How should we change the culture of health? A note on the margin of an outstanding debate

Aim

In 2014, Sally Davis, England’s Chief Medical Officer, proposed a paradigm shift in public health—the 5th Wave—which should focus on the culture of health. Her paper was meant to spark a debate, but this has been largely absent until now. This article argues why the concept of the culture of health needs to be incorporated into the theory of public health and shows a possible direction for applying it in practice.

Subjects and methods

Review of theoretical approaches and knowledge synthesis.

Results

Applying the culture of the health approach to change health behavior requires taking several different strands of thought into account. Any proposed effective intervention should be based on a framework including the ‘behavioral system,’ ecosocial theory, complex systems science, and school health promotion approaches. Changing culture is impeded by its complexity, but to solve this wicked problem, the focus should likely be on health promotion in schools.

Conclusion

To make interventions more effective, it is necessary for public health professionals to have an extensive debate on the interpretations of the role of the culture of health as highlighted in this article.

     

Evaluation of a continuing educational intervention for primary health care professionals about nutritional care of patients at home

Objective

Evaluate the effectiveness of a continuing educational intervention on primary health care professionals’ familiarity with information important to nutritional care in a palliative phase, their collaboration with other caregivers, and their level of knowledge about important aspects of nutritional care.

Design

Observational cohort study.

Setting

10 primary health care centers in Stockholm County, Sweden.

Participants

140 district nurses/registered nurses and general practitioners/physicians working with home care.

Intervention

87 professionals participated in the intervention group (IG) and 53 in the control group (CG). The intervention consisted of a web-based program offering factual knowledge; a practical exercise linking existing and new knowledge, abilities, and skills; and a case seminar facilitating reflection.

Measurements

The intervention’s effects were measured by a computer-based study-specific questionnaire before and after the intervention, which took approximately 1 month. The CG completed the questionnaire twice (1 month between response occasions). The intervention effects, odds ratios, were estimated by an ordinal logistic regression.

Results

In the intra-group analyses, statistically significant changes occurred in the IG’s responses to 28 of 32 items and the CG’s responses to 4 of 32 items. In the inter-group analyses, statistically significant effects occurred in 20 of 32 statements: all 14 statements that assessed familiarity with important concepts and all 4 statements about collaboration with other caregivers but only 2 of the 14 statements concerning level of knowledge. The intervention effect varied between 2.5 and 12.0.

Conclusion

The intervention was effective in increasing familiarity with information important to nutritional care in a palliative phase and collaboration with other caregivers, both of which may create prerequisites for better nutritional care. However, the intervention needs to be revised to better increase the professionals’ level of knowledge about important aspects of nutritional care.

     

Assessment of health professional education across five Asian countries—a protocol

Background

There is an increasing consensus globally that the education of health professionals is failing to keep pace with scientific, social, and economic changes transforming the healthcare environment. This catalyzed a movement in reforming education of health professionals across Bangladesh, China, India, Thailand, and Vietnam who jointly volunteered to implement and conduct cooperative, comparative, and suitable health professional education assessments with respect to the nation’s socio-economic and cultural status, as well as domestic health service system.

Methods

The 5C network undertook a multi-country health professional educational study to provide its countries with evidence for HRH policymaking. Its scope was limited to the assessment of medical, nursing, and public health education at three levels within each country: national, institutional, and graduate level (including about to graduate students and alumni).

Results

This paper describes the general issues related to health professional education and the protocols used in a five-country assessment of medical, nursing, and public health education. A common protocol for the situation analysis survey was developed that included tools to undertake a national and institutional assessment, and graduate surveys among about-to-graduate and graduates for medical, nursing, and public health professions. Data collection was conducted through a mixture of literature reviews and qualitative research.

Conclusions

The national assessment would serve as a resource for countries to plan HRH-related future actions.

     

Human rights and mental health in post-apartheid South Africa: lessons from health care professionals working with suicidal inmates in the prison system

Background

During the era of apartheid in South Africa, a number of mental health professionals were vocal about the need for socio-economic and political reform. They described the deleterious psychological and social impact of the oppressive and discriminatory Nationalist state policies. However, they remained optimistic that democracy would usher in positive changes. In this article, we consider how mental health professionals working in post-apartheid South Africa experience their work.

Methods

Our aim was to describe the experience of mental health professionals working in prisons who provide care to suicidal prisoners. Data were collected from in-depth semi-structured interviews and were analyzed using thematic content analysis.

