Health improvement for disadvantaged people in Nepal – an evaluation

Background

Diarrhoea is the second leading cause of death in children under five accounting for 1.8 million deaths yearly. Despite global efforts to reduce diarrhoea mortality through promotion of proper case management, there is still room for ample improvement. In order to seek options for such improvements this study explored the knowledge and practices of diarrhoea case management among health care providers at health centres and drug shops in Uganda.

Methods

Records were reviewed for case management and structured interviews concerning knowledge and practices were conducted with the staff at all health centres and at all identified drug shops in the rural district of Namutumba, Uganda.

Results

There was a significant gap between knowledge and documented practices among staff. Antibiotics, antimalarials and antipyretics were prescribed or recommended as frequently as Oral Rehydration Solution (ORS). In almost a third of the health facilities, ORS was out of stock. 81% of staff in health centres and 87% of staff in drug shops stated that they prescribed antibiotics for common diarrhoea. Zinc was not prescribed or recommended in any case.

Conclusions

The findings indicate that many children presenting with diarrhoea are inadequately treated. As a result they may not get the rehydration they need and are at risk of potential side effects from unjustified usage of antibiotics. Practices must be improved at health centres and drug shops in order to reduce childhood mortality due to diarrhoeal diseases.     

Policymakers’ experience of a capacity-building intervention designed to increase their use of research: a realist process evaluation

Background

An intervention’s success depends on how participants interact with it in local settings. Process evaluation examines these interactions, indicating why an intervention was or was not effective, and how it (and similar interventions) can be improved for better contextual fit. This is particularly important for innovative trials like Supporting Policy In health with Research: an Intervention Trial (SPIRIT), where causal mechanisms are poorly understood. SPIRIT was testing a multi-component intervention designed to increase the capacity of health policymakers to use research.

Methods

Our mixed-methods process evaluation sought to explain variation in observed process effects across the six agencies that participated in SPIRIT. Data collection included observations of intervention workshops (n = 59), purposively sampled interviews (n = 76) and participant feedback forms (n = 553). Using a realist approach, data was coded for context-mechanism-process effect configurations (retroductive analysis) by two authors.

Results

Intervention workshops were very well received. There was greater variation of views regarding other aspects of SPIRIT such as data collection, communication and the intervention’s overall value. We identified nine inter-related mechanisms that were crucial for engaging participants in these policy settings: (1) Accepting the premise (agreeing with the study’s assumptions); (2) Self-determination (participative choice); (3) The Value Proposition (seeing potential gain); (4) ‘Getting good stuff’ (identifying useful ideas, resources or connections); (5) Self-efficacy (believing ‘we can do this!’); (6) Respect (feeling that SPIRIT understands and values one’s work); (7) Confidence (believing in the study’s integrity and validity); (8) Persuasive leadership (authentic and compelling advocacy from leaders); and (9) Strategic insider facilitation (local translation and mediation). These findings were used to develop tentative explanatory propositions and to revise the programme theory.

Conclusion

This paper describes how SPIRIT functioned in six policy agencies, including why strategies that worked well in one site were less effective in others. Findings indicate a complex interaction between participants’ perception of the intervention, shifting contextual factors, and the form that the intervention took in each site. Our propositions provide transferable lessons about contextualised areas of strength and weakness that may be useful in the development and implementation of similar studies.

     

The spread of medical fake news in social media – The pilot quantitative study

Objectives

Fake news: misinformation and falsehood of health news in social media constitute a potential threat to the public health, but the scope of this issue remains unclear. Our pilot study is an initial attempt to measure a number of the top shared health misinformation stories in the Polish language social media.

The inclusion of an online journal in PubMed central – a difficult path

The indexing of a journal in a prominent database (such as PubMed) is an important imprimatur. Journals accepted for inclusion in PubMed Central (PMC) are automatically indexed in PubMed but must provide the entire contents of their publications as XML-tagged (Extensible Markup Language) data files compliant with PubMed’s document type definition (DTD). This paper describes the various attempts that the journal Images in Paediatric Cardiology made in its efforts to convert the journal contents (including all of the extant backlog) to PMC-compliant XML for archiving and indexing in PubMed after the journal was accepted for inclusion by the database.     

