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Eli K, Harlock J, Huxley CJ, Bernstein C, Mann C, Spencer R, Griffiths F, Slowther AM. Patient and relative experiences of the ReSPECT process in the community: an interview-based study. BMC Prim Care 2024; 25:115. [PMID: 38632508 PMCID: PMC11022317 DOI: 10.1186/s12875-024-02283-x] [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] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/19/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was launched in the UK in 2016. ReSPECT is designed to facilitate meaningful discussions between healthcare professionals, patients, and their relatives about preferences for treatment in future emergencies; however, no study has investigated patients' and relatives' experiences of ReSPECT in the community. OBJECTIVES To explore how patients and relatives in community settings experience the ReSPECT process and engage with the completed form. METHODS Patients who had a ReSPECT form were identified through general practice surgeries in three areas in England; either patients or their relatives (where patients lacked capacity) were recruited. Semi-structured interviews were conducted, focusing on the participants' understandings and experiences of the ReSPECT process and form. Data were analysed using inductive thematic analysis. RESULTS Thirteen interviews took place (six with patients, four with relatives, three with patient and relative pairs). Four themes were developed: (1) ReSPECT records a patient's wishes, but is entangled in wider relationships; (2) healthcare professionals' framings of ReSPECT influence patients' and relatives' experiences; (3) patients and relatives perceive ReSPECT as a do-not-resuscitate or end-of-life form; (4) patients' and relatives' relationships with the ReSPECT form as a material object vary widely. Patients valued the opportunity to express their wishes and conceptualised ReSPECT as a process of caring for themselves and for their family members' emotional wellbeing. Participants who described their ReSPECT experiences positively said healthcare professionals clearly explained the ReSPECT process and form, allocated sufficient time for an open discussion of patients' preferences, and provided empathetic explanations of treatment recommendations. In cases where participants said healthcare professionals did not provide clear explanations or did not engage them in a conversation, experiences ranged from confusion about the form and how it would be used to lingering feelings of worry, upset, or being burdened with responsibility. CONCLUSIONS When ReSPECT conversations involved an open discussion of patients' preferences, clear information about the ReSPECT process, and empathetic explanations of treatment recommendations, working with a healthcare professional to co-develop a record of treatment preferences and recommendations could be an empowering experience, providing patients and relatives with peace of mind.
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Affiliation(s)
- Karin Eli
- Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK.
| | - Jenny Harlock
- Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Caroline J Huxley
- Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Celia Bernstein
- Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Claire Mann
- Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Rachel Spencer
- Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Anne-Marie Slowther
- Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
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Malatji H, Griffiths F, Goudge J. Mobilisation towards formal employment in the healthcare system: A qualitative study of community health workers in South Africa. PLOS Glob Public Health 2024; 4:e0002226. [PMID: 38507456 PMCID: PMC10954165 DOI: 10.1371/journal.pgph.0002226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/07/2024] [Indexed: 03/22/2024]
Abstract
In low and middle-income countries, community health workers (CHWs) play a critical role in delivering primary healthcare (PHC) services. However, they often receive low stipends, function without resources and have little bargaining power with which to demand better working conditions. Using a qualitative case study methodology, we studied CHWs' conditions of employment, their struggle for recognition as health workers, and their activities to establish labour representation in South Africa. Seven CHW teams located in semi-urban and rural areas of Gauteng and Mpumalanga Provinces were studied. We conducted 43 in-depth interviews, 10 focus groups and 6 observations to gather data from CHWs and their representatives, supervisors and PHC facility staff. The data was analysed using thematic analysis method. In the rural and semi-urban sites, the CHWs were poorly resourced and received meagre remuneration, their employment outsourced, without employment benefits and protection. As a result of these challenges, the CHWs in the semi-urban sites established a task team to represent them. They held meetings and caused disruptions in the health facilities. After numerous unsuccessful attempts to negotiate for improved conditions of employment, the CHWs joined a labour union in order to participate in the local Bargaining Council. Though they were not successful in getting the government to provide permanent employment, the union negotiated an increase in their stipend. After the study ended, during the height of COVID-19 in 2020, when the need for motivated and effective CHWs became more apparent to decision makers, the semi-urban-based teams received permanent employment with a better remuneration. The task team and their protests raised awareness of the plight of the CHWs, and joining a formal union enabled them to negotiate a modest salary increase. However, it was the emergency created by the world-wide COVID-19 pandemic that forced decision-makers to acknowledge their reliance on this community-based cadre.
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Affiliation(s)
- Hlologelo Malatji
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Frances Griffiths
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Underwood M, Noufaily A, Blanchard H, Dale J, Harlock J, Gill P, Griffiths F, Spencer R, Slowther AM. General practitioners' views on emergency care treatment plans; an on-line survey. BJGP Open 2024:BJGPO.2023.0192. [PMID: 38191186 DOI: 10.3399/bjgpo.2023.0192] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/26/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND A holistic approach to emergency care treatment planning is needed to ensure that patients' preferences are considered should their clinical condition deteriorate. To address this Emergency Care and Treatment Plans (ECTPs) have been introduced. Little is known about their use in general practice. AIM To survey general practitioners' (GPs') experiences of, and views on, using ECTPs. DESIGN & SETTING On-line survey of GPs practising in England. METHOD A survey of 841 GPs using the monthly on-line survey provided by Medeconnect, a market research company. RESULTS ECTP forms were used by 49% of respondents' practices (84% of these were Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) plans); 51% used do not attempt cardio-pulmonary resuscitation (DNACPR) forms. GPs are the predominant professional group completing ECTPs in the community. There was broad support for a wider range of community-based health and social care professionals being able to complete ECTPs. There was no system for reviewing ECTPs in 20% of respondents' practices.When compared to using a DNACPR form GPs using a ReSPECT form for emergency care treatment planning were more comfortable having these conversations with patients (OR =1.72, 95% CI 1.1-2.69) and family members (OR =1.85 (95% CI 1.19-2.87). CONCLUSION The potential benefits and challenges of widening the pool of health and social care professionals initiating and / or completing the ECTP process needs consideration. ReSPECT plans appears to make GPs more comfortable with ECTP discussions supporting their implementation. Practice-based systems for reviewing ECTP decisions should be strengthened.
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Affiliation(s)
- Martin Underwood
- University of Warwick, Warwick Medical School, Warwick Clinical Trials Unit, Coventry, United Kingdom
| | - Angela Noufaily
- University of Warwick, Warwick Medical School, Warwick Clinical Trials Unit, Coventry, United Kingdom
| | | | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jenny Harlock
- University of Warwick, Warwick Medical School, Gibbet Hill Coventry, United Kingdom
| | - Paramjit Gill
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Frances Griffiths
- University of Warwick, Warwick Medical School, Gibbet Hill Coventry, United Kingdom
| | - Rachel Spencer
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Anne-Marie Slowther
- University of Warwick, Warwick Medical School, Gibbet Hill Coventry, United Kingdom
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Fruhstorfer BH, Jenkins SP, Davies DA, Griffiths F. International short-term placements in health professions education-A meta-narrative review. Med Educ 2023. [PMID: 38102955 DOI: 10.1111/medu.15294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 10/31/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION In order to be prepared for professional practice in a globalised world, health professions students need to be equipped with a new set of knowledge, skills and attitudes. Experiential learning gained during an international placement has been considered as a powerful strategy for facilitating the acquisition of global health competencies. The aim of this review was to synthesise the diverse body of empirical research examining the process and outcomes of international short-term placements in health professions education. METHODS A systematic review was conducted using a meta-narrative methodology. Six electronic databases were searched between September 2016 and June 2022: Medline, Embase, CINAHL, PsycINFO, Education Research Complete and Web of Knowledge. Studies were included if they reported on international placements undertaken by undergraduate health professions students in socio-economically contrasting settings. Included studies were first considered within their research tradition before comparing and contrasting findings between different research traditions. RESULTS This review included 243 papers from 12 research traditions, which were distinguished by health profession and paradigmatic approach. Empirical findings were considered in four broad themes: learner, educational intervention, institutional context and wider context. Most studies provided evidence on the learner, with findings indicating a positive impact of international placements on personal and professional development. The development of cultural competency has been more focus in research in nursing and allied health than in medicine. Whereas earlier research has focussed on the experience and outcomes for the learner, more recent studies have become more concerned with relationships between various stakeholder groups. Only few studies have looked at strategies to enhance the educational process. CONCLUSION The consideration of empirical work from different perspectives provides novel understandings of what research has achieved and what needs further investigation. Future studies should pay more attention to the complex nature of the educational process in international placements.
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Affiliation(s)
| | | | - David A Davies
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, University of Witwatersrand, Johannesburg, South Africa
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Babalola O, Levin J, Goudge J, Griffiths F. Community health workers' quality of comprehensive care: a cross-sectional observational study across three districts in South Africa. Front Public Health 2023; 11:1180663. [PMID: 38162597 PMCID: PMC10755947 DOI: 10.3389/fpubh.2023.1180663] [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: 03/06/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Background Community healthcare worker (CHW) training programs are becoming increasingly comprehensive (an expanded range of diseases). However, the CHWs that the program relies on have limited training. Since CHWs' activities occur largely during household visits, which often go unsupervised and unassessed, long-term, ongoing assessment is needed to identify gaps in CHW competency, and improve any such gaps. We observed CHWs during household visits and gave scores according to the proportion of health messages/activities provided for the health conditions encountered in households. We aimed to determine (1) messages/activities scores derived from the proportion of health messages given in the households by CHWs who provide comprehensive care in South Africa, and (2) the associated factors. Methods In three districts (from two provinces), we trained five fieldworkers to score the messages provided by, and activities of, 34 CHWs that we randomly selected during 376 household visits in 2018 and 2020 using a cross-sectional study designs. Multilevel models were fitted to identify factors associated with the messages/activities scores, adjusted for the clustering of observations within CHWs. The models were adjusted for fieldworkers and study facilities (n = 5, respectively) as fixed effects. CHW-related (age, education level, and phase of CHW training attended/passed) and household-related factors (household size [number of persons per household], number of conditions per household, and number of persons with a condition [hypertension, diabetes, HIV, tuberculosis TB, and cough]) were investigated. Results In the final model, messages/activities scores increased with each extra 5-min increase in visit duration. Messages/activities scores were lower for households with either children/babies, hypertension, diabetes, a large household size, numerous household conditions, and members with either TB or cough. Increasing household size and number of conditions, also lower the score. The messages/activities scores were not associated with any CHW characteristics, including education and training. Conclusion This study identifies important factors related to the messages provided by and the activities of CHWs across CHW teams. Increasing efforts are needed to ensure that CHWs who provide comprehensive care are supported given the wider range of conditions for which they provide messages/activities, especially in households with hypertension, diabetes, TB/cough, and children or babies.
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Affiliation(s)
- Olukemi Babalola
- Center for Health Policy, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Jonathan Levin
- Division of Epidemiology and Biostatistics, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Jane Goudge
- Center for Health Policy, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
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Pillay N, Ncube N, Moopelo K, Mothoagae G, Welte O, Shogole M, Gwiji N, Scott L, Moshani N, Tiffin N, Boulle A, Griffiths F, Fairlie L, Mehta U, LeFevre A, Scott K. Translating the consent form is the tip of the iceberg: using cognitive interviews to assess the barriers to informed consent in South African health facilities. Sex Reprod Health Matters 2023; 31:2302553. [PMID: 38277196 PMCID: PMC10823893 DOI: 10.1080/26410397.2024.2302553] [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] [Indexed: 01/27/2024] Open
Abstract
The increasing digitisation of personal health data has led to an increase in the demand for onward health data. This study sought to develop local language scripts for use in public sector maternity clinics to capture informed consent for onward health data use. The script considered five possible health data uses: 1. Sending of general health information content via mobile phones; 2. Delivery of personalised health information via mobile phones; 3. Use of women's anonymised health data; 4. Use of child's anonymised health data; and 5. Use of data for recontact. Qualitative interviews (n = 54) were conducted among women attending maternity services in three public health facilities in Gauteng and Western Cape, South Africa. Using cognitive interviewing techniques, interviews sought to:(1) explore understanding of the consent script in five South African languages, (2) assess women's understanding of what they were consenting to, and (3) improve the consent script. Multiple rounds of interviews were conducted, each followed by revisions to the consent script, until saturation was reached, and no additional cognitive failures identified. Cognitive failures were a result of: (1) words and phrases that did not translate easily in some languages, (2) cognitive mismatches that arose as a result of different world views and contexts, (3) linguistic gaps, and (4) asymmetrical power relations that influence how consent is understood and interpreted. Study activities resulted in the development of an informed consent script for onward health data use in five South African languages for use in maternity clinics.
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Affiliation(s)
- Nirvana Pillay
- Senior Lecturer, Department of Sociology, University of the Witwatersrand, Johannesburg, South Africa; Director, Sarraounia Public Health Trust, 20 4th Avenue, Parktown North, Johannesburg, 2193, South Africa. Correspondence:
| | - Nobukhosi Ncube
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Kearabetswe Moopelo
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Gaolatlhe Mothoagae
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Olivia Welte
- Social Scientist, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Manape Shogole
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Nasiphi Gwiji
- Social Scientist, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lesley Scott
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Noma Moshani
- Social Scientist, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Nicki Tiffin
- Professor, Life Sciences Building, South African Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Andrew Boulle
- Professor, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Frances Griffiths
- Professor, Warwick Medical School, UK; Professor, Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lee Fairlie
- Director of Maternal and Child Health, Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ushma Mehta
- Associate Professor, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Amnesty LeFevre
- Associate Professor, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Kerry Scott
- Independent research consultant, Toronto, Canada; Associate Faculty, Johns Hopkins School of Public Health, Baltimore, MD, USA
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LeFevre A, Welte O, Moopelo K, Tiffin N, Mothoagae G, Ncube N, Gwiji N, Shogole M, Slogrove AL, Moshani N, Boulle A, Goudge J, Griffiths F, Fairlie L, Mehta U, Scott K, Pillay N. Preferences for onward health data use in the electronic age among maternity patients and providers in South Africa: a qualitative study. Sex Reprod Health Matters 2023; 31:2274667. [PMID: 37982758 PMCID: PMC11001361 DOI: 10.1080/26410397.2023.2274667] [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] [Indexed: 11/21/2023] Open
Abstract
Despite the expanding digitisation of individual health data, informed consent for the collection and use of health data is seldom explicitly sought in public sector clinics in South Africa. This study aims to identify perceptions of informed consent practices for health data capture, access, and use in Gauteng and the Western Cape provinces of South Africa. Data collection from September to December 2021 included in-depth interviews with healthcare providers (n = 12) and women (n = 62) attending maternity services. Study findings suggest that most patients were not aware that their data were being used for purposes beyond the individualised provision of medical care. Understanding the concept of anonymised use of electronic health data was at times challenging for patients who understood their data in the limited context of paper-based folders and booklets. When asked about preferences for electronic data, patients overwhelmingly were in favour of digitisation. They viewed electronic access to their health data as facilitating rapid and continuous access to health information. Patients were additionally asked about preferences, including delivery of health information, onward health data use, and recontacting. Understanding of these use cases varied and was often challenging to convey to participants who understood their health data in the context of information inputted into their paper folders. Future systems need to be established to collect informed consent for onward health data use. In light of perceived ties to the care received, these systems need to ensure that patient preferences do not impede the content nor quality of care received.
