Search

Background: LGBTQ+ individuals have experienced many barriers to receiving quality health care, but the worldwide implementation of person‐centred care should make a positive change. However, as forthright disclosures are difficult to find using traditional methods, novel approaches should be utilized to uncover opinions and experiences on LGBTQ+ health care. Twitter could be a place where people post on this topic. Aim: This study aimed to explore tweets mentioning LGBTQ+ (centred) health care. Methods: The methods consisted of an explorative qualitative content analysis of tweets. The tweets were collected between 26 February and 30 March 2021, resulting in 2524 tweets of which 659 were relevant for content analysis. Results: The results showed an excess of political tweets involving LGBTQ+ health care. Many tweets included general statements on the need for LGBTQ+ health care. The few tweets on personal experiences in LGBTQ+ health care showed the overwhelming need for quality care that has been made difficult by political developments. Conclusion: Most tweets were made to inform others of the necessity of quality health care for LGBTQ+ individuals, but the utilization of person‐centred care is hardly noticeable. Public Contribution: This study was conducted with the involvement of a public partner (second author) who contributed to the design, data analyses and writing of the paper. Moreover, this study involves the analysis of data provided by the public and published on social media. [ABSTRACT FROM AUTHOR]

Background: Globally, health systems have been struggling to cope with the increasing burden of chronic diseases and respond to associated patient needs. Integrated care (IC) for chronic diseases offers solutions, but implementing these new models requires multi-stakeholder action and integrated policies to address social, organisational, and financial barriers. Policy implementation for IC has been little studied, especially through a political lens. This paper examines how IC policies in Belgium were developed over the last decade and how stakeholders have played a role in these policies. Methods: We used a case study design. After an exploratory document review, we selected three IC policies. We then interviewed 25 key stakeholders in the field of IC. The stakeholder analysis entailed a detailed mapping of the stakeholders' power, position, and interest related to the three selected policies. Interview participants included policy-makers, civil servants (from ministry of health and health insurance), representatives of health professionals' associations, academics, and patient organisations. Additionally, a processual analysis of IC policy processes (2007-2020) through literature review was used to frame the interviews by means of a chronic care policy timeline. Results: In Belgium, a variety of policy initiatives have been developed in recent years both at central and decentralised levels. The power analysis and policy position maps exposed tensions between federal and federated governments in terms of overlapping competence, as well as the implications of the power shift from federal to federated levels as a consequence of the 2014 state reform. Conclusion: The 2014 partial decentralisation of healthcare has created fragmentation of decisive power which undermines efforts towards IC. This political trend towards fragmentation is at odds with the need for IC. Further research is needed on how public health policy competences and reform durability of IC policies will evolve. [ABSTRACT FROM AUTHOR]

Australia is undergoing major aged care reforms, changing from the previous service provider‐driven approach to consumer‐directed care principles. In residential aged care, this has resulted in a significant reduction in government funding in order to support reform initiatives in home and community‐based care. There has been limited research on the impact of structural aspects of the reforms such as the effect of changes in funding focus. Using a qualitative descriptive research methodology, this study explores the impact of the reforms on staff at various levels of operational responsibility in residential aged care. Issues identified by participants centered on the capacity to deliver care in three areas, the impact of funding reduction, challenges in meeting increasingly complex needs of residents and their families, and new requirements for care roles within current limitations. This paper provides an insight into how and why operational issues have informed the findings of the current Australian Royal Commission into Aged Care Quality and Safety. It identifies areas of support for the aged care workforce that are crucial in fulfilling consumer‐focused care delivery. [ABSTRACT FROM AUTHOR]

