Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

BACKGROUND: Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. AIM: To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. DESIGN OF STUDY: A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. SETTING: Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. METHOD: Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. RESULTS: The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. CONCLUSION: A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children.

Adolescents' perceptions of a health survey using multimedia computer-assisted self-administered interview.

OBJECTIVE: To ascertain young people's perceptions of an adolescent health survey when administered by multimedia computer assisted self-administered Interview (M-CASI) through analysis of (1) questionnaire item responses and (2) focus group interviews. SETTING: Auckland, New Zealand, 1999. STUDY TYPE: Pilot testing of a 488-item branching questionnaire delivered using a youth-oriented and user-friendly M-CASI interface in a variety of settings using both desktop and laptop computers. Post pilot focus groups of participants identifying their perceptions and experiences of the survey. SAMPLE: 110 school students aged 12 to 18 years. RESULTS: The mean number of questions answered by participants was 316 with the median time to completion being 48 minutes. On average 65% of the total number of questions were seen and of these 1.5% were deliberately not answered. A high level of acceptability and enjoyment of M-CASI was found in the analysis of focus group responses and agreed with the item responses relating to M-CASI within the questionnaire itself. Participants identified privacy and confidentiality as being particularly important for the honesty of their responses. The passive matrix screens of the computers were popular as they could only be viewed from in front. CONCLUSIONS: M-CASI is an acceptable instrument for the administration of a youth health survey. Laptop computers with passive matrix screens are able to enhance perceptions of privacy and confidentiality, which may improve honesty of responses. IMPLICATIONS: M-CASI is now feasible and offers advantages in health surveying.

Cultural identity and psychological adjustment of adolescent Chinese immigrants in New Zealand.

Based on an integration of acculturation and developmental models, this study examined the relationship between psychological adjustment and cultural identity determined by the relative strength of identification with own ethnic group, and the mainstream society. Over 400 immigrant Chinese students completed questionnaires and 24 participated in interviews. Results indicated that adolescents who were integrated had higher self-esteem than their peers who were separated or marginalized p<0.001). This finding is consistent with research on ethnic minority adolescents in other countries, and suggests that integration has important implications on the psychological well-being of these adolescent immigrants.

Telling the story: parents' scripts for donor offspring.

This study documents experiences of parents who chose to disclose, and intended to disclose to their children, information about the donor involvement, and children's responses when they received this information. Of the 181 parents who responded, 30% (n = 54) gave their children information about their conception (34 families). Couples chose to tell when 'it just seemed right' or when they believed their children could understand their stories. The stories shared concerned the parents' inability to have children together, and the need for spermatozoa and specialist attention, and the families reading a book about donor insemination. There appeared to be an advantage in giving children this information at a young age, at which the information was processed in a factual, non-emotional way. Any questions asked by the children related to practical issues. These parents reported that it gave them opportunities gradually to introduce information as the children's understanding progressed. Of the parents who had not told (n = 127), 77% (n = 98) intended to disclose information in the future. This group gave their child's age and inability to understand as their main reasons for choosing to wait. Some 17% (n = 22) of parents who had not told chose not to disclose. There were no significant differences between the responses of mothers and fathers.

Donor insemination programmes with personal donors: issues of secrecy.

This study involved 46 recipients and donors in personal donor programmes interviewed anonymously by postal questionnaire and interview: 38% (30/80) of possible recipients responded. The total number of people told about the donor involvement ranged between two and 78, with no significant gender difference. Relationships had changed for half of the participants in the programmes with 75% reporting that they had developed a closer relationship and 25% reporting a deterioration. Contact between couples and donors was seen as being in the original role of family friend or relative rather than as donor. An equal proportion of recipients (63%) and donors (78%) agreed to the donor being identified to any offspring although this was qualified with regard to the age of the child. Reasons for identification were given as avoidance of family secrets and the rights of the child to have information concerning their conception. Those who did not agree said that the child was better off not knowing, or who wished to preserve donor anonymity. The donor group was more likely than the recipients to say that identification to the child was in the best interests of the social parents because it allowed all those involved to feel part of a single family group. It was found that for both recipients and donors, the advantages given for having a personal donor was openness within the relationship. For the recipients, this focused on knowledge of the donor background and, for related couples, having a common genetic relationship. For donors, the advantages given were: knowing the child's environment, having access to a child and the ability to choose recipients. A disadvantage for donors and recipients was the possibility of a change in the relationship and for donors an added disadvantage was having to share in the emotional stress of the treatment and negative outcomes. More men than women placed importance on having a donor with a similar genetic background.

