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Hadmon R, Pierre DM, Banga A, Clerville JW, Mautong H, Akinsanya P, Gupta RD, Soliman S, Hunjah TM, Hunjah BA, Hamza H, Qasba RK, Nawaz FA, Surani S, Kashyap R. Violence study of healthcare workers and systems in the Caribbean: ViSHWaS-Caribbean study. World J Methodol 2024; 14:92932. [PMID: 39310234 PMCID: PMC11230073 DOI: 10.5662/wjm.v14.i3.92932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/24/2024] [Accepted: 05/07/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Violence against healthcare workers (HCWs) in the Caribbean continues to prevail yet remains underreported. Our aim is to determine the cause, traits, and consequences of violence on HCWs in the Caribbean. AIM To determine the cause, traits, and consequences of violence on HCWs in the Caribbean. METHODS This research adopted an online cross-sectional survey approach, spanning over eight weeks (between June 6th and August 9th, 2022). The survey was generated using Research Electronic Data Capture forms and followed a snowballing strategy to contact individuals using emails, social media, text messages, etc. Logistic regression analysis was performed to evaluate the variables that influence violence, including gender, age, years of experience, institution type, and night shift frequency. RESULTS The survey was completed by 225 HCWs. Females comprised 61%. Over 51% of respondents belonged to the 21 to 35 age group. Dominica (n = 61), Haiti (n = 50), and Grenada (n = 31) had the most responses. Most HCWs (49%) worked for government academic institutions, followed by community hospitals (23%). Medical students (32%), followed by attending physicians (22%), and others (16%) comprised the most common cadre of respondents. About 39% of the participants reported experiencing violence themselves, and 18% reported violence against colleague(s). Verbal violence (48%), emotional abuse (24%), and physical misconduct (14%) were the most common types of violence. Nearly 63% of respondents identified patients or their relatives as the most frequent aggressors. Univariate logistic regression analyses demonstrated that female gender (OR = 2.08; 95%CI: 1.16-3.76, P = 0.014) and higher frequency of night shifts (OR = 2.22; 95%CI: 1.08-4.58, P = 0.030) were associated with significantly higher odds of experiencing violence. More than 50% of HCWs felt less motivated and had decreased job satisfaction post-violent conduct. CONCLUSION A large proportion of HCWS in the Caribbean are exposed to violence, yet the phenomenon remains underreported. As a result, HCWs' job satisfaction has diminished.
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Affiliation(s)
- Reshon Hadmon
- Department of Medicine, St. George University School of Medicine, Grenada FZ818, West Indies
| | - Daniella Myriam Pierre
- Department of Research, Global Remote Research Scholar Program, St Paul, MN 55101, United States
- Department of Public Health, Cuny Graduate School of Public Health and Health Policy, New York, NY 10027, United States
| | - Akshat Banga
- Department of Internal Medicine, Sawai Man Singh Medical College, Jaipur 302004, India
| | - Jacques W Clerville
- School of Public Health, Georgia State University, Atlanta, GA 30302, United States
| | - Hans Mautong
- Department of Sociology and Demography, School of Health, Universidad de Especialidades Espiritu Santo, Samborondon 092301, Ecuador
| | - Precious Akinsanya
- Department of Medicine, Holy Name Medical Center, Teaneck, NJ 07666, United States
| | - Rajat Das Gupta
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, United States
| | - Sama Soliman
- Department of Medicine, Pavlov First State Medical University of St Petersburg, Sankt-Peterburg 197022, Russia
| | - Tolupe M Hunjah
- Department of Medicine, University of Suffolk, Ipswich IP4 1QJ, United Kingdom
| | - Bamidele A Hunjah
- Department of Medicine, Unicaf University of Zambia, Lusaka 20842, Zambia
| | - Hafeez Hamza
- Department of Pharmacy, School of Pharmacy, Girne 99428, Cyprus
| | - Ruman Khurshid Qasba
- Department of Medicine, Sher-i-Kashmir, Institute of Medical Science, Srinagar 190011, India
| | - Faisal A Nawaz
- Department of Research, Global Remote Research Scholar Program, St Paul, MN 55101, United States
- Department of Psychiatry, Al Amal Psychiatric Hospital, Emirates Health Services, Dubai, United Arab Emirates
| | - Salim Surani
- Department of Research, Global Remote Research Scholar Program, St Paul, MN 55101, United States
- Department of Medicine and Pharmacology, Texas A and M University, College Station, TX 77843, United States
- Anesthesiology and Critical Care, Mayo Clinic, Rochester, MN 55905, United States
| | - Rahul Kashyap
- Department of Research, Global Remote Research Scholar Program, St Paul, MN 55101, United States
- Anesthesiology and Critical Care, Mayo Clinic, Rochester, MN 55905, United States
- Department of Research, Wellspan Health, York, PA 17403, United States
