Understanding client and provider perspectives of antenatal care service quality: a qualitative multi-method study from Tanzania

Effects of a Tanzanian prenatal group education program about preeclampsia/eclampsia: A quasi-experimental study

AIM

This study examined the effects of a prenatal group education program in Tanzania which was focused on preeclampsia/eclampsia according to knowledge, behavioral intention, Pregnancy-Related Empowerment Scale, satisfaction, and the incidence of preeclampsia.

METHODS

The study was conducted in two district hospitals in Tanzania and used a facility-based pre-post quasi-experimental design with concurrent control. The prenatal group education program was developed to focus on preeclampsia/eclampsia and consisted of lectures, discussions, and review sessions directed at participatory group education. The intervention group participated in a midwife-facilitated prenatal group education program, whereas the control group received routine care. Data were collected through questionnaires before the intervention and 1 month later. A descriptive analysis of the data was performed.

RESULTS

The study analyzed 95 pregnant women within an intervention group (n = 48) and control group (n = 47). At the 1-month post-test, statistically significant differences were observed between the intervention and control groups in the knowledge score (mean = 3.8, SD = 3.6 vs. mean = -0.8, SD = 3.1, p < .001) and satisfaction score (mean = 4.9 vs. mean = 4.6, p = .032). Between the two groups, there were no significant differences in the scores of behavioral intention, Pregnancy-Related Empowerment Scale, and the incidence of preeclampsia.

CONCLUSION

The prenatal group education program increased the knowledge level regarding preeclampsia and gave higher satisfaction among pregnant women. Knowledge was retained for at least 1 month. Continuity in implementation of this program is recommended.

Assessing courtesy reporting bias in facility-based surveys on person-centred maternity care: evidence from urban informal settlements in Nairobi and Lusaka

Background

Experience of care is typically measured through client exit surveys administered in the facility. Evidence suggests that such measures suffer from courtesy reporting bias whereby respondents do not accurately report on their experiences while in the facility. We explored the presence of courtesy bias by comparing women's reported experience of person-centred maternity care (PCMC) from facility-based client exit surveys to mobile phone-based surveys out of the facility in Nairobi and Lusaka's urban informal settlements.

Methods

We randomly and independently sampled women in the facilities for either a facility-based survey (n = 233 in Lusaka and n = 112 in Nairobi) or a mobile phone-based survey (n = 203 in Lusaka and n = 300 in Nairobi) within one to two weeks of facility discharge. The questionnaire included a validated PCMC scale. After adjusting for differences in women's characteristics across groups, we compared PCMC scores between facility and phone-based samples. We ran multilevel linear regression models to assess PCMC by survey modality in each city.

Results

In both cities, over 70.0% of women were aged 20-34 years and were married, at least two thirds had secondary education, and over 95.0% were unaccompanied during labour/delivery. The overall PCMC score was 69.3% among women surveyed on the phone compared to 70.2% among those surveyed in the facility in Nairobi. In Lusaka, it was 57.5% on the phone compared to 56.8% in-facility. We found no statistically significant differences in PCMC scores between survey modalities in both cities, after adjusting for differences in women's characteristics.

Conclusions

We did not detect significant courtesy reporting bias in PCMC in facility-based client exit surveys in the context of urban informal settlements in Nairobi and Lusaka. Experience of PCMC can be measured through in-facility client exit surveys or mobile phone surveys. However, it is critical to address challenges related to a mobile phone-based approach.

The representation of Australians living with dementia in voluntary assisted dying research: A scoping review

OBJECTIVES

To critically examine which stakeholders are participating in voluntary assisted dying (VAD) research, to identify the representation of Australians living with dementia.

METHODS

A scoping review of peer-reviewed literature to examine which stakeholders are represented in Australian VAD research was conducted. This review was informed by the Arksey and O'Malley Framework for Scoping Reviews, and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR). Searches were conducted systematically across key academic databases to gather Australian research articles written in English that were published between 2017 and August 2023.

RESULTS

After screening, 21 publications formed the dataset. Of the 21 publications, none of them represented Australians living with dementia. The voice of one person living with a terminal illness was included in a study of care partners, and four studies explored the views of community members. The most dominant voices in the dataset were health-care practitioners, who were represented in 16 studies.

CONCLUSIONS

Australian VAD research is a contested space where all stakeholders with a relevant contribution to policy and practice must be represented in contemporary Australian research. As living experience experts with a wealth of experiential knowledge to contribute, the voices of people living with dementia need to be represented in future Australian VAD research through inclusive research design, to ensure a greater balance in stakeholder representation across the VAD literature.

