Health & Social Care in the Community最新文献

A pervasive barrier to preventing, reducing, and ending homelessness is the stigmatization of and discrimination towards persons experiencing homelessness (PEH), termed “homeism.” To date, there has been no systematic review of the experiences and outcomes of stigmatization and discrimination among PEH or interventions to reduce this discrimination. To fill this gap in the literature, we conducted a scoping review to identify the ways in which PEH have been stigmatized and discriminated against, the results of these experiences, and interventions that have been used to reduce stigma and discrimination. We reviewed results from 12 databases with no date restrictions; 205 studies met our inclusion criteria. Thematic data analyses resulted in the identification of 12 categories. Using community consultation, the scoping review themes were reviewed and validated with 25 PEH or service providers in the homelessness sector and their feedback integrated into our results. Thematic categories included discrimination and stigmatization in healthcare, social services, workplaces and employment, and public spaces by the general public; discrimination and stigmatization from landlords, police and security guards, informal social networks, and by PEH toward PEH; discrimination and stigmatization linked to intersectional domains; PEH feelings about discrimination and stigmatization; outcomes of discrimination and stigmatization for PEH; and interventions to reduce stigma, discrimination, and prejudice towards PEH. Based on findings from this review, we argue that homeism serves as a social determinant of health as PEH confront multiple barriers to housing, income security, and healthcare due to interpersonal, institutional, structural, and intrapersonal stigmatization and discrimination.

Background. Clinical reasoning is a crucial process for healthcare professionals, involving both intuitive and analytical components. Intuition, which can be defined as immediate and context-sensitive thoughts, would play an important role in the clinical reasoning of occupational therapists (OTs). However, understanding of how OTs use their intuition remains limited. Thus, this study aimed to better understand the place of intuition in the clinical decision-making of OTs in a real-life context. Methods. Adopting a constructivist epistemological stance, this qualitative multiple-case study involved four OTs. For each OT, data were collected through a video-recorded clinical session and a subsequent explicitation interview. Conversational analysis of the video data and inductive thematic analysis of the interviews were conducted. Results. The OTs, with 2 to 34 years of experience, demonstrated a nuanced use of intuition in their clinical reasoning. Experienced OTs relied more heavily on intuitive reasoning, seamlessly integrating it into their analytical approach, while novice therapists alternated between the two modes, giving equal importance to both. Key themes highlighted the central role of practice context, professional experience, the therapeutic relationship, and emotional management in the expression of intuition. Conclusion. The study highlights the decisive influence of the practice context whether routine or unusual, on the expression of OTs’ intuition. Additionally, the findings underscore the regulatory role of the clinicians’ emotions and the importance of empathic management of the clients’ emotional aspects, which shape the intuitive reasoning processes.

Family-focussed practice is an important component of mental health care. In Australia, service users’ views about their experience of service are collected using instruments such as the Your Experience of Service (YES) survey. This study examined 10,579 Queensland (Australia) service users’ experiences of mental health services during 2019–2021, with a particular focus on their perspectives of how family and carers are involved in their care. The study examined if family-focussed practice is welcomed by service users and if it is important in terms of predicting recovery-related outcomes (e.g., hopefulness, managing day-to-day life, well-being, and experience of care) and which demographics (e.g., age, gender, and Indigenous status) and service characteristics (e.g., time in service, duration, year of service, and setting type) are associated with these outcomes and with family member involvement. A substantial majority of service users reported a positive experience of care (very good or excellent), feeling they had opportunities for family involvement and that their opinions about family involvement were respected (usually or always). Chi-square tests and nonlinear regression models showed that family involvement predicts care outcomes. Specifically, where individuals felt that their perspectives were recognised, their outcomes were consistently rated as more positive. The results also revealed that setting, age group, time in service, and admission status were significantly correlated with all user experience outcome variables and family-oriented variables. Future research has the potential to further strengthen this understanding of service users’ preferred opportunities and opinions about family involvement and how to improve family engagement and better meet the needs of service users and their families.

