What should we teach about disability? National consensus on disability competencies for health care education

BackgroundHealth care providers are unprepared to meet the health needs of patients who have disabilities. Disability training is needed, yet there is little agreement about what should be taught.ObjectiveEstablish a national consensus on what healthcare providers across disciplines need to know to provide quality care to patients with all types of disabilities (e.g., mobility, sensory, developmental, mental health).MethodsPeople with disabilities, disability advocates, family members of people with disabilities, disability and health professionals, and inter-disciplinary health educators systematically evaluated and provided feedback on a draft set of disability competencies. Based on this feedback, competencies were iteratively refined.ResultsAfter two waves of feedback, six competencies, 49 sub-competencies, and 10 principles and values emerged that addressed topics such as respect, person-centered care, and awareness of physical, attitudinal, and communication health care barriers. An overwhelming majority (89%) agreed or strongly agreed that the disability competencies reflected the core understandings needed to provide quality care for patients with disabilities, were relevant across disability types (85%), and across health care disciplines (96%). Averaging evaluative feedback across competencies, participants reported that the competencies were important (98%) and clear (96%).ConclusionsThis consensus on what to teach is an important milestone in preparing a disability competent health care workforce. Future directions for research, training, and policy are discussed. When disability is included in health care education, the health care workforce will be prepared to deliver accessible, patient-centered, quality health care to patients with disabilities.     

Messenger students’ engagement scale: Community perspectives on school-based malaria education in Ethiopia

A two-year school-based malaria education intervention was developed to engage students as implementers in malaria prevention and control in the Oromia region, Ethiopia. The current study aimed to validate messenger students’ engagement scale (MSES) in malaria education. The scale development process was done stepwise. Multiple behavioural theories were examined to derive possible domains of engagement. Next, a pool of items was developed by linking the domains with malaria target behaviours. The items critically reviewed, pretested and refined for clarity and appropriateness. A cross-sectional survey of 451 sample households with school-going children was conducted in five districts of the Jimma-Zone in March-2019. Exploratory factor analysis (EFA)/principal component analysis (PCA) was executed to evaluate the construct validity of the scale. Rotated factor loading coefficients of ≥0.4 were retained. Items loaded on multiple factors were retained on the factor with a higher loading score. Cronbach's alpha of 0.7 was used as the cutoff point for reliability. Discriminative validity was declared based on Pearson correlation (between the extracted factors) coefficients that were moderate (r < 0.7), and less than the respective variance explained (VE) by each factor. The validity of convergence of domains with the overall MSES assessed (0.4 < r < 0.9). Logistic regression for key malaria preventive practices was conducted to assess predictive validity. The study explored a 24-item MSES in six domains of malaria education: reminding, supporting, monitoring, messenger credibility, role modelling and norm setting. The domains explained 67.82% variance of MSES, with a reliability of 93.3%. The factors were convergent with the overall scale (r = 0.764–0.834). Most factors were discriminative, with moderate correlation to each other. Adjusted odds ratios showed engaging credible students in reminding malaria preventive messages and modelling practices predicted exposure to message, insecticide-treated net (ITN) utilisation and cleaning surrounding. The current MSES is reliable, valid and predictive of malaria preventive practices.     

Everyday translation: health practitioners’ perspectives on obesity and metabolic disorders in Samoa

Research in Samoa and the diaspora has documented the nutrition transition and related rising metabolic disorders. Research suggests cultural influences, including large body size preference, sedentarism, and dietary patterns, as well as political and economic influences, including changed labor patterns and food dependence, contribute to rising metabolic disorders. This article documents how Samoan health practitioners understand barriers to lifestyle change as primarily cultural rather than structural. They highlight differences between health, framed as individually oriented, and well-being, framed as socially oriented. Drawing from participant observation and semi-structured interviews, this article shows how health practitioners engage in ‘everyday translation’ by aiming to change the meaning of food, body, and wealth. Attention to everyday translation provides insights into the ambivalent ways interviewees identify culture as a barrier to health care. They avoid blaming patients, which has the paradoxical effect of suspending blame on individuals for not changing health behavior until cultural change occurs. This requires local leadership to effect community-wide change. When culture is recognized as the primary barrier to lifestyle change, health practitioners inadvertently reproduce structural inequalities in their daily interactions with patients. This has the effect of obscuring structural influences and promoting the idea that metabolic disorders are under individual control.     

