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PubMed2005

"Saying no is no easy matter" a qualitative study of competing concerns in rationing decisions in general practice.

BACKGROUND: The general practitioner in Norway is expected to ensure equity and effectiveness through fair rationing. At the same time, due to recent reforms of the Norwegian health care sector, both the role of economic incentives and patient autonomy have been strengthened. Studies indicate that modern general practitioners, both in Norway and in other countries are uncomfortable with the gatekeeper role, but there is little knowledge about how general practitioners experience rationing in practice. METHODS: Through focus group interviews with Norwegian general practitioners, we explore physicians' attitudes toward factors of influence on medical decision making and how rationing dilemmas are experienced in everyday practice. RESULTS: Four major concerns appeared in the group discussions: The obligation to ration health care, professional autonomy, patient autonomy, and competition. A central finding was that the physicians find rationing difficult because saying no in face to face relations often is felt uncomfortable and in conflict with other important objectives for the general practitioner. CONCLUSION: It is important to understand the association between using economic incentives in the management of health care, increasing patient autonomy, and the willingness among physicians to contribute to efficient, fair and legitimate resource allocation.

Attitude of Health Personnel↗

PubMed2004

Hazards in the home: using older adults' perceptions to inform warning design.

Older adults' perceptions of hazards associated with home product usage and beliefs about product warnings were assessed. Focus group interview data were coded along the dimensions of (a) product type; (b) hazard type; (c) hazard knowledge; (d) hazard avoidance; (e) product warning presence; and (f) product warning necessity. A survey supplemented the focus group results by gathering measures of usage patterns and usability difficulties associated with various types of household products. Older adults reported routine use of products they considered to be hazardous and identified an array of home safety concerns. Furthermore, personal experience was an important source of older adults' hazard knowledge and they described a number of hazard avoidance strategies. These data provide insight into older adults' home safety behaviour and suggest a number of approaches to improving hazard communication and warning design.

Aged↗

PubMed1999

Interdisciplinary pilot project in a rehabilitation setting.

This project qualitatively evaluated the planning, implementation, and outcome of an interdisciplinary model of clinical education. Expectations of physiotherapy (PT), occupational therapy (OT), and speech-language pathology (SLP) students and clinicians were assessed to determine whether the model allowed for the acquisition of the interdisciplinary knowledge and skills needed for current practice. Students from OT (n = 5), PT (n = 3), and SLP (n = 1) undertook normally scheduled five-to-eight-week clinical placements, beginning on the same start date. All students were at intermediate or senior levels in their programs. Discipline-specific activities were supervised by clinical instructors from the disciplines. Interdisciplinary sessions during the first five weeks covered cross-disciplinary activities related to clinical reasoning, interviewing techniques, professionalism, and communication skills for team reporting. Themes related to the clinical experience were derived from student and supervisor responses to pre-and post-placement questionnaires, post-placement focus group interviews, and student journals. The response to the model was positive. The students felt they had gained insights into developing interdisciplinary skills, although they did feel that some discipline-specific needs were not met. The instructors were less enthusiastic but, given better planning and communication before the placement, welcomed the opportunity to try it again.

Canada↗

PubMed2000

Qualitative techniques to investigate how patients evaluate dentists: a pilot study.

OBJECTIVES: Most previous studies have portrayed patient satisfaction as a rather simple outcome based solely on patient perceptions. The goal of this pilot study was to determine if evidence could be found to support the view that patient evaluation is a more complex process better explained by drawing on the theories of 'disconfirmation of expectations' and 'attribution'. METHODS: A qualitative methodological approach was chosen with data collection being achieved by means of four focus group interviews comprising a total of 25 participants (16 women and 9 men, mean age 43.8 years, standard deviation of 14.45) representing a wider population of adults (over the age of 18) who had attended for dental treatment within the previous 12 months. RESULTS: Analysis suggests that patient perceptions of dental practice alone do not fully account for the way patients evaluate dentists. Disconfirmation of expectations does take place during the evaluation process. Equally, patients appear to apply the attributional concepts of 'duty' and 'culpability' to determine either satisfaction or dissatisfaction. CONCLUSIONS: A better understanding of patient satisfaction, and the evaluation process that leads to satisfaction, can only be achieved if, in addition to patient perceptions, other antecedent factors such as patient expectations and desires are considered. Disconfirmation and attribution theory do appear to play an important role in this process and warrant further investigation.

