Mixed Methods Lot Quality Assurance Sampling: A novel, rapid methodology to inform equity focused maternal health programming in rural Rajasthan, India

India has experienced a significant increase in facility-based delivery (FBD) coverage and reduction in maternal mortality. Nevertheless, India continues to have high levels of maternal health inequity. Improving equity requires data collection methods that can produce a better contextual understanding of how vulnerable populations access and interact with the health care system at a local level. While large population-level surveys are valuable, they are resource intensive and often lack the contextual specificity and timeliness to be useful for local health programming. Qualitative methods can be resource intensive and may lack generalizability. We describe an innovative mixed-methods application of Large Country-Lot Quality Assurance Sampling (LC-LQAS) that provides local coverage data and qualitative insights for both FBD and antenatal care (ANC) in a low-cost and timely manner that is useful for health care providers working in specific contexts. LC-LQAS is a version of LQAS that combines LQAS for local level classification with multistage cluster sampling to obtain precise regional or national coverage estimates. We integrated qualitative questions to uncover mothers’ experiences accessing maternal health care in the rural district of Sri Ganganagar, Rajasthan, India. We interviewed 313 recently delivered, low-income women in 18 subdistricts. All respondents participated in both qualitative and quantitative components. All subdistricts were classified as having high FBD coverage with the upper threshold set at 85%, suggesting that improved coverage has extended to vulnerable women. However, only two subdistricts were classified as high ANC coverage with the upper threshold set at 40%. Qualitative data revealed a severe lack of agency among respondents and that household norms of care seeking influenced uptake of ANC and FBD. We additionally report on implementation outcomes (acceptability, feasibility, appropriateness, effectiveness, fidelity, and cost) and how study results informed the programs of a local health non-profit.

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The efficiency of the local health systems: investigating the roles of health administrations and health care providers

Health Economics Policy and Law ◽

10.1017/s1744133117000068 ◽

2017 ◽

Vol 13 (1) ◽

pp. 10-32 ◽

Cited By ~ 3

Author(s):

Laura Anselmi ◽

Mylène Lagarde ◽

Kara Hanson

Keyword(s):

Health Care ◽

Decision Making ◽

Health Systems ◽

Health Care Providers ◽

National Health ◽

Local Level ◽

Local Health ◽

Care Providers ◽

Frontier Analysis ◽

Decision Making Unit

AbstractThe analysis of efficiency in health care has largely focussed either on individual health care providers, or on sub-national health systems conceived as a unique decision-making unit. However, in hierarchically organized national health services, two separate entities are responsible for turning financial resources into services at the local level: health administrations and health care providers. Their separate roles and the one of health administrations in particular have not been explicitly considered in efficiency analysis. We applied stochastic frontier analysis to district-level panel data from Mozambique (2008-2011) to assess district efficiency in delivering outpatient care. We first assessed the efficiency of the whole district considered as an individual decision-making unit, and then we assessed separately the efficiency of health administrations and health care providers within the same district. We found that on average only 73% of the outpatient consultations deliverable using available inputs were realized, with large differences in performance across districts. Individual districts performed differently in administrative or health care delivery functions. On average, a reduction of administrative inefficiency by 10 percentage points, for a given expenditure would increase by 0.2% the volume of services delivered per thousand population per year. Identifying and targeting the specific drivers of administrative inefficiencies can contribute to increase service.

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Perceptions of Adult Arkansans Regarding Trusted Sources of Information about the COVID-19 Pandemic (Preprint)

10.2196/preprints.30992 ◽

2021 ◽

Author(s):

Rachel S Purvis ◽

Don E Willis ◽

Ramey Moore ◽

Cari Bogulski ◽

Pearl A McElfish

Keyword(s):

