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Corboz J, Dartnall E, Brown C, Fulu E, Gordon S, Tomlinson M. Co-creating a global shared research agenda on violence against women in low- and middle-income countries. Health Res Policy Syst 2024; 22:71. [PMID: 38914999 PMCID: PMC11194916 DOI: 10.1186/s12961-024-01153-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Despite a large growth in evidence on violence against women (VAW) over the last 25 years, VAW persists, as do gaps in the field's knowledge of how to prevent and respond to it. To ensure that research on VAW in low- and middle-income countries (LIMCs) is addressing the most significant gaps in knowledge, and to prioritise evidence needs to reduce VAW and better support victims/survivors, the Sexual Violence Research Initiative (SVRI) and Equality Institute (EQI) led a process of developing a global shared research agenda (GSRA) on VAW in LMICs. METHODS The GSRA was developed through a six-stage adaptation of the Child Health and Nutrition Research Initiative (CHNRI) method, which draws on the principle of the 'wisdom of the crowd'. These steps included: a review of the literature on VAW in LMICs and development of domains; the generation of research questions within four domains by an Advisory Group; the consolidation of research questions; scoring of research questions by a Global Expert Group and the Advisory Group according to three criteria (applicability, effectiveness and equity); consultation and validation of the findings with the Advisory Group; and wide dissemination of the findings. RESULTS The highest ranked research questions in the GSRA pertain to the domain of Intervention research, with some highly ranked questions also pertaining to the domain of Understanding VAW in its multiple forms. Questions under the other two domains, Improving existing interventions, and Methodological and measurement gaps, were not prioritised as highly by experts. There was strong consistency in top ranked research questions according to experts' characteristics, albeit with some important differences according to experts' gender, occupation and geographical location. CONCLUSIONS The GSRA findings suggest that currently the VAW field is shifting towards intervention research after several decades of building evidence on understanding VAW, including prevalence, drivers and impacts of violence. The findings also suggest a strong emphasis on under-served populations, and under-researched forms of VAW. Future priority setting exercises in LMICs that seek to decolonise knowledge should ensure that methodologies, and modalities of engagement, put diverse voices at the centre of engagement. Trial registration Not applicable.
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Affiliation(s)
| | | | - Chay Brown
- The Equality Institute, Melbourne, Australia
| | - Emma Fulu
- The Equality Institute, Melbourne, Australia
| | - Sarah Gordon
- Stellenbosch University, Stellenbosch, South Africa
| | - Mark Tomlinson
- Stellenbosch University, Stellenbosch, South Africa
- Queens University, Belfast, United Kingdom
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Karami B, Rezaei S, Gillan HD, Akbari S, Maleki R, Moradi F, Jalili F, Karami M, Soltani S. Inpatient healthcare utilization among people with disabilities in Iran: determinants and inequality patterns. BMC Health Serv Res 2024; 24:62. [PMID: 38212742 PMCID: PMC10785394 DOI: 10.1186/s12913-023-10383-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/26/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND People with disabilities (PWD) have different health service needs and different factors affect the utilization of these services. Therefore, the aim of this present study was to identify determinants of inpatient healthcare utilization among PWDs in Iran. METHODS This research was a secondary data analysis of a cross-sectional study. The present study used data gathered for 766 PWDs (aged 18 years and older) within the Iranian Society with Disabilities (ISD) between September and December 2020. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals in order to identify determinants of inpatient healthcare utilization among PWDs. RESULTS Data for 766 people with disabilities were analyzed. A large number of participants were over 28 years of age (70.94%), male (64.36%), and single (54.02%). In the present study, more than 71% of participants had no history of hospitalization during the last year. In this study, males [aOR 2.11(1.14-3.91), participants with Civil Servants health insurance coverage [aOR 3.44 (1.16 - 10.17)] and individuals in the 3th quartile of disability severity [aOR 2.13 (1.01 - 4.51)] had greater odds of inpatient healthcare utilization compared to the other groups. The value of the concentration index (C) for inpatient healthcare utilization was - 0.084 (P.value = 0.046). The decomposition analysis indicated that gender was the greatest contributor (21.92%) to the observed inequality in inpatient healthcare utilization among participants. CONCLUSION Our findings suggested that the likelihood of hospitalization among the study participants could be significantly influenced by factors such as gender, the health insurance scheme, and the degree of disability severity. These results underscore the imperative for enhanced access to outpatient services, affordable insurance coverage, and reduced healthcare expenditures for this vulnerable population. Addressing these issues has the potential to mitigate the burden of hospitalization and promote better health outcomes for disadvantaged individuals.
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Affiliation(s)
- Badriyeh Karami
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hadi Darvishi Gillan
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahram Akbari
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Raheleh Maleki
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fardin Moradi
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Faramarz Jalili
- School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Mohammad Karami
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Zwaan L, Smith KM, Giardina TD, Hooftman J, Singh H. Patient generated research priorities to improve diagnostic safety: A systematic prioritization exercise. PATIENT EDUCATION AND COUNSELING 2023; 110:107650. [PMID: 36731167 DOI: 10.1016/j.pec.2023.107650] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 01/13/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Most people experience a diagnostic error at least once in their lifetime. Patients' experiences with their diagnosis could provide important insights when setting research priorities to reduce diagnostic error. OBJECTIVE Our objective was to engage patients in research agenda setting for improving diagnosis. PATIENT INVOLVEMENT Patients were involved in generating, discussing, prioritizing, and ranking of research questions for diagnostic error reduction. METHODS We used the prioritization methodology based on the Child Health and Nutrition Research Initiative (CHNRI). We first solicited research questions important for diagnostic error reduction from a large group of patients. Thirty questions were initially prioritized at an in-person meeting with 8 patients who were supported by 4 researchers. The resulting list was further prioritized by patients who scored questions on five predefined criteria. We then applied previously determined weights to these prioritization criteria to adjust the final prioritization score for each question, resulting in 10 highest priority research questions. RESULTS Forty-one patients submitted 171 research questions. After prioritization, the highest priority topics included better care coordination across the diagnostic continuum and improving care transitions, improved identification and measurement of diagnostic errors and attention for implicit bias towards patients who are vulnerable to diagnostic errors. DISCUSSION We systematically identified the top-10 patient generated research priorities for diagnostic error reduction using transparent and objective methods. Patients prioritized different research questions than researchers and therefore complemented an agenda previously generated by researchers. PRACTICAL VALUE Research priorities identified by patients can be used by funders and researchers to conduct future research focused on reducing diagnostic errors. FUNDING This project was funded by the Gordon and Betty Moore Foundation.
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Affiliation(s)
- Laura Zwaan
- Institute of Medical Education Research Rotterdam, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands.
| | - Kelly M Smith
- Michael Garron Hospital - Toronto East Health Network, 825 Coxwell Ave, Toronto, ON M4C 3E7, Canada; Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M6, Canada.
| | - Traber D Giardina
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd. 152, Houston TX 77030, USA; Baylor College of Medicine, Houston, USA.
| | - Jacky Hooftman
- Institute of Medical Education Research Rotterdam, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, location VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd. 152, Houston TX 77030, USA; Baylor College of Medicine, Houston, USA.
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Dassah E, Aldersey HM, McColl MA, Davison C. Health care providers’ and persons with disabilities’ recommendations for improving access to primary health care services in rural northern Ghana: A qualitative study. PLoS One 2022; 17:e0274163. [PMID: 36112654 PMCID: PMC9481012 DOI: 10.1371/journal.pone.0274163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
In Ghana, many persons with physical disabilities are members of populations who face health disparities including physical, structural, knowledge, attitudinal and financial barriers to various health care services compared to those without disabilities. However, there is limited evidence on how to improve access to primary health care services for persons with physical disabilities. This study aimed to understand persons with physical disabilities’ experiences and health care providers’ perspectives for improving access to primary health care for persons with disabilities in rural Ghana. We used a qualitative approach and interviewed 33 persons with physical disabilities and health care providers, and thematically analysed data from in-depth interviews. We identified 4 major themes. According to the participants, health care could be more accessible by: i) Making it more affordable; ii) Increasing the availability of providers and services; iii) Providing more education about system navigation; and iv) Improving access to disability friendly health facilities and equipment. Participants’ recommendations were nested in the areas of policy and practice modifications. Policy makers need to consider supporting persons with physical disabilities who cannot afford non-medical services (i.e., cost of transportation). In terms of practice, the provision of education and training related to physical disability issues should be extended to both clinical and nonclinical health workers for better client centered care. There is an urgent need for policy makers and relevant key stakeholders to include persons with physical disabilities in designing and implementing policies and programs to ensure that they are meeting their needs.
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Affiliation(s)
- Ebenezer Dassah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- * E-mail:
| | - Heather M. Aldersey
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Colleen Davison
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
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Cannata G, Douryang M, Ljoka C, Giordani L, Monticone M, Foti C. The Burden of Disability in Africa and Cameroon: A Call for Optimizing the Education in Physical and Rehabilitation Medicine. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:873362. [PMID: 36188952 PMCID: PMC9397855 DOI: 10.3389/fresc.2022.873362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/20/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Giuseppe Cannata
- Physical Medicine and Rehabilitation, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
| | - Maurice Douryang
- Department of Physiotherapy and Physical Medicine, University of Dschang, Dschang, Cameroon
| | - Concetta Ljoka
- Physical Medicine and Rehabilitation Unit, Tor Vergata Hospital, Rome, Italy
| | - Laura Giordani
- Physical Medicine and Rehabilitation, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
| | - Marco Monticone
- Physical Medicine and Rehabilitation, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Calogero Foti
- Physical Medicine and Rehabilitation, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
- Physical Medicine and Rehabilitation Unit, Tor Vergata Hospital, Rome, Italy
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Adeloye D, Agarwal D, Barnes PJ, Bonay M, van Boven JF, Bryant J, Caramori G, Dockrell D, D'Urzo A, Ekström M, Erhabor G, Esteban C, Greene CM, Hurst J, Juvekar S, Khoo EM, Ko FW, Lipworth B, López-Campos JL, Maddocks M, Mannino DM, Martinez FJ, Martinez-Garcia MA, McNamara RJ, Miravitlles M, Pinnock H, Pooler A, Quint JK, Schwarz P, Slavich GM, Song P, Tai A, Watz H, Wedzicha JA, Williams MC, Campbell H, Sheikh A, Rudan I. Research priorities to address the global burden of chronic obstructive pulmonary disease (COPD) in the next decade. J Glob Health 2021; 11:15003. [PMID: 34737870 PMCID: PMC8542376 DOI: 10.7189/jogh.11.15003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The global prevalence of chronic obstructive pulmonary disease (COPD) has increased markedly in recent decades. Given the scarcity of resources available to address global health challenges and respiratory medicine being relatively under-invested in, it is important to define research priorities for COPD globally. In this paper, we aim to identify a ranked set of COPD research priorities that need to be addressed in the next 10 years to substantially reduce the global impact of COPD. Methods We adapted the Child Health and Nutrition Research Initiative (CHNRI) methodology to identify global COPD research priorities. Results 62 experts contributed 230 research ideas, which were scored by 34 researchers according to six pre-defined criteria: answerability, effectiveness, feasibility, deliverability, burden reduction, and equity. The top-ranked research priority was the need for new effective strategies to support smoking cessation. Of the top 20 overall research priorities, six were focused on feasible and cost-effective pulmonary rehabilitation delivery and access, particularly in primary/community care and low-resource settings. Three of the top 10 overall priorities called for research on improved screening and accurate diagnostic methods for COPD in low-resource primary care settings. Further ideas that drew support involved a better understanding of risk factors for COPD, development of effective training programmes for health workers and physicians in low resource settings, and evaluation of novel interventions to encourage physical activity. Conclusions The experts agreed that the most pressing feasible research questions to address in the next decade for COPD reduction were on prevention, diagnosis and rehabilitation of COPD, especially in low resource settings. The largest gains should be expected in low- and middle-income countries (LMIC) settings, as the large majority of COPD deaths occur in those settings. Research priorities identified by this systematic international process should inform and motivate policymakers, funders, and researchers to support and conduct research to reduce the global burden of COPD.
