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Hussien M. The role of perceived quality of care on outpatient visits to health centers in two rural districts of northeast Ethiopia: a community-based, cross-sectional study. BMC Health Serv Res 2024; 24:614. [PMID: 38730420 PMCID: PMC11084123 DOI: 10.1186/s12913-024-11091-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/08/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Patients who have had a negative experience with the health care delivery bypass primary healthcare facilities and instead seek care in hospitals. There is a dearth of evidence on the role of users' perceptions of the quality of care on outpatient visits to primary care facilities. This study aimed to examine the relationship between perceived quality of care and the number of outpatient visits to nearby health centers. METHODS A community-based cross-sectional study was conducted in two rural districts of northeast Ethiopia among 1081 randomly selected rural households that had visited the outpatient units of a nearby health center at least once in the previous 12 months. Data were collected using an interviewer-administered questionnaire via an electronic data collection platform. A multivariable analysis was performed using zero-truncated negative binomial regression model to determine the association between variables. The degree of association was assessed using the incidence rate ratio, and statistical significance was determined at a 95% confidence interval. RESULTS A typical household makes roughly four outpatient visits to a nearby health center, with an annual per capita visit of 0.99. The mean perceived quality of care was 6.28 on a scale of 0-10 (SD = 1.05). The multivariable analysis revealed that perceived quality of care is strongly associated with the number of outpatient visits (IRR = 1.257; 95% CI: 1.094 to 1.374). In particular, a significant association was found for the dimensions of provider communication (IRR = 1.052; 95% CI: 1.012, 1.095), information provision (IRR = 1.088; 95% CI: 1.058, 1.120), and access to care (IRR = 1.058, 95% CI: 1.026, 1.091). CONCLUSIONS Service users' perceptions of the quality of care promote outpatient visits to primary healthcare facilities. Effective provider communication, information provision, and access to care quality dimensions are especially important in this regard. Concerted efforts are required to improve the quality of care that relies on service users' perceptions, with a special emphasis on improving health care providers' communication skills and removing facility-level access barriers.
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Affiliation(s)
- Mohammed Hussien
- Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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Darcho SD, Ayele BH, Demena M, Firdisa D, Shawel S, Berhanu A. Organizational Communication Skills and Its Associated Factors Among Healthcare Providers Working at Wolaita Sodo Health Facilities, Southern Ethiopia: A Cross-Sectional Study. Risk Manag Healthc Policy 2024; 17:79-88. [PMID: 38222794 PMCID: PMC10785682 DOI: 10.2147/rmhp.s445682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/31/2023] [Indexed: 01/16/2024] Open
Abstract
Background Communication in healthcare organizations is an important factor in quality care, patient safety, and financial function. However, there was a dearth of evidence on the organizational communication skills of healthcare providers in Ethiopia, including the current study area, Wolaita Sodo. This study is aimed at assessing the level of organizational communication skills and their associated factors among healthcare providers working at Wolaita Sodo health facilities, SNNPRS, Ethiopia. Methods An institutional-based cross-sectional study design was conducted. A pretested and structured questionnaire was utilized using the self-administration method. The data were entered into Epi Data version 3.1 and analyzed using STATA version 17.0. Pearson correlation, a binary logistic regression analysis was carried out to identify factors associated with outcome variables. Accordingly, variables that fulfilled p-values <0.25 on the bivariate logistic regression were considered candidates for multivariate logistic regression to control for possible confounders. The odds ratios along with the 95% confidence interval were used to present the finding, and statistical significance was reported at a p-value of 0.05. Results In the current study, about 45.8% (95% CI: 40.9-50.7) of the health professionals experienced good organizational communication skills. Males [AOR = 2.29; 95% CI = 1.38, 3.82], who had training in communication skills [AOR = 2.30; 95% CI = 1.46, 3.63], and those working at laboratories [AOR = 3.22; 95% CI = 1.07, 9.65] were significantly associated with organizational communication skills. Conclusion Less than half of the participants practiced good organizational communication skills. Sex, training on communication skills, and working units were important factors affecting the communication skills of healthcare providers. Interventions to improve the communication skills of healthcare providers should be instituted targeting females, those who have never taken training on communication skills, and those who are working at the ward.
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Affiliation(s)
- Samuel Demissie Darcho
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Behailu Hawulte Ayele
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Melake Demena
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dawit Firdisa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Samrawit Shawel
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ashenafi Berhanu
- School of Environmental Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Naito YT, Fukuzawa R, Ganchimeg T, Afulani PA, Aiga H, Kim R, Katsumata AT. Validation of the person-centered maternity care scale at governmental health facilities in Cambodia. PLoS One 2023; 18:e0288051. [PMID: 37410783 DOI: 10.1371/journal.pone.0288051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Women's childbirth experience of interpersonal care is a significant aspect of quality of care. Due to the lack of a reliable Cambodian version of a measurement tool to assess person-centered maternity care, the present study aimed to adapt the "Person-Centered Maternity Care (PCMC) scale" to the Cambodian context and further determine its psychometric properties. METHODS The PCMC scale was translated into Khmer using the team translation approach. The Khmer version of PCMC (Kh-PCMC) scale was pretested among 20 Cambodian postpartum women using cognitive interviewing. Subsequently, the Kh-PCMC scale was administered in a survey with 300 Cambodian postpartum women at two governmental health facilities. According to the COnsensus-based Standards for the Selection of health status Measurement Instruments (COSMIN) standard, we performed psychometric analysis, including content validity, construct validity, criterion validity, cross-cultural validity, and internal consistency. RESULTS The preliminary processes of Kh-PCMC scale development including cognitive interviewing and expert review ensured appropriate levels of content validity and acceptable levels of cross-cultural validity of the Kh-PCMC scale with four-point frequency responses. The Scale-level Content Validity Index, Average (S-CVI/Avg) of 30-item Kh-PCMC scale was 0.96. Twenty items, however, performed optimally in the psychometric analysis from the data in Cambodia. The 20-item Kh-PCMC scale produced Cronbach's alpha of 0.86 for the full scale and 0.76-0.91 for the subscales, indicating adequately high internal consistency. Hypothesis testing found positive correlations between the 20-item Kh-PCMC scale and reference measures, which implies acceptable criterion validity. CONCLUSIONS The present study produced the Kh-PCMC scale that enables women's childbirth experiences to be quantitatively measured. The Kh-PCMC scale can identify intrapartum needs from women's perspectives for quality improvement in Cambodia. However, dynamic changes in and diverse differences of cultural context over time across provinces in Cambodia require the Kh-PCMC scale to be regularly reexamined and, when needed, to be further adjusted.
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Affiliation(s)
- Yuko Takahashi Naito
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Rieko Fukuzawa
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Patience A Afulani
- Departments of Epidemiology & Biostatistics and Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Hirotsugu Aiga
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Rattana Kim
- National Maternal and Child Health Center, Phnom Penh, Cambodia
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Basagoitia A, Burrowes S, Solis-Soto MT, MacMillan G, Sullivan S. Community and provider perceptions and experiences of cervical cancer screening in Rural Bolivia: a qualitative study. BMC Womens Health 2023; 23:359. [PMID: 37407967 PMCID: PMC10324272 DOI: 10.1186/s12905-023-02500-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Despite efforts to increase cervical cancer screening access in rural Bolivia, uptake remains low. Bolivia has one of the highest cervical cancer mortality rates in the Americas. As it redoubles efforts to deliver Universal Health Care, the Bolivian government needs information on the factors constraining cervical cancer screening access and utilization, especially in rural areas. METHODS Our qualitative study explored cervical cancer screening barriers and described community and provider perceptions and experiences of care. Bolivian and US researchers analyzed data collected from eight focus groups with male and female community members (n = 80) and interviews with healthcare providers (n = 6) in four purposively selected rural communities in Hernando Siles, Bolivia. Deductive and inductive codes were used to thematically analyze data using MaxQDA software. RESULTS Four themes emerged from the data: lack of knowledge/misconceptions, health system inadequacy, lack of confidence in providers, and opportunities for improvement. Both men and women displayed misconceptions about the causes of cervical cancer, its consequences, the recommended screening frequency, and the means of accessing care. Providers noted community members' lack of knowledge and low risk-perception as utilization barriers but also highlighted poor health service quality and inconsistent health education as factors. Poor healthcare quality was a significant barrier; this included poor patient-provider communication, lack of transportation to screening facilities, and severe delays in receiving test results. Providers also noted problems with provider training and physical space for screening. Community members reported low confidence in nurses to perform screening, preferring doctors and specialists. They also expressed discomfort in having male healthcare providers conduct screening. Suggestions for improvements included more intensive cervical cancer outreach to rural areas and having specialists train lower-level providers to perform screening. CONCLUSIONS Our findings suggest that poor healthcare quality has affected screening uptake in addition to physical barriers to care. They indicate a need for initiatives to reduce reporting time for Pap test results, the incorporation of community-based HPV self-sampling into screening protocols, and the implementation of programs to improve community confidence in providers' ability to perform screening.
