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Schulte PA, Guerin RJ, Cunningham TR, Hodson L, Murashov V, Rabin BA. Applying Translational Science Approaches to Protect Workers Exposed to Nanomaterials. Front Public Health 2022; 10:816578. [PMID: 35757639 PMCID: PMC9226388 DOI: 10.3389/fpubh.2022.816578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Like nanotechnology, translational science is a relatively new and transdisciplinary field. Translational science in occupational safety and health (OSH) focuses on the process of taking scientific knowledge for the protection of workers from the lab to the field (i.e., the worksite/workplace) and back again. Translational science has been conceptualized as having multiple phases of research along a continuum, beyond scientific discovery (T0), to efficacy (T1), to effectiveness (T2), to dissemination and implementation (D&I) (T3), to outcomes and effectiveness research in populations (T4). The translational research process applied to occupational exposure to nanomaterials might involve similar phases. This builds on basic and efficacy research (T0 and T1) in the areas of toxicology, epidemiology, industrial hygiene, medicine and engineering. In T2, research and evidence syntheses and guidance and recommendations to protect workers may be developed and assessed for effectiveness. In T3, emphasis is needed on D&I research to explore the multilevel barriers and facilitators to nanotechnology risk control information/research adoption, use, and sustainment in workplaces. D&I research for nanomaterial exposures should focus on assessing sources of information and evidence to be disseminated /implemented in complex and dynamic workplaces, how policy-makers and employers use this information in diverse contexts to protect workers, how stakeholders inform these critical processes, and what barriers impede and facilitate multilevel decision-making for the protection of nanotechnology workers. The T4 phase focuses on how effective efforts to prevent occupational exposure to nanomaterials along the research continuum contribute to large-scale impact in terms of worker safety, health and wellbeing (T4). Stakeholder input and engagement is critical to all stages of the translational research process. This paper will provide: (1) an illustration of the translational research continuum for occupational exposure to nanomaterials; and (2) a discussion of opportunities for applying D&I science to increase the effectiveness, uptake, integration, sustainability, and impact of interventions to protect the health and wellbeing of workers in the nanotechnology field.
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Affiliation(s)
- Paul A. Schulte
- Advanced Technologies and Laboratories (ATL) International, Inc., Gaithersburg, MD, United States
| | - Rebecca J. Guerin
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, United States
| | - Thomas R. Cunningham
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, United States
| | - Laura Hodson
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, United States
| | - Vladimir Murashov
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC, United States
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Setting-up an Ebola vaccine trial in a remote area of the Democratic Republic of the Congo: Challenges, mitigations, and lessons learned. Vaccine 2022; 40:3470-3480. [DOI: 10.1016/j.vaccine.2022.04.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/18/2022]
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Larson CP, Plamondon KM, Dubent L, Bicaba F, Bicaba A, Minh TH, Nguyen A, Girard JE, Ramdé J, Gyorkos TW. The Equity Tool for Valuing Global Health Partnerships. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00316. [PMID: 35487557 PMCID: PMC9053142 DOI: 10.9745/ghsp-d-21-00316] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/15/2022] [Indexed: 11/15/2022]
Abstract
There is a need to more comprehensively identify and respond to equity in global health partnerships. The Equity Tool can support dialogue at any stage of a partnership, by individuals at any level. This assists partnerships to embrace ways of recognizing, understanding, and advancing equity in all their processes. Global health partnerships (GHPs) involve complex relationships between individuals and organizations, often joining partners from high-income and low- or middle-income countries around work that is carried out in the latter. Therefore, GHPs are situated in the context of global inequities and their underlying sociopolitical and historical causes, such as colonization. Equity is a core principle that should guide GHPs from start to end. How equity is embedded and nurtured throughout a partnership has remained a constant challenge. We have developed a user-friendly tool for valuing a GHP throughout its lifespan using an equity lens. The development of the EQT was informed by 5 distinct elements: a scoping review of scientific published peer-reviewed literature; an online survey and follow-up telephone interviews; workshops in Canada, Burkina Faso, and Vietnam; a critical interpretive synthesis; and a content validation exercise. Findings suggest GHPs generate experiences of equity or inequity yet provide little guidance on how to identify and respond to these experiences. The EQT can guide people involved in partnering to consider the equity implications of all their actions, from inception, through implementation and completion of a partnership. When used to guide reflective dialogue with a clear intention to advance equity in and through partnering, this tool offers a new approach to valuing global health partnerships. Global health practitioners, among others, can apply the EQT in their partnerships to learning together about how to cultivate equity in their unique contexts within what is becoming an increasingly diverse, vibrant, and responsive global health community.
