scholarly journals The PROMISES study: a mixed methods approach to explore the acceptability of salivary progesterone testing for preterm birth risk among pregnant women and trained frontline healthcare workers in rural India

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040268
Author(s):  
Danielle Ashworth ◽  
Pankhuri Sharma ◽  
Sergio A Silverio ◽  
Simi Khan ◽  
Nishtha Kathuria ◽  
...  

IntroductionIndia has an overall neonatal mortality rate of 28/1000 live births, with higher rates in rural India. Approximately 3.5 million pregnancies in India are affected by preterm birth (PTB) annually and contribute to approximately a quarter of PTBs globally. Embedded within the PROMISES study (which aims to validate a low-cost salivary progesterone test for early detection of PTB risk), we present a mixed methods explanatory sequential feasibility substudy of the salivary progesterone test.MethodsA pretraining and post-training questionnaire to assess Accredited Social Health Activists (ASHAs) (n=201) knowledge and experience of PTB and salivary progesterone sampling was analysed using the McNemar test. Descriptive statistics for a cross-sectional survey of pregnant women (n=400) are presented in which the acceptability of this test for pregnant women is assessed. Structured interviews were undertaken with ASHAs (n=10) and pregnant women (n=9), and were analysed using thematic framework analysis to explore the barriers and facilitators influencing the use of this test in rural India.ResultsBefore training, ASHAs’ knowledge of PTB (including risk factors, causes, postnatal support and testing) was very limited. After the training programme, there was a significant improvement in the ASHAs’ knowledge of PTB. All 400 women reported the salivary test was acceptable with the majority finding it easy but not quick or better than drawing blood. For the qualitative aspects of the study, analysis of interview data with ASHAs and women, our thematic framework comprised of three main areas: implementation of intervention; networks of influence and access to healthcare. Qualitative data were stratified and presented as barriers and facilitators.ConclusionThis study suggests support for ongoing investigations validating PTB testing using salivary progesterone in rural settings.

2021 ◽  
Author(s):  
Lauren Lucas ◽  
Jack Parker

ABSTRACT Objectives: To explore how physiotherapists manage anxiety in patients with RRMS in community and outpatient settings. To identify further training and research to better develop physiotherapy practice. Design: A mixed-methods design, combining a cross-sectional survey and semi-structured interviews with UK-physiotherapists. Participants: Sixteen UK-registered physiotherapists: 11 in the survey, 5 in the interviews. Methods: To inform the qualitative study, a cross-sectional survey collected data from physiotherapists working in neurology to understand the impact and management of anxiety in people with MS (PwMS) during rehabilitation. Analysis used descriptive statistics and the findings formed the interview guide. Semi-structured interviews with specialist physiotherapists explored barriers and facilitators to managing anxiety, physiotherapy training needs and offered suggestions to develop physiotherapy research and practice. Themes were derived inductively. Results: The survey suggested how PwMS present with anxiety, its impact during rehabilitation, physiotherapy management practices, and physiotherapist skills and training needs. Five semi-structured interviews with specialist physiotherapists expanded on the survey findings and identified five main themes: Understanding the MS journey, modifying assessment and treatment, anxiety management toolbox, lagging behind Musculoskeletal Physiotherapy, and gaining knowledge and skills. Conclusion: Physiotherapists encounter anxiety in PwMS in community and outpatient rehabilitation and perceive they have a role in managing it as it presents. Facilitators included communication, listening skills and opportunities to develop strong therapeutic relationships. Poor training and support, lack of clinical guidelines and limited research evidence were considered barriers. Clinically relevant learning opportunities, interprofessional working, and greater support through clinical supervision is recommended to better develop physiotherapy practice.


BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e052560
Author(s):  
Amy Vassallo ◽  
Karen Walker ◽  
Melina Georgousakis ◽  
Rohina Joshi

ObjectivesIt is known that women are under-represented in senior positions within the health and medical research sector. The Franklin Women Mentoring Programme (Programme) is a professionally facilitated, cross-organisational initiative designed to support career development for mid-career women. The objective of this study was to evaluate Programme outcomes reported by participants 12 months following its formal conclusion.DesignExplanatory sequential mixed-methods study design using a cross-sectional survey and semi-structured interviews.SettingHealth and medical research institutes in Sydney, Australia.ParticipantsHealth and medical researchers from the 2018 Programme.Primary and secondary outcome measuresChanges in knowledge, skills, behaviours and research metrics directly attributed to Programme participation.ResultsA total of 50 mentors and mentees participated in the cross-sectional survey (68% of the total cohort) and 14 mentors and mentees participated in the interviews. All reported changes to their knowledge, skills, behaviours and research metrics which were directly attributed to participation in the Programme. This included changes in knowledge and skills to be more inclusive (96% mentees, 83% mentors), resilience (88% mentees, 67% mentors), ability to have difficult workplace conversations (88% mentees, 71% mentors) and improvements in supervisory and team management (82% mentees, 75% mentors) skills. Positive impacts on promotions and grant opportunities were also reported. All evaluation participants believed this Programme was a worthwhile initiative for their workplaces to invest in.ConclusionParticipation in this cross-organisational, professionally facilitated, structured mentoring programme has led to positive outcomes for mentees, as well as mentors. Reported outcomes indicate the Programme is meeting its aims to support the career development of mid-career women in health and medical research, while facilitating a more inclusive workforce.