Background. Many individuals with serious mental illness live in supported accommodation. Decisions regarding type of supported accommodation required and level of support to meet individual’s needs are crucial for continuing rehabilitation and recovery following admission to hospital. This study aimed to identify personal and contextual predictive factors for (1) discharge from hospital to different levels of supported accommodation and (2) self-directed support needs of individuals with serious mental illness once they are in supported accommodation in Scotland. Method. Linked data from the Scottish Morbidity Record-Scottish Mental Health and Inpatient Day Case Section and the Scottish Government Social Care Survey were analysed using multinomial regression and multivariable logistic regression to identify personal and contextual factors associated with accommodation destination at the time of discharge and four self-directed support needs: personal care; domestic care; healthcare; and social, educational, and recreational. Results. Personal factors (age and having a diagnosis of schizophrenia, schizotypal, or delusional disorder) were associated with individuals moving to supported accommodation with higher levels of support. One contextual factor, compulsory detention when admitted to hospital, decreased the likelihood of moving to any type of supported accommodation. The personal and contextual factors associated with identified self-directed support needs varied by need. Support provided by the local authority was associated with all self-directed support needs, with having a diagnosis of schizophrenia, schizotypal, or delusional disorder associated with identifying domestic care, healthcare, and social, educational, and recreational needs, while living in the most deprived areas was associated with identifying healthcare needs. Advancing age and being compulsorily detained decreased the likelihood of identifying social, educational, and recreational needs. Conclusion. The study highlights that older men with a diagnosis of schizophrenia, schizotypal, or delusional disorder require higher levels of support upon discharge from hospital. When living in supported accommodation, having this diagnosis increases the likelihood of identifying support with looking after the home, looking after their health, and social and recreational activities; however, being older decreases the likelihood of identifying support with social and recreational activities.

Objective. This research aimed to validate the Informal Supporter Readiness Inventory (ISRI) for evaluating the preparedness of informal supporters, in an Australian sample, to provide assistance in the context of intimate partner violence (IPV). Method. The ISRI’s four distinct factors were each assessed with separate confirmatory factor analyses (CFA). Reliability was calculated using Cronbach’s alpha values, and test-retest reliability was evaluated using intraclass correlation coefficients. Additionally, the ISRI’s validity was assessed through Pearson’s correlations with both convergent and divergent measures. Results. The CFAs supported the four distinct factors of the ISRI: normative, individual, situational-emotion, and situational-assessment. The measure exhibited good-to-excellent internal consistency across these factors and good test-retest reliability at four weeks. Convergent validity was supported by a strong positive correlation with the Intent to Help Friends Scale, while its weak association with the Generic Job Satisfaction Scale supported divergent validity. Discussion. The ISRI has emerged as a practical instrument with relevance to certain Australian sociocultural dynamics, offering utility in both research and clinical settings. The ISRI supports a network-oriented approach to IPV survivor support, assisting the alliance between formal and informal support mechanisms. Future research should focus on broadening the ISRI’s applicability by assessing its effectiveness across diverse Australian populations.

Purpose. Maintaining physical activity (PA) has significant implications for health. According to the World Health Organization (WHO), adults aged 18–64 should engage in at least 150 to 300 minutes of moderate-intensity aerobic PA per week. However, urban-rural disparities and economic geography variations in PA levels have not received enough attention. This study aimed to examine these disparities in the likelihood of meeting PA recommendations by using data from the Study of Community Sports in China. Methods. This is a nationwide cross-sectional community-based study. A total of 5,000 participants were randomly selected using a multistage sampling strategy. They were asked to complete a survey including demographics data and PA levels. The data were analyzed using mixed-effects logistic regression to evaluate the association between urban-rural residency, economic geography regions, and the likelihood of meeting PA recommendations. Results. A total of 3,779 participants met the eligible criteria, and only 816 (21.6%) met the PA recommendation. The urban participants were more likely to meet the PA recommendation than their rural peers [OR (95% CI) of 1.72 (1.09, 2.71)]. The association remained significant among those aged ≥30 [OR = 2.53 (1.51, 4.24)] and those with the education of high school and below [OR = 1.88 (1.18, 1.77)], but not in their younger, and more-educated peers (P_interaction = 0.009 and 0.034, respectively). Compared with the east coastal residents, western ones had a greater chance of meeting the recommendation [OR = 2.68 (1.25, 5.74)]. The association was more prominent among the more-educated [OR = 3.89 (1.58, 9.57)] than the less-educated [1.90 (0.83, 4.35)](P_interaction <0.001), but not modified by age. Conclusion. Urban and western residents were more active than their rural and east coastal counterparts. Studies should carefully consider the interactions between age and education level with urbanization and region while evaluating PA levels. Moreover, policymakers should develop policies and programs according to urban-rural disparity and regional variations to shorten the gaps.

If properly used, condoms can serve as an effective family planning method and preventive tool towards sexually transmitted diseases (STDs). Despite its anticipated effectiveness, there are different myths and misconceptions which have been observed as hindrances to both its use and effectiveness. This review examines the myths and misconceptions of condom use among youths and explores challenges in condom usage in sub-Saharan Africa (SSA). A narrative review was employed of which different journal articles were reviewed. The search words/phrases were “condom use in SSA, condom use among youths in SSA, myths and misconceptions on condom use among youths in SSA.” A total of 1074 studies were identified, 93 were relevant to the topic, and only 71 suited the review. The identified myths and misconceptions of condom use include that males were the ones to decide on the use of condoms during sexual intercourse, economic power determines the use of condoms, condom use reduces sexual pleasure, condom use relates to the spread of HIV/AIDS, and condom use is against God’s will. Other identified myths and misconceptions of condom use include that the use of condoms is a sign of lack of trust associated with fornication and adultery, also the use of condoms is only for family planning purposes. The challenges identified were breakage of condom during sexual intercourse, condom slippage, condom leakage, incorrect storage, and reuse of condoms. The identified myths and misconceptions lead to low knowledge of condom use within communities. There is a need for collaboration between governments, researchers, and NGOs to provide education on condom use to communities, particularly youths.