While recognition of transgender people has increased in Vietnam, this population continues to face significant stigma and discrimination within their families and in public, including in medical settings. Understanding of transgender health is limited, especially regarding the provision of care to transgender people. This paper explores providers' preparedness for delivering transgender care using data from qualitative interviews with twelve healthcare professionals in Hanoi and Ho Chi Minh City. Drawing on the socio-ecological model, we illustrated multi-level factors that influenced the provision of medical services to transgender people, including restrictive legislation (policy level); shortage of transgender-specific services, and lack of training and guidelines (organisational level); and ambiguous perceptions, inappropriate provider-patient communication, and medical knowledge gaps (individual level). Overall, our study has identified a healthcare environment that is under-prepared to meet the complex health needs of transgender individuals. With this study, we call for intervention strategies beyond individual-level support and emphasise the urgency of allowing medical institutions to provide transgender-specific health services including gender-affirming surgery and hormonal treatments. [ABSTRACT FROM AUTHOR]

Adolescents in Tanzania are at risk of many health problems attributed to limited access to quality sexual and reproductive health services. Health professionals are a crucial part of service delivery, and their perspective on providing care is important in understanding the barriers that hamper access to sexual and reproductive health services for adolescents. Better understanding these barriers will support the development of more effective interventions. This paper explores these perspectives in view of the health-policy context that surrounds them. This study has aimed to explore and understand health professionals' perceptions and attitudes regarding the provision of adolescent sexual and reproductive health care in a selected national sexual and reproductive health programme in the Arusha region and Kilimanjaro region, Tanzania. A qualitative cross-sectional interview design was applied. Sixteen in-depth interviews were conducted with health professionals and community health workers. Data was analysed following inductive thematic analysis. Four main themes are identified in the data: concern about the stigma directed towards adolescents; over-medicalisation of services; difficulty involving adolescent males; and ambiguous policies and contradictory messages. The findings suggest that health professionals providing care in the current adolescent sexual and reproductive health programme must navigate the legacy of vertical health programmes as well as contradicting views and messages that are influenced by social norms, by uncertainties about current laws and by statements from political leaders. The findings suggest that future research, policies and health programmes should consider the perspectives of health professionals and their challenges in delivering care for adolescents to help improve the understanding of how to effectively and sensitively implement sexual and reproductive health programmes for adolescents. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore implementation and development of step-down intermediate care (IC) in Glasgow City from the perspective of staff. Design/methodology/approach: The study used qualitative methods. Nine key members of staff were interviewed and three focus groups were run for social work, rehabilitation and care home staff. Framework analysis was used to identify common themes. Findings: The proposed benefits of IC were supported anecdotally by staff. Perceived enablers included: having a range of engaged stakeholders, strong leadership and a risk management system in place, good relationships, trust and communication between agencies, a discharge target, training of staff, changing perception of risk and risk aversion, the right infrastructure and staffing, an accommodation-based strategy for patients discharged from IC, the right context of political priorities, funding and ongoing adaptation of the model in discussion with frontline staff. Potential improvements included a common recording system shared across all agencies, improving transition of patients from hospital to IC, development of a tool for identifying suitable candidates for IC, overcoming placement issues on discharge from IC, ensuring appropriate rehabilitation facilities within IC units, attachment of social work staff to IC units and finding solutions to issues related to variation in health and social care systems between sectors and hospitals. Originality/value: The findings of this study help the ongoing refinement of the IC service. Some of the recommendations have already been implemented and will be of value to similar services being developed elsewhere. [ABSTRACT FROM AUTHOR]

