‘Keeping It Real’: women's Enactments of Lay Health Knowledges and Expertise on Facebook

This article presents findings from a qualitative study concerning Australian women's use of Facebook for health and medical information and support and the implications for understanding modes of lay knowledge and expertise. Thinking with feminist new materialism theory, we identify the relational connections, affective forces and agential capacities described by participants as technological affordances came together with human bodily affordances. Affective forces were a dominant feature in users’ accounts. Women were able to make relational connections with peers based on how valid or relevant they found other group members’ expertise and experiences, how supportive other members were, how strong they wanted their personal connection to be and how much privacy they wanted to preserve. We identified three modes of engagement: 1) expertise claims based on appropriation and distribution of biomedical knowledge and experience; 2) sharing experiential knowledge without claiming expertise and 3) evaluation and use of knowledge presented by others principally through observing. We conclude that an ‘expert patient’ is someone who is familiar with the rules of engagement on sites such as Facebook and is able to negotiate and understand the affects and levels of disclosure and intimacy that such engagement demands.     

Approach to easing occupational stress for high-stress workers: applying the brief job stress questionnaire to workplace mental health promotion]

We investigated job stress among 442 employees from 19 divisions in a Japanese company using the Brief Job Stress Questionnaire. Job stress of the employees was estimated by the score for total health risk. Among the 19 divisions, two divisions showed over 120 points of mean total health risk score. Intervention with a stress-reduction program was carried out in these 2 divisions. First, to assess the job stress, health care staff interviewed all workers in the 2 divisions. Second, the results of the interviews were reported to the divisions' managers. Third, the managers applied the best remedy for job stress in their workplaces. In addition, occupational health staff conducted mental health education as well as individual interviews for the workers from the 2 divisions. At reevaluation one year later, both divisions showed a decreased general health risk (under 120 points). No sick leaves for depression occurred within the 2 divisions during the intervention. The results of the present study suggest that the intervention was effective in easing occupational stress for high-stress workers. The stress reduction program also seemed to have helped managers to change their recognition of occupational mental health and enabled close cooperation with occupational health staff, which may improve mental health in the workplace.     

Sexuality, dementia and residential care: managers report and response

There is a growing literature on the subject of sexuality and an increased knowledge of sexuality and older people, but there is a dearth of information about sexuality and people with dementia, particularly those in residential care. The concern of this paper is with people with dementia; it also considers the impact of gender on their sexual expression. The expression of sexuality by people with dementia is an area which has been largely neglected by research, yet in practice appears to be of concern. The types and prevalence of sexual expression by people with dementia in residential care and staff's responses to such expression are examined. A postal questionnaire sent to managers of social work residential homes in one region in Scotland explored a number of different issues, including: the public versus private expression of sexuality by people with dementia, the public response versus the private feelings of managers to such expression, the influence of carer involvement on staff's responses, exploitation of one resident by another and sexual expression directed at staff by residents. Permeating all these was the issue of gender. The majority of homes were staffed predominantly by female managers and female care staff. Most residents were female yet the majority of incidents involving sexual expression, reported by managers, involved male residents directing their attention towards female staff or other residents. Female residents with dementia do express sexuality but numbers reported are considerably less with staff actions tending towards the protective. Some types of sexual expression appear to be of more concern than others, and some are reported to occur more frequently.     

User requirements and understanding of public health networks in England

BACKGROUND: The movement of public health professionals from health authorities to primary care trusts has increased their isolation and dependence on public health networks for communication. METHODS: A cross sectional survey of 60 public health professionals working in England was performed to determine their understanding of the term "public health network" and to explore the functions that they would like these networks to perform. It also assessed their attitudes towards a national network and towards individual, local, and national web sites to support these networks. RESULTS: The most popular functions were the support of CPD/education, the identification of expertise and maximisation of scarce resources, information sharing, and efficient information/knowledge management. The local and national networks and their web sites should provide information on current projects of the network and searches to identify people, expertise, and reports. CONCLUSION: Public health professionals have a similar but broader understanding of the term "public health network" than that of the government with greater emphasis on sharing of information. The network is more likely to be successful if its priorities are maximising scarce resources, identification of expertise, CPD/education, and knowledge management.     

