Health system decision makers' feedback on summaries and tools supporting the use of systematic reviews: a qualitative study

Abstract Background In Kenya, street-connected children and youth (SCY) have poor health outcomes and die prematurely due to preventable causes. This suggests they are not accessing or receiving adequately responsive healthcare to prevent morbidity and mortality. We sought to gain insight into the health systems responsiveness to SCY in Kenya through an in-depth exploration of SCY’s and healthcare provider’s reflections on their interactions with each other. Methods This qualitative study was conducted across 5 counties in western Kenya between May 2017 and September 2018 using multiple methods to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY in Kenya. The present analysis focuses on a subset of data from focus group discussions and in-depth interviews concerning the delivery of healthcare to SCY, interactions between SCY and providers, and SCY’s experiences in the health system. We conducted a thematic analysis situated in a conceptual framework for health systems responsiveness. Results Through three themes, context, negative patient-provider interactions, and positive patient-provider interactions, we identified factors that shape health systems responsiveness to SCY in Kenya. Economic factors influenced and limited SCY’s interactions with the health system and shaped their experiences of dignity, quality of basic amenities, choice of provider, and prompt attention. The stigmatization and discrimination of SCY, a sociological process shaped by the social-cultural context in Kenya, resulted in experiences of indignity and a lack of prompt attention when interacting with the health system. Patient-provider interactions were highly influenced by healthcare providers’ adverse personal emotions and attitudes towards SCY, resulting in negative interactions and a lack of health systems responsiveness. Conclusions This study suggests that the health system in Kenya is inadequately responsive to SCY. Increasing public health expenditures and expanding universal health coverage may begin to address economic factors, such as the inability to pay for care, which influence SCY’s experiences of choice of provider, prompt attention, and dignity. The deeply embedded adverse emotional responses expressed by providers about SCY, associated with the socially constructed stigmatization of this population, need to be addressed to improve patient-provider interactions.

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Health System Factors Constrain HIV Care Providers in Delivering High-Quality Care: Perceptions from a Qualitative Study of Providers in Western Kenya

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958218823285 ◽

2019 ◽

Vol 18 ◽

pp. 232595821882328 ◽

Cited By ~ 4

Author(s):

Becky Genberg ◽

Juddy Wachira ◽

Catherine Kafu ◽

Ira Wilson ◽

Beatrice Koech ◽

...

Keyword(s):

Qualitative Study ◽

Health System ◽

Working Environment ◽

Health System Strengthening ◽

Eastern Africa ◽

Hiv Care ◽

Care Providers ◽

High Quality ◽

Western Kenya ◽

System Factors

The burden on health systems due to increased volume of patients with HIV continues to rapidly increase. The goal of this study was to examine the experiences of HIV care providers in a high patient volume HIV treatment and care program in eastern Africa. Sixty care providers within the Academic Model Providing Access to Healthcare program in western Kenya were recruited into this qualitative study. We conducted in-depth interviews focused on providers’ perspectives on health system factors that impact patient engagement in HIV care. Results from thematic analysis demonstrated that providers perceive a work environment that constrained their ability to deliver high-quality HIV care and encouraged negative patient–provider relationships. Providers described their roles as high strain, low control, and low support. Health system strengthening must include efforts to improve the working environment and easing burden of care providers tasked with delivering antiretroviral therapy to increasing numbers of patients in resource-constrained settings.

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94 Short-term use of therapeutic opioids for children and future opioid use disorders: A systematic review and qualitative study of decision-maker information needs

Paediatrics & Child Health ◽

10.1093/pch/pxab061.076 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e68-e68

Author(s):

Malema Ahrari ◽

Samina Ali ◽

Michele Dyson ◽

Lisa Hartling

Keyword(s):

