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Merga A, Yetwale F, Sisay B, Shumye M. Clients' satisfaction with cervical cancer screening services and influencing factors at public health facilities in Debre Markos town, Northwest Ethiopia, 2022/23: a convergent parallel mixed method. BMC Womens Health 2024; 24:441. [PMID: 39095758 PMCID: PMC11295363 DOI: 10.1186/s12905-024-03250-5] [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: 08/21/2023] [Accepted: 07/08/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Satisfaction is defined as the perceived fulfillment of patient or client needs and desires through the delivery of healthcare services. In developed countries, more than 60% of women have been screened for cervical cancer. However, only 12% of women in sub-Saharan Africa have been screened for precancerous cervical lesions. There is limited evidence on client satisfaction with cervical cancer screening services (CSCCSS) in Ethiopia, particularly, there is no study conducted by mixed method in the Amhara region. OBJECTIVE The study aimed to assess clients' satisfaction with cervical cancer screening services and influencing factors among women screened in Debre Markos town public health facilities in Northwest Ethiopia, 2022/23. METHODS A convergent parallel mixed methods design was conducted in Debre Markos town's public health facilities from October 10th, 2022 to January 10th, 2023. For the quantitative wing, a total of 401 cervical cancer screening service users were selected using a systematic random sampling technique. Data were collected using an interviewer-administered structured questionnaire. Clients were interviewed on exit in a private area far from the screening unit and the data were entered into Epi-data version 4.6.0.2, then exported to STATA version 14 for analysis. A binary logistic regression model was fitted to identify factors associated with client satisfaction with cervical cancer screening services. The qualitative data were collected through in-depth and key informant interviews using a semi-structured topic guide. The data were analyzed using a thematic analysis approach with Open code software (version 4.0.2.3). RESULT The quantitative wing revealed that overall, 65% (95% CI: 60-69) of respondents were satisfied with the cervical cancer screening services they received. Gender of the provider (AOR: 6.11, 95% CI: 3.23-11.55, p-value = 0.000), waiting time (AOR: 4.77, 95% CI: 1.32-17.31, p-value = 0.017), clients' knowledge (AOR: 0.26, 95% CI: 0.12-0.59, p-value = 0.001), and clients' attitude (AOR: 6.43, 95% CI: 3.43-12.03, p-value = 0.000) were significantly associated with CSCCSS. QUALITATIVE RESULT The thematic analysis revealed three themes. Theme 1: facility-related barriers (shortage of skilled manpower, shortage of infrastructure, providers' skill gap, unavailability of full service, leadership problem, long waiting time). Theme 2: client-related barriers (poor knowledge and attitude, gender preference). Theme 3: facility-related facilitators (free service, presence of supportive partners). CONCLUSION According to the findings of this study, two-thirds of clients were satisfied with cervical cancer screening services, which was lower than the national target of 80%. Long waiting time, male gender of the service provider, unfavorable attitude, and good knowledge of clients were identified as significant factors negatively affecting client satisfaction with cervical cancer screening.
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Affiliation(s)
- Alemu Merga
- Department of Midwifery, school of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Fisseha Yetwale
- Department of Clinical Midwifery, school of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Beyene Sisay
- Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health sciences, Arsi University, Asella, Ethiopia
| | - Muhabaw Shumye
- Department of Clinical Midwifery, school of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Foster I, Biewer A, Vanqa N, Makanda G, Tisile P, Hayward SE, Wademan DT, Anthony MG, Mbuyamba R, Galloway M, Human W, van der Westhuizen HM, Friedland JS, Medina-Marino A, Schoeman I, Hoddinott G, Nathavitharana RR. "This is an illness. No one is supposed to be treated badly": community-based stigma assessments in South Africa to inform tuberculosis stigma intervention design. BMC GLOBAL AND PUBLIC HEALTH 2024; 2:41. [PMID: 38919729 PMCID: PMC11194205 DOI: 10.1186/s44263-024-00070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/20/2024] [Indexed: 06/27/2024]
Abstract
Background Though tuberculosis (TB)-related stigma is a recognized barrier to care, interventions are lacking, and gaps remain in understanding the drivers and experiences of TB-related stigma. We undertook community-based mixed methods stigma assessments to inform stigma intervention design. Methods We adapted the Stop TB Partnership stigma assessment tool and trained three peer research associates (PRAs; two TB survivors, one community health worker) to conduct surveys with people with TB (PWTB, n = 93) and caregivers of children with TB (n = 24) at peri-urban and rural clinic sites in Khayelitsha, Western Cape, and Hammanskraal, Gauteng Province, South Africa. We descriptively analyzed responses for each stigma experience (anticipated, internal, and enacted), calculated stigma scores, and undertook generalized linear regression analysis. We conducted 25 in-depth interviews with PWTB (n = 21) and caregivers of children with TB (n = 4). Using inductive thematic analysis, we performed open coding to identify emergent themes, and selective coding to identify relevant quotes. Themes were organized using the Constraints, Actions, Risks, and Desires (CARD) framework. Results Surveys revealed almost all PWTB (89/93, 96%) experienced some form of anticipated, internal, and/or enacted stigma, which affected engagement throughout the care cascade. Participants in the rural setting (compared to peri-urban) reported higher anticipated, internal, and enacted stigma (β-coefficient 0.72, 0.71, 0.74). Interview participants described how stigma experiences, including HIV intersectional stigma, act individually and together as key constraints to impede care, leading to decisions not to disclose a TB diagnosis, isolation, and exclusion. Stigma resilience arose through the understanding that TB can affect anyone and should not diminish self-worth. Risks of stigma, driven by fears related to disease severity and infectiousness, led to care disengagement and impaired psychological well-being. Participants desired counselling, identifying a specific role for TB survivors as peer counselors, and community education. Conclusions Stigma is highly prevalent and negatively impacts TB care and the well-being of PWTB, warranting its assessment as a primary outcome rather than an intermediary contributor to poor outcomes. Multi-component, multi-level stigma interventions are needed, including counseling for PWTB and education for health workers and communities. Such interventions must incorporate contextual differences based on gender or setting, and use survivor-guided messaging to foster stigma resilience. Supplementary Information The online version contains supplementary material available at 10.1186/s44263-024-00070-5.
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Affiliation(s)
- Isabel Foster
- TB Proof, Cape Town, South Africa
- International Development Research Center, Global Health Program, Ottawa, Canada
| | - Amanda Biewer
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA USA
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Sally E. Hayward
- Institute for Infection and Immunity, St George’s, University of London, London, UK
| | - Dillon T. Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Michaile G. Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | | | | | - Jon S. Friedland
- Institute for Infection and Immunity, St George’s, University of London, London, UK
| | - Andrew Medina-Marino
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Desmond Tutu Health Foundation, Cape Town, South Africa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Ruvandhi R. Nathavitharana
- TB Proof, Cape Town, South Africa
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA USA
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Mukhopadhyay DK, Choudhari SG. Critical Thinking and Clinical Reasoning in Undergraduate Medical Course: A Mixed-Methods Study in a Medical College in Kolkata, West Bengal, India. F1000Res 2024; 13:259. [PMID: 38779311 PMCID: PMC11109580 DOI: 10.12688/f1000research.146009.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/25/2024] Open
Abstract
Critical thinking is considered as the essential set of skills for medical practice, particularly during emergencies. However, there is lack of conceptual clarity around it and it was not explicitly included in the undergraduate medical curriculum in India. The present study has been planned to assess the critical thinking disposition and clinical reasoning skills among medical undergraduate students in a medical college in West Bengal, India. The perceived definition and attributes of critical thinking in medical education will be explored and the contexts where application of critical thinking skills may be crucial for medical practice will be identified. The content validity index, test-retest agreement; internal consistency and construct validity of the Critical Thinking Disposition Assessment Questionnaire (CTDAQ) will be assessed through step-by-step procedure. CTDAQ and the case-based objective-type questions for the clinical reasoning skills will be applied to around 200 medical undergraduate students. Their perception and experience on critical thinking in medical education will be assessed with structured open-ended questions. In-depth interviews with medical teachers of the second and third phases of undergraduate medical curriculum will be conducted to assess their perception and experiences on critical thinking. The quantitative analysis will be conducted with MS excel and R software using the relevant packages. The qualitative data will be transcribed and translated in English, close to the participants' verbatim. The thematic analysis will be conducted with inductive coding and memoing. The study will be conducted maintaining ethical standards for epidemiological studies. The present study, one of the first a few studies in India, will help to meet the conceptual gap in understanding the attributes of critical thinking, its association with clinical reasoning and the contexts of preferred application in medical practice.
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Affiliation(s)
- Dipta Kanti Mukhopadhyay
- School of Higher Education & Research, Datta Meghe Institute of Higher Education & Research, Sawangi (Meghe), Maharashtra, 442107, India
- Community Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, 700058, India
| | - Sonali G. Choudhari
- School of Higher Education & Research, Datta Meghe Institute of Higher Education & Research, Sawangi (Meghe), Maharashtra, 442107, India
- Community Medicine, Jawaharlal Nehru Medical College, Sawangi (Meghe), Maharashtra, 442107, India
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Hernandez-Pineda E, Amaya CA, González-Uribe C, Herrera A, Velasco N. Covid-19 vaccination: a mixed methods analysis of health system resilience in Latin America. Int J Equity Health 2024; 23:27. [PMID: 38347545 PMCID: PMC10863163 DOI: 10.1186/s12939-023-02073-4] [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: 07/28/2023] [Accepted: 12/01/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND This paper discusses the stages of health system resilience (HSR) and the factors underlying differences in HSR during the covid-19 pandemic, especially the vaccination challenge. We studied the relationship between vaccination strategies and macro-context backgrounds in 21 Latin American countries. Our objective was to capture the impact of those aspects in the SR and identify potential improvements for future crises and for vaccination programs in general. METHODS The study uses mixed-methods research to provide insights into how the countries' backgrounds and vaccination strategies impact the HSR. Particularly, we used explanatory sequential mixed methods, which entails a quantitative-qualitative two-phase sequence. The quantitative phase was conducted using cluster and variance analysis, in which the HSR was measured using as a proxy the covid-19 vaccination outcomes in three cut-offs of reaching 25%, 50%, and 75% of population coverage. This approach allows us to discriminate covid-19 vaccination progress by stages and contrast it to the qualitative stage, in which we performed a country-case analysis of the background conditions and the changes in vaccination strategies that occurred during the corresponding dates. RESULTS The paper provides a rich comparative case analysis of countries, classifying them by early, prompt, and delayed performers. The results show that differences in vaccination performance are due to flexibility in adapting strategies, cooperation, and the ability to design multilevel solutions that consider the needs of various actors in the health ecosystem. These differences vary depending on the vaccination stage, which suggests the importance of acknowledging learning, diffusion, and feedback processes at the regional level. CONCLUSIONS We identified the importance of societal well-being as an ideal country antecedent for high and sustained levels of performance in covid-19 vaccination. Whereas in other countries where the set-up and beginning phases were rough, the value of the operational decisions and the learning on the move regarding their own and their peers' trajectories were crucial and were reflected in performance improvement. A contribution of this study is that the above-mentioned analysis was done using vaccination coverage cut-off points that allow a performance view that takes into consideration the stages of the vaccination progress and the learning process that goes with it. As well as framing this into the HSR shock cycles that allow to differentiate the stages of resilience on which countries must act.
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Affiliation(s)
| | - Ciro-Alberto Amaya
- School of Engineering, Universidad de Los Andes, Cra 1 E ste N° 19A - 40, Bogotá, 111711, Colombia
| | - Catalina González-Uribe
- School of Medicine, Universidad de Los Andes, Carrera 1 No 18 A - 10 42 Bloque Q Piso 8, Bogotá, 111711, Colombia
| | - Andrea Herrera
- School of Engineering, Universidad de Los Andes, Cra 1 E ste N° 19A - 40, Bogotá, 111711, Colombia
| | - Nubia Velasco
- School of Management, Universidad de Los Andes, Calle 21 # 1-20, Bogotá, 111711, Colombia
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He W, Zhao P, Yang T, Wan Y, Wu D, Chen X, Huang Z, Luo H, Xu DR, Huang S, Wang C. Exploring causal mechanisms and essential factors in the prevention and control of chlamydia in Guangdong, Southern China: a study protocol. BMC Infect Dis 2023; 23:628. [PMID: 37749484 PMCID: PMC10519073 DOI: 10.1186/s12879-023-08597-y] [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: 07/27/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Chlamydia Trachomatis (CT) is among the most prevalent sexually transmitted diseases (STDs) globally. According to the World Health Organization, more than 131 million people get infected with CT annually. CT is usually transmitted via sexual contact or perinatal exposure and can result in severe long-term complications. In developing nations, particularly, the prevention and control of CT is challenging. Hence, this study will explore the feedback mechanisms of chlamydia prevention and control, as well as identify the essential factors affecting the control and prevention of this infection in China. METHODS Our study will employ a mixed-methods research design that encompasses both qualitative and quantitative methods. Firstly, we will develop a causal loop diagram (CLD) based on the literature review and optimize it via in-depth interviews with stakeholders. Additionally, we will utilize a quantitative method called MICMAC(Impact Matrix Cross-Reference Multiplication Applied to a Classification tool) to obtain consensus among different stakeholders and pinpoint the key information. Next, the CLD will be transformed into a system dynamics model (SDM) to evaluate the feedback mechanisms within the CLD. The causality in the CLD will be modeled using mathematical equations, which facilitate the transformation into an SDM. As such, we will be able to analyze the dynamic behavior of the system and its response to different decisions. DISCUSSION Our study offers a systematic perspective on the control and prevention of chlamydia infection through system dynamics modeling, examining the dynamic properties and background factors of the system. The creation of the CLD affords stakeholders the chance to comprehend the functionality of their relationships and improve cooperation. Consequently, by evaluating the outcomes of these simulations, it will be possible to analyze and determine potential interventions and their effects on chlamydia infections. This modeling approach can help us gain insight into the dynamic characteristics of the system, evaluate the potential outcomes of different decisions, and design control strategies to either stabilize the system or adjust its behavior.