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Affiliation(s)
- Amnesty LeFevre
- Associate Professor, School of Public Health, University of Cape Town, Falmouth Rd, Observatory, Cape Town7925, South Africa
| | - Olivia Welte
- Social Scientist, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kearabetswe Moopelo
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Nicki Tiffin
- Professor, South African Bioinformatics Institute, Life Sciences Building, University of the Western Cape, Bellville
| | - Gaolatlhe Mothoagae
- Associate Researcher, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Nobukhosi Ncube
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Nasiphi Gwiji
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Manape Shogole
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Amy L. Slogrove
- Associate Professor, Faculty of Medicine and Health Sciences, Department of Paediatrics & Child Health, Stellenbosch University, Worcester, South Africa
| | - Nomakhawuta Moshani
- Social Scientist, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Boulle
- Professor, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Jane Goudge
- Professor, Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Frances Griffiths
- Professor, Warwick Medical School, Warwick, UK; Professor, Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lee Fairlie
- Director of Maternal and Child Health, Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ushma Mehta
- Associate Professor, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Kerry Scott
- Independent research consultant, Toronto, Canada; Associate Faculty, Johns Hopkins School of Public Health, Baltimore, USA
| | - Nirvana Pillay
- Director, Sarraounia Public Health Trust, Johannesburg; Visiting Researcher, School of Sociology, University of the Witwatersrand, Johannesburg, South Africa
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Sumankuuro J, Griffiths F, Koon AD, Mapanga W, Maritim B, Mosam A, Goudge J. The Experiences of Strategic Purchasing of Healthcare in Nine Middle-Income Countries: A Systematic Qualitative Review. Int J Health Policy Manag 2023; 12:7352. [PMID: 38618795 PMCID: PMC10699827 DOI: 10.34172/ijhpm.2023.7352] [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: 04/26/2022] [Accepted: 10/18/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Efforts to move towards universal health coverage (UHC) aim to rebalance health financing in ways that increase efficiency, equity, and quality. Resource constraints require a shift from passive to strategic purchasing (SP). In this paper, we report on the experiences of SP in public sector health insurance schemes in nine middle-income countries to understand what extent SP has been established, the challenges and facilitators, and how it is helping countries achieve their UHC goals. METHODS We conducted a systematic search to identify papers on SP. Nine countries were selected for case study analysis. We extracted data from 129 articles. We used a common framework to compare the purchasing arrangements and key features in the different schemes. The evidence was synthesised qualitatively. RESULTS Five countries had health technology assessment (HTA) units to research what services to buy. Most schemes had reimbursement mechanisms that enabled some degree of cost control. However, we found evidenced-based changes to the reimbursement mechanisms only in Thailand and China. All countries have some form of mechanism for accreditation of health facilities, although there was considerable variation in what is done. All countries had some strategy for monitoring claims, but they vary in complexity and the extent of implementation; three countries have implemented e-claim processing enabling a greater level of monitoring. Only four countries had independent governance structures to provide oversight. We found delayed reimbursement (six countries), failure to provide services in the benefits package (four countries), and high out-of-pocket (OOP) payments in all countries except Thailand and Indonesia, suggesting the schemes were failing their members. CONCLUSION We recommend investment in purchaser and research capacity and a focus on strong governance, including regular engagement between the purchaser, provider and citizens, to build trusting relationships to leverage the potential of SP more fully, and expand financial protection and progress towards UHC.
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Affiliation(s)
- Joshua Sumankuuro
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Policy and Management, SD Dombo University of Business and Integrated Development Studies, Wa, Ghana
- School of Community Health, Charles Sturt University, Orange, NSW, Australia
| | - Frances Griffiths
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Adam D. Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Witness Mapanga
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Beryl Maritim
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Atiya Mosam
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Sturt J, Griffiths F, Ajisola M, Akinyemi JO, Chipwaza B, Fayehun O, Harris B, Owoaje E, Rogers R, Pemba S, Watson SI, Omigbodun A. Safety and upscaling of remote consulting for long-term conditions in primary health care in Nigeria and Tanzania (REaCH trials): stepped-wedge trials of training, mobile data allowance, and implementation. Lancet Glob Health 2023; 11:e1753-e1764. [PMID: 37858586 DOI: 10.1016/s2214-109x(23)00411-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND In-person health care poses risks to health workers and patients during pandemics. Remote consultations can mitigate these risks. The REaCH intervention comprised training and mobile data allowance provision for mobile phones to support remotely delivered primary care in Africa compared with no training and mobile data allowance. The aim of this study was to estimate the effects of REaCH among adults with non-communicable diseases on remote and face-to-face consultation rates, patient safety, and trustworthiness of consultations. METHODS In these two independent stepped-wedge cluster randomised controlled trials, we enrolled 20 primary care clusters in each of two settings (Oyo State, Nigeria, and Morogoro Region, Tanzania). Eligible clusters had 100 or more patients with diabetes, hypertension, and cardiovascular or pulmonary disease employing five health workers. Clusters were computer-randomised to one of ten (Nigeria) or one of seven (Tanzania) sequences to receive the REaCH intervention. Only outcome assessors were masked. Primary outcomes were consultation, prescription, and investigation rates, and trustworthiness collected monthly for 12 months (Nigeria) and 9 months (Tanzania) from open cohorts. Ten randomly sampled consulting patients per cluster-month completed patient reported outcome measures. This trial was registered with ISRCTN, ISRCTN17941313. FINDINGS Overall, 40 clusters comprising 8776 (Nigeria) and 3246 (Tanzania) patients' open cohort data were analysed (6377 [72·7%] of 8776 females in Nigeria, and 2235 [68·9%] of 3246 females in Tanzania). The mean age of the participants was 55·3 years (SD 13·9) in Nigeria and 59·2 years (14·2) in Tanzania. In Nigeria, no evidence of change in face-to-face consulting rate was observed (rate ratio [RR] 1·06, 95% CI 0·98 to 1·09; p=0·16); however, remote consultations increased four-fold (4·44, 1·34 to >10; p=0·01). In Tanzania, face-to-face (0·94, 0·61 to 1·67; p=0·99) and remote consulting rates (1·17, 0·56 to 5·57; p=0·39) were unchanged. There was no evidence of difference in prescribing rates (Nigeria: 1·05, 0·60 to 1·14; p=0·23; Tanzania: 0·92, 0·60 to 1·67; p=0·97), investigation rates (Nigeria: 1·06, 0·23 to 2·12; p=0·49; Tanzania: 1·15, 0·35 to 1·64; 0·58) or trustworthiness scores (Nigeria: mean difference 0·05, 95% CI -0·45 to 0·42; p=0·89; Tanzania: 0·07, -0·15 to 0·76; p=0·70). INTERPRETATION REaCH can be implemented and could improve intervention versus control health-care access. Remote consultations appear safe and trustworthy, supporting universal health coverage. FUNDING The UK Research and Innovation Collective Fund. TRANSLATIONS For the Swahili and Yoruba translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, UK; Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Joshua Odunayo Akinyemi
- College of Medicine, University of Ibadan Nigeria, Ibadan, Nigeria; Department of Epidemiology and Medical Statistics, University of Ibadan Nigeria, Ibadan, Nigeria
| | - Beatrice Chipwaza
- School of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Olufunke Fayehun
- Department of Sociology, University of Ibadan Nigeria, Ibadan, Nigeria
| | - Bronwyn Harris
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Eme Owoaje
- Department of Community Medicine, University of Ibadan Nigeria, Ibadan, Nigeria
| | - Rebecca Rogers
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Senga Pemba
- School of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Samuel I Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Darlong J, Govindasamy K, Ilozumba O, Choudhury S, Shrivastva A, Griffiths F, Watson S, Sartori J, Lilford R. An evaluation protocol of 'Replicability Model' project for detection and treatment of leprosy and related disability in Chhattisgarh, India. PLoS One 2023; 18:e0275763. [PMID: 37851621 PMCID: PMC10584107 DOI: 10.1371/journal.pone.0275763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/22/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION People affected by leprosy are at increased risk of impairments and deformities from peripheral nerve damage. This mostly occurs if diagnosis and treatment is delayed and contributes to continued transmission within the community. Champa district of Chhattisgarh state in India is an endemic area with the highest national annual case detection and disability rates for leprosy. The Replicability Model is a system strengthening intervention implemented by the Leprosy Mission Trust India in Champa that aims to promote early diagnosis and treatment of leprosy, improve on-going management of the effects of leprosy and improve welfare for the people affected by leprosy. This protocol presents a plan to describe the overall implementation of the Replicability Model and describe the barriers and facilitators encountered in the process. We will also quantify the effect of the program on one of its key aims- early leprosy diagnosis. METHODS The replicability model will be implemented over four years, and the work described in this protocol will be conducted in the same timeframe. We have two Work Packages (WPs). In WP1, we will conduct a process evaluation. This will include three methods i) observations of replicability model implementation teams' monthly meetings ii) key informant interviews (n = 10) and interviews with stakeholders (n = 30) iii) observations of key actors (n = 15). Our purpose is to describe the implementation process and identify barriers and facilitators to successful implementation. WP2 will be a quantitative study to track existing and new cases of leprosy using routinely collected data. If the intervention is successful, we expect to see an increase in cases (with a higher proportion detected at an early clinical stage) followed by a decrease in total cases. CONCLUSION This study will enable us to improve and disseminate the Replicability Model by identifying factors that promote success. It will also identify its effectiveness in fulfilling one of its aims: reducing the incidence of leprosy by finding and tracking cases at an earlier stage in the disease.
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Affiliation(s)
| | | | - Onaedo Ilozumba
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Sopna Choudhury
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | | | - Frances Griffiths
- Warwick Medical School, A-155, University of Warwick, Coventry, United Kingdom
| | - Samuel Watson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Jo Sartori
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Richard Lilford
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Zharima C, Griffiths F, Goudge J. Exploring the barriers and facilitators to implementing electronic health records in a middle-income country: a qualitative study from South Africa. Front Digit Health 2023; 5:1207602. [PMID: 37600481 PMCID: PMC10437058 DOI: 10.3389/fdgth.2023.1207602] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/06/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction As more countries are moving towards universal health care, middle-income countries in particular are trying to expand coverage, often using public funds. Electronic health records (EHR) are useful in monitoring patient outcomes, the performance of providers, and so the use of those public funds. With the multiple institutions or departments responsible for providing care to any individual, rather than a single record, an EHR is the interface through which to view data from a digital health information eco-system that draws on data from many different sources. South Africa plans to establish a National Health Insurance fund where EHRs will be essential for monitoring outcomes, and informing purchasing decisions. Despite various relevant policies and South Africa's relative wealth and digital capability, progress has been slow. In this paper, we explore the barriers and facilitators to implementing electronic health records in South Africa. Methods In this qualitative study, we conducted in-depth interviews with participants including academics, staff at parastatals, managers in the private health sector, NGO managers and government staff at various levels. Results The Western Cape provincial government over a 20-year period has managed to develop a digital health information ecosystem by drawing together existing data systems and building new systems. However, despite having the necessary policies in place and a number of stand-alone population level digital health information systems, several barriers still stand in the way of building national electronic health records and an efficient digital health ecosystem. These include a lack of national leadership and conflict, a failure to understand the scope of the task required to achieve scale up, insufficient numbers of technically skilled staff, failure to use the tender system to generate positive outcomes, and insufficient investment towards infrastructural needs such as hardware, software and connectivity. Conclusion For South Africa to have an effective electronic health record, it is important to start by overcoming the barriers to interoperability, and to develop the necessary underlying digital health ecosystem. Like the Western Cape, provincial governments need to integrate and build on existing systems as their next steps forward.
