Comparing expectations and experiences of care for sexually transmitted infections in general practice: a qualitative study

Background A key aim of England's National Strategy for Sexual Health is to extend high-quality sexual health services in primary care. Objectives To explore the expectations and experiences of men and women who initially presented at their general practice with a suspected sexually transmitted infection in order to identify areas where change could improve service delivery. Methods Semi-structured interviews were carried out in six general practices and two genitourinary medicine (GUM) clinics in Brent primary care trust (London) and Bristol (southwest England). Patients within general practice, and GUM patients who had initially attended general practice were eligible to participate. Interview transcripts were analysed using thematic analysis. Results 49 patients (29 women, 20 men) were interviewed. Patients approaching their GP practice typically expected written referral or in-house care, but this expectation was often not met. Absence of formal referral, lack of information and perceived avoidance of sexual health matters by practitioners were commonly cited as reasons for disappointment. However, a dedicated service within general practice met expectations well. Conclusion Purchasers and providers of all general practice services should ensure that any patient consulting in primary care with a suspected sexually transmitted infection can either receive appropriate care there, or a formal and supported referral to a specialised GUM clinic or primary care service.

Qualified immigrants' success: exploring the motivation to migrate and to integrate

High-quality employees with international experience bring valuable advantages to internationally operating organizations. The growing number and importance of immigrants, and particularly qualified, university-educated immigrants, deserves more attention from international business practitioners and scholars. The market for highly qualified people within MNCs is increasingly becoming international, and ever more of them have migrated to a new country to advance their career. Such employees can be a source of competitive advantage for international firms. We use qualitative research with qualified immigrants (QIs) in France to argue that the success of QIs depends in large part on their motivation to integrate into their host country, which is largely explained by their motivation to migrate. From the qualitative data we derive four different types of qualified migrant, and suggest that the type will determine the success of the immigrant within, and outside, the organization. The relationship between the motivation to migrate and the motivation to integrate is moderated by “met expectations” and “organizational integration policies”, such that the effects of these, in turn, vary with type. Recognition of the types of QI and the moderating factors will be valuable for practitioners, as well as opening up research avenues for scholars.

Improving employee outcomes in the public sector

Purpose – The purpose of this paper is to examine the efficacy of the demand-control-support model, augmented with employee perceptions of organisational justice and degree of met expectations.

Design/methodology/approach – Data were collected from 128 public sector employees working in a large state police force operating under many of the elements of new public management. Hierarchical multiple regression analyses were conducted using four indicators of occupational strain: employee wellbeing, job satisfaction, organisational commitment and intent to quit.

Findings – The results of this study suggest that the demand-control-support model has great utility in identifying those aspects of the work environment associated with employee strain. Job control and social support at work in particular were the most consistent predictors. In contrast, the expectation and justice variables failed to make significant contributions to the model in all but one analysis providing no support for the “injustice as stressor” perspective.

Research limitations/implications – Although a cross-sectional design was utilized, these results highlight the value of applying the parsimonious demand-control-support model to a wider set of outcomes, especially in a public sector environment.

Practical implications – The results emphasize the importance of the relatively neglected “softer” work characteristics support and control. In order to combat the ill-effects of organisational reforms and prompt a shift towards the public value approach, managers operating under elements of new public management should ensure that adequate social support at work is available and that employee control is commensurate with their demands.

Originality/value – This study examined an augmented demand-control-support model and identified that whilst perceptions of justice can influence employee attitudes and wellbeing, the demand, control, and support variables remain the most influential factors with regard to public sector employee attitudes and wellbeing.

Psychological contract development: An integration of existing knowledge to form a temporal model

The psychological contract has received substantial theoretical attention over the past two decades as a popular framework within which to examine contemporary employment relationships. Previous research mostly examines breach and violation of the psychological contract and its impact on employee organization outcomes. Few studies have employed longitudinal, prospective research designs to investigate the psychological contract and as a result, psychological contract content and formation are incompletely understood. It is argued that employment relationships may be better proactively managed with greater understanding of formation and changes in the psychological contract. We examine existing psychological contract literature to identify five key factors proposed to contribute to the formation of psychological contracts. We extend the current research by integrating these factors for the first time into a temporal model of psychological contract development.