Parental influences on the dieting beliefs and behaviors of adolescent females in New Zealand.

PURPOSE: To investigate parental influences on the weight perceptions and the dieting beliefs and behaviors of adolescent girls. METHODS: The subjects were 232, 8th and 9th grade girls attending an urban New Zealand secondary school. Data on girls' perceptions of being thinner, beliefs about dieting, and their dieting behavior were obtained via a number of self-report scales. RESULTS: An association was found between girls' perceptions of the impact of being thinner, dieting beliefs, dieting behaviors, and parental encouragements to diet (p < .0001). In general, parental dieting practices did not influence dieting beliefs except that fathers' dieting behavior was associated with some aspects of girls' dieting behaviors. CONCLUSIONS: Parental encouragement to diet was associated with a wide range of weight loss behaviors, including the more extreme measures. In addition, having a father who dieted was associated with participation in a number of the dieting behaviors.

The perceived social context of AIDS: study of inner-city sexually transmitted disease clinic patients.

The present study investigated perceptions of AIDS as a social problem relative to 10 other problems in a sample of 194 inner-city sexually transmitted disease (STD) clinic patients. Within-subjects analyses showed that AIDS was viewed as a more serious problem than housing, alcoholism, and child care, while AIDS was less of a problem than employment, drug abuse, crime, discrimination, and teen pregnancy, and no different from transportation and health care. Factor analysis was used to identify the interrelationships among social problems as perceived by STD patients. For men, factor analysis showed that AIDS was most closely related to crime, drug abuse, teen pregnancy, and discrimination, with these problems constituting the first factor and accounting for most of the variance in the analysis. Men also placed AIDS with alcoholism and child care on the third factor accounting for little variance. For women, however, AIDS clustered most closely with alcoholism and child care, accounting for a minimal amount of variance in the analysis. Results further showed that perceptions of social problems among women correlated with HIV-risk-related behaviors. The structural context of social problems, within which AIDS is embedded, is discussed with reference to HIV-AIDS-prevention interventions.

Attitudes of parents of young children to sperm donation--implications for donor recruitment.

An anonymous questionnaire was circulated to parents of young children to survey exposure to publicity about and attitudes to sperm donation (n = 192 couples; 50% response rate). Of those surveyed, 55% of men and women had seen or heard of the need for sperm donors; for 26% of couples, one or both partners had considered donation, and among half of those (13% of total) no objections to donating were raised. However, only two men had approached the clinic as donors. Objections to donation centred mainly on discomfort at having children outside their family, worry about future contact with donor insemination children, and worry about incest. Women were three times as likely to raise these objections as men. Of all respondents, 20% thought a donor should be used for only one recipient couple, while 50% suggested three or fewer families. Overall, 41% rated having non-identifying information about the recipient couple(s) as an important aspect of sperm donation, although only 9% of men and 17% of women considered personal contact important. While many people are aware of and receptive to the idea of being donors, very few act. Many would prefer that their spermatozoa were used for only one or a few couples about whom they had some information.

Sexual sensation seeking: scale development and predicting AIDS-risk behavior among homosexually active men.

