SSM - Health Systems最新文献

{"title":"Using causal loop diagrams to explore the maternal and child health system response to payment for performance in Zambia, and it’s generalisability across settings","authors":"Chitalu Miriam Chama-Chiliba ,&nbsp;Nkenda Sachingongu ,&nbsp;Rachel Cassidy ,&nbsp;Peter Binyaruka ,&nbsp;Collins Chansa ,&nbsp;Agnes Rwashana Semwanga ,&nbsp;Josephine Borghi","doi":"10.1016/j.ssmhs.2025.100082","DOIUrl":"10.1016/j.ssmhs.2025.100082","url":null,"abstract":"<div><div>This study investigates the generalisability of pathways depicted by causal loop diagrams (CLDs) in payment for performance (P4P) schemes by adapting and validating the Tanzanian CLDs to the Zambian context. Specifically, it explores whether the health system pathways represented by CLDs, are consistent across different settings and how variations in programme design and local context influence these pathways. Using a five-stage approach, the study adapted the Tanzanian CLDs to reflect the Zambian P4P programme context, validating them through stakeholder interviews, workshops, and secondary qualitative data. The findings show that while the overarching pathways influencing P4P outcomes are similar, differences in programme design and contextual factors shape their intensity and impact. Notably, Zambia’s higher facility autonomy and stronger trust in the health system contributed to greater health worker motivation and service delivery compared to Tanzania. Programme design features such as safeguards for non-incentivised services and adequate funding for facility investment with provider autonomy influenced performance outcomes. Additionally, contextual factors such as trust in the system mitigated programme delays, while decentralised procurement systems enhanced P4P effectiveness. These findings highlight the need for context-specific adaptation when implementing P4P programmes. The study advances the application of CLDs for cross-country health system analysis, highlighting both their potential and limitations in comparing health interventions across diverse settings.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143934959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organisational learning culture in maternity units: A mixed-method study in rural district hospitals in KwaZulu-Natal, South Africa","authors":"Christiane Horwood ,&nbsp;Lyn Haskins ,&nbsp;Veronique Filippi ,&nbsp;Loveday Penn-Kekana ,&nbsp;Samuel Manda ,&nbsp;Sphindile Mapumulo ,&nbsp;Silondile Luthuli ,&nbsp;Ruwayda Petrus ,&nbsp;Tanya Doherty","doi":"10.1016/j.ssmhs.2025.100081","DOIUrl":"10.1016/j.ssmhs.2025.100081","url":null,"abstract":"<div><h3>Background</h3><div>Building organisational learning in health facilities is a health system strengthening strategy that has particular relevance for rural health workers (HWs) who may be geographically isolated without access to learning opportunities or specialist support. We present the findings of a mixed methods study exploring organisational learning in rural hospital maternity units.</div></div><div><h3>Methods</h3><div>Data were collected from all cadres of HWs working in maternity units in 11 health facilities in two districts, including doctors, nurse managers, midwives and nursing assistants. A quantitative survey was conducted with all HWs using the validated Dimensions of Learning Organisation Questionnaire (DLOQ). We then conducted individual in-depth interviews with purposively selected HWs in each facility to explore their perceptions and experiences of learning, teamwork and leadership.</div></div><div><h3>Findings</h3><div>We completed 116 DLOQ self-administered questionnaires and conducted 35 in-depth interviews. Strategic leadership scored highest on the DLOQ, with HWs reporting that managers provided opportunities for mentoring and learning. Doctors and nurse managers experienced team learning, leadership and communication more positively than midwives and nursing assistants. Learning was driven by senior doctors and managers, frequently taking a top-down didactic approach rather than employing reflection and dialogue. This is supported by low DLOQ scores for inquiry and dialogue and empowerment among nurses compared to doctors and managers.</div></div><div><h3>Conclusions</h3><div>There is a need for shifts in learning approaches in maternity units from a didactic clinical focus to participatory dialogue and reflection, including interpersonal issues like respect and communication, and to ensure that all team members have access to learning opportunities.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where do traditional healers fit in the dentist-centred oral health system? An ethnography inquiry among the indigenous communities in Gudalur, South India","authors":"Rajeev B R ,&nbsp;Mahesh Madhav Mathpati ,&nbsp;Mahantu Yalsangi ,&nbsp;Ravi Narayan","doi":"10.1016/j.ssmhs.2025.100079","DOIUrl":"10.1016/j.ssmhs.2025.100079","url":null,"abstract":"<div><h3>Background</h3><div>Adivasi (Indigenous) communities in Gudalur, Tamil Nadu, India, face significant challenges in accessing equitable oral health care, influenced by cultural and socio-political factors. This study examines the role of traditional herbal medicine healers in delivering oral health services within these communities.</div></div><div><h3>Methods</h3><div>Guided by the Socio-Ecological Framework, the data were collected between April 2015 and July 2018, employing ethnography tools such as participant observation, focus group discussions, and semi-structured interviews. A total of twenty-four healers took part, offering insights into how Adivasi healers perceive and treat oral health issues. The study also incorporated perspectives from community members, dentists, and doctors to provide a broader understanding of oral healthcare within the community.