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PubMed2007

[Are Danish medical students concerned about their future job? A questionnaire study].

INTRODUCTION: Knowledge about the thoughts of Danish medical students regarding their job future is limited. The aim of this study was to investigate whether medical students are concerned about their future work, and if so, to describe the types of concerns they have, to what degree they are concerned, possible reasons for and consequences of their concerns; furthermore, to evaluate if gender and semester influate on the concerns. METHOD: A questionnaire was developed based on focus group interviews with medical students. The questionnaire was sent to 596 medical students from 3rd, 8th, and 13th semester at Copenhagen University. RESULTS: The response rate was 69.9%. A substantial number of students (47-90%) were very concerned or concerned to a certain degree with regard to aspects of working life that related to the patient and working conditions. A positive relation was seen between being highly concerned or concerned to a certain degree and daily or often worrying. Possible causes of the concerns were related to their experience through their clinical stays, the curriculum, comments about the job made by medical doctors and others and their own personality. Every sixth student had considered leaving university or refraining from entering clinical training due to these concerns. CONCLUSION: Medical students from 3rd, 8th, and 13th semester are concerned about their future work, especially in relation to the patient, regarding, for example, the risk of committing an error or being incompetent in relation to practical skills, but also work-related concerns are mentioned.

Clinical Competence↗

PubMedDate not supplied

The effect of exit-interview patient education on no-show rates at a family practice residency clinic.

BACKGROUND: Residency clinics with high no-show rates experience negative ramifications in patient health care, continuity, clinic productivity, and learning experiences for residents. This study tested patient education in the form of an exit interview to reduce no-show rates. METHODS: All eligible new patients at St. Mary's Family Practice Center between 1 February 1996 and 30 April 1997 were offered study enrollment. Patients with initial appointments during 5 of 9 clinic sessions were offered an exit interview with visit debriefing, written patient information where appropriate, and review of clinic policies. Missed patients or those with initial appointments during the remaining 4 sessions formed the control group. Interviewers were social work, medical, and nursing students. Insurance and subsequent appointment data were obtained from billing records. Median household income of ZIP codes in which patients resided was obtained from the 1990 Federal Census data. Data were analyzed using chi(2) tests, Wilcoxon rank-sum tests, and logistic regression. RESULTS: One hundred forty-six patients were enrolled into the intervention and 297 into the control group. Simple logistic regression showed a significant reduction in the risk of no-shows in the intervention group (odds ratio = 0.71, P =.04). CONCLUSIONS: The exit interview improved attendance at subsequent visits.

Adolescent↗

PubMed2005

Instrumental strategy: A stage in students' consultation skills training? Observations and reflections on students' communication in general practice consultations.

OBJECTIVES: To explore and examine students' abilities to communicate with patients during a general practice course in the final year of the curriculum and to analyse and consider this experience in relation to earlier consultation training. SETTING: General practice courses in the undergraduate curriculum. DESIGN: Qualitative data analysis was used. A special focus-group interview of experienced supervisors was performed and analysed (editing analysis). Credibility of data was tested at local seminars and conferences. Authors' experiences of observing student consultations over many years were also used. RESULTS: A main theme, 'open invitation', emerged based on categories 'initially attentive' and 'listening attitude'. In contrast, the second main theme was 'instrumental strategy', based on the following categories: 'one-sided collection of medical facts' and 'relationship-building lost'. The students also had difficulties in devoting attention to patients' life experiences. An hourglass metaphor of students' and young physicians' progression of communication strategies is presented. The narrow part of the hourglass corresponds to an instrumental strategy at the end of undergraduate clinical education. CONCLUSIONS: An instrumental strategy may be a stage in student's consultation learning progression that interferes with communication training. A question is raised: is training of a patient-centred approach throughout the clinical curriculum needed for optimal development of consultation skills? Further research is needed to test this hypothesis.

Clinical Competence↗

PubMed2005

Swedish teenager perceptions of teenage pregnancy, abortion, sexual behavior, and contraceptive habits--a focus group study among 17-year-old female high-school students.

