Perceptions of unmet needs for community social care services in England. A comparison of working carers and the people they care for

Previous UK research has found expressed unmet need for services by unpaid working carers and among disabled and older people. There are, however, suggestions from research that views on unmet needs for services differ between carers and care‐recipients. Working carers in the UK say that the care‐recipient is sometimes reluctant to accept services and the few international comparative dyad studies that have been carried out find that carers perceive higher unmet need than care‐recipients. Recent policy discussions in England have also recognised that there may be differences of opinion. We collected data in 2013 from working carer/care‐recipient dyads in England about perceived need for services for the care‐recipient, disability, unpaid care hour provision and individual and socio‐demographic characteristics. We find that care‐recipients as well as their carers perceive high unmet need for services, although carers perceive higher unmet need. For carers, unmet need is associated with the disability of the carer‐recipient and being the daughter or son of the care‐recipient; for care‐recipients it is associated with unpaid care hours, carers’ employment status and carers’ health. The majority of dyads agree on need for services, and agreement is higher when the working carer provides care for 10 hours or more hours a week. Services for care‐recipients may enable working carers to remain in employment so agreement on needs for services supports the implementation of legislation, policy and practice that has a duty to, or aims to, support carer's employment.     

Community needs and preferences for community pharmacy immunization services

This study explored the Saudi community’s needs and preferences related to community immunization services. Community member’s expectations about the services were assessed, and their concerns, attitudes, and beliefs around the pharmacist’s role in providing immunization were examined.MethodQualitative in-depth, semi-structured interviews were conducted with a convenience sample that comprised Saudi community members who visited Saudi community pharmacies. Interviews were audio-recorded, transcribed verbatim, and then translated. Data obtained were then thematically organized and analyzed using NVivo (QSR International) Software.ResultA total of 20 interviews were conducted for this study. Seven themes emerged from the interviews and were grouped into three major categories relating to the community pharmacy immunization service: (1) community needs for the service; (2) community expectations of the service; and (3) community concerns, and beliefs around the service. Participants expressed their need for such services and acceptance of immunization performed by community pharmacists, with the expectation that it would improve their immunization uptake and community health in general. However, some participants expressed concerns about community pharmacists current level of ability and skill in providing immunization, the lack of a private area for conducting the service, the lack of female community pharmacists, and the cost of the immunization service. Some participants advocated for supervision of such services by the Ministry of Health (MOH) and Saudization of community pharmacy staff.ConclusionThe research results clearly demonstrated the Saudi community’s need for community pharmacy immunization services, described their expectations, and highlighted their concerns relating to community pharmacy infrastructure and an appropriate level of training for community pharmacist-administered immunization.     

Assessing the health care needs of a rural community

This article describes the methods used to complete a recent community health needs assessment study in a rural area. It illustrates the strategic marketing and management value of conducting this type of assessment by examining selected results from the study and discussing their implications for the local health care delivery system.     

Opinions of rural physicians about their practices,community medical needs,and rural medical care.

In a study in the State of Washington during 1971-73, 41 general practitioners in rural areas were asked their opinions about (a) their present practices, (b) the medical care needs of their communities, and (c) rural medical care in general. The most frequently mentioned enjoyable aspects of their practices were the variety and challange of medical problems confronted, the favorable working conditions of the practices, and the types of communities in which the practices were located. The most frequently mentioned sources of frustration to the physicians were the "excess work, responsibility, demands and expectations by patients and community." The physicians were more reluctant to criticize the care received by the residents of their communities than they were to criticize the care that patients received in other rural areas. Suggestions made by the physicians for improving medical care in rural Washington focused on ways to increase the number of resources used to produce medical care, rather than on structural changes in the way medical care is organized, delivered, and financed.     

Power to the people? Involving users and carers in needs assessments and care planning—views from the practitioner

Central to community care policy is the notion of user and carer involvement in the process of assessment and care management. Drawing on interviews with 65 practitioners from four social work departments in Scotland, the paper describes both the mechanisms they sought to employ to give users and carers greater control over the process, and the factors that inhibited the realization of this goal. The workers' accounts reveal a gap between an ‘ideal’ of user and carer empowerment, and the reality of day to day practice.     

