BMC Health Services Research最新文献

{"title":"The other health care system in Germany: care for people without health insurance.","authors":"Matthias Zimmer","doi":"10.1186/s12913-024-12119-0","DOIUrl":"https://doi.org/10.1186/s12913-024-12119-0","url":null,"abstract":"<p><strong>Background: </strong>A large number of people in Germany have no health insurance. Their access to the official healthcare system is significantly more difficult or impossible. Charitable institutions try to provide medical care and create parallel healthcare structures. Their possibilities and limits are still unknown.</p><p><strong>Methods: </strong>This study identified 128 institutions for people without health insurance. A data query was used to determine the status of medical care for uninsured patients.</p><p><strong>Results: </strong>Sixty-eight of 128 identified institutions participated in the study. They provided care to 26,300 people, required €7,580,449 for their work, ran doctor's offices (57%), provided mobile care (7.8%), and arranged only medical care (29.6%). Patients of all ages need general, internal and gynecological care. The availability of health care is heterogeneous, and health care is not available throughout the country, especially not for people with limited personal mobility. The most frequent specialties were general medicine, internal medicine, gynecology, psychiatry, and surgery. Even complex care, such as pregnancy, was possible. In a self-assessment using a Likert scale, the median of the subjectively perceived level of care measured against a regular doctor's office for insured patients was 6 of 10. The provision of medicines, medical supplies or specialized medical services depended on private donations and thus on the economic situation in Germany. Participants often used multiple solutions in parallel to conserve available resources. Institutions showed a high level of responsibility to their patients. They were mostly professionally organized, with few full-time staff and many volunteers.</p><p><strong>Conclusion: </strong>Medical care for people without health insurance was heterogeneous and not universally available. Comprehensive legislative changes are needed to provide universal basic health care. The establishment of clearing houses and changes in pharmaceutical and tax law could stabilize care for people without health insurance.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1649"},"PeriodicalIF":2.7,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142880977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the quality of safe dental services based on the perception of patients with the IPA approach: a powerful diagnostic tool for managers.","authors":"Leila Keikavoosi-Arani, Javad Moghadasi","doi":"10.1186/s12913-024-11955-4","DOIUrl":"https://doi.org/10.1186/s12913-024-11955-4","url":null,"abstract":"<p><strong>Background: </strong>In today's competitive world, especially in critical situations, dental clinic managers seek to retain customers and allocate more market share. The importance-performance analysis (IPA) technique is a powerful diagnostic tool that helps managers identify fundamental deficiencies, establish priorities and provide insights into which service improvement areas managers should focus on. This study aimed to improve the quality of life of patients at the Alborz Dental Clinic based on their perception of safe services during the coronavirus pandemic using IPA.</p><p><strong>Materials and methods: </strong>In this analytical cross-sectional study, 324 patients referred to at Alborz Dental Clinic from April 2021 to February 2022 were enrolled in the study through simple random sampling. The data collection tool used was a researcher-designed questionnaire based on the indicators of the quality improvement model and the guidelines of the Ministry of Health, Medical Education and Health of Iran regarding the provision of dental services in the context of COVID-19, the validity and reliability of which were measured. The gap analysis results and determination of areas of improvement were obtained using IPA. The data analysis was performed using SPSS26 and Excel software.</p><p><strong>Results: </strong>The results of the paired ttest showed that the difference between importance and performance for all the research variables was significant (significance level less than 5%).The importance of the components exceeded their performance. The deepest gap among the five components of the model was related to accountability. IPA revealed that two variables, reliability and responsiveness, are placed in quadrant A, and three variables, tangibility, assurance, and empathy, are placed in quadrant B.