Evaluating the longitudinal impact of a disability education intervention on medical students’ attitudes towards persons with a disability

BackgroundThe attitudes and empathy levels of healthcare providers towards persons with a disability have been highlighted as important factors contributing to the quality of healthcare provided to this patient population.ObjectiveThis study aimed to investigate whether changes in medical students’ attitudes and empathy towards persons with a disability following an educational intervention were maintained when measured again one year post intervention. This study provided a one year longitudinal follow up to a previous study investigating the efficacy of an educational intervention to cultivate positive change in empathy levels and attitudes towards disability.MethodAn online survey was distributed to medical students who had completed a disability module one year previously during their second year of medical training. The survey comprised measures of attitude, empathy and level of social contact with persons with a disability.ResultsThough there was a statistically significant increase in both attitude and empathy measures immediately post intervention, these gains were not sustained when measured one year later. In the case of empathy, levels measured one year later had decreased significantly from baseline measures at pretest. No significant relationship was observed between level of social contact and measures of attitudes and empathy.ConclusionsWhile previous research suggests that the educational intervention has been successful in ameliorating both attitudes and empathy levels in the short term, this study highlights the difficulty in sustaining such improvements. Changes to the design and delivery of educational interventions may be necessary for the benefits to persist into the long term.     

Turning science into health solutions: KEMRI’s challenges as Kenya’s health product pathfinder

Background

A traditional pathway for developing new health products begins with public research institutes generating new knowledge, and ends with the private sector translating this knowledge into new ventures. But while public research institutes are key drivers of basic research in sub-Saharan Africa, the private sector is inadequately prepared to commercialize ideas that emerge from these institutes, resulting in these institutes taking on the role of product development themselves to alleviate the local disease burden. In this article, the case study method is used to analyze the experience of one such public research institute: the Kenya Medical Research Institute (KEMRI).

Discussion

Our analysis indicates that KEMRI’s product development efforts began modestly, and a manufacturing facility was constructed with a strategy for the facility’s product output which was not very successful. The intended products, HIV and Hepatitis B diagnostic kits, had a short product life cycle, and an abrupt change in regulatory requirements left KEMRI with an inactive facility. These problems were the result of poor innovation management capacity, variability in domestic markets, lack of capital to scale up technologies, and an institutional culture that lacked innovation as a priority.However, KEMRI appears to have adapted by diversifying its product line to mitigate risk and ensure continued use of its manufacturing facility. It adopted an open innovation business model which linked it with investors, research partnerships, licensing opportunities, and revenue from contract manufacturing. Other activities that KEMRI has put in place over several years to enhance product development include the establishment of a marketing division, development of an institutional IP policy, and training of its scientists on innovation management.

Summary

KEMRI faced many challenges in its attempt at health product development, including shifting markets, lack of infrastructure, inadequate financing, and weak human capital with respect to innovation. However, it overcame them through diversification, partnerships and changes in culture. The findings could have implications for other research institutes in Sub-Saharan Africa seeking to develop health products. Such institutes must analyze potential demand and uptake, yet be prepared to face the unexpected and develop appropriate risk-mitigating strategies.

     

“It is about being outside”: Canadian youth’s perspectives of good health and the environment

Drawing on qualitative data generated from an ethnographic study exploring Canadian youth’s understanding of health, this paper examines youth’s perspectives of the relationships between health and environment. Seventy-one youth (12 to 19 years of age) took part in individual and focus group interviews, as well as in photovoice interviews. Although initial discourse about health mainly focused on healthy eating and exercise, youth were more enthused and able to share their thoughts and feelings about the relationships between health and environment during the photovoice interviews. For these youth, good health was defined and visualized as “being outside” in a safe, clean, green, and livable space. Youth talked about conditions contributing to healthy environments and how healthy environments contributed to a strong sense of place. Overall, the conversations about the environment evoked many feelings in the youth. Results are discussed in the context of current research and in relation to youth, but also more broadly in relation to research on health and environment.     

Perceptions about Iranian-Kurds’ ethnic-inequality in health

Background

Evidence shows ethnic-inequality is a very effective variable in the Community and individual health associated outcomes. This study focused on gaining a deeper understanding of people’s perception on inequality of health in Iranian-Kurds and its determinants.

Methods

The study was conducted in the three cities of Marivan, Sanandaj (capital of Kurdistan province in Iran) and Tehran (capital of the country). The study was conducted through 34 in-depth interviews and ten focus group discussions with health services users, academic graduates and health delivery service personnel.

Results

Consensus on social, mental and physical health inequality did not exist within the study participants. However, there were concerns about differences in healthcare access and utilization. Several participants believed that access to health services and socio-cultural differences of Kurds affected the healthcare utilization.

