scholarly journals Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting – modern diagnostics meet age-old challenges

2020 ◽  
Author(s):  
Jacquie Narotso Oliwa ◽  
Sabina Adhiambo Odero ◽  
Jacinta Nzinga ◽  
Michaël Boele van Hensbroek ◽  
Caroline Jones ◽  
...  
Keyword(s):  
Diagnostic Tests ◽  
Health Workers ◽  
System Level ◽  
Resource Poor Setting ◽  
Structured Interviews ◽  
Group Discussions ◽  
Individual Level ◽  
Key Informant ◽  
Physical Conclusion ◽  
Hospital Practices

Abstract Background Detection of tuberculosis (TB) in children in Kenya is sub-optimal. Xpert MTB/RIF® assay (Xpert®) has potential to improve speed of TB diagnosis due to its sensitivity and fast turnaround for results. Significant effort and resources have been put into making it widely available in Kenya, but its use remains low, especially in children. We set out to explore the reasons for the under-detection of TB and underuse of Xpert® in children, identifying challenges that may be relevant to other newer diagnostics in similar settings.Methods This was an exploratory qualitative study and data collection involved semi-structured interviews; small-group discussions; key informant interviews; observations of TB trainings, sensitisation meetings, policy meetings, hospital practices; and desk review of guidelines, job aides and policy documents. The Capability , Opportunity and Motivation (COM-B) framework was used to interpret emerging themes.Results At individual level, knowledge, skill, competence and experience, as well as beliefs and fears impacted on capability (physical & psychological) as well as motivation (reflective) to diagnose TB in children and use diagnostic tests. Hospital level influencers included hospital norms, processes & patient flows and resources which affected how individual health workers attempted to diagnose TB in children by impacting on their capability (physical & psychological) , motivation (reflective & automatic) and opportunity (physical & social). At the wider system level, community practices & beliefs, and implementation of TB programme directives impacted some of the decisions that health workers made through capability (psychological) , motivation (reflective & automatic) and opportunity (physical).Conclusion We used comprehensive approaches to identify influencers of TB case detection and use of TB diagnostic tests in children in Kenya. These results are being used to design a contextually-appropriate intervention to improve TB diagnosis, which may be relevant to similar low-resource, high TB burden countries.

scholarly journals Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting – modern diagnostics meet age-old challenges

2020 ◽  
Author(s):  
Jacquie Narotso Oliwa ◽  
Sabina Adhiambo Odero ◽  
Jacinta Nzinga ◽  
Michaël Boele van Hensbroek ◽  
Caroline Jones ◽  
...  
Keyword(s):  
Diagnostic Tests ◽  
Health Workers ◽  
System Level ◽  
Resource Poor Setting ◽  
Structured Interviews ◽  
Group Discussions ◽  
Individual Level ◽  
Study Approach ◽  
Hospital Practices ◽  
Embedded Case Study

Abstract Background Detection of tuberculosis (TB) in children in Kenya is sub-optimal. Xpert MTB/RIF® assay (Xpert®) has the potential to improve speed of TB diagnosis due to its sensitivity and fast turnaround for results. Significant effort and resources have been put into making the machines widely available in Kenya, but use remains low, especially in children. We set out to explore the reasons for the under-detection of TB and underuse of Xpert® in children, identifying challenges that may be relevant to other newer diagnostics in similar settings. Methods This was an exploratory qualitative study with an embedded case study approach. Data collection involved semi-structured interviews; small-group discussions; key informant interviews; observations of TB trainings, sensitisation meetings, policy meetings, hospital practices; desk review of guidelines, job aides and policy documents. The Capability, Opportunity and Motivation (COM-B) framework was used to interpret emerging themes. Results At individual level, knowledge, skill, competence and experience, as well as beliefs and fears impacted on capability (physical & psychological) as well as motivation (reflective) to diagnose TB in children and use diagnostic tests. Hospital level influencers included hospital norms, processes, patient flows and resources which affected how individual health workers attempted to diagnose TB in children by impacting on their capability (physical & psychological), motivation (reflective & automatic) and opportunity (physical & social). At the wider system level, community practices and beliefs, and implementation of TB programme directives impacted some of the decisions that health workers made through capability (psychological), motivation (reflective & automatic) and opportunity (physical). Conclusion We used comprehensive approaches to identify influencers of TB case detection and use of TB diagnostic tests in children in Kenya. These results are being used to design a contextually-appropriate intervention to improve TB diagnosis, which may be relevant to similar low-resource, high TB burden countries and can be feasibly implemented by the National TB programme.

