1
|
Iqbal M, Cazaban CG, Morgan R, Bauer C, Siddiqi S. Rethinking Health Systems Responsiveness in Low- and Middle-Income Countries: Validation Study. JMIR Res Protoc 2024; 13:e59836. [PMID: 39293061 PMCID: PMC11447431 DOI: 10.2196/59836] [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: 04/23/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Health systems responsiveness (HSR) is the ability of systems to respond to legitimate non-health expectations of the population. The concept of HSR by the World Health Organization (WHO) includes respect for dignity, individual autonomy, confidentiality, prompt attention to care, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. The WHO tool is applied globally to assess HSR in low, middle, and high-income countries. OBJECTIVE We have revised the conceptual framework of HSR following a rigorous systematic review and made it specific for low- and middle-income countries (L&MICs). This study is designed to (1) run the Delphi technique to validate the upgraded conceptual framework of HSR, (2) modify and upgrade the WHO measurement tool for assessing HSR in the context of L&MICs, and (3) determine the validity of the upgraded HSR measurement tool by pilot testing it in Pakistan. METHODS The Delphi technique will be run by inviting global public health experts to provide suggestions on the domains and subdomains of HSR specific to L&MICs. Cronbach ɑ will be calculated to determine internal consistency among the participants. The upgraded HSR conceptual framework will serve as a beacon to modify the measurement tool by the research team, which will be reviewed by subject experts for refinement. The modified tool will be pilot-tested by administering it to 1128 participants from primary, secondary, and tertiary care hospitals in Rawalpindi district, Pakistan. Additionally, an "observation checklist" of HSR domains and subdomains will be completed to objectively measure the state of HSR across health care facilities. HSR assessment will be further strengthened by incorporating the perspective of hospital managers, service providers, and policy makers (ie, the supply side) as well as community leaders and representatives (ie, the demand side) through qualitative interviews. RESULTS The study was started in January 2024 and will continue until February 2025. A multidimensional approach will yield significant quantifiable information on HSR from the demand and supply sides of L&MICs. CONCLUSIONS This study will provide a conceptual understanding of HSR and a corresponding measurement tool specific to L&MICs. It will contribute to global public health literature and provide a snapshot of HSR in Rawalpindi district, Pakistan, with concrete action points for policy makers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/59836.
Collapse
Affiliation(s)
- Meesha Iqbal
- School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cecilia Ganduglia Cazaban
- School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Robert Morgan
- School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cici Bauer
- School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX, United States
| | | |
Collapse
|
2
|
Leroi I, Dolphin H, Dinh R, Foley T, Kennelly S, Kinchin I, O'Caoimh R, O'Dowd S, O'Philbin L, O'Reilly S, Trepel D, Timmons S. Navigating the future of Alzheimer's care in Ireland - a service model for disease-modifying therapies in small and medium-sized healthcare systems. BMC Health Serv Res 2024; 24:705. [PMID: 38840115 PMCID: PMC11151472 DOI: 10.1186/s12913-024-11019-7] [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: 10/02/2023] [Accepted: 04/19/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND A new class of antibody-based drug therapy with the potential for disease modification is now available for Alzheimer's disease (AD). However, the complexity of drug eligibility, administration, cost, and safety of such disease modifying therapies (DMTs) necessitates adopting new treatment and care pathways. A working group was convened in Ireland to consider the implications of, and health system readiness for, DMTs for AD, and to describe a service model for the detection, diagnosis, and management of early AD in the Irish context, providing a template for similar small-medium sized healthcare systems. METHODS A series of facilitated workshops with a multidisciplinary working group, including Patient and Public Involvement (PPI) members, were undertaken. This informed a series of recommendations for the implementation of new DMTs using an evidence-based conceptual framework for health system readiness based on [1] material resources and structures and [2] human and institutional relationships, values, and norms. RESULTS We describe a hub-and-spoke model, which utilises the existing dementia care ecosystem as outlined in Ireland's Model of Care for Dementia, with Regional Specialist Memory Services (RSMS) acting as central hubs and Memory Assessment and Support Services (MASS) functioning as spokes for less central areas. We provide criteria for DMT referral, eligibility, administration, and ongoing monitoring. CONCLUSIONS Healthcare systems worldwide are acknowledging the need for advanced clinical pathways for AD, driven by better diagnostics and the emergence of DMTs. Despite facing significant challenges in integrating DMTs into existing care models, the potential for overcoming challenges exists through increased funding, resources, and the development of a structured national treatment network, as proposed in Ireland's Model of Care for Dementia. This approach offers a replicable blueprint for other healthcare systems with similar scale and complexity.
Collapse
Affiliation(s)
- Iracema Leroi
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland.
- Global Brain Health Institute, Dublin, Ireland.
- HRB-CTN Dementia Trials Ireland, Dublin, Ireland.
| | - Helena Dolphin
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | - Rachel Dinh
- Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Tony Foley
- Department of General Practice, School of Medicine, University College Cork, Cork, Ireland
| | - Sean Kennelly
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland
- Global Brain Health Institute, Dublin, Ireland
- HRB-CTN Dementia Trials Ireland, Dublin, Ireland
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | - Irina Kinchin
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland
- Global Brain Health Institute, Dublin, Ireland
| | - Rónán O'Caoimh
- HRB-CTN Dementia Trials Ireland, Dublin, Ireland
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - Sean O'Dowd
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
- Health Service Executive's National Dementia Office, Dublin, Ireland
| | | | | | - Dominic Trepel
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland
- Global Brain Health Institute, Dublin, Ireland
| | - Suzanne Timmons
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland
- HRB-CTN Dementia Trials Ireland, Dublin, Ireland
- Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland
| |
Collapse
|
3
|
Ledford CJW, Harrison Z, Stein TL, Vikram SV, Williamson LD, Whitebloom GC, Seehusen DA. Education, trust, and likelihood to vaccinate against COVID-19 among patients with diabetes in the American South. PATIENT EDUCATION AND COUNSELING 2023; 115:107905. [PMID: 37506524 DOI: 10.1016/j.pec.2023.107905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/12/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE The purpose of this study was to explain the relationship among education, likelihood to vaccinate for COVID-19, and trust in healthcare providers among patients living with diabetes in the American South. METHODS Explanatory iterative sequential mixed methods design combined retrospective chart review, self-report surveys, and qualitative interviews. RESULTS Analysis of covariance revealed that severity of diabetes was not linked to vaccine acceptance. Overall, patients reported higher likelihood to vaccinate if their healthcare providers strongly recommend the vaccine. People with "some college" education reported lowest likelihood to vaccinate, before and after their healthcare providers' strong recommendation. Integrated analysis revealed the complexity of patient-provider trust and vaccination decisions. CONCLUSIONS In the context of COVID vaccination, particularly as conspiracy theories entered the mainstream, measures of trust in the system may be a clearer indicator of vaccine decision making than trust in personal physician. PRACTICE IMPLICATIONS The nonlinear relationship between education and likelihood to vaccinate challenges providers to talk to patients about knowledge and understanding beyond a superficial, quantitative screening question about education. Health systems and public health officials need to find strategies to build trusting relationships for patients across systems, such as community health workers.
Collapse
Affiliation(s)
- Christy J W Ledford
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
| | - Zachary Harrison
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Tao Li Stein
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Sandya V Vikram
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Grant C Whitebloom
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Dean A Seehusen
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| |
Collapse
|
4
|
Varga AI, Spehar I, Skirbekk H. Trustworthy management in hospital settings: a systematic review. BMC Health Serv Res 2023; 23:662. [PMID: 37340412 DOI: 10.1186/s12913-023-09610-5] [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: 08/29/2022] [Accepted: 05/26/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Trustful relationships play a vital role in successful organisations and well-functioning hospitals. While the trust relationship between patients and providers has been widely studied, trust relations between healthcare professionals and their supervisors have not been emphasised. A systematic literature review was conducted to map and provide an overview of the characteristics of trustworthy management in a hospital setting. METHODS We searched Web of Science, Embase, MEDLINE, APA PsycInfo, CINAHL, Scopus, EconLit, Taylor & Francis Online, SAGE Journals and Springer Link from database inception up until Aug 9, 2021. Empirical studies written in English undertaken in a hospital or similar setting and addressed trust relationships between healthcare professionals and their supervisors were included, without date restrictions. Records were independently screened for eligibility by two researchers. One researcher extracted the data and another one checked the correctness. A narrative approach, which involves textual and tabular summaries of findings, was undertaken in synthesising and analysing the data. Risk of bias was assessed independently by two researchers using two critical appraisal tools. Most of the included studies were assessed as acceptable, with some associated risk of bias. RESULTS Of 7414 records identified, 18 were included. 12 were quantitative papers and 6 were qualitative. The findings were conceptualised in two categories that were associated with trust in management, namely leadership behaviours and organisational factors. Most studies (n = 15) explored the former, while the rest (n = 3) additionally explored the latter. Leadership behaviours most commonly associated with employee's trust in their supervisors include (a) different facets of ethical leadership, such as integrity, moral leadership and fairness; (b) caring for employee's well-being conceptualised as benevolence, supportiveness and showing concern and (c) the manager's availability measured as being accessible and approachable. Additionally, four studies found that leaders' competence were related to perceptions of trust. Empowering work environments were most commonly associated with trust in management. CONCLUSIONS Ethical leadership, caring for employees' well-being, manager's availability, competence and an empowering work environment are characteristics associated with trustworthy management. Future research could explore the interplay between leadership behaviours and organisational factors in eliciting trust in management.
