Making Space for Qualitative Evidence in Global Maternal and Child Health Policymaking

The success of health interventions often hinges on complex processes of implementation, the impact of sociopolitical and cultural contexts, resource constraints and opportunity costs, and issues of equity and accountability. Qualitative research offers critical insights for understanding these issues. “Qualitative evidence syntheses” (or QES)—modeled on quantitative systematic reviews—have recently emerged as an important vehicle for integrating insights from qualitative evidence into global health policy. However, it is challenging to integrate QES into policymaking in ways that are both acceptable to the often-conservative health policy world and consonant with social science’s distinctive methodologies and paradigms. Based on my experiences participating in and observing numerous guideline working group meetings and interviews with key informants, this chapter offers an auto-ethnographic account of an effort to integrate QES into the World Health Organization’s global OptimizeMNH guidelines for task shifting in maternal and newborn health (MNH). It is based on my experiences participating in and observing numerous guideline working group meetings as well as interviews with several key informants. Advocates of QES were successful in helping to make a place for qualitative evidence in this global guideline. Their work, however, required a delicate balance between adopting quantitatively inspired methods for evidence synthesis and innovating new methods that would both suit the project needs and be seen as legitimate by qualitative researchers. This case study of the development of one WHO guideline does not signal a revolution in knowledge production, but it does show there remains room—perhaps growing room—for a more expansive vision of what forms of knowledge need to be on the table when developing global health policy.

Self-care deficit versus the potential to improve self-care: explanation of the nurse's clinical judgments

Background: people who become functionally dependent due to serious illness and/or the worsening of a chronic illness have different recovery paths. The attribution of the nursing diagnosis of self-care deficit versus potential to improve self-care requires, on the part of the nurse, a rigorous clinical judgment, for which a set of diagnostic activities is necessary. Objectives: the present study sought to identify the assumptions used by expert nurses when formulating the clinical judgment of self-care deficit versus the potential to improve self-care Methodology: qualitative design. Data were generated in two focus group meetings that included eleven nurses experienced in caring for persons with functional dependence and self-care defict. Previously prepared structured questions were used to facilitate discussion. The focus group meetings were recorded in audio and transcribed. Inductive content analysis was used to identify emerging themes. The checklist Consolidated Criteria for Reporting Qualitative Research (COREQ) was also used. Results: nurses` decision-making depends: the factors of influencing the potential to improve self-care abilities of a person with functional dependence, the domain of influence of these factors, and three fundamental aspects to consider when evaluating a person with functional dependence. Conclusions: the absence of recovery potential can rarely be deduced. People without cognitive impairment or with mild cognitive impairment present highest potential for recovery.

Co-Creation of a Multi-Component Health Literacy Intervention Targeting Both Patients with Mild to Severe Chronic Kidney Disease and Health Care Professionals

Limited health literacy (LHL) is common in chronic kidney disease (CKD) patients and frequently associated with worse self-management. Multi-component interventions targeted at patients and healthcare professionals (HCPs) are recommended, but evidence is limited. Therefore, this study aims to determine the objectives and strategies of such an intervention, and to develop, produce and evaluate it. For this purpose, we included CKD patients with LHL (n = 19), HCPs (n = 15), educators (n = 3) and students (n = 4) from general practices, nephrology clinics and universities in an Intervention Mapping (IM) process. The determined intervention objectives especially address the patients’ competences in maintaining self-management in the long term, and communication competences of patients and HCPs. Patients preferred visual strategies and strategies supporting discussion of needs and barriers during consultations to written and digital strategies. Moreover, they preferred an individual approach to group meetings. We produced a four-component intervention, consisting of a visually attractive website and topic-based brochures, consultation cards for patients, and training on LHL for HCPs. Evaluation revealed that the intervention was useful, comprehensible and fitting for patients’ needs. Healthcare organizations need to use visual strategies more in patient education, be careful with digitalization and group meetings, and train HCPs to improve care for patients with LHL. Large-scale research on the effectiveness of similar HL interventions is needed.

Group Mentoring of New Graduate Midwives: Emerging Professional Capacity: A Naturalistic Inquiry

<p>This research explores an innovative group mentoring model developed at the request of four newly graduated midwives who were mentored as a group by four experienced midwives. Since virtually all research on mentoring, both internationally and in New Zealand assumes that mentoring is a one-to-one activity, this study aimed to describe how this group mentoring model operated and explore whether it was successful in supporting new midwives to gain confidence. A naturalistic study design was used with a mixed methods approach to collecting and analysing a large amount of richly descriptive data. Data were gathered from records of individual contacts between mentors and new graduates, from a series of interviews with each of the eight participants, and from the actual audio recordings of regular group mentoring meetings across the mentoring year. Simple descriptive analysis of quantitative data and detailed thematic analysis of qualitative data were undertaken. The study found the group mentoring model provided everything that is expected of one-to-one mentoring and the new graduates felt well supported as they gained confidence during their first year in practice as autonomous self-employed midwives. The group model provided new graduates with 24/7 one-to-one mentor support whenever they asked for it. This was found to occur mostly in the first half of the year and was highly valued. The new graduates and the mentors all agreed that the most important part of the model were the regular group meetings. These meetings were entirely focused on day to day experiences that the new graduates chose to present to the group. Analysis of the meeting transcripts showed that the new graduates' issues ranged across the whole scope of practice; that they were sometimes prompted by self-reflection, sometimes by issues to do with relationships with others, and sometimes by a need to discuss technical matters. The mentors' responses were variously supportive; listening and exploring; directing or informing; and questioning or challenging. The group aspect of this mentoring model added a number of features that would not be possible in one-to-one mentoring. The new graduates valued how the group meetings exposed them to multiple perspectives from several mentors. The group meetings modelled a supportive and collegial way of working together that facilitated their emerging professional capacity now and into their future. The group provided a safe yet challenging space: a "stimulating sanctuary" for the new graduates' development. Overall the study found that group mentoring can successfully meet the needs of new graduates and provides several advantages over one-to-one mentoring. Group mentoring may be a more sustainable model than one-to-one, particularly where there are shortages of mentor midwives available. It is a model that promotes a supportive professional midwife culture, contributes to new knowledge in the area and is the preferred approach to mentoring in the future.</p>

