scholarly journals Health system resilience: a literature review of empirical research

2020 ◽  
Vol 35 (8) ◽  
pp. 1084-1109
Author(s):  
Louise Biddle ◽  
Katharina Wahedi ◽  
Kayvan Bozorgmehr
Keyword(s):  
Health System ◽  
Mixed Methods Research ◽  
Quantitative Research ◽  
Empirical Studies ◽  
Disease Outbreaks ◽  
Building Blocks ◽  
Theoretical Work ◽  
Empirical Literature ◽  
Quantitative And Qualitative Research ◽  
System Resilience

Abstract The concept of health system resilience has gained popularity in the global health discourse, featuring in UN policies, academic articles and conferences. While substantial effort has gone into the conceptualization of health system resilience, there has been no review of how the concept has been operationalized in empirical studies. We conducted an empirical review in three databases using systematic methods. Findings were synthesized using descriptive quantitative analysis and by mapping aims, findings, underlying concepts and measurement approaches according to the resilience definition by Blanchet et al. We identified 71 empirical studies on health system resilience from 2008 to 2019, with an increase in literature in recent years (62% of studies published since 2017). Most studies addressed a specific crisis or challenge (82%), most notably infectious disease outbreaks (20%), natural disasters (15%) and climate change (11%). A large proportion of studies focused on service delivery (48%), while other health system building blocks were side-lined. The studies differed in terms of their disciplinary tradition and conceptual background, which was reflected in the variety of concepts and measurement approaches used. Despite extensive theoretical work on the domains which constitute health system resilience, we found that most of the empirical literature only addressed particular aspects related to absorptive and adaptive capacities, with legitimacy of institutions and transformative resilience seldom addressed. Qualitative and mixed methods research captured a broader range of resilience domains than quantitative research. The review shows that the way in which resilience is currently applied in the empirical literature does not match its theoretical foundations. In order to do justice to the complexities of the resilience concept, knowledge from both quantitative and qualitative research traditions should be integrated in a comprehensive assessment framework. Only then will the theoretical ‘resilience idea’ be able to prove its usefulness for the research community.

scholarly journals Health system resilience – a conceptual and empirical review of health system literature

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K Wahedi ◽  
L Biddle ◽  
K Bozorgmehr
Keyword(s):  
Health System ◽  
Health Systems ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Empirical Studies ◽  
Building Blocks ◽  
Systems Research ◽  
System Resilience ◽  
Analytical Category ◽  
Operational Frameworks

Abstract Background The concept of health system resilience has gained popularity in the global health discourse, featuring in UN policies, academic articles and conferences. The term is commonly used to refer to the ability of health systems to respond to challenges. However, there has been no comprehensive overview of how the concept is understood and assessed in health systems research (HSR). Methods We conducted a conceptual and empirical review in 3 databases using systematic methods. Quantitative and narrative synthesis was used to trace the introduction of the concept to HSR, identify relevant definitions and examine its use in research. Results From 4063 references, we identified 96 articles concerned with health system resilience from 2007 - 2017, with a recent increase in literature (45% of studies published since 2016). Many articles take a general perspective; others focus on specific HSR building blocks (e.g. 28% on service delivery) or a particular type of crisis, such as climate change (12.5%) or natural disasters (10.4%). While the concept was developed from the ecological sciences, its meaning has been adapted in HSR, with a shift towards people-centred and process-oriented definitions. We identify three frameworks operationalising resilience: the “attributes” framework by Kruk et al. (2017), the “everyday resilience” framework by Barasa et al. (2017) and the “complex adaptive systems” framework by Blanchet et al. (2017). However, we find a mismatch between these frameworks and how the concept is assessed in 13 quantitative and 8 qualitative empirical studies. Conclusions The HSR literature has converged around a definition of resilience focusing on the system’s ability to mitigate ongoing challenges. Differences in emphasis remain, resulting in a variety of operational frameworks. The frameworks require further adaptation and testing in empirical studies to demonstrate the usefulness of “resilience” as an analytical category in HSR. Key messages There is a mismatch between conceptualisation and operationalisation of resilience in the HSR literature. Existing operational frameworks of resilience require further adaptation and testing in empirical studies to demonstrate the usefulness of “resilience” as an analytical category in HSR.

scholarly journals What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jennifer B. Nuzzo ◽  
Diane Meyer ◽  
Michael Snyder ◽  
Sanjana J. Ravi ◽  
Ana Lapascu ◽  
...  
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Health System ◽  
Natural Hazards ◽  
Health Systems ◽  
Scoping Review ◽  
Disease Outbreaks ◽  
World Health ◽  
Infectious Disease Outbreaks ◽  
System Resilience

Abstract Background The 2014–2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency. Methods We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization’s Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations. Results We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings. Conclusions An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.

