COVID-19 guidance in humanitarian settings: The need for dynamic guidelines adapted to changing humanitarian crisis contexts

Abstract Background: For humanitarian organisations to respond effectively to complex crises, they require access to up-to-date evidence-based guidance. In addition, the COVID-19 crisis has highlighted the importance of adapting and updating global guidance to context-specific and evolving needs in fragile and humanitarian settings. Our study aimed to understand the use of evidence in humanitarian responses during COVID-19.Methods: We collected and analysed COVID-19 guidance documents, and conducted semi-structured interviews remotely with a variety of humanitarian organisations responding and adapting to the COVID-19 pandemic. We used the COVID-19 Humanitarian platform, a website established by three universities in March 2020, to solicit, collate and document these experiences and knowledge.Results: We collected 180 guidance documents, and after excluding those that did not meet our inclusion criteria, analysed 131. We conducted 80 interviews with humanitarian organisations in the field, generating 61 published field experiences. Although COVID-19 guidance was quickly developed and disseminated in the initial phases of the crisis (from January to May 2020), updates or ongoing revision of the guidance has been limited. Interviews conducted between April and September 2020 showed that humanitarian organisations have responded to COVID-19 in innovative and context-specific ways, but have often had to adapt existing guidance to inform their operations in complex humanitarian settings.Conclusion: Experiences from the field indicate that adopting guidance to respond and adapt to COVID-19 is a complex process requiring innovation and collaboration based on the local context and resource availability. Global guidance aimed at humanitarian actors could be improved through responsive incorporation of contextualised field experiences in a timely manner using real-time feedback loops through online platforms like the COVID-19 Humanitarian platform.

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Use of COVID-19 evidence in humanitarian settings: the need for dynamic guidance adapted to changing humanitarian crisis contexts

Conflict and Health ◽

10.1186/s13031-021-00418-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Alex Odlum ◽

Rosemary James ◽

Audrey Mahieu ◽

Karl Blanchet ◽

Chiara Altare ◽

...

Keyword(s):

Primary Data ◽

Evidence Based ◽

Structured Interviews ◽

Humanitarian Crisis ◽

Evidence Use ◽

Humanitarian Settings ◽

Humanitarian Response ◽

Global Guidance ◽

Guidance Documents ◽

Context Specific

Abstract Background For humanitarian organisations to respond effectively to complex crises, they require access to up-to-date evidence-based guidance. The COVID-19 crisis has highlighted the importance of updating global guidance to context-specific and evolving needs in humanitarian settings. Our study aimed to understand the use of evidence-based guidance in humanitarian responses during COVID-19. Primary data collected during the rapidly evolving pandemic sheds new light on evidence-use processes in humanitarian response. Methods We collected and analysed COVID-19 guidance documents, and conducted semi-structured interviews remotely with a variety of humanitarian organisations responding and adapting to the COVID-19 pandemic. We used the COVID-19 Humanitarian platform, a website established by three universities in March 2020, to solicit, collate and document these experiences and knowledge. Results We analysed 131 guidance documents and conducted 80 interviews with humanitarian organisations, generating 61 published field experiences. Although COVID-19 guidance was quickly developed and disseminated in the initial phases of the crisis (from January to May 2020), updates or ongoing revision of the guidance has been limited. Interviews conducted between April and September 2020 showed that humanitarian organisations have responded to COVID-19 in innovative and context-specific ways, but have often had to adapt existing guidance to inform their operations in complex humanitarian settings. Conclusions Experiences from the field indicate that humanitarian organisations consulted guidance to respond and adapt to COVID-19, but whether referring to available guidance indicates evidence use depends on its accessibility, coherence, contextual relevance and trustworthiness. Feedback loops through online platforms like the COVID-19 Humanitarian platform that relay details of these evidence-use processes to global guidance setters could improve future humanitarian response.

