scholarly journals Added value of an open narrative in verbal autopsies: a mixed-methods evaluation from Malawi

2021 ◽  
Vol 5 (1) ◽  
pp. e000961
Author(s):  
Patricia Loh ◽  
Edward Fottrell ◽  
James Beard ◽  
Naor Bar-Zeev ◽  
Tambosi Phiri ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Data Quality ◽  
Emotional Distress ◽  
Emotional Stress ◽  
Group Discussion ◽  
Health Centre ◽  
Signs And Symptoms ◽  
Added Value ◽  
Additional Time ◽  
Automated Algorithms

BackgroundThe WHO standardised verbal autopsy (VA) instrument includes closed questions, ascertaining signs and symptoms of illness preceding death, and an optional open narrative. As VA analyses increasingly use automated algorithms, inclusion of narratives should be justified. We evaluated the role of open narratives on VA processes, data quality and respondent’s emotional stress.MethodsA mixed-methods analysis was conducted using VA data for child deaths (0–59 months), between April 2013 and November 2016 in Mchinji district, Malawi. Deaths were prospectively randomised to receive closed questions only or open narrative followed by closed questions. On concluding the VA, interviewers self-completed questions on respondents’ emotional stress. Logistic regression was used to determine associations with visible emotional distress during VAs. A group discussion with interviewers was conducted at the project end, to understand field experiences and explore future recommendations; data were coded using deductive themes.Results2509 VAs were included, with 49.8% (n=1341) randomised to open narratives. Narratives lasted a median of 7 minuntes (range: 1–113). Interviewers described improved rapport and felt narratives improved data quality, although there was no difference in the proportion of deaths with an indeterminate cause using an automated algorithm (5.3% vs 6.1%). The majority of respondents did not display visible emotional stress (81%). Those with a narrative had higher, but not statistically significant, odds of emotional distress (adjusted OR: 1.20; 95% CI: 0.98 to 1.47). Factors associated with emotional stress were: infant deaths versus neonates; deaths at a health centre or en-route to hospital versus home; and higher socioeconomic status. Non-parental respondents and increased time between death and interview were associated with lower odds of emotional distress.ConclusionConducting an open narrative may help build rapport, something valued by the interviewers. However, additional time and emotional burdens should be further justified, with quality and utility of narratives promoted through standardised recommendations.

scholarly journals The Added Value of An Open Narrative in Verbal Autopsies – A Mixed-Methods Evaluation from Malawi

2020 ◽  
Author(s):  
Patricia Loh ◽  
Edward Fottrell ◽  
James Beard ◽  
Naor Bar-Zeev ◽  
Tambosi Phiri ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Data Quality ◽  
Economic Status ◽  
Group Discussion ◽  
Health Centre ◽  
Signs And Symptoms ◽  
Added Value ◽  
World Health ◽  
Process Data ◽  
Additional Time

Abstract Background: The World Health Organization’s standardised verbal autopsy (VA) instrument consists of closed questions, ascertaining signs and symptoms of illness preceding death, and an optional open narrative. As VA analyses increasingly use automated algorithms, the inclusion of narratives should be justified. We evaluated the role of open narratives on VA processes, data quality and respondent emotion.Methods: A mixed-methods analysis was conducted using VA process data for deaths of children aged 0–59 months between April 2013 and November 2016 in Mchinji district, Malawi. Deaths were randomised at the point of interview to receive closed questions only or an open narrative followed by closed questions. Upon concluding the VA, interviewers self-completed questions relating to respondent emotions. Logistic regression was conducted to determine associations with visible emotions during VAs. A group discussion with the interviewers was conducted at the project end, to understand field experiences and explore future recommendations. Qualitative data were coded using deductive themes.Results: A total of 2509 VAs were included, with 49.8% (n = 1341) allocated to open narratives. Narratives lasted a median of 7 minutes (range: 1–113 minutes). Interviewers reported improved respondent rapport and felt narratives improved data quality, although there was no difference in the proportion of deaths with an indeterminate cause (5.3% vs. 6.1%). The majority of respondents did not display visible emotions during VA (81%). Those with a narrative had higher, but not statistically significant, odds of displaying emotion (aOR: 1.20; 95% CI: 0.98, 1.47). Factors associated with visible emotions were: infant deaths compared to neonates; deaths at a health centre or en-route to hospital versus home; and higher socio-economic status. Non-parental respondents and increased time between death and interview were associated with lower odds of emotion.Conclusion: Conducting an open narrative at the start of the VA to build rapport, something valued by the interviewers, may outweigh the additional time taken and slight increase in respondents becoming emotional. However, undue burdens associated with narratives may be further justified if the quality and utility of information from the narrative was promoted through standardised recommendations.

