scholarly journals Implementation of the Xpert MTB/RIF assay for tuberculosis in Mongolia: a qualitative exploration of barriers and enablers

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3567 ◽  
Author(s):  
Nicole L. Rendell ◽  
Solongo Bekhbat ◽  
Gantungalag Ganbaatar ◽  
Munkhjargal Dorjravdan ◽  
Madhukar Pai ◽  
...  
Keyword(s):  
Lessons Learned ◽  
Reference Laboratory ◽  
Structured Interviews ◽  
Middle Income ◽  
Laboratory Staff ◽  
Delayed Treatment ◽  
Barriers And Enablers ◽  
National Tuberculosis Program ◽  
National Tuberculosis ◽  
Qualitative Exploration

Objective The aim of our study was to identify barriers and enablers to implementation of the Xpert MTB/RIF test within Mongolia’s National Tuberculosis Program. Methods Twenty-foursemi-structured interviews were conducted between June and September 2015 with laboratory staff and tuberculosis physicians in Mongolia’s capital Ulaanbaatar and regional towns where Xpert MTB/RIF testing had been implemented. Interviews were recorded, transcribed, translated and analysed thematically using NVIVO qualitative analysis software. Results Eight laboratory staff (five from the National Tuberculosis Reference Laboratory in Ulaanbaatar and three from provincial laboratories) and sixteen tuberculosis physicians (five from the Mongolian National Center for Communicable Diseases in Ulaanbaatar, four from district tuberculosis clinics in Ulaanbaatar and seven from provincial tuberculosis clinics) were interviewed. Major barriers to Xpert MTB/RIF implementation identified were: lack of awareness of program guidelines; inadequate staffing arrangements; problems with cartridge supply management; lack of local repair options for the Xpert machines; lack of regular formal training; paper based system; delayed treatment initiation due to consensus meeting and poor sample quality. Enablers to Xpert MTB/RIF implementation included availability of guidelines in the local language; provision of extra laboratory staff, shift working arrangements and additional modules; capacity for troubleshooting internally; access to experts; opportunities for peer learning; common understanding of diagnostic algorithms and decentralised testing. Conclusion Our study identified a number of barriers and enablers to implementation of Xpert MTB/RIF in the Mongolian National Tuberculosis Program. Lessons learned from this study can help to facilitate implementation of Xpert MTB/RIF in other Mongolian locations as well as other low-and middle-income countries.

scholarly journals Setting Health Care Services Tariffs in Iran: Half a Century Quest for a Window of Opportunity

2020 ◽  
Author(s):  
Leila Doshmangir ◽  
Arash Rashidian ◽  
Farhad Kouhi ◽  
Vladimir S Gordeev
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Services ◽  
Analysis Data ◽  
Lessons Learned ◽  
Structured Interviews ◽  
Public And Private ◽  
Middle Income ◽  
Care Services ◽  
The Right

Abstract Background: The process of medical tariffs setting in Iran remains to be a contentious issue and is heavily criticized by many stakeholders. This paper explores the experience of setting health care services tariffs in the Iranian health care system over the last five decades. Methods: We analyzed data collected through literature review and reviews of the official documents developed at the various levels of the Iranian health system using inductive and deductive content analysis. Twenty-two face-to-face semi-structured interviews supplemented the analysis. Data were analysed and interpreted using 'policy triangle' and 'garbage can' models.Results: Our comprehensive review of changes in the medical tariff setting provides valuable lessons for major stakeholders. Most changes were implemented in a sporadic, inadequate, and a non-evidence-based manner. Disparities in tariffs between public and private sectors continue to exist. Lack of clarity in tariffs setting mechanisms and its process makes negotiations between various stakeholders difficult and can potentially become a source of a corrupt income. Such clarity can be achieved by using fair and technically sound tariffs. Technical aspects of tariff setting should be separated from the political negotiations over the overall payment to the medical professionals. Transparency regarding a conflict of interest and establishing punitive measures against those violating the rules could help improving trust in the doctor-patient relationship. Conclusion: Use of evidence-informed models and methods in medical tariff setting could help to strike the right balance in the process of health care services provision to address health system objectives. A sensitive application of policy models can offer significant insights into the nature of medical tariff setting and highlight existing constraints and opportunities. This study generates lessons learned in tariffs setting, particularly for low- and middle-income countries.

