Barriers to Elderly Health Care in the Occupied Palestinian Territories.

This study examined different barriers to the access and utilization of primary health care services by the elderly in the occupied Palestinians territories. We collected quantitative data from a larger convenience sample of a national survey of 1299 persons in the occupied Palestinian territories (oPt) that examined the effects of Israel's colonization and its effects on health care delivery between October 2021 and February 2022. The research tool was based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questionnaire. The data was obtained from 76 elderly participants with a mean age of 68.33 years standard deviation (SD = 7.09 years). The majority (75%) reported having at least one chronic health issue and having limited access to health care. They had all finished at least six years of education. The participants claimed having health insurance, while 47.4 percent reported paying for out-of-pocket expenses and medical care was a burden. Access and affordability of health care was a problem for 70 percent of participants. Older persons and their families face access to care issues created by political, geographic, and economic barriers. Poor incomes, war-like conditions, a weak health care system, and a lack of comprehensive care delivery all impact their health.

A mixed methods study of using wasta in healthcare services in Palestine: predictors, consequences and proposed solutions.

BACKGROUND: Equity in access to quality healthcare is a fundamental human right. Yet studies demonstrate that some people receive preferential treatment while others are discriminated against. Wasta is a prevalent strategy whereby personal connections are used for influence and may result in gaining unfair advantages over others. This study aims to investigate wasta use in healthcare, the factors associated with its use, and the impact of wasta use on the equity and quality of healthcare services. METHODS: A mixed-methods study utilizing a quantitative survey and qualitative interviews was conducted in Palestine (West Bank and Gaza) between October 2021 and February 2022. Quantitative analysis was performed using Stata version 14. Bivariate and multivariate logistic regressions assessed the relationship between wasta use and individual-level variables such as gender, residence, age, employment status, and financial situation. Content analyses of qualitative transcripts were performed using Dedoose version 9. Textual quotes were grouped into major and minor themes. RESULTS: Multivariate regressions revealed that wasta use is more prevalent among refugee camp dwellers and more frequent in Gaza compared to the West Bank. Wasta was also employed to a greater degree among government employees. Qualitative interviews complemented the quantitative results and added further insights into the consequences of Wasta use in healthcare settings such as negatively impacting quality and equity in healthcare services. CONCLUSION: Wasta use in healthcare can have an adverse effect on equity and quality. Ensuring efficient processes, reduced financial burdens, stringent accountability measures, transparency, and training programs can contribute to diminishing the need for using wasta in healthcare. By addressing both systemic and cultural factors that perpetuate wasta, societies can move closer to healthcare systems characterized by fairness, accessibility, and ethical integrity.

Experiences of Palestinian patients with hospital services: a mixed-methods study.

BACKGROUND: This study aimed at assessing patient experiences with hospital services and key factors associated with better experiences. METHODS: The study design is cross-sectional supported by qualitative interviews. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was used as data collection instrument. A convenience sample of 391 volunteers aged ≥18 years participated in this study. Qualitative interviews were conducted with patients and healthcare providers to further enrich and explain the quantitative results. RESULTS: The average age of the sample was 41.34, SD (16.4), range (18-87). Females represented 61.9% of the whole sample. Almost 75% were from the West Bank and 25% from the Gaza Strip. The majority of respondents reported that doctors and nurses were respectful, listened to them and explained clearly to them always or most of the time. Only 29.4% of respondents were given written information about the symptoms they may have after discharge from the hospital. Factors that were independently associated with higher scores on the HCAHPS scale were; being females (coef: 0.87, 95% CI: 0.157 to 1.587, p=0.017), being healthy (coef: -1.58, 95% CI: -2.458 to -0.706, p=0.000), being with high financial status (coef: 1.51, 95% CI: 0.437 to 2.582, p=0.006), being from Gaza (coef: 1.45, 95% CI: 0.484 to 2.408, p=0.003) and who visited hospitals outside of Palestine (coef: 3.37, 95% CI: 1.812 to 4.934, p=0.000). Overcrowding, weak organisational and management processes, and inadequate supply of goods, medicines, and equipment were reported factors impeding quality services via in-depth interviews. CONCLUSIONS: The overall hospital experiences of Palestinian patients were moderate but varied significantly based on patients' factors such as sex, health status, financial status and residency as well as by hospital type. Hospitals in Palestine should invest more in improving their services including communications with patients, the hospital environment and communication with patients.

FACT-G Assessment of the Quality of Life for Palestinian Patients with Cancer.

