Application of strengths, weaknesses, opportunities and threats analysis in the development of a health technology assessment program

Preparing future doctors for evidence-based practice: a study on health technology assessment awareness and its predictors in Malaysia

OBJECTIVES

To determine the level of awareness of health technology assessment (HTA) and its predictors among clinical year medical students in public universities in Klang Valley, Malaysia.

METHODS

A cross-sectional study using the stratified random sampling method was conducted among clinical year medical students in four public universities in Klang Valley, Malaysia. Data on the level of awareness of HTA and its associated factors were collected using a self-administered online questionnaire. Descriptive, bivariate, and multivariate analyses were performed using IBM SPSS version 27 to determine the level of awareness of HTA and its predictors.

RESULTS

Majority (69 percent) of participants had a low level of awareness of HTA. The predictors of high-level awareness of HTA were attitude toward HTA (adjusted odds ratio (AOR) = 7.417, 95 percent confidence interval (CI): 3.491, 15.758), peer interaction on HTA (AOR = 0.320, 95 percent CI: 0.115, 0.888), and previous training on HTA (AOR = 4.849, 95 percent CI: 1.096, 21.444).

CONCLUSIONS

Most future doctors in public universities exhibit a low awareness of HTA. This study highlights the interplay between attitudes toward HTA, peer interaction, and previous training as influential predictors of HTA awareness. An integrated and comprehensive educational approach is recommended to cultivate a positive attitude and harness the positive aspects of peer interaction while mitigating the potential negative impact of misconceptions. Emphasizing early exposure to HTA concepts through structured programs is crucial for empowering the upcoming generation of healthcare professionals, enabling them to navigate HTA complexities and contribute to evidence-based healthcare practices in Malaysia and beyond.

Effects of common interest groups on rural women and youth livelihood: A qualitative study from Central Ethiopia

The study was conducted to examine the implications of the Common Interest Group (CIG) scheme for rural livelihood change in the selected areas of the Wara-Jarso woreda, Central Ethiopia. The study focuses on the activities of the CIGs, their effectiveness, Strengths, Weaknesses, Opportunities, and Threats, along with the changes in the livelihood status of CIG members. Four CIGs that fits into the aim of the study were purposively selected from the CIGs operating in the woreda. Among a qualitative research approach, a case study was employed. The data were collected from January 1, 2021 to February 28, 2021. Primary data were gathered using Focus Group Discussions and Key Informant Interviews. A thorough desk review of official documents and other secondary sources was made as an auxiliary method to capture sets of relevant information. The data organization was performed by the MAXQDA 2020 qualitative data analysis package program. The data were analyzed using thematic analysis, relational analysis, and content analysis methods. It was found that the CIGs have encouraged strong social capital among members and becomes an important alternative financial source. It was also found that the CIGs operation has encountered problems related to lack of entrepreneurial education and skill training, monitoring and evaluation, workplace, coordination among stakeholders, inadequate and improper financial use, and non-existence of market linkage. Their strengths, weaknesses, and opportunities were also indicated. For successful rural women and youth livelihood change through the CIGs scheme, the study recommends access to entrepreneurial skill training, coordination among relevant stakeholders, strong monitoring and evaluation, access to market linkage and workplace, and adequate funding.

Evaluation of the feasibility and sustainability of the joint human and animal vaccination and its integration to the public health system in the Danamadji health district, Chad

BACKGROUND

One Health approaches such as the Joint human and animal vaccination programmes (JHAVP) are shown to be feasible and to increase health care access to hard-to-reach communities such as mobile pastoralists. However, the financial sustainability and the integration into the public health systems at the district level of such programmes are still challenging. The main objective of the present study was to give insight to the feasibility and financial sustainability of JHAVP integrated as part of the public health system in Chad.

METHODS

We conducted a mixed methods study using semi-structured key informant interviews, focus group discussions and budget impact analysis. Strengths, weaknesses, opportunities, and threats were analysed regarding the feasibility and sustainability of the implementation of JHAVP in Danamadji health district in Chad. Feasibility was further analysed using three dimensions: acceptability, implementation, and adaptation. Financial sustainability of JHAVP was analysed through budget impact analysis of implementation of the programme at district level.

RESULTS

The acceptability of this approach was regularly assessed by immunization campaign teams through evaluation meetings which included pastoralists. The presence of authorities in the meetings and workshops of the programme had an incentive effect since they represent a mark of consideration these populations generally declared to be lacking. The coordination between the public health and veterinary services at central and decentralized level seemed to be a key element in the success of the implementation of the programme. Regarding financial sustainability, the total incremental budget impact was 27% slightly decreasing to 26% after five years, which accounts for up to one third of the total budget of the district health office. Also, given that most of the costs for each round are recurrent costs, efficiency gains from scale effects over time are limited.

