Barriers and enablers affecting patient engagement in managing medications within specialty hospital settings

Background : Communication problems contribute enormously to medication errors and adverse events. Encouraging patient engagement can help to facilitate effective medication management.

Objectives : To examine barriers and enablers affecting how patients engage with managing their medications in specialty hospital settings.

Design : An exploratory qualitative design was used involving in-depth interviews with doctors, nurses, pharmacists, patients and family members.

Setting : An Australian public, metropolitan teaching hospital was the study site and five specialty hospital settings were used, including cardiac care, emergency care, intensive care, oncology care and perioperative care.

Results : In all, 21 health professionals, 11 patients and 12 family members participated in the study (n = 44). Barriers and enablers involved intrapersonal, interpersonal and environmental aspects, and differences in perceptions and experiences were found between the various settings. Health professionals had preconceived notions of what was appropriate behaviour in conveying information about medications. Many health professionals stated that they deliberately chose not to provide medication-related knowledge. Different barriers for patient engagement existed in various settings – in emergency care, patients could only stay for 4 h; in intensive care, medication changes regularly happened; in cardiac care, patients were discharged prematurely due to urgent need of beds; in oncology, there was lack of availability of oncology consultants; while in perioperative care, surgeons and anaesthetists were available just before surgery.

Conclusions : Complex barriers and enablers are associated with patient engagement in specialty clinical settings. By developing an understanding of these barriers and enablers, health professionals can help patients to understand and participate in their medication management.

'Ecological embeddedness' and its public health implications: findings from an exploratory study

Western culture over the last two centuries has become significantly ecologically 'dis-embedded', with nature increasingly reduced to resources for human use. The consequence is global environmental degradation, including accelerating climate change. Much recent research supports associations between nature contact and human health and well-being, and between feelings of nature-connectedness and pro-environmental attitudes and behaviours. The oft-cited Ottawa Charter for Health Promotion (WHO, Ottawa Charter for Health Promotion, 1986) emphasises human-environment inextricability; however public health discourse and response has not fully engaged with this recognition. This qualitative study explored the attitudes, motivations, and experiences-including formative influences-of six individuals whose behaviour was congruent with recognition of human-nature interconnectedness; such individuals may be understood as ecologically embedded. Key aspects of participants' experience, identified through grounded theory thematic analysis, were (i) connecting with nature (especially in childhood); (ii) seeing the threat and taking it personally; (iii) the nature of reality; (iv) dedicated beyond the ego-oriented self; and (v) sustaining the eco-centric self. The findings highlight the necessity for cross-sectoral advocacy at all levels of government policy development focused on recognition of human-environment connectedness, especially bridging health, planning and education policies affecting children. Only thus will both population health and ecological health on which population health depends be possible.

An evaluation of the role of green marketing and a firm's internal practices for environmental sustainability

The management of a firm's green operations is increasingly important for marketing strategists. The purpose of this study is to investigate the cross-influences of green marketing strategy and the key internal green functional areas in a firm. We use the antecedents of marketing strategy and identify relationships between green marketing strategy and key supporting internal environmental operations of firms with respect to (1) green suppliers, (2) environmental resource management, (3) green research and development, and (4) environmental manufacturing processes and procedures. The statistical techniques of parallel analysis, factor analysis and multiple regressions are used to analyze data collected from 332 firms. The results identify that among the four functional areas of firms adopting green marketing strategy. Two are more likely to influence green marketing strategy – supplier selection and research and development. Implications are discussed. The findings contribute to the theory of green marketing strategy. Future research is recommended.

Food concerns and support for environmental food policies and purchasing.

Consumer support for pro environmental food policies and food purchasing are important for the adoption of successful environmental policies. This paper examines consumers' views of food policy options as their predisposition to purchase pro environmental foods along with their likely demographic, educational and cognitive antecedents including food and environmental concerns and universalism values (relating to care for others and the environment). An online survey to assess these constructs was conducted among 2204 Australian adults in November 2011. The findings showed strong levels of support for both environmental food policies (50%-78% support) and pro environmental food purchasing (51%-69% intending to purchase pro environmental foods). Confirmatory factor analysis and structural equation modelling showed that different cognitive mediators exist along pathways between demographics and the two outcome variables. Support for food policy was positively related to food and environment concerns (std. Beta = 0.25), universalism (0.41), perceived control (0.07), and regulatory issues (0.64 but negatively with food security issues (-0.37). Environment purchasing intentions were positively linked to food and nutrition concerns (0.13), food and environment concerns (0.24), food safety concerns (0.19), food and animal welfare concerns (0.16), universalism (0.25), female gender (0.05), education (0.04), and perceived influence over the food system (0.17). In addition, health study in years 11 and 12 was positively related to the beginning of both of these pathways (0.07 for each). The results are discussed in relation to the opportunities that communications based on the mediating variables offer for the promotion of environmental food policies and purchasing.

