Supporting whanau during COVID-19 pandemic in Aotearoa New Zealand: a systems thinking case study.

BACKGROUND: The Aotearoa New Zealand COVID-19 pandemic response has been hailed as a success story, however, there are concerns about how equitable it has been. This study explored the experience of a collective of Maori health and social service providers in the greater Wellington region of Aotearoa New Zeland delivering COVID-19 responses. METHODS: The study was a collaboration between a large urban Maori health and social service provider, Takiri Mai Te Ata whanau ora collective, and public health researchers in Aotearoa New Zealand. Two online workshops were held with staff of the Maori service provider, collectively developing a qualitative causal loop diagram and generating systemic insights. The causal loop diagram showed interactions of various factors affecting COVID-19 response for supporting whanau (Maori family/households) at a community level. The iceberg model of systems thinking offered insights for action in understanding causal loop diagrams, emphasizing impactful changes at less visible levels. RESULTS: Six interacting subsystems were identified within the causal loop diagram that highlighted the systemic barriers and opportunities for effective COVID-19 response to Maori whanau. The medical model of health service produces difficulties for delivering kaupapa Maori services. Along with pre-existing vulnerability and health system gaps, these difficulties increased the risk of negative impacts on Maori whanau as COVID-19 cases increased. The study highlighted a critical need to create equal power in health perspectives, reducing dominance of the individual-focused medical model for better support of whanau during future pandemics. CONCLUSIONS: The study provided insights on systemic traps, their interactions and delays contributing to a relatively less effective COVID-19 response for Maori whanau and offered insights for improvement. In the light of recent changes in the Aotearoa New Zealand health system, the findings emphasize the urgent need for structural reform to address power imbalances and establish kaupapa Maori approach and equity as a norm in service planning and delivery.

Virtual Service Delivery in Mental Health and Substance Use Care: A Systematic Review of Preference Elicitation Studies.

Mental health and substance use disorders affect the lives of many people worldwide. Prevention and treatment of these conditions is important for optimal health and wellbeing, yet service access barriers are common. Virtual models of care may help to reduce barriers to receiving care. However, to facilitate uptake and use of virtual services, they need to appeal to patients and clinicians. This systematic review aimed to synthesise preference elicitation studies to determine what features of virtual mental health and substance use care are preferred by service users and service providers. Following the PRISMA guidelines for systematic reviews, we searched PubMed, PsycINFO, EconLit, MEDLINE, CINAHL, Academic Search Ultimate, and ProQuest Central for all available studies from database inception until May 2023. The Mixed Methods Appraisal Tool was used to assess the methodological quality of included studies. Nineteen studies met the eligibility criteria. However, none examined preferences for elements of different models of virtual care. Across the included studies, we identified 41 unique features that mapped to four themes of mental health and substance use care ('service', 'treatment', 'clinician' and 'additional supports'). Participant preferences were for individual, in-person, effective, flexible, and low-cost treatment. These preferences varied based on demographic factors, such as culture, gender, and participant type (e.g., patients, clinicians, general population). A user-centred approach should be adopted when designing and implementing mental health and substance use services. While preferences for features of mental health and substance use services more broadly are known, preferences for different models of virtual care remain unexplored. Future research should examine what features of virtual services would lead to optimal uptake and use across different users and stakeholders.

The lived experiences of rural HIV social workers.

HIV service providers are the primary implementers of HIV care services, but rural HIV service providers are under researched. We used an interpretative phenomenological analysis to explore rural HIV service providers' lived experiences of working in HIV care, who work in a rural region of a Midwestern state in the United States. From July to August 2019, 15 HIV service providers participated in a one-hour semi-structured telephone interview that elicited their experiences working in the rural HIV care continuum. Participants were tired of constantly educating and working to reduce HIV stigma; however, they received support from family and friends once they educated them about HIV. Participants felt they lacked control over systems and they developed emotional-based coping to address constant occupational stressors. Findings highlight the importance of resiliency and advocacy research and practice across ecological levels.

Contradictions hindering the provision of mental healthcare and psychosocial services to women experiencing homelessness in Addis Ababa, Ethiopia: service providers' and programme coordinators' experiences and perspectives.

