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[PMID]:29462152
[Au] Autor:Treacy L; Bolkan HA; Sagbakken M
[Ad] Endereço:Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
[Ti] Título:Distance, accessibility and costs. Decision-making during childbirth in rural Sierra Leone: A qualitative study.
[So] Source:PLoS One;13(2):e0188280, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Sierra Leone has one of the highest maternal mortality ratios in the world. Efforts to reduce maternal mortality have included initiatives to encourage more women to deliver at health facilities. Despite the introduction of the free health care initiative for pregnant women, many women still continue to deliver at home, with few having access to a skilled birth attendant. In addition, inequalities between rural and urban areas in accessing and utilising health facilities persist. Further insight into how and why women make decisions around childbirth will help guide future plans and initiatives in improving maternal health in Sierra Leone. The objective of this study was to explore the perceptions and decision-making processes of women and their communities during childbirth in rural Sierra Leone. METHODS AND FINDINGS: Data were collected through seven focus group discussions and 22 in-depth interviews with recently pregnant women and their community members in two rural villages. Data were analysed using systematic text condensation. Findings revealed that decision-making processes during childbirth are dynamic, intricate and need to be understood within the broader social context that they take place. Factors such as distance and lack of transport, perceived negative behaviour of hospital staff, direct and indirect financial obstacles, as well as the position of women in society all interact and influence how and what decisions are made. CONCLUSIONS: Pregnant women face multiple interacting vulnerabilities that influence their healthcare-seeking decisions during pregnancy and childbirth. Future initiatives to improve access and utilisation of safe healthcare services for pregnant women need to be based on adequate knowledge of structural constraints and health inequities that affect women in rural Sierra Leone.
[Mh] Termos MeSH primário: Tomada de Decisões
Custos de Cuidados de Saúde
Acesso aos Serviços de Saúde
População Rural
[Mh] Termos MeSH secundário: Feminino
Grupos Focais
Seres Humanos
Masculino
Gravidez
Pesquisa Qualitativa
Serra Leoa
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180221
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188280


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[PMID]:29462144
[Au] Autor:Schriver M; Cubaka VK; Itangishaka S; Nyirazinyoye L; Kallestrup P
[Ad] Endereço:Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.
[Ti] Título:Perceptions on evaluative and formative functions of external supervision of Rwandan primary healthcare facilities: A qualitative study.
[So] Source:PLoS One;13(2):e0189844, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: External supervision of primary healthcare facilities in low- and middle-income countries often has a managerial main purpose in which the role of support for professional development is unclear. AIM: To explore how Rwandan primary healthcare supervisors and providers (supervisees) perceive evaluative and formative functions of external supervision. DESIGN: Qualitative, exploratory study. DATA: Focus group discussions: three with supervisors, three with providers, and one mixed (n = 31). Findings were discussed with individual and groups of supervisors and providers. RESULTS: Evaluative activities occupied providers' understanding of supervision, including checking, correcting, marking and performance-based financing. These were presented as sources of motivation, that in self-determination theory indicate introjected regulation. Supervisors preferred to highlight their role in formative supervision, which may mask their own and providers' uncontested accounts that systematic performance evaluations predominated supervisors' work. Providers strongly requested larger focus on formative and supportive functions, voiced as well by most supervisors. Impact of performance evaluation on motivation and professional development is discussed. CONCLUSION: While external supervisors intended to support providers' professional development, our findings indicate serious problems with this in a context of frequent evaluations and performance marking. Separating the role of supporter and evaluator does not appear as the simple solution. If external supervision is to improve health care services, it is essential that supervisors and health centre managers are competent to support providers in a way that transparently accounts for various performance pressures. This includes delivery of proper formative supervision with useful feedback, maintaining an effective supervisory relationship, as well as ensuring providers are aware of the purpose and content of evaluative and formative supervision functions.
