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 ‘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 ◽  
Vol 16 (1) ◽  
Author(s):  
Arthur Bagonza ◽  
Stefan Peterson ◽  
Andreas Mårtensson ◽  
Milton Mutto ◽  
Phyllis Awor ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Role Model ◽  
Health Workers ◽  
Care Delivery ◽  
Group Discussions ◽  
Peer Supervision ◽  
Four Dimensions ◽  
Inappropriate Treatment ◽  
Key Informant ◽  
Drug Sellers

Abstract Background Peer 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 5 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. Methods In this qualitative study, six Key informant interviews were held with inspectors while ten focus group discussions were conducted with 130 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 Peer supervision experiences of drug sellers in a rural district in East-Central Uganda: a qualitative study

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Arthur Bagonza ◽  
Henry Wamani ◽  
Stefan Peterson ◽  
Andreas Mårtensson ◽  
Milton Mutto ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Rural District ◽  
Peer Supervision ◽  
East Central ◽  
Drug Sellers

scholarly journals UNDERSTANDING LOW UPTAKE OF MASS TREATMENT FOR INTESTINAL SCHISTOSOMIASIS AMONG SCHOOL CHILDREN: A QUALITATIVE STUDY IN JINJA DISTRICT, UGANDA

2014 ◽  
Vol 47 (4) ◽  
pp. 505-520 ◽  
Author(s):  
SIMON MUHUMUZA ◽  
ANNETTE OLSEN ◽  
FRED NUWAHA ◽  
ANNE KATAHOIRE
Keyword(s):  
Focus Group ◽  
Qualitative Study ◽  
School Children ◽  
Primary Schools ◽  
School Teachers ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
School Feeding ◽  
Intestinal Schistosomiasis ◽  
Key Informant

SummaryDespite attempts to control intestinal schistosomiasis through school-based mass drug administration (MDA) with praziquantel using school teachers in Uganda, less than 30% of the school children take the treatment in some areas. The aim of the study was to understand why the uptake of praziquantel among school children is low and to suggest strategies for improved uptake. This was a cross-sectional qualitative study in which 24 focus group discussions and 15 key informant interviews were conducted 2 months after MDA. The focus group discussions were held with school children in twelve primary schools and the key informant interviews were held with school teachers, sub-county health assistants and the District Vector Control Officer. The study shows that the low uptake of praziquantel among school children is a result of a complex interplay between individual, interpersonal, institutional, community and public policy factors. The individual and interpersonal factors underpinning the low uptake include inadequate information about schistosomiasis prevention, beliefs and attitudes in the community about treatment of schistosomiasis and shared concerns among children and teachers about the side-effects of praziquantel, especially when the drug is taken on an empty stomach. The institutional, policy and community factors include inadequate preparation and facilitation of teachers and the school feeding policy, which requires parents to take responsibility for providing their children with food while at school, yet many parents cannot meet the cost of a daily meal due to the prevailing poverty in the area. It is concluded that strategies to improve uptake of praziquantel among school children need to be multi-pronged addressing not only the preparation and motivation of teachers and health education for children, but also the economic and political aspects of drug distribution, including the school feeding policy.

scholarly journals “Like a doctor, like a brother”: Achieving competence amongst lay health workers delivering community-based rehabilitation for people with schizophrenia in Ethiopia

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246158
Author(s):  
Laura Asher ◽  
Rahel Birhane ◽  
Solomon Teferra ◽  
Barkot Milkias ◽  
Benyam Worku ◽  
...  
Keyword(s):  
Pilot Study ◽  
Problem Solving ◽  
Health Workers ◽  
Core Competencies ◽  
Lay Health Workers ◽  
Personal Factors ◽  
Group Discussions ◽  
Community Based ◽  
Peer Supervision ◽  
Community Based Rehabilitation

Background There are gaps in our understanding of how non-specialists, such as lay health workers, can achieve core competencies to deliver psychosocial interventions in low- and middle-income countries. Methods We conducted a 12-month mixed-methods study alongside the Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE) pilot study. We rated a total of 30 role-plays and 55 clinical encounters of ten community-based rehabilitation (CBR) lay workers using an Ethiopian adaptation of the ENhancing Assessment of Common Therapeutic factors (ENACT) structured observational rating scale. To explore factors influencing competence, six focus group discussions and four in-depth interviews were conducted with 11 CBR workers and two supervisors at three time-points. We conducted a thematic analysis and triangulated the qualitative and quantitative data. Results There were improvements in CBR worker competence throughout the training and 12-month pilot study. Therapeutic alliance competencies (e.g., empathy) saw the earliest improvements. Competencies in personal factors (e.g., substance use) and external factors (e.g., assessing social networks) were initially rated lower, but scores improved during the pilot. Problem-solving and giving advice competencies saw the least improvements overall. Multimodal training, including role-plays, field work and group discussions, contributed to early development of competence. Initial stigma towards CBR participants was reduced through contact. Over time CBR workers occupied dual roles of expert and close friend for the people with schizophrenia in the programme. Competence was sustained through peer supervision, which also supported wellbeing. More intensive specialist supervision was needed. Conclusion It is possible to equip lay health workers with the core competencies to deliver a psychosocial intervention for people with schizophrenia in a low-income setting. A prolonged period of work experience is needed to develop advanced skills such as problem-solving. A structured intervention with clear protocols, combined with peer supervision to support wellbeing, is recommended for good quality intervention delivery. Repeated ENACT assessments can feasibly and successfully be used to identify areas needing improvement and to guide on-going training and supervision.

