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Objective We aimed to explore the construct of “high need” and identify common need domains among high-need patients, their care professionals, and healthcare organizations; and to describe the interventions that health care systems use to address these needs, including exploring the potential unintended consequences of interventions. Methods We conducted a modified Delphi panel informed by an environmental scan. Expert stakeholders included patients, interdisciplinary healthcare practitioners (physicians, social workers, peer navigators), implementation scientists, and policy makers. The environmental scan used a rapid literature review and semi-structured interviews with key informants who provide healthcare for high-need patients. We convened a day-long virtual panel meeting, preceded and followed by online surveys to establish consensus. Results The environmental scan identified 46 systematic reviews on high-need patients, 19 empirical studies documenting needs, 14 intervention taxonomies, and 9 studies providing construct validity for the concept “high need.” Panelists explored the construct and terminology and established that individual patients’ needs are unique, but areas of commonality exist across all high-need patients. Panelists agreed on 11 domains describing patient (e.g., social circumstances), 5 care professional (e.g., communication), and 8 organizational (e.g., staffing arrangements) needs. Panelists developed a taxonomy of interventions with 15 categories (e.g., care navigation, care coordination, identification and monitoring) directed at patients, care professionals, or the organization. The project identified potentially unintended consequences of interventions for high-need patients, including high costs incurred for patients, increased time and effort for care professionals, and identification of needs without resources to respond appropriately. Conclusions Care for high-need patients requires a thoughtful approach; differentiating need domains provides multiple entry points for interventions directed at patients, care professionals, and organizations. Implementation efforts should consider outlined intended and unintended downstream effects on patients, care professionals, and organizations.

Over the last decade, the health care technology landscape has expanded significantly, introducing new and innovative solutions to address health care needs. The implications of cybersecurity incidents in the health care context extend beyond data breaches to potentially harming individuals' health and safety. Risk perception is influenced by various contextual factors, contributing to cybersecurity concerns that technological safeguards alone cannot address. Thus, it is imperative to study risk perceptions, contextual factors, and technological benefits to guide policy development, risk management, education, and implementation strategies. This study aims to investigate the differences in cybersecurity risk perception among various stakeholders in the health care sector in Norway and British Columbia (BC), Canada, and identify specific contextual factors that shape these perceptions. We expect to identify differences in risk perceptions for the explored health care technologies. We used a mixed methods approach comprising surveys and semistructured interviews to sample health care-related wearable technology stakeholders, including health care workers, patients (adults and adolescents) and their families, health authorities and hospital staff (biomedical engineers, information technology support, research staff), and device vendors/industry professionals in Norway and BC. Surveys explored information security scenarios based on the Behavioral-Cognitive Internet Security Questionnaire (BCISQ), risk perception, and contextualizing variables. We analyzed both survey data sets to summarize participants' characteristics and responses to questions related to the BCISQ (behavior and attitude) and risk perception. Interviews were analyzed thematically using an inductive-deductive approach to explore risk perception and contextual factors. Data from 274 survey respondents were available for analysis: 185 from Norway, including 139 (75.1%) females, and 89 from BC, including 57 (64%) females. A total of 45 respondents (31 in Norway and 14 in BC) participated in interviews. The BCISQ showed minor differences between locations; respondents demonstrated generally low-risk behavior and robust information security awareness. However, password simulation demonstrated discrepancies between self-assessed and \"real\" behavior by sharing or willingness to share passwords. Perceived risk is generally considered low, yet consequences of cybersecurity risks were evaluated as major but unlikely. Risk perception was stronger for assisted living and diabetes technologies than for smartwatches. The most important contextual factors shaping risk perceptions are human factors encompassing knowledge, competence, familiarity, feelings of dread, perceived benefit, and trust, as well as the technological factor of device functionality. Organizational and technological factors had lesser effects. We found minimal differences in behavior and risk perception among Norwegian and BC participants. Human factors and device functionality were most influential in shaping cybersecurity risk perceptions. Considering the rising need for assisted living technologies and wearables, insights into risk perceptions can strengthen risk management, awareness, and competence building. Further, it can address potential concerns among stakeholders to enable quicker technology adoption.

