Relieved after Doctor's Consultation? Primary Health Care Patients' Complaint-related Worries

Worry is one of the central factors in primary health care patients’ experience with their current complaint. Worry is associated with, e.g., patients’ expectations and the outcomes of doctor’s consultations. The aim of this study was to explore primary health care patients’ complaint-related worry and its changes, as well as contributing factors. Furthermore, the reasons behind patients’ pre-consultation worry and possible relief were examined. The study was conducted in a public primary health care centre in Forssa in Southern Finland. Patients, aged 18–39 years, with a current complaint were interviewed before and after a doctor’s consultation. The patients’ characteristics, perceptions of their complaint and their expectations and experiences concerning the consultation were obtained through interviews. In addition, two questionnaires were administered to measure general tendency to illness worry (IWS) and psychiatric symptoms (SCL-90). The patients’ ratings of the intensity of worry and the severity of their complaint were measured with a visual analogue scale (VAS 0–100). Changes in worry were measured by comparing pre- and post-consultation VAS ratings and asking the patients to compare their worry after the consultation with the worry they felt before it. In connection with these ratings the patients also gave reasons for their experiences in their own words. The patients’ doctors assessed the medical severity of the complaints and whether they had found a medical explanation for the complaints. Many patients were very worried before the consultation (65 % scored over 50 points on the VAS). Worry and severity ratings were associated with the duration and course of the complaint, with a general tendency to illness worry and hostility. On average, the patients were less worried after the consultation than before it. Persistent worry was associated with the patients’ uncertainty about their complaint, their perceiving it as severe, expectations for examinations and reporting symptoms of anxiety. Patients were most often worried about the nature of their complaint (e.g. duration or intensity), not knowing what was wrong, the possible harmful effects of the complaint on body functions, the complaint’s prognosis, e.g. will it get better, and their ability to function. Patients were relieved by getting an explanation or treatment or by having a positive view of the complaint’s prognosis. Patients who reported uncertainty (lack of an explanation, worry about the nature of the complaint) or worry about the complaint’s possible bodily harmfulness were relieved by getting an explanation, often accompanied with getting treatment. On the other hand, worries about the ability to function tended to persist. Doctors should bring up patients’ worries for discussion in order to be able to respond to them appropriately. Because it tends to persist, worry about the ability to function should be addressed. Uncertain patients with concerns about their complaint’s bodily harmfulness or psychological consequences need special attention from their doctor.

Exploring Customer-Oriented Service Offerings in Public Health: Developing Integrated Health Care Services for Rural Areas

Väestön ikääntyminen pakottaa yhteiskunnan ja julkisen terveydenhuollon muutoksiin. Jotta ikääntyvien ihmisten kotona asuminen voidaan mahdollistaa, palvelujärjestelmän pitää mukautua muuttuvaan tilanteeseen. Tämän diplomityön tarkoituksena on tunnistaa asiakaslähtöisiä lähellä asiakasta tarjottavia palvelukokonaisuuksia. Tutkimuksen teoreettinen viitekehys muodostuu asiakasarvon luomisesta ja palvelutarjoamista. Tarkasteluryhmänä on Etelä-Karjalan alueen 60–90-vuotiaat ja käytetty aineisto on kerätty vastaajilta postitse lähetetyllä kyselyllä. Tutkimus on eksploratiivinen ja tulosten tulkinnassa on hyödynnetty määrällisen tutkimuksen ja verkostoanalyysin menetelmiä. Työn keskeisimmät tulokset ovat tunnistetut asiakassegmentit ja heidän tarpeidensa pohjalta muodostetut palvelupaketit. Tulokset indikoivat asiakkaiden tarpeita ja tuloksia on analysoitu myös tuottajan näkökulmasta. Empiiristen tulosten lisäksi teoriaviitekehystä on kehitetty eteenpäin, jotta palvelukeskeiset teoriat voidaan ymmärtää yritysten näkökulman lisäksi asiakkaan näkökulmasta.

