Community Health Care Providers Research Articles

Little time, lasting impact: Bereaved caregiver perceptions of legacy in perinatal and infant loss.

Legacy interventions are standard in most children's hospitals, but little is known about how bereaved parents understand and describe the concept of legacy that these interventions are designed to Address. The aim of this qualitative study was to understand the legacy experiences and perceptions of parents who have experienced perinatal or early infant (less than three months of age) loss. Grounded in constructionist epistemology and phenomenological qualitative traditions, ten bereaved parents completed an in-depth phenomenological interview regarding their perceptions of and experiences with the legacy of their deceased child. Interviews were transcribed verbatim and analyzed using an open, inductive coding process to illuminate the essence of participants' experiences. Three themes were identified: 1) legacies are composed of memories and experiences that have a lasting effect on others; 2) healthcare experiences both generate and participate in infants' legacies; and 3) parents' legacy perceptions are shaped by cultural conceptions, spiritual beliefs, and grief experiences. Parents described experiences and interactions with community members and healthcare providers that honored or challenged their perceptions of their child's unique legacy. In the context of perinatal or early infant loss, bereaved parents describe legacy as enduring, unique to each child and family, and heavily influenced by healthcare experiences and staff relationships. Parent-led, legacy-oriented interventions are needed in maternal/fetal, labor/delivery, and neonatal intensive care settings to support parent coping with loss.

Health literacy training program for community healthcare providers using hybrid online team-based learning in Taiwan

BackgroundHealth literacy (HL) has proven to be a determining factor influencing the health of individuals. Community health providers (CHPs) work on the front line of improving public HL. Increasing their understanding of HL and their ability to incorporate HL into healthcare can reduce obstacles in healthcare services. This study evaluated the effectiveness of an HL training program for CHP by using the hybrid online team-based learning (TBL) model.MethodsA quasi-experimental study and focused group interviews were conducted. We developed a six weeks HL online course for CHPs. The program included teaching videos for pre-class preparation, a 90-min online TBL model, and a case discussion in the last two weeks. Team application activities were designed for each class to enhance knowledge application. A total of 81 CHPs from 20 public health centers took the course and provided complete data for analysis. Learning effectiveness was evaluated based on the familiarity, attitude, and confidence in implementing HL practices, course satisfaction, and participants’ learning experiences.ResultsThe comparison showed that the participants’ familiarity with HL (4.29 ± 1.76 vs 6.92 ± 1.52, p < .001), attitude (7.39 ± 1.88 vs 8.10 ± 1.44, p = .004), and confidence in implementing HL practices (6.22 ± 1.48 vs 7.61 ± 1.34, p < .001) increased after the course. The average satisfaction with the teaching strategies was 4.06 ± .53 points, the average helpfulness to practice was 4.13 ± .55 points, and the overall feedback on satisfaction with learning was 4.06 ± .58 points (the full score was 5 points). According to the learning experience of the 20 participants in the focus group discussion, the experiences of teaching strategies and the learning experiences of the HL course were summed up into two categories, seven themes, and 13 subthemes. The results showed a positive experience with the hybrid online TBL program.ConclusionThe use of hybrid online TBL model is a feasible and valid approach for the HL training of CHPs. The result can serve as a reference for the on-the-job training of various healthcare workers.

A qualitative study of how stigma influences HIV services for transgender men and women in Nigeria.

IntroductionTransgender men and women in Nigeria experience many barriers in accessing HIV prevention and treatment services, particularly given the environment of transphobia (including harassment, violence and discrimination) and punitive laws in the country. HIV epidemic control in Nigeria requires improving access to and quality of HIV services for key populations at high risk, including transgender men and women. We assessed how stigma influences HIV services for transgender people in Lagos, Nigeria.MethodsIn‐depth interviews (IDIs) and focus group discussions were conducted with transgender men (n = 13) and transgender women (n = 25); IDIs were conducted with community service organization (CSO) staff (n = 8) and healthcare providers from CSO clinics and public health facilities (n = 10) working with the transgender population in March 2021 in Lagos. Content analysis was used to identify how stigma influences transgender people's experiences with HIV services.Results and discussionThree main findings emerged. First, gender identity disclosure is challenging due to anticipated stigma experienced by transgender persons and fear of legal repercussions. Fear of being turned in to authorities was a major barrier to disclose to providers in facilities not affiliated with a transgender‐inclusive clinic. Providers also reported difficulty in eliciting information about the client's gender identity. Second, respondents reported lack of sensitivity among providers about gender identity and conflation of transgender men with lesbian women and transgender women with being gay or men who have sex with men, the latter being more of a common occurrence. Transgender participants also reported feeling disrespected when providers were not sensitive to their pronoun of preference. Third, HIV services that are not transgender‐inclusive and gender‐affirming can reinforce stigma. Both transgender men and women spoke about experiencing stigma and being refused HIV services, especially in mainstream public health facilities, as opposed to transgender‐inclusive CSO clinics.ConclusionsThis study highlights how stigma impedes access to appropriate HIV services for transgender men and women, which can have a negative impact along the HIV care continuum. There is a need for transgender‐inclusive HIV services and competency trainings for healthcare providers so that transgender clients can receive appropriate and gender‐affirming HIV services.

