On the road to prevention: road injury and health promotion

Road traffic injuries are already the leading cause of injury mortality and morbidity globally and by 2030 are predicted to be the fifth leading cause of mortality in the world. Australia has seen a dramatic reduction in road deaths and serious injuries since the 1970s and holds an international reputation for road traffic injury prevention due, in part, to its success in pioneering the multidisciplinary and intersectoral approach needed to address this significant issue and by applying an evidence‐led approach to policy development. The paper will discuss Australia's early success in road traffic injury prevention (road safety), particularly the achievements following the implementation of targeted programs that focussed on road user behaviours for which health promotion played a role. The most successful of these programs was the introduction of comprehensive seat belt laws, random breath testing and more recently, strategic speed enforcement programs. Amid an array of significant challenges faced by the transport system in the future, the rapid development in information and communication technologies applied to transport is likely to provide the next generation of road safety benefits. The potential for a semi‐autonomous transport system is likely to provide the next significant decline in road fatalities and serious injuries over the next 2 decades and the role of health promotion in relation to raising community engagement and building coalitions to increase uptake of new technologies will be discussed.     

Positive cancer care in Peru: Patient and provider perspectives

Abstract

Peruvian women experience high mortality from reproductive cancers, partially due to suboptimal cancer care utilization and experiences. In this qualitative study, we examined factors contributing to positive cancer care experiences. Our sample included 11 cancer patients and 27 cancer providers who attended the First International Cancer Symposium survivorship conference in Lima, Peru in 2015. We conducted thematic analysis. Emergent themes revealed that, for patients, individualized empathic care by providers was an important facilitator to positive cancer care experiences. For providers, the ability to provide such care depended on provider norms and facility infrastructure to support such patient-centered practices.     

Quality of life in tuberculosis: Patient and provider perspectives

Tuberculosis (TB) is a persistent problem in the United States; however, little is known about its impact on functioning and quality of life (QOL) among people with TB. The purpose of this study is to describe the impact of TB on patients' QOL by using focus groups to assess the domains of QOL that are affected. Participants included patients (n = 10) who received treatment for active TB and physicians (n = 4) and nurses (n = 9) caring for patients with TB at a public health clinic in Baltimore, Maryland. TB affected all predicted domains of QOL, including general health perceptions, somatic sensation, psychological health, spiritual well-being, and physical, social and role functioning. Social stigmatization, isolation, pill burden, long duration of therapy, sexual dysfunction, loss of income, and fear were additional specific problems related to TB. Surprisingly, 11% (33) of the comments described benefits of TB illness, including increased spirituality and improved life perspectives. In addition, four additional QOL domains and three elements of treatment specific to TB which substantially impact QOL were identified. While patients and clinicians both identified issues in many areas of QOL, only patients mentioned the impact on sexual function, spirituality and improved life perspectives. Despite available curative therapy, TB and its treatment still have significant short and long-term consequences on patients' QOL.     

Diabetes self-management among Arab Americans: patient and provider perspectives

Background

Arab Americans have a high burden of diabetes and poor outcomes compared to the general U.S. population. Diabetes self-management (DSM) requires a partnership between patients and providers that fosters mutual understanding and shared decision-making. Cultural factors influence this process; however, little is known regarding the cultural impact on DSM or if perceptions differ between patients and providers.

Methods

Qualitative content analysis was used to analyze five focus groups–two groups with Arab American providers (n?=?8) and three groups with adult Arab Americans with diabetes (n?=?23). Focus groups examined patient and provider perspectives on the meaning of DSM and cultural barriers and facilitators among Arab American patients.

Results

Four distinct themes included limited resources for DSM education and support, stigma as a barrier to ongoing support, family support as an opportunity and challenge, and Arab American patient-provider relationships.

Conclusions

Findings indicate several domains should be considered for clinical practice including a need to develop linguistically and culturally reliant educational materials and relevant supports for use in the Arab American population. Findings highlight differing views among providers and patients on the familial role in supporting DSM efforts and why some patients feel dissatisfied with clinical encounters.

