Point of care testing promises to reduce delays in diagnosing and initiating treatment for infectious diseases such as Human Immuno-deficiency Virus (HIV). In South Africa, decentralized HIV testing ...with rapid tests offers important lessons for point of care testing programs. Yet, little is known about the strategies of providers and clients to make HIV testing successful in settings short of equipment, human resources and space. We aimed at examining these strategies.
This paper is based on a larger qualitative study of diagnostic practices across major diseases and actors in homes, clinics, communities, hospitals and laboratories in South Africa. We conducted 101 semi-structured interviews and 7 focus group discussions with doctors, nurses, community health workers, patients, laboratory technicians, policymakers, hospital managers and manufacturers between September 2012 and June 2013 in Durban, Cape Town and Eastern Cape. The topics explored included diagnostic processes and challenges, understanding of diagnosis, and visions of ideal tests. For this paper, the data on HIV testing processes in clinics, communities and hospitals was used.
Strategies to make HIV testing work at point of care involve overcoming constraints in equipment, spaces, human resources and workload and actively managing diagnostic processes. We grouped these strategies into subthemes: maintaining relationships, adapting testing guidelines and practices to stock-outs, to physical space, and to different clients, turning the test into a tool to reach another aim and turning the testing process into a tool to enhance adherence. These adaptive strategies are locally negotiated solutions, often ad-hoc, depending on personal commitment, relationships, human resources, physical space and referral systems. In the process, testing is redefined and repurposed. Not all of these repurposing acts are successful in ensuring a timely diagnosis. Some lead to disruptions, unnecessary testing or delays with at times unclear implications for quality of diagnosis.
Tests shape relationships, professional roles and practices of users at point of care. At the same time, testing processes are dynamic and test results and processes take on new meanings for clients and providers. These insights are crucial for understanding the contexts within which diagnostic devices and policies need to function.
European civic integration programmes claim to provide newcomers with necessary tools for successful participation. Simultaneously, these programmes have been criticised for being restrictive, ...market-driven and for working towards an implicit goal of limiting migration. Authors have questioned how these programmes discursively construct an offensive image of the Other and how colonial histories are reproduced in the constructions seen today. The Dutch civic integration programme is considered a leading example of a restrictive programme within Europe. Research has critically questioned the discourses within its policies, yet limited research has moved beyond policy to focus on discourse in texts in practice. This study presents a critical discourse analysis of texts used in the civic integration programme and demonstrates that they participate in multiple discursive constructions: the construction of the Dutch nation-state and its citizens as inherently modern, the construction of the Other as Unmodern and thus a threat, and the construction of the hierarchical relationship between the two. The civic integration programme has been left out of discussions on decolonisation to date, contributing to it remaining a core practice of othering. This study applies post-colonial theories to understand the impacts of current discourse, and forwards possibilities for consideration of decolonised alternatives.
In January 2022 the new Dutch Civic Integration programme was launched together with promises of improvements it would bring in facilitating the 'integration' of newcomers to the Netherlands. This ...study presents a critical discourse analysis of texts intended for municipalities to take on their new coordinating role in this programme. The analysis aims to understand the discourse in the texts, which actors are mobilized by them, and the role these texts and these actors play in processes of governmental racialization. The analysis demonstrates shifting complex assemblages are brought into cascades of governance in which all actors are disciplined to accept the problem of integration as a problem of cultural difference and distance, and then furthermore disciplined to adopt new practices deemed necessary to identify and even 'objectively' measure the inherent traits contributing to this problematic. Lastly, the analysis displays that all actors are disciplined to accept the solution of 'spontaneous compliance'; a series of practices and knowledges, which move the civic integration programme beyond an aim of responsibilization, into a programme of internalization, wherein newcomers are expected to own and address their problematic 'nature', making 'modern' values their own.
Objectives
Successful point‐of‐care (POC) testing (completion of test‐and‐treat cycle in one patient encounter) has immense potential to reduce diagnostic and treatment delays, and improve patient ...and public health outcomes. We explored what tests are done and how in public/private, rural/urban hospitals and clinics in South Africa and whether they can ensure successful POC testing.
