BMC Health Services Research最新文献

{"title":"Factors affecting the retention of healthcare assistants in English mental health services: a qualitative interview study.","authors":"Michaela Senek, Jaqui Long, Sally Ohlsen, Rachael Finn, Scott Weich, Tony Ryan, Emily Wood","doi":"10.1186/s12913-025-12665-1","DOIUrl":"10.1186/s12913-025-12665-1","url":null,"abstract":"<p><strong>Background: </strong>In the UK, healthcare assistants (HCAs) work alongside registered nurses and other clinicians to provide frontline clinical care. HCAs provide a considerable amount of essential direct patient care which, dependent on the setting, can include monitoring of temperature, pulse, respirations and ECGs, support with daily activities, emotional support and facilitating communication with other health professionals. In 2019, the leaver rate of HCAs and support workers in the UK was 13.4%. In many Trusts this was higher than the leaving rate for nurses. The aim of this study was to explore HCAs' experiences and their perceptions of the reasons for poor retention rates.</p><p><strong>Methods: </strong>We recruited HCAs from three English mental health Trusts. Recruitment information was circulated using a variety of approaches. 31 participants took part in semi-structured interviews. We explored the factors they considered to affect HCAs' decision to leave their role, and any differences they perceived with registered staff. Interviews were coded and analysed using the framework generated in a previous phase of the study which focused on retention of registered mental health professionals.</p><p><strong>Findings: </strong>Three key factors impacted HCAs job satisfaction, wellbeing, and motivation to remain in post: (1) high workloads and unclear role boundaries creating stress and concerns for patient care; (2) good relationships with line managers and colleagues providing essential support to cope with both work and personal challenges; (3) feeling undervalued by the wider organisation, with a lack of investment including pay, facilities, and opportunities for development. These factors combined to create a situation of high stress and low job satisfaction, with many HCAs expressing an intention or desire to leave, particularly when the pay is similar to much less demanding jobs in other sectors.</p><p><strong>Conclusions: </strong>HCAs are a diverse group but many reported job dissatisfaction and feeling undervalued by the organisations they work for, with some struggling to cope with the cost-of-living crisis. Improved role boundaries, career pathways, and appreciation of the role such as reward and recognition schemes, could help retain this key staff group who provide a large proportion of essential patient care.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"505"},"PeriodicalIF":2.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators and barriers to implementation of early intensive manual therapies for young children with cerebral palsy across Canada.","authors":"Divya Vurrabindi, Alicia J Hilderley, Adam Kirton, John Andersen, Christine Cassidy, Shauna Kingsnorth, Sarah Munce, Brenda Agnew, Liz Cambridge, Mia Herrero, Eleanor Leverington, Susan McCoy, Victoria Micek, Keith O Connor, Kathleen O' Grady, Sandra Reist-Asencio, Chelsea Tao, Stephen Tao, Darcy Fehlings","doi":"10.1186/s12913-025-12621-z","DOIUrl":"10.1186/s12913-025-12621-z","url":null,"abstract":"<p><strong>Background: </strong>Cerebral Palsy (CP) is the most common childhood-onset motor disability. Play-based early intensive manual therapies (EIMT) is an evidence-based practice to improve long-term hand function particularly for children with asymmetric hand use due to CP. For children under two years old, this therapy is often delivered by caregivers who are coached by occupational therapists (OTs). However, why only a few Canadian sites implement this therapy is unclear. There is a need to identify strategies to support implementation of EIMT. The primary objective of this study was to identify the facilitators and barriers to EIMT implementation from the perspectives of (1) caregivers of children with CP (2), OTs and (3) healthcare administrators for paediatric therapy programs.</p><p><strong>Methods: </strong>The Consolidated Framework for Implementation Research (CFIR) was used to guide development of an online 5-point Likert scale survey to identify facilitators (scores of 4 and 5) and barriers (scores of 1 and 2) to implementation of EIMT. Three survey versions were co-designed with knowledge user partners for distribution to caregivers, OTs, and healthcare administrators across Canada. The five most frequently endorsed facilitators and barriers were identified for each respondent group.</p><p><strong>Results: </strong>Fifteen caregivers, 54 OTs, and 11 healthcare administrators from ten Canadian provinces and one territory participated in the survey. The majority of the identified facilitators and barriers were within the 'Inner Setting' CFIR domain, with 'Structural Characteristics' emerging as the most reported CFIR construct. Based on the categorization of the most frequently endorsed facilitators and barriers within the CFIR domains, the key facilitators to EIMT implementation included the characteristics of the intervention and establishing positive workplace relationships and culture. The key barriers included having workplace restrictions on EIMT delivery models and external influences (e.g., funding) on EIMT uptake.