scholarly journals Applying the Three Delays Model to understand emergency care seeking and delivery in rural Bangladesh: a qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042690
Author(s):  
Bansari Shah ◽  
Nandita Krishnan ◽  
Stephen R. Kodish ◽  
Gayane Yenokyan ◽  
Kaniz Fatema ◽  
...  

ObjectivesThe Three Delays Model has been commonly used to understand and prevent maternal mortality but has not been systematically applied to emergency medical conditions more generally. The objective of this study was to identify delays in emergency medical care seeking and delivery in rural Bangladesh and factors contributing to these delays by using the Three Delays Model as a framework.DesignA qualitative approach was used. Data were collected through focus group discussions and in-depth interviews using semistructured guides. Two analysts jointly developed a codebook iteratively and conducted a thematic analysis to triangulate results.SettingSix unions in Raiganj subdistrict of Bangladesh.ParticipantsEight focus group discussions with community members (n=59) and eight in-depth interviews with healthcare providers.ResultsDelays in the decision to seek care and timely receipt of care on reaching a health facility were most prominent. The main factors influencing care-seeking decisions included ability to recognise symptoms and decision-making power. Staff and resource shortages and lack of training contributed to delays in receiving care. Delay in reaching care was not perceived as a salient barrier. Both community members and healthcare providers expressed interest in receiving training to improve management of emergency conditions.ConclusionsThe Three Delays Model is a practical framework that can be useful for understanding barriers to emergency care and developing more tailored interventions. In rural Bangladesh, training community members and healthcare providers to recognise symptoms and manage acute conditions can reduce delays in care seeking and receiving adequate care at health facilities.

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022140
Author(s):  
Kyu Kyu Than ◽  
Victoria Oliver ◽  
Yasmin Mohamed ◽  
Thazin La ◽  
Pete Lambert ◽  
...  

ObjectiveThis study assessed the potential operational feasibility and acceptability of a heat-stable, inhaled oxytocin (IOT) product for community-based prevention of postpartum haemorrhage in Myanmar.MethodsA qualitative inquiry was conducted between June 2015 and February 2016 through focus group discussions and in-depth interviews. Research was conducted in South Dagon township (urban setting) and in Ngape and Thanlyin townships (rural settings) in Myanmar. Eleven focus group discussions and 16 in-depth interviews were conducted with mothers, healthcare providers and other key informants. All audio recordings were transcribed verbatim in Myanmar language and were translated into English. Thematic content analysis was done using NVivo software.ResultsFuture introduction of an IOT product for community-based services was found to be acceptable among mothers and healthcare providers and would be feasible for use by lower cadres of healthcare providers, even in remote settings. Responses from healthcare providers and community members highlighted that midwives and volunteer auxiliary midwives would be key advocates for promoting community acceptance of the product. Healthcare providers perceived the ease of use and lack of dependence on cold storage as the main enablers for IOT compared with the current gold standard oxytocin injection. A single-use disposable device with clear pictorial instructions and a price that would be affordable by the poorest communities was suggested. Appropriate training was also said to be essential for the future induction of the product into community settings.ConclusionIn Myanmar, where home births are common, access to cold storage and skilled personnel who are able to deliver injectable oxytocin is limited. Among community members and healthcare providers, IOT was perceived to be an acceptable and feasible intervention for use by lower cadres of healthcare workers, and thus may be an alternative solution for the prevention of postpartum haemorrhage in community-based settings in the future.


