Frontiers in health services最新文献

Introduction: Private hospitals in Ethiopia complement the resource constrained public hospitals. Health policy reforms have promoted further expansion of the private sector, despite a rigid policy that provide little room for strategic human resource management(SHRM). Consequently, private hospitals encounter challenges to live up to their potential. This study investigates the contextual mechanisms influencing SHRM in private for-profit (PFP) and not-for-profit (PNFP) hospitals, in comparison to public hospitals.

Materials and methods: A qualitative approach was employed, utilizing structured interviews with CEOs, administrators, and HR managers from ten private hospitals. To make the comparison between private and public hospitals possible, the same protocols of the companion studies in public hospitals was followed. Thematic analysis through deductive coding based on the Contextual SHRM framework was conducted, using ATLAS.ti 8 software.

Results: Our findings reveal that PNFP hospitals benefit from constructive government engagement and experiencing less coercive pressure, which appears to enable them to address underserved populations and mitigate public hospital capacity issues. In contrast, PFP hospitals perceive regulations as rigid and constraining. Though PFP hospitals compete for patients, they employ highly skilled workforce as a means towards delivering higher quality and valuable services to justify the higher price charged to patients.

Conclusions: Our study shows that stringent governmental policies/regulations exert pressure on SHRM of PFP hospitals. In contrast, PNFP hospitals perceive regulations as supportive. This condition is different from public hospitals which lack rooms to maneuver for crafting SHRM. Future research agenda are called for engaging employees for valuable insights into SHRM practices and performance.

Introduction: Falls are a leading cause of morbidity and mortality among older adults. Despite Prevention initiatives have been researched primarily in medical care. There is a dearth of studies on falls prevention in other primary care settings, such as outpatient physical therapy (PT). The purpose of this exploratory mixed methods study was to identify key partners' perceived barriers and facilitators to implementing the CDC's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) falls-prevention initiative as routine care for older adults receiving outpatient PT.

Materials and methods: Using a sequential explanatory mixed methods design, we collected surveys assessing familiarity, acceptability, appropriateness, and feasibility of STEADI and falls prevention, followed by semi-structured interviews to explore barriers and facilitators. Participants included physical therapy providers (n = 16), physicians (n = 5), administrative staff (n = 3), patients (n = 10), and care partners (n = 10). Quantitative data were summarized descriptively, and qualitative data were analyzed using rapid thematic analysis mapped to the Consolidated Framework for Implementation Research 2.0.

Results: Participants found STEADI acceptable, appropriate, and feasible for integration into routine outpatient PT. Barriers among therapists included time constraints and limited familiarity with STEADI while interest in learning and implementing STEADI and perceived compatibility were facilitators. Physicians supported therapists but expressed concerns about scope of practice and challenges with communication jargon. Administrative staff were willing to assist patients with screening. Patients and care partners were receptive to STEADI but anticipated that some older adults might resist participation.

Discussion: Findings support the potential feasibility of implementing STEADI in outpatient physical therapy. Addressing provider education, workflow, and interdisciplinary collaboration can address barriers. Aligning STEADI with therapists' scope of practice, improving interprofessional communication, and raising public awareness of physical therapists' role in falls prevention are critical for adoption. Our findings will inform co-development of implementation strategies to address barriers and capitalize on facilitators to support STEADI adoption in outpatient physical therapy.

Healthcare can be inappropriate and waste valuable and finite resources when it is not aligned to the needs and goals of patients. In mental health, although the importance of subjective experience and the patient's perspective is generally recognized, many current clinical measures do not reflect this. Mental health services might become more effective and efficient if the data being collected from patients more closely reflected patients' priorities and preferences. To promote embedded clinical research (EmCR) as well as leveraging its benefits, a service innovation was introduced to investigate the interchangeability of symptom ratings and botheredness ratings. A file audit examined routinely collected real-world data including ratings of impairment as well as ratings of botheredness from a clinical psychology outpatient clinic in a public mental health service. The Work and Social Adjustment Scale was modified and data from 61 files were analysed using resampling methods to explore associations between and interchangeability of the ratings. The data indicated that ratings of impairment and botheredness were strongly correlated. Null hypothesis significance testing, however, provided evidence that impairment and botheredness were not, in general, interchangeable. Current approaches to obtaining mental health information from patients might not be aligned with their priorities. These findings could have implications for making mental health services more effective and efficient by improving the extent to which service delivery is meaningful and useful to patients.

Introduction: To contribute to the growing literature applying implementation science frameworks, this study utilized the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) frameworks. Our objectives were to (1) describe surveys used to assess CFIR context and RE-AIM implementation outcomes and (2) explore correlations between constructs within and across the frameworks in a community-based home-visiting organization.