"Let's Be a Person to Person and Have a Genuine Conversation": Comparing Perspectives on PrEP and Sexual Health Communication Between Black Sexual Minority Men and Healthcare Providers.

Patient-provider communication is a key factor affecting HIV pre-exposure prophylaxis (PrEP) awareness and access among Black sexual minority men (SMM). Optimizing patient-provider communication requires a deeper understanding of communication dynamics. In this study, we investigated the perspectives of both HIV-negative/status-unknown Black SMM and practicing community healthcare providers regarding patient-provider communication about PrEP and sexual health. We conducted eleven semi-structured qualitative focus groups (six with Black SMM; five with providers) in the Northeastern USA and thematically analyzed transcripts. A total of 36 Black SMM and 27 providers participated in the focus groups. Our analysis revealed points of alignment and divergence in the two groups' perspectives related to patient-provider communication. Points of alignment included: (1) the importance ascribed to maximizing patients' comfort and (2) belief in patients' right to non-discriminatory healthcare. Points of divergence included: (1) Black SMM's preference for sexual privacy versus providers' preference that patients share sexual information, (2) Black SMM's perception that providers have an ethical responsibility to initiate conversations about PrEP with patients versus providers' perception of such conversations as being optional, and (3) Black SMM's preference for personalized sexual health conversations versus providers' preference for standardized conversations. Findings underscore a need for providers to offer more patient-centered sexual healthcare to Black SMM, which should entail routinely presenting all prevention options available-including PrEP-and inviting open dialogue about sex, while also respecting patients' preferences for privacy about their sexuality. This approach could increase PrEP access and improve equity in the US healthcare system.

Service-Learning Programs and Projects for Medical Students Engaged With the Community.

IntroductionThe medical school curriculum has changed from using the term “pedagogy” to framing adult learning theories with the goal of applying knowledge to a clinical situation or real-life experiences. Service-learning programs (SLPs) in medical schools illustrate one of several adult learning principles and practices now used in today’s curriculum that better prepare medical students for working with a variety of patients. ObjectiveThe researchers’ aim was to assess medical students’ learning experiences while participating with nonprofit organizations during a curricula-designed SLP.MethodThe authors analyzed 60 reflective essays over a three-year academic period from 192 medical students placed in teams of two to four. A qualitative study with a thematic analysis research design was employed in our study. This iterative approach allowed the researchers to identify themes and interpret meaning. The study was completed in 2020 using data from 2017-2020.ResultsFour major themes and one overarching theme emerged that reflect adult learning theories including: (1) transfer learning of one’s skills and knowledge to community and practice; (2) articulate a variety of ways to communicate with multiple, diverse community audiences; (3) employ a creative process for quality improvement strategies; (4) create positive trusting and rewarding relationships that highlight an enhanced level of conduct and professionalism. An overarching theme found was: collaboration emerges almost without forethought. Medical educators may find that replicating this SLP into the curriculum infrastructure provides agency and student buy-in. We established an SLP as part of the medical school curriculum that brings privilege and reward to students and to the community. Reflection provides for meaningfulness from SLP and helps students identify how experiential learning affects their professional development as members of the community and future health care providers.ConclusionImplementing SLPs into any medical school curriculum strengthens the adult learning theoretical delivery approach. Disseminating projects and lessons learned to and from the community also showcases experiential learning opportunities for medical students and other professionals. Many aspects of awareness from the medical students’ engagement during the SLP emerged. They learned about specific aspects of community engagement and found it a privilege to give and take many lessons from the experiences and opportunities.