Capacitação de Agentes Comunitários de Saúde para a prevenção e controle do câncer

O presente estudo tem como tema de discussão, o trabalho do Agente Comunitário de Saúde (ACS) como essencial para ações de prevenção e controle do câncer, em conjunto com a equipe da Estratégia Saúde da Família. Direcionou-se o olhar, através dos olhos do ACS, para os riscos e atitudes facilitadoras para o desenvolvimento do câncer, bem como para sinais de alarme. A questão que norteou a pesquisa foi: os Agentes Comunitários de Saúde, após receberem devida capacitação, alcançam habilidades suficientes para atuarem no controle do câncer, através de ações da identificação de riscos e educação em saúde? O objetivo principal consistiu em elaborar um modelo de intervenção que contribua para o controle do câncer na Atenção Básica, tendo o ACS como principal mediador. Trata-se de uma pesquisa de intervenção, transversal, de abordagem qualitativa, tendo como objeto de estudo, o trabalho do ACS como um instrumento da ESF para o controle do câncer. Foram selecionados cinco ACS‘s como participantes principais e oito famílias como participantes secundários. Para a produção dos dados usou-se da pesquisa de campo, que transcorreu entre os meses de janeiro a abril de 2014, e contou com o método observacional. Esta produção foi dividida em dois momentos: estudo de eficácia e estudo de eficiência. A análise dos dados foi organizada em duas matrizes interpretativas: considerações acerca das atividades desenvolvidas e o corolário das ações desenvolvidas, cada uma com suas respectivas categorias e temas. Esta análise contou com o suporte teórico-metodológico da análise de conteúdo temática proposta por Bardin (2011). Quanto aos resultados, os ACS‘s, após receberem o trabalho de capacitação, tiveram um bom desempenho nas atividades de investigação e educação em saúde. Em um primeiro momento, a intervenção despertou mudanças positivas no cotidiano das famílias participantes da pesquisa, isto é, após a educação em saúde realizada pelos ACS‘s conseguiram abandonar hábitos de risco que haviam sido identificados. Assim, após implementação do plano prévio de intervenção, evidenciou o modelo aplicável, ou seja, foi possível perceber como deve se organizar e quais os passos devem ser realizados. A presente pesquisa ainda não pode responder se a intervenção elaborada, em definitivo, é capaz de ocasionar mudanças positivas no cotidiano dos participantes a longo prazo e, principalmente, se estas mudanças ajudarão na redução dos índices de câncer. Cabe destacar, para que intervenções como esta tenham sucesso parcerias precisam ser fortalecidas. Pois para que possamos ter uma saúde pública eficiente e, ao mesmo tempo, uma Atenção Básica de qualidade, necessita-se de fato, que todos trabalhem juntos.

Evaluating Degradable Mulches for Muskmelon Production

Plastic mulches can provide vegetable growers with earlier crop maturity, increased yields and quality, improved disease, insect and weed control, and more efficient fertilizer and water use. However, standard polyethylene mulches must be removed and disposed of at the end of each season, which is a dirty and costly undertaking. One solution to this problem has been the development of degradable mulches that can be left in the field after harvest to disintegrate and be incorporated into the soil. Unfortunately, degradable mulch performance hasn’t always met expectations. And now there are different types of degradable mulches being aggressively marketed creating questions about which one is best. The objective of this study was to evaluate three types of degradable mulches for ease of use, speed of breakdown, and how they influence transplanted muskmelon performance.

