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Mishkin K, Flax C. Evaluation of Implicit Bias Training in Continuing Medical and Nursing Education to Address Racial Bias in Maternity Health Care Settings. Public Health Rep 2024:333549241245271. [PMID: 38646821 DOI: 10.1177/00333549241245271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVES Implicit bias can affect clinical decisions that influence the care received by patients whose ancestors had been subjected to unfair medical and social practices. However, literature describing the effects of implicit bias training as part of continuing medical and nursing education is scarce. We conducted a longitudinal evaluation of a training for maternal health care clinical and nonclinical staff. METHODS A total of 80 staff members at 2 clinical sites in Cleveland, Ohio, participated in the training and evaluation in 2020 and 2021. We used a mixed-methods evaluation to capture changes in knowledge, awareness of bias, and application of strategies to reduce biased behavior by conducting pre- and posttraining surveys immediately after training and interviews at 3 and 6 months posttraining. We conducted univariate and bivariate analyses of the surveys and recorded, transcribed, and analyzed interviews for themes. RESULTS Using a threshold of answering 3 of 5 knowledge questions correctly, 50 of 80 (62.5%) trainees who engaged in the evaluation passed the pretraining knowledge questions and 67 (83.8%) passed the posttraining knowledge questions. Of the 80 participants, 75 (93.8%) were women. Interviewees (n = 11) said that low staff-to-patient ratios, lack of racial and ethnic diversity in leadership, inadequate training on implicit bias, and lack of institutional consequences for poor behavior exacerbated bias in maternity care. Interviewees reported having heightened awareness of bias and feeling more empowered after the training to advocate for themselves and patients to prevent and mitigate bias in the hospital. CONCLUSION Additional study describing the effect of implicit bias training as part of continuing medical education should be conducted, and administrative and management changes should also be made to prevent bias and improve quality of care.
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Affiliation(s)
- Kathryn Mishkin
- Data Science and Mission Strategy Office, March of Dimes, Arlington, VA, USA
| | - Chasmine Flax
- Data Science and Mission Strategy Office, March of Dimes, Arlington, VA, USA
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Tepper NK, Chowdhury J, Moore CA, Werler MM, Mishkin K, Reefhuis J. Public health priorities for gastroschisis: Summary of a meeting sponsored by the Centers for Disease Control and Prevention and the March of Dimes. Birth Defects Res 2024; 116:e2299. [PMID: 38277411 PMCID: PMC10983047 DOI: 10.1002/bdr2.2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Gastroschisis has increased worldwide over several decades; however, there are significant gaps in understanding risk factors for development of the defect, particularly those that might be modifiable. Despite advances in survival, little is known about longer-term outcomes for affected individuals. METHODS On April 27- and 28, 2023, the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC) and March of Dimes sponsored a meeting entitled "Public Health Priorities for Gastroschisis". The meeting goals were to review current knowledge on gastroschisis, discuss research gaps, and identify future priorities for public health surveillance, research, and action related to gastroschisis. Meeting participants encompassed a broad range of expertise and experience, including public health, clinical care of individuals with gastroschisis, affected individuals and families, and representatives from professional organizations and federal agencies. RESULTS Several goals were identified for future public health surveillance and research, including focused theory-driven research on risk factors and increased study of longer-term effects of gastroschisis through improved surveillance. Certain public health actions were identified, that which could improve the care of affected individuals, including increased education of providers and enhanced resources for patients and families. CONCLUSIONS These efforts may lead to an improved understanding of pathogenesis, risk factors, and outcomes and to improved care throughout the lifespan.