     

Employer perspectives on the preferred provider organization concept

The goal of preferred provider organizations (PPOs) is to identify cost effective physicians, hospitals and other providers and form them into healthcare delivery systems. Widespread interest in PPOs stems from the belief that they can contain costs while offering consumers a choice of physicians and hospitals. But there is little information available about the demand by employers to offer PPOs as a health plan option. This study gathered information on employers' attitudes toward PPOs through a survey of companies in the Minneapolis metropolitan area. Most of the surveyed firms were found to be self-insured and offered a choice of healthcare plans, including HMOs. Contrary to some previous studies, healthcare costs are a major concern by all of the firms. PPOs are viewed as one part of an overall strategy to reduce those costs while maintaining quality of care and convenient access to providers. Although somewhat skeptical about potential savings and concerned over the administrative costs of offering a new health plan, most of the firms indicated support for the PPO concept. The greatest market opportunity for PPOs is to offer the plan as an alternative within the company's existing indemnity plan, wherein employees who use the preferred providers are exempt from at least a portion of the coinsurance and deductible requirements.     

Clandestine abortion in Latin America: provider perspectives.

This paper presents the results of in-depth interviews with ten clandestine abortion providers in urban Latin America. Three related issues are addressed: how abortion providers come to this line of work; their major difficulties; and their sources of job satisfaction. A variety of paths bring health professionals to the practice of abortion; common elements are a sense of calling, a desire to help women, personal experience with abortion, and a commitment to political change. Providers describe difficulties that include a lack of medical support, the need for secrecy, and threats of violence, extortion, and prosecution. In spite of difficulties, all providers report a great deal of fulfillment in their work, based on their satisfaction in saving women's lives, maintaining supportive relationships with colleagues, and empowering women.     

Consumer satisfaction with primary care provider choice and associated trust

Background  

Development of managed care, characterized by limited provider choice, is believed to undermine trust. Provider choice has been identified as strongly associated with physician trust. Stakeholders in a competitive healthcare market have competing agendas related to choice. The purpose of this study is to analyze variables associated with consumer's satisfaction that they have enough choice when selecting their primary care provider (PCP), and to analyze the importance of these variables on provider trust.     

Evidence-based HIV prevention in community settings: provider perspectives on evidence and effectiveness

As part of the efforts to expand evidence-based practice (EBP) in HIV prevention at the community level, the Centers for Disease Control and Prevention (CDC) created the Diffusion of Effective Behavioral Interventions (DEBI) program. Frontline service providers, who are charged with adopting and implementing these interventions, however, have resisted and criticized the dissemination of evidence-based HIV prevention interventions. Their failure to implement the interventions with fidelity and abandonment of plans to implement interventions in which they were trained have often been discussed from the framework of ‘capacity-building’. This framework points to ‘deficits’ within community-based organizations (CBOs) that impede the uptake of EBP. This article presents the perspective of 22 frontline service providers from CBOs (n?=?8) in a Midwestern state on their experiences with the DEBI program, and illustrates the reasons providers may not implement EBP. Analysis of interview responses reveals that providers cite diverse reasons – beyond organizational capacity – for lack of implementation with fidelity. Specifically, they offer critiques of the DEBI program based on the models of evidence of effectiveness on which it is based.     

Improving service delivery: provider perspectives on building community-based systems of care

This article examines the views of service providers toward different public policy efforts to improve service delivery to elders requiring multiple services from an array of organizations. The authors examine the relationship between provider assessments of the adequacy of their community-based systems of care and community resource levels, coordination strategies, and client characteristics. Findings, based on responses from managers of programs serving older adults (n = 250) to a mailed survey, were that two-thirds (69.4%) evaluated their service delivery systems as adequate or better. A regression model used to explain system adequacy indicated that 22% of the variance was accounted for by community resource level, information and service availability, attention to specific need clients, and percentage of minority clients served by the respondents' programs. Findings suggest that community resource level appears to be an important factor in respondents' evaluation of system adequacy. While respondents indicated that improved coordination could enhance their efforts to deliver services, this strategy was not one they favored in improving their community-based system of care. Instead, they preferred strategies which expanded or improved the services that were available.