Measuring quality of health care from the user’s perspective in 41 countries: psychometric properties of WHO’s questions on health systems responsiveness

OBJECTIVE: To evaluate, for different populations, psychometric properties of questions on "health systems responsiveness", a concept developed by World Health Organization (WHO) to describe non-clinical and non-financial aspects of quality of health care. DATA SOURCES/STUDY SETTING/DATA COLLECTION: The 2000-2002 WHO Multi-Country Study comprised 70 general population surveys. Forty-one surveys were interviewer-administered, from which we extracted respondent records indicating ambulatory and inpatient health services use (excluding long-term institutions) in the previous 12 months (50,876 ambulatory and 7,964 hospital interviews). STUDY DESIGN: We evaluated feasibility, reliability, and construct validity using 33 items with polytomous response options, comparing responses from populations identified by countries, sex, age, education, health and income. PRINCIPAL FINDINGS: Average item missing rates ranged from 0 to 16%. Domain-specific alpha coefficients exceeded 0.7 in 7 (of 9) cases. Average intertemporal reliability was acceptable in 6 (of 10) sites, where Kappas ranged from 0.54 to 0.79, but low in 4 sites (K < 0.5). Kappa statistics were higher for male, educated and healthier populations than for female, less educated and less healthy populations. Factor solutions confirmed the domain structure of 7 domains (only 7 were operationalized for ambulatory settings). As in other studies, higher incomes and age was associated with more positive responsiveness reports and ratings. CONCLUSIONS: Quality issues addressed by WHO's questions are understood and reported adequately across diverse populations. More research is needed to interpret user-assessed quality of care comparisons across population groups within and between countries.     

Impact of parallel trade on pharmaceutical firm’s profits: rise or fall?

Most existing studies on parallel trade conclude that it reduces pharmaceutical firms’ profits. One special feature of the pharmaceutical industry is the presence of price regulation in most countries. Taking into account the impact of parallel trade on the regulated pharmaceutical prices [Pecorino, P.: J. Health Econ. 21, 699–708 (2002)] shows that a pharmaceutical firm’s profit is greater in the presence of parallel trade. The present paper relaxes the assumption on identical demands among countries, and takes into account transaction costs. The results of our model show that a firm’s profits may increase or decrease in the presence of parallel trade, depending on its bargaining power in the price negotiation and market size of the drug. Changes in social welfare due to the transition to parallel trade regime are also considered.     

Community-living older people’s interpretation of the Norwegian version of older people’s quality of life (OPQOL) questionnaire

The aim of this study is to investigate how community-living older people interpret the Norwegian version of Older People's Quality of Life (OPQOL) questionnaire. The original OPQOL questionnaire was translated based on guidelines for cross-cultural translation. The Three-Step Test-Interview instrument was adopted to investigate how community-living older people interpreted the questionnaire. Data were collected from 14 participants (72–89 years). The questionnaire was filled in under observation. Semi-structured interviews were then conducted to clarify the observational data and elicit the participants’ experiences and opinions. Lastly, data were analysed using a hermeneutic interpretation approach. Our findings indicate that most of the participants managed to complete the OPQOL questionnaire without problems. The data analysis resulted in four primary themes: relevance & applicability, formulation, consistency & accuracy and subjectivity. The questionnaire covered all aspects related to the participants’ quality of life. However, statements related to religion were found to be irrelevant to their quality of life. Most of the participants thought that religion, philosophy and culture should be separate rather than included in the same statement. The participants missed the option of ‘not applicable’ when the statements were irrelevant to them. The statements are formulated in both positive and negative ways, which was sometimes confusing to them. The participants perceived phases such as “around me” “local,” and “things” as ambiguous, and thus they raised concerns about whether the OPQOL questionnaire could capture consistent data regarding their quality of life. The results of this study pinpoint the issues that community-living older people faced when interpreting and answering the Norwegian version of OPQOL questionnaire. These issues were mostly caused by sociocultural differences. Our work provides an overview of the changes that must be made in the questionnaire in order to address these sociocultural differences while using the OPQOL questionnaire in the Norwegian context.     

