262 results
Search Results
2. Stigma and mental health in the Royal Navy: A mixed methods paper.
- Author
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Langston, Victoria, Greenberg, Neil, Fear, Nicola, Iversen, Amy, French, Claire, and Wessely, Simon
- Subjects
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MENTAL illness , *PSYCHOLOGICAL distress , *MILITARY personnel , *MENTAL health , *SOCIAL stigma , *FEAR of falling - Abstract
Background: US research suggests that military personnel suffering from mental health problems are reluctant to seek help because of stigma. Aims: First, to identify the prevalence of mental health stigma beliefs in a UK military sample. Second, to investigate whether distressed personnel report more stigma than those who are not distressed. Method: A survey of 1599 naval personnel was undertaken as part of a larger trial prior to examining the effectiveness of a novel trauma support program. Results: The presence of internal stigma was substantial and significantly higher for distressed personnel. The prevalence of stigma about other people's mental health problems was low. Junior personnel reported being more uncomfortable in discussing emotional issues with their peer group than senior staff. Conclusions: Internal stigma remains a significant barrier to help seeking within the Royal Navy, especially for distressed personnel. This may be especially problematic for junior personnel who are known to be particularly vulnerable to developing mental health problems. [ABSTRACT FROM AUTHOR]
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- 2010
- Full Text
- View/download PDF
3. Living with epidermolysis bullosa: Daily challenges and health‐care needs
- Author
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Ann Donohoe, Eilish McAuliffe, and Sandra Kearney
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Adult ,Parents ,Gerontology ,Population ,barriers to care ,03 medical and health sciences ,Broad spectrum ,0302 clinical medicine ,Skin fragility ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Epidermolysis bullosa ,Child ,education ,Service (business) ,lcsh:R5-920 ,education.field_of_study ,business.industry ,lcsh:Public aspects of medicine ,030503 health policy & services ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,medicine.disease ,Psychosocial support ,Original Research Paper ,health‐care needs ,Distress ,Caregivers ,lived experience ,Health Facilities ,lcsh:Medicine (General) ,0305 other medical science ,business ,Psychology ,Delivery of Health Care ,Original Research Papers - Abstract
Background & Objective Epidermolysis bullosa (EB) is the term used for a group of genetic skin fragility disorders. For those living with EB, pain represents a constant challenge, with blistering and tasks such as changing dressings, adding to the distress. This paper focuses on describing and exploring the health‐care needs of children, adults and families who are affected by EB. The specific aim of the paper is to identify the needs of the EB population with a view towards informing the development of a community liaison service to support adults living with EB and the parents/carers of children living with EB. Setting and Participants Interviews with six adults and the parents of eight children with EB were conducted. The data were analysed thematically. All participants were resident on the island of Ireland and are therefore reflecting on services in this geographic region. Results Participants’ needs were grouped into five themes: support managing physical health‐care issues; access to community/home‐based services; EB‐specific information and psychosocial support; effective interaction with health‐care professionals; and advice regarding benefits and entitlements. Discussion and Conclusions This article represents the health‐care needs and preferences of a broad spectrum of those with EB, highlighting the need for a comprehensive service regardless of the severity of the condition.
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- 2020
4. GPT Technology to Help Address Longstanding Barriers to Care in Free Medical Clinics.
- Author
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Ong, Hannah, Ong, Joshua, Cheng, Rebekah, Wang, Calvin, Lin, Murong, and Ong, Dennis
- Abstract
The implementation of technology in healthcare has revolutionized patient-centered decision making by providing contextualized information about a patient's healthcare journey, leading to increased efficiency (Keyworth et al. in BMC Med Inform Decis Mak 18:93, 2018, https://doi.org/10.1186/s12911-018-0661-3). Artificial intelligence has been integrated within Electronic Health Records (EHR) to prompt screenings or diagnostic tests based on a patient's holistic health profile. While larger hospitals have already widely adopted these technologies, free clinics hold lower utilization of these advanced capability EHRs. The patient population at a free clinic faces a multitude of factors that limits their access to comprehensive care, thus requiring necessary efforts and measures to close the gap in healthcare disparities. Emerging Artificial Intelligence (AI) technology, such as OpenAI's ChatGPT, GPT-4, and other large language models (LLMs) have remarkable potential to improve patient care outcomes, promote health equity, and enhance comprehensive and holistic care in resource-limited settings. This paper aims to identify areas in which integrating these LLM AI advancements into free clinics operations can optimize and streamline healthcare delivery to underserved patient populations. This paper also identifies areas of improvements in GPT that are necessary to deliver those services. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Remote enrollment into a telehealth-delivering patient portal: Barriers faced in an urban population during the COVID-19 pandemic
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Christopher Ferrer, Charles Sanky, Matthew A. Weissman, Jordan A. Francke, Tristan Grogan, Dennis M. Bienstock, Danielle L. Tepper, Tania P. Chen, and Phillip Groden
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education.field_of_study ,Telemedicine ,Original Paper ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Population ,education ,Biomedical Engineering ,Patient portal ,COVID-19 ,Bioengineering ,Telehealth ,medicine.disease ,Applied Microbiology and Biotechnology ,Healthcare delivery ,Male patient ,Pandemic ,medicine ,Medical emergency ,Barriers to Care ,business ,health care economics and organizations ,Biotechnology - Abstract
Telehealth drastically reduces the time burden of appointments and increases access to care for homebound patients. During the COVID-19 pandemic, many outpatient practices closed, requiring an expansion of telemedicine capabilities. However, a significant number of patients remain unconnected to telehealth-capable patient portals. Currently, no literature exists on the success of and barriers to remote enrollment in telehealth patient portals. From March 26 to May 8, 2020, a total of 324 patients were discharged from Mount Sinai Beth Israel (MSBI), a teaching hospital in New York City. Study volunteers attempted to contact and enroll patients in the MyChart patient portal to allow the completion of a post-discharge video visit. If patients were unable to enroll, barriers were documented and coded for themes. Of the 324 patients discharged from MSBI during the study period, 277 (85%) were not yet enrolled in MyChart. Volunteers successfully contacted 136 patients (49% of those eligible), and 39 (14%) were successfully enrolled. Inability to contact patients was the most significant barrier. For those successfully contacted but not enrolled, the most frequent barrier was becoming lost to follow-up (29% of those contacted), followed by lack of interest in remote appointments (21%) and patient technological limitations (9%). Male patients, and those aged 40–59, were significantly less likely to successfully enroll compared to other patients. Telehealth is critical for healthcare delivery. Remote enrollment in a telemedicine-capable patient portal is feasible, yet underperforms compared to reported in-person enrollment rates. Health systems can improve telehealth infrastructure by incorporating patient portal enrollment into in-person workflows, educating on the importance of telehealth, and devising workarounds for technological barriers.
- Published
- 2021
6. Underuse of Behavioral Treatments for Headache: a Narrative Review Examining Societal and Cultural Factors
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Yuen Shan Christine Lee, Donald B. Penzien, Naomi M. Simon, Mia T. Minen, Richard B. Lipton, Felicia Fraser, Yuka Matsuzawa, and Donna Langenbahn
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Adult ,medicine.medical_specialty ,Migraine Disorders ,medicine.medical_treatment ,Psychological intervention ,Stigma (botany) ,Subspecialty ,Biofeedback ,01 natural sciences ,barriers to care ,03 medical and health sciences ,0302 clinical medicine ,Behavior Therapy ,behavioral interventions ,Internal Medicine ,medicine ,Humans ,migraine ,030212 general & internal medicine ,0101 mathematics ,Psychiatry ,Review Paper ,Cognitive Behavioral Therapy ,business.industry ,010102 general mathematics ,Headache ,Nausea ,medicine.disease ,Mental health ,Cognitive behavioral therapy ,Migraine ,Headaches ,medicine.symptom ,business - Abstract
Migraine affects over 40 million Americans and is the world’s second most disabling condition. As the majority of medical care for migraine occurs in primary care settings, not in neurology nor headache subspecialty practices, healthcare system interventions should focus on primary care. Though there is grade A evidence for behavioral treatment (e.g., biofeedback, cognitive behavioral therapy (CBT), and relaxation techniques) for migraine, these treatments are underutilized. Behavioral treatments may be a valuable alternative to opioids, which remain widely used for migraine, despite the US opioid epidemic and guidelines that recommend against them. Identifying and removing barriers to the use of headache behavioral therapy could help reduce the disability as well as the personal and social costs of migraine. These techniques will have their greatest impact if offered in primary care settings to the lower socioeconomic status groups at greatest risk for migraine. We review the societal and cultural challenges that impose barriers to optimal use of non-pharmacological treatment services. These barriers include insufficient knowledge of migraine/headache behavioral treatments and insufficient availability of clinicians trained in non-pharmacological treatment delivery; limited access in underserved communities; financial burden; and stigma associated with both headache and mental health diagnoses and treatment. For each barrier, we discuss potential approaches to minimizing its effect and thus enhancing non-pharmacological treatment utilization. Case Example A 25-year-old graduate student with a prior history of headaches in college is attending school in the evenings while working a full-time job. Now, his headaches have significant nausea and photophobia. They are twice weekly and are disabling enough that he is unable to complete homework assignments. He does not understand why the headaches occur on Saturdays when he pushes through all week to get through his examinations that take place on Friday evenings. He tried two different migraine preventive medications, but neither led to the 50% reduction in headache days his doctor had hoped for. His doctor had suggested cognitive behavioral therapy (CBT) before initiating the medications, but he had been too busy to attend the appointments, and the challenges in finding an in-network provider proved difficult. Now with the worsening headaches, he opted for the CBT and by the fifth week had already noted improvements in his headache frequency and intensity.