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Affiliation(s)
- Charles P Larson
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Katrina M Plamondon
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Okanagan, Canada
| | - Leslie Dubent
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
| | - Frank Bicaba
- Société d'Études et de Recherche en Santé Publique, Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherche en Santé Publique, Ouagadougou, Burkina Faso
| | - Tran Hung Minh
- Center for Creative Initiatives in Health and Population, Hanoi, Vietnam
| | - An Nguyen
- HealthBridge Vietnam, Hanoi, Vietnam
| | - Jacques E Girard
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
- Direction en Santé Mondiale, Faculté de Médecine, Université Laval, Québec, Canada
| | - Jean Ramdé
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
- HealthBridge Vietnam, Hanoi, Vietnam
| | - Theresa W Gyorkos
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
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Plamondon KM, Brisbois B, Dubent L, Larson CP. Assessing how global health partnerships function: an equity-informed critical interpretive synthesis. Global Health 2021; 17:73. [PMID: 34215301 PMCID: PMC8254362 DOI: 10.1186/s12992-021-00726-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Global health partnerships (GHPs) are situated in complex political and economic relationships and involve partners with different needs and interests (e.g., government agencies, non-governmental organizations, corporations, universities, professional associations, philanthropic organizations and communities). As part of a mixed methods study designed to develop an equity-sensitive tool to support more equity-centred North-South GHPs, this critical interpretive synthesis examined reported assessments of GHPs. Results We examined 30 peer-reviewed articles for power dynamics, equity and inequities, and contradictions or challenges encountered in North-South partnerships. Among articles reviewed, authors most often situated GHPs around a topical focus on research, capacity-building, clinical, or health services issues, with the ‘work’ of the partnership aiming to foster skills or respond to community needs. The specific features of GHPs that were assessed varied widely, with consistently-reported elements including the early phases of partnering; governance issues; the day-to-day work of partnerships; the performance, impacts and benefits of GHPs; and issues of inclusion. Articles shared a general interest in partnering processes and often touched briefly on issues of equity; but they rarely accounted for the complexity of sociopolitical and historical contexts shaping issues of equity in GHPs. Further, assessments of GHPs were often reported without inclusion of voices from all partners or named beneficiaries. GHPs were frequently portrayed as inherently beneficial for Southern partners, without attention to power dynamics and inequities (North-South, South-South). Though historical and political dynamics of the Global North and South were inconsistently examined as influential forces in GHPs, such dynamics were frequently portrayed as complex and characterized by asymmetries in power and resources. Generally, assessments of GHPs paid little attention to the macroeconomic forces in the power and resource dynamics of GHPs highlights the importance of considering the broader political. Our findings suggest that GHPs can serve to entrench both inequitable relationships and unfair distributions of power, resources, and wealth within and between countries (and partners) if inequitable power relationships are left unmitigated. Conclusions We argue that specific practices could enhance GHPs’ contributions to equity, both in their processes and outcomes. Enhancing partnering practices to focus on inclusion, responsiveness to North-South and South-South inequities, and recognition of GHPs as situated in a broader (and inequitable) political economy. A relational and equity-centred approach to assessing GHPs would place social justice, humility and mutual benefits as central practices—that is, regular, routine things that partners involved in partnering do intentionally to make GHPs function well. Practicing equity in GHPs requires continuous efforts to explicitly acknowledge and examine the equity implications of all aspects of partnering. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00726-z.
