A qualitative study of healthcare professionals’ perceptions of men and women's mental healthcare seeking in Rwanda

This study aimed to explore health care professionals (HCP’) perceptions about mental-health-seeking behaviours in men and women and its social and gender implications in Rwanda. Six focus group discussions including 43 HCPs working at mental health facilities and district hospitals in Rwanda were conducted. Data were analysed using qualitative content analysis. The emerging theme “Traditional gender role patterns and stigma are displayed in mental health care seeking, adherence to treatment and family effects” illustrated how HCPs perceived gender differences and outcomes in mental healthcare seeking. The theme was based on three categories: “Gender differences in health care seeking patterns,” “Gender roles and stigma affect adherence to counselling and treatment,” and “Gender roles exert an influence on family support” and related subcategories, with which each described various aspects contributing to the result. According to HCPs who regularly encountered people with mental health problems, neither men nor women with mental health problems could adequately benefit from the available mental health services because of the strong influence stigma and prevailing traditional gender roles had on men's and women's mental-healthcare-seeking behaviour. There is an urgent need for comprehensive societal interventions involving policy makers, HCPs, and the general population to diminish the stigma tied to mental illness and the traditional gender norms that negatively influence healthcare-seeking patterns; such actions can improve the health of many citizens.     

Strengthening patient and family engagement in healthcare — The New Haven Recommendations

Objective

Present and discuss the development and basic structure of a multilevel approach to strengthen patient and family engaged care, “The New Haven Recommendations on partnering with patients, families and citizens to enhance performance and quality in health promoting hospitals and health services”.

How patients’ use of social media impacts their interactions with healthcare professionals

Introduction

Patients are increasingly accessing online health information and have become more participatory in their engagement with the advent of social media (SM). This study explored how patients’ use of SM impacted their interactions with healthcare professionals (HCPs).

Clinical communication and the ‘triangle of care’ in mental health and deafness: Sign language interpreters’ perspectives

Objective To explore the processes by which therapeutic alliance develops in mental health consultations with Sign Language interpreters.Method Semi-structured interviews with 7 qualified interpreters were transcribed and analysed with interpretative phenomenological analysis.Results Two key themes were generated: (1) Nurturing the triangle of care, where the therapeutic process relied on collaboration, continuity, and trust; and (2) Shared vision and knowledge, in which participants felt misunderstood and unsupported; there was a lack of deaf awareness and clinicians appeared to feel deskilled.Conclusions Interpreters should be viewed as valued members of clinical teams and have access to clinical supervision so that they can be supported in interpreting emotional distressing content. Clinicians can aim to be collaborative with interpreters and improve their knowledge of mental health issues that are relevant to deaf people.Practice Implications An aide-memoire of the role and practicalities of working with SL interpreters should be developed and disseminated to relevant services to support collaborative working with clinicians. A core competence in SL interpreter training is reflexivity. This should be embedded in educational curricula and facilitated through clinical supervision. Funding by commissioning services should be subject to services being deaf aware and interpreters being mental health aware.     

The influence of medical students’ and doctors’ attachment style and emotional intelligence on their patient–provider communication

Objective

Attachment style and emotional intelligence (EI) have been highlighted as potential factors influencing the variation in medical students’ and doctors’ patient–provider communication (PPC), particularly in relation to emotive issues. The objective of this review is to systematically review and synthesise the published literature relating to the influence of medical students’ and/or doctors’ attachment style and EI on their PPC.

Methods

Electronic and hand searches were conducted to identify all published literature relating to the aim of the review. Data were narratively synthesised.

Results

1597 studies were identified. 14 were included in the review, of which 5 assessed the influence of attachment style and 9 assessed the influence of EI on PPC. No studies assessed the impact of both attachment style and EI on PPC.

Conclusion

Whilst tentative links were found between both PPC and both attachment style and EI, heterogeneity in study design, predictor variables and outcome measures made drawing conclusions difficult.

Practice implications

More research is needed to assess the influence of both attachment style and EI on PPC.     

