Search results for: health services evaluation

Authors: Mahnaz Motamedi, Mohammad Shahbazi, Shahrzad Rahimi-Naghani, Mehrdad Salehi

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Introduction: Identifying sexual health needs, developing appropriate plans, and delivering services to meet those needs is an essential component of health programs for women, men, and children all over the world, especially in poor countries. Main Subject: The aim of this study was to describe the needs of sexual health from the viewpoint of health policymakers in Iran. Methods: A qualitative study using thematic content analysis was designed and conducted. Data gathering was conducted through semi-structured, in-depth interviews with 25 key informants within the healthcare system. Key informants were selected through both purposive and snowball sampling. MAXQUDA software (version 10) was used to facilitate transcription, classification of codes, and conversion of data into meaningful units, by the process of reduction and compression. Results: The analysis of narratives and information categorized sexual health needs into five categories: culturalization of sexual health discourse, sexual health care services, sexual health educational needs, sexual health research needs, and organizational needs. Conclusion: Identifying and explaining sexual health needs is an important factor in determining the priority of sexual health programs and identification of barriers to meet these needs. This can help other policymakers and health planners to develop appropriate programs to promote sexual and reproductive health.

Keywords: sexual health, sexual health needs, policy makers, health system, qualitative study

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Authors: F.Sadoughi, A. Sarsarshahi, L, Eerfannia, S.M.A. Khatami

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Hospital information systems with lots of ability would lead to health care quality improvement. Evaluation of this system has done according different method and criteria. The main goal of present study is to prioritize the most important factors which are influence these systems evaluation. At the first step, according relevant literature, three main factor and 29 subfactors extracted. Then, study framework was designed. Based on analytical hierarchical process (AHP), 28 paired comparisons with Saaty range, in a questionnaire format obtained. Questionnaires were filled by 10 experts in health information management and medical informatics field. Human factors with weight of 0.55 were ranked as the most important. Organization (0.25) and technology (0.14) were in next place. It seems MADM methods such as AHP have enough potential to use in health research and provide positive opportunities for health domain decision makers.

Keywords: Analytical hierarchy process, Multiple criteria decision-making (MCDM), Hospital information system, Evaluation factors

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Authors: Natacha Julceus Fabien, Maryse Emmanuel Garcy

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Mental illness encompasses more than two hundred types of mental troubles, and more than half of the American population is at risk of being affected. If not effectively treated, mental illness can have dire consequences on health, the economy, and society. New York State, the second state after Florida with the most prominent Haitian/American, counted 180,710 inhabitants distributed in 60321 households in 2021, with almost half 46.4% being less than 35 years old. Studies show that while blacks are resilient, they are more likely to have severe mental diseases leading to disabilities compared to their white counterparts. Cultural competence in mental health services can narrow health disparities. Achieving this cultural competency in the health system involves good coordination in a robust health system where everyone is ready to contribute to its practical implementation. An effective way to address the issue is to have good baseline knowledge. However, there is not enough data that specifically informs on the accessibility to culturally competent mental health services for the Haitian American communities in New York. The purpose of this Community Needs Assessment is to assess the accessibility of minorities, particularly Haitian communities in New York, to culturally competent mental health services. This assessment will be conducted in the ten regions of New York State. Providers, clients, members of the community, and minority organizations will be recruited to collect quantitative and qualitative data. The quantitative part will be done in two surveys, one collecting primary data from the general population receiving the services and the other from health providers that provide health services. The questions and answers will be saved in Excel and analyzed on SPSS. For qualitative data, focus groups and in-depth guide interviews will be conducted and analyzed through Strengths, Weaknesses, Opportunities, and Threats (SWOT) Analysis of how the population and critical informants understand and identify cultural competency components in the mental health system. This research will be presented at the HAFALI research forum and specific minority organizations in New York. It will be submitted to mental health conferences and specific journals for publication. It will be shared with the heads of the community health service and the heads of the New York State Office of Mental Health. This needs assessment will be used as a tool to improve access to culturally competent mental health services nationally and worldwide.

Keywords: mental health, minorities, New York, needs assessment

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Authors: Emily Saurman, David Lyle

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In Australia, a well serviced rural town might have a psychiatrist visit once-a-month with more frequent visits from a psychiatric nurse, but many have no resident access to mental health specialists. Access to specialist care, would not only reduce patient distress and benefit outcomes, but facilitate the effective use of limited resources. The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) was developed to improve access to specialist emergency mental health care in rural and remote communities using telehealth technologies. However, there has been no current benchmark to gauge program efficiency or capacity; to determine whether the program activity is justifiably sufficient. The evaluation of MHEC-RAP used multiple methods and applied a modified theory of access to assess the program and its aim of improved access to emergency mental health care. This was the first evaluation of a telepsychiatry service to include a time and motion study design examining program time expenditure, efficiency, and capacity. The time and motion study analysis was combined with an observational study of the program structure and function to assess the balance between program responsiveness and efficiency. Previous program studies have demonstrated that MHEC-RAP has improved access and is used and effective. The findings from the time and motion study suggest that MHEC-RAP has the capacity to manage increased activity within the current model structure without loss to responsiveness or efficiency in the provision of care. Enhancing program responsiveness and efficiency will also support a claim of the program’s value for money. MHEC-RAP is a practical telehealth solution for improving access to specialist emergency mental health care. The findings from this evaluation have already attracted the attention of other regions in Australia interested in implementing emergency telepsychiatry programs and are now informing the progressive establishment of mental health resource centres in rural New South Wales. Like MHEC-RAP, these centres will provide rapid, safe, and contextually relevant assessments and advice to support local health professionals to manage mental health emergencies in the smaller rural emergency departments. Sharing the application of this methodology and research activity may help to improve access to and future evaluations of telehealth and telepsychiatry services for others around the globe.

