Experiences with Tuberculosis Management among Community-Based Care Providers in Indonesia: A Qualitative Study.

To explore experiences with TB management among community-based care providers. Descriptive qualitative study. A total of 25 care providers were selected using purposive sampling. Data were collected by semi-structured interviews and analyzed using content analysis. Six themes emerged from this study: "various dissemination channels," "compassionate religious volunteerism," "shortage of resources," "keeping TB cases hidden," "patient impediments to care," and "perceived economic burdens of patients." The findings can provide an understanding that the management of tuberculosis in the community requires collaboration between various institutions as well as patients. Building a sustainable TB system would be beneficial. A TB care model can be established between government and other institutions.

The experience of parents living with a child with cancer at the end of life.

The study was to describe the essence of the lived experience of parents with a child with incurable cancer at the end of life (EOL). A descriptive phenomenological study was conducted with ten parents of children with incurable cancer in a medical centre in Taiwan. Data were collected from in-depth interviews and were analysed according to the method of Giorgi. Two major themes emerged: (a) immersion in the struggling and suffering, which included conflicts and arguments, witnessing their child suffering, denying their child being at EOL and waiting for a miracle; and (b) acceptance of death, which included an end to suffering, living in the moment, discussion of death and letting go. Parents had difficulty adapting to a palliative care perspective due to their misconception that this meant giving up on their child. In addition, religion and belief played varied and important roles in the lived experience of these parents with a child with incurable cancer. Healthcare providers must address the core value of palliative care and help parents accept the reality of their child's situation at an earlier stage in order to provide a better quality of life for the child.

Associations of changes in psychosocial factors and their interactions with diabetes distress in patients with type 2 diabetes: a longitudinal study.

AIM: To assess the associations of changes in self-management behaviours, diabetes self-efficacy, resilience, social support, patient empowerment and their interactions with changes in diabetes distress in patients with type 2 diabetes mellitus. BACKGROUND: Many patients with type 2 diabetes mellitus experience diabetes distress. Few longitudinal studies have investigated the associations of changes in various psychosocial factors with changes in diabetes distress in patients with type 2 diabetes mellitus. DESIGN: This study adopted a longitudinal design. Data were collected at baseline and 12 months later. METHODS: Overall, 304 patients with type 2 diabetes were recruited from four hospitals in southern Taiwan by convenience sampling. A self-report questionnaire and medical record were used to collect demographic data, clinical indicators, self-management behaviours, diabetes self-efficacy, resilience, social support, patient empowerment, and diabetes distress. Data were collected from February 2014-March 2015. RESULTS/FINDINGS: An increase in resilience or diabetes self-efficacy significantly associated with a decrease in diabetes distress, whereas an increase in patient empowerment significantly associated with an increase in diabetes distress. The interactions between increase in patient empowerment and increase in self-management behaviours significantly associated with decrease in diabetes distress. CONCLUSION: Nurses could endeavour to improve the diabetes self-efficacy and resilience to reducing diabetes distress. Arbitrarily empowering patients may increase diabetes distress. Increasing self-care management behaviours and patient empowerment might need to be simultaneously addressed to reduce the diabetes distress in patients with type 2 diabetes.

The Effects of an Educational Intervention on Preventing Cervical Cancer Among Vietnamese Women in Southern Taiwan.

This paper aims to conduct and evaluate an educational intervention on preventing cervical cancer among married immigrant women of Vietnamese origin. The study design was a quasi-experimental method with two groups. In total, 260 married immigrant women of Vietnamese origin with national health insurance at least 30 years of age were recruited from November 2013 to January 2015 in southern Taiwan. The effects of the educational intervention, including cervical cancer and Papanicolaou test knowledge, attitudes towards cervical cancer, fatalism, barriers to receiving Papanicolaou tests, intention for receiving Papanicolaou tests within the next year, and intention for receiving Papanicolaou tests within the next 3 years, were evaluated. Repeated measures analyses of variance showed significant interactions between the intervention group and time for cervical cancer knowledge, knowledge of Papanicolaou test, attitudes towards cervical cancer, and intention for receiving a Papanicolaou test within the next 3 years; in addition, 71.4 % reported being satisfied or very satisfied with the intervention. The results of this study can provide information for governments to make appropriate health policies for screening behavior of cervical cancer, increase healthcare professionals' competencies towards Vietnamese women, and increase Papanicolaou test screening rates to decrease cervical cancer mortality. Effective interventions may require particular consideration of married immigrant women.