A systematic review of the impacts of intergenerational engagement on older adults’ cognitive,social, and health outcomes

BackgroundIntergenerational engagement could benefit health and wellbeing within an ageing population. This systematic review evaluated the impacts of intergenerational engagement on cognitive, social, and health outcomes in healthy older adults and older adults with mild cognitive impairment.Research design and methodsComprehensive literature searches were undertaken, with records filtered according to pre-registered criteria. Study quality was formally assessed, and a narrative synthesis of the findings produced.ResultsForty-four studies were reviewed. Regarding quantitative evidence, 4 out of 8 studies found significant intergenerational engagement effects on cognitive outcomes, 15 of 24 on social outcomes, and 21 of 31 on health-related outcomes. Qualitative evidence was also important for understanding perceived impacts and experiences of intergenerational programmes. Only 11 studies fully met criteria for high quality research, of which the majority focused on social outcomes.Discussion and implicationsThere are a range of potential benefits of intergenerational engagement, most notably regarding anxiety, generativity, cross-age attitudes, and physical activity. However, heterogeneity in programme context, sample design, dosage, and duration indicate that more research is required to enable wider implementation and generalisability. Scientific rigour in both quantitative and qualitative research should also be employed as far as possible, to provide the highest quality evidence.     

Faculty’s work engagement in patient care: impact on job crafting of the teacher tasks

Background

High levels of work engagement protect against burnout. This can be supported through the work environment and by faculty themselves when they try to improve their work environment. As a result, they can become more engaged and better performers. We studied the relationship between adaptations by physicians to improve their teaching work environment, known as job crafting, and their energy levels, or work engagement, in their work as care provider and teacher. Job crafting encompasses seeking social (i) and structural (ii) resources and challenges (iii) and avoiding hindrances (iv).

Methods

We established a cross-sectional questionnaire survey in a cohort of physicians participating in classroom and clinical teaching. Job crafting and work engagement were measured separately for physicians’ clinical and teaching activities. We analyzed our data using structural equation modelling controlling for age, gender, perceived levels of autonomy and participation in decision making.

Results

383 physicians were included. Physicians’ work engagement for patient care was negatively associated with two job crafting behaviors in the teaching roles: seeking structural resources (classroom teaching: ß?=???0.220 [95% CI: -0.319 to ??0.129]; clinical teaching: ß?=???0.148 [95% CI: -0.255 to ??0.042]); seeking challenges (classroom teaching: ß?=???0.215 [95% CI: -0.317 to ??0.113]; clinical teaching:, ß?=???0.190 [95% CI: -0.319 to ??0.061]). Seeking social resources and avoiding hindrances were unaffected by physicians’ work engagement for patient care.

Conclusions

High engagement for teaching leads to job crafting in teaching. High engagement for patient care does not lead to job crafting in teaching.

     

Associations between patient–provider communication and socio-cultural factors in prostate cancer patients: A cross-sectional evaluation of racial differences

Objective

To examine the association between socio-cultural factors and patient–provider communication and related racial differences.

Methods

Data analysis included 1854 men with prostate cancer from a population-based study. Participants completed an assessment of communication variables, physician trust, perceived racism, religious beliefs, traditional health beliefs, and health literacy. A multi-group structural equation modeling approach was used to address the research aims.

Results

Compared with African Americans, Caucasian Americans had significantly greater mean scores of interpersonal treatment (p < 0.01), prostate cancer communication (p < 0.001), and physician trust (p < 0.001), but lower mean scores of religious beliefs, traditional health beliefs, and perceived racism (all p values <0.001). For both African and Caucasian Americans, better patient–provider communication was associated with more physician trust, less perceived racism, greater religious beliefs (all p-values <0.01), and at least high school education (p < 0.05).

Conclusion

Socio-cultural factors are associated with patient–provider communication among men with cancer. No evidence supported associations differed by race.

Practice implication

To facilitate patient–provider communication during prostate cancer care, providers need to be aware of patient education levels, engage in behaviors that enhance trust, treat patients equally, respect religious beliefs, and reduce the difficulty level of the information.     

Patients’ perspectives on shared decision making in secondary mental healthcare in Taiwan: A qualitative study

ObjectiveThe aim of this study is to explore patient perspectives on shared decision making in secondary mental healthcare in Taiwan.MethodsQualitative semi-structured interviews were used to explore patient perspectives on shared decision making in secondary mental healthcare in Taiwan. Individual semi-structured interviews were conducted from July to August 2017 with a purposive sample of twenty patients using halfway houses. Data were analysed using thematic analysis.ResultsAnalysis of the interviews identified two themes: barriers to shared decision making; facilitators of shared decision making. Patients perceived that they were not involved in decision making due to: the professional status of health professionals; negative perception of making decisions; and limited time resources. However, patients reported a desire to be involved and felt sufficient information exchange would be a necessary step towards collaboration/sharing decisions about treatment with clinicians.ConclusionThe findings provided an understanding of significant barriers to and facilitators of implementing shared decision making to aid further professional training and the development of national policies.Practice implicationsThe findings could be the basis for developing effective strategies to overcome barriers to shared decision making and improve the process quality of delivering shared decision making.     

