Work conditions as predictors of Swedish occupational therapists' occupational balance

BACKGROUND

There is little knowledge of how organizational and social work environmental conditions impact workers' perceptions of occupational balance. The aim of the present study was to investigate organizational and social work environmental conditions as predictors of Swedish occupational therapists' perceptions of occupational balance.

MATERIALS/METHODS

This prospective study collected data twice, with a one-year interval, and used a web survey. The present study included 1835 participants. Logistic regression analysis was used to analyze the work predictors of occupational balance.

RESULTS

A reasonable workload, high control, and high reward predicted high occupational balance. Having no children living at home, a satisfactory financial situation, and being physically active also predicted high occupational balance.

CONCLUSION

A reasonable workload, high control and high reward predicted occupational balance among the occupational therapists. All these factors may be of importance for a sustainable working life for occupational therapists.

SIGNIFICANCE

This knowledge can support occupational therapists in the development of interventions at the work place, with focus on the workload and the resources (control and reward), to promote employees' occupational balance.

Training for mental health professionals in responding to experienced and anticipated mental health-related discrimination (READ-MH): protocol for an international multisite feasibility study

BACKGROUND

Mental health and other health professionals working in mental health care may contribute to the experiences of stigma and discrimination among mental health service users but can also help reduce the impact of stigma on service users. However, few studies of interventions to equip such professionals to be anti-stigma agents took place in high-income countries. This study assesses the feasibility, potential effectiveness and costs of Responding to Experienced and Anticipated Discrimination training for health professionals working in mental health care (READ-MH) across low- and middle-income countries (LMICs).

METHODS

This is an uncontrolled pre-post mixed methods feasibility study of READ-MH training at seven sites across five LMICs (China, Ethiopia, India, Nepal and Tunisia).

OUTCOME MEASURES

knowledge based on course content, attitudes to working to address the impact of stigma on service users and skills in responding constructively to service users' reports of discrimination. The training draws upon the evidence bases for stigma reduction, health advocacy and medical education and is tailored to sites through situational analyses. Its content, delivery methods and intensity were agreed upon through a consensus exercise with site research teams. READ-MH will be delivered to health professionals working in mental health care immediately after baseline data collection; outcome measures will be collected post-training and 3 months post-baseline, followed by qualitative data collection analysed using a combined deductive and inductive approach. Fidelity will be rated during the delivery of READ-MH, and data on training costs will be collected. Quantitative data will be assessed using generalised linear mixed models. Qualitative data will be evaluated by thematic analysis to identify feedback about the training methods and content, including the implementability of the knowledge and skills learned. Pooled and site-specific training costs per trainee and per session will be reported.

CONCLUSIONS

The training development used a participatory and contextualised approach. Evaluation design strengths include the diversity of settings, the use of mixed methods, the use of a skills-based measure and the knowledge and attitude measures aligned to the target population and training. Limitations are the uncertain generalisability of skills performance to routine care and the impact of COVID-19 restrictions at several sites limiting qualitative data collection for situational analyses.

Online learning for continuous professional development of healthcare workers: an exploratory study on perceptions of healthcare managers in Rwanda

BACKGROUND

Due to outbreaks of new diseases, development of new treatment regimens and requirement of evidence-based practice, health professionals continuously need to acquire updated knowledge and skills. This type of learning is known as continuous professional development (CPD). The scarcity of skilled health care professionals in developing countries further increases the need of CPD. Traditionally, face-to-face approach has been preferred as the best mode of CPD. Currently, health professionals have started using online learning for continued professional growth in different parts of the world. Consequently, research studies from different settings are needed to investigate the significance of online learning for CPD. Therefore, the aim of this study was to investigate the importance and challenges attributed to online learning by the managers of health facilities in Rwanda. Moreover, the study aimed to identify the status of infrastructures that could support online CPD, and assess the perceived enhancement and barriers for implementing online CPD.

METHODS

The study used a convergence mixed-method design to explore quantitative and qualitative data from 42 health care managers. A descriptive analysis was conducted on quantitative data while qualitative data were thematically analyzed to inform the study findings.

RESULTS

It was revealed that 90.5% of managers, who participated in this study, consider positively the use of online learning for CPD. All managers acknowledged that online learning could improve the knowledge and practice skills of health care professionals. Nevertheless, 52.4% of health institutions who participated in this study currently do not use online for CPD. Participants demonstrated challenges such as the lack of access to digital devices, poor or lack of internet access, poor online learning design, low digital skills of healthcare professionals, lack of time dedicated to online learning, and heavy workload of staff.

CONCLUSION

These findings indicate then that the managers of health institutions value the importance of online learning for CPD of health professionals. However, online learning should be designed to fit for the purpose and with a high consideration on needs and preferences of healthcare professionals and thereby improve information communication technology infrastructure that support online learning for CPD. Traditional in-person CPD courses are still recommended in health institutions with shortage in resources and technology. Also, the barriers of online CPD delivery such as low internet connectivity and lack of access to digital devices by healthcare professionals need to be co-creatively addressed through the pyramidal structure of the Rwandan health system.

Enablers and barriers for mandatory training including Basic Life Support in an interprofessional environment: An integrative literature review

OBJECTIVES

It is vital health services have systems in place for staff mandatory training to meet safe quality health outcomes. The aim of this review is to identify enablers supporting staff attendance at mandatory training (including BLS) and barriers that pose challenges for staff participation in mandatory training that will be used to inform the development of a structured mandatory staff training program in an IPE environment.

