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Sacks E, Brizuela V, Javadi D, Kim Y, Elmi N, Finlayson K, Crossland N, Langlois EV, Ziegler D, Parmar SM, Bonet M. Immigrant women's and families' views and experiences of routine postnatal care: findings from a qualitative evidence synthesis. BMJ Glob Health 2024; 8:e014075. [PMID: 38351019 PMCID: PMC10897958 DOI: 10.1136/bmjgh-2023-014075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/06/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Uptake of postnatal care (PNC) is low and inequitable in many countries, and immigrant women may experience additional challenges to access and effective use. As part of a larger study examining the views of women, partners, and families on routine PNC, we analysed a subset of data on the specific experiences of immigrant women and families. METHODS This is a subanalysis of a larger qualitative evidence synthesis. We searched MEDLINE, PUBMED, CINAHL, EMBASE, EBM-Reviews and grey literature for studies published until December 2019 with extractable qualitative data with no language restrictions. For this analysis, we focused on papers related to immigrant women and families. Two reviewers screened each study independently; inclusion was agreed by consensus. Data abstraction and quality assessment were carried out using a study-specific extraction form and established quality assessment tools. Study findings were identified using thematic analysis. Findings are presented by confidence in the finding, applying the GRADE-CERQual approach. FINDINGS We included 44 papers, out of 602 full-texts, representing 11 countries where women and families sought PNC after immigrating. All but one included immigrants to high-income countries. Four themes were identified: resources and access, differences from home country, support needs, and experiences of care. High confidence study findings included: language and communication challenges; uncertainty about navigating system supports including transportation; high mental health, emotional, and informational needs; the impact of personal resources and social support; and the quality of interaction with healthcare providers. These findings highlight the importance of care experiences beyond clinical care. More research is also needed on the experiences of families migrating between low-income countries. CONCLUSIONS Immigrant families experience many challenges in getting routine PNC, especially related to language, culture, and communication. Some challenges may be mitigated by improving comprehensive and accessible information on available services, as well as holistic social support. TRIAL REGISTRATION NUMBER CRD42019139183.
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Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Dena Javadi
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Yoona Kim
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Nika Elmi
- School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth Finlayson
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Etienne V Langlois
- Partnership for Maternal, Newborn, and Child Health, World Health Organization, Geneva, Switzerland
| | - Daniela Ziegler
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | | | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Javadi D, Murchland AR, Rushovich T, Wright E, Shchetinina A, Siefkas AC, Todd KP, Gitelman J, Hall E, Wynne JO, Zewge-Abubaker N, Krieger N. Systematic review of how racialized health inequities are addressed in Epidemiologic Reviews articles (1979-2021): a critical conceptual and empirical content analysis and recommendations for best practices. Epidemiol Rev 2023; 45:1-14. [PMID: 37386694 DOI: 10.1093/epirev/mxad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 04/25/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023] Open
Abstract
Critical analysis of the determinants of current and changing racialized health inequities, including the central role of racism, is an urgent priority for epidemiology, for both original research studies and epidemiologic review articles. Motivating our systematic overview review of Epidemiologic Reviews articles is the critical role of epidemiologic reviews in shaping discourse, research priorities, and policy relevant to the social patterning of population health. Our approach was first to document the number of articles published in Epidemiologic Reviews (1979-2021; n = 685) that either: (1) focused the review on racism and health, racial discrimination and health, or racialized health inequities (n = 27; 4%); (2) mentioned racialized groups but did not focus on racism or racialized health inequities (n = 399; 59%); or (3) included no mention of racialized groups or racialized health inequities (n = 250; 37%). We then conducted a critical content analysis of the 27 review articles that focused on racialized health inequities and assessed key characteristics, including (1) concepts, terms, and metrics used regarding racism and racialized groups (notably only 26% addressed the use or nonuse of measures explicitly linked to racism; 15% provided explicit definitions of racialized groups); (2) theories of disease distribution guiding (explicitly or implicitly) the review's approach; (3) interpretation of findings; and (4) recommendations offered. Guided by our results, we offer recommendations for best practices for epidemiologic review articles for addressing how epidemiologic research does or does not address ubiquitous racialized health inequities.
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Affiliation(s)
- Dena Javadi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Audrey R Murchland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Tamara Rushovich
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Emily Wright
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Anna Shchetinina
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Anna C Siefkas
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Kieran P Todd
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Julian Gitelman
- Postgraduate Medical Education, University of Toronto, Toronto, Ontario M5R 0A3, Canada
| | - Enjoli Hall
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Jhordan O Wynne
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Nishan Zewge-Abubaker
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
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Javadi D, Sacks E, Brizuela V, Finlayson K, Crossland N, Langlois EV, Ziegler D, Chandra-Mouli V, Bonet M. Factors that influence the uptake of postnatal care among adolescent girls: a qualitative evidence synthesis. BMJ Glob Health 2023; 8:e011560. [PMID: 37137533 PMCID: PMC10163540 DOI: 10.1136/bmjgh-2022-011560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Adolescent pregnancy is associated with increased risk of maternal and child morbidity and mortality globally. Access to safe, appropriate and affordable antenatal, childbirth and postnatal care (PNC) is essential in mitigating this risk. PNC is an often undervalued, underused, and understudied component of the continuum of maternal health services; however, it provides an important opportunity for adolescent girls to have access to health information and resources as they navigate the transition to motherhood and/or recovery from childbirth. This qualitative evidence synthesis seeks to highlight the experiences and perspectives of adolescent girls and their partners in accessing and using routine PNC. METHODS Papers were selected from a primary review on PNC where a global search of databases was conducted to identify studies with qualitative data focused on PNC utilisation. Within this primary review, a subset of studies focused on adolescents was tagged for subanalysis. A data extraction form drawing on an a priori framework was used to extract data from each study. Review findings were grouped across studies and mapped onto relevant themes, which were then adapted, as appropriate, to best reflect emergent themes from included studies. RESULTS Of 662 papers identified for full text review, 15 were included in this review on adolescents' experiences. Fourteen review findings were mapped onto four themes including: resources and access, social norms, experiences of care, and tailored support needs. CONCLUSION Improving uptake of PNC by adolescent girls requires multipronged approaches in improving availability of and access to adolescent-sensitive maternal health services and reducing feelings of shame and stigma in the postpartum period. Much should be done to address structural barriers to access, but tangible steps to improving the quality and responsiveness of available services can be taken immediately. PROSPERO REGISTRATION NUMBER CRD42019139183.
