A model for sustainable, partnership-based telehealth services in rural India: An early process evaluation from Tuver village, Gujarat

Background Telehealth can improve access to high-quality healthcare for rural populations in India. However, rural communities often have other needs, such as sanitation or employment, to benefit fully from telehealth offerings, highlighting a need for systems-level solutions. A Business of Humanity approach argues that innovative solutions to wicked problems like these require strategic decision-making that attends to a) humaneness, e.g., equity and safety and b) humankind, or the needs and potential of large and growing markets comprised of marginalized and low-income individuals. The approach is expected to improve economic performance and long-term value creation for partners, thus supporting sustainability. Methods A demonstration project was conducted in Tuver, a rural and tribal village in Gujarat, India. The project included seven components: a partnership that emphasized power-sharing and complementary contributions; telehealth services; health promotion; digital services; power infrastructure; water and sanitation; and agribusiness. Core partners included the academic partner, local village leadership, a local development foundation, a telehealth provider, and a design-build contractor. This early process evaluation relies on administrative data, field notes, and project documentation and was analyzed using a case study approach. Results Findings highlight the importance of taking a systems perspective and engaging inter-sectoral partners through alignment of values and goals. Additionally, the creation of a synergistic, health-promoting ecosystem offers potential to support telehealth services in the long-term. At the same time, engaging rural, tribal communities in the use of technological advances posed a challenge, though local staff and intermediaries were effective in bridging disconnects. Conclusion Overall, this early process evaluation highlights the promise and challenges of using a Business of Humanity approach for coordinated, sustainable community-level action to improve the health and well-being of marginalized communities.

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“My coupons are like gold”: experiences and perceived outcomes of low-income adults participating in the British Columbia Farmers’ Market Nutrition Coupon Program

Public Health Nutrition ◽

10.1017/s1368980021001567 ◽

2021 ◽

pp. 1-30

Author(s):

Stéphanie Caron-Roy ◽

Sayeeda Amber Sayed ◽

Katrina Milaney ◽

Bonnie Lashewicz ◽

Sharlette Dunn ◽

...

Keyword(s):

British Columbia ◽

Rural Communities ◽

Low Income ◽

Well Being ◽

Qualitative Description ◽

Farmers Markets ◽

Social Connections ◽

Structured Interviews ◽

Program Outcomes ◽

Farmers Market

ABSTRACT Objective: The British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides low-income households with coupons valued at $21/week for 16 weeks to purchase healthy foods in farmers’ markets. Our objective was to explore FMNCP participants’ experiences of accessing nutritious foods, and perceived program outcomes. Design: This study used qualitative description methodology. Semi-structured interviews were conducted with FMNCP participants during the 2019 farmers’ market season. Directed content analysis was used to analyse the data whereby the five domains of Freedman et al’s framework of nutritious food access provided the basis for an initial coding scheme. Data that did not fit within the framework’s domains were coded inductively. Setting: One urban and two rural communities in British Columbia, Canada. Participants: 28 adults who were participating in the FMNCP. Results: Three themes emerged: Autonomy and Dignity; Social Connections and Community Building; and Environmental and Programmatic Constraints. Firstly, the program promoted a sense of autonomy and dignity through financial support, increased access to high-quality produce, food-related education and skill development, and mitigating stigma and shame. Secondly, shopping in farmers’ markets increased social connections and fostered a sense of community. Finally, participants experienced limited food variety in rural farmers’ markets, lack of transportation, and challenges with redeeming coupons. Conclusions: Participation in the FMNCP facilitated access to nutritious foods and enhanced participants’ diet quality, well-being and health. Strategies such as increasing the amount and duration of subsidies, and expanding programs may help improve participants’ experiences and outcomes of farmers’ market food subsidy programs.

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The long term effect of pulmonary tuberculosis on income and employment in a low income, urban setting

Thorax ◽

10.1136/thoraxjnl-2020-215338 ◽

2020 ◽

pp. thoraxjnl-2020-215338

Author(s):

Jamilah Meghji ◽

Stefanie Gregorius ◽

Jason Madan ◽

Fatima Chitimbe ◽

Rachael Thomson ◽

...

