scholarly journals What methods and challenges for taking account of context when transferring complex interventions?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Villadsen ◽  
S Dias

Abstract For complex public health interventions to be effective their implementation needs to adapt to the situation of those implementing and those receiving the intervention. While context matter for intervention implementation and effect, we still insist on learning from cross-country comparison of implementation. Next methodological challenges include how to increase learning from implementation of complex public health interventions from various context. The interventions presented in this workshop all aims to improve quality of reproductive health care for immigrants, however with different focus: contraceptive care in Sweden, group based antenatal care in France, and management of pregnancy complications in Denmark. What does these interventions have in common and are there cross cutting themes that help us to identify the larger challenges of reproductive health care for immigrant women in Europe? Issues shared across the interventions relate to improved interactional dynamics between women and the health care system, and theory around a woman-centered approach and cultural competence of health care providers and systems might enlighten shared learnings across the different interventions and context. Could the mechanisms of change be understood using theoretical underpinnings that allow us to better generalize the finding across context? What adaption would for example be needed, if the Swedish contraceptive intervention should work in a different European setting? Should we distinguish between adaption of function and form, where the latter might be less important for intervention fidelity? These issues will shortly be introduced during this presentation using insights from the three intervention presentations and thereafter we will open up for discussion with the audience.

Author(s):  
Fatemeh Rahmanian ◽  
Soheila Nazarpour ◽  
Masoumeh Simbar ◽  
Ali Ramezankhani ◽  
Farid Zayeri

AbstractBackgroundA dimension of reproductive health services that should be gender sensitive is reproductive health services for adolescents.ObjectiveThis study aims to assess needs for gender sensitive reproductive health care services for adolescents.MethodsThis was a descriptive cross-sectional study on 341 of health care providers for adolescents in health centers and hospitals affiliated to Shiraz University of Medical Sciences in Iran in 2016. The subjects of the study were recruited using a convenience sampling method. The tools for data collection were: (1) a demographic information questionnaire and; (2) a valid and reliable questionnaire to Assess the Needs of Gender-Sensitive Adolescents Reproductive Health Care Services (ANQ-GSARHS) including three sections; process, structure and policy making for the services. Data were analyzed using SPSS 21.ResultsThree hundred and forty-one health providers with an average working experience of 8.77 ± 5.39 [mean ± standard deviation (SD)] years participated in the study. The results demonstrated the highest scores for educational needs (92.96% ± 11.49%), supportive policies (92.71% ± 11.70%) and then care needs (92.37% ± 14.34%) of the services.ConclusionsProviding gender sensitive reproductive health care services for adolescents needs to be reformed as regards processes, structure and policies of the services. However, the gender appropriate educational and care needs as well as supportive policies are the priorities for reform of the services.


2012 ◽  
Vol 19 (3) ◽  
pp. 231-256 ◽  
Author(s):  
Christina Zampas ◽  
Ximena Andión-Ibañez

Abstract The practice of conscientious objection often arises in the area of individuals refusing to fulfil compulsory military service requirements and is based on the right to freedom of thought, conscience and religion as protected by national, international and regional human rights law. The practice of conscientious objection also arises in the field of health care, when individual health care providers or institutions refuse to provide certain health services based on religious, moral or philosophical objections. The use of conscientious objection by health care providers to reproductive health care services, including abortion, contraceptive prescriptions, and prenatal tests, among other services is a growing phenomena throughout Europe. However, despite recent progress from the European Court of Human Rights on this issue (RR v. Poland, 2011), countries and international and regional bodies generally have failed to comprehensively and effectively regulate this practice, denying many women reproductive health care services they are legally entitled to receive. The Italian Ministry of Health reported that in 2008 nearly 70% of gynaecologists in Italy refuse to perform abortions on moral grounds. It found that between 2003 and 2007 the number of gynaecologists invoking conscientious objection in their refusal to perform an abortion rose from 58.7 percent to 69.2 percent. Italy is not alone in Europe, for example, the practice is prevalent in Poland, Slovakia, and is growing in the United Kingdom. This article outlines the international and regional human rights obligations and medical standards on this issue, and highlights some of the main gaps in these standards. It illustrates how European countries regulate or fail to regulate conscientious objection and how these regulations are working in practice, including examples of jurisprudence from national level courts and cases before the European Court of Human Rights. Finally, the article will provide recommendations to national governments as well as to international and regional bodies on how to regulate conscientious objection so as to both respect the practice of conscientious objection while protecting individual’s right to reproductive health care.


F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 98 ◽  
Author(s):  
Feisul Mustapha ◽  
Michael Calopietro ◽  
Karoline Kragelund Nielsen ◽  
Jens Aagaard-Hansen ◽  
Shiang Cheng Lim ◽  
...  