Adult↗

PubMed2001

Employee response to major organizational redesign.

A number of health care organizations are currently undergoing major organizational redesign. Despite these efforts, little is known about how these changes are affecting the employees participating in the redesign process. In response to this, a study was undertaken to determine the perceived impact of organizational redesign on nursing staff at 2 acute care hospitals that were undergoing major organizational change. Data were collected through semi-structured focus group interviews conducted on all 3 shifts (days, evenings, and nights). Findings suggest the early redesign period is highly turbulent and difficult for staff. Nurses expressed concern over changes in roles and responsibilities, disruption in work group relationships, loss of resource availability, reduction in quality of care, and alterations in physical and psychological state.

Attitude of Health Personnel↗

PubMedDate not supplied

Providing a healthcare input to children in special schools.

The education of children with special educational needs is often accompanied by a requirement for medical or healthcare provision. If this cannot be done safely then the child's access to education is limited. No standardized template for the delivery of a healthcare input to children in special schools is apparent. This study sought to explore, through the use of an indepth needs assessment exercise and focus group interviews, what the most appropriate healthcare role was for delivering health care in a special school catering for children with a broad range of severe learning disabilities. While an overwhelming viewpoint of participants in focus groups perceived that a nurse was the only suitable person to undertake the role, the evidence gathered prompted the research steering group to suggest to the contrary, i.e. that the role of a healthcare worker with a national vocational qualification (NVQ) level 3 in care was the more appropriate person to maximize both the role of the nurse and the quality of care provided to these children.

Child↗

PubMed2000

Poppies in a wheat field: exploring the lives of rural lesbians.

Many believe that lesbian identity is predicated upon the availability of opportunities in urban life to find information, support, and like others (Bell and Valentine 1995a). Indeed, exploring one's lesbian sense of self often involves identifying with a visible reference group, seeking out social arenas where there are other gays and lesbians, connecting with a local community, and taking part in gay and lesbian oriented activities. For rural residents, these opportunities are mostly unavailable, and the lack of access to information, to a public meeting space, and to connections with other lesbians further hinders the development of social group identity. Given that gay and lesbian identity has as its basis a social reference group, how might rural lesbians develop and sustain their sense of personal and group lesbian identity? With few exceptions (D'Augelli 1989; D'Augelli et al. 1987; Kramer 1995; Krieger 1982) the empirical research conducted on the lives of gays and lesbians has utilized urban and suburban samples. Likewise, research on rural life has omitted the experiences of gay and lesbian residents. Either way, information about rural lesbian life remains mostly uncovered. This pilot study attempts to provide new information about the experiences of rural lesbians. Utilizing focus group interviews, the challenges of sustaining lesbian identity in a rural setting are explored. The data show that for this sample, although rural lesbians initially felt isolated and unsure of how to develop a sense of group identity, the opportunity to connect with a small informal network of friends and acquaintances helped alleviate these problems. Further, because these women have little access to information, public gathering space, or to local gay culture, this network was said to be crucial. Without it, the women feel invisible and isolated, that is, their identity remains unseen.

Adolescent↗

PubMed2006

Rural residents with disabilities confront substantial barriers to obtaining primary care.

OBJECTIVE: To learn about the health care experiences of rural residents with disabilities. STUDY SETTING: Rural areas in Massachusetts and Virginia. STUDY DESIGN: Local centers for independent living recruited 35 adults with sensory, physical, or psychiatric disabilities to participate in four focus group interviews. DATA COLLECTION METHODS: Verbatim transcripts of interviews were reviewed to identify major themes. PRINCIPAL FINDINGS: Interviewees described the many well-recognized impediments to health care in rural America; disability appears to exacerbate these barriers. Interviewees reported substantial difficulties finding physicians who understand their disabilities and sometimes feel that they must teach their local doctors about their underlying conditions. Interviewees described needing to travel periodically to large medical centers to get necessary specialty care. Many are poor and are either uninsured or have Medicaid coverage, complicating their searches for willing primary care physicians. Because many cannot drive, they face great difficulties getting to their local doctor and especially making long trips to urban centers. Available public transportation often is inaccessible and unreliable. Physicians' offices are sometimes located in old buildings that do not have accessible entrances or equipment. Based on their personal experiences, interviewees perceive that rural areas are generally less sensitive to disability access issues than urban areas. CONCLUSIONS: Meeting the health care needs of rural residents with disabilities will require interventions beyond health care, involving transportation and access issues more broadly.

