BMC Health Services Research最新文献

{"title":"Strengthening the WHO Emergency Care Systems Framework: insights from an integrated, patient-centered approach in the Copenhagen Emergency Medical Services system-a qualitative system analysis.","authors":"Simone Böbel, Jeske Verhoeven, Mirjam Scholz, Bart Penders, Lorraine Frisina Doetter, Helle Collatz Christensen, Thomas Krafft","doi":"10.1186/s12913-025-12465-7","DOIUrl":"10.1186/s12913-025-12465-7","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization Emergency Care Systems Framework (WHO ECSF) was designed to offer guidance in establishing and developing effective Emergency Medical Services (EMS) systems. However, evolving disease patterns, changing community needs, and a rising demand for emergency care services, highlight the need for more integrated and patient-centered EMS systems. This evolution should be mirrored in the WHO ECSF. Hence, this study explores system components of the Copenhagen (CPH) EMS that may enhance the WHO ECSF´s emphasis on integrated and patient-centered care.</p><p><strong>Methods: </strong>A qualitative case study was conducted from April through June 2021, including (i) semi-structured interviews with researchers and professionals at the CPH EMS and (ii) a scoping literature review using PubMed, Google Scholar, expert recommendations and snowballing.</p><p><strong>Results: </strong>Thirteen expert interviews and 35 records were analyzed, revealing key integrated care components within the CPH EMS. These include education and citizen participation programs, early triaging, differentiated care pathways coordinated with primary care and out-of-hours services, and specialized mobile care units complementing \"traditional\" ambulance services. Technology supports integrated and patient-centered care by facilitating early differentiation of care, efficient dispatching, and communication. Data-driven approaches were fostered through technology-aided data collection, supporting research, quality improvement, and patient safety. The identified components were mapped within the WHO ECSF´s four domains: scene, transport, facility, and cross-cutting elements. Due to the prehospital focus of the CPH EMS, limited data was available for the \"facility\" site.</p><p><strong>Conclusions: </strong>The CPH EMS demonstrates an integrated, patient-centered systems approach that emphasizes seamless coordination along the patient care pathway, bridging EMS with broader health and social systems. Research-informed initiatives and intelligent technology solutions underscore the potential for enhancing the WHO ECSF. These findings highlight the importance of continued system integration and a holistic health perspective, including in emergency settings. Further research is needed to assess the transferability of these components across diverse global contexts.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"401"},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655774","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":"Workplace violence experiences of intensive care unit healthcare providers: a qualitative systematic review and meta--synthesis.","authors":"Jingyi Wang, Mao Liu, Hongling Zheng, Mingfang Xiang","doi":"10.1186/s12913-025-12446-w","DOIUrl":"10.1186/s12913-025-12446-w","url":null,"abstract":"<p><strong>Objective: </strong>Workplace violence (WPV) in intensive care units (ICUs) is a prevalent issue that affects staff well-being and patient care. Although individual studies have explored various facets of WPV, there is a need for a comprehensive synthesis to provide a cohesive understanding of the phenomenon and inform effective interventions. This study aimed to understand its impact on the mental health and work status of ICU staff, identify the coping strategies used by ICU staff to manage WPV and explore the support required by healthcare professionals when facing WPV.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed, Scopus, Medline, PsycINFO, and Web of Science from the date of inception until June 5, 2024. Only qualitative studies or the qualitative part of mixed methods studies were included in the analysis, with no restrictions on the type of ICU or type or source of violence. This study assessed the risk of bias in the included studies and synthesized the results according to the guidelines of the Joanna Briggs Institute (2024).</p><p><strong>Results: </strong>Six studies were included. These studies, which were published between 2018 and 2023, were conducted in four countries and involved 91 participants. Six analytical themes and 17 subthemes emerged from the qualitative data. The themes were as follows: Prevalence of ICUs Violence, ICU healthcare perceptions of WPV, The Ripple Effect of WPV in ICU, Practical Strategies for ICU Staff Dealing with WPV, What they need when facing WPV, and Reasons for Not Reporting WPV.</p><p><strong>Conclusions: </strong>The synthesized findings highlight the pervasive nature of WPV in ICUs and its profound impact on staff members. This review underscores the need for systematic interventions, including comprehensive training, accessible psychological support, and robust reporting mechanisms, to mitigate the effects of WPV.</p><p><strong>Other: </strong>This study was funded by the Wu Jieping Medical Foundation(320.6750.18526),China. The review protocol was prospectively registered in the Prospective Register of PROSPERO (CRD42024559076).