Survival in the gap: experiences of health management among people at high risk of stroke in China: A qualitative study (Preprint)

2019 ◽  
Author(s):  
Lina Guo ◽  
Lin Wang ◽  
Jo Booth ◽  
Yanjin Liu ◽  
Yiru Zhu ◽  
...  
Keyword(s):  
Social Support ◽  
High Risk ◽  
Family Income ◽  
Health Management ◽  
Healthcare Providers ◽  
Service Development ◽  
System Reform ◽  
Management Service ◽  
Structured Interviews ◽  
Step Method

BACKGROUND Effective health management of people at high risk of stroke is challenging. OBJECTIVE To identify and explore the experiences of health management among people at high risk of stroke in order to inform ideas for health management service development for this population. METHODS Semi-structured interviews were conducted with 31stroke people at high risk of stroke. The interviews were collated and analyzed using Colaizzi’s 7-step method. RESULTS The experiences of health management in people at high risk of stroke were described as ‘Survival in the gap’. Themes identified limited knowledge of health management, lack of confidence in health management and poor adherence with health management. The value of health management experience was highlighted and included: becoming active learners, promoting social interaction and enhancing self-health management. Health management was seen to be sensitive to multiple influencing factors including: The severity and complexity of diseases, family income and social support. CONCLUSIONS Health management of people at high risk of stroke is challenging and they ‘survive in the gap’. They learn to manage their ongoing health based mainly on their own experiences. Government and healthcare providers should pay attention to the situation for this special population and be devoted to health system reform, financial support and social support to manage the condition in the longer term.

scholarly journals Understanding patient outcomes to develop a multimorbidity adapted patient-reported outcomes measure: a qualitative description of patient and provider perspectives.

2021 ◽  
Author(s):  
Maxime Sasseville ◽  
Maud-Christine Chouinard ◽  
Martin Fortin
Keyword(s):  
Health Management ◽  
Healthcare Providers ◽  
Psychosocial Health ◽  
Qualitative Description ◽  
Valuable Insight ◽  
Structured Interviews ◽  
Respiratory Therapists ◽  
Wide Range ◽  
Patient Reported ◽  
Data Saturation

Abstract Background: Multimorbidity is a complex health situation that requires interventions tailored to patient needs; the outcomes of such interventions are difficult to evaluate. The purpose of this study was to describe the outcomes of patient-centred interventions for people with multimorbidity from the patients’ and healthcare providers’ perspectives.Methods: This study followed a qualitative descriptive design. Nine patients with multimorbidity and 18 healthcare professionals (nurses, general practitioners, nutritionists, and physical and respiratory therapists), participating in a multimorbidity-adapted intervention in primary care were recruited. Data were collected using semi-structured interviews with 12 open-ended questions. Triangulation of disciplines among interviewers, research team debriefing, data saturation assessment and iterative data collection and analysis ensured a rigorous research process.Results: Outcome constructs described by participants covered a wide range of themes and were grouped into seven outcome domains: Health Management, Physical Health, Functional Status, Psychosocial Health, Health-related Behaviours, General Health and Health Services. The description of constructs by stakeholders provides valuable insight on how outcomes are experienced and worded by patients.Conclusion: Participants described a wide range of outcome constructs, which were relevant to and observable by patients and were in line with the clinical reality. The description provides a portrait of multimorbidity-adapted intervention outcomes that are significant for the selection and development of clinical research outcome measures.

scholarly journals Implementing a Canadian Shared-care ADHD Program in Beijing: Barriers and Facilitators to Consider Prior to Start-up

2021 ◽  
Author(s):  
Sayna Bahraini ◽  
Alexander Maisonneuve ◽  
Yirong Liu ◽  
André Samson ◽  
Qian Ying ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Shared Care ◽  
Stepped Care ◽  
Barriers And Facilitators ◽  
Service Development ◽  
Care Pathways ◽  
Theory Approach ◽  
Structural Level ◽  
Structured Interviews ◽  
Intervention Level

