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Perceptions and practice behaviors regarding late-life depression among private duty home care workers: a mixed-methods study.

ABSTRACT: Background: This study aimed to examine personal care aides (PCAs)' knowledge, beliefs, and attitudes towards late-life depression and their experience caring for older adults with depression.Method: This study used a mixed-methods convergent parallel design involving an online survey (n = 87) and semi-structured interviews (n = 22). Survey respondents were recruited using convenience sampling and interviewees using purposive sampling from private duty home care agencies in Michigan. Qualitative data analyzed using a technique involving data reduction and open coding. Survey data were analyzed using descriptive statistics.Results: Most PCAs underestimated suicide rate among older adults, overrated self-help ability of the depressed person, underrated difficulty diagnosing depression, and attributed depression to personality flaws. PCAs favored psychotherapy and informal support and generally regarded medication as unhelpful, particularly in mild/moderate depression. Despite these discordances, PCAs' self-reported practice behaviors included strategies (i.e., communication, behavioral, cognitive, emotional regulation, relational, and external) that were largely consistent with the scientific view, particularly relating to behavioral activation. A prominent theme from PCAs' narratives was individualized care, reflected in their assessment of depressive symptoms, attitude towards depression treatment, and strategies caring for clients.Conclusions: Several areas of PCAs' perceptions regarding late-life depression were discordant with the current scientific view, although their practice behaviors were largely consistent with the principles of evidence-based practice for depression. Specialized mental health training, a standard depression care protocol, and higher training standards are essential to mobilize the large number of PCAs to improve the mental health outcomes of hard-to-reach older adults.

SUBMITTER: Xiang X

PROVIDER: S-EPMC6942236 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe Accreditation Council for Graduate Medical Education duty hour requirements may affect residents' understanding and practice of professionalism.ObjectiveWe explored residents' perceptions about the current teaching and practice of professionalism in residency and the impact of duty hour requirements.DesignAnonymous cross-sectional survey.ParticipantsInternal medicine, neurology, and family practice residents at 3 teaching hospitals (n=312).MeasurementsUsing Likert scales and open-ended questions, the questionnaire explored the following: residents' attitudes about the principles of professionalism, the current and their preferred methods for teaching professionalism, barriers or promoters of professionalism, and how implementation of duty hours has affected professionalism.ResultsOne hundred and sixty-nine residents (54%) responded. Residents rated most principles of professionalism as highly important to daily practice (91.4%, 95% confidence interval [CI] 90.0 to 92.7) and training (84.7%, 95% CI 83.0 to 86.4), but fewer rated them as highly easy to incorporate into daily practice (62.1%, 95% CI 59.9 to 64.3), particularly conflicts of interest (35.3%, 95% CI 28.0 to 42.7) and self-awareness (32.0%, 95% CI 24.9 to 39.1). Role-modeling was the teaching method most residents preferred. Barriers to practicing professionalism included time constraints, workload, and difficulties interacting with challenging patients. Promoters included role-modeling by faculty and colleagues and a culture of professionalism. Regarding duty hour limits, residents perceived less time to communicate with patients, continuity of care, and accountability toward their colleagues, but felt that limits improved professionalism by promoting resident well-being and teamwork.ConclusionsResidents perceive challenges to incorporating professionalism into their daily practice. The duty hour implementation offers new challenges and opportunities for negotiating the principles of professionalism.

