Experiences of Diabetes Self-Management: A Focus Group Study among the Middle-Aged Population of Rural Pakistan with Type 2 Diabetes

Objectives: The middle-aged population from rural areas of Pakistan is disproportionately at risk of developing and mismanaging their diabetes. The purpose of this study was to explore the self-management experiences of two focus groups in the middle-aged population with type 2 diabetes mellitus living in rural Pakistan. Methods: The study design is based on the exploratory research using a qualitative approach. Purposive sampling was used to recruit patients with diabetes from the metabolic outpatient clinics of medical centers in rural areas of Pakistan. The data were collected for two focus groups consisting of 20 persons (10 men and 10 women) with type 2 diabetes mellitus, ranging in age from 40 to 65 years, who were receiving diabetic care at a local health facility. Focus group discussions with a sample size of 10 participants each were all recorded, transcribed, and analyzed. The data were evaluated thematically. Results: Participants described diabetes management as emotionally, physically, and socially taxing. The analysis of the data indicated three major themes: (1) diabetes as a challenging disease; (2) understanding diabetes and its challenges; (3) following diabetes self-management practices. Throughout the session, participants discussed the impact of diabetes on their daily life. This study provided new insights into the experiences of the middle-aged population of Pakistan regarding their self-management of diabetes. Conclusions: Healthcare professionals should become involved in diabetes self-management education as soon as feasible to alleviate patient worry and establish better patient-centered, culturally sensitive professional abilities. Along with monitoring patients’ self-management, healthcare professionals should place a greater emphasis on patients’ understanding of the disease and its challenges and associated complications. It is recommended to establish diabetes support groups to encourage patients to share their experiences of diabetes self-management.

Coordination in Planning and Implementing Professional Development Programs for Teachers: A Much-needed Component in Rural Areas

Coordination among stakeholders has been considered as a significant influential factor in providing teachers with quality Professional Development (PD) opportunities. The importance of coordination intensifies when a variety of PD providers work on the capacity building of teachers in the same region such as in some rural areas of Pakistan. The current research explored the nature of coordination among various stakeholders while designing and implementing PD programs for teachers in rural Pakistan. To achieve this aim, qualitative case study approach was used and data were generated through focused group interviews from PD providers, education managers, school leaders, and teachers. The results indicated a limited coordination among the stakeholders leading to a variety of issues such as overlapping programs, conflicting expectations from teachers, and selection of irrelevant teachers for PD. Drawing on the experience of the stakeholders who participated in this research, the paper suggests a model of coordination which the educational reformers, especially the PD providers and education managers, should consider while designing and implementing the capacity building programs for teachers.

Effect of integrating Family Planning (FP) with Maternal, Newborn and Child Health (MNCH) services on uptake of voluntary modern contraceptive methods in rural Pakistan: Protocol for a Quasi-experimental study (Preprint)

BACKGROUND Background: The uptake of the Modern Contraceptive Methods (MCM) cumulatively remains low at 25% of women reporting the use in Pakistan. The overarching interventions covering service delivery platforms at facility and community levels necessitates the integration and scaling up of Family Planning (FP) and Maternal Newborn Child Health (MNCH) services OBJECTIVE The main objective of the study is to evaluate the impact of an integrated FP-MNCH service delivery model to increase coverage of MCM in a rural Pakistan. Moreover, to measure the level of effectiveness of interventions on the uptake MCM. METHODS A Quasi-experimental sequential mixed methods study design with pre and post evaluation will be adopted to design and evaluate the integrated FP with MNCH service delivery model. The Interventions include. (1) Capacity Strengthening of Health Care Providers including technical trainings, training for Counseling of women attending immunization centers and ANC and PNC clinics and Provision of Job aids. (2)Counseling of women and girls attending ANC, postnatal and pediatrics clinics. (3)Ensure sustained Provision of Supplies and Commodities. (4)Community Engagement including establishment adolescent friendly spaces, and (5) use of District health Information Data (DHIS) data in decision making. Descriptive statistics will be used to estimate prevalence (proportions) and frequencies of outcome indicators. A univariate difference-in-difference (DID) analytical approach will be used to estimate the effect of the interventions. In additions, a Blinder-Oaxaca decomposition analysis will be conducted to identify and quantifying determinants of mCPR. RESULTS Ethical clearance for this project was sought from Ethical Review Committee (ERC) of Aga Khan University on 26th June, 2020. The project started in January 2021 and will be completed in September 2022. CONCLUSIONS This project will evaluate the impact of integrated family planning with maternal newborn and child health services. Furthermore, identify the drivers and barriers in uptake of modern contraceptive methods and simultaneously helps in modifying the interventional strategies that can be scales up through existing service delivery platforms within public and private sector according to local socio-cultural and health system context. CLINICALTRIAL clinicaltrials.gov NCT05045599: https://clinicaltrials.gov/ct2/show/NCT05045599

Exploring the phenomenon of suicidal behaviour (SB): An explanatory, mixed-method study in rural Pakistan

Background: Despite scientific literature and media reports of rising cases of suicide and attempted suicide in different parts of Pakistan, the extent of this problem remains unknown, particularly from outside the main urban centres of the country. Aims: To report data on Suicidal Behaviour (SB) from Malakand Division, a rural and marginalised part of Khyber Pakhtunkhwa (KPK) province, explore aetiological factors and propose preventive strategies. Methods: This study followed an explanatory, mixed-method study design. The first part quantitative [QUANT] comprised of police reports on suicidal behaviour, from 2001 till first 8 months of 2018. Detailed analysis of only data from 2013 was undertaken, as data prior to 2013 contained insufficient information. The second part that is, qualitative (QUAL) consisted of in-depth interviews with relevant stakeholders. A mixed method of inductive and deductive analytical approach was used. Results: From 2013 until the first quarter of 2018, the police recorded 1,645 attempts of both males and females of which 144 (8.75%) resulted in fatalities. Suicide attempts rose by 83.4% over the 5 years and 8 months. Approximately, 43.3% of the attempts were attributed to ‘depression’. Domestic abuse was reported in 49.6% of cases. Of the total victims, 1,049 (63.7%) were females, whereas 60.1% were married. Ingestion of the organophosphates poison (pesticide) was reported in 53.2% ( n = 999) of suicide attempts. In more than 90% of the non-fatal suicide attempts, victims were booked under punitive laws. Poor socio-economic status, inter-personal stressors, violence against women and mental illnesses were the major causes of suicidal behaviour in Malakand [QUAL]. Investment in human development, strengthening of the healthcare system, de-stigmatisation of mental illnesses and women empowerment could possibly prevent suicidal behaviour in Malakand [QUAL]. Conclusion: SB in Malakand Division is steadily increasing. The increase is more evident in vulnerable populations such as women and the younger population. ‘Psychosocial stressors’ and ‘depression’ were the main causes of suicidal behaviour. A broad-based, proactive, multi-sectorial approach is needed to prevent SB in the region.