Innovation in a Non-Formal Adult Education Organisation – Multi-Case Study in Four Adult Education Centres

More than ever, education organisations are experiencing the need to develop new services and processes to satisfy expanding and changing customer needs and to adapt to the environmental changes and continually tightening economic situation. Innovation has been found in many studies to have a crucial role in the success of an organisation, both in the private and public sectors, in formal education and in manufacturing and services alike. However, studies concerning innovation in non-formal adult education organisations, such as adult education centres (AECs) in Finland, are still lacking. This study investigates innovation in the non-formal adult education organisation context from the perspective of organisational culture types and social networks. The objective is to determine the significant characteristics of an innovative non-formal adult education organisation. The analysis is based on data from interviews with the principals and fulltime staff of four case AECs. Before the case study, a pre-study phase is accomplished in order to obtain a preliminary understanding of innovation at AECs. The research found strong support for the need of innovation in AECs. Innovation is basically needed to accomplish the AEC system’s primary mission mentioned in the ACT on Liberal Adult Education. In addition, innovation is regarded vital to institutes and may prevent their decline. It helps the institutes to be more attractive, to enter new market, to increase customer satisfaction and to be on the cutting edge. Innovation is also seen as a solution to the shortage of resources. Innovative AECs search actively for additional resources for development work through project funding and subsidies, cooperation networks and creating a conversational and joyful atmosphere in the institute. The findings also suggest that the culture type that supports innovation at AECs is multidimensional, with an emphasis on the clan and adhocratic culture types and such values as: dynamism, future orientation, acquiring new resources, mistake tolerance, openness, flexibility, customer orientation, a risk-taking attitude, and community spirit. Active and creative internal and external cooperation also promote innovation at AECs. This study also suggests that the behaviour of a principal is crucial. The way he or she shows appreciation the staff, encouragement and support to the staff and his or her approachability and concrete participation in innovation activities have a strong effect on innovation attitudes and activities in AECs.

Adult education policy in the European Union during the Lisbon decade : the shift to vocational adult learning and work skills matching

This doctoral dissertation investigates the adult education policy of the European Union (EU) in the framework of the Lisbon agenda 2000–2010, with a particular focus on the changes of policy orientation that occurred during this reference decade. The year 2006 can be considered, in fact, a turning point for the EU policy-making in the adult learning sector: a radical shift from a wide--ranging and comprehensive conception of educating adults towards a vocationally oriented understanding of this field and policy area has been observed, in particular in the second half of the so--called ‘Lisbon decade’. In this light, one of the principal objectives of the mainstream policy set by the Lisbon Strategy, that of fostering all forms of participation of adults in lifelong learning paths, appears to have muted its political background and vision in a very short period of time, reflecting an underlying polarisation and progressive transformation of European policy orientations. Hence, by means of content analysis and process tracing, it is shown that the new target of the EU adult education policy, in this framework, has shifted from citizens to workers, and the competence development model, borrowed from the corporate sector, has been established as the reference for the new policy road maps. This study draws on the theory of governance architectures and applies a post-ontological perspective to discuss whether the above trends are intrinsically due to the nature of the Lisbon Strategy, which encompasses education policies, and to what extent supranational actors and phenomena such as globalisation influence the European governance and decision--making. Moreover, it is shown that the way in which the EU is shaping the upgrading of skills and competences of adult learners is modeled around the needs of the ‘knowledge economy’, thus according a great deal of importance to the ‘new skills for new jobs’ and perhaps not enough to life skills in its broader sense which include, for example, social and civic competences: these are actually often promoted but rarely implemented in depth in the EU policy documents. In this framework, it is conveyed how different EU policy areas are intertwined and interrelated with global phenomena, and it is emphasised how far the building of the EU education systems should play a crucial role in the formation of critical thinking, civic competences and skills for a sustainable democratic citizenship, from which a truly cohesive and inclusive society fundamentally depend, and a model of environmental and cosmopolitan adult education is proposed in order to address the challenges of the new millennium. In conclusion, an appraisal of the EU’s public policy, along with some personal thoughts on how progress might be pursued and actualised, is outlined.