Dementia in Media Coverage: A Comparative Analysis of Two Online Newspapers across Time

The news media, specifically online newspapers, is one of the powerful transmitters of discourse due to its rapid accessibility that contributes to social beliefs and attitudes that often shape our perceptions on dementia and Alzheimer’s disease. The media portrayal of dementia is largely heterogeneous, but there is certainly an association between the influence of online news coverage and the social perceptions of dementia that need to be understood more broadly. In this study, we examined the portrayal of dementia in two online newspapers (The New York Times and The Guardian) that might have an influence on dementia discourse by comparing the content and form of the news coverage on dementia across time. This study was guided by three interconnected theoretical understandings: cultivation theory, agenda-setting theory, and spiral of silence theory. A total of 291 published articles featuring dementia from 2014 to 2019 were included in this study and a content analysis of the articles provided insight into the dementia-related news coverage. Our results showed that both newspapers have a decreasing trend in publishing articles related to dementia over time. In addition, dementia-related (modifiable) risk factors as principal news content was significantly associated with the year of publication. Despite a weak association between story categories and newspapers, the majority of articles reported preventive measures as the main story category. Although both newspapers featured more articles with a less negative tone across time when reporting on dementia, derogative wording, as discourse, was commonly used to address the illness. We have provided some insight into understanding how online newspapers potentially affect subjective representations of dementia as well as perpetuate dementia discourse. Finally, we suggest that future study may benefit from establishing a linkage between the depiction of dementia in online newspapers and the contextualization of dementia within cultures.

Monitoring Quality of Care in the WHO Africa Region-A study design for measurement and tracking, towards UHC attainment

This paper reports on the design of a study to generate a quality of care index for countries in the World Health Organization Africa Region.

Quality of care, for all people at all times, remains pivotal to the advancement of the 2030 agenda and the attainment of Universal Health Coverage. We present a study protocol for deriving a quality of care index, hinged on indicators and data elements currently monitored through routine information systems and institutionalized facility assessments in the World Health Organization Africa Region.

This paper seeks to offer more insight into options in the Region for strengthening monitoring processes of quality of care, as a step towards generating empirical evidence which can galvanize action towards an improved care process.

The methodology proposed in this study design has broad implications for policymaking and priority setting for countries, emphasizing the need for robust empirical measures to understand the functionality of health systems for the delivery of quality essential services. Application of this protocol will guide policymaking, as countries work to increasingly improve quality of care and adopt policies that will best facilitate their advancement towards Universal Health Coverage.

Bilingualism: A Global Public Health Strategy for Healthy Cognitive Aging

Dementia is a global public health priority which cost global societies $818 billion in 2015 and is disproportionately impacting low and middle-income countries (LMICs). With limited availability of disease modifying drugs to treat Alzheimer's disease (AD), researchers have increasingly focused on preventative strategies which may promote healthy cognitive aging and mitigate the risk of cognitive impairment in aging. Lifelong bilingualism has been presented as both a highly debated and promising cognitive reserve factor which has been associated with better cognitive outcomes in aging. A recent metanalysis has suggested that bilingual individuals present on average 4.05 years later with the clinical features of AD than monolinguals. Bilinguals are also diagnosed with AD ~2.0 years later than monolingual counterparts. In this perspective piece we critically evaluate the findings of this metanalysis and consider the specific implications of these findings to LMICs. Furthermore, we appraise the major epidemiological studies conducted globally on bilingualism and the onset of dementia. We consider how both impactful and robust studies of bilingualism and cognition in older age may be conducted in LMICs. Given the limited expenditure and resources available in LMICs and minimal successes of clinical trials of disease modifying drugs we propose that bilingualism should be positioned as an important and specific public health strategy for maintaining healthy cognitive aging in LMICs. Finally, we reflect upon the scope of implementing bilingualism within the education systems of LMICs and the promotion of bilingualism as a healthy cognitive aging initiative within government policy.

Disrespectful care in family planning services among youth and adult simulated clients in public sector facilities in Malawi

Background

Provision of high-quality family planning (FP) services improves access to contraceptives. Negative experiences in maternal health have been documented worldwide and likely occur in other services including FP. This study aims to quantify disrespectful care for adult and adolescent women accessing FP in Malawi.

