"I wouldn't really believe statistics" - Challenges with influenza vaccine acceptance among healthcare workers in Singapore.

BACKGROUND: Influenza vaccine acceptance among healthcare workers (HCWs) is a worldwide problem, but relatively little research has focussed on Asia, including Singapore. Despite widespread access and recommendations from public health authorities, influenza vaccine uptake remains suboptimal among HCWs. METHODS: Our qualitative study used focus group discussions to identify and explain factors limiting influenza vaccine acceptance among HCWs in Singapore. A total of 73 doctors, nurses, allied health and ancillary staff across three public hospitals were included. RESULTS: Challenges identified include a fear of contracting influenza from vaccination exacerbated by negative anecdotes regarding vaccine safety and efficacy, distrust of published efficacy data, uncertainty regarding relevance of existing data for Singapore, reluctance to introduce chemicals or overmedicate, pain from injection, low risk attributed to influenza and limited awareness of influenza transmission with a preference for alternatives in patient protection. Differences in attitudes were observed across vocational groups. Lack of overt promotion by hospital leadership in some institutions, perceived vaccine hesitancy among doctors, access, and work culture that implicitly encourages working through illness were further barriers. CONCLUSION: Our findings highlight a combination of misperceptions about influenza vaccination and cognitive biases at the individual level, and challenges at the institutional level limiting uptake. Findings indicate an urgent need to provide targeted education and communication. Rather than providing more data, we recommend a widely-disseminated, locally-compiled synthesis addressing specific concerns of hesitant HCWs. Tailoring interventions to specific vocational groups should be considered. Institutional norms and culture may have a powerful influence in setting default behaviours: more effort is needed in improving influenza vaccine promotion and priority at some institutions, integrating vaccine-related communication with other infection control communication and addressing influenza vaccine hesitancy among doctors as a priority. Finally, further study of strategies to address cognitive biases affecting influenza vaccine acceptance in Singapore is desirable

Pharmacy practice in hyperdiverse, urban communities: perspectives of independent community pharmacists in East and South-East London

This study considers pharmacy practice in hyperdiverse, urban communities through the eyes of independent community pharmacists, who are underrepresented figures in anthropological research. Taking the role of the pharmacist as being dynamic and negotiable, this is an investigation into how pharmacists find ways to be relevant in the light of, or even in spite of, a shifting professional remit and the changing landscape of community pharmacy in Great Britain, (where almost 50% of pharmacy contracts are held by just 9 national chains). The study explores 'independence' as it is positioned by the pharmacists; expressed through a rhetorical framework of autonomy, engagement and the bespoke nature of practice, narratively embedded in accounts of urban situations. The research takes an ethnographic approach and was conducted in East and South-East London boroughs combining participant observation and active interviews with pharmacists. All but one of the pharmacists represented in the study were from ethnic minority backgrounds; this reflects a bias typical of urban independent pharmacy. The urban setting presents particular challenges but also particular opportunities and this study demonstrates how pharmacists cope with the constraints and possibilities afforded by their situation. In exploring concepts of professional personhood the study highlights the pharmacists' focus on the importance of autonomy and the creation of distinct professional personas. The significance of engagemen wtith customers is examined through stories of 'acceptance' and developing pharmacy 'communities' alongside the practice of maintaining personal relationships. This reveals the use of cultural capital by the pharmacists, taking advantage of shared cultural heritage and language skills to provide a distinct service offer. The value of providing a 'bespoke' service is investigated through areas of particular significance in differentiating independent pharmacy; 'time' and 'specialism'. The discussion concludes by raising questions about the place of independent pharmacy within the profession and emphasising the contribution independent pharmacists can make to the delivery of care in this setting

Community, autonomy and bespoke services: Independent community pharmacy practice in hyperdiverse, London communities.

