Barriers and facilitators to patients\' adherence to antiretroviral treatment in Zambia: a qualitative study

Patients\' adherence to antiretroviral therapy (ART) is important for effective medical treatment of HIV/AIDS. We conducted a qualitative interview study in the Copperbelt Province of Zambia in 2006. The aim of the study was to explore patients\' and health care professionals\' perceived barriers and facilitators to patients\' adherence to ART. Based on data from individual interviews and focus group interviews with a total of 60 patients and 12 health care professionals, we identified barriers and facilitators related to patients\' beliefs and behaviours, the health service, and socio-economic and cultural factors. Among the barriers we identified were lack of communication and information about ART, inadequate time during consultations, lack of follow-up and counselling, forgetfulness, stigma, discrimination and disclosure of HIV status, lack of confidentiality in the treatment centres, and lack of nutritional support. Feeling better, prospects of living longer, family support, information about ART, support for income-generating activities, disclosure of HIV status, prayers and transport support were among the facilitators. Our study suggests that several issues need to be considered when providing ART. Further research is needed to study interactions between patients and their health care providers. Our findings can inform interventions to improve adherence to ART. Keywords: AIDS, HIV, antiretroviral therapy, adherence, patient compliance, delivery of health care.SAHARA-J Vol. 5 (3) 2008: pp. 136-14

Motricidad y corporeidad en el logro de aprendizajes de los estudiantes de una institución educativa de Andahuaylas – Apurímac 2021

El objetivo general del trabajo de investigación es establecer la relación entre la motricidad y corporeidad con el logro de aprendizajes de los estudiantes de una I. E. de Andahuaylas – Apurímac 2021; La población de estudio del presente trabajo estuvo compuesta por 110 estudiantes de ambos sexos del segundo grado de secundaria pertenecientes VI ciclo de educación básica regular de una i.e. de Andahuaylas, quienes a la vez fueron la muestra censal; el trabajo presente es de tipo básico, de enfoque cuantitativo, metodología hipotético deductivo, nivel correlacional y de diseño no experimental. Para obtener los datos informativos se utilizaron como instrumentos a la encuesta y una ficha de observación documentaria creadas por el mismo autor y dichos datos informativos fueron procesados utilizando el programa Excel para el procesamiento de datos, así como el programa SPSS versión 26. Como resultado del análisis estadístico estudio se obtuvo una relación significativa positiva baja entre ambas variables por lo que se tuvo que admitir la hipótesis nula

Reducing unwarranted variation: can a ‘clinical dashboard’ be helpful for hospital executive boards and top-level leaders?

Background/aim: In the past decades, there has been an increasing focus on defining, identifying and reducing unwarranted variation in clinical practice. There have been several attempts to monitor and reduce unwarranted variation, but the experience so far is that these initiatives have failed to reach their goals. In this article, we present the initial process of developing a safety, quality and utilisation rate dashboard (‘clinical dashboard’) based on a selection of data routinely reported to executive boards and top-level leaders in Norwegian specialist healthcare. Methods: We used a modified version of Wennberg’s categorisation of healthcare delivery to develop the dashboard, focusing on variation in (1) effective care and patient safety and (2) preference-sensitive and supply-sensitive care. Results: Effective care and patient safety are monitored with outcome measures such as 30-day mortality after hospital admission and 5-year cancer survival, whereas utilisation rates for procedures selected on cost and volume are used to follow variations in preference-sensitive and supply-sensitive care. Conclusion: We argue that selecting quality indicators of patient safety, quality and utilisation rates and presenting them in a dashboard may help executive hospital boards and top-level leaders to focus on unwarranted variation

Naming the “baby” or the “beast”? The importance of concepts and labels in healthcare safety investigation

This paper focuses on concepts and labels used in investigation of adverse events in healthcare. The aim is to prompt critical reflection of how different stakeholders frame investigative activity in healthcare and to discuss the implications of the labels we use. We particularly draw attention to issues of investigative content, legal aspects, as well as possible barriers and facilitators to willingly participate, share knowledge, and achieve systemic learning. Our message about investigation concepts and labels is that they matter and influence the quality of investigation, and how these activities may contribute to system learning and change. This message is important for the research community, policy makers, healthcare practitioners, patients, and user representatives.publishedVersio

Health Care Delivery Practices in Huntington's Disease Specialty Clinics : An International Survey

The CHDI Foundation, Inc. funds Enroll-HD and the activities of the Enroll-HD Care Improvement Committee, including the present survey. We would like to acknowledge the Enroll-HD and REGISTRY administrative staff that assisted in the recruitment of sites and sites that completed the survey.Peer reviewedPublisher PD

Contextual factors of external inspections and mechanisms for improvement in healthcare organizations: a realist evaluation

External inspections constitute a key element of healthcare regulation. Improved quality of care is one of the important goals of inspections but the mechanisms of how inspections might contribute to quality improvement are poorly understood. Drawing on interviews with healthcare professionals and managers and health record data from inspected organizations, we used a realist evaluation approach to explore how twelve inspections of healthcare providers in x= Norway influenced quality improvement. We found that for inspections to contribute to quality improvement, there must be contextual structures present supporting accountability and engaging staff in improvement work. When such structures are present, inspections can contribute to improvement by creating awareness of gaps between desired and current practices, which leads to readiness for change and stimulates intra-organizational reasoning around quality improvement. We discuss our findings using the theory of de- and recoupling, noting how regulators can identify decoupling between intended goals, management systems, practices, and patient outcomes. We further argue that regulators can contribute to a recoupling between these levels by having the capacity to track the providers' clinical performance over time. This will hold the organization accountable for implementing improvement measures and evaluate the effects of the measures on quality of care.publishedVersio