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Affiliation(s)
- Katrina M Plamondon
- Michael Smith Foundation for Health Research Scholar, School of Nursing, Faculty of Health & Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | - Ben Brisbois
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Leslie Dubent
- Canadian Coalition for Global Health Research, 46 Cremona Crescent, Nepean, ON, K2G 1A1, Canada
| | - Charles P Larson
- Faculty of Medicine and Health Sciences, School of Population and Global Health, McGill University, 772 Sherbrooke Street West, Montreal, QC, H3A 1G1, Canada
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Adu PA, Spiegel JM, Yassi A. Towards TB elimination: how are macro-level factors perceived and addressed in policy initiatives in a high burden country? Global Health 2021; 17:11. [PMID: 33430902 PMCID: PMC7802197 DOI: 10.1186/s12992-020-00657-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/17/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Notwithstanding extensive general discussion of the effects of upstream forces on health, there has been limited empirical examination, let alone systematic evidence documenting policy responses to such pathways in the area of tuberculosis (TB) management and control. Our study aimed to gain insight into how macro level drivers of TB are perceived by key stakeholders involved in TB management and control in a high-endemic country, and to assess how such concerns are being addressed in policy initiatives in this setting. South Africa was chosen for this case study due to our team's long-standing collaborations there, its very high burden of TB, and its introduction of a strategic plan to combat this disease. METHOD Semi-structured interviews were conducted with 20 key informants who were purposively selected for their knowledge and expertise of TB in South Africa. South Africa's National Strategic Plan for HIV, TB and STIs 2017-2022 was then reviewed to examine how identified themes from the interviews were reflected in this policy document. RESULTS A history of colonization, the migrant labour system, economic inequality, poor shelter, health system challenges including TB governance, the HIV epidemic, and pertinent socio-cultural factors were all perceived to be major drivers of the epidemic. Although South Africa's current National Strategic Plan makes a firm discursive commitment to addressing the structural or macro-level drivers of TB, our analysis revealed that this commitment was not clearly reflected in projected budgetary allocations. CONCLUSION As in many other high burden settings, macro-level drivers of TB are widely recognized. Nonetheless, while micro-level (biomedical and clinical) measures, such as improving diagnostic procedures and investment in more efficacious drugs, are being (and well should be) implemented, our findings showed that macro-level drivers of TB are underrepresented in budgeting allocations for initiatives to combat this disease. Although it could be argued that structural drivers that undermine health-promoting actions are beyond the purview of the health sector itself, we argue that strategic plans to combat TB in high burden settings need more attention to directly considering such drivers to prompt the necessary changes and reduce the burden of this and other such diseases.
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Affiliation(s)
- Prince A. Adu
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1ZE Canada
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC V5Z 4R4 Canada
| | - Jerry M. Spiegel
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1ZE Canada
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1ZE Canada
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A systematic review of factors leading to occupational injuries and fatalities. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01427-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kombe MM, Zulu JM, Michelo C, Sandøy IF. Community perspectives on randomisation and fairness in a cluster randomised controlled trial in Zambia. BMC Med Ethics 2019; 20:99. [PMID: 31864351 PMCID: PMC6925446 DOI: 10.1186/s12910-019-0421-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One important ethical issue in randomised controlled trials (RCTs) is randomisation. Relatively little is known about how participating individuals and communities understand and perceive central aspects of randomisation such as equality, fairness, transparency and accountability in community-based trials. The aim of this study was to understand and explore study communities' perspectives of the randomisation process in a cluster RCT in rural Zambia studying the effectiveness of different support packages for adolescent girls on early childbearing. METHODS In this explorative study, in-depth semi-structured interviews were carried out in 2018 with 14 individuals who took part in the randomisation process of the Research Initiative to Support the Empowerment of Girls (RISE) project in 2016 and two traditional leaders. Two of the districts where the trial is implemented were purposively selected. Interviews were audio recorded and fully transcribed. Data were analysed by coding and describing emergent themes. RESULTS The understanding of the randomisation process varied. Some respondents understood that randomisation was conducted for research purposes, but most of them did not. They had trouble distinguishing research and aid. Generally, respondents perceived the randomisation process as transparent and fair. However, people thought that there should not have been a "lottery" because they wanted all schools to receive equal or balanced benefits of the interventions. CONCLUSIONS Randomisation was misunderstood by most respondents. Perceived procedural fairness was easier to realize than substantive fairness. Researchers working on Cluster Randomised Controlled Trials (CRCTs) should consider carefully how to explain randomisation.
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Affiliation(s)
- Maureen Mupeta Kombe
- School of Public Health, University of Zambia, Ridgeway Campus, P.O Box 50110, Lusaka, Zambia
| | - Joseph Mumba Zulu
- School of Public Health, University of Zambia, Ridgeway Campus, P.O Box 50110, Lusaka, Zambia
| | - Charles Michelo
- School of Public Health, University of Zambia, Ridgeway Campus, P.O Box 50110, Lusaka, Zambia
| | - Ingvild F. Sandøy
- Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Wouters E, Rau A, Engelbrecht M, Uebel K, Siegel J, Masquillier C, Kigozi G, Sommerland N, Yassi A. The Development and Piloting of Parallel Scales Measuring External and Internal HIV and Tuberculosis Stigma Among Healthcare Workers in the Free State Province, South Africa. Clin Infect Dis 2017; 62 Suppl 3:S244-54. [PMID: 27118854 DOI: 10.1093/cid/civ1185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The dual burden of tuberculosis and human immunodeficiency virus (HIV) is severely impacting the South African healthcare workforce. However, the use of on-site occupational health services is hampered by stigma among the healthcare workforce. The success of stigma-reduction interventions is difficult to evaluate because of a dearth of appropriate scientific tools to measure stigma in this specific professional setting. METHODS The current pilot study aimed to develop and test a range of scales measuring different aspects of stigma-internal and external stigma toward tuberculosis as well as HIV-in a South African healthcare setting. The study employed data of a sample of 200 staff members of a large hospital in Bloemfontein, South Africa. RESULTS Confirmatory factor analysis produced 7 scales, displaying internal construct validity: (1) colleagues' external HIV stigma, (2) colleagues' actions against external HIV stigma, (3) respondent's external HIV stigma, (4) respondent's internal HIV stigma, (5) colleagues' external tuberculosis stigma, (6) respondent's external tuberculosis stigma, and (7) respondent's internal tuberculosis stigma. Subsequent analyses (reliability analysis, structural equation modeling) demonstrated that the scales displayed good psychometric properties in terms of reliability and external construct validity. CONCLUSIONS The study outcomes support the use of the developed scales as a valid and reliable means to measure levels of tuberculosis- and HIV-related stigma among the healthcare workforce in a resource-limited context. Future studies should build on these findings to fine-tune the instruments and apply them to larger study populations across a range of different resource-limited healthcare settings with high HIV and tuberculosis prevalence.
