scholarly journals Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

2020 ◽  
Author(s):  
Martin Muddu ◽  
Andrew K. Tusubira ◽  
Brenda Nakirya ◽  
Rita Nalwoga ◽  
Fred C. Semitala ◽  
...  
Keyword(s):  
Implementation Research ◽  
Self Efficacy ◽  
Healthcare Providers ◽  
Health System Strengthening ◽  
Relative Advantage ◽  
Prior Work ◽  
Care Providers ◽  
Hiv Services ◽  
Increased Risk ◽  
Hiv Integration

Abstract Background: Persons Living with HIV (PLHIV) receiving antiretroviral therapy have increased risk of cardiovascular disease (CVD). Integration of services for hypertension (HTN), the primary CVD risk factor, into HIV clinics is recommended in Uganda. Our prior work demonstrated multiple gaps in implementation of integrated HTN care along the HIV treatment cascade. In this study, we sought to explore barriers to and facilitators of integrating HTN screening and treatment into HIV clinics in Eastern Uganda. Methods: We conducted a qualitative study at three HIV clinics with low, intermediate, and high HTN care cascade performance, which we classified based on our prior work. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews and focus group discussions with health services managers, health care providers and hypertensive PLHIV (n=83). Interviews were transcribed verbatim. Three qualitative researchers used the deductive (CFIR-driven) method to develop relevant codes and themes. Ratings were performed to determine valence and strengths of each CFIR construct regarding influencing HTN/HIV integration. Results: Barriers to HTN/HIV integration arose from six CFIR constructs: organizational incentives & rewards, available resources, access to knowledge & information, knowledge & beliefs about the intervention, self-efficacy and planning. The barriers include: lack of functional BP machines, inadequate supply of anti-hypertensive medicines, additional workload to providers for HTN services, PLHIV’s inadequate knowledge about HTN care, sub-optimal knowledge, skills and self-efficacy of healthcare providers to screen and treat HTN and inadequate planning for integrated HTN/HIV services. Relative advantage of offering HTN and HIV services in a one-stop centre, simplicity (non-complex nature) of HTN/HIV integrated care, adaptability and compatibility of HTN care with existing HIV services are the facilitators for HTN/HIV integration. The remaining CFIR constructs were non-significant regarding influencing HTN/HIV integration. Conclusion: Using the CFIR, we have shown that while there are modifiable barriers to HTN/HIV integration, HTN/HIV integration is of interest to patients, healthcare providers and managers. Improving access to HTN care among PLHIV will require overcoming barriers and capitalizing on facilitators using a health system strengthening approach. These findings are a springboard for designing contextually appropriate interventions for HTN/HIV integration in low- and middle-income countries.

scholarly journals Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

2020 ◽  
Author(s):  
Martin Muddu ◽  
Andrew K. Tusubira ◽  
Brenda Nakirya ◽  
Rita Nalwoga ◽  
Fred C. Semitala ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Implementation Research ◽  
Health System Strengthening ◽  
Relative Advantage ◽  
Prior Work ◽  
Care Providers ◽  
Increased Risk ◽  
Inner Setting ◽  
Hiv Integration

