Exploring the factors motivating continued Lay First Responder participation in Uganda: a mixed-methods, 3-year follow-up

BackgroundThe WHO recommends training lay first responders (LFRs) as the first step towards establishing emergency medical services (EMS) in low-income and middle-income countries. Understanding social and financial benefits associated with responder involvement is essential for LFR programme continuity and may inform sustainable development.MethodsA mixed-methods follow-up study was conducted in July 2019 with 239 motorcycle taxi drivers, including 115 (75%) of 154 initial participants in a Ugandan LFR course from July 2016, to evaluate LFR training on participants. Semi-structured interviews and surveys were administered to samples of initial participants to assess social and economic implications of training, and non-trained motorcycle taxi drivers to gauge interest in LFR training. Themes were determined on a per-question basis and coded by extracting keywords from each response until thematic saturation was achieved.ResultsThree years post-course, initial participants reported new knowledge and skills, the ability to help others, and confidence gain as the main benefits motivating continued programme involvement. Participant outlook was unanimously positive and 96.5% (111/115) of initial participants surveyed used skills since training. Many reported sensing an identity change, now identifying as first responders in addition to motorcycle taxi drivers. Drivers reported they believe this led to greater respect from the Ugandan public and a prevailing belief that they are responsible transportation providers, increasing subsequent customer acquisition. Motorcycle taxi drivers who participated in the course reported a median weekly income value that is 24.39% higher than non-trained motorcycle taxi counterparts (p<0.0001).ConclusionsA simultaneous delivery of sustained social and perceived financial benefits to LFRs are likely to motivate continued voluntary participation. These benefits appear to be a potential mechanism that may be leveraged to contribute to the sustainability of future LFR programmes to deliver basic prehospital emergency care in resource-limited settings.

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Developing a Lay First Responder Program in Chad: A 12-Month Follow-Up Evaluation of a Rural Prehospital Emergency Care Program

Prehospital and Disaster Medicine ◽

10.1017/s1049023x20000977 ◽

2020 ◽

Vol 35 (5) ◽

pp. 546-553 ◽

Cited By ~ 2

Author(s):

Canaan J. Hancock ◽

Peter G. Delaney ◽

Zachary J. Eisner ◽

Eric Kroner ◽

Issa Mahamet-Nuur ◽

...

Keyword(s):

Knowledge Acquisition ◽

Emergency Care ◽

Prehospital Emergency Care ◽

Voluntary Participation ◽

First Responder ◽

Taxi Drivers ◽

Post Test ◽

Prehospital Emergency ◽

Motorcycle Taxi

AbstractIntroduction:The World Health Organization (WHO; Geneva, Switzerland) recommends lay first responder (LFR) programs as a first step toward establishing formal Emergency Medical Services (EMS) in low- and middle-income countries (LMICs) to address injury. There is a scarcity of research investigating LFR program development in predominantly rural settings of LMICs.Study Objective:A pilot LFR program was launched and assessed over 12 months to investigate the feasibility of leveraging pre-existing transportation providers to scale up prehospital emergency care in rural, low-resource settings of LMICs.Methods:An LFR program was established in rural Chad to evaluate curriculum efficacy, using a validated 15-question pre-/post-test to measure participant knowledge improvement. Pre-/post-test score distributions were compared using a Wilcoxon Signed-Rank test. For test evaluation, each pre-test question was mapped to its corresponding post-test analog and compared using McNemar’s Chi-Squared Test to examine knowledge acquisition on a by-question basis. Longitudinal prehospital care was evaluated with incident reports, while program cost was tracked using a one-way sensitivity analysis. Qualitative follow-up surveys and semi-interviews were conducted at 12 months, with initial participants and randomly sampled motorcycle taxi drivers, and used a constructivist grounded theory approach to understand the factors motivating continued voluntary participation to inform future program continuity. The consolidated criteria for reporting qualitative research (COREQ) checklist was used to guide design, analysis, and reporting the qualitative results.Results:A total of 108 motorcycle taxi participants demonstrated significant knowledge improvement (P <.001) across three of four curricular categories: scene safety, airway and breathing, and bleeding control. Lay first responders treated 71 patients over six months, encountering five deaths, and provided patient transport in 82% of encounters. Lay first responders reported an average confidence score of 8.53/10 (n = 38). In qualitative follow-up surveys and semi-structured interviews, the ability to care for the injured, new knowledge/skills, and the resultant gain in social status and customer acquisition motivated continued involvement as LFRs. Ninety-six percent of untrained, randomly sampled motorcycle taxi drivers reported they would be willing to pay to participate in future training courses.Conclusion:Lay first responder programs appear feasible and cost-effective in rural LMIC settings. Participants demonstrate significant knowledge acquisition, and after 12 months of providing emergency care, report sustained voluntary participation due to social and financial benefits, suggesting sustainability and scalability of LFR programs in low-resource settings.