Keywords: access, emergency, mental health, rural, time and motion

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Authors: Jane Oliver, Angeline Ferdinand, Jessica Kaufman, Peta Edler, Nicole Allard, Margie Danchin, Katherine B. Gibney

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Background: The cohealth Health Concierge program operated in Melbourne, Australia, from July 2020 to 30 June 2022. The program was designed to provide place-based peer-to-peer COVID-19 education and support to culturally and linguistically diverse residents of high-rise public housing estates. During this time, the COVID-19 public health response changed frequently. We conducted a mixed-methods evaluation to determine the program’s impact on residents’ trust, engagement and communication with health services and public health activities. Methods: The RE-AIM model was used to assess program reach, effectiveness, adoption, implementation and maintenance and the evaluation was informed by a Project Reference Group including end-users. Data were collected between March and May 2022 in four estates where the program operated. We surveyed 301 residents, conducted qualitative interviews with 32 stakeholders and analyzed data from 20,901 forms reporting interactions between Health Concierges and residents collected from August 2021 to May 2022. These forms outlined the support provided by Health Concierges during each interaction. Results: Overall, the program was effective in guiding residents to testing and vaccination services and facilitating COVID-19 safe practices. Nearly two-thirds (191; 63.5%) of the 301 surveyed participants reported speaking with a Health Concierge in the previous six months, and some described having meaningful conversations with them. Despite this, many of the interactions residents described having with Health Concierges were superficial. When considering surveyed participants’ responses to the adapted Public Health Disaster Trust Scale, the mean score across all estates was 2.3 (or slightly more than ‘somewhat confident’) in public health authorities’ ability to respond to a localized infectious disease outbreak. While the program was valued during the rapidly changing public health response, many felt it had failed to evolve in the ‘living with COVID’ phase. Some residents expressed frustration with Health Concierges’ having perceived inactive, passive roles - although other residents felt Health Concierges were helpful and appreciated them. A perception that the true impact of Health Concierges’ work was underrecognized was widely voiced by health staff. All 20,901 Interaction Forms identified COVID-19-related supports provided to residents; almost all included provision of facemasks and/or hand sanitiser and 78% identified additional supports that were also provided, most frequently provision of other health information. Conclusions: The program disseminated up-to-date information to a diverse population within a rapidly changing public health setting. Health Concierges were able promote COVID-19-safe behaviours, including vaccine uptake, and link residents with support services. We recommend the program be revised and continued. New programs that draw on the Health Concierge model may be valuable in supporting future pandemic responses and should be considered in preparedness planning.

Keywords: community health, COVID-19 pandemic, infectious diseases, public health, community health workers

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Authors: Dolly Kumari, H. Lhungdim

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Maternal health is one of the crucial health indicators for any country. 5th goal of Millennium Development Goals is also emphasising on improvement of maternal health. Soon after Independence government of India realizing the importance of maternal and child health care services, and took steps to strengthen in 1st and 2nd five year plans. In past decade the other health indicator which is life expectancy at birth has been observed remarkable improvement. But still maternal mortality is high in India and in some states it is observe much higher than national average. Government of India pour lots of fund and initiate National Rural Health Mission (NRHM) in 2005 to improve maternal health in country by providing affordable and accessible health care services. Accredited Social Heath Activist (ASHA) is one of the key components of the NRHM. Mainly ASHAs are selected female aged 25-45 years from village itself and accountable for the monitoring of maternal health care for the same village. ASHA are trained to works as an interface between the community and public health system. This study tries to assess the role of ASHA in utilizing maternal health care services and to see the level of awareness about benefits given under JSY scheme and utilization of those benefits by eligible women. For the study concurrent evaluation data from National Rural health Mission (NRHM), initiated by government of India in 2005 has been used. This study is based on 78205 currently married women from 70 different districts of India. Descriptive statistics, chi2 test and binary logistic regression have been used for analysis. The probability of institutional delivery increases by 2.03 times (p<0.001) while if ASHA arranged or helped in arranging transport facility the probability of institutional delivery is increased by 1.67 times (p<0.01) than if she is not arranging transport facility. Further if ASHA facilitated to get JSY card to the pregnant women probability of going for full ANC is increases by 1.36 times (p<0.05) than reference. However if ASHA discuses about institutional delivery and approaches to get register than probability of getting TT injection is 1.88 and 1.64 times (p<0.01) higher than that if she did not discus. Further, Probability of benefits from JSY schemes is 1.25 times (p<0.001) higher among women who get married after 18 years. The probability of benefits from JSY schemes is 1.25 times (p<0.001) higher among women who get married after 18 year of age than before 18 years, it is also 1.28 times (p<0.001) and 1.32 times (p<0.001) higher among women have 1 to 8 year of schooling and with 9 and above years of schooling respectively than the women who never attended school. Those women who are working have 1.13 times (p<0.001) higher probability of getting benefits from JSY scheme than not working women. Surprisingly women belongs to wealthiest quintile are .53times (P<0.001) less aware about JSY scheme. Results conclude that work done by ASHA has great influence on maternal health care utilization in India. But results also show that still substantial numbers of needed population are far from utilization of these services. Place of delivery is significantly influenced by referral and transport facility arranged by ASHA.