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Affiliation(s)
- Dena Javadi
- Social and Behavioral Sciences, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Emma Sacks
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Kenneth Finlayson
- Research in Childbirth and Health (ReaCH) Unit, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- Research in Childbirth and Health (ReaCH) Unit, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Etienne V Langlois
- Partnership for Maternal, Newborn & Child Health (PMNCH), World Health Organization, Geneva, Switzerland
| | - Daniela Ziegler
- Library, Centre Hospitalier de l'Universite de Montreal, Montreal, Québec, Canada
| | - Venkatraman Chandra-Mouli
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Finlayson K, Sacks E, Brizuela V, Crossland N, Cordey S, Ziegler D, Langlois EV, Javadi D, Comrie-Thomson L, Downe S, Bonet M. Factors that influence the uptake of postnatal care from the perspective of fathers, partners and other family members: a qualitative evidence synthesis. BMJ Glob Health 2023; 8:e011086. [PMID: 37137532 PMCID: PMC10163465 DOI: 10.1136/bmjgh-2022-011086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/14/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Postnatal care (PNC) is a key component of maternity provision and presents opportunities for healthcare providers to optimise the health and well-being of women and newborns. However, PNC is often undervalued by parents, family members and healthcare providers. As part of a larger qualitative review exploring the factors that influence PNC uptake by relevant stakeholders, we examined a subset of studies highlighting the views of fathers, partners and family members of postpartum women. METHODS We undertook a qualitative evidence synthesis using a framework synthesis approach. We searched multiple databases and included studies with extractable qualitative data focusing on PNC utilisation. We identified and labelled a subset of articles reflecting the views of fathers, partners and other family members. Data abstraction and quality assessment were carried out using a bespoke data extraction form and established quality assessment tools. The framework was developed a priori based on previous research on the topic and adapted accordingly. Findings were assessed for confidence using the GRADE-CERQual approach and are presented by country income group. RESULTS Of 12 678 papers identified from the original search, 109 were tagged as 'family members views' and, of these, 30 were eligible for this review. Twenty-nine incorporated fathers' views, 7 included the views of grandmothers or mothers-in-law, 4 incorporated other family member views and 1 included comothers. Four themes emerged: access and availability; adapting to fatherhood; sociocultural influences and experiences of care. These findings highlight the significant role played by fathers and family members on the uptake of PNC by women as well as the distinct concerns and needs of fathers during the early postnatal period. CONCLUSION To optimise access to postnatal care, health providers should adopt a more inclusive approach incorporating flexible contact opportunities, the availability of more 'family-friendly' information and access to psychosocial support services for both parents.
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Affiliation(s)
- Kenneth Finlayson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Vanessa Brizuela
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nicola Crossland
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Sarah Cordey
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Daniela Ziegler
- Direction de l'enseignement et l'Académie CHUM | Bibliothèque du CHUM, Centre Hospitalier de l'Universite de Montreal, Montreal, Québec, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), World Health Organization, Geneva, Switzerland
| | - Dena Javadi
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Liz Comrie-Thomson
- Global Women's and Newborn's Health Group, Burnet Institute, Melbourne, Victoria, Australia
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Mercedes Bonet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Sacks E, Finlayson K, Brizuela V, Crossland N, Ziegler D, Sauvé C, Langlois ÉV, Javadi D, Downe S, Bonet M. Factors that influence uptake of routine postnatal care: Findings on women's perspectives from a qualitative evidence synthesis. PLoS One 2022; 17:e0270264. [PMID: 35960752 PMCID: PMC9374256 DOI: 10.1371/journal.pone.0270264] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 06/07/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Effective postnatal care is important for optimal care of women and newborns-to promote health and wellbeing, identify and treat clinical and psychosocial concerns, and to provide support for families. Yet uptake of formal postnatal care services is low and inequitable in many countries. As part of a larger study examining the views of women, partners, and families requiring both routine and specialised care, we analysed a subset of data on the views and experiences of women related to routine postnatal care. METHODS We undertook a qualitative evidence synthesis, using a framework analysis approach. We included studies published up to December 2019 with extractable qualitative data, with no language restriction. We focused on women in the general population and their accounts of routine postnatal care utilization. We searched MEDLINE, PUBMED, CINAHL, EMBASE, EBM-Reviews, and grey literature. Two reviewers screened each study independently; inclusion was agreed by consensus. Data abstraction and scientific quality assessment were carried out using a study-specific extraction form and established quality assessment tools. The analysis framework was developed a priori based on previous knowledge and research on the topic and adapted. Due to the number of included texts, the final synthesis was developed inductively from the initial framework by iterative sampling of the included studies, until data saturation was achieved. Findings are presented by high versus low/middle income country, and by confidence in the finding, applying the GRADE-CERQual approach. FINDINGS Of 12,678 papers, 512 met the inclusion criteria; 59 articles were sampled for analysis. Five themes were identified: access and availability; physical and human resources; external influences; social norms; and experience of care. High confidence study findings included the perceived low value of postnatal care for healthy women and infants; concerns around access and quality of care; and women's desire for more emotional and psychosocial support during the postnatal period. These findings highlight multiple missed opportunities for postnatal care promotion and ensuring continuity of care. CONCLUSIONS Factors that influence women's utilization of postnatal care are interlinked, and include access, quality, and social norms. Many women recognised the specific challenges of the postnatal period and emphasised the need for emotional and psychosocial support in this time, in addition to clinical care. While this is likely a universal need, studies on mental health needs have predominantly been conducted in high-income settings. Postnatal care programmes and related research should consider these multiple drivers and multi-faceted needs, and the holistic postpartum needs of women and their families should be studied in a wider range of settings. REGISTRATION This protocol is registered in the PROSPERO database for systematic reviews: CRD42019139183.
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Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Kenneth Finlayson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Vanessa Brizuela
- Department of Reproductive Health and Research, World Health Organization, Genève, Switzerland
| | - Nicola Crossland
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Daniela Ziegler
- Centre Hospitalier de l’Universite de Montreal, Montreal, Canada
| | - Caroline Sauvé
- Centre Hospitalier de l’Universite de Montreal, Montreal, Canada
| | - Étienne V. Langlois
- Partnership for Maternal, Newborn, and Child Health, World Health Organization, Genève, Switzerland
| | - Dena Javadi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Mercedes Bonet
- Department of Reproductive Health and Research, World Health Organization, Genève, Switzerland
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Abstract
BACKGROUND This is the fifth of our 11-paper supplement on "Community Health Workers at the Dawn of a New Era." When planning new community health worker (CHW) roles or expanding existing roles, programme planners need to analyse global and local research evidence and evidence-based guidance on the effectiveness and safety of relevant tasks performed by CHWs. METHODS In this paper, we explore key areas of consideration when selecting roles and tasks; present current knowledge regarding these issues; and suggest how decision-makers could consider these issues when assigning tasks in their setting. This paper draws on the chapter "Community Health Worker Roles and Tasks" in Developing and Strengthening Community Health Worker Programs at Scale: A Reference Guide and Case Studies for Program Managers and Policymakers, as well as on a recently published compendium of 29 case studies of national CHW programmes and on recently published literature pertaining to roles and tasks of CHWs. RESULTS This paper provides a list of questions that aim to help programme planners think about important issues when determining CHW roles and tasks in their setting. Planners need to assess whether the recommended roles and tasks are considered acceptable and appropriate by their target population and by the CHWs themselves and those who support them. Planners also need to think about the practical and organizational implications of each task for their particular setting with regard to training requirements, health systems support, work location, workload, and programme costs. CONCLUSION When planning CHW roles and tasks, planners, programme implementers, and policy-makers should draw from global guidance and research evidence, but they also need to engage with the experiences, needs, and concerns of local communities and health workers. By drawing from both sources of information, they will stand a better chance of developing programmes that are effective in achieving their goals while remaining acceptable to those affected by them, feasible to implement, and sustainable over time.
