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Dube A, Mwandira K, Akter K, khatun F, Lemma S, Seruwagi G, Shawar YR, Djellouli N, Mwakwenda C, English M, Colbourn T. Evaluating theory of change to improve the functioning of the network for improving quality of care for maternal, newborn and child health. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003532. [PMID: 39088520 PMCID: PMC11293647 DOI: 10.1371/journal.pgph.0003532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 07/03/2024] [Indexed: 08/03/2024]
Abstract
In 2017, WHO and global partners launched 'The Network for Improving Quality of Care for Maternal, Newborn and Child Health' (QCN) seeking to reduce in-facility maternal and newborn deaths and stillbirth by 50% in health facilities by 2022. We explored how the QCN theory of change guided what actually happened over 2018-2022 in order to understand what worked well, what did not, and to ultimately describe the consequences of QCN activities. We applied theory of change analysis criteria to investigate how well-defined, plausible, coherent and measurable the results were, how well-defined, coherent, justifiable, realistic, sustainable and measurable the assumptions were, and how independent and sufficient the causal links were. We found that the QCN theory of change was not used in the same way across implementing countries. While the theory stipulated Leadership, Action, Learning and Accountability as the principle to guide network activity implementation other principles and varying quality improvement methods have also been used; key conditions were missing at service integration and process levels in the global theory of change for the network. Conditions such as lack of physical resources were frequently reported to be preventing adequate care, or harm patient satisfaction. Key partners and implementers were not introduced to the network theory of change early enough for them to raise critical questions about their roles and the need for, and nature of, quality of care interventions. Whilst the theory of change was created at the outset of QCN it is not clear how much it guided actual activities or any monitoring and evaluation as things progressed. Enabling countries to develop their theory of change, perhaps guided by the global framework, could improve stakeholder engagement, allow local evaluation of assumptions and addressing of challenges, and better target QCN work toward achieving its goals.
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Affiliation(s)
- Albert Dube
- Parent and Child Health Initiative Trust (PACHI), Lilongwe, Malawi
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - Kondwani Mwandira
- Parent and Child Health Initiative Trust (PACHI), Lilongwe, Malawi
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - Kohenour Akter
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Fatama khatun
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Seblewengel Lemma
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Gloria Seruwagi
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Yusra Ribhi Shawar
- Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland, United States of America
- Paul H. Nitze School of Advanced International Studies, John Hopkins University, Washington D.C., United States of America
| | - Nehla Djellouli
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Mike English
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
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Romão DMM, Setti C, Arruda LHM, de Melo RC, de Araujo BC, Tan AR, DeMaio PN, Kuchenmüller T. Integration of evidence into Theory of Change frameworks in the healthcare sector: A rapid systematic review. PLoS One 2023; 18:e0282808. [PMID: 36893160 PMCID: PMC9997872 DOI: 10.1371/journal.pone.0282808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Theory of Change (ToC) has become an established approach to design and evaluate interventions. While ToC should-in line with the growing international focus on evidence-informed health decision-making-consider explicit approaches to incorporate evidence, there is limited guidance on how this should be done. This rapid review aims to identify and synthesize the available literature on how to systematically use research evidence when developing or adapting ToCs in the health sector. METHODS A rapid review methodology using a systematic approach, was designed. Eight electronic databases were consulted to search for peer-reviewed and gray publications detailing tools, methods, and recommendations promoting the systematic integration of research evidence in ToCs. The included studies were compared, and the findings summarized qualitatively into themes to identify key principles, stages, and procedures, guiding the systematic integration of research evidence when developing or revising a ToC. RESULTS This review included 18 studies. The main sources from which evidence was retrieved in the ToC development process were institutional data, literature searches, and stakeholder consultation. There was a variety of ways of finding and using evidence in ToC. Firstly, the review provided an overview of existing definitions of ToC, methods applied in ToC development and the related ToC stages. Secondly, a typology of 7 stages relevant for evidence integration into ToCs was developed, outlining the types of evidence and research methods the included studies applied for each of the proposed stages. CONCLUSION This rapid review adds to the existing literature in two ways. First, it provides an up-to-date and comprehensive review of the existing methods for incorporating evidence into ToC development in the health sector. Second, it offers a new typology guiding any future endeavors of incorporating evidence into ToCs.
