scholarly journals Health care workers’ experiences with implementation of “screen and treat” for cervical cancer prevention in Malawi: A qualitative study

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Corrina Moucheraud ◽  
Paul Kawale ◽  
Savel Kafwafwa ◽  
Roshan Bastani ◽  
Risa M. Hoffman
Keyword(s):  
Cervical Cancer ◽  
Low Income ◽  
Health Workers ◽  
Structural Characteristics ◽  
Individual Characteristics ◽  
Relative Advantage ◽  
Implementation Climate ◽  
Effective Prevention ◽  
The Government ◽  
Inner Setting

Abstract Background Cervical cancer remains a major cause of mortality and morbidity in low- and middle-income countries, despite the availability of effective prevention approaches. “Screen and treat” (a single-visit strategy to identify and remove abnormal cervical cells) is the recommended secondary prevention approach in low-resource settings, but there has been relatively scarce robust implementation science evidence on barriers and facilitators to providing “screen and treat” from the provider perspective, or about thermocoagulation as a lesion removal technique. Methods Informed by the Consolidated Framework for Implementation Research (CFIR), we conducted interviews with ten experienced “screen and treat” providers in Malawi. We asked questions based on the CFIR Guide, used the CFIR Guide codebook for a descriptive analysis in NVivo, and added recommended modifications for studies in low-income settings. Results Seven CFIR constructs were identified as positively influencing implementation, and six as negatively influencing implementation. The two strong positive influences were the relative advantage of thermocoagulation versus cryotherapy (Innovation Characteristics) and respondents’ knowledge and beliefs about providing “screen and treat” (Individual Characteristics). The two strong negative influences were the availability of ongoing refresher trainings to stay up-to-date on skills (Inner Setting, Implementation Climate) and insufficient resources (staffing, infrastructure, supplies) to provide “screen and treat” to all women who need it (Inner Setting, Readiness for Implementation). Weak positive factors included perceived scalability and access to knowledge/information, as well as compatibility, leadership engagement, and team characteristics, but these latter three were mixed in valence. Weak negative influences were structural characteristics and donor priorities; and mixed but weakly negative influences were relative priority and engaging clients. Cross-cutting themes included the importance of broad buy-in (including different cadres of health workers and leadership at the facility and in the government) and the opportunities and challenges of offering integrated care (screening plus other services). Conclusions Although “screen and treat” is viewed as effective and important, many implementation barriers remain. Our findings suggest that implementation strategies will need to be multi-level, include a diverse set of stakeholders, and explicitly address both screening and treatment.

scholarly journals Evaluating the implementation of interdisciplinary patient-centred care intervention for people with multimorbidity in primary care: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e046914
Author(s):  
Patrice Ngangue ◽  
Judith Belle Brown ◽  
Catherine Forgues ◽  
Mohamed Ali Ag Ahmed ◽  
Tu Ngoc Nguyen ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Structural Characteristics ◽  
Interdisciplinary Teams ◽  
Relative Advantage ◽  
Multiple Chronic Conditions ◽  
Design Quality ◽  
Patient Centred Care ◽  
Data Coding ◽  
Inner Setting

ObjectiveA patient-centred care interdisciplinary pragmatic intervention to support self-management for patients with multimorbidity was implemented in one region of Quebec, Canada. This embedded study aimed to evaluate the process of implementation.DesignA descriptive qualitative study was conducted in 2016–2017 using semistructured individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data coding, analysis and reporting of the findings.SettingThe study took place in seven Family Medicine Groups in one region (Saguenay-Lac-Saint-Jean) of Quebec, Canada.ParticipantsTen managers (including two family physicians) and 19 healthcare professionals (HCPs), nurses, kinesiologists, nutritionists and a respiratory therapist, were interviewed.ResultsMany key elements within the five CFIR domains were identified as impacting the implementation of the intervention : (1) intervention characteristics—evidence strength and quality, design quality and packaging, relative advantage and complexity; (2) outer setting—patients’ needs and resources, external policies and incentives; (3) inner setting—structural characteristics, networks and communication, culture, compatibility, readiness for implementation and leadership engagement; (4) characteristics of the managers and HCPs—knowledge and belief about the intervention; (5) process—planning, opinion leaders, formally appointed internal implementation leaders, reflecting and evaluating.ConclusionThis study revealed the organisational and contextual aspects of the implementation based on different and complementary perspectives. With the growing demand for interdisciplinary teams in primary care, we believe that our insights will be helpful for practices, researchers, and policymakers interested in the implementation of disease prevention and management programmes for people with multiple chronic conditions in primary care.Trial registration numberNCT02789800.