Collapse
Affiliation(s)
- Andreea Isabela Varga
- Department of Health Management and Health Economics, Institute of Health and Society, Medical Faculty, University of Oslo (UiO), P.O. Box 1089, Oslo, NO-0317, Norway
| | - Ivan Spehar
- Department of Health Management and Health Economics, Institute of Health and Society, Medical Faculty, University of Oslo (UiO), P.O. Box 1089, Oslo, NO-0317, Norway
- Institute of Psychology, Oslo New University College, Oslo, Norway
| | - Helge Skirbekk
- Department of Health Management and Health Economics, Institute of Health and Society, Medical Faculty, University of Oslo (UiO), P.O. Box 1089, Oslo, NO-0317, Norway.
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| |
Collapse
|
5
|
Lindström M, Pirouzifard M. Trust in regional politicians and mortality: A population-based prospective cohort study. Prev Med Rep 2023; 33:102189. [DOI: 10.1016/j.pmedr.2023.102189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/16/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023] Open
|
6
|
Understanding variation in person-centered maternity care: Results from a household survey of postpartum women in 6 regions of Ethiopia. AJOG GLOBAL REPORTS 2022; 3:100140. [PMID: 36594001 PMCID: PMC9803839 DOI: 10.1016/j.xagr.2022.100140] [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] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Effective communication, respect and dignity, and emotional support are critical for a positive childbirth experience that is responsive to the needs and preferences of women. OBJECTIVE This study evaluated the performance of a person-centered maternity care scale in a large, representative household sample of postpartum women, and it describes differences in person-centered maternity care across individuals and communities in Ethiopia. STUDY DESIGN The study used data from 2019 and 2020 from a representative sample of postpartum women in 6 regions of Ethiopia. It measured person-centered maternity care using a scale previously validated in other settings. To assess the scale validity in Ethiopia, we conducted cognitive interviews, measured internal consistency, and evaluated construct validity. Then, we fit univariable and multivariable linear regression models to test for differences in mean person-centered maternity care scores by individual and community characteristics. Lastly, multilevel modeling separated variance in person-centered maternity care scores within and between communities. RESULTS Effective communication and support of women's autonomy scored lowest among person-centered maternity care domains. Of 1575 respondents, 704 (44.7%) were never asked their permission before examinations and most said that providers rarely (n=369; 23.4%) or never (n=633; 40.2%) explained why procedures were done. Person-centered maternity care was significantly higher for women with greater wealth, more formal education, and those aged >20 years. Variation in person-centered maternity care scores between individuals within the same community (τ2=58.3) was nearly 3 times greater than variation between communities (σ2=21.2). CONCLUSION Ethiopian women reported widely varying maternity care experiences, with individuals residing within the same community reporting large differences in how they were treated by providers. Poor patient-provider communication and inadequate support of women's autonomy contributed most to poor person-centered maternity care.
Collapse
|
7
|
Hamon JK, Hoyt J, Krishnaratne S, Barbra AA, Morukileng J, Spilotros N, Mbembe M, Marcus S, Webster J. Perceptions of quality and the integrated delivery of family planning with childhood immunisation services in Kenya and Uganda. PLoS One 2022; 17:e0269690. [PMID: 35666759 PMCID: PMC9170085 DOI: 10.1371/journal.pone.0269690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
The integration of family planning (FP) with childhood immunisations is considered a promising approach to addressing postpartum women's unmet need for FP in resource limited settings. This study set out to examine client and health provider perceptions of the quality of FP services that were integrated with childhood immunisations in Kenya and Uganda. Semi-structured interviews with clients (n = 30) and health providers (n = 27) were conducted in 16 rural health facilities. Interviews centred on the respondents' experiences receiving/delivering FP services, their interactions with providers/clients, and their views on the quality of FP services. Client and provider perceptions of quality were compared through a thematic analysis of interview transcripts, and findings were synthesised using Jain and Hardee's revised FP Quality of Care Framework. Using audit data, health facility characteristics and resources were also summarised through descriptive statistics to contextualise the qualitative findings. The dignity and respect experienced by clients was central to the respondents' perceptions of quality. These two dimensions were not conceptualised as distinct facets of quality, but were instead perceived to be a product of the 1) access to needed services, 2) choice of contraceptives, 3) interpersonal communication, 4) information, and 5) confidentiality afforded to clients. Additionally, clients and providers alike believed that the integration of FP services with childhood immunisations had a positive effect on clients' access to needed services and on the confidentiality they experienced in a context where modern contraceptive use was stigmatised and where a lack of support from some husbands impeded access to FP services. Understanding clients' and providers' conceptualisation of quality is critical to the design of high quality and client-centred integrated FP services.
Collapse
Affiliation(s)
- Jessie K. Hamon
- Department of Disease Control, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Jenna Hoyt
- Department of Disease Control, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Shari Krishnaratne
- Department of Disease Control, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | | | - Job Morukileng
- International Rescue Committee Uganda, Kampala, Uganda
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Nathaly Spilotros
- International Rescue Committee US, New York, NY, United States of America
| | | | - Seth Marcus
- World Vision US, Monrovia, California, United States of America
| | - Jayne Webster
- Department of Disease Control, London School of Hygiene &Tropical Medicine, London, United Kingdom
| |
Collapse
|
8
|
Topp SM, Tully J, Cummins R, Graham V, Yashadhana A, Elliott L, Taylor S. Building patient trust in health systems: A qualitative study of facework in the context of the Aboriginal and Torres Strait Islander Health Worker role in Queensland, Australia. Soc Sci Med 2022; 302:114984. [PMID: 35523107 DOI: 10.1016/j.socscimed.2022.114984] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/06/2022] [Accepted: 04/17/2022] [Indexed: 10/18/2022]
Abstract
Healthcare services in Australia are the primary responsibility of state and territory governments, which recruit and deploy health providers in hospital and primary-care services. Among the various health professional roles, that of Aboriginal and Torres Strait Islander Health Worker (A&TSIHW) is one of only two positions that must be occupied by an Aboriginal and/or Torres Strait Islander person, carrying unique responsibility for enacting cultural brokerage and promoting cultural safety at the facility-level. Implicit to these responsibilities is the assumption that A&TSIHW will use cultural capital to build clients' trust in themselves and ultimately the broader health system. Drawing on 82 in-depth interviews including 52 with A&TSIHWs, we applied Kroegar's Facework theory to explore the structures, processes and relationships that contribute to, or inhibit, A&TISHWs' capacity and willingness to build trust (beyond themselves) in government health services in Queensland, Australia. Analysis demonstrates that despite A&TSIHWs viewing and enacting interpersonal trust-building as central to their role, structural features of the health system inhibit the development of service-users' system-level trust. Findings re-establish that health systems are not 'cultureless,' but rather, shaped by a dominant culture that privileges certain actors, types of knowledge, and modes of communication and action, which in turn influence efforts to build trust. The study demonstrates a novel theory-driven approach to exploring the interactions between behavioural and structural factors that influence the production of systems-level trust. In the context of the Queensland public health service findings highlight a disconnect between the expectations of, and support provided to A&TISHWs to engage Aboriginal and Torres Strait Islander service-users.
Collapse
Affiliation(s)
- Stephanie M Topp
- College of Public Health Medical and Vet Sciences, James Cook University, Australia; Nossal Institute for Global Health, University of Melbourne, Australia.
