Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 32.967
Filtrar
1.
Artículo en Inglés | MEDLINE | ID: mdl-34204913

RESUMEN

Research points to the health benefits of rehabilitation in urban green spaces. Nevertheless, more studies indicate complexity of utilising urban green spaces in an established health system context. An understanding of challenges related to rehabilitation in urban green spaces remains unaddressed. Therefore, the aim was to describe and analyse people with disabilities' and health professionals' perceptions on combining traditional indoor rehabilitation practice with an urban green rehabilitation context. The interpretive description methodology was applied supplemented by Edgar Schein's Model of Organisational Culture. Three online focus group interviews were conducted with people with disabilities (n = 4) and health professionals (n = 10). Three interrelated themes formed an understanding of rehabilitation practice in an urban green rehabilitation context: "ambivalence due to contextual change", "negotiating rehabilitation assumptions" and "expanding the frame of rehabilitation". Expanding the frame of rehabilitation to an urban green context may provide a basis for enhancing compatibility to everyday life for people with disabilities and still accommodate structural quality standards of professional rehabilitation practice.


Asunto(s)
Personas con Discapacidad , Grupos Focales , Personal de Salud , Humanos , Percepción , Práctica Profesional
2.
BMC Fam Pract ; 22(1): 143, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-34210284

RESUMEN

BACKGROUND: Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams' delivery of mental health care. METHODS: A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. RESULTS: We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. CONCLUSIONS: From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care's capacity for mental health care for the duration of the pandemic and beyond.


Asunto(s)
COVID-19 , Prestación Integrada de Atención de Salud/organización & administración , Servicios de Salud Mental , Grupo de Atención al Paciente/organización & administración , Atención Primaria de Salud , Telemedicina , Adulto , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/psicología , Femenino , Grupos Focales , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Salud Mental/tendencias , Servicios de Salud Mental/normas , Servicios de Salud Mental/provisión & distribución , Ontario/epidemiología , Pautas de la Práctica en Medicina/tendencias , Atención Primaria de Salud/métodos , Atención Primaria de Salud/tendencias , Mejoramiento de la Calidad/organización & administración , SARS-CoV-2 , Telemedicina/métodos , Telemedicina/estadística & datos numéricos
3.
Prev Med ; 151: 106542, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34217409

RESUMEN

The COVID-19 pandemic resulted in numerous changes in delivery of healthcare services, including breast cancer screening and surveillance. Although facilities have implemented a number of strategies to provide services, women's thoughts and experiences related to breast cancer screening and surveillance during a pandemic are not well known. This focus group study with women across seven states recruited through the Breast Cancer Surveillance Consortium aims to remedy this gap in information. Thirty women ranging in age from 31 to 69 participated in five virtual focus groups, eight of whom had prior breast cancer. The first three focus groups covered a range of topics related to screening and surveillance during the pandemic while the last two groups covered experiences and then a review of sample communications to women about screening and surveillance during the pandemic to obtain reactions and recommendations. More than half of the women had screening or surveillance during the pandemic. Coding and analyses resulted in nine themes in three topic areas: decision factors, screening experiences, and preferred communications. Themes included weighing the risks of COVID-19 versus cancer; feelings that screening and surveillance were mostly safe but barriers may be heightened; feeling safe when undergoing screening but receiving a range of pandemic-specific communications from none to a lot; and wanting communications that are personalized, clear and concise. Based on these findings, providers and facilities should assure women of pandemic safety measures, review methods and content of communications, and assess for barriers to screening that may be amplified during the pandemic, including anxiety and access.


Asunto(s)
Neoplasias de la Mama , COVID-19 , Neoplasias de la Mama/diagnóstico , Detección Precoz del Cáncer , Femenino , Grupos Focales , Humanos , Pandemias , SARS-CoV-2 , Estados Unidos
4.
Cien Saude Colet ; 26(7): 2807-2817, 2021 Jul.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-34231693

RESUMEN

This article describes health service utilization by Quilombola and non-Quilombola adolescents living in a rural area in the semi-arid region of Bahia. Quantitative and qualitative methods were used to gain a more in-depth understanding of the object of study. A cross-sectional household survey was conducted with 390 adolescents. Health service utilization was described using frequency distribution and 95% confidence intervals. Discussions were held with four focus groups, which were transcribed and analyzed using content analysis. The most commonly reported usual place of care was the local family care center (70,0%) and 15,1% of the adolescents had sought health care in the last 15 days. The main reason for seeking care was illness (37,3%). The findings of the qualitative component of the study reveal multiple factors influencing access to services, including long waiting times, lack of prioritization of adolescent care and geographical barriers. Health services should attempt to get closer adolescents and provide care tailored to the specific needs of this group.