Methods: This cross-sectional, baseline secondary analysis was conducted within a cluster-randomized trial partnered with parents as teachers (PAT), a national home-visiting, community-based organization. Guided by CFIR and RE-AIM, parent educators (provider level: seven scales, 26 items) and one leader per site (organization level: 11 scales, 56 items) completed surveys online before beginning the study. Standardized Cronbach coefficient alphas were calculated to reflect internal consistency reliability and intraclass correlation coefficients (ICCs) were used to reflect the agreement among parent educators within sites. Relationships between contextual factors (CFIR), antecedent outcomes (CFIR), and RE-AIM outcomes were calculated using Pearson correlations.

Results: A total of 271 parent educators and 26 site leaders completed the demographic survey. Most parent educators (72.5%) were white and a third of parent educators identified as Hispanic or Latino. Alphas ranged from 0.70 to 0.92 and 0.47 to 0.95 for scales completed by parent educators and site leaders, respectively. There was limited agreement among parent educators within sites; ICCs ranged from 0 to 0.24. Correlations for constructs within CFIR and between CFIR context and CFIR antecedent outcomes were statistically significant, while few correlations with these constructs and those in RE-AIM were statistically significant.

Discussion: This study demonstrates the application of CFIR, CFIR outcomes addendum, and RE-AIM. Investigators can use these findings to inform future studies incorporating implementation science in nutrition and physical activity research and to examine theoretical relationships between constructs and frameworks.

Introduction: Despite over 9.6 billion COVID-19 vaccine doses administered globally, vaccination access remains highly unequal. North America and Western Europe have over 50% vaccination coverage, contrasting sharply with African nations, like the Democratic Republic of Congo (DRC), which has under 10%. This scoping review explores the key factors contributing to the low COVID-19 vaccination rate in the Congolese population.

Methods: We conducted a scoping review using the Arksey and O'Malley framework, searching PubMed, ProQuest, and Scopus databases for peer-reviewed manuscripts published between 2019 and 2023. Six studies met the inclusion criteria, and focused on the factors of COVID-19 vaccine acceptance, hesitancy, and access in the DRC.

Results: Although surveys indicated a high willingness on the part of the people to get vaccinated, only 2.7% of the population were fully vaccinated. The primary barrier to vaccination was safety concerns, specifically, perceptions of the vaccine as new and experimental (84.4%) and fear of side effects (83.3%). Additional hesitancy factors included mistrust in vaccine effectiveness (60.4%) and a general lack of confidence (60.0%). Facilitators of acceptance included prior family vaccination, perceived risk of infection, belief in the existence of the virus, and awareness of vaccination strategies. Sociodemographic factors such as being a healthcare professional or male also positively influenced uptake.

Discussion: These findings highlight the gap between vaccine willingness and actual coverage in the DRC. Addressing safety concerns and building trust through targeted outreach, especially among key professional groups, may improve vaccine acceptance and equity.

Mental disorders in children and youth are on the rise worldwide, affecting approximately one in five young people in Europe. The negative educational, social and economic consequences of mental health problems underline the urgent need for accessible, high-quality mental health services. In response, the WHO Regional Office for Europe has developed Quality Standards for Child and Youth Mental Health Services to provide a framework for evidence-based, youth-centred care. Previous efforts have shown that translating quality standards and guidelines into practice remains a major challenge. While implementation science offers valuable approaches to improving the uptake of evidence-based quality standards and has been successfully applied in various healthcare fields, it remains underutilised in child and youth mental health care. This article explores how implementation science can be leveraged to improve the quality of child and youth mental health care. Using the implementation of the WHO European Quality Standards for Child and Youth Mental Health Services as a practical case example, we highlight the importance of a structured approach to implementation, guidance by theories, models and frameworks, timely stakeholder engagement, and context-specific adaptation. Harnessing implementation science in youth mental health policy and practice has the potential to bridge the gap between policy formulation and real-world service delivery, ensuring that all young people receive the high-quality mental health care they deserve.

Introduction: Healthcare professionals face high levels of stress and emotional demands, highlighting the need for supportive interventions. This study aimed to explore the experiences of healthcare staff participating in group supervision using the creative method of "taping," which involves arranging figures and symbols to visualize and reflect on complex work situations.

Methods: This qualitative study included fourteen participants divided into four healthcare work groups. Each group engaged in five to six supervision sessions, after which participants took part in individual interviews. Data were analyzed using thematic analysis. The study was approved by a local ethical review board.

Results: Three main themes were identified: (1) the significance of group supervision for the workgroup and work environment, (2) enhanced recognition and understanding of emotions and behaviors, and (3) support for behavioral change. Participants described increased trust, improved communication, and greater emotional insight. The taping method was perceived as particularly effective in clarifying challenges and fostering shared understanding through visual representation. It also encouraged collective and individual reflection, goal-setting and strategic action, associated with self-regulated learning.

Discussion: The findings suggest that group supervision using the taping method can enhance well-being, strengthen team cohesion, and promote professional development among healthcare staff. This creative approach appears to facilitate emotional awareness and collaborative learning. Further research with larger and more diverse samples is needed to examine the method's broader applicability and long-term effects.