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Affiliation(s)
| | - Dhiraj Agarwal
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | | | | | - Job F van Boven
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Department of Clinical Pharmacy & Pharmacology, Groningen, the Netherlands
| | - Jamie Bryant
- University of Newcastle, Newcastle, New South Wales, Australia
| | | | - David Dockrell
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | - John Hurst
- UCL Respiratory, University College London, UK
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Ee Ming Khoo
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Fanny W Ko
- The Chinese University of Hong Kong, Hong Kong
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | - Jose L López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS); Hospital Universitario Virgen del Rocio - Universidad de Sevilla - CIBERES, Spain
| | | | | | | | | | | | - Marc Miravitlles
- Pneumology Department, University Hospital Vall d'Hebron and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | | | | | | | - Peter Schwarz
- Bone-metabolic Research Unit, Copenhagen University Hospital Rigshospitalet, Denmark
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Peige Song
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Andrew Tai
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Henrik Watz
- Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Airway Research Center North (ARCN), German Centre for Lung Research (DZL), Germany
| | | | - Michelle C Williams
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Igor Rudan
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Zhao X, Wang H. Disparities in unmet health service needs among people with disabilities in China. Int J Qual Health Care 2021; 33:6382275. [PMID: 34613344 DOI: 10.1093/intqhc/mzab136] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/30/2021] [Accepted: 10/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Extensive research has explored disparities in access to health care between people with and without disabilities, but much less is understood about disparities and associated factors within the disabled population. OBJECTIVE The aim of this study was to examine differences in the prevalence of unmet health-care needs by residential status (hukou status) and disability type among people with disabilities. METHODS Our data were from the National Survey on Basic Public Service Delivery of Persons with Disabilities. The analysis sample included a nationally representative sample of 9 642 112 adults (aged 16+ years) with disabilities. Associated factors were obtained at both individual level and community level. Cross-sectional multivariable logistic regression analyses were conducted to compare unmet medical, care, rehabilitation and accessibility needs among people with different residential statuses and different types of disabilities. RESULTS The estimated prevalence of unmet medical, care, rehabilitation and accessibility needs is 15.4%, 10.2%, 45.6% and 13.7%, respectively. Rural hukou was associated with an important 13-40% increase in unmet health-care needs for people with disabilities in China. These rural-urban disparities in unmet health service needs can be partly explained by community-level factors, including access to facilities, social participation and health professionals. Disparities across the type of disability were smaller, but on average, people with multiple disabilities appeared to have the highest rates of unmet care, medical and accessibility needs, whereas those with physical disability had the highest unmet rehabilitation need. CONCLUSIONS Differences by residential status and impairment type were evident in all types of unmet health service needs. Targeted policy designs that meet the needs for justice and equality of people with disabilities are advisable. Public health and policy efforts are required to improve access to health service and meet the needs of people with disabilities, especially in rural practices and for particular disability groups.
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Affiliation(s)
- Xintong Zhao
- School of Labor and Human Resources, Renmin University of China, No. 59, Zhongguancun Street, Haidian, Beijing 100872, China
| | - Hongchuan Wang
- School of Public Policy & Management, Tsinghua University, No. 30 Shuangqing Road, Haidian, Beijing 100084, China
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Mac-Seing M, Ringuette L, Zinszer K, Godard B, Zarowsky C. How to navigate the application of ethics norms in global health research: reflections based on qualitative research conducted with people with disabilities in Uganda. BMC Med Ethics 2021; 22:140. [PMID: 34663292 PMCID: PMC8521956 DOI: 10.1186/s12910-021-00710-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As Canadian global health researchers who conducted a qualitative study with adults with and without disabilities in Uganda, we obtained ethics approval from four institutional research ethics boards (two in Canada and two in Uganda). In Canada, research ethics boards and researchers follow the research ethics norms of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2), and the National Guidelines for Research Involving Humans as Research Participants of Uganda (NGRU) in Uganda. The preparation and implementation of this qualitative research raised specific ethical issues related to research participant privacy and the importance of availability and management of financial resources. MAIN BODY Our field experience highlights three main issues for reflection. First, we demonstrate that, in a global health research context, methodological and logistic adjustments were necessary throughout the research implementation process to ensure the protection of study participants' privacy, especially that of people with disabilities, despite having followed the prescribed Canadian and Ugandan ethics norms. Data collection and management plans were adapted iteratively based on local realities. Second, securing financial support as a key aspect of financial management was critical to ensure privacy through disability-sensitive data collection strategies. Without adequate funding, the recruitment of research participants based on disability type, sex, and region or the hiring of local sign language interpreters would not have been possible. Third, although the TCPS2 and NGRU underscore the significance of participants' privacy, none of these normative documents clearly express this issue in the context of global health research and disability, nor broadly discuss the ethical issue related to financial availability and management. CONCLUSIONS Conducting research in resource limited settings and with study participants with different needs calls for a nuanced and respectful implementation of research ethics in a global health context. We recommend a greater integration in both the TCPS2 and NGRU of global health research, disability, and responsible conduct of research. This integration should also be accompanied by adequate training which can further guide researchers, be they senior, junior, or students, and funding agencies.
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Affiliation(s)
- Muriel Mac-Seing
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada.
- Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.
| | - Louise Ringuette
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
- Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- Laboratoire Transformation Numérique en Santé, Montreal, Canada
| | - Kate Zinszer
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
- Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Béatrice Godard
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
| | - Christina Zarowsky
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
- Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Advancing Diagnostic Safety Research: Results of a Systematic Research Priority Setting Exercise. J Gen Intern Med 2021; 36:2943-2951. [PMID: 33564945 PMCID: PMC8481519 DOI: 10.1007/s11606-020-06428-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Diagnostic errors are a major source of preventable harm but the science of reducing them remains underdeveloped. OBJECTIVE To identify and prioritize research questions to advance the field of diagnostic safety in the next 5 years. PARTICIPANTS Ninety-seven researchers and 42 stakeholders were involved in the identification of the research priorities. DESIGN We used systematic prioritization methods based on the Child Health and Nutrition Research Initiative (CHNRI) methodology. We first invited a large international group of expert researchers in various disciplines to submit research questions while considering five prioritization criteria: (1) usefulness, (2) answerability, (3) effectiveness, (4) potential for translation, and (5) maximal potential for effect on diagnostic safety. After consolidation, these questions were prioritized at an in-person expert meeting in April 2019. Top-ranked questions were subsequently reprioritized through scoring on the five prioritization criteria using an online questionnaire. We also invited non-research stakeholders to assign weights to the five criteria and then used these weights to adjust the final prioritization score for each question. KEY RESULTS Of the 207 invited researchers, 97 researchers responded and 78 submitted 333 research questions which were then consolidated. Expert meeting participants (n = 21) discussed questions in different breakout sessions and prioritized 50, which were subsequently reduced to the top 20 using the online questionnaire. The top 20 questions addressed mostly system factors (e.g., implementation and evaluation of information technologies), teamwork factors (e.g., role of nurses and other health professionals in the diagnostic process), and strategies to engage patients in the diagnostic process. CONCLUSIONS Top research priorities for advancing diagnostic safety in the short-term include strengthening systems and teams and engaging patients to support diagnosis. High-priority areas identified using these systematic methods can inform an actionable research agenda for reducing preventable diagnostic harm.
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Masuku KP, Moroe N, van der Merwe D. 'The world is not only for hearing people - It's for all people': The experiences of women who are deaf or hard of hearing in accessing healthcare services in Johannesburg, South Africa. Afr J Disabil 2021; 10:800. [PMID: 34395202 PMCID: PMC8335767 DOI: 10.4102/ajod.v10i0.800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/26/2021] [Indexed: 11/01/2022] Open
Abstract
Background Despite legal and adopted frameworks purporting access to healthcare and rehabilitation services, which are both a human right and key to developmental issues, women who are deaf and/or hard of hearing (HoH) are still excluded and experience barriers when accessing healthcare services. Largely, this is attributed to communication barriers between healthcare professionals and women who are deaf and/or HoH. There have been limited research studies carried out on women with invisible disabilities, such as deafness, especially amongst African women. Objectives This study sought to gain insights into the communication experiences of women who are deaf or HoH when accessing public healthcare services in hospitals in Johannesburg. Methods A qualitative research study employing semi-structured interviews with 10 African women who are deaf and/or HoH residing in Johannesburg, South Africa and attending government healthcare facilities was conducted. Participants were purposively selected. Data were analysed using thematic analysis. Results Data revealed the following themes: communication barriers resulting in compromised quality of care and infringement on participants' right to confidentiality; accommodation that is not accommodative and negative attitudes of healthcare professionals. Conclusion The findings of this study confirm the alienating, exclusion, marginalisation, discrimination, invisibility, lack of independence and autonomy of women who are deaf and/or HoH when accessing healthcare services. Therefore, this study argues for a need for the conscientisation of healthcare professionals on communication needs of persons who are deaf and/or HoH. This has implications for the implementation of training programmes that will address communication, reasonable accommodation and attitudes of healthcare professionals.
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Affiliation(s)
- Khetsiwe P Masuku
- Department of Speech Pathology, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomfundo Moroe
- Department of Audiology, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| | - Danielle van der Merwe
- Department of Speech Pathology and Audiology, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
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McKinney EL, McKinney V, Swartz L. Access to healthcare for people with disabilities in South Africa: Bad at any time, worse during COVID-19? S Afr Fam Pract (2004) 2021; 63:e1-e5. [PMID: 34342484 PMCID: PMC8335793 DOI: 10.4102/safp.v63i1.5226] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 11/15/2022] Open
Abstract
People with disabilities, especially those living in low- and middle-income countries, experience significant challenges in accessing healthcare services and support. At times of disasters and emergencies, people with disabilities are further marginalised and excluded. During the coronavirus disease 2019 (COVID-19) pandemic, many people with disabilities are unable to access healthcare facilities, receive therapeutic interventions or rehabilitation, or gain access to medication. Of those who are able to access facilities, many experience challenges, and at times direct discrimination, accessing life-saving treatment such as intensive care unit admission and ventilator support. In addition, research has shown that people with disabilities are at higher risk of contracting the virus because of factors that include the need for interpersonal caregivers and living in residential facilities. We explore some of the challenges that people with disabilities residing in South Africa currently experience in relation to accessing healthcare facilities.
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Affiliation(s)
- Emma L McKinney
- Interdisciplinary Centre for Sports Science and Development, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town.
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12
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Phillips KG, England E, Wishengrad JS. Disability-competence training influences health care providers' conceptualizations of disability: An evaluation study. Disabil Health J 2021; 14:101124. [PMID: 34103262 DOI: 10.1016/j.dhjo.2021.101124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Often, health care providers' approach to people with disabilities is grounded in a medical model perspective. This view highlights individual deficits and does not foster patient-centeredness. Learning about and adopting a more social model, focused on creating accessible and inclusive approaches and environments, could help providers to reshape their attitudes about disability, dismantling barriers to care. OBJECTIVE This study used innovative methods to evaluate a recorded, online disability-competence training for health care providers. It was hypothesized that the training would 1) shift providers' conceptualizations of disability away from a medical model view toward a social model view of disability and 2) equip providers with actionable strategies to improve access to care for people with disabilities. METHODS Quantitative and qualitative evaluation data were analyzed for n = 192 training participants. Measures included participants' pre- and post-training conceptualizations of disability, proposed actions steps to facilitate patient-centered care, and measures of satisfaction and self-assessed knowledge gain. RESULTS Both hypotheses were supported. After the training, participants' conceptualizations of disability were more reflective of the social model, and participants were better able to articulate specific action steps they could take to promote accessible, responsive care. CONCLUSIONS This study demonstrates that health care provider training can positively affect providers' knowledge, outlook, and approach to caring for people with disabilities. Its findings can inform broader efforts aimed at systematically changing the way health professionals are educated and trained to provide care in disability-competent ways.
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Affiliation(s)
- Kimberly G Phillips
- University of New Hampshire, Institute on Disability, 10 West Edge Drive, Suite 101, Durham, NH, 03824, USA.
| | - Evan England
- University of New Hampshire, Institute on Disability, 10 West Edge Drive, Suite 101, Durham, NH, 03824, USA
| | - Jeanne S Wishengrad
- University of New Hampshire, Institute on Disability, 10 West Edge Drive, Suite 101, Durham, NH, 03824, USA
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13
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Kobeissi L, Nair M, Evers ES, Han MD, Aboubaker S, Say L, Rollins N, Darmstadt GL, Blanchet K, Garcia DM, Hagon O, Ashorn P. Setting research priorities for sexual, reproductive, maternal, newborn, child and adolescent health in humanitarian settings. Confl Health 2021; 15:16. [PMID: 33771212 PMCID: PMC7995567 DOI: 10.1186/s13031-021-00353-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background An estimated 70.8 million people are forcibly displaced worldwide, 75% of whom are women and children. Prioritizing a global research agenda to inform guidance, service delivery, access to and quality of services is essential to improve the survival and health of women, children and adolescents in humanitarian settings. Method A mixed-methods design was adapted from the Child Health and Nutrition Research Initiative (CHNRI) methodology to solicit priority research questions across the sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) domains in humanitarian settings. The first step (CHNRI) involved data collection and scoring of perceived priority questions, using a web-based survey over two rounds (first, to generate the questions and secondly, to score them). Over 1000 stakeholders from across the globe were approached; 177 took part in the first survey and 69 took part in the second. These research questions were prioritized by generating a research prioritization score (RPP) across four dimensions: answerability, program feasibility, public health relevance and equity. A Delphi process of 29 experts followed, where the 50 scored and prioritized CHRNI research questions were shortlisted. The top five questions from the CHNRI scored list for each SRMNCAH domain were voted on, rendering a final list per domain. Results A total of 280 questions were generated. Generated questions covered sexual and reproductive health (SRH) (n = 90, 32.1%), maternal health (n = 75, 26.8%), newborn health (n = 42, 15.0%), child health (n = 43, 15.4%), and non-SRH aspects of adolescent health (n = 31, 11.1%). A shortlist of the top ten prioritized questions for each domain were generated on the basis of the computed RPPs. During the Delphi process, the prioritized questions, based on the CHNRI process, were further refined. Five questions from the shortlist of each of the SRMNCAH domain were formulated, resulting in 25 priority questions across SRMNCAH. For example, one of the prioritized SRH shortlisted and prioritized research question included: “What are effective strategies to implement good quality comprehensive contraceptive services (long-acting, short-acting and EC) for women and girls in humanitarian settings?” Conclusion Data needs, effective intervention strategies and approaches, as well as greater efficiency and quality during delivery of care in humanitarian settings were prioritized. The findings from this research provide guidance for researchers, program implementers, as well as donor agencies on SRMNCAH research priorities in humanitarian settings. A global research agenda could save the lives of those who are at greatest risk and vulnerability as well as increase opportunities for translation and innovation for SRMNCAH in humanitarian settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00353-w.
