Giving patients a voice for healthcare reform in Austria: the qualitative voice-study.

BACKGROUND: Inclusion of patients in healthcare service and system planning is an increasingly important tool to improve healthcare systems worldwide. In 2012, a focused healthcare reform was initiated in Austria to strengthen the primary care sector which is still underway in 2023. OBJECTIVE: The aim of this study was to assess the perceptions, desires, and needs of patients in terms of primary care as a necessary building block of the Austrian healthcare reform. METHODS: This study was designed as an exploratory qualitative study using semi-structured interviews between the years 2013 and 2018. Interviews with patients focused on positive and negative experiences with regard to general practice (GP) consultations and perceptions of the primary care system in general, as well as desires for improvement. Qualitative content analysis was used to analyse the material using the software atlas.ti. RESULTS: Altogether, 41 interviews were conducted with seven categories identified. These categories include organization and time management around consultation, access, and availability including opening hours, human and professional aspects of consultation, infrastructure and hygiene of the waiting room, healthcare system factors, as well as non-clinical/administrative staff. CONCLUSIONS: Appreciating and responding to patients' perceptions and needs, healthcare reform in Austria should include improvements regarding consultation/waiting time, coordination, and navigation in Primary Care. Successful healthcare reform has to include the patient voice.

Vaccine hesitancy among physicians: a qualitative study with general practitioners and paediatricians in Austria and Germany.

OBJECTIVE: This study aims to understand reasons for vaccine hesitancy (VH) among general practioners (GPs) and paediatricians. We aim to analyse how and when the healthcare workers (HCWs) developed vaccine-hesitant views and how they transfer these to patients. DESIGN AND SETTING: Semistructured interviews with vaccine-hesitant GPs and paediatricians were conducted in Austria and Germany using an explorative qualitative research design. PARTICIPANTS: We contacted 41 physicians through letters and emails and 10 agreed to participate, five were male and five female. DATA COLLECTION AND ANALYSIS: Ten interviews were recorded, transcribed verbatim and anonymised. The material was analysed inductively following a grounded theory approach with open coding using the software atlas.ti. RESULTS: Key themes that were identified were education and career path, understanding of medicine and medical profession, experiences with vaccines, doctor-patient interactions and continuous education activities and the link to VH. GPs and paediatricians' vaccine-hesitant attitudes developed during their medical training and, in particular, during extracurricular training in homeopathy, which most of the participants completed. Most participants work in private practices rather than with contracts with social insurance because they are not satisfied with the health system. Furthermore, they are critical of biomedicine. Most of the interview partners do not consider themselves antivaccination, but are sceptical towards vaccines and especially point out the side effects. Most do not vaccinate in their practices and some do only occasionally. Their vaccine-hesitant views are often fostered through respective online communities of vaccine-hesitant HCWs. CONCLUSIONS: More studies on a connection between complementary medicine and vaccine-hesitant views of HCWs are needed. Education about vaccines and infectious diseases among healthworkers must increase especially tailored towards the use of internet and social media. Physicians should be made aware that through time and empathy towards their patients they could have a positive impact on undecided patients and parents regarding vaccine decisions.

Risk communication and community engagement with vulnerable groups: Perceptions of social-services CSOs during Covid-19.

Risk communication enables people to be prepared, respond and recover from public health risks which can only be realized with a considerable amount of community engagement. Enabling community involvement is necessary in order to reach and protect vulnerable people during epidemics. In situations of acute emergency, it is difficult to reach everyone, which makes it necessary to work with intermediaries such as social and care facilities and civil society organizations (CSOs) who work to support the most vulnerable in our societies. This paper analyses the perceptions of experts working in social facilities or CSOs of Covid-19 RCCE efforts in Austria. It starts from a broad understanding of vulnerability which combines medical, social and economic determinants. We conducted 21 semi-structured interviews with CSO and social facility managers. The UNICEF core community engagement standards (2020) were used as a framework for qualitative content analysis. The results show that CSO's and social facilities were essential for allowing community involvement of vulnerable people in Austria during the pandemic. For the CSO's and social facilities participation of their vulnerable clients was a real challenge especially because direct contact was difficult and public services were switched to digital only. Nonetheless, they all put a lot of effort into adapting and discussing Covid-19 regulations and measures with their clients and employees which in many cases led to acceptance of public health measures. The study gives recommendations on how community engagement could be enhanced especially from government actors and how CSO's could be addressed more as essential partners.

