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Pillay N, Ncube N, Moopelo K, Mothoagae G, Welte O, Shogole M, Gwiji N, Scott L, Moshani N, Tiffin N, Boulle A, Griffiths F, Fairlie L, Mehta U, LeFevre A, Scott K. Translating the consent form is the tip of the iceberg: using cognitive interviews to assess the barriers to informed consent in South African health facilities. Sex Reprod Health Matters 2023; 31:2302553. [PMID: 38277196 PMCID: PMC10823893 DOI: 10.1080/26410397.2024.2302553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
The increasing digitisation of personal health data has led to an increase in the demand for onward health data. This study sought to develop local language scripts for use in public sector maternity clinics to capture informed consent for onward health data use. The script considered five possible health data uses: 1. Sending of general health information content via mobile phones; 2. Delivery of personalised health information via mobile phones; 3. Use of women's anonymised health data; 4. Use of child's anonymised health data; and 5. Use of data for recontact. Qualitative interviews (n = 54) were conducted among women attending maternity services in three public health facilities in Gauteng and Western Cape, South Africa. Using cognitive interviewing techniques, interviews sought to:(1) explore understanding of the consent script in five South African languages, (2) assess women's understanding of what they were consenting to, and (3) improve the consent script. Multiple rounds of interviews were conducted, each followed by revisions to the consent script, until saturation was reached, and no additional cognitive failures identified. Cognitive failures were a result of: (1) words and phrases that did not translate easily in some languages, (2) cognitive mismatches that arose as a result of different world views and contexts, (3) linguistic gaps, and (4) asymmetrical power relations that influence how consent is understood and interpreted. Study activities resulted in the development of an informed consent script for onward health data use in five South African languages for use in maternity clinics.
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Affiliation(s)
- Nirvana Pillay
- Senior Lecturer, Department of Sociology, University of the Witwatersrand, Johannesburg, South Africa; Director, Sarraounia Public Health Trust, 20 4th Avenue, Parktown North, Johannesburg, 2193, South Africa. Correspondence:
| | - Nobukhosi Ncube
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Kearabetswe Moopelo
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Gaolatlhe Mothoagae
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Olivia Welte
- Social Scientist, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Manape Shogole
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Nasiphi Gwiji
- Social Scientist, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lesley Scott
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Noma Moshani
- Social Scientist, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Nicki Tiffin
- Professor, Life Sciences Building, South African Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Andrew Boulle
- Professor, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Frances Griffiths
- Professor, Warwick Medical School, UK; Professor, Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lee Fairlie
- Director of Maternal and Child Health, Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ushma Mehta
- Associate Professor, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Amnesty LeFevre
- Associate Professor, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Kerry Scott
- Independent research consultant, Toronto, Canada; Associate Faculty, Johns Hopkins School of Public Health, Baltimore, MD, USA
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Couturier V, Srivastava S, Hidayat B, De Allegri M. Out-of-Pocket expenditure and patient experience of care under-Indonesia's national health insurance: A cross-sectional facility-based study in six provinces. Int J Health Plann Manage 2022; 37 Suppl 1:79-100. [PMID: 35951490 DOI: 10.1002/hpm.3543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Low- and middle-income countries worldwide are striving to achieve universal health coverage (UHC), frequently through expansion of statutory health insurance schemes. However, oftentimes evidence is lacking on progress towards quality patient-centred care and out-of-pocket expenditure (OOPE), particularly for poor population groups. We contribute patient-centred evidence examining patient experience and OOPE under JKN, the Indonesian social health insurance. METHODS Using data from 2526 patient exit interviews conducted among JKN beneficiaries in 2015, we computed a summative patient experience measure from 14 experience items. We used descriptive statistics to assess patient experience and the probability, amount and components of OOPE. We applied a two-part model to examine the relationships between socio-demographics, facility types, and OOPE and an OLS regression on patient experience determinants. RESULTS The mean patient experience measure was 11.7 out of 14 maximal points. Differences were observed between single items, with highest ratings on ease of understanding providers' language (97%) and lowest on waiting time (54%). OOPE were reported by 20% of patients with a mean equivalent to US$40, the most prevalent reason being medicines (61% of all OOPE). Considerable OOPE heterogeneity occurred by province and facility type. We found differentials in OOPE by gender (females paying more likely, but less) and subsidised JKN membership (same likelihood as non-subsidised, but paying less). CONCLUSION Our findings suggest that during its early implementation, patients under JKN reported mostly positive patient experience yet a fifth incurred OOPE, mostly on medicines. Further patient-centred research is needed to ensure JKN's progress towards UHC.
