The lay resource in health and health care

In our preoccupation with developing professional health careservices, we have lost sight of the contribution of lay peopleto their own health care. Indeed, health care has become synonymouswith professional care. Recently, however, studies in Europeand North America suggest that the lay resource in health careconstitutes at least 85% of all health care provided. As ourknowledge of the world of lay health care expands, there isan emerging appreciation of multiple levels of lay self care,including behaviours relating to promotion, prevention, minorillnesses and injury treatment, chronic disease care, and rehabilitation.These activities appear to derive from an eclectic conceptualbase that incorporates both allopathic and non-allopathic values,beliefs, and care-giving approaches. Furthermore, there is evidenceof patterns of lay health care where care functions tend tobe selectively distributed among discrete elements of the layhealth care "system", comprised of individuals, the immediatefamily, the extended family, friends, mutual aid groups, layvoluntary organizations, and religious organizations. There remain, however, serious conceptual and methodologicallimitations in defining, observing, evaluating and interpretingthe extent, quality and impact of the lay health resource. Itis not, by and large, a regulated or officially sanctioned resource,so baseline data are not routinely available. Research methodsuseful in accounting for the lay system need further developmentand must be sensitive to often very subtle social and culturalaspects of lay health care. Many questions remain regardingdemographic and social variations on the self-care theme. Several factors are proposed as important in enhancing self-care.Chief among these are: The shift in disease patterns from acuteto chronic; increased access to an effective self-care technology;widening public demand for more personal control in health;and the general health information explosion that has contributedto demystify the hitherto sacrosanct domain of medical care.Research on self-care remains on a frontier of knowledge.     

A world view model of health care utilization: the impact of social and provider context on health care decision-making

This article provides a conceptual model illustrating the filtering effect that social factors have on a health care event. Individual, family and social network filters translate the symptom for the patient before and after s/he enters the health care delivery system. Simultaneously, managed care and provider filters shape what resource is provided by the health care provider to the patient. Basic premises are that decision-making about health care utilization is a complex social interaction and that better attention to the social context will increase the likelihood of effective health care occurring.     

Competencies for health management practice: a practitioner's perspective

The current health care environment will require executive leadership with a new set of management competencies to effectively lead and manage the various components of a restructured health care delivery system. The traditional management skills of planning, organizing, directing, controlling, and staffing resources will remain relevant, but the true measure of professional success will be the development of conceptual skills. This means the ability to look at the health care enterprise as a whole, and recognize how changes in the environment shape your strategic mission, goals, and objectives. The successful health care leader will have a demonstrated ability to apply these conceptual skills to the development of information systems and integrated networks that position their organization to accept capitated risks. This paper examines the United States and Canadian health care systems from the perspective of both the more traditional hospital and the emerging medical care organizations. New importance of the team approach to leadership and management and all that entails is stressed.     

Community involvement in health policy; socio-structural and dynamic aspects of health beliefs

The notion of community involvement in health, as in fact in schemes of community welfare generally, has found wide acceptance in all kinds of political regimes and particularly in the Third World countries. Such involvement is expected not only to be cost-effective but, more importantly, the best way of providing comprehensive solutions to public health problems. More than 50 years of experience with schemes of community participation in India, however, show that the enthusiasm of the people generally tends to wane after a short period of time. Nevertheless, efforts at community involvement in health continue to be made. Governmental and non-governmental organizations and UN agencies, notably WHO, have been active in promoting the concept. The 1978 Alma Ata declaration on primary health care strongly emphasized the right and duty of people to plan and implement health care programmes. Even so, many operational problems remain and these are perhaps related partly to a lack of conceptual clarity. Ideally, community involvement should mean that the initiatives come from the people and the government and other agencies provide assistance. In reality, however, this rarely is so. The best that may be expected is that people will come forward voluntarily to participate in public health programmes. Generally, however, their co-operation has to be sought and they have to be motivated to participate in health schemes. Involvement could also be brought about through coercive measures but there is little support for such an approach, though many health programmes (such as that of small pox vaccination) have been known to have depended upon compliance for their success.(ABSTRACT TRUNCATED AT 250 WORDS)     

Towards a conceptual framework of lay evaluation of health care

It is argued in this paper that much of the empirical research into the public's and patients' perceptions of the adequacy of health care has suffered from conceptual weaknesses. In addition, and maybe as a result of these weaknesses, a contradictory pattern of findings has emerged from this research. To overcome some of these problems it is suggested that an investigation of lay evaluation of health care should be carried out within a conceptual framework which incorporates the following elements. (i) The goals of those seeking health care in each specific instance. (ii) The level of experience of use of health care. (iii) The socio-political values upon which the particular health care system is based. (iv) The images of health held by the lay population. Each of these elements interrelates with the others and their influence will be mediated through socio-demographic characteristics of the service users.     

