Is precarious employment more damaging to women's health than men's?

Current global economic trends in both developed and developing countries, including unregulated labor markets, trade competition and technological change, have greatly expanded a complex labor market situation characterised by many employees working under temporary work status, job insecurity, low social protection and low income level. Although the health of women is disproportionately affected by workplace flexibility, this has been largely ignored. The main purpose of this paper is to draw attention to this relevant but neglected topic.     

'Justifiable depression': how primary care professionals and patients view late-life depression? A qualitative study

BACKGROUND: Depression is the commonest mental health problem in elderly people and continues to be underdiagnosed and undertreated. AIM: To explore the ways that primary care professionals and patients view the causes and management of late-life depression. DESIGN: A qualitative study using semistructured interviews. SETTING: One Primary Care Trust in North West England. PARTICIPANTS: Fifteen primary care practitioners comprising nine GPs, three practice nurses, two district nurses and one community nurse; twenty patients who were over the age of 60 and who were participating in a feasibility study of a new model of care for late-life depression [PRIDE Trial: PRimary care Intervention for Depression in the Elderly (a feasibility study in Central Manchester funded by the Department of Health)]. RESULTS: Primary care practitioners conceptualized late-life depression as a problem of their everyday work, rather than as an objective diagnostic category. They described depression as part of a spectrum including loneliness, lack of social network, reduction in function and viewed depression as 'understandable' and 'justifiable'. This view was shared by patients. Therapeutic nihilism, the feeling that nothing could be done for this group of patients, was a feature of all primary care professionals' interviews. Patients' views were characterized by passivity and limited expectations of treatment. Depression was not viewed as a legitimate illness to be taken to the GP. Primary care professionals recognized that managing late-life depression did fall within their remit, but identified limitations in their own skills and capabilities in this area, as well as a lack of other resources to which they could refer patients. CONCLUSION: This study highlights the complicated nature of the diagnosis and management of late-life depression. Protocols for the diagnosis and treatment of depression emphasis the biomedical model which does not fit with the everyday experience of GPs or elderly patients who share the views of primary care professionals that depression is a consequence of social and contextual issues. There is a need for the development of evidence-based provision for older people with depression within primary care, but also a need for elderly patients to be made aware of the legitimacy of presenting low mood and misery to their primary care professional.     

Is cumulative exposure to economic hardships more hazardous to women's health than men's? A 16-year follow-up study of the Swedish Survey of Living Conditions

BACKGROUND: Previous research has shown an association between cumulative economic hardships and various health outcomes. However, the cumulative effects of economic hardships in regard to gender differences have not been given enough attention. METHODS: 1981 women and 1799 men were followed up over a period of 16 years (1981-1997), using data from the Swedish Survey of Living Conditions panel study. The temporal association between economic hardships and self-rated health, psychological distress and musculoskeletal disorders was analysed. RESULTS: A dose-response effect on women's health was observed with increasing scores of cumulative exposure to financial stress but not with low income. Women exposed to financial stress at both T(1) and T(2) had an increased risk of 1.4-1.6 for all health measures compared with those who were not exposed. A similar consistent dose-response effect was not observed among men. CONCLUSIONS: There is a temporal relationship between cumulative economic hardships and health outcomes, and health effects differ by gender. Financial stress seems to be a stronger predictor of poor health outcomes than low income, particularly among women. Policies geared towards reducing health inequalities should recognise that long-term exposure to economic hardships damages health, and actions need to be taken with a gender perspective.     

Patient experiences of engagement with care plans and healthcare professionals’ perceptions of that engagement

Background

Although patient engagement is internationally recognized as a core quality indicator of healthcare systems, no report has yet explored patient engagement in Saudi Arabia. Thus, we explored patients’ experiences of engagement with healthcare services and assessed physicians’ and nurses’ perceptions of this engagement.

Methods

We performed a cross-sectional study on patients and their family members admitted to either the rehabilitation or neurology department of King Fahad Medical City, Riyadh, Saudi Arabia. We also studied physicians and nurses involved in direct patient care in these departments. Two self-administered questionnaires were used to collect data on patients’ experiences of engagement with healthcare services and physicians’ and nurses’ perceptions of that engagement.

Results

We recruited 36 patients and 46 family members, as well as 64 nurses and 36 physicians. About 73% of patients and family members felt that doctors and nurses engaged them in decision making regarding care plans; 80% felt that they were a partners in the treatment plans. Over one-third of physicians and nurses believed that patient engagement improved healthcare outcomes, and about 7% believed that patient engagement was unimportant or not extremely important. Responses of physicians and nurses differed significantly from those of patients and family members with regards to the extent of the patient–physician/nurse relationship, the perception of involvement, and the degree of partnership and shared leadership.

Conclusion

We assessed patient experiences of engagement with health care service and physicians’ and nurses’ perceptions of that engagement. Most patients/family members reported good engagement. Although most physicians and nurses believed that patient engagement improved the healthcare outcomes, some believed that improving healthcare outcomes through patient engagement was not important or not extremely important.