Mobile clinics in public health care: Integrated service offerings for rural elderly

This research is an analysis of the value and content of local service offerings that enable longer periods of living at home for elderly people. Mobile health care and new distribution services have provided an interesting solution in this context. The research aim to shed light on the research question, ‘How do we bundle services based on different customer needs?’ A research process consisting of three main phases was applied for this purpose. During this process, elderly customers were segmented, the importance of services was rated and service offerings were defined. Value creation and service offering provides theoretical framework for the research. The target group is South Karelia’s 60 to 90-year old individuals and the data has been acquired via a postal questionnaire. Research has been conducted as exploratory research utilizing the methods of quantitative and social network analysis. The main results of the report are identified customer segments and service packages that fits to the segments’ needs. The results indicate the needs of customers and the results are additionally analysed from the producer’s point of view. In addition to the empirical results, the used theory framework has been developed further in order for the service-related theories to be seen from the customer’s point of view and not just from the producer’s point of view.

Worldview awareness and adult education /

This research derived data from two sets of interviews with 18 participants who were involved in adult education in either a community college or a university. The purpose was to explore their worldview awareness. Through the interviews, the participants shared their understanding of worldview as a term and concept and as something that might be seen to apply in their practice of teaching. The responses indicated that there are three kinds of awareness (noetic, experiential, and integrative) which appeared to develop upon a landscape of constraints and opportunities. Constraints were seen to fall into the 5 broad categories of institutional, circumstantial, self-imposed, other-imposed, and discipline-related constraints. Opportunities for developing awareness were linked to individual experiences and could occur to different extents in many directions, on different occasions, and in different phases of life. Through this research, and in spite of the prevalence of worldview in the human experience, it was foimd that the term and concept have remained on the margins of educational discourse. Consequently, theory, research, and practice have been deprived of a useful and usable concept.

Supporting and maximizing communication between individuals with intellectual disabilities and health care providers

The goal of the present study was to examine the barriers to access in health services faced by individuals with intellectual disabilities (ID), as well as the nature of communication between people with ID and those who are directly involved in supporting their health and well being. The study included in-depth interviews with five adults who have been identified as having ID and are supported by a community agency, five community agency support staff and four physicians who are specialists in supporting people who have ID. A qualitative content analysis approach facilitated the comparative exploration of key themes that each participant group saw as positive or negative influences on health care access and on effective health care communication. Themes drawn from the findings emphasize the unique roles each of these groups plays within the dialogical framework of the health care encounter. Of particular importance to informants was the issue of people with ID being seen as full participants in their own health care who, like all people, are unique individuals and not simply members of an identified or marginalized group. Participants across groups emphasized the need for the health care recipient to be known as an individual who is an expert in her/his own health and well being and, therefore, entitled to full participation with the support of but not control by others.

Predictors of primary health care utilization by former residents of institutions in Ontario

For years institutionalization has been the primary method of service delivery for persons with developmental disabilities (DD). However, in Ontario the last institution was closed on March 31, 2009 with former residents now residing in small, communitybased homes. This study investigated potential predictors of primary health care utilization by former residents. Several indirect measures were employed to gather information from 60 participants on their age, health status, adaptive functioning level, problem behaviour, mental health status and, total psychotropic medication use. A direct measure was used to gather primary health care utilization information, which served as the dependent variable. A stepwise linear regression failed to reveal significant predictors of health care utilization. The data were subsequently dichotomized and the outcomes of a logistic regression analysis indicated that mental health status, psychotropic medication use and, an interaction between mental health status and health status significantly predicted higher primary health care usage.