scholarly journals Processing of Positive Newborn Screening Results for Congenital Hypothyroidism: A Qualitative Exploration of Current Practice in England

2021 ◽  
Vol 7 (4) ◽  
pp. 64
Author(s):  
Pru Holder ◽  
Tim Cheetham ◽  
Alessandra Cocca ◽  
Holly Chinnery ◽  
Jane Chudleigh
Keyword(s):  
Congenital Hypothyroidism ◽  
Regional Differences ◽  
Communication Model ◽  
Structured Interviews ◽  
Laboratory Staff ◽  
Local Resources ◽  
Communication Practices ◽  
Newborn Bloodspot Screening ◽  
Qualitative Exploration ◽  
Pathways Of Care

The objective of this research was to explore current communication practices for positive newborn bloodspot screening results for congenital hypothyroidism from the newborn bloodspot screening laboratory to clinicians and then families, in order to (i) understand how the pathway is implemented in practice, (ii) highlight regional differences and (iii) identify barriers and facilitators. A qualitative exploratory design was employed using semi-structured interviews across 13 newborn bloodspot screening laboratories in England. Participants included 35 clinicians and 17 NBS laboratory staff across the 13 laboratories and 18 members of relevant clinical teams. Findings illuminated variations in how positive newborn bloodspot screening results for congenital hypothyroidism are communicated in practice. This included regional variations due to historical arrangements and local resources. Contacting the appropriate person could be challenging and obtaining feedback from clinical teams to the laboratory after the child has been seen could be time consuming for those involved. Standardised communication model(s) for positive newborn bloodspot screening results for congenital hypothyroidism, which include named contact individuals, defined pathways of care and processes for feeding back to laboratories, may help to ensure the process is less labour intensive, particularly from a laboratory perspective.

scholarly journals COVID-19 epidemiological, sociological and anthropological investigation: study protocol for a multidisciplinary mixed methods research in Burkina Faso

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Isidore Tiandiogo Traoré ◽  
Samiratou Ouedraogo ◽  
Dramane Kania ◽  
Firmin Nongodo Kaboré ◽  
Blahima Konaté ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Burkina Faso ◽  
Health Care Professionals ◽  
Mixed Methods Research ◽  
Lessons Learned ◽  
Preventive Strategies ◽  
Structured Interviews ◽  
Middle Income ◽  
Hygiene Measures ◽  
Bobo Dioulasso

Abstract Background The world has high hopes of vaccination against COVID-19 to protect the population, boost economies and return to normal life. Vaccination programmes are being rolled out in high income countries, but the pandemic continues to progress in many low-and middle-income countries (LMICs) despite implementation of strict hygiene measures. We aim to present a comprehensive research protocol that will generate epidemiological, sociological and anthropological data about the COVID-19 epidemic in Burkina Faso, a landlocked country in West Africa with scarce resources. Methods We will perform a multidisciplinary research using mixed methods in the two main cities in Burkina Faso (Ouagadougou and Bobo-Dioulasso). Data will be collected in the general population and in COVID-19 patients, caregivers and health care professionals in reference care centers: (i) to determine cumulative incidence of SARS-CoV-2 infection in the Burkinabe population using blood samples collected from randomly selected households according to the WHO-recommended protocol; (ii) develop a score to predict severe complications of COVID-19 in persons infected with SARS-CoV-2 using retrospective and prospective data; (iii) perform semi-structured interviews and direct observation on site, to describe and analyze the healthcare pathways and experiences of patients with COVID-19 attending reference care centers, and to identify the perceptions, acceptability and application of preventive strategies among the population. Discussion This study will generate comprehensive data that will contribute to improving COVID-19 response strategies in Burkina Faso. The lessons learned from the management of this epidemic may serve as examples to the country authorities to better design preventive strategies in the case of future epidemics or pandemics. The protocol was approved by the Ministry for Health (N° 2020-00952/MS/CAB/INSP/CM) and the Health Research Ethics Committee in Burkina Faso (N° 2020-8-140).