</p><p><strong>Conclusions: </strong>We identified key facilitators and barriers to implementing EIMT from a multi-level Canadian context. These findings will inform the next steps of designing evidence-informed and theory-driven implementation strategies to support increased delivery of EIMT for children under two years old with asymmetric hand use due to CP across Canada.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"503"},"PeriodicalIF":2.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does a waiting room increase same-day treatment for sexually transmitted infections among pregnant women? A quality improvement study at South African primary healthcare facilities.","authors":"Ranjana M S Gigi, Mandisa M Mdingi, Lukas Bütikofer, Chibuzor M Babalola, Jeffrey D Klausner, Andrew Medina-Marino, Christina A Muzny, Christopher M Taylor, Janneke H H M van de Wijgert, Remco P H Peters, Nicola Low","doi":"10.1186/s12913-025-12607-x","DOIUrl":"10.1186/s12913-025-12607-x","url":null,"abstract":"<p><strong>Background: </strong>Same-day testing and treatment of curable sexually transmitted infections (STI) is a strategy to reduce infection duration and onward transmission. South African primary healthcare facilities often lack sufficient waiting spaces. This study aimed to assess the proportion of, and factors influencing, pregnant women waiting for on-site STI test results before and after the installation of clinic-based waiting rooms.</p><p><strong>Methods: </strong>We conducted an observational quality improvement study at 5 public primary healthcare facilities in South Africa from March 2021 to May 2023. The intervention was the installation of a waiting room in two clinics. Three clinics were used as comparators: two already had a waiting room in an existing building and one had access to a shared waiting area. The outcome was the percentage of women who waited for their STI test results. We conducted univariable and multivariable analyses and report marginal risk differences (with 95% confidence intervals, CI) of the proportions of women who waited for results. A subset of women answered structured questions about factors influencing their decision to wait for results.</p><p><strong>Results: </strong>We analysed data from 624 women across the 5 facilities. Overall, 36% (95% CI 31 to 40) waited for their test results (range 7 to 89%). In the two intervention clinics, 17% (95% CI 11 to 24) waited for results before the introduction of a waiting room and 10% (95% CI 5 to 18) after (crude absolute difference - 7% (95% CI -16 to + 3), adjusted difference, -6% (95% CI -17 to + 5)). The percentages of pregnant women waiting for STI test results were higher throughout the study period in 2 clinics which always had a dedicated waiting room than in 2 clinics where a waiting room was installed, or in 1 clinic, which only had access to a shared waiting area. Most women reported before testing that they did not intend to wait and none of the suggested factors would change their decision.</p><p><strong>Conclusions: </strong>Introduction of a waiting room did not increase the proportion of women who waited for their results in this observational study. Future studies should investigate infrastructure, individual and test-based factors that affect same-day STI testing and treatment.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"501"},"PeriodicalIF":2.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond compliance: examining the completeness and determinants of WHO surgical safety checklist - a systematic review and meta-analysis.","authors":"Tesfaye Engdaw Habtie, Sefineh Fenta Feleke, Aregash Birhan Terefe, Molalign Aligaz Adisu","doi":"10.1186/s12913-025-12569-0","DOIUrl":"10.1186/s12913-025-12569-0","url":null,"abstract":"<p><p>The aim of this systematic review and meta-analysis was to assess the compliance, completeness, and key barriers to the successful initiation and implementation of checklists in surgical theaters.Methods This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure the accuracy and reliability of the included studies. The protocol was registered in PROSPERO (CRD42024589344).Results The review included 13 observational studies conducted globally, encompassing a total of 17,867 participants. The overall compliance rate with the World Health Organization Surgical Safety Checklist was 73% (95% CI: 62-85%). Compliance rates for individual components were 76% for \"Sign In,\" 61% for \"Time Out,\" and 62% for \"Sign Out.\" The overall completeness of checklist implementation was 51%. Factors that improve compliance rate include prior Surgical Safety Checklist exposure, training, a positive work environment, management support, and regular monitoring with feedback. Conversely, barriers such as insufficient staffing, high workloads, lack of checklist ownership, resistance to change, weak audit systems, and rapid staff turnover hinder effective implementation and compliance.Conclusion Despite the importance of Surgical Safety Checklist in improving healthcare outcomes, its overall compliance rate across healthcare settings remains suboptimal, with a notably low completeness rate. This highlights the frequent omission or inconsistent application of critical checklist components. Maximizing the checklist's full potential requires continuous efforts, including sustained support, regular audit, and strong commitment from all stakeholders.Recommendation Policymakers, healthcare administrators, and surgical teams must work together to integrate the checklist into routine workflows, ensure continuous monitoring and support, and foster a culture of safety to improve patient outcomes.