scholarly journals Evidence‐based priorities of under‐served pregnant and parenting adolescents: addressing inequities through a participatory approach to contextualizing evidence syntheses

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Anna Dion ◽  
Aime Klevor ◽  
Amy Nakajima ◽  
Neil Andersson
Keyword(s):  
Social Services ◽  
Adolescent Mothers ◽  
Priority Setting ◽  
Service Providers ◽  
Post Partum ◽  
Perinatal Outcomes ◽  
Health Inequities ◽  
Participatory Approach ◽  
Perinatal Health ◽  
Evidence Based

Abstract Purpose This study describes an interdiscursive evidence-based priority setting process with pregnant and parenting adolescents and their services providers. Methods A mixed methods literature review identified studies reporting on perinatal outcomes and experiences of adolescents during pregnancy to 12 months post-partum published in Canada after 2000. We also calculated relative risks for common perinatal risk factors and outcomes for adolescents compared to adult populations from 2012 to 2017 based on data from a provincial database of maternal and newborn outcomes. Two trained peer researchers identified outcomes most relevant to their peers. We shared syntheses results with four service providers and 13 adolescent mothers accessing services at a community service organization, who identified and prioritized their areas of concern. We repeated the process for the identified priority issue and expanded upon it through semi-structured interviews. Results Adolescent mothers face higher rates of poverty, abuse, anxiety and depression than do adult mothers. Adolescents prioritized the experience of judgment in perinatal health and social services, particularly as it contributed to them being identified as a child protection risk. Secondary priorities included loss of social support and inaccessibility of community resources. The experience of judgment in adolescent perinatal health literature was summarized around: being invisible, seen as incapable and seen as a risk. Adolescent mothers adapted these categories, emphasizing organizational and social barriers. Conclusions Young marginalized women are disproportionately affected by inequities in perinatal outcomes, yet their perspectives are rarely centered in efforts to address these inequities. This research addresses health inequities by presenting a robust, transparent and participatory approach to priority setting as a way to better represent the perspectives of those who carry the greatest burden of health inequities in evidence syntheses. In our work, marginalized adolescent parents adapted published literature around the experience and consequences of social stigma on perinatal outcomes, shifting our understanding of root causes and possible solutions.

scholarly journals “It is judgment by the people that have meant something to me that hurts the most”: Inter-discursive evidence synthesis incorporates the lived experience of adolescent mothers

2019 ◽  
Author(s):  
Anna Dion ◽  
Aime Klevor ◽  
Amy Nakajima ◽  
Neil Andersson
Keyword(s):  
Social Services ◽  
Adolescent Mothers ◽  
Child Protection ◽  
Service Providers ◽  
Post Partum ◽  
Evidence Synthesis ◽  
Adult Population ◽  
Perinatal Health ◽  
Local Health ◽  
Targeted Interventions

Abstract Background Evidence synthesis without meaningful stakeholder engagement can overlook factors considered relevant and influential by stakeholders. This paper presents an inter-discursive approach to grounding conventional mixed methods evidence synthesis in stakeholder views of adolescent perinatal health in Canada. Methods A parallel-results convergent mixed review identified studies reporting on perinatal outcomes and experiences of adolescents during pregnancy to 12 months post-partum, in French or English, published in Canada after 2000. We summarized findings using thematic synthesis and descriptive statistics. We then extracted data from a provincial database of maternal and newborn outcomes and calculated relative risks for common perinatal risk factors and outcomes for adolescents compared to adult population within a local health region and across Ontario from 2012-2017. Two trained peer researchers contributed to our evidence syntheses. We shared syntheses with four service providers and 13 marginalized adolescent mothers, who identified and prioritized their areas of concern. A second literature review refocused around the priority issues identified by the women and was then expanded through semi-structured interviews.      Results Adolescent mothers face more poverty, higher rates of abuse, anxiety and depression than adult mothers. They also report experiencing negative judgments when accessing services, highlighting the need for more youth-friendly services. Adolescent women prioritized the experience of judgment in perinatal health and social services, and more specifically how they felt judgment contributed to them being identified as a child protection risk. Other priorities included inadequate housing, judgment around breastfeeding, loss of social support and inaccessibility of community resources. Judgment in the adolescent perinatal health literature was summarized around three themes: being invisible, incapable and at risk. Adolescent mothers adapted and added onto these categories, emphasizing organizational and social challenges, with important consequences for their mental health and accessing appropriate care. Conclusions Incorporating young women’s voices changed the focus of our research. Women’s priorities highlighted the way motherhood norms are embedded in social and institutional structures. Adolescent women’s experiences of care have important implications for ensuring the effectiveness of more targeted interventions to maximize benefit to women and newborns.