scholarly journals Effectiveness of an escape room for undergraduate interprofessional learning: a mixed methods single group pre-post evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Leigh Moore ◽  
Narelle Campbell
Keyword(s):  
Mixed Methods ◽  
Rural Areas ◽  
Interprofessional Education ◽  
Added Value ◽  
Individual Student ◽  
Single Group ◽  
Interprofessional Practice ◽  
Student Focus ◽  
Practice Knowledge ◽  
Work Integrated Learning

Abstract Background Interprofessional practice (IPP) has been shown to contribute to quality service provision and improved health outcomes. This knowledge has led to the integration of interprofessional education into course curricula for many health-care disciplines. Offering interprofessional education in rural areas to students undertaking work integrated learning placements is challenging particularly because of the diversity of students and placement dates combined with the student focus on the assessable placement curriculum. This research investigated and evaluated the utility of an escape room as an educational modality that facilitates learning whilst providing a supportive and motivating learning environment. Our project focused on the acquisition of interprofessional practice knowledge and experience by a health professional student cohort. Methods This study used the novel intervention of an escape room combined with an interactive teaching session to test student engagement and learning about interprofessional practice and teamwork. The research used a mixed methods single group pre-post design. Results Fifty students (78% female) from seventeen universities and seven professions participated in teams of three to six members. Most participants (66%) had not previously completed an escape room. The results showed that the intervention provided effective and engaging learning and was intrinsically appealing to students despite its non-assessable nature. Individual student reflection on their participation showed developing insight into the critical importance of clear communication and intentional team member collaboration in the provision of effective interprofessional practice. Conclusions The escape room intervention added value to the placement curriculum and proved flexible for a heterogeneous student cohort.

Potentials for increasing resident wellbeing in energy renovation of multi-family social housing

2021 ◽  
pp. 1420326X2110398
Author(s):  
S. R. Jensen ◽  
C. Gabel ◽  
S. Petersen ◽  
P. H. Kirkegaard
Keyword(s):  
Mixed Methods ◽  
Built Environment ◽  
Social Housing ◽  
Global Climate ◽  
Perceived Health ◽  
Added Value ◽  
Design Processes ◽  
Mixed Methods Approach ◽  
Social Wellbeing

The paper explores potentials for increasing residents' wellbeing in multi-family social housing (MSH) undergoing energy renovation. The renovation measures needed to reach national and global climate goals are often not financially feasible when viewed in isolation. Therefore, it is relevant to identify potentials for added value, which can justify more extensive measures. This paper is based on the hypothesis that every renovation project holds potentials for added value in terms of increased resident wellbeing. Further, that it is crucial to extend current understandings of wellbeing beyond single, quantitative wellbeing parameters in order to promote more holistic, long-term sustainable renovation solutions. The paper sheds light on potentials for increased resident wellbeing based on an analysis of residents’ experience and satisfaction with gestures in the existing built environment and comparing these findings to their perceived health. The analysis is based on data collected through a mixed-methods approach in three MSH areas facing extensive renovation. The findings demonstrate and exemplify that energy renovation measures may influence a number of interrelated physiological, mental and social wellbeing aspects across scales. As such, the paper contributes with new insights, which can help promote previously neglected aspects of resident wellbeing in future energy renovation design processes.

scholarly journals Voice-Based Screening For SARS-CoV-2 Exposure In Cardiovascular Clinics

2021 ◽  
Author(s):  
Abhinav Sharma ◽  
Emily Oulousian ◽  
Jiayi Ni ◽  
Renato Lopes ◽  
Matthew Pellan Cheng ◽  
...  
Keyword(s):  
Healthcare Provider ◽  
Clinical Care ◽  
Health Centre ◽  
Healthcare Delivery ◽  
Signs And Symptoms ◽  
Kappa Statistic ◽  
Cohen’S Kappa ◽  
Cohen's Kappa ◽  
Mcgill University ◽  
Strongly Agree