- Published
- 2021
7. Barriers to help-seeking for memory problems in older adults
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Ann Pearman
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medicine.medical_specialty ,Hearing loss ,Convenience sample ,Help-seeking ,Memory complaints ,03 medical and health sciences ,0302 clinical medicine ,Hearing ,Hearing problems ,Surveys and Questionnaires ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Hearing Loss ,Aged ,Memory Disorders ,business.industry ,Patient Acceptance of Health Care ,Memory problems ,Outreach ,Mood ,Cross-Sectional Studies ,Family medicine ,Barriers to care ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Research Paper - Abstract
Key summary points Aim The aim of this study was to investigate potential barriers to help-seeking for memory problems as well as outreach to providers. Findings Participants who endorsed having hearing problems were the most likely to endorse barriers to help-seeking as well as speaking to a physician. Message Physicians and healthcare agencies can work to design outreach for persons who experience barriers, particularly hearing loss., Purpose Early detection of age- and disease-related cognitive problems affords patients the opportunities to receive medical treatment, engage in research, and plan for the future. Understanding help-seeking behavior has potential to aid both patients and clinicians. This study was designed to identify predictors of endorsed barriers to memory-related help-seeking as well as medical help-seeking endorsement. Methods This cross-sectional correlational study used a convenience sample of 97 older adults. The participants answered anonymous questionnaires about subjective memory, mood, and health and several items designed to investigate help-seeking for memory issues. Results Persons who endorsed multiple barriers to help-seeking were more likely to also endorse having hearing problems. In addition, participants who reported that they would not talk to a doctor or physician about memory concerns also had significantly worse subjective hearing. Conclusion Hearing loss may be a particular risk for not seeking help for memory problems. Physicians and healthcare agencies can work to design outreach for persons who experience barriers, such as hearing loss and the concomitant outcomes.
- Published
- 2020
8. Brachytherapy utilization for cervical cancer in Western United States border counties: seeking to understand referral patterns for outcome improvement
- Author
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Christine H. Feng, Corinne McDaniels-Davidson, Maria Elena Martinez, Jesse Nodora, Arno J. Mundt, and Jyoti S. Mayadev
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Original Paper ,barriers to care ,Oncology ,underutilization ,cervical cancer ,Clinical Research ,brachytherapy ,referral pattern ,Radiology, Nuclear Medicine and imaging ,survey ,Cancer - Abstract
Purpose Standard of care for definitive treatment of locally advanced cervical cancer (LACC) is concurrent chemoradiation followed by a brachytherapy boost. Only 55.8% of women in the United States receive brachytherapy, with even lower proportions in San Diego and Imperial Counties. The purpose of this study was to investigate brachytherapy practice and referral patterns in Western United States border region. Material and methods A short survey was sent to 28 radiation oncologists in San Diego and Imperial Counties, who treat patients with gynecologic malignancies. Descriptive statistics were used for analysis. Results Seventeen (61%) physicians responded to the survey. All physicians reported some training in cervical cancer brachytherapy during residency, with median 6 months. Only two physicians reported personally treating all cervical cancer patients with brachytherapy; however, 92% of remaining physicians would recommend brachytherapy for patients if given time and access. The most common reason for referral (78%) was patients deemed to require hybrid or interstitial brachytherapy implants. Barriers to referral included patients’ preference, insurance status, their resources, or logistics. No changes were reported for brachytherapy practices during the COVID-19 pandemic, except the addition of pre-procedural testing for SARS-CoV-2. Ninety-two percent of physicians identified inadequate maintenance of skills as a barrier to performing brachytherapy, but 77% were not interested in additional training. External beam radiation therapy boosts were rarely recommended in case scenarios describing potentially curable patients. Conclusions The importance of brachytherapy is widely recognized for conferring a survival benefit, but barriers to implementation include inadequate training or maintenance of skills, and larger systematic issues related to reimbursement policy, social support, and financial hardship. As most established providers were uninterested in additional brachytherapy training, future approaches to improve patients’ access should be multidimensional and reflect the value of brachytherapy in definitive treatment of patients with LACC.
- Published
- 2021
9. Barriers in care pathways and unmet mental health needs in LGBTIQ + communities.
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Silveri, Giada, Schimmenti, Simone, Prina, Eleonora, Gios, Lorenzo, Mirandola, Massimo, Converti, Manlio, Fiorillo, Andrea, Pinna, Federica, Ventriglio, Antonio, Galeazzi, Gian Maria, Sherriff, Nigel, Zeeman, Laetitia, Amaddeo, Francesco, Somaini, Giulia, Paribello, Pasquale, Giallanella, Daniela, Gaggiano, Costanza, Marchi, Mattia, Arcolin, Elisa, and Fiore, Gianluca
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ONLINE information services ,PSYCHOLOGY information storage & retrieval systems ,HEALTH services accessibility ,MEDICAL information storage & retrieval systems ,SUBSTANCE abuse ,PSYCHOLOGY of LGBTQ+ people ,SYSTEMATIC reviews ,COMMUNITIES ,MENTAL health ,SOCIAL stigma ,DESCRIPTIVE statistics ,MEDLINE ,THEMATIC analysis ,MEDICAL needs assessment - Abstract
Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatized and experience discrimination in health care settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ + communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. A total of 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ + people experience stigmatization and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing health care services, and fewer tailored interventions being provided. These findings have implications for policy, health care screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental health care providers can challenge social issues that maintain discriminatory and stigmatizing practices, and support LGBTIQ + individuals to sustain their resilience. [ABSTRACT FROM AUTHOR]
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- 2022
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10. Inequities in periodontal disease prevalence, prevention, and management.
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Mills, Arden and Levin, Liran
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PERIODONTAL disease treatment ,PERIODONTAL disease prevention ,WELL-being ,HEALTH services accessibility ,HOSPITAL emergency services ,ORAL health ,PERIODONTAL disease ,DENTAL care ,MEDICAL care ,TELEDENTISTRY ,HEALTH literacy ,DENTISTRY ,INSURANCE - Abstract
Periodontal disease is highly prevalent and contributes to the global burden of chronic diseases. Inherent and institutional inequities contribute to the prevalence of periodontal disease by facilitating barriers to accessing dental care and maintaining good oral health. The aim of this paper is to review the inequities experienced in the dental field in relation to periodontal disease. Barriers to dental care are experienced in many countries globally. They include cost, insurance coverage, geography, physician availability, and oral health literacy. These barriers influence the frequency of dental visits, oral hygiene, and risk behaviors of individuals which impact an individual's oral health status. Most often, postponed or improper dental care leads to worsened dental conditions that are more costly and detrimental to one's wellbeing. These dental conditions, like periodontitis, fall back on the health care system for treatment through emergency department resource use and comorbidities that can develop or be worsened as a result. To reduce the global burden of chronic disease and the costs of treatments for preventable conditions, and increase oral health, corrective actions are required. Such actions may include the use of teledentistry, greater oral health education, emergency departments staffing dental practitioners, subsidies for rural or remote dental practitioners, and policy changes for universal coverage of basic dental needs. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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11. Dialectics, power dynamics, and undercurrents of meaning: using psychotherapeutic strategies in primary care with trans and gender-diverse clients.
