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Galárraga O, Quijano-Ruiz A, Faytong-Haro M. The Effects of Mobile Primary Health Teams: Evidence from the Médico del Barrio Strategy in Ecuador. WORLD DEVELOPMENT 2024; 181:106659. [PMID: 38911668 PMCID: PMC11192489 DOI: 10.1016/j.worlddev.2024.106659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Starting in 2017, Ecuador gradually expanded its primary healthcare access program nationwide using mobile traveling healthcare teams through the Estrategia Médico del Barrio (EMB) [or Neighborhood Doctor Strategy]. EMB teams, composed of a primary care physician, a nurse, and a community health worker, made home visits in marginalized areas. We estimate the impact of the EMB on health and utilization outcomes using nationally representative household surveys for 2006 (N=55,666), 2012-13 (N=92,500) and 2018-19 (N=168,747). The treatment variable at the extensive margin is any exposure to EMB at the canton level. At the intensive margin, we use exposure in terms of weeks covered by EMB and the number and composition of EMB personnel per 1000 population. We identify outcomes of treated vs. non- or partially-treated cantons based on the random combination of the timing of the start of the program's implementation and the timing of the survey interview, which varied across cantons. We use difference-in-difference (DD) and difference-in-difference-in-difference (DDD) frameworks, the latter for cantons with high indigenous concentration. We find significant effects on the reported health problem and preventive care, but mixed results in terms of curative healthcare. The DDD specification shows that EMB improved health problem diagnoses and preventive healthcare utilization, including in highly indigenous cantons, yet it seemed to have had mixed results in terms of curative care use in Ecuador. Various alternative specifications and robustness tests do not qualitatively alter the main findings.
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Affiliation(s)
| | - Alonso Quijano-Ruiz
- Ecuadorian Development Research Lab, Guayaquil, Ecuador
- The Wang Yanan Institute for Studies in Economics, Xiamen University, Xiamen, China
| | - Marco Faytong-Haro
- Ecuadorian Development Research Lab, Guayaquil, Ecuador
- Pennsylvania State University, State College, PA, USA
- Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador
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Aryal A, Clarke-Deelder E, Phommalangsy S, Kounnavong S, Fink G. Health system inequities in Lao People's Democratic Republic: Evidence from a nationally representative phone survey. Trop Med Int Health 2024; 29:518-525. [PMID: 38685885 DOI: 10.1111/tmi.13997] [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: 05/02/2024]
Abstract
BACKGROUND Despite substantial economic growth in Lao People's Democratic Republic (PDR) over the past 20 years, high levels of income inequality and poverty persist and have likely been exacerbated by the COVID-19 pandemic. In this article, we use novel survey data to assess the extent to which socioeconomic status is associated with access to quality care in Lao PDR. METHODS We utilised data from the Lao People's Voice Survey (PVS), which was designed to measure health system performance from the perspective of the population. The survey was conducted between May and August 2022. Primary outcomes of interest were having a usual source of healthcare, using a government health centre (rather than a hospital or private clinic) as the usual source for care, receiving preventive health services, experiencing unmet healthcare needs, the quality of recent healthcare visit, and confidence in accessing and affording healthcare when needed. Poverty was measured using household asset ownership. We used logit models to assess the associations between poverty and health system performance measures, and additionally assessed differences between these associations in urban vs. rural areas by interacting urban residence with poverty. RESULTS Poverty was negatively associated with having a regular provider for care (adjusted odds ratio (aOR) 0.45, 95% CI 0.26-0.78), receiving preventive health services (aOR 0.54, 95% CI 0.37-0.80), and confidence in the ability to receive care (aOR 0.50, 95% CI 0.34-0.72) and afford care (aOR 0.50, 95% CI 0.34-0.73) when needed. Poverty was positively associated with using government managed health centres as a usual source or for care (aOR 2.16, 95% CI 1.35-3.48). Poverty was not significantly associated with user experience or perceived quality of care in the last visit to the health facility. No differences in the associations between poverty and access to quality care were found between rural and urban settings. CONCLUSIONS The results presented in this article suggest socioeconomic disparities in health care access in Lao PDR despite major national efforts to provide universal access to care. Universal health care policies may not be reaching the poor and additional targeted efforts may be needed to meet their healthcare needs.
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Affiliation(s)
- Amit Aryal
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Emma Clarke-Deelder
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Ebob Besem E O M, Chestnutt EG, Donovan L, Stratil AS, Counihan H, Nkfusai CN, Hawkings H, Homolova B, Maxwell K, Baker K, Zoungrana Y, Tanue EA, Ayuk G, Modjenpa NB, Metuge A, Nganmou I, Achu D, Wanji S, Berryman E, Omam LA. Exploring existing malaria services and the feasibility of implementing community engagement approaches amongst conflict-affected communities in Cameroon: a qualitative study. Malar J 2024; 23:155. [PMID: 38769514 PMCID: PMC11107007 DOI: 10.1186/s12936-024-04934-x] [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: 10/09/2023] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Cameroon is one of the countries with the highest burden of malaria. Since 2018, there has been an ongoing conflict in the country, which has reduced access to healthcare for populations in affected regions, and little is known about the impact on access to malaria services. The objective of this study was to understand the current situation regarding access to malaria services in Cameroon to inform the design of interventions to remove barriers and encourage the use of available services. METHODS A qualitative research study was carried out to understand the barriers preventing communities accessing care, the uptake of community health worker (CHW) services, and to gather perceptions on community engagement approaches, to assess whether these could be an appropriate mechanism to encourage uptake of community health worker (CHW) services. Twenty-nine focus group discussions and 11 in-depth interviews were carried out between May and July 2021 in two regions of Cameroon, Southwest and Littoral. Focus group discussions were held with CHWs and community members and semi-structured, in-depth interviews were conducted with key stakeholders including regional government staff, council staff, community leaders and community-based organisations. The data were analysed thematically; open, descriptive coding was combined with exploration of pre-determined investigative areas. RESULTS The study confirmed that access to healthcare has become increasingly challenging in conflict-affected areas. Although the Ministry of Health are providing CHWs to improve access, several barriers remain that limit uptake of these services including awareness, availability, cost, trust in competency, and supply of testing and treatment. This study found that communities were supportive of community engagement approaches, particularly the community dialogue approach. CONCLUSION Communities in conflict-affected regions of Cameroon continue to have limited access to healthcare services, in part due to poor use of CHW services provided. Community engagement approaches can be an effective way to improve the awareness and use of CHWs. However, these approaches alone will not be sufficient to resolve all the challenges faced by conflict-affected communities when accessing health and malaria services. Additional interventions are needed to increase the availability of CHWs, improve the supply of diagnostic tests and treatments and to reduce the cost of treatment for all.
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Affiliation(s)
- Margaret Ebob Besem E O
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, Cameroon
| | | | - Laura Donovan
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Ann-Sophie Stratil
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Helen Counihan
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Claude Ngwayu Nkfusai
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
- Department of Public Health, School of Nursing and Public Health, University of Kwa-Zulu Natal, Durban, South Africa
| | - Helen Hawkings
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Blanka Homolova
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Kolawole Maxwell
- Malaria Consortium Nigeria, No 33 Pope John Paul Street, Off Gana Street, Maitama, Abuja, FCT, Nigeria
| | - Kevin Baker
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
- Karolinksa Institute, Nobels Väg 15 A, 171 77, Stockholm, Sweden
| | - Yakouba Zoungrana
- Malaria Consortium Nigeria, No 33 Pope John Paul Street, Off Gana Street, Maitama, Abuja, FCT, Nigeria
| | - Elvis Asangbeng Tanue
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, Cameroon
- Reach Out Cameroon (REO), P.O Box 88, Buea, Cameroon
| | - Glennise Ayuk
- Reach Out Cameroon (REO), P.O Box 88, Buea, Cameroon
| | | | - Alain Metuge
- Reach Out Cameroon (REO), P.O Box 88, Buea, Cameroon
| | | | - Dorothy Achu
- National Malaria Control Programme, Ministry of Public Health, Yaoundé, Cameroon
| | - Samuel Wanji
- Department for Microbiology and Parasitology at the University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Elizabeth Berryman
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK.