CONCLUSION

Based on these findings, we conclude that for JHAVP to be routinely delivered at the district health level, a considerable increase in financial resources would be required. The district could benefit from joint immunization to maintain contact with mobile pastoralists to promote the use of available immunization services at district level.

[Public participation in research from the perspective of primary health care researchers]

OBJECTIVE

Explore the strengths, weaknesses, opportunities and threats (SWOT) for development of public involvement in research by Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol) according to primary health care researchers in Catalonia (Spain).

METHODS

Cross-sectional study carried out in 2017 with 36 primary health care research teams accredited by IDIAPJGol and its management staff. An open questionnaire (paper and online) was designed and piloted to develop a SWOT technique, and 65 answers were obtained (14 in paper and 51 online). A thematic content analysis was carried out.

RESULTS

Most informants consider public involvement in research a useful, innovative, viable and essential strategy, but it requires a change of mentality and a move away from the hierarchical paradigm. It can be difficult to execute and can complicate studies. They are concerned about which citizens should be involve, how to select them, possible conflicts of interest and training needs. The main proposals for its implementation are to disseminate previous strategies, encourage motivation and synergies among citizens, researchers and institutions, and to clarify the roles of the actors involved. IDIAPJGol should develop recommendations for the public involvement in research, encourage their inclusion, have a mentor and advise the research teams.

CONCLUSIONS

Despite the challenges, developing public involvement in research in primary health care is essential and feasible, what it is more should be based on a participatory strategy with all actors. The citizens can participate in any kind of design and phase of the research, adapting each project, being the primary health care a privileged area to develop the public involvement in research.

State of the Science in Dried Blood Spots

BACKGROUND

Advancements in the quality and availability of highly sensitive analytical instrumentation and methodologies have led to increased interest in the use of microsamples. Among microsamples, dried blood spots (DBS) are the most well-known. Although there have been a variety of review papers published on DBS, there has been no attempt at describing the full range of analytes measurable in DBS, or any systematic approach published for characterizing the strengths and weaknesses associated with adoption of DBS analyses.

CONTENT

A scoping review of reviews methodology was used for characterizing the state of the science in DBS. We identified 2018 analytes measured in DBS and found every common analytic method applied to traditional liquid samples had been applied to DBS samples. Analytes covered a broad range of biomarkers that included genes, transcripts, proteins, and metabolites. Strengths of DBS enable its application in most clinical and laboratory settings, and the removal of phlebotomy and the need for refrigeration have expanded biosampling to hard-to-reach and vulnerable populations. Weaknesses may limit adoption in the near term because DBS is a nontraditional sample often requiring conversion of measurements to plasma or serum values. Opportunities presented by novel methodologies may obviate many of the current limitations, but threats around the ethical use of residual samples must be considered by potential adopters.

SUMMARY

DBS provide a wide range of potential applications that extend beyond the reach of traditional samples. Current limitations are serious but not intractable. Technological advancements will likely continue to minimize constraints around DBS adoption.

Who’s afraid of institutionalizing health technology assessment (HTA)?: Interests and policy positions on HTA in the Czech Republic

This article identifies the interests and policy positions of key health policy stakeholders regarding the creation of a health technology assessment (HTA) agency in the Czech Republic, and what considerations influenced them. Vested interests have been suggested as a factor mitigating the diffusion of HTA bodies internationally. The Czech Republic recently considered and discarded establishing an HTA agency, making it a good case for studying actors’ policy positions throughout the policy debates. Findings are based on in-depth, semi-structured expert and elite interviews with 34 key Czech health policy actors, supported by document analysis and extensive triangulation. Findings show that the HTA epistemic community of ‘aspiring agents’ was the only actor strongly in favor of an HTA body. Payers and the medical device and diagnostics industry were against it; patients and clinicians had no clear preferences. Original decision-makers were in favor but a new minister of health opted for a simpler policy alternative to solve his need for expertise. Existing institutions, policy alternatives and the institutional design of a future HTA body influence domestic actors’ preferences for or against an HTA agency. Domestic and international proponents of HTA should give serious thought to their concerns when advocating for HTA bodies.