Health Care ◽

Mixed Methods ◽

Health Care Providers ◽

News Media ◽

Online Survey ◽

Medical Center ◽

Academic Medical Center ◽

Local Health ◽

Care Providers ◽

Sources Of Information

BACKGROUND The US leads the world in confirmed COVID-19 cases; Arkansas ranks fifth in average daily cases per 100,000. Historically, Americans relied on health communications from governmental sources and the news media. However, there has been a documented decline of trust in these sources. OBJECTIVE This study seeks to understand trusted sources of information about COVID-19 to improve health messaging because research shows the level of trust is associated with adherence to recommendations. METHODS A mixed methods concurrent triangulation design was used. Data were collected using an online survey and interview instrument from participants (N=1,221) who were 18 years of age or older and residing, employed, or accessing health care in Arkansas. RESULTS Two primary themes related to participants’ perceptions of sources of information about COVID-19 are reported: 1) trusted sources of information and 2) distrust or lack of trust in sources of information. Several subthemes emerged within each primary theme. Results showed high trust in the academic medical center, federal and state public health agencies, and local health care providers. The study also documents diverging voices of distrust and uncertainty in making sense of contradictory information. Participants reported the main reason for their lack of trust was the rapidly changing information and the lack of consistency in information provided across sources. CONCLUSIONS This finding provides insight into the importance of coordination between national, state, and local communications to bolster trust. This study makes a significant contribution as the largest mixed methods study on trusted sources of information for COVID-19.

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The evolving role of traditional birth attendants in maternal health in post-conflict Africa: A qualitative study of Burundi and northern Uganda

SAGE Open Medicine ◽

10.1177/2050312117753631 ◽

2018 ◽

Vol 6 ◽

pp. 205031211775363 ◽

Cited By ~ 9

Author(s):

Primus Che Chi ◽

Henrik Urdal

Keyword(s):

Health Care ◽

Maternal Health ◽

Health Care Providers ◽

Traditional Birth Attendants ◽

Northern Uganda ◽

Local Health ◽

Care Providers ◽

Birth Attendants ◽

Post Conflict

Objectives: Many conflict-affected countries are faced with an acute shortage of health care providers, including skilled birth attendants. As such, during conflicts traditional birth attendants have become the first point of call for many pregnant women, assisting them during pregnancy, labour and birth, and in the postpartum period. This study seeks to explore how the role of traditional birth attendants in maternal health, especially childbirth, has evolved in two post-conflict settings in sub-Saharan Africa (Burundi and northern Uganda) spanning the period of active warfare to the post-conflict era. Methods: A total of 63 individual semi-structured in-depth interviews and 8 focus group discussions were held with women of reproductive age, local health care providers and staff of non-governmental organisations working in the domain of maternal health who experienced the conflict, across urban, semi-urban and rural settings in Burundi and northern Uganda. Discussions focused on the role played by traditional birth attendants in maternal health, especially childbirth during the conflict and how the role has evolved in the post-conflict era. Transcripts from the interviews and focus group discussions were analysed by thematic analysis (framework approach). Results: Traditional birth attendants played a major role in childbirth-related activities in both Burundi and northern Uganda during the conflict, with some receiving training and delivery kits from the local health systems and non-governmental organisations to undertake deliveries. Following the end of the conflict, traditional birth attendants have been prohibited by the government from undertaking deliveries in both Burundi and northern Uganda. In Burundi, the traditional birth attendants have been integrated within the primary health care system, especially in rural areas, and re-assigned the role of ‘birth companions’. In this capacity they undertake maternal health promotion activities within their communities. In northern Uganda, on the other hand, traditional birth attendants have not been integrated within the local health system and still appear to undertake clandestine deliveries in some rural areas. Conclusion: The prominent role of traditional birth attendants in childbirth during the conflicts in Burundi and northern Uganda has been dwindling in the post-conflict era. Traditional birth attendants can still play an important role in facilitating facility and skilled attended births if appropriately integrated with the local health system.

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Pregnancy and childbirth in Mozambique: men as decision makers and women as caretakers?

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.879 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Galle ◽

H Cossa ◽

N Osman ◽

K Roelens ◽

S Griffin ◽

...