Women’s perceptions of everyday occupations: outcomes of the Redesigning Daily Occupations (ReDO) programme

Abstract

Aims: The aim was to (i) assess the outcomes of the 16-week Redesigning Daily Occupations (ReDO) programme for women on sick leave due to stress-related disorders, in terms of occupational value, satisfaction with everyday occupations, and participation level; (ii) investigate the relationships between those outcomes and return-to-work rate. Methods:A total of 42 women receiving ReDO and 42 receiving care as usual (CAU) were included in a matched-control study with measurements before and after the rehabilitation. Seventy-eight participated on both occasions. They completed self-report questionnaires regarding the aforementioned outcomes. Return-to-work data were obtained from the registers of the Social Insurance Offices. Results: Increases in concrete, symbolic, and self-reward values were found in both groups, but no statistically significant difference between the groups was demonstrated. The ReDO group improved more than the CAU group, however, on satisfaction with everyday occupations and participation level. Occupational value, but not satisfaction with everyday occupations, was related to return to work. Conclusions: Everyday occupations were shown to be relevant outcomes after work rehabilitation. They could play an important role in future development of profession-specific evidence of occupational therapy. Further support was obtained for viewing occupational value and satisfaction with everyday occupations as theoretically distinct phenomena.     

Validity and reliability of the Chinese (Singapore) version of the Parkinson’s Disease Questionnaire (PDQ-39)

Objective: The purpose of the study was to validate the Chinese (Singapore) version of the Parkinson’s Disease Questionnaire (PDQ-39CSV) and its briefer version (PDQ-8CSV). Methods: A convenience sample of Chinese-speaking Singaporeans with Parkinson’s disease (PD) (n=63) completed a questionnaire containing the PDQ-39CSV and the Chinese (Singapore) EQ-5D. A subgroup also participated in a retest and/or a focus group discussion. A priori hypotheses were tested by examining correlations between PDQ-39CSV, PDQ-8CSV and EQ-5D scores and using principal component factor analysis. Reliability was assessed using Cronbach’s α and intra-class correlation coefficients (ICC). Results: Thirty-two PDQ-39CSV items correlated satisfactorily with their hypothesized dimensions (Spearman’s ρ ≥ 0.4). Factor analysis yielded a component on which all 8 PDQ-39CSV dimensions were substantially loaded (loading range: 0.53–0.89). As hypothesized, the PDQ-39CSV and PDQ-8CSV summary indices were highly correlated (Pearson’s r:0.95, ICC:0.94); correlations between related PDQ and EQ-5D scores were generally strong (Spearman’s ρ: 0.38–0.76, p<0.001 for all). Cronbach’s α values ranged from 0.64 to 0.90 and ICC values from 0.66 to 0.86. Conclusion: This study provides preliminary evidence supporting validity and reliability of both the PDQ-39CSV and its briefer version.     

‘Basically,it’s sorcery for your vagina’: unpacking Western representations of vaginal steaming

Abstract

Vaginal steaming made global headlines in 2015 after its promotion by celebrity Gwyneth Paltrow. One of many female genital modification practices currently on offer in Anglo-Western nations – practices both heavily promoted and critiqued – vaginal steaming is claimed to offer benefits for fertility and overall reproductive, sexual or even general health and wellbeing. We analysed a selection of online accounts of vaginal steaming to determine the sociocultural assumptions and logics within such discourse, including ideas about women, women’s bodies and women’s engagement with such ‘modificatory’ practices. Ninety items were carefully selected from the main types of website discussing vaginal steaming: news/magazines; health/lifestyle; spa/service providers; and personal blogs. Data were analysed using thematic analysis, within a constructionist framework that saw us focus on the constructions and rationalities that underpin the explicit content of the texts. Within an overarching theme of ‘the self-improving woman’ we identified four themes: (1) the naturally deteriorating, dirty female body; (2) contemporary life as harmful; (3) physical optimisation and the enhancement of health; and (4) vaginal steaming for life optimisation. Online accounts of vaginal steaming appear both to fit within historico-contemporary constructions of women’s bodies as deficient and disgusting, and contemporary neoliberal and healthist discourse around the constantly improving subject.     

Quality of life in Parkinson’s disease patients: validation of the Short-Form Eight-item Parkinson’s Disease Questionnaire (PDQ-8) in Taiwan

Purpose  

This study sought to evaluate the Chinese version of the eight-item Parkinson’s Disease Questionnaire (PDQ-8), through standard psychometric techniques.     