Results

Findings draw attention to the challenges mental health professionals in post-apartheid South Africa face when attempting to provide psychological care in settings where resources are scarce and where the environment is anti-therapeutic. Findings highlight the significant gap between current policies, which protect prisoners’ human rights, and every-day practices within prisons.

Conclusions

The findings imply that there is still an urgent need for activism in South Africa, particularly in the context of providing mental health care services in settings which are anti-therapeutic and inadequately resourced, such as prisons.

     

Attitudes of health care professionals towards Mutual Health Organizations: evidence from two regions in the Northwest Province of Cameroon

Aim

Mutual Health Organizations (MHOs) can be a potential means to reduce barriers to health care in low-income countries with poor access to health care and high health care costs for the population. One important challenge is the relationship between MHOs and health care professionals (HCPs). Our study evaluates HCPs experiences of, and attitudes towards MHOs.

Subjects and Methods

A total of 210 HCPs from three private and two public clinics in Kumbo and Bamenda (Cameroon) were interviewed with a structured questionnaire, where answers are quantified by a five-point ordinal scale.

Results

We identified regional and institutional differences. HCPs in Kumbo and in private clinics tend to have a more positive attitude towards MHOs than in Bamenda and in public clinics (mean 1.66 vs. 2.02, respectively 1.72 vs. 2.05,). HCPs in Bamenda and in public clinics report more negative experiences with MHO members (mean 2.86 vs. 3.67, respectively 2.72 vs. 3.56) and rank quality of health care lower.

Conclusion

Our findings underline the important role of HCPs in the context of MHOs; therefore, programs should aim to involve HCPs in respect of regional and institutional differences.

     

Perceptions of healthcare professionals on the usage of percutaneous endoscopic gastrostomy in a teaching hospital from a middle-income South East Asian country

Objective

To explore the perceptions of healthcare professionals’ (HCPs) in a South East Asian nation towards percutaneous endoscopic gastrostomy (PEG) feeding.

Design

Semi-structured, qualitative interviews.

Settings

A teaching hospital in Kuala Lumpur, Malaysia.

Participants

A total of 17 healthcare professionals aged 23-43 years, 82% women.

Results

Thematic analysis revealed five themes that represent HCPs’ perceptions in relation to the usage of PEG feeding: 1) knowledge of HCPs, 2) communication, 3) understanding among patients, and 4) financial and affordability.

Conclusion

The rationale for reluctance towards PEG feeding observed in this regions was explained by lack of education, knowledge, communication, team work, and financial support. Future studies should assess the effects of educational programmes among HCPs and changes in policies to promote affordability on the utilization of PEG feeding in this region.

     

A model for analysis,systemic planning and strategic synthesis for health science teaching in the Democratic Republic of the Congo: a vision for action

Background

The problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? This is of utmost importance in primary health care.

Methods

Taking into account the level of training of secondary-level nurses in the Democratic Republic of the Congo (DRC), a systemic approach, based on the PRECEDE PROCEED model of analysis, led to a better understanding of the educational determinants and of the factors favourable to a better match between training in health sciences and the expected competences of the health professionals. This article must be read on two complementary levels: one reading, focused on the methodological process, should allow our findings to be transferred to other problems (adaptation of a health promotion model to the educational sphere). The other reading, revolving around the specific theme and results, should provide a frame of reference and specific avenues for action to improve human resources in the health field (using the results of its application in health science teaching in the DRC).

Results

The results show that it is important to start this training with a global and integrated approach shared by all the actors. The strategies of action entail the need for an approach taking into account all the aspects, i.e. sociological, educational, medical and public health.

Conclusions

The analysis of the results shows that one cannot bring any change without integrated strategies of action and a multidisciplinary approach that includes all the complex determinants of health behaviour, and to do it within the organization of local structures and institutions in the ministry of health in the DRC.

     

Perspectives on the causes of undernutrition of community-dwelling older adults: A qualitative study

Objectives

Undernutrition is a major health concern particularly in vulnerable older adults. The present study aimed to reveal the causes of undernutrition as reported by community-dwelling older adults.

Design

Twenty-five semi-structured interviews and two focus group discussions were performed and analyzed.

Setting

Community-dwelling.

Participants

Older adults.

Measurements

A questionnaire on demographics, Short Nutritional Assessment Questionnaire 65+ and interviews on the potential causes of undernutrition.

Results

33 older adults agreed to participate in the interviews and focus groups. Our findings indicate that a wide variety of causes of undernutrition, both modifiable and non-modifiable, were mentioned by the older adults. Many modifiable causes of undernutrition were reported in the mental, social or food & appetite theme, such as poor food quality provided by meal services, the inability to do groceries, loneliness and mourning. Non-modifiable causes included, forgetfulness, aging, surgery and hospitalization.