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Affiliation(s)
- Claire Glenton
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- TRS Centre for Rare Disorders, Sunnaas Hospital, Nesodden, Norway
| | - Dena Javadi
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Henry B Perry
- Department of International Health, Health Systems Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
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Javadi D, Ssempebwa J, Isunju JB, Yevoo L, Amu A, Nabiwemba E, Pfeiffer M, Agyepong I, Severi L. Implementation research on sustainable electrification of rural primary care facilities in Ghana and Uganda. Health Policy Plan 2021; 35:ii124-ii136. [PMID: 33156941 PMCID: PMC7646723 DOI: 10.1093/heapol/czaa077] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 11/13/2022] Open
Abstract
Access to energy is essential for resilient health systems; however, strengthening energy infrastructure in rural health facilities remains a challenge. In 2015–19, ‘Powering Healthcare’ deployed solar energy solutions to off-grid rural health facilities in Ghana and Uganda to improve the availability of maternal and child health services. To explore the links between health facility electrification and service availability and use, the World Health Organization (WHO), in partnership with Dodowa Health Research Centre and Makerere University School of Public Health, carried out an implementation research study. The objectives of this study were to (1) capture changes in service availability and readiness, (2) describe changes in community satisfaction and use and (3) examine the implementation factors of sustainable electrification that affect these changes. Data were collected through interviews with over 100 key informants, focus group discussions with over 800 community members and health facility assessment checklist adapted from the WHO’s Service Availability and Readiness Assessment tool. Implementation factors were organized using Normalization Process Theory constructs. The study found that access to energy is associated with increased availability of health services, access to communication technologies, appropriate storage of vaccines and medicines, enhanced health worker motivation and increased community satisfaction. Implementation factors associated with improved outcomes include stakeholder engagement activities to promote internalization, provision of materials and information to encourage participation, and establishment of relationships to support integration. Barriers to achieving outcomes are primarily health systems challenges—such as drug stockouts, lack of transportation and poor amenities—that continue to affect service availability, readiness and use, even where access to energy is available. However, through appropriate implementation and integration of sustainable electrification, strengthened energy infrastructure can be leveraged to catalyze investment in other components of functioning health systems. Improving access to energy in health facilities is, therefore, necessary but not sufficient for strengthening health systems.
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Affiliation(s)
- Dena Javadi
- Alliance for Health Policy and Systems Research, World Health Organization, 20 Ave Appia, Geneva 1211, Switzerland
| | - John Ssempebwa
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Kampala, Uganda
| | - Lucy Yevoo
- Ghana Health Service, Dodowa Health Research Center, Hospital Road, Matetse, Ghana
| | - Alberta Amu
- Ghana Health Service, Dodowa Health Research Center, Hospital Road, Matetse, Ghana
| | - Elizabeth Nabiwemba
- Department of Community Health and Behavioural Science, Makerere University School of Public Health, New Mulago Hill Road, Kampala, Uganda
| | - Michaela Pfeiffer
- Department of Public Health Environmental and Social Determinants of Health, World Health Organization, 20 Ave Appia, Geneva 1211, Switzerland
| | - Irene Agyepong
- Ghana Health Service, Dodowa Health Research Center, Hospital Road, Matetse, Ghana.,Ghana College of Physicians and Surgeons, Public Health Department, 54 independence Ave, Accra, Ghana
| | - Luc Severi
- Sustainable Energy for All, 1750 Pennsylvania Ave, Washington, DC, USA
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Javadi D, Hussain S. Enhancing diversity in public health scholarship: the role of publication mentorship. Health Policy Plan 2020; 35:i1-i3. [PMID: 33165578 PMCID: PMC7649664 DOI: 10.1093/heapol/czaa104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Sameera Hussain
- Public Health Agency of Canada, 130 Colonnade Road S, Ottawa, ON K1A 0K9, Canada
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Vindrola-Padros C, Andrews L, Dowrick A, Djellouli N, Fillmore H, Bautista Gonzalez E, Javadi D, Lewis-Jackson S, Manby L, Mitchinson L, Mulcahy Symmons S, Martin S, Regenold N, Robinson H, Sumray K, Singleton G, Syversen A, Vanderslott S, Johnson G. Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the UK. BMJ Open 2020; 10:e040503. [PMID: 33154060 PMCID: PMC7646318 DOI: 10.1136/bmjopen-2020-040503] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/07/2020] [Accepted: 10/18/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The COVID-19 pandemic has set unprecedented demand on the healthcare workforce around the world. The UK has been one of the most affected countries in Europe. The aim of this study was to explore the perceptions and experiences of healthcare workers (HCWs) in relation to COVID-19 and care delivery models implemented to deal with the pandemic in the UK. METHODS The study was designed as a rapid appraisal combining: (1) a review of UK healthcare policies (n=35 policies), (2) mass media and social media analysis of front-line staff experiences and perceptions (n=101 newspaper articles, n=1 46 000 posts) and (3) in-depth (telephone) interviews with front-line staff (n=30 interviews). The findings from all streams were analysed using framework analysis. RESULTS Limited personal protective equipment (PPE) and lack of routine testing created anxiety and distress and had a tangible impact on the workforce. When PPE was available, incorrect size and overheating complicated routine work. Lack of training for redeployed staff and the failure to consider the skills of redeployed staff for new areas were identified as problems. Positive aspects of daily work reported by HCWs included solidarity between colleagues, the establishment of well-being support structures and feeling valued by society. CONCLUSION Our study highlighted the importance of taking into consideration the experiences and concerns of front-line staff during a pandemic. Staff working in the UK during the COVID-19 pandemic advocated clear and consistent guidelines, streamlined testing of HCWs, administration of PPE and acknowledgement of the effects of PPE on routine practice.
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Affiliation(s)
| | - Lily Andrews
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Anna Dowrick
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Nehla Djellouli
- Institute of Global Health, University College London, London, UK
| | | | | | - Dena Javadi
- Harvard TH Chan School of Public Health, Department of Social and Behavioral Sciences, Harvard University, Cambridge, Massachusetts, USA
| | | | - Louisa Manby
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Lucy Mitchinson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
| | | | - Sam Martin
- Oxford Vaccine Group, Centre for Clinical Vaccinology and Tropical Medicine (CCVTM), Oxford University, Oxford, Oxfordshire, UK
| | - Nina Regenold
- Department of Anthropology, University College London, London, UK
| | - Hannah Robinson
- School for Policy Studies, Bristol University, Bristol, United Kingdom
| | - Kirsi Sumray
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Georgina Singleton
- Department of Targeted Intervention, University College London, London, UK
| | - Aron Syversen
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Samantha Vanderslott
- Oxford Vaccine Group, Centre for Clinical Vaccinology and Tropical Medicine (CCVTM), Oxford University, Oxford, Oxfordshire, UK
| | - Ginger Johnson
- Department of Targeted Intervention, University College London, London, UK
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Hussain S, Javadi D, Andrey J, Ghaffar A, Labonté R. Health intersectoralism in the Sustainable Development Goal era: from theory to practice. Global Health 2020; 16:15. [PMID: 32079530 PMCID: PMC7033925 DOI: 10.1186/s12992-020-0543-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/15/2020] [Indexed: 02/07/2023] Open
Abstract
In 2015, the United Nations’ (UN) Member States adopted a bold and holistic agenda of the Sustainable Development Goals (SDGs), integrating a vision of peace and prosperity for people and planet. Extensive work within, between, across sectors is required for this bold and holistic agenda to be implemented. It is in this context that this special article collection showcases multisectoral approaches to achieving SDG 3—Good Health and Well-Being—which, though focused explicitly on health, is connected to almost all other goals. A confluence of social and health inequities, within a context of widespread environmental degradation demands systems thinking and intersectoral action. Articles in this issue focus on the SDGs as a stimulus for renewed multisectoral action: processes, policies, and programs primarily outside the health sector, that have health implications through social, commercial, economic, environmental, and political determinants of health. Case studies offer critical lessons on effectively engaging other sectors to enhance their health outputs, identifying co-benefits and ‘win-wins’ that enhance human health.