Keyword(s):

Health Care ◽

Maternal Health ◽

Hiv Prevention ◽

Health Care Providers ◽

Male Involvement ◽

Sub Saharan Africa ◽

Care Providers ◽

Pregnancy And Childbirth ◽

Policy Level ◽

Sub Saharan

Abstract Background Increasing male involvement during pregnancy is considered an important, but often overlooked intervention for improving maternal health in sub-Saharan Africa. This study explores the attitudes and beliefs of health policymakers, health care providers and local communities regarding men's involvement in maternal health in southern Mozambique. Methods Ten key informant interviews with stakeholders were carried out to assess their attitudes and perspectives regarding male involvement in maternal health, followed by 10 days of semi structured observations in health care centers. Subsequently 16 focus group discussions were conducted in the community and at provider level, followed by three in depth couple interviews. Analysis was done by applying a socio-ecological systems theory in thematic analysis. Results Results show a lack of strategy at policy level to stimulate male involvement in maternal health. Invitation cards for men are used as an isolated intervention in health facilities but these have not lead to the expected success. Providers have a rather passive attitude towards male involvement initiatives and women accompanied by a husband are often put in a submissive position. In the community however, male attendance at ANC is considered important and men are willing to take a more participating role. Main barriers are the association of male attendance at ANC with being HIV infected and strong social norms and gender roles. On the one hand men are seen as caretakers of the family by providing money and making the decisions. On the other hand, men supporting their wife by showing interest in their health or sharing household tasks are seen as weak or as a manifestation of HIV seropositivity. Conclusions A clear strategy at policy level and a multi-level approach is needed. Gender-equitable relationships between men and women should be encouraged in all maternal health interventions and health programs should step away from linking male involvement to HIV prevention. Key messages Linking the promotion of gender equality to male involvement is the key for success. Step away from linking HIV prevention to male involvement in maternal health.

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Building Health Communities: Local Health Care Networks in Maryland

The American Review of Public Administration ◽

10.1177/0275074019864298 ◽

2019 ◽

Vol 50 (1) ◽

pp. 62-76 ◽

Cited By ~ 1

Author(s):

Aaron Wachhaus

Keyword(s):

Health Care ◽

Local Level ◽

Collaborative Networks ◽

Local Health ◽

Exploratory Research ◽

The Public ◽

Health Care Networks ◽

Local Health Care ◽

Health Communities ◽

Treatment Of Obesity

Combatting chronic disease (prevention and treatment of obesity, diabetes, heart health, and stroke) requires action at the local level, both to educate the public and to provide health services. Effective collaboration among local organizations devoted to educating the public about, and treating patients of, these diseases is a key component of successful health care. To better understand local efforts, a social network analysis of five local health care networks spanning eight counties in Maryland was conducted. The purpose of this exploratory research was to discover whether collaborative networks exist at the local level, to map the networks, and to assess their strengths and needs.

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Creating Academic and Health Care Partnerships that Impact Public Health

Kinesiology Review ◽

10.1123/kr.2015-0037 ◽

2015 ◽

Vol 4 (4) ◽

pp. 378-384

Author(s):

Peter W. Grandjean ◽

Burritt W. Hess ◽

Nicholas Schwedock ◽

Jackson O. Griggs ◽

Paul M. Gordon

Keyword(s):

Public Health ◽

Health Care ◽

Health Care Providers ◽

Professional Training ◽

Local Health ◽

Care Providers ◽

Research Partnerships ◽

Local Health Care ◽

Training Community ◽

The University

Kinesiology programs are well positioned to create and develop partnerships within the university, with local health care providers, and with the community to integrate and enhance the activities of professional training, community service, public health outreach, and collaborative research. Partnerships with medical and health care organizations may be structured to fulfill accreditation standards and the objectives of the “Exercise is Medicine®” initiative to improve public health through primary prevention. Barriers of scale, location, time, human resources, and funding can be overcome so all stakeholder benefits are much greater than the costs.

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M-health for maternal health- bridging the gaps!!

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175822 ◽

2017 ◽

Vol 7 (1) ◽

pp. 1

Author(s):

Sheeba Marwah ◽

Pratima Mittal

Keyword(s):

Health Care ◽

Cost Effectiveness ◽

Maternal Health ◽

Medical Care ◽

Health Care Providers ◽

Mobile Technology ◽

Clinical Applications ◽

Obstetrics And Gynecology ◽

Care Providers ◽

Effectiveness Data

This article reviews significance, potential and principles to consider when setting up a telemedicine (TM) program to provide care to women in the field of obstetrics and gynecology, essentially deploying mobile technology. There are various benefits of such TM clinical applications. The consensus among patients and health care providers is that this technology is convenient to provide needed subspecialty medical care, even when it is not available locally. Such innovations are clinically successful, but economic and cost-effectiveness data are lacking.

