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Purpose: This paper aims to explore the perspectives of registered nurses towards communication with family members of older people with a tracheostomy. Design/methodology/approach: A qualitative design was used. Ten participants were recruited through purposive sampling. Face-to-face, semi-structured interviews were used in collecting data. Data were analysed by thematic analysis. Findings: The four themes identified were as follows: communication by considering time difference; considering factors related to effective communication, either family member–related factors or registered nurse–related factors; strategies of communicating to support family members, such as giving an opportunity to ask for accurate information, communicating to build self-confidence and communicating through cases; and using the art of communication by speaking slowly and clearly, using colloquialisms, being steady and calm, as well as using positive language. Practical implications: Having strategies and using the art of communication are important to help family members in obtaining accurate information and in building self-confidence in the care of older people. Originality/value: The paper indicates that registered nurses consider factors related to communication, and they gave more information to family members using effective strategies and the art of communication. Therefore, effective communication training to nursing teams should be performed to promote adherence to treatment and family members' satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: Meals on Wheels (MOW) support older people to live in their own homes and communities. The purpose of this paper is to explore MOW experiences from a multi-stakeholder level to inform and better equip this valuable service. Design/methodology/approach: A qualitative approach was undertaken utilising semi-structured interviews and focus groups with current, former and potential MOW service users and MOW stakeholders. Findings: Qualitative analysis explored MOW perspectives and experiences, highlighting a lack of MOW information and awareness, the importance of a client-centred approach the multiple roles of MOW and service transition. Originality/value: This research explores MOW from the perspective of different groups directly involved in this community service, offering unique multi-stakeholder insights to understand and guide the future of this service. [ABSTRACT FROM AUTHOR]

Purpose: The concept of personal recovery is now a key pillar of service delivery. It aims to support individuals to flourish and establish a new identity following an acute episode or diagnosis. This view of recovery is unique to each person on that journey. However, there has been a significant focus on measuring these experiences. This paper aims to explore the influence of social constructionism on the concept of recovery within an Irish context, seeking to understand the influence of language, discourse and power on service users' experiences. Design/methodology/approach: A qualitative, interpretivist methodology was adopted for this case study design. Semi-structured interviews were conducted with 12 service users. Thematic analysis was chosen as the method of analysis. Findings: Personalising recovery did not always lead to the removal of biological symptoms, but with the appropriate supports, individual's recovery journey was greatly enhanced. On the contrary, personal recovery places overwhelmingly responsibility on the individual to succeed, largely driven by neoliberal discourse. This focus on individualism and the pressure to succeed was further experienced when people sought to re-integrate into society and participate in normalised social order. Ultimately, for many service users, they viewed personal recovery as an unfulfilled promise. Research limitations/implications: It is not a representative sample of service users within an Irish context. Originality/value: To the best of the authors' knowledge, this is the first study to explore influence of social constructionism on the concept of personal recovery within a mental health service context. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to consider how a South East project approached systems change to improve unsupported temporary accommodation (UTA) and the changes made for people experiencing multiple disadvantage ("multiple and complex needs"). This paper also covers some matters that are hard to change or uncertain, such as housing shortages and financial constraints. The paper focuses on a case study of the East Sussex Temporary Accommodation Action Group (TAAG) – a multi-agency action group. Design/methodology/approach: A qualitative case study involving a thematic analysis of seven semi-structured interviews, with a review of published literature and internal documentation. Findings: This example of setting up a TAAG shows us the value of having a dedicated forum to look at a part of the system that requires changing and to identify what works well. Creating a collaborative and democratic space with a common purpose brings different stakeholders and perspectives together and opens discussions to new ways of working. Equalising partners creates an opportunity to create change from the bottom-up within a system traditionally governed by statutory bodies. This study found that the TAAG has facilitated learning around trauma-informed practice and nurtured more sustainable changes towards a Standards Charter and women-only safe UTA. Originality/value: This is one of the first qualitative case studies of a local systems change approach to improving UTA for people experiencing multiple disadvantage in East Sussex. [ABSTRACT FROM AUTHOR]

Purpose: Community support is an integral aspect of health and well-being for Indigenous peoples. The purpose of this paper is to demonstrate the valuable role of community support for Indigenous women specifically, who experience reproductive health disparities at alarming rates. This study helps fill an important gap in Indigenous scholarship by centering the resilience of women and Indigenous tribes and by using a framework that is consistent with Indigenous holistic views of health. Design/methodology/approach: The data for this paper was collected as part of a larger study exploring the reproductive health experiences of a state-recognized Gulf Coast tribe. A total of 31 semi-structured interviews were conducted with individuals who identify as women and as members of this tribe using qualitative descriptive methodology. This method is recommended for research with Indigenous communities. A community advisory board with representatives from this tribe provided feedback throughout the project. Findings: Themes expressed by participants included Community Closeness and Support; Community Support in Raising Children; Informal Adoption Common; and Community Values of Mutual Aid and Self-Sufficiency. The findings support current literature noting the value of generational and communal ties for Indigenous peoples. Implications of this research include the need to value and support community networks in programs serving tribes, in addition to meaningfully including Indigenous communities in developing interventions. Originality/value: This paper centers Indigenous women's resilience, approaches the health and well-being of Indigenous tribes holistically and helps to fill an important gap in literature describing informal adoption (outside the legal system) in state-recognized Indigenous communities. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to assess the extent to which the LEADS Framework guided health-care leaders through organizational change and the COVID-19 pandemic in a western Canadian province. Design/methodology/approach: A qualitative exploratory inquiry assessed the extent to which health leaders applied competencies that aligned with the LEADS Framework. A purposeful sample of 22 health-care leaders participated in the study representing senior, mid-level and front-line health-care leaders in various health-care organizations to ensure diverse representation of leader competencies. The authors conducted semi-structured interviews to collect the data and used Braun and Clarke's (2006) six-phase approach to guide data analysis. Findings: The analysis suggests that health-care leaders found Engaging with Others and Developing Coalitions were the most critical themes of the LEADS Framework for change management and for navigating the COVID-19 pandemic. Findings reveal that during transformational change and a crisis context, leaders embrace relational approaches to adapt and improve performance in dynamic organizations. Practical implications: These findings have implications for a relational approach to improve teamwork and decrease emotional strain; a focus on mobilizing and sharing power with nurses; and educational programs to advance relational and self-management skills, shared leadership, communication, change management, human resource and talent development as critical learning components for current and future health-care leaders. Originality/value: The LEADS Framework is used to examine how health-care leaders responded to transformational change in the organization while situated in a pandemic context. [ABSTRACT FROM AUTHOR]

Purpose: At the outbreak of the COVID-19 pandemic, health care was at the centre of the crisis. New demands made existing organizational practices and services obsolete. Primary health care had a great deal of responsibility for COVID-19-related care. The pandemic demanded effective leadership to manage the new difficulties. This paper aims to explore experiences and perceptions of managers in primary health care in relation to their efforts to manage the COVID-19 crisis in their everyday work. Design/methodology/approach: The authors used a qualitative approach based on 14 semi-structured interviews with managers in primary health care from four regions in Sweden. The interviews were conducted during September to December 2020. Data were analysed using conventional qualitative content analysis. Findings: Data analysis yielded three categories: lonely in decision-making; stretched to the limit; and proud to have coped. The participants felt lonely in their decision-making, and they were stretched to the limit of their own and the organization's capacity. The psychosocial working conditions in primary care worsened considerably during the pandemic because demands on leaders increased while their ability to control the work situation decreased. However, they also expressed pride that they and their employees had managed the situation by being flexible and having a common focus. Originality/value: Looking ahead and using lessons learnt, and apart from making wise decisions under pressure, an important implication for primary health-care leaders is to not underestimate the power of acknowledging the virtues of humanity and justice during a crisis. Continuing professional education for leaders focusing on crisis leadership could help prepare leaders for future crises. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to understand the lived experience of a person living with dementia in a care home during the COVID-19 pandemic. It responds to the absence in research of the voices of people with dementia living in care homes during the pandemic. Design/methodology/approach: The paper adopts a single case study design applied thematic analysis to semi-structured interview data to discover the experiences of one person living with dementia in a care home during a period of lockdown. Findings: Five themes reveal how the participant responded to the practical and emotional challenges of the pandemic: autonomy; fears; keeping connected; keeping safe and other people living with dementia. These themes highlight the participant's ability to adapt, accept and dispute lockdown restrictions, revealing considerable insight into their situation. Research limitations/implications: The pandemic has restricted access to care homes, which informed the single case study design. This approach to the research may restrict the generalisability of the findings. Other researchers are encouraged to include the voices of people with dementia living in care homes in further studies. Practical implications: Implications for practice, presented in this paper, promote quality psychosocial approaches when health-care workers engage with people living with dementia during periods of restricted activity. Originality/value: Unlike other studies about the impact of the pandemic on care homes, this paper explores the experience of the pandemic in care homes from the perspective of a person living with dementia. [ABSTRACT FROM AUTHOR]