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Affiliation(s)
- Sameera Hussain
- Canadian Society for International Health, 1 Nicholas Street, Ottawa, Ontario, K1N 7B7, Canada. .,School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Dena Javadi
- Alliance for Health Policy and Systems Research, World Health Organization, 20 avenue Appia, 1211, Geneva, Switzerland
| | - Jean Andrey
- Faculty of Environment, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, 20 avenue Appia, 1211, Geneva, Switzerland
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
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11
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Bennett S, Jessani N, Glandon D, Qiu M, Scott K, Meghani A, El-Jardali F, Maceira D, Javadi D, Ghaffar A. Understanding the implications of the Sustainable Development Goals for health policy and systems research: results of a research priority setting exercise. Global Health 2020; 16:5. [PMID: 31918730 PMCID: PMC6953300 DOI: 10.1186/s12992-019-0534-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given the paradigmatic shift represented by the Sustainable Development Goals (SDGs) as compared to the Millennium Development Goals - in particular their broad and interconnected nature - a new set of health policy and systems research (HPSR) priorities are needed to inform strategies to address these interconnected goals. OBJECTIVES To identify high priority HPSR questions linked to the achievement of the Sustainable Development Goals. METHODS We focused on three themes that we considered to be central to achieving the health related SDGs: (i) Protecting and promoting access to health services through systems of social protection (ii) Strengthening multisectoral collaborations for health and (iii) Developing more participatory and accountable institutions. We conducted 54 semi-structured interviews and two focus group discussions to investigate policy-maker perspectives on evidence needs. We also conducted an overview of literature reviews in each theme. Information from these sub-studies was extracted into a matrix of possible research questions and developed into three domain-specific lists of 30-36 potential priority questions. Topic experts from the global research community then refined and ranked the proposed questions through an online platform. A final webinar on each theme sought feedback on findings. RESULTS Policy-makers continue to demand HPSR for many well-established issues such as health financing, human resources for health, and service delivery. In terms of service delivery, policy-makers wanted to know how best to strengthen primary health care and community-based systems. In the themes of social protection and multisectoral collaboration, prioritized questions had a strong emphasis on issues of practical implementation. For participatory and accountable institutions, the two priority questions focused on political factors affecting the adoption of accountability measures, as well as health worker reactions to such measures. CONCLUSIONS To achieve the SDGs, there is a continuing need for research in some already well established areas of HPSR as well as key areas highlighted by decision-makers. Identifying appropriate conceptual frameworks as well as typologies of examples may be a prerequisite for answering some of the substantive policymaker questions. In addition, implementation research engaging non-traditional stakeholders outside of the health sector will be critical.
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Affiliation(s)
- Sara Bennett
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Nasreen Jessani
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.,Africa Center for Evidence (ACE), University of Johannesburg, Johannesburg, South Africa.,Centre for Evidence Based Health Care (CEBHC), Stellenbosch University, Stellenbosch, South Africa
| | - Douglas Glandon
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Mary Qiu
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Kerry Scott
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Ankita Meghani
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | | | - Daniel Maceira
- Center for the Study of State and Society, Buenos Aires, Argentina
| | - Dena Javadi
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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12
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Agarwal G, Gaber J, Richardson J, Mangin D, Ploeg J, Valaitis R, Reid GJ, Lamarche L, Parascandalo F, Javadi D, O'Reilly D, Dolovich L. Pilot randomized controlled trial of a complex intervention for diabetes self-management supported by volunteers, technology, and interprofessional primary health care teams. Pilot Feasibility Stud 2019; 5:118. [PMID: 31673398 PMCID: PMC6815451 DOI: 10.1186/s40814-019-0504-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/21/2019] [Indexed: 01/01/2023] Open
Abstract
Background Most health care for people with diabetes occurs in family practice, yet balancing the time and resources to help these patients can be difficult. An intervention empowering patients, leveraging community resources, and assisting self-management could benefit patients and providers. Thus, the feasibility and potential for effectiveness of “Health Teams Advancing Patient Experience, Strengthening Quality through Health Connectors for Diabetes Management” (Health TAPESTRY-HC-DM) as an approach supporting diabetes self-management was explored to inform development of a future large-scale trial. Methods Four-month pilot randomized controlled trial (RCT), sequential explanatory qualitative component. Participants—patients of an interprofessional primary care team—were over age 18 years, diagnosed with diabetes and hypertension, and had Internet access and one of the following: uncontrolled HbA1c, recent diabetes diagnosis, end-stage/secondary organ damage, or provider referral. The Health TAPESTRY-HC-DM intervention focused on patient health goals/needs, integrating community volunteers, eHealth technologies, interprofessional primary care teams, and system navigation. Pilot outcomes included process measures (recruitment, retention, program participation), perceived program feasibility, benefits and areas for improvement, and risks or safety issues. The primary trial outcome was self-efficacy for managing diabetes. There were a number of secondary trial outcomes. Results Of 425 eligible patients invited, 50 signed consent (11.8%) and 35 completed the program (15 intervention, 20 control). Volunteers (n = 20) met 28 clients in 234 client encounters (home visits, phone calls, electronic messages); 27 reports were sent to the interprofessional team. At 4 months, controlling for baseline, most outcomes were better in the intervention compared to control group; physical activity notably better. The most common goal domains set were physical activity, diet/nutrition, and social connection. Clients felt the biggest impact was motivation toward goal achievement. They struggled with some of the technologies. Several participants perceived that the program was not a good fit, mostly those that felt they were already well-managing their diabetes. Conclusions Health TAPESTRY-HC-DM was feasible; a large-scale randomized controlled trial seems possible. However, further attention needs to be paid to improving recruitment and retention. The intervention was well received, though was a better fit for some participants than others. Trial registration ClinicalTrials.gov, NCT02715791. Registered 22 March 2016—retrospectively registered.
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Affiliation(s)
- Gina Agarwal
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Jessica Gaber
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Julie Richardson
- 2School of Rehabilitation Science, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Dee Mangin
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Jenny Ploeg
- 3Department of Health, Aging and Society, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada.,4School of Nursing, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Ruta Valaitis
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada.,4School of Nursing, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Graham J Reid
- 5Departments of Psychology, Family Medicine, & Paediatrics, The University of Western Ontario, Westminster Hall, Room 319E, London, Ontario N6A 3K7 Canada
| | - Larkin Lamarche
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Fiona Parascandalo
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Dena Javadi
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Daria O'Reilly
- 6Department of Health Research Methods, Evidence, and Impact, McMaster University, CRL, 2nd Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Lisa Dolovich
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
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Ho S, Javadi D, Causevic S, Langlois EV, Friberg P, Tomson G. Intersectoral and integrated approaches in achieving the right to health for refugees on resettlement: a scoping review. BMJ Open 2019; 9:e029407. [PMID: 31266840 PMCID: PMC6609038 DOI: 10.1136/bmjopen-2019-029407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Better understanding, documentation and evaluation of different refugee health interventions and their means of health system integration and intersectoral collaboration are needed. OBJECTIVES Explore the barriers and facilitators to the integration of health services for refugees; the processes involved and the different stakeholders engaged in levaraging intersectoral approaches to protect refugees' right to health on resettlement. DESIGN Scoping review. METHODS A search of articles from 2000 onward was done in MEDLINE, Web of Science, Global Health and PsycINFO, Embase. Two frameworks were applied in our analysis, the 'framework for analysing integration of targeted health interventions in systems' and 'Health in All Policies' framework for country action. A comprehensive description of the methods is included in our published protocol. RESULTS 6117 papers were identified, only 18 studies met the inclusion criteria. Facilitators in implementation included: training for providers, colocation of services, transportation services to enhance access, clear role definitions and appropriate budget allocation and financing. Barriers included: lack of a participatory approach, insufficient resources for providers, absence of financing, unclear roles and insufficient coordination of interprofessional teams; low availability and use of data, and turf wars across governance stakeholders. Successful strategies to address refugee health included: networks of service delivery combining existing public and private services; system navigators; host community engagement to reduce stigma; translation services; legislative support and alternative models of care for women and children. CONCLUSION Limited evidence was found overall. Further research on intersectoral approaches is needed. Key policy insights gained from barriers and facilitators reported in available studies include: improving coordination between existing programmes; supporting colocation of services; establishing formal system navigator roles that connect relevant programmes; establishing formal translation services to improve access and establishing training and resources for providers.
