Undergraduate students' contributions to health service delivery through community-based education: A qualitative study by the MESAU Consortium in Uganda

Explaining of existing challenges of community-based undergraduate nursing education in Iran: a qualitative study

BACKGROUND

The education of nursing students should be such that the health needs of the community are met, but in Iran, due to some problems, students do not receive such education. Therefore, the present study was conducted to explain the existing challenges of community-based undergraduate nursing education in Iran.

METHODS

Ten individual semi-structured interviews were conducted with the faculty members and nursing specialists in this qualitative study. Eight focus group interviews were conducted to the nurses and nursing students using a purpose-based sampling method in 2022. The interviews were recorded and transcribed and then content analysis was done by the Lundman and Granheim method.

RESULTS

Five themes were obtained from the analysis of participants' responses, which include "weakness in community-based nursing education and curriculum", "treatment-oriented health system and education", "defect in the infrastructure and basic structures of community-based nursing education", "weakness in the implementation of community-based nursing education" and "weakness in the stakeholder engagement and cooperation of interested organizations".

CONCLUSION

Interviews with the participants provided a vision of the challenges of community-based nursing education so that the reviewers of the undergraduate nursing curriculum in the ministry and nursing schools, educators, policymakers and nursing managers can use the results of the present study to improve the quality of education and the effective use of nursing students in responding to the community's needs and provide a proper context for improving students' learning.

Increasing the availability of health workers in rural sub-Saharan Africa: a scoping review of rural pipeline programmes

INTRODUCTION

Rural pipeline approach has recently gain prominent recognition in improving the availability of health workers in hard-to-reach areas such as rural and poor regions. Understanding implications for its successful implementation is important to guide health policy and decision-makers in Sub-Saharan Africa. This review aims to synthesize the evidence on rural pipeline implementation and impacts in sub-Saharan Africa.

METHODS

We conducted a scoping review using Joanna Briggs Institute guidebook. We searched in PubMed and Google scholar databases and the grey literature. We conducted a thematic analysis to assess the studies. Data were reported following the PRISMA extension for Scoping reviews guidelines.

RESULTS

Of the 443 references identified through database searching, 22 met the inclusion criteria. Rural pipeline pillars that generated impacts included ensuring that more rural students are selected into programmes; developing a curriculum oriented towards rural health and rural exposure during training; curriculum oriented to rural health delivery; and ensuring retention of health workers in rural areas through educational and professional support. These impacts varied from one pillar to another and included: increased in number of rural health practitioners; reduction in communication barriers between healthcare providers and community members; changes in household economic and social circumstances especially for students from poor family; improvement of health services quality; improved health education and promotion within rural communities; and motivation of community members to enrol their children in school. However, implementation of rural pipeline resulted in some unintended impacts such as perceived workload increased by trainee's supervisors; increased job absenteeism among senior health providers; patients' discomfort of being attended by students; perceived poor quality care provided by students which influenced health facilities attendance. Facilitating factors of rural pipeline implementation included: availability of learning infrastructures in rural areas; ensuring students' accommodation and safety; setting no age restriction for students applying for rural medical schools; and appropriate academic capacity-building programmes for medical students. Implementation challenges included poor preparation of rural health training schools' candidates; tuition fees payment; limited access to rural health facilities for students training; inadequate living and working conditions; and perceived discrimination of rural health workers.

CONCLUSION

This review advocates for combined implementation of rural pipeline pillars, taking into account the specificity of country context. Policy and decision-makers in sub-Saharan Africa should extend rural training programmes to involve nurses, midwives and other allied health professionals. Decision-makers in sub-Saharan Africa should also commit more for improving rural living and working environments to facilitate the implementation of rural health workforce development programmes.

What improves access to primary healthcare services in rural communities? A systematic review

BACKGROUND

To compile key strategies from the international experiences to improve access to primary healthcare (PHC) services in rural communities. Different innovative approaches have been practiced in different parts of the world to improve access to essential healthcare services in rural communities. Systematically collecting and combining best experiences all over the world is important to suggest effective strategies to improve access to healthcare in developing countries. Accordingly, this systematic review of literature was undertaken to identify key approaches from international experiences to enhance access to PHC services in rural communities.

