Psychiatric nurses advocating for the human rights of mental health care users in Gauteng.

Background: Psychiatric nurses play an important role in advocating for mental health care users such as advocating for the care, treatment and rehabilitation of mental health care users (MHCUs). Psychiatric nurses face various challenges while advocating for the human rights of MHCUs, particularly those unable to protect their rights because of the severity of their mental health conditions. Aim: This study aimed to explore and describe psychiatric nurses' lived experiences in advocating for the human rights of MHCUs in the Gauteng province. Setting: The study was conducted within the primary healthcare (PHC) setting's mental health services, Sedibeng District, Gauteng province. Methods: The study employed a qualitative, exploratory, descriptive and contextual research design. Three phenomenological focus group interviews were conducted, and audio recorded to collect data. Data were analysed using Tesch's method. Results: Three themes emerged: (1) advocating for human rights was a strong push and an exhausting plea for psychiatric nurses in their attempts to voice and protect MHCUs' rights; (2) MHCUs and mental health services were discriminated against and excluded by various stakeholders; mental health awareness should be raised and (3) training needs to be conducted as a matter of urgency in order to destigmatise mental illness from government to societal level. Conclusion: Psychiatric nurses experienced feelings of disempowerment, frustration and helplessness in advocating for MHCUs' human rights. Contribution: The study's findings will contribute to the body of knowledge in clinical psychiatric mental health practice on advocating for the human rights of MHCUs.

High health care use prior to elective surgery for osteoarthritis is associated with poor postoperative outcomes: A Canadian population-based cohort study.

BACKGROUND: The characterization and influence of preoperative health care use on quality-of-care indicators (e.g., readmissions) has received limited attention in populations with musculoskeletal disorders. The purpose of this study was to characterize preoperative health care use and examine its effect on quality-of-care indicators among patients undergoing elective surgery for osteoarthritis. METHODS: Data on health care use for 124,750 patients with elective surgery for osteoarthritis in Ontario, Canada, from April 1, 2015 to March 31, 2018 were linked across health administrative databases. Using total health care use one-year previous to surgery, patients were grouped from low to very high users. We used Poisson regression models to estimate rate ratios, while examining the relationship between preoperative health care use and quality-of-care indicators (e.g., extended length of stay, complications, and 90-day hospital readmissions). We controlled for covariates (age, sex, neighborhood income, rural/urban residence, comorbidities, and surgical anatomical site). RESULTS: We found a statistically significant trend of increasing worse outcomes by health care use gradients that persisted after controlling for patient demographics and comorbidities. Findings were consistent across surgical anatomical sites. Moreover, very high users have relatively large numbers of visits to non-musculoskeletal specialists. CONCLUSIONS: Our findings highlight that information on patients' preoperative health care use, together with other risk factors (such as comorbidities), could help decision-making when benchmarking or reimbursing hospitals caring for complex patients undergoing surgery for osteoarthritis.

Perspectives of Hospitalized Mental Health Care Users Concerning the Involvement of Family Members in Their Care: A Qualitative Study.

The value of families and professionals in mental health care is well understood. Patient perspectives appear to have gotten less attention to date. This study investigated the perspectives of hospitalized mental health care users on the involvement of family members in their care using a qualitative phenomenological design. The participants with lived experience of family members being involved in their care were chosen using non-probability, purposive sampling. Individual interviews were carried out with the assistance of a voice recorder and observation notes. Because of data saturation, only fifteen people were interviewed. The interviews were transcribed verbatim and analyzed using Colaizzi's method. It started with reading and reviewing the transcript to extract key statements about the phenomenon. The meaning was then determined by carefully studying the primary significant statements and phrases. The established meanings were then organized into themes and subthemes. The three themes that emerged from the data analysis are as follows: a wide variation in patients' perspectives when family members remind them of their medicine, unpredictable visitation by family members, and a lack of support from family members. There were also the following five sub-themes: not visiting mental health care users in the hospital causes uncertainty about their future, mental health care users were concerned by fewer visits from relatives, friends were perceived as a contributory factor to no or limited visitation by family members, disappointment by a lack of financial support, and perceived lack of emotional support from family members. There is a need for family members to visit mental health care users to remove uncertainty about their future. Healthcare providers should listen to mental health care users to identify the challenges they are faced with, and hospital policies tailored to enhancing the involvement of family members should be formulated.