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Affiliation(s)
- Edwin Wouters
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Belgium Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Asta Rau
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Michelle Engelbrecht
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Kerry Uebel
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Jacob Siegel
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Caroline Masquillier
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Belgium
| | - Gladys Kigozi
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Nina Sommerland
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Belgium
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Strengthening Human Immunodeficiency Virus and Tuberculosis Prevention Capacity among South African Healthcare Workers: A Mixed Methods Study of a Collaborative Occupational Health Program. Saf Health Work 2017; 9:172-179. [PMID: 29928531 PMCID: PMC6005912 DOI: 10.1016/j.shaw.2017.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/26/2017] [Accepted: 08/15/2017] [Indexed: 12/16/2022] Open
Abstract
Background Insufficient training in infection control and occupational health among healthcare workers (HCWs) in countries with high human immunodeficiency virus (HIV) and tuberculosis (TB) burdens requires attention. We examined the effectiveness of a 1-year Certificate Program in Occupational Health and Infection Control conducted in Free State Province, South Africa in an international partnership to empower HCWs to become change agents to promote workplace-based HIV and TB prevention. Methods Questionnaires assessing reactions to the program and Knowledge, Attitudes, Skills, and Practices were collected pre-, mid-, and postprogram. Individual interviews, group project evaluations, and participant observation were also conducted. Quantitative data were analyzed using Wilcoxon signed-rank test. Qualitative data were thematically coded and analyzed using the Kirkpatrick framework. Results Participants recruited (n = 32) were mostly female (81%) and nurses (56%). Pre-to-post-program mean scores improved in knowledge (+12%, p = 0.002) and skills/practices (+14%, p = 0.002). Pre-program attitude scores were high but did not change. Participants felt empowered and demonstrated attitudinal improvements regarding HIV, TB, infection control, and occupational health. Successful projects were indeed implemented. However, participants encountered considerable difficulties in trying to sustain improvement, due largely to lack of pre-existing knowledge and experience, combined with inadequate staffing and insufficient management support. Conclusion Training is essential to strengthen HCWs' occupational health and infection control knowledge, attitudes, skills, and practices, and workplace-based training programs such as this can yield impressive results. However, the considerable mentorship resources required for such programs and the substantial infrastructural supports needed for implementation and sustainability of improvements in settings without pre-existing experience in such endeavors should not be underestimated.