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Affiliation(s)
- Campion Zharima
- Centre for Health Policy, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Frances Griffiths
- Centre for Health Policy, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Medical School, University of Warwick, Warwick, United Kingdom
| | - Jane Goudge
- Centre for Health Policy, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Choudhury S, Ilozumba O, Darlong J, Govindasamy K, Tsaku PA, Udo S, Shrestha D, Napit IB, Ugwu L, Meka A, Sartori J, Griffiths F, Lilford RJ. Investigating the sustainability of self-help programmes in the context of leprosy and the work of leprosy missions in Nigeria, Nepal and India: a qualitative study protocol. BMJ Open 2023; 13:e070604. [PMID: 37192811 DOI: 10.1136/bmjopen-2022-070604] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Leprosy occurs among very poor people who may be stigmatised and pushed further to the margins of society. Programmes to improve social integration and stimulate economic development have been implemented to help break the vicious cycle of poverty, reduced quality of life and ulcer recurrence. These involve forming groups of people, with a common concern, to provide mutual support and form saving syndicates-hence the term 'self-help groups' (SHGs). While there is literature on the existence and effectiveness of SHGs during the funded periods, little is known about their sustainability. We aim to explore the extent to which SHG programme activities have continued beyond the funding period and record evidence of sustained benefits. METHODS AND ANALYSIS In India, Nepal and Nigeria, we identified programmes funded by international non-governmental organisations, primarily aimed at people affected by leprosy. In each case, financial and technical support was allocated for a predetermined period (up to 5 years).We will review documents, including project reports and meeting minutes, and conduct semistructured interviews with people involved in delivery of the SHG programme, potential beneficiaries and people in the wider environment who may have been familiar with the programme. These interviews will gauge participant and community perceptions of the programmes and barriers and facilitators to sustainability. Data will be analysed thematically and compared across four study sites. ETHICS AND DISSEMINATION Approval was obtained from the University of Birmingham Biomedical and Scientific Research Ethics Committee. Local approval was obtained from: The Leprosy Mission Trust India Ethics Committee; Federal Capital Territory Health Research Ethics Committee in Nigeria and the Health Research Ethics Committee of Niger State Ministry of Health; University of Nigeria Teaching Hospital and the Nepal Health and Research Council. Results will be disseminated via peer-reviewed journals, conference presentations and community engagement events through the leprosy missions.
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Affiliation(s)
- Sopna Choudhury
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Onaedo Ilozumba
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | | | | | - Sunday Udo
- The Leprosy Mission Nigeria, Abuja, Nigeria
| | | | - Indra B Napit
- The Leprosy Mission Nepal, Lalitpur, Kathmandu, Nepal
| | - Linda Ugwu
- The German Leprosy and Tuberculosis Relief Association, Enugu, Nigeria
| | - Anthony Meka
- The German Leprosy and Tuberculosis Relief Association, Enugu, Nigeria
| | - Jo Sartori
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, UK
- University of the Witwatersrand, Johannesburg, South Africa
| | - Richard J Lilford
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Onuegbu C, Harlock J, Griffiths F. Use, characteristics and influence of lay consultation networks on treatment-seeking decisions in slums of Nigeria: a cross-sectional survey. BMJ Open 2023; 13:e065152. [PMID: 37192804 DOI: 10.1136/bmjopen-2022-065152] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES To describe the use, characteristics and influence of lay consultants on treatment-seeking decisions of adults in slums of Nigeria. DESIGN Cross-sectional survey using a pre-piloted questionnaire. SETTINGS Two slum communities in Ibadan city, Nigeria. PARTICIPANTS 480 adults within the working age group (18-64). RESULTS Most respondents (400/480, 83.7%) spoke to at least one lay consultant during their last illness/health concern. In total, 683 lay consultants were contacted; all from personal networks such as family and friends. No respondent listed online network members or platforms. About nine in 10 persons spoke to a lay consultant about an illness/health concern without intending to seek any particular support. However, almost all (680/683, 97%) lay consultants who were contacted provided some form of support. Marital status (OR=1.92, 95% CI: 1.10 to 3.33) and perceiving that an illness or health concern had some effects on their daily activities (OR=3.25, 95% CI: 1.94 to 5.46) had a significant independent association with speaking to at least one lay consultant. Age had a significant independent association with having lay consultation networks comprising non-family members only (OR=0.95, 95% CI: 0.92 to 0.99) or mixed networks (family and non-family members) (OR=0.97, 95% CI: 0.95 to 0.99), rather than family-only networks. Network characteristics influenced individual treatment decisions as participants who contacted networks comprising non-family members only (OR=0.23, 95% CI: 0.08 to 0.67) and dispersed networks (combination of household, neighbourhood and distant network members) (OR=2.04, 95% CI: 1.02 to 4.09) were significantly more likely to use informal than formal healthcare, while controlling for individual characteristics. CONCLUSIONS Health programmes in urban slums should consider engaging community members so, when consulted within their networks, they are able to deliver reliable information about health and treatment-seeking.
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Affiliation(s)
- Chinwe Onuegbu
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jenny Harlock
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
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Ross JDC, Brittain C, Anstey Watkins J, Kai J, David M, Ozolins M, Jackson L, Abdali Z, Hepburn TM, Griffiths F, Montgomery A, Daniels J, Manley A, Dean G, Armstrong-Buisseret LK. Intravaginal lactic acid gel versus oral metronidazole for treating women with recurrent bacterial vaginosis: the VITA randomised controlled trial. BMC Womens Health 2023; 23:241. [PMID: 37161454 PMCID: PMC10169495 DOI: 10.1186/s12905-023-02303-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 03/21/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Bacterial vaginosis is a common and distressing condition for women. Short-term antibiotic treatment is usually clinically effective, but recurrence is common. We assessed the effectiveness of intravaginal lactic acid gel versus oral metronidazole for treating recurrent bacterial vaginosis. METHODS We undertook an open-label, multicentre, parallel group, randomised controlled trial in nineteen UK sexual health clinics and a university health centre. Women aged ≥ 16 years, with current bacterial vaginosis symptoms and a preceding history of bacterial vaginosis, were randomised in a 1:1 ratio using a web-based minimisation algorithm, to 400 mg twice daily oral metronidazole tablets or 5 ml once daily intravaginal lactic acid gel, for 7 days. Masking of participants was not possible. The primary outcome was participant-reported resolution of symptoms within 2 weeks. Secondary outcomes included time to first recurrence of symptoms, number of recurrences and repeat treatments over 6 months and side effects. RESULTS Five hundred and eighteen participants were randomised before the trial was advised to stop recruiting by the Data Monitoring Committee. Primary outcome data were available for 79% (204/259) allocated to metronidazole and 79% (205/259) allocated to lactic acid gel. Resolution of bacterial vaginosis symptoms within 2 weeks was reported in 70% (143/204) receiving metronidazole versus 47% (97/205) receiving lactic acid gel (adjusted risk difference -23·2%; 95% confidence interval -32.3 to -14·0%). In those participants who had initial resolution and for whom 6 month data were available, 51 of 72 (71%) women in the metronidazole group and 32 of 46 women (70%) in the lactic acid gel group had recurrence of symptoms, with median times to first recurrence of 92 and 126 days, respectively. Reported side effects were more common following metronidazole than lactic acid gel (nausea 32% vs. 8%; taste changes 18% vs. 1%; diarrhoea 20% vs. 6%, respectively). CONCLUSIONS Metronidazole was more effective than lactic acid gel for short-term resolution of bacterial vaginosis symptoms, but recurrence is common following both treatments. Lactic acid gel was associated with fewer reported side effects. TRIAL REGISTRATION ISRCTN14161293 , prospectively registered on 18th September 2017.
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Affiliation(s)
- Jonathan D C Ross
- Department of GU Medicine, University Hospitals Birmingham NHS Foundation Trust, Whittall Street Clinic, Whittall Street, Birmingham, B4 6DH, UK
| | - Clare Brittain
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Jocelyn Anstey Watkins
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Joe Kai
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, University Park, NG7 2RD, UK
| | - Miruna David
- Clinical Microbiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - Mara Ozolins
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Louise Jackson
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Zainab Abdali
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Trish M Hepburn
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
- Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Jane Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Alice Manley
- Department of GU Medicine, University Hospitals Birmingham NHS Foundation Trust, Whittall Street Clinic, Whittall Street, Birmingham, B4 6DH, UK
| | - Gillian Dean
- Elton John Research Centre, Sussex House, 1 Abbey Road, Brighton, BN2 1ES, UK
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Goudge J, Babalola O, Malatji H, Levin J, Thorogood M, Griffiths F. The effect of a roving nurse mentor on household coverage and quality of care provided by community health worker teams in South Africa: a longitudinal study with a before, after and 6 months post design. BMC Health Serv Res 2023; 23:186. [PMID: 36814259 PMCID: PMC9948528 DOI: 10.1186/s12913-023-09093-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE Community health workers (CHW) are undertaking more complex tasks as part of the move towards universal health coverage in many low- and middle-income settings. They are expected to provide promotive and preventative care, make referrals to the local clinic, and follow up on non-attendees for a range of health conditions. CHW programmes can improve access to care for vulnerable communities, but many such programmes struggle due to inadequate supervision, low levels of CHW literacy, and the marginalized status of CHW in the health system. In this paper, we assess the effect of a roving nurse mentor on the coverage and quality of care of the CHW service in two vulnerable communities in South Africa. PARTICIPANTS CHW, their supervisors, household members. INTERVENTION Roving professional nurse mentor to build skills of supervisors and CHW teams. METHODS Three household surveys to assess household coverage of the CHW service (baseline, end of the intervention, and 6 months after end of intervention); structured observations of CHW working in households to assess quality of care. RESULTS The intervention led to a sustained 50% increase in the number of households visited by a CHW in the last year. While the proportion of appropriate health messages given to household members by CHW remained constant at approximately 50%, CHW performed a greater range of more complex tasks. They were more likely to visit new households to assess health needs and register the household in the programme, to provide care to pregnant women, children and people who had withdrawn from care. CHW were more likely to discuss with clients the barriers they were facing in accessing care and take notes during a visit. CONCLUSION A nurse mentor can have a significant effect both on the quantity and quality of CHW work, allowing them to achieve their potential despite their marginalised status in the health system and their limited prior educational achievement. Supportive supervision is important in enabling the benefit of having a health cadre embedded in marginalised communities to be realised.
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Affiliation(s)
- Jane Goudge
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Olukemi Babalola
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hlologelo Malatji
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Levin
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Margaret Thorogood
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Warwick Medical School, Warwick University, Coventry, UK
| | - Frances Griffiths
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Warwick Medical School, Warwick University, Coventry, UK
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Malatji H, Griffiths F, Goudge J. Community-orientated primary health care: Exploring the interface between community health worker programmes, the health system and communities in South Africa. PLOS Glob Public Health 2023; 3:e0000881. [PMID: 36962793 PMCID: PMC10021906 DOI: 10.1371/journal.pgph.0000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023]
Abstract
Due to insufficient number of health workers and the evidence of the benefits of community health workers (CHWs), CHWs are being deployed to provide health care services to under-served communities. In this article, we explore to what extent the South African CHW programmes introduced between 2009 and 2011 are attuned to community needs, integrated into the healthcare system and community structures, and also implemented in accordance with community-orientated primary health care principles. Using a case study approach, we studied CHW teams in seven primary healthcare facilities located in semi-urban and rural areas of Gauteng and Mpumalanga provinces, South Africa. We collected data using in-depth interviews involving facility managers, CHW supervisors, community representatives and key informants, and focus groups and observations of CHWs. The implementation of community-orientated health interventions remains complex. In the different sites, there were efforts to integrate the views of stakeholders (e.g., political leaders) into the implementation of the CHW programmes. However, many residents were more concerned about access to housing than health services. The CHWs services' were found to be generally comprehensive, however inefficient training, supervision and mentorship limited their effectiveness. The multidisciplinary approach to care, as introduced by some sites, helped enhance the knowledge and skills of some of the CHWs on complex health topics. The roll out of community orientated primary health care services is crucial in a resource-constrained setting like South Africa. However, significant socio-economic issues disrupt community involvement and the effective provision of services. Governments need to provide sufficient funds for training, supervision, supplies and remuneration to help overcome these barriers.
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Affiliation(s)
- Hlologelo Malatji
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frances Griffiths
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ignatowicz A, Slowther AM, Bassford C, Griffiths F, Johnson S, Rees K. Evaluating interventions to improve ethical decision making in clinical practice: a review of the literature and reflections on the challenges posed. J Med Ethics 2023; 49:136-142. [PMID: 35241628 DOI: 10.1136/medethics-2021-107966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
Since the 1980s, there has been an increasing acknowledgement of the importance of recognising the ethical dimension of clinical decision-making. Medical professional regulatory authorities in some countries now include ethical knowledge and practice in their required competencies for undergraduate and post graduate medical training. Educational interventions and clinical ethics support services have been developed to support and improve ethical decision making in clinical practice, but research evaluating the effectiveness of these interventions has been limited. We undertook a systematic review of the published literature on measures or models of evaluation used to assess the impact of interventions to improve ethical decision making in clinical care. We identified a range of measures to evaluate educational interventions, and one tool used to evaluate a clinical ethics support intervention. Most measures did not evaluate the key impact of interest, that is the quality of ethical decision making in real-world clinical practice. We describe the results of our review and reflect on the challenges of assessing ethical decision making in clinical practice that face both developers of educational and support interventions and the regulatory organisations that set and assess competency standards.
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Affiliation(s)
| | | | - Christopher Bassford
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- University of Warwick, Warwick Medical School, Coventry, UK
| | | | | | - Karen Rees
- University of Warwick, Warwick Medical School, Coventry, UK
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Underwood M, Achana F, Carnes D, Eldridge S, Ellard DR, Griffiths F, Haywood K, Hee SW, Higgins H, Mistry D, Mistry H, Newton S, Nichols V, Norman C, Padfield E, Patel S, Petrou S, Pincus T, Potter R, Sandhu H, Stewart K, Taylor SJC, Matharu MS. A Supportive Self-Management Program for People With Chronic Headaches and Migraine: A Randomized Controlled Trial and Economic Evaluation. Neurology 2022; 100:e1339-e1352. [PMID: 36526428 PMCID: PMC10065208 DOI: 10.1212/wnl.0000000000201518] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 09/20/2022] [Indexed: 12/23/2022] Open
Abstract
Background and Objectives:Chronic headache disorders are a major cause of pain and disability. Education and supportive self-management approaches could reduce burden of headache disability. We tested the effectiveness of a group educational and supportive self-management programme for people living with chronic headaches.Methods:A pragmatic randomised controlled trial. Participants were aged ≥18 years with chronic migraine or chronic tension type headache, with or without medication overuse headache.We primarily recruited from general practices. Participants were assigned to either a two-day group education and self-management programme, a one-to-one nurse interview, and telephone support or to usual care plus relaxation material.The primary outcome was headache related quality of life using the Headache Impact Test (HIT-6) at 12 months. The primary analysis used intention-to-treat principles for participants with migraine and both baseline and 12-month HIT-6 data.Results:Between April 2017 and March 2019, we randomised 736 participants. Since only nine participants just had tension type headache our main analyses were on the 727 participants with migraine. Of these 376 were allocated to the self-management intervention 351 to usual care. Data from 586 (81%) participants were analysed for primary outcome. There was no between group difference in HIT-6, (adjusted mean difference = -0·3, 95% CI -1·23 to 0·67), or headache days (0·9, 95% CI -0·29, 2·05), at 12 months. The CHESS intervention generated incremental adjusted costs of £268 (95% CI,£176 to £377) [USD383 (95%CI USD252 to USD539)] and incremental adjusted quality-adjusted life years (QALYs) of 0.031 (95% CI -0.005 to .063). The incremental cost-effectiveness ratio was £8,617 (USD12,322) per QALY gained.Discussion:These findings conclusively show a lack of benefit for quality of life or monthly headache days from a brief group education and supportive self-management programme for people living with chronic migraine or chronic tension type headache with episodic migraine.Registered on the International Standard Randomized Controlled Trial Number registry,ISRCTN7970810016th December 2015https://doi.org/10.1186/ISRCTN79708100The first enrolment was 24th April 2017.Classification of evidence:This study provides Class III evidence that a brief group education and self-management program does not increase the probability of improvement in headache related quality of life in people with chronic migraine.