Health empowerment among immigrant women in transnational marriages in Taiwan.

PURPOSE: The aim of this study was to develop, implement, and evaluate a theory-based intervention designed to promote increased health empowerment for marriage migrant women in Taiwan. The rapid increase of international marriage immigration through matchmaking agencies has received great attention recently because of its impact on social and public health issues in the receiving countries. DESIGN AND METHODS: A participatory action research (PAR) and in-depth interviews were adopted. Sixty-eight women participated in this study. Eight workshops of the health empowerment project were completed. FINDINGS: Through a PAR-based project, participants received positive outcomes. Four outcome themes were identified: (a) increasing health literacy, (b) facilitating capacity to build social networks, (c) enhancing sense of self-worth, and (d) building psychological resilience. CONCLUSIONS: PAR was a helpful strategy that enabled disadvantaged migrant women to increase their health literacy, psychological and social health, and well-being. CLINICAL RELEVANCE: The findings can be referenced by the government in making health-promoting policies for Southeast Asian immigrant women to increase their well-being. Community health nurses can apply PAR strategies to plan and design health promotion intervention for disadvantaged migrant women.

Clinical competencies of emergency nurses toward violence against women: a delphi study.

BACKGROUND: An increasing number of survivors of intimate partner violence (IPV) have begun to seek help from hospital emergency departments. This study was conducted to develop a list of requisite clinical competencies for emergency nurses to provide adequate care for women experiencing IPV. METHOD: An e-mail survey using the Delphi technique was administered, involving three rounds of questionnaires from 30 participants. Participants were asked to score the importance of each item on a 4-point Likert scale. RESULTS: The study identified three dimensions, comprising 38 items of competencies related to care for individuals experiencing IPV, including Knowledge (10 items), Attitudes (11 items), and Practice (17 items). CONCLUSION: The emergency department is where direct medical treatment and care is provided for those who have experienced IPV. The study findings can provide a reference for the development of in-service educational programs in hospitals and can guide future policy making.

Barriers faced by Vietnamese immigrant women in Taiwan who do not regularly undergo cervical screenings: a qualitative study.

AIM: To assess and understand the barriers faced by Vietnamese marital immigrant women who do not regularly undergo cervical screenings in Southeast Taiwan. BACKGROUND: Studies have shown a low uptake rate of preventive medical services among immigrants. As immigrant women may not be aware of the healthcare delivery system in their host country, their uptake of and access to healthcare services might be limited. DESIGN: A qualitative, descriptive inquiry design was adopted. METHODS: This qualitative study employed semi-structured, individual, in-depth interviews of 17 Vietnamese immigrant women. Data were collected from February-July 2011 and analysed using content analysis. FINDINGS: The barriers to receiving cervical screening were lack of health literacy, lack of female healthcare providers, negative perceptions of cervical screening and personal reasons. CONCLUSION: The results might serve as a reference for government entities and healthcare providers in Taiwan to improve cervical screening rates; this should help enhance the effectiveness of healthcare services for Vietnamese immigrant women. The findings can also provide a reference for making appropriate healthcare policies for immigrant women in other countries.

The utilization of Pap tests among different female medical personnel: a nationwide study in Taiwan.

OBJECTIVE: The aim of this study is to clarify the conditions under which female medical personnel receive Pap tests and the influencing factors associated with not receiving Pap tests. METHODS: Data from the Taiwanese National Health Insurance Research Database (NHIRD) in Taiwan were analyzed. There were a total of 142,123 subjects: 5,196 physicians, 13,366 pharmacists, and 123,561 nurses. RESULTS: Of the subjects, 57.7% had received a Pap test in 2008-2010. Pap-test rates were highest for pharmacists (58.1%) and nurses (58.0%) and lowest for physicians (48.6%). After adjustment for age, having visited an obstetrics/gynecology clinic, gynecological disease, chronic disease, major illnesses, occupational diseases/injuries, and cancer, subjects were less likely to have received a Pap test if they were older, had visited an obstetric/gynecological clinic, or had gynecological diseases or major illnesses. Pharmacists and nurses who had occupational diseases/injuries and chronic diseases and nurses who had had cancer were less likely to have received a Pap test. CONCLUSION: Hopefully, by highlighting the factors associated with lower likelihood of receiving Pap tests, the study findings will increase self-awareness among female medical personnel, improving their rate of Pap-test participation.

