Social profile,maternal depression and welfare concerns in clients of health visitors and social workers: a comparative study

Research into the practice of health visitors and child care social workers with depressed mothers is limited. This is surprising in view of the known relationship between motherhood and depression, and the association also between child care problems and maternal depression. The study described below is the first which seeks to compare health visitor and child care social work clients/service users in relation to the issue of maternal depression. In particular, it seeks to compare the extent to which maternal depression is a feature of the work of social workers and health visitors, the relationship between maternal depression and the social composition of different client groups, the relationship between maternal depression and welfare concerns—particularly child abuse—and the extent to which such concerns lead to referral from health visitors to social workers. The research shows: (1) interesting similarities between the depressed health visitor clients and social work clients as a whole; (2) the importance of low income and absence of support in the ‘progression’ from health visitor to social work clients status; and (3) an alarming emerging gap in services provided for severely disadvantaged families with child and family care problems.     

Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni

Foster youth experience higher rates of mental health disorders and receive higher rates of mental health services in comparison to the general population. Yet, upon foster care exit, mental health service use drastically declines. Little is known as to the reasons for mental health service decline after foster care exit. However, research studies in the mental health literature have consistently shown that self-stigma and public stigma are significant in mental health service receipt. Studies have also shown that self-stigma affects an adolescent's self-identity, self-efficacy, and interpersonal relationships, which impact self-sufficiency once youth leave foster care. This study explores self-stigma in the utilization of mental health services while in foster care, and whether the stigma developed while in foster care impacts mental health service use upon foster care exit. The role of public stigma in the utilization of mental health services post foster care is also examined. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Results show that foster youth experienced self-stigma, which increased the negative impact of mental health service receipt while in foster care. After foster care exit, youth who identified experiencing self-stigma while in foster care tended to discontinue mental health services after foster care exit. In contrast, foster youth who did not identify self-stigma in the receipt of mental health services while in foster care continued accessing services upon foster care exit. Public stigma was not identified as influencing mental health service use post foster care, but was coupled with negative labels, stereotypes, and negative perceptions. Implications for preventive and intervention measures are also discussed/proposed.     

Child protection pathways for newborn infants: A multi-disciplinary retrospective chart review of an Irish maternity hospital’s records

In Ireland, little is known about mothers and infants where child welfare and protection concerns arise during the perinatal period. This study explores, for the first time, perinatal child protection. A retrospective audit was carried out of a large maternity hospital's medical social work, neonatal and psychiatric files for a five-year period from 2016 to 2020. The study identified 99 children, born to 86 mothers, who were either subject to a child protection conference; placed for adoption; discharged to someone other than the mother; or discharged home under supervision. The study found that two-thirds of the children were discharged to their mother's care. When compared to national data, the health indicators for this cohort of mothers and children painted a grim picture. The maternal profiles identified high prevalence of mental health and addiction difficulties and domestic violence. The study found evidence of supports provided to the mothers to enable them to care for their infants while they remained in the hospital and during an initial discharge from hospital. However, a significant number of the mothers were not caring for their children when viewed across a longer time frame. Dedicated multi-disciplinary clinics and improved data systems were identified as of importance.     

The Role of Information and Communication Technologies in Addressing Safe Motherhood in South Asia

ABSTRACT

As it is recently recognized in academic and policy circles, limited access to information and limited knowledge are among key factors contributing to worldwide poverty, especially in low developed countries. Consequently, access to “knowledge” has become an integral part of discussions about global development, improvement of societal well-being, and empowerment of women. This article addresses the problem of the limited spread of information about maternal health and available maternal care services across impoverished South Asian countries. Lack of knowledge greatly contributes to underutilization of medical services and available maternal care that leads to high rates of maternal and infant mortality and pregnancy-related complications which, with proper medical care, could be avoided.     