Positive mental health of patients at a psychiatric hospital, Gauteng province, South Africa.

Background: Positive mental health (PMH) forms the basis of well-being and positive mind set, which includes a range of cognitive-emotional attributes and coping skills of an individual towards the family and society. Assessment of PMH in psychiatric patients is critical in understanding their needs, improving mental health and the treatment of their illnesses. Aim: To investigate the levels of PMH among patients attending the outpatient department at a public sector tertiary referral psychiatric hospital using the multidimensional PMH instrument. Setting: Adult psychiatric patients attending the outpatient department at a public sector tertiary referral hospital, Gauteng province, South Africa. Methods: A quantitative, cross-sectional and descriptive study was conducted using a multi-dimensional PMH instrument with a convenient sample of 346 outpatients who provided consent. Results: Females reported significantly high PMH scores (3.86 vs 3.6; p = 0.018) compared to males. Patients with higher education (Gr. 0-7 vs Gr. 8-12 vs Tertiary education, PMH scores 3.34 vs 3.75 vs 4.18; p < 0.001), being married (single vs married, 3.67 vs 3.81, p = 0.342) and employed (unemployed vs employed, 3.62 vs 3.97, p = 0.005) reported significantly high total PMH score and across various domains. Conclusion: The results of the study highlighted the multi-dimensionality of mental health and justified importance of evaluating the domains of PMH in mental health care users. Identifying the reasons for the deficits in the PMH domains and implementing coping strategies will improve the emotional and psychological well-being of patients. Contribution: Examining the PMH domains will assist healthcare workers intervene to improve the mental health of patients.

Psychiatric nurses' experiences after the closure of Life Esidimeni psychiatric care centres.

BACKGROUND:  A national tragedy occurred between October 2015 and June 2016 when psychiatric patients with profound intellectual disabilities were transferred from psychiatric care centres to non-governmental organisations (NGOs). The process of transferring psychiatric patients had severe consequences for psychiatric patients and psychiatric nurses. OBJECTIVES:  The study's objective was to explore and describe psychiatric nurses' experiences after the closure of Life Esidimeni psychiatric care centres. METHOD:  A qualitative, exploratory, descriptive and contextual research design was employed. Semi-structured interviews were utilised to collect data. Purposive sampling was utilised to select eight psychiatric nurses to participate in the study. Data were analysed using Tesch's thematic method of coding. RESULTS:  The analysis of data revealed the following themes: With the closure of the care centres participants experienced (1) shock, dismay and life interruption; (2) trauma related to the disintegration, of psychiatric patients' lives, their own families and work-life and (3) sense of resilience. CONCLUSION:  From the findings, it is clear that the psychiatric nurses needed support as evidenced by the challenges they experienced. The healthcare professionals in mental health and mental health nursing post-graduate students could conduct further research focusing on the experiences and the impact that the closure of Life Esidimeni psychiatric care centres have on the psychiatric nurses' mental health.Contribution: This study contributes to the body of knowledge in psychiatric nursing by highlighting the impact of hospital closure on psychiatric nurses.

Family Perspectives Related to Caring for Mental Health Care Users: A Case Study in the Long-Term Mental Health Institutions of Limpopo Province, South Africa.

Family involvement in long-term mental health care is a significant therapeutic aspect in managing mentally ill patients. This study aimed to determine the perspectives of family members about caring for mental health care users at selected long-term mental health institutions in Limpopo Province. A qualitative explorative and contextual descriptive design was used. Purposive sampling was used to select family members with mental health care users admitted in long-term health institutions in Limpopo Province. Data were collected with in-depth individual interviews aided by an audio recorder and field notes. Data were qualitatively analysed. Trustworthiness and ethical considerations were ensured. Two themes yielded from the interviews: Perspectives of family members about their involvement in the care of mental health care users and difficulties in caring for mental health care users at home when granted leave of absence or discharged. Sub-themes: Caring for mental health care users leads to an understanding of mental illness; Lack of skill and inability to monitor mental health care users at home; Mental health care users abuse substances during leave of absence which makes family reluctant to request them for visit; Caring for mental health care users at home viewed as a difficult task and stigma from the community. The challenges experienced by family members contribute to poor interaction with mentally ill patients. We recommend that family members of mental health care users be educated about mental illnesses and encouraged to participate in the care of the patients.

