Healthcare providers' perspectives on integrating NCDs into primary healthcare in Thailand: a mixed method study

Multisectoral actions in primary health care: A realist synthesis of scoping review

BACKGROUND

Multisectoral actions (MSAs) on health are key to implementation of primary health care (PHC) and achieving the targets of the Sustainable Development Goal 3. However, there is limited understanding and interpretation of how MSAs on health articulate and mediate health outcomes. This realist review explored how MSAs influence on implementing PHC towards universal health coverage (UHC) in the context of multilevel health systems.

METHODS

We reviewed published evidence that reported the MSAs, PHC and UHC. The keywords used in the search strategy were built on these three key concepts. We employed Pawson and Tilley's realist review approach to synthesize data following Realist and Meta-narrative Evidence Syntheses: Evolving Standards publication standards for realist synthesis. We explained findings using a multilevel lens: MSAs at the strategic level (macro-level), coordination and partnerships at the operational level (meso-level) and MSAs employing to modify behaviours and provide services at the local level (micro-level).

RESULTS

A total of 40 studies were included in the final review. The analysis identified six themes of MSAs contributing to the implementation of PHC towards UHC. At the macro-level, themes included influence on the policy rules and regulations for governance, and health in all policies for collaborative decision makings. The meso-level themes were spillover effects of the non-health sector, and the role of community health organizations on health. Finally, the micro-level themes were community engagement for health services/activities of health promotion and addressing individuals' social determinants of health.

CONCLUSION

Multisectoral actions enable policy and actions of other sectors in health involving multiple stakeholders and processes. Multisectoral actions at the macro-level provide strategic policy directions; and operationalise non-health sector policies to mitigate their spillover effects on health at the meso-level. At micro-level, MSAs support service provision and utilisation, and lifestyle and behaviour modification of people leading to equity and universality of health outcomes. Proper functional institutional mechanisms are warranted at all levels of health systems to implement MSAs on health.

Levels and Predictors of Proactive Practical Experience to Solve COVID-19 among Public Health Officers in Primary Care Units in the Upper Southern Region, Thailand: An Explanatory Mixed Methods Approach

Public Health Officers (PHOs)' experiences in reaction to the COVID-19 pandemic can be based on whether the PHO is active or passive regarding five experience aspects, including knowledge, understanding, opinion, participation, and practice. Therefore, this study's objectives are to identify the types of experiences and analyse the predictors of proactive practical experiences in addressing the COVID-19 pandemic among PHOs in the southern region of Thailand.

METHODS

An explanatory mixed methods approach was used to collect data, through questionnaires and online in-depth interviews. This study was conducted from 4 August 2020 to 3 August 2021.

RESULTS

The results include 60 PHOs from 60 Primary Care Units in six provinces, with 41 (68.3%) females and an average age of 35.57 years (SD = 11.61). The PHOs' knowledge, understanding, and participation experience aspects were mostly proactive rather than passive. The factors that significantly predicted proactive practical experiences included sex (ORadj = 1.52, 95% CI = 1.04-2.21), age (ORadj = 1.69, 95% CI = 1.16-2.48), married status (ORadj = 1.69, 95% CI = 1.16-2.48), education level (ORadj = 1.50, 95% CI = 1.02-2.20), and position for work (ORadj = 1.69, 95% CI = 1.16-2.48). The results of quantitative method were confirmed by 12 sub-themes of 8 PHOs' experiences from qualitative method.

CONCLUSIONS

The PHOs' knowledge, understanding, opinion, and participation experiences were significant predictors of practical experience. Primary health care systems should promote proactive experiences in all four aspects to increase proactive practical experiences.

Healthcare service utilization of hill tribe children in underserved communities in thailand: Barriers to access

BACKGROUND

Hill tribe children, an ethnic minority group in Thailand, experience wide-ranging social and health inequalities. Previous reports indicate that hill tribe children, especially age under 5 years, face social health disadvantages but little is known about the underlying causes. Exploring healthcare utilization among hill tribe children is therefore essential and it may well provide some insight.

METHODS

A qualitative study was conducted using purposive sampling techniques to recruit participants based on our criteria. In-depth interviews and focus-group discussions were employed to explore the experiences of parents (n = 20), community leaders (n = 20), and healthcare providers (n = 20) when caring for children aged under 5 years. Interview transcripts were coded, and thematic analysis was then performed.

RESULTS

The participants shared their experiences with accessing healthcare services in underserved areas. Barriers to access was the central theme identified. Sub-themes included: (1) distance matters, (2) education and socioeconomic deprivation, (3) lack of cultural sensitivity, (4) communication problems, (5) tradition, beliefs, and differences in cultural practice, (6) lack of child health professionals, and (7) bureaucratic hurdles.

CONCLUSIONS

Healthcare services and environments must be transformed to provide healthcare services, education, and information appropriate to the cultures and beliefs prevalent in the hill tribe population.