Conclusions

This study provides guidance to better understand the underlying causes of undernutrition from an older adult’s perspective. The modifiable causes provide specific direction towards practical implications that might decrease or prevent undernutrition. Non-modifiable causes should raise awareness of an increased risk of undernutrition by health professionals in primary and secondary care, caregivers and family members.

     

Living with invisible illness: social support experiences of individuals with systemic lupus erythematosus

Purpose

Because symptoms are not immediately visible to others, systemic lupus erythematosus (SLE) is often considered an invisible illness. This invisibility can reduce the social support received from network members and adversely affect the quality of life. In the light of this, social support from formal support groups and from medical professionals can be particularly important; however, literature examining support from these sources is scarce. The purpose of this study was to explore the nature and impact of social support from medical professionals and from support groups for individuals with SLE.

Methods

Participants responded to open-ended questions on an online survey administered by Lupus UK and Lupus Group Ireland. Qualitative data from 133 participants (77 % of respondents) were analysed.

Results

Thematic analysis revealed three overarching themes: invisibility, inadequate care, and validation. Respondents felt that their SLE was invisible to social ties and to medical professionals. In addition, treatment and organisational factors in health care contributed to the sense of inadequate care. Finally, validation was derived from informational and emotional support from both support groups, and from some medical professionals.

Conclusions

The findings suggest that individuals with SLE have mixed experiences in terms of contact with medical professionals and involvement with support groups. Furthermore, low public awareness of lupus appears to contribute to feelings of invisibility for patients, leading to loneliness and isolation. Medical professionals might benefit from skills training in terms of managing the psychosocial consequences of lupus.

     

Identifying research priorities for public health research to address health inequalities: use of Delphi-like survey methods

Background

In the funding of health research and public health research it is vital that research questions posed are important and that funded research meets a research need or a gap in evidence. Many methods are used in the identification of research priorities, however, these can be resource intensive, costly and logistically challenging. Identifying such research priorities can be particularly challenging for complex public health problems as there is a need to consult a number of experts across disciplines and with a range of expertise. This study investigated the use of Delphi-like survey methods in identifying important research priorities relating to health inequalities and framing tractable research questions for topic areas identified.

Methods

The study was conducted in two phases, both using Delphi-like survey methods. Firstly, public health professionals with an interest in health inequalities were asked to identify research priorities. Secondly academic researchers were asked to frame tractable research questions relating to the priorities identified. These research priorities identified using Delphi-like survey methods were subsequently compared to those identified using different methods.

Results

A total of 52 public health professionals and 21 academics across the United Kingdom agreed to take part. The response rates were high, from public health professionals across three survey rounds (69%, 50% and 40%) and from academics across one round (52%), indicating that participants were receptive to the method and motivated to respond. The themes identified as encompassing the most important research priorities were mental health, healthy environment and health behaviours. Within these themes, the topic areas that emerged most strongly included community interventions for prevention of mental health problems and the food and alcohol environment. Some responses received from academic researchers were (as requested) in the form of tractable research questions, whereas others contributed further potential topic areas instead.

Conclusions

Delphi-like survey methods are practical and productive as a means of obtaining opinions from a wide number of relevant experts identifying potential priority topic areas for research; however, this method is less appropriate for framing tractable research questions.

     

Age and IQ Explained Working Memory Performance in a RCT with Fatty Fish in a Group of Forensic Inpatients

Objectives

To investigate the effect of a long-term fatty fish intervention on a pure cognitive mechanism important for self-regulation and mental health, i.e. working memory (WM), controlling for age and IQ.

Design

A randomized controlled trial.

Setting

A forensic facility.

Participants

Eighty-four young to middle aged male forensic inpatients with psychiatric disorders.

Intervention

Consumption of farmed salmon or control meal (meat) three times a week during 23 weeks.

Measurement

Performance on WM tasks, both accuracy and mean reaction time, were recorded pre and post intervention.

Results

Performance on a cognitive functioning tasks taxing WM seemed to be explained by age and IQ.

Conclusion

Fatty fish consumption did not improve WM performance in a group of young to middle aged adults with mental health problems, as less impressionable factors such as aging and intelligence seemed to be the key components. The present study improves the knowledge concerning the interaction among nutrition, health and the aging process.

