Health & Social Care in the Community最新文献

Family physician contract service (FPCS) was introduced by the Chinese government in 2016, which entailed the registration of individual patients with a designated family physician in primary healthcare facilities. To assess the yet-to-be realized impacts of incentives for family physicians on the performance of the FPCS policy in China, a qualitative semistructured interview was conducted in 2019 with 36 participants, including directors of local health commissions, leaders of primary healthcare facilities, family physicians, and nurses in eight community health centers in four cities deemed to have advanced and effectively implemented FPCS policies. The data analysis was guided by the framework method, which indicated the necessity of implementing a patient-based capitation system for FPCS and augmenting its financial allocation. The analysis further reveals a divergence in how incentives are perceived based on professional seniority: nonsenior physicians view financial incentives as a matter of livelihood and fairness, while senior physicians approach them strategically, weighing them against other professional activities. The independent distribution method was found to have the potential to enhance the motivation of family physicians in their work. A financing model that relies on health insurance payments may give rise to adverse selection concerns, as it could encourage the selection of healthier patients when making contracts. This issue can be effectively addressed through an innovative modification of the distribution method, whereby higher contract fees are assigned to individuals with more serious medical conditions. The implementation of nonfinancial incentives, including increased authority delegation, closer work relationships, and sufficient self-identification, has the potential to enhance the performance of the FPCS program. Consequently, it remains important to augment family physicians’ income and enhance their sense of self-fulfillment in the implementation of the FPCS policy in China.

This paper reports on a study exploring the experiences of working carers in the South of England—part of a larger research project exploring carers’ needs, experiences and ideas about improving carer involvement in research. The purpose of this element of the project was to understand the experience of being in paid employment whilst providing unpaid care to someone, including adjustments made to employment, support provided by employers and support agencies, the impact on the carers perceived well-being and ideas for improving their involvement in carers research. An online survey was distributed across a range of employers in four counties located in the South of England, and n = 51 participants responded to share their experiences. The survey was coproduced with n = 6 unpaid carers who attended a one and a half hour facilitated workshop where they contributed to the design and development of the questionnaire. Amendments to the questionnaire were then reviewed by n = 2 of the workshop participants chosen at random who provided additional comments and revisions before it was distributed. Several themes emerged concerning the carers experience at work, the support mechanisms in place which were helpful to them, issues and challenges experienced and ranked suggestions for future research to develop further understanding of the world of the working carer. We discuss areas where changes in policy and practice might address working carer concerns in relation to their retention in the workforce and ability to juggle all aspects of their working life with their caring responsibilities. This research highlights the importance of developing more humanised ways of understanding working carer needs—including further training to support wider organisational culture—to meaningfully support them in meeting their full potential within the workforce.

Addressing children’s complex health and well-being issues requires the collaborative efforts of health and social care professionals and teachers to develop effective care solutions and prevent the escalation of problems. Consequently, there is a recognized need to prepare professionals in children’s services for interprofessional collaboration already during undergraduate studies. However, knowledge on interdisciplinary collaboration aimed at promoting related competencies is fragmented. A scoping review was conducted to map the scientific literature on educational collaboration among health sciences, social sciences and teacher training, including collaboration with working life and the studies common for the students of these fields. Scientific publication in English in 2000–2023 was searched. A total of 1197 papers were initially identified. Following the selection process, 25 articles were included in the thematic analysis. Of the 25 articles analysed, 60% were empirical and 40% were theoretical. Perspectives included education (n = 10), healthcare (n = 5), social work (n = 2) and general interprofessional work (n = 8). The main contexts were children with special needs (n = 11) and child and family well-being (n = 5). The reporting was guided by the PRISMA-ScR checklist. The literature described the requirements for collaboration between faculties in universities for interdisciplinary education and the challenges experienced. In higher education, programmes in health sciences, social sciences and teacher training collaborated to enhance students’ interprofessional competencies through two main strategies: interfaculty collaboration in designing and delivering joint studies and collaboration with working life to provide authentic, practice-based learning. These shared studies emphasised skills such as collaborative attitudes, role understanding and knowledge exchange—competencies that are essential for professionals working with clients of all ages. This review contributes to the knowledge base on interprofessional education and highlights the importance of both academic and practice-based collaboration. It also identifies key challenges, including structural barriers within universities—such as rigid curricula and disciplinary silos—and limited resources for engaging in professional practices.

