Hospital to Community Transitions for Adults: Discharge Planners and Community Service Providers’ Perspectives

Discharges from the hospital to community-based settings are more difficult for older adults when there is lack of communication, resource sharing, and viable partnerships among service providers in these settings. The researchers captured the perspectives of three different groups of participants from hospitals, independent living centers, and Area Agencies on Aging, which has rarely been done in studies on discharge planning. Findings include identification of barriers in the assessment and referral process (e.g., timing of discharge, inattention to client goals, lack of communication and partnerships between hospital discharge planners and community providers), and strategies for overcoming these barriers. Implications are discussed including potential for Medicaid and Medicare cost reductions due to fewer re-hospitalizations.     

Exploring Social Service Providers’ Perspectives on Barriers to Social Services for Early Adjustment of Immigrant Adolescents in South Korea

Recently arrived immigrant adolescents experience difficulties in adjusting to school in South Korea. However, the existing social services do not meet their psychosocial needs. This study investigates the perspectives of social service providers about challenges in providing services for immigrant adolescents early in their adjustments. We conducted qualitative, in-depth interviews with 27 South Korean social service providers. We identified barriers to social services, categorized into three themes: (1) Initial Contact Phase; (2) Service Delivery Phase; and (3) Structural Challenges. We suggest interventions concerning work-related stress for the social service providers, family-level involvement, diversity training, and integrated and collaborative immigration services. An examination of social service providers’ challenges in working with immigrant adolescents is a necessary first step toward the development of programs and policies.     

Providers’ Perspectives on High-Quality Dementia Care in Long-Term Care

ObjectivesTo understand dementia care providers’ perspectives on high-quality care for persons living with dementia (PLWD) in long-term care (LTC).DesignA qualitative study using a directed content analysis approach.Setting and ParticipantsNine national LTC dementia care providers.MethodsWe facilitated 5 listening sessions centered around dementia care philosophies, models, and practices. Two researchers first mapped qualitative data to the Holistic Approach to Transformational Change (HATCh) model for dementia care using a directed content analysis approach. They then identified themes and subthemes emerging from the data using a conventional analysis approach. They coded data iteratively and solicited input from 3 additional researchers to reach consensus where needed. Member checks were performed to ensure the trustworthiness of the data during 2 follow-up listening sessions.ResultsThe 9 participants described the importance of understanding the experiences of PLWDs in order to provide high-quality dementia care and to deliver such care with the residents and their preferences as the focus. They emphasized experiential education as essential for families and all staff, regardless of role. They noted the need to balance safety with resident choice, as well as the corresponding need for facility leadership and regulators to support such choices. The listening sessions revealed areas to foster person-centered care for PLWD, but also highlighted barriers to implementing this philosophy in LTC settings.Conclusions and ImplicationsEmergent themes included care practices that center on resident preferences and are supported by staff with the experiential education and communication skills necessary to relate to and support PLWD. These findings provide contextual information for researchers seeking to identify and test interventions that reflect LTC providers’ priorities for PLWD and emphasize the need to align research priorities with provider priorities.     

Predictors of Parent Engagement Based on Child Care Providers’ Perspectives

Objective

Determine the predictors of child care providers’ parent engagement regarding child nutrition in child care centers (CCCs) and family child care homes (FCCHs).

Patients’ and Healthcare Professionals’ Perspectives on Better Use of Patient-Reported Outcome Measures in Head and Neck Cancer

