scholarly journals How does the effectiveness of strategies to improve healthcare provider practices in low-income and middle-income countries change after implementation? Secondary analysis of a systematic review

2021 ◽  
pp. bmjqs-2020-011717
Author(s):  
Catherine Arsenault ◽  
Samantha Y Rowe ◽  
Dennis Ross-Degnan ◽  
David H Peters ◽  
Sanam Roder-DeWan ◽  
...  
Keyword(s):  
Problem Solving ◽  
Low Income ◽  
Secondary Analysis ◽  
Effect Sizes ◽  
Group Problem ◽  
Middle Income ◽  
Group Problem Solving ◽  
Middle Income Countries ◽  
Service Training

BackgroundA recent systematic review evaluated the effectiveness of strategies to improve healthcare provider (HCP) performance in low-income and middle-income countries. The review identified strategies with varying effects, including in-service training, supervision and group problem-solving. However, whether their effectiveness changed over time remained unclear. In particular, understanding whether effects decay over time is crucial to improve sustainability.MethodsWe conducted a secondary analysis of data from the aforementioned review to explore associations between time and effectiveness. We calculated effect sizes (defined as percentage-point (%-point) changes) for HCP practice outcomes (eg, percentage of patients correctly treated) at each follow-up time point after the strategy was implemented. We estimated the association between time and effectiveness using random-intercept linear regression models with time-specific effect sizes clustered within studies and adjusted for baseline performance.ResultsThe primary analysis included 37 studies, and a sensitivity analysis included 77 additional studies. For training, every additional month of follow-up was associated with a 0.19 %-point decrease in effectiveness (95% CI: –0.36 to –0.03). For training combined with supervision, every additional month was associated with a 0.40 %-point decrease in effectiveness (95% CI: –0.68 to –0.12). Time trend results for supervision were inconclusive. For group problem-solving alone, time was positively associated with effectiveness, with a 0.50 %-point increase in effect per month (95% CI: 0.37 to 0.64). Group problem-solving combined with training was associated with large improvements, and its effect was not associated with time.ConclusionsTime trends in the effectiveness of different strategies to improve HCP practices vary among strategies. Programmes relying solely on in-service training might need periodical refresher training or, better still, consider combining training with group problem-solving. Although more high-quality research is needed, these results, which are important for decision-makers as they choose which strategies to use, underscore the utility of studies with multiple post-implementation measurements so sustainability of the impact on HCP practices can be assessed.

scholarly journals Rates of rehospitalisation in the first 2 years among preterm infants discharged from the NICU of a tertiary children hospital in Vietnam: a follow-up study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e036484
Author(s):  
Chuong Huu Thieu Do ◽  
Malene Landbo Børresen ◽  
Freddy Karup Pedersen ◽  
Ronald Bertus Geskus ◽  
Alexandra Yasmin Kruse
Keyword(s):  
Preterm Infants ◽  
Low Income ◽  
Neonatal Intensive Care ◽  
Respiratory Diseases ◽  
Scale Up ◽  
Middle Income ◽  
Middle Income Countries ◽  
Potential Risk Factors ◽  
The Difference

ObjectivesTo describe the characteristics of rehospitalisation in Vietnamese preterm infants and to examine the time-to-first-readmission between two gestational age (GA) groups (extremely/very preterm (EVP) vs moderate/late preterm (MLP)); and further to compare rehospitalisation rates according to GA and corrected age (CA), and to examine the association between potential risk factors and rehospitalisation rates.Design and settingA cohort study to follow up preterm infants discharged from a neonatal intensive care unit (NICU) of a tertiary children’s hospital in Vietnam.ParticipantsAll preterm newborns admitted to the NICU from July 2013 to September 2014.Main outcomesRates, durations and causes of hospital admission during the first 2 years.ResultsOf 294 preterm infants admitted to NICU (all outborn, GA ranged from 26 to 36 weeks), 255 were discharged alive, and 211 (83%) NICU graduates were followed up at least once during the first 2 years CA, of whom 56% were hospital readmitted. The median (IQR) of hospital stay was 7 (6–10) days. Respiratory diseases were the major cause (70%). Compared with MLP infants, EVP infants had a higher risk of first rehospitalisation within the first 6 months of age (p=0.01). However, the difference in risk declined thereafter and was similar from 20 months of age. There was an interaction in rehospitalisation rates between GA and CA. Longer duration of neonatal respiratory support and having older siblings were associated with higher rehospitalisation rates. Lower rates of rehospitalisation were seen in infants with higher cognitive and motor scores (not statistically significant in cognitive scores).ConclusionsHospital readmission of Vietnamese preterm infants discharged from NICU was frequent during their first 2 years, mainly due to respiratory diseases. Scale-up of follow-up programmes for preterm infants is needed in low-income and middle-income countries and attempts to prevent respiratory diseases should be considered.