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Affiliation(s)
- Shirley Ho
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Dena Javadi
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Sara Causevic
- Swedish Institute for Global Health Transformation, Royal Swedish Academy of Sciences, Stockholm, Sweden
- Global and Sexual Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Etienne V Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Peter Friberg
- Swedish Institute for Global Health Transformation, Royal Swedish Academy of Sciences, Stockholm, Sweden
- Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Göran Tomson
- Swedish Institute for Global Health Transformation, Royal Swedish Academy of Sciences, Stockholm, Sweden
- Medical Management Centre, Department of Learning, Informatics, Management, Ethics, Karolinska Institute, Stockholm, Sweden
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Koroma IB, Javadi D, Hann K, Harries AD, Smart F, Samba T. Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak. F1000Res 2019; 8:795. [PMID: 31354948 PMCID: PMC6652098 DOI: 10.12688/f1000research.18563.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/05/2023] Open
Abstract
Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality in the world. During infectious disease outbreaks, such as the Ebola virus disease outbreak in West Africa from 2014-2015, the health system is often strained, and diagnosis, management and care of NCDs may be compromised. This study assessed numbers and distribution of NCDs in all health facilities in the Western-Area District, Sierra Leone, in the post-Ebola period (June-December 2015) comparing findings with the pre-Ebola (June-December 2013) and Ebola outbreak (June-December 2014) periods. Methods: This was a cross-sectional study using secondary data from routine records of aggregate monthly NCD reports. Data were analysed using Open EPI and comparisons were made between the post-Ebola and pre-Ebola/Ebola periods using the chi square test. Results: There were 10,011 people reported with NCDs during the three six-month periods, with 6194 (62%) presenting at peripheral health units (PHU). Reported NCDs decreased during Ebola and increased post-Ebola, but did not recover to pre-Ebola levels. Hypertension cases remained fairly constant throughout being mainly managed at PHU. Numbers with diabetes mellitus generally stayed the same except for a significant post-Ebola increase in tertiary hospitals. Small numbers were reported with mental health disorders across all facilities in all time periods. Conclusion: NCD reporting is recovering in the immediate post-Ebola period. Decentralization of NCD care is welcome and is an effective strategy for management as evidenced by hypertension. To be successful, this must be supported by strengthening other elements of the health system such as training of health workers, robust information and referral systems and reliable medicine supply chains.
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Affiliation(s)
- Ibrahim Baimba Koroma
- Directorate of Policy, Planning and Information (DPPI), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - Dena Javadi
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Katrina Hann
- Sustainable Health Systems, Freetown, Sierra Leone
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene and Tropical Medicine, London, UK
| | - Francis Smart
- Directorate of Policy, Planning and Information (DPPI), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - Thomas Samba
- National Public Health Agency (NPHA), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
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15
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Abstract
Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality in the world. During infectious disease outbreaks, such as the Ebola virus disease outbreak in West Africa from 2014-2015, the health system is often strained, and diagnosis, management and care of NCDs may be compromised. This study assessed numbers and distribution of NCDs in all health facilities in the Western-Area District, Sierra Leone, in the post-Ebola period (June-December 2015) comparing findings with the pre-Ebola (June-December 2013) and Ebola outbreak (June-December 2014) periods. Methods: This was a cross-sectional study using secondary data from routine records of aggregate monthly NCD reports. Data were analysed using Open EPI and comparisons were made between the post-Ebola and pre-Ebola/Ebola periods using the chi-square test. Results: There were 10,011 people reported with NCDs during the three six-month periods, with 6194 (62%) presenting at peripheral health units (PHU). Reported NCDs decreased during Ebola and increased post-Ebola, but did not recover to pre-Ebola levels. Hypertension cases remained fairly constant throughout being mainly managed at PHU. Numbers with diabetes mellitus generally stayed the same except for a significant post-Ebola increase in tertiary hospitals. Small numbers were reported with mental health disorders across all facilities in all time periods. Conclusion: NCD reporting is recovering in the immediate post-Ebola period. Decentralization of NCD care is welcome and is an effective strategy for management as evidenced by hypertension. To be successful, this must be supported by strengthening other elements of the health system such as training of health workers, robust information and referral systems and reliable medicine supply chains.
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Affiliation(s)
- Ibrahim Baimba Koroma
- Directorate of Policy, Planning and Information (DPPI), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - Dena Javadi
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Katrina Hann
- Sustainable Health Systems, Freetown, Sierra Leone
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene and Tropical Medicine, London, UK
| | - Francis Smart
- Directorate of Policy, Planning and Information (DPPI), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - Thomas Samba
- National Public Health Agency (NPHA), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
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Bohren MA, Javadi D, Vogel JP. Gender balance in WHO panels for guidelines published from 2008 to 2018. Bull World Health Organ 2019; 97:477-485. [PMID: 31258217 PMCID: PMC6593333 DOI: 10.2471/blt.18.226894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the gender composition of guideline contributors for all World Health Organization (WHO) guidelines published from 2008 to 2018. Methods We searched for guidelines in the WHO Guideline Review Committee database. We extracted data about the guidelines (title, publication year) and individuals participating (name, role, gender). Guideline roles included: member or chair of guideline development group, WHO steering group, external reviewer or methodologist. We used descriptive statistics to analyse gender composition for each role and the proportion of guideline development group members and chairs who were female. Findings We included 230 guidelines involving 13 329 individuals: 219 guidelines (95.2%) reported a guideline development group (4912 individuals). More group members were male (2606; 53.1%) than female (2241; 45.5%). The median proportion of female members per guideline was 47.1% (interquartile range: 35.7–56.3). Half of the guidelines (110; 50.2%) had a development group composed of 40.1–60% females and 75 guidelines (34.2%) had ≤ 40% females in the group. From 2016 to 2018, there were some improvements: one quarter of groups were composed of ≤ 40.0% females in 2016 and 2017, and this reduced to 9.1% in 2018. Among 243 group chairs, 145 (59.7%) were male and 96 (39.5%) were female. Conclusion Participation on a guideline panel is a prestigious leadership role in global health. The under-representation of women across most WHO guideline roles shows that inequalities persist even where standards and policies call for gender balance. Attention can be shifted to strengthening accountability mechanisms and understanding the root causes of this imbalance.
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Affiliation(s)
- Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053 Australia
| | - Dena Javadi
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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Dolovich L, Oliver D, Lamarche L, Thabane L, Valaitis R, Agarwal G, Carr T, Foster G, Griffith L, Javadi D, Kastner M, Mangin D, Papaioannou A, Ploeg J, Raina P, Richardson J, Risdon C, Santaguida P, Straus S, Price D. Combining volunteers and primary care teamwork to support health goals and needs of older adults: a pragmatic randomized controlled trial. CMAJ 2019; 191:E491-E500. [PMID: 31061074 PMCID: PMC6509035 DOI: 10.1503/cmaj.181173] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The Health TAPESTRY (Health Teams Advancing Patient Experience: STRengthening QualitY) intervention was designed to improve primary care teamwork and promote optimal aging. We evaluated the effectiveness of Health TAPESTRY in attaining goals of older adults (e.g., physical activity, productivity, social connection, medical status) and other outcomes. METHODS We conducted a pragmatic randomized controlled trial between January and October 2015 in a primary care practice in Hamilton, Ontario. Older adults were randomized (1:1) to Health TAPESTRY (n = 158) or control (n = 154). Trained community volunteers gathered information on people's goals, needs and risks in their homes, using electronic forms. Interprofessional primary care teams reviewed summaries and addressed issues. Participants reported goal attainment (primary outcome), self-efficacy, quality of life, optimal aging, social support, empowerment, physical activity, falls, and access to and comprehensiveness of the health system. We determined use of health care resources through chart audit. RESULTS There were no differences between groups in goal attainment or many other patient-reported outcome and experience assessments at 6 months. More primary care visits took place in the intervention versus control group over 6 months (mean ± standard deviation [SD] 4.93 ± 3.86 v. 3.50 ± 3.53; difference of 1.52 [95% confidence interval (CI) 0.84 to 2.19]). The odds of having 1 or more hospital admission were lower for the intervention group (odds ratio [OR] 0.44 [95% CI 0.20 to 0.95]). INTERPRETATION Health TAPESTRY did not improve the primary outcome of goal attainment but showed signals of shifting care from reactive to active preventive care. Further evaluation will help in understanding effective components, costs and consequences of the intervention. Trial registration: ClinicalTrials.gov, no. NCT02283723.