ObjectivesPatients with head and neck cancer (HNC) are often highly affected by disease and treatment, resulting in impaired physical functioning and quality of life. Therefore, evaluation of patients’ psychosocial and functional outcomes can be facilitated by patient-reported outcome measures (PROMs). By providing the patients’ own perspectives, PROMs are crucial to improving patient-centered care. This study aimed to improve understanding of the perceived value of PROMs in HNC care and how to optimize their clinical value based on patients’ and multidisciplinary healthcare professionals’ (HCPs) perspectives.MethodsPopulation-based surveys among patients with HNC through their patient association and among HCPs nationwide through the Dutch Head and Neck Audit.ResultsA total of 54 patients and 40 multidisciplinary HCPs from all 14 nationwide HNC centers (100%) responded. For patients, the most important element of patient-reported outcome collection systems was including a call to action for those with worse-than-average scores (28%), whereas clinicians found discussing scores during clinical visits the most important (39%). Although 16% of clinicians found short completion time the most important element, none of the patients selected completion time as most important. Additionally, 17% of patients stated completion time was not an issue, provided clinicians would use the outcomes for clinical purposes.ConclusionsAlthough patients and clinicians acknowledged the value of patient-reported outcomes, patients would like to be more involved in the clinical implications of their outcomes. Enhancing patients’ involvement by a call to action and providing feedback on their scores during outpatient clinic visits may improve the clinical value of PROMs.     

Emerging Adults’ Discussion of Substance Use and Sexual Behavior with Providers

Emerging adulthood (ages 18–25) is a time of increased autonomy and associated with a high rate of risky substance use and sexual behavior. As emerging adults (EA) increasingly have more independence, they have the ability to make health decisions, including whether to see a provider (primary care (PCP) and/or gynecologist (GYN)) and whether to discuss substance use and sexual behavior. The current study aimed to determine: (1) factors associated with PCP and GYN health-care seeking by sexually active EA who use alcohol and/or marijuana; (2) gender differences in substance use and sexual risk topics initiated by providers; (3) whether PCPs compared to GYNs discuss different topics with women. Alcohol and/or marijuana-using, sexually active EA (n = 500) were recruited as part of a health behaviors study. Among participants, 39% did not see a PCP in the previous year. Women, White individuals, and EA with health insurance were most likely to attend a PCP appointment. Even among participants who saw a provider, many participants reported that providers did not initiate a discussion about substance use (approximately half discussed substance use) and sexual behavior (about half discussed STI history, two-thirds discussed condom use, and three-quarters discussed sexual partners). Among women with a PCP and GYN provider, discussions on substance use were more likely to be initiated by a PCP while sexual issues were more likely to be initiated by a GYN. Thus, even among sexually active, substance-using EA, central topics – specifically substance use and sexual behavior – are not routinely brought up by providers.     

Manager Perspectives on Implementation of a Farmers’ Market Incentive Program in Maryland

ObjectiveA growing number of farmers’ markets offer incentive programs to increase access to fresh produce in low-income communities and support local farmers, yet program implementation has not been widely studied. This qualitative study explored market manager perspectives on implementing a Maryland statewide farmers’ market incentive program.DesignSemistructured interviews with market managers.SettingParticipating farmers’ markets across Maryland.ParticipantsManagers of participating farmers’ markets (n = 19).Phenomenon of InterestBarriers and facilitators to program implementation and recommendations for improvement.AnalysisInterviews were analyzed using a phronetic iterative approach and themes were organized using an adapted version of a multilevel implementation framework.ResultsManagers reported overall favorable attitudes toward the incentive program. They identified barriers to implementation such as vendor buy-in and funding uncertainties, facilitators such as private fund-raising and local champions, and opportunities for improvement such as strengthening promotion and increasing the use of technology to reduce the data collection burden.Conclusions and ImplicationsManagers identified implementation barriers (eg, customer confusion) and facilitators (eg, ease of staff training) that may be shared by other incentive programs. Based on these findings, barriers and recommendations may be addressed through collaborative problem-solving with managers, vendors, and customers, and facilitators can be amplified broadly. Future research is warranted to explore incentive program implementation in other settings.     

Stakeholders’ Perspectives on Communication and Collaboration Following School Reintegration of a Seriously Ill Child: A Literature Review

Background

Reintegration into school is a decisive time for children who have been absent from school due to health problems, such as survivors of brain tumours and other types of acquired brain injury or cancer in childhood. Parents, school staff and healthcare providers are important stakeholders during this phase of transition.