scholarly journals Peer-support to increase uptake of screening for diabetic retinopathy: process evaluation of the DURE cluster randomized trial

2020 ◽  
Vol 48 (1) ◽  
Author(s):  
Nyawira Mwangi ◽  
Covadonga Bascaran ◽  
Jacqueline Ramke ◽  
Mathew Kipturgo ◽  
Min Kim ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Process Evaluation ◽  
Peer Support ◽  
Scale Up ◽  
Individual Characteristics ◽  
Policy Framework ◽  
Relative Advantage ◽  
Outer Setting ◽  
Cluster Randomized ◽  
Inner Setting

Abstract Background There is limited evidence on how implementation of peer support interventions influences effectiveness, particularly for individuals with diabetes. We conducted a cluster randomized controlled trial to compare the effectiveness of a peer-led health education package versus usual care to increase uptake of screening for diabetic retinopathy (DR). Methods Our process evaluation used a mixed-method design to investigate the recruitment and retention, reach, dose, fidelity, acceptability, and context of implementation, and was guided by the Consolidated Framework for Implementation Research (CFIR). We reviewed trial documents, conducted semi-structured interviews with key informants (n = 10) and conducted four focus group discussions with participants in both arms of the trial. Three analysts undertook CFIR theory-driven content analysis of the qualitative data. Quantitative data was analyzed to provide descriptive statistics relevant to the objectives of the process evaluation. Results The trial had positive implementation outcomes, 100% retention of clusters and 96% retention for participants, 83% adherence to delivery of content of group talks (fidelity), and 78% attendance (reach) to at least 50% (3/6) of the group talks (dose). The data revealed that intervention characteristics, outer setting, inner setting, individual characteristics, and process (all the constructs of CFIR) influenced the implementation. There were more facilitators than barriers to the implementation. Facilitators included the relative advantage of the intervention compared with current practice (intervention characteristics); awareness of the growing prioritization of diabetes in the national health policy framework (outer setting); tension for change due to the realization of the vulnerability to vision loss from DR (inner setting); a strong collective sense of accountability of peer supporters to implement the intervention (individual characteristics); and regular feedback on the progress with implementation (process). Potential barriers included the need to queue at the eye clinic (intervention characteristic), travel inconveniences (inner setting), and socio-political disruption (outer setting). Conclusions The intervention was implemented with high retention, reach, fidelity, and dose. The CFIR provided a valuable framework for evaluating contextual factors that influenced implementation and helped to understand what adaptations may be needed during scale up. Trial registration Pan African Clinical Trials Registry: PACTR201707002430195 registered 15 July 2017

scholarly journals Attitude towards entrepreneurship: a study among Asnaf Millennials in Malaysia

2020 ◽  
Vol 14 (1) ◽  
pp. 2-14 ◽  
Author(s):  
Tengku Mohd Azizuddin Tuan Mahmood ◽  
Abdullah Al Mamun ◽  
Mohamed Dahlan Ibrahim
Keyword(s):  
Low Income ◽  
Cognitive Skills ◽  
Cross Sectional Study ◽  
Individual Characteristics ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Content Type ◽  
Internal Locus Of Control ◽  
The Government ◽  
Entrepreneurial Activities

Purpose This study intended to determine the effect of selected entrepreneurial traits on the attitude of Asnaf Millennials in Malaysia towards entrepreneurship. Design/methodology/approach This is a cross-sectional study that collected the quantitative data via structured interviews from 310 randomly selected Asnaf Millennials from Kelantan, Malaysia. Findings The findings confirmed the positive and statistically significant effect of innovativeness, internal locus of control, need for achievement and proactive personality on the attitude of Asnaf Millennials on entrepreneurship. Originality/value This study focussed on the development of non-cognitive skills for individual characteristics regarding entrepreneurship for the benefit of development practitioners and policymakers. The government and development organisations should focus on developing entrepreneurial traits that are expected to improve the attitude towards entrepreneurship and increase the entrepreneurial activities in Malaysia. This initiative can improve the socio-economic condition of Asnaf Millennials with low income.

