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Corrigendum: Social mobility and perinatal depression in Black women. 更正:黑人妇女的社会流动性与围产期抑郁症。
Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-24 eCollection Date: 2024-01-01 DOI: 10.3389/frhs.2024.1349547
Melissa Hawkins, Arun Mallapareddi, Dawn P Misra

[This corrects the article DOI: 10.3389/frhs.2023.1227874.].

[此处更正了文章 DOI:10.3389/frhs.2023.1227874]。
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引用次数: 0
Demand management processes to improve access to cognitive-behavioral therapies for anxiety disorders: a grounded theory study. 改善焦虑症认知行为疗法获取途径的需求管理流程:一项基础理论研究。
IF 1.6 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-11 eCollection Date: 2023-01-01 DOI: 10.3389/frhs.2023.1266987
Jean-Daniel Carrier, Frances Gallagher, Alain Vanasse, Pasquale Roberge

Introduction: Anxiety disorders are impactful mental health conditions for which evidence-based treatments are available, notably cognitive-behavioral therapies (CBTs). Even when CBTs are available, demand-side factors limit their access, and actors in a position to perform demand management activities lack a framework to identify context-appropriate actions.

Methods: We conducted a constructivist grounded theory study in Quebec, Canada, to model demand management targets to improve access to CBTs for anxiety disorders. We recruited key informants with diverse experiences using purposeful, then theoretical sampling. We analyzed data from 18 semi-directed interviews and 20 documents through an iterative coding process centered around constant comparison.

Results: The resulting model illustrates how actors can target clinical-administrative processes fulfilling the demand management functions of detection, evaluation, preparation, and referral to help patients progress on the path of access to CBTs.

Discussion: Modeling clinical-administrative processes is a promising approach to facilitate leveraging the competency of actors involved in demand management at the local level to benefit public mental health.

引言焦虑症是一种影响深远的精神疾病,目前已有循证治疗方法,特别是认知行为疗法(CBT)。即使可以使用 CBT,需求方面的因素也会限制其使用,有能力开展需求管理活动的行为者缺乏一个框架来确定适合具体情况的行动:方法:我们在加拿大魁北克省开展了一项建构主义基础理论研究,以建立需求管理目标模型,从而改善焦虑症患者获得 CBT 治疗的机会。我们通过有目的的理论抽样,招募了具有不同经历的关键信息提供者。我们通过以不断比较为中心的迭代编码过程,对来自 18 个半定向访谈和 20 份文件的数据进行了分析:结果:由此产生的模型说明了参与者如何针对临床-行政流程履行检测、评估、准备和转介等需求管理职能,帮助患者在获得 CBT 的道路上取得进展:讨论:对临床-行政流程进行建模是一种很有前途的方法,可促进地方一级参与需求管理的人员发挥能力,从而造福于公共心理健康。
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引用次数: 0
Combining legal epidemiology and implementation science to improve global access to medicines: challenges and opportunities 将法律流行病学与实施科学相结合,改善全球药品获取:挑战与机遇
Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-09 DOI: 10.3389/frhs.2023.1291183
Jeff Lane, Andy Stergachis
Laws and policies affecting access to medicines have been in the global health spotlight for decades, yet our understanding of their effects remains substantially underdeveloped. The emerging field of legal epidemiology combined with the methods of implementation science presents an opportunity to help address this gap. Legal epidemiology refers to the scientific study and deployment of law as a factor in the cause, distribution, and prevention of disease and injury in a population. Legal epidemiology studies consist of a systematic collection and coding of laws and policies relating to a particular topic. Quasi-experimental or observational research methods can then be applied to take advantage of natural experiments resulting from heterogenous adoption and/or implementation of laws and policies. Often legal epidemiology studies fail to account for heterogenous law implementation processes, presenting a need and opportunity to integrate implementation science methods. Researchers may face challenges in integrating these methods for access to medicines studies, including data access issues and a complex legal and implementation environment. Yet, the opportunities presented by increasingly transparent legal environments, improved monitoring of medicine availability, universal health coverage expansion, and electronic health and insurance records integration may facilitate overcoming these challenges. Improved collaboration and communication between researchers, health authorities, manufacturers, and health providers from public and private sectors will be critical. In spite of the challenges, combining the fields of legal epidemiology and implementation science may present an important strategy toward creating a legal and policy environment that supports global and equitable access to medicines.
