Informing the scale-up of Kenya’s nursing workforce: a mixed methods study of factors affecting pre-service training capacity and production

Abstract Background The expanding roles and increasing importance of the nursing workforce in health services delivery in resource-limited settings is not adequately documented and sufficiently recognized in the current literature. Drawing upon the theme of 2020 as the international year of the nurse and midwife, we set out to describe how the role of nurses had expanded tremendously in health facilities in Uganda during the era of anti-retroviral therapy (ART) scale-up between 2004 and 2014.Methods A mixed-methods study was conducted in two phases. Phase One entailed a cross-sectional health facility survey (n=195) to assess the extent to which human resource management strategies (such as task shifting) were common. Phase Two entailed qualitative case-studies of 16 (of the 195) health facilities for an in-depth understanding of the strategies adopted (e.g. nurse-centred HIV care). We adopted a qualitatively-led mixed methods approach whereby core thematic analyses were supported by descriptive statistics.Results We found that nurses were the most represented cadre of health workers involved in the overall leadership of HIV clinics across Uganda. Most of nurse-led HIV clinics were based in rural settings although this trend was fairly even across all settings (rural/urban/peri-urban). A number of health facilities in our sample (n=36) deliberately adopted nurse-led HIV care models. Nurses were empowered to be multi-skilled with a wide range of competencies across the HIV care continuum right from HIV testing to mainstream clinical HIV disease management. In several facilities, nursing cadre were the backbone of ART service delivery. A select number of facilities devised differentiated models of task shifting from physicians to doctors to nurses in which the latter handled patients who were stable on ART.Conclusion Overall, our study reveals a wide expansion in the scope-of-practice of nurses during the initial ART scale-up phase in Uganda. Nurses were thrust in roles of HIV disease management that were traditionally the preserve of medical doctors. Our study underscores the importance of reforming regulatory frameworks governing nursing workforce scope of practice in Uganda such as the need for evolving a policy on task shifting which is currently lacking in Uganda.

Download Full-text

Scale-up and Sustainability of a Personalized End-of-Life Care Intervention: A Longitudinal Mixed-Methods Study

10.21203/rs.3.rs-91142/v1 ◽

2020 ◽

Author(s):

Alyson Takaoka ◽

Benjamin Tam ◽

Meredith Vanstone ◽

France J. Clarke ◽

Neala Hoad ◽

...

Keyword(s):

Mixed Methods ◽

End Of Life ◽

Life Support ◽

Scale Up ◽

Fold Increase ◽

Mixed Methods Study ◽

Secondary Outcome ◽

Patient Death ◽

Dying Patients ◽

Clinical Program

Abstract Background: Scaling-up and sustaining healthcare interventions can be challenging. Our objective was to describe how the 3 Wishes Project (3WP), a personalized end-of-life intervention, was scaled-up and sustained in an intensive care unit (ICU).Methods: In a longitudinal mixed-methods study from January 1,2013 - December 31, 2018, dying patients and families were invited to participate if the probability of patient death was >95% or after a decision to withdraw life support. A research team member or bedside clinician learned more about each of the patients and their family, then elicited and implemented <3 personalized wishes for patients and/or family members. We used a qualitative descriptive approach to analyze interviews and focus groups conducted with 25 clinicians who cared for patients enrolled in the project. We used descriptive statistics to summarize patient, wish, and clinician characteristics, and analyzed outcome data in quarters using Statistical Process Control charts. The primary outcome was enrollment of terminally ill patients and respective families; the secondary outcome was the number of wishes per patient; tertiary outcomes included wish features and stakeholder involvement. Results: Both qualitative and quantitative analyses suggested a three-phase approach to the scale-up of this intervention during which 369 dying patients were enrolled, having 2039 terminal wishes implemented. From a research project to clinical program to an approach to practice, we documented a three-fold increase in enrolment with a five-fold increase in total wishes implemented, without a change in cost. Beginning as a study, the protocol provided structure; starting gradually enabled frontline staff to experience and recognize the value of acts of compassion for patients, families, and clinicians. The transition to a clinical program was marked by handover from the research staff to bedside staff, whereby project catalysts mentored project champions to create staff partnerships, and family engagement became more intentional. The final transition involved empowering staff to integrate the program as an approach to care, expanding it within and beyond the organization. Conclusions: The 3WP is an end-of-life intervention which was implemented as a study, scaled-up into a clinical program, and sustained by becoming integrated into practice as an approach to care.