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Affiliation(s)
- Lisa Dolovich
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont.
| | - Doug Oliver
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Larkin Lamarche
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Lehana Thabane
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Ruta Valaitis
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Gina Agarwal
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Tracey Carr
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Gary Foster
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Lauren Griffith
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Dena Javadi
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Monika Kastner
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Dee Mangin
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Alexandra Papaioannou
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Jenny Ploeg
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Parminder Raina
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Julie Richardson
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Cathy Risdon
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Pasqualina Santaguida
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - Sharon Straus
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
| | - David Price
- Departments of Family Medicine (Dolovich, Oliver, Lamarche, Agarwal, Carr, Javadi, Mangin, Risdon, Price), Medicine (Papaioannou), and Health Research Methods, Evidence and Impact (Thabane, Foster, Griffith, Raina, Santaguida, Papaioannou), McMaster Institute for Research on Aging (Raina), Schools of Rehabilitation Science (Richardson) and of Nursing (Valaitis, Ploeg), McMaster University; Hamilton Health Sciences (Price), Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich); University of Toronto; Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Straus), Toronto, Ont
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18
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Javadi D, Lamarche L, Avilla E, Siddiqui R, Gaber J, Bhamani M, Oliver D, Cleghorn L, Mangin D, Dolovich L. Feasibility study of goal setting discussions between older adults and volunteers facilitated by an eHealth application: development of the Health TAPESTRY approach. Pilot Feasibility Stud 2018; 4:184. [PMID: 30564435 PMCID: PMC6292127 DOI: 10.1186/s40814-018-0377-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 11/26/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In keeping with the changing needs of the Canadian population, primary care systems need to become more person-focused in providing quality care to older adults. As part of Health TAPESTRY, a complex intervention to strengthen primary care for older adults, a goal setting exercise was developed and tested in an initial feasibility study, intended to foster collaboration between patients and providers. METHODS Participants-clinic clients-were recruited from the McMaster Family Health Team in Hamilton, Ontario. Five participants took part in the goal setting feasibility study phase I, which tested the functionality of a technology-enabled goal setting exercise between older adults and volunteers. Based on observations and feedback from volunteers, interprofessional team members, and older adults, the exercise was refined to include a guided survey and goals report. The goal setting survey is a list of probing questions designed based on SMART (specific, measurable, attainable, relevant, timely) goal setting strategies and goal attainment scaling (GAS). This was used in phase II, carried out with 16 participants, where the feasibility of goal setting and goal attainment with support from volunteers and interprofessional teams was tested. Volunteers carried out the goal setting survey via a tablet computer, a report of client goals was generated and sent to interprofessional teams, and client goals were discussed during clinic huddles. At 6 months of follow-up, clients self-evaluated their progress using GAS. RESULTS AND DISCUSSION The goal setting exercise in phase I took an average of 24:45 (SD 11:42) minutes and yielded a diverse set of life and health goals. Goals identified by older adults were primarily focused on the maintenance of a certain level of activity or health state. Phase I work resulted in important changes to the goal setting process (e.g., asking about goal setting later in conversation, changing wording of questions) and development of a summary report of goals sent to the interprofessional team. In phase II, 44 goals were set by 16 participants during an average 7:23 (SD 4:26) minute discussion. Of these goals, 43.9% were characterized as health goals while 63.4% were characterized as life goals. Under the umbrella of Life goals, productivity featured most prominently at 22.9% of all goals. Goal attainment was not measured in phase I. In phase II, clients had an average weighted goal attainment score of 51.5. Considering client preferences for one goal over another, 68.8% of clients, on average, at least partially achieved the goals they had set. CONCLUSION Goal setting as part of the Health TAPESTRY approach was feasible and provided interprofessional teams with client narratives that helped improve care management for older adults. The overall intervention-including the refined goal setting component-is being scaled and evaluated in a pragmatic randomized controlled trial.
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Affiliation(s)
- Dena Javadi
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Larkin Lamarche
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Ernie Avilla
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Raied Siddiqui
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Jessica Gaber
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Mehreen Bhamani
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Doug Oliver
- McMaster University, DFM DBHSC, 3rd Floor, 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Laura Cleghorn
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Dee Mangin
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Lisa Dolovich
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
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Abstract
INTRODUCTION The era of the Sustainable Development Goals calls for multidisciplinary research and intersectoral approaches to addressing health challenges. This presents a unique opportunity for multidisciplinary fields concerned with complex systems. Those working in system-oriented fields such as health policy and systems research (HPSR) and health services research must be forward-thinking in optimizing their collective ability to address these global challenges. OBJECTIVES The objective of this commentary was to share reflections on challenges and strategies in managing the HPSR workforce in order to stimulate dialogue and cross-learning across similar fields. STRATEGIES/FINDINGS The following strategies are discussed here: definitional clarity of expected competencies and coordination across HPS researchers, national investment in HPSR, institutional capacity for coproduction of knowledge across different types of actors, and participatory leadership. CONCLUSIONS Creative approaches in training, financing, developing, and leading the diverse workforce required to strengthen health systems can pave the way for its full-time and part-time members to work together.
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Affiliation(s)
- Dena Javadi
- Alliance for Health Policy and Systems ResearchWorld Health OrganizationGenevaSwitzerland
| | - Nhan Tran
- Alliance for Health Policy and Systems ResearchWorld Health OrganizationGenevaSwitzerland
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems ResearchWorld Health OrganizationGenevaSwitzerland
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Shroff ZC, Javadi D, Gilson L, Kang R, Ghaffar A. Institutional capacity to generate and use evidence in LMICs: current state and opportunities for HPSR. Health Res Policy Syst 2017; 15:94. [PMID: 29121958 PMCID: PMC5680819 DOI: 10.1186/s12961-017-0261-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 10/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-informed decision-making for health is far from the norm, particularly in many low- and middle-income countries (LMICs). Health policy and systems research (HPSR) has an important role in providing the context-sensitive and -relevant evidence that is needed. However, there remain significant challenges both on the supply side, in terms of capacity for generation of policy-relevant knowledge such as HPSR, and on the demand side in terms of the demand for and use of evidence for policy decisions. This paper brings together elements from both sides to analyse institutional capacity for the generation of HPSR and the use of evidence (including HPSR) more broadly in LMICs. METHODS The paper uses literature review methods and two survey instruments (directed at research institutions and Ministries of Health, respectively) to explore the types of institutional support required to enhance the generation and use of evidence. RESULTS Findings from the survey of research institutions identified the absence of core funding, the lack of definitional clarity and academic incentive structures for HPSR as significant constraints. On the other hand, the survey of Ministries of Health identified a lack of locally relevant evidence, poor presentation of research findings and low institutional prioritisation of evidence use as significant constraints to evidence uptake. In contrast, improved communication between researchers and decision-makers and increased availability of relevant evidence were identified as facilitators of evidence uptake. CONCLUSION The findings make a case for institutional arrangements in research that provide support for career development, collaboration and cross-learning for researchers, as well as the setting up of institutional arrangements and processes to incentivise the use of evidence among Ministries of Health and other decision-making institutions. The paper ends with a series of recommendations to build institutional capacity in HPSR through engaging multiple stakeholders in identifying and maintaining incentive structures, improving research (including HPSR) training, and developing stronger tools for synthesising non-traditional forms of local, policy-relevant evidence such as grey literature. Addressing challenges on both the supply and demand side can build institutional capacity in the research and policy worlds and support the enhanced uptake of high quality evidence in policy decisions.