Abstract Background: The ADHD Shared Care Pathways is a program that has been developed in Canada with two main strategies: (a) to implement shared care between general practitioners (GPs) and specialists, and (b) to implement stepped care in which the patient is treated at the most appropriate level of care, depending on complexity or outcome of their illness. The current study aims to identify challenges and facilitators in implementing this program in a Chinese context. Methods: Two focus groups were conducted using semi-structured interviews with a total of 7 healthcare providers in Beijing. A grounded theory approach using open, axial and selective coding provided three main themes pertaining to the barriers and facilitators faced at: (1) a social-level from of the perspectives of patients and healthcare providers; (2) at a structural-level related to both internal and external organizational environments; (3) and at the intervention-level. Results: Results reveal multilayered challenges in implementing an ADHD Shared Care Pathways program for children in China. Conclusion: Our study highlights the importance of consultation in a new implementation context in order to get a “lay of the land”. By extension, our results demonstrate areas for service development and further research.

scholarly journals Implementing a Canadian Shared-Care ADHD Program in Beijing: Barriers and Facilitators To Consider Prior To Start-Up.

2021 ◽  
Author(s):  
Sayna Bahraini ◽  
Alexander Maisonneuve ◽  
Yirong Liu ◽  
André Samson ◽  
Qian Ying ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Shared Care ◽  
Stepped Care ◽  
Barriers And Facilitators ◽  
Service Development ◽  
Care Pathways ◽  
Theory Approach ◽  
Structural Level ◽  
Structured Interviews ◽  
Intervention Level

Abstract Background The ADHD Shared Care Pathways is a program that has been developed in Canada with two main strategies: (a) to implement shared care between general practitioners (GPs) and specialists, and (b) to implement stepped care in which the patient is treated at the most appropriate level of care, depending on complexity or outcome of their illness. The current study aims to identify challenges and facilitators in implementing this program in a Chinese context. Methods Two focus groups were conducted using semi-structured interviews with a total of 7 healthcare providers in Beijing. A grounded theory approach using open, axial and selective coding provided three main themes pertaining to the barriers and facilitators faced at: (1) a Social-level from of the perspectives of patients and healthcare providers; (2) at a structural-level related to both internal and external organizational environments; (3) and at the intervention-level. Results Results reveal multilayered challenges in implementing an ADHD Shared Care Pathways program for children in China. Conclusion Our study highlights the importance of consultation in a new implementation context in order to get a “lay of the land”. By extension, our results demonstrate areas for service development and further research.

A qualitative exploration of the feasibility of incorporating depression apps into integrated primary care clinics

2021 ◽  
Author(s):  
Danae Dinkel ◽  
Jennifer Harsh Caspari ◽  
Louis Fok ◽  
Maxine Notice ◽  
David J Johnson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Management ◽  
Mobile Apps ◽  
Healthcare Providers ◽  
Cost Effective ◽  
Integrated Primary Care ◽  
Healthcare Team ◽  
Structured Interviews ◽  
Potential Cost ◽  
Share Data

Abstract The use of mobile applications or “apps” is beginning to be identified as a potential cost-effective tool for treating depression. While the use of mobile apps for health management appears promising, little is known on how to incorporate these tools into integrated primary care settings—especially from the viewpoints of patients and the clinic personnel. The purpose of this study was to explore patient- and clinic-level perceptions of the use of depression self-management apps within an integrated primary care setting. Patients (n = 17), healthcare providers, and staff (n = 15) completed focus groups or semi-structured interviews in-person or via Zoom between January and July 2020. Participants were asked about barriers and facilitators to app use, how to best integrate it into care, and reviewed pre-selected mental health apps. Data were analyzed using a directed content analysis approach. From a patient perspective, features within the app such as notifications, the provision of information, easy navigation, and a chat/support function as well as an ability to share data with their doctor were desirable. Providers and staff identified integration of app data into electronic health records to be able to share data with patients and the healthcare team as well as clear evidence of effectiveness as factors that could facilitate implementation. All participants who reviewed apps identified at least one of them they would be interested in continuing to use. Overall, patients, healthcare providers, and staff believed depression apps could be beneficial for both patients and the clinic.

