Operational and contextual barriers to accessing supervised consumption services in two Canadian cities

2021 ◽  
Vol 88 ◽  
pp. 102991
Author(s):  
Marta-Marika Urbanik ◽  
Carolyn Greene
Keyword(s):  
Contextual Barriers

scholarly journals Process evaluation of co-designed interventions to improve communication of positive newborn bloodspot screening results

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e050773
Author(s):  
Jane Chudleigh ◽  
Pru Holder ◽  
Louise Moody ◽  
Alan Simpson ◽  
Kevin Southern ◽  
...  
Keyword(s):  
Newborn Screening ◽  
Process Evaluation ◽  
Healthcare Professionals ◽  
Normalisation Process Theory ◽  
Future Research ◽  
Health Service Provider ◽  
Laboratory Staff ◽  
Newborn Bloodspot Screening ◽  
Screening Result ◽  
Contextual Barriers

ObjectiveTo implement and evaluate co-designed interventions to improve communication of positive newborn bloodspot screening results and make recommendations for future research and practice.DesignA process evaluation underpinned by Normalisation Process Theory.SettingThree National Health Service provider organisations in England.ParticipantsTwenty-four healthcare professionals (7 newborn screening laboratory staff and 24 clinicians) and 18 parents were interviewed.InterventionsThree co-designed interventions were implemented in practice: standardised laboratory proformas, communication checklists and an email/letter template.Primary outcome measuresAcceptability and feasibility of the co-designed interventions.ResultsAuditing the implementation of these interventions revealed between 58%–76% of the items on the laboratory proforma and 43%–80% of items on the communication checklists were completed. Interviews with healthcare professionals who had used the interventions in practice provided positive feedback in relation to the purpose of the interventions and the ease of completion both of which were viewed as enhancing communication of positive newborn bloodspot screening results. Interviews with parents highlighted the perceived benefit of the co-designed interventions in terms of consistency, pacing and tailoring of information as well as providing reliable information to families following communication of the positive newborn bloodspot screening result. The process evaluation illuminated organisational and contextual barriers during implementation of the co-designed interventions in practice.ConclusionVariations in communication practices for positive newborn bloodspot screening results continue to exist. The co-designed interventions could help to standardise communication of positive newborn screening results from laboratories to clinicians and from clinicians to parents which in turn could improve parents’ experience of receiving a positive newborn bloodspot screening result. Implementation highlighted some organisational and contextual barriers to effective adoption of the co-designed interventions in practice.Trial registration numberISRCTN15330120.

scholarly journals Get Smart: Learning and partnership with Ethiopia’s Health Extension Programme to re-envision contraceptive service delivery to young couples

2019 ◽  
Vol 3 ◽  
pp. 1570
Author(s):  
Gabrielle Appleford ◽  
Claire Cole ◽  
Metsehate Ayenekulu ◽  
Sue Newport ◽  
Emma Mulhern
Keyword(s):  
Adolescent Pregnancy ◽  
Process Evaluation ◽  
Addis Ababa ◽  
Sampling Strategy ◽  
Married Couples ◽  
Early Marriage ◽  
Health Extension Workers ◽  
Barriers And Enablers ◽  
Health Extension Programme ◽  
Contextual Barriers

Background: Adolescents 360 (A360) implements the Smart Start (SS) programme through Ethiopia’s Health Extension Programme (HEP). SS is premised on financial planning as an entry point to discuss family planning (FP) with newly married couples and central to its delivery are the health extension workers (HEW). This article evaluates the A360 experience and learning from the process evaluation implemented by Itad to understand contextual barriers and enablers from the perspective of the HEW. Methods: A purposive sampling strategy was employed whereby 27 key stakeholders were identified from Oromia, Addis Ababa and Amhara, based on exposure to the SS programme. Findings from the action research were shared with A360 through a one day sounding workshop. Results: Findings revealed that many local government and communal respondents do not view adolescent pregnancy as a problem, unless out of wedlock, and adolescent pregnancy is closely linked to early marriage. As a result, some providers, including HEWs, acknowledged that married adolescent girls were previously ‘neglected’ by them, while husbands indicated that they had not previously been included in FP counselling. Findings also revealed some challenges with SS implementation as HEWs were ‘deprioritizing’ the intervention and many HEWs had been in situ for several years and were overworked and frustrated. Against this backdrop, A360 was viewed as adding to the HEW workload. While the programme design was focused on adolescent users, there was increasing recognition that HEWs also needed to be at the centre of solution design. Conclusions: Despite challenges associated with the HEP, Ethiopia FP2020 plans to support the ‘next generation’ of HEWs, including a focus on adolescents and youth. To gain deeper insight and put the HEW at the centre of design, A360 will continue to work with the process evaluation to understand contextual barriers and enablers from the perspective of the HEW.

scholarly journals Implementation, Mechanisms and Context of the MAMAACT Intervention to Reduce Ethnic and Social Disparity in Stillbirth and Infant Health

2021 ◽  
Vol 18 (16) ◽  
pp. 8583
Author(s):  
Trine Damsted Rasmussen ◽  
Helle Johnsen ◽  
Signe Smith Jervelund ◽  
Ulla Christensen ◽  
Anne-Marie Nybo Andersen ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Pregnancy Complications ◽  
Infant Health ◽  
Training Session ◽  
Organizational Factors ◽  
Warning Signs ◽  
Interaction Patterns ◽  
Cross Sectional Survey ◽  
Social Disparity ◽  
Contextual Barriers

The MAMAACT intervention aimed to address ethnic and social disparity in stillbirth and infant health by improving management of pregnancy complications. This process evaluation of the intervention was guided by the British Medical Research Council’s framework. We examined implementation through dose, reach, and fidelity, important mechanisms and the influence of contextual factors. The intervention included a six-hour training session for antenatal care (ANC) midwives in intercultural communication and cultural competence, two follow-up dialogue meetings, and health education materials (leaflet and app) on warning signs of severe pregnancy complications and how to respond for pregnant women. A mixed-methods approach was applied. Cross-sectional survey data and administrative data were used to assess intervention reach and dose. Qualitative data (records from dialogue meetings with midwives, participant observations and field notes from ANC visits, focus group interviews with midwives, and individual interviews with non-Western immigrant women) evaluated intervention fidelity, mechanisms, and contextual barriers. More than 80% of women received the MAMAACT leaflet and many found the content useful. The app was used more selectively. Midwives described being more aware and reflective in their communication with women from various cultural backgrounds. Organizational factors in ANC (time pressure, lack of flexibility in visits, poor interpreter services), barriers in women’s everyday life (lack of social network, previous negative experiences/lack of trust and domestic responsibilities), and habitual interaction patterns among midwives served as contextual barriers. The reach of the intervention was high and it was evaluated positively by both pregnant women and midwives. Organizational factors hindered changes towards more needs-based communication in ANC potentially hindering the intended mechanisms of the intervention. When interpreting the intervention effects, attention should be drawn to both organizational and interpersonal factors in the clinic as well as the pregnant women’s life situations.

Contextual Barriers to Condom Accessibility in Economically Diverse Neighborhoods

2013 ◽  
Author(s):  
Lynda M. Sagrestano ◽  
Ruthbeth Finerman ◽  
Joy Clay ◽  
Teresa Diener ◽  
Ace Madjlesi
Keyword(s):  
Contextual Barriers
Sign in / Sign up

Export Citation Format

Share Document