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Affiliation(s)
- Wenjun He
- School of Public Health, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Peizhen Zhao
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health, Guangzhou, China
| | - Tao Yang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Yuting Wan
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Dadong Wu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
- Center for World Health Organization Studies and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Xiaoshan Chen
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Zizhen Huang
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Huanyuan Luo
- Southern Medical University Institute for Global Health, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
- Center for World Health Organization Studies and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Dong Roman Xu
- School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China.
- Center for World Health Organization Studies, Southern Medical University, Guangzhou, China.
- Acacia Lab for Implementation Science, Southern Medical University Institute for Global Health (SIGHT), Guangzhou, China.
- Acacia Lab for Implementation Science, School of Public Health, Southern Medical University, Guangzhou, China.
| | - Shujie Huang
- Dermatology Hospital, Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health, Guangzhou, China.
| | - Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health, Guangzhou, China.
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Habtamu D, Abebe B, Seid T. Health risk perceptions of household air pollution and perceived benefits of improved stoves among pregnant women in rural Ethiopia: a mixed method study. BMJ Open 2023; 13:e072328. [PMID: 37648392 PMCID: PMC10471873 DOI: 10.1136/bmjopen-2023-072328] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE Since community perceptions of the risk of biomass smoke and the benefits of improved stoves play a critical role in behaviour change to the uptake and sustainable utilisation of improved stoves, we aimed to assess the level of health risk perception on kitchen smoke and benefits of using improved stoves among pregnant women. DESIGN A community-based cross-sectional mixed method study. SETTING In six kebeles of a low-income rural community of South Gondar Zone, Northwestern Ethiopia. PARTICIPANTS All 455 households with pregnant women aged 18-38 years, in their first-trimester or second-trimester gestation, exclusively use traditional biomass-fuelled or locally modified mud stoves, and the primary cook in her household were included. But completed data were obtained only from 422 households. RESULT From 422 completed data, more than half, 63% (95% CI 58% to 68%) had high-level health risk perception of household air pollution, and nearly three-fourths, 74% (95% CI 70% to 79%) of the respondents perceived that using improved stove had benefits for their families. Participants in the 32-38 years age group, rich in asset index, presence of under-five children, being a member of any women group and large family size were positively associated with high-level health risk perception. Whereas respondents in the 18-24 years age group, presence of under-five children, husbands of primary or higher education, high health risk perception and not happy with the current stove were positively associated with perceived benefits of using an improved stove. CONCLUSION The observed level of health risk perception of biomass smoke and the benefits of using improved stoves may help to adopt effective intervention measures. This study also suggests that for successful intervention, clean cooking programmes and policies must consider many local factors influencing health risk perception and benefits of using improved stoves. TRIAL REGISTRATION NUMBER ACTR202111534227089.
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Affiliation(s)
| | - Beyene Abebe
- Department of Environmental Health Science and Technology, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Tiku Seid
- Department of Environmental Health Science and Technology, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
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Ahuja S, Phillips L, Smartt C, Khalid S, Coldham T, Fischer L, Rae S, Sevdalis N, Boaz A, Robinson S, Gaughran F, Lelliott Z, Jones P, Thornicroft G, Munshi JD, Drummond C, Perez J, Littlejohns P. What interventions should we implement in England's mental health services? The mental health implementation network (MHIN) mixed-methods approach to rapid prioritisation. FRONTIERS IN HEALTH SERVICES 2023; 3:1204207. [PMID: 37638343 PMCID: PMC10456870 DOI: 10.3389/frhs.2023.1204207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023]
Abstract
Introduction Setting mental health priorities helps researchers, policy makers, and service funders improve mental health services. In the context of a national mental health implementation programme in England, this study aims to identify implementable evidence-based interventions in key priority areas to improve mental health service delivery. Methods A mixed-methods research design was used for a three step prioritisation approach involving systematic scoping reviews (additional manuscript under development), expert consultations and data triangulation. Groups with diverse expertise, including experts by experience, worked together to improve decision-making quality by promoting more inclusive and comprehensive discussions. A multi-criteria decision analysis (MCDA) model was used to combine participants' varied opinions, data and judgments about the data's relevance to the issues at hand during a decision conferencing workshop where the priorities were finalised. Results The study identified mental health interventions in three mental health priority areas: mental health inequalities, child and adolescent mental health, comorbidities with a focus on integration of mental and physical health services and mental health and substance misuse problems. Key interventions in all the priority areas are outlined. The programme is putting some of these evidence-based interventions into action nationwide in each of these three priority mental health priority areas. Conclusion We report an inclusive attempt to ensure that the list of mental health service priorities agrees with perceived needs on the ground and focuses on evidence-based interventions. Other fields of healthcare may also benefit from this methodological approach if they need to make rapid health-prioritisation decisions.
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Affiliation(s)
- Shalini Ahuja
- Methodologies Research Division, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Lawrence Phillips
- Department of Management, London School of Economics and Political Science, London, United Kingdom
| | - Caroline Smartt
- Department of Health Service & Population Research, School of Mental Health & Psychological Sciences, King's College London, London, United Kingdom
| | - Sundus Khalid
- Department of Health Service & Population Research, School of Mental Health & Psychological Sciences, King's College London, London, United Kingdom
| | - Tina Coldham
- Participation Involvement & Engagement Advisor at NIHR (National Institute for Health Research), London, United Kingdom
| | - Laura Fischer
- Department of Health Service & Population Research, School of Mental Health & Psychological Sciences, King's College London, London, United Kingdom
| | - Sarah Rae
- Independent Expert by Experience, and Patient Community Involvement and Engagement Participation (PCIEP) Lead, co-Lead Workstream 2 (Patient and Public Involvement), London, United Kingdom
| | - Nick Sevdalis
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Annette Boaz
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Sarah Robinson
- Eastern Academic Health Science Network, Cambridge, United Kingdom
| | - Fiona Gaughran
- Social and Psychiatric Epidemiology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Zoe Lelliott
- Social and Psychiatric Epidemiology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Peter Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Graham Thornicroft
- Department of Health Service & Population Research, School of Mental Health & Psychological Sciences, King's College London, London, United Kingdom
| | - Jayati-Das Munshi
- Social and Psychiatric Epidemiology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Colin Drummond
- Social and Psychiatric Epidemiology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Peter Littlejohns
- Social and Psychiatric Epidemiology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Uba UJ, Efut EN, Bassey Obeten U, Asuquo EE, Uba JC. Sociodemographic factors and environmental workers' knowledge of the impact of awareness creation on sustainable disposal of solid wastes. Heliyon 2023; 9:e18122. [PMID: 37539142 PMCID: PMC10393608 DOI: 10.1016/j.heliyon.2023.e18122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 06/09/2023] [Accepted: 07/07/2023] [Indexed: 08/05/2023] Open
Abstract
This study examined sociodemographic factors and environmental workers' knowledge of the impact of awareness-creation on the sustainable disposal of solid waste in Cross River State, Nigeria. To achieve the purpose of the study, two research questions and two hypotheses guided the study. The sequential explanatory mixed-method design was adopted in the study. The population for the study was 331 respondents, consisting of 120 staff and 211 government-approved service providers from the Cross-River State Ministry of Environment. The population also comprised the sample size of the study. The total enumeration sampling technique was employed. A 42-item structured questionnaire titled "Questionnaire Instrument on Sociodemographic Factors and Environmental Workers' Knowledge of the Impact of Awareness Creation on Sustainable Disposal of Solid Wastes" (QISFEWKIACSDSW) and a Focus Group Discussion Schedule (FGDS) were the instruments used for data collection. The instruments were face validated by three experts: two from Social Science Education and one from the Measurement and Evaluation Unit of the Department of Science Education, University of Nigeria, Nsukka. The Cronbach Alpha Reliability Method was used to determine the internal consistency of the instrument. Data collected from the questionnaire was analyzed using mean and standard deviation for the research questions while independent sampled t-test statistic was used to test the null hypotheses at a 0.05 level of significance and the FGDS was used to supplement the findings of the quantitative analysis. Findings of the study revealed that, to a high extent, awareness creation based on location and gender can contribute positively to the sustainable disposal of solid waste materials. Based on the findings of the study, it was recommended, among others, that enlightenment programs such as awareness creation, town hall meetings, and workshops be organized among community members on the need for sustainable disposal of solid waste materials in Cross River State, Nigeria.
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Affiliation(s)
- Uba James Uba
- School of General Studies, Federal Polytechnic Ugep, Cross River State, Nigeria
| | - Etim Nkanu Efut
- Department of Environmental Education, Faculty of Arts and Social Science Education, University of Calabar, Nigeria
| | - Udumo Bassey Obeten
- Department of Environmental Education, Faculty of Arts and Social Science Education, University of Calabar, Nigeria
| | - Edung Etim Asuquo
- Department of Environmental Education, Faculty of Arts and Social Science Education, University of Calabar, Nigeria
| | - James Connie Uba
- Department of Biochemistry, Nutrition and Food Science, University of Calabar, Nigeria
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Ofori R, Takyi SA, Amponsah O, Gagakuma D. Mining-induced displacement and resettlement in Ghana: an assessment of the prospects and challenges in selected mining communities. SOCIAL NETWORK ANALYSIS AND MINING 2023. [DOI: 10.1007/s13278-023-01075-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Hutchinson E, Hansen KS, Sanyu J, Amonya LP, Mundua S, Balabanova D, Clarke SE, Kitutu FE. Is it possible for drug shops to abide by the formal rules? The structural determinants of community medicine sales in Uganda. BMJ Glob Health 2023; 8:bmjgh-2022-011097. [PMID: 36822666 PMCID: PMC9950907 DOI: 10.1136/bmjgh-2022-011097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/05/2023] [Indexed: 02/25/2023] Open
Abstract
The medicines retail sector is an essential element of many health systems in Africa and Asia, but it is also well known for poor practice. In the literature, it is recognised that improvements in the sector can only be made if more effective forms of governance and regulation can be identified. Recent debate suggests that interventions responsive to structural constraints that shape and underpin poor practice is a useful way forward. This paper presents data from a mixed-methods study conducted to explore regulation and the professional, economic and social constraints that shape rule breaking among drug shops in one district in Uganda. Our findings show that regulatory systems are undermined by frequent informal payments, and that although drug shops are often run by qualified staff, many are unlicensed and sell medicines beyond their legal permits. Most shops have either a small profit or a loss and rely on family and friends for additional resources as they compete in a highly saturated market. We argue that in the current context, drug shop vendors are survivalist entrepreneurs operating in a market in which it is extremely difficult to abide by policy, remain profitable and provide a service to the community. Structural changes in the medicines market, including removing unqualified sellers and making adjustments to policy are likely prerequisite if drug shops are to become places where individuals can earn a living, abide by the rules and facilitate access to medicines for people living in some of the world's poorest countries.
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Affiliation(s)
- Eleanor Hutchinson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Jacquellyn Sanyu
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Lydia Peace Amonya
- Infectious Diseases Research Collaboration, Kampala, Central Region, Uganda
| | - Sunday Mundua
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Sian E Clarke
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Freddy Eric Kitutu
- Makerere University College of Health Sciences, Kampala, Uganda
- Department of Pharmacy, Makerere University School of Health Sciences, Kampala, Uganda
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11
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Assefa D, Tekassa T, Alemu S. Extent and barriers to providing effective pharmaceutical compounding services in hospital and community pharmacies of a low-income country: Case of Southwest Ethiopia. THE JOURNAL OF MEDICINE ACCESS 2023; 7:27550834231183753. [PMID: 37427249 PMCID: PMC10328152 DOI: 10.1177/27550834231183753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Background and objective In low- and middle-income countries, pharmaceutical compounding is vital to provide high-quality healthcare service. Accordingly, this study aimed to investigate the extent status of practice and barriers to compounding services in hospital and community pharmacies of Southwest Ethiopia. Methods A healthcare institution-based cross-sectional study was conducted from 15 September 2021 to 25 January 2022. Data were collected from 104 pharmacists using a self-administered questionnaire. The responding pharmacists were selected by purposive sampling technique. Finally, descriptive statistical methods were used for data analysis with the help of IBM SPSS Statistics V21.0. Results A total of 104 pharmacists (27 hospital pharmacists and 77 community pharmacists) responded (response rate: 0.945). Besides providing other routine essential pharmacy services, around 93.3% of contacted pharmacies have a history of practicing compounding services. The most common practices were granule or powder reconstitution to suspensions or solutions (98.97%) and crushing tablets into smaller forms (92.8%). Commonly, compounding was requested and practiced for preparing pediatrics (97.9%) and geriatrics (96.9%) doses from adult doses, unavailable dosage forms (88.7%), and solving therapeutic gaps (86.6%). All compounding pharmacies participated in compounding antimicrobial medications. They often cited lacking skills or training (76.3%) and insufficient equipment and supplies needed for compounding (99%) as the main barriers. Conclusion and recommendation With many facilitators, challenges, and limitations, medication compounding services remain one of the core healthcare services. Areas needing improvement include strengthening comprehensive and continuous professional development for pharmacists on compounding standards.