Purpose: The steady rise in aged population has brought many challenges such as social, economic and health care that confront of the older people in their later life. The purpose of this study is to understand the nature of challenges among the older people and to assess the role of social security programmes for the welfare of the older people. The qualitative descriptive research has been applied in this paper. Design/methodology/approach: The qualitative descriptive research has been applied in this paper. The study was conducted in a sample of 220 elderly living in Lucknow, Uttar Pradesh, using purposive sampling. The study was based on interviews. The order of questions and samples depended on the information flow during the interviews. The purposes of using the qualitative descriptive research in the present study are to satisfy the researcher's curiosity and desire for better understanding to discuss the challenges faced by older people (these challenges are social vulnerability, poor economic conditions, poor health and no familiarity with government programmes), to understand the practicability of the study in extensive way and to explain why any phenomenon occurs or why older people face problems in later life. Findings: The first finding demonstrates that the different challenges among older people such as social, economic and health challenges are affecting their way of life and sense of well-being and are fracturing their social bonds from the family and society. The second finding indicates that only 46.3% older people are benefitted from government pension programmes schemes. While the numbers of older people are unknown from other government welfare programmes such as health programmes, concession for older people and maintenance and welfare of parent and senior citizen act are not able to work properly due to lack of awareness and lack of proper communication between older people and government bodies. Originality/value: This is an original work of the author. The research work is based on primary data that examine the nature of challenges such as health, economic and social challenges faced by older people in later life and impact of these problems on the well-being of older people. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to understand the perspectives of frontline health and social care professionals in relation to delays in discharge from community hospitals.Design/methodology/approach A qualitative approach was taken, using semi-structured interviews and non-participant observation, within three community hospitals in NHS Scotland. In total, 12 frontline health and social care professionals were interviewed and observation of the multi-disciplinary team meeting was completed. Thematic content analysis was used to analyse the data produced.Findings The key findings were delayed discharge as an issue, lack of resources and capacity, difficulties in the relationship between acute and community health staff, silo working between health and social care, conflicting pressures on staff, and influence over services and external factors. There were perceived different ways of working within acute health, community health and social work, which were suggested to reduce efficiency, cause tension and ultimately result in delays. All professionals perceived an inability to influence any of the factors causing delays in discharge.Practical implications The internal issues regarding inter-professional working could potentially damage integration, indicating a need to teach collaborative team skills as well as quality improvement training to support staff to challenge and change current ways of working.Originality/value The paper contributes to the evidence base of community hospitals. There are implications for both health and social care policy. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to report on a postdoctoral research study examining the importance of multi-level leadership and health governance for ensuring the implementation of national and provincial health sector strategies that aim to improve maternal and neonatal health (MNH) in low- and middle-income countries (LMICs).Design/methodology/approach A descriptive-interpretive qualitative, institutional approach was undertaken to explore the impact of provincial and district governance mechanisms on the delivery of MNH services in two districts in East New Britain Province (ENBP), Papua New Guinea (PNG). Data were collected from 12 key informants. Informants were selected on the basis of their direct involvement in health system management and deployment of health at provincial and district health governance levels.Findings The analysis revealed alignment between global strategies and national and provincial policy, suboptimal provincial government support related to implementation of policy, divergent data between districts and a disconnect between the local governance mechanisms and a donor-funded initiative for raising midwifery education.Research limitations/implications This qualitative study was limited by the small sample size and does not claim to be representative of ENBP or other provinces in PNG.Originality/value This paper contributes empirical evidence to the literature on health policy, leadership and governance for MNH, by recognising and exploring the formal and informal rules at play in a given context, and examining how they are made, changed, monitored and enforced. These insights are critical to understanding how the system actually functions (or not) to implement MNH strategies in LMICs. [ABSTRACT FROM AUTHOR]

Purpose: Approximately 20 per cent of Australian children live with a parent who experiences mental illness. These children have poorer health and psychosocial outcomes than their peers. While family-focused practice (FFP) can improve these outcomes, family-focused service provision is inconsistent. The purpose of this paper is to understand clinicians' experiences of FFP and associated workplace factors. Design/methodology/approach: In-depth interviews were conducted with ten community mental health clinicians. Interviews were audio recorded and transcribed. Data were analysed using thematic analysis. Findings: A global theme of "navigating rocky terrain" captured clinicians' experiences of working with families. The rocky terrain encompassed both family complexity and workplace barriers to FFP. Clinicians navigated this terrain by using multiple strategies to support families, working in partnership with families and other clinicians and services, and drawing on personal resources. Interactive approaches to enhancing knowledge and skills were preferred over paper-based information. While an organisation-wide approach to support FFP was beneficial, clinicians continued to feel challenged in implementing FFP. Research limitations/implications: Working with families in which parents experience mental illness is affected by systemic issues at the family and organisational levels. Systemic approaches to both delivering and supporting this work are required. Partnership working and organisation-wide capacity building strategies emphasising interactive approaches to learning appear to have positive effects. Originality/value: This study explores the challenges of FFP in a real-world multidisciplinary context where there has been a systemic approach to enabling this work. It highlights the challenges clinicians face in family-focused practice in spite of substantial organisational supports and suggests some approaches that might be effective. This is a topic which has received minimal attention in the literature. [ABSTRACT FROM AUTHOR]

Purpose: Fear of crime is an emerging social problem in Indian society that has a significant impact on the quality of life of the elderly. In the view of this fact, the purpose of this paper is to examine the factors such as (prior victimisation, vulnerability and incivility) which contribute their role in bringing fear of crime among the elderly. Design/methodology/approach: Mixed method approach has been applied in this paper. This study has been designed as an exploratory lead-in to a planned wider study into rural–urban context as possible factors in shaping the victimisation experience. The study has been conducted from October 2012 to January 2013 on a sample of 220 elderly living in both rural and urban areas of Lucknow in the state of Uttar Pradesh, India. Findings: The study found that elderly have been victimised by known persons as compared to unknown persons. Further, the study found that immediate neighbourhood was swarming with loiters, unruly teenagers, gangs, beggars and alcoholic people walk in the society which have significantly impact on the elderly and give threat in neighbourhood. Originality/value: This is an original work of researcher. [ABSTRACT FROM AUTHOR]

Purpose: Patient experience (PE) evaluation can identify critical issues in healthcare quality. Various methods are used for PE evaluation in the healthcare system in Ontario; however, evidence suggests that PE evaluation is not systematically performed and has not received substantial buy-in from healthcare providers. This study explores the perspectives of healthcare providers, managers and policymakers in Ontario on PE evaluation methods, barriers, utility and reliability. Design/methodology/approach: The study used a qualitative descriptive design. Twenty-one semistructured interviews were conducted with healthcare providers, managers and policymakers in Ontario between April 2018 and May 2019. The authors used thematic analysis to analyze the data. The Consolidated Criteria for Reporting Qualitative Research quality criteria were used. Findings: Barriers to PE evaluation include evaluation cost and the time and effort required to collect and analyze the data. Several factors affect the reliability of the evaluation, resulting in an unrealistically high level of patient satisfaction. These include the inclusivity of evaluation, the subjective nature of patient feedback, patients' concerns about health service continuity and the anonymity of evaluation. Participants were skeptical about the meaningfulness of evaluation because it may only yield general information that cannot be acted upon by healthcare providers, managers and policymakers for quality improvement. Originality/value: This paper reveals that many healthcare providers, managers and policymakers do not see a tangible value in PE evaluation, regardless of Ontario's patient-centeredness and "patient first" rhetoric. An improvement in evaluation methods and a cultural change in the healthcare system regarding the value of PE are required to foster a better appreciation of the benefits of PE evaluation. [ABSTRACT FROM AUTHOR]

Purpose: Research findings provide the professional community with knowledge that enables to better understand healthcare interventions. Many authors point out that whilst these findings are valued, the findings are not always translated into healthcare practise. The purpose of the paper is to assess the applicability of the essential elements of an integrated palliative care system (IPCS) found in research into the practise of Osona Palliative Care System (OPCS). Design/methodology/approach: The study used a qualitative methodology with a case study design. In total, 24 health professionals were interviewed in Osona for the research, and the results were analysed using deductive content analysis. Findings: The study concludes that research findings can better be translated into specific contexts by incorporating the needs and characteristics of the system. The process could be a strategy for bridging the research–practise gap. Originality/value: Combining the findings from the study and the findings found in the literature reviewed led to the creation of the IPCS-elements-blended model of research and practise. Such a kind of mixed model could be used in other studies seeking to overcome the research and practice gap. [ABSTRACT FROM AUTHOR]