Potentially Inappropriate Prescribing in Hospitalized Older Adult High-Cost Health Care Users: A Pilot Study.

Background: High-cost health care users use disproportionate amounts of health care resources relative to the typical patient. It is unclear to what extent poor-quality prescribing, including potentially inappropriate prescribing (PIP), may be contributing to their adverse outcomes and health utilization costs. Objectives: To evaluate the prevalence of PIP and to explore its impact in older adult high-cost health care users. Methods: The charts of older adult high-cost health care users admitted to 2 academic hospitals in Ontario, Canada, in fiscal year 2015/16 were reviewed. Eligible patients were at least 66 years old with at least 5 emergency department visits and 3 hospital admissions in the previous year. A total of 243 patients met these criteria, of whom 100 were randomly selected for review. Cases of PIP were identified using explicit prescribing quality indicators, including the STOPP/START criteria. Types of PIP included potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Log-linear regression was used to characterize the relationship between PIP and future health care utilization. Medications were reconciled to determine the proportion of PIP addressed by the time of discharge. Results: Eighty-nine of the 100 patients had at least 1 instance of PIP. In total, 276 PIMs and 54 PPOs were identified. Of the 271 instances of PIP identified on admission, only 38 (14%) were resolved by the time of hospital discharge. Each additional PPO was associated with a 1.43-fold increase in the rate of future emergency department visits (p < 0.001). Conclusions: The rate of PIP among older adult high-cost health care users was high. Despite frequent interactions with the health care system, many opportunities to improve the quality of prescribing for this vulnerable population were missed. Greater attention to medication optimization is needed.

Contexte: Les grands utilisateurs de soins de santé consomment une proportion disproportionnée des ressources par rapport aux patients moyens. On ne sait pas vraiment dans quelle mesure la prescription de mauvaise qualité, notamment la prescription potentiellement inappropriée (PPI), contribue aux effets indésirables et aux coûts d'utilisation des soins de santé. Objectifs: Évaluer la prévalence des PPI et étudier ses effets chez les grands utilisateurs des soins de santé âgés. Méthodes: Les dossiers des grands utilisateurs de soins de santé âgés admis dans 2 hôpitaux universitaires en Ontario, au Canada, pendant l'exercice 2015­2016 ont été examinés. Les patients admissibles étaient âgés d'au moins 66 ans, avaient effectué au moins 5 visites à l'urgence et avaient été admis 3 fois à l'hôpital au cours de l'année précédente. Au total, 243 patients répondaient à ces critères, dont 100 ont été sélectionnés au hasard pour un examen. Les cas de PPI ont été identifiés à l'aide d'indicateurs explicites de la qualité de prescription, notamment les critères STOPP/START. Les types de PPI comprenaient des médicaments potentiellement inappropriés (MPI) et les omissions potentielles de prescription (OPP). La régression log-linéaire a été utilisée pour caractériser la relation entre la PPI et l'utilisation future des soins de santé. Un bilan comparatif des médicaments prescrits a été effectué pour déterminer la proportion de PPI traités au moment de la sortie de l'hôpital. Résultats: Quatre-vingt-neuf (89 %) des patients présentaient au moins 1 cas de PPI. Au total, 276 MPI et 54 OPP ont été identifiées. Sur les 271 cas de PPI identifiés au moment de l'admission, seuls 38 (14 %) étaient résolus au moment de la sortie de l'hôpital. Chaque OPP supplémentaire était associée à une augmentation de 1,43 fois du taux de futures visites à l'urgence (p < 0,001). Conclusions: Le taux de PPI chez les grands utilisateurs de soins de santé âgés était élevé. Malgré des interactions fréquentes avec le système de santé, de nombreuses occasions d'amélioration de la qualité des prescriptions pour cette population vulnérable ont été manquées. Une plus grande attention doit être portée à l'optimisation des médicaments.

Optimizing a Halfway House to Meet Mental Health Care Users' Occupational Needs.

