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1.
Vivian Lin BA MPH DrPH Rachel Canaway MSH PhD Bronwyn Carter DipApSc PostGradCert Rehab MPH Lenore Manderson BA Asian Stud. PhD 《Health expectations》2015,18(5):1451-1462
Context
People with chronic conditions who are often in contact with the health‐care system are well placed to reflect on how services meet their needs. Some research characterizes people who use complementary and alternative medicines (CAMs) as a distinct group who opt out of the mainstream health system. However, many CAM users are people with chronic or terminal health conditions who concurrently use mainstream health‐care services. The difference in perspectives between people with chronic conditions who do or do not use CAM has received little attention by researchers.Objective
To explore the views of CAM users with chronic conditions and identify their perspectives on the health system.Design and Setting
In‐depth interviews and a self‐administered questionnaire were used to collect data on care‐seeking, self‐management and CAM use among people with type 2 diabetes and/or cardiovascular disease living in Victoria, Australia.Results
One in four CAM practitioner users was partly motivated to use CAM as a result of their dissatisfaction with the mainstream health system. In general, their dissatisfaction mirrored the concerns of the general population. This included the perceived lack of a humanistic or person‐centred approach, which was central to problems relating to individuals'' clinical encounters as well as to health system design.Discussion and Conclusion
Participants'' concerns suggest room for improvement in the Australian health system to better reflect patients'' needs. A systems approach is needed to reorient health‐care practitioners to modify the organization of care because of the incentives embedded in the structure of the health‐care system. 相似文献2.
Parents' experiences of living with a child with a long‐term condition: a rapid structured review of the literature
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Joanna Smith BSc MSc PhD RSCN Francine Cheater MA PhD RGN Hilary Bekker BSc MSc PhD 《Health expectations》2015,18(4):452-474
Background
Living with a child with a long‐term condition can result in challenges above usual parenting because of illness‐specific demands. A critical evaluation of research exploring parents'' experiences of living with a child with a long‐term condition is timely because international health policy advocates that patients with long‐term conditions become active collaborators in care decisions.Methods
A rapid structured review was undertaken (January 1999–December 2009) in accordance with the United Kingdom Centre for Reviews and Dissemination guidance. Three data bases (MEDLINE, CINAHL, PSYCINFO) were searched and also hand searching of the Journal of Advanced Nursing and Child: Care, Health and Development. Primary research studies written in English language describing parents'' experiences of living with a child with a long‐term condition were included. Thematic analysis underpinned data synthesis. Quality appraisal involved assessing each study against predetermined criteria.Results
Thirty‐four studies met the inclusion criteria. The impact of living with a child with a long‐term condition related to dealing with immediate concerns following the child''s diagnosis and responding to the challenges of integrating the child''s needs into family life. Parents'' perceived they are not always supported in their quest for information and forming effective relationships with health‐care professionals can be stressful. Although having ultimate responsibility for their child''s health can be overwhelming, parents developed considerable expertise in managing their child''s condition.Conclusion
Parents'' accounts suggest they not always supported in their role as manager for their child''s long‐term condition and their expertise, and contribution to care is not always valued. 相似文献3.
Development of a model to guide decision making in amyotrophic lateral sclerosis multidisciplinary care
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Anne Hogden PhD David Greenfield PhD Peter Nugus PhD Matthew C Kiernan PhD 《Health expectations》2015,18(5):1769-1782
Background
Patients with amyotrophic lateral sclerosis (ALS) face numerous decisions for symptom management and quality of life. Models of decision making in chronic disease and cancer care are insufficient for the complex and changing needs of patients with ALS .Objective
The aim was to examine the question: how can decision making that is both effective and patient‐centred be enacted in ALS multidisciplinary care?Setting and participants
Fifty‐four respondents (32 health professionals, 14 patients and eight carers) from two specialized ALS multidisciplinary clinics participated in semi‐structured interviews. Interviews were transcribed, coded and analysed thematically.Results
Comparison of stakeholder perspectives revealed six key themes of ALS decision making. These were the decision‐making process; patient‐centred focus; timing and planning; information sources; engagement with specialized ALS services; and access to non‐specialized services. A model, embedded in the specialized ALS multidisciplinary clinic, was derived to guide patient decision making. The model is cyclic, with four stages: ‘Participant Engagement’; ‘Option Information’; ‘Option Deliberation’; and ‘Decision Implementation’.Discussion
Effective and patient‐centred decision making is enhanced by the structure of the specialized ALS clinic, which promotes patients'' symptom management and quality of life goals. However, patient and carer engagement in ALS decision making is tested by the dynamic nature of ALS, and patient and family distress. Our model optimizes patient‐centred decision making, by incorporating patients'' cyclic decision‐making patterns and facilitating carer inclusion in decision processes.Conclusions
The model captures the complexities of patient‐centred decision making in ALS. The framework can assist patients and carers, health professionals, researchers and policymakers in this challenging disease environment. 相似文献4.