Asunto(s)
Accesibilidad a los Servicios de Salud , Servicios de Salud , Adolescente , Brasil , Estudios Transversales , Grupos Focales , Humanos
5.
Health Qual Life Outcomes ; 19(1): 175, 2021 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-34225737

RESUMEN

BACKGROUND: Although telemedical applications are increasingly used in the area of both mental and physical illness, there is no quality of life (QoL) instrument that takes into account the specific context of the healthcare setting. Therefore, the aim of this study was to determine a concept of quality of life in telemedical care to inform the development of a setting-sensitive patient-reported outcome measure. METHODS: Overall, 63 semi-structured single interviews and 15 focus groups with 68 participants have been conducted to determine the impact of telemedical care on QoL. Participants were patients with chronic physical or mental illnesses, with or without telemedicine supported healthcare as well as telemedical professionals. Mayring's content analysis approach was used to encode the qualitative data using MAXQDA software. RESULTS: The majority of aspects that influence the QoL of patients dealing with chronic conditions or mental illnesses could be assigned to an established working model of QoL. However, some aspects that were considered important (e. g. perceived safety) were not covered by the pre-existing domains. For that reason, we re-conceptualized the working model of QoL and added a sixth domain, referred to as healthcare-related domain. CONCLUSION: Interviewing patients and healthcare professionals brought forth specific aspects of QoL evolving in telemedical contexts. These results reinforce the assumption that existing QoL measurements lack sensitivity to assess the intended outcomes of telemedical applications. We will address this deficiency by a telemedicine-related re-conceptualization of the assessment of QoL and the development of a suitable add-on instrument based on the resulting category system of this study.


Asunto(s)
Enfermedad Crónica , Calidad de Vida , Telemedicina , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Grupos Focales , Humanos , Entrevistas como Asunto , Masculino , Trastornos Mentales , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Investigación Cualitativa , Adulto Joven
6.
Curr Oncol ; 28(3): 2248-2259, 2021 06 17.
Artículo en Inglés | MEDLINE | ID: mdl-34204531

RESUMEN

Patients awaiting cancer treatment were classified as "vulnerable" and advised to shield to protect themselves from exposure to coronavirus during the pandemic. These measures can negatively impact patients. We sought to establish the feasibility and effects of a telehealth-delivered home-based prehabilitation program during the pandemic. Eligible patients were referred from multiple centers to a regional prehabilitation unit providing home-based prehabilitation. The enrolled patients received telehealth-delivered prehabilitation prior to surgery and/or during non-surgical cancer treatment, which included personalized training exercises, dietary advice, medical optimization therapies, and psychological support. The primary outcome was to investigate the feasibility of our program. The secondary outcome was to investigate the relationship between our program and patient-reported outcomes (PROs). The patients completed two questionnaires (the EQ-5D-3L and the FACIT-Fatigue Scale) pre- and post-intervention. A total of 182 patients were referred during the study period. Among the 139 (76%) patients that were enrolled, 100 patients completed the program, 24 patients have still to complete, and 15 have discontinued. A total of 66 patients were able to return completed questionnaires. These patients were recruited from colorectal, urology, breast, and cardiothoracic centers. The patients significantly improved their self-perceived health (p = 0.001), and fatigue (p = 0.000). Home-based prehabilitation is a feasible intervention. The PROs improved post-intervention.