几十年来,影响药品获取的法律和政策一直是全球健康领域的焦点,但我们对其影响的了解仍然远远不够。新兴的法律流行病学领域与实施科学的方法相结合,为帮助解决这一差距提供了机会。法律流行病学是指将法律作为人口中疾病和伤害的成因、分布和预防因素进行科学研究和部署。法律流行病学研究包括对与特定主题相关的法律和政策进行系统收集和编码。然后可以采用准实验或观察研究方法,利用因采用和/或实施法律和政策的异质性而产生的自然实验。法律流行病学研究往往未能考虑到不同的法律实施过程,这就为整合实施科学方法提供了需要和机会。研究人员在整合这些方法进行药品获取研究时可能会面临挑战,包括数据获取问题以及复杂的法律和实施环境。然而,日益透明的法律环境、对药品供应情况的更好监控、全民医保的扩大以及电子健康和保险记录的整合所带来的机遇可能有助于克服这些挑战。加强研究人员、卫生部门、制造商以及公共和私营部门医疗服务提供者之间的合作与沟通将至关重要。尽管挑战重重,但将法律流行病学和实施科学领域结合起来可能是一项重要战略,有助于创造一个支持全球公平获取药品的法律和政策环境。
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引用次数: 0
Editorial: Innovations in quality of care 社论:护理质量的创新
Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-05 DOI: 10.3389/frhs.2023.1352322
João Breda, A. Darzi, H. Ashrafian, Francisco Goiana-da-Silva, Natasha Azzopardi-Muscat
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引用次数: 0
Using CFIR framework for understanding barriers and facilitators to implementation of community tuberculosis program in Burkina Faso 利用 CFIR 框架了解布基纳法索实施社区结核病计划的障碍和促进因素
Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-05 DOI: 10.3389/frhs.2023.1294176
F. M. Donessouné, Olivier G. Sossa, S. Kouanda
In 2020, there were nearly 9.9 million new Tuberculosis cases and 1.3 million deaths, with about 95% occurring in developing nations. Burkina Faso implemented a community Tuberculosis program, involving Civil Society Organizations, to increase screening and improve treatment outcomes. Therefore, this study aims to identify the factors influencing the implementation of community interventions involving these organizations in the fight against TB in Burkina Faso.This qualitative study conducted semi-structured key informant interviews with a purposive sample of health providers from the ministry of health and community health workers. We used framework (the consolidated framework for implementation research was used method to identify barriers and facilitators to implementation of community tuberculosis program in Burkina Faso.A total of 23 interviews were conducted. The results of this research shed light on several key factors that either contributed to or hindered the program's success. Among the facilitating factors, we identified close collaboration between national and international stakeholders, as well as remarkable program flexibility to adapt to local conditions. Furthermore, continuous training and support for community health workers proved crucial for the program's implementation. However, significant challenges were also unveiled. These challenges encompassed insufficient financial resources, difficulties related to the recruitment and management of civil society associations, and issues regarding program ownership at the peripheral level. Additionally, irregular payments to community health workers had a detrimental impact on their motivation and commitment.Our study conducted a comprehensive examination of the obstacles and facilitators encountered in the implementation of a community-based tuberculosis control program in Burkina Faso. The results of this research shed light on several key factors that either contributed to or hindered the success implementation of program. Measures should be taken to mobilize national resources, strengthen the capacities of associations, and promote local ownership of the program. Special attention should also be given to improving financial management and resolving issues related to the recruitment and compensation of community health workers. For such community-based tuberculosis programs to succeed in Burkina Faso and in similar context it is essential to address these obstacles and facilitators.
