Health workers' perceptions of private-not-for-profit health facilities' organizational culture and its influence on retention in Uganda

The Role of Trust as a Driver of Private-Provider Participation in Disease Surveillance: Cross-Sectional Survey From Nigeria

BACKGROUND

Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny into private providers' intentions, motives, and obstacles to comply with an Integrated Disease Surveillance Response (IDSR) framework. Appreciation of how private providers' attitudes shape their tuberculosis (TB) notification behaviors can yield lessons for the surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among actors and institutions is an understudied part of the "software" of surveillance.

OBJECTIVE

We aimed to assess the self-reported knowledge, motivation, barriers, and TB case notification behavior of private health care providers to public health authorities in Lagos, Nigeria. We measured the concordance between self-reported notification, TB cases found in facility records, and actual notifications received.

METHODS

A representative, stratified sample of 278 private health care workers was surveyed on TB notification attitudes, behavior, and perceptions of public health authorities using validated scales. Record reviews were conducted to identify the TB treatment provided and facility case counts were abstracted from the records. Self-reports were triangulated against actual notification behavior for 2016. The complex health system framework was used to identify potential predictors of notification behavior.

RESULTS

Noncompliance with the legal obligations to notify infectious diseases was not attributable to a lack of knowledge. Private providers who were uncomfortable notifying TB cases via the IDSR system scored lower on the perceived benevolence subscale of trust. Health care workers who affirmed "always" notifying via IDSR monthly reported higher median trust in the state's public disease control capacity. Although self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, the self-report numbers did not tally with actual TB notifications.

CONCLUSIONS

Providers perceived both risks and benefits to recording and reporting TB cases. To improve private providers' public health behaviors, policy makers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. Renewed attention to the "software" of health systems (eg, norms, values, and relationships) is vital to address pandemic threats. Surveys with private providers may overestimate their actual participation in public health surveillance.

Nurses' perceptions of quality of work life in private hospitals in Enugu, Nigeria: A qualitative study

Despite being essential for retaining nurses, not much is known about nurses' quality of work life (QWL) in private hospitals in sub-Saharan Africa, including Nigeria. We explored nurses' perceptions of QWL, factors influencing it, how it affects motivation, and strategies for its improvement. The study was conducted in seven private hospitals in Enugu, Nigeria. The design was qualitative, using focus group discussion (n = 7) with registered nurses (n = 66) purposively selected using maximum variation sampling and the inclusion criteria. Data were analyzed using verbatim transcription and thematic analysis. The nurses understood QWL from work-family life, work design, work context and work world perspectives. Opportunities for skill acquisition, resource availability, helpfulness from colleagues, and a hygienic work environment improved the QWL and motivation of nurses. Work-family life factors including caring obligations, night shifts, long hours, burnout, and inappropriate leave policies; work design factors including declining autonomy, inadequate staffing, and a high workload; work context factors consisting of a lack of participatory decision-making, blaming nurses for gaps, restrictive training policy, limited training opportunity, and insecurity; and work world factors related to poor remuneration, poor community view of nursing and ease of job termination undermined QWL and demotivated nurses. Strategies identified by the nurses to improve QWL included improving staffing, vacation, care coordination, supportive supervision, teamwork, promotion, participatory decision-making, training opportunities, timely hand-over of shifts, job recognition, and compensation. The quality of nursing work life in private hospitals in Enugu needs improvement. Quality improvement programs addressing the barriers to nurses' QWL are warranted.

Support model for nurses caring for people living with HIV and AIDS in the Limpopo province, South Africa

BACKGROUND

Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) caregiving has created a foundation for stress and burnout amongst nurses as they are burdened by the increased workload of HIV and AIDS care.

OBJECTIVES

This study aimed to develop a support model for nurses caring for people living with HIV and AIDS (PLWH).

METHOD

The study employed concept analysis and the identified concept of interest within the caring context of HIV and AIDS was conceptualised using six elements of practice-oriented theory, namely, the context, agent, recipient, dynamic, procedure and purpose.

RESULTS

The framework consisted of six components: health service and legislative (context); nursing service managers (agents); nurses (recipients); decreasing power imbalance, participative and transformational leadership and trust (dynamics); initiation of support process through teamwork and mutual goal-setting, implementation and sustenance through reflections, monitoring and evaluation (process) and empowered nurses (outcome).

CONCLUSION

Poor organisational support deteriorates the quality of nurses' lives on a personal level and imposes a direct economic cost on the employer by decreasing overall nursing workforce productivity. The conceptual framework could be a guide to support nurses in healthcare services regarding the management of HIV and AIDS in the workplace.

Knowledge, Attitudes, and Practices Regarding COVID-19 among Healthcare Workers in Uganda: A Cross-Sectional Survey

Healthcare workers (HCWs) are at high risk of COVID-19. However, data on HCWs' knowledge, attitudes, and practices (KAP) toward COVID-19 are limited. Between September and November 2020, we conducted a questionnaire-based COVID-19 KAP survey among HCWs at three hospitals in Uganda. We used Bloom's cut-off of ≥80% to determine sufficient knowledge, good attitude, and good practice, and multivariate Poisson regression with robust variance for statistical analysis. Of 717 HCWs invited to participate, 657 (91.6%) agreed and were enrolled. The mean age (standard deviation) of enrollees was 33.2 (10.2) years; most were clinical HCWs (64.7%) and had advanced secondary school/other higher-level education (57.8%). Overall, 83.9% had sufficient knowledge, 78.4% had a positive attitude, and 37.0% had good practices toward COVID-19. Factors associated with KAP were: Knowledge: being a clinical HCW (aRR: 1.12; 95% CI: 1.02-1.23) and previous participation in health research (aRR: 1.10; 95% CI: 1.04-1.17); Attitude: age > 35 years (aRR: 0.88; 95% CI: 0.79-0.98); Practice: being a clinical HCW (aRR: 1.91; 95% CI: 1.41-2.59). HCWs in Uganda have good knowledge and positive attitude but poor practices towards COVID-19. Differences in COVID-19 KAP between clinical and non-clinical HCWs could affect uptake of COVID-19 interventions including vaccination.