Background. Halfway houses (HwH) may support community reintegration of mental health care users and can be effective in meeting occupational needs of residents. However, they are not optimally used in South Africa. Purpose. This study aimed to improve the functioning of a HwH so that it better meets occupational needs of the resident mental health care users. It draws on Doble & Santha (2008); seven occupational needs. Method. A four-phase Participatory Action Research methodology was used. We conducted thematic analysis to describe met and unmet needs within PAR phases. Findings. Occupational needs of accomplishment, renewal, pleasure and companionship were being met. However, coherence, agency and affirmation needs were not being met. An additional occupational need for interdependence, based on the African ethic of Ubuntu, was identified. Implications. HwH functioning affected residents' experiences of health and wellbeing. Engagement in collective occupations can contribute to meeting the occupational need of interdependence.

Coping mechanisms used by the families of mental health care users in Mahikeng sub-district, North West province.

BACKGROUND: Families of the mental health care users (MHCUs) face different challenges in dealing with, supporting and caring for MHCUs on a daily basis. The divergent coping mechanisms that the family members use aim to lower the negative, psychological and emotional impact of the stress. These include: escape, avoidance and denial. AIM: To explore, describe and contextualise coping mechanisms used by the families of MHCUs and to suggest recommendations for improving their coping mechanisms in Mahikeng sub-district, North West province (NWP), South Africa. SETTING: The study was conducted in three community health centres in Mahikeng sub-district, NWP, South Africa. METHODS: A qualitative-exploratory-descriptive and contextual research design was used. Non-probability convenience and purposive sampling techniques were used to select participants. WhatsApp video calls were used to collect data which were analysed following Creswell's six steps of qualitative data analysis. RESULTS: The study established three themes namely; challenges experienced by the family members, coping mechanism used by the family members, and suggestions for improvement in the coping mechanisms for the family members. CONCLUSION: The findings of this study show that the family members of MHCUs are faced with different challenges. Some of the coping mechanisms used by the family members are insufficient and require improvement to enable them to cope effectively. When the coping mechanisms of the family members of MHCUs are improved, their well-being and that of the MHCUs might improve significantly. CONTRIBUTION: The findings of this study provides information that may be used to improve the coping mechanisms of the families of MHCUs in the NWP, South Africa.

Patients' perspective on prostatic artery embolization: A qualitative study.

OBJECTIVES: The aim was to describe the patients' experience of undergoing prostatic artery embolization. METHODS: A retrospective qualitative interview study was undertaken with 15 patients of mean age 73 years who had undergone prostatic artery embolization with a median duration of 210 min at two medium sized hospitals in Sweden. The reasons for conducting prostatic artery embolization were clean intermittent catheterization (n = 4), lower urinary tract symptoms (n = 10) or haematuria (n = 1). Data were collected through individual, semi-structured telephone interviews 1-12 months after treatment and analysed using qualitative content analysis. RESULTS: Four categories with sub-categories were formulated to describe the results: a diverse experience; ability to control the situation; resumption of everyday activities and range of opinions regarding efficacy of outcomes. Overall, the patients described the procedure as painless, easy and interesting and reported that while the procedure can be stressful, a calm atmosphere contributed to achieving a good experience. Limitations on access to reliable information before, during and after the procedure were highlighted as a major issue. Practical ideas for improving patient comfort during the procedure were suggested. Improved communications between treatment staff and patients were also highlighted. Most patients could resume everyday activities, some felt tired and bruising caused unnecessary worry for a few. Regarding functional outcome, some patients described substantial improvement in urine flow while others were satisfied with regaining undisturbed night sleep. Those with less effect were considering transurethral resection of the prostate as a future option. Self-enrolment to the treatment and long median operation time may have influenced the results. CONCLUSIONS: From the patients' perspective, prostatic artery embolization is a well-tolerated method for treating benign prostate hyperplacia.

The Challenges Faced by Mental Health Care Users in a Primary Care Setting: A Qualitative Study.

Over the past two decades, the value and benefits of integrated mental health care services have been increasingly recognised. Despite the potential benefits, barriers exist at primary care level to receiving mental health care services, interfering with continuity of care. We conducted semi-structured interviews with mental healthcare users at a primary care clinic in South Africa, to explore their experiences of receiving mental health care services. A convenience sample of 15 participants identified challenges such as limited infrastructure, organisation, medication, services in local communities, allied mental health care services, communication and long waiting times. Mental health care users felt uncared for and disrespected, especially if they were treated by unskilled and overworked staff. Mental health care users described clinic visits as stressful and frustrating. Mental health care users described marked challenges in mental health care service provision in a South African primary health care setting.

