Talk to PAPA: A Systematic Review of Patient/Participant (PAPA) Feedback on Interactions With Community Health Workers Using a Depth Analysis Approach.
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ABSTRACT:
SUBMITTER: George S
PROVIDER: S-EPMC6884075 | biostudies-literature | 2020 Jan/Mar
REPOSITORIES: biostudies-literature
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Project description:PurposeRoutine outcome monitoring (ROM) and clinical feedback systems (CFS) are becoming increasingly prevalent in mental health services. Their overall efficacy is unclear, but quantitative evidence suggests they can be useful tools for preventing treatment failure and enhancing therapeutic outcomes, especially for patients who are not progressing in therapy. The body of qualitative material, however, is smaller and less refined. We need to know more about how ROM/CFS is used in psychotherapy, and why it is helpful for some patients, but not others.MethodsWe recorded therapy sessions of 12 patients who were using a CFS as part of their therapies at an outpatient clinic in Norway. We then conducted video-assisted interviews and follow-up interviews with patients. Data were analyzed with systematic text condensation.ResultsAnalysis revealed three themes: (1) triggering reflections, emotions, and self-awareness, (2) Ambivalent and ambiguous self-presentation, and (3) potential for feeling understood and talking about what matters.ConclusionAnswering questions in a CFS is an interpretative and intentional process of self-presentation and the results from ROM/CFS must be interpreted and explored in conversation to be clinically useful. When they are, they have potential for enhancing the therapeutic process by stimulating self-awareness, reflexivity, and allowing access to new therapeutic topics. Further research should explore this how-to aspect of ROM/CFS with different CFS and different types of patients. Integrating clinical feedback in therapeutic practice can be conceptualized as a clinical skill, which should be a part of training programs for therapists.
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Project description:To examine barriers community health centers (CHCs) face in using workers' compensation insurance (WC).Leadership of CHCs in Massachusetts.We used purposeful snowball sampling of CHC leaders for in-depth exploration of reimbursement policies and practices, experiences with WC, and decisions about using WC. We quantified the prevalence of perceived barriers to using WC through a mail survey of all CHCs in Massachusetts.Emergent coding was used to elaborate themes and processes related to use of WC. Numbers and percentages of survey responses were calculated.Few CHCs formally discourage use of WC, but underutilization emerged as a major issue: "We see an awful lot of work-related injury, and I would say that most of it doesn't go through workers' comp." Barriers include lack of familiarity with WC, uncertainty about work-relatedness, and reliance on patients to identify work-relatedness of their conditions. Reimbursement delays and denials lead patients and CHCs to absorb costs of services.Follow-up studies should fully characterize barriers to CHC use of WC and experiences in other states to guide system changes in CHCs and WC agencies. Education should target CHC staff and workers about WC.
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Project description:The relationships between ticks and hosts are relevant to capture the ecological background driving the evolution of these parasites. We used a set of 4,764 records of ticks of the genera Amblyomma, Ixodes, and Haemaphysalis and their hosts in the Neotropics to approach the tick-host relationships using a network-based construct. The network identified 9 clusters of interacting hosts and ticks partially connected by 22 tick species that switch their host range according to their life cycle stage. These links among clusters do not confer an extra resilience to the network following removal of hosts and subsequent cascade extinctions of ticks: the robustness of the network slightly changed when these inter-clusters links are considered. Phylogenetic clustering of ticks to hosts at cluster level was not significant (p?>?0.15) but if examined individually 63 tick species/stages (59%) displayed such clustering, suggesting that their hosts have a related phylogenetic background. We interpreted these results under an ecological perspective in which ticks could track its environmental niche associating to vertebrates that would maximize tick survival under the range of abiotic traits. We encourage these integrated analyses to capture the patterns of circulation of tick-transmitted pathogens, a topic still unaddressed in the Neotropical region.