DESIGN

An integrative literature review was sought to answer the question: What are the enablers and barriers that influence health professional attendance and successful completion of mandatory training (including BLS) in an IPE environment?

DATA SOURCES

An international literature search was undertaken using advance search of the databases: Medline, CINAHL, Google Scholar and Web of Science (WoS). English language, peer reviewed articles published from 2010 to 2022 were retrieved and screened for relevance.

REVIEW METHODS

An integrative review of papers included systematic reviews, a case study, quantitative and qualitative studies, RCT, mixed method studies and expert opinion papers.

RESULTS

Only 34 articles were eligible for inclusion in the review based on their relevance to staff attendance at mandatory training (including BLS). Analysis of literature identified four key themes: 'mandatory training' and 'certification'; 'knowledge and skills'; 'enablers' and 'barriers' for 'mandatory training (including BLS) attendance' and 'IPE'. The literature highlighted that IPE is an appropriate means of delivering a redesign education/training process that may increase attendance at mandatory training with recommendations for increased inclusivity and interactivity as well as providing useful logistic information.

CONCLUSION

The outcome of the review can inform development of an IPE Implementation Strategy in a health service aiming to improve staff attending and engaging in mandatory training. The findings are valuable to other health services seeking to improve and achieve mandatory and accreditation targets.

Mediterranean diet and the risk of COVID-19 in the 'Seguimiento Universidad de Navarra' cohort

BACKGROUND & AIMS

A potential protection against COVID-19 by a high-quality dietary pattern is to be expected given the biological plausibility supporting the beneficial effects of an adequate dietary intake on the immune system. However, knowledge on the relationship between long-term maintained healthy dietary patterns, such as the Mediterranean diet, and the risk of SARS-CoV-2 infection is still sparse. We longitudinally assessed this association in a well-known Mediterranean cohort.

METHODS

We assessed 9,677 participants from the SUN Project, a prospective cohort of middle-aged university graduates in Spain. We inquired about a positive result in a COVID-19 diagnostic test during the months of February to December 2020. After excluding health professionals (HP), 5,194 participants were included in the statistical analyses (mean age: 52.6, SD: 12.4; 55.2% women). Food habits were assessed at baseline using a previously validated semiquantitative 136-item food frequency questionnaire. Adherence to the Mediterranean diet (cumulative average of 2 repeated measurements 10 years apart) was assessed using the 0-to-9 Mediterranean Diet Score (MDS). We used multivariable logistic regression models to estimate odds ratios and 95% confidence intervals for incident COVID-19 according to the MDS.

RESULTS

Among 5,194 non-HP participants, 122 reported to have received a positive COVID-19 diagnostic test. Participants with intermediate adherence to the Mediterranean diet (3 < MDS ≤ 6) had a significantly lower odds of developing COVID-19 (multivariable-adjusted OR = 0.50, 95% CI: 0.34-0.73), and those with the highest adherence (MDS > 6) exhibited the lowest risk (multivariable-adjusted OR = 0.36, 95% CI: 0.16-0.84, p for trend < 0.001) as compared with participants with MDS ≤ 3. This inverse association remained robust within subgroups and in sensitivity analyses. Notwithstanding, no significant associations were observed for health professionals (p for interaction = 0.06).

CONCLUSION

In conclusion, better adherence to the Mediterranean diet may be associated with a lower risk of COVID-19. Our results are applicable only to persons who are not health professionals.

Knowledge, attitudes, and practices of fetal alcohol spectrum disorder in health, justice, and education professionals: A systematic review

BACKGROUND AND AIMS

Fetal alcohol spectrum disorder (FASD) is one of the most common forms of developmental disability, and yet, anecdotally, is poorly understood by both the public and professionals across health, justice, education, and social services. This review aims to understand the knowledge, attitudes, and practices of professionals who work across a range of sectors - specifically health, education and justice - where they may encounter people with FASD, their families and caregivers.

METHOD

We conducted a systematic search for research using surveys or questionnaires to address knowledge, and attitudes of professionals in health, education, and justice with regards to FASD between 1990 and 2021. Our search consisted of electronic databases (APA PsychInfo, CINAHL, EMBASE, Medline, PubMed, and PAIS Index) and grey literature sources.

RESULTS

Our search yielded 971 results, of which 58 were relevant. The studies surveyed professionals from health (n = 35), education (n = 10), justice (n = 8), social services (n = 1), and multiple settings (n = 4). Most studies were conducted in North America. The areas surveyed included knowledge of FASD, attitudes towards people with FASD, experience with FASD, practices towards people with FASD, and education and training needs.

CONCLUSIONS

Knowledge, attitudes, and practices towards FASD have been surveyed extensively in healthcare professionals over the last 30 years, but less so with those working in justice and education sectors. Findings from surveys suggest that although most professionals had some knowledge of the effects of FASD, their knowledge of the specific criteria of Fetal Alcohol Syndrome (FAS) and FASD is poor across most professional groups, including most health professionals. Our review highlights the need to provide training and information across sectors ongoing surveillance to determine where gaps in knowledge are and what resources are needed.

WHAT THIS PAPER ADDS

This study is the first to systematically synthesize knowledge, attitudes, and practices toward FASD across different sectors. Poor knowledge and insufficient training were common. Knowledge, attitudes, and practices about FASD have been surveyed extensively in the healthcare setting, but surveys are more limited outside of this setting. Continuous surveillance is needed to identify and respond to knowledge gaps and changes in practice.

