Whether and how people reach care.
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1251 to 1275 of 2,047'I'll be in a safe place': a qualitative study of the decisions taken by people with advanced cancer to seek emergency department care.
Objective: To explore the decisions of people with advanced cancer and their caregivers to seek emergency department (ED) care, and understand the issues that influence the decision-making process.
Design: Cross-sectional qualitative study incorporating semistructured patient and caregiver interviews.
Methods: Between December 2014 and July 2015, semistructured interviews were conducted with 18 people with advanced cancer, all of whom had recently attended the ED of a large university teaching hospital located in south-east London; and six of their caregivers. Interviews were audio recorded, transcribed verbatim and analysed using a constant comparative approach. Padgett and Brodsky's modified version of the 'Behavioral Model of Health Services Use' was used as a framework to guide the study.
Results: Issues influencing the decision-making process included: (1) disease-related anxiety-th…
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Palliative care reimagined: a needed shift.
Palliative care, since its inception over 60 years ago, has set the standard of how to care for people who are dying. Key features among these standards have been the professional development of clinical specialisms such as palliative medicine and palliative nursing; the essential addition of the multidisciplinary team to these two new specialisms that included social, spiritual and allied health workers-an outgrowth of the recognition that routine work with the dying, their carers, and the bereaved required more than solely clinical skills; and the unique partnership with communities that yielded the volunteer movement within palliative care. Professional, evidence-based symptom management and the importance of supportive care in its widest possible sense were and remain the cornerstones of the modern palliative care approach. However, the majority of people with terminal illnesses do n…
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What Matters: Quantity or Quality of Pornography Use? Psychological and Behavioral Factors of Seeking Treatment for Problematic Pornography Use.
Introduction: Pornography has become popular with Internet technology. For most people, pornography use (PU) is entertainment; for some, it can result in seeking treatment for out-of-control behavior. Previous studies have suggested that PU can influence sexual behaviors, but the direct relation between frequency of PU and treatment-seeking behaviors has not been examined.
Aims: To investigate whether individuals seeking treatment as a consequence of their problematic PU do so because of their quantity of pornography consumption or because of more complex psychological and behavioral factors related to PU, such as the severity of negative symptoms associated with PU and/or subjective feeling of loss of control over one's behavior.
Methods: A survey study was conducted of 569 heterosexual Caucasian men 18 to 68 years old, including 132 seeking treatment for problematic PU (referred by psy…
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Factors associated with contraceptive use and intention to use contraceptives among married women in Ethiopia.
Family planning has improved the well-being of families by preventing high-risk pregnancies and abortions and reducing unplanned pregnancies. However, the effectiveness of family planning efforts has not been consistent across countries. This study examined factors associated with contraceptive use among married women in Ethiopia. Data were from the 2011 Ethiopian Demographic and Health Survey. The sample comprised 10,204 married women (aged 15-49 years). Logistic regression models were used to analyze the data. Among married women in Ethiopia, 29.2% used contraceptive methods. About 44.1% of women who were not current users of contraceptives reported that they intended to use contraceptives in the future. Age at first marriage, being educated, number of living children, exposure to mass media, being employed, having educated partners, and having been informed about contraceptive use at …
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Quality versus quantity: The role of socioeconomic status on parent-reported service knowledge, service use, unmet service needs, and barriers to service use.
Research within the autism spectrum disorder field has emphasized the role of socioeconomic status in shaping parents' ability to access services for their child with autism spectrum disorder. However, research has yet to explore the possible mechanisms underlying this relationship. This study sought to address this research gap by examining the following questions: (1) Does parents' service knowledge mediate the relationship between parent socioeconomic status and parents' autism spectrum disorder service use? (2) What are parents' reported service needs and service barriers, and do these needs vary across higher and lower socioeconomic status groups? Quantitative results from 244 parents of a child with autism spectrum disorder indicate that parents' autism spectrum disorder service knowledge partially mediates the relationship between parent socioeconomic status and parents' autism sp…
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"When everything changes:" Parent perspectives on the challenges of accessing care for a child with a disability.
