Health Expectations最新文献

Introduction

Iran is vulnerable to natural disasters, especially earthquakes. Frequent earthquakes in the Khoy city and followed by the devastating Van earthquake in Turkey, caused panic among the people and forced them to settle in camps. So, this study aims to explore lived experiences of people affected by the Khoy earthquake from living in temporary camps.

Methods

In this qualitative study, semi-structured interviews were conducted using conventional content analysis method and purposive sampling in health centers, with 24 people affected by the earthquake in Khoy city. After obtaining written informed consent, interviews were recorded and continued until data saturation was reached. Data were analyzed using MAXQDA version 12 software.

Results

From the analysis of qualitative data, two themes were extracted: “Disruption of the normal life routine” and “life reconsideration.” The three subcategories of the first them included “difficult life events,” “disruption of social life routine,” and “crisis mismanagement,” and the three themes of life reconsideration included “struggling to adapt to harsh conditions,” “changes in perceived life priorities,” and “enhancing spiritual well-being.”

Conclusion

Living in temporary camps disrupted survivors' daily lives and intensified feelings of injustice and distrust due to poor crisis management. Yet, many reevaluated their life priorities and found strength in spiritual beliefs. These findings underscore the need for policymakers to implement timely, equitable, and participatory programs that support both material and psychosocial recovery.

Patient or Public Contribution

Individuals who had experienced the earthquake participated in the interviews. Their lived experiences were analyzed, and the findings of the study were subsequently reviewed and validated by the participants themselves to ensure accuracy and resonance with their perspectives.

Introduction

While there is a growing emphasis on Patient and Public Involvement (PPI) within maternal and neonatal research, there is a lack of evidence on how PPI is currently implemented. The aim of this qualitative evidence synthesis was to gain insight into stakeholders' experiences and perspectives of PPI in maternal and neonatal trials.

Methods

CINAHL, MEDLINE, PsycINFO, EMBASE, Web of Science, and Maternity and Infant Care (OVID) were searched from inception dates to September 2023, supplemented by a search of Google Scholar. Eligibility screening and quality appraisal of each included record were independently undertaken by two reviewers. Data extracted from the included records were thematically synthesised using Thomas and Harden's approach.

Results

Nine records were identified as eligible and included in the review. Three themes were generated from the synthesis, each with two or three subthemes. The main themes were ‘building a successful PPI partnership’, ‘impact of PPI on trial design and development’, and ‘impact of PPI on stakeholders’. Of 15 discrete findings, 1 was assessed as having high confidence, 11 as moderate and 3 were assessed as having low confidence.

Conclusion

Researchers who facilitated PPI described it as a positive and enjoyable experience that improved trial design and considered PPI as an asset to research. However, there was a lack of information available on PPI contributors' first-hand perspectives or experiences, which considerably limits our understanding of their opinions on how PPI is currently conducted.

Protocol Registration: The protocol for this qualitative evidence synthesis was registered on PROSPERO (PROSPERO registration number CRD42023383878).

Objectives

People with breast cancer are widely encouraged to ‘look on the bright side’ and ‘think positive’ in the face of adversity, and research suggests a positive correlation between patient optimism and health outcomes. However, the promotion of a bright-side disposition has also been criticised because it can be perceived as a moral obligation that implies poor outcomes are a result of individual failure to adopt the correct attitude. In this paper, instead of treating bright-side talk as empirical evidence for a person's mental state, or reporting evidence for or against bright-side thinking, we systematically examine what bright-side talk is doing interactionally, and how it functions in real-time clinical consultations.

Design and Methods

Thirty-three instances of bright sides were identified from a corpus of 73 transcribed video-recordings of clinician-patient consultations (totalling 30+ hours) in a National Health Service breast unit, and analysed using conversation analysis.

