scholarly journals A qualitative and quantitative performance evaluation of Swaziland’s Rural Health Motivator program

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 607
Author(s):  
Pascal Geldsetzer ◽  
Maria Vaikath ◽  
Jan-Walter De Neve ◽  
Till Bärnighausen ◽  
Thomas J. Bossert
Keyword(s):  
Rural Health ◽  
Health Workers ◽  
Qualitative Interviews ◽  
Household Survey ◽  
Evaluation Framework ◽  
Simple Random Sample ◽  
Care Seeking ◽  
Community Members ◽  
Emergency Situations ◽  
Quantitative Performance

Background: Community health workers (CHWs) are increasingly used to increase access to primary healthcare, and considered to be a key health worker cadre to achieve the UNAIDS 90-90-90 target. Despite the recent policy interest in effectively designing, implementing, and evaluating new CHW programs, there is limited evidence on how long-standing CHW programs are performing. Using the CHW Performance Logic model as an evaluation framework, this study aims to assess the performance of Swaziland’s long-standing national CHW program, called the rural health motivator (RHM) program. Methods: This study was carried out in the Manzini and Lubombo regions of Swaziland. We conducted a survey of 2,000 households selected through two-stage cluster random sampling and a survey among a stratified simple random sample of 306 RHMs. Additionally, semi-structured qualitative interviews were conducted with 25 RHMs. Results: While RHMs are instructed to visit every household assigned to them at least once a month, only 15.7% (95% CI: 11.4 – 20.4%) of RHMs self-reported to be meeting this target. Less than half (46.3%; 95% CI: 43.4 – 49.6%) of household survey respondents, who reported to have ever been visited by a RHM, rated their overall satisfaction with RHM services as eight or more points on a 10-point scale (ranging from “very dissatisfied” to “very satisfied”). A theme arising from the qualitative interviews was that community members only rarely seek care from RHMs, with care-seeking tending to be constrained to emergency situations. Conclusions: The RHM program does not meet some of its key performance objectives. Two opportunities to improve RHM performance identified by the evaluation were increasing RHM's stipend and improving the supply of equipment and material resources needed by RHMs to carry out their tasks.

scholarly journals The effect of community dialogues and sensitization on patient reporting of adverse events in rural Uganda: uncontrolled before-after study

2018 ◽  
Author(s):  
Helen Byomire Ndagije ◽  
Leonard Manirakiza ◽  
Dan Kajungu ◽  
Edward Galiwango ◽  
Donna Kusemererwa ◽  
...  
Keyword(s):  
Adverse Events ◽  
Community Engagement ◽  
Adverse Drug Events ◽  
Health Workers ◽  
Household Survey ◽  
Rural Setting ◽  
Health Issues ◽  
Community Members ◽  
Cross Sectional ◽  
Before And After

AbstractBackgroundThe patients that experience adverse events are in the best position to report them, only if they were empowered to do so. Systematic community engagement and support to patients in a rural setting to monitor any potential harm from medicines should provide evidence for patient safety.MethodsThis paper describes an uncontrolled before and after study aimed at assessing the effect of a community engagement strategy, the Community Dialogues and Sensitization (CDS) intervention between January and April 2017, on the knowledge, attitude and practice of reporting adverse drug events by community members in the two eastern Ugandan districts. A representative cross-sectional baseline household survey was done prior to the intervention in September 2016 (n=1034) and the end-line survey (n=827) in July 2017.ResultsAfter implementation of the CDS intervention, there was an overall 20% (95% CI=16- 25) increase in awareness about adverse drug events in the community. The young people (15- 24 years) demonstrated a 41% (95% CI =31-52) increase and the un-educated showed a 50% (95% CI=37-63) increase in awareness about adverse drug events. The attitudes towards reporting increased overall by 5% in response to whether there was a need to report ADEs (95% CI =3-7). An overall 115% (95% CI =137-217) increase in the population that had ever experienced ADEs was also reported.ConclusionOur evaluation shows that the CDS intervention increases knowledge, improves attitudes by catalyzing discussions among community members and health workers on health issues and monitoring safety of medicines.