Abstract BackgroundPersons Living with HIV (PLHIV) receiving antiretroviral therapy have increased risk of cardiovascular disease (CVD). Integration of services for hypertension (HTN), the primary CVD risk factor, into HIV clinics is recommended in Uganda. Our prior work demonstrated multiple gaps in implementation of integrated HTN care along the HIV treatment cascade. In this study, we sought to explore barriers to, and facilitators of, integrating HTN screening and treatment into HIV clinics in Eastern Uganda.MethodsWe conducted a qualitative study at three HIV clinics with low, intermediate, and high HTN care cascade performance, which we classified based on our prior work. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews with health services managers, health care providers and hypertensive PLHIV (n=83). Interviews were transcribed verbatim. Three qualitative researchers used both deductive (CFIR model-driven) and inductive (open coding) methods to develop relevant codes and themes. Ratings were performed to determine valence and strengths of each CFIR construct regarding influencing HTN/HIV integration. ResultsOf the 39 CFIR constructs assessed, 17 were relevant to either barriers or facilitators to HTN/HIV integration. Six constructs strongly distinguished performance and were barriers, three of which were in the Inner setting (Organizational Incentives & Rewards, Available Resources, Access to Knowledge & Information); two in Characteristics of individuals (Knowledge & Beliefs about the Intervention and Self-efficacy) and one in Intervention characteristics (Design Quality & Packaging). Four additional constructs were weakly distinguishing and negatively influenced HTN/HIV integration. There were four facilitators for HTN/HIV integration related to the intervention (Relative advantage, Adaptability, Complexity and Compatibility). The remaining three constructs negatively influenced HTN/HIV integration but were non-distinguishing. ConclusionUsing the CFIR, we have shown that while there are modifiable barriers to HTN/HIV integration in the Inner setting, Outer setting, Characteristics of individuals and implementation Process, HTN/HIV integration is of interest to patients, health care providers and managers. Improving access to HTN care among PLHIV will require overcoming barriers and capitalizing on the facilitators using a health system strengthening approach. These findings are a springboard for designing contextually appropriate interventions for HTN/HIV integration in low- and middle-income countries.

scholarly journals Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

2019 ◽  
Author(s):  
Martin Muddu ◽  
Andrew K. Tusubira ◽  
Brenda Nakirya ◽  
Rita Nalwoga ◽  
Fred C. Semitala ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Providers ◽  
Implementation Research ◽  
Barriers And Facilitators ◽  
Health System Strengthening ◽  
Prior Work ◽  
Care Providers ◽  
Inner Setting ◽  
Hiv Integration

AbstractBackgroundPersons Living with HIV (PLHIV) receiving antiretroviral therapy have increased risk of cardiovascular disease (CVD). Integration of services for hypertension (HTN), the primary CVD risk factor, into HIV clinics is recommended in Uganda. Our prior work demonstrated multiple gaps in implementation of integrated HTN care along the HIV treatment cascade. In this study, we sought to explore barriers to, and facilitators of, integrating HTN screening and treatment into HIV clinics in Eastern Uganda.MethodsWe conducted a qualitative study at three HIV clinics with low, intermediate, and high HTN care cascade performance, which we classified based on our prior work. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews with health services managers, health care providers and hypertensive PLHIV (n=83). Interviews were transcribed verbatim. Three qualitative researchers used both deductive (CFIR model-driven) and inductive (open coding) methods to develop relevant codes and themes. Ratings were performed to determine valence and strengths of each CFIR construct regarding influencing HTN/HIV integration.ResultsOf the 39 CFIR constructs assessed, 17 were relevant to either barriers or facilitators to HTN/HIV integration. Six constructs strongly distinguished performance and were barriers, three of which were in the Inner setting (Organizational Incentives & Rewards, Available Resources, Access to Knowledge & Information); two in Characteristics of individuals (Knowledge & Beliefs about the Intervention and Self-efficacy) and one in Intervention characteristics (Design Quality & Packaging). Four additional constructs were weakly distinguishing and negatively influenced HTN/HIV integration. There were four facilitators for HTN/HIV integration related to the intervention (Relative advantage, Adaptability, Complexity and Compatibility). The remaining four constructs negatively influenced HTN/HIV integration but were non-distinguishing.ConclusionUsing the CFIR, we have shown that while there are modifiable barriers to HTN/HIV integration in the Inner setting, Outer setting, Characteristics of individuals and implementation Process, HTN/HIV integration is of interest to patients, health care providers and managers. Improving access to HTN care among PLHIV will require overcoming barriers and capitalizing on the facilitators using a health system strengthening approach. These findings are a springboard for designing contextually appropriate interventions for HTN/HIV integration in low- and middle-income countries.Contribution to the literatureWe used the widely used and validated CFIR to assess the HIV program for HTN/HIV integration.To our knowledge, this is the first study to explore barriers and facilitators to integrating hypertension screening and treatment into HIV clinics using the CFIR.The barriers and facilitators identified are a basis for designing contextualized implementation interventions for HTN/HIV integration in Uganda and other LMIC using a health system strengthening approach.