BACKGROUND: Mental health conditions are among the health issues associated with homelessness, and providing mental healthcare to people experiencing homelessness is challenging. Despite the pressing issue of homelessness in Addis Ababa, Ethiopia, there is scant research on how service providers address women's mental health and psychosocial needs. Therefore, we explored service providers' and programme coordinators' perceptions and experiences regarding mental healthcare and psychosocial services delivery to women experiencing street homelessness in the city. METHODS: We conducted a descriptive qualitative study with selected healthcare and social support providers and programme coordinators. The study involved 34 participants from governmental and non-governmental organisations in Addis Ababa, Ethiopia. Data were analysed using an inductive thematic approach. RESULTS: Four themes were derived from the analysis. The first of these was "divergent intentions and actions". While service providers and programme coordinators showed empathy and compassion, they also objectified and blamed people for their own homelessness. They also expressed opposing views on mental health stigma and compassion for these people. The second theme addressed "problem-solution incompatibility", which focused on the daily challenges of women experiencing homelessness and the types of services participants prioritised. Service providers and programme coordinators proposed non-comprehensive support despite the situation's complexity. The participants did not emphasise the significance of gender-sensitive and trauma-informed care for women experiencing street homelessness in the third theme, "the lack of gendered and trauma-informed care despite an acknowledgement that women face unique challenges". The fourth theme, "mismatched resources," indicated structural and systemic barriers to providing services to homeless women. CONCLUSIONS: Conflicting attitudes and practices exist at the individual, organisational, and systemic levels, making it challenging to provide mental healthcare and psychosocial services to women experiencing homelessness. An integrated, gender-sensitive, and trauma-informed approach is necessary to assist women experiencing homelessness.

Data-Driven Threat Analysis for Ensuring Security in Cloud Enabled Systems.

Cloud computing offers many benefits including business flexibility, scalability and cost savings but despite these benefits, there exist threats that require adequate attention for secure service delivery. Threats in a cloud-based system need to be considered from a holistic perspective that accounts for data, application, infrastructure and service, which can pose potential risks. Data certainly plays a critical role within the whole ecosystem and organisations should take account of and protect data from any potential threats. Due to the variation of data types, status, and location, understanding the potential security concerns in cloud-based infrastructures is more complex than in a traditional system. The existing threat modeling approaches lack the ability to analyse and prioritise data-related threats. The main contribution of the paper is a novel data-driven threat analysis (d-TM) approach for the cloud-based systems. The main motivation of d-TM is the integration of data from three levels of abstractions, i.e., management, control, and business and three phases, i.e., storage, process and transmittance, within each level. The d-TM provides a systematic flow of attack surface analysis from the user agent to the cloud service provider based on the threat layers in cloud computing. Finally, a cloud-based use case scenario was used to demonstrate the applicability of the proposed approach. The result shows that d-TM revealed four critical threats out of the seven threats based on the identified assets. The threats targeted management and business data in general, while targeting data in process and transit more specifically.

"You say you're inclusive, but can you show us?" The importance of cultural competence when working with sexual minorities in a mental health setting.

OBJECTIVES: Sexual minorities experience higher rates of psychological distress than heterosexual people, likely due to minority stress. While rates of help-seeking by sexual minorities are high, sexual minorities report greater dissatisfaction with mental health service providers. This dissatisfaction may result from poor cultural competence practices. Our study sought to determine the importance of service provider cultural competence practices to a community sample of sexual minority people. METHODS: Participants (n = 274) were sexual minority Australians recruited from affirming Facebook groups, organizations, and research-based organizations. To measure the importance of cultural competence practices, participants completed a modified online version of the Gay Affirming Practices Scale (GAP) and responded to open-ended questions. RESULTS: Between 80% and 99% of participants endorsed each item on the GAP, indicating the importance of service providers demonstrating an array of culturally affirming practices. No significant associations were found between overall GAP score and age or sexual orientation, though further analyses revealed individual items on the GAP showed associations with age. A structured tabular thematic analysis, of open-ended participant responses, found positive attitudes, knowledge, and affirming practices were the three most important characteristics for service providers seeking to demonstrate culturally competent practices, mirroring the tripartite model (attitudes, knowledge, and skills) of cultural competence. CONCLUSION: Recommendations for service providers to demonstrate cultural competence include: utilizing affirming practices such as inclusive language, increasing knowledge about sexual minorities, and utilizing education resources such as cultural competence workshops, lived experience stories, and seeking mentorship from service providers with expertise in working with sexual minorities.