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Health Care Providers’ Knowledge of HPV Vaccination, Barriers, and Strategies in a State With Low HPV Vaccine Receipt: Mixed-Methods Study

JMIR Cancer ◽

10.2196/cancer.7345 ◽

2017 ◽

Vol 3 (2) ◽

pp. e12 ◽

Cited By ~ 9

Author(s):

Echo L Warner ◽

Qian Ding ◽

Lisa Pappas ◽

Julia Bodson ◽

Brynn Fowler ◽

...

Keyword(s):

Health Care ◽

Mixed Methods ◽

Health Care Providers ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Mixed Methods Study ◽

Care Providers ◽

Vaccination Barriers

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Generating Evidence From Contextual Clinical Research in Low- to Middle Income Countries: A Roadmap Based on Theory of Change

Frontiers in Pediatrics ◽

10.3389/fped.2021.764239 ◽

2021 ◽

Vol 9 ◽

Author(s):

Babar S. Hasan ◽

Muneera A. Rasheed ◽

Asra Wahid ◽

Raman Krishna Kumar ◽

Liesl Zuhlke

Keyword(s):

Health Care ◽

Health Care Providers ◽

Theory Of Change ◽

Health Priorities ◽

Global Health Research ◽

Local Health ◽

Care Providers ◽

Middle Income ◽

Middle Income Countries ◽

Health Ministries

Along with inadequate access to high-quality care, competing health priorities, fragile health systems, and conflicts, there is an associated delay in evidence generation and research from LMICs. Lack of basic epidemiologic understanding of the disease burden in these regions poses a significant knowledge gap as solutions can only be developed and sustained if the scope of the problem is accurately defined. Congenital heart disease (CHD), for example, is the most common birth defect in children. The prevalence of CHD from 1990 to 2017 has progressively increased by 18.7% and more than 90% of children with CHD are born in Low and Middle-Income Countries (LMICs). If diagnosed and managed in a timely manner, as in high-income countries (HICs), most children lead a healthy life and achieve adulthood. However, children with CHD in LMICs have limited care available with subsequent impact on survival. The large disparity in global health research focus on this complex disease makes it a solid paradigm to shape the debate. Despite many challenges, an essential aspect of improving research in LMICs is the realization and ownership of the problem around paucity of local evidence by patients, health care providers, academic centers, and governments in these countries. We have created a theory of change model to address these challenges at a micro- (individual patient or physician or institutions delivering health care) and a macro- (government and health ministries) level, presenting suggested solutions for these complex problems. All stakeholders in the society, from government bodies, health ministries, and systems, to frontline healthcare workers and patients, need to be invested in addressing the local health problems and significantly increase data to define and improve the gaps in care in LMICs. Moreover, interventions can be designed for a more collaborative and effective HIC-LMIC and LMIC-LMIC partnership to increase resources, capacity building, and representation for long-term productivity.

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Implementing E-Health

10.1093/oxfordhb/9780198705109.013.19 ◽

2016 ◽

Author(s):

Bill Doolin

Keyword(s):

Health Care ◽

Health Care Providers ◽

Point Of Care ◽

Health Care Organization ◽

Technical Problem ◽

Local Health ◽

Care Organization ◽

Care Providers ◽

Health Care Information ◽

Local Health Care

The application of information and communication technology to support health care organization, management, and delivery is high on the health policy agenda in many countries, and its implementation has become a significant issue. Despite optimistic expectations and increasing investment in e-health, the anticipated benefits are often elusive. This chapter reviews the factors driving the development of e-health before introducing a conceptualization of e-health focused on the management and use of health care information at the point of care, between health care providers and, ultimately, by health care consumers. The chapter then explores a range of issues that render e-health implementation problematic. In particular, implementing e-health is both a complex and emergent process that requires consideration of local health care contexts, and a socio-technical problem involving changes in work processes, interactions, and behaviors.

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