Methods

We used simulated clients (SCs) to measure disrespectful care in a census of public facilities in six districts of Malawi in 2018. SCs visited one provider in each of the 112 facilities: two SCs visits (one adult and one adolescent case scenario) or 224 SC visits total. We measured disrespectful care using a quantitative tool and field notes and report the prevalence and 95% confidence intervals for the indicators and by SC case scenarios contextualized with quotes from the field notes.

Results

Some SCs (12%) were refused care mostly because they did not agree to receive a HIV test or vaccination, or less commonly because the clinic was closed during operating hours. Over half (59%) of the visits did not have privacy. The SCs were not asked their contraceptive preference in 57% of the visits, 28% reported they were not greeted respectfully, and 20% reported interruptions. In 18% of the visits the SCs reported humiliation such as verbal abuse. Adults SCs received poorer counseling compared to the adolescent SCs with no other differences found.

Conclusions

We documented instances of refusal of care, lack of privacy, poor client centered care and humiliating treatment by providers. We recommend continued effort to improve quality of care with an emphasis on client treatment, regular quality assessments that include measurement of disrespectful care, and more research on practices to reduce it.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06353-z.

Facilitators and barriers to implement nurse-led interventions in long-term dementia care: a qualitative interview study with Swiss nursing experts and managers

Background

To support the implementation of nurse-led interventions in long-term dementia care, in-depth knowledge of specific supporting factors and barriers is required. Conditions and structures of caring for people with dementia differ widely, depending on the country and the care context. Our study aimed to describe the experiences and opinions of nursing experts and managers with regard to facilitators and barriers to the implementation of nurse-led interventions in long-term dementia care.

Methods

We conducted a qualitative descriptive study using individual interviews based on qualitative vignettes as a useful stimulus to generate narrations allowing to study peoples’ perceptions and beliefs. The study took place in nursing homes in the German-speaking part of Switzerland and in the Principality of Liechtenstein using purposive sampling. We intended to conduct the interviews face-to-face in a quiet room according to the participant’s choice. However, due to the lockdown of nursing homes during the COVID-19 pandemic in spring 2020, we performed interviews face-to-face and by video. We analysed data thematically following Braun and Clarke to achieve a detailed, nuanced description. To verify our interpretation and to ensure congruence with participants’ perspectives, we conducted member checks. The Standards for Reporting Qualitative Research (SRQR) served to structure our manuscript.

Results

Six dyads of nursing home managers and nursing experts from six nursing homes took part in our study (n = 12). Our thematic analysis yielded seven themes reflecting facilitators and barriers to implementing nurse-led interventions in long-term dementia care: «A common attitude and cohesion within the organization», «Commitment on several levels», «A needs-oriented implementation», «The effect and the public perception of the intervention», «A structured and guided implementation process», «Supporting knowledge and competencies», as well as «Resources for implementing the intervention».

Conclusions

To support the implementation of nurse-led interventions in long-term dementia care, active commitment-building seems essential. It is necessary that the value of the intervention is perceptible.Commitment-building is the precondition to reach the persons involved, such as nursing home managers, nursing staff, residents and relatives. Furthermore, nurses should precisely inform about the intervention. It is necessary that the value of the intervention is perceptible. In addition, nurses should adjust the interventions to the situational needs of people with dementia, thus. Therefore, it is important to support dementia-specific competencies in long-term care. Findings indicate that the barrier is determined by the intervention and its implementation – and not by the behaviour of the person with dementia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02120-1.

A cross-national study of depression in preclinical dementia: A COSMIC collaboration study

INTRODUCTION

Depression commonly accompanies Alzheimer's disease, but the nature of this association remains uncertain.

METHODS

Longitudinal data from the COSMIC consortium were harmonized for eight population-based cohorts from four continents. Incident dementia was diagnosed in 646 participants, with a median follow-up time of 5.6 years to diagnosis. The association between years to dementia diagnosis and successive depressive states was assessed using a mixed effect logistic regression model. A generic inverse variance method was used to group study results, construct forest plots, and generate heterogeneity statistics.

RESULTS

A common trajectory was observed showing an increase in the incidence of depression as the time to dementia diagnosis decreased despite cross-national variability in depression rates.

DISCUSSION

The results support the hypothesis that depression occurring in the preclinical phases of dementia is more likely to be attributable to dementia-related brain changes than environment or reverse causality.

