Reproductive Health Service Preferences And Perceptions of Quality Among Low‐Income Women: Racial,Ethnic and Language Group Differences

CONTEXT: Eliminating racial and ethnic disparities in health care is an important national priority. Despite substantial research documenting such disparities, this topic has received limited attention in the reproductive health field. METHODS: Logistic regression was used to test for group differences in three service delivery preferences and five service quality perceptions among a nationally representative sample of 1,741 low‐income black, Latina and white women aged 18–34; the data were collected in 1995 and represent the most recent data available for looking at these issues. RESULTS: English‐speaking Latinas and Spanish‐speaking Latinas were more likely than whites to prefer a female clinician at their visits (odds ratios, 1.8 and 3.6, respectively) and to highly value clinician continuity (1.7 and 2.2). English‐speaking Latinas and blacks were more likely than whites to prefer receiving reproductive health care at a site delivering general health care (1.5 and 1.6). Both groups of Latinas were less likely than whites to give the facility environment or the patient‐centeredness at their most recent reproductive health visit the highest rating (0.3–0.5). Blacks were more likely than whites to report ever having been pressured by a clinician to use contraceptives (2.3). CONCLUSIONS: Efforts to reduce racial, ethnic and language group differences in clients’ perceptions of reproductive health service quality should focus on improving client‐clinician communication, the service environment and contraceptive counseling. Future research should continue to assess group differences and try to determine their underlying causes.     

Striving to Make a Difference: Health Care Worker Experiences With Intimate Partner Violence Clients in Tanzania

In this article we describe health care workers (HCWs’) experiences and perceptions of meeting clients exposed to intimate partner violence (IPV). Qualitative content analysis of in-depth interviews from 16 informants resulted in four main themes. The first, “internalizing women's suffering and powerlessness,” describes HCWs’ perceptions of violence, relating it to gender relations. The second, “caught between encouraging disclosure and lack of support tools,” refers to views on possibilities for transparency and openness. The third, “Why bother? A struggle to manage with limited resources,” illustrates the consequences of a heavy workload. Last; “striving to make a difference,” emphasizes a desire to improve abilities to support clients and advocate for prevention.     

Clients’ Perceptions of Service Quality and Satisfaction at Their Initial Title X Family Planning Visit

Family planning service quality and clients’ satisfaction with services are important determinants of clients’ contraceptive use and continuation. We examine women’s experiences at family planning clinics on a range of dimensions, including patient-centered communication (PCC), and identify experiences associated with higher ratings of service quality and satisfaction. New female clients (n = 748), ages 18–35 years, from clinics in three major metropolitan areas completed computer-administered interviews between 2008 and 2009. Factors associated with primary outcomes of service quality and satisfaction were assessed using multinomial and ordinary logistic regression, respectively. Higher scores on a Clinician–Client Centeredness Scale, measuring whether clinicians were respectful, listened, and provided thoughtful explanations, were associated with perceptions of good quality care and being very satisfied. Higher scores on a Clinic Discomfort Scale, measuring staff and waiting-room experiences, were associated with reduced satisfaction. Clients’ interactions with clinicians, especially PCC, influence their perceptions of service quality, whereas their satisfaction with services is also influenced by the facility environment. These measures are adaptable for agencies to identify the factors contributing to their own clients’ satisfaction–dissatisfaction with care and perceptions of service quality.     

American Sign Language Interpreters Perceptions of Barriers to Healthcare Communication in Deaf and Hard of Hearing Patients

Communication barriers between healthcare providers and patients contribute to health disparities and the effectiveness of health promotion messages. This is especially true regarding communication between providers and deaf and hard of hearing (HOH) patients due to lack of understanding of cultural and linguistic differences, ineffectiveness of various means of communication and level of health literacy within that population. This research aimed to identify American Sign Language (ASL) interpreters’ perceptions of barriers to effective communication between deaf and HOH patients and healthcare providers. We conducted a survey of ASL interpreters attending the 2015 National Symposium on Healthcare Interpreting with an overall response rate of 25%. Results indicated a significant difference (p?<?0.05) in all areas of preferred communication between providers and deaf/HOH patients as perceived by interpreters. ASL interpreters observed that patients did not understand provider instructions in nearly half of appointments. Eighty-one percent of interpreters said that providers “hardly ever” use “teach-back” methods with patients to ensure understanding. A focus on improving health care and health promotion efforts in the deaf/HOH community depends on improving communication, health literacy, and patient empowerment and involves holding health care organizations accountable for assuring adequate staffing of ASL interpreters and communication resources in order to reduce health disparities in this population.     