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Affiliation(s)
- Armando Basagoitia
- Salud Global, Urriolagoitia #354 Primer Piso Urriolagoitia 354, Sucre, Bolivia
| | - Sahai Burrowes
- Touro University California Public Health Program, CEHS, 1310 Club Drive Vallejo, Vallejo, CA 94592 USA
| | | | - Genevieve MacMillan
- Touro University California Public Health Program, CEHS, 1310 Club Drive Vallejo, Vallejo, CA 94592 USA
| | - Sarah Sullivan
- Touro University California Public Health Program, CEHS, 1310 Club Drive Vallejo, Vallejo, CA 94592 USA
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Naito YT, Fukuzawa R, Afulani PA, Kim R, Aiga H. Cultural adaptation of the person-centered maternity care scale at governmental health facilities in Cambodia. PLoS One 2023; 18:e0265784. [PMID: 36595538 PMCID: PMC9810154 DOI: 10.1371/journal.pone.0265784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 12/10/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In Cambodia, the importance of valuing women's childbirth experiences in improving quality of care has been understudied. This is largely because of absence of reliable Khmer tools for measuring women's intrapartum care experiences. Generally, cross-cultural development of those tools often involves translation from a source language into a target language. Yet, few earlier studies considered Cambodian cultural context. Thus, we developed the Cambodian version of the Person-Centered Maternity Care (PCMC) scale, by culturally adapting its original to Cambodian context for ensuring cultural equivalence and content validity. METHODS Three rounds of cognitive interviewing with 20 early postpartum women were conducted at two governmental health facilities in Cambodia. Cognitive interviewing was composed of structured questionnaire pretesting and qualitative probing. The issues identified in the process of transcribing and translating audio-recorded cognitive interviews were iteratively discussed among study team members, and further analyzed. RESULTS A total of 14 issues related to cultural adaptations were identified in the 31 translated questions for the Cambodian version of the PCMC scale. Our study identified three key findings: (i) discrepancies between the WHO recommendations on intrapartum care and Cambodian field realities; (ii) discrepancies in recognition on PCMC between national experts and local women; and (iii) challenges in correctly collecting and interpreting less-educated women's views on intrapartum care. CONCLUSION Not only women's verbal data but also their non-verbal data and cultural contexts should be comprehensively counted, when reflecting Cambodian women's intrapartum practice realities in the translated version. This is the first study that attempted to develop the tool for measuring Cambodian women's experiences during childbirth, by addressing cross-cultural issues.
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Affiliation(s)
- Yuko Takahashi Naito
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
- * E-mail:
| | - Rieko Fukuzawa
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Patience A. Afulani
- Departments of Epidemiology & Biostatistics & Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Rattana Kim
- National Maternal and Child Health Center, Phnom Penh, Cambodia
| | - Hirotsugu Aiga
- School of Tropical Medicine and Global Health, University of Nagasaki, Nagasaki, Japan
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Wachira J, Mwangi A, Genberg B, Ngeresa A, Galárraga O, Kimayo S, Dick J, Braitstein P, Wilson I, Hogan J. Continuity of Care is Associated with Higher Appointment Adherence Among HIV Patients in Low Clinician-to-Patient Ratio Facilities in Western Kenya. AIDS Behav 2022; 26:3516-3523. [PMID: 35467227 DOI: 10.1007/s10461-022-03686-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
We sought to determine the relationship between continuity of care and adherence to clinic appointments among patients receiving HIV care in high vs. low clinician-to-patient (C:P) ratios facilities in western Kenya. This retrospective analysis included 12,751 patients receiving HIV care from the Academic Model Providing Access to Healthcare (AMPATH) program, between February 2016-2019. We used logistic regression analysis with generalized estimating equations to estimate the relationship between continuity of care (two consecutive visits with the same provider) and adherence to clinic appointments (within 7 days of a scheduled appointment) over time. Adjusting for covariates, patients in low C:P ratio facilities who had continuity of care, were more likely to be adherent to their appointments compared to those without continuity (adjusted odds ratio = 1.50; 95% confidence interval, 1.33-1.69). Continuity in HIV care may be a factor in clinical adherence among patients in low C:P ratio facilities and should therefore be promoted.
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Affiliation(s)
- Juddy Wachira
- Department of Mental Health & Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University Eldoret, P.O Box 4604-30100, Eldoret, Kenya.
- Department of Media Studies, School of Literature, Language and Media, University of Witwatersrand, Johannesburg, South Africa.
| | - Ann Mwangi
- Department of Maths, Physics and Computing, School of Science and Aerospace Studies, Moi University, Eldoret, Kenya
| | - Becky Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anthony Ngeresa
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Omar Galárraga
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Sylvester Kimayo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Jonathan Dick
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ira Wilson
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Joseph Hogan
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, USA
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Gillipelli SR, Kaye EC, Garza M, Ferrara G, Rodriguez M, Soberanis Vasquez DJ, Mendez Aceituno A, Antillón‐Klussmann F, Gattuso JS, Mandrell BN, Baker JN, Rodriguez‐Galindo C, Agulnik A, Graetz DE. Pediatric Early Warning Systems (PEWS) improve provider-family communication from the provider perspective in pediatric cancer patients experiencing clinical deterioration. Cancer Med 2022; 12:3634-3643. [PMID: 36128882 PMCID: PMC9939098 DOI: 10.1002/cam4.5210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/05/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Communication between providers and patients' families is an integral part of clinical care. Family concern is a validated component of Pediatric Early Warning Systems (PEWS); however, little is known about the impact of PEWS on provider-family communication. METHODS Semi-structured interviews were conducted with 83 ward and Pediatric Intensive Care Unit (PICU) providers involved in the care of patients with deterioration at two pediatric oncology hospitals of different resource levels: St. Jude Children's Research Hospital (n = 42) in the United States and Unidad Nacional de Oncología Pediátrica (UNOP, n = 41) in Guatemala. Interviews were conducted in the participants' native language (English or Spanish), transcribed, and translated into English. Transcripts were coded by two researchers and analyzed for thematic content surrounding family communication and concern. RESULTS All participants recognized patients' families as a valuable part of the care team, particularly during events requiring escalation of care. Perceived barriers to communication included limited time spent at the bedside, and, at UNOP, language and literacy challenges which occasionally limited providers' ability to assess family concern and involve families in patient care. Despite these barriers, providers perceived PEWS improved communication by facilitating more interaction with families, allowing for relationship-building, anticipatory guidance, and destigmatization of the PICU. PEWS assessments also allowed families to contribute to identification of deterioration. CONCLUSIONS PEWS improve the quality of communication between providers and families by providing more opportunities for interaction, building relationships, and trust. These findings further support the use of PEWS in the care of children with cancer in hospitals of all resource-levels.
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Affiliation(s)
- Srinithya R. Gillipelli
- Baylor College of MedicineHoustonTexasUSA,Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Erica C. Kaye
- Division of Quality of Life and Palliative CareSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Marcela Garza
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Gia Ferrara
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Mario Rodriguez
- Department of OncologyUnidad Nacional de Oncología PediátricaGuatemala CityGuatemala
| | | | | | - Federico Antillón‐Klussmann
- Department of OncologyUnidad Nacional de Oncología PediátricaGuatemala CityGuatemala,School of MedicineFrancisco Marroquin UniversityGuatemala CityGuatemala
| | - Jami S. Gattuso
- Department of Nursing ResearchSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Belinda N. Mandrell
- Department of Nursing ResearchSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Justin N. Baker
- Division of Quality of Life and Palliative CareSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | | | - Asya Agulnik
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Dylan E. Graetz
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
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Musitia P, Boga M, Oluoch D, Haaland A, Nzinga J, English M, Molyneux S. Strengthening respectful communication with patients and colleagues in neonatal units - developing and evaluating a communication and emotional competence training for nurse managers in Kenya. Wellcome Open Res 2022; 7:223. [PMID: 38708375 PMCID: PMC11066535 DOI: 10.12688/wellcomeopenres.18006.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 05/07/2024] Open
Abstract
Introduction: Effective communication is essential to delivering compassionate, high-quality nursing care. The intensive, stressful and technical environment of a new-born unit (NBU) in a low-resource setting presents communication-related challenges for nurses, with negative implications for nurse well-being, team relationships and patient care. We adapted a pre-existing communication and emotional competence course with NBU nurse managers working in Kenya, explored its' value to participants and developed a theory of change to evaluate its' potential impact. Methods: 18 neonatal nurse managers from 14 county referral hospitals helped adapt and participated in a nine-month participatory training process. Training involved guided 'on the job' self-observation and reflection to build self-awareness, and two face-to-face skills-building workshops. The course and potential for future scale up was assessed using written responses from participant nurses (baseline questionnaires, reflective assignments, pre and post workshop questionnaires), workshop observation notes, two group discussions and nine individual in-depth interviews. Results: Participants were extremely positive about the course, with many emphasizing its direct relevance and applicability to their daily work. Increased self-awareness and ability to recognize their own, colleagues' and patients' emotional triggers, together with new knowledge and practical skills, reportedly inspired nurses to change; in turn influencing their ability to provide respectful care, improving their confidence and relationships and giving them a stronger sense of professional identity. Conclusion: Providing respectful care is a major challenge in low-resource, high-pressure clinical settings but there are few strategies to address this problem. The participatory training process examined addresses this challenge and has potential for positive impacts for families, individual workers and teams, including worker well-being. We present an initial theory of change to support future evaluations aimed at exploring if and how positive gains can be sustained and spread within the wider system.
