Diabetes Self-Care Behaviors and Barriers to Clinical Care During COVID-19 Pandemic for Marshallese Adults

Purpose: The purpose of the study was to explore experiences of Marshallese adults related to diabetes self-care behaviors during the COVID-19 pandemic. Methods: A qualitative descriptive design was utilized to understand participants’ diabetes self-care behaviors during the pandemic. Nine focus groups with 53 participants were held via videoconference and conducted in English, Marshallese, or a mixture of both languages. A priori codes based on diabetes self-care behaviors provided a framework for analyzing and summarizing participant experiences. Results: Both increases and decreases in healthy eating and exercise were described, with improvements in health behaviors attributed to health education messaging via social media. Participants reported increased stress and difficulty monitoring and managing glucose. Difficulty obtaining medication and difficulty seeing their health care provider regularly was reported and attributed to health care provider availability and lack of insurance due to job loss. Conclusions: The study provides significant insight into the reach of health education campaigns via social media and provides important information about the reasons for delays in care, which extend beyond fear of contracting COVID-19 to structural issues.

Quality of Counselling Services for Pregnant Women in Community Clinics

Maternal health service had a potentially critical role in the improvement of reproductive health. This descriptive study was carried out in Tangail district, from 1st January to 31st December, 2019 to find out the quality of counselling of services for pregnant women in community clinics during pregnancy period. Data were collected among 289 respondents by face to face interview who had delivered within last 24 months and respondents were selected purposively. The majority (97.6%) of the respondents were housewife and maximum (72%) of the respondent were below SSC in this study monthly family income mean was taka 16124.00± 10065.480. Majority of the respondents (99.2%) had received antenatal check-up from different health care facilities and highest (87.2%) had received from the community clinic other hands (6.0%) pregnant women got antenatal care from non-government hospital among 250 respondents (94.0%) pregnant women received ANC from CHCP also (4%) pregnant women received ANC from HA. Out of 250 pregnant women (70%) of the respondents were problem suffer during pregnancy. Here majority (59.6%) pregnant women were suffer from nausea and vomiting and only (6.3%) were suffering from constipation. Majority (89.2%) of the respondents had preparation about danger sign during pregnancy. Most 245 (98%) of the respondents of pregnant women had information about ANC and most (85.7%) got information from CHCF on other hand ride got information (2.9%) from neighbour. half (4.8%) of the respondents choice of conduct delivery at upazila health complex followed by (48.8%) only choice of conduct clinics. Most (98%) of the respondents had received TT vaccine and maximum (95.1%) of the respondents had completed TT vaccine. Enough skilled manpower for patient care (98.4%). Health care provider perform ANC check-up (96.8%). Health care provider counselling during pregnancy (96.4%) physical examination (98.0%) explanation of health. (99.2%) health care provider give any advice before departure (70.4%). Continue to follow-up health status over phone (99.2%). Service providers in health care shows that 33.3% was BSc/BA, 42.9% of service providers were masters and above their professional training more than one third (38.1%) of the providers has basic training, 47.6% had basic & CSBA and rest 14.3% had ECT and nutritional training. Majority 100% of the provider’s designation had CHCP, number of staff in two health care had more than half (57.1%) providers.

The effectiveness of supervision strategies to improve health care provider practices in low- and middle-income countries: secondary analysis of a systematic review

Background Although supervision is a ubiquitous approach to support health programs and improve health care provider (HCP) performance in low- and middle-income countries (LMICs), quantitative evidence of its effects is unclear. The objectives of this study are to describe the effect of supervision strategies on HCP practices in LMICs and to identify attributes associated with greater effectiveness of routine supervision. Methods We performed a secondary analysis of data on HCP practice outcomes (e.g., percentage of patients correctly treated) from a systematic review on improving HCP performance. The review included controlled trials and interrupted time series studies. We described distributions of effect sizes (defined as percentage-point [%-point] changes) for each supervision strategy. To identify attributes associated with supervision effectiveness, we performed random-effects linear regression modeling and examined studies that directly compared different approaches of routine supervision. Results We analyzed data from 81 studies from 36 countries. For professional HCPs, such as nurses and physicians, primarily working at health facilities, routine supervision (median improvement when compared to controls: 10.7%-points; IQR: 9.9, 27.9) had similar effects on HCP practices as audit with feedback (median improvement: 10.1%-points; IQR: 6.2, 23.7). Two attributes were associated with greater mean effectiveness of routine supervision (p < 0.10): supervisors received supervision (by 8.8–11.5%-points), and supervisors participated in problem-solving with HCPs (by 14.2–20.8%-points). Training for supervisors and use of a checklist during supervision visits were not associated with effectiveness. The effects of supervision frequency (i.e., number of visits per year) and dose (i.e., the number of supervision visits during a study) were unclear. For lay HCPs, the effect of routine supervision was difficult to characterize because few studies existed, and effectiveness in those studies varied considerably. Evidence quality for all findings was low primarily because many studies had a high risk of bias. Conclusions Although evidence is limited, to promote more effective supervision, our study supports supervising supervisors and having supervisors engage in problem-solving with HCPs. Supervision’s integral role in health systems in LMICs justifies a more deliberate research agenda to identify how to deliver supervision to optimize its effect on HCP practices.

Information seeking behaviors, attitudes, and beliefs about pregnancy-related nutrition and supplementation: A qualitative study among US women

Background: Maternal behavior during pregnancy is crucial to her own and her infant's health, and as such, it is important to understand the nutrition and supplement habits of women during pregnancy and what informs those behaviors. Aim: We aimed to assess the information seeking habits, attitudes, and beliefs about pregnancy-related nutrition and supplementation among pregnant women in the United States. Methods: Qualitative study using key informant interviews with pregnant and recently pregnant ( n = 21) US women. Themes related to concerns, attitudes, behaviors, and information seeking habits were extracted. Results: The mean age was 31.9 years and all had at least a university degree. Two major themes that emerged: (1) nutrition information-related attitudes and beliefs and (2) food and supplement-related attitudes and beliefs. Pregnant women in the US were underwhelmed with their health care provider experience when receiving information about pregnancy-related nutrition and supplementation. Nutrition was most often addressed in a reactive manner while women desired a more proactive approach. As a result, they conducted their own research using the internet as their primary tool, and ultimately made nutrition and supplement decisions based largely on their own instincts. Conclusion: Women interviewed for this study encountered barriers to pregnancy related nutrition information from a lack of clear communication from their health care provider and ambiguity and inconsistencies in information within and between sources. Women relied on themselves for information seeking and nutrition related decision making throughout their pregnancy.