- Author
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Waldron, Elizabeth, Solonsch, Lucy, and Stone, Louise
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MEDICAL quality control ,GENDER affirming care ,HEALTH services accessibility ,MINORITIES ,GENDER-nonconforming people ,MENTAL health ,PRIMARY health care ,SEX distribution ,DIALECTICAL behavior therapy ,AUSTRALIANS ,HEALTH equity ,NEEDS assessment ,PSYCHOTHERAPY - Abstract
Trans and gender-diverse individuals experience poor mental health, and face significant barriers when trying to access appropriate mental health care. Most seek treatment from mainstream primary care services, who have an ethical duty to provide care to all. Primary care practitioners can ameliorate traumatic harms by identifying helpful strategies and avoiding inappropriate or harmful strategies. However, there is limited robust, culturally sensitive evidence informing clinicians about the appropriateness and efficacy of psychological interventions for trans and gender-diverse clients. This forum article argues that the epistemological and ontological frameworks underlying psychotherapies can impact the therapeutic relationship, and are therefore important factors to consider in primary care practice with trans and gender-diverse clients. Our paper synthesises selected psychotherapies into four clusters. Each cluster is accompanied by discussion of the potential or demonstrated benefits and limitations of the underlying framework, in the context of primary care with trans and gender-diverse clients. We also explore power dynamics in therapeutic relationships with trans and gender-diverse clients, and the challenges these factors pose to developing a shared understanding of the client's needs and preferences. The article concludes with some practical considerations for managing these issues in primary care. Trans and gender-diverse individuals tend to experience poor mental health, often exacerbated by culturally unsafe services in primary care. This paper offers four key frameworks for understanding and anticipating the potential benefits and harms of different psychological therapies when caring for trans and gender-diverse clients. The article concludes with recommendations for implementing the frameworks in practice, and discussion of the scope for involving peer workers in multidisciplinary care teams. [ABSTRACT FROM AUTHOR]
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- 2023
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12. Unmet Need for Mental Healthcare in a Population Sample in Sweden: A Cross-Sectional Study of Inequalities Based on Gender, Education, and Country of Birth
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Jesper Löve, Gunnel Hensing, Bo Burström, and Sara Olsson
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Gerontology ,Male ,Mental Health Services ,Health (social science) ,Inequality ,Cross-sectional study ,media_common.quotation_subject ,Psychological intervention ,Sample (statistics) ,Logistic regression ,Common mental disorders ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Social inequality ,030212 general & internal medicine ,Depression (differential diagnoses) ,media_common ,Sweden ,Original Paper ,Descriptive statistics ,Depression ,Public Health, Environmental and Occupational Health ,030227 psychiatry ,Psychiatry and Mental health ,Cross-Sectional Studies ,Barriers to care ,Educational Status ,Female ,Psychology ,Unmet need ,Social inequalities - Abstract
This cross-sectional study investigated if gender, education, and country of birth were associated with perceived need and unmet need for mental healthcare (i.e., refraining from seeking care, or perceiving care as insufficient when seeking it). Questionnaire and register data from 2008 were collected for 3987 individuals, aged 19–64 years, in a random population-based sample from western Sweden. Descriptive statistics and logistic regression analyses were used. Men were less likely to perceive a need for care than were women, even after adjusting for mental well-being. Men were also less likely to seek care and perceiving care as sufficient. People with secondary education were less likely to seek care than those with university education. There were no statistically significant differences based on country of birth. The observed gender and education-based inequalities increases our understanding of where interventions can be implemented. These inequalities in unmet need for mental healthcare should be targeted by the healthcare system.
- Published
- 2019
13. Community engagement to inform development of strategies to improve referral for hypertension: perspectives of patients, providers and local community members in western Kenya.
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Naanyu, Violet, Njuguna, Benson, Koros, Hillary, Andesia, Josephine, Kamano, Jemima, Mercer, Tim, Bloomfield, Gerald, Pastakia, Sonak, Vedanthan, Rajesh, and Akwanalo, Constantine
- Subjects
MEDICAL personnel ,PATIENTS' attitudes ,HEALTH information technology ,HYPERTENSION ,HEALTH facilities - Abstract
Background: Hypertension is the leading cause of death and disability. Clinical care for patients with hypertension in Kenya leverages referral networks to provide basic and specialized healthcare services. However, referrals are characterized by non-adherence and delays in completion. An integrated health information technology (HIT) and peer-based support strategy to improve adherence to referrals and blood pressure control was proposed. A formative assessment gathered perspectives on barriers to referral completion and garnered thoughts on the proposed intervention. Methods: We conducted a qualitative study in Kitale, Webuye, Kocholya, Turbo, Mosoriot and Burnt Forest areas of Western Kenya. We utilized the PRECEDE-PROCEED framework to understand the behavioral, environmental and ecological factors that would influence uptake and success of our intervention. We conducted four mabaraza (customary heterogenous community assemblies), eighteen key informant interviews, and twelve focus group discussions among clinicians, patients and community members. The data obtained was audio recorded alongside field note taking. Audio recordings were transcribed and translated for onward coding and thematic analysis using NVivo 12. Results: Specific supply-side and demand-side barriers influenced completion of referral for hypertension. Key demand-side barriers included lack of money for care and inadequate referral knowledge. On the supply-side, long distance to health facilities, low availability of services, unaffordable services, and poor referral management were reported. All participants felt that the proposed strategies could improve delivery of care and expressed much enthusiasm for them. Participants appreciated benefits of the peer component, saying it would motivate positive patient behavior, and provide health education, psychosocial support, and assistance in navigating care. The HIT component was seen as reducing paper work, easing communication between providers, and facilitating tracking of patient information. Participants also shared concerns that could influence implementation of the two strategies including consent, confidentiality, and reduction in patient-provider interaction. Conclusions: Appreciation of local realities and patients' experiences is critical to development and implementation of sustainable strategies to improve effectiveness of hypertension referral networks. Incorporating concerns from patients, health care workers, and local leaders facilitates adaptation of interventions to respond to real needs. This approach is ethical and also allows research teams to harness benefits of participatory community-involved research. Trial registration: Clinicaltrials.gov, NCT03543787, Registered June 1, 2018. https://clinicaltrials.gov/ct2/show/NCT03543787 [ABSTRACT FROM AUTHOR]
- Published
- 2023
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14. Out-of-pocket payments: impacts on healthcare decision-making and system and individual level measures to minimise the burden.
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Neil, Amanda L.
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HEALTH services accessibility ,MEDICAL care costs ,PATIENT-centered care ,DECISION making ,SAFETY-net health care providers ,MENTAL health services ,MEDICARE - Abstract
Out-of-pocket healthcare payments are a concern for all, particularly those least able to afford them, a situation only being exacerbated by the current cost-of-living crisis. This article aims to provide an overview of out-of-pocket payments and their impacts on decision-making: whether, or not to delay care or seek care at all. The impact of average out-of-pocket payments on demand for mental healthcare services is provided as a specific example. The available data indicate a positive linear relationship between the average out-of-pocket payments for Medicare services by type of provider, and the proportion of patients who decide not to obtain care from a given type provider. This article also poses that current safety net processes are not consumer centric, the Pharmaceutical Benefits Scheme (PBS) Safety Net particularly so, and that change is required. It is recommended that a consumer-centric approach should be adopted with everyone listed on a Medicare card automatically included in the assessment of the Medicare and PBS Safety Nets and for the PBS Safety Net to be automatically assessed through Services Australia. Links to websites are provided to support individual decision-making and registering for available safety nets. Finally, supply side considerations and their implications for market equilibrium and the economy are briefly overviewed. What is known about the topic? Out-of-pocket payments can have significant impacts on healthcare choices; whether or not to delay or seek care. What does this paper add? This article provides an overview of out-of-pocket payments and their impacts on decision-making with a focus on Medicare-subsidised mental health services. Current government measures to contain out-of-pocket payments are overviewed and their limitations highlighted. What are the implications for practitioners? Current Medicare Benefits Schedule and Pharmaceutical Benefits Scheme (PBS) safety nets are not consumer centric, the PBS Safety Net particularly so. Changes should be made to these schemes to further address the burden of out-of-pocket payments. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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15. Subjective experiences, perceptions, and meanings associated with barriers to seeking mental health care among first responders.
- Author
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O'Dare, Kellie, Atwell, Leah, King, Erin, Dillard, Dana, Herzog, Joseph, and Rotunda, Robert
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ObjectiveMethodsResultsDiscussionSeeking mental health services can be challenging for first responders due to various barriers that impede access to care. The objective of this study was to gain a deeper understanding of the subjective experiences, perceptions, and meanings associated with seeking services among first responders.The survey-design instrument consisted of questions regarding stress, psychological health, health-related difficulties, and potential barriers to treatment that first responders may experience. The questions were asked in multiple formats including multiple choice, select all that apply, and one open-ended question. This paper includes responses from the optional open-ended question (
n = 78). Researchers conducted data analysis using ATLAS.ti and the analysis followed a thematic approach.Three (3) themes and several sub-themes were identified. First responders provided diverse explanations for their reluctance to seek care, such as organisational and leadership factors, stigma related to mental health, concerns about being red-flagged, limited access to care, and the financial implications of treatment. A prevailing sentiment was a lack of trust in the mental health field.By giving voice to the lived experiences of first responders, this study can inform the development of targeted interventions and support programs that address their specific needs and enhance overall well-being of first responders. [ABSTRACT FROM AUTHOR]- Published
- 2024
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16. Impact of Patient Navigation on Population-Based Breast Screening: a Systematic Review and Meta-analysis of Randomized Clinical Trials.