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"504"},"PeriodicalIF":2.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing digital readiness and capability in healthcare: a systematic review of interventions, barriers, and facilitators.","authors":"Norah Alotaibi, Christine Brown Wilson, Marian Traynor","doi":"10.1186/s12913-025-12663-3","DOIUrl":"10.1186/s12913-025-12663-3","url":null,"abstract":"<p><strong>Introduction: </strong>The rapid integration of digital technologies in healthcare requires healthcare professionals to be digitally ready and capable. This systematic review aims to identify interventions that improve digital readiness and capability among health professionals and to understand the barriers and facilitators they encounter during this digital transformation.</p><p><strong>Methodology: </strong>A mixed-methods systematic review was conducted following the Joanna Briggs Institute (JBI) guidelines. We searched five databases CINAHL Plus, MEDLINE, EMBASE, PsychINFO, and Web of Science. The review used the Unified Theory of Acceptance and Use of Technology (UTAUT) framework to investigate factors influencing technology adoption. Studies were selected based on predefined inclusion and exclusion criteria, focusing on health professionals' digital capability in healthcare settings. Quality assessment was performed using the MMAT checklist, and data were analysed and synthesized to extract relevant themes and sub-themes.</p><p><strong>Results: </strong>Initially, 1140 studies were identified, with 21 meeting the inclusion criteria after screening. These studies, published between 2017 and 2023.The results were categorized into four main themes: Performance Expectancy, Effort Expectancy, Facilitating Conditions, and Social Influence, with two sub-themes. The studies indicated that technology positively impacts job performance, facilitating acceptance among healthcare professionals. Ease of use was crucial for technology acceptance, while complexity and multiple logins were significant barriers. The importance of sufficient training and organizational support was highlighted to enhance digital competency and address technical issues, with inadequate training and infrastructure being major barriers. Social influence, including motivation of healthcare workers and shared decision-making, played a significant role in technology acceptance.</p><p><strong>Conclusion: </strong>This review highlights critical factors influencing the digital readiness and capability of healthcare professionals. Interventions enhancing performance expectancy, addressing effort expectancy, improving facilitating conditions, and leveraging social influence are essential for successful digital health adoption. Future research should develop comprehensive frameworks to overcome barriers and promote digital health readiness. Integrating specialized training into educational programs is crucial for preparing healthcare professionals to navigate the evolving digital landscape.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"500"},"PeriodicalIF":2.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which questionnaires can be used to elicit patients' preferences regarding patient-provider consultations? Results of a scoping review.","authors":"Alina Zoe Bambas, Diana Wahidie, Yüce Yilmaz-Aslan, Patrick Brzoska, Claudia Kiessling","doi":"10.1186/s12913-025-12567-2","DOIUrl":"10.1186/s12913-025-12567-2","url":null,"abstract":"<p><strong>Objective: </strong>Active patient involvement and attention to patient preferences in patient-provider consultations are increasingly recognized as essential to improve patient satisfaction and outcomes. Aim of the review was to provide an overview of questionnaires that measure patient preferences regarding communication, information provision and involvement in decision-making in patient-provider consultations.</p><p><strong>Methods: </strong>Inclusion criteria were studies that provided primary data, were published in German or English, and included adult patients. The systematic search was conducted in PubMed and PsycInfo. Data extraction and summary focused on information about the development process, topic and structure, and reliability of instruments.</p><p><strong>Results: </strong>Of 6,667 abstracts screened, 34 articles were included, describing 37 different instruments, often originating from an Anglo-American context. Twelve articles reported patient involvement in the development process. Majority of questionnaires measures aspects of information and/or decision-making preferences. Fewer instruments focus on patient-centeredness or communication preferences. Length of questionnaires varied from one to 80 items. Only 15 studies reported reliability indices.</p><p><strong>Conclusion: </strong>Due to the heterogeneous description, a more consistent reporting of data would be desirable for future publications as well as more participatory research.</p><p><strong>Practice implications: </strong>Although there is a wide range of questionnaires available, more research is needed to determine the extent to which they can be used in everyday clinical practice to elicit preferences from individual patients with a wide range of conditions and cultural backgrounds.