Introduction: Providers may underestimate patient health literacy, and patients may not understand commonly used medical terms. Undiagnosed cognitive impairment among Urogynecology and Reconstructive Pelvic Surgery (URPS) patients may further hinder communication. We assessed communication barriers between URPS clinic patients and their providers.

Methods: Following IRB approval, women aged 18-80 years attending outpatient visits were invited to participate. Non-English speakers and those with diagnosed cognitive impairment were excluded. Participants completed a health literacy measure (REALM-SF), a validated cognitive impairment screen (STMS questionnaire), and an 8th-grade level URPS Lexicon of ten medical terms. Providers, blinded to questionnaire results, then answered questions about their perception of the patient's health literacy and cognitive status.

Results: From June to December 2024, 157 patients were invited to participate (9 declined). Of the 59 who scored in at least the mild impairment range (29-33) on the STMS, only 2 were noted by the provider as cognitively impaired. All words were correctly identified by 100 patients (68%), and at least 8 words by 82%. "Vagina" was the most commonly misdefined, followed by "bowel," "pelvis," and "urethra." Providers identified 7 patients as having low health literacy, 4 of whom answered 6 or fewer words correctly, while 3 answered all 10 words correctly. Patients with lower health literacy had significantly lower STMS scores as compared to the patients with high-school level health literacy (p = 0.036).

Conclusions: Discrepancies between provider assessments and screening results highlight the need for improved recognition of cognitive impairment and health literacy to enhance communication and patient care.

Background: Workplace smoking cessation programs remain underused in small and medium-sized enterprises (SMEs) due to limited resources and implementation barriers. interactive assistance via eHealth for SMEs' employers and healthcare manager teams on tobacco control (eSMART-TC), was developed to address this gap. Effective contextual adaptation is essential for optimizing implementation strategies in real-world settings. To address this, we analyzed how the eSMART-TC strategies were adapted to diverse workplace contexts, aiming to clarify which components were essential and which could be modified to maintain effectiveness. In doing so, we proposed and operationalized the concept of "Key forms"-strategy elements that should remain unchanged to ensure fidelity. This study applied the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) to systematically document and analyze these adaptations.

Methods: This study analyzed data from the waitlist control group of the eSMART-TC cluster randomized controlled trial. Program delivery to the waitlist control group was designed to permit context-specific adaptations, with the condition that all adaptations be documented using the FRAME-IS framework. Data sources included provider checklists, discussion transcripts, employee surveys, and company-level evaluations. Adaptations were assessed using the Function and Forms Matrix to distinguish core functions from specific forms and to identify modifications necessary for optimization.

Results: Of 26 identified forms supporting four core functions, 19 were classified as essential for maintaining fidelity. Seven forms, primarily involving session frequency and duration, were modified during implementation. These reactive yet context-sensitive changes aimed to meet organizational needs and improve feasibility. Provider discussions facilitated the identification of acceptable adaptations, underscoring the value of co-creation.

Conclusion: The FRAME-IS supported systematic documentation of reactive modifications and clarified which implementation strategy elements were essential vs. flexible. Defining key forms offers practical guidance for balancing fidelity and adaptation. Co-creation with providers was critical for optimizing implementation in resource-constrained workplace settings.Clinical Trial Registration: The study protocol has been registered in the UMIN Clinical Trials Registry (UMIN-CTR; ID: UMIN000044526). Registered on 06/14/2021.

Background: Assessing healthcare provider performance factors (HCPP) is crucial for enhancing the quality of healthcare services and the overall effectiveness of the healthcare system. Existing measurement tools often focus on limited aspects of factors independently and fail to comprehensively capture the organizational and individual factors influencing performance across diverse healthcare settings. To address this gap, this study developed and validated a multidimensional tool to assess HCPP across diverse settings.

Methods: The validation process involved a two-phase analysis, in which Phase 1 used Exploratory Factor Analysis (EFA) to establish the initial factorial structure and Cronbach's alpha to assess preliminary internal consistency reliability, while Phase 2 employed Confirmatory Factor Analysis (CFA) to evaluate the model's fit, composite reliability, and construct convergent and discriminant validity.

Results: EFA identified six factors consisting of Feedback and Organizational Support (FOS), Environment and Tools (ET), Incentives and Consequences (IC), Health Status (HS), Work-Family Conflict (WFC), and Healthcare Provider Performance (HCP),.explaining 63.7% of the total variance. The reliability of the scale was high (Cronbach's α = 0.837), with domains' subscales ranging from 0.793 to 0.906. CFA confirmed the six-factor model with acceptable indices fit (CFI = 0.91, RMSEA = 0.08, GFI = 0.91). All factors loading exceeded 0.60 (p < 0.001). CR values ranged from 0.765 to 0.910, and AVE values supported the convergent validity (0.583-0.736). Discriminant for most of the constructs was established.

Conclusion: The HCPP scale demonstrates acceptable psychometric properties, including acceptable reliability, factorial structure, and construct validity. The tool provides a robust measurement for assessing the factors associated with healthcare provider performance concerning individual and contextual-level determinants.