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COVID-19 in humanitarian settings: documenting and sharing context-specific programmatic experiences

Conflict and Health ◽

10.1186/s13031-020-00321-w ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Neha S. Singh ◽

Orit Abrahim ◽

Chiara Altare ◽

Karl Blanchet ◽

Caroline Favas ◽

...

Keyword(s):

Large Scale ◽

Field Experiences ◽

Gender Based Violence ◽

Humanitarian Settings ◽

Humanitarian Organizations ◽

Country Level ◽

Guidance Documents ◽

Gender Based ◽

And Gender ◽

Context Specific

AbstractHumanitarian organizations have developed innovative and context specific interventions in response to the COVID-19 pandemic as guidance has been normative in nature and most are not humanitarian specific. In April 2020, three universities developed a COVID-19 humanitarian-specific website (www.covid19humanitarian.com) to allow humanitarians from the field to upload their experiences or be interviewed by academics to share their creative responses adapted to their specific country challenges in a standardised manner. These field experiences are reviewed by the three universities together with various guidance documents and uploaded to the website using an operational framework. The website currently hosts 135 guidance documents developed by 65 different organizations, and 65 field experiences shared by 29 organizations from 27 countries covering 38 thematic areas. Examples of challenges and innovative solutions from humanitarian settings are provided for triage and sexual and gender-based violence. Offering open access resources on a neutral platform by academics can provide a space for constructive dialogue among humanitarians at the country, regional and global levels, allowing humanitarian actors at the country level to have a strong and central voice. We believe that this neutral and openly accessible platform can serve as an example for future large-scale emergencies and epidemics.

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SUSTAINING FAMILY ROUTINES AFTER TRANSITIONING INTO PARENTHOOD: COUPLES’ PERCEPTIONS OF ASSISTING FACTORS

SOUTHERN AFRICAN JOURNAL OF SOCIAL WORK AND SOCIAL DEVELOPMENT ◽

10.25159/2415-5829/1347 ◽

2016 ◽

Vol 28 (1) ◽

pp. 3-17

Author(s):

Christine De Goede ◽

Abraham P Greeff

Keyword(s):

Low Income ◽

Transition To Parenthood ◽

Specific Problem ◽

Family Members ◽

Major Theme ◽

Structured Interviews ◽

Theory Analysis ◽

Family Routines ◽

Temporal Complexity ◽

Context Specific

The aim of this qualitative study was to explore what assists couples in sustaining family routines after the transition to parenthood. Participants were recruited from two day-care centres in Cape Town, South Africa. In-depth, semi-structured interviews were conducted with 10 couples, mostly from low-income households, who had gone through this transition between one and four years previously. Grounded theory analysis revealed one major theme, Factors that decrease task and temporal complexity, with seven subthemes: Support from the wider family network; Couple cooperation and tag-teaming; Planning and pre-empting future problems; Adhering to schedules; Facilitative characteristics and skills of individual family members; Parents’ sense of commitment and responsibility towards family members; and idiosyncratic accommodations. Results underscore the need for professionals to help parents gain support from relatives; strengthen partner teamwork; foster schedule consistency; improve skills such as planning; foster their caretaker self-concepts; and facilitate context-specific problem-solving.

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The availability of global guidance for the promotion of women’s, newborns’, children’s and adolescents’ health and nutrition in conflicts

BMJ Global Health ◽

10.1136/bmjgh-2019-002060 ◽

2020 ◽

Vol 5 (Suppl 1) ◽

pp. e002060

Author(s):

Samira Aboubaker ◽

Egmond Samir Evers ◽

Loulou Kobeissi ◽

Lauren Francis ◽

Robinah Najjemba ◽

...