     

Health literacy of patients admitted for elective surgery

Aim

Patients with limited health literacy have poorer surgical outcomes. However, current studies assessing the prevalence of limited health literacy in patients expecting surgery are small scale. We aimed to provide insight into the health literacy level of patients undergoing planned surgery.

Subject and Methods

Patients aged ≥18 years visiting the preoperative screening department were approached in the waiting area and invited to participate in a brief interview including the Functional Communicative Critical Health Literacy (FCCHL).

Results

In total, 225 patients (84.9% response) were studied. Based on the FCCHL, 37.3% of the patients were classified as having limited health literacy. The mean score in the critical domain (2.7?±?0.9) was lower than scores in the functional (3.3?±?0.6) and communicative (3.3?±?0.6) domains.

Conclusion

More than one third of the patients admitted to the hospital for surgery had limited health literacy. Healthcare professionals should be aware of the different health literacy levels and tailor their information provision strategies accordingly.

     

Genetics in the medical and psychosocial practice: on the role of value hierarchies in counselling

Aim

Values and value hierarchies play an important role in different health and counselling settings. Since personal values underlie our actions, guide our decisions and influence interactions, they can be assumed to influence doctor-patient relationships and therefore especially counselling situations. The aim of our study is to provide a sound empirical contribution to the increasing literature on values in health care settings.

Subject and methods

This article focusses on the personal values of professional groups involved in the medical and psychosocial care of patients or clients with genetic concerns. Results from 120 survey respondents who completed the Schwartz value survey reveal differences between the professional groups in their value hierarchies.

Results

There is a widespread, pan-cultural similarity regarding value hierarchies. Our results are in accordance with this universal hierarchy but show slight differences between the professional groups of the sample: Medical professionals ranked achievement and power values significantly higher. Psychosocial professionals, on the other hand, ranked universalism and hedonism values significantly higher than medical professionals.

Conclusion

Values motivate actions and serve as standards to evaluate them. As they can be presumed to influence the doctor-patient relationship and health care decisions, it is worth discussing differences in values and value hierarchies. Particular attention to that topic might be of interest for training and further education.

     

Mental health assessments in refugees and asylum seekers: evaluation of a tablet-assisted screening software

Background

Mental health problems resulting from persecution and forced migration are very common among refugees and asylum seekers and evolve into a major public health challenge in hosting societies. Language barriers often prevent timely access to appropriate health care, leading to chronic trajectories and abortive social integration. Tools for multilingual screening and assessment could be of great benefit for this particularly vulnerable population as well as for policy makers. This study aimed at testing the reliability, feasibility and usability of the Multi-Adaptive Psychological Screening Software (MAPSS), a newly developed Audio Computer-Assisted Self-Interview Software (ACASI) for touchscreen devices, for screening purposes in a clinical setting.

Methods

In a randomized cross-over design including both MAPSS and paper-pencil clinician-administered interviews, 30 treatment-seeking refugees completed clinical measures and a feasibility questionnaire to rate the user interface of MAPSS. Five professionals performed given tasks in MAPSS and completed usability questionnaires for the administration interface.

Results

Results showed no differences between the two assessment modalities with regard to symptom scores. The findings suggest good feasibility and usability of MAPSS in traumatized refugees. The administration via MAPSS was significantly shorter than the paper-pencil interview.

Conclusion

MAPSS may be a cost-effective, flexible and valid alternative to interpreter-based psychometric screening and assessment.

     

Relationship between diet-related indicators and overweight and obesity in older adults in rural Japan

Objectives

To identify the relationship between diet-related indicators and overweight and obesity in older adults in rural Japan.

Design

Cross-sectional survey.

Setting

Obira, Hokkaido, Japan.

Participants

Local residents aged between 65 and 74 years, except for those with poor health, were included.

Intervention

A health- and diet-related questionnaire was applied to participants house-to-house by trained health professionals.

Measurements

The following indicators were examined: number of meals, number of balanced meals, food diversity, food group diversity, chewing ability, alcohol intake habit, smoking habit, instrumental activities of daily living scores, age, and residing alone or with family.

Results

Of 550 residents, 317 residents completely responded to the questionnaire. Of these, 41 were had low body mass index (BMI≤20) and were excluded. This resulted in a sample of 307 subjects comprising 117 men and 190 women; 37.6% and 46.8% of men and women were classified as obese (BMI≥25), respectively. Women with a normal BMI (20<BMI<25) had significantly higher food diversity in diet-related indicators compared with women with high BMI. The mean number of meals per day of normal men was significantly higher than of obese men. Using logistic regression analysis (stepwise), it was found that the number of meals per day was associated with obesity in men (OR=3.02; 95% CI 0.91–9.98; P=0.071), and food diversity was significantly associated with obesity in women (OR=1.95; 95% CI 1.12–3.38; P=0.018).

