CONSUMER SATISFACTION IN TWO SMALL RURAL COMMUNITIES: A QUICK METHODOLOGY TO EMPOWER RURAL COMMUNITIES TO ASSESS THEIR OWN HEALTHCARE NEEDS

ABSTRACT: This study was designed to develop a quick methodology to assess the healthcare needs of a rural community and to determine what factors make these communities 'happy' or 'unhappy' with respect to medical service provision. Two rural shires of approximately 4000 people each were chosen from different health regions of Western Australia. The methodology consisted of interviews with healthcare providers and key community informants as well as a community questionnaire. The interviewing process showed that key community informants offered no new information in addition to that already provided by the healthcare providers. Furthermore, all key points would have been covered by interviewing approximately 60% of all healthcare providers in each community. Hand delivery of the community questionnaire yielded the highest response rate. The level of community satisfaction with general practitioner (GP) and hospital services determines whether a community is medically 'happy' or 'unhappy'.     

Healthy vision. Baton Rouge, LA, healthcare organizations collaborate to complete a needs assessment

Baton Rouge, LA, has in recent years seen rocketing rates of syphilis, alcohol abuse, and other health problems. In response, 10 local healthcare organizations met in 1993 to form the Baton Rouge Health Forum. The forum began its work by conducting a community needs assessment. The forum organized three task forces. One compiled existing data on area demographics, public health, economics, and education. A second task force employed personal interviews and focus groups to gather residents' opinions on the area's top 10 healthcare needs. The third task force kept local media and community leaders informed about the assessment's findings. As in other U.S. communities, Baton Rouge residents' top 10 needs centered around social issues with health implications. The number one perceived need, for example, was a central clearing-house to provide information about healthcare to those who lack it.     

Sponsorship networks. A new model for preserving congregations' presence in the Catholic healthcare ministry

A renewal of vision is necessary today as healthcare shifts from an acute care to a community health focus. In regions where there are multiple sponsors, they can foster this renewed vision by forming sponsorship networks. A sponsorship network begins when sponsors in a region come together to discuss collaboration and explore ways to motivate the leaders of their institutions to better meet their community's healthcare needs. A sponsorship network would focus on community health through more effective resource use and integration of resources among providers. Such a network encourages providers to assess community needs and collaborate to meet them, provides criteria for maintaining quality and mission, and explores sponsorship responsibilities within institutions and beyond. The collaborative process involves five stages: preplanning, foundation building, problem setting, implementing, and assessing. A group of sponsors in St. Louis provides an example of how sponsors can initiate such a process.     

‘The disease isn't listening to the drug’: The socio-cultural context of antibiotic use for viral respiratory infections in rural Uganda

To identify factors precipitating antibiotic misuse and discuss how to promote safe antibiotics use and curb antibiotic resistance. Antibiotic misuse is a significant problem globally, leading to increased antibiotic resistance. Many socio-cultural factors facilitate antibiotic misuse: patient and provider beliefs about antibiotics, inadequate regulation, poor health literacy, inadequate healthcare provider training, and sub-optimal diagnostic capability. This study investigates the influence of such factors on antibiotic use and community health in rural Uganda. Attention was paid to patient-provider dynamics, providers’ concerns, and the role of drug shops in the communities and how these situations exacerbate antibiotic misuse. Using a grounded ethnographic approach, interviews, focus groups, and observations were conducted over six weeks. Five salient themes emerged from data analysis. Based on the study results and a review of past literature on antibiotic resistance, there is need for improved health literacy and education, continued focus on efficiency and affordability in healthcare, and recognition of the role of stewardship and government in providing better healthcare. The problem of antibiotic misuse is multifactorial. Proposed solutions must target multiple contributing factors and must ultimately modify the culture and beliefs surrounding antibiotic use and encourage proper use. Such a multi-pronged approach would be most effective and would decrease rates of antibiotic resistance.     