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Ayaz B, Dozois G, Baumann AL, Fuseini A, Nelson S. Perpetrators of gender-based workplace violence amongst nurses and physicians-A scoping review of the literature. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003646. [PMID: 39240832 PMCID: PMC11379169 DOI: 10.1371/journal.pgph.0003646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/02/2024] [Indexed: 09/08/2024]
Abstract
In healthcare settings worldwide, workplace violence (WPV) has been extensively studied. However, significantly less is known about gender-based WPV and the characteristics of perpetrators. We conducted a comprehensive scoping review on Type II (directed by consumers) and Type III (perpetuated by healthcare workers) gender based-WPV among nurses and physicians globally. For the review, we followed the Preferred Reporting Items for Systematic and Meta Analyses extension for Scoping Review (PRISMA-ScR). The protocol for the comprehensive review was registered on the Open Science Framework on January 14, 2022, at https://osf.io/t4pfb/. A systematic search in five health and social science databases yielded 178 relevant studies that indicated types of perpetrators, with only 34 providing descriptive data for perpetrators' gender. Across both types of WPV, men (65.1%) were more frequently responsible for perpetuating WPV compared to women (28.2%) and both genders (6.7%). Type II WPV, demonstrated a higher incidence of violence against women; linked to the gendered roles, stereotypes, and societal expectations that allocate specific responsibilities based on gender. Type III WPV was further categorized into Type III-A (horizontal) and Type III-B (vertical). With Type III WPV, gendered power structures and stereotypes contributed to a permissive environment for violence by men and women that victimized more women. These revelations emphasize the pressing need for gender-sensitive strategies for addressing WPV within the healthcare sector. Policymakers must prioritize the security of healthcare workers, especially women, through reforms and zero-tolerance policies. Promoting gender equality and empowerment within the workforce and leadership is pivotal. Additionally, creating a culture of inclusivity, support, and respect, led by senior leadership, acknowledging WPV as a structural issue and enabling an open dialogue across all levels are essential for combating this pervasive problem.
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Affiliation(s)
- Basnama Ayaz
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrea L Baumann
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Adam Fuseini
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sioban Nelson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Ajuwa MEPE, Veyrier CA, Cousin Cabrolier L, Chassany O, Marcellin F, Yaya I, Duracinsky M. Workplace violence against female healthcare workers: a systematic review and meta-analysis. BMJ Open 2024; 14:e079396. [PMID: 39209501 PMCID: PMC11369783 DOI: 10.1136/bmjopen-2023-079396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Workplace violence (WPV) is highly prevalent in the health sector and remains a major occupational issue causing significant harm, ranging from bodily and psychological harm to death. Female healthcare workers (HCWs) are at high risk of WPV. OBJECTIVES Identify risk factors of WPV among different professional categories of female HCWs. DATA SOURCES PubMed, EMBASE and Web of Science, along with their references lists January 2010 and March 2022. ELIGIBILITY CRITERIA English language observational studies focusing on WPV among HCWs evaluating the risk factors, impacts and consequences of WPV in female HCWs. METHOD Risk of bias was assessed for all studies by Joanna Briggs Institute critical appraisal checklists. We estimated the pooled prevalence of WPV and the associated 95% CI using a random-effects meta-analysis model. We then described the associated factors and effects of WPV. RESULTS 28 reviewed studies (24 quantitative, 4 qualitative and 1 mixed-method) from 20 countries were selected. From the available results of 16 studies, the pooled prevalence of WPV was estimated at 45.0% (95% CI 32% to 58%). Types of violence included verbal abuse, verbal threats, physical assaults, sexual harassment, mobbing, bullying and discrimination. Perpetrators were patients, patients' relatives, colleagues and supervisors. Nurses were the most studied HCWs category. WPV was found to affect both mental and physical health. Age, marital status, lower occupational position, substance abuse, shorter work experience and low support at work were the main socio-demographic and organisational factors associated with higher risk of WPV. CONCLUSION WPV prevalence is high among female HCWs, warranting a multilevel intervention approach to address and mitigate its impact. This approach should include targeted policies and individual-level strategies to create a safer work environment and prevent adverse effects on both HCWs and the broader healthcare system. Further research is needed to better document WPV in categories of HCWs other than nurses. PROSPERO REGISTRATION NUMBER CRD42022329574.