</div></div><div><h3>Results</h3><div>Adivasi healers identified overlapping oral health symptoms and provided local care that fills gaps in the formal health system. Challenges such as resource limitations and competition with Western biomedicine affect the continuity of their practices. Oral health among Adivasis is deeply intertwined with cultural and structural determinants, exacerbated by marginalisation within the mainstream public healthcare system.</div></div><div><h3>Conclusion</h3><div>Local health traditions, particularly those practised by Adivasi healers, play a crucial role in primary oral health care where formal dental services are inadequate. Addressing oral health disparities requires a shift towards inclusive, community-oriented health systems that recognise and integrate local healing practices.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100079"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative study of doulas providing emotional support during the perinatal period: An unharnessed opportunity in the United States","authors":"Elysia Larson ,&nbsp;Ronald M. Cornely ,&nbsp;Christina Gebel ,&nbsp;Ebunoluwa Falade ,&nbsp;Caroline Ezekwesili ,&nbsp;Sayida Peprah-Wilson ,&nbsp;Laura E. Dodge ,&nbsp;Clevanne Julce ,&nbsp;Nancy Byatt","doi":"10.1016/j.ssmhs.2025.100077","DOIUrl":"10.1016/j.ssmhs.2025.100077","url":null,"abstract":"<div><h3>Introduction</h3><div>To address unmet mental health needs, support needs to be integrated into settings where individuals seek care. Doula care during the perinatal period offers a community-based setting for exploring opportunities to promote perinatal mental health.</div></div><div><h3>Methods</h3><div>We elucidated doulas’ and perinatal individuals’ views on how doulas can support perinatal mental health through four focus group discussions (FGDs) with doulas (n = 18) and three FGDs with perinatal individuals (n = 10); all participants were living in the United States.</div></div><div><h3>Findings</h3><div>Participants reported two main ways doulas can and do support perinatal mental health: first, by acting as a bridge to mental health services and resources, and second, through providing direct emotional support by listening and validating the client’s experiences and emotions. Doulas suggested that because they spend more time interacting with perinatal individuals than most obstetricians, and because they are often seen as an independent third party, they may be more likely to identify social and emotional challenges. However, many doulas indicated they had a lack of formal training in how to provide mental health support and would benefit from additional training.</div></div><div><h3>Conclusions</h3><div>Doulas often provide social and emotional support along with linkage to additional care or resources. Doula FGD participants described a need for additional skills to provide emotional support and to identify when support from a mental health professional is warranted. Doula engagement has the potential to expand support systems to both provide a supportive environment for perinatal individuals and to facilitate prevention and access to treatment for mood disorders.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100077"},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding oxygen access: Feasibility, acceptability, and implementation challenges in primary healthcare centers in Guinea and Mali","authors":"Sarah Louart ,&nbsp;Habibata Baldé ,&nbsp;Abdourahmane Coulibaly ,&nbsp;Bakary Dembélé ,&nbsp;Ibrahima Sory Diallo ,&nbsp;Valéry Ridde ,&nbsp;Antoine Maillard","doi":"10.1016/j.ssmhs.2025.100078","DOIUrl":"10.1016/j.ssmhs.2025.100078","url":null,"abstract":"<div><h3>Introduction</h3><div>Access to oxygen in Sub-Saharan Africa faces numerous challenges, especially in rural areas where it is usually only available in hospitals. Even when low oxygen saturation is detected at the primary care level, referring patients to higher-level facilities is often complicated and time-consuming. This study assessed the feasibility and acceptability of introducing mobile filling stations for ambulatory oxygen cylinders in primary healthcare centres in Guinea and Mali.</div></div><div><h3>Methods</h3><div>Data collection included quantitative monitoring of equipment use and maintenance; as well as qualitative interviews with health workers, patients, community representatives, and institutional representatives to assess the implementation process and acceptability. Analysis was guided by two conceptual framework.</div></div><div><h3>Results</h3><div>During a median monitoring period of 7 weeks per site, 29 oxygen cylinders were used, with higher usage in Mali compared to Guinea. Nearly all hypoxemic patients received oxygen. Most equipment use occurred on-site rather than during referrals. Interviews revealed that oxygen access improved patient care by enhancing local management of respiratory issues and reducing the need for hospital referrals. However, challenges included difficulties in transporting patients, concerns about long-term equipment maintenance, and the need for continuous training due to high staff turnover.