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Bruckner TA, Lin TK, Liu J, Bornemisza O, Ajuebor O, Diallo K, Cometto G. A novel approach to estimate the impact of health workforce investments on health outcomes through increased coverage of HIV, TB and malaria services. HUMAN RESOURCES FOR HEALTH 2023; 21:67. [PMID: 37605211 PMCID: PMC10441693 DOI: 10.1186/s12960-023-00854-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Globally, HIV, TB and malaria account for an estimated three million deaths annually. The Global Fund partnered with the World Health Organization to assist countries with health workforce planning in these areas through the development of an integrated health workforce investment impact tool. Our study illustrates the development of a user-friendly tool (with two MS Excel calculator subcomponents) that computes associations between human resources for health (HRH) investment inputs and reduced morbidity and mortality from HIV, TB, and malaria via increased coverage of effective treatment services. METHODS We retrieved from the peer-reviewed literature quantitative estimates of the relation among HRH inputs and HRH employment and productivity. We converted these values to additional full-time-equivalent doctors, nurses and midwives (DNMs). We used log-linear regression to estimate the relation between DNMs and treatment service coverage outcomes for HIV, TB, and malaria. We then retrieved treatment effectiveness parameters from the literature to calculate lives saved due to expanded treatment coverage for HIV, TB, and malaria. After integrating these estimates into the tool, we piloted it in four countries. RESULTS In most countries with a considerable burden of HIV, TB, and malaria, the health workforce investments include a mix of pre-service education, full remuneration of new hires, various forms of incentives and in-service training. These investments were associated with elevated HIV, TB and malaria treatment service coverage and additional lives saved. The country case studies we developed in addition, indicate the feasibility and utility of the tool for a variety of international and local actors interested in HRH planning. CONCLUSIONS The modelled estimates developed for illustrative purposes and tested through country case studies suggest that HRH investments result in lives saved across HIV, TB, and malaria. Furthermore, findings show that attainment of high targets of specific treatment coverage indicators would require a substantially greater health workforce than what is currently available in most LMICs. The open access tool can assist with future HRH planning efforts, particularly in LMICs.
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Affiliation(s)
- Tim A Bruckner
- Program in Public Health and Center for Population, Inequality, and Policy, University of California, Irvine, USA
| | - Tracy K Lin
- Institute for Health and Aging, Bixby Center for Global Reproductive Health, University of California, San Francisco. 409 Illinois St. 123J, San Francisco, CA, 94158, USA
| | - Jenny Liu
- Institute for Health and Aging, Bixby Center for Global Reproductive Health, University of California, San Francisco. 409 Illinois St. 123J, San Francisco, CA, 94158, USA
| | - Olga Bornemisza
- Technical Advice and Partnerships Department, The Global Fund, Chem. du Pommier 40, Le Grand-Saconnex, 1218, Geneva, Switzerland
| | - Onyema Ajuebor
- Health Workforce Department, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
| | - Khassoum Diallo
- Health Workforce Department, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Giorgio Cometto
- Health Workforce Department, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
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Abstract
The literature supports the effectiveness of systems-based integrated care models, particularly collaborative care, to improve access, quality of care, and health outcomes for behavioral health conditions. There is growing evidence for the promise of collaborative care to reduce behavioral health disparities for racial and ethnic, low-income, and other at-risk populations. Using rapid literature review, this article highlights what is known about how collaborative care may promote health equity for behavioral health conditions, by reducing disparities in access, quality, and outcomes of care. Further, it explores innovative intervention and engagement strategies to promote behavioral health equity for at-risk groups.
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Affiliation(s)
- Maga E Jackson-Triche
- UCSF Health, UCSF Weill Institute for Neurosciences, 401 Parnassus Avenue, Suite LP 342, San Francisco, CA 94143-2211, USA.