Keywords: institutional delivery, JSY beneficiaries, referral faculty, public health

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Authors: Sabyasachi Behera, Shiv Kumar, Pramod Gautam, Anisur Rahman, Pawan Pathak, Rahul Bhadouria

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Background: The increasing proportion of population especially urban poor and vulnerable groups or groups with specific needs, with health indicators worse than their rural counterparts in India face various issues related with availability and quality of health care. The reasons are myriad, starting from information and awareness of the community, especially, in a scenario wherein the needs and challenges of floating and migrant urban populations remain poorly understood. Weak linkages between health care facilities and slum dwellers and vulnerable populations hinder the improvement of health services for urban poor. Method: To address this issue, TCIHC program is helping health department of Indore city of Madhya Pradesh to establish a referral mechanism with a dual approach: at both community and facility level. The former is based on the premise of ‘building social capital’, i.e. norms and networks within a community facilitating collective action, helps improve the demand and supply of health services at appropriate levels of care (Minus 2: Accredited Social Health Activist and Community Health Groups; Minus 1: Urban Health Nutrition Days; Zero: Urban Primary Health Center; Plus 1: secondary facility with BEmONC services; Plus 2: secondary facilities with CEmONC services; Plus 3: tertiary level facility) for the urban poor. The latter focuses on encouraging the provision of all services at various levels of service delivery points and stakeholders to function in a coordinated manner to ensure better health service availability and coverage in underserved slum areas. Results: This initiative has enhanced the utilization of community based, primary and secondary level services through defined referral pathways that are clearly known to a community dweller. Conclusion: An ideal referral mechanism should begin with referral at the community level wherein services of a frontline health care provider are accessed by them at their door-step, causing no delay in both understanding and decision on the health issues faced by them.

Keywords: levels of care, linkages, referral mechanism, service delivery

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Authors: Melissa Hartley, Erika McCoy

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Military-connected children with disabilities often require services in different countries throughout their school career. This research and development text seeks to provide current practices in finding and obtaining comparable special education services globally. Considerations in service provision include: language of the service provider, service delivery format, current service availability and finding comparable services, location of services, and readily available services. After providing current practices, the researchers will engage the audience in brainstorming additional ways at finding and obtaining comparable special education services globally.

Keywords: collaboration, international education, service delivery, special education services

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Authors: Sengul Celik, Alper Ketenci

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In Turkish Constitution about health care in Article 56, it is said that: everyone has the right to live in a healthy and balanced environment. It is the duty of the state and citizens to improve the environment, protect environmental health, and prevent environmental pollution. The state ensures that everyone lives their lives in physical and mental health; it organizes the planning and service of health institutions from a single source in order to realize cooperation by increasing savings and efficiency in human and substance power. The state fulfills this task by utilizing and supervising health and social institutions in the public and private sectors. General health insurance can be established by law for the widespread delivery of health services. To have health care is one of the basic rights of patients. After the coupe attempt in July 2016, the Government of Turkey has announced a state of emergency and issued lots of emergency decrees. By these emergency decrees, lots of people were dismissed from their jobs and lost their some basic social rights. The violations occur in social life. One of the most common observations is the discrimination by government in health care system. This study aims to put forward the violation of human rights in health care system in Turkey due to their discriminated position by an emergency decree. The study is a case study that is based on nine interviews with the people or relatives of people who lost their jobs by an emergency decree in Turkey. In this study, no personally identifiable information was obtained for the safety of individuals. Also no distinctive questions regarding the identity of individuals were asked. The interviews are obtained through internet call applications. The data were analyzed through the requirements of regular health care system in Turkey. The interviews expose that the people or the relatives of people lost their right to have regular health care. They have to pay extra amount both in clinical services and in medication treatment. The patient right to quality medical care without prejudice is violated. It was assessed that the people who are involved in emergency decree and their relatives are discriminated by government and deprived of regular medical care and supervision. Although international legal arrangements and legal responsibilities of the state have been put forward by Article 56, they are violated in practice. To prevent these kinds of violations, some measures should be taken against the deprivation in health care system especially towards the discriminated people by an emergency decree.

Keywords: emergency decree in Turkey, health care, discriminated people, patients rights

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Authors: Minna K. Miller, Chantel. E. Canessa, Suzanna V. McRae, Susan Shumay, Alissa Collingridge

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Primary care provides the first point of contact and access to health care services. For the pediatric population, the goal is to help healthy children stay healthy and to help those that are sick get better. Primary care facilitates regular well baby/child visits; health promotion and disease prevention; investigation, diagnosis and management of acute and chronic illnesses; health education; both consultation and collaboration with, and referral to other health care professionals. There is a protective association between regular well-child visit care and preventable hospitalization. Further, low adherence to well-child care and poor continuity of care are independently associated with increased risk of hospitalization. With a declining number of family physicians caring for children, and only a portion of pediatricians providing primary care services, it is becoming increasingly difficult for children and their families to access primary care. Nurse practitioners are in a unique position to improve access to primary care and improve health outcomes for children. Limited literature is available on the nurse practitioner role in primary care pediatrics. The purpose of this paper is to describe the development, implementation and evaluation of a Nurse Practitioner-led pediatric primary care clinic in a tertiary care setting. Utilizing the participatory, evidence-based, patient-focused process for advanced practice nursing (PEPPA framework), this paper highlights the results of the initial needs assessment/gap analysis, the new service delivery model, populations served, and outcome measures.