Burnout and its Association with Musculoskeletal Pain among Primary Care Providers

2017 ◽  
Vol 61 (1) ◽  
pp. 1010-1014 ◽  
Author(s):  
Xuanxuan Zhang ◽  
Mark C. Schall ◽  
Richard Sesek ◽  
Sean Gallagher ◽  
Jesse Michel
Keyword(s):  
Primary Care ◽  
Musculoskeletal Pain ◽  
Healthcare Providers ◽  
Primary Care Providers ◽  
Care Providers ◽  
Cross Sectional ◽  
Body Regions ◽  
Increased Risk ◽  
The Right

Burnout is a growing concern among primary care providers (PCPs). The condition may lead to diminished quality of patient care as well as reduced quality of life. Although self-reported musculoskeletal pain is common among healthcare providers, the relationship between burnout and musculoskeletal pain among PCPs has been studied very little. We describe a cross-sectional pilot survey conducted among 38 PCPs (MDs, DOs, PAs, and NPs) in the Midwestern United States. Self-reported feelings of burnout and musculoskeletal pain in different body regions were analyzed using regression models. Results suggested that increasing number of hours worked per day, severity of pain in the neck / shoulder area, and severity of pain in the right wrist were associated with an increased risk of burnout. On the contrary, burnout decreased with increasing age. The findings suggest that additional research is needed to understand the risk factors for burnout among PCPs, particularly during the early stages of their career.

scholarly journals Barriers to and Facilitators of Accessing HIV Services for Street-Involved Youth in Canada and Kenya

2022 ◽  
Author(s):  
Momina Khan ◽  
Katie MacEntee ◽  
Reuben Kiptui ◽  
Amy Berkum ◽  
Abe Oudshoorn ◽  
...  
Keyword(s):  
Public Policy ◽  
Hiv Prevention ◽  
Health Care Providers ◽  
Healthcare Providers ◽  
Educational Outreach ◽  
High Risk Population ◽  
Hiv Education ◽  
Care Providers ◽  
Community Based ◽  
Hiv Services

Abstract Introduction: UNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV prevention, testing, and treatment services as Phase I of an implementation study evaluating the use of Peer Navigators to increase access to HIV services.Methods: Semi-structured interviews, focus group discussions (FGD), and Theatre Testing were conducted with individuals who identify as SIY, health care providers, and community stakeholders living in Canada (Toronto, Montreal, London) and Kenya (Eldoret, Huruma, Kitale). Data were analyzed using a directed content approach, guided by the socio-ecological model (SEM).Results: Across the six sites were 195 participants: 64 SIY, 42 healthcare providers, and 97 community-based stakeholders. Barriers were identified at the societal (e.g. intersectional stigma and discrimination), public policy (e.g., inadequate access to basic needs, legal documentation, lack of health insurance, and limited community-based funding), institutional (e.g. lack of inclusive education and training, inadequate HIV educational outreach, and restrictive service provision), interpersonal (e.g., ineffective communication from healthcare providers), and intrapersonal levels (e.g. lack of trust and associated fear, low perception for healthcare, and lack of self-esteem). These contributed to limited HIV services utilization among SIY. Conversely, numerous facilitators were also identified at the public policy (e.g. affordable HIV services and treatment), institutional (e.g. available and accessible HIV prevention tools, HIV education and awareness programs, and holistic models of care), interpersonal level (e.g., systems navigation support, peer support, and personal relationships), and intrapersonal levels (e.g. self-efficacy) as positively supporting SIY access to HIV services.Conclusions: Intersectional stigma was a critical barrier in all sites, and policies and programs that foster welcoming environments for youth from diverse backgrounds and living circumstances may be better able to respond to the HIV service needs of this high risk population. Social support and navigation services were reported to facilitate access to HIV services in all sites.