Purpose: The research reported here forms part of a study of children's participation in children in care reviews and decision making in one local authority in England. The purpose of this paper is to outline the views of 11 social workers and 8 Independent Reviewing Officers (IROs) and explores their perceptions of children's participation in reviews. The paper considers the barriers to young people participating meaningfully in decision making and how practice could be improved in this vital area so that children's voices are more clearly heard and when possible acted upon by professionals. Design/methodology/approach: The data reported here derive from a qualitative cross-sectional study in one English local authority. The entire study involved interviewing children in care, IROs, social workers and senior managers about young people's participation in their reviews. Findings from the interviews with young people and senior managers have been reported elsewhere (Diaz and Aylward, 2018; Diaz et al., 2018); this paper focusses on the interviews with social workers and IROs. Specifically, the authors were interested in gaining insight into their views about the following research questions: To what degree do children and young people meaningfully participate in reviews? What are the barriers to participation? What can be done to improve children and young people's participation in reviews? Findings: During this process seven themes were identified, five of which concerned barriers to effective participation and two which concerned factors that appeared to support effective participation. These are summarised below and explained further in the following sections. Barriers to effective participation: social workers and IROs' high caseloads and ensuing time pressures; high turnover of social workers and inexperienced staff; lack of understanding and training of professionals in participation; children and young people's negative experiences of reviews and consequent reticence in taking part; and structure and process of the review not being child-centred. Factors which assist participation: quality of the relationship between the child and professionals; and the child or young person chairing their own review meeting. Research limitations/implications: Although these findings reflect practice in one local authority, their consistency with other research in this area suggests that they are applicable more widely. Practical implications: The practice of children chairing their own reviews was pioneered by The Children's Society in North West England in the 1990s (Welsby, 1996), and has more recently been implemented with some success by IROs in Gloucestershire (see Thomas, 2015, p. 47). A key recommendation from this study would be for research to explore how this practice could be developed and embedded more widely. Previous research has noted the tension between the review being viewed as an administrative process and as a vehicle of participation (Pert et al., 2014). This study highlighted practitioner reservations about young people chairing their own reviews, but it also gave examples of how this had been done successfully and how it could improve children's participation in decision making. At the very least, it is essential that young people play a role in deciding where the review is going to take place, when it will take place, who is going to be invited and what will be included on the agenda. Social implications: The paper highlights that in this Local Authority caseloads for social workers were very high and this, combined with a high turnover of staff and an inexperienced workforce, meant that children in care struggled to have a consistent social worker. This often meant that young people were not able to build up a positive working relationship with their social worker, which negatively impacted on their ability to play a meaningful role in decision making. Originality/value: There have been very few recent studies that have considered professionals' perspectives of children's participation in key meetings and decision making, so that this provides a timely and worthwhile contribution to this important area of work. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to understand if effective road safety education is being provided to students by embedding educational programmes within a curriculum framework. Design/methodology/approach: A qualitative methodology was used to gain in-depth understanding of the health-promoting initiatives of Saudi Arabian universities and colleges in preventing risky driving behaviour among students. Interviews were used to collect data from 11 faculty members. Findings: Results suggest that educational programmes for changing the risky driving behaviour of students are still in their infancy. The findings raise questions about road safety and driving. While initiatives are being taken for promoting awareness within educational institutions on road safety, there is still a lack of awareness of traffic regulations and signs. Originality/value: Since there is a paucity of research on health promotions specifically related to aberrant and risky driving in the Kingdom, this paper adds value to educators and policy-makers. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore how Palestinian refugee families in Malaysia cope with the challenges they face during their transitional destination. These families have recently fled from conflict zones in various Arab countries and moved to Malaysia where they registered in the office of the United Nations High Commissioner for Refugees (UNHCR) in Kuala Lumpur, waiting for resettlement in a third country. Design/methodology/approach: The paper utilizes the qualitative research approach, drawing descriptive analysis (thematic analysis technique) of data collected by semi-structured, in-depth interviews with 30 Palestinian families. For sample selection, the author used purposive sampling and employed the Snowball technique to select the families who have experienced refuge life for the second time. Then the sample was equally divided into three groups to include ten families moving from Iraq, Syria and the Gaza Strip. The interviews were conducted with the head of the families who varied in terms of gender and age composition. The study involved 9 female participants and 21 males. They are all Muslims and aged between 24 and 80 years old. In terms of educational background, all of the participants are literate with formal school education, diploma or tertiary education. Findings: The study shows that refugee families adopt four main ways of coping commonly used to improve the quality of their life during their transition in Malaysia. They turn to religion and spirituality, keep in touch with relatives and friends in the diaspora and conflict zones, develop a positive image about their present situation by comparing it to worse living conditions of others living in conflict zones and plan to migrate to Europe to hold a European passport which will give them the opportunity to visit their original country, Palestine. Originality/value: The paper tackles the Palestinian refugee family life and explores their real-life stories and experiences during transition in Malaysia. It provides them with an opportunity to speak up their suffering and reveal the various strategies they adopt to cope with life challenges. Besides, the result of the study will be a fruitful addition to the corpus of sociological knowledge as well as an important contribution to the families that stay in transition in different societies around the world. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to identify the most important factors for strategic purchasing of health services in the health sector by the Iran Health Insurance Company and to provide an applicable model for other similar organizations in developing countries.Design/methodology/approach The present qualitative study was conducted in 2017 to identify the factors affecting the implementation of strategic purchasing of health services in the health sector by the Iran Health Insurance Company and to provide an indigenous and practical model through two phases: semi-structured interview followed by a Delphi process.Findings According to the findings of this study, Ministry of Welfare, Labor and Social Security plays a central role in the strategic purchasing. In addition, this was also approved by the representatives of citizens in communities concerning professional associations, insurance agencies and representative of the Council of Ministers. Model development explored 9 themes and 54 sub-themes.Research limitations/implications Based on the model, most attention has been paid to consumer role and inter-sector leadership of the company with other relevant organizations and systems including other insurance organizations and the welfare ministry. More importantly, the health insurance company should be able to communicate with providers and to choose the best providers, receiving price information through competition in the most appropriate mechanism. Guided by this model, it can strategically buy the best and the most effective services for its insured population.Social implications It might help developing societies to promote their health systems based on targeting the health budgeting and financial constraints so that it is prioritized according to the strategic purchasing criteria and consequently, economic evaluation.Originality/value The linchpins of the present study are as follow: first, the pragmatic model presented in the paper could help developing health systems to overcome the impediment in the implementation progress of strategic purchasing. Second, the model satisfies the need of enough knowledge to apply strategic purchasing in the health system. Third, the indigents have long been given special protection and consideration in the model that has continued to capture the attention of every policy-maker, in particular, developing countries, the portion of which is significant. Fourth, based on this model, attention has been paid to consumer role and inter-sector leadership of organization with other relevant organizations and systems. Fifth, this model could be correspondent for every insurance company in countries with similar developing conditions. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to investigate the cases of Bangladeshi, Filipina, Nigerian, Palestinian and Pakistani migrant workers and how the frame of their work and employment in precarious, low-status/ low-wage jobs affects their perceptions and practices regarding health and access to healthcare services. Design/methodology/approach - Using qualitative research methodology, the analysis via in-depth interviews focuses on male Bangladeshi, Nigerian, Pakistani and Palestinian unskilled manual and textile laborers as well as street vendors, and female Filipina live-in domestic workers. Findings - Migrants are entrapped in a context of isolative and exploitative working conditions, i.e., in unskilled labor, textile work, street-vending, personal services, care and domestic work, which lead them to adopt a self-perception in which healthcare and social protection are not a priority. Social implications - Throughout the paper it has become clear that these precarious low-status/low-wage jobs have an important underside effect on migrants' lives, intensifying labor and health instability and exposing migrants to employment-generating activities that do not guarantee health safety. In Greek society, the impact of migration on public health is characterized by many as a "time bomb ready to explode," especially in urban centers. Meanwhile, the economy and particularly the informal sector of the labor market is benefiting from migrant workers.More research is needed as thismode of exploitative labor and precarious employment needs to be adequately addressed to mitigate barriers in the access of labor and healthcare rights. Originality/value - Via its contribution to the sociology of migration with particular emphasis on labor healthcare, the paper provides evidence that due to their concentration in precarious, low-status/low-wage jobs migrant workers have very limited access to healthcare services. The removal of inequalities and discrimination against migrant workers in accessing healthcare services and medical care is a challenge for South European Union countries and particularly for Greece. However, in spite of this, there is no uniform policy in the management of migrants with respect to their access to health services. The paper will aid debates between policy makers and academics working on migration and inequalities due to the division of labor and health disparities, will contribute to the understanding of the perils attached to precarious, low-status/low-wage jobs and in addressing health inequalities effectively. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to report on the findings of a qualitative study that explored the views of 53 service providers assisting Indigenous young people (known in Australia as Aboriginal and Torres Strait Islander youth) transitioning from out-of-home care (OOHC) in Australia. Design/methodology/approach: A qualitative approach was adopted involving semi-structured interviews and focus groups with 53 representatives of state and territory government departments, non-government organisation service providers and Aboriginal community-controlled organisations (ACCOs) across Australia. The project was designed to gain the perspectives of those working within the system and their views on how it interacts with Indigenous care leavers. Interview questions aimed to ascertain the strengths and weaknesses of the leaving care support systems available to this cohort, as well as the key challenges facing service providers in supporting them. Finally, the study aimed to make recommendations for policy development in this area and identify potential best practice service responses. Findings: The study found that the OOHC service systems continue to fail Indigenous care leavers, their families and communities. Study findings revealed that Indigenous care-leavers face substantial challenges and that the support systems for those leaving OOHC are often culturally insensitive and ineffective. Many Indigenous OOHC leavers lacked the supports they needed to develop safe and ongoing relationships with their traditional Country, family and communities. To promote more positive transitions and outcomes, effective practice responses were identified, including culturally safe programmes and proportional funding for ACCOs to advance greater self-determination. Originality/value: This research is the first national study in Australia to examine the specific transition from care pathways and experiences of Indigenous young people. The findings add to the limited existing knowledge on Indigenous care leavers globally and should inform practice and policy innovations with this cohort in Australia and beyond. [ABSTRACT FROM AUTHOR]