Keywords: access, health outcomes, nurse practitioner, pediatric primary care, PEPPA framework

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Authors: Yuliya Leonidovna Kiva-Khamzina

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The legal nature of the contract for educational services causes a lot of controversies. In particular, it raises the question about industry sector relationships, which require making a contract for educational services. The article describes the different types of contracts classifications for services provision from the perspective of civil law, deals with the specifics of the contract on rendering educational services; the author makes the conclusion that the contract for the provision of educational services is a complex institution that includes elements of the civil and administrative law. The following methods were used to conduct the study: dialectical method of cognition, the historical method, systemic analysis, classification.

Keywords: administrative aspect, civil aspect, educational service, industry, legal nature, services provision

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Authors: Francesca Carta, Giovanna Linfante, Laura Agneni, Debora Radicchia, Camilla Micheletta, Angelo Del Cimmuto

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Overtaking competence mismatches and fostering career pathways congruent with the individual skills profile would significantly contribute to fighting unemployment. The aim of this paper is to examine the usefulness and efficiency of qualitative tools in supporting and improving the quality of caseworkers’ activities during the jobseekers’ profile analysis and career guidance process. The selected target groups are long-term and middle term unemployed, job seekers, young people at the end of the vocational training pathway and unemployed woman with social disadvantages. The experimentation is conducted in Italy at public employment services in 2017. In the framework of Italian labour market reform, the experimentation represents the first step to develop a customized qualitative model profiling; the final general object is to improve the public employment services quality. The experimentation tests the transferability of an OECD self-assessment competences tool in the Italian public employment services. On one hand, the first analysis results will indicate the user’s perception concerning the tool’s application and their different competence levels (literacy, numeracy, problem solving, career interest, subjective well-being and health, behavioural competencies) with reference to the specific target. On the other hand, the experimentation outcomes will show caseworkers understanding regarding the tool’s usability and efficiency for career guidance and reskilling and upskilling programs.

Keywords: career guidance, evaluation competences, reskilling pathway, unemployment

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Authors: Virginia Dickson-Swift, Amanda Kenny, Jane Farmer, Sarah Larkins, Karen Carlisle, Helen Hickson

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In this presentation, we will focus on the methods of Remote Services Futures (RSF), an evidence-based method of community participation that was developed in Scotland. Using oral health as the focus, we will discuss the ways that RSF can be used to achieve sustainable engagement with stakeholders from various parts of the community. We will describe our findings of using RSF methods to engage with rural communities, including the steps involved and what happened when we asked people about the oral health services that they thought were needed in their community. We found that most community members started by thinking that a public dental clinic was required in every community, which is not a sustainable health service delivery option. Through a series of facilitated workshops, communities were able to discuss and prioritise their needs and develop a costed plan for their community which will ensure sustainable service delivery into the future. Our study highlights the complexities of decision making in rural communities. It is important to ensure that when communities participate in health care planning that the outcomes are practical, feasible and sustainable.

Keywords: community participation, sustainable health planning, Remote Services Futures, rural communities

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Authors: Till Gramberg, Max Kellner, Erwin Gross

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This paper presents a comprehensive investigation into the topic of smart services and IIoT-Platforms, focusing on their selection and prioritization in manufacturing organizations. First, a literature review is conducted to provide a basic understanding of the current state of research in the area of smart services. Based on discussed and established definitions, a definition approach for this paper is developed. In addition, value propositions for smart services are identified based on the literature and expert interviews. Furthermore, the general requirements for the provision of smart services are presented. Subsequently, existing approaches for the selection and development of smart services are identified and described. In order to determine the requirements for the selection of smart services, expert opinions from successful companies that have already implemented smart services are collected through semi-structured interviews. Based on the results, criteria for the evaluation of existing methods are derived. The existing methods are then evaluated according to the identified criteria. Furthermore, a novel method for the selection of smart services in manufacturing companies is developed, taking into account the identified criteria and the existing approaches. The developed concept for the method is verified in expert interviews. The method includes a collection of relevant smart services identified in the literature. The actual relevance of the use cases in the industrial environment was validated in an online survey. The required data and sensors are assigned to the smart service use cases. The value proposition of the use cases is evaluated in an expert workshop using different indicators. Based on this, a comparison is made between the identified value proposition and the required data, leading to a prioritization process. The prioritization process follows an established procedure for evaluating technical decision-making processes. In addition to the technical requirements, the prioritization process includes other evaluation criteria such as the economic benefit, the conformity of the new service offering with the company strategy, or the customer retention enabled by the smart service. Finally, the method is applied and validated in an industrial environment. The results of these experiments are critically reflected upon and an outlook on future developments in the area of smart services is given. This research contributes to a deeper understanding of the selection and prioritization process as well as the technical considerations associated with smart service implementation in manufacturing organizations. The proposed method serves as a valuable guide for decision makers, helping them to effectively select the most appropriate smart services for their specific organizational needs.

Keywords: smart services, IIoT, industrie 4.0, IIoT-platform, big data

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Authors: Julie Wittmannová, Petr Šeda

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Quality of life measurements (QLF) help to evaluate interventions programs in different groups of persons with special needs. Our presentation deals with QLF of persons with addiction in relation to the physical activity (PA), type of addiction, age, gender and other variables. The aim of presentation is to summarize the basic findings and offer thoughts for questions arose. Methods: SQUALA (Subjective Quality of Life Analysis); SEIQoL (Schedule for the Evaluation of Individual Quality of Life); questionnaire of own construction. The results are evaluated by Mann­Whitney U test and Kruskall­Wallis ANOVA test (p ≤ 0,05). Sample of 64 participants – clients of aftercare center, aged 18 plus. Findings: Application of the methods SQUALA and SEIQoL in the chosen population seems appropriate, the obtaining information regarding the QLF correlate to intervention program topics, the need of an activelifestyle and health related topics in persons with addiction is visible. Conclusions or Implications: The subjective evaluation of quality of life of Aftercare clients is an important part of evaluation process, especially used to evaluate satisfaction with offered services and programs. Techniques SQUALA and SEIQoL gave us the desired outcomes.