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Affiliation(s)
- Peris Musitia
- Health Service Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mwanamvua Boga
- Health Service Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Dorothy Oluoch
- Health Service Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ane Haaland
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jacinta Nzinga
- Health Service Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mike English
- Health Service Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Oxford Centre for Global Health Research, Oxford, Oxford, UK
| | - Sassy Molyneux
- Health Service Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Oxford Centre for Global Health Research, Oxford, Oxford, UK
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Ndwiga C, Warren CE, Okondo C, Abuya T, Sripad P. Experience of care of hospitalized newborns and young children and their parents: A scoping review. PLoS One 2022; 17:e0272912. [PMID: 36037213 PMCID: PMC9423633 DOI: 10.1371/journal.pone.0272912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 07/28/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Several global initiatives put parent involvement at the forefront of enabling children's well-being and development and to promote quality of care for newborns and hospitalized young children aged 0-24 months. Scanty evidence on mistreatment such as delays or neglect and poor pain management among newborns exists, with even less exploring the experience of their parents and their hospitalized young children. To address this gap, authors reviewed research on experience of care for hospitalized young children and their parents, and potential interventions that may promote positive experience of care. METHODS A scoping review of English language articles, guidelines, and reports that addressed the experiences of care for newborns and sick young children 0-24 months in health facilities was conducted. Multiple databases: PubMed, PROSPERO, COCHRANE Library and Google Scholar were included and yielded 7,784 articles. Documents published between 2009 and November 2020, in English and with evidence on interventions that addressed family involvement and partnership in care for their sick children were included. RESULTS The scoping review includes 68 documents across 31 countries after exclusion. Mistreatment of newborns comprises physical abuse, verbal abuse, stigma and discrimination, failure to meet professional standards, poor rapport between providers and patients, poor legal accountability, and poor bereavement and posthumous care. No literature was identified describing mistreatment of hospitalized children aged 60 days- 24 months. Key drivers of mistreatment include under-resourced health systems and poor provider attitudes. Positive experience of care was reported in contexts of good parent-provider communication. Three possible interventions on positive experience of care for hospitalized young children (0-24 months) emerged: 1) nurturing care; 2) family centered care and 3) provider and parental engagement. Communication and counseling, effective provider-parental engagement, and supportive work environments were associated with reduced anxiety and stress for parents and hospitalized young children. Few interventions focused on addressing providers' underlying attitudes and biases that influence provider behaviors, and how they affect engaging with parents. CONCLUSION Limited evidence on manifestations of mistreatment, lack of respectful care, drivers of poor experience and interventions that may mitigate poor experience of care for hospitalized young children 0-24 months especially in low resource settings exists. Design and testing appropriate models that enhance socio-behavioral dimensions of care experience and promote provider-family engagement in hospitals are required.
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Affiliation(s)
| | | | | | | | - Pooja Sripad
- Population Council, Washington, DC, United States of America
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Schmitz T, Beynon F, Musard C, Kwiatkowski M, Landi M, Ishaya D, Zira J, Muazu M, Renner C, Emmanuel E, Bulus SG, Rossi R. Effectiveness of an electronic clinical decision support system in improving the management of childhood illness in primary care in rural Nigeria: an observational study. BMJ Open 2022; 12:e055315. [PMID: 35863838 PMCID: PMC9310162 DOI: 10.1136/bmjopen-2021-055315] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the impact of ALgorithm for the MANAgement of CHildhood illness ('ALMANACH'), a digital clinical decision support system (CDSS) based on the Integrated Management of Childhood Illness, on health and quality of care outcomes for sick children attending primary healthcare (PHC) facilities. DESIGN Observational study, comparing outcomes of children attending facilities implementing ALMANACH with control facilities not yet implementing ALMANACH. SETTING PHC facilities in Adamawa State, North-Eastern Nigeria. PARTICIPANTS Children 2-59 months presenting with an acute illness. Children attending for routine care or nutrition visits (eg, immunisation, growth monitoring), physical trauma or mental health problems were excluded. INTERVENTIONS The ALMANACH intervention package (CDSS implementation with training, mentorship and data feedback) was rolled out across Adamawa's PHC facilities by the Adamawa State Primary Health Care Development Agency, in partnership with the International Committee of the Red Cross and the Swiss Tropical and Public Health Institute. Tablets were donated, but no additional support or incentives were provided. Intervention and control facilities received supportive supervision based on the national supervision protocol. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was caregiver-reported recovery at day 7, collected over the phone. Secondary outcomes were antibiotic and antimalarial prescription, referral, and communication of diagnosis and follow-up advice, assessed at day 0 exit interview. RESULTS We recruited 1929 children, of which 1021 (53%) attended ALMANACH facilities, between March and September 2020. Caregiver-reported recovery was significantly higher among children attending ALMANACH facilities (adjusted OR=2·63, 95% CI 1·60 to 4·32). We observed higher parenteral and lower oral antimicrobial prescription rates (adjusted OR=2·42 (1·00 to 5·85) and adjusted OR=0·40 (0·22 to 0·73), respectively) in ALMANACH facilities as well as markedly higher rates for referral, communication of diagnosis, and follow-up advice. CONCLUSION Implementation of digital CDSS with training, mentorship and feedback in primary care can improve quality of care and recovery of sick children in resource-constrained settings, likely mediated by better guideline adherence. These findings support the use of CDSS for health systems strengthening to progress towards universal health coverage.
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Affiliation(s)
- Torsten Schmitz
- University of Basel, Basel, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Fenella Beynon
- University of Basel, Basel, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Capucine Musard
- University of Basel, Basel, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Marek Kwiatkowski
- University of Basel, Basel, Switzerland
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Marco Landi
- Regional Delegation Nigeria, International Committee of the Red Cross, Jimeta Yola, Nigeria
| | - Daniel Ishaya
- Adamawa State Primary Health Care Development Agency, Jimeta Yola, Nigeria
| | - Jeremiah Zira
- Adamawa State Primary Health Care Development Agency, Jimeta Yola, Nigeria
| | - Muazu Muazu
- Adamawa State Primary Health Care Development Agency, Jimeta Yola, Nigeria
| | - Camille Renner
- University of Basel, Basel, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Edwin Emmanuel
- Regional Delegation Nigeria, International Committee of the Red Cross, Jimeta Yola, Nigeria
| | | | - Rodolfo Rossi
- Health Unit, International Committee of the Red Cross, Geneve, Switzerland
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Kohrt BA, Turner EL, Gurung D, Wang X, Neupane M, Luitel NP, Kartha MR, Poudyal A, Singh R, Rai S, Baral PP, McCutchan S, Gronholm PC, Hanlon C, Lempp H, Lund C, Thornicroft G, Gautam K, Jordans MJD. Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial. Implement Sci 2022; 17:39. [PMID: 35710491 PMCID: PMC9205129 DOI: 10.1186/s13012-022-01202-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/10/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. DESIGN In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. DISCUSSION This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. TRIAL REGISTRATION ClinicalTrials.gov, NCT04282915 . Date of registration: February 25, 2020.
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Affiliation(s)
- Brandon A. Kohrt
- grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington D.C., USA
| | - Elizabeth L. Turner
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Pokhara, Nepal
| | - Xueqi Wang
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Mani Neupane
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Pokhara, Nepal
| | - Nagendra P. Luitel
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Muralikrishnan R. Kartha
- grid.13097.3c0000 0001 2322 6764King’s Health Economics, IOPPN, King’s College London, London, UK
| | - Anubhuti Poudyal
- grid.21729.3f0000000419368729Department of Sociomedical Sciences, Columbia University, New York, NY USA ,grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, D.C., 20036 USA
| | - Ritika Singh
- grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, D.C., 20036 USA
| | - Sauharda Rai
- grid.34477.330000000122986657Jackson School of International Studies and Department of Global Health, University of Washington, Seattle, USA
| | - Phanindra Prasad Baral
- grid.500537.4Non-communicable Disease and Mental Health Section, Epidemiology and Disease Control Division (EDCD), Department of Health Services (DoHS), Ministry of Health and Population (MoHP), Kathmandu, Nepal
| | - Sabrina McCutchan
- grid.26009.3d0000 0004 1936 7961Duke Global Health Institute, Duke University, Durham, NC USA
| | - Petra C. Gronholm
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charlotte Hanlon
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine and Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- grid.13097.3c0000 0001 2322 6764Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Crick Lund
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7836.a0000 0004 1937 1151Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Mark J. D. Jordans
- grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King’s College London, London, UK
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Hämmerli P, Moukam AD, Wisniak A, Sormani J, Vassilakos P, Kenfack B, Petignat P, Schmidt NC. "My motivation was to save": a qualitative study exploring factors influencing motivation of community healthcare workers in a cervical cancer screening program in Dschang, Cameroon. Reprod Health 2022; 19:133. [PMID: 35668427 PMCID: PMC9167909 DOI: 10.1186/s12978-022-01420-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer is a major public health issue among women in Cameroon and uptake of screening programs remains a challenge in many low- and middle-income countries. Community healthcare workers can play an important role in promoting cervical cancer services. This study aimed to explore factors affecting the motivation of community healthcare workers in a cervical cancer screening program in Dschang, Cameroon. Methods A qualitative approach including 11 in-depth individual interviews with community healthcare workers was used. The interviews were audio-recorded, transcribed and coded using thematic analysis assisted by ATLAS.ti software. Results Four women and seven men aged between 21 and 77 years old were interviewed. Community healthcare workers had high motivation. Factors affecting motivation were divided into individual and environmental level, based on a theoretical framework. Factors with a positive influence on motivation were mainly on the individual side while impeding factors were mainly associated with the environmental level. Conclusions Key interventions to improve motivation among community healthcare workers include: (i) more training and supportive supervision; (ii) evaluation of remuneration systems by workload; and (iii) provision of job-enabling resources such as uniforms, cellphone cards and transport. Trial registration: Geneva Cantonal Ethics Committee on Human Research (No. 2017-01110) and the Cameroonian National Ethics Committee for Human Health Research (No. 2018/07/1083/CE/CNERSH/SP). Cervical cancer is the second leading cause of cancer-related death among women in Cameroon. This is mainly due to the absence of routine cervical cancer screening programs and the lack of treatment. However, even in case of availability of cervical cancer screening programs, barriers exist. Therefore, community healthcare workers have been involved successfully to increase the screening coverage. As retention of these actors remains a challenge, the main objective of this study was to identify key factors affecting their motivation aiming to suggest interventions to address motivational factors. 11 qualitative interviews with individual community healthcare workers were conducted at a cervical cancer screening program in Dschang, Cameroon. Motivation was generally high and affecting factors were divided into the individual and the environmental level. Factors with a positive influence on motivation were mainly on the individual side while impeding factors were mainly associated with the environmental level. Ongoing collaboration with community healthcare workers is beneficial for cervical cancer screening programs, and key interventions should therefore include: (i) more training and supportive supervision; (ii) evaluation of remuneration systems by workload; and (iii) provision of job-enabling resources such as uniforms, cellphone cards and transport.
