The goal of this study is to identify factors which may be preventing use of an experimental health care program in the People's Republic of Benin. While previous surveys have focused more specifically on the impact of fees on use and demand, our aim to identify a wider range of factors. / There are two principle methods by which this can be done. One is to extract possible factors from a review of the relevant literature. The other is to carry out an exploratory, qualitative study in the field. We have used both these methods. / A qualitative study is a necessary prelude to a survey, since we initially have no specific idea about which factors to measure and investigate. The aim is to identify factors which may be relevant so that a subsequent survey, with a larger number of cases, could quantify and measure their influence and statistical significance.

Accessibility is a key tenet of the Canadian health care system. As many older persons, age 60 years and older, are managing ongoing chronic health conditions as part of their everyday lives, issues of access to health services are particularly important. Vancouver has a substantial number of older Korean immigrants, yet little is known about their experience and perceptions about accessing Primary Health Care (PHC) services. This study explored issues related to PHC access by older (aged 60 years and older) Korean immigrants. This qualitative study employed purposive sampling and interpretive description methodology. Open-ended interview data and field notes were gathered from 10 older Korean immigrants (five male and five female) recruited in Vancouver from mid-October 2006 to April 2007. The findings revealed that older Korean immigrants have had difficulty gaining access to appropriate PHC services because of the shifts in their social positioning and other barriers which contributed to an inappropriate use of PHC services, delays in care and lack of continuity in PHC. Also, the data revealed a number of ways the PHC system is unresponsive to the health care needs of older Korean immigrants. This study offers insights that may assist health care professionals to understand the nature of the challenges older Korean immigrants face when seeking health care and how they seek to resolve them. The analysis proposes a number of interventions that respect the older Korean immigrants’ values and interventions that may improve their access to PHC.

Primary health care is a part of health care chain, in which primary contact of individuals, families and society is made with national health system, making health care nearer to people’s living and work places. In Lithuanian health program it is estimated to decentralize the management of health care institutions and create conditions for the development of private health institutions. In Lithuanian national health system it is possible to distinguish three models (types) of institutions, providing primary health care, depending on service organization and ownership type. This research is seeking to evaluate the changes of primary health care institutions in the context of health care reform, evaluate them among institutions of different models, depending on service organization and ownership type. The aim: to distinguish the differences of Vilnius region institutions providing primary health care, depending on peculiarities of work organization. Methods: In years 2003 – 2005 a cross-sectional descriptive research was carried out. The data of State Patient Fund information system database Sveidra was analyzed. The research includes all institutions of Vilnius region, which provided primary health care services in years 1998 – 2003 and signed agreements with Vilnius Territorial Patient Fund. All the chosen institutions were divided into three groups: public institutions, providing primary care and secondary health care services, the establishers of which are... [to full text]

SUMMARY The aim of the study is to evaluate attitude of physicians and patients towards primary health care reform. The objectives: 1) to assess patients' attitude to primary health care reform and its relations to demographic and social factors. 2) to evaluate physicians' attitude to primary health care reform. 3) to compare viewpoint of patients and physicians on primary health care reform. Methods. The subject of the survey is the attitude of the patients and physicians towards primary health care reform. The survey was conducted in five primary health care centres and three private primary health care practices in Prienai region. Of the 400 questionnaires handed out to patients 82.5% were returned and of the 112 questionnaires given to doctors 87.5% were returned. The participants in the survey were 330 patients and 98 medical doctors. The questionnaires were compiled both for the patients and the doctors. The questionnaire for the patients covered 24 questions, for the doctors - 19 questions. The data analysis was done applying the statistical package SPSS 11.0 version. The statistical procedures were employed by Chi-square’s (χ2) parameters, degree of freedom and statistical significance. The difference of indices were statistical significant at p<0.05. Results. 55.9% of the patients’ attitude towards primary health care reform is positive, while 29.9% of the patients - negative. 18.3% of the patients have the opinion that due to health care reform the quality of... [to full text]

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This thesis has explored the implementation of the primary health care strategy in Ghana, focusing on the Maternal Child Health program, one of main components of the strategy and the program that seems to have been most widely implemented in the country. / The analysis has been concerned primarily with identifying the obstacles to the implementation of this strategy in rural areas of the country, where levels of utilization and participation have been found to be lower than what was hoped for by the government. It does this by using data collected through in-depth interviews and participant observation in three rural villages of the country. / The findings reveal that a complex range of interrelated factors influence or deter women from utilizing and participating in the MCH program.

Introduction: Integrated management of childhood illness (IMCI) is a child survival strategy that has been adopted in South Africa (SA) as the standard of care for managing sick children in the primary health care setting. IMCI includes guidelines for management of paediatric HIV. This study aimed to investigate effectiveness of IMCI as a vehicle to deliver essential child survival interventions, particularly HIV interventions, in routine practise in a high HIV prevalence setting, and to investigate barriers and enabling factors for IMCI implementation. Methods: The study was conducted in Limpopo and KwaZulu-Natal provinces, SA. In the qualitative component, focus group discussions were conducted with IMCI trained health workers and carers of children under 5 years, to explore experiences of IMCI implementation, particularly the HIV component, from the perspective of both target groups. A comparative survey was then conducted. Randomly selected IMCI trained nurses were observed for up to 20 consultations with sick children presenting consecutively to the facility, and their findings compared to those of an IMCI expert who subsequently assessed the child. Observed children were tested for HIV. Results: IMCI trained nurses found IMCI training informative and empowering, and there was agreement among nurses that their skills in managing sick children improved after training. Barriers to IMCI implementation included increased time required for IMCI consultations and lack of support from colleagues. IMCI trained nurses expressed reluctance to implement the HIV component of IMCI, believing it to be unnecessary, unacceptable to mothers and that they lacked the skills to implement HIV care. In total, 77 IMCI trained nurses were observed for a total of 1357 consultations between May 2006 and January 2007; nurses were observed for a mean of 17.7 consultations. Components of the IMCI assessment were frequently omitted; 14/77(18%) nurses asked about all main symptoms in every child. IMCI classifications were often incorrect; 52/112 (46.4%) children with a general danger sign were correctly classified. The HIV component was poorly implemented, 342/1357 (25.2%) children were correctly classified for HIV, although the HIV algorithm performed well when implemented by IMCI experts. Conclusion: IMCI implementation is fragmented and incomplete. Interventions are urgently needed to achieve and maintain high quality health worker performance in implementing IMCI. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.