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The impact of the Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia training course in Ethiopia: A mixed methods longitudinal cohort study

Anaesthesia and Intensive Care ◽

10.1177/0310057x20940330 ◽

2020 ◽

Vol 48 (4) ◽

pp. 297-305

Author(s):

Jolene N Moore ◽

Wayne W Morriss ◽

Gebrehiwot Asfaw ◽

Gosa Tesfaye ◽

Aaliya R Ahmed ◽

...

Keyword(s):

Cohort Study ◽

Mixed Methods ◽

Maternal Mortality ◽

Longitudinal Cohort Study ◽

Structured Interviews ◽

Middle Income ◽

Longitudinal Cohort ◽

Obstetric Anaesthesia ◽

The Impact

Summary Reducing maternal mortality remains a global priority, particularly in low- and middle-income countries (LMICs). The Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia (OB) course is a three-day refresher course for trained anaesthesia providers addressing common causes of maternal mortality in LMICs. This aim of this study was to investigate the impact of SAFE training for a cohort of anaesthesia providers in Ethiopia. We conducted a mixed methods longitudinal cohort study incorporating a behavioural questionnaire, multiple-choice questionnaires (MCQs), structured observational skills tests and structured interviews for anaesthesia providers who attended one of four SAFE-OB courses conducted in two regions of Ethiopia from October 2017 to May 2018. Some 149 participants from 60 facilities attended training. Behavioural questionnaires were completed at baseline ( n = 101, 69% response rate). Pre- and post-course MCQs ( n = 121, n = 123 respectively) and pre- and post-course skills tests ( n = 123, n = 105 respectively) were completed, with repeat MCQ and skills tests, and semi-structured interviews completed at follow-up ( n = 88, n = 76, n = 49 respectively). The mean MCQ scores for all participants improved from 80.3% prior to training to 85.4% following training ( P < 0.0001) and skills test scores improved from 56.5% to 83.2% ( P < 0.0001). Improvements in MCQs and skills were maintained at follow-up 3–11 months post-training compared to baseline ( P = 0.0006, < 0.0001 respectively). Participants reported improved confidence, teamwork and communication at follow-up. This study suggests that the SAFE-OB course can have a sustained impact on knowledge and skills and can improve the confidence of anaesthesia providers and communication within surgical teams.

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Does Sense make sense? Mixed methods study of a Dutch sexual health program

European Journal of Public Health ◽

10.1093/eurpub/ckz185.353 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

R Joosten ◽

L Jochems ◽

C Wijsen ◽

T Heijman ◽

A Timen

Keyword(s):