Perceptions of community participation and health gain in a community project for the South Asian population: a qualitative study

BACKGROUND: The new public health rejects old individualist attempts at improving health and embraces community-based approaches in reducing health inequalities. Primary Care Trusts in England face the challenge of converting community participation in health into reality. This study explores differences in perception of participation between lay and professional stakeholders of a community health project for a South Asian population in Greater Manchester. METHODS: In-depth interviews and focus groups were used to explore the views of professional and lay stakeholders. All data were audio-taped, transcribed and analysed for emerging themes using a qualitative framework. RESULTS: Professionals talked of working in partnership with the community but lay stakeholders did not feel that they had control over the project. There were problems in engaging the community and local health professionals in the project. Lack of cultural awareness hampered participation in the project. There was agreement that the project improved the self-confidence of participants and created a more informed population. However, there was little support for claims of improvements in social cohesion and changes in lifestyle directly as a result of the project. CONCLUSION: Converting the rhetoric of community participation in health into reality is a greater challenge than was envisaged by policy makers. Marginalized communities may not be willing participants and issues of language and cultural sensitivity are important. Project outcomes need to be agreed to ensure projects are evaluated appropriately. Projects with South Asian communities should not be seen to be dealing with all 'ethnic health' issues without addressing changes in statutory organizations and other wider social determinants of health.     

Choice and change in health care in Britain

Health authorities in Britain are under pressure to shift the balance of health care towards long-term patients and non-hospital services. Financial cut-backs mean that changes in priorities can no longer be implemented from development monies alone and there is a need to take resources from existing services. At first glance, the least difficult option appears to be to make savings in the ways in which care is delivered rather than to cut or abolish whole services or to reduce 'standards' of care. However there are factors other than resource constraints which influence the ability of health authorities to choose and implement shifts of resources; they include professional and technical developments, lay expectations and health service management structures and processes. These factors and their implications are reviewed and issues are identified which are amenable to research by existing groups of research workers.     

我国卫生治理中行业组织的角色定位与职能分析

行业组织是具有互益性的社会组织,医疗卫生行业的特殊性决定了行业组织应在卫生治理中发挥重要作用。目前,我国行业组织的角色定位和职能分工不明确,影响了卫生治理的发展水平。本文从理论上梳理行业组织的特点、职能,分析我国卫生治理的特点,提出医疗卫生行业组织在我国卫生治理中的角色定位和职能分工。在此基础上,提出了促使行业组织更好地发挥作用的政策建议。     

姜堰市市级预防保健机构人力资源状况分析

目的了解和分析姜堰市市级预防保健、机构人力资源现状,为合理配置人力资源提供依据。方法采用分类统计分析方法。结果市级防保机构人力资源配置不足,全市每万人口拥有的疾病控制、卫生监督和妇幼保健专业技术人员仅为2.02人、0.45人和0.34人。结论职称结构优于国家规定标准,但年龄结构存在“断层”现象,尚有部分中专及以下学历人员。     

Project community diagnosis: participatory research as a first step toward community involvement in primary health care

'Community participation' and 'bottom up planning' have become fashionable themes in international health circles. However, in the absence of sociocultural perspective these themes remain largely rhetoric. In this paper, a deprofessionalization of social science is advocated in the service of participatory research as a first step towards community involvement in primary health care. Deprofessionalization is suggested as an adjunct to, not a replacement for in-depth professional social science research. An exploratory community diagnosis of health project conducted in rural south India is described. During the project, lay researchers received rudimentary social science field training and collected data on health behaviour deemed important to health planners as well as the health concerns of the community. Illustrative data, generated by the project is presented on the rural poors' utilization of government health facilities, their attitudes towards Primary Health Centre staff, and their ideas about how a proposed community health worker scheme could best serve them.     

Defining and assessing the competence of health care professionals in France

INTRODUCTION: During the past decade, the public, health care professionals, and governments have shown much interest in ensuring that professionals, specifically physicians, are skilled in their work and competent in managing health care organizations. The need to assess competence in the health care sector was explored, with the aim of proposing a policy for monitoring and assessing competence during active professional life. METHODS: A literature search and semistructured interviews were conducted. The 16 health care professions listed in the French health care code were included. The main questions were: What is your organization's definition of competence? What are the principal elements that define competence in health care activities? How can a system for assessing competence be implemented? Which methods for such a system are most appropriate, based on foreign experiences? Who are the players in the field of competence? And how can organizations participate in monitoring competence? RESULTS: 265 people representing 148 French organizations were interviewed. Competence in health care should be defined as follows: "professional competence is based on the initial diploma, the implementation of effective continuing education, a minimal professional activity and a regular peer review process." There was an agreement on the basic elements of competence, on the responsibilities of public institutions and professional organizations, and on the need to work together. DISCUSSION: We have shown that in France health care professionals would like to have a better system that allows them to exchange more information on the main health care issues; this is a serious requirement for most professionals.     