Psychometric testing of the Chinese version of the Contraceptive Behavior Scale: a preliminary study.

AIMS AND OBJECTIVES: To test the psychometric characteristics of a five-item Chinese Contraceptive Behavior Scale (CBS) among female adolescents in Taiwan. BACKGROUND: Improving contraceptive practice is important for reducing adolescent pregnancy. A scale for measuring contraceptive behaviour of sexually active female adolescents will help nurses promote contraceptive practices to sexually active female adolescents. DESIGN: A cross-sectional design. METHODS: Based on literature review and interview with female adolescents, a five-item CBS was developed. Using convenience sampling, 525 sexually active female adolescents were invited to complete the (anonymous) CBS. Exploratory factor analysis, confirmatory factor analysis (CFA), contrasting group validity and concurrent validity were tested to examine the validity of CBS. A multiple-group analysis was used to test the cross-validation of the structure of CBS in two groups. Cronbach's α and test-retest reliability were used to examine the reliability of CBS. RESULTS: One factor was produced by exploratory factor analysis. Each item significantly loaded on the CBS by CFA. A multiple-group analysis indicated that the structure of CBS was reliable across two different samples. The overall chi-square and model fit indices were χ(2)=13.554, df=8, p=0.094, normed fit index=0.992, comparative fit index=0.994 and root mean square error of approximation=0.036 (90% CI=0.001, 0.069). The scores of CBS significantly correlated with subscales of perceptions of benefits to contraception (r=0.47, p<0.001) and subscales of perceptions of barriers to contraception (r=-0.29, p<0.001). CBS mean scores significantly differed between the participants who used and did not use contraceptives at first sexual intercourse (t=10.00, p<0.001). Cronbach's α for the CBS was 0.81. The intraclass correlation coefficient was 0.94. Conclusions. The CBS had satisfactory validity and reliability. Relevance to clinical practice. Nurses can use CBS to initiate discussions with sexually active female adolescents about their contraceptive practices and provide them with useful strategies to improve their contraceptive practices.

Exploring the Taiwanese Anticipatory Experience of Grief Among Primary Caregivers in Palliative Home Care.

Aims and Objectives: The goal of the present study was to explore anticipatory grief experiences among primary caregivers in home-based palliative care. We placed a special emphasis on coping methods adopted by individuals from Eastern cultures when facing death. Background: Most patients prefer spending their last days at home, which often exerts considerable physical and mental stress on their primary caregivers. Design: This study adopted a qualitative exploratory research design and used open-ended in-depth interviews to explore anticipatory grief experiences among primary caregivers of patients receiving palliative home care. Methods: In the study of the factors that Anticipatory Experience of Grief among Primary Caregivers in Palliative Home Care, we used the phenomenological approach and methods to glean answers. Posters and snowball sampling were used to individually recruit participants. In total, 16 primary hospice home caregivers participated. We used semi-structured interviews to collect data. The interviews were audio-recorded in a quiet location. Each interview was divided into two to three sessions, and each session lasted 60-90 minutes. For data analysis, field notes and audio recordings are transcribed into protocols. A thematic analysis method was used to analyze the context of the interviews. Sampling and analysis processes were repeated until theoretical saturation was achieved. Results: Four major themes emerged from the categorized interview data: meaning and manifestation as to the essence of life, the art of coping with death, realization and the gift of death, and adapting, coping with, and controlling emotions. Additionally, we observed, as with many Eastern cultures, a lunar calendar death in July and crying at the death of a relative is considered taboo. Conclusions: The coping methods adopted by individuals in Eastern cultures when facing death were summarized accordingly. These findings could serve as a reference to better understand the coping mechanisms these individuals use to address anticipatory grief when facing a family member's impending death. Relevance to Clinical Practice: Potential relevance for the present findings include acceptance of Eastern cultural grief customs, early hospice and palliative care interventions for helping individuals adjust to their grief, case management and resource consolidation, providing 24-hour telephone consultation services, regular assessment visits, and developing localized teaching materials for life-and-death education.