2019 ◽  
Author(s):  
Oluwaseun Akinyemi ◽  
Bronwyn Harris ◽  
Mary Kawonga

AbstractObjectivesTo explore how sociocultural factors may support or impede the adoption of community-based distribution of injectable contraceptives in Nigeria.DesignA qualitative study based on a grounded theory approach was conducted through in-depth interviews and focus group discussions.SettingMost participants lived in Gombe State, North East Nigeria. Other participants were from Ibadan (South West) and Abuja (Federal capital territory).ParticipantsThrough seven key informant interviews, 15 in-depth interviews and 10 focus group discussions, 102 participants were involved in the study.MethodsThis study, conducted in 2016 was part of a larger study on scale up of community-based distribution of injectable contraceptives. Qualitative data were collected from traditional and religious leaders, health workers and community members. The data were audio recorded, transcribed and analysed using a thematic framework method.ResultsSociocultural challenges to scale up included patriarchy and men’s fear of losing control over their spouses, traditional and religious beliefs about fertility, and myths about contraceptives and family planning. As a result of deep-rooted beliefs that children are ‘divine blessings’ and that procreation should not be regulated, participants described a subtle resistance to uptake of injectable contraceptives. Since Gombe is largely a patriarchal society, male involvement emerged as important to the success of meaningful innovation uptake. Community leaders largely described their participation in the scale up process as active, although they also identified scope for further involvement and recognition.ConclusionScale up is more than setting up health sector implementing structures, training health workers and getting innovation supplies, but also requires preparedness which includes paying attention to complex contextual issues. This requires the health system and those who work in it, to move beyond a narrow health ‘comfort zone’ by actively engaging with, and learning from, those who are leading, caring for and living in, the community.Strengths and limitations of this studyThe study participants represented a range of stakeholders - users of injectable contraceptives, community members, providers and health system managers.Our results highlighted that scale up is influenced by several socio-cultural factors; thus, showing the importance of paying attention to complex contextual issues during innovation uptake.The findings of our study emphasized how health systems and communities should interact in order to ensure successful scale up of health innovations.As with any qualitative study, the findings of this study are not statistically generalizable.FundingThis research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No--B 8606.R02), Sida (Grant No:54100113), the DELTAS Africa Initiative (Grant No: 107768/Z/15/Z) and Deutscher Akademischer Austauschdienst (DAAD). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (UK) and the UK government. The statements made and views expressed are solely the responsibility of the authors.Declarations of interestNone.


Curationis ◽  
2013 ◽  
Vol 36 (1) ◽  
Author(s):  
Elizeus Rutebemberwa ◽  
Sheila K. Katureebe ◽  
Sheba N. Gitta ◽  
Amos D. Mwaka ◽  
Lynn Atuyambe

Background: People diagnosed with diabetes mellitus are increasing in sub-Saharan Africa and prompt care seeking depends on perceptions of the illness. Objective: The objective was to explore perceptions of diabetes in rural areas. Method: We conducted a qualitative, explorative and descriptive study in rural eastern Uganda. Eight focus group discussions with community members were conducted. Community members were presented with a story about a person with diabetes symptoms and their perceptions of the diagnosis and treatment elicited. Four focus group discussions with people with diabetes and seven key informant interviews with health workers were conducted. Respondents were asked how the community interpreted symptoms of diabetes, its causes and whether it was curable. Manifest content analysis was used. Results: Some respondents thought people with diabetes symptoms had HIV or were bewitched. Causes of diabetes mentioned included consuming too much fatty food. Some respondents thought diabetes is transmitted through air, sharing utensils with or sitting close to people with diabetes. Some respondents thought that diabetes could heal fast whilst others thought it was incurable. Conclusion: Misdiagnosis may cause delay in seeking proper care. Preventive programmes could build on people’s thinking that too much fatty food causes diabetes to promote diets with less fat. The perception of diabetes as a contagious disease leads to stigmatisation and affects treatment seeking. Seeing diabetes as curable could create patient expectations that may not be fulfilled in the management of diabetes. Rural communities would benefit from campaigns creating awareness of prevention, symptoms, diagnosis and management of diabetes.


BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e043652
Author(s):  
Jessica Price ◽  
Merlin Willcox ◽  
Vuyiswa Dlamini ◽  
Audrey Khosa ◽  
Phindile Khanyile ◽  
...  