| | - Lundi-Anne Omam
- Reach Out Cameroon (REO), P.O Box 88, Buea, Cameroon
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Yslado Mendez RM, Sanchez-Broncano J, Mendoza Ramirez GD, Villarreal-Zegarra D. Prevalence and factors associated with burnout syndrome in Peruvian health professionals before the COVID-19 pandemic: A systematic review. Heliyon 2024; 10:e30125. [PMID: 38726126 PMCID: PMC11078627 DOI: 10.1016/j.heliyon.2024.e30125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Burnout syndrome (BS) is a prevalent occupational health problem in health professionals. To describe the prevalence and factors associated with BS in Peruvian health professionals. Method A systematic review and meta-analysis were performed. The key terms "burnout" and "professional exhaustion" were used with words related to Peru. The databases consulted were LILACS/Virtual Health Library, Medline/PubMed, Science Direct, EBSCO, Scopus, SciELO, and RENATI-SUNEDU; articles published between January 2000 to December 2020 were considered for inclusion. Methodological quality was evaluated using the Newcastle-Ottawa scale. Results Thirty studies were identified (8 scientific articles and 22 graduate theses). The median sample size was 78, with an interquartile range of 50-110. A meta-analysis was performed to calculate a dichotomic prevalence of burnout syndrome in health professionals of 25 % (95%CI: 9 %-45 %; I2 = 97.14 %; 5 studies). Also, our meta-analysis estimated the overall prevalence of mild burnout (27 %; 95%CI: 16%-41 %; I2 = 96.50 %), moderate burnout (48 %; 95%CI: 32%-65 %; I2 = 97.54 %), and severe burnout (17 %; 95%CI: 10%-24 %; I2 = 92.13 %; 18 studies). We present meta-analyses by region, profession, hospital area, and by dimension of the Maslach Burnout Inventory. Overall, the studies presented adequate levels of quality in 96.7 % of the included studies (n = 29). In addition, our narrative review of factors associated with BS and its three dimensions identified that different studies find associations with labor, socio-demographic, individual, and out-of-work factors. Conclusions There is a higher prevalence of moderate BS in Peruvian health professionals at MINSA and EsSalud hospitals in Peru, with severity differing by region of Peru, type of profession, work area, and dimensions of BS.
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Tiruneh MG, Fenta ET, Endeshaw D, Delie AM, Adal O, Tareke AA, Bogale EK, Anagaw TF. Health extension service utilization in Ethiopia: systematic review and meta-analysis. BMC Health Serv Res 2024; 24:537. [PMID: 38671447 PMCID: PMC11046976 DOI: 10.1186/s12913-024-11038-4] [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] [Received: 11/18/2023] [Accepted: 04/24/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Ethiopia strives to achieve Universal Health Coverage (UHC) through Primary Health Care (PHC) by expanding access to services and improving the quality and equitable comprehensive health services at all levels. The Health Extension Program (HEP) is an innovative strategy to deliver primary healthcare services in Ethiopia and is designed to provide basic healthcare to approximately 5000 people through a health post (HP) at the grassroots level. Thus, this review aimed to assess the magnitude of health extension service utilization in Ethiopia. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist guideline was used for this review and meta-analysis. The electronic databases (PubMed, Cochrane Library, and African Journals Online) and search engines (Google Scholar and Grey literature) were searched to retrieve articles by using keywords. The Joanna Briggs Institute (JBI) meta-analysis of statistics assessment and review instrument was used to assess the quality of the studies. Heterogeneity was assessed using the I2 statistic. The meta-analysis with a 95% confidence interval using STATA 17 software was computed to present the pooled utilization of health extension services. Publication bias was assessed by visually inspecting the funnel plot and statistical tests using Egger's and Begg's tests. RESULT 22 studies were included in the systematic review with a total of 28,171 participants, and 8 studies were included in the meta-analysis. The overall pooled magnitude of health extension service utilization was 58.5% (95% CI: 40.53, 76.48%). In the sub-group analysis, the highest pooled proportion of health extension service utilization was 60.42% (28.07, 92.77%) in the mixed study design, and in studies published after 2018, 59.38% (36.42, 82.33%). All studies were found to be within the confidence interval of the pooled proportion of health extension service utilization in leave-out sensitivity analysis. CONCLUSIONS The utilization of health extension services was found to be low compared to the national recommendation. Therefore, policymakers and health planners should come up with a wide variety of health extension service utilization strategies to achieve universal health coverage through the primary health care.
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Affiliation(s)
- Misganaw Guadie Tiruneh
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia.
| | - Eneyew Talie Fenta
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Destaw Endeshaw
- Department of Adult Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amare Mebrat Delie
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Ousman Adal
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abiyu Abadi Tareke
- Amref Health Africa in Ethiopia, SLL project COVID-19/EPI technical assistant at West Gondar Zonal Health Department, Gondar, Ethiopia
| | - Eyob Ketema Bogale
- Department of Health Promotion and Behavioral Sciences, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, PO. Box.079, Bahir Dar, Ethiopia
| | - Tadele Fentabel Anagaw
- Department of Health Promotion and Behavioral Sciences, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, PO. Box.079, Bahir Dar, Ethiopia
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Tikkanen RS, Closser S, Prince J, Chand P, Justice J. An anthropological history of Nepal's Female Community Health Volunteer program: gender, policy, and social change. Int J Equity Health 2024; 23:70. [PMID: 38614976 PMCID: PMC11015651 DOI: 10.1186/s12939-024-02177-5] [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: 12/28/2023] [Accepted: 04/06/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Community health workers (CHWs) are central to Primary Health Care globally. Amidst the current flourishing of work on CHWs, there often is a lack of reference to history-even in studies of programs that have been around for decades. This study examines the 35-year trajectory of Nepal's Female Community Health Volunteers (FCHVs). METHODS We conducted a content analysis of an archive of primary and secondary research materials, grey literature and government reports collected during 1977-2019 across several regions in Nepal. Documents were coded in MAXQDA using principles of inductive coding. As questions arose from the materials, data were triangulated with published sources. RESULTS Looking across four decades of the program's history illuminates that issues of gender, workload, and pay-hotly debated in the CHW literature now-have been topics of discussion for observers and FCHVs alike since the inception of the program. Following experiments with predominantly male community volunteers during the 1970s, Nepal scaled up the all-female FCHV program in the late 1980s and early 1990s, in part because of programmatic goals focused on maternal and child health. FCHVs gained legitimacy as health workers in part through participation in donor-funded vertical campaigns. FCHVs received a stable yet modest regular stipend during the early years, but since it was stopped in the 1990s, incentives have been a mix of activity-based payments and in-kind support. With increasing outmigration of men from villages and growing work responsibilities for women, the opportunity cost of health volunteering increased. FCHVs started voicing their dissatisfaction with remuneration, which gave rise to labor movements starting in the 2010s. Government officials have not comprehensively responded to demands by FCHVs for decent work, instead questioning the relevance of FCHVs in a modern, medicalized Nepali health system. CONCLUSIONS Across public health, an awareness of history is useful in understanding the present and avoiding past mistakes. These histories are often not well-archived, and risk getting lost. Lessons from the history of Nepal's FCHV program have much to offer present-day debates around CHW policies, particularly around gender, workload and payment.