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Affiliation(s)
- Loulou Kobeissi
- SRH Integration in Health Systems (SHS), Department of Sexual and Reproductive Health and Research (SRH), World Health Organization (WHO), Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland.
| | - Mahalakshmi Nair
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Egmond Samir Evers
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Mansuk Daniel Han
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | | | - Lale Say
- SRH Integration in Health Systems (SHS), Department of Sexual and Reproductive Health and Research (SRH), World Health Organization (WHO), Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Gary L Darmstadt
- Maternal and Child Health, Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, the Graduate Institute, Geneva, Switzerland
| | - Daniel Martinez Garcia
- Women and Child Health Unit, Medical Department of Médecins Sans Frontières (MSF), Geneva, Switzerland
| | - Olivier Hagon
- Center for Humanitarian Medicine and Disaster Management (CHMDM), WHO Collaborative center, Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Gur K, Dolaner G, Rabia Turan S. Health literacy of hearing-impaired adolescents, barriers and misunderstandings they encounter, and their expectations. Disabil Health J 2020; 13:100929. [DOI: 10.1016/j.dhjo.2020.100929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/05/2020] [Accepted: 04/05/2020] [Indexed: 11/26/2022]
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15
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Mishra RS, Mishra R, Mohanty SK. Gender differential and regional disparity of disability-free life-expectancy among disable in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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The Movember Prostate Cancer Landscape Analysis: an assessment of unmet research needs. Nat Rev Urol 2020; 17:499-512. [PMID: 32699318 PMCID: PMC7462750 DOI: 10.1038/s41585-020-0349-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 12/24/2022]
Abstract
Prostate cancer is a heterogeneous cancer with widely varying levels of morbidity and mortality. Approaches to prostate cancer screening, diagnosis, surveillance, treatment and management differ around the world. To identify the highest priority research needs across the prostate cancer biomedical research domain, Movember conducted a landscape analysis with the aim of maximizing the effect of future research investment through global collaborative efforts and partnerships. A global Landscape Analysis Committee (LAC) was established to act as an independent group of experts across urology, medical oncology, radiation oncology, radiology, pathology, translational research, health economics and patient advocacy. Men with prostate cancer and thought leaders from a variety of disciplines provided a range of key insights through a range of interviews. Insights were prioritized against predetermined criteria to understand the areas of greatest unmet need. From these efforts, 17 research needs in prostate cancer were agreed on and prioritized, and 3 received the maximum prioritization score by the LAC: first, to establish more sensitive and specific tests to improve disease screening and diagnosis; second, to develop indicators to better stratify low-risk prostate cancer for determining which men should go on active surveillance; and third, to integrate companion diagnostics into randomized clinical trials to enable prediction of treatment response. On the basis of the findings from the landscape analysis, Movember will now have an increased focus on addressing the specific research needs that have been identified, with particular investment in research efforts that reduce disease progression and lead to improved therapies for advanced prostate cancer. The Movember global Landscape Analysis Committee (LAC) was established to act as an independent group of experts across urology, medical oncology, radiation oncology, radiology, pathology, translational research, health economics and patient advocacy to identify the highest priority research needs across the prostate cancer biomedical research domain. Findings from the landscape analysis illustrate the research priorities in prostate cancer and will enable Movember to focus on specific needs, with particular investment in research to reduce disease progression and improve therapies for advanced prostate cancer.
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Harrison JAK, Thomson R, Banda HT, Mbera GB, Gregorius S, Stenberg B, Marshall T. Access to health care for people with disabilities in rural Malawi: what are the barriers? BMC Public Health 2020; 20:833. [PMID: 32487088 PMCID: PMC7268500 DOI: 10.1186/s12889-020-08691-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 04/13/2020] [Indexed: 02/06/2023] Open
Abstract
Background People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside a mobility or sensory impairment, on health care accessibility is explored. Methods Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Short Set (WGSS) questions, were recruited. The WGSS questions concern a person’s ability in core functional domains (including seeing, hearing and moving), and a score of 3 indicates ‘a lot of difficulty’ whilst 4 means ‘cannot do at all’. People with cognitive impairments were not included in this study. All who were selected for the study participated in an individual in-depth interview and full recordings of these were then transcribed and translated. Results Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Attitudinal factors were explored and, whilst unfavourable health seeking behaviour was found to act as an access barrier for some participants, community and health care workers’ attitudes towards disability were not reported to influence health care accessibility in this study. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision.
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Affiliation(s)
| | - Rachael Thomson
- Collaboration for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hastings T Banda
- Research for Equity And Community Health (REACH) Trust, Lilongwe, Malawi
| | - Grace B Mbera
- Research for Equity And Community Health (REACH) Trust, Lilongwe, Malawi
| | - Stefanie Gregorius
- Collaboration for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Tim Marshall
- School for Policy Studies, University of Bristol, Bristol, UK
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Tomlinson M, Darmstadt GL, Yousafzai AK, Daelmans B, Britto P, Gordon SL, Tablante E, Dua T. Global research priorities to accelerate programming to improve early childhood development in the sustainable development era: a CHNRI exercise. J Glob Health 2019; 9:020703. [PMID: 31673352 PMCID: PMC6815874 DOI: 10.7189/jogh.09.020703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Approximately 250 million children under the age of five in low and middle-income countries (LMICs) will not achieve their developmental potential due to poverty and stunting alone. Investments in programming to improve early childhood development (ECD) have the potential to disrupt the cycle of poverty and therefore should be prioritised. Support for ECD has increased in recent years. Nevertheless, donors and policies continue to neglect ECD, in part from lack of evidence to guide policy makers and donors about where they should focus policies and programmes. Identification and investment in research is needed to overcome these constraints and in order to achieve high quality implementation of programmes to improve ECD. Methods The Child Health and Nutrition Research Initiative (CHNRI) priority setting methodology was applied in order to assess research priorities for improving ECD. A group of 348 global and local experts in ECD-related research were identified and invited to generate research questions. This resulted in 406 research questions which were categorised and refined by study investigators into 54 research questions across six thematic goals which were evaluated using five criteria: answerability, effectiveness, feasibility, impact, and effect on equity. Research options were ranked by their final research priority score multiplied by 100. Results The top three research priority options from the LMIC experts came from the third thematic goal of improving the impact of interventions, whereas the top three research priority options from high-income country experts came from different goals: improving the integration of interventions, increasing the understanding of health economics and social protection strategies, and improving the impact of interventions. Conclusion The results of this process highlight that priorities for future research should focus on the need for services and support to parents to provide nurturing care, and the training of health workers and non-specialists in implementation of interventions to improve ECD. Three of the six thematic goals of the present priority setting centred on interventions (ie, improving impact, implementation of interventions and improving the integration of interventions). In order to achieve higher coverage through sustainable interventions to improve ECD with equitable reach, interventions should be integrated and not be sector driven.
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Affiliation(s)
- Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA
| | | | - Pia Britto
- Early Childhood Development Unit, UNICEF, New York, New York, USA
| | - Sarah L Gordon
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Tarun Dua
- World Health Organization, Geneva, Switzerland
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Driver S, Swank C, Froehlich-Grobe K, McShan E, Calhoun S, Bennett M. Weight Loss After Stroke Through an Intensive Lifestyle Intervention (Group Lifestyle Balance-Cerebrovascular Accident): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e14338. [PMID: 31628790 PMCID: PMC7010352 DOI: 10.2196/14338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/11/2019] [Accepted: 07/19/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Weight gain can be a consequence of stroke, or cerebrovascular accident (CVA), because of impaired mobility, behavioral and emotional disorders, and sensory losses. Weight gain increases the patient's risk of recurrent stroke and chronic diseases, such as diabetes, metabolic syndrome, and pulmonary and heart disease. Approaches to weight loss in this population are lacking, although necessary because of the unique physiological and cognitive needs of persons after a stroke. Evidence shows that intensive behavioral therapy interventions that address both physical activity and diet offer the greatest potential for weight loss. The Group Lifestyle Balance (GLB) intervention is a 12-month, evidence-based weight loss program that has been used extensively with the general population; this program was modified to meet the needs of people who have had a stroke (GLB-CVA). OBJECTIVE This randomized controlled trial (RCT) aims to examine the efficacy of the GLB-CVA on weight and secondary outcomes, compared with that of a waitlist control group. METHODS This RCT will enroll and randomize 64 patients over an 18-month period. RESULTS Currently, 51 people are waitlisted, with 23 out of 51 screened and 16 out of 23 eligible. CONCLUSIONS It is anticipated that the findings from this RCT will contribute to the evidence base regarding weight loss strategies for people living with stroke. CLINICAL TRIAL ClinicalTrials.gov NCT03873467; https://clinicaltrials.gov/ct2/show/NCT03873467.
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Affiliation(s)
- Simon Driver
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, United States
| | - Chad Swank
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, United States
| | | | - Evan McShan
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, United States
| | - Stephanie Calhoun
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, United States
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20
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Healthcare providers' perspectives of providing primary healthcare services to persons with physical disabilities in rural Ghana. Prim Health Care Res Dev 2019; 20:e108. [PMID: 32799998 PMCID: PMC6609974 DOI: 10.1017/s1463423619000495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: A growing body of evidence has shown that persons with physical disabilities experience substantial barriers in accessing primary healthcare (PHC) services in rural areas. Negative attitudes from healthcare providers and inaccessible healthcare facilities and equipment are common experiences that negatively affect access to quality healthcare for persons with physical disabilities. However, there is limited research that explores this issue from the perspectives of healthcare providers. This qualitative study explores the perspectives of healthcare providers in delivering PHC services to persons with physical disabilities in rural Ghana. Understanding healthcare providers’ perspectives could help leverage previous findings from clients’ experiences to more fully inform the development of specific and actionable research and interventions to improve healthcare delivery for disabled people. Methods: We conducted in-depth interviews with 15 healthcare providers and used thematic analysis to analyze the data. Results: Participants reported their perspectives in three major themes: challenges in providing healthcare (eg, limited availability of drugs and medical equipment, limited healthcare providers, financial constraints, and inaccessible facilities and equipment); strategies in navigating the challenges (eg, improvising techniques and employing professional values, referring clients, and providing financial assistance to clients); and positive experience in providing healthcare (eg, feeling rewarded and appreciated). Conclusion: The findings reinforce the need to consider the availability of rehabilitation professionals and services to address the specific healthcare needs of disabled people at the PHC level in Ghana. The findings also point to a need for further research on the perspectives of healthcare policymakers about how to navigate the systemic barriers encountered by providers in providing care to persons with physical disabilities in rural Ghana in particular, and other similar rural areas.
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21
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Scheffler E, Mash R. Surviving a stroke in South Africa: outcomes of home-based care in a low-resource rural setting. Top Stroke Rehabil 2019; 26:423-434. [PMID: 31169468 DOI: 10.1080/10749357.2019.1623473] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Little is known of stroke outcomes in low- and middle-income countries with limited formal stroke rehabilitation services and of homebased-stroke services delivered within the primary health care (PHC) context by community health workers (CHWs). Objectives: To describe and analyze the outcomes of patients with stroke from a rural PHC setting in the Western Cape, South Africa. Methods: In a longitudinal survey, 93 stroke patients, referred to home and community-based care services (HCBC) between June 2015 and December 2017, were assessed at baseline, one month and three months. Changes in function (Barthel Index (BI)), caregiver strain (Caregiver Strain Index (CSI)), impact of environmental factors and satisfaction with stroke care were measured. Results: HCBC was delayed, fragmented and brief (median session duration 20 minutes (IQR 15.0-30.0)). Although function improved significantly, dependence remained high: median BI score changed from 40.0 (IQR 15.0-70.0) to 62.5 (IQR 30.0-81.25) (p = .019). A third (33.0% (30/91)) of caregivers initially experienced strain and the median CSI score remained 3.0 (IQR 0.0-7.0) (p = .672). Overall, patient and caregiver satisfaction with HCBC was low with only 46.9% (31/66) of caregivers and 17.4% (12/69) of patients satisfied with all aspects of care. Only 47.6% of assistive product needs were met. Environmental factors negatively impacted on patient function and caregiving. Conclusions: Clinical practice pathways and referral guidelines should be developed for the HCBC platform. Specific training of CHWs, focusing on how to educate, support and train family caregivers, provide assistive devices and refer to health services is needed.