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Affiliation(s)
- Viktoria Couturier
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany.,Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Friedrich-Ebert-Allee 32, Bonn, Germany
| | - Swati Srivastava
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Budi Hidayat
- Faculty of Public Health, University of Indonesia, Depok, Indonesia
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
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Wallace DD, Núñez I, Barrington C. Revising the Diabetes Distress Scale for Use Among Adults in the Dominican Republic: Findings From Cognitive Interviews. DIABETES EDUCATOR 2022; 48:459-468. [PMID: 36218379 PMCID: PMC9693704 DOI: 10.1177/26350106221128003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to assess the content validity of the Diabetes Distress Scale (DDS) among adults with type 2 diabetes mellitus (T2DM) living in rural Dominican Republic communities. METHODS Researchers conducted cognitive interviews with 20 adults with T2DM to assess how they answered a Spanish version of the 17-item DDS, a commonly used scale to measure diabetes distress. Interviews were done iteratively to allow for revisions and testing of those revisions with the participants. Analysis involved field notes, text summaries, and cognitive coding. RESULTS The sample was 55% women, had a mean age of 55 years, and came from 10 rural communities. The cognitive interviews highlighted needed changes across comprehension, judgment (clarity), recall, response process, and logical/structural issue domains. Participants generally understood the DDS; however, 4 items, the introduction, and response options were revised to improve participant response. The items were revised using wording from the participants themselves. By changing certain terms and splitting a couple of items, these items improved comprehension and judgment. The introduction was simplified from 2 paragraphs to 1 to reduce structural issues (ie, scale's features), and the response options were reduced from 6 options to 5 options to improve the response process. CONCLUSIONS Based on iterative study findings, the researchers propose expanding the 17-item DDS to 19 items to improve participant response. Revising the DDS to account for cultural and structural changes will improve clinical and public health understanding of the role of diabetes distress on T2DM management among Dominican adults.
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Affiliation(s)
- Deshira D Wallace
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Ivania Núñez
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Clare Barrington
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
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Wenemark M, Ngwili N, Ndoboli D, Wieland B, Roesel K. “How Are My Age and Cows Related?” Cognitive Interviewing as a Tool to Pretest Survey Questions in Two Limited Resource Settings. Front Vet Sci 2022; 9:833748. [PMID: 35873686 PMCID: PMC9305482 DOI: 10.3389/fvets.2022.833748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial resistance is a complex topic requiring interdisciplinary solutions embedded in One Health thinking. Currently, many surveys are underway in low- and middle-income countries to study how antimicrobial use in the livestock sector is driving resistance. In a survey, the respondents must understand and answer the questions correctly to produce accurate and valuable results. Pretesting survey questions is therefore important but sometimes not performed due to limited time and resources. Cognitive interviewing is a pretesting method to give insights into the respondent's way of interpreting and mentally processing the survey questions to identify problems and finding ways to improve the questions. It has previously been suggested that cognitive interviews may be difficult to use in some cultural settings. This study aimed to use cognitive interviews in a respondent-adjusted way to study how survey questions related to antimicrobial use are understood and answered by 12 small-scale farmers in Kenya and Uganda. The results show that even a small number of interviews and using interviewers with limited knowledge of cognitive interviewing can identify many problems in survey questions and the survey tool. Cognitive interviews may provide a feasible and affordable way of pretesting questionnaires in situations where time and resources are limited, for example, during a disease outbreak.
