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BMJ Glob Health ; 6(2)2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33632772


INTRODUCTION: The COVID-19 pandemic has led to a rapid implementation of telemedicine for the provision of maternal and newborn healthcare. The objective of this study was to document the experiences with providing telemedicine for maternal and newborn healthcare during the pandemic among healthcare professionals globally. METHODS: The second round of a global online survey of maternal and newborn health professionals was conducted, disseminated in 11 languages. Data were collected between 5 July and 10 September 2020. The questionnaire included questions regarding background, preparedness and response to COVID-19, and experiences with providing telemedicine. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregated by country income level. RESULTS: Responses from 1060 maternal and newborn health professionals were analysed. Telemedicine was used by 58% of health professionals and two-fifths of them reported not receiving guidelines on the provision of telemedicine. Key telemedicine practices included online birth preparedness classes, antenatal and postnatal care by video/phone, a COVID-19 helpline and online psychosocial counselling. Challenges reported lack of infrastructure and technological literacy, limited monitoring, financial and language barriers, lack of non-verbal feedback and bonding, and distrust from patients. Telemedicine was considered as an important alternative to in-person consultations. However, health providers emphasised the lower quality of care and risk of increasing the already existing inequalities in access to healthcare. CONCLUSIONS: Telemedicine has been applied globally to address disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem difficult to deliver by telemedicine. More research regarding the effectiveness, efficacy and quality of telemedicine for maternal healthcare in different contexts is needed before considering long-term adaptations in provision of care away from face-to-face interactions. Clear guidelines for care provision and approaches to minimising socioeconomic and technological inequalities in access to care are urgently needed.

Pessoal de Saúde/psicologia , Serviços de Saúde Materna , Telemedicina , Barreiras de Comunicação , Feminino , Humanos , Masculino , Inquéritos e Questionários
BMJ Open ; 11(1): e045529, 2021 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514584


INTRODUCTION: The current COVID-19 pandemic has increased the need for populational adherence to measures for the prevention and control of respiratory infectious diseases. However, their effectiveness depends on the population's preventive behaviour, which may be divergent from public policies. Therefore, this study aims to summarise and evaluate the evidence on barriers and facilitators to populational adherence to prevention and control measures in COVID-19 and other respiratory infectious diseases. METHODS AND ANALYSIS: We will search on MEDLINE, Embase and PsycINFO for studies focusing on adults receiving protective behaviour recommendations to combat COVID-19 and other respiratory infectious diseases. The searches will be carried out from database's inception to the present. We will include studies that use qualitative methods in their data collection and analysis and studies that use mixed methods if they include any qualitative methods of analysis. Studies published in English, Portuguese and Spanish will be included. Two review authors will independently screen the studies for inclusion and extract data. We will assess the quality of the included studies using the Critical Skills Appraisal Programme tool. For the assessment of the confidence in the synthesised findings, we will use the GRADE-Confidence in the Evidence from Reviews of Qualitative research. Data analysis will be conducted using the best-fit framework approach based on adapted dimensions from the Health Belief Model and the Behaviour Change Wheel. ETHICS AND DISSEMINATION: This study will be conducted on published evidence, and thus, no ethical approval is required. The findings of this rapid qualitative evidence synthesis will be disseminated to academic audiences, health policy-makers and the general population. We will publish the results in peer-reviewed journals, present our findings in conferences, and disseminate results via social media. We also aim to present the research findings in plain language and disseminate the knowledge to the general population to increase public interest. PROSPERO REGISTRATION NUMBER: CRD42020205750.