</p><p><strong>Relevance to clinical practice: </strong>The research findings can provide important evidence for hospital managers and policymakers, helping them develop more effective workplace management policies to enhance the safety and well-being of ICU staff.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"399"},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11917093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655935","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":"Bridging the gap in sustainable radiography: insights from five countries in Asia and Africa.","authors":"Mohamed Abuzaid, Nora Almuqbil, Christian Ven Emery, Wiam Elshami, Manal Ibham, Naifah Alsubaie, Zuhal Hamd, Mohamed Aljamal","doi":"10.1186/s12913-025-12562-7","DOIUrl":"10.1186/s12913-025-12562-7","url":null,"abstract":"<p><strong>Introduction: </strong>Sustainability in healthcare, particularly in medical imaging, is increasingly important as healthcare operations contribute significantly to global emissions. Radiographers, as integral members of imaging departments, play a vital role in implementing sustainable practices. This study examines radiographers' perceptions, practices, and barriers to sustainability across five countries: the United Arab Emirates, Saudi Arabia, Palestine, Sudan, and Ghana, highlighting regional differences and factors influencing engagement.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among 441 radiographers using an online platform. The survey included questions on demographic information, sustainability perceptions, practices, and barriers. Data were analyzed using descriptive statistics and the Kruskal-Wallis H test to evaluate regional variations in sustainability engagement.</p><p><strong>Results: </strong>Results revealed moderate sustainability knowledge among participants, with 45.1% (n = 199) understanding the concept and 46.7% (n = 206) recognizing its benefits. Common practices included digital documentation (34.6%, n = 289) and daily energy reduction efforts (32.2%, n = 142). However, advanced practices such as recycling residual contrast media or adopting energy-efficient equipment were limited. Key barriers included lack of training (39.2%, n = 173), financial constraints (44.7%, n = 197), and insufficient managerial support (39.2%, n = 173). Regional variations were evident, with Ghana showing the highest engagement across knowledge, attitudes, and practices, while Saudi Arabia scored the lowest. Statistical analysis indicated significant differences in sustainability engagement by region (p < 0.05), with Ghana benefiting from targeted educational initiatives and international collaborations. In contrast, resource limitations and insufficient institutional support hindered progress in other regions.</p><p><strong>Conclusion: </strong>The findings emphasize the need for tailored strategies to promote sustainability in radiography. Recommendations include integrating sustainability into radiography curricula, providing targeted training, enhancing leadership support, and adopting region-specific interventions. Addressing these challenges can empower radiographers to contribute to environmentally sustainable healthcare systems.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"392"},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647026","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":"Nurses' perspectives on the adoption of new smart technologies for patient care: focus group interviews.","authors":"Hyein Choi, Sunghee H Tak, Young Ae Song, Jiyeon Park","doi":"10.1186/s12913-025-12578-z","DOIUrl":"10.1186/s12913-025-12578-z","url":null,"abstract":"<p><strong>Background: </strong>The adoption of smart technologies for patient care is greatly increasing. IoT-based smart mattresses offer features such as automatic body repositioning for pressure ulcer prevention, weight measurement, vital sign tracking, and rapid response to emergencies. This study explores nurses' perspectives on the adoption of smart technologies, with a particular focus on smart mattresses in hospitals.</p><p><strong>Methods: </strong>Focus group interviews were conducted with 17 nurses from intensive care parts, general wards, and COVID-19 designated wards in a tertiary university hospital in South Korea. Data were collected through online meetings and analyzed using thematic analysis.</p><p><strong>Results: </strong>Thematic analysis revealed six major themes and 14 subthemes under three categories. Patient-related perspectives included themes of 'difficulties in meeting patients' care needs' and 'identified areas for technology adoption based on patient care experiences.' Nursing-related perspectives encompassed 'potentials of smart technology for nursing care' and 'increased time and workload due to new device usage.' Technology-related perspectives included 'previous experience with technology devices' and 'expectations for in-development devices.'</p><p><strong>Conclusions: </strong>Nurses generally expressed receptiveness to smart technologies including smart mattresses, recognizing their potential to enhance patient care and nursing efficiency. Perspectives varied by department, highlighting the need for tailored solutions. Prior experiences, both positive and negative, offered important insights for designing devices that are more compatible with clinical practice. Incorporating nurses' feedback and addressing educational needs are critical for successful adoption.