Background: The South African allied health (AH) primary healthcare (PHC) workforce is challenged with the complex rehabilitation needs of escalating patient numbers. The application of evidence-based care using clinical practice guidelines (CPGs) is one way to make efficient and effective use of resources. Although CPGs are common for AH in high-income countries, there is limited understanding of how to do this in low- to middle-income countries. This paper describes barriers and enablers for AH CPG uptake in South African PHC.Methods: Semi-structured individual interviews were undertaken with 25 South African AH managers, policymakers, clinicians and academics to explore perspectives on CPGs. Interviews were conducted by researcher dyads, one being familiar with South African AH PHC practice and the other with CPG expertise. Rigour and transparency of data collection was ensured. Interview transcripts were analysed by structuring content into codes, categories and themes. Exemplar quotations were extracted to support themes.Results: CPGs were generally perceived to be relevant to assist AH providers to address the challenges of consistently providing evidence-based care in South African PHC settings. CPGs were considered to be tools for managing clinical, social and economic complexities of AH PHC practice, particularly if CPG recommendations were contextusalised. CPG uptake was one way to deal with increasing pressures to make efficient use of scarce financial resources, and to demonstrate professional legitimacy. Themes comprised organisational infrastructures and capacities for CPG uptake, interactions between AH actors and interaction with broader political structures, the nature of AH evidence in CPGs, and effectively implementing CPGs into practice.Conclusion: CPGs contextualised to local circumstances offer South African PHC AH services with an efficient vehicle for putting evidence into practice. There are challenges to doing this, related to local barriers such as geography, AH training, workforce availability, scarce resources, an escalating number of patients requiring complex rehabilitation, and local knowledge. Concerted attempts to implement locally relevant CPGs for AH primary care in South Africa are required to improve widespread commitment to evidence-based care, as well as to plan efficient and effective service delivery models. [ABSTRACT FROM AUTHOR]

Women in South Africa experience a disproportionately high prevalence of common perinatal mental disorders (CPMDs). These disorders often remain a silent burden and a complex health, social, and policy concern, both nationally and globally. Moreover, policy efforts to address this concern have been fragmented. Greater understanding of the governance of perinatal mental illness is needed to address this complex issue. No research to date has focused explicitly on the importance of 'issue framing' to advance governance for perinatal mental health. We sought to achieve a more nuanced understanding of clinical governance and issue framing for perinatal mental health in South Africa by interviewing 24 key informants with expertise in perinatal mental illness. Dominant themes encompassed: framing of perinatal mental health determines its priority; perinatal mental health is not prioritised due to competition from other health concerns; and, screening policy responses are shaped by the framing. We found that understanding the varying views influencing perinatal mental illness provides insights into how experts frame the problem. Findings suggest that a better understanding of policy implementation and responses in South Africa is important in guiding research, policy, and practice, while improving the governance of perinatal mental illness. [ABSTRACT FROM AUTHOR]

Globally, it is recognised that the fundamental causes of iniquitous health outcomes lie within unequal distributions of wealth and power. Internationally, however, policies and interventions persist in individualising the inequalities problem and targeting individual behaviours as the main solution. This approach has been argued to represent 'Fantasy Paradigms'. This paper explores one example of such 'Fantasy' intervention from the perspective of health practitioners. Further, it explores opportunities for deepening practitioner understandings of the socio-political determination of health. Data were collected through in-depth interviews with 47 professionals involved in delivering a social prescribing programme in poor areas of Glasgow, Scotland. Data were analysed thematically across and within transcripts. Narratives highlighted different explanatory types concerning how the intervention could tackle health inequalities including: firm commitment to individualised approaches; hopeful pessimism; the social-determinants-of-health as an unpoliticised and nondeterministic backdrop to poor health; and finally, incomplete understanding of the social gradient as a population concept. Disrupted narratives of the social determination of health were also evident. This paper contributes new insights to existing debates on health inequalities discourse. These are conceptually important and identify opportunities for sharpening practitioner understanding of the social determinants of health which could in turn contribute to better, non-stigmatising primary care. It argues that re-engaging communities of practice with what is meant by determination of health is necessary and that there is a need to de-couple the policy aim of reducing health inequalities from the delivery of structurally competent and equality-focused public services. • Why are individually-focused interventions thought to reduce health inequalities? • From our data, we identify believers, 'hopeful pessimists', and dissonant discourses. • Lifestyle-oriented understandings of health problems and their solutions prevail. • Important opportunities for deliberative dialogue and agenda-setting are identified. • Decoupling health inequalities policy from health mitigation of poverty is advocated. [ABSTRACT FROM AUTHOR]