Asunto(s)
COVID-19/epidemiología , Neoplasias/terapia , Telemedicina/métodos , Anciano , Inglaterra , Ejercicio Físico , Estudios de Factibilidad , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/psicología , Medicina de Precisión/métodos , Cuidados Preoperatorios , Ejercicio Preoperatorio , Estudios Prospectivos , Calidad de Vida , Resultado del Tratamiento
7.
BMC Res Notes ; 14(1): 276, 2021 Jul 21.
Artículo en Inglés | MEDLINE | ID: mdl-34289873

RESUMEN

OBJECTIVE: Marginalised populations are less likely to take part in health research, and are sometimes considered 'easy to ignore'. We aimed to describe our approach and results of recruiting parents who experience disadvantage, for focus groups exploring infant feeding on the island of Ireland. Upon receiving ethical approval, we implemented recruitment strategies that included building rapport with community organisations through existing networks, targeting specific organisations with information about our aims, and utilising social media groups for parents. RESULTS: We approached 74 organisations of which 17 helped with recruitment. We recruited 86 parents/carers (one male) for 19 focus groups (15 urban/4 rural). Seventy two percent met at the eligibility criteria. Most participants were recruited through organisations (91%), and the remainder on social media (9%). Recruitment barriers included multiple steps, research fatigue, or uncertainty around expectations. Factors such as building rapport, simplifying the recruitment process and being flexible with procedures were facilitators. Despite comprehensive, multi-pronged approaches, the most marginalised parents may not have been reached. Further alternative recruitment strategies are required for recruiting fathers, rural populations, or those without the capacity or opportunity to engage with local services.


Asunto(s)
Promoción de la Salud , Medios de Comunicación Sociales , Grupos Focales , Humanos , Lactante , Irlanda , Masculino , Investigación Cualitativa
8.
BMC Health Serv Res ; 21(1): 714, 2021 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-34284758

RESUMEN

BACKGROUND: Extreme disparities in access, experience, and outcomes highlight the need to transform how pregnancy care is designed and delivered in the United States, especially for low-income individuals and people of color. METHODS: We used human-centered design (HCD) to understand the challenges facing Medicaid-insured pregnant people and design interventions to address these challenges. The HCD method has three phases: Inspiration, Ideation, and Implementation. This study focused on the first and second. In the Inspiration phase we conducted semi-structured interviews with a purposeful sample of stakeholders who had either received or participated in the care of Medicaid-insured pregnant people within our community, with a specific emphasis on representation from marginalized communities. Using a general inductive approach to thematic analysis, we identified themes, which were then framed into design opportunities. In the Ideation phase, we conducted structured brainstorming sessions to generate potential prototypes of solutions, which were tested and iterated upon through a series of community events and engagement with a diverse community advisory group. RESULTS: We engaged a total of 171 stakeholders across both phases of the HCD methodology. In the Inspiration phase, interviews with 23 community members and an eight-person focus group revealed seven insights centered around two main themes: (1) racism and discrimination create major barriers to access, experience, and the ability to deliver high-value pregnancy care; (2) pregnancy care is overmedicalized and does not treat the pregnant person as an equal and informed partner. In the Ideation phase, 162 ideas were produced and translated into eight solution prototypes. Community scoring and feedback events with 140 stakeholders led to the progressive refinement and selection of three final prototypes: (1) implementing telemedicine (video visits) within the safety-net system, (2) integrating community-based peer support workers into healthcare teams, and (3) delivering co-located pregnancy-related care and services into high-need neighborhoods as a one-stop shop. CONCLUSIONS: Using HCD methodology and a collaborative community-health system approach, we identified gaps, opportunities, and solutions to address perinatal care inequities within our urban community. Given the urgent need for implementable and effective solutions, the design process was particularly well-suited because it focuses on understanding and centering the needs and values of stakeholders, is multi-disciplinary through all phases, and results in prototyping and iteration of real-world solutions.


Asunto(s)
Atención Perinatal , Diseño Universal , Niño , Femenino , Grupos Focales , Humanos , Recién Nacido , Medicaid , Embarazo , Atención Prenatal , Estados Unidos
9.
Reprod Health ; 18(1): 147, 2021 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-34243778

