Inquiry-The Journal of Health Care Organization Provision and Financing最新文献

In digital era, the self-concept clarity of college students is increasingly alarming in Chinese educational system. In view of this, the current study investigated the structural associations between smart-phone addiction, social anxiety, social withdrawal, and self-concept clarity among Chinese college students. A chain mediation model was employed in statistical analysis, and the participants were 891 college students selected from 2 universities in Shandong, China. The findings demonstrated that smart-phone addiction can not only directly and negatively influence self-concept clarity, but also indirectly and negatively affect self-concept clarity through the single mediation of social withdrawal as well as the chain mediation of social anxiety and social withdrawal. Besides, although the direct associations between smart-phone addiction and social anxiety and between social anxiety and self-concept clarity were significant, the indirect effect of smart-phone addiction on self-concept clarity via social anxiety was insignificant. Smart-phone addiction may lead to social anxiety and social withdrawal, whereby impairing the self-concept clarity of Chinese college students.

Patient satisfaction is a key indicator of healthcare quality, influencing patient adherence, health outcomes, and service utilization. This study evaluated patient-satisfaction in outpatient maternity and child hospitals, considering demographic factors such as age, gender, and regional differences. Findings were compared with international healthcare systems to identify strengths and areas for improvement. A cross-sectional survey was conducted using a validated electronic questionnaire distributed to patients attending outpatient maternal and child clinics. Data from 14 718 respondents were analyzed to assess satisfaction across service domains and identify demographic determinants. Statistical analyses included ANOVA, correlation, and regression to explore associations between satisfaction scores and gender, age, and regional differences. A total of 14 718 participant surveys were analyzed of which 72.8% were females. The mean age was 22.4 ± 16.5 years, with 46.4% aged ≤ 18 years, and 93.5% were Saudi nationals. The overall satisfaction score was 75.9 ± 26.4 with Pharmacy services (83.3%) and Laboratory services (82.5%) scoring highest and Moving Through (waiting times) the lowest (67.5%). Males reported higher satisfaction (77.9 ± 26.2%) compared to females (75.1 ± 26.4%; P < .0001). Elderly patients (≥65 years) had the highest satisfaction (82.6%), 13.9 points higher than young adults (P < .001). Regionally, the Central region had the highest satisfaction (80.6 ± 22.7%), outperforming the Northern region by 8.73 points (P < .001). The findings highlighted disparities in patient-satisfaction across different demographic and regional groups emphasizing the need to improve waiting times, communication, and digital services. Limitations included potential response bias and varying expectations. Future research should focus on digital transformation and policy reforms to support Vision-2030 goals and international standards.

Antibiotics are vital for treating infections, but their inappropriate use has driven widespread resistance, now a major global health threat. This systematic review examines antibiotic use patterns in low- and middle-income countries using WHO's prescribing indicator, aiming to guide interventions that promote rational antibiotic use, reduce resistance, and improve public health outcomes. The review followed PRISMA guidelines, searching databases such as Scopus, Embase (Ovid), and Medline (Ovid) for publications from January 2010 to November 2025. Titles and abstracts were initially screened by the first reviewer and discussed with a second reviewer to assess eligibility. Full texts of eligible articles were then independently reviewed by the reviewers, with final inclusion determined through consensus. The methodological quality of selected studies was evaluated using the Kmet Critical Appraisal Checklist. Studies were categorized into 3 groups-public and private sector, public sector only, and private sector only-to examine antibiotic use patterns relative to WHO standards, alongside demographic and institutional data. Electronic searches identified 2912 studies, of which 20 cross-sectional studies were from 11 countries considered eligible for inclusion. Their methodological quality scores ranged from 0.50 to 0.78. Across all studies, the average "percentage of prescriptions with antibiotics" was 51.4%, with 52.7% in the private sector, 49.3% in the public sector, and 61.8% in studies covering both sectors. Amoxicillin, an "Access" antibiotic under the WHO AWaRe framework, was most frequently prescribed, while "Watch" antibiotics such as ceftriaxone and cefixime were also widely used. Some studies reported high Watch antibiotic use (47.4%-74.0%), exceeding WHO recommendation and raising significant concern. The types of antibiotics prescribed also varied across age groups. The percentage of prescriptions with antibiotics and prescribing Watch group antibiotics was found to be higher than the WHO recommendation across studies. Implementing effective antibiotic stewardship programs is recommended.