Healthcare providers infection prevention practices and associated factors in community clinics in Bangladesh: A cross-sectional study.

Healthcare associated infections impose serious challenges to safe and high-quality healthcare delivery, and have been closely associated with poor infection prevention practices. Infection prevention practices are poorly studied in Bangladesh, and no previous studies have examined these practices among healthcare providers of community clinics. The study aimed to assess infection prevention practices and associated factors among healthcare providers of community clinics in the rural area of Bangladesh. A cross-sectional study was conducted among 128 community healthcare providers in the Kurigram district of Bangladesh who were identified from 128 community clinics using a stratified random sampling technique. Data were collected between November and December, 2019 via face-to-face survey using a pre-tested semi-structured questionnaire. Only 37.5% community healthcare providers had adequate knowledge on infection prevention measures, and 39.1% had good infection prevention practices. Community healthcare providers with higher education were significantly more likely to have good infection prevention practices, and good infection prevention practices were associated with availability of hand washing facilities, and of soap in community clinic, and adequate knowledge of infection prevention. Implementation of an effective training program regarding infection prevention, along with adequate supply of infection prevention basic resources, and continuous monitoring and supervision are required to improve the currently faltering infection prevention knowledge and practices among community healthcare providers in Bangladesh.

Depression and Cognition Mediate the Effect of Self-Perceptions of Aging Over Frailty Among Older Adults Living in the Community in China.

ObjectivesThe aims of the study were first to investigate the association between self-perceptions of aging and frailty and second to determine whether self-perceptions of aging affects frailty via depressive symptoms and cognitive status among older adults living in the community in China.MethodsAmong 850 older adults who participated in this cross-sectional study, 822 older adults made valid responses to Tilburg Frailty Indicator, Brief Aging Perceptions Questionnaire, UCLA loneliness scale-8, Mini-Mental State Examination, and Patient Health Questionnaire-9 between March to December 2019. The possible pathways of self-perceptions of aging affecting frailty were analyzed based on the structural equation modeling analysis.ResultsA total of 21.53% of older adults reported frailty. Correlation analyses showed that higher degrees of frailty were related to greater loneliness, more depressive symptoms, more negative self-perceptions of aging, worse locomotive function, and cognitive status (r = 0.267, r = 0.440, r = 0.481, r = 0.451, r = −0.337; p < 0.001). Multiple regression analysis showed that loneliness, depressive symptoms, self-perceptions of aging, locomotive function, and cognitive status were the five factors to be entered the regression equation, and the variance of joint explanation was 46.60%. SPA had a direct effect on frailty (β = 0.306 and p < 0.001), and SPA indirectly affects frailty by independently affecting depressive symptoms (β = 0.391, 95% CI [0.027, 0.061], and p < 0.001) or cognitive status (β = 0.148, 95% CI [0.009, 0.024], and p < 0.001) of older adults.ConclusionThese findings help explain the potential psychological mechanisms through which SPA impacts frailty and may aid community healthcare providers in China in identifying individuals at high risk of frailty. The results suggest that health staff should help older adults improve their perspectives on aging, alleviate or prevent depressive symptoms, and improve cognitive status to delay the progress of frailty and promote healthy aging.

Community Survey on Wearing Mask to Prevent COVID-19, Bangladesh, 2021

Aims: To understand the mask wearing behavior of people, to identify why people do not wear masks, what obstacles are present, and what suggestions people have to increase mask wearing.&#x0D; Study Design: It was a cross sectional study.&#x0D; Place and Duration of Study: In the outpatient department of the government hospital, community clinics and expanded program for immunization centers in Sub district area Monohargonj Upazila (Sub district), Bangladesh from 21st November to 20th December 2020.&#x0D; Methodology: Mask wearing was categorized as always wear mask in outside or not, reasons for not wearing mask, perception on prevention of COVID-19 and suggested punishment for not wearing mask. The researchers recruited people from 18 years and over from the Government Hospital, community clinics, and Expanded Immunization Program (EPI) centers in Monoharganj Upazila, Cumilla District, Bangladesh. The sample size of 384 assumed 50% mask wearing. However, 401 persons were participated in this study. A questionnaire was prepared in local language. Data were collected through face-to-face interview after obtaining verbal informed consent. Interviewers were doctors, nurses, health assistants and community health care providers.&#x0D; Results: Of the 401 survey participants, 51% of the males always wear mask. Mask wearing was highest among in-service holders (68%), Hindus (67%) and students (61%) and increased with educational level and income. While 73% said a mask can prevent COVID-19 only 48% wore a mask. Of the people who don’t wear masks, 39% said it was uncomfortable, 5% felt it did not prevent COVID-19, and 8% thought it did not look nice. Most participants agreed to fine or jail people who don’t wear masks.&#x0D; Conclusion: Wearing masks is a reasonable and economical intervention to prevent COVID-19 transmission. In Bangladesh, many people don’t wear masks because its uncomfortable, unattractive, and not protective. The government should encourage people to wear masks and enforce the infection prevention law on wearing masks.