Abstract Aims Artificial intelligence (A.I) driven voice-based assistants may facilitate data capture in clinical care and trials; however, the feasibility and accuracy of using such devices in a healthcare environment are unknown. We explored the feasibility of using the Amazon Alexa (‘Alexa’) A.I. voice-assistant to screen for risk-factors or symptoms relating to SARS-CoV-2 exposure in quaternary care cardiovascular clinics. Methods We enrolled participants to be screened for signs and symptoms of SARS-CoV-2 exposure by a healthcare provider and then subsequently by the Alexa. Our primary outcome was interrater reliability of Alexa to healthcare provider screening using Cohen’s Kappa statistic. Participants rated the Alexa in a post-study survey (scale of 1 to 5 with 5 reflecting strongly agree). This study was approved by the McGill University Health Centre ethics board. Results We prospectively enrolled 215 participants. The mean age was 46 years (17.7 years standard deviation [SD]), 55% were female, and 31% were French speakers (others were English). In total, 645 screening questions were delivered by Alexa. The Alexa mis-identified one response. The simple and weighted Cohen’s kappa statistic between Alexa and healthcare provider screening was 0.989 (95% CI: 0.982, 0.997) and 0.992 (955 CI 0.985, 0.999) respectively. The participants gave an overall mean rating of 4.4 (out of 5, 0.9 SD). Conclusion Our study demonstrates the feasibility of an A.I. driven multilingual voice-based assistant to collect data in the context of SARS-CoV-2 exposure screening. Future studies integrating such devices in cardiovascular healthcare delivery and clinical trials are warranted. Registration https://clinicaltrials.gov/ct2/show/NCT04508972

scholarly journals Penanganan Balita Gizi Buruk di Puskesmas Provinsi Banten, Jawa Barat, Kalimantan Barat, dan Nusa Tenggara Timur

2019 ◽  
pp. 175-183
Author(s):  
Astuti Lamid ◽  
Nova Sri Hartati ◽  
Fitriana Fitriana ◽  
Srilaning Driyah
Keyword(s):  
Content Analysis ◽  
Health Center ◽  
Group Discussion ◽  
Health Centre ◽  
Health Centers ◽  
Severe Malnutrition ◽  
Center Staff ◽  
Depth Interview ◽  
Therapeutic Food ◽  
Mix Methods

Abstrak Masalah balita gizi buruk cenderung menurun pada tahun 2018, namun di beberapa daerah kasus gizi buruk meningkat menjadi KLB. Salah satu penanganannya melalui pemulihan di puskesmas. Tujuan penelitian ini untuk mengetahui sejauh mana penanganan gizi buruk dilakukan oleh tenaga kesehatan puskesmas dan kader posyandu. Desain penelitian menggunakan pendekatan mix methods, berlokasi di Kalimantan Barat, Banten, Jawa Barat dan Nusa Tenggara Timur. Dua kabupaten dipilih dari masing-masing provinsi, selanjutnya dari tiap kabupaten diambil satu puskesmas yang banyak kasus gizi buruk. Informan penelitian adalah Tenaga Pelaksana Gizi (TPG) puskesmas dan kader posyandu. Data yang dikumpulkan meliputi pelayanan gizi dan kesehatan, makanan terapi, dan penyuluhan serta peranan kader. Cara pengumpulan data dengan wawancara, in-depth interview dan diskusi kelompok terarah. Analisis data kuantitatif disajikan secara deskriptif dan kualitatif dengan content analysis. Hasil penelitian menunjukkan sebagian besar puskesmas di daerah penelitian menangani gizi buruk dengan cara rawat jalan. Belum semua TPG puskesmas mendapat pelatihan gizi buruk, hanya sebagian puskesmas menggunakan makanan terapi sedangkan lainnya menggunakan makanan tambahan yang tidak sesuai dengan pedoman. Dukungan sebagian kader dalam penanganan gizi buruk di puskesmas berupa penemuan kasus gizi buruk dan merujuknya, membagikan PMT ke rumah balita. Penanganan balita gizi buruk di puskesmas belum optimal karena tidak didukung dengan ketersediaan input berupa makanan terapi dan belum semua TPG mendapat pelatihan gizi buruk. Pelatihan gizi buruk untuk tenaga puskesmas perlu ditingkatkan dan sistem pengadaan makanan terapi di daerah perlu diperbaiki, agar kualitas pelayanan gizi buruk menjadi lebih baik. Kata kunci: gizi buruk, TPG, PMT, sistem pengadaan, pelayanan kesehatan Abstract The problem of severe malnutrition children under five years old tends to decline in 2018. One of the treatment measures was through recovery at the health center. The purpose of this study was to evaluate the extent to which severe malnutrition children was handled by health center nutrition officer and posyandu cadre. Mix methods approach was used as research design and the study was located in West Kalimantan, Banten, West Java and East Nusa Tenggara Provinces. Two districts were chosen, then one health center from each district was selected based on the highest severe malnutrition cases. The informants were nutrition officer of health center and posyandu cadres. The data collected were nutrition and health services, therapeutic food, counseling, and the role of cadres. Data was collected through interview, in-depth interview, and focus group discussion. Quantitative data analysis was presented descriptively and qualitative data was presented with content analysis.The majority of health centers handled severe malnutrition children in outpatient treatment setting. Not all nutrition officer of health centre have received training in handling severe malnutrition. Only some health centers used therapeutic food while others used supplementary foods that was not recommended. The support of cadre was seen in the form of finding cases of malnutrition and distributing supplementary food to the malnourished children’s homes. The handling of malnourished children in health centers was not optimal, because it was not supported by the availability of therapeutic food and not all nutrition officer have been trained. For recommendations, nutrition training for health center staff needs to be increased and the system for provision therapeutic food in the regions needs to be improved in order to improve the quality of nutrition services. Keywords: severe malnutrition, health center nutrition officer, mix methods, indepth interview, content analysis