The burden of diabetes continues to increase in Malaysia, and the public primary health sector has an insufficient number of health care providers well-trained in diabetes care. The Ministry of Health Malaysia collaborated with Steno Diabetes Center to educate primary care doctors and nurses on the fundamentals of clinical diabetes care using a competency-based approach that blends e-learning, classroom-based learning, and clinic-based group work. This programme is called Steno REACH Certificate Course in Clinical Diabetes Care (SRCC). The aim of this study was to assess the effectiveness of the SRCC intervention in improving diabetes-related knowledge, attitudes, skills and clinical practices among non-specialised doctors and general nurses working in public health clinics in Malaysia. This paper presents the study protocol. A quasi-experimental, mixed-methods study based on Solomon’s Four Group Design was applied. Non-specialist doctors and general nurses from ten health clinics were randomly selected to receive the educational intervention. Comparison clinics were purposive selected matching on proxy indicators for quality of diabetes care. The intervention consisted of 50 hours of e-learning, 48 hours of classroom-based learning and approximately 25 hours of work-based learning that covered all main aspects of clinical diabetes care and delivered over a six-month period. Primary outcomes were changes in diabetes-related knowledge, attitudes, skills, and clinical practice. Patients’ perceptions regarding the quality of care provided were classified as a secondary outcome. Other outcome measures included patients' assessment of their chronic disease care and providers' perceptions, attitudes and perceived barriers in care delivery. Results from this study will inform future educational approaches within the Malaysian health system. The study is unique because it evaluated a pertinent public health topic using a very robust methodology.


Author(s):  
Sourav Goswami ◽  
Subodh S. Gupta ◽  
Abhishek V. Raut ◽  
Bishan S. Garg

Background: Melghat, the hilly and forest dense area in the northeastern Maharashtra is the home of the Gond and Korku tribes. The maternal and child health indicators in Melghat are poor compared to other parts of Maharashtra. Apart from poor socio-economic development, traditions and social norms prevailing in the area also prevent people to seek reproductive health care. The current study tried to capture the perception of women in reproductive health regarding their practices during the antenatal, natal and postnatal period and reasons for not seeking medical advice during pregnancy or childbirth. Methods: This qualitative study was conducted during September to October 2015 in the selected villages under three PHC areas of Melghat region, where we used in-depth, key informant interviews and focus group discussion with the purposively chosen participants, after taking verbal consent from them. All the interviews were audio recorded which were transcribed for doing the analysis. Ethical clearance was taken from institutional ethical committee. Results: We identified different practices during the antenatal, natal and postnatal period in Melghat, which could be classified into common and deviant. Though some of the mothers go to health facilities for delivery but still there are many others who prefer home delivery due to poor health literacy, family customs, poor communication network, perception regarding quality of health care in government health facilities and more reliance on health seeking from unqualified health care providers and faith healers. Conclusions: More emphasis should be given on counselling for increasing the awareness among the mothers and their families regarding institutional delivery, birth preparedness and maternal deaths in Melghat, along with improvement in quality of services at government health facilities and the inter-sectorial coordination. 


2021 ◽  
Vol 10 (3) ◽  
pp. 522
Author(s):  
Rosalinda S. Guingab ◽  
Pedrita N. Medrano

The quality of provider-interaction determines client satisfaction and decision to seek health care. This research aimed to determine the women clients’ perception of their quality of interaction with the health care providers in a government reproductive health clinic in one of the municipalities in northern Philippines. Respondents consisted of 30 pregnant women who had visited the clinic for prenatal health care check-up were interviewed. A structured questionnaire and a semi-structured guided for probing served as the study’s research instruments. Women perceived the health care providers to possess good communication skills, and had displayed behavior that showed a regard for them. However, the providerinteraction was considered to be unilinear, with the provider perceived to have dominated the interface, The women also perceived only a somewhat evident show of sympathy/empathy. Hostile words were heard frequently. Creation of a two-way interaction with respect for their clients must be considered by the health care providers. Policies must also be formulated to improve the quality of provider-client interaction inside reproductive health clinics.


2020 ◽  
Vol 64 (2) ◽  
pp. 277-284 ◽  
Author(s):  
Sara E Davies ◽  
Sophie Harman

Abstract Failure to access reproductive health care is a threat to the security of women around the world. This article offers three propositions to recognize reproductive health as a matter of international peace and security. The first is to recognize current processes of advancement and backlash politics as a silent security dilemma that undermines rights, justice, and public health based approaches to reproductive health. The second is to draw on the human security origins of global health security to reorient the concept away from protecting states to protecting individuals. Finally, a feminist approach to security is incomplete without recognising reproductive health as a threat to women's security and as a barrier to their participation in international peace and security processes. Reproductive health is central to effective peacebuilding yet remains curiously absent from the international peace and security discourse. We discuss how and why reproductive security should become integrated within the Women, Peace, and Security (WPS) agenda in order to hold states to account for reproductive health access. Reproductive security defines the urgency and threat of restricted reproductive health care to the lives of women, health-care providers, and sustained international peace and security.


2007 ◽  
Vol 7 ◽  
pp. 1875-1883 ◽  
Author(s):  
Amie B. Jackson ◽  
Pamela K. Mott

Women with spina bifida have unique health care concerns and as the life expectancy of this population increases, they are transitioning from adolescence to womanhood and entering their reproductive years with little information about what to expect. Likewise, their health care providers do not have the benefit of evidence-based research that comprehensively addresses the issues these women may face related to reproduction or aging. Few studies have focused on the effects that spina bifida may have on these women's reproductive systems, nor has attention been paid to the effects that possible reproductive endocrine changes may have on their disability. Needless to say, concerns about sexuality, sexual function, and pregnancy are just as important to these women as they are to their able-bodied counterparts.


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