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Affiliation(s)
- Marika Wenemark
- Department of Health, Medicine and Caring Science, Faculty of Medicine, Linköping University, Linköping, Sweden
- Department of Health and Care Development, Region Östergötland, Linköping, Sweden
- *Correspondence: Marika Wenemark
| | - Nicholas Ngwili
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
- Animal and Human Health Program, International Livestock Research Institute, Addis Ababa, Ethiopia
| | - Dickson Ndoboli
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
- Animal and Human Health Program, International Livestock Research Institute, Addis Ababa, Ethiopia
- Central Diagnostic Laboratory, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Barbara Wieland
- Animal and Human Health Program, International Livestock Research Institute, Addis Ababa, Ethiopia
- Institute of Virology and Immunology, Mittelhäusern Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Kristina Roesel
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
- Animal and Human Health Program, International Livestock Research Institute, Addis Ababa, Ethiopia
- Department of Veterinary Medicine, Institute of Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
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LeFevre AE, Shah N, Scott K, Chamberlain S, Ummer O, Bashingwa JJH, Chakraborty A, Godfrey A, Dutt P, Ved R, Mohan D. The impact of a direct to beneficiary mobile communication program on reproductive and child health outcomes: a randomised controlled trial in India. BMJ Glob Health 2022; 6:bmjgh-2022-008838. [PMID: 35835477 PMCID: PMC9288869 DOI: 10.1136/bmjgh-2022-008838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022] Open
Abstract
Background Direct-to-beneficiary communication mobile programmes are among the few examples of digital health programmes to have scaled widely in low-resource settings. Yet, evidence on their impact at scale is limited. This study aims to assess whether exposure to mobile health information calls during pregnancy and postpartum improved infant feeding and family planning practices. Methods We conducted an individually randomised controlled trial in four districts of Madhya Pradesh, India. Study participants included Hindi speaking women 4–7 months pregnant (n=5095) with access to a mobile phone and their husbands (n=3842). Women were randomised to either an intervention group where they received up to 72 Kilkari messages or a control group where they received none. Intention-to-treat (ITT) and instrumental variable (IV) analyses are presented. Results An average of 65% of the 2695 women randomised to receive Kilkari listened to ≥50% of the cumulative content of calls answered. Kilkari was not observed to have a significant impact on the primary outcome of exclusive breast feeding (ITT, relative risk (RR): 1.04, 95% CI 0.88 to 1.23, p=0.64; IV, RR: 1.10, 95% CI 0.67 to 1.81, p=0.71). Across study arms, Kilkari was associated with a 3.7% higher use of modern reversible contraceptives (RR: 1.12, 95% CI 1.03 to 1.21, p=0.007), and a 2.0% lower proportion of men or women sterilised since the birth of the child (RR: 0.85, 95% CI 0.74 to 0.97, p=0.016). Higher reversible method use was driven by increases in condom use and greatest among those women exposed to Kilkari with any male child (9.9% increase), in the poorest socioeconomic strata (15.8% increase), and in disadvantaged castes (12.0% increase). Immunisation at 10 weeks was higher among the children of Kilkari listeners (2.8% higher; RR: 1.03, 95% CI 1.00 to 1.06, p=0.048). Significant differences were not observed for other maternal, newborn and child health outcomes assessed. Conclusion Study findings provide evidence to date on the effectiveness of the largest mobile health messaging programme in the world. Trial registration number Trial registration clinicaltrials.gov; ID 90075552, NCT03576157.