Social participation in health services: concepts of users and community leaders in two municipalities of Northeastern Brazil

Social participation in management of the health care system at different levels of government is one of the key policies promoted by the Unified National Health System (SUS) in Brazil. As with any new policy, success hinges on several factors such as stakeholders' interests and opinions, which have not always been considered in the past. This paper analyzes the underlying concepts of two groups of stakeholders with respect to social participation in health and the potential influence of these concepts on the effectiveness of policy implementation. A case study of two municipalities in Northeast Brazil was conducted using a combination of qualitative and quantitative social science research methods. Health services users and community leaders were interviewed. Various concepts were found in which the participatory approach to health policies was only partially reflected. Likely influences on stakeholders' concepts of social participation in health are the evolution of the broader Brazilian social context and the traditional performance of health services. Particular attention should be paid to stakeholders' opinions and concepts if policy effectiveness is to be improved.     

Social participation and community orientation in health services

The community participation in the health systems is a concept that develops from the health policy proposals that have led the World Health Organization and that they highlight the fundamental role of health promotion and of primary care to answer to the health challenges from the middle of the XXth century. Its development has encountered big obstacles that have become major from the increasing trend of introduction of healthcare marketing. This explains partly its scanty advance in the developed countries, though there exist very interesting experiences that are based especially on the effort of professionals and social organizations. The fundamental dilemma is one in the option among the assumption of the role like consumers or clients that it supports a relation subordinated of the patients with a major dependence of the consumption, or on the contrary to give voice and vote for the citizens incorporating them into the productive process and turning them into producers of health. There are analyzed also the existing practices of community participation in Spain and offers are realized for its impulse and development.     

Community participation in a rural community health trust: the case of Lawrence,New Zealand

Since the mid-1980s, the New Zealand health sector has been in a state of continual change. The most radical changes were in the early-1990s, with the creation of an internal market system for public health care delivery. Rural health services, seen to be unviable, were given the option of establishing themselves as 'community trusts', owning and running their own services. Community trusts have since become a feature of rural health care in New Zealand. An expectation was that community trusts would facilitate community participation. This article reports on a study of participation in a rural community health trust. The 'pentagram model' of Rifkin and coworkers, with its five dimensions of participation-needs assessment, leadership, resource mobilization, management and organization-was applied. High levels of participation were found across each of these dimensions. The research revealed additional dimensions that could be added to the framework, including 'sustainability of participation', 'equity in participation' and 'the dynamic socio-political context'. In this regard, it supports recent theoretical work by Laverack (2001) and Laverack and Wallerstein (2001). Finally, the article comments on the future of rural health trusts in the current round of health sector restructuring.     

Whether and where community health center users obtain screening services.

This study measures associations between minority and low socioeconomic status and the use of screening services for secondary prevention among adult community health center users. Among those who obtained timely screening services, the study also measures associations between minority and low socioeconomic status and obtaining these preventive services at a community health center. The data include 1,175 individuals ages 18 and older from a 1995 survey of community health center users. Minority and lower socioeconomic status adult community health center users were not less likely to obtain timely screening services than other adult community health center users. This differs from the trend in the general population. Minority and lower socioeconomic status community health center users who used timely screening services were more likely to obtain them at community health centers, which appear to facilitate the use of timely screening services for minority and low socioeconomic status users.     

Health services needs of children in day care centers.

In order to assess health services needs of children in day care centers, interviews were carried out with health coordinators or directors of 52 licensed day care centers in Berkeley, California. Over one-third of the centers lacked a designated health coordinator; one-fourth of the centers lacked written health guidelines and/or emergency guidelines; almost one-half lacked nutrition education services; and over two-thirds lacked a dental health education program. Only one out of five centers was willing to admit mildly ill children. Health coordinators and directors showed strong preference for care of mildly ill children at home by a trained worker. The presence of a designated health coordinator and of state funds was highly associated with the content and scope of health services provided.