Participatory Action for Access to Clinical Trials (PAACT): Increasing participation of blacks in Southeastern Michigan in cancer clinical trails.

e18527 Background: The underrepresentation of minority populations in research violates principles of distributive justice, slows scientific progress, and exacerbates health disparities. Henry Ford Cancer Institute (HFCI) is one of 20 sites offering clinical trials in Michigan and currently participates in 1300 trials. The rate of cancer cases at HFCI is 78% in whites and 21.9% in Blacks/African Americans (B/AA). However, analysis of cancer clinical trials conducted at HFCI showed participation rates to be 2.66% in B/AA and 90.28% in whites. Diverse attempts by HFCI to improve participation of B/AA in clinical trials have yielded limited success. The Participatory Action for Access to Clinical Trials (PAACT) project is using a community-based participatory research (CBPR) approach to design/adapt, pilot, and evaluate interventions which address cancer clinical trial participation barriers among B/AA. Methods: PAACT uses a 5-step approach: 1. Establish a steering committee (SC) in partnership with the Detroit Urban Research Center, which has a strong history of implementing CBPR programs in Detroit. 2. Conduct a scoping review to evaluate evidence-based strategies and interventions used to engage B/AA communities in clinical trials. 3. Conduct qualitative and quantitative research with members of B/AA community, cancer survivors/patients, and HFCI providers. 4. Engage stakeholders in the interpretation and translation of data to inform intervention strategies. 5. Pilot the intervention(s) to assess B/AA individuals’ behavioral intentions to enroll and participate in cancer clinical trials, and health care providers’ intentions to engage in change processes. Results: We have conducted 13 SC meetings, co-facilitated by a community, academic and health system partner. The SC has been actively engaged in all aspects of the project. Through the scoping review, we identified five categories of recruitment and retention strategies. We have conducted 13 focus groups with 100 participants, 7 provider interviews, and administered 1 survey to HFCI staff. Data from the focus groups has provided information on respondents’ clinical trial knowledge and systemic, socio-cultural, and economic barriers to trial participation. Data from the provider interviews has provided information on experience with clinical trial recruitment and recommendations for improving participation among B/AA community members. Conclusions: Through CBPR, PAACT actively engages B/AA community members, survivors/patients, healthcare providers, and researchers in the process to develop/adapt, implement, and evaluate strategies to better inform communities and patients about cancer clinical trials. The long-term goal of this project is to implement changes in both the community and the health care system thereby increase levels of participation in clinical trials among B/AA.

Pediatric Chronic Tracheostomy Care: An Evaluation of an Innovative Competency-Based Education Program for Community Health Care Providers.

ObjectiveTo evaluate the immediate and sustained knowledge retention and sense of self-efficacy of homecare nurses following completion of a standardized competency-based tracheostomy education course. Safe discharge of children requiring tracheostomy with or without ventilation relies on the competence of homecare nurses.Study DesignPragmatic, randomized controlled trial of 44 homecare nurses. Participants were randomized into the intervention group (n = 21), which received the tracheostomy course, or the control group (n = 23), which received an enterostomy and vascular access course. Multiple-choice question (MCQ) knowledge assessments and self-efficacy questionnaires were administered to both groups pre-course and post-course at 6 week, 3 month, 6 month, and 12 month follow-ups.ResultsTwenty participants in the intervention group and 19 in the control group were included. Four withdrew from the study and two crossed over from the control into the intervention arm. The change in mean self-efficacy scores (total score = 100) was significantly higher in the intervention group than in the control group at 6 weeks (intervention (mean ± SD): 18.6 ± 14.5; control: 6.6 ± 20.4; p = 0.04) and 3 months (intervention: 19.6 ± 14.2; control: 5.2 ± 17.0; p = 0.007), and trended higher at 6 months (intervention: 18.0 ± 14.5; control: 6.9 ± 24.1; p = 0.1). The change in mean MCQ assessment scores (total score = 20) trended higher in the intervention group than in the control group at 6 weeks (intervention (mean ± SD): 1.8 ± 2.2; control: 1.6, ± 2.9; p = 0.8).ConclusionsHomecare nurses who attended the tracheostomy course demonstrated a higher sense of self-efficacy at long-term follow-up.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT04559932.