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Affiliation(s)
| | - Clair-Antoine Veyrier
- URC ECO, Assistance Publique - Hopitaux de Paris, Paris, France
- ECEVE UMR 1123, INSERM, Paris, France
| | - Lorraine Cousin Cabrolier
- URC ECO, Assistance Publique - Hopitaux de Paris, Paris, France
- ECEVE UMR 1123, INSERM, Paris, France
| | - Olivier Chassany
- URC ECO, Assistance Publique - Hopitaux de Paris, Paris, France
- ECEVE UMR 1123, INSERM, Paris, France
| | | | - Issifou Yaya
- URC ECO, Assistance Publique - Hopitaux de Paris, Paris, France
- ECEVE UMR 1123, INSERM, Paris, France
| | - Martin Duracinsky
- URC ECO, Assistance Publique - Hopitaux de Paris, Paris, France
- ECEVE UMR 1123, INSERM, Paris, France
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Singh P, Sriram V, Vaid S, Nanda S, Keshri VR. Examining representation of women in leadership of professional medical associations in India. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003587. [PMID: 39133694 PMCID: PMC11318910 DOI: 10.1371/journal.pgph.0003587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 07/18/2024] [Indexed: 08/15/2024]
Abstract
Women constitute 70% of the global health workforce but are significantly underrepresented in leadership positions. In India, professional medical associations (PMAs) play a crucial role in shaping policy agenda in the health sector, but very little is known about gender diversity in their leadership. Therefore, we analysed the gender representation of current and past leaderships of Indian PMAs. Data of the current and past national leadership and leadership committees of 46 leading PMAs representing general, specialities, and super-specialities were extracted from their official websites. Gender composition of leadership was analysed using a sequential approach. For Indian Medical Association (IMA), the largest Indian PMA, an analysis of its 32 sub-chapters was also undertaken. The findings revealed that only 9 (19.5%) out of 46 associations are currently led by a woman. Leadership committees of half the associations have less than 20% women, while there were no women in the central committee of nine PMAs. Among past presidents, information was publicly available for 31 associations and all of them have had less than 20% of women presidents till date. Among the 64 individuals currently serving as presidents and secretaries of 32 sub-chapters of IMA, only three (4.6%) are women. Even in associations closely related to women's health, such as obstetrics and gynecology, pediatrics, and neonatology, unequal representation persists, highlighting male dominance. These results demonstrate significant gender disparities in PMA leadership in India, necessitating urgent efforts to promote gender equality. Gender-transformative leadership is crucial to develop gender-sensitive health care policies and practices which can serve as a catalyst for broader societal change.
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Affiliation(s)
| | - Veena Sriram
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- School of Public Policy and Global Affairs, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Vikash R. Keshri
- The George Institute for Global Health, New Delhi, India
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- State Health Resource Centre, Raipur, India
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Olayinka F, O’Connell TS, Morgan C, Monzon MF, Oshin T, Tampe T, Reed A, Cometto G, Clarke AT, Kazi MA, Shearer JC. Applying a Primary Health Care Approach to Closing the Human Resource for Health Gaps for Immunization. Healthcare (Basel) 2024; 12:1449. [PMID: 39057592 PMCID: PMC11276841 DOI: 10.3390/healthcare12141449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
This perspective is focused on the evidence on human resources for health (HRH) solutions for immunization, as a part of a primary health care (PHC) approach.. In the wake of the COVID-19 pandemic and 50 years since the Expanded Program on Immunization (EPI) clocks 50 years since its inception. was initiated, evidence and experience demonstrate the significant HRH gaps in many countries and globally, and how countries are seeking innovative ways of closing them with limited resources. The aim of this perspective article is to highlight the growing gap between the needs and the realities related to health workforce for PHC, including immunization, and to call for increasing the visibility of HRH within global and national immunization agendas. This perspective highlights key guidelines and tools to improve HRH, such as integrating immunization and primary health care, addressing the mental health needs of the health workforce, addressing gender-related issues, rationalizing the roles and composition of PHC workforce teams, and meeting the surge requirements related to health emergencies.