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Affiliation(s)
- Martin Underwood
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
| | - Felix Achana
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Dawn Carnes
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Sandra Eldridge
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - David R Ellard
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Frances Griffiths
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Kirstie Haywood
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Siew Wan Hee
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Helen Higgins
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Dipesh Mistry
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Hema Mistry
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Sian Newton
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Vivien Nichols
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Chloe Norman
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Emma Padfield
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Shilpa Patel
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Stavros Petrou
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Tamar Pincus
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Rachel Potter
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Harbinder Sandhu
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Kimberley Stewart
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Stephanie J C Taylor
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Manjit S Matharu
- From the Warwick Clinical Trials Unit (M.U., F.A., D.E., H.H., D.M., H.M., V.N., C.N., E.P., S.P., R.P., H.S., K.S.), and Division of Health Sciences (F.G., K.H., S.W.H.), Warwick Medical School University of Warwick, Coventry; University Hospitals Coventry and Warwickshire (M.U., D.E., H.M.), Coventry; University College of Osteopathy (D.C.), London; Wolfson Institute of Population Health (S.E., S.N., S.J.C.T.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Nuffield Department of Primary Care Health Sciences (S.P.), University of Oxford; Department of Psychology (T.P.), Royal Holloway University of London; and Headache Group Institute of Neurology (M.S.M.) and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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Sanchez-Santos MT, Williamson E, Nicolson PJA, Bruce J, Collins GS, Mallen CD, Griffiths F, Garret A, Morris A, Slark M, Lamb SE. Development and validation of a prediction model for self-reported mobility decline in community-dwelling older adults. J Clin Epidemiol 2022; 152:70-79. [PMID: 36108957 DOI: 10.1016/j.jclinepi.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/26/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The aim of this study is to develop and validate two models to predict 2-year risk of self-reported mobility decline among community-dwelling older adults. STUDY DESIGN AND SETTING We used data from a prospective cohort study of people aged 65 years and over in England. Mobility status was assessed using the EQ-5D-5L mobility question. The models were based on the outcome: Model 1, any mobility decline at 2 years; Model 2, new onset of persistent mobility problems over 2 years. Least absolute shrinkage and selection operator logistic regression was used to select predictors. Model performance was assessed using C-statistics, calibration plot, Brier scores, and decision curve analyses. Models were internally validated using bootstrapping. RESULTS Over 18% of participants who could walk reported mobility decline at year 2 (Model 1), and 7.1% with no mobility problems at baseline, reported new onset of mobility problems after 2 years (Model 2). Thirteen and 6 out of 31 variables were selected as predictors in Models 1 and 2, respectively. Models 1 and 2 had a C-statistic of 0.740 and 0.765 (optimism < 0.013), and Brier score = 0.136 and 0.069, respectively. CONCLUSION Two prediction models for mobility decline were developed and internally validated. They are based on self-reported variables and could serve as simple assessments in primary care after external validation.
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Affiliation(s)
- Maria T Sanchez-Santos
- Centre for Rehabilitation Research, Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Esther Williamson
- Centre for Rehabilitation Research, Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, UK; College of Medicine and Health, University of Exeter, UK
| | - Philippa J A Nicolson
- Centre for Rehabilitation Research, Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Angela Garret
- Centre for Rehabilitation Research, Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alana Morris
- Centre for Rehabilitation Research, Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mandy Slark
- Centre for Rehabilitation Research, Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, UK
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Griffiths F, Srikesavan C, Ward L, Boniface G, Williamson E, Lamb SE. Longitudinal qualitative study of living with neurogenic claudication. BMJ Open 2022; 12:e060128. [PMID: 36104131 PMCID: PMC9476140 DOI: 10.1136/bmjopen-2021-060128] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Neurogenic claudication (NC) causes pain and reduced mobility, particularly in older people, and can negatively affect mental and social well-being, so limiting successful ageing. This qualitative study explored how people with NC changed over 12 months. DESIGN A longitudinal qualitative study using semi-structured interviews. SETTING Participants were recruited from a UK clinical trial of a physiotherapy intervention for NC. PARTICIPANTS Interviews were undertaken at baseline, 1 month after receiving any intervention and at 12 months. We analysed 30 sets of three interviews. RESULTS Interview data were summarised for each time point into biopsychosocial domains: pain, mobility and activities of daily living, psychological impact, and social and recreational participation. Through comparative analysis we explored participant trajectories over time.Progressive improvement in at least one domain was experienced by 13 participants, but there was variability in trajectories with early improvements that remained the same, transient changes and no change also commonly observed.Eleven participants described co-present improvement trajectories in all domains. Three participants described co-present improvement in all domains except participation; one had never stopped their participation and two had unattainable expectations. Five participants described co-present improvement in one domain and deterioration in another and 14 participants described co-present no change in one domain and change in another.There was evidence of interaction between domains; for example, improved mobility led to improved participation and for some participants, specific factors influenced change. Of the 15 participants who experienced improved participation, 10 reported improvements in all other domains and five participants did not; for two, pain did not prevent participation, one used a walking aid and two had a positive psychological outlook. CONCLUSION The daily lived experiences of older adults with NC are variable and include interaction between biopsychosocial domains. Therapist understanding of these trajectories and their interactions may help to provide personalised therapy TRIAL REGISTRATION NUMBER: ISRCTN12698674.
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Affiliation(s)
- Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Cynthia Srikesavan
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Lesley Ward
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Graham Boniface
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Esther Williamson
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
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Summers C, Griffiths F, Cave J, Panesar A. Understanding the Security and Privacy Concerns About the Use of Identifiable Health Data in the Context of the COVID-19 Pandemic: Survey Study of Public Attitudes Toward COVID-19 and Data-Sharing. JMIR Form Res 2022; 6:e29337. [PMID: 35609306 PMCID: PMC9273043 DOI: 10.2196/29337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/10/2022] [Accepted: 05/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background The COVID-19 pandemic increased the availability and use of population and individual health data to optimize tracking and analysis of the spread of the virus. Many health care services have had to rapidly digitalize in order to maintain the continuity of care provision. Data collection and dissemination have provided critical support for defending against the spread of the virus since the beginning of the pandemic; however, little is known about public perceptions of and attitudes toward the use, privacy, and security of data. Objective The goal of this study is to better understand people’s willingness to share data in the context of the COVID-19 pandemic. Methods A web-based survey was conducted on individuals’ use of and attitudes toward health data for individuals aged 18 years and older, and in particular, with a reported diagnosis of a chronic health condition placing them at the highest risk of severe COVID-19. Results In total, 4764 individuals responded to this web-based survey, of whom 4674 (98.1%) reported a medical diagnosis of at least 1 health condition (3 per person on average), with type 2 diabetes (n=2974, 62.7%), hypertension (n=2147, 45.2%), and type 1 diabetes (n=1299, 27.4%) being most prominent in our sample. In general, more people are comfortable with sharing anonymized data than personally identifiable data. People reported feeling comfortable sharing data that were able to benefit others; 66% (3121 respondents) would share personal identifiable data if its primary purpose was deemed beneficial for the health of others. Almost two-thirds (n=3026; 63.9%) would consent to sharing personal, sensitive health data with government or health authority organizations. Conversely, over a quarter of respondents (n=1297, 27.8%) stated that they did not trust any organization to protect their data, and 54% (n=2528) of them reported concerns about the implications of sharing personal information. Almost two-thirds (n=3054, 65%) of respondents were concerned about the provisions of appropriate legislation that seeks to prevent data misuse and hold organizations accountable in the case of data misuse. Conclusions Although our survey focused mainly on the views of those living with chronic health conditions, the results indicate that data sensitivity is highly contextual. More people are more comfortable with sharing anonymized data rather than personally identifiable data. Willingness to share data also depended on the receiving body, highlighting trust as a key theme, in particular who may have access to shared personal health data and how they may be used in the future. The nascency of legal guidance in this area suggests a need for humanitarian guidelines for data responsibility during disaster relief operations such as pandemics and for involving the public in their development.
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Affiliation(s)
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jonathan Cave
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Department of Economics, University of Warwick, Coventry, United Kingdom
- Data Ethics Group, The Alan Turing Institute, London, United Kingdom
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22
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Downie A, Mashanya T, Chipwaza B, Griffiths F, Harris B, Kalolo A, Ndegese S, Sturt J, De Valliere N, Pemba S. Remote Consulting in Primary Health Care in Low- and Middle-Income Countries: Feasibility Study of an Online Training Program to Support Care Delivery During the COVID-19 Pandemic. JMIR Form Res 2022; 6:e32964. [PMID: 35507772 PMCID: PMC9200055 DOI: 10.2196/32964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/23/2021] [Revised: 03/04/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care. Objective As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic. Methods We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania’s rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick's model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation. Results Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97%) completed the cascaded training. Of the 10 (83%) tier 1 trainees who completed the survey, 9 (90%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care. Conclusions The REaCH training program is feasible, acceptable, and effective in changing trainees’ behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings.
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Affiliation(s)
- Andrew Downie
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Titus Mashanya
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
| | - Beatrice Chipwaza
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Bronwyn Harris
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Albino Kalolo
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
| | - Sylvester Ndegese
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Nicole De Valliere
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | - Senga Pemba
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
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23
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Abstract
OBJECTIVES To systematically review interventions that include an element of menstrual education delivered to young adolescent girls. DESIGN This was a systematic review and meta-analysis. Selected articles were quality assessed using the Mixed Methods Appraisal Tool quality appraisal checklist. A meta-analysis was conducted on a subset of articles, and the effect size of the intervention was calculated using Cohen's d. A logic model was constructed to frame the effect of menstrual education interventions on menstrual health. SETTING Papers reporting on interventions in high-income and low-income and middle-income countries were sought. INFORMATION SOURCES Seven electronic databases were searched for English-language entries that were published between January 2014 and May 2020. PARTICIPANTS The interventions were aimed at younger adolescent girls aged 10-14 years old. INTERVENTIONS The interventions were designed to improve the menstrual health of the recipients, by addressing one or more elements of menstrual knowledge, attitude or practices (KAP). ELIGIBILITY CRITERIA Interventions that had not been evaluated were excluded. PRIMARY AND SECONDARY OUTCOMES The most common type of output was a difference in knowledge or skill score ascertained from a pre and post test. Some studies measured additional outcomes, such as attitude or confidence. RESULTS Twenty-four eligible studies were identified. The number of participants varied from 1 to 2564. All studies reported improvements in menstrual KAP. The meta-analysis indicates that larger effect sizes were attained by those that encouraged discussion than those that distributed pamphlets. CONCLUSIONS Education interventions are effective in increasing the menstrual knowledge of young adolescent girls and skills training improves competency to manage menstruation more hygienically and comfortably. Interactive interventions are more motivating than didactic or written. Sharing concerns gives girls confidence and helps them to gain agency on the path to menstrual health. TRIAL REGISTRATION NUMBER For this review, a protocol was not prepared or registered.
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Affiliation(s)
- Rebecca Lane Evans
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Bronwyn Harris
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Chinwe Onuegbu
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Babalola O, Goudge J, Levin J, Brown C, Griffiths F. Assessing the Utility of a Quality-of-Care Assessment Tool Used in Assessing Comprehensive Care Services Provided by Community Health Workers in South Africa. Front Public Health 2022; 10:868252. [PMID: 35651863 PMCID: PMC9149253 DOI: 10.3389/fpubh.2022.868252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/04/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Few studies exist on the tools for assessing quality-of-care of community health worker (CHW) who provide comprehensive care, and for available tools, evidence on the utility is scanty. We aimed to assess the utility components of a previously-reported quality-of-care assessment tool developed for summative assessment in South Africa. Methods In two provinces, we used ratings by 21 CHWs and three team leaders in two primary health care facilities per province regarding whether the tool covered everything that happens during their household visits and whether they were happy to be assessed using the tool (acceptability and face validity), to derive agreement index (≥85%, otherwise the tool had to be revised). A panel of six experts quantitatively validated 11 items of the tool (content validity). Content validity index (CVI), of individual items (I-CVI) or entire scale (S-CVI), should be >80% (excellent). For the inter-rater reliability (IRR), we determined agreement between paired observers' assigned quality-of-care messages and communication scores during 18 CHW household visits (nine households per site). Bland and Altman plots and multilevel model analysis, for clustered data, were used to assess IRR. Results In all four CHW and team leader sites, agreement index was ≥85%, except for whether they were happy to be assessed using the tool, where it was <85% in one facility. The I-CVI of the 11 items in the tool ranged between 0.83 and 1.00. For the S-CVI, all six experts agreed on relevancy (universal agreement) in eight of 11 items (0.72) whereas the average of I-CVIs, was 0.95. The Bland-Altman plot limit of agreements between paired observes were −0.18 to 0.44 and −0.30 to 0.44 (messages score); and −0.22 to 0.45 and −0.28 to 0.40 (communication score). Multilevel modeling revealed an estimated reliability of 0.77 (messages score) and 0.14 (communication score). Conclusion The quality-of-care assessment tool has a high face and content validity. IRR was substantial for quality-of-care messages but not for communication score. This suggests that the tool may only be useful in the formative assessment of CHWs. Such assessment can provide the basis for reflection and discussion on CHW performance and lead to change.