Evaluating the effect of a patient education brochure on patients’ expectations and satisfaction with emergency department service

Introduction: The purpose of this study was to assess the capacity of a written intervention, in this case a patient information brochure, to improve patient satisfaction during an Emergency Department (ED) visit. For the purpose of measuring the effect of the intervention the ED journey was conceptualised as a series of distinct areas of service comprising waiting time, service by the triage nurse, care from doctors and nurses and information giving Background of study: Research into patient satisfaction has become a widespread activity endorsed by both governments and hospital administrations. The literature on ED patient satisfaction has consistently indicated three primary areas of patient dissatisfaction: waiting time, nursing care and communication. Recent developments in the literature on patient satisfaction studies however have highlighted the relationship between patients. expectations of a service encounter and their consequent assessment of the experience as dissatisfying or satisfying. Disconfirmation theory posits that the degree to which expectations are confirmed will affect subsequent levels of satisfaction. The conceptual framework utilised in this study is Coye.s (2004) model of disconfirmation. Coye while reiterating satisfaction is a consequence of the degree expectations are either confirmed or disconfirmed also posits that expectations can be modified by interventions. Coye.s work conceptualises these interventions as intra encounter experiences (cues) which function to adjust expectations. Coye suggests some cues are unintended and may have a negative impact which also reinforces the value of planned cues intended to meet or exceed consumer expectations. Consequently the brochure can be characterized as a potentially positive cue, encouraging the patient to understand processes and to orient them in what can be a confronting environment. Only a limited number of studies have examined the effect of written interventions within an ED. No studies could be located which have tested the effect of ED interventions using a conceptual framework which relates the effect of the degree to which expectations are confirmed or disconfirmed in terms of satisfaction with services. Method: Two studies were conducted. Study One used qualitative methods to explore patients. expectations of the ED from the perspective of both patients and health care professionals. Study One was used in part to direct the development of the intervention (brochure) in Study Two. The brochure was an intervention designed to modify patients. expectations thus increasing their satisfaction with the provision of ED service. As there was no existing tools to measure ED patients. expectations and satisfaction a new tool was also developed based on the findings and the literature of Study One. Study Two used a non-randomised, quasi-experimental approach using a non-equivalent post-test only comparison group design used to investigate the effect of the patient education brochure (Stommel and Wills, 2004). The brochure was disseminated to one of two study groups (the intervention group). The effect of the brochure was assessed by comparing the data obtained from both the intervention and control group. These two groups consisted of 150 participants each. It was expected that any differences in the relevant domains selected for examination would indicate the effect of the brochure both on expectation and potentially satisfaction. Results: Study One revealed several areas of common ground between patients and nurses in terms of relevant content for the written intervention, including the need for information on the triage system and waiting times. Areas of difference were also found with patients emphasizing communication issues, whereas focus group members expressed concern that patients were often unable to assimilate verbal information. The findings suggested the potential utility of written material to reinforce verbal communication particularly in terms of the triage process and other ED protocols. This material was synthesized within the final version of the written intervention. Overall the results of Study Two indicated no significant differences between the two groups. The intervention group did indicate a significant number of participants who viewed the brochure of having changed their expectations. The effect of the brochure may have been obscured by a lack of parity between the two groups as the control group presented with statistically significantly higher levels of acuity and experienced significantly shorter waiting times. In terms of disconfirmation theory this would suggest expectations that had been met or exceeded. The results confirmed the correlation of expectations with satisfaction. Several domains also indicated age as a significant predictor with older patients tending to score higher satisfaction results. Other significant predictors of satisfaction established were waiting time and care from nurses, reinforcing the combination of efficient service and positive interpersonal experiences as being valued by patients. Conclusions: Information presented in written form appears to benefit a significant number of ED users in terms of orientation and explaining systems and procedures. The degree to which these effects may interact with other dimensions of satisfaction however is likely to be limited. Waiting time and interpersonal behaviours from staff also provide influential cues in determining satisfaction. Written material is likely to be one element in a series of coordinated strategies to improve patient satisfaction during periods of peak demand.