Keyword(s):

Low Income ◽

Disease Onset ◽

Treatment Completion ◽

Well Being ◽

Urban Setting ◽

Financial Strain ◽

First Episode ◽

Health Seeking ◽

Tb Treatment

BackgroundMitigating the socioeconomic impact of tuberculosis (TB) is key to the WHO End TB Strategy. However, little known about socioeconomic well-being beyond TB-treatment completion. In this mixed-methods study, we describe socioeconomic outcomes after TB-disease in urban Blantyre, Malawi, and explore pathways and barriers to financial recovery.MethodsAdults ≥15 years successfully completing treatment for a first episode of pulmonary TB under the National TB Control Programme were prospectively followed up for 12 months. Socioeconomic, income, occupation, health seeking and cost data were collected. Determinants and impacts of ongoing financial hardship were explored through illness narrative interviews with purposively selected participants.Results405 participants were recruited from February 2016 to April 2017. Median age was 35 years (IQR: 28–41), 67.9% (275/405) were male, and 60.6% (244/405) were HIV-positive. Employment and incomes were lowest at TB-treatment completion, with limited recovery in the following year: fewer people were in paid work (63.0% (232/368) vs 72.4% (293/405), p=0.006), median incomes were lower (US$44.13 (IQR: US$0–US$106.15) vs US$72.20 (IQR: US$26.71–US$173.29), p<0.001), and more patients were living in poverty (earning <US$1.90/day: 57.7% (211/366) vs 41.6% (166/399), p<0.001) 1 year after TB-treatment completion compared with before TB-disease onset. Half of the participants (50.5%, 184/368) reported ongoing dissaving (use of savings, selling assets, borrowing money) and 9.5% (35/368) reported school interruptions in the year after TB-treatment completion. Twenty-one participants completed in-depth interviews. Reported barriers to economic recovery included financial insecurity, challenges rebuilding business relationships, residual physical morbidity and stigma.ConclusionsTB-affected households remain economically vulnerable even after TB-treatment completion, with limited recovery in income and employment, persistent financial strain requiring dissaving, and ongoing school interruptions. Measures of the economic impact of TB disease should include the post-TB period. Interventions to protect the long-term health and livelihoods of TB survivors must be explored.

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Responding to unforeseen disasters in a large health system

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa358 ◽

2020 ◽

Author(s):

Ryan J Hannan ◽

Margaret K Lundholm ◽

Dennis Brierton ◽

Noelle R M Chapman

Keyword(s):

Supply Chain ◽

Health System ◽

Disaster Response ◽

Well Being ◽

Lessons Learned ◽

Strategic Decision ◽

Pharmacy Services ◽

Efficient System ◽

Team Members

Abstract Purpose To describe how health systems may respond to sudden changes in operations by leveraging existing resources and to share one organization’s experience responding to the coronavirus disease (COVID-19) pandemic. Summary In a health system based in Illinois and Wisconsin, pharmacy services are provided by a single, integrated department responsible for all aspects of pharmaceutical care within the organization. Hospital, retail, ambulatory care, and population health services are all managed under one leadership team. All pertinent ancillary services are also managed within the department, including informatics, supply chain, and drug policy. During the COVID-19 pandemic, the pharmacy services leadership has successfully managed volume and capacity challenges by redirecting resources to where they are needed. A disaster response framework based on Federal Emergency Management Agency guidance was put in place, and change management principles were used to rapidly operationalize change. Components of the nimble response have included quickly increasing capacity, thoughtful and timely communication to all team members, strategic decision making with available data, creating an agile pool of labor, and maintaining an efficient system supply chain. Well-being and resilience are emphasized alongside reflection on lessons learned. Some changes made in the urgent response to the pandemic are being considered for long-term implementation. Conclusion Organizations have the potential to respond to almost any situation if they are integrated and teams work together to build flexibility. The keys to success are thoughtful maximization of existing resources and strong communication.

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Changing Nature of Power and Leadership: How do They Matter in Rural Nepal?

Dhaulagiri Journal of Sociology and Anthropology ◽

10.3126/dsaj.v14i0.30545 ◽

2020 ◽

Vol 14 ◽

pp. 79-89

Author(s):

Mahendra Sapkota

Keyword(s):

Local Governance ◽

Local Development ◽

Academic Research ◽

Power Structure ◽

Well Being ◽

Power Sharing ◽

Local Power ◽

To Come ◽

Rural Nepal ◽

Ontological Position

Globally, power and leadership are considered as two unavoidable factors of social change and local development. In Nepal’s federal context, the nexus of power and leadership has been less addressed in academic research though most of the studies are focused on local governance. The present study attempts to analyze the nature of leadership and its power structure in the context of rural Nepal. It follows a critical ontological position of the development of power and leadership. Methodologically, a complete leadership of Dogana village in Suddhodhan Rural Municipality of Rupandehi district (Lumbini Province) was undertaken to assess the rural leadership. It is found that the most important factor for holding the rural leadership was ‘affiliation with the political party’, which was followed by ‘well-being ranking’ and ‘caste/ ethnic status’ of the leadership. The rural leaders used to change their policies and strategies to create and sustain power, such as doing multiple professions and building networks other than politics. The paper, therefore, concludes that a significant change occurred in leadership pattern and power structure of rural Nepal from informal to formal, and less inclusive to more inclusive and representative. Despite this, the changes are still elite-centric, politically vested, and economically favorable either to the upper-class people or middle-class mediators (bichauliyas). The study predicts that the contestations in leadership and power-sharing could be more critical in the days to come with the implementation of federalism in the rural context. The implication of this study largely relies on the context of local power structure and village politics in Nepal.

