| 1. |
- Charise, A, et al.
(författare)
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Questioning Context: A set of interdisciplinary questions for investigating contextual factors affecting health decision-making
- 2011
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Ingår i: Health Expectations. - : Wiley. - 1369-7625 .- 1369-6513. ; 14:2, s. 115-132
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making.Background: Decision-making processes and outcomes may be shaped by a range of non-medical or contextual factors particular to an individual including social, economic, political, geographical and institutional conditions. Research concerning contextual factors occurs across many disciplines and theoretical domains, but few conceptual tools have attempted to integrate and translate this wide ranging research for health decision-making purposes.Methods: To formulate this tool we employed an iterative, collaborative process of scenario development and question generation. Five hypothetical health decision-making scenarios (preventative, screening, curative, supportive and palliative) were developed and used to generate a set of exploratory questions that aim to highlight potential contextual factors across a range of health decisions. Findings: We present an exploratory tool consisting of questions organized into four thematic domains – Bodies, Technologies, Place and Work (BTPW) – articulating wide-ranging contextual factors relevant to health decision making. The BTPW tool encompasseshealth-related scholarship and research from a range of disciplines pertinent to health decision making, and identifies concrete points of intersection between its four thematic domains. Examples of the practical application of the questions are also provided.
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| 2. |
- Werntoft, Elisabet, et al.
(författare)
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Prioritization and resource allocation in health care. The views of older people receiving continuous public care and service.
- 2007
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Ingår i: Health Expectations. - : Wiley. - 1369-6513 .- 1369-7625. ; 10:2, s. 117-128
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Tidskriftsartikel (refereegranskat)abstract
- Objective To describe the views of people, 65 years and over, receiving continuous public care and service, on prioritization and resource allocation in health care, in relation to gender, age, housing, health-related quality of life (QoL) and degree of activities of daily living (ADL) dependency. Background How older people receiving continuous public care and service view prioritization and resource allocation in health care is sparsely investigated, although this group most certainly has the experience and also often is the target in discussions concerning prioritization. It is necessary, for democracy and for the development of new models of service delivery, to find out how people receiving long-term care and service view these issues. Design 146 persons, 34 men (23%) and 112 women (77%), aged 66–100 years were interviewed face to face, following a structured questionnaire. Results The respondents thought that the patients’ well-being, way of living and family situation should affect prioritization, not age per se. Resourcing of several health-care services were considered to be below what is required by a majority of the respondents. The respondents wanted doctors to decide on prioritization at an individual level and wanted higher taxes to finance increasing health-care costs. Although the respondents wanted publicly financed health care, a relatively high number were willing to pay for treatment. Conclusions Knowledge of how older people receiving care and services, view prioritization and resource allocation has not previously been available. It seems that their views are in line with the Swedish Parliamentary Priority Commission which suggested that no account should be taken of age when allocating resources within the health-care system. Respondents’ age, gender, housing, health-related QoL and degree of dependency in ADL had limited influence on their views of resource allocation.
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| 3. |
- Arnetz, Judith E., et al.
(författare)
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Is patient involvement during hospitalization for acute myocardial infarction associated with post-discharge treatment outcome? : an exploratory study
- 2010
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Ingår i: Health Expectations. - : Wiley. - 1369-6513 .- 1369-7625. ; 13:3, s. 298-311
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate whether patient involvement during hospitalization for acute myocardial infarction (MI) was associated with health and behavioural outcomes 6–10 weeks after hospital discharge. Background Patient involvement has been associated with improved health outcomes in chronic disease, but less research has focused on the effects of patient involvement in acute conditions, such as MI. Design Self-administered questionnaire study. Questionnaire results were run against medical outcome data in a national database of cardiac patients. Setting and participants Cardiac patients (n = 591) on their first follow-up visit after hospitalization for MI at 11 Swedish hospitals. Main outcome measures Patient ratings of three questionnaire scales related to involvement; cardiovascular symptoms, medication compliance, participation in cardiac rehabilitation, and achievement of secondary preventive goals. Results More positive patient ratings of involvement were significantly associated with fewer cardiovascular symptoms 6–10 weeks after hospital discharge. In contrast, patients who attended cardiac rehabilitation and achieved the goals for smoking cessation and systolic blood pressure were significantly less satisfied with their involvement. No association was found between involvement ratings and medication compliance. Conclusion This study represents a first attempt to examine associations between patient involvement in the acute phase of illness and short-term health outcomes. Some significant associations between involvement and health and behavioural outcomes after acute MI were found. However, higher involvement ratings were not consistently associated with more desirable outcomes, and involvement during hospitalization was not associated with MI patient health and behaviour 6–10 weeks after hospital discharge to the extent hypothesized.