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Affiliation(s)
- Naomi K. Tepper
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julia Chowdhury
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Jennita Reefhuis
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Brill SB, Juckett LA, Chandler E, Brown J, Thomas N, Flax C, Miles L, Howard M, Thung S, Mishkin K. Implementing the Better Starts For All Pilot Mobile and Telehealth Intervention in Ohio Appalachia: Improving Access to Maternal Healthcare. J Health Care Poor Underserved 2023; 34:1037-1050. [PMID: 38015135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Women in Ohio Appalachia experience greater maternal health disparities relative to the general U.S. population, resulting in poorer health outcomes. This paper describes the Ohio Better Starts for All (BSFA) program that provides mobile maternal health services in rural Ohio. METHODS This three-year intervention was delivered through a community-clinical partnership in Ohio Appalachia. The program's preliminary evaluation and opportunities were informed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. RESULTS Over six months, 86 patients were referred to the BSFA program, 54 (62.8 %) were seen by the maternal care team, and 14 out of 19 scheduled clinic days were held. Five clinics were canceled due to inclement weather, mobile unit breakdown, or provider COVID-19 infection. DISCUSSION Maternal care providers must provide equitable care to patients, with particular attention to those who face substantial challenges accessing obstetric services. The BSFA program offers one promising solution to help women overcome barriers to accessing care.
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Mishkin K, Perera U, Olaniyan A, Carson L. Investing in the Next Generation of Maternal and Child Health Leaders: The APHA Maternal and Child Health Section Student Fellows Program. Matern Child Health J 2022:10.1007/s10995-022-03415-4. [PMID: 35567702 DOI: 10.1007/s10995-022-03415-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 02/27/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Practical experience in maternal and child health (MCH) settings is critical for professional development and learning. In 2002, the Maternal and Child Health (MCH) Section of the American Public Health Association (APHA) formalized its inclusion of students in section activities through the establishment of the Student Fellows Program. The Program provides graduate-level students opportunities to learn about MCH and APHA, build professional networks, and develop leadership skills. DESCRIPTION Since its inception, 18 cohorts of Fellows have benefited. This paper presents findings describing the Program from both written records about Fellow projects and activities recorded in past MCH Section communications as well as an online survey that was distributed to former and current Fellows to assess their perceptions and the benefits of the Student Fellows Program. ASSESSMENT Eighteen cohorts of Fellows have engaged with Section committees and working groups in diverse ways, including MCH-related research, policy, advocacy, and education. An online survey distributed to 151 participants was answered by 79 to document their perceptions of the Student Fellows Program. Of them, 56 (71%) indicated that the Program was important for their career development, 44 (55%) reported being current members of the APHA MCH Section, and 21 (27%) reported serving in a leadership position in the Section. The Fellows highlighted that networking, mentorship and leadership development were key benefits of the Student Fellows Program. CONCLUSION After several years of involving students in its programs, the APHA MCH Section established the Student Fellows Program in 2002. The Fellows Program has been important for developing the next generation of MCH leaders. The findings suggest that this Program supports long-term interest and commitment to the field of MCH and contributed to the formation of leadership skills and behaviors of Fellows.
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Affiliation(s)
- Kathryn Mishkin
- University at Albany School of Public Health, Rensselaer, United States.
