Health & Social Care in the Community最新文献

Aims. To understand what domains of acculturation are experienced by Chinese immigrants with cardiovascular disease (CVD) in Australia and how these domains of acculturation influence their CVD self-care behaviours. Design. A qualitative descriptive design. Methods. Individual phone interviews were conducted among Chinese immigrants with CVD in Sydney, recruited from Chinese Community associations and social media. Inductive and deductive thematic analysis was employed, guided by the Middle-Range Theory of Self-Care of Chronic Illness and the conceptual model of acculturation. Results. Twenty participants, mean age 69.9 years, were interviewed. The domains of acculturation in relation to CVD self-care behaviours encompassed cultural practices, cultural values, healthcare system navigation, and new living environment. Retaining their Chinese culture and integrating into Australian culture regarding dietary practices, social networks, traditional values and family relationships served as both enablers and barriers of self-care maintenance through factors such as heart-healthy diets, physical activity, stress management and medication adherence. Many participants denied encountering difficulties to utilize primary care services, but language barriers deterred them from accessing acute services and heart-health information from mainstream sources. Some preserved beliefs and practices in Traditional Chinese Medicine may complicate their self-care maintenance (medication adherence) and self-care management (responding to acute angina episodes). Conclusion. The influence of acculturation on CVD self-care behaviours among Chinese immigrants is multifaceted and individualized. Clinicians and community health workers should assess patients’ acculturation experiences to enable culturally sensitive practices. The lack of culturally and linguistically appropriate heart health information in the community should be addressed urgently to mitigate the cardiac health disparity. Collaboration with Chinese community associations offers an opportunity for co-design and dissemination of information about Australian healthcare systems and heart health education to upskill CVD self-care practices and mitigate the health inequities experienced by Chinese immigrants.

Background. High numbers of young people are living with obesity in England, with associated negative impacts on their mental and physical health. Social prescribing involves professionals referring individuals to community-based services to provide additional health and well-being support. Social prescribing may be a helpful way to provide holistic support to young people living with obesity alongside weight management services. However, there is a need to better understand the availability of community-based services that could provide this support. Aims. This study aimed to explore the process for mapping community-based services to be part of a social prescribing offer within children’s specialist weight management services in one region of England and to provide an understanding of the availability of community-based services in this region that are accessible for this population. Method. Community-based services providing physical activity opportunities to young people in an area local to a specialist weight management service (South Yorkshire) were mapped using a mixed methods approach, including scoping of online resources and meetings with relevant contacts. Services were identified and reviewed against criteria developed through stakeholder engagement to assess suitability for young people living with obesity. Results. A total of 933 community-based services were identified across South Yorkshire between January and June 2023. Scoping and suitability assessment of these services took 6 months. There was often limited information provided about services, particularly relating to costs. Nineteen services met all suitability criteria. Conclusion. It requires time and capacity to identify relevant community-based services as part of a social prescribing offering. Although a high number of services were identified, few of these were suitable for young people living with obesity. Consideration should be given to how young people can be supported to access services, as well as how services can be supported to meet the needs of young people living with severe obesity.

The past decade has seen a growing recognition of the role of supported self-management in the provision of long-term care and support for stroke survivors in primary and community care. However, its implementation and delivery across different contexts and models of community stroke care is inconsistent and patchy. This realist evaluation explored how and in which circumstances supported self-management is enacted and delivered within community stroke rehabilitation. Specifically, the study aimed to identify and explore contexts, mechanisms, and outcomes related to the delivery of collaborative supported self-management. It comprised a realist synthesis, Q-methodology study, and realist-informed interviews and focus groups with stroke survivors (n = 20), community-based stroke practitioners (n = 20), and community service delivery managers/clinical leads (n = 8) in stroke. The findings revealed that delivering supported self-management effectively and consistently in community stroke rehabilitation starts with embedding the ethos of collaborative supported self-management across staff, teams, and the organisation and involves collaborative relationships with stroke survivors that aim to build trust, confidence, and resilience. The findings identified specific mechanisms and facilitatory and inhibitory contexts that influence how well this is enacted and achieved in practice. A realist approach in this study is novel and has helped to generate new insights and perspectives how and when supported self-management approaches work in community stroke rehabilitation. The findings expand on and complement existing research on the efficacy of supported self-management in stroke and are of clinical importance for informing how collaborative, relational supported self-management approaches can be implemented, personalised, and tailored to people’s needs and evaluated within current healthcare systems.