The health disparities and care needs of lesbian, gay, bisexual, transgender and intersex (LGBTI+) patients are becoming well known. However, healthcare practitioners (HCPs) and medical students across the Global North report limited understanding of this population and express concern about their capacity to meet the needs of LGBTI + patients. To address these gaps in literature and practice, this study draws on qualitative interviews with 12 clinicians and five health professional students exploring their understandings and approaches to LGBTI + inclusive practice in Tasmania, Australia. Through a reflexive thematic analysis, we identified that both practicing clinicians and students did not believe that their training adequately prepared them to treat LGBTI + patients. Other key barriers included reduced awareness of LGBTI + community needs due to the lack of exposure to LGBTI + patients and unfamiliarity with appropriate referral pathways in the regional Tasmanian context. Conversely, factors enabling provision of LGBTI + inclusive care included prior experience working with LGBTI + patients and establishing a network of supportive colleagues and local services. Participants who identified as LGBTI + themselves saw their personal experiences as a strength in supporting LGBTI + patients. While awareness of LGBTI + inclusive health practice is increasing, Tasmanian practitioners report insufficient training and practical difficulties with referral as key challenges. [ABSTRACT FROM AUTHOR]

Purpose: This study explores key governance, leadership and management activities that have impact on quality, risk and safety within Australian healthcare organisations. Design/methodology/approach: Current non-executive directors (n = 12) of public and private health boards were interviewed about contemporary approaches to fiduciary and corporate responsibilities for quality assurance and improvement outcomes in the context of risk and safety management for patient care. Verbatim transcripts were subjected to thematic analysis triangulated with Leximancer-based text mining. Findings: Boards operate in a strong legislative, healthcare standards and normative environment of quality and risk management. Support and influence that create a positive quality and risk management culture within the organisation, actions that disseminate quality and risk broadly and at depth for all levels, and implementation and sustained development of quality and risk systems that report on and contain risk were critical tasks for boards and their directors. Practical implications: Findings from this study may provide health directors with key quality and risk management agenda points to expand or deepen the impact of governance around health facilities' quality and risk management. Originality/value: This study has identified key governance activities and responsibilities where boards demonstrate that they add value in terms of potential improvement to hospital and health service quality care outcomes. The demonstrable influence identified makes an important contribution to our understanding of healthcare governance. [ABSTRACT FROM AUTHOR]

Introduction: Persistent low rates of case notification and treatment coverage reflect that accessing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in Nigeria remains a challenge, even though it is provided free of charge to patients. Equity in health access requires availability of comparable, appropriate services to all, based on needs, and irrespective of socio-demographic characteristics. Our study aimed to identify the reasons for Nigeria's low rates of case-finding and treatment for DR-TB. To achieve this, we analyzed elements that facilitate or hinder equitable access for different groups of patients within the current health system to support DR-TB management in Nigeria. Methods: We conducted documentary review of guidelines and workers manuals, as well as 57 qualitative interviews, including 10 focus group discussions, with a total of 127 participants, in Nigeria. Between August and November 2017, we interviewed patients who were on treatment, their treatment supporter, and providers in Ogun and Plateau States, as well as program managers in Benue and Abuja. We adapted and used Levesque's patient-centered access to care framework to analyze DR-TB policy documents and interview data. Results: Thematic analysis revealed inequitable access to DR-TB care for some patient socio-demographic groups. While patients were mostly treated equally at the facility level, some patients experienced more difficulty accessing care based on their gender, age, occupation, educational level and religion. Health system factors including positive provider attitudes and financial support provided to the patients facilitated equity and ease of access. However, limited coverage and the absence of patients' access rights protection and considerations in the treatment guidelines and workers manuals likely hampered access. Conclusion: In the context of Nigeria's low case-finding and treatment coverage, applying an equity of access framework was necessary to highlight gaps in care. Differing social contexts of patients adversely affected their access to DR-TB care. We identified several strengths in DR-TB care delivery, including the current financial support that should be sustained. Our findings highlight the need for government's commitment and continued interventions. [ABSTRACT FROM AUTHOR]