Risk and Protective Factors in the Life of Youth in Relation to Resilience

2018 ◽  
Vol 52 (1) ◽  
pp. 50-59
Author(s):  
Silvia Barnová ◽  
Viola Tamášová
Keyword(s):  
Social Support ◽  
Protective Factors ◽  
School Psychologists ◽  
Social Environment ◽  
Social Services ◽  
Service Providers ◽  
Vital Role ◽  
Great Role ◽  
Health Service Providers

Abstract Introduction: A certain degree of stress is present in everyone’s life and young people are not an exception. Most of them show a certain degree of resilience and can cope with stressful situations without any difficulties, however there is a group of youth who live in toxic environments and need help. If there is a risk of failure due to the intensity of stressors; external formal and informal support have a great role to play as they have the potential to prevent negative developmental outcomes. Purpose: The authors’ intention was to make a review of available literature on the current issues of resilience research with a focus on the importance of protective factors in young people’s lives – especially when they are exposed to adversity. An emphasis is placed on the vital role of social support to individuals provided by schools as well as social services. Methods: In the presented literature review, multiple formal search methods including hand searching of key journals; electronic searching of journal databases and subject specific websites; reference scanning; and citation tracking were used. Conclusion: Individuals commonly demonstrate some level of resilience, yet most of them are able to deal with stressful situations without any harm. On the other hand, if the adversity is too high, the presence of social support provided by their social environment is important. In this context, good relationships in general and sufficient external protective factors provided by their social environment (schools, school psychologists, institutional social and health service providers) are important.

CHALLENGES TO BUILDING AUTHENTIC PARTNERSHIPS: LESSONS FROM BHAMBAYI, KWAZULU-NATAL, SOUTH AFRICA

2017 ◽  
Vol 26 (2) ◽  
pp. 124-140 ◽  
Author(s):  
Tanusha Raniga ◽  
Barbara Simpson ◽  
Ntokozo Mthembu
Keyword(s):  
South Africa ◽  
Social Services ◽  
Service Providers ◽  
Informal Settlement ◽  
Mutual Trust ◽  
Open Communication ◽  
Community Based ◽  
Individual Interviews ◽  
Kwazulu Natal ◽  
Qualitative Phase

In contemporary South Africa, partnerships between service providers in government, non-governmental organisations, the private sector and community based organisations have been identified as a means to strengthen communities and the sustainability of social services. However, the unequal power relations that exists between and within these organisations often leads to fragmentation, duplication, and lack of coordination of social services. Using Fowler’s (1998) conceptualisation of authentic partnerships, this qualitative phase of a larger study explored the challenges of building authentic partnerships in Bhambayi, a predominantly informal settlement in KwaZulu-Natal, South Africa. Individual interviews and a focus group held with nine service providers revealed that intraorganisational challenges, cross-boundary and inter-organisational relations as well as political influences were obstacles to the development of authentic partnerships. The article suggests that open communication, clarity of roles and mutual trust between service providers is vital.

scholarly journals Development of a checklist to guide equity considerations in health technology assessment

2021 ◽  
Vol 37 ◽  
Author(s):  
Maria Benkhalti ◽  
Manuel Espinoza ◽  
Richard Cookson ◽  
Vivian Welch ◽  
Peter Tugwell ◽  
...  
Keyword(s):  
Knowledge Translation ◽  
Health Technology Assessment ◽  
Priority Setting ◽  
Technology Assessment ◽  
Literature Search ◽  
Health Inequities ◽  
Health Technology ◽  
Decision Makers ◽  
Added Value ◽  
Pilot Test