Qualitative, Quantitative, and Mixed Methods Research Sampling Strategies

Education ◽  
2020 ◽  
Author(s):  
Timothy C. Guetterman
Keyword(s):  
Qualitative Research ◽  
Mixed Methods ◽  
Mixed Methods Research ◽  
Quantitative Research ◽  
Target Population ◽  
Research Process ◽  
Sampling Strategies ◽  
Quantitative And Qualitative Research ◽  
Purposeful Sampling ◽  
Relationship Of

Sampling is a critical, often overlooked aspect of the research process. The importance of sampling extends to the ability to draw accurate inferences, and it is an integral part of qualitative guidelines across research methods. Sampling considerations are important in quantitative and qualitative research when considering a target population and when drawing a sample that will either allow us to generalize (i.e., quantitatively) or go into sufficient depth (i.e., qualitatively). While quantitative research is generally concerned with probability-based approaches, qualitative research typically uses nonprobability purposeful sampling approaches. Scholars generally focus on two major sampling topics: sampling strategies and sample sizes. Or simply, researchers should think about who to include and how many; both of these concerns are key. Mixed methods studies have both qualitative and quantitative sampling considerations. However, mixed methods studies also have unique considerations based on the relationship of quantitative and qualitative research within the study.

scholarly journals A checklist to improve health system resilience to infectious disease outbreaks and natural hazards

2020 ◽  
Vol 5 (8) ◽  
pp. e002429 ◽  
Author(s):  
Diane Meyer ◽  
David Bishai ◽  
Sanjana J Ravi ◽  
Harunor Rashid ◽  
Shehrin Shaila Mahmood ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Health System ◽  
Natural Hazards ◽  
Health Systems ◽  
Disease Outbreaks ◽  
Health Systems Strengthening ◽  
Effective Response ◽  
Health Security ◽  
Infectious Disease Outbreaks ◽  
System Resilience

Recent infectious disease outbreaks, including the ongoing global COVID-19 pandemic and Ebola in the Democratic Republic of the Congo, have demonstrated the critical importance of resilient health systems in safeguarding global health security. Importantly, the human, economic and political tolls of these crises are being amplified by health systems’ inabilities to respond quickly and effectively. Improving resilience within health systems can build on pre-existing strengths to enhance the readiness of health system actors to respond to crises, while also maintaining core functions. Using data gathered from a scoping literature review, interviews with key informants and from stakeholders who attended a workshop held in Dhaka, Bangladesh, we developed a Health System Resilience Checklist (‘the checklist’). The aim of the checklist is to measure the specific capacities, capabilities and processes that health systems need in order to ensure resilience in the face of both infectious disease outbreaks and natural hazards. The checklist is intended to be adapted and used in a broad set of countries as a component of ongoing processes to ensure that health actors, institutions and populations can mount an effective response to infectious disease outbreaks and natural hazards while also maintaining core healthcare services. The checklist is an important first step in improving health system resilience to these threats, but additional research and resources will be necessary to further refine and prioritise the checklist items and to pilot the checklist with the frontline health facilities that would be using it. This will help ensure its feasibility and durability for the long-term within the health systems strengthening and health security fields.

scholarly journals A Framework for Mixed-method Research

2020 ◽  
Vol 8 (2) ◽  
pp. 45-53
Author(s):  
Sindhu Shantha Nair ◽  
Smritika S Prem
Keyword(s):  
Mixed Method ◽  
Quantitative Research ◽  
Empirical Studies ◽  
Future Research ◽  
Mixed Method Research ◽  
Mixed Method Approach ◽  
Quantitative And Qualitative Research ◽  
Main Components ◽  
Method Approach

This article presents the basics of mixed-method research as a distinct methodology that uses both quantitative and qualitative research methods to create empirical research. The method of this study is a review. Through a substantive review, this paper explains the basic idea of a mixed method approach. The article identifies the main components of the mixed-method approach, provides examples, and describes how to conduct mixed-method research. A quantitative study involves collecting, identifying, and analyzing data. A qualitative study uses interviews or focus groups. An integration of both approaches helps a better understanding of the issue. This study brings out the role of mixed-method research to assess further approaches in future research practices. The combination of qualitative and quantitative research will enable a broader reach in empirical studies.