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Affiliation(s)
- Roosa Sofia Tikkanen
- Institute of Sociology and Political Science, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Edvard Bulls veg 1, 7491, Trondheim, Norway.
| | - Svea Closser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
| | - Justine Prince
- Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, 3400 N. Charles Street, Baltimore, Maryland, 21218, USA
| | - Priyankar Chand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
| | - Judith Justice
- Institute for Health & Aging, School of Nursing, University of California at San Francisco, 490 Illinois Street, San Francisco, CA, 94143, USA
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Soepnel LM, Norris SA, Mabetha K, Motlhatlhedi M, Nkosi N, Lye S, Draper CE. A qualitative analysis of community health worker perspectives on the implementation of the preconception and pregnancy phases of the Bukhali randomised controlled trial. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002578. [PMID: 38483881 PMCID: PMC10939222 DOI: 10.1371/journal.pgph.0002578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/22/2024] [Indexed: 03/17/2024]
Abstract
Community health workers (CHWs) play an important role in health systems in low- and middle-income countries, including South Africa. Bukhali is a CHW-delivered intervention as part of a randomised controlled trial, to improve the health trajectories of young women in Soweto, South Africa. This study aimed to qualitatively explore factors influencing implementation of the preconception and pregnancy phases of Bukhali, from the perspective of the CHWs (Health Helpers, HHs) delivering the intervention. As part of the Bukhali trial process evaluation, three focus group discussions were conducted with the 13 HHs employed by the trial. A thematic approach was used to analyse the data, drawing on elements of a reflexive thematic and codebook approach. The following six themes were developed, representing factors impacting implementation of the HH roles: interaction with the existing public healthcare sector; participant perceptions of health; health literacy and language barriers; participants' socioeconomic constraints; family, partner, and community views of trial components; and the HH-participant relationship. HHs reported uses of several trial-based tools to overcome implementation challenges, increasing their ability to implement their roles as planned. The relationship of trust between the HH and participants seemed to function as one important mechanism for impact. The findings supported a number of adaptations to the implementation of Bukhali, such as intensified trial-based follow-up of referrals that do not receive management at clinics, continued HH training and community engagement parallel to trial implementation, with an increased emphasis on health-related stigma and education. HH perspectives on intervention implementation highlighted adaptations across three broad strategic areas: navigating and bridging healthcare systems, adaptability to individual participant needs, and navigating stigma around disease. These findings provide recommendations for the next phases of Bukhali, for other CHW-delivered preconception and pregnancy trials, and for the strengthening of CHW roles in clinical settings with similar implementation challenges. Trial registration: Pan African Clinical Trials Registry; PACTR201903750173871, Registered March 27, 2019.
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Affiliation(s)
- Larske M. Soepnel
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Shane A. Norris
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, United Kingdom
| | - Khuthala Mabetha
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Molebogeng Motlhatlhedi
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Nokuthula Nkosi
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Lye
- Department of Physiology and Medicine, Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Catherine E. Draper
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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Nida S, Tyas ASA, Putri NE, Larasanti A, Widoyopi AA, Sumayyah R, Listiana S, Espressivo A. A systematic review of the types, workload, and supervision mechanism of community health workers: lessons learned for Indonesia. BMC PRIMARY CARE 2024; 25:82. [PMID: 38468218 PMCID: PMC10926673 DOI: 10.1186/s12875-024-02319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Community health workers (CHWs) have demonstrated capability to improve various health indicators, however, many programmes require support in meeting their objectives due to subpar performance and a high rate of CHW attrition. This systematic review investigated the types of CHWs, their workloads, and supervision practices that contribute to their performance in different countries. METHODS The search was carried out in November 2022 in Medline, Embase, and Neliti for studies published in Indonesian or English between 1986 and 2022 that reported public health services delivered by CHWs who live and serve the community where they live but are not considered health professionals. The findings were synthesised using a thematic analysis to assess key factors influencing the performance of CHWs. RESULTS Sixty eligible articles were included in this review. CHWs were responsible for more than two diseases (n = 35) and up to fifteen, with more than eighteen activities. Their roles covered the human life cycle, from preparation for pregnancy, care for newborns, health for children, adolescents, and productive age to elderly individuals. They were also involved in improving environmental health, community empowerment, and other social issues hindering access to health services. They carried out promotive, preventive, and curative interventions. The CHW-population ratio varied from eight to tens of thousands of people. Some CHWs did not have a clear supervision system. Challenges that were often faced by CHWs included inappropriate incentives, inadequate facilities, insufficient mentoring, and supervision, many roles, and a broad catchment area. Many studies revealed that CHWs felt overburdened and stressed. They needed help to balance their significant work and domestic tasks. CONCLUSIONS Effective planning that considered the scope of work of CHWs in proportion to their responsibilities and the provision of necessary facilities were crucial factors in improving the performance of CHWs. Supportive supervision and peer-supervision methods are promising, however, any CHW supervision required a detailed protocol. This systematic review emphasised the opportunity for CHW management system improvement in Indonesia.
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Affiliation(s)
- Sofwatun Nida
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia.
| | - Agatha Swasti Ayuning Tyas
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Nidya Eka Putri
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Ayudina Larasanti
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Aldhea Ayu Widoyopi
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Rima Sumayyah
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Saetia Listiana
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Aufia Espressivo
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
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Lenoir KM, Paul R, Wright E, Palakshappa D, Pajewski NM, Hanchate A, Hughes JM, Gabbard J, Wells BJ, Dulin M, Houlihan J, Callahan KE. The Association of Frailty and Neighborhood Disadvantage with Emergency Department Visits and Hospitalizations in Older Adults. J Gen Intern Med 2024; 39:643-651. [PMID: 37932543 PMCID: PMC10973290 DOI: 10.1007/s11606-023-08503-x] [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: 07/13/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Risk stratification and population management strategies are critical for providing effective and equitable care for the growing population of older adults in the USA. Both frailty and neighborhood disadvantage are constructs that independently identify populations with higher healthcare utilization and risk of adverse outcomes. OBJECTIVE To examine the joint association of these factors on acute healthcare utilization using two pragmatic measures based on structured data available in the electronic health record (EHR). DESIGN In this retrospective observational study, we used EHR data to identify patients aged ≥ 65 years at Atrium Health Wake Forest Baptist on January 1, 2019, who were attributed to affiliated Accountable Care Organizations. Frailty was categorized through an EHR-derived electronic Frailty Index (eFI), while neighborhood disadvantage was quantified through linkage to the area deprivation index (ADI). We used a recurrent time-to-event model within a Cox proportional hazards framework to examine the joint association of eFI and ADI categories with healthcare utilization comprising emergency visits, observation stays, and inpatient hospitalizations over one year of follow-up. KEY RESULTS We identified a cohort of 47,566 older adults (median age = 73, 60% female, 12% Black). There was an interaction between frailty and area disadvantage (P = 0.023). Each factor was associated with utilization across categories of the other. The magnitude of frailty's association was larger than living in a disadvantaged area. The highest-risk group comprised frail adults living in areas of high disadvantage (HR 3.23, 95% CI 2.99-3.49; P < 0.001). We observed additive effects between frailty and living in areas of mid- (RERI 0.29; 95% CI 0.13-0.45; P < 0.001) and high (RERI 0.62, 95% CI 0.41-0.83; P < 0.001) neighborhood disadvantage. CONCLUSIONS Considering both frailty and neighborhood disadvantage may assist healthcare organizations in effectively risk-stratifying vulnerable older adults and informing population management strategies. These constructs can be readily assessed at-scale using routinely collected structured EHR data.
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Affiliation(s)
- Kristin M Lenoir
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA.
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Rajib Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Elena Wright
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Deepak Palakshappa
- Section of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of General Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Amresh Hanchate
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jaime M Hughes
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Gabbard
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Brian J Wells
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Michael Dulin
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Jennifer Houlihan
- Value Based Care and Population Health, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Kathryn E Callahan
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Blondino CT, Knoepflmacher A, Johnson I, Fox C, Friedman L. The use and potential impact of digital health tools at the community level: results from a multi-country survey of community health workers. BMC Public Health 2024; 24:650. [PMID: 38429773 PMCID: PMC10905785 DOI: 10.1186/s12889-024-18062-3] [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] [Received: 08/31/2023] [Accepted: 02/10/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Community health workers (CHWs) are increasingly viewed as a critical workforce to address health system strengthening and sustainable development goals. Optimizing and widening the capacity of this workforce through digital technology is currently underway, though there is skepticism regarding CHWs' willingness and optimism to engage in digital health. We sought to understand CHWs' perceptions on the use of digital health tools in their work. METHODS We obtained survey data from 1,141 CHWs from 28 countries with complete study information. We conducted regression analyses to explore the relationship between CHWs' training and perceived barriers to digital health access with current use of digital devices/tools and belief in digital impact while adjusting for demographic factors. RESULTS Most of the CHWs worked in Kenya (n = 502, 44%) followed by the Philippines (n = 308, 27%), Ghana (n = 107, 9.4%), and the United States (n = 70, 6.1%). There were significant, positive associations between digital tools training and digital device/tool use (Adjusted Odds Ratio (AOR) = 2.92, 95% CI = 2.09-4.13) and belief in digital impact (AORhigh impact = 3.03, 95% CI = 2.04-4.49). CHWs were significantly less likely to use digital devices for their work if they identified cost as a perceived barrier (AORmobile service cost = 0.68, 95% CI = 0.49-0.95; AORphone/device cost = 0.66, 95% CI = 0.47-0.92). CHWs who were optimistic about digital health, were early adopters of technology in their personal lives, and found great value in their work believed digital health helped them to have greater impact. Older age and greater tenure were associated with digital device/tool use and belief in digital impact, respectively. CONCLUSIONS CHWs are not an obstacle to digital health adoption or use. CHWs believe that digital tools can help them have more impact in their communities regardless of perceived barriers. However, cost is a barrier to digital device/tool use; potential solutions to cost constraints of technological access will benefit from further exploration of reimbursement models. Digital health tools have the potential to increase CHW capacity and shape the future of community health work.
