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Sr Care Pharm ; 35(2): 93-106, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32019644


OBJECTIVE: To identify key beliefs that influence behavior, regarding Medicare's Annual Wellness Visit (AWV) and older patients' willingness to implement personalized prevention plans.
DESIGN: Cross-sectional. In-depth semi-structured focus group sessions with Medicare patients in July 2018.
SETTING: Two primary care physician-based practices.
INTERVENTION: A trained moderator facilitated two focus group sessions, and used open-ended questions based on the theory of planned behavior to elicit behavioral, normative, and control beliefs associated with implementing personalized prevention plans.
MAIN OUTCOME MEASURE: Content analysis of the focus groups' transcribed data was used to identify modal salient beliefs. Transcribed focus group sessions were analyzed utilizing grounded-theory methods for emergent themes.
RESULTS: A total of 13 older patients participated in the focus group sessions. Prevalent behavioral beliefs among participants influenced by patient-centered care outcomes included improvement in physical activity, adopting a healthy balanced diet, and weight loss.
Interpersonal and environmental disparities influenced commonly reported control factors such as lack of support at home and affordable fitness facilities. Macro-level influences such as physicians and social marketing by insurance providers, and health partners and spousal support were identified as important normative factors.
CONCLUSION: Identified salient beliefs were congruent to social determinants of health in Medicare patients. Results of the study demonstrate perceived enablers and barriers of elderly patients regarding implementing health-promoting advice. AWV pharmacists should address perceived barriers to improve attitudes and self-efficacy; and incorporate enabling beliefs into adherence strategies to improve adoption of health recommendations.

Medicare , Farmacéuticos , Anciano , Estudios Transversales , Ejercicio , Grupos Focales , Humanos , Estados Unidos
Forensic Sci Int ; 306: 110062, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31786514


The renowned work of Clyde Snow and the development of the Equipo Argentino de Anthropología Forense (EAAF) team has inspired the use of forensic anthropological and archaeological skills in human rights interventions around the world. Whether for medico-legal intervention and acquisition of evidence or humanitarian repatriation and identification of human remains, forensic expertise has garnered attention in the global arena. Arguably fulfilling evidentiary and psychosocial needs, there has been growing interest in this post-conflict redress. However, as part of the critique of these interventions, scholars and practitioners have pointed out - primarily in medico-legal investigations - a lack of sensitization of local communities regarding forensic work, increasing the potential for re-traumatization, unrealistic expectations, or an unintentional increase in political tensions. Research regarding forensic intervention and human remains have permeated social sciences, peace and conflict studies, and science and technology studies, revealing both intentional and unintentional impacts of forensic sciences after mass violence. In an effort to mitigate negative impacts of medico-legal or humanitarian interventions, the research described here sought to sensitize communities in Uganda about forensic methods. Findings from this study suggest that sensitization is necessary and desired, and that a multi-step approach can assist in managing expectations.

Conflictos Armados , Antropología Forense/organización & administración , Sobrevivientes/psicología , Altruismo , Arqueología , Recursos Audiovisuales , Entierro , Relaciones Comunidad-Institución , Grupos Focales , Antropología Forense/educación , Derechos Humanos , Humanos , Población Rural , Uganda
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1048348


Objetivo: elaborar um bundle de cuidados para a prevenção e o controle das infecções hospitalares em unidade de emergência, com base no conhecimento e prática dos profissionais de saúde e nas evidências científicas disponíveis na literatura. Método: pesquisa convergente assistencial, realizada em um serviço de emergência adulto de um hospital geral universitário localizado em uma capital do Sul do Brasil com aplicação de um Survey para 52 trabalhadores da equipe multiprofissional e posterior discussão em grupos "Aqui e Agora". Foi aprovado pelo CEPSH/UFSC com CAAE: 56390616.0.0000.0121. Resultados: emergiram três aspectos mais significativos que compuseram o bundle de cuidados: higienização das mãos; uso de equipamentos de proteção individual; e assepsia de materiais e equipamentos. Conclusão: a utilização do bundle permite informar, orientar, melhorar hábitos e relembrar a equipe de saúde sobre a necessidade de aderir a atitudes que tornem o cuidado realizado mais qualificado e seguro, tanto para o paciente, quanto para o profissional

Objective: develop a care bundle in order to help preventing and controlling hospital infections in emergency care units, based on the knowledge and practice of health professionals, as well as on scientific evidences available in the literature. Method: The study was carried out through the application of a survey comprising 52 health professionals working in the multi-professional team of the aforementioned hospital. The data from the survey were discussed in "Here-and-Now" groups. It was approved by CEPSH / UFSC with CAAE: 56390616.0.0000.0121. Results: the three most significant aspects composing the care bundle were selected based on data derived from the survey, from the groups and from the literature, namely: hand hygiene; use of personal protection equipment; and asepsis of materials and equipment. Conclusion: using the bundle allows inform, guide, as well as to improve habits and remind health teams about the need to adhere to measures able to make the health care practice more qualified and safer for both the patients and the professionals