scholarly journals Linking Research Questions to Mixed Methods Data Analysis Procedures 1

2015 ◽  
Author(s):  
Anthony Onwuegbuzie ◽  
Nancy Leech
Keyword(s):  
Qualitative Research ◽  
Mixed Methods ◽  
Data Analysis ◽  
Mixed Method ◽  
Mixed Methods Research ◽  
Quantitative Research ◽  
Analysis Techniques ◽  
Quantitative And Qualitative Research ◽  
Research Questions ◽  
Compare And Contrast

The purpose of this paper is to discuss the development of research questions in mixed methods studies. First, we discuss the ways that the goal of the study, the research objective(s), and the research purpose shape the formation of research questions. Second, we compare and contrast quantitative research questions and qualitative research questions. Third, we describe how to write mixed methods research questions, which we define as questions that embed quantitative and qualitative research questions. Finally, we provide a framework for linking research questions to mixed methods data analysis techniques. A major goal of our framework is to illustrate that the development of research questions and data analysis procedures in mixed method studies should occur logically and sequentially.

scholarly journals Community engagement for health system resilience: evidence from Liberia’s Ebola epidemic

2020 ◽  
Vol 35 (4) ◽  
pp. 416-423 ◽  
Author(s):  
Kathryn M Barker ◽  
Emilia J Ling ◽  
Mosoka Fallah ◽  
Brian VanDeBogert ◽  
Yvonne Kodl ◽  
...  
Keyword(s):  
Health System ◽  
Community Engagement ◽  
Empirical Literature ◽  
System Response ◽  
Group Discussions ◽  
Low Resource ◽  
Critical Gap ◽  
Health Authorities ◽  
Health Response ◽  
System Resilience

Abstract The importance of community engagement (CE) for health system resilience is established in theoretical and empirical literature. The practical dimensions of how to operationalize theory and implement its principles have been less explored, especially within low-resource crisis settings. It is therefore unclear how CE is drawn upon and how, if at all, it facilitates health system resilience in times of health system crises. To address this critical gap, we adapt and apply existing theoretical CE frameworks to analyse qualitative data from 92 in-depth interviews and 16 focus group discussions collected with health system stakeholders in Liberia in the aftermath of the 2014–15 Ebola outbreak. Health system stakeholders indicated that CE was a crucial contributing factor in addressing the Ebola epidemic in Liberia. Multiple forms of CE were used during the outbreak; however, only some forms were perceived as meaningful, such as the formation of community-based surveillance teams. To achieve meaningful CE, participants recommended that communities be treated as active participants in—as opposed to passive recipients of—health response efforts and that communication platforms for CE be established ahead of a crisis. Participant responses highlight that meaningful CE led to improved communication with and increased trust in health authorities and programming. This facilitated health system response efforts, leading to a fortuitous cycle of increased trust, improved communication and continued meaningful CE—all necessary conditions for health system resilience. This study refines our understanding of CE and demonstrates the ways in which meaningful CE and trust work together in mutually reinforcing and beneficial ways. These findings provide empirical evidence on which to base policies and programmes aimed at improving health system resilience in low-resource settings to more effectively respond to health system crises.

Yogic Intervention in Sexual Dysfunction - A Review

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Rakshith K. R. ◽  
Shivakumar . ◽  
Kaushal Sinha ◽  
Vijeth Kumar L. A.
Keyword(s):  
Psychological Functioning ◽  
Empirical Studies ◽  
Empirical Literature ◽  
Future Research ◽  
Therapeutic Effects ◽  
Yoga Therapy ◽  
Cognitive Component ◽  
Beneficial Effects ◽  
Breathing Exercises ◽  
The Mind

Yoga is an ancient practice with Eastern roots that involves both physical postures (Asanas) and breathing techniques (Pranayamas). Yoga therapy for male sexual problems can effectively be treated through Yoga therapy, particularly with the help of Yoga poses and breathing exercises, Yoga has proven itself highly very effective in the treatment of a number of incurable and sometimes terminable diseases. Then again, Yoga's therapeutic effects are just a spin-off and supplementary. Yoga which has proved to be very effective in the treatment of many impossible and incurable diseases, the therapeutic effect of Yoga is only a by product and incidental. Problems related to sex can very well be handled with Yoga as most often these problems are more related to the mind than body. Either they are caused by lack of confidence or stress or fatigue or fear and very few times some physical cause is there. There is also a cognitive component focusing on meditation and concentration, which aids in achieving the goal of union between the self and the spiritual. Although numerous empirical studies have found a beneficial effect of Yoga on different aspects of physical and psychological functioning, claims of Yoga's beneficial effects on sexuality derive from a rich but no empirical literature. The goal of this article is to review the philosophy and forms of Yoga, to review the no empirical and (limited) empirical literatures linking Yoga with enhanced sexuality, and to propose some future research avenues focusing on Yoga as a treatment for sexual disorder.