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Affiliation(s)
- Courtney T Blondino
- Department of Health Studies, School of Arts and Sciences, University of Richmond, Richmond, VA, 23173, USA.
- Mercer, New York, NY, 10036, USA.
| | | | | | - Cameron Fox
- Platform for Shaping the Future of Health & Healthcare, World Economic Forum, New York, NY, 10017, USA
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Jain S, Pillai P, Mathias K. Opening up the 'black-box': what strategies do community mental health workers use to address the social dimensions of mental health? Soc Psychiatry Psychiatr Epidemiol 2024; 59:493-502. [PMID: 38261003 PMCID: PMC10944393 DOI: 10.1007/s00127-023-02582-1] [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: 10/30/2022] [Accepted: 10/25/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Community-based workers promote mental health in communities. Recent literature has called for more attention to the ways they operate and the strategies used. For example, how do they translate biomedical concepts into frameworks that are acceptable and accessible to communities? How do micro-innovations lead to positive mental health outcomes, including social inclusion and recovery? The aim of this study was to examine the types of skills and strategies to address social dimensions of mental health used by community health workers (CHWs) working together with people with psychosocial disability (PPSD) in urban north India. METHODS We interviewed CHWs (n = 46) about their registered PPSD who were randomly selected from 1000 people registered with a local non-profit community mental health provider. Notes taken during interviews were cross-checked with audio recordings and coded and analyzed thematically. RESULTS CHWs displayed social, cultural, and psychological skills in forming trusting relationships and in-depth knowledge of the context of their client's lives and family dynamics. They used this information to analyze political, social, and economic factors influencing mental health for the client and their family members. The diverse range of analysis and intervention skills of community health workers built on contextual knowledge to implement micro-innovations in a be-spoke way, applying these to the local ecology of people with psychosocial disabilities (PPSD). These approaches contributed to addressing the social and structural determinants that shaped the mental health of PPSD. CONCLUSION Community health workers (CHWs) in this study addressed social aspects of mental health, individually, and by engaging with wider structural factors. The micro-innovations of CHWs are dependent on non-linear elements, including local knowledge, time, and relationships. Global mental health requires further attentive qualitative research to consider how these, and other factors shape the work of CHWs in different locales to inform locally appropriate mental health care.
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Affiliation(s)
- Sumeet Jain
- The University of Edinburgh, Edinburgh, Scotland, UK.
| | - Pooja Pillai
- Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, Uttarakhand, India
| | - Kaaren Mathias
- Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, Uttarakhand, India
- The University of Canterbury, Christ Church, New Zealand
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Chaomuang N, Panya R, Saokaew S, Umnuaypornlert A. Effects of instructional video and community radio broadcasting interventions to improve knowledge and behavior of antibiotic use in the COVID-19 era. J Am Pharm Assoc (2003) 2024:102030. [PMID: 38341087 DOI: 10.1016/j.japh.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/11/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Antibiotic overuse is a serious health issue. It has been demonstrated that improper antibiotic use is linked to a lack of knowledge in the public. To encourage judicious antibiotic use in the COVID-19 ERA, it is critical to provide accessible and secure therapies. OBJECTIVES This study aimed to assess the effects of instructional video and community radio broadcasting interventions on knowledge and behavior of antibiotic use. METHODS Adults over the age of 20 were enrolled in a quasi-experimental study. A total of 369 representatives were divided into two groups: 185 participants in the control group and 184 participants in the intervention group. Data were collected twice, before and after the educational program by community health workers. Both descriptive and inferential statistics were used to analyze the data. RESULTS The participants' average age was 56.4 ± 0.6 years. Most of the respondents were female (264, 71.5%) and had only received an elementary education (186, 50.4%). A mean difference score was produced for the control and intervention groups. Both groups experienced a statistically significant gain in mean difference score of knowledge following the educational program (3.42 ± 4.18, [95% CI 2.81-4.02] vs 5.42 ± 4.97, [95% CI 4.69-6.14]) (P < 0.001). A mean difference score was produced with behavior (1.78 ± 3.45, [95% CI 1.28-2.28] vs 2.77 ± 3.06, [95% CI 2.28-3.27]) (P < 0.001). A mean difference in knowledge score between the groups was greater, with the intervention group scoring higher; all significant variables were controlled by multivariable regression analysis (1.31 [95% CI 0.53-2.09]) (P = 0.001). Similarly, a mean difference behavior score (1.34 [95% CI 0.82-1.86]) (P < 0.001). CONCLUSION The integration of an educational poster, instructional video, and community radio broadcasting interventions about antibiotic use through CHWs in local communities is beneficial. This program should be implemented at the national level to promote rational drug use. Future studies should investigate how the educational program affects antibiotic use rates in the long term.
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Jiee SF, Joo LK, Eng PN, Simon Sumeh A, Jantim A, Shanmuganathan S, Muniandy SR. At the Heart of the Community: Implementation of Echocardiographic Screening for Rheumatic Heart Disease in Primary Care Facilities of Northern Borneo Island. J Prim Care Community Health 2024; 15:21501319241233178. [PMID: 38420774 PMCID: PMC10906056 DOI: 10.1177/21501319241233178] [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] [Received: 10/21/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a potentially life-threatening condition that causes long-standing public health concerns. Echocardiography is a reliable diagnostic and screening technique for many cardiovascular conditions, including RHD. It is commonly used in tertiary care facilities worldwide but less so in the community setting. The primary aim of this study was to introduce and elaborate on the echocardiographic screening for RHD that was implemented by a Malaysian primary care clinic in Penampang district, Sabah. We also set out to present the uptake of the service in its initial years of establishment, as well as the challenges faced. METHODS In the first part of this study, document reviews were conducted to compile relevant information about the conceptualization and implementation of this service. Following that, we also obtained secondary data on the echocardiographic screening service from its first implementation in April 2020 until May 2021 to examine the uptake and the patient profile. RESULTS From April 2020 to May 2021, a total of 189 echocardiographic screening was conducted by primary care doctors using handheld ultrasound. Of the 189 children screened, 19 (10.1%) were found to have cardiac anomalies and were referred for a formal echocardiogram. Upon follow-up, 8 were detected with mild mitral regurgitation and referred to the nearest tertiary hospital for further management. CONCLUSION Based on our review, the echocardiographic screening for RHD among children conducted by the Penampang Health Clinic was deemed successful. Echocardiogram service provided by primary care centers located in suburban and rural areas is highly beneficial for patients with poor access to specialized health care services because they stay far away from tertiary care facilities. Tapping into family medicine physicians located closer to communities to conduct echocardiographic screening and review the results can improve the detection of cardiac anomalies requiring further investigation. With the success of this project, echocardiographic services in the primary healthcare setting can be expanded by garnering the necessary collaborative efforts and consistent support from various stakeholders.