Welfare technologies are becoming a necessity for health and long-term care, but little is known about their acceptance by nurses working with older adults in institutional, home, or community setting. The aim of this five-stage scoping review was to address this knowledge gap by identifying factors influencing nurses’ acceptance of welfare technologies, both before and after using them. A search of seven bibliographic databases and grey literature was conducted in December 2022, and based on defined selection criteria, 27 sources published between 2007 and 2022 were then considered. The data were examined with ATLAS.ti 9 using content-based analysis, and five groups of acceptance factors were identified: individual, organisational, patient, technological, and social influence. Post-use acceptance factors were found to be more nuanced than pre-use factors. While the pre-use factors included mainly attitudes, needs, outcome expectations, and ethical concerns, the post-use factors more prominently featured experience, usefulness, technical issues, device characteristics, effort expectancy, and organisational factors. Nevertheless, patient-centeredness was reflected in both. This study contributes to a better understanding of the factors affecting nurses’ acceptance of welfare technologies in the care of older adults in non-clinical settings, and it underscores the patient’s pivotal role in all aspects of nursing practice. By offering insights into both pre-use and post-use factors, this study gives an enriched perspective on the acceptance of welfare technologies in nursing care and provides guidance for future research and practice.

Collaboration between services addressing domestic violence and substance use presents scope for enhancement. This study presents the first stage of an Australian action research project that aimed to investigate cross-sector collaboration between domestic violence and substance use services. The study employed purposive sampling for data collection, with the primary author conducting semistructured interviews with 26 senior policy workers, practitioners, and managers about their previous experiences in promoting collaboration between these two sectors. Employing metaphor analysis as a heuristic tool, the authors identified the metaphorical concepts that interviewees used to frame their understanding of cross-sector collaboration. These metaphorical concepts reveal the diverse approaches to conceptualizing and implementing cross-sector collaboration. Collaboration was understood by participants as engaging with geopolitics, fixing infrastructure, running a business, and playing a game. Each metaphorical concept has implications for how professionals understand and perform cross-sector collaboration. The predominant language of cross-sectoral collaboration illuminates the discursive field in which policymakers and senior managers are situated. Certain metaphorical concepts hindered participants’ capacity to engage and sustain collaborative practice, while others held potential to promote collaboration. Researchers identified potential opportunities to promote collaborative practices between substance use and domestic violence sectors. By gaining insight into how professionals conceptualized cross-sector collaboration, leverage points were identified that supported the development of a policy stakeholder group working to address systemic issues of cross-sectoral practice.

Background. Rural older adults are an important vulnerable group facing the pandemic crisis. They are at a greater risk and have suffered more. They need more support and have challenged the society more. Thus, their pandemic crisis coping is essential for national emergency management. Objectives. This study was designed to address issues of rural older adults’ pandemic crisis coping, with the aim of better protecting rural older adults’ health and supporting national emergency management. Methods. Grounded theory was employed in this study. Open questions were designed by theoretical sampling and theoretical coding processes until theoretical saturation. In total, 56 participants were recruited via a snowballing process, from ZX city, Hubei Province, China. Results. Rural older adults’ pandemic crisis coping was impacted by many limitations, including less coping awareness, lower coping capacity, and insufficient coping support. Pandemic crisis coping awareness was difficult to initiate and lagged. The older adults’ pandemic crisis coping capacity was impacted by limited knowledge, weak personal finances, and a deficient ability to obtain and stockpile materials. Social support for coping with the pandemic crisis was limited to life support, official support, and health support. Conclusion. Much attention needs to be paid in strengthening the pandemic crisis coping of rural older adults. Thus, future works should focus on raising rural older adults’ pandemic crisis coping awareness, improving their pandemic crisis coping capacity, and providing them with appropriate pandemic crisis coping support.

