<p>As psychologists continue to engage the growing diversity within the United States and around the world, there is an imperative need for psychological services that are specific to cultural needs and integrate relevant sociohistorical and community factors. Currently, ethnocentrism in psychological interventions, research, and graduate training limit psychologists’ international engagement and perpetuate a focus on U.S. psychology. For graduate programs in health service psychology (i.e., clinical, school, and counseling psychology), there is a dearth of literature on their methods of preparation of health service professionals engaging in psychological work outside of the U.S. However, graduate training programs have opportunities to intervene on the field’s colonialism by preparing professionals to effectively engage internationally. Addressing ethnocentrism in training is a critical next step for the field of health service psychology.</p><p>This dissertation is comprised of two distinct chapters that are conceptually related. In the first chapter, I review health service psychology’s current international engagement. As psychologists engage outside of the United States, the field of psychology and the training community must critically examine the applicability of psychological interventions, research, and graduate education to international contexts. I propose six recommendations for training programs to deconstruct colonialism and enhance preparation of graduates for competent work outside of the U.S.</p><p>In the second chapter, I report an original, empirical study, using qualitative descriptive methodology, which critically examines how U.S. training prepares graduates to work internationally. Through semi-structured interviews, I explored internationally based psychologists’ reflections on their training experiences and preparation for their current roles in teaching, practice, research, consultation and policy, and psychological infrastructure. Data analysis utilized consensual qualitative research methodology (CQR). Results provided valuable information regarding psychologists’ professional roles outside of the U.S., factors contributing to their vocational experiences, country-specific mental health attitudes, values, and practices, the impact of U.S.-centric psychology in the country of location, lessons taken from their graduate training, and recommendations for international work. Findings provided recommendations to the training community to incorporate more of an international focus and enhance preparation of students for work outside of the U.S.</p>

Background The Sustainable Development Goals provides targets that foster greater mobilization of global resources and efforts. SDG Goal 3 Ensure healthy lives and promote well-being for all at all ages, sets targets for the reduction of maternal mortality rates and mortality rates for children under-five. Health insurance coverage is thought to provide access to needed primary services to accomplish these goals. West Africa is the region of the world with the highest burden of disease and it is unclear if insurance coverage does provide needed access to services. The articles within this thesis examine whether or not health insurance provides greater access to primary services for mothers and children, while determining other factors to be considered. Method For the systematic review, we carried out a search on four databases. Eligible studies included mother’s under-five and children in West Africa. The primary outcome was insurance impacting the rate of utilization of services. Data was extracted using standardized form, and methodology was assessed using the Joanna Briggs Institute forms. Our cross-sectional study used DHS data from 10 West African countries. Data was cleaned, weighed and analyzed using Stata. The independent variable was health insurance, and the variable of outcome was making a minimum of four antenatal care visits. Data was analyzed using binary logistic regression and we presented results using crude and adjusted odds ratio at 95% confidence interval. Results The narrative synthesis was chosen for the review. We found that in most study settings, insurance increased access to services. The cross-sectional study found that women with insurance were more likely to make the recommended number of ANC visits than their uninsured counterparts (aOR [95% CI] =1.55 [1.37-1.73]). Socio-economic status also impact access to services. Conclusion Health insurance does increase access to services and should be pursued as a viable long-term policy, but access is still dependent on socio-economic status. Due to the COVID-19 pandemic, burden of disease of the region and systems challenges, other solutions should be pursued in the near-term. Future investigation should consider the role of equity as a guiding principle.