Results

Bright sides function as practical, in-the-moment tools to do identity work. Consistently positioned following expressions of dissatisfaction with, or bad news about, treatment outcomes, bright sides manage and deflect potential inferences that patients may be overly upset by, or complaining about the trivialities of what has been lifesaving treatment. Instead, bright sides offer a comparatively ‘upbeat’ counterbalance to the prior negative stance that focuses attention on the ‘bigger picture’ of the patient's survival and its appreciation.

Conclusions

Clinicians and psycho-oncology interventions can usefully deconstruct cultural mandates to ‘look on the bright side’ by encouraging discussion of legitimate patient concerns that may otherwise remain hidden.

Introduction

Healthcare is becoming substantially complex in part due to greater multimorbidity, climate-related health issues, and problems related to access to care. While patient partnership is widely advocated as a strategy to adapt medical practice to the complexity, significant barriers persist.

Aim

We sought to shed light on the ontological and epistemological ‘tensions' generated by the implementation, sometimes by imposition, of the concept of physician–patient partnership in medical practice.

Methods

This reconceptualization of the distinctive ways of knowing is based on illustrative physician-patient interactions used to contrast the fundamental belief-systems that generate ontological and epistemological tensions impeding physician-patient partnership. We contrast knowledge valued by the prevailing positivist paradigm with the kinds of knowledge patients can contribute to ensure optimal healthcare outcomes.

Findings

Identifying the complementarity of evidence-based and experiential knowledges leads to a paradigmatic shift in how we perceive, interpret, and use data in the clinical setting. The two co-existing but distinct ontologies and epistemologies—neither is inherently superior to the other—are essential for a broader and concrete understanding of illness, its experience and its management.

Conclusion

This exploration into the complex nature of physician-patient partnerships provides insights about avenues for strengthening them and making them fulfil their promise to enhance health care access and outcomes for all.

Patient Contribution

The first author is a kidney transplant recipient (2008) and has been actively involved in patient partnership within health research and medical education since 2010. This paper reflects his accumulated insights and observations regarding the barriers that hinder the development of effective partnerships in health care.

Introduction

Despite its importance, oral health (OH) is often excluded from comprehensive public health coverage in Europe, resulting in financial hardship and exacerbating OH inequalities. Defining what ‘essential’ means in OH is a prerequisite for developing a public benefits basket to expand public coverage and financial protection.

Method

This qualitative study explored the population's and experts' perspectives on ‘essential’ OH in Europe. Participants were purposively sampled from eight European countries. Data were collected through 37 focus group discussions (FGDs) gathering 228 participants. As data saturation was reached, data from 21 FGDs were analysed using thematic analysis.

Results

‘Essential’ in OH was perceived as a state of good OH, encompassing both performing basic functions and the psychosocial dimension, which aligns with the WHO definition of good OH. Participants highlighted multiple considerations to define an ‘essential’ OH benefits basket, including services' contributions to improving health, economic criteria, societal values, people-centred care and feasibility. Considering OH as part of a broader health system was seen as crucial.

Conclusion

Findings emphasise the fluid and multidimensional nature of the ‘essential’ concept in OH and highlight the myriad considerations for priority-setting in public coverage. This underscores the importance of first defining what is ‘essential’ in each country's context. This study identifies three key lessons relevant for policy-making. First, people's expectations vary between and within countries but remain realistic, as considerations are similar to those used in other health fields. Second, OH should be better integrated into the general health system. Finally, involving patients and potential patients in the decision-making process is key to (re-)defining an OH benefits basket that responds to the health system's goals.

Public Contribution

OH patients and potential patients were at the centre of this study, informing how to conceptualise ‘essential’ in OH in Europe. This is a concrete example of how public participation mechanisms can support decision-making over the definition of an (OH) benefits basket.

Background

Informal carers compose approximately 7% of the UK population and, through their unpaid care, they make important contributions to society and the health care industry. Being an informal carer is higher in people experiencing socioeconomic deprivation; however, no qualitative research has explored the impact of this on the ability to provide care for those with long-term conditions.

Aim

To explore the experiences and challenges of being a carer whilst experiencing socioeconomic deprivation.