- Author
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Tian, Lu, Huang, Lei, Liu, Jie, Li, Xia, Ajmal, Aisha, Ajmal, Maryam, Yao, Yunjin, and Tian, Li
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MEDICAL screening ,CLINICAL trials ,EARLY detection of cancer ,RANDOMIZED controlled trials ,BREAST exams ,NAVIGATION - Abstract
Background: Unsatisfactory cancer screening results are often associated with poor prognosis. This study synthesized the literatures addressing the impact of patient navigation (PN) interventions on population-based breast cancer screening promotion to identify characteristics of the model for addressing breast cancer disparities. Methods: We searched Pubmed, Embase, Web of Science, and the Cochrane Central Registry from inception to 31 December 2020 for randomized controlled trials (PROSPERO: CRD42021246890). We double blindly abstracted data and assessed study quality. We assessed screening completion rates and diagnostic resolution using random-effects models between those receiving navigation and controls. Results: Of 236 abstracts identified, 15 studies met inclusion criteria. Nine of the papers evaluated the impact of PN on breast screening, while the other six were on the resolution of abnormal screening results. Compared to the non-PN group, PN improved screening completion (OR: 2.0, 95% CI: 1.4–2.8]) and shortened the time to diagnosis (WMD: − 9.90 days, 95% CI: − 19.09 to − 0.71). Conclusions: Patient navigation improves breast cancer screening rates but does not improve resolution of abnormal tests. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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17. Living with epidermolysis bullosa: Daily challenges and health‐care needs.
- Author
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Kearney, Sandra, Donohoe, Ann, and McAuliffe, Eilish
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ACTION research ,CAREGIVERS ,COMMUNICATION ,COMMUNITY health services ,EPIDERMOLYSIS bullosa ,HEALTH services accessibility ,HEALTH status indicators ,INTERVIEWING ,RESEARCH methodology ,MEDICAL care ,MEDICAL needs assessment ,NEEDS assessment ,PARENTS ,PATIENTS ,RESEARCH ,RESEARCH funding ,QUALITATIVE research ,SOCIAL support ,THEMATIC analysis ,HUMAN services programs ,PHYSICAL activity ,DATA analysis software ,MEDICAL coding ,ADULTS - Abstract
Background & Objective: Epidermolysis bullosa (EB) is the term used for a group of genetic skin fragility disorders. For those living with EB, pain represents a constant challenge, with blistering and tasks such as changing dressings, adding to the distress. This paper focuses on describing and exploring the health‐care needs of children, adults and families who are affected by EB. The specific aim of the paper is to identify the needs of the EB population with a view towards informing the development of a community liaison service to support adults living with EB and the parents/carers of children living with EB. Setting and Participants: Interviews with six adults and the parents of eight children with EB were conducted. The data were analysed thematically. All participants were resident on the island of Ireland and are therefore reflecting on services in this geographic region. Results: Participants' needs were grouped into five themes: support managing physical health‐care issues; access to community/home‐based services; EB‐specific information and psychosocial support; effective interaction with health‐care professionals; and advice regarding benefits and entitlements. Discussion and Conclusions: This article represents the health‐care needs and preferences of a broad spectrum of those with EB, highlighting the need for a comprehensive service regardless of the severity of the condition. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
18. Peer navigators' role in supporting people living with human immunodeficiency virus in Australia: Qualitative exploration of general practitioners' perspectives.
- Author
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Khalpey, Zoyah, Fitzgerald, Lisa, Howard, Chris, Istiko, Satrio Nindyo, Dean, Judith, and Mutch, Allyson
- Subjects
HIV infections & psychology ,AFFINITY groups ,OCCUPATIONAL roles ,HIV infections ,PRIVACY ,SOCIAL support ,MEDICINE information services ,HEALTH services accessibility ,PROFESSIONS ,WORK ,RESEARCH methodology ,SELF-management (Psychology) ,PATIENT-centered care ,PHYSICIANS' attitudes ,INTERVIEWING ,FEAR ,SOCIAL stigma ,COMMUNITY health services ,PRIMARY health care ,QUALITATIVE research ,HEALTH information services ,EXPERIENTIAL learning ,RESEARCH funding ,DESCRIPTIVE statistics ,SOUND recordings ,MEDICAL ethics ,COMMUNICATION ,PATIENT education ,THEMATIC analysis ,PSYCHOLOGY of HIV-positive persons ,SOCIAL case work - Abstract
The redefining of human immunodeficiency virus (HIV) from an acute disease to a manageable chronic illness has reshaped the focus of care, emphasising clinical outcomes and sidelining the complex social barriers many people living with HIV (PLHIV) still face. This parallels changes in the location of HIV care in Australia, with many PLHIV seeking care from private general practitioners whose ability to address complex social issues is constrained by limitations of time and resources. In response, peer navigation has emerged as a model of care implemented by some HIV‐based community health organisations seeking to support PLHIV's biomedical and psychosocial needs. However, there is limited understanding of how peer navigation operates in community settings or of the way these programmes integrate with primary care. This paper is the first to explore peer navigation from the perspective of general practitioners (GPs), with experience in treating PLHIV, to understand the role they see for peer navigators (PNs) in supporting PLHIV. Semi‐structured in‐depth interviews were conducted with six GPs (11.5% of specialty HIV GPs in Queensland, Australia) to examine their views and experiences of peer navigation in the context of HIV care. GPs highlighted the complexities of care for PLHIV and the need for additional resources and supports for psychosocial care. GPs valued peer navigation as part of a patient support network and bridge to health and social care systems. PNs normalised HIV, alleviating fear and stigma, educating and translating clinical information for patients. However, a key challenge was the absence of direct communication pathways with PNs. Peer navigation has clear potential in supporting the care of PLHIV, to alleviate constraints in GP settings and expand HIV care beyond the clinic. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
19. Development of a patient-oriented navigation model for patients with lung cancer and stroke in Germany.
- Author
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Gödde, Kathrin, Fügemann, Hella, Desch, Anke, Stumm, Judith, Schindel, Daniel, Rieckmann, Nina, Meisel, Andreas, Müller-Nordhorn, Jacqueline, Goerling, Ute, and Holmberg, Christine
- Abstract
Background: The concept of patient navigation was first established in the USA to support vulnerable patient groups in receiving timely and comprehensive access to cancer care. It has recently gained increasing interest in Germany to support patients with chronic diseases in a fragmented healthcare system. The aim of this paper is to present the development of such a model adapted to the German context based on the results of mixed-methods studies investigating the need for and barriers to patient-oriented care.Methods: In a process adapted from Delphi rounds, we conducted regular structured workshops with investigators of the project to discuss results of their studies and identify content and structure of the model based on the data. Workshop discussions were structured along seven core components of a navigation model including target patient groups, navigator tasks, occupational background and education of navigators, and patient-navigator interaction mode.Results: Using an approach based on empirical data of current care practices with special focus on patients' perspectives, we developed a patient-oriented navigation model for patients who have experienced stroke and lung cancer in the German healthcare context. Patients without personal social support were viewed as struggling most with the healthcare system, as well as multimorbid and elderly patients. Navigators should serve as a longer-term contact person with a flexible contact mode and timing based on the individual situation and preferences of patients. Navigator tasks include the provision of administrative and organizational support as well as referral and guidance to available resources and beneficial health programs with special forms of knowledge. Implementation of the navigator should be flexibly located to ensure a reliable outreach to vulnerable patients for first contact in settings like specialized in-patient and out-patient settings, while navigation itself focuses on care coordination in the out-patient setting.Conclusion: Flexibility of navigator tasks needed to be a core characteristic of a navigation model to be perceived as supportive from patients' perspectives. In a subsequent feasibility study, an intervention based on the model will be evaluated according to its acceptance, demand, and practicality. [ABSTRACT FROM AUTHOR]- Published
- 2022
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- View/download PDF
20. Mothers’ Experiences of Accessing Mental Health Care for their Child with an Autism Spectrum Disorder
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Jackson, Laura, Keville, Saskia, and Ludlow, Amanda K.
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- 2020
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21. A cognitive behavioural intervention for dental anxiety for people with learning disabilities: a case study.
