Providing antenatal corticosteroids for preterm birth: a quality improvement initiative in Cambodia and the Philippines

Readiness to Provide Antenatal Corticosteroids for Threatened Preterm Birth in Public Health Facilities in Northern India

INTRODUCTION

In 2014, the Government of India (GOI) released operational guidelines on the use of antenatal corticosteroids (ACS) in preterm labor. However, without ensuring the quality of childbirth and newborn care at facilities, the use of ACS in low- and middle-income countries is potentially harmful. This study assessed the readiness to provide ACS at primary and secondary care public health facilities in northern India.

METHODS

A cross-sectional study was conducted in 37 public health facilities in 2 districts of Haryana, India. Facility processes and program implementation for ACS delivery were assessed using pretested study tools developed from the World Health Organization (WHO) quality of care standards and WHO guidelines for threatened preterm birth.

RESULTS

Key gaps in public health facilities' process of care to provide ACS for threatened preterm birth were identified, particularly concerning evidence-based practices, competent workforce, and actionable health information system. Emphasis on accurate gestational age estimation, quality of childbirth care, and quality of preterm care were inadequate. Shortage of trained staff was widespread, and a disconnect was found between knowledge and attitudes regarding ACS use. ACS administration was provided only at district or subdistrict hospitals, and these facilities did not uniformly record ACS-specific indicators. All levels lacked a comprehensive protocol and job aids for identifying and managing threatened preterm birth.

CONCLUSIONS

ACS operational guidelines were not widely disseminated or uniformly implemented. Facilities require strengthened supervision and standardization of threatened preterm birth care. Facilities need greater readiness to meet required conditions for ACS use. Increasing uptake of a single intervention without supporting it with adequate quality of maternal and newborn care will jeopardize improvement in preterm birth outcomes. We recommend updating and expanding the existing GOI ACS operational guidelines to include specific actions for the safe and effective use of ACS in line with recent scientific evidence.

Psychometric Testing of the Effort-Reward Imbalance-Short Form Among Blue-Collar Workers Employed in Small Industrial Settings in Korea

The Effort Reward Imbalance tool is a measure of psychosocial work characteristics used to identify work-related stress. The purpose of this study was to assess the reliability and validity of the Korean version of the effort-reward imbalance-short form (ERI-SF) in industrial workers. The Korean version of ERI-SF was tested among 250 blue-collar workers. The reliability, content validity, and construct validity with confirmatory factor analysis, as well as interaction terms were analyzed. Reliability assessed by Cronbach's alpha coefficients were satisfactory for all three subscales: effort 0.75, reward 0.74, and over-commitment 0.72. Confirmatory factor analysis showed an acceptable model fit with the three component theoretical structure (root mean square error of approximation = 0.07, comparative fit index = 0.84). Content validity was assessed with respect to a measure of perceived health. In addition, a significant synergistic interaction of ERI and over-commitment on job strain was found. In conclusion, the ERI-SF demonstrated good psychometric properties with Korean industrial workers. The ERI-SF is ideal for examining work-related stress in the workplace by occupational health professionals. This shorter version makes it easier to administer and score in the occupational health setting.

Conceptualizing and assessing improvement capability: a review

Purpose

The literature is reviewed to examine how ‘improvement capability’ is conceptualized and assessed and to identify future areas for research.

Data sources

An iterative and systematic search of the literature was carried out across all sectors including healthcare. The search was limited to literature written in English.

Data extraction

The study identifies and analyses 70 instruments and frameworks for assessing or measuring improvement capability. Information about the source of the instruments, the sectors in which they were developed or used, the measurement constructs or domains they employ, and how they were tested was extracted.

Results of data synthesis

The instruments and framework constructs are very heterogeneous, demonstrating the ambiguity of improvement capability as a concept, and the difficulties involved in its operationalisation. Two-thirds of the instruments and frameworks have been subject to tests of reliability and half to tests of validity. Many instruments have little apparent theoretical basis and do not seem to have been used widely.

Conclusion

The assessment and development of improvement capability needs clearer and more consistent conceptual and terminological definition, used consistently across disciplines and sectors. There is scope to learn from existing instruments and frameworks, and this study proposes a synthetic framework of eight dimensions of improvement capability. Future instruments need robust testing for reliability and validity. This study contributes to practice and research by presenting the first review of the literature on improvement capability across all sectors including healthcare.