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Affiliation(s)
- Amnesty Elizabeth LeFevre
- University of Cape Town, School of Public Health and Family Medicine, Cape Town, South Africa .,International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neha Shah
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kerry Scott
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sara Chamberlain
- BBC Media Action, London, UK.,BBC Media Action, New Delhi, Delhi, India
| | - Osama Ummer
- BBC Media Action, New Delhi, Delhi, India.,Oxford Policy Management, New Delhi, Delhi, India
| | - Jean Juste Harrisson Bashingwa
- MRC/Wits-Agincourt Unit, University of the Witwatersrand, School of Public Health, Johannesburg, Gauteng, South Africa.,Computational Biology Division, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Faculty of Health Sciences, Cape Town, South Africa
| | - Arpita Chakraborty
- Research and Evidence Practice, Oxford Policy Management, New Delhi, Delhi, India
| | | | - Priyanka Dutt
- BBC Media Action, London, UK.,BBC Media Action, New Delhi, Delhi, India
| | - Rajani Ved
- National Health Systems Resource Centre, New Delhi, Delhi, India.,Bill and Melinda Gates Foundation, Delhi, India
| | - Diwakar Mohan
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Hamon JK, Kambanje M, Pryor S, Kaponda AS, Mwale E, Burchett HED, Mayhew SH, Webster J. Integrated delivery of family planning and childhood immunisation services: a mixed methods assessment of service responsiveness. BMC Health Serv Res 2022; 22:572. [PMID: 35484622 PMCID: PMC9052445 DOI: 10.1186/s12913-022-07983-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Postpartum women represent a considerable share of the global unmet need for modern contraceptives. Evidence suggests that the integration of family planning (FP) with childhood immunisation services could help reduce this unmet need by providing repeat opportunities for timely contact with FP services. However, little is known about the clients’ experiences of FP services that are integrated with childhood immunisations, despite being crucial to contraceptive uptake and repeat service utilisation. Methods The responsiveness of FP services that were integrated with childhood immunisations in Malawi was assessed using cross-sectional convergent mixed methods. Exit interviews with clients (n=146) and audits (n=15) were conducted in routine outreach clinics. Responsiveness scores across eight domains were determined according to the proportion of clients who rated each domain positively. Text summary analyses of qualitative data from cognitive interviewing probes were also conducted to explain responsiveness scores. Additionally, Spearman rank correlation and Pearson’s chi-squared test were used to identify correlations between domain ratings and to examine associations between domain ratings and client, service and clinic characteristics. Results Responsiveness scores varied across domains: dignity (97.9%); service continuity (90.9%); communication (88.7%); ease of access (77.2%); counselling (66.4%); confidentiality (62.0%); environment (53.9%) and choice of provider (28.4%). Despite some low performing domains, 98.6% of clients said they would recommend the clinic to a friend or family member interested in FP. The choice of provider, communication, confidentiality and counselling ratings were positively associated with clients’ exclusive use of one clinic for FP services. Also, the organisation of services in the clinics and the providers’ individual behaviours were found to be critical to service responsiveness. Conclusions This study establishes that in routine outreach clinics, FP services can be responsive when integrated with childhood immunisations, particularly in terms of the dignity and service continuity afforded to clients, though less so in terms of the choice of provider, environment, and confidentiality experienced. Additionally, it demonstrates the value of combining cognitive interviewing techniques with Likert questions to assess service responsiveness.
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Affiliation(s)
- Jessie K Hamon
- Department of Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK.
| | | | | | | | | | - Helen E D Burchett
- Department of Public Health, Environments and Society, LSHTM, London, UK
| | | | - Jayne Webster
- Department of Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
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Ng A, Mohan D, Shah N, Scott K, Ummer O, Chamberlain S, Bhatnagar A, Dhar D, Agarwal S, Ved R, LeFevre AE. Assessing the reliability of phone surveys to measure reproductive, maternal and child health knowledge among pregnant women in rural India: a feasibility study. BMJ Open 2022; 12:e056076. [PMID: 35273055 PMCID: PMC8915337 DOI: 10.1136/bmjopen-2021-056076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Efforts to understand the factors influencing the uptake of reproductive, maternal, newborn, child health and nutrition (RMNCH&N) services in high disease burden low-resource settings have often focused on face-to-face surveys or direct observations of service delivery. Increasing access to mobile phones has led to growing interest in phone surveys as a rapid, low-cost alternatives to face-to-face surveys. We assess determinants of RMNCH&N knowledge among pregnant women with access to phones and examine the reliability of alternative modalities of survey delivery. PARTICIPANTS Women 5-7 months pregnant with access to a phone. SETTING Four districts of Madhya Pradesh, India. DESIGN Cross-sectional surveys administered face-to-face and within 2 weeks, the same surveys were repeated among two random subsamples of the original sample: face-to-face (n=205) and caller-attended telephone interviews (n=375). Bivariate analyses, multivariable linear regression, and prevalence and bias-adjusted kappa scores are presented. RESULTS Knowledge scores were low across domains: 52% for maternal nutrition and pregnancy danger signs, 58% for family planning, 47% for essential newborn care, 56% infant and young child feeding, and 58% for infant and young child care. Higher knowledge (≥1 composite score) was associated with older age; higher levels of education and literacy; living in a nuclear family; primary health decision-making; greater attendance in antenatal care and satisfaction with accredited social health activist services. Survey questions had low inter-rater and intermodal reliability (kappa<0.70) with a few exceptions. Questions with the lowest reliability included true/false questions and those with unprompted, multiple response options. Reliability may have been hampered by the sensitivity of the content, lack of privacy, enumerators' and respondents' profile differences, rapport, social desirability bias, and/or enumerator's ability to adequately convey concepts or probe. CONCLUSIONS Phone surveys are a reliable modality for generating population-level estimates data about pregnant women's knowledge, however, should not be used for individual-level tracking. TRIAL REGISTRATION NUMBER NCT03576157.