HTA Implementation Roadmap in Central and Eastern European Countries

The opportunity cost of inappropriate health policy decisions is greater in Central and Eastern European (CEE) compared with Western European (WE) countries because of poorer population health and more limited healthcare resources. Application of health technology assessment (HTA) prior to healthcare financing decisions can improve the allocative efficiency of scarce resources. However, few CEE countries have a clear roadmap for HTA implementation. Examples from high-income countries may not be directly relevant, as CEE countries cannot allocate so much financial and human resources for substantiating policy decisions with evidence. Our objective was to describe the main HTA implementation scenarios in CEE countries and summarize the most important questions related to capacity building, financing HTA research, process and organizational structure for HTA, standardization of HTA methodology, use of local data, scope of mandatory HTA, decision criteria, and international collaboration in HTA. Although HTA implementation strategies from the region can be relevant examples for other CEE countries with similar cultural environment and economic status, HTA roadmaps are not still fully transferable without taking into account country-specific aspects, such as country size, gross domestic product per capita, major social values, public health priorities, and fragmentation of healthcare financing.

Role of training activities for the reduction of pre-analytical errors in laboratory samples from primary care

BACKGROUND

The presence of pre-analytical errors (PE) is a usual contingency in laboratories. The incidence may increase where it is difficult to control that period, as it is the case with samples sent from primary care (PC) to clinical reference laboratory. Detection of a large number of PE in PC samples in our Institution led to the development and implementation of preventive strategies. The first of these has been the realization of a cycle of educational sessions for PC nurses, followed by the evaluation of their impact on PE number.

METHODS

The incidence of PE was assessed in two periods, before (October-November 2007) and after (October-November, 2009) the implementation of educational sessions. Eleven PC centers in the urban area and 17 in the rural area participated. In the urban area, samples were withdrawn by any PC nurse; in the rural area, samples were obtained by the patient's reference nurse. The types of analyzed PE included missed sample (MS), hemolyzed sample (HS), coagulated sample (CS), incorrect sample (ISV) and others (OPE), such as lipemic or icteric serum or plasma.

RESULTS

In the former period, we received 52,669 blood samples and 18,852 urine samples, detecting 3885 (7.5%) and 1567 (8.3%) PEs, respectively. After the educational intervention, there were 52,659 and 19,048 samples with 5057 (9.6%) and 1.256 (6.5%) PEs, respectively (p<0.001). According to the type of PE, the incidents compared before and after compared incidences were: MS, 4.8% vs. 3.8%, p<0.001; HS, 1.97% vs. 3.9%, p<0.001; CS, 0.54% vs. 0.25%, p<0.001; ISV, 0.15% vs. 0.19% p=0.08; and OPE, 0.3% vs. 0.42%, p<0.001.

CONCLUSIONS

Surprisingly the PE incidence increased after the educational intervention, although it should be noted that it was primarily due to the increase of HS, as the other EP incidence decreased (MS and CS) or remained unchanged (ISV). This seems to indicate the need for a comprehensive approach to reduce the incidence of errors in the pre-analytical period, as one stage interventions do not seem to be effective enough.

Public health and clinical impact of increasing emergency department-based HIV testing: perspectives from the 2007 conference of the National Emergency Department HIV Testing Consortium

OBJECTIVE

Understanding perceived benefits and disadvantages of HIV testing in emergency departments (EDs) is imperative to overcoming barriers to implementation. We codify those domains of public health and clinical care most affected by implementing HIV testing in EDs, as determined by expert opinion.

METHODS

Opinions were systematically collected from attendees of the 2007 National ED HIV Testing Consortium meeting. Structured evaluation of strengths, weaknesses, opportunities, and threats analysis was conducted to assess the impact of ED-based HIV testing on public health. A modified Delphi method was used to assess the impact of ED-based HIV testing on clinical care from both individual patient and individual provider perspectives.

RESULTS

Opinions were provided by 98 experts representing 42 academic and nonacademic institutions. Factors most frequently perceived to affect public health were (strengths) high volume of ED visits and high prevalence of HIV, (weaknesses) undue burden on EDs, (opportunities) reduction of HIV stigma, and (threats) lack of resources in EDs. Diagnostic testing and screening for HIV were considered to have a favorable impact on ED clinical care from both individual patient and individual provider perspectives; however, negative test results were not perceived to have any benefit from the provider's perspective. The need for HIV counseling in the ED was considered to have a negative impact on clinical care from the provider's perspective.

CONCLUSION

Experts in ED-based HIV testing perceived expanded ED HIV testing to have beneficial impacts for both the public health and individual clinical care; however, limited resources were frequently cited as a possible impediment. Many issues must be resolved through further study, education, and policy changes if the full potential of HIV testing in EDs is to be realized.