Recruitment of Rural Health Care Providers: A Regional Recruiter Strategy

ABSTRACT: Context: Access to care in rural areas is a major problem. Despite more than 20% of the US population residing in these areas, only 9% of physicians practice there. Extensive research has documented multiple issues that affect where physicians decide to locate and maintain practices. Creative strategies have been used to influence these recruitment and retention decisions. An emerging strategy, borne out of the Robert Wood Johnson Foundation's Southern Rural Access Program (SRAP), effectively uses a targeted regional approach to assist rural Communities and health care facilities in assessing health care needs and recruiting primary care providers. Purpose: This article examines the issues surrounding recruitment and retention of primary care providers to rural areas and describes the experiences of the regional recruitment strategy in several states and in particular in the Mississippi Delta region of Arkansas. Methods: A case study approach is used to examine the targeted regional recruiter strategy in the Mississippi Delta region of Arkansas. Findings: The regional recruiter strategy, which combines traditional recruitment efforts with community development activities, has been successful in recruiting health care providers to rural communities. The cost-effective strategy can be easily replicated in other rural states. Conclusions: Community factors affect provider decisions on practice locations. Addressing community factors in recruitment efforts through community development activities may increase their success.     

Catholic hospitals and community benefit activities. A comparative inventory of policies and programs reveals a wide range of services

Results from a 1990 survey of 595 acute care, short-term, U.S. Catholic hospitals help identify and describe the most and least common community benefit activities and propose ways Catholic healthcare providers can become more involved in their local communities. The response rate for this mailed, self-administered questionnaire was 72 percent (n = 429). The survey data indicated that Catholic hospitals engaged in a variety of healthcare efforts in their local communities. These efforts ranged from occasional activities (e.g., delivering food baskets to the needy at Christmastime) to sponsoring long-term programs (e.g., continuing case management). To expand involvement throughout the community, hospitals can do the following relatively low-cost tasks: Have volunteers visit area residents in their homes and report their findings. Sponsor focus groups (facilitated by graduate students from area colleges and universities) that include the various community members. Assess the human needs of the communities that surround the hospital. Graduate students may conduct preliminary studies to identify the scope and variety of community healthcare needs.     

“Every interaction you have …should be an opportunity to discuss and offer influenza vaccination”. Health service perspectives on influenza vaccination promotion and delivery to Aboriginal families living in New South Wales,Australia

IntroductionThere is little research to understand reasons for suboptimal influenza vaccination uptake among Aboriginal people of different ages in Australia. This study aimed to better understand the communication needs and preferences of Aboriginal families (Phase 2) in New South Wales, Australia, and their health service providers (Phase 1), to inform future interventions to improve influenza immunisation coverage in Aboriginal communities. This paper reports from Phase 1 of the study.Material and methodsAboriginal and non-Aboriginal researchers designed and conducted the study, with cultural governance provided by Aboriginal health care professionals and other community members working within health departments or community healthcare settings across Australia. In Phase 1 we conducted interviews and focus groups with 18 Aboriginal immunisation providers and mainstream immunisation co-ordinators from three geographic areas in New South Wales. We used group-based thematic analysis with a cultural lens and sought participants’ feedback prior to finalising results.ResultsWe identified four themes, framed as opportunities for improvement: better supporting Aboriginal Medical Services as providers of influenza vaccinations; improving the accessibility and appropriateness of mainstream services for Aboriginal families; improving health providers’ knowledge of Aboriginal people’ influenza risk and their willingness to recommend vaccination; and engaging communities to design influenza vaccination resources.ConclusionsTo achieve optimal influenza vaccination coverage, all health services must take responsibility for providing culturally responsive clinical care to Aboriginal families. We suggest that, where possible, mainstream services incorporate elements of the family-centred and broader model of health used by Aboriginal Medical Services. This includes creating a welcoming environment, appropriately identifying and getting to know Aboriginal patients, taking a preventative approach, and opportunistically offering and strongly encouraging influenza vaccination to the individual and their family.     

