'E-health': the internet and the transformation of patients into consumers and producers of health knowledge

This article analyses the use and production of health information on the Internet. The paper will show that users of health services have also become significant providers of health information and advice. This analysis is based on two studies. The first involved a qualitative study of households that used home computers to find health information on the Internet. The second piece of research involved the examination of home pages that contained accounts of ill health and an e-mailed questionnaire to home page authors. Drawing upon this research the consumption of health information is examined and related to how users make discussions about their health. This is followed by an analysis of the provision of health information on home pages. It is shown that these include web sites that provide simple accounts of an individual illness as well as sites that advocate a particular approach to health or offer services and products. The interweaving of personal experience with advice is considered and linked to debates about the quality of health information on the Internet and the reconfiguration of 'expertise'.     

Alternative Worldviews and the Utilization of Conventional and Complementary Medicine*

We use the Midlife in the United States (MIDUS) database and an expanded Anderson model that incorporates health beliefs, including sacred worldviews as predisposing factors, to explore conventional and complementary and alternative medical (CAM) service use. Findings are that health care need, especially the number of chronic conditions is positively associated with both conventional and CAM services use. However, net of need, health beliefs and sacred worldviews differentiate CAM users versus nonusers or the number of different CAM practices that are used. Higher self‐rated spirituality is associated with being a CAM user and, if a user, with adopting a wider range of practices. Individuals with higher self‐rated religiosity are not more or less likely to be CAM users but adopt significantly fewer techniques, if users. We discuss the attraction to very different faces of health care, on the basis of religiosity, spirituality, and other health beliefs, with implications for policymakers and care providers.     

Experiences of Family Carers for Persons Using Antipsychotic Medication

Given the emphasis on the use of antipsychotic medication for severe mental illness, it is important to understand family carers’ perspectives on these medications and their effects on consumers’ lives. Such information may enable providers of family interventions to better understand families’ circumstances and more effectively support them in caring for mental health service users. Snowball sampling was used to recruit 29 family carers. Family carers acknowledged the calming effect of antipsychotic medication on service users, but also noted that there were few other therapeutic benefits. Moreover, the positive influence of antipsychotic medication was in most cases largely offset by the detrimental impact of antipsychotic medication on service users’ quality of life. The family carers in rationalising the trade‐off between beneficial and adverse antipsychotic medication effects typically experienced resignation, which was often accompanied by a sense of frustration that resulted from the reliance on medication.     

Exploring the Hidden Nature of Gambling Problems among People Who Are Homeless

Abstract

Although people with gambling problems are now recognised to be among those groups of people at increased risk of homelessness, little research has explored their experiences. This qualitative interpretive study explored the experiences of people who were homeless and had gambling problems, and the housing and gambling service providers assisting them. In-depth interviews were conducted with 17 service users and 18 service providers. A key finding was that gambling problems among those experiencing homelessness are often hidden; few people presented to housing services admitting to gambling problems. Shame, stigma, and identity issues were described as the main reasons service users did not disclose their gambling activities. The research highlighted that the relationship between service providers and service users was infused with power imbalances and shaped by social discourses and policies that demand self-responsibility and hinder information sharing between service providers and service users.     

DECENTRALIZATION AND PARTICIPATORY SERVICE DELIVERY

User participation has been promoted to improve the quality, responsiveness, and outreach of public services in India. This qualitative study evaluates new grassroots institutions—Village Education Committees and Mothers’ Committees—in Andhra Pradesh, which promoting parents’ participation in the management and monitoring of local schools and maternal/child health services. Although the committees were found to have increased participation in public affairs by the poor and brought about some improvements in service quality, inclusive and meaningful participation has often been hindered by illiteracy and lack of information, as well as caste, gender, and socioeconomic inequalities. The article suggests that there are considerable tensions between inclusive participation and committee effectiveness as members need skills, status, and resources in order to have a meaningful impact on service provision. In addition, research findings point to the need for more structured opportunities for committee members to interact with authorities and service providers, as well as for children to voice their concerns and ideas. Lastly, in order to tackle childhood poverty more holistically, the focus of these committees should be revised to give greater emphasis to improving service quality improvements and cross-sectoral synergies, rather than the current move narrow focus on infrastructural development and singlesector initiatives.     

Contrasting perspectives of parents and service providers on respite care in Queensland,Australia

Abstract

Parent-carers need support to continue to care for their child with significant disability in their home. There has, however, been little evidence that respite interventions have consistent or enduring beneficial effects on carer well-being. This article reports the findings of a qualitative study which adopted an Appreciative Inquiry philosophy to interview parent-carers of children with significant intellectual and/or developmental disabilities on how formal support services have helped them maintain their health and well-being, and disability support staff on how they help such parent-carers foster their health and well-being. We conclude that better communication and collaboration between service providers and users, more targeted training of workers, and embracing a person-centred and family-centred approach to respite services are needed. In addition, clearer definition and communication of the scope of respite services are required to best support families of children with significant disability in their home.     