[Mh] Termos MeSH primário: Atenção Primária à Saúde/organização & administração
[Mh] Termos MeSH secundário: Grupos Focais
Seres Humanos
Pesquisa Qualitativa
Ruanda
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180221
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189844


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[PMID]:29364937
[Au] Autor:Nuzum D; Meaney S; O'Donoghue K
[Ad] Endereço:Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.
[Ti] Título:The impact of stillbirth on bereaved parents: A qualitative study.
[So] Source:PLoS One;13(1):e0191635, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To explore the lived experiences and personal impact of stillbirth on bereaved parents. METHODS: Semi-structured in-depth interviews analysed by Interpretative Phenomenological Analysis (IPA) on a purposive sample of parents of twelve babies born following fetal death at a tertiary university maternity hospital in Ireland with a birth rate of c8,500 per annum and a stillbirth rate of 4.6/1000. RESULTS: Stillbirth had a profound and enduring impact on bereaved parents. Four superordinate themes relating to the human impact of stillbirth emerged from the data: maintaining hope, importance of the personhood of the baby, protective care and relationships (personal and professional). Bereaved parents recalled in vivid detail their experiences of care following diagnosis of stillbirth and their subsequent care. The time between diagnosis of a life-limiting anomaly or stillbirth and delivery is highlighted as important for parents as they find meaning in their loss. CONCLUSIONS: The impact of stillbirth on bereaved parents is immense and how parents are cared for is recalled in precise detail as they revisit their experience. Building on existing literature, these data bring to light the depth of personal experience and impact of stillbirth for parents and provides medical professionals with valuable insights to inform their care of bereaved parents and the importance of clear and sensitive communication.
[Mh] Termos MeSH primário: Luto
Pais/psicologia
Natimorto
[Mh] Termos MeSH secundário: Seres Humanos
Pesquisa Qualitativa
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191635


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[PMID]:28449648
[Au] Autor:Oxenford K; Daley R; Lewis C; Hill M; Chitty LS
[Ad] Endereço:Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK.
[Ti] Título:Development and evaluation of training resources to prepare health professionals for counselling pregnant women about non-invasive prenatal testing for Down syndrome: a mixed methods study.
[So] Source:BMC Pregnancy Childbirth;17(1):132, 2017 04 27.
[Is] ISSN:1471-2393
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The availability of non-invasive prenatal testing (NIPT) for aneuploidies is expanding rapidly throughout the world. Training health professionals to offer NIPT in a way that supports informed choice is essential for implementation. The aim of this study was to develop and evaluate a training package for health professionals to support the introduction of NIPT into clinical practice. METHODS: Training on NIPT was offered to health professionals, primarily midwives, involved in Down syndrome screening and testing in eight hospitals located in England and Scotland as part of a research study evaluating the implementation of NIPT in the UK National Health Service. Training was evaluated using a mixed methods approach that included quantitative questionnaires at three time points and post-training qualitative interviews. The questionnaires measured confidence, self-perceived knowledge and actual knowledge about NIPT for Down syndrome. Interviews explored opinions about the training and experiences of offering NIPT. RESULTS: The training provided to the health professionals was found to positively impact on their confidence in discussing NIPT with women in their clinic, and both their perceived and actual knowledge and understanding of NIPT was improved. Knowledge remained weak in four areas; cell-free fetal DNA levels increase with gestation; turnaround time for NIPT results; cell-free fetal DNA is placental in origin; and NIPT false positive rate. CONCLUSIONS: Training materials, including a lesson plan, PowerPoint presentation and written factsheet on NIPT, have been developed and evaluated for use in educating midwives and supporting the introduction of NIPT. Implementation of training should include a greater focus on the areas where knowledge remained low. Some groups of midwives will need additional training or support to optimise their confidence in discussing NIPT with women.