Purpose: High demand for speech-language pathology services is reflected in long waiting lists. Waiting can be active or passive and has implications for stakeholders, including consumers, professionals, and organisations. The present study explored experiences and perspectives regarding waiting for speech-language pathology services through analysis of stakeholders' written submissions to an Australian Government Senate Inquiry. Method: Written submissions (n = 337) were screened for terms related to waiting. Included submissions (n = 133) were written by organisations (36.8%), speech-language pathologists (29.3%), parents (27.8%), individuals with communication and/or swallowing difficulties (5.3%), and others. Result: Inductive thematic analysis identified three themes. (1) Duration. Consistently described as long. (2) Consequences. Consumers' consequences included: burden on physical health, finances, time, emotional wellbeing, and relationships, reduced continuity of care, and increased intervention needs. Professional consequences included: stress and burnout impacting job satisfaction, and reduced effectiveness. Societal consequences included: social and ethical burden, and a drain on health and legal systems. (3) Actions. Consumers advocated and sought alternatives (e.g. threats to harm their child, relocation to a capital city), professionals implemented service delivery and policy actions, and organisations lacked effective system-wide strategies. Conclusion: Existing services did not appear to meet stakeholders' needs. Action is needed to improve speech-language pathology waiting lists and access to services, and minimise possible consequences for stakeholders. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The purpose of this descriptive qualitative study was to explore nurse and healthcare leaders' experiences and perceptions of care coordination and transition management (CCTM®). Four barriers emerged that added insight into the lack of adopting and integrating CCTM knowledge, skills, and attitudes in nursing education in the following categories: curriculum redesign, silos of care settings and care providers, knowledge gap, and faculty development/resistance. Recommendations and implications for education, for both nursing students and practicing nurses, are described. [ABSTRACT FROM AUTHOR]

Background: Primary health care (PHC) outreach teams are part of a policy of PHC re-engineering in South Africa. It attempts to move the deployment of community health workers (CHWs) from vertical programmes into an integrated generalised team-based approach to care for defined populations in municipal wards. There has little evaluation of PHC outreach teams. Managers' insights are anecdotal.Methods: This is descriptive qualitative study with focus group discussions with health district managers of Johannesburg, the largest city in South Africa. This was conducted in a sequence of three meetings with questions around implementation, human resources, and integrated PHC teamwork. There was a thematic content analysis of validated transcripts using the framework method.Results: There were two major themes: leadership-management challenges and human resource challenges. Whilst there was some positive sentiment, leadership-management challenges loomed large: poor leadership and planning with an under-resourced centralised approach, poor communications both within the service and with community, concerns with its impact on current services and resistance to change, and poor integration, both with other streams of PHC re-engineering and current district programmes. Discussion by managers on human resources was mostly on the plight of CHWs and calls for formalisation of CHWs functioning and training and nurse challenges with inappropriate planning and deployment of the team structure, with brief mention of the extended team.Conclusions: Whilst there is positive sentiment towards intent of the PHC outreach team, programme managers in Johannesburg were critical of management of the programme in their health district. Whilst the objective of PHC reform is people-centred health care, its implementation struggles with a centralising tendency amongst managers in the health service in South Africa. Managers in Johannesburg advocated for decentralisation. The implementation of PHC outreach teams is also limited by difficulties with formalisation and training of CHWs and appropriate task shifting to nurses. Change management is required to create true integrate PHC teamwork. Policy review requires addressing these issues. [ABSTRACT FROM AUTHOR]

