Capacity Of Health Care Providers Research Articles

Pricing and Capacity Design for Profit-Driven and Welfare-Driven Healthcare Providers

In choosing healthcare services, price and waiting time are two important factors that matter to patients. Price is set by healthcare providers, while waiting time is usually endogenously determined by patient choice and the healthcare provider's capacity investment. We study the pricing and capacity design for profit-driven hospitals offering two types of healthcare services—regular and premium—serving heterogeneous patients who choose from either of the two types of services. Patients make their choices based on both price and endogenously determined equilibrium waiting time. We then benchmark profit-driven hospitals to welfare-driven hospitals to reveal how the behaviors of for-profit hospitals deviate from the socially optimal outcomes in patients waiting, service capacity, and price. We find that fewer patients are treated by premium services in profit-driven hospitals, and thus profit-driven hospitals invest less in premium service capacity and charge a higher premium for premium services than welfare-driven hospitals. These inefficiency distortions exist in profit-driven hospitals primarily because they are incentivized to differentiate between the waiting times of the two types of service to induce patients to pay a higher premium for premium services. Our results also show that if the inefficiency in patient partition is corrected, profit-driven hospitals would choose the welfare-maximizing level of premium service capacity and thus achieve socially optimal results. However, we also find that regulations such as price ceiling and capacity regulation cannot fully correct the inefficiency in patient partition and capacity decisions of profit-driven hospitals. Lastly, the model is extended in several ways to ensure robustness.

Complementary and Alternative Medicine/Therapy for Tobacco Cessation in India: A Secondary Analysis of GATS-1 and 2.

India has nearly 267 million adult tobacco users, with a slowly improving quitting rate. Among the many approaches to quitting the habit, such as counseling, nicotine replacement therapy, nicotine patch or gum, and prescribed allopathic medicines. Complementary and alternative medicine/therapy (CAM), a thousand-year-old practice in India, may also prove to be a potential method in tobacco cessation; however, there is scarce literature on the extent of use of CAM among tobacco users who attempt to quit the habit. Therefore, this study attempts to examine the potential of CAM as a strategy for tobacco control in India. We undertook a secondary analysis of the data from both rounds of the Global Adult Tobacco Survey (GATS 2009 and 2016). The dependent variable included in the analysis was the use of traditional medicine as a method for quitting tobacco in three types of users-smokers, smokeless tobacco users, and dual users. The prevalence of CAM use was reported, and Chi-square test was applied to find the factors significantly associated with the use of CAM among tobacco users considering a P value of 0.05 to be statistically significant. The overall prevalence of traditional medicine use for GATS-1 was observed to be more among dual users (4%), while for GATS-2, it was highest among smokers (3%). For both rounds of the GATS survey, the use of traditional medicine was found to be higher among males, rural residents, users with no education or less than primary education, and the eastern region. CAM has a promising potential for supporting tobacco cessation provided a concerted effort is undertaken to standardize pharmacopeia and establish robust clinical evidence. In addition, there is a need to create awareness, build the capacity of healthcare providers, and foster academic-industrial research in indigenous Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) systems.

Opportunities and challenges in delivering maternal and child nutrition services through public primary health care facilities in urban Bangladesh: a qualitative inquiry

BackgroundPublic primary health facilities are an important source of nutrition services for the urban areas in Bangladesh. We aimed to understand the challenges and facilitators of delivering maternal and child nutrition services through public sector from the perspectives of the users and service providers.MethodThe study was conducted in selected public primary health care facilities and their catchment area in Dhaka city from April-July 2019. We carried out 15 free listing exercises and 43 semi-structured interviews (SSI) with pregnant women and mothers of 0–24 months old children; 6 key informant interviews (KII) with facility managers and healthcare providers; and observed service delivery in 8 health facilities.ResultsFindings reveal that public primary health facilities address some economic and cultural barriers to access such as cost and provision of female service providers for maternal and child health services but challenges such as distance, waiting time, and cleanliness remained. In terms of service provision, there were gaps in provision of anthropometric measurement and counseling, and healthcare providers had inadequate training and therefore, knowledge of nutrition. The low priority given to nutrition services during program design hampered the delivery of nutrition services provided through urban public sector health facilities.ConclusionsThere were important gaps in terms of service provision and capacity of healthcare providers, and therefore, the quality of nutrition service provided through public primary health care facilities. To maximize the coverage of quality nutrition services in the urban areas, it is important to think through the design of nutrition service delivery and allocate adequate resources to fill the material and capacity gaps.