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Affiliation(s)
- Desta Assefa
- School of Pharmacy, Jimma University, Jimma,
Ethiopia
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12
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Chaiya C, Panezai S, Saqib SE, Ashraf M. Satisfaction of Tuberculosis Patients with Directly Observed Treatment Strategy under Pakistan Health Care Policy: A Mixed-Method Study. Healthcare (Basel) 2022; 10:healthcare10122529. [PMID: 36554053 PMCID: PMC9778783 DOI: 10.3390/healthcare10122529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Patients' satisfaction is based on the perceived health care services of individuals and is influenced by the level of care provided by the health care system. It is often based on the patients' expectations of care and self-assessment of their experiences. The success of the Directly Observed Treatment Strategy (DOTS) also depends on the quality of health care provided at the Tuberculosis (TB) centers, which can be evaluated by satisfaction levels of the patients. (2) Methods: A tuberculosis facility-based cross-sectional study was carried out in Khyber Pakhtunkhwa province in Pakistan. A mixed-method approach was adopted for data collection. An interviewer-administered questionnaire was used for quantitative data collection from 269 patients who were registered at 11 TB centers and private clinics. Qualitative data were collected through 20 in-depth interviews, 15 key informant interviews, and a focus-group discussion. Binary logistic regression was employed for analysis of the data. (3) Results: More than half of the respondents (63.94%) were satisfied with the DOTS strategy. A high percentage of patients were dissatisfied with the availability of safe water, waiting space for patients, waiting time, privacy, and the processing of appointments. Results from the binary logistic regression showed that gender (AOR = 2.21, CI 1.07-4.58, p = 0.033), marital status (AOR = 3.12, CI 1.45-6.73, p = 0.004), employment status (AOR = 5.22, CI 2.44-1.21, p = 0.000), home ownership (AOR = 3.82, CI 1.94-7.54, p = 0.000), literacy (AOR = 2.17, CI 1.11-4.25, p = 0.023), households' main occupation (AOR = 4.42, CI 1.12-17.38, p = 0.033), and level of income (AOR = 2.39, CI 1.13-5.04, p = 0.023) were the significant factors affecting satisfaction levels of the patients. (4) Conclusion: There are a number of areas that need improvement for successful TB eradication. Significant work is required to improve the quality of TB care in these specific areas from the patients' perspective. For instance, female health workers' involvement in the DOTS program can solve the problems of female respondents in rural areas. Improving the infrastructure facilities at the TB centers, allocation of doctors and nurses at the rural health centers would result in positive outcomes of the DOTS in Pakistan as well as in other developing countries.
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Affiliation(s)
- Chitralada Chaiya
- College of Politics and Governance, Mahasarakham University, Maha Sarakham 44150, Thailand
- Correspondence: ; Tel.: +66-831-879-358
| | - Sanaullah Panezai
- Department of Geography and Regional Planning, University of Balochistan, Quetta 87300, Pakistan
| | - Shahab E. Saqib
- Directorate of Commerce Education and Management Sciences, Higher Education Department Khyber Pakhtunkhwa, Peshawar 25000, Pakistan
| | - Muhammad Ashraf
- Department of Disaster Management and Development Studies, University of Balochistan, Quetta 87300, Pakistan
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13
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Pascoe KJ, Walsh E, Gage BC, Van Son C. Health Research in a Jail: Methodological Challenges. Nurs Sci Q 2022; 35:477-482. [PMID: 36171705 DOI: 10.1177/08943184221115129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Strict regulations are in place for conducting research with prisoners. Published studies are limited that focus on improving the health and well-being of incarcerated persons. Subsequently, institutional review boards established methods to guide researchers in conducting fair and ethical research in carceral settings. The authors of this paper discuss some of the methodological challenges that exist when conducting research with incarcerated persons. Unique methodological challenges were found during the process of conducting a research study inside a jail setting. The authors discuss challenges and provide guidance for future studies. Despite challenges, researchers can conduct studies that can benefit incarcerated persons.
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Affiliation(s)
- Kelsey J Pascoe
- Assistant Professor, Washington State University College of Nursing, Vancouver, WA, USA
| | - Elaine Walsh
- Associate Professor, University of Washington School of Nursing, Seattle, WA, USA
| | - Bruce C Gage
- Chief of Psychiatry, WA State Department of Corrections, WA, USA.,Clinical Associate Professor, Psychiatry and Behavioral Sciences, UW School of Medicine, Seattle, WA, USA
| | - Catherine Van Son
- Associate Professor, Washington State University College of Nursing, Vancouver, WA, USA
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14
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Faulkner SM, Drake RJ, Ogden M, Gardani M, Bee PE. A mixed methods expert opinion study on the optimal content and format for an occupational therapy intervention to improve sleep in schizophrenia spectrum disorders. PLoS One 2022; 17:e0269453. [PMID: 35666738 PMCID: PMC9170103 DOI: 10.1371/journal.pone.0269453] [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: 04/06/2021] [Accepted: 05/22/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction People with schizophrenia spectrum disorder diagnoses commonly have poor sleep, which predicts various negative outcomes. The problems are diverse, including substantial circadian dysregulation, sleep-wake timing issues, hypersomnia (excessive sleep), and more classic insomnia. Methods This paper reports on a mixed methods expert opinion study based on the principles of Delphi methodology. The study examines and explores opinion on the optimal contents and format for an occupational therapy intervention to improve poor sleep in this population. Views of clinical and academic topic experts (n = 56), were elicited, examined and explored in three rounds, views from previous rounds being presented back to participants in subsequent rounds. Participants with relevant personal experience (n = 26) then rated and commented on suggestions, with a focus on acceptability. Descriptive statistics and graphs of ratings were triangulated with qualitative content analysis of free-text. Results Participants emphasised the central importance of intervention personalisation, although the manner and extent of personalisation suggested varied. Many components and domains were acknowledged as important, with the challenge being how to keep such an intervention simple, brief, and feasible for end-users, for sustainable implementation. The strongest consensus was to address evening routine, daytime activity, and environmental interventions. Relaxation, mindfulness, thermoregulation, sensory factors, and cognitive or psychological approaches were rated as less important. There was disagreement on whether to include time in bed restriction, and how to address napping, as well as how far to address medication timing. Clinicians and researchers advocated some version of stimulus control, but participants with personal experience reported low levels of acceptability for this, describing entirely negative experiences using ‘the 15-minute rule’ (part of stimulus control). Conclusion These results are informative for clinicians treating sleep problems in people with schizophrenia and related conditions, as well as for decision makers considering the potential contribution of the profession of occupational therapy toward sleep treatment.
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Affiliation(s)
- Sophie M. Faulkner
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- * E-mail:
| | - Richard J. Drake
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Margaret Ogden
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Maria Gardani
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Penny E. Bee
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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15
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Fostering exploration and exploitation behavior in management teams to enhance organizational performance: the LearnOvation leadership development program. LEADERSHIP & ORGANIZATION DEVELOPMENT JOURNAL 2022. [DOI: 10.1108/lodj-04-2021-0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to assess the impact and effectiveness of the LearnOvation leadership development program in the welfare services sector in Sweden.Design/methodology/approachLearnOvation was based on ambidexterity theory for the program content and the research study design. A mixed-method design was applied, using questionnaires among staff (n = 523) and written evaluations with the management teams (n = 60).FindingsQuantitative analysis of the questionnaires indicated little change in managers' and staffs' innovation behaviors, though employee exploration behaviors were strongly and positively correlated with their innovation behaviors. Qualitative leader-written evaluations reported increased understanding of innovation management and the use of exploration and exploitation activities to involve staff in the implementation of creative ideas within the organization.Practical implicationsThe authors argue that innovating is about creating a fertile ground for exploration and exploitation processes of learning that support staff's willingness to meet goals, as well as their capability to explore new ideas and experiment in new ways of working. Leadership development activities that engage the entire management team can build the necessary capacity and power to lead innovation processes in highly structured welfare services and free the employees' innovativeness, potentially leading to improved services and employee satisfaction.Originality/valueWith the goal of enhancing the innovation capacity in daily practice, this study adds to the scarcity of research in welfare services on how to actually support management's work on leading successful implementation of creative ideas.
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16
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Baugh Littlejohns L, Hill C, Neudorf C. Diverse Approaches to Creating and Using Causal Loop Diagrams in Public Health Research: Recommendations From a Scoping Review. Public Health Rev 2022; 42:1604352. [PMID: 35140995 PMCID: PMC8712315 DOI: 10.3389/phrs.2021.1604352] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Complex systems thinking methods are increasingly called for and used as analytical lenses in public health research. The use of qualitative system mapping and in particular, causal loop diagrams (CLDs) is described as one promising method or tool. To our knowledge there are no published literature reviews that synthesize public health research regarding how CLDs are created and used. Methods: We conducted a scoping review to address this gap in the public health literature. Inclusion criteria included: 1) focused on public health research, 2) peer reviewed journal article, 3) described and/or created a CLD, and 4) published in English from January 2018 to March 2021. Twenty-three articles were selected from the search strategy. Results: CLDs were described as a new tool and were based upon primary and secondary data, researcher driven and group processes, and numerous data analysis methods and frameworks. Intended uses of CLDs ranged from illustrating complexity to informing policy and practice. Conclusion: From our learnings we propose nine recommendations for building knowledge and skill in creating and using CLDs for future public health research.
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Affiliation(s)
| | - Carly Hill
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Cory Neudorf
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
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17
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Jayanna K, Rao S, Kar A, Gowda PD, Thomas T, Swaroop N, Washington M, Shashidhar AR, Rai P, Chitrapu S, Mohan HL, Martines J, Mony P. Accelerated scale-up of Kangaroo Mother Care: Evidence and experience from an implementation-research initiative in south India. Acta Paediatr 2022. [PMID: 35146803 DOI: 10.1111/apa.16236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
Abstract
AIM Though Kangaroo Mother Care (KMC) has demonstrated benefits for low birth weight newborns, coverage continues to be low in India. As part of a World Health Organization (WHO) multi-country study, we explored intervention models to accelerate KMC coverage in a high priority district of Karnataka, India. METHODS We used implementation-research methods, formative assessments and quality improvement approaches to design and scale-up interventions. Evaluation was done using prospective cohort study design; data were collected from facility records, and client interviews during KMC initiation, at discharge and at home after discharge. RESULTS KMC was initiated at health facilities for 87.6% of LBW babies under 2000 g. At discharge, 85.0% received KMC; 67.9% continued to receive KMC at home on the 7th day post-discharge. The interventions included training, mentoring and constant advocacy at many levels: public health facilities, private sector and the community. Innovations like a KMC case sheet, counselling, peer support group triggered KMC in the facilities; a KMC-link card, a microplanning and communication tool for CHWs helped to sustain practice at homes. CONCLUSION The study provides a novel approach to designing and scaling up interventions and suggests lessons that are applicable to KMC as well as to broader reproductive, maternal, neonatal and child health programmes.
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Affiliation(s)
- Krishnamurthy Jayanna
- Karnataka Health Promotion Trust Bangalore India
- M S Ramaiah University of Applied Sciences Bangalore India
| | - Suman Rao
- Department of Neonatology St John’s Medical College and Hospital St John’s National Academy of Health Sciences Bangalore India
- Division of Epidemiology, Biostatistics & Population Health St John’s Research Institute St John’s National Academy of Health Sciences Bangalore India
| | - Arin Kar
- Karnataka Health Promotion Trust Bangalore India
| | | | - Tinku Thomas
- Division of Epidemiology, Biostatistics & Population Health St John’s Research Institute St John’s National Academy of Health Sciences Bangalore India
| | | | - Maryann Washington
- Division of Epidemiology, Biostatistics & Population Health St John’s Research Institute St John’s National Academy of Health Sciences Bangalore India
| | - A Rao Shashidhar
- Department of Neonatology St John’s Medical College and Hospital St John’s National Academy of Health Sciences Bangalore India
| | | | | | | | | | - Prem Mony
- Division of Epidemiology, Biostatistics & Population Health St John’s Research Institute St John’s National Academy of Health Sciences Bangalore India
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18
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Dunbar W, Alcide Jean-Pierre MC, Pétion JS, Labat A, Maulet N, Coppieters Y. A realist evaluation of the continuum of HIV services for men who have sex with men. AIDS Res Ther 2021; 18:67. [PMID: 34627315 PMCID: PMC8502381 DOI: 10.1186/s12981-021-00396-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022] Open
Abstract
Background Men who have Sex with Men (MSM) represent the risk group that are disproportionately most affected by the human immunodeficiency virus (HIV) and continue to drop-off from the steps of the continuum of HIV services that have been adopted to overcome poor engagement and retention in care. This realist evaluation aimed at: (1) describing the evaluation carried out in Haiti aiming to ascertain why, how and under which circumstances MSM are linked and retained along the continuum, (2) assessing the outcomes of this approach and (3) exploring the motivators and facilitators for the HIV continuum of services through mechanisms and pathways. Methods Guided by a realist approach, first, an initial program theory (IPT) was developed based on literature and frameworks review, participant observations and discussions with stakeholders. Then, the IPT was tested using a mixed method explanatory study: a quantitative phase to build the continuum from a cross-sectional analysis, and a qualitative phase to explore the motivators and facilitators related to proper linkages along the continuum. Finally, the IPT was refined by eliciting the mechanisms and pathways for outcomes improvement. Results The results showed that the current service delivery model is suboptimal in identifying, engaging, linking and retaining MSM, resulting in loss to follow-up at every step of the continuum and failure to fully realize the health and prevention benefits of antiretroviral. However, the mechanisms through which linkages across the continuum can be improved are: self-acceptance, sense of community support and sense of comprehensive and tailored HIV services. These mechanisms are based on 10 different pathways: self-esteem, awareness and pride, perception of HIV risk, pcceptance and HIV status, addressing community stigma, strengthening of MSM organizations and community networks, societal acceptation and tolerance, stigma reduction training for healthcare providers, engagement of peers as educators and navigators and, adapted services delivery through drug dispensing points and mobile technology and financial assistance. Conclusions The study findings show that engagement, adherence and retention to the continuum of HIV service for MSM are affected by a multi-layer of factors, thus highlighting the importance of taking a comprehensive approach to improve the program.