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Affiliation(s)
- Folake Olayinka
- Public Health Institute, Via United States Agency for International Development’s Global Health Training, Advisory and Support Contract (GHTASC) Project, Washington, DC 20024, USA;
| | - Thomas S. O’Connell
- Department of Global and Environmental Health, New York University, New York, NY 10003, USA;
| | - Christopher Morgan
- Jhpiego, The Johns Hopkins University Affiliate, Baltimore, MD 21231, USA;
| | | | - Tokunbo Oshin
- High Impact Countries, Country Programmes Delivery, Gavi, The Vaccine Alliance, 1218 Geneva, Switzerland;
| | - Tova Tampe
- Special Programme on Primary Health Care, World Health Organization, 1211 Geneva, Switzerland;
| | - Alexandra Reed
- Public Health Institute, Via United States Agency for International Development’s Global Health Training, Advisory and Support Contract (GHTASC) Project, Washington, DC 20024, USA;
| | - Giorgio Cometto
- Health Workforce Department, World Health Organization, 1211 Geneva, Switzerland;
| | | | - Muhammad Ahmad Kazi
- Federal Directorate of Immunization, Government of Pakistan, Islamabad 44000, Pakistan;
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Nelson S, Ayaz B, Baumann AL, Dozois G. A gender-based review of workplace violence amongst the global health workforce-A scoping review of the literature. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003336. [PMID: 38954697 PMCID: PMC11218983 DOI: 10.1371/journal.pgph.0003336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/20/2024] [Indexed: 07/04/2024]
Abstract
Workplace violence (WPV) impacts all levels of the health workforce, including the individual provider, organization, and society. While there is a substantial body of literature on various aspects of WPV against the health workforce, gender-based WPV (GB-WPV) has received less attention. Violence in both the workplace and broader society is rooted in gendered socio-economic, cultural, and institutional factors. Developing a robust understanding of GB-WPV is crucial to explore the differing experiences, responses, and outcomes of GB-WPV with respect to gender. We conducted a scoping review and report on the prevalence and risk factors of GB-WPV in healthcare settings globally. The review followed the Preferred Reporting Items for Systematic and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We registered the scoping review protocol on the Open Science Framework on January 14, 2022, at https://osf.io/t4pfb/. A systematic search was conducted of empirical literature in five health and social science databases. Of 13667, 226 studies were included in the analysis. Across the studies, more women than men experienced non-physical violence, including verbal abuse, sexual harassment, and bullying. Men experienced more physical violence compared to women. Younger age, less experience, shifting duties, specific clinical settings, lower professional status, organizational hierarchy, and minority status were found to be sensitive to gender, reflecting women's structural disadvantages in the workplace. Given the high prevalence and impact of GB-WPV on women, we provided recommendations to address systemic issues in clinical practice, academia, policy, and research.