Older adults receiving aged care services within their own homes have high prevalence rates of depression and anxiety. Psychological treatments are effective for this population, but mental health services are underutilised. Little is known about the mental healthcare preferences of in-home aged care recipients and the specific types of barriers and facilitators they experience when seeking mental health support. To understand these lived experiences and perspectives, an exploratory qualitative study was conducted with individuals experiencing symptoms of depression and/or anxiety who were receiving in-home aged care services from an Australian national aged care provider. Twenty-nine older adults participated in a semistructured telephone interview. Transcripts were analysed using thematic analysis. Four themes were generated, which indicate that in-home aged care recipients: (1) differ in their mental health self-appraisals and approaches to wellbeing; (2) value varied supports in utilising mental healthcare; (3) want personalised and flexible care; and (4) face barriers and facilitators in accessing mental health services which are influenced by attitudes, awareness, availability and accessibility. The study emphasised the role of primary care physicians in enabling mental health services. It also highlighted that participants were receptive to receiving mental health services from an in-home aged care provider. Understanding care preferences and the barriers and facilitators for seeking mental health support will enable aged care and mental healthcare providers to improve engagement with recipients of in-home aged care in the use of mental health services and enhance the psychological wellbeing of older Australians.

This paper analyses the experiences and management of power during the co-production of a service blueprint for The Linker Service—a service aimed to assist women over 50 years old, sole parents and carers experiencing financial hardship to navigate service systems and supports in South Australia. We specifically focus on the co-production of the service blueprint. In the timeline of events, co-production was facilitated between (1) co-design of the initial service concept/theory of change; and (2) prototyping of a service blueprint. To understand the experiences and management of power, we applied a sequential mixed-method design involving observation of co-production, documentation, and iterative reflective notetaking, which informed survey design. Surveys seeking co-production experiences, e.g., being heard, feeling safe to contribute, being valued, sharing of power, and contributions leading to action, were completed by living experience participants (n = 22) and organisational participants (staff, NGO representatives, and evaluators, n = 12). Descriptive statistical analysis was performed on quantitative data and mixed with qualitative responses. To assist interpretation of results, a theoretical framework on the dimensions of power in ‘co-’processes and a realist social theory lens were applied. Results showed how timeline processes and strategic facilitation during co-production led to a disruption of professional power relations. This disruption was particularly evident because participants with lived experience had already established their presence prior to NGO workers joining the workshops, generating feelings of uncertainty around professional hierarchies. Weighting in favour of living experience power led to the emergence of collective power as human capacity evolved. Ideas morphed and actors worked together in co-production, leading to the development of a blueprint collectively agreed upon and ready for prototyping.

This paper investigates rural–urban disparities in the experiences of in-home care services for older adults in a sparsely populated municipality (Storuman) in Northern Sweden. Such municipalities are characterised by long-term population loss and ageing, an increasing concentration of residents and services in municipal centres and resultant rural ‘resource deserts’. Disparities are measured through four ‘endpoint’ measures—exits to residential care, resource use, longevity and survival in the in-home care system. Data were drawn from the municipality’s care service contract database (2014–2020). Users living in the municipal centre had lower resource use and used direct care less frequently than those in smaller and more distant settlements. Those living near a grocery store were more likely than others to survive long term in the in-home care system. The research reveals a potential to reduce exits to residential care, to make more effective use of direct care and shopping services and to limit disruptive transfers of care, particularly between municipal and regional health services. Overall, there was limited evidence of rural–urban disparities in in-home care outcomes, but particular attention should be paid to transactional proximity of different parts of the care system and proactive rather than reactive care planning. The paper contributes to debates about quality measures for in-home care and the impacts of micro-urbanisation on the lives of people living in sparsely populated areas.