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Affiliation(s)
- Elsje Scheffler
- a Division of Family Medicine and Primary Care, Stellenbosch University , Stellenbosch , South Africa
| | - Robert Mash
- a Division of Family Medicine and Primary Care, Stellenbosch University , Stellenbosch , South Africa
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Driver S, Juengst S, McShan EE, Bennett M, Bell K, Dubiel R. A randomized controlled trial protocol for people with traumatic brain injury enrolled in a healthy lifestyle program (GLB-TBI). Contemp Clin Trials Commun 2019; 14:100328. [PMID: 30775611 PMCID: PMC6365803 DOI: 10.1016/j.conctc.2019.100328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/10/2019] [Accepted: 01/18/2019] [Indexed: 01/07/2023] Open
Abstract
Weight gain is prevalent among people with traumatic brain injury (TBI) and may be attributable to environmental or injury-specific factors such as mobility impairment, endocrine dysfunction, behavioral and emotional disorders, and sensory loss. Few weight management programs exist to meet the unique needs of this population. Researchers modified a nationally recognized, evidence-based weight-loss program, Group Lifestyle Balance™ (GLB), to address the needs of over-weight and obese people post TBI (GLB-TBI). This current randomized controlled trial (RCT) examines the efficacy of the GLB-TBI on weight and secondary outcomes compared to an attention control educational support group. Furthermore, researchers have developed a mobile technology app to further engage participants in the program. This RCT will enroll and randomize 66 participants over a two-year period. It is anticipated that findings from this current RCT will contribute to the knowledge and evidence for an effective weight-loss intervention among this underserved population, with a goal of achieving full recognition by the Centers for Disease Control and Prevention-National Diabetes Prevention Program and subsequent Center for Medicare and Medicaid Services reimbursement for participation.
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Affiliation(s)
- Simon Driver
- North Texas Traumatic Brain Injury Model System, USA
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington, Dallas, TX, 75246, USA
| | - Shannon Juengst
- North Texas Traumatic Brain Injury Model System, USA
- University of Texas at Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Evan Elizabeth McShan
- North Texas Traumatic Brain Injury Model System, USA
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington, Dallas, TX, 75246, USA
| | - Monica Bennett
- North Texas Traumatic Brain Injury Model System, USA
- Baylor Scott and White Health, 8080 N. Central Expy, Dallas, TX, 75206, USA
| | - Kathleen Bell
- North Texas Traumatic Brain Injury Model System, USA
- University of Texas at Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Rosemary Dubiel
- North Texas Traumatic Brain Injury Model System, USA
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington, Dallas, TX, 75246, USA
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Taylor WJ, Green SE. Use of multi-attribute decision-making to inform prioritization of Cochrane review topics relevant to rehabilitation. Eur J Phys Rehabil Med 2019; 55:322-330. [PMID: 30947492 DOI: 10.23736/s1973-9087.19.05787-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Limited resources imply the need for prioritization; this also applies to the conduct of Cochrane Reviews. Therefore, processes for identifying the most important topics for review should be determined. AIM The aim of this study was to describe some examples of prioritization approaches used within Cochrane; to introduce the concept of multi-criteria decision analysis, provide an example of how this is being used to determine the relative importance of research questions in musculoskeletal health by the Australasian Musculoskeletal Clinical Trials (ANZMUSC) network and how a similar approach could be used to inform Cochrane Rehabilitation priorities. METHODS A narrative overview of the Cochrane Methods Priority Setting Group and new guidance from Cochrane on priority setting; a description of the ANZMUSC prioritization project and the proposed outline of a prioritization process that could be undertaken by Review Groups related to rehabilitation. RESULTS There are no explicit processes for prioritization for Cochrane Reviews that involve multi-criteria decision making, even though such approaches appear to be potentially useful and may overcome some disadvantages of alternative approaches. DISCUSSION Although the ANZMUSC prioritization project is not yet complete nor shown to be successful, it may offer a useful road-map for developing a transparent method of prioritizing which research topics to pursue, in a way that could be easily implemented and updated.
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Affiliation(s)
- William J Taylor
- Unit of Rehabilitation Teaching and Research, Department of Medicine, University of Otago, Wellington, New Zealand -
| | - Sally E Green
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Ge T, Zhang Q, Lu J, Chen G, Sun M, Li X. Association between education and health outcomes among adults with disabilities: evidence from Shanghai, China. PeerJ 2019; 7:e6382. [PMID: 30809431 PMCID: PMC6385680 DOI: 10.7717/peerj.6382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/01/2019] [Indexed: 01/15/2023] Open
Abstract
Background Adults with disabilities often have worse health outcomes than do their peers without disabilities. While education is a key determinant of health, there is little research available on the health disparities across education levels among adults with disabilities in developing countries. We therefore examined the association between health outcomes and education among adults with disabilities in Shanghai, China. Methods We used the health examination records of 42,715 adults with disabilities in Shanghai in 2014. Five health outcomes, including two diseases (fatty liver and hemorrhoids) and three risk factors (overweight [body mass index ≥ 24]), high blood glucose, and high blood lipid), were evaluated. Descriptive statistics and Pearson’s chi-square test were used to assess differences in participants’ demographic and disability characteristics. Pearson’s chi-square test and Fisher’s exact test were conducted to compare the prevalence of each health outcome among the different education levels. Finally, logistic regression analyses were conducted to explore the association between education and health outcomes after adjusting for sociodemographic characteristics. Results People with an elementary school or lower degree had the highest prevalence of overweight (52.1%) and high blood glucose (20.8%), but the lowest prevalence of hemorrhoids (18.6%) and fatty liver (38.9%). We observed significant differences in the association between education and health outcomes across disability types. For example, in physically disabled adults, higher education was related to higher odds of hemorrhoids (p < 0.001); however, there were no significant disparities in hemorrhoids across the education levels among adults with intellectual disabilities. Discussion Compared with people without disabilities, adults with disabilities in Shanghai have relatively poor health. The association between education and health outcomes differed according to the health condition and disability type. To reduce the prevalence rate of overweight and high blood glucose among people with disabilities, tailored health promotion initiatives must be developed for people with lower education levels. In contrast, specific attention should be paid to the prevention of hemorrhoids and fatty liver among more-educated people with disabilities. Our study provides important evidence for targeting educational groups with specific disability types for health promotion and intervention.
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Affiliation(s)
- Tong Ge
- Department of Health Policy and Management/ School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| | - Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, United States of America
| | - Jun Lu
- Department of Health Policy and Management/ School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| | - Gang Chen
- China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China.,Department of Health Law and Health Inspection/ School of Public Health, Fudan University, Shanghai, China
| | - Mei Sun
- Department of Health Policy and Management/ School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| | - Xiaohong Li
- Department of Health Policy and Management/ School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
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25
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Masulani-Mwale C, Kauye F, Gladstone M, Mathanga D. Development of a psycho-social intervention for reducing psychological distress among parents of children with intellectual disabilities in Malawi. PLoS One 2019; 14:e0210855. [PMID: 30742648 PMCID: PMC6370275 DOI: 10.1371/journal.pone.0210855] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/03/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The burden of intellectual disabilities in low and middle income countries (LMIC) is high and is associated with parental psychological distress. There are few services for children and parents in most developing countries and few interventions have been created that target the psychological issues among parents of such children. This study aimed to develop a contextualized intervention to provide psychological support for parents of children with intellectual disabilities in an African setting. METHODS Six steps were adopted from the Medical Research Council framework for designing complex interventions. This include: literature review of similar interventions and models, qualitative studies to gain insights of lived experiences of parents of such children, a consensus process with an expert panel of professionals working with children with disabilities and piloting and pre-testing the draft intervention for its acceptability and practicability in this settings. RESULTS 21 intervention modules were found from a systematic search of the literature which were listed for possible use in our intervention along with four themes from our qualitative studies. An expert panel formed consensus on the eight most pertinent and relevant modules for our setting. This formed the intervention; "Titukulane." This intervention was piloted and found to have high acceptability and practicability when contextualized in the field. CONCLUSION The use of a systematic framework for designing a complex intervention for supporting the mental health of parents of children with disabilities enables good acceptability and practicability for future use in low resource settings.
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Affiliation(s)
| | - Felix Kauye
- Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Melissa Gladstone
- University of Liverpool, UK Department of Women and Children’s Health, Institute of Translational Medicine, University of Liverpool, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Don Mathanga
- Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi
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26
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Dassah E, Aldersey H, McColl MA, Davison C. Factors affecting access to primary health care services for persons with disabilities in rural areas: a "best-fit" framework synthesis. Glob Health Res Policy 2018; 3:36. [PMID: 30603678 PMCID: PMC6305566 DOI: 10.1186/s41256-018-0091-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022] Open
Abstract
Background Access to primary health care (PHC) is a fundamental human right and central in the performance of health care systems, however persons with disabilities (PWDs) generally experience greater barriers in accessing PHC than the general population. These problems are further exacerbated for those with disabilities in rural areas. Understanding PHC access for PWDs is particularly important as such knowledge can inform policies, clinical practice and future research in rural settings. Methods We conducted a synthesis of published literature to explore the factors affecting access to PHC for PWDs in rural areas globally. Using an adapted keyword search string we searched five databases (CINAHL, EMBASE, Global Health, Medline and Web of Science), key journals and the reference lists of included articles. We imported the articles into NVivo and conducted deductive (framework) analysis by charting the data into a rural PHC access framework. We subsequently conducted inductive (thematic) analysis. Results We identified 36 studies that met our inclusion criteria. A majority (n = 26) of the studies were conducted in low-and middle-income countries. We found that PWDs were unable to access PHC due to obstacles including the interplay of four major factors; availability, acceptability, geography and affordability. In particular, limited availability of health care facilities and services and perceived low quality of care meant that those in need of health care services frequently had to travel for care. The barrier of geographic distance was worsened by transportation problems. We also observed that where health services were available most people could not afford the cost. Conclusion Our synthesis noted that modifying the access framework to incorporate relationships among the barriers might help better conceptualize PHC access challenges and opportunities in rural settings. We also made recommendations for policy development, practice consideration and future research that could lead to more equitable access to health care. Importantly, there is the need for health policies that aim address rural health problems to consider all the dimensions and their interactions. In terms of practice, the review also highlights the need to provide in-service training to health care providers on how to enhance their communication skills with PWDs. Future research should focus on exploring access in geographical contexts with different health care systems, the perspectives of health care providers and how PWDs respond to access problems in rural settings. Electronic supplementary material The online version of this article (10.1186/s41256-018-0091-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ebenezer Dassah
- 1School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston, Ontario K7L 3N6 Canada
| | - Heather Aldersey
- 1School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston, Ontario K7L 3N6 Canada
| | - Mary Ann McColl
- 1School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston, Ontario K7L 3N6 Canada
| | - Colleen Davison
- 2Department of Public Health Sciences, Queen's University, Carruthers Hall, 62 Fifth Field Company Lane, Kingston, Ontario K7L 3N6 Canada
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27
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Odgers HL, Tong A, Lopez-Vargas P, Davidson A, Jaffe A, McKenzie A, Pinkerton R, Wake M, Richmond P, Crowe S, Caldwell PHY, Hill S, Couper J, Haddad S, Kassai B, Craig JC. Research priority setting in childhood chronic disease: a systematic review. Arch Dis Child 2018; 103:942-951. [PMID: 29643102 DOI: 10.1136/archdischild-2017-314631] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/07/2018] [Accepted: 03/12/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate research priority setting approaches in childhood chronic diseases and to describe the priorities of stakeholders including patients, caregivers/families and health professionals. DESIGN We conducted a systematic review of MEDLINE, Embase, PsycINFO and CINAHL from inception to 16 October 2016. Studies that elicited stakeholder priorities for paediatric chronic disease research were eligible for inclusion. Data on the prioritisation process were extracted using an appraisal checklist. Generated priorities were collated into common topic areas. RESULTS We identified 83 studies (n=15 722). Twenty (24%) studies involved parents/caregivers and four (5%) children. The top three health areas were cancer (11%), neurology (8%) and endocrine/metabolism (8%). Priority topic areas were treatment (78%), disease trajectory (48%), quality of life/psychosocial impact (48%), disease onset/prevention (43%), knowledge/self-management (33%), prevalence (30%), diagnostic methods (28%), access to healthcare (25%) and transition to adulthood (12%). The methods included workshops, Delphi techniques, surveys and focus groups/interviews. Specific methods for collecting and prioritising research topics were described in only 60% of studies. Most reviewed studies were conducted in high-income nations. CONCLUSIONS Research priority setting activities in paediatric chronic disease cover many discipline areas and have elicited a broad range of topics. However, child/caregiver involvement is uncommon, and the methods often lack clarity. A systematic and explicit process that involves patients and families in partnership may help to inform a more patient and family-relevant research agenda in paediatric chronic disease.