Canadians are worried about the future of the health care system, and provincial governments are questioning the ability of the existing system to support Canadians health care needs in the 21st Century(Industry Canada, 2011). Health care providers and system administrators are both driving and experiencing a paradigm shift; moving away from paternalism and toward an egalitarian approach. In order to practice patient centredness, health care providers must prioritize patient needs; provide information regarding treatments while taking patient preferences into account (Romanow, 2002). While there is a growing body of literature regarding patient centredness, there is scant information from the patient perspective. If the most effective and acceptable health services are those that realize the expectations of the users, this is an important area of study. Using phenomenological research methods and the theory of planned behaviour as a theoretical framework, the purpose of the study was to explore the influence of beliefs, attitudes and experiences on behaviour from the perspective of patients in primary health care or stroke rehabilitation. A second purpose was to explore the degree to which beliefs, attitudes and behaviour were similar between clinical contexts. The theory of planned behaviour was unsuitable for understanding peoples’ beliefs, attitudes and behaviour about being a patient. Being a patient was not a single, observable behaviour, but rather a set of contextually dependent strategies patients’ directed at a particular goal. The goal for each participant group was different; rehabilitation patients focused on the specific goal of recovery and discharge, while PHC patients focused on a broader goal of accessing and receiving best health care possible. These goals were reflected in their respective approaches to accessing health care services, an experience they described as socially oriented, governed and reinforced. Although patients described themselves as actively engaged, they did not approach each interaction with health care with a set of behavioural beliefs about being a patient. During the course of their participation, patients identified, developed and adopted strategies to assist in achieving the target; and evaluated those strategies more positively.

New Zealand is a country populated by migrants and the Asian population is the largest fastest growing cohort and are predicted to outnumber Māori (i.e. the indigenous people of New Zealand) by 2050. Due to the requirements of immigration to New Zealand the Asian community tends to be highly educated, with Asian ethnicities being more likely to have a university bachelors or post-graduate degree. Asian people are distributed more towards lower household income categories than Europeans, but the proportion of Asian people living in the lowest New Zealand deprivation quintile areas has declined in recent years. Migrants applying for residency are required to have, and thus can be expected to arrive in the country, with good health. The research on health care utilisation in geography has suffered by its tendency to neglect migration and culture as an influencing factor. In New Zealand this neglect is compounded by the near absence of a research focus on Asians and where they do appear it is in collated national surveys that have tended to group all sub-Asian ethnicities as one. This study explored the utilisation of health care from two directions. First, the response and perceptions of health care use from the view of the health services and, second, the perceptions of health care provision from the view of Asian migrants. For these reasons qualitative methods were utilised as they allow a focus on the everyday life situations of subjects.They provide opportunity to expand and flow with the research process. In New Zealand, health services are available that specifically target Asian patients, but they are not uniformly available across New Zealand. This study identifies features of mainstream general practice services, as well as factors that migrants bring with them that act as barriers for Asian people accessing health services, including affordability, language and negative experiences that influence trust of the New Zealand health care system. In many cases affordability was linked to a perceived lack of value for money, where no treatment or tangible outcome was received through a visit to the doctor. Language was indicated to be the most pressing barrier to accessing health care and participants’ home country health experiences continued to influence perceptions and use of health care in New Zealand. The study also highlights some strategies that can be implemented into various stages of the Asian patient’s introduction into and then through the health system and health care to improve the availability and acceptability of these services.

Background: Mental illness has increased in Sweden and the individuals seeking care expect to be met with respect. The way patients perceive themselves to be treated by health care professionals plays a central part to care and treatment of patients, and the patients experience will decide how future care will proceed. The majority of complaints from patients with mental illness suggest that the way they are treated in health care is inadequate. For people with mental illness it is crucial how they perceive themselves to be treated since poor treatment can lead to reluctance in seeking future help. Aim: The purpose of this study was to describe how people with mental illness perceive themselves to be treated in primary health care. Method: A literature review was chosen as a method and data was collected from seven articles, both qualitative and quantitative. Results: The results were analyzed and compiled into three main themes; (1) To feel exposed to generalization, (2) To feel respected and (3) To feel involved. The subthemes describe experiences of; focus on medicine, one size fits all, lack of knowledge, to be listened to, humanity, attitudes, time, information and dialogue. Conclusion: There are both positive and negative experiences of how patients perceive themselves to be treated in primary health care but the negative experiences are predominant. This study can lead to an increased understanding and knowledge of how the primary care professionals should treat people with mental illness and which actions should be avoided.