Ethical concerns in maternal and child healthcare in Malawi

Background Caring is a core function of nurses and it confers upon them ethical obligations as ethical agents. Failure to carry out such ethical obligations raises ethical concerns. This study was not intended to explore ethical concerns, but the reported findings reveal problems which have ethical implications. This paper aims to elucidate the ethical issues inherent in the findings and propose strategies to mitigate them. Research design and methods An exploratory-descriptive qualitative design was used within a larger Action Research Study. Data were collected through focus group discussions with nurse/midwives, and through exit interviews which were conducted with the women who participated in the study on their day of discharge. Six focus group discussions and thirty exit interviews were conducted, and data were analysed through thematic analysis. Participants and research context The study took place at selected maternal and child healthcare settings in Lilongwe, Malawi. The participants were nurse/midwives and women who were admitted in maternal and child healthcare settings and were purposively sampled. Ethical considerations Ethical approval was obtained from the relevant ethics committee and all ethical guidelines were followed in the conduct of the study. Findings The findings are presented under three themes which emerged from the data. The findings reveal effects of staff shortages on patient outcomes, problems experienced in low resource clinical settings and disrespectful nurse/patient communication. Conclusion The findings reveal that institutional factors constrain moral agency and patient safety is severely compromised in some of the clinical settings in Malawi which raises serious ethical concerns.

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Marginalization of Professionalism in Clinical Settings; A qualitative study at Tehran University of Medical Sciences

Quarterly Journal of Management Strategies in Health System ◽

10.18502/mshsj.v4i4.2486 ◽

2020 ◽

Author(s):

Fateme Alipour ◽

Zahra Shahvari

Keyword(s):

Focus Group ◽

Qualitative Study ◽

Faculty Members ◽

Professional Behavior ◽

Clinical Settings ◽

Medical Sciences ◽

Focus Group Discussions ◽

Group Discussions ◽

Management Level ◽

Management Issues

Background: Management-level challenges are among the factors that undermine the individuals' adherence to professional behavior in clinical settings. This study investigated glitches of the management system in clinical settings from the perspective of staff, faculty members, and medical students/residents in hospitals affiliated to Tehran University of Medical Sciences. Methods: This qualitative study was conducted in 2 parts by exploring the viewpoints of personnel and physicians. In this regard, 8 focus group discussions were performed with 85 faculty members, clinical residents, and interns. Furthermore, 15 focus group discussions were held with 165 staffs. Available sampling method was applied to collect the participants and the data were analyzed using the content analysis method. Results: A total of 22 focus-group discussions were conducted with 250 participants; Participants' age ranged from 24 to 65 years. Participants' education levels varied from diploma to postgraduate for the staff and from medical student to sub-specialist for the physicians. Finally, management-level barriers, which undermine the staffs' ability to adhere to professional behavior in clinical settings were explained with 315 codes, 12 subcategories, and 2 main categories of "macro management issues " and "hospital management issues". Conclusion: Managers are required to consider providing a proper context for enforcing the professional behavior law, selecting middle managers based on their empowerment in performing the professional behaviors, prioritizing the professional behavior in policy making, and promoting the professional behavior in an administrative system consistent with the health system. In selecting the hospital managers, authorities are recommended to consider the managers' professional behavior and power in implementing the professionalism leadership. Moreover, the possibility of conducting professional behavior should be considered in making the policies.

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Ethical challenges experienced by public health nurses related to adolescents’ use of visual technologies

Nursing Ethics ◽

10.1177/0969733018779179 ◽

2018 ◽

Vol 26 (6) ◽

pp. 1822-1833 ◽

Cited By ~ 2

Author(s):

Hilde Laholt ◽

Kim McLeod ◽

Marilys Guillemin ◽

Ellinor Beddari ◽

Geir Lorem

Keyword(s):