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| 4. |
- Broqvist, Mari, 1958-, et al.
(författare)
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To accept, or not to accept, that is the question : citizen reactions to rationing
- 2014
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Ingår i: Health Expectations. - : John Wiley & Sons. - 1369-6513 .- 1369-7625. ; 17:1, s. 82-92
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Tidskriftsartikel (refereegranskat)abstract
- Background The publicly financed health service in Sweden has come under increasing pressure, forcing policy makers to consider restrictions. Objective To describe different perceptions of rationing, in particular, what citizens themselves believe influences their acceptance of having to stand aside for others in a public health service. Design Qualitative interviews, analysed by phenomenography, describing perceptions by different categories. Setting and participants Purposeful sample of 14 Swedish citizens, based on demographic criteria and attitudes towards allocation in health care. Results Participants expressed high awareness of limitations in public resources and the necessity of rationing. Acceptance of rationing could increase or decrease, depending on one's (i) awareness that healthcare resources are limited, (ii) endorsement of universal health care, (iii) knowledge and acceptance of the principles guiding rationing and (iv) knowledge about alternatives to public health services. Conclusions This study suggests that decision makers should be more explicit in describing the dilemma of resource limitations in a publicly funded healthcare system. Openness enables citizens to gain the insight to make informed decisions, i.e. to use public services or to 'opt out' of the public sector solution if they consider rationing decisions unacceptable.
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| 5. |
- Eldh, Ann Catrine, et al.
(författare)
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Considering patient non-participation in health care
- 2008
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Ingår i: Health Expectations. - : Wiley. - 1369-7625 .- 1369-6513. ; 11:3, s. 263-71
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to depict patient non-participation as described by a diverse group with recent experiences of being patients. BACKGROUND: Patient participation is regarded as a primary condition for optimal quality of care, suggesting that non-participation should be avoided. A common understanding of the concept of patient non-participation is needed. A discrepancy in definitions of patient non-participation has been found in health-care interactions, health-care classifications and health-care research, and little is known of what patient non-participation represents to patients. STUDY DESIGN: A survey consisting of closed-ended and open-ended questions was administered to persons that had recently been patients to gather respondents' descriptions of what they considered as patient non-participation. Qualitative content analysis was used to analyse free-text descriptions, and descriptive statistics were used for the close-ended alternatives. FINDINGS: Lacking information (e.g. not being provided with appropriate information) and lacking recognition (e.g. not being listened to and/or lacking recognition as an individual with individual needs and concerns) were significant aspects of patient non-participation. Furthermore, non-participation encompassed facing organization-centred, as opposed to patient-centred, health care as well as feeling insecure in health care interactions. CONCLUSION: The findings provide input for a better understanding of what patients experience as non-participation. Organising for the caregivers to be able to thoroughly listen to the patients' illness narratives would easily reduce the risk of patient's experiencing what is described as non-participation and would provide a sound base for patient learning needs.
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| 6. |
- Renberg, Tobias, 1977-, et al.
(författare)
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Pharmacy users' expectations of pharmacy encounters : a Q-methodological study
- 2011
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Ingår i: Health Expectations. - : Wiley. - 1369-6513 .- 1369-7625. ; 14:4, s. 361-373
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pharmacy practice is evolving according to general healthcare trends such as increased patient involvement, evidence-based practice and public health initiatives. In addition to this, pharmacists strive to find new professional roles. Clients’ expectations of service encounters at pharmacies is an under-explored topic but crucial to understand how pharmacy practice can evolve efficiently. Objective: To identify and describe clusters of people with different normative expectations of the pharmacy encounter. Methods: Q-methodology, an approach to systematically explore subjectivity that retain complete patterns of response and organises these into factors of operant subjectivity. Setting and participants: 85 regular prescription medication users mainly recruited at Swedish community pharmacies. Results: Seven factors of operant subjectivity were identified, organised into two groups. Factors that emphasised the physical drug product as the central object of the pharmacy encounter were labelled as independent drug shopping; logistics of drug distribution; and drugs before drug use before healthcare. Factors that emphasised personal support as desirable were labelled competence as individual support; individualist professional relations, just take care of me; and practical healthcare and lifestyle support. Discussion and conclusions: The systematic q-methodological approach yielded valuable insights in how pharmacy clients construct their expectations for service encounters. They hold differentiating normative expectations for pharmacy services. Understanding these varying viewpoints is important for developing and prioritising among efficient pharmacy services. Clients’ expectations do not correspond with many of the trends that guide current pharmacy practice development. This might be a challenge for promoting or implementing services based on such trends.