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Prangnell, Simon J. and Green, Karen
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CASE studies ,FEAR of dentists ,HEALTH services accessibility ,PEOPLE with learning disabilities ,COGNITIVE therapy ,PSYCHOLOGY - Abstract
Accessible summary • A lot of people worry about going to the dentist. • Sometimes people aren’t given a choice about the treatment they have at the dentist. • We worked with somebody to help them feel better about going to the dentist. • People can copy our work to help other people feel better going to the dentist. Dental anxiety is a common form of anxiety problem, and research suggests that more people with learning disabilities experience dental anxiety than in the general population. Very little work has been done to investigate effective non-medical approaches for supporting people with a learning disability and dental anxiety to access dental care. This has created a significant barrier to accessing treatment, and meant that individual’s are not offered a meaningful choice between treatment options. Using a case study, this paper demonstrates that a simple cognitive behavioural intervention can be effective in reducing dental anxiety, and offer a more meaningful choice of treatment options. This paper is limited in that no formal assessment measures were used, and was evaluated through client feedback. It is possible that this intervention could be applied by other practitioners to increase the accessibility of dental health services. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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- View/download PDF
22. Barriers to correct pronoun usage in healthcare settings.
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Makara, Jodie, Cain, Roman, Glock, Lucas, Ioerger, Michael, and Holliday, Scott
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DYNKIN diagrams ,MEDICAL students ,FISHBONE diagrams ,ROOT cause analysis ,HEALTH services accessibility - Abstract
Background: Using correct pronouns is an impactful way to establish affirming environments for transgender and nonbinary (TGNB) patients. However, physicians often report struggling with this. Objective: This study set out to conduct an initial root cause analysis of factors contributing to medical students and physicians failing to use TGNB patients' correct pronouns. Methods: A 10-item Qualtrics survey was sent to medical students, residents, and physicians practicing in Central Ohio. Participants were asked to describe perceived challenges or barriers colleagues have regarding correctly using TGNB patients' correct pronouns. A directed content analysis of participant responses was performed utilizing a fishbone diagram root cause analysis tool as a basis for conceptualizing and categorizing barriers. All coding was completed by independent reviewers utilizing a consensus reconciliation methodology. Results: Of 928 survey respondents, 763 met the study inclusion criteria, of which 453 provided analyzable responses. Of these 453, attendings with five or more years of practice (32.5%) and medical students (27.4%) made up the two largest demographic categories. 1.7% of respondents identified as transgender, nonbinary, and/or genderqueer, and 64% identified as heterosexual/straight. Five core barrier categories were identified: documentation, patient care, environment, knowledge, and individuals. Sub-categories were also identified, including lack of documentation, discomfort, medical culture, lack of standardization, prejudice, and assumptions. Conclusion: The study identifies important barriers to medical professionals correctly using TGNB patients' pronouns. The root cause analysis conducted as part of this study demonstrates the necessity of multi-pronged, system-level interventions to support ensuring TGNB patients are addressed using the correct pronouns. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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- View/download PDF
23. The Patient's Journey in Obesity within the United States: An Exercise of Resilience against Disease.
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Northam, Kayla, Hinds, Malikiya, Bodepudi, Sreevidya, and Stanford, Fatima Cody
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SLEEP apnea syndromes ,TYPE 2 diabetes ,MYOCARDIAL infarction ,HEALTH services accessibility ,BARIATRIC surgery - Abstract
Obesity is often viewed as a result of patient failure to adhere to healthy dietary intake and physical activity; however, this belief undermines the complexity of obesity as a disease. Rates of obesity have doubled for adults and quadrupled for adolescents since the 1990s. Without effective interventions to help combat this disease, patients with obesity are at increased risk for developing type 2 diabetes, heart attack, stroke, liver disease, obstructive sleep apnea, and more. Patients often go through several barriers before they are offered pharmacotherapy or bariatric surgery, even though evidence supports the use of these interventions earlier. This partially stems from the cultural barriers associated with using these therapies, but it is also related to healthcare provider bias and limited knowledge of these therapies. Finally, even when patients are offered treatment for obesity, they often run into insurance barriers that keep them from treatment. There needs to be a cultural shift to accept obesity as a disease and improve access to effective treatments sooner to help decrease the risk of health complications associated with obesity. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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- View/download PDF
24. Characterizing barriers to care in migraine: multicountry results from the Chronic Migraine Epidemiology and Outcomes – International (CaMEO-I) study.
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Lanteri-Minet, Michel, Leroux, Elizabeth, Katsarava, Zaza, Lipton, Richard B., Sakai, Fumihiko, Matharu, Manjit, Fanning, Kristina, Manack Adams, Aubrey, Sommer, Katherine, Seminerio, Michael, and Buse, Dawn C.
- Subjects
MIGRAINE diagnosis ,MEDICAL care use ,HEALTH services accessibility ,RESEARCH funding ,DESCRIPTIVE statistics ,CHI-squared test ,POPULATION geography ,PROFESSIONS ,PHYSICIANS ,MEDICAL needs assessment ,MIGRAINE ,MEDICAL referrals - Abstract
Objective: To assess rates of traversing barriers to care to access optimal clinical outcomes in people with migraine internationally. Background: People in need of medical care for migraine should consult a health care professional knowledgeable in migraine management, obtain an accurate diagnosis, and receive an individualized treatment plan, which includes scientific society guideline-recommended treatments where appropriate. Methods: The Chronic Migraine Epidemiology and Outcomes-International (CaMEO-I) Study was a cross-sectional, web-based survey conducted from July 2021 through March 2022 in Canada, France, Germany, Japan, the United Kingdom, and the United States (US). Respondents who met modified International Classification of Headache Disorders, 3rd edition, criteria for migraine and had Migraine Disability Assessment Scale (MIDAS) scores of ≥ 6 (i.e., mild, moderate, or severe disability) were deemed to need medical care and were included in this analysis. Minimally effective treatment required that participants were currently consulting a health care professional for headache (barrier 1), reported an accurate diagnosis (barrier 2), and reported use of minimally appropriate pharmacologic treatment (barrier 3; based on American Headache Society 2021 Consensus Statement recommendations). Proportions of respondents who successfully traversed each barrier were calculated, and chi-square tests were used to assess overall difference among countries. Results: Among 14,492 respondents with migraine, 8,330 had MIDAS scores of ≥ 6, were deemed in need of medical care, and were included in this analysis. Current headache consultation was reported by 35.1% (2926/8330) of respondents. Compared with the US, consultation rates and diagnosis rates were statistically significantly lower in all other countries except France where they were statistically significantly higher. Total appropriate treatment rates were also statistically significantly lower in all other countries compared with the US except France, which did not differ from the US. All 3 barriers were traversed by only 11.5% (955/8330) of respondents, with differences among countries (P < 0.001). Conclusions: Of people with migraine in need of medical care for migraine, less than 15% traverse all 3 barriers to care. Although rates of consultation, diagnosis, and treatment differed among countries, improvements are needed in all countries studied to reduce the global burden of migraine. Trial registration: NA. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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- View/download PDF
25. A Qualitative Investigation into the Trauma Exhibited by First Responders Impacted by the Opioid Epidemic.
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Nicholson, Thalia P., Blazer, Erin C., Hymes, Aaron S., and Ginley, Meredith K.
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SECONDARY traumatic stress ,OPIOID epidemic ,POST-traumatic stress ,PHENOMENOLOGY ,HEALTH services accessibility - Abstract
This qualitative study aimed to capture the lived experiences of first responders (FRs) combatting the opioid epidemic in an effort to better understand how the increase in opioids, opioid-related harm, and opioid-related death has affected the FR profession. FRs (N = 30) from Tennessee partook in semi-structured interviews investigating the impact of responding to opioid-related incidents. Using a phenomenological approach, three response themes emerged including (1) opioid epidemic burden on FR mental health, (2) variable availability and effectiveness of resources, and (3) identified roles of FRs in reducing the impact of the epidemic. The findings indicate that FRs are experiencing posttraumatic stress and secondary traumatic stress symptoms due to a shift in their duties, as well as repeated exposures to the adverse impacts of opioid use. This study finds a deficit in resources and support to combat the mental health repercussions FRs have experienced due to the epidemic. Given that FRs are often directly involved in preventing opioid-related deaths, ensuring that they are well resourced is an essential component of harm reduction and will ultimately augment care for individuals experiencing opioid-related harm. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
26. Caregiver-reported barriers to care for children and adults with Williams Syndrome.
- Author
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Barnhardt, Elizabeth W., Martens, Marilee, Andridge, Rebecca, and Walton, Jennifer
- Abstract
Individuals with Williams syndrome (WS) may experience a variety of medical, behavioral, and educational concerns. The primary objective of this study was to assess barriers to health care for patients with WS, primarily using the Barriers to Care Questionnaire (BCQ), and to assess whether various demographic factors are correlated with these barriers. A REDCap survey was distributed using the Williams Syndrome Association Research Registry. 319 caregivers of individuals with WS in the United States completed the BCQ. On the BCQ, lower scores indicate more barriers to care. Younger age was associated with lower scores for both the pragmatics and the skills subscales while lower income levels and increased distances to providers knowledgeable about WS were consistently associated with lower total BCQ scores. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
