Frontiers in health services最新文献

Objectives: This study aimed to understand the key barriers to successfully implementing Social Prescribing (SP) initiatives from different perspectives.

Methods: An in-depth process evaluation using a multi-method qualitative design was conducted. Qualitative data was collected via semi-structured interviews (N = 23) and Focus Group Discussion (FGD' N = 4). Twenty-three stakeholders took part in the study, including community support providers (n = 7), SP link workers (n = 6), service users (n = 6), NHS employees/referrals, and those who were involved in SP leadership and coordination (n = 4). MAXQDA Version 20.0 was used for management and data analysis.

Results: We identified eight themes representing challenges for a successful implementation of a SP programme. The themes included (i) financial issues and sustainability, (ii) human resources challenges, (iii) partnership working challenges, (iv) inadequate and inconsistent implementation, (v) information system challenges, (vi) referral system issues, (vii) training and knowledge gaps, and (viii) accessibility and privacy concerns.

Conclusion: Study findings provide insight for commissioners, providers, and link workers to guide the delivery of appropriate SP services by identifying a range of factors that hinder the successful implementation of the programme. Future policy, service development, and research should consider tackling these challenges and generating different ideas for potential solutions to address the root causes of problems.

Introduction: Excessive alcohol consumption is a leading global risk factor for ill-health and premature death. Digital alcohol interventions can be effective at reducing alcohol consumption, but their widespread adoption is lagging behind. This study aimed to identify factors promoting or inhibiting the implementation of a digital alcohol intervention in Norwegian primary care, by using Normalization Process Theory (NPT).

Methods: A mixed methods feasibility study combining quantitative and qualitative methods. A digital alcohol intervention called "Endre" was implemented across four GP practices in Stavanger and Oslo. Usage of the intervention was logged on the digital platform. General practitioners (GPs) reported their perceived uptake of the intervention via a web-based survey. The Normalization MeAsure Development (NoMAD) survey was used to measure support staff's perceived normalization of the intervention. Qualitative data were analyzed using the NPT framework, with quantitative data analyzed descriptively and using χ ² and Wilcoxon signed-rank test for differences in current and future normalization.

Results: Thirty-seven GPs worked in the clinics and could recruit patients for the digital intervention. Thirty-six patients registered for the intervention. Nine patients dropped out early and 25 completed the intervention as intended. Low normalization scores at follow-up (n = 27) indicated that Endre did not become fully embedded in and across practices. Nonetheless, staff felt somewhat confident about their use of Endre and thought it may become a more integral part of their work in the future. Findings from six semi-structured group interviews suggested that limited implementation success may have been due to a lack of tailored implementation support, staff's lack of involvement, their diminished trust in Endre, and a lack of feedback on intervention usage. The outbreak of the Covid-19 pandemic further limited opportunities for GPs to use Endre.

Conclusion: This study investigated the real-world challenges of implementing a digital alcohol intervention in routine clinical practice. Future research should involve support staff in both the development and implementation of digital solutions to maximize compatibility with professional workflows and needs. Integration of digital solutions may further be improved by including features such as dashboards that enable clinicians to access and monitor patient progress and self-reported outcomes.

Introduction: With the goal of patient engagement, an initiative was formulated to equip each patient in the general wards with a tablet whereby they can access their health information and patient education materials and communicate with their healthcare team. This paper presented the methodology of the implementation efforts as well as an evaluation of the preliminary outcomes.

Methods: The process of hospital-wide implementation was shared using the implementation research logic model. The bedside tablets were rolled out hospital-wide in a step-wedge manner over 12 months. Barriers and facilitators to this implementation were discussed together with strategies to optimize the situation. Preliminary outcomes of the implementation were evaluated using the RE-AIM framework.

Results: The initial adoption rate for the bedside tablet was low. Additional strategies, such as survey audits and provision of feedback, development of education materials for patients, facilitation, and purposefully re-examining the implementation strategies, were used to improve adoption. The trend of adoption increased over the course of 2 years from the start of implementation.

Discussion: The initial lower adoption rates may reflect Singapore's paternalistic healthcare culture. While this implementation was driven by the need to move away from paternalism and toward patient engagement, more time is required for significant cultural change.

Background: The Avicenna unified Health Information System (HIS) was implemented by the Palestinian Ministry of Health in 2010 across government hospitals. Despite its potential, the acceptance of Avicenna HIS by healthcare providers remains unclear after 14 years of application. Understanding the factors that influence healthcare provider acceptance is essential for optimizing the system's success. We investigated factors affecting acceptance of Avicenna HIS among healthcare providers in Palestinian healthcare institutions, focusing on perceived usefulness, ease of use, human factors, technological factors, and organizational support.

Materials and methods: A cross-sectional study was conducted at the Palestine Medical Complex (PMC) in Ramallah, West Bank, where the Avicenna HIS has been fully implemented since 2010. A systematic random sampling was used to select participants, resulting in 300 completed questionnaires. The study utilized a self-administered questionnaire adapted from a structured tool based on the Technology Acceptance Model (TAM). The questionnaire was validated through expert review and pilot testing, achieving a Cronbach's alpha of 0.86. Each selected healthcare provider was contacted face-to-face, and written informed consent was obtained before administering the questionnaire.

