Understanding U.S. Health Systems: Using Mixed Methods to Unpack Organizational Complexity

Abstract Background In 2015 the US President’s Emergency Plan for AIDS Relief (PEPFAR) initiated its Geographic Prioritization (GP) process whereby it prioritized high burden areas within countries, with the goal of more rapidly achieving the UNAIDS 90–90-90 targets. In Kenya, PEPFAR designated over 400 health facilities in Northeastern Kenya to be transitioned to government support (known as central support (CS)). Methods We conducted a mixed methods evaluation exploring the effect of GP on health systems, and HIV and non-HIV service delivery in CS facilities. Quantitative data from a facility survey and health service delivery data were gathered and combined with data from two rounds of interviews and focus group discussions (FGDs) conducted at national and sub-national level to document the design and implementation of GP. The survey included 230 health facilities across 10 counties, and 59 interviews and 22 FGDs were conducted with government officials, health facility providers, patients, and civil society. Results We found that PEPFAR moved quickly from announcing the GP to implementation. Despite extensive conversations between the US government and the Government of Kenya, there was little consultation with sub-national actors even though the country had recently undergone a major devolution process. Survey and qualitative data identified a number of effects from GP, including discontinuation of certain services, declines in quality and access to HIV care, loss of training and financial incentives for health workers, and disruption of laboratory testing. Despite these reports, service coverage had not been greatly affected; however, clinician strikes in the post-transition period were potential confounders. Conclusions This study found similar effects to earlier research on transition and provides additional insights about internal country transitions, particularly in decentralized contexts. Aside from a need for longer planning periods and better communication and coordination, we raise concerns about transitions driven by epidemiological criteria without adaptation to the local context and their implication for priority-setting and HIV investments at the local level.

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Global health systems partnerships: a mixed methods analysis of Mozambique’s HPV vaccine delivery network actors

BMC Public Health ◽

10.1186/s12889-020-08958-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Caroline Soi ◽

Jessica Shearer ◽

Baltazar Chilundo ◽

Vasco Muchanga ◽

Luisa Matsinhe ◽

...

Keyword(s):

Mixed Methods ◽

Global Health ◽

Health Systems ◽

Hpv Vaccine ◽

Vaccine Delivery ◽

Delivery Network

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Acceptability and preferences for self‐collected screening for cervical cancer within health systems in rural Uganda: A mixed‐methods approach

International Journal of Gynecology & Obstetrics ◽

10.1002/ijgo.13454 ◽

2020 ◽

Vol 152 (1) ◽

pp. 103-111

Author(s):

Angeli Rawat ◽

Catherine Sanders ◽

Nadia Mithani ◽

Catherine Amuge ◽

Heather Pedersen ◽

...

Keyword(s):

Cervical Cancer ◽

Mixed Methods ◽

Health Systems ◽

Mixed Methods Approach

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Giving Back: A mixed methods study of the contributions of US-Based Nigerian physicians to home country health systems

Globalization and Health ◽

10.1186/s12992-016-0165-9 ◽

2016 ◽

Vol 12 (1) ◽

Cited By ~ 6

Author(s):

Joseph Nwadiuko ◽

Keyonie James ◽

Galen E. Switzer ◽

Jamie Stern

Keyword(s):

Mixed Methods ◽

Health Systems ◽

Home Country ◽

Mixed Methods Study

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Global Health Classroom: Mixed Methods Evaluation of an Interinstitutional Model for Reciprocal Global Health Learning Among Samoan and New Zealand Medical Students

10.21203/rs.3.rs-49169/v1 ◽

2020 ◽

Author(s):

Roshit Bothara ◽

Malama Tafuna'i ◽

Tim Wilkinson ◽

Jen Desrosiers ◽

Susan Jack ◽

...

Keyword(s):

Mixed Methods ◽

New Zealand ◽

Medical Students ◽

Global Health ◽

Learning Outcomes ◽

Health Systems ◽

Virtual Classroom ◽

Determinants Of Health ◽

Mutual Benefit ◽

Global Health Education

Abstract Background Global health education partnerships should be collaborative and reciprocal to ensure mutual benefit. Utilisation of digital technologies can overcome geographic boundaries and facilitate collaborative global health learning. Global Health Classroom (GHCR) is a collaborative global health learning model involving medical students from different countries learning about each other’s health systems, cultures, and determinants of health via videoconference. Principles of reciprocity and inter-institutional partnership informed the development of GHCR. This study explores learning outcomes and experiences in GHCR between students from New Zealand and Samoa. Methods The study used a mixed methods approach employing post-GHCR questionnaires and semi-structured face-to-face interviews to explore self-reported learning and experiences among medical students in GHCR. The GHCR collaboration studied was between the medical schools at the University of Otago, New Zealand and the National University of Samoa, Samoa.ResultsQuestionnaire response rate was 85% (74/87). Nineteen interviews were conducted among New Zealand and Samoan students. Students reported acquiring the intended learning outcomes relating to patient care, health systems, culture, and determinants of health with regards to their partner country. There was evidence of attitudinal changes including cultural curiosity and humility. Some reported a vision for progress regarding their own health system. Students reported that interacting with their international peers in the virtual classroom made learning about global health real and tangible. Mutual benefit to students from both countries indicated reciprocity.Conclusions The study demonstrates GHCR to be a promising model for collaborative and reciprocal global health learning using a student-led format and employing digital technology to create a virtual classroom. The self-reported learning outcomes align favourably with those recommended in the literature. In view of our positive findings, we present GHCR as an adaptable model for equitable, collaborative global health learning between students in internationally partnered institutions.