METHODS

All published and unpublished qualitative and/or mixed method studies conducted to improvement access to PHC services were searched from MEDLINE, Scopus, Web of Science, WHO Global Health Library, and Google Scholar. Articles published other than English language, citations with no abstracts and/or full texts, and duplicate studies were excluded. We included all articles available in different electronic databases regardless of their publication years. We assessed the methodological quality of the included studies using mixed methods appraisal tool (MMAT) version 2018 to minimize the risk of bias. Data were extracted using JBI mixed methods data extraction form. Data were qualitatively analyzed using emergent thematic analysis approach to identify key concepts and coded them into related non-mutually exclusive themes.

RESULTS

Our analysis of 110 full-text articles resulted in ten key strategies to improve access to PHC services. Community health programs or community-directed interventions, school-based healthcare services, student-led healthcare services, outreach services or mobile clinics, family health program, empanelment, community health funding schemes, telemedicine, working with traditional healers, working with non-profit private sectors and non-governmental organizations including faith-based organizations are the key strategies identified from international experiences.

CONCLUSION

This review identified key strategies from international experiences to improve access to PHC services in rural communities. These strategies can play roles in achieving universal health coverage and reducing disparities in health outcomes among rural communities and enabling them to get healthcare when and where they want.

Impact of interprofessional service-learning on the effectiveness of knowledge transfer of antimicrobial resistance to Hong Kong elders: a quasi-experiment

Background

Community perception on antimicrobials plays a role in driving the development of antimicrobial resistance (AMR). The aim of the study was to evaluate the impact of interprofessional service-learning on the effectiveness of AMR knowledge transfer in Hong Kong elders aged 65 or above and students from university and secondary schools.

Methods

A quasi-experimental pretest–posttest controlled study was carried out from July 2018 to March 2019 for elderly subjects and a pre- and post-test were conducted in students from May to August 2018. Elderly subjects were recruited from the university-based community outreach program. The community outreach team consisted of both university and secondary school students. Students were provided with training of geriatric care and AMR before they reached out to the community. The one-to-one intervention with the aid of video and verbal explanation to educate the elderly about the definition, causes, and consequences of AMR, and preventive measures against AMR was provided. Questionnaires on knowledge of antibiotics and AMR were used as tools to reflect on the effectiveness for both students and elderly subjects. The questionnaire was completed twice, before and 1 week after the intervention. Chi-square test, t tests and regression analysis were used to analyze the data.

Results

A total of 93 Chinese elders, 61 of them in the intervention group and 32 in the control group participated in the study. The score obtained by the intervention group increased from 40.1 to 83.3% (p < 0.001) following intervention, while that of control group increased from 33.0 to 44.0% (p < 0.001). The increase attained in the intervention group was significantly greater than that of the control group (p < 0.001). A total of 95 secondary students and 88 university students have completed the pre-post questionnaires with 42.21% and 13% increment in AMR knowledge after the training (p < 0.001).

Conclusion

The significant change in knowledge level showed effective AMR knowledge transfer to both elders and students. The study could be used as a reference when allocating resources to implement effective interprofessional service-learning for better community health education in elderly populations.

Trial registration: This study was approved by the Chinese University of Hong Kong Survey and Behavioural Research Ethics Committee in December 2018 (Ref no. SBRE-18-214).

Consequences, conditions and caveats: a qualitative exploration of the influence of undergraduate health professions students at distributed clinical training sites

BACKGROUND

Traditionally, the clinical training of health professionals has been located in central academic hospitals. This is changing. As academic institutions explore ways to produce a health workforce that meets the needs of both the health system and the communities it serves, the placement of students in these communities is becoming increasingly common. While there is a growing literature on the student experience at such distributed sites, we know less about how the presence of students influences the site itself. We therefore set out to elicit insights from key role-players at a number of distributed health service-based training sites about the contribution that students make and the influence their presence has on that site.

METHODS

This interpretivist study analysed qualitative data generated during twenty-four semi-structured interviews with facility managers, clinical supervisors and other clinicians working at eight distributed sites. A sampling grid was used to select sites that proportionally represented location, level of care and mix of health professions students. Transcribed data were subjected to thematic analysis. Following an iterative process, initial analyses and code lists were discussed and compared between team members after which the data were coded systematically across the entire data set.