Bakgrund: Tobaksanvändande är kraftigt associerat med ohälsa i munnen. Socioekonomiskt svaga grupper har högre tobaksanvändning, vilket resulterar i att de drabbas av mer tobaksrelaterad ohälsa. Denna ojämlikhet i hälsa minskar möjligheten till en hållbar utveckling. I synnerhet är rökare överrepresenterade bland patienter med tandlossningssjukdom. Tidigare forskning har fokuserat på tandvårdens upplevelser av att tillhandahålla tobaksrådgivning och tobaksavvänjning, mycket få studier har fokuserat på patienternas perspektiv. Sveriges åtta folkhälsopolitiska mål strävar åt en mer jämlik hälsa och betonar vikten av att agera mot tobaksanvändning. För att nå framgång i detta arbete måste organisationer samarbeta och samverka tvärsektoriellt. Detta har givit tandvården incitament att ge rökande patienter tobaksrådgivning och stöd i tobaksavvänjning. Syfte: Syftet är att utforska patienters upplevelse av råd och stöd för tobaksavvänjning inom tandvård genom en systematisk litteraturöversikt. Metod: Systematisk litteraturstudie har genomförts på 15 artiklar publicerade mellan 1999–2021. Samtliga artiklar hämtades från PubMed och behandlade patienters upplevelser kring tobaksrådgivning och stöd för tobaksavvänjning. Resultat: Majoriteten av patienterna upplever tandvården som en god arena för tobaksrådgivning och tobaksavvänjning. Tandläkare har möjlighet att påverka patienterna, då resultatet visar att yrkesrollen erhåller ett högt förtroendekapital. Tobakens påverkan på munhälsan betonas vara en viktig faktor för att inse att en beteendeförändring måste ske. Slutsats: Efter analys av granskade artiklar visar resultatet att en majoritet av patienterna förväntar sig råd om tobaksanvändning och även stöd i tobaksavvänjning av sin tandläkare. Genom att använda samtalsmetoder för att stärka empowerment kan tandläkare och tandvårdspersonal bidra till folkhälsofrämjande interventioner.

Yes / Objective: To better understand the factors influencing the uptake of direct oral anticoagulants (DOACs) across different health economies in National Health Service England from the perspective of health professionals and other health economy stakeholders. Design: Qualitative interview study using a critical realism perspective and informed by the Diffusion of Innovations in Service Organisations model. Setting: Three health economies in the North of England, United Kingdom. Participants: Healthcare professionals involved in the management of patients requiring oral anticoagulants, stakeholders involved in the implementation of DOACs and representatives of pharmaceutical industry companies and patient support groups. Intervention: Semistructured interviews (face-to-face or telephone) were conducted with 46 participants. Interviews were analysed using the Framework method. Results: Identified factors having an impact on the uptake of DOACs were grouped into four themes: perceived value of the innovation, clinician practice environment, local health economy readiness for change, and the external health service context. Together, these factors influenced what therapy options were offered and prescribed to patients with atrial fibrillation. The interviews also highlighted strategies used to improve or restrict the uptake of DOACs and tensions between providing patient-centred care and managing financial implications for commissioners. Conclusions: The findings contribute to the wider literature by providing a new and in-depth understanding on the uptake of DOACs. The findings may be applicable to other new medicines used in chronic health conditions. / This work presents research funded by the Pharmacy Research UK (grant number: PRUK-2018-GA-1-KM) and Leeds Teaching Hospitals NHS Trust (grant number: N/A).

Yes / This article reports on case study research conducted in a hospital Trust and explores the impact that the Investors in People award had on employees. Investors in People is widely seen as the principal mechanism for increasing workforce skills within a voluntarist system as well as supporting `good¿ employment policies. Yet in this case study, as elsewhere, most of the `soft¿ human resource initiatives had existed prior to accreditation and the internal marketing of corporate value statements was met with both amnesia and cynicism. More worryingly, training activity was focused on business need, and business need was defined in the narrowest sense, with the result that some employees had fewer opportunities for individual development. Motivation and commitment levels were high, staff were enthusiastic about their work and many actively engaged in training and development. But this owed little to Investors in People and its impact here raises questions about its influence on skill levels more broadly.

Yes / Medicines management is only one part of NHS (UK) procurement and management, but essentially a very expensive part. According to the Commercial Medicines Unit (Department of Health, 2013), NHS hospitals in England currently spend around £3.6 billion annually on pharmaceuticals, having risen from £2.2. billion in 2005. The NHS continuously strives to promote excellence in what it does and justify how it does it. In undertaking this preliminary analysis 45 pharmacy staff members contributed to an online survey. The results presented a broad mix of views on how smart technology (e.g. iPhone, iPad) could be used and if it should be used at all in this setting. The outcome of this small scale study demonstrates the lack of knowledge as to if and how such technologies could be used in hospital pharmacy and therefore present grounds for testing out the broader application of smart technology via academic and practitioner consultations.

