Barriers to utilisation of cancer rehabilitation from the expert's view: A cross-sectional survey.

OBJECTIVE: The goal of this study was to investigate barriers to utilisation of cancer rehabilitation by querying a large sample of various professionals in health care with a comprehensive set of barriers. METHODS: We developed a questionnaire comprising 55 barriers to utilisation of cancer rehabilitation and administered it to four different types of medical, care and social work experts involved in the referral to cancer rehabilitation. An exploratory factor analysis was conducted and the extracted factors were ranked by mean values. Additionally, ANOVAs were calculated to test for group differences. RESULTS: Our sample (N = 606) consisted of 249 physicians, 194 social workers, 105 nurses and 55 psychologists in Germany. We identified seven barrier-dimensions: low appreciation of rehabilitation by professionals, insufficient coordination, insufficient application procedure, rehabilitation requirements not met, patients' unfulfilled demands, patients' social responsibilities and patients' coping style, with the latter being rated as the most obstructive thereof. Furthermore, we found statistically significant group differences for six of these factors with small- to medium-sized effects. CONCLUSION: Our results support previous publications implicating the patients' coping style as a barrier. We furthermore found evidence for barriers relating to processes and organisational issues, thereby expanding on the scope of patient-oriented publications. Suggestions for improving patients' health services accessibility are made.

[Barriers in the Application Process for Oncological Rehabilitation: A Nationwide Expert Study]. / Barrieren der Antragstellung in der Onkologischen Rehabilitation: Eine bundesweite Expertenstudie.

PURPOSE: From the perspective of various expert groups involved in the care of oncological patients, barriers to the application process of oncological rehabilitation programs will be identified. The study was funded by the German Pension Insurance Association (DRV). METHODS: Based on an interview study (N=61), a questionnaire instrument with 55 items describing possible barriers in the application process was designed and implemented online. Participants with more than 33% missing values were excluded from the analyses. Mean value analyses were used to identify the most significant relevance. To identify overall dimensions an explorative factor analysis was conducted . RESULTS: A total of 606 experts from the oncological field were included in the analyses. Among them were 249 doctors, 194 social workers, 105 nurses / medical assistants, 55 psychologists / psycho-oncologists and three other professional groups. The queried experts were on average 51 years old (SD=10.4) and had been working in the oncological field for 17 years (SD=9.8). The barriers could be assigned to the following seven factor-analytically determined content sections: coping style, application procedure, rehabilitation requirements, coordination, social responsibilities, desires of patient and the priority of rehabilitation. According to the experts statements the main obstacles to an application were the patient's desire for normality, the rigid deadline for the application and the application procedure which is difficult for patients with a migration background to understand. It was also pointed out that it is difficult to place multimorbid patients in rehabilitation facilities. CONCLUSION: The following recommendations for action to facilitate access to rehabilitation can be derived from the expert study: optimization of the coordination between different expert groups, institutions and the cost units, flexibilisation of the deadline for follow-up, simplifying the application process, providing applications/information material in additional languages, orienting rehabilitation clinics towards specific patient groups.

[Relational Evidence in Preventive Child Protection: Evaluation of a Manual Based Group Intervention "Strengthening Resources of Mentally Ill and Addicted Parents"]. / Relationale Wirksamkeit im präventiven Kinderschutz: Evaluation der modularen Gruppenintervention "Ressourcen psychisch kranker und suchtkranker Eltern stärken".

Relational Evidence in Preventive Child Protection: Evaluation of a Manual Based Group Intervention "Strengthening Resources of Mentally Ill and Addicted Parents" This article describes results of the evaluation of the manual-based group intervention programme "Strengthening Resources of mentally ill and addicted Parents". This intervention's objective is to encourage parents in mentalization, emotional regulation, coping with stress and social support competencies. Strengthening these reflexive competencies aims at promoting parents' recourses and minimizing risks for child abuse. Therefore, the evaluation design is based on data triangulation: combining standardised instruments and qualitative interviews of participants and professional providers. Besides intervention effects, this design aims to analyse aspects by parents' and professionals' subjective perspectives, which promote the interventions in it's effect. 160 parents participated. The results show, that parents feel statistical significant less overwhelmed by the responsibility of being a parent, recognise more capacity to act and support in everyday. Qualitative data analysis reinforces these results and shows how the manual's concept supports parents' benefit from the intervention in their every day life.

["For me, Pressure at School is the Most Relevant in my Life" - Empirical Based Implications for Life World Orientation in Health Promotion at School]. / "Also ich finde, es gibt eigentlich nur Schulstress!" ­ Empiriebasierte Implikationen für eine lebensweltorientierte Praxis schulischer Gesundheitsförderung.

"For me, Pressure at School is the Most Relevant in my Life" - Empirical Based Implications for Life World Orientation in Health Promotion at School School is a key system that supports all processes of adolescent development. Next to qualification, as one part of personality development, all developmental tasks of adolescence can take place within the school environment, through close interplay. This interplay both influences, and is influenced by young people's health which is essential to promote adolescent development and foster wellbeing in everyday life for young people. On one hand, risk taking behaviour can impact health and developmental progress. On the other hand, biopsychosocial changes can emerge to challenge young people in terms of coping with life and managing the tasks of normal adolescent development. Experiencing ill health can further limit young people's access to systems and social interaction essential to promote development. In this instance, life world orientation in health promotion becomes one fundamental part of social work, especially school social work (Rademaker, 2017b). In this paper a holistic perspective on health is formulated, as an essential part of young people's daily life. The paper specifically focusses on social work's potential to empower young people to engage with their available resources to promote health related agency. A triangulated study (2013-2015) provides an empirical example. Based on a questionnaire with 500 pupils aged 15-16 years (N = 395), three health types could be identified, a healthy, an unhealthy and one in average, and prototypical cases (N = 12) were interviewed in focus group discussions. The interplay of resources and structural borders in the life world of the participants could be reconstructed to provide understanding of how health related agency emerges in the lives of young people and shape their option to health.