Partner notification by family physicians for sexually transmitted infections: Facilitators and barriers.

OBJECTIVE: To explore Canadian FPs' experiences with, perceived barriers to, and perceived facilitators of FP-initiated partner notification (PN) for HIV and other sexually transmitted infections (STIs), as well as to inform the development of tools that might enhance this work. DESIGN: Online survey. SETTING: British Columbia. PARTICIPANTS: A total of 146 FPs recruited through the Divisions of Family Practice community-based networks of FPs throughout the province. MAIN OUTCOME MEASURES: Family physicians' current STI and PN practices, opinions regarding FP-initiated PN, perceived barriers to and facilitators of FP-initiated PN, and preferred PN resources. RESULTS: More than 90% of FPs had diagnosed an STI within the past year, and most (60.3% to 96.6%, depending on the STI) told patients to inform their partners. Two-thirds (66.4%) felt that PN should not be done by FPs, and fewer than 10% reported contacting partners. Reported barriers included inaccurate or incomplete lists of partners (67.1%), poor compensation (54.1%), and insufficient time (54.1%). Facilitators chosen by respondents included another health professional assigned to follow up with PN (77.4%) and improved remuneration (74.7%). Electronic PN tools directed at patients (eg, PN slips) were favoured over resources directed at providers. CONCLUSION: Family physicians regularly manage STIs and currently take part in PN primarily through educating index cases. However, most do not feel that PN should be conducted by FPs, and most believe that FP-initiated PN would require additional personnel, remuneration, and legal guidance.

Facilitators and Barriers to Expedited Partner Therapy: Results From a Survey of Family Physicians.

BACKGROUND: Expedited partner therapy (EPT) can prevent transmission of sexually transmitted infections (STIs) and reinfection of the index patient. We surveyed family physicians (FPs) in British Columbia to understand their perceptions of barriers and facilitators to EPT use and explored how perceptions varied by demographic and practice characteristics. METHODS: Survey participants were recruited through the Divisions of Family Practice, which include greater than 90% of FPs in British Columbia. Common barriers and facilitators for EPT were identified using descriptive statistics. The association between each EPT barrier and facilitator and demographic and practice characteristics were tested using χ test. RESULTS: One hundred eighty-one FPs started the survey, of which 146 (80.7%) answered 10 questions or more and were analyzed. Overall, inaccurate information about sex partners (88 [60.3%] of 146) and medicolegal concerns (87 [59.6%] of 146) were the most common barriers reported. Family physicians in nonurban settings were more likely to identify insufficient time as a barrier compared with FPs in urban settings (P < 0.01). The most common facilitators were having a health care professional for follow-up after prescribing EPT (110 [75.3%] of 146), improved remuneration (93 [63.7%] of 146), clear clinical guidelines around EPT (87/146, 59.6%), and having a legal framework (92 [63.0%] of 146). Family physicians practicing for less than 9 years (the median) were more likely to identify the latter as facilitating EPT compared with FPs practicing for 9 years or longer (P < 0.05). CONCLUSIONS: Ensuring patients have access to a health care professional for follow-up, improved remuneration, and development of clinical guidelines and a legal framework can support the implementation of EPT. Tools catered to different practice types and contexts may help increase EPT use.

Implementing a province-wide mandatory vaccinate-or-mask policy at healthcare facilities in British Columbia, Canada.

OBJECTIVES: In 2012, British Columbia (BC) became the first Canadian province to implement an influenza prevention policy requiring healthcare workers (HCW) to either be vaccinated annually against influenza or wear a mask in patient care areas during the influenza season. This study describes an evaluation of influenza policy implementation processes and identifies supports and challenges related to successful policy implementation at the level of healthcare facilities, during the second policy year (2013/14). METHODS: Implementation leaders from 262 long-term care (LTC) and acute care facilities, mostly in three of BC's five regional Health Authorities, were invited to participate in an online survey following the 2013/14 influenza season. Descriptive quantitative and qualitative analyses identified common and effective strategies for improving vaccination coverage and policy compliance. RESULTS: A total of 127 respondents completed the survey on behalf of 33 acute care and 99 LTC facilities, representing 36% of acute care and 27% of LTC facilities in BC. Respondents agreed that the policy was successfully implemented at 89% of facilities, and implementation was reported to be easy at 52% of facilities. The findings elaborate on communication and leadership strategies, campaign logistics and enforcement approaches involved in policy implementation. CONCLUSION: Implementation of a vaccinate-or-mask influenza policy is complex. This study provides insight for other jurisdictions considering implementing such a policy and offers practical recommendations for facilities and health authorities.

Process evaluation of the Living Green, Healthy and Thrifty (LiGHT) web-based child obesity management program: combining health promotion with ecology and economy.