Political competition and environmental reporting: evidence from New Zealand local governments

Purpose - The purpose of this paper is to investigate the relationship between "political competition" and "environmental reporting" by New Zealand local governments. Design/methodology/approach - The research method includes a longitudinal analysis of environmental reporting by New Zealand local governments in their annual reports for the financial years 2005-2006 to 2009-2010. "Content analysis" was used to attach scores to the extent of environmental reporting. The "number of candidates divided by the number of available positions at the previous election" was used as the proxy for "political competition". Findings - The study reports a positive relationship between "political competition" and "environmental reporting" in 2007-2008. The number of local governments reporting voluntary environmental information increased in 2006-2007 and 2007-2008 compared to 2005-2006, followed by a reduction in such numbers following the 2007-2008 financial year. This trend in disclosure can be attributed to the local government elections in October 2007. This finding is consistent with the expectation of "agency theory" and provides insight into the pattern of perceived agency costs. The study also finds a dearth in reporting "monetary" and "bad" news. Originality/value - The study contributes towards the previous literature on environmental reporting by concentrating on the public sector and New Zealand, together with investigating the relationship of such reporting with "political competition" through a longitudinal analysis. The theoretical contribution of this study is the adoption of "agency theory" in the context of public sector voluntary reporting and investigating the significance attached by agents to environmental reporting to minimise agency cost. The practical contribution of the study is in the area of future development of reporting standards in regards to environmental reporting.

Environmental contributions to social and mental health outcomes following pediatric stroke

Mental health and social outcomes following acquired brain injury (ABI) in children are often considered to be due to brain insult, but other factors, such as environment, may also play a role. We assessed mental health and social function in children with chronic illness, with and without stroke (a form of ABI), and typically developing (TD) controls to examine environmental influences on these outcomes. We recruited 36 children diagnosed with stroke, 15 with chronic asthma, and 43 TD controls. Children and parents completed questionnaires rating child mental health and social function and distal and proximal environment. TD children had significantly less internalizing and social problems than stroke and asthma groups, and engaged in more social activities than children with stroke. Poorer parent mental health predicted more internalizing and social problems and lower social participation. Family dysfunction was associated with internalizing problems. Lower parent education contributed to children's social function. Children with chronic illness are at elevated risk of poorer mental health and social function. Addition of brain insult leads to poorer social participation. Quality of home environment contributes to children's outcomes, suggesting that supporting parent and family function provides an opportunity to optimize child mental health and social outcomes.

An evaluation of the role of green marketing and a firm's internal practices for environmental sustainability

The management of a firm's green operations is increasingly important for marketing strategists. The purpose of this study is to investigate the cross-influences of green marketing strategy and the key internal green functional areas in a firm. We use the antecedents of marketing strategy and identify relationships between green marketing strategy and key supporting internal environmental operations of firms with respect to (1) green suppliers, (2) environmental resource management, (3) green research and development, and (4) environmental manufacturing processes and procedures. The statistical techniques of parallel analysis, factor analysis and multiple regressions are used to analyze data collected from 332 firms. The results identify that among the four functional areas of firms adopting green marketing strategy. Two are more likely to influence green marketing strategy – supplier selection and research and development. Implications are discussed. The findings contribute to the theory of green marketing strategy. Future research is recommended.

Measures of environmental correlates of physical activity for urban Chinese preschool-aged children: development and reliability

We adapted/developed and examined the test–retest reliability and internal consistency of eight parent-report measures of home and neighborhood environmental correlates of physical activity appropriate for Chinese preschool-aged children and their parents/primary caregivers living in densely populated urban environments. This study consisted of a qualitative (cognitive interviews) and a quantitative (test–retest reliability) component. Chinese versions of the measures were pilot-tested on 20 parents of Hong Kong preschool-aged children using cognitive interviews. Measures were then administered to 61 parents twice, 1 week apart. Test–retest reliability and internal consistency were computed. Except for two items, the test–retest reliability of items and scale summary scores ranged from moderate to excellent. The internal consistency of the measures exceeded recommended minimal values (Cronbach’s α >.70). The parent-report measures examined in this study are potentially appropriate for use in investigations of environmental correlates of the physical activity of Chinese preschool-aged children living in densely populated urban environments. However, their predictive validity with respect to Chinese preschool-aged children’s physical activity needs to be assessed in future studies.