The health status of postpartum immigrant women in Taiwan.

AIMS: This study aims to contribute to the current body of literature by examining immigrant women's postpartum health in the context of Taiwan, in particular, their experience with postpartum stress and depression as well as the levels of social support available to them. This study also aims to identify predictors of their postpartum health status. BACKGROUND: While there has been considerable research on the risk factors for poor postpartum health in the general population, research on the factors influencing immigrant women's postpartum health has been limited. DESIGN: A non-experimental research design. METHODS: We collected data from a sample of 340 immigrant postpartum women who could speak Mandarin Chinese, recruited from 10 general hospitals and one obstetric clinic in Taiwan from March 2005-September 2006. The Hung Postpartum Stress Scale, Beck Depression Inventory-II, Social Support Scale and Chinese Health Questionnaire were used in this study. RESULTS: We found that immigrant women's postpartum health status differed significantly in relation to their key helpers, depression status, levels of postpartum stress and social support. The logistic regression analysis showed that a one-point increase in immigrant women's postpartum stress increased the probability of suffering from minor psychiatric morbidity by 1·04 times. CONCLUSIONS: These findings suggest that health care professionals should pay attention not only to immigrant postpartum women's basic financial and support needs but also to their postpartum stress and stressors. RELEVANCE TO CLINICAL PRACTICE: The use of trained community health advocates in partnership with registered nurses can help meet the needs of postpartum women and improve maternal and infant health through their home visits. These nursing interventions should be tailored specifically to decrease immigrant Asian women's postpartum stress and improve their overall health status and well-being.

Experience of Indigenous Peoples' Access to Long-Term Care Services in Taiwan: A Qualitative Study among Bunun Tribes.

Indigenous communities usually have poorer access to long-term care services than non-indigenous communities because of their remote locations and unique cultural backgrounds. However, there was little exploration into the experience of indigenous people's access to the official long-term care services in Taiwan-the gap this study aimed to fill. A qualitative study design using semi-structured interviews was used to obtain data from a purposive sample. Fourteen participants who were disabled and lived among the indigenous communities of the Bunun tribes in central Taiwan were interviewed individually. The data were analyzed using Graneheim and Lundman's qualitative content analysis. The theme-"helpful but still difficult and unfit"-and three categories with eight subcategories emerged. While official long-term care services provided by the government can benefit people with disabilities in indigenous tribes, their use of such services faces a number of obstacles, which points to the need for considering culturally appropriate care. To protect the rights and interests of indigenous tribal communities, long-term care policies and practical planning must be adopted, cultural differences at play must be respected and recognized, and the necessary support must be offered to eliminate inequalities in healthcare.

Hydration status of nursing home residents in Taiwan: a cross-sectional study.

AIM: To investigate fluid intake, dehydration and the key factors affecting nursing home residents' fluid intake and dehydration. BACKGROUND: Inadequate fluid intake is a common problem in nursing homes, but related studies on risk factors of inadequate fluid intake and dehydration in nursing homes have seldom been explored in detail in nursing research. METHODS: A cross-sectional design was developed and implemented. The sample was composed of 111 residents from nursing homes in Kaohsiung, Taiwan. Data of demographic characteristics, activities of daily living, and modes of feeding were collected and tested for association with hydration status. Laboratory data on hydration status were also collected. Data was collected from October to December 2005. RESULTS: Average daily fluid intake of the residents was 2083 mL. Forty-five per cent of the residents had a daily fluid intake that was less than their estimated requirements. Seventeen per cent of the residents had a blood urea nitrogen/creatinine ratio that was higher than 20. Mode of feeding and a diagnosis of dementia were the significant predictors of daily fluid intake and contributed to 28.8% of the total variance in daily fluid intake. Age, gender and a diagnosis of heart disease were the significant predictors of blood urea nitrogen/creatinine ratio, contributing to 17.0% of the total variance in the ratio. CONCLUSION: The nursing home residents in our study, especially females or those fed orally, had a comparatively higher prevalence of inadequate fluid intake. It is important to assess periodically the hydration status of nursing home residents and adjust their fluid intake accordingly.

Development of the model of health for older adults.