Being treated differently: Stigma experiences with family,peers, and school staff among adolescents with mental health disorders

Stigma directed at adolescents diagnosed with emotional and behavioral disorders by individuals in their interpersonal network likely undermines their wellbeing, yet little is known about their subjective stigma experiences. In particular, the prospect of diagnosed youth experiencing prejudice and discrimination by family members has not previously been examined. This study examines adolescents' perceptions of being treated ‘differently’ because of mental health problems by family members, peers, and school staff. Qualitative analysis of narratives from mixed method interviews with 56 adolescents in a mid-western US city demonstrated variation in the perceived extent and nature of stigma and in contextual factors perceived as promoting or protecting from stigmatization, depending on the interpersonal domain. The greatest number of participants experienced stigmatization in relationships with peers (62%); this often led to friendship losses and transitions. Participants reporting no peer stigmatization often reported socializing with others “in the same boat” or concealing problems—methods of avoiding potentially stigmatizing interactions. Close to half (46%) described experiencing stigmatization by family members, which often took the form of unwarranted assumptions, distrust, avoidance, pity, and gossip. About one third (35%) of participants reported stigma perpetrated by school staff, who expressed fear, dislike, avoidance, and under-estimation of their abilities. Fortunately, 22% reported “different” treatment by school staff, but this treatment was interpreted as positive and supportive. Results showed that perceived stigmatization in one domain was associated with perceived stigma in other domains. The results suggest that efforts to combat stigmatization of youth with mental health disorders must help family members, peers, and school staff overcome their inclinations to make negative assumptions and discriminate against these youth.     

Senior manager decision‐making and interactions with frontline staff in intellectual disability organisations: A Delphi study

Very little is known of the activities of the most senior managers in organisations providing social care in the community to people with intellectual disabilities. Yet the importance of the focus and activities of senior managers in directing and supporting staff practice and staff experiences is likely to be central to an organisation's functioning and support provided for staff and service users. This study employed Delphi methodology with a panel of 11 senior managers, mostly chief executives, managing small to very large organisations providing support for people with intellectual disabilities, in the UK. Answering three rounds of questions, senior managers described their face‐to‐face and non‐face‐to‐face contacts with staff and decision‐making. Narrative data were subject to quantitative and thematic analysis. In the last round, themes were subject to quantitative analysis. Most contacts between senior managers and staff were in formal structured contexts and all managers used social media to promote the organisations' ambitions regarding good practice. The panel focused upon accessing and understanding the informal aspects of their organisations and staff factors. Decisions were both short‐term reactive and long‐term strategic and an effort to link these was felt to improve organisational functioning. A framework for understanding senior managers' activities emerged showing two sources of demands and opportunity, extra‐organisational focused upon meeting legal and regulatory demands and intra‐organisational focused upon understanding and influencing informal staff practices/experiences and cultures within their organisations.     

Candidate change agent identification among men at risk for HIV infection

Despite limited HIV prevention potency, peer-based programs have become one of the most often used HIV prevention approaches internationally. These programs demonstrate a need for greater specificity in peer change agent (PCA) recruitment and social network evaluation. In the present three-phase study based in India (2009-2010), we first explored the nature of friendship among truck-drivers, a group of men at high risk for HIV infection, in order to develop a thorough understanding of the social forces that contribute to and maintain their personal networks. This was accomplished in the first two study phases through a combination of focus group discussions (n = 5 groups), in-depth qualitative interviews (n = 20), and personal network analyses (n = 25) of truck-drivers to define friendship and deepen our understanding of friendship across geographic spaces. Measures collected in phases I and II included friend typologies, discussion topics, social network influences, advice-giving, and risk reduction. Outcomes were assessed through an iterative process of qualitative textual analysis and social network analysis. The networks of truck-drivers were found to comprise three typologies: close friends, parking lot friends, and other friends. From these data, we developed an algorithmic approach to the identification of a candidate PCA within a high-risk man's personal network. In phase III we piloted field-use of this approach to identify and recruit PCAs, and further evaluated their potential for intervention through preliminary analysis of the PCA's own personal networks. An instrument was developed to translate what social network theory and analysis has taught us about egocentric network dynamics into a real-world methodology for identifying intervention-appropriate peers within an individual's personal network. Our approach can be tailored to the specifications of any high-risk population, and may serve to enhance current peer-based HIV interventions.     

医院信息化建设必须重视人的作用

作者以南京军区福州总医院信息化建设为例，提出了重视人的作用，做好人才规划与培养也是医院信息化建设的关键。进一步论述了医院首先要有重视信息化建设的领导者、管理者；其次要有一支水平较高的信息技术队伍；第三，要有能熟练操作计算机的大批工作人员；第四，合理地配置人力资源，发挥整体效能。     