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Yassi A, Adu PA, Nophale L, Zungu M. Learning from a cluster randomized controlled trial to improve healthcare workers' access to prevention and care for tuberculosis and HIV in Free State, South Africa: the pivotal role of information systems. Glob Health Action 2016; 9:30528. [PMID: 27341793 PMCID: PMC4920939 DOI: 10.3402/gha.v9.30528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/27/2016] [Accepted: 04/27/2016] [Indexed: 12/02/2022] Open
Abstract
Background Occupational tuberculosis (TB) continues to plague the healthcare workforce in South Africa. A 2-year cluster randomized controlled trial was therefore launched in 27 public hospitals in Free State province, to better understand how a combined workforce and workplace program can improve health of the healthcare workforce. Objective This mid-term evaluation aimed to analyze how well the intervention was being implemented, seek evidence of impact or harm, and draw lessons. Methods Both intervention and comparison sites had been instructed to conduct bi-annual and issue-based infection control assessments (when healthcare workers [HCW] are diagnosed with TB) and offer HCWs confidential TB and HIV counseling and testing, TB treatment and prophylaxis for HIV-positive HCWs. Intervention sites were additionally instructed to conduct quarterly workplace assessments, and also offer HCWs HIV treatment at their occupational health units (OHUs). Trends in HCW mortality, sick-time, and turnover rates (2005–2014) were analyzed from the personnel salary database (‘PERSAL’). Data submitted by the OHUs were also analyzed. Open-ended questionnaires were then distributed to OHU HCWs and in-depth interviews conducted at 17 of the sites to investigate challenges encountered. Results OHUs reported identifying and treating 23 new HCW cases of TB amongst the 1,372 workers who used the OHU for HIV and/or TB services; 39 new cases of HIV were also identified and 108 known-HIV-positive HCWs serviced. Although intervention-site workforces used these services significantly more than comparison-site healthcare staff (p<0.001), the data recorded were incomplete for both the intervention and comparison OHUs. An overall significant decline in mortality and turnover rates was documented over this period, but no significant differences between intervention and comparison sites; sick-time data proved unreliable. Severe OHU workload as well as residual confidentiality concerns prevented the proper implementation of protocols, especially workplace assessments and data recording. Particularly, the failure to implement computerized data collection required OHU staff to duplicate their operational data collection duties by also entering research paper forms. The study was therefore halted pending the implementation of a computerized system. Conclusions The significant differences in OHU use documented cannot be attributable to the intervention due to incomplete data reporting; unreliable sick-time data further precluded ascertaining the benefit potentially attributable to the intervention. Computerized data collection is essential to facilitate operational monitoring while conducting real-world intervention research. The digital divide still requires the attention of researchers along with overall infrastructural constraints.
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Affiliation(s)
- Annalee Yassi
- Global Health Research Program, The University of British Columbia (UBC), Vancouver, BC, Canada;
| | - Prince A Adu
- Global Health Research Program, The University of British Columbia (UBC), Vancouver, BC, Canada
| | - Letshego Nophale
- Provincial Occupational Health Unit, Free State Department of Health, University of the Free State, Bloemfontein, South Africa
| | - Muzimkhulu Zungu
- National Institute for Occupational Health, A Division of the National Health Laboratory Service, Johannesburg, South Africa.,School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Kaae S, Sporrong SK, Traulsen JM, Wallach Kildemoes H, Nørgaard LS, Jakupi A, Raka D, Gürpinar EU, Alkan A, Hoxha I, Malaj A, Cantarero LA. Experiences from a pilot study on how to conduct a qualitative multi-country research project regarding use of antibiotics in Southeast Europe. J Pharm Policy Pract 2016; 9:20. [PMID: 27222721 PMCID: PMC4878000 DOI: 10.1186/s40545-016-0069-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/11/2016] [Indexed: 01/31/2023] Open
Abstract
Background In 2014, a qualitative multi-country research project was launched to study the reasons behind the high use of antibiotics in regions of Southeast Europe by using previously untrained national interviewers (who were engaged in other antibiotic microbial resistance-related investigations) to conduct qualitative interviews with local patients, physicians and pharmacists. Little knowledge exists about how to implement qualitative multi-country research collaborations involving previously untrained local data collectors. The aim of this paper was therefore to contribute to the knowledge regarding how to conduct these types of research projects by evaluating a pilot study of the project. Methods Local data collectors conducted the study according to a developed protocol and evaluated the study with the responsible researcher-team from University of Copenhagen. The pilot study focused on ‘local ownership’, ‘research quality’ and ‘feasibility’ with regard to successful implementation and evaluation. The evaluation was achieved by interpreting ‘Skype’ and ‘face to face’ meetings and email correspondence by applying ‘critical common sense’. Results Local data collectors achieved a sense of joint ownership. Overall, the protocol worked well. Several minor challenges pertaining to research quality and feasibility were identified, in particular obtaining narratives when conducting interviews and recruiting patients for the study. Furthermore, local data collectors found it difficult to allocate sufficient time to the project. Solutions were discussed and added to the protocol. Conclusions Despite the challenges, it was possible to achieve an acceptable scientific level of research when conducting qualitative multi-country research collaboration under the given circumstances. Specific recommendations to achieve this are provided by the authors.