Objective

To study the perspectives of parents, school personnel and healthcare providers on communication and collaboration following the child’s return to school, to gain insight into their experiences, and to develop recommendations for each stakeholder.

Method

We reviewed the literature on school reintegration in accordance with the configurative approach for research synthesis. Search and selection processes ended in 22 articles published between January 2000 and September 2015, consisting of quantitative, qualitative or mixed methods research. Data analysis resulted in themes with emphasis on communication and collaboration.

Results

Knowledge about the child’s condition, education and support are the main topics of consultation between parents, school personnel and healthcare providers. Based on their experiences, practices of communication and collaboration are variable and mostly inadequate. They report clear and complementary needs and expectations on how to effectively work together. Especially the need for a school liaison as connection between family, education and healthcare is commonly discussed.

Conclusion

The often suboptimal communication and collaboration between parents, school personnel and healthcare providers needs more coordination and consistency, starting from the child’s return to school. In addition, all stakeholders should be aware of related factors that facilitate or hinder the child’s reintegration process.

     

WIC Participants’ Perspectives About Online Ordering and Technology in the WIC Program

ObjectiveThe objective of this study was to assess the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants’ perceptions about ordering WIC groceries online.MethodsQualitative semistructured interviews were conducted with 24 WIC participants in East Tennessee from May to October 2019. Interviews were transcribed verbatim and analyzed using a grounded theory approach.ResultsParticipants were interested in online ordering and spoke favorably about delivery and pickup options. Participants were willing to pay $2–5 to order online, though they were more willing to pay for a home or curbside delivery than an in-store pickup. Participants suggested additional ways to integrate technology into WIC food retail operations, such as providing benefit balances via text message and developing a mobile phone application for Tennessee WIC.Conclusions and ImplicationsFindings can inform pilot tests for WIC online ordering.     

A Qualitative Study of Mothers’ Perspectives on Enrolling and Engaging in an Evidence-Based Nurse Home Visiting Program

Prevention Science - Prevention programs like Nurse-Family Partnership® (NFP) must enroll and retain clients of the intended population to maximize program impact. NFP is an evidence-based...     

Validation of a Collaboration Readiness Assessment Tool for Use by Supplemental Nutrition Assistance Program–Education (SNAP-Ed) Agencies and Partners

Objective

To evaluate content and face validity of a collaboration readiness assessment tool developed to facilitate collaborative efforts to implement policy, systems, and environment changes in Supplemental Nutrition Assistance Program–Education (SNAP-Ed).

Healthcare Providers’ Knowledge, Attitudes and Counselling on Injury Prevention for Preschool Children in Croatia

Injuries are the leading cause of death for children and young adults in Croatia. Research has indicated that health care providers can be effective in reducing the risk for traumatic injury through anticipatory guidance, but successful guidance requires that providers have injury knowledge and informed safety attitudes. This is the first study in Croatia to identify health care provider’s knowledge, attitudes, and practices regarding anticipatory guidance on injury prevention for children. A stratified, random sample of licensed Croatian healthcare providers was mailed a survey, with a response of rate of 39.5 %. Participants included pediatricians, family physicians, gynecologists, each with a focus on primary care, and community nurses. Participants filled out a 15-minute paper-and-pencil survey that tested their knowledge of injury risks and prevention strategies, assessed their safety-prone attitudes, and measured the extent to which they counselled their patients on injury prevention. Pediatricians had the highest knowledge of injury risks and intervention approaches, with an average correct score of six out of ten (significantly higher than all other provider types). Knowledge was highest regarding infant fall risk and lowest for safe sleep positions. Pediatricians and community nurses had the highest safety-prone attitudes. Safety prone attitudes were strongest for transportation safety and weakest for safe sleeping position for all providers. Community nurses reported the highest level of patient counselling, followed by pediatricians. Both factual education and support in translating knowledge into everyday practice are necessary for health care providers. Implementing anticipatory guidance for child safety is a promising approach in Croatia.     