scholarly journals Development of dental caries and risk factors between 1 and 7 years of age in areas of high risk for dental caries in Stockholm, Sweden

2021 ◽  
Author(s):  
M. Anderson ◽  
G. Dahllöf ◽  
A. Warnqvist ◽  
M. Grindefjord
Keyword(s):  
High Risk ◽  
Dental Caries ◽  
Family Income ◽  
Fluoride Varnish ◽  
Secondary Outcome ◽  
Free Sugar ◽  
Secondary Outcome Measure ◽  
Structured Interviews ◽  
Fluoride Toothpaste ◽  
Immigrant Background

Abstract Purpose To explore caries predictors at age 1 year and caries development at ages 5 and 7 years in two groups of children following different fluoride-based preventive programs. Methods We conducted a prospective cluster-randomized controlled intervention trial with two parallel arms comparing two prevention programs: one program included fluoride varnish applications every 6 months, the other did not; otherwise, the programs were the same. Participants were 1- and 3-year-old children enrolled at 23 dental clinics in high-risk areas in Stockholm, Sweden. The baseline examination included structured interviews. Caries data were extracted from dental records. The primary outcome measures were ICDAS 1–6 > 0 at baseline (age 1 year) and defs > 0 at ages 2, 3, 5, and 7 years. The secondary outcome measure at age 7 was DFS > 0. Results Continuous caries development occurred: defs > 0 in 23% at 5 years and in 42% at 7 years. We found no difference in caries development between children who had or had not received fluoride varnish as toddlers. At age 1-year, significant predictors for dental caries in later preschool years were immigrant background, family income, and sweets consumption. Fluoride toothpaste > once a day at 1 year had an OR < 1 for defs > 0 at 5- and 7 years. Conclusions For toddlers, fluoride varnish does not seem to be an adequate prevention tool. Brushing with fluoride toothpaste from 1 year of age could not arrest caries development. Immigrant background was the strongest predictor. A new toolbox as well as collaborative upstream actions for reducing free-sugar intake are needed.

scholarly journals The Perceived Social Support by Iranian Women with Breast Cancer: A Qualitative Study

2021 ◽  
Author(s):  
Leila Mokhtari ◽  
Abdollah Khorami Markani ◽  
Hamid Reza Khalkhali ◽  
Aram Feizi
Keyword(s):  
Breast Cancer ◽  
Social Support ◽  
Qualitative Study ◽  
Lived Experience ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
Well Being ◽  
Medical Sciences ◽  
Structured Interviews ◽  
The Family

Abstract Background: Social support has an importnat role in improving health outcomes and is considered as one of the crucial aspects of the modern care in cancer patients. Therefore this article aims at discovering and describing the dimensions of social support based on the lived experience of women suffering from breast cancer.Methods: In this qualitative study, 22 women with breast cancer were selected through purposive sampling from 7 hospitals affiliated to Urmia University of Medical Sciences. The data were collected through semi-structured interviews and were analyzed by the Conventional Qualitative Content Analysis and Graneheim’s and Lundman’s (2004) approach, using MAXQDA software, version 10.Results: After completion of the analyzing process, 6 categories were appeared including “creating an empathic atmosphere by family and community”, “creating a safe communication network for the patient”, “adaption to disease”, “giving meaning to life”, “the feeling of satisfaction with the healthcare providers for fulfilling their role”, and “accepting the support and help of family and friends in fighting the disease”. Conclusion: According to the findings, good social support during the illness can result in the spiritual, mental, and physical well-being of the patients and is one of the most effective factors in fighting the disease and feeling of recovery. The findings of this study can be used to develop plans to help the patients to achieve more support from the family, healthcare providers and the community and even providing the required supportive care for this group of women.

scholarly journals Barriers and facilitators to recognize and discuss depression and anxiety experienced by adults with vision impairment or blindness: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Edine P. J. van Munster ◽  
Hilde P. A. van der Aa ◽  
Peter Verstraten ◽  
Ruth M. A. van Nispen
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Visually Impaired ◽  
Mental Health Problems ◽  
Low Vision ◽  
Healthcare Providers ◽  
Health Problems ◽  
Vision Impairment ◽  
Depression And Anxiety ◽  
Structured Interviews