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Affiliation(s)
| | | | | | | | | | | | | | - Tanja Kuchenmüller
- Evidence to Policy and Impact, World Health Organization, Geneva, Switzerland
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van Rensburg AJ, Petersen I, Awotiwon A, Bachmann MO, Curran R, Murdoch J, Ras CJ, Fairall L. Applying learning health systems thinking in codeveloping integrated tuberculosis interventions in the contexts of COVID-19. BMJ Glob Health 2022; 7:e009567. [PMID: 36316026 PMCID: PMC9627575 DOI: 10.1136/bmjgh-2022-009567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
The COVID-19 pandemic reversed much of global progress made in combatting tuberculosis, with South Africa experiencing one of the largest impacts on tuberculosis detection. The aim of this paper is to share our experiences in applying learning health systems (LHS) thinking to the codevelopment of an intervention improving an integrated response to COVID-19 and tuberculosis in a South African district. A sequential partially mixed-methods study was undertaken between 2018 and 2021 in the district of Amajuba in KwaZulu-Natal. Here, we report on the formulation of a Theory of Change, codesigning and refining proposed interventions, and piloting and evaluating codesigned interventions in primary healthcare facilities, through an LHS lens. Following the establishment and formalisation of a district Learning Community, diagnostic work and a codevelopment of a theory of change, intervention packages tailored according to pandemic lockdowns were developed, piloted and scaled up. This process illustrates how a community of learning can generate more responsive, localised interventions, and suggests that the establishment of a shared space of research governance can provide a degree of resilience to facilitate adaption to external shocks. Four main lessons have been gleaned from our experience in adopting an LHS approach in a South African district, which are (1) the importance of building and sustaining relationships, (2) the utility of colearning, coproduction and adaptive capacity, (3) the centrality of theory-driven systems strengthening and (4) reflections on LHS as a framework.
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Affiliation(s)
- André Janse van Rensburg
- Centre for Rural Health, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
- Centre for Health Systems Research & Development, University of the Free State Faculty of Humanities, Bloemfontein, South Africa
| | - Inge Petersen
- Centre for Rural Health, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
- Institute of Global Health, University College London, London, UK
| | - Ajibola Awotiwon
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Max Oscar Bachmann
- Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
| | - Robyn Curran
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Jamie Murdoch
- School of Life Course and Population Sciences, King's College, London, UK
| | - Christy Joy Ras
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
- King's Global Health Institute, King's College, London, UK
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St-Onge C, Boileau E, Langevin S, Nguyen LHP, Drescher O, Bergeron L, Thomas A. Stakeholders' perception on the implementation of Developmental Progress Assessment: using the Theoretical Domains Framework to document behavioral determinants. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:735-759. [PMID: 35624332 DOI: 10.1007/s10459-022-10119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The widespread implementation of longitudinal assessment (LA) to document trainees' progression to independent practice rests more on speculative rather than evidence-based benefits. We aimed to document stakeholders' knowledge of- and attitudes towards LA, and identify how the supports and barriers can help or hinder the uptake and sustainable use of LA. METHODS We interviewed representatives from four stakeholder groups involved in LA. The interview protocols were based on the Theoretical Domains Framework (TDF), which contains a total of 14 behaviour change determinants. Two team members coded the interviews deductively to the TDF, with a third resolving differences in coding. The qualitative data analysis was completed with iterative consultations and discussions with team members until consensus was achieved. Saliency analysis was used to identify dominant domains. RESULTS Forty-one individuals participated in the study. Three dominant domains were identified. Participants perceive that LA has more positive than negative consequences and requires substantial ressources. All the elements and characteristics of LA are present in our data, with differences between stakeholders. CONCLUSION Going forward, we could develop and implement tailored and theory driven interventions to promote a shared understanding of LA, and maintain potential positive outcomes while reducing negative ones. Furthermore, ressources to support LA implementation need to be addressed to facilitate its uptake.