Perceptions and attitudes towards exercise among Chinese elders – the implications of culturally based self‐management strategies for effective health‐related help seeking and person‐centred care
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Background
Encouraging the uptake of physical activity among a culturally diverse elderly population presents a challenge for health‐care providers across the world. Little is known about the health‐care needs of these populations, for example the increasingly ageing group of Chinese elders in many parts of the world who are now facing later life and increasing challenges to their health.Objective
This study aimed to explore behaviours and attitudes towards exercise among older Chinese immigrants in the UK to provide insights into the health of Chinese populations in the UK and elsewhere.Design
A Grounded Theory approach using purposive and theoretical sampling with in‐depth semi‐structured interviews.Setting and participants
Chinese elders were recruited from Chinese communities in the North West of England. Thirty‐three participants were interviewed face‐to‐face and audio‐recorded.Results
Participants self‐managed exercise based on cultural perceptions of health and ingrained Chinese values. Professional support and information was lacking and relied on folk norms rather than person‐centred recommendations for healthy living. Inappropriate exercise regimes could act as a substitute for seeking health‐related advice when exercise was often used as a self‐monitored barometer to assess their perceived health status.Discussion and conclusion
Chinese elders may undertake inappropriate exercise, leading to high‐risk situations, if appropriate professional information is not provided. Health‐care practitioners should devote attention to understanding Chinese elders'' attitudes towards exercise, as this may ultimately lead to successful health promotion activities. A person‐centred approach that acknowledges and works with self‐management practices is advocated. 相似文献5.
Rhian Parker PhD Laura Forrest PhD James McCracken PG Dip Ian McRae PhD 《Health expectations》2014,17(5):733-740
Background
Nurses are becoming increasingly important as providers of primary health care in Australia. In November 2010, Medicare provider rights and Pharmaceutical Benefits Scheme rights for nurse practitioners, working in private practice and in collaboration with a medical practitioner, were introduced in Australia. Although international evidence suggests that nurse practitioners would be appropriate and acceptable providers of care at the first point of contact, such as primary health care, there is little Australian evidence about what care consumers are willing to accept from nurse practitioners.Objectives
To ascertain what care Australian health‐care consumers would accept from nurse practitioners in this setting.Participants
Australian adults over 18 years of age.Methods
National Survey delivered online. Information about the survey was disseminated through a media campaign, stakeholder engagement and through the health‐care consumer networks nationally.Results
The total number of respondents that started the survey was n = 1883. Ninety‐five percentage (n = 1784) of respondents completed the survey. The majority of respondents were women, aged 25–54 years, had completed tertiary education and had an annual household income of more than A$80 000. The majority of the respondents (n = 1562, 87%) said they would be prepared to see a nurse practitioner for some of their primary health‐care needs.Conclusions
The findings of this study suggest consumers are accepting of a range of activities undertaken by nurse practitioners in primary health care and this has relevance for primary health‐care workforce mix and organization, particularly for areas that are underserved by medical practitioners. 相似文献6.
