Health & Social Care in the Community最新文献

Health equity for people who have been socially marginalised (PSM) is still a major challenge for health systems, further exacerbated by the COVID-19 syndemic and vaccination campaign. Nevertheless, the relevance of these events may open windows of opportunity to reorient health policies from an equity perspective. Based on this premise, a qualitative study was conducted in the Emilia-Romagna region (Italy) during the COVID-19 vaccination campaign, with the aim to identify the policies and practices adopted by local health authorities in order to ensure vaccination of PSM. The study involved key informants working in dedicated outpatient clinics for PSM or in primary healthcare (PHC) departments. A short checklist was used to assess local practices, followed by semistructured interviews to further understand areas such as (a) strategies to promote accessibility/access, (b) approaches for vaccination delivery, (c) information system and data collection, (d) planning and governance and (f) opportunities and future perspectives. The findings show that the regional COVID-19 vaccination campaign was based on a tailored approach, promoting multimethod strategies to increase accessibility for PSM. Limitations of the study are the lack of direct experience of PSM and the lack of correlation between the identified strategies and vaccination rates. However, the study confirms the existence of systematic shortcomings and barriers in accessing PHC services, which contribute to the process of social marginalisation that is responsible for health inequalities among PSM. In this respect, the COVID-19 vaccination campaign ensured broader access to a specific intervention without addressing the structural and organisational determinants of health inequalities among PSM, thus representing a failed opportunity to institute health equity. Our findings suggest the need to strengthen political commitment and promote effective participatory health policies capable of identifying and overcoming structural barriers in order to achieve a structural change towards greater health equity.

Background: Evidence-based medicine (EBM) is a prime component of medical practice. EBM often translate into clinical practice guidelines (CPG) widely used by healthcare providers. However, CPGs are often focused on a specific pathology, and they rarely make a room for shared decision-making (SDM) another key dimension, centered on the information exchange between the physician and the patient, the deliberation/discussion, and the decision made based on a common agreement. An assessment tool is therefore needed to determine whether the structure of CPGs allows or not the integration of SDM.

Objectives: To develop an assessment tool in French that could quantify the degree to which CPG facilitate SDM by translating and adapting the elements developed in international consensus studies.

Method: A Delphi consensus method including seven experts selected from the leading scientific community on the topic. Consensus was considered to have been reached when the approval rate reached 70%.

Results: A consensus for the adaptation, relevance, and adjustment of 19 strategies was reached after three rounds. Based on these strategies, 17 criteria were developed. They include general strategies such as adding a specific chapter on SDM, using wording that makes patient involvement explicit, presenting outcomes, benefits and harms of all options including “doing nothing,” and recommendation-specific strategies such as giving to the patient a copy of his/her personalized treatment plan, recommending which patient decision aid could be used and when, or encouraging the patient to exchange with close relatives and friends for the discussion.

Conclusion: We developed a 17-item tool to assess whether or not a CPG facilitates sustainable development. This tool will have to be tested to ensure that it is easy to use, relevant and reproducible, and thus meets the expected quality criteria. Such a tool would enable researchers and patients alike to assess CPGs using a common benchmark, would support national and international benchmarking processes, and provide a starting point for future improvement. Translations into other languages could broaden the scope of use.

Objective: Doctor–patient trust, especially patients’ trust in doctors, represents patients’ compliance with doctors’ behavior and may affect patients’ choice of medical treatment behavior. This paper aims to delve into the profound impact of doctor–patient trust on the hierarchical diagnosis and treatment system. Additionally, it formulates corresponding policy suggestions for reforming this system from a practical perspective, offering a useful reference for the development of both the theory and practice of China’s healthcare protections.

Methods: In this paper, the rank-dependent expected utility theory was used to construct a tripartite evolutionary game model of hierarchical diagnosis and treatment system for observing the interactions and behaviors between superior hospitals, primary hospitals, and patients under different levels of doctor–patient trust. Meanwhile, descriptive statistics and binary logistic regression methods were used in empirical research for revealing the specific mechanism.

Results: When the doctor–patient trust is at a high level, it is easier for each participant in the hierarchical diagnosis and treatment system to choose cooperative strategies, thus enabling the system to operate smoothly. Specifically, the medical level of healthcare institutions exerts a significantly positive impact on the level of doctor–patient trust and concurrently, an enhanced level of doctor–patient trust promotes patients’ adherence to the hierarchical diagnosis and treatment system when making healthcare choices.