Psychotropic medications in child welfare: From federal mandate to direct care

Background and objectiveChildren in the welfare system are prone to uncoordinated and unmonitored mental health care, including psychotropic medications. To address these issues, federal legislation mandated that state child welfare agencies improve the coordination and oversight of psychotropic medications. However, there is no clear guidance on how to improve these practices, particularly at the level of direct care. We aimed to identify specific areas for improvement through state-wide surveys of four groups.MethodsWe surveyed all known members of four groups working directly with children in foster care in one small northeastern state. Respondents included 209 foster and adoptive parents, 169 child welfare staff, 84 mental health therapists, and 33 clinical prescribers. Survey items addressed practices and perceptions related to sharing of information and cross-system communication and monitoring of medication effects and side effects.ResultsNearly two in five foster and adoptive parents reported not regularly receiving information about the purpose or side effects of psychotropic medications, and they disagreed among themselves on who was primarily responsible for monitoring safety and effectiveness. One-third of child welfare staff and two-thirds of mental health therapists reported that information about psychotropic medications is not regularly shared with the child's provider team. Half of clinical prescribers reported not regularly communicating with child welfare staff.ConclusionsWe identified specific areas for improvement related to communication, sharing of information, monitoring, and role clarification. Strategies to improving these activities are key to ensuring the safe and effective use of psychotropic medications in this population.     

Healthcare Use in the Heartland: How Health Care Selection Varies Between Rural,Retirement‐Age Migrants and Long‐Term Residents

One increasingly important problem affecting rural health care selection is the tendency of older residents to bypass local health care providers. This research investigates how the effects of community characteristics and attachment on health care bypass behavior vary between rural retirement‐age migrants and retirement‐age long‐term residents. Non‐health‐related behaviors, such as purchasing goods and services outside one's community during a health care trip, that is, “outshopping,” could influence bypass if individuals combine trips for their medical care with other consumer needs. Basing our work on the outshopping theory, we argue that bypass behavior is one facet of consumer consumption patterns for both rural retirement‐age migrants and long‐term residents. In addition, dissatisfaction with local health care and services like shopping can “push” rural residents to bypass local health care and travel greater distances for primary health care. We further contend that strong community attachment has an opposite “pull” effect that can help to negate the push of outshopping and reduce the likelihood of bypass. Our results reveal retirement‐age migrants are significantly more likely to bypass local primary health care providers than retirement‐age long‐term residents. Furthermore, our analysis bridges the rural health care and retirement community development literature to suggest that outshopping theory can now be applied to rural primary health care bypass behavior.     

Can healthcare providers at a university health clinic predict patient satisfaction?

Patient satisfaction in university health settings has received little research attention, and it is unclear whether the issue is being addressed in college health clinics. Because providers may make their own evaluations of patient satisfaction in the absence of other information, the authors conducted a study to determine whether healthcare providers at a university health clinic could accurately assess patient satisfaction. Ten providers completed a 10-item questionnaire immediately following the medical encounter to rate their perceptions of selected patients' levels of satisfaction. After seeing a healthcare provider, 201 patients completed a comparable questionnaire indicating how satisfied they were with the experience. Responses of providers and patients were compared, using a paired-sample t test. The results showed that providers' ratings were significantly lower than patients' ratings, indicating that providers were unable to judge patient satisfaction accurately. The results suggest that formal evaluations of patient satisfaction should be included in college health services.     

Coordinating co-production in complex network settings

This article draws together the concepts of network management and co-production with complexity sciences. So far, these approaches have rarely been connected in research literature. We suggest that this conceptual framework offers new insights for analyzing the challenges of co-production in complex network settings in the local public services. The aim of the article is to find out how complex network structures meet the co-production process in the context of social and health care services. The empirical part of the article presents a Finnish case study of a multiprofessional service network producing social and health care services for youth. Here, the clients, in this case children and young people with a need for social services, often need multiple services from different service providers simultaneously. Our research findings suggest that the outcomes of the service process are not only dependent on the client's needs, but rather on organizational and professional interests. Our research gives new insights for the discussion on co-production; when it is applied as an intended policy to improve and deliver public services, the complexity of interaction among the street-level workers and the detached professional frameworks should be kept in mind.     

Managing physical and mental health conditions: Consumer perspectives on integrated care

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses (SMI) manage comorbid conditions or view integrated services. We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services. We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting. Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness, and knowledge of providers, and collaboration between providers. Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.     