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19
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Harris B, Ajisola M, Alam RM, Watkins JA, Arvanitis TN, Bakibinga P, Chipwaza B, Choudhury NN, Kibe P, Fayehun O, Omigbodun A, Owoaje E, Pemba S, Potter R, Rizvi N, Sturt J, Cave J, Iqbal R, Kabaria C, Kalolo A, Kyobutungi C, Lilford RJ, Mashanya T, Ndegese S, Rahman O, Sayani S, Yusuf R, Griffiths F. Mobile consulting as an option for delivering healthcare services in low-resource settings in low- and middle-income countries: A mixed-methods study. Digit Health 2021; 7:20552076211033425. [PMID: 34777849 PMCID: PMC8580492 DOI: 10.1177/20552076211033425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Remote or mobile consulting is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during coronavirus disease 2019 and beyond. We explored whether mobile consulting is a viable option for communities with minimal resources in low- and middle-income countries. METHODS We reviewed evidence published since 2018 about mobile consulting in low- and middle-income countries and undertook a scoping study (pre-coronavirus disease) in two rural settings (Pakistan and Tanzania) and five urban slums (Kenya, Nigeria and Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites) and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mobile consulting providers, and local and national decision-makers. Project advisory groups guided the study in each country. RESULTS We reviewed four empirical studies and seven reviews, analysed data from 5322 urban slum households and engaged with 424 stakeholders in rural and urban sites. Regulatory frameworks are available in each country. Mobile consulting services are operating through provider platforms (n = 5-17) and, at the community level, some direct experience of mobile consulting with healthcare workers using their own phones was reported - for emergencies, advice and care follow-up. Stakeholder willingness was high, provided challenges are addressed in technology, infrastructure, data security, confidentiality, acceptability and health system integration. Mobile consulting can reduce affordability barriers and facilitate care-seeking practices. CONCLUSIONS There are indications of readiness for mobile consulting in communities with minimal resources. However, wider system strengthening is needed to bolster referrals, specialist services, laboratories and supply chains to fully realise the continuity of care and responsiveness that mobile consulting services offer, particularly during/beyond coronavirus disease 2019.
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Affiliation(s)
| | - Motunrayo Ajisola
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Raisa Meher Alam
- Centre for Health, Population and Development, Independent University
Bangladesh, Bangladesh
| | | | | | | | - Beatrice Chipwaza
- St Francis University College of Health and Allied Sciences,
Tanzania
| | | | - Peter Kibe
- African Population and Health Research
Center, Kenya
| | - Olufunke Fayehun
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Akinyinka Omigbodun
- Department of Obstetrics and Gynaecology, Faculty of Clinical
Sciences, College of Medicine, University of Ibadan, Nigeria
| | - Eme Owoaje
- Department of Community Medicine, Faculty of Public Health, College
of Medicine, University of Ibadan, Nigeria
| | - Senga Pemba
- St Francis University College of Health and Allied Sciences,
Tanzania
| | - Rachel Potter
- Clinical Trials Unit Warwick Medical School, University of Warwick, University of Warwick, UK
| | - Narjis Rizvi
- Community Health Sciences Department, Aga Khan University, Pakistan
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King’s
College London, UK
| | | | - Romaina Iqbal
- Community Health Sciences Department, Aga Khan University, Pakistan
| | | | - Albino Kalolo
- St Francis University College of Health and Allied Sciences,
Tanzania
| | | | - Richard J Lilford
- Institute of Applied Health Research, College of Medical and Dental
Sciences, University of Birmingham, UK
| | - Titus Mashanya
- St Francis University College of Health and Allied Sciences,
Tanzania
| | - Sylvester Ndegese
- St Francis University College of Health and Allied Sciences,
Tanzania
| | - Omar Rahman
- University of Liberal Arts
Bangladesh, Bangladesh
| | - Saleem Sayani
- Aga Khan Development Network Digital Health Resource Centre (Asia
and Africa), Aga Khan University, Pakistan
| | - Rita Yusuf
- Centre for Health, Population and Development, Independent University
Bangladesh, Bangladesh
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, UK
- Centre for Health Policy, University of the Witwatersrand, South
Africa
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20
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Carnahan E, Gurley N, Asiimwe G, Chilundo B, Duber HC, Faye A, Kamya C, Mpanya G, Nagasha S, Phillips D, Salisbury N, Shearer J, Shelley K. Lessons Learned From Implementing Prospective, Multicountry Mixed-Methods Evaluations for Gavi and the Global Fund. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:771-782. [PMID: 33361241 PMCID: PMC7784079 DOI: 10.9745/ghsp-d-20-00126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/30/2020] [Indexed: 11/24/2022]
Abstract
Lessons learned from implementing evaluations for Gavi, the Vaccine Alliance and the Global Fund for AIDS, Tuberculosis, and Malaria can help inform the design and implementation of ongoing or future evaluations of complex interventions. We share 5 lessons distilled from over 7 years of experience implementing evaluations in 7 countries. Introduction: As global health programs have become increasingly complex, corresponding evaluations must be designed to assess the full complexity of these programs. Gavi and the Global Fund have commissioned 2 such evaluations to assess the full spectrum of their investments using a prospective mixed-methods approach. We aim to describe lessons learned from implementing these evaluations. Methods: This article presents a synthesis of lessons learned based on the Gavi and Global Fund prospective mixed-methods evaluations, with each evaluation considered a case study. The lessons are based on the evaluation team’s experience from over 7 years (2013–2020) implementing these evaluations. The Centers for Disease Control and Prevention Framework for Evaluation in Public Health was used to ground the identification of lessons learned. Results: We identified 5 lessons learned that build on existing evaluation best practices and include a mix of practical and conceptual considerations. The lessons cover the importance of (1) including an inception phase to engage stakeholders and inform a relevant, useful evaluation design; (2) aligning on the degree to which the evaluation is embedded in the program implementation; (3) monitoring programmatic, organizational, or contextual changes and adapting the evaluation accordingly; (4) hiring evaluators with mixed-methods expertise and using tools and approaches that facilitate mixing methods; and (5) contextualizing recommendations and clearly communicating their underlying strength of evidence. Conclusion: Global health initiatives, particularly those leveraging complex interventions, should consider embedding evaluations to understand how and why the programs are working. These initiatives can learn from the lessons presented here to inform the design and implementation of such evaluations.
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Affiliation(s)
| | | | | | | | - Herbert C Duber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.,Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Adama Faye
- Institut de Santé et Développement/University Cheikh Anta Diop, Dakar, Senegal
| | - Carol Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | - David Phillips
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Sarkies MN, Francis-Auton E, Long JC, Partington A, Pomare C, Nguyen HM, Wu W, Westbrook J, Day RO, Levesque JF, Mitchell R, Rapport F, Cutler H, Tran Y, Clay-Williams R, Watson DE, Arnolda G, Hibbert PD, Lystad R, Mumford V, Leipnik G, Sutherland K, Hardwick R, Braithwaite J. Implementing large-system, value-based healthcare initiatives: a realist study protocol for seven natural experiments. BMJ Open 2020; 10:e044049. [PMID: 33371049 PMCID: PMC7757496 DOI: 10.1136/bmjopen-2020-044049] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/27/2020] [Accepted: 11/19/2020] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Value-based healthcare delivery models have emerged to address the unprecedented pressure on long-term health system performance and sustainability and to respond to the changing needs and expectations of patients. Implementing and scaling the benefits from these care delivery models to achieve large-system transformation are challenging and require consideration of complexity and context. Realist studies enable researchers to explore factors beyond 'what works' towards more nuanced understanding of 'what tends to work for whom under which circumstances'. This research proposes a realist study of the implementation approach for seven large-system, value-based healthcare initiatives in New South Wales, Australia, to elucidate how different implementation strategies and processes stimulate the uptake, adoption, fidelity and adherence of initiatives to achieve sustainable impacts across a variety of contexts. METHODS AND ANALYSIS This exploratory, sequential, mixed methods realist study followed RAMESES II (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) reporting standards for realist studies. Stage 1 will formulate initial programme theories from review of existing literature, analysis of programme documents and qualitative interviews with programme designers, implementation support staff and evaluators. Stage 2 envisages testing and refining these hypothesised programme theories through qualitative interviews with local hospital network staff running initiatives, and analyses of quantitative data from the programme evaluation, hospital administrative systems and an implementation outcome survey. Stage 3 proposes to produce generalisable middle-range theories by synthesising data from context-mechanism-outcome configurations across initiatives. Qualitative data will be analysed retroductively and quantitative data will be analysed to identify relationships between the implementation strategies and processes, and implementation and programme outcomes. Mixed methods triangulation will be performed. ETHICS AND DISSEMINATION Ethical approval has been granted by Macquarie University (Project ID 23816) and Hunter New England (Project ID 2020/ETH02186) Human Research Ethics Committees. The findings will be published in peer-reviewed journals. Results will be fed back to partner organisations and roundtable discussions with other health jurisdictions will be held, to share learnings.
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Affiliation(s)
- Mitchell N Sarkies
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Andrew Partington
- Centre for the Health Economy, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Hoa Mi Nguyen
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Wendy Wu
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Richard O Day
- Clinical Pharmacology, St Vincents Hospital Sydney, Darlinghurst, New South Wales, Australia
- Pharmacology, University of New South Wales, Kensington, New South Wales, Australia
| | - Jean-Frederic Levesque
- Bureau of Health Information, St Leonards, New South Wales, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Kensington, New South Wales, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Henry Cutler
- Centre for the Health Economy, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Diane E Watson
- Bureau of Health Information, St Leonards, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
- University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
| | - Reidar Lystad
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - George Leipnik
- New South Wales Ministry of Health, St Leonards, New South Wales, Australia
| | - Kim Sutherland
- New South Wales Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | | | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
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De Allegri M, Brenner S, Kambala C, Mazalale J, Muula AS, Chinkhumba J, Wilhelm D, Lohmann J. Exploiting the emergent nature of mixed methods designs: insights from a mixed methods impact evaluation in Malawi. Health Policy Plan 2020; 35:102-106. [PMID: 31625554 DOI: 10.1093/heapol/czz126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2019] [Indexed: 11/13/2022] Open
Abstract
The application of mixed methods in Health Policy and Systems Research (HPSR) has expanded remarkably. Nevertheless, a recent review has highlighted how many mixed methods studies do not conceptualize the quantitative and the qualitative component as part of a single research effort, failing to make use of integrated approaches to data collection and analysis. More specifically, current mixed methods studies rarely rely on emergent designs as a specific feature of this methodological approach. In our work, we postulate that explicitly acknowledging the emergent nature of mixed methods research by building on a continuous exchange between quantitative and qualitative strains of data collection and analysis leads to a richer and more informative application in the field of HPSR. We illustrate our point by reflecting on our own experience conducting the mixed methods impact evaluation of a complex health system intervention in Malawi, the Results Based Financing for Maternal and Newborn Health Initiative. We describe how in the light of a contradiction between the initial set of quantitative and qualitative findings, we modified our design multiple times to include additional sources of quantitative and qualitative data and analytical approaches. To find an answer to the initial riddle, we made use of household survey data, routine health facility data, and multiple rounds of interviews with both healthcare workers and service users. We highlight what contextual factors made it possible for us to maintain the high level of methodological flexibility that ultimately allowed us to solve the riddle. This process of constant reiteration between quantitative and qualitative data allowed us to provide policymakers with a more credible and comprehensive picture of what dynamics the intervention had triggered and with what effects, in a way that we would have never been able to do had we kept faithful to our original mixed methods design.
