scholarly journals A model for scale up of family health innovations in low-income and middle-income settings: a mixed methods study

BMJ Open ◽  
2012 ◽  
Vol 2 (4) ◽  
pp. e000987 ◽  
Author(s):  
Elizabeth H Bradley ◽  
Leslie A Curry ◽  
Lauren A Taylor ◽  
Sarah Wood Pallas ◽  
Kristina Talbert-Slagle ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Low Income ◽  
Scale Up ◽  
Family Health ◽  
Mixed Methods Study ◽  
Middle Income ◽  
Health Innovations

scholarly journals Application of the PRECEDE–PROCEED model in the development of evidence-informed interventions for drowning prevention: a mixed-methods study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e050688
Author(s):  
Jonathan P Guevarra ◽  
Amy E Peden ◽  
Richard Charles Franklin
Keyword(s):  
Mixed Methods ◽  
Low Income ◽  
Local Community ◽  
Evaluation Model ◽  
Population Data ◽  
The Philippines ◽  
Mixed Methods Study ◽  
Global Public Health ◽  
Middle Income ◽  
Drowning Prevention

IntroductionDrowning is a global public health threat, disproportionately impacting low-income and middle-income countries. In the Philippines, it is estimated that more than 5200 people die from drowning per annum. This number is likely to be higher than currently estimated with the inclusion of disaster-related and transportation-related drowning. Drowning is preventable if appropriate preventive interventions are put in place which redress known risk factors.Methods and analysisThis study uses the PRECEDE–PROCEED model (PPM), an eight-step health promotion planning and evaluation model for building and improving intervention programmes. This mixed-methods study, which can be used in any location, will be implemented in Los Baňos, Laguna, Philippines, identified as an area of concern for drowning. Using the PPM, data on drowning will be collected from death records, community observation, key informant interviews, focus group discussions and community survey. A range of analytical methods will be used to explore drowning data including univariate and χ2 analyses, analysis of variance, relative risk and calculating rates using population data. The quantitative data and themes drawn from qualitative data will be used to populate the first four phases of the PPM. Following the data collection, the remaining stages of the PPM will be designed and implemented in the barangay (village) with the highest drowning rate.Ethics and disseminationThis study has obtained ethical clearance from the University of the Philippines Manila Research Ethics Board (UPMREB 2017-425-01). Study findings will be disseminated through workshops and presentations to the local community as well as through peer-reviewed literature and conference presentations. The PPM has rarely been applied to drowning prevention and it is the aim that the study described in this protocol is expanded across other areas of the Philippines and to other countries with a high drowning burden to inform prevention efforts.

scholarly journals Accelerating access and scale-up of optimized antiretroviral therapy in low-income and middle-income countries: results of a coordinated end-to-end approach

AIDS ◽  
2021 ◽  
Vol 35 (Supplement 2) ◽  
pp. S165-S171
Author(s):  
Emily Lark Harris ◽  
Katherine Blumer ◽  
Carmen Perez Casas ◽  
Danielle Ferris ◽  
Carolyn Amole ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Low Income ◽  
Scale Up ◽  
Middle Income ◽  
Middle Income Countries ◽  
End To End

Scale-up and Sustainability of a Personalized End-of-Life Care Intervention: A Longitudinal Mixed-Methods Study

2020 ◽  
Author(s):  
Alyson Takaoka ◽  
Benjamin Tam ◽  
Meredith Vanstone ◽  
France J. Clarke ◽  
Neala Hoad ◽  
...  
Keyword(s):  
Mixed Methods ◽  
End Of Life ◽  
Life Support ◽  
Scale Up ◽  
Fold Increase ◽  
Mixed Methods Study ◽  
Secondary Outcome ◽  
Patient Death ◽  
Dying Patients ◽  
Clinical Program