Research on organizational issues in health care social work

A rich body of knowledge spans organizational topics relevant to the practice, conceptual development and planning of social work health care services. At a time when health care organizations are experiencing major changes in their structure and financing; organizational research informs both the system adjustments and leadership which social work can offer the health care field. Organizational research on health care social work is grouped into three categories: management and administrative issues; interprofessional and interorganizational relations; and service delivery topics. Within each category, the major issues are presented with single site and multi-site research reviewed. Recommendations to improve the contributions of this body of research include greater attention to methodological rigor in designing and implementing research projects.     

Self-certification in lay midwives'' organizations: A vehicle for professional autonomy

The recent resurgence of lay midwifery in the United States has been intimately connected with the establishment of grassroots organizations which address women's health issues and make the reappearance of the lay midwife a different kind of phenomenon than was the case earlier in this century. This paper describes the organizational structure of 32 lay midwives' organizations and compares them to a model of alternative women's health groups as well as more traditional health professional organizations. Are lay midwives' groups the beginnings of new professional organizations which eventually will become part of the dominant system or do they model themselves more closely after alternative women's health groups? Voluntary self-certification in five lay midwives' groups is described in detail as a means of determining how a group handles the question of integration with or separation from the existing medical care system. Certification plays a critical role in promoting acceptance and credibility of midwifery practice and is seen increasingly as a mechanism to preempt regulation by another body.     

Leadership/citizen participation: perceived impact of advocacy activities by people with physical disabilities on access to health care,attendant care and social services

Increasingly, the climate of shrinking health care resources will impact access to health care for the people most vulnerable-those with disabilities. This study looked at the perceived impact of leadership and participation by people with physical disabilities and at their ability to gain increased access to health care, attendant care and social services. Respondents were randomly selected from Canada and the United States, from a pool of participants with physical disabilities serving in leadership roles within disability organizations in either country. Responses from a mail-out survey questionnaire were tabulated using logistic regression procedures to identify the perceived impact of advocacy activity on improved access to health care, attendant care and social ser- vices. Findings suggest that those who participated in advocacy activities were significantly more likely to feel that their action improved access to health care resources, attendant care resources and social services. Advocates also perceived the impact of access for their family, local organizations, and at a regional/national level. This study highlights the value of consumer/citizen participation, and the vital role this action can play in collaboration with social work professionals for system changes, health resource planning and policy development.     

Diversity policies and practices - a new perspective for health care

Background Globalization and migration intensify relations of interdependence between individuals all over the world and lead to complex forms of social and cultural diversity both within and across societies. The changing structure of family patterns and processes of individualization also contribute to growing diversity. Organizations and actors in health care will therefore also be challenged to achieve social inclusion of care seekers with different social and cultural backgrounds. Disparities in the health status of people from socially and culturally diverse backgrounds have been examined broadly, but the question is how diversity as an innovative concept will influence any agenda of research on human health and health care provision. Objective The purpose of this article is to theorize what a diversity framework could imply for health research and care system alike. Our thesis is that diversity as a reference point for research and practices will gain significance in Germany and Europe. We will present methodologies to understand diversity and “intersectionality” as paradigms to investigate the complexity and interdependence of health modifiers. Methodologies Diversity does not construct hierarchies of health modifiers and avoids focusing on groups without further differentiation. Health care programs will not only be challenged by the rising diversity among both patients and staff in the health care sector but also by supporting the integration of more disabled and chronically ill persons into the labor markets of ageing societies which cannot afford leaving groups behind as an unrecognized potential. Antidiscrimination legislation in Europe will possibly drive implementation of diversity policies in health care functions. Last but not least diversity management may become attractive as a strategy for improving the effectiveness of any structured health care program for prevention, rehabilitation and treatment alike through the implementation of a more consistent, multidimensional target group orientation. Conclusion Diversity as a conceptual framework applied to the health care field has yet to prove whether it may be a new tool possibly worthwhile to be developed to improve quality of care - but it has the potential to meat the challenges of health equity, defined in terms of resource allocations and access to health care determined by needs of multiple groups of patients.     