Competence of Health Care Providers on Clinical Management of Myocardial Infarction in Selected Hospitals with Intensive Care Unit Western Kenya

Background: The capacity of healthcare providers to execute an accurate initial assessment is crucial for recognizing the urgency and treatment needs of patients and for creating baseline data from which any changes in patient status may be monitored. In Western Kenya, there is little evidence of studies carried out on the competence of healthcare providers in the clinical management of myocardial infractions thus this study's main aim was to investigate the competence of healthcare providers in the clinical management of myocardial infractions.
 Material and Methods: A cross-sectional analytical study design was used. The study population comprised a total sample of 114 healthcare providers. A structured questionnaire and observation checklist were used. Participants will be picked using a systematic sampling method for those who meet the inclusion criteria. The sample size was determined using Fisher's Method. The data collected was compiled using SPSS software version 22. The data was analyzed through the application of descriptive statistical analysis.
 Findings: Variables that positively influenced the competency are specialization (AOR: 15.1; 95% CI: 2.6 – 87.3; p = 0.002), knowledge (AOR: 5.4; 95% CI: 1.1 – 26.5; p = 0.04) and having a protocol in patient's file (AOR: 10.2; 95% CI: 0.9 – 112.6.5; p = 0.06), although the latter was marginally statistically significant. Healthcare provider's qualification (KRCHN) (AOR: 0.04; 95% CI: 0.008 – 0.219; p = 0.002), filling of the protocol (AOR: 0.03; 95% CI: 0.001 – 0.585; p = 0.02) and use of high dose heparin as opposed to the use of other thrombolytic like Metalase (AOR: 0.1; 95% CI: 0.01 – 0.63; p = 0.02) were all negatively associated with healthcare providers competency.
 Recommendation/Conclusion: The study recommends the need of specialized training and knowledge advancement for health care providers on critical care nursing. This study found marginal statistical significance between the factors that influence competence among healthcare providers on clinical management of myocardial infraction.

The design and evaluation of a training program on culturally competent psychosocial care provision for men who have sex with men in Senegal.

Men who have sex with men (MSM) experience a high degree of discrimination and marginalization in Senegal. Homophobia is pervasive in Senegalese society at the cultural, religious, and political levels. Its effects are reflected in the disproportionately high levels of depression, anxiety, and substance abuse among men who have sex with men when compared to the general population. Given the widespread stigma and the lack of structural support, healthcare providers play a critical role in reconciling the physical and psychological needs of men who have sex with men. This led to the design of a training program that aimed to improve the capacity of healthcare providers to deliver MSM-competent psychosocial care. The training was delivered virtually to 37 Senegal-based nurses and physicians. The program was quantitatively and qualitatively evaluated using pre- and post-testing. The findings demonstrate a general post-training increase in knowledge acquisition (9. 23%, p-value = 0.0021) and a 6.39% reduction in homophobia, which was statistically significant (p = 0.0376); with male providers outperforming female providers, and physicians outperforming nurses. This demonstrates the effectiveness and applicability of the program to support the psychosocial needs of men who have sex with men, and its capacity for future and broader implementation among healthcare providers.

Knowledge and Attitudes about Mother-to-Child Transmission of the Human Immunodeficiency Virus in a Context of Social Vulnerability: The Case of the Province of Essaouira, Morocco.

Despite health education efforts, pregnant women still face major health problems.The aim of this study was to assess the knowledge and attitudes of pregnant women on measures to prevent mother-to-child transmission of the human immunodeficiency virus in a context of social vulnerability. This is a cross-sectional survey of 384 pregnant women randomly selected from the 20 health districts in the province of Essaouira. This study was carried out from January 2022 to June 2022. A questionnaire was used, and bivariable logistic regression analyses were done to identify factors associated with knowledge and attitudes of pregnant women about mother-to-child transmission of the human immunodeficiency virus. Low knowledge (75.8%) and negative attitudes (72.7%) about preventing mother-to-child transmission of HIV were observed in study participants. The knowledge and attitudes of pregnant women about the prevention of mother-to-child transmission of HIV varied by education level, number of children, and source of information. There was a very significant correlation between knowledge and attitude (p=0.000). A significant number of pregnant women have incomplete knowledge and attitudes about preventing mother-to-child transmission of HIV. Actions to increase the knowledge of pregnant women are essential. The capacity of healthcare providers should also be strengthened to improve the quality of care.

