Health & Social Care in the Community最新文献

Background: Social prescribing (SP) has received increasing interest in recent years due to its potential to encourage health-promoting behaviours, such as physical activity (PA). However, to develop effective SP interventions, it is critical to enhance our understanding of the mechanisms of change associated with SP and their potential to promote PA. This review aimed to synthesise the mechanisms of change in SP interventions and to develop a logic model illustrating a theoretical framework for SPs potential to promote PA.

Methods: A narrative review was performed, including a systematic literature search in Medline, Embase and PsycINFO. The systematic literature search was finalised on 21 February 2023, and studies investigating mechanisms of change in SP interventions were included. Findings were synthesised and illustrated in a logic model illustrating how SP interventions may promote PA as an outcome.

Results: The systematic literature search identified 340 studies, of which 11 met the inclusion criteria. The SP interventions comprised three processes: referral, linking and engagement. These processes influenced various mechanisms of change, which were classified into two perspectives. From a person-centred perspective, the mechanisms with the potential to promote PA comprised self-efficacy, motivation, empowerment and ‘having a voice’. These mechanisms were associated with crucial elements of SP, such as tailoring to needs, trusted relationships, nonstigmatising activities and peer-to-peer support. From a system-based perspective, the mechanisms with the potential to promote PA included system capacity and resources together with shared understanding and knowledge. These mechanisms were related to crucial elements of SP, including reliance on established communication and network, local agency and accessibility.

Conclusion: A person-centred perspective describes SPs potential to promote PA through various mechanisms of change. However, these mechanisms appear to be intricately connected with the local context. Consequently, SP intervention research could benefit from incorporating contextual factors and, ideally, also integrating system thinking.

In the context of long-term care facilities, mealtime situations have been linked to residents’ health and well-being. The optimisation of mealtime situations is dependent on multiple aspects and is complex. To better understand this complexity, this qualitative study aimed to identify staffs’ beliefs about the values of mealtime situations for residents’ health and well-being and to explore the facilitators of, barriers to, and challenges and actions in accomplishing and upholding these values. The results demonstrated that staffs’ belief consisted of achieving social and relational values, vitality values, self-strengthening values and atmospheric values. During mealtimes, participating staff had to constantly balance these values in relation to mealtime situational preconditions and residents’ individual and communal needs. Experienced facilitators, challenges, barriers and actions could be traced to and explained by identified beliefs, implying that knowledge regarding beliefs about values could be helpful for understanding and managing the complexity inherent in the mealtime situation.

Objectives: The effectiveness of telemedicine in rural areas with low-quality primary care remains unclear. This study examined the relationship of telemedicine adoption with life satisfaction and satisfaction with care in rural China. It also investigated the association of telemedicine with health-seeking behaviour, healthcare utilisation and heterogeneity in the type of telemedicine collaboration and the quality of healthcare workforce.

Methods: Data were retrieved from the China Livelihood Survey, a nationally representative multi-level survey conducted in 2021. Ordinary least-squares regression models were employed to analyse the relationship between telemedicine adoption at the village level and rural households’ life satisfaction and satisfaction with healthcare. Propensity score matching was used to address the potential selection bias.

Results: A total of 4638 households were included in the analysis. The results show that telemedicine adoption in village clinics was associated with higher levels of life satisfaction and satisfaction with healthcare among rural households. This improvement was primarily attributed to an increased likelihood of seeking care at primary care facilities, rather than a reduction in healthcare expenditures. The association was stronger when village clinics collaborated with township health centres in telemedicine initiatives, compared to those partnering with higher-level hospitals. Moreover, the association was more pronounced in villages with lower-quality healthcare workers compared to those with higher-quality staff.

Conclusion: These findings highlight telemedicine as an effective tool for improving rural residents’ satisfaction. Strategies such as promoting strengthened telemedicine collaboration at local levels and targeting telemedicine resources to remote areas with deficient primary care workforces are recommended to optimise telemedicine adoption in primary care in China and other developing countries.

Objective: The relationship between end-of-life care and the quality of death remains inconclusive. This study explores the association between end-of-life care and the quality of death among aging individuals in China and examines its heterogeneity.