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Affiliation(s)
| | - Lim Kai Joo
- Penampang District Health Office, Sabah State Health Department, Ministry of Health Malaysia, Malaysia
| | - Pee Nai Eng
- Penampang District Health Office, Sabah State Health Department, Ministry of Health Malaysia, Malaysia
| | - Aini Simon Sumeh
- Penampang District Health Office, Sabah State Health Department, Ministry of Health Malaysia, Malaysia
| | - Anisah Jantim
- Penampang District Health Office, Sabah State Health Department, Ministry of Health Malaysia, Malaysia
| | - Selvanaayagam Shanmuganathan
- Penampang District Health Office, Sabah State Health Department, Ministry of Health Malaysia, Malaysia
- The University of Sydney, Australia
| | - Siva Rao Muniandy
- Queen Elizabeth Hospital II, Sabah State Health Department, Ministry of Health Malaysia, Malaysia
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Pieterse P, Saracini F. Unsalaried health workers in Sierra Leone: a scoping review of the literature to establish their impact on healthcare delivery. Int J Equity Health 2023; 22:255. [PMID: 38066622 PMCID: PMC10709924 DOI: 10.1186/s12939-023-02066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The World Health Organisation (WHO) estimates a 10 million health worker shortage by 2030. Despite this shortage, some low-income African countries paradoxically struggle with health worker surpluses. Technically, these health workers are needed to meet the minimum health worker-population ratio, but insufficient job opportunities in the public and private sector leaves available health workers unemployed. This results in emigration and un- or underemployment, as few countries have policies or plans in place to absorb this excess capacity. Sierra Leone, Liberia and Guinea have taken a different approach; health authorities and/or public hospitals 'recruit' medical and nursing graduates on an unsalaried basis, promising eventual paid public employment. 50% Sierra Leone's health workforce is currently unsalaried. This scoping review examines the existing evidence on Sierra Leone's unsalaried health workers (UHWs) to establish what impact they have on the equitable delivery of care. METHODS A scoping review was conducted using Joanna Briggs Institute guidance. Medline, PubMed, Scopus, Web of Science were searched to identify relevant literature. Grey literature (reports) and Ministry of Health and Sanitation policy documents were also included. RESULTS 36 texts, containing UHW related data, met the inclusion criteria. The findings divide into two categories and nine sub-categories: Charging for care and medicines that should be free; Trust and mistrust; Accountability; Informal provision of care, Private practice and lack of regulation. Over-production of health workers; UHW issues within policy and strategy; Lack of personnel data undermines MoHS planning; Health sector finance. CONCLUSION Sierra Leone's example demonstrates that UHWs undermine equitable access to healthcare, if they resort to employing a range of coping strategies to survive financially, which some do. Their impact is wide ranging and will undermine Sierra Leone's efforts to achieve Universal Health Coverage if unaddressed. These findings are relevant to other LICs with similar health worker surpluses.
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Affiliation(s)
- Pieternella Pieterse
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland.
| | - Federico Saracini
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
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Carmichael AE, Lennon NH, Qualters JR. Analysis of social determinants of health and individual factors found in health equity frameworks: Applications to injury research. JOURNAL OF SAFETY RESEARCH 2023; 87:508-518. [PMID: 38081722 PMCID: PMC10775896 DOI: 10.1016/j.jsr.2023.10.001] [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: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION This research evaluated existing health equity frameworks as they relate to social determinants of health (SDOHs) and individual factors that may impact injury outcomes and identify gaps in coverage using the Healthy People (HP) 2030 key domains. METHODS The study used a list of health equity frameworks sourced from previous literature. SDOHs and individual factors from each framework were identified and categorized into the Healthy People 2030 domains. Five injury topic areas were used as examples for how SDOHs and individual factors can be compared to injury topic-specific health disparities to identify health equity frameworks to apply to injury research. RESULTS The study identified 59 SDOHs and individual factors from the list of 33 health equity frameworks. The number of SDOHs and individual factors identified varied by Healthy People 2030 domain: Neighborhood and Built Environment contained 16 (27.1%) SDOHs and individual actors, Social and Community Context contained 22 (37.3%), Economic Stability contained 10 (16.9%), Healthcare Access and Quality contained 10 (16.9%), and Education Access and Quality contained one (1.7%). Twenty-three (39.0%) SDOHs/individual factors related to traumatic brain injury, thirteen (22.0%) related to motor vehicle crashes and suicide, 11 (18.6%) related to drowning and older adult falls. Eight frameworks (24.2%) covered all HP 2030 key domains and may be applicable to injury topics. CONCLUSIONS Incorporating health equity into research is critical. Health equity frameworks can provide a way to systematically incorporate health equity into research. The findings from this study may be useful to health equity research by providing a resource to injury and other public health fields. PRACTICAL APPLICATIONS Health equity frameworks are a practical tool to guide injury research, translation, evaluation, and program implementation. The findings from this study can be used to guide the application of health equity frameworks in injury research for specific topic areas.
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Affiliation(s)
- Andrea E Carmichael
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Natalie H Lennon
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Judith R Qualters
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Adam HS, Merkin SS, Anderson MD, Seeman T, Kershaw KN, Magnani JW, Everson-Rose SA, Lutsey PL. Personal Health Literacy and Life Simple 7: The Multi-Ethnic Study of Atherosclerosis. AMERICAN JOURNAL OF HEALTH EDUCATION 2023; 54:451-462. [PMID: 38486878 PMCID: PMC10939068 DOI: 10.1080/19325037.2023.2254354] [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: 12/23/2022] [Accepted: 07/14/2023] [Indexed: 03/17/2024]
Abstract
Background Personal Health literacy (PHL) is essential in cardiovascular risk management. Hindrances in PHL can lead to poor cardiovascular outcomes. Purpose To investigate whether limited PHL is associated with lower likelihoods of i) overall cardiovascular health and ii) individual cardiovascular health components as defined by the American Heart Association's Life Simple (LS7). Methods Multi-Ethnic Study of Atherosclerosis participants (N=3719; median age[range]: 59[45-84]) completed a PHL questionnaire in 2016-2018. PHL was classified as limited (score ≥10) or adequate (score <10). LS7 components were measured in 2000-2002. Robust Poisson regression was employed to compute prevalence ratios and 95% confidence intervals (PR[95%CI]) of LS7 measures. Results 14.7% of participants had limited PHL. Limited PHL was associated with lower likelihoods of optimal LS7 (0.69[0.50, 0.95], p=0.02) and average LS7 (0.95[0.88, 1.02], p=0.15) after adjustment. Limited PHL was significantly associated with a 7% lower likelihood of ideal fasting blood glucose level after adjustment (0.93[0.89, 0.98], p<0.01). Discussion Limited PHL was modestly associated with suboptimal cardiovascular health and elevated blood glucose, independent of income and education. Translation to Health Education Practice Health educators and providers should equitably address PHL barriers to improve cardiovascular management and quality of care for patients and communities.
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D'Ambruoso L, Abruquah NA, Mabetha D, van der Merwe M, Goosen G, Sigudla J, Witter S. Expanding Community Health Worker decision space: learning from a Participatory Action Research training intervention in a rural South African district. HUMAN RESOURCES FOR HEALTH 2023; 21:66. [PMID: 37596628 PMCID: PMC10439531 DOI: 10.1186/s12960-023-00853-1] [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: 12/17/2022] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND While integral to decentralising health reforms, Community Health Workers (CHWs) in South Africa experience many challenges. During COVID-19, CHW roles changed rapidly, shifting from communities to clinics. In the contexts of new roles and re-engineered primary healthcare (PHC), the objectives were to: (a) implement a training intervention to support local decision-making capability of CHWs; and (b) assess learning and impacts from the perspectives of CHWs. METHODS CHWs from three rural villages (n = 9) were trained in rapid Participatory Action Research (PAR) with peers and community stakeholders (n = 33). Training equipped CHWs with tools and techniques to convene community groups, raise and/or respond to local health concerns, understand concerns from different perspectives, and facilitate action in communities and public services. CHWs' perspectives before and after the intervention were gained through semi-structured interviews. Data were collected and analysed using the decision space framework to understand local actors' power to affect devolved decision-making. RESULTS CHWs demonstrated significant resilience and commitment in the face of COVID-19. They experienced multiple, intersecting challenges including: limited financial, logistical and health systems support, poor role clarity, precarious employment, low and no pay, unstable organisational capacity, fragile accountability mechanisms and belittling treatment in clinics. Together, these restricted decision space and were seen to reflect a low valuing of the cadre in the system. CHWs saw the training as a welcome opportunity to assert themselves as a recognised cadre. Regular, spaces for dialogue and mutual learning supported CHWs to gain tools and skills to rework their agency in more empowered ways. The training improved management capacity, capabilities for dialogue, which expanded role clarity, and strengthened community mobilisation, facilitation and analysis skills. Development of public speaking skills was especially valued. CHWs reported an overall 'tripe-benefit' from the training: community-acceptance; peer support; and dialogue with and recognition by the system. The training intervention was recommended for scale-up by the health authority as an implementation support strategy for PHC. CONCLUSIONS Lack of recognition of CHWs is coupled with limited opportunities for communication and trust-building. The training supported CHWs to find and amplify their voices in strategic partnerships, and helped build functionality for local decision-making.