Results: A total of 300 questionnaires were completed and returned. The study sample included 178 males (59.3%) and 122 females (40.7%). The majority of participants was aged 20-39 years (270 participants, 90%) and held a bachelor's degree (250 participants, 83.3%). Nurses comprised the largest professional group (153 participants, 51.0%). High levels of perceived usefulness and ease of use were reported, both with mean scores of 4.511 (S.D. = 0.295). Technological factors had a mean score of 4.004 (S.D. = 0.228), while organizational factors scored 2.858 (S.D. = 0.304). Overall acceptance of the HIS was moderately high, with a mean score of 4.218 (S.D. = 0.387). Significant differences in perceived usefulness and ease of use were noted based on gender, age, and experience.

Conclusion: This study concludes that both technological and human factors significantly influence the acceptance of HIS among healthcare providers in Palestine. To improve HIS adoption, it is recommended to enhance system functionality, ensure reliable data quality, and provide comprehensive training programs for healthcare providers.

Introduction: The implementation of fall prevention interventions in homecare services is crucial for reducing falls among older adults and effective leadership could determine success. Norwegian homecare services provide home nursing, rehabilitation, and practical assistance, to residents living in private homes or assisted living facilities. This study aims to explore how managers in Norwegian homecare services experience implementation of fall prevention interventions and how they perceive their roles.

Methods: We conducted 14 semi-structured individual interviews with managers from different levels of homecare services in five city districts. The interviews were transcribed verbatim and reflexive thematic analysis was used to analyze the material.

Results: The analysis resulted in three main themes: (1) understanding organizational mechanisms to facilitate new practices, (2) practicing positive leadership behavior to facilitate implementation, and (3) demonstrating persistence to sustain implementation. Our results showed the importance of clear leadership across all levels of the organization and the value of devoting time and utilizing existing systems. Managers described using recognition and positive attitudes to motivate employees in the implementation process. They emphasized listening to and involving employees, providing trust, and being flexible. However, the implementation process could be challenging, highlighting the need for managers to be persistent.

Conclusion: Managers at all levels play an important role in the implementation of fall prevention, but there is a need to define and align their specific roles in the process. Understanding how to use existing systems and influence through positive leadership behavior seem to be vital for success. Recognizing the demanding nature of implementation, managers emphasized the importance of systems for long term support. The study findings may influence how managers in clinical practice engage in the implementation process and inform future researchers about managers' roles in implementation in homecare services.

Introduction: Globally, one in every six people will be elderly by 2030. In Nepal, there has been a notable rise in the aging and elderly. Addressing the healthcare needs of them is crucial. Despite the different efforts to advocate for healthy aging, various factors continue to limit this process. This paper aims to explore the utilization of healthcare services among the elderly population and uncover influences on the ability to access these services.

Method: A mixed-method community-based study was conducted in Bihadi Rural Municipality of Parbat, Nepal. The quantitative segment involved interviews with 355 individuals aged ≥60 years, while 18 respondents were enlisted for in-depth interviews. We used descriptive statistics, chi-square test, and logistic regression in quantitative analysis. Similarly, content and thematic analysis were performed in the qualitative component.

Results: This study reported that health service utilization among the respondents was 65.4%. Among the factors ethnicity (OR 3.728, 95% CI 1.062-15.887), not good health status (OR 2.943, 95% CI 1.15-8.046), bus as means of transportation (OR 8.397, 95% CI 1.587-55.091) had higher odds whereas government hospital (OR 0.046, 95% CI 0.009-0.193), not always available health staffs (OR 0.375, 95% CI 0.147-0.931), not sufficient medicine (OR 0.372, 95% CI 0.143-0.924), not available medicine (OR 0.014, 95% CI 0.002-0.068) had lower odds for health service utilization. Other factors identified from qualitative components include long waiting times, insufficient medicine, lack of trained health personnel, financial capacity, low utilization of health insurance, distance, and support from family members.

Conclusions: Nonetheless, a portion of the elderly remained excluded from mainstream of healthcare services. A combination of social, healthcare-related, and individual factors influences the utilization of healthcare services. To ensure elderly-friendly services, prioritize geriatric care training, secure medication availability, and establish a dedicated health insurance program for them. In the current federal context, localizing evidence-based, innovative strategies to address the healthcare needs of the elderly is crucial.

Background: Upwards of ninety percent of individuals living with depression in India do not have access to evidence-based treatments, especially in rural areas. Integrating these treatments into primary care is essential for bridging this care gap. This trial aims to evaluate whether a remote coaching implementation support strategy, referred to as Enhanced Implementation Support, is superior to routine support, referred to as Routine Implementation Support, in supporting the delivery of collaborative depression care in rural primary care centers.

Methods: Employing a cluster-randomized hybrid type-III implementation trial design, 14 primary care facilities in Sehore district, Madhya Pradesh, will implement a collaborative depression care package based on the WHO's mhGAP program. Facilities will be randomized to either Enhanced Implementation Support or the Routine Implementation Support control condition. Enhanced Implementation Support consists of remote coaching and technical assistance, supplemented with in-person visits, and guided by the Plan-Do-Study-Act implementation cycles. The primary implementation outcome is the proportion of outpatients screened for depression by facility staff, with secondary outcomes including the proportions of outpatients who screen positive for depression, are referred to the medical officer, and initiate treatment. Secondary patient outcomes include proportion of patients who achieve reduction in depression symptom severity at 3-month follow up. Acceptability, feasibility, and fidelity of the depression care package will be assessed through routine observations collected during field visits, facility audits, and qualitative exit interviews with facility staff. Costs of delivering the Enhanced Implementation Support strategy will also be estimated.

Discussion: This trial can inform efforts to integrate depression care in rural primary care facilities in a low-resource setting, and illuminate whether external coaching support is superior relative to existing implementation support for achieving these goals.

Trial registration: NCT05264792.