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| 7. |
- Röing, Marta, et al.
(författare)
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Involving patients in treatment decisions : a delicate balancing act for Swedish dentists
- 2014
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Ingår i: Health Expectations. - : Wiley. - 1369-6513 .- 1369-7625. ; 17:4, s. 500-510
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Tidskriftsartikel (refereegranskat)abstract
- Background This study focuses on patients' participation in treatment decisions related to the delivery of oral health care in the social welfare state of Sweden. In 1985, the National Dental Service Act gave dental patients the right to take an active role in decisions regarding their treatment and, in doing so, strengthened them as consumers. Little is known how dentists in Sweden have adapted to this change.Objective This study explores how dentists in Sweden perceive and experience involving patients in dental treatment decisions.Design Data were collected from open-ended interviews with nineteen dentists, and an inductive qualitative content analysis was chosen to analyse the transcribed interviews.Findings Involving patients in treatment decisions appeared to be delicate balancing acts between the ideals of patient involvement and the reality of how it is practised in Sweden. These balancing acts in turn revealed obstacles to patient involvement and the role that economy can play on the decisions of some patients regarding their treatment.Conclusions This study has given insight into a relationship in which some dentists in Sweden find it hard to adapt to and change their professional role with patients who appear to act more as consumers. For these dentists, better practice of patient involvement may require adoption of a more consumerist approach. However, in situations where economy influences patients' treatment choices, the ideals of patient involvement may remain unattainable.
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| 8. |
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| 9. |
- Werntoft, Elisabet, et al.
(författare)
-
Prioritization and resource allocation in health care : the views of older people receiving continuous public care and service.
- 2007
-
Ingår i: Health Expectations. - 1369-6513 .- 1369-7625. ; 10:2, s. 117-128
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the views of people, 65 years and over, receiving continuous public care and service, on prioritization and resource allocation in health care, in relation to gender, age, housing, health-related quality of life (QoL) and degree of activities of daily living (ADL) dependency.BACKGROUND: How older people receiving continuous public care and service view prioritization and resource allocation in health care is sparsely investigated, although this group most certainly has the experience and also often is the target in discussions concerning prioritization. It is necessary, for democracy and for the development of new models of service delivery, to find out how people receiving long-term care and service view these issues.DESIGN: 146 persons, 34 men (23%) and 112 women (77%), aged 66-100 years were interviewed face to face, following a structured questionnaire.RESULTS: The respondents thought that the patients' well-being, way of living and family situation should affect prioritization, not age per se. Resourcing of several health-care services were considered to be below what is required by a majority of the respondents. The respondents wanted doctors to decide on prioritization at an individual level and wanted higher taxes to finance increasing health-care costs. Although the respondents wanted publicly financed health care, a relatively high number were willing to pay for treatment.CONCLUSIONS: Knowledge of how older people receiving care and services, view prioritization and resource allocation has not previously been available. It seems that their views are in line with the Swedish Parliamentary Priority Commission which suggested that no account should be taken of age when allocating resources within the health-care system. Respondents' age, gender, housing, health-related QoL and degree of dependency in ADL had limited influence on their views of resource allocation.
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| 10. |
- Oscarsson, Maria, et al.
(författare)
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“I do not need to… I do not want to… I do not give it priority …” : why women choose not to attend cervical cancer screening.
- 2008
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Ingår i: Health Expectations. - : Wiley. - 1369-6513 .- 1369-7625. ; 11:1, s. 26-34
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Tidskriftsartikel (refereegranskat)abstract
- Objective To describe and interpret why women with no cervical smear taken during the previous 5 years choose not to attend a cervical cancer screening (CCS) programme. Background CCS programme is a service for early detection of cervical cancer. Today, some women choose not to attend the programme. Design Data were collected by tape-recorded interviews and analysed by qualitative inductive content analysis. Setting and participants Purposive sample of 14 women in southeast Sweden, who had chosen not to attend CCS during the previous 5 years. Findings The following themes were revealed: I do not need to…, I do not want to… and I do not give it priority…. The women had a positive attitude to CCS but as long as they felt healthy, they chose not to attend. A negative body image, low self-esteem, feelings of discomfort when confronted with the gynaecological examination and fear of the results also influenced their non-attendance. The women prioritized more important things in life and reported various degrees of lack of trust in health-care. Conclusion Women's choice not to attend CCS were complex and influenced by present and earlier intra- and inter-personal circumstances. They had a positive attitude to CCS, but other things in life were more important. Health-care professionals have to facilitate a co-operative discussion with the women in order to contribute to a mutual understanding for the perspectives of the women and the professionals.
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