An evaluation of the impact for healthcare professionals after a leadership innovation fellowship program

BACKGROUND

Leadership among healthcare professionals is required to address important healthcare challenges. The TAHSNp Health Professions Innovation Fellowship program ("Program") supports health professionals' leadership development by offering them an opportunity to lead a quality improvement project and participate in a curriculum focused on leading change.

OBJECTIVE

As part of an outcome evaluation of the program, our objective was to determine the program's impact on leadership activities and roles undertaken by alumni.

METHODS

A questionnaire was administered to participants who completed the program in 2019 and 2020 at 6 and 18 months post-program to assess their leadership activities, leadership roles and the program's impact. Prospectively, we conducted internal and LinkedIn searches to identify current roles and obtained personal statements from program alumni of medical imaging health professions as complementary data sources for our program evaluation.

RESULTS

At 6 and 18 months post-program, 47% - 59% of alumni respondents reported participation in hospital/organization committees, mentoring fellows or students, and presenting scholarly work inside or outside their organizations (6 months: N = 25, response rate = 39.1%; 18 months: N = 17, response rate = 26.6%). Additionally, at 18 months post program, 35% - 41% of alumni reported leading a new quality improvement initiative, pursuing formal education, and having a new leadership role. Most alumni reported their leadership activities were influenced by the program, with the largest impact occurring after 18 months post-program for leading a new quality improvement initiative (100%), career plans for the next five years (94%), mentoring fellowship staff (91%), presenting at their healthcare organization (91%) and a new leadership role (90%). Alumni reported the program helped build their confidence, create networking opportunities, leadership skill-building and interest in pursuing other roles beyond their clinical role. More specifically, alumni reported that leadership skills gained from the program were used in subsequent roles and responsibilities.

CONCLUSION/IMPLICATIONS

The program evaluation demonstrates engaged alumni who undertake informal and formal leadership activities and roles. Our results are illustrative of the value-add as a result of healthcare organizations' investment in developing leadership among healthcare professionals. As continued engagement and career development are known to be important for staff retention and succession planning strategies, our findings are highly relevant given the current staffing challenges in healthcare.

"I don't think there's a point for me to discuss it with my patients": exploring health care providers' views and behaviours regarding COVID-19 vaccination

BACKGROUND

Health care providers' knowledge and attitudes about vaccines are important determinants of their own vaccine uptake, their intention to recommend vaccines, and their patients' vaccine uptake. This qualitative study' objective was to better understand health care providers' vaccination decisions, their views on barriers to COVID-19 vaccine acceptance and proposed solutions, their opinions on vaccine policies, and their perceived role in discussing COVID-19 vaccination with patients.

METHODS

Semi-structured interviews on perceptions of COVID-19 vaccines were conducted with Canadian health care providers (N = 14) in spring 2021. A qualitative thematic analysis using NVivo was conducted.

RESULTS

Participants had positive attitudes toward vaccination and were vaccinated against COVID-19 or intended to do so once eligible (two delayed their first dose). Only two were actively promoting COVID-19 vaccination to their patients; others either avoided discussing the topic or only provided answers when asked questions. Participants' proposed solutions to enhance COVID-19 vaccine uptake in the public were in relation to access to vaccination services, information in multiple languages, and community outreach. Most participants were in favor of mandatory vaccination policies and had mixed views on the potential impact of the Canadian vaccine-injury support program.

CONCLUSIONS

While health care providers are recognized as a key source of information regarding vaccines, participants in our study did not consider it their role to provide advice on COVID-19 vaccination. This is a missed opportunity that could be avoided by ensuring health care providers have the tools and training to feel confident in engaging in vaccine discussions with their patients.

Epilepsy and stigma in Africa: Viewpoint of healthcare professionals and combat strategies

Epilepsy is a major public health problem in developing countries where eighty percent (80%) of people with epilepsy (PWE) live. Stigma has psychological consequences as well as serious repercussions on patients' quality of life. This study assesses the perception of health professionals in Africa regarding the stigmatization of PWE.

METHODOLOGY

This is a multicenter descriptive, cross-sectional study, from 1st August 2020 to 1st September 2021. Medical practitioners from African countries involved in the management of epilepsy and who agreed to fill out forms were included in the study. Sampling was nonrandom and based on respondent choice. The data were analyzed using the EPI INFO 7 software.

RESULTS

A total of two hundred and twenty-nine (229) health workers from twenty-six (26) African countries participated in this survey. 24.89% of the respondents were specialists and 46.72% were neurologists. Ninety-one percent (91%) of practitioners felt that PWE were stigmatised. The main forms of stigma were isolation (68.56%), celibacy (60.70%), unemployment (53.28%), divorce (44.54%) and exclusion (37.99%)%). Community, school and family were recognized as the main places of stigmatization. The fight against this stigma was carried out mainly in hospitals and in isolation in 58.4% and 55.8% of cases, respectively. Only 0.4% of practitioners opted for mass awareness.

CONCLUSION

PWE are victims of various forms of stigmatization, particularly in community settings. Measures aimed at raising awareness of the public are essential to reduce this stigma and improve patients' quality of life.

