Assessing the Usability of a Task-Shifting Device for Inserting Subcutaneous Contraceptive Implants for Use in Low-Income Countries

Abstract Women in low- and middle-income countries (LMICs) have limited access to long-acting contraceptives. Access to long-acting contraceptives, such as subcutaneous contraceptive implants, could be increased by task-shifting implant administration from advanced to minimally trained healthcare providers. The objective of this study was to investigate the usability of a task-shifting device for administering subcutaneous contraceptive implants. Healthcare providers (n = 128) from multiple health centers in Ethiopia were trained to administer implants on an arm simulator with the traditional method and a method using the device. Participants were observed while inserting implants into the arm simulator, and procedural error rates were calculated. Observations were analyzed using an iterative inductive coding methodology. For the device-assisted method, minimally trained healthcare providers had larger procedural error rates than other professions (p = 0.002). For the traditional method, physicians had larger procedural error rates than nurses and midwives (p = 0.03). Several procedural errors were identified such as participants inserting and removing the trocar and plunger completely or inserting and/or removing the trocar too far or not enough. These findings reinforce the importance of performing formative usability testing during the early phases of a medical device design process, considering users' mental models, and avoiding assumptions about healthcare providers' abilities.

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International barriers and facilitators for cervical cancer screening among young people: a systematic review

10.22541/au.159620944.40309212/v2 ◽

2021 ◽

Author(s):

Abirami Kirubarajan ◽

Shannon Leung ◽

Xinglin Li ◽

Matthew Yau ◽

Mara Sobel

Keyword(s):

Systematic Review ◽

Cervical Cancer ◽

Cancer Screening ◽

Young People ◽

Cervical Cancer Screening ◽

Low Income ◽

Healthcare Providers ◽

Barriers And Facilitators ◽

Low Income Countries ◽

Age Group

Background Though cervical cancer is one of the leading causes of death globally, its incidence is nearly entirely preventable. Young people have been an international priority for screening. However, in both high-income and low-income countries, young people have not been screened appropriately according to country-specific guidelines and in many countries, screening rates for this age-group have even dropped. Objectives The aim of this systematic review was to systematically characterize the existing literature on barriers and facilitators for cervical cancer screening among young people globally. Search Strategy We conducted a systematic review following PRISMA guidelines of four databases: Medline-OVID, EMBASE, CINAHL, and ClinicalTrials.Gov. Selection Criteria We only examined original, peer-reviewed literature. Databases were examined from inception until the date of our literature searches (12/03/2020). Articles were excluded if they did not specifically discuss cervical cancer screening, were not specific to young people, or did not report outcomes or evaluation. Data Collection and Analysis All screening and extraction was completed in duplicate with two independent reviewers. Main Results Of the 2177 original database citations, we included 36 studies that met inclusion criteria. Our systematic review found that there are three large categories of barriers for young people: lack of knowledge/awareness, negative perceptions of the test, and practical barriers to testing. Facilitators included stronger relationships with healthcare providers, social norms, support from family, and self-efficacy. Conclusions Health systems worldwide should address the barriers and facilitators to increase cervical cancer screening rates in young people. Further research is required to understand this age group.

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Point of Care Diagnostics in Resource-Limited Settings: A Review of the Present and Future of PoC in Its Most Needed Environment

Biosensors ◽

10.3390/bios10100133 ◽

2020 ◽

Vol 10 (10) ◽

pp. 133

Author(s):

Benjamin Heidt ◽

Williane Siqueira ◽

Kasper Eersels ◽

Hanne Diliën ◽

Bart van Grinsven ◽

...