Keyword(s):

Adolescent Health ◽

English Language ◽

Guideline Development ◽

Newborn Care ◽

Evidence Base ◽

Communicable Diseases ◽

Key Informants ◽

Humanitarian Settings ◽

Health And Nutrition ◽

Guidance Documents

BackgroundSignificant global gains in sexual, reproductive, maternal, newborn, child and adolescent health and nutrition (SRMNCAH&N) will be difficult unless conflict settings are adequately addressed. We aimed to determine the amount, scope and quality of publically available guidance documents, to characterise the process by which agencies develop their guidance and to identify gaps in guidance on SRMNCAH&N promotion in conflicts.MethodsWe identified guidance documents published between 2008 and 2018 through English-language Internet sites of humanitarian response organisations, reviewed them for their scope and assessed their quality with the AGREE II (Appraisal of Guidelines for REsearch and Evaluation II) tool. Additionally, we interviewed 22 key informants on guidance development, dissemination processes, perceived guidance gaps and applicability.FindingsWe identified 105 conflict-relevant guidance documents from 75 organisations. Of these, nine were specific to conflicts, others were applicable also to other humanitarian settings. Fifteen documents were technical normative guidelines, others were operational guides (67), descriptive documents (21) or advice on legal, human rights or ethics questions (2). Nutrition was the most addressed health topic, followed by communicable diseases and violence. The documents rated high quality in their ‘scope and purpose’ and ‘clarity of presentation’ and low for ‘rigour of development’ and ‘editorial independence’. Key informants reported end user need as the primary driver for guideline development and WHO technical guidelines as their main evidence base. Insufficient local contextualisation, lack of inter-agency coordination and lack of systematic implementation were considered problems in guideline development. Several guidance gaps were noted, including abortion care, newborn care, early child development, mental health, adolescent health beyond sexual and reproductive health and non-communicable diseases.InterpretationOrganisations are motivated and actively producing guidance for SRMNCAH&N promotion in humanitarian settings, but few documents address conflicts specifically and there are important guidance gaps. Improved inter-organisation collaboration for guidance on SRMNCAH&N promotion in conflicts and other humanitarian settings is needed.

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Metaphors and cultural narratives on adaptive responses to severe adversity: A field study among the Indigenous Pitaguary community in Brazil

Transcultural Psychiatry ◽

10.1177/1363461519890435 ◽

2019 ◽

Vol 57 (2) ◽

pp. 332-345 ◽

Cited By ~ 1

Author(s):

Iara Meili ◽

Eva Heim ◽

Ana C Pelosi ◽

Andreas Maercker

Keyword(s):

Posttraumatic Growth ◽

Field Study ◽

Cultural Context ◽

Field Research ◽

Adaptive Responses ◽

Cultural Narratives ◽

Structured Interviews ◽

The Core ◽

Recovery Processes ◽

Context Specific

The expressions resilience and posttraumatic growth represent metaphorical concepts that are typically found in Euro-American contexts. Metaphors of severe adversity or trauma and the expressions of overcoming it vary across cultures—a lacuna, which has not been given much attention in the literature so far. This study aimed to explore the metaphorical concepts that the Indigenous Pitaguary community in Brazil uses to talk about adaptive and positive responses to severe adversity and to relate them to their socio-cultural context. We carried out 14 semi-structured interviews during field research over a one-month period of fieldwork. The data were explored with systematic metaphor analysis. The core metaphors included images of battle, unity, spirituality, journeys, balance, time, sight, transformation, and development. These metaphors were related to context-specific cultural narratives that underlie the Pitaguary ontological perspective on collectivity, nature, and cosmology. The results suggest that metaphors and cultural narratives can reveal important aspects of a culture’s collective mindset. To have a contextualized understanding of expressive nuances is an essential asset to adapt interventions to specific cultures and promote culture-specific healing and recovery processes.

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A qualitative study of organisational response to national quality standards for 7-day services in English hospitals

BMC Health Services Research ◽

10.1186/s12913-021-06213-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Elizabeth Sutton ◽

Julian Bion ◽

Russell Mannion ◽

Janet Willars ◽

Elizabeth Shaw ◽

...