Pattern and perception of wellbeing, quality of work life and quality of care of health professionals in Southwest Nigeria

BACKGROUND

Personal wellbeing (PW) including quality of life and work life is a very complex concept that influences health professionals' commitment and productivity. Improving PW may result in positive outcomes and good quality of care. Therefore, this study aimed to assess the pattern and perception of wellbeing, quality of work life (QoWL) and quality of care (QoC) of health professionals (HPs) in southwest Nigeria.  METHODS: The study was a convergent parallel mixed method design comprising a cross-sectional survey (1580 conveniently selected participants) and a focus group interview (40 purposively selected participants). Participants' PW, quality of life (QoL), QoWL, and QoC were assessed using the PW Index Scale, 5-item World Health Organization Well-Being Index, QoWL questionnaire, and Clinician QoC scale, respectively. The pattern of wellbeing, QoWL and quality of care of HPs were evaluated using t-test and ANOVA tests. Binary regression analysis was used to assess factors that could classify participants as having good or poor wellbeing, QoWL, and quality of care of HPs. The qualitative findings were thematically analyzed following two independent transcriptions. An inductive approach to naming themes was used. Codes were assigned to the data and common codes were grouped into categories, leading to themes and subthemes.

RESULTS

Of 1600 administered questionnaires, 1580 were returned, giving a 98.75% response rate. Only 45.3%, 43.9%, 39.8% and 38.4% of HP reported good PW, QoL, QoC and QoWL, respectively; while 54.7%, 56.1%, 60.2% and 61.6% were poor. There were significant gender differences in PW and QoC in favor of females. With an increase in age and years of practice, there was a significant increase in PW, QoWL and QoC. As the work volume increased, there was significant decrease in QoWL. Participants with master's or Ph.D. degrees reported improved QoWL while those with diploma reported better QoC. PWI and QoC were significantly different along the type of appointment, with those who held part-time appointments having the least values. The regression models showed that participant's characteristics such as age, gender, designation, and work volume significantly classified health professionals who had good or poor QoC, QoWL, PW and QoL. The focus group interview revealed four themes and 16 sub-themes. The four themes were the definitions of QoC, QoWL, and PW, and dimensions of QoC.

CONCLUSION

More than half of health professionals reported poor quality of work life, quality of life and personal wellbeing which were influenced by personal and work-related factors. All these may have influenced the poor quality of care reported, despite the finding of a good knowledge of what quality of care entails.

Health promotion and disease prevention in the education of health professionals: a mapping of European educational programmes from 2019

BACKGROUND

Health professionals face barriers in carrying out effective health promotion and disease prevention. To indicate what are the needs for curriculum development in educational programmes, this study aims to provide an overview of how various health professionals are currently trained in health promotion and disease prevention at different educational levels.

METHODS

In 2019, a descriptive mapping exercise was performed focusing on European programmes for different health and healthcare professionals at the three levels of education (undergraduate, postgraduate, and continuous professional development [CPD]). Data were collected by a self-developed online survey that was distributed using a modified snowball method.

RESULTS

A total of 186 educational programmes of 17 different health professionals were analysed, implemented in 31 countries (60% were undergraduate, 30% postgraduate and 10% CPD programmes). Nearly all programmes indicated that expected outcomes were defined on knowledge (99%), skills (94%) and behaviours/attitudes (89%) regarding health promotion and disease prevention. A multidisciplinary approach was reported to be applied by 81% of the programmes. Traditional teaching methods such as lectures (97%) and assignments (81%) were dominant, while e-learning was less frequently used (46%). Digitalization in health promotion and digital health coaching were the least addressed topics in most programmes.

CONCLUSIONS

Health promotion and disease prevention are reported at all surveyed levels of education for a broad spectrum of health professionals. Educational programmes cover contents on knowledge, skills, and behaviours. There is a need for capacity building and joint development in health promotion education. Specifically, there is a need to include digitalisation and novel teaching in the educational programmes of health promotion and disease prevention.

Effect of the COVID-19 pandemic on the mental health, daily and occupational activities among health professionals in Colombia: a national study

BACKGROUND

The COVID-19 pandemic has placed an unprecedented physical and mental burden on healthcare workers who are frequently at high risk of infection, particularly in low-income countries. This study aimed to assess the prevalence and associated factors of anxiety, depression, and stress, as well as changes in daily and occupational activities among healthcare professionals due to the COVID-19 pandemic in Colombia.

METHODS

An observational, cross-sectional study was conducted between February and June 2021. The survey incorporated validated mental health tools such as the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Perceived Stress Scale-10. Multivariable ordinal logistic regression analysis was performed to determine the factors associated with severe mental health outcomes.

RESULTS

Among 1345 healthcare workers the prevalence of anxiety, depression, and stress were 75.61, 59.18, and 53.09%, respectively. Anxiety (OR:1.44; 95%CI:1.16-1.8), depression (OR:1.74; 95%CI:1.27-2.37), and stress (OR:1.51; 95%CI:1.18-1.94) were more frequent in women, and individuals who expressed fear of a negative outcome (death, sequelae) (OR:2.25; 95%CI:1.60-3.25), (OR:1.49; 95%CI:1.03-2.16) and (OR:2.36; 95%CI:1.69-3.29) respectively. Age was negatively associated with anxiety (OR:0.98; 95%CI:0.98-0.99), stress (OR:0.98; 95%CI:0.97-0.99), and depression (OR:0.97; 95% CI:0.96-0.98). Reduction in consultations and surgeries (OR:1.01; 95%CI:1.0-1.01) was positively associated with anxiety. Due to the pandemic, most specialists expected to incorporate drastic long-term (> 1 year) changes in their clinical setting and daily activities.

CONCLUSIONS

The prevalence of anxiety, depression, and stress is higher among Colombian healthcare workers compared to previous reports. Further research regarding these psychological outcomes is needed to achieve early mental health intervention strategies.

TRIAL REGISTRATION

Hospital Universitario Fundación Santa Fe, Ethical Committee Registration ID: CCEI-12992-2021.