| | - Josslyn Tully
- Torres and Cape Hospital and Health Service, Queensland, Australia
| | - Rachel Cummins
- College of Public Health Medical and Vet Sciences, James Cook University, Australia
| | - Veronica Graham
- College of Public Health Medical and Vet Sciences, James Cook University, Australia
| | - Aryati Yashadhana
- Centre for Primary Health Care, University of New South Wales, Australia; School of Population Health, University of New South Wales, Australia; School of Social Sciences, University of New South Wales, Australia
| | - Lana Elliott
- College of Public Health Medical and Vet Sciences, James Cook University, Australia; School of Public Health and Social Work, Queensland University of Technology, Australia
| | - Sean Taylor
- NT Health, Darwin, Northern Territory, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia
| |
Collapse
|
9
|
Govender V, Topp SM, Tunçalp Ö. Rethinking trust in the context of mistreatment of women during childbirth: a neglected focus. BMJ Glob Health 2022; 7:e009490. [PMID: 35606016 PMCID: PMC9125697 DOI: 10.1136/bmjgh-2022-009490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/07/2022] [Indexed: 01/13/2023] Open
Affiliation(s)
- Veloshnee Govender
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Özge Tunçalp
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
10
|
Lindström M, Pirnouzifard M. Trust in the healthcare system and mortality: A population-based prospective cohort study in southern Sweden. SSM Popul Health 2022; 18:101109. [PMID: 35535209 PMCID: PMC9077527 DOI: 10.1016/j.ssmph.2022.101109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 11/27/2022] Open
Abstract
Aims To investigate associations between trust in the healthcare system and all-cause, cardiovascular, cancer and other causes mortality. Study design Prospective cohort study. Methods A public health questionnaire was conducted in 2008 in Scania, the southernmost part of Sweden, with a 54.1% participation rate with a postal questionnaire and three reminders. In this study 24,833 respondents were included. The baseline questionnaire study was linked to prospective 8.3-year follow-up cause-specific mortality register data. Survival (Cox) regression analyses were conducted. Results A 15.2% proportion of respondents reported very high, 59.1% rather high, and 21.7% not particularly high trust in the healthcare system, while 3.2% reported no trust at all and 0.9% did not know. The groups with rather high and not particularly high trust in the healthcare system had significantly lower all-cause mortality than the reference group with very high trust in the healthcare system. These statistically significant results remained throughout the multiple analyses, and were explained by lower cancer mortality in both the rather high and not particularly high trust respondent groups, and lower cardiovascular mortality in the not particularly high trust respondent group. No significant results were observed in the adjusted models for other causes mortality. No significant results were observed for the no trust and don't know categories in the multiple adjusted models, but these groups are small. Conclusions The results suggest a comparative advantage of moderate trust compared to very high trust in this setting of long waiting times for cancer and CVD treatment. Trust in the healthcare system and mortality was investigated. Rather high and not particularly high trust groups had lower all-cause mortality than the very high trust group. The lower mortality was mainly explained by lower cancer mortality. The lower mortality was partly explained by lower CVD mortality. The findings are associated with long-term queueing for particularly cancer treatment.
Collapse
|
11
|
Arakelyan S, Jailobaeva K, Dakessian A, Diaconu K, Caperon L, Strang A, Bou-Orm IR, Witter S, Ager A. The role of trust in health-seeking for non-communicable disease services in fragile contexts: A cross-country comparative study. Soc Sci Med 2021; 291:114473. [PMID: 34662762 PMCID: PMC8689406 DOI: 10.1016/j.socscimed.2021.114473] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 12/01/2022]
Abstract
Non-communicable diseases (NCDs) disproportionately affect people living in fragile contexts marked by poor governance and health systems struggling to deliver quality services for the benefit of all. This combination can lead to the erosion of trust in the health system, affecting health-seeking behaviours and the ability of individuals to sustain their health. In this cross-country multiple-case study, we analyse the role of trust in health-seeking for NCD services in fragile contexts. Our analysis triangulates multiple data sources, including semi-structured interviews (n = 102) and Group Model Building workshops (n = 8) with individuals affected by NCDs and health providers delivering NCD services. Data were collected in Freetown and Makeni (Sierra Leone), Beirut and Beqaa (Lebanon), and Morazán, Chalatenango and Bajo Lempa (El Salvador) between April 2018 and April 2019. We present a conceptual model depicting key dynamics and feedback loops between contextual factors, institutional, interpersonal and social trust and health-seeking pathways. Our findings signal that firstly, the way health services are delivered and experienced shapes institutional trust in health systems, interpersonal trust in health providers and future health-seeking pathways. Secondly, historical narratives about public institutions and state authorities' responses to contextual fragility drivers impact institutional trust and utilisation of services from public health institutions. Thirdly, social trust mediates health-seeking behaviour through social bonds and links between health systems and individuals affected by NCDs. Given the repeated and sustained utilisation of health services required with these chronic diseases, (re)building and maintaining trust in public health institutions and providers is a crucial task in fragile contexts. This requires interventions at community, district and national levels, with a key focus on promoting links and mutual accountability between health systems and communities affected by NCDs.
Collapse
Affiliation(s)
- Stella Arakelyan
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK.
| | - Kanykey Jailobaeva
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Arek Dakessian
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Karin Diaconu
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Lizzie Caperon
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Alison Strang
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Ibrahim R Bou-Orm
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Sophie Witter
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Alastair Ager
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK.
| |
Collapse
|
12
|
Ramsey K. Systems on the Edge: Developing Organizational Theory for the Persistence of Mistreatment in Childbirth. Health Policy Plan 2021; 37:400-415. [PMID: 34755181 DOI: 10.1093/heapol/czab135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/05/2021] [Accepted: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
Mistreatment in childbirth is institutionalized in many healthcare settings globally, causing widespread harm. Rising concern has elicited research on its prevalence and characteristics, with limited attention to developing explanatory theory. Mistreatment, a complex systemic and behavioral phenomenon, requires social science theory to explain its persistence despite official norms that promote respectful care. Diane Vaughan's normalization of organizational deviance theory from organizational sociology, emerged from studies of how things go wrong in organizations. Its multi-level framework provided an opportunity for analogical cross-case comparison to elaborate theory on mistreatment as normalized organizational deviance. To elaborate the theory, the Tanzanian public health system in the period of 2010-2015 was selected as a case. A broad Scopus search identified 4,068 articles published on the health system and maternal health in Tanzania of which 122 were selected. Data was extracted using a framework based on the theory and reviews of mistreatment in healthcare. Relationships and patterns emerged through comparative analysis across concepts and system levels and then were compared with Vaughan's theory and additional organizational theories. Analysis revealed that normalized scarcity at the macro-level combined with production pressures for biomedical care and imbalanced power-dependence altered values, structures, and processes in the health system. Meso-level actors struggled to achieve production goals with limited autonomy and resources, resulting in workarounds and informal rationing. Biomedical care was prioritized, and emotion work was rationed in provider interactions with women, which many women experienced as disrespect. Analogical comparison with another case of organizational deviance based on literature enabled a novel approach to elaborate theory. The emergent theory sheds light on opportunities to transform systems and routinize respectful care. Theory application in additional settings and exploration of other social theories is needed for further understanding of this complex problem.
Collapse
Affiliation(s)
- Kate Ramsey
- Columbia University Mailman School of Public Health, Department of Population and Family Health, 60 Haven Avenue, New York, NY 10032, USA
| |
Collapse
|
13
|
Rodrigues CF. Communicative trust in therapeutic encounters: users' experiences in public healthcare facilities and community pharmacies in Maputo, Mozambique. Soc Sci Med 2021; 291:114512. [PMID: 34717287 DOI: 10.1016/j.socscimed.2021.114512] [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: 04/30/2021] [Revised: 10/07/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022]
Abstract
Interactions between healthcare users and providers are an essential but often problematic element in therapeutic processes. In many settings worldwide, there has been a general recognition of the importance of adopting care approaches that understand patients as active agents, moving away from traditional paternalistic forms of interaction. Research shows that improving the quality of communication in therapeutic encounters fosters mutual understanding and cooperation in healthcare processes, helping to create the grounding conditions for building trusting relationships. But what are the communicative mechanisms through which trust in healthcare providers is cultivated? Going beyond the traditional 'doctor-patient' dyad analysis, and using data from a mixed-method study on medicine use in Maputo, Mozambique, this paper explores healthcare users' experiences and interpretations of their interactions with public healthcare professionals (medical doctors and prescribing nurses) and community pharmacy workers (pharmacists, technicians and other attendants). The analysis evolves around various communicative and relational aspects, emphasised by users as meaningful and underpinning different qualities of care, competence, integrity and trustworthiness. These attributes were assessed based on a combination of verbal conversation and information exchange, together with the use of other (non-verbal) situationally valued artefacts such as biomedical tools and communicative rituals performed by providers. This study shows that despite healthcare providers' different attributes of competence and authority, it is mainly their communicative performances during interactions that influence whether (symbolic) trust has the space to evolve or crystallise. Moreover, while performing certain rituals may be an effective form of communication, the lack of other (verbal and non-verbal) communicative elements during the interaction may compromise patient trust in what is being prescribed or advised. Efforts to improve the quality and responsiveness of healthcare services centred around citizens' needs should take users' perspectives into account and pay particular attention to these communicative and relational dimensions.
Collapse
Affiliation(s)
- Carla F Rodrigues
- Department of Anthropology, University of Amsterdam, Amsterdam, the Netherlands; Department of Sociology, Eduardo Mondlane University, Maputo, Mozambique.
| |
Collapse
|
14
|
Letta S, Aga F, Yadeta TA, Geda B, Dessie Y. Barriers to Diabetes Patients' Self-Care Practices in Eastern Ethiopia: A Qualitative Study from the Health Care Providers Perspective. Diabetes Metab Syndr Obes 2021; 14:4335-4349. [PMID: 34712054 PMCID: PMC8547594 DOI: 10.2147/dmso.s335731] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND All types of diabetes can damage the heart, blood vessels, eyes, kidneys, nerves and increase the overall risk of disability and premature death. Diabetes mellitus requires a range of self-care practices, scientifically recommended to control the glycemic level and maintain the patient's health. However, perceived barriers that hinder patients from fully implementing these diabetes self-care practices and obstacles have not been thoroughly explored. Therefore, this study aimed to explore the barriers to diabetes patients' self-care practices from the perspective of health care providers in two public hospitals in Harar City, Eastern Ethiopia. METHODS Researchers conducted an exploratory qualitative study among 26 health care providers working in two public hospitals from March to June 2021. The study participants were recruited from different disciplines working on diabetes care. Interviews were conducted in the Amharic language until the saturation point was reached. The interviews were tape-recorded, transcribed, and translated to English. Each transcript was read, re-read, and then exported to ATLAS.ti 7 software for coding. Field notes were used to supplement verbatim transcriptions. Initial codes were generated. The consistency between the two coders and their alignment with research questions were checked and applied to all subsequent transcripts after reached on consensus. The thematic analysis was employed in line with the primary set research question. RESULTS Researchers identified barriers to diabetes patients' self-care practices such as system, health care providers, and patient-level. These barriers were categorized under three main themes: lack of organized diabetes care services, limited collaborative care practices, and perceived lack of knowledge on self-care practices. In addition, the lack of multidisciplinary team care, lack of training for health care providers on diabetes self-care practices, and availability of laboratory tests and diabetes medication were prominent barriers. CONCLUSION Multi-level barriers to diabetes patients' self-care practices such as system, health care providers, and patients were identified. Therefore, interventions targeting proper service integration, building providers' and patients' capacity on diabetes self-care practices, and ensuring the sustainability of laboratory tests and medication supplies are essential. These interventions need to be accomplished through multi-level stakeholders' engagement and one-to-one or group interventions covering the multi-level challenges.