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Affiliation(s)
- Olukemi Babalola
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Goudge
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Levin
- Department of Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Celia Brown
- Division of Health Sciences, University of Warwick, Warwick Medical School, Coventry, United Kingdom
| | - Frances Griffiths
- Division of Health Sciences, University of Warwick, Warwick Medical School, Coventry, United Kingdom
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25
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Eli K, Huxley CJ, Hawkes CA, Perkins GD, Slowther AM, Griffiths F. Why are some ReSPECT conversations left incomplete? A qualitative case study analysis. Resusc Plus 2022; 10:100255. [PMID: 35734306 PMCID: PMC9207560 DOI: 10.1016/j.resplu.2022.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/10/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background As an emergency care and treatment planning process (ECTP), a key feature of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is the engagement of patients and/or their representatives in conversations about treatment options including, but not limited to, cardiopulmonary resuscitation (CPR). However, qualitative research suggests that some ReSPECT conversations lead to partial or no decision-making about treatment recommendations. This paper explores why some ReSPECT conversations are left incomplete. Methods Drawing on observation and interview data collected in four National Health Service (NHS) hospital sites in England, this paper offers an in-depth exploration of six case studies in which ReSPECT conversations were incomplete. Using thematic analysis, we triangulate fieldnote data documenting these conversations with interview data in which the doctors who conducted these conversations shared their perceptions and reflected on their decision-making processes. Results We identified two themes, both focused on ‘mismatch’: (1) Mismatch between the doctor’s clinical priorities and the patient’s/family’s immediate needs; and (2) mismatch between the doctor’s conversation scripts, which included patient autonomy, the feasibility of CPR, and what medicine can and should do to prolong a patient’s life, and the patient’s/family’s understandings of these concepts. Conclusions This case study analysis of six ReSPECT conversations found that mismatch between doctors’ priorities and understandings and those of patients and/or their relatives led to incomplete ReSPECT conversations. Future research should explore methods to overcome these mismatches.
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Affiliation(s)
- Karin Eli
- Warwick Medical School, University of Warwick, UK
- Corresponding authors at: Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry CV4 7AL, UK.
| | | | | | - Gavin D. Perkins
- Warwick Medical School, University of Warwick, UK
- University Hospitals Birmingham NHS Foundation Trust, UK
| | | | - Frances Griffiths
- Warwick Medical School, University of Warwick, UK
- Corresponding authors at: Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry CV4 7AL, UK.
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Park JE, Kibe P, Yeboah G, Oyebode O, Harris B, Ajisola MM, Griffiths F, Aujla N, Gill P, Lilford RJ, Chen YF. Factors associated with accessing and utilisation of healthcare and provision of health services for residents of slums in low and middle-income countries: a scoping review of recent literature. BMJ Open 2022; 12:e055415. [PMID: 35613790 PMCID: PMC9125718 DOI: 10.1136/bmjopen-2021-055415] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To identify factors associated with accessing and utilisation of healthcare and provision of health services in slums. DESIGN A scoping review incorporating a conceptual framework for configuring reported factors. DATA SOURCES MEDLINE, Embase, CINAHL, Web of Science and the Cochrane Library were searched from their inception to December 2021 using slum-related terms. ELIGIBILITY CRITERIA Empirical studies of all designs reporting relevant factors in slums in low and middle-income countries. DATA EXTRACTION AND SYNTHESIS Studies were categorised and data were charted according to a preliminary conceptual framework refined by emerging findings. Results were tabulated and narratively summarised. RESULTS Of the 15 469 records retrieved from all years, 4368 records dated between 2016 and 2021 were screened by two independent reviewers and 111 studies were included. The majority (63 studies, 57%) were conducted in Asia, predominantly in India. In total, 104 studies examined healthcare access and utilisation from slum residents' perspective while only 10 studies explored provision of health services from providers/planners' perspective (three studies included both). A multitude of factors are associated with accessing, using and providing healthcare in slums, including recent migration to slums; knowledge, perception and past experience of illness, healthcare needs and health services; financial constraint and competing priorities between health and making a living; lacking social support; unfavourable physical environment and locality; sociocultural expectations and stigma; lack of official recognition; and existing problems in the health system. CONCLUSION The scoping review identified a significant body of recent literature reporting factors associated with accessing, utilisation and provision of healthcare services in slums. We classified the diverse factors under seven broad categories. The findings can inform a holistic approach to improving health services in slums by tackling barriers at different levels, taking into account local context and geospatial features of individual slums. SYSTEMATIC REVIEW REGISTRATION NUMBER: https://osf.io/694t2.
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Affiliation(s)
- Ji-Eun Park
- Warwick Medical School, University of Warwick, Coventry, UK
- KM Data Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Peter Kibe
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
| | - Godwin Yeboah
- Information and Digital Group, University of Warwick, Coventry, UK
| | | | - Bronwyn Harris
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Navneet Aujla
- Warwick Medical School, University of Warwick, Coventry, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- Warwick Medical School, University of Warwick, Coventry, UK
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27
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Walsh J, Dwumfour C, Cave J, Griffiths F. Spontaneously generated online patient experience data - how and why is it being used in health research: an umbrella scoping review. BMC Med Res Methodol 2022; 22:139. [PMID: 35562661 PMCID: PMC9106384 DOI: 10.1186/s12874-022-01610-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Social media has led to fundamental changes in the way that people look for and share health related information. There is increasing interest in using this spontaneously generated patient experience data as a data source for health research. The aim was to summarise the state of the art regarding how and why SGOPE data has been used in health research. We determined the sites and platforms used as data sources, the purposes of the studies, the tools and methods being used, and any identified research gaps. METHODS A scoping umbrella review was conducted looking at review papers from 2015 to Jan 2021 that studied the use of SGOPE data for health research. Using keyword searches we identified 1759 papers from which we included 58 relevant studies in our review. RESULTS Data was used from many individual general or health specific platforms, although Twitter was the most widely used data source. The most frequent purposes were surveillance based, tracking infectious disease, adverse event identification and mental health triaging. Despite the developments in machine learning the reviews included lots of small qualitative studies. Most NLP used supervised methods for sentiment analysis and classification. Very early days, methods need development. Methods not being explained. Disciplinary differences - accuracy tweaks vs application. There is little evidence of any work that either compares the results in both methods on the same data set or brings the ideas together. CONCLUSION Tools, methods, and techniques are still at an early stage of development, but strong consensus exists that this data source will become very important to patient centred health research.
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Affiliation(s)
- Julia Walsh
- Warwick Medical School, University of Warwick, Coventry, UK.
| | | | - Jonathan Cave
- Department of Economics, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, UK.,Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
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28
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Malatji H, Griffiths F, Goudge J. Supportive supervision from a roving nurse mentor in a community health worker programme: a process evaluation in South Africa. BMC Health Serv Res 2022; 22:323. [PMID: 35272666 PMCID: PMC8908295 DOI: 10.1186/s12913-022-07635-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many low and middle- income countries (LMICs) are repositioning community health worker (CHW) programmes to provide a more comprehensive range of promotive and preventive services and referrals to the formal health service. However, insufficient supervision, fragmented programmes, and the low literacy levels of CHWs often result in the under-performance of the programmes. We evaluate the impact of a roving nurse mentor working with CHW teams proving supportive supervision in a semi-rural area of South Africa. METHODS We conducted a longitudinal process evaluation, using in-depth interviews, focus groups and observations prior to the intervention, during the intervention, and 6 months post-intervention to assess how the effects of the intervention were generated and sustained. Our participants were CHWs, their supervisors, clients and facility staff members and community representatives. RESULTS The nurse mentor operated in an environment of resource shortages, conflicts between CHWs and facility staff, and an active CHW labour union. Over 15 months, the mentor was able to (1) support and train CHWs and their supervisors to gain and practice new skills, (2) address their fears of failing and (3) establish operational systems to address inefficiencies in the CHWs' activities, resulting in improved service provision. Towards the end of the intervention the direct employment of the CHWs by the Department of Health and an increase in their stipend added to their motivation and integration into the local primary care clinic team. However, given the communities' focus on accessing government housing, rather than better healthcare, and volatile nature of the communities, the nurse mentor was not able to establish a collaboration with local structures. CONCLUSIONS A roving nurse mentor overseeing several CHW teams within a district healthcare system is a feasible option, particularly in a context where there is a shortage of qualified supervisors to support CHWs activities. A roving nurse mentor can contribute to the knowledge and skills development of the CHWs and enhance the capacity of junior supervisors. However, the long-term sustainability of the effects of intervention is dependent on CHWs' formal employment by the Department of Health.
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Affiliation(s)
- Hlologelo Malatji
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Frances Griffiths
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Warwick Medical School, Warwick University, Coventry, UK
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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29
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Eli K, Hawkes C, Perkins GD, Slowther AM, Griffiths F. Caring in the silences: why physicians and surgeons do not discuss emergency care and treatment planning with their patients - an analysis of hospital-based ethnographic case studies in England. BMJ Open 2022; 12:e046189. [PMID: 35256437 PMCID: PMC8905976 DOI: 10.1136/bmjopen-2020-046189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite increasing emphasis on integrating emergency care and treatment planning (ECTP) into routine medical practice, clinicians continue to delay or avoid ECTP conversations with patients. However, little is known about the clinical logics underlying barriers to ECTP conversations. OBJECTIVE This study aims to develop an ethnographic account of how and why clinicians defer and avoid ECTP conversations, and how they rationalise these decisions as they happen. DESIGN A multisited ethnographic study. SETTING Medical, orthopaedic and surgical wards in hospitals within four acute National Health Service trusts in England. PARTICIPANTS Thirty-four doctors were formally observed and 32 formally interviewed. Following an ethnographic case study approach, six cases were selected for in-depth analysis. ANALYSIS Fieldnote data were triangulated with interview data, to develop a 'thick description' of each case. Using a conceptual framework of care, the analysis highlighted the clinical logics underlying these cases. RESULTS The deferral or avoidance of ECTP conversations was driven by concerns over caring well, with clinicians attempting to optimise both medical and bedside practice. Conducting an ECTP conversation carefully meant attending to patients' and relatives' emotions and committing sufficient time for an in-depth discussion. However, conversation plans were often disrupted by issues related to timing and time constraints, leading doctors to defer these conversations, sometimes indefinitely. Additionally, whereas surgeons and geriatricians deferred conversations because they did not have the time to offer detailed discussions, emergency and acute medicine clinicians deferred conversations because the high-turnover ward environment, combined with patients' acute conditions, meant triaging conversations to those most in need. CONCLUSION Overcoming barriers to ECTP conversations is not simply a matter of enhancing training or hospital policies, but of promoting good conversational practices that take into account the affordances of hospital time and space, as well as clinicians' understandings of caring well.
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Affiliation(s)
- Karin Eli
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Claire Hawkes
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Temple A, Hamilton K, Bryce C, Griffiths F, Sturt J. Perspective on digital communication with health professions from close supporters of young people with long-term health conditions (The LYNC Study). Digit Health 2022; 8:20552076221092536. [PMID: 35433015 PMCID: PMC9005813 DOI: 10.1177/20552076221092536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/21/2020] [Accepted: 03/18/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To understand the impact of digital communication using email and text between young people and their health care team on those in close supporting roles. Methods Twelve people (nine parents and three partners) of young people with long-term health conditions were interviewed between November 2014 and March 2016. Thematic analysis was performed followed Braun and Clarke's (2006) 6-phase method. Results Four main themes were identified. Close supporters felt that digital clinical communication was useful for young persons’ self-management. As well as young patients, close supporters would also like to have direct access to the clinicians, but it was necessary to build up a trusting relationship between close supporters and clinicians initially. Video appointments were suggested for future digital communication technology. Conclusions Close supporters were encouraging digital communication for their young person with diabetes. Clinicians should put an emphasis on establishing trusting relationships with both young people and close supporters which would be beneficial for their digital clinical communications.
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Affiliation(s)
- Ayako Temple
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
| | - Kathryn Hamilton
- Department of Clinical, Educational and Health Psychology, Hunter Street Health Centre, London, UK
| | - Carol Bryce
- Warwick Medical School – Social Science and Systems in Health, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Warwick Medical School – Social Science and Systems in Health, University of Warwick, Coventry, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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Armstrong-Buisseret L, Brittain C, Kai J, David M, Anstey Watkins J, Ozolins M, Jackson L, Abdali Z, Hepburn T, Griffiths F, Montgomery A, Daniels J, Manley A, Dean G, Ross JDC. Lactic acid gel versus metronidazole for recurrent bacterial vaginosis in women aged 16 years and over: the VITA RCT. Health Technol Assess 2022; 26:1-170. [DOI: 10.3310/zzkh4176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background
Bacterial vaginosis is a common and distressing condition associated with serious comorbidities. Antibiotic treatment is usually clinically effective in the short term, but recurrence is common and side effects can occur.
Objectives
The objective is to assess whether or not intravaginal lactic acid gel is clinically effective and cost-effective for treating recurrent bacterial vaginosis compared with oral metronidazole (Flagyl, Sanofi).
Design
This was an open-label, multicentre, parallel-arm, randomised (1 : 1) controlled trial.
Setting
This took place in one general practice and 19 sexual health centres in the UK.
Participants
Women aged ≥ 16 years with bacterial vaginosis symptoms and one or more episode(s) within the past 2 years took part.
Interventions
The interventions were 5 ml of intravaginal lactic acid gel taken once daily for 7 days (intervention) or 400-mg oral metronidazole tablets taken twice daily for 7 days (control).