Purpose: Nongovernmental organizations (NGOs) play a critical role in modern health-care systems complementing state organizations. The purpose of this paper is to investigate the challenges of NGOs' participation in Iran's health-care system. Design/methodology/approach: This qualitative study was conducted in 2020. Data were collected through semi-structured interviews with 26 participants: 11 managers and experts at the office of NGOs in the Ministry of Health (MOH) and universities of medical sciences and 15 chief executive officers (CEOs) of health-related NGOs in Tehran, Iran. The participants were chosen using the non-probabilistic approach of purposive sampling with maximum variation. Data analysis was performed using the thematic analysis method and MAXQDA 10 software. Findings: Challenges of NGOs' participation in Iran's health-care system are categorized into external and internal challenges. Financial issues, the process of getting permissions, lack of trust in NGOs, weak relationships with the public sector and lack of law are identified as main challenges. Building trust in NGOs, passing the NGOs' law, making people more familiar with NGOs and capacity development are the most important measures that improve the role of NGOs and resolve barriers to their participation in Iran's health-care system. Originality/value: In this study, for the first time, the challenges of NGOs' participation in Iran's health-care system are investigated by examining the views of both the public sector and NGOs. Improving the participation of NGOs in the health-care system provides Iran's MOH with the opportunity to make use of the NGOs' capacities to eliminate public health issues. [ABSTRACT FROM AUTHOR]

Purpose There is a recognition in Europe and in the western world of a demographic shift in the ageing population. While the overall ageing of the general population is growing, the numbers of immigrants getting old in their host countries is also increasing, thereby increasing the racial and ethnic proportion of older people in these countries. This changing landscape calls for understanding of issues related to health care provision, policy and research regarding ethnic minorities. Communication is seen as a key factor in understanding the needs of ethnic minority elders (EMEs). The purpose of this paper is to explore health care workers’ (HCWs) perceptions and experiences of communication with EMEs. In this paper the term HCW includes qualified nurses and health care assistants.Design/methodology/approach A descriptive qualitative study design using semi-structured interviews was employed. Ten HCWs, who had ethnic minorities in their care were individually interviewed to explore their perceptions and experiences of communication when caring for EMEs.Findings Analysis of data revealed that in common with all older people, EMEs experience stereotyped attitudes and difficulties in communication. However, EMEs face particular challenges, including cultural differences, different language and stereotyping of care based on misunderstood needs of EMEs. Facilitators of communication included appropriate training of HCWs and appropriate use of interpreters.Research limitations/implications Only homes willing to take part in the study gave permission for their staff to be interviewed. In addition, the HCWs came from various settings. Therefore, views of staff in homes who did not give permission may not be represented.Practical implications The diversity of older people needing care in nursing homes and the community calls for training in culturally competent communication for effective provision care provision for EMEs.Originality/value Training of health care staff in culturally appropriate communication requires effective practice. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore keyworkers’ experience and perceptions working with people experiencing homelessness and the use of psychologically informed approaches in an Irish context.Design/methodology/approach In this paper a qualitative descriptive methodology was employed and face-to-face in-depth semi-structured interviews were conducted. Data collected were analysed using a thematic framework and transcribed by the researcher.Findings It was the view of the keyworkers psychological approaches allowed them greater understanding of psychological trauma and its effects promotes safe physical and emotional environments builds rapport between staff and clients and enables keyworkers to work more effectively with people with complex needs. There was also convincing evidence staff are quite receptive to training.Originality/value Given there is no research exploring the use of psychologically informed approaches in homelessness service settings, this study researched an area that has not yet been explored in Ireland. This qualitative descriptive research provides a platform from which further research can be conducted. It is hoped that highlighting the psychological issues of homeless people, the data obtained will help improve Irish homeless services, and the findings extracted beneficial in terms of future service developments, professional training and education. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to extensively report the implications of the global trend of declining fertility rates and an increasingly ageing population. The experiences of childless men are mostly absent from gerontological, psychological, reproduction, and sociological, research. These disciplines have mainly focussed on family formation and practices, whilst the fertility intentions, history, and experience of men have been overlooked. Not fulfilling the dominant social status of parenthood provides a significant challenge to both individual and cultural identity. Distress levels in both infertile men and women have been recorded as high as those with grave medical conditions.Design/methodology/approach The aim of this paper is to provide some insight into the affect involuntarily childless has on the lives of older men. This auto/biographical qualitative study used a pluralistic framework drawn from the biographical, feminist, gerontological, and life course approaches. Data were gathered from in-depth semi-structured biographical interviews with 14 self-defined involuntary men aged between 49 and 82 years from across the UK. A broad thematic analysis highlighted the complex intersections between involuntary childlessness and agency, biology, relationships, and socio-cultural structures.Findings Diverse elements affected the men’s involuntary childlessness: upbringing, economics, timing of events, interpersonal skills, sexual orientation, partner selection, relationship formation and dissolution, bereavement, and the assumption of fertility. The importance of relationship quality was highlighted for all the men: with and without partners. Quality of life was affected by health, relationships, and social networks. Awareness of “outsiderness” and a fear of being viewed a paedophile were widely reported.Research limitations/implications This is a study based on a small self-selecting “fortuitous” sample. Consequently care should be taken in applying the findings to the wider population.Originality/value Health and social care policy, practice and research have tended to focus on family and women. The ageing childless are absent and excluded from policy, practice, and research. Recognition of those ageing without children or family is urgent given that it is predicted that there will be over two million childless people aged 65 and over by 2030 (approximately 25 per cent of the 65 and over population). The consequences for health and social care of individuals and organisations are catastrophic if this does not happen. [ABSTRACT FROM AUTHOR]