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"502"},"PeriodicalIF":2.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life, death, and ethics: medical and dental students' attitudes on assisted dying in Austria.","authors":"Carmen Trost, Julia S Grundnig, Marlen A Roehe, Anahit Anvari-Pirsch, Anita Holzinger","doi":"10.1186/s12913-025-12608-w","DOIUrl":"10.1186/s12913-025-12608-w","url":null,"abstract":"<p><strong>Background: </strong>The Sterbeverfügungsgesetz (StVfG) Austria's law on assisted dying, came into force on January 1, 2022. Since then, only limited research has examined the attitudes of medical and dental students in Austria toward assisted dying. To address this gap, a survey was conducted among medical and dental students at the Medical University of Vienna, as they represent potential future opinion leaders. Understanding their perspectives is essential for the effective implementation and future development of assisted dying within the public healthcare system.</p><p><strong>Methods: </strong>An online survey was conducted between May and June 2023. The questionnaire included two open-ended questions designed to capture medical and dental students' personal reasons for and against assisted dying. Responses were analyzed using Mayring's qualitative content analysis and categorized into micro (individual), meso (institutional) and macro (societal) levels.</p><p><strong>Results: </strong>Of 5526 eligible students, 337 responded (response rate 6.1%). Key arguments in favor of assisted dying included subjective considerations like autonomy, relief of suffering, and dying with dignity. Main counterarguments highlighted societal concerns such as potential misuse (e.g., inheritance fraud or murder), legal uncertainties, and financial reasons. Less focus was given to immediate social impacts like the psychological burden on medical staff.</p><p><strong>Conclusions: </strong>The diverse perspectives reflect a spectrum of ethical and practical considerations. Incorporating assisted dying, along with its ethical and legal issues, into the medical curriculum is essential for fostering a comprehensive understanding. Moreover, ongoing debates indicate the need for a thorough review of the legal framework to address loopholes and consider potential revisions.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"499"},"PeriodicalIF":2.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a national Distress Brief Intervention: a multi-agency service to provide connected, compassionate support for people in distress.","authors":"Ambrose J Melson, Karen Wetherall, Kevin O'Neill, Margaret Maxwell, Eileen Calveley, Martin McCoy, Rory C O'Connor","doi":"10.1186/s12913-025-12469-3","DOIUrl":"10.1186/s12913-025-12469-3","url":null,"abstract":"<p><strong>Background: </strong>Mental health problems, self-harm and suicide are major public health concerns. Following national strategic commitments to improve the response and follow-up support for adults in Scotland presenting to frontline services in emotional distress, this study describes the development of the first national Distress Brief Intervention, a multi-agency service to provide connected, compassionate support for people in distress.</p><p><strong>Methods: </strong>The six step Intervention Mapping protocol was used to account for the complexity of the intervention and to guide development, testing and implementation. Data/information sources comprised: literature and evidence review; delivery partner and stakeholder consultations (n = 19); semi-structured interviews and/or focus-groups with frontline services staff experienced in responding to distress (n = 8); interviews and/or focus groups with adults with experience of distress (n = 9); feedback from test training for staff (n = 16); self-assessed confidence ratings provided by staff immediately before and following training (n = 388).</p><p><strong>Results: </strong>We developed a time-limited, two-level, complex intervention for adults experiencing emotional distress, provided by 'frontline' statutory services (primary and acute healthcare, police, ambulance) and third-sector community organisations in Scotland. Intervention components included competency-based training programmes for staff, information, protocols and guidance for providers, personalised distress management planning and behaviour change tools. During the development phase, 525 intervention providers (n = 472 frontline statutory service staff; n = 53 third-sector community organisation staff) completed training programmes in four pilot areas in Scotland. Training evaluations from 388 providers (74%) indicated significantly greater confidence following training on key competencies.</p><p><strong>Conclusions: </strong>A multi-agency national Distress Brief Intervention was systematically developed and implemented in a range of non-specialist frontline and community settings in Scotland. Up-take of training and evaluations of training indicate it is highly acceptable to potential providers and improves key competencies. Following independent evaluation, the Distress Brief Intervention has been rolled out nationally across the whole of Scotland, and has significant potential as a model of care and prevention internationally, including countries with low statutory health resources.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"478"},"PeriodicalIF":2.