Immigrant women's experiences and views on the prevention of cervical cancer: a qualitative study
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Maria Grandahl RN MMSc Tanja Tydén PhD RNM Maria Gottvall RN Ragnar Westerling PhD MD Marie Oscarsson PhD RNM 《Health expectations》2015,18(3):344-354
Background
Many Western countries have cervical cancer screening programmes and have implemented nation‐wide human papillomavirus (HPV) vaccination programmes for preventing cervical cancer.Objective
To explore immigrant women''s experiences and views on the prevention of cervical cancer, screening, HPV vaccination and condom use.Design
An exploratory qualitative study. The Health Belief Model (HBM) was used as a theoretical framework.Setting and participants
Eight focus group interviews, 5–8 women in each group (average number 6,5), were conducted with 50 women aged 18–54, who studied Swedish for immigrants. Data were analysed by latent content analysis.Results
Four themes emerged: (i) deprioritization of women''s health in home countries, (ii) positive attitude towards the availability of women''s health care in Sweden, (iii) positive and negative attitudes towards HPV vaccination, and (iv) communication barriers limit health care access. Even though the women were positive to the prevention of cervical cancer, several barriers were identified: difficulties in contacting health care due to language problems, limited knowledge regarding the relation between sexual transmission of HPV and cervical cancer, culturally determined gender roles and the fact that many of the women were not used to regular health check‐ups.Conclusion
The women wanted to participate in cervical cancer prevention programmes and would accept HPV vaccination for their daughters, but expressed difficulties in understanding information from health‐care providers. Therefore, information needs to be in different languages and provided through different sources. Health‐care professionals should also consider immigrant women''s difficulties concerning cultural norms and pay attention to their experiences. 相似文献7.
‘The onus is on me’: primary care patient views of Medicare‐funded team care in chronic disease management in Australia
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Michele M. Foster PhD B SocWk Geoffrey K. Mitchell MBBS PhD FRACGP FAChPM 《Health expectations》2015,18(5):879-891
Background and objective
This study investigated the views of primary care patients in receipt of Medicare‐funded team care for chronic disease management (CDM) in Australia.Design
A qualitative study using a repeat in‐depth interview design.Participants and setting
Twenty‐three patients (17 female), aged 32–89, were recruited over a six‐month period from two purposively selected general practices: one urban and one regional practice in Queensland, Australia.Data collection procedure
Semi‐structured interviews were conducted with participants 6 months apart. An interview guide was used to ensure consistency of topics explored. Interviews were recorded and transcribed, and a thematic analysis was conducted.Results
Patients in this study viewed the combined contributions of a GP and other health professionals in team care as thorough and reassuring. In this case of Medicare‐funded team care, patients also saw obligations within the structured care routine which cultivated a personal ethics of CDM. This was further influenced by how patients viewed their role in the health‐care relationship. Aside from personal obligations, Medicare funding got patients engaged in team care by providing financial incentives. Indeed, this was a defining factor in seeing allied health professionals. However, team care was also preferential due to patients'' valuations of costs and benefits.Conclusion
Patients are likely to engage with a structured team care approach to CDM if there is a sense of personal obligation and sufficient financial incentive. The level of engagement in team care is likely to be optimized if patient expectations and preferences are considered in decisions. 相似文献8.
Jo Brett MSc MA BSc Sophie Staniszewska DPhD BSc Carole Mockford DPhil MA BSc Sandra Herron‐Marx PhD BA DPSN RGN John Hughes Colin Tysall Rashida Suleman 《Health expectations》2014,17(5):637-650
Background
There is an increasing international interest in patient and public involvement (PPI) in research, yet relatively little robust evidence exists about its impact on health and social care research.Objective
To identify the impact of patient and public involvement on health and social care research.Design
A systematic search of electronic databases and health libraries was undertaken from 1995 to 2009. Data were extracted and quality assessed utilizing the guidelines of the NHS Centre for Reviews and Dissemination 2009 and the Critical Appraisal Skills Programme (CASP). Grey literature was assessed using the Dixon‐Woods et al. (2005) checklist.Inclusion criteria
All study types that reported the impact PPI had on the health and/or social care research study.Main results
A total of 66 studies reporting the impact of PPI on health and social care research were included. The positive impacts identified enhanced the quality and appropriateness of research. Impacts were reported for all stages of research, including the development of user‐focused research objectives, development of user‐relevant research questions, development of user‐friendly information, questionnaires and interview schedules, more appropriate recruitment strategies for studies, consumer‐focused interpretation of data and enhanced implementation and dissemination of study results. Some challenging impacts were also identified.Conclusion
This study provides the first international evidence of PPI impact that has emerged at all key stages of the research process. However, much of the evidence base concerning impact remains weak and needs significant enhancement in the next decade. 相似文献9.
