Overcrowding in emergency departments: Revealing the social perspectives through a medical sociological analysis
Jeffrey Yuk Chiu YIP
Published Online: October 15, 2019
In the past decade, several studies have evaluated the causes of overcrowding in emergency departments in different healthcare systems. Many of the perspectives, however, have emerged from a biomedically centered conceptual framework. An explanatory model that integrates the concepts and views of medical sociology is generally lacking. This paper argues that a critical and qualitative medical sociological analysis may reveal the salient and multidimensional social factors that underlie emergency department overcrowding. These sociological considerations can assist in understanding the phenomenon and in taking steps to optimize the prevailing conceptual framework. In this paper, the congestion of emergency departments is presented within the sociocultural context of Hong Kong, China, which is a metropolitan city that had nearly 2.2 million recorded emergency attendances at public hospitals in 2017. Evidence from the relevant literature is used to support this analysis. An interplay of social ideologies and factors at different social levels is identified as contributing to emergency department overcrowding. The factors are discussed at the individual, microsocial, intermediate, and macrosocial levels. The sociological hypothesis is that the overcrowding issue may be multidimensional in nature and that a linear explanatory approach that attributes the root cause to the healthcare system per se may not be adequate. This paper sheds light on the importance of a sociocultural analytical approach for explaining the phenomenon. The diverse sociocultural etiologies should be contextualized when formulating strategies to address the global issue of overcrowding in emergency departments.
The role of self-efficacy in the relationship between discrimination and health care utilization among college students in the United States
Klaus E Cavalhieri, Kathleen Chwalisz, Tawanda M Greer
Published Online: September 30, 2019
Introduction: This study is an investigation of the direct and indirect effects of experiences of discrimination on health care utilization among young college students.
Methods: One hundred and eighty-five students completed an online survey. Measures included experiences of discrimination, outcome expectations, self-efficacy, attitudes, and demographic variables. The relationships tested were informed by Andersen’s Behavioral Model of Health Services Use, which has been modified as it oversimplified the role of ethnicity as a predictor. Regression and mediation analysis were conducted.
Results: Self-efficacy to communicate with physicians was a significant direct predictor of health care utilization (t = 2.965, P = .003), although experiences of discrimination were not. The effects of discrimination on health care utilization were further found to be mediated by self-efficacy to communicate with physicians (95% CI [-.0907, -.0025]).
Conclusion: These findings provided support for the inclusion of psychosocial variables (i.e., self-efficacy) in Andersen’s model to increase its explanatory power.
A scoping review examining the relationship between green tea and skin cancers
Ram Lakhan, Louisa Summers, Olugbemiga Ekundayo, Jedidiah Radosevich, Sierra Turner, Sangyal Dorjee, Vinayak K. Nahar, Manoj Sharma
Published Online: September 30, 2019
Introduction: Skin cancers are among the most commonly diagnosed cancers in the US and are becoming a major public health problem. Polyphenols particularly, (-)-epigallocatechin-3-gallate (EGCG) found in green tea has been shown to have anti-carcinogenic properties in animal models. Chemo-preventative role of green tea has been studied through epidemiological studies in several cancers such as breast, lung, oral cavity and others. The results have been mixed.
Purpose: The purpose of this study was to conduct a scoping review to examine the relationship between green tea and skin cancers and discuss its implications for humans.
Methods: Literature searches using the keywords “green tea” and skin cancer” were conducted in MEDLINE (PubMed), CINAHL, and Google Scholar. The inclusion criteria were: (1) articles published in the past approximately ten years; (2) in the English language; (3) published in peer-reviewed journals in the above databases; and (4) all accounts of descriptive and epidemiological or evaluation studies. Excluded were articles published before 2008, published in grey literature and non-peer-reviewed journals.
Results: In the literature, systemic and topical applications of green tea polyphenols have shown to have mixed effects against the formation and development of skin cancers in animals. Particularly, EGCG has been found as a contributing factor to inhibit cell invasion, angiogenesis, and metastasis in skin cancer.
Discussion: Use of green tea and its extracts may offer promising implications for use in humans about prevention and retarding the progress of skin cancers but at present, the data are very limited. Large scale randomized controlled trials on the efficacy of green tea and its extracts are required.
Applying the Multi Theory Model (MTM) of health behavior change for explaining fruits and vegetables consumption behavior among African American women in Mississippi, USA
LaVonne Brown, Vinayak K. Nahar, Manoj Sharma
Published Online: September 30, 2019
Objective: The aim of this study was to explain fruit and vegetable consumption behavior through application of the multi-theory model (MTM) of health behavior change among African American women in Mississippi, USA.