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Affiliation(s)
- Christina St-Onge
- Université de Sherbrooke, Christina St-Onge, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
| | - Elisabeth Boileau
- Université de Sherbrooke, Christina St-Onge, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Serge Langevin
- Université de Sherbrooke, Christina St-Onge, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | | | | | - Linda Bergeron
- Université de Sherbrooke, Christina St-Onge, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
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Robertson D, Carins J, Rundle‐Thiele S, Harris J. Evaluation of Social Impact Within Primary School Health Promotion: A Systematic Review. THE JOURNAL OF SCHOOL HEALTH 2022; 92:739-764. [PMID: 35365879 PMCID: PMC9544285 DOI: 10.1111/josh.13160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Health promotion programs and interventions are designed to encourage behavioral changes in children, encouraging them to make safe and healthy life choices. This systematic review seeks to examine how social impact is measured in primary school health promotion interventions. METHOD A systematic search and review process was used to identify and examine primary school health promotion interventions. The PRISMA guidelines were followed to source articles from 6 electronic databases reporting school health promotion programs or interventions in Australia, Canada, New Zealand, or the United Kingdom. RESULTS A total of 77 studies were located, representing 55 health promotion interventions delivered in primary school settings. Of these interventions, only 8 (15%) measured or attempted to measure social impact, whereas another 8 (15%) alluded to social impact. The predominant theories reported were social based theories (theories which examine the social influences on people, environments, and behaviors) (n = 17, 59%), with almost a third not informed by an overt health promotion framework or model (n = 34, 59%). A systematic rating system identified some level of stakeholder engagement (n = 30, 53%). CONCLUSIONS This systematic review highlights the need for social impact measurement within health promotion to illuminate the role of school programs in delivering lasting change.
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Affiliation(s)
- Dianne Robertson
- Social Marketing @ GriffithDepartment of Marketing, Griffith University170 Kessels RoadNathanQLD4111Australia
| | - Julia Carins
- Social Marketing @ GriffithDepartment of Marketing, Griffith University170 Kessels RoadNathanQLD4111Australia
| | - Sharyn Rundle‐Thiele
- Social Marketing @ GriffithDepartment of Marketing, Griffith University170 Kessels RoadNathanQLD4111Australia
| | - Jessica Harris
- Social Marketing @ GriffithDepartment of Marketing, Griffith University170 Kessels RoadNathanQLD4111Australia
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Identifying psychosocial determinants of water, sanitation, and hygiene (WASH) behaviors for the development of evidence-based Baby WASH interventions (REDUCE program). Int J Hyg Environ Health 2021; 238:113850. [PMID: 34673353 DOI: 10.1016/j.ijheh.2021.113850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/22/2022]
Abstract
Diarrheal disease remains a leading cause of child mortality, globally. In the Democratic Republic of the Congo (DRC), each year there are an estimated 45 million episodes of diarrhea in children under five years of age. The Reducing Enteropathy, Diarrhea, Undernutrition, and Contamination in the Environment (REDUCE) program seeks to develop theory-driven, evidence-based approaches to reduce diarrheal diseases among young children. The REDUCE prospective cohort study in Walungu Territory in Eastern DRC took guidance from the risks, attitudes, norms, abilities, and self-regulation model, the integrated behavioral model for water, sanitation, and hygiene (WASH), and other behavior change theories to identify psychosocial factors associated with WASH behaviors. Psychosocial factors were measured among 417 caregivers at baseline and caregiver responses to child mouthing of dirty fomites and handwashing with soap was assessed by 5-hour structured observation at the 6-month follow-up. Caregivers who agreed that their child could become sick if they put dirt in their mouth (perceived susceptibility) and caregivers that agreed they could prevent their child from playing with dirty things outside (self-efficacy) were significantly more likely to stop their child from mouthing a dirty fomite. Higher perceived susceptibility, self-efficacy, and disgust, and lower dirty reactivity, were associated with higher handwashing with soap behaviors. This study took a theory-driven and evidence-based approach to identify psychosocial factors to target for intervention development. The findings from this study informed the development of the REDUCE Baby WASH Modules that have been delivered to over 1 million people in eastern DRC.