scholarly journals Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting – modern diagnostics meet age-old challenges

2020 ◽  
Author(s):  
Jacquie Narotso Oliwa ◽  
Sabina Adhiambo Odero ◽  
Jacinta Nzinga ◽  
Michaël Boele van Hensbroek ◽  
Caroline Jones ◽  
...  
Keyword(s):  
Diagnostic Tests ◽  
Health Workers ◽  
System Level ◽  
Resource Poor Setting ◽  
Structured Interviews ◽  
Group Discussions ◽  
Individual Level ◽  
Study Approach ◽  
Hospital Practices ◽  
Embedded Case Study

Abstract Background Detection of tuberculosis (TB) in children in Kenya is sub-optimal. Xpert MTB/RIF® assay (Xpert®) has the potential to improve speed of TB diagnosis due to its sensitivity and fast turnaround for results. Significant effort and resources have been put into making the machines widely available in Kenya, but use remains low, especially in children. We set out to explore the reasons for the under-detection of TB and underuse of Xpert® in children, identifying challenges that may be relevant to other newer diagnostics in similar settings.Methods This was an exploratory qualitative study with an embedded case study approach. Data collection involved semi-structured interviews; small-group discussions; key informant interviews; observations of TB trainings, sensitisation meetings, policy meetings, hospital practices; desk review of guidelines, job aides and policy documents. The Capability, Opportunity and Motivation (COM-B) framework was used to interpret emerging themes. Results At individual level, knowledge, skill, competence and experience, as well as beliefs and fears impacted on capability (physical & psychological) as well as motivation (reflective) to diagnose TB in children and use diagnostic tests. Hospital level influencers included hospital norms, processes, patient flows and resources which affected how individual health workers attempted to diagnose TB in children by impacting on their capability (physical & psychological), motivation (reflective & automatic) and opportunity (physical & social). At the wider system level, community practices and beliefs, and implementation of TB programme directives impacted some of the decisions that health workers made through capability (psychological), motivation (reflective & automatic) and opportunity (physical). Conclusion We used comprehensive approaches to identify influencers of TB case detection and use of TB diagnostic tests in children in Kenya. These results are being used to design a contextually-appropriate intervention to improve TB diagnosis, which may be relevant to similar low-resource, high TB burden countries and can be feasibly implemented by the National TB programme.

scholarly journals Conservation Agriculture Promotion and Uptake in Mufulira, Zambia-A Political Agronomy Approach

2017 ◽  
Vol 10 (1) ◽  
pp. 156 ◽  
Author(s):  
Bridget Bwalya Umar
Keyword(s):  
Conservation Agriculture ◽  
Structured Interviews ◽  
Public Officials ◽  
Focus Group Discussions ◽  
Smallholder Farming ◽  
Group Discussions ◽  
Tillage Systems ◽  
The Public ◽  
Key Informant ◽  
Farming Households

This study utilized 120 semi-structured interviews with smallholder farming households and two focus group discussions; as well as several key informant interviews with experts to explore the promotion and uptake of conservation agriculture (CA) in Mufulira, Zambia. Results reveal that ridges and flat culture continued to be the preferred tillage systems (97 per cent and 55 per cent respectively) despite the farmers having been trained in the use of a minimum tillage technique. None of the interviewed farmers perceived CA as a solution to any of their agricultural related problems. The NGO promoting CA in the district had framed it as suited for and claimed to target labour constrained HIV/AIDS affected households. Conversely, farmers complained that CA was challenging for them due to its high labour demands (23 per cent); poor harvests (18 per cent) and was unsuited to the rainfall patterns of the area (10 per cent). Local agricultural experts contested the promotion of basins in Mufulira. The framing of CA as a solution to labour constraints did not seem to hold in the study area. This effectively limited the contestation spaces available to the public officials with dissenting views on the suitability of basin CA in the district.

scholarly journals ‘I know those people will be approachable and not mistreat us’: a qualitative study of inspectors and private drug sellers on peer supervision in rural Uganda

2020 ◽  
Author(s):  
Arthur Bagonza ◽  
Stefan Peterson ◽  
Andreas Mårtensson ◽  
Milton Mutto ◽  
Phllis Awor ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Role Model ◽  
Health Workers ◽  
Care Delivery ◽  
Group Discussions ◽  
Peer Supervision ◽  
Four Dimensions ◽  
Inappropriate Treatment ◽  
Key Informant ◽  
Drug Sellers