Controle de Doenças Transmissíveis/métodos , Barreiras de Comunicação , Transmissão de Doença Infecciosa/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , /epidemiologia , /psicologia , Comportamentos Relacionados com a Saúde , Comportamentos de Risco à Saúde , Humanos , Pesquisa Qualitativa , Projetos de Pesquisa , Percepção Social
N C Med J ; 82(1): 7-13, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33397748


BACKGROUND Early access to quality prenatal care is an essential component of improving maternal and neonatal outcomes as it allows for early intervention and risk stratification. Women who receive late or infrequent prenatal care are at high risk for complications including preterm birth, infant death, and stillbirth. We sought to better understand the barriers Spanish-speaking women face in accessing quality prenatal care and to identify facilitators in obtaining timely quality prenatal care.METHODS We recruited a homogeneous group of 11 women with Spanish as their primary language who were pregnant or had given birth within the last six months. We then conducted two focus groups in Spanish. The focus groups were recorded, translated, and transcribed, and then coded using grounded theory.RESULTS In our cohort of participants, the three major themes included desire for psychosocial support, health care system logistics, and barriers due to Latinx ethnicity.LIMITATIONS Our study has several limitations, including a small sample size and single site design.CONCLUSION Latinx women experience unique barriers to care including language barriers, a lack of cultural competency on the part of health care personnel, and ethnic discrimination. Additional research is needed to develop patient-centered interventions to address these barriers.

Cuidado Pré-Natal , Barreiras de Comunicação , Feminino , Grupos Focais , Humanos , Recém-Nascido , Idioma , Gravidez , Nascimento Prematuro
J Gen Intern Med ; 36(3): 786-789, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33409888


Through experiences with hospital visitor restrictions during the COVID-19 pandemic, a group of frontline trainees at the University of California San Francisco (UCSF) uncovered patient stories highlighting the unique challenges that patients with limited English proficiency (LEP) face in the hospital, particularly their vulnerability to social isolation. Here, we recount patient stories illustrative of this isolation, generated by insufficient professional interpreter use, ad hoc interpretation, and scarcity of media in preferred languages. When confronted with the social isolation faced by all patients during COVID-19, we more clearly saw the healthcare disparities affecting patients with LEP. A trainee-led videoconferencing initiative facilitating social calls between patients at UCSF and their loved ones proved especially helpful in reducing the disconnection that patients with LEP experience in the hospital. Motivated by the findings of this project, we advocate for other institutions to take similar action, such as hiring inpatient telehealth navigators and providing tablets for ad lib use. Enacting these changes will keep patients with LEP connected to their families and communities while in the hospital, an essential step towards establishing an equitable experience for patients with LEP.

/epidemiologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Proficiência Limitada em Inglês , Relações Médico-Paciente , Isolamento Social/psicologia , /terapia , Barreiras de Comunicação , Feminino , Acesso aos Serviços de Saúde/organização & administração , Humanos , Masculino , São Francisco
Am J Speech Lang Pathol ; 30(1): 318-323, 2021 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-33400556


Purpose In this article, we draw a parallel between the experience of social isolation that occurred throughout the world during the Coronavirus Disease 2019 pandemic and similar experiences occurring in everyday life for people with communication disorders living in long-term care (LTC) facilities. We propose that speech-language pathologists can use the widespread experience of social isolation as a learning catalyst in the effort to shift the LTC culture to one that more highly values a communicative environment that is accessible to all, thereby reducing risk of social isolation for those with communication disorders. Conclusions Many training paradigms for promoting an accessible communicative environment are available in the speech-language pathology literature, yet institutional barriers exist for their widespread implementation. Overcoming these barriers is a challenge that requires awareness and learning on the part of staff and administration regarding the impact of an unfriendly communicative environment on social isolation, and the resulting psychosocial consequences. Learning theory indicates that new learning in adults is motivated by connections between personal experiences and the material to be learned. Explicitly infusing established training programs with the experience of social isolation brought on by the Coronavirus Disease 2019 pandemic may be the key needed for changing the communicative environment in LTC.