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Affiliation(s)
| | - Alida Datchoua Moukam
- Department of Gynaecology and Obstetrics, District Hospital of Dschang, Dschang, Cameroon
| | - Ania Wisniak
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Jessica Sormani
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.,Geneva School of Health Sciences, HESSO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Bruno Kenfack
- Department of Gynaecology and Obstetrics, District Hospital of Dschang, Dschang, Cameroon
| | - Patrick Petignat
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicole Christine Schmidt
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland. .,Faculty of Social Science, Catholic University of Applied Science, Preysingstr. 95, 81667, Munich, Germany.
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Okondo C, Ndwiga C, Sripad P, Abuya T, Warren CE. " You can't even ask a question about your child": Examining experiences of parents or caregivers during hospitalization of their sick young children in Kenya: A qualitative study. FRONTIERS IN HEALTH SERVICES 2022; 2:947334. [PMID: 36925844 PMCID: PMC10012665 DOI: 10.3389/frhs.2022.947334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Background Globally, about 5.2 million children under the age of five died in 2019, and more than half of those deaths occurred in Sub-Saharan Africa. In almost every death of a sick child, there is a parent/caregiver seeking health services for their child. This study sought to understand the experiences of care for parents/caregivers (caregivers) as they navigate the hospital system with the aim of identifying opportunities to improve service delivery and child health outcomes. Methods Qualitative data were collected from five hospitals in Kenya: three in Nairobi County and two in Bungoma County. Twenty-five in-depth interviews with caregivers (couples and single women) of young children 0-24 months old, 17 focus group discussions with women and men, and 64 institutional ethnographic observations were completed. Data were analyzed by initial annotation of transcripts and field materials, followed by open coding and thematic analysis using Nvivo 12 software. Summary themes were used to compare experiences between female and male caregivers, their child's age group, and study sites. Results Caregivers faced complex processes of care while seeking health services for their sick young children. Three overarching themes emerged with some variability across female and male caregiver perspectives: (1) Navigating structural issues: long wait times, confusing payment mechanisms, overcrowding, unhygienic conditions, and strict visitation policies; (2) Interactions with providers: positive experiences, including providers showing empathy and concern, and negative experiences of harsh language, neglect, lack of privacy, discounting caregiver perspectives, and not involving men; Limited communication between caregivers and providers on child's diagnosis, treatment, and progress and lack of communication specifically between male caregivers and providers; and (3) Limited emotional support for both caregivers during difficult diagnosis or bereavement. Conclusions To improve experiences, interventions, programs, and policies need to focus on good provider-caregiver partnerships; enhancing opportunities for male engagement, such as supportive visiting hours; effective communication between caregivers and providers; access to adequate emotional support; and an enabling hospital environment.
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Affiliation(s)
| | | | - Pooja Sripad
- Population Council, Washington, DC, United States
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Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi. PLoS One 2021; 16:e0255788. [PMID: 34379657 PMCID: PMC8357126 DOI: 10.1371/journal.pone.0255788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 07/23/2021] [Indexed: 11/19/2022] Open
Abstract
Malawi faces challenges with retaining women in prevention of mother-to-child HIV transmission (PMTCT) services. We evaluated Cooperative for Assistance and Relief Everywhere, Inc. (CARE's) community score card (CSC) in 11 purposively selected health facilities, assessing the effect on: (1) retention in PMTCT services, (2) uptake of early infant diagnosis (EID), (3) collective efficacy among clients, and (4) self-efficacy among health care workers (HCWs) in delivering quality services. The CSC is a participatory community approach. In this study, HCWs and PMTCT clients identified issues impacting PMTCT service quality and uptake and implemented actions for improvement. A mixed-methods, pre- and post-intervention design was used to evaluate the intervention. We abstracted routine clinical data on retention in PMTCT services for HIV-positive clients attending their first antenatal care visit and EID uptake for their infants for 8-month periods before and after implementation. To assess collective efficacy and self-efficacy, we administered questionnaires and conducted focus group discussions (FGDs) pre- and post-intervention with PMTCT clients recruited from CSC participants, and HCWs providing HIV care from facilities. Retention of HIV-positive women in PMTCT services at three and six months and EID uptake was not significantly different pre- and post-implementation. For the clients, the collective efficacy scale average improved significantly post-intervention, (p = 0.003). HCW self-efficacy scale average did not improve. Results from the FGDs highlighted a strengthened relationship between HCWs and PMTCT clients, with clients reporting increased satisfaction with services. However, the data indicated continued challenges with stigma and fear of disclosure. While CSC may foster mutual trust and respect between HCWs and PMTCT clients, we did not find it improved PMTCT retention or EID uptake within the short duration of the study period. More research is needed on ways to improve service quality and decrease stigmatized behaviors, such as HIV testing and treatment services, as well as the longer-term impacts of interventions like the CSC on clinical outcomes.
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"Cervical cancer screening: awareness is not enough". Understanding barriers to screening among women in West Cameroon-a qualitative study using focus groups. Reprod Health 2021; 18:147. [PMID: 34243778 PMCID: PMC8268254 DOI: 10.1186/s12978-021-01186-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer is the second leading cause of cancer-related death among women in sub-Saharan countries, constituting a major public health concern. In Cameroon, cervical cancer ranks as the second most common type of cancer among women and the leading cause of cancer-related deaths, mainly due to the lack of prevention. OBJECTIVES Our first and main objective was to understand the barriers affecting women's decision-making process regarding participation in a cervical cancer screening program in the Dschang district (West Cameroon). Second, we aimed to explore the acceptability and perception of a single-visit approach (screen and treat). METHODS A qualitative study using focus groups (FGs) was conducted from February to March 2020. Female participants aged between 30 and 49 years and their male partners were invited to participate. Thematic analysis was used, and barriers were classified according to the three-delay model of Thaddeus and Maine. RESULTS In total, six FGs with 43 participants (31 women and 12 men) were conducted. The most important barriers were lack of health literacy, low accessibility of the program (in respect to cost and distance), and disrespectful treatment by healthcare workers. CONCLUSIONS Our study identified three needs: (1) enhancing health literacy; (2) improving the delivery of cervical cancer screening in rural areas; and (3) providing training for healthcare providers and community healthcare workers to improve patient-provider-communication. Trial registration Ethical Cantonal Board of Geneva, Switzerland (CCER, N°2017-0110 and CER-amendment n°3) and Cameroonian National Ethics Committee for Human Health Research (N°2018/07/1083/CE/CNERSH/SP). NCT: 03757299.
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16
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Olaniyan A, Isiguzo C, Hawk M. The Socioecological Model as a framework for exploring factors influencing childhood immunization uptake in Lagos state, Nigeria. BMC Public Health 2021; 21:867. [PMID: 33952252 PMCID: PMC8098781 DOI: 10.1186/s12889-021-10922-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background Nigeria is one of the ten countries globally that account for 62% of under- and unvaccinated children worldwide. Despite several governmental and non-governmental agencies’ interventions, Nigeria has yet to achieve significant gains in childhood immunization coverage. This study identifies intrapersonal, interpersonal, organizational, community, and policy-level factors that influence childhood immunization uptake from various stakeholders’ perspectives using the Socioecological Model (SEM). Methods Using the Socioecological Model as a guiding framework, we conducted ten focus group sessions with mothers/caregivers and community leaders residing in Lagos state and nine semi-structured interviews with healthcare workers who provide routine immunization services in Lagos state primary healthcare facilities. We performed a qualitative analysis of focus groups and semi-structured interviews using deductive coding methods. Results The study sample included 44 mothers/caregivers and 24 community leaders residing in Lagos State, Nigeria, and 19 healthcare workers (routine immunization focal persons) working in the primary healthcare setting in Lagos state. Study participants discussed factors at each level of the SEM that influence childhood immunization uptake, including intrapersonal (caregivers’ immunization knowledge, caregivers’ welfare and love of child/ren), interpersonal (role of individual relationships and social networks), organizational (geographical and financial access to health facilities, health facilities attributes, staff coverage, and healthcare worker attributes), community (community outreaches and community resources), and policy-level (free immunization services and provision of child immunization cards). Several factors were intertwined, such as healthcare workers’ education of caregivers on immunization and caregivers’ knowledge of vaccination. Conclusions The reciprocity of the findings across the Socioecological Model levels emphasizes the importance of developing multi-pronged interventions that operate at multiple levels of the SEM. Our results can inform the design of culturally appropriate and effective interventions to address Nigeria’s suboptimal immunization coverage.
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Affiliation(s)
- Abisola Olaniyan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA.
| | - Chinwoke Isiguzo
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA
| | - Mary Hawk
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA
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Johnson E, Heyns T, Nilsson S. Nurses' perspectives on alternative communication strategies use in critical care units. Nurs Crit Care 2021; 27:120-129. [PMID: 33624908 DOI: 10.1111/nicc.12612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Critically ill patients have the right to communicate and participate in their treatment to avoid adverse medical outcomes due to the severity of their illness, their responsiveness, and level of consciousness. This human right has often been neglected by health care professionals, as a result of limited alternative communication support provided to patients who are unable to speak due to, for example, endotracheal intubation. Despite the successful use of alternative communication strategies in critical care units (CCUs) in other countries, limited implementation in South African hospitals has been reported. AIMS AND OBJECTIVES This study aimed to determine the perspectives of South African nurses working in CCUs on the frequency of use of alternative communication strategies to support patient-centred communication with critically ill adult patients. DESIGN The study followed a quantitative non-experimental survey research design. METHODS A total of 210 nurses working in both private and public hospitals completed a survey on their perspectives on the use of alternative communication strategies in CCUs. RESULTS Nurse participants reported experience working with critically ill and communication-vulnerable patients. Nurse-patient communication mainly involved the use of pen and paper, facial expressions and gestures to obtain information relating to patients' needs and their health history. Limited use of speech-generating communication devices was reported. CONCLUSION Nurse training on the use and implementation of alternative communication strategies, such as communication boards or electronic speech-generating devices, should be investigated to improve nurses' communication with communication-vulnerable patients in South Africa. RELEVANCE TO CLINICAL PRACTICE The results are applicable in clinical practice due to patients' need for alternative communication. The nurses mainly used low-tech solutions, which are cheap and easy to access. However, there exists an opportunity to increase the use of available digital solutions.