Correction to: "With fever it's the real flu I would say": laypersons' perception of common cold and influenza and their differences - a qualitative study in Austria, Belgium and Croatia.

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"With fever it's the real flu I would say": laypersons' perception of common cold and influenza and their differences - a qualitative study in Austria, Belgium and Croatia.

BACKGROUND: There is little research on laypersons' perceptions regarding common cold and influenza, their symptomatic distinction and considerations of risk. This study investigates understanding of pathogenesis across three European countries and provides a knowledge base from which adequate prevention recommendations and treatment advice can be derived. METHODS: This is a qualitative research study. Semi-structured face-to-face interviews were conducted with 85 participants from three European countries (Austria n = 31, Belgium n = 30, Croatia n = 24) about their experiences, perceptions and risk considerations regarding the common cold and influenza. We performed a qualitative thematic content analysis. RESULTS: Three main themes were identified: common cold as harmless with individualistic symptoms; influenza as mainly distinguishable by fever, confinement to bed and severity of symptoms, but description about onset and duration are diverse; and views on pathogenesis contain references to disease causing agents and circumstances. Overall we found that risk perception is based largely on personal experience and risk is assumed moderate for both diseases. CONCLUSIONS: Study participants possessed a fairly good understanding of symptoms, differences and pathogenesis of common cold and influenza; but explanations integrated misconceptions, such as misinterpretation of fever, disease continuums, diverse onset ideas etc. Perceptions were largely based on lived experiences and interventions for prevention and treatment should be led by health care workers and focus on these issues. Basic consultations, awareness raising activities and other knowledge disseminations strategies should include aspects of communicableness and the self-limiting nature of both diseases. An informed understanding of both infectious diseases is crucial and may also increase influenza vaccination coverage in the three respective countries effectively.

No common understanding of profession terms utilized in health services research : An add-on qualitative study in the context of the QUALICOPC project in Austria.

BACKGROUND: Health services research, especially in primary care, is challenging because the systems differ widely between countries. This study aimed to explore the different understanding of the terminology used, particularly, regarding the professions nursing and medical secretaries. METHODS: The study was an add-on study to the Quality and Costs in Primary Care (QUALICOPC) project in Austria and designed as qualitative research. The qualitative phase was conducted by using semi-structured telephone interviews with general practitioners (GP). and17 GPs participated in the study. RESULTS: No uniform meaning of the terms commonly utilized for the abovementioned health professions could be found among Austrian GPs. For example, under the profession term practice assistants, nurses as well as literal medical secretaries with and without special education and related work competencies and responsibilities were subsumed. CONCLUSIONS: Our study results show that no uniform meaning of the terms commonly utilized for above described health profession could be found even within one country by GPs. These findings are highly relevant, especially, when trying to compare results with similar data from other countries or negotiating about workforce issues. Our findings implicate several action points for health services research and health policy. We propose the development of a harmonized terminology in Europe for the health profession based on standards of undergraduate and postgraduate education, competencies and continuous education commitments. This would not only benefit comparative health system research but also patient safety across Europe.

The views of migrant health workers living in Austria and Belgium on return migration to sub-Saharan Africa.

BACKGROUND: The negative consequences of the brain drain of sub-Saharan African health workers for source countries are well documented and include understaffed facilities, decreased standards of care and higher workloads. However, studies suggest that, if migrated health workers eventually return to their home countries, this may lead to beneficial effects following the transfer of their acquired skills and knowledge (brain gain). The present study aims to explore the factors influencing the intentions for return migration of sub-Saharan African health workers who emigrated to Austria and Belgium, and gain further insight into the potential of circular migration. METHODS: Semi-structured interviews with 27 sub-Saharan African health workers in Belgium and Austria were conducted. RESULTS: As mentioned by the respondents, the main barriers for returning were family, structural crises in the source country, and insecurity. These barriers overrule the perceived drivers, which were nearly all pull factors and emotion driven. Despite the fact that only a minority plans to return permanently, many wish to return regularly to work in the healthcare sector or to contribute to the development of their source country. CONCLUSION: As long as safety and structural stability cannot be guaranteed in source countries, the number of return migrants is likely to remain low. National governments and regional organizations could play a role in facilitating the engagement of migrant health workers in the development of the healthcare system in source countries.

How to create more supportive supervision for primary healthcare: lessons from Ngamiland district of Botswana: co-operative inquiry group.

BACKGROUND: Supportive supervision is a way to foster performance, productivity, motivation, and retention of health workforce. Nevertheless there is a dearth of evidence of the impact and acceptability of supportive supervision in low- and middle-income countries. This article describes a participatory process of transforming the supervisory practice of district health managers to create a supportive environment for primary healthcare workers. OBJECTIVE: The objective of the study was to explore how district health managers can change their practice to create a more supportive environment for primary healthcare providers. DESIGN: A facilitated co-operative inquiry group (CIG) was formed with Ngamiland health district managers. CIG belongs to the participatory action research paradigm and is characterised by a cyclic process of observation, reflection, planning, and action. The CIG went through three cycles between March 2013 and March 2014. RESULTS: Twelve district health managers participated in the inquiry group. The major insights and learning that emerged from the inquiry process included inadequate supervisory practice, perceptions of healthcare workers' experiences, change in the managers' supervision paradigm, recognition of the supervisors' inadequate supervisory skills, and barriers to supportive supervision. Finally, the group developed a 10-point consensus on what they had learnt regarding supportive supervision. CONCLUSION: Ngamiland health district managers have come to appreciate the value of supportive supervision and changed their management style to be more supportive of their subordinates. They also developed a consensus on supportive supervision that could be adapted for use nationally. Supportive supervision should be prioritised at all levels of the health system, and it should be adequately resourced.

Influenza vaccination prevalence and demographic factors of patients and GPs in primary care in Austria and Croatia: a cross-sectional comparative study in the framework of the APRES project.

BACKGROUND: The aim of this study was to compare influenza vaccination coverage rates in Austria and Croatia, countries with missing data in the Eurosurveillance and European Centre for Disease Prevention and Control reports. In addition, we assessed demographic factors of GPs and patients and calculated associations regarding vaccination rates. METHODS: This cross-sectional study was conducted within the context of thethe appropriateness of prescribing antibiotics in primary health care in Europe with respect to antibiotic resistance (APRES) project. Between November 2010 and July 2011, 40 GP practices attempted to recruit 200 patients to complete questionnaires about their influenza vaccination status and demographics. Statistical analyses included subgroup analyses and logistic regression models. RESULTS: Data from 7269 patient questionnaires could be analyzed (3309 Austria and 3960 Croatia). The vaccination coverage rates were low (2009/2010: A 18.2 vs. C 20.9%, P < 0.001; 2010/2011: A 13.7 vs. C 18.6%; P < 0.001). The rates were found to be highest in persons aged 65 years and older (2009/2010: A 35.1 vs. C 49.5%, P < 0.001; 2010/2011: A 31.1 vs. C 45.7%, P < 0.001) and lowest in children (2009/2010: A 8.5 vs. C 2.0%, P < 0.001; 2010/2011: A 4.3 vs. C 1.6%, P = 0.002). Besides, demographics in the adjusted regression model for Austria being vaccinated was associated with consulting a female GP (OR, 4.20; P < 0.001) and in Croatia with five or more GP consultations per year (OR, 4.41; P < 0.001). CONCLUSION: The vaccination coverage rates for Austria and Croatia were low, with the highest rates found in persons aged 65 years and older, showing that public coverage of the vaccination costs might increase vaccination rates. However, other factors seem to be relevant, including the engagement of GPs.

Diaspora engagement of African migrant health workers - examples from five destination countries.

