Development of guidelines to facilitate improved support of South Asian carers by primary health care teams

BACKGROUND: Evidence based guidelines are regarded as an appropriate basis for providing effective health care, but few guidelines incorporate the views of users such as carers. AIM:To develop guidelines to assist primary health care teams (PHCTs) in their work with carers within South Asian communities. METHODS: The guidelines were drawn up by a development group consisting of members of teams in areas with South Asian communities (Leicester and Bradford). The teams were invited to make their recommendations based on a systematic review of literature on minority ethnic carers and the findings of a study of the needs and experiences of local South Asian carers. A grading system was devised to enable the teams and a group of expert peer reviewers to assess the quality of evidence in support of each recommendation. RESULTS: The teams agreed seven recommendations, graded according to available evidence and strength of opinion. External peer review supported the PHCTs' interpretation of evidence and their recommendations. The recommendations included consideration of communication and information for carers, coordination of care within teams, and recognition by team members of the roles of carers and their cultural and religious beliefs. CONCLUSION: There are particular steps that PHCTs can take to improve their support of South Asian carers. It is possible to develop guidelines that take users' views into account and incorporate evidence from qualitative studies.     

Regional collaborations as a way forward for maternal, newborn and child health: the South Asian healthcare professional workshop

This article reviews the importance of regional initiatives in the context of global efforts to achieve the Millennium Development Goal 4 and 5 and describes the action-oriented multi-country healthcare professional association (HCPA) workshops organized by the Partnership for Maternal, Newborn and Child Health. The South Asian HCPA workshop served as a catalyst for strengthening the ability of HCPAs in South Asian countries to organize and coordinate their activities effectively, play a larger role in national planning, and collaborate with other key stakeholders in maternal, newborn and child health.     

Enhancing primary care support for informal carers: A scoping study with professional stakeholders

Informal carers (i.e. people who provide unpaid care to family and/or friends) are crucial in supporting people with long‐term conditions. Caring negatively impacts on carers’ health and experiences of health services. Internationally and nationally, policies, legislation, professional guidance and research advocate for health and care services to do more to support carers. This study explored the views of health and social care providers, commissioners and policy makers about the role and scope for strengthening health service support for carers. Twenty‐four semi‐structured interviews, with 25 participants were conducted, audio‐recorded, transcribed verbatim and analysed by thematic analysis. Three main themes emerged: (a) identifying carers, (b) carer support, and (c) assessing and addressing carer needs. Primary care, and other services, were seen as not doing enough for carers but having an important role in identifying and supporting carers. Two issues with carer identification were described, first people not self‐identifying as carers and second most services not being proactive in identifying carers. Participants thought that carer needs should be supported by primary care in collaboration with other health services, social care and the voluntary sector. Concerns were raised about primary care, which is under enormous strain, being asked to take on yet another task. There was a clear message that it was only useful to involve primary care in identifying carers and their needs, if benefit could be achieved through direct benefits such as better provision of support to the carer or indirect benefit such as better recognition of the carer role. This study highlights that more could be done to address carers’ needs through primary care in close collaboration with other health and care services. The findings indicate the need for pilots and experiments to develop the evidence base. Given the crucial importance of carers, such studies should be a high priority.     

Cultural competency and diversity among hospice palliative care volunteers

This case study examines the current state of cultural competence in hospice and palliative care in the Greater Toronto Area (GTA). Because of changing demographic trends and ethnic minorities underutilizing hospice palliative care services, this research examined the current state of culturally competent care in a hospice setting, and the challenges to providing culturally competent care in a hospice in the GTA. A case study was conducted with a hospice and included in-depth interviews with 14 hospice volunteers. The findings reveal that volunteers encountered cultural clashes when their level of cultural competency was weak. Second, volunteers revealed there was a lack of adequate cultural competency training with their hospice, and finally, there was a lack of ethnic, cultural, and linguistic diversity among the hospice volunteers.     