Background: Health disparities exist among individuals living in rural and urban contexts in terms of access to health care and overall mortality. These disparities are typically greater for youth with disabilities living in rural areas, who face additional barriers in receiving health and support services specific to their disability. Parents are typically the ones responsible for coordinating the care needed by children with a disability; however, with numerous barriers present families are not provided adequate support to care for a child with disabilities.
Objective: The purpose of this study was to examine barriers and facilitators to accessing health and support services among urban and rural families of children with disabilities.
Methods: In-depth interviews were conducted with parents who provide care for an adolescent with a disability. The sample was comprised of parents from …
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Bauer MS, Miller C, Kim B, Lew R, Weaver K, Coldwell C, Henderson K, Holmes S, Seibert MN, Stolzmann K, Elwy AR, Kirchner J (2016)MEDLINE-indexed journal, not yet read by usImplementation science : IS44 citations Partnering with health system operations leadership to develop a controlled implementation trial.
Background: Outcome for mental health conditions is suboptimal, and care is fragmented. Evidence from controlled trials indicates that collaborative chronic care models (CCMs) can improve outcomes in a broad array of mental health conditions. US Department of Veterans Affairs leadership launched a nationwide initiative to establish multidisciplinary teams in general mental health clinics in all medical centers. As part of this effort, leadership partnered with implementation researchers to develop a program evaluation protocol to provide rigorous scientific data to address two implementation questions: (1) Can evidence-based CCMs be successfully implemented using existing staff in general mental health clinics supported by internal and external implementation facilitation? (2) What is the impact of CCM implementation efforts on patient health status and perceptions of care?
Methods/desig…
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Evaluating Religious Influences on the Utilization of Maternal Health Services among Muslim and Christian Women in North-Central Nigeria.
Introduction: Uptake of antenatal services is low in Nigeria; however, indicators in the Christian-dominated South have been better than in the Muslim-dominated North. This study evaluated religious influences on utilization of general and HIV-related maternal health services among women in rural and periurban North-Central Nigeria.
Materials and methods: Targeted participants were HIV-positive, pregnant, or of reproductive age in the Federal Capital Territory and Nasarawa. Themes explored were utilization of facility-based services, provider gender preferences, and Mentor Mother acceptability. Thematic and content approaches were applied to manual data analysis.
Results: Sixty-eight (68) women were recruited, 72% Christian and 28% Muslim. There were no significant religious influences identified among barriers to maternal service uptake. All participants stated preference for facility-b…
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Can Community Social Cohesion Prevent Posttraumatic Stress Disorder in the Aftermath of a Disaster? A Natural Experiment From the 2011 Tohoku Earthquake and Tsunami.
In the aftermath of a disaster, the risk of posttraumatic stress disorder (PTSD) is high. We sought to examine whether the predisaster level of community social cohesion was associated with a lower risk of PTSD after the earthquake and tsunami in Tohoku, Japan, on March 11, 2011. The baseline for our natural experiment was established in a survey of older community-dwelling adults who lived 80 kilometers west of the epicenter 7 months before the earthquake and tsunami. A follow-up survey was conducted approximately 2.5 years after the disaster. We used a spatial Durbin model to examine the association of community-level social cohesion with the individual risk of PTSD. Among our analytic sample (n = 3,567), 11.4% of respondents reported severe PTSD symptoms. In the spatial Durbin model, individual- and community-level social cohesion before the disaster were significantly associated with…
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Factor associated with experience of modern contraceptive use before pregnancy among women who gave birth in Kersa HDSS, Ethiopia.