Health Care Providers’ Perceptions of Human Trafficking on the U.S. Frontier: Contextualizing Future Steps

ABSTRACT This study explored health care providers’ perceptions of human trafficking in the frontier U.S. state of Wyoming. There were 235 professionals who responded to open-ended questions aimed at illuminating barriers and supports for enhancing the capacity of health care providers to identify and respond to human trafficking while situating that response in the unique rural and frontier settings of the Western United States. Six themes emerged: education and training needs; identification tools; community- and system-level supports; unique sociocultural contexts; challenges of the frontier setting; and collaboration with the two Tribal nations that share a reservation. The findings shed light, through the lens of provider perceptions, on community attitudes toward human trafficking and victims/survivors; the impact of the state’s frontier status; and potential pathways forward for health care providers. This study also provides important contextual considerations pertaining to opinions on the role of the state. Such knowledge is critical to policymaking that promotes human rights broadly and UN Sustainable Development Goals 5 and 16: respectively, the achievement of gender equality and the empowerment of women and girls and the promotion to just and inclusive societies. The findings of this study highlight the importance of confronting persistent victim-blaming as well as the marginalization of Indigenous people in the state if future efforts are to be empowering and inclusive for all.

Development and implementation of clinical mentorship in Rwanda: successes and challenges

Rwanda has prioritized the decentralization and integration of HIV services over the past decade to ensure universal access to HIV services throughout the nation. Improving the capacity of healthcare providers to provide high-quality HIV prevention and treatment services was a crucial component of this process. In partnership with the authors, Rwanda’s national health implementation agency developed a national clinical mentorship program from 2011 to 2017 to facilitate this transition. The Rwanda Clinical Mentorship Model aims to effectively manage HIV-infected patients across all levels of healthcare delivery, implement task shifting, and adhere to national guidelines. The clinical care of HIV-positive individuals was transferred from HIV specialists to family physicians and nurses. The facility team was trained, supervised, and mentored by a multidisciplinary team. Mentorship consisted of routine site visits during which clinical case reviews, clinical supervision teaching, and data reviews were conducted to assess the facility’s performance and identify obstacles. Between 2012 and 2020, 5,774 healthcare professionals across the country received HIV testing and treatment training. This clinical mentoring has demonstrated a pragmatic, data-driven, and enduring strategy for enhancing clinical practice at all levels of care. A dedicated cadre of mentors is required to ensure the coordination and sustainability of this approach, according to one finding. The authors participated in accelerating the geographic and scope expansion of clinical mentoring in Rwanda. Developing a sustainable HIV clinical mentorship program in Rwanda requires longterm partnerships and evolving technical assistance.

“After all, we are all sick”: multi-stakeholder understanding of stigma associated with integrated management of HIV, diabetes and hypertension at selected government clinics in Uganda

BackgroundIntegrated care is increasingly used to manage chronic conditions. In Uganda, the integration of HIV, diabetes and hypertension care has been piloted, to leverage the advantages of well facilitated and established HIV health care provision structures. This qualitative study aimed to explore HIV stigma dynamics whilst investigating multi-stakeholder perceptions and experiences of providing and receiving integrated management of HIV, diabetes and hypertension at selected government clinics in Central Uganda. MethodsWe adopted a qualitative-observational design. Participants were purposively selected. In-depth interviews were conducted with patients and with health care providers, clinical researchers, policy makers, and representatives from international nongovernmental organizations (NGOs). Focus group discussions were conducted with community members and leaders. Clinical procedures in the integrated care clinic were observed. Data were managed using Nvivo 12 and analyzed thematically.ResultsTriangulated findings revealed diverse multi-stakeholder perceptions around HIV related stigma. Integrated care reduced the frequency with which patients with combinations of HIV, diabetes, hypertension visited health facilities, reduced the associated treatment costs, increased interpersonal relationships among patients and healthcare providers, and increased the capacity of health care providers to manage multiple chronic conditions. Integration reduced stigma through creating opportunities for health education, which allayed patient fears and increased their resolve to enroll for and adhere to treatment. Patients also had an opportunity to offer and receive psycho-social support and coupled with the support they received from healthcare worker. This strengthened patient-patient and provider-patient relationships, which are building blocks of service integration and of HIV stigma reduction. Although the model significantly reduced stigma, it did not eradicate service level challenges and societal discrimination among HIV patients.ConclusionThe study reveals that, in a low resource setting like Uganda, integration of HIV, diabetes and hypertension care can improve patient experiences of care for multiple chronic conditions, and that integrated clinics may reduce HIV related stigma.