The increased funding provided for Community Health Worker (CHW) hiring and training as part of the COVID-19 pandemic response was to increase their impact in alleviating the effects of negative social determinants of health in the lives of the most vulnerable individuals and communities. This enhanced use of CHW in vulnerable populations can also be used to improve access to such populations for applied research to study ways to improve health outcomes for low-income minority populations. We carried out a feasibility study using the State CHW association as partners to reach CHWs working with low-income minority population. Three hundred and three (303) clients of CHWs were interviewed on various demographic, health access, and employment information and both univariate and multivariate analyses was used to determine factors associated with being unvaccinated against COVID-19 and chi-squared used to determine if employment was associated with having health insurance. About half of the clients self-identified as Black/African American and half as Hispanic. Two-thirds were women and 52.1% were unemployed and 55.1% had no health insurance. There was no association between employment status and having health insurance. Majority (71.6%) had received one dose of a type of COVID-19 vaccine and being younger and being African American were associated with not getting a dose of COVID-19 vaccine, as well as being unemployed and not having health insurance. Most of the clients came to see the CHW about a Health/Healthcare issue of the five social determinants of health (SDOH). There were 38 different job titles provided by the clients and the job titles were mainly blue collar jobs and jobs in health and personal care. Our results indicate that CHWs reach the most vulnerable population who have limited health access and high unemployment and that CHWs can effectively be used for linkage to low-income minority population for applied research. Our analyses found that in this low-income population, being younger, being African American, being unemployed, and not having health insurance are each associated with not getting vaccinated against COVID-19, and employment is not associated with having health insurance. We have shown that partnership with CHWs to access their clients as research subjects leads to elucidating new information on the population that can be used in addressing public health programming.

Dental hygienist is the main provider of preventive oral care to promote and improve the oral health of individuals, families, and groups in society. However, the participation of dental hygienists in community outreach and public health programmes in Lithuania is limited, mainly due to the lack of institutional support and the unavailability of positions in public health initiatives, and the country’s population has insufficient access to cost-effective oral health promotion services. This exploratory study aimed to analyse dental hygienists’ perception of their profession–to evaluate the scope of practice and professional challenges faced by dental hygienists in Lithuania, focusing on their provision of preventive dental care and educational roles. This study is one part of a prospective study which was conducted in 2021. By using the qualitative approach, with a semistructured interview, the dental hygienists’ experience, towards understanding their duties and concept of profession, was collected. Interviews were conducted with seven dental hygienists. A thematic analysis of data from the interview was performed. Three themes were extracted from the contents: (1) concept of dental hygienist’s profession, (2) personal qualities, and (3) practical activities carried out by dental hygienists. The study results showed dental hygienists in Lithuania have a broad role focusing on patient care, educational activities, and preventive methods in line with European standards. Key attributes such as communication skills, diligence, and empathy are essential for effective practice, ensuring quality patient care and professional standards. Despite fulfilling nationally defined roles, dental hygienists seek expanded competencies and greater involvement in clinical and preventive care.

Background. Mobile health (mHealth) interventions hold promise in assisting older adults to meet physical activity (PA) guidelines. Yet, little is known about how older adults perceive using smartphones to enhance their PA. This study explored older adults’ experiences with the “My Health Plan” mHealth intervention and examined which person-level factors were associated with adherence. Methods. Forty older adults (52.5% female, mean age: 72.6 years) were instructed to use the My Health Plan application, which provided up to six stretch- and strengthening exercises per day and to wear a Fitbit Charge activity monitor for seven consecutive days. Person-level factors (e.g., gender and age) and psychosocial factors (e.g., intention and motivation) were assessed using a questionnaire. Afterwards, semistructured interviews were conducted to gather participants’ experiences with the application and Fitbit. Deductive thematic analysis (qualitative data) and regression analyses (quantitative data) were conducted. Results. Key themes emerging from the interviews were (1) smartphone notifications (including timing and number) and carrying the smartphone throughout the day, (2) suggested stretch- and strengthening exercises, (3) providing feedback, (4) experiences with Fitbit, and (5) overall suggestions for improving the application and mHealth interventions. Overall, participants reported positive experiences with the application and Fitbit. Being male, having higher baseline PA, lower anxiety, and greater ability to participate in social roles and activities were related to increased engagement with the proposed exercises. Conclusions. This study provides valuable insights to optimize future mHealth interventions tailored to older adults’ specific needs, aligning with their perceptions of the digital transformation in health promotion.