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Affiliation(s)
- Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK.
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
- Public Health, National Health Service (NHS) Grampian, Aberdeen, Scotland, UK.
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.
| | - Nana Akua Abruquah
- The University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Denny Mabetha
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Cochrane South Africa, South African Medical Research Council (MRC), Cape Town, South Africa
| | - Maria van der Merwe
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Maria Van Der Merwe Consulting, White River, South Africa
| | | | - Jerry Sigudla
- Mpumalanga Department of Health, Mbombela, South Africa
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Musselburgh, Scotland, UK
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Nyagah LM, Bangura S, Omar OA, Karanja M, Mirza MA, Shajib H, Njiru H, Mengistu K, Malik SMMR. The importance of community health workers as frontline responders during the COVID-19 pandemic, Somalia, 2020-2021. Front Public Health 2023; 11:1215620. [PMID: 37663863 PMCID: PMC10469613 DOI: 10.3389/fpubh.2023.1215620] [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: 05/02/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction We examined the contribution of community health workers as frontline responders for the community-based surveillance in Somalia during the first year of the COVID-19 pandemic for detection of COVID-19 cases and identification of contacts. Methods We retrieved COVID-19 surveillance data from 16 March 2020 to 31 March 2021 from the health ministry's central database. These data were collected through community health workers, health facilities or at the points of entry. We compared the number of suspected COVID-19 cases detected by the three surveillance systems and the proportion that tested positive using the chi-squared test. We used logistic regression analysis to assess association between COVID-19 infection and selected variables. Results During the study period, 154,004 suspected cases of COVID-19 were detected and tested, of which 10,182 (6.6%) were positive. Of the notified cases, 32.7% were identified through the community-based surveillance system, 54.0% through the facility-based surveillance system, and 13.2% at points of entry. The positivity rate of cases detected by the community health workers was higher than that among those detected at health facilities (8.6% versus 6.4%; p < 0.001). The community health workers also identified more contacts than those identified through the facility-based surveillance (13,279 versus 1,937; p < 0.001). The odds of COVID-19 detection generally increased by age. Community-based surveillance and health facility-based surveillance had similar odds of detecting COVID-19 cases compared with the points-of-entry surveillance (aOR: 7.0 (95% CI: 6.4, 7.8) and aOR: 7.5 (95% CI: 6.8, 8.3), respectively). Conclusion The community health workers proved their value as first responders to COVID-19. They can be effective in countries with weak health systems for targeted community surveillance in rural and remote areas which are not covered by the facility-based surveillance system.
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Gaitán-Rossi P, Vilar-Compte M, Bustamante AV. Adaptation of a community health outreach model during the COVID-19 pandemic: the case of the Mexican consulates in the United States of America. Int J Equity Health 2023; 22:138. [PMID: 37491265 PMCID: PMC10369756 DOI: 10.1186/s12939-023-01911-9] [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: 02/23/2023] [Accepted: 05/07/2023] [Indexed: 07/27/2023] Open
Abstract
The Ventanillas de Salud (VDS - "Health Windows") are a culturally sensitive outreach program within the 49 Mexican Consulates in the United States that provides information and health care navigation support to underserved and uninsured Mexican immigrants. During the COVID-19 pandemic the VDS rapidly transitioned to remote operations adding new services. Based on the EquIR implementation framework, this qualitative study investigates how adaptations to improve emergency preparedness were performed. We conducted motivational interviews with three actors - six VDS coordinators, eight partner organizations, and ten VDS users- in two VDS, Los Angeles and New York, to document specific needs of the target population and identify implementation processes to adapt and continue operating. The VDS adapted their model by adding new services for emerging needs, by switching service provision modalities, and by expanding the network of partner organizations. According to the VDS staff, these adaptations increased their topics, depth, reach, and diversified their users. Users had mostly positive opinions about the VDS adaptation, although they highlighted some heterogeneity across service provision. The VDS is a public health intervention able to serve a marginalized population and its implementation offers valuable lessons to complement health systems and to improve preparedness and resiliency for future crises.
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Affiliation(s)
- Pablo Gaitán-Rossi
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana Mexico City, Mexico City, Mexico
| | - Mireya Vilar-Compte
- Department of Public Health, Montclair State University, Montclair, NJ, USA.
| | - Arturo Vargas Bustamante
- Department of Health Policy and Management, University of California Los Angeles, Los Angeles, CA, USA
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Van Iseghem T, Jacobs I, Vanden Bossche D, Delobelle P, Willems S, Masquillier C, Decat P. The role of community health workers in primary healthcare in the WHO-EU region: a scoping review. Int J Equity Health 2023; 22:134. [PMID: 37474937 PMCID: PMC10357780 DOI: 10.1186/s12939-023-01944-0] [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: 04/12/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Existing evidence on the role of community health workers (CHWs) in primary healthcare originates primarily from the United States, Canada and Australia, and from low- and middle-income countries. Little is known about the role of CHWs in primary healthcare in European countries. This scoping review aimed to contribute to filling this gap by providing an overview of literature reporting on the involvement of CHWs in primary healthcare in WHO-EU countries since 2001 with a focus on the role, training, recruitment and remuneration. METHODS This systematic scoping review followed the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses, extension for Scoping Reviews. All published peer-reviewed literature indexed in PubMed, Web of Science, and Embase databases from Jan 2001 to Feb 2023 were reviewed for inclusion. Included studies were screened on title, abstract and full text according to predetermined eligibility criteria. Studies were included if they were conducted in the WHO-EU region and provided information regarding the role, training, recruitment or remuneration of CHWs. RESULTS Forty studies were included in this review, originating from eight countries. The involvement of CHWs in the WHO-EU regions was usually project-based, except in the United Kingdom. A substantial amount of literature with variability in the terminology used to describe CHWs, the areas of involvement, recruitment, training, and remuneration strategies was found. The included studies reported a trend towards recruitment from within the communities with some form of training and payment of CHWs. A salient finding was the social embeddedness of CHWs in the communities they served. Their roles can be classified into one or a combination of the following: educational; navigational and supportive. CONCLUSION Future research projects involving CHWs should detail their involvement and elaborate on CHWs' role, training and recruitment procedures. In addition, further research on CHW programmes in the WHO-EU region is necessary to prepare for their integration into the broader national health systems.
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Affiliation(s)
- Tijs Van Iseghem
- Interuniversity Centre for Health Economics Research (ICHER), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Ilka Jacobs
- Equity Research Group, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Dorien Vanden Bossche
- Unit Family Medicine, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Peter Delobelle
- Chronic Diseases Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
- MENT Research Group, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sara Willems
- Equity Research Group, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Caroline Masquillier
- 'Family Medicine and Population Health' - FAMPOP, Faculty of Medical Sciences & 'Centre for Family, Population and Health', Faculty of Social sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Decat
- Unit Family Medicine, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Kang J, Kang P. Relationship Building between International Healthcare Volunteers and Local Healthcare Providers in Ethiopia: Real-Life Experiences in Low-Income Country. Healthcare (Basel) 2023; 11:1969. [PMID: 37444804 DOI: 10.3390/healthcare11131969] [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: 05/05/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The number of international healthcare volunteers in low-income countries that need trained human resources has been increasing. However, migrating to a foreign country requires adapting to its environment and culture. The purpose of this study was to explore the international healthcare volunteers' experiences in Ethiopia in building relationships with local healthcare providers. METHODS Six participants were enrolled in the study, and data were collected through individual in-depth interviews conducted between September and October 2018. The collected data were analyzed using Colaizzi's phenomenological method. RESULTS Ten subthemes emerged from five themes: "facing new situations", "accepting myself as an outsider in Ethiopia", "impact on the wall of prejudice", "adapting to a new culture", and "positive outlook". CONCLUSIONS This study shows that international healthcare volunteers in Ethiopia experienced challenges in building relationships with local healthcare providers due to linguistic and cultural gaps. Nevertheless, they strived to accept the culture and play their part as helpers in providing healthcare services.