Strengthening the capacity of healthcare providers to administer intermittent preventive therapy for malaria in pregnancy in Nigeria using a quality improvement strategy.

Intermittent Preventive Therapy using Sulfadoxine Pyrimethamine (IPTp-SP) is a malaria control strategy to reduce cases of malaria in pregnancy in endemic countries. However, the administration of the recommended three doses of Intermittent Preventive Therapy (IPTp) throughout the stages of pregnancy still remains low in Nigeria. Limited knowledge by health workers on the administration of the recommended doses of IPTp to pregnant women receiving antenatal care (ANC) services is partly responsible for this gap. This study applied Quality Improvement (QI) approach to improve knowledge and practice among healthcare providers with respect to the administration of IPTp-SP. A quasi-experimental study design was carried out to evaluate the effect of QI approach consisting of training and coaching of healthcare providers to improve the administration of IPTp during ANC services. Primary Healthcare Centre Samaru was purposively selected and 11 healthcare providers participated in the study. The total duration of the intervention was for a period of 4weeks which comprises of four training sessions conducted over a period of 2weeks and four coaching sessions conducted for a period of another 2weeks. The training package involved the use of the Information, Education and Communication approach of healthcare providers on IPTp administration while the coaching package involved supervision and follow-up meetings guiding healthcare providers on the protocol of IPTp administration. Antenatal care daily register was reviewed pre-intervention, intervention and post-intervention period of the study. Data were analysed using line graphs and run charts. A total of 36 ANC visit weeks were observed between 21 November 2016 and 27 July 2017. There was overestimation of first dose of IPTp (IPTp1) as 8 of the 16Weeks in the pre-intervention period had more than 100% of eligible women administered IPTp1. There was evidence indicating the process of IPTp1 was relatively stable post-intervention as the data crosses the median line only six times that is, 7 runs. This indicates that the process of IPTp1 was within normal variation over the post-intervention period. The patterns of IPTp2+ administrations shows the levels of IPTp2+ administration were erratic. There was an upward shift showing immediate improvement of the administration of IPTp2+ post-intervention. The integrated training and coaching intervention approach improved the administration of the recommended three doses of IPTp within the context of a Primary Healthcare Centre. The data quality of the ANC daily register improved post-intervention.

Perspectives of older adults, caregivers, healthcare providers on frailty screening in primary care: a systematic review and qualitative meta-synthesis

BackgroundScreening is often recommended as a first step in frailty management. Many guidelines call to implicate frailty screening into practice in the primary care setting. However, few countries or organizations implement it. Understanding and clarifying the stakeholders’ views and issues faced by the implementation is essential to the successful implementation of frailty screening. However, the systematic review on stakeholders’ views of frailty screening in primary care is decidedly limited. Our objective was to explore the perspective of older adults, caregivers, and healthcare providers on frailty screening and determine the enablers and barriers to implementing frailty screening in primary care.MethodsA systematic search of six databases and other resources was conducted following JBI’s three-step search strategy. The search resulted in 7362 articles, of which 97 were identified for further assessment according to the inclusion criteria. After the full-text screening, quality assessment and data extraction were carried out using the tools from Joanna Briggs Institute (JBI). Moreover, reviewers used the approach of meta-aggregative of JBI to analyze data and synthesis the findings.ResultsSix studies were included. A total of 63 findings were aggregated into 12 categories and then further grouped into three synthesized findings:1) capacity of healthcare providers and older adults; 2) opportunity in the implementation of frailty screening; 3) motivation in the implementation of frailty screening. These themes can help identify what influences the implementation of screening from the perspective of stakeholders.ConclusionsThis meta-synthesis provides evidence on the barriers and enablers of frailty screening in primary care, from the aspects of psychological, physical, social, material, etc. However, stakeholder perspectives of frailty screening have not been adequately studied. More research and efforts are needed to explore the influencing factors and address the existing barriers.