Cheryl Rathert PhD Eric S. Williams PhD Deirdre McCaughey PhD MBA Ghadir Ishqaidef PhD 《Health expectations》2015,18(2):199-209
Aim
Patient perception measures are gaining increasing interest among scholars and practitioners. The aim of this study was to empirically examine a conceptual model of patient‐centred care using patient perception survey data.Background
Patient‐centred care is one of the Institute of Medicine''s objectives for improving health care in the 21st century. Patient interviews conducted by the Picker Institute/Commonwealth Fund in the 1980s resulted in a theoretical model and survey questions with dimensions and attributes patients defined as patient‐centered.Method
The present study used survey data from patients with overnight visits at 142 U.S. hospitals.Results
Regression analysis found significant support for the theoretical model. Perceptions of emotional support had the strongest relationship with overall care ratings. Coordination of care, and physical comfort were strongly related as well.Conclusion
Understanding how patients experience their care can help improve understanding of what patients believe is patient‐centred, and of how care processes relate to important patient outcomes. 相似文献10.
Patient and service user engagement in research: a systematic review and synthesized framework
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Nathan D. Shippee PhD Juan Pablo Domecq Garces MD Gabriela J. Prutsky Lopez MD Zhen Wang PhD Tarig A. Elraiyah MBBS Mohammed Nabhan MD Juan P. Brito MBBS Kasey Boehmer BA Rim Hasan MD Belal Firwana MD Patricia J. Erwin MLS Victor M. Montori MD Msc M Hassan Murad MD MPH 《Health expectations》2015,18(5):1151-1166
11.
Rebecca Whear MSc BSc Jo Thompson‐Coon PhD BSc Kate Boddy MSc MA BSc Helen Papworth MA PGCert BA Julie Frier BM BCh BA MSc MFPH Ken Stein MB ChB MSc MD DipRACOG MRCGP FFPH 《Health expectations》2015,18(1):8-21
Aim/Background
To describe the two‐stage prioritization process being used by the UK National Institute for Health Research''s Collaboration for Leadership in Applied Health Research and Care for the South‐West Peninsula (or PenCLAHRC) – a joint health service and university partnership and reflect on implications for the wider context of priority setting in health‐care research.Method
PenCLAHRC''s process establishes the priorities of Stakeholders including service users across a regional health system for locally relevant health services research and implementation. Health research questions are collected from clinicians, academics and service users in Devon and Cornwall (UK) using a web‐based question formulation tool. There is a two‐stage prioritization process which uses explicit criteria and a wide Stakeholder group, including service users to identify important research questions relevant to the south‐west peninsula locality.Results
To date, a wide variety of health research topics have been prioritized by the PenCLAHRC Stakeholders. The research agenda reflects the interests of academics, clinicians and service users in the local area. Potential challenges to implementation of the process include time constraints, variable quality of questions (including the language of research) and initiating and maintaining engagement in the process. Shared prioritization of local health research needs can be achieved between Stakeholders from a wide range of perspectives.Conclusions
The processes developed have been successful and, with minor changes, will continue to be used during subsequent rounds of prioritization. Engagement of Stakeholders in establishing a research agenda encourages the most relevant health questions to be asked and may improve implementation of research findings and take up by service users. 相似文献12.
Managing the pain of labour: factors associated with the use of labour pain management for pregnant Australian women
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Amie Steel MPH Grad Cert Ed BHSc Jon Adams PhD MA BA David Sibbritt PhD MMedStats BMath Alex Broom PhD MA BA Cindy Gallois PhD MA BS FASSA MAPsS Jane Frawley MClSci GradCertAppSc BHSc 《Health expectations》2015,18(5):1633-1644
Background
Despite high rates of women''s use of intrapartum pain management techniques, little is known about the factors that influence such use.Objective
Examine the determinants associated with women''s use of labour pain management.Design
Cross‐sectional survey of a substudy of women from the ‘young’ cohort of the Australian Longitudinal Study of Women''s Health (ALSWH).Setting and participants
Women aged 31–35 years who identified as being pregnant or recently given birth in the 2009 ALSWH survey (n = 2445) were recruited for the substudy. The substudy survey was completed by 1835 women (RR = 79.2%).Main variables studied
Determinants examined included pregnancy health and maternity care [including complementary and alternative medicine (CAM)] for their most recent pregnancy and any previous pregnancies. Participants'' attitudes and beliefs related to both CAM and maternity care were also included in the analysis.Main outcome measures
The outcome measures examined were the use of both pharmacological and non‐pharmacological pain management techniques (NPMT).Results
Differences were seen in the effects of demographics, health service utilization, health status, use of CAM, and attitudes and beliefs upon use of intrapartum pain management techniques across all categories. The only variable that was identified as a determinant for use of all types of pain management techniques was a previous caesarean section (CS).Discussion and conclusions
The effect of key determinants on women''s use of pain management techniques differs significantly, and, other than CS, no one determinant is clearly influential in the use of all pain management options. 相似文献13.
