Conectar
by Isabel Baltzan, Lisa Merry, William Fraser, Sonia Semenic, Sandra Pelaez, Alexis Edington, Ayesha Baig, Anita Gagnon
ObjectiveWe assessed the extent to which recommended migrant-friendly maternity care (MFMC) components were provided to recently-arrived international migrants giving birth in Montreal, Canada, and the extent to which the provision of MFMC components was related to socioeconomic and migratory characteristics.
MethodsWe conducted a cross-sectional study of migrant women giving birth in four hospitals in 2014–2015. Data were collected using the Migrant-Friendly Maternity Care Questionnaire (MFMCQ), focusing on access to prenatal care, communication facilitation, healthcare provider (HCP) support, and responsiveness to preferences for care. Data were analyzed descriptively and through logistic regression.
ResultsOf 2636 participants, most reported always being kept informed (86.1%) and finding HCPs helpful (90.3%), although 22.9% reported barriers to accessing services during pregnancy, and only 11% or less were asked about care preferences. Of 847 needing interpreters, 84.7% reported not being offered any. Worse access to prenatal care was reported among women who had arrived more recently [OR 0.55, 95% CI 0.36, 0.85], had lower income [0.69 (0.52, 0.90)], or had less education [0.66 (0.47, 0.94)]. Low language ability was most often associated with inadequate MFMC [e.g., worse HCP support during pregnancy [0.56 (0.36, 0.87)] and worse responsiveness to preferences for care during labour [0.55 (0.31, 0.98)]]. Maternal region of birth was associated both positively and negatively with all MFMC components.
ConclusionAlthough some MFMC has been implemented, gaps remain. Addressing language barriers remains a top priority. To deliver optimal MFMC, HCPs and policymakers should provide care that is responsive to women’s socioeconomic and migratory backgrounds.
To assess the implementation feasibility and acceptability of a structured digital psychosocial communication tool (DIALOG+) to strengthen the quality of person-centric care in psychiatric settings within Pakistan and India.
A hybrid inductive and thematic qualitative analysis using individual interviews (IDIs) and focus group discussions (FGDs).
Two psychiatric hospitals (Karwan-e-Hayat and Jinnah Postgraduate Medical Centre) in Karachi, Pakistan and one psychiatric care organisation (Schizophrenia Research Foundation) in Chennai, India
Interviews were conducted with 8 mental health clinicians and 40 patients who completed the DIALOG+ pilot as well as wider stakeholders, that is, 12 mental health clinical providers, 15 caregivers of people with psychosis and 13 mental health experts.
A technology-assisted communication tool (DIALOG+) to structure routine meetings and inform care planning, consisting of monthly sessions over a period of 3 months. The intervention comprises a self-reported assessment of patient satisfaction and quality of life on eight holistic life domains and three treatment domains, followed by a four-step solution-focused approach to address the concerns raised in chosen domains for help.
Key insights for the implementation feasibility and acceptability of DIALOG+ were assessed qualitatively using inductive thematic analysis of 22 IDIs and 8 FGDs with 54 individuals.
Clinicians and patients ascribed value to the efficiency and structure that DIALOG+ introduced to consultations but agreed it was challenging to adopt in busy outpatient settings. Appointment systems and selective criteria for who is offered DIALOG+ were recommended to better manage workload. Caregiver involvement in DIALOG+ delivery was strongly emphasised by family members, along with pictorial representation and relevant life domains by patients to enhance the acceptability of the DIALOG+ approach.
Findings highlight that the feasibility of implementing DIALOG+ in psychiatric care is closely tied to strategies that address clinician workload. Promoting institutional ownership in strengthening resource allocation is essential to reduce the burden on mental health professionals in order to enable them to provide more patient-centric and holistic care for people with psychosis. Further research is required to explore the appropriateness of including caregivers in DIALOG+ delivery to adapt to communal cultural attitudes in South Asia.
To critically assess the impact of theory-guided positive psychological interventions on the quality of life of breast cancer patients and survivors.
Systematic review and meta-analysis.
A comprehensive literature search was conducted across seven electronic databases from inception to August 2024. Randomised controlled trials that examined the effects of theory-guided positive psychological interventions on adult breast cancer patients or survivors and reported quality of life outcomes were included. Screening, data extraction and critical appraisal were independently performed by the reviewers using the revised Cochrane risk-of-bias tool (RoB2). A meta-analysis was conducted using RevMan Web. The study was reported following the PRISMA 2020 Statement.
Five randomised controlled trials were included. Only two of these studies showed a low risk of bias across all quality measures. The meta-analysis demonstrated a significant improvement in quality of life following theory-guided positive psychological interventions, with low heterogeneity. Subgroup analyses revealed that interventions lasting either less than or longer than 3 weeks, and both group-based and individual-based formats, had positive effects on quality of life. Additional psychological benefits were observed including reductions in depressive symptoms, anxiety, perceived stress and improvements in post-traumatic growth, resilience, hope and perceived benefits. One study also reported improvements in sleep quality.
The findings demonstrate that theory-guided positive psychological interventions can potentially significantly improve quality of life in breast cancer patients. However, the limited number of studies underscores the need for further high-quality research to validate these findings and identify the most effective intervention characteristics.
Our systematic review highlights that theory-guided positive psychological interventions show promise as an effective strategy for improving the quality of life in breast cancer patients. These interventions can enhance psychosocial support strategies, paving the way for better-informed approaches that lead to improved patient outcomes.
No patient or public contribution.
The systematic review and meta-analysis had been registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration ID number: CRD42024581382
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