scholarly journals The factors influencing clinician use of hypertension guidelines in different resource settings: a qualitative study investigating clinicians’ perspectives and experiences

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amelia Kataria Golestaneh ◽  
Jonathan M Clarke ◽  
Nicholas Appelbaum ◽  
Carmen Rodriguez Gonzalvez ◽  
Arun P Jose ◽  
...  
Keyword(s):  
Health System ◽  
Healthcare Worker ◽  
Influencing Factors ◽  
Low Income ◽  
Small Body ◽  
System Level ◽  
Middle Income ◽  
Middle Income Countries ◽  
Factors Influencing ◽  
Hypertension Guidelines

Abstract Background Hypertension accounts for the greatest burden of disease worldwide, yet hypertension awareness and control rates are suboptimal, especially within low- and middle-income countries. Guidelines can enable consistency of care and improve health outcomes. A small body of studies investigating clinicians’ perceptions and implementation of hypertension guidelines exists, mostly focussed on higher income settings. This study aims to explore how hypertension guidelines are used by clinicians across different resource settings, and the factors influencing their use. Methods A qualitative approach was employed using convenience sampling and in-depth semi-structured interviews. Seventeen medical doctors were interviewed over video or telephone call from March to August 2020. Two clinicians worked in low-income countries, ten in middle-income countries, and five in high-income countries. Interviews were recorded, transcribed, and coded inductively. Reflexive thematic analysis was used. Results Themes were generated at three levels at which clinicians perceived influencing factors to be operating: healthcare worker, healthcare worker interactions with patients, and the wider health system. Within each level, influencing factors were described as barriers to and facilitators of guideline use. Variation in factors occurred across income settings. At the healthcare worker level, usability of guidelines, trust in guidelines, attitudes and views about guidelines’ purpose, and relevance to patient populations were identified as themes. Influencing factors at the health system level were accessibility of equipment and medications, workforce, and access to healthcare settings. Influences at the patient level were clinician perceived patient motivation and health literacy, and access to, and cost of treatment, although these represented doctors’ perceptions rather than patient perceived factors. Conclusions This study adds a high level global view to previous studies investigating clinician perspectives on hypertension guideline use. Guidelines should be evidence-based, regularly updated and attention should be given to increasing applicability to LMICs and a range of healthcare professionals.

scholarly journals The Factors Influencing Clinician Use of Hypertension Guidelines in Different Resource Settings: a Qualitative Study Investigating Clinicians’ Perspectives and Experiences.

2021 ◽  
Author(s):  
Amelia Kataria Golestaneh ◽  
Jonathan M Clarke ◽  
Nicholas Appelbaum ◽  
Carmen Rodriguez Gonzalvez ◽  
Arun P Jose ◽  
...  
Keyword(s):  
Health System ◽  
Healthcare Worker ◽  
Influencing Factors ◽  
Low Income ◽  
Small Body ◽  
System Level ◽  
Low Income Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Hypertension Guidelines

Abstract Background: Hypertension accounts for the greatest burden of disease worldwide, yet hypertension awareness and control rates are suboptimal, especially within low- and middle-income countries. Guidelines can enable consistency of care and improve health outcomes. A small body of studies investigating clinicians’ perceptions and implementation of hypertension guidelines exists, mostly focussed on higher income settings. This study aims to explore how hypertension guidelines are used by clinicians across different resource settings, and the reasons for preferential use of certain hypertension guidelines.Methods: A qualitative approach was employed using convenience sampling and in-depth semi-structured interviews. Seventeen medical doctors were interviewed over video or telephone call from March to August 2020. Two clinicians worked in low-income countries, ten in middle-income countries, and five in high-income countries. Interviews were recorded, transcribed, and coded inductively. Thematic analysis was used. Results: Three main themes emerged, each a level at which clinicians perceived influencing factors to be operating: health system, healthcare worker and patient. Within each theme, influencing factors were described as barriers to and facilitators of guideline use. Variation in themes occurred across income settings. Influencing factors at the health system level were accessibility of equipment and medications, workforce, and access to healthcare settings. At the healthcare worker level, usability of guidelines, trust in guidelines, attitudes and views about guidelines’ purpose, and relevance to patient populations were identified as subthemes. Patient centred influences were clinician perceived patient motivation and health literacy, and access to, and cost of treatment, although these represented doctors’ perceptions rather than patient perceived factors.Conclusions: This study adds a high level global view to previous studies investigating clinician perspectives on hypertension guideline use. Guidelines should be evidence-based, regularly updated and attention should be given to increasing applicability to LMICs and a range of healthcare professionals.