Effectiveness of alternative prenatal genetic counselling methods in a cohort of pregnant women from a low socio-economic population.

There are concerns about the capacity of healthcare providers to adequately counsel women on the implications of noninvasive prenatal screening (NIPS). Studies suggest that more resource-efficient counselling methods are needed for broad adoption. We prospectively examined the effectiveness of alternative methods of prenatal counselling on a patient's knowledge and understanding of prenatal testing choices, with a focus on NIPS. We also evaluated prenatal test choice and emotional well-being after making this decision. Women from a low socio-economic population were offered NIPS at no additional cost along with typical prenatal screening and diagnosis. Study participants underwent prenatal counselling via a web-based video consultation or a telephone consultation with a genetic counsellor. Participants were asked to complete pre-counselling and post-counselling questionnaires. Of 1000 women enrolled, 600 completed both surveys in full and were included in the analysis. Of these, 354 (59%) underwent counselling via a telephone consultation and 246 (41%) via the web-based video consultation. Both counselling methods led to a significant increase in patient knowledge (P < 0.01). NIPS uptake was equivalent between groups. Patients expressed a high level (90%) of satisfaction with their prenatal screen choice, with no significant difference (P > 0.10) between telephone and web participants. Alternative methods of counselling such as a web-based education portal can be highly effective and should be considered to enable informed decision-making prior to undergoing prenatal screening such as NIPS. Further, web-based education tools could be beneficial for those in rural areas with limited access to healthcare providers and non-native speakers.

Enhancing Healthcare Workers’ Capacity in Cancer and Other Non-Communicable Diseases (NCDs) Care in Sub-Saharan Africa (SSA) Through e-Health Innovations: A Case of International Cancer Institute (ICI), Eldoret, Kenya

PURPOSE Sub-Saharan Africa (SSA) hosts 11% of the world’s population yet bears 24% of the global disease burden with only 3% of the world’s health workforce at the frontline. The new threat of NCDs is worsened by the challenge of infrastructure, access to care and health workforce capacity. E-health bridges the gap of formal education and training through telemedicine and virtual e-learning platforms. METHODS International Cancer Institute (ICI) leveraged on telemedicine to build capacity of Health Care Providers (HCPs) in the COVID era. Through bi-weekly virtual multi-disciplinary tumour boards, on-line preceptorship training programs and tele-consultations between healthcare providers across Kenya and SSA, access to quality and timely cancer care was evaluated. RESULTS Between May 2020 and April 2021, ICI conducted 95 virtual multi-disciplinary tumour boards which were attended by 7,483 health care workers from 21 countries across the world, 16 from countries in SSA. ICI also conducted 27 virtual unique training programs in cancer and other NCDs care which attracted 578 participants from across the globe, 95% of which were from SSA. The training participants distribution included 77% clinical healthcare providers; 17% non-clinical health care workers and 6% allied healthcare workers. The online training platform provided the opportunity for HCPs to be trained from their locality thus bridging the gap of cost and distance to advance their training. The innovative e-learning platform has made it possible to reach more healthcare workers across SSA without the limitation of restricted classroom sessions. CONCLUSION Capacity building of HCPs in SSA in cancer and other NCDs care and control goes beyond formal training. On-going peer to peer mentorship and on-job skills training have proved to be effective in building HCP capacity in improved standard of care across the cancer and other NCDs care. Use of a multi-disciplinary approach to care while leveraging on e-health solutions contributes to positive patient outcomes in resource limited settings.