Knowledge management practices in healthcare settings: a systematic review

Knowledge is an intangible asset in Organizations, and provides a comparative advantage to those who possess it. Hospitals are complex organizations with unique characteristics because of the heterogeneity of health professionals' orientation, the composite networking and the decision‐making processes. A deeper understanding of knowledge management (KM) could streamline productivity and coordinate the use of resources more efficient. We conducted a systematic literature search of peer‐reviewed papers that described key elements of KM using three databases (Medline, Cinahl and Health Source: nursing/academic edition) for a 10‐year period (1/1/2004–25/11/2014). The included articles were subjected to qualitative content analysis. We retrieved 604 articles of which 20 articles were eligible for analysis. Most of the studies (n=13) used a qualitative methodology. The total sample size was 2155 participants. The key elements that arose were as follows: perceptions of KM, synthesis, dissemination, collaboration, means of KM and leadership. Moreover, this study identified barriers for KM implementation, like time restrictions and limited skills. Healthcare managers ought to cultivate a knowledge environment, operate as role models, provide the tools for KM and reward people who act as knowledge brokers. Opportunities for collaboration and knowledge sharing should be encouraged. Successful KM should be patient‐centered to gain its maximum value. Copyright © 2015 John Wiley & Sons, Ltd.     

Patient perspectives on health advice posted on Internet discussion boards: a qualitative study

Background  Use of the Internet for health information by patients is growing, and there have been diverse responses to this both within the research community and the medical and health-related professions. The use of Internet discussion boards are one way that people living with long-term conditions can interact with their peers and offer and seek advice, support and information. We report patient perspectives on using a discussion board within a wider pilot study of an Internet-based self-management system for diabetes.
Design  Qualitative data was gathered during three stages of developing and piloting the wider self-management system. These are: (1) patient focus groups as part of a stakeholder consultation; (2) a pre-test session and focus group; and 3. a 6-month pilot study including follow-up individual interviews.
Results  Three main themes were identified within participants' perspectives on Internet discussion boards. First, a focus on the importance and value of peer support to these patients. Secondly, participants' awareness of the need to evaluate the information posted by others in light of their own circumstances. Thirdly, the value placed upon the experiential knowledge of others living with the same condition.
Conclusions  Many people living with long-term conditions would like to be in contact with their peers, and Internet discussion boards represent a cost-effective and interactive way of achieving this. Within the context of diabetes, the knowledge and expertise accumulated over many years of self-management is central to participants' self-reported ability to evaluate information posted and make decisions on its possible use.     

Cell Phone Use among Homeless Youth: Potential for New Health Interventions and Research

Cell phone use has become nearly ubiquitous among adolescents in the United States. Despite the potential for cell phones to facilitate intervention, research, and care for homeless youth, no data exists to date on cell phone use among this population. In 2009, a survey of cell phone use was conducted among a non-probability sample of 169 homeless youth in Los Angeles, CA. Levels of ownership and use, instrumental uses (connecting to case workers, employers) and patterns of connecting to various network types were assessed (family, home-based peers, street-based peers). Differences in socio-demographic characteristics and cell phone ownership were assessed via t test and chi-square statistics. Sixty-two percent of homeless youth own a cell phone; 40% have a working phone. Seventeen percent used their phone to call a case manager, 36% to call either a potential or current employer. Fifty-one percent of youth connected with home-based peers on the phone and 41% connected to parents. Cell phones present new opportunities for intervention research, connecting homeless youth to family and home-based peers who can be sources of social support in times of need. Moreover, cell phones provide researchers and providers with new avenues to maintain connections with these highly transient youth.     

Building departmental influence in health care organizations

This article has outlined several steps to follow in assessing and building department influence at the top management levels of health care organizations. Identifying and contributing to resolving the organization's key areas of uncertainty are strategies that have improved the influence of many departments in recent years. Individual strategies, such as developing one's expertise and sharing that expertise with other departments and top management (an example of the "involvement" technique), also are being used daily by effective department managers. Decentralized management, which entails the assignment of greater responsibilities to middle managers, is increasingly popular in health care organizations. This trend will no doubt facilitate the building of departmental influence in organizational decision making. However, the steps outlined in this article can be implemented whether or not top management endorses a decentralized management style. In a critical sense, departmental influence is too important to be left to top management. It is up to department managers to exert their influence for the good of their employees, the organization as a whole, and their own careers.     

Formulation and feedback: an illustration of two methods for improving access to effective therapies

It is now recognised that therapists require career-long training in order to maintain and improve their expertise. However, training will fail to improve services to clients unless the work environment supports staff in its use. Although this "training transfer" problem is widely acknowledged, to the authors' knowledge the way that the work environment influences clients' access to effective therapies has not been subjected to a detailed and systematic formulation. Therefore, this small study illustrates a suitable formulation, based on the training received by a group of National Health Service (NHS) staff in "psychosocial interventions", and proposes its use as a "feedback fascia" to managers and others. To do this, structured interviews were held with a self-selected sample of n = 20 therapists (mostly nurses) and all of their managers (n = 11) in one NHS Trust. The results indicated an impressive degree of training transfer. It is concluded that staff training can improve clients' access to effective treatments, but that significant organisational support for innovation is required. A feedback fascia can guide such support.     

