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Our aim was to explore peer counselors' work and their role in supporting patients' adherence to antiretroviral treatment (ART) in resource-limited settings in Ethiopia and Uganda. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Two main categories with related subcategories emerged from the analysis. The first main category, peer counselors as facilitators of adherence, describes how peer counselors played an important role by acting as role models, raising awareness, and being visible in the community. They were also recognized for being close to the patients while acting as a bridge to the health system. They provided patients with an opportunity to individually talk to someone who was also living with HIV, who had a positive and life-affirming attitude about their situation, and were willing to share personal stories of hope when educating and counseling their patients. The second main category, benefits and challenges of peer counseling, deals with how peer counselors found reward in helping others while at the same time acknowledging their limitations and need of support and remuneration. Their role and function were not clearly defined within the health system and they received negligible financial and organizational support. While peer counseling is acknowledged as an essential vehicle for treatment success in ART support in sub-Saharan Africa, a formal recognition and regulation of their role should be defined. The issue of strategies for disclosure to support adherence, while avoiding or reducing stigma, also requires specific attention. We argue that the development and implementation of support to peer counselors are crucial in existing and future ART programs, but more research is needed to further explore factors that are important to sustain and strengthen the work of peer counselors. [ABSTRACT FROM AUTHOR]

The objective was to explore and describe nursing staff's body awareness and communication in patient transfers and evaluate any changes made after an educational intervention to promote staff competence in guiding patients to move independently. In total, 63 nursing staff from two hospitals wrote weekly notes before and after the intervention. The topics were: A) reflect on a transfer during the last week that you consider was good and one that was poor; B) reflect on how your body felt during a good and a poor transfer. The notes were analysed with content analysis. The results showed five different communication modes connected with nursing staff's physical and verbal communication. These communication modes changed after 1 year to a more verbal communication, focusing on the patient's mobility. The use of instructions indicated a new or different understanding of patient transfer, which may contribute to a development of nursing staff's competence. Statement of Relevance: The present findings indicate that patient transfer consists of communication. Therefore, verbal and bodily communication can have an integral part of training in patient transfer; furthermore, the educational design of such programmes is important to reach the goal of developing new understanding and enhancing nursing staff's competence in patient transfer. [ABSTRACT FROM AUTHOR]

This paper explores HIV patients' adherence to antiretroviral treatment (ART) in resource-limited contexts in Uganda and Ethiopia, where ART is provided free of charge. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Interviewees voiced their experiences of, and views on ART adherence both from an individual and a system level perspective. Two main themes emerged from the content analysis: “Patients' competing costs and systems' resource constraints” and “Patients' trust in ART and quality of the patient-provider encounters.” The first theme refers to how patients' adherence was challenged by difficulties in supporting themselves and their families, paying for transportation, for drug refill and follow-up as well as paying for registration fees, opportunistic infection treatment, and expensive referrals to other hospitals. The second theme describes factors that influenced patients' capacity to adhere: personal responsibility in treatment, trust in the effects of antiretroviral drugs, and trust in the quality of counseling. To grant patients a fair choice to successfully adhere to ART, transport costs to ART facilities need to be reduced. This implies providing patients with drugs for longer periods of time and arranging for better laboratory services, thus not necessitating frequent revisits. Services ought to be brought closer to patients and peripheral, community-based healthworkers used for drug distribution. There is a need for training providers and peer counselors, in communication skills and adherence counseling. [ABSTRACT FROM AUTHOR]