Conclusions: Doctor–patient trust is a significant bridge connecting medical institutions and patients. It is an important factor to realize the orderly operation of hierarchical diagnosis and treatment system. To attain the objective of strengthening doctor–patient trust and fostering the smooth functioning of the hierarchical diagnosis and treatment system, it is essential to capitalize on policy mechanism to motivate healthcare service providers to enhance their medical capabilities and gradually guide patients to make healthcare choices in an orderly manner according to the system design.

Introduction: Intensive home support (IHS) is a contemporary, innovative outreach approach in the supported housing sector designed to meet the growing need for community living initiatives for people with severe mental illness. Unlike regular outreach, IHS provides 24/7 accessible staff, numerous support hours, and several facilities supporting independent living, including daily activity programs. IHS has not been evaluated before. As the first IHS study, we aimed to identify the critical ingredients for IHS according to clients and unravel how it works.

Methods: We used a longitudinal qualitative design with semistructured interviews after recruiting a purposive sample of IHS clients after 1 year of their recovery journey. Utilizing a realist evaluation approach based on CAIMeR theory and thematic analysis, we explored clients’ perspectives on the impact and key components of IHS.

Results: A total of 42 clients participated in this study, with 32 remaining involved after 1 year. Thematic analysis identified five critical ingredients experienced by IHS clients, including: (1) working alliance; (2) autonomy; (3) relationships; (4) mental and physical health; and (5) housing and living environment factors. The results also highlighted how IHS works and under what conditions, namely, by highlighting trust, continuity, recognition, belonging, and self-confidence. Clients viewed these components as crucial, collectively empowering them toward independent living and recovery. The 24/7 accessibility of trusted support workers increased clients’ self-confidence, although actual use was infrequent.

Conclusions: This study indicated that with IHS, more formerly residential SH clients with severe mental illness can live independently despite experiencing a sense of insecurity and feelings of loneliness. These elements collectively position IHS as an innovative approach to complement existing services, offering valuable support to enhance the independence of individuals with severe mental illness.

Drawing on the metaphor of “care convoys,” this study explores the experiences and strategies of family caregivers of older adults with dementia in rural areas of Northern Norway. The study is part of a broader project that investigates how these older adults and their caregivers use or do not use municipal health and care services. We conducted qualitative in-depth interviews with 11 family caregivers in rural municipalities. The thematic analysis of the interview data yielded three main themes: Delaying the transition to long-term care amid evolving needs, facilitating knowledge transition, and navigating divergent expectations about involvement. In addition, a fourth theme, caregiving in the rural Arctic, was identified as cross-cutting, reflecting the unique rural Arctic context that was a backdrop across all themes. In navigating the caregiving journey, family caregivers assume various roles within care convoys. They may act as solitary vessels, as an integral part of a larger care convoy, or as the main ship guiding the convoy. At times, family caregivers serve as vessels called upon by the convoy when needed. Difficulties in assembling an adequate or robust care convoy were exacerbated by the context of the Artic North, which represents treacherous waters for the convoy to navigate, primarily due to two factors: first, many of the smaller ships (other family members) were not present or had to travel great distances to join the convoy and second, the lengthy journeys (long travel distances), and particularly in the winter time, made the convoys susceptible to loosing ships along the way.

Population-based colorectal cancer screening programs decrease mortality, but the participation rates are still unsatisfactory. Drawing from relevant psychosocial literature, this study aims to test a widely integrated theory of planned behaviour model applied to colorectal cancer screening attendance. The model considered, at the same time, additional proximal predictors (anticipated regret and self-identity) and distal (via attitude) predictors (trust in institutions and perceived risk in their affective and cognitive facets) of intention. On top, to bridge the intention–behaviour gap, the role of two additional mediators (action and coping planning) was explored. In May-June 2022, 435 adults residing in Campania (Italy) joined a survey assessing variables of interest. Structural equation model results showed that both action and coping planning, which were predicted by intention, significantly predicted attendance. Intention was predicted by attitude, subjective norms, perceived behavioural control, anticipated regret and self-identity. Attitude was predicted by trust in institutions and affective perceived risk. A parallel mediation analysis confirmed the role of both action and coping planning as full mediators in the intention–behaviour relation. The proposed comprehensive model can inform future interventions and orienteer the improvement of healthcare access processes.