Objetivo: elaborar un bundle de cuidados para la prevención y el control de las infecciones hospitalarias en unidad de emergencia, con base en el conocimiento y práctica de los profesionales de salud y en las evidencias científicas disponibles en la literatura. Método: se realizó con aplicación de un Survey de que participaron 52 trabajadores del equipo multiprofesional. Los datos de Survey fueron discutidos posteriormente en grupos "Aquí y Ahora". Fue aprobado por el CEPSH / UFSC con CAAE: 56390616.0.0.0000.0121. Resultados: en base a los datos de Survey, de los grupos y de la literatura se seleccionaron los tres aspectos más significativos que compusieron el bundle de cuidados: higienización de las manos; uso de equipos de protección individual; y asepsia de materiales y equipos. Conclusión: la utilización del bundle permite informar, orientar, mejorar hábitos y recordar el equipo de salud sobre la necesidad de adherir a actitudes que hagan del cuidado realizado más calificado y seguro, tanto para el paciente, como para el profesional

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Grupo de Atención al Paciente , Infección Hospitalaria/prevención & control , Servicios Médicos de Urgencia , Conocimientos, Actitudes y Práctica en Salud , Encuestas y Cuestionarios , Grupos Focales , Seguridad del Paciente , Paquetes de Atención al Paciente
Int J Radiat Oncol Biol Phys ; 106(1): 32-36, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31647968


PURPOSE: Radiation treatment planning (RTP) is a unique skill that requires interdisciplinary collaboration among radiation oncologists (ROs), dosimetrists, and medical physicists (MP) to train and assess residents. With the adoption of competency-based medical education (CBME) in Canada, it is essential residency program curricula focuses on developing competencies in RTP to facilitate entrustment. Our study investigates how radiation oncology team members' perspectives on RTP education align with requirements of the CBME approach, and its implications for improving residency training. METHODS AND MATERIALS: This qualitative research study took place in the Department of Oncology at a midsize academic institution. Through convenience sampling, focus groups were conducted with radiation oncologists (n = 11), dosimetrists (n = 7), medical physicists (n = 7), and residents (n = 7). Thematic design was adopted to analyze the transcripts through open coding resulting in 3 overarching themes. RESULTS: The results identified existing strengths and weaknesses of the residency program and future opportunities to redesign the curriculum and assessment process within a CBME model. Three overarching themes emerged from the analysis: (1) the strengths of RTP in the CBME environment; (2) challenges of RTP in CBME; and (3) opportunities for change. Stakeholders were optimistic CBME will help enrich resident learning with the increased frequency and quality of competency-based assessments. Participants suggested building a library of cases and developing computer-based learning resources to provide a safe environment to develop skills in contouring, dosimetry, and plan evaluation, in accordance with CBME training. CONCLUSIONS: This study identified future opportunities to redesign the RTP curriculum and assessment process within a CBME model. The need for innovative teaching and learning strategies, including case libraries, computer-based learning, and quality assessments, were highlighted in designing an innovative RTP planning curriculum.

Competencia Clínica , Educación Basada en Competencias , Internado y Residencia , Oncología por Radiación/educación , Planificación de la Radioterapia Asistida por Computador , Canadá , Competencia Clínica/normas , Educación Basada en Competencias/normas , Grupos Focales , Predicción , Humanos , Internado y Residencia/normas , Cultura Organizacional , Investigación Cualitativa , Oncólogos de Radiación , Oncología por Radiación/normas , Enseñanza/organización & administración , Carga de Trabajo
J Homosex ; 67(1): 79-103, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30307800


Young Black Men Who Have Sex With Men (BMSM) have been the subject of much research focused on health disparities in HIV occurrence, stigma, and mental health. Although such research is important, fewer studies focus on other equally salient areas of their lives such as spirituality, religious practices, and social support. Informed by literature on social support, this research endeavors to better understand these dynamics for a group of young BMSM who reside in a metropolitan city in Tennessee. Focus group results and content analysis uncover themes related to religion and resilience; queering Christianity; and virtual spirituality. Participants expressed an overarching need for support, safe spaces, genuine relationships, and godly instruction, conveyed through traditional Black Church involvement and nontraditional Internet usage. Findings are important for strategic, proactive, cross-generational collaboration with young BMSM to holistically meet their varied needs.