ObjectivesThis study aimed to better understand reasons why children in South Africa die at home, including caregivers’ care-seeking experiences, decision-making, choice of treatment provider and barriers to accessing care during a child’s final illness.DesignThis qualitative study included semi-structured in-depth interviews and focus group discussions with caregivers of children who died below the age of 5 years. Data were thematically analysed, and key findings compared with the Pathways to Survival Framework—a model frequently used in the study of child mortality. An adapted model was developed.SettingTwo rural health and demographic surveillance system (HDSS) sites in South Africa—the Agincourt HDSS and the Africa Health Research Institute.ParticipantsThirty-eight caregivers of deceased children (29 participated in in-depth interviews and 9 were participants in two focus group discussions). Caregivers were purposively sampled to ensure maximum variation across place of death, child age at death, household socioeconomic status, maternal migration status and maternal HIV status.FindingsAlthough caregivers faced barriers in providing care to children (including insufficient knowledge and poor transport), almost all did seek care from the formal health system. Negative experiences in health facilities did not deter care-seeking, but most respondents still received poor quality care and were not given adequate safety-netting advice. Traditional healers were only consulted as a last resort when other approaches had failed.ConclusionBarriers to accessing healthcare disrupt the workings of previously accepted care-seeking models. The adapted model presented in this paper more realistically reflects care-seeking experiences and decision-making during severe childhood illness in rural South Africa and helps explain both the persistence of home deaths despite seeking healthcare, and the impact of a child’s death on care-seeking in future childhood illness. This model can be used as the basis for developing interventions to reduce under-5 mortality.


2020 ◽  
Vol 4 (1) ◽  
pp. e000822
Author(s):  
Robert C Hughes ◽  
Patricia Kitsao-Wekulo ◽  
Sunil Bhopal ◽  
Elizabeth W Kimani-Murage ◽  
Zelee Hill ◽  
...  

IntroductionThe early years are critical. Early nurturing care can lay the foundation for human capital accumulation with lifelong benefits. Conversely, early adversity undermines brain development, learning and future earning.Slums are among the most challenging places to spend those early years and are difficult places to care for a child. Shifting family and work structures mean that paid, largely informal, childcare seems to be becoming the ‘new normal’ for many preschool children growing up in rapidly urbanising Africa. However, little is known about the quality of this childcare.AimsTo build a rigorous understanding what childcare strategies are used and why in a typical Nairobi slum, with a particular focus on provision and quality of paid childcare. Through this, to inform evaluation of quality and design and implementation of interventions with the potential to reach some of the most vulnerable children at the most critical time in the life course.Methods and analysisMixed methods will be employed. Qualitative research (in-depth interviews and focus group discussions) with parents/carers will explore need for and decision-making about childcare. A household survey (of 480 households) will estimate the use of different childcare strategies by parents/carers and associated parent/carer characteristics. Subsequently, childcare providers will be mapped and surveyed to document and assess quality of current paid childcare. Semistructured observations will augment self-reported quality with observable characteristics/practices. Finally, in-depth interviews and focus group discussions with childcare providers will explore their behaviours and motivations. Qualitative data will be analysed through thematic analysis and triangulation across methods. Quantitative and spatial data will be analysed through epidemiological methods (random effects regression modelling and spatial statistics).Ethics and disseminationEthical approval has been granted in the UK and Kenya. Findings will be disseminated through journal publications, community and government stakeholder workshops, policy briefs and social media content.


Human Affairs ◽  
2011 ◽  
Vol 21 (4) ◽  
Author(s):  
Olayinka Akanle ◽  
Olanrewau Olutayo

AbstractUnderstanding the selves, situations and actions of Africans can never be comprehended outside kinship. Local and foreign worldviews are first pigeonholed into culture and defined within kinship realities in Nigeria and Africa. There have been studies on kinship in Africa. However, the findings from such studies portrayed the immutability of African kinship. Thus, as an important contribution to the on-going engagement of kinship in the twenty-first century as an interface between the contemporary Diaspora, this article engaged kinship within international migration. This is a major behavioural and socio-economic force in Nigeria. Methodological triangulation was adopted as part of the research design and primary data were collected through in-depth interviews (IDIs), and life histories of international migrants were documented and focus group discussions (FGDs) were held with kin of returnees. The article found and concluded that while returnees continued to appreciate local kinship infrastructures, the infrastructures were liable to reconstruction primarily determined by dominant support situations in the traditional African kinship networks.