Sensation seeking, the propensity to prefer exciting, optimal, and novel stimulation or arousal, is a potential mediating factor in sexual risk for human immunodeficiency virus infection (HIV), the cause of acquired immunodeficiency syndrome (AIDS). However, the most widely used measure of sensation seeking, the Sensation Seeking Scale (Zuckerman, Kolin, Price, & Zoob, 1964), contains numerous culturally outdated items and items that do not pertain to sexual behavior. In this study, 106 homosexually active men completed newly developed measures of sensation seeking related to sexual and nonsexual experiences, as well as a measure of sexual compulsivity. Results show that the new scales were internally consistent and time-stable. Additional analyses demonstrated convergent, divergent, and discriminant validity for these scales, showing them to be of use as mediating variables in models of high-risk sexual behavior. Implications for HIV prevention and behavior change are discussed.

Progesterone secretion and mitochondrial size of aging porcine corpora lutea.

A functional dependency between the nongravid uterus and the ovaries is essential to luteolysis and the return to estrus in the pig. After mating of gilts, the corpora lutea develop, and they are required for the maintenance of pregnancy to a normal duration of about 114 days. Hysterectomy of luteal phase (day 6) nongravid gilts results in persistence of the corpora lutea to 150 days. We report that these corpora secrete greater quantities (P less than 0.025) of progesterone than during the later half of gestation (days 54-108). Although aging corpora lutea remain functional for at least an additional 35 days, an abrupt reduction by half in progesterone secretion (16 ng/ml) occurs about day 114 in hysterectomized gilts that coincides with the prepartum decrease to basal serum levels (less than 0.5 ng/ml) at parturition (day 114) and during lactation. Aging corpora lutea remain large (averaging greater than 450 mg) on days 124 and 136 in hysterectomized gilts, whereas they regress (averaging less than 75 mg) in the lactating dams. Mitochondria continue to increase in size in aging corpora lutea of hysterectomized gilts until day 136; in contrast, they decrease during the postpartum period in lactating dams. A precisely timed signal, possibly of ovarian origin or from the CNS and pituitary gland, entrains in hysterectomized and pregnant pigs at day 113 that results in marked shifts in relaxin and progesterone secretion. Progesterone secretion and mitochondrial features suggest that porcine corpora lutea seem genetically controlled and are preprogrammed at estrus for the duration of pregnancy, regardless of the presence of conceptuses or absence of the uterus.

Relaxin production and release after hysterectomy in the pig.

Relaxin secretion by luteal tissue and into peripheral blood was examined in relation to changes in the fine structure of aging porcine corpora lutea. Sequential bleedings every sixth day reveal a similar increase in serum relaxin concentrations from days 6-114 in hysterectomized and pregnant gifts. The span of the estrous cycle is about 21 days, and the length of pregnancy is about 115 days in pigs. Estrone (E1) and 17 beta-estradiol (17 beta-E2) serum levels increase with placental development; after hysterectomy, they are low from days 12-168. In luteal tissue, peak quantities of relaxin and electron-dense granules occur on day 100 in hysterectomized and pregnant gilts. By day 112, luteal tissue relaxin levels and granule populations decrease by about half, while relaxin secretion into peripheral blood approaches peak concentrations about day 114 in hysterectomized as well as pregnant gilts. Between days 114 and 120, serum relaxin decreases by half even though the corpora lutea persist to day 150 in hysterectomized animals. Thereafter, cytoplasmic granules and blood and luteal tissue levels of relaxin decrease gradually to day 150 in hysterectomized gilts; in contrast, they disappear abruptly after parturition. In hysterectomized gilts, relaxin release coincides with diminished populations of granules in corpora lutea, and the initiation of these events seems to be precisely timed. E1 and 17 beta-E2 secretion is unrelated to relaxin secretion in pregnant and hysterectomized gilts. High peripheral blood levels of E1 and 17 beta-E2, primarily of placental origin, or even the presence of the uterus are not required in the release of relaxin at day 114. By using steroidogenic and protein synthetic capabilities of luteal cells as criteria essential to the evolution of reproduction in this species, the results presented here suggest that 114 days rather than 21 days characterize the reproductive cycle, even in the absence of the uterus. These results indicate that the production and, particularly, the release of relaxin into peripheral blood on about day 114 in hysterectomized gilts as well as pregnant animals may be genetically controlled.