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195-6560, USA
| | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, 10920 Wilshire Boulevard, Suite 300, Los Angeles, CA 90024-6505, USA; Department of Health Policy and Management, Fielding School of Public Health, Los Angeles, CA, USA; Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA; California Center for Excellence in Behavioral Health, Greater Los Angeles VA Health System, Los Angeles, CA, USA
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Wu S, Roychowdhury I, Khan M. Evaluations of training programs to improve human resource capacity for HIV, malaria, and TB control: a systematic scoping review of methods applied and outcomes assessed. Trop Med Health 2017; 45:16. [PMID: 28680324 PMCID: PMC5493875 DOI: 10.1186/s41182-017-0056-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/16/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Owing to the global health workforce crisis, more funding has been invested in strengthening human resources for health, particularly for HIV, tuberculosis, and malaria control; however, little is known about how these investments in training are evaluated. This paper examines how frequently HIV, malaria, and TB healthcare provider training programs have been scientifically evaluated, synthesizes information on the methods and outcome indicators used, and identifies evidence gaps for future evaluations to address. METHODS We conducted a systematic scoping review of publications evaluating postgraduate training programs, including in-service training programs, for HIV, tuberculosis, and malaria healthcare providers between 2000 and 2016. Using broad inclusion criteria, we searched three electronic databases and additional gray literature sources. After independent screening by two authors, data about the year, location, methodology, and outcomes assessed was extracted from eligible training program evaluation studies. Training outcomes evaluated were categorized into four levels (reaction, learning, behavior, and results) based on the Kirkpatrick model. FINDINGS Of 1473 unique publications identified, 87 were eligible for inclusion in the analysis. The number of published articles increased after 2006, with most (n = 57, 66%) conducted in African countries. The majority of training evaluations (n = 44, 51%) were based on HIV with fewer studies focused on malaria (n = 28, 32%) and TB (n = 23, 26%) related training. We found that quantitative survey of trainees was the most commonly used evaluation method (n = 29, 33%) and the most commonly assessed outcomes were knowledge acquisition (learning) of trainees (n = 44, 51%) and organizational impacts of the training programs (38, 44%). Behavior change and trainees' reaction to the training were evaluated less frequently and using less robust methods; costs of training were also rarely assessed. CONCLUSIONS Our study found that a limited number of robust evaluations had been conducted since 2000, even though the number of training programs has increased over this period to address the human resource shortage for HIV, malaria, and TB control. Specifically, we identified a lack evaluation studies on TB- and malaria-related healthcare provider training and very few studies assessing behavior change of trainees or costs of training. Developing frameworks and standardized evaluation methods may facilitate strengthening of the evidence base to inform policies on and investments in training programs.
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Affiliation(s)
- Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
| | - Imara Roychowdhury
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
| | - Mishal Khan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore.,Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
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Seidman G, Atun R. Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries. HUMAN RESOURCES FOR HEALTH 2017; 15:29. [PMID: 28407810 PMCID: PMC5390445 DOI: 10.1186/s12960-017-0200-9] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/29/2017] [Indexed: 05/27/2023]
Abstract
BACKGROUND Task shifting has become an increasingly popular way to increase access to health services, especially in low-resource settings. Research has demonstrated that task shifting, including the use of community health workers (CHWs) to deliver care, can improve population health. This systematic review investigates whether task shifting in low-income and middle-income countries (LMICs) results in efficiency improvements by achieving cost savings. METHODS Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL, and the Health Economic Evaluation Database on March 22, 2016. We included any original peer-review articles that demonstrated cost impact of a task shifting program in an LMIC. RESULTS We identified 794 articles, of which 34 were included in our study. We found that substantial evidence exists for achieving cost savings and efficiency improvements from task shifting activities related to tuberculosis and HIV/AIDS, and additional evidence exists for the potential to achieve cost savings from activities related to malaria, NCDs, NTDs, childhood illness, and other disease areas, especially at the primary health care and community levels. CONCLUSIONS Task shifting presents a viable option for health system cost savings in LMICs. Going forward, program planners should carefully consider whether task shifting can improve population health and health systems efficiency in their countries, and researchers should investigate whether task shifting can also achieve cost savings for activities related to emerging global health priorities and health systems strengthening activities such as supply chain management or monitoring and evaluation.
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Affiliation(s)
- Gabriel Seidman
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 United States of America
| | - Rifat Atun
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 United States of America
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Inrig SJ, Higashi RT, Tiro JA, Argenbright KE, Lee SJC. Assessing local capacity to expand rural breast cancer screening and patient navigation: An iterative mixed-method tool. EVALUATION AND PROGRAM PLANNING 2017; 61:113-124. [PMID: 28011433 PMCID: PMC5323072 DOI: 10.1016/j.evalprogplan.2016.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 11/08/2016] [Accepted: 11/15/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Despite federal funding for breast cancer screening, fragmented infrastructure and limited organizational capacity hinder access to the full continuum of breast cancer screening and clinical follow-up procedures among rural-residing women. We proposed a regional hub-and-spoke model, partnering with local providers to expand access across North Texas. We describe development and application of an iterative, mixed-method tool to assess county capacity to conduct community outreach and/or patient navigation in a partnership model. METHODS Our tool combined publicly-available quantitative data with qualitative assessments during site visits and semi-structured interviews. RESULTS Application of our tool resulted in shifts in capacity designation in 10 of 17 county partners: 8 implemented local outreach with hub navigation; 9 relied on the hub for both outreach and navigation. Key factors influencing capacity: (1) formal linkages between partner organizations; (2) inter-organizational relationships; (3) existing clinical service protocols; (4) underserved populations. Qualitative data elucidate how our tool captured these capacity changes. CONCLUSIONS Our capacity assessment tool enabled the hub to establish partnerships with county organizations by tailoring support to local capacity and needs. Absent a vertically integrated provider network for preventive services in these rural counties, our tool facilitated a virtually integrated regional network to extend access to breast cancer screening to underserved women.