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Affiliation(s)
- Susanne Kaae
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark
| | - Sofia Kälvemark Sporrong
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark
| | - Janine Morgall Traulsen
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark
| | - Helle Wallach Kildemoes
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark
| | - Lotte Stig Nørgaard
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark
| | - Arianit Jakupi
- A2 Pharmaceutical Consulting, Mother Teresa boulevard, B1, No:19, Prishtinë, Republika e Kosovës
| | - Denis Raka
- Medical Faculty, Pharmacy Department, University of Prishtina, Bulevardi Dëshmorët e Kombit, p.n., 10000 Prishtinë, Republika e Kosovës
| | - Emre Umut Gürpinar
- Turkish Medicines and Medical Devices Agency, Söğütözü Mahallesi 2176. Sokak, No:5 PK:06520, Çankaya/Ankara, Turkey
| | - Ali Alkan
- Turkish Medicines and Medical Devices Agency, Söğütözü Mahallesi 2176. Sokak, No:5 PK:06520, Çankaya/Ankara, Turkey
| | - Iris Hoxha
- Faculty of Pharmacy, University of Medicine Tirana, Albania, Fakulteti Farmacise, Rr. Dibres 371, 1000 Tirana, Albania
| | - Admir Malaj
- Faculty of Pharmacy, University of Medicine Tirana, Albania, Fakulteti Farmacise, Rr. Dibres 371, 1000 Tirana, Albania
| | - Lourdes Arevalo Cantarero
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark
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Yassi A, Spiegel JB, Lockhart K, Fels L, Boydell K, Marcuse J. Ethics in Community-University-Artist Partnered Research: Tensions, Contradictions and Gaps Identified in an 'Arts for Social Change' Project. JOURNAL OF ACADEMIC ETHICS 2016; 14:199-220. [PMID: 27563284 PMCID: PMC4981172 DOI: 10.1007/s10805-016-9257-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Academics from diverse disciplines are recognizing not only the procedural ethical issues involved in research, but also the complexity of everyday “micro” ethical issues that arise. While ethical guidelines are being developed for research in aboriginal populations and low-and-middle-income countries, multi-partnered research initiatives examining arts-based interventions to promote social change pose a unique set of ethical dilemmas not yet fully explored. Our research team, comprising health, education, and social scientists, critical theorists, artists and community-activists launched a five-year research partnership on arts-for-social change. Funded by the Social Science and Humanities Research Council in Canada and based in six universities, including over 40 community-based collaborators, and informed by five main field projects (circus with street youth, theatre by people with disabilities, dance for people with Parkinson’s disease, participatory theatre with refugees and artsinfused dialogue), we set out to synthesize existing knowledge and lessons we learned. We summarized these learnings into 12 key points for reflection, grouped into three categories: community-university partnership concerns (n = 3), dilemmas related to the arts (n = 5), and team issues (n = 4). In addition to addressing previous concerns outlined in the literature (e.g., related to consent, anonymity, dangerous emotional terrain, etc.), we identified power dynamics (visible and hidden) hindering meaningful participation of community partners and university-based teams that need to be addressed within a reflective critical framework of ethical practice. We present how our team has been addressing these issues, as examples of how such concerns could be approached in community-university partnerships in arts for social change.
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Affiliation(s)
- Annalee Yassi
- School of Population and Public Health, University of British Columbia, 430-2206 East Mall, UBC, Vancouver, BC V6T 1Z3 Canada
| | - Jennifer Beth Spiegel
- International Centre for Art for Social Change and Faculty of Education, Simon Fraser University, Burnaby, BC Canada ; English Department, Concordia University, Montreal, QC Canada
| | - Karen Lockhart
- School of Population and Public Health, University of British Columbia, 430-2206 East Mall, UBC, Vancouver, BC V6T 1Z3 Canada
| | - Lynn Fels
- International Centre for Art for Social Change and Faculty of Education, Simon Fraser University, Burnaby, BC Canada
| | - Katherine Boydell
- Black Dog Institute, University of New South Wales, Sydney, Australia ; Departments of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Judith Marcuse
- International Centre for Art for Social Change and Faculty of Education, Simon Fraser University, Burnaby, BC Canada
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Yassi A, Zungu M, Spiegel JM, Kistnasamy B, Lockhart K, Jones D, O’Hara LM, Nophale L, Bryce EA, Darwin L. Protecting health workers from infectious disease transmission: an exploration of a Canadian-South African partnership of partnerships. Global Health 2016; 12:10. [PMID: 27036516 PMCID: PMC4818531 DOI: 10.1186/s12992-016-0145-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 03/09/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Health workers are at high risk of acquiring infectious diseases at work, especially in low and middle-income countries (LMIC) with critical health human resource deficiencies and limited implementation of occupational health and infection control measures. Amidst increasing interest in international partnerships to address such issues, how best to develop such collaborations is being actively debated. In 2006, a partnership developed between occupational health and infection control experts in Canada and institutions in South Africa (including an institute with a national mandate to conduct research and provide guidance to protect health workers from infectious diseases and promote improved working conditions). This article describes the collaboration, analyzes the determinants of success and shares lessons learned. METHODS Synthesizing participant-observer experience from over 9 years of collaboration and 10 studies already published from this work, we applied a realist review analysis to describe the various achievements at global, national, provincial and hospital levels. Expectations of the various parties on developing new insights, providing training, and addressing service needs were examined through a micro-meso-macro lens, focusing on how each main partner organization contributed to and benefitted from working together. RESULTS A state-of-the-art occupational health and safety surveillance program was established in South Africa following successful technology transfer from a similar undertaking in Canada and training was conducted that synergistically benefitted Northern as well as Southern trainees. Integrated policies combining infection control and occupational health to prevent and control infectious disease transmission among health workers were also launched. Having a national (South-South) network reinforced by the international (North-south) partnership was pivotal in mitigating the challenges that emerged. CONCLUSIONS High-income country partnerships with experience in health system strengthening - particularly in much needed areas such as occupational health and infection control - can effectively work through strong collaborators in the Global South to build capacity. Partnerships are particularly well positioned to sustainably reinforce efforts at national and sub-national LMIC levels when they adopt a "communities of practice" model, characterized by multi-directional learning. The principles of effective collaboration learned in this "partnership of partnerships" to improve working conditions for health workers can be applied to other areas where health system strengthening is needed.