     

The weaker sex? Exploring lay understandings of gender differences in life expectancy: A qualitative study

Despite increasing interest in gender and health, 'lay' perceptions of gender differences in mortality have been neglected. Drawing on semi-structured interview data from 45 men and women in two age cohorts (born in the early 1950s and 1970s) in the UK, we investigated lay explanations for women's longer life expectancy. Our data suggest that respondents were aware of women's increased longevity, but found this difficult to explain. While many accounts were multifactorial, socio-cultural explanations were more common, more detailed and less tentative than biological explanations. Different socio-cultural explanations (i.e. gendered social roles, 'macho' constraints on men and gender differences in health-related behaviours) were linked by the perception that life expectancy would converge as men and women's lives became more similar. Health behaviours such as going to the doctor or drinking alcohol were often located within wider structural contexts. Female respondents were more likely to focus on women's reproductive and caring roles, while male respondents were more likely to focus on how men were disadvantaged by their 'provider' role. We locate these narratives within academic debates about conceptualising gender: e.g. 'gender as structure' versus 'gender as performance', 'gender as difference' versus 'gender as diversity'.     

What shapes GPs' work with depressed patients? A qualitative interview study

BACKGROUND: The ways that GPs treat depressed patients have been criticized in a number of studies. OBJECTIVE: To explore factors that shape how GPs work with depressed patients. METHODS: Seventeen GPs from the county of Orebro, Sweden participated in a qualitative semi-structured interview study. GPs' conceptions of factors shaping their way of working with depressed patients, especially continuing medical education (CME), commercial information, inter-collegial support, collaboration with psychiatrists and GPs' gender were recorded. RESULTS: Private life experiences as well as professional experiences from family medicine were more often stressed as formative factors than university education and training in psychiatry. Groups of GPs discussisng the doctor-patient relationship set out from real cases (Balint groups) and CME groups were regarded as good forms of education. Most GPs considered company-sponsored lectures valuable. Commercial drug information was seen as more powerful than non-commercial information and GPs wished for more non-commercial information. Collaboration with psychiatry consultants was perceived as insufficient, and GPs felt a need for more inter-collegial support. Traditional female qualities were generally seen as advantageous in the work with depressed patients. CONCLUSIONS: Many GPs consider personal qualities and experiences, including those of gender, to be more influential than academic education and professional literature. This reflects a preference for individual 'tacit knowledge'. Although tacit knowledge is indispensable in consultations, the low priority given to theoretical CME may make GPs less inclined to make optimal use of different therapeutic alternatives and also less critical of commercial marketing. CME on depression should start with GPs' individual tacit knowledge and assume a more independent stance from the drug industry.     

What happened when Scottish women were given advance supplies of emergency contraception? A survey and qualitative study of women's views and experiences

The Lothian Emergency Contraception Project in Scotland was a radical intervention in which women aged 16-29 were given 5 packs of emergency contraception (EC) to keep at home. We use survey and qualitative interview data to describe how women used the project packs and their views of advance supplies. The women's accounts suggest that concerns that eased access to emergency contraception will lead to repeated use and risky sex appear to be largely unfounded. Women were pleased to be offered the packs, which were reported as having practical advantages and also sparing them the difficulty of negotiating a sometimes awkward consultation. Respondents explained how they used their packs of EC and in their accounts used justifications, repetition and distancing to emphasise that they would not take risks with contraception or sexually transmitted infections. We interpret the data in the light of the observation that EC has an anomalous role in contraception and the work of applied linguists Candlin and Lucas who have demonstrated the difficulties inherent in the family planning consultation.     

Checklists in the operating room: Help or hurdle? A qualitative study on health workers' experiences

Background  

Checklists have been used extensively as a cognitive aid in aviation; now, they are being introduced in many areas of medicine. Although few would dispute the positive effects of checklists, little is known about the process of introducing this tool into the health care environment. In 2008, a pre-induction checklist was implemented in our anaesthetic department; in this study, we explored the nurses' and physicians' acceptance and experiences with this checklist.     

Solutions to tackle the mental health consequences of the economic recession: A qualitative study integrating primary health care users and professionals’ perspectives

This qualitative study explores solutions proposed by primary health care users and professionals to address the consequences of the economic recession and austerity measures on populations' mental health and delivery of care in Portugal. Qualitative data were collected in three primary health care centres in the Lisbon Metropolitan Area. Five focus groups with 26 users and semistructured interviews with 27 health professionals were conducted. Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis.Solutions proposed by users focused on improvements in accessibility and management of services, socioeconomic and living conditions, human resources for health, and investment in mental health. Health professionals focused on improvements in integration and articulation of services, infrastructure and structural barriers to primary care, recruitment and retention of human resources, and socioeconomic and living conditions. The themes from both groups were integrated and organized into three axes for action: 1) increasing investment and reversing austerity measures in health and social sectors; 2) coordination and integration of mental health care; and 3) tackling the social determinants of mental health.The findings provide an assessment of the needs and priorities set by primary health care users and professionals, reflecting their contextspecific experiences. These complementary perspectives highlight the need for inter-sectoral efforts in policy-making to improve delivery of care and to mitigate social inequalities in health across the Portuguese population.     

