Frontiers in health services最新文献

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.

Introduction: The applications of artificial intelligence (AI) in healthcare are very diverse. AI-based systems can assist with diagnosis and decision-making, particularly in intensive care medicine. However, physicians must accept these systems to fully exploit their potential. We investigated attitude and perception toward AI among physicians with intensive care experience.

Methods: A cross-sectional questionnaire survey was conducted between August and October 2024 among 7,475 physicians with intensive care experience. Participants were recruited via the hospital operator Knappschaftskliniken GmbH, the German Sepsis Society and via an address register. The questionnaire collected background information on the participants as well as their attitude toward and perception to AI. Their general attitudes toward AI were assessed using the validated Attari-12 tool. Questions specifically addressing attitude and perception of AI in healthcare were developed independently. Descriptive statistics and subgroup analysis were conducted.

Results: Of the 7,475 physicians initially contacted, 620 returned the questionnaire. Of these, 445 questionnaires were included in the evaluation. Most were male (81.8%) aged over 50 years in leadership positions (92.1%). In both cases, general and health care specific, the attitude toward AI was rather positive. The majority of physicians asked for AI applications that are comprehensible to the treating physicians (87.1%) and agreed that objective values alone are not always sufficient for making medical decisions (87.3%). Furthermore, physicians faced problems in finding reliable information about AI in healthcare (52.6%) and only 21.6% considered communication about AI in the medical community as appropriate. Subgroup analysis revealed few differences for age and gender. The correlation between conscious use of AI in a professional context and attitude toward it was notable.

Discussion: Physicians with intensive care experience generally hold a positive attitude toward AI, particularly in healthcare. However, the sample was predominantly male, older, and in leadership positions, so these findings may not fully reflect the attitudes of younger or female physicians. Several considerations were highlighted: AI outputs should be interpretable, clinical decisions cannot rely solely on objective data, and physicians need reliable information and guidance for further AI education. Leveraging the positive attitude could help make healthcare systems more efficient, effective, and sustainable.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality globally, and rural patients are at higher risk for poor COPD health outcomes. The United States National Institutes of Health (NIH) has issued a call for innovative care delivery models to address this gap in COPD care quality in rural communities. This paper explores the perspective of healthcare teams at two rural VA medical centers sustaining an innovative interprofessional COPD care delivery model, COPD Coordinated Access to Reduce Exacerbations (CARE).

Methods: This qualitative evaluation was conducted at two rural VA medical centers in the Southeast and Midwest regions of the US. Eleven semi-structured interviews with diverse clinical stakeholders were conducted including: facility leaders, hired pharmacists, clinical pharmacists, nurse care managers, primary care providers, and referral champions. The Practical Robust Implementation and Sustainability Model (PRISM) was applied to develop interview guides and informed data analysis. Interviews were transcribed and a mixed inductive-deductive approach was used for data analysis, involving iterative coding and consensus-building among five evaluators to identify emerging themes.

Results: Five overarching themes emerged as key facilitators of COPD CARE sustainment including (1) leadership support, (2) value alignment, (3) service institutionalization, (4) service adaptation, and (5) interprofessional collaboration. Notably, clinical pharmacists were described as filling care gaps in these under-resourced facilities.

Conclusion: This evaluation demonstrated the impact of clinical pharmacists serving as prescribers in improving COPD management in rural settings. The sustainment factors identified can be utilized to inform the expansion of similar, team-based healthcare programs across rural settings.

Background: Myanmar has a longstanding and severe shortage of paediatric neurologists, with only 11 specialists serving an estimated 14 million children, most of whom live in rural areas with limited access to tertiary care. This workforce constraint, combined with high out-of-pocket costs and long travel distances, creates substantial barriers to timely diagnosis, treatment, and follow-up for children with neurological conditions. In response to the growing burden of childhood neurological disorders and persistent inequities in access to specialist services, a blended outreach and telemedicine model was developed to extend paediatric neurology care to underserved regions beyond major urban centres.

Methods: A hub-and-spoke model was implemented, linking paediatric neurologists at Yangon Children's Hospital with general paediatricians in seven regional public hospitals. The model combined quarterly in-person outreach clinics by paediatric neurologists from Yangon supplemented with ongoing virtual support delivered through telemedicine and mobile messaging to support continuity of care. Routinely collected data on clinic activity, diagnoses, and costs from 2017 to early 2020 were analysed to assess service reach, impact, and cost.

Results: Between 2017 and 2020, the programme facilitated 2,603 patient consultations. Epilepsy was the most common diagnosis (54%), followed by cerebral palsy (12%). The blended model enabled more efficient use of limited specialist time, with pre-clinic coordination improving case triage and care consistency. Cost analysis demonstrated substantial reductions in patient-related costs, ranging from 81% to 98% per hospital. The mean cost per patient consultation decreased from US$193 under the standard tertiary referral model to US$7 under the outreach model. The programme also supported local capacity building through continuing medical education, strengthened referral pathways, and enhanced regional clinical networks.

Conclusions: This evaluation demonstrates that a hybrid outreach and telemedicine model can deliver accessible, high-quality, and cost-effective paediatric neurology services in a low-resource setting. By leveraging existing national infrastructure and integrating local providers, the model improved access to specialist care, reduced financial barriers for families, and contributed to the long-term capacity of the system. The approach offers a scalable framework for other specialities and health systems facing similar constraints and supports progress towards universal health coverage.

Negative and stigmatising attitudes towards human rights and mental health exist worldwide. The Ghanaian government has attempted to tackle such discriminatory attitudes and practices to align with a human rights-based approach in mental healthcare through the implementation of the World Health Organisation QualityRights Initiative in Ghana. As part of the initiative, the World Health Organisation has developed a range of capacity building tools on mental health, disability, human rights and recovery. National stakeholders in Ghana completed the WHO QualityRights e-training to build capacity and change attitudes to promote recovery and respect for human rights for people with mental health conditions, psychosocial and intellectual disabilities. Participants completed pre- and post-training questionnaires assessing perceived attitude and practice change. Thematic analysis was conducted on the open-ended questions on the post e-training questionnaires to discover how attitudes were impacted by the e-training. Three themes emerged: "legal capacity and the right to decide", "coercion, violence and abuse" and "equality and community inclusion." Attitudes on the right to make decisions, treatment of individuals with mental health conditions, psychosocial and intellectual disabilities, equality, social inclusion and non-discrimination had improved to be more in line with a human rights-based and recovery-oriented approach to mental health. The QualityRights training shows promise as a scalable intervention to reduce stigma, promote rights, and improve care for individuals with mental health conditions, psychosocial and intellectual disabilities.