1
|
Uwamahoro NS, McRae D, Zibrowski E, Victor-Uadiale I, Gilmore B, Bergen N, Muhajarine N. Understanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis. BMJ Glob Health 2022; 7:bmjgh-2022-009605. [PMID: 36180098 PMCID: PMC9528638 DOI: 10.1136/bmjgh-2022-009605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Maternity waiting homes (MWHs) link pregnant women to skilled birth attendance at health facilities. Research suggests that some MWH-facility birth interventions are more success at meeting the needs and expectations of their intended users than others. We aimed to develop theory regarding what resources work to support uptake and scale-up of MHW-facility birth interventions, how, for whom, in what contexts and why. Methods A four-step realist review was conducted which included development of an initial programme theory; searches for evidence; selection, appraisal and extraction of data; and analysis and data synthesis. Results A programme theory was developed from 106 secondary sources and 12 primary interviews with MWH implementers. The theory demonstrated that uptake and scale-up of the MWH-facility birth intervention depends on complex interactions between three adopter groups: health system stakeholders, community gatekeepers and pregnant women and their families. It describes relationships between 19 contexts, 11 mechanisms and 31 outcomes accross nine context-mechanism-outcome configurations (CMOCs) which were grouped into 3 themes: (1) Engaging stakeholders to develop, integrate, and sustain MWH-facility birth interventions, (2) Promoting and enabling MWH-facility birth utilisation and (3) Creating positive and memorable MWH-facility birth user experiences. Belief, trust, empowerment, health literacy and perceptions of safety, comfort and dignity were mechanisms that supported diffusion and adoption of the intervention within communities and health systems. Examples of resources provided by implementers to trigger mechanisms associated with each CMOC were identified. Conclusions Implementers of MWHs cannot merely assume that communities will collectively value an MWH-facility birth experience over delivery at home. We posit that MWH-facility birth interventions become vulnerable to under-utilisation when implementers fail to: (1) remove barriers that hinder women’s access to MWH and (2) ensure that conditions and interactions experienced within the MWH and its affiliated health facility support women to feel treated with compassion, dignity and respect. PROSPERO registration number CRD42020173595.
Collapse
Affiliation(s)
- Nadege Sandrine Uwamahoro
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Faculty of Medical Sciences, Newcastle University, Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - Daphne McRae
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Chilliwack Division of Family Practice, Chilliwack General Hospital, Chiliwack, British Colombia, Canada
| | - Elaine Zibrowski
- Best Care COPD, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ify Victor-Uadiale
- Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Ireland
| | - Nicole Bergen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nazeem Muhajarine
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Population Health and Evaluation Research Unit, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
2
|
Mapuranga H, Pitcher RD, Jakanani GC, Banhwa J. An audit of Zimbabwean public sector diagnostic ultrasound services. Pan Afr Med J 2021; 39:99. [PMID: 34466201 PMCID: PMC8379399 DOI: 10.11604/pamj.2021.39.99.28342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction the provision of basic diagnostic imaging services is pivotal to achieving universal health coverage. An estimated two-thirds of the world's population have no access to basic diagnostic imaging. Accurate data on current imaging equipment resources are required to inform health delivery strategy and policy at national level. This is an audit of Zimbabwean public sector diagnostic ultrasound resources and services. Methods utilising the Ministry of Health and Child Care (MHCC) database, sequential interviews were conducted with provincial health authorities and local facility managers. Ultrasound equipment, personnel and services in all hospitals and clinics, nationally were recorded, collated, and analysed for the whole country, and by province. Results of the 1798 Zimbabwean public sector healthcare facilities, sixty-six (n=66, 3.67%) have ultrasound equipment. Ninety-nine (n=99) ultrasound units are distributed across the sonar facilities, representing a national average of 8 units per million people. More than half the equipment units (n=53, 54%) are in secondary-level healthcare facilities (district and mission hospitals), and approximately one-fifth (n=22, 22%) in the central hospitals (quaternary level). The best-resourced province has twice the resources of the least resourced. One-hundred and forty-two (n=142) healthcare workers, from six different professional groups, provide the public sector ultrasound service. Most facilities with sonar equipment (n=64/66, 97%) provide obstetrics and gynaecology services, while general abdominal scanning is available at one third (n=22, 33%). Two facilities with ultrasound equipment have no capacity to offer a sonography service. Conclusion in order to reach the WHO recommendation of 20 sonar units per million people, an estimated 140 additional sonar units are required nationally. The need is greatest in Masvingo, Midlands and Mashonaland East Provinces. Task-shifting plays a key role in the provision of Zimbabwean sonar services. Consideration should be given to formal training and accreditation of all healthcare workers involved in sonar service delivery.