Abstract BackgroundPeer supervision improves health care delivery by health workers. However, in rural Uganda, self-supervision is what is prescribed for licensed private drug sellers by statutory guidelines. Evidence shows that self-supervision encourages inappropriate treatment of children less than five years of age by private drug sellers. This study constructed a model for an appropriate peer supervisor to augment the self-supervision currently practiced by drug sellers at district level in rural Uganda.MethodsIn this qualitative study, six Key informant interviews were held with inspectors while ten focus group discussions were conducted with one hundred and thirty drug sellers. Data analysis was informed by the Kathy Charmaz constructive approach to grounded theory. Atlas ti.7 software package was used for data management.Results A model with four dimensions defining an appropriate peer supervisor was developed. The dimensions included; incentives, clearly defined roles, mediation and role model peer supervisor. While all dimensions were regarded as being important, all participants interviewed agreed that incentives for peer supervisors were the most crucial. Overall, an appropriate peer supervisor was described as being exemplary to other drug sellers, operated within a defined framework, well facilitated to do their role and a good go-between drug sellers and government inspectors. Conclusion Four central contributions advance literature by the model developed by our study. First, the model fills a supervision gap for rural private drug sellers. Second, it highlights the need for terms of reference for peer supervisors. Third, it describes who an appropriate peer supervisor should be. Lastly, it elucidates the kind of resources needed for peer supervision.

scholarly journals ‘I know those people will be approachable and not mistreat us’: a qualitative study of inspectors and private drug sellers’ views on peer supervision in rural Uganda

2020 ◽  
Author(s):  
Arthur Bagonza ◽  
Stefan Peterson ◽  
Andreas Mårtensson ◽  
Milton Mutto ◽  
Phllis Awor ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Role Model ◽  
Health Workers ◽  
Care Delivery ◽  
Group Discussions ◽  
Peer Supervision ◽  
Four Dimensions ◽  
Inappropriate Treatment ◽  
Key Informant ◽  
Drug Sellers

Abstract BackgroundPeer supervision improves health care delivery by health workers. However, in rural Uganda, self-supervision is what is prescribed for licensed private drug sellers by statutory guidelines. Evidence shows that self-supervision encourages inappropriate treatment of children less than five years of age by private drug sellers. This study constructed a model for an appropriate peer supervisor to augment the self-supervision currently practiced by drug sellers at district level in rural Uganda.MethodsIn this qualitative study, six Key informant interviews were held with inspectors while ten focus group discussions were conducted with one hundred and thirty drug sellers. Data analysis was informed by the Kathy Charmaz constructive approach to grounded theory. Atlas ti.7 software package was used for data management.Results A model with four dimensions defining an appropriate peer supervisor was developed. The dimensions included; incentives, clearly defined roles, mediation and role model peer supervisor. While all dimensions were regarded as being important, all participants interviewed agreed that incentives for peer supervisors were the most crucial. Overall, an appropriate peer supervisor was described as being exemplary to other drug sellers, operated within a defined framework, well facilitated to do their role and a good go-between drug sellers and government inspectors. Conclusion Four central contributions advance literature by the model developed by our study. First, the model fills a supervision gap for rural private drug sellers. Second, it highlights the need for terms of reference for peer supervisors. Third, it describes who an appropriate peer supervisor should be. Lastly, it elucidates the kind of resources needed for peer supervision.

scholarly journals Community involvement in health services at Namayumba and Bobi health centres: A case study

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Jane F. Namatovu ◽  
Fred Ndoboli ◽  
Julius Kuule ◽  
Innocent Besigye
Keyword(s):  
Health Services ◽  
Community Involvement ◽  
Health Workers ◽  
Health Centre ◽  
Group Discussions ◽  
Key Informant ◽  
Health Centres ◽  
Support Mechanisms ◽  
Health Programmes