RESUMEN

BACKGROUND: Cervical cancer is the second leading cause of cancer-related death among women in sub-Saharan countries, constituting a major public health concern. In Cameroon, cervical cancer ranks as the second most common type of cancer among women and the leading cause of cancer-related deaths, mainly due to the lack of prevention. OBJECTIVES: Our first and main objective was to understand the barriers affecting women's decision-making process regarding participation in a cervical cancer screening program in the Dschang district (West Cameroon). Second, we aimed to explore the acceptability and perception of a single-visit approach (screen and treat). METHODS: A qualitative study using focus groups (FGs) was conducted from February to March 2020. Female participants aged between 30 and 49 years and their male partners were invited to participate. Thematic analysis was used, and barriers were classified according to the three-delay model of Thaddeus and Maine. RESULTS: In total, six FGs with 43 participants (31 women and 12 men) were conducted. The most important barriers were lack of health literacy, low accessibility of the program (in respect to cost and distance), and disrespectful treatment by healthcare workers. CONCLUSIONS: Our study identified three needs: (1) enhancing health literacy; (2) improving the delivery of cervical cancer screening in rural areas; and (3) providing training for healthcare providers and community healthcare workers to improve patient-provider-communication. Trial registration Ethical Cantonal Board of Geneva, Switzerland (CCER, N°2017-0110 and CER-amendment n°3) and Cameroonian National Ethics Committee for Human Health Research (N°2018/07/1083/CE/CNERSH/SP). NCT: 03757299.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Alfabetización en Salud , Neoplasias del Cuello Uterino , Adulto , Actitud del Personal de Salud , Camerún , Detección Precoz del Cáncer , Femenino , Grupos Focales , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Investigación Cualitativa , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/etnología , Neoplasias del Cuello Uterino/prevención & control
10.
Artículo en Inglés | MEDLINE | ID: mdl-34204475

RESUMEN

Multiple sclerosis (MS) is a chronic, inflammatory autoimmune disease of the central nervous system mainly of adults ranging from 20 to 45 years of age. The risk of developing MS is 50% higher in women than in men. Most people with MS (PwMS) experience a spectrum of symptoms such as spasticity, continence dysfunctions, fatigue, or neurobehavioral manifestations. Due to the complexity of MS and the variety of patient-centered needs, a comprehensive approach of interprofessional collaboration (IPC) of multiple health care professionals (HCP) is necessary. The aim of this qualitative study was to explore the meaning of IPC in the comprehensive care of PwMS from a HCP perspective. Focus groups (FG) with HCP were conducted, recorded, and transcribed verbatim. The sample contained HCP from three MS clinics in different phases of care and rehabilitation. Four main categories emerged: (a) experience with IPC, (b) relevant aspects for IPC in patients' treatment, (c) differences in in- and outpatient settings, and (d) influence of patient perspective. IPC plays a crucial role in HCP perspective when treating PwMS, which can benefit from an IPC therapeutic approach because HCP work together in a patient-centered way. The inpatient setting of HCP strongly supports the implementation of IPC. This prerequisite does not exist in outpatient settings.


Asunto(s)
Relaciones Interprofesionales , Esclerosis Múltiple , Adulto , Conducta Cooperativa , Atención a la Salud , Femenino , Grupos Focales , Personal de Salud , Humanos , Masculino , Esclerosis Múltiple/terapia , Suiza
11.
Scand J Trauma Resusc Emerg Med ; 29(1): 99, 2021 Jul 21.
Artículo en Inglés | MEDLINE | ID: mdl-34289881

RESUMEN

BACKGROUND: In chemical incidents, infrequent but potentially disastrous, the World Health Organization calls for inter-organizational coordination of actors involved. Multi-organizational studies of chemical response capacities are scarce. We aimed to describe chemical incident experiences and perceptions of Swedish fire and rescue services, emergency medical services, police services, and emergency dispatch services personnel. METHODS: Eight emergency service organizations in two distinct and dissimilar regions in Sweden participated in one organization-specific focus group interview each. The total number of respondents was 25 (7 females and 18 males). A qualitative inductive content analysis was performed. RESULTS: Three types of information processing were derived as emerging during acute-phase chemical incident mobilization: Unspecified (a caller communicating with an emergency medical dispatcher), specified (each emergency service obtaining organization-specific expert information), and aligned (continually updated information from the scene condensed and disseminated back to all parties at the scene). Improvable shortcomings were identified, e.g. randomness (unspecified information processing), inter-organizational reticence (specified information processing), and downprioritizing central information transmission while saving lives (aligned information processing). CONCLUSIONS: The flow of information may be improved by automation, public education, revised dispatcher education, and use of technical resources in the field. Future studies should independently assess these mechanism's degree of impact on mobilisation of emergency services in chemical incidents.