scholarly journals Iterative Adaptation of a Maternal Nutrition Videos mHealth Intervention Across Countries Using Human-Centered Design: Qualitative Study (Preprint)

2019 ◽  
Author(s):  
Jasmin Isler ◽  
N Hélène Sawadogo ◽  
Guy Harling ◽  
Till Bärnighausen ◽  
Maya Adam ◽  
...  
Keyword(s):  
Focus Group ◽  
Qualitative Study ◽  
South African ◽  
Maternal Nutrition ◽  
Health Workers ◽  
Video Adaptation ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Human Centered Design ◽  
Depth Interviews

BACKGROUND Mobile health (mHealth) video interventions are often transferred across settings. Although the outcomes of these transferred interventions are frequently published, the process of adapting such videos is less described, particularly within and across lower-income contexts. This study fills a gap in the literature by outlining experiences and priorities adapting a suite of South African maternal nutrition videos to the context of rural Burkina Faso. OBJECTIVE The objective of this study was to determine the key components in adapting a suite of maternal nutrition mHealth videos across settings. METHODS Guided by the principles of human-centered design, this qualitative study included 10 focus group discussions, 30 in-depth interviews, and 30 observations. We first used focus group discussions to capture insights on local nutrition and impressions of the original (South African) videos. After making rapid adjustments based on these focus group discussions, we used additional methods (focus group discussions, in-depth interviews, and observations) to identify challenges, essential video refinements, and preferences in terms of content delivery. All data were collected in French or Dioula, recorded, transcribed, and translated as necessary into French before being thematically coded by two authors. RESULTS We propose a 3-pronged Video Adaptation Framework that places the aim of video adaptation at the center of a triangle framed by end recipients, health workers, and the environment. End recipients (here, pregnant or lactating mothers) directed us to (1) align the appearance, priorities, and practices of the video’s protagonist to those of Burkinabe women; (2) be mindful of local realities whether economic, health-related, or educational; and (3) identify and routinely reiterate key points throughout videos and via reminder cards. Health workers (here, Community Health Workers and Mentor Mothers delivering the videos) guided us to (1) improve technology training, (2) simplify language and images, and (3) increase the frequency of their engagements with end recipients. In terms of the environment, respondents guided us to localize climate, vegetation, diction, and how foods are depicted. CONCLUSIONS Design research provided valuable insights in terms of developing a framework for video adaptation across settings, which other interventionists and scholars can use to guide adaptations of similar interventions.

scholarly journals Peer supervision experiences of drug sellers in a rural district in East-Central Uganda: a qualitative study

2020 ◽  
Author(s):  
Arthur Bagonza ◽  
Henry Wamani ◽  
Stefan Peterson ◽  
Andreas Mårtensson ◽  
Milton Mutto ◽  
...  
Keyword(s):  
Sick Child ◽  
Health Workers ◽  
Performance Outcomes ◽  
Drug Shop ◽  
Peer Supervision ◽  
East Central ◽  
Good Relationship ◽  
Children Under Five ◽  
Under Five ◽  
Drug Sellers

Abstract BackgroundSupport supervision improves performance outcomes among health workers. However, the national professional guidelines for new licenses and renewal for class C drug shops in Uganda prescribe self-supervision of licensed private drug sellers.As such, inappropriate treatment of malaria, pneumonia and diarrhoea among children under five years of age continues unabated. This study assessed experiences of drug sellers and peer supervisors at the end of a peer supervision intervention in Luuka district in East Central Uganda.MethodsEightin-depth interviews (IDIs) were held with peer supervisors while five focus group discussions (FGDs) were conducted among registered drug sellersat the end of the peer supervision intervention. The study assessed experiences and challenges of peer supervisors and drug sellers regarding peer supervision.Transcripts were imported into Atlas ti 7 qualitative data management software (ATLAS.ti GmbH, Berlin) where they were analysedusing thematic content analysis.ResultsInitially, peer supervisors were disliked and regarded as another extension of drug inspectors by drug sellers. However, with time a good relationship was established between drug sellers and peer supervisors leading to regular, predictable and supportive peer supervision. This increased confidence of drug sellers in using respiratory timers and rapid diagnostic tests in diagnosing pneumonia symptoms and uncomplicated malaria respectively among children under five years. There was also an improvement in completing the sick child register which was used for self-assessment by drug sellers. The drug shop association was mentioned as a place where peer supervision should be anchored since it was a one-stop center for sharing experiences and continuous professional development. Drug sellers proposed including community health workers in monthly drug shop association meetings so that they mayalso gain from the associated benefits. Untimely completion of the sick child registers by drug sellers and inadequate financial resources were the main peer supervision challenges mentioned.ConclusionDrug sellers benefitted from peer supervision by developing a good relationship with peer supervisors.This relationship guaranteed reliable and predictable supervision ultimately leading to improved treatment practices.There is need to explore the minimum resources needed for peer supervision of drug sellers to further inform practice and policy.