Preparing students to deal with the consequences of the workforce shortage among health professionals: a qualitative approach

BACKGROUND

Healthcare is facing a shortage of qualified healthcare professionals. The pandemic has brought to light the fragile balance that affects all healthcare systems. Governments have realized that these systems and the professionals working in them need support at different levels to strengthen the retention of the workforce. Health professionals' education can play an important role in ensuring that new generations of workers have sound personal and professional competencies to successfully face the challenges of professional practice. These challenges are described in the literature, but the extent to which they are considered in health professionals' education is less clear.

METHODS

This qualitative study compares the professional challenges and educational needs described in the literature with the current curricula for health professionals offered in Switzerland. Data were collected nationally through focus group interviews with 65% of Switzerland's directors of bachelor's and master's programs of health professions (nursing, physiotherapy, occupational therapy, midwifery, nutrition and dietetics, osteopathy, radiologic medical imaging technology, health promotion and prevention, and health sciences). The data attained were analyzed using knowledge mapping.

RESULTS

The results reveal a gap among education programs with regard to occupational health promotion and cultural diversity. Both topics are taught with a sole focus on patients, and students are expected to adopt similar strategies for their health promotion and stress management. Physicians are insufficiently involved in interprofessional education. The programs fail to enhance health professionals' political, economic and digital competencies.

CONCLUSION

The results of this study offer clear guidance about what topics need to be integrated into curricula to improve health professionals' well-being at work and their preparedness to face daily professional challenges.

A new wave of leaders: Early evaluation of the interdisciplinary Foundations of Leadership in Radiation Oncology (FLiRO) program

PURPOSE

Effective leadership across all areas of radiation oncology (RO) is vital to fully realise the benefits of radiation therapy in cancer care. We report outcomes of a novel interdisciplinary leadership program designed for RO professionals under a global joint society initiative.

METHODS

The Foundations of Leadership in RO (FLiRO) program was designed for aspiring RO leaders. Initially delivered in a blended learning format, it was adapted to fully virtual in 2021. It comprised a webinar tutorial, on-line modules and homework followed by 'live' in-person/virtual workshops over an approximately 6-week period. Topics included personal awareness, effective teamwork, quality improvement skills, leading change and conflict management. An immediate post-program online survey was performed using Likert scales to measure self-reported educational value, interaction with others and the likely application of learning to practice. Open comments were invited.

RESULTS

170 participants from 36 countries and 6 continents took part from 2018 to 2021 (99 doctors, 36 physicists, 32 radiation therapists/RTTs and 3 others). 141 (83%) participants responded to the post-program survey. Average weightings for responders' views on whether pre-determined learning objectives were met ranged from 4.30 to 4.61 on a 5-point scale (1 = 'not met at all' and 5 = completely met). For the question addressing potential value of learning for application to their workplace, 124 of 130 (95%) of responders indicated that FLIRO would be 'very useful' or 'extremely useful'.

CONCLUSION

Initial evaluation of the FLiRO program supports its continuation and expansion with ongoing evolution based on emerging evidence around leadership education and participant feedback.

[Factors associated with the hospital at home workload: A Delphi consensus study]

OBJECTIVES

To identify and prioritize a list of factors that contribute to the workload of the hospital at home (HaH) professionals.

MATERIAL AND METHODS

A qualitative methodology study performed between January and December 2019 in the 10 HAH units of the Basque Country. The data were obtained in 4phases: 1. Systematic literature search and review; 2. Expert group meeting; 3. Consensus method: Delphi technique (2 survey rounds) and nominal group meeting; 4. Meeting of the research team.

RESULTS

In the systematic literature search and review 85 factors were initially identified. These were reduced to 38 after the 8-person expert group meeting, in which 10 new factors were added. After the 2 Delphi rounds (106 and 57 professionals, respectively), 17 factors were maintained and 12 remained in doubt. The latter were evaluated at the nominal group meeting, consisting of 13 professionals who decided to eliminate 5 factors, include 3, and keep 3 as doubt. After the 8-person research team meeting, 14 potential factors were finally selected. They are related to the place of residence, the health state and social situation of the patients, as well as the health care provided at home.

CONCLUSIONS

The identified factors could serve for improving the organization and optimize the daily word of the HaH professionals.

Research and academic output evaluation for career initiation or progression: Critical issues for Health Professionals

In current times, much stress is being laid on the evaluation of research productivity of researchers or faculty in addition to the academic qualifications and experience for the purposes of recruitment, promotion, and research grant funding. Over the years, several quantitative indices have been devised for this purpose. Some of these indices such as h-index, impact factor and e-index are being extensively used by research organizations, universities, accreditation bodies and funding agencies for basic scientists as well as health professionals. In the absence of any formal training, these parameters or their advantages and shortcomings may not be well understood by the health professionals, especially in the early stages of their careers and sometimes, even by the evaluators. A big unanswered question is the validity of the same criteria for health professionals as are applicable for the basic science researchers. Since health professional undertaking research assignments are neither adequately trained in basic research nor can they comprehend these indices well, the same yardstick to evaluate these two widely different groups of researchers often places the health professionals at a disadvantage.This paper aims to highlight certain vital issues related to the application of research productivity indicators for recruitment and career progression of health care professionals.

"You can't swim well if there is a weight dragging you down": cross-sectional study of intimate partner violence, sexual assault and child abuse prevalence against Australian nurses, midwives and carers

Background

Domestic and family violence (DFV), including intimate partner violence (IPV), sexual assault and child abuse are prevalent health and social issues, often precipitating contact with health services. Nurses, midwives and carers are frontline responders to women and children who have experienced violence, with some research suggesting that health professionals themselves may report a higher incidence of IPV in their personal lives compared to the community. This paper reports the largest study of DFV against health professionals to date.