Optimizing electronic capture of patient-reported outcome measures in oncology clinical trials: lessons learned from a qualitative study

2020 ◽  
Vol 9 (17) ◽  
pp. 1195-1204
Author(s):  
Florence D Mowlem ◽  
Brad Sanderson ◽  
Jill V Platko ◽  
Bill Byrom
Keyword(s):  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Lessons Learned ◽  
Structured Interviews ◽  
Patient Reported ◽  
Oncology Clinical Trials ◽  
Anticancer Treatment ◽  
Fit For Purpose ◽  
The Impact ◽  
Electronic Implementation

Aim: To understand the impact of anticancer treatment on oncology patients’ ability to use electronic solutions for completing patient-reported outcomes (ePRO). Materials & methods: Semi-structured interviews were conducted with seven individuals who had experienced a cancer diagnosis and treatment. Results: Participants reported that the following would impact the ability to interact with an ePRO solution: peripheral neuropathy of the hands (4/7), fatigue and/or concentration and memory issues (6/7), where they are in a treatment cycle (5/7). Approaches to improve usability included: larger, well-spaced buttons to deal with finger numbness, the ability to pause a survey and complete at a later point and presenting the recall period with every question to reduce reliance on memory. Conclusion: Symptoms associated with cancers and anticancer treatments can impact the use of technologies. The recommendations for optimizing the electronic implementation of patient-reported outcome instruments in this population provides the potential to improve data quality in oncology trials and places patient needs at the forefront to ensure ‘fit-for-purpose’ solutions.

scholarly journals Can Watching Online Videos Be Addictive? A Qualitative Exploration of Online Video Watching among Chinese Young Adults

2021 ◽  
Vol 18 (14) ◽  
pp. 7247
Author(s):  
Zeyang Yang ◽  
Mark Griffiths ◽  
Zhihao Yan ◽  
Wenting Xu
Keyword(s):  
Social Interaction ◽  
Short Form ◽  
Leisure Activity ◽  
Online Video ◽  
Video Content ◽  
Structured Interviews ◽  
Negative Effects ◽  
Online Videos ◽  
Chinese Young Adults ◽  
Qualitative Exploration

Watching online videos (including short-form videos) has become the most popular leisure activity in China. However, a few studies have reported the potential negative effects of online video watching behaviors (including the potential for ‘addiction’) among a minority of individuals. The present study investigated online video watching behaviors, motivational factors for watching online videos, and potentially addictive indicators of watching online videos. Semi-structured interviews were conducted among 20 young Chinese adults. Qualitative data were analyzed using thematic analysis. Eight themes were identified comprising: (i) content is key; (ii) types of online video watching; (iii) platform function hooks; (iv) personal interests; (v) watching becoming habitual; (vi) social interaction needs; (vii) reassurance needs; and (viii) addiction-like symptoms. Specific video content (e.g., mukbang, pornography), platform-driven continuous watching, and short-form videos were perceived by some participants as being potentially addictive. Specific features or content on Chinese online video platforms (e.g., ‘Danmu’ scrolling comments) need further investigation. Future studies should explore users’ addictive-like behaviors in relation to specific types of online video content and their social interaction on these platforms.

scholarly journals The Experiences of Grief and Personal Growth in University Students: A Qualitative Study

2021 ◽  
Vol 18 (4) ◽  
pp. 1899
Author(s):  
Jovita Tan ◽  
Karl Andriessen
Keyword(s):  
University Students ◽  
Emerging Adults ◽  
Personal Growth ◽  
Lessons Learned ◽  
Continuing Bonds ◽  
Structured Interviews ◽  
Supportive Services ◽  
Negative Effects ◽  
Positive Effects ◽  
Formal Services

Background: Experiencing the death of a close person, especially in emerging adults and students, can have profound effects on the bereaved individual’s life. As most research in this field has focused on negative effects of a loss, little is known about potential positive effects experienced by bereaved university students. This study investigated the experience of grief and personal growth in a sample of students from The University of Melbourne, Australia. Methods: Semi-structured interviews via Zoom/telephone with bereaved students (n = 14), who were invited to reflect on their loss and any personal growth potentially experienced. Thematic analysis of the data was based on a deductive and inductive approach. Results: The analysis identified four themes: (i) sharing of grief as a coping mechanism, (ii) balance between grief reactions and moving forward in life, (iii) lessons learned and personal growth, and (iv) adopting values from the deceased person and continuing bonds. Conclusions: Participants emphasized personal growth regarding self-perception and philosophical views on life. Following the loss, they preferred peer support, and used formal services only when they had a specific need. The findings indicate the importance of social support for bereaved students, and the complimentary role of peer and professional support. Hence, academic institutions should offer supportive services tailored to both students and professionals to help bereaved students.