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Affiliation(s)
- Stephen J Inrig
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX75390-9066, USA.
| | - Robin T Higashi
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX75390-9066, USA.
| | - Jasmin A Tiro
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX75390-9066, USA; Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75390, USA.
| | - Keith E Argenbright
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX75390-9066, USA; Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75390, USA; Moncrief Cancer Institute, 400 W. Magnolia Ave, Fort Worth, TX 76104, USA.
| | - Simon J Craddock Lee
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX75390-9066, USA; Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75390, USA.
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de Vries DH, Pool R. The Influence of Community Health Resources on Effectiveness and Sustainability of Community and Lay Health Worker Programs in Lower-Income Countries: A Systematic Review. PLoS One 2017; 12:e0170217. [PMID: 28095475 PMCID: PMC5240984 DOI: 10.1371/journal.pone.0170217] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 01/02/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Despite the availability of practical knowledge and effective interventions required to reduce priority health problems in low-income countries, poor and vulnerable populations are often not reached. One possible solution to this problem is the use of Community or Lay Health Workers (CLHWs). So far, however, the development of sustainability in CLHW programs has failed and high attrition rates continue to pose a challenge. We propose that the roles and interests which support community health work should emerge directly from the way in which health is organized at community level. This review explores the evidence available to assess if increased levels of integration of community health resources in CLHW programs indeed lead to higher program effectiveness and sustainability. METHODS AND FINDINGS This review includes peer-reviewed articles which meet three eligibility criteria: 1) specific focus on CLHWs or equivalent; 2) randomized, quasi-randomized, before/after methodology or substantial descriptive assessment; and 3) description of a community or peer intervention health program located in a low- or middle-income country. Literature searches using various article databases led to 2930 hits, of which 359 articles were classified. Of these, 32 articles were chosen for extensive review, complemented by analysis of the results of 15 other review studies. Analysis was conducted using an excel based data extraction form. Because results showed that no quantitative data was published, a descriptive synthesis was conducted. The review protocol was not proactively registered. Findings show minimal inclusion of even basic community level indicators, such as the degree to which the program is a community initiative, community input in the program or training, the background and history of CLHW recruits, and the role of the community in motivation and retention. Results show that of the 32 studies, only one includes one statistical measure of community integration. As a result of this lack of data we are unable to derive an evidence-based conclusion to our propositions. Instead, our results indicate a larger problem, namely the complete absence of indicators measuring community relationships with the programs studied. Studies pay attention only to gender and peer roles, along with limited demographic information about the recruits. The historicity of the health worker and the community s/he belongs to is absent in most studies reviewed. None of the studies discuss or test for the possibility that motivation emanates from the community. Only a few studies situate attrition and retention as an issue enabled by the community. The results were limited by a focus on low-income countries and English, peer-reviewed published articles only. CONCLUSION Published, peer-reviewed studies evaluating the effectiveness and sustainability of CLHW interventions in health programs have not yet adequately tested for the potential of utilizing existing community health roles or social networks for the development of effective and sustainable (retentive) CLHW programs. Community relationships are generally seen as a "black box" represented by an interchangeable CLHW labor unit. This disconnect from community relationships and resources may have led to a systematic and chronic undervaluing of community agency in explanations of programmatic effectiveness and sustainability.
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Affiliation(s)
- Daniel H. de Vries
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert Pool
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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Evaluating the impact of healthcare provider training to improve tuberculosis management: a systematic review of methods and outcome indicators used. Int J Infect Dis 2016; 56:105-110. [PMID: 27979785 DOI: 10.1016/j.ijid.2016.11.421] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/26/2016] [Accepted: 11/29/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Developing human resources capacity is vital for tuberculosis (TB) control in low- and middle-income countries. Although investments in TB healthcare provider (HCP) training programmes have increased, it is unclear whether these are robustly evaluated. The objective of this systematic review was to synthesize the methods and outcome indicators used to assess TB HCP training programmes. METHODS A systematic scoping review of publications reporting on evaluations of training programmes for TB HCPs - including doctors, nurses, paramedics, and lay health workers - was conducted through a search in three electronic databases, Google Scholar, and five websites of non-profit organizations. Data on the study location, population trained, outcomes assessed, and evaluation approach were extracted. RESULTS After screening 499 unique publications, 21 were eligible for inclusion in the analysis. The majority of evaluations were conducted in Africa. The most common evaluation methods were a review of patient records (n=8, 38%) and post-training interview with trainees (n=7, 33%). In terms of outcomes, more than half of the studies (n=12, 57%) evaluated knowledge acquisition of trainees, with only six (29%) assessing on-the-job behaviour change. CONCLUSIONS Even though more funds have been invested in TB HCP training, publications from robust evaluations assessing the impact on quality of care and behaviour change are limited.