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Morse T, Luwe K, Lungu K, Chiwaula L, Mulwafu W, Buck L, Harlow R, Fagan GH, McGuigan K. A Transdisciplinary Methodology for Introducing Solar Water Disinfection to Rural Communities in Malawi-Formative Research Findings. INTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT 2020; 16:871-884. [PMID: 32048797 PMCID: PMC7687190 DOI: 10.1002/ieam.4249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/14/2019] [Accepted: 02/10/2020] [Indexed: 06/10/2023]
Abstract
Despite the increasing volume of evidence demonstrating the efficacy of solar water disinfection (SODIS) as a household water treatment technology, there still appear to be significant barriers to uptake in developing countries. The potential of SODIS is often treated with skepticism in terms of effective treatment, volume, and safety, and is dismissed in preference for more accepted technologies such as ceramic filters and dose chlorination. As part of WATERSPOUTT (EU H2020 688928), our study used a transdisciplinary methodology to cocreate an innovative SODIS system in rural Malawi. The formative work focused on the design of 1) an appropriate and acceptable system and 2) a context-specific intervention delivery program using a behavior-centered design. Initial research identified specific water needs and challenges, which were discussed along with a cocreation process with potential end users, through a series of shared dialogue workshops (SDWs). Specifications from end users outlined a desire for higher volume systems (20 L) that were "familiar" and could be manufactured locally. Development of the "SODIS bucket" was then undertaken by design experts and local manufacturers, with input from end users and subject to controlled testing to ensure efficacy and safety. Concurrent data were collated using questionnaires (n = 777 households), water point mapping (n = 121), water quality testing (n = 46), and behavior change modeling (n = 100 households). These identified specific contextual issues (hydrogeology, water access, gender roles, social capital, and socioeconomic status), and behavioral determinants (normative, ability, and self-regulation factors) that informed the development and delivery mechanism for the implementation toolkit. Integr Environ Assess Manag 2020;16:871-884. © 2020 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).
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Affiliation(s)
- Tracy Morse
- Department of Civil and Environmental EngineeringUniversity of StrathclydeGlasgowUnited Kingdom
- Centre for Water, Sanitation, Hygiene and Appropriate Technology Development, University of Malawi (Polytechnic)BlantyreMalawi
| | - Kondwani Luwe
- Centre for Water, Sanitation, Hygiene and Appropriate Technology Development, University of Malawi (Polytechnic)BlantyreMalawi
| | - Kingsley Lungu
- Centre for Water, Sanitation, Hygiene and Appropriate Technology Development, University of Malawi (Polytechnic)BlantyreMalawi
- Department of Environmental HealthUniversity of Malawi (Polytechnic)BlantyreMalawi
| | - Levison Chiwaula
- Faculty of Social Sciences and Humanities, University of Malawi (Chancellor College)ZombaMalawi
| | - Wapulumuka Mulwafu
- Faculty of Social Sciences and Humanities, University of Malawi (Chancellor College)ZombaMalawi
| | - Lyndon Buck
- Department of Product DesignBuckinghamshire New UniversityLondonUnited Kingdom
| | - Richard Harlow
- Department of Product DesignBuckinghamshire New UniversityLondonUnited Kingdom
| | - G Honor Fagan
- Department of Sociology and Social Science Institute (MUSSI)Maynooth UniversityMaynoothIreland
| | - Kevin McGuigan
- Department of Physiology and Medical PhysicsRoyal College of SurgeonsIrelandDublinIreland
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Tumwebaze IK, Rose JB, Hofstra N, Verbyla ME, Musaazi I, Okaali DA, Kaggwa RC, Nansubuga I, Murphy HM. Translating pathogen knowledge to practice for sanitation decision-making. JOURNAL OF WATER AND HEALTH 2019; 17:896-909. [PMID: 31850897 DOI: 10.2166/wh.2019.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Sanitation planners make complex decisions in the delivery of sanitation services to achieve health outcomes. We present findings from a stakeholder engagement workshop held in Kampala, Uganda, to educate, interact with, and solicit feedback from participants on how the relevant scientific literature on pathogens can be made more accessible to practitioners to support decision-making. We targeted Water, Sanitation and Hygiene (WASH) practitioners involved in different levels of service delivery. Practitioners revealed that different sanitation planning tools are used to inform decision-making; however, most of these tools are not user-friendly or adapted to meet their needs. Most stakeholders (68%) expressed familiarity with pathogens, yet less than half (46%) understood that fecal coliforms were bacteria and used as indicators for fecal pollution. A number of stakeholders were unaware that fecal indicator bacteria do not behave and persist the same as helminths, protozoa, or viruses, making fecal indicator bacteria inadequate for assessing pathogen reductions for all pathogen groups. This suggests a need for awareness and capacity development around pathogens found in excreta. The findings underscore the importance to engage stakeholders in the development of support tools for sanitation planning and highlighted broader opportunities to bridge science with practice in the WASH sector.