The role of weight bias and role-modeling in medical students’ patient-centered communication with higher weight standardized patients

ObjectivePatients with obesity may experience less patient-centered care. We assessed whether medical students’ implicit/explicit weight-related attitudes and perceptions of normative attitudes are associated with patient-centered care for patients with obesity.MethodsThird and fourth year medical students (N = 111) at one medical school completed a survey and participated in a patient care scenario with a standardized patient with obesity. Encounters were coded for patient-centered behavior. Predictors of patient-centered behaviors were assessed.ResultsStudent perceptions that negative attitudes about patients with obesity are normative in medical school were significantly associated with poorer patient-centered behaviors, including lower attentiveness (b=?0.19, p = 0.01), friendliness (b=?0.28, p < 0.001), responsiveness (b=?0.21, p = 0.002), respectfulness (b=?0.17, p = 0.003), interactivity (b=?0.22, p = 0.003), likelihood of being recommended by observers (b=?0.34, p < 0.001), and patient-centeredness index scores (b=?0.16, p = 0.002). Student reported faculty role-modeling of discrimination against patients with obesity predicted lower friendliness (b=?0.16, p = 0.03), recommendation likelihood (b=?0.22, p = 0.04), and patient-centeredness index score (b=?0.12, p = 0.03).ConclusionsNegative normative attitudes and behaviors regarding obesity in the medical school environment may adversely influence the quality of patient-centered behaviors provided to patients with obesity.Practice implicationsEfforts to improve patient-centered communication quality among medical trainees may benefit from intervention to improve group normative attitudes about patients with obesity.     

‘Alternate-goal bias’ in antisaccades and the influence of expectation

Saccadic performance depends on the requirements of the current trial, but also may be influenced by other trials in the same experiment. This effect of trial context has been investigated most for saccadic error rate and reaction time but seldom for the positional accuracy of saccadic landing points. We investigated whether the direction of saccades towards one goal is affected by the location of a second goal used in other trials in the same experimental block. In our first experiment, landing points (‘endpoints’) of antisaccades but not prosaccades were shifted towards the location of the alternate goal. This spatial bias decreased with increasing angular separation between the current and alternative goals. In a second experiment, we explored whether expectancy about the goal location was responsible for the biasing of the saccadic endpoint. For this, we used a condition where the saccadic goal randomly changed from one trial to the next between locations on, above or below the horizontal meridian. We modulated the prior probability of the alternate-goal location by showing cues prior to stimulus onset. The results showed that expectation about the possible positions of the saccadic goal is sufficient to bias saccadic endpoints and can account for at least part of this phenomenon of ‘alternate-goal bias’.     

Dynamic modeling of patient and physician eye gaze to understand the effects of electronic health records on doctor–patient communication and attention

ObjectiveThe aim of this study was to examine eye gaze patterns between patients and physicians while electronic health records were used to support patient care.BackgroundEye gaze provides an indication of physician attention to patient, patient/physician interaction, and physician behaviors such as searching for information and documenting information.MethodsA field study was conducted where 100 patient visits were observed and video recorded in a primary care clinic. Videos were then coded for gaze behaviors where patients’ and physicians’ gaze at each other and artifacts such as electronic health records were coded using a pre-established objective coding scheme. Gaze data were then analyzed using lag sequential methods.ResultsResults showed that there are several eye gaze patterns significantly dependent to each other. All doctor-initiated gaze patterns were followed by patient gaze patterns. Some patient-initiated gaze patterns were also followed by doctor gaze patterns significantly unlike the findings in previous studies. Health information technology appears to contribute to some of the new significant patterns that have emerged. Differences were also found in gaze patterns related to technology that differ from patterns identified in studies with paper charts. Several sequences related to patient–doctor–technology were also significant. Electronic health records affect the patient–physician eye contact dynamic differently than paper charts.ConclusionThis study identified several patterns of patient–physician interaction with electronic health record systems. Consistent with previous studies, physician initiated gaze is an important driver of the interactions between patient and physician and patient and technology.     

Assessment of inflammatory bowel disease educational videos for increasing patient engagement and family and friends’ levels of understanding

ObjectiveWe developed five educational videos through a user-centered approach for patients with inflammatory bowel diseases (IBD) and their families and friends. Here, we assessed if IBD patient activation and family and friends’ abilities to understand IBD patients’ thoughts, feelings, and behaviors (i.e., perspective taking) changed after watching the videos.MethodsThrough a pre-post survey, we assessed patient activation and perspective taking levels in people with a self-reported IBD diagnosis and their family and friends, respectively, before and after watching one of the videos.ResultsAmong 767 participants with IBD, patient activation scores increased significantly after watching each video. In regression analyses, patient activation levels were less likely to increase in biologic-naïve participants after viewing the coping video. Among 232 people who knew someone with IBD, perspective taking scores increased significantly in 8/9 domains, which was more likely to occur among women.ConclusionsEducational videos developed through a user-centered approach were associated with higher self-reported IBD patient activation scores and perspective taking levels among family and friends.Practice implicationsThese videos, which are now widely disseminated on social media, serve as a model for how to create educational materials for improving patient activation and empathy in the social media era.     