Systematic Review ◽

Qualitative Study ◽

Information Needs ◽

Policy Decision ◽

Decision Makers ◽

Snowball Sampling ◽

Opioid Use ◽

Short Term ◽

Short Term Exposure ◽

Evidence Summary

Abstract Primary Subject area Emergency Medicine - Paediatric Background Healthcare visits, hospitalizations, and deaths due to opioid-related harms continue to rise for children, despite an overall decline in opioid prescriptions. Decision-makers (including patients and families, clinicians, and policy-makers) require high quality syntheses to inform decisions regarding opioid use. Previous research has found that how systematic review (SR) results are presented may influence uptake by decision-makers. Evidence summaries are appealing to decision-makers as they provide key messages in a succinct manner. Objectives 1) To conduct an SR examining the association between short-term therapeutic exposure to opioids in children and development of opioid use disorder, and 2) To gain perspectives from policy decision-makers on the usability and presentation of results through the form of an evidence summary. Design/Methods We conducted an SR following methods recommended by Cochrane. A medical librarian conducted a comprehensive search and two authors were involved in study selection, data extraction and quality assessment. Studies were eligible if they reported primary research in English or French, and study participants had therapeutic exposure to opioids before age 18 years. Results were described narratively. Decision makers were recruited through purposive and snowball sampling methods, and they participated in interviews to discuss an evidence summary based on the SR. Interviews were transcribed and data were analyzed using content analysis. Ethics approval was obtained for the qualitative study. Results Nineteen American studies involving 47,191,990 participants were included. One study demonstrated that short-term therapeutic exposure may be associated with opioid abuse. Four others showed an association without specifying duration of exposure. Fourteen studies provided information on prevalence or incidence of opioid misuse following therapeutic exposure, median 27.8% [interquartile range 21.4% – 30.7%]; notably, 12 of them did not specify duration of therapeutic exposure. Identified risk factors were contradictory and remain unclear. Decision makers had mixed preferences for the presentation of evidence, depending on their degree of involvement in research versus practice. A majority preferred having methods and key characteristics of studies included in the first page of the evidence summary. They noted that the summary should not be text-heavy and details should be appended. Conclusion A number of studies suggest there is an association between lifetime therapeutic opioid use (unknown duration) and future nonmedical opioid use; however, there is limited evidence to determine whether short-term exposure is specifically associated with these outcomes. Policy and decision-makers prefer a succinct evidence summary for this SR, with study-specific details provided as an appendix. PROSPERO Registration: 122681.

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Health Priority Setting in Iran: Evaluating Against the Social Values Framework

Global Journal of Health Science ◽

10.5539/gjhs.v8n10p212 ◽

2016 ◽

Vol 8 (10) ◽

pp. 212

Author(s):

Hakimeh Mostafavi ◽

Arash Rashidian ◽

Mohammad Arab ◽

Mohammad R. V. Mahdavi ◽

Kioomars Ashtarian

Keyword(s):

Health Care ◽

Health System ◽

Priority Setting ◽

Social Values ◽

City Council ◽

Decision Makers ◽

The Public ◽

Health Technologies ◽

Health Priority ◽

The Social

Background: Health systems, as part of the social system, consider public values. This study was conducted to examine the role of social values in the health priority setting in the Iranian health system.Methods: In this qualitative case study, three main data sources were used: literature, national documents, and key informants who were purposefully selected from health care organizations and other related institutions. Data was analyzed and interpreted using the Clark-Weale Framework.Results: According to our results, the public indirectly participates in decision-making. The public representatives participate in the meetings of the health priority setting as parliament members, representatives of some unions, members of the city council, and donors. The transparency of the decisions and the accountability of the decision makers are low. Decision makers only respond to complaints of the Audit Court and the Inspection Organization. Individual choice, although respected in hospitals and clinics, is limited in health care networks because of the referral system. Clinical effectiveness is considered in insurance companies and some hospitals. There are no technical abilities to determine the cost-effectiveness of health technologies; however, some international experiences are employed. Equity and solidarity are considered in different levels of the health system.Conclusion: Social values are considered in the health priority decisions in limited ways. It seems that the lack of an appropriate value-based framework for priority setting and also the lack of public participation are the major defects of the health system. It is recommended that health policymakers invite different groups of people and stakeholders for active involvement in health priority decisions.

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Improving Health System Efficiency: Perspectives of Decision-Makers

Healthcare Quarterly ◽

10.12927/hcq.2017.25143 ◽

2017 ◽

Vol 20 (1) ◽

pp. 10-13 ◽

Cited By ~ 1

Author(s):

Sara Allin ◽

Sara Guilcher ◽

Dana Riley ◽

Yu Janice Zhang

Keyword(s):

Health System ◽

Decision Makers ◽

System Efficiency ◽

Health System Efficiency

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Perception of ‘Comprehensiveness of Care’: a qualitative study amongst dentists in the Brazilian Health System