</div></div><div><h3>Conclusion</h3><div>Improving oxygen access at the primary care level through mobile filling stations and solar systems in Guinea and Mali demonstrates potential for better hypoxemia management. The study highlights the importance of local solutions to enhance healthcare quality in resource-limited settings. However, challenges related to equipment sustainability were identified, necessitating further research to evaluate long-term viability and cost-effectiveness.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100078"},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of willingness and ability to pay for an improved community-based health insurance in Rwanda","authors":"Mark Akanko Achaw ,&nbsp;Charles Mulindabigwi Ruhara ,&nbsp;Edouard Musabanganji ,&nbsp;Regis Hitimana","doi":"10.1016/j.ssmhs.2025.100069","DOIUrl":"10.1016/j.ssmhs.2025.100069","url":null,"abstract":"<div><div>The Rwanda Community-Based Health Insurance (CBHI) is the most crucial financial mechanism against catastrophic health expenses in the country, covering over 87 % of the population since its inception in 2003. Although the scheme has expanded significantly in terms of coverage, premium rates have remained unchanged. In 2021, the Rwanda Social Security Board (RSSB), which manages the CBHI, initiated a study to assess the population's willingness and ability to pay higher CBHI premiums and explore strategies for attracting the remaining informal population into the scheme. The study used the Contingent Valuation method to collect responses from a random sample of 6086 households.</div><div>The analysis revealed a strong reputation for the CBHI among the general population, despite some challenges such as recurring drug shortages and the unavailability of certain services in health centers. Regarding the willingness to enroll, many respondents, including non-CBHI members, expressed interest in joining the scheme. Most were willing to pay a maximum premium ranging from RWF 3229 (USD 3.2) to RWF 3817 (USD 3.8), which is higher than the current premium of RWF 3000. The logistic regression model identified key determinants of enrollment, including the age of household heads, household size, healthcare utilization, and economic status. In terms of willingness to pay, the most significant factors were the household's economic status (proxied by their socioeconomic classification, or Ubudehe category), household size, employment status of the head, healthcare utilization, savings habits, and participation in economic activities.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100069"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data quality of out-of-pocket payment on institutional delivery in India","authors":"Sanjay K. Mohanty ,&nbsp;Laxmi Kant Dwivedi ,&nbsp;Santosh Kumar Sharma ,&nbsp;Sowmya Ramesh ,&nbsp;Priyanka Gautam ,&nbsp;Suraj Maiti ,&nbsp;Saritha Nair ,&nbsp;S.K. Singh","doi":"10.1016/j.ssmhs.2025.100071","DOIUrl":"10.1016/j.ssmhs.2025.100071","url":null,"abstract":"<div><div>Estimates of out-of-pocket (OOP) payments on health care are increasingly being used in research and policy. In India, these estimates are typically derived from health surveys by the National Sample Survey (NSS). The questions on OOP payment on delivery care have recently been integrated into the last two rounds of India’s National Family and Health Surveys. These surveys differs on content of questions, reporting, and recording of responses that may have a bearing on the reliability of OOP payment estimates. This paper examines issues related to the data quality of OOP payments using recent rounds of two large-scale population-based surveys: the NFHS, 2019–21 and the 2018 National Sample Survey (NSS). Our analysis includes 155,624 births delivered in healthcare facilities from NFHS-5 and 27,664 cases of hospital-based delivery care recorded in the 75th round of the NSS health survey, 2018. We have used descriptive statistics and a two-part regression model to examine variations of OOP payment across surveys. OOP payments showed variations across socioeconomic and demographic groups in both surveys, with some notable correspondence alongside significant differences. Variations are similar for those availing services from private health centres. After controlling for socio-economic and demographic factors, OOP payments in the NFHS were lower among the poorest and higher among the wealthiest compared to the NSS. State-level variations in OOP payments were also more pronounced between the two surveys. The variations in OOP payment across surveys were possibly due to the structure of questions, recall bias, and variations in the price level. We recommend standardizing survey questions to improve the reliability of OOP payment estimates across surveys.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100071"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care as repair, but whose responsibility? Front-line health workers’ resourcefulness in implementing a PMTCT tracing policy in Kenya","authors":"Katrine Judith Chamorro De Angeles ,&nbsp;Simone Storey ,&nbsp;Björn Nordberg ,&nbsp;Eunice Kaguiri ,&nbsp;John Dusabe-Richards ,&nbsp;Anna Mia Ekström ,&nbsp;Edwin Were ,&nbsp;Morten Skovdal ,&nbsp;Anna Kågesten","doi":"10.1016/j.ssmhs.2025.100075","DOIUrl":"10.1016/j.ssmhs.2025.100075","url":null,"abstract":"<div><div>Defaulter tracing policies for Prevention of Mother-to-Child Transmission (PMTCT) services are vital for achieving the global goal of zero new HIV infections. However, little is known about their implementation. This qualitative study explores the role of tracers—community volunteers, retention workers, and mentor mothers—in implementing such policy across six facilities in Western