Maternal Health: a Qualitative Study of Male Partners’ Participation in Lagos,Nigeria

Purpose

Male involvement in maternal healthcare has been described as a key factor to reducing maternal mortality globally. Hence, this study investigated the choice of facility to be used during pregnancy and examined factors that influence male participation in maternal healthcare issues of their spouses as these factors may sometimes influence the choice of health care services for pregnant women.

Method

The study was cross-sectional in design; the setting was at Badagry, Lagos, Nigeria. Thirty married men with at least the experience of birth of baby, who consented to participate, were purposively recruited for the study. Data were transcribed and content analysed using free narrative.

Result

The results show that orthodox health care, traditional birth attendance (TBA), and faith healing were utilised by the respondents. The majority of the participants identified cost of health care services, economic recession, and their job demand as the reasons for their non-active participation in accompanying their spouses for antenatal clinic visit.

Conclusion

However, to increase the level of men’s participation in maternal healthcare, especially visiting antenatal clinic with spouses, antenatal services should be free of any monetary charges so as to encourage men to be involved and not look for excuses of financial needs. Utilisation of skilled birth attendance should be reinvigorated.

     

Physicians,emotion, and the clinical encounter: A survey of physicians’ experiences

ObjectivesTraining in emotion management is not a standard part of medical education. This study’s objective was to understand physicians’ challenges navigating emotion (their own and their patients’) and identify areas for intervention to support physician wellness and enhance patient care.MethodsIn 2019, we surveyed 103 physicians in emergency medicine, internal medicine, family medicine, and neurology. Participants quantitatively reported emotion training, emotions that were challenging, and barriers to addressing emotion. They provided qualitative examples of emotion challenges and successes that we analyzed using an inductive thematic analysis.ResultsThere were no significant differences in responses by specialty. Only 10% reported receiving emotion management training, with no evidence that more recently trained physicians received more. Those who had received training on emotion reported greater comfort in dealing with patients’ emotions and were more likely to engage in teaching on emotion. There were gender and career stage differences regarding which emotions physicians found most challenging. The authors identified central themes of emotion-related challenges and successes.ConclusionsTargeted educational initiatives are needed to advance physicians’ ability to navigate emotion in clinical encounters.Practice implicationsDeveloping strategies for managing patients’ emotions may better prepare physicians for navigating the emotional demands of practicing medicine.     

Health Professionals’ Attitudes Towards Using a Web 2.0 Portal for Child and Adolescent Diabetes Care: Qualitative Study

Background

The Internet, created and maintained in part by third-party apomediation, has become a dynamic resource for living with a chronic disease. Modern management of type 1 diabetes requires continuous support and problem-based learning, but few pediatric clinics offer Web 2.0 resources to patients as part of routine diabetes care.

Objectives

To explore pediatric practitioners’ attitudes towards the introduction of a local Web portal for providing young type 1 diabetes patients with interactive pedagogic devices, social networking tools, and locally produced self-care and treatment information. Opportunities and barriers related to the introduction of such systems into clinical practice were sought.

Methods

Twenty clinicians (seven doctors, nine nurses, two dieticians, and two social welfare officers) from two pediatric diabetes teams participated in the user-centered design of a local Web 2.0 portal. After completion of the design, individual semi-structured interviews were performed and data were analyzed using phenomenological methods.

Results

The practitioners reported a range of positive attitudes towards the introduction of a local Web 2.0 portal to their clinical practice. Most interviewees were satisfied with how the portal turned out, and a sense of community emerged during the design process and development of the portal’s contents. A complementary role was suggested for the portal within the context of health practice culture, where patients and their parents would be able to learn about the disease before, between, and after scheduled contacts with their health care team. Although some professionals expected that email communication with patients and online patient information would save time during routine care, others emphasized the importance of also maintaining face-to-face communication. Online peer-to-peer communication was regarded as a valuable function; however, most clinicians did not expect that the portal would be used extensively for social networking amongst their patients. There were no major differences in attitudes between different professions or clinics, but some differences appeared in relation to work tasks.

Conclusions

Experienced clinical practitioners working in diabetes teams exhibited positive attitudes towards a Web 2.0 portal tailored for young patients with type 1 diabetes and their parents. The portal included provision of third-party information, as well as practical and social means of support. The practitioners’ early and active participation provides a possible explanation for these positive attitudes. The findings encourage close collaboration with all user groups when implementing Web 2.0 systems for the care of young patients with chronic diseases, particularly type 1 diabetes. The study also highlights the need for efforts to educate clinical practitioners in the use of Web publishing, social networking, and other Web 2.0 resources. Investigations of attitudes towards implementing similar systems in the care of adults with chronic diseases are warranted.     

Spirituality and health: is there a relationship?