scholarly journals Demand for malaria rapid diagnostic test, health care-seeking behaviour, and drug use among rural community members with fever or malaria-like illness in Ebonyi state, Nigeria: a cross-sectional household survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ugwu I. Omale ◽  
Onyinyechukwu U. Oka ◽  
Ifeyinwa M. Okeke ◽  
Benedict N. Azuogu ◽  
Chihurumnanya Alo ◽  
...  
Keyword(s):  
Health Care ◽  
Drug Use ◽  
Rural Community ◽  
Malaria Diagnosis ◽  
Household Survey ◽  
Health Care Seeking ◽  
Care Seeking ◽  
Community Members ◽  
Cross Sectional ◽  
Traditional Practitioners

Abstract Background A good understanding of the demand for malaria rapid diagnostic test (MRDT), malaria health care-seeking behavior, and drug use among community members is crucial to malaria control efforts. The aim of this study was to assess the demand (use and/or request) for MRDT, health care-seeking behavior, and drug use, as well as associated factors, among rural community members (both children and adults) with fever or malaria-like illness in Ebonyi state, Nigeria. Methods A cross-sectional household survey was conducted between October 1st and November 7th, 2018, in 18 rural geographical clusters. Data was collected using a structured interviewer-administered questionnaire. Descriptive analysis was done using summary statistics. Associated factors (socio-demographic, knowledge and opinion level) were assessed using bivariate and multivariate binomial logistic regressions while the overall effects of these factors were assessed using the “postestimation test” command in Stata. Results A total of 1310 children under 5 years of age and 2329 children ages 5 years and above and adults (excluding pregnant women) (3639 overall) participated in the study. Among the 1310 children under 5 years of age: 521 (39.8%) received MRDT of which the caregivers of 82 (15.7%) requested for the MRDT; 931 (71.1%) sought care with public/private sector providers (excluding traditional practitioners/drug hawkers) the same/next day; 495 (37.8%) sought care at government primary health centres, 744 (56.8%) sought care with the patent medicine vendors (PMVs); 136 (10.4%) sought care with traditional practitioners; 1020 (77.9%) took ACTs (=88.2%, 1020/1156 of those who took anti-malarial drugs). Generally, lower values were respectively recorded among the 2329 children ages 5 years and above and adults (excluding pregnant women). The most important overarching predictor of the demand for MRDT and care-seeking behaviour was the knowledge and opinion level of respondent female heads of households about malaria and malaria diagnosis. Conclusions Among the rural community members with fever or malaria-like illness in Ebonyi state, Nigeria, while majority did not receive MRDT or diagnostic testing, and sought care with the PMVs, most took anti-malaria drugs, and mostly ACTs. Interventions are needed to improve the knowledge and opinion of the female heads of households about malaria and malaria diagnosis.

scholarly journals SMS feedback system as a quality assurance mechanism: experience from a household survey in rural India

2021 ◽  
Vol 6 (Suppl 5) ◽  
pp. e005287
Author(s):  
Neha Shah ◽  
Osama Ummer ◽  
Kerry Scott ◽  
Jean Juste Harrisson Bashingwa ◽  
Nehru Penugonda ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Data Quality ◽  
Health Workers ◽  
Digital Health ◽  
Qualitative Interviews ◽  
Household Survey ◽  
Feedback Loops ◽  
Text Messages ◽  
Data Capture ◽  
Quality Assurance Mechanism