Asunto(s)
Liberación de Peligros Químicos , Operador de Emergencias Médicas/estadística & datos numéricos , Servicios Médicos de Urgencia/organización & administración , Desastres , Femenino , Grupos Focales , Humanos , Masculino , Policia , Suecia/epidemiología
12.
BMC Health Serv Res ; 21(1): 633, 2021 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-34210298

RESUMEN

BACKGROUND: Total knee arthroplasty (TKA) is performed to treat end-stage knee osteoarthritis. In Germany, a minimum volume threshold of 50 TKAs/hospital/year was implemented to ensure outcome quality. This study, embedded within a systematic review, aimed to investigate the perspectives of potential TKA patients on the hospital volume-outcome relationship for TKA (higher volumes associated with better outcomes). METHODS: A convenience sample of adults with knee problems and heterogeneous demographic characteristics participated in the study. Qualitative data were collected during a focus group prior to the systematic review (n = 5) and during telephone interviews, in which preliminary results of the systematic review were discussed (n = 16). The data were synthesised using content analysis. RESULTS: All participants (n = 21) believed that a hospital volume-outcome relationship exists for TKA while recognising that patient behaviour or the surgeon could also influence outcomes. All participants would be willing to travel longer for better outcomes. Most interviewees would choose a hospital for TKA depending on reputation, recommendations, and service quality. However, some would also choose a hospital based on the results of the systematic review that showed slightly lower mortality/revision rates at higher-volume hospitals. Half of the interviewees supported raising the minimum volume threshold even if this were to increase travel time to receive TKA. CONCLUSIONS: Potential patients believe that a hospital volume-outcome relationship exists for TKA. Hospital preference is based mainly on subjective factors, although some potential patients would consider scientific evidence when making their choice. Policy makers and physicians should consider the patient perspectives when deciding on minimum volume thresholds or recommending hospitals for TKA, respectively.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Grupos Focales , Alemania , Hospitales de Alto Volumen , Humanos , Osteoartritis de la Rodilla/cirugía , Resultado del Tratamiento
13.
Comunidad (Barc., Internet) ; 23(1): 0-0, mar.-jun. 2021. tab
Artículo en Español | IBECS | ID: ibc-201953

RESUMEN

OBJETIVO: Conocer los cambios percibidos por las mujeres participantes de un grupo de empoderamiento sobre su estado físico, psíquico y social. DISEÑO: Metodología cualitativa mediante grupos focales. EMPLAZAMIENTO: Centro de salud (CS) urbano. PARTICIPANTES Y7O CONTEXTOS: Mujeres incluidas en alguna edición del Programa de Grupo de Empoderamiento del CS, dirigido por la trabajadora social desde 2012. MÉTODO: Grupos focales audiograbados durante 60-70 minutos. Transcripción literal, codificación y triangulación de los datos, comprobando saturación de la información. Análisis con MaxQDA. RESULTADOS: Desde el punto de vista psicológico, la situación previa de las participantes presentaba una baja autoestima, sintiéndose por lo general relegadas al último lugar en la jerarquía familiar. Las herramientas adquiridas durante las sesiones les ha permitido reivindicar un papel de mayor protagonismo. Respecto a su estado de salud físico, no perciben cambios importantes, excepto la menor dependencia farmacológica y la mayor capacidad para afrontar sus problemas de salud. A su vez, este programa les ha proporcionado la oportunidad de crear nuevas relaciones fuera de su entorno habitual. En contraposición, se comprueba una gran dependencia a la pertenencia al grupo. CONCLUSIONES: Destaca que el aprendizaje y la adquisición de nuevas herramientas, la mejora y ampliación de la red social, así como los cambios en la percepción de su propio yo, han dotado a las mujeres de mayor autonomía y ha mejorado su autoestima globalmente. En los aspectos negativos destaca la gran dependencia del grupo hacia la figura dinamizadora, que dificulta su propia autonomía


OBJECTIVE: To ascertain the changes perceived by the women participating in an empowerment group on their physical, mental and social state. DESIGN: Qualitative methodology by means of focus groups. LOCATION: Urban Health Centre (HC). Participants and/or backgrounds. Female sex, included in an edition of the HS Empowerment Group Programme, which has been supervised by the social worker since 2012. METHOD: Audio-recorded focus groups 60-70 minutes long. Literal transcription, coding and triangulation of the data guaranteeing information saturation. Analysis with MaxQDA. RESULTS: From the psychological point of view, the previous situation of the participants presented a low self-esteem, feeling in general relegated to the last place in the family hierarchy. The tools acquired during sessions enabled them to claim a role of greater prominence. Regarding their state of physical health, they do not perceive important changes except lower pharmacological dependence and greater capacity to tackle their health problems. In turn, this programme has provided them with the opportunity to create new relationships outside their usual environment. In contrast, a major dependence on belonging to the group was revealed. CONCLUSIONS: It is notable that learning and the acquisition of new tools, improvement and expansion of the social network, as well as changes in the perception of their own selves, have given women greater autonomy and have improved their self-esteem globally. In terms of negative aspects, the major dependence of the group on the dynamic figure, which hinders its own autonomy, stands out


Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Empoderamiento para la Salud/métodos , Estado de Salud , Salud Mental , Calidad de Vida , Empoderamiento para la Salud/organización & administración , Grupos Focales , Educación en Salud/organización & administración , Autonomía Personal , Investigación Cualitativa , Trastornos de Ansiedad/epidemiología , Depresión , Autoimagen , Relaciones Interpersonales
14.
Stud Health Technol Inform ; 282: 102-119, 2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-34085962

RESUMEN

For the creation of inclusive design solutions, designers require relevant knowledge about a diversity of users throughout the design process. Besides understanding users' needs and expectations, the ways in which users perceive and experience the environment contain valuable knowledge for designers. Since users' perceptions and experiences are mainly tacit by nature, they are much more difficult to communicate and therefore more difficult to externalize. Hence, more insight is needed into the ways designers can build knowledge on Universal Design through direct user contact. In a project called 'Light up for all' architecture students are asked to design a light switch and socket, elegant, usable and understandable to the greatest extent possible by everyone. Two workshops with user/experts are organized in the first stages of the design process in which students could gain insight into users' experiences and perceptions through direct contact. Three data collection techniques are used to analyze the teams' design processes: (1) a design diary, (2) observations of the workshops and (3) a focus group. By means of analyzing collected qualitative data, we have identified three different design aspects that affect designers' UD knowledge building process. First, findings give indications on values and limitations of working with selected design artefacts when externalizing users' experiences. Second, the value of stories clearly affected designers' deeper understanding about users' experiences. Finally, results show that in some situations, designers encountered contradictory information between observations and verbal conversations. These insights may help researchers to better understand designers' process of building knowledge on UD from users' experiences and perceptions, which may result in better incorporating users' experiences when designing for everyone.


Asunto(s)
Comunicación , Diseño Universal , Recolección de Datos , Grupos Focales , Humanos , Estudiantes
15.
J Pak Med Assoc ; 71(5): 1476-1478, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34091638

RESUMEN

This qualitative study aimed to explore medical students' experience of generation gap in their interactions with senior teachers (aged >55) in Japan. Focus group interviews were conducted with 28 medical students (20 to 30 years, mean age 22 ±2 years, classified as millennials, with only one year of studies since starting specialised courses for medicine. The participants were interviewed in groups of four, with each interview lasting 60 minutes. Topics covered included generation gap experienced in daily life and during their studies, and work-life balance issues. The discussions were recorded and transcribed, and content analysis was applied. Four specific influential generation-gap categories were identified - distinctive sociocultural backgrounds, more recent educational media tools and faster information dissemination speed, new-era values, and challenges in communication - that were consistent with findings from previous studies. More senior personnel involved in medical education need to consider these categories to enhance effectiveness of teaching.


Asunto(s)
Educación Médica , Estudiantes de Medicina , Adulto , Grupos Focales , Humanos , Relaciones Intergeneracionales , Investigación Cualitativa , Adulto Joven
16.
BMC Infect Dis ; 21(1): 511, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-34074268