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Affiliation(s)
- Annalee Yassi
- />Global Health Research Program (GHRP), The University of British Columbia (UBC), Rm. 430, 2206 East Mall, V6T 1Z3 Vancouver, BC Canada
| | - Muzimkhulu Zungu
- />National Institute for Occupational Health (NIOH), a division of National Health Laboratory Service (NHLS), Johannesburg, South Africa
- />University of Pretoria, School of Health Systems and Public Health, Pretoria, South Africa
| | - Jerry M. Spiegel
- />Global Health Research Program (GHRP), The University of British Columbia (UBC), Rm. 430, 2206 East Mall, V6T 1Z3 Vancouver, BC Canada
| | - Barry Kistnasamy
- />Department of Health, Compensation Commissioner, Johannesburg, South Africa
| | - Karen Lockhart
- />Global Health Research Program (GHRP), The University of British Columbia (UBC), Rm. 430, 2206 East Mall, V6T 1Z3 Vancouver, BC Canada
| | - David Jones
- />National Institute for Occupational Health (NIOH), a division of National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Lyndsay M. O’Hara
- />Global Health Research Program (GHRP), The University of British Columbia (UBC), Rm. 430, 2206 East Mall, V6T 1Z3 Vancouver, BC Canada
| | - Letshego Nophale
- />Provincial Occupational Health Unit and Centre for Health Systems Research & Development, University of the Free State (UFS), Bloemfontein, South Africa
| | - Elizabeth A. Bryce
- />Vancouver General Hospital (VGH), Vancouver Coastal Health, Vancouver, BC Canada
| | - Lincoln Darwin
- />National Institute for Occupational Health (NIOH), a division of National Health Laboratory Service (NHLS), Johannesburg, South Africa
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O’Hara NN, Roy L, O’Hara LM, Spiegel JM, Lynd LD, FitzGerald JM, Yassi A, Nophale LE, Marra CA. Healthcare Worker Preferences for Active Tuberculosis Case Finding Programs in South Africa: A Best-Worst Scaling Choice Experiment. PLoS One 2015. [PMID: 26197344 PMCID: PMC4511419 DOI: 10.1371/journal.pone.0133304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Healthcare workers (HCWs) in South Africa are at a high risk of developing active tuberculosis (TB) due to their occupational exposures. This study aimed to systematically quantify and compare the preferred attributes of an active TB case finding program for HCWs in South Africa. Methods A Best–Worst Scaling choice experiment estimated HCW’s preferences using a random-effects conditional logit model. Latent class analysis (LCA) was used to explore heterogeneity in preferences. Results “No cost”, “the assurance of confidentiality”, “no wait” and testing at the occupational health unit at one’s hospital were the most preferred attributes. LCA identified a four class model with consistent differences in preference strength. Sex, occupation, and the time since a previous TB test were statistically significant predictors of class membership. Conclusions The findings support the strengthening of occupational health units in South Africa to offer free and confidential active TB case finding programs for HCWs with minimal wait times. There is considerable variation in active TB case finding preferences amongst HCWs of different gender, occupation, and testing history. Attention to heterogeneity in preferences should optimize screening utilization of target HCW populations.