Health Care ◽

Mixed Methods ◽

Young People ◽

Sexual Health ◽

Health Care Professionals ◽

Mixed Methods Study ◽

Structured Interviews ◽

Open Atmosphere ◽

Study Results

Abstract In the Netherlands, the Sense program addresses several key elements of sexual health for young people <25 year. This program offers free consultations at the PHS concerning STI, contraceptives, pregnancy or sexuality. The performance of this program has not been studied yet. This mixed methods study investigates facilitators and barriers of a Sense consultation from the perspective of clients and health care professionals (HCP) and investigates the outcome of the consultation at three points in time. Semi-structured interviews were conducted after consultation among 16 clients and 6 HCP. Questionnaires were collected directly after consultation and at 3, 6 and 12 months after consultation. Two cohorts were recruited; clients with STI consultation only and clients with questions related to sexuality, contraception and pregnancy (Sense consultation, SC). Satisfaction of the consultation and applicability of the given advice was measured. In the follow up presence of STI, pregnancy, sexual problem and contraceptive use was measured. A minority of the interviewed clients were familiar with Sense, highly valued the expertise of the HCP and the open atmosphere during the consultation. Reasons for visiting Sense included expertise, more anonymity and feeling more comfortable than at the GP. The questionnaire after consultation was returned by 144 STI clients and 32 SC clients. Both type of consultation were highly valued and advice was easily applicable. The follow up cohort included 97 STI clients and 23 SC clients. Response rate of the 3- and 6 month-questionnaires was 61%. Results of the full one year follow-up are expected in September 2019. Study results provide evidence for a highly valued Sense program, by both clients and HCP. Sense is a platform to discuss STI, contraception and sexuality in an open atmosphere, though familiarity with Sense is low. A major conclusion is that an STI consultation provides the opportunity to address questions related to sexuality. Key messages The Sense program is highly valued by young people, and yet the program is not widely known among young people. There is need for more publicity to the program to enable more young people to use this program and to improve the sexual health care of young Dutch people.

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Stress and family relationships among college student parents: A mixed methods study

Journal of Social and Personal Relationships ◽

10.1177/0265407520975198 ◽

2020 ◽

pp. 026540752097519

Author(s):

Aryn M. Dotterer ◽

Audrey C. Juhasz ◽

Kristin N. Murphy ◽

SuJung Park ◽

Lisa K. Boyce

Keyword(s):

Mixed Methods ◽

College Student ◽

Low Income ◽

Family Relationships ◽

Online Survey ◽

Qualitative Interviews ◽

Multiple Roles ◽

Structured Interviews ◽

External Resources ◽

Student Parents

College student parents represent a unique population because they are typically low-income, accrue more debt than traditional students, and must balance the role of student and parent. Using a mixed methods design, this study examined the relation between college student parents’ stress and distress in their relationships with their children and examined how parents managed their multiple roles. Parent participants ( n = 80; 54 mothers, 26 fathers; M age = 28.74 years, SD = 4.72) completed an online survey and a subsample ( n = 14) participated in semi-structured interviews. Results revealed that college student parents experience a variety of stressors that spillover into their relationships with their children and these associations appear more detrimental for father-child relationships. However, in-depth qualitative interviews not only highlighted the various sources of stress (e.g., time demands, multiple roles), but also revealed internal and external resources that college student parents draw on to help cope with stressors. Findings suggest that program efforts to strengthen the co-parenting relationship and to help college student parents more effectively manage their stress may be beneficial for improved parent-child relationships.

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DETERMINANT OF PERSONAL HYGIENE BEHAVIOR OF ONLINE MOTORBIKE TAXI DRIVERS IN COVID 19 PREVENTION IN SEMARANG CENTRAL JAVA

Jurnal Riset Kesehatan ◽

10.31983/jrk.v10i1.6525 ◽

2021 ◽

Vol 10 (1) ◽

pp. 19-26

Author(s):

Sekar Putranti Widantari ◽

Nur Endah Wahyuningsih ◽

Nikie Astorina Yunita Dewanti

Keyword(s):