The role of spiritual and religious factors in health, viewed from a scientific perspective, has been yielding interesting if not intriguing results. In general, studies have reported fairly consistent positive relationships with physical health, mental health, and substance abuse outcomes, mostly using cross-sectional or prospective designs. Some spiritual or religious factors, however, have failed in some studies to demonstrate significant outcomes. Empirical relationships have been commonly based on only a few questionnaire items. Adequate controls for possible moderating or confounding factors that could explain health outcomes have often been missing. A healthy skepticism seems called for, given the need to clarify and refine concepts, such as spirituality; to develop comprehensive assessments; and to conduct experimentally designed studies. Although the overall evidence is promising enough to warrant careful and expanded study, the need for a methodological pluralism in research and for cultural sensitivity is recommended.     

Patients’ Attitudes Toward Electronic Health Information Exchange: Qualitative Study

Background

In many countries, there has been substantial progress in establishing the electronic transmission of patients’ health information between health care providers, but little is known about how best to engage patients in the process.

Objective

We explored patients’ views about sharing of electronic health information and their preferences for learning about and participating in this process.

Methods

Patients in one Massachusetts community in the northeastern United States were recruited to participate in focus-group discussions. Prior to discussion, participants completed a written questionnaire that captured their reactions to draft educational materials and a consent form. The discussion moderator and two physicians analyzed the moderator’s detailed notes from each session and participants’ written comments, using an immersion-crystallization approach.

Results

Three dominant themes emerged: (1) concerns about privacy and security, (2) the potential benefit to a person’s health, and (3) the desire for more information about the consent process. On the pre-discussion questionnaire, 55 out of 62 participants (88%) indicated that they would provide consent for their information to be shared electronically among their health care providers, given the materials they had reviewed.

Conclusions

Patients are enthusiastic about electronic health information exchange, recognizing its capacity to improve the quality and safety of health care; however, they are also concerned about its potential to result in breached privacy and misuse of health data. As the exchange of electronic health information becomes more widespread, policy makers will need to ensure that patients have access to concise educational materials and opportunities to engage in conversations about the risks and benefits of participation.     

Legionella and Legionnaires’ Disease: Time to Explore in India

Legionella pneumophila was first recognised as a fatal cause of pneumonia more than four decades ago, during the 1976-American Legion convention in Philadelphia, USA. Legionella spp. continue to cause disease outbreaks of public health significance, and at present, Legionnaires’ disease (LD) has emerged as an important cause of community and hospital-acquired pneumonia. Parallel to this, the understanding of LD has also increased exponentially. However, the disease is likely to be underreported in many countries because of the dearth of common definitions, diagnostic tests and active surveillance systems. In this review, we outline the basic concepts of Legionella including clinical presentations, epidemiology, laboratory diagnosis and the status of LD in India. This article also summarises the progress of research related to Legionella in this country, identifying the research gaps and discussing priorities to explore this unexplored pathogen in India.     

Physicians’ perspectives of adopting computer-assisted navigation in orthopedic surgery

ObjectivesUsing Computer-assisted orthopedic navigation surgery system (CAOS) has many advantages but is not mandatory to use during an orthopedic surgery. Therefore, opinions obtained from clinical orthopedists with this system are valuable. This paper integrates technology acceptance model and theory of planned behavior to examine the determinants of continued CAOS use to facilitate user management.MethodsOpinions from orthopedists who had used a CAOS for at least two years were collected through a cross-sectional survey to verify the research framework. Follow-up interviews with an expert panel based on their experiences of CAOS were conducted to reason the impacts of factors of the research framework.ResultsThe results show that factors of “perceived usefulness” and “facilitating condition” determine the intention to continue using CAOS, and “perceived usefulness” was driving by “complexity of task” and “social influence”. Additionally, support in practice from high-level managers had an influence on orthopedists’ satisfaction after using a CAOS.ConclusionsThe aging population is accompanied by the increasing requirements for medical care and medical care attendant expenses, especially in total knee replacement. More precision and improvements on survivorship of patients’ artificial joints are needed. This study facilitates suggestions in user management when encountering an obstacle in implementing a CAOS. Based on these findings, scientific and practical implications are then discussed.     

Blastocystis in Health and Disease: Are We Moving from a Clinical to a Public Health Perspective?

Blastocystis is a genus of common single-celled intestinal parasitic protists with an unsettled role in human health and disease. Being a stable component of intestinal microbiota, once established, the Blastocystis parasite appears more common in healthy individuals than in patients with infectious, functional, or inflammatory bowel disease. Recent data suggest that the parasite is associated with certain gut microbiota profiles and health indices. Convincing data and tools differentiating asymptomatic colonization from infection are yet to be demonstrated. Although the parasite may elicit disease under certain circumstances, the focus on Blastocystis may be shifting from a clinical to a public health perspective.     