Adult↗

PubMed2006

[Extralegal coercive measures in psychiatric wards-- patients' perspectives].

INTRODUCTION: A revision of the Danish Mental Health Act is planned to take place in 2005-2006. The Ministry of Health requires investigation into whether extralegal coercive measures take place in psychiatric wards. Extralegal coercion refers to restrictions and rules not included in the current Mental Health Act and considered by patients to be coercion. MATERIALS AND METHODS: Twenty-two psychiatric patients participated in four group interviews directed by two physicians at four University Hospitals in Copenhagen, Denmark. The patients were asked to define what they perceived as extralegal coercion, house rules and psychiatric treatment. RESULTS: The majority of patients perceived lack of single rooms, restrictions on leaving the ward and shielding, i.e., being confined to one's room, to be extralegal coercion. A few also found the pressure to take medication and collection of clothes items to be extralegal coercion. Rules on smoking, clothing, day and night routines, the use of radio and TV, drugs, alcohol, visits, eating and the use of telephones were considered not extralegal coercion but necessary house rules. House rules should be clear and stated in writing. Restrictions on the use of money and locking of the front door at night were accepted in certain situations, hence not considered to be extralegal coercion. DISCUSSION: Extralegal coercion does occur in psychiatric wards but in certain situations is accepted if documented. House rules are considered to be necessary and not extralegal coercion. Increased use of compulsory protocols for documenting coercive measures was not considered to be necessary, but documentation in patients' files was useful alternative.

Coercion↗

PubMed2005

[E-mail communication in general practice].

INTRODUCTION: Our aim was to examine how e-mail communication in general practice affects the doctor/patient relationship and doctors' workload. MATERIALS AND METHODS: Registration was done of e-mail activity in three Danish GP surgeries over a period of 12 months and focus group interviews with patients and doctors. RESULTS: The practices received 191 e-mails per 1,000 patients per year. The male/female ratio was 0.9 to 1. The average patient age was 47.2 years; the oldest user was 88 years old. Qualitative data were categorized under various headings, such as need, expectations, usability, workload, patient service, the communication part of professionalism, worries and barriers against use. DISCUSSION: E-mail is a requested and useful communication form between doctors and patients in general practice. But it requires guidance and structured communication. It works best when the doctor and patient know each other. It is being used less than might be expected. The barriers from patients' point of view are lack of knowledge of and access to computers, lack of awareness of the possibility of contacting the physician by e-mail and the absence of a personal invitation for use by the personal physician. It is a matter of concern that patients apparently don't read the recommendations concerning proper use of e-mail communication, even though they are clearly described on the Web site and patients have to click "has been read" to be able to continue.

Adult↗

PubMedDate not supplied

Reducing HIV sexual risk among African American women who use drugs: hearing their voices.

A pilot study was conducted to understand women's realities, perspectives, and perceived needs regarding the interaction between substance use, types of sexual relationships, and the challenges and barriers they pose to practicing safer sex. An additional purpose was to examine this population's willingness to participate in the program and receptiveness to the components of proposed interventions. Data were collected in this descriptive, exploratory study by the use of one focus group. Twelve African American women between 20 and 55 years of age who had previous drug detoxification experience participated in a 3-hour focus group. All participants were sexually active as well as current users of illicit substances, and all but one had traded sex for money, drugs, or alcohol. The focus group interview was guided by a semistructured questionnaire. Participants were recruited by counselors in detoxification units. Each unit counselor was asked to randomly select a third of their residents, explain and read the purpose of the focus group, and get the residents' verbal consent to participate. The women discussed their sexual behaviors and drug use that increased their risk for acquiring HIV. They provided insight about the effects of different drugs on one's sexual behavior, motivation for sex, and reasons for unsafe sex and made recommendations for HIV prevention intervention. Participants agreed that safer sex and healthy living intervention would be most beneficial if placed within the context of a detoxification program. The juxtaposition of increased sexual risk behavior and the potential to acquire and transmit HIV infection suggests the urgency of intervening with African American women who are substance abusers.

Adult↗

PubMed2000

The utilization of a Midwifery Obstetrical Unit (MOU) in a Metropolitan area.