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Affiliation(s)
- Angela Ng
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neha Shah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Osama Ummer
- Oxford Policy Management, New Delhi, Delhi, India
| | - Sara Chamberlain
- BBC Media Action, New Delhi, Delhi, India
- BBC Media Action, London, UK
| | - Aarushi Bhatnagar
- Health, Nutrition and Population, World Bank New Delhi Office, New Delhi, India
| | - Diva Dhar
- The Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Smisha Agarwal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rajani Ved
- National Health Systems Resource Centre, New Delhi, Delhi, India
- The Bill and Melinda Gates Foundation, Delhi, India
| | - Amnesty Elizabeth LeFevre
- Division of Public Health and Family Medicine, University of Cape Town, School of Public Health and Family Medicine, Cape Town, South Africa
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Gonsalves L, Hunter EC, Brizuela V, Tucker JD, Srinivas ML, Gitau E, Mercer CH, Bajos N, Collins D. Cognitive testing of a survey instrument to assess sexual practices, behaviours, and health outcomes: a multi-country study protocol. Reprod Health 2021; 18:249. [PMID: 34923998 PMCID: PMC8684588 DOI: 10.1186/s12978-021-01301-w] [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] [Received: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population level data on sexual practices, behaviours and health-related outcomes can ensure that responsive, relevant health services are available for all people of all ages. However, while billions of dollars have been invested in attempting to improve sexual and reproductive health (including HIV) outcomes, far less is understood about associated sexual practices and behaviours. Therefore, the World Health Organization embarked on a global consultative process to develop a short survey instrument to assess sexual health practices, behaviours and health outcomes. In order for the resulting draft survey instrument to be published as a 'global' standard instrument, it is important to first determine that the proposed measures are globally comprehensible and applicable. This paper describes a multi-country study protocol to assess the interpretability and comparability of the survey instrument in a number of diverse countries. METHODS This study will use cognitive interviewing, a qualitative data collection method that uses semi-structured interviews to explore how participants process and respond to survey instruments. We aim to include study sites in up to 20 countries. The study procedures consist of: (1) localizing the instrument using forward and back-translation; (2) using a series of cognitive interviews to understand how participants engage with each survey question; (3) revising the core instrument based on interview findings; and (4) conducting an optional second round of cognitive interviews. Data generated from interviews will be summarised into a predeveloped analysis matrix. The entire process (a 'wave' of data collection) will be completed simultaneously by 5+ countries, with a total of three waves. This stepwise approach facilitates iterative improvements and sharing across countries. DISCUSSION An important output from this research will be a revised survey instrument, which when subsequently published, can contribute to improving the comparability across contexts of measures of sexual practices, behaviours and health-related outcomes. Site-specific results of the feasibility of conducting this research may help shift perceptions of who and what can be included in sexual health-related research.