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Affiliation(s)
- Sioban Nelson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Basnama Ayaz
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Andrea L. Baumann
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Graham Dozois
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Craveiro I, Choudhury PK, de OLiveira APC, Pereira A, Fronteira I, Chança R, Cometto G, Poz MRD, Ferrinho P. Impacts of industrial actions, protests, strikes and lockouts by health and care workers during COVID-19 and other pandemic contexts: a systematic review. HUMAN RESOURCES FOR HEALTH 2024; 22:47. [PMID: 38956631 PMCID: PMC11221126 DOI: 10.1186/s12960-024-00923-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 05/17/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Public health emergencies of international concern (PHEICs) as the COVID-19 pandemic and others that have occurred since the early 2000s put enormous pressure on health and care systems. This is being a context for protests by health and care workers (HCWs) because of additional workload, working conditions and effects on mental and physical health. In this paper, we intended to analyze the demands of HCWs associated with industrial actions, protests, strikes and lockouts (IAPSLs) which occurred during COVID-19 pandemic and other PHEICs; to identify the impact of these grievances; and describe the relevant interventions to address these IAPSLs. METHODS We included studies published between January 2000 and March 2022 in PubMed, Embase, Scopus, BVS/LILACS, WHO's COVID-19 Research Database, ILO, OECD, HSRM, and Google Scholar for grey literature. Eligibility criteria were HCWs as participants, IAPSLs as phenomenon of interest occurring in the context of COVID-19 and other PHEICs. GRADE CERQual was used to assess risk of bias and confidence of evidence. RESULTS 1656 records were retrieved, and 91 were selected for full-text screening. We included 18 publications. A system-wide approach, rather than a limited approach to institutions on strike, makes it possible to understand the full impact of the strike on health and care services. PHEICs tend to aggravate already adverse working conditions of HCWs, acting as drivers for HCWs strikes, leading to staff shortages, and financial issues, both in the North and in the Global South, particularly evident in Asia and Africa. In addition, issues related to deficiencies in leadership and governance in heath sector and lack of medical products and technologies (e.g., lack of personal protective equipment) were the main drivers of strikes, each contributing 25% of the total drivers identified. CONCLUSIONS It is necessary to focus on the preparedness of health and care systems to respond adequately to PHEICs, and this includes being prepared for HCWs' IAPSLs, talked much in the context of COVID-19 pandemic. Evidence to assist policymakers in defining strategies to respond adequately to the health and care needs of the population during IAPSLs is crucial. The main impact of strikes is on the disruption of health care services' provision. Gender inequality being a major issue among HCWs, a proper understanding of the full impact of the strike on health and care services will only be possible if gender lens is combined with a systemic approach, rather than gender-undifferentiated approaches limited to the institutions on strike.
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Affiliation(s)
- Isabel Craveiro
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal.
| | - Pradeep Kumar Choudhury
- Zakir Husain Centre for Educational Studies, School of Social Sciences, Jawaharlal Nehru University, Room No. 234, New Delhi, India
| | - Ana Paula Cavalcante de OLiveira
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524, 7º Andar, Blocos D E E, Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Alessandra Pereira
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524, 7º Andar, Blocos D E E, Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Inês Fronteira
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal
- National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University of Lisbon, Avenida Padre Cruz, 1600-560, Lisbon, Portugal
| | - Raphael Chança
- Instituto Nacional de Cancer, Ministério da Saúde, Rua Marquês de Pombal, 125, Centro, Rio de Janeiro, RJ, 20230240, Brazil
| | - Giorgio Cometto
- Health Workforce Department, World Health Organization, Av. Appia 20, 1202, Geneva, Switzerland
| | - Mario Roberto Dal Poz
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524, 7º Andar, Blocos D E E, Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Paulo Ferrinho
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal
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Choi UY, Patterson P, Chinho N. Reducing the Burdens of Paid Caregivers of Older Adults by Using Assistive Technology: A Scoping Review. West J Nurs Res 2024; 46:315-326. [PMID: 38420931 PMCID: PMC10955782 DOI: 10.1177/01939459241234233] [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] [Indexed: 03/02/2024]
Abstract
BACKGROUND Paid caregivers are needed to support older adults, but caregiver burden contributes to high turnover rates. Assistive technologies help perform activities of daily living (ADLs) and can reduce caregiver burden, but little is known about how they impact paid caregivers. OBJECTIVE This scoping review provides an overview of evidence on using assistive technology to reduce burdens on paid caregivers working with older adults. DESIGN The review was conducted from May to August 2022. The eligibility criteria included: (1) publication within 5 years in peer-reviewed journals, (2) investigation of assistive technology, (3) main participants include paid caregivers supporting older adults, and (4) describing impacts on caregiver burden. Searches were conducted in 6 databases, generating 702 articles. The charted data included (1) country of study, (2) participant care roles, (3) study design, (4) main outcomes, and (5) types of assistive technology. Numerical description and qualitative content analysis of themes were used. RESULTS Fifteen articles reporting on studies in 9 countries were retained for analysis. Studies used a variety of quantitative (8/15), qualitative (5/15), and mixed (2/15) methods. Technologies studied included grab bars and handrails, bidet seats, bed transfer devices, sensor and monitoring systems, social communication systems, and companion robots. Articles identified benefits for reducing stress and workload, while paid caregivers described both positive and negative impacts. CONCLUSIONS Literature describing the impact of assistive technology on paid caregivers who work with older adults is limited and uses varied methodologies. Additional research is needed to enable rigorous evaluation of specific technologies and impacts on worker turnover.