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in level of education and area of residence of users of a mobile app to support treatment of urinary incontinence.","authors":"Ina Asklund, Stina Åhman, Anna Lindam, Eva Samuelsson","doi":"10.1186/s12913-025-12632-w","DOIUrl":"10.1186/s12913-025-12632-w","url":null,"abstract":"<p><strong>Background: </strong>Between 25% and 45% of women experience urinary incontinence. The Tät^® app is intended to treat stress urinary incontinence in women, and has been evaluated for efficacy and effectiveness. The level of usage of digital healthcare differs depending on demographics, and this might lead to unequal access to healthcare. This study aims to analyse the change in level of education and area of residence of users of the Tät app over time, and compare this with overall demographic data for Sweden.</p><p><strong>Methods: </strong>When the app was downloaded, the user was invited to respond anonymously to a questionnaire. We included women aged 18-89 years living in Sweden. We weighted the app data to reflect the age distribution of the general female population of Sweden. We then compared the users' level of education and area of residence with data from Statistics Sweden.</p><p><strong>Results: </strong>The study encompassed 153,819 users between 2016 and 2021. The percentage of Tät users with university education decreased from 63.14% (95% CI 62.16-64.11) to 61.07% (95% CI 60.53-61.61), and the percentage of users with fewer than 7 years of education increased from 0.02% (95% CI 0.006-0.077) to 1.94% (95% CI 1.80-2.10). In contrast to this, the Statistics Sweden data comparing 2016 with 2020, showed an increase in the category \"university or higher education institution\" from 38.94 to 42.10% and a decrease in the other categories. Comparing Tät users' area of residence between 2018 and 2021 showed an increase in the amount of users living in rural areas from 16.90% (95% CI 16.44-17.37) to 20.53% (95% CI 20.08-20.98). Data from Statistics Sweden did not show any significant change, and in 2020 6.23% of women in Sweden lived in rural areas.</p><p><strong>Conclusions: </strong>The proportion of Tät users in both the highest and the lowest educational categories had changed to be more like the overall Swedish female population. The proportion of Tät users living in rural areas had increased and was considerably larger than for the population in general. We thus see positive trends in the distribution of users, although users with a university education are still over-represented.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"498"},"PeriodicalIF":2.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the unique goals of complex support clients accessing alcohol and other drug treatment.","authors":"Emily Deans, Wing See Yuen, George Economidis, Anthony Shakeshaft, Sara Farnbach","doi":"10.1186/s12913-025-12559-2","DOIUrl":"10.1186/s12913-025-12559-2","url":null,"abstract":"<p><strong>Background: </strong>Actively involving clients of Alcohol and Other Drug (AOD) services in selecting their own treatment goals may help to align clients' and service providers' expectations of treatment and improve engagement with services. This study explored the type and frequency of client-selected treatment goals; self-reported progress towards their goals; client and clinician views of their progress, and the acceptability of selecting and tracking goals in a non-residential AOD treatment provider in New South Wales, Australia.</p><p><strong>Methods: </strong>A mixed method study was conducted. Clients selected their goals during AOD treatment then self-rated their progress towards goals using the validated 11-point goal-based outcome (GBO) rating tool. Qualitative interviews were conducted with clients and clinicians. Mean GBO ratings were reported for each timepoint. Goals were thematically analysed to identify type, then descriptively analysed to identify frequency. Interviews were thematically analysed by one researcher and reviewed by a second.</p><p><strong>Results: </strong>Among the 22 clients who completed the GBO at least once, the median number of self-identified goals was 3. The most common goals included: (1) managing mental health and (2) developing strategies to prevent relapse and manage AOD cravings. Most participants reported improvements in their selected goals; there were no participants who reported lower GBO scores at the second timepoint compared to the first. Qualitative themes demonstrate that while the GBO approach provided clarity for clients, was acceptable to clients and clinicians, and considered client expectations of treatment, the approach was difficult for those with limited literacy and reflexive thinking. Those experiencing lapse or relapse reported the linear GBO rating approach was potentially demotivating.</p><p><strong>Conclusions: </strong>Findings demonstrate that a goals-based outcome approach can promote shared decision-making between client and clinicians about treatment goals which are valued by clients. Service providers should be aware of potential complexity of recalling selected goals and completing ratings particularly among clients with co-occurring mental illness and memory impairment. Goals that are time-specific, realistic and relevant should be prioritised to minimise risks of demotivation arising from non-linear progress towards goals.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"494"},"PeriodicalIF":2.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}