From assessment to action. A hospital-community coalition provides needed services to children

In December 1991 St. Mary Hospital, Port Arthur, TX, began a three-phase procedure to provide underserved persons in the community better access to care. The process began with a community needs assessment, after which St. Mary developed a hospital-community coalition to plan and implement programs to address identified needs. The needs assessment revealed two underserved populations: racial and ethnic minorities, and youth in two separate categories (below five years old, and from five to the teen years). The top needs were for greater access to healthcare and an increase in primary care services. Having determined that St. Mary Hospital was better equipped to address the lack of primary care, the needs assessment team forged a coalition with community leaders and providers. Collaborative efforts led to the opening of three primary care clinics for children in 1993. The hospital also participated in a task force that identified and alerted the parents of more than 3,800 Port Arthur children in need of Early and Periodic Screening and Developmental Testing. St. Mary is currently working on a plan to contact the family of every Port Arthur child at the age of three months to ensure immunizations are current and a relationship has been established with a healthcare provider.     

USE OF COMMUNITY HEALTH NEEDS ASSESSMENT FOR REGIONAL PLANNING IN COUNTRY SOUTH AUSTRALIA

ABSTRACT: This study examined the impact of community health needs assessments used in country South Australian health service planning between 1995 and 1999. Data were collected from regional health planning officers during a Search Conference and a series of Delphi rounds. The needs assessments were found to vary from regionally to locally driven approaches. Locally driven approaches ensured local involvement but the process was slower and required more effort from the planner. It was also felt that locally driven approaches could exacerbate tension between a community's imperatives and the regional focus of regional decision-makers. In the overall regional budgets, the reallocation of health service funds according to the needs assessment findings was only small because of difficulties in refocusing from traditional clinical services in the short term. In contrast, the impact on health service thinking about population health issues was thought to have been more significant, for example, in the development of regional women's health plans. The use of community health needs assessments was useful, but for greater impact these should not now be so 'broad-brushed', but be more focused on feasible changes that health services could support. Other priority-setting techniques, such as marginal analysis, should also be used to determine where maximum health gains can be obtained.     

Getting to the truth? Researching user views of primary health care

In countries at all levels of development, assessing the opinions of health service users is increasingly promoted as an integral part of quality evaluations. However, there has been much debate on how best to measure user opinions. This article discusses findings from a study in South Africa, which employed both closed-ended facility exit interviews (total 337) and open-ended community-based focus group discussions (total 14) to obtain users' views on the same set of primary care providers. We outline various difficulties encountered in the interpretation of the data. First, in the absence of explicit and universal standards, users evaluated providers against their experiences with other health care services available to them in their areas. Responses were thus highly context specific, dependent on the particular configuration of services in each site. Secondly, the focus group discussions provided a very different (generally more negative) picture of providers to the exit interviews, suggesting that where and how views of health services are elicited has a large bearing on the results obtained. Thirdly, the focus group discussions appeared to encourage dramatic representations of what was, on observation, a banal everyday reality. Both methods defied superficial reading, and each appeared to have limitations in establishing the 'truth' about people's opinions. We conclude that there is a need for greater recognition, in quality assessments and in quality assurance, that user and community opinion is a social rather than a technical phenomenon. As such it is dynamic, bound to particular contexts and difficult to capture in single, 'snap-shot' assessments, no matter how well designed. In the context of quality assurance programmes, time spent assessing user views may be better used in other ways such as training and supporting health care workers to engage directly in dialogue with communities around needs and expectations.     

Applying a basic development needs approach for sustainable and integrated community development in less-developed areas: report of ongoing Iranian experience

INTRODUCTION: Despite considerable achievements in the provision of basic developmental facilities in terms of drinking water, access to primary healthcare services, high-quality and nutritious food, social services, and proper housing facilities, there are many rural and slum communities in Iran where these essential needs remain unfulfilled. Lack of equity is prominent, as large differences exist in underprivileged provinces. New policies developed in the past two decades have resulted in substantial achievements in meeting population needs and reducing the socio-economic gap; nevertheless, poverty levels, unemployment due to a large increase in the birth rate in the early 1980s, and lack of community participation are matters yet to be addressed. To overcome these deficiencies, a basic development needs approach was adopted to promote the concept of community self-help and self-reliance through intersectoral collaboration, creating an environment where people could take an active part in the development process, with the Iranian government providing the necessary support to achieve the desired level of development. DESCRIPTION OF THE PROJECT: Following firm commitment from the Iranian government and technical support from the World Health Organization Regional Office, basic development needs was assigned a high priority in health and health-related sectors, reflected in the third National Masterplan (2001-2005). A comprehensive intersectoral plan was designed, and pilot projects were commenced in three villages. Each village elected a representative, and committee clusters were formed to run and monitor projects identified by a process of local needs assessment and priority assignment. In each region, a variety of needs were elicited from these assessments, which were actively supported by local authorities. LESSON LEARNED: A basic development needs approach was found to be a reliable discipline to improve community participation, needs-led resource allocation and intersectoral co-operation in community development, particularly in underprivileged areas. Iran's initial experience of basic development needs has gained widespread public support but will require periodical evaluation as it is introduced into other rural and urban regions across the country.     