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Affiliation(s)
- Lianne Gonsalves
- 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, Avenue Appia 20, 1211, Geneva, Switzerland.
| | - Erin C Hunter
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Vanessa Brizuela
- 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, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Joseph D Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA
| | - Megan L Srinivas
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA
| | - Evelyn Gitau
- African Population and Health Research Center, Nairobi, Kenya
| | - Catherine H Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London, UK
| | - Nathalie Bajos
- Institut National de la Santé et de la Recherche Medicale (INSERM), IRIS-EHESS, Paris, France
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9
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Aronson KI, Suzuki A. Health Related Quality of Life in Interstitial Lung Disease: Can We Use the Same Concepts Around the World? Front Med (Lausanne) 2021; 8:745908. [PMID: 34692737 PMCID: PMC8526733 DOI: 10.3389/fmed.2021.745908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/31/2021] [Indexed: 01/17/2023] Open
Abstract
Health-Related Quality of Life (HRQOL) is increasingly viewed as an important patient-centered outcome by leading health organizations, clinicians, and patients alike. This is especially true in the interstitial lung disease community where patients often struggle with progressive and debilitating disease with few therapeutic options. In order to test the effectiveness of new pharmacologic therapies and non-pharmacologic interventions globally in ILD, this will require expansion of clinical research studies to a multinational level and HRQOL will be an important endpoint to many. In order to successfully expand trials across multiple nations and compare the results of studies between different communities we must recognize that there are differences in the concepts of HRQOL across the world and have strategies to address these differences. In this review, we will describe the different global influences on HRQOL both generally and in the context of ILD, discuss the processes of linguistic translation and cross-cultural adaptation of HRQOL Patient Reported Outcome Measures (PROMs), and highlight the gaps and opportunities for improving HRQOL measurement in ILD across the world.
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Affiliation(s)
- Kerri I. Aronson
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Atsushi Suzuki
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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10
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Scott K, Ummer O, LeFevre AE. The devil is in the detail: reflections on the value and application of cognitive interviewing to strengthen quantitative surveys in global health. Health Policy Plan 2021; 36:982-995. [PMID: 33978729 PMCID: PMC8227989 DOI: 10.1093/heapol/czab048] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
Cognitive interviewing is a qualitative research method for improving the validity of quantitative surveys, which has been underused by academic researchers and monitoring and evaluation teams in global health. Draft survey questions are administered to participants drawn from the same population as the respondent group for the survey itself. The interviewer facilitates a detailed discussion with the participant to assess how the participant interpreted each question and how they formulated their response. Draft survey questions are revised and undergo additional rounds of cognitive interviewing until they achieve high comprehension and cognitive match between the research team's intent and the target population's interpretation. This methodology is particularly important in global health when surveys involve translation or are developed by researchers who differ from the population being surveyed in terms of socio-demographic characteristics, worldview, or other aspects of identity. Without cognitive interviewing, surveys risk measurement error by including questions that respondents find incomprehensible, that respondents are unable to accurately answer, or that respondents interpret in unintended ways. This methodological musing seeks to encourage a wider uptake of cognitive interviewing in global public health research, provide practical guidance on its application, and prompt discussion on its value and practice. To this end, we define cognitive interviewing, discuss how cognitive interviewing compares to other forms of survey tool development and validation, and present practical steps for its application. These steps cover defining the scope of cognitive interviews, selecting and training researchers to conduct cognitive interviews, sampling participants, collecting data, debriefing, analysing the emerging findings, and ultimately generating revised, validated survey questions. We close by presenting recommendations to ensure quality in cognitive interviewing.