RESULTS

The clustering and categorising of codes led to the generation of three over-arching themes: influence on the facility (culturally and materially); on patient care and community (contribution to service; improved patient outcomes); and on supervisors (enriched work experience, attitude towards teaching role). A subsequent stratified analysis of emergent events identified some consequences of taking clinical training to distributed sites. These consequences occurred when certain conditions were present. Further critical reflection pointed to a set of caveats that modulated the nature of these conditions, emphasising the complexity inherent in this context.

CONCLUSIONS

The move towards training health professions students at distributed sites potentially offers many affordances for the facilities where the training takes places, for those responsible for student supervision, and for the patients and communities that these facilities serve. In establishing and maintaining relationships with the facilities, academic institutions will need to be mindful of the conditions and caveats that can influence these affordances.

Students' perceptions on community-based education at Avalon University School of Medicine during the first two years of the program

This article was migrated. The article was marked as recommended. Objectives The socio-cultural learning theory can be divided into a social and cultural process. Learner's learning occurs within the context rather than anticipating and preparing for the future context. It may happen in the workplace through apprenticeship, experiential learning, or community-based learning. Community-based education and community services have always been part of the students' volunteer services at Avalon University School of Medicine. The importance of community-based education has led to its recent integration into the curriculum. The objective of this study is to observe the community services in the field and to record the perceptions of students regarding community-based education at Avalon University School of Medicine. Methods This is a qualitative study. The research was conducted in the form of an observational study and framework analysis was done. The community-based education and community services were observed and recorded along with individual interviews. Students from different semesters were selected randomly for the interviews. The interviews were audio-recorded and transcribed. Results All interviewed students (100%) reported that they are involved in community services. 53.8% of students were not able to recognize the health issues of Curacao. 84.6% of students recognized and acknowledged the local health issues after reminding them of the activities conducted in the community services. 84.6% of students believed community services enhanced their clinical skills and increased their confidence in communication skills. Conclusion Community-based education enhances the competency of future physicians in clinical and communication skills.

Influence of community-based education on undergraduate health professions students' decision to work in underserved areas in Uganda

Background

Uganda is beset by a shortage of health workers and the few available are mal-distributed. Providing rural exposure through community-based education could positively influence students’ perspectives towards work in rural areas. We aimed to assess the impact of Community-Based Education and Research (COBERS) on health professions students’ attitudes towards working in rural areas. This was a before-and-after study among 525 students of 4 medical universities in Uganda. Data was collected using self-administered paper-based questionnaires. Logistic regression and Poisson regression respectively were used to assess intention and intended number of years of work in rural areas.

Results

Before COBERS, 228/518 (44.0%) students indicated that they intended to work in rural areas as compared to 245/506 (48.4%) after the COBERS placement. Before the COBERS placement, the factors that were associated with students considering to work in a rural area were: extra allowance (OR = 0.2; 95% CI 0.1–0.6), and availability of social amenities (OR = 0.2; 95% CI 0.1–0.7). After their COBERS placement, the factors were: access to long distance courses (OR = 2.0; 95% CI 1.0–3.7) and being posted to a facility in a rural area (OR = 15.0; 95% CI 6.5–35.5). Before the COBERS placement the factors that influenced how long students thought they would be willing to work in a rural environment were: reliable electricity (IRR = 0.6; 95% CI 0.3–1.0) and Internet (IRR = 1.5; 95% CI 1.0–2.3), high salary (IRR = 0.4; 95% CI 0.3–0.7), and having skills to practice in rural settings (IRR = 2.0; 95% CI 1.3–3.1). Reliable electricity (IRR = 0.5; 95% CI 0.3–0.8) and long distance courses (IRR = 2.1; 95% CI 1.4–3.1) were significant motivators after having undergone the COBERS placement.

Conclusions

The majority of health professions students do not intend to work in rural areas after they graduate. Improving the welfare of health professionals working in rural areas could attract more health professionals to rural areas thus addressing the maldistribution of health workers in Uganda.

Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries

PURPOSE

African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities.

METHOD

Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences.

RESULTS

The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students.

CONCLUSIONS

Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments.