A qualitative study of determinants of patient behaviour leading to an infection related hospital admission.

Objectives To describe and understand the determinants of patients' behaviours surrounding admission to hospital for an acute infective episode Method Patients admitted to the infection or acute medicine admission units of a major Scottish teaching hospital and commenced on antibiotic therapy after admission were included. Semi-structured face-to-face interviews were conducted using a pre-piloted interview schedule guide that focused on gathering information about patient behaviours and experiences prior to admission to hospital with an acute infection. Interviews were audio-recorded, transcribed verbatim and analysed using the Framework Approach. Emerging themes were matched to the Theoretical Domains Framework of behavioural determinants. Results Twenty-one patients consented to participate and 18 transcripts were suitable for analysis. The most common infections were those of the skin, soft tissue and respiratory tract. From the patients' perspectives, behavioural determinants that appeared to impact their admission to hospital were principally their knowledge, beliefs of consequences, the environmental context and resources (mainly out-of-hours services), social influences and their own emotions. Determinants such as knowledge of the signs and symptoms, beliefs of consequences and environmental context were facilitators of health seeking behaviours. The main barriers were a lack of awareness of consequences of infection potentially leading to delayed admission impacting infection severity, stay in secondary care and resource utilisation. Conclusions This study has shown that any initial patient-centred intervention that is proposed to change patient behaviour needs to be based on behavioural determinants emerging in this research. The intervention may include aspects such as patient education on resources available out-of-hours and ways to access the healthcare system, education on recognising signs of infection leading to prompter treatment and positive reinforcement for patients who present with recurrences of infection.

Getting to know oncology inpatients and their families: a continuous quality improvement approach.

Given the overall magnitude of cancer, a climate of stretched health care resources, and the political activism of cancer survivors and families, it is becoming increasingly clear that local service providers need to assess and reassess the care they provide. A qualitative design was used to seek the patient and family's perspectives on whether or not their needs were being met while in hospital. Direct feedback from a convenience sample of 19 oncology patients and families was elicited through a semi-structured interview. Qualitative data analysis revealed eight important aspects of care for oncology patients and their families. These included: communication between patients and caregivers, caregiver availability and concerns about health care cutbacks, coordination and continuity of care, physical care and comfort, psychosocial care, caregiver sensitivity, caregiver competence, and the physical environment of the hospital. Challenges faced by individuals and their families affected by cancer are highlighted as they navigate through our health care system. Respondents provide positive reinforcement for use of appropriate interventions by caregivers, while clearly outlining areas needing improvement.