Collapse
Affiliation(s)
- Humphrey Mapuranga
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Richard Denys Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | | | - Josephat Banhwa
- Department of Medical Physics and Imaging Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| |
Collapse
|
3
|
Kpokiri EE, Chen E, Li J, Payne S, Shrestha P, Afsana K, Amazigo U, Awor P, de Lavison JF, Khan S, Mier-Alpaño J, Ong A, Subhedar S, Wachmuth I, Cuervo LG, Mehta KM, Halpaap B, Tucker JD. Social Innovation For Health Research: Development of the SIFHR Checklist. PLoS Med 2021; 18:e1003788. [PMID: 34516565 PMCID: PMC8475987 DOI: 10.1371/journal.pmed.1003788] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Social innovations in health are inclusive solutions to address the healthcare delivery gap that meet the needs of end users through a multi-stakeholder, community-engaged process. While social innovations for health have shown promise in closing the healthcare delivery gap, more research is needed to evaluate, scale up, and sustain social innovation. Research checklists can standardize and improve reporting of research findings, promote transparency, and increase replicability of study results and findings. METHODS AND FINDINGS The research checklist was developed through a 3-step community-engaged process, including a global open call for ideas, a scoping review, and a 3-round modified Delphi process. The call for entries solicited checklists and related items and was open between November 27, 2019 and February 1, 2020. In addition to the open call submissions and scoping review findings, a 17-item Social Innovation For Health Research (SIFHR) Checklist was developed based on the Template for Intervention Description and Replication (TIDieR) Checklist. The checklist was then refined during 3 rounds of Delphi surveys conducted between May and June 2020. The resulting checklist will facilitate more complete and transparent reporting, increase end-user engagement, and help assess social innovation projects. A limitation of the open call was requiring internet access, which likely discouraged participation of some subgroups. CONCLUSIONS The SIFHR Checklist will strengthen the reporting of social innovation for health research studies. More research is needed on social innovation for health.
Collapse
Affiliation(s)
- Eneyi E. Kpokiri
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elizabeth Chen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Jingjing Li
- Social Entrepreneurship to Spur Health (SESH), Global Health Center Office, Guangzhou City, Guangdong Province, Guangzhou, China
| | - Sarah Payne
- Department of Medical Anthropology, School of Global Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Priyanka Shrestha
- International Diagnostics Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kaosar Afsana
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Uche Amazigo
- Pan-African Community Initiative on Education and Health (PACIEH), Enugu, Nigeria
| | - Phyllis Awor
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | | | - Saqif Khan
- BRAC Health Programme, BRAC Centre, Dhaka, Bangladesh
| | - Jana Mier-Alpaño
- Social Innovation in Health Initiative (SIHI) Philippines Hub, Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Philippines
| | - Alberto Ong
- Alliance for Improving Health Outcomes (AIHO), Quezon City, Philippines
| | - Shivani Subhedar
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Isabelle Wachmuth
- Service Delivery and Safety Department, Health Systems and Innovation, World Health Organization, Geneva, Switzerland
| | - Luis Gabriel Cuervo
- Research for Health, Pan American Health Organization, Washington, DC, United States of America
| | - Kala M. Mehta
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Beatrice Halpaap
- TDR, the Special Programme for Research and Training in Tropical Diseases, cosponsored by UNICEF, UNDP, the World Bank, and WHO, Geneva, Switzerland
| | - Joseph D. Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Social Entrepreneurship to Spur Health (SESH), Global Health Center Office, Guangzhou City, Guangdong Province, Guangzhou, China
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, United States of America
| |
Collapse
|
4
|
Maternal Vaccination in Uganda: Exploring Pregnant Women, Community Leaders and Healthcare Workers' Perceptions. Vaccines (Basel) 2021; 9:vaccines9060552. [PMID: 34070536 PMCID: PMC8230088 DOI: 10.3390/vaccines9060552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background: We investigated pregnant women, community leaders, healthcare workers (HCWs) and programme managers' perceptions of maternal vaccination in Kampala, Uganda. Methods: We conducted focus group discussions, key informant interviews and in-depth discussions with HCWs (3), community leaders (3), pregnant women (8) and programme managers (10) between November 2019 and October 2020. Data were analysed thematically. Results: Pregnant women, community leaders and some HCWs had limited maternal immunisation knowledge. There was confusion over what constitutes a vaccine. Pregnant women may not receive vaccines because of mistrust of government; use of expired vaccines; reliance on traditional medicine; religious beliefs; fear of side effects; HCWs attitudes; and logistical issues. The key facilitators of maternal vaccination were a desire to prevent diseases, positive influences from HCWs and information about vaccine side effects. Community leaders and some pregnant women highlighted that pregnant women do not make decisions about maternal vaccination independently and are influenced by different individuals, including other pregnant women, older people, partners, relatives (parents), community leaders, HCWs and the government. Conclusions: Our results indicate that public health messaging should target all community members, including partners and parents of pregnant women as well as HCWs, to improve knowledge of and confidence in maternal vaccines.