scholarly journals Surgical follow-up in low-income and middle-income countries

2013 ◽  
Vol 1 (3) ◽  
pp. e132 ◽  
Author(s):  
Rele Ologunde ◽  
Sohaib R Rufai
Keyword(s):  
Low Income ◽  
Middle Income ◽  
Middle Income Countries

scholarly journals Group problem-solving skills training for self-harm: randomised controlled trial

2014 ◽  
Vol 204 (5) ◽  
pp. 383-390 ◽  
Author(s):  
Carmel McAuliffe ◽  
Breda C. McLeavey ◽  
Tony Fitzgerald ◽  
Paul Corcoran ◽  
Bernie Carroll ◽  
...  
Keyword(s):  
Mental Health ◽  
Problem Solving ◽  
Skills Training ◽  
Group Problem ◽  
Treatment As Usual ◽  
Problem Solving Skills ◽  
Treatment Groups ◽  
Group Problem Solving ◽  
Self Harm

BackgroundRates of self-harm are high and have recently increased. This trend and the repetitive nature of self-harm pose a significant challenge to mental health services.AimsTo determine the efficacy of a structured group problem-solving skills training (PST) programme as an intervention approach for self-harm in addition to treatment as usual (TAU) as offered by mental health services.MethodA total of 433 participants (aged 18–64 years) were randomly assigned to TAU plus PST or TAU alone. Assessments were carried out at baseline and at 6-week and 6-month follow-up and repeated hospital-treated self-harm was ascertained at 12-month follow-up.ResultsThe treatment groups did not differ in rates of repeated self-harm at 6-week, 6-month and 12-month follow-up. Both treatment groups showed significant improvements in psychological and social functioning at follow-up. Only one measure (needing and receiving practical help from those closest to them) showed a positive treatment effect at 6-week (P = 0.004) and 6-month (P = 0.01) follow-up. Repetition was not associated with waiting time in the PST group.ConclusionsThis brief intervention for self-harm is no more effective than treatment as usual. Further work is required to establish whether a modified, more intensive programme delivered sooner after the index episode would be effective.

scholarly journals Labour companionship and women’s experiences of mistreatment during childbirth: results from a multi-country community-based survey

2020 ◽  
Vol 5 (Suppl 2) ◽  
pp. e003564
Author(s):  
Mamadou Dioulde Balde ◽  
Khalidha Nasiri ◽  
Hedieh Mehrtash ◽  
Anne-Marie Soumah ◽  
Meghan A Bohren ◽  
...  
Keyword(s):  
Physical Abuse ◽  
Low Income ◽  
Descriptive Analysis ◽  
Secondary Analysis ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Country Level ◽  
Context Specific ◽  
The Relationship

BackgroundEvidence has shown the benefits of labour companions during childbirth. Few studies have documented the relationship between the absence of labour companions and mistreatment of women during childbirth in low-income and middle-income countries using a standardised tool.MethodsWe conducted a secondary analysis of the WHO multi-country study on how women are treated during childbirth, where a cross-sectional community survey was conducted with women up to 8 weeks after childbirth in Ghana, Guinea, Nigeria and Myanmar. Descriptive analysis and multivariable logistic regression were used to examine whether labour companionship was associated with various types of mistreatment.ResultsOf 2672 women, about half (50.4%) reported the presence of a labour companion. Approximately half (49.6%) of these women reported that the timing of support was during labour and after childbirth and most of the labour companions (47.0%) were their family members. Across Ghana, Guinea and Nigeria, women without a labour companion were more likely to report physical abuse, non-consented medical procedures and poor communication compared with women with a labour companion. However, there were country-level variations. In Guinea, the absence of labour companionship was associated with any physical abuse, verbal abuse, or stigma or discrimination (adjusted OR (AOR) 3.6, 1.9–6.9) and non-consented vaginal examinations (AOR 3.2, 1.6–6.4). In Ghana, it was associated with non-consented vaginal examinations (AOR 2.3, 1.7–3.1) and poor communication (AOR 2.0, 1.3–3.2). In Nigeria, it was associated with longer wait times (AOR 0.6, 0.3–0.9).ConclusionLabour companionship is associated with lower levels of some forms of mistreatment that women experience during childbirth, depending on the setting. Further work is needed to ascertain how best to implement context-specific labour companionship to ensure benefits while maintaining women’s choices and autonomy.