Increasing global supply chains' resilience after the COVID-19 pandemic: Empirical results from a Delphi study.

COVID-19 has revealed global supply chains' vulnerability and sparked debate about increasing supply chain resilience (SCRES). Previous SCRES research has primarily focused on near-term responses to large-scale disruptions, neglecting long-term resilience approaches. We address this research gap by presenting empirical evidence from a Delphi study. Based on the resource dependence theory, we developed 10 projections for 2025 on promising supply chain adaptations, which were assessed by 94 international supply chain experts from academia and industry. The results reveal that companies prioritize bridging over buffering approaches as long-term responses for increasing SCRES. Promising measures include increasing risk criteria importance in supplier selection, supply chain collaboration, and supply chain mapping. In contrast, experts ascribe less priority to safety stocks and coopetition. Moreover, we present a stakeholder analysis confirming one of the resource dependence theory's central propositions for the future of global supply chains: companies differently affected by externalities will choose different countermeasures.

Re-Conceptualizing Bereavement Care Practices: Insights Gained from Service Providers.

The management and delivery of bereavement care and support services present practical challenges. A national-level, qualitative study was conducted to examine the current practices in Singapore. The study's purpose was to inform bereavement care practices by drawing from perspectives of service providers offering death, dying and bereavement-related services. This qualitative study was undertaken using focused group discussion (FGD) with service providers from the health, social and death-related sectors. Ten FGDs were conducted with a total of 69 participants. Thematic analysis yield two themes - identifying challenging circumstances to provide bereavement care and strategies for dealing with the gaps in service delivery. The service providers' experiential knowledge could be borrowed to strengthen the current bereavement care practices for the good of the community. The findings have informed the reconceptualization of a local bereavement care and support service model, with the public health model as the recommended underpinning conceptual framework.

Palliative care for adults with intellectual disability.

Contemporary disability principles and values suggest that adults with intellectual disability should be able to access and participate in any mainstream service rather than having a separate service for them. In the case of healthcare services, achievement of optimal access to and participation in healthcare by adults with intellectual disability requires the presence of both adequate disability supports for the person and reasonable adjustments to generic health systems to enable a person-centred approach to care. Development of an interface between people with lived experience of intellectual disability, disability and health sectors help clarify the required nature of disability supports and types of adjustments to mainstream health services. The article describes a case study of an adult with intellectual disability with a serious illness warranting palliative care, and focusses on the reasonable adjustments to mainstream core palliative care principles for adults with intellectual disability.

Service providers endorse integrated services model for youth with mental health and substance use challenges: findings from a discrete choice experiment.

BACKGROUND: Given high rates of mental health and substance challenges among youth and substantial system access barriers, system innovation is required. Integrated youth services (IYS) models aim to transform youth mental health and substance use services by creating integrative, collaborative models of care in youth-friendly settings. This study examines service provider perspectives on the key service components to include in IYS models. METHOD: A discrete choice experiment modeled service provider preferences for the service components of IYSs. The sample includes 388 service provider/agency leader participants (age 18+) from youth-serving organizations in Ontario. Importance scores and utility values were calculated for 12 attributes represented by four levels each. Latent class analysis identified subgroups of participants with different preferences. RESULTS: The majority of participants were direct service providers working in larger organizations in the mental health and/or substance use sectors in large urban centers. Participants strongly endorsed service models that provide rapid access to the widest variety of culturally sensitive service options, with supplementary e-health services, in youth-focused community settings with evening and weekend hours. They prefer caregiver involvement in youth services and treatment decisions and support youth and family engagement. Latent class analyses reveal three segments of service providers: a Youth-Focused Service Accessibility segment representing 62.1% (241/388) of participants, a Service Options segment representing 27.6% (107/388) of participants, and a Caregiver Integration segment representing 10.3% (40/388) of participants. Within these segments, the degree of prioritization of the various service components differ; however, the overall endorsement of the service components remains largely consistent across classes for most attributes. The segments did not differ based on demographic or agency characteristics. CONCLUSIONS: The core characteristics of IYS settings for youth with mental health and substance use challenges, i.e., rapid access to a wide range of youth-oriented services, are strong priorities of service providers and youth-serving agency leaders. These findings confirm that youth-oriented service providers endorse the importance and relevance of IYS models as a whole; strong service provider buy-in to the model is expected to facilitate development, implementation and scaling of IYS models. Hearing stakeholder perspectives, including those of service providers, youth, and caregivers, is essential to developing, effectively implementing, and scaling effective youth services.