Keywords: adapted physical activity, addiction, quality of life, physical activity, aftercare

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Authors: Suzanne L. Stewart, Sarah J. Ponton, Mikaela D. Gabriel, Roy Strebel, Xinyi Lu

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Indigenous Peoples have faced unique barriers to accessing and receiving culturally safe and appropriate mental health care while also facing daunting rates of mental health diagnoses and comorbidities. Indigenous researchers and clinicians have well established the connection of the current mental health issues in Indigenous communities as a direct result of colonization by way of intergenerational trauma throughout Canada’s colonial history. Such mental health barriers and challenges have become exacerbated during the COVID-19 pandemic. Throughout the pandemic, access to mental health, cultural, ceremonial, and community services were severely impacted and restricted; however, it is these same cultural activities and community resources that are key to supporting Indigenous mental health from a traditional and community-based perspective. This research employed a unique combination of a thorough, analytical scoping review of the existent mental health literature of Indigenous mental health in the COVID-19 pandemic, alongside narrative interviews employing an oral storytelling tradition methodology with key community informants that provide comprehensive cultural services to the Indigenous community of Toronto, as well as across Canada. These key informant interviews provided a wealth of insights into virtual transitions of Indigenous care and mental health support; intersections of historical underfunding and current financial navigation in technology infrastructure; accessibility and connection with Indigenous youth in remote locations; as well as maintaining community involvement and traditional practices in a current pandemic. Both the scoping review and narrative interviews were meticulously analyzed for overarching narrative themes to best explore the extent of the literature on Indigenous mental health and services during COVID-19; identify gaps in this literature; identify barriers and supports for the Indigenous community, and explore the intersection of community and cultural impacts to mental health. Themes of the scoping review included: Historical Context; Challenges in Culturally-Based Services; and Strengths in Culturally-Based Services. Meta themes across narrative interviews included: Virtual Transitions; Financial Support for Indigenous Services; Health Service Delivery & Wellbeing; and Culture & Community Connection. The results of this scoping review and narrative interviews provide wide application and contribution to the mental health literature, as well as recommendations for policy, service provision, autonomy in Indigenous health and wellbeing, and crucial insights into the present and enduring mental health needs of Indigenous Peoples throughout the COVID-19 pandemic.

Keywords: indigenous community services, indigenous mental health, indigenous scoping review, indigenous peoples and Covid-19

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Authors: Suantak Demkhosei Vaiphei

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Mental illness is still considered as an illness not to be treated, resulting India becoming the most depressed country in the world. At present, 150 million Indians are suffering from mental illness and desperately in need of immediate care assessment for their mental health condition. However, only 0.06 per cent of India’s health budget is devoted to mental health treatment, in which the available data suggests that the state of spending the sanctioned budget in this regard is abysmal. Lack of awareness, ignorance, social stigma, and discriminations becomes the underlying factors for worsening the individual mental health conditions. Unfortunately, India becomes the most depressed country in the world, which is hugely affected by anxiety, schizophrenia, and bipolar disorder followed by China and USA as per the latest World Health Organization report. The National Care of Medical Health stated that at least 6.5 per cent of the Indian populations are under serious mental disorder both in the rural and the urban areas’Mental health is the integral part of health and can be affected by a range of psychosocial-economic factors that need comprehensive strategically approach for promotion, prevention, treatment, and recovery. In a low- and middle-income country like India, the advance progress in mental health service is visible consistently slow and minimal. Some of the major barriers can be seen in the existing public health priorities and its influence on funding; challenges to delivery of basic mental health care in the primary care settings; the minimal numbers of well-trained professionals in the area of mental health care; and lack of mental health perspective in public-health leadership. The existing barriers according to WHO (2007) are; lack of funding for mental health services is the core barrier in implementing quality mental health services, including inadequate coordinated and consensus based national mental health advocacy and plans, the absence of mental health in major donor priorities, marketing of expensive pharmaceuticals by industry, cost-effectiveness information on mental health services that is unknown to senior decision-makers and social stigma among others. Moreover, lack of strong mental health advocacy in countries to increase resources for mental health services and the role of social stigma and the view that mental health is a private responsibility are also the two barriers to mental health.

Keywords: mental health, depression, stigma, barriers

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Authors: Amanda Kenny, Virginia Dickson-Swift, Jane Farmer, Sarah Larkins, Karen Carlisle, Helen Hickson

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Rural ECOH (Engaging Communities in Oral Health) is a collaborative project that connects policy makers, service providers and community members. The aim of the project is to empower community members to determine what is important for their community and to design the services that they need. This three-year project is currently underway in six rural communities across Australia. This study is specifically focused on Remote Services Futures (RSF), an evidence-based method of community participation that was developed in Scotland. The findings highlight the complexities of community participation in health service planning. We assumed that people living in rural communities would welcome participation in oral health planning and engage with their community to discuss these issues. We found that to understand the relationships between community members and health service providers, it was essential to identify the formal and informal community leaders and to engage stakeholders from the various community governance structures. Our study highlights the sometimes ‘messiness’ of decision making in rural communities as well as ways to ensure that community members have the training and practical skills necessary to participate in community decision making.