| | - Udara Perera
- Drexel University Dornsife School of Public Health, Philadelphia, United States
- Harvard T.H. Chan School of Public Health, Boston, United States
| | - Abisola Olaniyan
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, United States
| | - Leslie Carson
- Association of Schools and Programs of Public Health, Washington, United States
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Payton C, Mishkin K, Davis CA, Katzburg J, Walker DK. A Review of the Maternal and Child Health APHA Policy Statements, 1970-2019. Matern Child Health J 2022:10.1007/s10995-022-03398-2. [PMID: 35522358 DOI: 10.1007/s10995-022-03398-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/23/2022] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The American Public Health Association (APHA) policy statements are written by members and approved by the APHA Governing Council. Policy statements inform APHA's position on key public health issues. Maternal and child health (MCH) is a broad discipline focused on health issues concerning women, children, youth, and families. APHA's MCH policies from the last 50 years were reviewed in celebration of the 100th anniversary of the MCH Section of APHA. METHODS A cross-sectional design was utilized to identify MCH-related statements within the larger APHA policy statement database from 1970 to 2019 (N = 1,110). The policy statements were coded as primary MCH (main focus was MCH) or secondary MCH (mentioned MCH subpopulations as vulnerable population). The primary MCH themes were also identified. RESULTS 545 (49%) of the APHA policy statements were related to MCH, including 226 (20%) coded as primary MCH and 319 (29%) secondary MCH. The primary MCH policy statements had a main focus on the following subpopulations: women (44%), children (33%), adolescents/young adults (15%), infants (12%), families (5%), and men (2%). Major themes included reproductive health/family planning, school health, children's health, pregnancy/childbirth, and breastfeeding/nutrition. CONCLUSIONS MCH policy statements remained an important part of APHA's policy and advocacy focus over time as indicated through the continuous high number and proportion of MCH policy statements. The historical overview of MCH policy provides insight into critical policy issues confronting the MCH field over the decades and provides guidance for future policy initiatives including a need for increased emphasis on diverse MCH populations. SIGNIFICANCE This analysis provides a 50 year overview of MCH themes as viewed by the policy statements published by APHA, the largest public health professional organization in the United States. These policy statements represent the cutting edge of MCH policy efforts and were written to influence national, state, and local public health policy. APHA policy statements should continue to address these important MCH topics in the future with an increased emphasis on diverse MCH populations. APHA policy making is a valuable national professional activity for the MCH field with the goal of improving the health for MCH communities.
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Affiliation(s)
- Colleen Payton
- School of Nursing and Public Health, Moravian University, 18018, Bethlehem, PA, USA.
| | | | - Cee Ann Davis
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, 23298, Richmond, VA, USA
| | - Judith Katzburg
- VA Greater Los Angeles Healthcare System, 91343, North Hills, CA, United States
| | - Deborah Klein Walker
- Boston University School of Public Health and Tufts University School of Medicine, 02118, Boston, MA, USA
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Mishkin K, Maqsood SS, Ahmed HM. Antenatal Depression Symptoms Among Pregnant Women Seeking Health Services in Erbil, Iraq. Matern Child Health J 2021; 25:1043-1049. [PMID: 33905065 DOI: 10.1007/s10995-021-03142-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Maternal depression, which includes depression in the prenatal and postpartum periods, is estimated to affect between 10 and 20% of women globally but the rate is higher in the Middle East. Research focused on maternal depression in Iraq is limited to one study focused on postpartum depression. This paper identifies the prevalence and factors associated with antenatal depression among pregnant Iraqi women. METHODS Women seeking maternal health services at primary health centers were invited to participate. Data were collected by trained midwifery students in Erbil, Iraq. Responses to the PHQ-2 PRIME-MD depression questions were used to identify depressive symptoms. Chi-square and logistic regression analyses were used to analyze findings. RESULTS Of the 179 participants, 86 (48%) reported depressive symptoms. In bivariate analysis, antenatal depression was associated with gestational age (p = 0.03), first prenatal visit in the second trimester (p = 0.003), loss of appetite (p = 0.003), not having help at home (p = 0.03), and use of prenatal vitamins (p = 0.002). Gravida approached significance (p = 0.07). In adjusted analysis, women reporting loss of appetite were more likely to report depressive symptoms (OR = 3.09, 95% CI: 1.47-6.51). DISCUSSION Consistent with other research from the region, nearly half the women reported depressive symptoms. Because lack of appetite is associated with depressive symptoms, women reporting loss of appetite should be prioritized for depression screening in time-constrained settings.
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Affiliation(s)
- Kathryn Mishkin
- Department of Health Policy, Management, Behavior, University at Albany, Albany, NY, USA.