MoHRiPA-An Architecture for Hybrid Resources Management of Private Cloud Environments.

The high demand for data processing in web applications has grown in recent years due to the increased computing infrastructure supply as a service in a cloud computing ecosystem. This ecosystem offers benefits such as broad network access, elasticity, and resource sharing, among others. However, properly exploiting these benefits requires optimized provisioning of computational resources in the target infrastructure. Several studies in the literature improve the quality of this management, which involves enhancing the scalability of the infrastructure, either through cost management policies or strategies aimed at resource scaling. However, few studies adequately explore performance evaluation mechanisms. In this context, we present the MoHRiPA-Management of Hybrid Resources in Private cloud Architecture. MoHRiPA has a modular design encompassing scheduling algorithms, virtualization tools, and monitoring tools. The proposed architecture solution allows assessing the overall system's performance by using complete factorial planning to identify the general behavior of architecture under high demand of requests. It also evaluates workload behavior, the number of virtualized resources, and provides an elastic resource manager. A composite metric is also proposed and adopted as a criterion for resource scaling. This work presents a performance evaluation by using formal techniques, which analyses the scheduling algorithms of architecture and the experiment bottlenecks analysis, average response time, and latency. In summary, the proposed MoHRiPA mapping resources algorithm (HashRefresh) showed significant improvement results than the analyzed competitor, decreasing about 7% percent in the uniform average compared to ListSheduling (LS).

Faecal sludge management in Toamasina, Madagascar: Emptying - Transport - Treatment.

In Toamasina, the second largest city in Madagascar with 326,286 inhabitants and located at sea level, 97% of households uses latrines. The city produces 14,100 m³ faecal sludge per year and 28,000 latrines need to be emptied annually. Most latrines are emptied manually and sludge used to be buried in the compound, thus contaminating sub surface water that is used for domestic purposes by 60% of the population. This article shows how through an action-research process coordinated by Join For Water emptying, transport and treatment services were improved, these services remain accessible to the lowest social class, and a profitable private service provider, Clean Impact, was created. It further describes the construction of a treatment plant consisting of planted humification beds, and the process towards a sustainable exploitation, today managed by Clean Impact.

Describing the Nature and Correlates of Health Service Providers' Competency Working With Sexual and Gender Minority Patients: A Systematic Review.

Disparities in the health services delivered to sexual and gender minority (SGM) individuals are widespread across health service disciplines. Many health service providers do not have the knowledge, comfort, or skills necessary to provide health services to SGM individuals. The objective of the current systematic review was to review the correlates of competency (defined as knowledge, attitude, and skill) that health service providers possess for working with SGM individuals. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was utilized to guide search and reporting strategies. PsycInfo/PsycArticles, PubMed/Medline, and Google Scholar databases were searched to find studies that addressed health service providers' competency working with SGM individuals. There were 31 studies included in the review. Approximately half of the studies utilized the full definition of competency (knowledge, attitude, and skill). The most common competency assessed was knowledge, and the least common was skill. The majority of the studies addressed health service providers in the social sciences. Health service education needs to emphasize competency working with SGM individuals. Of particular importance is developing skill sets, as many providers reported that they did not have the skills necessary to provide culturally competent health services to SGM individuals.

Malaria situation in a clear area of Iran: an approach for the better understanding of the health service providers' readiness and challenges for malaria elimination in clear areas.