[Mh] Termos MeSH primário: Aconselhamento/educação
Síndrome de Down/diagnóstico
Pessoal de Saúde/educação
Diagnóstico Pré-Natal/psicologia
Ensino
[Mh] Termos MeSH secundário: Adulto
Aneuploidia
Aconselhamento/métodos
Feminino
Seres Humanos
Masculino
Meia-Idade
Gravidez
Diagnóstico Pré-Natal/métodos
Pesquisa Qualitativa
Inquéritos e Questionários
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1186/s12884-017-1315-7


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[PMID]:29219248
[Au] Autor:Mackworth-Young CR; Bond V; Wringe A; Konayuma K; Clay S; Chiiya C; Chonta M; Sievwright K; Stangl AL
[Ad] Endereço:Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
[Ti] Título:"My mother told me that I should not": a qualitative study exploring the restrictions placed on adolescent girls living with HIV in Zambia.
[So] Source:J Int AIDS Soc;20(4), 2017 Dec.
[Is] ISSN:1758-2652
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Adolescent girls in sub-Saharan Africa are disproportionately affected by HIV due to a range of social and structural factors. As they transition to adulthood, they are recipients of increasing blame for HIV infection and 'improper' sex, as well as increasing scrutiny, restrictions and surveillance. This study used a qualitative and participatory approach to explore the messaging and restrictions imposed on adolescent girls living with HIV in Zambia. METHODS: Thirty-four in-depth interviews and four participatory workshops were carried out with 24 adolescent girls aged 15 to 19 years old living with HIV in Lusaka, Zambia. Key themes explored included experiences living with HIV, finding out about HIV status, disclosure, experiences with antiretroviral treatment, and support needs. Data were organized, coded and analysed using a grounded theory approach to thematic analysis. This analysis uses data on participants' experiences of living with HIV and their interactions with their parents, guardians and healthcare providers. RESULTS: Family and healthcare providers, partly in a quest to protect both the health of adolescent girls living with HIV and also to protect them from blaming discourse, imposed restrictions on their behaviour around three main topics: don't disclose your HIV status, don't have sex, and don't miss your medicines. These restrictions were often delivered using tactics of fear, and usually disconnected from other options. Participants responded to these messages in several ways, including internalizing the messages, changing their behaviour either to comply with or resist the restrictions, by remaining silent and anxious when restrictions were broken, and developing concerns around their own health and sexual and reproductive aspirations. Participants also sometimes experiencing stigma when restrictions could not be maintained. CONCLUSIONS: Restrictive messages were delivered to adolescent girls living with HIV through the broader social discourses of stigma, religion, and global and local narratives about HIV. Programmes aiming to support adolescent girls living with HIV need to work together with parents and healthcare providers to reflect on the impact of sanctioning messages, and to encourage more enabling and empowering messaging for adolescent girls living with HIV.
[Mh] Termos MeSH primário: Infecções por HIV/psicologia
Responsabilidade Social
Estigma Social
[Mh] Termos MeSH secundário: Adolescente
Atitude Frente à Saúde
Medo
Feminino
Pessoal de Saúde
Seres Humanos
Pesquisa Qualitativa
Religião
Comportamento Sexual
Zâmbia/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:171209
[St] Status:MEDLINE
[do] DOI:10.1002/jia2.25035


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[PMID]:29210185
[Au] Autor:Camlin CS; Charlebois ED; Geng E; Semitala F; Wallenta J; Getahun M; Kampiire L; Bukusi EA; Sang N; Kwarisiima D; Clark TD; Petersen ML; Kamya MR; Havlir DV
[Ad] Endereço:University of California, San Francisco, CA, USA.
[Ti] Título:Redemption of the "spoiled identity:" the role of HIV-positive individuals in HIV care cascade interventions.
[So] Source:J Int AIDS Soc;20(4), 2017 Dec.