Purpose: This study explores how menstruation is perceived, experienced and navigated by school-going adolescent girls living in low-to-middle income settings in South Africa. Existing research from developing countries suggest that the onset of menstruation has implications for school attendance and academic performance. There is evidence that menstrual cycle–related symptoms (primarily physical) lead to difficulties in, or interference with, and disengagement from school, social relations, and physical activities (van Iersel et al., 2016; Steiner et al., 2011; Kiesner and Pastore, 2010; Taras, 2005). The onset of menstruation can be shame-inducing and has been associated with anxiety and confusion. Few studies have been conducted on menstruation in countries with a history of sectarian violence and characterised by substantial socio-economic disparities and high levels of gender-based violence. Understanding the experiences of girls in these contexts is important in generating contextually-grounded knowledge and appropriate interventions. Design/methodology/approach: A qualitative, exploratory, descriptive and contextual research design was used to collect data from 48 adolescent girls aged 13–16 year-old. A total of six focus group discussions (FGDs) were conducted using a semi-structured questionnaire among a purposive sampling method. Data collected were transcribed verbatim and thematically analysed. Written parental consent was obtained for participants under 18 years old. Findings: The findings illustrated complex psychological experiences in response to menarche and menstruation. Experiences of shame in relation to menstruation were aggravated by unsupportive responses from school teachers. Challenges such as scarcity of sanitary products were experienced as creating a barrier for girls' school attendance. Research limitations/implications: Existing research from developing countries suggests that the onset of menstruation has implications for school attendance and academic performance. The research data includes the views of adolescent learners and their negative reactions and positive experiences towards menstruation within the school environment. Practical implications: Given the comparative paucity of research emerging from developing countries in sub-Saharan Africa, this paper addresses an important gap in the literature by providing contextually-nuanced information about the menstrual experiences of adolescent girls. The study can further provide information for efforts made by the Department of Education and Department of Health regarding the impact of menstruation on adolescent girls' school attendance. Social implications: This study provides important insights regarding the experiences of South African school girls in relation to menstruation. Although dominant feelings of shame, confusion and disgust may surround menstruation, the study also highlighted potential positive experiences associated with menstruation. Teachers and school administrators need to be oriented towards the needs of adolescent girls if issues regarding poor school attendance are to be addressed. Originality/value: To reduce absenteeism in schools and ensure learners are provided with improved allocation of sanitary products in schools, there is a need for the advocacy regarding sexuality education and resources to promote the psychological health of adolescent girls. [ABSTRACT FROM AUTHOR]

Purpose: People with mental disorders experience higher rates of disability and mortality disproportionately than the general population. Until recently, psychiatric palliative care (PPC) for people with serious mental illness (SMI) was not explored as a treatment option. This paper aims to explore the feasibility of PPC as a supportive care model for people with serious mental illness. Design/methodology/approach: Fifteen health-care professionals' in the USA and Europe participated in semi-structured phone interviews regarding PPC for people with SMI. The Qualitative Analysis Guide of Leuven (QUAGOL) was used to conduct thematic analysis of the data. Findings: PPC was identified as a supportive care model that could improve quality of life and enhance patient autonomy for people with SMI. While PPC was endorsed as a possible new standard of care, it is imperative that the model be piloted to determine its efficacy as a viable treatment option among adults. Originality/value: There are limited studies that investigate the perceptions of health professionals' regarding the use of PPC as a treatment option for people with SMI. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore and capture workforce perceptions, experiences and insights of the phenomena of integrated care (IC) in a community health and care NHS trust in England; including whether there are any associated factors that are enablers, barriers, benefits or challenges; and the level of workforce engagement in the process of integrated health and care. Design/methodology/approach: A qualitative design based on an interpretivist research paradigm was used with a purposive sampling technique. Five in-depth semi-structured interviews were conducted with community nursing, social workers and allied health professionals. Colaizzi's (1978) descriptive phenomenological seven-step method was applied to analyse data, with the emergence of 170 significant statements, 170 formulated meanings and 8 thematic clustering of themes to reveal 4 emergent themes and 1 fundamental structure capturing the essential aspects of the structure of the phenomenon IC. Findings: This study revealed four interdependent emergent themes: (1) Insight of IC and collaboration: affording the opportunity for collaboration, shared goals, vision, dovetailing knowledge, skills and expertise. Professional aspirations of person-centred and strength-based care to improve outcomes. (2) Awareness of culture and professionalism: embracing inter-professional working whilst appreciating the fear of losing professional identity and values. Working relationships based on trust, respect and understanding of professional roles to improve outcomes. (3) Impact of workforce engagement: participants felt strongly about their differing engagement experience in terms of restructuring and redesigning services. (4) Impact of organisational structure: information technology (IT) highlighted a barrier to IC as differing IT platforms prevent interoperability with one system to one patient. Shared positivity of IC, embracing new ways of working. Originality/value: This study proposes considerations for future practice, policy and research from a local, national and global platform, highlighting the need for any IC strategy or policy to incorporate the uniqueness of the "voice of the workforce" as a key enabler to integration developments, only then can IC be a fully collaborative approach. [ABSTRACT FROM AUTHOR]

Purpose: This paper explores the perceptions of a small cohort of participants in the "Involving People" programme. This 35-week course recruited staff from across statutory, voluntary and charity sectors who aimed to lead and develop change initiatives within their respective organisations. The study captured staff views on the extent to which their training in co-production enabled them to deliver sustainable service improvement within their organisations. Design/methodology/approach: This was a small scale, qualitative study, using a purposive sampling approach. Of the 18 staff participants, 5 agreed to participate in face-to-face semi-structured interviews. Through a process of free text analysis, several themes and sub-themes were identified. Findings: Several barriers and opportunities were highlighted coupled with suggestions on changes to public service delivery based on equal and reciprocal relationships between professionals, service users and their families. Organisational structures and silo working still act as an inhibiter for real change. Research limitations/implications: Additionally, it was demonstrated that training in the area of co-production can act as a catalyst for wider service improvements. It can enhance staff confidence to profile the importance of service user involvement, persuading their colleagues of its benefits and challenging practice where co-production is not happening. However, a collective leadership and a shared language on co-production are still needed to develop inclusive organisational cultures. Originality/value: This was the first study of its kind in Northern Ireland which highlighted that there was a need for a collective leadership and a shared language on co-production to develop inclusive organisational cultures. [ABSTRACT FROM AUTHOR]

Purpose: There has been little research into the use and efficacy of Mental Health First Aid (MHFA) across UK workplaces. This paper aims to investigate the implementation of MHFA across six UK organisations, identifying key barriers and facilitators. Design/methodology/approach: Twenty-seven workplace representatives were recruited from six organisations through purposive sampling and took part in semi-structured interviews exploring their experiences of workplace MHFA. The data underwent thematic analysis, identifying key themes around implementation. Findings: Implementation varied across organisations, including different reasons for initial interest in the programme, and variable ways that MHFA-trained employees operated post-training. Key barriers to successful implementation included negative attitudes around mental health, the perception that MHFA roles were onerous, and employees' reluctance to engage in the MHFA programme. Successful implementation was perceived to be based on individual qualities of MHFA instructors and good practice demonstrated by trained individuals in the workplace. The role of the inner organisational setting and employee characteristics were further highlighted as barriers and facilitators to effective implementation. Research limitations/implications: MHFA is a complex intervention, presenting in different ways when implemented into complex workplace settings. As such, traditional evaluation methods may not be appropriate for gaining insights into its effectiveness. Future evaluations of workplace MHFA must consider the complexity of implementing and operationalising this intervention in the workplace. Originality/value: This study is the first to highlight the factors affecting successful implementation of MHFA across a range of UK workplaces. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on the implementation of a physical activity (PA) scheme - Let's Motivate (LM) - within private care homes (CHs) in Dumfries and Galloway (D&G), Scotland; aiming to provide an insight into the different factors which might contribute to its success and further sustainability. Design/methodology/approach: A qualitative study is described in which one-to-one semi-structured interviews were carried out with eight key staff involved in implementing the project within two purposively sampled CHs; in order to explore their views and experiences of implementation. Findings: The paper provides an insight into the different factors which stand to both promote and impede the successful implementation of LM, within the two CHs involved. Originality/value: This paper explores a new and innovative PA initiative in CHs in D&G, Scotland. Studies exploring the factors which can both promote and impede implementation are important as they can help to usefully inform the implementation and sustainability of initiatives. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to investigate the factors influencing the leadership effectiveness of hospital managers in Iran. Design/methodology/approach: Top managers (15), middle managers (10) and operational managers (5) of public, private or social security hospitals in Tehran participated in a qualitative study using semi-structured in-depth interviews. Data were recorded, transcribed and then analyzed via MAXQDA 10 software. Findings: The findings were categorized into two main themes of internal and external factors with eight sub-themes. The most important internal factors that had an influence on the leadership of the hospital managers were intra-organizational relations, manager's personality traits, knowledge, attitude and skills of the manager. The most important external factors included extra-organizational relations, macro-level health policies, access to special financial resources, and social, economic and political factors. Research limitations/implications: The results call for a need to understand and analyze the socioeconomic factors influencing managers' leadership while adopting appropriate strategies. Practical implications: The results of the current study can help design training programs for hospital managers, and suggest criteria for appointing hospital managers across the country and this can enhance the effectiveness of their leadership. Health sector policymakers and decision makers should reform the programs that target training and empowerment of hospital managers so that the right people with the right competencies will hold such positions. Social implications: The results of this study showed that leadership effectiveness is also influenced by social and external factors. On the other hand, the effectiveness of management leadership can play a significant role in the quality of care provided to the community, patient satisfaction and in hospital social performance through the appropriate management of all hospital resources. Such factors should also be considered in training and appointing hospital managers. Originality/value: Although there are several studies on hospital managers' leadership worldwide, this study is the first to investigate the leadership effectiveness of hospital managers in Iran. [ABSTRACT FROM AUTHOR]