Keyword(s):

Low Income ◽

Value Chain ◽

Point Of Care ◽

Healthcare Providers ◽

Low Income Countries ◽

Patient Treatment ◽

Resource Limited Settings ◽

Widespread Application ◽

Resource Limited ◽

Fundamental Research

Point of care (PoC) diagnostics are at the focus of government initiatives, NGOs and fundamental research alike. In high-income countries, the hope is to streamline the diagnostic procedure, minimize costs and make healthcare processes more efficient and faster, which, in some cases, can be more a matter of convenience than necessity. However, in resource-limited settings such as low-income countries, PoC-diagnostics might be the only viable route, when the next laboratory is hours away. Therefore, it is especially important to focus research into novel diagnostics for these countries in order to alleviate suffering due to infectious disease. In this review, the current research describing the use of PoC diagnostics in resource-limited settings and the potential bottlenecks along the value chain that prevent their widespread application is summarized. To this end, we will look at literature that investigates different parts of the value chain, such as fundamental research and market economics, as well as actual use at healthcare providers. We aim to create an integrated picture of potential PoC barriers, from the first start of research at universities to patient treatment in the field. Results from the literature will be discussed with the aim to bring all important steps and aspects together in order to illustrate how effectively PoC is being used in low-income countries. In addition, we discuss what is needed to improve the situation further, in order to use this technology to its fullest advantage and avoid “leaks in the pipeline”, when a promising device fails to take the next step of the valorization pathway and is abandoned.

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A Descriptive, Cross-Sectional Study of Ugandan Students in Health Care Education regarding Postgraduate Migration and Future Practice

ISRN Education ◽

10.5402/2012/357280 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Arabat Kasangaki ◽

Andrew Macnab ◽

Faith Gagnon

Keyword(s):

Health Care ◽

Low Income ◽

Urban Areas ◽

Community Health Centers ◽

Healthcare Providers ◽

Cross Sectional Study ◽

Rural Practice ◽

Low Income Countries ◽

Cross Sectional ◽

Future Practice

A growing challenge of globalization is the migration of many healthcare trainees to richer nations when they complete their education. This loss of intellectual capital compromises the ability of low-income countries to provide adequate health care. Despite recognition of this loss most African nations keep no track of those they train. Effective investment in health care demands retention of this resource; the ability to direct healthcare providers where needed; understanding of local factors driving migration, choices regarding postgraduate training abroad, and future practice preference. Self-administered questionnaires were distributed to a random sample of 200 Uganda College of Health Sciences students for anonymous completion; 141/200 (70.5%) were completed; 84% of respondents intended to pursue postgraduate studies abroad; 63% to migrate within five years of graduation; 57% to work in urban areas. While partly due to global trends and awareness of international opportunities, this negative trend of migration and shunning rural practice is also influenced by sociopolitical and educational elements within Uganda. One option (adopted elsewhere) is mandatory practice in government community health centers for a period following graduation. But the ethics, consequences, and implications of current international migratory trends need to be addressed locally and by the global medical education community.

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The traditional belief system in relation to mental health and psychiatric services in Sudan

International Psychiatry ◽

10.1192/s1749367600002940 ◽

2012 ◽

Vol 9 (1) ◽

pp. 18-19

Author(s):

E. A. Sorketti ◽

N. Z. Zuraida ◽

M. H. Habil

Keyword(s):

Mental Health ◽

Health Services ◽

Low Income ◽

Healthcare Providers ◽

Belief System ◽

Traditional Healers ◽

Low Income Countries ◽

Social Scientists ◽

Policy Makers ◽

Central Sudan

Traditional healers' centres may constitute community resources for people with a mental illness. Many low-income countries are seeking to integrate mental health into their mainstream health services and primary healthcare, so as to decrease the duration of untreated illness. Traditional healers can help to meet these needs. A series of four studies has been conducted in central Sudan. In-patients with mental disorders undergoing treatment with traditional healers were recruited, as well as some of the healers themselves. The resulting observations should help practitioners trained in Western psychiatry to better understand traditional healing as an alternative healthcare system. The results should contribute to current debates on whether or not traditional healers in Africa should be officially recognised as healthcare providers. They should also deepen social scientists' understanding of the role of culture in mental health and help policy makers to improve mental health services.