[Is] ISSN:1758-2652
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The concept of "therapeutic citizenship" has drawn attention to ways in which public testimony, the "story-telling in the public sphere" undertaken by people living with HIV (PLHIV), has shaped the global response to the epidemic. This paper presents qualitative findings from two large studies in eastern Africa that reveal how the advent of population-based HIV testing campaigns and efforts to accelerate antiretroviral "treatment for all" has precipitated a rapidly expanding therapeutic citizenship "project," or social movement. The title of this paper refers to Goffman's original conceptualization of stigma as a social process through which a person's identity is rendered "spoiled." METHODS: Data were derived from qualitative studies embedded within two clinical trials, Sustainable East African Research in Community Health (SEARCH) (NCT# 01864603) in Kenya and Uganda, and START-ART (NCT# 01810289) in Uganda, which aimed to offer insights into the pathways through which outcomes across the HIV care continuum can be achieved by interventions deployed in the studies, any unanticipated consequences, and factors that influenced implementation. Qualitative in-depth semi-structured interviews were conducted among cohorts of adults in 2014 through 2015; across both studies and time periods, 217 interviews were conducted with 166 individuals. Theoretically informed, team-based analytic approaches were used for the analyses. RESULTS: Narratives from PLHIV, who have not always been conceptualized as actors but rather usually as targets of HIV interventions, revealed strongly emergent themes related to these individuals' use of HIV biomedical resources and discourses to fashion a new, empowered subjecthood. Experiencing the benefits of antiretroviral therapy (ART) emboldens many individuals to transform their "spoiled" identities to attain new, valorized identities as "advocates for ART" in their communities. We propose that the personal revelation of what some refer to as the "gospel of ARVs," the telling of personal stories about HIV in the public sphere and actions to accompany other PLHIV on their journey into care, is driven by its power to redeem the "spoiled identity:" it permits PLHIV to overcome self-stigma and regain full personhood within their communities. CONCLUSIONS: PLHIV are playing an unanticipated but vital role in the successful implementation of HIV care cascade interventions.
[Mh] Termos MeSH primário: Infecções por HIV/terapia
Papel do Doente
Estigma Social
[Mh] Termos MeSH secundário: Adulto
Grupo com Ancestrais do Continente Africano
Continuidade da Assistência ao Paciente
Feminino
Infecções por HIV/tratamento farmacológico
Infecções por HIV/psicologia
Seres Humanos
Quênia
Masculino
Meia-Idade
Quartos de Pacientes
Pesquisa Qualitativa
Identificação Social
Uganda
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE
[do] DOI:10.1002/jia2.25023


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[PMID]:29206357
[Au] Autor:Semitala FC; Camlin CS; Wallenta J; Kampiire L; Katuramu R; Amanyire G; Namusobya J; Chang W; Kahn JG; Charlebois ED; Havlir DV; Kamya MR; Geng EH
[Ad] Endereço:Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
[Ti] Título:Understanding uptake of an intervention to accelerate antiretroviral therapy initiation in Uganda via qualitative inquiry.
[So] Source:J Int AIDS Soc;20(4), 2017 Dec.
[Is] ISSN:1758-2652
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The Streamlined Antiretroviral Therapy Initiation Strategy (START-ART) study found that a theory-based intervention using opinion leaders to inform and coach health care providers about the risks of treatment delay, provision of point of care (POC) CD4 testing machines (PIMA) and reputational incentives, led to rapid rise in ART initiation. We used qualitative research methods to explore mechanisms of provider behaviour change. METHODS: We conducted in-depth interviews (IDIs) with 24 health care providers and nine study staff to understand perceptions, attitudes and the context of changes in ART initiation practices. Analyses were informed by the Theoretical Domains Framework. RESULTS: Rapid dissemination of new practices was enabled in the environmental context of an existing relationship based on communication, implementation and accountability between Makerere University Joint AIDS Program (MJAP), a Ugandan University-affiliated organization that provided technical oversight for HIV service delivery at the health facilities where the intervention was implemented, and a network of health facilities operated by the Uganda Ministry of Health. Coaching carried out by field coordinators from MJAP strengthened influence and informal accountability for carrying out the intervention. Frontline health workers held a pre-existing strong sense of professional identity. They were proud of attainment of new knowledge and skills and gratified by providing what they perceived to be higher quality care. Peer counsellors, who were not explicitly targeted in the intervention design, effectively substituted some functions of health care providers; as role models for successful ART uptake, they played a crucial role in creating demand for rapid ART initiation through interactions with patients. Point of care (POC) CD4 testing enabled immediate action and relieved providers from frustrations of lost or delayed laboratory results, and led to higher patient satisfaction (due to reduced costs because of ability to initiate ART right away, requiring fewer return trips to clinic). CONCLUSIONS: Qualitative data revealed that a multicomponent intervention to change provider behaviour succeeded in the context of strong institutional and individual relationships between a University-affiliated organization, government facilities, and peer health workers (who acted as a crucial link between stakeholders) and the community. Fostering stable institutional relationships between institutional actors (non-governmental organization (NGOs) and ministry-operated facilities) as well as between facilities and the community (through peer health workers) can enhance uptake of innovations targeting the HIV cascade in similar clinical settings.
