scholarly journals Barriers inhibiting effective detection and management of postpartum hemorrhage during facility-based births in Madagascar: findings from a qualitative study using a behavioral science lens

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara V. Flanagan ◽  
Tina Razafinamanana ◽  
Charlotte Warren ◽  
Jana Smith
Keyword(s):  
Decision Making ◽  
Best Practices ◽  
Low Income ◽  
Postpartum Hemorrhage ◽  
Clinical Decision Making ◽  
Behavioral Science ◽  
Low Risk ◽  
Low Income Countries ◽  
Care Providers ◽  
Clinical Practices

Abstract Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries, and is the most common direct cause of maternal deaths in Madagascar. Studies in Madagascar and other low-income countries observe low provider adherence to recommended practices for PPH prevention and treatment. Our study addresses gaps in the literature by applying a behavioral science lens to identify barriers inhibiting facility-based providers’ consistent following of PPH best practices in Madagascar. Methods In June 2019, we undertook a cross-sectional qualitative research study in peri-urban and rural areas of the Vatovavy-Fitovinany region of Madagascar. We conducted 47 in-depth interviews in 19 facilities and five communities, with facility-based healthcare providers, postpartum women, medical supervisors, community health volunteers, and traditional birth attendants, and conducted thematic analysis of the transcripts. Results We identified seven key behavioral insights representing a range of factors that may contribute to delays in appropriate PPH management in these settings. Findings suggest providers’ perceived low risk of PPH may influence their compliance with best practices, subconsciously or explicitly, and lead them to undervalue the importance of PPH prevention and monitoring measures. Providers lack clear feedback on specific components of their performance, which ultimately inhibits continuous improvement of compliance with best practices. Providers demonstrate great resourcefulness while operating in a challenging context with limited equipment, supplies, and support; however, overcoming these challenges remains their foremost concern. This response to chronic scarcity is cognitively taxing and may ultimately affect clinical decision-making. Conclusions Our study reveals how perception of low risk of PPH, limited feedback on compliance with best practices and consequences of current practices, and a context of scarcity may negatively affect provider decision-making and clinical practices. Behaviorally informed interventions, designed for specific contexts that care providers operate in, can help improve quality of care and health outcomes for women in labor and childbirth.

Developing Training Tools for Clinicians in LICs: Using Hidden Markov Modeling to Study the Decision-Making Strategies of Expert and Novice Prosthetists

2020 ◽  
Author(s):  
Pratima Saravanan ◽  
Michael Walker ◽  
Jessica Menold
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Low Income ◽  
Decision Support Tool ◽  
Low Income Countries ◽  
Controlled Study ◽  
Clear Understanding ◽  
Care Providers ◽  
Support Tool ◽  
Expert And Novice

Abstract Approximately, 40 million amputees reside in the rural parts of Low-Income Countries (LICs), and 95% of this population do not have proper access to prosthetic devices and rehabilitation services. A proper prosthetic prescription requires a clear understanding of the patient’s ambulation, goals, cultural and societal norms, locally available prosthetic materials, etc., which can be accomplished only by a local prosthetist. However, due to the lack of prosthetic schools and training centers in LICs, the rural parts lack well-trained amputee care providers. Hence there is a need to educate the prosthetists and prosthetic technicians in the LIC, specifically in the rural regions. To accomplish this, the current research proposes a decision-support tool to aid decision-making during prescription and educate prosthetists. A controlled study was conducted with expert and novice prosthetists to compare effective decision-making strategies. Results suggest that experts leverage distinct decision-making strategies when prescribing prosthetic and orthotic devices; in comparison, novices exhibited less consistent patterns of decision-making tendencies. By modeling the decision-making strategies of expert prosthetists, this work lays the foundation to develop an automated decision support tool to support decision-making for prosthetists in LICs, improving overall amputee care.