The researchers’ role in knowledge translation: a realist evaluation of the development and implementation of diagnostic pathways for cancer in two United Kingdom localities

Background

In examining an initiative to develop and implement new cancer diagnostic pathways in two English localities, this paper evaluates ‘what works’ and examines the role of researchers in facilitating knowledge translation amongst teams of local clinicians and policy-makers.

Methods

Using realist evaluation with a mixed methods case study approach, we conducted documentary analysis of meeting minutes and pathway iterations to map pathway development. We interviewed 14 participants to identify the contexts, mechanisms and outcomes (CMOs) that led to successful pathway development and implementation. Interviews were analysed thematically and four CMO configurations were developed.

Results

One site produced three fully implemented pathways, while the other produced two that were partly implemented. In explaining the differences, we found that a respected, independent, well-connected leader modelling partnership working and who facilitates a local, stable group that agree about the legitimacy of the data and project (context) can empower local teams to become sufficiently autonomous (mechanism) to develop and implement research-based pathways (outcome). Although both teams designed relevant, research-based cancer pathways, in the site where the pathways were successfully implemented the research team merely assisted, while, in the other, the research team drove the initiative.

Conclusion

Based on our study findings, local stakeholders can apply local and research knowledge to develop and implement research-based pathways. However, success will depend on how academics empower local teams to create autonomy. Crucially, after re-packaging and translating research for local circumstances, identifying fertile environments with the right elements for implementation and developing collaborative relationships with local leaders, academics must step back.

     

SMS-based smartphone application for disease surveillance has doubled completeness and timeliness in a limited-resource setting – evaluation of a 15-week pilot program in Central African Republic (CAR)

Background

It is a challenge in low-resource settings to ensure the availability of complete, timely disease surveillance information. Smartphone applications (apps) have the potential to enhance surveillance data transmission.

Methods

The Central African Republic (CAR) Ministry of Health and Médecins Sans Frontières (MSF) conducted a 15-week pilot project to test a disease surveillance app, Argus, for 20 conditions in 21 health centers in Mambéré Kadéi district (MK 2016). Results were compared to the usual paper-based surveillance in MK the year prior (MK 2015) and simultaneously in an adjacent health district, Nana-Mambére (NM 2016). Wilcoxon rank sum and Kaplan-Meier analyses compared report completeness and timeliness; the cost of the app, and users’ perceptions of its usability were assessed.

Results

Two hundred seventy-one weekly reports sent by app identified 3403 cases and 63 deaths; 15 alerts identified 28 cases and 4 deaths. Median completeness (IQR) for MK 2016, 81% (81–86%), was significantly higher than in MK 2015 (31% (24–36%)), and NM 2016 (52% (48–57)) (p?<?0.01). Median timeliness (IQR) for MK 2016, 50% (39–57%) was also higher than in MK 2015, 19% (19–24%), and NM 2016 29% (24–36%) (p?<?0.01). Kaplan-Meier Survival Analysis showed a significant progressive reduction in the time taken to transmit reports over the 15-week period (p?<?0.01). Users ranked the app’s usability as greater than 4/5 on all dimensions. The total cost of the 15-week pilot project was US$40,575. It is estimated that to maintain the app in the 21 health facilities of MK will cost approximately US$18,800 in communication fees per year.

Conclusions

The app-based data transmission system more than doubled the completeness and timeliness of disease surveillance reports. This simple, low-cost intervention may permit the early detection of disease outbreaks in similar low-resource settings elsewhere.

     

The physical activity – mental wellbeing association in young people: A case study in dealing with a complex public health topic using a ‘realistic evaluation’ framework

BackgroundSome public health problems can be considered as complex and the evidence base associated with them narrow and ambiguous. This paper reports and reflects on our experiences of undertaking a critical evidence review in an area of this nature – the relationship between physical activity and mental wellbeing among young people.MethodsA critical literature review and wider conceptual reflection.ResultsThe assertion that physical activity is associated with mental wellbeing was generally upheld, though a range of quandaries were raised that suggested the narrowness of some approaches to evidence. A wider systems orientation was adopted, deploying Pawson and Tilley’s ‘Realistic Evaluation’ framework to gain insight into – what is the nature of the association, why might there be an association and how might we best deliver interventions to exploit potential association?ConclusionsThe evidence broadly supported the hypothesis that physical activity has the potential to improve mental wellbeing in young people. We suggest that this more conditional position may have more utility. That is, it is best not to see the relationship as a ‘given’; it can be difficult to achieve; and can only be realised in association of a series of conducive ‘change mechanisms’.     