Do Florida Medicaid Providers’ Barriers to HPV Vaccination Vary Based on VFC Program Participation?

This study aimed to determine if physicians’ perceived barriers to human papillomavirus (HPV) vaccination were associated with participation in the federal Vaccines for Children (VFC) program. A sample of 800 Florida Medicaid providers was randomly selected from the Florida Medicaid Master Provider File. A cross-sectional study was conducted using a 27-item survey that included 13 potential barriers to immunizing Medicaid patients against HPV, including concerns about vaccine safety and efficacy, discussing sexuality, vaccinated teens practicing riskier sexual behaviors, cost and reimbursement, ensuring 3-dose series completion, and school attendance requirements associated with HPV vaccination. Pearson χ² tests were conducted to investigate differences between each barrier and VFC program participation. Data were analyzed for 449 physicians. Compared to non-VFC providers, VFC providers were significantly less likely to somewhat or strongly agree that the following were barriers to vaccination: the cost of stocking the HPV vaccine (p = 0.0011), lack of adequate reimbursement for HPV vaccination (p < 0.0001), and lack of timely reimbursement for HPV vaccination (p < 0.0001). After adjusting for provider specialty and number of years since completion of residency training, VFC status remained significantly associated with the barrier regarding lack of adequate reimbursement for vaccination such that non-VFC providers had a 2.6-fold (95 % confidence interval, 1.1–5.8) greater odds of somewhat or strongly agreeing that this barrier applied to them. Increasing participation in the VFC program may decrease physicians’ cost-related barriers, which may increase the number of children vaccinated on time according to the recommended schedule.     

Patients’ Perspectives of Oral Healthcare Providers’ Communication: Considering the Impact of Message Source and Content

This study explores patients’ perceptions of positive and negative communication experiences with dentists and dental hygienists using a sample of 267 individuals who reported having a general dental provider. Patients’ oral health literacy, dental mistrust, use of dental health services, anxiety, and provider satisfaction are examined on the basis of reported communication experiences in the dental context. When comparing participants who had or had not experienced positive communication with a dentist, individuals with positive experiences demonstrated significantly higher levels of oral health literacy and provider satisfaction, as well as lower levels of dental mistrust. Participants who had experienced negative communication with a dentist reported significantly higher levels of anxiety and dental mistrust, as well as greater likelihood of ever leaving a dental practice, as compared to those without negative communication experiences. By contrast, positive and negative communication experiences with hygienists had limited impact on patient outcomes. Information derived from this investigation can be used by dental providers to guide communicative actions with patients, as well as by scholars to enhance existing theoretical explanations of the function of communication in dentistry.     

School Personnel Perspectives on their School’s Implementation of a School-Based Suicide Prevention Program

Youth suicide is a national public health priority, with policymakers highlighting schools as an ideal setting in which to deliver suicide prevention programs. Over the past decade, the number of schools implementing such programs has grown substantially, yet little is known about how successfully such programs are being implemented. This study examines the implementation of a district-wide suicide prevention program through key informant interviews with school personnel. Schools with higher rates of implementing district protocols for at-risk students had an organized system to respond to at-risk students, a process for effectively responding to students who were at-risk for suicide, and strong administrative support. In contrast, schools that had lower rates of implementing district protocols relied on a handful of individuals for suicide prevention activities and had limited administrative support. Attention to organizational factors leading to successful implementation of school-based suicide prevention programs may enhance the role of schools in national adolescent suicide prevention efforts.     