BACKGROUND: Sweden has the highest abortion numbers among the Nordic countries. Since 1995, the abortion rate among teenagers has increased by nearly 50%. We therefore undertook a study where the overall aim was to gain a deeper understanding on which factors female teenagers believe may explain the increasing numbers of teenage abortions. Teenagers' perceptions of teenage pregnancy, abortion, sexual behavior, and contraceptive habits were investigated. METHODS: Six focus group interviews with 17-year-old Swedish girls were conducted. The interviews were tape-recorded, transcribed verbatim, and analyzed by manifest content analysis. RESULTS: Negative attitudes toward teenage pregnancy and supportive attitudes toward abortion were expressed. Risk-taking behaviors such as negligence in contraceptive use and intercourse under the influence of alcohol were suggested as main reasons behind the increasing numbers of abortions among Swedish teenagers. The contemporary, sexualized, media picture was believed to influence adolescents' sexual behavior, and liberal attitudes toward casual sex were expressed. Girls were perceived as more obliged than boys in taking responsibility for contraceptive compliance and avoidance of pregnancy. The apprehension that hormonal contraceptives cause negative side-effects was widely spread, and the participants were found to have a somewhat limited knowledge of abortion. The majority were unsatisfied with the quality of sexual education provided by the schools. CONCLUSION: Possible reasons for increased abortion numbers among teenagers in Sweden could be liberal attitudes toward casual sex in combination with negligence in contraceptive use, use of alcohol followed by sexual risk-taking, fear of hormonal contraceptives, and a deterioration of sexual education in the schools.

Abortion, Induced↗

PubMed2006

Overweight men's motivations and perceived barriers towards weight loss.

OBJECTIVE: To explore motivation and perceived barriers towards weight loss among Danish men. DESIGN: The study was of an explorative nature, using qualitative focus group interviews as a method. SETTING: Copenhagen, Denmark. SUBJECTS: Twenty-two overweight men, at the age of 25-44 years and motivated for weight loss, were recruited and distributed into four focus groups. The men were primarily unskilled workers. Overall 13 men participated and each group contained three or four participants. INTERVENTION: The interview guide was partly structured, partly unstructured and the themes of the interviews were motives and perceived barriers towards weight loss. RESULTS: Main barriers for losing weight appeared to be lack of motivation and the perception of the slimming diet. The men had a desire to have a lean appearance and avoid illness, but in all the interviews it appeared that the strongest motive for losing weight was a strong desire to become more effective and a greater asset for one's workplace. Overweight subjects were considered less effective and attractive for the labour market. CONCLUSION: This study indicates that if men from lower socioeconomic backgrounds are to be motivated to weight loss the focus should not be on leanness and good health but rather on increased effectiveness and performance, and the arena should include the working place. SPONSORSHIP: The Royal Veterinary and Agricultural University supplied the necessary equipment and conference rooms.

Adult↗

PubMed2003

A hidden curriculum: mapping cultural competency in a medical programme.

BACKGROUND: Cultural competency can be understood as those learned skills which help us understand cultural differences and ease communication between people who have different ways of understanding health, sickness and the body. Recently, medical schools have begun to recognise a need for cultural competency training. However, few reports have been published that articulate and evaluate cultural competency in medical curricula. AIM: This study was performed in order to evaluate the current status of cultural competency training at a medical school in southern Sweden. METHODS: We used a multimethod approach to curriculum evaluation. We reviewed the published list of learning objectives for the medical programme, interviewed curriculum directors and individual teachers for each term about course content and carried out focus group interviews with students in all stages of the medical programme. RESULTS: Cultural competency is a present but mostly hidden part of the curriculum. We found learning objectives about cultural competency. Teachers reported a total of 25 instances of teaching that had culture or cultural competency as the main theme or 1 of many themes. Students reported few specific learning instances where cultural competency was the main theme. Students and teachers considered cultural competency training to be integrated into the medical programme. Cultural competency was not assessed. CONCLUSION: This evaluation showed places in the curriculum where cultural competency is a present, absent or hidden part of the curriculum. The differences between the 3 perspectives on the curriculum lead us to propose curriculum changes. This study illustrates how triangulation with a multifactorial methodology leads to understanding of the current curriculum and changes for the future.

Cultural Diversity↗

PubMed2005

[Scale for assessing interests of Japanese elderly people in their daily life].

