Facilitators and barriers of service utilization: Perspectives of stakeholders in a family health center of central Kerala - A qualitative study.

BACKGROUND: Transformation of Primary Health Centers to Family Health Centers (FHC) in Kerala is a new movement. It is important to study the perspectives of stakeholders about it so that strengthening of the facilitators and tackling the barriers can be done. OBJECTIVES: The objectives of this study were to understand the perspectives of patients and health-care workers on the facilitators and barriers of service utilization in a FHC in Central Kerala. METHODS: Descriptive qualitative study was done for a period of 3 months at FHC, Mundur, Thrissur district, Kerala. In-depth interview of medical officer, health supervisor, and accountant was conducted. Two focus group discussions at the FHC among Accredited Social Healthcare Activists (ASHAs) and patients and one among community members were done. The Attride-Stirling's thematic network analysis framework was followed for data analysis. The findings are reported in accordance with Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: The facilitators identified for service utilization are good behavior of staff, evening outpatient department and special clinics, improved infrastructure and clean premise, trust in ASHA workers, subsidized laboratory service, local self-government involvement, funds, and rewards. The barriers of service utilization are staff shortage and workload, lack of awareness among general population about some services, and shortage of medicines. CONCLUSION: The concept of FHC is agreeable to both the health-care workers and the community. The barriers can be tackled at this stage, and there is a scope to improve health-care quality if this model is introduced across the country.

Hormone-receptor expression and survival patterns in operated cases of female invasive ductal breast carcinoma in Kerala: a retrospective cohort study.

BACKGROUND: Though breast cancer is the most common cancer among women in Kerala, India, epidemiological data on breast cancer in the state is largely lacking. The objectives of this study were to analyze the survival pattern of female breast carcinoma in this region of the country and to compare the differences in survival with different hormone-receptor expressions. METHODS: One hundred eighty-nine female breast cancer patients who were operated between 1 August 2008 and 3 July 2009 were followed up over telephone to obtain data on five-year survival. Grade, stage of the disease, and hormone-receptor (HR) status were obtained from treatment records. Logistic regression and the Kaplan-Meier survival analysis were used for statistical analysis. RESULTS: The mean age of the study population was 49.07 (SD, 10.35) years. A majority of the patients had estrogen receptor (ER)+/progesterone receptor (PR)+tumors (n=103, 54.5%), followed by 72 (38.1%) ER-/PR-, 10 (5.3%) ER-/PR+, and 4 (2.1%) ER+/PR-. Stage of the disease, axillary nodal status, and hormone-receptor status showed statistically significant association with overall survival in breast cancer. Overall survival rate at the end of 5 years was 71.4%. Mortality was found to be highest for the ER-PR-group (47.2%). CONCLUSIONS: Women in Kerala are diagnosed with breast carcinoma at a relatively younger age, yet the overall five-year survival for the disease is low when compared to developed nations. It is imperative that comprehensive breast cancer screening and treatment strategies be developed to enable earlier diagnosis and improve the survival of breast cancer in the state.