Public Health ◽

Focus Group ◽

Child Neglect ◽

Ethical Issues ◽

Public Health Nurses ◽

Ethical Challenges ◽

Focus Group Discussions ◽

Group Discussions ◽

Ethical Concerns ◽

Visual Technologies

Background: Visual technologies are central to youth culture and are often the preferred communication means of adolescents. Although these tools can be beneficial in fostering relations, adolescents’ use of visual technologies and social media also raises ethical concerns. Aims: We explored how school public health nurses identify and resolve the ethical challenges involved in the use of visual technologies in health dialogues with adolescents. Research design: This is a qualitative study utilizing data from focus group discussions. Participants and research context: We conducted focus group discussions using two semi-structured discussion guides with seven groups of public health nurses (n = 40) working in Norwegian school health services. The data were collected during January and October 2016. Discussions were audio recorded, transcribed, and coded into themes and subthemes using systematic text condensation. Ethical considerations: The leader of the public health nursing service who agreed to provide access for the study and the Norwegian Center for Research Data that reviewed and approved the study. All participants gave informed consent. Findings: In adolescents’ use of visual materials with public health nurses, ethical concerns were raised regarding suicide ideations, socially unacceptable content, violation of privacy, and presentations of possible child neglect. The nurses utilized their professional knowledge and experience when identifying and navigating these ethical dilemmas; they resolved ethical uncertainties through peer discussion and collaboration with fellow nurses and other professionals. Discussion: We discussed the findings in light of Annemarie Mol’s interpretation of the ethics of care. Mol expands the notion of ethical care to include the action of technologies. Conclusion: Although the increasing use of visual technologies offered benefits, school nurses faced ethical challenges in health dialogues with adolescents. To address and navigate these ethical issues, they relied on their experience and caring practices based on their professional ethics. Uncertainties were resolved through peer dialogue and guidance.

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Dari Idealisme ke Pragmatisme: Pergeseran Paradigma dalam Pengembangan Hukum Ekonomi Syariah di Indonesia

Al-Manahij Jurnal Kajian Hukum Islam ◽

10.24090/mnh.v14i2.3408 ◽

2020 ◽

Vol 14 (2) ◽

pp. 191-210

Author(s):

Addiarrahman Addiarrahman ◽

Illy Yanti

Keyword(s):

Focus Group ◽

Focus Group Discussions ◽

Group Discussions ◽

Business World ◽

Key Informants ◽

The Public ◽

Financial Products ◽

Legal Consideration ◽

Economic Law ◽

Islamic Economic

This study seeks to understand the pragmatism of the development of sharia economic law, and its implications for Islamic financial products in Indonesia. The data comes from the results of interviews and focus group discussions with key informants from academics, practitioners, authorities, and the public. This research finds that pragmatism in the development of Islamic economic law is an approach that still dominates the DSN-MUI fatwas. The pragmatism style used is complex-eclectic pragmatism which is represented through makhārij al-fiqhiyyah, which is to choose a mild opinion by sticking to the strongest method or also called "taysīr al-manhajī". The use of this method is intended to ensure that the fatwa is truly able to answer the needs of the business world, as well as being in line with sharia principles. DSN-MUI also does not use maslahah as a legal consideration in a free or liberal way. Rather, it returns maslahah in consideration of the method, so that it is permissible to use the bay’ al-'inān contract only in a forced state (ḍarurah).

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“Stages of change, smoking behavior and acceptability of a textmessaging intervention for tobacco cessation among cigarette, dokha and shishasmokers: A qualitative research study.”

BMJ Open ◽

10.1136/bmjopen-2019-029144 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029144 ◽

Cited By ~ 2

Author(s):

Yusra Elhidaia Elobaid ◽

Andrea Leinberger Jabari ◽

Aisha Al Hamiz ◽

Abdul Rizzak Al Kaddour ◽

Sherif Bakir ◽

...