[Mh] Termos MeSH primário: Fármacos Anti-HIV/uso terapêutico
Infecções por HIV/tratamento farmacológico
Pessoal de Saúde
Aceitação pelo Paciente de Cuidados de Saúde
[Mh] Termos MeSH secundário: Instituições de Assistência Ambulatorial
Feminino
Pessoal de Saúde/psicologia
Seres Humanos
Masculino
Motivação
Grupo Associado
Sistemas Automatizados de Assistência Junto ao Leito
Pesquisa Qualitativa
Uganda
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1002/jia2.25033


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[PMID]:28470163
[Au] Autor:Kang S
[Ad] Endereço:Department of Nursing, Kkottongnae University, Cheongju, Korea. srkang@kkot.ac.kr.
[Ti] Título:[The Recovery Process of Alcohol Dependent Men Living in a Therapeutic Community].
[So] Source:J Korean Acad Nurs;47(2):267-276, 2017 Apr.
[Is] ISSN:2093-758X
[Cp] País de publicação:Korea (South)
[La] Idioma:kor
[Ab] Resumo:PURPOSE: The purpose of this study was to explore the recovering process of men who had abused alcohol and has lived in a therapeutic community. METHODS: Individual in-depth interviews were used to collect data from 10 of these men who has lived in the therapeutic community for more than one year. Qualitative data from field notes and transcribed notes were analyzed using the grounded theory methodology developed by Strauss and Corbin. RESULTS: The core category about the recovering process of the men who had abused alcohol and are now in the therapeutic community was identified as "reconstructing a broken life". The recovering process of these men in the therapeutic community consisted of four phases; 'self-awareness stage', 'unfreezing stage', 'readjustment stage', and 'challenging stage'. CONCLUSION: In this study "reconstructing a broken life", as the core category vividly showed joys and sorrows of men who had abused alcohol and has lived in the recovering process of managing the yoke of life-long disease. In this process of recovery from alcoholic dependence the men gradually adjusted themselves to their given condition. Also they gained coping strategies to care for, and protect themselves. Therefore health care providers can establish supportive programs in the clinical field to empower these men by reflecting their proactive coping strategies.
[Mh] Termos MeSH primário: Adaptação Psicológica
Alcoolismo/psicologia
[Mh] Termos MeSH secundário: Seres Humanos
Entrevistas como Assunto
Masculino
Meia-Idade
Avaliação de Programas e Projetos de Saúde
Pesquisa Qualitativa
Comunidade Terapêutica
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.4040/jkan.2017.47.2.267


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[PMID]:28453827
[Au] Autor:Gagliardi AR; Lehoux P; Ducey A; Easty A; Ross S; Bell CM; Trbovich P; Takata J; Urbach DR
[Ad] Endereço:Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada.
[Ti] Título:Factors constraining patient engagement in implantable medical device discussions and decisions: interviews with physicians.
[So] Source:Int J Qual Health Care;29(2):276-282, 2017 Apr 01.
