided into two groups based on their TNM classification: "early stage" and "late stage". Three instruments were used in this study: an individual questionnaire about demographic and socioeconomic chara…
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Ayton D, Manderson L, Smith BJ (2017)MEDLINE-indexed journal, not yet read by usHealth promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals Barriers and challenges affecting the contemporary church's engagement in health promotion.
Issue addressed Christian churches have historically undertaken welfare and community service activities to practise faith and increase their relevance to communities. However, the church in Australia has received little attention from health promotion practitioners and researchers. The objective of this qualitative study was to explore the barriers and challenges that affect church engagement in health promotion to assist practitioners' understanding of the potential for these civil society organisations to play a role in health promotion programs and partnerships. Methods The research was based on interviews with five directors of church-affiliated organisations and with the church leaders (ministers, pastors, priests) of 30 churches in urban and rural Victoria. Analysis was iterative using open, axial and thematic coding. Results The challenges to church involvement in health promotio…
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Social Isolation and Medicare Spending: Among Older Adults, Objective Social Isolation Increases Expenditures while Loneliness Does Not.
Objectives: Evaluate objective isolation and loneliness' impact on Medicare spending and outcomes.
Methods: We linked Health and Retirement Study data to Medicare claims to analyze objective isolation (scaled composite of social contacts and network) and loneliness (positive response to 3-item loneliness scale) as predictors of subsequent Medicare spending. In multivariable regression adjusting for health and demographics, we determined marginal differences in Medicare expenditures. Secondary outcomes included spending by setting, and mortality.
Results: Objective isolation predicts greater spending, $1,644(p<0.001) per beneficiary annually, whereas loneliness predicts reduced spending, -$768(p<0.001). Increased spending concentrated in inpatient and nursing-home (SNF) care; despite more healthcare, objectively isolated beneficiaries had 31%(p<0.001) greater risk of death. Loneliness did…
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A Pilot Trial of Mindfulness Meditation Training for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotion Dysregulation.
Objective: Mindfulness meditation training is garnering increasing empirical interest as an intervention for ADHD in adulthood, although no studies of mindfulness as a standalone treatment have included a sample composed entirely of adults with ADHD or a comparison group. The aim of this study was to assess the feasibility, acceptability, and preliminary efficacy of mindfulness meditation for ADHD, executive functioning (EF), and emotion dysregulation symptoms in an adult ADHD sample.
Method: Adults with ADHD were stratified by ADHD medication status and otherwise randomized into an 8-week group-based mindfulness treatment ( n = 11) or waitlist group ( n = 9).
Results: Treatment feasibility and acceptability were positive. In addition, self-reported ADHD and EF symptoms (assessed in the laboratory and ecological momentary assessment), clinician ratings of ADHD and EF symptoms, and self-r…
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Social capital and health during pregnancy; an in-depth exploration from rural Sri Lanka.
Background: Dimensions of social capital relevant to health in pregnancy are sparsely described in the literature. This study explores dimensions of social capital and the mechanisms in which they could affect the health of rural Sri Lankan pregnant women.
Methods: An exploratory qualitative study of solicited diaries written by pregnant women on their social relationships, diary interviews and in-depth interviews with key informants was conducted. A framework approach for qualitative data analysis was used.
Results: Pregnant women (41), from eight different communities completed diaries and 38 post-diary interviews. Sixteen key informant interviews were conducted with public health midwives and senior community dwellers. We identified ten cognitive and five structural constructs of social capital relevant to health in pregnancy. Domestic and neighborhood cohesion were the most commonly …
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Fayyad J, Sampson NA, Hwang I, Adamowski T, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Borges G, de Girolamo G, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Lee S, Navarro-Mateu F, O'Neill S, Pennell BE, Piazza M, Posada-Villa J, Ten Have M, Torres Y, Xavier M, Zaslavsky AM, Kessler RC, WHO World Mental Health Survey Collaborators (2017)MEDLINE-indexed journal, not yet read by usAttention deficit and hyperactivity disorders492 citations The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys.
We previously reported on the cross-national epidemiology of ADHD from the first 10 countries in the WHO World Mental Health (WMH) Surveys. The current report expands those previous findings to the 20 nationally or regionally representative WMH surveys that have now collected data on adult ADHD. The Composite International Diagnostic Interview (CIDI) was administered to 26,744 respondents in these surveys in high-, upper-middle-, and low-/lower-middle-income countries (68.5% mean response rate). Current DSM-IV/CIDI adult ADHD prevalence averaged 2.8% across surveys and was higher in high (3.6%)- and upper-middle (3.0%)- than low-/lower-middle (1.4%)-income countries. Conditional prevalence of current ADHD averaged 57.0% among childhood cases and 41.1% among childhood subthreshold cases. Adult ADHD was significantly related to being male, previously married, and low education. Adult ADHD …
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The Effect of Early Marriage Timing on Women's and Children's Health in Sub-Saharan Africa and Southwest Asia.
Background: Age of marriage is a barrier to mother's health care around pregnancy and children health outcomes.