Keyword(s):

Qualitative Research ◽

Smoking Cessation ◽

Focus Group ◽

United Arab Emirates ◽

Text Messaging ◽

Tobacco Cessation ◽

Text Messages ◽

Controlled Study ◽

Focus Group Discussions ◽

Group Discussions

ObjectivesTo explore: (A) the underlying motivators and barriers to smoking cessation among young Arabic speaking smokers and (B) to examine the suitability and preferences for tobacco cessation interventions (specifically text messages) and study the possibility of enrollment methods for a randomised controlled study using text messages as an intervention for tobacco cessation.DesignQualitative research using focus group discussions and content analysis.Setting(s)Two universities, one of them is the first and foremost comprehensive national university in the United Arab Emirates (UAE). The third setting is the largest hospital in the UAE and the flagship institution for the public health system in the emirate of Abu Dhabi.ParticipantsSix focus group discussions with a total of 57 participants. Forty-seven men and 10 women. Fifty-three of them were current smokers.ResultsThe analysis of six focus groups was carried out. Main themes arose from the data included: preferences for tobacco cessation interventions and acceptability and feasibility of text messaging as tobacco cessation intervention. Different motives and barriers for quitting smoking including shisha and dokha were explored.ConclusionInterventions using text messaging for smoking cessation have not been used in the Middle East and they could potentially be effective; however, tailoring and closely examining the content and acceptability of text messages to be used is important before the conduction of trials involving their use. Social media is perceived to be more effective and influential, with a higher level of penetration into communities of young smokers.

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Perspectives of future pharmacists on the potential for development and implementation of pharmacist prescribing in Qatar

International Journal of Clinical Pharmacy ◽

10.1007/s11096-019-00946-9 ◽

2020 ◽

Vol 42 (1) ◽

pp. 110-123

Author(s):

Mohammad Issam Diab ◽

Angham Ibrahim ◽

Oraib Abdallah ◽

Alla El-Awaisi ◽

Monica Zolezzi ◽

...

Keyword(s):

Focus Group ◽

Treatment Options ◽

Developed Countries ◽

Focus Group Discussions ◽

Cross Sectional Survey ◽

Group Discussions ◽

Cross Sectional ◽

Pharmacist Prescribing ◽

Barriers To Implementation ◽

Special Training Program

AbstractBackground Pharmacists in many developed countries have been granted prescribing authorities under what is known as “non-medical prescribing” or “pharmacist prescribing”. However, such prescribing privileges are not available in many developing countries. Objective The objective of this study was to determine the perspectives of future pharmacists (recent pharmacy graduates and pharmacy students) on pharmacist prescribing and its potential implementation in Qatar. Methods A convergent parallel mixed-methods design was used: (1) a cross-sectional survey using a pre-tested questionnaire and; (2) focus group discussions to allow for an in-depth understanding of the issue, with a focus on pharmacists prescribing competencies as well as barriers for its implementation. Main outcome measures Future pharmacists’ perspectives and attitudes towards pharmacist prescribing in Qatar. Results The majority of the respondents (94.4%) indicated awareness of the prescribing competency related to selecting treatment options. Furthermore, the majority (92.4%) believed that pharmacists should undergo prescribing training and accreditation before been legally allowed to prescribe, a point that was reiterated in the focus group discussions. Participants generally expressed support for collaborative and supplementary prescribing models when developing prescribing frameworks for Qatar. Four categories emerged under the theme barriers to implementation of pharmacist prescribing: lack of prescribing competency, pharmacist mindset, lack of accessibility to patient records and counseling rooms, and diversity of education and training background. Conclusion The majority of recent pharmacy graduates and students were in favor of pharmacist prescribing been implemented in Qatar. However, a special training program was deemed necessary to qualify pharmacists to prescribe safely and effectively.

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Nairobi Early Childcare in Slums (NECS) Study Protocol: a mixed-methods exploration of paid early childcare in Mukuru slum, Nairobi

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000822 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000822

Author(s):

Robert C Hughes ◽

Patricia Kitsao-Wekulo ◽

Sunil Bhopal ◽

Elizabeth W Kimani-Murage ◽

Zelee Hill ◽

...

Keyword(s):

Mixed Methods ◽

Focus Group ◽

Early Years ◽

Epidemiological Methods ◽

Focus Group Discussions ◽

Group Discussions ◽

Early Childcare ◽

Depth Interviews ◽

Childcare Providers

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.