Method

An online descriptive, cross-sectional survey of 10,674 women and 772 men members of the Australian Nursing and Midwifery Federation (ANMF) (Victorian Branch). The primary outcome measures were 12-month and adult lifetime IPV prevalence (Composite Abuse Scale); secondary outcomes included sexual assault and child abuse (Australian Bureau of Statistics Personal Safety Survey) and prevalence of IPV perpetration (bespoke).

Results

Response rate was 15.2% of women/11.2% of men who were sent an invitation email, and 38.4% of women/28.3% of men who opened the email. In the last 12-months, 22.1% of women and 24.0% of men had experienced IPV, while across the adult lifetime, 45.1% of women and 35.0% of men had experienced IPV. These figures are higher than an Australian community sample. Non-partner sexual assault had been experienced by 18.6% of women and 7.1% of men, which was similar to national community sample. IPV survivors were 2-3 times more likely to have experienced physical, sexual or emotional abuse in childhood compared to those without a history of IPV (women OR 2.7, 95% CI 2.4 to 2.9; men OR 2.8, 95% CI 2.0 to 4.1). Since the age of sixteen, 11.7% of men and 1.7% of women had behaved in a way that had made a partner or ex-partner feel afraid of them.

Conclusions

The high prevalence of intimate partner violence and child abuse in this group of nurses, midwives and carers suggests the need for workplace support programs. The findings support the theory that childhood adversity may be related to entering the nursing profession and has implications for the training and support of this group.

Navigating uncertain illness trajectories for young children with serious infectious illness: a modified grounded theory study

Background

Infectious illness is the biggest cause of death in children due to a physical illness, particularly in children under five years. If mortality is to be reduced for this group of children, it is important to understand factors affecting their pathways to hospital.

The aim of this study was to retrospectively identify organisational and environmental factors, and individual child, family, and professional factors affecting timing of admission to hospital for children under five years of age with a serious infectious illness (SII).

Methods

An explanatory modified grounded theory design was used in collaboration with parents. Two stages of data collection were conducted: Stage 1, interviews with 22 parents whose child had recently been hospitalised with a SII and 14 health professionals (HPs) involved in their pre-admission trajectories; Stage 2, focus groups with 18 parents and 16 HPs with past experience of SII in young children. Constant comparative analysis generated the explanatory theory.

Results

The core category was ‘navigating uncertain illness trajectories for young children with serious infectious illness’. Uncertainty was prevalent throughout the parents’ and HPs’ stories about their experiences of navigating social rules and overburdened health services for these children. The complexity of and lack of continuity within services, family lives, social expectations and hierarchies provided the context and conditions for children’s, often complex, illness trajectories. Parents reported powerlessness and perceived criticism leading to delayed help-seeking. Importantly, parents and professionals missed symptoms of serious illness. Risk averse services were found to refer more children to emergency departments.

Conclusions

Parents and professionals have difficulties recognising signs of SII in young children and can feel socially constrained from seeking help. The increased burden on services has made it more difficult for professionals to spot the seriously ill child.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08420-5.

Mental health and the effects on methylation of stress-related genes in front-line versus other health care professionals during the second wave of COVID-19 pandemic: an Italian pilot study

Healthcare workers experienced high degree of stress during COVID-19. Purpose of the present article is to compare mental health (depressive and Post-Traumatic-Stress-Disorders-PTSD-symptoms) and epigenetics aspects (degree of methylation of stress-related genes) in front-line healthcare professionals versus healthcare working in non-COVID-19 wards. Sixty-eight healthcare workers were included in the study: 39 were working in COVID-19 wards (cases) and 29 in non-COVID wards (controls). From all participants, demographic and clinical information were collected by an ad-hoc questionnaire. Depressive and PTSD symptoms were evaluated by the Patient Health Questionnaire-9 (PHQ-9) and the Impact of Event Scale-Revised (IES-R), respectively. Methylation analyses of 9 promoter/regulatory regions of genes known to be implicated in depression/PTSD (ADCYAP1, BDNF, CRHR1, DRD2, IGF2, LSD1/KDM1A, NR3C1, OXTR, SLC6A4) were performed on DNA from blood samples by the MassARRAY EpiTYPER platform, with MassCleave settings. Controls showed more frequent lifetime history of anxiety/depression with respect to cases (χ² = 5.72, p = 0.03). On the contrary, cases versus controls presented higher PHQ-9 (t = 2.13, p = 0.04), PHQ-9 sleep item (t = 2.26, p = 0.03), IES-R total (t = 2.17, p = 0.03), IES-R intrusion (t = 2.46, p = 0.02), IES-R avoidance (t = 1.99, p = 0.05) mean total scores. Methylation levels at CRHR1, DRD2 and LSD1 genes was significantly higher in cases with respect to controls (p < 0.01, p = 0.03 and p = 0.03, respectively). Frontline health professionals experienced more negative effects on mental health during COVID-19 pandemic than non-frontline healthcare workers. Methylation levels were increased in genes regulating HPA axis (CRHR1) and dopamine neurotransmission (DRD2 and LSD1), thus supporting the involvement of these biological processes in depression/PTSD and indicating that methylation of these genes can be modulated by stress conditions, such as working as healthcare front-line during COVID-19 pandemic.