Conditional Cash Incentive and Use of Health Care Services: New Evidence from a Household Experiment

Studies have recently provided insights into the effects of incentive modalities in the health care sector. However, there is insufficient evidence on the underlying causes of the partial effectiveness of these strategies in the health systems of developing countries. This study presents results from a large-scale randomized experiment across 6848 households in Afghanistan that evaluates the impact of a conditional incentive pay scheme on health facilities. Supported by the target-income hypothesis framework and relaxing the compliance assumption in the empirical modeling, the estimated coefficients yield causal effects of the supply-side conditional incentive on the utilization for health care services. After 2 years, the conditional incentive increased the use of pre-targeted maternal and children health care services among the households at lower levels and at contracted-out health facilities. Additionally, the incentive scheme is associated with sizable efficiency gains at the facility level. These gains are realized at the expense of deterring service users’ satisfaction with physicians’ communication qualities. This study establishes that margins of improvement do exist in the supply-side performance conditioning on an organizational structure and the service contractual arrangements of health facilities. This work provides a framework for the plausible implementation of incentive policies in the health care sector.

     

Safe Motherhood in the Context of Nepal

ABSTRACT

Nepal ranks low on the Human Development Index and has a high maternal mortality rate. Various factors contribute to the high rate of maternal mortality and include a shortage of health care professionals, limited access to basic maternal health care, poverty, illiteracy, women's low social status, a poorly developed transportation system, a limited communication system, political conflict, and a diverse population. Interviews with pregnant women, observational data, and national statistics provide the basis for suggestions provided by the author. These include upgrading and opening new maternal care facilities, integrating midwives into local health services, providing education on women's health needs during pregnancy, and improving public awareness of the availability of maternal care services.     

The effects of domestic violence during pregnancy on maternal and infant health

The present study examined the impact of domestic violence on maternal and infant health by assessing maternal health during pregnancy and infant health at two months postpartum. Two hundred and two women (68 battered and 134 non-battered) were recruited from the community and completed both pregnancy and 2-month postpartum interviews. Results revealed that domestic violence during pregnancy was associated with numerous health problems for mothers and infants including more health problems during pregnancy, more likelihood of premature labor, later entrance into prenatal care, lower infant birth weight, greater utilization of health care resources, and more prenatal substance use. After income was controlled, the relationship between violence and timing of prenatal care and infant birth weight became nonsignificant. Maternal social support was found to protect against the effects of violence for several health outcomes. The current findings suggest the need for domestic violence screening during pregnancy, as well as clinical interventions for battered, pregnant women in order to prevent serious physical and emotional problems for both mothers and their infants.     

Variables Affecting Patient Satisfaction with Health Care Services in the College Health Setting

Abstract

Patient satisfaction with health care services is an important factor in health care delivery. It will significantly influence whether or not a patient seeks medical care, complies with prescribed treatment, and/or maintains a continuing relationship with a medical practitioner.

A survey questionnaire, relating patient satisfaction with a number of variables identified through a literature review, was mailed to a random sample of 500 students utilizing Student Health Service (SHS) at Kent State University (KSU) during the five week study period. The data obtained would be utilized to help with planning future health care services and staff inservice education programs.

The findings of this survey indicate that patient satisfaction has a statistically significant correlation with perceived technical competence of the practitioner and perceived adequacy of the interpersonal aspects of the practitioner-patient relationship. A significant relationship did not exist between satisfaction and expectations the patient holds of the practitioner's role performance. A statistically significant relationship was found to exist between receiving health information/education related to diagnosis, prognosis, and treatment plan and satisfaction with health care services. This relationship did not hold for health information/education related to activity restrictions or preventive measures. The study also revealed that time waited during the medical care encounter was inversely related to satisfaction. Last, stepwise regression found that perceived technical competence of the practitioner was the most important variable influencing patient satisfaction with health care services.

This study provides data about factors important to personal satisfaction with health care services for a selected group of college students.     

Maternal Health Policy and the Politics of Scale in Mexico

Since 1987, international organizations have accorded greaterattention to the problem of maternal mortality, particularlywith the inclusion of its reduction in the Millennium DevelopmentGoals. This article examines maternal health policies in Mexico,focusing on interactions between the international, national,and local scales and considering the case of local projectsin two states, Chiapas and Guerrero. Although the discourseof maternal health expressed at the international level hasfacilitated the creation of networks dedicated to maternal health,the restructuring of health services in Mexico and the rescalingof their provision have often conflicted with the realizationof this goal. The impact of decentralizing health services hasdiffered according to (a) the timing and nature of decentralization;(b) the number and expertise of nongovernmental organizations(NGOs) working on maternal health issues, and the connectionsbetween these NGOs and international networks; and (c) the responsivenessof the state governments to maternal health issues.     