Barreiras de Comunicação , Infecções por Coronavirus/psicologia , Assistência de Longa Duração/psicologia , Infecções por Coronavirus/terapia , Humanos , Capacitação em Serviço , Relações Profissional-Paciente , Meio Social , Isolamento Social
Am J Obstet Gynecol ; 224(4): B16-B23, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33309561


Women should be provided with evidence-based information when considering options for contraception and pregnancy management. When counseling about health conditions and available treatments, healthcare practitioners should employ strategies that encourage the incorporation of informed patient preferences into a shared decision-making process with the patient. To optimize the health of women at risk of experiencing adverse health outcomes during or after pregnancy, counseling should be a continuous process throughout the reproductive life course. The purpose of this Consult is to provide guidance for all healthcare practitioners about counseling reproductive-aged women who may be at high risk of experiencing maternal morbidity or mortality.

Aconselhamento , Mortalidade Materna , Complicações na Gravidez/prevenção & controle , Gravidez de Alto Risco , Barreiras de Comunicação , Continuidade da Assistência ao Paciente , Anticoncepção , Tomada de Decisão Compartilhada , Parto Obstétrico , Feminino , Acesso aos Serviços de Saúde , Nível de Saúde , Humanos , Trabalho de Parto , Saúde Materna , Satisfação do Paciente , Relações Médico-Paciente , Cuidado Pré-Concepcional , Gravidez , Transtornos Puerperais/prevenção & controle
Nursing ; 51(1): 56-59, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33346620


ABSTRACT: Positive patient outcomes depend on successful communication. Increased use of personal protective equipment such as face masks during the COVID-19 pandemic can exacerbate communication difficulties. This article describes situations in which miscommunications may occur, identifies sources of communication breakdowns, and offers strategies to prevent them in real-life scenarios.

/enfermagem , Barreiras de Comunicação , Máscaras , Relações Profissional-Paciente , Humanos , Equipe de Assistência ao Paciente/organização & administração
RECIIS (Online) ; 14(4): 870-879, out.-dez. 2020.
Artigo em Português | LILACS | ID: biblio-1145563


O trabalho apresenta as reflexões iniciais do projeto de pós-doutorado desenvolvido no Programa de Pós-Graduação em Comunicação e Cultura da Universidade Federal do Rio de Janeiro, que pretende ouvir artistas idosos de dois grupos distintos: no primeiro os sujeitos acometidos por patologias que afetam a memória, entre elas o Alzheimer, em suas fases iniciais; e no segundo sujeitos que se constroem e são construídos identitariamente como idosos, com base em seu lugar etário. Por meio de entrevistas, usando metodologicamente uma técnica que cruza os modos de fazer da história oral com os da entrevista clínica, realizaremos encontros com artistas (músicos, atores, artistas plásticos etc.) procurando perceber as vozes desses indivíduos como sujeitos de comunicação afetados pelo tempo (e, em alguns casos, pela doença).

The work presents the initial reflections of the postdoctoral project developed on the Graduate Program in Communication and Culture at Federal University of Rio de Janeiro, which intends to listen to old artists of two different groups: in the first, subjects affected by pathologies that affect the memory, includin Alzheimer's, in its early stages; and in the second subjects who build and are built identically as old based on their age. Based on interviews, using the foundations of psychological clinic and oral history, we will hold meetings with artists (musicians, actors, visual artists, etc.) seeking to perceive the voices of these individuals as subjects of communication affected by time (and often by the disease).

El trabajo presenta las reflexiones iniciales del proyecto posdoctoral desarrollado con el Programa de Posgrado en Comunicación y Cultura de la Universidad Federal de Río de Janeiro, que pretende escuchar a artistas antiguos de dos grupos diferentes: en el primero, los sujetos afectados por patologías que afectan la memoria, incluido el Alzheimer, en sus primeras etapas; y el segundo sujetos que construyen y se construyen de manera idéntica a los ancianos, en función de su su edad. Mediante el uso de entrevistas, utilizando metodológicamente una técnica que cruza las formas de hacer historia oral con las de la entrevista clínica psicológica, mantendremos reuniones con artistas (músicos, actores, artistas visuales etc.) para percibir las voces de estas personas como sujetos de comunicación afectados por el tiempo (y a menudo por la enfermedad).