2021 ◽  
Vol 80 (1) ◽  
pp. 49-60
Author(s):  
Justin Raycraft

This paper addresses how Makonde Muslim villagers living on the Swahili coast of southern Tanzania conceptualize and discuss environmental change. Through narratives elicited during in-depth interviews and focus group discussions, I show that respondents associate various forms of environmental change—ecological, climatic, political, and socioeconomic—with God’s plan. Respondents had a sound grasp of the material workings of their lived realities and evoked religious causality to fill in the residual explanatory gaps and find meaning in events that were otherwise difficult to explain. Such narratives reveal both a culturally engrained belief system that colors people’s understandings of change and uncertainty and a discursive idiom for making sense of social suffering. On an applied note, I submit that social science approaches to studying environmental change must take into account political and economic contexts relative to local cosmologies, worldviews, and religious faiths, which may not disaggregate the environment into distinct representational categories.


2019 ◽  
Vol 1 (1) ◽  
pp. 1
Author(s):  
Muslimah Muslimah ◽  
Dian Ayubi

Measles and Rubella (MR) is a disease that is highly contagious and usually occurs in children aged 9 months until the age of 15 years. One effort that can be done to reduce the incidence of the disease is through health promotion about the importance of immunization. Purpose the promotion was packaged in the form of advertisements on electronic media with the aim of building perceptions that the importance of immunization for public health. Methods this research was a qualitative study with a method of collecting in-depth interviews and focus group discussions. The number of informants in this study was 19 mothers who had children aged 0.9 to 15 years in one of the Puskesmas work areas in Merangin District, Jambi Province. Before the data collection process, all informants were asked to see two MR immunization advertisements. Results that immunization advertisements are interesting and contain humor. Meanwhile, informants who did not give MR immunization to their children tended to be negative towards MR immunization advertisements and tended to ignore the effects that arose if they did not give immunizations to their children. The recommendation that MR immunization advertisements should avoid using the fear arousal method and use the pay off idea method in those ads


2019 ◽  
Vol 8 (2) ◽  
pp. 73-80
Author(s):  
Cau Kim Jiu ◽  
Somporn Rungreangkulkij

The condition of families with autistic children raises many views and judgments both from family and society. This ethnographic study aimed to describe the meaning of families and communities towards families with autistic children. Data were collected through focus group discussions and in-depth interviews. Key informants come from families who have autistic children and community members recruited by purposive sampling, while the data were analyzed using thematic analysis. This study results generate  two categories of perception of the meaning of having autistic children.  The first category was made by the families which comprises four themes such as 1) A test from God, 2) Destiny of God, 3) Autistic children different with other children, and 4) Children who need intensive helping. The second category was the perception made by the community members which consists of two themes, such as 1) Test for family, and 2) An autistic child as a holy child. This study further shows that  culture is believed to determine how families and the members of the community perceive and interpret the existence of autistic children in the families so that it is very important for health workers to understand the culture that exists in the community.


Author(s):  
Woubishet Girma ◽  
Dessalegn Tamiru ◽  
Mirkuzie Woldie ◽  
Ayantu Kebede ◽  
Zewdie Birhanu ◽  
...  

Background Establishing maternity waiting homes is a key strategy to address the geographic barrier to obstetric care access among women living in rural areas. In Ethiopia, maternity waiting homes have been in use for several years, with a sharp increase in the number of such facilities recently. However, there is little empirical evidence detailing the experiences and challenges faced by women during the implementation of this initiative in Ethiopia. Methods This study used a multiple case study design with qualitative data collection methods, and was conducted from October to November 2016. Data were collected using focus group discussions, in-depth interviews and direct observation of each maternity waiting home. All interviews and focus group discussions were recorded using a digital voice recorder. Data were transcribed and translated into English. The coding process and formation of thematic structure was assisted by Atlas ti7.5 computer software. Results The participants reported that they were satisfied and comfortable with the services at the maternity waiting homes, as were their husbands and community leaders. Facility, social and environmental challenges were identified as common barriers to the utilisation of maternity waiting homes by stakeholders at different levels. Healthcare providers reported common challenges at maternity waiting homes include a lack of basic utilities (water and electric supply), and overcrowding because of a shortage of space and lack of medical supplies. Some women reported that poor transportation services and the distance to facilities hindered the utilisation of maternity waiting homes. Conclusions There are social and facility challenges related to the use of maternity waiting homes in Ethiopia. Policymakers and health managers should work with relevant sectors to mitigate the effect of facility, social and environmental barriers and maximise the use of maternity waiting homes.


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