scholarly journals Neurosurgeons’ experiences of conducting and disseminating clinical research in low-income and middle-income countries: a reflexive thematic analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e051806
Author(s):  
Charlotte Jane Whiffin ◽  
Brandon George Smith ◽  
Ignatius N Esene ◽  
Claire Karekezi ◽  
Tom Bashford ◽  
...  
Keyword(s):  
Clinical Research ◽  
Thematic Analysis ◽  
Low Income ◽  
Demographic Data ◽  
Middle Income ◽  
Survey Tool ◽  
Middle Income Countries ◽  
Specific Effects ◽  
The Impact

ObjectivesLow-income and-middle-income countries (LMICs) are increasing investment in research and development, yet there remains a paucity of neurotrauma research published by those in LMICs. The aim of this study was to understand neurosurgeons’ experiences of, aspirations for, and ability to conduct and disseminate clinical research in LMICs.DesignThis was a two-stage inductive qualitative study situated within the naturalistic paradigm. This study committed to an interpretivist way of knowing (epistemology), and considered reality subjective and multiple (ontology). Data collection used online methods and included a web-based survey tool for demographic data, an asynchronous online focus group and follow-up semistructured interviews. Data were analysed using Braun and Clarke’s Reflexive Thematic Analysis supported by NVivo V.12.SettingLMICs.ParticipantsIn April–July 2020, 26 neurosurgeons from 11 LMICs participated in this study (n=24 in the focus groups, n=20 in follow-up interviews).ResultsThe analysis gave rise to five themes: The local landscape; creating capacity; reach and impact; collaborative inquiry; growth and sustainability. Each theme contained an inhibitor and stimulus to neurosurgeons conducting and disseminating clinical research, interpreted as ‘the neurosurgical research potential in LMICs’. Mentorship, education, infrastructure, impact and engagement were identified as specific accelerators. Whereas lack of generalisability, absence of dissemination and dissemination without peer review may desensitise the impact of research conducted by neurosurgeons.ConclusionThe geographical, political and population complexities make research endeavour challenging for neurosurgeons in LMICs. Yet in spite of, and because of, these complexities LMICs provide rich opportunities to advance global neurosurgery. More studies are required to evaluate the specific effects of accelerators of research conducted by neurosurgeons and to understand the effects of desensitisers on high-quality, high-impact clinical research.

scholarly journals The effectiveness of supervision strategies to improve health care provider practices in low- and middle-income countries: secondary analysis of a systematic review

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Samantha Y. Rowe ◽  
Dennis Ross-Degnan ◽  
David H. Peters ◽  
Kathleen A. Holloway ◽  
Alexander K. Rowe
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Problem Solving ◽  
Care Provider ◽  
Secondary Analysis ◽  
Middle Income ◽  
Improve Health Care ◽  
Middle Income Countries ◽  
Supervision Strategies ◽  
Improve Health

Abstract Background Although supervision is a ubiquitous approach to support health programs and improve health care provider (HCP) performance in low- and middle-income countries (LMICs), quantitative evidence of its effects is unclear. The objectives of this study are to describe the effect of supervision strategies on HCP practices in LMICs and to identify attributes associated with greater effectiveness of routine supervision. Methods We performed a secondary analysis of data on HCP practice outcomes (e.g., percentage of patients correctly treated) from a systematic review on improving HCP performance. The review included controlled trials and interrupted time series studies. We described distributions of effect sizes (defined as percentage-point [%-point] changes) for each supervision strategy. To identify attributes associated with supervision effectiveness, we performed random-effects linear regression modeling and examined studies that directly compared different approaches of routine supervision. Results We analyzed data from 81 studies from 36 countries. For professional HCPs, such as nurses and physicians, primarily working at health facilities, routine supervision (median improvement when compared to controls: 10.7%-points; IQR: 9.9, 27.9) had similar effects on HCP practices as audit with feedback (median improvement: 10.1%-points; IQR: 6.2, 23.7). Two attributes were associated with greater mean effectiveness of routine supervision (p < 0.10): supervisors received supervision (by 8.8–11.5%-points), and supervisors participated in problem-solving with HCPs (by 14.2–20.8%-points). Training for supervisors and use of a checklist during supervision visits were not associated with effectiveness. The effects of supervision frequency (i.e., number of visits per year) and dose (i.e., the number of supervision visits during a study) were unclear. For lay HCPs, the effect of routine supervision was difficult to characterize because few studies existed, and effectiveness in those studies varied considerably. Evidence quality for all findings was low primarily because many studies had a high risk of bias. Conclusions Although evidence is limited, to promote more effective supervision, our study supports supervising supervisors and having supervisors engage in problem-solving with HCPs. Supervision’s integral role in health systems in LMICs justifies a more deliberate research agenda to identify how to deliver supervision to optimize its effect on HCP practices.