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"391"},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11917002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647033","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":"A web-based platform for optimizing healthcare resource allocation and workload management using agile methodology and WISN theory.","authors":"Akash Gajanan Prabhune, P S Karpaga Priya, Rohit Chandra, Ankur Thakur, Viany R Srihari, Sachin S Bhat","doi":"10.1186/s12913-025-12473-7","DOIUrl":"10.1186/s12913-025-12473-7","url":null,"abstract":"<p><strong>Background: </strong>Effective healthcare workforce management is critical for ensuring quality care delivery, particularly in resource-constrained settings. The World Health Organization's (WHO) Workload Indicators of Staffing Need (WISN) methodology provides an evidence-based framework for optimizing staffing levels. However, manual implementation of the WISN methodology is labour-intensive, error-prone, and time-consuming. To address these challenges, the Platform for Resource Allocation and Optimization for Healthcare Facilities (PRAYOJN) platform was developed as a web-based tool to automate WISN calculations, streamline data analysis, and improve workforce planning.</p><p><strong>Objective: </strong>To develop and validate a web-based system that automates the WISN methodology for healthcare workforce planning.</p><p><strong>Methods: </strong>The PRAYOJN platform was developed using an agile methodology, structured over five iterative sprints. These sprints incorporated stakeholder feedback to refine system functionalities, ensuring adaptability to real-world healthcare needs. The platform integrates data for principal, supporting, and ancillary tasks to calculate staffing requirements. Key functionalities include automated computation of Available Work Time (AWT), Standard Workload (SW), Category Allowance Factor (CAF), and Individual Allowance Factor (IAF). Alpha testing validated usability and accuracy, while beta testing in a clinical phlebotomy department assessed real-world performance.</p><p><strong>Results: </strong>The platform calculated an ideal staffing requirement of 15.53 Full-Time Equivalent (FTE) for the phlebotomy department, aligning closely with the current staff strength of 15 FTE. Agile development ensured iterative improvements, enhancing user interface (UI) and user experience (UX). Feedback highlighted the platform's user-friendly design, with dynamic visualizations such as pie charts and bar graphs aiding workload interpretation. Users praised its efficiency, adaptability, and role in reducing calculation complexity.</p><p><strong>Conclusion: </strong>PRAYOJN modernizes and enhances WISN-based workforce planning by automating workload calculations, improving data visualization, and supporting real-time decision-making. Its scalability and intuitive interface position it as a valuable tool for optimizing staffing efficiency across diverse healthcare environments.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"400"},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655582","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":"Interpretable machine learning models for prolonged Emergency Department wait time prediction.","authors":"Hao Wang, Nethra Sambamoorthi, Devin Sandlin, Usha Sambamoorthi","doi":"10.1186/s12913-025-12535-w","DOIUrl":"10.1186/s12913-025-12535-w","url":null,"abstract":"<p><strong>Objective: </strong>Prolonged Emergency Department (ED) wait times lead to diminished healthcare quality. Utilizing machine learning (ML) to predict patient wait times could aid in ED operational management. Our aim is to perform a comprehensive analysis of ML models for ED wait time prediction, identify key feature importance and associations with prolonged wait times, and interpret prediction model clinical relevance among ED patients.</p><p><strong>Methods: </strong>This is a single-centered retrospective study. We included ED patients assigned an Emergency Severity Index (ESI) level of 3 at triage. Patient wait times were categorized as <30 minutes and ≥30 minutes (prolonged wait time). We employed five ML algorithms - cross-validation logistic regression (CVLR), random forest (RF), extreme gradient boosting (XGBoost), artificial neural network (ANN), and support vector machine (SVM) - for predicting patient prolonged wait times. Performance assessment utilized accuracy, recall, precision, F1 score, false positive rate (FPR), and false negative rate (FNR). Furthermore, using XGBoost as an example, model key features and partial dependency plots (PDP) of these key features were illustrated. Shapley additive explanations (SHAP) were employed to interpret model outputs. Additionally, a top key feature interaction analysis was conducted.</p><p><strong>Results: </strong>Among total 177,665 patients, nearly half of them (48.20%, 85,632) experienced prolonged ED wait times. Though all five ML models exhibited similar performance, minimizing FNR is associated with the most clinical relevance for wait time predictions. The top features influencing patient wait times and gaining the top ranked interactions were ED crowding condition and patient mode of arrival.</p><p><strong>Conclusions: </strong>Nearly half of the patients experienced prolonged wait times in the ED. ML models demonstrated acceptable performance, particularly in minimizing FNR when predicting ED wait times. The prediction of prolonged wait times was influenced by multiple interacting factors. Proper application of ML models to clinical practice requires interpreting their predictions of prolonged wait times in the context of clinical significance.