Collapse
|
5
|
van Niekerk L, Manderson L, Balabanova D. The application of social innovation in healthcare: a scoping review. Infect Dis Poverty 2021; 10:26. [PMID: 33685487 PMCID: PMC7938294 DOI: 10.1186/s40249-021-00794-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/05/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Social innovation has been applied increasingly to achieve social goals, including improved healthcare delivery, despite a lack of conceptual clarity and consensus on its definition. Beyond its tangible artefacts to address societal and structural needs, social innovation can best be understood as innovation in social relations, in power dynamics and in governance transformations, and may include institutional and systems transformations. METHODS A scoping review was conducted of empirical studies published in the past 10 years, to identify how social innovation in healthcare has been applied, the enablers and barriers affecting its operation, and gaps in the current literature. A number of disciplinary databases were searched between April and June 2020, including Academic Source Complete, CIHAHL, Business Source Complete Psych INFO, PubMed and Global Health. A 10-year publication time frame was selected and articles limited to English text. Studies for final inclusion was based on a pre-defined criteria. RESULTS Of the 27 studies included in this review, the majority adopted a case research methodology. Half of these were from authors outside the health sector working in high-income countries (HIC). Social innovation was seen to provide creative solutions to address barriers associated with access and cost of care in both low- and middle-income countries and HIC settings in a variety of disease focus areas. Compared to studies in other disciplines, health researchers applied social innovation mainly from an instrumental and technocratic standpoint to foster greater patient and beneficiary participation in health programmes. No empirical evidence was presented on whether this process leads to empowerment, and social innovation was not presented as transformative. The studies provided practical insights on how implementing social innovation in health systems and practice can be enhanced. CONCLUSIONS Based on theoretical literature, social innovation has the potential to mobilise institutional and systems change, yet research in health has not yet fully explored this dimension. Thus far, social innovation has been applied to extend population and financial coverage, principles inherent in universal health coverage and central to SDG 3.8. However, limitations exist in conceptualising social innovation and applying its theoretical and multidisciplinary underpinnings in health research.
Collapse
Affiliation(s)
| | - Lenore Manderson
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,School of Social Sciences, Monash University, Clayton, Australia
| | | |
Collapse
|
6
|
Hanulakova E, Dano F, Kukura M, Hula R. Marketing in social innovations targeted at healthcare. MARKETING AND MANAGEMENT OF INNOVATIONS 2021. [DOI: 10.21272/mmi.2021.3-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The paper deals with the implementation of marketing in social innovations, types of marketing, and the effects they can bring in the sphere of social innovations. The principalaim of the paper is to explain the possibilities of marketing approach implementation in social innovations and point out some specific areas of marketing which can contribute to more efficient applicability of social innovations and reaching a desirable change with social added value. The authors focused on the sphere of health and the population attitudes to its protection, emphasizing breast carcinoma prevention. The research was implemented on a sample of Slovak women to identify the level of women’s awareness of this issue, whether they are familiar with the methods of protecting their health and whether they use them. This study involved the methods of cluster analysis and binary logistic regression. The research uncovered the facts that are truly alarming from the perspective of societal benefit and women’s health protection. The respondents’ insufficient awareness and low activity in the field of their health protection result in the low level of prevention in this area on the side of women and on the side of medical doctors – specialists, particularly gynecologists. Such a situation includes the women’s insufficient awareness of prevention, low motivation, insufficient accessibility and validity of the needed data and precision, and doctor specialists’ lack of awareness of the possibilities and tools available to improve this area. That is exactly the space allowing for the use of marketing in a whole spectrum of its tools and processes and specific solutions capable of delivering the desired societal change and influencing women’s behavior in the preferred direction. Besides, it is especially effective to implement social marketing and social marketing programs that would mediate necessary information to the receivers and stimulate their motivation towards the desired approach to their health protection. The use of neuromarketing would be beneficial. It would be reflected in the better accuracy of the survey and thus the higher quality of the answers obtained. Based on them, it is subsequently possible to create better-targeted campaigns and strategies of social marketing that would approach the target audience more effectively than in acquiring the information via traditional marketing research methods. The findings would benefit marketing agencies, medical doctors (gynecologists, mammologists), and non-profit organizations actively working in this field.