Methods
This qualitative research study examined POC testing across major diseases in Cape Town, Durban and Eastern Cape. We conducted 101 semi‐structured interviews and seven focus group discussions with doctors, nurses, community health workers, patients, laboratory technicians, policymakers, hospital managers and diagnostic manufacturers.
Results
In South Africa, diagnostics are characterised by a centralised system. Most tests conducted on the spot can be made to work successfully as POC tests. The majority of public/private clinics and smaller hospitals send samples via couriers to centralised laboratories and retrieve results the same way, via internet, fax or phone. The main challenge to POC testing lies in transporting samples and results, while delays risk patient loss from diagnostic/treatment pathways. Strategies to deal with associated delays create new problems, such as artificially prolonged turnaround times, strains on human resources and quality of testing, compounding additional diagnostic and treatment delays.
Conclusions
For POC testing to succeed, particular characteristics of diagnostic ecosystems and adaptations of professional practices to overcome associated challenges must be taken into account.
Objectifs
La réussite des tests sur le lieu des services (LS) (réalisation complète du test et du cycle de traitement lors d'une rencontre avec le patient) possède un immense potentiel de réduire les retards de diagnostic et de traitement, et d'améliorer les résultats des patients et de la santé publique. Nous avons exploré quels tests étaient effectués et comment, dans les hôpitaux publics/privés, ruraux/urbains et dans les cliniques en Afrique du Sud et s'ils pouvaient effectuer des tests LS avec succès.
Méthodes
Cette étude qualitative a examiné les tests LS dans les maladies majeures à Cape Town, à Durban et dans l'Eastern Cape. Nous avons mené 101 entretiens semi‐structurés et sept discussions focalisées de groupes avec les médecins, infirmières, agents de santé communautaires, patients, techniciens de laboratoire, décideurs, gestionnaires d'hôpitaux et fabricants de diagnostic.
Résultats
En Afrique du Sud, les diagnostics sont caractérisés par un système centralisé. La plupart des tests effectués sur place peuvent être appliqués avec succès comme tests LS. La majorité des cliniques publiques/privées et les petits hôpitaux envoient des échantillons sous forme de courriers à des laboratoires centralisés et récupèrent les résultats de la même manière, via internet, fax ou téléphone. Le principal défi pour les tests LS réside dans le transport des échantillons et des résultats, tandis que les retards risquent la perte du patient par les structures de diagnostic/traitement. Des stratégies pour faire face aux retards associés créent de nouveaux problèmes, tels qu'une durée artificiellement prolongée du processus, des contraintes sur les ressources humaines et sur la qualité des tests, ce qui aggrave les retards de diagnostic et de traitement.
Conclusions
Pour la réussite des tests LS, des caractéristiques particulières des écosystèmes de diagnostic et une adaptation des pratiques professionnelles pour relever les défis associés doivent être prises en compte.
Objetivos
Las pruebas de diagnóstico inmediato (POC) exitosas (completar la prueba y el ciclo de tratamiento en un solo encuentro con el paciente) tienen un potencial inmenso a la hora de reducir los retrasos en el diagnóstico y el tratamiento, y mejorar los resultados para el paciente y la salud pública. Hemos explorado qué pruebas se llevan a cabo y como se realizan en las clínicas y hospitales público/privados, rural/urbanas de Sudáfrica y si se podría asegurar el éxito en su uso de las POCs.
Métodos
Este estudio cualitativo examinó el diagnóstico mediante POC de enfermedades graves en Ciudad del Cabo, Durban y Cabo del Este. Hemos realizado 101 entrevistas semiestructuradas y 7 discusiones de grupo focalizadas con doctores, enfermeras, trabajadores sanitarios comunitarios, pacientes, técnicos de laboratorio, políticos, gerentes de hospital y fabricantes de pruebas diagnósticas.