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Naimoli JF, Perry HB, Townsend JW, Frymus DE, McCaffery JA. Strategic partnering to improve community health worker programming and performance: features of a community-health system integrated approach. HUMAN RESOURCES FOR HEALTH 2015; 13:46. [PMID: 26323276 PMCID: PMC4556219 DOI: 10.1186/s12960-015-0041-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 06/02/2015] [Indexed: 05/04/2023]
Abstract
BACKGROUND There is robust evidence that community health workers (CHWs) in low- and middle-income (LMIC) countries can improve their clients' health and well-being. The evidence on proven strategies to enhance and sustain CHW performance at scale, however, is limited. Nevertheless, CHW stakeholders need guidance and new ideas, which can emerge from the recognition that CHWs function at the intersection of two dynamic, overlapping systems - the formal health system and the community. Although each typically supports CHWs, their support is not necessarily strategic, collaborative or coordinated. METHODS We explore a strategic community health system partnership as one approach to improving CHW programming and performance in countries with or intending to mount large-scale CHW programmes. To identify the components of the approach, we drew on a year-long evidence synthesis exercise on CHW performance, synthesis records, author consultations, documentation on large-scale CHW programmes published after the synthesis and other relevant literature. We also established inclusion and exclusion criteria for the components we considered. We examined as well the challenges and opportunities associated with implementing each component. RESULTS We identified a minimum package of four strategies that provide opportunities for increased cooperation between communities and health systems and address traditional weaknesses in large-scale CHW programmes, and for which implementation is feasible at sub-national levels over large geographic areas and among vulnerable populations in the greatest need of care. We postulate that the CHW performance benefits resulting from the simultaneous implementation of all four strategies could outweigh those that either the health system or community could produce independently. The strategies are (1) joint ownership and design of CHW programmes, (2) collaborative supervision and constructive feedback, (3) a balanced package of incentives, and (4) a practical monitoring system incorporating data from communities and the health system. CONCLUSIONS We believe that strategic partnership between communities and health systems on a minimum package of simultaneously implemented strategies offers the potential for accelerating progress in improving CHW performance at scale. Comparative, retrospective and prospective research can confirm the potential of these strategies. More experience and evidence on strategic partnership can contribute to our understanding of how to achieve sustainable progress in health with equity.
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Affiliation(s)
- Joseph F Naimoli
- United States Agency for International Development, 1300 Pennsylvania Avenue, NW, Washington, DC, 20523, USA.
| | - Henry B Perry
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - John W Townsend
- Population Council, 4301 Connecticut Avenue, NW, Washington, DC, 20008, USA.
| | - Diana E Frymus
- United States Agency for International Development, 1300 Pennsylvania Avenue, NW, Washington, DC, 20523, USA.
| | - James A McCaffery
- Training Resources Group, 4401 Wilson Boulevard, Arlington, VA, 22203, USA.
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March S, Torres E, Ramos M, Ripoll J, García A, Bulilete O, Medina D, Vidal C, Cabeza E, Llull M, Zabaleta-del-Olmo E, Aranda JM, Sastre S, Llobera J. Adult community health-promoting interventions in primary health care: A systematic review. Prev Med 2015; 76 Suppl:S94-104. [PMID: 25625691 DOI: 10.1016/j.ypmed.2015.01.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 12/11/2014] [Accepted: 01/18/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine evidence on the effectiveness of health-promoting community interventions carried out in primary health care. METHODS Systematic review of originals and systematic reviews of health-promoting community interventions with the participation of primary health care. A working definition of community activities was used in the inclusion criteria. Databases searched up to 2013: PUBMED, EMBASE, CINHAL, Web of SCIENCE, IBECS, IME, and PSICODOC. No restrictions on year of publication or design. Articles were reviewed by separate researchers to identify risks of bias. RESULTS Fifty-one articles published between 1966 and 2013 were included: 11 systematic reviews and 40 originals that described 39 community interventions. There is evidence on the effectiveness of community interventions in reducing cardiovascular risk factors, encouraging physical exercise, preventing falls and improving self-care among chronic patients compared with usual individual care. The effectiveness of some interventions increases when the community is involved in their development. Most assessments show positive results despite design limitations. CONCLUSIONS The community approach may be more effective than the individual in usual preventive interventions in primary care. There is a lack of evidence on many community interventions in primary care and further research is needed.