Heterogeneity in The drivers of health expenditures financed by health insurance in a fragmented health system: The case of Switzerland

Switzerland is the world’s second largest spender on health care, both per capita and as a share of the Gross Domestic Product (GDP). The Swiss health care system is a federation of 26 cantonal systems with highly fragmented provision and financing of care, leading to important geographical disparities in expenditures. We propose a simple conceptual framework to guide the decomposition of health care expenditures into five core components (i.e. demography, propensity to use health services, substitution between domains of care, quantity of services delivered, and unit price of these services), with the objective of better understanding the drivers of geographic variation. We illustrate this framework using aggregated insurance data from 85 % of the 2006 insured population and measure cross-cantonal variation disaggregated into these five components. Results obtained indicated a West-East gradient of controllable costs after adjusting for demography and propensity to use health services. Moreover, we found specific explanations for cost overruns: visits to physicians in private practice in some cantons, and, e.g., outpatient hospital care or variations in drug related expenses in others. This shows that the simple proposed approach provides interesting insights into the drivers of cost differences between regions, specifically in terms of substitution among health services, quantity of delivered services, and their prices.     

Current Approaches to Shortage Area Designation*

This paper reviews the various indicators and criteria that are in use to identify rural and urban areas with shortages of primary care physicians, dentists, psychiatrists, or nurses; areas with medically under served populations; high migrant impact areas; and areas of greatest need/shortage, leading to lists of designated shortage or underserved areas eligible for various federal and state programs; and to lists of areas with priority for resource placement. Presenting these shortage and under service criteria at a workshop dealing with adequacy was not meant to suggest an equivalency between the concepts of “shortage,”“underservice,” and “adequacy,” but the shortage and underservice criteria can be thought of as a floor on the definition of adequacy, and may contain elements of that definition. Refinements or revisions to the various criteria could probably better identify the needs in rural areas, or the kind of staffing mix needed in various types of areas, or improve priority setting among designated areas; but the existing criteria remain a good first screen to identify those areas with health services-related needs that require further attention.     

Exploring issues relating to disability cultural competence among practicing physicians

BackgroundMany factors contribute to the well-recognized health care disparities experienced by persons with disability, including failure of physicians to understand the lives of individuals with disability. Disability cultural competence considers physicians’ ability to meet the social, cultural, and linguistic needs of this population.ObjectivesTo assess physicians’ understanding of disability cultural competence and attitudes towards patients with disability.MethodsQualitative analyses of open-ended individual interviews averaging 41 min with 20 Massachusetts physicians from 5 different subspecialties, in practice for 8–51 years. Interview recordings were transcribed verbatim for conventional content analysis.ResultsMost participants defined disability using medically-focused concepts rather than concepts that recognize how social factors contribute to disability. All participants used disability culturally-competent language, such as “person-first language,” at some points throughout their interviews. However, most participants also employed language that is now considered unacceptable or archaic, such as variations on the word “handicap,” “wheelchair-bound,” describing persons with disability as “suffering,” and calling persons by their health condition (e.g., “COPDer”). Participants mentioned persons with mental illness and intellectual disability as particularly challenging, especially around communication and performing even routine tests or examinations. Recommendations for improving care included better listening to patients with disability and seeking their views about their care.ConclusionsIn this exploratory study, most participants used language that is considered disability culturally competent at times but also employed many terms and concepts that are considered outdated and may be troubling to some persons with disability.     

Obstetrics and Gynecology Practices and Patient Insurance Type

BackgroundDespite research on health disparities based on insurance status, little is known about the differences in practice patterns among physicians who cater to privately and non-privately insured patients. The aim of this study was to assess how obstetrician–gynecologists (ob-gyns) who primarily see patients with private insurance differ from those who see mainly uninsured or publicly insured patients. This could be informative of the needs of these two groups of physicians and patients.MethodsA questionnaire was mailed or emailed to 1,000 members of the American College of Obstetricians and Gynecologists, 600 of whom participate in the Collaborative Ambulatory Research Network.FindingsA 56.4% response rate was obtained. Of the valid responders, the 335 reported providing care to a majority of patients with private insurance (“private group”) and the 105 reported providing care to mostly publicly insured or uninsured patients (“non-private group”) were included in our analyses. Differences between groups included that the private group was more likely to see patients before their becoming pregnant and spent more time on well-woman care. The private group was more likely to see patients who are White, Asian, or between the ages of 45 and 64. The non-private group was more likely to see Hispanic patients and those under age 18.ConclusionResults reveal that ob-gyns who see mostly privately insured patients have different clinical experiences than those who see mainly uninsured or publicly insured patients in terms of patient characteristics, preconception care, distribution of time on activities, and the of likelihood performing certain procedures and screening tests.     

