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Colombini M, Shrestha S, Pereira S, Kalichman B, Siriwardhana P, Silva T, Halaseh R, d’Oliveira AF, Rishal P, Bhatt PR, Shaheen A, Joudeh N, Rajapakse T, Alkaiyat A, Feder G, Moreno CG, Bacchus LJ. Comparing health systems readiness for integrating domestic violence services in Brazil, occupied Palestinian Territories, Nepal and Sri Lanka. Health Policy Plan 2024; 39:552-563. [PMID: 38758072 PMCID: PMC11145909 DOI: 10.1093/heapol/czae032] [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: 10/17/2023] [Revised: 02/29/2024] [Accepted: 04/26/2024] [Indexed: 05/18/2024] Open
Abstract
Domestic violence (DV) is a global prevalent health problem leading to adverse health consequences, yet health systems are often unprepared to address it. This article presents a comparative synthesis of the health system's pre-conditions necessary to enable integration of DV in health services in Brazil, Nepal, Sri Lanka and occupied Palestinian Territories (oPT). A cross-country, comparative analysis was conducted using a health systems readiness framework. Data collection involved multiple data sources, including qualitative interviews with various stakeholders; focus-group discussions with women; structured facility observations; and a survey with providers. Our findings highlight deficiencies in policy and practice that need to be addressed for an effective DV response. Common readiness gaps include unclear and limited guidance on DV, unsupportive leadership coupled with limited training and resources. Most providers felt unprepared, lacked guidance and felt unsupported and unprotected by managers and their health system. While in Brazil most providers felt they should respond to DV cases, many in Sri Lanka preferred not to. Such organizational and service delivery challenges, in turn, also affected how health providers responded to DV cases leaving them not confident, uncertain about their knowledge and unsure about their role. Furthermore, providers' personal beliefs and values on DV and gender norms also impacted their motivation and ability to respond, prompting some to become 'activists' while others were reluctant to intervene and prone to blame women. Our synthesis also pointed to a gap in women's use of health services for DV as they had low trust in providers. Our conceptual framework demonstrates the importance of having clear policies and highlights the need to engage leadership across every level of the system to reframe challenges and strengthen routine practices. Future research should also determine the ways in which women's understanding and needs related to DV help-seeking are addressed.
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Affiliation(s)
- Manuela Colombini
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9RA, United Kingdom
| | - Satya Shrestha
- Kathmandu University School of Medical Sciences, Nepal and Faculty of Health Sciences, Dhulikhel 45209, Nepal
- University of Bristol, Bristol BS81UD, United Kingdom
| | - Stephanie Pereira
- Faculty of Medicine, University of São Paulo Institute of Biomedical Sciences, Sao Paulo, Sao Paulo CEP 01246 903, Brazil
| | - Beatriz Kalichman
- Department of Preventive Medicine, Faculty of Medicine, Sao Paulo CEP 01246 903, Brazil
| | - Prabhash Siriwardhana
- Department of Social Sciences, Rajarata University of Sri Lanka, Mihintale 50300, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | - Tharuka Silva
- Department of Psychiatry, Faculty of Medicine, Kandy, Sri Lanka
| | - Rana Halaseh
- Occupied Palestinian Territories, An-Najah National University, Palestine
| | - Ana Flavia d’Oliveira
- Faculty of Medicine, University of São Paulo Institute of Biomedical Sciences, Sao Paulo, Sao Paulo CEP 01246 903, Brazil
| | - Poonam Rishal
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel 45209, Nepal
| | - Pusp Raj Bhatt
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel 45209, Nepal
| | - Amira Shaheen
- Faculty of Medicine and Health Sciences, Occupied Palestinian Territories, An-Najah National University, Nablus, Palestine
| | - Nagham Joudeh
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | | | - Abdulsalam Alkaiyat
- Faculty of Medicine and Health Sciences, Occupied Palestinian Territories, An-Najah National University, Nablus, Palestine
| | - Gene Feder
- University of Bristol, Centre for Academic Primary Care, Bristol BS81UD, United Kingdom
| | - Claudia Garcia Moreno
- Formerly at Department of Reproductive Health and Research, World Health Organisation, Geneva 1211, Switzerland
| | - Loraine J Bacchus
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9RA, United Kingdom