Developing better casemix education for rural New South Wales

ABSTRACT: Casemix is now an important mechanism for the planning, evaluation and funding of health services in Australia. In New South Wales (NSW) it was believed that while staff from most hospitals in metropolitan Sydney had become both literate and vocal about casemix, staff from rural areas were less familiar and much less likely to participate in casemix initiatives. In conjunction with the NSW Casemix Clinical Committee (NCCC), NSW Health considered a special program of casemix education for rural NSW. Before an education program was attempted, NSW Health inquired into the specific needs for casemix education in rural NSW. Qualitative and quantitative methods of analysis were used. Results of the quantitative analysis indicate that the understanding of casemix classifications is highest among managers. Of concern were the relatively low proportion of Allied Health staff who had more than a vague understanding of the Sub- and Non-Acute Patient (SNAP) classification; the lack of any knowledge of the Mental Health Costing And Service Classification (MH-CASC) by nursing staff; and the lack of any knowledge of the emergency department classification: Urgency, Disposition and Age-related Groups (UDAG), either by clinical or nursing staff. The results of the qualitative analysis show that casemix education for rural areas needs to differ from metropolitan education programs. The analysis also highlights the perception of casemix in rural areas and the special circumstances in rural hospitals that place limits on the ability to use casemix more fully.     

Modeling Online Health Information-Seeking Behavior in China: The Roles of Source Characteristics,Reward Assessment,and Internet Self-Efficacy

The outbreak of severe acute respiratory syndrome (SARS) in 2003 marked the explosion of health information seeking online in China and the increasing emergence of Chinese health websites. There are both benefits and potential hazards of people’s online health information seeking. This article intended to test part of Wilson’s second model of information behavior, including source characteristics and activating mechanisms, and to identify the relationships among perceived access, perceived expertise credibility, reward assessment, Internet self-efficacy, and online health information-seeking behavior. Data were drawn from face-to-face surveys and an online survey of health information seekers (N = 393) in China. The results showed that source characteristics predicted activating mechanisms, which in turn predicted online health information-seeking behavior. Activating mechanisms, that is, reward assessment and Internet self-efficacy, mediated the relationship between source characteristics (i.e., access and credibility) and online health information-seeking behavior. Strategies for improving information access, expertise credibility, and Internet self-efficacy are discussed in order to maximize the benefits of online health information seeking and to minimize the potential harm.     

Housing for ageing LGBTQ people in Sweden: a descriptive study of needs,preferences, and concerns

Background/aim: With an increasing number of ageing people who identify themselves as lesbian, gay, bisexual, transgender, or queer (LGBTQ), there is a risk that traditional housing for older people fails to meet the needs of these people. The aim of this study was to describe LGBTQ people’s needs, preferences, and concerns according to ageing and housing.

Materials and methods: Based on a survey (n?=?487), and six focus-group discussions (n?=?30), with LGBTQ persons, quantitative and qualitative approaches were used to analyse the findings.

Results: When comparing the ranking of preferences (in terms of activity options, environmental features, and staff competence) in a senior housing setting between the LGBTQ people (n?=?200) and heterosexual matched controls (n?=?198), only minor differences were detected. The findings from the focus groups included: (1) a dilemma between segregation and openness, (2) the importance of safety associated with ageing together with persons with similar experiences, and (3) networks of persons at different ages connected through close friendship supported participation in activities in LGBTQ-profiled senior housing.

Conclusion and significance: The findings provide knowledge to improve awareness of sexual orientation when it comes to needs and preferences in relation to ageing and housing in a Swedish context.     

Away from home: an ethnographic study of a transitional rehabilitation scheme for older people in the UK

While intermediate care is an international phenomenon, it is particularly developed in the UK where it is a central element of the Government's response to the care needs for older people (The National Service Framework of Older People. London: HMSO). In the UK, intermediate care services are proliferating despite lack of evidence of effectiveness. We present the findings of an ethnographic study of an intermediate care scheme in six residential care homes that examined the perspectives of three key groups--older people, care home managers and rehabilitation staff. We discovered a consensus among managers and rehabilitation staff that the scheme was successful, yet no such agreement existed amongst older people. We also found that the scheme created the conditions for the emergence of a more optimistic vision of the potential of older people, with rehabilitation assistants seeing core elements of their work in a new light. However, much of what was characterised as 'rehabilitation' was more a process of adaptation to the norms, expectations and values of the institution. Our findings point in positive and negative directions: positive in that this scheme may have generated a new culture of more personalised care amongst experienced care staff, and negative in showing the limitations of a rehabilitation scheme that is not based within a person's own living environment. Our findings have implications for policy makers, researchers and managers of services.