Kenya. It uses the conceptual lens of 'repair work' to unveil their ‘everyday work in keeping systems going’ ensuring care delivery to women and their infants. Data were collected through 31 semi-structured interviews with tracers and PMTCT managers, observations, document reviews, and analyzed using thematic network analysis. Our findings reveal significant variability in policy implementation, influenced by integration of PMTCT services to maternal and child health clinics and facility resources. Tracing and retaining women in PMTCT care heavily relied on tracers’ adaptive strategies and ingenuity to compensate – through repair work – for systemic shortcomings, resulting in the delivery of differentiated, person-centered care using social networks, personal funds and improvisations. Key challenges included inadequate remuneration, lack of institutional resources and support, and insufficient information and evaluation systems. Our results highlight the social nature of health systems and demonstrate the relevance of 'repair work' for health systems research, used in our paper to unveil the often-unrecognized efforts of tracers in maintaining PMTCT care continuity. To ensure sustainable and effective translation of policy into practice, policymakers, donors and program managers must allocate sufficient resources, and provide formal employment to tracers rather than relying on repair work to keep systems going.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100075"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the influence of mHealth interventions on quality of life among individuals living with HIV or hypertension: A systematic narrative review","authors":"Danleen James Hongoro ,&nbsp;Andre Pascal Kengne ,&nbsp;Olufunke Alaba","doi":"10.1016/j.ssmhs.2025.100076","DOIUrl":"10.1016/j.ssmhs.2025.100076","url":null,"abstract":"<div><h3>Background</h3><div>The coexistence of communicable diseases like HIV and non-communicable diseases such as hypertension poses significant global health challenges. For individuals managing chronic conditions, maintaining a good Quality of Life (QoL) is essential. Mobile health (mHealth) interventions, propelled by the extensive use of mobile technologies, present innovative approaches to healthcare. Therefore, this review aims to synthesize existing definitions, frameworks, facilitators and barriers to scaling-up health innovation in low-middle-income-countries (LMICs).</div></div><div><h3>Methods</h3><div>We conducted a thorough search across major databases from January 2000 to January 2024, focusing on mHealth interventions targeting HIV and/or hypertension. Peer-reviewed studies employing validated QoL instruments, available in full text and published in English were included.</div></div><div><h3>Results</h3><div>Out of 5082 initially identified articles, 18 met the inclusion criteria after the exclusion of duplicates and irrelevant studies. Our thematic synthesis categorized the studies according to the type of mHealth intervention, and its impact on patients with HIV and/or hypertension, and identified broader trends, challenges, and recommendations. Intervention strategies varied, ranging from simple text reminders and interactive platforms like WeChat to comprehensive telehealth solutions and personalized coaching programs. The impact of mHealth on the QoL of people with HIV showed a spectrum from positive to neutral, influenced by factors such as technology used and patient demographics. For hypertensive patients, mHealth interventions generally improved QoL, although some studies reported neutral impacts. Key trends highlighted the importance of personalization and user engagement in correlating with improved QoL outcomes. Challenges identified included participant dropout, privacy issues, software malfunctions, time constraints, and the difficulty of catering to diverse patient needs. A notable hindrance to evaluating intervention effectiveness was the inconsistency in outcome measurement tools used across studies.</div></div><div><h3>Conclusion</h3><div>mHealth interventions demonstrate potential in improving QoL for individuals living with HIV and/or hypertension. Optimizing these interventions and their integration into existing healthcare systems is essential for maximizing benefits. However, addressing barriers to equitable access and overcoming challenges is crucial for the effective adoption and efficacy of mHealth solutions across these populations.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100076"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunities for authentic co-production in integrated care implementation","authors":"Marisa Sklar ,&nbsp;Anna Brubaker ,&nbsp;Lilliana Conradi ,&nbsp;Euan Sadler ,&nbsp;Nicole A. Stadnick","doi":"10.1016/j.ssmhs.2025.100074","DOIUrl":"10.1016/j.ssmhs.2025.100074","url":null,"abstract":"<div><div>This Short Communication proposes opportunities for authentic co-production in integrated care implementation. While there are targeted efforts to implement integrated care across healthcare systems, the extent to which these efforts have prioritized co-production is unknown. Opportunities for authentic integrated care implementation co-production are anchored to five core principles for implementation collaborations: 1) equity in relationship building, (2) reflexivity, (3) reciprocity and mutuality, (4) transformative and personalized, and (5) collaborative relationship structures or procedures.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100074"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}