Evaluation of human papillomavirus self-collection offered by community health workers at home visits among under-screened women in Brazil

2020 ◽  
pp. 096914132094105
Author(s):  
Naitielle de Paula Pantano ◽  
José H Fregnani ◽  
Júlio CP Resende ◽  
Luiz C Zeferino ◽  
Bruno de Oliveira Fonseca ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
High Risk ◽  
Community Health ◽  
Community Health Workers ◽  
Low Income ◽  
Pap Smear ◽  
Health Workers ◽  
Major Public Health Problem ◽  
Adult Women

Objective To explore the acceptability of high-risk human papillomavirus self-testing, involving community health workers, for never/under-screened Brazilian women. Cervical cancer is the most common cause of cancer-related death among adult women in a large number of low-income and lower-middle-income countries, where it remains a major public health problem. High-risk human papillomavirus persistence is required for the development of cervical neoplasia. Methods The target population was all women aged 30+ from the list of families available in healthcare centre data, who had never been screened or were not screened in the previous 3 years (under-screened women), and who were living in the 17 cities included in this study. Results Of the 377 women included, 16.9% ( n = 64) had never had a pap smear. Of all samples included in the study, 97.1% ( n = 366) were considered adequate for evaluation, as 2.9% ( n = 11) were considered invalid for all high-risk human papillomavirus types. Analysing these 366 samples, 9.6% ( n = 35) of the women were infected by at least one high-risk human papillomavirus type and 90.4% ( n = 331) had no infection with any high-risk type of the virus. Conclusions Vaginal self-sampling is an adequate strategy to improve the effectiveness of the cervical cancer program by increasing screening in a high-risk group.

scholarly journals 4112 Tools for Self-Management of Obstetric Fistula in Low and Middle-income Countries: A Qualitative Study Exploring Pre-implementation Barriers and Facilitators among Global Stakeholders

2020 ◽  
Vol 4 (s1) ◽  
pp. 149-150
Author(s):  
Nessa E Ryan ◽  
Bernadette Boden-Albala ◽  
Gabriel Ganyaglo ◽  
Alison El Ayadi
Keyword(s):  
Obstetric Fistula ◽  
Clinical Care ◽  
Individual Characteristics ◽  
Relative Advantage ◽  
Self Management ◽  
Implementation Climate ◽  
Middle Income ◽  
Middle Income Countries ◽  
Global Stakeholders ◽  
Low And Middle Income

OBJECTIVES/GOALS: Insertable devices (IDs) for obstetric fistula (OF) management are feasible, acceptable, but not accessible; implementation determinants in low and middle-income countries (LMICs) are unknown. Thus, the purpose of this study was to understand pre-adoption facilitators and barriers among global stakeholders for a therapeutic ID for OF in LMICs. METHODS/STUDY POPULATION: Stakeholders, including researchers (n = 11), clinicians (n = 4), government officials (n = 2), and administrators (n = 4), were purposefully identified from various sectors involved in understanding and addressing the needs of women with OF: clinical care, academia, international health, civil society, and government. Twenty-one individuals were interviewed about their perceptions of IDs for OF self-management and their implementation. Interviews were audio-recorded and transcribed. The Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis. Thematic analyses were carried out within Nvivo v.12. RESULTS/ANTICIPATED RESULTS: Determinants of implementation of an ID for OF self-management (by CFIR domain) include: (1) intervention characteristics—relative advantage and cost; (2) individual characteristics—knowledge and beliefs about the innovation; (3) inner setting-- organizational culture, implementation climate, tension for change, and compatibility; (4) outer setting-- patient needs and resources and external policy and incentives; (5) process—opinion leaders and collaboration. Facilitators include: tension for change for low-cost, accessible IDs; relative advantage over existing tools; development of partnerships; and identification of implementation champions. Barriers include: need for educational strategies to encourage clinical provider acceptability; lack of evidence of the optimal beneficiary. DISCUSSION/SIGNIFICANCE OF IMPACT: Tools for therapeutic OF self-management could be integrated into comprehensive OF programming. Employing the CFIR as an overarching typology allows for comparison across contexts and settings where OF care occurs and may be useful for clinicians, researchers, and policy-makers interested in implementing IDs for OF self-management in LMICs. CONFLICT OF INTEREST DESCRIPTION: I am working with colleagues at the non-profit Restore Health on developing an insertable cup for therapeutic self-management of obstetric fistula in LMICs

scholarly journals Advancing Implementation of Evidence-Based Public Health in China: An Assessment of the Current Situation and Suggestions for Developing Regions

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Jianwei Shi ◽  
Chenghua Jiang ◽  
Duxun Tan ◽  
Dehua Yu ◽  
Yuan Lu ◽  
...  
Keyword(s):  
Public Health ◽  
Structural Characteristics ◽  
Evidence Based ◽  
Implementation Climate ◽  
Developing Regions ◽  
Community Healthcare ◽  
Health Practitioners ◽  
The Status ◽  
Inner Setting ◽  
Public Health Practitioners