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Affiliation(s)
- Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Tanya Heyns
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
| | - Stefan Nilsson
- Institute of Health and Care Sciences, University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Manu A, Zaka N, Bianchessi C, Maswanya E, Williams J, Arifeen SE. Respectful maternity care delivered within health facilities in Bangladesh, Ghana and Tanzania: a cross-sectional assessment preceding a quality improvement intervention. BMJ Open 2021; 11:e039616. [PMID: 33472772 PMCID: PMC7818820 DOI: 10.1136/bmjopen-2020-039616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess respectful maternity care (RMC) in health facilities. DESIGN Cross-sectional study. SETTING Forty-three (43) facilities across 15 districts in Bangladesh, 16 in Ghana and 12 in Tanzania. PARTICIPANTS Facility managers; 325 providers (nurses/midwives/doctors)-Bangladesh (158), Ghana (86) and Tanzania (81); and 849 recently delivered women-Bangladesh (295), Ghana (381) and Tanzania (173)-were interviewed. Observation of 641 client-provider interactions was conducted-Bangladesh (387), Ghana (134) and Tanzania (120). ASSESSMENT Trained social scientists and clinicians assessed infrastructure, policies, provision and women's experiences of RMC (emotional support, respectful care and communication). PRIMARY OUTCOME RMC provided and/or experienced by women. RESULTS Three (20%) facilities in Bangladesh, four (25%) in Ghana and three (25%) in Tanzania had no maternity clients' toilets and one-half had no handwashing facilities. Policies for RMC such as identification of client abuses were available: 81% (Ghana), 73% (Bangladesh) and 50% (Tanzania), but response was poor. Ninety-four (60%) Bangladeshi, 26 (30%) Ghanaian and 20 (25%) Tanzanian providers were not RMC trained. They provided emotional support during labour care to 107 (80%) women in Ghana, 95 (79%) in Tanzania and 188 (48.5%) in Bangladesh, and were often courteous with them-236 (61%) in Bangladesh, 119 (89%) in Ghana and 108 (90%) in Tanzania. Due to structural challenges, 169 (44%) women in Bangladesh, 49 (36%) in Ghana and 77 (64%) in Tanzania had no privacy during labour. Care was refused to 13 (11%) Tanzanian and 2 Bangladeshi women who could not pay illegal charges. Twenty-five (7%) women in Ghana, nine (6%) in Bangladesh and eight (5%) in Tanzania were verbally abused during care. Providers in all countries highly rated their care provision (95%-100%), and 287 (97%) of Bangladeshi women, 368 (97%) Ghanaians and 152 (88%) Tanzanians reported 'satisfaction' with the care they received. However, based on their facility experiences, significant (p<0.001) percentages-20% (Ghana) to 57% (Bangladesh)-will not return to the same facilities for future childbirth. CONCLUSIONS Facilities in Bangladesh, Ghana and Tanzania have foundational systems that facilitate RMC. Structural inadequacies and policy gaps pose challenges. Many women were, however, unwilling to return to the same facilities for future deliveries although they (and providers) highly rated these facilities.
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Affiliation(s)
- Alexander Manu
- Epidemiology and Disease Cintrol, School of Public Health, University of Ghana, Legon, Accra, Ghana
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nabila Zaka
- Headquarters, UNICEF, New York City, New York, USA
| | | | - Edward Maswanya
- National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
| | | | - Shams E Arifeen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
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Bhura M, Ariff S, Qazi SA, Qazi Z, Ahmed I, Nisar YB, Suhag Z, Soomro AW, Soofi SB. Evaluating implementation of "management of Possible Serious Bacterial Infection (PSBI) when referral is not feasible" in primary health care facilities in Sindh province, Pakistan. PLoS One 2020; 15:e0240688. [PMID: 33052981 PMCID: PMC7556471 DOI: 10.1371/journal.pone.0240688] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background The World Health Organization (WHO) launched a guideline in 2015 for managing Possible Serious Bacterial Infection (PSBI) when referral is not feasible in young infants aged 0–59 days. This guideline was implemented across 303 Basic Health Unit (BHU) Plus primary health care (PHC) facilities in peri-urban and rural settings of Sindh, Pakistan. We evaluated the implementation of PSBI guideline, and the quality of care provided to sick young infants at these facilities. Methods Thirty (10%) out of 303 BHU Plus facilities were randomly selected for evaluation. A survey team visited each facility for one day, assessed the health system support, observed the management of sick young infants by health care providers (HCP), validated their management, interviewed HCPs and caretakers of sick infants. HCPs who were unable to see a young infant on the day of survey were evaluated using pre-prepared case scenarios. Results Thirty (100%) BHU Plus facilities had oral amoxicillin, injectable gentamicin, thermometers, baby weighing scales and respiratory timers available; 29 (97%) had disposable syringes and needles; 28 (93%) had integrated management of childhood illness (IMCI)/PSBI chart booklets and job aids and 18 (60%) had a functional ambulance. Each facility had at least one HCP trained in PSBI, and 21 (70%) facilities had been visited by a supervisor in the preceding six months. Of 42 HCPs, 19 (45.3%) were trained within the preceding 12 months. During the survey, 26 sick young infants were identified in 18 facilities. HCPs asked about history of breastfeeding in 23 (89%) infants, history of vomiting in 17 (65%), and history of convulsions in 14 (54%); weighed 25 (97%) infants; measured respiratory rate in all (100%) and temperature in 24 (92%); assessed 20 (77%) for movement and 14 (54%) for chest indrawing. HCPs identified two infants with fast breathing pneumonia and managed them correctly per IMCI/PSBI protocol. HCPs identified six (23%) infants with clinical severe infection (CSI), two of them were referred to a higher-level facility, only one accepted the referral advice. Only one CSI patient was managed correctly per IMCI/PSBI protocol at the outpatient level. HCPs described the PSBI danger signs to eight (31%) caretakers. Caretakers of five infants with CSI and two with pneumonia were not counselled for PSBI danger signs. Five of the six CSI cases categorized by HCPs were validated as CSI on re-examination, whereas one had pneumonia. Similarly, one of the two pneumonia patients categorized by HCPs had CSI and one identified as local bacterial infection was classified as CSI upon re-examination. Conclusion Health system support was adequate but clinical management and counselling by HCPs was sub-optimal particularly with CSI cases who are at higher risk of adverse outcomes. Scaling up PSBI management is potentially feasible in PHC facilities in Pakistan, provided that HCPs are trained well and mentored, receive refresher training to appropriately manage sick young infants, and have adequate supplies and counselling skills.
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Affiliation(s)
- Maria Bhura
- Center of Excellance in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shamim Ahmad Qazi
- Retired from Department of Maternal, Newborn, Child, and Adolescent Health, WHO, Working as a WHO Consultant, Geneva, Switzerland
| | | | - Imran Ahmed
- Center of Excellance in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Yasir bin Nisar
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Zamir Suhag
- People’s Primary Healthcare Initiative, Sindh, Pakistan
| | | | - Sajid Bashir Soofi
- Center of Excellance in Women & Child Health, Aga Khan University, Karachi, Pakistan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- * E-mail:
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Camara BS, Belaid L, Manet H, Kolie D, Guillard E, Bigirimana T, Delamou A. What do we know about patient-provider interactions in sub-Saharan Africa? a scoping review. Pan Afr Med J 2020; 37:88. [PMID: 33244351 PMCID: PMC7680249 DOI: 10.11604/pamj.2020.37.88.24009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/17/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction patient-centred care has become a rallying call for improving quality and access to care in countries where health system responsiveness and satisfaction with health services remain low. Understanding patient-provider interactions is important to guide implementation of an effective patient-centred care approach in sub-Saharan Africa. This review aims to overcome this knowledge gap by synthesizing the evidence on patient-provider interactions in sub-Saharan Africa. Methods we conducted a scoping review using Arksey and O´Malley´s framework. We searched in eight databases and the grey literature. We conducted a thematic analysis using an inductive approach to assess the studies. Results of the 80 references identified through database searching, nine met the inclusion criteria. Poor communication and several types of mistreatment (service denial, oppressive language, harsh words and rough examination) characterize patient-provider interactions in sub-Saharan Africa. Nevertheless, some health providers offer support to patients who cannot afford their medical expenses, cost of transportation, food or other necessities. Maintaining confidentiality depends on the context of care. Some patients blamed health providers for consulting with the door open or carrying out concomitant activities in the consultation room. However, in the context of HIV care provision, nurses emphasized the importance of keeping their patients´ HIV status confidential. Conclusion this review advocates for more implementation studies on patient-provider interactions in sub-Saharan Africa so as to inform policies and practices for patient-centred health systems. Decision-makers should prioritize training, mentorship and regular supportive supervision of health providers to provide patient-centred care. Patients should be empowered in care processes.