Initiatives to enhance medical subspecialist training in Zambia: A cross-sectional analysis

Introduction

There is a significant shortage of medical subspecialists in Zambia. The government of Zambia, through programmes at the Ministry of Health, spends considerable resources to send patients outside the country for subspecialist medical treatment. The objective of this analysis was to evaluate the current situation pertaining to medical subspecialty training at the University of Zambia School of Medicine (UNZASOM) and to illustrate the new programmes that are to be introduced.

Methods

We collected data from formal desk reviews on the state of medical specialisation in Zambia, the UNZASOM graduation archives and patient referral records at the Ministry of Health (MoH). In addition, information on planned subspecialist programmes is presented.

Results

From the first graduates in 1986up to 2019,UNZASOM produced 351medical specialists, 63 (18%) in Internal Medicine, 77 (22%) in Obstetrics &Gynaecology, 82 (23%) in Paediatrics&Child Health, 68 (19%) in General Surgery, 17 (5%) in Anaesthesia & Critical Care, 20 (6%) in Orthopaedics &Trauma and 8 (2%) in Urology. The remaining graduates were in Ophthalmology, Psychiatry, Infectious Diseases, Paediatric Surgery and Pathology contributing 1% each. To enhance medical subspecialist training at UNZASOM, new curricula for Breast Surgery, Urology, Glaucoma, Vitreo-retinalSurgery, Adult Gastroenterology, Forensic Pathology, Dermatology & Venereology, Ophthalmology, Gynaecological Oncology and Paediatric anaesthesia, Infectious Diseases, and Gastroenterology were developed. Since 2013, only 44% of patients requiring subspecialist treatment out of Zambia got assisted with the remainder still on the waiting list or having had bad outcomes.

Conclusions

These programmes will provide an opportunity for accessible and affordable medical subspecialization training for Zambia and its neighbouring countries. With enhanced infrastructural support, the subspecialists will contribute toward enhanced healthcare provision and improvement in patient outcomes. They will also form a cohort of trainers to expand the space for quality training and skills building of specialists and subspecialists in the region and beyond.

Health professionals' licensing: the practice and its predictors among health professional hiring bodies in Ethiopia

BACKGROUND

Evidence suggests that not all human resource departments have hired their facility staff based on federal licensing standards, with some hiring without an active license. This is common in some, if not all, parts of the country. The paucity of healthcare experts, high turnover rates, employee burnout, and challenges in training and development issues were all key recruiting challenges globally.

OBJECTIVE

To assess the practice of health professionals' licensing and its predictors among hiring bodies in Ethiopia, March 24/2021-May 23/2021.

METHODS

A cross-sectional study was conducted in privately and publicly funded health facilities throughout Ethiopia. For each region, a stratified sampling strategy was utilized, followed by a simple random sampling method. Documents from the recruiting bodies for health professionals were reviewed. A pretested structured questionnaire and document review tool were used to extract data confidentially. A descriptive analysis of the basic hiring body characteristics was conducted. Hiring body characteristics were analyzed in bivariate and multivariate logistic regression to identify factors associated with best health professionals licensing practice. Data management and analysis were conducted with Epi-Data version 4.4.3.1 and SPSS version 23, respectively.

RESULTS

The analysis included 365 hiring bodies and 4991 files of health professionals (1581 from private and 3410 from public health organizations). Out of 365 hiring bodies studied, 66.3% practiced health professional licensing. A total of 1645 (33%) of the 4991 professionals whose files were reviewed were found to be working without any professional license at all. Furthermore, about 2733 (55%) have an active professional license, and about 603 (12%) were found to work with an expired license. Being a private facility (adjustedOR = 21.6; 95% CI = 8.85-52.55), obtaining supervision from a higher organ (adjustedOR = 19.7; 95%CI: 2.3-169.1), and conducting an internal audit (adjustedOR = 2.7; 95% CI: 1.15-6.34) were predictors of good licensing practice.

CONCLUSIONS

The licensing of health practitioners was poorly practiced in Ethiopia as compared to the expected proclamation of the country. A system for detecting fake licenses and controlling revoked licenses does not exist in all regions of the country.

The development and education of a workforce in childhood cancer services in low- and middle-income countries: a scoping review protocol

BACKGROUND

An estimated 400,000 children develop cancer worldwide. Of those, 90% occur in low- and middle-income countries, where survival rates can be as low as 30%. To reduce the childhood cancer survival gap between high- and low- and middle-income countries (LMIC), the World Health Organization launched the Global Initiative for Childhood Cancer in 2018, to support governments in building sustainable childhood cancer programs, with the aim to increase access and quality of care for children with cancer. Developing a high-quality and trained workforce is key to the success of childhood cancer services, but more information is needed on the interventions used to develop and train a workforce. The objective of this review is to understand the key factors described in the literature in relation to the development and training of a workforce in childhood cancer (defined here as ages 0-19) in LMIC, including challenges, interventions and their outcomes.

METHODS

We will include sources of evidence that describe the development or training of a childhood cancer workforce in health services that diagnose, refer or treat children and adolescents with cancer, in low- and middle-income countries as defined by the World Bank. The following databases will be searched: OVID Medline, Embase and Pubmed from 2001 to present with no restriction of language. Grey literature searches will also be performed in Proquest Dissertation and Theses, as well as relevant organizations' websites, and conference proceedings will be searched in conference websites. In addition, references lists will be reviewed manually. Two people will screen abstracts and full-texts and extract data. Data will be presented in a table or chart, with an accompanying narrative summary responding to the review questions. A framework synthesis will be conducted: data will be charted against a framework adapted from the 2016 WHO Global Strategy for Human Resources for Heath: Workforce 2030.