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Affiliation(s)
- Harrison Lindsay Odgers
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Pamela Lopez-Vargas
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Kid's Research Institute, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Andrew Davidson
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, France.,Department of Anaesthesiology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Adam Jaffe
- Department of Respiratory Medicine, The Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Discipline of Paediatrics, The University of New South Wales, Sydney, New South Wales, Australia
| | - Anne McKenzie
- Western Australian Health Translation Network, The University of Western Australia, Perth, Western Australia, Australia
| | - Ross Pinkerton
- Department of Oncology, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Melissa Wake
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, France.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Peter Richmond
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.,Departments of General Paediatrics and Immunology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | | | - Patrina Ha Yuen Caldwell
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Nephrology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Sophie Hill
- Center for Health Communication and Participation, La Trobe University, Melbourne, Victoria, Australia
| | - Jennifer Couper
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Suzy Haddad
- Patient and Carer Representative, Sydney, New South Wales, Australia
| | - Behrouz Kassai
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Centre d'Investigation Clinique de Lyon, Lyon, France
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Skempes D, Melvin J, von Groote P, Stucki G, Bickenbach J. Using concept mapping to develop a human rights based indicator framework to assess country efforts to strengthen rehabilitation provision and policy: the Rehabilitation System Diagnosis and Dialogue framework (RESYST). Global Health 2018; 14:96. [PMID: 30285888 PMCID: PMC6167891 DOI: 10.1186/s12992-018-0410-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/10/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Rehabilitation is crucial for the realization of the right to health and a proper concern of global health. Yet, reliable information to guide rehabilitation service planning is unavailable in many countries in part due to the lack of appropriate indicators. To ensure universal health coverage and meet the central imperative of "leaving no one behind" countries must be able to assess key aspects of rehabilitation policy and provision and monitor how they have discharged their human rights responsibilities towards those most disadvantaged, including people with disability. This article describes the process of developing an expert guided indicator framework to assess governments' efforts and progress in strengthening rehabilitation in line with the Convention on the Rights of Persons with Disabilities. METHODS A systems methodology - concept mapping - was used to capture, aggregate and confirm the knowledge of diverse stakeholders on measures thought to be useful for monitoring the implementation of the Convention with respect to health related rehabilitation. Fifty-six individuals generated a list of 107 indicators through online brainstorming which were subsequently sorted by 37 experts from the original panel into non overlapping categories. Forty-one participants rated the indicators for importance and feasibility. Multivariate statistical techniques where used to explore patterns and themes in the data and create the indicators' organizing framework which was verified and interpreted by a select number of participants. RESULTS A concept map of 11 clusters of indicators emerged from the analysis grouped into three broader themes: Governance and Leadership (3 clusters); Service Delivery, Financing and Oversight (6 clusters); and Human Resources (2 clusters). The indicator framework was comprehensive and well aligned with the Convention. On average, there was a moderately positive correlation between importance and feasibility of the indicators (r = .58) with experts prioritizing the indicators contained in the clusters of the Governance and Leadership domain. Two of the most important indicators arose from the Service Delivery, Financing and Oversight domain and reflect the need to monitor unmet needs and barriers in access to rehabilitation. In total, 59 indicators achieved above average score for importance and comprised the two-tiered priority set of indicators. CONCLUSION Concept mapping was successful in generating a shared model that enables a system's view of the most critical legal, policy and programmatic factors that must be addressed when assessing country efforts to reform, upscale and improve rehabilitation services. The Rehabilitation Systems Diagnosis and Dialogue framework provides a data driven basis for the development of standardized data collection tools to facilitate comparative analysis of rehabilitation systems. Despite agreement on the importance and feasibility of 59 indicators, further research is needed to appraise the applicability and utility of the indicators and secure a realistic assessment of rehabilitation systems.
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Affiliation(s)
- Dimitrios Skempes
- Department of Health Sciences and Health Policy, Center for Rehabilitation in Global Health Systems, University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, CH-6002 Lucerne, Switzerland
- Swiss Paraplegic Research (SPF), Guido A. Zaech Institute, CH-6207 Nottwil, Switzerland
| | - John Melvin
- Department of Rehabilitation Medicine, Thomas Jefferson University, 25 S. Ninth Street, Philadelphia, PA 19107 USA
| | - Per von Groote
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Gerold Stucki
- Department of Health Sciences and Health Policy, Center for Rehabilitation in Global Health Systems, University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, CH-6002 Lucerne, Switzerland
- Swiss Paraplegic Research (SPF), Guido A. Zaech Institute, CH-6207 Nottwil, Switzerland
| | - Jerome Bickenbach
- Department of Health Sciences and Health Policy, Center for Rehabilitation in Global Health Systems, University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, CH-6002 Lucerne, Switzerland
- Swiss Paraplegic Research (SPF), Guido A. Zaech Institute, CH-6207 Nottwil, Switzerland
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29
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Vergunst R, Swartz L, Hem KG, Eide AH, Mannan H, MacLachlan M, Mji G, Schneider M. The perceived needs-access gap for health services among persons with disabilities in a rural area within South Africa. Disabil Rehabil 2018; 41:2676-2682. [PMID: 29957079 DOI: 10.1080/09638288.2018.1478001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: Health should be a universal phenomenon. However, little is known about the relationship between disability status and health issues - particularly in rural areas. This study looks at health issues of persons with disabilities in Madwaleni, a rural impoverished area in South Africa in 2011, and compares them to persons with no disabilities. Materials and Methods: Standardized questionnaires were used in the survey to assess disability and health status. The sample comprised of 773 individuals - 322 persons with disability and 451 comparisons (without disability) - covering 527 households. Children under the age of five were excluded from the sample. We used purposive sampling. Results and Conclusion: This study found that persons with disabilities have poorer reported health outcomes than persons with no disabilities. There is also an association between disability severity and mental health issues as assessed by the GHQ-12. A significantly higher percentage of persons with disability did not get health care when needed. Persons with disabilities also have less favorable attitudes toward competence of health care workers. This study has shown greater health needs and less satisfaction with services, which strongly indicates insufficient access for persons with disabilities in a rural impoverished are within South Africa. Implications for rehabilitation Persons with disabilities in rural South Africa have poorer reported health outcomes. Persons with disabilities have less favorable attitudes towards competence of health care workers in rural South Africa. Better access to health care for persons with disabilities is needed in rural South Africa.
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Affiliation(s)
- Richard Vergunst
- Department of Psychology, Alan J Flisher Centre for Public Mental Health, Stellenbosch University , Stellenbosch , South Africa
| | - Leslie Swartz
- Department of Psychology, Alan J Flisher Centre for Public Mental Health, Stellenbosch University , Stellenbosch , South Africa
| | - Karl-Gerhard Hem
- Department of Health, SINTEF Technology and Society , Oslo , Norway
| | - Arne Henning Eide
- Department of Health, SINTEF Technology and Society , Oslo , Norway.,Centre for Rehabilitation Studies, Stellenbosch University , Stellenbosch , South Africa
| | - Hasheem Mannan
- School of Nursing Midwifery & Health Systems, Health Sciences Centre University College Dublin , Dublin , Ireland
| | - Malcolm MacLachlan
- Centre for Rehabilitation Studies, Stellenbosch University , Stellenbosch , South Africa.,Assisting Living & Learning (ALL) Institute, Maynooth University , Ireland.,Olomouc University Social Health Institute, Palacky University , Olomouc , Czech
| | - Gubela Mji
- Centre for Rehabilitation Studies, Stellenbosch University , Stellenbosch , South Africa
| | - Marguerite Schneider
- Department of Psychiatry & Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town , Cape Town , South Africa
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30
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Vanderbom KA, Eisenberg Y, Tubbs AH, Washington T, Martínez AX, Rauworth A. Changing the Paradigm in Public Health and Disability through a Knowledge Translation Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E328. [PMID: 29438334 PMCID: PMC5858397 DOI: 10.3390/ijerph15020328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/26/2018] [Accepted: 02/07/2018] [Indexed: 11/28/2022]
Abstract
People with disabilities are a health disparity population that face many barriers to health promotion opportunities in their communities. Inclusion in public health initiatives is a critical approach to address the health disparities that people with disabilities experience. The National Center on Health, Physical Activity and Disability (NCHPAD) is tackling health disparities in the areas of physical activity, healthy nutrition, and healthy weight management. Using the NCHPAD Knowledge Adaptation, Translation, and Scale-up Framework, NCHPAD is systematically facilitating, monitoring, and evaluating inclusive programmatic, policy, systems, and environmental (PPSE) changes in communities and organizations at a local and national level. Through examples we will highlight the importance of adapting knowledge, facilitating uptake, developing strategic partnerships and building community capacity that ultimately creates sustainable, inclusive change.
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Affiliation(s)
- Kerri A Vanderbom
- Department of Physical Therapy, University of Alabama at Birmingham/Lakeshore Research Collaborative, Birmingham, AL 35209, USA.
| | - Yochai Eisenberg
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL 60608, USA.
| | - Allison H Tubbs
- The National Center on Health, Physical Activity and Disability, Birmingham, AL 35209, USA.
| | - Teneasha Washington
- Department of Health Behavior, University of Alabama at Birmingham/Lakeshore Research Collaborative, Birmingham, AL 35209, USA.
| | - Alex X Martínez
- The National Center on Health, Physical Activity and Disability, Birmingham, AL 35209, USA.
| | - Amy Rauworth
- The National Center on Health, Physical Activity and Disability, Birmingham, AL 35209, USA.
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31
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Vergunst R, Swartz L, Hem KG, Eide AH, Mannan H, MacLachlan M, Mji G, Braathen SH, Schneider M. Access to health care for persons with disabilities in rural South Africa. BMC Health Serv Res 2017; 17:741. [PMID: 29149852 PMCID: PMC5693516 DOI: 10.1186/s12913-017-2674-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 11/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at "triple vulnerability" - poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa. METHODS The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis. RESULTS Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age. CONCLUSIONS This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.
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Affiliation(s)
- R. Vergunst
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, PO Box X1, Stellenbosch, Matieland 7602 South Africa
| | - L. Swartz
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, PO Box X1, Stellenbosch, Matieland 7602 South Africa
| | - K.-G. Hem
- SINTEF Technology and Society, Department of Health Research, PB 124 Blindern, 0314 Oslo, Norway
| | - A. H. Eide
- SINTEF Technology and Society, Department of Health Research, PB 124 Blindern, 0314 Oslo, Norway
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa
| | - H. Mannan
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - M. MacLachlan
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa
- ALL Institute and Department of Psychology, Maynooth University, Maynooth, Ireland
- Olomouc University Social Health Institute, Palacký University Olomouc, Olomouc, Czech Republic
| | - G. Mji
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa
| | - S. H. Braathen
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, PO Box X1, Stellenbosch, Matieland 7602 South Africa
- SINTEF Technology and Society, Department of Health Research, PB 124 Blindern, 0314 Oslo, Norway
| | - M. Schneider
- Alan J Flisher Centre for Public Mental Health Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
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32
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Tomlinson M, Jordans M, MacMillan H, Betancourt T, Hunt X, Mikton C. Research priority setting for integrated early child development and violence prevention (ECD+) in low and middle income countries: An expert opinion exercise. CHILD ABUSE & NEGLECT 2017; 72:131-139. [PMID: 28802211 DOI: 10.1016/j.chiabu.2017.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 06/07/2023]
Abstract
Child development in low and middle income countries (LMIC) is compromised by multiple risk factors. Reducing children's exposure to harmful events is essential for early childhood development (ECD). In particular, preventing violence against children - a highly prevalent risk factor that negatively affects optimal child development - should be an intervention priority. We used the Child Health and Nutrition Initiative (CHNRI) method for the setting of research priorities in integrated Early Childhood Development and violence prevention programs (ECD+). An expert group was identified and invited to systematically list and score research questions. A total of 186 stakeholders were asked to contribute five research questions each, and contributions were received from 81 respondents. These were subsequently evaluated using a set of five criteria: answerability; effectiveness; feasibility and/or affordability; applicability and impact; and equity. Of the 400 questions generated, a composite group of 50 were scored by 55 respondents. The highest scoring research questions related to the training of Community Health Workers (CHW's) to deliver ECD+ interventions effectively and whether ECD+ interventions could be integrated within existing delivery platforms such as HIV, nutrition or mental health platforms. The priority research questions can direct new research initiatives, mainly in focusing on the effectiveness of an ECD+ approach, as well as on service delivery questions. To the best of our knowledge, this is the first systematic exercise of its kind in the field of ECD+. The findings from this research priority setting exercise can help guide donors and other development actors towards funding priorities for important future research related to ECD and violence prevention.
