Frontiers in health services最新文献

Background: Immigrant youth population is more susceptible to poor mental and overall health due to environmental factors, such as higher risks of poverty, trauma, displacement, and settlement period, learning a new language, adapting to a new culture, and a lack or loss of social supports. The overall goal of this project was to identify the research priorities of immigrant youth with lived experience of mental health concerns to guide research in mental health and inform health policy in a partnership with community organizations across Alberta, Canada.

Methods: This patient-oriented research was designed based on the James Lind Alliance Priority Setting Partnership five steps: (1) creating a steering committee; (2) gathering uncertainties (questions which cannot be answered by existing research); (3) refining uncertainties through steering committee; (4) prioritization with immigrant youth via focus groups and with stakeholder involved in the care of immigrant youth through a nominal group technique; and (5) finalizing priority setting, report and dissemination. A steering committee was created with immigrant youth who self-identified with lived experience of mental health issues, leaders from immigrant communities (aged 18-25), researchers, non-profit organization leaders, and healthcare or community service providers. The electronic survey was distributed in rural, remote, suburban, and urban settings to recruit self-identified immigrant ("someone who has permanently located in a country other than their place of home origin") youth between the ages of 15 and 25 residing in Alberta, Canada.

Results: Based on 148 responses from immigrant youth with a mental health concern, 25 uncertainties were refined. The top five priorities were chosen at the focus groups and NGT. Youth prioritized uncertainties related to them and their communities, while key informants emphasized higher-level uncertainties (resources, institutional barriers). Both prioritized community roles in reducing stigma, schools' role in addressing mental health, and the impact of COVID-related isolation.

Conclusions: This study underscores the need for policies that support the tailoring of mental health services to the individual needs of immigrant youth. The findings from this study affirm that immigrant youth recognize mental health as not linear or universal; they seek to support each other and advocate for systemic changes that increase literacy and access to care.

Digital mental health interventions (DMHIs) offer promising solutions to address unmet mental health needs among children and young people, yet how to get DMHIs commissioned into the NHS can seem mystifying for innovators. This perspective paper draws on insights from a collaborative commissioning event focused on the Online Remote Behavioural Intervention for Tics (ORBIT) intervention, a digital behavioural therapy for young people with tic disorders, to explore the barriers and enablers to commissioning DMHIs in England. Key challenges identified include unclear commissioning pathways, limited clinical expertise, integration hurdles, and short-term funding models. Enablers included clinical advocacy, robust research evidence, and alignment with national frameworks. These insights highlight the importance of early collaboration between academics, developers, and policymakers in the product development cycle seeking to bridge the gap between innovation and implementation in digital mental health care.

Background: COVID-19 affected 777 million people globally, with 7.1 million deaths. In Africa, 9.6 million cases and 176,000 deaths were reported. Long COVID, a significant consequence of the COVID-19, presented by chronic symptoms, affects the physical and mental health, thereby impacting the quality of life. While high-income countries implemented rehabilitation programs for managing long COVID symptoms, low- and middle-income countries faced healthcare disparities. In South Africa, limited multidisciplinary interventions were evident. This study aimed to assess the acceptability and feasibility of an 8-week rehabilitation and self-management program for long COVID using mixed-methods approach in Johannesburg.

Methods: Patients and hospital staff who suffered from at least one symptom of long COVID for a period of two months and who consented to participate in the intervention were recruited from Tembisa Provincial Tertiary Hospital. The recruitment was from July to October 2023. Questionnaires were administered and interviews with selected participants were conducted to assess the acceptability and feasibility of the intervention. A descriptive analysis was carried out for the quantitative data, and a deductive thematic analysis was used for the interviews.

Results: The participants had positive perceptions towards the design of the intervention, delivery, materials used and support by research staff and external consultants such as dietitians, physiotherapists, and psychologists. The participants stated that the intervention had improved their knowledge of long COVID and increased their self-confidence. Major barriers related to the intervention perceived by the participants were infrastructure, time and language. Recommendations from the participants included expanding the intervention at the community level and extending the duration of the intervention beyond 8-weeks.

Conclusion: This pilot intervention, that aimed to manage the symptoms of long COVID, was well accepted by the participants and achieved its intended outcome. Similar interventions are required at the clinical as well as community levels.