scholarly journals 22.F. Workshop: What makes for resilient health systems? Evidence from the State of Health in the EU country profiles

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Building Blocks ◽  
The State ◽  
Lessons Learned ◽  
Three Dimensions ◽  
Health System Strengthening ◽  
New Work ◽  
State Of Health ◽  
The Eu

Abstract The European Commission's State of Health in the EU (SoHEU) initiative aims to provide factual, comparative data and insights into health and health systems in EU countries. The resulting Country Health Profiles, published every two years (current editions: November 2019) are the joint work of the European Observatory on Health Systems and Policies and the OECD, in cooperation with the European Commission. They are designed to support the efforts of Member States in their evidence-based policy making and to contribute to health care systems' strengthening. In addition to short syntheses of population health status, determinants of health and the organisation of the health system, the Country Profiles provide an assessment of the health system, looking at its effectiveness, accessibility and resilience. The idea of resilient health systems has been gaining traction among policy makers. The framework developed for the Country Profiles template sets out three dimensions and associated policy strategies and indicators as building blocks for assessing resilience. The framework adopts a broader definition of resilience, covering the ability to respond to extreme shocks as well as measures to address more predictable and chronic health system strains, such as population ageing or multimorbidity. However, the current framework predates the onset of the novel coronavirus pandemic as well as new work on resilience being done by the SoHEU project partners. This workshop aims to present resilience-enhancing strategies and challenges to a wide audience and to explore how using the evidence from the Country Profiles can contribute to strengthening health systems and improving their performance. A brief introduction on the SoHEU initiative will be followed by the main presentation on the analytical framework on resilience used for the Country Profiles. Along with country examples, we will present the wider results of an audit of the most common health system resilience strategies and challenges emerging from the 30 Country Profiles in 2019. A roundtable discussion will follow, incorporating audience contributions online. The Panel will discuss the results on resilience actions from the 2019 Country Profiles evidence, including: Why is resilience important as a practical objective and how is it related to health system strengthening and performance? How can countries use their resilience-related findings to steer national reform efforts? In addition, panellists will outline how lessons learned from country responses to the Covid-19 pandemic and new work on resilience by the Observatory (resilience policy briefs), OECD (2020 Health at a Glance) and the EC (Expert Group on Health Systems Performance Assessment (HSPA) Report on Resilience) can feed in and improve the resilience framework that will be used in the 2021 Country Profiles. Key messages Knowing what makes health systems resilient can improve their performance and ability to meet the current and future needs of their populations. The State of Health in the EU country profiles generate EU-wide evidence on the common resilience challenges facing countries’ health systems and the strategies being employed to address them.

scholarly journals How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links

2021 ◽  
Vol 18 (8) ◽  
pp. 3860
Author(s):  
Katarzyna Krot ◽  
Iga Rudawska
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health System ◽  
Health Systems ◽  
Quantitative Research ◽  
Public Trust ◽  
Complex Problem ◽  
Health Care Consumption ◽  
Mediating Role ◽  
Countries In Transition

Overconsumption of health care is an ever-present and complex problem in health systems. It is especially significant in countries in transition that assign relatively small budgets to health care. In these circumstances, trust in the health system and its institutions is of utmost importance. Many researchers have studied interpersonal trust. Relatively less attention, however, has been paid to public trust in health systems and its impact on overconsumption. Therefore, this paper seeks to identify and examine the link between public trust and the moral hazard experienced by the patient with regard to health care consumption. Moreover, it explores the mediating role of patient satisfaction and patient non-adherence. For these purposes, quantitative research was conducted based on a representative sample of patients in Poland. Interesting findings were made on the issues examined. Patients were shown not to overconsume health care if they trusted the system and were satisfied with their doctor-patient relationship. On the other hand, nonadherence to medical recommendations was shown to increase overuse of medical services. The present study contributes to the existing knowledge by identifying phenomena on the macro (public trust in health care) and micro (patient satisfaction and non-adherence) scales that modify patient behavior with regard to health care consumption. Our results also provide valuable knowledge for health system policymakers. They can be of benefit in developing communication plans at different levels of local government.

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