Mapping social dynamics on Facebook: The Brexit debate

Nowadays users get informed and shape their opinion through social media. However, the disintermediated access to contents does not guarantee quality of information. Selective exposure and confirmation bias, indeed, have been shown to play a pivotal role in content consumption and information spreading. Users tend to select information adhering (and reinforcing) their worldview and to ignore dissenting information. This pattern elicits the formation of polarized groups – i.e., echo chambers – where the interaction with like-minded people might even reinforce polarization. In this work we address news consumption around Brexit in UK on Facebook. In particular, we perform a massive analysis on more than 1 million users interacting with Brexit related posts from the main news providers between January and July 2016. We show that consumption patterns elicit the emergence of two distinct communities of news outlets. Furthermore, to better characterize inner group dynamics, we introduce a new technique which combines automatic topic extraction and sentiment analysis. We compare how the same topics are presented on posts and the related emotional response on comments finding significant differences in both echo chambers and that polarization influences the perception of topics. Our results provide important insights about the determinants of polarization and evolution of core narratives on online debating.     

Introducing Technology in Child Welfare Referrals: A Case Study

Access to social services is important for the safety of children and ultimately for reunification of families involved in the child welfare system. The process of linking families to services, however, varies by caseworker and can be cumbersome and time consuming. The Department of Children and Family Services (DCFS) Needs Portal is an Internet-based intervention to improve the timing and quality of social service referrals in Los Angeles County We used a case study approach including in-depth interviews, direct observations, and user feedback obtained from the Needs Portal to (a) determine perceived benefits and barriers to adopting the Needs Portal, and (b) report how the flow of information between users and developers was used to adapt to user needs. Our analyses revealed four major barriers: (a) caseworker apprehension regarding new technology, (b) variation in communication styles by user type, (c) lack of technological infrastructure, and (d) competing workplace demands. Information sharing between developers and users has the potential to better meet the needs of users and ultimately maximize utilization of new technology. Although Internet-based interventions are designed to inexpensively and effectively coordinate services, emerging interventions may require in-person assistance and modifications in order to succeed.     

Financing Rural New England University Health Services: A Pilot Study

Abstract

Patient satisfaction in university health settings has received little research attention, and it is unclear whether the issue is being addressed in college health clinics. Because providers may make their own evaluations of patient satisfaction in the absence of other information, the authors conducted a study to determine whether healthcare providers at a university health clinic could accurately assess patient satisfaction. Ten providers completed a 10-item questionnaire immediately following the medical encounter to rate their perceptions of selected patients' levels of satisfaction. After seeing a healthcare provider, 201 patients completed a comparable questionnaire indicating how satisfied they were with the experience. Responses of providers and patients were compared, using a paired-sample t test. The results showed that providers' ratings were significantly lower than patients' ratings, indicating that providers were unable to judge patient satisfaction accurately. The results suggest that formal evaluations of patient satisfaction should be included in college health services.     

Developing Family-Centered Models of Genetic Services

Abstract

This article reports the findings of an exploratory, multi-method study conducted for a state health authority to examine stakeholder perceptions of existing genetic services and service ideals using survey and focus group methodologies. A web-based survey of medical providers and allied health professionals (N = 567) examined the knowledge needed by service providers to deliver competent genetic care. A second web-based survey of programs (N = 15) viewed as potential partners in the delivery of genetic services was conducted to explore the potential for interagency coordination, the family-centered nature of these services, existing training, and general agency ideals and values. Focus groups were also conducted with 4 groups of families and 3 groups of service providers to explore their perceptions of current and ideal services. The strategies yielded important information around service needs, resource issues, barriers to service, psychological issues, and education and information needs related to the delivery of genetic services. Implications for professional education, especially social work education, are also covered.     

Child care improvement on a shoestring: evaluating a low-cost approach to improving the availability of quality child care

The Philadelphia Early Childhood Collaborative (the Collaborative) was designed to improve the quality of child care by increasing coordination among organizations that locally deliver professional resources to child care providers. The evaluation examined the implementation of the Collaborative, utilization of its services, and the impact of service use on child care quality. Child care providers reported gains in their professional knowledge and behavior from using Collaborative resources and rated the resources highly. No long-term effects on provider behavior, knowledge, or attitudes were observed. Although the original organizations were able to function collaboratively and Collaborative services were widely used, more intensive interventions may be required to change the availability of quality child care.     

Facilitators and barriers to family engagement and retention of young children in mental health care: A qualitative study of caregivers’ perspectives

This study examines facilitators and barriers that influence family engagement and retention of children in mental healthcare from the parent and caregiver perspective. Researchers recruited and interviewed parents and caregivers (n=18) from urban community health and early childcare centers. The study team analyzed the data and identified barriers to retention in care, including stigma, lack of integrated health care services,and a shortage of providers with the expertise in early childhood mental health care. Social workers, case managers, parent peers, and community support groups helped facilitate parent and caregiver engagement and retention of children in care. Education,community support programs, and integrated healthcare systems would improve access to quality early childhood mental health care.