Abstract Background: Scaling-up and sustaining healthcare interventions can be challenging. Our objective was to describe how the 3 Wishes Project (3WP), a personalized end-of-life intervention, was scaled-up and sustained in an intensive care unit (ICU).Methods: In a longitudinal mixed-methods study from January 1,2013 - December 31, 2018, dying patients and families were invited to participate if the probability of patient death was >95% or after a decision to withdraw life support. A research team member or bedside clinician learned more about each of the patients and their family, then elicited and implemented <3 personalized wishes for patients and/or family members. We used a qualitative descriptive approach to analyze interviews and focus groups conducted with 25 clinicians who cared for patients enrolled in the project. We used descriptive statistics to summarize patient, wish, and clinician characteristics, and analyzed outcome data in quarters using Statistical Process Control charts. The primary outcome was enrollment of terminally ill patients and respective families; the secondary outcome was the number of wishes per patient; tertiary outcomes included wish features and stakeholder involvement. Results: Both qualitative and quantitative analyses suggested a three-phase approach to the scale-up of this intervention during which 369 dying patients were enrolled, having 2039 terminal wishes implemented. From a research project to clinical program to an approach to practice, we documented a three-fold increase in enrolment with a five-fold increase in total wishes implemented, without a change in cost. Beginning as a study, the protocol provided structure; starting gradually enabled frontline staff to experience and recognize the value of acts of compassion for patients, families, and clinicians. The transition to a clinical program was marked by handover from the research staff to bedside staff, whereby project catalysts mentored project champions to create staff partnerships, and family engagement became more intentional. The final transition involved empowering staff to integrate the program as an approach to care, expanding it within and beyond the organization. Conclusions: The 3WP is an end-of-life intervention which was implemented as a study, scaled-up into a clinical program, and sustained by becoming integrated into practice as an approach to care.

scholarly journals Establishing Global School Feeding Program Targets: How Many Poor Children Globally Should Be Prioritized, and What Would Be the Cost of Implementation?

2020 ◽  
Vol 8 ◽  
Author(s):  
Lesley J. Drake ◽  
Nail Lazrak ◽  
Meena Fernandes ◽  
Kim Chu ◽  
Samrat Singh ◽  
...  
Keyword(s):  
Low Income ◽  
School Health ◽  
Scale Up ◽  
Good Health ◽  
Global Strategy ◽  
Low Income Countries ◽  
School Age Children ◽  
Middle Income ◽  
Middle Income Countries ◽  
School Feeding

The creation of Human Capital is dependent upon good health and education throughout the first 8,000 days of life, but there is currently under-investment in health and nutrition after the first 1,000 days. Working with governments and partners, the UN World Food Program is leading a global scale up of investment in school health, and has undertaken a strategic analysis to explore the scale and cost of meeting the needs of the most disadvantaged school age children and adolescents in low and middle-income countries globally. Of the 663 million school children enrolled in school, 328 million live where the current coverage of school meals is inadequate (&lt;80%), of these, 251 million live in countries where there are significant nutrition deficits (&gt;20% anemia and stunting), and of these an estimated 73 million children in 60 countries are also living in extreme poverty (&lt;USD 1.97 per day). 62.7 million of these children are in Africa, and more than 66% live in low income countries, with a substantial minority in pockets of poverty in middle-income countries. The estimated overall financial requirement for school feeding is USD 4.7 billion, increasing to USD 5.8 billion annually if other essential school health interventions are included in the package. The DCP3 (Vol 8) school feeding edition and the global coverage numbers were launched in Tunis, 2018 by the WFP Executive Director, David Beasley. These estimates continue to inform the development of WFP's global strategy for school feeding.

scholarly journals Barriers and facilitators of implementation of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda using the Consolidated Framework for Implementation Research

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Rawlance Ndejjo ◽  
Rhoda K. Wanyenze ◽  
Fred Nuwaha ◽  
Hilde Bastiaens ◽  
Geofrey Musinguzi
Keyword(s):  
Cardiovascular Disease ◽  
Low Income ◽  
Implementation Research ◽  
Health Workers ◽  
Scale Up ◽  
Barriers And Facilitators ◽  
Prevention Programme ◽  
Intervention Implementation ◽  
Design Quality ◽  
Middle Income

