Health & Social Care in the Community

Consumer-directed care (CDC) is a policy solution for quality deficiencies in aged care where seniors accessing care services are empowered with full choice and flexibility over their service packages. Various programs have been developed using this policy approach around the world, and implementation has invoked a mixture of responses. While consumer organisations welcome a policy direction providing additional choice, there is a concern that this policy complicates the decision-making process, leading people to rely on “rules of thumb” (heuristics) that may not reflect their best interests. Behavioural science provides a lens for looking at heuristics and biases that may occur during complex decision making, particularly as people age. Objective. To explore the presence and influence of heuristics and biases on the decision-making processes of older people receiving home care services under a CDC model. Method. Qualitative systematic review involving systematic searching of PubMed, MEDLINE via Ovid, Embase via Elsevier, CINAHL via Ebsco, PsycINFO via Ovid, Web of Science, Scopus, and EconLit, from inception until 14th April 2022 was undertaken. Identified articles were deduplicated, screened, and extracted for information relevant to the research question using PRISMA guidelines. Data extraction considered descriptive data and metadata including study type, participants, overall objectives, chosen methodologies, and their relationship to the research question. The variety of study types prompted a thematic synthesis to achieve greater comprehension of the existing knowledge base. Results. Descriptive categories were analysed to reveal five themes relevant to the presence and influence of heuristics and biases in decisions made by older people when allocating home care resources. Principally, CDC is implemented to afford autonomy but is complicated by the decision-making environment. Choice and decision making are both specific to the individual, and the processes employed for decision making vary over the life-course. Decision quality can be improved through the identification and mitigation of complicating factors. More research is needed to understand how modifications can assist decision making and improve health outcomes.

Research on peer support programmes for people with type 2 diabetes has shown a positive effect on health-related behaviours, yet little is known about what causes this effect. This study researched the mechanisms generating immediate outcomes (changes in awareness) and intermediate outcomes (behavioural changes) among socially vulnerable people with type 2 diabetes in a Danish peer support intervention. Using a realist-informed evaluation approach, we investigated how nonprofessional volunteers perceived and performed as peer supporters, and how these activated mechanisms in the interaction between peers and peer supporters. Furthermore, we explored how contextual factors related to peers and peer supporters influenced how mechanisms worked. The study was based on a qualitative multimethod case-study design (n = 11). Data consisted of semistructured interviews with four key informants (peer, peer supporter, project manager, and a diabetes nurse) (n = 27), participation observation of two peer supporter training courses, one network meeting, two supervisions for peer supporters, and logbooks from peer supporters. Data were analysed using systematic text condensation. The findings revealed that the peer supporters used their lived experience to perceive and perform in the peer support meetings. Furthermore, being with a like-minded person with type 2 diabetes activated mechanisms, such as trust, respect, empathy, care, and honesty between peers and peer supporters, which led to increased self-care awareness among the peers (immediate outcome). Finally, the findings revealed that contextual factors, such as peer supporters’ lived experiences and peers’ and peer supporters’ sociodemographic characteristics and health conditions, affected how the mechanisms were at stake. Thus, our study contributes on how to support socially vulnerable people with type 2 diabetes and where peer support programmes can supplement the established healthcare system by providing social and emotional support to this vulnerable group. This trial is registered with ClinicalTrials.gov, Retrospective Registration (20 Jan 2021), registration number NCT04722289.

Priority Populations in oral health are defined as people from remote areas of Australia, low-income households, specialised medical needs, and Indigenous people. Children in these groups have irregular dental visiting patterns and a higher proportion have never accessed services. The Child Dental Benefits Schedule (CDBS) is a means-tested policy which provides financial support for eligible children to access dental services. This study aimed to explore how the introduction of CDBS affected dental visiting behaviours of Priority Populations. The outcomes of interest were the use of CDBS and its monetary benefit in the four-year period post-CDBS implementation based on a sample from the Longitudinal Study of Australian Children. Binary logit and linear models with interaction terms were used to estimate the effect of priority status and previous reported dental visiting behaviours on the probability of use and the value of subsidy claimed from CDBS. Of the children with no previous access to dental services, 33.7% were CDBS users, compared to 29.9%, 41.1%, and 44.1% who reported historically accessing services once, twice, and thrice, respectively. After adjustment for confounders, there were no significant interactions between Priority Populations and previously reported visiting behaviours; however, the pattern of lower utilisation by those with no previously reported access was evident. The state of Western Australia had a significantly lower proportion of estimated utilisation compared to all other states and territories. Children from low-income families benefitted relatively more from CDBS compared to other income groups; however, only a small proportion of the program was used to subsidise new utilisation of dental care. Children with unfavourable past dental visiting behaviours are likely to have higher unmet need, face barriers to access, and the oral health benefit is likely to be the highest. Policymakers should consider how this and similar programs can better target populations with difficulty accessing services, which will also contribute to reducing inequalities in oral health outcomes.

