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Fletcher-Hildebrand S, Williamson L, Lawson K, Dell C. Remotely and collaboratively evaluating a campus-based therapy dog program during the COVID-19 pandemic. EVALUATION AND PROGRAM PLANNING 2023; 98:102239. [PMID: 37086706 PMCID: PMC9841739 DOI: 10.1016/j.evalprogplan.2023.102239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/07/2022] [Accepted: 01/15/2023] [Indexed: 05/03/2023]
Abstract
The COVID-19 pandemic adversely affected the wellbeing of university students and adults in general, emphasizing the need for mental health programming that was compliant with physical distancing mandates. The present evaluation investigated mental health and social connection within the context of COVID-19 by remotely evaluating a virtual animal-assisted activity at the University of Saskatchewan - PAWS Your Stress. The purpose of this article is to outline our evaluation methods and findings, while calling specific attention to the collaborative strategies that were implemented within a remote, time-sensitive context. The evaluation findings revealed that remote animal-assisted programming can facilitate connections with humans and animals, and promote multiple mental health benefits, despite the lack of physical interaction with the animals. Our lessons learned indicate that remote program logic modelling workshops are feasible when suited to audience demographics. Further, our experience suggests that the Most Significant Change technique (a qualitative, participatory, storytelling method that elicits outcome data) can be useful in time-restricted evaluations, and the necessity of central steps in the process may vary depending on evaluation goals. This project has implications for future evaluation work, by demonstrating the effective use of remote methods that allowed for successful stakeholder collaboration.
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Affiliation(s)
| | - Linzi Williamson
- University of Saskatchewan, Room 191, 9 Campus Drive, Saskatoon, Saskatchewan S7N 5A5, Canada
| | - Karen Lawson
- University of Saskatchewan, Room 154, 9 Campus Drive, Saskatoon, Saskatchewan S7N 5A5, Canada
| | - Colleen Dell
- University of Saskatchewan, Room 1109, 9 Campus Drive, Saskatoon, Saskatchewan S7N 5A5, Canada
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Gadsden T, Maharani A, Sujarwoto S, Kusumo BE, Jan S, Palagyi A. Does social capital influence community health worker knowledge, attitude and practices towards COVID-19? Findings from a cross-sectional study in Malang district, Indonesia. SSM Popul Health 2022; 19:101141. [PMID: 35693476 PMCID: PMC9173822 DOI: 10.1016/j.ssmph.2022.101141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/11/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022] Open
Abstract
Community health workers (CHWs) are the first point of contact with the primary health care system in many low- and middle-income countries and are situated to play a critical role in the public health response to the COVID-19 pandemic. The knowledge, attitude and practices of CHWs regarding COVID-19 may be influenced by their level of trust and participation in the community, collectively defined as their level of social capital. To assess whether social capital influences CHWs’ knowledge, attitude and practices related to COVID-19, we conducted a web-based survey of CHWs (n = 478) in Malang district, Indonesia between October 2020 and January 2021. CHW social capital was measured using the Shortened Adapted Social Capital Assessment Tool. Multiple logistic regression results show that cognitive social capital was associated with higher self-reported knowledge of COVID-19, more confidence in answering COVID-related questions from the community and feeling safe from COVID-19 when working. Membership of community organisations was associated with a higher number of COVID-related tasks conducted. Thus, CHWs in Malang district with higher levels of cognitive social capital were more likely to be confident in their knowledge and ability to respond to COVID-19, and CHWs embedded in their community were more likely to be engaged in pandemic response duties. Our findings suggest that policies aimed at promoting CHW embeddedness, targeted recruitment and addressing training needs hold promise in strengthening the positive contribution of the community health workforce to the COVID-19 response. We conducted a survey to examine how social capital influences CHW knowledge, attitudes and practices re COVID-19 in Malang district, Indonesia. Structural social capital was associated with a higher number of COVID-related tasks conducted. Cognitive social capital was associated with higher knowledge of COVID-19 and higher confidence in answering COVID-related questions. Promoting CHW embeddedness and targeted recruitment may strengthen the contribution of CHWs to future public health crises in Malang district.