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Affiliation(s)
- Sebastià March
- Research Unit, Mallorca Primary Care, Ib-Salut Balears, Reina Esclaramunda Street, 9, 07003 Palma, Spain; IUNICS-IdISPa, UIB, 07010 Palma, Spain.
| | - Elena Torres
- Research Unit, Mallorca Primary Care, Ib-Salut Balears, Reina Esclaramunda Street, 9, 07003 Palma, Spain; IUNICS-IdISPa, UIB, 07010 Palma, Spain.
| | - María Ramos
- IUNICS-IdISPa, UIB, 07010 Palma, Spain; Registro de Cáncer, Servicio de Epidemiología, Dirección General de Salud Pública y Consumo, Conselleria de Salut, Família i Benestar Social, Camí de Jesús 38 A, 07010 Palma, Spain.
| | - Joana Ripoll
- Research Unit, Mallorca Primary Care, Ib-Salut Balears, Reina Esclaramunda Street, 9, 07003 Palma, Spain; IUNICS-IdISPa, UIB, 07010 Palma, Spain.
| | - Atanasio García
- Mallorca Primary Care, Ib-Salut Balears, Centro de Salud Coll d'en Rabassa, Guayaquil Street, 9, 07006 Palma, Spain.
| | - Oana Bulilete
- Mallorca Primary Care, Ib-Salut Balears, Centro de Salud Son Pisà, Vicens Joan Rosselló Ribas Street, 65, 07011 Palma, Spain.
| | - David Medina
- IUNICS-IdISPa, UIB, 07010 Palma, Spain; Mallorca Primary Care, Ib-Salut Balears, Centro de Salud de Manacor, Central Street, 1, Son Macià, 07509 Manacor, Spain.
| | - Clara Vidal
- Research Unit, Mallorca Primary Care, Ib-Salut Balears, Reina Esclaramunda Street, 9, 07003 Palma, Spain; IUNICS-IdISPa, UIB, 07010 Palma, Spain.
| | - Elena Cabeza
- IUNICS-IdISPa, UIB, 07010 Palma, Spain; Dirección General de Salud Pública y Consumo, Conselleria de Salut, Família i Benestar Social, Camí de Jesús 38 A, 07010 Palma, Mallorca, Spain.
| | - Micaela Llull
- Mallorca Primary Care, Ib-Salut Balears, Centro de Salud Sant Agustí, Plaça Pça, Sant Salvador, 2, 07015 Gènova, Spain.
| | - Edurne Zabaleta-del-Olmo
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain.
| | - José Manuel Aranda
- Grupo de Investigación en Salud Mental, Servicios y Atención Primaria (SAMSERAP), Centro de Salud San Andres Torcal, C/José Palanca, s/n, 29003 Málaga, Spain.
| | - Silvia Sastre
- Mallorca Primary Care, Ib-Salut Balears, Biblioteca Virtual de Ciencias de la Salud de las Islas Baleares, Reina Esclaramunda Street, 9, 07003 Palma, Spain.
| | - Joan Llobera
- Research Unit, Mallorca Primary Care, Ib-Salut Balears, Reina Esclaramunda Street, 9, 07003 Palma, Spain; IUNICS-IdISPa, UIB, 07010 Palma, Spain.
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Wallace LR. Nursing curriculum development in remote southwest Uganda. Int Nurs Rev 2015; 62:360-7. [PMID: 25891189 DOI: 10.1111/inr.12189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE/AIM To describe an intercollaborative outreach between the USA and a school of nursing in Uganda. INTRODUCTION Ugandan nurses are essential providers of health care in remote regions. High vacancy rates in health centers impacts care in rural areas. BACKGROUND A 112-bed health center in southwest Uganda supports village health teams that visit remote villages and provides medical, surgical, and maternal-child services to a population of 250,000. A new Ugandan school of nursing has aligned with the hospital to prepare graduates to provide primary care in remote villages. A team from the USA visited the school and hospital to assess the curriculum and offer educational strategies and support to the school's leadership. EVIDENCE Provision of primary health care in the developing world is a longstanding global priority. Nurses are at the center of primary care in remote regions. Educational support for advanced nursing and strategic international relationships can positively impact nursing education in both high and low-income countries. DISCUSSION The USA team took part in assessments, teaching, simulation, and remote village outreach. Educational strategies and modalities were shared. CONCLUSIONS The Ugandan nursing school is established and affiliated with another Ugandan university. Standardized curriculum is in place, however continued collaboration is needed for program adaptation to accommodate the unique border region environment. IMPLICATIONS FOR HEALTH POLICY AND NURSING Intercollaborative sharing of information and resources between schools of nursing can have a direct impact on global health initiatives in both high-income and low-income countries.