Keywords: community participation, health planning, rural ECOH, Remote Services Futures

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Authors: Md. Rashed Aalm, Md. Nuruzzaman Khan, Yothin Sawangdee

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Background: Around 47% of the total pregnancies are unintended in Bangladesh, which lead to several adverse consequences, including maternal and child mortality. Use of menstrual regulation (MR) can help women to reduce unintended pregnancy related adverse consequences. We explored the prevalence and determinants of MR services among ever-married women in Bangladesh. Methods: Total of 14,346 ever-married women data were analysed from the 2017 Bangladesh Demographic and Health Survey. Our study variable was use or non-use of MR services. Individual, household, and community level factors were the explanatory factors. Multilevel mixed-effect Poisson regression model was used to determine the factors associated with MR services in Bangladesh. Results: Nearly 7% of the total women in Bangladesh use MR services. Use of MR services was found higher among women who were aged 20-30 ages (IRR 1.60, 95% CI: 1.17–2.17), who were overweight (IRR 1.43, 95% CI: 1.13–1.81), had at least 1 child (IRR 2.97, 95% CI: 2.34– 3.77) or > 2 children (IRR 3.22, 95% CI: 2.45–4.20), and the birth preceding birth interval was(2 – 4) years (IRR 1.56, 95% CI: 1.13–2.15). Around 1.39 times (95% CI: 1.11–1.73) higher likelihood of MR was found among women whose husbands were engage with business. At the community level, MR service was found lower among the women who resided in the community with higherilliteracy (IRR 0.67, 95% CI: 0.42–0.96) and the Mymensingh division (IRR 0.39, 95% CI: 0.31–0.91). Conclusion: Use of MR service is comparatively low, which indicate a significant proportion of unintended pregnancy continued toward life-birth. This could be responsible for higher adverse maternal and child health outcomes in Bangladesh. Initiatives should be taken to ensure MR services is available when women need this service.

Keywords: menstrual regulation, pattern, risk, maternal health, Bangladesh

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Authors: Richard Ssempala, Francis Kintu, Christine K. Tashobya

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Funding for health remains a key constraint facing many developing countries, Uganda inclusive. Uganda’s health sector budget to the national budgetary allocation has stagnated between 8.2% to 10% over the years. Using data collected from different government documents, we sought to establish the implications of the budget allocation over the period (FY2010/11-2018/19) on health services delivery in Uganda to inform policymakers specifically Members of Parliament who are critical in making sectorial allocation on the steps they can adapt to change the terrain of health financing in Uganda. Findings revealed that the contribution of public funding to the health sector is low (15.7%) with private sources (42.6%) and donors contributing much more, with the bulk of private funds, are out of pocket. The study further revealed that low budget allocation had been manifested in inadequate and poorly motivated health workers, essential drug stock-outs that ultimately contribute to poor access to services, catastrophic health expenditures, and high morbidity rates. We recommend for a substantial and sustained increase in the government health budget, optimizing the available resources by addressing wastages, prioritizing health promotion, prevention and finally, institutionalizing the National Health Insurance Scheme.

Keywords: budget allocations, universal health coverage, health service delivery, Uganda

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Authors: Chia-Feng Yen, Shyang-Woei Lin

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Background: In Taiwan, people with disability can obtain national social welfare services after evaluation. All subsidies and services in- kind are pronounced in People with Disabilities Rights Protection Act. The new disability eligibility determination system base on ICF has carried out five years in Taiwan. There were no systematic outcomes to discuss the relationships between the evaluation results of activity and participation functioning (AP functioning) and ratification of social services for people with disability. The decision-making of welfare resources allocation is in local government, so the ratification could be affected by resource variations in every area (local governments). The purposes of this study are to compare the ratification rate between different areas (the equity of allocation), and to understand the ratification of social services for people with disability after needs assessment stage that can help to predict the resources allocation for local governments in the further. Methods: A cross-sectional study was used, and the data came from Disability Eligibility Determination System in Taiwan between 2013/11/04-2015/01/12. All samples were evaluated by FUNDES-adult version 7th and they all above 18 years old. The samples were collected face to face by physicians and AP evaluators. Result: In the needs assessment stage, the welfare ratification rates are significant differences between these local governments for the samples with the similar impairment and AP functioning.

Keywords: allocation, activity and participation, people with disability, justice

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Authors: Soori Nnko, Zaina Mchome, John Dusabe, Angela Obasi

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In sub-Saharan Africa, adolescent girls living in urban and periurban settings are among the groups at increased risk of getting sexually transmitted infections. One of the challenges to improve uptake of sexual and reproductive health (SRH) services among adolescents is linked to little appreciation about their vulnerability and the knowledge on availability of the SRH services. Objective: This study assesses adolescents’ perceptions on risks for SRH problems and the availability of services to prevent against SRH problems. Methodology: The study was conducted in March 2011 in Mwanza region, Tanzania. Data collection techniques included 18 Participatory Group Discussions and 17 In-depth Interviews with adolescents and young mothers aged 15-20 years. Results: Adolescents indicated that risk places included their homes, bushes, commercial centers, roadsides as well as school settings. Risk for having unprotected sex varied depending on where you are, and the time of the day. For example, collection of firewood in the bushes or water from the wells exposed girls to men who forced or lured them to have sex. The girls reported to encounter motorcyclists who offered the ride in exchange for sex. Girls also knew myriads places to seek SRH services, including public and private clinics, drug shops and traditional healers. Despite being aware of risky environment, and places to seek the services, access to SRH services were limited due to the stigma and negative attitude of community regarding adolescents’ utilization of SRH services. Conclusion: Adolescents are exposed to various risky environments, yet due to social stigma they have difficult to access the available SRH services.