Survey of patients' experiences and perceptions of care provided by nurse and pharmacist independent prescribers in primary care
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Michela Tinelli MSc MSc PharmD MRPharmS PhD Alison Blenkinsopp OBE PhD BPharm MRPharmS Sue Latter BSc RN PGDipHV PhD Alesha Smith BSc MSc PhD 《Health expectations》2015,18(5):1241-1255
Background
In the United Kingdom, nurses and pharmacists who have undertaken additional post‐registration training can prescribe medicines for any medical condition within their competence (non‐medical prescribers, NMPs), but little is known about patients'' experiences and perceptions of this service.Objective
to obtain feedback from primary care patients on the impact of prescribing by nurse independent prescribers (NIPs) and pharmacist independent prescribers (PIPs) on experiences of the consultation, the patient–professional relationship, access to medicines, quality of care, choice, knowledge, patient‐reported adherence and control of their condition.Design
Two cross‐sectional postal surveys.Setting and participants
Patients prescribed for by either NIPs or PIPs in six general practices from different regions in England.Results
30% of patients responded (294/975; 149/525 NIPs; 145/450 PIPs). Most said they were very satisfied with their last visit (94%; 87%), they were told as much as they wanted to know about their medicines (88%; 80%), and felt the independent prescriber really understood their point of view (87%; 75%). They had a good relationship with (89%; 79%) and confidence in (84%; 77%) their NMP. When comparing NMP and doctor prescribing services, most patients reported no difference in their experience of care provided, including access to it, control of condition, support for adherence, quality and safety of care.Discussion and conclusions
Patients had positive perceptions and experience from their NMP visit. NMPs were well received, and patients'' responses indicated the establishment of rapport. They did not express a strong preference for care provided by either their non‐medical or medical prescriber. 相似文献14.
Patients' and clinicians' experiences and perceptions of the primary care management of insomnia: qualitative study
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Zowie Davy PhD Jo Middlemass MSc Aloysius N. Siriwardena PhD 《Health expectations》2015,18(5):1371-1383
Background
Insomnia is common leading to patients with sleep problems often presenting to primary care services including general practice, community pharmacies and community mental health teams. Little is known about how health professionals in primary care respond to patients with insomnia.Aim
We aimed to explore health professionals'' and patients'' experiences and perceptions of the management of insomnia in primary care.Design
We used a qualitative design and thematic approach.Setting
Primary care in Nottinghamshire and Lincolnshire.Method
We undertook focus groups and one‐to‐one interviews with a purposive sample of health professionals and adults with insomnia.Results
We interviewed 28 patients and 23 health professionals. Practitioners focused on treating the cause of insomnia rather than the insomnia itself. They described providing stepped care for insomnia, but this focused on sleep hygiene which patients often disregarded, rather than cognitive behavioural therapy for insomnia (CBT‐I). Practitioners were ambivalent towards hypnotic drugs but often colluded with patients to prescribe to avoid confrontation or express empathy. Patients sometimes took hypnotics in ways that were not intended, for example together with over‐the‐counter medication. Practitioners and patients were sometimes but not always concerned about addiction. Practitioners sometimes prescribed despite these concerns but at other times withdrew hypnotics abruptly without treating insomnia. Both patients and practitioners wanted more options and better training for the management of insomnia in primary care.Conclusion
A better understanding of the current approaches and difficulties in the management of insomnia will help to inform more therapeutic options and health professional training. 相似文献15.