Comportamento Social , Comunicação , Barreiras de Comunicação , Doença de Alzheimer , Processos Mentais , Arte , Idoso , Envelhecimento , Entrevistas como Assunto , Traços de História de Vida , Memória
Texto & contexto enferm ; 29: e20190073, Jan.-Dec. 2020.
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1145168


ABSTRACT Objective: to identify potential risks to patient safety during the transfer of pre-hospital care. Method: a descriptive-exploratory study, with a qualitative approach. Data collection occurred between April and June 2018, with non-participant observation and semi-structured interview, in a Mobile Emergency Care Service in the Southern Brazil. Twenty-eight professionals were interviewed, including nursing technicians/auxiliaries, nurses and physicians, and 135 hours of care were observed. The data were submitted to thematic analysis. Results: two interrelated categories emerged a) Stakeholders in patient and team safety; and b) The (inter) personal/professional dimension of the transfer of care. The study's findings showed that, in addition to the inherent vulnerabilities to traffic and urban violence, patients are exposed to circumstances that include potential risks related to falling on stretchers, medication errors and clinical judgment. The vertical communication by hierarchies, influenced by personal and emotional factors of each professional, generated implications for the continuity of care. Conclusion: given the potential risks to patient safety at the time of transfers of pre-hospital care, one should invest in effective communication strategies, as well as in forms of interpersonal relationships and links between services in the emergency network.

RESUMEN Objetivo: identificar riesgos potenciales para la seguridad del paciente durante la transferencia de la atención prehospitalaria. Método: estudio descriptivo-exploratorio, con enfoque cualitativo. La recopilación de datos se produjo entre abril y junio de 2018, con observación no participante y entrevista semiestructurada, en un Servicio móvil de atención de emergencia en el sur de Brasil. Se entrevistó a 28 profesionales, incluidos técnicos / auxiliares de enfermería, enfermeras y médicos, y se observaron 135 horas de atención. Los datos fueron sometidos a análisis temático. Resultados: surgieron dos categorías interrelacionadas a) Partes interesadas en la seguridad del paciente y del equipo; y b) La dimensión (inter) personal / profesional de la transferencia de atención. Los hallazgos del estudio mostraron que, además de las vulnerabilidades inherentes al tráfico y la violencia urbana, los pacientes están expuestos a circunstancias que incluyen riesgos potenciales relacionados con la caída en camillas, errores de medicación y juicio clínico. La comunicación vertical por jerarquías, influenciada por factores personales y emocionales de cada profesional, generó implicaciones para la continuidad de la atención. Conclusión: dados los riesgos potenciales para la seguridad del paciente en el momento de las transferencias de atención prehospitalaria, uno debe invertir en estrategias de comunicación efectivas, así como en formas de relaciones interpersonales y vínculos entre los servicios en la red de emergencia.

RESUMO Objetivo: identificar potenciais riscos para a segurança do paciente durante a transferência do cuidado pré-hospitalar. Método: estudo do tipo descritivo-exploratório, com abordagem qualitativa. A coleta de dados ocorreu entre abril e junho de 2018, com observação não-participante e entrevista semiestruturada, em um Serviço de Atendimento Móvel de Urgência da região Sul, Brasil. Foram entrevistados 28 profissionais incluindo técnicos/auxiliares de enfermagem, enfermeiros e médicos e observadas 135 horas de atendimentos. Os dados foram submetidos à análise temática. Resultados: emergiram duas categorias inter-relacionadas: a) Intervenientes na segurança do paciente e da equipe; e b) A dimensão (inter)pessoal/profissional da transferência do cuidado. Os achados do estudo mostraram que, além das vulnerabilidades inerentes ao trânsito e à violência urbana, os pacientes estão expostos a circunstâncias que incluem potenciais riscos relacionados à queda de macas, aos erros de medicação e de julgamento clínico. A comunicação verticalizada pelas hierarquias, influenciada por fatores pessoais e emocionais de cada profissional, geraram implicações para a continuidade do cuidado. Conclusão: diante dos potenciais riscos à segurança do paciente no momento das transferências do cuidado pré-hospitalar, deve-se investir em estratégias de comunicação eficaz, bem como em formas de melhorar as relações interpessoais e a articulação entre os serviços na rede de urgências.