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Affiliation(s)
- Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland.
| | - Dena Javadi
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland
| | - Lucy Gilson
- Health Economics Unit, Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rockie Kang
- University of Queensland, Brisbane, Australia
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland
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Javadi D, Langlois EV, Ho S, Friberg P, Tomson G. Intersectoral approaches and integrated services in achieving the right to health for refugees upon resettlement: a scoping review protocol. BMJ Open 2017; 7:e016638. [PMID: 28855201 PMCID: PMC5629659 DOI: 10.1136/bmjopen-2017-016638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Global insecurity and climate change are exacerbating the need for improved management of refugee resettlement services. International standards hold states responsible for the protection of the right of non-citizens to an adequate standard of physical and mental health while recognising the importance of social determinants of health. However, programmes to protect refugees' right to health often lack coordination and monitoring. This paper describes the protocol for a scoping review to explore barriers and facilitators to the integration of health services for refugees; the content, process and actors involved in protecting refugee health; and the extent to which intersectoral approaches are leveraged to protect refugees' right to health on resettlement, especially for vulnerable groups such as women and children. METHODS AND ANALYSIS Peer-reviewed (through four databases including MEDLINE, Web of Science, Global Health and PsycINFO) and grey literature were searched to identify programmes and interventions designed to promote refugee health in receiving countries. Two reviewers will screen articles and abstract data. Two frameworks for integration and intersectoral action will be applied to understand how and why certain approaches work while others do not and to identify the actors involved in achieving success at different levels of integration as defined by these frameworks. ETHICS AND DISSEMINATION Findings from the scoping review will be shared in relevant conferences and meetings. A brief will be created with lessons learnt from successful programmes to inform decision making in design of refugee programmes and services. Ethical approval is not required as human subjects are not involved. TRIAL REGISTRATION NUMBER Registered on Open Science Framework at https://osf.io/gt9ck/.
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Affiliation(s)
- Dena Javadi
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Etienne V Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Shirley Ho
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Peter Friberg
- Swedish Institute for Global Health Transformation (SIGHT), Royal Swedish Academy of Sciences, Geneva, Switzerland
- Department of Molecular and Clinical Medicine, Sahlgrens Academy and University Hospital, Gothenburg University, Gothenburg, Sweden
| | - Göran Tomson
- Swedish Institute for Global Health Transformation (SIGHT), Royal Swedish Academy of Sciences, Geneva, Switzerland
- Health System and Policy, Global Health, Karolinska Institutet, Stockholm, Sweden
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Javadi D, Feldhaus I, Mancuso A, Ghaffar A. Applying systems thinking to task shifting for mental health using lay providers: a review of the evidence. Glob Ment Health (Camb) 2017; 4:e14. [PMID: 29230310 PMCID: PMC5719475 DOI: 10.1017/gmh.2017.15] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/14/2017] [Accepted: 06/20/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This paper seeks to review the available evidence to determine whether a systems approach is employed in the implementation and evaluation of task shifting for mental health using lay providers in low- and middle-income countries, and to highlight system-wide effects of task-shifting strategies in order to better inform efforts to strength community mental health systems. METHODS Pubmed, CINAHL, and Cochrane Library databases were searched. Articles were screened by two independent reviewers with a third reviewer resolving discrepancies. Two stages of screens were done to ensure sensitivity. Studies were analysed using the World Health Organization's building blocks framework with the addition of a community building block, and systems thinking characteristics to determine the extent to which system-wide effects had been considered. RESULTS Thirty studies were included. Almost all studies displayed positive findings on mental health using task shifting. One study showed no effect. No studies explicitly employed systems thinking tools, but some demonstrated systems thinking characteristics, such as exploring various stakeholder perspectives, capturing unintended consequences, and looking across sectors for system-wide impact. Twenty-five of the 30 studies captured elements other than the most directly relevant building blocks of service delivery and health workforce. CONCLUSIONS There is a lack of systematic approaches to exploring complexity in the evaluation of task-shifting interventions. Systems thinking tools should support evidence-informed decision making for a more complete understanding of community-based systems strengthening interventions for mental health.
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Affiliation(s)
- D. Javadi
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | - I. Feldhaus
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - A. Mancuso
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A. Ghaffar
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
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Ghaffar A, Tran N, Langlois E, Shroff Z, Javadi D. Alliance for Health Policy and Systems Research: aims, achievements and ambitions. Public Health Res Pract 2017; 27:2711703. [PMID: 28243669 DOI: 10.17061/phrp2711703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The Alliance for Health Policy and Systems Research was established in 1999 and is hosted as an international partnership by the World Health Organization (WHO). The Alliance emerged from recommendations of the 1996 WHO Ad Hoc Committee on Health Research, which recognised the role of research in strengthening health policies and the overall development of health systems. Work towards the Alliance's mission - to promote the generation and use of health policy and systems research (HPSR) as a means to strengthen health systems in low- and middle-income countries - historically focused on three areas: generation of policy and systems knowledge, promotion of its use in decision making to improve the performance of health systems, and strengthening researchers' and decision makers' capacity to engage in these efforts. Now, after nearly 20 years of learning and accomplishments, the Alliance is launching new strategic objectives to reflect a changed context, and new challenges and opportunities. Over the coming years, the Alliance plans to provide a unique forum for the HPSR community; support institutional capacity to conduct and use HPSR; stimulate the generation of knowledge and innovations to nurture learning and resilience in health systems; and increase demand for, and use of, knowledge for strengthening health systems.