Download Full-text

Factors Affecting Definitions of and Approaches to Integrative Medicine: A Mixed Methods Study Examining China’s Integrative Medicine Development

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2015/458765 ◽

2015 ◽

Vol 2015 ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Weijun Zhang ◽

Sonya E. Pritzker ◽

Ka-Kit Hui

Keyword(s):

Mixed Methods ◽

Integrative Medicine ◽

Mixed Methods Study ◽

Working Environment ◽

Snowball Sampling ◽

Key Factors ◽

Factors Affecting ◽

Education Practice ◽

Key Characteristics ◽

Semistructured Interviews

Aim. This study identifies existing definitions and approaches among China’s integrative medicine (IM) experts and examines relationships with key characteristics distinguishing individual experts.Methods. Snowball sampling was used to select 73 IM experts for semistructured interviews. In this mixed methods study, we first identified definitions and approaches through analyzing core statements. Four key factors, including age, education, practice type, and working environment, were then chosen to evaluate the associations with the definitions.Results. Four unique definitions were identified, including IM as a “new medicine” (D1), as a combination of western medicine (WM) and Chinese medicine (CM) (D2), as a modernization of CM (D3), and as a westernization of CM (D4). D4 was mostly supported by those working in WM organizations, while D3 was more prominent from individuals working in CM organizations (P=0.00004). More than 64% clinicians had D2 while only 1 (5.9%) nonclinician had D2. Only 1 clinician (1.8%) had D4 while almost 30% nonclinicians had D4 (P=0.0001). Among nonclinicians working in WM organizations, 83.3% of them had D4 (P=0.001).Conclusion. Findings indicate that institutional structure and practice type are factors affecting IM approaches. These results carry implications for the ways in which western countries move forward with the definition and implementation of IM.

Download Full-text

Factors affecting hepatitis C treatment intentions among Aboriginal people in Western Australia: a mixed-methods study

Australian Health Review ◽

10.1071/ah19194 ◽

2020 ◽

Vol 44 (5) ◽

pp. 755

Author(s):

Amineh Rashidi ◽

Peter Higgs ◽

Susan Carruthers

Keyword(s):

Mixed Methods ◽

Hepatitis C ◽

Aboriginal People ◽

Mixed Methods Study ◽

Hcv Treatment ◽

Aboriginal Australians ◽

Hepatitis C Treatment ◽

Factors Affecting ◽

Unstable Housing ◽

Stable Housing

ObjectiveThe aim of this study was to identify the hepatitis C treatment intentions of Aboriginal people living with hepatitis C virus (HCV) in Western Australia. MethodsThis study used a mixed-methods design. In the cross-sectional survey, 123 Aboriginal people who inject drugs and self-report as living with hepatitis C completed a purpose-designed questionnaire. In the qualitative phase, 10 participants were interviewed about the factors influencing their future intentions to undertake hepatitis C treatment. ResultsAnalysis of the survey data revealed significant associations between an intention to undertake hepatitis C treatment and support, community attachment, stable housing and stigma. In addition, there was a high overall level of expressed intention to undertake HCV treatment, with 54% of participants responding positively. Analysis of the qualitative data supported quantitative findings, revealing concerns about stigma, lack of social support and unstable housing as factors affecting the intention to undertake hepatitis C treatment. ConclusionThis mixed methods study with Aboriginal people living with self-reported HCV indicates interventions focused on reducing stigma and unstable housing could positively affect hepatitis C treatment intentions. These findings have implications for developing holistic programs to promote and support people on hepatitis C treatment. What is known about the topic?Substantial knowledge gaps need to be resolved if HCV elimination among Aboriginal Australians is to be achieved. Current research has prioritised non-Aboriginal communities. What does this paper add?This study found that stigma and unstable housing require attention if Aboriginal Australians are to obtain the full benefits of direct acting antiviral (DAA) hepatitis C treatment. What are the implications for practitioners?Reducing stigma (in the primary healthcare setting) and providing access to stable housing are vital components of supportive, non-judgemental and culturally appropriate care for Aboriginal people. This study highlights the importance of education for nurses and other primary care providers to increase engagement in the hepatitis cascade of care. To achieve this, scaling-up of HCV treatment engagement, trained Aboriginal community healthcare workers and HCV treatment advocates must mobilise and support Aboriginal people to avoid the negative effects of stigma, build positive and enabling relationships and reinforce positive attitudes towards DAA hepatitis C treatment.