Group Mentoring of New Graduate Midwives: Emerging Professional Capacity: A Naturalistic Inquiry

<p>This research explores an innovative group mentoring model developed at the request of four newly graduated midwives who were mentored as a group by four experienced midwives. Since virtually all research on mentoring, both internationally and in New Zealand assumes that mentoring is a one-to-one activity, this study aimed to describe how this group mentoring model operated and explore whether it was successful in supporting new midwives to gain confidence. A naturalistic study design was used with a mixed methods approach to collecting and analysing a large amount of richly descriptive data. Data were gathered from records of individual contacts between mentors and new graduates, from a series of interviews with each of the eight participants, and from the actual audio recordings of regular group mentoring meetings across the mentoring year. Simple descriptive analysis of quantitative data and detailed thematic analysis of qualitative data were undertaken. The study found the group mentoring model provided everything that is expected of one-to-one mentoring and the new graduates felt well supported as they gained confidence during their first year in practice as autonomous self-employed midwives. The group model provided new graduates with 24/7 one-to-one mentor support whenever they asked for it. This was found to occur mostly in the first half of the year and was highly valued. The new graduates and the mentors all agreed that the most important part of the model were the regular group meetings. These meetings were entirely focused on day to day experiences that the new graduates chose to present to the group. Analysis of the meeting transcripts showed that the new graduates' issues ranged across the whole scope of practice; that they were sometimes prompted by self-reflection, sometimes by issues to do with relationships with others, and sometimes by a need to discuss technical matters. The mentors' responses were variously supportive; listening and exploring; directing or informing; and questioning or challenging. The group aspect of this mentoring model added a number of features that would not be possible in one-to-one mentoring. The new graduates valued how the group meetings exposed them to multiple perspectives from several mentors. The group meetings modelled a supportive and collegial way of working together that facilitated their emerging professional capacity now and into their future. The group provided a safe yet challenging space: a "stimulating sanctuary" for the new graduates' development. Overall the study found that group mentoring can successfully meet the needs of new graduates and provides several advantages over one-to-one mentoring. Group mentoring may be a more sustainable model than one-to-one, particularly where there are shortages of mentor midwives available. It is a model that promotes a supportive professional midwife culture, contributes to new knowledge in the area and is the preferred approach to mentoring in the future.</p>

Disaster Risk Awareness: The Turkish Migrants Living in Northern Italy

In this study, we analysed the socio-demographic characteristics and disaster risk awareness of the Turkish migrants living in northern Italy. We initiated the study with an extensive face-to-face questionnaire with 544 individual respondents. With the help of the questionnaire, we gathered information on the socio-demographic structure of the Turkish community living in the area and the immigrants’ disaster experience, their level of disaster preparedness and disaster risk awareness, and their potential behaviour during an emergency. Additionally, we conducted focus group meetings in Milan, Lecco, Como and Varese with 49 migrants living in the region. In the focus group meetings, we discussed the migrants’ awareness of disasters and potential behaviour patterns during emergencies. We collected the informative booklets and past event reports prepared by civil protection centres and municipalities and used them in focus group meetings to collect participants’ opinions. The results show that the migrant communities’ disaster risk awareness is low, but their capacity to adapt to suddenly changing conditions is higher than presumed.

Success Factors for Community Health Workers inImplementing an Integrated Group-Based Child Development Intervention in Rural Bangladesh

Community Health Workers (CHWs) can effectively implement maternal and child health interventions, but there is paucity of evidence on how to integrate child stimulation into these interventions, and their delivery at scale. In rural Bangladesh, CHWs implemented an intervention integrating psychosocial stimulation, nutrition, maternal mental health, water, sanitation, hygiene (WASH) and lead exposure prevention. In each of 16 intervention villages, one CHW worked with 20 households. CHWs bi-weekly held group meetings or alternated group meetings and home visits with pregnant women and lactating mothers. We assessed the intervention through five focus groups, four interviews and one group discussion with CHWs and their supervisors to explore success factors of implementation. CHWs’ training, one-on-one supervision and introduction by staff to their own community, and adoption of tablet computers as job aids, enabled successful session delivery to convey behavioral recommendations. CHWs reported difficulties delivering session due to the complexity of behavioral recommendations and struggled with age-specific intervention material. Young children’s attendance in group sessions generated distractions that undermined content delivery. We identified ways to minimize the difficulties to strengthen intervention-delivery during implementation, and scale-up. Iterative revisions of similarly integrated interventions based on qualitative evaluation findings could be delivered feasibly by CHWs and allow for implementation at scale.