Resultados
En Sudáfrica los diagnósticos se caracterizan por tener un sistema centralizado. La mayoría de las pruebas realizadas en el punto de atención al paciente podrían funcionar con éxito utilizando POCs. La mayoría de las clínicas público/privadas y hospitales más pequeños envían muestras a través de servicios de mensajería a laboratorios centrales y reciben los resultados de la misma forma, a través de internet, fax o teléfono. El principal reto de las POC está en el transporte de las muestras y el envío de los resultados, mientras que los retrasos ponen en riesgo el perder al paciente durante el diagnóstico / tratamiento. Las estrategias para manejar los retrasos asociados crean nuevos problemas, tales como unos ciclos artificialmente prolongados, tensión sobre los recursos humanos y la calidad de las pruebas, agravando los retrasos en el diagnóstico y tratamiento.
Conclusiones
Para que el diagnóstico mediante POC tenga éxito, deben tenerse en cuenta las características particulares de los ecosistemas de diagnóstico y las adaptaciones de las prácticas profesionales para poder sobreponerse a los retos asociados.
Background: Globalisation trends such as increased migration to and within European countries have led to even greater cultural diversity in European societies. Cultural diversity increases the ...demand of cultural competency amongst professionals entering their work field. In particular, healthcare professionals need knowledge and skills to equip them to work with clients from different cultural backgrounds. Within higher education (HE), the professional development of cultural competency should ideally feature in undergraduate education and is often promoted as a by-product of a study abroad period. However, recognising that logistical and financial barriers often exist for extended study abroad, one alternative approach could be participation, at home or abroad, in a short-term international programme set within students' own HE institutions.
Purpose: The aim of this study was to explore HE students' experiences of participating in international 'short-term mobility week' programmes at three European universities.
Methods: Each university involved in the research offered short-term programmes for healthcare professions students at their own institution, where both local students and students from abroad could participate. Participants were healthcare students in the programme at one of the three universities. Data were collected through focus group interviews (4-8 students per group; n = 25). The data were transcribed and then analysed qualitatively, using a content comparison method.
Results: The analysis identified six categories, which reflected students' journeys within the short-term international experiences.
Conclusions: The analysis suggested that, for these students, engagement in a short-term mobility week programme provided valuable opportunities for encounters with others, which contributed to personal and professional development, greater confidence in the students' own professional identities, as well as an increasing sense of cultural awareness.
This paper reports on the collective ideas of the occupational scientists and therapists who attended the "Refugees - Addressing Key Social Issues" think tank at the Occupational Science Conference ...held in Hildesheim (2017). Forced migration is recognized as a prevalent issue in today's society. Forced migrants face many occupational challenges, which are being exacerbated by restrictive migration policies. This paper outlines the discussions held during the think tank and presents an occupational perspective of forced migrants' needs, followed by a desired vision of what an occupationally just world would look like for forced migrants, and future directions to guide occupation-based social transformation.
Abstract
Objectives
Successful point‐of‐care (
POC
) testing (completion of test‐and‐treat cycle in one patient encounter) has immense potential to reduce diagnostic and treatment delays, and improve ...patient and public health outcomes. We explored what tests are done and how in public/private, rural/urban hospitals and clinics in South Africa and whether they can ensure successful
POC
testing.
Methods
This qualitative research study examined
POC
testing across major diseases in Cape Town, Durban and Eastern Cape. We conducted 101 semi‐structured interviews and seven focus group discussions with doctors, nurses, community health workers, patients, laboratory technicians, policymakers, hospital managers and diagnostic manufacturers.
Results
In South Africa, diagnostics are characterised by a centralised system. Most tests conducted on the spot can be made to work successfully as
POC
tests. The majority of public/private clinics and smaller hospitals send samples via couriers to centralised laboratories and retrieve results the same way, via internet, fax or phone. The main challenge to
POC
testing lies in transporting samples and results, while delays risk patient loss from diagnostic/treatment pathways. Strategies to deal with associated delays create new problems, such as artificially prolonged turnaround times, strains on human resources and quality of testing, compounding additional diagnostic and treatment delays.
Conclusions
For
POC
testing to succeed, particular characteristics of diagnostic ecosystems and adaptations of professional practices to overcome associated challenges must be taken into account.