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Affiliation(s)
- U Yeong Choi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Patrick Patterson
- AGE-WELL National Innovation Hub APPTA, Department of Community and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Norma Chinho
- AGE-WELL National Innovation Hub APPTA, Department of Community and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- AGE-WELL National Innovation Hub APPTA, Department of Community and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Boydell V, Gilmore K, Kaur J, Morris J, Wilkins R, Lurken F, Shaw S, Austen K, Karp M, Pairman S, Alcalde MA. Hostilities faced by people on the frontlines of sexual and reproductive health and rights: a scoping review. BMJ Glob Health 2023; 8:e012652. [PMID: 37949497 PMCID: PMC10649386 DOI: 10.1136/bmjgh-2023-012652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/11/2023] [Indexed: 11/12/2023] Open
Abstract
Frontline workers for sexual and reproductive health and rights (SRHR) provide life-changing and life-saving services to millions of people every year. From accompanying the pregnant, delivering babies and caring for the newborn to supporting those subjected to sexual violence; from treating debilitating infections to expanding contraceptive choices; from enabling access to safe abortion services to countering homophobia: all over the world frontline SRHR carers and advocates make it possible for so many more to experience dignity in sex, sexuality and reproduction. Yet they are also subjected to hostility for what they do, for whom they provide care, for where they work and for the issues they address. From ostracistion and harassment in the workplace to verbal threats and physical violence, hostilities can extend even into their private lives. In other words, as SRHR workers seek to fulfil the human rights of others, their own human rights are put at risk. Yet, as grave as that is, it is a reality largely undocumented and thus also underestimated. This scoping review sets out to marshal what is known about how hostilities against frontline SRHR workers manifest, against whom, at whose hands and in which contexts. It is based on review of six sources: peer-reviewed and grey literature, news reports, sector surveys, and consultations with sector experts and, for contrast, literature issued by opposition groups. Each source contributes a partial picture only, yet taken together, they show that hostilities against frontline SRHR workers are committed the world over-in a range of countries, contexts and settings. Nevertheless, the narratives given in those sources more often treat hostilities as 'one-off', exceptional events and/or as an 'inevitable' part of daily work to be tolerated. That works in turn both to divorce such incidents from their wider historical, political and social contexts and to normalise the phenomena as if it is an expected part of a role and not a problem to be urgently addressed. Our findings confirm that the SRHR sector at large needs to step-up its response to such reprisals in ways more commensurate with their scale and gravity.
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Affiliation(s)
- Victoria Boydell
- Institute of Women's Health, University College London, London, UK
| | - Kate Gilmore
- International Development Department, The London School of Economics and Political Science, London, UK
| | - Jameen Kaur
- International Federation of Gynecology and Obstetrics, London, UK
| | - Jessica Morris
- International Federation of Gynecology and Obstetrics, London, UK
| | | | - Frieda Lurken
- International Planned Parenthood Federation, London, UK
| | | | | | - Molly Karp
- International Confederation of Midwives, The Hague, Netherlands
| | - Sally Pairman
- International Confederation of Midwives, The Hague, The Netherlands
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Schaaf M, Lavelanet A, Codjia L, Nihlén Å, Rehnstrom Loi U. A narrative review of challenges related to healthcare worker rights, roles and responsibilities in the provision of sexual and reproductive services in health facilities. BMJ Glob Health 2023; 8:e012421. [PMID: 37918835 PMCID: PMC10626880 DOI: 10.1136/bmjgh-2023-012421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/07/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION This paper identifies and summarises tensions and challenges related to healthcare worker rights and responsibilities and describes how they affect healthcare worker roles in the provision of sexual and reproductive health (SRH) care in health facilities. METHOD The review was undertaken in a two-phase process, namely: (1) development of a list of core constructs and concepts relating to healthcare worker rights, roles and responsibilities to guide the review and (2) literature review. RESULT A total of 110 papers addressing a variety of SRH areas and geographical locations met our inclusion criteria. These papers addressed challenges to healthcare worker rights, roles and responsibilities, including conflicting laws, policies and guidelines; pressure to achieve coverage and quality; violations of the rights and professionalism of healthcare workers, undercutting their ability and motivation to fulfil their responsibilities; inadequate stewardship of the private sector; competing paradigms for decision-making-such as religious beliefs-that are inconsistent with professional responsibilities; donor conditionalities and fragmentation; and, the persistence of embedded practical norms that are at odds with healthcare worker rights and responsibilities. The tensions lead to a host of undesirable outcomes, ranging from professional frustration to the provision of a narrower range of services or of poor-quality services. CONCLUSION Social mores relating to gender and sexuality and other contested domains that relate to social norms, provider religious identity and other deeply held beliefs complicate the terrain for SRH in particular. Despite the particularities of SRH, a whole of systems response may be best suited to address embedded challenges.
