Religion, Spirituality, or Existentiality in Bad News Interactions: The Perspectives and Practices of Physicians in India.

A qualitative study was conducted to identify the role of religion, spirituality, or existentiality in clinical interactions. Grounded theory design was used to generate narrative data from 27 physicians working in four teaching hospitals in Karnataka, India, using a semi-structured interview schedule. Physicians reported that they explored religious, spiritual, and existential beliefs and practices of patients, along with other psychosocial and disease aspects, to assess their tolerance to bad news, to make decisions about delivering it, and to address the distress that might emerge from receiving bad news. They also reported taking recourse to religious or spiritual practices to cope with their own stress and feelings of failure.

Coping strategies of older rural Bangladeshi women with health problems.

In this study we explore the strategies used by older women to cope with their ill health, in order to provide insight into how they might be drawn to use modern health services. We used qualitative methods to collect data from 17 older women living in Bibirchar Union, Sherpur District, Bangladesh. Participants reported that they utilized both emotion-focused and problem-focused strategies, and that many of these were faith-based. Health policymakers need to acknowledge these strategies in the delivery of health care if older women are to take up health promotion activities and engage with the modern health care system.

A synthesis of the literature on breaking bad news or truth telling: potential for research in India.

The high incidence of fatal diseases, inequitable access to health care, and socioeconomic disparities in India generate plentiful clinical bad news including diagnosis of a life-limiting disease, poor prognosis, treatment failure, and impending death. These contexts compel health care professionals to become the messengers of bad news to patients and their families. In global literature on breaking bad news, there is very little about such complex clinical interactions occurring in India or guiding health care providers to do it well. The purpose of this article is to identify the issues for future research that would contribute to the volume, comprehensiveness, and quality of empirical literature on breaking bad news in clinical settings across India. Towards this end, we have synthesized the studies done across the globe on breaking bad news, under four themes: (a) deciding the amount of bad news to deliver; (b) attending to cultural and ethical issues; (c) managing psychological distress; and (d) producing competent messengers of bad news. We believe that robust research is inevitable to build an indigenous knowledge base, enhance communicative competence among health care professionals, and thereby to improve the quality of clinical interactions in India.

In search of healing between two worlds: the use of traditional and modern health services by older women in rural Bangladesh.

The objective of this study is to gain a deeper understanding of the use of traditional and modern medicine among older adult women living in rural Bangladesh. Factors are identified that guide the women's decisions about who to seek help from when they are ill. The findings provide evidence that, in spite of the availability of modern health care, traditional healers--faith-based and herbalists--are widely utilized. Reasons given for their choice of health care providers fall into two categories: belief in the effectiveness of the intervention and service delivery considerations. These data suggest that use of traditional healers persists among women in rural areas of Bangladesh and that health policy should be developed with an acknowledgment of these health practices.

Improving access to government health care in rural bangladesh: the voice of older adult women.

Our purpose in this study was to provide an in-depth understanding of the health-system-related barriers to utilization of health services by older women living in rural Bangladesh. Interviews were conducted with 17 women in Bibirchar Union, Sherpur district, Bangladesh, in June 2006. Three main barriers were identified: perceived discrimination based on age, class, and gender; structural aspects of the health care delivery system; and quality of care. Recommendations for change in the delivery of health care in the rural regions of Bangladesh are made based on the insights provided by this marginalized group of health care service users.

A socially excluded space: restrictions on access to health care for older women in rural Bangladesh.

This study was an exploration of the experiences of 17 women, age 60 or more years, from Bangladesh. The women were asked about decision-making processes with respect to their access to health care and whether they perceived that there were differences based on age and sex in the way a household responds to an illness episode. The overall theme that characterized their experiences was "being in a socially excluded space." The themes that explained this perception of social exclusion included gender- and age-based social practices, gender- and class-based economic practices, religious beliefs that restricted the mobility of women, and social constructions of health and illness that led the women to avoid seeking health care. We conclude that the Bangladesh constitutional guarantee that disparities will be eliminated in access to health care between rich and poor, men and women, rural and urban residents, and younger and older citizens has not yet been realized.

Choice and outcome in mental health supported housing.