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Affiliation(s)
| | - Mark Jordans
- War Child Holland, Netherlands & King's College London, UK
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Smythe T, Mactaggart I, Kuper H, Oye J, Sieyen NC, Lavy C, Polack S. Prevalence and causes of musculoskeletal impairment in Fundong District, North-West Cameroon: results of a population-based survey. Trop Med Int Health 2017; 22:1385-1393. [PMID: 28881434 DOI: 10.1111/tmi.12971] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Epidemiological data on musculoskeletal conditions such as degenerative joint diseases and bone fractures are lacking in low- and middle-income countries. This survey aimed to estimate the prevalence and causes of musculoskeletal impairment in Fundong Health District, North-West Cameroon. METHODS Fifty-one clusters of 80 people (all ages) were selected using probability proportionate to size sampling. Households within clusters were selected by compact segment sampling. Six screening questions were asked to identify participants likely to have a musculoskeletal impairment (MSI). Participants screening positive to any screening question underwent a standardised examination by a physiotherapist to assess presence, cause, diagnosis and severity of impairment. RESULTS In total, 3567 of 4080 individuals enumerated for the survey were screened (87%). The all-age prevalence of MSI was 11.6% (95% CI: 10.1-13.3). Prevalence increased with age, from 2.9% in children to 41.2% in adults 50 years and above. The majority of MSI cases (70.4%) were classified as mild, 27.2% as moderate and 2.4% as severe. Acquired non-trauma comprised 67% of the diagnoses. The remainder included trauma (14%), neurological (11%), infection (5%) and congenital (3%). The most common individual diagnosis was degenerative joint disease (43%). Over one-third (38%) of individuals with MSI had never received medical care or rehabilitation for their condition. CONCLUSIONS This survey contributes to the epidemiological data on MSI in low- and middle-income countries. Nearly half of adults aged over 50 years had an MSI. There is a need to address the treatment and rehabilitative service gap for people with MSI in Cameroon.
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Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Christopher Lavy
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Hussey M, MacLachlan M, Mji G. Barriers to the Implementation of the Health and Rehabilitation Articles of the United Nations Convention on the Rights of Persons with Disabilities in South Africa. Int J Health Policy Manag 2017; 6:207-218. [PMID: 28812804 PMCID: PMC5384983 DOI: 10.15171/ijhpm.2016.117] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 08/15/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) is a milestone in the recognition of the human rights of persons with disabilities, including the right to health and rehabilitation. South Africa has signed and ratified the CRPD but still has a long way to go in reforming policies and systems in order to be in compliance with the convention. This paper seeks to fill a gap in the literature by exploring what the barriers to the implementation of the health and rehabilitation articles of the CRPD are, as identified by representatives of the disability community. METHODS This investigation used a qualitative, exploratory methodology. 10 semi-structured interviews of a purposive sample of representatives of disabled persons organizations (DPOs), non-governmental organizations (NGOs), and service providers in South Africa were conducted. Participants were drawn from urban, peri-urban, and rural settings in order to reflect diverse perspectives within South Africa. Data was analysed using a multi-stage coding process to establish the main categories and relationships between them. RESULTS Six main categories of barriers to the implementation of the health and rehabilitation articles of the CRPD were identified. Attitude barriers including stigma and negative assumptions about persons with disabilities were seen as an underlying cause and influence on all of the other categories; which included political, financial, health systems, physical, and communication barriers. CONCLUSION The findings of this study have important implications for strategies and actions to implement the CRPD. Given the centrality of attitudinal barriers, greater sensitization around the area of disability is needed. Furthermore, disability should be better integrated and mainstreamed into more general initiatives to develop the health system and improve the lives of persons living in poverty in South Africa.
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Affiliation(s)
- Meghan Hussey
- Centre for Global Health, Trinity College Dublin, Dublin 2, Ireland
| | | | - Gubela Mji
- Centre for Rehabilitation Studies, Department of Interdisciplinary Health Sciences, School of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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McNeely CA, Morland L, Doty SB, Meschke LL, Awad S, Husain A, Nashwan A. How Schools Can Promote Healthy Development for Newly Arrived Immigrant and Refugee Adolescents: Research Priorities. THE JOURNAL OF SCHOOL HEALTH 2017; 87:121-132. [PMID: 28076923 DOI: 10.1111/josh.12477] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 05/05/2016] [Accepted: 08/11/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The US education system must find creative and effective ways to foster the healthy development of the approximately 2 million newly arrived immigrant and refugee adolescents, many of whom contend with language barriers, limited prior education, trauma, and discrimination. We identify research priorities for promoting the school success of these youth. METHODS The study used the 4-phase priority-setting method of the Child Health and Nutrition Research Initiative. In the final stage, 132 researchers, service providers, educators, and policymakers based in the United States were asked to rate the importance of 36 research options. RESULTS The highest priority research options (range 1 to 5) were: evaluating newcomer programs (mean = 4.44, SD = 0.55), identifying how family and community stressors affect newly arrived immigrant and refugee adolescents' functioning in school (mean = 4.40, SD = 0.56), identifying teachers' major stressors in working with this population (mean = 4.36, SD = 0.72), and identifying how to engage immigrant and refugee families in their children's education (mean = 4.35, SD = 0.62). CONCLUSION These research priorities emphasize the generation of practical knowledge that could translate to immediate, tangible benefits for schools. Funders, schools, and researchers can use these research priorities to guide research for the highest benefit of schools and the newly arrived immigrant and refugee adolescents they serve.
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Affiliation(s)
- Clea A McNeely
- Department of Public Health, University of Tennessee, Knoxville, 1914 Andy Holt Avenue, Suite 390, Knoxville, TN 37919
| | - Lyn Morland
- Innovation, Policy and Research, Bank Street College of Education, 610 West 112th Street, New York, NY 10025
| | - S Benjamin Doty
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205
| | - Laurie L Meschke
- Department of Public Health, University of Tennessee, Knoxville, 1914 Andy Holt Avenue, Suite 390, Knoxville, TN 37919
| | - Summer Awad
- Department of Public Health, University of Tennessee, Knoxville, 1212 Wallingford Road, Knoxville, TN 32923
| | - Altaf Husain
- Department of Social Work, Howard University, 601 Howard Place, NW, Washington, DC 20059
| | - Ayat Nashwan
- Yarmouk University, Shafiq Irshidat St, Irbid 21163, Jordan
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Shah H, Albanese E, Duggan C, Rudan I, Langa KM, Carrillo MC, Chan KY, Joanette Y, Prince M, Rossor M, Saxena S, Snyder HM, Sperling R, Varghese M, Wang H, Wortmann M, Dua T. Research priorities to reduce the global burden of dementia by 2025. Lancet Neurol 2016; 15:1285-1294. [DOI: 10.1016/s1474-4422(16)30235-6] [Citation(s) in RCA: 189] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/04/2016] [Accepted: 08/28/2016] [Indexed: 10/20/2022]
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Mikton CR, Tanaka M, Tomlinson M, Streiner DL, Tonmyr L, Lee BX, Fisher J, Hegadoren K, Pim JE, Wang SJS, MacMillan HL. Global research priorities for interpersonal violence prevention: a modified Delphi study. Bull World Health Organ 2016; 95:36-48. [PMID: 28053363 PMCID: PMC5180342 DOI: 10.2471/blt.16.172965] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/15/2016] [Accepted: 08/31/2016] [Indexed: 11/27/2022] Open
Abstract
Objective To establish global research priorities for interpersonal violence prevention using a systematic approach. Methods Research priorities were identified in a three-round process involving two surveys. In round 1, 95 global experts in violence prevention proposed research questions to be ranked in round 2. Questions were collated and organized according to the four-step public health approach to violence prevention. In round 2, 280 international experts ranked the importance of research in the four steps, and the various substeps, of the public health approach. In round 3, 131 international experts ranked the importance of detailed research questions on the public health step awarded the highest priority in round 2. Findings In round 2, “developing, implementing and evaluating interventions” was the step of the public health approach awarded the highest priority for four of the six types of violence considered (i.e. child maltreatment, intimate partner violence, armed violence and sexual violence) but not for youth violence or elder abuse. In contrast, “scaling up interventions and evaluating their cost–effectiveness” was ranked lowest for all types of violence. In round 3, research into “developing, implementing and evaluating interventions” that addressed parenting or laws to regulate the use of firearms was awarded the highest priority. The key limitations of the study were response and attrition rates among survey respondents. However, these rates were in line with similar priority-setting exercises. Conclusion These findings suggest it is premature to scale up violence prevention interventions. Developing and evaluating smaller-scale interventions should be the funding priority.
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Affiliation(s)
- Christopher R Mikton
- Department of Health and Social Sciences, University of the West of England, Bristol Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, England
| | | | | | | | - Lil Tonmyr
- Public Health Agency of Canada, Ottawa, Canada
| | - Bandy X Lee
- Yale University, New Haven, United States of America (USA)
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Berghs M, Atkin K, Graham H, Hatton C, Thomas C. Implications for public health research of models and theories of disability: a scoping study and evidence synthesis. PUBLIC HEALTH RESEARCH 2016. [DOI: 10.3310/phr04080] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BackgroundPublic health interventions that are effective in the general population are often assumed to apply to people with impairments. However, the evidence to support this is limited and hence there is a need for public health research to take a more explicit account of disability and the perspectives of people with impairments.Objectives(1) To examine the literature on theories and models of disability; (2) to assess whether or not, and how, intervention studies of effectiveness could incorporate more inclusive approaches that are consistent with these theories and models; and (3) to use the findings to draw out implications for improving evaluative study designs and evidence-based practice.Review methodsThe project is a scoping review of the literature. The first stage examines theories and models of disability and reflects on possible connections between theories of disability and public health paradigms. This discussion is used to develop an ethical–empirical decision aid/checklist, informed by a human rights approach to disability and ecological approaches to public health. We apply this decision aid in the second stage of the review to evaluate the extent to which the 30 generic public health reviews of interventions and the 30 disability-specific public health interventions include the diverse experiences of disability. Five deliberation panels were also organised to further refine the decision aid: one with health-care professionals and four with politically and socially active disabled people.ResultsThe evidence from the review indicated that there has been limited public health engagement with theories and models of disability. Outcome measures were often insensitive to the experiences of disability. Even when disabled people were included, studies rarely engaged with their experiences in any meaningful way. More inclusive research should reflect how people live and ‘flourish’ with disability.LimitationsThe scoping review provides a broad appraisal of a particular field. It generates ideas for future practice rather than a definite framework for action.ConclusionsOur ethical–empirical decision aid offers a critical framework with which to evaluate current research practice. It also offers a resource for promoting more ethical and evidence-based public health research that is methodologically robust while being sensitive to the experiences of disability.Future workDeveloping more inclusive research and interventions that avoid conceptualising disability as either a ‘burden’ or ‘problem’ is an important starting point. This includes exploring ways of refining and validating current common outcome measures to ensure that they capture a diverse range of disabling experiences, as well as generating evidence on meaningful ways of engaging a broad range of disabled children and adults in the research process.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Maria Berghs
- Department of Health Sciences, University of York, York, UK
| | - Karl Atkin
- Department of Health Sciences, University of York, York, UK
| | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Chris Hatton
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
| | - Carol Thomas
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
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Rohleder P. Disability and HIV in Africa: Breaking the barriers to sexual health care. J Health Psychol 2016; 22:1405-1414. [PMID: 26893296 DOI: 10.1177/1359105316628738] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Three decades into the HIV pandemic, the issues affecting people with disabilities remain less known. Increasing attention has been given to this overlooked population when it comes to HIV prevention, treatment and care. This is related to the significant unmet sexual and reproductive healthcare needs facing people with disabilities worldwide. This article discusses the barriers to sexual health for people with disabilities in Africa and presents an argument about how mainstream HIV prevention work and research do not adequately attend to the sorts of systemic barriers that exclude people with disabilities, which a more targeted and critical approach could.