In this qualitative study, women's perceptions and experiences of the quality of family planning services at public primary health centres were explored in the city of Tabriz, Iran. Nine focus group discussions were carried out with a total of 53 married women of reproductive age. The public services were appreciated for being accessible and affordable, but important shortcomings were identified. The need for improved privacy, a wider choice of contraceptive methods and accurate and more comprehensive information about methods and side effects were stressed. The issue of marital counselling was raised as an important unmet need, especially in one discussion group. The women's sense of having the right to make autonomous, informed choices and to be treated with dignity and respect emerged as the main theme. A second, cross-cutting theme was their wish for their husbands to be more strongly involved in family planning and marital counselling and education. Women's experiences and suggestions for improvements in service delivery should be considered in future plans. Multifaceted interventions are needed to narrow the existing gap between women's needs and rights and the actual quality of services. Cette étude qualitative a analysé la façon dont les femmes voient la qualité des services de planification familiale et leur expérience dans les centres de santé primaires dans la ville iranienne de Tabriz. Neuf discussions de groupes ont été menées avec 53 femmes mariées en âge de procréer. Ces femmes appréciaient les services publics car ils étaient accessibles et abordables. Mais elles ont cité d'importantes lacunes, notamment la nécessité d'améliorer le respect de la vie privée, d'élargir le choix de méthodes contraceptives et de donner une information exacte et plus détaillée sur les méthodes et les effets secondaires. La question du conseil conjugal a été soulevée comme besoin insatisfait majeur, particulièrement dans un groupe de discussion. Le fait que les femmes estiment avoir le droit de faire des choix autonomes et éclairés, et d'être traitées avec dignité et respect est apparu comme le thème principal. Un second thème transversal était leur souhait que les maris participent plus activement à la planification familiale et aux séances d'éducation et de conseil conjugal. Les plans futurs devront tenir compte des expériences et des suggestions des femmes en vue d'améliorer la prestation des services. Des interventions à plusieurs facettes sont nécessaires pour combler l'écart entre les besoins et les droits des femmes, et la qualité réelle des services. En este estudio cualitativo, se exploraron las percepciones y experiencias de las mujeres respecto a la calidad de los servicios de planificación familiar en centros de salud pública del primer nivel de atención, en la ciudad de Tabriz, en Irán. Se realizaron nueve discusiones en grupos focales con un total de 53 mujeres casadas, en edad reproductiva, quienes agradecieron que los servicios públicos fueran accesibles, a precios asequibles, pero identificaron importantes deficiencias. Se hizo hincapié en la necesidad de más privacidad, una variedad más amplia de métodos anticonceptivos e información exacta y más completa sobre los métodos y efectos secundarios. La consejería matrimonial se destacó como una importante necesidad insatisfecha, especialmente en uno de los grupos de discusión. Como tema principal surgió el sentir de las mujeres de que tienen derecho de tomar decisiones informadas y autónomas y de ser tratadas con dignidad y respeto. Un segundo tema transversal fue su deseo de que sus esposos participaran más en la planificación familiar y en la consejería y educación matrimonial. Las experiencias y sugerencias de las mujeres en cuanto a mejorías en la prestación de servicios deben considerarse en futuros planes. Se necesitan intervenciones multifacéticas para reducir la brecha actual entre las necesidades y derechos de las mujeres y la calidad de los servicios. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the effects of a half-day course in Natural Mobility, which is an interactive instruction method in patient-transfer. A physiotherapist communicates her tacit knowledge to caregivers, who learn how to understand and improve verbal and non-verbal communication to get patients move themselves. Two hundred and twelve caregivers responded to three questionnaires before the course and 4-5 months and one year after the course respectively. The questions ad dressed the number of transfer methods the staff used, whether they changed their use of methods, how the strain of work was affected, and how satisfied they were with their way of assisting patient-transfer. The results showed that sixty-eight percent had changed their use of methods and the change remained one year after the course. The strain experienced was significantly reduced 4-5 months after the course and this reduction was retained one year later. Work satisfaction showed a significant increase; which was retained one year after the course. The changes in working habits were few, but retained, and comments indicated that the treatment of the patients had changed. Natural Mobility training appears to be a useful complement to the patient-transfer methods used today, by involving physiotherapist's tacit knowledge in the training of health care staff. [ABSTRACT FROM AUTHOR]

Objective - To identify and describe variations in ways of experiencing asthma management among general practitioners (GPs) in Sweden. Design - Descriptive and explorative study using a phenomenographic approach. Semi-structured tape-recorded face-to-face interviews, focusing on the GP's own experiences regarding asthma management. Setting - Primary health care. Subjects - Twenty GPs (12 men, eight women) from 16 health centres in seven counties in central Sweden, 15 from rural areas and small cities and five from medium sized cities or Stockholm suburbs. Main outcome measures - Descriptions of ways of experiencing asthma management. Results - Four categories were identified, which described qualitatively different ways of experiencing asthma management: A. The GP focuses on transferring factual knowledge to the patient; B. The GP primarily addresses the patients' application of knowledge in management of the disease; C. The GP aims at improving the patients' understanding of the disease and its management as a prerequisite for self-management; D. The GP concentrates on how to maintain/improve the patient's quality of life despite the asthma disease. Conclusion - The GPs describe their ways of experiencing asthma management in qualitatively different ways, likely to have implications for patient care and educational programmes on asthma for GPs. [ABSTRACT FROM AUTHOR]