Empirical evaluation on the effect of enterprise quality immune response based on EMIBSGTD-TAS

Effective enterprise quality immune response can grasp the “pathogenesis”, “clinical manifestations” and “treatment” of enterprise quality dissident factors, which is the goal pursued continuously by enterprise quality management. Drawing on the theory of enterprise immunity, construct the evaluation index system of enterprise quality immune response effect, and use the evaluation model of interval binary semantic grey target decision based on two-dimensional association sampling (EMIBSGTD-TAS) to evaluate the quality immune response effect of the selected target company. The boundary and internal distribution situation weaken the influence of the extreme value of the index on the decision result, and introduce the interval binary semantic set value statistical method to determine the index weight, reduce the information loss and fuzzy error. It can be seen from the evaluation results that the model has practicability and feasibility, and provides a new idea for the evaluation of the effect of enterprise quality immune response.

Willingness to participate in COVID-19 vaccine trials; a survey among a population of healthcare workers in Uganda

BACKGROUND

Healthcare workers (HCWs) are at high risk of acquiring SARS-CoV-2 and COVID-19 and may therefore be a suitable population for COVID-19 vaccine trials. We conducted a survey to evaluate willingness-to-participate in COVID-19 vaccine trials in a population of HCWs at three hospitals in Uganda.

METHODS

The survey was conducted between September and November 2020. Using a standardised questionnaire, data were collected on socio-demographics, previous participation in health research, COVID-19 information sources, underlying health conditions, and willingness-to-participate in COVID-19 vaccine trials. Data were analysed descriptively and a binomial generalised linear model with a log link function used to investigate factors associated with unwillingness to participate.

RESULTS

657 HCWs (female, 63%) were enrolled with a mean age of 33 years (Standard Deviation, 10). Overall willingness-to-participate was 70.2%. Key motivating factors for participation were: hope of being protected against COVID-19 (81.1%), altruism (73.3%), and the opportunity to get health care (26.0%). Selected hypothetical trial attributes reduced willingness-to-participate as follows: weekly-quarterly study visits over a 12-month period (70.2%-63.2%, P = 0.026); provision of approximately 50ml of blood at each study visit (70.2%-63.2%, P = 0.026); risk of mild-moderate local adverse reactions (70.2%-60.3%, P<0.001); chance of receiving candidate vaccine or placebo (70.2%-56.9%, P<0.001); and delay of pregnancy [Overall, 70.2%-57.1% P<0.001); Female, 62.8%-48.4% (P = 0.002); Male, 82.5%-71.5% (P = 0.003)]. Collectively, these attributes reduced willingness-to-participate from [70.2%-42.2% (P<0.001) overall; 82.5%-58.1% (P<0.001) in men; 62.8%-32.6% (P<0.001) in women]. Among individuals that were unwilling to participate, the commonest barriers were concerns over vaccine safety (54.6%) and fear of catching SARS-CoV-2 (31.6%). Unwillingness to participate was associated with being female (aRR 1.97, CI 1.46-2.67, P<0.001) and having university or other higher-level education (aRR 1.52, CI 1.05-2.2, P = 0.026).

CONCLUSIONS

Willingness-to-participate in COVID-19 vaccine trials among HCWs in Uganda is high but may be affected by vaccine trial requirements and concerns about the safety of candidate vaccines.

Values statements

Purpose

This paper aims to examine 611 values statements to determine if values statements contain characteristics of organizational culture as provided by Denison and Mishra (1995). The general hypothesis given is there is a relationship between values statements and culture characteristics. Four testable hypotheses, one for each of Denison and Mishra’s (1995) characteristics, are created and tested.

Design/methodology/approach

The process in testing the hypotheses had two components. First, a taxonomy of the values statements had to be determined. This involved using natural language characteristics rather than predetermined classes to create a taxonomy based on the language itself. Second, a custom dictionary for each characteristic had to be created based on Neuendorf (2017) to perform content analysis. Once the values statements were coded with a taxonomic classification and with culture characteristics, a Chi-Square test was performed to determine a relationship between the statement type and the cultural characteristic, and then a multinomial regression test was performed to determine strength and direction of the relationships.

Findings

The tests for all four hypotheses produced significant results in the Chi-Square test. The multinomial regression tests showed primarily that Business statements types often lack adaptability and stakeholder involvement cultural elements. Additionally, Religion statement types are positively related to adaptability and mission.

Research limitations/implications

This paper creates a taxonomy and supplies the rules for classification. Values statements can now be classified using those rules and the classification used in analysis. Additionally, as values statements span over organizational culture, strategic management and strategic communication, these statements become a focal point for studying multiple topics across these fields. More particularly, finding the negative relationship between the Adaptability characteristic with the Business statement type and the involvement characteristic with the Business statement type may provide a cultural explanation for many mixed result studies on organizational success.

Practical implications

Organizational culture can be displayed by way of values statements and can potentially affect organizational strategy and organizational communication. Wording is extremely important in creating a values statement, and that statement must clearly reflect the cultural values of the organization.

Originality/value

First, this paper creates a taxonomy of values statements that is far more complete than anything created before. Second, by examining language, this paper discovers a link between organizational culture, strategic management and strategic communication.