</p><p><strong>Conclusion: </strong>To improve the quality of safe services, dental clinic managers need to pay attention to the three dimensions of \"tangibility\", \"assurance\" and \"empathy\" and plan and make decisions about the two dimensions of \"reliability\" and \"responsiveness\".</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1647"},"PeriodicalIF":2.7,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142880963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Completeness of repeated patient-reported outcome measures in adult rehabilitation: a randomized controlled trial in a diverse clinical population.","authors":"Anne-Lene Sand-Svartrud, Ingvild Kjeken, Renate Foss Skardal, Gunhild M Gjerset, Tonje Jossie Johnsen, Anne Dorte Lyken, Hanne Dagfinrud, Rikke Helene Moe","doi":"10.1186/s12913-024-12103-8","DOIUrl":"https://doi.org/10.1186/s12913-024-12103-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Data collection through patient-reported outcome measures (PROMs) is essential for the purpose of rehabilitation research and registries. Existing problems with incomplete PROM data may relate to the patient burden and data set length. This study aimed to analyse response patterns and degree of data completeness in systematic outcome assessments conducted within a clinical study in a multidisciplinary rehabilitation setting, comparing completeness of a brief and a longer set of PROMs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Norwegian RehabNytte Cohort was developed to monitor patients' long-term benefit of rehabilitation and progress on PROMs. Adults admitted to one of 17 institutions providing mostly inpatient rehabilitation in secondary healthcare were included between January 2019 and March 2020, and followed for one year. For the purpose of the current randomized controlled trial, the Cohort-patients in 16/17 institutions were randomized to complete either a brief or a longer set of PROMs at admission, discharge, and after 3, 6 and 12 months. The brief set comprised the EQ-5D-5L and additional generic PROMs commonly used in rehabilitation settings. The longer data set expanded upon the brief set by including the Patient-Specific Functional Scale and the 29-item version of the PROMIS Profile instruments. Completeness was measured as the extent of present applicable PROM data at each time point. In addition, we assessed response patterns in terms of dropout rates and intermittently missed assessment events. The RehabNytte study is registered under ClinicalTrial.gov (NCT03764982, first posted 05.12.2018).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 2904 patients included, 1455 were assigned to the brief data set and 1449 to the longer data set. The majority of patients were referred to rehabilitation for rheumatic and musculoskeletal diseases (39.3%) or cancer (26.9%). The data set completeness was significantly higher in the brief set compared to the longer (p &lt; 0.001). From admission to 12 months follow-up, differences in completeness between groups ranged from 6.5 to 12.6 percentage points, consistently favouring the brief set. Completeness was highest at admission, reaching 96.8% (95% CI 0.96-0.98) for the brief set and 84.2% (95% CI 0.82-0.86) for the longer set. The lowest completeness was observed at discharge, with 46.0% (95% CI 0.43-0.49) for the brief set and 39.5% (95% CI 0.37-0.42) for the longer one. Discharge was the only time point without automatic reminders to non-responders from the digital data collection system. Patients responding to the longer data set exhibited the highest dropout rates, while degree of intermittent missing data was comparable between groups. In both groups, only one-third of patients provided complete or partly responses at all five time points.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study demonstrated that a brief set of PROMs achieved higher data completeness compared to a longe","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1648"},"PeriodicalIF":2.7,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142880651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why are people with dementia overlooked in long-term care insurance policy in Guangzhou, China?","authors":"Bei Ye, Yingxin Xu, Wing Kit Chan, Zhongyan Zhang, Sophia Lobanov-Rostovsky, Natasha Curry, Eric John Brunner, Jing Liao","doi":"10.1186/s12913-024-12126-1","DOIUrl":"https://doi.org/10.1186/s12913-024-12126-1","url":null,"abstract":"<p><strong>Background and objectives: </strong>There is a growing demand for dementia care to be funded by long-term care insurance (LTCI). However, evidence indicates that people with dementia are overlooked in China's LTCI policy and empirical research on this issue is notably scarce. Among the first seven LTCI pilot cities that officially enrolled people with dementia, Guangzhou is unique for roll-back LTCI policies related to eligibility criteria and benefits. This study aims to explore why people with dementia are overlooked in China's LTCI policy, using Guangzhou as a case study.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with stakeholders involved in LTCI need assessment and care delivery in Guangzhou. Eight LTCI assessment specialists, 22 formal caregivers, and six informal caregivers were interviewed from December 2021 to October 2022. Data was analyzed using NVivo 11.0 software and the Gilbert welfare framework to identify themes.</p><p><strong>Results: </strong>Interviewees reported that need assessment lacked a clear definition, were poorly supervised, and had high moral hazards. Challenges to care delivery included unprofessionalism of formal caregivers, shortage of resources, unprepared informal caregivers, a lack of a supportive environment and the negative impact of COVID-19. DISCUSSION AND IMPLICATIONS: People with dementia are overlooked in LTCI policy which may result from difficulties in implementing dementia-related assessment criteria, and hampered service delivery due to a shortage of skilled caregivers. These issues need to be carefully considered before scaling up the coverage of LTCI policy nationwide.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1646"},"PeriodicalIF":2.7,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142880913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"You go an extra mile\": a qualitative study of community health worker perspectives in a health promotion intervention in urban South Africa.","authors":"Catherine E Draper, Larske Soepnel, Khuthala Mabetha, Molebogeng Motlhatlhedi, Nokuthula Nkosi, Stephen J Lye, Shane A Norris","doi":"10.1186/s12913-024-12127-0","DOIUrl":"https://doi.org/10.1186/s12913-024-12127-0","url":null,"abstract":"<p><strong>Background: </strong>As part of the Healthy Life Trajectories Initiative in South Africa, the Bukhali health promotion intervention is being implemented by community health workers (CHW's) with young women in urban Soweto. The perspectives of these CHW's have not been fully explored.</p><p><strong>Methods: </strong>A qualitative study was conducted to describe CHW's perspectives and experiences of delivering the Bukhali intervention. Three focus groups were conducted with the 13 CHWs employed at the time of the study, and a thematic approach was taken to data analysis.</p><p><strong>Results: </strong>Themes identified included: contextual realities for participants and CHWs, building relationships with participants, workload, emotional toll, and learning and development. Since they are recruited from Soweto, CHWs experienced similar contextual challenges to participants, and have to manage multiple roles, including health promotion and education, referral and support within the health system, counselling (although out of their scope of work), and data recording. The findings indicate the critical role CHWs play in building relationships with participants, especially establishing trust. Many CHWs spoke about going beyond what was expected in their role, which sometimes involved taking participants to medical facilities, and sharing resources with their participants. They spoke about the emotional toll of managing these relationships, their workload, and particularly the need for resilience and boundaries. CHWs experienced learning and development in their role as positive.</p><p><strong>Conclusions: </strong>These findings provide a voice for these CHWs, but they also offer important learning of the implementation of the Bukhali intervention within the context of Soweto, as well as, future potential scale-up of CHW-delivered interventions in South Africa and other low- and middle-income countries.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1641"},"PeriodicalIF":2.7,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis on equity of health service utilization and influencing factors in patients with hypertension in China: a longitudinal study.","authors":"Xiaoqian Yang, Chunmei Lin, Jiangmei Qin, Yanchun Zhang, Lifang Zhang","doi":"10.1186/s12913-024-11839-7","DOIUrl":"https://doi.org/10.1186/s12913-024-11839-7","url":null,"abstract":"<p><strong>Background: </strong>Hypertension has become a major public health and social problem endangering the health of Chinese residents, and has brought a large economic burden of diseases to families and even the whole society. Promoting the equity of health service utilization for patients with hypertension is of great significance for reducing the occurrence of cardiovascular and cerebrovascular diseases and reducing the economic burden of patients with hypertension. This study aims to analyze the equity and change of outpatient and inpatient service utilization in patients with hypertension, and to explore its influencing factors.</p><p><strong>Methods: </strong>Using the data of Household Health Interview Survey from 34 key points of contact for comprehensive healthcare reform in 17 provinces in 2014 and 2016, the equity and change of outpatient and inpatient service utilization of patients with hypertension were analyzed by concentration index, and the contribution degree of each influencing factor to utilization inequality was analyzed by decomposition of concentration index.</p><p><strong>Results: </strong>In 2014 and 2016, the standardized concentration index of two-week visits of hypertension patients was 0.0217 and 0.0141, respectively, indicating that the utilization of outpatient services was basically equitable. The standardized concentration index of times of hospitalization was 0.1593 and 0.1364, and the standardized concentration index of hospital length of stay was 0.1517 and 0.1369, respectively. The rich groups utilized more hospitalization services. Compared with 2014, the concentration index of outpatient and inpatient service utilization of patients with hypertension decreased in 2016, indicating that the inequity of outpatient and inpatient service utilization has further improved. The level of family income was the primary factor affecting the inequality of hospitalization utilization.</p><p><strong>Conclusions: </strong>The utilization of outpatient services in patients with hypertension was basically equitable; however, wealthier groups had greater utilization of inpatient services. Overall, the degree of inequity has been reduced. Family economic status was the main factor affecting inequality in utilization of medical services. To achieve common prosperity was the most fundamental measure to improve the inequitable utilization of hospitalization services. At this stage, we should improve the medical assistance system and increase the assistance to vulnerable groups, such as the low-income groups.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1644"},"PeriodicalIF":2.7,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol of randomized-controlled trial to examine the effectiveness of three different interventions to reduce healthcare provider burnout.","authors":"Catalina Ruple, John Brodhead, Lila Rabinovich, Doerte U Junghaenel, Tiffany Nakamura, Jonathan Wong, Sophia De-Oliveira, Joan Brown, Phuong Nguyen, Jenny Horn, Renee Middleton, Michelle Brahe, Cheng Wen, Sujeet Rao, Caroline Nguyen, Gil Shlamovitz, Dara Marino, Felipe Osorno, Steven Siegel","doi":"10.1186/s12913-024-12131-4","DOIUrl":"https://doi.org/10.1186/s12913-024-12131-4","url":null,"abstract":"<p><strong>Background: </strong>Burnout is among the greatest challenges facing healthcare today. Healthcare providers have been found to experience burnout at significant rates, with COVID-19 exacerbating the challenge. Burnout in the healthcare setting has been associated with decreases in job satisfaction, productivity, professionalism, quality of care, and patient satisfaction, as well as increases in career choice regret, intent to leave, and patient safety incidents. In this context, there is a growing need to reduce provider burnout through targeted interventions, yet little is known about what types of interventions may be most effective. The present study aims to contribute to and extend prior literature by using rigorous randomized controlled trial (RCT) methodology with a parallel group design to examine the effectiveness of different interventions in decreasing mental distress, increasing self-efficacy and attenuating inefficiencies and dissatisfiers in the work environment to achieve sustainable improvement.'</p><p><strong>Methods: </strong>The present study is an ongoing randomized controlled trial (RCT) that examines the effectiveness of three different types of interventions to reduce provider burnout: an intervention targeting emotional wellbeing and resilience, Electronic Health Record (EHR) skills training, and performance improvement training, relative to a no-treatment control group. This study aims to enroll a total of 400 healthcare providers in a large urban hospital system. Outcomes will be assessed at post-treatment and 6-month follow-up. Key outcomes include burnout, emotional health, intent to leave, EHR mastery, and confidence in performance improvement. Changes in outcome measurements from baseline to post-intervention across the intervention and control groups will be conducted using linear mixed-effects models (LMM).</p><p><strong>Discussion: </strong>This study is novel in that it compares several interventions addressing both personal as well as system-level drivers of provider burnout that have been theorized to operate among healthcare providers. In addition, post-treatment and longer-term follow-up assessments will provide insight into the maintenance of effects. Another innovation is the inclusion of different types of patient-facing providers in the study population (doctors, nurses, and therapists).</p><p><strong>Trial registration: </strong>This study was registered at ClinicalTrials.gov (NCT05780892) on March 10th, 2023.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1643"},"PeriodicalIF":2.7,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142880887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Creating effective teams and valuing patient-centered care to change culture and improve equity on labor and delivery: a qualitative study.","authors":"Emily White Vangompel, Shelly Verma, Caroline Wator, Francesca Carlock, Audrey Lyndon, Ann Borders, Jane Holl","doi":"10.1186/s12913-024-12108-3","DOIUrl":"https://doi.org/10.1186/s12913-024-12108-3","url":null,"abstract":"<p><strong>Background: </strong>Efforts to reduce cesarean birth overuse have had varied success. De-implementation strategies that incorporate change to organizational characteristics (i.e. culture) can improve adoption and sustainability. This study aimed to identify culture change strategies used by hospitals that achieved significant and sustained cesarean reduction and eliminated racial disparities in cesarean birth.</p><p><strong>Methods: </strong>Hospitals in California and Florida that (1) engaged in quality initiatives to reduce cesarean births; (2) demonstrated at least a 5% cesarean birth reduction; and (3) sustained the reduction for 18 months after participation were invited to participate. Hospitals that reduced also cesarean racial disparity were prioritized for recruitment. Qualitative, semi-structured interviews were performed with leaders, obstetricians, family physicians, midwives, and nurses providing intrapartum care. Reflexive thematic analysis and values coding were used.</p><p><strong>Results: </strong>35 participants from 6 hospitals (3 in California, 3 in Florida) participated in interviews or focus groups. Nurse-focused strategies included: leadership demonstrating support for proactive labor support (e.g., Spinning Babies, comfort measures, nursing time at bedside); enhanced communication through inter-disciplinary team huddles; clear delineation of roles; and a chain of command that assured nurses could advocate for their patients freely and without retribution. Physician-focused strategies included regular and publicly visible feedback delivered by trusted messengers, drawing attention to successful vaginal births, and highlighting the contributions of labor support. A theme of hiring/retaining for \"fit\" was articulated at all hospitals, most notably, the hospital that eliminated their cesarean birth racial disparity, where \"fit\" was conceptualized as empathy, humanism, and a desire to meet community needs.</p><p><strong>Conclusions: </strong>This study identified specific de-implementation strategies for hospitals to change implementation context, namely culture, to achieve and sustain reduction of cesarean birth. Hospitals looking to sustain culture change should adapt strategies to align with existing clinician values, change attitudes through sharing successful vaginal births, and modify beliefs through education from trusted messengers. Strategies to reduce racial disparities should emphasize designing teams that are aware of and prioritize community needs, including hiring staff from the local community, and partnering with community-based organizations.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1645"},"PeriodicalIF":2.7,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142880951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social interaction of people living with dementia in residential long-term care: an ecological momentary assessment study.","authors":"Doris Gebhard, Leonie Lang, Marco J Maier, Martin N Dichter","doi":"10.1186/s12913-024-12056-y","DOIUrl":"https://doi.org/10.1186/s12913-024-12056-y","url":null,"abstract":"<p><strong>Background: </strong>The importance of social health is increasingly recognized in dementia research. For most people living with dementia, their social environment changes as the disease progresses, especially when they move into a long-term care facility. However, maintaining social interactions in the new living environment contributes significantly to health and quality of life. Staff and other residents are the most readily available interaction partners to provide this. The aim of this study is to investigate the frequency, contexts, partners and influencing factors (personal and contextual) of social interactions of people living with dementia in residential long-term care.