Improving Medication Adherence in Convalscent Psychiatric Out-Patients Exposed to Psychotomimetic Medications in South-West, Nigeria: The Role of Medication Literacy and `Therapeutic Relationships.

Medication adherence is a growing concern to clinicians and healthcare providers in psychiatric communities, mounting evidence of the prevalence of non-adherence have been significantly associated with undesirable health outcomes and burdensome healthcare expenditure. This study examined medication adherence in psychiatric patients exposed to psychotomimetic medications and how therapeutic relationship predicts the level of medication adherence. This study was a cross-sectional survey design. Snowballing sampling technique was used to select psychiatric out-patients. The total number of participants for this study was thirty-six (36), males (65%) and females (35%). Majority of participants were between the ages of 31-50 years. Participants responded to Morinsky Medication Adherence Scale (α=0.91), Liverpool University Neuroleptic Side-Effect Scale (α= 0.89), and Therapeutic Relationship Scale (patient version) (α=0.71). Three hypotheses were formulated and tested using multiple regression analysis. Results of the multiple regression indicate that psychotomimetic side-effects inversely predicted medication adherence among psychiatric patients exposed to psychotomimetic drugs [β = .35, p &lt;0.01]. Also, the outcome of the results indicated that therapeutic relationship was a significant predictor of medication adherence among psychiatric patients exposed to psychotomimetic drugs [β = .40, p &lt;0.01]. Therefore, it was recommended that therapeutic relationship should be an integral part of the modalities in psychiatric treatment and to adopt best practices by effectively communicating with patients about the importance of adhering to treatment plans; and provide medication support services to patients and family caregivers. This helps to improve, build a sustainable therapeutic relationship (nurse-patient) through empathy and professional intimacy that facilitates diagnosis accuracy, and desired health outcome.

Quality and accreditation in Cellular Therapy

Quality in a Health System as we know it today can trace its origins back to the early twentieth century, when a number of measures were taken to address great variations in medical education and care. The complexity of haematopoietic cell transplantation (HCT) as a medical technology and the frequent need for close interaction and interdependence between different services, teams and external providers (donor registries, typing laboratories, etc.) distinguish it from many other medical fields. The implementation of a Quality Management program with its components including quality control, quality assurance, quality assessment and quality improvement advances the quality of service provided for patients and helps programs to address external threats and internal weaknesses, which could negatively impact services and products. In HCT, different stakeholders have been identifed as holding an interest in ensuring that patients receive quality care: patients and their families, referring physicians, payers, other community healthcare providers, commercial suppliers, regulatory authorities, insurance payers and professional and patient organizations. Evidence does exist for HCT, where studies using European HCT registry data have correlated the different phases of preparation for and achievement of accreditation at centre level with incremental improvements in patient survival and reduction in procedural mortality. It also proves the level of commitment to high-quality measures and monitoring cellular therapy practice and patient care. This Manual chapter will deepen the theme of quality in cell therapy, as discussed in the Consensus 2021 of SBTMO, in order to stimulate the development of quality in the centers, as well as to give a north in the proper deployments. We will briefly go through all the steps of the implementation of quality in a Stem Cell and Cell Therapy Center

Relationship of vegetable and fruit consumption with farmers' blood sugar levels in Pakusari Health Center, Jember