Is the Give Youth a Voice questionnaire an appropriate measure of teen‐centred care in paediatric oncology: a Rasch measurement theory analysis
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Anne F Klassen DPhil Stefan J. Cano PhD Roona Sinha MD Areej Shahbaz BHSc Robert Klaassen MD David Dix MBChB 《Health expectations》2015,18(5):1686-1697
Background
Adolescents have their own views about the cancer care they receive and how they feel they are treated, but their opinions are rarely solicited.Objective
To determine whether the 56‐item Give Youth a Voice (GYV‐56), its subscales and its 20‐item short‐form, are clinically meaningful and psychometrically sound instruments that can be used to measure teen‐centred care (TCC) in paediatric oncology.Design
Qualitative interviews and a questionnaire survey.Setting and participants
Qualitative interviews with 38 childhood cancer survivors. GYV‐56 data collected from 200 paediatric cancer patients and survivors.Main outcome measure
The GYV‐56, which measures the following four aspects of service delivery: Supportive and respectful relationships; Information sharing and communication; Supporting independence; and Teen‐centred services.Results
Qualitative data provided broad support for the TCC conceptual framework and GYV‐56 items. After post‐hoc reduction of the response options from 7 to 3 (to correct for disordered thresholds), fit to the Rasch model was good, most items showed acceptable fit residuals and chi‐square P‐values, scale reliability were supported and item locations defined a continuum for TCC that was well‐targeted to the sample. By calibrating the items for each subscale and the short‐form to the full scale, the scores obtained on each measure are directly comparable.Conclusion
Our study found initial support for use of the GYV with a reduced response option format for examining TCC in the adolescent oncology patients. in this paediatric population. Further research using the GYV is needed to elaborate upon our findings. 相似文献16.
Does implementing a development plan for user participation in a mental hospital change patients' experience? A non‐randomized controlled study
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Background
Governments in several countries attempt to strengthen user participation through instructing health‐care organizations to implement user participation initiatives. There is, however, little knowledge on the effect on patients'' experience from comprehensive plans for enhancing user participation in whole health service organizations.Objective
To investigate whether implementing a development plan intending to enhance user participation in a mental hospital had any effect on the patients'' experience of user participation.Design, setting and participants
A non‐randomized controlled study including patients in three mental hospitals in Central Norway, one intervention hospital and two control hospitals.Interventions
A development plan intended to enhance user participation was implemented in the intervention hospital as a part of a larger reorganizational process. The plan included establishment of a patient education centre and a user office, purchase of user expertise, appointment of contact professionals for next of kin and improvement of the centre''s information and the professional culture.Main outcome measures
Perceptions of Care, Inpatient Treatment Alliance Scale and questions made for this study.Results
A total of 1651 patients participated. Implementing a development plan in a mental hospital intending to enhance user participation had no significant effect on the patients'' experience of user participation.Discussions and conclusions
The lack of effect can be due to inappropriate initiatives or challenges in implementation processes. Further research should ensure that initiatives and implementation processes are appropriate to impact the patients'' experience. 相似文献17.
Vincent C. H. Chung BCM PhD Polly H. X. Ma MPH Chun Hong Lau MSSc PhD Samuel Y. S. Wong MPH MD Eng Kiong Yeoh MBBS FHKAM Sian M. Griffiths MB BChir FFPH 《Health expectations》2014,17(5):622-636
Background
Health‐care professionals worldwide have started to appreciate patients'' perspectives on the use of complementary and alternative medicine (CAM) particularly given its popularity. However, cultural perspectives may vary and it may not be possible to apply research findings on the use of CAM from the west to the east.Objective
This systematic review aims to synthesize usage patterns of traditional Chinese medicine (TCM) amongst Chinese populations in different parts of the world and explore potential geographical variations.Search strategy
Six international and four Chinese databases were searched, and manual searches of relevant monographs and government publications were carried out.Inclusion criteria
Quantitative, qualitative or mixed‐method research that aimed to investigate Chinese patients'' perception of, and perspectives on, TCM was included.Data extraction and synthesis
For each study included, texts under the headings of ‘results’ or ‘findings’ were extracted and subjected to analysis. A thematic synthesis approach was adopted for synthesizing qualitative and quantitative studies.Main results
Amongst the 28 studies included, twenty were quantitative surveys, six were qualitative studies and two were mixed‐method studies. The overall methodological quality was mediocre. Data synthesis suggested that patients from all regions share a common cultural affinity to TCM and consider it to be an effective complement to western medicine (WM) for treating chronic or serious diseases. However, heterogeneous views on (i) disclosing TCM use to WM doctors and (ii) the potential harm of herbs emerged across different study locations.Discussion and conclusions
Future research should explore how variation in health systems may influence patients'' perception of CAM in different countries. 相似文献18.