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Affiliation(s)
- K Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - O Ummer
- Oxford Policy Management, 4/6 1st Floor, Siri Fort Institutional Area, 11049 New Delhi, India.,BBC Media Action, India Office, Innov8 Old Fort Saket District Mall, Saket District Centre, Sector 6, Pushp Vihar, 110017 New Delhi, India
| | - A E LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.,Division of Public Health Medicine, Public Health and Family Medicine, University of Cape Town, Observatory 7925, Cape Town, South Africa
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Schaaf M, Kapilashrami A, George A, Amin A, Downe S, Boydell V, Samari G, Ruano AL, Nanda P, Khosla R. Unmasking power as foundational to research on sexual and reproductive health and rights. BMJ Glob Health 2021; 6:bmjgh-2021-005482. [PMID: 33832951 PMCID: PMC8039258 DOI: 10.1136/bmjgh-2021-005482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 01/19/2023] Open
Affiliation(s)
- Marta Schaaf
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Anuj Kapilashrami
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Asha George
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, Western Province, South Africa
| | - Avni Amin
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire, UK
| | - Victoria Boydell
- Global Health Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Goleen Samari
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ana Lorena Ruano
- Centre for International Health, University of Bergen, Bergen, Norway.,Center for the Study of Equity and Governance in Health Systems (CEGSS), Guatemala City, Guatemala
| | - Priya Nanda
- Bill and Melinda Gates Foundation India, New Delhi, Delhi, India
| | - Rajat Khosla
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
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Larson E, Sharma J, Nasiri K, Bohren MA, Tunçalp Ö. Measuring experiences of facility-based care for pregnant women and newborns: a scoping review. BMJ Glob Health 2020; 5:e003368. [PMID: 33219000 PMCID: PMC7682195 DOI: 10.1136/bmjgh-2020-003368] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/23/2020] [Accepted: 10/14/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Access to high-quality, person-centred care during pregnancy and childbirth is a global priority. Positive experience of care is key in particular, because it is both a fundamental right and can influence health outcomes and future healthcare utilisation. Despite its importance for accountability and action, systematic guidance on measuring experience of care is limited. METHODS We conducted a scoping review of published literature to identify measures/instruments for experience of facility-based pregnancy and childbirth (abortion, antenatal, intrapartum, postnatal and newborn) care. We systematically searched five bibliographic databases from 1 January 2007 through 1 February 2019. Using a predefined evidence template, we extracted data on study design, data collection method, study population and care type as reported in primary quantitative articles. We report results narratively. RESULTS We retrieved 16 528 unique citations, including 171 eligible articles representing, 157 unique instruments and 144 unique parent instruments across 56 countries. Half of the articles (90/171) did not use a validated instrument. While 82% (n=141) of articles reported on labour and childbirth care, only one reported on early pregnancy/abortion care. The most commonly reported sub-domains of user experience were communication (84%, 132/157) and respect and dignity (71%, 111/157). The primary purpose of most papers was measurement (70%, 119/171), largely through cross-sectional surveys. CONCLUSION There are alarming gaps in measurement of user experience for abortion, antenatal, postnatal and newborn care, including lack of validated instruments to measure the effects of interventions and policies on user experience. PROTOCOL REGISTRATION DETAILS This review was registered and published on PROSPERO (CRD42017070867). PROSPERO is an international database of prospectively registered systematic reviews in health and social care.
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Affiliation(s)
- Elysia Larson
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jigyasa Sharma
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Khalidha Nasiri
- Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Department of Sexual and Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneve, Switzerland
| | - Meghan A Bohren
- Centre for Health Equity, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneve, Switzerland
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Shah N, Mohan D, Bashingwa JJH, Ummer O, Chakraborty A, LeFevre AE. Using Machine Learning to Optimize the Quality of Survey Data: Protocol for a Use Case in India. JMIR Res Protoc 2020; 9:e17619. [PMID: 32755886 PMCID: PMC7439143 DOI: 10.2196/17619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/18/2020] [Accepted: 06/13/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Data quality is vital for ensuring the accuracy, reliability, and validity of survey findings. Strategies for ensuring survey data quality have traditionally used quality assurance procedures. Data analytics is an increasingly vital part of survey quality assurance, particularly in light of the increasing use of tablets and other electronic tools, which enable rapid, if not real-time, data access. Routine data analytics are most often concerned with outlier analyses that monitor a series of data quality indicators, including response rates, missing data, and reliability of coefficients for test-retest interviews. Machine learning is emerging as a possible tool for enhancing real-time data monitoring by identifying trends in the data collection, which could compromise quality. OBJECTIVE This study aimed to describe methods for the quality assessment of a household survey using both traditional methods as well as machine learning analytics. METHODS In the Kilkari impact evaluation's end-line survey amongst postpartum women (n=5095) in Madhya Pradesh, India, we plan to use both traditional and machine learning-based quality assurance procedures to improve the quality of survey data captured on maternal and child health knowledge, care-seeking, and practices. The quality assurance strategy aims to identify biases and other impediments to data quality and includes seven main components: (1) tool development, (2) enumerator recruitment and training, (3) field coordination, (4) field monitoring, (5) data analytics, (6) feedback loops for decision making, and (7) outcomes assessment. Analyses will include basic descriptive and outlier analyses using machine learning algorithms, which will involve creating features from time-stamps, "don't know" rates, and skip rates. We will also obtain labeled data from self-filled surveys, and build models using k-folds cross-validation on a training data set using both supervised and unsupervised learning algorithms. Based on these models, results will be fed back to the field through various feedback loops. RESULTS Data collection began in late October 2019 and will span through March 2020. We expect to submit quality assurance results by August 2020. CONCLUSIONS Machine learning is underutilized as a tool to improve survey data quality in low resource settings. Study findings are anticipated to improve the overall quality of Kilkari survey data and, in turn, enhance the robustness of the impact evaluation. More broadly, the proposed quality assurance approach has implications for data capture applications used for special surveys as well as in the routine collection of health information by health workers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17619.