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Affiliation(s)
- Bienvenu Salim Camara
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Loubna Belaid
- Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Hawa Manet
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Delphin Kolie
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | | | | | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
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Laterra A, Callahan T, Msiska T, Woelk G, Chowdhary P, Gullo S, Mwale PM, Modi S, Chauwa F, Kayira D, Kalua T, Wako E. Bringing women's voices to PMTCT CARE: adapting CARE's Community Score Card© to engage women living with HIV to build quality health systems in Malawi. BMC Health Serv Res 2020; 20:679. [PMID: 32698814 PMCID: PMC7376699 DOI: 10.1186/s12913-020-05538-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/13/2020] [Indexed: 11/19/2022] Open
Abstract
Background Coverage of prevention of mother-to-child transmission of HIV (PMTCT) services has expanded rapidly but approaches to ensure service delivery is patient-centered have not always kept pace. To better understand how the inclusion of women living with HIV in a collective, quality improvement process could address persistent gaps, we adapted a social accountability approach, CARE’s Community Score Card© (CSC), to the PMTCT context. The CSC process generates perception-based score cards and facilitates regular quality improvement dialogues between service users and service providers. Methods Fifteen indicators were generated by PMTCT service users and providers as part of the CSC process. These indicators were scored by each population during three sequential cycles of the CSC process which culminates in a sharing of scores in a collective meeting followed by action planning. We aggregated these scores across facilities and analyzed the differences in first and last scorings to understand perceived improvements over the course of the project (z-test comparing the significance of two proportions; one-tailed p-value ≤ .05). Data were collected over 12 months from September 2017 to August 2018. Results Fourteen of the fifteen indicators improved over the course of this project, with eight showing statistically significant improvement. Out of the indicators that showed statistically significant improvement, the majority fell within the control of local communities, local health facilities, or service providers (7 out of 8) and were related to patient or user experience and support from families and community members (6 out of 8). From first to last cycle, scores from service users’ and service providers’ perspectives converged. At the first scoring cycle, four indicators exhibited statistically significant differences (p-value ≤ .05) between service users and service providers. At the final cycle there were no statistically significant differences between the scores of these two groups. Conclusions By creating an opportunity for mothers living with HIV, health service providers, communities, and local government officials to jointly identify issues and implement solutions, the CSC contributed to improvements in the perceived quality of PMTCT services. The success of this model highlights the feasibility and importance of involving people living with HIV in quality improvement and assurance efforts. Trial registration Trial registration: ClincalTrials.gov NCT04372667 retrospectively registered on May 1st 2020.
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Affiliation(s)
- Anne Laterra
- CARE USA, 151 Ellis Street NE, Atlanta, GA, USA.
| | - Tegan Callahan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Godfrey Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, D.C, USA
| | | | - Sara Gullo
- Independent consultant, Atlanta, GA, USA
| | | | - Surbhi Modi
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Felluna Chauwa
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Dumbani Kayira
- Centers for Disease Control and Prevention, Lilongwe, Malawi
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Kahindi J, Jones C, Berkley JA, Mwangome M. Establishing exclusive breastfeeding among in-patient malnourished infants in a rural Kenyan hospital: mothers' experiences of a peer supporter intervention. Int Breastfeed J 2020; 15:40. [PMID: 32408904 PMCID: PMC7227239 DOI: 10.1186/s13006-020-00278-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 04/13/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The 2013 WHO guidelines for nutritional rehabilitation of hospitalized and non-hospitalized malnourished infants under six months (u6m) recommend the re-establishment of exclusive breastfeeding. However, in most low-income settings these recommendations are not consistently applied. A recently concluded pilot study on the effects of implementing these guidelines among hospitalized malnourished infants u6m of age in Kilifi, Kenya introduced breastfeeding peer supporters (BFPS) to the inpatient setting to support guideline implementation. Here we report a sub-study investigating mothers' experiences and perceptions of the process of re-establishing exclusive breastfeeding during their infant's admission to hospital. METHODS Interviews were conducted with mothers just prior to their infant's discharge to explore their experiences and perceptions of the breastfeeding support process. A trained social science researcher conducted the interviews in Kiswahili language using a structured interview guide with open questions. Interviews were tape recorded, transcribed and translated into English for analysis. Data were managed and organized using NVIVO version 10 and analyzed using a framework approach. RESULTS Twenty mothers were interviewed. While some mothers found re-establishing breastfeeding challenging, they all reported improved knowledge on the relationships between maternal nutrition, stress management, hygiene practices and breastmilk production. They also reported gaining skills in breast care, breastfeeding techniques, hand expression and handling of expressed breastmilk. The breastfeeding peer supporters were said to have provided technical, social and emotional support which facilitated the process of re-establishing exclusive breastfeeding. The mothers identified the key characteristics of an effective and trustworthy BFPS as well as gaps in support. CONCLUSION BFPS are able share knowledge and skills in a way that is understood and appreciated by the mothers of inpatient malnourished infants u6m of age, enhancing the reestablishment of exclusive breastfeeding. Central to the success of BFPS is their ability to develop close and supportive relationships with the mothers based on shared social and cultural backgrounds. Future studies should focus on evaluating the long-term impact of inpatient breastfeeding support strategies on the quality of breastfeeding and growth, as well as on understanding where, when and how BFPS might be incorporated into routine hospital settings.
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Affiliation(s)
- Jane Kahindi
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 230, Kilifi, 80108 Kenya
| | - Caroline Jones
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 230, Kilifi, 80108 Kenya
- Centre for Tropical Medicine and Global health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ UK
| | - James A. Berkley
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 230, Kilifi, 80108 Kenya
- Centre for Tropical Medicine and Global health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ UK
- The Childhood Acute Illness & Nutrition (CHAIN) Network, 197 Lenana Place, P. O Box 43640, Nairobi, 0100 Kenya
| | - Martha Mwangome
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 230, Kilifi, 80108 Kenya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, 197 Lenana Place, P. O Box 43640, Nairobi, 0100 Kenya
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Umar N, Quaife M, Exley J, Shuaibu A, Hill Z, Marchant T. Toward improving respectful maternity care: a discrete choice experiment with rural women in northeast Nigeria. BMJ Glob Health 2020; 5:e002135. [PMID: 32201626 PMCID: PMC7059545 DOI: 10.1136/bmjgh-2019-002135] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/20/2020] [Accepted: 02/04/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction There is a limited understanding of the importance of respectful maternity care on utilisation of maternal and newborn health services. This study aimed to determine how specific hypothetical facility birth experience of care attributes influenced rural Nigerian women’s stated preferences for hypothetical place of delivery. Methods Attributes were identified through a comprehensive review of the literature. These attributes and their respective levels were further investigated in a qualitative study. We then developed and implemented a cross-sectional discrete choice experiment with a random sample of 426 women who had facility-based childbirth to elicit their stated preferences for facility birth experience of care attributes. Women were asked to choose between two hypothetical health facilities or home birth for future delivery. Choice data were analysed using multinomial logit and mixed multinomial logit models. Results Complete data for the discrete choice experiment were available for 425 of 426 women. The majority belonged to Fulani ethnic group (60%) and were married (95%). Almost half (45%) had no formal education. Parameter estimates were all of expected signs suggesting internal validity. The most important influence on choice of place of delivery was good health system condition, followed by absence of sexual abuse, then absence of physical and verbal abuse. Poor facility culture, including an unclean birth environment with no privacy and unclear user fee, was associated with the most disutility and had the most negative impact on preferences for facility-based childbirth. Conclusion The likelihood of poor facility birth experiences had a significant impact on stated preferences for place of delivery among rural women in northeast Nigeria. The study findings further underline the important relationship between facility birth experience and utilisation. Achieving universal health coverage would require efforts toward addressing poor facility birth experiences and promoting respectful maternity care, to ensure women want to access the services available.
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Affiliation(s)
- Nasir Umar
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew Quaife
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Josephine Exley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Abdulrahman Shuaibu
- Department of Primary System Development, State Primary Health Care Development Agency, Gombe, Nigeria
| | - Zelee Hill
- Institute for Global Health, University College London, London, UK
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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Peven K, Purssell E, Taylor C, Bick D, Lopez VK. Breastfeeding support in low and middle-income countries: Secondary analysis of national survey data. Midwifery 2020; 82:102601. [DOI: 10.1016/j.midw.2019.102601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
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Larson E, Mbaruku G, Kujawski SA, Mashasi I, Kruk ME. Disrespectful treatment in primary care in rural Tanzania: beyond any single health issue. Health Policy Plan 2020; 34:508-513. [PMID: 31369079 PMCID: PMC6788213 DOI: 10.1093/heapol/czz071] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2019] [Indexed: 12/03/2022] Open
Abstract
Knowing how patients are treated in care is foundational for creating patient-centred, high-quality health systems and identifying areas where policies and practices need to adapt to improve patient care. However, little is known about the prevalence of disrespectful treatment of patients in sub-Saharan Africa outside of maternity care. We used data from a household survey of 2002 women living in rural Tanzania to describe the extent of disrespectful care during outpatient visits, who receive disrespectful care, and determine the association with patient satisfaction, rating of quality and recommendation of the facility to others. We asked about women’s most recent outpatient visit to the local clinic, including if they were made to feel disrespected, if a provider shouted at or scolded them, and if providers made negative or disparaging comments about them. Women who answered yes to any of these questions were considered to have experienced disrespectful care. We report risk ratios with standard errors clustered at the facility level. The most common reasons for seeking care were fever or malaria (33.9%), vaccination (33.6%) and non-emergent check-up (13.4%). Disrespectful care was reported by 14.3% of women and was more likely if the visit was for sickness compared to a routine check-up [risk ratio (RR): 1.6, 95% confidence interval (CI): 1.1–2.2]. Women who did not report disrespectful care were 2.1 times as likely to recommend the clinic (95% CI: 1.6–2.7). While there is currently a lot of attention on disrespectful maternity care, our results suggest that this is a problem that goes beyond this single health issue and should be addressed by more horizontal health system interventions and policies.