scholarly journals Level of confidence in and endorsement of the health system among internet users in 12 low-income and middle-income countries

2020 ◽  
Vol 5 (8) ◽  
pp. e002205
Author(s):  
Sanam Roder-DeWan ◽  
Anna Gage ◽  
Lisa R Hirschhorn ◽  
Nana A Y Twum-Danso ◽  
Jerker Liljestrand ◽  
...  
Keyword(s):  
Health System ◽  
Low Income ◽  
Internet Survey ◽  
Health Coverage ◽  
Middle Income ◽  
Middle Income Countries ◽  
Internet Users ◽  
Effective Care ◽  
Universal Health

IntroductionPeople’s confidence in and endorsement of the health system are key measures of system performance, yet are undermeasured in low-income and middle-income countries (LMICs). We explored the prevalence and predictors of these measures in 12 countries.MethodsWe conducted an internet survey in Argentina, China, Ghana, India, Indonesia, Kenya, Lebanon, Mexico, Morocco, Nigeria, Senegal and South Africa collecting demographics, ratings of quality, and confidence in and endorsement of the health system. We used multivariable logistic regression to assess the association between confidence/endorsement and self-reported quality of recent healthcare.ResultsOf 13 489 respondents, 62% reported a health visit in the past year. Applying population weights, 32% of these users were very confident that they could receive effective care if they were to ‘become very sick tomorrow’; 30% endorsed the health system, that is, agreed that it ‘works pretty well and only needs minor changes’. Reporting high quality in the last visit was associated with 4.48 and 2.69 greater odds of confidence (95% CI 3.64 to 5.52) and endorsement (95% CI 2.33 to 3.11). Having health insurance was positively associated with confidence and endorsement (adjusted odds ratio (AOR) 1.68, 95% CI 1.49 to 1.90 and AOR 1.34, 95% CI 1.22 to 1.48), while experiencing discrimination in healthcare was negatively associated (AOR 0.67, 95% CI 0.56 to 0.80 and AOR 0.63, 95% CI 0.53 to 0.76).ConclusionConfidence and endorsement of the health system were low across 12 LMICs. This may hinder efforts to gain support for universal health coverage. Positive patient experience was strongly associated with confidence in and endorsement of the health system.

scholarly journals Factors influencing the performance of community health volunteers working within urban informal settlements in low- and middle-income countries: a qualitative meta-synthesis review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Michael Ogutu ◽  
Kui Muraya ◽  
David Mockler ◽  
Catherine Darker
Keyword(s):  
Health System ◽  
Family Support ◽  
Contextual Factors ◽  
Informal Settlements ◽  
Supportive Supervision ◽  
Personal Safety ◽  
Middle Income ◽  
Middle Income Countries ◽  
Factors Influencing ◽  
Urban Informal Settlements

Abstract Background There is limited information on community health volunteer (CHV) programmes in urban informal settlements in low- and middle-income countries (LMICs). This is despite such settings accounting for a high burden of disease. Many factors intersect to influence the performance of CHVs working in urban informal settlements in LMICs. This review was conducted to identify both the programme level and contextual factors influencing performance of CHVs working in urban informal settlements in LMICs. Methods Four databases were searched for qualitative and mixed method studies focusing on CHVs working in urban and peri-urban informal settlements in LMICs. We focused on CHV programme outcome measures at CHV individual level. A total of 13 studies met the inclusion criteria and were double read to extract relevant data. Thematic coding was conducted, and data synthesized across ten categories of both programme and contextual factors influencing CHV performance. Quality was assessed using both the Critical Appraisal Skills Programme (CASP) and the Mixed Methods Assessment Tool (MMAST); and certainty of evidence evaluated using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. Results Key programme-level factors reported to enhance CHV performance in urban informal settlements in LMICs included both financial and non-financial incentives, training, the availability of supplies and resources, health system linkage, family support, and supportive supervision. At the broad contextual level, factors found to negatively influence the performance of CHVs included insecurity in terms of personal safety and the demand for financial and material support by households within the community. These factors interacted to shape CHV performance and impacted on implementation of CHV programmes in urban informal settlements. Conclusion This review identified the influence of both programme-level and contextual factors on CHVs working in both urban and peri-urban informal settlements in LMICs. The findings suggest that programmes working in such settings should consider adequate remuneration for CHVs, integrated and holistic training, adequate supplies and resources, adequate health system linkages, family support and supportive supervision. In addition, programmes should also consider CHV personal safety issues and the community expectations.