Background: Vaccine hesitancy is a multifactorial construct that posits vaccine uptake is based on person, place, time, and vaccine type. This study sought to identify individuals at about the six-month mark of COVID-19 vaccine availability in Central Texas to determine if they were vaccine acceptors, vaccine refusers, or in the moveable middle using the COVID-19 Vaccination Uptake Behavioral Science Task Force framework developed for the US Centers for Medicare and Medicaid Services and to disentangle individuals in the moveable middle to either vaccine acceptors or vaccine refusers.

Methods: An online survey was distributed to individuals with Affordable Care Act insurance to assess: (1) COVID-19 vaccine uptake; and (2) plans to obtain a COVID-19 vaccine for those who had not yet received at least one dose of a COVID-19 vaccine. The study period was June 27, 2021, through July 13, 2021. Quantitative and qualitative data were collected.

Results: 900 individuals participated in this study. The point prevalence of COVID-19 vaccine acceptance and refusal was 94.9% (n = 854) and 5.1% (n = 46), respectively. For those who were initially identified in the moveable middle, 84.6% exited the moveable middle as vaccine refusers. Black or African American race (p < 0.001), income level (p = 0.004), and education level (p = 0.015) were associated with obtaining at least one dose of the COVID-19 vaccine.

Conclusions: Real-world evidence at the time of a public health emergency can be used to determine point prevalence of vaccine uptake to stratify individuals as vaccine acceptors, vaccine refusers, or the moveable middle. Such evidence can be used to support health policy and planning during a public health emergency.

Introduction: Disparities in healthcare resource allocation present a significant challenge in China, particularly in underdeveloped western regions like Guangxi. Moving beyond analyses of isolated factors, this study investigates the complex, synergistic interactions of socioeconomic, governmental, and demand-side conditions that shape allocation efficiency.

Methods: We employed a two-stage, mixed-methods approach. First, Data Envelopment Analysis (DEA) evaluated the relative efficiency of 14 prefecture-level cities in Guangxi, using healthcare personnel and hospital beds as inputs, and outpatient visits and hospital discharges as outputs. Second, Fuzzy-Set Qualitative Comparative Analysis (fsQCA) was used to identify configurations of conditions (including per capita GDP, urbanization, government expenditure, and per capita health spending) leading to high or low efficiency.

Results: The overall efficiency of healthcare resource allocation in Guangxi was suboptimal (mean score: 0.364), with significant regional disparities. The fsQCA revealed multiple, equifinal pathways to outcomes, demonstrating causal asymmetry. We identified four configurations for high efficiency (solution consistency: 0.809; coverage: 0.771), where robust socioeconomic development (per capita GDP, urbanization) was a core condition in most paths. Conversely, seven configurations led to low efficiency (solution consistency: 0.876; coverage: 0.733), often characterized by insufficient government support or socioeconomic development, even when other factors like health demand were high.

Discussion: Our findings indicate that healthcare resource allocation efficiency is shaped by the synergistic interaction of multiple conditions rather than any single factor. This configurational perspective explains the stark regional disparities, with ethnic minority areas being particularly vulnerable due to unfavorable condition profiles. We recommend tailored, place-based policies, such as strengthening primary care, promoting "Internet + Healthcare," and establishing regional medical centers, to create synergistic effects and optimize resource allocation.

[This corrects the article DOI: 10.3389/frhs.2025.1654516.].

Introduction: Several barriers, such as lack of time, knowledge and support, hinder clinicians from providing an individually tailored physical activity (PA) prescription and referral to their patients. As a result, "exercise is medicine" (E = M) is not systematically implemented in clinical care today. Many studies have identified facilitators and barriers to implementation, yet linking these factors to tailored implementation strategies is still an under-researched area. Therefore, this study aimed to apply Implementation Mapping to develop an implementation protocol to support the individually tailored PA prescription in hospital care.

Methods: We used strong stakeholder participation and, we applied the five tasks of the systematic Implementation Mapping approach to match implementation strategies to implementation barriers and facilitators identified through interviews with clinicians working at two university hospitals in the Netherlands.