Download Full-text

A model for scale up of family health innovations in low-income and middle-income settings: a mixed methods study

BMJ Open ◽

10.1136/bmjopen-2012-000987 ◽

2012 ◽

Vol 2 (4) ◽

pp. e000987 ◽

Cited By ~ 47

Author(s):

Elizabeth H Bradley ◽

Leslie A Curry ◽

Lauren A Taylor ◽

Sarah Wood Pallas ◽

Kristina Talbert-Slagle ◽

...

Keyword(s):

Mixed Methods ◽

Low Income ◽

Scale Up ◽

Family Health ◽

Mixed Methods Study ◽

Middle Income ◽

Health Innovations

Download Full-text

Community Dialogue Approach for addressing the drivers of antibiotic resistance in Bangladesh: a mixed methods study on developing a sustainable and scalable approach to community engagement

10.21203/rs.3.rs-15638/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Rebecca King ◽

Joseph Hicks ◽

Christian Rassi ◽

Muhammad Shafique ◽

Deepa Barua ◽

...

Keyword(s):

Antibiotic Resistance ◽

Mixed Methods ◽

Health System ◽

Community Engagement ◽

Cultural Context ◽

Scale Up ◽

International Standards ◽

Mixed Methods Study ◽

Small Scale ◽

Engagement Interventions

Abstract Background Community engagement approaches that have impacted on health outcomes are often time intensive, small-scale and require high levels of financial and human resources. They can be difficult to sustain and scale-up in low resource settings. Given the reach of health services into communities in low income countries, the health system provides a valuable and potentially sustainable entry point that would allow for scale-up of community engagement interventions. This study explores the process of developing an embedded approach to community engagement taking the global challenge of antibiotic resistance as an example. Methods The intervention was developed using a sequential mixed methods study design. This consisted of: exploring the evidence base through an umbrella review, and identifying key international standards on the appropriate use of antibiotics; undertaking detailed exploratory research through a) a qualitative study to explore the most appropriate mechanisms through which to embed the intervention within the existing health system and community infrastructure, and to understand patterns of knowledge, attitudes and practice regarding antibiotics and antibiotic resistance; and b) a household survey – which drew on the qualitative findings - to quantify knowledge, and reported attitudes and practice regarding antibiotics and antibiotic resistance within the target population; and c) drawing on appropriate theories regarding change mechanisms and experience of implementing community engagement interventions to co-produce the intervention processes and materials with key stakeholders at policy, health system and community level. Results A community engagement intervention was co-produced and was explicitly designed to link into existing health system and community structures and be appropriate for the cultural context, and therefore have the potential to be implemented at scale. We anticipate that taking this approach increases local ownership, as well as the likelihood that the intervention will be sustainable and scalable. Conclusions This study demonstrates the value of ensuring that a range of stakeholders co-produce the intervention, and ensuring that the intervention is designed to be appropriate for the health system, community and cultural context.

Download Full-text

Trends and factors affecting the US adult hematology workforce: a mixed methods study

Blood Advances ◽

10.1182/bloodadvances.2019000307 ◽

2019 ◽

Vol 3 (22) ◽

pp. 3550-3561 ◽

Cited By ~ 1

Author(s):

Deva Sharma ◽

Natalie Wallace ◽

Erik A. Levinsohn ◽

Ariela L. Marshall ◽

Karen Kayoumi ◽

...