Family caregivers' ideal expectations of Canada's Compassionate Care Benefit

We present the findings of 57 interviews conducted in 2007-2008 with Canadians who have cared for a dying family member to examine their ideal expectations of the Compassionate Care Benefit (CCB) - a social programme providing job security and income support for workers caring for a dying person. Our aims are to (1) appreciate how intended users and other family caregivers view the programme's very nature; (2) identify programme challenges and improvements that emerge from considering family caregivers' ideal expectations; and (3) contribute to a larger evaluative study designed to make policy-relevant recommendations for CCB improvement. Review of transcripts across three respondent groups reveals four categories of ideal expectations: (1) eligibility, (2) informational, (3) timing and (4) financial. Ideal expectations were typically derived from respondents' experiences of care-giving, their knowledge of the programme and, for some, of applying for and/or receiving the CCB. Findings reveal that there are gaps between respondents' ideal expectations and their experienced realities. Such gaps may lead to disappointment being experienced by those who believe they should be eligible for the programme but are not, or should be entitled to receive some form of support that is not presently available. This analysis plays an important role in identifying potential changes for the CCB that may better support family caregivers, in that the ideal expectations serve as a starting point for articulating desirable programme amendments. This analysis also has wider relevance. For jurisdictions looking to create new social programmes to support caregivers based upon labour policy strategies and legislation, this analysis identifies considerations that should be made at the outset of development. For jurisdictions that already have employment-based caregiver support programmes, this analysis demonstrates that programme challenges may not always be met through legislative changes alone but also through measures such as increasing awareness. © 2011 Blackwell Publishing Ltd.

What aspects of rehabilitation provision contribute to self-reported met needs for rehabilitation one year after stroke - amount, place, operator or timing?

BACKGROUND AND OBJECTIVE: To a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self-reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke. METHODS: The participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self-reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home-based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset. RESULTS: Participants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd-4th quarters of the first year (OR 8.36, CI 1.40-49.88 P = 0.020) were more likely to report met rehabilitation needs. CONCLUSION: For people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self-reported met needs for rehabilitation.

Understanding student expectations in developing environmental science courses

Developing relevant and innovative University courses is a complex and often difficult task. This is particularly true when developing environmental science courses as the banner of environmental science has the potential to include an extremely vast array of subject material and course content. Added to this is the diversity of students entering these courses, and their associated course expectations and aspirations. A third component that cannot be ignored when developing courses includes employer demands and expectations of graduates at course completion. As tertiary educators we therefore have the challenge of developing innovative environmental science courses that are academically challenging, but meet the expectations of students, staff and potential future employers. To ensure that we meet this challenge it is vital that we determine the expectations of all relevant parties (students, staff, and potential employers) and develop our courses accordingly.  Here we report on the 'student expectations' component of this. To determine student expectations we conducted a survey of all commencing first year environmental science students. The survey asked students to provide information on drivers for course selection, preferred learning styles, the importance of different approaches to teaching, subject interest areas and employment aspirations. Our results found that environmental science students have a preference for fieldwork and hands-on experience and are very supportive of teaching that combines different teaching methods. On-line teaching was not supported by commencing environmental science students. Commencing students showed a very strong interest in key subject areas of environmental science such as Wildlife, animal conservation, national and marine parks, conservation and marine Wildlife; however, some of the critical areas of environmental science such as population statistics, social sciences and chemistry did not attract the same level of interest. Most commencing students had some idea on where they would like to gain employment on course completion. Knowledge relating to student expectations is Vital, particularly when designing courses, developing specific unit content and undertaking marketing and course information sessions. With this knowledge we can be confident that students enrolling in environmental science will, to a large extent, have their expectations met.

What did they expect? Exploring a link between students’ expectations, attendance and attrition on English language enhancement courses

This article reports on and discusses the findings of an investigationcarried out to explore the expectations of an English language enhancementcourse (ELEC) held by a group of undergraduate students at anAustralian university. For the study, a mixed-methods approach was utilised,with two instruments: a survey with a combination of closed- andopen-ended questions and semi-structured interviews. The research wasguided by the following three questions: (1) What do the students expectto learn on the course? (2) How are they developing their expectations?(3) Are the students’ expectations being met? The literature concerningstudent expectations foregrounds the complexity and multi-faceted natureof the concept, the satisfaction of which can impact on student engagement,satisfaction, performance, retention and attrition. Findings showthat the participants’ expectations of the course content and teachingstaff were largely met; nonetheless, a lack of class attendance was notedthroughout. Expectations were reported to have been developed largelythrough consultation with previous students of the course (43 per cent)and information materials provided by the university (42 per cent). Thearticle concludes with a discussion regarding the implications of thefindings for universities and education providers both in Australia andabroad.