Patients report positive impacts of collaborative care

Collaborative Care refers to a partnership between healthcare professionals and patients who feel confident to manage their health conditions. Using an Internet-based assessment of health needs and healthcare quality, we surveyed 24,609 adult Americans aged 19 to 69 who had common chronic diseases or significant dysfunction. In these patients, we examined the association of Collaborative Care with specific measures for treatment effect, disease control, prevention, and economic impacts. These measures were adjusted for respondents' demographic characteristics, burden of illness, health behaviors, and overall quality of healthcare. Only 21% of respondents participated in good Collaborative Care, 36% attained fair Collaborative Care, and 43% experienced poor Collaborative Care. Regardless of overall care quality or the respondents' personal characteristics, burden of illness, or health behaviors, good Collaborative Care was associated with better control of blood pressure, blood glucose level, serum cholesterol level, and treatment effectiveness for pain and emotional problems. Some preventive actions were better, and some adverse economic impacts of illness were mitigated.     

Estimating community health needs against a Triple Aim background: What can we learn from current predictive risk models?

IntroductionTo support providers and commissioners in accurately assessing their local populations’ health needs, this study produces an overview of Dutch predictive risk models for health care, focusing specifically on the type, combination and relevance of included determinants for achieving the Triple Aim (improved health, better care experience, and lower costs).MethodsWe conducted a mixed-methods study combining document analyses, interviews and a Delphi study. Predictive risk models were identified based on a web search and expert input. Participating in the study were Dutch experts in predictive risk modelling (interviews; n = 11) and experts in healthcare delivery, insurance and/or funding methodology (Delphi panel; n = 15).ResultsTen predictive risk models were analysed, comprising 17 unique determinants. Twelve were considered relevant by experts for estimating community health needs. Although some compositional similarities were identified between models, the combination and operationalisation of determinants varied considerably.ConclusionsExisting predictive risk models provide a good starting point, but optimally balancing resources and targeting interventions on the community level will likely require a more holistic approach to health needs assessment. Development of additional determinants, such as measures of people's lifestyle and social network, may require policies pushing the integration of routine data from different (healthcare) sources.     

Understanding and Coping with Diversity in Healthcare

In the healthcare sector, race, ethnicity and religion have become an increasingly important factor in terms of patient care due to an increasingly diverse population. Health agencies at a national and local level produce a number of guides to raise awareness of cultural issues among healthcare professionals and hospitals may implement additional non-medical services, such as the provision of specific types of food and dress to patients or the hiring of chaplains, to accommodate the needs of patients with religious requirements. However, in an attempt to address the spiritual, cultural and religious needs of patients healthcare providers often assume that ethnic minority groups are homogenous blocks of people with similar needs and fail to recognize that a diverse range of views and practices exist within specific groups themselves. This paper describes the example of the Sikh community and the provision of palliative care in hospitals and hospices. Although, the majority of patients classifying themselves as Sikhs have a shared language and history, they can also be divided on a number of lines such as caste affiliation, degree of assimilation in the west, educational level and whether baptized or not, all of which influence their beliefs and practices and hence impact on their needs from a health provider. Given that it is unfeasible for health providers to have knowledge of the multitude of views within specific religious and ethnic communities and accounting for the tight fiscal constraints of healthcare budgets, this paper concludes by raising the question whether healthcare providers should step away from catering for religious and cultural needs that do not directly affect treatment outcomes, and instead put the onus on individual communities to provide resources to meet spiritual, cultural and religious needs of patients.     