The increasing use of digital health solutions to support data capture both as part of routine delivery of health services and through special surveys presents unique opportunities to enhance quality assurance measures. This study aims to demonstrate the feasibility and acceptability of using back-end data analytics and machine learning to identify impediments in data quality and feedback issues requiring follow-up to field teams using automated short messaging service (SMS) text messages. Data were collected as part of a postpartum women’s survey (n=5095) in four districts of Madhya Pradesh, India, from October 2019 to February 2020. SMSs on common errors found in the data were sent to supervisors and coordinators. Before/after differences in time to correction of errors were examined, and qualitative interviews conducted with supervisors, coordinators, and enumerators. Study activities resulted in declines in the average number of errors per week after the implementation of automated feedback loops. Supervisors and coordinators found the direct format, complete information, and automated nature of feedback convenient to work with and valued the more rapid notification of errors. However, coordinators and supervisors reported preferring group WhatsApp messages as compared with individual SMSs to each supervisor/coordinator. In contrast, enumerators preferred the SMS system over in-person group meetings where data quality impediments were discussed. This study demonstrates that automated SMS feedback loops can be used to enhance survey data quality at minimal cost. Testing is needed among data capture applications in use by frontline health workers in India and elsewhere globally.

scholarly journals Communities and service providers address access to perinatal care in postconflict Northern Uganda: socialising evidence for participatory action

2021 ◽  
Vol 9 (2) ◽  
pp. e000610
Author(s):  
Loubna Belaid ◽  
Pamela Atim ◽  
Eunice Atim ◽  
Emmanuel Ochola ◽  
Martin Ogwang ◽  
...  
Keyword(s):  
Service Provider ◽  
Service Providers ◽  
Health Workers ◽  
Perinatal Care ◽  
Household Survey ◽  
Service Improvement ◽  
Northern Uganda ◽  
Care Seeking ◽  
Short Term ◽  
Provider Attitudes

ObjectivesDescribe participatory codesign of interventions to improve access to perinatal care services in Northern Uganda.Study designMixed-methods participatory research to codesign increased access to perinatal care. Fuzzy cognitive mapping, focus groups and a household survey identified and documented the extent of obstructions to access. Deliberative dialogue focused stakeholder discussions of this evidence to address the obstacles to access. Most significant change stories explored the participant experience of this process.SettingThree parishes in Nwoya district in the Gulu region, Northern Uganda.ParticipantsPurposively sampled groups of women, men, female youth, male youth, community health workers, traditional midwives and service providers. Each of seven stakeholder categories included 5–8 participants in each of three parishes.ResultsStakeholders identified several obstructions to accessing perinatal care: lack of savings in preparation for childbirth in facility costs, lack of male support and poor service provider attitudes. They suggested joining saving groups, practising saving money and income generation to address the short-term financial shortfall.They recommended increasing spousal awareness of perinatal care and they proposed improving service provider attitudes. Participants described their own improved care-seeking behaviour and patient–provider relationships as short-term gains of the codesign.ConclusionParticipatory service improvement is feasible and acceptable in postconflict settings like Northern Uganda. Engaging communities in identifying perinatal service delivery issues and reflecting on local evidence about these issues generate workable community-led solutions and increases trust between community members and service providers.

scholarly journals Perceptions of diabetes in rural areas of Eastern Uganda

Curationis ◽  
2013 ◽  
Vol 36 (1) ◽  
Author(s):  
Elizeus Rutebemberwa ◽  
Sheila K. Katureebe ◽  
Sheba N. Gitta ◽  
Amos D. Mwaka ◽  
Lynn Atuyambe
Keyword(s):  
Focus Group ◽  
Rural Areas ◽  
Health Workers ◽  
Sub Saharan Africa ◽  
Care Seeking ◽  
Community Members ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Fatty Food ◽  
Eastern Uganda

Background: People diagnosed with diabetes mellitus are increasing in sub-Saharan Africa and prompt care seeking depends on perceptions of the illness. Objective: The objective was to explore perceptions of diabetes in rural areas. Method: We conducted a qualitative, explorative and descriptive study in rural eastern Uganda. Eight focus group discussions with community members were conducted. Community members were presented with a story about a person with diabetes symptoms and their perceptions of the diagnosis and treatment elicited. Four focus group discussions with people with diabetes and seven key informant interviews with health workers were conducted. Respondents were asked how the community interpreted symptoms of diabetes, its causes and whether it was curable. Manifest content analysis was used. Results: Some respondents thought people with diabetes symptoms had HIV or were bewitched. Causes of diabetes mentioned included consuming too much fatty food. Some respondents thought diabetes is transmitted through air, sharing utensils with or sitting close to people with diabetes. Some respondents thought that diabetes could heal fast whilst others thought it was incurable. Conclusion: Misdiagnosis may cause delay in seeking proper care. Preventive programmes could build on people’s thinking that too much fatty food causes diabetes to promote diets with less fat. The perception of diabetes as a contagious disease leads to stigmatisation and affects treatment seeking. Seeing diabetes as curable could create patient expectations that may not be fulfilled in the management of diabetes. Rural communities would benefit from campaigns creating awareness of prevention, symptoms, diagnosis and management of diabetes.