scholarly journals Closing the communication Loop: a hybrid mixed methods implementation study of a clinical communication tool for team-based care (Preprint)

2020 ◽  
Author(s):  
Amna Husain ◽  
Eyal Cohen ◽  
Raluca Dubrowski ◽  
Trevor Jamieson ◽  
Allison Kurahashi ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Continuity Of Care ◽  
Implementation Research ◽  
Asynchronous Communication ◽  
Barriers And Facilitators ◽  
Relative Advantage ◽  
Care Providers ◽  
Clinical Communication ◽  
Circle Of Care ◽  
Team Based Care

BACKGROUND Communication within the circle of care is central to coordinated, safe, and effective care; yet patients, caregivers, and healthcare providers often experience poor communication and fragmented care [1,2]. Through a sequential program of research, the Loop Research Collaborative developed a web-based clinical communication system for team-based care. Loop assembles the circle of care centred on a patient, in private networking spaces called Patient Loops. The patient, and/or their caregiver, is part of the Patient Loop. The communication is threaded; it can be filtered and sorted in multiple ways; it is securely stored and can be exported for upload to a medical record. OBJECTIVE The objective of this study was to implement and evaluate Loop. The study reporting adheres to the Standards for Reporting Implementation Research. METHODS The study was a Hybrid Type II mixed methods design to simultaneously evaluate Loop’s clinical and implementation effectiveness, and implementation barriers and facilitators in six healthcare sites. Data included monthly user check-in interviews and bi-monthly surveys to capture patient or caregiver experience of continuity of care, in-depth interviews to explore barriers and facilitators based on the Consolidated Framework of Implementation Research (CFIR) and Loop usage extracted directly from the Loop system. RESULTS We recruited 25 initiating healthcare professionals (iHCPs) across six sites who then identified patients and/or caregivers for recruitment. Of 147 patient or caregiver participants who were assessed and met screening criteria, 57 consented and 52 were enrolled on Loop, creating 52 Patient Loops. Across all Patient Loops, 96 additional health care providers (HCPs) consented to join the Loop teams. Loop usage was followed for up to 8 months. The median number of messages exchanged per team was 1 with a range of 0-28. The monthly check-in and CFIR interviews showed that although participants acknowledged that Loop could potentially fill a gap, existing modes of communication, workflows, incentives, and the lack of integration with the hospital EMRs and patient portals were barriers to its adoption. While participants acknowledged Loop’s potential value for engaging the patient and caregiver, and for improving communication within the patient’s circle of care, Loop’s relative advantage was not realized during the study and there was insufficient tension for change. Missing data limited the analysis of continuity of care. CONCLUSIONS Fundamental structural and implementation challenges persist toward realizing Loop’s potential as a shared system of asynchronous communication. Barriers include health information system integration; system, organizational, and individual tension for change; and a fee structure for healthcare provider compensation for asynchronous communication.

scholarly journals Staff wellbeing in times of COVID-19

2020 ◽  
pp. 175114372096806 ◽  
Author(s):  
Adrian Wong ◽  
Olusegun Olusanya ◽  
Prashant Parulekar ◽  
Julie Highfield
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Healthcare Providers ◽  
Adverse Outcomes ◽  
Burnout Syndrome ◽  
Care Providers ◽  
Increased Risk ◽  
The Individual ◽  
Staff Wellbeing ◽  
The Impact

In the last 10 years, there has been increasing interest into the psychological wellbeing of healthcare providers. Within critical care, increasing attention is being paid to the concept of ‘burnout’ – a cluster of symptoms that adversely affect the health of critical care providers. Publications and statements from the major critical care societies have all addressed this syndrome and emphasised urgency in tackling it. The current COVID-19 pandemic has fundamentally changed the way we work, communicate and learn. Even before the pandemic, there have been growing concerns and acknowledgement that healthcare practitioners in intensive care are at increased risk of burnout and burnout syndrome. There has never been greater pressure on intensive care or indeed healthcare as a whole to look after so many patients during this pandemic and yet there is global acknowledgement that key to overcoming these challenges is to look after the care providers – both physically and psychologically. In this paper, we review the issue of burnout amongst healthcare practitioners during current pandemic. We present the impact of burnout on the individual and the system as a whole but perhaps most importantly, we provide a review of steps being taken to mitigate against these adverse outcomes in the short and longer term.