Challenges in the Provision of Sexual and Reproductive Health Care to Refugee and Migrant Women: A Q Methodological Study of Health Professional Perspectives

This Q methodological study was conducted to examine the perspectives of health professionals in providing sexual and reproductive health (SRH) care to refugee and migrant women. Forty-seven health professionals rank-ordered 42 statements and commented on their rankings in subsequent open-ended questions. A bi-person factor analysis was performed and factors were extracted according to the centroid method with a varimax rotation. Seven factors each with a distinct and meaningful viewpoint were identified. These factors are: “Communication difficulties—hurdles to counselling”, “Lack of access to culturally appropriate care”, “Navigating SRH care”, “Cultural constraints on effective communication”, “Effects of the lack of cultural competency”, “Impacts of low income and language barrier” and “SRH services are accessible, but not culturally relevant”. A more culturally adaptive healthcare model that considers refugee and migrant women’s linguistic, cultural and socio-economic backgrounds; and engages health professionals on an ongoing process of building cultural competency is central to improve SRH access to these women.     

Mental Healthcare Provider Perceptions of Race and Racial Disparity in the Care of Black and White Clients

Black-white disparities in mental healthcare persist, despite efforts to eliminate them via culturally competent care. To gain insight into how providers implement culturally competent care practices, interviews were conducted with mental healthcare providers’ about their self-reported behaviors with black and white clients and their perceptions of how race affects the treatment they provide. Thematic analysis was used to analyze 12 semi-structured interviews with providers from a Veterans Affairs healthcare system. Three sets of themes emerged: providers’ general beliefs and behaviors (discomfort discussing race; belief that socioeconomic differences explained disparities; and use of coded language for race groups), providers’ clinical beliefs and behaviors (race-matching enhances care and recognition of intersecting cultural identities), and providers’ professional beliefs and behaviors (participation in passive racism facilitated by provider-provider alliance). Mental healthcare providers showed good awareness of intersectionality and subtle racism but held limiting beliefs that led to avoidance of discussions of race.

     

The expression of ‘policy’ in palliative care: A critical review

The importance of ‘policy’ within palliative care has steadily increased over the past 25 years. Whilst this has been welcomed within the palliative care field and seen as a route to greater recognition, we focus here on a more critical perspective that challenge the effectiveness of a ‘policy turn’ in palliative care. Applying Bacchi's “What's the Problem Represented to Be?” (WPR) framework to data from a systematic search, we address the research question, “in what ways has ‘policy’ been articulated in palliative care literature?”. The paper describes the construction of ‘the problem’ context and reflects critically on the robustness and pragmatic utility of such representations. In particular, we identify five elements as prominent and problematic: (1) a lack of empirical evidence that connects policy to practice; (2) the dominance of ‘Global North’ approaches; (3) the use of a policy narrative based on ‘catastrophe’ in justifying the need for palliative care; (4) the use of idealistic and aspirational ‘calls to action’; and (5) a disengaged and antagonistic orientation to existing health systems. We conclude by suggesting that the efficacy of palliative care policy could be enhanced via greater emphases on ‘Global South’ perspectives, ‘assets-based’ approaches and attention to pragmatic implementation.     

Health Workers’ Perceptions of Italian Female Adolescents: A Qualitative Study About Sexuality,Contraception, and Caring Practices in Family Health Centers

Our aim was to explore health workers’ perceptions of providing sexuality and contraception care for female adolescents within family health centers. We interviewed 26 volunteer health workers and analyzed the interviews using thematic analysis. We identified three main themes: (a) “adolescents and sexuality,” with the subthemes “initiation rite,” “me like the others,” and “just for fun”; (b) “adolescents and contraception,” with the subthemes “omnipotent adolescents,” “aware adolescents,” and “women's responsibility”; and (c) “health workers and adolescents,” with the subthemes “to put in order,” “to catch,” and “to teach to take care of themselves.” Our results provided an interesting picture of health workers’ perceptions of their work with Italian female adolescents regarding sexuality and contraception.     