Methods

Semi-structured one-to-one interviews with adults experiencing socioeconomic deprivation (n = 12) living in London and Sheffield, United Kingdom. Participants were recruited through social media and community channels. Data were managed in NVivo and analysed using reflexive thematic analysis.

Results

Three analytical themes were developed: (1) Economic insecurity including insecure housing and challenges with financial welfare leading to sacrificing the necessities such as healthy food, water and heating; (2) social and structural barriers such as a lack of opportunities for social mobility due to care impacting employment and educational attainment, as well as area-based barriers and feeling unheard by professionals; (3) the emotional challenges and rewards of being a carer such as managing people with poor mental well-being exacerbated by their socioeconomic situation, whilst finding their caring role meaningful.

Conclusion

Carers experiencing socioeconomic deprivation face additional challenges and barriers in their ability to provide care such as more emotional work, making sacrifices of necessities due to financial constraints and feeling unheard. Policy changes are needed to better support this population financially and to enable social mobility, as well as development of interventions and support resources for carers to use to feel empowered and to maintain good well-being.

Introduction

Patient Classification Systems (PCS) are essential for managing resources and staffing in hospitals. However, existing systems are predominantly nursing-centric and fail to capture the interdisciplinary nature and complexity of care in rehabilitation settings, leading to inaccuracies in workload assessment and resource allocation. This study aims to develop and validate a novel, context-specific PCS for rehabilitation hospitals through a participatory approach that actively engages patients and stakeholders.

Methods

This mixed-methods study protocol comprises three sequential stages. First, a systematic scoping review following Arksey and O'Malley's framework will identify key PCS components from existing evidence. Second, structured expert panel sessions employing a modified Delphi technique will develop a consensus-based preliminary framework. Third, the developed PCS will undergo rigorous validation through pilot implementation, assessing inter-rater reliability using Cohen's Kappa and criterion validity against established tools, including the Functional Independence Measure (FIM) and Barthel Index, with explicit sample size calculation and reliability criteria.

Conclusion

The study will generate a validated PCS specifically designed for rehabilitation hospital settings through systematic integration of evidence and stakeholder insights. The resulting tool is expected to enhance workload measurement accuracy, promote equitable resource distribution, and ultimately improve both care quality and operational efficiency in rehabilitation contexts.

Patient or Public Contribution

Stakeholders, including patients, their families, administrators, and multidisciplinary clinical staff, have been engaged from the initial conception of the study. They contributed to defining the research objectives, formulating the scoping review questions, and are integral participants in the co-design and validation stages, ensuring the resulting system is relevant and applicable to real-world practice.

Introduction

Non-communicable diseases (NCDs) are a leading cause of morbidity and mortality in the United Kingdom, placing significant pressure on the National Health Service (NHS). Despite the growing popularity of Ayurveda for managing NCDs, little is known about its use among people with these conditions in the United Kingdom. This study explored the experiences and perspectives of people with NCDs who use Ayurveda to manage their conditions in the United Kingdom.

Methods

Twenty qualitative semi-structured interviews were conducted with UK-based adults with NCDs. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

Findings

Three key themes were identified. First, participants chose Ayurveda due to its alignment with personal values like natural, holistic healing and dissatisfaction with Western medicine, particularly side effects and impersonal care. Second, they reported positive experiences with Ayurvedic treatment, including personalised consultations, diverse treatment options and improved health outcomes. Third, participants highlighted challenges in sustaining Ayurvedic care, such as concerns over product safety, difficulty following complex regimens, limited medicine availability and financial barriers—especially since treatments are not covered by the NHS.

Conclusion

People living with NCDs described Ayurveda as a more natural and philosophically congruent healing system, reflecting their cultural and personal perspectives. Despite structural and financial challenges, they considered it a relevant option for managing their conditions. These findings suggest that Ayurveda continues to hold significance as a complementary approach to NCD management in the United Kingdom.