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Affiliation(s)
- L R Wallace
- Dominican University of California, San Rafael, CA, USA
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Abstract
In Thailand, several barriers exist that prevent people with life-limiting illnesses from accessing good-quality palliative care, namely: lack of palliative care providers; lack of training and education for the palliative care workforce; and issues with availability and distribution of opioids. Without palliative care, people suffer needlessly during the last months of their life. This paper gives an analysis of these issues and provides recommendations for clinical practice, research and health policy that may help to alleviate these issues.
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Affiliation(s)
- Panit Krongyuth
- Public Health Nursing Doctoral Student, Mahidol University Bangkok, Thailand
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Ovbiagele B. Tackling the growing diabetes burden in Sub-Saharan Africa: a framework for enhancing outcomes in stroke patients. J Neurol Sci 2015; 348:136-41. [PMID: 25475149 PMCID: PMC4298457 DOI: 10.1016/j.jns.2014.11.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/08/2014] [Accepted: 11/17/2014] [Indexed: 12/24/2022]
Abstract
According to the World Health Organization (WHO), more than 80% of worldwide diabetes (DM)-related deaths presently occur in low- and middle-income countries (LMIC), and left unchecked these DM-related deaths will likely double over the next 20 years. Cardiovascular disease (CVD) is the most prevalent and detrimental complication of DM: doubling the risk of CVD events (including stroke) and accounting for up to 80% of DM-related deaths. Given the aforementioned, interventions targeted at reducing CVD risk among people with DM are integral to limiting DM-related morbidity and mortality in LMIC, a majority of which are located in Sub-Saharan Africa (SSA). However, SSA is contextually unique: socioeconomic obstacles, cultural barriers, under-diagnosis, uncoordinated care, and shortage of physicians currently limit the capacity of SSA countries to implement CVD prevention among people with DM in a timely and sustainable manner. This article proposes a theory-based framework for conceptualizing integrated protocol-driven risk factor patient self-management interventions that could be adopted or adapted in future studies among hospitalized stroke patients with DM encountered in SSA. These interventions include systematic health education at hospital discharge, use of post-discharge trained community lay navigators, implementation of nurse-led group clinics and administration of health technology (personalized phone text messaging and home tele-monitoring), all aimed at increasing patient self-efficacy and intrinsic motivation for sustained adherence to therapies proven to reduce CVD event risk.
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Affiliation(s)
- Bruce Ovbiagele
- Department of Neurology and Neurosurgery, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 301, MSC 606, Charleston, SC 29425, United States.
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Kok MC, Dieleman M, Taegtmeyer M, Broerse JEW, Kane SS, Ormel H, Tijm MM, de Koning KAM. Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy Plan 2014; 30:1207-27. [PMID: 25500559 PMCID: PMC4597042 DOI: 10.1093/heapol/czu126] [Citation(s) in RCA: 292] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 12/21/2022] Open
Abstract
Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors influence CHW performance. A systematic review was conducted to identify intervention design related factors influencing performance of CHWs. We systematically searched six databases for quantitative and qualitative studies that included CHWs working in promotional, preventive or curative primary health services in LMICs. One hundred and forty studies met the inclusion criteria, were quality assessed and double read to extract data relevant to the design of CHW programmes. A preliminary framework containing factors influencing CHW performance and characteristics of CHW performance (such as motivation and competencies) guided the literature search and review. A mix of financial and non-financial incentives, predictable for the CHWs, was found to be an effective strategy to enhance performance, especially of those CHWs with multiple tasks. Performance-based financial incentives sometimes resulted in neglect of unpaid tasks. Intervention designs which involved frequent supervision and continuous training led to better CHW performance in certain settings. Supervision and training were often mentioned as facilitating factors, but few studies tested which approach worked best or how these were best implemented. Embedment of CHWs in community and health systems was found to diminish workload and increase CHW credibility. Clearly defined CHW roles and introduction of clear processes for communication among different levels of the health system could strengthen CHW performance. When designing community-based health programmes, factors that increased CHW performance in comparable settings should be taken into account. Additional intervention research to develop a better evidence base for the most effective training and supervision mechanisms and qualitative research to inform policymakers in development of CHW interventions are needed.