Keywords: adolescent girls, sexual and reproductive health, AIDS, risk, opportunities, interventions, sub Saharan africa

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Authors: Ayşegül Bilge, Hacer Demirkol, Merve Uğuryol

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Therapeutic touch is one of the most important methods of complementary and alternative treatments. Therapeutic touch requires the sharing of universal energy. Therapeutic touch (TT) provides the interaction between the patient and the nurse. In addition, nurses can be aware of physical and mental symptoms of patients through therapeutic touch. Therapeutic touch (TT) is short-term provides the advantage for the nurse. For this reason, nurses have to be aware of the importance of therapeutic touch and they can use it from the primary care to tertiary care in nursing practices at in health field.

Keywords: health care services, complementary treatment, nursing, therapeutic touch

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Authors: Johnnie Hay

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New Zealand is well known for its natural beauty, diversity of people but also for its strong focus on mental health through the provision of a vast network of psycho-social support services. South African-trained psychologists often make New Zealand their new home when emigrating - as it is relatively simple to slot into the well-established mental health system. South Africa is bigger in size, population, GDP and probably people diversity than New Zealand but struggles to provide adequate educational and psychological support services to schools. This is mainly due to budgetary pressures brought about by the imperative to first ensure that the approximately 13 million learners all have a teacher in front of their classes and at an average ratio of not more than 40 learners per class. In this paper, perspectives on educational and psychological support in New Zealand and South African schools will be shared. Through basic qualitative research encompassing semi-structured interviews with two South African educational psychologists who returned from New Zealand, supplemented by document analysis, the New Zealand situation will be scrutinized. South African perspectives will be obtained through a number of semi-structured interviews and questionnaires administered by education support services specialists working in district-based support teams in three provinces of the country. This research is in process, but preliminary findings indicate large disparities between the two countries' emphasis, funding, post provisioning and structure regarding educational and psychological support services.

Keywords: educational psychological support services, support for learners experiencing special needs, education support services, diverse learner population

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Authors: Mathew Nyashanu, George K. Kiggundu, Mandu S. Ekpenyong

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There is an increased number of young people engaging in early sexual relationships worldwide. Furthermore, statistics for early pregnancy among young people have also increased, especially in low and middle-income countries. This has health implications for both the parents and the baby. High uptake in family planning contraception among young people can reduce early pregnancy and subsequent negative health outcomes on the young parents and the baby. This study was set to explore the factors influencing the uptake of family planning contraceptive services among young people (18-24 years) at a community level in rural Budaka district, Uganda. The study utilised an explorative qualitative approach. The study found out that religion, partner resistance; perceived loss of libido, perceived barren, long waiting time and distance from the health facility, lack of privacy/confidentiality, excessive menstrual bleeding, cancer, and fear of having disabled babies, limited the utilisation of family planning contraceptive services while contraception as HIV prevention and child spacing encouraged young people to use family planning contraceptive services. There is a need for a culturally orientated community-based contraceptive health promotion approach to increase the uptake of family planning contraception services among young people.

Keywords: Young people, Family Planning, Contraceptives, Black sub-Sahara African

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Authors: S. Cheng, C. Catallo

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Introduction: Canada's healthcare and social services systems are failing high risk, vulnerable older adults. Care for vulnerable older Canadians (65 and older) is not optimal in Canada. It does not address the care needs of vulnerable, high risk adults using a holistic approach. Given the growing aging population, and the care needs for seniors with complex conditions is one of the highest in Canada's health care system, there is a sense of urgency to optimize care. Integration of health and social services is an emerging trend in Canada when compared to European countries. There is no common and universal understanding of healthcare and social services integration within the country. Consequently, a clear understanding and definition of integrated health and social services are absent in Canada. Objectives: A study was undertaken to develop a case definition for integrated health and social care initiatives that serve older adults, which was then tested against three Canadian integrated initiatives. Methodology: A limited literature review was undertaken to identify common characteristics of integrated health and social care initiatives that serve older adults, and comprised both scientific and grey literature, in order to develop a case definition. Three Canadian integrated initiatives that are located in the province of Ontario, were identified using an online search and a screening process. They were surveyed to determine if the literature-based integration definition applied to them. Results: The literature showed that there were 24 common healthcare and social services integration characteristics that could be categorized into ten themes: 1) patient-care approach; 2) program goals; 3) measurement; 4) service and care quality; 5) accountability and responsibility; 6) information sharing; 7) Decision-making and problem-solving; 8) culture; 9) leadership; and 10) staff and professional interaction. The three initiatives showed agreement on all the integration characteristics except for those characteristics associated with healthcare and social care professional interaction, collaborative leadership and shared culture. This disagreement may be due to several reasons, including the existing governance divide between the healthcare and social services sectors within the province of Ontario that has created a ripple effect in how professions in the two different sectors interact. In addition, the three initiatives may be at maturing levels of integration, which may explain disagreement on the characteristics associated with leadership and culture. Conclusions: The development of a case definition for healthcare and social services integration that incorporates common integration characteristics can act as a useful instrument in identifying integrated healthcare and social services, particularly given the emerging and evolutionary state of this phenomenon within Canada.