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Alim M, Lindley R, Felix C, Gandhi DBC, Verma SJ, Tugnawat DK, Syrigapu A, Anderson CS, Ramamurthy RK, Langhorne P, Murthy GVS, Shamanna BR, Hackett ML, Maulik PK, Harvey LA, Jan S, Liu H, Walker M, Forster A, Pandian JD. Family-led rehabilitation after stroke in India: the ATTEND trial, study protocol for a randomized controlled trial. Trials 2016; 17:13. [PMID: 26739268 PMCID: PMC4704425 DOI: 10.1186/s13063-015-1129-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/17/2015] [Indexed: 11/26/2022] Open
Abstract
Background Globally, most strokes occur in low- and middle-income countries, such as India, with many affected people having no or limited access to rehabilitation services. Western models of stroke rehabilitation are often unaffordable in many populations but evidence from systematic reviews of stroke unit care and early supported discharge rehabilitation trials suggest that some components might form the basis of affordable interventions in low-resource settings. We describe the background, history and design of the ATTEND trial, a complex intervention centred on family-led stroke rehabilitation in India. Methods/design The ATTEND trial aims to test the hypothesis that a family-led caregiver-delivered home-based rehabilitation intervention, designed for the Indian context, will reduce the composite poor outcome of death or dependency at 6 months after stroke, in a multicentre, individually randomized controlled trial with blinded outcome assessment, involving 1200 patients across 14 hospital sites in India. Discussion The ATTEND trial is testing the effectiveness of a low-cost rehabilitation intervention that could be widely generalizable to other low- and middle-income countries. Trial registration Clinical Trials Registry-India CTRI/2013/04/003557. Australian New Zealand Clinical Trials Registry ACTRN12613000078752. Universal Trial Number U1111-1138-6707. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1129-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammed Alim
- Research and Development, George Institute for Global Health India, Unit 301, Second Floor ANR Centre, Road No 1, Banjara Hills, Hyderabad, Telangana, India.
| | - Richard Lindley
- The George Institute for Global Health, Sydney, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia.
| | | | | | | | | | | | - Craig Stuart Anderson
- The George Institute for Global Health, Sydney, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia. .,Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia.
| | | | | | | | | | - Maree Lisa Hackett
- The George Institute for Global Health, Sydney, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia. .,University of Central Lancashire, Preston, Lancashire, UK.
| | - Pallab Kumar Maulik
- Research and Development, George Institute for Global Health India, Unit 301, Second Floor ANR Centre, Road No 1, Banjara Hills, Hyderabad, Telangana, India. .,The George Institute for Global Health, Oxford University, Oxford, UK.
| | | | - Stephen Jan
- The George Institute for Global Health, Sydney, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Hueiming Liu
- The George Institute for Global Health, Sydney, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia.
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Kuenburg A, Fellinger P, Fellinger J. Health Care Access Among Deaf People. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2016; 21:1-10. [PMID: 26405210 DOI: 10.1093/deafed/env042] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 08/19/2015] [Indexed: 05/24/2023]
Abstract
Access to health care without barriers is a clearly defined right of people with disabilities as stated by the UN Convention on the Rights of People with Disabilities. The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in global health knowledge for deaf people including those with even higher risk of marginalization. Examples of approaches to improve access to health care, such as providing powerful and visually accessible communication through the use of sign language, the implementation of important communication technologies, and cultural awareness trainings for health professionals are discussed. Programs that raise health knowledge in Deaf communities and models of primary health care centers for deaf people are also presented. Published documents can empower deaf people to realize their right to enjoy the highest attainable standard of health.
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Malnutrition and Childhood Disability in Turkana, Kenya: Results from a Case-Control Study. PLoS One 2015; 10:e0144926. [PMID: 26689213 PMCID: PMC4686999 DOI: 10.1371/journal.pone.0144926] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 11/26/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Children with disabilities may be particularly vulnerable to malnutrition, as a result of exclusions and feeding difficulties. However, there is limited evidence currently available on this subject. METHODS A population-based case-control study was conducted in Turkana County, Kenya, between July and August 2013. Key informants in the community identified children aged 6 months to 10 years who they believed may have a disability. These children were screened by a questionnaire (UNICEF-Washington Group) and assessed by a paediatrician to confirm whether they had a disability and the type. Two controls without disabilities were selected per case: A sibling control (sibling nearest in age) and a neighbourhood control (nearest neighbour within one year of age). The caregiver completed a questionnaire on behalf of the child (e.g. information on feeding, poverty, illness, education), and anthropometric measures were taken. We undertook multivariable logistic and linear regression analyses to estimate the relationship between disability and malnutrition. RESULTS The study included 311 cases with disabilities, 196 sibling controls and 300 neighbour controls. Children with disabilities were more likely to report a range of feeding difficulties. They were 1.6-2.9 times more likely to have malnutrition in comparison to neighbour controls or family controls, including general malnutrition (low weight for age), stunting (low height for age), low body mass index (BMI) or low mid upper arm circumference (MUAC) for age. Children with disabilities were almost twice as likely to have wasting (low weight for height) in comparison to neighbour controls (OR = 1.9, 95% CI 1.1-3.2), but this difference was not apparent compared with siblings (OR = 1.5, 95% CI 0.8-2.7). Children with disabilities also faced other exclusions. For instance those aged 5+ were much more likely not to attend school than neighbour controls (OR = 8.5, 95% CI 4.3-16.9). CONCLUSIONS Children with disabilities were particularly vulnerable to malnutrition, even within this area of food insecurity and widespread malnutrition. Efforts need to be made to include children with disabilities within food supplementation programmes, and school based programmes alone may be inadequate to meet this need. Exclusion of children with disabilities from education is also a priority area to be addressed.
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Raftery J, Young A, Stanton L, Milne R, Cook A, Turner D, Davidson P. Clinical trial metadata: defining and extracting metadata on the design, conduct, results and costs of 125 randomised clinical trials funded by the National Institute for Health Research Health Technology Assessment programme. Health Technol Assess 2015; 19:1-138. [PMID: 25671821 DOI: 10.3310/hta19110] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND By 2011, the Health Technology Assessment (HTA) programme had published the results of over 100 trials with another 220 in progress. The aim of the project was to develop and pilot 'metadata' on clinical trials funded by the HTA programme. OBJECTIVES The aim of the project was to develop and pilot questions describing clinical trials funded by the HTA programme in terms of it meeting the needs of the NHS with scientifically robust studies. The objectives were to develop relevant classification systems and definitions for use in answering relevant questions and to assess their utility. DATA SOURCES Published monographs and internal HTA documents. REVIEW METHODS A database was developed, 'populated' using retrospective data and used to answer questions under six prespecified themes. Questions were screened for feasibility in terms of data availability and/or ease of extraction. Answers were assessed by the authors in terms of completeness, success of the classification system used and resources required. Each question was scored to be retained, amended or dropped. RESULTS One hundred and twenty-five randomised trials were included in the database from 109 monographs. Neither the International Standard Randomised Controlled Trial Number nor the term 'randomised trial' in the title proved a reliable way of identifying randomised trials. Only limited data were available on how the trials aimed to meet the needs of the NHS. Most trials were shown to follow their protocols but updates were often necessary as hardly any trials recruited as planned. Details were often lacking on planned statistical analyses, but we did not have access to the relevant statistical plans. Almost all the trials reported on cost-effectiveness, often in terms of both the primary outcome and quality-adjusted life-years. The cost of trials was shown to depend on the number of centres and the duration of the trial. Of the 78 questions explored, 61 were well answered, 33 fully with 28 requiring amendment were the analysis updated. The other 17 could not be answered with readily available data. LIMITATIONS The study was limited by being confined to 125 randomised trials by one funder. CONCLUSIONS Metadata on randomised controlled trials can be expanded to include aspects of design, performance, results and costs. The HTA programme should continue and extend the work reported here. FUNDING The National Institute for Health Research HTA programme.
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Affiliation(s)
- James Raftery
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Amanda Young
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Louise Stanton
- University of Southampton Clinical Trials Unit, Southampton General Hospital, Southampton, UK
| | - Ruairidh Milne
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew Cook
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Turner
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Peter Davidson
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, UK
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Betancourt TS, Zuilkowski SS, Ravichandran A, Einhorn H, Arora N, Bhattacharya Chakravarty A, Brennan RT. Development of the SAFE Checklist Tool for Assessing Site-Level Threats to Child Protection: Use of Delphi Methods and Application to Two Sites in India. PLoS One 2015; 10:e0141222. [PMID: 26540159 PMCID: PMC4634981 DOI: 10.1371/journal.pone.0141222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/05/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The child protection community is increasingly focused on developing tools to assess threats to child protection and the basic security needs and rights of children and families living in adverse circumstances. Although tremendous advances have been made to improve measurement of individual child health status or household functioning for use in low-resource settings, little attention has been paid to a more diverse array of settings in which many children in adversity spend time and how context contributes to threats to child protection. The SAFE model posits that insecurity in any of the following fundamental domains threatens security in the others: Safety/freedom from harm; Access to basic physiological needs and healthcare; Family and connection to others; Education and economic security. Site-level tools are needed in order to monitor the conditions that can dramatically undermine or support healthy child growth, development and emotional and behavioral health. From refugee camps and orphanages to schools and housing complexes, site-level threats exist that are not well captured by commonly used measures of child health and well-being or assessments of single households (e.g., SDQ, HOME). METHODS The present study presents a methodology and the development of a scale for assessing site-level child protection threats in various settings of adversity. A modified Delphi panel process was enhanced with two stages of expert review in core content areas as well as review by experts in instrument development, and field pilot testing. RESULTS Field testing in two diverse sites in India-a construction site and a railway station-revealed that the resulting SAFE instrument was sensitive to the differences between the sites from the standpoint of core child protection issues.
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Affiliation(s)
- Theresa S. Betancourt
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, United States of America
| | - Stephanie S. Zuilkowski
- Learning Systems Institute and Department of Educational Leadership and Policy Studies, Florida State University, University Center C4600, Tallahassee, FL, 32306, United States of America
| | - Arathi Ravichandran
- FXB Center for Health and Human Rights, Harvard University, 651 Huntington Avenue, Boston, MA, 02115, United States of America
| | - Honora Einhorn
- FXB Center for Health and Human Rights, Harvard University, 651 Huntington Avenue, Boston, MA, 02115, United States of America
| | - Nikita Arora
- Indian Institute of Public Health–Delhi, Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurgaon, 122002, India
| | - Aruna Bhattacharya Chakravarty
- Indian Institute of Public Health–Delhi, Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurgaon, 122002, India
| | - Robert T. Brennan
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, United States of America
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Abdi K, Arab M, Rashidian A, Kamali M, Khankeh HR, Farahani FK. Exploring Barriers of the Health System to Rehabilitation Services for People with Disabilities in Iran: A Qualitative Study. Electron Physician 2015; 7:1476-85. [PMID: 26767101 PMCID: PMC4700893 DOI: 10.19082/1476] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/01/2015] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The United Nations (UN) identified health as a basic human right, but, unfortunately, the evidence shows that people with disabilities (PWD) often have lower levels of health than the general population. This can be associated with problems in access to the services and programs. The aim of this study was to explore barriers of the health system to rehabilitation services for PWD in Iran. METHODS This was a qualitative study conducted on 21 participants using semi-structured, in-depth interviews and content analysis from June 2014 to July 2015. Data analysis was performed by MAXQDA version 10. RESULTS "Barriers" were the most prominent challenge of people with disabilities that needed access to rehabilitation services. These barriers were categorized into eight concepts of deficiency in the system that provides rehabilitation services, defect of education, deficiency in detecting and screening of people with disability, defect of stewardship in rehabilitation, ignoring socio-cultural factors, accessibility hardships, lack of identification, and financial hardships in rehabilitation. CONCLUSIONS An efficient rehabilitation plan requires a common understanding, considering the long-term complications involved in addressing the barriers. Understanding the barriers of the health system to rehabilitation services requires comprehensive management that first should be familiar with all of PWD, providers, policy makers, and other beneficiaries. It also is necessary for policy makers to consider rehabilitation services as a main part of the health plan; especially, they must change their oversight of rehabilitation services and programs. Thus, policy makers should have need comprehensive management and recommended further research.
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Affiliation(s)
- Kianoush Abdi
- Ph.D. Student of Health Services Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Arab
- Professor of Health Management, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Professor of Health Management and Economics, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kamali
- Ph.D. of Health Education, Associate Professor, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Khankeh
- Ph.D. of Nursing, Associate Professor, Department of Health in Emergency and Disaster and Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farideh Khalajabadi Farahani
- Ph.D. of Population Studies/Reproductive Health, Assistant Professor, Department of Population, Health and Family Planning, National Institute for Population Research, Tehran, Iran
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Yoshida S, Martines J, Lawn JE, Wall S, Souza JP, Rudan I, Cousens S, Aaby P, Adam I, Adhikari RK, Ambalavanan N, Arifeen SE, Aryal DR, Asiruddin S, Baqui A, Barros AJ, Benn CS, Bhandari V, Bhatnagar S, Bhattacharya S, Bhutta ZA, Black RE, Blencowe H, Bose C, Brown J, Bührer C, Carlo W, Cecatti JG, Cheung PY, Clark R, Colbourn T, Conde-Agudelo A, Corbett E, Czeizel AE, Das A, Day LT, Deal C, Deorari A, Dilmen U, English M, Engmann C, Esamai F, Fall C, Ferriero DM, Gisore P, Hazir T, Higgins RD, Homer CS, Hoque DE, Irgens L, Islam MT, de Graft-Johnson J, Joshua MA, Keenan W, Khatoon S, Kieler H, Kramer MS, Lackritz EM, Lavender T, Lawintono L, Luhanga R, Marsh D, McMillan D, McNamara PJ, Mol BWJ, Molyneux E, Mukasa GK, Mutabazi M, Nacul LC, Nakakeeto M, Narayanan I, Olusanya B, Osrin D, Paul V, Poets C, Reddy UM, Santosham M, Sayed R, Schlabritz-Loutsevitch NE, Singhal N, Smith MA, Smith PG, Soofi S, Spong CY, Sultana S, Tshefu A, van Bel F, Gray LV, Waiswa P, Wang W, Williams SLA, Wright L, Zaidi A, Zhang Y, Zhong N, Zuniga I, Bahl R. Setting research priorities to improve global newborn health and prevent stillbirths by 2025. J Glob Health 2015; 6:010508. [PMID: 26401272 PMCID: PMC4576458 DOI: 10.7189/jogh.06.010508] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025. Methods We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. Results Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. Conclusion These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.