Conclusions

Since, people perceived ethnic-inequality in healthcare access and utilization, ethnicity must be considered as a mandatory stratifier in monitoring health status and a concern during planning health interventions. People’s awareness, resources management and allocation are factors requiring more consideration when choosing policy options.

     

Identifying the gaps in Irish cancer care: Patient,public and providers’ perspectives

BackgroundThe University of Limerick Cancer network (ULCaN) was established in 2019 with funding from the Health Research Institute at the University of Limerick in order to build a network between individuals in academia, primary and secondary care and the general public so that cancer services can be coordinated and more effective. The aim of this paper is to outline our experience of engaging with stakeholders to identify gaps in the cancer journey locally.MethodsFour focus group discussions were conducted with patients; their carers; members of the public; and healthcare providers with 2 main aims: 1) to investigate gaps in cancer services; 2) to identify knowledge, attitudes and opportunities available to promote cancer research. The focus groups were audio recorded, transcribed and thematically analysed.Results15 themes within the topics of cancer care, palliation, communication, clinical trials, diet and exercise and public and patient involvement in research and advocacy were identified. These include directing people to reliable information and navigating misinformation and stigma linked with cancer, promoting awareness of clinical trials and palliative care services and improving communication when multiple healthcare providers are involved.ConclusionThe need to make more coherent, efficient and integrated cancer research amongst local stakeholders was evident. Embedding patients and members of the public into ULCaN is an important deliverable for collaborative research.     

Children’s perspectives on their learning: exploring methods

This paper reports on efforts to access four‐year‐old children’s perspectives on their learning experiences. Interviews with children in various contexts were carried out using photographs of recent activities to stimulate discussion and recall. Small group interviews with a researcher or teacher; one‐to‐one interviews between researcher and child; researcher interviews with target child and a friend; researcher interviews with target child and a parent; and informal conversations between a researcher and child in the context of play and activities were the varying methods used. All contexts elicited useful information on children’s perspectives, although the focus groups were difficult to manage. Photographs were an effective way of locating the conversation in the child’s experience and adults were able to provide a supportive framework to encourage children to interpret their interests and involvement in learning. Children’s perspectives are an important source of information about what engages them in learning and why.     

‘They don’t know much about us’: educational reform impacts on students’ learning in the clinical environment

Placements are an integral component of the medical, nursing, and allied health curriculum. Literature on problem-based learning indicates that curriculum change can impact student experience. However, outside of the nursing literature, there is little research on the impact of education reform on students’ experiences of placements. This paper reports on medical, midwifery and paramedic students’ perception of the impact of education reform they experienced in the clinical setting. A qualitative study using a semi-structured schedule was conducted. Data was collected using focus groups (17), individual interviews (48) and written responses (2) from undergraduate students (103) and graduates (27) from a tertiary institution in Victoria, Australia. Recorded interviews were analysed, coded and categorised into themes. Whilst students indicated they were prepared for the impact of educational reform on their placement experience, they perceived that clinical educators responsible for teaching them were less prepared. Three themes were identified from the data: clinical educator’s lack of familiarity with new curriculum, clinical educator’s negative attitudes to curricular change and looking to the future. Our study advances the understanding of the implications of education reform during the clinical placement of medical, midwifery, and paramedic students. Whilst important lessons can be learned from the medical and nursing literature this study highlights that staff responsible for curriculum change need to action change management process to ensure that the clinical educators are able to deliver the revised program.     

What does ‘disability’ mean for medical students? An exploration of the words medical students associate with the term ‘disability’

CONTEXT: Disability teaching is a core theme in undergraduate medical education. Medical students bring a range of experiences of disability to their medical training. AIM: The principal aim of this study was to explore the words that medical students associate with the term "disability" and to consider how the resulting information could inform teaching. A secondary aim was to see if a short disability course changed the word associations. METHODS: Students were asked to write down 2 words that came to mind when they heard the word "disability", before and after a 4-day course in disability. Words from 4 cohorts were analysed by frequency and the following word dichotomies: visual icons/personal attributes; loss/enabling, and medical model/social model. A random sample of students took part in focus groups at the beginning and end of the course. RESULTS: A total of 381 students provided 667 before-course words and 189 students provided 336 after-course words. Before the course, words denoting visual icons of disability, and loss were prominent, accounting for 85% of the words, and 74% of the words describing personal attributes were negative. Focus group responses at this stage reflected an eagerness to help but patronising terms were prominent, along with concern about political correctness. Students also expressed nervousness about encountering disabled people. In response, teaching was adapted to make it more learner-focused, to offer a safe environment in which students can test out their language, to build on the positive associations and to develop a range of pre-course creative activities with disabled people. After the course a considerable and significant shift in emphasis was observed, with a reduction in the use of visual icon words, an increase in words denoting enablement, and an increase in words relating to the social model of disability and to positive personal attributes (P < 0.001). Focus group participants at this stage reported greater confidence in approaching disabled people but continued to question political correctness. CONCLUSIONS: Medical students associate disability predominantly with depersonalised or negative words. A short disability course appears to change these associations. Reasons for this and implications for teaching are discussed.     