Background: Worldwide, every year 289,000 women die related to pregnancy and its complications. Nearly, all of these deaths occur in developing countries and more than half of this deaths occur in sub-Saharan Africa. Report suggested that using contraceptives can reduce this maternal mortality by 44 %. Even if, Ethiopia is one of the countries with highest maternal mortality, only 41 % of married women are using family planning. This analysis aimed at assessing factor associated with experience of contraceptive use before pregnancy among women who gave birth in Kersa Health and Demographic Surveillance System, Ethiopia.
Methods: This study was part of data generated for Kersa Health and Demographic Surveillance System. Women who gave birth during October 2011 to September 2012 were asked whether they had used contraceptive before getting their last pregnancy. Data were collected by using…
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Labels, Gender-Role Conflict, Stigma, and Attitudes Toward Seeking Psychological Help in Men.
Despite a comparable need, research has indicated that on average men hold more negative attitudes toward psychological help seeking than women. Several researchers have suggested that the gender gap in service use and attitudes could be addressed through efforts to better market psychological services to men; however, a limited number of studies have tested this hypothesis. This study examined whether altering the labels for mental health providers (psychologist or counselor), settings (mental health clinic or counseling center), and treatments (problem or feeling focused) could result in less perceived stigma (social and self) by men. Participants, 165 male college students, were asked to read one of eight randomly assigned vignettes that described a man who was experiencing symptoms of depression and was considering seeking help. The vignettes differed in the labels that were used to …
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I Do Not Even Say "It" - a Mixed Methods Study on Breast Cancer Awareness of Omani Women.
Background: The incidence of breast cancer is rising in Oman, and the disease is diagnosed at late stages, when treatment success is limited. Omani women might benefit from better awareness, so that breast cancer can be detected early and treated. This study was conducted to assess Omani women's levels of breast cancer awareness and early detection practice, and explore factors which might influence these levels.
Materials and methods: A mixed methods study was conducted in 2014, including a quantitative survey of 1,372 and a qualitative assessment of 19 Omani women, aged ≥20 years from five Omani governorates using convenient sampling. Demographic information and scores for awareness levels were used in a multivariate regression model to investigate factors associated with awareness. Thematic analysis and interpretive description were used to analyse the qualitative data.
Results: The o…
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Acceptability of Mental Health Apps for Aboriginal and Torres Strait Islander Australians: A Qualitative Study.
Background: Aboriginal and Torres Strait Islander Australians experience high rates of mental illness and psychological distress compared to their non-Indigenous counterparts. E-mental health tools offer an opportunity for accessible, effective, and acceptable treatment. The AIMhi Stay Strong app and the ibobbly suicide prevention app are treatment tools designed to combat the disproportionately high levels of mental illness and stress experienced within the Aboriginal and Torres Strait Islander community.
Objective: This study aimed to explore Aboriginal and Torres Strait Islander community members' experiences of using two culturally responsive e-mental health apps and identify factors that influence the acceptability of these approaches.
Methods: Using qualitative methods aligned with a phenomenological approach, we explored the acceptability of two culturally responsive e-mental heal…
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Exploring models for the roles of health systems' responsiveness and social determinants in explaining universal health coverage and health outcomes.
Background: Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking.
Objective: To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health.
Design: The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002-2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables w…
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Religious beliefs and mammography intention: findings from a qualitative study of a diverse group of American Muslim women.
Objective: Studies suggest that American Muslim women underutilize mammography. While religion has a strong influence upon Muslim health behaviors, scant research has examined how religion-related beliefs inform Muslim women's intention for mammography. Our study identifies and examines such beliefs.
Methods: Muslim women aged 40 years and older sampled from mosques participated in focus groups and individual interviews. Drawing upon the theory of planned behavior, interviews elicited salient behavioral, normative, and control beliefs regarding mammography and the influence of Islam upon screening intention.
Results: Fifty women participated in 6 focus groups and 19 in semistructured interviews, with near-equal numbers of African American, South Asian, and Arab Muslims. Forty-two percent of participants had not had a mammogram within the past 2 years. Across differences in race/ethnicity…
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The Influence of Religiosity and Spirituality on Rural Parents' Health Decision Making and Human Papillomavirus Vaccine Choices.