Results: We identified clinicians as primary actors. Secondary actors were managers of the departments and stakeholders in the broader context. For each actor group, performance objectives were defined. We matched previously identified facilitators and barriers to theory and evidence-informed implementation strategies from the Effective Practice and Organisation of Care taxonomy using the CFIR Strategy Matching Tool. Next, we translated these implementation strategies (e.g., active learning, audit, and feedback, technical assistance, peer education) into practical activities to support the implementation of the E = M tool, such as training for clinicians, creating overviews of possible local exercise referral options, and appointing role models for clinicians. Lastly, these activities were bundled into an implementation protocol. The implementation protocol consisted of a set of implementation activities to support and guide clinicians during the adoption, implementation, and sustainability process of the prescription of E = M. All activities were supported by implementation tools, practical applications, and materials while allowing tailoring to the specific clinical context.

Discussion/conclusion: This study illustrates the application of Implementation Mapping to design an implementation protocol to support and guide the prescription of E = M by clinicians in the hospital environment, using strong stakeholder participation in the development process. The stepwise development of the implementation protocol can serve as an example for researchers or practitioners preparing for E = M implementation.

Background: Psychiatric patients admitted through emergency pathways often presented with severe comorbid physical illnesses, which posed challenges for timely diagnosis and effective management in psychiatric specialty hospitals. To address this gap, our hospital established an integrated model that linked the Psychiatric Emergency Department (PED) with the Psychiatric Intensive Care Unit (PICU), aiming to create a continuous and coordinated emergency-critical care system.

Description of the model: The PED-PICU integrated model was developed through progressive institutional innovations, including the establishment of a dedicated PICU, functional integration of the PED, and the creation of specialized rapid-response centers. This model enabled early identification of critical conditions, seamless transfer between emergency and intensive care, and continuity of treatment until recovery.

Experience and outcomes: In practice, the model improved coordination between emergency and critical care teams, facilitated timely interventions, and ensured that patients with severe psychiatric and medical comorbidities received comprehensive management within a single institutional framework. The integration also strengthened multidisciplinary collaboration and highlighted the unique role of psychiatric specialty hospitals in managing complex emergencies.

Conclusions: The PED-PICU integrated model represented a pioneering and unique practice in psychiatric specialty hospitals. By closing the gaps between emergency stabilization and intensive care, it established a closed-loop system that might serve as a valuable reference for developing similar subspecialties and improving emergency-critical care pathways in mental health services.

Background: A growing workforce is being employed internationally to assist patients in navigating between health and social care providers. These roles operate under various care models including patient navigation, social prescribing, and care coordination; tasks and responsibilities of care navigators are highly variable and often lack clarity. Understanding the similarities and differences amongst care navigator roles could improve the embedding of roles into health and social care systems and legitimise professional identity. This umbrella review synthesises evidence on care navigator roles, role titles, tasks, and functions, across diverse models that integrate care at the health and social care interface.

Methods: MEDLINE, Embase, CINAHL, Scopus, and PsycINFO were searched from 1 Jan 2019-31 May 2024. Reviews that used systematic, scoping, or other rigorous methodology were included if they discussed the role or function of workers who coordinated services involving health and social care. Data were synthesised using an inductive thematic approach.

Results: Twenty-six review articles were included, which synthesised 824 unique primary sources. Seventy-eight unique role titles were used to describe care navigators, which aggregated under seven role categories: Patient Navigator, Link Worker, Care Coordinator, Case Manager, Social Prescriber, Intermediary, Health Mediator. The most common were Patient Navigator and Link Worker. Tasks related to navigation, building service users' capacity for self-management, and providing person-centred care overlapped across all role categories, indicating the core functions of the navigation workforce. Patient Navigators' scope of practice included the provision of education, appointment coordination, and assistance with logistic issues, while the roles of Link Workers typically only provided referral-based navigation and developed the capacity of service users for self-management.

Conclusions: The range in the titles and role scope of care navigators highlights increasing demand for system integration, however, the high variability of interchangeable terms and overlapping tasks create complexity for service users, providers, and researchers. An international Delphi study could create a consensus on the nomenclature and taxonomy for navigator roles that interface between health and social care systems. Developing professional identities, training, and strategies to seamlessly embed such roles into existing health and social care structures is also needed.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, PROSPERO #CRD42024572605.