Improving knowledge about breast cancer and breast self examination in female Nigerian adolescents using peer education: a pre-post interventional study

Background Prevention of BC of which the cornerstone is creating awareness and early detection is important in adolescents and young women because of their worse outcomes. Early detection strategies such as mammography are currently beyond the reach of most women in sub-Saharan Africa.. Lack of awareness and late presentation contribute to the poor outcomes. Awareness creation among adolescents may result in modification of some risk factors for BC with adoption of healthy life styles including accessing early detection activities. This study determined the effect of peer education as a strategy to create awareness on BC and breast self examination (BSE) among in-school female adolescents in Benin City. Methods This was a pre-post interventional study carried out in October –December 2016 on female students of four secondary schools in Benin City. Pre-peer training, using a pre-tested self-administered questionnaire, knowledge about BC and BSE was assessed in about 30% of each school population. This was followed by training of 124 students selected from the schools (one student per class) as peer trainers. The peer trainers provided training on BC and BSE (the intervention) for their classmates. Within two weeks of peer training knowledge about BC and BSE was reassessed in 30% of each school population. Selection of students for assessment pre and post intervention was by systematic sampling. Correct knowledge was scored and presented as percentages. Chi square test, student t test and ANOVA were used to assess associations and test differences with level of significance set at p < 0.05. Results There were 1337 and 1201 students who responded to the pre and post-training questionnaires respectively. The mean BC knowledge score (20.61 ± 13.4) prior to training was low and it statistically significantly improved to 55.93 ± 10.86 following training p < 0.0001 Following peer training, statistically significant improvement (p 0.037- < 0.001) occurred in most knowledge domains apart from symptomatology. Pre-peer training 906(67.8%) students knew about BSE but only 67(4.8%). Significantly more students 1134(94.7%) knew about BSE following peer training. Conclusions Peer education strategy can be used to improve BC and BSE knowledge in adolescents. This strategy is low cost and could be very useful in low resource settings.

STEM doctoral students’ skill development: does funding mechanism matter?

Background A substantial monetary investment supports STEM doctoral students in the United States (U.S.) through a variety of funding mechanisms (e.g., fellowships, research, and teaching assistantships). However, we have limited knowledge of how students’ funding influences their development of career-relevant skills during graduate school. Using survey data from STEM doctoral students (n = 719) across 35 highly ranked U.S. institutions, we use exploratory factor analysis and nested multivariate regression modeling to understand how students’ primary funding influences development of: (a) research skills; (b) teamwork and project management skills; (c) peer training and mentoring skills, and (d) communication skills. Results We find significant differences in students’ self-reported development for all four career-related skills based on their primary funding type. Students with research assistantships reported higher research and teamwork and project management skills than those with teaching assistantships. Yet, students with teaching assistantships reported significantly higher development of peer training and mentoring than students funded via all other types. Students funded via external fellowships reported lower skill development than students funded primarily by research assistantships across all four career-relevant skills. Conclusions Doctoral students' development of career-relevant skills are not uniform across primary funding types. Particularly, the perceived benefits of external fellowship funding (i.e., prestige, autonomy, increased pay) may come at the cost of fewer opportunities to develop skills important for career success. STEM graduate education scholars, practitioners, and policymakers should consider and ameliorate the varied impacts that funding mechanisms can have on graduate students’ development of career-relevant skills.