Comparing the application of Health Information Technology in primary care in Denmark and Andalucía, Spain

BACKGROUND: It is generally acknowledged that Denmark is one, if not the, leading country in terms of the use of information technology by its primary care physicians. Other countries, notably excluding the United States and Canada, are also advanced in terms of electronic medical records in general practitioner offices and clinics. PURPOSE: This paper compares the status of primary care physician office computing in Andalucía to that of Denmark by contrasting the functionality of electronic medical records (EMRs) and the ability to electronically communicate clinical information in both jurisdictions. METHODS: A novel scoring system has been developed based on data gathered from databases held by the respective jurisdictional programs, and interviews with individuals involved in the deployment of the systems. The scoring methodology was applied for the first time in a comparison of the degree of automation in primary care physician offices in Denmark and the province of Alberta in Canada. It was also used to compare Denmark and New Zealand. This paper is the third offering of this method of scoring the adoption of electronic medical records in primary care office settings which hopefully may be applicable to other health jurisdictions at national, state, or provincial levels. RESULTS: Although similar in many respects, there are significant differences between these two relatively autonomous health systems which have led to the rates of uptake of physician office computing. Particularly notable is the reality that the Danish primary care physicians have individual "Electronic Medical Records" while in Andalucía, the primary care physicians share a common record which when secondary care is fully implemented will indeed be an "Electronic Health Record". CONCLUSION: It is clear that the diffusion of technology, within the primary care physician sector of the health care market, is subject to historical, financial, legal, cultural, and social factors. This tale of two places illustrates the issues, and different ways that they have been addressed.     

Shared decision making: Physicians’ preferred role,usual role and their perception of its key components

ObjectiveTo investigate physicians’ preferred and usual roles in decision making in medical consultations, and their perception of shared decision making (SDM).MethodsA cross-sectional survey of 785 physicians in a large Dutch general teaching hospital was undertaken in June 2018, assessing their preferred and usual decision making roles (Control Preference Scale), and their view on SDM key components (SDMQ9 questionnaire).ResultsMost physicians (n = 232, 58%) preferred SDM, but more often performed paternalistic decision making (n = 121, 31%) in daily practice than they preferred (n = 80, 20%, p < 0.0001), most commonly because they judged the patient to be incapable of participating in decision making. Most physicians preferring SDM presented different options for treatment (n = 213, 92%) with their advantages and disadvantages (n = 209, 90%) but fewer made clear that a decision had to be made (n = 104, 45%) or explored the patient’s wish how to be involved in decision making (n = 80, 34%).ConclusionAlthough most physicians prefer SDM, they often revert to a paternalistic approach and tend to limit SDM to discussing treatment options.Practice implicationTeaching physicians in SDM should include raising awareness about discussing the decision process itself and help physicians to counter their tendency to revert to paternalistic decision making in daily practice.     

Physician self-disclosure in primary care: a mixed methods study of GPs’ attitudes,skills, and behaviour

Background

There is a debate in medicine about the use and value of self-disclosure by the physician as a communication tool. There is little empirical evidence about GPs and self-disclosure.

Aim

To explore what GPs’ attitudes, skills, and behaviour are with regard to self-disclosure during a clinical consultation and whether there is a need for the development of training resources.

Design and setting

Mixed methods using open-ended and semi-structured interviews in Auckland, New Zealand, and the surrounding districts.

Method

Sixteen GPs were interviewed on the issue of self-disclosure in clinical practice. A general inductive approach was used for data analysis.

Results

Self-disclosure was common in this group of GPs, contrary to training in some of the groups, and was seen as a potentially positive activity. Family and physical topics were most common, yet psychological and relationship issues were also discussed. Knowing patients made self-disclosure more likely, but a GP’s intuition played the main role in determining when to self-disclose, and to whom. GPs have developed their own guidelines, shaped by years of experience; however, there was a consensus that training would be helpful.

Conclusion

Self-disclosure is common and, in general, seen as positive. Major personal issues were acceptable for some GPs to self-disclose, especially to known patients. Although participants had developed their own guidelines, exposure of trainees to the issue of self-disclosure would be of value to prevent future mistakes and to protect both doctor and patient from any unintended harm, for example, developing a dependent relationship.     

Comparison of the middle-aged and older users’ adoption of mobile health services in China

ObjectiveGiven the increasing number of older people, China has become an aging society. A mobile health service is a type of health informatics that provides personalized healthcare advice to those who require it, especially the older people and the middle-aged. However, few studies consider the adoption of mobile health services with regard to older and middle-aged users. This paper explored a research model based on the value attitude behavior model, theory of planned behavior, and four aging characteristic constructs to investigate how older and middle-aged citizens adopted mobile health services.MethodThe hypothesized model was empirically tested using data collected from a survey of 424 residents older than 40 years in China. Structural equation modeling was used to estimate the significance of the path coefficients.ResultsThe findings revealed that (1) perceived value, attitude, perceived behavior control, and resistance to change can be used to predict intention to use mobile health services for the middle-aged group; (2) perceived value, attitude, perceived behavior control, technology anxiety, and self-actualization need positively affected the behavior intention of older users; and (3) subjective norm and perceived physical condition showed no significant effects on the behavior intention to use mobile health services for the two groups. The theoretical and practical implications and contributions of this study are then discussed.