scholarly journals Knowledge, Awareness, and Health-Seeking Behaviour regarding Tuberculosis in a Rural District of Khyber Pakhtunkhwa, Pakistan

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Adeela Khan ◽  
Babar Tasneem Shaikh ◽  
Mirza Amir Baig
Keyword(s):  
Health Workers ◽  
Household Survey ◽  
Care Seeking ◽  
Health Seeking Behaviour ◽  
Health Seeking ◽  
Group Discussions ◽  
Khyber Pakhtunkhwa ◽  
Ethical Approval ◽  
Khyber Pakhtunkhwa Province ◽  
Quantitative Results

Background. Pakistan is a country with one of the highest burden of tuberculosis (TB) in the world, and therefore, it is imperative to revisit the design of behaviour change interventions in the program. This study was designed to understand and assess the knowledge, awareness, perceptions, and health-seeking behaviour of general and specifically TB-affected population and to determine the presence and level of stigma and discrimination toward TB patients. Methods. A mixed-method study was conducted in district Haripur of the Khyber Pakhtunkhwa province, comprising a household survey, whereby 526 individuals were interviewed, and five focus group discussions with various subgroups including TB patients and health workers and authorities. Study sought an ethical approval, and data of all respondents was kept confidential. Results. Quantitative results show that women were more knowledgeable on symptomatology and spread of TB, and with rising education, awareness on TB improves. The majority of our respondents had the understanding that it is a curable disease, yet some would avoid TB patients. Most of the respondents (both men and women) knew that one must go to a government facility for treatment. Only one-third would speak to doctor first, if they suspect TB-like symptoms. Television was a popular source of information on TB. Qualitative results captured people’s perceptions that TB was related with poverty and was still considered a stigma in the community; hence, patients afflicted feared disclosing the disease. Conclusion. With contextual understanding of communities’ knowledge, attitudes, health-seeking behaviour, and care-seeking patterns, it can be concluded that there is a need to increase the awareness about TB symptoms, mode of transmission, prevention, diagnosis and treatment, and destigmatization of the disease through health education.

An Intelligent Computer-Assisted Instruction System Designed for Rural Health Workers in Developing Countries

1992 ◽  
Vol 31 (03) ◽  
pp. 193-203 ◽  
Author(s):  
B. Auvert ◽  
V. Gilbos ◽  
F. Andrianiriana ◽  
W. E. Bertrand ◽  
X. Emmanuelli ◽  
...  
Keyword(s):  
Developing Countries ◽  
Decision Support ◽  
Rural Health ◽  
Health Workers ◽  
Computer Assisted Instruction ◽  
Computer Assisted ◽  
Instruction System ◽  
Knowledge Based ◽  
Assisted Instruction ◽  
Intelligent Computer

Abstract:This paper describes an intelligent computer-assisted instruction system that was designed for rural health workers in developing countries. This system, called Consult-EAO, includes an expert module and a coaching module. The expert module, which is derived from the knowledge-based decision support system Tropicaid, covers most of medical practice in developing countries. It allows for the creation of outpatient simulations without the help of a teacher. The student may practice his knowledge by solving problems with these simulations. The system gives some initial facts and controls the simulation during the session by guiding the student toward the most efficient decisions. All student answers are analyzed and, if necessary, criticized. The messages are adapted to the situation due to the pedagogical rules of the coaching module. This system runs on PC-compatible computer.