In this study an explorative, descriptive design which is contextual in nature, is utilized. The objective of the study is three-fold: Firstly, to describe the opinions of members of the community about the reasons for the under-utilization of the Midwifery Obstetrical Unit (MOU); secondly, to describe the suggestions of the community for improving the utilization of the MOU and thirdly, to describe intervention strategies for community nurses to improve the utilization of the MOU. Data was collected by means of focus group interviews, and was analysed using Tesch's (in Cresswell, 1994: 154-155) method of data analysis. Trustworthiness was ensured by using the method of Guba and Lincoln (1985). The respondents were mothers who delivered their babies at the hospital, mothers who delivered their babies at the MOU, members of the Community Health Committee and MOU nurses. Data was collected in two phases. Phase I dealt with the first question: What is your opinion about the reasons for the under-utilization of the MOU? Phase II dealt with the second question: What are your suggestions for improving the utilization of the MOU? The four groups participated in Phase I as well as in Phase II, the reason being to involve the groups in identifying problems and finding solutions with which they would be comfortable, since it would be their ideas. This whole exercise was, however, carried out in line with the RDP principle of people driven approach or community involvement. The investigation revealed that the community was not utilizing the MOU because of the following reasons: Negative attitudes of nurses. Lack of material and human resources. Poor safety and security measures. Lack of community involvement/participation. The focus groups then identified the following suggestions for improving the utilization of the MOU: Change of attitudes by nurses towards the patients. Availability of material and human resources. Proper safety and security measures in the MOU. Community involvement/participation. Integration of health services. Intervention strategies for community nurses to improve the utilization of the MOU were based on the literature as well as the suggestions made by the focus group respondents because the researcher found the suggestions to be realistic.

Attitude of Health Personnel↗

PubMed2002

Distributed Web-supported radiology clerkship for the required clinical clerkship year of medical school: development, implementation, and evaluation.

RATIONALE AND OBJECTIVES: The authors performed this study to develop, implement, and evaluate a new radiology clerkship for the required clinical clerkship year of medical school. MATERIALS AND METHODS: A mandatory radiology clerkship experience was added to the required clinical clerkships as a series of 10 independent half-day teaching sessions. These sessions were distributed as one session per existing clerkship throughout the year. To provide continuity and organization, Web-based curriculum materials were designed and implemented as a component of the radiology clerkship. The new clerkship was evaluated with observations, pretest and posttest measures with a control group, structured and unstructured student and faculty surveys, and individual and small group interviews. RESULTS: The clerkship was successfully developed and implemented. Ninety-five students have completed the clerkship. Their mean posttest score (84.8) was significantly higher than their mean pretest score (58.8, P < .001) and the mean control group score (59.7, P < .001). Students rarely used the Web site. Disadvantages of the distributed clerkship were identified. CONCLUSION: A radiology clerkship distributed among existing clerkships is feasible but has many disadvantages. Students greatly prefer live instruction, and Web-based educational materials are more valuable to faculty and administrators than to students.

Attitude↗

PubMed2005

General public's knowledge, interest and information needs related to genetic cancer: an exploratory study.

Single-group interviews were conducted with 49 people to get an idea of what and how the general public thinks about genetic cancer. Understanding what people think and need is crucial for adequate public health communication about genetic issues. Group discussions revealed that people believed that the vulnerability for cancer was largely dependent on their lifestyle, and that they were at risk if cancer ran in their family. Participants found it difficult to distinguish cancer from genetic cancer since in both cases the cause was related to cell problems. People felt that they lacked adequate knowledge of genetic cancer, which was also confirmed by the misconceptions revealed during the discussions. Participants mentioned both advantages (knowing one's risk, performing preventive actions, more openness, less taboo, and more knowledge) and disadvantages (fear arousal, difficult to time, undirected, tenability) of receiving genetic information. Although people felt ambivalent about wanting to receive genetic cancer information, as yet the general tendency seemed to be to postpone opening up to such information until there was a relevant case in the family. Subsequently, preferred information sources were family members and health professionals. According to the participants mass media should provide information on relevant features of genetic cancer to look out for. As yet, people showed little interest in biological genetic information.

Adult↗

PubMed2003

Individuals exhibiting conspicuous nevi (lentigo simplex) are resistant to allergic rhinitis/conjunctivitis (pollinosis), but those who do not show increased susceptibility to pollinosis.