Afroamericanos/psicología , Homosexualidad Masculina/psicología , Minorías Sexuales y de Género/psicología , Medios de Comunicación Sociales , Espiritualidad , Adolescente , Adulto , Grupos Focales , Infecciones por VIH/psicología , Humanos , Masculino , Estigma Social , Tennessee , Adulto Joven
J Homosex ; 67(1): 104-126, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30307803


Malay-Muslim men who have sex with men (MSM) are marginalized and hidden in Malaysia, a predominantly Muslim country in southeast Asia. We explored the policy, network, community, and individual factors related to HIV infection among Malay-Muslim MSM through 26 in-depth interviews and one focus group discussion (n = 5) conducted in Kuala Lumpur and Kota Bharu between October 2013 and January 2014. As religion plays an important role in their lives, participants viewed homosexuality as a sin. Low risk perception and misconceptions about HIV/AIDS were common, and most participants expressed reluctance to consult a doctor unless they had symptoms. Additionally, buying condoms was embarrassing and anxiety-producing. Fear of discrimination by health care providers and community hindered participants from disclosing sexual behaviors and accessing health services. Homophobic comments and policies by the government and religious leaders were concerns of participants. A safe and enabling environment is needed to reduce HIV risks among Malay-Muslim MSM.

Revelación , Infecciones por VIH/psicología , Homofobia , Homosexualidad Masculina , Islamismo , Religión y Sexo , Minorías Sexuales y de Género/psicología , Adulto , Redes Comunitarias , Condones , Grupos Focales , Personal de Salud , Accesibilidad a los Servicios de Salud , Humanos , Malasia , Masculino , Factores de Riesgo
N Z Med J ; 132(1488): 38-48, 2019 01 18.
Artículo en Inglés | MEDLINE | ID: mdl-31851660


AIM: In New Zealand, there are sexually active adolescents who are using poor or no methods of contraception, and who do not intend to become pregnant. The most effective methods of contraception suitable to this population are long acting reversible contraceptive (LARC) methods. A proactive LARC provision (PLP) programme has been proposed, and this study investigates whether such a model would be acceptable to adolescents. This study aims to determine how adolescents feel about a PLP programme. METHODS: We conducted four focus groups (FGs) of female adolescents at three high schools and one university residential college, with 32 participants in total. The data from these were analysed for themes using a general inductive thematic analysis approach. RESULTS: When asked how they felt about a PLP programme, the adolescents found the concept acceptable. This study identified misconceptions and myths around contraception in the adolescent population. The five identified themes were reproductive health fear, sex and body shame, adolescents' requirements for sexual health provision, barriers to contraception and sexual health knowledge. CONCLUSIONS: Adolescents consider a PLP programme to be acceptable. More research is needed about the acceptability of an adolescent PLP programme in other groups, and the feasibility of such a programme.

Conocimientos, Actitudes y Práctica en Salud , Anticoncepción Reversible de Larga Duración/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Femenino , Grupos Focales , Humanos , Nueva Zelanda , Estudiantes/psicología , Estudiantes/estadística & datos numéricos
Rev. Esc. Enferm. USP ; 53: e03464, Jan.-Dez. 2019.
Artículo en Español | LILACS, BDENF - Enfermería | ID: biblio-1020376


RESUMEN Objetivo Explorar la construcción social que sobre violencia obstétrica han elaborado mujeres Tének y Náhuatl de México. Método Estudio cualitativo-sociocrítico, mediante gupos focales se profundizó en las experiencias de parto de quienes vivieron un parto en el periodo 2015-2016. Resultados Participaron 57 mujeres. Mediante análisis de discurso se identificó que las participantes no poseen suficiente información sobre violencia obstétrica y/o derechos sexuales y reproductivos, lo que las imposibilita para asociar sus experiencias negativas al término legal "violencia obstétrica". Sus discursos corresponden en su mayoría a lo que desde el marco legal se ha denominado "violencia obstétrica", sin embargo, experiencias como el ayuno prolongado o el uso de tecnologías para la invasión de su intimidad fueron narradas como algo que conciben violento y que no se ha incorporado dentro del término legal. Conclusión Múltiples acciones que atentan contra los derechos humanos de las mujeres tienen lugar dentro de las salas de parto, la mayor parte no son identificadas por las usuarias, puesto que no han construido socialmente la imagen de la violencia obstétrica, ello no las hace menos susceptibles sin embargo, a sentirse agredidas y denigradas en sus partos.

RESUMO Objetivo Explorar a construção social que as mulheres Tének e Náhuatl do México elaboraram sobre a violência obstétrica. Método Estudo qualitativo-sociocrítico; por meio de grupos focais, houve um aprofundamento nas experiências de parto daquelas que passaram por um parto no período de 2015 a 2016. Resultados Participaram 57 mulheres. Mediante análise do discurso, foi identificado que as participantes não possuem informação suficiente sobre violência obstétrica e/ou direitos sexuais e reprodutivos, o que as impossibilita de associar suas experiências negativas ao termo legal "violência obstétrica". Seus discursos correspondem na sua maioria ao que, a partir do marco legal, foi denominado "violência obstétrica"; entretanto, experiências como jejum prolongado ou uso de tecnologias para a invasão da sua intimidade foram narradas como algo que concebem ser violento e que não foi incorporado ao termo legal. Conclusão Múltiplas ações que atentam contra os direitos humanos das mulheres têm lugar dentro das salas de parto, a maior parte não é identificada pelas usuárias, visto que não construíram socialmente a imagem da violência obstétrica, mas isso não as faz menos suscetíveis de sentir-se agredidas e denegridas nos seus partos.