New York State Public Health Law Section 2805-z (NYSPHL§2805-z) mandates that hospitals implement certain protocols for the identification of domestic violence (DV) to strengthen support for DV survivors. However, there are challenges within our current health care delivery settings that raise critical questions about the effectiveness and adaptability of mandated policies for DV screening. The COVID-19 pandemic significantly accelerated the adoption of telehealth services, leading to the widespread use of combined telehealth and in-person clinical care. This shift has brought challenges associated with implementing the mandated DV screening protocols. This study aimed to explore the challenges health care providers face in implementing DV screening that complies with NYSPHL§2805-z to support effective screening practices. Considering both the telehealth and in-person environment, we aimed to identify the challenges that health care providers face in meeting policy requirements, with a focus on the technical, environmental, and social factors impeding effective DV screening. We also explored potential sources of support to address these challenges. This study sought to provide actionable insights for enhancing policy implementation and improving care for DV survivors. We conducted interviews with health care professionals-nurses, social workers, and physicians-across New York City involved in DV screening. These interviews were analyzed using an adapted version of the Centers for Disease Control and Prevention sociotechnical model to understand how policy, organizational structures, and individual practices intersect and impact the effectiveness of DV screening, especially in telehealth settings. Our findings revealed gaps in awareness of the policy and inconsistent DV screening processes. Through our interviews, we identified challenges in effective DV screening and strategies to improve the screening process. We found that the shift to telehealth introduced additional layers of complexity, with challenges in ensuring patient privacy and safety. Our findings revealed a lack of clear guidelines tailored to remote DV screenings and a need for training programs to prepare health care providers for the nuances of telehealth-based DV screening, both of which are crucial for complying with policy mandates. On the basis of this analysis, we developed a list of recommendations to support health care providers in effective screening for DV. Through user feedback, we confirmed that this list is consistent with the application of NYSPHL§2805-z among health care providers. As telehealth care is increasingly becoming an integral component of health care, there is an urgent need to refine and reinforce DV screening policies and procedures designed to comply with NYSPHL§2805-z. This study highlights the importance of developing practical and consistent telehealth protocols, enhancing provider training, creating supportive workflows, allotting adequate resources, and fostering collaboration among stakeholders to ensure that DV survivors receive the care they need in both remote and in-person clinical settings.

Objectives Governance and leadership are regarded as the most crucial aspects in delivering quality health care, and yet they are arguably the most complex functions of any health system. The objective of the study was to investigate the structural problems affecting the implementation of the National Health Insurance (NHI) and address the challenges affecting the NHI building blocks. Further objective of the study was to evaluate if there were appropriate controls and accountability measures in leadership and governance to inform the development of a workable model for the implementation of the NHI in South Africa. Design A quantitative study was undertaken to interrogate the structural problems affecting the implementation of the NHI by seeking to address the challenges affecting the NHI building blocks. Setting and participants The study was undertaken with participants who are decision-makers and/or contribute to the health sector reforms in South Africa in the realization of the NHI. Main outcome The main outcome of the study was to determine the requisite interventions to deal with challenges that affect governance and/or leadership functions in the implementation of the NHI. Methods The questionnaire was distributed via SurveyMonkey over a period of 2 months, and the data were analysed using R Statistical computing software of the R Core Team, 2020, version 3.6.3. The results were presented in the form of descriptive and inferential statistics. Results The study found that the success to implement NHI needs to be supported by clarity and commitment to specific policy fundamentals aimed at improving efficiency, stakeholder participation, and accountability. This imperative remains very much in doubt since the different occupations hold different views about the progress made in the implementation of the NHI across the governance and leadership functions. Conclusions The study confirmed the interrelatedness of the subthemes identified for the governance and leadership construct and pointed to the importance of sharpening policy development and implementation approaches in collaboration with all relevant stakeholders. Protocol registration The Ethics approval reference number is HSSREC 00002565/2021.