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Affiliation(s)
- Maryse C Kok
- KIT Health, Royal Tropical Institute, Amsterdam, The Netherlands,
| | | | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK and
| | | | - Sumit S Kane
- KIT Health, Royal Tropical Institute, Amsterdam, The Netherlands
| | - Hermen Ormel
- KIT Health, Royal Tropical Institute, Amsterdam, The Netherlands
| | - Mandy M Tijm
- KIT Health, Royal Tropical Institute, Amsterdam, The Netherlands
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14
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Miranda J, Ong MK, Jones L, Chung B, Dixon EL, Tang L, Gilmore J, Sherbourne C, Ngo VK, Stockdale S, Ramos E, Belin TR, Wells KB. Community-partnered evaluation of depression services for clients of community-based agencies in under-resourced communities in Los Angeles. J Gen Intern Med 2013; 28:1279-87. [PMID: 23670566 PMCID: PMC3785668 DOI: 10.1007/s11606-013-2480-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/27/2013] [Accepted: 04/18/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND As medical homes are developing under health reform, little is known regarding depression services need and use by diverse safety-net populations in under-resourced communities. For chronic conditions like depression, primary care services may face new opportunities to partner with diverse community service providers, such as those in social service and substance abuse centers, to support a collaborative care model of treating depression. OBJECTIVE To understand the distribution of need and current burden of services for depression in under-resourced, diverse communities in Los Angeles. DESIGN Baseline phase of a participatory trial to improve depression services with data from client screening and follow-up surveys. PARTICIPANTS Of 4,440 clients screened from 93 programs (primary care, mental health, substance abuse, homeless, social and other community services) in 50 agencies, 1,322 were depressed according to an eight-item Patient Health Questionnaire (PHQ-8) and gave contact information; 1,246 enrolled and 981 completed surveys. Ninety-three programs, including 17 primary care/public health, 18 mental health, 20 substance abuse, ten homeless services, and 28 social/other community services, participated. MAIN MEASURES Comparisons by setting in 6-month retrospective recall of depression services use. KEY RESULTS Depression prevalence ranged from 51.9 % in mental health to 17.2 % in social-community programs. Depressed clients used two settings on average to receive depression services; 82 % used any setting. More clients preferred counseling over medication for depression treatment. CONCLUSIONS Need for depression care was high, and a broad range of agencies provide depression care. Although most participants had contact with primary care, most depression services occurred outside of primary care settings, emphasizing the need to coordinate and support the quality of community-based services across diverse community settings.
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Affiliation(s)
- Jeanne Miranda
- Department of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, USA,
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15
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Mnisi SD, Peu MD, Meyer SM. Role of community nurses in the prevention of tuberculosis in the Tshwane Health District of Gauteng. Curationis 2012; 35:47. [PMID: 23327774 DOI: 10.4102/curationis.v35i1.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 07/06/2012] [Accepted: 08/07/2012] [Indexed: 11/01/2022] Open
Abstract
The objectives of this study were to identify the role of community nurses in the prevention of tuberculosis (TB) and to identify problems experienced by them when fulfilling this role in the Tshwane Health District of Gauteng. A non-experimental, descriptive, quantitative research design method was used to collect data from community nurses. The sample included 59 registered nurses who voluntarily agreed to participate in the study. A questionnaire was used to collect data and quantitative data analysis methods were employed. Various opinions and ideas on the role of community nurses in the prevention of TB and the problems experienced were identified. Based on the results of this research, measures to protect community nurses from contracting TB whilst on duty should be a priority. Government should support TB programmes by providing money to non-governmental organisations and direct observed treatment short course (DOTS) supporters to make follow-up visits to patients possible, thus reducing the number of defaulters. Stringent measures should be taken at all border points to ensure that foreigners are screened for TB, multidrug-resistant TB and extensively drug-resistant TB. This study was limited to community nurses in the Tshwane Health District of Gauteng who were registered with the South African Nursing Council (SANC) and therefore this study could not be generalised to registered nurses in the hospital setting or even to clinics in the rest of South Africa.