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Affiliation(s)
- Thomas Gadsden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Asri Maharani
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Sujarwoto Sujarwoto
- Department of Public Administration, University of Brawijaya, Malang, Indonesia
| | - Budiarto Eko Kusumo
- Department of Public Administration, University of Brawijaya, Malang, Indonesia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, Australia
| | - Anna Palagyi
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Gadsden T, Sujarwoto S, Purwaningtyas N, Maharani A, Tampubolon G, Oceandy D, Praveen D, Angell B, Jan S, Palagyi A. Understanding community health worker employment preferences in Malang district, Indonesia, using a discrete choice experiment. BMJ Glob Health 2022; 7:bmjgh-2022-008936. [PMID: 35953209 PMCID: PMC9379506 DOI: 10.1136/bmjgh-2022-008936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/28/2022] [Indexed: 11/04/2022] Open
Abstract
Background Community health workers (CHWs) play a critical role in supporting health systems, and in improving accessibility to primary healthcare. In many settings CHW programmes do not have formalised employment models and face issues of high attrition and poor performance. This study aims to determine the employment preferences of CHWs in Malang district, Indonesia, to inform policy interventions. Methods A discrete choice experiment was conducted with 471 CHWs across 28 villages. Attributes relevant to CHW employment were identified through a multistage process including literature review, focus group discussions and expert consultation. Respondents’ choices were analysed with a mixed multinomial logit model and latent class analyses. Results Five attributes were identified: (1) supervision; (2) training; (3) monthly financial benefit; (4) recognition; and (5) employment structure. The most important influence on choice of job was a low monthly financial benefit (US$~2) (β=0.53, 95% CI=0.43 to 0.63), followed by recognition in the form of a performance feedback report (β=0.13, 95% CI=0.07 to 0.20). A large monthly financial benefit (US$~20) was most unappealing to respondents (β=−0.13, 95% CI=−0.23 to −0.03). Latent class analysis identified two groups of CHWs who differed in their willingness to accept either job presented and preferences over specific attributes. Preferences diverged based on respondent characteristics including experience, hours’ worked per week and income. Conclusion CHWs in Malang district, Indonesia, favour a small monthly financial benefit which likely reflects the unique cultural values underpinning the programme and a desire for remuneration that is commensurate with the limited number of hours worked. CHWs also desire enhanced methods of performance feedback and greater structure around training and their rights and responsibilities. Fulfilling these conditions may become increasingly important should CHWs work longer hours.
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Affiliation(s)
- Thomas Gadsden
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
| | | | | | - Asri Maharani
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Gindo Tampubolon
- Global Development Institute, The University of Manchester, Manchester, UK
| | - Delvac Oceandy
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Devarsetty Praveen
- Better Care India, The George Institute for Global Health India, Hyderabad, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Blake Angell
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
| | - Stephen Jan
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
| | - Anna Palagyi
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
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Crinall K. Evaluating a peer-led wellbeing programme for doctors-in-training during the COVID-19 pandemic in Victoria, Australia, using the Most Significant Change technique. EVALUATION JOURNAL OF AUSTRALASIA 2022; 22:90-107. [PMID: 38603061 PMCID: PMC8961201 DOI: 10.1177/1035719x221080576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article discusses the use of the Most Significant Change (MSC) technique in a mixed-methods evaluation of a pilot wellbeing programme for obstetrics and gynaecology doctors-in-training introduced at a large public hospital during Melbourne, Australia's second coronavirus (COVID-19) lockdown, which occurred from 7 July to 26 October 2020. The evaluation was conducted remotely using videoconferencing technology, to conform with pandemic restrictions. MSC complemented the program's participatory principles and was chosen because it seeks to learn about participants' perceptions of programme impacts by evaluating their stories of significant change. Stakeholders select one story exemplifying the most significant change resulting from the evaluated program. Inductive thematic analysis of all stories is combined with reasons for making the selection, to inform learnings (Dart & Davies, 2003; Tonkin et al., 2021). Nine stories of change were included in the selection. The most significant change was a more supportive workplace culture brought about by enabling basic needs to be met and breaking down hierarchical barriers. This was linked to five interconnected themes - connection, caring, communication, confidence and cooperation. The evaluation learnings are explored and reflections on remotely conducting MSC evaluation are shared.