Background There are many factors during pregnancy and labor that influence women’s acceptability of maternal healthcare. Nevertheless, the concept of acceptability of maternal healthcare has unfortunately not been clearly defined and remains difficult to assess, affecting its implications and approaches from maternal health perspectives. In this study, we proposed a practical definition of maternal healthcare acceptability and developed a tool to measure maternal healthcare acceptability from patients’ perspective at a selected health sub-district in South Africa. Methods We applied known techniques to develop measurement tools in health settings. The concept development drew from the literature review leading to the proposed definition of maternal healthcare acceptability which was then refined and validated by experts through Delphi technique. Other techniques included specification of concept constructs; selection of indicators; formation of indices; measurement tool/scale construction; and testing of reliability and validity. Factor analysis and simple arithmetic equation were performed on secondary and primary datasets respectively. Results Experts in the field reached a consensual definition of maternal healthcare acceptability. Factor analysis revealed three factors retained to predict maternal healthcare acceptability indices, namely provider, healthcare and community. Structural equation model showed good fit (CFI = 0.97), with good reliability and validity. Hypothesis testing confirmed that items and their corresponding factors were related ( p  < 0.01). Simple arithmetic equation was recommended as alternative method to measure acceptability when factor analysis was not applicable. Conclusion This study provides new insights into defining and measuring acceptability of maternal healthcare with significant contributions on existing theories and practices on this topic and practical applications not only for maternal health but also across diverse health disciplines.

Background To address the many challenges health systems and communities face, primary care is constantly searching for new strategies to improve quality of care. One of the strategies is to focus on patients’ personal goals to direct the care process. To adopt an explicit focus on patients’ personal goals, actions at different levels are required. As a first step in this process, this study aims to explore the experiences of primary care stakeholders (i.e., scholars, primary care providers, and policy makers) and develop a comprehensive understanding on the idea ‘putting patients’ goals first’. This will help to formulate suggestions about what these actions should include. Method In this study, 41 primary care stakeholders participating in six focus groups between January 2020 and September 2020, were recruited via maximal variation purposive sampling. Data collection was done through an open-ended semi-structured interview guide. Focus groups were audio-recorded, transcribed verbatim, and analyzed following a phenomenological-hermeneutical philosophy of Lindseth and Norberg. Results All participants expressed a strong fundamental belief for putting patients’ personal goals first. The primary care providers shared that they created space for patients’ personal goals by letting them talk about their values and stories. They reported to integrate their medical expertise with patients’ personal goals in order to develop a balanced relationship. In this context, they also talked about the importance of taking into account the perspectives of patients’ significant others. Primary care providers also talked about how they used patients’ personal goals as a guide in interprofessional collaboration. Scholars denoted that (future) care providers need more training to acquire competencies to discuss patients’ personal goals. The providers and policy makers talked about organizational limitations in terms of time restrictions and the lack of registration systems to support a workflow oriented towards patients’ personal goals. Conclusions This study can be used to support the coherence of the development of different actions and strategies to get primary care stakeholders fully on board to support the adoption of patients’ personal goals in care delivery at different levels. However, models of practice and policy plans are needed to work towards a person-centered integrated system.

There is an increased focus on involving members of the public in health research. These types of groups, such as \"health consumer groups,\" bring different expertise to inform the design of a research study. There is a growing general concern about older adults' acceptance and use of technologies. This becomes critical when it involves health care services. To understand the use of social robots among older adults, it is prudent to gauge stakeholders' perspectives on optimal research design. In line with the philosophy of the \"triple helix model,\" researchers sought the expertise and guidance of a health consumer group. Researchers recruited an expert health consumer group for this study. This included 5 participants from an 8-member panel. Semistructured interviews were conducted. Each interviewee was introduced to visual stimuli of assistive technologies, older adults, and social robots. Subsequently, they were asked for their perspectives on what they viewed and to provide guidance on how to best design upcoming research on these phenomena. Key themes were derived from the interview transcripts with the health consumer group members. Findings include panel members' advice and guidance on explaining the research aims to technology-averse older adults, approaching data collection from this demographic, and, finally, their perceptions of the appearance of social robots. The advice and guidance of this expert health consumer, in tandem with researchers and industry partners, substantially aid in advancing research efforts toward social robot use among technology-averse older adults in Australia. This research provides vital information, including how best to approach data collection about social robots from this demographic.