Project description:ImportanceDespite broad public support for gun safety policies, minimal policy implementation has occurred.ObjectiveTo investigate factors that encourage greater private support for and public action on gun safety policy.Design, setting, and participantsThree studies were conducted: a public opinion survey (Study 1) was conducted from January 8 to 22, 2019, and 2 experiments (Studies 2 and 3) were conducted from August 27 to October 17, 2019, and April 15 to 21, 2020, respectively. Adults living in the US were eligible to participate in Studies 1 and 3. Students 18 years and older participating in a research experience program were eligible to participate in Study 2. Study 1 was administered online by Ipsos, a market research company. A nationally representative sample of 1000 US adults was obtained from Ipsos' online KnowledgePanel, of whom 508 completed the public opinion survey. For Study 2, which was conducted in a university laboratory, 354 participants were recruited from a university research pool, all of whom completed the study. Study 3 was administered online by the market research company YouGov, which identified 727 US gun owners from its opt-in panel, from which it constructed a census-matched sample of 400 participants.ExposuresParticipants read a statement about the 2018 Marjory Stoneman Douglas High School shooting. Content was manipulated as a 2 (corrective information vs no corrective information) × 2 (system changeable vs system not changeable) between-subjects factorial design with random assignment. The corrective information included polling data highlighting widespread support among gun owners for several gun safety policies. System changeable described gun safety policies passed by Florida's legislature.Main outcomes and measuresMain outcomes were support for gun safety policies and public disclosure of support.ResultsThe 3 studies included a total of 1262 participants (Study 1: 508 participants; weighted mean [SD] age, 47.7 [17.5] years; 261.9 women [51.6%]; 82.5 Hispanic [16.2%] and 60.3 Black [11.9%]; Study 2: 354 participants; mean [SD] age, 20.0 [2.3] years; 232 women [65.9%]; 100 Asian [28.3%] and 37 Black [10.5%]; Study 3: 400 participants; weighted mean [SD] age, 52.1 [16.4] years; 187.3 women [46.8%]; 295.5 White [73.9%], 44.5 Hispanic [11.1%], and 32.4 Black [8.1%]). Study 1 found that 63% to 91% of gun owners and 83% to 93% of non-gun owners supported key gun safety policies, yet both groups significantly underestimated gun owners' support for these policies by between 12% and 31%. Studies 2 and 3 found that exposure to corrective information was associated with a small increase in support for 2 gun safety policies of between 4% and 15%, both in terms of participants' privately held beliefs and the beliefs they would be willing to share publicly.Conclusions and relevanceThis survey study found that many US adults failed to recognize that most gun owners support key gun safety policies. Correcting this misperception was associated with greater private and public support for gun safety policy.

Project description:BackgroundAcute bleeding is an omnipresent challenge for all physicians. Uncontrolled hemorrhage is the most common preventable cause of death after trauma worldwide. In different surgical disciplines, hemorrhage represents an independent risk factor for increased postoperative morbimortality, directly affecting patients' outcomes. This study asked anesthesiologists about their personal perceived challenges when treating bleeding patients.MethodsThis investigator-initiated, prospective, international, dual-center, mixed qualitative and quantitative study interrogated anesthesiologists about what they found easy and what difficult in treating acutely bleeding patients. Following the template approach for qualitative research, we identified major and minor topics through free inductive coding and word count. In a second step, we derived ten statements from the participants' answers. Using a field survey, we then asked the participants to rate their level of agreement with the derived statements. We analyzed the answers using one sample Wilcoxon test and the Mann-Whitney test.ResultsWe included a total of 84 physicians in the qualitative interrogations and a different group of 42 anesthesiologists in the quantitative part. We identified 11 major topics and 19 associated subtopics. The main topics and the degree of agreement (here as agree or strongly agree) were as follows: "Complexity of the topic" (52.4% agreed to find the topic complex), "Cognitive aids" (92.9% agreed to find them helpful), "Time management" (64.3% agreed to feeling time pressure), "Human factors" (95.2% agreed that human factors are essential), "Resources" (95.2% agreed that resources are essential), "Experience" and "Low frequency of cases" (57.1% agreed to lack practice), "Diagnostic methods" (31.0% agreed that the interpretation of test results is difficult), "Anticoagulation" (85.7% agreed to it being difficult), "Treatment" (81.0% agreed to knowing the first therapeutic steps), and "Nothing".ConclusionsAnesthesiologists in two large tertiary care facilities in different parts of the world found coagulation management, especially in anticoagulated patients, complex. We identified the delayed diagnostic test results and their interpretation as challenges. Resources, treatment protocols and human factors such as team communication were perceived to facilitate management. Future studies should explore the challenges in smaller hospitals and other parts of the world and test new technologies addressing the identified difficulties.

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Perceptions and practice behaviors regarding late-life depression among private duty home care workers: a mixed-methods study.

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