Main outcome measures
The primary outcome was the resolution of bacterial vaginosis symptoms 14 days after randomisation. The secondary outcomes were time to first recurrence of symptoms; number of recurrences and treatment courses over 6 months; microbiological resolution on microscopy of vaginal smears at week 2; time to resolution of symptoms; tolerability, adherence and acceptability of the treatment; prevalence of concurrent sexually transmitted infections; quality of life; and cost-effectiveness.
Results
Recruitment stopped prior to reaching the target of 1900 participants on recommendation from the Data Monitoring Committee and Trial Steering Committee after a planned review of the results indicated that the research question had been answered. Overall, 518 participants were randomised and primary outcome data were available for 409 participants (79%; 204 in the metronidazole arm, 205 in the lactic acid gel arm). Participant-reported symptom resolution at week 2 was higher with metronidazole (143/204; 70%) than with lactic acid gel (97/205; 47%) (adjusted risk difference –23.2%, 95% confidence interval –32.3% to –14.0%). Recurrence in 6 months in a subset of participants who had initial resolution and were available for follow-up was similar across arms (metronidazole arm: 51/72, 71%; lactic acid gel arm: 32/46, 70%). A higher incidence of some side effects was reported with metronidazole than with lactic acid gel (nausea 32% vs. 8%; taste changes 18% vs. 1%; diarrhoea 20% vs. 6%, respectively). At week 2, the average cost per participant with resolved symptoms was £86.94 (metronidazole), compared with £147.00 (lactic acid gel). Some participants preferred using lactic acid gel even if they perceived it to be less effective than metronidazole.
Limitations
Loss to follow-up for collection of the primary outcome data was 21% and was similar in both arms. There is a risk of bias owing to missing outcome data at 3 and 6 months post treatment.
Conclusions
A higher initial response was seen with metronidazole than with lactic acid gel, but subsequent treatment failure was common with both. Lactic acid gel was less cost-effective than metronidazole. In general, women disliked taking repeated courses of metronidazole and preferred lactic acid gel, even when they were aware that it was less likely to provide symptom resolution. In the absence of effective curative therapy, further evaluation of non-antibiotic treatments to control the symptoms of recurrent bacterial vaginosis is required to improve quality of life for these patients. Further microbiological analysis of vaginal samples would be useful to identify additional factors affecting response to treatment.
Trial registration
Current Controlled Trials ISRCTN14161293.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Clare Brittain
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Joe Kai
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Miruna David
- Clinical Microbiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jocelyn Anstey Watkins
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Mara Ozolins
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Louise Jackson
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Zainab Abdali
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Trish Hepburn
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Jane Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Alice Manley
- Department of Genitourinary Medicine, Whittall Street Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jonathan DC Ross
- Department of Genitourinary Medicine, Whittall Street Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Onuegbu C, Larweh M, Harlock J, Griffiths F. Systematic review of lay consultation in symptoms and illness experiences in informal urban settlements of low-income and middle-income countries. BMJ Open 2021; 11:e050766. [PMID: 34933858 PMCID: PMC8693092 DOI: 10.1136/bmjopen-2021-050766] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/18/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Lay consultation is the process of discussing a symptom or an illness with lay social network members. This can have positive or negative consequences on health-seeking behaviours. Understanding how consultation with lay social networks works in informal urban settlements of low-income and middle-income countries (LMICs) is important to enable health and policy-makers to maximise its potential to aid healthcare delivery and minimise its negative impacts. This study explored the composition, content and consequences of lay consultation in informal urban settlements of LMICs. DESIGN Mixed-method systematic review. DATA SOURCES Six key public health and social science databases, Google Scholar and reference lists of included studies were searched for potential articles. ELIGIBILITY CRITERIA Papers that described discussions with lay informal social network members during symptoms or illness experiences. DATA ANALYSIS AND SYNTHESIS Quality assessment was done using the Mixed Methods Appraisal Tool. Data were analysed and synthesised using a stepwise thematic synthesis approach involving two steps: identifying themes within individual studies and synthesising themes across studies. RESULTS 13 studies were included in the synthesis. Across the studies, three main categories of networks consulted during illness: kin, non-kin associates and significant community groups. Of these, kin networks were the most commonly consulted. The content of lay consultations were: asking for suggestions, negotiating care-seeking decisions, seeking resources and non-disclosure due to personal or social reasons. Lay consultations positively and negatively impacted access to formal healthcare and adherence to medical advice. CONCLUSION Lay consultation is mainly sought from social networks in immediate environments in informal urban settlements of LMICs. Policy-makers and practitioners need to utilise these networks as mediators of healthcare-seeking behaviours. PROSPERO REGISTRATION NUMBER CRD42020205196.
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Affiliation(s)
- Chinwe Onuegbu
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Maxwell Larweh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jenny Harlock
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Walsh J, Cave J, Griffiths F. Spontaneously Generated Online Patient Experience of Modafinil: A Qualitative and NLP Analysis. Front Digit Health 2021; 3:598431. [PMID: 34713085 PMCID: PMC8521895 DOI: 10.3389/fdgth.2021.598431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/24/2020] [Accepted: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To compare the findings from a qualitative and a natural language processing (NLP) based analysis of online patient experience posts on patient experience of the effectiveness and impact of the drug Modafinil. Methods: Posts (n = 260) from 5 online social media platforms where posts were publicly available formed the dataset/corpus. Three platforms asked posters to give a numerical rating of Modafinil. Thematic analysis: data was coded and themes generated. Data were categorized into PreModafinil, Acquisition, Dosage, and PostModafinil and compared to identify each poster's own view of whether taking Modafinil was linked to an identifiable outcome. We classified this as positive, mixed, negative, or neutral and compared this with numerical ratings. NLP: Corpus text was speech tagged and keywords and key terms extracted. We identified the following entities: drug names, condition names, symptoms, actions, and side-effects. We searched for simple relationships, collocations, and co-occurrences of entities. To identify causal text, we split the corpus into PreModafinil and PostModafinil and used n-gram analysis. To evaluate sentiment, we calculated the polarity of each post between −1 (negative) and +1 (positive). NLP results were mapped to qualitative results. Results: Posters had used Modafinil for 33 different primary conditions. Eight themes were identified: the reason for taking (condition or symptom), impact of symptoms, acquisition, dosage, side effects, other interventions tried or compared to, effectiveness of Modafinil, and quality of life outcomes. Posters reported perceived effectiveness as follows: 68% positive, 12% mixed, 18% negative. Our classification was consistent with poster ratings. Of the most frequent 100 keywords/keyterms identified by term extraction 88/100 keywords and 84/100 keyterms mapped directly to the eight themes. Seven keyterms indicated negation and temporal states. Sentiment was as follows 72% positive sentiment 4% neutral 24% negative. Matching of sentiment between the qualitative and NLP methods was accurate in 64.2% of posts. If we allow for one category difference matching was accurate in 85% of posts. Conclusions: User generated patient experience is a rich resource for evaluating real world effectiveness, understanding patient perspectives, and identifying research gaps. Both methods successfully identified the entities and topics contained in the posts. In contrast to current evidence, posters with a wide range of other conditions found Modafinil effective. Perceived causality and effectiveness were identified by both methods demonstrating the potential to augment existing knowledge.
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Affiliation(s)
- Julia Walsh
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jonathan Cave
- Department of Economics, University of Warwick, Coventry, United Kingdom
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Haywood KL, Achana F, Nichols V, Pearce G, Box B, Muldoon L, Patel S, Griffiths F, Stewart K, Underwood M, Matharu MM. Measuring health-related quality of life in chronic headache: A comparative evaluation of the Chronic Headache Quality of Life Questionnaire and Headache Impact Test (HIT-6). Cephalalgia 2021; 41:1100-1123. [PMID: 33942667 PMCID: PMC8411468 DOI: 10.1177/03331024211006045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/08/2021] [Accepted: 03/07/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the quality and acceptability of a new headache-specific patient-reported measure, the Chronic Headache Quality of Life Questionnaire (CHQLQ) with the six-item Headache Impact Test (HIT-6), in people meeting an epidemiological definition of chronic headaches. METHODS Participants in the feasibility stage of the Chronic Headache Education and Self-management Study (CHESS) (n = 130) completed measures three times during a 12-week prospective cohort study. Data quality, measurement acceptability, reliability, validity, responsiveness to change, and score interpretation were determined. Semi-structured cognitive interviews explored measurement relevance, acceptability, clarity, and comprehensiveness. RESULTS Both measures were well completed with few missing items. The CHQLQ's inclusion of emotional wellbeing items increased its relevance to participant's experience of chronic headache. End effects were present at item level only for both measures. Structural assessment supported the three and one-factor solutions of the CHQLQ and HIT-6, respectively. Both the CHQLQ (range 0.87 to 0.94) and HIT-6 (0.90) were internally consistent, with acceptable temporal stability over 2 weeks (CHQLQ range 0.74 to 0.80; HIT-6 0.86). Both measures responded to change in headache-specific health at 12 weeks (CHQLQ smallest detectable change (improvement) range 3 to 5; HIT-6 2.1). CONCLUSIONS While both measures are structurally valid, internally consistent, temporally stable, and responsive to change, the CHQLQ has greater relevance to the patient experience of chronic headache.Trial registration number: ISRCTN79708100. Registered 16th December 2015, http://www.isrctn.com/ISRCTN79708100.
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Affiliation(s)
- Kirstie L Haywood
- Warwick Research in Nursing, Warwick Medical School, University
of Warwick, Coventry, UK
| | - Felix Achana
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
- Nuffield Department of Primary Care Health Sciences, Oxford
University, Oxford, UK
| | - Vivien Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
| | - Gemma Pearce
- School of Psychology, Social and Behavioural Sciences, Coventry
University, Coventry, UK
| | - Barbara Box
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
| | - Lynne Muldoon
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
| | - Shilpa Patel
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
| | - Frances Griffiths
- Social Science and Systems in Health, Warwick Medical School,
University of Warwick, Coventry, UK
| | - Kimberly Stewart
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry,
UK
| | - Manjit M Matharu
- The Headache Group, National Hospital for Neurology and
Neurosurgery, University College of London Hospitals NHS Foundation Trust, AC1
London, UK
| | - on behalf of the CHESS Team
- Warwick Research in Nursing, Warwick Medical School, University
of Warwick, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
- Nuffield Department of Primary Care Health Sciences, Oxford
University, Oxford, UK
- School of Psychology, Social and Behavioural Sciences, Coventry
University, Coventry, UK
- Social Science and Systems in Health, Warwick Medical School,
University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry,
UK
- The Headache Group, National Hospital for Neurology and
Neurosurgery, University College of London Hospitals NHS Foundation Trust, AC1
London, UK
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Eli K, Hawkes CA, Fritz Z, Griffin J, Huxley CJ, Perkins GD, Wilkinson A, Griffiths F, Slowther AM. Assessing the quality of ReSPECT documentation using an accountability for reasonableness framework. Resusc Plus 2021; 7:100145. [PMID: 34382025 PMCID: PMC8340300 DOI: 10.1016/j.resplu.2021.100145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/18/2020] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form, which supports the ReSPECT process, is designed to prompt clinicians to discuss wider emergency treatment options with patients and to structure the documentation of decision-making for greater transparency. Methods Following an accountability for reasonableness framework (AFR), we analysed 141 completed ReSPECT forms (versions 1.0 and 2.0), collected from six National Health Service (NHS) hospitals in England during the early adoption of ReSPECT. Structured through an evaluation tool developed for this study, the analysis assessed the extent to which the records reflected consistency, transparency, and ethical justification of decision-making. Results Recommendations relating to CPR were consistently recorded on all forms and were contextualised within other treatment recommendations in most forms. The level of detail provided about treatment recommendations varied widely and reasons for treatment recommendations were rarely documented. Patient capacity, patient priorities and preferences, and the involvement of patients/relatives in ReSPECT conversations were recorded in some, but not all, forms. Clinicians almost never documented their weighing of potential burdens and benefits of treatments on the ReSPECT forms. Conclusion In most ReSPECT forms, CPR recommendations were captured alongside other treatment recommendations. However, ReSPECT form design and associated training should be modified to address inconsistencies in form completion. These modifications should emphasise the recording of patient values and preferences, assessment of patient capacity, and clinical reasoning processes, thereby putting patient/family involvement at the core of good clinical practice. Version 3.0 of ReSPECT responds to these issues.
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Affiliation(s)
- Karin Eli
- Warwick Medical School, University of Warwick, UK
| | | | - Zoë Fritz
- Cambridge University Hospitals NHS Foundation Trust, UK
| | | | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, UK.,University Hospitals Birmingham NHS Foundation Trust, UK
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Huxley CJ, Eli K, Hawkes CA, Perkins GD, George R, Griffiths F, Slowther AM. General practitioners' experiences of emergency care and treatment planning in England: a focus group study. BMC Fam Pract 2021; 22:128. [PMID: 34167478 PMCID: PMC8224258 DOI: 10.1186/s12875-021-01486-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 06/07/2021] [Indexed: 11/21/2022]
Abstract
Background Emergency Care and Treatment Plans are recommended for all primary care patients in the United Kingdom who are expected to experience deterioration of their health. The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was developed to integrate resuscitation decisions with discussions about wider goals of care. It summarises treatment recommendations discussed and agreed between patients and their clinicians for a future emergency situation and was designed to meet the needs of different care settings. Our aim is to explore GPs’ experiences of using ReSPECT and how it transfers across the primary care and secondary care interface. Methods We conducted five focus groups with GPs in areas being served by hospitals in England that have implemented ReSPECT. Participants were asked about their experience of ReSPECT, how they initiate ReSPECT-type conversations, and their experiences of ReSPECT-type recommendations being communicated across primary and secondary care. Focus groups were transcribed and analysed using Thematic Analysis. Results GPs conceptualise ReSPECT as an end of life planning document, which is best completed in primary care. As an end of life care document, completing ReSPECT is an emotional process and conversations are shaped by what a ‘good death’ is thought to be. ReSPECT recommendations are not always communicated or transferable across care settings. A focus on the patient’s preferences around death, and GPs’ lack of specialist knowledge, could be a barrier to completion of ReSPECT that is transferable to acute settings. Conclusion Conceptualising ReSPECT as an end of life care document suggests a difference in how general practitioners understand ReSPECT from its designers. This impacts on the transferability of ReSPECT recommendations to the hospital setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01486-w.