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The usability of Jordan stillbirths and neonatal deaths surveillance (JSANDS) system: results of focus group discussions

Archives of Public Health ◽

10.1186/s13690-021-00551-1 ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Yousef S. Khader ◽

Khulood K. Shattnawi ◽

Nihaya Al-Sheyab ◽

Mohammad Alyahya ◽

Anwar Batieha

Keyword(s):

Focus Group ◽

System Performance ◽

Surveillance System ◽

Healthcare Professionals ◽

Qualitative Approach ◽

Focal Points ◽

Focus Group Discussions ◽

Group Discussions ◽

Neonatal Deaths ◽

Technical Issues

Abstract Background Jordan Stillbirths and Neonatal Deaths Surveillance system (JSANDS) is a newly developed system and is currently implemented in five large hospitals in Jordan. This study aimed at exploring the healthcare professionals’ perception about the usability of JSANDS. Methods A descriptive qualitative approach, using focus group discussions, was adopted. A total of 5 focus groups including 23 focal points were conducted in five participating hospitals in Jordan. Results Data analysis identified nine main issues related to the JSANDS system: the system usefulness, the system performance, data quality, the system limitations, human rights, female empowerment, nurses’ competencies strengthened, the sustainability of the JSANDS, and COVID-19 impact on the system. Users reported that JSANDS data were useful, the system was simple and easy to use, and the data were accurate and complete. However, some users reported that some technical issues need to be enhanced. Conclusions JSANDS was perceived positively by the current users. According to them, it provides a formative and comprehensive data on stillbirths and neonatal deaths and their causes, and therefore, was recommended to be adopted by its users and scaled up.

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A comparative assessment of two tools designed to support patient safety culture in UK general practice

BMC Family Practice ◽

10.1186/s12875-021-01438-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ian Litchfield ◽

Kate Marsden ◽

Lucy Doos ◽

Katherine Perryman ◽

Anthony Avery ◽

...

Keyword(s):

General Practice ◽

Patient Safety ◽

Focus Group ◽

Safety Culture ◽

Improve Patient Safety ◽

Patient Safety Culture ◽

Focus Group Discussions ◽

Group Discussions ◽

Staff Members ◽

Practice Team

Abstract Background The NHS has recognised the importance of a high quality patient safety culture in the delivery of primary health care in the rapidly evolving environment of general practice. Two tools, PC-SafeQuest and MapSaf, were developed with the intention of assessing and improving patient safety culture in this setting. Both have been made widely available through their inclusion in the Royal College of General Practitioners’ Patient Safety Toolkit and our work offerss a timely exploration of the tools to inform practice staff as to how each might be usefully applied and in which circumstances. Here we present a comparative analysis of their content, and describe the perspectives of staff on their design, outputs and the feasibility of their sustained use. Methods We have used a content analysis to provide the context for the qualitative study of staff experiences of using the tools at a representative range of practices recruited from across the Midlands (UK). Data was collected through moderated focus groups using an identical topic guide. Results A total of nine practices used the PC-SafeQuest tool and four the MapSaf tool. A total of 159 staff completed the PC-SafeQuest tool 52 of whom took part in the subsequent focus group discussions, and 25 staff completed the MapSaf tool all of whom contributed to the focus group discussions. PC-SafeQuest was perceived as quick and easy to use with direct questions pertinent to the work of GP practices providing useful quantitative insight into important areas of safety culture. Though MaPSaF was more logistically challenging, it created a forum for synchronous cross- practice discussions raising awareness of perceptions of safety culture across the practice team. Conclusions Both tools were able to promote reflective and reflexive practice either in individual staff members or across the broader practice team and the oversight they granted provided useful direction for senior staff looking to improve patient safety. Because PC SafeQuest can be easily disseminated and independently completed it is logistically suited to larger practice organisations, whereas the MapSaf tool lends itself to smaller practices where assembling staff in a single workshop is more readily achieved.