Keyword(s):

Organisational Culture ◽

National Standards ◽

Local Context ◽

Structured Interviews ◽

Improvement Strategy ◽

Senior Staff ◽

National Quality ◽

History Of ◽

Day Services ◽

The Impact

Abstract Background National standards are commonly used as an improvement strategy in healthcare, but organisations may respond in diverse and sometimes negative ways to external quality demands. This paper describes how a sample of NHS hospital trusts in England responded to the introduction of national standards for 7-day services (7DS), from an organisational behaviour perspective. Methods We conducted 43 semi-structured interviews with executive/director level and clinical staff, in eight NHS trusts that varied in size, location, and levels of specialist staffing at weekends. We explored approaches to implementing standards locally, and the impact of organisational culture and local context on organisational response. Results Senior staff in the majority of trusts described a focus on hitting targets and achieving compliance with the standards. Compliance-based responses were associated with a hierarchical organisational culture and focus on external performance. In a minority of trusts senior staff described mobilising commitment-based strategies. In these trusts senior staff reframed the external standards in terms of organisational values, and used co-operative strategies for achieving change. Trusts that took a commitment-based approach tended to be described as having a developmental organisational culture and a history of higher performance across the board. Audit data on 7DS showed improvement against standards for most trusts, but commitment-focused trusts were less likely to demonstrate improvements on the 7DS audit. The ability of trusts to respond to external standards was limited when they were under pressure due to a history of overall poor performance or resource limitations. Conclusions National standards and audit for service-level improvement generate different types of response in different local settings. Approaches to driving improvement nationally need to be accompanied by resources and tailored support for improvement, taking into account local context and organisational culture.

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Ugandan stakeholder hopes and concerns about gene drive mosquitoes for malaria control: new directions for gene drive risk governance

Malaria Journal ◽

10.1186/s12936-021-03682-6 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Sarah Hartley ◽

Robert D. J. Smith ◽

Adam Kokotovich ◽

Chris Opesen ◽

Tibebu Habtewold ◽

...

Keyword(s):

Malaria Control ◽

Stakeholder Involvement ◽

Control Programme ◽

Local Context ◽

Risk Governance ◽

Malaria Control Programme ◽

Gene Drive ◽

Structured Interviews ◽

New Directions ◽

High Level

Abstract Background The African Union’s High-Level Panel on Emerging Technologies identified gene drive mosquitoes as a priority technology for malaria elimination. The first field trials are expected in 5–10 years in Uganda, Mali or Burkina Faso. In preparation, regional and international actors are developing risk governance guidelines which will delineate the framework for identifying and evaluating risks. Scientists and bioethicists have called for African stakeholder involvement in these developments, arguing the knowledge and perspectives of those people living in malaria-afflicted countries is currently missing. However, few African stakeholders have been involved to date, leaving a knowledge gap about the local social-cultural as well as ecological context in which gene drive mosquitoes will be tested and deployed. This study investigates and analyses Ugandan stakeholders’ hopes and concerns about gene drive mosquitoes for malaria control and explores the new directions needed for risk governance. Methods This qualitative study draws on 19 in-depth semi-structured interviews with Ugandan stakeholders in 2019. It explores their hopes for the technology and the risks they believed pertinent. Coding began at a workshop and continued through thematic analysis. Results Participants’ hopes and concerns for gene drive mosquitoes to address malaria fell into three themes: (1) ability of gene drive mosquitoes to prevent malaria infection; (2) impacts of gene drive testing and deployment; and, (3) governance. Stakeholder hopes fell almost exclusively into the first theme while concerns were spread across all three. The study demonstrates that local stakeholders are able and willing to contribute relevant and important knowledge to the development of risk frameworks. Conclusions International processes can provide high-level guidelines, but risk decision-making must be grounded in the local context if it is to be robust, meaningful and legitimate. Decisions about whether or not to release gene drive mosquitoes as part of a malaria control programme will need to consider the assessment of both the risks and the benefits of gene drive mosquitoes within a particular social, political, ecological, and technological context. Just as with risks, benefits—and importantly, the conditions that are necessary to realize them—must be identified and debated in Uganda and its neighbouring countries.