Purpose: A nursing home is a place that is familiar with death, since many older adults will spend the latter part of their lives in such a setting. However, research on this topic is still limited, especially in Indonesia. The purpose of this paper is to explore the barriers to successful palliative and, more generally, end-of-life care (EOLC) for older adults in nursing homes and to explore nurses' views on the subject. Design/methodology/approach: The study is of a qualitative nature and it employs a phenomenological approach. In-depth interviews with 15 nurses who taken care of older adults in a nursing home were conducted. The data were analysed using thematic content analysis. Findings: Barriers to effective EOLC include lack of knowledge, ineffectual communication and insufficient resources. Research limitations/implications: Better policies are needed, especially in training related to palliative/EOLC subjects and equitable distribution of professional health workers to overcome the barriers. The government should also encourage collaboration involving hospitals, Puskesmas (Health Centre Services), community and resident care settings in sharing knowledge and skills, especially for nurses. Originality/value: The barriers identified in palliative and EOLC have been found to be almost identical to those encountered in other health services. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to investigate parents' beliefs about the causes of their child's Type 1 diabetes to understand if this affects the way diagnosis is processed and if this impacts on sibling parenting. Design/methodology/approach: Online, semi-structured qualitative interviews with nine parents of children with Type 1 diabetes who have at least one non-diabetic child. The results were analysed using interpretative phenomenological analysis (IPA). Findings: Two interlinked themes were identified: "What ifs": parents postulated underlying genetic reasons for their child's diabetes and had working theories about the triggers of diabetes that included stress, infection, vaccination or a virus. Developing a personal aetiology of their child's condition allowed some a feeling of control, while others focused on practical ways to manage diabetes. "Having something to blame": narratives dwelt on the relationship between beliefs about causes and self-blame. Some believed that acting on an identified trigger reduced personal guilt. Research limitations/implications: Although internet access is widespread in the UK, a limitation of this research is that it excluded those without internet access. Practical implications: The findings of this research may provide greater depth and a more holistic perspective to the health promoter to better support parents of Type 1 diabetics. Social implications: The analysis of illness narratives that this research provides may offer a greater understanding of the social context in which health and illness develop. This research found some examples of parental confidence about the causes and triggers of their child's diabetes being positively associated with a sense of control. This might indicate the value of a more comprehensive larger-scale study to establish whether parents who are supported to develop a personalised conception of the aetiology of their child's diabetes develop a greater sense of coherence and well-being regarding their child's condition. Originality/value: There is very limited literature focusing on the beliefs of sufferers and their families about Type 1 diabetes causality. Of that which does exist, some research is heterogenous in its sampling of Types 1 and 2 diabetes sufferers. This study offers a rare, focused insight into the beliefs of parents about the background causes and more proximal triggers of their child's Type 1 diabetes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the effects of social networks on contraceptive adoption in Bangladesh. Design/methodology/approach: Data were collected from 430 couples; the age of men was between 15 and 49 years. χ2 test was applied to test the association between independent variables and current contraceptive use. Binary logistic regression was applied to examine the effects of social network on contraceptive use, and multinomial logistic regression was applied to examine the effect of social network on the choice of method. Findings: Results from binary logistic regression reveal that social networks of both men (OR=2.71, 95% CI=1.371−5.354) and women (OR= 3.597, 95% CI=1.754−7.380) had a strong positive effect on current contraceptive use. The result from multinomial logistic regression also shows that men's social network (OR= 2.74, 95% CI= 1.356−5.548) and women's social network (OR=4.165,95% CI=1.958−8.860) were also associated with choosing a modern contraceptive method. Originality/value: Social networks have a significant effect on current contraceptive use and modern method choice in Bangladesh. A social network approach should be included in family planning program in Bangladesh. [ABSTRACT FROM AUTHOR]

Purpose: The effectiveness of non-governmental organization (NGO) participation in the healthcare sector has been demonstrated globally. The purpose of this paper is to investigate the status of Iranian NGOs' contribution to health policy-making, the barriers to and strategies for developing their contribution. Design/methodology/approach: In this qualitative study, 25 participants were recruited from health-related NGOs in Tabriz, Iran. Semi-structured, in-depth qualitative interviews were conducted. Furthermore, a set of relevant documents were collected and their contents evaluated. The text of documents and interviews were analyzed using a thematic (deductive–inductive) approach using NVivo software. Findings: Most NGO activity has been in the area of providing services, whereas the least amount of activity has been in the domain of policy-making. Factors that were influential for NGO participation in policy-making were divided into three categories: those related to government, to civil society and within NGOs themselves. The primary barriers to participation in policy-making were related to government and the way that NGOs operated. Recommendations include the production of supportive law, financial aid to NGO and infrastructure that facilitates NGO participation. Practical implications: Financial support from the government and legislation of supportive laws could help to realize the potential of NGOs. Originality/value: No such research has been undertaken before to evaluate what activities health-related NGOs undertake, their contribution in health policy-making and obstacles and facilitators of this contribution. NGOs can play a key role in ensuring accountability, transparency and empower citizens to demand basic health services from government. [ABSTRACT FROM AUTHOR]

Purpose: Advanced care planning (ACP) involves the discussion of preferences relevant to a possible future time when one's ability to make decisions may be compromised. ACP is considered as having potential to enhance choice and control and thereby to improve the experience of care for people with dementia and their carers. Care coordinators have been highlighted as possibly playing a central role in facilitating these discussions among people with long-term care needs. However, there is limited evidence of how ACP is facilitated by community mental health professionals who may be supporting people with dementia and carers. The paper aims to discuss this issue. Design/methodology/approach: This exploratory study took the form of qualitative semi-structured interviews to explore the views and experiences of community mental health professionals when discussing ACP with people with dementia and/or their carers. A convenience sample of 14 participants working in community mental health services in one NHS Mental Health Trust in London, England, was recruited and interview data were analysed using a framework approach. Findings: Five themes emerged from the interviews – knowledge and experience, use of ACP, inhibitors of discussion, service influences and the future. The depth of ACP facilitation appeared dependent on the knowledge, confidence and skills of the individual professional. Limited resources leading to service rationing were cited as a major barrier to ACP engagement. Helping people with dementia and their carers with ACP was not viewed as a priority in the face of competing and increasing demands. A further organisational barrier was whether ACP was viewed by service managers as "core business". Findings indicate that practice was generally to refer people with dementia to other agencies for ACP discussions. However, pockets of ACP practice were reported, such as explaining proxy decision making options for finances. Research limitations/implications: This exploratory study took place in the community mental health services in one NHS Mental Health Trust that may not be representative of other such teams. Case records were not scrutinised or clinical conversations with people with dementia or carers. Practical implications: Barriers to initiating ACP discussions were cited, such as limited resources, lack of time and knowledge; unclear role remit, uncertain service direction and poor documentation sharing processes. However, participants held a common belief that ACP for people with dementia is potentially important and were interested in training, a greater team focus on ACP and pathway development. This indicates the potential for staff development and continuing professional development. Originality/value: Few studies have asked a wide range of members of community mental health services about their knowledge, skills and confidence in ACP and this study suggests the value of taking a team-wide approach rather than uni-professional initiatives. [ABSTRACT FROM AUTHOR]

Purpose: Currently, the health system is a treatment-oriented system focused on service providers. In this system, the main focus is on the health market, with little attention on insured. One way to get out of existing conditions is to empower the insured in order to involve them actively in maintaining and improving health. The paper aims to discuss these issues. Design/methodology/approach: This qualitative study was done using the content analysis method. Based on the purposive sampling method and theoretical saturation criterion, 24 individuals including 12 health insurance experts and 12 insured participated in the study in 2018. The semi-structured interview method was used to collect data. Data were analyzed using MAXQDA10 software. Findings: Having analyzed the interviews, 750 codes were obtained. These codes were categorized into two categories of "insurance experts" and "insured" and ten subcategories of "informing and educating, cost reduction, intersectional activities, expectations from the insured, services package, access to services, inability to pay costs, participation, and expectations from the insurance organization." Originality/value: This qualitative study was conducted to assess and determine the effective strategies for empowering the insured under health insurance. The results of this study are helpful to the health insurance organizations and health decision makers to detect the effective ways to develop the quality of insurance services, improve the status of insured, and increase access to health care goods and services. [ABSTRACT FROM AUTHOR]