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Affiliation(s)
- Sachiyo Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - José Martines
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Norway
| | - Joy E Lawn
- London School of Hygiene and Tropical Medicine, London, UK ; Saving Newborn Lives, Save the Children, Washington, USA
| | - Stephen Wall
- Saving Newborn Lives, Save the Children, Washington, USA
| | - Joăo Paulo Souza
- Department of Social Medicine, Ribeirăo Preto School of Medicine, University of Săo Paulo, Brazil
| | - Igor Rudan
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh Medical School, Scotland, UK
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Peter Aaby
- Bandim Health Project, Indepth Network, Guinea-Bissau
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Sudan
| | | | | | - Shams Ei Arifeen
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Dhana Raj Aryal
- Department of Neonatology Paropakar Maternity and women's Hospital, Nepal
| | - Sk Asiruddin
- TRAction Bangladesh Project, University Research Co., LLC
| | | | - Aluisio Jd Barros
- Centro de Pesquisas Epidemiológicas, Universidade Federal de Pelotas, Brazil
| | - Christine S Benn
- Research Center for Vitamins and Vaccines, Statens Serum Institut, and University of Southern Denmark/Odense University Hospital, Denmark
| | - Vineet Bhandari
- Program in Perinatal Research, Yale University School of Medicine, USA
| | - Shinjini Bhatnagar
- Pediatric Biology Centre, Translational Health Science and Technology Institute, India
| | | | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Robert E Black
- Institute of International Programs, Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Carl Bose
- The University of North Carolina at Chapel Hill School of Medicine, USA
| | | | - Christoph Bührer
- Department of Neonatology, Charité University Medical Center, Germany
| | | | - Jose Guilherme Cecatti
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Brazil
| | - Po-Yin Cheung
- Departments of Pediatrics, Pharmacology & Surgery, University of Alberta, Canada
| | | | - Tim Colbourn
- University College London Institute for Global Health, UK
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, Maryland and Detroit, Michigan, USA
| | - Erica Corbett
- Independent consultant maternal health research, Rwanda
| | - Andrew E Czeizel
- Foundation for the Community Control of Hereditary Diseases, Hungary
| | - Abhik Das
- Biostatistics and Epidemiology, RTI International, USA
| | | | - Carolyn Deal
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases National Institute of Health, USA
| | | | - Uğur Dilmen
- Pediatrics and Neonatology, Yıldırım Beyazıt University Medical Faculty, Turkey
| | - Mike English
- Nuffield Department of Medicine & Department of Paediatrics, University of Oxford, UK and KEMRi-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Cyril Engmann
- Newborn Health, Family Health Division, The Bill & Melinda Gates Foundation and the University of North Carolina Schools of Medicine and Public Health, USA
| | | | - Caroline Fall
- International Paediatric Epidemiology; Affiliations: Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, UK
| | | | - Peter Gisore
- School of Medicine, Child Health and Pediatrics, Moi University, Kenya
| | - Tabish Hazir
- Children's Hospital, Pakistan Institute of Medical Sciences, Pakistan
| | - Rosemary D Higgins
- Eunice Kennedy Shriver NICHD Neonatal Research Network, Pregnancy and Perinatology, Branch, National Institute of Health, USA
| | - Caroline Se Homer
- Centre for Midwifery, Child and Family Health, University of Technology, Sydney, Australia
| | - D E Hoque
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Lorentz Irgens
- University of Bergen and Norwegian Institute of Public Health, Norway
| | - M T Islam
- Japan International Cooperation Agency (JICA), Bangladesh
| | | | | | | | - Soofia Khatoon
- Paediatrics and Head of Department Shaheed Suhrawardy Medical College, Bangladesh
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Karolinska Institute, Sweden
| | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Eve M Lackritz
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), USA
| | - Tina Lavender
- University of Manchester School of Nursing Midwifery & Social Work, University of Manchester, UK
| | | | | | | | | | - Patrick J McNamara
- Departments of Paediatrics & Physiology, University of Toronto; Physiology & Experimental Medicine program, Hospital for Sick Children, Toronto, Canada
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, the Netherlands
| | | | - G K Mukasa
- International Baby Food Action Network, Uganda
| | - Miriam Mutabazi
- STRIDES for Family Health, Management Sciences for Health, Uganda
| | - Luis Carlos Nacul
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK
| | - Margaret Nakakeeto
- Kampala Children's Hospital Limited and Childhealth Advocacy International, Uganda
| | - Indira Narayanan
- United States Agency for International Development /Maternal and Child Health Integrated Program, USA
| | | | - David Osrin
- Wellcome Trust Senior Research Fellow in Clinical Science, Institute for Global Health, University College London, UK
| | - Vinod Paul
- All India Institute of Medical Sciences, India
| | | | - Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, USA
| | - Mathuram Santosham
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, USA
| | | | | | | | - Mary Alice Smith
- Environmental Health Science Department, University of Georgia, USA
| | - Peter G Smith
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Sajid Soofi
- Department of Pediatrics & Child Health, Women & Child Health Division, Aga Khan University, Pakistan
| | - Catherine Y Spong
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, USA
| | - Shahin Sultana
- National Institute of Population Research and Training (NIPORT), Ministry of Health and Family Welfare, Bangladesh
| | - Antoinette Tshefu
- Kinshasa School of Public Health, School of Medicine, University of Kinshasa, Democratic Republic of Congo
| | - Frank van Bel
- Department of Neonatology, University of Utrecht, the Netherlands
| | | | - Peter Waiswa
- Division of Global Health, Karolinska Institutet, Sweden
| | - Wei Wang
- School of Medical Sciences, Edith Cowan University, Australia and School of Public Health, Capital Medical University, China
| | | | - Linda Wright
- Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, USA
| | | | - Yanfeng Zhang
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, China
| | - Nanbert Zhong
- Developmental Genetics Laboratory, New York State Institute for Basic Research in Developmental Disabilities, USA
| | | | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Vergunst R, Swartz L, Mji G, MacLachlan M, Mannan H. 'You must carry your wheelchair'--barriers to accessing healthcare in a South African rural area. Glob Health Action 2015; 8:29003. [PMID: 26434691 PMCID: PMC4592846 DOI: 10.3402/gha.v8.29003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/22/2015] [Accepted: 09/07/2015] [Indexed: 11/18/2022] Open
Abstract
Background There is international evidence that people with disabilities face barriers when accessing primary healthcare services and that there is inadequate information about effective interventions that work to improve the lives of people with disabilities, especially in low-income and middle-income countries. Poor rural residents generally experience barriers to accessing primary healthcare, and these problems are further exacerbated for people with disabilities. Objective In this study, we explore the challenges faced by people with disabilities in accessing healthcare in Madwaleni, a poor rural Xhosa community in South Africa. Design Purposive sampling was done with 26 participants, using semi-structured interviews and content analysis to identify major themes. Results This study showed a number of barriers to healthcare for people with disabilities. These included practical barriers, including geographical and staffing issues, and attitudinal barriers. Conclusions It is suggested that although there are practical barriers that need to be addressed, attitudinal barriers could potentially be addressed more easily and cost effectively.
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Affiliation(s)
- Richard Vergunst
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa;
| | - Gubela Mji
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa
| | - Malcolm MacLachlan
- Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa.,Centre for Global Health, School of Psychology, Trinity College, Dublin, Ireland
| | - Hasheem Mannan
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
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Rudan I, Sridhar D. Structure, function and five basic needs of the global health research system. J Glob Health 2015; 6:010505. [PMID: 26401270 PMCID: PMC4576460 DOI: 10.7189/jogh.06.010505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Two major initiatives that were set up to support and co–ordinate global health research efforts have been largely discontinued in recent years: the Global Forum for Health Research and World Health Organization's Department for Research Policy and Cooperation. These developments provide an interesting case study into the factors that contribute to the sustainability of initiatives to support and co–ordinate global health research in the 21st century. Methods We reviewed the history of attempts to govern, support or co–ordinate research in global health. Moreover, we studied the changes and shifts in funding flows attributed to global health research. This allowed us to map the structure of the global health research system, as it has evolved under the increased funding contributions of the past decade. Bearing in mind its structure, core functions and dynamic nature, we proposed a framework on how to effectively support the system to increase its efficiency. Results Based on our framework, which charted the structure and function of the global health research system and exposed places and roles for many stakeholders within the system, five basic needs emerged: (i) to co–ordinate funding among donors more effectively; (ii) to prioritize among many research ideas; (iii) to quickly recognize results of successful research; (iv) to ensure broad and rapid dissemination of results and their accessibility; and (v) to evaluate return on investments in health research. Conclusion The global health research system has evolved rapidly and spontaneously. It has not been optimally efficient, but it is possible to identify solutions that could improve this. There are already examples of effective responses for the need of prioritization of research questions (eg, the CHNRI method), quick recognition of important research (eg, systems used by editors of the leading journals) and rapid and broadly accessible publication of the new knowledge (eg, PLoS One journal as an example). It is still necessary to develop tools that could assist donors to co–ordinate funding and ensure more equity between areas in the provided support, and to evaluate the value for money invested in health research.
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Affiliation(s)
- Igor Rudan
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Devi Sridhar
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
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49
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Marella M, Huq NL, Devine A, Baker SM, Quaiyum MA, Keeffe JE. Prevalence and correlates of disability in Bogra district of Bangladesh using the rapid assessment of disability survey. BMC Public Health 2015; 15:867. [PMID: 26346063 PMCID: PMC4561432 DOI: 10.1186/s12889-015-2202-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to estimate the prevalence of disability and its associated risk factors among adults aged 18 years and over in Bogra district, Bangladesh. Methods The Rapid Assessment of Disability (RAD) survey was conducted using probability-proportional-to-size sampling to select 66 clusters each with 50 people aged 18 years and older in 2010. Households within clusters were selected through compact segment sampling. Disability was identified based on the responses to the self-assessment of functioning section of the RAD questionnaire. Descriptive and multivariate logistic regression analyses were performed to model the associations between risk factors and disability status. Results Of 1855 adults who participated in the study, 195 (10.5 %) had disability. Age and gender adjusted prevalence of disability in Bogra district was 8.9 % (95 % CI: 7.7, 10.3). The highest prevalence of functional limitation was related to psychological distress (4.7 %; 95 % CI: 3.8, 5.7) followed by vision (4.4 %; 95 % CI: 3.6, 5.4), and hearing (2.3 %; 95 % CI: 1.7, 3.0) difficulties. The adjusted odds of disability increased with age with approximately eight-fold increase from 2.9 % (95 % CI: 1.6, 5.1) in 18–24 years to 24.5 % (95 % CI: 20.2, 29.4) in 55 years and above. People with poor socio-economic status (OR 1.90; 95 % CI: 1.1, 3.3) and who were unemployed (OR = 4.6; 95 % CI: 1.8, 11.6) were more like to have disability compared to the higher socio-economic status and those who have an occupation respectively. Conclusions There is a significant need for promoting programs for health, well-being, and rehabilitation, and policies specifically targeting the older population, women, unemployed and poor people in Bangladesh.
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Affiliation(s)
- Manjula Marella
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia.
| | - Nafisa L Huq
- Centre for Reproductive Health, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Bangladesh.
| | - Alexandra Devine
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia.
| | - Sally M Baker
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia.
| | - Md A Quaiyum
- Centre for Reproductive Health, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Bangladesh.
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50
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Hoekstra F, Hettinga FJ, Alingh RA, Duijf M, Dekker R, van der Woude LHV, van der Schans CP. The current implementation status of the integration of sports and physical activity into Dutch rehabilitation care. Disabil Rehabil 2015; 39:181-186. [DOI: 10.3109/09638288.2015.1073371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Femke Hoekstra
- Centre for Human Movement Sciences, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands,
- Centre for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands,
| | - Florentina J. Hettinga
- Centre of Sport and Exercise Science, School of Biological Sciences, University of Essex, Colchester, UK,
| | - Rolinde A. Alingh
- Centre for Human Movement Sciences, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands,
- Centre for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands,
| | - Marjo Duijf
- Stichting Onbeperkt Sportief, Bunnik, The Netherlands,
| | - Rienk Dekker
- Centre for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands,
- Centre for Sports Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands, and
| | - Lucas H. V. van der Woude
- Centre for Human Movement Sciences, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands,
- Centre for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands,
| | - Cees P. van der Schans
- Centre for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands,
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
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