Pregnancy outcomes and migration in Switzerland: results from a focus group study

Summary Objectives: To explore the issues of pregnancy and delivery in migrant women in their interaction with the Swiss healthcare system. Methods: Focus groups were conducted with women of the Turkish and Portuguese communities. Swiss women were included as the reference group. Interpreters were used when needed. Group discussions were recorded and transcribed; all communications were categorized by specific themes and subdivided as to content. Results: Eight focus groups were held: there were a total of 40 participants including 14 Turkish, 17 Portuguese, 9 Swiss. The study revealed that migrant women in Switzerland face stressful situations, which may differ according to nationality and length of stay in the country. Main factors negatively affecting pregnancy were stress due to precarious living conditions, heavy work during pregnancy, inadequate communication with healthcare providers, and feelings of racism and discrimination in society. Conclusions: Main findings of this qualitative study confirm that migrant communities need focused health attention because of numerous barriers to healthcare experienced in Switzerland. Improving the reproductive health of the migrant community is a priority that can be addressed by public health interventions, including integration of migrants into the society, strict observance of labor regulations, improved communication with healthcare providers, and better information targeting migrant communities. Submitted: 9 January 2006; Revised: 20 June, 11 November 2006; Accepted: 5 December 2006     

Assessment of management education and training for healthcare providers in the Slovak Republic

The authors' purpose of this study was to analyze the current system of healthcare managers' education in the Slovak Republic. The study was essentially qualitative and used a triangular approach. This included an analysis of the range of healthcare management education providers, an assessment of needs that was based on questionnaires distributed to a sample of top managers in hospitals, and a focus group discussion. The findings revealed a gap between the estimated needs and the current capacities for management education. The results serve as a baseline for a discussion of future management training and education for healthcare providers in the Slovak Republic.     

A comprehensive, multitiered, targeted community needs assessment model: methodology, dissemination, and implementation

This article describes methodological best practices for a comprehensive, multitiered, targeted community needs assessment and strategies used to disseminate and implement findings. Although the methods could be applied to different populations, this article illustrates a community needs assessment targeting older adults. The assessment methodology included public data; local healthcare facility data; telephone survey of older adults; targeted focus groups of older adults; and surveys of caregivers, service and healthcare providers, religious organizations, and key informants. Dissemination strategies included community forums and conferences, a Web site, and publications. Collaborative projects implemented to address areas identified for improvement are also described.     

“It's not just about being here,but what brought you here”: A qualitative study of the role of migration experiences in shaping im/migrant women's access to healthcare

This qualitative study aimed to understand how migration experiences shape im/migrant women's needs, desire for, and expectations of healthcare in the British Columbia (BC), Canada context. Interviews with 33 im/migrant women (December 2018–January 2020) highlighted that traumatic experiences across migration increased healthcare needs; insufficient prior health system information contributed to poor experiences; and comparative healthcare experiences across places shaped future healthcare expectations. We use the BC setting to demonstrate the need to abide by global commitments to protect people during migration, train providers in trauma-informed care, develop health assessments that center migration journeys, and appropriately fund im/migrant-serving community organizations.     

Identification of Environmental Supports for Healthy Eating in Older Adults

Many environmental settings and influences can affect food choices and eating behaviors in the growing population of community-dwelling older adults. Using the Social Ecological model, an expert panel participated in online discussions and an Analytic Hierarchy Process survey to identify the most important and changeable environmental settings and enabling factors that promote healthy eating in older adults. Food stores were rated most important when considering accessibility and affordability. Congregate nutrition sites were important for social support along with supporting access and affordability of healthful foods and living accommodations. Senior housing, health care, and religious settings also contributed to the goal of promoting healthful eating in aging adults. Restaurants were rated of lower importance. Based on these results, it is recommended that community food policies include the nutritional needs of older adults by addressing food accessibility and affordability, social support, and living accommodations, with a focus on congregate nutrition sites, food stores, senior housing, health care, and religious organizations.