The role of National Immunization Technical Advisory Groups (NITAG) in strengthening health system governance: Lessons from three middle-income countries—Argentina,Jordan, and South Africa (2017–2018)

IntroductionToward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance.MethodsIn 2017–2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC).ResultsDocument review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation.ConclusionsSystematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.     

Children’s participative citizenship within the context of integral care and daily life

The concept of participation was reviewed as a component of children's citizenship in order to promote a programme for Integral Development. A narrative revision of the literature was carried out as well as a group discussion was organized along with the staff of an Integral Care Programme, in order to identify notions of democracy and child citizenship related to care and rearing. Some elements that favoured the child participation and some parenting skills were identified. Among the elements that must be encouraged in children are: the development of emotional, cognitive and communicative skills and promotion of decision-making; among the parent skills development included are: sensitivity and responsivity; establishing routines and participation experiences. It is important to stand out that the identified elements to promote child participation and parental competences should be adapted to every specific cultural context.     

Participation in patient self‐management programs

Objective

Participation in evidenced‐based arthritis self‐management programs (SMPs) has not been well documented. The purpose of this study was to investigate the participation rate and participant characteristics in a closed cohort of subjects in a geographic region where arthritis SMPs have been offered multiple times and continuously for 2 decades.

Methods

Data were from osteoarthritis (OA) and rheumatoid arthritis subjects participating in the Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) who resided in the San Francisco (SF) Bay area who had responded to questions about ever participating in an SMP. Differences between participants and nonparticipants were examined by t‐tests and chi‐square tests.

Results

Questions added to the Health Assessment Questionnaire were returned by 1,176 patients; 618 resided in the SF Bay area. Of the SF Bay area sample, 41.9% had participated in an SMP. Small group SMPs, which had been offered multiple times, in diverse settings, continuously over the past 2 decades, were attended by the highest proportion (28%) of participants. Characteristics of participants and nonparticipants in the SF Bay area were similar (～70 years old, 15 years of education, and the majority had OA [～72%]). However, a higher proportion of participants were white (88% versus 82%; P = 0.046) and female (82% versus 73%; P < 0.05).

Conclusion

When arthritis SMPs were offered multiple times in diverse settings and continuously over many years, >40% of the cohort was reached. More research is needed with larger samples and different geographic regions to identify participation rates in more diverse populations.     

“The experiences and needs of persons with disabilities in using paratransit services”

BackgroundPersons with disabilities do not yet experience equality with the rest of the population when using transportation. Paratransit services take over transportation for persons with disabilities when public transportation cannot be used or can only be used to a limited extent. The usefulness of these services remains limited due to financial and structural reasons.ObjectiveThis study aims to identify the experiences of persons with disabilities with paratransit in Switzerland, explores their needs and verifies facilitators and barriers to the use of paratransit services. Furthermore, perceived experiences of how barriers and facilitators of transportation influence the participation in different areas of life of these persons are examined.MethodsIn this study, we adopted a qualitative approach with four online focus group discussions and one physically present discussion group, including 31 participants overall. We collected data between July and October 2021 and analyzed the data using content analysis according to Mayring (2015).ResultsOverall, persons with disabilities experience paratransit as important and appreciated this alternative to public transportation. Specifically, the services’ need is individual for each person and depends on different facilitating factors (e.g., habits, health condition, activities, safety, accessibility, service) and barriers (e.g., costs, weather conditions).ConclusionsThe need for paratransit services is highly individual and impacts participation in different life areas. On one hand, the federalist system in Switzerland supports a local and cultural embedment, but on the other hand leads to difficulties concerning transportation beyond the close local environment and for longer distances.     