scholarly journals Women’s multiple uses of an overdose prevention technology to mitigate risks and harms within a supportive housing environment: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Geoff Bardwell ◽  
Taylor Fleming ◽  
Ryan McNeil ◽  
Jade Boyd
Keyword(s):  
Qualitative Interviews ◽  
Urban Setting ◽  
Supportive Housing ◽  
People Who Use Drugs ◽  
Opioid Overdose ◽  
Response Button ◽  
Gender Based Violence ◽  
Emergency Situations ◽  
Housing Environment ◽  
Gender Based

Abstract Background North America is amidst an opioid overdose epidemic. In many settings, particularly Canada, the majority of overdose deaths occur indoors and impact structurally vulnerable people who use drugs alone, making targeted housing-based interventions a priority. Mobile applications have been developed that allow individuals to solicit help to prevent overdose death. We examine the experiences of women residents utilizing an overdose response button technology within a supportive housing environment. Methods In October 2019, we conducted semi-structured qualitative interviews with 14 residents of a women-only supportive housing building in an urban setting where the overdose response button technology was installed. Data was analyzed thematically and framed by theories of structural vulnerability. Results While participants described the utility and disadvantages of the technology for overdose response, most participants, unexpectedly described alternate adoptions of the technology. Participants used the technology for other emergency situations (e.g., gender-based violence), rather than its intended purpose of overdose response. Conclusions Our findings highlight the limitations of current technologies while also demonstrating the clear need for housing-based emergency response interventions that address not just overdose risk but also gender-based violence. These need to be implemented alongside larger strategies to address structural vulnerabilities and provide greater agency to marginalized women who use drugs.

scholarly journals Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kirsten Austad ◽  
Michel Juarez ◽  
Hannah Shryer ◽  
Patricia L. Hibberd ◽  
Mari-Lynn Drainoni ◽  
...  
Keyword(s):  
Health Workers ◽  
Positive Impact ◽  
Qualitative Evaluation ◽  
Obstetric Care ◽  
Hospital Staff ◽  
Public Hospitals ◽  
Future Research ◽  
Care Seeking ◽  
Structured Interviews ◽  
The Impact

Abstract Background Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands. Methods We conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff—namely physicians, nurses, and social workers—of the main public hospital in the pilot’s catchment area (Chimaltenango). Interviews queried OCN’s impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis. Results Maternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks. Conclusions Many barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers’ experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff—especially nurses—appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers’ future care seeking behavior.

scholarly journals Humanitarian crisis and sustainable development: perspectives and preferences of internally displaced persons in the northeastern Nigeria

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Muazu Shehu ◽  
Adamu Abba
Keyword(s):  
Sustainable Development ◽  
Qualitative Interviews ◽  
Internally Displaced ◽  
Emergency Situations ◽  
Development Agenda ◽  
Conflict Situations ◽  
Durable Solutions ◽  
Local Integration ◽  
The Government ◽  
Major Factors

AbstractThis study seeks to contribute to the knowledge of linkages between humanitarian actions in conflict situations and sustainable development. We analysed data generated from qualitative interviews and focus group discussions with encamped and self-settled internally displaced victims (IDPs) of the Boko Haram insurgency in the northeastern Nigeria. Our analysis searched for themes that summarise their preferences and desires of durable solutions. Overall, the majority of the IDPs were more inclined to local integration or resettlement than return. More than males, female IDPs were likely to cite personal experience of violence as a reason for rejecting voluntary repatriation. Feelings of vulnerability, experience of violence and hope of economic and social empowerment were major reasons given in support of local integration or resettlement. Self-settled IDPs are more disposed to returning to their places of origin than encamped IDPs. The need to rebuild livelihoods and restore social and community networks were the major factors participants associated with the choice of return. Beliefs in divine destiny, lack of trust and confidence in the government were dominant views expressed by participants who were indifferent about durable solutions. There is a sense that cultural androcentric norms which give men the power to make decisions for the family shape decision-making even in emergency situations. We conclude that, regardless of their preferences about durable solutions, IDPs have long-term needs that can only be provided if humanitarian actions are integrated into the overall development agenda and programmes of governments.

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