Health technology assessment: Research trends and future priorities in Europe

Objective:

To provide an overview of health services research related to health technology assessment (HTA) and to identify research priorities from a European perspective.

Methods:

Several methods were used: systematic review of articles indexed with the MeSH term ‘technology assessment’ in PubMed from February 1999-2009; online survey among experts; and conference workshop discussions.

Results:

Research activity in HTA varies considerably across Europe. The research was categorised into six areas: (1) the breadth of analysis in HTA (such as economic, organizational and social aspects); (2) HTA products developed to meet the needs of policy-makers (such as horizon scanning, mini-HTA, and core HTA); (3) handling life-cycle perspectives in relation to technologies; (4) topics that challenge existing methods and for which HTA should be developed to address the themes more comprehensively (such as public health interventions and organizational interventions); (5) development of HTA capacity and programmes; and (6) links between policy and HTA. An online survey showed that the three areas that were given priority were the relationship between HTA and policy-making (71%), the impact of HTA (62%) and incorporating patient aspects in HTA (50%). Policy-makers highlighted HTA and innovation processes as their main research priority (42%). Areas that the systematic review identified as future priorities include issues within the six existing research areas such as disinvestment, developing evidence for new technologies, assessing the wider effects of technology use, and determining how HTA affects decision-making. In addition, relative effectiveness and individualized treatments are areas of growing interest.

Conclusions:

The research priorities identified are important for obtaining high quality and cost-effective health care in Europe. Managing the introduction, use and phasing out of technologies challenges health services throughout Europe, and these processes need to be improved to successfully manage future more general challenges. An ageing population and a diminishing workforce both require strong efforts to ensure effective and well-organized use of human resources and technologies. Furthermore, Europe needs to focus on innovation. This is closely linked to use of technologies and calls for future research.

The role of information technology in the development of community pharmacy services: visions and strategic views of international experts

BACKGROUND

Community pharmacy's strategic vision has been to extend practice responsibilities beyond dispensing and provide patient care services. Few studies have evaluated the strategic and long-term development of information technology (IT) systems to support this vision.

OBJECTIVE

The objective of this study was to explore international experts' visions and strategic views on IT development needs in relation to service provision in community pharmacies.

METHOD

Semistructured interviews were conducted with a purposive sample of 14 experts from 8 countries in 2007-2008. These experts had expertise in the development of community pharmacy services and IT. The interviews were content analyzed using a constant comparison approach and a SWOT (strengths, weaknesses, opportunities, threats) analysis was undertaken.

RESULTS

Most of the experts shared the vision for community pharmacy adopting a patient care orientation; supported by IT-based documentation, new technological solutions, access to information, and shared patient data. Opportunities to achieve this vision included IT solutions, professional skills, and interprofessional collaboration. Threats included costs, pharmacists' attitude, and the absence of IT solutions.

CONCLUSIONS

Those responsible for IT development in community pharmacy sector should create long-term IT development strategies that are in line with community pharmacy service development strategies.

A new user-centered design approach: a hair washing assistive device design for users with shoulder mobility restriction

This study utilized a user-centered design approach as the foundation for a new Assistive Device (AD) design process. Observation and evaluation results from a Usability Context Analysis (UCA) was used to improve the analysis of Strengths, Weaknesses, Opportunities and Threats (SWOT Analysis) and the matrix of Threats, Opportunities, Weaknesses, and Strengths (TOWS matrix), resulting in two assistive device design methods named AD-SWOT and AD-TOWS. Thus, an AD-design process, tailored for designing assistive devices, was both established and tested. Owing to the information gained from using the design processes and evaluating product efficiency with various cases in the early part of the research, it was decided to use the AD-design process for the entire design process. Using this process, an adjustable hair washer for physically disabled individuals to wash their hair using normal postures was developed. Furthermore, the method derived in this study can also be applied to users suffering from single-sided shoulder-joint mobility disabilities, such as frontal flexion, scapular plan elevation, and restricted abductors.

A new design approach of user-centered design on a personal assistive bathing device for hemiplegia

PURPOSE

To move closer to the goal of independent living for stroke patients with hemiplegia, this study is to design an assistive bathing device approached from a User-Centred Design (UCD).

METHOD

Based on User-Centred Design methodology, a design process is adopted for this study. Observation and evaluation results from a Usability Context Analysis (UCA) are employed to improve the strengths, weaknesses, opportunities and threats (SWOT) and the matrix for matching the environmental threats and opportunities with company's weaknesses and especially it's strengths (TOWS), resulting in two assistive device (AD) design methods named AD-SWOT and AD-TOWS. Therefore, a new assistive device design process (AD-Design process) is proposed. A case study of stroke patients is conducted to practically apply the AD-Design process to the design of assistive bathing devices for stroke patients.