After years of effort, sub-Saharan Africa has seen little improvement in maternal and neonatal health indicators. Providing all women with access to emergency obstetric care is an accepted effective strategy to reduce maternal and neonatal mortality. In many African countries such as Benin, the cost of health care is a major obstacle to access obstetric care. The aim of this study was to evaluate the caesarean section expenditures of households in Benin and to determine the strategies for obtaining the necessary resources to meet the caesarean section expenditures of the households. Three hospitals and 505 households in the Littoral region were sampled, and data were collected by applying a questionnaire to the people accompanying the woman to the hospital. The socioeconomic status of the households was evaluated using a wealth index created by principal component analysis. Factors significantly associated with expenditure were determined using multivariate linear regression analysis. Despite the free caesarean section policy in effect, households spend a median of US$180.60 (IQR: 148.13–222.35) for a caesarean section, of which 76.0% are direct costs, 17.0% are indirect costs, and 7.0% are opportunity costs. Expenditures vary considerably depending on the residence area of the household, the presence of complications, the presence of health insurance, the socioeconomic class of the households, the education level, and working status of the woman. Finally, households use 11 strategies to obtain funds to pay for the caesarean costs. While poor households resort to foreign aid, asset sales, and/or current spending cuts, the rich use their income and/or savings to cover their caesarean section expenses. The results favour the adoption of a mechanism for direct exemption of the costs of caesarean sections payable by the poorest households, in addition to the current free caesarean policy.

Tropical and potentially fatal malaria is brought on by the parasite Plasmodium spp which spreads through infected female anopheles mosquitoes within the human populations. In Ghana, malaria is endemic and perennial, with distinct seasonal fluctuations in the northern part. Children aged below five years are among the population most vulnerable to malaria in Ghana. This study’s goal is to establish how suspected malaria cases, tested malaria cases, and climatic conditions impact confirmed malaria cases in children under five years in the Sunyani Municipality, Bono Region, Ghana. The dependent variable, monthly number of confirmed cases of malaria in children under five years, was modelled with the independent variables, monthly number of tested cases of malaria in children under five years, mean monthly relative humidity, mean monthly rainfall, and mean monthly temperature, in the Sunyani Municipality. We employed multiple linear regression after data transformation, exploratory data analysis, and correlation analysis. Results show that tested malaria cases and climatic factors significantly influence confirmed malaria cases in children under 5 years. About 41.8% of variations in confirmed malaria cases among children under 5 years is attributed to climatic factors and the number of tested cases. Moreover, results show that increase in tested cases and rainfall leads to more confirmed malaria cases among children under 5 years, while increase in temperature reduces malaria infections. To reduce the incidence of malaria in children under five years, the government and its stakeholders should encourage parent to let their children sleep in treated mosquito nets, distil stagnant waters during raining seasons, spray bushes with antimosquito insecticides, and destroy all breeding grounds of mosquitoes at all times. We proposed that all malaria cases should be laboratory tested and properly confirmed.

Increasing evidence of the effects of the COVID-19 pandemic on healthcare workers’ mental health and wellbeing has prompted concerns about the longer-term impacts on healthcare delivery and health workforce sustainability. For rural health services and communities, the pandemic has compounded existing challenges including workforce shortages, potentially leading to further health inequalities. This qualitative interview study aimed to explore factors within and external to the health service environment that influenced health service staff mental health and wellbeing in rural and regional Victoria, Australia, during the first two years of the COVID-19 pandemic (2020-2021). Participants were recruited from nine publicly funded rural and regional health services. Semistructured interviews were conducted via videoconference, audio-recorded, and transcribed. Data were analysed using a five-stage framework approach. Eighteen health service staff from four rural areas participated in the study. A range of factors that were perceived by participants to influence their wellbeing were identified. These were coded to four main themes: (1) rural community relations, (2) the nature of the health workplace, (3) self-care and supportive networks, and (4) public health measures and the unpredictable nature of the pandemic. Factors coded to these themes were described as both positive and negative influences on health staff mental health and wellbeing. Optimising the mental health and wellbeing of rural health staff is imperative to the sustainability of this workforce during and beyond the COVID-19 pandemic. Rural health services must consider the community and health service (meso-level), individual (microlevel), and broader pandemic context (macrolevel) when developing and implementing strategies to promote staff wellbeing. Strategies must encompass the development of senior leadership capabilities, mechanisms to support effective leadership, and optimal communication processes within health services. Given the potential for community support to positively influence rural health staff wellbeing, community engagement should be a feature of health service wellbeing strategies.