高校心理委员专业能力培训效果评价

探索高校心理委员专业能力培训对受训者心理健康工作知识和技能的影响,为推动高校心理健康教育工作提供参考.方法 采用抽样方法,抽取南京某大学大一年级心理委员198名、非心理委员210名进行问卷调查,使用SPSS 21.0软件对数据进行统计分析.结果 培训前心理委员心理健康工作的内容认知与实际技能得分与非心理委员差异均无统计学意义(t值分别为0.34,-0.08,P值均>0.05).配对样本t检验显示,心理委员培训后在内容认知、实际技能、合格预期维度评分均高于培训前(t值分别为23.34,23.21,3.30,P值均<0.01).经过培训,心理委员对于工作职责与基本助人技能、人际沟通、大学生常见心理问题、班级心理活动开展、心理咨询、心理障碍识别、团体辅导、危机干预相关知识的了解程度和相应技能评分均高于培训前(P值均<0.01).结论 专业能力培训可提高高校新任心理委员心理健康工作的知识和技能,并对其态度产生积极变化.     

呼吸科专业护士核心能力的界定及评价

目的：探讨核心能力培训在呼吸科专业护士在职培训中应用,提高呼吸科专业护士专科护理能力。方法：通过问卷调查的方法确定呼吸科专业护士的核心能力培训需求,制定呼吸科专业护士核心能力培训模块,分层培训,比较培训前后护士的理论、技能成绩及患者、医生等对护理工作的满意度。结果：在呼吸科实施护士核心能力培训2年后,护士的理论、技能考核成绩明显提高,新护士的临床适应周期缩短,患者、医生、护士的满意度均提高。结论：呼吸科护士核心能力培训,有利于提高专科护理水平,为患者提供优质浦意的护理服务。     

Supporting people with AIDS and their carers in rural South Africa: possibilities and challenges

Under-served rural areas--home to over half of people in sub-Saharan Africa--bear a heavy HIV/AIDS burden. We present a case study of the existence and quality of support networks available to people with AIDS and their carers in a South African rural area. Drawing on 45 interviews and 13 focus groups, we identify key local HIV/AIDS-relevant actors and agencies in civil society, the public and the private sectors. The most effective support comes from families and neighbours, volunteer health workers and two lone missionaries. This support is undermined by counter-productive responses by faith-based organisations, traditional healers and local leaders, and by poor levels of support from public and private sector agencies. We discuss ways in which existing and latent networks might best be strengthened and supported.     

Balancing satisfaction and stress: carer burden among White and British Asian Indian carers of stroke survivors

Objectives: This paper presents the findings of a qualitative study exploring White and British Indian informal stroke carers’ experiences of caring, factors contributing to their stress, and strategies used to overcome stress.

Design: A qualitative approach involving in-depth interviews was used to explore informal carers’ experiences of caring for stroke survivors and the stress of caring at one and three to six months from the onset of stroke. Interviewers bilingual in English and Gujarati or Punjabi conducted interviews with carers. Socio-demographic data of carers and stroke survivors were collected at one, and three to six months by dedicated stroke research nurses.

Results: A total of 37 interviews with carers caring for stroke survivors with a wide range of physical and mental impairments were completed. A majority of carers had assumed the task of caring within a few weeks of the stroke. Irrespective of ethnicity, carers’ emotional and physical well-being was undermined by the uncertainty and unpredictability of caring for stroke survivors, and meeting their expectations and needs. The strain of managing social obligations to care was common to all carers irrespective of gender and ethnicity, but the higher levels of anxiety and depression reported by Indian British female carers appeared to stem from the carers’ pre-existing physical ailments, their cultural and religious beliefs, and household arrangements. Carers’ strain in extended households was exacerbated by the additional responsibility of caring for other dependent relatives.

Conclusion: Since the role of carers is clearly indispensable in the successful rehabilitation of survivors, it is vital to ensure that their well-being is not undermined by a lack of information and training, and that their need for professional support is prioritised.     