2021 ◽  
Author(s):  
Sadie Bell ◽  
Richard M Clarke ◽  
Sharif A Ismail ◽  
Oyinkansola Ojo-Aromokudu ◽  
Habib Naqvi ◽  
...  

AbstractBackgroundThe UK began delivering its COVID-19 vaccination programme on 8 December 2020, with health and social care workers (H&SCWs) given high priority for vaccination. Despite well- documented occupational exposure risks, however, there is evidence of lower uptake among some H&SCW groups.MethodsWe used a mixed-methods approach - involving an online cross-sectional survey and semi- structured interviews – to gain insight into COVID-19 vaccination beliefs, attitudes, and behaviours amongst H&SCWs in the UK by socio-demographic and employment variables. 1917 people were surveyed – 1658 healthcare workers (HCWs) and 261 social care workers (SCWs). Twenty participants were interviewed.FindingsWorkplace factors contributed to vaccination access and uptake. SCWs were more likely to not be offered COVID-19 vaccination than HCWs (OR:1.453, 95%CI: 1.244 – 1.696). SCWs specifically reported uncertainties around how to access COVID-19 vaccination. Participants who indicated stronger agreement with the statement ‘I would recommend my organisation as a place to work’ were more likely to have been offered COVID-19 vaccination (OR:1.28, 95%CI: 1.06 – 1.56). Those who agreed more strongly with the statement ‘I feel/felt under pressure from my employer to get a COVID-19 vaccine’ were more likely to have declined vaccination (OR:1.75, 95%CI: 1.27– 2.41). Interviewees that experienced employer pressure to get vaccinated felt this exacerbated their vaccine concerns and increased distrust.In comparison to White British and White Irish participants, Black African and Mixed Black African participants were more likely to not be offered (OR:2.011, 95%CI: 1.026 – 3.943) and more likely to have declined COVID-19 vaccination (OR:5.55, 95%CI: 2.29 – 13.43). Reasons for declining vaccination among Black African participants included distrust in COVID-19 vaccination, healthcare providers, and policymakers.ConclusionH&SCW employers are in a pivotal position to facilitate COVID-19 vaccination access, by ensuring staff are aware of how to get vaccinated and promoting a workplace environment in which vaccination decisions are informed and voluntary.


2020 ◽  
Vol 5 (2) ◽  
pp. 66
Author(s):  
Lorraine Chapot ◽  
Thang Nguyen-Tien ◽  
Long Pham-Thanh ◽  
Hung Nguyen-Viet ◽  
Luke Craven ◽  
...  

Dengue is a growing problem in Hanoi, with cyclical epidemics of increasing frequency and magnitude. In June 2019, we conducted a cross-sectional survey using mixed methods to investigate how inhabitants of Hanoi perceive and respond to the risk of mosquito-borne diseases (MBD). A total of 117 participants recruited using a stratified random sampling method were interviewed in three districts of Hanoi. Knowledge and practices (KP) regarding MBDs were assessed using a pre-tested questionnaire. Inferential statistics were used to identify factors associated with KP scores and describe the relationship between variables. Additionally, a “risk-mapping” exercise was conducted in a subsample through semi-structured interviews and analyzed qualitatively and quantitatively using the System Effects platform. Factors significantly associated with knowledge scores were education and family history of MBDs. While knowledge and practice scores were found to be positively correlated in the statistical analysis, this was not corroborated by our observations on the field. The results also revealed gaps in knowledge about MBDs and vectors and highlighted a general feeling of powerlessness which prevented the adoption of protective behaviors. Therefore, educational interventions which provide concrete tools to empower communities should have a positive impact on improving vector control.