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Akeju D, Okusanya B, Okunade K, Ajepe A, Allsop MJ, Ebenso B. Sustainability of the Effects and Impacts of Using Digital Technology to Extend Maternal Health Services to Rural and Hard-to-Reach Populations: Experience From Southwest Nigeria. Front Glob Womens Health 2022; 3:696529. [PMID: 35211694 PMCID: PMC8861509 DOI: 10.3389/fgwh.2022.696529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Nigeria has one of the worst health and development profiles globally. A weak health system, poor infrastructure, and varied socio-cultural factors are cited as inhibitors to optimal health system performance and improved maternal and child health status. eHealth has become a major solution to closing these gaps in health care delivery in low- and middle-income countries (LMICs). This research reports the use of satellite communication (SatCom) technology and the existing 3G mobile network for providing video training (VTR) for health workers and improving the digitization of healthcare data. Objective To evaluate whether the expected project outcomes that were achieved at the end-line evaluation of 2019 were sustained 12 months after the project ended. Methods From March 2017 to March 2019, digital innovations including VTR and data digitization interventions were delivered in 62 healthcare facilities in Ondo State, southwest Nigeria, most of which lacked access to a 3G mobile network. Data collection for the evaluation combined documents' review with quantitative data extracted from health facility registers, and 24 of the most significant change stories to assess the longevity of the outcomes and impacts of digital innovation in the four domains of healthcare: use of eHealth technology for data management, utilization of health facilities by patients, the standard of care, and staff attitude. Stories of the most significant changes were audio-recorded, transcribed for analysis, and categorized by the above domains to identify the most significant changes 12 months after the project closedown. Results Findings showed that four project outcomes which were achieved at end-line evaluation were sustained 12 months after project closedown namely: staff motivation and satisfaction; increased staff confidence to perform healthcare roles; improved standard of healthcare delivery; and increased adoption of eHealth innovations beyond the health sector. Conversely, an outcome that was reversed following the discontinuation of SatCom from health facilities is the availability of accurate and reliable data for decision-making. Conclusion Digital technology can have lasting impacts on health workers, patients, and the health system, through improving data management for decision-making, the standard of maternity service delivery, boosting attendance at health facilities, and utilization of services. Locally driven investment is essential for ensuring the long-term survival of eHealth projects to achieve sustainable development goals (SDGs) in LMICs.
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Affiliation(s)
- David Akeju
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Babasola Okusanya
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Kehinde Okunade
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Adegbenga Ajepe
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Matthew J. Allsop
- Academic Unit of Palliative Care, University of Leeds, Leeds, United Kingdom
| | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
- *Correspondence: Bassey Ebenso
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Morassaei S, Campbell M, Di Prospero L. Measuring the Impact of Patient Engagement From the Perspective of Health Professionals Leading Quality Improvement Projects. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2021; 41:247-252. [PMID: 34825900 DOI: 10.1097/ceh.0000000000000405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The value of engaging patients and families in health care quality improvement (QI) initiatives is to help align health care system efforts with patient priorities. Meaningful evaluation of engaging with patients and families within QI may promote future collaboration. The aim of this study was to identify the experiential impact of patient engagement from the perspective of health professionals who were leading health care QI projects. METHODS Point-of-care health professionals who completed a fellowship capacity building program between 2014 and 2018 that provided an opportunity to learn about patient engagement concepts and to engage patients, families, and caregivers in their QI projects were invited to participate in the study. The Most Significant Change technique was used as a participatory approach to obtain qualitative evaluative data from semistructured interviews with health professional fellows. Significant change stories were curated from self-narratives grounded in the experiences of health professional fellows. RESULTS The stories demonstrated that gaining new knowledge on concepts related to patient engagement as part of a structured curriculum is effective in both supporting engagement in practice and cultivating the importance of patient engagement among health professionals. The early and ongoing involvement of patients was a key factor in shaping the project while fostering a patient-centered focus. Seeking out the patient voice throughout the QI project led to improvements in patient care experiences. DISCUSSION The findings of this study can inform programs seeking to promote patient engagement in health care QI. The positive changes that stem from aligning capacity building programs with patient-oriented priorities support the vision that patient engagement should be at the foundation of health care QI.
