scholarly journals Community-based interventions for detection and management of diabetes and hypertension in underserved communities: a mixed-methods evaluation in Brazil, India, South Africa and the USA

2020 ◽  
Vol 5 (6) ◽  
pp. e001959
Author(s):  
Luisa S Flor ◽  
Shelley Wilson ◽  
Paurvi Bhatt ◽  
Miranda Bryant ◽  
Aaron Burnett ◽  
...  
Keyword(s):  
South Africa ◽  
Blood Pressure ◽  
Mixed Methods ◽  
Health System ◽  
Diabetes Management ◽  
Full Potential ◽  
Community Based ◽  
Underserved Communities ◽  
Treatment Targets ◽  
The Usa

IntroductionAs non-communicable disease (NCD) burden rises worldwide, community-based programmes are a promising strategy to bridge gaps in NCD care. The HealthRise programme sought to improve hypertension and diabetes management for underserved communities in nine sites across Brazil, India, South Africa and the USA between 2016 and 2018. This study presents findings from the programme’s endline evaluation.MethodsThe evaluation utilises a mixed-methods quasi-experimental design. Process indicators assess programme implementation; quantitative data examine patients’ biometric measures and qualitative data characterise programme successes and challenges. Programme impact was assessed using the percentage of patients meeting blood pressure and A1c treatment targets and tracking changes in these measures over time.ResultsAlmost 60 000 screenings, most of them in India, resulted in 1464 new hypertension and 295 new diabetes cases across sites. In Brazil, patients exhibited statistically significant reductions in blood pressure and A1c. In Shimla, India, and in South Africa, country with the shortest implementation period, there were no differences between patients served by facilities in HealthRise areas relative to comparison areas. Among participating patients with diabetes in Hennepin and Ramsey counties and hypertension patients in Hennepin County, the percentage of HealthRise patients meeting treatment targets at endline was significantly higher relative to comparison group patients. Qualitative analysis identified linking different providers, services, communities and information systems as positive HealthRise attributes. Gaps in health system capacities and sociodemographic factors, including poverty, low levels of health education and limited access to nutritious food, are remaining challenges.ConclusionsFindings from Brazil and the USA indicate that the HealthRise model has the potential to improve patient outcomes. Short implementation periods and strong emphasis on screening may have contributed to the lack of detectable differences in other sites. Community-based care cannot deliver its full potential if sociodemographic and health system barriers are not addressed in tandem.

scholarly journals Implementation contextual factors related to community-based active travel to school interventions: a mixed methods interview study

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
MacKenzie Koester ◽  
Carolina M. Bejarano ◽  
Ann M. Davis ◽  
Ross C. Brownson ◽  
Jon Kerner ◽  
...  
Keyword(s):  
Physical Activity ◽  
Mixed Methods ◽  
Thematic Analysis ◽  
Active Travel ◽  
Family Needs ◽  
School Bus ◽  
Community Based ◽  
The Usa ◽  
Walking School Bus ◽  
Active Travel To School

Abstract Background Active travel to school contributes to multiple physical and psychosocial benefits for youth, yet population rates of active travel to school are alarmingly low in the USA and many other countries. Though walking school bus interventions are effective for increasing rates of active travel to school and children’s overall physical activity, uptake of such interventions has been low. The objective of this study was to conduct a mixed methods implementation evaluation to identify contextual factors that serve as barriers and facilitators among existing walking school bus programs. Methods Semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) were conducted with leaders of low-sustainability (n = 9) and high-sustainability (n = 11) programs across the USA. A combination of quantitative (CFIR-based) coding and inductive thematic analysis was used. The CFIR-based ratings were compared between the low- and high-sustainability programs and themes, subthemes, and exemplary quotes were provided to summarize the thematic analysis. Results In both the low- and high-sustainability programs, three of the 15 constructs assessed were commonly rated as positive (i.e., favorable for supporting implementation): student/family needs and resources, implementation climate, and planning. Three constructs were more often rated as positive in the high-sustainability programs: organizational incentives and rewards, engaging students and parents, and reflecting and evaluating. Three constructs were more often rated as positive in the low-sustainability programs: student/family needs and resources - built environment, available resources, and access to knowledge and information. Four themes emerged from the thematic analysis: planning considerations, ongoing coordination considerations, resources and supports, and benefits. Conclusions Engagement of students, parents, and community members were among the factors that emerged across the quantitative and qualitative analyses as most critical for supporting walking school bus program implementation. The information provided by program leaders can help in the selection of implementation strategies that overcome known barriers for increasing the long-term success of community-based physical activity interventions such as the walking school bus.

scholarly journals Emergency contraception for the South African healthcare professional

2020 ◽  
pp. 155-159
Author(s):  
J Markram
Keyword(s):  
South Africa ◽  
Healthcare Professional ◽  
Health System ◽  
South African ◽  
Teenage Pregnancy ◽  
Emergency Contraception ◽  
Common Knowledge ◽  
Unintended Pregnancies ◽  
The Usa ◽  
Very High