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Sexual and reproductive health of Syrian refugee adolescent girls: a qualitative study using focus group discussions in an urban setting in Lebanon

Reproductive Health ◽

10.1186/s12978-021-01178-9 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Rayan Korri ◽

Sabine Hess ◽

Guenter Froeschl ◽

Olena Ivanova

Keyword(s):

Focus Group ◽

Reproductive Health ◽

Sexual Harassment ◽

Qualitative Study ◽

Adolescent Girls ◽

Sexual And Reproductive Health ◽

Urban Setting ◽

Focus Group Discussions ◽

Group Discussions ◽

To Receive

Abstract Background The war in Syria caused the forced displacement of millions of Syrians to neighboring countries. Lebanon is the host country with the largest overall number of Syrian refugees per capita. Adolescent refugee girls experience a unique level of vulnerability during human emergencies and are at increased risk of suffering from poor sexual and reproductive health (SRH) outcomes. We conducted an exploratory qualitative study to learn about the SRH perceptions and experiences of refugee adolescent girls living in Bourj Hammoud, an urban setting in Lebanon. Methods We employed a qualitative design with eight focus group discussions (FGDs) conducted with 40 Syrian Arab and Syrian Kurdish adolescent girls between January and March 2020. Every FGD consisted of five participants aged 13 to 17 years. A semi-structured guide was used covering multiple themes: menstruation, puberty, SRH awareness, and sexual harassment. FGDs were transcribed and analyzed using thematic analysis. Findings The participants discussed adolescent girls’ health and named six elements of good health, such as healthy activities and self-protection. The majority of the FGD participants reported a lack of awareness about menstruation when they experienced it for the first time and the social stigma associated with menstruation. When defining puberty, they indicated its social link to a girl’s readiness for marriage and her need to become cautious about sexual harassment. Most FGD participants had very poor knowledge of the female reproductive system. Mothers were the most approached persons to receive information on SRH issues; however, the girls indicated a wish to receive advice from specialists in a comfortable and private atmosphere. All the girls reported that either they themselves, or an acquaintance, had experienced some type of sexual harassment. The girls rarely reported those incidents due to fear of being blamed or subjected to mobility restrictions, or forced to drop out of school. Conclusions The findings show the refugee girls need for satisfactory knowledge on SRH issues and interventions to prevent sexual and gender-based violence that take into consideration the complexity of urban settings.

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Drivers and barriers to workplace-based HIV self-testing among high-risk men in Uganda: a qualitative study

BMC Public Health ◽

10.1186/s12889-021-11041-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Patience A. Muwanguzi ◽

Robert C. Bollinger ◽

Stuart C. Ray ◽

LaRon E. Nelson ◽

Noah Kiwanuka ◽

...

Keyword(s):

Focus Group ◽

Hiv Testing ◽

Private Security ◽

Focus Group Discussions ◽

Group Discussions ◽

Private Security Companies ◽

Self Testing ◽

Key Informant ◽

Hiv Testing Services ◽

Security Companies

Abstract Background Men in Sub-Saharan Africa are less engaged than women in accessing HIV testing and treatment and, consequently, experience higher HIV-related mortality. Reaching men with HIV testing services is challenging, thus, increasing the need for innovative ways to engage men with low access and those at higher risk. In this study, we explore men’s perceptions of drivers and barriers of workplace-based HIV self-testing in Uganda. Methods An exploratory study involving men working in private security companies employing more than 50 men in two districts, in central and western Uganda. Focus group discussions and key informant interviews were conducted. Data were analyzed using inductive content analysis. Results Forty-eight (48) men from eight private security companies participated in 5 focus group discussions and 17 key informant interviews. Of the 48 men, 14(29.2%) were ages 26–35 years. The majority 31(64.6%) were security guards. The drivers reported for workplace-based HIV self-testing included convenience, autonomy, positive influence from work colleagues, the need for alternative access for HIV testing services, incentives, and involvement of employers. The barriers reported were the prohibitive cost of HIV tests, stigma, lack of testing support, the fear of discrimination and isolation, and concerns around decreased work productivity in the event of a reactive self-test. Conclusions We recommend the involvement of employers in workplace-based HIV self-testing to encourage participation by employees. There is need for HIV self-testing support both during and after the testing process. Both employers and employees recommend the use of non-monetary incentives, and regular training about HIV self-testing to increase the uptake and acceptability of HIV testing services at the workplace.

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