General practitioners (GPs) face complex decisions when choosing between prescribing medication or referring patients to social prescriptions. Increasing awareness of overprescribing and the risks of polypharmacy are a key driver of patient-centred preventative approaches to healthcare. One such approach, increasingly common in the United Kingdom, is social prescribing (SP). GPs have a central role in prescribing medication or referring to a social prescription. Following a thematic analysis of data from interviews with 12 GPs, this study used the concept of mindlines to frame a consideration of their reasoning about the appropriateness of social prescriptions as adjuncts to or alternatives for medical prescriptions. We identified seven considerations that shaped their decision-making process. These factors spanned the patient’s socioeconomic circumstances, the severity of their symptoms and their expectations. Additionally, GPs factored in their time constraints, the extent to which medical options had been exhausted, and finally issues related to the SP system itself—specifically, the integration of SP workflows in GP practices and resource constraints. SP is, in theory at least, a part of the healthcare system that offers the possibility of improved health both for people and the environment. Our consideration of the role of the GP in this suggests that the challenges for design and evaluation of SP interventions that result in a reduction in medical prescriptions are considerable.

Women experiencing homelessness may face heightened vulnerabilities and encounter barriers to accessing social services, which could perpetuate their situation and exacerbate the impact on their physical and mental health. This research aims to identify barriers and opportunities for women experiencing homelessness to access social care services based on a systematic integrative literature review. The inclusion criteria encompassed scientific articles and gray literature, focusing on studies of the access to social care services for women experiencing homelessness. English and Spanish documents from the past 20 years were considered, excluding publications lacking full-text access. The search was conducted until April 30, 2024, across 6 databases including Web of Science, Scopus, PsycINFO, Social Services Abstracts, Sociology, and Cochrane. Article quality was assessed before inclusion to mitigate bias. Data analysis employed a narrative approach using categories and subcategories. Thirty-eight publications were included, consisting of 36 articles and 2 theses. These publications predominantly relied on qualitative methods. Two main areas and eight categories emerged, covering structural, institutional, social, and personal barriers and opportunities, with 36 subcategories identified. Study limitations include a predominance of women in the study sample who had access to social care services, making it hard to include those experiencing hidden homelessness. Nonetheless, the research underscores the significance of gender-specific barriers and opportunities in access to social care. The need for gender-sensitive and intersectional policies is emphasized, as well as professional practices and training, to enhance the well-being of women experiencing homelessness and improve their access to services.

Introduction: Recent research has identified social capital as an essential element of social context that influences the healthy aging experience. Since social capital is a resource that is context and culture relative, this study builds on and extends the existing literature on social capital among older adults by investigating different dimensions of social capital in later life and related individual and environmental characteristics in the Chinese context.

Materials & Methods: Using the China Family Panel Study (CFPS) 2016 wave, 8097 individuals aged 60 years and older were included in the sample. Factor analysis was used to explore the dimensions that comprise the social capital of Chinese older adults. Multiple indicators, multiple cause (MIMIC) structural equation models were used to identify influential individual and environmental characteristics.

Results: The findings of this study showed that as an interaction between the actor and the multiple levels of the social environment, the social capital of Chinese older adults derived from three levels of social environment—family, community, and macro society. Rural older adults had higher levels of social capital across all three levels. While demographic factors and functioning, including female, age, marital status, education, and functional limitations, had a significant relationship with family-based social capital, having higher income and better self-rated health were related to higher level of community- and society-based social capital. Additionally, the physical community environment was a key determinant across all three levels of social capital.

Discussion and Conclusion: Findings from this study demonstrate the important roles of neighborhood environment in shaping older adults’ all levels of social capital. The findings also identified the unique role of family social capital and the need for policies and practices to reduce the vulnerability associated with a limited ability to adapt to the broader environment.

Background: Under a housing affordability crisis, Montreal, Canada, is host to a growing homeless population. While people who use drugs or alcohol make up a large part of this group, homeless resources in the city continue to exclude them through sobriety rules or by not adapting programming to their specific needs. This systematic exclusion, and the conditions of these resources, can often be retraumatizing for individuals seeking help. Applying a trauma-informed spaces of care framework, this research asks what are the needs of homeless individuals who use substances to exit homelessness? What are the current limits within homeless resources in Montreal to actualize these needs? How can they change to meet these needs?

Methods: In 2023, 30 semistructured interviews were conducted, with follow-up at 3 months, with individuals who use drugs or alcohol currently experiencing homelessness. Transcribed interviews were analyzed in Nvivo.

Results: Findings called for serious reforms to homeless service provision, with an emphasis on more forms of harm reduction-based programming, integrated occupational activities, improved psychosocial accompaniment, better division of service users, and alternative and adapted housing interventions for substance users. Most participants disclosed potentially traumatic life experiences, highlighting the need for trauma-informed programming.

Conclusion: Allowing individuals to articulate their needs and desires for programming demonstrates that this group recognizes the inadequacy of services and identifies the homeless resource as a site of potential traumatization. While the recommendations of people with living experience of homelessness and substance use articulate promising practices in substance use recovery, as well as homelessness service provision, homeless service providers are slow to adapt their programming accordingly.