BACKGROUND: The landscape of pharmacy continues to evolve including in Great Britain, where, by 2012, almost 50% of pharmacy contracts were held by just 9 national chains. OBJECTIVE: To further explicate the concept of 'independence' as it was positioned by independent pharmacists, particularly examining personal interpretations of their role in contemporary pharmacy and health care delivery. METHODS: Research was situated in East and South-east London between 2008 and 2009. The study took an ethnographic approach; combining participant observation within 7 pharmacies and 36 active interviews with pharmacists. Recruitment criteria demanded that pharmacists self-identified as independent and were either owners or managers in sole-owned or independent chain pharmacies. RESULTS: Independence was expressed through a framework of three overarching themes: autonomy, engagement and bespoke practice. Autonomy formed the basis of professional expression ultimately enabling pharmacists to exercise control over customer relationships. This facilitated engagement with communities and individuals and ultimately made possible an offering of a bespoke 'personal' service. The diverse urban environment was a space where independence was seen to be of particular value. The complexity of this setting was used symbolically to support the need for independent thinking. These themes are examined through stories of 'acceptance' and developing pharmacy 'communities' alongside the practise of maintaining personal relationships to provide a distinct service offer. CONCLUSIONS: This study highlights distinct 'independent' expression of professional identity and suggests the need to assess the value of independent community pharmacy as being different from but complementary to the service provided by multiples/large chains

China national health attitudes survey 2012-13

This is a nationwide survey of adults in mainland China that explored attitudes towards health care, including how people evaluate their health system and their trust in doctors and health care providers. It also includes data on respondents’ health-related behaviours and utilization of preventive and other health services, as well as trust in political institutions, cultural values, economic status, social capital and standard demographic variables

Evaluating social and behavioural impacts of English smoke-free legislation in different ethnic and age groups: implications for reducing smoking-related health inequalities.

OBJECTIVE: To explore social and behavioural impacts of English smoke-free legislation (SFL) in different ethnic groups. DESIGN: A longitudinal, qualitative panel study of smokers using in-depth interviews conducted before and after introduction of SFL. PARTICIPANTS: A purposive sample of 32 smokers selected from three ethnic groups in deprived London neighbourhoods with approximately equal numbers of younger and older, male and female respondents. RESULTS: SFL has had positive impacts with half smoking less and three quitting. Although there were no apparent differences in smoking and quitting behaviours between groups, there were notable differences in the social impacts of SFL. The greatest negative impacts were in smokers over 60 years, potentially increasing their social isolation, and on young Somali women whose smoking was driven more underground. In contrast, most other young adult smokers felt relatively unaffected by SFL, describing unexpected social benefits. Although there was high compliance, reports of illegal smoking were more frequent among young, ethnic minority smokers, with descriptions of venues involved suggesting they are ethnically distinct and well hidden. Half of respondents reported stopping smoking in their own homes after SFL, but almost all were Somali or Turkish. White respondents tended to report increases in home smoking. DISCUSSION: Although our study suggests that SFL can lead to reductions in tobacco consumption, it also shows that impacts vary by ethnicity, age and sex. This study highlights the importance of understanding the meaning of smoking in different social contexts so future tobacco control interventions can be developed to reduce health and social inequalities

The risk-adjusted vision beyond casemix (DRG) funding in Australia

Hospital funding, Risk adjustment, Diagnosis-Related Groups, Diagnostic Cost Groups, Casemix funding,

Risk adjustment policy options for casemix funding: international lessons in financing reform

Risk adjustment, Casemix funding, Diagnosis-related groups, Hospital costs,

Representation and reporting of communicatively vulnerable patients in patient experience research

PURPOSE: To apply a human rights lens to measuring patient experience. Specifically, to determine if the perspectives of communicatively vulnerable people have been included in the patient experience research used to inform the development of the Australian Hospital Patient Experience Question Set (AHPEQS). METHOD: Thirty-nine qualitative studies on patient experience that informed the development of AHPEQS were critically appraised in terms of reporting on: population of interest, eligibility criteria, communicative demands of the research and communicative supports provided. RESULT: Eleven of 39 studies included sufficient information about the population to determine that communicatively vulnerable people would have been approached to participate. Three of these studies explicitly excluded people who were communicatively vulnerable, and four did not report on the provision of any communication supports to enable communicatively vulnerable people to participate. CONCLUSION: Intentional exclusion and/or a lack of communication supports restrict the rights of people who are communicatively vulnerable to express their opinions about what matters to them in hospital. Inadequate reporting of qualitative research on patient experience also makes it difficult to determine if the perspectives of people who are communicatively vulnerable have informed the development of the AHPEQS