Low consumption of vegetables and fruits are one of the causes of digestive problems, coronary heart disease, and diabetes. Farmers are a vulnerable group for consuming vegetables and fruit less than the recommended 5 portions (250 grams) a day. The aim of this study was to analyze the relationship between vegetable and fruit consumption and the level of blood sugar among farmers with non-communicable diseases in the integrated health post (Posbindu) of Pakusari Health Center, Jember Regency. A retrospective cohort study design was used to analyze secondary data of Posbindu registered patients from January to March 2020 among 140 farmers. The characteristics of participants, vegetable and fruit consumption, and blood sugar were measured through the monitoring card of Posbindu. The data were analyzed using Chi-square tests (p-value &lt;0.05). Among 140 farmers as many as 71.4% were identified who consumed vegetables and fruit less than 5 portions a day and 35.7% who have hyperglycemia. There was a relationship between vegetable and fruit consumption and the farmer's blood sugar level (p-value: &lt;0.001; χ2: 13.144). Farmers who consumed vegetables and fruits less than 5 portions a day were 5 times more likely to experience hyperglycemia (RR:5.727; 95% CI=2.072–15.827). Therefore, community health nurses and health care providers should provide counseling to improve the consumption of vegetables and fruits to prevent the incidence of hyperglycemia among farmers.

Exploring nutrition education for migrants to Canada in Alberta’s health and community sectors: Promising practices and gaps as informed by community workers and healthcare providers

ABSTRACT This qualitative study explored how migrant-serving agencies and healthcare providers in Alberta can support migrants to maintain healthy eating patterns. Through semi-structured interviews, respondents provided insight on their experiences working with migrant populations in the community. Observations about dietary acculturation (including food access, unfamiliar food environments, and perceptions of common foods in Canada) point to nutrition information that may be relevant for migrants. Respondents provided recommendations, noting the importance of culturally appropriate services, visual education materials, and collaboration between healthcare providers and community workers. The collective knowledge presented here could be applied by those developing programming supports for migrant communities.

Implementation of a Rural Community Diagnostic Testing Strategy for SARS-CoV-2 in Upstate South Carolina.

By developing a partnership amongst a public university lab, local city government officials and community healthcare providers, we established a drive-through COVID-19 testing site aiming to improve access to SARS-CoV-2 testing in rural Upstate South Carolina. We collected information on symptoms and known exposures of individuals seeking testing to determine the number of pre- or asymptomatic individuals. We completed 71,102 SARS-CoV-2 tests in the community between December 2020-December 2021 and reported 91.49% of results within 24 h. We successfully identified 5,244 positive tests; 73.36% of these tests originated from individuals who did not report symptoms. Finally, we identified high transmission levels during two major surges and compared test positivity rates of the local and regional communities. Importantly, the local community had significantly lower test positivity rates than the regional community throughout 2021 (p < 0.001). While both communities reached peak case load and test positivity near the same time, the local community returned to moderate transmission as indicated by positivity 4 weeks before the regional community. Our university lab facilitated easy testing with fast turnaround times, which encouraged voluntary testing and helped identify a large number of non-symptomatic cases. Finding the balance of simplicity, accessibility, and community trust was vital to the success of our widespread community testing program for SARS-CoV-2.

Defining the burden of febrile illness in rural South and Southeast Asia: an open letter to announce the launch of the Rural Febrile Illness project.

In rural areas of South and Southeast Asia malaria is declining but febrile illnesses still account for substantial morbidity and mortality. Village health workers (VHWs) are often the first point of contact with the formal health system, and for patients with febrile illnesses they can provide early diagnosis and treatment of malaria. However, for the majority of febrile patients, VHWs lack the training, support and resources to provide further care. Consequently, treatable bacterial illnesses are missed, antibiotics are overused and poorly targeted, and patient attendance wanes along with declining malaria. This Open Letter announces the start of a new initiative, the Rural Febrile Illness (RFI) project, the first in a series of projects to be implemented as part of the South and Southeast Asian Community-based Trials Network (SEACTN) research programme. This multi-country, multi-site project will run in Bangladesh, Cambodia, Lao PDR, Thailand, and Myanmar. It will define the epidemiological baseline of febrile illness in nine remote and underserved areas of Asia where malaria endemicity is declining and access to health services is limited. The RFI project aims to determine the incidence, causes and outcomes of febrile illness; understand the opportunities, barriers and appetite for adjustment of the role of VHWs to include management of non-malarial febrile illnesses; and establish a network of community healthcare providers and facilities capable of implementing interventions designed to triage, diagnose and treat patients presenting with febrile illnesses within these communities in the future.

Compliance to hand hygiene and its determinant factors among Community Health Care Providers in Community Clinics: an observational study in Bangladesh.