Ebm@school – a curriculum of critical health literacy for secondary school students: results of a pilot study

Objectives:  Increasingly, patients and consumers are taking responsibility for their diagnostic and therapeutic decisions. This requires a certain amount of health literacy in order to critically assess the various procedures and products. The aim of this study was to develop and pilot test a curriculum of critical health literacy for secondary school students. Methods:  The curriculum is based on the concept of evidence-based medicine and consists of six modules. Development and pilot testing was performed with two classes of secondary school students (n = 45) in Grade 11. The Metaplan method was used to document feedback regarding teaching methods, worksheets, satisfaction and individually perceived benefits. Additionally, systematic observations by researchers were documented and students’ presentations assessed. A sample of untrained students (n = 218) served as a control group. The Critical Health Competency Test was employed for evaluating competencies in critical health literacy. Data were analyzed qualitatively and person parameters were calculated. Results:  Overall, the pilot courses were well-accepted and have been proven to be feasible. Students’ feedback guided revision of the curriculum. Trained students achieved significantly higher person parameters (± SD) than the control group: 597 (± 79) versus 483 (± 94), p < 0.01, indicating enhancement of critical health competencies. Conclusion:  Teaching critical health literacy to secondary school students is feasible and is likely to enhance the competence of critical health literacy. Further studies are needed to show the effectiveness of the intervention. Submitted: 31 March 2007; revised: 11 February 2008, 13 June 2008, 26 August 2008; accepted: 26 August 2008     

Educational DVD for parents of children with congenital heart disease – a pilot study

Parental knowledge regarding their child’s congenital heart defect (CHD) is limited. This study developed and evaluated an interactive DVD that helped parents to understand their child’s CHD. A DVD describing four cardiac abnormalities was created using videos and Adobe Flash. The parents’ knowledge was assessed via a questionnaire before and after receiving the DVD. A control group did not receive the DVD. The DVDs were successfully created and improved the parental knowledge of their child’s cardiac anomaly. The pilot study suggests the need for further development of DVDs to describe additional abnormalities, whilst incorporating local management and outcomes.     

Eradication of MRSA in chronic wounds of outpatients with leg ulcers is accelerated by antiseptic washes – Results of a pilot study

Whereas several studies evaluate MRSA in inpatients, for outpatients there are merely expert recommendations, but no systematic studies. Mostly, MRSA in outpatients is tolerated but not eradicated. Particularly, for risk patients with chronic wounds some experts postulate that MRSA-eradication is even impossible. For the first time, this pilot study systematically searched for the results of an eradication of MRSA in chronic leg ulcers of outpatients. 38 outpatients with a MRSA colonized leg ulcer were included in the survey and retrospective data analysis. Additionally to a wound therapy with silver-containing wound dressings, all patients were recommended to apply antiseptic eradication measures in accordance with the recommendations for inpatient treatment. MRSA was considered to be persistent, if it was detectable in the wound after at least one month of recommended eradication therapy. In 16 patients the MRSA could be successfully eradicated (MRSA-E), in 22 it could not (MRSA-P). Results showed a significant benefit of antiseptic body washes during the decontamination (MRSA-E 62.5%, MRSA-P 22.7%; p=0.0082). Other antiseptic measures like daily change of clothes and linen or disinfections of personal things and surroundings did not show significance. In conclusion, this pilot study shows that eradication of MRSA in chronic wounds is possible in outpatients. Antiseptic measurements, even administered by the patients themselves, seem to have a positive influence. Their efficacy has to be proven in larger, placebo-controlled studies for outpatient eradication.     

Estimating the effectiveness of a hospital’s interventions in India: impact of the choice of disability weights