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Affiliation(s)
- Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland,
| | - Nhan Tran
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Etienne Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Zubin Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Dena Javadi
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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Turchyn JS, Gravesande J, Agarwal G, Mangin D, Javadi D, Peter J, Parascandalo F, Dolovich L, Richardson J. A healthy lifestyle app for older adults with diabetes and hypertension: usability assessment. IJHTM 2017. [DOI: 10.1504/ijhtm.2017.088862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Richardson J, Peter J, Parascandalo F, Dolovich L, Javadi D, Mangin D, Agarwal G, Gravesande J, Smith Turchyn J. A healthy lifestyle app for older adults with diabetes and hypertension: usability assessment. IJHTM 2017. [DOI: 10.1504/ijhtm.2017.10009747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Affiliation(s)
- Dena Javadi
- Alliance for Health Policy and Systems Research, Geneva, Switzerland
| | - Jeanette Vega
- National Chilean Public Health Insurance Agency (FONASA), Santiago, Chile
| | | | | | | | - Sania Nishtar
- Heartfile, Pakistan
- Commission on Ending Childhood Obesity, WHO
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Affiliation(s)
- Michael R Reich
- Department of Global Health and Population , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | - Dena Javadi
- Alliance for Health Policy and Systems Research, World Health Organization , Geneva , Switzerland
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization , Geneva , Switzerland
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Dolovich L, Oliver D, Lamarche L, Agarwal G, Carr T, Chan D, Cleghorn L, Griffith L, Javadi D, Kastner M, Longaphy J, Mangin D, Papaioannou A, Ploeg J, Raina P, Richardson J, Risdon C, Santaguida PL, Straus S, Thabane L, Valaitis R, Price D. A protocol for a pragmatic randomized controlled trial using the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) platform approach to promote person-focused primary healthcare for older adults. Implement Sci 2016; 11:49. [PMID: 27044360 PMCID: PMC4820854 DOI: 10.1186/s13012-016-0407-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/12/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Healthcare systems are not well designed to help people maintain or improve their health. They are generally not person-focused or well-coordinated. The objective of this study is to evaluate the effectiveness of the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) approach in older adults. The overarching hypothesis is that using the Health TAPESTRY approach to achieve better integration of the health and social care systems into a person's life that centers on meeting a person's health goals and needs will result in optimal aging. METHODS/DESIGN This is a 12-month delayed intervention pragmatic randomized controlled trial. The study will be performed in Hamilton, Ontario, Canada in the two-site McMaster Family Health Team. Participants will include 316 patients who are 70 years of age or older. Participants will be randomized to the Health TAPESTRY approach or control group. The Health TAPESTRY approach includes intentional, proactive conversations about a person's life and health goals and health risks and then initiation of congruent tailored interventions that support achievement of those goals and addressing of risks through (1) trained volunteers visiting clients in their homes to serve as a link between the primary care team and the client; (2) the use of novel technology including a personal health record from the home to link directly with the primary healthcare team; and (3) improved processes for connections, system navigation, and care delivery among interprofessional primary care teams, community service providers, and informal caregivers. The primary outcome will be the goal attainment scaling score. Secondary outcomes include self-efficacy for managing chronic disease, quality of life, the participant perspective on their own aging, social support, access to health services, comprehensiveness of care, patient empowerment, patient-centeredness, caregiver strain, satisfaction with care, healthcare resource utilization, and cost-effectiveness. Implementation processes will also be evaluated. The main comparative analysis will take place at 6 months. DISCUSSION Evidence of the individual elements of the Health TAPESTRY platform has been shown in isolation in the previous research. However, this study will better understand how to best integrate them to maximize the system's transformation of person-focused, primary care for older adults. TRIAL REGISTRATION ClinicalTrials.gov NCT02283723.
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Affiliation(s)
- Lisa Dolovich
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada.
| | - Doug Oliver
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
- McMaster Family Health Team, Hamilton, Canada
| | - Larkin Lamarche
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
- McMaster Family Health Team, Hamilton, Canada
| | - Tracey Carr
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | - David Chan
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | - Laura Cleghorn
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
- School of Nursing, McMaster University, Hamilton, Canada
| | - Lauren Griffith
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Dena Javadi
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | - Monika Kastner
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Jennifer Longaphy
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | | | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Canada
| | - Parminder Raina
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Cathy Risdon
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
- McMaster Family Health Team, Hamilton, Canada
| | - P Lina Santaguida
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Sharon Straus
- Institute of Health Management and Policy, University of Toronto, Toronto, Canada
| | - Lehana Thabane
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Ruta Valaitis
- School of Nursing, McMaster University, Hamilton, Canada
| | - David Price
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
- McMaster Family Health Team, Hamilton, Canada
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Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, Aguiar C, Saraiva Coneglian F, Diniz ALA, Tunçalp Ö, Javadi D, Oladapo OT, Khosla R, Hindin MJ, Gülmezoglu AM. The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Med 2015; 12:e1001847; discussion e1001847. [PMID: 26126110 PMCID: PMC4488322 DOI: 10.1371/journal.pmed.1001847] [Citation(s) in RCA: 746] [Impact Index Per Article: 82.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 05/22/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite growing recognition of neglectful, abusive, and disrespectful treatment of women during childbirth in health facilities, there is no consensus at a global level on how these occurrences are defined and measured. This mixed-methods systematic review aims to synthesize qualitative and quantitative evidence on the mistreatment of women during childbirth in health facilities to inform the development of an evidence-based typology of the phenomenon. METHODS AND FINDINGS We searched PubMed, CINAHL, and Embase databases and grey literature using a predetermined search strategy to identify qualitative, quantitative, and mixed-methods studies on the mistreatment of women during childbirth across all geographical and income-level settings. We used a thematic synthesis approach to synthesize the qualitative evidence and assessed the confidence in the qualitative review findings using the CERQual approach. In total, 65 studies were included from 34 countries. Qualitative findings were organized under seven domains: (1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) stigma and discrimination, (5) failure to meet professional standards of care, (6) poor rapport between women and providers, and (7) health system conditions and constraints. Due to high heterogeneity of the quantitative data, we were unable to conduct a meta-analysis; instead, we present descriptions of study characteristics, outcome measures, and results. Additional themes identified in the quantitative studies are integrated into the typology. CONCLUSIONS This systematic review presents a comprehensive, evidence-based typology of the mistreatment of women during childbirth in health facilities, and demonstrates that mistreatment can occur at the level of interaction between the woman and provider, as well as through systemic failures at the health facility and health system levels. We propose this typology be adopted to describe the phenomenon and be used to develop measurement tools and inform future research, programs, and interventions.
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Affiliation(s)
- Meghan A. Bohren
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Joshua P. Vogel
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Erin C. Hunter
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Olha Lutsiv
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Suprita K. Makh
- Population Services International, Washington, D. C., United States of America
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carolina Aguiar
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Fernando Saraiva Coneglian
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Alex Luíz Araújo Diniz
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Özge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Dena Javadi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Olufemi T. Oladapo
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Rajat Khosla
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Michelle J. Hindin
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - A. Metin Gülmezoglu
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
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30
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Bigdeli M, Javadi D, Hoebert J, Laing R, Ranson K. Health policy and systems research in access to medicines: a prioritized agenda for low- and middle-income countries. Health Res Policy Syst 2013; 11:37. [PMID: 24124696 PMCID: PMC3854087 DOI: 10.1186/1478-4505-11-37] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 09/26/2013] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To identify priority policy issues in access to medicines (ATM) relevant for low- and middle-income countries, to identify research questions that would help address these policy issues, and to prioritize these research questions in a health policy and systems research (HPSR) agenda. METHODS The study involved i) country- and regional-level priority-setting exercises performed in 17 countries across five regions, with a desk review of relevant grey and published literature combined with mapping and interviews of national and regional stakeholders; ii) interviews with global-level stakeholders; iii) a scoping of published literature; and iv) a consensus building exercise with global stakeholders which resulted in the formulation and ranking of HPSR questions in the field of ATM. RESULTS A list of 18 priority policy issues was established following analysis of country-, regional-, and global-level exercises. Eighteen research questions were formulated during the global stakeholders' meeting and ranked according to four ranking criteria (innovation, impact on health and health systems, equity, and lack of research). The top three research questions were: i) In risk protection schemes, which innovations and policies improve equitable access to and appropriate use of medicines, sustainability of the insurance system, and financial impact on the insured? ii) How can stakeholders use the information available in the system, e.g., price, availability, quality, utilization, registration, procurement, in a transparent way towards improving access and use of medicines? and iii) How do policies and other interventions into private markets, such as information, subsidies, price controls, donation, regulatory mechanisms, promotion practices, etc., impact on access to and appropriate use of medicines? CONCLUSIONS Our HPSR agenda adopts a health systems perspective and will guide relevant, innovative research, likely to bear an impact on health, health systems and equity.
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Affiliation(s)
- Maryam Bigdeli
- Alliance for Health Policy and Systems Research, World Health Organization, 20, avenue Appia, 1211 Geneva, Switzerland.
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