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Affiliation(s)
- Elysia Larson
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave., Building 2, Boston, MA, USA
| | | | - Stephanie A Kujawski
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, NY, USA
| | | | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Ave., Building 2, Boston, MA, USA
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Bhatnagar H. User-experience and patient satisfaction with quality of tuberculosis care in India: A mixed-methods literature review. J Clin Tuberc Other Mycobact Dis 2019; 17:100127. [PMID: 31788569 PMCID: PMC6880015 DOI: 10.1016/j.jctube.2019.100127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Tuberculosis affected 2.7 million people in India in 2017. The Revised National TB Control Programme has achieved milestones in coverage, however quality of TB care remains highly variable and often poor, with significant gaps in provider knowledge, practices, and patients consistently lost to follow-up. These quality gaps are largely informed by studies on provider practices or objective chart abstractions and case data. Per the knowledge of the author, no review has been conducted on first-hand patient perspectives on the quality of TB care they receive. This mixed-methods literature review aims to synthesize evidence on user-experience and patient satisfaction with TB care in India and inform areas for service quality improvement. METHODS Five medical databases, including PubMed, EMBASE, Global Health (Ovid), Web of Science, and CINAHL were searched for empirical studies on patient perspectives on TB health services published between January 1st, 2000 to December 31st, 2017. Studies in English with adult patients with any form of TB in the public or private health system were included. Studies prior to entering the health system, on distance to health facilities and cost were excluded. Seven Indian journals were hand searched and a grey literature search was conducted in GoogleScholar. Studies were assessed for methodological quality and thematic analysis was conducted by categorizing data using NVivo 12. RESULTS A total of 498 studies were screened, of which 23 met the inclusion criteria. 16 supplementary studies were identified from Indian journals and grey literature. Of the 39 total studies included most were quantitative (29; 74%), based in South India (17; 44%) and focused on drug-sensitive TB patients (19; 49%) within the public health system (25; 64%). Data collection methods were highly heterogenous which limited synthesis and comparisons across population demographics, health sectors, or regions. Overall quantitative patient satisfaction measured in seven studies was high. Two major themes identified were provider-related factors (n = 26 studies) and convenience (n = 25), and six minor themes were supplies and equipment availability (n = 12), confidence (n = 10), information and communication (n = 10), waiting time (n = 8), stigma (n = 4), and confidentiality (n = 4). Each reported positive and negative user-experiences. Most significantly, DOTS did not fit the daily needs and obligations of many patients, particularly due to conflicts with employment and frequency of visits; while positive provider support, information, and flexibility helped patients adhere to treatment. CONCLUSION Although quantitative patient satisfaction was found to be high, data were not collected using robust, validated tools. Qualitative and quantitative user-experiences in each theme were variable, making them both barriers and facilitators of good quality TB care. Poor user-experiences were often responsible for patients interrupting treatment or dropping out of TB care. Patient-centeredness, or user-friendliness of TB care can be improved by introducing individualized or flexible DOTS that is responsive to user circumstances and needs. User-experience data should be systematically collected using a standardized, national tool for identification of specific bottlenecks and successes in quality of TB care from the patients' perspective.
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Moucheraud C, Stern AF, Ahearn C, Ismail A, Nsubuga-Nyombi T, Ngonyani MM, Mvungi J, Ssensamba J. Barriers to HIV Treatment Adherence: A Qualitative Study of Discrepancies Between Perceptions of Patients and Health Providers in Tanzania and Uganda. AIDS Patient Care STDS 2019; 33:406-413. [PMID: 31517526 PMCID: PMC6745526 DOI: 10.1089/apc.2019.0053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Previous qualitative studies about antiretroviral therapy (ART) adherence have largely focused on patient experiences. Less is known about the perspective of health care providers-particularly in low-income countries-who serve as gatekeepers and influencers of patients' HIV care experiences. This study explored patients' and providers' perceptions of important ART adherence determinants. Interviews were conducted at HIV treatment sites in Tanzania and Uganda, with adult patients on ART (n = 148), and with health care providers (n = 49). Patients were asked about their experiences with ART adherence, and providers were asked about their perceptions of what adherence challenges are faced by their patients. All interviews were conducted in local languages; transcripts were translated into English and analyzed using a codebook informed by the social ecological model. Themes were examined across and within countries. Adherence-related challenges were frequently reported, but patients and providers did not often agree about the reasons. Many patients cited challenges related to being away from home and therefore away from their pill supply; and, in Uganda, challenges picking up refills (access to care) and related to food sufficiency/diet. Providers also identified these access to care barriers, but otherwise focused on different key determinants (e.g., they rarely mentioned food/diet); instead, providers were more likely to mention alcohol/alcoholism, stigma, and lack of understanding about the importance of adhering. These findings suggest areas of opportunity for future research and for improving clinical care by aligning perceptions of adherence challenges, to deliver better-informed and useful ART counseling and support.
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Affiliation(s)
- Corrina Moucheraud
- Department of Health Policy and Management, University of California Fielding School of Public Health, Los Angeles, California
| | - Amy F. Stern
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Chevy Chase, Maryland
| | - Canice Ahearn
- Division of HIV, Infectious Diseases & Global Medicine, Department of Medicine, University of California, San Francisco, California
| | - Anisa Ismail
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Chevy Chase, Maryland
| | - Tamara Nsubuga-Nyombi
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Kampala, Uganda
| | - Monica M. Ngonyani
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Dar es Salaam, Tanzania
| | - Jane Mvungi
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Dar es Salaam, Tanzania
| | - Jude Ssensamba
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Kampala, Uganda
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Arsenault C, Jordan K, Lee D, Dinsa G, Manzi F, Marchant T, Kruk ME. Equity in antenatal care quality: an analysis of 91 national household surveys. LANCET GLOBAL HEALTH 2019; 6:e1186-e1195. [PMID: 30322649 PMCID: PMC6187112 DOI: 10.1016/s2214-109x(18)30389-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 12/17/2022]
Abstract
Background Emerging data show that many low-income and middle-income country (LMIC) health systems struggle to consistently provide good-quality care. Although monitoring of inequalities in access to health services has been the focus of major international efforts, inequalities in health-care quality have not been systematically examined. Methods Using the most recent (2007–16) Demographic and Health Surveys and Multiple Indicator Cluster Surveys in 91 LMICs, we described antenatal care quality based on receipt of three essential services (blood pressure monitoring and urine and blood testing) among women who had at least one visit with a skilled antenatal-care provider. We compared quality across country income groups and quantified within-country wealth-related inequalities using the slope and relative indices of inequality. We summarised inequalities using random-effects meta-analyses and assessed the extent to which other geographical and sociodemographic factors could explain these inequalities. Findings Globally, 72·9% (95% CI 69·1–76·8) of women who used antenatal care reported blood pressure monitoring and urine and blood testing; this number ranged from 6·3% in Burundi to 100·0% in Belarus. Antenatal care quality lagged behind antenatal care coverage the most in low-income countries, where 86·6% (83·4–89·7) of women accessed care but only 53·8% (44·3–63·3) reported receiving the three services. Receipt of the three services was correlated with gross domestic product per capita and was 40 percentage points higher in upper-middle-income countries compared with low-income countries. Within countries, the wealthiest women were on average four times more likely to report good quality care than the poorest (relative index of inequality 4·01, 95% CI 3·90–4·13). Substantial inequality remained after adjustment for subnational region, urban residence, maternal age, education, and number of antenatal care visits (3·20, 3·11–3·30). Interpretation Many LMICs that have reached high levels of antenatal care coverage had much lower and inequitable levels of quality. Achieving ambitious maternal, newborn, and child health goals will require greater focus on the quality of health services and their equitable distribution. Equity in effective coverage should be used as the new metric to monitor progress towards universal health coverage. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Keely Jordan
- Department of Public Health Policy and Management, NYU College of Global Public Health, New York University, New York, NY, USA
| | - Dennis Lee
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Girmaye Dinsa
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Public Health and Health Policy, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
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Trimmer C, Målqvist M. Clinical communication and caregivers' satisfaction with child healthcare in Nepal; results from Nepal Health Facility Survey 2015. BMC Health Serv Res 2019; 19:17. [PMID: 30621685 PMCID: PMC6325866 DOI: 10.1186/s12913-018-3857-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Patient satisfaction is an important measure of quality of care and a determinant of health service utilisation and the choice of health facility. Measuring patients’ experiences is important for understanding and improving the quality of care at health facilities. The aim of this study was to assess levels and identify associated factors of caregivers’ satisfaction and provider-caregiver communication within child healthcare in Nepal. Methods Secondary analysis of Sick Child Exit Interviews (n = 2092) sourced from 2015 Nepal Health Facility Survey data. Satisfaction was measured through caregivers’ satisfaction with services received and their willingness to recommend the health facility visited. Communication indicators were chosen based on the 2014 WHO IMCI guidelines and aggregate communication scores were calculated based on the number of indicators acknowledged during assessments. Logistic regression was used for analysis. Results Although most respondents (82.1%) reportedly were satisfied with the care provided, only 35.9% experienced good communication with their providers. Caregivers who had ever attended school were more likely to be satisfied with services (1.44, CI 95% 1.04–1.99). Type of provider, sex of child or who the caregiver was had no association with caregivers’ satisfaction. Having been given a diagnosis doubled the chances of satisfaction (AOR 2.04, 95% CI 1.38–3.00), as did discussion of the child’s growth (OR 1.71, 95% CI 1.06–2.76) and having discussed any of the included topics (AOR 1.98, CI 95% 1.14–3.45). Conclusions Interventions to improve healthcare staff’s communication skills are needed in Nepal to further enhance satisfaction with services and increase quality of care. However, this is an area that need further investigation given the high levels of satisfaction displayed despite poor communication. Other factors in the health care exchange between provider and clients are influencing the level of satisfaction and need to be identified and promoted further. High-quality care is no longer a goal for the future or only for high income settings; it is essential for reaching global health goals.
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Affiliation(s)
- Charlotte Trimmer
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Mats Målqvist
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden.