BACKGROUND: Migrant health workers fill care gaps in their destination countries, but they also actively engage in improving living conditions for people of their countries of origin through expatriate professional networks. This paper aims to explore the professional links that migrant health workers from sub-Saharan African countries living in five African and European destinations (Botswana, South Africa, Belgium, Austria, and the United Kingdom) have to their countries of origin. DESIGN: Qualitative interviews were conducted with migrant doctors, nurses, and midwives from sub-Saharan Africa (N=66). A qualitative content analysis of the material was performed using the software ATLAS.ti. RESULTS: Almost all migrant health workers have professional ties with their countries of origin supporting health, education, and social structures. They work with non-governmental organizations, universities, or hospitals and travel back and forth between their destination country and country of origin. For a few respondents, professional engagement or even maintaining private contacts in their country of origin is difficult due to the political situation at home. CONCLUSIONS: The results show that African migrant health workers are actively engaged in improving living conditions not only for their family members but also for the population in general in their countries of origin. Our respondents are mediators and active networkers in a globalized and transnationally connected world. The research suggests that the governments of these countries of origin could strategically use their migrant health workforce for improving education and population health in sub-Saharan Africa. Destination countries should be reminded of their need to comply with the WHO Global Code of Practice for the international recruitment of health professionals.

Associations between the prevalence of influenza vaccination and patient's knowledge about antibiotics: a cross-sectional study in the framework of the APRES-project in Austria.

BACKGROUND: This study aimed to identify associations between GP patient's knowledge about the spectrum of effectiveness of antibiotics and the probability of vaccination against influenza. The underlying hypothesis was that individuals with an understanding that antibiotics are ineffective against viruses, common colds, and flu were more likely to be vaccinated than persons lacking this knowledge. METHODS: This cross-sectional study was conducted within the context of the European APRES project in Austria. Between November 2010 and July 2011, patients were recruited from GP practices to complete questionnaires about their knowledge about antibiotics and their influenza vaccination status. Statistical analyses included subgroup analyses and logistic regression models. RESULTS: Data of 3224 patients was analyzed, demonstrating that patients with better knowledge concerning antibiotics had a significantly higher likelihood of being vaccinated (OR 1.35, CI 95 % 1.18-1.54). While the overall vaccination rate was low (18.6 % in 2009/2010 and 14.0 % in 2010/2011), elderly compared to younger adults (OR 0.06 CI 95 % 0.03-0.13) and healthcare workers (OR 2.24, CI 95 % 1.42-3.54) demonstrated higher likelihood of vaccination. Additionally, female GPs had significantly more vaccinated patients than male GPs (OR 2.90, CI 95 % 1.32-6.40). DISCUSSION: There has been little prior study on the association between a patient's knowledge of the effectiveness spectrum of antibiotics and influenza vaccination status. Given the public health imperative to increase annual prevalence of influenza vaccination, understanding this educational gap can improve specificity in counseling as well as vaccination rates. Ultimately, we found that those with a better knowledge on about antibiotics had a significantly higher likelihood of being vaccinated. CONCLUSIONS: The results of this study demonstrate that vaccination prevalence is associated with patient's knowledge about antibiotics. It can be concluded that one strategy to improve the overall low vaccination rates for seasonal influenza in Austria would be, particularly for male GPs, to have a specific discussion with patients about these circumstances by focusing on younger patients. Further, public health efforts could supplement in-office strategies to improve this area of health literacy.

Stressed and overworked? A cross-sectional study of the working situation of urban and rural general practitioners in Austria in the framework of the QUALICOPC project.

AIM: To assess the workload of general practitioners (GPs) in Austria, with a focus on identifying the differences between GPs working in urban and rural areas. METHODS: Within the framework of the Quality and Costs of Primary Care in Europe (QUALICOPC) study, data were collected from a stratified sample of GPs using a standardized questionnaire between November 2011 and May 2012. Data analysis included descriptive statistics and regression analysis. RESULTS: The analysis included data from 173 GPs. GPs in rural areas reported an average of 49.3 working hours per week, plus 23.7 on-call duties per 3 months and 26.2 out-of-office care services per week. Compared to GPs working in urban areas, even in the fully adjusted regression model, rural GPs had significantly more working hours (B 7.00; P=0.002) and on-call duties (B 18.91; P<0.001). 65.8% of all GPs perceived their level of stress as high and 84.6% felt they were required to do unnecessary administrative work. CONCLUSION: Our findings show a high workload among Austrian GPs, particularly those working in rural areas. Since physicians show a diminishing interest to work as GPs, there is an imperative to improve this situation.

African Female Physicians and Nurses in the Global Care Chain: Qualitative Explorations from Five Destination Countries.