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Affiliation(s)
- Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg University, INF 130.3, Sixth floor, 69120 Heidelberg, Germany
| | - Stephan Brenner
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg University, INF 130.3, Sixth floor, 69120 Heidelberg, Germany
| | - Christabel Kambala
- Environmental Health Department, The Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi
| | - Jacob Mazalale
- Department of Economics, Chancellor College, University of Malawi, P. O. Box 280, Zomba, Malawi
| | - Adamson S Muula
- College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Jobiba Chinkhumba
- College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Danielle Wilhelm
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg University, INF 130.3, Sixth floor, 69120 Heidelberg, Germany
| | - Julia Lohmann
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg University, INF 130.3, Sixth floor, 69120 Heidelberg, Germany.,Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Intersectional structural vulnerability to abusive policing among people who inject drugs: A mixed methods assessment in California's central valley. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 87:102981. [PMID: 33129133 DOI: 10.1016/j.drugpo.2020.102981] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Abusive and violent policing is an important determinant of health for people who inject drugs (PWID), which has been linked to structural vulnerability. However, further exploration of the intersectional nature of this vulnerability is warranted. California's Central Valley is a largely rural/suburban and politically conservative area, with high rates of injection drug use and overdose mortality, where rates of abusive policing of PWID have not been characterized. METHODS We assessed self-reported experiences of abusive policing using a sequential mixed-methods approach, consisting of n = 54 in-depth qualitative interviews followed by a respondent driven survey of n = 494 PWID. Qualitative conclusions were used to guide the development a novel quantitative framework to explore intersectional structural vulnerability, drawing on UpSet visualization and multivariable logistic regression. RESULTS Qualitative analysis suggests that abusive policing is not random or isolated; instead it can be understood in the context of routinized police harassment of PWID, which can escalate into physical or other forms of violence. These cycles are mediated by various forms of social disadvantage-often articulated through the frame of "looking like a drug user"-with deep connections to markers of race, class, gender, occupation and other elements of personal identity. Quantitative results confirm high frequency of abusive encounters with police, including physical violence (42%), verbal abuse (62%), sexual violence (9%), and the confiscation of new/unused syringes (39%). Females report higher rates of sexual violence and exploitation (aOR= 4.2; 95% CI: 2.1-9.0) and males report higher rates of physical violence (aOR=3.6; 95% CI: 2.4-5.6) and all other outcomes. Experiencing homelessness, having traded sex, and living in a rural zip code, are independently associated with numerous forms of police abuse. Intersectional analysis reveals clusters of individuals with highly elevated vulnerability, and in general, having a greater number of vulnerability factors was associated with increased odds of police abuse. CONCLUSIONS We find that structural vulnerability is linked-in a highly intersectional manner-with experiencing abusive police encounters among PWID in California's Central Valley. Monitoring, prevention, and response to deleterious law enforcement practices must be integrated into structural interventions to protect vulnerable groups. Reform is especially urgent in rural/suburban areas that are increasingly important focal points to reduce social and health harms associated with injection drug use.
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Aghaji A, Burchett H, Hameed S, Webster J, Gilbert C. The Technical Feasibility of Integrating Primary Eye Care Into Primary Health Care Systems in Nigeria: Protocol for a Mixed Methods Cross-Sectional Study. JMIR Res Protoc 2020; 9:e17263. [PMID: 33107837 PMCID: PMC7655465 DOI: 10.2196/17263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022] Open
Abstract
Background Approximately 90% of the 253 million blind or visually impaired people worldwide live in low- and middle-income countries. Lack of access to eye care is why most people remain or become blind. The World Health Organization Regional Office for Africa (WHO-AFRO) recently launched a primary eye care (PEC) package for sub-Saharan Africa—the WHO-AFRO PEC package—for integration into the health system at the primary health care (PHC) level. This has the potential to increase access to eye care, but feasibility studies are needed to determine the extent to which the health system has the capacity to deliver the package in PHC facilities. Objective Our objective is to assess the technical feasibility of integrating the WHO-AFRO PEC package in PHC facilities in Nigeria. Methods This study has several components, which include (1) a literature review of PEC in sub-Saharan Africa, (2) a Delphi exercise to reach consensus among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it in PHC facilities, (3) development of PEC technical capacity assessment tools, and (4) data collection, including facility surveys and semistructured interviews with PHC staff and their supervisors and village health workers to determine the capacities available to deliver PEC in PHC facilities. Analysis will identify opportunities and the capacity gaps that need to be addressed to deliver PEC. Results Consensus was reached among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it as part of PHC. Quantitative tools (ie, structured questionnaires, in-depth interviews, and observation checklists) and topic guides based on agreed-upon technical capacities have been developed and relevant stakeholders have been identified. Surveys in 48 PHC facilities and interviews with health professionals and supervisors have been undertaken. Capacity gaps are being analyzed. Conclusions This study will determine the capacity of PHC centers to deliver the WHO-AFRO PEC package as an integral part of the health system in Nigeria, with identification of capacity gaps. Although capacity assessments have to be context specific, the tools and findings will assist policy makers and health planners in Nigeria and similar settings, who are considering implementing the package, in making informed choices. International Registered Report Identifier (IRRID) DERR1-10.2196/17263
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Affiliation(s)
- Ada Aghaji
- Department of Ophthalmology, College of Medicine, Enugu, Nigeria.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen Burchett
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shaffa Hameed
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jayne Webster
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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25
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Omori S, Alagon M. Polycentric governance and the provision of free healthcare services at public hospitals in the Philippines. Health Policy Plan 2020; 35:983-992. [PMID: 32754754 DOI: 10.1093/heapol/czaa053] [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] [Accepted: 05/04/2020] [Indexed: 11/14/2022] Open
Abstract
What explains the variation among public hospitals in implementing the free healthcare policy of the Philippines? We draw on Ostrom's theory of polycentric governance, which assumes that policy actors' autonomous interactions at various levels produce better policy implementation when managing the provision of public goods. To explain the various degrees of implementation, we analyse the effects of face-to-face horizontal and vertical interactions between public hospitals and other policy actors by employing sequential explanatory mixed methods. Using originally collected survey data of public hospitals in two regions of the Philippines, we quantitatively demonstrate that the vertical interactions between hospitals and implementing agencies at local levels as well as monitoring and prompt disbursement of the costs by the implementation agency matter when seeking to enhance the delivery of free health care at public hospitals in the Philippines. We further qualitatively explore why horizontal and vertical interactions are made possible by comparing three public hospitals.
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Affiliation(s)
- Sawa Omori
- Department of Politics and International Studies, International Christian University, 3-8-10 Osawa, Mitaka, Tokyo 181-8585, Japan
| | - Marah Alagon
- Division Chief IV, Field Operations Division, PhilHealth Regional Office CAR, 19 SNOBT Building, Leonard Wood Road, 2600 Baguio City, Philippines
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26
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Cange CW, Wirtz AL, Ky-Zerbo O, Lougue M, Kouanda S, Baral S. Effects of traumatic events on sex workers' mental health and suicide intentions in Burkina Faso: a trauma-informed approach. Sex Health 2020; 16:348-357. [PMID: 31295417 DOI: 10.1071/sh17213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/12/2019] [Indexed: 11/23/2022]
Abstract
Background Data from other settings suggest that female sex workers (FSWs) are regularly exposed to violence and risks of psychological and physical trauma, although less is known about the effects of this violence. The objective of this study was to understand the experiences of violence and relationships with mental health symptomatology among FSWs. METHODS A mixed-methods design was used to explore the contexts and social perceptions of violence and mental health effects among FSW in Burkina Faso in 2013. RESULTS In all, 696 FSWs were recruited via respondent-driven sampling and enrolled in the study in Ouagadougou and Bobo-Dioulasso, Burkina Faso. Seventy participants were also recruited into qualitative research. Nearly two-thirds of quantitative respondents (61.7%) reported experiencing lifetime physical violence, of whom 77.4% reported experiencing violence after initiating sex work. Further, 40.9% of participants reported forced non-consensual sex, most of which occurred after they had started sex work (73.0%). In some cases, the male perpetrator used physical force to force non-consensual sex. Forced non-consensual sex was often without condoms. Among quantitative participants, 41.8% reported ever having feelings of depression; there was also a high prevalence of suicide ideation in this group. Qualitative participants also described feelings of depression, alienation, and suicide ideation. Some qualitative participants described using protective methods to avoid violence and to promote social protection among FSWs. CONCLUSIONS The findings suggest that stigma and physical and sexual abuse are prevalent among FSWs. Within this context of sex work, lifetime experiences of physical and sexual violence were highly correlated with self-reported mental health symptoms.
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Affiliation(s)
- Charles W Cange
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; and Department of Health Sciences, Lehman College, The City University of New York, 250 Bedford Park Boulevard, New York, NY 10468, USA; and Corresponding author.
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Odette Ky-Zerbo
- Program d'Appui au Monde Associatif et Communautaire, 11 BP 1023 CMS Ouagadougou, Burkina Faso
| | - Marcel Lougue
- Program d'Appui au Monde Associatif et Communautaire, 11 BP 1023 CMS Ouagadougou, Burkina Faso
| | - Seni Kouanda
- Program d'Appui au Monde Associatif et Communautaire, 11 BP 1023 CMS Ouagadougou, Burkina Faso
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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Friedman J, Karandinos G, Hart LK, Castrillo FM, Graetz N, Bourgois P. Structural vulnerability to narcotics-driven firearm violence: An ethnographic and epidemiological study of Philadelphia's Puerto Rican inner-city. PLoS One 2019; 14:e0225376. [PMID: 31751394 PMCID: PMC6872141 DOI: 10.1371/journal.pone.0225376] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/02/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The United States is experiencing a continuing crisis of gun violence, and economically marginalized and racially segregated inner-city areas are among the most affected. To decrease this violence, public health interventions must engage with the complex social factors and structural drivers-especially with regard to the clandestine sale of narcotics-that have turned the neighborhood streets of specific vulnerable subgroups into concrete killing fields. Here we present a mixed-methods ethnographic and epidemiological assessment of narcotics-driven firearm violence in Philadelphia's impoverished, majority Puerto Rican neighborhoods. METHODS Using an exploratory sequential study design, we formulated hypotheses about ethnic/racial vulnerability to violence, based on half a dozen years of intensive participant-observation ethnographic fieldwork. We subsequently tested them statistically, by combining geo-referenced incidents of narcotics- and firearm-related crime from the Philadelphia police department with census information representing race and poverty levels. We explored the racialized relationships between poverty, narcotics, and violence, melding ethnography, graphing, and Poisson regression. FINDINGS Even controlling for poverty levels, impoverished majority-Puerto Rican areas in Philadelphia are exposed to significantly higher levels of gun violence than majority-white or black neighborhoods. Our mixed methods data suggest that this reflects the unique social position of these neighborhoods as a racial meeting ground in deeply segregated Philadelphia, which has converted them into a retail endpoint for the sale of astronomical levels of narcotics. IMPLICATIONS We document racial/ethnic and economic disparities in exposure to firearm violence and contextualize them ethnographically in the lived experience of community members. The exceptionally concentrated and high-volume retail narcotics trade, and the violence it generates in Philadelphia's poor Puerto Rican neighborhoods, reflect unique structural vulnerability and cultural factors. For most young people in these areas, the narcotics economy is the most readily accessible form of employment and social mobility. The performance of violence is an implicit part of survival in these lucrative, illegal narcotics markets, as well as in the overcrowded jails and prisons through which entry-level sellers cycle chronically. To address the structural drivers of violence, an inner-city Marshall Plan is needed that should include well-funded formal employment programs, gun control, re-training police officers to curb the routinization of brutality, reform of criminal justice to prioritize rehabilitation over punishment, and decriminalization of narcotics possession and low-level sales.
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Affiliation(s)
- Joseph Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, CA, United States of America
- * E-mail: (PB); (JF)
| | | | - Laurie Kain Hart
- Department of Anthropology, University of California, Los Angeles, CA, United States of America
| | | | - Nicholas Graetz
- Department of Demography, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Philippe Bourgois
- Center for Social Medicine and Humanities, University of California, Los Angeles, CA, United States of America
- * E-mail: (PB); (JF)
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Chandrasekharan N. Practical Approach to Mixed Methods Research for Clinicians. Nepal J Epidemiol 2019; 9:753-754. [PMID: 31210996 PMCID: PMC6546153 DOI: 10.3126/nje.v9i1.24002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/26/2019] [Accepted: 03/22/2019] [Indexed: 11/18/2022] Open
Abstract
As a clinician, finding the time as well as the opportunity to pursue and follow research actively is usually quite challenging. Moreover, with the passage of time, a focus on developing research falls by the wayside in our emphasis on patient care and the related demands on time and energy.
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29
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Ahuja S, Gronholm PC, Shidhaye R, Jordans M, Thornicroft G. Development of mental health indicators at the district level in Madhya Pradesh, India: mixed methods study. BMC Health Serv Res 2018; 18:867. [PMID: 30453960 PMCID: PMC6245827 DOI: 10.1186/s12913-018-3695-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/08/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Strengthening routine information systems for mental health can augment scale up of community mental health services in India and other low- and middle-income countries. Currently little routine data is available in Indian settings. This study aimed to develop a core set of indicators for monitoring mental health care in primary health care settings METHODS: By using a sequential exploratory mixed methods design, key mental health indicators measuring service delivery and system performance were developed for the context of Madhya Pradesh, India. The research design involved a situation analysis, and conducting a prioritisation exercise and consultation workshops with key stakeholders. RESULTS This study resulted in nine key mental health indicators covering both mental health service delivery indicators and mental health system indicators for Sehore district of Madhya Pradesh. Mean indicator priority scores ranging from 4.48 to 3.78 were reported. CONCLUSIONS This study demonstrated a phased approach to strengthen routine information systems for mental health at a primary care level in India. We recommend that similar research methods can be applied across comparable settings and these indicators can be adopted as a part of national routine information systems.