Family Support ◽

Low Income ◽

Sampling Technique ◽

Personal Hygiene ◽

Taxi Driver ◽

P Value ◽

Cross Sectional ◽

Taxi Drivers ◽

Hygiene Behavior ◽

Motorcycle Taxi

Online motorcycle taxi drivers are at risk of contracting COVID-19 because they have a high frequency of contact with other people and objects that have the possibility of SARS-CoV 2 on their surface. This study aims to determine the determinants of personal hygiene in online motorcycle taxi drivers in an effort to prevent COVID-19 in the city of Semarang, which is an analytical observational study using a cross-sectional approach. The sample in this study were 385 drivers who were in the online motorcycle taxi driver communities on Facebook and Twitter. The sampling technique uses a snowball, and the research instrument is a questionnaire distributed via google forms. Data analysis using Chi-Square Test. 89.4% of online motorcycle taxi drivers are male, 76.1% have low levels of education, 58.7% have low-income levels, 32.2% have poor knowledge, 46.2% have poor attitudes, 48.3% had poor family support, 26.2% had poor peer support, 45.2% had poor information accessibility, and 47% had poor personal hygiene behavior. There is a relationship between knowledge (p-value 0.001) attitude (p-value 0.001 ) and family support (p-value 0.001 ) with personal hygiene behavior. Knowledge becomes the most influential determinant of personal hygiene behavior. Providing an educational menu in the driver application can help to increase knowledge.

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Exploring the impact of shielding advice on the health and wellbeing of individuals identified as extremely vulnerable and advised to shield in Southwest England amid the COVID-19 pandemic: A mixed-methods evaluation

10.1101/2022.01.05.21268251 ◽

2022 ◽

Author(s):

Gemma Lasseter ◽

Polly Compston ◽

Charlotte Robin ◽

Helen Lambert ◽

Matthew Hickman ◽

...

Keyword(s):

Mental Health ◽

Mixed Methods ◽

Negative Impact ◽

Community Support ◽

Supplementary Information ◽

Physical And Mental Health ◽

Structured Interviews ◽

Health And Wellbeing ◽

The Impact

Objective: Explore the impact and responses to public health advice on the health and wellbeing of individuals identified as clinically extremely vulnerable (CEV) and advised to shield (not leave home for 12 weeks at start of the pandemic) in Southwest England during the first COVID-19 lockdown. Design: Mixed-methods study; structured survey and follow-up semi-structured interviews. Setting: Communities served by Bristol, North Somerset & South Gloucestershire Clinical Commissioning Group. Participants: 204 people (57% female, 54% >69 years, 94% White British, 64% retired) in Southwest England identified as CEV and were advised to shield completed the survey. Thirteen survey respondents participated in follow-up interviews (53% female, 40% >69years, 100% White British, 61% retired). Results: Receipt of official communication from NHS England or General Practitioner (GP) was considered by participants as the legitimate start of shielding. 80% of survey responders felt they received all relevant advice needed to shield, yet interviewees criticised the timing of advice and often sought supplementary information. Shielding behaviours were nuanced, adapted to suit personal circumstances, and waned over time. Few interviewees received community support, although food boxes and informal social support were obtained by some. Worrying about COVID-19 was common for survey responders (90%). Since shielding had begun, physical and mental health reportedly worsened for 35% and 42% of survey responders respectively. 21% of survey responders scored 10 or more on the PHQ-9 questionnaire indicating possible depression and 15% scored 10 or more on the GAD-7 questionnaire indicating possible anxiety. Conclusions: This research highlights the difficulties in providing generic messaging that is applicable and appropriate given the diversity of individuals identified as CEV and the importance of sharing tailored and timely advice to inform shielding decisions. Providing messages that reinforce self-determined action and assistance from support services could reduce the negative impact of shielding on mental health and feelings of social isolation.