</p><p><strong>Methods: </strong>Participants were observed for two days in 20-min slots (from 7 am to 7 pm) in 12 long-term care facilities in Germany. The Maastricht Electronic Daily Live Observation Tool (MEDLO-tool) was used for ecological momentary assessment. Age, gender, functional status, cognitive status and length of stay at the facility were recorded. Generalized linear mixed-effect models were used for the data analysis.</p><p><strong>Results: </strong>In all, 106 people living with dementia (average age: 85.16 ± 7.42 years, 82.9% female) were observed at 6134 time points. No social interaction take place in 71.9% of the observations. The place where the participants spend their time influences the occurrence of social interaction (p < 0.001), with a significantly higher probability of social interaction in communal spaces. Most frequently, interaction takes place with staff (43.4%), closely followed by other residents (40.9%), with the context (location, p < 0.001; time of day, p < 0.001) and functional status (care level, p < 0.001) influencing which of the two groups people living with dementia interact with.</p><p><strong>Conclusion: </strong>A better understanding of the context of social interactions and its influencing factors provide a basis for more targeted interventions. As the increasing staff shortage will further limit the opportunities for social interaction with staff, future concepts should focus on other residents. Meaningful activities that enable people living with dementia to co-operate and share responsibility can provide a stimulating framework for this. In addition, social assistance robots and the application of peer-mentoring/leading represent promising approaches for creating a socially interactive environment.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1640"},"PeriodicalIF":2.7,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142880975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A methodological research for development and psychometric properties of a new Measure to Assess Health Literate Organization (MAHLO-76) in hospital settings.","authors":"Bahrambeygi Fatemeh, Rakhshanderou Sakineh, Ghaffari Mohtasham","doi":"10.1186/s12913-024-12130-5","DOIUrl":"https://doi.org/10.1186/s12913-024-12130-5","url":null,"abstract":"<p><strong>Background: </strong>Toward delivering appropriately safe, high quality and effective health care, healthcare organization should be health literate. This paper presents the development and psychometrics of an instrument for assessing the attributes of a health literate hospital which is called MAHLO-76 (Measure to Assess Health Literate Organization) here by authors.</p><p><strong>Methods: </strong>The current study is methodological research which is involved two phases of tool development and psychometric evaluation. MAHLO primary item pool was prepared using the data extracted from the semi-structured, in-depth interviews and literature review. The face and content validity were evaluated applying qualitative and quantitative approaches. Exploratory factor analysis with varimax rotation after Bartlett sphericity and KMO tests was used to evaluate the construct validity. Confirmatory factor analysis was conducted to evaluate the structural factors, applying the most common goodness-of-fit indices. In order to determine internal consistency and test-retest stability, Cronbach's alpha and intra-class correlation coefficient were calculated respectively.</p><p><strong>Results: </strong>The initial tool after checking for duplicates and excluding was contained 79 items. In terms of face validity, 3 items were modified using qualitative method and none of the items had an impact score of less than 1.5. In the qualitative content validity assessment, 16 items were revised and none of the items had CVR score less than 0.59 and CVI score less than 0.79. The results of the EFA obtained from the KMO showed the adequacy of the sample size (KMO value = 0.884) and the Bartlett's sphericity test showed a significant correlation between the items (χ2 = 38124.040, df = 3081, P < 0.0001). The exploratory factor analysis indicated that 14 initially extracted factors explained 63.716% of the total variance. In Confirmatory factor analysis, the chi-square was 205.016 and other model fit indices including NFI:0.812, NNFI:0.875, CFI:0.919, IFI:0.921, MFI:0.857, GFI:0.930, AGFI:0.918, RMR:0.051, RMSEA:0.06 were calculated. In reliability assessment, Cronbach's alpha was 0.94 and the value of ICC was 0.98.</p><p><strong>Conclusion: </strong>Measure to Assess Health Literate Organization (MAHLO-76) is a valid and reliable instrument that can be used as assessment as well as self-assessment tool in hospital settings. Its application could disclosure those organizational health literacy aspects in clinical environments that need necessary interventions.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1642"},"PeriodicalIF":2.7,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}