Reducing the burden of tobacco: what’s the endgame?

Tobacco use causes a tremendous amount of morbidity and mortality globally, with a staggering level of financial costs. In many countries, public health interventions have been able to reduce the prevalence of smoking and the associated burden. However, despite these successes, there is still much work left to be done. This commentary argues that the tobacco control interventions recommended by the World Health Organization are necessary but not sufficient to adequately address the consequences of tobacco use.     

Economic (in)equality and sustainability: preschool children’s views of the economic situation of other children in the world

This study explored preschool children’s knowledge and views of other children’s economic situation worldwide, and their self-reported sources of such knowledge. A total of 53 final-year preschool children, aged 5–6, from 12 preschools in Sweden were interviewed. Children’s responses were analysed using content analysis and the Structure of the Observed Learning Outcomes Taxonomy. Most of them seemed to have knowledge about the lives and the economic situation of other children in the world. Many of the preschool children could justify their views with one or more relevant ideas or thoughts, and a few of them were also able to logically connect their arguments. Parents, media and observations of real-life situations were reported as major sources of knowledge, while preschool was mentioned by a few. Further research is needed to enhance our knowledge about how to integrate social and economic sustainability in preschool’s pedagogical activities and to engage children meaningfully in such learning.     

Turning up the heat: Effect of new vaccine for children’s (VFC) program recommendations for use of temperature monitors upon incorrect product storage adverse event reporting

BackgroundThe Centers for Disease Control and Prevention (CDC) coordinates the Vaccines For Children (VFC) program, which provides free vaccines to qualified children in the US. In 2009, the CDC issued Vaccine Storage Requirements, which were later replaced (2012) with an interim guidance and toolkit for vaccine storage and handling. The guidance called for use of Digital Data Loggers (DDL) to monitor vaccine storage temperatures. We describe a change in frequency of Incorrect Product Storage Reports (IPSRs) following issuance of the 2009 CDC guidance.MethodsMerck & Co., Inc., Kenilworth, NJ, USA, systematically evaluates vaccine safety concerns for all products. The safety database was queried (01-Jan-2004 through 31-December-2016) to identify all IPSRs associated with 10 vaccines. We compared IPSRs received prior to and following the 2009 CDC guidance, comparing reports received from the US with those received from international sources during the same period.ResultsFollowing the release of the DDL guidance, a progressive increase in IPSRs was identified in the US (1 report received in 2004, 12,993 reports in 2016). In contrast, non-US IPSRs – have not had a similar increase: no reports received in 2004, 216 reports received in 2016. US reports of IPSRs 2004 through 2016 account for 96% of reports worldwide. There were no serious reports found in the database in conjunction with IPSRs, nor were there any additional safety findings in any of the reports with additional events reported.ConclusionVFC DDL guidance was followed by an increase in IPSRs. No similar trend was seen outside the US (where no broad change in DDL guidance occurred). Despite the increase in IPSRs, there have been few associated adverse events (AEs) reported; no new safety concerns were identified. These findings suggest that the increase in IPSRs was associated with the introduction of use of DDLs, and suggests the need for further impact assessment.     

‘I just don’t think it’s that natural’: adolescent mothers’ constructions of breastfeeding as deviant

Breastfeeding is recognised globally as the optimal method of infant feeding. For Murphy (1999) its nutritional superiority positions breastfeeding as a moral imperative where mothers who formula-feed are open to charges of maternal deviance and must account for their behaviour. We suggest that this moral superiority of breastfeeding is tenuous for mothers from marginalised contexts and competes with discourses which locate breastfeeding, rather than formula feeding, as maternal deviance. We draw on focus group and interview data from 27 adolescent mothers from socio-economically deprived neighbourhoods in three areas of the UK, and five early years professionals working at a Children’s Centre in the Northeast of England. We argue that breastfeeding is constructed as deviance at three ‘levels’ as (i) a deviation from broad social norms about women’s bodies, (ii) a deviation from local mothering behaviours and (iii) a transgression within micro-level interpersonal and familial relationships. Given this positioning of breastfeeding as deviant, breastfeeding mothers feel obliged to account for their deviance. In making this argument, we extend and rework Murphy’s (1999) framework to encompass diverse experiences of infant feeding. We conclude with reflections on future research directions and potential implications for practice.     