Abstract Background In low- and middle-income countries, there is an increasing attention towards community approaches to deal with the growing burden of cardiovascular disease (CVD). However, few studies have explored the implementation processes of such interventions to inform their scale up and sustainability. Using the consolidated framework for implementation research (CFIR), we examined the barriers and facilitators influencing the implementation of a community CVD programme led by community health workers (CHWs) in Mukono and Buikwe districts in Uganda. Methods This qualitative study is a process evaluation of an ongoing type II hybrid stepped wedge cluster trial guided by the CFIR. Data for this analysis were collected through regular meetings and focus group discussions (FGDs) conducted during the first cycle (6 months) of intervention implementation. A total of 20 CHWs participated in the implementation programme in 20 villages during the first cycle. Meeting reports and FGD transcripts were analysed following inductive thematic analysis with the aid of Nvivo 12.6 to generate emerging themes and sub-themes and thereafter deductive analysis was used to map themes and sub-themes onto the CFIR domains and constructs. Results The barriers to intervention implementation were the complexity of the intervention (complexity), compatibility with community culture (culture), the lack of an enabling environment for behaviour change (patient needs and resources) and mistrust of CHWs by community members (relative priority). In addition, the low community awareness of CVD (tension for change), competing demands (other personal attributes) and unfavourable policies (external policy and incentives) impeded intervention implementation. On the other hand, facilitators of intervention implementation were availability of inputs and protective equipment (design quality and packaging), training of CHWs (Available resources), working with community structures including leaders and groups (process—opinion leaders), frequent support supervision and engagements (process—formally appointed internal implementation leaders) and access to quality health services (process—champions). Conclusion Using the CFIR, we identified drivers of implementation success or failure for a community CVD prevention programme in a low-income context. These findings are key to inform the design of impactful, scalable and sustainable CHW programmes for non-communicable diseases prevention and control.

Health-related quality of life in adult CHD surgical patients in a low middle-income country: a mixed-methods study

2020 ◽  
Vol 30 (8) ◽  
pp. 1126-1137
Author(s):  
Laila A. Ladak ◽  
Robyn Gallagher ◽  
Babar S. Hasan ◽  
Khadija Awais ◽  
Ahmed Abdullah ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mixed Methods ◽  
Mixed Methods Study ◽  
Income Country ◽  
Surgical Patients ◽  
Health Related Quality ◽  
Middle Income ◽  
Related Quality ◽  
Health Related

AbstractBackground and objectives:This mixed-methods study aimed to assess health-related quality of life in young adults with CHD following surgery in a low middle-income country, Pakistan. Despite the knowledge that geographic, cultural and socio-economic factors may shape the way health and illness is experienced and managed and consequently determine a person’s health-related quality of life, few health-related quality of life studies are conducted in low middle-income countries. This deficit is pronounced in CHD, so there is little guidance for patient care.Methods:The study utilised concurrent, mixed methods. Adults with CHD (n = 59) completed health-related quality of life surveys (PedsQLTM 4.0 Generic Core Scale, PedsQLTM Cognitive Functioning Scale and PedsQLTM 3.0 Cardiac Module). Semi-structured interview data were collected from a nested sub-sample of 17 participants and analysed using qualitative content analysis, guided by the revised Wilson–Cleary model of health-related quality of life.Results:The lowest health-related quality of life domain was emotional with the mean score (71.61 ± 20.6), followed by physical (78.81 ± 21.18) and heart problem (79.41 ± 18.05). There was no statistical difference in general or cardiac-specific health-related quality of life between mild, moderate or complex CHD. Qualitative findings suggested low health-related quality of life arose from a reduced capacity to contribute to family life including family income and gender. A sense of reduced marriageability and fear of dependency were important socio-cultural considerations.Conclusions:CHD surgical patients in this low-income country experience poor health-related quality of life, and contributing factors differ to those reported for high-income countries. Socio-cultural understandings should underpin assessment, management and care-partnering with young adults with CHD following surgical correction.

