A qualitative investigation of visual tasks with which to assess distance-specific visual function.

BACKGROUND: The ability to perform many daily tasks relies on good visual acuity at various distances. A review of existing measures of visual function revealed gaps in task content, particularly tasks that rely on intermediate vision. PURPOSE: This research sought to extend the content base and visual range coverage of tasks used to assess visual function. METHODS: Ophthalmology patients (n = 72) with myopia, hyperopia, presbyopia, astigmatism, cataracts, and/or glaucoma were involved in various qualitative sub-studies, including life event journaling, telephone interviews, and both on-line and face-to-face focus groups. The resulting journal entries and transcripts were thematically analyzed to identify visual tasks that rely on visual acuity in the near, intermediate, and distant visual ranges. RESULTS: A wide variety of distance-specific visual tasks were identified. Certain types of tasks relied on distance vision, such as; ambulation, driving, leisure and sports, and social functions. Other task groupings such as technology use and activities of daily living relied primarily on near and intermediate vision. Two new content areas were identified, technology use and safe task performance. CONCLUSIONS: This thematic analysis provides a rich body of information about tasks that affect daily life and are made more difficult by poor visual acuity at various distance ranges.

Assessing needs for mental health and other services among transition-age youths, parents, and providers.

OBJECTIVES: This qualitative study assessed the needs for mental health and other services among transition-age youths who were receiving services in youth-specific programs. METHODS: Thirteen focus groups were conducted between June 2008 and January 2009. The purposefully sampled participants included transition-age youths age 18 to 24 who were receiving services in youth-specific programs (N=75, eight groups), parents of transition-age youths (N=14, two groups), and providers in the youth-specific programs (N=14, three groups). The qualitative analysis used an inductive approach in which investigators focused on generating themes and identifying relationships between themes. Through a process of repeated comparisons, the categories were further condensed into broad themes illustrating service needs. RESULTS: Youths expressed needs for improved scheduling of services, stronger patient-provider relationships, and group therapies that address past experiences of violence, loss, and sexual abuse and that provide skills for developing and nurturing healthy relationships. Parents and providers expressed needs for increased community-based and peer-led services. Youths, parents, and providers all expressed needs for more housing options and for mentors with similar life experiences who could serve as role models, information brokers, and sources of social support for youths who were pursuing education and employment goals. CONCLUSIONS: Findings from the focus groups suggest that there is room for improvement in the provision of services that are relevant to the current needs and life experiences of transition-age youths. Even within age-specific programs, improvements in services are needed to foster transitions to independence.

Anonymous versus confidential HIV testing: client and provider decision making under uncertainty.

Six intensive observational studies of HIV testing sites were undertaken in order to improve understanding of confidential and anonymous testing. Three sites offered only confidential testing (a large health maintenance organization's Urgent Care clinic, the same organization's HIV clinic, and a private medical practitioner's office), one offered only anonymous testing (a free clinic), and two offered a choice of confidential or anonymous testing (a thrift shop alternate testing site and a mobile testing unit). Multiple data collection strategies were used including direct field observation, semistructured interviews with clients and providers, and document and policy analysis. Using an organizational/interactional uncertainty framework, this study found that the choice between anonymous and confidential testing is a central aspect of the HIV testing process, that some clients are unclear about the differences between anonymous and confidential testing, that alternate testing sites' providers play a significant role in encouraging confidential rather than anonymous testing in order to further their organization's resource needs and public health goals, and that testing counselors' may consider that some clients prefer anonymous testing because of fear of stigma, discrimination, or loss of privacy.

Evaluating the accessibility of HIV testing organizations.

Consumer-based indicators were developed to evaluate the accessibility of private and public nonhospital HIV testing organizations. A comprehensive roster of 148 nonhospital HIV testing organizations in Los Angeles County was constructed from publicly available listings. A telephone survey protocol was used to contact sites and assess consumer relevant accessibility measures. Only 50% of the sites could be contacted and indicated that HIV testing was available. Hence, a consumer who tried to reach one site had only a 50-50 chance of success. HIV testing sites differed with regard to how frequently they offered testing; whether they offered anonymous and/or confidential testing; what types of counseling they provided; how quickly test results were available; and how friendly, helpful, attentive, and knowledgeable about testing procedures their attendants were. HIV testing sites must make their services accessible and be perceived by consumers as responsive if they are to be effective service providers.