Background: Community involvement has been employed in the development of both vertical and horizontal health programmes. In Uganda, there is no empirical evidence on whether and how communities are involved in their health services.Aim and Setting: The aim of this study was to establish the existence of community involvement in health services and to identify its support mechanisms in Namayumba and Bobi health centres in Wakiso and Gulu districts, respectively.Methods: Participants were selected with the help of a community mobiliser. Key informants were selected purposively depending on their expertise and the roles played in their respective communities. The focus group discussions and key informant interviews were audio-recorded and transcribed verbatim. The transcripts were analysed manually for emerging themes and sub-themes.Results: Several themes emerged from the transcripts and we categorised them broadly into those that promote community involvement in health services and those that jeopardise it. Easy community mobilisation and several forms of community and health centre efforts promote community involvement, whilst lack of trust for health workers and poor communication downplay community involvement in their health services.Conclusion: Community involvement is low in health services in both Namayumba and Bobi health centres.

scholarly journals Reinforcing social learning beyond video: lessons from the sasakawa global 2000 rice videos in kamwenge district, Uganda

2019 ◽  
Vol 9 (1) ◽  
pp. 66-72
Author(s):  
G Karubanga ◽  
F Okry ◽  
P Kibwika ◽  
JG Agea ◽  
H Sseguya
Keyword(s):  
Social Learning ◽  
Qualitative Data ◽  
Structured Interviews ◽  
Group Discussions ◽  
Rice Farmers ◽  
Quantitative Data Analysis ◽  
Key Informant ◽  
The Impact ◽  
Exchange Visit

The study assesses how social learning was triggered and reinforced through video-mediated extension as used by Sasakawa Global 2000 (SG 2000) from 2007 to 2010 among rice farmers in Kamwenge district, Uganda. A longitudinal study involving six focus group discussions and 100 semi-structured interviews were conducted in August 2015 to February 2016, and later 21 key informant interviews in June 2018 to generate data from farmers. While thematic-content analysis was used for the qualitative data, SPSS v.18 was used for quantitative data analysis. Results indicate that video-complementary extension methods were non-discriminative as evidenced by the diversity of farmers who participated in the demonstration sites, field days and exchange visits in terms of age mix and level of education attained. Furthermore, use of videos in extension is more effective when combined with other complementary follow-up extension methods; thus, deepening social learning among farmers. For effective scaling-up of the impact of video-mediated extension messages, use of complementary extension methods such as demonstration plots, exchange visit and field days offer greater opportunities for developing more localized videos for farmer learning. However, this requires pragmatic retooling of extension workers to effectively document local videos on the interactive learning that occurs in these complementary extension methods. Int. J. Agril. Res. Innov. & Tech. 9 (1): 66-72, June, 2019

scholarly journals Opportunities for improving patient experiences among medical travellers from Canada’s far north: a mixed-methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e030885 ◽  
Author(s):  
Kate Kerber ◽  
Fariba Kolahdooz ◽  
Meeka Otway ◽  
Melinda Laboucan ◽  
Se Lim Jang ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Group ◽  
Cultural Awareness ◽  
Health Workers ◽  
Patient Experiences ◽  
Access To Healthcare ◽  
Community Advisory Board ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Key Informant

ObjectivesThis paper explores patient experiences and identifies barriers and opportunities for improving access to healthcare for patients from the Canadian north who travel to receive medical care in a Southern province.DesignA mixed-methods, cross-sectional study involved one-on-one interviews, focus group discussions and key informant interviews.Participants52 one-on-one interviews with Northwest Territories (NWT) patients and patient escorts and two focus group discussions (n=10). Fourteen key informant interviews were conducted with health workers, programme managers and staff of community organisations providing services for out-of-province patients. A Community Advisory Board guided the development of the questionnaires and interpretation of results.ResultsRespondents were satisfied with the care received overall, but described unnecessary burdens and bureaucratic challenges throughout the travel process. Themes relating to access to healthcare included: plans and logistics for travel; level of communication between services; clarity around jurisdiction and responsibility for care; indirect costs of travel and direct costs of uninsured services; and having a patient escort or advocate available to assist with appointments and navigate the system. Three themes related to healthcare experiences included: cultural awareness, respect and caring, and medical translation. Respondents provided suggestions to improve access to care.ConclusionsPatients from NWT need more information and support before and during travel. Ensuring that medical travellers and escorts are prepared before departing, that healthcare providers engage in culturally appropriate communication and connecting travellers to support services on arrival have the potential to improve medical travel experiences.

scholarly journals Physicians’, Nurses’ and Pharmacists’ Perceptions of Determinants to Deprescribing in Nursing Homes Considering Three Levels of Action: A Qualitative Study