Participation in the Chronic Phase of Stroke

Abstract

Background: Participation is a multidimensional concept, consisting of an objective and a subjective dimension. Many studies have focused on determinants of only 1 dimension of participation post stroke. Objective: To describe participation (both objective and subjective) and to determine how physical and cognitive independence and subjective complaints (pain, fatigue, and mood) influence participation in community-dwelling stroke survivors in the Netherlands. Methods: The Utrecht Scale for Evaluation of Rehabilitation (USER) measures physical and cognitive independence and subjective complaints. USER-Participation measures 3 dimensions of participation: frequency (objective perspective), restrictions (subjective perspective), and satisfaction (subjective perspective). Spearman correlations and backward linear regression analyses were used to analyze associations between the 3 USER-Participation scores with demographics, stroke characteristics, physical and cognitive independence, and subjective complaints. Results: Of the 111 participants, 48.5% returned to work post stroke, but mostly for only 1 to 16 hours a week. Experienced participation restrictions were most prevalent in physical exercise, chores in/around the house, housekeeping, and outdoor activities. On average, participants were relatively satisfied with their participation, but dissatisfaction occurred in cognition, activities outdoors, and work/housekeeping. Regression analysis revealed that objective participation was determined by physical and cognitive independence, age, and education, whereas subjective participation was determined by physical and cognitive independence, fatigue, and mood. Conclusions: Most participants experienced participation problems, despite relatively good physical recovery. In addition to physical and cognitive factors, subjective complaints of persons with stroke should be addressed in the rehabilitation program.     

Disability and voting

BackgroundFor millions of people with disabilities in the United States, exercising the fundamental right to vote remains a challenge. Over the last few decades, the U.S. government has enacted several pieces of legislation to make voting accessible to individuals with disabilities.ObjectiveWe examine trends in self-reported voting rates among people with and without disabilities to uncover evidence for the effects of these policies on political participation. We also explore what policy change is necessary to encourage people with disabilities to vote by investigating whether the participation rates vary by the types of disabilities.MethodsWe analyze the Current Population Survey (CPS) data in the years of presidential elections for the period of 1980–2008.ResultsOur analysis shows that the population aged 18–64 with work-preventing disabilities has been persistently less likely to vote compared to the corresponding population without such disabilities. In addition, individuals with cognitive and mobility impairments have the lowest rates of electoral participation. The gap in the likelihood of voting in-person between people with and without disabilities is considerably larger than the gap in the likelihood of voting by-mail, regardless of the types of impairments that they have.ConclusionsThe participation gap between people with and without disabilities did not decrease over the last three decades despite the presence of federal laws that aimed at removing barriers for voting.     

In-situ at a distance? challenges and opportunities for health and place research methods in a post-COVID-19 world

In-situ methodologies, including go-along and photo-elicited interviews, are ideal for harnessing people's lived experiences of place and their meanings for health and health equity. Their immersive nature means that the COVID-19 pandemic has impacted their use. Physical distancing measures combined to anxiety over the sharing of physical space have created ethical and practical challenges to the conduct of in-person in-situ methodologies. However, in-situ methodologies are precisely needed to gain deeper understandings of people's changing relationships to place post-COVID-19. In this commentary we discuss emerging challenges, highlight questions researchers should ask before engaging in these methods in the future, and explore adaptations and alternatives to traditional in-person in-situ methodologies.     

A scoping review of public building accessibility

BackgroundThe built environment needs to be designed so that all people can participate in the activities they want and need to do. Yet, accessibility is difficult to put into practice, and accessibility issues tend to be overlooked in the building and planning processes.ObjectivesThe aim of this scoping review was to summarize the research front in the area of accessibility to public buildings. Specific aims were to identify knowledge gaps, to identify access activities in relation to environmental features and to link to predominant activities in terms of the International Classification of Functioning, Disability and Health (ICF).MethodsA literature search was performed in PubMed, PsycINFO, Inspec, Embase and Cochrane databases. Articles in English based on original empirical studies investigating accessibility of public buildings for adults aged ≥18 years with functional limitations were considered.ResultsOf the 40 articles included, ten involved study participants, while 30 only examined buildings using instruments to assess accessibility. In addition, the psychometric properties were only tested for a few of them. All articles concerned mobility and several visual limitations, while few addressed cognitive or hearing limitations. Ten main access activities were identified, from using parking/drop-off area to exiting building.ConclusionsBy using the ICF and theoretically relating the accessibility problems to activities, the results revealed that there are large knowledge gaps about accessibility to public buildings for older people and people with functional limitations and that there is a need for more methodological considerations in this area of research.     

Social participation and psychosocial outcomes of young adults with chronic physical conditions: Comparing recipients and non-recipients of disability benefits

Background

Little is known about any differences between young people with chronic physical conditions who do and do not apply for disability benefits in young adulthood for providing insights for future policy and rehabilitation care.