A review of Vietnam’s healthcare reform through the Direction of Healthcare Activities (DOHA)

Objective

This article provides a comprehensive review of the healthcare reform process driven by the Vietnamese Ministry of Health’s Direction of Healthcare Activities (DOHA) scheme.

Methods

We reviewed policy documents relating to DOHA, along with historical literature and background information describing its formation.

Results

DOHA (Ch? ??o tuy?n in Vietnamese) literally means guidance line or level in English. It requires healthcare facilities at higher government administration levels to support those at lower levels (the four levels being central, provincial, district, and commune), to help lower level hospitals to provide medical services for local communities in primary care settings and reduce the number of patients in higher level (central and provincial) hospitals. Since the 1990s, there have been too many patients attending higher level hospitals, and DOHA has therefore focused on technical skills transfer training to help alleviate this situation. Designated core central hospitals now provide technical skills transfer to provincial hospitals. Professional technical lists for each level of health facility have enabled strong commitment and proactive ownership of the process of training management in both higher and lower level hospitals.

Conclusion

The DOHA scheme has accelerated the necessary up-skilling of healthcare at lower level public hospitals across Vietnam. These reforms are highly relevant for other countries with limited healthcare resources.

     

Implementing patient-reported outcome measures in clinical practice: a companion guide to the ISOQOL user’s guide

Quality of Life Research - The use of patient-reported outcome (PRO) measures in clinical practice is increasing. Following the creation of a ‘User’s Guide to Implementing PRO...     

“It’s up to the Woman’s People”: How Social Factors Influence Facility-Based Delivery in Rural Northern Ghana

To explore the impact of social factors on place of delivery in northern Ghana. We conducted 72 in-depth interviews and 18 focus group discussions in the Upper East Region of northern Ghana among women with newborns, grandmothers, household heads, compound heads, community leaders, traditional birth attendants, traditional healers, and formally trained healthcare providers. We audiotaped, transcribed, and analyzed interactions using NVivo 9.0. Social norms appear to be shifting in favor of facility delivery, and several respondents indicated that facility delivery confers prestige. Community members disagreed about whether women needed permission from their husbands, mother-in-laws, or compound heads to deliver in a facility, but all agreed that women rely upon their social networks for the economic and logistical support to get to a facility. Socioeconomic status also plays an important role alone and as a mediator of other social factors. Several “meta themes” permeate the data: (1) This region of Ghana is undergoing a pronounced transition from traditional to contemporary birth-related practices; (2) Power hierarchies within the community are extremely important factors in women’s delivery experiences (“someone must give the order”); and (3) This community shares a widespread sense of responsibility for healthy birth outcomes for both mothers and their babies. Social factors influence women’s delivery experiences in rural northern Ghana, and future research and programmatic efforts need to include community members such as husbands, mother-in-laws, compound heads, soothsayers, and traditional healers if they are to be maximally effective in improving women’s birth outcomes.     

Metals in the Caudal Scutes of Morelet’s Crocodile (Crocodylus moreletii) from the Southern Gulf of Mexico

Caudal scutes were collected from 92 Morelet’s crocodiles (Crocodylus moreletii) between May and August 2012, in three Wildlife Management and Use Units (UMAs, from its name in Spanish) and three wild sites in Campeche, Mexico. The UMAs are intensive, with an ex situ approach to manage crocodiles in captivity. The concentrations of arsenic, mercury, lead, nickel, cadmium and chromium were analyzed in each sample. As and Pb were detected in all samples, Hg in 86 and Ni in 74. The metal concentrations estimated were higher than most of the concentrations reported for skin, tail tip and caudal scutes in other crocodilians around the world. The concentration of As, Pb and Ni was significantly greater in the free-ranging groups than in the captive groups in UMAs (p < 0.05). Negative linear relationship was estimated between the snout-vent length and the concentration of Pb (in five groups) and Ni (in three groups). In this region C. moreletii is exposed to metals contamination and more studies are necessary to establish if represents a risk to their populations.