Scale-up of prevention programmes: sustained state-wide use of programme delivery software is explained by normalised self-organised adoption and non-adoption

Background Population-level health promotion is often conceived as a tension between “top-down” and “bottom-up” strategy and action. We report behind-the-scenes insights from Australia’s largest ever investment in the “top-down” approach, the $45m state-wide scale-up of two childhood obesity programmes. We used Normalisation Process Theory (NPT) as a template to interpret the organisational embedding of the purpose-built software designed to facilitate the initiative. The use of the technology was mandatory for evaluation, i.e. for reporting the proportion of schools and childcare centres which complied with recommended health practices (the implementation targets). Additionally, the software was recommended as a device to guide the implementation process. We set out to study its use in practice. Methods Short-term, high-intensity ethnography with all 14 programme delivery teams across New South Wales was conducted, cross-sectionally, 4 years after scale-up began. The four key mechanisms of NPT (coherence/sensemaking, cognitive participation/engagement, collective action and reflexive monitoring) were used to describe the ways the technology had normalised (embedded). Results Some teams and practitioners embraced how the software offered a way of working systematically with sites to encourage uptake of recommended practices, while others rejected it as a form of “mechanisation”. Conscious choices had to be made at an individual and team level about the practice style offered by the technology—thus prompting personal sensemaking, re-organisation of work, awareness of choices by others and reflexivity about professional values. Local organisational arrangements allowed technology users to enter data and assist the work of non-users—collective action that legitimised opposite behaviours. Thus, the technology and the programme delivery style it represented were normalised by pathways of adoption and non-adoption. Normalised use and non-use were accepted and different choices made by local programme managers were respected. State-wide, implementation targets are being reported as met. Conclusion We observed a form of self-organisation where individual practitioners and teams are finding their own place in a new system, consistent with complexity-based understandings of fostering scale-up in health care. Self-organisation could be facilitated with further cross-team interaction to continuously renew and revise sensemaking processes and support diverse adoption choices across different contexts.

Elderly suicides in Denizli, Turkey: a retrospective study from 2011 to 2020

Background Although suicide rates and methods used may vary according to society, gender, and age there are epidemiological studies reporting that suicide rates increase with advanced age in all societies, particularly accelerating after the age of 65 years. This study aimed to investigate the demographic data and suicide characteristics—such as the location and method, among others—of the elderly suicide deaths among forensic deaths between 2011 and 2020 in Denizli, Turkey. Results It was determined that elderly suicides constituted 13.8% of all suicides and increased gradually over the years during the 10-year period. The vast majority of cases were male (82%). It has been observed that hanging is the most frequently used method. It is also noteworthy that although firearm suicide among men was the second most common method, women do not choose this method at all. The majority of elderly suicides (88.5%) in Denizli occurred in the home and its annexes. Conclusions Suicide prevention programmes should promote the elderly to benefit widely from social and health services. Therefore, there is a need to include widespread home care services and firearms regulations in prevention programmes.

Assessing the Impacts of HIV/AIDS Programmes on Sexual Health among the Youths of Obiyebe Community in Ogba/Ebgema/Ndoni Local Government Area of Rivers State

This study assessed the impacts of HIV/AIDS programmes on sexual health among youths of Obiyebe community in Ogba/Egbema/Ndoni LGA of Rivers State. The purpose of the study was to identify HIV/AIDS programmes on sexual health, to assess the knowledge of HIV/AIDS programmes on sexual health among the youths and to examine the impacts of HIV/AIDS programmes on sexual health among youths. The study adopted a descriptive survey study design with a sample size of 83 participants which are selected through a simple random sampling technique. A structured questionnaire was used as the instrument for data collection, while a frequency table and simple percentage were used as the instrument for data analysis. The findings of the study revealed that HIV/AIDS programmes on sexual health are; HIV/AIDS testing programmes, HIV/AIDS treatment programmes, HIV/AIDS prevention programmes, and United Nations Programmes on HIV/AIDS (UNAIDS). Another finding of the study showed that sexuality, condoms, sexual anatomy and sex, and adolescence sexual features and puberty are the knowledge of sexual health among the youths that enhance their good sexual health and prevention of HIV/AIDS. Again the study revealed that the impacts of HIV/AIDS programmes on the sexual health of the youths were that their understanding of sexuality is increased, they understand the importance of using condoms if sexually active, there is a reduction in unwanted teenage pregnancies, they are informed of their normal sexual features development, puberty, reproductive anatomy and physiology, they are informed of the option to delay sexual activity until they are ready (matured), and there is a reduction of new HIV/AIDS/ other STI infections. The study made some recommendations and suggestions.