Migration of health professionals is an important policy issue for both source and destination countries around the world. The majority of migrant care workers in industrialized countries today are women. However, the dimension of mobility of highly skilled females from countries of the global south has been almost entirely neglected for many years. This paper explores the experiences of high-skilled female African migrant health-workers (MHW) utilising the framework of Global Care Chain (GCC) research. In the frame of the EU-project HURAPRIM (Human Resources for Primary Health Care in Africa), the research team conducted 88 semi-structured interviews with female and male African MHWs in five countries (Botswana, South Africa, Belgium, Austria, UK) from July 2011 until April 2012. For this paper we analysed the 34 interviews with female physicians and nurses using the qualitative framework analysis approach and the software atlas.ti. In terms of the effect of the migration on their career, almost all of the respondents experienced short-term, long-term or permanent inability to work as health-care professionals; few however also reported a positive career development post-migration. Discrimination based on a foreign nationality, race or gender was reported by many of our respondents, physicians and nurses alike, whether they worked in an African or a European country. Our study shows that in addition to the phenomenon of deskilling often reported in GCC research, many female MHW are unable to work according to their qualifications due to the fact that their diplomas are not recognized in the country of destination. Policy strategies are needed regarding integration of migrants in the labour market and working against discrimination based on race and gender.

Portrayal of the human resource crisis and accountability in healthcare: a qualitative analysis of ugandan newspapers.

BACKGROUND: Uganda is one of the 57 countries with a critical shortage of health workers. The aim of this study was to determine how the human resources and health service crisis was covered in Ugandan newspapers and, in particular, how the newspapers attributed accountability for problems in the health services. METHODS: We collected all articles related to health workers and health services for the calendar year 2012 in the two largest national newspapers in Uganda (collection on daily basis) and in one local newspaper (collection on weekly basis). These articles were analysed qualitatively regarding the main themes covered and attribution of accountability. RESULTS: The two more urban national newspapers published 229 articles on human resources and health services in Uganda (on average over two articles per week), whereas the local more rural newspaper published only a single article on this issue in the 12 month period. The majority of articles described problems in the health service without discussing accountability. The question of accountability is raised in only 46% of articles (106 articles). The responsibility of the government was discussed in 50 articles (21%), and negligence, corruption and misbehaviour by individual health workers was reported in 56 articles (25%). In the articles about corruption (n=35), 60% (21 articles) mention corruption by health workers and 40% (14 articles) mention corruption by government officials. Six articles defended the situation of health workers in Uganda. CONCLUSIONS: The coverage of accountability in the Ugandan newspapers surveyed is insufficient to generate informed debate on what political actions need to be taken to improve the crisis in health care and services. There exists not only an "inverse care law" but also an "inverse information law": those sections of society with the greatest health needs and problems in accessing quality health care receive the least information about health services.

The inverse primary care law in sub-Saharan Africa: a qualitative study of the views of migrant health workers.

BACKGROUND: Many low-income and middle-income countries globally are now pursuing ambitious plans for universal primary care, but are failing to deliver adequate care quality because of intractable human resource problems. AIM: To understand why migrant nurses and doctors from sub-Saharan Africa did not wish to take up available posts in primary and first-contact care in their home countries. DESIGN AND SETTING: Qualitative study of migrant health workers to Europe (UK, Belgium, and Austria) or southern Africa (Botswana and South Africa) from sub-Saharan Africa. METHOD: Semi-structured interviews with 66 health workers (24 nurses and 42 doctors) from 18 countries between July 2011 and April 2012. Transcripts were analysed thematically using a framework approach. RESULTS: The reasons given for choosing not to work in primary care were grouped into three main analytic streams: poor working environment, difficult living experiences, and poor career path. Responders described a lack of basic medicines and equipment, an unmanageable workload, and lack of professional support. Many had concerns about personal security, living conditions (such as education for children), and poor income. Primary care was seen as lower status than hospital medicine, with lack of specialist training opportunities and more exposure to corruption. CONCLUSIONS: Clinicians are reluctant to work in the conditions they currently experience in primary care in sub-Saharan Africa and these conditions tend to get worse as poverty and need for primary care increases. This inverse primary care law undermines achievement of universal health coverage. Policy experience from countries outside Africa shows that it is not immutable.