Prevalence of burnout among nurses working at a psychiatric hospital in the Western Cape.

BACKGROUND: Nurses are exposed to stress when working in the mental health care environment. This may be because of nurses being frontline health care providers. They develop close interpersonal relationships with mental health care users (MHCUs), which is inherent in the type of care that is provided. Mental health nursing may therefore be demanding and stressful, which could render mental health nurses susceptible to burnout. OBJECTIVES: To determine the prevalence of burnout among nurses working at a selected psychiatric hospital in the Western Cape. METHODS: A quantitative, descriptive, survey design, by using simple random sampling was used to select 198 nurses employed at a psychiatric hospital in the Western Cape, South Africa. Maslach Burnout Inventory-Human Services Survey measuring emotional exhaustion, depersonalisation and personal accomplishment was used to collect the data. Domain scores were calculated, and the influence of the demographic variables on the domains was tested with independent samples Kruskal-Wallis tests and Mann-Whitney U tests. RESULTS: The study had a 100% response rate. Most of the respondents experienced low emotional exhaustion, low depersonalisation and high personal accomplishment. Enrolled nursing assistants reported significantly higher emotional exhaustion than did the advanced psychiatric nurses and professional registered nurses. Respondents with more than 5 years of experience scored significantly higher in depersonalisation. No respondents met the criteria for burnout on all three domains. CONCLUSION: Maintaining a safe working environment with adequate nursing staff is recommended. Strategies to prevent burnout in the future include the provision of resources and the promotion of open communication between staff and management.

Men's view on participation in decisions about prostate-specific antigen (PSA) screening: patient and public involvement in development of a survey.

BACKGROUND: Prostate-Specific Antigen (PSA) screening for early detection of prostate cancer (PCa) may prevent some cancer deaths, but also may miss some cancers or lead to unnecessary and potentially harmful treatment. Therefore, involving patients in decision-making about PSA screening is recommended. However, we know little about the attitude of men regarding participation in decisions about PSA screening and how to assess such attitudes. The purpose of this paper is to describe patient and public participation in the development of a national, web-based case vignette survey for studying men's view on participation in decision-making about PSA screening. METHODS: The project group developed a first draft plan for the survey, its vignettes and choice of measurements. This included multiple vignette variants representing various levels of patient participation in decision-making about PSA screening with different outcomes. Additionally, it included questions on respondents' satisfaction with imagined courses of health care, their propensity to initiate a malpractice complaint, their own health care experiences, socio-demography, personality, and preferences for control regarding health care decision-making. Following feedback from a workshop with academic peers on the draft plan, a group of 30 adult men was engaged to help develop case vignette versions and questionnaire items by providing feedback on structure, comprehension, response patterns, and time required to complete the survey. Furthermore, a panel of three patients with PCa experience was assembled to assist development through a separate review-and-feedback process. RESULTS: Based on reviews of survey drafts, the large group made further suggestions about construction of the survey (e.g. clarification and modification of case vignette versions, deletion of items and adjustment of wording, instructions to guide respondents, replacement of technical terms, and optimization of sequence of survey elements). The patient panel ensured fine-tuning of vignette versions and questionnaire items and helped review the internet version of the survey. CONCLUSIONS: Patient and public involvement during various phases of the survey development helped modify and refine survey structure and content. The survey exemplifies a way to measure health care users' satisfaction with imagined courses of health care and wish to complain, taking into account their characteristics.

The Role of Empathy in Health and Social Care Professionals.

The current article is an integrative and analytical literature review on the concept and meaning of empathy in health and social care professionals. Empathy, i.e., the ability to understand the personal experience of the patient without bonding with them, constitutes an important communication skill for a health professional, one that includes three dimensions: the emotional, cognitive, and behavioral. It has been proven that health professionals with high levels of empathy operate more efficiently as to the fulfillment of their role in eliciting therapeutic change. The empathetic professional comprehends the needs of the health care users, as the latter feel safe to express the thoughts and problems that concern them. Although the importance of empathy is undeniable, a significantly high percentage of health professionals seem to find it difficult to adopt a model of empathetic communication in their everyday practice. Some of the factors that negatively influence the development of empathy are the high number of patients that professionals have to manage, the lack of adequate time, the focus on therapy within the existing academic culture, but also the lack of education in empathy. Developing empathetic skills should not only be the underlying objective in the teaching process of health and social care undergraduate students, but also the subject of the lifelong and continuous education of professionals.