Methods: This study utilized three waves of data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) focusing on aging individuals in their final phase of life (N = 9974). By employing structural equation modeling (SEM) and the SEM-based regression models, we examined the impact of end-of-life care on the quality of death among aging individuals.

Results: These findings indicate that the current provision of end-of-life care falls short in improving the quality of death for aging individuals (β = −0.3177; p ≤ 0.001), while lifestyles factors have a significant positive effect (β = 1.7054; p ≤ 0.001). Furthermore, the impact of end-of-life care on the quality of death varies based on gender (β = −0.3370, −0.3301; p ≤ 0.001) and rural–urban disparities (β = −0.3768, −0.3083; p ≤ 0.001). Various aspects of end-of-life care exhibit distinct influences on specific dimensions of death quality in aging individuals.

Conclusion: These results underscore the necessity of enhancing end-of-life and death education in China. It is essential to reshape traditional perspectives concerning life and death, raise awareness and acceptance of end-of-life care, increase the availability of end-of-life care services, and improve the professionalism of care.

This rapid review explores the use of social prescribing for individuals with mental health needs. Mental health conditions are one of the six areas of focus in the UK government’s major conditions strategy, which aims to increase healthy life expectancy, alleviate pressure on the health system, and recognise the impact of comorbidity. It aims to improve the treatment of patients through the integration of mental health and physical health pathways. Social prescribing shows promise in contributing to positive mental health outcomes and could be a viable option as part of this strategy. Fifty-three articles were included in this rapid review from 4 databases (CINAHL, Cochrane, PubMed and Scopus) which discussed the use of social prescribing in addressing mental health conditions. Social prescribing activities, the roles and responsibilities of practitioners, and the need for further underpinning research are all explored. Overall, this review highlights the potential benefits of social prescribing for individuals with mental health conditions.

Sexual violence is a global problem with significant individual and societal health and social costs. Services that support victim-survivors of sexual violence across a range of sectors are crucial. This study investigated the scope, range, funding and commissioning of voluntary sector specialist (VSS) sexual violence services in England and victim-survivors’ experiences of using such services. The specialist voluntary sector plays a pivotal role in providing crisis and longer-term support to victim-survivors. However, there is limited empirical evidence about the scope, range and use of VSS provision, or what victim-survivors value and want from services. The aim of the study was to address this gap and provide much-needed evidence to inform the VSS sector nationally. This co-produced study included five co-researchers and one co-applicant with lived experience of sexual violence. There were three empirical phases: (1) exploratory interviews with commissioners and service providers and focus groups with victim-survivors; (2) national survey of service providers and commissioners; (3) in-depth case study analysis in four areas of England. The purpose of this paper is to synthesise the findings from each of these phases and map them onto a conceptual model, encompassing six themes: the complex and precarious funding landscape; the challenge of competition for funding and contracts; the role of partnership working; the pressured environments within which VSS services work; the different roles, scope and eligibility of voluntary and statutory services within an area; the ways services are delivered, underpinned by services’ values and philosophies. The study provides new, empirical insights into how these arrangements affect those connected with the services—namely, staff, volunteers and victim-survivors. The paper sets out 14 recommendations for all parties involved in the funding and commissioning of specialist services, including commissioners, grant funders and VSS organisations in England.

Background: Health interventions have been prioritised worldwide to curb the growth and life impact of Type 2 diabetes mellitus (T2DM). Social prescribing (SP), as a complex health intervention, has shown promise in producing positive outcomes. This study aims to establish an expert consensus on a model and SP intervention’s multicomponents to empower self-care and health literacy in T2DM patients.

Methods: A descriptive design using two consensus-building techniques took place between June and September 2023. The modified nominal group technique (NGT) was used to reach a consensus on the SP intervention model with 12 experts, who participated in two online meetings and voted on a scale of 1–9. In addition, a modified Delphi panel with 10 experts in two online rounds to reach a consensus on the intervention’s multicomponents, who rated the categories of the intervention on a Likert scale of 1–5. Consensus was reached when an agreement level ≥ 75% was obtained. The data were analysed via descriptive analysis, and the consensus level was calculated based on the mean, standard deviation and percentage.