Collapse
Affiliation(s)
- Shiferaw Letta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fekadu Aga
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- Department of Nursing, College of Health Sciences, Madda Walabu University, Shashamene Campus, Shashamene, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
15
|
Tur-Sinai A, Barnea R, Tal O. Analyzing patient trust through the lens of hospitals managers-The other side of the coin. PLoS One 2021; 16:e0250626. [PMID: 33901238 PMCID: PMC8075209 DOI: 10.1371/journal.pone.0250626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/10/2021] [Indexed: 11/28/2022] Open
Abstract
Trust is an essential element in patient-physician relationships, yet trust is perceived differently among providers and customers exist. During January-February 2020 we examined the standpoints of medical managers and administrative directors from the private and public health hospitals on patient-physician trust, using a structured questionnaire. Thirty-six managers in public and private hospitals (24 from the public sector and 12 from the private sector) responded to the survey. Managers in the private sector rated trust higher in comparison to managers in the public sector, including trust related to patient satisfaction, professionalism and accountability. Managers from public hospitals gave higher scores to the need for patient education and shared responsibility prior to medical procedures. Administrative directors gave higher scores to various dimensions of trust and autonomy while medical managers gave higher scores to economic considerations. Trust is a fundamental component of the healthcare system and may be used to improve the provision and quality of care by analyzing standpoints and comparable continuous monitoring. Differences in position, education and training influence the perception of trust among managers in the health system. This survey may allow policy makers and opinion leaders to continue building and maintaining trust between patients and care providers.
Collapse
Affiliation(s)
- Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel
- School of Nursing, University of Rochester Medical Center, Rochester, NY, United States of America
- * E-mail:
| | - Royi Barnea
- Assuta Health Services Research Institute, Tel Aviv, Israel
| | - Orna Tal
- Shamir Medical Center (Assaf Harofeh), Be’er Ya’akov, Israel
- Israeli Center for Emerging Technologies (ICET), Tel Aviv, Israel
- Department of Management, Bar Ilan University, Ramat Gan, Israel
| |
Collapse
|
16
|
Craig BJ, Almatkyzy G, Yurashevich Y. The Influence of In-Group Membership on Trust in Health-Care Professionals in Kazakhstan. J Patient Exp 2020; 7:554-560. [PMID: 33062878 PMCID: PMC7534136 DOI: 10.1177/2374373519864827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Trust in providers is key to positive health outcomes. However, perceptions of trust in health-care professionals can vary by population. Factors beyond the immediate behaviors of health-care professionals such as group association may influence perceptions of trust. Objective: To examine the possible association of in-group membership and levels of trust in health-care professionals in Kazakhstan. Method: We used an online survey including the General Trust in Physicians scale along with demographic questions and a question regarding family members as health-care professionals. Bivariate analysis was used to compare the mean differences between general levels of trust and sociodemographic characteristics. Then multivariate analysis was conducted to examine the association between having a family member who is a health-care professional and general level of trust in health-care professionals among Kazakhstani citizens. Statistical tests were 2-sided. Results: A total of 497 Kazakhstani participants completed the survey. In adjusted multivariate regression, participants with family members as health-care professionals scored significantly higher on the trust scale (P < .001), and other factors such as language (P < .001) and interaction term of language and education (P< .05) were also shown to be influential in the general level of trust. Conclusion: Further examinations of how group membership influences reported trust levels in health-care professionals in Kazakhstan are warranted. Such studies would be beneficial if trust in health-care professionals is to be understood and improved in order to achieve more desirable health outcomes.
Collapse
Affiliation(s)
- Brett J Craig
- Liberal Arts Department, St Louis College of Pharmacy, St Louis, MO, USA
| | - Gulaiim Almatkyzy
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Yuliya Yurashevich
- Communication Department, College of Letters and Science, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| |
Collapse
|
17
|
Aberese-Ako M, Magnussen P, Gyapong M, Ampofo GD, Tagbor H. Managing intermittent preventive treatment of malaria in pregnancy challenges: an ethnographic study of two Ghanaian administrative regions. Malar J 2020; 19:347. [PMID: 32977827 PMCID: PMC7519547 DOI: 10.1186/s12936-020-03422-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/20/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Malaria in pregnancy (MiP) is an important public health problem across sub-Saharan Africa. The package of measures for its control in Ghana in the last 20 years include regular use of long-lasting insecticide-treated bed nets (LLINs), directly-observed administration (DOT) of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) and prompt and effective case management of MiP. Unfortunately, Ghana like other sub-Saharan African countries did not achieve the reset Abuja targets of 100% of pregnant women having access to IPTp and 100% using LLINs by 2015. METHODS This ethnographic study explored how healthcare managers dealt with existing MiP policy implementation challenges and the consequences on IPTp-SP uptake and access to maternal healthcare. The study collected date using non-participant observations, conversations, in-depth interviews and case studies in eight health facilities and 12 communities for 12 months in two Administrative regions in Ghana. RESULTS Healthcare managers addressed frequent stock-outs of malaria programme drugs and supplies from the National Malaria Control Programme and delayed reimbursement from the NHIS, by instituting co-payment, rationing and prescribing drugs for women to buy from private pharmacies. This ensured that facilities had funds to pay creditors, purchase drugs and supplies for health service delivery. However, it affected their ability to enforce DOT and to monitor adherence to treatment. Women who could afford maternal healthcare and MiP services and those who had previously benefitted from such services were happy to access uninterrupted services. Women who could not maternal healthcare services resorted to visiting other sources of health care, delaying ANC and skipping scheduled ANC visits. Consequently, some clients did not receive the recommended 5 + doses of SP, others did not obtain LLINs early and some did not obtain treatment for MiP. Healthcare providers felt frustrated whenever they could not provide comprehensive care to women who could not afford comprehensive maternal and MiP care. CONCLUSION For Ghana to achieve her goal of controlling MiP, the Ministry of Health and other supporting institutions need to ensure prompt reimbursement of funds, regular supply of programme drugs and medical supplies to public, faith-based and private health facilities.
Collapse
Affiliation(s)
| | - Pascal Magnussen
- Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Margaret Gyapong
- University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| | - Gifty D Ampofo
- University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| | - Harry Tagbor
- University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| |
Collapse
|
18
|
Stasiulis E, Gibson BE, Webster F, Boydell KM. Resisting governance and the production of trust in early psychosis intervention. Soc Sci Med 2020; 253:112948. [PMID: 32244151 DOI: 10.1016/j.socscimed.2020.112948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/15/2020] [Accepted: 03/19/2020] [Indexed: 01/17/2023]
Abstract
Trust is vital in mental healthcare where uncertainty and risk prevail and where relationship building is central to effective service delivery. Despite its significance, research on trust, particularly among multi-disciplinary healthcare teams and between service providers and users is limited and explored only tangentially within early psychosis intervention (EPI) programs. An institutional ethnographic approach is used to examine how trust within an EPI setting is produced and operates. Drawing on participant observation, textual analysis of clinic documents and in-depth interviews with 27 participants (staff, young people and family members), our analysis outlines how the clinic manager's and staff's resistance to hospital rulings that impeded EPI policy principles were part of the extended sequence of activities that produced trust. These acts of resistance, alongside the clinic manager's reflective leadership practices, cultivated spaces for staff to take risks, share their ideas and build consensus - culminating in staff-designed protocols that produced trust among one another, and between service providers and young people and their families. Drawing from Brown and Calnan's framework of "vicious" and "virtuous" cycles of (dis)trust, we highlight how management and staff responses to vulnerability and uncertainty generated trust through their communication practices and knowledge sharing. We also suggest that protocols to manage the risk of medication non-adherence and treatment dis-engagement among young people contained regulatory functions, pointing to the complex interplay of trust, control and risk. Study implications suggest shifting the emphasis from risk management and quality governance as an organizing framework in mental health to a framework based on trust.