scholarly journals Socio-cultural Factors Associated with Complementary Feeding in Two Rural Districts in Ghana: A qualitative study involving Health Workers

2020 ◽  
pp. 10-24
Author(s):  
Christiana Naa Atsreh Nsiah-Asamoah
Keyword(s):  
Focus Group ◽  
Qualitative Study ◽  
Complementary Feeding ◽  
Health Workers ◽  
Cultural Beliefs ◽  
Feeding Practices ◽  
Cultural Factors ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Rural Districts

Aim: This study sought to explore the cultural factors that are associated with complementary feeding from the reports of Community Health Workers (CHWs) and Volunteers (CHVs) in two rural districts in Ghana. Study Design: This was a cross-sectional qualitative study that assessed cultural beliefs, norms, superstitions and practices that influence complementary feeding practices of young children under two years in two rural farming districts in Ghana Study Area: The study was conducted at Kwahu Afram Plains North and South Districts in the Eastern Region of Ghana. Methodology: The study employed qualitative methods which entailed conducting 9 focus group discussions among CHWs and CHVs working at two rural districts in Ghana. The focus group discussions were conducted with the aid of a validated, interview guide, after obtaining informed consent (written) from the health workers. Ethical clearance for the study was obtained from the Institutional Review Boards of the Dodowa Health Research Centre and the University of Cape Coast. Thematic content analytical procedures were applied to analyze the transcripts, interpret and present findings as a narrative account. Results: The reports of the health workers indicate a common practice of early introduction of solid foods to infants before they attain six(6) months of age. Cultural beliefs, superstitions, beliefs, food taboos and prohibitions influence mothers’ complementary-feeding practices and result in limiting the food scope and dietary diversity of their young children. Conclusions: Interventions designed to promote appropriate complementary feeding practices should incorporate an understanding of social context, family, and cultural factors in developing nutrition promotion messages that are tailored to meet the needs of rural populations. More community interventions that draw on the support of key influential persons in the community and fathers are needed to address cultural barriers to appropriate complementary feeding practices.

scholarly journals Perceptions and experiences of men and women towards acceptability and use of contraceptives in underserved areas of Karachi, Pakistan: A Midline Qualitative Assessment of Sukh Initiative, Karachi Pakistan

2020 ◽  
Author(s):  
Sarah Saleem ◽  
Narjis Rizvi ◽  
Anam Feroz ◽  
Sayyeda Reza ◽  
Saleem Jessani ◽  
...  
Keyword(s):  
Focus Group ◽  
Qualitative Study ◽  
Contraceptive Use ◽  
Health Workers ◽  
Healthcare Providers ◽  
Reproductive Age ◽  
Qualitative Assessment ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Men And Women

Abstract Background: Family planning (FP) is an essential component of Sustainable Development Goals (SDG) and contributes directly to SDG targets 3.7 and 5.6. In Pakistan, contraceptive use has remained stagnant over the past 5 years. This change has been very slow when compared to the FP2020 pledge. The Sukh initiative project was conceived and implemented to alleviate these challenges by providing access to quality contraceptive methods in some underserved areas of Karachi, Pakistan. A qualitative study was been conducted to understand the perceptions and experiences of men and women towards acceptability and contraceptive use.Methods: A qualitative study was conducted at ten Sukh stations located in four towns of Karachi. Focus group discussions (FGDs) were conducted with Married Women of Reproductive Age (MWRA) and married men who received FP services through the Sukh initiative. Study participants were purposively sampled for focus group discussions (FGDs). Interview data was manually transcribed and analyzed using thematic analysis.Results: A total of 20 FDGs(Men=10 FGDs; MWRA=10 FGDs) were conducted. Three overarching themes were identified: (I) Appropriateness and means to promote contraceptive use; (II) Equity and Accessibility to contraceptives; and (III) Perspective on available FP services. Generally, both men and women were informed about FP methods but women were more cognizant of FP information. The Door to Door services by community health workers in Sukh initiative areas was largely appreciated both by women and men as it has made the accessibility and availability of the information and services easy. Women suggested that the Sukh initiative should bring some strategies that can help men broaden their perspective towards FP. The study informed that the men feel left out from the FP programs. Therefore, male participants expressed keen interest in initiatives for men in their communities that would cater to their FP needs.Conclusions: This qualitative study provided a unique opportunity to understand the perceptions of men and women towards the phenomena of contraceptive use. The study identified the need for trained and qualified female and male healthcare providers and well-established health facilities alongside door-to-door services.

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.

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