Clinical Practices in Head and Neck Cancer: A Speech-Language Pathologist Practice Pattern Survey

2021 ◽  
pp. 000348942110010
Author(s):  
Ashley M. Logan ◽  
Mario A. Landera
Keyword(s):  
Decision Making ◽  
Head And Neck Cancer ◽  
Best Practices ◽  
Head And Neck ◽  
Neck Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Years Of Experience ◽  
Group Consensus ◽  
Clinical Practices

Objective: Clinical practices of speech-language pathologists (SLP) treating head and neck cancer (HNC) patients range widely despite literature trending toward best practices. This survey study was designed to identify current patterns and assess for gaps in clinical implementation of research evidence. Method: A web-based survey was distributed to SLPs via listserv and social media outlets. Descriptive statistics and group calculations were completed to identify trends and associations in responses. Results: Of 152 received surveys, the majority of respondents were hospital-based (86%) and had greater than 5 years of experience (65%). There was group consensus for the use of prophylactic exercise programs (95%), recommendations for SLP intervention during HNC treatment (75%), and use of maintenance programs post-treatment (97%). Conversely, no group consensus was observed for use of pre-treatment swallow evaluations, frequency of service provision, and content of therapy sessions. Variation in clinical decision making was noted in use of prophylactic feeding tubes and number of patients taking nothing by mouth during treatment. No associations were found between years of experience and decision-making practices, nor were any associations found between practice setting and clinical decision making. Conclusion: Despite the growing body of literature outlining evidence-based treatment practices for HNC patients, clinical practice patterns among SLPs continue to vary widely resulting in inconsistent patient care across practice settings. As compared to prior similar data, increased alignment with best practices was observed relative to early referrals, implementation of prophylactic intervention programs, and intervention with the SLP during the period of HNC treatment.

Perceived Effectiveness of Artificial Intelligence based Decision Support System in a Clinical Setting: A Systematic Literature Review (Preprint)

2020 ◽  
Author(s):  
Avishek Choudhury
Keyword(s):  
Artificial Intelligence ◽  
Decision Making ◽  
Decision Support ◽  
Literature Review ◽  
Decision Support System ◽  
Support System ◽  
Clinical Setting ◽  
Clinical Decision Making ◽  
Theoretical Perspective ◽  
Care Providers

UNSTRUCTURED Objective: The potential benefits of artificial intelligence based decision support system (AI-DSS) from a theoretical perspective are well documented and perceived by researchers but there is a lack of evidence showing its influence on routine clinical practice and how its perceived by care providers. Since the effectiveness of AI systems depends on data quality, implementation, and interpretation. The purpose of this literature review is to analyze the effectiveness of AI-DSS in clinical setting and understand its influence on clinician’s decision making outcome. Materials and Methods: This review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta- Analyses reporting guidelines. Literature will be identified using a multi-database search strategy developed in consultation with a librarian. The proposed screening process consists of a title and abstract scan, followed by a full-text review by two reviewers to determine the eligibility of articles. Studies outlining application of AI based decision support system in a clinical setting and its impact on clinician’s decision making, will be included. A tabular synthesis of the general study details will be provided, as well as a narrative synthesis of the extracted data, organised into themes. Studies solely reporting AI accuracy an but not implemented in a clinical setting to measure its influence on clinical decision making were excluded from further review. Results: We identified 8 eligible studies that implemented AI-DSS in a clinical setting to facilitate decisions concerning prostate cancer, post traumatic stress disorder, cardiac ailment, back pain, and others. Five (62.50%) out of 8 studies reported positive outcome of AI-DSS. Conclusion: The systematic review indicated that AI-enabled decision support systems, when implemented in a clinical setting and used by clinicians might not ensure enhanced decision making. However, there are very limited studies to confirm the claim that AI based decision support system can uplift clinicians decision making abilities.

scholarly journals The development of the WHO Labour Care Guide: an international survey of maternity care providers

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Veronica Pingray ◽  
Mercedes Bonet ◽  
Mabel Berrueta ◽  
Agustina Mazzoni ◽  
María Belizán ◽  
...  
Keyword(s):  
Decision Making ◽  
Maternity Care ◽  
Health Personnel ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Research Network ◽  
Respectful Maternity Care ◽  
Care Providers ◽  
Skilled Health Personnel ◽  
Skilled Health