RESULTS

By using the AD-Design process, three design concept orientations (AD-SO, AD-ST, AD-WO) were found for design concept generating from AD-TOWS. Four concepts for AD were decided and designed by the viewpoint of UCD. Finally, three ADs for bathing were tested by user-based assessment. And results showed the devices can help individuals clean case's body parts, such as case's backs and armpits that they were previously unable to clean independently.

CONCLUSIONS

AD-design process could help a product designer to generate suitable design approaching from UCD. In this study, three ADs (Back Cleaning Board, Feet Cleaning and Single-Sided Elastic Bathing Belt) were designed for a stroke patient's individual bathing.

Analysis of strengths, weaknesses, opportunities, and threats in the development of a health technology assessment program in Turkey

Objectives:The Turkish healthcare system is currently undergoing reform, and efficient use of resources has become a key factor in determining the allocation of resources. The objective of this study was to analyze strengths, weaknesses, opportunities, and threats (SWOT) in the development of a health technology assessment (HTA) program in Turkey.

Methods:A SWOT analysis was performed using a literature review and interviews with key people in the Turkish Ministry of Health and Ministry of Labor and Social Security.

Results:Regarding recent reforms in health care, investments for information network and databank are the strengths, but the traditional “expert-based” decision making, poor availability of data, and poor quality of data could be seen as some of the weaknesses. Another major weakness is lack of general awareness of HTA. Increasing demand for transparency in decision making, demand for evidence, and demand for credibility by decision makers are some of the opportunities, and current healthcare reforms, i.e., restructuring of healthcare and general health insurance, could also be seen as major opportunities. These opportunities unfortunately could be threatened by lack of funding, and resources are challenged by large, recent national investments.

Conclusions:There is a good opportunity for Turkey to use the skills in HTA currently being developed through activities in Europe and the Americas to assist in the development of a much more cost-effective and transparent healthcare system in Turkey.

Community capacity for cancer control collaboration: weaving an Islander Network for Cancer Awareness, Research and Training for Pacific Islanders in Southern California

BACKGROUND

Addressing cancer health disparities constitutes a national priority in this country, with funding for Pacific Islander efforts initiated 7 years ago by the National Cancer Institute. In 2005, the Weaving an Islander Network for Cancer Awareness, Research and Training (WINCART) was launched in Southern California by a collaboration of community and university organizations to build upon past efforts to decrease cancer health disparities for Chamorros, Native Hawaiians, Marshallese, Samoans and Tongans.

METHODS

To assess community organizational capacity to participate in collaborative cancer control for Pacific Islanders, a strengths, weaknesses, opportunities, and threats (SWOT) analysis was undertaken. Two staff members per community organization (CBO) performed the SWOT analyses, with grids analyzed for commonalities and differences between all organizations.

RESULTS

Staff informants provided many examples of what they perceived as organizational strengths and weaknesses with regards to promoting cancer control for their respective Pacific Islander populations. CBO strengths included strong leadership and extensive community experience. Challenges included limited resources, lack of staff skills in some areas, and difficulty in recruiting volunteers. In addition, many external opportunities and threats to cancer control promotion were identified.

CONCLUSION

Results from the SWOT analyses have been used to identify topics for community organizational trainings and supports within WINCART, with the goals of increasing their participation in the development and implementation of collaborative, community-university driven efforts to decrease cancer disparities for Pacific Islanders in Southern California.

A systematic analysis of influenza vaccine shortage policies

OBJECTIVES

The aim of this study was to apply SWOT analysis (strengths, weaknesses, opportunities, threats) to a domestic shortage of influenza vaccine, to identify lessons learned, and to generate effective solutions for future public health rationing emergencies.

STUDY DESIGN/METHODS

SWOT and TOWS techniques were employed to characterize the vulnerability of the USA to disruptions in the supply of influenza vaccine. A group of five researchers reviewed relevant literature, engaged in group brainstorming, and categorized elements according to the SWOT framework.

RESULTS

Three strengths, five weaknesses, five threats and seven opportunities were identified in the areas of vaccine production, purchasing and distribution, and provision. Four future recommendations emerged with respect to government investment, communications, sanctioning of physicians, and incident command.

CONCLUSIONS

Application of the SWOT technique is highly relevant to the health policy realm and can assist public health planners in planning for future resource scarcity.