Collapse
Affiliation(s)
- Elaine Stasiulis
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada; Institute of Medical Science, University of Toronto, 1 King's Circle, Toronto, Ontario, M5S 3K1, Canada.
| | - Barbara E Gibson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, Ontario, M4G 1R8, Canada; Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - Fiona Webster
- Arthur Labatt Family School of Nursing, Western University, FIMS and Nursing Building, London, Ontario, N6A 5B9, Canada
| | - Katherine M Boydell
- Black Dog Institute, Hospital Road, Randwick, New South Wales, NSW 2031, Australia; Institute of Medical Science, University of Toronto, 1 King's Circle, Toronto, Ontario, M5S 3K1, Canada
| |
Collapse
|
19
|
AlRuthia Y, Sales I, Almalag H, Alwhaibi M, Almosabhi L, Albassam AA, Alharbi FA, Bashatah A, Asiri Y. The Relationship Between Health-Related Quality of Life and Trust in Primary Care Physicians Among Patients with Diabetes. Clin Epidemiol 2020; 12:143-151. [PMID: 32104098 PMCID: PMC7008194 DOI: 10.2147/clep.s236952] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/20/2020] [Indexed: 01/10/2023] Open
Abstract
Background Trust is pivotal for a productive relationship between patients and healthcare providers and is positively correlated with multiple clinical and humanistic outcomes. However, the impact of trust in healthcare providers on different domains of health-related quality of life (HRQoL) among diabetic patients has not been studied in detail. Purpose The aim of this study was to examine the association between the physical, mental or psychological, social, and environmental domains of HRQoL with the patients’ trust in their primary care physicians while controlling for several sociodemographic and clinical factors. The study was conducted among a sample of diabetic patients. Patients and Methods This study had a prospective questionnaire-based, multi-center, cross-sectional design. The patients were recruited from three public hospitals in Saudi Arabia. Patients’ experiences and trust in their primary care physicians were assessed using the Health Care Relationship Trust (HCR-Trust) scale. HRQoL was assessed using the Arabic version of the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Multiple linear regression was conducted to assess the relationship between HCR-Trust and the WHOQOL-BREF physical, psychological, social, and environmental domains controlling for age, Charlson Comorbidity Index (CCI) score, health literacy, sex, education, annual income, nationality, and illness duration. Results Three hundred and sixty-four patients participated in the study. The scores in all four domains of WHOQOL-BREF were positively associated with HCR-Trust scores of the diabetic patients. Additionally, the scores in the physical (β = −10.26; 95% CI: −13.77 to −6.74; P < 0.0001) and psychological (β = −3.91; 95% CI: −7.44 to −0.38; P < 0.0001) domains were negatively associated with female gender. Furthermore, the physical domain score was negatively associated with the duration of illness (β = −0.26; 95% CI: −0.506 to −0.02; P = 0.032). The environmental domain score was positively associated with annual income (β = 2.31; 95% CI: 1.05 to 3.56; P = 0.030). Other patient characteristics, such as age and education, were not associated with the scores of any of the WHOQOL-BREF domains. Conclusion Patient trust in healthcare providers is positively associated with different domains of HRQoL. Therefore, building and maintaining trust with patients is important to achieve favorable treatment outcomes.
Collapse
Affiliation(s)
- Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Sales
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Haya Almalag
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Latifa Almosabhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed A Albassam
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | | | - Adel Bashatah
- Department of Nursing Education and Administration, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Yousif Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
20
|
Lazzari C, Kotera Y, Thomas H. Social Network Analysis of Dementia Wards in Psychiatric Hospitals to Explore the Advancement of Personhood in Patients with Alzheimer's Disease. Curr Alzheimer Res 2019; 16:505-517. [PMID: 31195945 PMCID: PMC6806538 DOI: 10.2174/1567205016666190612160955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/27/2019] [Accepted: 04/29/2019] [Indexed: 11/22/2022]
Abstract
Background: Little is known on investigating how healthcare teams in dementia wards act for promoting personhood in persons with Alzheimer’s disease (PWA). Objective: The current research aimed to identify the social networks of dementia health carers promoting the personhood of PWA in acute or long-term dementia wards in public and private psychiatric hospitals. Methods: We used a mixed-method research approach. Ethnographic observations and two-mode Social Network Analysis (SNA) captured the role and social networks of healthcare professionals promoting PWA personhood, using SocNetv version 2.4. The social network graphs illustrated how professionals participated in PWA care by computing the degree of centrality (%DC) for each professional; higher values indicated more statistical significance of a professional role compared to others in the provision of personhood care. The categories of personhood were biological, individual, and sociologic. Nurses, doctors, ward managers, hospital managers, clinical psychologists, occupational therapists, care coordinators, physiotherapists, healthcare assistants, and family members were observed if they were promoting PWA personhood. Results: The highest %DC in SNA in biological personhood was held by the ward nurses (36%), followed by the ward doctors (20%) and ward managers (20%). All professional roles were involved in 16% of cases in the promotion of individual personhood, while the hospital managers had the highest %DC (33%) followed by the ward managers and nurses (27%) in the sociologic personhood. Conclusion: All professional roles were deemed to promote PWA personhood in dementia wards, although some limitation exists according to the context of the assessment.
Collapse
Affiliation(s)
- Carlo Lazzari
- Centre for Health Care and Medical Education, Bristol, United Kingdom
| | - Yasuhiro Kotera
- Centre for Human Sciences Research, University of Derby, United Kingdom
| | - Hywel Thomas
- College of Human and Health Sciences, Swansea University, United Kingdom
| |
Collapse
|
21
|
Palagyi A, Marais BJ, Abimbola S, Topp SM, McBryde ES, Negin J. Health system preparedness for emerging infectious diseases: A synthesis of the literature. Glob Public Health 2019; 14:1847-1868. [PMID: 31084412 DOI: 10.1080/17441692.2019.1614645] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This review reflects on what the literature to date has taught us about how health systems of low- and middle-income countries (LMICs) respond to emerging infectious disease (EID) outbreaks. These findings are then applied to propose a conceptual framework characterising an EID prepared health system. A narrative synthesis approach was adopted to explore the key elements of LMIC health systems during an EID outbreak. Overarching themes ('core health system constructs') and sub-themes ('elements') relevant to EID preparedness were extracted from 49 peer-reviewed articles. The resulting conceptual framework recognised six core constructs: four focused on material resources and structures (i.e. system 'hardware'), including (i) Surveillance, (ii) Infrastructure and medical supplies, (iii) Workforce, and (iv) Communication mechanisms; and two focused on human and institutional relationships, values and norms (i.e. system 'software'), including (i) Governance, and (ii) Trust. The article reinforces the interconnectedness of the traditional health system building blocks to EID detection, prevention and response, and highlights the critical role of system 'software' (i.e. governance and trust) in enabling LMIC health systems to achieve and maintain EID preparedness. The review provides recommendations for refining a set of indicators for an 'optimised' health system EID preparedness tool to aid health system strengthening efforts.
Collapse
Affiliation(s)
- Anna Palagyi
- Faculty of Medicine and Health, The University of Sydney School of Public Health , Sydney , Australia.,The George Institute for Global Health, University of New South Wales , Sydney , Australia
| | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity and the Children's Hospital at Westmead, University of Sydney , Sydney , Australia
| | - Seye Abimbola
- Faculty of Medicine and Health, The University of Sydney School of Public Health , Sydney , Australia.,The George Institute for Global Health, University of New South Wales , Sydney , Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University , Townsville , Australia.,Nossal Institute for Global Health, University of Melbourne , Melbourne , Australia
| | - Emma S McBryde
- Australian Institute of Tropical Health & Medicine, James Cook University , Townsville , Australia
| | - Joel Negin
- Faculty of Medicine and Health, The University of Sydney School of Public Health , Sydney , Australia
| |
Collapse
|
22
|
Ogbuabor DC, Onwujekwe OE. Implementation of free maternal and child healthcare policies: assessment of influence of context and institutional capacity of health facilities in South-east Nigeria. Glob Health Action 2019; 11:1535031. [PMID: 30353792 PMCID: PMC6201800 DOI: 10.1080/16549716.2018.1535031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Studies examining how the capacity of health facilities affect implementation of free healthcare policies in low and middle-income countries are limited. OBJECTIVE This study describes how the context and institutional capacity of health facilities influenced implementation of the free maternal and child health programme (FMCHP) in Enugu state, South-east Nigeria. METHODS We conducted a qualitative case study at the state level and in two health districts (Isi-Uzo and Enugu Metropolis) in Enugu State. Data were collected through document review and semi-structured, in-depth interviews with policymakers (n = 16), healthcare providers (n = 16) and health facility committee leaders (n = 12) guided by an existing capacity framework and analysed using a thematic framework approach. RESULTS The findings reveal that active health facility committees, changes in provider payment process, supportive supervision, drug revolving fund, availability of medical equipment, electronic data transmission and staff sanction system enhanced the capacity of health facilities to offer free healthcare. However, ineffective decentralisation, irregular supervision and weak citizen participation limited this capacity. Uncertain provider payment, evidence of tax payment policy and a co-existing fee-exempt scheme constrained health facilities in following the FMCHP guidelines. Poor recording and reporting skills and lack of support from district officials constrained providers' adherence to claims' submission timeline. Poor funding, weak drug supply system, inadequate infrastructure and lack of participatory decision-making constrained delivery of free healthcare. Insufficient trained workforce, mission-inconsistent postings and transfers, and weak staff disciplinary system limited the human resource capacity. CONCLUSIONS Effectiveness of FMCHP at the health facility level depends on the extent of decentralisation, citizen participation, concurrent and conflictive policies, timely payment of providers, organisation of service delivery and human resources practices. Attention to these contextual and institutional factors will enhance responsiveness of health facilities, sustainability of free healthcare policies and progress towards universal health coverage.