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Affiliation(s)
- Nathan N. O’Hara
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lilla Roy
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lyndsay M. O’Hara
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jerry M. Spiegel
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry D. Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - J. Mark FitzGerald
- Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Letshego E. Nophale
- Department of Community Health, Faculty Of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Carlo A. Marra
- School of Pharmacy, Memorial University, St. John’s, Newfoundland, Canada
- * E-mail:
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Siegel J, Yassi A, Rau A, Buxton JA, Wouters E, Engelbrecht MC, Uebel KE, Nophale LE. Workplace interventions to reduce HIV and TB stigma among health care workers - Where do we go from here? Glob Public Health 2015; 10:995-1007. [PMID: 25769042 DOI: 10.1080/17441692.2015.1021365] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fear of stigma and discrimination among health care workers (HCWs) in South African hospitals is thought to be a major factor in the high rates of HIV and tuberculosis infection experienced in the health care workforce. The aim of the current study is to inform the development of a stigma reduction intervention in the context of a large multicomponent trial. We analysed relevant results of four feasibility studies conducted in the lead up to the trial. Our findings suggest that a stigma reduction campaign must address community and structural level drivers of stigma, in addition to individual level concerns, through a participatory and iterative approach. Importantly, stigma reduction must not only be embedded in the institutional management of HCWs but also be attentive to the localised needs of HCWs themselves.
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Affiliation(s)
- Jacob Siegel
- a School of Population and Public Health , University of British Columbia , Vancouver , BC , Canada
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Spiegel JM, Breilh J, Yassi A. Why language matters: insights and challenges in applying a social determination of health approach in a North-South collaborative research program. Global Health 2015; 11:9. [PMID: 25880442 PMCID: PMC4353467 DOI: 10.1186/s12992-015-0091-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/27/2015] [Indexed: 01/21/2023] Open
Abstract
Background Focus on “social determinants of health” provides a welcome alternative to the bio-medical illness paradigm. However, the tendency to concentrate on the influence of “risk factors” related to living and working conditions of individuals, rather than to more broadly examine dynamics of the social processes that affect population health, has triggered critical reaction not only from the Global North but especially from voices the Global South where there is a long history of addressing questions of health equity. In this article, we elaborate on how focusing instead on the language of “social determination of health” has prompted us to attempt to apply a more equity-sensitive approaches to research and related policy and praxis. Discussion In this debate, we briefly explore the epistemological and historical roots of epidemiological approaches to health and health equity that have emerged in Latin America to consider its relevance to global discourse. In this region marked by pronounced inequity, context-sensitive concepts such as “collective health” and “critical epidemiology” have been prominent, albeit with limited acknowledgement by the Global North. We illustrate our attempts to apply a social determination approach (and the “4 S” elements of bio-Security, Sovereignty, Solidarity and Sustainability) in five projects within our research collaboration linking researchers and knowledge users in Ecuador and Canada, in diverse settings (health of healthcare workers; food systems; antibiotic resistance; vector borne disease [dengue]; and social circus with street youth). Conclusions We argue that the language of social determinants lends itself to research that is more reductionist and beckons the development of different skills than would be applied when adopting the language of social determination. We conclude that this language leads to more direct analysis of the systemic factors that drive, promote and reinforce disparities, while at the same time directly considering the emancipatory forces capable of countering negative health impacts. It follows that “reverse innovation” must not only recognize practical solutions being developed in low and middle income countries, but must also build on the strengths of the theoretical-methodological reasoning that has emerged in the South.
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Affiliation(s)
- Jerry M Spiegel
- School of Population and Public Health, Department of Medicine, the University of British Columbia, Rm. 430 - 2206 East Mall, Vancouver, V6T 1Z3, BC, Canada.
| | - Jaime Breilh
- Health Sciences Area, University Andina Simon Bolivar, Quito, Ecuador.
| | - Annalee Yassi
- School of Population and Public Health, Department of Medicine, the University of British Columbia, Rm. 430 - 2206 East Mall, Vancouver, V6T 1Z3, BC, Canada.
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Tsuei SHT, Yassi A, Spiegel JM. Critical reflection on a summer global health research internship: the need for education on global development paradigms in medical schools. MEDICAL TEACHER 2015; 37:196-198. [PMID: 25180880 DOI: 10.3109/0142159x.2014.955843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Rees D, Phillips JI. Investigating the effectiveness of occupational health interventions in the workplace. Occup Environ Med 2014; 71:809-10. [PMID: 25183705 DOI: 10.1136/oemed-2014-102389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- David Rees
- Division of Occupational Medicine, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, Gauteng, South Africa School of Public Health, Medical School, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - James Ian Phillips
- Department of Pathology, NIOH, Johannesburg, South Africa Faculty of Health Sciences, Department of Biomedical Technology, University of Johannesburg, Johannesburg, South Africa
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