DISCUSSION

This scoping review will allow to map the existing literature on workforce development in LMIC, identify potential interventions and highlight data and knowledge gaps. This constitutes a first step towards adopting successful strategies more broadly, formulating research priorities and developing effective policies and interventions.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework osf.io/3mp7n.

What do Italian healthcare professionals think about orthorexia nervosa? Results from a multicenter survey

PURPOSE

Orthorexia nervosa (ON) is an obsession for healthy and proper nutrition. Diagnostic criteria for ON are lacking and the psychopathology of ON is still a matter of debate in the clinical and scientific community. Our aim was to better understand the Italian clinical and scientific community's opinion about ON.

METHODS

Anonymous online survey for Italian healthcare professionals, implemented with the REDCap platform and spread through a multicenter collaboration. Information was gathered about socio-demographic, educational and occupational features, as well as about experience in the diagnosis and treatment of EDs. The main part of the survey focused on ON and its features, classification and sociocultural correlates.

RESULTS

The survey was completed by 343 participants. Most responders (68.2%) considered ON as a variant of Eating Disorders (EDs), and 58.6% a possible prodromal phase or evolution of Anorexia Nervosa (AN). Most participants (68.5%) thought the next DSM should include a specific diagnostic category for ON, preferably in the EDs macro-category (82.1%). Moreover, 77.3% of responders thought that ON deserves more attention on behalf of researchers and clinicians, and that its treatment should be similar to that for EDs (60.9%). Participants thinking that ON should have its own diagnostic category in the next DSM edition had greater odds of being younger (p = 0.004) and of considering ON a prodromic phase of another ED, such as AN (p = 0.039).

DISCUSSION

Our survey suggests that the scientific community still seems split between those who consider ON as a separate disorder and those who do not. More research is still needed to better understand the construct of ON and its relationship with EDs; disadvantages and advantages of giving ON its own diagnosis should be balanced.

LEVEL OF EVIDENCE

V (descriptive cohort study).

Experiences and needs of women in vulnerable situations receiving additional interventions in maternity care: a qualitative study

BACKGROUND

Tailoring an intervention to the needs and wishes of pregnant women in vulnerable situations (e.g., socioeconomic disadvantages) can reduce the risk of adverse outcomes and empower these women. A relatively high percentage of pregnant women in the North of the Netherlands are considered vulnerable to adverse pregnancy outcomes because of their low socioeconomic status and the intergenerational transmission of poverty. In order to improve perinatal and maternal health, next to standard prenatal care, various interventions for pregnant women in vulnerable situations have been developed. We do not know to what extent these additional interventions suit the needs of (pregnant) women. Therefore, the aim of this study is to gain insight into the experiences and needs of women in vulnerable situations who receive additional maternity care interventions in the Northern Netherlands.

METHODS

Qualitative research was performed. We used a phenomenological framework, which is geared towards understanding people's experiences in the context of their everyday lives. In-depth semi-structured interviews were conducted with 17 pregnant women in vulnerable situations living in the Northern Netherlands. A thematic analysis was carried out.

RESULTS

We found three themes that reflect the experiences and needs of pregnant women in vulnerable situations in relation to the intervention they receive. These themes relate to the care provided by health professionals, to the impact of being offered an intervention, and to practical issues related to receiving an additional intervention. We found that the needs of pregnant women in vulnerable situations who received an additional maternity care intervention varied. This variation in needs was mainly related to practical issues. Women also expressed common needs, namely the desire to have control over their situation, the wish to receive tailor-made information about the intervention, and the wish for the intervention to be specifically tailored to their circumstances.

CONCLUSIONS

Living in vulnerable situations and being offered additional care evoked diverse reactions and emotions from pregnant women. We recommend that health professionals ensure open and clear communication with women, that they ensure continuity of care and relationship-centered care, and that they become aware of the process of stigmatization of women in vulnerable situations.

Practice of code of ethics and associated factors among health professionals in Central Gondar Zone public hospitals, Northwest Ethiopia, 2021: a mixed-method study design

BACKGROUND

Ethics is the science of moral and ethical rules recognised in human life and attempts to verify what is morally right and wrong. Healthcare ethics is seen as an integrated part of the daily activities of health facilities. Healthcare professionals' standardisation and uniformity in healthcare ethics are urgent and basic requirements. Therefore, this study aimed to assess the practice of the code of ethics and associated factors among health professionals in Central Gondar Zone public hospitals, Northwest Ethiopia, 2021.

METHODS

A facility-based cross-sectional study design with a mixed method was conducted on 631 health professionals from Central Gondar Zone public hospitals. For the quantitative part, pre-tested self-administered questionnaires were used, and for the qualitative part, key informant interviews with a semi-structured questionnaire were used. Variables with a p value of < 0.2 in binary logistic regression entered into a multivariable logistic regression, then p value < 0.05 and AOR were used to declare statistically significant variables in quantitative data. A thematic content analysis was used for qualitative data analysis.

RESULTS

This study revealed that only 286 (46.7%) health professionals had good practice of the code of ethics. Good ethical knowledge (AOR = 1.95, 95% CI 1.37, 2.77), favourable attitude (AOR = 1.55, 95% CI 1.11, 2.16), and satisfaction of health professionals with their jobs (AOR = 1.45, 95% CI (1.04, 2.04) were significantly associated with the practice of health care ethics.

CONCLUSIONS

Health professionals' overall level of practice of health care ethics in the Central Gondar Zone public hospitals was poor. This necessitates practical training, ongoing follow-up, availing of necessary medical equipment, a smooth working environment, and modification of the recognition system for health professionals.