scholarly journals Health workers’ perspectives on informed consent for caesarean section in Southern Malawi

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wouter Bakker ◽  
Siem Zethof ◽  
Felix Nansongole ◽  
Kelvin Kilowe ◽  
Jos van Roosmalen ◽  
...  
Keyword(s):  
Informed Consent ◽  
Caesarean Section ◽  
Health Workers ◽  
Group Discussion ◽  
Legal Protection ◽  
Analytical Framework ◽  
Structured Interviews ◽  
Middle Income ◽  
Partial Disclosure ◽  
Labour Pains

Abstract Objective Informed consent is a prerequisite for caesarean section, the commonest surgical procedure in low- and middle-income settings, but not always acquired to an appropriate extent. Exploring perceptions of health care workers may aid in improving clinical practice around informed consent. We aim to explore health workers’ beliefs and experiences related to principles and practice of informed consent. Methods Qualitative study conducted between January and June 2018 in a rural 150-bed mission hospital in Southern Malawi. Clinical observations, semi-structured interviews and a focus group discussion were used to collect data. Participants were 22 clinical officers, nurse-midwives and midwifery students involved in maternity care. Data were analysed to identify themes and construct an analytical framework. Results Definition and purpose of informed consent revolved around providing information, respecting women’s autonomy and achieving legal protection. Due to fear of blame and litigation, health workers preferred written consent. Written consent requires active participation by the consenting individual and was perceived to transfer liability to that person. A woman’s refusal to provide written informed consent may pose a dilemma for the health worker between doing good and respecting autonomy. To prevent such refusal, health workers said to only partially disclose surgical risks in order to minimize women's anxiety. Commonly perceived barriers to obtain a fully informed consent were labour pains, language barriers, women’s lack of education and their dependency on others to make decisions. Conclusions Health workers are familiar with the principles around informed consent and aware of its advantages, but fear of blame and litigation, partial disclosure of risks and barriers to communication hamper the process of obtaining informed consent. Findings can be used to develop interventions to improve the informed consent process.

scholarly journals Needs of LMIC-based tobacco control advocates to counter tobacco industry policy interference: insights from semi-structured interviews

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e044710
Author(s):  
Britta Katharina Matthes ◽  
Lindsay Robertson ◽  
Anna B Gilmore
Keyword(s):  
Tobacco Control ◽  
Structural Changes ◽  
Tobacco Industry ◽  
Control Policy ◽  
Qualitative Description ◽  
Structured Interviews ◽  
Middle Income ◽  
Adoption And Implementation ◽  
National Coalition ◽  
Industry Policy

IntroductionAdvocacy is vital for advancing tobacco control and there has been considerable investment in this area. While much is known about tobacco industry interference (TII), there is little research on advocates’ efforts in countering TII and what they need to succeed. We sought to examine this and focused on low- and middle-income countries (LMICs) where adoption and implementation of the Framework Convention on Tobacco Control (FCTC) tend to remain slower and weaker.MethodWe interviewed 22 advocates from eight LMICs with recent progress in a tobacco control policy. We explored participants’ experiences in countering TII, including the activities they undertake, challenges they encounter and how their efforts could be enhanced. We used Qualitative Description to analyse transcripts and validated findings through participant feedback.ResultsWe identified four main areas of countering activities: (1) generating and compiling data and evidence, (2) accessing policymakers and restricting industry access, (3) working with media and (4) engaging in a national coalition. Each area was linked to challenges, including (1) lack of data, (2) no/weak implementation of FCTC Article 5.3, (3) industry ties with media professionals and (4) advocates’ limited capacity. To address these challenges, participants suggested initiatives, including access to country-specific data, building advocates’ skills in compiling and using such data in research and monitoring, and in coalition development; others aiming at training journalists to question and investigate TII; and finally, diverse interventions intended to advance a whole-of-government approach to tobacco control. Structural changes to tobacco control funding and coordination were suggested to facilitate the proposed measures.ConclusionThis research highlights that following years of investment in tobacco control in LMICs, there is growing confidence in addressing TII. We identify straightforward initiatives that could strengthen such efforts. This research also underscores that more structural changes to enhance tobacco control capacity building should be considered.

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