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Developing implementation strategies for firearm safety promotion in paediatric primary care for suicide prevention in two large US health systems: a study protocol for a mixed-methods implementation study

BMJ Open ◽

10.1136/bmjopen-2016-014407 ◽

2017 ◽

Vol 7 (6) ◽

pp. e014407 ◽

Cited By ~ 5

Author(s):

Courtney Benjamin Wolk ◽

Shari Jager-Hyman ◽

Steven C Marcus ◽

Brian K Ahmedani ◽

John E Zeber ◽

...

Keyword(s):

Primary Care ◽

Mixed Methods ◽

Health Systems ◽

Suicide Prevention ◽

Study Protocol ◽

Implementation Strategies ◽

Implementation Study ◽

Safety Promotion ◽

Paediatric Primary Care ◽

Firearm Safety

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Collective Care: Multiple Caregivers and Multiple Care Recipients in Mexican American Families

Journal of Transcultural Nursing ◽

10.1177/1043659616657878 ◽

2016 ◽

Vol 28 (4) ◽

pp. 398-407 ◽

Cited By ~ 1

Author(s):

Bronwynne C. Evans ◽

David W. Coon ◽

Michael J. Belyea ◽

Ebere Ume

Keyword(s):

Mixed Methods ◽

Health Systems ◽

Informal Care ◽

Mexican American ◽

Family Members ◽

Mixed Methods Study ◽

Family Interventions ◽

Mexican American Families ◽

Care Recipients ◽

American Families

Purpose: Specific stressors associated with caregiving in Mexican American (MA) families are not well documented, yet caregiving issues are paramount because informal care for parents is central to their culture. Although MA families who band together to provide care for one member are not unique, the literature does not describe the phenomenon of collective caregiving, which may be widespread but unrecognized. This article describes these understudied families who are poorly served by contemporary health systems because their characteristics are unknown. Design: Descriptive, multisite, longitudinal mixed-methods study of MA caregiving families. Findings: We identified three types of collective caregivers: those providing care for multiple family members simultaneously, those providing care successively to several family members, and/or those needing care themselves during their caregiving of others. Discussion and Conclusions: Collective caregiving of MA elders warrants further investigation. Implications for Practice: Exploration of collective caregiving may provide a foundation for tailored family interventions.

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Global health classroom: mixed methods evaluation of an interinstitutional model for reciprocal global health learning among Samoan and New Zealand medical students

Globalization and Health ◽

10.1186/s12992-021-00755-8 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Roshit K. Bothara ◽

Malama Tafuna’i ◽

Tim J. Wilkinson ◽

Jen Desrosiers ◽

Susan Jack ◽

...

Keyword(s):

Mixed Methods ◽

New Zealand ◽

Medical Students ◽

Global Health ◽

Learning Outcomes ◽

Health Systems ◽

Virtual Classroom ◽

Determinants Of Health ◽

Cultural Humility ◽

Questionnaire Response

Abstract Background Global health education partnerships should be collaborative and reciprocal to ensure mutual benefit. Utilisation of digital technologies can overcome geographic boundaries and facilitate collaborative global health learning. Global Health Classroom (GHCR) is a collaborative global health learning model involving medical students from different countries learning about each other’s health systems, cultures, and determinants of health via videoconference. Principles of reciprocity and interinstitutional partnership informed the development of the GHCR. This study explores learning outcomes and experiences in the GHCR between students from New Zealand and Samoa. Methods This study used a mixed methods approach employing post-GHCR questionnaires and semi-structured face-to-face interviews to explore self-reported learning and experiences among medical students in the GHCR. The GHCR collaboration studied was between the medical schools at the University of Otago, New Zealand and the National University of Samoa, Samoa. Results Questionnaire response rate was 85% (74/87). Nineteen interviews were conducted among New Zealand and Samoan students. Students reported acquiring the intended learning outcomes relating to patient care, health systems, culture, and determinants of health with regards to their partner country. Interview data was indicative of attitudinal changes in relation to cultural humility and curiosity. Some reported a vision for progress regarding their own health system. Students in the GHCR reported that learning with their international peers in the virtual classroom made learning about global health more real and tangible. The benefits to students from both countries indicated reciprocity. Conclusions This study demonstrates GHCR to be a promising model for collaborative and reciprocal global health learning using a student-led format and employing digital technology to create a virtual classroom. The self-reported learning outcomes align favourably with those recommended in the literature. In view of our positive findings, we present GHCR as an adaptable model for equitable, collaborative global health learning between students in internationally partnered institutions.

Download Full-text