Keyword(s):

Mixed Methods ◽

Focus Groups ◽

Program Directors ◽

The State ◽

Mixed Methods Study ◽

Fellowship Program ◽

Factors Affecting ◽

Key Points ◽

The Us

Key Points A mixed methods study of surveys, interviews, and focus groups raises concerns about the state of the adult hematology workforce. Hematology/oncology fellowship program directors, fellows, and practicing clinicians offer different strategies to address these problems.

Download Full-text

Factors Affecting the Uptake of HIV Testing among Men: A Mixed-Methods Study in Rural Burkina Faso

PLoS ONE ◽

10.1371/journal.pone.0130216 ◽

2015 ◽

Vol 10 (7) ◽

pp. e0130216 ◽

Cited By ~ 14

Author(s):

Manuela De Allegri ◽

Isabelle Agier ◽

Justin Tiendrebeogo ◽

Valerie Renée Louis ◽

Maurice Yé ◽

...

Keyword(s):

Mixed Methods ◽

Burkina Faso ◽

Hiv Testing ◽

Mixed Methods Study ◽

Factors Affecting

Download Full-text

Voices of home-based palliative care community health workers in rural Malawi: A mixed methods study on factors affecting role and sustainability

Progress in Palliative Care ◽

10.1080/09699260.2020.1760533 ◽

2020 ◽

Vol 28 (6) ◽

pp. 346-353

Author(s):

Grace H. Wang ◽

Casey Nesbit ◽

Sally Rankin

Keyword(s):

Palliative Care ◽

Mixed Methods ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Mixed Methods Study ◽

Factors Affecting ◽

Care Community ◽

Home Based

Download Full-text

Countermeasures against COVID-19: how to navigate medical practice through a nascent, evolving evidence base — a European multicentre mixed methods study

BMJ Open ◽

10.1136/bmjopen-2020-043015 ◽

2021 ◽

Vol 11 (2) ◽

pp. e043015 ◽

Cited By ~ 1

Author(s):

Fabian Eibensteiner ◽

Valentin Ritschl ◽

Tanja Stamm ◽

Asil Cetin ◽

Claus Peter Schmitt ◽

...

Keyword(s):

Mixed Methods ◽

Expert Opinion ◽

Tertiary Care ◽

Rapid Change ◽

Evidence Base ◽

Routine Care ◽

Resource Dependency ◽

Mixed Methods Study ◽

European Countries ◽

Factors Affecting

ObjectivesIn a previously published Delphi exercise the European Pediatric Dialysis Working Group (EPDWG) reported widely variable counteractive responses to COVID-19 during the first week of statutory public curfews in 12 European countries with case loads of 4–680 infected patients per million. To better understand these wide variations, we assessed different factors affecting countermeasure implementation rates and applied the capability, opportunity, motivation model of behaviour to describe their determinants.DesignWe undertook this international mixed methods study of increased depth and breadth to obtain more complete data and to better understand the resulting complex evidence.SettingThis study was conducted in 14 paediatric nephrology centres across 12 European countries during the COVID-19 pandemic.ParticipantsThe 14 participants were paediatric nephrologists and EPDWG members from 12 European centres.Main outcome measures52 countermeasures clustered into eight response domains (access control, patient testing, personnel testing, personal protective equipment policy, patient cohorting, personnel cohorting, suspension of routine care, remote work) were categorised by implementation status, drivers (expert opinion, hospital regulations) and resource dependency. Governmental strictness and media attitude were independently assessed for each country and correlated with relevant countermeasure implementation factors.ResultsImplementation rates varied widely among response domains (median 49.5%, range 20%–71%) and centres (median 46%, range 31%–62%). Case loads were insufficient to explain response rate variability. Increasing case loads resulted in shifts from expert opinion-based to hospital regulation-based decisions to implement additional countermeasures despite increased resource dependency. Higher governmental strictness and positive media attitude towards countermeasure implementation were associated with higher implementation rates.ConclusionsCOVID-19 countermeasure implementation by paediatric tertiary care centres did not reflect case loads but rather reflected heterogeneity of local rules and of perceived resources. These data highlight the need of ongoing reassessment of current practices, facilitating rapid change in ‘institutional behavior’ in response to emerging evidence of countermeasure efficacy.

Download Full-text