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 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 How medical dominance and interprofessional conflicts undermine patient-centred care in hospitals: historical analysis and multiple embedded case study in Morocco

2021 ◽  
Vol 6 (7) ◽  
pp. e006140
Author(s):  
Zakaria Belrhiti ◽  
Sara Van Belle ◽  
Bart Criel
Keyword(s):  
Soft Power ◽  
Health Workers ◽  
Interprofessional Collaboration ◽  
Historical Analysis ◽  
Best Interests ◽  
Group Discussions ◽  
Power Struggles ◽  
Embedded Case Study ◽  
Health Managers

BackgroundIn Morocco’s health systems, reforms were accompanied by increased tensions among doctors, nurses and health managers, poor interprofessional collaboration and counterproductive power struggles. However, little attention has focused on the processes underlying these interprofessional conflicts and their nature. Here, we explored the perspective of health workers and managers in four Moroccan hospitals.MethodsWe adopted a multiple embedded case study design and conducted 68 interviews, 8 focus group discussions and 11 group discussions with doctors, nurses, administrators and health managers at different organisational levels. We analysed what health workers (doctors and nurses) and health managers said about their sources of power, perceived roles and relationships with other healthcare professions. For our iterative qualitative data analysis, we coded all data sources using NVivo V.11 software and carried out thematic analysis using the concepts of ‘negotiated order’ and the four worldviews. For context, we used historical analysis to trace the development of medical and nursing professions during the colonial and postcolonial eras in Morocco.ResultsOur findings highlight professional hierarchies that counterbalance the power of formal hierarchies. Interprofessional interactions in Moroccan hospitals are marked by conflicts, power struggles and daily negotiated orders that may not serve the best interests of patients. The results confirm the dominance of medical specialists occupying the top of the professional hierarchy pyramid, as perceived at all levels in the four hospitals. In addition, health managers, lacking institutional backing, resources and decision spaces, often must rely on soft power when dealing with health workers to ensure smooth collaboration in care.ConclusionThe stratified order of care professions creates hierarchical professional boundaries in Moroccan hospitals, leading to partitioning of care and poor interprofessional collaboration. More attention should be placed on empowering health workers in delivering quality care by ensuring smooth interprofessional collaboration.

scholarly journals Does public service motivation matter in Moroccan public hospitals? A multiple embedded case study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Zakaria Belrhiti ◽  
Wim Van Damme ◽  
Abdelmounim Belalia ◽  
Bruno Marchal
Keyword(s):  
Intrinsic Motivation ◽  
Public Service ◽  
Religious Beliefs ◽  
Health Workers ◽  
Public Service Motivation ◽  
Public Hospitals ◽  
Common Interest ◽  
Group Discussions ◽  
Embedded Case Study

Abstract Background The motivation of health workers is a key concern of policy makers, practitioners and researchers. Public Service Motivation (PSM), defined as the altruistic desire to serve the common interest, to serve others and to help patients and their families regardless of financial or external rewards, has been shown to be key to the performance of public servants. Yet, limited attention has been paid to this kind of motivation in health care settings in low- and middle-income countries. Little is known about PSM and its contextual specificity in the Moroccan health system. We set out to qualitatively explore the meaning of PSM and its expression among health workers in four public hospitals. Methods We adopted a multiple embedded case study design to explore PSM in two well-performing and two poor-performing hospitals. We carried out 68 individual interviews, eight focus group discussions and 11 group discussions with different cadres (doctors, administrators and nurses). We carried out thematic analysis using NVivo 10. Results Our analysis shows that public service motivation is a notion that seems natural to the health workers we interviewed. Daily interactions with patients catalysed health providers’ affective motives (compassion and self- sacrifice), a central element of PSM. It also provided them with job satisfaction aligned with their intrinsic motivation. Managers and administrative personnel express other PSM components: attraction to public policy making and commitment to public values. A striking result is that health workers expressed strong religious beliefs about expected rewards from God when properly serving patients. Conclusion This study highlights the presence of PSM as a driver of motivation among health workers in four Moroccon hospitals, and the prominence of intrinsic motivation and compassion in the motivation of frontline health workers. Religious beliefs were found to shape the expression of PSM in Morocco.