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Affiliation(s)
- Marta Schaaf
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Antonella Lavelanet
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Laurence Codjia
- Department of Health Workforce, World Health Organization, Geneva, Switzerland
| | - Åsa Nihlén
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Ulrika Rehnstrom Loi
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Orth Z, Meyer Z, Singh S, Riha J. Breaking barriers and building bridges: reimagining a feminist health workforce. BMJ 2023; 381:p1268. [PMID: 37268315 DOI: 10.1136/bmj.p1268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Zaida Orth
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Zesca Meyer
- Eersterivier Hospital, Western Cape Department of Health, Cape Town, South Africa
| | - Sagri Singh
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
- Gender and Health, The United Nations University, International Institute for Global Health
| | - Johanna Riha
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
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Closser S, Sultan M, Tikkanen R, Singh S, Majidulla A, Maes K, Gerber S, Rosenthal A, Palazuelos D, Tesfaye Y, Finley E, Abesha R, Keeling A, Justice J. Breaking the silence on gendered harassment and assault of community health workers: an analysis of ethnographic studies. BMJ Glob Health 2023; 8:bmjgh-2023-011749. [PMID: 37208121 DOI: 10.1136/bmjgh-2023-011749] [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: 01/11/2023] [Accepted: 04/21/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Across a variety of settings, women in tenuous financial circumstances are drawn to community health work as a way to advance themselves in the context of limited employment options. Female Community Health Workers (CHWs) are often preferred because they can more easily access mothers and children; at the same time, gender norms are at the heart of many of the challenges and inequities that these workers encounter. Here, we explore how these gender roles and a lack of formal worker protections leave CHWs vulnerable to violence and sexual harassment, common occurrences that are frequently downplayed or silenced. METHODS We are a group of researchers who work on CHW programmes in a variety of contexts globally. The examples here are drawn from our ethnographic research (participant observation and in-depth interviews). RESULTS CHW work creates job opportunities for women in contexts where such opportunities are extremely rare. These jobs can be a lifeline for women with few other options. Yet the threat of violence can be very real: women may face violence from the community, and some experience harassment from supervisors within health programmes. CONCLUSION Taking gendered harassment and violence seriously in CHW programmes is critical for research and practice. Fulfilling CHWs' vision of health programmes that value them, support them and give them opportunities may be a way for CHW programmes to lead the way in gender-transformative labour practices.
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Affiliation(s)
- Svea Closser
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Marium Sultan
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Roosa Tikkanen
- Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway
| | - Shalini Singh
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Arman Majidulla
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kenneth Maes
- Anthropology, Oregon State University, Corvallis, Oregon, USA
| | - Sue Gerber
- Independent Consultant, Truchas, New Mexico, USA
| | - Anat Rosenthal
- Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Southern, Israel
| | - Daniel Palazuelos
- Blavatnik Institute of Global Health and Social Medicine, Harvard University, Cambridge, Massachusetts, USA
| | | | - Erin Finley
- Psychiatry and Behavioral Sciences, UT Health San Antonio, San Antonio, Texas, USA
| | - Roza Abesha
- Independent Consultant, Gondar, Amhara, Ethiopia
| | | | - Judith Justice
- Institute for Health and Aging, University of California at San Francisco, Berkeley, California, USA
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Ferrinho P, Patrício SR, Craveiro I, Sidat M. Is workplace violence against health care workers in Mozambique gender related? Int J Health Plann Manage 2023; 38:265-269. [PMID: 36451269 PMCID: PMC10100475 DOI: 10.1002/hpm.3603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Abstract
This report revisits data used to describe the typology and the perceived impact of violence against health care workers (VHCW) at the health services of the City of Lichinga in Mozambique, based on an observational, descriptive, cross-sectional study, carried out from March to May 2019. In this report we attempt to understand if our reanalysis of VHCW in Niassa can explain it as an example of gender-based violence. Our findings-particularly that women more than men reported not knowing if the health services had any policies or procedures to deal with VHCW, felt that they were not encouraged to report acts of VHCW and were more frequently threatened/violented by different sex aggressors-although not conclusive, support the need to consider gender as a dimension when conducting research on VHCW. If we do not do so, gender will continue to be an invisible and ignored dimension of intervention strategies to prevent and address VHCW.