Conclusions

The associations between dietary indicators and obesity differed by sex. Food diversity may be a potential indicator to measure nutritional status in women.

     

An extended cost-effectiveness analysis of schizophrenia treatment in India under universal public finance

Background

Schizophrenia remains a priority condition in mental health policy and service development because of its early onset, severity and consequences for affected individuals and households.

Aims and methods

This paper reports on an ‘extended’ cost-effectiveness analysis (ECEA) for schizophrenia treatment in India, which seeks to evaluate through a modeling approach not only the costs and health effects of intervention but also the consequences of a policy of universal public finance (UPF) on health and financial outcomes across income quintiles.

Results

Using plausible values for input parameters, we conclude that health gains from UPF are concentrated among the poorest, whereas the non-health gains in the form of out-of-pocket private expenditures averted due to UPF are concentrated among the richest income quintiles. Value of insurance is the highest for the poorest quintile and declines with income.

Conclusions

Universal public finance can play a crucial role in ameliorating the adverse economic and social consequences of schizophrenia and its treatment in resource-constrained settings where health insurance coverage is generally poor. This paper shows the potential distributional and financial risk protection effects of treating schizophrenia.

     

Leisure,risk awareness and personality factors among female students

Purpose

The physical and psychological well-being of students is a subject of concern and public health. This study addresses the question of leisure among female students, their risk assessment concerning these leisure activities and the possible relations with the Multidimensional Health Locus of Control (MHLC).

Methods

A sample of 61 female students completed two questionnaires about their leisure activities and the risk assessment and the Multidimensional Health Locus of Control (MHLC) Scale. Several statistical methods were used.

Results

Female students do not consider their leisure activities risky. Female students are more internal than external. The power given to the others, in particular to the family, can play a positive role in the awareness of risks, and thus it can favor good health.

Conclusion

If most of the hypotheses are confirmed, certain invalidations give rise to new reflections concerning the direction that preventive action should take for the physical and psychological well-being of female students.

     

Acute interstitial nephritis,toxic hepatitis and toxic myocarditis following multiple Asian giant hornet stings in Shaanxi Province,China

Objectives

During July to October 2013, the Asian giant hornet has killed 42 and injured 1,675 people in the southern part of Shaanxi Province, China. This study investigated this unusual and frequent public health event.

Methods

During the 3 months, 103 patients with severe Asian hornet stings were hospitalized in our hospital. Clinical data were collected using a standardized data collection form which included sex, age, length of hospital stay and medical recorder.

Results

After physical examination and laboratory investigation, 25.2, 46.6 and 44.7 % of the patients were found with varying degrees of acute interstitial nephritis, acute toxic hepatitis and acute toxic myocarditis, respectively. After timely and appropriate treatment including removal of the stings and the use of intravenous methylprednisolone and antihistamines, the kidney function, liver function and heart function of 99 patients recovered within 1 month, while four patients died.

Conclusions

This study provided a good opportunity for recognizing the effect of Asian giant hornet stings and evaluating this serious public health event.

     

The characteristics of diagnosis,patient care and education of asthma and COPD patients from the perspective of the actors in the Hungarian healthcare system

Aim

In our study, we wanted to assess the workload under which health professionals work with asthmatic and COPD patients, the average time spent on investigation, patient care, patient education and on checking their previously acquired knowledge. We also wanted to know who educates these patients to the proper use of inhalation devices and how often they check their usage.

Subject and methods

We have conducted personal interviews and online surveys among health professionals. We made distinguished time spent on “freshly” diagnosed patients, routine control examinations and previously diagnosed patients. Participants: asthma nurses from the pulmonary care network, hospital departments, specialized practices and pulmonary care units; pulmonologists; specialists from internal medicine departments and emergency health care centres and GPs (general practitioners).

Results

Our results show that in every group of healthcare professionals involved in the treatment of these patients, the number of daily meetings between healthcare professionals and patients is remarkably high (an average of 30 patients a day), and there is not enough time for patient education. Checking the proper usage of the device is often skipped and no appropriate educational materials are available.

Conclusions

Patients are not likely to have sufficient knowledge of their disease or the appropriate usage of their inhalation devices. Reorganization of the Hungarian COPD and asthmatic patient care system is needed as soon as possible to provide effective patient education and patient care.