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Wang J, Tan F, Wang Z, Yu Y, Yang J, Wang Y, Shao R, Yin X. Understanding Gaps in the Hypertension and Diabetes Care Cascade: Systematic Scoping Review. JMIR Public Health Surveill 2024; 10:e51802. [PMID: 38149840 PMCID: PMC10907944 DOI: 10.2196/51802] [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: 08/15/2023] [Revised: 10/22/2023] [Accepted: 12/27/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Hypertension and diabetes are global health challenges requiring effective management to mitigate their considerable burden. The successful management of hypertension and diabetes requires the completion of a sequence of stages, which are collectively termed the care cascade. OBJECTIVE This scoping review aimed to describe the characteristics of studies on the hypertension and diabetes care cascade and identify potential interventions as well as factors that impact each stage of the care cascade. METHODS The method of this scoping review has been guided by the framework by Arksey and O'Malley. We systematically searched MEDLINE, Embase, and Web of Science using terms pertinent to hypertension, diabetes, and specific stages of the care cascade. Articles published after 2011 were considered, and we included all studies that described the completion of at least one stage of the care cascade of hypertension and diabetes. Study selection was independently performed by 2 paired authors. Descriptive statistics were used to elucidate key patterns and trends. Inductive content analysis was performed to generate themes regarding the barriers and facilitators for improving the care cascade in hypertension and diabetes management. RESULTS A total of 128 studies were included, with 42.2% (54/128) conducted in high-income countries. Of them, 47 (36.7%) focused on hypertension care, 63 (49.2%) focused on diabetes care, and only 18 (14.1%) reported on the care of both diseases. The majority (96/128, 75.0%) were observational in design. Cascade stages documented in the literature were awareness, screening, diagnosis, linkage to care, treatment, adherence to medication, and control. Most studies focused on the stages of treatment and control, while a relative paucity of studies examined the stages before treatment initiation (76/128, 59.4% vs 52/128, 40.6%). There was a wide spectrum of interventions aimed at enhancing the hypertension and diabetes care cascade. The analysis unveiled a multitude of individual-level and system-level factors influencing the successful completion of cascade sequences in both high-income and low- and middle-income settings. CONCLUSIONS This review offers a comprehensive understanding of hypertension and diabetes management, emphasizing the pivotal factors that impact each stage of care. Future research should focus on upstream cascade stages and context-specific interventions to optimize patient retention and care outcomes.
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Affiliation(s)
- Jie Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fangqin Tan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhenzhong Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yiwen Yu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingsong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yueqing Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruitai Shao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuejun Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Diabetes-Related Healthcare Services in Nepal—A Qualitative Exploration of Healthcare Professionals’ Opinions. PHARMACY 2020; 8:pharmacy8030131. [PMID: 32751261 PMCID: PMC7560237 DOI: 10.3390/pharmacy8030131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/30/2022] Open
Abstract
Healthcare professionals’ level of engagement in diabetes care and their perceptions of challenges to effective diabetes care are key indicators impacting diabetes management. This study investigated diabetes-related healthcare services provided in Nepal, and explored healthcare professionals’ opinions of the barriers to, and strategies for, effective diabetes care. In-depth face-to-face interviews were conducted with thirty healthcare professionals providing healthcare or medication-related services to patients with type 2 diabetes within Kathmandu Valley. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Participants were physicians, dieticians, nurses and pharmacy staff. Diabetes care services varied between healthcare institutions, between healthcare professionals and between patients, with the overall patient-care model reported as sub-optimal. Diabetes related services were mostly limited to physician-patient consultations. Only a few hospitals or clinics provided additional diabetes education classes, and individual dietician or nurse consultations. Limited collaboration, large patient-load and workforce shortages (particularly lack of diabetes educators) were reported as major issues affecting diabetes care. Regulatory measures to address healthcare system barriers were identified as potential facilitators for effective diabetes management. Whilst the findings are specific to Nepal, there are lessons to be learnt for other healthcare settings as the fundamental barriers to optimal diabetes care appear to be similar worldwide.
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