Abstract Objectives Health technology assessment (HTA) can impact health inequities by informing healthcare priority-setting decisions. This paper presents a novel checklist to guide HTA practitioners looking to include equity considerations in their work: the equity checklist for HTA (ECHTA). The list is pragmatically organized according to the generic HTA phases and can be consulted at each step. Methods A first set of items was based on the framework for equity in HTA developed by Culyer and Bombard. After rewording and reorganizing according to five HTA phases, they were complemented by elements emerging from a literature search. Consultations with method experts, decision makers, and stakeholders further refined the items. Further feedback was sought during a presentation of the tool at an international HTA conference. Lastly, the checklist was piloted through all five stages of an HTA. Results ECHTA proposes elements to be considered at each one of the five HTA phases: Scoping, Evaluation, Recommendations and Conclusions, Knowledge Translation and Implementation, and Reassessment. More than a simple checklist, the tool provides details and examples that guide the evaluators through an analysis in each phase. A pilot test is also presented, which demonstrates the ECHTA's usability and added value. Conclusions ECHTA provides guidance for HTA evaluators wishing to ensure that their conclusions do not contribute to inequalities in health. Several points to build upon the current checklist will be addressed by a working group of experts, and further feedback is welcome from evaluators who have used the tool.

scholarly journals Impact of immediate postpartum insertion of TCu380A on the quantity and duration of lochia discharges in Tanzania

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Projestine Selestine Muganyizi ◽  
Grasiana Festus Kimario ◽  
France John Rwegoshora ◽  
Ponsian Patrick Paul ◽  
Anita Makins
Keyword(s):  
Service Providers ◽  
International Federation ◽  
Teaching Hospitals ◽  
Evidence Based ◽  
Contraceptive Device ◽  
Postpartum Contraception ◽  
Gynecology And Obstetrics ◽  
Intrauterine Contraceptive ◽  
The Difference

Abstract Background The insertion of Intrauterine Contraceptive Device (PPIUD) for the purpose of contraception immediately after delivery is becoming popular in countries where the use of IUD for contraception has been extremely low. Since 2015, Tanzania implemented the initiative by the International Federation of Gynecology and Obstetrics (FIGO) to institutionalize PPIUD. As a result of capacity building and information delivery under the initiative, there have been increased uptake of the method. Working in this context, the focus of the study was to generate evidence on the effect of TCu380A IUD on amount and duration of lochia and equip service providers with evidence-based knowledge which can help them in counselling their PPIUD clients. Objective Establish impact of postpartum TCu380A on amount and duration of lochia. Methods A prospective cohort study of delivered women in two teaching hospitals in Tanzania with immediate insertion of TCu380A or without use of postpartum contraception in 2018. TCu380A models; Optima (Injeflex Co. Brazil) and Pregna (Pregna International, Chakan, India) were used. Follow-up was done by weekly calls and examination at 6th week. Lochia was estimated by Likert Scale 0–4 relative to the amount of lochia on the delivery day. An estimated 250 women sample (125 each group) would give 80% power to detect a desired 20% difference in the proportion of women with prolonged lochia discharges among the Exposed and Unexposed groups. Data analysis was by SPSS. Results Two hundred sixty women were analysed, 127 Exposed and 133 Unexposed. Medical complaints were reported by 41 (28.9%) Exposed and 37 Unexposed (27.8%), p = 0.655. Lack of dryness by end of 6th week was to 31 (23.3%) Exposed and 9 (7.1%) Unexposed, p < 0.001. Exposed had higher weekly mean lochia scores throughout with the difference most marked in 5th week (3.556 Versus 2.039, p < 0.001) and 6th week (1.44 Versus 0.449, p<0.001). Conclusion PPIUD is associated with increased amount of lochia and slows progression to dryness within 6 weeks of delivery. The implications of PPIUD clients’ needs to be informed about the possibility of delayed dryness of lochia at time of counseling are discussed.

scholarly journals Developing a postgraduate professional education framework for emergency nursing: a co-design approach