Objective: We provide evidence on the health benefits of postponing early marriage among young wives (from age 10-14 to age 15-17) on women's health care and children's health for sub-Saharan Africa (SSA) and Southwest Asia (SWA).
Methods: We use data for 39 countries from the Demographic and Health Surveys to estimate the effects of postponing early marriage for women's health care and children's health outcomes and immunization using matching techniques. We also assess whether women's health empowerment and health constraints are additional barriers.
Findings: We found that in SSA, delaying the age of marriage from age 10-14 to age 15-17 and from age 15-17 to age 18 or older leads to an increase in maternal neotetanus vaccinations of 2.4% and 3.2%, respectively; gains in the …
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The Influence of Self-efficacy in Medical Drama Television Programming on Behaviors and Emotions that Promote Cervical Cancer Prevention.
Objectives: We explored the influences of medical drama viewing on health behaviors and emotions, and examined the role of self-efficacy in medical drama programming.
Methods: A single-factor, 2-condition experimental design that manipulated self-efficacy levels was adopted. A total of 131 female undergraduate students who were likely involved with the issues of HPV vaccination and cervical cancer participated in this experiment.
Results: In line with social cognitive theory, the results indicated that participants in the high self-efficacy condition showed greater behavioral intention to receive a Pap smear (F (1, 126) = 4.38, p < .05, partial η2 = .03) and the HPV vaccine (F (1, 35) = 4.82, p < .05, partial η2 = .12) and higher levels of hope (F (1, 126) = 12.22, p < .01, partial η2 = .09) than participants in the low self-efficacy condition. In addition, hope mediated the relationship…
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Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh.
Background: Traditional gender roles result in women lagging behind men in the use of modern technologies, especially in developing countries. Although there is rapid uptake of mobile phone use in Bangladesh, investigation of gender differences in the ownership, access and use of mobile phones in general and mHealth in particular has been limited. This paper presents gender differentials in the ownership of mobile phones and knowledge of available mHealth services in a rural area of Bangladesh.
Methods: We interviewed 4915 randomly selected respondents aged 18 years and above. Associations between gender and knowledge of available mHealth services, use of existing mHealth services and intentions to use mHealth services in the future were examined by multivariate logistic regression analysis, controlling for the effect of categorised covariates.
Results: Of the 4915 respondents to the sur…
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Depression and Suicidality in Gay Men: Implications for Health Care Providers.
Gay men are a subgroup vulnerable to depression and suicidality. The prevalence of depression among gay men is three times higher than the general adult population. Because depression is a known risk factor for suicide, gay men are also at high risk for suicidality. Despite the high prevalence of depression and suicidality, health researchers and health care providers have tended to focus on sexual health issues, most often human immunodeficiency virus in gay men. Related to this, gay men's health has often been defined by sexual practices, and poorly understood are the intersections of gay men's physical and mental health with social determinants of health including ethnicity, locale, education level, and socioeconomic status. In the current article summated is literature addressing risk factors for depression and suicidality among gay men including family acceptance of their sexual ide…
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Intersectoral approaches and integrated services in achieving the right to health for refugees upon resettlement: a scoping review protocol.
Introduction: Global insecurity and climate change are exacerbating the need for improved management of refugee resettlement services. International standards hold states responsible for the protection of the right of non-citizens to an adequate standard of physical and mental health while recognising the importance of social determinants of health. However, programmes to protect refugees' right to health often lack coordination and monitoring. This paper describes the protocol for a scoping review to explore barriers and facilitators to the integration of health services for refugees; the content, process and actors involved in protecting refugee health; and the extent to which intersectoral approaches are leveraged to protect refugees' right to health on resettlement, especially for vulnerable groups such as women and children.
Methods and analysis: Peer-reviewed (through four database…
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"The mosquitoes that destroy your face". Social impact of Cutaneous Leishmaniasis in South-eastern Morocco, A qualitative study.
Objective: To document the psychosocial burden of Cutaneous Leishmaniasis (CL) in rural communities in Southeastern Morocco.
Method: Between March and April 2015, we conducted qualitative research in communities exposed to Leishmania major or L. tropica in Errachidia and Tinghir provinces. Twenty-eight focus groups discussions (FGDs) were realized, with a stratification by gender and tradition of medicine (users of folk versus professional medicine). Data were analyzed using content analysis.
Results: This rural population most exposed to CL in Morocco lacks access to health care in general and clearly points out there are other major public health issues that need to be resolved. Nonetheless, respondents consider the impact of CL lesions and scars as important and similar to that of burn scar tissue. Young women with CL scars in the face are stigmatized and will often be rejected for ma…
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Hoque R, Sorwar G (2017)MEDLINE-indexed journal, not yet read by usInternational journal of medical informatics302 citations Understanding factors influencing the adoption of mHealth by the elderly: An extension of the UTAUT model.