27. Children's Opportunities and Constraints in European Parent Care Over Time: A Within-Family Approach.
- Author
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Vergauwen, Jorik
- Subjects
ELDER care ,SIBLINGS ,RESEARCH funding ,PARENT-child relationships ,QUESTIONNAIRES ,POPULATION geography ,PSYCHOLOGY of caregivers ,PSYCHOSOCIAL factors ,EMPLOYMENT ,TIME ,REGRESSION analysis ,INTERGENERATIONAL relations ,CHILDREN - Abstract
The role of children's caregiving has received substantial attention in studies on care in old age. Previous research shows that children's care provision is strongly intertwined with both their individual and siblings' situation regarding employment and geographic parent-child distance. This study uses data from six waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), taking a within-family approach, to examine how caregiving is (re-)distributed between siblings over time. The provision of continuous parent care is observed more frequent and volatile in European countries with a family-based care system. The results from family fixed-effects regression models demonstrate that children working less than siblings persist in caregiving more. Living closest to parents facilitates children to keep up care efforts, while changing to living closest enhances the start of parent care. This study suggests that geographic distance is vital in the long-term organization of parent care between siblings. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
28. Obstacles to Accepting Care: Understanding Why Obstetric Patients Leave against Medical Advice
- Author
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Lu, Connie F., Matovina, Chloe N., Premkumar, Ashish, and Watson, Katie
- Published
- 2024
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- View/download PDF
29. Barriers to Mental Health Care in US Military Veterans
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Lewis, Connor, Fischer, Ian C., Tsai, Jack, Harpaz-Rotem, Ilan, and Pietrzak, Robert H.
- Published
- 2024
- Full Text
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30. Barriers to Mental Health Care Transition for Youth and Young Adults with Intellectual and Developmental Disabilities and Co-occurring Mental Health Conditions: Stakeholders’ Perspectives
- Author
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Mirzaian, Christine B., Deavenport-Saman, Alexis, Hudson, Sharon M., and Betz, Cecily L.
- Published
- 2024
- Full Text
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31. Barriers to care and treatment experiences among individuals with postpartum psychosis
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Kobylski, Lauren A., Arakelian, Miranda H., Freeman, Marlene P., Gaw, Margaret L., Cohen, Lee S., and Vanderkruik, Rachel
- Published
- 2024
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- View/download PDF
32. Barriers to Care among Adults with Chronic Liver Disease in the United States
- Author
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Wong, Carrie
- Subjects
Public health ,Health sciences ,Epidemiology ,Barriers to care ,Chronic liver disease ,Health care access - Abstract
Chronic liver disease is increasingly prevalent with high rates of morbidity and mortality, yet it receives less attention than other similar chronic diseases such as cardiovascular disease and chronic obstructive pulmonary disease. Barriers to timely medical care may preclude diagnosis and management and thus, exacerbate potentially avoidable morbidity and mortality for persons with chronic liver disease. This dissertation explored the extent of health care barriers among adults with chronic liver disease compared to other chronic conditions and identified latent classes derived from different health care barriers to phenotype those at highest risk for recurrent acute care use within the adult population with chronic liver disease in the United States.The first paper, “Evaluation of the Extent of Health Care Barriers among Adults with Chronic Liver Disease vs. Other Chronic Diseases in the United States,” compared estimates of any and the number of health care barriers and the association of recurrent acute care use by prevalence of barriers to care among adults with chronic liver disease versus those with cardiovascular disease and/or chronic obstructive pulmonary disease. Using a multivariable hurdle model, the study found that adults with chronic liver disease were significantly more likely to have any barriers to care (incident rate ratio, 1.12), but such a significant difference did not exist for the frequency of health care barriers. There was a dose-dependent relationship between likelihood of recurrent acute care use and prevalence of barriers to care. Inclusion of chronic liver disease as a high-risk group in future health policies that aim to improve access to care may help reduce challenges that persons with chronic liver disease encounter when seeking timely medical care and potentially reduce preventable acute care use.The second paper, “Identification of Hidden Phenotypes Using Self-Reported Barriers to Care to Predict Risk of Recurrent Hospitalization or Emergency Department Visits among Adults with Chronic Liver Disease in the United States,” identified latent classes within the adult population with chronic liver disease using self-reported barriers to care and assessed each phenotype’s likelihood of recurrent acute care use. The best fitting model to the data included four latent classes or phenotypes: minimal barriers, unaffordability, care delays, and inability to establish care. The study used a multivariable multinomial logistic regression model to identify likelihood of class membership. The unaffordability phenotype was significantly associated with younger age, fair or poor health, functional limitation due to health, and uninsurance. Membership in the care delays class was significantly associated with Hispanics, fair or poor health, and functional limitation due to health. The inability to establish care phenotype was significantly associated with younger age, female sex, functional limitation due to health, and non-private insurance. The inability to establish care group had the highest odds of recurrent acute care use, followed by the care delays and unaffordability groups. An emphasis on risk stratification using health care barriers can potentially help improve interventions that aim to reduce recurrent acute care use among adults with chronic liver disease, particularly for those who struggle to establish care.In summary, both chapters highlighted the prevalence of health care barriers and its association with recurrent acute care use for adults with chronic liver disease. Findings from the second chapter showed the consistent disparity in health care barriers for adults with chronic liver disease versus other chronic diseases and aimed to capture the attention of health policy makers to include chronic liver disease in future iterations of existing health policies or new programs that strive to improve outpatient care access to reduce preventable hospitalizations. The third chapter identified novel phenotypes of persons with chronic liver disease with different associated sociodemographic, health, and insurance characteristics and risks of recurrent acute care use. The third chapter also introduced the concept of using self-reported barriers to care as a way to risk stratify and allocate resources to the most vulnerable individuals with chronic liver disease. Both chapters intend to help improve health care access, reduce preventable acute care use, and potentially improve the morbidity and mortality trends among adults with chronic liver disease in the United States.
- Published
- 2023
33. Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?
- Author
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Nisingizwe, Marie Paul, Tuyisenge, Germaine, Hategeka, Celestin, and Karim, Mohammad Ehsanul
- Published
- 2020
- Full Text
- View/download PDF
34. Perceived stigma and barriers to care in UK Armed Forces personnel and veterans with and without probable mental disorders
- Author
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Williamson, Victoria, Greenberg, Neil, and Stevelink, Sharon A. M.
- Published
- 2019
- Full Text
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35. Gaps in transgender medical education among healthcare providers: A major barrier to care for transgender persons.
- Author
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Korpaisarn, Sira and Safer, Joshua D.
- Abstract
A lack of access to knowledgeable providers is the greatest reported barrier to care for transgender individuals. The purpose of this manuscript is to review the recent literature characterizing transgender medicine education for medical providers and to summarize effective interventions for improving education in transgender care. The PubMed database was searched for all literature that assessed transgender medical education among physicians or trainees and all papers that reported results of transgender-specific educational interventions. Literature that only evaluated general lesbian, gay, bisexual, and transgender (LGBT) educational interventions was excluded. The lack of education in transgender care continues among providers across all levels of medical education from medical students and physician trainees to primary care providers, endocrinologists and other specialists involved in transgender care. Several interventions have been shown to effectively improve transgender knowledge and cultural competency. Education among healthcare providers is deficient and is considered a major barrier to care for transgender individuals. Effective interventions should be applied to fundamental medical education. Additional focused education also should be taught with specialty-appropriate content to produce needed proficiency among providers of transgender care. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
36. Optimizing Patient Engagement in Treatment for Opioid Use Disorder: Primary Care Team Perspectives on Influencing Factors
- Author
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Austin, Elizabeth J., Chen, Jessica, Soyer, Elena, Idrisov, Bulat, Briggs, Elsa S., Ferro, Lori, Saxon, Andrew J., Fortney, John C., Curran, Geoffrey M., Moghimi, Yavar, Blanchard, Brittany E., Williams, Emily C., Ratzliff, Anna D., Ruiz, Monica S., and Koch, Ulrich
- Published
- 2024
- Full Text
- View/download PDF
37. Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation
- Author
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Fleury, Marie-Josée, Imboua, Armelle, and Grenier, Guy
- Published
- 2024
- Full Text
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38. Mental Health Service Use, Barriers, and Service Preferences During COVID-19 among Low-Income Housing and Market-Rate Housing Residents of Harlem in New York City
- Author
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Ngo, Victoria K., Vu, Thinh T., Punter, Malcolm A., Levine, Deborah, Borrell, Luisa N., and Mateu-Gelabert, Pedro
- Published
- 2024
- Full Text
- View/download PDF
39. Gender differences in structural and attitudinal barriers to mental healthcare in UK Armed Forces personnel and veterans with self-reported mental health problems
- Author
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Trompeter, Nora, Rafferty, Laura, Dyball, Daniel, McKenzie, Amber, Greenberg, Neil, Fear, Nicola T., and Stevelink, Sharon A. M.