Defining and characterizing task-shifting medical devices

Background Task shifting could help address limited human resources available for the delivery of quality health care services in low-resource settings. However, the role of medical devices in supporting task shifting is not fully understood. This study aimed to 1) define “task-shifting medical devices” and 2) identify product characteristics to guide the design and development of task-shifting medical devices. A three-part survey questionnaire comprising open-ended, rank-ordering, and multiple-choice questions was disseminated to healthcare professionals worldwide. The survey included questions to capture stakeholders’ general understanding of and preferences for task shifting in medicine and public health, and questions to define task-shifting medical devices and identify desirable product characteristics of task-shifting medical devices. Results Task-shifting medical devices were defined by respondents as “devices that can be used by a less specialized health worker”. Aside from safe and effective, both essential characteristics for medical devices, easy to use was the most cited product characteristic for a task-shifting medical device. Responses also emphasized the importance of task-shifting medical devices to enable local agency, such as peer-to-peer training and local maintenance. Several additional frequently mentioned attributes included low cost, contextually appropriate, maintainable, capable of using an alternative power source, easy to understand, easy to learn, reusable, and easy to manage throughout its use cycle. Conclusion This study defines and characterizes task-shifting medical devices based on healthcare professionals’ responses. Ease of use was identified as the most important characteristic that defines a task-shifting medical device, alongside safe and effective, and was strongly associated with enabling peer-to-peer training and maintainability. The findings from this study can be used to inform technology product profiles for medical devices used by lower-level cadres of healthcare workers in low-resource settings.

Using Case-Based Reasoning in a Learning System: A Prototype of a Pedagogical Nurse Tool for Evidence-Based Diabetic Foot Ulcer Care

Background: Currently, evidence-based learning systems to increase knowledge and evidence level of wound care are unavailable to wound care nurses in Denmark, which means that they need to learn about diabetic foot ulcers from experience and peer-to-peer training, or by asking experienced colleagues. Interactive evidence-based learning systems built on case-based reasoning (CBR) have the potential to increase wound care nurses’ diabetic foot ulcer knowledge and evidence levels. Method: A prototype of a CBR-interactive, evidence-based algorithm-operated learning system calculates a dissimilarity score (DS) that gives a quantitative measure of similarity between a new case and cases stored in a case base in relation to six variables: necrosis, wound size, granulation, fibrin, dry skin, and age. Based on the DS, cases are selected by matching the six variables with the best predictive power and by weighing the impact of each variable according to its contribution to the prediction. The cases are ranked, and the six cases with the lowest DS are visualized in the system. Results: Conventional education, that is, evidence-based learning material such as books and lectures, may be less motivating and pedagogical than peer-to-peer training, which is, however, often less evidence-based. The CBR interactive learning systems presented in this study may bridge the two approaches. Showing wound care nurses how individual variables affect outcomes may help them achieve greater insights into pathophysiological processes. Conclusion: A prototype of a CBR-interactive, evidence-based learning system that is centered on diabetic foot ulcers and related treatments bridges the gap between traditional evidence-based learning and more motivating and interactive learning approaches.

Defining and Characterizing Task-Shifting Medical Device

Background Task shifting could help address limited human resources available for the delivery of quality health care services in low-resource settings. However, the role of medical devices in supporting task shifting is not fully understood. This study aimed to 1) define “task-shifting medical devices” and 2) identify product characteristics to guide the design and development of task-shifting medical devices.A three-part survey questionnaire comprising open-ended, rank-ordering, and multiple-choice questions was disseminated to healthcare professionals worldwide. The survey included questions to capture stakeholders’ general understanding of and preferences for task shifting in medicine and public health, and questions to define task-shifting medical devices and identify desirable product characteristics. Results Task-shifting medical devices were defined by respondents as “devices that can be used by a less specialized health worker”. Aside from safe and effective, both essential characteristics for medical devices, easy to use was the most cited product characteristic for a task-shifting medical device. Respondents further defined “easy to use” task-shifting medical devices as simple devices that leverage digital or automated features and are supportive of data management and privacy protection good practices. Responses also emphasized the importance of task-shifting medical devices to enable local agency, such as peer-to-peer training and local maintenance. Several additional frequently mentioned attributes included low cost, contextually appropriate, maintainable, capable of using an alternative power source, easy to understand, easy to learn, reusable, and easy to manage throughout its use cycle. Conclusion This study defines and characterizes task-shifting medical devices based on healthcare professionals’ responses. Ease of use was identified as the most important characteristic that defines a task shifting medical device, in addition to safe and effective, and was strongly associated with enabling peer-to-peer training and maintainability. The findings from this study can be used to inform technology product profiles for medical devices used by lower-level cadres of healthcare workers in low-resource settings.