Frontiers in health services最新文献

Healthcare systems are witnessing the rapid emergence of new professional roles, including physician assistants, nurse practitioners, technical physicians, and healthcare data scientists. These occupational groups develop in contexts marked by role ambiguity, contested expertise claims, and fragmented organizational structures, making professional identity work-the processes through which individuals and groups construct, negotiate, and revise understandings of who they are as professionals-a central challenge shaping their development. This targeted conceptual review synthesizes current debates and identifies four strategic dilemmas that arise when emerging healthcare professions attempt to construct collective identity. These dilemmas concern whether to maintain flexible, generative identities or establish standardized, fixative definitions; whether collective professional identity emerges organically from practice or requires deliberate engineering in emerging professions where weak infrastructures leave unclear who has the authority to coordinate identity work; whether to position through differentiation claiming unique expertise or complementarity as essential partners; and whether to pursue jurisdictional control or relational accountability within interprofessional networks. Each dilemma is shaped by internal stratification along career paths, positional power, disciplinary traditions, and geographic locations, while professions simultaneously manage relationships with diverse external stakeholders including other professions, patients, policymakers, and the public. The review identifies critical research gaps concerning the recursive relationship between identity and practice, identity work proceeding without established occupational communities, the neglect of failed professionalization projects, and the underexplored material basis of professional expertise. Professional identity construction is fundamentally political. Understanding these dynamics is essential for workforce policy and professional development models that support person-centered care.

The COVID-19 vaccine has been classified as an 'essential medicine', yet shortages and unequal distribution during the pandemic have reignited concerns about vaccine self-sufficiency in Africa. This study examined the mechanisms for acquiring, distributing, and administering existing COVID-19 vaccines in the Democratic Republic of Congo (DRC). A qualitative case study was conducted using semi-structured interviews with 23 key informants selected using reasoned choice, based on their professional roles in vaccine policy, logistics, and implementation. Participants were recruited from public institutions, with most being medical doctors and having experience in vaccination. Data were transcribed and analyzed were transcribed and analysis thematically using Atlas-ti 7.0. The study found that vaccine acquisition in the DRC relied heavily on international donations and multilateral initiatives, with limited national financial contribution. Distribution followed a five-tier supply chain managed by the Expanded Program on Immunization, moving vaccines from Kinshasa to provincial and field offices, then to selected health facilities. The Cold chain limitations, transport issues, and inconsistent vaccine availability challenged the administration. To improve vaccine access and coverage, stakeholders emphasized the need to strengthen logistical infrastructure and promote regional vaccine production. Honoring government commitments to co-finance procurement was also identified as a critical step toward sustainable vaccine supply.

Background: The COVID-19 pandemic exposed significant infection prevention and control (IPC) gaps in Sierra Leone's primary health care system. We evaluated whether a decentralised multicomponent mentorship model could improve IPC performance across 450 government primary health facilities and support sustainable domestic financing for IPC.

Methods: We conducted a pre-post quasi-experimental evaluation without a comparison group using facility-level indicators at baseline (April 2021) and endline (January 2022). The intervention package included competency-based IPC training, twice-monthly facility mentorship using structured observation checklists, routine monitoring with feedback using national IPC assessment tools configured in District Health Information Software 2 (DHIS2), targeted support for IPC commodities and water, sanitation and hygiene (WASH)-related infrastructure, community engagement, and budget advocacy through policy briefs and stakeholder meetings. We compared paired facility indicators using McNemar's chi-square test and examined service delivery patterns using month-matched comparisons to pre-pandemic levels (April 2019-January 2020). Primary outcome domains included training coverage, IPC supplies and infrastructure availability, and observed adherence to core IPC practices.