Exploring the Roles of Family Members in Women’s Decision to Use Postpartum Healthcare Services from the Perspectives of Women and Health Care Providers

Although the postpartum period is a significant time in a family’s life, few studies have addressed the lack of continuity of care and service use during the postpartum period. The aim of this study was to explore the roles of family members in Jordanian women’s decision to use postpartum health care services. An exploratory qualitative design was employed to elicit the perspectives of 24 women and 30 health care providers through six focus groups discussions conducted in April 2006. Interviews were transcribed verbatim, translated to English, and analyzed using an inductive content analysis approach. In our study, three roles of family members influencing Jordanian women’s decision to use postpartum health care services emerged: supporter role, opponent role, and active participant in care role. Findings supported the need for a family-centered approach when providing postpartum care to enhance positive family roles and limit negative ones to promote continuity of healthcare services use during the postpartum period.     

Incarcerated Youths’ Perspectives on Protective Factors and Risk Factors for Juvenile Offending: A Qualitative Analysis

Objectives. We sought to understand incarcerated youths’ perspectives on the role of protective factors and risk factors for juvenile offending.Methods. We performed an in-depth qualitative analysis of interviews (conducted October–December 2013) with 20 incarcerated youths detained in the largest juvenile hall in Los Angeles.Results. The adolescent participants described their homes, schools, and neighborhoods as chaotic and unsafe. They expressed a need for love and attention, discipline and control, and role models and perspective. Youths perceived that when home or school failed to meet these needs, they spent more time on the streets, leading to incarceration. They contrasted the path through school with the path to jail, reporting that the path to jail felt easier. All of them expressed the insight that they had made bad decisions and that the more difficult path was not only better but also still potentially achievable.Conclusions. Breaking cycles of juvenile incarceration will require that the public health community partner with legislators, educators, community leaders, and youths to determine how to make success, rather than incarceration, the easier path for disadvantaged adolescents.With 2 million juveniles arrested and over 60 000 detained annually, the United States incarcerates a larger proportion of youths than any other developed country.1–3 Incarcerated adolescents represent a high-risk, vulnerable population with disproportionately high rates of unmet physical, developmental, social, and mental health needs, and higher mortality.4–7 Juvenile offending predicts a higher likelihood of chronic adult offending, as well as adverse adult outcomes such as poor health, substance use, and increased mortality.8 Further, significant disparities exist. African American youths are approximately 5 times more likely, and Latino and American Indian adolescents are 3 times more likely, to be detained than their White counterparts.3 Additionally, adolescents from socially disadvantaged neighborhoods are at higher risk for incarceration.9 These inequities perpetuate future incarcerations. Prior incarceration places youths at greater risk for repeat offending throughout adolescence and adulthood.10 Within 3 years of release, approximately 75% of adolescents are rearrested.2Identification of protective and risk factors for juvenile offending can inform programs and policies to disrupt youths’ pathways to jail. Quantitative studies identify low school achievement, poor mental health, substance use, parental incarceration, large family size, single-parent families, poor parental supervision, delinquent peer groups, and residing in high-crime neighborhoods as risk factors for juvenile offending.11,12 The modest literature on protective factors for juvenile incarceration highlights the importance of supportive family relationships, prosocial peers, academic achievement, reading ability, and psychological factors such as self-esteem and empathy.13–15Qualitative research to identify underlying mechanisms for these associations is needed. For effective implementation, predictive factors need to be understood in the context of youths’ situations, goals, and ideas about pathways to jail within their communities. Yet adolescent voices on pathways to jail are notably lacking in this literature. To date, only 1 published study has examined incarcerated youths’ perspectives on protective and risk factors for incarceration. The study, which focused on barriers and protective factors during community reentry after juvenile incarceration, identified social connectedness and having a future-oriented perspective as the main predictors of success.16 Adolescents’ views of the pathways to jail across the entire trajectory of juvenile offending—from initiation of delinquency and entry into the juvenile justice system, to repeat arrests and, ultimately, their expected endpoints for these trajectories—remain unknown.To address these gaps, we interviewed incarcerated youths to elucidate their perspectives on pathways to jail across the trajectory of juvenile offending. We explored their perceptions of protective and risk factors in their communities, with the ultimate goal of strengthening programs that prevent juvenile offending and disrupt cycles of incarceration.