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Affiliation(s)
- Innocent K Tumwebaze
- Water, Health and Applied Microbiology Lab (WHAM Lab), Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA E-mail:
| | - Joan B Rose
- Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI, USA
| | - Nynke Hofstra
- Water Systems and Global Change Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Matthew E Verbyla
- Department of Civil, Construction and Environmental Engineering, San Diego State University, San Diego, CA, USA
| | - Isaac Musaazi
- Department of Civil, Construction and Environmental Engineering, San Diego State University, San Diego, CA, USA
| | - Daniel A Okaali
- Water Systems and Global Change Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Rose C Kaggwa
- National Water and Sewerage Corporation, Kampala, Uganda
| | | | - Heather M Murphy
- Water, Health and Applied Microbiology Lab (WHAM Lab), Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA E-mail:
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Evans EW, Redmond EC. Video observation of hand-hygiene compliance in a manufacturer of ready-to-eat pie and pastry products. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2019; 29:593-606. [PMID: 30569758 DOI: 10.1080/09603123.2018.1558183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/07/2018] [Indexed: 06/09/2023]
Abstract
Food-handler hand-hygiene can be a contributory factor for food-borne illness. Cognitive data (knowledge/attitudes/self-reported practices), while informative, are not indicative of behaviour, and are subject to biases. Consequently, observation of behaviour is superior to survey data. However, researcher presence in direct observation increases reactivity, whereas video observation gives comprehensive analysis over a longer period, furthermore, familiarity reduces reactivity. Although video observation has been used to assess food safety at retail/foodservice, this valuable method is under-utilized in food-manufacturing environments. For the study, footage (24 h) was reviewed to assess compliance in a food-manufacturing site with company protocol. Video observation of food-handlers entering production (n = 674) was assessed; upon 70 occasions no attempt to implement hand-hygiene was observed. Of attempted hand-hygiene practices (n = 604), only 2% implemented compliant practices. Although 78% of attempts utilized soap, only 42% included sanitizer. Duration ranged from 1 to 69 s (Median 17 s). The study provides hand-hygiene data in an area that observational data is seldom captured.
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Affiliation(s)
- Ellen W Evans
- ZERO2FIVE Food Industry Centre, Cardiff Metropolitan University , Cardiff , Wales
| | - Elizabeth C Redmond
- ZERO2FIVE Food Industry Centre, Cardiff Metropolitan University , Cardiff , Wales
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Dockx K, Van Remoortel H, De Buck E, Schelstraete C, Vanderheyden A, Lievens T, Kinyagu JT, Mamuya S, Vandekerckhove P. Effect of Contextualized Versus Non-Contextualized Interventions for Improving Hand Washing, Sanitation, and Health in Rural Tanzania: Study Design of a Cluster Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142529. [PMID: 31311186 PMCID: PMC6678137 DOI: 10.3390/ijerph16142529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/18/2022]
Abstract
Nearly 90% of diarrhea-related mortalities are the result of unsafe drinking water, poor sanitation, and insufficient hygiene. Although “Water, Sanitation, and Hygiene” (WASH) interventions may significantly reduce the risk of diarrheal disease, it is currently unclear which interventions are the most effective. In this study, we aim to determine the importance of contextualizing a WASH intervention to the local context and the needs for increasing impact (Clinicaltrials.gov NCT03709368). A total of 1500 households in rural Tanzania will participate in this cluster randomized controlled trial. Households will be randomized into one of three cohorts: (1) a control group receiving a basic intervention and 1 placebo household visit, (2) an intervention group receiving a basic intervention + 9 additional household visits which are contextualized to the setting using the RANAS approach, and (3) an intervention group receiving a basic intervention + 9 additional household visits, which are not contextualized, i.e., a general intervention. Assessments will take place at a baseline, 1 and 2 years after the start of the intervention, and 1 year after the completion of the intervention. Measurements involve questionnaires and spot checks. The primary outcome is hand-washing behavior, secondary objectives include, the impact on latrine use, health, WASH infrastructure, quality of life, and cost-effectiveness.
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Affiliation(s)
- Kim Dockx
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen 2800, Belgium.
| | - Hans Van Remoortel
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen 2800, Belgium
| | - Emmy De Buck
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen 2800, Belgium
- Faculty of Medicine, Department of Public Health and Primary Care, KU Leuven, Leuven 3000, Belgium
| | | | | | | | | | - Simon Mamuya
- Department of Environmental and Occupational Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Philippe Vandekerckhove
- Belgian Red Cross, Mechelen 2800, Belgium
- Faculty of Medicine, Department of Public Health and Primary Care, KU Leuven, Leuven 3000, Belgium
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Hart AM. Preventing Outpatient Health Care–associated Infections. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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