Building a country-wide Fistula Treatment Network in Kenya: results from the first six years (2014-2020)

It is estimated that one million women worldwide live with untreated fistula, a devastating injury primarily caused by prolonged obstructed labor when women do not have access to timely emergency obstetric care. Women with fistula are incontinent of urine and/or feces and often suffer severe social and psychological consequences, such as profound stigma and depression. Obstetric fistula affects economically vulnerable women and garners little attention on the global health stage. Exact figures on fistula incidence and prevalence are not known. In Kenya, results from a 2014 population-based survey suggest that 1% of reproductive-aged women have experienced fistula-like symptoms. In collaboration with key stakeholders, Fistula Foundation launched the Fistula Treatment Network (initially known as Action on Fistula) in 2014 to increase access to timely, quality fistula treatment and comprehensive post-operative care for women with fistula in Kenya. The integrated model built linkages between the community and the health system to support women through all parts of their treatment journey and to build capacity of healthcare providers and community leaders who care for these women. Fistula Foundation and its donors provided the program’s funding. Seed funding, representing about 30% of the program budget, was provided by Astellas Pharma EMEA.Over the six-year period from 2014 to 2020, the network supported 6,223 surgeries at seven hospitals, established a fistula training center, trained eleven surgeons and 424 Community Health Volunteers, conducted extensive community outreach, and contributed to the National Strategic Framework to End Female Genital Fistula. At 12 months post fistula repair, 96% of women in a community setting reported that they were not experiencing any incontinence and the proportion of women reporting normal functioning increased from 18% at baseline to 85% at twelve-months.The Fistula Treatment Network facilitated collaboration across hospital and community actors to enhance long-term outcomes for women living with fistula. This model improved awareness and reduced stigma, increased access to surgery, strengthened the fistula workforce, and facilitated post-operative follow-up and reintegration support for women. This integrated approach is an effective and replicable model for building capacity to deliver comprehensive fistula care services in other countries where the burden of fistula is high.

Immunization data quality and decision making in pertussis outbreak management in southern Ethiopia: a cross sectional study

BackgroundThe aim of this study was to investigate the quality of immunization data and monitoring systems in the Dara Malo District (Woreda) of the Gamo Administrative Zone, within the Southern Nations, Nationalities, and Peoples’ Region (SNNPR) of Ethiopia.MethodsA cross-sectional study was conducted from August 4 to September 27, 2019, in Dara Malo District. The district was purposively selected during the management of a pertussis outbreak, based on a hypothesis of ‘there is no difference in reported and recounted immunization status of children 7 to 23 months in Dara Malo District of Ethiopia’. The study used the World Health Organization (WHO) recommended Data Quality Self-Assessment (DQS) tools. The accuracy ratio was determined using data from routine Expanded Program of Immunization (EPI) and household surveys. Facility data spanning the course of 336 months were abstracted from EPI registers, tally sheets, and monthly routine reports. In addition, household surveys collected data from caretakers, immunization cards, or oral reports. Trained DQS assessors collected the data to explore the quality of monitoring systems at health posts, health centers, and at the district health office level. A quality index (QI) and proportions of completeness, timeliness, and accuracy ratio of the first and third doses of pentavalent vaccines and the first dose of measles-containing vaccines (MCV) were formulated.ResultsIn this study, facility data spanning 336 months were extracted. In addition, 595 children aged 7 to 23 months, with a response rate of 94.3% were assessed and compared for immunization status, using register and immunization cards or caretakers’ oral reports through the household survey. At the district level, the proportion of the re-counted vaccination data on EPI registers for first dose pentavalent was 95.20%, three doses of pentavalent were 104.2% and the first dose of measles was 98.6%. However, the ratio of vaccination data compared using tallies against the reports showed evidence of overreporting with 50.8%, 45.1%, and 46.5% for first pentavalent, third pentavalent, and the first dose of measles vaccinations, respectively. The completeness of the third dose of pentavalent vaccinations was 95.3%, 95.6%, and 100.0% at health posts, health centers, and the district health office, respectively. The timeliness of the immunization reports was 56.5% and 64.6% at health posts and health centers, respectively, while the district health office does not have timely submitted on time to the next higher level for twelve months. The QI scores ranged between 61.0% and 80.5% for all five categories, namely, 73.0% for recording, 71.4% for archiving and reporting, 70.4% for demographic information, 69.7% for core outputs, and 70.4% for data use and were assessed as suboptimal at all levels. The district health office had an emergency preparedness plan. However, pertussis was not on the list of anticipated outbreaks.ConclusionImmunization data completeness was found to be optimal. However, in the study area, the accuracy, consistency, timeliness, and quality of the monitoring system were found to be suboptimal. Therefore, poor data quality has led to incorrect decision making during the reported pertussis outbreak management. Availing essential supplies, including tally sheets, monitoring charts, and stock management tools, should be prioritized in Daro Malo District. Enhancing the capacity of healthcare providers on planning, recording, archiving, and reporting, analyzing, and using immunization data for evidence-based decision making is recommended. Improving the availability of recording and reporting tools is also likely to enhance the data accuracy and completeness of the community health information system. Adapting pertussis outbreak management guidelines and conducting regular data quality assessments with knowledge sharing events to all stakeholders is recommended.