2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Lauren Lucas ◽  
Jack Parker

Abstract Background Anxiety is common for people with Multiple Sclerosis (PwMS) and is higher in those with relapsing-remitting MS (RRMS) and in community-based samples. Anxiety can impact self-efficacy, pain, fatigue, engagement in physical activity and treatment adherence, all of which influence the rehabilitation process. Little is known about how physiotherapists manage anxiety in PwMS and the challenges associated with anxiety throughout the rehabilitation process, in community and outpatient settings. Methods A mixed-methods design, combining a cross-sectional survey and semi-structured interviews with UK-physiotherapists, was used to answer the research question. To inform the qualitative study, a cross-sectional survey collected data from physiotherapists working in neurology to understand the impact and management of anxiety in people with MS (PwMS) during rehabilitation. Analysis used descriptive statistics and the findings formed the interview guide. Semi-structured interviews with specialist physiotherapists explored barriers and facilitators to managing anxiety in PwMS in community and outpatient settings, identified perceived physiotherapy training needs and offered suggestions to develop physiotherapy research and practice. Themes were derived inductively. Results The survey suggested how PwMS present with anxiety, its impact during rehabilitation, physiotherapy management practices, and physiotherapist skills and training needs. Five semi-structured interviews with specialist physiotherapists expanded on the survey findings and identified five main themes: Understanding the MS journey, modifying assessment and treatment, anxiety management toolbox, lagging behind Musculoskeletal Physiotherapy, and gaining knowledge and skills. Conclusion Physiotherapists encounter anxiety in PwMS in community and outpatient rehabilitation and perceive they have a role in managing it as it presents. Facilitators included communication, listening skills and opportunities to develop strong therapeutic relationships. Poor training and support, lack of clinical guidelines and limited research evidence were considered barriers. Clinically relevant learning opportunities, interprofessional working, and greater support through clinical supervision is recommended to better develop physiotherapy practice.


BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017047 ◽  
Author(s):  
Melissa Kang ◽  
Fiona Robards ◽  
Lena Sanci ◽  
Katharine Steinbeck ◽  
Stephen Jan ◽  
...  

BackgroundThe integration of digital technology into everyday lives of young people has become widespread. It is not known whether and how technology influences barriers and facilitators to healthcare, and whether and how young people navigate between face-to-face and virtual healthcare. To provide new knowledge essential to policy and practice, we designed a study that would explore health system access and navigation in the digital age. The study objectives are to: (1) describe experiences of young people accessing and navigating the health system in New South Wales (NSW), Australia; (2) identify barriers and facilitators to healthcare for young people and how these vary between groups; (3) describe health system inefficiencies, particularly for young people who are marginalised; (4) provide policy-relevant knowledge translation of the research data.Methods and analysisThis mixed methods study has four parts, including: (1) a cross-sectional survey of young people (12–24 years) residing in NSW, Australia; (2) a longitudinal, qualitative study of a subsample of marginalised young people (defined as young people who: identify as Aboriginal and/or Torres Strait Islander; are experiencing homelessness; identify as sexuality and/or gender diverse; are of refugee or vulnerable migrant background; and/or live in rural or remote NSW); (3) interviews with professionals; (4) a knowledge translation forum.Ethics and disseminationEthics approvals were sought and granted. Data collection commenced in March 2016 and will continue until June 2017. This study will gather practice and policy-relevant intelligence about contemporary experiences of young people and health services, with a unique focus on five different groups of marginalised young people, documenting their experiences over time.Access 3will explore navigation around all levels of the health system, determine whether digital technology is integrated into this, and if so how, and will translate findings into policy-relevant recommendations.


2020 ◽  
Author(s):  
Mukta Gundi ◽  
Malavika Ambale Subramanyam

Gender bias in the patriarchal Indian society becomes evident in the form of worse sexual and reproductive health outcomes for girls than boys. While girls face menstrual taboos that affect their health, understanding of, and participation in the menstruation discourse remains limited among boys. We investigate how gender through its micro-interactional and macro-structural ways makes menstruation a gendered experience for adolescents; how various social determinants influence gendered menstruation experience among girls across social domains; and whether the lived gendered experience of menstruation harms their health. Using a sequential mixed-methods design semi-structured interviews of 21 boys and girls each; 12 adult key-respondent interviews; and a cross-sectional survey of 1421 adolescents from urban, rural and tribal settings of Nashik district, India, were conducted. Applying social constructivist theory and gender analysis framework, we thematically analysed the qualitative data. Multivariable regression analysis of survey data yielded risk ratios. Respondents reported a gendered experience of menstruation. Fewer boys (versus girls) reported receiving information in schools [Incidence Rate Ratio (IRR) at 95% CI: 0.34 (0.24, 0.49)]. Gendered menstrual experiences varied across social domains and various socioeconomic backgrounds. Menstrual health among girls was poorer among those with a lived experience of gendered menstruation [IRR: 0.22 (0.05, 0.90)]. Key respondents shared the need to engage boys in the menstruation discourse though apprehensive regarding its consequences. Gender bias along with other social factors negatively influence social construction regarding menstruation. Further, the discrimination is embodied by girls as poor health, thus perpetuating health inequalities across socioeconomic settings.