GEOGRAPHICAL PERSPECTIVES ON SAFE MOTHERHOOD IN THE HILL COUNTRY OF SRI LANKA: A CASE STUDY OF THE DORAGALA TEA PLANTATION IN PUSSELLAWA

ABSTRACT

In comparison with other South Asian countries, Sri Lanka maintains well-developed health care systems. Nonetheless, limited health care services are provided to mothers and children in the hill country. This research raises a series of questions concerning current challenges for safe motherhood, such as health care services already present, spatial distribution of health care professionals, and health policy in the hill counties of Sri Lanka. The authors argue that to understand the existing infrastructure of health care systems and future challenges to provision of health care services, it is important to depict the spatial location of health care units and to recognize the complexity of interactions between these units and the social, economic, and health environment. Such assessment provides a human geography approach that investigates health care systems in spatial dimensions. This study uses the geographical techniques of Geographic Information Systems and Global Positioning Systems to answer the fundamental questions of “what is where,” “why is it there,” and “why do we care.” The questions underline the importance of spatial methodology in assessment of safe motherhood and the importance of accurate and precise knowledge about the status of maternal health.     

Running out of time: A qualitative investigation of homeless men’s access to health services

Abstract

This study examined health beliefs and health care utilisation among 20 homeless men in Liverpool, through the voices of homeless men themselves. Using semi-structured interviews and framework analysis, narratives highlighted the interplay between the limiting structures of the health care system and an individual's ability to know how to seek out health care in order to improve their own health. Specifically, we found that individual agency was contingent on the availability of a set of minimum resources, to which homeless men did not have access. These findings have important implications in terms of practical policy recommendations for improving health care utilisation among the homeless.     

Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

Children in the child welfare system are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of children in the child welfare system. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on children's use of mental health services, controlling for child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect children in the child welfare system who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these children.     

Relationship of service satisfaction to life satisfaction and perceived well-being

Two procedures for gaining patients' evaluations of health services were compared: (a) the Client Satisfaction Questionnaire (CSQ-18B), a direct approach assessing the setting and services actually encountered, and (b) the Patient Satisfaction Questionnaire (PSQ), an approach that indirectly assesses satisfaction with service by inquiring about general health care attitudes. Results from 148 public health patients indicated that the PSQ produced the most acceptability problems and was tapping aspects of life satisfaction other than service satisfaction. However, the PSQ produced significantly lower reports of satisfaction. Additional comparison and interpretation of typical responses generated from the two approaches suggested, on the whole, that the CSQ-18B data provided clearer, more efficient, and more useful information for program planning and evaluation. In this study, service satisfaction measured by the CSQ-18B did not have any significant relationship to global or multidimensional (LDQ-30) measures of life satisfaction and well-being. In contrast, over a third of the variance in PSQ scores was accounted for by measures of life satisfaction. It appears that the PSQ elicits attitudes toward the more generalized health care delivery system as well as aspects of life satisfaction rather than reactions to specific services actually received.     

Is caring for older parents detrimental to women’s mental health? The role of the European North–South gradient

In the last decades, both the lengthening of life expectancy and an accentuated decline in birth rates have reduced the consistency of the younger generational cohorts. Due to an ageing population, the burden of caregiving is expected to intensify in the next quarter of the century in Europe, especially for mature women. This paper investigates the impact of the provision of constant care for older parents on the mental health of adult daughters, between the ages of 50 and 75, living in different European countries. Data is drawn from the Survey of Health, Ageing and Retirement in Europe. Information on mental health status is provided by Euro-D depression scale, a measure of depression standardized across European countries. We focus on differences in the effects according to the North–South gradient: we test whether the relationship between informal caregiving and mental health differs across European macro-regions. Our results, robust under different specifications of the propensity score model, reveal a clear North–South gradient: the provision of informal care has a negative and significant impact on daughters’ mental health in the Mediterranean countries only, where the amount of resources allocated to the Long Term Care is minimal and the local system of health and social services for the elderly lacks the necessary structures to meet the increasing demand for eldercare.     