scholarly journals Implementation of the Human Papillomavirus School-entry Requirement in Puerto Rico: Barriers and Facilitators Using the Consolidated Framework for Implementation Research

2021 ◽  
Author(s):  
Vivian Colón-López ◽  
Roxana Soto-Abreu ◽  
Diana T. Medina-Laabes ◽  
Olga L. Díaz-Miranda ◽  
Ana P. Ortiz ◽  
...  
Keyword(s):  
Puerto Rico ◽  
Human Papillomavirus ◽  
Implementation Research ◽  
Hpv Vaccine ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Negative Influence ◽  
Barriers And Facilitators ◽  
School Entry ◽  
Relative Advantage

Abstract Background: In 2018, Puerto Rico (PR) enacted a Human papillomavirus (HPV) vaccine school-entry requirement for students ages 11 to 12. Using the Consolidated Framework for Implementation Research (CFIR), we aimed to identify potential barriers and facilitators of this implementation.Methods: We conducted a total of 36 qualitative interviews with key informants who were stakeholders from different organizations (Department of Health, Schools, Healthcare Providers, and Community organizations in favor of the requirement) from July 2018 to January 2020. Three researchers performed the interview guide, data coding, and analysis according to the CFIR framework. We evaluated construct rating variability between the organizations to determine barriers and facilitators. Results: The strongest facilitators determined under the CFIR construct include the stakeholder's awareness of the parent's and student's needs to meet the HPV school-entry requirement. Other facilitators include initiatives for school-entry policies and the relative advantage of this requirement over different strategies. The strongest barriers included the cost for private providers to administer the HPV vaccine, the negative influence of social media about the vaccine, which affected parents' acceptance, and the lack of school nurses as available staff resources for the school entry requirement. Conclusions: Findings from this study can be used to improve implementation (adaptations/modifications) and inform other US states and countries in earlier stages of consideration of the adoption of similar immunization policies. Most barriers can be modifiable with the implementation of educational programs/training across schools, considering that they are the first line of response to parents of this school entry requirement.

scholarly journals COVID 19 Knowledge, Attitude, and Practice of The Healthcare Providers in United Arab Emirates

2021 ◽  
Author(s):  
Aljazia Khalfan Alghfeli ◽  
Amal Abdul Rahim Al Zarooni ◽  
Hamda Musabbah Alremeithi ◽  
Roqayah Abdulla Almadhaani ◽  
Latifa Baynouna Alketbi
Keyword(s):  
Health Care ◽  
United Arab Emirates ◽  
Health Care Providers ◽  
Disease Transmission ◽  
Healthcare Providers ◽  
Care Providers ◽  
Cross Sectional ◽  
Increased Risk ◽  
Overall Performance ◽  
Knowledge And Practice

Abstract BackgroundHealth care providers at increased risk of COVID-19 infection, inadequate knowledge and practice about COVID-19, and infection control may lead to increased risk of disease transmission. Early diagnosis and appropriate management of COVID 19 cases is important in preventing transmission and improving patient outcomes. The aim of this study was to assess the knowledge, altitude, and practice of healthcare providers in the United Arab Emirates toward COVID-19 and to examine its determinants. MethodA cross-sectional study was conducted to assess knowledge, attitudes, and practice (KAP) of Healthcare providers regarding COVID-19. The study was conducted during the COVID-19 pandemic from April to July 2020 , using an online anonymous self-administered questionnaire.ResultsA total of 2371 healthcare providers responded to the survey. A total of 1091 worked in inpatient hospitals, 494 in primary health care, and 388 in emergency and ICU care. The overall performance score for all healthcare providers was as follows: 49.1%, poor score; 41.8 %, intermediate score; and 9.2%, good score with a mean result of 17.14. Factors leading to better overall performance scores were years of experience, pediatricians’ specialty, and specialist’s occupation. A total of 55.7% received good direct knowledge from all healthcare providers. In practice, 48% had good practices toward COVID-19. The overall attitude mean was 2.8, from a maximum score of 7, indicating a positive attitude toward COVID-19.ConclusionsThe study-demonstrated gaps in specific aspects of knowledge and practice that should be focused on in future education and HCP awareness. A structured training program targeting all HCPs is needed to have good clinical knowledge and practice about COVID-19.