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"403"},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11917090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655751","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":"How are fast tracks organized in adult and pediatric emergency departments in Switzerland? A cross-sectional survey.","authors":"Franziska G Berger-von Orelli, Rebecca A-B Hertzog, Thomas C Sauter, Michelle Seiler, Fabian Spigariol, Maren Tomaske, Gianluca Gualco, Alex Donas, Rodo O von Vigier, Dagmar I Keller, Kristina Keitel","doi":"10.1186/s12913-025-12570-7","DOIUrl":"10.1186/s12913-025-12570-7","url":null,"abstract":"<p><strong>Background: </strong>In response to the challenges faced by emergency departments (ED), including overcrowding and high patient volumes, Fast Track (FT) systems are designed to optimize patient flow, yet their implementation and impact in Switzerland remain understudied. Our study provides a comprehensive description of Fast Track (FT) processes across both pediatric and adult settings in Switzerland and compares challenges.</p><p><strong>Methods: </strong>We conducted a cross-sectional online survey of ED leadership in Switzerland from May to September 2023, using the WHO SARA framework to explore FT processes. The survey included 28 pediatric EDs and their corresponding adult EDs, with questions addressing FT availability, staffing, infrastructure, and operational challenges. Results were analyzed descriptively, providing insights into FT organization and highlighting barriers to implementation and expansion.</p><p><strong>Results: </strong>The survey achieved a response rate of 93% (52/56 EDs). Overall, 68% of surveyed hospitals have implemented a FT system, with a higher prevalence in adult EDs (88%) than in pediatric EDs (59%). The absence of FTs in certain pediatric departments was primarily due to structural and personnel constraints. Most FTs are managed internally by hospitals, employing emergency team members, and occasionally general practitioners, reflecting a tailored approach to staffing based on departmental needs. Despite the strategic organization of FTs, operational challenges persist; 45% of respondents identified staff shortages as a major challenge, particularly in pediatric FTs (63%) compared to adult FTs (32%). Financial barriers, including disparities in external physician compensation, remain significant obstacles to FT expansion. Satisfaction levels among EDs with their FT systems were generally high, with improvements in personnel resource allocation and patient flow frequently reported.</p><p><strong>Conclusion: </strong>While FT systems in Swiss EDs have enhanced patient care and operational efficiency, their expansion and effectiveness are hampered by staffing and financial limitations. Addressing these barriers requires a collaborative effort to reform health system policies and financial frameworks, ensuring the sustainable implementation of FTs to meet the growing demands of emergency care.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"395"},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655806","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":"Hub-and-Spoke regional system supported by telehealth for managing coeliac disease in Liguria: a mixed-methods survey followed by an observational pilot study.","authors":"Marco Crocco, Federica Malerba, Paolo Gandullia, Noemi Zampatti, Maria Franca Corona, Monica Barrani, Massimiliano Leoni, Sara Ceresoli, Andrea Gazzolo, Alberto Gaiero, Riccardo Borea, Alessandro Giorgio Lo Curto, Maria Paola Ierardi, Silvia Scelsi, Giuseppe Spiga, Raffaele Spiazzi, Renato Botti, Marisa Alberti","doi":"10.1186/s12913-025-12459-5","DOIUrl":"10.1186/s12913-025-12459-5","url":null,"abstract":"<p><strong>Background: </strong>Due to the need to reorganize the care network for the national screening mandated by law, a new healthcare model was required for the management of coeliac disease. The hub-and-spoke model is a new healthcare organizational system, here we describe its application (supported by telehealth), in the management of pediatric coeliac disease (CD) in Liguria. The results of the pilot phase are presented and the system's strengths and weaknesses discussed.</p><p><strong>Methods: </strong>A mixed-methods survey followed by an observational pilot study was performed. A multiphase approach was used including preparation setting, operative planning and application. The pilot phase involves a single primary center. The reduction of families' expenditure and environmental impact was assessed using the Viamichelin calculator.</p><p><strong>Results: </strong>A regional meeting followed by a survey (specifically developed for this study) and a needs analysis highlighted the priority to have an efficient, up to date and homogeneous model of care assistance throughout the network. A diagnostic and therapeutic care pathway (PDTC) was developed by the regional working group. The project involved 986 Ligurian families and allowed a 90% reduction in the distance traveled by families residing within the pilot center's catchment area, saving €177 and 113 kg of CO2 on average per family per year.</p><p><strong>Conclusions: </strong>The Gaslini Diffuso hub-and-spoke system for managing CD in Liguria exemplifies a commitment to enhancing healthcare efficiency and patient care, reducing environmental impact and cost for both family and healthcare system.