OBJECTIVE: To conduct a process evaluation of the Living Green, Healthy and Thrifty (LiGHT) program, a novel virtual child obesity management program that combines health promotion with ecology and economy (Phase 1). METHODS: We carried out a mixed methods process evaluation involving qualitative and quantitative data collection in 3 phases: among 3 child-parent units, (group 1) that informed program development; 9 child-parent units (group 2) that tested the draft program and further aided program refinement; and 17 child-parent units (group 3) for a 4-week pilot of the program. In the program pilot, we assessed participants' knowledge and readiness to change pre- and postintervention and explored perceptions of the program. RESULTS: Participants generally felt that the online format for program delivery was convenient and accessible, the content was practical, and the integration of health-environment-economy was well received. Many parents also appreciated the involvement of the family. However, the lack of visual appeal and overabundance of text was identified as a challenge, and children/youth in particular requested assurance that their personal information (e.g. weight) was not seen by their parents. The online method of program delivery holds the unique challenge of requiring special efforts to create a sense of personal connection and community. The presence of a "Way-finder" to assist participants and discussion boards/forums are potential solutions. CONCLUSION: The LiGHT online weight management program offers an accessible, convenient weight management resource that children and families appreciate for its availability, broader educational scope, and practicality. Outcome evaluation of LiGHT will be carried out in Phase 2 of the project.

Health promotion as practiced by public health inspectors: the BC experience.

OBJECTIVE: To explore the experiences of British Columbia's (BC's) Public Health Inspectors in practicing health promotion. METHODS: We administered a mixed qualitative-quantitative survey to 15 BC Public Health Inspectors (in BC, titled Environmental Health Officers--EHOs), selected to represent different levels of authority, areas of work and geographic regions. We queried whether and how they practice health promotion, strategies utilized, how health promotion relates to their enforcement mandates, perceived effectiveness of health promotion, and barriers and enabling factors affecting its adoption. RESULTS: Fourteen respondents (93%) practiced health promotion. Common practices included building healthy public policy, developing personal skills, and creating environments that support health. Health promotion was most often applied as " part of enforcement"; EHOs first attempted to educate and create environments that support regulatory standards and best practices, utilizing enforcement measures should the former prove ineffective. Enforcement was recognized as an important tool. Most respondents did not feel that their enforcement mandate limited their use of health promotion; however barriers exist where the EHO is perceived unfavourably as an "enforcer". The majority felt that an increased use of health promotion would make their protection work more effective. Strategies to facilitate its application include practical training in implementation, clear expectations and accountability at all levels of planning, resources, and relationships with stakeholders. CONCLUSION: EHOs engage in a broad and varied health promotion practice. Practical training with a focus on health promotion implementation in the BC context, and clear and consistent direction regarding expectations and accountability, would facilitate greater involvement.

Understanding the social consequences of chronic obstructive pulmonary disease: the effects of stigma and gender.

Stigma is a social construction that defines people in terms of a distinguishing characteristic or mark, and devalues them as a consequence. Stigma occurs when society labels someone as tainted, less desirable, or handicapped. There is emerging evidence that chronic obstructive pulmonary disease (COPD) is a physical condition with social consequences. The valuing, and devaluing, of individuals within society are social judgments that have roots in sociocultural values and beliefs. Cultural norms and values dictate the distinct roles and behaviors that are expected of men and women in a given culture. Social reactions to individuals with COPD can have an effect on their illness experience. This article explores the relationships between COPD and stigma and gender, particularly how these key elements may interact to affect experiences of individuals with COPD within their social milieu. The aim of this article is to begin to set out questions and issues that require further empirical exploration. The stigma of COPD arises because people are held responsible for their disease, are noted to have engaged in a stigmatized behavior (smoking), are marked with oxygen equipment and bodily changes, and experience a disruption in their social interactions.

An evaluation of a domiciliary respite service for younger people with dementia.

RATIONALE, AIMS AND OBJECTIVES: There is a lack of respite services designed specifically for younger people with dementia. There is also a dearth of studies on the evaluation of domiciliary respite services for carers of people with dementia in general. This paper reports on the evaluation of a domiciliary respite service for carers of younger people with dementia, in one area in Northern Ireland, provided by a local branch of the Alzheimer's Society. METHODS: Using a qualitative approach, eight carers and their families were interviewed in their own homes about their views and expectations of the service, the benefits and problems they experienced, and other issues of relevance to them. RESULTS: Overall, they reported great satisfaction with the service. The way they used, and benefited from, the service differed for individuals. Most of them, however, gained respite in the form of help with bathing and dressing the person with dementia. Carers reported that they did not engage in social or recreational activities during the period of respite. Instead they used the respite time to catch up with household chores and shopping. DISCUSSION AND CONCLUSIONS: The benefits and concerns can only be understood from the perspectives of carers and in the context of their needs, values, beliefs and traditions. The insight gained can be used to inform future provision of services for this population.