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Affiliation(s)
- Caroline J Huxley
- Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK
| | - Karin Eli
- Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK
| | - Claire A Hawkes
- Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK
| | - Rob George
- St Christopher's Hospice, 51-59 Lawrie Park Road, London, SE26 6DZ, UK
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK.
| | - Anne-Marie Slowther
- Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK
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Abstract
INTRODUCTION Community health workers (CHWs) enable marginalised communities, often experiencing structural poverty, to access healthcare. Trust, important in all patient-provider relationships, is difficult to build in such communities, particularly when stigma associated with HIV/AIDS, tuberculosis and now COVID-19, is widespread. CHWs, responsible for bringing people back into care, must repair trust. In South Africa, where a national CHW programme is being rolled out, marginalised communities have high levels of unemployment, domestic violence and injury. OBJECTIVES In this complex social environment, we explored CHW workplace trust, interpersonal trust between the patient and CHW, and the institutional trust patients place in the health system. DESIGN, PARTICIPANTS, SETTING Within the observation phase of a 3-year intervention study, we conducted interviews, focus groups and observations with patients, CHWs, their supervisors and, facility managers in Sedibeng. RESULTS CHWs had low levels of workplace trust. They had recently been on strike demanding better pay, employment conditions and recognition of their work. They did not have the equipment to perform their work safely, and some colleagues did not trust, or value, their contribution. There was considerable interpersonal trust between CHWs and patients, however, CHWs' efforts were hampered by structural poverty, alcohol abuse and no identification documents among long-term migrants. Those supervisors who understood the extent of the poverty supported CHW efforts to help the community. When patients had withdrawn from care, often due to nurses' insensitive behaviour, the CHWs' attempts to repair patients' institutional trust often failed due to the vulnerabilities of the community, and lack of support from the health system. CONCLUSION Strategies are needed to build workplace trust including supportive supervision for CHWs and better working conditions, and to build interpersonal and institutional trust by ensuring sensitivity to social inequalities and the effects of structural poverty among healthcare providers. Societies need to care for everyone.
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Affiliation(s)
- Jocelyn Anstey Watkins
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Aujla N, Chen YF, Samarakoon Y, Wilson A, Grolmusova N, Ayorinde A, Hofer TP, Griffiths F, Brown C, Gill P, Mallen C, Sartori JO, Lilford RJ. Corrigendum to: comparing the use of direct observation, standardized patients and exit interviews in low- and middle-income countries: a systematic review of methods of assessing quality of primary care. Health Policy Plan 2021; 36:998. [PMID: 33987647 PMCID: PMC8227990 DOI: 10.1093/heapol/czab046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Shrestha D, Napit IB, Ansari S, Choudhury SM, Dhungana B, Gill P, Griffiths F, Gwyther H, Hagge D, Kandel S, Puri S, Sartori J, Watson SI, Lilford R. Evaluation of a self-help intervention to promote the health and wellbeing of marginalised people including those living with leprosy in Nepal: a prospective, observational, cluster-based, cohort study with controls. BMC Public Health 2021; 21:873. [PMID: 33957899 PMCID: PMC8101219 DOI: 10.1186/s12889-021-10847-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People affected by leprosy are at increased risk of ulcers from peripheral nerve damage. This in turn can lead to visible impairments, stigmatisation and economic marginalisation. Health care providers suggest that patients should be empowered to self-manage their condition to improve outcomes and reduce reliance on services. Self-care involves carrying out personal care tasks with the aim of preventing disabilities or preventing further deterioration. Self-help, on the other hand, addresses the wider psychological, social and economic implications of leprosy and incorporates, for example, skills training and microfinance schemes. The aim of this study, known as SHERPA (Self-Help Evaluation for lepRosy and other conditions in NePAl) is to evaluate a service intervention called Integrated Mobilization of People for Active Community Transformation (IMPACT) designed to encourage both self-care and self-help in marginalised people including those affected by leprosy. METHODS A mixed-method evaluation study in Province 5, Nepal comprising two parts. First, a prospective, cluster-based, non-randomised controlled study to evaluate the effectiveness of self-help groups on ulcer metrics (people affected by leprosy only) and on four generic outcome measures (all participants) - generic health status, wellbeing, social integration and household economic performance. Second, a qualitative study to examine the implementation and fidelity of the intervention. IMPACT This research will provide information on the effectiveness of combined self-help and self-care groups, on quality of life, social integration and economic wellbeing for people living with leprosy, disability or who are socially and economically marginalised in low- and middle- income countries.
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Affiliation(s)
- Dilip Shrestha
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Indra B. Napit
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Subi Ansari
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Sopna Mannan Choudhury
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Bishnu Dhungana
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Paramjit Gill
- grid.7372.10000 0000 8809 1613Warwick Centre for Applied Health Research & Delivery (W-CAHRD), Warwick Medical School, University of Warwick, Warwick, UK
| | - Frances Griffiths
- grid.7372.10000 0000 8809 1613Warwick Centre for Applied Health Research & Delivery (W-CAHRD), Warwick Medical School, University of Warwick, Warwick, UK
| | - Holly Gwyther
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Deanna Hagge
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Shovakhar Kandel
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Suraj Puri
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Jo Sartori
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Samuel Ian Watson
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Richard Lilford
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
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Aujla N, Chen YF, Samarakoon Y, Wilson A, Grolmusová N, Ayorinde A, Hofer TP, Griffiths F, Brown C, Gill P, Mallen C, Sartori J, Lilford RJ. Comparing the use of direct observation, standardized patients and exit interviews in low- and middle-income countries: a systematic review of methods of assessing quality of primary care. Health Policy Plan 2021; 36:341-356. [PMID: 33313845 PMCID: PMC8058951 DOI: 10.1093/heapol/czaa152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 12/31/2022] Open
Abstract
Clinical records in primary healthcare settings in low- and middle-income countries (LMIC) are often lacking or of too poor quality to accurately assess what happens during the patient consultation. We examined the most common methods for assessing healthcare workers' clinical behaviour: direct observation, standardized patients and patient/healthcare worker exit interview. The comparative feasibility, acceptability, reliability, validity and practicalities of using these methods in this setting are unclear. We systematically review and synthesize the evidence to compare and contrast the advantages and disadvantages of each method. We include studies in LMICs where methods have been directly compared and systematic and narrative reviews of each method. We searched several electronic databases and focused on real-life (not educational) primary healthcare encounters. The most recent update to the search for direct comparison studies was November 2019. We updated the search for systematic and narrative reviews on the standardized patient method in March 2020 and expanded it to all methods. Search strategies combined indexed terms and keywords. We searched reference lists of eligible articles and sourced additional references from relevant review articles. Titles and abstracts were independently screened by two reviewers and discrepancies resolved through discussion. Data were iteratively coded according to pre-defined categories and synthesized. We included 12 direct comparison studies and eight systematic and narrative reviews. We found that no method was clearly superior to the others-each has pros and cons and may assess different aspects of quality of care provision by healthcare workers. All methods require careful preparation, though the exact domain of quality assessed and ethics and selection and training of personnel are nuanced and the methods were subject to different biases. The differential strengths suggest that individual methods should be used strategically based on the research question or in combination for comprehensive global assessments of quality.
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Affiliation(s)
- Navneet Aujla
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Yen-Fu Chen
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Yasara Samarakoon
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Anna Wilson
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Natalia Grolmusová
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Abimbola Ayorinde
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Timothy P Hofer
- Department of Medicine, UM Institute for Health Policy and Innovation, Building 16 3rd Floor, North Campus Research Centre, University of Michigan Medical School, Ann Arbor, MI 48109-2800 USA
| | - Frances Griffiths
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Celia Brown
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Paramjit Gill
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Christian Mallen
- Keele School of Medicine, David Wetherall Building, Keele University, Keele, ST5 5BG, UK
| | - Jo Sartori
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Phelps EE, Wellings R, Kunar M, Hutchinson C, Griffiths F. A qualitative study exploring the experience of viewing three-dimensional medical images during an orthopaedic outpatient consultation from the perspective of patients, health care professionals, and lay representatives. J Eval Clin Pract 2021; 27:333-343. [PMID: 32488922 DOI: 10.1111/jep.13417] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Three-dimensional (3D) medical images are shown to patients during clinical consultations about certain health conditions. However, little is known about patients' experience of viewing them. The aim of this qualitative study was to explore the impact of sharing 3D medical images with patients during a clinical consultation about hip surgery, from the perspective of patients, health care professionals, and lay representatives. METHOD Interviews were conducted with 14 patients who were shown their own 3D medical images during their clinical consultation and four health care professionals conducting consultations within one orthopaedic outpatient clinic. In addition to interviews, 31 lay representatives participated in six focus groups. The focus groups aimed to gain a broader understanding of the advantages and concerns of showing patients their medical images and to compare 3D and two-dimensional (2D) medical images. Interviews and focus groups were audio-recorded, transcribed verbatim, and analysed using thematic analysis. RESULTS Three themes were developed from the data: (a) the truthful image, (b) the empowering image, and (c) the unhelpful image. Focus group participants' preference for 3D or 2D images varied between conditions and groups, suggesting that the experience of viewing images may differ between individuals and conditions. CONCLUSIONS When shown to patients during an orthopaedic clinical consultation, 3D medical images may be an empowering resource. However, in this study, patients and focus group participants perceived medical images as factual and believed they could provide evidence of a diagnoses. This perception could result in overreliance in imaging tests or disregard for other forms of information.
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Affiliation(s)
- Emma E Phelps
- Warwick Medical School, University of Warwick, Coventry, UK.,Kadoorie Centre, John Radcliffe Hospital, NDORMS, University of Oxford, Oxford, UK
| | - Richard Wellings
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Melina Kunar
- Department of Psychology, University of Warwick, Coventry, UK
| | - Charles Hutchinson
- Warwick Medical School, University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, UK.,University of the Witwatersrand, Johannesburg, South Africa
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Heidenreich K, Slowther AM, Griffiths F, Bremer A, Svantesson M. UK consultants' experiences of the decision-making process around referral to intensive care: an interview study. BMJ Open 2021; 11:e044752. [PMID: 33762241 PMCID: PMC7993217 DOI: 10.1136/bmjopen-2020-044752] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The decision whether to initiate intensive care for the critically ill patient involves ethical questions regarding what is good and right for the patient. It is not clear how referring doctors negotiate these issues in practice. The aim of this study was to describe and understand consultants' experiences of the decision-making process around referral to intensive care. DESIGN Qualitative interviews were analysed according to a phenomenological hermeneutical method. SETTING AND PARTICIPANTS Consultant doctors (n=27) from departments regularly referring patients to intensive care in six UK hospitals. RESULTS In the precarious and uncertain situation of critical illness, trust in the decision-making process is needed and can be enhanced through the way in which the process unfolds. When there are no obvious right or wrong answers as to what ought to be done, how the decision is made and how the process unfolds is morally important. Through acknowledging the burdensome doubts in the process, contributing to an emerging, joint understanding of the patient's situation, and responding to mutual moral duties of the doctors involved, trust in the decision-making process can be enhanced and a shared moral responsibility between the stake holding doctors can be assumed. CONCLUSION The findings highlight the importance of trust in the decision-making process and how the relationships between the stakeholding doctors are crucial to support their moral responsibility for the patient. Poor interpersonal relationships can damage trust and negatively impact decisions made on behalf of a critically ill patient. For this reason, active attempts must be made to foster good relationships between doctors. This is not only important to create a positive working environment, but a mechanism to improve patient outcomes.
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Affiliation(s)
- Kaja Heidenreich
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Anders Bremer
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Mia Svantesson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Dixon S, Duddy C, Harrison G, Papoutsi C, Ziebland S, Griffiths F. Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations. BMJ Open 2021; 11:e039809. [PMID: 33753429 PMCID: PMC7986780 DOI: 10.1136/bmjopen-2020-039809] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/11/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Little is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients. SETTING Primary care in England. DATA SOURCES Realist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients. PRIMARY OUTCOME MEASURE This realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated. RESULTS 124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations. CONCLUSIONS There is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities' health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation. PROSPERO REGISTRATION NUMBER CRD42018091996.
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Affiliation(s)
- Sharon Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Frances Griffiths
- Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
- Warwick Medical School, University of Warwick, Coventry, UK
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Griffiths F, Parekh S. Is it time to reconsider the use of vital teeth bleaching in children and adolescents in Europe? Eur Arch Paediatr Dent 2021; 22:759-763. [PMID: 33666898 DOI: 10.1007/s40368-021-00609-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to determine whether carbamide peroxide is effective in bleaching vital permanent teeth in children. METHODS A literature search was conducted using all keywords relevant to the research subject. The outcome measures were identified as colour change, tooth sensitivity, oral irritation and patient satisfaction. The certainty of evidence for each outcome was assessed using the current GRADE guidelines. RESULTS Of 115 potentially relevant articles, 112 were excluded, as they did not exclusively involve children, intervention involved additional treatment such as microabrasion or restorative work, or case studies. Patient satisfaction was not assessed in the three articles so no analysis could be made with regards to this outcome. The GRADE assessment showed that all of the three articles demonstrated very low certainty of evidence for the other assessed outcomes. The overall findings from the studies suggest that a 10% carbamide peroxide overnight tray system is effective at bleaching vital permanent teeth in children and associated tooth sensitivity and oral irritation are found to be in a similar range compared to those reported in adult studies. However, due to the very low certainty of the evidence, it is not possible to draw these conclusions. CONCLUSION Better quality randomised controlled trials are needed to investigate the indication, short and long term effectiveness and side effects of carbamide teeth in vital permanent teeth in children.