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"398"},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11917075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655824","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":"Influencing factors of self-advocacy in stroke patients from multiple perspectives: a qualitative study.","authors":"Zhixin Zhao, Beilei Lin, Zhenxiang Zhang, Chunhui Zhang, Yongxia Mei, Zhiwei Liu, Hu Jiang, Xiaoxuan Wang","doi":"10.1186/s12913-025-12563-6","DOIUrl":"10.1186/s12913-025-12563-6","url":null,"abstract":"<p><strong>Background: </strong>Self-advocacy can help stroke patients actively participate in disease management and maximize health benefits, which is a central issue in chronic disease management. The aim of the study was to explore the influencing factors of self-advocacy in stroke patients from multiple perspectives.</p><p><strong>Methods: </strong>A descriptive qualitative interview study was performed. Semi-structured in-depth interviews were conducted with 19 stroke patients, 6 caregivers, and 8 medical staff from two hospitals in Henan province between October 2023 to February 2024. This study analyzed interview data using a Social Ecological Model (SEM) and content analysis strategies.</p><p><strong>Results: </strong>Factors associated with stroke patients' self-advocacy were categorized using the social ecological model: (1) individual factors: influence of individual cognitive and psychological factors (weak sense of autonomy, insufficient disease cognition, severity of the disease, self-perceived burden, concerns about deteriorating doctor-patient relationship). (2) interpersonal factors: influence of family, peers and medical staff (insufficient family support, lack of peer support, authority of medical staff dominates). (3) community factors: influence of socio-environmental factors (shortage of medical staff, incomplete rehabilitation equipment, limited channels for information). (4) policy-economic factors: influence of existing policy (insufficient support from medical insurance, long-term financial burden).</p><p><strong>Conclusion: </strong>This study's application of a social ecological model helped to illuminate the complex and multilevel factors that may influence self-advocacy in stroke patients. Stroke patients' self-advocacy was influenced by the patients themselves, interpersonal relationships, community factors, and policy-economic factors. These findings can be used to guide the development of a multi-pronged intervention strategy to increase the level of self-advocacy for stroke patients in the self-management process.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"396"},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655828","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":"A mixed method impact assessment of the use of aerial logistics to improve maternal health and emergencies outcomes in the Ashanti Region of Ghana.","authors":"Pedro Kremer, Florence Haruna, Christina Briegleb, Maame Esi Amoah, Kenneth Fosu Oteng, Stephanie Boadi, Samuel Dwomoh, Adwoa Bentil, Emmanuel Tinkorang","doi":"10.1186/s12913-025-12479-1","DOIUrl":"10.1186/s12913-025-12479-1","url":null,"abstract":"<p><p>Maternal mortality, a critical global public health issue, is notably higher in low-to-middle-income countries (LMICs). In Ghana, access to healthcare, especially maternal and emergency services, is hindered by infrastructural deficiencies such as poor road networks and unreliable electricity, making the delivery of medical supplies and services difficult. The study used a mixed-method approach to assess the impact of aerial logistics on various maternal health outcomes in the Ashanti Region, focusing on the intervention by Zipline Mpanya distribution center. The study was conducted in the Ashanti Region of Ghana, where clinical outcome data were sourced from the health directorate. Pre-exposure years were 2017-2020, and post-exposure years were 2021-2022. Statistical analysis involved univariate explorations, T-tests, ANOVAs, and Zero-Inflated Poisson regressions, adjusting for factors like poverty. The qualitative study was to describe and analyze changes in providers' and patients' satisfaction, perceived quality across maternal health and health emergencies, and experiences using or being treated with the aerial logistics. The Zero-Inflated Poisson regression analysis indicated significant pre-post increases in antenatal visits and deliveries by 20% and 26% respectively, and a notable 3.41-fold increase in referrals, while emergency visits decreased by 4%. Maternal deaths decreased by 56%, with no substantial changes observed in rates of hysterectomies and neonatal deaths. Nonetheless, marginal means estimations in absolute terms showed overall declines in performance, consistent with the effects of the COVID-19 pandemic. Patients and healthcare providers perceived improvement in access to maternal and emergency medications. In conclusion, this study underscores the groundbreaking role of medical drones in enhancing public health strategies, especially in LMICs, by mitigating the impact of health emergencies on maternal health.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"390"},"PeriodicalIF":2.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646944","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}