[Is] ISSN:1464-3677
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: Patient engagement (PE) is warranted when treatment risks and outcomes are uncertain, as is the case for higher risk medical devices. Previous research found that patients were not engaged in discussions or decisions about implantable medical devices. This study explored physician views about engaging patients in such discussions. Design: Qualitative interviews using a basic descriptive approach. Setting: Canada. Participants: Practicing cardiovascular and orthopaedic physicians. Main outcome measures: Level, processes and determinants of PE in medical device discussions and decisions. Results: Views were largely similar among 10 cardiovascular and 12 orthopaedic physicians interviewed. Most said that it was feasible to inform and sometimes involve patients in discussions, but not to partner with them in medical device decision-making. PE was constrained by patient (comfort with PE, technical understanding, physiologic/demographic characteristics, prognosis), physician (device preferences, time), health system (purchasing contracts) and device factors (number of devices on market, comparative advantage). A framework was generated to help physicians engage patients in discussions about medical devices, even when decisions may not be preference sensitive due to multiple constraints on choice. Conclusions: This study identified that patients are not engaged in discussions or decisions about implantable medical devices. This may be due to multiple constraints. Further research should establish the legitimacy, prevalence and impact of constraining factors, and examine whether and how different levels and forms of PE are needed and feasible.
[Mh] Termos MeSH primário: Tomada de Decisões
Participação do Paciente/métodos
Médicos/psicologia
Próteses e Implantes
[Mh] Termos MeSH secundário: Atitude do Pessoal de Saúde
Canadá
Cardiologistas/psicologia
Seres Humanos
Cirugiões Ortopédicos/psicologia
Relações Médico-Paciente
Pesquisa Qualitativa
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/intqhc/mzx013


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[PMID]:28450271
[Au] Autor:Latulippe K; Hamel C; Giroux D
[Ad] Endereço:Department of Studies of Teaching and Learning, Laval University, Québec, QC, Canada.
[Ti] Título:Social Health Inequalities and eHealth: A Literature Review With Qualitative Synthesis of Theoretical and Empirical Studies.
[So] Source:J Med Internet Res;19(4):e136, 2017 Apr 27.
[Is] ISSN:1438-8871
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: eHealth is developing rapidly and brings with it a promise to reduce social health inequalities (SHIs). Yet, it appears that it also has the potential to increase them. OBJECTIVES: The general objective of this review was to set out how to ensure that eHealth contributes to reducing SHIs rather than exacerbating them. This review has three objectives: (1) identifying characteristics of people at risk of experiencing social inequality in health; (2) determining the possibilities of developing eHealth tools that avoid increasing SHI; and (3) modeling the process of using an eHealth tool by people vulnerable to SHI. METHODS: Following the EPPI approach (Evidence for Policy and Practice of Information of the Institute of Education at the University of London), two databases were searched for the terms SHIs and eHealth and their derivatives in titles and abstracts. Qualitative, quantitative, and mixed articles were included and evaluated. The software NVivo (QSR International) was employed to extract the data and allow for a metasynthesis of the data. RESULTS: Of the 73 articles retained, 10 were theoretical, 7 were from reviews, and 56 were based on empirical studies. Of the latter, 40 used a quantitative approach, 8 used a qualitative approach, 4 used mixed methods approach, and only 4 were based on participatory research-action approach. The digital divide in eHealth is a serious barrier and contributes greatly to SHI. Ethnicity and low income are the most commonly used characteristics to identify people at risk of SHI. The most promising actions for reducing SHI via eHealth are to aim for universal access to the tool of eHealth, become aware of users' literacy level, create eHealth tools that respect the cultural attributes of future users, and encourage the participation of people at risk of SHI. CONCLUSIONS: eHealth has the potential to widen the gulf between those at risk of SHI and the rest of the population. The widespread expansion of eHealth technologies calls for rigorous consideration of interventions, which are not likely to exacerbate SHI.
[Mh] Termos MeSH primário: Conhecimentos em Informática/estatística & dados numéricos
Disparidades nos Níveis de Saúde
Internet/utilização
Telemedicina/utilização
[Mh] Termos MeSH secundário: Seres Humanos
Pobreza/estatística & dados numéricos
Pesquisa Qualitativa
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.2196/jmir.6731



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