Keywords: Canada, case definition, healthcare and social services integration, integration, seniors health, services delivery

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Authors: Manisha Singh, Padam Simkhada

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Background: Although mental health policy has been adapted in Nepal since 1997, the implementation of the policy framework is yet to happen. The fact that mental health services are largely concentrated in urban areas more specific to treatment only provides a clear picture of the scarcity of mental health services in the country. The shreds of evidence from around the world, along with WHO’s (World Health Organization) Mental Health Gap Action Program (mhGAP) suggest that effective mental health services can be provided from Primary Health Care (PHC) centers through community-based programs without having to place a specialized health worker. However, the country is still facing the same challenges to date with very few psychiatrists and psychologists, but they are largely based in cities. Objectives: The main objectives of this study are; (a) to understand the perception of health workers at PHC on maternal mental health, and (b) to assess the availability of the mental health services at PHC to address maternal mental health. Methods: This study used a qualitative approach where an in-depth interview was conducted with the health workers at the primary level. “Mayadevi” rural municipality in Rupendehi District that comprised of 13 small villages, was chosen as the study site. A total 8 health institutions which covered all 13 sites were included where either the health post in- charge or health worker working in maternal and child health care was interviewed for the study. All the health posts in the study area were included in the study. The interviews were conducted in Nepali; later, they were translated in English, transcribed, and triangulated. NViVO was used for the analysis. Results: The findings show that most of the health workers understood what maternal mental health was and deemed it as a public health issue. They could explain the symptoms and knew what medication to prescribe if need be. However, the majority of them failed to name the screening tools in place for maternal mental health. Moreover, they hadn’t even seen one. None of the health care centers had any provision for screening mental health status. However, one of the centers prescribed medication when the patients displayed symptoms of depression. But they believed there were a significant number of hidden cases in the community due to the stigma around mental health and being a woman with mental health problem makes the situation even difficult. Nonetheless, the health workers understood the importance of having screening tools and acknowledged the need of training and support in order to provide the services from PHC. Conclusion: Community health workers can identify cases with mental health problems and prevent them from deteriorating further. But there is a need for robust training and support to build the capacity of the health workers. The screening tools on mental health needs to be encouraged to be used in the PHC levels. Furthermore, community-based culture-sensitive programs need to be initiated and implemented to mitigate the stigma related issues around mental health.

Keywords: maternal mental health, health care providers, screening, Nepal

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Authors: Manal Sultan Alhussein, Xiang Michelle Liu

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Telehealth is an advanced technology using digital information and telecommunication facilities that provide access to health services from a distance. It slows the transmission factor of COVID-19, especially for elderly patients and patients with chronic diseases during the pandemic. Therefore, understanding patient perspectives on telehealth services and the factors impacting their option of telehealth service will shed light on the measures that healthcare providers can take to improve the quality of telehealth services. This study aimed to evaluate perceptions of telehealth services among different patient groups and explore various aspects of telehealth utilization in the United States during the COVID-19 pandemic. An online survey distributed via social media platforms was used to collect research data. In addition to the descriptive statistics, both correlation and regression analyses were conducted to test research hypotheses. The empirical results highlighted that the factors such as accessibility to telehealth services and the type of specialty clinics that the patients required play important roles in the effectiveness of telehealth services they received. However, the results found that patients’ waiting time to receive telehealth services and their annual income did not significantly influence their desire to select receiving healthcare services via telehealth. The limitations of the study and future research directions are discussed.

Keywords: telehealth, patient satisfaction, pandemic, healthcare, survey

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Authors: B. Parchem, M. Watanabe, D. Modrakovic, L. Mathew, A. Franklin, M. Cao, R. E. Broudy

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Objective: Executive functioning (EF) deficits underlie several mental health diagnoses including ADHD, anxiety, and depression. Community mental health clinics face extensive waitlists for services with many referrals involving EF deficits. A pilot trial of a four-week group therapy was developed using key components from Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and mindfulness with an aim to improve EF skills and offer low-fee services. Method: Eight adults (M = 34.5) waiting for services at a community clinic were enrolled in a four-week group therapy at an in-house training clinic for doctoral trainees. Baseline EF, pre-/post-intervention ADHD and distress symptoms, group satisfaction, and curriculum helpfulness were assessed. Results: Downward trends in ADHD and distress symptoms pre/post-intervention were not significant. Favorable responses on group satisfaction and helpfulness suggest clinical utility. Conclusion: Preliminary pilot data from a brief group therapy to improve EF may be an efficacious, acceptable, and feasible intervention for adults waiting for services at community mental health and training clinics where there are high demands and limits to services and staffs.

Keywords: executive functioning, cognitive-behavioral therapy, dialectical behavior therapy, mindfulness, adult group therapy

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Authors: Weera Chotithammaporn, Bannasorn Santhan

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The purpose of this study was to investigate the students’ satisfaction towards the counseling services of the Faculty of Industrial Technology, Suan Sunandha Rajabhat University. The sample group consisted of 311 students coming for counseling services during September to October 2012 BE to complete the questionnaires developed by the researcher. The data were analyzed to find percentage, arithmetic mean, and SD, from which it can be concluded that: 1) Personal information including gender, GPA, department, year of the study, and hometown revealed that most of the students in the Faculty of Industrial Technology, Suan Sunandha Rajabhat University were female with the GPA between 2.01 and 2.50 and studied in the Department of Interior and Exhibition Design and Graphic and Multimedia Design. Most of them were in the first year of the study and came from the southern part of Thailand. 2) The level of students’ satisfaction towards the counseling services of the Faculty of Industrial Technology, Suan Sunandha Rajabhat University was in overall at high level with the highest aspect on IT services followed by follow-up and evaluation service, counseling service, individual personal data collecting service, and personal placement service respectively.

Keywords: satisfaction, students, counseling service, Faculty of Industrial Technology

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