2020 年,新增肺结核病例近 990 万例,死亡 130 万例,其中约 95% 发生在发展中国家。布基纳法索实施了一项有民间社会组织参与的社区结核病计划,以增加筛查和改善治疗效果。因此,本研究旨在确定影响布基纳法索实施由这些组织参与的社区结核病防治干预措施的因素。这项定性研究对卫生部的医疗服务提供者和社区医疗工作者进行了半结构化关键信息访谈。我们采用了实施研究综合框架方法来确定布基纳法索实施社区结核病防治计划的障碍和促进因素。研究结果揭示了促进或阻碍计划成功的几个关键因素。在促进因素中,我们发现了国家和国际利益相关者之间的密切合作,以及项目适应当地条件的显著灵活性。此外,对社区卫生工作者的持续培训和支持对计划的实施也至关重要。然而,我们也发现了一些重大挑战。这些挑战包括财政资源不足、与民间社会协会的招聘和管理有关的困难,以及与外围层面的计划所有权有关的问题。我们的研究全面考察了布基纳法索在实施社区结核病控制项目过程中遇到的障碍和促进因素。研究结果揭示了促进或阻碍计划成功实施的几个关键因素。应采取措施调动国家资源,加强协会的能力,促进地方对计划的自主权。还应特别注意改善财务管理,解决与社区卫生工作者的招聘和报酬有关的问题。此类社区结核病防治计划要想在布基纳法索及类似地区取得成功,就必须解决这些障碍和促进因素。
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引用次数: 0
Insights into implementation planning for point-of-care testing to guide treatment of chronic obstructive pulmonary disease exacerbation: a mixed methods feasibility study 对指导慢性阻塞性肺病恶化治疗的护理点检测实施规划的见解:一项混合方法可行性研究
Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-03 DOI: 10.3389/frhs.2023.1302653
Julie Hart, Alexander Daniel Edwards, Andrew Stainthorpe
The purpose of this mixed methods feasibility study was to gain insights into unmet clinical needs, stakeholder preferences and potential barriers and enablers to adoption for planning the implementation of point-of-care testing for earlier detection and guided treatment of chronic obstructive pulmonary disease (COPD) acute exacerbation in the NHS in England. Exacerbations of COPD cause considerable mortality and morbidity. Earlier identification of exacerbations and guided treatment would lead to reduced exacerbation duration, reduced hospitalizations and mortality, improve health-related quality of life, reduce unnecessary treatments (including inappropriate antibiotic prescribing) which could save the NHS over £400 per patient. During the early stages of product design, we took a multi-disciplinary approach to evidence generation, gaining insights from key stakeholders to test the product concept and inform evidence-based implementation planning. Primary data was collected from 11 health care and service professionals involved in the management of acute COPD exacerbations. Overall, participants agreed that by earlier differentiation of acute exacerbation from stable COPD, patients could be started on appropriate treatment. To implement point-of-care testing into clinical practice, evidence is required to demonstrate the accuracy of differentiating between exacerbation etiologies and to provide information on the beneficial impact to the system in terms of optimized management, reduced long-term side effects, admission avoidance, and cost-effectiveness. This research provides an evidence base for future implementation planning of point-of-care testing for earlier detection and guided treatment of COPD acute exacerbation. Moreover, the technology developers can decide whether to refine the product design and value proposition thereby de-risking product development.
这项混合方法可行性研究的目的是深入了解未满足的临床需求、利益相关者的偏好以及采用这种方法的潜在障碍和推动因素,以便规划在英格兰国家医疗服务系统中实施护理点检测,从而更早地发现慢性阻塞性肺病(COPD)急性加重并指导治疗。慢性阻塞性肺疾病的恶化会导致相当高的死亡率和发病率。更早地识别病情恶化并进行指导性治疗将缩短病情恶化的持续时间,降低住院率和死亡率,改善与健康相关的生活质量,减少不必要的治疗(包括不适当的抗生素处方),从而为每位患者节省超过 400 英镑的 NHS 费用。在产品设计的早期阶段,我们采用了多学科方法来生成证据,从主要利益相关者那里获得见解,以检验产品概念并为基于证据的实施规划提供信息。我们从参与慢性阻塞性肺疾病急性加重管理的 11 名医疗保健和服务专业人员那里收集了原始数据。总体而言,参与者一致认为,通过尽早区分慢性阻塞性肺病急性加重与稳定期,可以让患者开始接受适当的治疗。要在临床实践中实施护理点检测,需要有证据证明区分加重病因的准确性,并提供信息说明在优化管理、减少长期副作用、避免入院和成本效益方面对系统产生的有益影响。这项研究为今后规划实施护理点检测提供了证据基础,以便更早地发现慢性阻塞性肺病急性加重并指导治疗。此外,技术开发人员还可以决定是否完善产品设计和价值主张,从而降低产品开发风险。
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引用次数: 0
Pre-implementation adaptation of suicide safety planning intervention using peer support in rural areas 在农村地区利用同伴支持对自杀安全规划干预措施进行实施前调整
Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-22 DOI: 10.3389/frhs.2023.1225171
Eva N. Woodward, Amanda Lunsford, Rae Brown, Douglas Downing, Irenia A Ball, Jennifer M. Gan-Kemp, Anthony Smith, Olympia Atkinson, Thomas Graham
Currently, seventeen veterans die by suicide daily in the United States (U.S.). There are disparities in suicide behavior and access to preventative treatment. One disparity is the suicide rate in rural areas, including the state of Arkansas—suicide deaths among rural veterans increased 48% in the last 2 decades, double that of urban veterans. One major challenge for veterans in rural areas is the lack of healthcare providers to provide Safety Planning Intervention, which is an effective intervention to reduce suicide attempts in the general adult population and among veterans. One solution is more broadly implementing Safety Planning Intervention, by using peers to deliver the intervention in rural communities. Before implementation, the intervention needs to be adapted for peer-to-peer delivery, and barriers and facilitators identified.Since January 2021, using community-based participatory research, we collaboratively developed and executed a 1 year study to adapt Safety Planning Intervention for peer-to-peer delivery in rural communities and identified implementation barriers and facilitators prior to spread. From July 2022 to February 2023, we conducted group interviews with 12 participants: rural veterans with prior suicidal thoughts or attempts in one U.S. state, their support persons, and healthcare professionals with expertise in veteran suicide prevention, Safety Planning Intervention, and/or peer delivery. We collected qualitative data through interviews during nine, 2 h meetings, and quantitative data from one anonymous survey and real-time anonymous voting—all on the topic of core and adaptable components of Safety Planning Intervention and implementation barriers and facilitators for peer delivery in rural communities. Questions about adaptation were designed according to processes in the ENGAGED for CHANGE community-engaged intervention framework and questions about facilitators and barriers were designed according to the Health Equity Implementation Framework. Participants categorized which Safety Planning Intervention components were core or adaptable, and how freely they could be adapted, using the metaphor of a traffic light in red (do not change), yellow (change with caution), and green (change freely) categories.Participants made few actual adaptations (categorized according to the FRAME modification system), but strongly recommended robust training for peers. Participants identified 27 implementation facilitators and 47 barriers, organized using the Health Equity Implementation Framework. Two example facilitators were (1) peer-to-peer safety planning intervention was highly acceptable to rural veterans; and (2) some state counties already had veteran crisis programs that could embed this intervention for spread. Two example barriers were (1) some community organizations that might spread the intervention have been motivated initially, wanting to help right away, yet not able to sustain interventions; and (2) uncertainty abou