Parenting and family support are key prevention and intervention strategies for improving outcomes for children and families affected by parental drug misuse. However, little is known about the delivery of parenting support for drug-dependent parents, particularly within universal healthcare services. This study aimed to explore the way healthcare practitioners engage with this challenging agenda. Four multidisciplinary focus groups involving a purposive sample of 18 experienced healthcare professionals were conducted in Scotland. Participants included general practitioners, midwives, public health nurses and addiction staff who work together to provide care for vulnerable families. A focus group topic guide was developed to explore the views and experiences of these healthcare professionals in relation to providing parenting support for drug-using parents, predominantly those receiving opioid substitution therapy. Data were analysed using a constant comparison method and thematic approach. The overarching narrative which united the focus group discussions was about the 'burden of care' that these families pose for frontline healthcare professionals. Recurring themes centred on three key issues: the problematic nature of drug-using parents themselves; clinical challenges in living up to the ideals of professional practice; and the wider context in which current practice is governed. Professionals expressed ambivalence over their parenting support role; anxiety over responsibility for intervening with this 'hard-to-engage' population; and concern over 'dwindling' resources and lack of organisational support. Nevertheless, strategies and opportunities for providing parenting support were acknowledged and there was consensus about the need for further skills training. Despite a proliferation of policy and good practice guidance on the delivery of parenting support for drug-dependent parents, the findings of this study suggest that significant challenges remain. Notably, our findings raise questions about whose role it is to provide parenting support to drug-using mothers and fathers, especially those who are not involved in the child protection system. [ABSTRACT FROM AUTHOR]

Background: Program evaluation is widely recognized in the international humanitarian sector as a means to make interventions and policies more evidence based, equitable, and accountable. Yet, little is known about the way humanitarian non-governmental organizations (NGOs) actually use evaluations.Methods: The current qualitative evaluation employed an instrumental case study design to examine evaluation use (EU) by a humanitarian NGO based in Burkina Faso. This organization developed an evaluation strategy in 2008 to document the implementation and effects of its maternal and child healthcare user fee exemption program. Program evaluations have been undertaken ever since, and the present study examined the discourses of evaluation partners in 2009 (n = 15) and 2011 (n = 17). Semi-structured individual interviews and one group interview were conducted to identify instances of EU over time. Alkin and Taut's (Stud Educ Eval 29:1-12, 2003) conceptualization of EU was used as the basis for thematic qualitative analyses of the different forms of EU identified by stakeholders of the exemption program in the two data collection periods.Results: Results demonstrated that stakeholders began to understand and value the utility of program evaluations once they were exposed to evaluation findings and then progressively used evaluations over time. EU was manifested in a variety of ways, including instrumental and conceptual use of evaluation processes and findings, as well as the persuasive use of findings. Such EU supported planning, decision-making, program practices, evaluation capacity, and advocacy.Conclusions: The study sheds light on the many ways evaluations can be used by different actors in the humanitarian sector. Conceptualizations of EU are also critically discussed. [ABSTRACT FROM AUTHOR]

Background: Moral case deliberation (MCD) as a form of clinical ethics support is usually implemented in health care institutions and educational programs. While there is no previous research on the use of clinical ethics support on the level of health care regulation, employees of regulatory bodies are regularly confronted with moral challenges. This pilot study describes and evaluates the use of MCD at the Dutch Health Care Inspectorate (IGZ). The objective of this pilot study is to investigate: 1) the current way of dealing with moral issues at the IGZ; 2) experience with and evaluation of MCD as clinical ethics support, and 3) future preferences and (perceived) needs regarding clinical ethics support for dealing with moral questions at the IGZ.Methods: We performed an explorative pilot study. The research questions were assessed by means of: 1) interviews with MCD participants during four focus groups; and 2) interviews with six key stakeholders at the IGZ. De qualitative data is illustrated by data from questionnaires on MCD outcomes, perspective taking and MCD evaluation.Results: Professionals do not always recognize moral issues. Employees report a need for regular and structured moral support in health care regulation. The MCD meetings are evaluated positively. The most important outcomes of MCD are feeling secure and learning from others. Additional support is needed to successfully implement MCD at the Inspectorate.Conclusion: We conclude that the respondents perceive moral case deliberation as a useful form of clinical ethics support for dealing with moral questions and issues in health care regulation. [ABSTRACT FROM AUTHOR]