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Lall D, Engel N, Devadasan N, Horstman K, Criel B. Models of care for chronic conditions in low/middle-income countries: a 'best fit' framework synthesis. BMJ Glob Health 2018; 3:e001077. [PMID: 30687524 PMCID: PMC6326308 DOI: 10.1136/bmjgh-2018-001077] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 11/23/2022] Open
Abstract
Management of chronic conditions is a challenge for healthcare delivery systems world over and especially for low/middle-income countries (LMIC). Redesigning primary care to deliver quality care for chronic conditions is a need of the hour. However, much of the literature is from the experience of high-income countries. We conducted a synthesis of qualitative findings regarding care for chronic conditions at primary care facilities in LMICs. The themes identified were used to adapt the existing chronic care model (CCM) for application in an LMIC using the ‘best fit’ framework synthesis methodology. Primary qualitative research studies were systematically searched and coded using themes of the CCM. The results that could not be coded were thematically analysed to generate themes to enrich the model. Search strategy keywords were: primary health care, diabetes mellitus type 2, hypertension, chronic disease, developing countries, low, middle-income countries and LMIC country names as classified by the World Bank. The search yielded 404 articles, 338 were excluded after reviewing abstracts. Further, 42 articles were excluded based on criteria. Twenty-four studies were included for analysis. All themes of the CCM, identified a priori, were represented in primary studies. Four additional themes for the model were identified: a focus on the quality of communication between health professionals and patients, availability of essential medicines, diagnostics and trained personnel at decentralised levels of healthcare, and mechanisms for coordination between healthcare providers. We recommend including these in the CCM to make it relevant for application in an LMIC.
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Affiliation(s)
- Dorothy Lall
- Health Service Research, Institute of Public Health, Bengaluru, India
| | - Nora Engel
- Department of Health Ethics and Society, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Klasien Horstman
- Department of Health Ethics and Society, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Bart Criel
- Department of Health Financing, Institute of Tropica Medicine, Antwerp, Belgium
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Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, Adeyi O, Barker P, Daelmans B, Doubova SV, English M, García-Elorrio E, Guanais F, Gureje O, Hirschhorn LR, Jiang L, Kelley E, Lemango ET, Liljestrand J, Malata A, Marchant T, Matsoso MP, Meara JG, Mohanan M, Ndiaye Y, Norheim OF, Reddy KS, Rowe AK, Salomon JA, Thapa G, Twum-Danso NAY, Pate M. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health 2018; 6:e1196-e1252. [PMID: 30196093 PMCID: PMC7734391 DOI: 10.1016/s2214-109x(18)30386-3] [Citation(s) in RCA: 1459] [Impact Index Per Article: 243.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/16/2018] [Accepted: 08/10/2018] [Indexed: 12/19/2022]
Affiliation(s)
| | - Anna D Gage
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Keely Jordan
- New York University College of Global Public Health, New York, NY, USA
| | | | | | | | - Pierre Barker
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | | | | | - Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience, Drug and Alcohol Abuse, University of Ibadan, Ibadan, Nigeria
| | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lixin Jiang
- National Centre for Cardiovascular Disease, Beijing, China
| | | | | | | | - Address Malata
- Malawi University of Science and Technology, Limbe, Malawi
| | - Tanya Marchant
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - John G Meara
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Manoj Mohanan
- Duke University Sanford School of Public Policy, Durham, NC, USA
| | - Youssoupha Ndiaye
- Ministry of Health and Social Action of the Republic of Senegal, Dakar, Senegal
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Gagan Thapa
- Legislature Parliament of Nepal, Kathmandu, Nepal
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Mbatia R, Cohen J, Zuakulu M, Bukuku A, Chandarana S, Eliakimu E, Moshi S, Larson E. Basic Accountability to Stop Ill-Treatment (BASI); Study Protocol for a Cluster Randomized Controlled Trial in Rural Tanzania. Front Public Health 2018; 6:273. [PMID: 30320053 PMCID: PMC6165889 DOI: 10.3389/fpubh.2018.00273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/03/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Poor health system experiences negatively affect the lives of poor people throughout the world. In East Africa, there is a growing body of evidence of poor quality care that in some cases is so poor that it is disrespectful or abusive. This study will assess whether community feedback through report cards (with and without non-financial rewards) can improve patient experience, which includes aspects of patient dignity, autonomy, confidentiality, communication, timely attention, quality of basic amenities, and social support. Methods/Design: This cluster-randomized controlled study will randomize 75 primary health care facilities in rural Pwani Region, Tanzania to one of three arms: private feedback (intervention), social recognition reward through public reporting (intervention), or no feedback (control). Within both intervention arms, we will give the providers at the study facilities feedback on the quality of patient experience the facility provides (aggregate results from all providers) using data from patient surveys. The quality indicators that we report will address specific experiences, be observable by patients, fall into well-identified domains of patient experience, and be within the realm of action by healthcare providers. For example, we will measure the proportion of patients who report that providers definitely “explained things in a way that was easy to understand.” This feedback will be delivered by a medical doctor to all the providers at the facility in a small group session. A formal discussion guide will be used. Facilities randomized to the social recognition intervention reward arm will have two additional opportunities for social recognition. First, a poster that displays their achieved level of patient experience will be publicly posted at the health facility and village government offices. Second, recognition from senior officials at the local NGO and/or the Ministry of Health will be given to the facility with the best or most-improved patient experience ratings at endline. We will use surveys with parents/guardians of sick children to measure patient experience, and surveys with healthcare providers to assess potential mechanisms of effect. Conclusion: Results from this study will provide evidence for whether, and through what mechanisms, patient reported feedback can affect interpersonal quality of care. Pan African Clinical Trials Registry (PACTR): 201710002649121 Protocol version 7, November 8, 2017
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Affiliation(s)
| | - Jessica Cohen
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Martin Zuakulu
- Tanzania Health Promotion Support (THPS), Msasani, Tanzania
| | | | - Shikha Chandarana
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Eliudi Eliakimu
- Ministry of Health, Community Development, Gender, Elderly and Children-MoHCDGEC, Dodoma, Tanzania
| | - Sisty Moshi
- Tanzania Health Promotion Support (THPS), Msasani, Tanzania
| | - Elysia Larson
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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Shen X, Lu M, Feng R, Cheng J, Chai J, Xie M, Dong X, Jiang T, Wang D. Web-Based Just-in-Time Information and Feedback on Antibiotic Use for Village Doctors in Rural Anhui, China: Randomized Controlled Trial. J Med Internet Res 2018; 20:e53. [PMID: 29444768 PMCID: PMC5830611 DOI: 10.2196/jmir.8922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/01/2017] [Accepted: 12/18/2017] [Indexed: 02/02/2023] Open
Abstract
Background Excessive use of antibiotics is very common worldwide, especially in rural China; various measures that have been used in curbing the problem have shown only marginal effects. Objective The objective of this study was to test an innovative intervention that provided just-in-time information and feedback (JITIF) to village doctors on care of common infectious diseases. Methods The information component of JITIF consisted of a set of theory or evidence-based ingredients, including operation guideline, public commitment, and takeaway information, whereas the feedback component tells each participating doctor about his or her performance scores and percentages of antibiotic prescriptions. These ingredients were incorporated together in a synergetic way via a Web-based aid. Evaluation of JITIF adopted a randomized controlled trial design involving 24 village clinics randomized into equal control and intervention arms. Measures used included changes between baseline and endpoint (1 year after baseline) in terms of: percentages of patients with symptomatic respiratory or gastrointestinal tract infections (RTIs or GTIs) being prescribed antibiotics, delivery of essential service procedures, and patients’ beliefs and knowledge about antibiotics and infection prevention. Two researchers worked as a group in collecting the data at each site clinic. One performed nonparticipative observation of the service process, while the other performed structured exit interviews about patients’ beliefs and knowledge. Data analysis comprised mainly of: (1) descriptive estimations of beliefs or knowledge, practice of indicative procedures, and use of antibiotics at baseline and endpoint for intervention and control groups and (2) chi-square tests for the differences between these groups. Results A total of 1048 patients completed the evaluation, including 532 at baseline (intervention=269, control=263) and 516 at endpoint (intervention=262, control=254). Patients diagnosed with RTIs and GTIs accounted for 76.5% (407/532) and 23.5% (125/352), respectively, at baseline and 80.8% (417/532) and 19.2% (99/532) at endpoint. JITIF resulted in substantial improvement in delivery of essential service procedures (2.6%-24.8% at baseline on both arms and at endpoint on the control arm vs 88.5%-95.0% at endpoint on the intervention arm, P<.001), beliefs favoring rational antibiotics use (11.5%-39.8% at baseline on both arms and at endpoint on the control arm vs 19.8%-62.6% at endpoint on the intervention arm, P<.001) and knowledge about side effects of antibiotics (35.7% on the control arm vs 73.7% on the intervention arm, P<.001), measures for managing or preventing RTIs (39.1% vs 66.7%, P=.02), and measures for managing or preventing GTIs (46.8% vs 69.2%, P<.001). It also reduced antibiotics prescription (from 88.8%-62.3%, P<.001), and this decrease was consistent for RTIs (87.1% vs 64.3%, P<.001) and GTIs (94.7% vs 52.4%, P<.001). Conclusions JITIF is effective in controlling antibiotics prescription at least in the short term and may provide a low-cost and sustainable solution to the widespread excessive use of antibiotics in rural China.
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Affiliation(s)
- XingRong Shen
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Manman Lu
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Rui Feng
- Department of Literature Review and Analysis, Library of Anhui Medical University, Hefei, China
| | - Jing Cheng
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Jing Chai
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Maomao Xie
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Xuemeng Dong
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Tao Jiang
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Debin Wang
- School of Health Service Management, Anhui Medical University, Hefei, China
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