AIMS: This study aimed to explore the pertinent health indicators and to form a model of health for older adults. BACKGROUND: Health assessment and early detection are foundations for health promotion. Finding essential health indicators for older adults can better reflect the health status of this population and efficiently detect their health problems in a timely and economical manner. METHODS: This study had two phases. Data were collected from July 2008 to January 2009. Phase I began with sending evaluation surveys to a panel of ten professional experts to generate health indicators for older adults. Phase II was a preliminary determination of the extent of health predictions using these indicators by conducting a descriptive survey involving a stratified random sample of 55 community-dwelling older adults. RESULTS: The ten experts had fairly high agreement on the representativeness and importance of the proposed health model for older adults. The predictability of the health of older adults in the three domains (physical health, psychological health and social-economic health), four constructs (activities of daily living, physical status, emotional health and social engagement), and 47 indicators in this model was 84·50%. CONCLUSION: Results of this study could be used for making health policy and/or to set the goals for intervention. In addition, nurses who care for the older adults may use the health indicators to plan and control the given quality of care. The researchers may further examine the effects of study programmes for health promotion.

Knowledge gap regarding dementia care among nurses in Taiwanese acute care hospitals: A cross-sectional study.

AIM: The quality of dementia care in hospitals is typically substandard. Staff members are underprepared for providing care to older people with dementia. The objective of the present study was to examine dementia care knowledge, attitude and behavior regarding self-education about dementia care among nurses working in different wards. METHODS: This was a descriptive cross-sectional study. The present study was carried out from July 2013 to December 2013. In total, 387 nurses working in different wards were recruited from two hospitals in Taiwan by using convenience sampling. The nurses completed a self-report questionnaire on demographic data, experience and learning behavior, and attitude towards dementia care, and a 16-item questionnaire on dementia care knowledge. Descriptive and inferential statistics were used to analyze the status and differences in dementia care knowledge among nurse in different wards. RESULTS: The average dementia care knowledge score was 10.46 (SD 2.13), with a 66.5% mean accuracy among all nurses. Dementia care knowledge was significantly associated with age, nursing experience, possession of a registered nurse license, holding a bachelor's degree, work unit, training courses and learning behavior towards dementia care. The dementia care knowledge of the emergency room nurses was significantly lower than that of the psychiatric and neurology ward nurses. A significantly lower percentage of emergency room nurses underwent dementia care training and actively searched for information on dementia care, compared with the psychiatric and neurology ward nurses. CONCLUSIONS: Hospital nurses show a knowledge gap regarding dementia care, especially emergency room nurses. Providing dementia care training to hospital nurses, particularly emergency room nurses, is crucial for improving the quality of care for patients with dementia. Geriatr Gerontol Int 2018; 18: 276-285.

Health Care Providers' Perceptions of Maternal Health Concerns in the Solomon Islands.

PURPOSE: The objective of this study was to explore the maternal health risk factors and sentinel events among women in the Solomon Islands, from the viewpoints of health care providers in the Solomon Islands. DESIGN AND METHOD: Three focus group interviews were conducted in July and August 2011 at a secondary referral hospital in an urban area. The study consisted of 10 registered nurses and 11 skilled birth assistants. Thematic analysis was used for this qualitative data analysis. FINDINGS: Six major themes were emerged from the data: (a) environmental hazard: malaria, (b) malnutrition: iron deficiency anemia, (c) adolescent pregnancy, (d) betel nut chewing, (e) cultural beliefs influencing women's health, and (f) difficulty accessing health care services. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The results of this study provide a useful first step toward identifying specific maternal health risks among women in the Solomon Islands. The findings may assist the health sector and midwives/antenatal educators to better understand the health risks and reduce the disease burden among pregnant women in South Pacific countries. The results may also contribute to the development of policies to improve maternal health and to accelerate progress toward the fifth target goal of UNICEF's Millennium Development Goals.

Influencing Factors of Intention to Receive Pap Tests in Vietnamese Women who Immigrated to Taiwan for Marriage.