ObjectiveTo calculate the effect of using two different sets of disability weights for estimates of disability-adjusted life-years (DALYs) averted by interventions delivered in one hospital in India.MethodsDALYs averted by surgical and non-surgical interventions were estimated for 3445 patients who were admitted to a 106-bed private hospital in a semi-urban area of northern India in 2012–2013. Disability weights were taken from global burden of disease (GBD) studies. We used the GBD 1990 disability weights and then repeated all of our calculations using the corresponding GBD 2010 weights. DALYs averted were estimated for surgical and non-surgical interventions using disability weight, risk of death and/or disability, and effectiveness of treatment.FindingsThe disability weights assigned in the GBD 1990 study to the sequelae of conditions such as cataract, cancer and injuries were substantially different to those assigned in the GBD 2010 study. These differences in weights led to large differences in estimates of DALYs averted. For all surgical interventions delivered to this patient cohort, 11 517 DALYs were averted if we used the GDB 1990 weights and 9401 DALYs were averted if we used the GDB 2010 disability weights. For non-surgical interventions 5168 DALYs were averted using the GDB 1990 disability weights and 5537 DALYS were averted using the GDB 2010 disability weights.ConclusionEstimates of the effectiveness of hospital interventions depend upon the disability weighting used. Researchers and resource allocators need to be very cautious when comparing results from studies that have used different sets of disability weights.     

Whole-body MRI for cancer surveillance in ataxia–telangiectasia: A qualitative study of the perspectives of people affected by A-T and their families

Background/Objectives

Ataxia–telangiectasia (A-T) is a complex inherited disease associated with an increased risk of malignancy. Surveillance guidelines have demonstrated significant health benefits in other cancer predisposition syndromes. However, evidence-based guidelines for cancer screening are not currently used in the United Kingdom for people affected by A-T. This study aims to understand how people with A-T and their parents feel about cancer surveillance using whole-body magnetic resonance imaging (MRI) to inform the future development of cancer surveillance guidelines.

Design/Methods

We conducted semistructured interviews with people affected by A-T. Data were analysed inductively using thematic analysis.

Results

Nine parents of children with A-T and four adults with A-T were interviewed. Five main themes emerged from the data, including (1) cancer screening was considered invaluable with the perceived value of early detection highlighted; (2) the cancer fear can increase anxiety; (3) the perceived limitations around current practice, with the responsibility for monitoring falling too strongly on parents and patients; (4) the need for effective preparation for cancer screening, including clear communication and (5) the challenges associated with MRI screening, where specific recommendations were made for improving the child's experience.

Conclusion

This study suggests that stakeholders are positive about the perceived advantages of a cancer screening programme. Ongoing support and preparation techniques should be adopted to maximise adherence and minimise adverse psychosocial outcomes.

Patient or Public Contribution

People with A-T and parents of people with A-T were actively involved in this study by giving their consent to be interviewed. An independent parent representative contributed to the study, supporting the research team in interpreting and commenting on the appropriateness of the language used in this report.     

What happened in the ‘Move for Well-being in School’: a process evaluation of a cluster randomized physical activity intervention using the RE-AIM framework

Background

The aim of this study was to address the gap in the translation of research into practice through an extensive process evaluation of the Move for Well-being in School programme using the RE-AIM framework. The purpose was to gain insight into the extent by which the intervention was adopted and implemented as intended and to understand how educators observed its effectiveness and maintenance.

Methods

Public schools located in seven municipalities in Denmark were invited to enroll their 4th to 6th grade classes in the project. Of these, 24 school decided to participate in the project in the school-year 2015–16 and were randomly (cluster) allocated to either intervention or control group. A process survey was completed online by school personnel at the start, at midterm, and at the end of the school year. Additionally, informal interviews and observations were conducted throughout the year.

Results

At the 12 intervention schools, a total of 148 educators were involved in the implementation of the programme over the school-year. More than nine out of ten educators integrated brain breaks in their lessons and practically all the physical education teachers used the physical education lesson plans. The educators delivered on average 4.5 brain breaks per week and up to 90% of the physical education teachers used the project lesson plans for at least half of their classes. Half of the educators initiated new recess activities.A total of 78%, 85% and 90% of the educators believed that the implemented recess, brain break and physical education components ‘to a high degree’ or ‘to some degree’ promoted the pupils’ well-being, respectively.

Conclusions

This study shows that it is possible to design a school-based PA intervention that educators largely adopt and implement. Implementation of the PA elements was stable throughout the school year and data demonstrate that educators believed in the ability of the intervention to promote well-being among the pupils. Finally, the study show that a structured intervention consisting of competence development, set goals for new practices combined with specific materials, and ongoing support, effectively reached a vast majority of all teachers in the enrolled schools with a substantial impact.

Trial registration

Date of registration: retrospectively registered on 24 April 2015 at Current Controlled Trials (DOI 0.1186/ISRCTN12496336 – named: “The role of physical activity in improving the well-being of children and youth”).