Complex responses of birds to landscape-level fire extent, fire severity and environmental drivers

Aim: To quantify bird responses to a large unplanned fire, taking into consideration landscape-level fire severity and extent, pre-fire site detection frequency and environmental gradients. Location: South-eastern Australia. Methods: A major wildfire in 2009 coincided with a long-term study of birds and provided a rare opportunity to quantify bird responses to wildfire. Using hierarchical Bayesian analysis, we modelled bird species richness and the detection frequency of individual species in response to a suite of explanatory variables, including (1) landscape-level fire severity and extent (2) pre-fire detection frequency, (3) site-level vegetation density and (4) environmental variables (e.g. elevation and topography). Results: Landscape-level fire severity had strong effects on bird species richness and the detection frequency of the majority of bird species. These effects varied markedly between species; most responded negatively to amount of severely burned forest in the landscape, one negatively to the amount of moderately burned forest and one responded negatively to the total area of burned forest. Only one species - the Flame Robin - responded positively to the amount of burned forest. Relationships with landscape-scale fire extent changed over time for one species - the Brown Thornbill - with initially depressed rates of detection recovering after just 2 years. The majority of species were significantly more likely to be detected in burned areas if they have been recorded there prior to the fire. Main conclusions: Birds responded strongly to the severity and spatial extent of fire. They also exhibited strong site fidelity even after severe wildfire which causes profound changes in vegetation cover - a response likely influenced by environmental features such as elevation and topography.

Psychological health and lifestyle management preconception and in pregnancy

Healthful lifestyles before and during pregnancy are important to facilitate healthy outcomes for mother and baby. For example, behaviors such as a sedentary lifestyle and consuming an energy-dense/nutrient-poor diet increase the risk of overweight/obesity before pregnancy and excessive weight gain during pregnancy, leading to adverse maternal and child health outcomes. Maternal psychopathology may be implicated in the development of suboptimal maternal lifestyle behaviors before and during pregnancy, perhaps through impacts on motivation. This article explores this notion using maternal obesity and excessive gestational weight gain as examples of the health impacts of psychological states. We suggest that factors such as psychological well-being, individual motivation for behavior change, and broader environmental influences that affect both individual and system-wide determinants all play important roles in promoting healthy lifestyles periconception and are key modifiable aspects for intervention designers to consider when trying to improve dietary behaviors and increase physical activity before and during pregnancy. In addition, implementing system-wide changes that impact positively on individual and environmental barriers to behavior change that are sustainable, measureable, and effective is required.

Impact of patient and environmental factors on capillary refill time in adults

OBJECTIVES: Capillary refill time (CRT) has been taught as a rapid indicator of circulatory status. The aim of this study was to define normal CRT in the Australian context and the environmental, patient, and drug factors that influence it.

METHODS: This prospective observational study included healthy adults at hospital clinics, workplaces, universities, and community groups. Volunteer participants provided their age, sex, ethnic group, and use of hypertensive or cardiac medications. Capillary refill time, ambient temperature, and patient temperature were recorded in a standard manner. Data were analyzed using descriptive statistics and regression analyses. The 95th percentile was used to define the upper limit of normal.

RESULTS: One thousand participants were included; 57% were women, 90% were white, and 21% were taking cardiac medications. The median CRT was 1.9 seconds (95th percentile, 3.5 seconds). The CRT increased 3.3% for each additional decade of age. The CRT was also on average 7% lower in men than in women. The CRT decreased by 1.2% per degree-Celsius rise of ambient temperature, independently of patient's temperature, and decreased by 5% for each degree-Celsius rise in patient temperature, independently of ambient temperature. On multivariant analysis, age, sex, ambient temperature, and patient temperature were statistically significant predictors of CRT, but together explain only 8% of the observed variability.

CONCLUSION: Capillary refill time varies with environmental and patient factors, but these account for only a small proportion of the variability observed. Its suitability as a reliable clinical test is doubtful.