To better determine the rate of aging and offer tailored intervention or medical care, it is essential to create a comprehensive indicator that can evaluate physical fitness in middle-aged and older people. This study aimed to create an indicator of physical fitness age (PFA) that can be used to comprehensively evaluate physical performance and to confirm its validity. There were 5,368 participants in the constructing PFA group and 1,846 participants in the validating PFA group (aged ≥40 for all). We measure five physical fitness items to develop PFA by using principal component analysis. To assess the validity of PFA, we compared chronological age (CA) and PFA in participants with and without possible sarcopenia and used receiver operating characteristic (ROC) curve analysis to assess the discriminating power of the CA and PFA in identifying possible sarcopenia. We established an indicator of PFA which was expressed as PFA = 24.857 − 0.034 × peak expiratory flow − 0.609 × handgrip strength + 9.238 × walking speed + 1.238 × 5-time chair stand test + 0.742 × CA for men, and PFA = 22.171 − 0.051 × peak expiratory flow − 0.735 × handgrip strength + 7.603 × walking speed + 1.108 × 5-time chair stand test + 0.753 × CA for women. The validation test demonstrated that PFA was statistically lower than CA in participants without possible sarcopenia, while the PFA was significantly greater than CA in those with possible sarcopenia. ROC analysis showed that PFA had a larger area under the curve than CA. The findings suggest that PFA is a valid predictor of physical performance in Chinese middle-aged and older adults, which can discriminate persons of the same CA but different levels of physical performance.

This paper considers the role of collective forms of day care for older people and their carers during the enforced closure of services in 2020 due to COVID-19. The study provides a unique opportunity to examine how the sector adapted to these unprecedented times. The paper draws on qualitative data collected from 8 case studies conducted in England, during which 120 interviews were held with older people, their carers, staff, and managers of services and local stakeholders. The findings demonstrate how day centres reimagined their services to meet the needs of older people and their carers in new and imaginative ways. They offer insights into the potential role day care centres could play in the new place-based partnerships envisaged in recent legislation. The study provides an opportunity to consider the importance of day care services in the light of their enforced closure, providing a more nuanced understanding of day care provision. The impact of COVID-19 on the social care sector meant that many day care centres were not fully operational and consequently the samples may not reflect the experiences of all centres.

Kinship care and child fostering are a common practice in certain parts of Africa. This narrative review seeks to explore and thematically code the contextual circumstances in which children leave their natal homes and are fostered across Africa and the corresponding outcomes for these children. It draws on case studies from Cameroon, the Democratic Republic of the Congo, Ethiopia, Kenya, and Namibia and other countries across the region to illustrate the diversity and cultural importance of kinship care and child fostering. These countries were selected based on their inclusion in the Thrive by Five International Program, a child rearing program promoting social, emotional, and cognitive development of children from birth to age five. The importance of kinship care and child fostering is also reinforced by outcomes from codesign workshops conducted for the Thrive by Five International Program in which parents, caregivers, and subject matter experts discussed their perspectives on child rearing practices and the challenges faced by caregivers in their home countries. The paper highlights the need to support kinship and foster caregivers in Africa with culturally adapted and place-based child rearing programs to help ensure fostered children reach their full developmental potential.

Background. Paediatric patients in Australia experience lengthy wait times for Primary and Allied Healthcare Service (PAHCS) appointments. This results in a lack of satisfaction and adverse health outcomes. However, very few studies have explored wait times for appointments with PAHCSs in Australia. This study explored the length of wait time and associated barriers to timely access to paediatric PAHCSs in Australia. Methods. The scoping review followed PRISMA-ScR guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We comprehensively searched for relevant studies from five databases, including Scopus, Emcare, Medline (via Ovid), CINAHL, and Google Scholar in August 2023 without any time limitations. Studies that reported qualitative findings on the wait times and associated barriers to timely accessing to PAHCSs were selected in this scoping review. We performed a reflexive thematic analysis using NVivo software in this review. Results. A total of seven studies out of ninety-one retrieved records were eligible to be included in this review. Studies show that Australian children, in general, had to wait more than one year for health assessments and interventions in PAHCSs. The long waiting times were perceived as frustrating and worrying by caregivers of children. Several overarching themes related to the barriers of timely accessing to paediatric PAHCSs in Australia were identified, such as strict appointment criteria for children, disparity between demand and provision, parental unawareness, and inadequate public funding in rural PAHCSs. Conclusion. Australian paediatric patients are severely burdened with long wait times for appointments with PAHCSs, primarily, due to the poor government initiatives in rural PAHCSs. This study suggested that the criteria for booking an appointment in PAHCSs need to be simplified. Besides, adequate public health funding and the provision of resources are required in rural PAHCSs.