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Karen A. Theobald ◽  
Fiona Maree Coyer ◽  
Amanda Jane Henderson ◽  
Robyn Fox ◽  
Bernadette F. Thomson ◽  
...  
Keyword(s):  
Professional Education ◽  
Service Providers ◽  
Postgraduate Education ◽  
Evidence Based ◽  
Emergency Nursing ◽  
Integration Framework ◽  
Graduate Certificate ◽  
University Settings ◽  
Assessment Strategies ◽  
University Industry

Abstract Background Hospital and university service providers invest significant but separate resources into preparing registered nurses to work in the emergency department setting. This results in the duplication of both curricula and resource investment in the health and higher education sectors. This paper describes an evidence-based co-designed study with clinical-academic stakeholders from hospital and university settings. Methods The study was informed by evidence-based co-design, using emergency nursing as an exemplar. Eighteen hours of co-design workshops were completed with 21 key clinical-academic stakeholders from hospital and university settings. Results Outcomes were matrices synchronising professional and regulatory imperatives of postgraduate nursing coursework; mutually-shaped curriculum content, teaching approaches and assessment strategies relevant for postgraduate education; a new University-Industry Academic Integration Framework; five agreed guiding principles of postgraduate curriculum development for university-industry curriculum co-design; and a Graduate Certificate of Emergency Nursing curriculum exemplar. Conclusion Industry-academic service provider co-design can increase the relevance of postgraduate specialist courses in nursing, strengthening the nexus between both entities to advance learning and employability. The study developed strategies and exemplars for future use in any mutually determined academic-industry education partnership.

57: Can You Predict Contraceptive Use of Adolescent Mothers at 12 Months Post Partum?

2008 ◽  
Vol 42 (2) ◽  
pp. 40-41
Author(s):  
Sarah Needham ◽  
Vaughn I. Rickert ◽  
Mariam Chacko ◽  
Constance M. Wiemann
Keyword(s):  
Adolescent Mothers ◽  
Contraceptive Use ◽  
Post Partum

Evidence-based practice and management-by-knowledge of disability care: rigid constraint or fluid support?

2022 ◽  
Author(s):  
Isabella Pistone ◽  
Allan Lidström ◽  
Ingemar Bohlin ◽  
Thomas Schneider ◽  
Teun Zuiderent-Jerak ◽  
...  
Keyword(s):  
Social Workers ◽  
Social Care ◽  
Evidence Based Practice ◽  
Service Providers ◽  
Evidence Based ◽  
Epistemic Injustice ◽  
Dynamic Interactions ◽  
Local Practices ◽  
Rigid Constraint ◽  
Care Practices

Background: Although increasingly accepted in some corners of social work, critics have claimed that evidence-based practice (EBP) methodologies run contrary to local care practices and result in an EBP straitjacket and epistemic injustice. These are serious concerns, especially in relation to already marginalised clients.Aims and objectives: Against the backdrop of criticism against EBP, this study explores the ramifications of the Swedish state-governed knowledge infrastructure, ‘management-by-knowledge’, for social care practices at two care units for persons with intellectual disabilities.Methods: Data generated from ethnographic observations and interviews were analysed by applying a conceptual framework of epistemic injustice; also analysed were national, regional and local knowledge products within management-by-knowledge related to two daily activity (DA) units at a social care provider in Sweden.Findings: In this particular case of disability care, no obvious risks of epistemic injustice were discovered in key knowledge practices of management-by-knowledge. Central methodologies of national agencies did include perspectives from social workers and clients, as did regional infrastructures. Locally, there were structures in place that focused on creating a dynamic interplay between knowledge coming from various forms of evidence, including social workers’ and clients’ own knowledge and experience.Discussion and conclusions: Far from being a straitjacket, in the case studied management-by-knowledge may be understood as offering fluid support. Efforts which aim at improving care for people with disabilities might benefit from organisational support structures that enable dynamic interactions between external knowledge and local practices.<br />Key messages<br /><ul><li>Examining one case of disability care in Sweden, both social workers’ and clients’ experiences were included in EBP infrastructures.</li><br /><li>In this study, Swedish EBP infrastructures functioned more like fluid support than a straitjacket.</li><br /><li>Organisational structures that combine different knowledge sources at service providers can minimise the risk of epistemic injustice within social care.</li></ul>

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