General health implications of religiosity and spirituality on health have been associated with health promotion, so the purpose of this study was to examine the influence of religiosity and spirituality on rural parents' decision making to vaccinate their children against human papillomavirus (HPV). The associations of religiosity and spirituality with parental HPV vaccine decisions were examined in a sample of parents residing in small rural communities (N = 37). Parents of children aged 9 to 13 years participated in focus groups held in rural community contexts. Religiosity (i.e., participation in religious social structures) was a recurring and important theme when discussing HPV vaccination. Spirituality (i.e., subjective commitment to spiritual or religious beliefs) was found to influence the ways in which parents perceived their control over and coping with health issues potential…
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Colorectal cancer screening uptake over three biennial invitation rounds in the English bowel cancer screening programme.
Objective: To examine patterns of colorectal cancer (CRC) screening uptake over three biennial invitation rounds in the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP) in England.
Methods: We analysed data from the BCSP's Southern Hub for individuals (n=62,099) aged 60-64 years at the time of first invitation to screening with a follow-up period that allowed for two further biennial invitations. Data on sex, age and a neighbourhood-level measure of socioeconomic deprivation were used in the analysis. Outcomes included uptake of guaiac-based faecal occult blood (gFOB) test screening, inadequate gFOB screening (≥1 test kit(s) returned but failed to complete further gFOB tests needed to reach a conclusive test result), test positivity, compliance with follow-up examinations (usually colonoscopy) and diagnostic outcomes.
Results: Overall gFOB uptake was 57.4% in the fir…
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Challenges Faced by Refugee New Parents from Africa in Canada.
This study examines challenges faced by refugee new parents from Africa in Canada. Refugee new parents from Zimbabwe (n = 36) and Sudan (n = 36) were interviewed individually about challenges of coping concurrently with migration and new parenthood and completed loneliness and trauma/stress measures. Four group interviews with refugee new parents (n = 30) were subsequently conducted. Participants reported isolation, loneliness, and stress linked to migration and new parenthood. New gender roles evoked marital discord. Barriers to health-related services included language. Compounding challenges included discrimination, time restrictions for financial support, prolonged immigration and family reunification processes, uncoordinated government services, and culturally insensitive policies. The results reinforce the need for research on influences of refugees' stressful experiences on parent…
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Profile and predictors of service needs for families of children with autism spectrum disorders.
Purpose: Increasing demand for autism services is straining service systems. Tailoring services to best meet families' needs could improve their quality of life and decrease burden on the system. We explored overall, best, and worst met service needs, and predictors of those needs, for families of children with autism spectrum disorders.
Methods: Parents of 143 children with autism spectrum disorders (2-18 years) completed a survey including demographic and descriptive information, the Family Needs Survey-Revised, and an open-ended question about service needs. Descriptive statistics characterize the sample and determine the degree to which items were identified and met as needs. Predictors of total and unmet needs were modeled with regression or generalized linear model. Qualitative responses were thematically analyzed.
Results: The most frequently identified overall and unmet service n…
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Delay discounting, treatment motivation and treatment retention among substance-dependent individuals attending an in inpatient detoxification program.
Background: Recent studies consistently indicate high rates of delay discounting in drug users, which refers to a strong tendency to devaluate delayed rewards. Many addiction treatment programs however, place high demands on the ability to postpone immediate gratification. Therefore, these programs may be particularly challenging for drug users who are disproportionally oriented towards the present, potentially leading to a drop in their treatment involvement. Still, few studies to date have looked at whether delay discounting in drug users is associated with poorer treatment motivation or shorter treatment retention (i.e., the length of stay in treatment).
Method: In the current study, we examined whether delay discounting, as measured shortly following treatment entry, was predictive of poor treatment retention among 84 substance-dependent individuals (SDI) attending an inpatient detox…
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Challenges in researching migration status, health and health service use: an intersectional analysis of a South London community.