Regulating the health care workforce: next steps for research

This article explores the recent ferment surrounding professional self-regulation in medicine and other health professions. It reviews the academic literature and sets out an agenda for research. The first section considers definitions, acknowledging the particularly complex regulatory maze in UK health care at present, in which professional self-regulation is only one part. The second section reviews academic writing, currently dispersed among the disciplines. 'The logic of light touch regulation', a feature of the 19th century establishment of the General Medical Council, can perhaps shed light on present debates. Alongside the intense political spotlight on regulation in the wake of the Bristol case, consumer-led research and consumer pressure to rethink the principles of regulation has emerged. This is examined in the third section. Finally, themes for research are advanced. First, there is a need to explore the changing relationship between the state and professions and implications, not only for the professions but for health care more broadly. Second, calls for a new professionalism need to be given clearer content. Third, the moves towards more lay involvement in regulatory bodies need study. Fourth, questions of human rights and professional registers must be explored. Fundamental questions of what professional self-regulation can hope to achieve and where it fits in relation to government ambitions as a whole, remain unresolved. Alongside the work programme of the new overarching regulator, there may well be scope for a new style of public enquiry covering the whole territory of regulation.     

A Community and Medical Library Collaboration to Address Senior Caregivers Barriers to Health Services Access

This describes an outreach program to improve access to community resources and online health information for the lay public and professionals engaged in caregiving to seniors. An academic health sciences library and a coalition of community organizations collaborated to develop an authoritative, web-enabled clearinghouse that consolidated access to regional and national health and social service resources and online health information. Findings from a mixed-methods approach of roundtable discussions, key informant structured interviews, and surveys of professionals involved in senior care planning and discharge management were used to develop, pilot test, and evaluate the project. The website was promoted through a series of webinars outlining the range of services and resources available as well as engagement with a variety of community health care organizations. This project advanced understanding of the needs of seniors and their caregivers and created mechanisms to improve access to authoritative health care information supporting senior care. Community feedback on the website launch highlights its value for the lay public and professional caregivers. It also provided a platform for volunteerism and service learning through which individuals can have a collective impact on their community.     

Relationships between self-help health organizations and professional health care providers

This paper discusses areas of conflict in the relationships between professional and lay knowledge and values, in the context of disease-specific self-help groups. In the current climate of Government emphasis on consumer satisfaction, and local voice initiatives, collaboration amongst professionals, clients and consumers has become of increased importance. Agreement and harmony between professional and lay care-givers is essential to the development of improved and extended health care provision. Findings from a study of patients who have undergone open heart surgery, and their families, are used to identifiy areas of conflicts generally, between professional and lay discourses, and illustrates these problem areas by examples found in the individual self-help group study. If the highest possible quality of health care is to be achieved, both professional and lay discourses should be of value, and both contribute to patients' well-being and recovery. Professional courses should include information and training on consumer issues, and mutual support principles.     

The use of research in local health service agencies.

A critical and often overlooked component of the use and transfer of research in the health care system is the local health and social service delivery agency. There is also very little understanding of the extent to which local community-based agencies conduct research internally to improve their operational capacity. More than ever, these local service organizations require research to guide activity in a rapidly changing health care environment which is characterized by diminishing health and social service budgets, de-institutionalization and concomitant increases and metamorphoses in service demands. This study interviewed 25 executive directors and held a focus group with a group of other directors to examine the use and transfer of research in these organizations. A number of central issues were identified by the directors that affect the contribution of research to the delivery of their programs and services. A conceptual model for developing 'locally-based research transfer' was subsequently outlined that could serve as the basis for enhanced research use and research transfer in other local area contexts.     

NGOs in community health insurance schemes: examples from Guatemala and the Philippines

In poor rural communities, access to basic health care is often severely limited by inadequate supply as well as financial barriers to seeking care. National policies may introduce social health insurance, but these are likely to begin with the salaried public and private sector workers while the informal sector population may be the last to be covered. Community initiatives to generate health care financing require a complex development process. This paper covers attempts to develop such schemes in rural populations in Guatemala and the Philippines through non-government organizations and notes the major factors which have contributed to unequal progress in the two schemes. The scheme of the Association por Salud de Barillas (ASSABA) in Guatemala was not sufficiently established as an administrative body at the conceptual stage and there was no clear national policy on health care financing. By the time the necessary action was taken, local conflicts hindered progress. In the Philippines, the ORT Health Plus Scheme (OHPS) was implemented during the period of legislation of a national health insurance act. The appraisal after three years of operation shows that OPHS has made health care affordable and accessible to the target population, composed mainly of low and often unstable income families in rural areas. The major success factors are probably the administrative structure provided by a cooperative and controls in the delivery system and in expenditures, through the salaried primary health care team, referral process and the capitation agreement for hospital-based services. The proliferation of such schemes could benefit from national guidelines, a formal accreditation process and an umbrella organization to provide assistance in design, training and information services, involving government, non-government and academic institutions as an integral part of the development process.