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Affiliation(s)
- Shalini Ahuja
- Centre for Implementation Science, H3.08 Health Services and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - Petra C. Gronholm
- Centre for Implementation Science, H3.08 Health Services and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
- Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, UK
| | | | - Mark Jordans
- Centre for Implementation Science, H3.08 Health Services and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - Graham Thornicroft
- Centre for Implementation Science, H3.08 Health Services and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
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30
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Hart J, Furber C, Chisholm A, Aspinall S, Lucas C, Runswick E, Mann K, Peters S. A mixed methods investigation of an online intervention to facilitate student midwives' engagement in effective conversations about weight-related behaviour change with pregnant women. Midwifery 2018; 63:52-59. [PMID: 29803013 DOI: 10.1016/j.midw.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/04/2018] [Accepted: 05/01/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE (1) To identify whether an online training intervention could increase midwifery students' knowledge of behaviour change techniques (BCTs) and intentions to use them in practice. (2) To identify students' views and current experiences of talking to women about weight-related behaviour change. DESIGN Mixed methods study involving pre- and post-training assessments, and qualitative interviews with midwifery students. SETTING Online training course delivered at a University in the North of England, UK. PARTICIPANTS Midwifery students in the third year of their undergraduate degree during 2015-2016. INTERVENTION Online training focused on equipping students with knowledge of theoretically-informed BCTs, and the skills to use them opportunistically in existing practice settings. MEASUREMENTS Likelihood of discussing obesity with women was assessed via a 12-item, 7-point Likert scale assessing students' attitudes, subjective norms, perceived behavioural control, and intentions. A 14-item checklist was used to assess BCT knowledge whereby students selected recognised BCTs (of 7 correct, 7 false). Students' views and experiences of current practice was explored through in-depth, semi-structured one-on-one interviews with a member of the research team. FINDINGS Students' subjective norms, perceived behavioural control, and knowledge of BCTs increased post-training but intention and attitudes did not. Interviews revealed three themes accounting for students experiences and views of behaviour change practice: (1) 'How training fits with current encounters with maternal obesity in midwifery training' (2) 'TEnT PEGS prepares students for practice', and (3) 'Value of tailored training'. KEY CONCLUSIONS Online BCT training can improve the midwifery students' confidence, knowledge and beliefs that this is part of their role. They also reported finding the training helpful in better preparing them for this challenging element of their routine practice. IMPLICATIONS FOR PRACTICE Online BCT training can be used to prepare undergraduate midwifery students for practice.
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Affiliation(s)
- Jo Hart
- Division of Medical Education, University of Manchester, Oxford Rd, Manchester M13 9PT, United Kingdom.
| | - Christine Furber
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester M13 9PT, United Kingdom.
| | - Anna Chisholm
- Department of Psychological Sciences, University of Liverpool, Liverpool L69 3BX, United Kingdom.
| | - Samantha Aspinall
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PT, United Kingdom.
| | - Charlotte Lucas
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PT, United Kingdom.
| | - Emma Runswick
- Division of Medical Education, University of Manchester, Manchester M13 9PT, United Kingdom.
| | | | - Sarah Peters
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PT, United Kingdom.
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31
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Mackintosh M, Mugwagwa J, Banda G, Tibandebage P, Tunguhole J, Wangwe S, Karimi Njeru M. Health-industry linkages for local health: reframing policies for African health system strengthening. Health Policy Plan 2018; 33:602-610. [PMID: 29562286 PMCID: PMC5894083 DOI: 10.1093/heapol/czy022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2018] [Indexed: 12/15/2022] Open
Abstract
The benefits of local production of pharmaceuticals in Africa for local access to medicines and to effective treatment remain contested. There is scepticism among health systems experts internationally that production of pharmaceuticals in sub-Saharan Africa (SSA) can provide competitive prices, quality and reliability of supply. Meanwhile low-income African populations continue to suffer poor access to a broad range of medicines, despite major international funding efforts. A current wave of pharmaceutical industry investment in SSA is associated with active African government promotion of pharmaceuticals as a key sector in industrialization strategies. We present evidence from interviews in 2013-15 and 2017 in East Africa that health system actors perceive these investments in local production as an opportunity to improve access to medicines and supplies. We then identify key policies that can ensure that local health systems benefit from the investments. We argue for a 'local health' policy perspective, framed by concepts of proximity and positionality, which works with local priorities and distinct policy time scales and identifies scope for incentive alignment to generate mutually beneficial health-industry linkages and strengthening of both sectors. We argue that this local health perspective represents a distinctive shift in policy framing: it is not necessarily in conflict with 'global health' frameworks but poses a challenge to some of its underlying assumptions.
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Affiliation(s)
- Maureen Mackintosh
- Faculty of Arts and Social Sciences, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK
| | - Julius Mugwagwa
- Department of Science, Technology, Engineering and Public Policy, University College London, London W1T 6EY, UK
| | - Geoffrey Banda
- Science, Technology and Innovation Studies, University of Edinburgh, Edinburgh EH1 1LZ, UK
| | | | - Jires Tunguhole
- Economic and Social Research Foundation, Dar es Salaam, Tanzania
| | - Samuel Wangwe
- Economic and Social Research Foundation, Dar es Salaam, Tanzania
| | - Mercy Karimi Njeru
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
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De Allegri M, Sieleunou I, Abiiro GA, Ridde V. How far is mixed methods research in the field of health policy and systems in Africa? A scoping review. Health Policy Plan 2018; 33:445-455. [PMID: 29365123 PMCID: PMC5886233 DOI: 10.1093/heapol/czx182] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 12/25/2022] Open
Abstract
Both the academic and the policy community are calling for wider application of mixed methods research, suggesting that combined use of quantitative and qualitative methods is most suitable to assess and understand the complexities of health interventions. In spite of recent growth in mixed methods studies, limited efforts have been directed towards appraising and synthetizing to what extent and how mixed methods have been applied specifically to Health Policy and Systems Research (HPSR) in low- and middle-income countries (LMICs). We aimed at filling this gap in knowledge, by exploring the scope and quality of mixed methods research in the African context. We conducted a scoping review applying the framework developed by Arksey and O'Malley and modified by Levac et al. to identify and extract data from relevant studies published between 1950 and 2013. We limited our search to peer-reviewed HPSR publications in English, which combined at least one qualitative and one quantitative method and focused on Africa. Among the 105 studies that were retained for data extraction, over 60% were published after 2010. Nearly 50% of all studies addressed topics relevant to Health Systems, while Health Policy and Health Outcomes studies accounted respectively for 40% and 10% of all publications. The quality of the application of mixed methods varied greatly across studies, with a relatively small proportion of studies stating clearly defined research questions and differentiating quantitative and qualitative elements, including sample sizes and analytical approaches. The methodological weaknesses observed could be linked to the paucity of specific training opportunities available to people interested in applying mixed methods to HPSR in LMICs as well as to the limitations on word limit, scope and peer-review processes at the journals levels. Increasing training opportunities and enhancing journal flexibility may result in more and better quality mixed methods publications.
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Affiliation(s)
- M De Allegri
- Institute of Public Health, Medical Faculty, Heidelberg University, INF 103.3, 69120 Heidelberg, Germany
| | - I Sieleunou
- IRSPUM, Preventive and Social Medicine, 7101, avenue du Parc, Montréal-Québec, H3N 1X9, Canada
- ESPUM, 7101, avenue du Parc, Montréal-Québec, H3N 1X9, Canada
| | - G A Abiiro
- Department of Planning, Faculty of Planning and Land Management, University for Development Studies, Post Office Box UPW 3, Wa, Upper West Region, Ghana
| | - V Ridde
- IRSPUM, Preventive and Social Medicine, 7101, avenue du Parc, Montréal-Québec, H3N 1X9, Canada
- IRD (French Institute For Research on sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD. 45 rue des saint Pères, 75006 Paris, France
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Walwyn DR, Nkolele AT. An evaluation of South Africa's public-private partnership for the localisation of vaccine research, manufacture and distribution. Health Res Policy Syst 2018; 16:30. [PMID: 29587777 PMCID: PMC5870219 DOI: 10.1186/s12961-018-0303-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/05/2018] [Indexed: 11/28/2022] Open
Abstract
Background Public–private partnerships (PPPs), widely used as a means of leveraging the skills, expertise and resources of the private sector to mutual advantage, were similarly adopted by South Africa to support public sector delivery. This study has evaluated one such partnership, namely the Biovac Institute, which was established in 2003 to cover vaccine research and development, manufacturing, and supply. The initiative was highly unusual given that it attempted to combine all three aspects in a single PPP. Methods The research has followed a concurrent mixed methods approach. In the quantitative study, data for prices and product volumes were extracted from secondary data sources and used to calculate the economic cost and value-for-money of the PPP. Simultaneously, a qualitative study was undertaken in which a number of key stakeholders were interviewed using a semi-structured questionnaire on their perceptions of the PPP’s value. Results The institute earns a premium on the procurement cost of a broad range of vaccines required by the South African National Department of Health for its immunisation programme, the net value of which was US$85.7 million over the period 2010 to 2014. These funds were used to finance the institute’s operations, including vaccine research, distribution and quality control. Capital expenditure to support the establishment of facilities for laboratory testing, packaging and labelling, filling, formulation and, finally, active pharmaceutical ingredient manufacture, approximately US$40 million in total, had to be secured through loans and grants. According to the respondents in the qualitative survey, the principal benefit of the PPP has been the uninterrupted supply of vaccines and the ability to respond quickly to vaccine shortages. The main disadvantages appear to have been a slow and ineffectual establishment of a vaccine manufacturing centre and, initially, a limited ability to negotiate highly competitive vaccine prices. Conclusions Overall, it is concluded that a positive value-for-money has been achieved and the institute has been of significant public benefit. Relationships of this nature can be used to achieve public health goals, but need to be realistic about timeframes, costs and the limitations of relational governance in ensuring that complex programmatic outcomes are achieved. It is recommended that a more incremental approach, with clearer contractual goals, penalties and incentives, is adopted in attempting initiatives aimed at the localisation of manufacturing technology by leveraging public procurement.
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Affiliation(s)
- David R Walwyn
- Department of Engineering and Technology Management, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa.
| | - Adolph T Nkolele
- Department of Engineering and Technology Management, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
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Mackintosh M, Tibandebage P, Karimi Njeru M, Kariuki Kungu J, Israel C, Mujinja PGM. Rethinking health sector procurement as developmental linkages in East Africa. Soc Sci Med 2018; 200:182-189. [PMID: 29421465 DOI: 10.1016/j.socscimed.2018.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/27/2017] [Accepted: 01/08/2018] [Indexed: 11/19/2022]
Abstract
Health care forms a large economic sector in all countries, and procurement of medicines and other essential commodities necessarily creates economic linkages between a country's health sector and local and international industrial development. These procurement processes may be positive or negative in their effects on populations' access to appropriate treatment and on local industrial development, yet procurement in low and middle income countries (LMICs) remains under-studied: generally analysed, when addressed at all, as a public sector technical and organisational challenge rather than a social and economic element of health system governance shaping its links to the wider economy. This article uses fieldwork in Tanzania and Kenya in 2012-15 to analyse procurement of essential medicines and supplies as a governance process for the health system and its industrial links, drawing on aspects of global value chain theory. We describe procurement work processes as experienced by front line staff in public, faith-based and private sectors, linking these experiences to wholesale funding sources and purchasing practices, and examining their implications for medicines access and for local industrial development within these East African countries. We show that in a context of poor access to reliable medicines, extensive reliance on private medicines purchase, and increasing globalisation of procurement systems, domestic linkages between health and industrial sectors have been weakened, especially in Tanzania. We argue in consequence for a more developmental perspective on health sector procurement design, including closer policy attention to strengthening vertical and horizontal relational working within local health-industry value chains, in the interests of both wider access to treatment and improved industrial development in Africa.
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Affiliation(s)
| | - Paula Tibandebage
- REPOA, 157 Mgombani Street, Regent Estate, P.O. Box 33223, Dar es Salaam, Tanzania.
| | - Mercy Karimi Njeru
- Kenya Medical Research Institute (KEMRI), Mbagathi Rd., P.O. Box 54840, Nairobi, Kenya.
| | - Joan Kariuki Kungu
- African Centre for Technology Studies (ACTS), Gigiri Court 49, P.O. Box 45917-00100, Nairobi, Kenya.
| | - Caroline Israel
- REPOA, 157 Mgombani Street, Regent Estate, P.O. Box 33223, Dar es Salaam, Tanzania.
| | - Phares G M Mujinja
- Muhimbili University of Health and Allied Sciences, United Nations Road, P.O.Box 65001, Dar es Salaam, Tanzania.