scholarly journals Integrating community health workers into the formal health system to improve performance: a qualitative study on the role of on-site supervision in the South African programme

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e022186 ◽  
Author(s):  
Yu-hwei Tseng ◽  
Frances Griffiths ◽  
Julia de Kadt ◽  
Nonhlanhla Nxumalo ◽  
Teurai Rwafa ◽  
...  
Keyword(s):  
Health System ◽  
Community Health ◽  
South African ◽  
Health Workers ◽  
Group Discussions ◽  
Skill Levels ◽  
Clinic Staff ◽  
Study Approach

ObjectivesTo explore the role of on-site supervision in community health worker (CHW) programmes and CHW integration into the health system. We compared the functioning of CHW teams reporting to a clinic-based nurse with teams supervised by a community-based nurse. We also consider whether a junior nurse can provide adequate supervision, given the shortage of senior nurses.DesignA case study approach to study six CHW teams with different configurations of supervision and location. We used a range of qualitative methods: observation of CHW and their supervisors (126 days), focus group discussions (12) and interviews (117).SettingSouth Africa where a national CHW programme is being implemented with on-site supervision.ParticipantsCHWs, their supervisors, clinic managers and staff, district managers, key informants from the community and CHW clients.ResultsEffective supervisors supported CHWs through household visits, on-the-job training, debriefing, reviewing CHWs’ daily logs and assistance with compiling reports. CHWs led by senior nurses were motivated and performed a greater range of tasks; junior nurses in these teams could better fulfil their role. Clinic-based teams with senior supervisors were better integrated and more able to ensure continuity of care. In contrast, teams with only junior supervisors, or based in the community, had less engagement with clinic staff, and were less able to ensure necessary care for patients, resulting in lower levels of trust from clients.ConclusionSenior supervisors raised CHW skills, and successfully negotiated a place for CHWs in the health system. Collaboration with clinic staff reduced CHWs’ marginalisation and increased motivation. Despite being clinic-based, teams without senior supervisors had lower skill levels and were less integrated into the health system.

“Educated or Warehoused?”: The educational experiences of former NEET and so-called disengaged youth in a Further Education (FE) College in England

2017 ◽  
Vol 6 (1) ◽  
pp. 318
Author(s):  
Carlene Cornish
Keyword(s):  
Empirical Research ◽  
Academic Failure ◽  
Further Education ◽  
Structured Interviews ◽  
Group Discussions ◽  
Study Approach ◽  
Research Findings ◽  
Fit For Purpose ◽  
Level 1 ◽  
South East England

RPA (Raising of Participation Age) legislation re-positioned all youth in England to participate in post-16 education and training, the ultimate aim to develop ‘human capital’, i.e. skills, abilities and knowledge (Foucault 2008). However, how does RPA play out in practice with previously NEET and so-called disengaged youth engaged on a Level 1 prevocational course? Empirical research was conducted at a large general further education (FE) college in South East England, named The Site with seven tutors and twenty six students from the 2013-14 and 2014-15 cohorts. Adopting a case study approach, multiple methods of data collection were used, including classroom observations, semi-structured interviews, focus group discussions and document analysis. Key findings problematize education and highlighted complications for marginalised youth that participated in the study. Far from being a straightforward experience for former NEET and disadvantaged youth to gain knowledge and skills whilst at college, conversely, these Level 1 pre-vocational students faced multiple barriers that challenged student efforts to access essential provision in an attempt to improve on previous academic failure. Research findings revealed ‘warehousing’ appeared to be the main purpose of education for these particular students in this study. Distinctly different to stereotypical ideas, these particular students wanted to learn. In a profound way, empirical research highlighted how stringent academic conditions were powerfully used to demarcate access and predetermined which types of youth were permitted on higher levels of study programmes and apprenticeship. This study adopts a social justice framework and therefore advocated for numerous structural and pedagogical changes. Amongst others, the recommendation was made for an overhaul in government and organisational policies on GCSE provision. This study also calls for a sharpened political focus, inviting academic and government debate for a critical re-think and revamp of re-engagement provision - so it is fit for purpose for disadvantaged students.

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.

scholarly journals Nosocomial Infection Prevention through Universal Precaution in Yogyakarta Muhammadiyah Hospital

2016 ◽  
Vol 5 (3) ◽  
pp. 233
Author(s):  
Triani Marwati ◽  
Siti Kurnia Widi Hastuti ◽  
Lina Handayani ◽  
Solikhah Solikhah ◽  
Lafi Munira
Keyword(s):  
Nosocomial Infections ◽  
Infection Prevention ◽  
Health Workers ◽  
Hand Washing ◽  
Universal Precaution ◽  
Group Discussions ◽  
Universal Precautions ◽  
Study Approach ◽  
Nurses And Physicians

<p>Prevention of nosocomial infections in hospitals can be done through the implementation of universal precaution program or action asepsis and antisepsis tapping. These actions undertaken by health workers, both nurses and physicians, universal precaution measures include: hand washing, use of gloves, use aseptic liquid, processing of used equipment and waste disposal. The purpose of this study to determine the prevention of nosocomial infections in hospitals through universal precautions in hospitals Muhammadiyah Yogyakarta area. Design of this research is descriptive qualitative case study approach. Collecting data used techniques focus group discussions. Data analyzed using content analysis. The application of universal precautions in hospitals throughout Yogyakarta PKU show that health workers have attempted to implement universal precautions including hand washing action on the water flow, perform hand hygiene, and always tries to wear personal protective equipment. Nurses knowledge about nosocomial infections has been well and for prevention need to implement universal precautions. The attitude of nurses in implementing universal precautions have been good, to the extent responsible. Most hospitals have had the availability of facilities and support the implementation of universal precaution well, and partly still exist limitations in the availability of facilities and support the implementation of universal precaution.</p>

scholarly journals Impact of the COVID-19 pandemic on the human resources for health in India and key policy areas to build a resilient health workforce

2020 ◽  
Vol 4 ◽  
pp. 159
Author(s):  
Ankita Mukherjee ◽  
Rakesh Parashar
Keyword(s):  
Human Resources ◽  
Health Workforce ◽  
Emergency Preparedness ◽  
Health Workers ◽  
Human Resources For Health ◽  
System Level ◽  
Individual Level ◽  
Media Reports ◽  
Critical Components ◽  
The Individual

The COVID-19 pandemic has disrupted the already low resourced, fragmented and largely unregulated health systems in countries like India. It has only further exacerbated the stress on human resources for health (HRH) in many unanticipated ways. We explored the effect of COVID-19 pandemic on the health workforce in India, and analytically extrapolated the learnings to draw critical components to be addressed in the HRH policies, which can further be used to develop a detailed ‘health workforce resilience’ policy. We examined the existing literature and media reports published during the pandemic period, covering the gaps and challenges that impeded the performance of the health workers. Recommendations were designed by studying the learnings from various measures taken within India and in some other countries. We identified seven key areas that could be leveraged and improved for strengthening resilience among the health workforce. The system-level factors (at macro level) include developing a health workforce resilience policy, planning and funding for emergency preparedness, stakeholder engagement and incentivization mechanisms; the organization-level factors (meso level) include identifying HRH bench strength, mobilizing the health workforce, psycho-social support, protection from disease; and the individual-level factors (micro level) include measures around self-care by health workers. In keeping with the interdisciplinary nature of the associated factors, we emphasize on developing a future-ready health workforce using a multi-sectoral approach for building its strength and resilience.

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