Reducing the time-lag between onset of chest pain and seeking professional medical help: a theory-based review

Background: Research suggests that there are a number of factors which can be associated with delay in a patient seeking professional help following chest pain, including demographic and social factors. These factors may have an adverse impact on the efficacy of interventions which to date have had limited success in improving patient action times. Theory-based methods of review are becoming increasingly recognised as important additions to conventional systematic review methods. They can be useful to gain additional insights into the characteristics of effective interventions by uncovering complex underlying mechanisms. Methods: This paper describes the further analysis of research papers identified in a conventional systematic review of published evidence. The aim of this work was to investigate the theoretical frameworks underpinning studies exploring the issue of why people having a heart attack delay seeking professional medical help. The study used standard review methods to identify papers meeting the inclusion criterion, and carried out a synthesis of data relating to theoretical underpinnings. Results: Thirty six papers from the 53 in the original systematic review referred to a particular theoretical perspective, or contained data which related to theoretical assumptions. The most frequently mentioned theory was the self-regulatory model of illness behaviour. Papers reported the potential significance of aspects of this model including different coping mechanisms, strategies of denial and varying models of treatment seeking. Studies also drew attention to the potential role of belief systems, applied elements of attachment theory, and referred to models of maintaining integrity, ways of knowing, and the influence of gender. Conclusions: The review highlights the need to examine an individual’s subjective experience of and response to health threats, and confirms the gap between knowledge and changed behaviour. Interventions face key challenges if they are to influence patient perceptions regarding seriousness of symptoms; varying processes of coping; and obstacles created by patient perceptions of their role and responsibilities. A theoretical approach to review of these papers provides additional insight into the assumptions underpinning interventions, and illuminates factors which may impact on their efficacy. The method thus offers a useful supplement to conventional systematic review methods

Avaliação de serviços de saúde auditiva sob a perspectiva do usuário: proposta de instrumento Hearing health service evaluation under the perspective of the users: proposal of an instrument

OBJETIVO: Verificar a aplicabilidade de um questionário de avaliação do serviço, sob a perspectiva do usuário. MÉTODOS: O questionário foi inspirado no estudo conduzido pelo Hearing and Communication Group, e apresenta 18 questões nas dimensões: acesso ao serviço, avaliação da audição, atendimento personalizado, benefício para família, comunicação e informação, e competência profissional. Cada questão foi apresentada em escala graduada de cinco pontos. A casuística foi composta por 53 pacientes (ou responsável/acompanhante), que foram convidados, pelos profissionais da recepção, a responder ao questionário. Os dados foram calculados em porcentagem e a pontuação de cada domínio e a pontuação total foi estabelecida. A estatística inferencial foi aplicada, adotando nível de significância de 5%, a fim de verificar a influência das características demográficas no escore total. RESULTADOS: O escore para o domínio acesso foi 62,25%, para avaliação da audição foi 85,96%, para atendimento personalizado foi 82,05%, para benefício para família foi 68,57%, para comunicação e informação foi 79,13%, para competência profissional foi 97,39% e para o escore total 70,65%. Verificou-se que pacientes com menor nível de escolaridade, menor tempo de atendimento no serviço e os que já receberam o AASI apresentam resultados mais elevados no escore total do questionário. CONCLUSÃO: O questionário do presente estudo mostrou-se de fácil aplicabilidade no serviço de saúde auditiva, porém, é necessária sua aplicação em serviços de saúde auditiva em nível nacional para que a padronização e os critérios de confiabilidade e validade possam ser estabelecidos.<br>PURPOSE: To verify the applicability of a questionnaire for the assessment of hearing health services, under the perspective of the users. METHODS: The questionnaire was inspired on the study conducted by the Hearing and Communication Group, and presents 18 questions focused on the following dimensions: access to the service, hearing evaluation, personal attendance, family benefits, communication and information, and professional competence. Each question of this instrument was presented in a graduation scale of five points. The casuistic comprised 53 patients (or caregiver), that were invited, by the reception professionals, to answer to the questionnaire. Data were calculated in percentage, and the score for each domain and the total score were established. Inferential statistic tests were applied, adopting a significant level of 5%, in order to verify the influences of demographic characteristics on the total score. RESULTS: The score for the access domain was 62.25%, for hearing evaluation was 85.96%, for personal attendance was 82.05%, for family benefits was 68.57%, for the domain communication and information was 79.13%, for professional competence was 97.39%, and the total score was 70.65%. It was verified that patients with lower schooling levels, lesser time attending the service, and those that had already received the hearing aid obtained higher total scores on the questionnaire. CONCLUSION: The questionnaire used in the present study proved to be easily applicable in hearing health services; however, its application on national level is necessary, so that standardization and reliability and validity can be established