Background: mHealth (mobile health) services are becoming an increasingly important form of information and communication technology (ICT) enabled delivery for healthcare, especially in low-resource environments such as developing countries like Bangladesh. Despite widespread adoption of mobile phones and the acknowledged potential of using them to improve healthcare services, the adoption and acceptance of this technology among the elderly is significantly low. However, little research has been done to draw any systematic study of the elderly's intention to adopt mHealth services.
Objective: The aim of this study was to develop a theoretical model based on the Unified Theory of Acceptance and Use of Technology (UTAUT) and then empirically test it for determining the key factors influencing elderly users' intention to adopt and use the mHealth services.
Methods: A face-to-face structured…
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Spectacle Compliance among Adolescents: A Qualitative Study from Southern India.
Purpose: To understand the perceptions of adolescents and their parents about spectacle compliance of adolescents in Southern India.
Methods: Using a qualitative snapshot design, three focus group discussions were conducted each with parents and adolescents studying in schools located in and around Chennai, Tamil Nadu. Purposive sampling technique was used in the selection of participants. Separate focus group guides were developed for parents and adolescents. All focus group discussions were conducted in the school premises and audio recorded. These audio files were then transcribed verbatim and then translated into English. A framework analytical approach was used for data analysis that involved gaining familiarity with the data to identify a thematic framework.
Results: Two major themes that emerged were (1) perceptions on barriers to spectacle compliance that was further subdivided i…
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"Where It Falls Apart": Barriers to Retention in HIV Care in Latino Immigrants and Migrants.
Latino immigrants in the United States are disproportionately affected by HIV. Barriers to consistent attendance (retention) in HIV primary care constrain opportunities for HIV treatment success, but have not been specifically assessed in this population. We conducted semistructured interviews with 37 HIV-infected Latinos (aged ≥18 years and born in Puerto Rico or a Latin American Spanish-speaking country) and 14 HIV providers in metropolitan Boston (total n = 51). The Andersen Model of Healthcare Utilization informed a semistructured interview guide, which bilingual research staff used to explore barriers to HIV care. We used thematic analysis to explore the processes of retention in care. Six ubiquitous themes were perceived to influence HIV clinic attendance: (1) stigma as a barrier to HIV serostatus disclosure; (2) social support as a safety net during negative life circumstances; (3…
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Association Between Spousal Suicide and Mental, Physical, and Social Health Outcomes: A Longitudinal and Nationwide Register-Based Study.
Importance: Bereavement after spousal suicide has been linked to mental disorders; however, a comprehensive assessment of the effect of spousal suicide is needed.
Objective: To determine whether bereavement after spousal suicide was linked to an excessive risk of mental, physical, and social health outcomes when compared with the general population and spouses bereaved by other manners.
Design, setting, and participants: This nationwide, register-based cohort study conducted in Denmark of 6.7 million individuals aged 18 years and older from 1980 to 2014 covered more than 136 million person-years and compared people bereaved by spousal suicide with the general population and people bereaved by other manners of death. Incidence rate ratios were calculated using Poisson regressions while adjusting for sociodemographic characteristics and the presence of mental and physical disorders.
Main o…
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Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions.
Mental illness-related stigma, including that which exists in the healthcare system and among healthcare providers, creates serious barriers to access and quality care. It is also a major concern for healthcare practitioners themselves, both as a workplace culture issue and as a barrier for help seeking. This article provides an overview of the main barriers to access and quality care created by stigmatization in healthcare, a consideration of contributing factors, and a summary of Canadian-based research into promising practices and approaches to combatting stigma in healthcare environments.
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Understanding and promoting treatment-seeking for eating disorders and body image concerns on college campuses through online screening, prevention and intervention.
While there have been important recent advances in the development of effective universal prevention and intervention programs, it is not yet clear how to engage large numbers of students in these programs. In this paper, we report findings from a two-phase pilot study. In the first phase, we used a population-level, online survey to assess eating disorder symptom level and habits/attitudes related to service utilization (N=2180). Using validated screening tools, we found that roughly one in three students has significant symptoms of eating disorders or elevated weight concerns, the vast majority of whom (86.5%) have not received treatment. In the second phase, we referred students to online prevention and selective/indicated intervention programs based on symptom classification (N=1916). We find that program enrollment is highest for students in the indicated intervention (18.1%) and lo…
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Barriers to postpartum screening for type 2 diabetes: a qualitative study of women with previous gestational diabetes.
Introduction: Risk of developing type 2 diabetes is increased in women with previous gestational diabetes mellitus (GDM). Postpartum glycemic screening is recommended in women with recent GDM. But this screening rate is low and the reasons are unclear. The aim of this study was to explore the experiences of Iranian women with recent GDM on barriers of postpartum screening for diabetes.
Methods: This qualitative study was conducted in Tehran, Iran in 2016. Semi-structured interview was used for data collection. 22 women with recent GDM were interviewed. These women gave birth in Tehran hospitals at a minimum of 6 months before interview. The missed screening defined as not attending to laboratory for Fasting Blood Sugar and/or Oral Glucose Tolerance Test, 6 week to 6 month after their child birthing. The data was analyzed by content analysis method.
Results: Themes and sub-themes that ill…
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