Using stated preference methods to inform public health decision making

Croatia has recognised the importance of prevention programmes in the field of public health, although their effectiveness is not satisfactory due to the low population response, which has a negative impact on the rationalisation of public spending. One of the possible solutions is to consider the stated preferences of the target population. Therefore, the main objective of this study is to evaluate the use of stated preference methods in improving public health prevention programmes. For the purpose of the study, a questionnaire was designed using three different methods - Discrete Choice Experiment (DCE), Contingent Rating method (CR) and Best-Worst Scaling method (BWS). This study shows that the attributes of the Croatian cervical cancer screening programme are significantly associated with the respondents' utility level, which in turn is related to women's response. Since BWS, DCE, and CR measure the same construct - utility - we can say that convergent validity partially confirms the external validity of the methods. The author concludes that it is necessary to implement market principles, i.e. the demand-side analysis using stated preference methods, in the planning, implementation and re-evaluation of public health programmes.

Exploring Attrition and Completion in a Community Situated Family Violence Intervention Programme

<p>This thesis aims to explore the factors associated with attrition and completion for a New Zealand based community situated family violence intervention programme. It takes a mixed methods approach across two studies. Study one quantitatively investigated the attrition rate of the programme, and factors that predict this attrition. It used survival analysis techniques to analyse data files collected during the assessment phase of the programme. An attrition rate of 46% was identified, which is slightly higher than the average rate of attrition across family violence prevention programmes internationally. Ethnicity was the only variable found to predict attrition. Study two qualitatively explored the experiences of men who completed the intervention programme. Men were interviewed to provide insights into the facilitators and barriers to programme completion. Thematic analysis identified three themes of overcoming barriers to engagement and attendance; motivating factors for engagement; and the importance of active participation in facilitating healing. Aspects of the programme that could be strengthened to improve the engagement and attendance of future participants are discussed alongside the wider implications for family violence prevention practice and policy.</p>

Exploring Attrition and Completion in a Community Situated Family Violence Intervention Programme

<p>This thesis aims to explore the factors associated with attrition and completion for a New Zealand based community situated family violence intervention programme. It takes a mixed methods approach across two studies. Study one quantitatively investigated the attrition rate of the programme, and factors that predict this attrition. It used survival analysis techniques to analyse data files collected during the assessment phase of the programme. An attrition rate of 46% was identified, which is slightly higher than the average rate of attrition across family violence prevention programmes internationally. Ethnicity was the only variable found to predict attrition. Study two qualitatively explored the experiences of men who completed the intervention programme. Men were interviewed to provide insights into the facilitators and barriers to programme completion. Thematic analysis identified three themes of overcoming barriers to engagement and attendance; motivating factors for engagement; and the importance of active participation in facilitating healing. Aspects of the programme that could be strengthened to improve the engagement and attendance of future participants are discussed alongside the wider implications for family violence prevention practice and policy.</p>

The Influence of Fraud Prevention Mechanisms on Fraud Awareness in The Federal Ministries in Malaysia

This study examined the extent of fraud prevention mechanisms that influence the awareness of curbing the occurrence of fraudulent activities in public sector organisations, particularly the Federal Ministries in Malaysia. The key factors in this study thereby attributed as the fraud prevention mechanisms that influenced by ethical leadership, internal control system, and fraud prevention programmes. Following this, the Agency Theory was employed to guide the study. A survey was conducted among the officers of various Federal Ministries who were sampled via the purposive sampling method and yielded 210 total responses. The results showed that ethical leadership and the implementation of a virtuous internal control system ranked as the most effective fraud prevention mechanism that influenced their awareness towards curbing the occurrence of fraud. A regression analysis further revealed that the fraud prevention programmes were not statistically significant in influencing awareness of fraud. The main value of this paper is the effect of fraud prevention mechanisms; namely, ethical leadership, internal control systems, and fraud prevention programmes, on awareness of fraud amongst officers in the Federal Ministries in Malaysia. The findings of this study provide useful insights for the Federal government to improve and reconsider current fraud prevention mechanisms, especially fraud prevention programmes to improve awareness of fraud and recover public trust. Keywords: fraud awareness, ethical leadership, internal control system, prevention programme, Malaysian federal ministries