OBJECTIVE: This paper discusses choice in mental health supported housing, providing results from a longitudinal study of two models of supported housing (a higher support and a lower support model). METHODS: The progress of 27 tenants at the two sites was tracked on measures of satisfaction with housing, social support satisfaction, mental health, physical health, and mastery over the course of one year. Measurements were taken at baseline, 6 months, and 12 months. RESULTS: Although there were trends toward positive changes at both sites, with the Bonferroni adjustment, only positive within group changes in perceptions of physical health between baseline and 12 months at the higher support site endured. There were no significant differences in changes between the two sites. CONCLUSIONS: We conclude that there appears to be some support for the positive effects of choice in mental health supported housing. Further research in this area will require flexible programming and funding that create opportunities for true partnerships with consumer-survivors.

Assessing the impact of an emotion regulation booster program for elementary school-aged children.

The purpose of this study was to determine whether children who participated in a booster program 3 years after completing an emotion regulation program show a greater increase between pretest and post-test in the development of emotion regulation skills than children in a comparison group. A booster program was implemented as a pilot project with seven children ages 12-14. The contrast group consisted of eight children ages 10-14. Results of the study showed that the booster group had significant increases on 4 of 10 outcome measures: emotional awareness, emotional expressiveness, number of identified body cues, and number of identified calming activities. The contrast group showed no significant pretest post-test changes on the outcomes measured. EDITORS' STRATEGIC IMPLICATIONS: Replication will be required with a larger sample size, but the emotion regulation results presented are encouraging. Program developers and evaluators will benefit from the authors' discussion of the importance and role of booster programs.

Developing theory from complexity: reflections on a collaborative mixed method participatory action research study.

Research studies are increasingly complex: They draw on multiple methods to gather data, generate both qualitative and quantitative data, and frequently represent the perspectives of more than one stakeholder. The teams that generate them are increasingly multidisciplinary. A commitment to engaging community members in the research process often adds a further layer of complexity. How to approach a synthesizing analysis of these multiple and varied data sources with a large research team requires considerable reflection and dialogue. In this article, we outline the strategies used by one multidisciplinary team committed to a participatory action research (PAR) approach and engaged in a mixed method program of research to synthesize the findings from four subprojects into a conceptual framework that could guide practice in community mental health organizations. We also summarize factors that hold promise for increasing productivity when managing complex research projects.

Mental health respite services: a grounded service delivery model.

A needs assessment for mental health respite services was undertaken at Waterloo Regional Homes for Mental Health in Kitchener, Ontario. Twenty-seven participants (consumers, carers, and service providers) were asked about their perceptions of the need for mental health respite services, and about their preferences for a model of respite in their community. A convergent analysis of participants' responses leads to one possible model of respite, while a divergent analysis considers program and value dilemmas for potential planners of programs directed at multiple stakeholders. Participants' frustrations with current services remind mental health programs of the importance of consulting with all stakeholders as they evaluate and develop programs.

The medicine that might kill the patient: Structural Adjustment and its impacts on health care in Bangladesh.

Over the past decade, reforms of the health sector have evolved as a global phenomenon. There is, by now, a fair literature on the relationship between globalization and health. Within this literature, however, there is relatively little attention given to the Structural Adjustment Program (SAP), one aspect of globalization, and its impact on health. It can be observed that the SAP has had a dramatic impact on the status of education, health, the environment, and women and children in many developing countries. The restructuring of the health sector has led to the collapse of preventive and curative care due to the lack of medical equipment, supplies, poor working conditions, low pay of medical personnel, and the resulting low morale in Ghana, Philippines, and Zimbabwe. User fees in primary health care have led to the exclusion of a large section of the population from accessing health services as they are unable to pay. This article discusses the health specific impact of the SAP and the economic reforms initiated under it in Bangladesh. In particular, it will analyze how these policies affect the health care delivery system in Bangladesh in relation to geographic accessibility, affordability, quality of services, administrative efficiency, the rural urban service gap, public provision of health care, and donor influence on health policy.

Rural women's access to health care in Bangladesh: swimming against the tide?

Large segments of the population in developing countries are deprived of a fundamental right: access to basic health care. The problem of access to health care is particularly acute in Bangladesh. One crucial determinant of health seeking among rural women is the accessibility of medical care and barriers to care that may develop because of location, financial requirements, bureaucratic responses to the patient, social distance between client and provider, and the sex of providers. This article argues that to increase accessibility fundamental changes are required not only in resource allocation but also in the very structure of health services delivery.