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Perception of Nature’s Contributions to People in Rural Communities in the Eastern Amazon

Sustainability ◽

10.3390/su12187665 ◽

2020 ◽

Vol 12 (18) ◽

pp. 7665

Author(s):

Rafael Melo de Brito ◽

Valente José Matlaba ◽

Vera Lúcia Imperatriz-Fonseca ◽

Tereza Cristina Giannini

Keyword(s):

Rural Communities ◽

Protected Areas ◽

Low Income ◽

Statistical Tests ◽

Well Being ◽

Environmental Conservation ◽

Policy Makers ◽

Face To Face ◽

Almost All ◽

First Time

Nature’s contributions to people (NCP) are increasingly being considered in decisions by policy-makers because of their relevance to the well-being of people. Learning the value of nature from the perception of communities can help to define priorities and to guide the development of public policies for environmental conservation. The objective of this study was to analyze the perception of the importance, benefits, and problems of NCP among residents of five rural communities, and their opinion about the protected areas of the municipality, considering their socioeconomic characteristics. The method consisted of conducting questionnaire-based, semi-structured, face-to-face interviews with a sample of 214 randomly selected households in five rural communities of Parauapebas (Pará, Eastern Amazon). We used appropriate statistical tests for data analysis. The main results show that the communities were highly homogeneous and that 52% of the households had low income (below a minimum wage of USD 250). A high proportion of respondents gave the highest importance to all categories of NCP (2/3 of respondents for material, 3/4 for non-material, and 4/5 for regulating NCP). The most commonly mentioned benefits of NCP referred to subsistence or livelihood and quality of life (40% of total mentions). Environmental degradation problems were the most cited (38% of total mentions). Almost all respondents stated that they had a positive opinion about the protected areas of the municipality, despite underusing them. This study is relevant because it analyses, for the first time, the perceptions of NCP among residents of rural communities in the Eastern Amazon, an essential aspect for decision-and public policy-making.

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Mechanisms Of Impact And Contextual Aspects of A Care Concept From A Dementia Special Care Unit In Long-Term Care: Process Evaluation As Part of A Theory-Driven Evaluation

10.21203/rs.3.rs-557180/v1 ◽

2021 ◽

Author(s):

Laura Adlbrecht ◽

Sabine Bartholomeyczik ◽

Hanna Mayer

Keyword(s):

Social Interaction ◽

Process Evaluation ◽

Long Term Care ◽

Complex Interventions ◽

Well Being ◽

Special Care ◽

Care Process ◽

Special Care Unit ◽

Term Care

Abstract Background: In long-term care, persons with dementia are often cared for in specialised facilities, which are rather heterogeneous in regard to their design and care concepts. Little information is available on how these facilities and care concepts bring about changes in the targeted outcomes. Such knowledge is needed to understand the effects of care concepts and to consciously shape further developments. This study aimed to explore the mechanisms of impact of a specific care concept from a dementia special care unit and the contextual aspects that influence its implementation or outcomes.Methods: Using a qualitative approach to process evaluation of complex interventions, we conducted participating observations and focus groups with nurses and single interviews with ward and nursing home managers. Data were collected from two identical dementia special care units to enhance the contrasts in the analysis of two non-specialised nursing homes. We analysed the data thematically. We conducted 16 observations, three group interviews and eleven individual interviews.Results: We identified seven themes in three domains related to mechanisms that lead to outcomes regarding residents’ and nurses’ behaviour and well-being. The development of nurses' skills and knowledge changes team-level competence and leads to an altered understanding of nursing. The promotion of a positive work climate reduces distress and promotes the long-term implementation of the care concept. Adjusted spatial structures and personnel strategies facilitate the implementation of interventions for residents and promote the fulfilment of their needs. Personalised psychosocial interventions promote residents' relaxation, engagement in activities and social interaction and thereby empower them to become part of the social community, to spend their time purposefully, to have positive experiences and to experience belonging and affection. The implementation and outcomes of the care concept are influenced by contextual aspects relating to the (target) population and cultural, organisational and financial features.Conclusions: The care concept of the dementia special care unit results in higher levels of relaxation, activities, and social interaction of residents. Its implementation highly depends on the shared understanding of nursing and the skills of the nursing team. Changes in residents’ characteristics result in altered effects of the concept.Trial registration: DRKS00011513