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Affiliation(s)
- Paulo Ferrinho
- Research Center on Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Sérgio Roques Patrício
- Niassa Operational Research Unit, Provincial Health Department, Niassa Province, Lichinga, Mozambique
| | - Isabel Craveiro
- Research Center on Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Mohsin Sidat
- Research Center on Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.,Community Health Department, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
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Das P, Ramani S, Newton-Lewis T, Nagpal P, Khalil K, Gharai D, Das S, Kammowanee R. "We are nurses - what can we say?": power asymmetries and Auxiliary Nurse Midwives in an Indian state. Sex Reprod Health Matters 2022; 29:2031598. [PMID: 35171082 PMCID: PMC8856050 DOI: 10.1080/26410397.2022.2031598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
In India, nurses and midwives are key to the provision of public sexual and reproductive health services. Research on impediments to their performance has primarily focused on their individual capability and systemic resource constraints. Despite emerging evidence on gender-based discrimination and low professional acceptance faced by these cadres, little has been done to link these constraints to power asymmetries within the health system. We analysed data from an ethnography conducted in two primary healthcare facilities in an eastern state in India, using Veneklasen and Miller's expressions of power framework, to explore how power and gender asymmetries constrain performance and quality of care provided by Auxiliary Nurse Midwives (ANMs). We find that ANMs' low position within the official hierarchy allows managers and doctors to exercise "power over" them, severely curtailing their expression of all other forms of power. Disempowerment of ANMs occurs at multiple levels in interlinked and interdependent ways. Our findings contribute to the empirical evidence, advancing the understanding of gender as a structurally embedded dimension of power. We illustrate how the weak positioning of ANMs reflects their lack of representation in policymaking positions, a virtual absence of gender-sensitive policies, and ultimately organisational power structures embedded in patriarchy. By deepening the understanding of empowerment, the paper suggests implementable pathways to empower ANMs for improved performance. This requires addressing entrenched gender inequities through structural and organisational changes that realign power relations, facilitate more collaborative ways of exercising power, and create the antecedents to individual empowerment.
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Affiliation(s)
- Priya Das
- Consultant, Oxford Policy Management Limited, New Delhi, India. Correspondence:
| | - Sudha Ramani
- Senior Consultant, Oxford Policy Management Limited, New Delhi, India
| | | | - Phalasha Nagpal
- Assistant Consultant, Oxford Policy Management Limited, New Delhi, India
| | - Karima Khalil
- Senior Consultant, Oxford Policy Management Limited, New Delhi, India
| | - Dipanwita Gharai
- Nurse Researcher, Oxford Policy Management Limited, New Delhi, India
| | - Shamayita Das
- Nurse Researcher, Oxford Policy Management Limited, New Delhi, India
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Adamakos F. What are gender micro- and macroaggressions in medicine and what are the solutions? AEM EDUCATION AND TRAINING 2021; 5:e10615. [PMID: 34485801 PMCID: PMC8393186 DOI: 10.1002/aet2.10615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Frosso Adamakos
- Emergency MedicineMetropolitan‐Harlem Emergency Medicine ResidencyNew York Medical CollegeNew YorkNYUSA
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Amin A, Remme M, Allotey P, Askew I. Gender equality by 2045: reimagining a healthier future for women and girls. BMJ 2021; 373:n1621. [PMID: 34183331 PMCID: PMC8237157 DOI: 10.1136/bmj.n1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Gender equality is achievable and an imperative
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Affiliation(s)
- Avni Amin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Michelle Remme
- International Institute for Global Health at the United Nations University, Kuala Lumpur, Malaysia
| | - Pascale Allotey
- International Institute for Global Health at the United Nations University, Kuala Lumpur, Malaysia
| | - Ian Askew
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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