Analyzing the Implementation of Policies and Guidelines for the Prevention and Management of Type 2 Diabetes at Primary Health Care Level in Nepal.

BackgroundNepal, in recent years, is witnessing an increasing problem of type 2 diabetes that has resulted significant premature deaths and disability. Prevention and management of non-communicable diseases (NCDs) including diabetes have been prioritized in the national policies and guidelines of the Nepal Government. However, research looking at the overview of the implementation of the existing policies and guidelines for diabetes prevention and control is scarce. Hence, this study reviewed diabetes related existing policies and its implementation process at the primary health care level in Nepal.MethodsThis study involved two phases: Phase I: situation analyses through review of documents and Phase II: qualitative exploratory study. In phase I, four databases (Medline, Web of Science, Embase and PubMed) were systematically searched using key search terms related to diabetes care and policies between January 2000 and June 2021. Also, relevant gray literature was reviewed to understand the trajectory of policy development and its translation with regards to diabetes prevention and management at primary health care level in Nepal. Following the phase I, we conducted in-depth interviews (IDI) and key informant interviews (KII) with health care providers, policy makers, and managers (IDI = 13, and KII = 7) at peripheral and central levels in Kavrepalanchowk and Nuwakot districts of Nepal. The in-depth interviews were audio recorded, transcribed, and coded. The triangulation of data from document review and interviews was done and presented in themes.ResultsFour key themes were identified through triangulating findings from the document review and interviews including (i) limited implementation of policies into practices; (ii) lack of coordination among the different levels of service providers; (iii) lack of trained human resources for health and inadequate quality services at the primary health care level, and (iv) inadequate access and utilization of diabetes care services at primary health care level. Specifically, this study identified some key pertinent challenges to the implementation of policies and programs including inadequate resources, limited engagement of stakeholders in service design and delivery, lack of trained health care providers, lack of financial resources to strengthen peripheral health services, fragmented health governance, and weak reporting and monitoring systems.ConclusionThis study revealed that the policies, plans, and strategies for prevention and management of NCDs in Nepal recognized the importance of diabetes prevention and control. However, a major gap remains with adequate and lack of clarity in terms of implementation of available policies, plans, strategies, and programs to address the problem of diabetes. We suggest the need for multisectoral approach (engaging both health and non-health sectors) at central as well as peripheral levels to strengthen the policies implementation process, building capacity of health care providers, ensuring adequate financial and non-financial resources, and improving quality of services at primary health care levels.

Advancing Patient-Centered Cancer Survivorship Care: Evaluation of a Dissemination Project.

Care coordination among primary care providers and oncologists continues to be a challenge in cancer survivorship care. The Advancing Patient-Centered Cancer Survivorship Care Toolkit ("Toolkit") was developed to provide a "workshop in a box" for comprehensive cancer control (CCC) stakeholders to advance patient-centered cancer survivorship care in their region. The Toolkit was disseminated through an e-learning module, established webpages, an online forum, and social media. Toolkit dissemination was evaluated using the RE-AIM framework. For effectiveness, e-learning module and workshop participants were surveyed to assess changes in confidence in learning objectives. The Toolkit Web page received over 10,000 impressions. E-learning module participants (n = 212) reported statistically significant improvement (p < 0.001) between the pre- (M = 3.42, SD = 0.85) and post-test (M = 4.18, SD = 0.60) mean scores on self-confidence to describe patient-reported priorities for cancer survivorship care. Among virtual workshop trainees (n = 121), 28 participants completed paired pre- and post-workshop surveys. Among those with matched responses, there were statistically significant improvements from pre- to post-workshop self-reported knowledge on what patients want in cancer survivorship care (M = 2.5, SD = 1.0, vs. M = 3.3, SD = 1.0; p = 0.001); confidence in describing critical components of patient-centered cancer survivorship care (M = 3.1, SD = 1.2, vs. M = 4.2, SD = 0.5; p < 0.001); and confidence in describing patient priorities for cancer survivorship care (M = 3.0, SD = 1.1, vs. M = 4.1, SD = 0.6; p < 0.001). Provision of technical assistance resources in a variety of formats can successfully build capacity of healthcare providers and comprehensive cancer coalition stakeholders to feel more prepared to deliver patient-centered, coordinated cancer survivorship care.