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Affiliation(s)
- Sara Morassaei
- Ms. Morassaei: Program Manager, Practice-Based Research and Innovation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada, and PhD candidate and Teaching Fellow, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada. Ms. Campbell: Strategic Initiatives Manager, Radiation Treatment Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada, and Assistant Professor, Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Ms. Di Prospero: Director, Practice-Based Research and Innovation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada, and Assistant Professor, Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Wang B. Study on the Improving Effect of the Teaching of Health Qigong Mawangdui Daoyin Technique on the Immune Function of Middle and Old Women. 2021 2ND ASIA-PACIFIC CONFERENCE ON IMAGE PROCESSING, ELECTRONICS AND COMPUTERS 2021. [DOI: 10.1145/3452446.3452675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Bin Wang
- Shanghai University of Traditional Chinese Medicine
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Tonkin K, Silver H, Pimentel J, Chomat AM, Sarmiento I, Belaid L, Cockcroft A, Andersson N. How beneficiaries see complex health interventions: a practice review of the Most Significant Change in ten countries. ACTA ACUST UNITED AC 2021; 79:18. [PMID: 33557938 PMCID: PMC7871616 DOI: 10.1186/s13690-021-00536-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022]
Abstract
Background The Most Significant Change is a story-based evaluation approach used in many international development programs. This practice review summarises practical experience with the approach in complex health interventions in ten countries, with the objective of making it more accessible in evaluation of other complex health interventions. Results Participatory research practitioners and trainees discussed five themes following brief presentations by each of the seven attendees who led the exercise: (i) sampling and recruitment; (ii) phrasing the questions to elicit stories; (iii) story collection strategies; (iv) quality assurance; and (v) analysis. Notes taken during the meeting provided the framework for this article. Recruitment strategies in small studies included universal engagement and, in larger studies, a purposive, systematic or random sampling. Meeting attendees recommended careful phrasing and piloting of the question(s) as this affects the quality and focus of the stories generated. They stressed the importance of careful training and monitoring of fieldworkers collecting stories to ensure full stories are elicited and recorded. For recording, in most settings they preferred note taking with back-checking or self-writing of stories by story tellers, rather than audio-recording. Analysis can combine participatory selection of a small number of stories, deductive or inductive thematic analysis and discourse analysis. Meeting attendees noted that involvement in collection of the stories and their analysis and discussion had a positive impact for research team members. Conclusions Our review confirms the plasticity, feasibility and acceptability of the Most Significant Change technique across different sociopolitical, cultural and environmental contexts of complex interventions. Although the approach can surface unexpected impacts, it is not a 360-degree evaluation. Its strength lies in characterising the changes, where these happen, in the words of the beneficiaries. We hope this distillation of our practice makes the technique more readily available to health sector researchers.
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Affiliation(s)
- Kendra Tonkin
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
| | - Hilah Silver
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
| | - Juan Pimentel
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
| | - Anne Marie Chomat
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Ivan Sarmiento
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
| | - Loubna Belaid
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada.,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada. .,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico.
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Naal H, El Koussa M, El Hamouch M, Hneiny L, Saleh S. Evaluation of global health capacity building initiatives in low-and middle-income countries: A systematic review. J Glob Health 2020; 10:020412. [PMID: 33110574 PMCID: PMC7568934 DOI: 10.7189/jogh.10.020412] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) are in dire need to improve their health outcomes. Although Global Health Capacity Building (GHCB) initiatives are recommended approaches, they risk being ineffective in the absence of standardized evaluation methods. This study systematically reviews evaluation approaches for GHCB initiatives in LMICs. METHODS We searched the Medline (OVID), PubMed, Scopus, and Embase.com databases for studies reporting evaluation of a GHCB initiative in a LMIC from January 1, 2009 until August 15, 2019. To differentiate them from intervention, prevention, and awareness initiatives, included articles reported at least one approach to evaluate their learning modality. We excluded cross-sectional studies, reviews, and book chapters that only assessed the effect of interventions. Data identifying the learning modality, and evaluation method, level, time interval, and approach were extracted from articles as primary outcomes. RESULTS Of 8324 identified studies, 63 articles were eligible for analysis. Most studies stemmed from Africa and Asia (69.8%), were delivered and evaluated face-to-face (74.6% and 76.2%), mainly to professionals (57.1%) and community workers (20.6%). Although the use of online and blended modalities showed an increase over the past 4 years, only face-to-face initiatives were evaluated long-term beyond individual-level. GHCB evaluations in general lacked standardization especially regarding the tools. CONCLUSION This is an important resource for evaluating GHCB initiatives in LMICs. It synthesizes evaluation approaches, offers recommendations for improvement, and calls for the standardization of evaluations, especially for long-term and wider impact assessment of online and blended modalities.
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Affiliation(s)
- Hady Naal
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Maria El Koussa
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Melissa El Hamouch
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Layal Hneiny
- Saab Medical Library at the American University of Beirut, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
- Faculty of Health Sciences at the American University of Beirut, Beirut, Lebanon
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Budiawan T, Ferdiana A, Daendel S, Widayati R, de Hart J, Soesman M, Mieras L. “We are not afraid anymore…” Capturing the most significant change of the Leprosy Friendly Village approach in North Sulawesi, Indonesia. LEPROSY REV 2020. [DOI: 10.47276/lr.91.2.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lam S, Dodd W, Whynot J, Skinner K. How is gender being addressed in the international development evaluation literature? A meta-evaluation. RESEARCH EVALUATION 2019. [DOI: 10.1093/reseval/rvy042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Steven Lam
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON, Canada
| | - Warren Dodd
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada
| | - Jane Whynot
- Institute of Feminist and Gender Studies, University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, Canada
| | - Kelly Skinner
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada
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