ABSTRACT
OBJECTIVE: To assess leaders' perceptions of challenges and opportunities to providing sexually transmitted disease (STD) services in public health departments. DESIGN AND SAMPLE: Semi-structured interviews were conducted in 2017 with health directors and other designated leaders in 19 public health departments who have an STD clinic. Purposive sampling accounted for geographical differences, providing balanced representation of urban, suburban, and rural agencies in North Carolina. MEASUREMENT: Audiotaped interviews were transcribed verbatim. All transcripts were independently coded, with cross comparison and agreement between researchers. Rigorous thematic and content analyses were performed. RESULTS: Perceived stigma, funding constraints, and client-centered issues were identified as the greatest challenges to providing services. Opportunities to improve these services were offering comprehensive screening methods, quality improvement, and public health accreditation. Focused training on revenue and billing practices for staff was acknowledged as the most needed technical assistance. A "culture of free services", perceived by clients and staff, was revealed throughout several themes. CONCLUSIONS: Leaders in publicly funded STD clinics face many challenges and opportunities to providing clinical services. Health directors often serve as change agents and improving the sexual health of communities remains a priority. Results of this study will assist in crafting future policy and practice for STD clinics in the public health sector.
Subject(s)
Public Health/methods , Sexually Transmitted Diseases/drug therapy , Sexually Transmitted Diseases/prevention & control , Female , Humans , Interviews as Topic , Leadership , Male , North Carolina , Rural PopulationABSTRACT
BACKGROUND: Self management is an essential, central component of effective care for diabetes and other chronic illnesses, yet very few instruments exist to assess delivery or consistency of self-management support. The Assessment of Primary Care Resources and Supports for Chronic Disease Self-Management (PCRS) tool assesses both organizational infrastructure and delivery of self-management support services. METHODS: The PCRS was developed by the Robert Wood Johnson Foundation Diabetes Initiative and underwent several stages of development, including three pilot tests, review by experts, and implementation by a national quality improvement (QI) program. RESULTS: The development and testing of the instrument resulted in the current 16-item measure. Use of the PCRS in a QI collaborative with 20 diverse health care teams across the United States demonstrated that the instrument is helpful in assessing areas for improvement. DISCUSSION: Initial experience suggests that the PCRS is a user-friendly self-assessment tool that primary care teams can use to assess their current capacity to support and implement consistent patient-centered self management. The initial evaluation indicates that the PCRS has acceptable psychometric properties and is applicable across different types of primary care teams and chronic illness conditions.
Subject(s)
Chronic Disease/therapy , Patient Compliance , Patient-Centered Care , Primary Health Care/standards , Quality Assurance, Health Care/methods , Self Care , Diabetes Mellitus/therapy , Humans , Medical Audit , Missouri , Patient Care Team , Program Development , Program Evaluation , Psychometrics/instrumentation , Social Support , Surveys and QuestionnairesABSTRACT
PURPOSE: The purpose of the Diabetes Initiative of the Robert Wood Johnson Foundation is to demonstrate feasible and sustainable approaches to promoting diabetes self-management in primary care and community settings. METHODS: The Diabetes Initiative of the Robert Wood Johnson Foundation includes 14 demonstration projects in primary care settings and in community-clinical partnerships. Projects serve predominantly indigent populations from varied cultural and linguistic backgrounds in urban, rural, and frontier settings around the United States. This report describes the Initiative, its ecological perspective on self-management, and implications for program development, sustainability, and dissemination. RESULTS: Ecological perspectives stress varied levels of influence ranging from individuals to communities and policies. Based on this, the Initiative has identified key resources and supports for self-management (individualized assessment, collaborative goal setting, enhancing skills, follow-up and support, community resources, and continuity of quality clinical care). Lessons learned include the central roles of community health workers, integration of healthy coping and attention to negative emotion and depression in self-management, community partnerships, approaches to ongoing follow-up and support, organizational factors in sustaining programs, and the utility of a collaborative learning network for program development. Sustainability stresses organizational and policy supports for the program. Dissemination of lessons learned will stress collaboration among interested parties, stimulating consumer understanding and demand for self-management services as central to diabetes care. CONCLUSIONS: The Diabetes Initiative demonstrates that effective self-management programs and supports can be implemented in real-world clinical and community settings, providing models of worthwhile, sustainable programs.