Noncommunicable diseases (NCDs) are shaped by modifiable and nonmodifiable factors. Addressing them requires multisectoral strategies that complement clinical care. Social prescribing (SP) enables health professionals to identify health needs that might benefit from community supports and refer patients to services that promote well-being. This study examined the characteristics of patients referred to an SP programme in Lisbon, Portugal, and factors associated with uptake. We conducted a cross-sectional study including all referrals to two Family Health Units from September 2018 to December 2022, using referral forms and electronic health records. Logistic regression was applied to identify factors linked to uptake, defined as attending at least one SP appointment. Of 1022 referrals, 55.1% resulted in uptake. Compared with patients aged 0–25 years, uptake was more likely among those aged 51–75 years (OR 1.65; 95% CI 0.99–2.75) and those aged > 75 years (OR 2.21; 95% CI 1.42–3.46). Referrals for social or financial reasons (vs. no referred for this reason) (OR 1.47; 95% CI 1.12–1.92), having one chronic disease (OR 1.67; 95% CI 1.13–2.48) or two to three chronic diseases (OR 1.55; 95% CI 1.05–2.29) (vs. no chronic condition), and referrals during the COVID-19 period (vs. prepandemic) (OR 1.47; 95% CI 1.12–1.93) were also associated with uptake. Identifying which patients are more likely to engage can inform targeted outreach to improve participation and ensure the sustainability of SP initiatives.

Background: Research priority setting projects provide a method to engage stakeholders in the prioritisation of research activities. We conducted a priority setting project to identify priorities for research into the primary and secondary prevention of stroke.

Methods: A modified James Lind Alliance method was used for this project undertaken in Australia and New Zealand with two online surveys (September–November 2021 and May-June 2022) and an online workshop (August 2022). The main question addressed was ‘What question about preventing stroke would you like to see answered by researchers?’ Responses to Survey 1 were refined and reviewed to identify evidence uncertainties. Questions with uncertain evidence were presented in Survey 2 where participants rated the importance of questions. Quantitative analysis of the importance ratings identified highly rated questions. These questions were taken to the online workshop with two rounds of facilitated discussion to create a final list of priorities. A postworkshop evaluation questionnaire explored user’s perceptions of the process.

Results: In Survey 1, 375 people proposed > 700 research questions. These were refined to 134 questions that were checked against evidence with 47 determined to be unanswered and distributed for consideration in Survey 2. Respondents to Survey 2 (n = 97) rated 24 of the 47 questions highly that were then discussed in the online workshop (n = 16 participants). There was agreement on the most highly rated question ‘How can we improve early detection and measurement of stroke risk?’ but limited agreement on the remaining questions. Participants favoured keeping all questions but presenting them thematically. The final list includes 22 questions under behavioural; pharmacological/clinical; structural; policy; individual; population and secondary prevention themes. Participants rated the workshop experience as acceptable.

Conclusion: A suite of research priorities for the primary and secondary prevention of stroke were identified by a broad range of stakeholders including people with lived experience of stroke, the public and health professionals.

Background: The increasing adoption of mobile technologies among older adults presents new opportunities for cognitive health interventions. This study explores the acceptability and feasibility of a Cantonese-language gamified mobile application, Challenges in Town, designed to support cognitive training through real-life simulations. Grounded in the Technology Acceptance Model (TAM), the research investigates how gender, age, education and socioeconomic status influence older adults’ engagement with the app.

Method: A qualitative methodology was employed, involving 18 semistructured interviews and two focus groups with 20 participants aged 66–85 years in Hong Kong. Thematic analysis was conducted using TAM constructs: perceived usefulness (PU), perceived ease of use (PEU), attitude towards use (ATU) and behavioural intention to use (BIU). Stratified analysis provided insights into demographic-specific experiences.

Results: Findings revealed high acceptability, with participants reporting cognitive benefits, emotional satisfaction and motivation to continue use. Younger and more tech-savvy users adapted quickly, while older participants required initial support but expressed satisfaction postadaptation. Gendered differences emerged, with men valuing cognitive challenge and women emphasising practical memory support. Educational and socioeconomic backgrounds influenced expectations and perceived utility.

Discussion and Conclusion: The study highlights the importance of user-centred design, including intuitive navigation, customizable features and family-assisted onboarding. While TAM provided a useful framework, emergent themes such as family support and intergenerational support, and emotional engagement and social dimensions suggest the need for broader models. These findings inform the development of inclusive digital tools that promote cognitive well-being in ageing populations.