Private Providers' Experiences Implementing a Package of Interventions to Improve Quality of Care in Kenya: Findings From a Qualitative Evaluation

INTRODUCTION

Quality of care is an important element in health care service delivery in low- and middle-income countries. Innovative strategies are critical to ensure that private providers implement quality of care interventions. We explored private providers' experiences implementing a package of interventions intended to improve the quality of care in small and medium-sized private health facilities in Kenya.

METHODS

Data were collected as part of the qualitative evaluation of the African Health Markets for Equity (AHME) program in Kenya between June and July 2018. Private providers were purposively selected from 2 social franchise networks participating in AHME: the Amua network run by Marie Stopes Kenya and the Tunza network run by Population Services Kenya. Individual interviews (N=47) were conducted with providers to learn about their experiences with a package of interventions that included social franchising, SafeCare (a quality improvement program), National Hospital Insurance Fund (NHIF) accreditation assistance, and business support.

RESULTS

Private providers felt they benefited from trainings in clinical methods and quality improvement offered through AHME. Providers especially appreciated the mentorship and guidelines offered through programs like social franchising and SafeCare, and those who received support for NHIF accreditation felt they were able to offer higher quality services after going through this process. However, quality improvement was sometimes prohibitively expensive for private providers in smaller facilities that already realize relatively low revenue and the NHIF accreditation process was difficult to navigate without the help of the AHME partners due to complexity and a lack of transparency.

CONCLUSION

Our findings suggest that engaging private providers in a comprehensive package of quality improvement activities is achievable and may be preferable to a simpler program. However, further research that looks at the implications for cost and return on investment is required.

Extracts or Active Components from Acorus gramineus Aiton for Cognitive Function Impairment: Preclinical Evidence and Possible Mechanisms

Extracts or active components from Acorus gramineus Aiton (EAAGA) have been clinically used for cognition impairment more than hundreds of years and are still used in modern times in China and elsewhere worldwide. Previous studies reported that EAAGA improves cognition impairment in animal models. Here, we conducted a preclinical systematic review to assess the current evidence of EAAGA for cognition impairment. We searched 7 databases up until June 2019. Methodological quality for each included studies was accessed according to the CAMARADES 10-item checklist. The primary outcome measures were neurobehavioral function scores evaluated by the Morris water maze test, electrical Y-maze test, step-down test, radial eight-arm maze test, and step-through test. The secondary outcome measures were mechanisms of EAAGA for cognition function. Finally, 34 studies involving 1431 animals were identified. The quality score of studies range from 1 to 6, and the median was 3.32. Compared with controls, the results of the meta-analysis indicated EAAGA exerted a significant effect in decreasing the escape latency and error times and in increasing the length of time spent in the platform quadrant and the number of platform crossings representing learning ability and memory function (all P < 0.01). The possible mechanisms of EAAGA are largely through anti-inflammatory, antioxidant, antiapoptosis activities, inhibition of neurotoxicity, regulating synaptic plasticity, protecting cerebrovascular, stimulating cholinergic system, and suppressing astrocyte activation. In conclusion, EAAGA exert potential neuroprotective effects in experimental cognition impairment, and EAAGA could be a candidate for cognition impairment treatment and further clinical trials.

Development of summary indices of antenatal care service quality in Haiti, Malawi and Tanzania

INTRODUCTION

Measuring quality of care in low-income and middle-income countries is complicated by the lack of a standard, universally accepted definition for 'quality' for any particular service, as well as limited guidance on which indicators to include in measures of quality of care, and how to incorporate those indicators into summary indices. The aim of this paper is to develop, characterise and compare a set of antenatal care (ANC) indices for facility readiness and provision of care.

METHODS

We created nine indices for facility readiness using three methods for selecting items and three methods for combining items. In addition, we created three indices for provision of care using one method for selecting items and three methods for combining items. For each index, we calculated descriptive statistics, categorised the continuous index scores using tercile cut points to assess comparability of facility classification, and examined the variability and distribution of scores.

RESULTS

Our results showed that, within a country, the indices were quite similar in terms of mean index score, facility classification, coefficient of variation, floor and ceiling effects, and the inclusion of items in an index with a range of variability. Notably, the indices created using principal components analysis to combine the items were the most different from the other indices. In addition, the index created by taking a weighted average of a core set of items had lower agreement with the other indices when looking at facility classification.

CONCLUSIONS

As improving quality of care becomes integral to global efforts to produce better health outcomes, demand for guidance on creating standardised measures of service quality will grow. This study provides health systems researchers with a comparison of methodologies commonly used to create summary indices of ANC service quality and it highlights the similarities and differences between methods.