BACKGROUND: Malaria mortality and morbidity have decreased in recent years. Malaria elimination (ME) and effective efforts to achieve ME is one of the most important priorities for health systems in countries in the elimination phase. In very low transmission areas, the ME programme is faced with serious challenges. This study aimed to assess the trend while getting a better understanding of Health Service Providers' (HSPs) readiness and challenges for ME in a clear area of Iran. METHODS: This study was performed in two phases. At first, the malaria trend in East Azerbaijan Province, was surveyed from 2001 to 2018; afterward, it was compared with the national situation for a better understanding of the second phase of the study. Data were collected from the Ministry of Health's protocol and the health centre of the province. In the second phase, malaria control programme experts, health system researchers, and health managers' opinions were collected via in-depth interviews. They were asked regarding HSPs readiness and appropriate Malaria Case Management (MCM) in a clear area and possible challenges. RESULTS: A total of 135 and 154,560 cases were reported in the last 18 years in East Azerbaijan Province and Iran, respectively. The incidence rate decreased in East Azerbaijan Province from 0.4/10,000 in 2001 to zero in 2018. Furthermore, no indigenous transmission was reported for 14 years. Also, for the first time, there was no indigenous transmission in Iran in 2018. The main elicited themes of HSPs readiness through in-depth interviews were: appropriate MCM, holistic and role-playing studies for assessment of HSPs performance, system mobilization, improving identification and diagnosis of suspected cases in the first line. Similarly, the main possible challenges were found to be decreasing health system sensitivity, malaria re-introduction, and withdrawing febrile suspected cases from the surveillance chain. CONCLUSION: Health systems in eliminating phase should be aware that the absence of malaria cases reported does not necessarily mean that malaria is eliminated; in order to obtain valid data and to determine whether it is eliminated, holistic and role-playing studies are required. Increasing system sensitivity and mobilization are deemed important to achieve ME.

A Two-Stage Service Migration Algorithm in Parked Vehicle Edge Computing for Internet of Things.

Parked vehicle edge computing (PVEC) utilizes both idle resources in parked vehicles (PVs) and roadside units (RSUs) as service providers (SPs) to improve the performance of vehicular internet of things (IoT). However, it is difficult to make optimal service migration decisions in PVEC networks due to the uncertain parking duration and resources heterogeneity of PVs. In this paper, we formulate the service migration of all the vehicles as an optimization problem with the objective of minimizing the average latency. We propose a two-stage service migration algorithm for PVEC networks, which divides the original problem into the service migration between SPs and the serving PV selection in parking lots. The service migration between SPs is transformed to an online problem based on Lyapunov optimization, where the expected parking duration of PVs is utilized. A modified Hungarian algorithm is proposed to select the PVs for migration. A series of simulation experiments based on the real-world vehicle traces are conducted to verify the superior performance of the proposed two-stage service migration (SEA) algorithm as compared with the state-of- art solutions.

Views of Service Providers and Adolescents on Use of Sexual and Reproductive Health Services by Adolescents: A Systematic Review.

This review examines the literature on adolescents' and providers' views on access and use of Sexual and Reproductive Health (SRH) information and services. The SRH services referred to in this study were predominantly family planning services, STI treatment including HIV testing and counselling services. The study design was a systematic review of empirical studies. Twenty-five databases were searched using a well-defined search strategy and Boolean operators. A total of 45 studies were included in the review, and the findings were reported thematically under four emerging themes. The review showed that adolescents and sexual health service providers had differing views on barriers and enablers to adolescent access to SRH services and often had contradictory views on key markers of youth-friendly services, service preferences, barriers and enablers of service use. While service providers perceived physical and financial barriers as fundamental, adolescents identified barriers emanating from providers' attitude as the key hindrance to their access and use of services. The review also revealed that the unprofessional attitudes of some service providers limit adolescents' access to SRH services. These findings serve as evidence to policy actors at all levels to consider attitudinal qualities of service providers when planning and designing sexual health services for adolescents.

A Rights-Based Approach for Service Providers to Measure the Quality of Life of Children with a Disability.

BACKGROUND: This paper identifies the best instruments for service providers to measure the quality of life (QoL) of children with a disability, with a focus on their alignment with the Convention on the Rights of Persons with a Disability (CRPD). METHODS: This study reviewed systematic reviews to identify generic QoL instruments for children and adolescents, followed by an appraisal process using newly developed criteria. QoL instruments with a health status, functioning, and condition-specific focus were excluded. RESULTS: Twenty generic QoL instruments for children were identified from existing systematic reviews to undergo further review. Only 2 of the 20 instruments were recommended for service providers to measure the QoL of children with a disability (KIDSCREEN and KINDL). Many pediatric QoL instruments (N = 9) focus on functioning and are not consistent with the CRPD, confounding a child's functioning with their feelings about their life. KIDSCREEN and KINDL have self-report and parent report versions, are applicable for childhood and adolescence, demonstrate adequate reliability and validity, involved children in their development, focus on wellbeing, are likely to be able to be completed by a child with a disability, and are low in cost. CONCLUSIONS: Many instruments focus on functioning rather than wellbeing and thus may not capture the QoL of children with a disability. A child's functional limitations may not be consistent with their feelings about life. Two instruments that assess wellbeing and meet the criteria important for service providers now require further testing to explore their usefulness and validity for children with varying abilities.