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Tsevelvaanchig U, Gouda H, Baker P, Hill PS. Role of emerging private hospitals in a post-Soviet mixed health system: a mixed methods comparative study of private and public hospital inpatient care in Mongolia. Health Policy Plan 2017; 32:476-486. [PMID: 28025323 DOI: 10.1093/heapol/czw157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 11/14/2022] Open
Abstract
Background The collapse of the Soviet Union in 1990 severely impacted the health sector in Mongolia. Limited public funding for the post-Soviet model public system and a rapid growth of poorly regulated private providers have been pressing issues for a government seeking to re-establish universal health coverage. However, the evidence available on the role of private providers that would inform sector management is very limited. This study analyses the current contribution of private hospitals in Mongolia for the improvement of accessibility of health care and efficiency. Methods We used mixed research methods. A descriptive analysis of nationally representative hospital admission records from 2013 was followed by semi-structured interviews that were carried out with purposively selected key informants (N = 45), representing the main actors in Mongolia's mixed health system. Results Private-for-profit hospitals are concentrated in urban areas, where their financial model is most viable. The result is the duplication of private and public inpatient services, both in terms of their geographical location and the range of services delivered. The combination of persistent inpatient-oriented care and perverse financial incentives that privilege admission over outpatient management, have created unnecessary health costs. The engagement of the private sector to improve population health outcomes is constrained by a series of issues of governance, regulation and financing and the failure of the state to manage the private sector as an integral part of its health system planning. Discussions/Conclusion For a mixed system like in Mongolia, a comprehensive policy and plan which defines the complementary role of private providers to optimize private public service mix is critical in the early stages of the private sector development. It further supports the importance of a system perspective that combines regulation and incentives in consistent policy, rather than an isolated approach to provide regulation.
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Mays DC, O’Neil EJ, Mworozi EA, Lough BJ, Tabb ZJ, Whitlock AE, Mutimba EM, Talib ZM. Supporting and retaining Village Health Teams: an assessment of a community health worker program in two Ugandan districts. Int J Equity Health 2017; 16:129. [PMID: 28728553 PMCID: PMC5520299 DOI: 10.1186/s12939-017-0619-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/03/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Uganda's national community health worker program involves volunteer Village Health Teams (VHTs) delivering basic health services and education. Evidence demonstrates their positive impact on health outcomes, particularly for Ugandans who would otherwise lack access to health services. Despite their impact, VHTs are not optimally supported and attrition is a growing problem. In this study, we examined the support needs and existing challenges of VHTs in two Ugandan districts and evaluated specific factors associated with long-term retention. We report on findings from a standardized survey of VHTs and exploratory interviews with key stakeholders and draw conclusions that inform efforts to strengthen and sustain community health care delivery in Uganda. METHODS A mixed-methods approach was employed through a survey of 134 individual VHT members and semi-structured interviews with six key stakeholders. Descriptive and bivariate regression analysis of quantitative survey data was performed along with thematic analysis of qualitative data from surveys and interviews. In the regression analysis, the dependent variable is 10-year anticipated longevity among VHTs, which asked respondents if they anticipate continuing to volunteer as VHTs for at least 10 more years if their current situation remains unchanged. RESULTS VHTs desire additional support primarily in the forms of money (e.g. transportation allowance) and material supplies (e.g. rubber boots). VHTs commonly report difficult working conditions and describe a lack of respect from their communities and other health workers. If their current situation remains unchanged, 57% of VHTs anticipate remaining in their posts for at least 10 years. Anticipated 10-year longevity was positively associated with stronger partnerships with local health center staff and greater ease in home visiting. CONCLUSIONS Supporting and retaining Uganda's VHTs would be enhanced by building stronger partnerships between VHTs and other health workers and regularly providing supplies and transportation allowances. Pursuing such measures would likely improve equity in access to healthcare for all Ugandans.
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Affiliation(s)
- Daniel C. Mays
- George Washington University School of Medicine & Health Sciences, 2300 Eye St. NW, Washington D.C., 20037 USA
| | | | - Edison A. Mworozi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Benjamin J. Lough
- University of Illinois at Urbana-Champaign, School of Social Work, 1010 W. Nevada Street, Urbana, IL 61801 USA
| | - Zachary J. Tabb
- Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903 USA
| | - Ashlyn E. Whitlock
- George Washington University School of Medicine & Health Sciences, 2300 Eye St. NW, Washington D.C., 20037 USA
| | | | - Zohray M. Talib
- George Washington University School of Medicine & Health Sciences, 2300 Eye St. NW, Washington D.C., 20037 USA
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Ebenso B, Huque R, Azdi Z, Elsey H, Nasreen S, Mirzoev T. Protocol for a mixed-methods realist evaluation of a health service user feedback system in Bangladesh. BMJ Open 2017; 7:e017743. [PMID: 28679679 PMCID: PMC5734574 DOI: 10.1136/bmjopen-2017-017743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Responsiveness to service users' views is a widely recognised objective of health systems. A key component of responsive health systems is effective interaction between users and service providers. Despite a growing literature on patient feedback from high-income settings, less is known about effectiveness of such systems in low-income and middle-income countries. METHODOLOGY AND ANALYSIS This paper disseminates the protocol for an 18-month 'RESPOND' project that aims to evaluate the system of collecting and responding to user feedback in Bangladesh. This mixed-method study uses a realist evaluation approach to examine user feedback systems at two Upazila health complexes in Comilla District of Bangladesh, and comprises three steps: (1) initial theory development; (2) theory validation; and (3) theory refinement and development of lessons learnt. The project also uses (1) process evaluation to understand causal mechanisms and contexts of implementation; (2) statistical analysis of patient feedback to clarify the nature of issues reported; (3) social science methods to illuminate feedback processes and user and provider experiences; and (4) health policy and systems research to clarify issues related to integration of feedback systems with quality assurance and human resource management. During data analysis, qualitative and quantitative findings will be integrated throughout to help achieve study objectives. Analysis of qualitative and quantitative data will be done using a convergent mixed-methods model, involving continuous triangulation of multiple data sets to facilitate greater understanding of the context of user feedback systems including the links with relevant policies, practices and programmes. ETHICS AND DISSEMINATION Ethics approvals were obtained from the University of Leeds and the Bangladesh Medical Research Council. All data collected for this study will be anonymised, and identifying characteristics of respondents will not appear in a final manuscript or reports. The study findings will be presented at scientific conferences and published in peer-reviewed journals.
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Affiliation(s)
- Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Rumana Huque
- ARK Foundation, Dhaka, Bangladesh
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
| | | | - Helen Elsey
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | | | - Tolib Mirzoev
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
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Zoellner J, Harris JE. Mixed-Methods Research in Nutrition and Dietetics. J Acad Nutr Diet 2017; 117:683-697. [DOI: 10.1016/j.jand.2017.01.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
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Dunphy E, Hamilton FL, Button K. Taxonomy for the Rehabilitation of Knee Conditions (TRAK), a Digital Intervention to Support the Self-Care Components of Anterior Cruciate Ligament Rehabilitation: Protocol of a Feasibility Study. JMIR Res Protoc 2016; 5:e234. [PMID: 27919864 PMCID: PMC5168535 DOI: 10.2196/resprot.6402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Rupture of the anterior cruciate ligament (ACL) is common, especially in the active population. In defining the problem of ACL rehabilitation, this study draws from the knowledge that improved self-care, strength, and fitness are associated with better outcomes. Traditional rehabilitation involves regular physiotherapy, but it is not clear what the optimal way for delivering rehabilitation is, and it varies widely across the world. Evidence for treatments are discussed in the literature, however standard length of rehabilitation and frequency of appointments are unknown. Additionally, current rehabilitation models in the National Health Service (NHS) struggle with catering to large volumes of patients and the lengthy time span over which rehabilitation is delivered. The use of eHealth (the Internet in health care) has been successful at delivering behavior change to a number of diverse patient groups. In physiotherapy, problems such as exercise compliance, exercise technique, and managing a broad program of rehabilitation and advice can be challenging. An eHealth intervention called Taxonomy for the Rehabilitation of Knee Conditions (TRAK) to support self-management and behavior change has been developed by patients and clinicians, and acceptability studies have yielded positive results. TRAK is not an exercise rehabilitation protocol; it is a tool to support ACL rehabilitation with personalized plans, prompts, and logs to help adherence and videos and instructions to improve quality and address queries. The patients have their own log-ins and can email their physiotherapist through the website. This novel platform is directly in line with current NHS England, National Institute for Health and Care Excellence, and NHS Improvement agendas that call for rehabilitation initiatives using both technology and supported self-management for patients. This study forms part of a research platform to identify a best practice model of ACL care from the literature and opinions of key stakeholders. Patients' exercise programs and duration of treatment are still based on individual needs, but use of the website may offer improved self-management and function and reduced health resource use. OBJECTIVE This is a feasibility study to establish recruitment, retention, sample size estimates, and practicality of collecting outcome measures to inform a future trial comparing the TRAK intervention, which has been rigorously designed to address the challenges of ACL rehabilitation, to usual care. METHODS This is a feasibility study comparing 2 groups: standard care and standard care plus eHealth. It will use convergent parallel mixed methods where both qualitative and quantitative data are sought for a more thorough understanding of the objectives. Primary outcomes relate to feasibility, including recruitment, retention, and usage. Secondary outcomes relate to health resource use and patient-rated outcome measures. RESULTS This research expects to establish the feasibility of a full-scale randomized controlled trial to explore whether patients who use an eHealth intervention to support ACL rehabilitation have better outcomes plus improved self-efficacy and reduced health resource use than a usual care group. CONCLUSIONS The study will provide essential information to support the development and powering of a future clinical trial of eHealth and physiotherapy for patients with ACL reconstruction in the NHS.
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Affiliation(s)
- Emma Dunphy
- EHealth Unit, Primary Care and Population Health, University College London, London, United Kingdom
| | - Fiona L Hamilton
- EHealth Unit, Primary Care and Population Health, University College London, London, United Kingdom
| | - Kate Button
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
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Ratnayake R, Ho LS, Ansumana R, Brown H, Borchert M, Miller L, Kratz T, McMahon SA, Sahr F. Improving Ebola infection prevention and control in primary healthcare facilities in Sierra Leone: a single-group pretest post-test, mixed-methods study. BMJ Glob Health 2016; 1:e000103. [PMID: 28588978 PMCID: PMC5321376 DOI: 10.1136/bmjgh-2016-000103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Accomplishing infection prevention and control (IPC) in health facilities in Sub-Saharan Africa is challenging. Owing to poor IPC, healthcare workers (HCWs) were frequently infected during Sierra Leone's Ebola epidemic. In late 2014, IPC was rapidly and nationally scaled up. We carried out workshops in sampled facilities to further improve adherence to IPC. We investigated HCW experiences and observed practice gaps, before and after the workshops. METHODS We conducted an uncontrolled, before and after, mixed-methods study in eight health facilities in Bo and Kenema Districts during December 2014 and January 2015. Quantitative methods administered to HCWs at baseline and follow-up included a survey on attitudes and self-efficacy towards IPC, and structured observations of behaviours. The intervention involved a workshop for HCWs to develop improvement plans for their facility. We analysed the changes between rounds in survey responses and behaviours. We used interviews to explore attitudes and self-efficacy throughout the study period. RESULTS HCWs described IPC as 'life-saving' and personal protective equipment (PPE) as uncomfortable for providers and frightening for patients. At baseline, self-efficacy was high (median=4/strongly agree). Responses reflecting unfavourable attitudes were low for glove use (median=1/strongly disagree, IQR, 1-2) and PPE use with ill family members (median=1, IQR, 1-2), and mixed for PPE use with ill HCWs (median=2/disagree, IQR, 1-4). Observations demonstrated consistent glove reuse and poor HCW handwashing. The maintenance of distance (RR 1.09, 95% CI 1.02 to 1.16) and patient handwashing (RR 1.19, 95% CI 1.3 to 1.25) improved to >90%. CONCLUSIONS We found favourable attitudes towards IPC and gaps in practice. Risk perceptions of HCWs and tendencies to ration PPE where chronic supply chain issues normally lead to PPE stock-outs may affect practice. As Sierra Leone's Ebola Recovery Strategy aims to make all facilities IPC compliant, socio-behavioural improvements and a secure supply chain are essential.