2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697349
Author(s):  
Anna Lalonde ◽  
Emma Teasdale ◽  
Ingrid Muller ◽  
Joanne Chalmers ◽  
Peter Smart ◽  
...  

BackgroundCellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis and their information needs.MethodMixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.ResultsThirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.


2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S39-S39
Author(s):  
Erika Z Lopatynsky-Reyes ◽  
Sue Ann Costa-Clemens ◽  
Enrique Chacon-Cruz ◽  
Michael Greenberg

Abstract Background Influenza in pregnancy is associated with elevated morbidity and mortality. Influenza vaccines are both safe and effective in pregnancy, supporting routine use in this population. Even though influenza vaccination in Mexico is recommended for pregnant women, there are no publications of influenza vaccine coverage in pregnancy. This is the first Latin American survey done only in physicians aiming to assess the knowledge, beliefs, and attitudes that Mexican Obstetrics-Gynecologists (OBG) and Family Physicians (FP) have towards influenza and influenza immunization during pregnancy. Methods A cross-sectional survey was conducted, both paper-based and online. The questionnaire was composed of 35 questions, which addressed general knowledge of influenza, recommendations for vaccination during pregnancy, and beliefs and attitudes concerning the acceptability of the vaccine in pregnant women. Results A total of 206 completed surveys were available, 98 (47.6%) from OBG, 108 (52.4%) from FP. Regarding current practicing medical institutions, 76 (37%), 69 (34%), 31 (14.5%), 30 (14.5%) reported working for the Mexican Institute of Social Security, Private Sector, Secretariat of Health, or a combination of all respectively, representing an estimated 2,472 daily pregnancy consultations. About a quarter (26.2%) reported not having a notion that influenza is more severe among pregnant women. More than half (51.5%) ignored the potential side effects of influenza infection on the fetus. The majority (56.8%) did not know when vaccination during pregnancy should occur. Pregnancy as a risk factor for developing influenza complications was known only in 48.1%. Also, 46.1 % believed that vaccination only confers protection to the mother, but not to the fetus. Nevertheless, 96.1% considered that immunization against influenza during pregnancy is a safe and effective preventive intervention. A results’ summary is shown in Figure-1. Conclusion Based on this survey, current knowledge of OBG and FP for influenza morbidity and mortality during pregnancy, and the importance of influenza vaccination in pregnant women, is poor. Mandatory recommendations to educate medical providers regarding influenza vaccination during pregnancy in Mexico are necessary, even as imperative for CME credits. Disclosures All Authors: No reported disclosures


BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028843 ◽  
Author(s):  
Danmeng Liu ◽  
Yue Cheng ◽  
Shaonong Dang ◽  
Duolao Wang ◽  
Yaling Zhao ◽  
...  

ObjectivesTo report the situation of maternal micronutrient supplementation before and during pregnancy in Northwest China and to examine the rates of and factors related to the adherence to micronutrient supplementation among pregnant women in this region, where dietary micronutrient intake is commonly insufficient.DesignA large-scale population-based cross-sectional survey.SettingTwenty counties and ten districts of Shaanxi Province.ParticipantsA sample of 30 027 women were selected using a stratified multistage random sampling method. A total of 28 678 women were chosen for the final analysis after excluding those who did not provide clear information about nutritional supplementation before and during pregnancy.Main outcome measuresMaternal adherence to micronutrient supplementation (high and low) were the outcomes. They were determined by the start time and duration of use according to Chinese guidelines (for folic acid (FA) supplements) and WHO recommendations (for iron, calcium and multiple-micronutrient (MMN) supplements).ResultsIn total, 83.9% of women took at least one kind of micronutrient supplement before or during pregnancy. FA (67.6%) and calcium (57.5%) were the primarily used micronutrient supplements; few participants used MMN (14.0%) or iron (5.4%). Adherence to supplementation of all micronutrients was low (7.4% for FA, 0.6% for iron, 11.7% for calcium and 2.7% for MMN). Higher educational levels, higher income levels, urban residence and better antenatal care (including pregnancy consultation and a higher frequency of antenatal visits) were associated with high adherence to micronutrient supplementation.ConclusionMaternal micronutrient supplementation before and during pregnancy in Northwest China was way below standards recommended by the Chinese guidelines or WHO. Targeted health education and future nutritional guidelines are suggested to improve this situation, especially in pregnant women with disadvantaged sociodemographic conditions.


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