Determinants of healthcare utilisation by migrant workers in the State of Qatar

BackgroundLabour migration enables populations to adjust to changing economic and social conditions, yet often precipitates increased health risks. Few previous studies examined healthcare utilisation by migrant workers. This study aimed to examine the healthcare utilisation by migrant workers in Qatar.MethodsIn 2011, Qatar launched National Health Strategy 2011–2016, phasing in Universal Health Care accessible to both Qataris and non-Qataris. Qatar’s high proportion of foreign migrant workers to Qatari citizens is unique, estimated at 5:1. Multivariate analysis on Household Utilization and Expenditure Survey (HUES) 2014 data yielded determinant factors for healthcare utilisation by migrant workers in Qatar.ResultsIn nationally-representative sampling, the proportion of migrant labourers accessing outpatient care was only half of expatriates and Qataris, with inpatient care utilisation even less. Results suggest all forms of health insurance coverage had protective effects for expatriate and labourer healthcare utilisation. Specifically, such protective impact on all migrant groups’ inpatient care use was much greater than outpatient.ConclusionsThis study highlights differences in the pattern of care-seeking and total health expenditure across migrant worker groups in Qatar. Improving health insurance coverage to migrant worker groups can promote higher utilisation of care, and thereby reduce health disparities of migrant workers to better protect their health and productivity.     

TOPSIS法结合RSR法综合评价2017年全国31省市儿童保健工作质量

目的 综合评价2017年我国各省市儿童保健工作质量,为相关政策与措施制定提供参考。方法 以《中国卫生健康统计年鉴》2018卷中的6个儿童保健指标（出生体重＜2 500克婴儿比重、围产儿死亡率、5岁以下儿童中重度营养不良比重、新生儿访视率、3岁以下儿童系统管理率和7岁以下儿童保健管理率）为评价指标,利用Excel和SPSS 19.0软件,采取TOPSIS和RSR相结合的方法对各省市儿童保健质量进行综合评价并分档。结果 上海和北京两省市儿童保健质量评为“优”（Ci＞0.472）,吉林、安徽、山东、浙江、江苏、陕西、天津、江西、重庆和四川10个省市结果评为“良”（0.283≤Ci＜0.472）,其余省市结果评为“中”（0.094≤Ci＜0.283）。且方差分析显示各档差异具有统计学意义（F = 94.462,P＜0.001）。结论 儿童保健工作质量存在地区差异,要从政府责任、经费投入、服务体系建设、服务管理质量等方面来提高中西部等偏远地区、贫困地区的儿童保健工作质量,进而提高儿童身心健康水平。     

‘I’m not sure if they speak to everyone about this option’: analyzing disparate access to and use of genetic health services in the US from the perspective of genetic counselors

Much research has documented disparities in access to and uses of health care services in the US. With the rise of genomic medicine and its use of complex technology, some scholars are concerned that such inequalities of health care will not only continue but also grow. Drawing on 27 semi-structured interviews with front-line genetic workers – master’s-level genetic counselors – this qualitative study explores the factors they view as contributing to variable uptake of genetic health services among US population groups. Patient-centered factors such as attitudes, norms, and education were perceived by some genetic counselors as explanations for disparities in uptake of genetic services. However, genetic counselors more frequently discussed structural and institutional factors (e.g. cost, insurance, type and location of hospital/clinic, and/or staffing issues) when accounting for different rates of usage of genetic services among populations. The prominence of structural impediments to access found in genetic counselors’ narratives about population differences in the uptake of genetic services suggests that genetic medicine could exacerbate rather than ameliorate health disparities in the US.     