scholarly journals Cost of scaling up mental healthcare in low-and middle-income countries

2007 ◽  
Vol 191 (6) ◽  
pp. 528-535 ◽  
Author(s):  
Dan Chisholm ◽  
Crick Lund ◽  
Shekhar Saxena
Keyword(s):  
Low Income ◽  
Scale Up ◽  
Mental Healthcare ◽  
Scaling Up ◽  
Psychosocial Treatment ◽  
Economic Evaluations ◽  
Middle Income ◽  
Middle Income Countries ◽  
Per Capita ◽  
Low And Middle Income

BackgroundNo systematic attempt has been made to calculate the costs of scaling up mental health services in low-and middle-income countries.AimsTo estimate the expenditures needed to scale up the delivery of an essential mental healthcare package over a 10-year period (2006–2015).MethodA core package was defined, comprising pharmacological and/or psychosocial treatment of schizophrenia, bipolar disorder, depression and hazardous alcohol use. Current service levels in 12 selected low-and middle-income countries were established using the WHO–AIMS assessment tool. Target-level resource needs were derived from published need assessments and economic evaluations.ResultsThe cost per capita of providing the core package attarget coverage levels (in US dollars) ranged from $1.85 to $2.60 per year in low-income countries and $3.20 to $6.25 per year in lower-middle-income countries, an additional annual investment of $0.18–0.55 per capita.ConclusionsAlthough significant new resources need to be invested, the absolute amount is not large when considered at the population level and against other health investment strategies.

scholarly journals ‘Maybe we can turn the tide’: an explanatory mixed-methods study to understand how knowledge brokers mobilise health evidence in low- and middle-income countries

2019 ◽  
Author(s):  
Theresa C. Norton ◽  
Daniela C. Rodriguez ◽  
Catherine Howell ◽  
Charlene Reynolds ◽  
Sara Willems
Keyword(s):  
Mixed Methods ◽  
Online Survey ◽  
Newborn Health ◽  
Mixed Methods Study ◽  
Promising Practices ◽  
Policy And Practice ◽  
Middle Income ◽  
Middle Income Countries ◽  
Knowledge Brokers ◽  
Low And Middle Income

Background: Little is known about how knowledge brokers (KBs) operate in low- and middle-income countries (LMICs) to translate evidence for health policy and practice. These intermediaries facilitate relationships between evidence producers and users to address public health issues.<br />Aims and objectives: To increase understanding, a mixed-methods study collected data from KBs who had acted on evidence from the 2015 Global Maternal Newborn Health Conference in Mexico.<br />Methods: Of the 1000 in-person participants, 252 plus 72 online participants (n=324) from 56 countries completed an online survey, and 20 participants from 15 countries were interviewed. Thematic analysis and application of knowledge translation (KT) theory explored factors influencing KB actions leading to evidence uptake. Descriptive statistics of respondent characteristics were used for cross-case comparison.Findings: Results suggest factors supporting the KB role in evidence uptake, which include active relationships with evidence users through embedded KB roles, targeted and tailored evidence communication to fit the context, user receptiveness to evidence from a similar country setting, adaptability in the KB role, and action orientation of KBs.<br />Discussion and conclusions: Initiatives to increase evidence uptake in LMICs should work to establish supportive structures for embedded KT, identify processes for ongoing cross-country learning, and strengthen KBs already showing effectiveness in their roles.<br /><br />key messages<br /><br /><ol><li>Little is known about how knowledge brokers mobilise evidence in low- and middle-income countries.</li><br /><li>A multi-country study of knowledge brokers identified promising practices for evidence uptake.</li><br /><li>Embedded brokers who adapted messaging and evidence to context in active relationships worked well.</li><br /><li>Capacity building should use KB promising practices and facilitate multi-country evidence exchange.</li></ol>

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