Objective. Existing research shows a serious scarcity of EBPH practice in China and other developing regions; as an exploratory study, this study aimed to assess the current EBPH implementation status in Shanghai of China qualitatively.Methods. Using semistructured key informant interviews, we examined the status of and impediments to the lagging EBPH in China. Data were analyzed based on the Consolidated Framework for Implementation Research (CFIR).Results. Chinese public health practitioners knew more about evidence-based medicine but less about EBPH. The situation was worse in community healthcare centers. Participants perceived that evidence sources were limited and the quality of evidence was low. Concerning the inner setting factors, the structural characteristics, networks and communications, implementation climate, and leadership engagement were confronted with many problems. Among the outer setting factors, external government policies and incentives and low patient compliance were the key problems. Additionally, public health practitioners in Shanghai lacked sufficient awareness of EBPH. Furthermore, the current project-based EBPH lacks a systematic implementation system.Conclusions. Existing practical perspectives on EBPH indicate a lag in the advocacy of this new ideology in China. It would be advisable for healthcare institutions to take the initiative to explore feasible and multiple methods of EBPH promotion.

scholarly journals Aspects of Prophylactic Vaccination against Cervical Cancer and Other Human Papillomavirus-Related Cancers in Developing Countries

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Kari Natunen ◽  
Johannes Lehtinen ◽  
Proscovia Namujju ◽  
John Sellors ◽  
Matti Lehtinen
Keyword(s):  
Cervical Cancer ◽  
Developing Countries ◽  
Human Papillomavirus ◽  
Health Services ◽  
Low Income ◽  
Vaccine Coverage ◽  
Prevention Strategies ◽  
Rural Regions ◽  
Effective Prevention ◽  
Vaccination Strategies

Cervical cancer and other human papillomavirus- (HPV-) related cancers are preventable, but preventive measures implemented in developing countries and especially in low-income rural regions have not been effective. Cervical cancer burden derived from sexually transmitted HPV infections is the heaviest in developing countries, and a dramatic increase in the number of cervical cancer cases is predicted, if no intervention is implemented in the near future. HPV vaccines offer an efficient way to prevent related cancers. Recently implemented school-based HPV vaccination demonstration programmes can help tackle the challenges linked with vaccine coverage, and access to vaccination and health services, but prevention strategies need to be modified according to regional characteristics. In urban regions WHO-recommended vaccination strategies might be enough to significantly reduce HPV-related disease burden, but in the rural regions additional vaccination strategies, vaccinating both sexes rather than only females when school attendance is the highest and applying a two-dose regime, need to be considered. From the point of view of both public health and ethics identification of the most effective prevention strategies is pivotal, especially when access to health services is limited. Considering cost-effectiveness versus justice further research on optional vaccination strategies is warranted.

scholarly journals Experiences of care in the context of payment for performance (P4P) in Tanzania

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Victor Chimhutu ◽  
Marit Tjomsland ◽  
Mwifadhi Mrisho
Keyword(s):  
Health Service ◽  
Low Income ◽  
Health Workers ◽  
Qualitative Content Analysis ◽  
Health Sector ◽  
Governing Committee ◽  
Low Income Countries ◽  
Service Users ◽  
Health Coverage ◽  
The Government

Abstract Background Tanzania is one of many low income countries committed to universal health coverage and Sustainable Development Goals. Despite these bold goals, there is growing concern that the country could be off-track in meeting these goals. This prompted the Government of Tanzania to look for ways to improve health outcomes in these goals and this led to the introduction of Payment for Performance (P4P) in the health sector. Since the inception of P4P in Tanzania a number of impact, cost-effective and process evaluations have been published with less attention being paid to the experiences of care in this context of P4P, which we argue is important for policy agenda setting. This study therefore explores these experiences from the perspectives of health workers, service users and community health governing committee members. Methods A qualitative study design was used to elicit experiences of health workers, health service users and health governing committee members in Rufiji district of the Pwani region in Tanzania. The Payment for Performance pilot was introduced in Pwani region in 2011 and data presented in this article is based on this pilot. A total of 31 in-depth interviews with health workers and 9 focus group discussions with health service users and health governing committee members were conducted. Collected data was analysed through qualitative content analysis. Results Study informants reported positive experiences with Payment for Performance and highlighted its potential in improving the availability, accessibility, acceptability and quality of care (AAAQ). However, the study found that persistent barriers for achieving AAAQ still exist in the health system of Tanzania and these contribute to negative experiences of care in the context of P4P. Conclusion Our findings suggest that there are a number of positive aspects of care that can be improved by Payment for Performance. However its targeted nature on specific services means that these improvements cannot be generalized at health facility level. Additionally, health workers can go as far as they can in improving health services but some factors that act as barriers as demonstrated in this study are out of their control even in the context of Payment for Performance. In this regard there is need to exercise caution when implementing such initiatives, despite seemingly positive targeted outcomes.