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Integrating Youth into Community Development: Implications for Policy Planning and Program Evaluation

Journal of Youth Development ◽

10.5195/jyd.2006.382 ◽

2006 ◽

Vol 1 (2) ◽

pp. 5-19 ◽

Cited By ~ 13

Author(s):

Rosemary V. Barnett ◽

M. A. Brennan

Keyword(s):

High School ◽

Community Development ◽

Development Process ◽

Local Development ◽

Well Being ◽

Policy Planning ◽

School Programs ◽

High School Programs ◽

Youth Attitudes

As non-profits, volunteer groups, and nongovernmental organizations take on increasingly larger roles in contributing to local well-being, the active collaboration between youth and adults is vital to the long-term success of community development efforts. Similarly, as service activities become standardized components of high-school programs, youth are empowered to becoming long-term contributors to local development efforts. Through this process youth engage in shared citizenship, leading to greater investment in their communities. This research was based on the premise that youth, acting as central parts of the community development process, have the capacity to improve local well-being. It reflects input from 12 key informants and 418 youth who participated in a survey conducted on the development issues contributing to their involvement. The findings of this study provide insights into the factors most directly shaping youth attitudes and involvement in their communities, as well as presenting direct implications for applied use.

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Addressing Spatial Inequality in Broadband Use and Community-Level Outcomes

10.1093/oso/9780190082871.003.0006 ◽

2021 ◽

pp. 101-136

Author(s):

Caroline J. Tolbert ◽

Karen Mossberger ◽

Natasha Gaydos ◽

Mattia Caldarulo

Keyword(s):

Rural Communities ◽

Low Income ◽

Urban Neighborhoods ◽

Spatial Inequality ◽

Community Level ◽

Quasi Experimental ◽

Measuring Outcomes ◽

Term Evaluation ◽

Smart Communities

This chapter considers the significance of place for broadband policy evaluation and examines long-term data on Chicago neighborhoods as an example of quasi-experimental design. Interventions are often targeted to low-income urban neighborhoods or rural communities, with goals for increased local employment, economic development, or community health. Measuring outcomes by place provides a way to aggregate impacts for individual residents and to suggest potential spillover benefits for communities. Evaluating broadband use (i.e., subscriptions) over time in communities can address issues of causation as well as long-term outcomes of use. Chicago’s Smart Communities program illustrates the benefits of conducting long-term evaluation, taking advantage of new American Community Survey data that allows tracking of broadband subscriptions in smaller or less-populated geographies such as neighborhoods or rural communities. Finally, the chapter discusses strategies for expanding community-level research through other quasi-experimental designs and the creation and utilization of community-level data on broadband adoption and use.

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Social and economic inequality limits disaster prevention amongst the most vulnerable in Vietnam

Disaster Prevention and Management An International Journal ◽

10.1108/dpm-07-2018-0213 ◽

2019 ◽

Vol 28 (1) ◽

pp. 50-59 ◽

Cited By ~ 1

Author(s):

Guillaume Chantry ◽

John Norton

Keyword(s):

Low Income ◽

Local Development ◽

East Asian ◽

Well Being ◽

Practical Experience ◽

Capitalist Development ◽

Content Type ◽

Disaster Impacts ◽

Political Environments ◽

Collecting Methods

Purpose Vietnam is historically hit by extensive disasters. However, the most vulnerable populations are far from being backed by national/local programmes to reduce disaster impacts on their well-being. In practice, political and socio-economic top-down organisation, channels efforts and limited resources into wealthier parts of the country. The paper aims to discuss these issues. Design/methodology/approach Learning from 30 years work in Vietnam, this paper presents how “horizontal” solidarity and networking should be promoted and reinforced to really target the needs of vulnerable poor communities. Findings on conditions and challenges are based on practical experience, from family/village level to provincial/national administration, in promoting safe housing and safer communities and in evaluating the barriers for extending and sharing such practices. Findings Political environments in South East Asian countries become similar to Vietnamese systems, and share a common attitude towards DRR (and CCA): official statements reaffirm the need for DRR at all levels, and the CC threats for local development. But year after year, the situation of marginalised or low-income poor facing disasters does not really see progress. Originality/value New data collecting methods and technologies are proposed, resilience is quoted as criteria for development, but the major issue remains: how could communities be “at the frontline” when receiving so little “backline” support and resources, compared to benefits from capitalist development shared by only richer parts of society – not concerned in the same way by disasters? The SFDRR in encouraging non-compulsory Civil Society involvement will remain inadequate faced with the increased vulnerability by Vietnam and South East Asian inhabitants.

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