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Understanding Patient Perspectives Regarding Long Acting Reversible Contraception: A Qualitative Study to Inform A Key Domain of Implementation Science

10.21203/rs.3.rs-424042/v1 ◽

2021 ◽

Author(s):

William C Livingood ◽

Katryne Lukens Bull ◽

Staci Biegner ◽

Andrew M Kaunitz ◽

LaRonda Howard ◽

...

Keyword(s):

African American ◽

Focus Group ◽

Implementation Science ◽

Low Income ◽

Healthcare Providers ◽

Implementation Strategies ◽

Patient Centered ◽

Unintended Pregnancies ◽

Induced Abortions ◽

Long Acting

Abstract Background: Evidence has continued to emerge that Long-acting reversible contraception (LARC) is highly effective in preventing unintended pregnancies and induced abortions, but utilization of LARC remains low among US women, particularly among minority and low income women. Aims: We designed this study to develop insights into factors that can better inform urban, predominantly African American women’s decisions to use LARC.Methods: We conducted focus group interviews with women, in conjunction with a community-based organization providing programs for underserved women, in an urban southeastern U.S city with sites in predominantly African American neighborhoods. Results: Key insights from the focus group results for healthcare providers include: the importance of framing discussions with patients within the context of the patients’ goals; the need to acknowledge and respect the support systems that women rely on for child birthing and childcare; recognition of the clinician’s role as a trusted and respected source of information; and the need to understand and be prepared to address much of the inaccurate and misleading information that can interfere with the patients’ optimal choices for contraception. Discussion: A critical component for applying Implementation Science theory to increase utilization of evidence based practices such as LARC requires understanding women’s perspectives of the factors influencing their decisions to use LARC. Conclusion: This study provides important insights into: 1) the potential barriers inherent in minority women’s concerns about LARC, and 2) how these insights can inform implementation strategies such as patient centered counseling and education to overcome those barriers.

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B1.4 Development of a robust and reliable pulse oximeter for use by frontline healthcare providers caring for children with pneumonia in low-income countries

10.1136/archdischild-2017-084620.8 ◽

2017 ◽

Author(s):

N Boyd ◽

I Walker ◽

C King ◽

B Zadutsa ◽

E McCollum ◽

...

Keyword(s):

Low Income ◽

Pulse Oximeter ◽

Healthcare Providers ◽

Low Income Countries

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The Role of Nutrition in Integrative Preventive Medicine

10.1093/med/9780190241254.003.0010 ◽

2017 ◽

Author(s):

Walter C. Willett

Keyword(s):

Low Income ◽

Healthcare Providers ◽

Well Being ◽

The United States ◽

Fellowship Training ◽

Dietary Factors ◽

Low Income Countries ◽

Noncommunicable Diseases ◽

Premature Deaths ◽

Major Illness

Until recently, and still today in low-income countries, undernutrition during pregnancy and early childhood was a major cause of mortality. However, in recent decades, noncommunicable diseases account for the majority of premature deaths both in the United States and globally. Although dietary factors have been identified as the most important causes of this, physicians and other healthcare providers are taught little about nutrition in medical school or fellowship training. In conventional medical practice almost no attention is given to knowing what a patient is eating or providing dietary guidance that has the potential to improve dramatically their long-term health. This chapter describes what we know about the elements of a healthy diet and how these elements can be combined into an overall dietary pattern for the prevention of major illness and promotion of well-being. A brief section considers ways that this knowledge can be integrated into preventive healthcare.

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Allocation of the “Already” Limited Medical Resources Amid the COVID-19 Pandemic, an Iterative Ethical Encounter Including Suggested Solutions From a Real Life Encounter

Frontiers in Medicine ◽

10.3389/fmed.2020.616277 ◽

2021 ◽

Vol 7 ◽

Author(s):

Yazan Nedal Alhalaseh ◽

Hatem A. Elshabrawy ◽

Madiha Erashdi ◽

Mohammed Shahait ◽

Abdulrahman Mohammad Abu-Humdan ◽

...