scholarly journals Analisis partisipasi ibu balita dalam pemanfaatan Posyandu di wilayah Puskesmas Kota Banda Aceh

2020 ◽  
Vol 1 (2) ◽  
pp. 185
Author(s):  
Siti Fatimah ◽  
Asnawi Abdullah ◽  
Amin Harris
Keyword(s):  
Child Health ◽  
Group Discussion ◽  
Health Centre ◽  
Development Programs ◽  
Policy Makers ◽  
Children Under Five ◽  
Under Five ◽  
Child Health Centre ◽  
Banda Aceh

Background: Public participation generally seen as a form of health behavior is the participation of mothers of children under five in the of Maternal & Child Health Centre it program. Its is a form of integrated services organized for and by the community with work programs from related agencies to then obtain basic health services, decrease maternal and child mortality rates and for the achievement of Small Prosperous Happy Families (KKBS).Purpose: The study aims to analyze the coverage of weighing children under five to Maternal & Child Health Centre (D/S) in the area of the Banda Aceh City Health Center.Method: This research is a qualitative study with a descriptive approach conducted with a Focus Group Discussion (FGD) of 3 main informants, 4 implementing informants and 7 policy makers in the lowest D / S region (Lampaseh Puskesmas area) and 3 main informants, 4 implementing informants and 8 informants policy makers in the highest D/S region (Kopelma Darussalam Puskesmas area).Results: The results of this study found that the availability of facilities is still limited, the role of cadres is still low (not yet able to carry out development programs), the role of the gampong government is still lacking in supporting the implementation and improvement of posyandu visits, policy makers do not fully understand that the conditions in posyandu are a big responsibility from the village, and in practice in the field there has not been an effort to monitor and evaluate the extent of the implementation of the posyandu by the health department.Conclusion: The cadres' low knowledge of development programs in an effort to increase community motivation for posyandu visits. Suggestions for implementing of Maternal & Child Health Centre activities to provide an understanding of how to implement a Maternal & Child Health Centre, improve competence, provide suggestions for development programs and for policymakers.

scholarly journals Data Quality of the Routine Health Management Information System at the Primary Healthcare Facility and District Levels in Tanzania

2020 ◽  
Author(s):  
SUSAN F. RUMISHA ◽  
EMANUEL P. LYIMO ◽  
IRENE R. MREMI ◽  
PATRICK K. TUNGU ◽  
VICTOR S. MWINGIRA ◽  
...  
Keyword(s):  
Information System ◽  
Data Quality ◽  
Management Information System ◽  
Health Management ◽  
Health Centre ◽  
Healthcare Facility ◽  
Health Management Information System ◽  
Management Information ◽  
Service Areas