Abstract Background The partograph is the most commonly used labour monitoring tool in the world. However, it has been used incorrectly or inconsistently in many settings. In 2018, a WHO expert group reviewed and revised the design of the partograph in light of emerging evidence, and they developed the first version of the Labour Care Guide (LCG). The objective of this study was to explore opinions of skilled health personnel on the first version of the WHO Labour Care Guide. Methods Skilled health personnel (including obstetricians, midwives and general practitioners) of any gender from Africa, Asia, Europe and Latin America were identified through a large global research network. Country coordinators from the network invited 5 to 10 mid-level and senior skilled health personnel who had worked in labour wards anytime in the last 5 years. A self-administered, anonymous, structured, online questionnaire including closed and open-ended questions was designed to assess the clarity, relevance, appropriateness of the frequency of recording, and the completeness of the sections and variables on the LCG. Results A total of 110 participants from 23 countries completed the survey between December 2018 and January 2019. Variables included in the LCG were generally considered clear, relevant and to have been recorded at the appropriate frequency. Most sections of the LCG were considered complete. Participants agreed or strongly agreed with the overall design, structure of the LCG, and the usefulness of reference thresholds to trigger further assessment and actions. They also agreed that LCG could potentially have a positive impact on clinical decision-making and respectful maternity care. Participants disagreed with the value of some variables, including coping, urine, and neonatal status. Conclusions Future end-users of WHO Labour Care Guide considered the variables to be clear, relevant and appropriate, and, with minor improvements, to have the potential to positively impact clinical decision-making and respectful maternity care.

scholarly journals Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide

2020 ◽  
Vol 16 (1) ◽  
pp. 79-87
Author(s):  
Meaghan Lunney ◽  
Aminu K. Bello ◽  
Adeera Levin ◽  
Helen Tam-Tham ◽  
Chandra Thomas ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Low Income ◽  
Kidney Failure ◽  
Low Income Countries ◽  
Multidisciplinary Teams ◽  
Spiritual Support ◽  
Care Providers ◽  
The Status ◽  
Kidney Health

Background and objectivesPeople with kidney failure typically receive KRT in the form of dialysis or transplantation. However, studies have suggested that not all patients with kidney failure are best suited for KRT. Additionally, KRT is costly and not always accessible in resource-restricted settings. Conservative kidney management is an alternate kidney failure therapy that focuses on symptom management, psychologic health, spiritual care, and family and social support. Despite the importance of conservative kidney management in kidney failure care, several barriers exist that affect its uptake and quality.Design, setting, participants, & measurementsThe Global Kidney Health Atlas is an ongoing initiative of the International Society of Nephrology that aims to monitor and evaluate the status of global kidney care worldwide. This study reports on findings from the 2018 Global Kidney Health Atlas survey, specifically addressing the availability, accessibility, and quality of conservative kidney management.ResultsRespondents from 160 countries completed the survey, and 154 answered questions pertaining to conservative kidney management. Of these, 124 (81%) stated that conservative kidney management was available. Accessibility was low worldwide, particularly in low-income countries. Less than half of countries utilized multidisciplinary teams (46%); utilized shared decision making (32%); or provided psychologic, cultural, or spiritual support (36%). One-quarter provided relevant health care providers with training on conservative kidney management delivery.ConclusionsOverall, conservative kidney management is available in most countries; however, it is not optimally accessible or of the highest quality.

Naturalistic Decision Making and the Practice of Health Care

2018 ◽  
Vol 12 (3) ◽  
pp. 178-193 ◽  
Author(s):  
Paul R. Falzer
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Best Practices ◽  
Clinical Decision Making ◽  
Resistance To Change ◽  
Care Practice ◽  
Evidence Based ◽  
Naturalistic Decision Making ◽  
Late 20Th Century ◽  
Care Community

A recent essay in this journal identified health care as a fertile domain for extending the reach of naturalistic decision making (NDM). It targeted the “best practices regimen,” a host of initiatives begun in the late 20th century that address problems in service delivery, skyrocketing costs, and impediments in transforming products of basic science into effective treatments. Of particular importance are efforts to base treatment decisions on empirical research findings and to gauge the quality of decisions by their conformance to evidence-based practices. The challenges that the essay identified and the ways of addressing these challenges are well known in the health care community. They have had limited impact owing to several factors, including how advocates of the best practices regimen envision clinical decision making and their tendency to equate the exercise of skill with resistance to change. This paper describes the regimen’s concept of decision making and its principles and deficiencies. It also identifies a conundrum: oversimplification prevents complexity from being recognized; as a result, evidence-based recommendations frequently have unforeseeable and deleterious consequences. The paper proposes that NDM is well positioned to address these problems and make a valuable contribution to health care practice. It illustrates NDM-based theories and concepts with a research example and describes their ability to address complex issues that arise in treating chronic illnesses.