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Support and follow-up needs of patients discharged from Intensive Care after severe COVID-19: a mixed-methods study of the views of UK general practitioners and intensive care staff during the pandemic’s first wave

10.1101/2020.12.23.20248798 ◽

2020 ◽

Author(s):

Ana Castro-Avila ◽

Laura Jefferson ◽

Veronica Dale ◽

Karen Bloor

Keyword(s):

Intensive Care ◽

Mixed Methods ◽

General Practitioners ◽

Large Cohort ◽

Care Staff ◽

Support Needs ◽

List Type ◽

Structured Interviews ◽

Icu Discharge

AbstractBackgroundAfter discharge from an intensive care unit(ICU), over 50% of patients face significant physical, mental and cognitive problems. The COVID-19 pandemic has resulted in a large cohort of these patients who will need follow-up services that can address their support needs.ObjectivesTo identify follow-up services planned for COVID-19 patients discharged from ICU, and to explore the views of ICU staff and General Practitioners(GPs) regarding these patients’ future needs and care coordination.DesignSequential mixed-methods UK study. We explored usual follow-up practice after ICU discharge and changes in follow-up during the pandemic through a survey of ICU staff, and GP awareness of follow-up and support needs of patients discharged from ICU through a survey of GPs. Through these surveys, we identified participants for semi-structured interviews with both groups.ResultsWe obtained 170 survey responses and conducted 23 interviews. Over 60% of GPs were unaware of the follow-up services generally provided by their local hospitals, and whether or not these were functioning during the pandemic. Eighty percent of ICUs reported some form of follow-up services, with 25% of these suspending provision during the peak of the pandemic, and over half modifying their provision (usually to provide the service remotely). Complex funding streams, poor communication between primary and secondary care, and lack of clarity about who was responsible for referrals and follow-up were the most common problems identified. Discharge documentation was described as poor and lacking key information. Both groups mentioned difficulties accessing services in the community.ConclusionsThe pandemic has highlighted long-standing issues of continuity of care and complex funding streams for post-ICU follow-up care. The large cohort of ICU patients admitted due to COVID-19 highlights the need for improved follow-up services and communication between specialists and GPs, not only for COVID-19 patients, but for all those discharged from ICU.Article SummaryStrengths and limitations of this studyThis is the first study exploring NHS staff views of post-ICU follow-up services to support patients recovering from severe COVID-19.Responses to our survey had good geographic spread but were limited in number and relied on volunteers.GP interviews were small in number, but our findings align with those of larger studies conducted before the pandemic.

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Cardiac donation after circulatory determination of death: protocol for a mixed-methods study of healthcare provider and public perceptions in Canada

BMJ Open ◽

10.1136/bmjopen-2019-033932 ◽

2020 ◽

Vol 10 (7) ◽

pp. e033932

Author(s):

Kimia Honarmand ◽

Ian Ball ◽

Matthew Weiss ◽

Marat Slessarev ◽

Robert Sibbald ◽

...

Keyword(s):

Mixed Methods ◽

Healthcare Providers ◽

Determination Of Death ◽

Transplant Recipients ◽

Structured Interviews ◽

The Public ◽

Number Of Patients ◽

End Stage

IntroductionCardiac transplantation remains the best treatment for patients with end-stage heart disease that is refractory to medical or device therapies, however, a major challenge for heart transplantation is the persistent discrepancy between the number of patients on waiting lists and the number of available hearts. While other countries (eg, UK, Australia and Belgium) have explored and implemented alternative models of transplantation, such as cardiac donation after circulatory determination of death (DCDD) to alleviate transplantation wait times, ethical concerns have hindered implementation in some countries. This study aims to explore the attitudes and opinions of healthcare providers and the public about cardiac DCDD in order to identify and describe opportunities and challenges in ensuring that proposed cardiac DCDD procedures in Canada are consistent with Canadian values and ethical norms.Methods and analysisThis study will include two parts that will be conducted concurrently. Part 1 is a qualitative study consisting of semi-structured interviews with Canadian healthcare providers who routinely care for organ donors and/or transplant recipients to describe their perceptions about cardiac DCDD. Part 2 is a convergent parallel mixed-methods design consisting of a series of focus groups and follow-up surveys with members of the Canadian general public to describe their perceptions about cardiac DCDD.Ethics and disseminationThis study has been approved by the Research Ethics Board at Western University. The findings will be presented at regional and national conferences and reported in peer-reviewed publications.