Brazilian Oral Research ◽

10.1590/1807-3107bor-2015.vol29.0037 ◽

2015 ◽

Vol 29 (1) ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Grazielle Christine Maciel MATTOS ◽

Jennifer Elizabeth GALLAGHER ◽

Saul Martins PAIVA ◽

Mauro Henrique Nogueira Guimarães ABREU

Keyword(s):

Qualitative Study ◽

Health System ◽

Brazilian Health System

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Exploring the Potential Factors Influencing the Adoption of M-Government Services in Saudi Arabia: A Qualitative Analysis

International Journal of Business and Management ◽

10.5539/ijbm.v11n8p56 ◽

2016 ◽

Vol 11 (8) ◽

pp. 56 ◽

Cited By ~ 4

Author(s):

Raed Alotaibi ◽

Luke Houghton ◽

Kuldeep Sandhu

Keyword(s):

Saudi Arabia ◽

Qualitative Study ◽

Relevant Literature ◽

Decision Makers ◽

Intention To Use ◽

Structured Interviews ◽

Government Services ◽

Factors Influencing ◽

Tam Model ◽

Potential Factors

In Saudi Arabia, Mobile government (m-government) is in its infancy. This study aims to explore potential factors influencing adoption of m-government services in Saudi Arabia to improve future implementation. The review of the relevant literature revealed a lack of research regarding the factors that may potentially influence the adoption m-government services in Saudi Arabia by using TAM model based on the perspective of experts in Yesser. To examine relationships between external factors and behavioural intention to use (BIU) in the TAM model, a qualitative study was conducted using semi-structured interviews with five experts from Yesser. Analysis demonstrated that the factors of trustworthiness, usage experience, awareness and security might influence the adoption of m-government services in Saudi Arabia. The results of the qualitative study also demonstrated that enjoyment does not influence the adoption of m-government services in Saudi Arabia. These findings may help decision makers in Saudi government to improve future implementation of m-government services.

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Development of the ACTIVE framework to describe stakeholder involvement in systematic reviews

Journal of Health Services Research & Policy ◽

10.1177/1355819619841647 ◽

2019 ◽

Vol 24 (4) ◽

pp. 245-255 ◽

Cited By ~ 5

Author(s):

Alex Pollock ◽

Pauline Campbell ◽

Caroline Struthers ◽

Anneliese Synnot ◽

Jack Nunn ◽

...

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Health Professionals ◽

Public Involvement ◽

Review Process ◽

Data Extraction ◽

Stakeholder Involvement ◽

Decision Makers ◽

Literature Searching ◽

Health Decision

Objectives Involvement of patients, health professionals, and the wider public (‘stakeholders’) is seen to be beneficial to the quality, relevance and impact of research and may enhance the usefulness and uptake of systematic reviews. However, there is a lack of evidence and resources to guide researchers in how to actively involve stakeholders in systematic reviews. In this paper, we report the development of the ACTIVE framework to describe how stakeholders are involved in systematic reviews. Methods We developed a framework using methods previously described in the development of conceptual frameworks relating to other areas of public involvement, including: literature searching, data extraction, analysis, and categorization. A draft ACTIVE framework was developed and then refined after presentation at a conference workshop, before being applied to a subset of 32 systematic reviews. Data extracted from these systematic reviews, identified in a systematic scoping review, were categorized against pre-defined constructs, including: who was involved, how stakeholders were recruited, the mode of involvement, at what stage there was involvement and the level of control or influence. Results The final ACTIVE framework described whether patients, carers and/or families, and/or other stakeholders (including health professionals, health decision makers and funders) were involved. We defined: recruitment as either open or closed; the approach to involvement as either one-time, continuous or combined; and the method of involvement as either direct or indirect. The stage of involvement in reviews was defined using the Cochrane Ecosystem stages of a review. The level of control or influence was defined according to the roles and activities of stakeholders in the review process, and described as the ACTIVE continuum of involvement. Conclusions The ACTIVE framework provides a structure with which to describe key components of stakeholder involvement within a systematic review, and we have used this to summarize how stakeholders have been involved in a subset of varied systematic reviews. The ACTIVE continuum of involvement provides a new model that uses tasks and roles to detail the level of stakeholder involvement. This work has contributed to the development of learning resources aimed at supporting systematic review authors and editors to involve stakeholders in their systematic reviews. The ACTIVE framework may support the decision-making of systematic review authors in planning how to involve stakeholders in future reviews.

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