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Affiliation(s)
- Siphiwe D Mnisi
- Department of Health, SG Lourens Nursing College, South Africa
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16
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Abstract
PROBLEM Village health workers (VHWs) promote health and provide basic health care in areas of the world where basic health knowledge and health professionals are scarce. The 1960s-1980s saw a dramatic increase in the training of VHWs in resource-limited environments. Politics changed, disillusionment set in, and enthusiasm waned. Recently, increased pressures on health resources have led to the resurgence of VHWs. Until the shortage of health professionals is alleviated, the need for VHWs to extend the reach of scientifically verified health care into remote and conflict areas will remain acute. This need provides a compelling reason to pursue research concerning VHWs. Village health workers are usually trained by professional nurses and refer patients to them, so nursing is positioned to lead this important research. METHODS The author developed the concept of the VHW using Meleis's Integrated Approach. Meleis's approach was chosen because it is appropriate for undeveloped concepts, emphasizes exploration and discovery, and can begin with clinical practice, taking advantage of the author's experience with VHWs. RESULTS The resultant concept definition, with antecedents and consequences, provides a foundation other nurse researchers can build upon. Existing research concerning VHWs was reviewed and gaps suitable for future nursing research were identified.
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Affiliation(s)
- Linda L L Benskin
- Graduate School of Biomedical Sciences, The University of Texas Medical Branch, Galveston, TX, USA.
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Fàbregas R, Grau A, Ruiz S. Desarrollo de un nuevo sistema de gestión de la investigación universitaria. REVISTA ESPANOLA DE DOCUMENTACION CIENTIFICA 2012. [DOI: 10.3989/redc.2012.3.852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Sissolak D, Marais F, Mehtar S. TB infection prevention and control experiences of South African nurses--a phenomenological study. BMC Public Health 2011; 11:262. [PMID: 21518434 PMCID: PMC3096589 DOI: 10.1186/1471-2458-11-262] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 04/25/2011] [Indexed: 11/12/2022] Open
Abstract
Background The tuberculosis (TB) epidemic in South Africa is characterised by one of the highest levels of TB/HIV co-infection and growing multidrug-resistant TB worldwide. Hospitals play a central role in the management of TB. We investigated nurses' experiences of factors influencing TB infection prevention and control (IPC) practices to identify risks associated with potential nosocomial transmission. Methods The qualitative study employed a phenomenological approach, using semi-structured interviews with a quota sample of 20 nurses in a large tertiary academic hospital in Cape Town, South Africa. The data was subjected to thematic analysis. Results Nurses expressed concerns about the possible risk of TB transmission to both patients and staff. Factors influencing TB-IPC, and increasing the potential risk of nosocomial transmission, emerged in interconnected overarching themes. Influences related to the healthcare system included suboptimal IPC provision such as the lack of isolation facilities and personal protective equipment, and the lack of a TB-IPC policy. Further influences included inadequate TB training for staff and patients, communication barriers owing to cultural and linguistic differences between staff and patients, the excessive workload of nurses, and a sense of duty of care. Influences related to wider contextual conditions included TB concerns and stigma, and the role of traditional healers. Influences related to patient behaviour included late uptake of hospital care owing to poverty and the use of traditional medicine, and poor adherence to IPC measures by patients, family members and carers. Conclusions Several interconnected influences related to the healthcare system, wider contextual conditions and patient behavior could increase the potential risk of nosocomial TB transmission at hospital level. There is an urgent need for the implementation and evaluation of a comprehensive contextually appropriate TB IPC policy with the setting and auditing of standards for IPC provision and practice, adequate TB training for both staff and patients, and the establishment of a cross-cultural communication strategy, including rapid access to interpreters.
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Affiliation(s)
- Dagmar Sissolak
- Academic Unit for Infection Prevention and Control, Department of Interdisciplinary Health Sciences, Faculty of Health Sciences, University of Stellenbosch & Tygerberg Academic Hospital, Tygerberg Campus, 9th Floor, Tygerberg Hospital, Tygerberg 7505, Cape Town, South Africa.
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Earle-Richardson G, Sorensen J, Brower M, Hawkes L, May JJ. Community collaborations for farmworker health in New York and Maine: process analysis of two successful interventions. Am J Public Health 2009; 99 Suppl 3:S584-7. [PMID: 19890162 DOI: 10.2105/ajph.2009.166181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We conducted a process evaluation of 2 successful farmworker community-based participatory research intervention development projects (in Maine and New York State). Participant surveys measured satisfaction with the program process. We used qualitative methods to analyze free-text responses. Respondents indicated high satisfaction levels overall. The main concern was long-distance project coordination. Community-based participatory research programs in which (1) the work team defines the target health issue, (2) agricultural employers are meaningfully included, and (3) interventions are carried through to completion, warrant further study.
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Affiliation(s)
- Giulia Earle-Richardson
- New York Center for Agricultural Medicine & Health, Bassett Healthcare, One Atwell Rd, Cooperstown, NY 13326, USA.
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