Humanos , Transferência de Pacientes , Barreiras de Comunicação , Serviços Médicos de Emergência , Segurança do Paciente
Pan Afr Med J ; 35(Suppl 2): 130, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193945


The COVID-19 pandemic has strained health care systems beyond capacity resulting in many people not having access to life-sustaining measures even in well-resourced countries. Palliative and end-of-life care are therefore essential to alleviate suffering and ensure a continuum of care for patients unlikely to survive. This is challenging in sub-Saharan Africa where lack of trained teams on basic palliative care and reduced access to opioids limit implementation of palliative and end-of-life care. At the same time, health care providers have to cope with local cultural conceptions of death and absence of advance care directives.

Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Paliativos/organização & administração , Pandemias , Pneumonia Viral/terapia , Assistência Terminal/organização & administração , Diretivas Antecipadas , África ao Sul do Saara/epidemiologia , Analgésicos Opioides/provisão & distribução , Analgésicos Opioides/uso terapêutico , Atitude Frente a Morte , Barreiras de Comunicação , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Cultura , Acesso aos Serviços de Saúde , Humanos , Cuidados Paliativos/psicologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Relações Profissional-Paciente , Insuficiência Respiratória/tratamento farmacológico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Estigma Social , Assistência Terminal/psicologia
Health Educ Behav ; 47(6): 845-849, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33148042


The COVID-19 pandemic has exposed, and intensified, health inequities faced by Latinx in the United States. Washington was one of the first U.S. states to report cases of COVID-19. Public health surveillance shows that 31% of Washington cases are Latinx, despite being only 13% of the state population. Unjust policies related to immigration, labor, housing, transportation, and education have contributed to both past and existing inequities. Approximately 20% of Latinx are uninsured, leading to delays in testing and medical care for COVID-19, and early reports indicated critical shortages in professional interpreters and multilingual telehealth options. Washington State is taking action to address some of these inequities. Applying a health equity framework, we describe key factors contributing to COVID-19-related health inequities among Latinx populations, and how Washington State has aimed to address these inequities. We draw on these experiences to make recommendations for other Latinx communities experiencing COVID-19 disparities.

Infecções por Coronavirus/etnologia , Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos/estatística & dados numéricos , Pneumonia Viral/etnologia , Betacoronavirus , Barreiras de Comunicação , Política de Saúde , Acesso aos Serviços de Saúde/organização & administração , Habitação/normas , Humanos , Pandemias , Tradução , Estados Unidos/epidemiologia , Washington/epidemiologia , Trabalho/estatística & dados numéricos
Gesundheitswesen ; 82(11): 877-884, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33049792


Since 2014, the number of new cases of tuberculosis (TB) has risen in Germany by about 20%. This coincides with a large number of people applying for asylum in Germany. Some of them are from countries in which TB is much more prevalent than in Germany. The objectives of this contribution are to identify and explain barriers in the diagnosis and treatment of asylum seekers with TB and potential improvements in those fields. Data are derived from 14 problem-centred interviews that were carried out with doctors and staff from public health offices, representing the views of experts in the field of health care. On the one hand, the results suggest that structural factors are responsible for some of the barriers mentioned by the experts. For example, the restricted access to health care for asylum seekers leads to a delayed diagnosis since they visit the doctor too late (if at all). Accordingly, a nationwide implementation of an electronic health card for asylum seekers was proposed. On the other hand, individual and cultural factors play important roles as well. To those belong language barriers: they not only complicate history taking and diagnosis, but also educating patients about their disease and therapy. Moreover, the lack of knowledge concerning the German health care system increases the risk of treatment interruptions. To alleviate those problems, experts propose to carry out train-the-trainer-programmes and to install "guides" who pilot asylum seekers with TB through the German health care system.

Refugiados , Tuberculose , Barreiras de Comunicação , Alemanha/epidemiologia , Humanos , Pesquisa Qualitativa , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/terapia