Developing, Testing, and Implementing a Falls Prevention and Healthy Aging App (Keep-On-Keep-Up) for Older Adults

Falls are a common and costly concern for older adults. Digital technologies can offer new, inexpensive approaches to increase access and engagement with falls prevention programmes. Keep-On-Keep-Up is a personalised, falls prevention App with strength and balance exercises plus health literacy games. This study reports on the user-centred design, usability testing and implementation of the KOKU App. Older adults aged 55 years and older in the UK were invited to take part in the study. Data collection included focus groups; baseline and 6 week questionnaires and assessments; semi-structured interviews and one focus group with falls prevention therapists to explore App usability. Thirty older adults were invited to use KOKU unsupervised, 3 times a week for 6 weeks. Data were analysed using thematic content analysis. Focus groups (n=11) with 66 older users and 11 therapists informed development. Thirty older adults (mean age = 75) were recruited for the in-depth testing. Mean SUS score was 71 indicating high usability. Qualitative themes included: ease of use (app usability; iPad properties; exercise presentation), usefulness (physical/psychological benefits; falls education), attitude towards the App and intention to use (technological barriers; flexibility of use; exercise class versus App). Therapists (n=6) viewed the KOKU platform positively and suggested extensions for further progression. No adverse events were reported during the study. This research demonstrates that KOKU is an acceptable and easy to use falls prevention intervention that facilitates older adults’ ability to access falls prevention training at a time, and in a location, that suits them.

Assessment of Community Pharmacists Knowledge on dispensing of Antimicrobial drugs and Prevention of Antimicrobial Resistance in Community practice

The antimicrobial resistance has more impact on the health care division which would increase the mortality and hospital readmission duration. Our objective is to assess the community pharmacist’s knowledge on dispensing of antimicrobial drugs and prevention of antimicrobial resistance in community practice. A cross-sectional study was conducted for six months. A sample size of 150 registered community pharmacists participated in the study. We have used simple random techniques to select the community pharmacists. Questionnaire were distributed to the community pharmacists at pre and post visits and the response was analyzed. The collected data was analyzed using graph pad prism software. The mean and standard deviation was calculated and P<0.005 was considered to be statistically significant. For 25-30 years of age , community pharmacists were more 68 (45.33%) as compared to other ages. Pre visit before and after average mean antimicrobial resistance score was found to be 4.87. Proper implementation of antimicrobial resistance prevention programmes would drastically increases the rational use of antimicrobials could and minimizes the health care cost.

Prevalence of blindness and its major causes in sub-Saharan Africa in 2020: A systematic review and meta-analysis

Background: Global studies show that the prevalence of visual impairment and blindness continued to rise despite the implementation of strategies outlined in the Global Action Plan, aimed at reducing these by the year 2020. Vision impairment impacts negatively on one’s independence, opportunities, and quality of life. Therefore, knowledge of the prevalence, and the major causes of blindness impairment in any population, is vital in designing strategies to address this public health challenge. Methods: Literature mapping evidence of vision impairment was searched for on PubMed, Google Scholar, and EBSCOhost databases MEDLINE, Health Source: Nursing/Academic Edition, Health Source – Consumer Edition, CINAHL, and Academic Search Complete. Studies that were searched for included peer-reviewed and grey literature published in English from various countries in sub-Saharan Africa (SSA). Results: Only 77 studies with 191,173 participants, contributing data from 26 countries within SSA, met the inclusion criteria for the final review. The overall pooled prevalence estimate (PPE) of blindness from the selected studies was 10% (95% confidence interval [CI]: 8.0% – 11.0%). West Africa and East Africa had the highest prevalence. The identified leading causes of blindness were cataracts (46%; 95% CI: 40% – 52%), followed by glaucoma (14%; 95% CI: 11% – 18%). There was a high level of heterogeneity in most pooled estimates (I2 ˃ 80%, p < .001). Conclusion: The prevalence of blindness in SSA has increased in all four regions with most cases being avoidable. Policymakers should prioritise blindness prevention programmes, ensure enabling health systems, and provide the necessary resources towards reducing blindness in SSA.