Role of Combat Exposure and Insomnia in Student Veterans’ Adaptation to College

Objective/Background: Since 2002, the number of college student veterans has nearly doubled, although 30–40% of veterans fail to complete their degree. Few research efforts to understand the challenges veterans face transitioning to college in recent years have looked beyond the effects of posttraumatic stress disorder. Insomnia is the most frequently reported symptom of combat veterans and can have serious implications for college students. The purpose of this study was to examine the role of insomnia in student veteran adaptation to college relative to civilian students. Participants: College students (N = 588), including 154 veterans, participated in a large online study examining the psychological, relational, and academic functioning of college students. Approximately 61% of the veteran subsample reported combat exposure. Methods: Students were administered a Background Information Questionnaire, the Insomnia Severity Index, the Deployment Risk and Resilience Inventory, and the Student Adaptation to College Questionnaire. Data was analyzed using multivariate analysis of covariance and regression to test for direct and indirect effects. Results and Conclusions: Student veterans reported better academic and personal-emotional adaptation than civilian students, while civilians reported better social adjustment than veterans. However, follow-up analyses revealed that these effects might be explained by group differences in gender, income, and marital status. Although combat veterans without insomnia had better academic adjustment than noncombat veterans and civilian students, insomnia seemed to have a greater negative effect on combat veterans’ academic adjustment relative to civilian students. Furthermore, insomnia mediated the relationship between combat exposure and veterans’ personal-emotional adjustment to college.     

Impact of patient information behaviours in online health communities on patient compliance and the mediating role of patients’ perceived empathy

ObjectivePatient health information seeking and physician-patient communication in OHCs proved to have impacts on patient compliance, but related studies from psychological perspectives are limited. This study aims to investigate the impact of patient health information seeking and physician-patient communication in OHCs on patient compliance.MethodsThis study established a research model and proposed six hypotheses. An anonymous investigation was conducted using Chinese OHCs. Confirmatory factor analysis, partial least squares, and structural equation modelling were used to test the hypotheses.ResultsWe received 371 responses, and 316 of them were valid. Patient health information seeking and physician-patient communication frequency in OHCs had positive impacts on patients’ perceived affective and cognitive empathies, which positively impacted patient compliance.ConclusionsPatient compliance can be improved by patient health information seeking and physician-patient communication in OHCs and affective and cognitive empathies. Patients’ perceived affective empathy is the preferred perspective to improve patient compliance.Practice implicationsPhysicians should encourage patients to seek health information and communicate with them through OHCs, be concerned about patients’ experiences, feelings, and attitudes, understand patients’ demands and mental states, and show their patients that they can feel patients’ pain. Increasing physician-patient communication frequency in OHCs can help improve patient compliance.     

Quantifying positive communication: Doctor’s language and patient anxiety in primary care consultations

Objective

Positive communication is advocated for physicians during consultations with patients presenting medically unexplained symptoms (MUS), but studies generally focus on what is said rather than how it is said. This study quantified language use differences of general practitioners (GPs), and assessed their relation to patient anxiety.

Why don't patients take their drugs? The role of communication, context and culture in patient adherence and the work of the pharmacist in HIV/AIDS

Objective

This study examined facilitators and barriers to adherence in four South African antiretroviral therapy (ART) clinic sites and explored context and communication factors in relation to the role of the pharmacist.

Methods

Data were collected from interviews and narratives of patients and health professionals around the issues of adherence and qualitatively analysed using principles of Thematic Content Analysis.

Results

Findings confirm the complex interplay between illness, communication, sociocultural, economic, context and systemic issues. Analysis suggests adherence is multifaceted and reinforces the critical role of communication factors in achieving concordance between patient and pharmacist.

Conclusion

Successful treatment of HIV/AIDS depends on pharmacists and healthcare teams understanding contextual and interactional factors which play a role in adherence.

Practice implications

The findings reinforce the importance of embedding a patient-centred approach in the training and everyday practice of pharmacists. The value of qualitative methods in understanding barriers to adherence and the potential value of the cultural broker in intercultural settings is discussed. Some suggestions are made as to how adherence counselling can be made relevant and effective.