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Affiliation(s)
- Jiwon Kang
- School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA
| | - Purum Kang
- College of Nursing, Woosuk University, Wanju 55338, Jeollabuk-do, Republic of Korea
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Arasu S, Shanbhag DN. Effectiveness of a Community Health Worker-Driven Intervention in Improving the Quality of Life of Caregivers of Children With Disability in Rural Karnataka, India. Cureus 2023; 15:e41798. [PMID: 37575798 PMCID: PMC10423073 DOI: 10.7759/cureus.41798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose To assess the effectiveness of a community-health-worker (CHW)-driven intervention in improving the quality of life (QOL) of caregivers of children with disability in rural Karnataka, India. Methodology A community-based quasi-experimental study with cluster randomization on the village level was done. CHWs provided structured health education and training for the intervention arm. Pre- and post-intervention, the QOL and Zarit burden scores were compared between and within the two arms. Results From baseline, the physical domain score improved from 49.66 to 53.88 (p < 0.001). The Zarit burden scores decreased from 33.27 to 28.89 (p < 0.001). On comparing the post-test QOL scores between the two arms, the physical domain scores increased from 51.68 to 56.08 (p = 0.025). The Zarit burden scores also significantly decreased from 31.50 to 26.28. Conclusion The intervention by the CHWs on the caregivers has significant improvements in the physical domain of QOL and a reduction in caregiver burden.
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Affiliation(s)
- Sakthi Arasu
- Occupational Health, St. John's Medical College, Bangalore, IND
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23
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Leta K, Lauwerier E, Willems S, Vermeersch S, Demeester B, Verloigne M. Smoking prevention within social work organizations: a qualitative study about youngsters' and youth workers' perceptions. Health Promot Int 2023; 38:7171694. [PMID: 37202340 DOI: 10.1093/heapro/daad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Tobacco smoking uptake is still a major public health concern, especially among youngsters living in vulnerable situations. Finding optimal ways to engage youngsters in smoking prevention is important. Compared to traditional settings such as schools, social work settings providing sports-based and recreational activities (SR-settings) tend to reach and engage youngsters more. This study aimed to gain insight into the reasons for smoking uptake among youngsters living in vulnerable situations and the conditions through which SR-settings are potentially beneficial for smoking prevention initiatives. Data were collected in two SR-settings in Flanders, Belgium, by means of five focus group discussions and six individual interviews with youngsters (n = 38, mean age = 12.9 ± 2.61 years, 69.7% boys) and eight individual interviews with youth workers (n = 8, mean age = 27.5 ± 7.95 years, 87.5% men). A thematic analysis (TA) approach was applied to analyse the data. Besides individual factors, such as attitudes towards smoking, the desire to be part of a group and conformity to group norms seem to be important drivers of smoking uptake among youngsters in vulnerable situations. The presence of powerful role models in SR-settings with whom youngsters identify may counteract group norms by encouraging healthy behaviour. SR-settings seem suitable for questioning perceptions of vulnerable youngsters, unlike other settings where they may struggle to be heard. The conditional characteristics of SR-settings, such as authentic group processes, having meaningful roles, and being heard, make these contexts promising venues for smoking prevention efforts among vulnerable youngsters. Youth workers who have established trusting relationships with youngsters seem well-suited to communicate smoking prevention messages. A participatory approach, in which youngsters are involved in developing smoking prevention programs, is desirable.
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Affiliation(s)
- Kenji Leta
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Emelien Lauwerier
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Sarah Vermeersch
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Babette Demeester
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Maïté Verloigne
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Shakerian S, Gharanjik GS. Recruitment and selection of community health workers in Iran; a thematic analysis. BMC Public Health 2023; 23:839. [PMID: 37161389 PMCID: PMC10169114 DOI: 10.1186/s12889-023-15797-3] [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: 12/24/2022] [Accepted: 05/03/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND In Iran, community health workers (CHWs) are selected and employed according to the instructions of the Ministry of Health (MOH). The present study aimed to investigate the views of different stakeholders regarding the selection criteria, as well as the competency of CHWs. METHODS This study was conducted using a qualitative thematic analysis in Golestan Province, Iran. Data were collected using semi-structured interviews with managers, supervisors, CHWs, and common people in 2021. The interviews were recorded and then transcribed. To extract key themes, the six-step Brown model was used, which involved becoming acquainted with the data, meaningful organization of transcripts, extracting primary open codes, searching for themes in an iterative approach, theme extraction, defining themes, and preparing a report. The relationships between codes and sub-themes and themes were represented using ATLAS.ti version 8. RESULTS Data saturation was achieved after interviewing 22 people. The extracted data included 340 open codes, two main sub-themes of "CHW effectiveness" and "CHW sustainability", and three main themes of "criteria for employing competent people", "barriers to employing competent people", and "identifying the barriers to employing competent people", according to the MOH instructions. CONCLUSION In the present study, local hiring was one of the major challenges in the competency-based selection of CHWs. One of the most repeated codes was expanding the local hiring concept and its requirements. Since different regions of Iran have different climatic, economic, cultural, and social conditions, the selection and hiring criteria for CHWs should be tailored to the needs of the community.
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Affiliation(s)
- Sareh Shakerian
- Departments of Community Based Education of Health Sciences, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Gozal Shafeei Gharanjik
- Departments of Community Based Education of Health Sciences, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Tangcharoensathien V, Dhillon I. Health and Care Workers in Pandemic Recovery: Major Challenges and Solutions. Int J Health Policy Manag 2023; 12:8081. [PMID: 37579399 PMCID: PMC10425659 DOI: 10.34172/ijhpm.2023.8081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 08/16/2023] Open
Affiliation(s)
| | - Ibadat Dhillon
- World Health Organization, South-East Asia Regional Office, New Delhi, India
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Doğan A, Mohamed Alİ A, Abdullahi Alİ M, Orul H. Assessment of tetanus Immunization among healthcare workers in Mogadishu, Somalia. Hum Vaccin Immunother 2023:2202128. [PMID: 37133877 DOI: 10.1080/21645515.2023.2202128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Tetanus is still a major problem in sub-Saharan African countries. This study aims to evaluate tetanus disease and vaccine awareness among healthcare workers in Mogadishu. This descriptive, cross-sectional study was scheduled for January 2-7, 2022. A questionnaire consisting of 28 questions was applied in a face-to-face manner to 418 healthcare workers. Only health workers aged≥18 living in Mogadishu were included. Questions about sociodemographic characteristics, tetanus disease, and vaccines were developed. 71.1% of the participants were female, 72% were ˂25 years old, 42.6% were nursing students, and 63.2% had a university education. It was observed that 46.9% of the volunteers had an income level of <$250, and 60.8% resided in the city center. 50.5% of the participants received a tetanus vaccine in their childhood. Questions to determine participants' level of knowledge about tetanus and the tetanus vaccine were responded to with an accuracy of between 44 and 77%. Although 38.5% of the participants reported that they were exposed to trauma at least once a day, the rate of those who had three or more doses of the vaccine was only 10.8%. On the other hand, 51.4% reported that they had received training about tetanus and vaccination. There was a significant difference (p < .001) in terms of knowledge level among sociodemographic characteristics. The fear of side effects was the most important reason for not being vaccinated. Healthcare workers in Mogadishu have little awareness of tetanus disease and vaccines. Efforts to improve education and other factors will be sufficient to eliminate the disadvantage brought about by the socio-demographic structure.
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Affiliation(s)
- Ahmet Doğan
- Department of Infectious Diseases and Clinical Microbiology, Somalia-Mogadishu Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Ahmed Mohamed Alİ
- Department of Infectious Diseases and Clinical Microbiology, Somalia-Mogadishu Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Mukhtar Abdullahi Alİ
- Department of Infectious Diseases and Clinical Microbiology, Somalia-Mogadishu Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Havva Orul
- Infection Committee Control Nurse, Somalia-Mogadishu Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
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Farrell TW, Greer AG, Bennie S, Hageman H, Pfeifle A. Academic Health Centers and the Quintuple Aim of Health Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:563-568. [PMID: 36255204 DOI: 10.1097/acm.0000000000005031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The Quintuple Aim of health care adds health equity to the existing Quadruple Aim of improving the individual experience of care for patients, improving the health of populations, reducing the per capita cost of care, and improving the experience of health care professionals. Health equity has previously been subsumed within the other 4 aims. Elevating health equity to the status of a distinct aim is necessary to address persistent health inequities that disproportionately affect underrepresented and minoritized groups. Academic health centers (AHCs) bear a unique responsibility to advance health equity due to the societal importance of their 4 missions: patient care, education, research, and community collaboration. Interprofessional education and practice provide natural connection points that enable AHCs to prepare both health professions students and practicing health care professionals to address all 5 aims. AHCs are well positioned to assess health outcomes related to health equity, develop a health care workforce that is representative of their communities, develop innovative research questions regarding health equity, and engage and invest in the communities they serve.