Purpose: A recent study on the implementation of telemonitoring has provided an opportunity to explore how telemonitoring could be further developed to enhance better patient, carer and clinician experiences for patients living with chronic disease. The purpose of this paper is to identify the challenges and lessons of the telemonitoring implementation and to identify strategies to inform future implementation. Design/methodology/approach: A qualitative study was conducted with a purposive sample using semi-structured interviews to explore their views about the issues identified in the research aims. Interview themes were informed by current literature and the findings from local studies. Interviews were recorded, transcribed verbatim and analyzed thematically. Findings: A total of 16 participants were interviewed. Overall the recruitment of 56 percent were from identified potential participants. Five core themes were identified, linking different aspects of the telemonitoring implementation: impact of telemonitoring; implementation and management lessons; program risks; program main changes from beginning; and future strategies and recommendations. Originality/value: This study will inform the wider roll out of telemonitoring across the region with the goal of ensuring future interventions achieve better clinical outcomes, patient, carer experience and deliver better value. [ABSTRACT FROM AUTHOR]

Purpose: Suicide is a major cause of preventable mortality and primary healthcare professionals, including pharmacists, require appropriate training to communicate with and support people at risk of suicide. Mental Health First Aid (MHFA) training teaches participants how to communicate with and support people experiencing suicidal thoughts. The purpose of this paper is to use a novel MHFA assessment approach involving simulated role-plays enacted by people with a lived experience of mental illness and explore MHFA participants' and simulated patients' views of participating in simulated role-plays of mental health crises. Design/methodology/approach: MHFA is embedded into the Sydney School of Pharmacy curriculum. Post-MHFA training, pharmacy students were randomly allocated to participate in or observe a simulated role-play of one of three suicide crisis scenarios, with a person with a lived experience of mental illness. Two purpose-designed, semi-structured interview guides were used to conduct student focus groups and interviews with simulated patients to explore their views. Focus groups and interviews were digitally recorded, transcribed verbatim and thematically content analysed using a constant comparison approach. Findings: In total, 22 pharmacy students participated in two focus groups and three simulated patients participated in interviews. Five themes emerged including: the benefits of participating; the value of having a lived experience; challenges with suicide assessment; communication; and the value of immediate feedback and debrief. Originality/value: Students and simulated patients both benefited from participating in the role-plays. Students valued practicing their MHFA skills post-training with simulated patients with lived experiences. This unique approach to post-training assessment provides an opportunity to practice skills realistically and authentically, in a safe, learning environment. [ABSTRACT FROM AUTHOR]

Purpose: Motivation is central to the ongoing professional development, performance and retention of healthcare workers. Despite the increasing prevalence of people with dementia (PwD) and the associated demand for geriatric nurses, there exists a paradoxical shortage. The purpose of this paper is to explore the motivation and demotivation of healthcare professionals for working with older PwD, challenges faced, factors influencing intention to leave the field of work and methods to enhance staff motivation to continue working with this group. Design/methodology/approach: This grounded-theory study used thematic analysis to synthesise data from 13 semi-structured interviews relating to the motivating and demotivating factors of healthcare professionals (nurses and healthcare assistants) for working with older PwD in a hospital setting. Findings: Staff were motivated by previous personal experiences, personal characteristics and the fulfilment of the carer–patient relationship. Conversely, staff were mostly demotivated by organisational and working environment factors (e.g. poor leadership characteristics, inadequate staffing levels, lack of development opportunities), negatively influencing their intention to remain in employment. Research limitations/implications: The generalisability of the results is limited by the size of the sample. Different organisational strategies/interventions (i.e. support, training, recognition and rewards) are necessary to nurture staff motivation, improve retention, create positive working environments and enhance patient care. Originality/value: This study offers numerous ways in which to address factors contributing to demotivation in working with PwD, thereby helping to improve staff retention and support the needs of a growing population. [ABSTRACT FROM AUTHOR]

Purpose: Let's Talk about Children (LTC) is a structured intervention which aims to improve outcomes for children of parents with a mental illness. An enhanced form of training has been developed to support clinician uptake of this intervention. The purpose of this paper is to explore clinicians' experiences of this form of training and of implementing LTC. Design/methodology/approach: A qualitative research design was adopted, underpinned by social constructionism. Semi-structured interviews were conducted with adult community mental health clinicians (n=10) and were audio-recorded. The interview data were transcribed verbatim, coded and thematically analysed. Findings: Participants experienced both the training and the LTC intervention as a step in the right direction, with the enhanced training seen as superior to standard online modules, but not sufficient for implementation in practice. Additional training support, partnership working with families and service partners and overcoming challenges by adapting the model are some strategies that may support routine implementation of LTC. Originality/value: This study is the first to explore clinician experiences of this enhanced face-to-face training format followed by the implementation of LTC in an Australian context. Findings suggest strategies for enhancing clinician skills and confidence, improving fidelity to the model and identifying success factors for services looking to implement LTC. The potential value of face-to-face over online training and common barriers to implementation at an organisational level are identified and require further exploration in future studies. [ABSTRACT FROM AUTHOR]

Purpose: Teachers disseminate food knowledge and skills in secondary school curricula that provide essential skills for a healthy life. The purpose of this paper is to explore Australian secondary school teachers' views of healthy eating and their sources of information in planning their food, nutrition and health curriculum. Design/methodology/approach: Secondary school teachers' perceptions were explored through semi-structured, in-depth interviews that were de-identified and transcribed verbatim. Codes were ascribed to sections of the transcripts and throughout the process of inductive thematic analysis. The teachers' responses were grouped into five main themes: approaches to teaching healthy eating, sources of food and nutrition information, curriculum planning, teaching goals and teacher career influences. Findings: The teachers were clear about the aims and importance of teaching healthy eating in an experiential curriculum. They reported that teaching healthy eating assists the health and well--being of adolescents and their families. The effectiveness of current teaching in Australian secondary schools may be compromised by the positioning of food, nutrition and health topics in two separate curriculum areas: technologies and health and physical education, and competing school priorities and resources that limit the students' exposures to food curricula. The teachers sourced food information from online websites, popular culture and social media. Their knowledge and views of healthy eating appeared to be associated with their interests, life experiences, education and employment histories. Practical implications: These findings can assist with health promotion and education policy development. They can assist the design of healthy eating curriculum approaches for secondary schools and professional development courses for teachers, which will foster healthy food habits for adolescents, and their families in the future. Originality/value: Secondary school teacher perceptions of the place of healthy eating in food, and nutrition curricula have been under examined. [ABSTRACT FROM AUTHOR]

Purpose Health Sector Evolution Plan (HSEP) is known as the biggest and most comprehensive reform in Iran's health system. One of the goals of HSEP is to reduce inequity in the healthcare financing. The purpose of this paper is to demonstrate HSEP agenda setting from the perspective of equity in healthcare financing (EHCF) using the multiple streams model.Design/methodology/approach This qualitative study was conducted by 26 documents review and analysis, and 30 semi-structured interview with Iranian key informants in the field of HSEP that were selected based on purposeful and snowball sampling method. Data were collected using a researcher-made checklist based on the goals. All audio-taped interviews were transcribed and analyzed thematically. Data management and analysis were performed using the framework analysis in MAXQDA software.Findings The framework analysis identified 12 complementary sub-themes totally. Problem stream included four sub-themes (high share of Out Of Pocket, high index of catastrophic health expenditures, low EHCF index, and inappropriate economic state and sanctions). Focus on EHCF in general policies of the Iran World Health Organization's report in 2000, the Targeted Subsidies Law and emphasis on equalizing healthcare financing in the Fourth and Fifth Development Plan were considered as policy stream sub-themes. Finally, political stream showed four sub-themes including strong support from the Minister of Health for HSEP, mass media, the pressure of WHO and people's request to reduce health costs.Research limitations/implications The limitations of the present study included paying attention to one package (evolution in the treatment sector) of three health packages to assess EHCF, as well as the lack of similar national and international evidence in implementation framework.Practical implications The results of this study can be used to analyze other health sector reforms around the word and can help the formulation and implementation of most practical reforms, especially in field of health system financing.Social implications This study gives a holistic view about health system policy setting that can be used for understanding policy-making streams to population.Originality/value This is the first study that has examined HSEP (the biggest health sector reform in Iran) from the perspective of agenda setting. In addition, using the popular and well-known Kingdon's model to explain HSEP agenda setting is one of the strengths of this study. Furthermore, taking advantage of a wide range of related views by including highly informed people increased the strength of the results of the study. In addition, the short interval between the interview and reviewing the results on reforms reduced the recall bias of the participants in the study. [ABSTRACT FROM AUTHOR]