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Mishkin K, Nugmanova Z, Urbaeva J, Nugumanova G, Abdumananova M, Kim E, Lazariu V, McNutt LA. Anxiety and depression among women living with HIV in Kazakhstan. AIDS Care 2020; 33:172-179. [PMID: 31983231 DOI: 10.1080/09540121.2020.1719277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
An increase in new HIV infections among women in Kazakhstan has motivated efforts to improve access to comprehensive health services. This study estimates anxiety and depression frequency among women seeking HIV services. A cross-sectional survey was administered to women seen at the Almaty AIDS Center. Bivariable analyses (e.g., Chi-square, means with 95% confidence intervals) were performed to assess the relationship between anxiety (score of 10 or more on the Generalized Anxiety Disorder-7 Scale (GAD-7)), major depression (Patient Health Questionnaire 8 (PHQ-8)), and comorbid anxiety and major depression with sociodemographic characteristics, health functioning, and medication history. Of the 410 participants, 62 (15.1%) had a GAD-7 ≥ 10; 52 (12.7%) met major depression criteria; 35 (8.5%) met both criteria, and 79 (19.3%) met GAD-7, major depression, or both criteria. Women reporting depression or anxiety were more likely to lack food security (p < 0.01), not finish secondary school (p < 0.01), speak Russian at home (p < 0.01), perceive their health to be poor (p < 0.01), and report poorer physical and mental health functioning (p < 0.05). No medications approved for the treatment of anxiety or depression were reported. The considerable number of women reporting major depression and anxiety symptoms suggests a need for improving access to mental health care.
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Affiliation(s)
- Kathryn Mishkin
- Department of Health Policy, Management, and Behavior, University at Albany, NY, USA
| | - Zhamilya Nugmanova
- Division of HIV Infection, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Gulnara Nugumanova
- Division of HIV Infection, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Elena Kim
- Division of HIV Infection, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Victoria Lazariu
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, SUNY, NY, USA
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Comeau DL, Mishkin K, Tukvadze N, Avaliani Z, Kempker RR, Sthreshley L, Magee MJ, Eisen H, Mariam DH, Aseffa A, Blumberg HM. Mentoring in Global Health: Formative Evaluation of Tuberculosis Research Training Programs in Ethiopia and Georgia. Am J Trop Med Hyg 2018; 99:565-577. [PMID: 30014815 DOI: 10.4269/ajtmh.17-0746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Mentoring is a critical component of career development for research scientists and is related to mentee success both in terms of career selection and advancement. However, there are limited data on the role of mentoring in low- and middle-income countries (LMICs). Cross-cultural mentorship programs have the potential to foster the transfer of knowledge and the development of capacity to resource-poor settings. This formative evaluation explores the cultural context of mentoring in the countries of Georgia and Ethiopia. Results were used to build culturally relevant mentor training programs for two Global Infectious Disease Research Training Programs focused on tuberculosis funded by the Fogarty International Center at the US National Institutes of Health. Four focus group discussions were conducted with research trainees and mentors to explore the perceptions of mentorship, identify obstacles for successful mentoring, and generate recommendations to strengthen mentoring in each program situated in a LMIC. Data revealed the barriers to mentoring in Ethiopia and Georgia included gaps in knowledge about mentoring roles and responsibilities, lack of knowledge about the responsibilities of the trainee in a mentoring relationship, and the need to set clear expectations between mentors and trainees. All of the focus group participants desired formal mentor training. These data informed six key components of the development and implementation of the mentor training programs in both countries. The topics included the following: a foundation in mentoring, establishing expectations between mentees and mentors, increasing interactions between mentees and mentors, additional mentor training, a case study curriculum, and methods of evaluating mentoring relationships.
