Culturally and linguistically diverse patients' perspectives and experiences on medicines management in Australia: a systematic review.

BACKGROUND: Within the quality use of medicines (QUM)-which entails timely access to, and the rational use of, medicines-medicine safety is a global health priority. In multicultural countries, such as Australia, national medicines policies are focused on achieving QUM, although this is more challenging among their Culturally and Linguistically Diverse (CALD) patients (i.e., those from ethnic minority groups). AIM: This review aimed to identify and explore the specific challenges to achieving QUM, as experienced by CALD patients living in Australia. METHOD: A systematic literature search was conducted using Web of Science, Scopus, Academic search complete, CINHAL, PubMed and Medline. Qualitative studies describing any aspects of QUM among CALD patients in Australia were included. RESULTS: Major challenges in facilitating QUM among CALD patients in Australia were identified, particularly in relation to the following medicines management pathway steps: difficulties around participation in treatment decision-making alongside deficiencies in information provision about medicines. Furthermore, medication non-adherence was commonly observed and reported. When mapped against the bio-psycho-socio-systems model, the main contributors to the medicine management challenges identified related to "social" and "system" factors, reflecting the current health-system's lack of capacity and resourcing to respond to patients' low health literacy levels, communication and language barriers, and cultural and religious perceptions about medicines. CONCLUSION: QUM challenges were different among different ethnic groups. This review suggests a need to engage with CALD patients in co-designing culturally appropriate resources and/or interventions to enable the health-system to address the identified barriers to QUM.

Perspectives and Experiences of Smartphone Overuse among University Students in Umm Al-Qura University (UQU), Saudi Arabia: A Qualitative Analysis.

Smartphone overuse and addiction is a growing concern worldwide. However, there are limited studies about smartphone addiction and its impacts on university students in Saudi Arabia. This qualitative study aimed to elicit students' and university staff's perspectives and experiences about smartphone overuse/addiction in Umm Al-Qura University (UQU), Saudi Arabia. Fifteen undergraduate students and 18 university staff (13 lecturers and five professionals) were recruited for the purpose of this study. The study data were collected using semi-structured interviews and analysed using thematic analysis. The qualitative data comprising 33 participants (students and staff) identified four major themes including the perception of smartphone use; causes of smartphone overuse; negative impacts of smartphone overuse; and strategies to reduce the overuse of smartphone. The overall findings confirmed that students and staff alike held both positive and negative perceptions about using a smartphone. Potential factors leading to smartphone overuse included personal factors (extended free time and low self-confidence, irresponsibility/escaping certain social gatherings/passing the time); smartphone factors (reasonable price, attractive advertisements (ads), and engaging smartphone Apps); and social factors (social pressure and fear of losing a connection). The main negative impacts of smartphone overuse were found to be related to low academic productivity, poor physical health (body pain, lack of sleep, and low exercise), compromised mental well-being (stress and negative emotions), and decreased socialisation (social isolation and a reduction in face-to-face communication). Our findings suggested that awareness campaigns about smartphone overuse, promoting family and social events, encouraging physical activities, and limiting internet use can reduce smartphone usage among university students. This finding has significant implications for decision-makers.

Activating primary care COPD patients with multi-morbidity through tailored self-management support.

Given the dearth of COPD self-management interventions that specifically acknowledge multi-morbidity in primary care, we aimed to activate COPD patients through personalised self-management support that recognised the implications of co-morbidities. This single-group experimental study included patients aged 40-84 with a spirometry diagnosis of COPD and at least one co-morbidity. A self-management education programme for COPD in the context of multi-morbidity, based on the Health Belief Model, was tailored and delivered to participants by general practice nurses in face-to-face sessions. At 6 months' follow-up, there was significant improvement in patient activation (p < 0.001), COPD-related quality of life (p = 0.012), COPD knowledge (p < 0.001) and inhaler device technique (p = 0.001), with no significant change in perception of multi-morbidity (p = 0.822) or COPD-related multi-morbidity (0.084). The programme improved patients' self-efficacy for their COPD as well as overall health behaviour. The findings form an empirical basis for further testing the programme in a large-scale randomised controlled trial.