scholarly journals COVID 19 Knowledge, Attitude, and Practice of the Healthcare Providers in United Arab Emirates

2021 ◽  
Author(s):  
Aljazia Khalfan Alghfeli ◽  
Amal Abdul Rahim Al Zarouni ◽  
Hamda Musabbah Alremeithi ◽  
Roqayah Abdulla Almadhaani ◽  
Latifa Baynouna Alketbi
Keyword(s):  
Health Care ◽  
United Arab Emirates ◽  
Health Care Providers ◽  
Disease Transmission ◽  
Healthcare Providers ◽  
Care Providers ◽  
Cross Sectional ◽  
Increased Risk ◽  
Overall Performance ◽  
Knowledge And Practice

AbstractBackgroundHealth care providers at increased risk of COVID-19 infection, inadequate knowledge and practice about COVID-19, and infection control may lead to increased risk of disease transmission. Early diagnosis and appropriate management of COVID 19 cases is important in preventing transmission and improving patient outcomes. The aim of this study was to assess the knowledge, altitude, and practice of healthcare providers in the United Arab Emirates toward COVID-19 and to examine its determinants.MethodA cross-sectional study was conducted to assess knowledge, attitudes, and practice (KAP) of Healthcare providers regarding COVID-19. The study was conducted during the COVID-19 pandemic from of April 11 to July 23, using an online anonymous self-administered questionnaire.ResultsA total of 2371 healthcare providers responded to the survey. A total of 1091 worked in inpatient hospitals, 494 in primary health care, and 388 in emergency and ICU care. The overall performance score for all healthcare providers was as follows: 49.1%, poor score; 41.8 %, intermediate score; and 9.2%, good score with a mean result of 17.14. Factors leading to better overall performance scores were years of experience, pediatricians’ specialty, and specialist’s occupation. A total of 55.7% received good direct knowledge from all healthcare providers. In practice, 48% had good practices toward COVID-19. The overall attitude mean was 2.8, from a maximum score of 7, indicating a positive attitude toward COVID-19.ConclusionsThe study-demonstrated gaps in specific aspects of knowledge and practice that should be focused on in future education and HCP awareness. A structured training program targeting all HCPs is needed to have good clinical knowledge and practice about COVID-19.

scholarly journals Consensual Non-Monogamous Parenting Couples’ Perceptions of Healthcare Providers during the Transition to Parenthood

Aporia ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 36-45
Author(s):  
Jacqueline Avanthay Strus ◽  
Viola Polomeno
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Transition To Parenthood ◽  
Healthcare Providers ◽  
Clinical Approach ◽  
Reproductive Justice ◽  
Negative Consequences ◽  
Care Providers ◽  
Structured Interviews ◽  
Increased Risk

Consensual non-monogamous parenting couples are at increased risk for health inequities, especially during the transition to parenthood. This article presents partial results of a more extensive mixed-methods study exploring the conciliation of these couples’ parenting role and their sexual lifestyle, more specifically, their perceptions of health care providers including nurses. Semi-structured interviews and online questionnaires were completed with a total of 6 participants. Positive and negative issues were identified that were clients- and health care providers-based. The Expanding the Movement for Empowerment and Reproductive Justice lens was used to discuss the positive and negative consequences. Nurses need to develop, implement and evaluate a different clinical approach with these couples, who are aware of the health risks associated with their lifestyle, yet they always put their families first. Nurse administrators need to assess their institutional policies that are based on hetero-mononormative assumptions.

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