Youth Homelessness: The Impact of Supportive Relationships on Recovery.

Background Homeless youth are the fastest growing sub-group within the homeless population. They face impaired access to health services and are often left unsupported. They lack social and family support or relationships with service providers. Unsupported homeless youth often become homeless adults. Purpose To test a model based on Peplau's Theory of Interpersonal Relations, examining the influence of a network of service providers, perceptions of social supports, and family relations on a homeless youth's perceptions of recovery. Methods This study is a secondary analysis and used a sample (n = 187) of data collected as part of the original Youth Matters in London study. A cross-sectional design was used to analyze the relationship between variables. Participants were interviewed at 6-month intervals over a 2.5-year period. Hierarchical multiple regression analysis was used. Results Network of service providers, perceived social supports, and perceived family relations explained 21.8% of the variance in homeless youth perceptions of recovery. Perceived social support and family relations were significantly, positively correlated to perceptions of recovery. Network of service providers was not significantly correlated to perceptions of recovery. Conclusions The findings suggest that stronger social supports and family relations may contribute to increased perceptions of recovery among homeless youth.

Economic Feasibility of Wireless Sensor Network-Based Service Provision in a Duopoly Setting with a Monopolist Operator.

We analyze the feasibility of providing Wireless Sensor Network-data-based services in an Internet of Things scenario from an economical point of view. The scenario has two competing service providers with their own private sensor networks, a network operator and final users. The scenario is analyzed as two games using game theory. In the first game, sensors decide to subscribe or not to the network operator to upload the collected sensing-data, based on a utility function related to the mean service time and the price charged by the operator. In the second game, users decide to subscribe or not to the sensor-data-based service of the service providers based on a Logit discrete choice model related to the quality of the data collected and the subscription price. The sinks and users subscription stages are analyzed using population games and discrete choice models, while network operator and service providers pricing stages are analyzed using optimization and Nash equilibrium concepts respectively. The model is shown feasible from an economic point of view for all the actors if there are enough interested final users and opens the possibility of developing more efficient models with different types of services.

Post-abortion family planning counselling practice among abortion service providers in China: a nationwide cross-sectional study.

OBJECTIVE: To assess the practice of post-abortion family planning (PAFP) counselling among Chinese abortion service providers, and identify the influencing factors. METHODS: A cross-sectional questionnaire survey was conducted between July and September 2013 among abortion services providers in 30 provinces in China. Univariate and multivariable logistic regression analyses were used to identify the factors that influenced PAFP counselling. RESULTS: 94% of the 579 service providers responded to the questionnaire in the survey. The median age was 39 years (range 20-72), and 95% were females. 92% providers showed a positive attitude and had promoted the PAFP counselling services; however, only 57% spent more than 10 min for it. The overall knowledge on PAFP was limited to the participants. After adjusting for potential confounding factors: providers from the middle region (compared with 'east region', ORadj = 3.33, 95% CI: 2.12-5.21) conducted more PAFP counseling; providers with more knowledge (ORadj = 2.08, 95% CI: 1.38-3.15) provided more counseling; and compared with 'middle school and below', providers with higher education gave more counseling [ORadj(95% CI)] for 'college', 'university' and 'master/doctor' [1.99 (1.01,3.92), 2.32 (1.22,4.40) and 2.34 (1.06,5.17), respectively]. CONCLUSIONS: The majority of providers could provide PAFP counselling to women undergone an abortion, but some of them had insufficient time to make it available. Education, knowledge about fertility and reproductive health and residence region were the main factors influencing the practice. Training of health providers and integrating family planning as a part of abortion services are essential to provide adequate PAFP to abortion seekers, thereby reducing the risk of unintended pregnancy.