Collapse
Affiliation(s)
- Daniel C Ogbuabor
- a Department of Health Administration and Management , University of Nigeria Enugu Campus , Enugu , Nigeria.,b Department of Health Systems and Policy , Sustainable Impact Resource Agency , Enugu , Nigeria
| | - Obinna E Onwujekwe
- a Department of Health Administration and Management , University of Nigeria Enugu Campus , Enugu , Nigeria.,c Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine , University of Nigeria Enugu Campus , Enugu , Nigeria
| |
Collapse
|
23
|
Areskoug Josefsson K, Avby G, Andersson Bäck M, Kjellström S. Workers' experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study. Scand J Prim Health Care 2018; 36:406-414. [PMID: 30259767 PMCID: PMC6381530 DOI: 10.1080/02813432.2018.1523987] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Staff experiences of healthy work environment (HWE) indicators at primary care units can assist in understanding why some primary care units function better than others. The aim of the study was to create increased understanding of how workers experienced HWE indicators at well-functioning primary care units. DESIGN Fifty in-depth interviews with staff at six primary care units in Sweden were analysed with deductive content analysis, revisiting a systematic review of HWE indicators. RESULTS The study presents additional perspectives on staff experiences of HWE indicators at well-functioning primary care units. The included primary care units (PCU) shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges. Staff at the included PCUs were encouraged to work to create and sustain a HWE, but each domain (indicator) also provided challenges that the staff and organisation needed to meet. The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work. CONCLUSIONS Both managers and staff are encouraged to actively work not only to create and sustain an HWE but also to promote organisational virtuousness, employee commitment, joy at work and to increase the performance at work, which is of benefit to staff, patients and society. Key Points Staff at well-functioning primary care units (PCUs) experienced healthy work environments The included PCUs shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges. Staff at the included PCUs were encouraged to work to create and sustain a healthy work environment, but each domain (indicator) also provided challenges that the staff and organisation needed to meet. The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work.
Collapse
Affiliation(s)
- Kristina Areskoug Josefsson
- School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden;
- CONTACT Kristina Areskoug Josefsson The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Box 1026, 551 11Jönköping, Sweden
| | - Gunilla Avby
- School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden;
| | | | - Sofia Kjellström
- School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden;
| |
Collapse
|
24
|
Topp SM, Sharma A, Chileshe C, Magwende G, Henostroza G, Moonga CN. The health system accountability impact of prison health committees in Zambia. Int J Equity Health 2018; 17:74. [PMID: 30244684 PMCID: PMC6151934 DOI: 10.1186/s12939-018-0783-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/23/2018] [Indexed: 11/21/2022] Open
Abstract
Background From 2013, the Zambian Corrections Service (ZCS) worked with partners to strengthen prison health systems and services. One component of that work led to the establishment of facility-based Prison Health Committees (PrHCs) comprising of both inmates and officers. We present findings from a nested evaluation of the impact of eight PrHCs 18 months after programme initiation. Methods In-depth-interviews were conducted with 11 government ministry and Zambia Corrections Service officials and 6 facility managers. Sixteen focus group discussions were convened separately with PrHC members (21 females and 51 males) and non-members (23 females and 46 males) in 8 facilities. Memos were generated from participant observation in workshops and meetings preceding and after implementation. We sought evidence of PrHC impact, refined with reference to Joshi’s three domains of impact for social accountability interventions – state (represented by facility-based prison officials), society (represented here by inmates), and state-society relations (represented by inmate-prison official relations). Further analysis considered how project outcomes influenced structural dimensions of power, ability and justice relating to accountability. Results Data pointed to a compelling series of short- and mid-term outcomes, with positive impact on access to, and provision of, health services across most facilities. Inmates (members and non-members) reported being empowered via a combination of improved health literacy and committee members’ newly-given authority to seek official redress for complaints and concerns. Inmates and officers described committees as improving inmate-officer relations by providing a forum for information exchange and shared decision making. Contributing factors included more consistent inmate-officer communications through committee meetings, which in turn enhanced trust and co-production of solutions to health problems. Nonetheless, long-term sustainability of accountability impacts may be undermined by permanently skewed power relations, high rates of inmate (and thus committee member) turnover, variable commitment from some officers in-charge, and the anticipated need for more oversight and resources to maintain members’ skills and morale. Conclusion Our study shows that PrHCs do have potential to facilitate improved social accountability in both state and societal domains and at their intersection, for an extremely vulnerable population. However, sustained and meaningful change will depend on a longer-term strategy that integrates structural reform and is delivered through meaningful cross-sectoral partnership.
Collapse
Affiliation(s)
- Stephanie M Topp
- Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia. .,James Cook University, College of Public Health, Medical and Veterinary Sciences, Townsville, QLD, 4810, Australia.
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia.,Department of Global Health, University of Washington, Harris Hydraulics Laboratory, Box 357965, Seattle, WA, USA
| | | | | | - German Henostroza
- Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia.,University of Alabama at Birmingham, School of Medicine, Birmingham, AL, 35233, USA
| | - Clement N Moonga
- Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia
| |
Collapse
|
25
|
Topp SM. The Lancet Global Health Commission on High Quality Health Systems-where's the complexity? LANCET GLOBAL HEALTH 2018; 5:e571. [PMID: 28495257 DOI: 10.1016/s2214-109x(17)30176-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 04/10/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4812, Australia.
| |
Collapse
|
26
|
Cubaka VK, Schriver M, Kayitare JB, Cotton P, Maindal HT, Nyirazinyoye L, Kallestrup P. 'He should feel your pain': Patient insights on patient-provider communication in Rwanda. Afr J Prim Health Care Fam Med 2018; 10:e1-e11. [PMID: 29781688 PMCID: PMC5913761 DOI: 10.4102/phcfm.v10i1.1514] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/02/2017] [Accepted: 11/09/2017] [Indexed: 12/30/2022] Open
Abstract
Background Patient–provider communication is an interpersonal interaction between a patient and a health care provider. Objective This study explored patients’ communication preferences and perceptions on what factors influence the patient–provider communication in primary health care settings in Rwanda. Methods In-depth semi-structured interviews with 15 individuals including 8 with limited literacy. A thematic inductive analysis was used. Results Patients valued communication with providers and expressed the need for interacting with caring, empathic providers who can share all the information they want and involve them in their own care. Health literacy and power issues were factors that may influence patient–provider communication. Patients with limited literacy appeared to rely highly on health care providers for making decisions about and managing their health care. Conclusion The expressed preferences, including those of patients with limited literacy, aligned well with the patient-centred care model. There were indications of a power imbalance weighing on the provider’s side. Although patients with limited literacy were reliant on providers for decision-making, they were ready to be more involved in the care, suggesting a potential for improved patient involvement even for patients with paternalistic care preferences. These patients’ insights can impact policies and curricula to optimise clinical practice. Generated knowledge will contribute to the indispensable yet underdeveloped field of health communication in sub-Saharan Africa. Practice implications Findings call for more inclusion of patient perspectives in the patient–provider encounter. This could require more training of professionals and research on the topic, both in Rwanda and in other regions.
Collapse
Affiliation(s)
- Vincent K Cubaka
- School of Medicine and Pharmacy, University of Rwanda, Rwanda; Department of Public Health, Aarhus University.
| | | | | | | | | | | | | |
Collapse
|
27
|
Topp SM, Mwamba C, Sharma A, Mukamba N, Beres LK, Geng E, Holmes CB, Sikazwe I. Rethinking retention: Mapping interactions between multiple factors that influence long-term engagement in HIV care. PLoS One 2018. [PMID: 29538443 PMCID: PMC5851576 DOI: 10.1371/journal.pone.0193641] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Failure to keep people living with HIV engaged in life-long care and treatment has serious implications for individual and population-level health. Nested within a four-province study of HIV care and treatment outcomes, we explored the dynamic role of social and service-related factors influencing retention in HIV care in Zambia. METHODS From a stratified random sample of 31 facilities, eight clinics were selected, one urban and one rural from each province. Across these sites we conducted a total of 69 in-depth interviews, including with patients (including pregnant women) engaged in-care (n = 28), disengaged from care (n = 15), engaged facility transferee (n = 12), and friends/family of deceased patients (n = 14). At the same sites we conducted 24 focus group discussions with a total of 192 lay and professional healthcare workers (HCWs). Two-day observations in each of the eight facilities helped triangulate data on operational context, provider relations and patient-provider interactions. We ordered and analysed data using an adapted version of Ewart's Social Action Theory. RESULTS Three overarching findings emerged. First, the experience of living with HIV and engaging in HIV care in Zambia is a social, not individual experience, influenced by social and gendered norms and life goals including financial stability, raising family and living stigma-free. Second, patients and their networks act collectively to negotiate and navigate HIV care. Anticipated responses from social network influenced patients' willingness to engage in care, while emotional and material support from those networks influenced individuals' capacity to remain in HIV care. Lastly, health system factors were most influential where they facilitated or undermined peoples' collective approach to health service use. Participants living with HIV reported facilitation of both their initial and continued engagement in care where services involved social networks, such as during couples testing and community outreach. Conversely, service features that were poorly aligned with respondents' social reality (e.g. workplace obligations) hindered long-term engagement. CONCLUSIONS This study moves beyond listing barriers or socio-ecological groupings, to explain how social and health systems interact to produce HIV care outcomes. Our findings challenge the implicit assumption of individual agency underpinning many retention studies to highlight the social nature of illness and healthcare utilization for HIV in Zambia. This understanding of collective action for accessing and remaining in HIV care should underpin future efforts to revise and reform HIV and potentially other chronic service models and systems.