scholarly journals A questionnaire study of the negative outcomes for UK health professional volunteers in low and middle income countries

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e037647
Author(s):  
Natasha Tyler ◽  
Helen Louise Ackers ◽  
Anya Ahmed ◽  
Ged Byrne ◽  
Lucie Byrne-Davis
Keyword(s):  
Health Professional ◽  
Low Income ◽  
Healthcare Professionals ◽  
Secondary Analysis ◽  
Past Research ◽  
Negative Outcomes ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Professional Volunteers

IntroductionPast research has reported considerable benefits of international health professional volunteering for British healthcare professionals; however, there are also some negative outcomes reported. Negative outcomes reportedly happen on a personal, professional and organisational level. However, there is little evidence of the frequency they might occur.MethodsWe aimed to understand what the negative outcomes of health professional volunteering in low-income and middle-income countries were, and how frequently they occurred, in an opportunistic sample of UK health professionals. We used a questionnaire developed using potential negative outcomes reported in the peer-reviewed papers. We conducted secondary analysis on cross-sectional questionnaire data from 222 healthcare professionals.ResultsThis research provides an indication of the frequency that negative outcomes might occur. Post hoc analyses revealed that some outcomes were experienced by the majority of health professional volunteers, for example, lack of formal recognition (131/169, 78%) and financial cost (92/169, 68%). While others happened less, for example, a reliance on agency or locum work (12/169, 7%) and loss of pension (31/169, 18%).ConclusionThe outcomes reported in this research quantify some of the concerns that have been raised in previous literature. Negative outcomes might be associated with certain features of volunteering and further research is needed to prospectively compare different features. Organisers of volunteering opportunities should be aware of the potential negative outcomes and engage with the research into negative outcomes to generate and apply findings about minimising potential negative outcomes, carefully balancing these against the needs of the host country.

scholarly journals Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: Systematic review

2015 ◽  
Vol 207 (5) ◽  
pp. 377-384 ◽  
Author(s):  
N. Mehta ◽  
S. Clement ◽  
E. Marcus ◽  
A.-C. Stona ◽  
N. Bezborodovs ◽  
...  
Keyword(s):  
Social Contact ◽  
Effect Sizes ◽  
Middle Income ◽  
Middle Income Countries ◽  
Stigma And Discrimination ◽  
Effective Interventions ◽  
Mean Differences ◽  
Google Search

BackgroundMost research on interventions to counter stigma and discrimination has focused on short-term outcomes and has been conducted in high-income settings.AimsTo synthesise what is known globally about effective interventions to reduce mental illness-based stigma and discrimination, in relation first to effectiveness in the medium and long term (minimum 4 weeks), and second to interventions in low- and middle-income countries (LMICs).MethodWe searched six databases from 1980 to 2013 and conducted a multi-language Google search for quantitative studies addressing the research questions. Effect sizes were calculated from eligible studies where possible, and narrative syntheses conducted. Subgroup analysis compared interventions with and without social contact.ResultsEighty studies (n = 422 653) were included in the review. For studies with medium or long-term follow-up (72, of which 21 had calculable effect sizes) median standardised mean differences were 0.54 for knowledge and −0.26 for stigmatising attitudes. Those containing social contact (direct or indirect) were not more effective than those without. The 11 LMIC studies were all from middle-income countries. Effect sizes were rarely calculable for behavioural outcomes or in LMIC studies.ConclusionsThere is modest evidence for the effectiveness of anti-stigma interventions beyond 4 weeks follow-up in terms of increasing knowledge and reducing stigmatising attitudes. Evidence does not support the view that social contact is the more effective type of intervention for improving attitudes in the medium to long term. Methodologically strong research is needed on which to base decisions on investment in stigma-reducing interventions.

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