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Affiliation(s)
- F Griffiths
- Eastman Dental Institute, University College London, 123 Grays Inn Road, Holborn, London, WC1X 8LT, UK.
| | - S Parekh
- Eastman Dental Institute, University College London, 123 Grays Inn Road, Holborn, London, WC1X 8LT, UK
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45
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Svantesson M, Griffiths F, White C, Bassford C, Slowther A. Ethical conflicts during the process of deciding about ICU admission: an empirically driven ethical analysis. J Med Ethics 2021; 47:medethics-2020-106672. [PMID: 33402429 PMCID: PMC8639921 DOI: 10.1136/medethics-2020-106672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Besides balancing burdens and benefits of intensive care, ethical conflicts in the process of decision-making should also be recognised. This calls for an ethical analysis relevant to clinicians. The aim was to analyse ethically difficult situations in the process of deciding whether a patient is admitted to intensive care unit (ICU). METHODS Analysis using the 'Dilemma method' and 'wide reflective equilibrium', on ethnographic data of 45 patient cases and 96 stakeholder interviews in six UK hospitals. ETHICAL ANALYSIS Four moral questions and associated value conflicts were identified. (1) Who should have the right to decide whether a patient needs to be reviewed? Conflicting perspectives on safety/security. (2) Does the benefit to the patient of getting the decision right justify the cost to the patient of a delay in making the decision? Preventing longer-term suffering and understanding patient's values conflicted with preventing short-term suffering and provision of security. (3) To what extent should the intensivist gain others' input? Professional independence versus a holistic approach to decision-making. (4) Should the intensivist have an ongoing duty of care to patients not admitted to ICU? Short-term versus longer-term duty to protect patient safety. Safety and security (experienced in a holistic sense of physical and emotional security for patients) were key values at stake in the ethical conflicts identified. The life-threatening nature of the situation meant that the principle of autonomy was overshadowed by the duty to protect patients from harm. The need to fairly balance obligations to the referred patient and to other patients was also recognised. CONCLUSION Proactive decision-making including advance care planning and escalation of treatment decisions may support the inclusion of patient autonomy. However, our analysis invites binary choices, which may not sufficiently reflect reality. This calls for a complementary relational ethics analysis.
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Affiliation(s)
- Mia Svantesson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Frances Griffiths
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Catherine White
- Patient and Public Representative, Trustee, ICUsteps - the Intensive Care Patient Support Charity, Coventry, UK
| | - Chris Bassford
- Department of Anaesthesia, Critical Care and Pain, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, UK
| | - AnneMarie Slowther
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
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46
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Maula A, Kendrick D, Kai J, Griffiths F. Evidence generated from a realist synthesis of trials on educational weight loss interventions in type 2 diabetes mellitus. Diabet Med 2021; 38:e14394. [PMID: 32871624 DOI: 10.1111/dme.14394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/29/2020] [Accepted: 08/25/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Obesity and diabetes are major public health problems. Current approaches to weight loss show varying success. Complex community-based interventions work through several interconnected stages. An individual's actions in response to an intervention depend on many known and unknown factors, which vary among individuals. AIM To conduct a realist synthesis to identify in which context, for whom, in what circumstances, and how weight loss interventions work in obese or overweight individuals with type 2 diabetes. METHODS A total of 49 trials identified during a systematic review were subsequently analysed using realist methodology. This iterative process involved hypothesis generation about how participants within a particular context respond to an intervention's resources producing the outcomes. We used established behaviour change theory to look for repeating themes. Theory and 'mechanisms' were tested against the literature on what is shown to be effective. Where established theory was lacking, we discussed issues during discussion groups with individuals living with the condition to generate our own programme theories. RESULTS Mechanisms that were repeatedly identified included high-frequency contact with those delivering the intervention, social support, education increasing awareness of diabetes-related modifiable risk factors, motivational interviewing and counselling, goal-setting, self-monitoring and feedback and meal replacements. The central theme underlying successful mechanisms was personalising each intervention component to the participants' gender, culture and family setting. CONCLUSION This is the first comprehensive realist synthesis in this field. Our findings suggest that, for weight loss interventions to be successful in those with diabetes, they must be personalized to the individual and their specific context.
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Affiliation(s)
- Asiya Maula
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joe Kai
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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47
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Harris B, Ajisola M, Alam RM, Watkins JA, Arvanitis TN, Bakibinga P, Chipwaza B, Choudhury NN, Kibe P, Fayehun O, Omigbodun A, Owoaje E, Pemba S, Potter R, Rizvi N, Sturt J, Cave J, Iqbal R, Kabaria C, Kalolo A, Kyobutungi C, Lilford RJ, Mashanya T, Ndegese S, Rahman O, Sayani S, Yusuf R, Griffiths F. Mobile consulting as an option for delivering healthcare services in low-resource settings in low- and middle-income countries: A mixed-methods study. Digit Health 2021; 7:20552076211033425. [PMID: 34777849 PMCID: PMC8580492 DOI: 10.1177/20552076211033425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/05/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Remote or mobile consulting is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during coronavirus disease 2019 and beyond. We explored whether mobile consulting is a viable option for communities with minimal resources in low- and middle-income countries. METHODS We reviewed evidence published since 2018 about mobile consulting in low- and middle-income countries and undertook a scoping study (pre-coronavirus disease) in two rural settings (Pakistan and Tanzania) and five urban slums (Kenya, Nigeria and Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites) and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mobile consulting providers, and local and national decision-makers. Project advisory groups guided the study in each country. RESULTS We reviewed four empirical studies and seven reviews, analysed data from 5322 urban slum households and engaged with 424 stakeholders in rural and urban sites. Regulatory frameworks are available in each country. Mobile consulting services are operating through provider platforms (n = 5-17) and, at the community level, some direct experience of mobile consulting with healthcare workers using their own phones was reported - for emergencies, advice and care follow-up. Stakeholder willingness was high, provided challenges are addressed in technology, infrastructure, data security, confidentiality, acceptability and health system integration. Mobile consulting can reduce affordability barriers and facilitate care-seeking practices. CONCLUSIONS There are indications of readiness for mobile consulting in communities with minimal resources. However, wider system strengthening is needed to bolster referrals, specialist services, laboratories and supply chains to fully realise the continuity of care and responsiveness that mobile consulting services offer, particularly during/beyond coronavirus disease 2019.
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Affiliation(s)
| | - Motunrayo Ajisola
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Raisa Meher Alam
- Centre for Health, Population and Development, Independent University Bangladesh, Bangladesh
| | | | | | | | - Beatrice Chipwaza
- St Francis University College of Health and Allied Sciences, Tanzania
| | | | - Peter Kibe
- African Population and Health Research Center, Kenya
| | - Olufunke Fayehun
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Akinyinka Omigbodun
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria
| | - Eme Owoaje
- Department of Community Medicine, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
| | - Senga Pemba
- St Francis University College of Health and Allied Sciences, Tanzania
| | - Rachel Potter
- Clinical Trials Unit Warwick Medical School, University of Warwick, University of Warwick, UK
| | - Narjis Rizvi
- Community Health Sciences Department, Aga Khan University, Pakistan
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, UK
| | | | - Romaina Iqbal
- Community Health Sciences Department, Aga Khan University, Pakistan
| | | | - Albino Kalolo
- St Francis University College of Health and Allied Sciences, Tanzania
| | | | - Richard J Lilford
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Titus Mashanya
- St Francis University College of Health and Allied Sciences, Tanzania
| | - Sylvester Ndegese
- St Francis University College of Health and Allied Sciences, Tanzania
| | - Omar Rahman
- University of Liberal Arts Bangladesh, Bangladesh
| | - Saleem Sayani
- Aga Khan Development Network Digital Health Resource Centre (Asia and Africa), Aga Khan University, Pakistan
| | - Rita Yusuf
- Centre for Health, Population and Development, Independent University Bangladesh, Bangladesh
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, UK.,Centre for Health Policy, University of the Witwatersrand, South Africa
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48
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Griffiths F, Svantesson M, Bassford C, Dale J, Blake C, McCreedy A, Slowther AM. Decision-making around admission to intensive care in the UK pre-COVID-19: a multicentre ethnographic study. Anaesthesia 2020; 76:489-499. [PMID: 33141939 DOI: 10.1111/anae.15272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 12/24/2022]
Abstract
Predicting who will benefit from admission to an intensive care unit is not straightforward and admission processes vary. Our aim was to understand how decisions to admit or not are made. We observed 55 decision-making events in six NHS hospitals. We interviewed 30 referring and 43 intensive care doctors about these events. We describe the nature and context of the decision-making and analysed how doctors make intensive care admission decisions. Such decisions are complex with intrinsic uncertainty, often urgent and made with incomplete information. While doctors aspire to make patient-centred decisions, key challenges include: being overworked with lack of time; limited support from senior staff; and a lack of adequate staffing in other parts of the hospital that may be compromising patient safety. To reduce decision complexity, heuristic rules based on experience are often used to help think through the problem; for example, the patient's functional status or clinical gestalt. The intensive care doctors actively managed relationships with referring doctors; acted as the hospital generalist for acutely ill patients; and brought calm to crisis situations. However, they frequently failed to elicit values and preferences from patients or family members. They were rarely explicit in balancing burdens and benefits of intensive care for patients, so consistency and equity cannot be judged. The use of a framework for intensive care admission decisions that reminds doctors to seek patient or family views and encourages explicit balancing of burdens and benefits could improve decision-making. However, a supportive, adequately resourced context is also needed.
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Affiliation(s)
- F Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - M Svantesson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - C Bassford
- Department of Intensive Care Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - J Dale
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - C Blake
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - A McCreedy
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - A-M Slowther
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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49
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Spence T, Kander I, Walsh J, Griffiths F, Ross J. Perceptions and Experiences of Internet-Based Testing for Sexually Transmitted Infections: Systematic Review and Synthesis of Qualitative Research. J Med Internet Res 2020; 22:e17667. [PMID: 32663151 PMCID: PMC7481875 DOI: 10.2196/17667] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/08/2020] [Accepted: 06/14/2020] [Indexed: 01/19/2023] Open
Abstract
Background Internet-based testing for sexually transmitted infections (STIs) allows asymptomatic individuals to order a self-sampling kit online and receive their results electronically, reducing the need to attend a clinic unless for treatment. This approach has become increasingly common; however, there is evidence that barriers exist to accessing it, particularly among some high-risk populations. We review the qualitative evidence on this topic, as qualitative research is well-placed to identify the complex influences that relate to accessing testing. Objective This paper aims to explore perceptions and experiences of internet-based testing for STIs among users and potential users. Methods Searches were run through 5 electronic databases (CINAHL, EMBASE, MEDLINE, PsycINFO, and Web of Science) to identify peer-reviewed studies published between 2005 and 2018. Search terms were drawn from 4 categories: STIs, testing or screening, digital health, and qualitative methods. Included studies were conducted in high-income countries and explored patient perceptions or experiences of internet-based testing, and data underwent thematic synthesis. Results A total of 11 studies from the 1735 studies identified in the initial search were included in the review. The synthesis identified that internet-based testing is viewed widely as being acceptable and is preferred over clinic testing by many individuals due to perceived convenience and anonymity. However, a number of studies identified concerns relating to test accuracy and lack of communication with practitioners, particularly when receiving results. There was a lack of consensus on preferred media for results delivery, although convenience and confidentiality were again strong influencing factors. The majority of included studies were limited by the fact that they researched hypothetical services. Conclusions Internet-based testing providers may benefit from emphasizing this testing’s comparative convenience and privacy compared with face-to-face testing in order to improve uptake, as well as alleviating concerns about the self-sampling process. There is a clear need for further research exploring in depth the perceptions and experiences of people who have accessed internet-based testing and for research on internet-based testing that explicitly gathers the views of populations that are at high risk of STIs. Trial Registration PROSPERO CRD42019146938; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=146938
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Affiliation(s)
- Tommer Spence
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Inès Kander
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Julia Walsh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jonathan Ross
- Whittall Street Clinic, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
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Goudge J, de Kadt J, Babalola O, Muteba M, Tseng YH, Malatji H, Rwafa T, Nxumalo N, Levin J, Thorogood M, Daviaud E, Watkins J, Griffiths F. Household coverage, quality and costs of care provided by community health worker teams and the determining factors: findings from a mixed methods study in South Africa. BMJ Open 2020; 10:e035578. [PMID: 32819939 PMCID: PMC7440700 DOI: 10.1136/bmjopen-2019-035578] [Citation(s) in RCA: 8] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Community health workers (CHWs) are undertaking more complex tasks as part of the move towards universal health coverage in South Africa. CHW programmes can improve access to care for vulnerable communities, but many such programmes struggle with insufficient supervision. In this paper, we assess coverage (proportion of households visited by a CHW in the past year and month), quality of care and costs of the service provided by CHW teams with differing configurations of supervisors, some based in formal clinics and some in community health posts. PARTICIPANTS CHW, their supervisors, clinic staff, CHW clients. METHODS We used mixed methods (a random household survey, focus group discussions, interviews and observations of the CHW at work) to examine the performance of six CHW teams in vulnerable communities in Sedibeng, South Africa. RESULTS A CHW had visited 17% of households in the last year, and we estimated they were conducting one to two visits per day. At household registration visits, the CHW asked half of the questions required. Respondents remembered 20%-25% of the health messages that CHW delivered from a visit in the last month, and half of the respondents took the action recommended by the CHW. Training, supervision and motivation of the CHW, and collaboration with other clinic staff, were better with a senior nurse supervisor. We estimated that if CHW carried out four visits a day, coverage would increase to 30%-90% of households, suggesting that some teams need more CHW, as well as better supervision. CONCLUSION Household coverage was low, and the service was limited. Support from the local facility was key to providing a quality service, and a senior supervisor facilitated this collaboration. Greater investment in numbers of CHW, supervisors, training and equipment is required for the potential benefits of the programme to be delivered.
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Affiliation(s)
- Jane Goudge
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Julia de Kadt
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Olukemi Babalola
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michel Muteba
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yu-Hwei Tseng
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hlologelo Malatji
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Teurai Rwafa
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nonhlanhla Nxumalo
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Levin
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Emmanuelle Daviaud
- Health Systems, South African Medical Research Council, Tygerberg, South Africa
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