Abstract Background: Effective planning for disease prevention and control requiresaccurate, adequately-analysed, interpreted and communicated data. This study assessed the quality of routine Health Management Information System (HMIS) data at healthcare facility (HF) and district levels in Tanzania. Methods: HMIS tools used at primary health care facilities (dispensary, health centre, hospital) and district office were reviewed to assess their availability, completeness, and accuracy of collected data. The assessment involved seven health service areas namely, Outpatient department, Inpatient department, Antenatal care, Family Planning, Post-natal care, Labour and Delivery and Provider-initiated Testing and Counselling.Results: A total of 115 HFs in 11 districts were assessed. Registers (availability rate=91.1%; interquartile range (IQR):66.7%-100%) and reportforms (86.9%;IQR:62.2%-100%) were the most utilized tools. There was a limited use of tally-sheets (77.8%;IQR:35.6%-100%). Tools availability at dispensary was 91.1%, health-centre 82.2% and hospital 77.8%, and was poor in urban districts. The availability rate atthe district level was 65% (IQR:48%-75%). Reports were highly over-represented in comparison to registers’ records, with large differences observed at HF phase of the data journey and more profound in hospitals.Tool availability and data quality varied by service-areas, indicators, facility level, and districts, however, with a remarkable improvement over the years.Conclusion: There are high variations and improvements in the tool utilisation and data accuracy at facility and district levels. The routine HMIS is weak and data at district level inaccurately reflects what is available at the HFs. These results highlight the need to design tailored and inter-service strategies for improving data quality.

The Gaia Explorer, a Powerful Search Platform

2021 ◽  
Author(s):  
Xavier Du Bernard ◽  
Jonathan Gallon ◽  
Jérôme Massot
Keyword(s):  
Added Value ◽  
Continuous Training ◽  
Additional Time ◽  
Geological Formation ◽  
Knowledge Platform ◽  
Academic Publications ◽  
Document Collection ◽  
Alternative Scenarios ◽  
Text Content ◽  
The Right

Abstract After two years of development, the GAIA Explorer is now ready to assist Geoscientists at Total! This knowledge platform works like a little Google, but with a focus solely on Geosciences - for the time being. The main goal of the GAIA Explorer is to save time finding the right information. Therefore, it is particularly useful for datarooms or after business acquisitions to quickly digest the knowledge, but also for feeding databases, exploration syntheses, reservoir studies, or even staff onboarding specially when remote working. With this additional time, Geoscientists can focus on tasks with added value, such as to synthesize, find analogies or propose alternative scenarios. This new companion automatically organizes and extracts knowledge from a large number of unstructured technical documents by using Machine Learning (ML). All the models relie on Google Cloud Platform (GCP) and have been trained on our own datasets, which cover main petroleum domains such as geosciences and operations. First, the layout of more than 75,000 document pages were analyzed for training a segmentation model, which extracts three types of content (text, images and tables). Secondly, the text content extracted from about 6,500 documents labelled amongst 30 classes was used to train a model for document classification. Thirdly, more than 55,000 images were categorized amongst 45 classes to customize a model of image classification covering a large panel of figures such as maps, logs, seismic sections, or core pictures. Finally, all the terms (n-grams) extracted from objects are compared with an inhouse thesaurus to automatically tag related topics such as basin, field, geological formation, acquisition, measure. All these elementary bricks are connected and used for feeding a knowledge database that can be quickly and exhaustively searched. Today, the GAIA Explorer searches within texts, images and tables from a corpus (document collection), which can be made up of both technical and operational reports, meeting presentations and academic publications. By combining queries (keywords or natural language) with a large array of filters (by classes and topics), the outcomes are easily refined and exploitable. Since the release of a production version in February 2021 at Total, about 180 users for 30 projects regularly use the tool for exploration and development purposes. This first version is following a continuous training cycle including active learning and, preliminary user feedback is good and admits that some information would have been difficult to locate without the GAIA Explorer. In the future, the GAIA Explorer could be significantly improved by implementing knowledge graph based on an ontology dedicated specific to petroleum domains. Along with the help of Specialists in related activities such as drilling, project or contract, the tool could cover the complete range of upstream topics and be useful for other business with time.

Applied mixed methods and the added value

2021 ◽  
pp. 209-209
Author(s):  
Steve Harris ◽  
Bradley Pettitt ◽  
Ruth Hillary ◽  
Aharon Factor ◽  
John Parm Ulhøi
Keyword(s):  
Mixed Methods ◽  
Added Value
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