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Ecocultural assessment in families of children with developmental delays: construct and concurrent validities.

Home interviews were conducted with 102 families of children with developmental delays to assess ecocultural family resources and constraints, values, and goals as well as proactive adaptive efforts to deal with their circumstances. Interview topics included (a) economic factors; (b) child safety, health, and education; (c) domestic and childcare workloads; (d) familial support networks; and (e) sociocultural influences. Factor analyses performed on the ecocultural measures revealed 12 salient factors. Results indicated that some of the ecocultural factors were unique and statistically independent of the traditional measures of home environment (e.g., child-rearing attitudes, cognitive stimulation of the child, and general psychosocial climate). Significant relations were found between certain ecocultural factors and child's developmental status. Both ecocultural factors and traditional family measures accounted for significant variation in child outcomes.

Adult↗

Patient perspectives on computer-based medical records.

BACKGROUND: Despite emerging interest in computer-based patient records (CPRs), less than 1% of medical records in the United States are stored electronically. Some physicians may be reluctant to implement CPR systems because of fear that the physician-patient relationship would be adversely affected. This study ascertained the attitudes of patients regarding the use of CPR systems. METHODS: This study was an in-depth interview survey of 16 patients concerning the CPR system used at the family medicine department at the Medical University of South Carolina. Interview topics included patient knowledge, perceived advantages and disadvantages, and the impact of the CPR system on their relationship with their physician. RESULTS: Most patients were informed about the nature of the CPR system and had positive attitudes toward it. Common perceptions were that CPR provides physicians with easy access to information, facilitates clinical encounters, and improves physician-patient relationship and the quality of care delivered. Although confidentiality was the major concern expressed about the CPR system, only one respondent indicated that this factor limited his interaction with his physician. CONCLUSIONS: This study demonstrated patient acceptance and support for the CPR system in use at the study site. These findings should encourage physicians to use CPRs.

Adult↗

"Not as bad as it could have been": assessing and mitigating harm during research interviews on sensitive topics.

Research on sensitive subjects such as perinatal loss places participants at particular risk for psychological distress. Although authors have discussed strategies for minimizing distress during interview research, less is known about the ways participants communicate and investigators respond to psychological pain incurred during the interview itself. Therefore, we describe both verbal and nonverbal indicators of distress during a phenomenological study on perinatal loss. We also offer suggestions for interviewers on ways to minimize participants' discomfort. We believe this account will help other researchers identify and reduce respondent distress during their own research.

Adaptation, Psychological↗

A qualitative study to explore influences on general practitioners' decisions to prescribe new drugs.

BACKGROUND: Ensuring appropriate prescribing is an important challenge for the health service, and the need for research that takes account of the reasons behind individual general practitioners' (GPs) prescribing decisions has been highlighted. AIM: To explore differences among GPs in their decisions to prescribe new drugs. DESIGN OF STUDY: Qualitative approach, using in-depth semistructured interviews. SETTING: Northern and Yorkshire Health Authority Region. METHOD: Participants were identified from a random sample of 520 GPs in a quantitative study of patterns of uptake of eight recently introduced drugs. Purposeful sampling ensured inclusion of GPs prescribing any of the eight drugs and working in a range of practice settings. Fifty-six GPs were interviewed, using a topic guide. Interviews were recorded on audiotape. Transcribed text was methodically coded and data were analysed by constantly comparing emerging themes. RESULTS: Both low and high prescribers shared a view of themselves as conservative in their prescribing behaviour. Low prescribers appeared to conform more strongly to group norms and identified a consensus among practice partners in prescribing and cost-consciousness. Conformism to group norms was represented by a commitment to practice formularies. High prescribers more often expressed themselves to be indifferent to drug costs and a shared practice ethos. CONCLUSIONS: A shift in the attitudes of some GPs is required before cost-effectiveness is routinely incorporated in drug prescribing. The promotion of rational prescribing is likely to be more successful if efforts are focused on GPs' appreciation of cost issues and attitudes towards shared decision-making and responsibility.

Attitude of Health Personnel↗

[Greenlanders in hospital. An interview study of communication between patients and therapists, satisfaction and therapeutic preferences].

In four hospitals in Greenland, 50 Greenlandic patients and their Danish therapist (18 doctors, 26 nurses and six other staff) have been interviewed about the same topics. The interviews were semistructured with open ended questions on the following subjects: Language difficulties, perception of diagnosis and therapy, patients' satisfaction and points of criticism. Several of the patients had not understood the most important medical information about diagnosis and treatment. But most of the patients did not consider the information problem to be serious and patients were satisfied with most of the consultations. Language difficulties and insufficient communications do not correspond to patients' satisfaction but have to be analysed in the wider cultural context. There was a tendency towards the elder patients being more satisfied than the younger.

Adult↗

Comrades.

Four organisations have collaborated to produce a consensus statement on clinical management. The result, writes Alys Harwood, could lead to a revolution in patient care.

Decision Making, Organizational↗

Breaking the rules.

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Contract Services↗