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Affiliation(s)
- Dawn L Comeau
- Rollins School of Public Health, Emory University, Atlanta, Georgia.,Emory University School of Medicine, Atlanta, Georgia
| | - Kathryn Mishkin
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Zaza Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | | | - Lisa Sthreshley
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Matthew J Magee
- School of Public Health, Georgia State University, Atlanta, Georgia
| | - Hannah Eisen
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Henry M Blumberg
- Rollins School of Public Health, Emory University, Atlanta, Georgia.,Emory University School of Medicine, Atlanta, Georgia
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Alaei A, Nautiyal N, Mishkin K, Saifuddin Karimov D, Saidi D, Alaei K. Factors associated with linkage to care for HIV patients in Tajikistan. Int J STD AIDS 2018; 29:1183-1189. [PMID: 29945541 DOI: 10.1177/0956462418779658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a growing human immunodeficiency virus (HIV) epidemic in Tajikistan. This paper presents factors associated with linkage to HIV care among people aged 15 years and older in Tajikistan. This retrospective cross-sectional study used the Tajikistan Ministry of Health HIV registry data from patients diagnosed with HIV at age 15 years or older from 2000 to 2016. Chi squared tests and logistic regression models tested factors associated with linkage to care. A multivariable logistic regression model examined effect modifications. While linkage to care had an overall increase from 2000 to 2016, the odds of linkage were lower among certain sub-groups including among people in Dushanbe, men, people engaging in sex work, injection drug users, and older people. Regional differences exist with linkage to care, occurring least frequently in Dushanbe. While access to care and quality of care have increased significantly over time, findings suggest that linkage to care is low, especially in the capital city where many services are provided. Evaluation focusing on acceptability of HIV services should be undertaken to understand why certain people do not link with services. Additional research about the types of barriers to linking with HIV care is needed to increase linkage to HIV care.
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Affiliation(s)
- Arash Alaei
- 1 Institute for International Health and Education, University of Albany, Albany, NY, USA
| | - Nisheet Nautiyal
- 2 Department of Biostatistics, Yale University, New Haven, CT, USA
| | - Kathryn Mishkin
- 3 Global Institute for Health and Human Rights, University at Albany, State University of New York, Albany, NY, USA
| | - D Saifuddin Karimov
- 4 Republican AIDS Center, Tajikistan Ministry of Health, Dushanbe, Tajikistan
| | - Dilshod Saidi
- 4 Republican AIDS Center, Tajikistan Ministry of Health, Dushanbe, Tajikistan
| | - Kamiar Alaei
- 3 Global Institute for Health and Human Rights, University at Albany, State University of New York, Albany, NY, USA.,5 Rockefeller College, University at Albany, State University of New York, Albany, NY, USA
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Ahmadi Q, Danesh H, Makharashvili V, Mishkin K, Mupfukura L, Teed H, Huff-Rousselle M. SWOT analysis of program design and implementation: a case study on the reduction of maternal mortality in Afghanistan. Int J Health Plann Manage 2015; 31:247-59. [PMID: 25950757 DOI: 10.1002/hpm.2288] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This case study analyzes the design and implementation of the Basic Package of Health Services (BPHS) in Afghanistan by synthesizing the literature with a focus on maternal health services. The authors are a group of graduate students in the Brandeis University International Health Policy and Management Program and Sustainable International Development Program who used the experience in Afghanistan to analyze an example of successfully implementing policy; two of the authors are Afghan physicians with direct experience in implementing the BPHS. Data is drawn from a literature review, and a unique aspect of the case study is the application of the business-oriented SWOT analysis to the design and implementation of the program that successfully targeted lowering maternal mortality in Afghanistan. It provides a useful example of how SWOT analysis can be used to consider the reasons for, or likelihood of, successful or unsuccessful design and implementation of a policy or program. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Qudratullah Ahmadi
- Ministry of Higher Education, University Medical School, Kandahar, Afghanistan
| | - Homayoon Danesh
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, USA
| | - Vasil Makharashvili
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, USA
| | - Kathryn Mishkin
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, USA
| | - Lovemore Mupfukura
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, USA
| | - Hillary Teed
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, USA
| | - Maggie Huff-Rousselle
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, USA.,Massachusetts College of Pharmacy, Boston, MA, USA
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