Abstract Background Depression and anxiety are highly prevalent, but often unrecognized in adults with vision impairment (VI) or blindness. The purpose of this study was to explore visually impaired and blind adults’ views on facilitators and barriers in recognizing and discussing mental health problems. Methods Semi-structured interviews, based on the Integrated Model for Change, were conducted with 16 visually impaired or blind adults receiving support from three Dutch low vision service organizations. Interview data was analyzed using the framework approach. Results Participants perceived their focus on practical support with regard to their VI, lack of mental health literacy, and misattribution of symptoms of depression or anxiety as barriers for recognizing mental health problems. With regard to discussing mental health problems, they perceived difficulties in acknowledging their VI and mental health problems due to feelings of vulnerability and inequality. Participants mentioned that their social support system and healthcare providers (could) facilitate them in recognizing and discussing mental health problems. However, participants thought that healthcare providers currently often lacked the knowledge, skills and attitude to recognize and discuss this topic with their clients. Conclusion Our findings suggest that visually impaired and blind adults may experience several barriers to recognize, acknowledge and discuss mental health. Healthcare providers and social support systems seem essential for them in reducing these barriers. However, there might be a mismatch between the needs of visually impaired and blind adults and healthcare providers’ knowledge, skills and attitude. Training healthcare providers may improve detection of depression and anxiety in adults with VI or blindness, and enhance clinician-patient communication on mental health.

scholarly journals Challenge or Opportunity? Impacts of Falls among Older Adults Living with Dementia on their Care Partners

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 938-938
Author(s):  
Yuanjin Zhou ◽  
Emily Ishado ◽  
Tatiana Sadak
Keyword(s):  
Older Adults ◽  
Health Management ◽  
Healthcare Providers ◽  
Work Productivity ◽  
Self Care ◽  
Community Dwelling ◽  
Negative Consequences ◽  
Structured Interviews ◽  
Care Partners ◽  
Fall Risks

Abstract Previous studies suggest that falls among community-dwelling older adults living with dementia (OLWD) harm the health and wellbeing of their family/friend care partners. However, little is known about the process through which falls impact care partners. We conducted a grounded theory analysis using 59 semi-structured interviews with care partners of OLWD who were recently hospitalized and had a history of falls. We identified several areas of care partners’ functioning that were affected by falls in positive and negative ways: everyday life, health management for OLWD, and interactions with healthcare providers. Both the fall events and fall risks had negative consequences of reducing care partners' self-care activities and work productivity. Other adverse consequences of fall risks were (1) care partners’ fatigue and conflicts with OLWD due to the intense requirement of daily monitoring, and (2) hesitance to ask healthcare providers for assistance because clinicians frequently did not teach care partners how to address fall risks and might recommend institutionalization. However, OLWD's fall events became a transition point for some care partners to seek support and gain more information and skills about managing OLWD’s health conditions, which might reduce care partners’ burden in the long term. Because OLWD’s falls may have negative and positive consequences for care partners, both problem-solving and strength-based fall management approaches are needed. These strategies focus on developing and sustaining care partners’ self-care, developing collaborative relationships with OLWD, enhancing successful capacity for OLWD’s health management, and cultivating partnerships with healthcare providers.

scholarly journals Population health management in France: specifying population groups through the DRG system

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
A. Malone ◽  
S. Gomez ◽  
S. Finkel ◽  
D. Chourchoulis ◽  
E. Morcos ◽  
...  
Keyword(s):  
Population Health ◽  
Health Management ◽  
Healthcare Providers ◽  
Automated Analysis ◽  
French Population ◽  
Step Method ◽  
Population Groups ◽  
Population Health Management ◽  
Healthcare Facilities ◽  
Hospital Stays