Keyword(s):

Low Income ◽

Healthcare Workers ◽

Healthcare Providers ◽

Real Life ◽

Developed Countries ◽

Low Income Countries ◽

Health Issues ◽

The Face ◽

Automated Screening ◽

Comprehensive Programs

The shortage of healthcare providers is well-documented in low-income countries (LIC) prior to COVID-19, due to various causes including the migration to developed countries, scarcity of supplies, poor healthcare infrastructure, limited ICU facilities, and lack of access to guidelines and protocols. One of the important hitches in LIC is the insufficient testing capacity that precluded accurate assessment of disease burden and subsequently resource allocations. Trying to adhere to the principles of bioethics including respect to others, beneficence, and justice should be applied on the ground in the particular setting of the LIC. Solutions should be tailored to the tangible needs and possibility of implementation in real life in the face of the “already” limited resources by making use of simple, yet plausible, measures. Implementing guidelines and frameworks that were set to work in the better-resourced nations is a call for futility. The adoption of novel solutions to overcome the unique challenges in the LIC is exigent. These include the use of automated screening algorithms and virtual video clinics. Moreover, integrating electronic intensive care unit (e-ICU) software may allow for remote monitoring of multiple patients simultaneously. Telemedicine could help in getting consultations worldwide. It can also enhance healthcare workers' knowledge and introduce new skills through teleconferences, e-workshops, and free webinars. Healthcare workers can be remotely trained to enhance their skills. Agencies, such as the WHO, should develop comprehensive programs to tackle different health issues in LIC in collaboration with major institutions and experts around the world.

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Utilization of Life-Saving Skills Among Nurses and Midwives at Murtala Muhammad Specialist Hospital, Kano

International Journal of Childbirth ◽

10.1891/2156-5287.9.1.30 ◽

2019 ◽

Vol 9 (1) ◽

pp. 30-38

Author(s):

Rajah Amina Suleiman ◽

Dalhatu Adamu ◽

Muhammad Haddad Mahfuz ◽

Rahmat Bashir Jumoke ◽

Aisha Suleiman Abdullahi

Keyword(s):

Low Income ◽

Healthcare Providers ◽

Low Income Countries ◽

Cross Sectional ◽

Negative Attitudes ◽

Pregnancy And Childbirth ◽

Life Saving ◽

Barriers To Implementation ◽

High Level ◽

Nurses And Midwives

Maternal morbidity and mortality associated with pregnancy and childbirth have a significant impact on women, their families, and communities in low-income countries. This study aimed at exploring the level of awareness on Life-Saving Skills (LSS), LSS practices employed, barriers to implementation, and strategies to promote effectiveness of LSS practice. The study utilized a cross-sectional research design and a pre-tested structured interviewer-administered questionnaire to survey 154 nurses and midwives in a hospital in Nigeria with 150 maternity beds, about their “awareness” of LSS, LSS practices, and what they consider barriers to implementation and strategies to promote effectiveness of LSS practice. Results demonstrated that while 87.0% of the respondents were aware of LSS, the majority reported numerous challenges in implementing LSS. These challenges included: a shortage of skilled birth attendants (93.5%); negative attitudes of healthcare providers (79.2%); inadequate equipment and supplies (81.8%); and inadequate training for midwives (77.9%). Respondents also recommended some strategies to promote effectiveness of LSS, including provision of life-saving skills equipment (84.4%); training and retraining of personnel in LSS (88.3%); and increasing accessibility of LSS services for childbearing women (97.4%). The study concluded that although there is a high level of awareness of LSS, the midwives and nurses faced many challenges that hindered the utilization of LSS. It is recommended that multilateral collaboration be used in the study setting to overcome the limitations to utilize LSS.

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