Educating adolescents about puberty: what are we missing?

Adolescents undergo significant physical and cognitive changes during their pubertal development. These changes contribute to and impact their future development. Educating adolescents at an early age about their expected development decreases the possible anxiety associated with this period of life and also helps adolescents make better choices in regards to their sexuality. In order to assess the degree of education regarding pubertal development and sexuality, we conducted a survey of late adolescents (Median age 19 years) and parents of adolescents. A total of 409 adolescents (237 females, 172 males) and 124 parents completed the survey. 14.4% of teens (36.6% of males and 2% of females) reported that no one spoke to them prior or during puberty about pubertal development or sexuality issues. Teens receiving some form of puberty/sexuality education did so at a median age of 13 for girls and 15 for boys. More than one source of information was the most common (49%) followed by mother only (20%). 85% of parents reported talking to their teens about pubertal development and sexuality. There were several differences between areas reported covered by parents but not by teens, for example 72% of parents reported talking to their teens about gender differences in growth but only 31% of teens reported being spoken to about that. Areas that are very poorly covered are breast development in boys and sexual assault/date rape in girls at 5% and 26% respectively. In summary, it appears that we continue to do a relatively poor job in educating our kids about their development and sexuality and we do it late. Boys are even less likely than girls to be talked to about many areas of pubertal development and sexuality and when that is done, it is done at a later age.     

Prisoners’ perspectives on the transition from the prison to the community: implications for settings-based health promotion

Through qualitative exploration with soon-to-be released men in three prisons in England, this article examines the difficulties that prisoners envisage on returning back to community settings, entering other settings such as workplaces, and the implications the transition may have for their health. Interviews and focus groups were conducted with 36 prisoners, some of whom were convicted of sexual offences and based on a vulnerable prisoner unit. While not all prisoners offered the information, approximately two-thirds of the sample had offended previously. The transition that individuals make from the prison setting to the community can be potentially complex and often detrimental to health. Accommodation issues were forecast as a major concern for those men without family ties. Temporarily residing with friends or living in hostel residences were viable options for many prisoners, but both had drawbacks which could increase the probability of engaging in substance misuse. Resettlement issues were perceived to be more difficult for sex-offenders; their ‘identity’ provided an additional burden which created further reintegration difficulties. Employment opportunities, for example, were predicted to be drastically reduced as the men had signed the sex-offenders’ register. This article suggests that opportunities for successful transition could be enhanced by a more ‘joined-up’ settings perspective and proposes that a settings-based approach to health promotion, which emphasises the synergy between social settings and addressing wider determinants of health, should be applied to prisons to reduce, rather than exacerbate, inequalities.     

Public school teachers’ perceptions about mental health

OBJECTIVE

To examine public school teachers’ perceptions about general health and mental health, and the way in which they obtained this information.

METHODS

Qualitative research was conducted with 31 primary and secondary school teachers at a state school in the municipality of Sao Paulo, SP, Southeastern Brazil, in 2010. The teachers responded to a questionnaire containing open-ended questions about mental health and general health. The following aspects were evaluated: Teachers’ understanding of the terms “health and “mental health,” the relevance of the need for information on the subject, the method preferred for obtaining information, their experience with different media regarding such matters, and perceptions about the extent to which this available information is sufficient to support their practice. The data were processed using the Qualiquantisoft software and analyzed according to the Discourse of the Collective Subject technique.

RESULTS

From the teachers’ perspective, general health is defined as the proper physiological functioning of the body and mental health is related to the balance between mind and body, as a requirement for happiness. Most of the teachers (80.6%) showed great interest in acquiring knowledge about mental health and receiving educational materials on the subject. For these teachers, the lack of information creates insecurity and complicates the management of everyday situations involving mental disorders. For 61.3% of the teachers, television is the medium that provides the most information on the topic.

CONCLUSIONS

The data indicate that there is little information available on mental health for teachers, showing that strategies need to be developed to promote mental health in schools.