ABSTRACT Objective To explore the social construction of obstetric violence developed by Tenek and Nahuatl women in Mexico. Method Qualitative, socio-critical study conducted through focal groups in which were deepened the childbirth experiences lived in the period 2015-2016. Results Participation of 57 women. Through discourse analysis, it was identified that participants do not have enough information about obstetric violence and/or sexual and reproductive rights. This makes the association of their negative experiences with the legal term "obstetric violence" impossible. Most of their speeches correspond to the legal denomination of "obstetric violence". Experiences like prolonged fasting or the use of technologies for invading their privacy were narrated like situations they perceive as violent, but have not been incorporated within the legal term. Conclusion Multiple actions against women's human rights take place within delivery rooms. Most remain unidentified by users, since they have not socially constructed the image of obstetric violence. However, that fact does not make them less susceptible to feel attacked and denigrated during their childbirth experiences.

Humanos , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Salas de Parto , Parto , Población Indígena , Violencia contra la Mujer , México , Grupos Focales , Investigación Cualitativa , Enfermería Obstétrica
Rev. Esc. Enferm. USP ; 53: e03495, Jan.-Dez. 2019.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1020381


RESUMO Objetivo Descrever o ambiente de trabalho e reconhecer os riscos ocupacionais a que a equipe do Consultório na Rua está exposta, bem como as medidas preventivas aplicáveis segundo a percepção dos profissionais integrantes da equipe. Método Pesquisa qualitativa, exploratória, descritiva, realizada com profissionais representantes das seis equipes de Consultório na Rua existentes em um estado do Nordeste brasileiro. As informações foram coletadas a partir da técnica de grupo focal, e os dados foram analisados à luz da análise temática. Resultados Participaram 14 profissionais. O ambiente de trabalho foi descrito como de tensões, dificuldades e vulnerabilidades, mas também de crescimento pessoal. Foram reconhecidos riscos ocupacionais ocasionados por fatores físicos, biológicos, químicos, de acidentes e psicossociais. As medidas de prevenção utilizadas foram predominantemente tecnologias leves. Sugeriu-se a inclusão de novos equipamentos de proteção individual. Conclusão A reflexão grupal sobre o ambiente e processo de trabalho permitiu o reconhecimento de seus riscos, dificuldades e desafios, demonstrando a necessidade de implementação de medidas de enfrentamento dos fatores identificados.

RESUMEN Objetivo Describir el ambiente laboral y reconocer los riesgos ocupacionales a que está expuesto el equipo del Consultorio en la Calle, así como las medidas preventivas aplicables según la percepción de los profesionales integrantes del equipo. Método Investigación cualitativa, exploratoria, descriptiva, realizada con profesionales representantes de los seis equipos del Consultorio en la Calle existentes en un Estado del Nordeste brasileño. Las informaciones fueron recogidas mediante la técnica de grupo focal, y los datos fueron analizado a la luz del análisis temático. Resultados Participaron 14 profesionales. El ambiente de trabajo fue descrito como de tensiones, dificultades y vulnerabilidades, pero también de crecimiento personal. Fueron reconocidos los riesgos ocupacionales ocasionados por factores físicos, biológicos, químicos, de accidentes y psicosociales. Las medidas de prevención utilizadas fueron predominantemente tecnologías ligeras. Se sugirió la inclusión de nuevos equipos de protección individual. Conclusión La reflexión en grupo acerca del ambiente y el proceso laboral permitió el reconocimiento de sus riesgos, dificultades y retos, demostrando la necesidad de implementación de medidas de enfrentamiento de los factores identificados.

ABSTRACT Objective To describe the work environment and recognize the occupational hazards to which Street Medical Consultation teams are exposed, as well as the applicable preventive measures according to the perception of the professionals who are part of the team. Method A qualitative, exploratory and descriptive study carried out with professionals representing the six Street Medical Consultation teams existing in a Northeast Brazilian state. The information was collected from the focus group technique, and the data were analyzed by the thematic analysis technique. Results Fourteen (14) professionals participated. The work environment was described as stressful, with difficulties and vulnerabilities, but also enabling personal growth. Occupational risks caused by physical, biological, chemical, accident and psychosocial factors were recognized. Implemented preventive measures were predominantly light technologies. New personal protective equipment was suggested to be included/used. Conclusion The group reflection on the environment and work process enabled recognizing its risks, difficulties and challenges, demonstrating the need to implement measures to address the identified factors.