Objectives: This study aimed to investigate the associations between migration status and health-related outcomes and to examine whether and how the effect of migration status changes when it is disaggregated by length of residence, first language, reason for migration and combined with ethnicity.
Design: A total of 1698 adults were interviewed from 1076 randomly selected households in two South London boroughs. We described the socio-demographic and socio-economic differences between migrants and non-migrants and compared the prevalence of health-related outcomes by migration status, length of residence, first language, reason for migration and migration status within ethnic groups. Unadjusted models and models adjusted for socio-demographic and socio-economic indicators are presented.
Results: Migrants were disadvantaged in terms of socio-economic status but few differences were found …
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Austin A (2015)MEDLINE-indexed journal, not yet read by usContraception43 citations Unmet contraceptive need among married Nigerian women: an examination of trends and drivers.
Objective: The aim of this study is to examine trends in and drivers of unmet need for contraceptives among married Nigerian women between 2003 and 2013.
Methods: This analysis utilized combined data from the 2003, 2008 and 2013 cross-sectional Nigerian Demographic Health Surveys, resulting in a sample size of 54,873 currently married women. Multinomial logistic regression examined associations between trends in unmet need for spacing and limiting, and the demographic, socioeconomic, and reproductive profiles of the respondents.
Results: Women in 2008 were 30% more likely to have an unmet need for spacing, relative to women in 2013. Despite these significant declines in unmet need to space fertility between 2008 and 2013, the adjusted results show that between 2003 and 2013, there was no significant change in the trends in unmet need to space fertility. Unmet need to limit fertility was …
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Somatic symptom burden and health anxiety in the population and their correlates.
Objective: Somatic symptom burden and health anxiety demonstrate overlapping clinical characteristics but their relationship in the general population is unclear. This study examined the association between these dimensions after adjustment for confounders and their respective correlation with outcome measures.
Methods: A randomly selected population-based sample of 3014 respondents aged 15-65 was interviewed by telephone using a structured questionnaire that included the 15-item Patient Health Questionnaire (PHQ-15), Whiteley-7, Kessler-6, Sheehan Disability Scale, socio-demographic variables and items regarding health care utilization. Respondents who scored 10 or above on PHQ-15 and 4 or above on Whiteley-5 were regarded as having high somatic symptom burden and high health anxiety respectively.
Results: Somatic symptom burden and health anxiety are moderately correlated after adjustm…
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Social capital: theory, evidence, and implications for oral health.
In the last two decades, there has been increasing application of the concept of social capital in various fields of public health, including oral health. However, social capital is a contested concept with debates on its definition, measurement, and application. This study provides an overview of the concept of social capital, highlights the various pathways linking social capital to health, and discusses the potential implication of this concept for health policy. An extensive and diverse international literature has examined the relationship between social capital and a range of general health outcomes across the life course. A more limited but expanding literature has also demonstrated the potential influence of social capital on oral health. Much of the evidence in relation to oral health is limited by methodological shortcomings mainly related to the measurement of social capital, …
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Caregivers' treatment-seeking behaviour for children under age five in malaria-endemic areas of rural Myanmar: a cross-sectional study.
Background: A community-based malaria intervention was introduced through fixed and mobile clinics in rural Myanmar. This study attempted to identify treatment-seeking behaviour of caregivers for children under five and the determinants of appropriate treatment-seeking behaviour in mobile clinic villages (MV) and non-mobile clinic villages (NMV) in malaria-endemic rural areas in Myanmar.
Methods: A cross-sectional study was conducted in 23 MV and 25 NMV in Ingapu Township, Myanmar. Appropriate treatment-seeking behaviour was operationally defined as seeking treatment from trained personnel or at a health facility within 24 hours after the onset of fever. Multiple logistic regression analyses were conducted to identify the determinants of appropriate treatment-seeking behaviour.
Results: Among the 597 participants in both types of villages, 166 (35.3%) caregivers sought appropriate treatm…
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