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A Qualitative Assessment of an Ambient Display to Support In-Home Medication of Older Adults

Proceedings ◽

10.3390/proceedings2191248 ◽

2018 ◽

Vol 2 (19) ◽

pp. 1248

Author(s):

Marcela D. Rodríguez ◽

Ernesto Zarate-Bravo ◽

Juan-Pablo García-Vázquez ◽

Ángel G. Andrade ◽

René F. Navarro ◽

...

Keyword(s):

Older Adults ◽

Family Caregivers ◽

Low Income ◽

Qualitative Assessment ◽

Computing Technology ◽

Structured Interviews ◽

Pharmaceutical Policies ◽

Home Medication ◽

Ambient Computing

Studies on ambient computing technologies have shown their potential for assisting older adults to manage medications. However, their results cannot be generalizable, since they were conducted in different settings. We assessed the feasibility of a Medication Ambient Display (MAD) to improve the medication adherence of low-income Mexican older adults with mild-cognitive impairment (MCI). Through semi-structured interviews to 11 dyads of older adults and family caregivers who used MAD, we identified the effects of the setting conditions in the adoption and use of our technology. Our results showed that older adults forgot less to medicate. However, we observed that seniors have risky medication-related behaviors as a consequence of the challenges impose by our setting, such as the lack of adequate pharmaceutical policies regarding the rational use of medicines and the follow-up on patients’ medication regimens. We outline design implications for developing ambient computing technology to reduce drug adverse events associated with these challenges.

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Investigating COVID-19 in Low-income Settings: Protocol for a Multidisciplinary Mixed Methods Research in Burkina Faso

10.21203/rs.3.rs-553045/v1 ◽

2021 ◽

Author(s):

Isidore Traoré ◽

Samiratou Ouedraogo ◽

Dramane Kania ◽

Nongodo Firmin ◽

Blahima Konaté Kaboré ◽

...

Keyword(s):

Mixed Methods ◽

Burkina Faso ◽

Low Income ◽

Mixed Methods Research ◽

Lessons Learned ◽

Low Income Countries ◽

Preventive Strategies ◽

Structured Interviews ◽

Hygiene Measures ◽

Bobo Dioulasso

Abstract Background: The world has high hopes of vaccination against COVID-19 to protect the population, boost economies and return to normal life. Vaccination programmes are being rolled out in high income countries, but the pandemic continues to rage in many low-income countries (LICs) despite implementation of strict hygiene measures. We aim to present a comprehensive research protocol that will generate epidemiological, sociological, and anthropological data about the COVID-19 epidemic in Burkina Faso a landlocked country in West Africa with scares resources. Methods: We will perform a multidisciplinary research using mixed methods in the two main cities in Burkina Faso (Ouagadougou and Bobo-Dioulasso). Data will be collected in general population and in COVID-19 patients, caregivers and health care professional in reference care centers: (i) to determine cumulative incidence of SARS-CoV-2 infection in the Burkinabe population using blood samples collected from randomly selected households according to the WHO-recommended protocol; (ii) develop a score to predict severe complications of COVID-19 in persons infected with SARS-CoV-2 using retrospective and prospective data; (iii) perform semi-structured interviews and direct observation on site, to describe and analyze the healthcare pathways and experiences of patients with COVID-19 attending reference care centers, and to identify the perceptions, acceptability and application of preventive strategies among the population. Discussion: This study will generate comprehensive data that will contribute to improve COVID-19 response strategies in Burkina Faso. The lessons learned from the management of the epidemic may serve as examples to the country authorities to better design preventive strategies in the case of future epidemics or pandemics.Ethics and disseminationThis project was approved by the Ministry for Health (N° 2020 - 00952/MS/CAB/INSP/CM) and the Ethics Committee for Health Research of Burkina Faso (N° 2020-8-140).

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