Collapse
Affiliation(s)
- Stephanie M. Topp
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- * E-mail:
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Njekwa Mukamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K. Beres
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Elvin Geng
- School of Medicine, University of San Francisco, San Francisco, California, United States of America
| | - Charles B. Holmes
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| |
Collapse
|
28
|
Akdere M, Top M, Tekingündüz S. Examining patient perceptions of service quality in Turkish hospitals: The SERVPERF model. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2018. [DOI: 10.1080/14783363.2018.1427501] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mesut Akdere
- Department of Technology Leadership & Innovation, Purdue University, West Lafayette, IN, USA
| | - Mehmet Top
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
| | - Sabahattin Tekingündüz
- Department of Health Care Management, School of Health, Mersin University, Mersin, Turkey
| |
Collapse
|
29
|
Topp SM, Mwamba C, Sharma A, Mukamba N, Beres LK, Geng E, Holmes CB, Sikazwe I. Rethinking retention: Mapping interactions between multiple factors that influence long-term engagement in HIV care. PLoS One 2018; 13:e0193641. [PMID: 29538443 PMCID: PMC5851576 DOI: 10.1371/journal.pone.0193641&type=printable] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/13/2018] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Failure to keep people living with HIV engaged in life-long care and treatment has serious implications for individual and population-level health. Nested within a four-province study of HIV care and treatment outcomes, we explored the dynamic role of social and service-related factors influencing retention in HIV care in Zambia. METHODS From a stratified random sample of 31 facilities, eight clinics were selected, one urban and one rural from each province. Across these sites we conducted a total of 69 in-depth interviews, including with patients (including pregnant women) engaged in-care (n = 28), disengaged from care (n = 15), engaged facility transferee (n = 12), and friends/family of deceased patients (n = 14). At the same sites we conducted 24 focus group discussions with a total of 192 lay and professional healthcare workers (HCWs). Two-day observations in each of the eight facilities helped triangulate data on operational context, provider relations and patient-provider interactions. We ordered and analysed data using an adapted version of Ewart's Social Action Theory. RESULTS Three overarching findings emerged. First, the experience of living with HIV and engaging in HIV care in Zambia is a social, not individual experience, influenced by social and gendered norms and life goals including financial stability, raising family and living stigma-free. Second, patients and their networks act collectively to negotiate and navigate HIV care. Anticipated responses from social network influenced patients' willingness to engage in care, while emotional and material support from those networks influenced individuals' capacity to remain in HIV care. Lastly, health system factors were most influential where they facilitated or undermined peoples' collective approach to health service use. Participants living with HIV reported facilitation of both their initial and continued engagement in care where services involved social networks, such as during couples testing and community outreach. Conversely, service features that were poorly aligned with respondents' social reality (e.g. workplace obligations) hindered long-term engagement. CONCLUSIONS This study moves beyond listing barriers or socio-ecological groupings, to explain how social and health systems interact to produce HIV care outcomes. Our findings challenge the implicit assumption of individual agency underpinning many retention studies to highlight the social nature of illness and healthcare utilization for HIV in Zambia. This understanding of collective action for accessing and remaining in HIV care should underpin future efforts to revise and reform HIV and potentially other chronic service models and systems.
Collapse
Affiliation(s)
- Stephanie M. Topp
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- * E-mail:
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Njekwa Mukamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K. Beres
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Elvin Geng
- School of Medicine, University of San Francisco, San Francisco, California, United States of America
| | - Charles B. Holmes
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| |
Collapse
|
30
|
Mirzoev T, Kane S. What is health systems responsiveness? Review of existing knowledge and proposed conceptual framework. BMJ Glob Health 2017; 2:e000486. [PMID: 29225953 PMCID: PMC5717934 DOI: 10.1136/bmjgh-2017-000486] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/06/2017] [Accepted: 10/11/2017] [Indexed: 11/05/2022] Open
Abstract
Responsiveness is a key objective of national health systems. Responsive health systems anticipate and adapt to existing and future health needs, thus contributing to better health outcomes. Of all the health systems objectives, responsiveness is the least studied, which perhaps reflects lack of comprehensive frameworks that go beyond the normative characteristics of responsive services. This paper contributes to a growing, yet limited, knowledge on this topic. Herewith, we review the current frameworks for understanding health systems responsiveness and drawing on these, as well as key frameworks from the wider public services literature, propose a comprehensive conceptual framework for health systems responsiveness. This paper should be of interest to different stakeholders who are engaged in analysing and improving health systems responsiveness. Our review shows that existing knowledge on health systems responsiveness can be extended along the three areas. First, responsiveness entails an actual experience of people’s interaction with their health system, which confirms or disconfirms their initial expectations of the system. Second, the experience of interaction is shaped by both the people and the health systems sides of this interaction. Third, different influences shape people’s interaction with their health system, ultimately affecting their resultant experiences. Therefore, recognition of both people and health systems sides of interaction and their key determinants would enhance the conceptualisations of responsiveness. Our proposed framework builds on, and advances, the core frameworks in the health systems literature. It positions the experience of interaction between people and health system as the centrepiece and recognises the determinants of responsiveness experience both from the health systems (eg, actors, processes) and the people (eg, initial expectations) sides. While we hope to trigger further thinking on the conceptualisation of health system responsiveness, the proposed framework can guide assessments of, and interventions to strengthen, health systems responsiveness.
Collapse
Affiliation(s)
- Tolib Mirzoev
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sumit Kane
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| |
Collapse
|
31
|
Erasmus E, Gilson L, Govender V, Nkosi M. Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals. Int J Equity Health 2017; 16:164. [PMID: 28911338 PMCID: PMC5599896 DOI: 10.1186/s12939-017-0659-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/23/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This paper uses the concepts of organisational culture and organisational trust to explore the implementation of equity-oriented policies - the Uniform Patient Fee Schedule (UPFS) and Patients' Rights Charter (PRC) - in two South African district hospitals. It contributes to the small literatures on organisational culture and trust in low- and middle-income country health systems, and broader work on health systems' people-centeredness and "software". METHODS The research entailed semi-structured interviews (Hospital A n = 115, Hospital B n = 80) with provincial, regional, district and hospital managers, as well as clinical and non-clinical hospital staff, hospital board members, and patients; observations of policy implementation, organisational functioning, staff interactions and patient-provider interactions; and structured surveys operationalising the Competing Values Framework for measuring organisational culture (Hospital A n = 155, Hospital B n = 77) and Organisational Trust Inventory (Hospital A n = 185, Hospital B n = 92) for assessing staff-manager trust. RESULTS Regarding the UPFS, the hospitals' implementation approaches were similar in that both primarily understood it to be about revenue generation, granting fee exemptions was not a major focus, and considerable activity, facility management support, and provincial support was mobilised behind the UPFS. The hospitals' PRC paths diverged quite significantly, as Hospital A was more explicit in communicating and implementing the PRC, while the policy also enjoyed stronger managerial support in Hospital A than Hospital B. Beneath these experiences lie differences in how people's values, decisions and relationships influence health system functioning and in how the nature of policies, culture, trust and power dynamics can combine to create enabling or disabling micro-level implementation environments. CONCLUSIONS Achieving equity in practice requires managers to take account of "unseen" but important factors such as organisational culture and trust, which are key aspects of the organisational context that can profoundly influence policies. In addition to implementation "hardware" such as putting in place necessary staff and resources, it emphasises "software" implementation tasks such as relationship management and the negotiation of values, where equity-oriented policies might be interpreted as challenging health workers' status and values, and paying careful attention to how policies are practically framed and translated into practice, to ensure key equity aspects are not neglected.