Choosing vs. allocating: discrete choice experiments and constant‐sum paired comparisons for the elicitation of societal preferences
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Chris D. Skedgel MDE Allan J. Wailoo PhD Ron L. Akehurst BSc Hon MFPHM 《Health expectations》2015,18(5):1227-1240
Background
There is growing evidence of a reluctance to allocate health care solely on the basis of maximizing quality‐adjusted life years (QALYs). Stated preference methods can be used to elicit preferences for efficiency vs. equity in the allocation of health‐care resources.Objective
To compare discrete choice experiment (DCE) and constant‐sum paired comparison (CSPC) methods for eliciting societal preferences.Methods
Over a series of choice pairs, DCE respondents allocated a fixed budget to one preferred group and CSPC respondents allocated budget percentages between the groups. Questionnaires were compared in terms of completion rates, preference consistency, dominant preferences and derived attribute importance.Results
There was no significant difference in the proportions that rated the questionnaires somewhat or extremely difficult, but a significantly greater proportion completed the DCE compared to the CSPC. Preference consistency was also higher in the DCE. The incidence of dominant preferences, including for aggregate QALYs, was low and not significantly different between questionnaires. Similarly, no CSCP respondents equalized budgets or outcomes in every task. Final health state was the most important attribute in both questionnaires, but the rankings diverged for the other attributes. Notably, the total patients'' treated attribute was important in the CSPC but insignificant in the DCE, perhaps reflecting a ‘prominence effect’.Conclusions
Despite lower completion rates and preference consistency, CSPC may offer advantages over DCE in eliciting preferences over the distribution of resources and/or outcomes as well as attribute levels, avoiding extreme ‘all‐or‐nothing’ distributions and possibly aligning respondent attention more closely with a societal perspective. 相似文献19.
Den‐Ching A. Lee B App Sc Grad Dip Lesley Day PhD Keith Hill PhD Lindy Clemson PhD Fiona McDermott PhD Terry P. Haines PhD 《Health expectations》2015,18(5):1593-1609
Objective
To identify from the older adults'' perspective, the factors associated with discussion about falls with their general practitioners and other health professionals and the factors associated with initiation of these discussions. We explored the content of and barriers to discussion about falls.Methods
A prospective cohort study where a baseline cross‐sectional survey was followed by a survey 1 year later. Survey domains were drawn from constructs of behavioural change models. Data from 245 older community dwellers in Victoria, Australia, in the follow‐up survey were used for this study. Survey format consisted of yes and no responses, Likert scale and open/closed‐ended responses.Results
Few older adults talked with and initiated a talk with their health‐care providers about falls in the follow‐up period. Multiple regression showed anxiety or depression [OR = 2.78, 95% CI (1.21–6.41)], chronic medical conditions such as diabetes [OR = 2.71, 95% CI (1.19–6.17)] and having a self‐reported fall in the last 12 months [OR = 4.26, 95% CI (2.16–8.41)] were associated with discussion of falls with general practitioners. Higher perception of risk of sustaining a serious injury from falling [OR = 1.49 (1.03–2.13)] was associated with discussion about falls with other health professionals. Participants discussed various topics of falls with their health‐care providers. Different barriers to discussion about falls were identified.Conclusion
Health‐care providers should routinely discuss falls prevention with older adults. Dissemination of evidence‐based advice and followed up with referral during consultations, particularly in general practitioners could advance falls prevention practice. The results could help to develop a conceptual framework to predict the likelihood of falls discussion. 相似文献20.
‘You likes your way,we got our own way’: Gypsies and Travellers’ views on infant feeding and health professional support
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Debra Salmon RGN BA HV diploma MSc PhD 《Health expectations》2015,18(5):784-795