Collapse
|
7
|
Kpokiri E, Chen E, Li J, Payne S, Shrestha P, Afsana K, Amazigo U, Awor P, de Lavison JF, Khan S, Mier-Alpaño JD, Ong A, Subhedar S, Wachmuth I, Mehta KM, Halpaap B, Tucker JD. Social innovation research checklist: A crowdsourcing open call and digital hackathon to develop a checklist for research to advance social innovation in health. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.11.03.20225110. [PMID: 33173931 PMCID: PMC7654927 DOI: 10.1101/2020.11.03.20225110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
While social innovations in health have shown promise in closing the healthcare delivery gap, especially in low- and middle-income countries (LMICs), more research is needed to evaluate, scale up, and sustain social innovations. Research checklists can standardize and improve reporting of research findings, promote transparency, and increase replicability of study results and findings. This article describes the development of a 17-item social innovation in health research checklist to assess and report social innovation projects and provides examples of good reporting. The checklist is adapted from the TIDieR checklist and will facilitate more complete and transparent reporting and increase end user engagement. SUMMARY POINTS While many social innovations have been developed and shown promise in closing the healthcare delivery gap, more research is needed to evaluate social innovationThe Social Innovation in Health Research Checklist, the first of its kind, is a 17-item checklist to improve reporting completeness and promote transparency in the development, implementation, and evaluation of social innovations in healthThe research checklist was developed through a three-step process, including a global open call for ideas, a scoping review, and a three-round modified Delphi processUse of this research checklist will enable researchers, innovators and partners to learn more about the process and results of social innovation in health research.
Collapse
Affiliation(s)
- Eneyi Kpokiri
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Chen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jingjing Li
- Social Entrepreneurship to Spur Health (SESH), 1 Global Health Center Office, 2nd Floor of Lao Gan Building, No. 7 Lujing Road, Yuexiu District, Guangzhou City, Guangdong Province, Guangzhou, China
| | - Sarah Payne
- Department of Medical Anthropology, School of Global health, University of North Carolina, Chapel Hill, NC, USA
| | - Priyanka Shrestha
- International Diagnostics Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Kaosar Afsana
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Uche Amazigo
- Pan-African Community Initiative on Education and Health (PACIEH), Enugu, Nigeria
| | - Phyllis Awor
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | | | - Saqif Khan
- BRAC Health Programme, BRAC Centre, Dhaka, Bangladesh
| | - Jana D. Mier-Alpaño
- Social Innovation in Health Initiative (SIHI) Philippines Hub, Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Philippines
| | - Alberto Ong
- Alliance for Improving Health Outcomes (AIHO), West Avenue, West Triangle, Quezon City, Philippines
| | - Shivani Subhedar
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Isabelle Wachmuth
- Service Delivery and Safety Department, Health Systems and Innovation, World Health Organization, Geneva, Switzerland
| | - Kala M. Mehta
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Beatrice Halpaap
- TDR, the Special Programme for Research and Training in Tropical Diseases co-sponsored by UNICEF, UNDP, the World Bank and WHO, Geneva, Switzerland
| | - Joseph D. Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Social Entrepreneurship to Spur Health (SESH), 1 Global Health Center Office, 2nd Floor of Lao Gan Building, No. 7 Lujing Road, Yuexiu District, Guangzhou City, Guangdong Province, Guangzhou, China
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|