South Asian diets and insulin resistance

A role of dietary nutrients in relation to insulin resistance has been suggested but conclusive evidence in human beings is lacking. Asian Indians and South Asians are prone to develop insulin resistance and the metabolic syndrome. In the present paper, data pertaining to nutrient intake, insulin resistance and cardiovascular risk factors in Asian Indians and South Asians have been reviewed. In these populations, several dietary imbalances have been reported: low intake of MUFA, n-3 PUFA and fibre, and high intake of fats, saturated fats, carbohydrates and trans-fatty acids (mostly related to the widespread use of Vanaspati, a hydrogenated oil). Some data suggest that these nutrient imbalances are associated with insulin resistance, dyslipidaemia and subclinical inflammation in South Asians. Specifically, in children and young individuals, a high intake of n-6 PUFA is correlated with fasting hyperinsulinaemia, and in adults, high-carbohydrate meal consumption was reported to cause hyperinsulinaemia, postprandial hyperglycaemia and hypertriacylglycerolaemia. Dietary supplementation with n-3 PUFA leads to an improved lipid profile but not insulin sensitivity. Inadequate maternal nutrition in pregnancy, low birth weight and childhood 'catch-up' obesity may be important for the development of the metabolic syndrome and diabetes. Even in rural populations, who usually consume traditional frugal diets, there is an increasing prevalence of cardiovascular risk factors and the metabolic syndrome due to changes in diets and lifestyle. Nationwide community intervention programmes aimed at creating awareness about the consequences of unhealthy food choices and replacing them by healthy food choices are urgently needed in urban and rural populations in India, other countries in South Asia and in migrant South Asians.     

Cultural stereotypes of women from South Asian communities: mental health care professionals' explanations for patterns of suicide and depression

Low rates of treated depression and high rates of suicide in women from some South Asian communities are evident in epidemiological studies in the UK. It is argued here that explanations for these apparent differences are likely to be located in stereotypes of repressive South Asian cultures. This small scale study, utilising focus groups and individual interviews, sought to explore the construction of cultural stereotypes within mental health discourse with specific reference to stereotypes of women from South Asian communities. Mental health carers from a UK inner city area of relatively high social deprivation were targeted. Focus groups were conducted with a range of mental health care professionals who worked in both inpatient and outpatient mental health care services. In addition, individual interviews were conducted with consultant psychiatrists and General Practitioners. Extensive reference is made in this paper to the content of focus groups and interviews and how health carer's knowledge about and experience of South Asian cultures and caring for women from these communities was contextualised. Mental health care professionals constructed cultural difference in terms of fixed and immutable categories which operated to inferiorise Britain's South Asian communities. It is argued that their knowledge is constructed upon stereotypes of western culture as superior to a construction of eastern cultures as repressive, patriarchal and inferior to a western cultural ideal. Ultimately, it is argued that these stereotypes become incorporated as 'fact' and have the potential to misdirect diagnosis and therefore, also misdirect treatment pathways.     

医院感染管理专职人员专业胜任力评价体系的构建

目的 构建医院感染管理专职人员专业胜任力量化评价体系,通过科学评价为专职人员培养提供科学依据。方法 利用文献资料和经验总结构建评价要点,通过专家咨询法筛选评价要点并计算评价要点的权重系数,由专家组为各评估要点设计等级化的评价内容选项并赋予分值。每项评价要点得分与权重的乘积即为此要点得分,所有评价要点得分合计计算被评价者总得分。结果 评价体系包括“基础条件”“医院感染识别能力”“医院感染监测能力”“医院感染防控技术应用能力”,“应急处置能力”“组织协调能力”“质量改进能力”“教育培训能力”和“感染防控专业科研能力”共9个维度,25项评价要点,每项评价要点包含3项等级量化评分内容。专家问卷咨询的内部一致性信度Cronbach’s α系数为0.873,总内容效度指数(S-CVI)为0.868,条目内容效度(I-CVI)范围为0.71～1。结论 本研究构建的量化评价体系信度、效度结果满足要求,评价体系科学可行,用于医院感染管理专职人员专业胜任力的科学评价,可以有效识别能力短板,确定培养方向和重点,为医疗机构医院感染管理专职人员的人才培养和梯队建设提供科学依据,促进医院高质量发展。     