scholarly journals Economic support, education and sexual decision making among female adolescents in Zambia: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
J. Milimo ◽  
J. M. Zulu ◽  
J. Svanemyr ◽  
E. Munsaka ◽  
O. Mweemba ◽  
...  
Keyword(s):  
Decision Making ◽  
Randomised Controlled Trial ◽  
Low Income ◽  
Controlled Trial ◽  
Community Support ◽  
Female Adolescents ◽  
Low Income Countries ◽  
Sexual Decision Making ◽  
Economic Support ◽  
Randomised Controlled

Abstract Background The importance of educating female adolescents has been recognized as critical to the development of any country. However, in low income countries like Zambia they often drop out of school due to poverty, early pregnancy and early marriages. Some studies indicate that economic support such as Social Cash Transfers (SCTs) can mitigate the effects of poverty on female adolescents by improving their school participation and helping postpone pregnancy and marriage. This study aimed to explore the role of economic support in influencing education and sexual decision making among female adolescents in a randomised controlled trial in Zambia. Methods The study adopted a qualitative approach. It utilized purposive and convenient sampling. Data were collected from 6 schools using 18 in-depth interviews (IDIs) and 4 focus group discussions (FGDs) comprising 48 school-going female adolescents in grade 8 aged 14 to 17. All participants received economic support in form of SCTs and payment of school fees as part of the Research Initiative to Support the Empowerment of Girls (RISE), a Cluster Randomised Controlled Trial. Data were analyzed using thematic analysis. Results Findings suggested several benefits of the economic support for the female adolescents such as economic independence and empowerment; increased assertiveness and autonomy; reduced desire for sexual relationships with boys in exchange for cash and gifts; increased motivation for school; enhanced parental and community support for female adolescents’ education and; reduced school dropouts. However, they also experienced jealousy from those who did not benefit from the economic support. Conclusion Economic support played a significant role in influencing both educational and sexual decision making among female adolescents. Trial registration ISRCTN Registry: ISRCTN12727868, (4 March 2016).

scholarly journals Counseling at all contacts for postpartum contraceptive use: can paper-based tools help community health workers improve continuity of care? A qualitative study from Ethiopia

2019 ◽  
Vol 3 ◽  
pp. 1652 ◽  
Author(s):  
Muluneh Yigzaw Mossie ◽  
Anne Pfitzer ◽  
Yousra Yusuf ◽  
China Wondimu ◽  
Eva Bazant ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Community Health ◽  
Low Income ◽  
Health Workers ◽  
Continuum Of Care ◽  
Low Income Countries ◽  
Health Extension Workers ◽  
Pregnancy Risk ◽  
The Continuum

Background: Globally, there has been a resurgence of interest in postpartum family planning (PPFP) to advance reproductive health outcomes. Few programs have systematically utilized all contacts a woman and her baby have with the health system, from pregnancy through the first year postpartum, to promote PPFP. Nested into a larger study covering two districts, this study assessed the use, acceptability, and feasibility of tools for tracking women’s decision-making and use of PPFP in the community health system in Oromia region, Ethiopia. Community-level tracking tools included a modified Integrated Maternal and Child Health (IMCH) card with new PPFP content, and a newly developed tool for pregnant and postpartum women for use by Women Development Armies (WDAs). Proper completion of the tools was monitored during supervision visits. Methods: In-depth interviews and focus group discussions were conducted with health officials, health extension workers, and volunteers. A total of 34 audio-files were transcribed and translated into English, double-coded using MAXQDA, and analyzed using a thematic approach. Results: The results describe how HEWs used the modified IMCH card to track women’s decision making through the continuum of care, to assess pregnancy risk and to strengthen client-provider interaction. Supervision data demonstrated how well HEWs completed the modified IMCH card. The WDA tool was intended to promote PPFP and encourage multiple contacts with facilities from pregnancy to extended postpartum period. HEWs have reservations about the engagement of WDAs and their use of the WDA tool. Conclusions: To conclude, the IMCH card improves counseling practices through the continuum of care and is acceptable and feasible to apply. Some elements have been incorporated into a revised national tool and can serve as example for other low-income countries with similar community health systems. Further study is warranted to determine how to engage WDAs in promoting PPFP.

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