Unintended pregnancies are very common and it is estimated that almost 45% of all pregnancies in 2011 in the USA were not planned. In South Africa the situation could even be worse as it is common knowledge that we have a very high teenage pregnancy rate. It puts the already overburdened health system under enormous pressure.

scholarly journals Responding to health inequities: Indigenous health system innovations

2016 ◽  
Vol 1 ◽  
Author(s):  
J. G. Lavoie ◽  
D. Kornelsen ◽  
L. Wylie ◽  
J. Mignone ◽  
J. Dwyer ◽  
...  
Keyword(s):  
Health System ◽  
Indigenous Health ◽  
Indigenous Communities ◽  
Health Inequities ◽  
Healthcare Services ◽  
International Perspective ◽  
Full Potential ◽  
Community Members ◽  
Culturally Informed ◽  
The Usa

Over the past decades, Indigenous communities around the world have become more vocal and mobilized to address the health inequities they experience. Many Indigenous communities we work with in Canada, Australia, Latin America, the USA, New Zealand and to a lesser extent Scandinavia have developed their own culturally-informed services, focusing on the needs of their own community members. This paper discusses Indigenous healthcare innovations from an international perspective, and showcases Indigenous health system innovations that emerged in Canada (the First Nation Health Authority) and Colombia (Anas Wayúu). These case studies serve as examples of Indigenous-led innovations that might serve as models to other communities. The analysis we present suggests that when opportunities arise, Indigenous communities can and will mobilize to develop Indigenous-led primary healthcare services that are well managed and effective at addressing health inequities. Sustainable funding and supportive policy frameworks that are harmonized across international, national and local levels are required for these organizations to achieve their full potential. In conclusion, this paper demonstrates the value of supporting Indigenous health system innovations.

scholarly journals A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda

2021 ◽  
Author(s):  
Henry Zakumumpa ◽  
Kimani Makobu ◽  
Ntawiha Wilbrod ◽  
Everd Maniple
Keyword(s):  
Mixed Methods ◽  
Health System ◽  
Fast Track ◽  
Health Workers ◽  
Drug Distribution ◽  
Health Facilities ◽  
Hiv Care ◽  
Adult Males ◽  
Community Based ◽  
Art Delivery

Abstract INTRODUCTIONSince 2017, Uganda has been implementing differentiated antiretroviral therapy services (DARTS) to improve the quality of HIV care and health-system efficiencies. The Ministry of Health endorsed five models. The community-based models include Community Client-Led Drug Delivery (CCLAD) and Community Drug Distribution Points (CDDPs), with facility-based models being either Fast Track Drug Refill (FTDR), Facility Based Group (FBG) or Facility-Based Individual Management (FBIM). It is unclear what the uptake of DARTS is since roll-out in 2017. We set out to assess the extent of uptake of DARTS models and to describe barriers to uptake of either facility-based or community-based models.METHODSBetween August and December 2019, we conducted a mixed-methods study entailing a cross-sectional health facility survey (n=116) and in-depth interviews (n=18) with ART clinic managers in ten case-study facilities as well as six focus group discussions (56 participants) with patients enrolled in DARTS models. Facilities were selected based on the 10 geographic sub-regions of Uganda. Statistical analyses were performed in STATA (v13) while qualitative data were analyzed by thematic approach. The qualitative arm of our study was dominant.RESULTSMost facilities 63 (57%) commenced implementation of DARTS in 2018. The most implemented facility-based model was Fast Track Drug Refill (FTDR) implemented in 100 (86%) of health facilities. Community Client-Led ART Delivery (CCLAD) was the most popular community model implemented in more than a half of facilities (63/116 or 54%). Community Drug Distribution Points (CDDP) model had the lowest uptake and was implemented in only 33 (24.88%) facilities. Overall, there has been a higher uptake of facility-based models. Barriers to enrollment in community-based models include; HIV-related stigma and a fear of breach of confidentiality of HIV status, low enrollment of adult males in community models. Health-system constraints include insufficient training of health workers in DARTS and inadequate funding to facilities for implementing community-based models.CONCLUSIONTo the best of our knowledge this is the first study reporting national DARTS coverage in Uganda. There is need to devise stigma-reduction interventions to enhance uptake of community models and increased donor and government funding for community models to maximize DARTS potential for achieving health-system efficiencies.

scholarly journals Pay for perfomance and the quality of diabetes management in individuals with and without co-morbid medical conditions

2009 ◽  
Vol 102 (9) ◽  
pp. 369-377 ◽  
Author(s):  
Christopher Millett ◽  
Alex Bottle ◽  
Anthea Ng ◽  
Vasa Curcin ◽  
Mariam Molokhia ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diabetes Management ◽  
Pay For Performance ◽  
Research Database ◽  
Treatment Targets ◽  
Co Morbidity ◽  
The Impact ◽  
Underlying Trend ◽  
Morbid Conditions ◽  
Diabetes Patients