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“What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

BMC Health Services Research ◽

10.1186/s12913-021-06110-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anh Ly ◽

Roger Zemek ◽

Bruce Wright ◽

Jennifer Zwicker ◽

Kathryn Schneider ◽

...

Keyword(s):

Emergency Department ◽

Health Care Providers ◽

Clinical Pathways ◽

Theoretical Domains Framework ◽

Local Context ◽

Emergency Department Physician ◽

Evidence Based ◽

Care Providers ◽

Structured Interviews ◽

Pediatric Concussion

Abstract Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.

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Context-Specific Challenges, Opportunities, and Ethics of Drones for Healthcare Delivery in the Eyes of Program Managers and Field Staff: A Multi-Site Qualitative Study

Drones ◽

10.3390/drones4030044 ◽

2020 ◽

Vol 4 (3) ◽

pp. 44

Author(s):

Vyshnave Jeyabalan ◽

Elysée Nouvet ◽

Patrick Meier ◽

Lorie Donelle

Keyword(s):

Thematic Analysis ◽

Health Program ◽

Healthcare Delivery ◽

Health It ◽

Structured Interviews ◽

Field Staff ◽

Program Managers ◽

Context Specific ◽

Diverse Context ◽

Study Participants

Unmanned aerial vehicles (UAVs), also known as drones, have significant potential in the healthcare field. Ethical and practical concerns, challenges, and complexities of using drones for specific and diverse healthcare purposes have been minimally explored to date. This paper aims to document and advance awareness of diverse context-specific concerns, challenges, and complexities encountered by individuals working on the front lines of drones for health. It draws on original qualitative research and data from semi-structured interviews (N = 16) with drones for health program managers and field staff in nine countries. Directed thematic analysis was used to analyze interviews and identify key ethical and practical concerns, challenges, and complexities experienced by participants in their work with drones for health projects. While some concerns, challenges, and complexities described by study participants were more technical in nature, for example, those related to drone technology and approval processes, the majority were not. The bulk of context-specific concerns and challenges identified by participants, we propose, could be mitigated through community engagement initiatives.

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Understanding Pasifika Educational Aspirations and Conceptions of Development in Wainuiomata

10.26686/wgtn.17151731.v1 ◽

2021 ◽

Author(s):

◽

Holly McLeod

Keyword(s):

Educational Aspirations ◽

Methodological Approach ◽

Educational Experiences ◽

Alternative Conceptions ◽

Local Context ◽

Structured Interviews ◽

Academic Context ◽

Education And Development ◽

Time And Energy ◽

The Way

<p>Education is good for development. This positive relationship between education and development is often stated without challenge, resulting in education being posited at the forefront of global development strategies. Yet, within the subject of Development Studies, postdevelopment theorists have questioned the very basis of ‘development’, not only its definition but also the inherent assumption that it is necessarily desirable and positive. Instead, they point to examples such as Buen Vivir and argue that we should explore different ways of conceptualising what is a good life. The present research has sought to examine the way the Pasifika community in Wainuiomata, Aotearoa perceives and engages with education to fulfil its own vision of development. Some 30 research participants contributed their valuable time and energy to this project through semi-structured interviews, offering insight into their own educational experiences and aspirations. Through employing a methodological approach informed by the ethos of talanoa and participatory research, this research has privileged the narratives of participants, giving voice to their experiences within an academic context. This research has identified that while the experiences of these families within Aotearoa’s education system have been frustrating and challenging, such adversity has not served to disenfranchise Pasifika families from engaging within this educational system. Rather, it has served as motivation to create better educational experiences for youth in this community today. Furthermore, the vision of development aspired toward by this community is one that draws both similarities and contrasts with mainstream conceptions of development. The existence of alternative conceptions of development supports post-development’s call for development practise to examine local context and community aspirations, and to value community knowledge and action. In examining the way this community has engaged with education to progress their own vision of development, it was found that Pasifika families in Wainuiomata are taking ownership of their own development, and are actively involved in creating better educational outcomes for their youth.</p>

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