Background: With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study.Methods: We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR).Results: In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care.Conclusions: If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process. [ABSTRACT FROM AUTHOR]

This qualitative study aimed to explore an under-researched issue within the emerging body of research about carers and personalisation - the carer-service user relationship. It was carried out across 11 English local authorities between 2011 and 2012 and focused on the impact of a change in the service user's social care arrangements to a personal budget on this relationship. Using purposive sampling and explicit inclusion criteria, data were gathered through semi-structured in-depth interviews with 23 carers in long-term dyadic relationships with an adult in receipt of social care who had changed to a personal budget. The interviews explored carers' perceptions of the carer-service user relationship before and after the advent of the personal budget and changes that had occurred. The findings were thematically analysed and reflect the fact that in addition to the effects of the move to a personal budget on the carer-service user relationship, the interviewees talked at length about a range of other effects of this move. Just over half of those interviewed felt that the personal budget had enhanced the carer-service user relationship. The other effects were both positive and negative. Three quarters reported positive outcomes, such as feeling happier, healthier and having more control over their lives. Although two thirds experienced negative feelings about having less involvement in the service user's care, these feelings eased over time and if they had confidence in the quality of the care. Over half found administering the personal budget stressful. Further analysis of these findings showed the study contributes not only to existing knowledge about the carer-service user relationship within personalisation but also to knowledge about the effects of personalisation on carers more generally. It therefore simultaneously develops the emergent knowledge base about carers and personalisation. Recommendations based on this analysis are made about future practice and research. [ABSTRACT FROM AUTHOR]

Background: Andalusia has been one of the regions most damaged by the economic crisis in Spain. A qualitative study of the effects of the economic crisis and austerity policies in this region has been conducted within the framework of the IMPACT-A project. This research seeks to analyse the perceived impact of the crisis upon the health of the Andalusian population through the first-hand discourses of professionals from the health and social sectors on the one hand, and citizens of different socioeconomic status (SES) on the other. Methods: A total of five focus groups and ten semi-structured interviews were conducted and analysed following an inductive process based on Grounded Theory (GT). Results: Our results show a general perception among professionals: the financial crisis has either directly or indirectly affected population health in Andalusia, though mostly impacting low-income individuals who were already at risk of social exclusion. Professionals' perceptions have been confirmed through the discourses of citizens of a lower SES, which differ from those of middle and upper SES. Conclusion: Findings reveal some of the most salient consequences on the socially vulnerable groups and people at risk of social exclusion. In particular, our study highlights the importance of addressing three areas of priority action: mental health, unmet (basic and medical) needs, and decline in the health system. [ABSTRACT FROM AUTHOR]

Background: Women with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there is little knowledge of actual current practice. The aim of this study was to explore current policies and clinical practices relating to antenatal and post-natal care for women with GDM in South Africa, as well as health sector stakeholders' perspectives on the barriers to -- and opportunities for -- delivering an integrated mother - baby health service that extends beyond the first week post-partum, to the infant's first year of life.Methods: Following a document review of policy and clinical practice guidelines, in-depth interviews were conducted with 11 key informants who were key policy makers, health service managers and clinicians working in the public health services in South Africa's two major cities (Johannesburg and Cape Town). Data were analysed using qualitative content analysis procedures.Results: The document review and interviews established that it is policy that health services adhere to international guidelines for GDM diagnosis and management, in addition to locally developed guidelines and protocols for clinical practice. All key informants confirmed that lack of postpartum follow-up for GDM women is a significant problem. Health systems barriers include fragmentation of care and the absence of standardised postnatal care for post-GDM women. Key informants also raised patient - related challenges including lack of perceived future risk of developing type 2 diabetes and non-attendance for postpartum follow up, as barriers to postnatal care for GDM women. All participants supported integrated primary health services but cautioned against overloading health workers.Conclusion: Although there is alignment between international guidelines, local policy and reported clinical practice in the management of GDM, there is a gap in continuation of care in the postpartum period. Health systems interventions that support and facilitate active follow-up for women with prior GDM are needed if high rates of progression to type 2 diabetes are to be avoided. [ABSTRACT FROM AUTHOR]