Methods: This study utilized a cross sectional design. A 39-item face and content valid questionnaire based on MTM was completed by participants drawn from churches. The study utilized a convenience quota sampling. Participants who reported that they consumed more than five cups of fruits and vegetables within the last 24 hours were excluded from the study. Stepwise multiple regressions were conducted to explain fruit and vegetable consumption behavior.
Results: A total of 116 participants (66.5% response rate) completed the surveys. The mean age of participants was 48.8 years (SD 17.82, range 21 to 84). Modeling utilizing multiple regression showed that the MTM constructs of participatory dialogue (P = 0.009), behavioral confidence (P = 0.0001), and changes in the physical environment (P = 0.0001) accounted for 50.8% of the predictability in the intention to initiate fruit and vegetable consumption behavior. Further, 59.9% of the variance in sustenance of fruit and vegetable consumption behavior was explained by the constructs of practice for change (P = 0.016), emotional transformation (P = 0.0001), and changes in the social environment (P = 0.0001).
Discussion and Conclusion: The study provides credible support to reify MTM framework for developing programs to increase fruit and vegetable consumption among African American women.
The impact of the Affordable Care Act on health insurance coverage in the Gulf States and the Rest of the United States by rural and urban areas
Hosik Min, Kenneth Hudson
Published Online: September 15, 2019
Background:This study examines the effects of the Affordable Care Act (ACA) on rural and urban health insurance coverage in the Gulf Coast region of the United States, which includes five states: Alabama (AL), Florida (FL), Mississippi (MS), Louisiana (LA), and Texas (TX).
Methods: Data from the 2009 and 2015 American Community survey micro-sample was used to examine the effects of ACA policy on health insurance coverage in the Gulf States and the rest of the nation. Health insurance coverage rates were presented before and after the implementation of the ACA for rural and urban areas in the Gulf States region and for the rest of the nation. Multivariate logistic regression was used to estimate the likelihood of coverage net of relevant socio-demographic and labor market variables.
Results: Our results show the implementation of the ACA increased health insurance coverage nationwide but was still less in the Gulf States than rest of the nation, and less in rural than urban areas. Within the Gulf States region, the increase in coverage varied by state and by rural and urban areas. In Alabama and Mississippi, the net increase in rural areas was 26.2% but in Florida, Texas, and Louisiana, it was only 0.8%. Coverage increased in urban areas in all of the Gulf State (28% for AL and MS, 54% in FL, LA, and TX) but less than the rest of the nation (85%). The health insurance coverage for the rural area compared to urban area after the ACA implementation was higher by 17% in Alabama and Mississippi, yet lower by 23% in Florida, Louisiana, and Texas.
Discussion and Conclusions: Although the Gulf states did not expand their Medicaid programs, each of the states showed some increase in health insurance coverage after the implementation of the ACA. Future research should examine the health insurance area boundaries on insurance coverage and the effects of the Medicaid Waiver program and in each state.
Social and structural factors that influence refugee women’s use of mental health care services in Canada: A narrative review
Shreya Mahajan, Samantha B. Meyer
Published Online: August 30, 2019
Background: There is an increasing number of female refugees entering Canada with mental health service needs. The aim of this paper is to identify social and structural factors that influence Canadian refugee women’s use (or lack thereof) of mental health care services.
Methods: This review follows Rosella Ferrari’s Narrative Review Framework. The PRISMA statement was used for the search strategy. A total of 430 articles were retrieved across PubMed/Medline, Scopus, and ProQuest. A final 24 articles were used in our paper after full-text screenings. Data presented in the review were organized by themes that emerged in various papers. The final section is used to highlight the main points of this review, establish future research directions, and explain how the review as achieved the research objective.
Results and Discussion: Our findings unveil the complexities of refugee status, discrimination and stigma, the social experience of gender, and previous health experiences in relation to how they influence mental health service use. Additionally, culture and cultural competency as they are regarded in health care offer insightful explanations for understanding the relationships between patient and physician which ultimately influences use of services. Finally, this paper uncovers policies and power divides between patients and doctors that impacts how mental health care is welcomed by women who are refugees.
Conclusions: Data suggest that social support innovations are desirable by refugee women in Canada but that further research is required to mitigate social and structural barriers to seeking care. Practice and research recommendations are provided for agendas focused on improving mental health service use.
Recreational prescription opioid misuse among college students in the USA: An application of the theory of planned behavior
Robert E. Davis, Martha A. Bass, Mary A. Ford, John P. Bentley, KoFan Lee, Nicole A. Doyle
Published Online: July 15, 2019
Introduction: Young adults aged 18-25 are at elevated risk for prescription drug misuse compared to other age groups. The purpose of the current study was to utilize the Theory of Planned Behavior (TPB) to predict the intention to engage in recreational prescription opioid misuse (RPOM) among college students while identifying specific salient beliefs that underlie this behavior.