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Affiliation(s)
- Ruwan Ratnayake
- Health Unit, International Rescue Committee, New York, New York, USA
| | - Lara S Ho
- Health Unit, International Rescue Committee, Washington, District of Columbia, USA
| | - Rashid Ansumana
- Mercy Hospital Research Laboratory, Kulanda Town, Bo, Sierra Leone
| | - Hannah Brown
- Anthropology Department, Durham University, Durham, UK
| | - Matthias Borchert
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Laura Miller
- International Rescue Committee, Freetown, Sierra Leone
| | - Thomas Kratz
- Information Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Shannon A McMahon
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Foday Sahr
- Department of Microbiology, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Nimpagaritse M, Korachais C, Roberfroid D, Kolsteren P, Zine Eddine El Idrissi MD, Meessen B. Measuring and understanding the effects of a performance based financing scheme applied to nutrition services in Burundi-a mixed method impact evaluation design. Int J Equity Health 2016; 15:93. [PMID: 27301741 PMCID: PMC4908705 DOI: 10.1186/s12939-016-0382-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/08/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Malnutrition is a huge problem in Burundi. In order to improve the provision of services at hospital, health centre and community levels, the Ministry of Health is piloting the introduction of malnutrition prevention and care indicators within its performance based financing (PBF) scheme. Paying for units of services and for qualitative indicators is expected to enhance provision and quality of these nutrition services, as PBF has done, in Burundi and elsewhere, for several other services. METHODS This paper presents the protocol for the impact evaluation of the PBF scheme applied to malnutrition. The research design consists in a mixed methods model adopting a sequential explanatory design. The quantitative component is a cluster-randomized controlled evaluation design: among the 90 health centres selected for the study, half receive payment related to their results in malnutrition activities, while the other half get a budget allocation. Qualitative research will be carried out both during the intervention period and at the end of the quantitative evaluation. Data are collected from 1) baseline and follow-up surveys of 90 health centres and 6,480 households with children aged 6 to 23 months, 2) logbooks filled in weekly in health centres, and 3) in-depth interviews and focus group discussions. The evaluation aims to provide the best estimate of the impact of the project on malnutrition outcomes in the community as well as outputs at the health centre level (malnutrition care outputs) and to describe quantitatively and qualitatively the changes that took place (or did not take place) within health centres as a result of the program. DISCUSSION Although PBF schemes are blooming in low in-come countries, there is still a need for evidence, especially on the impact of revising the list of remunerated indicators. It is expected that this impact evaluation will be helpful for the national policy dialogue in Burundi, but it will also provide key evidence for countries with an existing PBF scheme and confronted with malnutrition problems on the appropriateness to extend the strategy to nutrition services. TRIAL REGISTRATION ClinicalTrials.gov PRS Identifier: NCT02721160; registered March 2016.
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Affiliation(s)
- Manassé Nimpagaritse
- />Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- />Institut de Recherche Santé et Société, Université Catholique de Louvain, Clos Chapelle-aux-Champs, 30 boîte 3016-1200, Bruxelles, Belgique
- />Direction de la Recherche, Institut National de Santé Publique, avenue de l’Hôpital n°3, BP 6807 Bujumbura, Burundi
| | - Catherine Korachais
- />Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- />Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Brussels, Belgium
| | - Dominique Roberfroid
- />Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Brussels, Belgium
| | | | | | - Bruno Meessen
- />Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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Mirzoev T, Etiaba E, Ebenso B, Uzochukwu B, Manzano A, Onwujekwe O, Huss R, Ezumah N, Hicks JP, Newell J, Ensor T. Study protocol: realist evaluation of effectiveness and sustainability of a community health workers programme in improving maternal and child health in Nigeria. Implement Sci 2016; 11:83. [PMID: 27268006 PMCID: PMC4896007 DOI: 10.1186/s13012-016-0443-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achievement of improved maternal and child health (MCH) outcomes continues to be an issue of international priority, particularly for sub-Saharan African countries such as Nigeria. Evidence suggests that the use of Community Health Workers (CHWs) can be effective in broadening access to, and coverage of, health services and improving MCH outcomes in such countries. METHODS/DESIGN In this paper, we report the methodology for a 5-year study which aims to evaluate the context, processes, outcomes and longer-term sustainability of a Nigerian CHW scheme. Evaluation of complex interventions requires a comprehensive understanding of intervention context, mechanisms and outcomes. The multidisciplinary and mixed-method realist approach will facilitate such evaluation. A favourable policy environment within which the study is conducted will ensure the successful uptake of results into policy and practice. A realist evaluation provides an overall methodological framework for this multidisciplinary and mixed methods research, which will be undertaken in Anambra state. The study will draw upon health economics, social sciences and statistics. The study comprises three steps: (1) initial theory development; (2) theory validation and (3) theory refinement and development of lessons learned. Specific methods for data collection will include in-depth interviews and focus group discussions with purposefully identified key stakeholders (managers, service providers and service users), document reviews, analyses of quantitative data from the CHW programme and health information system, and a small-scale survey. The impact of the programme on key output and outcome indicators will be assessed through an interrupted time-series analysis (ITS) of monthly quantitative data from health information system and programme reports. Ethics approvals for this study were obtained from the University of Leeds and the University of Nigeria. DISCUSSION This study will provide a timely and important contribution to health systems strengthening specifically within Anambra state in southeast Nigeria but also more widely across Nigeria. This paper should be of interest to researchers who are interested in adapting and applying robust methodologies for assessing complex health system interventions. The paper will also be useful to policymakers and practitioners who are interested in commissioning and engaging in such complex evaluations to inform policies and practices.
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Affiliation(s)
- Tolib Mirzoev
- Nuffield Centre for International Health and Development, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, UK
| | - Enyi Etiaba
- Health Policy Research Group & the Department of Health Administration and Management, College of Medicine, University of Nigeria Enugu-Campus, Enugu, 400001, Nigeria.
| | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, UK
| | - Benjamin Uzochukwu
- Health Policy Research Group & the Department of Health Administration and Management, College of Medicine, University of Nigeria Enugu-Campus, Enugu, 400001, Nigeria
| | - Ana Manzano
- School of Sociology and Social Policy, Social Sciences Building, University of Leeds, Leeds, UK
| | - Obinna Onwujekwe
- Health Policy Research Group & the Department of Health Administration and Management, College of Medicine, University of Nigeria Enugu-Campus, Enugu, 400001, Nigeria
| | - Reinhard Huss
- Nuffield Centre for International Health and Development, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, UK
| | - Nkoli Ezumah
- Health Policy Research Group & the Department of Health Administration and Management, College of Medicine, University of Nigeria Enugu-Campus, Enugu, 400001, Nigeria
| | - Joseph P Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, UK
| | - James Newell
- Nuffield Centre for International Health and Development, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, UK
| | - Timothy Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, UK
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Ridde V, Olivier de Sardan JP. A mixed methods contribution to the study of health public policies: complementarities and difficulties. BMC Health Serv Res 2015; 15 Suppl 3:S7. [PMID: 26559730 PMCID: PMC4652477 DOI: 10.1186/1472-6963-15-s3-s7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The use of mixed methods (combining quantitative and qualitative data) is developing in a variety of forms, especially in the health field. Our own research has adopted this perspective from the outset. We have sought all along to innovate in various ways and especially to develop an equal partnership, in the sense of not allowing any single approach to dominate. After briefly describing mixed methods, in this article we explain and illustrate how we have exploited both qualitative and quantitative methods to answer our research questions, ending with a reflective analysis of our experiment.
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Walker JG, Ofithile M, Tavolaro FM, van Wyk JA, Evans K, Morgan ER. Mixed methods evaluation of targeted selective anthelmintic treatment by resource-poor smallholder goat farmers in Botswana. Vet Parasitol 2015; 214:80-8. [PMID: 26493540 PMCID: PMC4671485 DOI: 10.1016/j.vetpar.2015.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/30/2015] [Accepted: 10/04/2015] [Indexed: 11/18/2022]
Abstract
Due to the threat of anthelmintic resistance, livestock farmers worldwide are encouraged to selectively apply treatments against gastrointestinal nematodes (GINs). Targeted selective treatment (TST) of individual animals would be especially useful for smallholder farmers in low-income economies, where cost-effective and sustainable intervention strategies will improve livestock productivity and food security. Supporting research has focused mainly on refining technical indicators for treatment, and much less on factors influencing uptake and effectiveness. We used a mixed method approach, whereby qualitative and quantitative approaches are combined, to develop, implement and validate a TST system for GINs in small ruminants, most commonly goats, among smallholder farmers in the Makgadikgadi Pans region of Botswana, and to seek better understanding of system performance within a cultural context. After the first six months of the study, 42 out of 47 enrolled farmers were followed up; 52% had monitored their animals using the taught inspection criteria and 26% applied TST during this phase. Uptake level showed little correlation with farmer characteristics, such as literacy and size of farm. Herd health significantly improved in those herds where anthelmintic treatment was applied: anaemia, as assessed using the five-point FAMACHA(©) scale, was 0.44-0.69 points better (95% confidence interval) and body condition score was 0.18-0.36 points better (95% C.I., five-point scale) in treated compared with untreated herds. Only targeting individuals in greatest need led to similar health improvements compared to treating the entire herd, leading to dose savings ranging from 36% to 97%. This study demonstrates that TST against nematodes can be implemented effectively by resource-poor farmers using a community-led approach. The use of mixed methods provides a promising system to integrate technical and social aspects of TST programmes for maximum uptake and effect.
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Affiliation(s)
- Josephine G Walker
- School of Biological Sciences, University of Bristol, Bristol Life Sciences Building, 24 Tyndall Avenue, Bristol BS8 1TQ, UK; Cabot Institute, University of Bristol, BS8 1UJ, UK; Elephants for Africa, Maun, Botswana.
| | | | - F Marina Tavolaro
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, 0110, South Africa; School of Veterinary Science, University of Bristol, Langford House, Langford, North Somerset, BS40 5DU, UK.
| | - Jan A van Wyk
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, 0110, South Africa.
| | - Kate Evans
- School of Biological Sciences, University of Bristol, Bristol Life Sciences Building, 24 Tyndall Avenue, Bristol BS8 1TQ, UK; Elephants for Africa, Maun, Botswana.
| | - Eric R Morgan
- Cabot Institute, University of Bristol, BS8 1UJ, UK; School of Veterinary Science, University of Bristol, Langford House, Langford, North Somerset, BS40 5DU, UK.
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Honda A, Vio F. Incentives for non-physician health professionals to work in the rural and remote areas of Mozambique--a discrete choice experiment for eliciting job preferences. HUMAN RESOURCES FOR HEALTH 2015; 13:23. [PMID: 25924927 PMCID: PMC4415227 DOI: 10.1186/s12960-015-0015-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 04/10/2015] [Indexed: 05/09/2023]
Abstract
BACKGROUND Successfully motivating and retaining health workers is critical for the effective performance of health systems. In Mozambique, a shortage of health care professionals and low levels of staff motivation in rural and remote areas pose challenges to the provision of equitable health care delivery. This study provides quantitative information on the job preferences of non-physician health professionals in Mozambique, examining how different aspects of jobs are valued and how health professionals might respond to policy options that would post them to district hospitals in rural areas. METHODS The study used a discrete choice experiment (DCE) to elicit the job preferences of non-physician health professionals. Data collection took place in four Mozambique provinces: Maputo City, Maputo Province, Sofala and Nampula. DCE questionnaires were administered to 334 non-physician health professionals with specialized or university training ('mid-level specialists' and N1 and N2 categories). In addition, questionnaires were administered to 123 N1 and N2 students to enable comparison of the results for those with work experience with those without and determine how new N1 and N2 graduates can be attracted to rural posts. RESULTS The results indicate that the provision of basic government housing has the greatest impact on the probability of choosing a job at a public health facility, followed by the provision of formal education opportunities and the availability of equipment and medicine at a health facility. The sub-group analysis suggests that job preferences vary according to stage of life and that incentive packages should vary accordingly. Recruitment strategies to encourage non-clinical professionals to work in rural/remote areas should also consider birthplace, as those born in rural/remote areas are more willing to work remotely. CONCLUSION The study was undertaken within an overarching project that aimed to develop incentive packages for non-physician health professionals assigned to work in remote/rural areas. Based on the DCE results, the project team, together with the Mozambique Ministry of Health, has developed a range of health workforce retention strategies focusing on the provision of housing benefits and professional development opportunities to be utilized when assigning non-physician health professionals to rural/remote areas.
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Affiliation(s)
- Ayako Honda
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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Evaluation methods used on health information systems (HISs) in Iran and the effects of HISs on Iranian healthcare: a systematic review. Int J Med Inform 2015; 84:444-53. [PMID: 25746766 DOI: 10.1016/j.ijmedinf.2015.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 02/06/2015] [Accepted: 02/08/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The most important goal of a health information system (HIS) is improvement of quality, effectiveness and efficiency of health services. To achieve this goal, health care systems should be evaluated continuously. The aim of this paper was to study the impacts of HISs in Iran and the methods used for their evaluation. METHODS We systematically searched all English and Persian papers evaluating health information systems in Iran that were indexed in SID, Magiran, Iran medex, PubMed and Embase databases until June 2013. A data collection form was designed to extract required data such as types of systems evaluated, evaluation methods and tools. RESULTS In this study, 53 out of 1103 retrieved articles were selected as relevant and reviewed by the authors. This study indicated that 28 studies used questionnaires to evaluate the system and in 27 studies the study instruments were distributed within a research population. In 26 papers the researchers collected the information by means of interviews, observations, heuristic evaluation and the review of documents and records. The main effects of the evaluated systems in health care settings were improving quality of services, reducing time, increasing accessibility to information, reducing costs and decreasing medical errors. CONCLUSION Evaluation of health information systems is central to their development and enhancement, and to understanding their effect on health and health services. Despite numerous evaluation methods available, the reviewed studies used a limited number of methods to evaluate HIS. Additionally, the studies mainly discussed the positive effects of HIS on health care services.
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Miller WL, Crabtree BF, Harrison MI, Fennell ML. Integrating mixed methods in health services and delivery system research. Health Serv Res 2014; 48:2125-33. [PMID: 24279834 DOI: 10.1111/1475-6773.12123] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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