Entre ausência de doença e cuidado possível: a saúde segundo usuárias da estratégia saúde da família / Between the absence of illness and possible care: health according to female users of the family health strategy program / Entre ausencia de enfermedad y cuidado posible: la salud según usuarios de la estrategia salud de la familia

Resumo O artigo apresenta sentidos que usuárias da Estratégia de Saúde da Família atribuem à saúde e sua relação com o cuidado. Utilizou-se o método qualitativo, tomando-se como referencial teórico as discussões de Canguilhem e Winnicott acerca da noção de saúde, bem como apontamentos sobre medicalização da vida. O trabalho de campo foi desenvolvido por meio de entrevistas em profundidade entre maio e julho de 2015 com usuários da Estratégia de Saúde da Família e tratado pela análise hermenêutica. A saúde, relacionada tanto à ausência de doença e ao completo bem-estar, quanto à disposição para enfrentar os sofrimentos inerentes à vida. Coexistem a confiança incondicional na tecnologia médica e a aposta em modos de cuidado intuitivos ou oriundos de relações sociais. O serviço de saúde contribui com o acesso ao tratamento e, simultaneamente, reforça a aposta na prevenção de todos os infortúnios do corpo, bem como a ideia de que o direito à saúde é correlato à responsabilização individual de mantê-la perfeita. Numa cultura marcada pelo individualismo e competitividade, indivíduos que vivem em contextos de profundas injustiças sociais submetem-se a regras de prevenção do risco de adoecer, mas são restritas suas possibilidades de criação de modos singulares de fruição da vida.

Abstract This article presents meanings that women users of the Family Health Strategy program attribute to health and its relation to care. The qualitative method was applied, using as a theoretical reference the discussions of Canguilhem and Winnicott on the notion of health, as well as notes on the medicalization of life. The fieldwork was developed through in-depth interviews between May and July 2015, with users of the Family Health Strategy program, and was treated with a hermeneutical analysis. Health, related both to the absence of illness and to complete well-being, as well as to the disposition to face the sufferings inherent to life. There is a coexistence between the unconditional trust in medical technology and a wager on intuitive care modes or those originated from social relationships. The health service contributes to the access to the treatment and, at the same time, reinforces the commitment to the prevention of all the misfortunes of the body, as well as the idea that the right to health care is related to the individual responsibility to keep it perfect. In a culture marked by individualism and competitiveness, individuals living in contexts of deep social injustice submit to rules to prevent the risk of becoming ill, but their possibilities of creating unique ways of enjoying life are restricted.

Resumen El artículo presenta sentidos que usuarias de la Estrategia de Salud de la Familia atribuyen a la salud y su relación con el cuidado. Se utilizó el método cualitativo, tomándose como referencial teórico las discusiones de Canguilhem y Winnicott acerca de la noción de salud, así como apuntes sobre medicalización de la vida. El trabajo de campo fue desarrollado por medio de entrevistas en profundidad entre mayo y julio de 2015 con usuarios de la Estrategia de Salud de la Familia y tratado por el análisis hermenéutico. La salud, relacionada tanto a la ausencia de enfermedad y al completo bienestar, cuanto a la disposición para enfrentar los sufrimientos inherentes a la vida. Coexisten la confianza incondicional en la tecnología médica y la apuesta en modos de cuidados intuitivos u oriundos de relaciones sociales. El servicio de salud contribuyó con el acceso al tratamiento y, simultáneamente, refuerza la apuesta en la prevención de todos los infortunios del cuerpo, así como la idea de que el derecho a la salud es correlativo a la responsabilidad individual de mantenerla perfecta. En una cultura marcada por el individualismo y competitividad, individuos que viven en contextos de profundas injusticias sociales se someten a reglas de prevención del riesgo de enfermarse, pero son restrictas sus posibilidades de creación de modos singulares de fruición de la vida.

Frequency and reasons for missed appointments of outpatient mental health care users in the uMgungundlovu District.