Predisposing,Enabling, and Need Predictors of Community versus Institutional Long-Term Care

Abstract

This research explored characteristics of the elderly that are associated with the use of long-term care services. Using the 1999 National Long Term Care Survey, logistic regression was employed to examine the relationship of race with the use of formal and informal long-term care. This study also examined the relationship of health insurance with the use of formal and informal long-term care. The Andersen Model on health services utilization was used as the theoretical framework. The findings indicated that race was not associated with the use of long-term care but rather with predisposing, enabling, and need variables. Health insurance was found to be associated with the use of long-term care even after controlling for predisposing enabling and need variables.     

Maternal and child health and family planning services in the Sudan

Given the high rates of infant and maternal mortalty, the prevalence of infectious diseases, poor nutritional status among women and children, and numerous endemic diseases such as malaria and bilharzia, maternal-child health serivces have been given a high priority in the Sudan. In reality, however, this area has not received adequate attention within the primary health care system in terms of management, service provision, and training. Major obstacles to effective maternal-child health services include: 1) the lack of involvement of community health workers, the main providers of other primary health care services in the Sudan, in the area; 2) the clinical orientation of physicians, which mitigates against attention to the promotive and preventive components of health care; 3) a lack of standardization of medical records or data collection routines, which hinders program monitoring; and 4) the failure to integrate related national programs such as immunization into a comprehensive maternal-child health program. In addition, there are administrative and organizational obstacles, such as the lack of institutionalization of maternal-child health services within the Ministry of Health, inadequate managerial capabilities, an absence of guidelines for service delivery at the regional and provincial levels, delays in the procurement of equipment and supplies, a widely dispersed population, and transportation difficulties. Family planning, too, is supposed to be the responsibility of all primary health care workers in the Sudan. However, current training programs for physicians, nurses, village midwives, and community health workers do not prepare them to fulfill this role. Development of an official population policy in the Sudan is recommended to ameliorate some of these problems.     

Culturally-Protective Health Practices

ABSTRACT

Everyday pregnancy care may play an important role in explaining why Mexican immigrant women have positive birth outcomes despite relatively low incomes, low formal education levels, and lack of access to medical care. The paper is based on findings from a qualitative study utilizing in-depth ethnographically-in-formed interviews with 41 Mexican immigrant women in Chicago who had recently given birth. Results indicate that everyday pregnancy care guides maternal behaviors in pregnancy and has important effects on birth weight. Implications for the design of prenatal health care and social services for immigrant women are discussed.     

Modern health services and health care behavior: a survey in Kathmandu, Nepal

The most important problem regarding health service utilization in Third World countries is that established indigenous forms of health care are readily available and compete with modern health care. Thus, in addition to understanding the components of the decision to seek medical help, we must understand the conditions that affect the choice of a specific health care system. This study examines the impact of medical pluralism on the use of modern forms of health care in Nepal. The findings show that the presence of medical pluralism is a significant factor which delays use of modern health services. Policy implications are discussed, and the need for more research in this area is stressed.     

Young African American Males: Barriers to Access to Health Care

African American males continue to experience an unacceptable and disproportionate number of health disparities when compared with other racial and ethnic groups. Young African American males can expect to live the least amount of time when compared to any other ethnic minority or racial sub-group. Understanding the obstacles and barriers that impede access to health care and wellness services among young African American males is essential to begin the process of decreasing health disparities. The goal of this qualitative study was to explore and identify the barriers experienced by young African American males in accessing health care services while also creating a rare opportunity to give voice to young African American males. The study results indicate that young African American males have multiple perceptions of barriers to health care services. Their perceptions fell into three categories: the negative impact of environment or community, lack of finances or no insurance, and distrust of medical practices associated with race history resulting in accessing healthcare as a last resort. Additional research is needed to craft community-based programs to: a) educate young African American males on the importance of preventative strategies to maintain wellness; and b) ensure that the appropriate medical and wellness services are available and reaching young African American males in need.