目前,美国每天有 17 名退伍军人死于自杀。在自杀行为和获得预防性治疗方面存在差异。其中一个差距是包括阿肯色州在内的农村地区的自杀率--在过去 20 年中,农村退伍军人的自杀死亡率增加了 48%,是城市退伍军人的两倍。农村地区退伍军人面临的一个主要挑战是缺乏提供安全规划干预的医疗服务提供者,而安全规划干预是一种有效的干预措施,可以减少普通成年人和退伍军人的自杀企图。解决方法之一是更广泛地实施安全规划干预,利用同伴在农村社区提供干预。自 2021 年 1 月起,我们利用基于社区的参与式研究,合作开发并实施了一项为期 1 年的研究,以调整安全规划干预措施,使其适用于在农村社区开展同伴互助活动,并在推广前确定实施障碍和促进因素。从 2022 年 7 月到 2023 年 2 月,我们对 12 名参与者进行了小组访谈:美国某州曾有自杀想法或企图的农村退伍军人、他们的支持者,以及在退伍军人自杀预防、安全规划干预和/或同伴传递方面拥有专业知识的医疗保健专业人员。我们通过 9 次 2 小时会议期间的访谈收集了定性数据,并通过一份匿名调查和实时匿名投票收集了定量数据,所有数据都是关于安全规划干预的核心和可调整部分,以及在农村社区实施同伴服务的障碍和促进因素。有关适应性的问题是根据 "参与改变 "社区参与干预框架中的流程设计的,有关促进因素和障碍的问题是根据 "健康公平实施框架 "设计的。参与者将安全规划干预措施的哪些部分归为核心部分或可调整部分,以及可调整的自由度,用红灯(不要改变)、黄灯(谨慎改变)和绿灯(自由改变)的比喻进行分类。根据健康公平实施框架,与会者确定了 27 个实施促进因素和 47 个障碍。两个促进因素的例子是:(1)农村退伍军人对同伴安全规划干预的接受度很高;(2)一些州县已经有了退伍军人危机计划,可以嵌入这一干预措施进行推广。两个障碍是:(1)一些可能推广该干预措施的社区组织起初很积极,希望立即提供帮助,但却无法持续进行干预;以及(2)不确定如何接触到自杀风险适中的退伍军人,因为许多危机项目都是在自杀风险较高时识别他们的。下一步的重要工作之一就是将这些障碍和促进因素与同伴互助的实施策略相结合。有一个发现让我们的研究团队感到惊讶--尽管农村社区的社会环境恶劣,导致自杀死亡人数过多,但参与者们特别指出了几个有关农村社区的积极促进因素,可以在实施过程中加以利用。
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引用次数: 0
Editorial: Going beyond the traditional tools of implementation science 社论:超越实施科学的传统工具
Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-21 DOI: 10.3389/frhs.2023.1343058
Per Nilsen, J. Kirk, Kristin Thomas
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引用次数: 0
Evidencing the effectiveness of upper limb prostheses: a multi-stakeholder perspective on study requirements 证明上肢假肢的有效性:多方利益相关者对研究要求的看法
Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-21 DOI: 10.3389/frhs.2023.1213752
H. Jones, Alix Chadwell, Matthew Dyson
The provision of upper limb prosthetic devices through the National Health Services (NHS) within the United Kingdom is driven by national policies. NHS England have recently published a new policy to provide multi-grip myoelectric hands. The policy highlighted that there was limited evidence to support its deployment and it will be reviewed should new information arise. The clear identification of the evidence gap provides an opportunity for the academic research community to conduct studies that will inform future iterations of this and other upper limb prosthetic related policies. This paper presents a summary of findings and recommendations based on two multi-stakeholder workshops held in June 2022 and July 2022, which explored the design requirements for policy-driven research studies. The workshops involved people from a broad range of stakeholder groups: policy, academia, NHS clinical and management, industry, and a person with upper limb absence. The workshop discussions focused on the research questions that NHS England identified in the policy evidence review: (1) Clinical Effectiveness; (2) Cost Effectiveness; (3) Safety; and (4) Patient Subgroups. The recommendations based on stakeholder discussions included the need to gather qualitative and quantitative research evidence, use goal-based outcome measures, and conduct longitudinal studies. Future research studies also need to address the complexities of conducting national and international policy-driven research, such as clinical resource capacity and participant involvement.
英国国家医疗服务系统(NHS)通过国家政策提供上肢假肢装置。英国国家医疗服务系统(NHS)最近发布了一项新政策,旨在提供多抓握肌电手。该政策强调,支持其部署的证据有限,如果出现新的信息,将对该政策进行审查。对证据差距的明确认定为学术研究界提供了开展研究的机会,从而为该政策及其他上肢假肢相关政策的未来迭代提供依据。本文概述了 2022 年 6 月和 2022 年 7 月举行的两次多方利益相关者研讨会的结论和建议,这两次研讨会探讨了政策驱动型研究的设计要求。参与研讨会的人员来自广泛的利益相关者群体:政策、学术界、国家医疗服务体系临床和管理部门、行业以及一名上肢缺失患者。研讨会讨论的重点是英国国家医疗服务体系在政策证据审查中确定的研究问题:(1) 临床效果;(2) 成本效益;(3) 安全性;以及 (4) 患者亚群。根据利益相关者的讨论提出的建议包括:需要收集定性和定量研究证据、使用基于目标的结果衡量标准并开展纵向研究。未来的研究还需要解决开展国家和国际政策驱动研究的复杂性,如临床资源能力和参与者参与。
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引用次数: 0
Editorial: Advancements and challenges in mental health services: 2022 社论:心理健康服务的进步与挑战:2022
Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-21 DOI: 10.3389/frhs.2023.1348169
Carolyn S. Dewa
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引用次数: 0
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