BACKGROUND: Cancer is a leading cause of mortality in Palestine. The number of cancer cases is increasing, whereas the late stage of diagnosis is common for the majority of cases. Modern diagnostics and medicine are contributing to more positive outcomes for patients when diagnosed early; however, the holistic approach to patient care, patient satisfaction, quality of life (QOL), and survivorship are often overlooked. Patients with cancer are usually treated by physicians and other health professionals employing the "medical model" without considering other factors that might positively affect their treatment. For this pioneering survey, the Functional Assessment of Chronic Illness Therapy-General (FACT-G) tool was used. This study aimed to measure the satisfaction of patients with cancer undergoing outpatient treatments and assess their QOL. MATERIALS AND METHODS: The FACT-G scale in Arabic has four sections, measuring physical, emotional, social, and functional well-being, was used in a survey of 203 patients with cancer currently undergoing chemotherapy, radiotherapy, and hormonal therapies. Patients were surveyed in the summer of 2019, within 1 year of diagnosis when they were outpatients, all of whom were attending a major cancer center in a Palestinian hospital. RESULTS: Emotional well-being scored the lowest (from a total of 24; mean 11.31 (standard deviation (SD) 5.45)) whereas social/family well-being scored the highest (from a total of 28), mean 22, (SD ±  5.78). The overall mean for the four sections was 63.57 (SD 12.44). CONCLUSION: To ensure better management of symptoms and treatments, important indicators are now available for health professionals and researchers to learn more about the QOL of patients. Evaluating the physical, social, emotional, and functional states of patients with cancer undergoing outpatient treatments enabled us to learn more about the struggles they face while understanding how they were coping during their cancer journey.

Identification and management of Lynch syndrome in the Middle East and North African countries: outcome of a survey in 12 countries.

BACKGROUND: Lynch syndrome (LS), the most common inherited form of colorectal cancer (CRC), is responsible for 3% of all cases of CRC. LS is caused by a mismatch repair gene defect and is characterized by a high risk for CRC, endometrial cancer and several other cancers. Identification of LS is of utmost importance because colonoscopic surveillance substantially improves a patient's prognosis. Recently, a network of physicians in Middle Eastern and North African (ME/NA) countries was established to improve the identification and management of LS families. The aim of the present survey was to evaluate current healthcare for families with LS in this region. METHODS: A questionnaire was developed that addressed the following issues: availability of clinical management guidelines for LS; attention paid to family history of cancer; availability of genetic services for identification and diagnosis of LS; and assessment of knowledge of LS surveillance. Members of the network and authors of recent papers on LS from ME/NA and neighbouring countries were invited to participate in the survey and complete the online questionnaire. RESULTS: A total of 55 individuals were invited and 19 respondents from twelve countries including Algeria, Azerbaijan, Cyprus, Egypt, Iran, Jordan, Kuwait, Lebanon, Morocco, Palestine, Tunisia, and Turkey completed the questionnaire. The results showed that family history of CRC is considered in less than half of the surveyed countries. Guidelines for the management of LS are available in three out of twelve countries. The identification and selection of families for genetic testing were based on clinical criteria (Amsterdam criteria II or Revised Bethesda criteria) in most countries, and only one country performed universal screening. In most of the surveyed countries genetic services were available in few hospitals or only in a research setting. However, surveillance of LS families was offered in the majority of countries and most frequently consisted of regular colonoscopy. CONCLUSION: The identification and management of LS in ME/NA countries are suboptimal and as a result most LS families in the region remain undetected. Future efforts should focus on increasing awareness of LS amongst both the general population and doctors, and on the improvement of the infrastructure in these countries.

A new hereditary colorectal cancer network in the Middle East and eastern mediterranean countries to improve care for high-risk families.

Colorectal cancer (CRC) has a very high incidence in the western world. Data from registries in the Middle East showed that the incidence of CRC is relatively low in these countries. However, these data also showed that CRC incidence has increased substantially over the past three decades and that a high proportion of cases are diagnosed at an early age (<50 years). In view of these findings, more attention should be paid to prevention. Because of the often limited financial resources, focused screening of individuals with hereditary CRC, in particular those with Lynch syndrome, appears to be the most cost-effective strategy. During recent meetings of the Palestinian Society of Gastroenterology and the Mediterranean Task force for Cancer Control (MTCC) in Jericho, and the Patient's Friends Society of Jerusalem in Hebron the issue of hereditary CRC in the Middle East was discussed and the idea was conceived to establish a network on hereditary colorectal cancer (HCCN-ME) with the goal of improving care for high-risk groups in the Middle East and (Eastern) Mediterranean Countries.

Barriers to breast cancer screening and treatment among women in Emirate of Abu Dhabi.

OBJECTIVES: The objectives of this study were to explore attitudes and beliefs among major national groups of women resident in the Emirate of Abu Dhabi (EAD) in relation to breast cancer screening and treatment. DESIGN: A qualitative study utilizing age and nationality specific focus group discussions and interviews in all parts of EAD. SETTING: Study was conducted among women living in various areas of EAD during April-September 2009. PARTICIPANTS: A total of 329 participants divided into four nationality groups and categorized into two functional groups (well women and regular screeners) were included in this study and participated in 46 focus groups and 30 personal interviews. RESULTS: Some differences in beliefs, perceptions and opinions related to stated causes of breast cancer, preferences regarding breast care services, financial considerations, trust in health services and cultural attitudes towards breast cancer were observed across nationality and age groups. CONCLUSIONS: New information has been obtained that will shape more focused awareness messages, emphasizing on decreasing fear and shame, discouraging use of cauterization and herbal preparations in delaying care, and activating the role of older female peers in favor of breast screening. Ensuring a sufficient number of trained female health care providers and devising creative approaches to ensure preventive health care costs to reimburse non-nationals are structural changes to the health care system which may further improve breast health for all women in EAD.