RESUMEN

INTRODUCTION: Discontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death. DTT in children is understudied in Uganda. We examined the level and factors associated with DTT among children at four large health facilities in Kampala Capital City Authority and documented the reasons for DTT from treatment supporters and healthcare provider perspectives. METHODS: We conducted a retrospective analysis of records for children < 15 years diagnosed and treated for TB between January 2018 and December 2019. We held focus group discussions with treatment supporters and key informant interviews with healthcare providers. We defined DTT as the stoppage of TB treatment for 30 or more consecutive days. We used a stepwise generalized linear model to assess factors independently associated with DTT and content analysis for the qualitative data reported using sub-themes. RESULTS: Of 312 participants enrolled, 35 (11.2%) had discontinued TB treatment. The reasons for DTT included lack of privacy at healthcare facilities for children with TB and their treatment supporters, the disappearance of TB symptoms following treatment initiation, poor implementation of the community-based directly observed therapy short-course (CB-DOTS) strategy, insufficient funding to the TB program, and frequent stock-outs of TB drugs. DTT was more likely during the continuation phase of TB treatment compared to the intensive phase (Adjusted odds ratio (aOR), 5.22; 95% Confidence Interval (CI), 1.76-17.52) and when the treatment supporter was employed compared to when the treatment supporter was unemployed (aOR, 3.60; 95% CI, 1.34-11.38). CONCLUSION: Many children with TB discontinue TB treatment and this might exacerbate TB morbidity and mortality. To mitigate DTT, healthcare providers should ensure children with TB and their treatment supporters are accorded privacy during service provision and provide more information about TB symptom resolution and treatment duration versus the need to complete treatment. The district and national TB control programs should address gaps in funding to TB care, the supply of TB drugs, and the implementation of the CB-DOTS strategy.


Asunto(s)
Tuberculosis/tratamiento farmacológico , Adolescente , Niño , Preescolar , Terapia por Observación Directa , Femenino , Grupos Focales , Instituciones de Salud , Humanos , Lactante , Recién Nacido , Masculino , Oportunidad Relativa , Estudios Retrospectivos , Tuberculosis/epidemiología , Tuberculosis/prevención & control , Uganda/epidemiología
17.
Reprod Health ; 18(1): 110, 2021 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-34078408

RESUMEN

BACKGROUND: Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity globally. Planned delivery between 34+0 and 36+6 weeks may reduce adverse pregnancy outcomes but is yet to be evaluated in a low and middle-income setting. Prior to designing a randomised controlled trial to evaluate this in India and Zambia, we carried out a 6-month feasibility study in order to better understand the proposed trial environment and guide development of our intervention. METHODS: We used mixed methods to understand the disease burden and current management of pre-eclampsia at our proposed trial sites and explore the acceptability of the intervention. We undertook a case notes review of women with pre-eclampsia who delivered at the proposed trial sites over a 3-month period, alongside facilitating focus group discussions with women and partners and conducting semi-structured interviews with healthcare providers. Descriptive statistics were used to analyse audit data. A thematic framework analysis was used for qualitative data. RESULTS: Case notes data (n = 326) showed that in our settings, 19.5% (n = 44) of women with pre-eclampsia delivering beyond 34 weeks experienced an adverse outcome. In women delivering between 34+0 and 36+6 weeks, there were similar numbers of antenatal stillbirths [n = 3 (3.3%)] and neonatal deaths [n = 3 (3.4%)]; median infant birthweight was 2.2 kg and 1.9 kg in Zambia and India respectively. Lived experience of women and healthcare providers was an important facilitator to the proposed intervention, highlighting the serious consequences of pre-eclampsia. A preference for spontaneous labour and limited neonatal resources were identified as potential barriers. CONCLUSIONS: This study demonstrated a clear need to evaluate the intervention and highlighted several challenges relating to trial context that enabled us to adapt our protocol and design an acceptable intervention. Our study demonstrates the importance of assessing feasibility when developing complex interventions, particularly in a low-resource setting. Additionally, it provides a unique insight into the management of pre-eclampsia at our trial settings and an understanding of the knowledge, attitudes and beliefs underpinning the acceptability of planned early delivery.


Asunto(s)
Parto Obstétrico , Preeclampsia/epidemiología , Nacimiento Prematuro , Estudios de Factibilidad , Femenino , Grupos Focales , Humanos , India/epidemiología , Lactante , Recién Nacido , Embarazo , Zambia/epidemiología
18.
BMC Public Health ; 21(1): 1029, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-34074273