PURPOSE: This study aimed to explore the factors associated with the intention to receive a Pap test among married immigrant women of Vietnamese origin living in Taiwan. METHODS: This was a cross-sectional community-based study. We enrolled 281 women aged 30 years and over in the study, from July 2013 to January 2014. The participants' characteristics, cervical cancer knowledge, Pap test knowledge, attitudes toward cervical cancer, barriers to receiving a Pap test, fatalism, and intention to receive a Pap test, were measured using self-report questionnaires. Hierarchical multiple regression analyses were performed to examine the variables associated with participants' intentions to receive a Pap test. RESULTS: Vietnamese women with low scores on the measures of cervical cancer knowledge and perceived barriers to receiving a Pap test were more willing to receive the test, as were those with high scores on the measures of Pap test knowledge and fatalism. Women who received a Pap test in the previous year were more willing to receive a Pap test within the next 3 years. CONCLUSIONS: Preventive healthcare for immigrant women should be a focus of nurses. The development of culturally appropriate health education and strategies should enhance their knowledge of Pap tests and reduce perceived barriers to Pap test participation. This study's results can be a reference for nurses who work with immigrant women.

Conditions and Patterns of Intimate Partner Violence among Taiwanese Women.

PURPOSE: Intimate partner violence (IPV) is a serious public health issue among women. IPV victims usually seek help from hospitals, and emergency nurses are the frontline staff with whom the victims come into contact first. This study examined the conditions and patterns of IPV in southern Taiwan. METHODS: From designated hospitals in Kaohsiung under the Department of Health Injury Assessment Clinic, data were collected on 497 women regarding their injury assessment for IPV reported to the Kaohsiung City Government. RESULTS: Taiwanese survivors were older compared to immigrant survivors. Taiwanese survivors also had higher education levels compared to immigrant survivors. Taiwanese survivors had higher employment rate than immigrant survivors did. The time between IPV and medical help seeking was longer for divorced than married women. CONCLUSIONS: These results can facilitate understanding of the conditions and patterns of IPV in Taiwan, increase the awareness of nurses, especially the emergency nurses for the prevention of IPV, and increase professional competency for the provision of appropriate healthcare services to survivors of IPV.

Life and health concerns of Indonesian women in transnational marriages in Taiwan.

The number of transnational marriages between Taiwanese men and Southeast Asian women is increasing rapidly in Taiwan. Approximately one out of nine marriages in Taiwan is transnational. The rapid increase the number of foreign brides has greatly transformed Taiwan's social and demographic structures. This study focuses on Indonesian brides, the second largest immigrant group in Taiwan, to explore their life and health concerns. In-depth interview assisted by participant observation for a qualitative study was used in this study. Fifteen women participated in the study. Content analysis was used for data analysis. Findings revealed life and health concerns of immigrant Indonesian women in Taiwan could be categorized into four themes: immigrant adaptation, communication difficulty, family continuity, and barriers to healthcare system utilization. Based on the findings of this study, suggestions are made for healthcare and health policies. Moreover, healthcare professionals should understand that designing and providing culturally sensitive and appropriate healthcare to these women is very important for promoting their and their children's health.

Health literacy and health-promoting behaviors among multiethnic groups of women in Taiwan.

OBJECTIVE: To understand the current status of health literacy and the relationship between health literacy and health-promoting behaviors among multiethnic groups of women in Taiwan. DESIGN: Convenience and snowball sampling methods were used to recruit study participants. Data were collected using a cross-sectional questionnaire survey. SETTING: We recruited community female adults who lived in greater Taipei or Taoyuan areas (northern Taiwan) from January 1, 2010 through June 30, 2011. PARTICIPANTS: A total of 378 female participants were contacted, of which 351 consented to participate and 347 completed valid questionnaires for analysis. METHODS: Health literacy was measured with the Taiwan Health Literacy Scale, and health-promoting behaviors were measured by the Chinese version of the Health-Promoting Lifestyle Profile. RESULTS: Participants had a moderate level of health literacy, and one third of them had inadequate health literacy. Participants with inadequate health literacy were more likely to be younger, not a high school graduate, and Vietnamese; to have a low monthly family income and no diagnosed diseases; to use a second language; and to regard TV/radio as the most useful source of health information. Health literacy alone could significantly predict health-promoting behaviors among the participants. CONCLUSIONS: Our findings confirmed that low health literacy is prevalent among underprivileged women in Taiwan. Health-related programs that are literacy sensitive and culturally appropriate are needed to teach and encourage health-promoting behaviors.