We investigated 115 individuals in Tokyo from two groups of persons with conspicuous nevi on the head, neck, and arms, etc. (nevus-positive group) and persons who do not exhibit such nevi (nevi-negative group) interviewing them to determine whether they suffered from allergic rhinitis/conjunctivitis (pollinosis) and examining them for the presence and extent of nevi. There was a distinct correlation: only 5 persons among 85 individuals of the nevus-positive group suffered from pollinosis, and all 30 people in the nevus-negative group had pollinosis. Thus, individuals exhibiting conspicuous nevi are resistant to pollinosis, but those who do not show increased susceptibility to pollinosis.

Adolescent↗

PubMed2002

Vaginal wetness: an underestimated problem experienced by progestogen injectable contraceptive users in South Africa.

This paper reports on the common experience of vaginal wetness amongst South African users of progestogen-only injectable contraceptives. The observations emerged in the course of a community-based cross-sectional household survey undertaken in a rural district of KwaZulu-Natal in South Africa. The purpose of the survey was to elicit self-reporting on side effects of injectable contraceptive methods. Eight hundred and forty-eight women aged 15-49 were interviewed and 22.1% reported current use of an injectable contraceptive method, either depot medroxyprogesterone acetate (Depo-Provera) or norethisterone oenanthate (Nur-Isterate). Other modern methods used were oral hormonal contraceptives (4.5%), male condoms (1.3%), the intrauterine device (0.1%), and tubal ligation (0.1%). Vaginal wetness was reported by 18.4% of users and was one of the most common side effects, second only to amenorrhoea (62.5%). It was also what 17.5% of the women liked least about using this method. According to almost half the respondents, men regard women who use the injectable contraceptive as "wet", "cold" and/or "tasteless". These survey findings were supported by participants of 14 focus group interviews held in the sub-district. Since some South African men may prefer dry sex the perception that the injectable contraceptive increases vaginal wetness may be problematic for women who use it. Whilst vaginal wetness can only be classified as a subjective side effect at this stage, further investigations are needed as many South African women opt to use this method.

Adolescent↗

PubMedDate not supplied

Practice what we preach? HIV knowledge, beliefs, and behaviors of adolescents and adolescent peer educators.

The purpose of this article is to (a) describe the knowledge, beliefs, and sexual behaviors of urban adolescents and adolescent peer educators, and (b) identify elements needed to design effective HIV/AIDS prevention programs for out-of-school youth. Thirty-three predominantly African American adolescents (female = 14; male = 19) between the ages of 14 and 24 in a large urban city including adolescent (n = 18) and adolescent peer educators (n = 15) participated. Paper-and-pencil questionnaire and focus-group interviewing methods were used. Adolescents and adolescent peer educators had a moderately high level of HIV knowledge, confidence in their ability to use condoms, and beliefs that condom use would not decrease sexual pleasure or imply infidelity. Both groups reported low perceptions of susceptibility of HIV infection. Engagement in sexual risk behavior was low, but was significantly higher among males. Although adolescent male peer educators engaged in a higher frequency of risk behaviors over time, they had a lower frequency of sexual risk behaviors in the past 2 months compared with male adolescents. Study findings showed that HIV prevention interventions need to include information about specific risk behaviors, such as using condoms for oral sex, and cleaning drug paraphernalia. Community-based and church programs, visible HIV prevention messages, specifically those aimed at increasing perceptions of HIV risk, and the development of condom-use skills were identified by adolescents and adolescent peer educators as relevant approaches to reduce HIV infection among this population.

Adolescent↗

PubMed2000

An exploration into the role of the teacher/lecturer in practice: findings from a case study in adult nursing.

Against a background of increasing concern over the widening theory practice gap and research evidence of problems in providing quality practice education, the English National Board (ENB) commissioned an 18 month study into the role of the teacher/lecturer in practice. This article, after providing a brief overview of the background, literature and methods, outlines the results from the Adult Case Study stage of the research. Documents, individual and focus group interviews of lecturers (n = 76), practitioners (n = 46) and students (n = 131) in five schools of nursing and midwifery provided data for analysis. A role labeled as 'link lecturer' was the most common approach acknowledged by all respondent groups. Despite overt commitment to the practice role by schools of nursing and midwifery, findings indicate that lecturers are unprepared, unsupported and unmonitored. Students and practitioners had very variable experiences and expressed a strong need for a better-organized approach which would provide them with consistent and sustained support in the practice setting. Overall the study highlighted a lack of strategic management of the practice role by university schools of nursing and midwifery. Convergence of findings from midwifery and the other branches of nursing provides strong research evidence for recommendations for more active management of the practice curriculum to be implemented as part of any future proposed reforms for nurse education in the UK.

Adult↗