Summary Objective To examine the impact of the Quality and Outcomes Framework, a major pay-for-performance incentive introduced in the UK during 2004, on diabetes management in patients with and without co-morbidity. Design Cohort study comparing actual achievement of treatment targets in 2004 and 2005 with that predicted by the underlying (pre-intervention) trend in diabetes patients with and without co-morbid conditions. Setting A total of 422 general practices participating in the General Practice Research Database. Main outcomes measures Achievement of diabetes treatment targets for blood pressure (< 140/80 mm Hg), HbA1c (≤ 7.0%) and cholesterol (≤ 5 mmol/L). Results The percentage of diabetes patients with co-morbidity reaching blood pressure and cholesterol targets exceeded that predicted by the underlying trend during the first two years of pay for perfomance (by 3.1% [95% CI 1.1–5.1] for BP and 4.1% [95% CI 2.2–6.0] for cholesterol among patients with ≥ 5 co-morbidities in 2005). Similar improvements were evident in patients without co-morbidity, except for cholesterol control in 2004 (−0.2% [95% CI −1.7–1.4]). The percentage of patients meeting the HbA1c target in the first two years of this program was significantly lower than predicted by the underlying trend in all patients, with the greatest shortfall in patients without co-morbidity (3.8% [95% CI 2.6–5.0] lower in 2005). Patients with co-morbidity remained significantly more likely to meet treatment targets for cholesterol and HbA1c than those without after the introduction of pay for perfomance. Conclusions Diabetes patients with co-morbid conditions appear to have benefited more from this pay-for-performance program than those without co-morbidity.

scholarly journals Diabetes Connect

2014 ◽  
Vol 41 (1) ◽  
pp. 118-126 ◽  
Author(s):  
Krysia Crabtree ◽  
Nathan Sherrer ◽  
Tullia Rushton ◽  
Amanda Willig ◽  
April Agne ◽  
...  
Keyword(s):  
Health System ◽  
Support Groups ◽  
Diabetes Management ◽  
Diabetes Education ◽  
Management Strategies ◽  
Safety Net ◽  
Self Management ◽  
Jefferson County ◽  
Community Based ◽  
Community Based Programs

Purpose The purpose of the study is to explore African American men’s perceptions of how community-based, community-health worker (CHW)–delivered diabetes interventions might best be implemented. Methods Four 90-minute focus groups were guided by a trained moderator with a written guide to facilitate discussion on the topic of diabetes management and preferences for community-based programs. Participants were recruited from the diabetes education database at a safety-net health system in Jefferson County, AL. Two independent reviewers performed content analysis to identify major themes using an iterative, combined deductive and inductive approach. Results There were 25 male participants. Mean years living with diabetes was 9.6 (range, 1-20). Participants demonstrated knowledge of self-management strategies and identified various hardships including emotional and physical manifestations of diabetes, dietary restrictions, and institutional frustrations with the health system that contributed to self-management barriers. Their preferred CHW responsibilities were to educate, hold support groups, help track daily activities, and help find resources. Potential concerns included the need for confidentiality and fears of being stereotyped. Conclusions Participants identified critical self-management strategies but endure hardships that present barriers to daily diabetes management. Preferences for community-based programs and suggested CHW responsibilities could help to overcome many of those barriers by increasing access and providing support.

scholarly journals Assessing the impact of community-based interventions on hypertension and diabetes management in three Minnesota communities: findings from the prospective evaluation of US HealthRise programs

2021 ◽  
Author(s):  
Nancy Fullman ◽  
Krycia Cowling ◽  
Luisa S Flor ◽  
Shelley Wilson ◽  
Paurvi Bhatt ◽  
...  
Keyword(s):  
Diabetes Management ◽  
The United States ◽  
Routine Care ◽  
Models Of Care ◽  
Community Based Interventions ◽  
Community Based ◽  
Underserved Communities ◽  
Positive Effects ◽  
Percentage Points ◽  
The Impact

Background Community-based health interventions are increasingly viewed as models of care that can bridge healthcare gaps experienced by underserved communities in the United States (US). With this study, we sought to assess the impact of such interventions, as implemented through the US HealthRise program, on hypertension and diabetes among underserved communities in Hennepin, Ramsey, and Rice Counties, Minnesota. Methods and findings HealthRise patient data from June 2016 to October 2018 were assessed relative to comparison patients in a difference-in-difference analysis, quantifying program impact on reducing systolic blood pressure (SBP) and hemoglobin A1c, as well as meeting clinical targets (< 140 mmHg for hypertension, < 8% Al1c for diabetes), beyond routine care. For hypertension, HealthRise participation was associated with SBP reductions in Rice (6.9 mmHg [95% confidence interval: 0.9-12.9]) and higher clinical target achievement in Hennepin (27.3 percentage-points [9.8-44.9]) and Rice (17.1 percentage-points [0.9 to 33.3]). For diabetes, HealthRise was associated with A1c decreases in Ramsey (1.3 [0.4-2.2]). Qualitative data showed the value of home visits alongside clinic-based services; however, challenges remained, including community health worker retention and program sustainability. Conclusions HealthRise participation had positive effects on improving hypertension and diabetes outcomes at some sites. While community-based health programs can help bridge healthcare gaps, they alone cannot fully address structural inequalities experienced by many underserved communities.

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