Humanos , Ambiente de Trabajo , Personas sin Hogar , Riesgos Laborales , Salud Laboral , Grupos Focales/métodos , Prestación de Atención de Salud , Investigación Cualitativa , Enfermería de Atención Primaria
Rev. Esc. Enferm. USP ; 53: e03512, Jan.-Dez. 2019. graf
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1020387


OBJETIVO: Desvelar as práticas de Educação Permanente em Saúde desenvolvidas pelo Núcleo de Apoio à Saúde da Família na atenção ao idoso. MÉTODO: Estudo qualitativo e exploratório-descritivo, desenvolvido em um município do estado do Paraná, com profissionais do Núcleo de Apoio à Saúde da Família. Os dados foram obtidos pela técnica de Grupo Focal e submetidos à Classificação Hierárquica Descendente utilizando o software IRaMuTeQ. Os referenciais teórico-analíticos foram a Política Nacional de Educação Permanente em Saúde e a Teoria Dialógica. RESULTADOS: Participaram 46 profissionais. Surgiram cinco classes que permitiram desvelar que as práticas de educação permanente na atenção ao idoso ocorrem durante os momentos de discussão de casos, no matriciamento, nas visitas domiciliares, nos grupos operativos e no cotidiano do trabalho de modo informal. CONCLUSÃO: As práticas de educação permanente desenvolvidas pelos profissionais na atenção ao idoso ocorrem em distintos momentos da atuação profissional e são permeadas pela prática

OBJETIVO: Desvelar las prácticas de Educación Permanente en Salud desarrolladas por el Núcleo de Apoyo a la Salud de la Familia en la atención a la persona mayor. MÉTODO: Estudio cualitativo y exploratorio descriptivo, desarrollado en un municipio del Estado de Paraná, con profesionales del Núcleo de Apoyo a la Salud de la Familia. Los datos fueron obtenidos por la técnica de Grupo Focal y sometidos a la Clasificación Jerárquica Descendiente utilizando el software IRaMuTeQ. Los marcos de referencia teóricos analíticos fueron la Política Nacional de Educación Permanente en Salud y la Teoría Dialógica. RESULTADOS: Participaron 46 profesionales. Surgieron cinco clases que permitieron desvelar que las prácticas de educación permanente en la atención a la persona mayor ocurren durante los momentos de discusión de casos, en el matriciamiento, las visitas domiciliarias, los grupos operativos y el cotidiano del trabajo de modo informal. CONCLUSIÓN: Las prácticas de educación permanente desarrolladas por los profesionales en la atención a la persona mayor ocurren en distintos momentos de la actuación profesional y traen consigo la práctica

OBJECTIVE: To unveil the Permanent Education in Health practices developed by the Family Health Support Center in the care provided to older adults. METHOD: A qualitative and exploratory-descriptive study developed in a municipality in the state of Paraná with professionals from the Family Health Support Center. Data were obtained by the Focus Group technique and submitted to the Descending Hierarchical Classification using IRaMuTeQ software. The implemented theoretical-analytical references were the National Policy of Permanent Education in Healthcare and the Dialogical Theory. RESULTS: Forty-six (46) professionals participated. Five classes emerged which revealed that the practices of permanent education in care provided to older adults occur during the moments of discussion of cases, in collaborative care planning (matriciamento ), in the home visits, in the operative groups and in the daily life of the informal work. CONCLUSION: The permanent education practices developed by the professionals in the care provided to older adults occur at different moments of professional performance and are permeated by the practice

Humanos , Masculino , Femenino , Anciano , Atención Primaria de Salud/normas , Educación Continua/métodos , Enfermería de Atención Primaria/normas , Servicios de Salud para Ancianos/normas , Personal de Salud , Grupos Focales , Investigación Cualitativa
Afr J Reprod Health ; 23(3): 19-29, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31782628


Globally, few programs consider the needs of first-time young parents (FTYPs), who face disproportionate negative health consequences during pregnancy and childbirth. Scant evidence exists on FTYPs' broader health needs. Formative research in two regions of Madagascar used a socio-ecological lens to explore, via 44 interviews and 32 focus group discussions, the influences on FTYPs at the individual, couple, family, community, and system levels. We spoke with FTYPs who had, and who had not, used sexual and reproductive health (SRH) services, their parents/kin and influential adults, and community health workers and facility health providers. Data analysis, guided by a codebook, used Atlas.ti. Age, social position, and implicit power dynamics operating within and across socio-ecological levels affected FTYPs' service-seeking behaviors. The nature and extent of influence varied by health service type. Cross-cutting social factors affecting service use/non-use included gender dynamics, pressures from mothers, in-laws, and family tradition, and adolescent stigmatization for too-early pregnancy. Structural and economic factors included limited awareness of and lack of trust in available services, unfriendliness of services, and FTYPs' limited financial resources. A socio-ecological program perspective can inform tailoring of activities to address broader SRH issues, including how relationships, gender, power, and intergenerational dynamics influence service use.

Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Padres/psicología , Servicios de Salud Reproductiva/estadística & datos numéricos , Adolescente , Estudios Transversales , Familia , Femenino , Grupos Focales , Humanos , Madagascar , Masculino , Embarazo , Investigación Cualitativa , Salud Reproductiva/etnología , Conducta Sexual/etnología , Conducta Sexual/psicología , Adulto Joven
Afr J Reprod Health ; 23(3): 106-119, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31782636


Unmet need for contraception remains a challenge especially in low and middle-income countries. Community participation or the -active involvement of affected populations in all stages of decision-making and implementation of policies, programs, and services‖ is a precondition for attaining the highest standard of health. Participation as a key component of rights and quality of care frameworks could increase met needs. However, it has been inadequately addressed in contraceptive programs. A qualitative, exploratory methodology that included focus group discussions and in-depth interviews with community members, healthcare providers, and other stakeholders were conducted to identify domains or key thematic areas of action through which stakeholders could be engaged. The study conducted in Kenya, South Africa, and Zambia explored knowledge and use of contraceptives, barriers and enablers to access, quality of care, and participatory practices. Thematic analysis was used, facilitated by NVivo (version 10 QSR International) with a single master codebook. Comparing the thematic areas that emerged from the county data, four domains were selected: quality of care, informed decision-making, acceptability, and accountability. These domains informed the theory of change of a participatory programme aiming to meet unmet needs. Identifying possible generalizable domains establishes measurable and comparable intermediate outcomes for participatory programs despite diverse African contexts.

Participación de la Comunidad , Anticoncepción , Servicios de Planificación Familiar/estadística & datos numéricos , Personal de Salud , Evaluación de Necesidades , Anticoncepción/métodos , Grupos Focales , Necesidades y Demandas de Servicios de Salud , Humanos , Entrevistas como Asunto , Kenia , Investigación Cualitativa , Sudáfrica , Zambia
BMC Public Health ; 19(1): 1423, 2019 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-31666036


BACKGROUND: Sexual and reproductive health and rights (SRHR) have historically been regarded as a woman's issue. It is likely that these gender norms also hinder health care providers from perceiving boys and men as health care recipients, especially within the area of SRHR. The aim of this study was to explore midwives' thoughts and experiences regarding preventive work for men's sexual and reproductive health and rights in the primary care setting. METHODS: An exploratory qualitative study. Five focus group interviews, including 4-5 participants in each group, were conducted with 22 midwives aged 31-64, who worked with reproductive, perinatal and sexual health within primary care. Data were analysed by latent content analysis. RESULTS: One overall theme emerged, in everybody's interest, but no one's assigned responsibility, and three sub-themes: (i) organisational aspects create obstacles, (ii) mixed views on the midwife's role and responsibility, and (iii) beliefs about men and women: same, but different. CONCLUSIONS: Midwives believed that preventive work for men's sexual and reproductive health and rights was in everybody's interest, but no one's assigned responsibility. To improve men's access to sexual and reproductive health care, actions are needed from the state, the health care system and health care providers.

Actitud del Personal de Salud , Salud del Hombre , Enfermeras Obstetrices , Atención Primaria de Salud , Rol Profesional , Salud Reproductiva , Salud Sexual , Adolescente , Adulto , Prestación de Atención de Salud , Femenino , Grupos Focales , Derechos Humanos , Humanos , Masculino , Hombres , Persona de Mediana Edad , Partería , Embarazo , Servicios Preventivos de Salud , Reproducción , Conducta Sexual , Suecia , Adulto Joven
BMC Public Health ; 19(1): 1429, 2019 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-31672141


BACKGROUND: The feminization and ethnic diversification of HIV infection, has resulted in a call for gender- and culture-specific prevention strategies for at-risk groups including Latinos in the United States. The steadily changing demographic profile of the AIDS epidemic challenges prevention strategies to remain relevant and up-to-date, particularly in populations of women midlife and older where an understanding of risk remains under explored. As the CDC requests country-specific HIV risk profiles for Latino communities in the US, understanding the socio-economic, behavioral and personal risk reasons of HIV risk for older Dominican women is critical for prevention. METHODS: We conducted focus group discussions informed by the Theory of Gender and Power (TGP). The three constructs of the TGP: 1) Affective influences/social norms; 2) Gender-specific norms and. 3) Power and Authority guided the thematic analysis and identified themes that described the socio-cultural and contextual reasons that that contribute to perceptions of HIV risk. RESULTS: Sixty Dominican American women ages 57-73 participated in our focus group discussions. Sexual Division of Labour: 1) Economic Dependence; 2) Financial Need and 3) Education and Empowerment. Sexual Division of Power: 4) HIV Risk and 5) Relationship Dynamics. Cathexis: Affective Influences/Social Norms: 6) HIV/AIDS Knowledge and 7) Prevention and Testing. Importantly, participants were concerned about partner fidelity when visiting the Dominican Republic, as the country accounts for the second highest HIV rates in the Caribbean. CONCLUSIONS: Our results confirm previous findings about perceptions of HIV risk and provide additional insight into aging-related aspects of HIV risk for Latino women midlife and older.