OBJECTIVE: Programs to support independent living for elderly people are generally designed taking into account physical and psychological conditions. The interests of individuals are diverse even when the physical conditions are the same. Interests in daily life are important factors for adequate planning of the programs for independent living. The purpose of this study was to examine an evaluation structure of interests of Japanese elderly people in their daily life. METHODS: Focus group interviews were conducted to collect items for interests in daily life by several researchers targeting activity groups of elderly people. Eighteen items were extracted from a total of 50 following the principles: (1) Items with similar meanings are brought together; (2) Items which might have big differences in meaning depending on the subject were excluded; and (3) Items which were double barreled were excluded. The questionnaire 18 items were designed to give a 4-point Likart scale for answers from "very important" to "not important at all". The survey was conducted in 20 municipalities all over Japan in 2000. From residents aged 65 years and over, 6,094 individuals were selected randomly as the study population. RESULTS: Of 5,565 participants, 4,527 individuals answered all 18 items. "To have a good time with the family" was the favorite answer (54.8%), rated as "very important". Four factors (eigenvalue > 1) were extracted by applying principal component analysis: "to live with good communication", "to achieve one's purpose", "to live socially", and "to live comfortably". "To live with good communication" showed the highest score and "To live socially" showed the lowest score. CONCLUSION: With this scale, we could precisely determine the diversity of interests of Japanese elderly people in their daily life. We suggest that this scale might be useful not only to analyze the interests of individuals, but also to plan programs in terms of quality of life or independent living in late life.

Activities of Daily Living↗

PubMed1998

Head and neck cancer services: views of patients, their families and professionals.

OBJECTIVES: To explore views of patients, their families and professionals about head and neck cancer services. METHODS: Focus group interviews of 33 patients and relatives and 33 professionals from four hospitals and two patient support groups in SouthEast England. RESULTS: Although patients and relatives were grateful for their care, many thought that some areas could be improved. Many thought that their ward facilities were inappropriate. Patients wanted to have more information about the impact of their treatment and about different treatment options whereas professionals tended to concentrate on giving information about the details of operations. Counselling services were often found to be inaccessible and inappropriate. Administrative difficulties were a major source of frustration for professionals, as were failure of treatment and communication difficulties. Professionals valued joint clinics and a team approach in keeping up to date, in clinical decision making, and in providing mutual support. CONCLUSION: The findings highlight areas that could be improved which would benefit both patients and professionals.

Communication↗

PubMed2001

Consumers' views of quality in the consultation and their relevance to 'shared decision-making' approaches.

BACKGROUND: There is a recognized need to assess the effects of shared decision-making and other communication interventions. However, the outcomes usually assessed for evidence of 'effectiveness' are determined by researchers and have not been based on consumers' views. AIM: This study aimed to identify the important outcomes of consultations for consumers, and to compare with those reported in the current literature. SETTING AND PARTICIPANTS: Forty-seven participants attending six focus group interviews. Most interviews took place in and all were orientated towards the UK primary care setting. METHODS: Focus group study. RESULTS: Many affective outcomes were identified, consistent with the current literature trends. However, many cognitive and behavioural outcomes that are assessed in the current literature were not noted by participants as important. Furthermore, a broader range of outcomes than is evident in the current literature was viewed as important to these participants. CONCLUSIONS: There is a need to revisit the outcomes which are assessed in decision-making and communication research. The outcomes of greatest importance to consumers must be identified and confirmed by new research which is based directly on the views of consumers themselves.

Consumer Behavior↗

PubMed2000

The perceptions of nurse teachers, student nurses and preceptors of the theory-practice gap in nurse education.

The theory-practice gap has been the subject of much debate within nursing. Issues include: where the gap is, whether it is a positive or negative phenomenon and whether attempts should be made to bridge it. This paper describes a research study adopting an innovative approach to exploring the theory-practice gap by investigating it from the perspectives of three different groups: nurse teachers, student nurses and clinical preceptors. Combining the perceptions of these diverse groups has allowed a more complete picture of the theory-practice gap to emerge than is possible when examining it from one group's perspective alone. Twenty-three group interviews were conducted and content analysed to identify common themes. Mutual concerns were identified by all groups: shortness of clinical placements, sequencing of theory and practice, lack of collaboration between clinical areas and educational institutions and the lack of clarity regarding link teacher roles. All interviewees felt a theory-practice gap does exist, and whilst this could be viewed positively as a means of developing students' problem-solving skills, attempts should be made to minimize its impact. Ways to achieve this include: the development of an innovative curriculum allowing closer sequencing of theory and practice, evaluating the effect length of clinical placement has on knowledge and skill acquisition, improving collaboration between clinical areas and educational institutions and developing preceptors' lecturing roles.