scholarly journals Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review

BMJ Open ◽  
2017 ◽  
Vol 7 (2) ◽  
pp. e013501 ◽  
Author(s):  
Shyam Sundar Budhathoki ◽  
Prisca A C Zwanikken ◽  
Paras K Pokharel ◽  
Albert J Scherpbier
Keyword(s):  
Systematic Review ◽  
Medical Students ◽  
Low Income ◽  
Rural Areas ◽  
Middle Income ◽  
Middle Income Countries ◽  
Factors Influencing

scholarly journals Interventions to improve district-level routine health data in low-income and middle-income countries: a systematic review

2021 ◽  
Vol 6 (6) ◽  
pp. e004223
Author(s):  
Jieun Lee ◽  
Caroline A Lynch ◽  
Lauren Oliveira Hashiguchi ◽  
Robert W Snow ◽  
Naomi D Herz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Quality ◽  
Health System ◽  
Low Income ◽  
Controlled Trial ◽  
Grey Literature ◽  
Health Data ◽  
Post Intervention ◽  
Middle Income ◽  
Middle Income Countries

BackgroundRoutine health information system(s) (RHIS) facilitate the collection of health data at all levels of the health system allowing estimates of disease prevalence, treatment and preventive intervention coverage, and risk factors to guide disease control strategies. This core health system pillar remains underdeveloped in many low-income and middle-income countries. Efforts to improve RHIS data coverage, quality and timeliness were launched over 10 years ago.MethodsA systematic review was performed across 12 databases and literature search engines for both peer-reviewed articles and grey literature reports on RHIS interventions. Studies were analysed in three stages: (1) categorisation of RHIS intervention components and processes; (2) comparison of intervention component effectiveness and (3) whether the post-intervention outcome improved above the WHO integrated disease surveillance response framework data quality standard of 80% or above.Results5294 references were screened, resulting in 56 studies. Three key performance determinants—technical, organisational and behavioural—were proposed as critical to RHIS strengthening. Seventy-seven per cent [77%] of studies identified addressed all three determinants. The most frequently implemented intervention components were ‘providing training’ and ‘using an electronic health management information systems’. Ninety-three per cent [93%] of pre–post or controlled trial studies showed improvements in one or more data quality outputs, but after applying a standard threshold of >80% post-intervention, this number reduced to 68%. There was an observed benefit of multi-component interventions that either conducted data quality training or that addressed improvement across multiple processes and determinants of RHIS.ConclusionHolistic data quality interventions that address multiple determinants should be continuously practised for strengthening RHIS. Studies with clearly defined and pragmatic outcomes are required for future RHIS improvement interventions. These should be accompanied by qualitative studies and cost analyses to understand which investments are needed to sustain high-quality RHIS in low-income and middle-income countries.

scholarly journals Scoping review protocol of service delivery-related interventions to improve maternal and newborn health in low-income and middle-income countries

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e042952
Author(s):  
Solange Mianda ◽  
Olamide O Todowede ◽  
Helen Schneider
Keyword(s):  
Service Delivery ◽  
Health System ◽  
Low Income ◽  
Newborn Health ◽  
Health System Strengthening ◽  
Maternal And Newborn Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Qualitative Phase ◽  
Maternal And Newborn

IntroductionThis review will explore the characteristics of service delivery-related interventions to improve maternal and newborn health in low-income and middle-income countries, comparing three common framing approaches of these interventions (referred to as archetypes), namely, quality improvement (QI), health system strengthening (HSS) and implementation science (IS), over the last 20 years.Methods and analysisThis study will review the literature on health service interventions from 2000 to 2020. This will be achieved by searching for English peer-reviewed articles in the following electronic databases EBSCOhost, PubMed, Web of Science, MASCOT/Wotro Map of Maternal Health Research and Google scholar. We will develop a systematic search strategy using a combination of keywords and Boolean operators AND/OR. Eligibility screening and data extraction will be conducted by two independent reviewers, and disagreements resolved by a third independent reviewer. Analyses will be conducted in two steps, a quantitative and a qualitative phase. The quantitative phase will provide a descriptive profile of papers, including the category (QI, HSS, IS, mixed or other) of papers. In the follow-up qualitative phase, all three reviewers will independently code for key concepts in a subset of papers, jointly selected as representing each archetype, and analysed in batches until concept saturation is achieved.Ethics and disseminationThis review does not require ethical approval. The results will be published as an article in a peer-reviewed journal and presented to stakeholders involved in implementing health system interventions in maternal and newborn.

Sign in / Sign up

Export Citation Format

Share Document