scholarly journals Model strategies to address barriers to cervical cancer treatment and palliative care among women in Zimbabwe: a public health approach

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Oscar Tapera ◽  
Greta Dreyer ◽  
Anna Mary Nyakabau ◽  
Webster Kadzatsa ◽  
Babill Stray-Pedersen ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Low Income ◽  
Health Workers ◽  
Qualitative Inquiry ◽  
Health Facilities ◽  
System Level ◽  
Public Health Approach ◽  
Multidisciplinary Teams

Abstract Background Cervical cancer treatment and care remains limited in Zimbabwe despite the growing burden of the disease among women. This study was aimed at investigating strategies to address barriers in accessing treatment and care by women with cervical cancer in Harare, Zimbabwe. Methods A qualitative inquiry was conducted to generate evidence for this study. Eighty-four (84) participants were purposively selected for interviews and participation in focus group discussions. The participants were selected from cervical cancer patients, caregivers of cervical cancer patients, health workers involved in the care of cervical cancer patients as well as relevant policy makers in the Ministry of Health and Child Care. Participants were selected in such as a way as to ensure different of characteristics to obtain diverse perspectives about the issues under study. Discussion and interview guides were used as data collection tools and discussions/interviews were audio-recorded, transcribed and translated into English. Inductive thematic analysis was conducted using Dedoose software. Results Salient sub-themes that emerged in the study at the individual patient level were: provision of free or subsidized services, provision of transport to treating health facilities and provision of accommodation to patients undergoing treatment. At the societal level, the sub-themes were: strengthening of health education in communities and training of health workers and community engagement. Salient sub-themes from the national health system level were: establishment of more screening and treatment health facilities, increasing the capacities of existing facilities, decentralization of some services, building of multidisciplinary teams of health workers, development and rolling out of standardized guidelines and reformation of Acquired Immunodeficiency Virus (AIDS) levy into a fund that would finance priority disease areas. Conclusion This study revealed some noteworthy strategies to improve access to cervical cancer treatment and care in low-income settings. Improved domestic investments in health systems and reforming health policies underpinned on strong political are recommended.

scholarly journals Oral Health of Tobacco and Non-Tobacco Consumers Inyaounde, Cameroon

2020 ◽  
Vol 1 (2) ◽  
Author(s):  
Ashu Michael Agbor ◽  
Yougang Francine Josepha Jupkwo
Keyword(s):  
Oral Health ◽  
Low Socioeconomic Status ◽  
Low Income ◽  
Tooth Loss ◽  
Health Workers ◽  
Periodontal Diseases ◽  
Tobacco Consumption ◽  
Oral Diseases ◽  
Cross Sectional ◽  
The Government

Introduction: Tobacco consumption is risk factor of many infectious and endemic diseases. The objective of our study was to compare the oral health of smokers and non-smokers in the city of Yaoundé, Cameroon.  Methodology: This was a cross-sectional descriptive study using a stratified random sampling that took place between April to September 2014 in which both smokers and non-smokers participated. Results: Two hundred smokers and 200 non-smokers comprising 341 men and 59 women participated in the study with the 25-35 years age group was most represented. A third of the smokers were unemployed 72 (36.0%), 45(22.5%) had low income employment, 94(51.4%) were initiated into smoking when they were less than 10 years old; 90(45.5%) took between 1 and 15 sticks of cigarettes a day. Supra-gingival calculus, halitosis, xerostomia, periodontal diseases, tooth mobility, painless carious cavitation’s and tooth loss were more frequent in smokers. Toothache from carious cavitations, tooth loss was more frequent in smokers while toothache from deep caries was found more in non-smokers. Conclusion: The frequency of oral diseases was higher in tobacco smokers than non-smokers. People from low socioeconomic status, males and the unemployed were mostly affected. Recommendations: The government and stake holders in public health should formulate policies that will reduce cigarette smoking and also involve oral health workers in their campaigns.

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