Attitude of Health Personnel↗

PubMedDate not supplied

Effects of treatment history and centralized intake on drug treatment outcomes.

This study assesses differences between first-time treatment clients (n=90) and repeat treatment clients (n=361), including whether entering treatment through a central intake unit affects outcomes differently for the two groups. Interview data were collected at baseline, one-month and 12-month follow-up. Study groups were similar in gender, race and age, but repeat treatment participants were more educated, more likely to primarily use heroin and more likely to have ever injected drugs. First-time treatment clients were more likely to have been required to enter treatment, but less likely to have applied to another program or to be in the program they desired. First-time treatment clients were also more likely to be in outpatient or day treatment, and less likely to be in residential treatment. Problem severity decreased for both groups over time, with no significant differences between groups. There was one significant interaction effect of study group and length of stay on social problem severity, such that longer stays in treatment led to a greater reduction in social problems for repeat treatment clients. Route of treatment entry (CIU/non-CIU) was not associated with problem severity nor change in problem severity over time for either study group.

Adult↗

PubMed2005

The challenges associated with providing community care for people with complex needs in rural areas: a qualitative investigation.

The aim of the present study was to explore the experiences of recipients and providers of community care in rural areas in Northern Ireland. Additionally, the authors sought to examine the impact of location, housing and environmental factors on the delivery of community care to older people with complex needs. Individual, semistructured interviews were held with service users (n = 17) and family carers (n = 14). Individual and focus group interviews were conducted with care assistants, health and social care professionals, and senior managers from a large health and social care trust and health and social services board in Northern Ireland. The importance of enabling older people to remain in their own homes and communities was emphasised by all participants. The main challenges associated with care provision in rural areas included: difficulties recruiting care assistants; lack of choice of care assistants; isolation; travel and distance between clients and their care assistants; and poor housing conditions. There was a general consensus among participants that the effectiveness of rural community care was perceived to be reliant upon the goodwill of the community. Additionally, changing demographic trends and the predicted shortfall in the number of formal and informal carers were considered key issues for service planners. A number of creative strategies could be used to address many of the limitations associated with rural isolation. These should involve capitalising on available community networks. However, planners should also acknowledge that additional resources are required to maintain older people in rural communities.

Community Health Services↗

PubMed2004

HIV medication adherence programs: the importance of social support.

Since the advent of medical treatments for HIV, the promotion of adherence to these difficult treatment regimens has proven critical to disease management. Three Connecticut state-funded HIV medication adherence programs were evaluated.1 The purpose of this process evaluation was to explore and compare the goals and modality of each adherence program, assess client and staff satisfaction, and provide recommendations for the improvement of these programs. Focus group interviews with clients and individual interviews with staff were conducted at each of the programs. Interviews were transcribed, coded and analyzed with a code and retrieve method of theme identification. Focus group themes included the importance of social support on medication adherence and the "lifesaving" effect the program has had. The staff expressed that although complete adherence should be the long-term objective, more intermediate objectives should be considered (e.g., behavioral changes to increase clients' ability, self-esteem, and self-efficacy to take medications).

Anti-HIV Agents↗

PubMed2006

The role of faith-based institutions in addressing health disparities: a case study of an initiative in the southwest Bronx.

Although many public health initiatives have been implemented through collaborations with faith-based institutions, little is known about best practices for developing such programs. Using a community-based participatory approach, this case study examines the implementation of an initiative in the Bronx, New York, that is designed to educate community members about health promotion and disease management and to mobilize church members to seek equal access to health care services. The study used qualitative methods, including the collaborative development of a logic model for the initiative, focus groups, interviews, analysis of program reports, and participant observation. The paper examines three key aspects of the initiative's implementation: (1) the engagement of the church leadership; (2) the use of church structures as venues for education and intervention; and (3) changes in church policies. Key findings include the importance of pre-existing relationships within the community and the prominent agenda-setting role played by key pastors, and the strength of the Coalition's dual focus on health behaviors and health disparities. Given the churches' demonstrated ability to pull people together, to motivate and to inspire, there is great potential for faith-based interventions, and models developed through such interventions, to address health disparities.

Community Health Planning↗

PubMed2005

[Profile of a medical auditing group in the state of Rio Grande do Sul].