RESUMEN

BACKGROUND: In Bangladesh overweight and obesity among urban school children are on the rise. Urban school children tend to consume foods dense in calories and few fruits and vegetables which is associated with overweight and obesity. The current study explored the barriers and opportunities for promoting healthy diets among school children from the perspective of teachers and parents in Dhaka, Bangladesh. METHODS: We conducted 14 key informant interviews with teachers and principals, six focus group discussions with 31 mothers of school children (5 to 15 year old) and 14 structured observations of the school food environment. Inductive thematic analysis was performed manually. RESULTS: Schools were important for development of food preferences of children, however, most school cafeterias provided foods based on profit rather than health considerations. A shift in food culture resulted in making eating out acquire many meanings beyond convenience. Mothers, especially those who were employed, struggled to prepare healthy foods due to time pressure. Mothers were generally concerned about chemicals added to raw foods in markets which led to limited fruit and vegetable consumption. CONCLUSIONS: There were many challenges to promoting healthy foods to school children within and outside the school. It is important to formulate policies and guidance to create a supportive environment for healthy foods in and in the proximity of schools. It is also important to educate consumers about identifying and choosing healthy foods. Laws related to food safety should be adequately implemented to boost the population's confidence in safety of available healthy foods in the food system.


Asunto(s)
Servicios de Alimentación , Instituciones Académicas , Adolescente , Bangladesh , Niño , Preescolar , Dieta Saludable , Femenino , Grupos Focales , Frutas , Humanos , Investigación Cualitativa , Verduras
19.
Cien Saude Colet ; 26(5): 1637-1646, 2021 May.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-34076106

RESUMEN

The work of Community Health Workers (ACS) was analyzed in light of Communities of Practice (CP) theory. This is a qualitative cross-sectional study carried out in four municipalities in Ceará. Six focus groups and six interviews were carried out with 45 Community Health Workers (ACS), observing ethical aspects. The data corpus was analyzed using the content analysis technique. The results show that ACS participation in the ESF is marked by experience in the community, and the main focus is monitoring priority groups. The practices put them before the diverse social and family complexities, generating reflections and building new meanings for themselves and their work process. The ACS CPs engage and share challenges and unique learning from work, characterized by close contact and relationships with the families of the territory, which reveals needs hardly perceived by other ESF professionals. The meaning of being ACS as one who listens, embraces, and perceives the needs of families invisible to services, is evident in the reification processes. The ACS better exercise their role as ESF articulators in the territories the greater the spaces for dialogue between them, the other team members, and management.


Asunto(s)
Servicios de Salud Comunitaria , Agentes Comunitarios de Salud , Brasil , Estudios Transversales , Grupos Focales , Humanos , Investigación Cualitativa
20.
BMC Public Health ; 21(1): 1091, 2021 06 07.
Artículo en Inglés | MEDLINE | ID: mdl-34098911

RESUMEN

BACKGROUND: The aim was to identify the most important determinants of practice for the implementation of person-centered tools which enhance work participation for patients with chronic health conditions. METHODS: A mixed-method study was conducted consisting of semi-structured interviews, a focus group and a survey. Various stakeholders were involved including (representatives of) workers with chronic health conditions, insurance physicians, occupational physicians, other healthcare professionals, researchers, employers, and policymakers. The semi-structured interviews were performed to identify implementation determinants, followed by a focus group to validate resulting determinants. To conclude, a survey was conducted to select the most important implementation determinants through prioritization by ranking the order of importance. The Tailored Implementation of Chronic Diseases checklist (TICD) was used as concept-driven coding frame for the qualitative analysis of the interviews and focus group. The self-developed survey was based on the domains of the TICD. The survey was analyzed by frequency count of first ranking of determinants per and between domains of the TICD. RESULTS: Various stakeholders participated (N = 27) in the interviews and focus group. The qualitative data retrieved yielded a list of determinants with additional in-depth themes according to the TICD. For the selection of the most important determinants, a survey with 101 respondents was conducted, consisting of occupational physicians, insurance physicians and workers with a chronic health condition. From the seven domains of the TICD, respondents emphasized the importance of taking into account the needs and factors associated with workers with a chronic health condition as this determinant ranked highest. Taking into account the individual needs and wishes of workers was mentioned to enable successful implementation, whereas stress of the workers was indicated to impede implementation. Other important determinants included 'being able to work with the tools' in terms of time and usability or 'cognitions, beliefs and attitudes of occupational and insurance physicians' to be able to use the tools. CONCLUSION: This study identified the most important determinants from the perspective of various stakeholders involved in the implementation of client-centered tools in occupational health for workers with chronic health conditions. Furthermore, by prioritizing the most important determinants, targeted implementation strategies can be developed.


Asunto(s)
Lista de Verificación , Proyectos de Investigación , Enfermedad Crónica , Grupos Focales , Personal de Salud , Humanos , Investigación Cualitativa
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...