- Published
- 2024
- Full Text
- View/download PDF
40. Living with epidermolysis bullosa: Daily challenges and health‐care needs
- Author
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Sandra Kearney, Ann Donohoe, and Eilish McAuliffe
- Subjects
barriers to care ,Epidermolysis bullosa ,health‐care needs ,lived experience ,Medicine (General) ,R5-920 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background & Objective Epidermolysis bullosa (EB) is the term used for a group of genetic skin fragility disorders. For those living with EB, pain represents a constant challenge, with blistering and tasks such as changing dressings, adding to the distress. This paper focuses on describing and exploring the health‐care needs of children, adults and families who are affected by EB. The specific aim of the paper is to identify the needs of the EB population with a view towards informing the development of a community liaison service to support adults living with EB and the parents/carers of children living with EB. Setting and Participants Interviews with six adults and the parents of eight children with EB were conducted. The data were analysed thematically. All participants were resident on the island of Ireland and are therefore reflecting on services in this geographic region. Results Participants’ needs were grouped into five themes: support managing physical health‐care issues; access to community/home‐based services; EB‐specific information and psychosocial support; effective interaction with health‐care professionals; and advice regarding benefits and entitlements. Discussion and Conclusions This article represents the health‐care needs and preferences of a broad spectrum of those with EB, highlighting the need for a comprehensive service regardless of the severity of the condition.
- Published
- 2020
- Full Text
- View/download PDF
41. Factors associated with health service utilisation for common mental disorders: a systematic review
- Author
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Roberts, Tessa, Miguel Esponda, Georgina, Krupchanka, Dzmitry, Shidhaye, Rahul, Patel, Vikram, and Rathod, Sujit
- Published
- 2018
- Full Text
- View/download PDF
42. Βarriers and Gaps to Medical Care for Transgender Individuals: A TRANSCARE Scoping Review with a Focus on Greece.
- Author
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Anastasaki, Marilena, Angelaki, Agapi, Paganis, Philippos, Christidi, Elena Olga, Papathanasiou, Nancy, Stoupa, Eleni Panagiota, Karamagioli, Evika, Pikoulis, Emmanouil, and Lionis, Christos
- Subjects
HEALTH services accessibility ,RESEARCH funding ,GENDER affirming care ,SYSTEMATIC reviews ,MEDLINE ,INFORMATION needs ,LITERATURE reviews ,ONLINE information services ,NEEDS assessment ,QUALITY assurance - Abstract
Trans people face substantial barriers to care worldwide. In Greece, limited evidence regarding trans health and actions to improve accessibility in healthcare services is available. This study aims to identify barriers to care for transgender populations in order to discuss the potential gaps in healthcare providers' training in this direction. A scoping review was conducted in PubMed. Study eligibility criteria included: (a) reporting on at least one barrier to care for trans individuals or at least one educational need for healthcare providers; (b) free full text availability; and (c) publishing from 2015 and afterwards. Discrepancies in study inclusion were discussed between the research team until consensus was reached. Out of 560 identified references, 69 were included in this study, with only three reporting empirical research from Greece. Several individual-, interpersonal-, and institutional-level barriers to healthcare for trans individuals were identified. These included discriminatory treatment by healthcare providers, a lack of knowledgeable providers trained on trans-specific healthcare issues, lack of trusted and safe healthcare environments, health coverage-related issues, and healthcare systems that do not take into account particular transgender health issues during care provision. Improving access to care for transgender people is a multidimensional issue that should be addressed at the societal, healthcare, and research levels. Actions for future professional education initiatives should focus on respecting transgender identity, protecting confidentiality, creating trusted provider–patient relationships, and providing sufficient competency on trans-specific healthcare issues. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
43. Perceptions of provider awareness of traditional and cultural treatments among Indigenous people who use unregulated drugs in Vancouver, Canada.
- Author
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Norton, Alexa, Homayra, Fahmida, Defriend, Courtney, Barker, Brittany, Meilleur, Louise, Hayashi, Kanna, and Nosyk, Bohdan
- Subjects
INDIGENOUS peoples ,CULTURAL awareness ,MULTIPLE regression analysis ,DRUG utilization ,HEALTH services accessibility - Abstract
Introduction: Indigenous people who use unregulated drugs (IPWUD) face significant barriers to care, including sparse availability of culturally safe health services. Integrating Indigenous traditional and cultural treatments (TCT) into health service delivery is one way to enhance culturally safe care. In a Canadian setting that implemented cultural safety reforms, we sought to examine the prevalence and correlates of client perceptions of primary care provider awareness of TCT among IPWUD. Methods: Data were derived from two prospective cohort studies of PWUD in Vancouver, Canada between December 2017 and March 2020. A generalized linear mixed model with logit-link function was used to identify longitudinal factors associated with perceived provider awareness of TCT. Results: Among a sample of 507 IPWUD who provided 1200 survey responses, a majority (n = 285, 56%) reported their primary care provider was aware of TCT. In multiple regression analyses, involvement in treatment decisions always (Adjusted Odds Ratio [AOR] = 3.6; 95% confidence interval [CI]: 1.6–7.8), involvement in treatment decisions most or some of the time (AOR = 3.3; 95% CI: 1.4–7.7), comfort with provider or clinic (AOR = 2.7; 95% CI: 1.5–5.0), and receiving care from a social support worker (AOR = 1.5; 95% CI: 1.0–2.1) were positively associated with provider awareness of TCT. Conclusion: We found high levels of perceived provider awareness of TCT and other domains of culturally safe care within a cohort of urban IPWUD. However, targeted initiatives that advance culturally safe care are required to improve healthcare and health outcomes for IPWUD, who continue to bear a disproportionate burden of substance use harms. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
44. Overcoming Barriers to Eye Care: Patient Response to a Medical Social Worker in a Glaucoma Service.
- Author
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Fudemberg, Scott, Amarasekera, Dilru, Silverstein, Marlee, Linder, Kathryn, Heffner, Paul, Hark, Lisa, and Waisbourd, Michael
- Subjects
GLAUCOMA diagnosis ,COMMUNITY health services ,EYE care ,GLAUCOMA ,HEALTH services accessibility ,MEDICAL care ,MEDICAL quality control ,MEDICAL referrals ,MEDICAL practice ,PATIENTS ,RACE ,SOCIAL workers ,DISEASE complications ,PREVENTION - Abstract
This paper investigates the patient response to a medical social worker in a glaucoma clinic. The literature suggests that medical social workers are effective in a variety of health care settings, yet the efficacy of a medical social worker in an adult ophthalmic setting has not been studied. We present the results of a retrospective chart review of 50 patients with glaucoma referred to a medical social worker between January 5, 2015 and June 31, 2015 in an outpatient clinic of an urban eye hospital. Clinical and demographic data, as well as the data from a quality of care questionnaire, were collected for each patient. Patients rated their interaction with the medical social worker as highly positive (mean = 4.75, 5-point Likert scale), and nearly 90 % of patients expressed interest in future contact with the social worker. Additionally, most patients reported that the social worker resolved the issues they were facing (61.1 %), supported them in seeing their ophthalmologist (70.6 %), and helped them to manage their glaucoma (69.7 %). Reported barriers to glaucoma care were emotional distress; cost of office visits and medications; lack of medical insurance; transportation; poor medication adherence; impairment of daily activities; follow-up adherence; and language. As vision loss from glaucoma is irreversible, it is important to detect and treat patients at early stages of the disease. Therefore, it is imperative for patients to regularly visit their eye care providers and adhere to treatment and follow-up recommendations. This study suggests that a medical social worker could play a pivotal role in helping patients with glaucoma overcome barriers to treatment and facilitate disease management. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