BACKGROUND: This paper aims to determine the profile of the medical auditor in the State of Rio Grande do Sul, Brazil, based upon a group of physicians who participated in the post-graduation courses of Unimed Foundation Health Auditing, in the cities of Porto Alegre and Caxias do Sul, together with other professionals performing the same activity in the State of Rio Grande do Sul. METHODS: A historical review, a study of the laws and norms that guide the role of the Medical Auditor is presented as well as a review of the literature on medical auditing in Brazil. A non identifiable questionnaire was administered, where questions on personal data and professional training were made, as well as others related to personal satisfaction, health and well-being. RESULTS: The questionnaire was answered by 71 Medical Auditors, with a total of 85 positions in medical auditing at several workplaces. 83.8% are male, ages ranging from 41 to 50 years (38%), on the average they had been graduated for 21.96 +/- 7.68 years, performing medical auditing activities for 7.24 +/- 6.62 years and 88.7% hold a medical academic title and/or medical specialization courses in several areas. In the group researched, 25.37% are formally employed 60% are personally and professionally satisfied and are physically well. In the interviewed group, there are no physicians under 33 years of age nor any graduated for less than 7 years. CONCLUSIONS: A high level of medical education, specialization and updating is evident among the Medical Auditors that were interviewed. Data from the present study will contribute for the definition of the Brazilian Medical Auditor's Profile.

Adult↗

PubMed1994

Perceptions of African American women regarding health care.

An exploratory study utilizing ethnographic, participatory and Afrocentric research methodologies was conducted to identify causative factors related to the reluctance of a large percentage of African American women to avail themselves and their children to available health care in San Joaquin County, California. Although this qualitative study sought the responses of only ten African American women, the use of a windshield survey, a 20-item demographic questionnaire, five descriptive questions, a 128-item guide to dialogue, and transcription of dialogue from serial 60-90 minute individual and group interview sessions resulted in the identification of ten taxonomies and five prominent themes operating among this group of participants. The findings implied the need for nursing measures to enhance personal empowerment of this historically underserved population; as well as the need for nursing education to incorporate cultural-specific health care practices in curricula.

Adolescent↗

PubMed1999

What pediatricians can do to further youth violence prevention--a qualitative study.

OBJECTIVE: Youth violence is a public health problem world wide. However, the United States has the worst rate of youth violence among industralized countries. This study was conducted to learn what pediatricians, community leaders, and parents think the doctor's role is in youth violence prevention during the well-child examination for children. METHODS: Interviews were conducted with pediatricians, community leaders, and parents living or working in Los Angeles, California. RESULTS: All three groups interviewed believed that the physician should incorporate violence prevention counseling as part of the well-child examination. The mechanism of action differed for the three groups. Almost half of pediatricians' statements focused on their role as prevention counselor, with respect to such issues as appropriate discipline and gun safety. One third of community leaders' statements, however, related to physician referral to existing community resources. More than half of parents' statements referred to the pediatrician as someone who can directly educate their child about making positive choices. CONCLUSIONS: Although pediatricians cannot solve the problem of youth violence alone, findings from this study suggest that they should address this issue with their patients and should work in tandem with existing community resources to further a solution to this growing epidemic.

Adult↗

PubMed1999

Health professionals' perspectives on service delivery in two Northern Ireland communities.

This research builds on the findings of an ethnographic study of health inequalities in two small, rural communities in Northern Ireland. Through further analysis of existing data, this second study aimed to explore health professionals' perspectives on issues of service delivery relevant to government policy on primary care. Anthropological fieldwork was conducted for two consecutive 4-month periods during 1995 and 1996 in one predominantly Catholic and one predominantly Protestant town. To preserve confidentiality, the locations have been given the pseudonyms, respectively, of Ballymacross and Hunterstown. Research tools included fieldwork journals and a fieldwork diary, meetings with key informants, tape-recorded interviews, group discussions, participant observation and use of secondary material such as census data, local newspapers and community health profiles. Interviews with 15 health workers revealed that there was not a coherent approach to achieving health gain, little collaborative enterprise and minimal interaction between the different professional groups. The National Health Service (NHS)-employed primary care professionals, more than local community workers, appeared to be demoralized, exhausted and suspicious of the business-orientated health service. In this respect, the primary care-led NHS appeared not to be working. It is concluded that a shared health agenda should be developed by NHS-employed primary care professionals and local community workers to create a health-inducing environment at community level. This needs to be complemented by the establishment of formal mechanisms for inter-agency working at local, professional and government levels.

Community Participation↗