     

And they call this progress? Consequences for young people of living and working in resource-extraction communities

Communities dependent on natural resource extraction (e.g. oil/gas, mining) are routinely exposed to rhetoric that associates notions of progress (including health and social welfare) with a booming economy. These places frequently experience demographic and social disruptions associated with reliance on resource-extraction sectors (e.g. the influx of young male workers and money, increasing rates of drug/alcohol consumption, infrastructural shortfalls). However, research regarding the problematic health and social impacts associated with resource-extraction booms are markedly absent from contemporary research pertaining to high-income countries. This paper investigates how an economic boom is perceived to affect young people's health and social well-being in Fort St. John, a booming oil/gas community in British Columbia, Canada. We conducted ethnographic fieldwork (8 weeks), including in-depth interviews with 25 young people (ages 15–25) and 14 health and social service providers. Participants identified education, addictions, and housing as key areas where the negative consequences of living and working in an oil/gas community have affected them the most. The findings illustrate the fallacy of the colloquialism that ‘the only drawback to a boom is a bust’. While the issues presented have substantial public health implications, they are generated by – and can be addressed via – sectors outside public health. Partnerships between resource-extraction companies, public health, and community organizations offer innovative and feasible opportunities to address these problems.     

Determining patient and primary care delay in the diagnosis of cancer – lessons from a pilot study of patients referred for suspected cancer

Background

Migraine is considered to have a negative influence on sex life. The present study was to analyse the perceptions of importance of and satisfaction with sex life as well as the expression of interest in sex among people having migraines in a prospective follow-up mail survey in 1998 and 2003.

Methods

The random sample was stratified according to gender and age in four age groups (20–24, 30–34, 40–44, and 50–54 years). Altogether 25 898 individuals responded to the baseline and 19 626 to the follow-up questionnaire (75.8% response rate). We examined as to how the perceptions of sex life of those suffering from migraine changed during a 5-year follow-up. Conditional logistic regression was used to analyse the data of the responses on self-reported migraine in the baseline and follow-up surveys (N = 2 977, 79.2% women). Each person with migraine was assigned a gender- and age-matched control in the analysis.

Results

All three outcome variables tended to decrease in value. Importance of sex life was higher among men with migraine than among their controls. Among women migraine lessened interest in sex life.

Conclusion

Our findings suggested that migraine has a different impact on sex life among women from that among men.     

Nutrition intervention program for the management of iron‐deficiency anemia in a group of pregnant women in Jordan

The impact of a nutrition education intervention program on the prevention of iron deficiency anemia in a group of pregnant Jordanian women was evaluated. The program was based on planned meals from local food sources in combination with nutritional counseling as an alternative approach to more costly iron supplementation.

Data on dietary intake, anthropometric measures, iron status indices and nutrition knowledge were used in evaluation of program effectiveness.

The treatment group showed increased nutrition knowledge, more adequate nutrient intake, normal weight gain and better iron status than the control group, which received only usual care including limited nutrition counseling.

Results of the study indicate the feasibility of the nutrition intervention program in the management of iron‐deficiency and prevention of anemia in women from communities of low socio‐economic status.     

Compassion in healthcare – lessons from a qualitative study of the end of life care of people with dementia

Objectives

A lack of compassion in UK healthcare settings has received much recent attention. This study explores the experiences of people with dementia in the last year of life and time surrounding death and how the presence and lack of compassion, kindness and humanity influenced the experience of care.

Design

Qualitative in-depth interviews with bereaved informal carers of people with dementia.

Setting

United Kingdom.

Participants

Forty bereaved carers – 31 women and nine men – with an age range of 18–86 years and from wide socioeconomic backgrounds participated.

Main outcome measures

Experiences of carers of care for person with dementia during last year of life.

Results

The interviews highlighted differences and challenges in care settings in providing compassionate, humanistic care and the impact of the care experienced by the person with dementia during the last year of life on informal carers during the bereavement period and beyond. Excellent examples of compassionate care were experienced alongside very poor and inhumane practices.

Conclusion

The concepts of compassion, kindness and humanity in dementia care are discussed within the paper. The ability to deliver care that is compassionate, kind and humanistic exists along a continuum across care settings – examples of excellent care sit alongside examples of very poor care and the reasons for this are explored together with discussion as to how health and social care staff can be trained and supported to deliver compassionate care.