Purpose Education systems throughout the world seek to take the advantage of every presenting opportunity for achieving a standard level of ethical accountability and capability. The purpose of this paper is to explain the challenges of professional ethics training from the perspective of faculty members at the Ardabil University of Medical Sciences (ARUMS).Design/methodology/approach The present qualitative framework analysis held interviews with 21 key faculty members were selected using the purposeful and snowball method to interview from ARUMS in 2016. The duration of each interview varied between 45 and 120 min. The data obtained were analyzed in MAXQDA-10. Codes were extracted using inductive methods.Findings Three main themes were extracted from the interviews, namely, educational efficacy, professional interaction and equity in education along with 12 subthemes, namely, teacher's personal capability, work in the area of expertise, regular class attendance, quality class attendance, inclusion of theoretical bases, the teacher as an ethical role model, respect for the student, encouragement of ethical behaviors, respect for the patient's rights, fair assessment, attention to differences and positive discrimination.Practical implications This study results could help to improve the quality of training and ethical standards in medical education.Originality/value To comply with the codes of ethics in research, permission was obtained from the Ethics Committee and the participants were ensured about the confidentiality of their data and their right to withdraw from the study at any stage. Given that this project was a qualitative study, the authors did not have a moral or practical problem in the study. This study was approved with number "IR.ARUMS.FEC.1394.25" at the Ardabil University of Medical Sciences Research Ethics Council. The cooperation of participants in the study was completely voluntary; moreover, the authors obtained written consent from participants for the study. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore how the psychological constructs volition and motivation influence successful and unsuccessful weight maintainers' experiences during the difficult period following an intensive lifestyle intervention. Design/methodology/approach: Post lifestyle intervention semi-structured interviews with 11 successful and four unsuccessful weight maintainers were conducted. Findings: The eight themes that emerged and the differences between successful and unsuccessful maintainers were theoretically explained applying the self-determination theory (motivation) and the personal systems interaction (volition). Practical implications: The study validates and coheres with previous findings on the importance of self-regulation and autonomous motivation for weight loss maintenance. Additionally, the study's findings expand the literature by explaining both empirically and theoretically how the quality of motivation concerning an activity influences the level of volitional intensity needed when wanting to either engage in goal oriented or refrain from goal opposing activities. Originality/value: Developing effective obesity interventions has become essential, as obesity is a growing health threat in most countries in the world. However, there is a gap in the literature with regards to qualitative psychological studies with a clear theoretical framework informing intervention development. [ABSTRACT FROM AUTHOR]

Purpose Between 2012 and 2016, the Government of Canada modified health insurance for refugees and asylum seekers. In Quebec, this resulted in refusals of care and uncertainties about publicly reimbursed services, despite guaranteed coverage for people with this status under the provincial plan. The Chronic Viral Illness Service (CVIS) at the McGill University Health Centre in Montreal continued to provide care to refugees and asylum seekers living with HIV. The purpose of this paper is to explain how and why challenges brought by this policy change could be overcome.Design/methodology/approach A qualitative case study was conducted using interviews with patients and staff members, observation sessions and a review of media, documents and articles. A discussion group validated the interpretation of preliminary results.Findings The CVIS provides patient-centered care through a multidisciplinary team. It collectively responds to medical, social and legal issues specific to refugees. Its organizational culture and expertise explain the sustained provision of care. The team's empathetic view of patients, anchored in the service's history, care for men who have sex with men and commitment to human rights, is key. A culture of care developed over time thanks to the commitment of exemplary figures. Because they countered the team's values, changes in refugee healthcare coverage strengthened the service's culture of care. However, the healthcare system reform launched in 2014 in Quebec is perceived as jeopardizing the culture of care, as it makes, refugee and asylum-seeker patients a non-lucrative venture for providers.Originality/value This research analyzes the origin of sustained provision of care to refugees and asylum seekers living with HIV through the lens of culture of care. It considers the historical and political contexts in which this culture developed. [ABSTRACT FROM AUTHOR]

Purpose – Hope is regarded central to recovery in a broad range of health conditions including mental health and substance use problems. Still the phenomenon, along with its implications to research and practice, has gained limited attention. The purpose of this paper is to explore first-person accounts of how practitioners nurture and inspire hope. Design/methodology/approach – This qualitative study is part of a larger action research project. Data were collected using in-depth interviews with eight participants. The interviews were transcribed verbatim and analyzed applying thematic analysis. Findings – Hope was perceived as a central phenomenon to practitioners within mental health and substance use services. The following overarching themes were identified through thematic analysis: “Believing in oneself and others,” “Seeing and acknowledging opportunities” and “maneuvering towards hope.” Research limitations/implications – It seems that there is a need for extending knowledge in how practitioners may inspire hope. In addition there seems to be a need for developing more knowledge on how practitioners’ own hope may be nurtured within a system that is constantly undergoing change and new demands. Practical implications – Participants considered their own hope as a prerequisite in being able to hope on behalf of others and strategies for inspiring hope were presented on both an individual and system level. Working conditions and challenges within the service system in itself entailed challenges, which at times made nurturing hope difficult. Systems need to embrace flexibility and openness, allowing efforts aimed at inspiring hope to be made. In addition, practitioner’s own hope and the importance of nurturing it, needs to be acknowledged within services. Hope needs to be viewed as a joint venture, in context and in relation to others. Originality/value – The paper contributes to the knowledge base on hope inspiring practices within a field sometimes associated with challenges and despair. It points out some important preconditions in relation to the challenges practitioners might encounter, both on an individual level and in relation to the service system per se. [ABSTRACT FROM AUTHOR]

Purpose Hypertension is the most common chronic disease throughout the world. Self-care is the key criteria in determining the final course of the disease. However, the majority of elderly people do not observe self-care behaviors. The purpose of this paper is to analyze the experiences of elderly people with hypertension in order to understand the barriers of their self-care behaviors.Design/methodology/approach This is a qualitative study with a conventional content analysis approach conducted in Tehran, Iran in 2017. Data collection was done among 23 participants – 14 elderly people; 6 cardiologists, geriatric physicians and nurses working in the cardiovascular ward; and 3 caregivers – who were selected by purposeful sampling. Using semi-structured, face-to-face interviews, data collection was continued until data saturation.Findings Three main categories, including attitude limitations, inefficient supportive network and desperation, all showed barriers to self-care by the experiences of elderly people with hypertension.Originality/value Lack of knowledge of the disease and its treatment process is one of the main barriers to self-care in elderly people with hypertension. Deficient supportive resources along with economic and family problems exacerbate the failure to do self-care behaviors. [ABSTRACT FROM AUTHOR]

Purpose According to the great importance of community health as well as the ever-increasing development of health technologies, the importance of designing an interactive model of factors affecting health technology assessment (HTA) can be highlighted. The purpose of designing and implementing the framework of health information system assessment is to ensure that the required accurate data which are necessary to measure the main health indicators are available. The purpose of this paper is to design an interactive model of factors affecting HTA.Design/methodology/approach This is a cross-sectional, descriptive-analytic study conducted in the Iran Ministry of Health and Medical Education in the second half of 2017. A sample of 60 experts and professionals working in the field of health technologies are selected using purposive and snowball sampling methods. Two researcher-made questionnaires are used to collect the required data. The collected data are analyzed using decision-making trial and evaluation laboratory (DEMATEL) and MATLAB R2013a.Findings The results showed that “Legal dimension,” “safety,” “Effectiveness” and “Social dimension” were the affecting factors and net causes, and “Current application,” “Knowledge of technology,” “Ethical dimension,” “Costs” and “Organizational dimension” were the affected factors and net effects in the interactive model. Furthermore, “Legal dimension” with the coordinates C: [1.88, 1.27] and “Ethical dimension” with the coordinates C: [1.75, −75] were known as the most affecting and most affected factors in the interactive model, respectively.Originality/value The DEMATEL model is an appropriate tool for managers and policy makers to structure and prioritize factors influencing the HTA. Policy makers and decision makers can use this model for identifying relationships among factors and prioritize them. Because health policy makers and managers have a major role in formulating the regulations and guidelines related to the HTA, they should pay more attention to the legal considerations in their decisions and use the management tools to move the available resources toward implementing and enforcing rules and guidelines related to the HTA. [ABSTRACT FROM AUTHOR]