45. Oral health care experiences of people living with HIV in Kwazulu-Natal and Western Cape, South Africa.
- Author
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Turton, Mervyn and Sudeshni Naidoo
- Abstract
Purpose -- The purpose of this paper is to ascertain the oral health experiences of people living with HIV/AIDS in the provinces of Kwazulu-Natal (KZN) and Western Cape (WC) in South Africa. Many studies have reported that people living with HIV have unmet needs for dental care and this study considered the various factors that affect the accessibility and utilisation of dental services as these factors are even more pertinent for the people living with HIV who have increased need for dental care. Design/methodology/approach -- The participants were selected among HIV-positive people attending selected Community Health Centre and regional hospital HIV clinics in KZN and WC provinces. The sample consisted of people living with HIV that were 18 years or older and who had given written, informed consent. The sample (n=435) comprised mainly of black females in the age group 20-29 years. In total, 347 participants (79.8 per cent) had an oral health problem of which 83 per cent (n=288) received care. Findings -- Of those that received care, 56.6 per cent (n=163) of the participants stated that the staff were aware of their HIV status. Almost a third of the participants who received care reported a negative experience at the clinic. If the participant lived in a metropolitan area, the participant was 3.647 times more likely to receive care than if the participant lived in a non-metropolitan area (p<0.01) If the participant earned R5,000 or less, the participant was 0.106 times less likely to receive care (p=0.048). If the participant lived 1-5 km from the clinic, the participant was 3.371 times more likely to receive care (p=0.015). Research limitations/implications -- The results are specific to KZN and WC and cannot be extrapolated with caution to the rest of South Africa. However, to the best of the author's knowledge, there is no other study that has compared differences in the use of oral health care services by people with HIV in South Africa and these results serve as an indication of some the important issues in this regard. Additionally, this study did not have a control group of HIV-negative people which would have enabled one to determine whether certain barriers were unique to people living with HIV. Practical implications -- The study highlighted the barriers to care existing within the current public health system relative to the provision of oral health services for people living with HIV in KZN and WC. It was anticipated that by ascertaining the nature and extent of unmet needs and barriers to dental care for people living with HIV, measures can be put in place to remove or at least reduce the barriers to care and improve the quality of life for people living with HIV/AIDS in South African communities. Social implications -- The high prevalence of oral health problems in people living with HIV makes it imperative for the DOH to make every attempt to remove barriers to oral health care and thereby secure equitable, affordable and accessible oral health care which is acceptable for people living with HIV and accountable to the greater society. Originality/value -- This study emphasises the importance of embracing people that are being discriminated and marginalised by society such as people living with HIV to ensure that they feel a franchised member of society who can take the initiative to be in control of their own health and, with the necessary aid from public resources and societal support, join forces to reduce the public health burden and its impact on the socio-economic milieu. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
46. A Sociological Analysis of Military Resilience: Opening Up the Debate.
- Author
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McGarry, Ross, Walklate, Sandra, and Mythen, Gabe
- Subjects
PSYCHOLOGICAL resilience ,MILITARY psychology ,MASCULINITY ,PHYSICAL fitness research ,SOCIAL stigma ,MILITARY sociology ,PSYCHOLOGY of military personnel ,MENTAL health of military personnel - Abstract
The term ‘resilience’ has grown in its usage across a range of disciplines and practices. The US military and the British armed forces have typified this increasing use of ‘resilience’ in recent years within such initiatives as Comprehensive Soldier Fitness (CSF) and throughout British Army Doctrine. However by unpacking what being ‘resilient’ for soldiers might mean we explore the interaction between their personal ‘masculine’ characteristics, the structural environment within which they operate, and the civilian life they return to. In doing so this paper offers a critical sociological analysis combining the agency of the soldiers’ body with the structure of the military as a [total institution] to problematize issues of masculinity, stigma and resilience within the military setting. As such, we question if the fostering of ‘resilience’ in military personnel is something that may be productive during service, but counter-productive thereafter when service personnel return to civilian life as veterans. [ABSTRACT FROM PUBLISHER]
- Published
- 2015
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- View/download PDF
47. Mental Disorders, Perceived Need and Perceived Barriers to Care in Military Samples.
- Author
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Sareen, Jitender, Stein, Murray B, Belik, Shay-Lee, Afifi, Tracie O, and Asmundson, Gordon JG
- Abstract
Untreated mental illness is an enormous problem in civilian and military populations. This paper reviews the literature on 1) methods and controversy related to defining the need for mental health treatment at a population level, 2) studies examining the relationship between mental disorder diagnoses and self-perceived need for mental health treatment, and 3) studies examining attitudes and barriers toward mental health care. Similar to civilian populations, the few studies in military samples have found that the majority of soldiers meeting criteria for a mental disorder do not receive mental health treatment or perceive a need for treatment. Attitudinal barriers (e.g., I would be seen as weak; a wish to solve the problem on their own) are more commonly endorsed than structural barriers (e.g., cost of services) toward seeking mental health care. Implications for future research and interventions are discussed. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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48. Exploring barriers to using modern contraceptives and accessing safe abortion care in women who terminated unintended pregnancies in Southern Ethiopia.
- Author
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Woldetsadik, Mahlet A., Yoseph, Yeshihareg, and Degu, Mekonnen
- Subjects
ABORTION statistics ,UNPLANNED pregnancy ,CONTRACEPTION ,ABORTION ,CONTRACEPTIVES ,UNWANTED pregnancy - Abstract
Background: Unsafe abortion is a major medical and public health problem in Ethiopia and contributes significantly to abortion-related morbidity and mortality in the country. We explored women's experiences with modern contraceptives and identified barriers to accessing safe abortion care and other sexual and reproductive health services. Methods: We recruited participants from six health clinics and a public hospital in southern Ethiopia. We conducted one-on-one interviews with 34 women aged 18–49 years who sought abortion care within the past twelve months of the study. Interviews were recorded, transcribed verbatim, translated to English, and imported into Dedoose software. We analysed the data using a directed content analysis. Results: Our findings show prevailing belief among participants that contraceptives caused infertility, abnormalities in subsequent pregnancies, and other side effects. Some of the women suggested that medical or unsafe abortions were a better alternative to using modern contraceptives for terminating unplanned pregnancies. Barriers to accessing safe abortion care included costs of services, lack of privacy, and fear of judgment from providers. Women who had negative experiences with providers were more likely to seek unsafe abortion the second time around. Conclusion: Providers need to address women's concerns about using modern contraceptives, educate their clients about the best ways to prevent unwanted pregnancies, and provide non-judgemental services. In addition, comprehensive counselling services that include contraceptive counselling should be made available to women before, during, and after abortion care. Finally, providers should strive to be facilitators of, not barriers to, safe abortion care. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
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49. Community engagement to inform development of strategies to improve referral for hypertension: perspectives of patients, providers and local community members in western Kenya
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Violet Naanyu, Benson Njuguna, Hillary Koros, Josephine Andesia, Jemima Kamano, Tim Mercer, Gerald Bloomfield, Sonak Pastakia, Rajesh Vedanthan, and Constantine Akwanalo
- Subjects
Hypertension ,Referral networks ,Barriers to care ,Health information technology ,Peer support ,LMIC ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Hypertension is the leading cause of death and disability. Clinical care for patients with hypertension in Kenya leverages referral networks to provide basic and specialized healthcare services. However, referrals are characterized by non-adherence and delays in completion. An integrated health information technology (HIT) and peer-based support strategy to improve adherence to referrals and blood pressure control was proposed. A formative assessment gathered perspectives on barriers to referral completion and garnered thoughts on the proposed intervention. Methods We conducted a qualitative study in Kitale, Webuye, Kocholya, Turbo, Mosoriot and Burnt Forest areas of Western Kenya. We utilized the PRECEDE-PROCEED framework to understand the behavioral, environmental and ecological factors that would influence uptake and success of our intervention. We conducted four mabaraza (customary heterogenous community assemblies), eighteen key informant interviews, and twelve focus group discussions among clinicians, patients and community members. The data obtained was audio recorded alongside field note taking. Audio recordings were transcribed and translated for onward coding and thematic analysis using NVivo 12. Results Specific supply-side and demand-side barriers influenced completion of referral for hypertension. Key demand-side barriers included lack of money for care and inadequate referral knowledge. On the supply-side, long distance to health facilities, low availability of services, unaffordable services, and poor referral management were reported. All participants felt that the proposed strategies could improve delivery of care and expressed much enthusiasm for them. Participants appreciated benefits of the peer component, saying it would motivate positive patient behavior, and provide health education, psychosocial support, and assistance in navigating care. The HIT component was seen as reducing paper work, easing communication between providers, and facilitating tracking of patient information. Participants also shared concerns that could influence implementation of the two strategies including consent, confidentiality, and reduction in patient-provider interaction. Conclusions Appreciation of local realities and patients’ experiences is critical to development and implementation of sustainable strategies to improve effectiveness of hypertension referral networks. Incorporating concerns from patients, health care workers, and local leaders facilitates adaptation of interventions to respond to real needs. This approach is ethical and also allows research teams to harness benefits of participatory community-involved research. Trial registration Clinicaltrials.gov, NCT03543787, Registered June 1, 2018. https://clinicaltrials.gov/ct2/show/NCT03543787
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- 2023
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50. Caring for older adults with cancer in Canada: Views from healthcare providers and cancer care allies in the community
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Li, Hong, Kilgour, Heather, Leung, Bonnie, Cho, Michelle, Pollock, Joy, Culbertson, Stuart, Hedges, Penelope, Mariano, Caroline, and Haase, Kristen R.
- Published
- 2024
- Full Text
- View/download PDF
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