Patient safety indicators are core measures for improving healthcare. We aimed to conceptualize the prioritization of such indicators and the requirements for developing a core set of nationwide, valid, low-bureaucracy patient safety indicators. We also aimed to develop a decision aid for adapting the core set to strengthen the resilience of healthcare provision with respect to crisis situations and to identify factors related to successful implementation. A hybrid focus group design of 4 guided online focus group interviews was used by combining a semi-structured discussion and supporting materials, including questionnaires. The data were analyzed using content and descriptive analysis. A framework for prioritizing patient safety indicators for core set development and adaptation was developed. Indicator prioritization is guided by the aim of the core set, considering stakeholders' needs, potential for improvement, context of use, scientific quality, and implementability criteria. Together with the requirement criteria, such as patient safety dimensions, the breadth and depth of the indicator set can be defined. The developed decision aid for crisis events was deemed suitable for maintaining patient safety. A modular system is recommended for the adaptation of the core set to address several different indicator measurement scenarios. The developed framework and decision aid allow context-(in)dependent prioritization on the basis of the criteria for prioritizing patient safety indicators for a core indicator set and for indicator decision-making in adapting the core set for crisis events. Further real-world validation of the framework and decision aid and the associated criteria is recommended.

This study aimed to evaluate the impact of a simulation-based Advanced Life Support (ALS) training programme on the self-efficacy and communication of health personnel. The research focussed on whether such training could enhance both technical and non-technical skills, particularly in managing cardiopulmonary resuscitation (CPR) situations. A quasi-experimental pre- and post-intervention study was conducted in primary care centres across Andalusia, Spain. A total of 106 health personnel (doctors and nurses), aged 21 to 65 years, participated in the study. Participants completed questionnaires measuring self-efficacy and communication styles before and after a 27-hour blended ALS training programme, which incorporated high-fidelity simulation exercises. Communication was assessed across several dimensions, including expressiveness, preciseness, impression manipulativeness, and emotionality. Post-intervention analysis revealed significant changes in communication styles. Specifically, doctors exhibited a reduction in "impression manipulativeness," while nurses showed an increase in "expressiveness." Although self-efficacy scores improved slightly after the training, the changes were not statistically significant. Correlational analyses indicated that higher self-efficacy was positively associated with "expressiveness" and "preciseness," and negatively associated with "emotionality." In conclusion, simulation-based ALS training led to improved communication among health personnel, with distinct patterns emerging between doctors and nurses. While the simulation training did not significantly increase self-efficacy, the trends observed suggest potential benefits. These findings support the inclusion of simulation in continuing professional development programmes to strengthen non-technical skills essential for effective CPR performance.

Labor induction (IOL) is a common obstetric intervention to stimulate uterine contractions before the spontaneous onset of labor, with the goal of achieving vaginal delivery. It is indicated for various reasons, including post-term pregnancy, premature rupture of membranes (PROM), maternal medical conditions, and fetal growth restriction. This study aims to evaluate the prevalence of labor induction, its indications, and the associated maternal and fetal outcomes in Ethiopia. A comprehensive search for relevant articles was conducted using widely recognized databases such as Google Scholar, Cochrane, PubMed, HINARI, Web of Science, African Online, and institutional repositories from Ethiopian universities. Data were extracted using the standard format provided by the Joanna Briggs Institute. The Cochran Q test and I² statistics were employed to assess the heterogeneity of the studies. Publication bias was evaluated using a Funnel plot and Egger's test. A Forest plot was used to present the pooled prevalence of labor induction in Ethiopia. This systematic review and meta-analysis revealed that the overall pooled prevalence of induction of labor in Ethiopia was 14.4% (95% CI: 11.09-17.70; I² = 95.7%, P < .01). The primary indications for labor induction included premature rupture of membranes (33.91%), intrauterine fetal death (8.8%), intrauterine growth restriction (4.85%), post-term pregnancy (21.49%), oligohydramnios (12.2%), and hypertensive disorders (30.7%). Maternal complications related to induction of labor included postpartum hemorrhage (9.47%), cesarean section (28.68%), instrumental delivery (18.82%), and vaginal tears (14.45%). Adverse fetal outcomes included low Apgar scores at 1 min, fetal death, and neonatal intensive care unit (NICU) admission, with respective rates of 48.2%, 6.11%, and 15.5%. According to this systematic review and meta-analysis, the estimated overall prevalence of induction of labor in Ethiopia is 14.4%. The indications for induction of labor include premature rupture of membranes (PROM), intrauterine fetal death (IUFD), intrauterine growth restriction (IUGR), post-term pregnancy, oligohydramnios, and hypertensive disorders. Maternal complications of labor induction include postpartum hemorrhage (PPH), cesarean section, instrumental delivery, and vaginal tear. Adverse fetal outcomes associated with induction of labor include a low first-minute Apgar score, fetal death, and admission to the neonatal intensive care unit (NICU). Careful consideration and balancing of risks are essential when deciding to induce labor. Additionally, clear national protocols and follow-up on induction of labor are crucial to mitigate these risks. Registration number: reviewregistry2051.