Actitud Frente a la Salud/etnología , Infecciones por VIH/etnología , Infecciones por VIH/psicología , Hispanoamericanos/psicología , Anciano , República Dominicana/etnología , Femenino , Grupos Focales , Hispanoamericanos/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Medición de Riesgo , Conducta Sexual/etnología , Parejas Sexuales/psicología , Estados Unidos
Gynecol Oncol ; 155(3): 461-467, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31706666


OBJECTIVE: Although a high proportion of women with advanced stage ovarian cancer die within five years, approximately 30% will survive longer than this. The factors contributing to exceptional survival are currently poorly understood. The viewpoints of ovarian cancer survivors were qualitatively explored to determine the factors they felt have influenced their exceptional ovarian cancer survival. METHODS: Four focus groups, one each in Los Angeles (California), Ann Arbor (Michigan), New York (New York) and Edmonton (Alberta, Canada), were conducted with women who had survived at least five years. Physical activity, diet, meditation, prayer, treatment, complementary medicine, and side effects were explored in semi-structured discussions. The audiotaped sessions were transcribed and coded and then analyzed using Dedoose Version 8.0.35, a qualitative analysis software. RESULTS: Of the 26 women who participated, 23 had advanced stage disease. Three overarching themes emerged: (a) survivors had improved their 'lifestyles', including but not limited to fitness and diet; (b) survivors were able to draw on strong support systems, which included family, friends, support groups, faith communities, and healthcare workers; and (c) survivors had a strong life purpose, which manifested as positivity, taking charge of their lives, and advocating for themselves. CONCLUSIONS: Long-term survivors have varying experiences with their cancer, but identified lifestyle modification, motivation and persistence, strong life purpose, and strong support systems as key elements in their better survival. These preliminary findings indicate the need for further prospective studies to determine whether meaningful differences exist between short term and long term survivors on these characteristics.

Supervivientes de Cáncer/psicología , Neoplasias Ováricas/psicología , Alberta/epidemiología , California/epidemiología , Femenino , Grupos Focales , Estilo de Vida Saludable , Humanos , Michigan/epidemiología , Persona de Mediana Edad , Estadificación de Neoplasias , New York/epidemiología , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/patología , Neoplasias Ováricas/terapia , Apoyo Social
Br J Nurs ; 28(21): 1394-1398, 2019 Nov 28.
Artículo en Inglés | MEDLINE | ID: mdl-31778343


A coaching pilot was developed following the publication of a number of reports that recommended a review into how student nurses are taught in clinical practice. A bespoke version of the Collaborative Learning in Practice (CLiP) model was developed, which used both coaching and peer learning to encourage students to lead the delivery of care for a designated group of patients. A senior student led a team consisting of two junior students and they were given the responsibility of directing and coordinating the team in the manner expected of a registered nurse. A qualified nurse was responsible for the supervision of the students and used a coaching approach to teach. Findings from an evaluation revealed that the students benefitted from being able to work autonomously and were able to enhance their leadership and management skills.

Docentes de Enfermería/psicología , Relaciones Interprofesionales , Tutoría/métodos , Personal de Enfermería/psicología , Estudiantes de Enfermería/psicología , Grupos Focales , Humanos , Aprendizaje , Investigación en Educación de Enfermería , Investigación en Evaluación de Enfermería , Investigación Metodológica en Enfermería
Tidsskr Nor Laegeforen ; 139(17)2019 Nov 19.
Artículo en Noruego, Inglés | MEDLINE | ID: mdl-31746175


BACKGROUND: The doctors' strike in 2016 highlighted an ongoing debate on the tightening of working conditions for doctors. With this strike as a backdrop, we wanted to investigate the attitudes and expectations for future working conditions among medical students. MATERIAL AND METHOD: Four focus-group interviews with a total of 21 medical students (48 % women, age 21-38 years) in their third to sixth year of study were conducted and analysed with the aid of systematic text condensation. RESULTS: The students described how the doctors' efforts to help each other had a positive effect on the working environment, but might also paradoxically worsen the working conditions of the collegial community. They highlighted the importance of consensus around public health services, a good professional community and idealism, but perceived that these aspects could be threatened by competition for positions and distrust in political governance processes. The need to be competent and succeed in competing for temporary jobs, as well as a strong motivation to become a doctor, made the students vulnerable to accepting tough working conditions. The students' attitudes and expectations had mainly been formed through work placement experience and by family members, but the strike had impacted particularly the older cohorts' assessment of their future working situation. INTERPRETATION: Medical students express concerns about accepting entry into a system that they are not immediately able to change, and where safeguarding their own needs and a favourable work-life balance might be difficult. This has implications for raising awareness of these issues during the medical studies and developing an organisational culture that ensures justifiable and sustainable working conditions for doctors.