Abstract Background Population health management (PHM) by hospital groups is not yet defined nor implemented in France. However, in 2019, the French Hospitals Federation launched a pilot program to experiment PHM in five territories around five Territorial Hospital Groups (GHT’s). In order to implement PHM, it is necessary to firstly define the population which healthcare facilities (hospitals) have responsibility for. In the French healthcare system, mapping of health territories however relies mainly on administrative data criteria which do not fit with the actual implementation of GHT’s. Mapping for the creation of territorial hospital groups (GHTs) also did not include medical criteria nor all healthcare offers particularly in private hospitals and primary care services, who are not legally part of GHT’s but are major healthcare providers. The objective of this study was to define the French population groups for PHM per hospital group. Methods A database study based on DRG (acute care, post-acute and rehabilitation, psychiatry and home care) from the French National Hospitals Database was conducted. Data included all hospital stays from 1 January 2016 to 31 December 2017. The main outcome of this study was to create mutually exclusive territories that would reflect an accurate national healthcare service consumption. A six-step method was implemented using automated analysis reviewed manually by national experts. Results In total, 2840 healthcare facilities, 5571 geographical zones and 31,441,506 hospital stays were identified and collated from the database. In total, 132 GHTs were included and there were 72 zones (1.3%) allocated to a different GHTs. Furthermore, 200 zones were manually reviewed with 33 zones allocated to another GHT. Only one area did not have a population superior to 50,000 inhabitants. Three were shown to have a population superior to 2 million. Conclusions Our study demonstrated a feasible methodology to define the French population under the responsibility of 132 hospital groups validated by a national group of experts.

Patients’ and providers’ perspectives and needs of telemonitoring to support clinical management and self-care of people at high-risk for preeclampsia (Preprint)

2021 ◽  
Author(s):  
Maria Aquino ◽  
Janessa Griffith ◽  
Tessy Vattaparambil ◽  
Sarah Munce ◽  
Michelle Hladunewich ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Thematic Analysis ◽  
Clinical Management ◽  
Healthcare Providers ◽  
Self Care ◽  
Self Management ◽  
Close Monitoring ◽  
Structured Interviews ◽  
Increased Risk

BACKGROUND Preeclampsia is one of the leading causes of maternal mortality in the world with the global prevalence at 2% to 8% of pregnancies. Patients at high-risk for preeclampsia (PHRPE) have an increased risk of complications such as fetal growth restriction, preterm delivery, abnormal clotting, and liver and kidney disease. Telemonitoring for PHRPE may allow for a timelier diagnosis and enhanced management, which may improve maternal and perinatal outcomes. OBJECTIVE The objective of this study was to determine the perceptions and needs of PHRPE and their healthcare providers with respect to telemonitoring through semi-structured interviews with both groups. This study explored: 1) What are the needs and challenges of monitoring PHRPE during pregnancy and in the postpartum period? 2) What are the features required in a telemonitoring program to support self-care and clinical management of PHRPE? METHODS This study used a qualitative descriptive approach and thematic analysis was conducted. PHRPE and healthcare providers from a high-risk obstetrical clinic in a large academic hospital in Toronto, Canada were asked to participate in individual semi-structured interviews. Two researchers jointly developed a coding framework and coded each interview separately to ensure that the interviews were double coded. The software program NVivo version 12 was used to help organize the codes. RESULTS Seven PHRPE and five healthcare providers, which included a nurse practitioner and physicians, participated in the semi-structured interviews. Using thematic analysis, perceptions on the benefits, barriers, and desired features were determined. Perceived benefits of telemonitoring for PHRPE included close monitoring of home blood pressure measurements and appropriate interventions for abnormal blood pressure readings; the development of a tailored telemonitoring system for pregnant patients; and facilitation of self-management. Perceived barriers of telemonitoring for PHRPE included financial and personal barriers as well as the potential for increased clinician workload. Desired features of a secure platform for PHRPE included the facilitation of self-management for patients and decision-making for clinicians, as well as the inclusion of evidence-based action prompts. CONCLUSIONS The perceptions of patients and providers on the use of telemonitoring for PHRPE support the need for a telemonitoring program for the management of PHRPE. Recommendations from this study included the specific features of a telemonitoring program for PHRPE, as well as use of frameworks and design processes in the design and implementation of a telemonitoring program for PHRPE.

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