To accept,or not to accept,that is the question: citizen reactions to rationing

Background The publicly financed health service in Sweden has come under increasing pressure, forcing policy makers to consider restrictions. Objective To describe different perceptions of rationing, in particular, what citizens themselves believe influences their acceptance of having to stand aside for others in a public health service. Design Qualitative interviews, analysed by phenomenography, describing perceptions by different categories. Setting and participants Purposeful sample of 14 Swedish citizens, based on demographic criteria and attitudes towards allocation in health care. Results Participants expressed high awareness of limitations in public resources and the necessity of rationing. Acceptance of rationing could increase or decrease, depending on one’s (i) awareness that healthcare resources are limited, (ii) endorsement of universal health care, (iii) knowledge and acceptance of the principles guiding rationing and (iv) knowledge about alternatives to public health services. Conclusions This study suggests that decision makers should be more explicit in describing the dilemma of resource limitations in a publicly funded healthcare system. Openness enables citizens to gain the insight to make informed decisions, i.e. to use public services or to ‘opt out’ of the public sector solution if they consider rationing decisions unacceptable.     

Sláintecare – A ten-year plan to achieve universal healthcare in Ireland

In May 2017, an Irish cross-party parliamentary committee published the ‘Houses of the Oireachtas Committee on the Future of Healthcare “Sláintecare” report’. The report, known as ‘Sláintecare’, is unique and historic as it is the first time there has been a cross-party political consensus on major health reform in Ireland.Sláintecare sets out a high level policy roadmap to deliver whole system reform and universal healthcare, phased over a ten year period and costed.Sláintecare details reform proposals which, if delivered, will establish; a universal, single-tier health service where patients are treated solely on the basis of health need; the reorientation of the health system ‘towards integrated primary and community care, consistent with the highest quality of patient safety in as short a time-frame as possible’.Sláintecare has five interrelated components: population health; entitlements and access to healthcare; integrated care; funding; and implementation.In this article, the authors use documents in the public domain (parliamentary reports, public hearings, submissions to the Committee, media coverage, the final report of the Committee, speeches by Committee members) to describe the policy process and the main contents of the proposed Sláintecare reforms.It is too soon tell if the political consensus in the policy formation can hold for its implementation.     

Evaluation of the processes of family‐centred care for young children with intellectual disability in Western Australia

Introduction Government early intervention services for children with intellectual disability (ID) in Western Australia have adopted the model of family‐centred care. The aim of this study was to evaluate how well it was being practised, to describe the pattern of service utilization and to identify factors influencing parental perceptions of family‐centred care. Methods The study included children aged 0–6 years with ID, who were registered clients of Disability Services Commission, Western Australia. Parents completed a postal survey questionnaire about the frequency and type of services received and their perceptions of services using the Measure of Processes of Care (MPOC‐56) questionnaire. Mean scores for the five MPOC domains were compared using anova against the independent variables of child age group, child diagnostic group, service type and frequency, place of residence, family and demographic variables. Significant variables in each domain were then entered into multivariate analyses. Results Of 292 eligible families, 165 (59%) returned a completed questionnaire. While over 50% of children had contact with occupational, speech and physical therapists at least once per month, less than 20% of children had at least annual contact with either psychology or dental services. Families rated their satisfaction highest for ‘respectful and supportive care’ and lowest for ‘providing general information’. Individual item analyses indicated less satisfaction with ‘co‐ordinated and comprehensive care’. Higher means were associated with more frequent contact with occupational therapy. Conclusion Overall respondents reported early intervention services for young children with ID in Western Australia provided satisfactory family‐centred care by means of the 56‐item MPOC. The frequency of contact with allied health professionals was positively associated with parental ratings of family‐centred care. The study indicates under‐servicing in dental care and psychology services.     

Female Migrant Sex Workers in Moscow: Gender and Power Factors and HIV Risk

This study aimed to build formative knowledge regarding HIV risks in female migrant sex workers in Moscow, focusing on gender and power. This was a collaborative ethnographic study, informed by the theory of gender and power, in which researchers conducted minimally structured interviews with 24 female sex workers who were migrants to Moscow and who provided sexual services to male migrant laborers. Overall, the female migrant sex workers engaged in HIV risk behaviors and practiced inadequate HIV protection with their clients. These behaviors were shaped by gender and power factors in the realms of labor, behavior, and cathexis. In the labor realm, because some female migrants were unable to earn enough money to support their families, they were pushed or pulled into sex work providing service to male migrants. In the behavior realm, many female migrant sex workers were intimidated by their male clients, feared violence, and lacked access to women's health care and prevention. In the cathexis realm, many had a sense of shame, social isolation, emotional distress, and lacked basic HIV knowledge and prevention skills. To prevent HIV transmission requires addressing the gender and power factors that shape HIV/AIDS risks among female migrant sex workers through multilevel intervention strategies.