Results: Facilities meeting ≥80% staff training coverage increased from 38% to 100% (p < 0.001). Availability of IPC SOPs/registers, triage infrastructure, and core IPC supplies improved in 20 of 22 indicators (p < 0.001). Observed adherence improved for hand hygiene (39% to 89%), appropriate mask use (50% to 98%), screening at entry (27% to 96%), waste segregation (21% to 98%), and sharps safety (89% to 100%) (all p < 0.001). Service delivery volumes were maintained or increased during the intervention period compared to pre-pandemic levels for six of eight indicators examined (p ≤ 0.007). The Ministry of Health (MoH) established the first dedicated IPC budget line, increasing domestic allocation by 25% from USD 384,000 to USD 480,000, with USD 2.3 million secured from partners.

Conclusions: A decentralized mentorship model embedded in government structures can rapidly strengthen primary care IPC capacity while catalysing the policy and financing commitments essential for sustainability. The consistency of improvements across indicators supports this approach for similar low-resource settings. Controlled designs are needed to establish attribution and assess long-term impact.

Objective: This study aims to analyze the latent profiles of job embeddedness among physical examination nurses and their influencing factors, providing a scientific basis for nursing talent management.

Methods: Using convenience sampling, 150 physical examination nurses from Shanghai Public Health Clinical Center were surveyed. Data were collected using a general information questionnaire, the Job Embeddedness Scale, the Nurse Retention Intention Scale, the Nurse Work Environment Scale, and the Psychological Capital Questionnaire (PCQ). Latent profile analysis and multivariate logistic regression analysis were employed.

Results: The average score of job embeddedness among nurses was 69.89 ± 11.67, revealing three latent profiles: low (26.7%), medium (31.4%), and high (41.9%). Multivariate analysis indicated that annual income, promotion satisfaction, retention intention, and psychological capital (PCQ) were the main influencing factors (p < 0.05).

Conclusion: Job embeddedness among physical examination nurses exhibits heterogeneity. It is recommended to enhance job embeddedness and stabilize the nursing workforce through comprehensive measures, such as establishing standardized management systems, optimizing nursing management structures, and ensuring reasonable income.

The Healthcare Career Pathways (HCCP) programme, implemented by EMMS International and Duncan Hospital in Bihar, India, addresses dual public health challenges: the shortage of long-term healthcare workforce in hard-to-staff health facilities, and the systemic exclusion of vulnerable women from higher education and professional employment. Since its expansion in 2019 to Bihar, India, HCCP has ensured targeted advocacy and selection, mentoring, financial support to pursue accredited healthcare qualifications, and guaranteed employment to economically and socially vulnerable women. This case study presents the HCCP model as implemented in Raxaul, Bihar, India, including its outcomes between 2019 and 2025, impacts, strengths and challenges. It is based on the findings of a comprehensive, independent, objective evaluation of HCCP, which was conducted using quantitative review of programme records and documents, qualitative study design comprising semi-structured interviews and focus groups, and thematic analysis of the data. By the year 2025, HCCP has supported 54 economically and socially marginalised young women in healthcare training and qualifications, with 24 of these graduates employed at The Duncan Hospital. The evaluation findings reveal substantial impacts on the young women and their families' economic independence and self-efficacy; gender norms including delayed marriage and reduction in dowry demands; and shifts in community perceptions and attitudes towards girls' marriageability, education and employment particularly in the healthcare sector as well as intergenerational educational and childbirth aspirations whereby families now welcome the birth of a girl child rather than opposing it. Key challenges include limited geographical reach, partial financial support, and narrowing of career aspirations to nursing among the young women and families. This evaluation demonstrates HCCP as an evidence-based model with potential for replicability and sustainability in lower and middle-income countries to strengthen health systems in rural and underserved regions through workforce development and guaranteed recruitment in the local geographical setting while advancing gender equity and empowerment aligned with the sustainable development goals. As of 2025, HCCP is already being replicated in Madhipura Hospital in Bihar and Jiwan Jyoti Hospital in Uttar Pradesh in India. Recommendations focus on positioning HCCP within the local socio-cultural and geographical context, diversifying career pathways, strengthening mentorship, and appropriate follow-up, monitoring and evaluation mechanisms.

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.