Background: Studies examining how the capacity of health facilities affect implementation of free healthcare policies in low and middle-income countries are limited. Objective: This study describes how the context and institutional capacity of health facilities influenced implementation of the free maternal and child health programme (FMCHP) in Enugu state, South-east Nigeria. Methods: We conducted a qualitative case study at the state level and in two health districts (Isi-Uzo and Enugu Metropolis) in Enugu State. Data were collected through document review and semi-structured, in-depth interviews with policymakers (n = 16), healthcare providers (n = 16) and health facility committee leaders (n = 12) guided by an existing capacity framework and analysed using a thematic framework approach. Results: The findings reveal that active health facility committees, changes in provider payment process, supportive supervision, drug revolving fund, availability of medical equipment, electronic data transmission and staff sanction system enhanced the capacity of health facilities to offer free healthcare. However, ineffective decentralisation, irregular supervision and weak citizen participation limited this capacity. Uncertain provider payment, evidence of tax payment policy and a co-existing fee-exempt scheme constrained health facilities in following the FMCHP guidelines. Poor recording and reporting skills and lack of support from district officials constrained providers' adherence to claims' submission timeline. Poor funding, weak drug supply system, inadequate infrastructure and lack of participatory decision-making constrained delivery of free healthcare. Insufficient trained workforce, mission-inconsistent postings and transfers, and weak staff disciplinary system limited the human resource capacity. Conclusions: Effectiveness of FMCHP at the health facility level depends on the extent of decentralisation, citizen participation, concurrent and conflictive policies, timely payment of providers, organisation of service delivery and human resources practices. Attention to these contextual and institutional factors will enhance responsiveness of health facilities, sustainability of free healthcare policies and progress towards universal health coverage. [ABSTRACT FROM AUTHOR]

Background: Fibromyalgia is a painful chronic disease, suffered mainly by women, that consolidates a number of symptoms and skeletal muscle issues which are little understood. Objectives: To explore the social construction of FM from the perspective of health policies, patients, and health professionals involved in their medical attention. Methods: I) Policy review of national and regional health plans in a national and international context, the clinical protocols for fibromyalgia in Spain, and the Parliamentary initials in the European and Spanish context; and ii) Qualitative study involving 28 personal interviews with 16 fibromyalgia patients and 12 interviews with health care professionals in Spain. Results: The findings show that in Spain, the fact that fibromyalgia lacks recognition still remains: in policies, in the clinical and professional fields, and in the patients’ social circle. International health policy has not yet taken steps to reflect the emergence of this recently diagnosed disease. The care for patients suffering from fibromyalgia, who are mainly women, leads to frustration among the healthcare professionals and desperation among the patients themselves, as a resolutive treatment for the disease is not existing. Patients show resistance at assuming the sick role. They want to carry on undertaking their daily activities, both in the public sphere and in the private one. Roles involving the gendered division of labour were found to follow a rigid pattern, both prior to and subsequent to the disease, as the causes that led to frustration for men or women differ according to activities that are socially assigned to them. In practice, FM is conceived exclusively as a women’s health problem, which may result in a gender-biased patient healthcare attention. Conclusion: Political, professional and individual spheres have an influence on how this disease is constructed on a social level: as one of the “invisible women’s diseases”. It is recommended to resolve the disease’s lack of recognition by i) implementing specific policies for FM and ii) increasing the training and sensitization of health providers about the severity of FM and the existence of gender prejudices biasing the attention. [ABSTRACT FROM PUBLISHER]