Methods: A random sample of college students in the USA completed an electronic survey measuring TPB constructs, salient beliefs, RPOM, and demographic items. Salient beliefs regarding RPOM were identified through a qualitative elicitation process using a subsample (n = 17) of the target population. Content analysis identified specific beliefs that would form questionnaire items to be assessed among the larger sample.
Results: Among the entire sample (n = 776), 20.7% reported lifetime RPOM with 11.9% reporting past 6-month RPOM. Ten behavioral, two normative, and eight control beliefs identified in the subsample significantly and positively correlated with intention for RPOM when measured among the entire sample. A staged hierarchical logistic regression model examined the relationship between TPB constructs and intention. With the exception of perceived behavioral control, all constructs were significantly related to intention to engage in RPOM in the next six months. Descriptive norms had the strongest relationship to intention (OR = 1.37, 95% CI 1.23 to 1.54, P < .001), followed by subjective norms (OR = 1.33, 95% CI 1.20 to 1.48, P < .001), and finally attitude (OR = 1.13, 95% CI 1.09 to 1.17, P <.001). Further, attitude significantly moderated the descriptive norm-intention relationship.
Conclusion: The beliefs identified by this study may benefit interventions aimed at preventing prescription opioid misuse among this population. Further, targeting global perceptions of peer behavior, as well as, attitudes toward recreational use of prescription opioids may be particularly efficacious.
Investigating the effectiveness of theory-based interventions for improving treatment adherence of patients with type 2 Diabetes Mellitus: A systematic review of Randomised Controlled Clinical Trials
Despoina Menti, Caroline Limbert, Georgios Lyrakos
Published Online: May 30, 2019
Introduction: Theory can enhance the effectiveness of interventions designed to change health-related behaviours, however, there is a significant lack of such interventions to improve treatment adherence of Type 2 Diabetes Mellitus (T2DM) patients. This systematic review aims at examining the effectiveness of theory-based interventions on improving adherence of T2DM patients, also examining their methodological quality.
Methods: An electronic search was conducted, including only Randomised Controlled Trials published in English and Greek from 2004 to 2016. Databases searched included PubMed/Medline, Science Direct, Wiley Online Library, Oxford Journals and PsychInfo. The review protocol was designed and performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
Results: The review included reports of 11 interventions, using the Health Belief Model (n = 3), Social Cognitive Theory (SCT) (n = 2), Theory of Planned Behaviour (n = 2), Transtheoretical Model (n = 2), Information-Motivation-Behavioural skills model (n = 1) and Motivational Interviewing (n = 1). Nine interventions improved adherence of T2DM patients; the mean quality of the studies was 6.6, out of 10.
Discussion and Conclusion: Most theory-based interventions were effective in improving adherence of T2DM patients, especially SCT, which successfully improved all three aspects of treatment (i.e., medication taking, diet and physical exercise). Self-efficacy is included in most of the theories and was the most effective element, especially when combined with goal setting practices, another common, effective element across interventions. However, the wide heterogeneity in the methodology of the studies impeded comparison and synthesis of findings. Common limitations were the use of self-reports, short follow-up periods and insufficient information on how theoretical constructs were used to design the intervention.
The Public Health Surveillance Well-Being Scale: Reliability and validity study of the Turkish version
Selma Infal Kesim, Faith Kara
Published Online: April 30, 2019
Introduction: The Public Health Surveillance Well-Being Scale (PHS-WB) is a measuring tool developed by Bann and colleagues (2012) for determining the well-being status of a community, expressed in terms of physical, mental, and social well-being. This study aimed to adapt, translate and validate the PHS-WB from English into the Turkish language.
Methods: A questionnaire ad hoc for collecting socio-demographic characteristics of participants, the Public Health Surveillance Well-Being Scale (PHS-WS) and the Perceived Wellness Scale (PWS) were used in our study. For the validity of the PHS-WS language, the original language of the scale was first translated from English into Turkish, whereas the back translation of the final draft was carried out from Turkish to English by a different language expert. The Content Validity Index was calculated. For the scale (criterion) validity, the coincidental scale validation method was used. The structural validity was assessed by using the exploratory factor analysis (EFA).
Results: The scale showed a high internal consistency, as the Cronbach’s alpha coefficient was 0.83 for the total score and 0.66, 0.76, and 0.69 for the physical, social and mental subscales, respectively. There was a total of 12 items in the final Turkish form of the PHS-WB, having the same factor structure as the original as result of the validity and safety studies performed.
Discussion and Conclusions: The validity and reliability of the Public Health Surveillance Well-being Scale was ensured. This questionnaire could be used by researchers for further investigation in different regions of Turkey, on larger sample groups and for evaluation of special groups, such as individuals with chronic illness and disability, or individuals employed in specific occupation (e.g., healthcare and social care professionals, unemployed, and students).