Objectifs
La réussite des tests sur le lieu des services (
LS
) (réalisation complète du test et du cycle de traitement lors d'une rencontre avec le patient) possède un immense potentiel de réduire les retards de diagnostic et de traitement, et d'améliorer les résultats des patients et de la santé publique. Nous avons exploré quels tests étaient effectués et comment, dans les hôpitaux publics/privés, ruraux/urbains et dans les cliniques en Afrique du Sud et s'ils pouvaient effectuer des tests
LS
avec succès.
Méthodes
Cette étude qualitative a examiné les tests
LS
dans les maladies majeures à Cape Town, à Durban et dans l'Eastern Cape. Nous avons mené 101 entretiens semi‐structurés et sept discussions focalisées de groupes avec les médecins, infirmières, agents de santé communautaires, patients, techniciens de laboratoire, décideurs, gestionnaires d'hôpitaux et fabricants de diagnostic.
Résultats
En Afrique du Sud, les diagnostics sont caractérisés par un système centralisé. La plupart des tests effectués sur place peuvent être appliqués avec succès comme tests
LS
. La majorité des cliniques publiques/privées et les petits hôpitaux envoient des échantillons sous forme de courriers à des laboratoires centralisés et récupèrent les résultats de la même manière, via internet, fax ou téléphone. Le principal défi pour les tests
LS
réside dans le transport des échantillons et des résultats, tandis que les retards risquent la perte du patient par les structures de diagnostic/traitement. Des stratégies pour faire face aux retards associés créent de nouveaux problèmes, tels qu'une durée artificiellement prolongée du processus, des contraintes sur les ressources humaines et sur la qualité des tests, ce qui aggrave les retards de diagnostic et de traitement.
Conclusions
Pour la réussite des tests
LS
, des caractéristiques particulières des écosystèmes de diagnostic et une adaptation des pratiques professionnelles pour relever les défis associés doivent être prises en compte.
Objetivos
Las pruebas de diagnóstico inmediato (
POC
) exitosas (completar la prueba y el ciclo de tratamiento en un solo encuentro con el paciente) tienen un potencial inmenso a la hora de reducir los retrasos en el diagnóstico y el tratamiento, y mejorar los resultados para el paciente y la salud pública. Hemos explorado qué pruebas se llevan a cabo y como se realizan en las clínicas y hospitales público/privados, rural/urbanas de Sudáfrica y si se podría asegurar el éxito en su uso de las
POC
s.
Métodos
Este estudio cualitativo examinó el diagnóstico mediante
POC
de enfermedades graves en Ciudad del Cabo, Durban y Cabo del Este. Hemos realizado 101 entrevistas semiestructuradas y 7 discusiones de grupo focalizadas con doctores, enfermeras, trabajadores sanitarios comunitarios, pacientes, técnicos de laboratorio, políticos, gerentes de hospital y fabricantes de pruebas diagnósticas.
Resultados
En Sudáfrica los diagnósticos se caracterizan por tener un sistema centralizado. La mayoría de las pruebas realizadas en el punto de atención al paciente podrían funcionar con éxito utilizando
POC
s. La mayoría de las clínicas público/privadas y hospitales más pequeños envían muestras a través de servicios de mensajería a laboratorios centrales y reciben los resultados de la misma forma, a través de internet, fax o teléfono. El principal reto de las
POC
está en el transporte de las muestras y el envío de los resultados, mientras que los retrasos ponen en riesgo el perder al paciente durante el diagnóstico / tratamiento. Las estrategias para manejar los retrasos asociados crean nuevos problemas, tales como unos ciclos artificialmente prolongados, tensión sobre los recursos humanos y la calidad de las pruebas, agravando los retrasos en el diagnóstico y tratamiento.
Conclusiones
Para que el diagnóstico mediante
POC
tenga éxito, deben tenerse en cuenta las características particulares de los ecosistemas de diagnóstico y las adaptaciones de las prácticas profesionales para poder sobreponerse a los retos asociados.
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