Yes / Background Recently, primary care in the United Kingdom has undergone substantial changes in skill mix. Non-medical prescribing was introduced to improve patient access to medicines, make better use of different health practitioners’ skills and increase patient choice. There is little evidence about value-based patient preferences for ‘prescribing nurse’ in a general practice setting. Objective To quantify value-based patient preferences for the profession of prescriber and other factors that influence choice of consultation for managing a minor illness. Design Discrete choice experiment patient survey. Setting and participants Five general practices in England with non-medical prescribing services, questionnaires completed by 451 patients. Main outcome measure Stated choice of consultation. Main results There was a strong general preference for consulting ‘own doctor’ for minor illness. However, a consultation with a nurse prescriber with positive patient-focused attributes can be more acceptable to patients than a consultation provided by a doctor. Attributes ‘professional’s attention to patients’ views’ and extent of ‘help offered’ were pivotal. Past experience influenced preference. Discussion and conclusion Respondents demonstrated valid preferences. Preferences for consulting a doctor remained strong, but many were happy to consult with a nurse if other aspects of the consultation were improved. Findings show who to consult is not the only valued factor in choice of consultation for minor illness. The ‘prescribing nurse’ role has potential to offer consultation styles that patients value. Within the study’s limitations, these findings can inform delivery of primary care to enhance patient experience and substitute appropriate nurse prescribing consultations for medical prescribing consultations. / Department of Health, Project 016/0108. NIHR, CDF/01/2008/009.

Yes / The National Health Service (NHS) Five Year Forward View in 2014 issued a grave warning that if healthcare demand in the UK continued to grow as its current rate, and efficiency or funding changes were not instigated there could be a mismatch between the service (in terms of resource provision) and patients of up to £30 billion a year by 2020/21. The report asserted that in order to “sustain a comprehensive high-quality NHS; action will be needed on all three fronts – demand, efficiency and funding” (2014:5). Based on this escalating issue, and with a focus on the expanded and value-added role of Community Pharmacists, this study chooses to focus on this service operation in light of the pressures as highlighted above by examining what Sustainability means and how it is applied in Community Pharmacy as a service provider in the NHS (UK).

No / Following legislative changes in 2004 and the establishment of the Human Tissue Authority, access to human tissues for biomedical research became a more onerous and tightly regulated process. Ethical Tissue was established to meet the growing demand for human tissues, using a process that provided ease of access by researchers whilst maintaining the highest ethical and regulatory standards. The establishment of a licensed research tissue bank entailed several key criteria covering ethical, legal, financial and logistical issues being met. A wide range of stakeholders, including the HTA, University of Bradford, flagged LREC, hospital trusts and clinical groups were also integral to the process.

Participants from earlier nationwide studies on predictors of internship match were contacted 7-10 years after obtaining their doctoral degree to gather additional data concerning their attained early career competencies and benchmarks (e.g., scores on the national licensing exam). In this sample (N = 190), licensure exam scores were significantly positively associated with scores obtained on the Graduate Record Examination (GRE), family of origin socioeconomic status, and student debt load. However, obtained licensure scores were not found to be significantly associated with any pre-doctoral training variables (e.g., intervention/ assessment hours, number of integrated reports, number of publications, rank order of matched internship site) or most post-doctoral early career activities. Weak positive associations between licensures scores and engaging in teaching / supervision / consultation services were observed. Few self-reported early career competencies were found to be weakly positively associated with scores on the national licensing exam (i.e., integrity, seeking supervision, scientific mindedness, evidence-based practice). Significantly inverse associations were found between national licensing exam scores and self-reported competencies in the areas of management and systems change. Findings are discussed and implications for the national licensing exam considered.