BACKGROUND:  Over the years, there has been a rapid growth in the use of mobile technology which has been proven to increase treatment adherence. Short message services may improve service delivery through appointment reminders and improve communication between health care workers and patients. Missed appointments are becoming common amongst mental health care users, and this has a significant economic burden on mental health symptoms. OBJECTIVES:  The aim of the study was to determine the frequency and reasons for missed appointments of outpatient mental health care users for their follow-up care in the uMgungundlovu District. METHOD:  This study used a quantitative survey. A non-probability convenient sampling method was used to select 182 participants at the psychiatric clinics. RESULTS:  Of the 182 participants, results of the study indicated that n = 84 (46.2%) respondents had missed their appointment at some stage. Of the n = 84 (46.2%) respondents who had missed appointments, n = 28 (33.3%) had missed their appointment once, and n = 45 (53.6%) had missed their appointment 2-3 times. Most common reasons for missed appointments included mental health care users forgetting (n = 58; 69%), work commitments (n = 14; 16.7%), no transportation (n = 4; 4.8%) and financial constraints (n = 5; 6%). CONCLUSION:  The main reasons for missed appointments that were identified included forgetfulness, work commitments, lack of transportation and financial constraints. A significant number of participants (53.6%) had missed their appointments 2-3 times.

Interacting With Providers: An Intersectional Exploration of the Experiences of Carers of Aboriginal Children With a Disability.

Intersectionality has potential to create new ways to describe disparities and craft meaningful solutions. This study aimed to explore Aboriginal carers' experiences of interactions with health, social, and education providers in accessing services and support for their child. Carers of Aboriginal children with a disability were recruited from an Australian metropolitan Aboriginal community-controlled health service. In-depth, semistructured interviews were conducted with 19 female carers. Intersectionality was applied as an analytical framework due to the inherent power differentials for Aboriginal Australians and carers for people with a disability. Marginalization and a lack of empowerment were evident in the experiences of interactions with providers due to cultural stereotypes and racism, lack of cultural awareness and sensitivity, and poverty and homelessness. Community-led models of care can help overcome the intersectional effects of these identities and forms of oppression in carers' interactions with providers and enhance access to care.

"Hopefully This Will All Make Sense at Some Point": Meaning and Performance in Illness Blogs.

AIMS: To analyze the narratives of illness blogs created by parents of children with cancer. BACKGROUND: The profound effects of the childhood cancer experience on family members and the turn to the Internet by parents for help in the process are gaining research attention. DESIGN: The qualitative study design involved secondary narrative analysis of 14 illness blogs: 9 by the parents of children with neuroblastoma and 5 by the parents of children with leukemia. Daily blog entries were analyzed as individual units of illness experience expression and in relation to one another to identify thematic and linguistic similarities. METHODS: The initial analysis of these illness blogs resulted in identification of the quest for balance as a primary theme. Narratives in parents' childhood cancer illness blogs illustrated themes of performance. During this initial analysis, however, the author repeatedly asked, "Why are they writing this? And why publish this?" A second analysis of the data answered these questions of why parents blog about the experience. RESULTS: Narrative analysis resulted in the discovery of 6 main reasons that parents wrote and published the childhood cancer experience online: to report, explain, express, reflect, archive, and advocate. CONCLUSION: The analysis suggests that incorporation of parent writing may improve family--provider communication, enhance the family-health care professional relationship, enhance safety by preventing medical errors, improve reporting of clinical trial data such as adverse events, and improve satisfaction.

"Treat Me Like a Normal Person!" A Meta-Ethnography of Adolescents' Expectations of Their Health Care Providers.

PURPOSE: Preventive health care services provide an important opportunity to assist adolescents to establish and maintain a healthy lifestyle and assume an increasing independent role in their health care. National guidelines emphasize the importance of an annual wellness visit to identify and address risk-behaviors that contribute significantly to the morbidity and mortality in this population. Despite these recommendations, adolescents utilize preventive health care at declining rates throughout adolescence. The purpose of this study was to capture a more holistic view of what adolescents, as consumers of health care services, expect from their primary health care providers (HCPs). METHOD: A metasynthesis of 12 qualitative research studies was conducted using Noblit and Hare's (1988) meta-ethnographic approach. RESULTS: Five overarching metaphors, Talk with Me- Not at Me, Accept Me, Respect My Privacy and Confidentiality, Show Me You Are a Professional, and A Trusted Relationship described adolescents' expectations of their HCPs. CONCLUSIONS: This study provides a more holistic view of adolescents' expectations of their HCPs. Clinical strategies are suggested to assist HCPs to meet adolescents' expectations.