Developing Rational Empathy in Health Care Policy:The Usefulness of Online Comments

Studies of interactions have gained an increasing importance in research related to healthcare.Most empirical studies have explored the dynamics of exchanges between patients and practitioners(Barry et al.,2001,Beach et al.,2001).This study is devoted to the analysis of discussions in two forums to investigate how to develop what we call‘a rational empathy’so as to understand the attitudes and beliefs which constitute the basis of these opinions.

Perinatal mental health in China:views of health system professionals in Shanghai

Background:Mental health has recently been receiving a growing amount of attention in China's Mainland,with mental disorders increasingly being recognized as a major public health concern.However,the treatment gap for mental health care is markedly high in China.Previous research and clinical practice have focused on high-risk physical disorders but overlooked psychosocial factors,especially during the perinatal period.Aims:To explore Chinese professionals'perception and attributions of perinatal mental health in China.Method:The study was conducted in Shanghai,China,in 2018,drawing on interviews with 15 key informants including health professionals,government officials,and policymakers recruited through snowball sampling.Content analysis of the semi-structured interviews was performed.Results:The study yielded insights into the perceptions of perinatal mental health among health professionals in Shanghai.Three themes emerged from the informants'reports:(1)mental health influenced by tradition—describing traditions affecting the perception of mental health at both the societal and individual level;(2)societal changed contributing perinatal mental health problems—referring to a rapidly changing cultural and economic backdrop as a source of stress leading to mental health problems;and(3)existing and required resources—demonstrating a lack of professional training,staff shortages,and inadequacy of resources to provide the required mental health care.Conclusion:Our results provide new insights into key health professionals'perceptions of mental health problems in Shanghai.Hesitation to seek care owing to a lack of knowledge,and resource shortages in health care systems are obstacles to improve mental health among women in urban China.

Integration for coexistence？ Implementation of intercultural health care policy in Ghana from the perspective of service users and providers

OBJECTIVE： In spite of the World Health Organization＇s recommendations over the past decades, Ghana features pluralistic rather than truly integrated medical system. Policies about the integration of complementary medicine into the national health care delivery system need to account for individuallevel involvement and cultural acceptability of care rendered by health care providers. Studies in Ghana, however, have glossed over the standpoint of the persons of the illness episode about the intercultural health care policy framework. This paper explores the health care users, and providers＇ experiences and attitudes towards the implementation of intercultural health care policy in Ghana. METHODS： In-depth interviews, augmented with informal conversations, were conducted with 16 health service users, 7 traditional healers and 6 health professionals in the Sekyere South District and Kumasi Metropolis in the Ashanti Region of Ghana. Data were thematically analysed and presented based on the a posteriori inductive reduction approach. RESULTS： Findings reveal a widespread positive attitude to, and support for integrative medical care in Ghana. However, inter-provider communication in a form of cross-referrals and collaborative mechanisms between healers and health professionals seldom occurs and remains unofficially sanctioned. Traditional healers and health care professionals are skeptical about intercultural health care policy mainly due to inadequate political commitment for provider education. The medical practitioners have limited opportunity to undergo training for integrative medical practice. We also find a serious mistrust between the practitioners due to the ＂diversity of healing approaches and techniques.＂ Weak institutional support, lack of training to meet standards of practice, poor registration and regulatory measures as well as negative perception of the integrative medical policy inhibit its implementation in Ghana. CONCLUSION： In order to advance any useful intercultural health care policy in Ghana, the government＇s total commitment in informed training and provider education, enforcement of regulatoryinstrument and improved community engagement is needed. Evidence-based incorporation of traditional medical therapies into clinical practice will provide safer, faster and more effective health care for the underserved and resource-poor, particularly in the rural areas.

Integration of community health workers into health systems in developing countries:Opportunities and challenges

Background:Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health work-ers(CHWs).It is imperative that health care systems focus on improving access to quality continu-ous primary care through the use of CHWs while paying attention to the factors that impact on CHWs and their effectiveness.Objective:To explore the possible opportunities and challenges of integrating CHWs into the health care systems of developing countries.Methods:Six databases were examined for quantitative,qualitative,and mixed-methods stud-ies that included the integration of CHWs,their motivation and supervision,and CHW policy making and implementation in developing countries.Thirty-three studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programs.Thematic coding was conducted and evidence on the main categories of contextual factors influencing integration of CHWs into the health system was synthesized.Results:CHWs are an effective and appropriate element of a health care team and can assist in addressing health disparities and social determinants of health.Important facilitators of integration of CHWs into health care teams are support from other health workers and inclusion of CHWs in case management meetings.Sustainable integration of CHWs into the health care system requires the formulation and implementation of polices that support their work,as well as financial and nonfinancial incentives,motivation,collaborative and supportive supervision,and a manageable workload.Conclusions:For sustainable integration of CHWs into health care systems,high-performing health systems with sound governance,adequate financing,well-organized service delivery,and adequate supplies and equipment are essential.Similarly,competent communities could contrib-ute to better CHW performance through sound governance of community resources,promotion of inclusiveness and cohesion,engagement in participatory decision making,and mobilization of local resources for community welfare.