NOABSTRACTPatient safety culture is a concern in every healthcare organization, therefore, the healthcare leadership is encountering issues related to patient safety across the globe. In India, there is limited research and information about patient safety culture among healthcare stakeholders and there is relatively little qualitative research available that captures the factors of patient safety culture. Hence, this study aims to explore the perception of healthcare professionals on patient safety culture.An exploratory qualitative study design was adopted in a tertiary care hospital. Structured focus group discussion (FGD) (n = 4) among healthcare professionals and two in-depth interview focus groups were audio-recorded and transcribed. Two coders reviewed transcripts using the editing approach and organized codes into themes. The data were analyzed through MAXQDA 2022 (VERBI Software GmbH, Berlin, Germany), qualitative data analysis software, and descriptive analysis technique. The main codes and themes were generated using inductive and deductive method and smart coding was done.Overall, there were 190 unique mentions of codes related to patient safety culture from 4 FGDs. They were categorized into 6 major themes and subcodes were derived via smart coding using the MAXQDA software. “Resources and constraints” was the most prominent code, followed by management support, manpower shortage, burnout, and lack of personnel commitment.The study highlights significant gaps in patient safety culture within the healthcare setting, with resource constraints, management support, and manpower shortages emerging as critical challenges. Burnout and lack of personnel commitment further exacerbate these issues, underscoring the need for targeted interventions.

The use of information and communication technologies for health-eHealth-is described as having potential to improve the quality of health care service delivery. Consequently, there is an increased global trend toward adoption of eHealth interventions by health care systems worldwide. Despite the proliferation of eHealth solutions, many health care institutions especially in transitioning countries are struggling to attain effective data governance approaches. The Ministry of Health in Botswana is an exemplar institution continually seeking better approaches to strengthen health data governance (HDG) approaches following the adoption of eHealth solutions. Recognizing the need for a global HDG framework, the Transform Health coalition conceptualized HDG principles that are structured around 3 interconnected objectives: protecting people, promoting the value of health, and prioritizing equity. The aim of the study is to solicit and evaluate perceptions and attitudes of health sector workers in Botswana toward the HDG principles by Transform Health and derive any future guidance. Purposive sampling was used to select participants. A total of 23 participants from various health care organizations in Botswana completed a web-based survey and 10 participated in a follow-up remote round-table discussion. The aim of the round-table discussion was to gain further insight into participants' responses from the web-based survey. Participants were from the following health care cadres: nurses, doctors, information technology professionals, and health informaticians. Both validity and reliability testing were performed for the survey tool before sharing it with study participants. An analysis of participants' close-ended responses from the survey was performed using descriptive statistics. Thematic analysis of open-ended responses from the questionnaire and the round-table discussion was achieved using the Delve software and the widely accepted principles of thematic analysis. Although some participants highlighted having measures in place similar to the HDG principles, there were some who either did not know or disagreed that their organizations already had in place mechanisms similar to the proposed HDG principles. Participants further expressed relevance and importance of the HDG principles in the context of Botswana. However, some modifications to the principles were also suggested. This study highlights the necessity of data governance in health care particularly toward meeting the requirements for Universal Health Coverage. The existence of other health data governance frameworks calls for a critical analysis to assess the most appropriate and applicable framework in the context of Botswana and similar transitioning countries. An organization-centered approach may be most appropriate, as well as strengthening of existing organizations' HDG practices with the Transform Health principles.

The rapid expansion of telemedicine, accelerated by the COVID-19 pandemic, has transformed healthcare delivery by enabling remote consultation, monitoring, and diagnostics. However, existing telemedicine systems often suffer from fragmented architectures, limited interoperability, and inadequate alignment with regulatory and operational requirements. This paper proposes a comprehensive architectural framework for telemedicine systems that integrates key technological components, stakeholder roles, and implementation considerations into a unified model. Through a systematic review and comparative analysis of established frameworks including outcome-oriented models, semantic healthcare standards, and emerging technology-driven architectures critical gaps were identified in current telemedicine design approaches. The proposed framework delineates modular layers encompassing user interfaces, communication protocols, service components (e.g., electronic health records and AI engines), data management, integration with third-party systems, and governance mechanisms to ensure privacy and compliance. Additionally, the framework explicitly defines the roles and responsibilities of patients, healthcare providers, system administrators, institutions, and regulatory bodies to facilitate coordinated operation and oversight. Implementation challenges such as data security, infrastructure limitations in rural areas, interoperability across diverse EHR systems, scalability, user training, and deployment costs are thoroughly discussed. This work offers a foundational reference model to guide researchers, developers, and policymakers in advancing telemedicine platforms that are scalable, secure, and interoperable. Future efforts will focus on validating the framework through simulation, prototype development, and pilot studies to enhance practical adoption and impact.