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Affiliation(s)
- Timothy W Farrell
- T.W. Farrell is professor of medicine and associate chief for age-friendly care, Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, and physician investigator, VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0003-0070-8757
| | - Annette G Greer
- A.G. Greer is associate professor and vice chair of diversity, equity, and inclusion, Department of Bioethics and Interdisciplinary Studies, Brody School of Medicine, East Carolina University, Greenville, North Carolina; ORCID: https://orcid.org/0000-0002-2868-0306
| | - Scott Bennie
- S. Bennie is dean of academic affairs, Kettering College, Kettering, Ohio; ORCID: https://orcid.org/0000-0001-7601-452X
| | - Heather Hageman
- H. Hageman is director, Center for Interprofessional Practice and Education, Washington University Medical Center, a collaboration between Goldfarb School of Nursing at Barnes-Jewish College, the University of Health Sciences and Pharmacy in St Louis, and Washington University School of Medicine, St Louis, Missouri
| | - Andrea Pfeifle
- A. Pfeifle is professor of family and community medicine and associate vice chancellor for interprofessional practice and education, The Ohio State University and Wexner Medical Center, Columbus, Ohio
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Masquillier C, Cosaert T. Community health workers: A sustainable health system innovation or just an emergency response? Front Public Health 2022; 10:1040539. [PMID: 36561858 PMCID: PMC9763587 DOI: 10.3389/fpubh.2022.1040539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Caroline Masquillier
- Department of Sociology, University of Antwerp, Antwerp, Belgium,Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium,*Correspondence: Caroline Masquillier
| | - Theo Cosaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Lennon NH, Carmichael AE, Qualters JR. Health equity guiding frameworks and indices in injury: A review of the literature. JOURNAL OF SAFETY RESEARCH 2022; 82:469-481. [PMID: 36031278 PMCID: PMC10569058 DOI: 10.1016/j.jsr.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In early 2021, CDC released the CORE Health Equity Strategy, which resolves to integrate a comprehensive health equity approach to the work of the Agency. One priority of the Injury Center's Division of Injury Prevention is to move health equity research in injury forward. The purpose of this research is to perform an initial exploration of health equity guiding frameworks and indices to better understand which of these has been applied to injury research topics. METHODS A PubMed and CINAHL search of meta-analysis and systematic review articles was conducted from January 1998 through April 2022. Articles of any type and additional frameworks/indices were also identified from staff knowledge of the literature. Books were also considered, where accessible. The following areas were reviewed for each resource: population addressed, guiding framework/index, other health equity variables, gaps identified, and whether the articles addressed an injury topic. FINDINGS The PubMed/CINAHL search produced 230 articles, and an additional 29 articles and 8 books were added from previous knowledge of the literature, resulting in a total of 267 resources for review. There were 60 frameworks/indices compiled that were relevant to health equity. Out of all the resources, three reported on an injury topic and used the PROGRESS-Plus framework, the WHO Social Determinants of Health Conceptual Framework, and a social-ecological framework. CONCLUSIONS This study found there were many frameworks/indices for measuring health equity; however, there were few injury-related meta-analysis and systematic review articles. Some frameworks/indices may be more appropriate than others for measuring health equity in injury topic areas, depending on which social determinants of health (SDOHs) they address. PRACTICAL APPLICATIONS Measuring health equity in injury and other public health research areas can help build a foundation of evidence. Moving forward, injury researchers can consider the frameworks/indices identified through this study in their health equity injury research.
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Affiliation(s)
- Natalie H Lennon
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, GA 30341, USA; Oak Ridge Associated Universities (ORAU), Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | - Andrea E Carmichael
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, GA 30341, USA
| | - Judith R Qualters
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, GA 30341, USA
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Hostiuc S, Isailă OM, Curcă GC. Perceptions of Dental Medicine Students on Equity within Healthcare Systems in Romania: A Pilot Study. Healthcare (Basel) 2022; 10:857. [PMID: 35627993 PMCID: PMC9141564 DOI: 10.3390/healthcare10050857] [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: 03/28/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
The scope of this paper is to evaluate the opinion of future dentists on equity within healthcare systems from a social and medical perspective. MATERIAL AND METHODS We conducted an observational study based on a survey among year five students from the "Carol Davila" Faculty of Dental Medicine Bucharest using an online questionnaire composed of graded answers to 14 statements on the theme of equity within healthcare systems before taking this course. RESULTS The questionnaire was sent to 300 students, of whom 151 (50.3%) responded; 79.47% of these were female and 20.53% were male; 9.3% had a rural background and 90.7% had an urban background. The majority of respondents expressed strong agreement that equity in public healthcare and acknowledging disadvantaged populations was important. The majority of students also strongly agreed that inequity came about from a lack of accessibility to medical care, lack of financial resources, and the absence of a second medical opinion. There were no statistically significant differences specific to the gender and background environment of the respondents. CONCLUSIONS The notion of equity is known to future dentists. However, contextual clarifications of the concept itself and its adequate quantification are necessary.
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Affiliation(s)
- Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Mina Minovici” National Institute of Legal Medicine, 042122 Bucharest, Romania;
| | - Oana-Maria Isailă
- Department of Legal Medicine and Bioethics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Mina Minovici” National Institute of Legal Medicine, 042122 Bucharest, Romania;
| | - George-Cristian Curcă
- “Mina Minovici” National Institute of Legal Medicine, 042122 Bucharest, Romania;
- Department of Legal Medicine and Bioethics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Evans MV, Andréambeloson T, Randriamihaja M, Ihantamalala F, Cordier L, Cowley G, Finnegan K, Hanitriniaina F, Miller AC, Ralantomalala LM, Randriamahasoa A, Razafinjato B, Razanahanitriniaina E, Rakotonanahary RJL, Andriamiandra IJ, Bonds MH, Garchitorena A. Geographic barriers to care persist at the community healthcare level: Evidence from rural Madagascar. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001028. [PMID: 36962826 PMCID: PMC10022327 DOI: 10.1371/journal.pgph.0001028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/26/2022] [Indexed: 12/28/2022]
Abstract
Geographic distance is a critical barrier to healthcare access, particularly for rural communities with poor transportation infrastructure who rely on non-motorized transportation. There is broad consensus on the importance of community health workers (CHWs) to reduce the effects of geographic isolation on healthcare access. Due to a lack of fine-scale spatial data and individual patient records, little is known about the precise effects of CHWs on removing geographic barriers at this level of the healthcare system. Relying on a high-quality, crowd-sourced dataset that includes all paths and buildings in the area, we explored the impact of geographic distance from CHWs on the use of CHW services for children under 5 years in the rural district of Ifanadiana, southeastern Madagascar from 2018-2021. We then used this analysis to determine key features of an optimal geographic design of the CHW system, specifically optimizing a single CHW location or installing additional CHW sites. We found that consultation rates by CHWs decreased with increasing distance patients travel to the CHW by approximately 28.1% per km. The optimization exercise revealed that the majority of CHW sites (50/80) were already in an optimal location or shared an optimal location with a primary health clinic. Relocating the remaining CHW sites based on a geographic optimum was predicted to increase consultation rates by only 7.4%. On the other hand, adding a second CHW site was predicted to increase consultation rates by 31.5%, with a larger effect in more geographically dispersed catchments. Geographic distance remains a barrier at the level of the CHW, but optimizing CHW site location based on geography alone will not result in large gains in consultation rates. Rather, alternative strategies, such as the creation of additional CHW sites or the implementation of proactive care, should be considered.
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Affiliation(s)
| | | | | | - Felana Ihantamalala
- NGO PIVOT, Ranomafana, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, United Sates of America
| | | | | | | | | | - Ann C Miller
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, United Sates of America
| | | | | | | | | | | | | | - Matthew H Bonds
- NGO PIVOT, Ranomafana, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, United Sates of America
| | - Andres Garchitorena
- MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France
- NGO PIVOT, Ranomafana, Ifanadiana, Madagascar
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