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Project description:INTRODUCTION:Little is known of acupuncture patients' experiences and opinions of clinical trials, and what may influence their compliance when participating in an acupuncture trial. OBJECTIVES:To explore the potential factors that influence patients' choice and determinants to participate in acupuncture clinical trials. METHODS:Ten qualitative, in-depth interviews were conducted with patients from acupuncture clinics in Beijing, who had previously participated in acupuncture clinical trials. RESULTS:Four main themes emerged from the interview data: effectiveness of the treatment, convenience of participating in a trial, doctor-participant communication, and participant acceptance of the treatment (or the trial). Effectiveness of acupuncture in treating the health condition was the most important factor for participant adherence. Pragmatics of treatment schedules, travel and attendance burden, together with confidence in the doctor's ability additionally influenced trial and treatment compliance. CONCLUSIONS:In-depth interviews suggest that treatment effectiveness, the pragmatics of attending treatment sessions, and the expertise and attitudes of acupuncturists are determining factors of participation and compliance in acupuncture clinical trials. Participants' confidence in, and expectation of, acupuncture may facilitate compliance, while their fear of acupuncture and negative perceptions of the trial's purpose may reduce treatment compliance. Compliance may be facilitated by enhanced doctor-patient communication, personalized treatment programs, and feedback on treatment outcomes.
| S-EPMC7162473 | biostudies-literature
Project description:Background: Medication communication from physicians to patients often is poor, by this among others enhancing the risk of non-adherence. In this context, a neglect regarding the prescription talk has been complained. Aim of the project: In a newly developed elective medical students work on physician-patient conversations dealing with drug prescription. Essential aspects related to an effective and safe drug treatment are combined with steps of shared decision-making. Together with a tutor, students develop a (model) conversation guide that might be tailored according to individual needs and views. Description/Methods: In a one-week course 3rd-5th year medical students treat a paper case according to problem-based learning. This is accompanied by a one-hour lecture and literature provided on an online learning platform (ILIAS). During a workshop, aspects of drug treatment and patient participation are integrated into a guide for a prescription talk. At the end of the week the students are invited to apply the (if need be individualized) guide in a simulated physician-patient communication with an actor. The conversation is evaluated using a checklist based upon the (model) conversation guide. Results: Informal and formalized feedback indicate high acceptance and satisfaction of participants with this elective. The checklist turned out to be of acceptable to good reliability with mostly selective items. Portfolio entries and written evaluation suggest that participants' positions and attitudes are influenced.
| S-EPMC5450434 | biostudies-other
Project description:Little research has been done to evaluate the occupational health of electronic waste (e-waste) recycling workers in Latin America. The objective of this study was to complete comprehensive health evaluations on e-waste recycling workers in Chile and to compare those that work in informal (i.e., independent) to those that work in formal (i.e., established company) settings. A cross-sectional study in the summer of 2017 recruited 78 informal recycling workers from two cities and 15 formal e-waste recycling workers from a single recycling facility to assess exposures and health outcomes. Participants completed a health questionnaire and underwent a full health assessment. Herein, only health questionnaire data are reported. Participants were primarily male, middle-aged, married with children, and had worked in e-waste recycling for an average of 12 years. Participants generally reported good health status, and their prevalence of chronic diseases was comparable to national rates. Workers frequently reported exposures to several occupational stressors, including noise and insufficient income, as well as other mental health stressors. Occupational injuries were commonly reported and use of safety equipment was low. Only a few significant differences, generally of a rather small magnitude, were found between informal and formal workers. In conclusion, from survey data, we did not identify major risks to health among e-waste workers, and only minor differences between workers in informal and formal settings.
| S-EPMC6388190 | biostudies-literature
Project description:Pressure is increasing on not-for-profit hospitals to demonstrate that they provide sufficient benefit to the community to justify their tax-exempt status. Many industry observers have suggested that this community benefit should address unmet medical needs within the community, deficits in the social determinants of health, or health disparities within communities. We argue that one area of clear unmet need is assistance in helping bridge the transition that people with disabilities (PWD) must make from rehabilitation patient to wellness participant. Programs to bridge this transition are necessary because many PWD struggle to identify strategies to maintain and maximize their own well-being after discharge from the healthcare system. As a result, PWD have worse health outcomes than non-disabled individuals. To address these needs, we propose hospitals take a leading role in establishing new, community-based efforts to provide PWD with benefits that will support their effort to self-manage health. Hospitals are well-suited to lead the creation of these programs because of the important role they play in providing services to PWD and because of their ability to bring together multiple stakeholders required to make supportive programs sustainable.
| S-EPMC7156537 | biostudies-literature
Project description:The Internet provides us with tools (user metrics or paradata) to evaluate how users interact with online interventions. Analysis of these paradata can lead to design improvements.The objective was to explore the qualities of online participant engagement in an online intervention. We analyzed the paradata in a randomized controlled trial of alternative versions of an online intervention designed to promote consumption of fruit and vegetables.Volunteers were randomized to 1 of 3 study arms involving several online sessions. We created 2 indirect measures of breadth and depth to measure different dimensions and dynamics of program engagement based on factor analysis of paradata measures of Web pages visited and time spent online with the intervention materials. Multiple regression was used to assess influence of engagement on retention and change in dietary intake.Baseline surveys were completed by 2513 enrolled participants. Of these, 86.3% (n = 2168) completed the follow-up surveys at 3 months, 79.6% (n = 2027) at 6 months, and 79.4% (n = 1995) at 12 months. The 2 tailored intervention arms exhibited significantly more engagement than the untailored arm (P < .01). Breadth and depth measures of engagement were significantly associated with completion of follow-up surveys (odds ratios [OR] = 4.11 and 2.12, respectively, both P values < .001). The breadth measure of engagement was also significantly positively associated with a key study outcome, the mean increase in fruit and vegetable consumption (P < .001).By exploring participants' exposures to online interventions, paradata are valuable in explaining the effects of tailoring in increasing participant engagement in the intervention. Controlling for intervention arm, greater engagement is also associated with retention of participants and positive change in a key outcome of the intervention, dietary change. This paper demonstrates the utility of paradata capture and analysis for evaluating online health interventions.NCT00169312; http://clinicaltrials.gov/ct2/show/NCT00169312 (Archived by WebCite at http://www.webcitation.org/5u8sSr0Ty).
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Project description:BackgroundThe development of evidence-based care geared towards Black and Latina women living with uncontrolled type 2 diabetes is contingent upon their active recruitment into clinical interventions. Well-documented impediments to recruitment include a historical mistrust of the research community and socioeconomic factors that limit awareness and access to research studies. Although sociocultural and socioeconomic factors deter minorities from participating in clinical research, it is equally important to consider the role of stigma in chronic disease intervention studies.ObjectiveWe aim to share our discovery of diabetes-related stigma as an underrecognized impediment to recruitment for the Women in Control 2.0 virtual diabetes self-management education study.MethodsOur initial recruitment plan used traditional strategies to recruit minority women with uncontrolled type 2 diabetes, which included letters and phone calls to targeted patients, referrals from clinicians, and posted flyers. After engaging a patient advisory group and consulting with experts in community advocacy, diabetes-related stigma emerged as a prominent barrier to recruitment. The study team reviewed and revised recruitment scripts and outreach material in order to better align with the lived experience and needs of potential enrollees.ResultsUsing a more nuanced, community-centered recruitment approach, we achieved our target recruitment goal, enrolling 309 participants into the study, exceeding our target of 212.ConclusionsThere is a need for updated recruitment methods that can increase research participation of patients who experience internalized diabetes stigma. To address disparities in minority health, further research is needed to better understand diabetes-related stigma and devise strategies to avert or address it.
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Project description:There is increasing evidence that volatile organic compounds (VOCs) play an important role in the interactions between fungi and bacteria, two major groups of soil inhabiting microorganisms. Yet, most of the research has been focused on effects of bacterial volatiles on suppression of plant pathogenic fungi whereas little is known about the responses of bacteria to fungal volatiles. In the current study we performed a metabolomics analysis of volatiles emitted by several fungal and oomycetal soil strains under different nutrient conditions and growth stages. The metabolomics analysis of the tested fungal and oomycetal strains revealed different volatile profiles dependent on the age of the strains and nutrient conditions. Furthermore, we screened the phenotypic responses of soil bacterial strains to volatiles emitted by fungi. Two bacteria, Collimonas pratensis Ter291 and Serratia plymuthica PRI-2C, showed significant changes in their motility, in particular to volatiles emitted by Fusarium culmorum. This fungus produced a unique volatile blend, including several terpenes. Four of these terpenes were selected for further tests to investigate if they influence bacterial motility. Indeed, these terpenes induced or reduced swimming and swarming motility of S. plymuthica PRI-2C and swarming motility of C. pratensis Ter291, partly in a concentration-dependent manner. Overall the results of this work revealed that bacteria are able to sense and respond to fungal volatiles giving further evidence to the suggested importance of volatiles as signaling molecules in fungal-bacterial interactions.
| S-EPMC4700264 | biostudies-literature