Facilitators and barriers to the self-management of COPD: a qualitative study from rural Nepal.

OBJECTIVE: To understand the facilitators and barriers to the self-management of chronic obstructive pulmonary disease (COPD) in rural Nepal. SETTINGS: Community and primary care centres in rural Nepal. PARTICIPANTS: A total of 14 participants (10 people with COPD and 4 health care providers) were interviewed. PRIMARY AND SECONDARY OUTCOME MEASURES: People with COPD and healthcare provider's experience of COPD self-management in rural Nepal. RESULTS: Facilitators and barriers affecting COPD self-management in Nepal operated at the patient-family, community and service provider levels. People with COPD were found to have a limited understanding of COPD and medications. Some participants reported receiving inadequate family support and described poor emotional health. At the community level, widespread use of complementary and alternative treatment was found to be driven by social networks and was used instead of western medicine. There were limited quality controls in place to monitor the safe use of alternative treatment. While a number of service level factors were identified by all participants, the pertinent concerns were the levels of trust and respect between doctors and their patients. Service level factors included patients' demands for doctor time and attention, limited confidence of people with COPD in communicating confidently and openly with their doctor, limited skills and expertise of the doctors in promoting behavioural change, frustration with doctors prescribing too many medicines and the length of time to diagnose the disease. These service level factors were underpinned by resource constraints operating in rural areas. These included inadequate infrastructure and resources, limited skills of primary level providers and lack of educational materials for COPD. CONCLUSIONS: The study findings suggest the need for a more integrated model of care with multiple strategies targeting all three levels in order to improve the self-management practices among people with COPD.

Nutritional assessment and factors associated with malnutrition among the elderly population of Nepal: a cross-sectional study.

OBJECTIVES: This study aimed at assessing the nutritional status among the elderly population and factors associated with malnutrition in the community setting in rural Nepal. RESULTS: Out of 339 participants, 24.8% (95% CI 20.21-29.30) fell into the normal nutritional status range; 49.6% (95% CI 44.29-54.91) were at risk for malnutrition while 24.8% (95% CI 20.21-29.30) were in the malnourished range, based on Mini Nutritional Assessment scores. Our findings revealed that belonging to a Dalit community, being unemployed, having experience of any form of mistreatment, lack of physical exercise, experiencing problems with concentration in past 30 days and taking medication for more than one co-morbidity was significantly associated with the malnutrition status of the elderly.

Healthcare reform: implications for knowledge translation in primary care.

BACKGROUND: The primary care sector represents the linchpin of many health systems. However, the translation of evidence-based practices into patient care can be difficult, particularly during healthcare reform. This can have significant implications for patients, their communities, and the public purse. This is aptly demonstrated in the area of sexual health. The aim of this paper is to determine what works to facilitate evidence-based sexual healthcare within the primary care sector. METHODS: 431 clinicians (214 general practitioners and 217 practice nurses) in New South Wales, Australia, were surveyed about their awareness, their use, the perceived impact, and the factors that hindered the use of six resources to promote sexual healthcare. Descriptive statistics were calculated from the responses to the closed survey items, while responses to open-ended item were thematically analyzed. RESULTS: All six resources were reported to improve the delivery of evidence-based sexual healthcare. Two resources - both double-sided A4-placards - had the greatest reach and use. Barriers that hindered resource-use included limited time, limited perceived need, and limited access to, or familiarity with the resources. Furthermore, the reorganization of the primary care sector and the removal of particular medical benefits scheme items may have hampered clinician capacity to translate evidence-based practices into patient care. CONCLUSIONS: Findings reveal: (1) the translation of evidence-based practices into patient care is viable despite reform; (2) the potential value of a multi-modal approach; (3) the dissemination of relatively inexpensive resources might influence clinical practices; and (4) reforms to governance and/or funding arrangements may widen the void between evidence-based practices and patient care.