Global governance and the broader determinants of health: A comparative case study of UNDP’s and WTO’s engagement with global health

This comparative case study investigated how two intergovernmental organisations without formal health mandates – the United Nations Development Programme (UNDP) and the World Trade Organization (WTO) – have engaged with global health issues. Triangulating insights from key institutional documents, ten semi-structured interviews with senior officials, and scholarly books tracing the history of both organisations, the study identified an evolving and broadened engagement with global health issues in UNDP and WTO. Within WTO, the dominant view was that enhancing international trade is instrumental to improving global health, although the need to resolve tensions between public health objectives and WTO agreements was recognised. For UNDP, interviewees reported that the agency gained prominence in global health for its response to HIV/AIDS in the 1990s and early 2000s. Learning from that experience, the agency has evolved and expanded its role in two respects: it has increasingly facilitated processes to provide global normative direction for global health issues such as HIV/AIDS and access to medicines, and it has expanded its focus beyond HIV/AIDS. Overall, the study findings suggest the need for seeking greater integration among international institutions, closing key global institutional gaps, and establishing a shared global institutional space for promoting action on the broader determinants of health.     

Planning and Public Health professionals’ experiences of using the planning system to regulate hot food takeaway outlets in England: A qualitative study

Takeaway food outlets offer limited seating and sell hot food to be consumed away from their premises. They typically serve energy-dense, nutrient-poor food. National planning guidelines in England offer the potential for local planning policies to promote healthier food environments through regulation of takeaway food outlets. Around half of English local government areas use this approach, but little is known about the process of adoption. We aimed to explore experiences and perceived success of planning policy adoption. In 2018 we recruited Planning and Public Health professionals from 16 local government areas in England and completed 26 telephone interviews. We analysed data with a thematic analysis approach. Participants felt that planning policy adoption was appropriate and can successfully regulate takeaway food outlets with the intention to improve health. They identified several facilitators and barriers towards adoption. Facilitators included internal co-operation between Planning and Public Health departments, and precedent for planning policy adoption set elsewhere. Barriers included “nanny-state” criticism, and difficulty demonstrating planning policy effectiveness. These could be considered in future guidelines to support widespread planning policy adoption.     

Exploring care from extended family through rural women's accounts of perinatal mental illness – a qualitative study with implications for policy and practice

Extended family often have an important role in caring for women experiencing perinatal mental illness; but rural women's perspectives are under-researched. We explored women's experiences of living in rural northern England and receiving care from extended family during periods of perinatal mental illness through 21 qualitative interviews. Key findings were that companionship, practical support - informal childcare and transport, and emotional support were important forms of care - filling gaps in formal service provision. Findings highlight women's needs for support from extended families in rural areas. The rural infrastructure and inequity in formal services can create vulnerability for women.     

Are doctors unhappy? A study of residents with an open interview form

Several recent reports show that many physicians feel discontented and unhappy with their work situation. This could in part be due to a decline in status, loss of influence on health care organization, reduced wages etc. It is important to find ways to better understand their experiences of working life to get more facets of this issue. The Medical Management Centre at the Karolinska Institute in Stockholm offers courses in leadership for physicians in specialty training (residency). Participants in 2 courses were used in a study of their views of their work situation and their employer, using an open interview form. The results with the residents in the present study do not support the statement that physicians are unhappy. On the contrary, findings in the study indicate that they have a predominantly positive view of their work situation and of their employer. It is proposed that the mixed feelings they show to some extent is a natural stage in professional development. A possible way for achieving a better dialogue between physicians and managers is suggested.     

Low literacy Chinese patients: how are they affected and how do they cope with health matters? A qualitative study

Background  

Low literacy is common in Hong Kong and China, especially among the females and the elderly. These are often the patients with the greatest health care needs. However little is known about how low literacy affects the ability of patients to obtain adequate medical care and comply with the recommendations of health professionals.     

Do health workers practice what they preach? A study of knowledge, opinions and practices of health care professionals, with respect to their own health, in Madagascar

In this study, a questionnaire was used to study the individual behavior of a sample of fifty health workers, doctors and nurses from Tamatave (Madagascar) with respect to a number of current health issues. We used the results to assess the impact and efficacy of previous training and to obtain information about the extent to which health staff actually follow the recommendations and standards that they are given and expected to teach, as far as their own health is concerned. It was clear that the standard management procedures and instructions concerning basic health-preserving behavior were far from being universally accepted and followed by health workers themselves. This was the case even for common diseases and health issues for which specific training had been given, such as malaria, diarrhea, AIDS and STDs, tobacco use, HBP management and the use of antibiotics. More attention should be paid to involving health workers in their training programs so that they are really convinced by the recommendations given. So long as most health workers are not themselves committed to the recommendations and have inadequate behavior regarding their own health, they are unlikely to be effective at promoting good health practice.