Voices of South Asian women: immigration and mental health

PURPOSE: This qualitative research aimed to elicit experiences and beliefs of recent South Asian immigrant women about their major health concerns after immigration. METHODS: Four focus groups were conducted with 24 Hindi-speaking women who had lived less than five years in Canada. The audiotaped data were transcribed, translated, and analyzed by identification of themes and subcategories. RESULTS: Mental health (MH) emerged as an overarching health concern with three major themes i.e. appraisal of the mental burden (extent and general susceptibility), stress-inducing factors, and coping strategies. Many participants agreed that MH did not become a concern to them until after immigration. Women discussed their compromised MH using verbal and symptomatic expressions. The stress-inducing factors identified by participants included loss of social support, economic uncertainties, downward social mobility, mechanistic lifestyle, barriers in accessing health services, and climatic and food changes. Women's major coping strategies included increased efforts to socialize, use of preventative health practices and self-awareness. CONCLUSION: Although participant women discussed a number of ways to deal with post-immigration stressors, the women's perceived compromised mental health reflects the inadequacy of their coping strategies and the available resources. Despite access to healthcare providers, women failed to identify healthcare encounters as opportunities to seek help and discuss their mental health concerns. Health and social care programs need to actively address the compromised mental health perceived by the studied group.     

学校卫生保健教师专业能力标准的构建

目的构建适合学校卫生保健教师岗位任务需要的专业能力标准及其评价模型,为中小学校卫生保健教师队伍的专业化建设提供依据。方法采用岗位任务分析、质性访谈、专家咨询法筛选75项能力标准条目,对上海市16个行政区教育局卫生专干、教研员、中小学校校长、卫生保健教师及我国首届卫生教育专业本科毕业生共计282人进行问卷调研;采用项目分析确定各能力条目的适当性,探索性因子分析构建学校卫生保健教师专业能力标准的指标维度和结构特征。结果所构建的学校卫生保健教师能力标准体系由四大领域(基本素养、学校健康教育、学校基本卫生保健服务、学校卫生管理)、9个能力维度、70项具体的能力指标组成。9个维度包括"师德修养""专业通识素养""协助应对紧急/意外健康事件和管理常见病/慢性病""辅助预防接种和学生健康评估""监测/沟通学生健康状况""具备健康教育知识和教学技能""有效实施健康教育活动并持续改进效果""管理校园传染病和环境/饮水/食品安全""监测学校卫生状况并持续优化学校卫生管理策略"。能力标准总体系Cronbachα系数为0.98,各维度Cronbachα系数为0.86～0.96;总体系折半信度系数0.93,各维...     

Metabolic syndrome in children: current issues and South Asian perspective

OBJECTIVE: The objective of this review is to discuss definition, determinants, and management issues of the metabolic syndrome in children with a focus on South Asians. METHODS: The literature search was done using the PubMed search engine (National Library of Medicine, Bethesda, MD, USA). Manual searches for other important references and medical databases were also done. RESULTS: There is a need for an integrated definition of the metabolic syndrome in children and adolescents, taking cognizance of the ethnic-specific variations. Obesity and body fat patterning are important determinants of insulin resistance and the metabolic syndrome in children and ethnic variations in these parameters are seen. Excess body fat and thicker truncal subcutaneous fat are important predisposing factors for development of insulin resistance in South Asian children. Because the metabolic syndrome tracks into adulthood, its manifestations need to be recognized early for prevention of diabetes and coronary heart disease. Therapeutic lifestyle changes, maintenance of high levels of physical activity and normal weight are most important strategies; pharmacologic therapy for individual components of the metabolic syndrome is occasionally needed. CONCLUSION: The metabolic syndrome in children is an important clinical marker of diabetes and coronary heart disease in adults. In view of the rapid increase in the metabolic syndrome in most populations, high-risk screening and effective public-intervention educational programs are urgently needed.     

Cultural competency, human genomics, and the elimination of health disparities

It is unclear what impact human genomics research will have on the nation's efforts to close the gap in health disparities between and among racial/ethnic and disadvantaged groups. The literature suggests that understanding socio-economic and cultural factors are important for understanding the complex issues offer by genetic explanations of racial/ethnic differences. While this research will lead to tremendous improvements in health status of the overall population, its impact on reducing health disparities is likely to be minimal. Establishment of culturally competent systems of care, in contrast, offers great promise for reducing and eliminating health disparities.