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 17
Author(s):  
Rose-Anna Foley ◽  
Lucie Lechevalier Hurard ◽  
Damien Cateau ◽  
Daria Koutaissoff ◽  
Olivier Bugnon ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Healthcare System ◽  
Interprofessional Collaboration ◽  
Common Knowledge ◽  
System Level ◽  
Potentially Inappropriate Medications ◽  
Structured Interviews ◽  
Individual Level ◽  
Medication Costs ◽  
The Individual

Background: Polypharmacy and the use of potentially inappropriate medications are frequent safety issues among nursing home (NH) residents. Deprescribing can significantly reduce the number of drugs used, medication costs, and mortality. This qualitative study sought to understand and compare the perceptions and practices of nurses, pharmacists, and physicians regarding deprescribing in Swiss NHs, referring to an implementation approach on three levels of action: the individual, the institution, and the healthcare system. Methods: Two focus groups were held with 21 participants: one focus group with 11 pharmacists, another with 10 nurses and six semi-structured interviews with physicians were conducted and focused on their individual experience and practices. They were audiotaped and fully transcribed, and a content analysis was performed using to MAXQDA (Ver 12) software. Results: (1) At an individual level, physicians were concerned by consequences of deprescribing in terms of safety. Nurses were closest to residents and stressed the importance of finding the right time, creating a bond of trust before deprescribing and considering the purpose of the stay in the NH. Pharmacists relied on structured guides for deprescribing, which led their reflection and practice. All professionals saw the complexity of the clinical situations, as well as residents’ and relatives’ fears of interruption of care. (2) At an institutional level, the professionals stressed the lack of time to discuss patients’ health and treatment, while pre-existing interprofessional collaboration, specifically, quality circles, seemed useful tools to create common knowledge. In order to reduce prescriptions, better coordination between physicians, nurses, pharmacists and specialists seemed crucial. (3) At the health system level, funding still needs to be provided to consolidate the process, go beyond organisational constraints and ensure deprescribing serves the patient’s wellbeing above all. Conclusions: At the individual level of implementation, the different healthcare professionals expressed specific concerns about deprescribing, depending on their defined role in NHs. Their perspective about the different levers to promote deprescribing at institutional and healthcare system levels converge towards interprofessional collaboration supported by the healthcare system. Specific funding and incentives are therefore needed to support a sustainable interprofessional team.

scholarly journals Factors that affect the adoption and maintenance of weekly vitamin A supplementation among women in Ghana

2007 ◽  
Vol 10 (8) ◽  
pp. 827-833 ◽  
Author(s):  
Zelee Hill ◽  
Betty Kirkwood ◽  
Carl Kendall ◽  
Eunice Adjei ◽  
Paul Arthur ◽  
...  
Keyword(s):  
Vitamin A ◽  
Communication Channel ◽  
Health Workers ◽  
Structured Interviews ◽  
Group Discussions ◽  
Vitamin A Supplementation ◽  
Potential Barriers ◽  
Birth Attendants ◽  
Drug Sellers

AbstractObjectiveTo identify regimen, individual, community and cultural factors that affect adoption and adherence to weekly vitamin A supplementation in Ghana.DesignFifty semi-structured interviews were conducted with women who would be eligible for vitamin A supplementation, 30 with husbands, and 13 with drug sellers, birth attendants and health workers. Six focus group discussions were also conducted with women. These interviews were followed by a 4-month capsule trial with 60 women. Data from a previously conducted communication channel survey of 332 women were also reviewed.SettingThe study was conducted in Kintampo District in central Ghana.SubjectsParticipants for the semi-structured interviews and focus groups were selected from four villages and the district capital, and women in the capsule trial were selected at random from two villages.ResultsKnowledge of vitamins was low and taking ‘medicines’ for long periods and when healthy is a new concept. In spite of this, long-term supplementation will be accepted if motives are explained, specific questions answered and clear instructions are given. Potential barriers included the idea of ‘doctor’ medicines as curative, false expectations of the supplement, forgetting to take the supplement, losing the supplement, travelling, lack of motivation, perceived side-effects, concerns that the supplement is really family planning or will make delivery difficult, and concerns about taking the supplement with other ‘doctor’ or herbal medicine, or when pregnant or breast-feeding, or if childless.ConclusionSuccessful supplementation programmes require appropriately designed information, education and communication strategies. Designing such strategies requires pre-programme formative research to uncover barriers and facilitators for supplementation.

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