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Affiliation(s)
- Neha Shah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jean Juste Harisson Bashingwa
- Faculty of Health Sciences, Department of Integrative Biomedical Sciences, & Member of the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - Amnesty E LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Shah N, Mohan D, Agarwal S, Scott K, Chamberlain S, Bhatnagar A, Labrique A, Indurkar M, Ved R, LeFevre A. Novel approaches to measuring knowledge among frontline health workers in India: Are phone surveys a reliable option? PLoS One 2020; 15:e0234241. [PMID: 32598348 PMCID: PMC7323989 DOI: 10.1371/journal.pone.0234241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/21/2020] [Indexed: 11/24/2022] Open
Abstract
Background In 2017, India was home to nearly 20% of maternal and child deaths occurring globally. Accredited social health activists (ASHAs) act as the frontline for health services delivery in India, providing a range of reproductive, maternal, newborn, child health, and nutrition (RMNCH&N) services. Empirical evidence on ASHAs’ knowledge is limited, yet is a critical determinant of the quality of health services provided. We assessed the determinants of RMNCH&N knowledge among ASHAs and examined the reliability of alternative modalities of survey delivery, including face-to-face and caller attended telephone interviews (phone surveys) in 4 districts of Madhya Pradesh, India. Methods We carried out face-to-face surveys among a random cross-sectional sample of ASHAs (n = 1,552), and administered a follow-up test-retest survey within 2 weeks of the initial survey to a subsample of ASHAs (n = 173). We interviewed a separate sub-sample of ASHAs 2 weeks of the face-to-face interview over the phone (n = 155). Analyses included bivariate analyses, multivariable linear regression, and prevalence and bias adjusted kappa analyses. Findings The average ASHA knowledge score was 64% and ranged across sub-domains from 71% for essential newborn care, 71% for WASH/ diarrhea, 64% for infant feeding, 61% for family planning, and 60% for maternal health. Leading determinants of knowledge included geographic location, age <30 years of age, education, experience as an ASHA, completion of seven or more client visits weekly, phone ownership and use as a communication tool for work, as well as the ability to navigate interactive voice response prompts (a measure of digital literacy). Efforts to develop a phone survey tool for measuring knowledge suggest that findings on inter-rater and inter-modal reliability were similar. Reliability was higher for shorter, widely known questions, including those about timing of exclusive breastfeeding or number of tetanus shots during pregnancy. Questions with lower reliability included those on sensitive topics such as family planning; questions with multiple response options; or which were difficult for the enumerator to convey. Conclusions Overall results highlight important gaps in the knowledge of ASHAs. Findings on the reliability of phone surveys led to the development of a tool, which can be widely used for the routine, low cost measurement of ASHA RMNCH&N knowledge in India.
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Affiliation(s)
- Neha Shah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Smisha Agarwal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Meenal Indurkar
- National Health Systems Resource Center, National Institute of Health & Family Welfare, New Delhi, Delhi, India
| | - Rajani Ved
- National Health Systems Resource Center, National Institute of Health & Family Welfare, New Delhi, Delhi, India
| | | | - on behalf of the Kilkari Impact Evaluation team
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
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