Results: Using the modified NGT, the experts reached a 93.52% consensus on the final model flowchart. In the modified Delphi panel’s first round, 27 original interventions were evaluated. In the second round, one was removed because of low agreement, six were revised, and five new ones were added based on participant feedback. A consensus was achieved on 30 interventions across the six categories (cross-cutting intervention components, physical activity, nutrition, medication management, self-monitoring and well-being).

Conclusions: Both consensus techniques ensure that the SP model and these interventions meet the person’s needs and the community it serves. They allow a better understanding of self-care and health literacy strategies, contributing to future health programs and policies for more efficiently managing T2DM.

Home-care nursing is gaining importance because of the increasing number of people requiring care. Home-care nurses are exposed to high demands, which can have adverse health consequences. This study aimed to conduct an integrative literature review to identify the job characteristics and their relationship with health-related outcomes among home-care nurses. A systematic literature review was conducted using the Cochrane Library, Medline, CINAHL Complete, PsycInfo, PsycArticles, and Psyndex databases. A total of 5510 studies were screened, and the final sample for this integrative review comprised 52 studies. We used a descriptive thematic method to synthesize the data. Our analysis revealed that the most relevant job demands for home-care nurses were work overload, time pressure, fragmented care, sexual harassment and violence, role conflicts and work–family conflicts, and emotional and physical demands. These demands are risk factors for stress; mental, musculoskeletal, and cardiovascular diseases; and the intention to leave the profession. Job resources that positively influenced health outcomes were identified as social support, especially reachability during the shift and room for peer exchange; learning and personal development within the home-care service; provision of feasibility equipment; possibilities to participate in organizational decisions; autonomy to schedule their own work; a promoting leadership style; and sufficient payment. To improve home-care nurses’ job characteristics and thus protect their health, interventions should be taken at the political, organizational, and individual levels.

Background: With growing interest in nature-based interventions for health, establishing implementation frameworks for prescribing nature in diverse settings is crucial. This study aims to develop and validate a nature prescribing framework tailored for the Australian healthcare context, employing a Delphi methodology to harness expert consensus.

Methods: The study utilised a two-round Delphi technique to gather insights from experts across various health and environmental sectors. Participants included healthcare providers, managers and policymakers engaged in or knowledgeable about nature prescribing. The initial framework, which was informed by earlier interviews with parties who prescribe or provide nature-based health interventions, was refined through the Delphi process, aiming for consensus on implementation criteria and associated practices.

Results: Sixteen experts participated in the first Delphi round, with 13 completing the second round. Participants reached consensus on five essential domains of the nature prescribing framework, which included Community: consultation and customisation, Systems: building partnerships and networks, Prescribers: cultivating awareness and capacity, Providing prescriptions: psychosocial foundations and External settings: interfacing social and natural environments. Perceived barriers and enablers to application were considered within the framework, including contextual and environmental factors, awareness and capacity among prescribers and public, and the role of infrastructure support.

Conclusion: The nature prescribing framework offers a structured approach to integrating nature-based activities into health practices, addressing both individual and community health needs. It is adaptable to various Australian settings, promoting broader implementation of nature-based prescriptions. Future research should focus on implementing and evaluating the feasibility and effectiveness of the framework in diverse demographic and geographic contexts.

Children in families experiencing socioeconomic disadvantage are more likely to start school with unaddressed developmental needs than children who do not experience disadvantage. Participation in well-child checks and developmental screening programs is low in Australian disadvantaged communities. This research explores an integrated approach to addressing this challenge by embedding place-based child and family nurses in early childhood education settings and community centres to facilitate easy access for families to health services. We conducted a mixed methods study, employing focus group, survey, interview and data linkage methods to evaluate a trial of the ‘Check-Ups Before School’ (CUBS) program. Our participants included health and community service providers, early childhood educators, primary school teachers, parents and carers. We found that a child health check, conducted in a safe and familiar environment for the child and their family, can act as a catalyst for wrap-around care and service integration. Such an approach should be place-based, listen to families and provide them with tools and information for agency, where relationships are fundamental to good care and supported by information flow through the family’s ecological environment, particularly in the transition to school. These findings can inform agencies in the design and implementation of integrated health and school readiness initiatives for children in the early years. Also discussed in the paper are policy implications for realising the potential of early childhood services as ‘community hubs’ and sites for integrated health and education, as well as implications for the role of educators as ‘brokers’ in relationships between parents/family members and health professionals.