Health literacy competencies enable physicians to communicate effectively, fostering patients' understanding, trust, and shared decision-making. However, research has largely emphasized physicians' views rather than patients'. This study examined how patients perceive physicians' health literacy competencies and how these perceptions shape their views of "good communication" in family medicine. Forty-four Q-statements were developed based on established indicators of physician health literacy and professional competencies. A total of 62 patients were randomly invited from family medicine outpatient clinics at 2 medical centers in northern Taiwan, with 42 completing the Q-sorting task. Data were analyzed using Q-factor analysis, combining quantitative statistical methods with qualitative interview data to identify distinct groups of patient perspectives. The Q-factor analysis identified 5 distinct patient perspectives, accounting for 50.88% of the total variance. These perspectives were categorized as: (1) Paternalistic Model - Physician-Dependent, characterized by patient reliance on physician authority; (2) Interpretive Model - Self-Empowered, emphasizing patient autonomy and active participation; (3) Interpretive Model - Shared Decision-Making, reflecting a balance of physician expertise and patient autonomy; (4) Informative Model - Patient-Centered, prioritizing clear communication and patient rights; and (5) Deliberative Model - Physician-Respecting, balancing professional competence with empathetic patient engagement. Patients perceive "good communication" in various ways influenced by health literacy, cultural values, and expectations of the physician's role. The findings emphasize the need for communication training that adjusts to patients' different health literacy levels and preferences, incorporating these perspectives into physician education and practice to encourage patient-centered, health literacy-oriented care.

The study examines the barriers and facilitators influencing rural smokers in seeking treatment at quit-smoking clinics using Andersen's Healthcare Utilization Model. It explores predisposing, enabling, and need factors affecting healthcare utilization and provides recommendations for improving quit-smoking clinics services. Qualitative research design was employed. Data were collected through purposive sampling, and in-depth interviews (IDIs) were conducted with eligible informants. Framework analysis was used to analyze data. Fourteen informants (11 referred clients to the quit smoking clinic, 3 voluntary) participated in this study. Framework analysis revealed subthemes related to predisposing factors (social influences, individual perceptions, knowledge of smoking cessation methods) and enabling factors (access to services and medical, distance, employment, waiting times and treatment as well as effectiveness of services). The need factors which have been identified are poor health symptoms due to smoking and greater perceived need for help to quit smoking. Recommendations from informants to enhance smoking cessation clinic services are discussed. The findings of our study emphasize the role of predisposing, enabling, and need factors in shaping treatment-seeking behaviors. Key recommendations include enhancing clinic promotion, improving accessibility, implementing group counseling, strengthening policies on tobacco control, refining treatment approaches, and conducting follow-up studies on former smokers. These insights are valuable for clients, healthcare providers, and policymakers in supporting smoking cessation efforts and advancing public health initiatives.

The digital food environment is relevant for public health, as it shapes food access, promotion, and consumption. However, evidence on how different socioeconomic groups engage with this environment is limited. This study aimed to compare how adults from high- and low-socioeconomic status (SES) neighborhoods in Santiago, Chile, interact with the digital food environment. This qualitative, cross-sectional study conducted 11 focus groups with 78 adults from high- and low-SES neighborhoods. Data were analyzed using inductive reflexive thematic analysis. Two themes and 6 subthemes emerged. (1) Digital food environment as a space of access, consumption, and social differentiation: SES shaped the nature of digital food engagement. High-SES participants described routine use of online platforms to purchase meals and groceries, including healthier options. Low-SES participants engaged sporadically, driven by promotions and support from younger relatives. (2) Digital food environment as a communicative and affective space of influence: Participants reported exposure to unhealthy food advertising. High-SES individuals demonstrated greater awareness of targeted marketing and employed strategies to avoid ads. In contrast, low-SES participants tend to adopt a passive stance, valuing online information for economic reasons. Motivations also diverged: high-SES adults sought content related to self-care and healthy eating, whereas low-SES adults looked mainly for discounts or cheaper options. These findings highlight the interaction with the digital food environment is widespread among adults, showing disparities by SES. Findings underscore the need for targeted policies, including regulating digital marketing, promoting digital literacy, reducing socioeconomic disparities, and fostering healthier digital food environments.