Actitud del Personal de Salud , Médicos , Estudiantes de Medicina , Adulto , Femenino , Grupos Focales , Humanos , Masculino , Motivación , Adulto Joven
Pan Afr Med J ; 34: 10, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31762879


Introduction: There is an increasing commitment in the African Region towards diabetes care, following acknowledgement that it is an important public health issue which needs to be addressed in order to improve population health. We conducted a situational analysis of diabetes care in Guinea Bissau in order to identify the main issues faced in the management of the disease in this country. Methods: The study design was qualitative and data collection was done using semi directive interviews and focus groups with participants involved in primary diabetes care and management in Guinea Bissau (health care professionals, non-governmental organization staff, traditional healers) and patients. The data was analyzed using the five-phase approach of the thematic analysis framework. Results: The major themes identified included: the lack of specialists and properly trained healthcare personnel; no standardized care protocol for diagnosis, treatment, follow up and proper management for diabetic patients; resources poor primary health care settings; no validated epidemiological dataset on prevalence and the lack of awareness about diabetes (in general population and also in medical staff). Conclusion: This first situational analysis can serve as a baseline to develop an action plan to address the main issues identified.

Diabetes Mellitus/terapia , Personal de Salud/organización & administración , Atención Primaria de Salud/organización & administración , Adulto , Niño , Diabetes Mellitus/diagnóstico , Grupos Focales , Guinea Bissau , Humanos , Entrevistas como Asunto
BMC Health Serv Res ; 19(1): 693, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615529


BACKGROUND: Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognized as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP project, a public-private partnership, tests a community-based model that engages the private sector and utilizes information and communication technology (ICT) to control hypertension. This paper, focuses on the various challenges associated with managing hypertension in Ghana, as reported by ComHIP stakeholders. METHODS: A total of 55 informants - comprising patients, health care professionals, licensed chemical sellers (LCS), national and sub-national policymakers - were purposively selected for interview and focus group discussions (FGDs). Interviews were audio-recorded and transcribed verbatim. Where applicable, transcriptions were translated directly from local language to English. The data were then analysed using two-step thematic analysis. The protocol was approved by the two ethics review committees based in Ghana and the third, based in the United Kingdom. All participants were interviewed after giving informed consent. RESULTS: Our data have implications for the on-going implementation of ComHIP, especially the importance of policy maker buy-in, and the benefits, as well as drawbacks, of the program to different stakeholders. While our data show that the ComHIP initiative is acceptable to patients and healthcare providers - increasing providers' knowledge on hypertension and patients' awareness of same- there were implementation challenges identified by both patients and providers. Policy level challenges relate to task-sharing bottlenecks, which precluded nurses from prescribing or dispensing antihypertensives, and LCS from stocking same. Medication adherence and the phenomenon of medical pluralism in Ghana were identified challenges. The perspectives from the national level stakeholders enable elucidation of whole of health system challenges to ComHIP and similarly designed programmes. CONCLUSIONS: This paper sheds important light on the patient/individual, and system level challenges to hypertension and related non-communicable disease prevention and treatment in Ghana. The data show that although the ComHIP initiative is acceptable to patients and healthcare providers, policy level task-sharing bottlenecks preclude optimal implementation of ComHIP.

Hipertensión/prevención & control , Enfermedades no Transmisibles/prevención & control , Personal Administrativo , Adulto , Concienciación , Servicios de Salud Comunitaria/organización & administración , Femenino , Grupos Focales , Ghana , Programas de Gobierno , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Política de Salud , Hospitales , Humanos , Masculino , Asistencia Médica , Sector Privado , Salud Pública , Sector Público , Asociación entre el Sector Público-Privado , Investigación Cualitativa , Factores de Riesgo
Sante Publique ; Vol. 31(3): 405-415, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31640328


INTRODUCTION: Poor oral health in persons with schizophrenia is a major public health issue affecting 600,000 people in France. The aim of this article was to present the different stages in the development of a specific oral health educational program for persons with schizophrenia. It takes into account experimental knowledge of these persons and presents the results of the feasibility study. PATIENTS AND METHOD: The focus group method was applied to a group of health professionals and users to highlight an exploratory corpus in order to develop an oral health educational program. An expert group including persons with schizophrenia among others validated the fields and tools of this program. A feasibility study was then conducted in a control group of 7 persons with schizophrenia. RESULTS: Altogether, 26 persons participated in this feasibility study. The main fields investigated by the expert group aimed to promote personal responsibility for one's health, to improve access to the healthcare system and to promote the global management of health. The feasibility study showed the ability of this program to change persons with schizophrenia representations and knowledge of this health problem. Most educational tools were considered relevant. CONCLUSION: An oral health educational program was built as part of a caregiver-persons with schizophrenia partnership and showed its feasibility. A multicentric randomized trial is currently ongoing to assess the efficacy of this program with a high level of proof.

Cuidadores/psicología , Salud Bucal/educación , Educación del Paciente como Asunto/organización & administración , Esquizofrenia/terapia , Estudios de Factibilidad , Grupos Focales , Francia , Humanos