A qualitative study of online information-seeking preferences among cancer survivors.

PurposeAs the cancer survivor population increases, diminished health care provider capacity will place more responsibility on survivors to obtain health information. Many survivors search for cancer information online, yet there is a dearth of research on how survivors obtain and engage with this information. This study examined cancer survivors’ information-seeking behaviors and perceptions during a self-guided online search task.MethodsTen adult cancer survivors (largely breast and thyroid) completed a task in which they searched for online cancer-related information of their choice. Participants were asked to verbally narrate the procedural aspects of the task and provide real-time responses to the search results and experiences related to the task. Transcripts were analyzed using a qualitative descriptive approach, and codes and themes were examined and interpreted.ResultsParticipants searched primarily for information specific to their cancer type and stage, seeking personalized information about risk factors, prognosis, and treatments. Additionally, participants reported having to engage in excessive navigation to find relevant cancer information, citing aesthetic, usability, and credibility features of the websites that they considered barriers to obtaining this information.ConclusionsSurvivors’ online health information needs require streamlined cancer information resources that are disaggregated by cancer type, stage, and treatment course and located on websites with aesthetic and usability features that facilitate expedient searches for personally relevant cancer information.Implications for Cancer SurvivorsThis study provides useful perspectives of cancer survivors that may inform the development of online cancer resources to better serve this population.

Health-seeking and diagnosis delay and its associated factors: a case study on COVID-19 infections in Shaanxi Province, China

This time-to-event study examines social factors associated with health-seeking and diagnosis of 165 COVID-19 cases in response to the pandemic spread in Shaanxi Province, China. In particular, we investigate the differential access to healthcare in terms of delayed time from symptom onset to first medical visit and subsequently to diagnosis by factors such as sex, age, travel history, and type of healthcare utilization. We show that it takes more time for patients older than 60 (against those under 30) to seek healthcare after developing symptoms (+ 2.5 days, p<0.01), surveillance on people with living or travel history to Wuhan helps shorten the time to the first doctor visit (− 0.8 days) and diagnosis (− 2.2 days, p<0.01). A delay cut is associated with the adoption of intermediary and large hospitals rather than community-based care as primary care choices (− 1.6 days, p<0.1 and − 2.2 days, p<0.05). One unit increase of healthcare workers per 1000 people saves patients 0.5 days (p<0.1) for diagnosis from the first doctor visit and 0.6 days (p<0.05) in total. Our analysis of factors associated with the time delay for diagnosis may provide a better understanding of the health-seeking behaviors of patients and the diagnosis capacity of healthcare providers during the COVID-19 pandemic.

A blockchain empowered and privacy preserving digital contact tracing platform

The spread of the COVID-19 virus continues to increase fatality rates and exhaust the capacity of healthcare providers. Efforts to prevent transmission of the virus among humans remains a high priority. The current efforts to quarantine involve social distancing, monitoring and tracking the infected patients. However, the spread of the virus is too rapid to be contained only by manual and inefficient human contact tracing activities. To address this challenge, we have developed Connect, a blockchain empowered digital contact tracing platform that can leverage information on positive cases and notify people in their immediate proximity which would thereby reduce the rate at which the infection could spread. This would particularly be effective if sufficient people use the platform and benefit from the targeted recommendations. The recommendations would be made in a privacy-preserving fashion and contain the spread of the virus without the need for an extended period of potential lockdown.Connect is an identity wallet platform which will keep user digital identities and user activity trace data on a blockchain platform using Self-Sovereign Identity(SSI) proofs. User activities include the places he/she has travelled, the country of origin he/she came from, travel and dispatch updates from the airport etc. With these activity trace records, Connect platform can easily identify suspected patients who may be infected with the COVID-19 virus and take precautions before spreading it. By storing digital identities and activity trace records on blockchain-based SSI platform, Connect addresses the common issues in centralized cloud-based storage platforms (e.g. lack of data immutability, lack of traceability).