Collapse
Affiliation(s)
- Ermin Erasmus
- Health Policy and Systems Division, School of Public Health and Family Medicine University of Cape Town, Rondebosch, South Africa
| | - Lucy Gilson
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
- Department of Global Health and Development, Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine, London, UK
| | - Veloshnee Govender
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | | |
Collapse
|
32
|
Schaaf M, Topp SM, Ngulube M. From favours to entitlements: community voice and action and health service quality in Zambia. Health Policy Plan 2017; 32:847-859. [PMID: 28369410 PMCID: PMC5448457 DOI: 10.1093/heapol/czx024] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2017] [Indexed: 11/13/2022] Open
Abstract
Social accountability is increasingly invoked as a way of improving health services. This article presents a theory-driven qualitative study of the context, mechanisms and outcomes of a social accountability program, Citizen Voice and Action (CVA), implemented by World Vision (WV) in Zambia. Primary data were collected between November 2013 and January 2014. It included in-depth interviews and focus group discussions with program stakeholders. Secondary data were used iteratively-to inform the process for primary data collection, to guide primary data analysis and to contextualize findings from the primary data. CVA positively impacted the state, society, state-society relations and development coordination at the local level. Specifically, sustained improvements in some aspects of health system responsiveness, empowered citizens, the improved provision of public goods (health services) and increased consensus on development issues appeared to flow from CVA. The central challenge described by interviewees and FGD participants was the inability of CVA to address problems that required central level input. The mechanisms that generated these outcomes included productive state-society communication, enhanced trust, and state-society co-production of priorities and the provision of services. These mechanisms were activated in the context of existing structures for state-society interaction, willing political leaders, buy-in by traditional leaders, and WV's strong reputation and access to resources. Prospective observational research in multiple contexts would shed more light on the context, mechanisms and outcomes of CVA programs. In addition to findings that are intuitive and well supported in the literature we identified new areas that are promising areas for future research. These include (1) the context of organizational reputation by the organization(s) spearheading social accountability efforts; (2) the potential relationship between social accountability efforts and making ambitious national programs operational at the frontlines of the health system and (3) the feasibility of scale up for certain types of local level responsiveness.
Collapse
Affiliation(s)
- Marta Schaaf
- Averting Maternal Death and Disability Program, Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Stephanie M. Topp
- College of Public Health, Medical & Vet Sciences, Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, 1 Townsville City, Australia
| | - Moses Ngulube
- World Vision Southern Africa Regional Office (WV SARO), Lusaka, Zambia
| |
Collapse
|
33
|
Topp SM, Chipukuma JM. How did rapid scale-up of HIV services impact on workplace and interpersonal trust in Zambian primary health centres: a case-based health systems analysis. BMJ Glob Health 2016; 1:e000179. [PMID: 28588985 PMCID: PMC5321392 DOI: 10.1136/bmjgh-2016-000179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/07/2016] [Accepted: 11/24/2016] [Indexed: 11/09/2022] Open
Abstract
Background In sub-Saharan Africa, large amounts of funding continue to be directed towards HIV-specific care and treatment, often with claims of ‘health system strengthening’ effect. Such claims rarely account for the impact on human relationships and decisions that are core to functional health systems. This research examined how establishment of externally funded HIV services influenced trusting relationships in Zambian health centres. Methods An in-depth, multicase study included four health centres selected for urban, peri-urban and rural characteristics. Case data included healthcare worker (HCW) interviews (60); patient interviews (180); direct observation of facility operations (2 weeks/centre) and key informant interviews (14) which were recorded and transcribed verbatim. Thematic analysis adopted inductive and deductive coding guided by a framework incorporating concepts of workplace trust, patient–provider trust, intrinsic and extrinsic motivation. Results HIV service scale-up impacted trust in positive and negative ways. Investment in HIV-specific infrastructure, supplies and quality assurance mechanisms strengthened workplace trust, HCW motivation and patient–provider trust in HIV departments in the short-term. In the health centres more broadly and over time, however, non-governmental organisation-led investment and support of HIV departments reinforced HCW's perceptions of the government as uninterested or unable to provide a quality work environment. Exacerbating existing perceptions of systemic workplace inequity and nepotism, uneven distribution of personal and professional opportunities related to HIV service establishment contributed to interdepartmental antagonism and reinforced workplace practices designed to protect individual HCW's interests. Conclusions Findings illustrate long-term negative effects of the vertical HIV resourcing and support structures which failed to address and sometimes exacerbated HCW (dis)trust with their own government and supervisors. The short-term and long-term effects of weakened workplace trust on HCWs' motivation and performance signal the importance of understanding how such relationships play a role in generating virtuous or perverse cycles of actor interactions, with implications for service outcomes.
Collapse
Affiliation(s)
- Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | |
Collapse
|
34
|
Watt N, Yupar A, Sender P, Campbell F, Legido-Quigley H, Howard N. Provider and service-user perspectives of volunteer health-worker service provision in Ayeyarwady Region, Myanmar: a qualitative study. BMJ Open 2016; 6:e012762. [PMID: 27940629 PMCID: PMC5168650 DOI: 10.1136/bmjopen-2016-012762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To explore perspectives and reported experiences of service users, community providers and policymakers related to volunteer health-worker services provision in a rural area of Myanmar. METHODS A qualitative interview study was conducted in rural communities with 54 service users and 17 community providers in Ayeyarwady Region, Myanmar, and with 14 national managers and policymakers in Yangon Myanmar. Topics included reasons for seeking health services, views and experiences, and comparison with experiences of other services. Data were analysed thematically using deductive and inductive coding. RESULTS Accessibility and affordability were important to all participants. Service users described the particular relevance of trust, familiarity and acceptability in choosing a provider. Perceived quality and effectiveness were necessary for trust to develop. Perceived value of volunteers was a cross-cutting dimension, which was interpreted differently by different participants. CONCLUSIONS Results suggest that volunteers are appropriate and valued, and support 'availability', 'accessibility' and 'acceptability' as dimensions of health services access in this setting. However, social complexities should be considered to ensure effective service delivery. Further research into trust-building, developing quality perceptions and resulting service-user choices would be useful to inform effective policy and planning.
Collapse
Affiliation(s)
- Nicola Watt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Aye Yupar
- Formerly Merlin Country Office, Yangon, Myanmar
- PR-GFATM, UNOPS, Yangon, Myanmar
| | - Paul Sender
- Formerly Merlin Country Office, Yangon, Myanmar
- PR-GFATM, UNOPS, Yangon, Myanmar
| | - Fiona Campbell
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Formerly Merlin Country Office, Yangon, Myanmar
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore,Singapore, Singapore
| | - Natasha Howard
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
35
|
Freedman LP. Implementation and aspiration gaps: whose view counts? Lancet 2016; 388:2068-2069. [PMID: 27642027 DOI: 10.1016/s0140-6736(16)31530-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 11/21/2022]
Affiliation(s)
- Lynn P Freedman
- Averting Maternal Death and Disability Program (AMDD), Columbia University Mailman School of Public Health, New York, NY 10032, USA.
| |
Collapse
|
36
|
Kok MC, Ormel H, Broerse JEW, Kane S, Namakhoma I, Otiso L, Sidat M, Kea AZ, Taegtmeyer M, Theobald S, Dieleman M. Optimising the benefits of community health workers' unique position between communities and the health sector: A comparative analysis of factors shaping relationships in four countries. Glob Public Health 2016; 12:1404-1432. [PMID: 27133127 DOI: 10.1080/17441692.2016.1174722] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Community health workers (CHWs) have a unique position between communities and the health sector. The strength of CHWs' relationships with both sides influences their motivation and performance. This qualitative comparative study aimed at understanding similarities and differences in how relationships between CHWs, communities and the health sector were shaped in different Sub-Saharan African settings. The study demonstrates a complex interplay of influences on trust and CHWs' relationships with their communities and actors in the health sector. Mechanisms influencing relationships were feelings of (dis)connectedness, (un)familiarity and serving the same goals, and perceptions of received support, respect, competence, honesty, fairness and recognition. Sometimes, constrained relationships between CHWs and the health sector resulted in weaker relationships between CHWs and communities. The broader context (such as the socio-economic situation) and programme context (related to, for example, task-shifting, volunteering and supervision) in which these mechanisms took place were identified. Policy-makers and programme managers should take into account the broader context and could adjust CHW programmes so that they trigger mechanisms that generate trusting relationships between CHWs, communities and other actors in the health system. This can contribute to enabling CHWs to perform well and responding to the opportunities offered by their unique intermediary position.
Collapse
Affiliation(s)
- Maryse C Kok
- a KIT Health , Royal Tropical Institute , Amsterdam , The Netherlands.,b Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University Amsterdam , Amsterdam , The Netherlands
| | - Hermen Ormel
- a KIT Health , Royal Tropical Institute , Amsterdam , The Netherlands
| | - Jacqueline E W Broerse
- b Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University Amsterdam , Amsterdam , The Netherlands
| | - Sumit Kane
- a KIT Health , Royal Tropical Institute , Amsterdam , The Netherlands
| | - Ireen Namakhoma
- c Research for Equity and Community Health (REACH) Trust , Lilongwe , Malawi
| | - Lilian Otiso
- d Research and Strategic Information Department , LVCT Health , Nairobi , Kenya
| | - Moshin Sidat
- e Department of Community Health , University Eduardo Mondlane , Maputo , Mozambique
| | | | - Miriam Taegtmeyer
- g Department of International Public Health , Liverpool School of Tropical Medicine , Liverpool , UK
| | - Sally Theobald
- g Department of International Public Health , Liverpool School of Tropical Medicine , Liverpool , UK
| | - Marjolein Dieleman
- a KIT Health , Royal Tropical Institute , Amsterdam , The Netherlands.,b Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University Amsterdam , Amsterdam , The Netherlands
| |
Collapse
|