Healthcare-associated infections caused by poor hand hygiene (HH) practices can affect both the care seekers and the health care providers (HCPs) while providing primary health care. No study has been conducted on the compliance of HH practices among the primary level HCPs in Bangladesh. The study aimed to assess the compliance rates of HH and its determinant factors among Community Health Care Providers (CHCPs) in Community Clinics (CC). A cross-sectional study was conducted from September 2019 to February 2020 among 150 randomly selected CHCPs with functional HH facilities in Patuakhali district, Bangladesh. Structured interviews and observation tools were used to collect data. Good HH compliance among CHCPs was found to be 16.7% (95% CI: 11.3-21.3). Out of all 1218 possible HH opportunities, only 255 (20.9%) resulted in any HH action. Presence of 70% alcohol-based hand sanitiser at the point of care (aOR: 6.4, 95% CI: 1.1-38.3), HH training (aOR: 4.6, 95% CI: 1.1-18.9), displayed visual cues (aOR: 4.4, 95% CI: 1.1-17.7), knowledge about HH (aOR: 3.8, 95% CI: 1.1-13.6) and number of HH opportunities (aOR: 0.6, 95% CI: 0.4-0.8) were factors associated with HH compliance. Overall HH compliance among CHCPs was relatively low. It was recommended to implement multimodal HH improvement strategies, including a continuous training program, supply of alcohol-based hand rub, reminder, provision of five moments of HH in the training modules and feedback on HH performance.

WHAT IS NEUROPALLIATIVE CARE: Making it work in India

The burden of neurologic disease is substantial and rising worldwide. India is no exception. These illnesses cause prolonged disability and distress for the patient, family and community. Palliative care (PC) is an approach that focuses on providing relief from suffering. Till about two decades ago, PC was largely restricted to oncology but there is now a growing community of healthcare providers and others, working to incorporate the same principles in the care of our patients, through the International Neuropalliative Care Society (INPCS). This paper outlines the evolution of this new subspecialty and the knowledge and skill sets required to practice it. Education and research priorities are important and are also discussed.

Understanding factors influencing utilization of HIV prevention and treatment services among patients and providers in a heterogeneous setting: A qualitative study from South Africa.

Despite advances made in HIV prevention and treatment interventions in South Africa, barriers to their utilization continue to exist. Understanding perspectives from patients and providers of healthcare can shed light on the necessary strategies to enhance uptake of HIV services. A cross-sectional qualitative study was conducted in July 2020 in Ekurhuleni District. Based on HIV prevalence estimates from a national survey, male condom use coverage and antiretroviral treatment (ART) initiation rates from routinely collected clinical data for 2012, we selected facilities from geographical areas with varying HIV prevalence and uptake of HIV services. In-depth interviews were conducted with adult (≥18 years) patients and healthcare workers in selected primary healthcare facilities. Thematic analysis was performed following a framework built around the social cognitive theory to describe behavioural, personal, and social/environmental factors influencing utilization of HIV services. Behavioural factors facilitating uptake of HIV services included awareness of the protective value of condoms, and the benefits of ART in suppressing viral load and preventing mother-to-child HIV transmission which was evident across geographical areas. Barriers in high prevalence areas included suboptimal condom use, fears of a positive HIV result, and anticipated HIV-related stigma while seeking healthcare services. Across the geographical areas, personal factors included ability to correctly use available services enhanced by knowledge acquired during counselling sessions and community-based health promotion activities. Further, social support from family reinforced engagement in care. Compared to low uptake areas, clinics in high uptake areas used care-facilitators, outreach teams and decanting programs to address the environmental barriers including staff shortages and long queues. Barriers at multiple levels prevent optimal utilization of HIV services, calling for strategies that target and address the different levels and tailored to needs of specific settings. Overall, improved delivery of HIV prevention or treatment interventions can be achieved through strengthening training of healthcare providers in facilities and communities and addressing negative sequelae from utilising services in low uptake areas.

At the front of the front-line: Ontario paramedics' experiences of occupational safety, risk and communication during the 2020 COVID-19 pandemic

PurposeThe study aimed to (1) determine on what bases paramedics in this context have defined themselves as feeling safe or at risk while serving on the front lines and (2) develop recommendations to support paramedics in their critical public health emergency response role.Design/methodology/approachThis qualitative study consisted of 21 semi-structured interviews with primary care paramedics (PCPs), advanced care paramedics (ACPs) and critical care paramedics (CCPs) with first-hand experience responding to the COVID-19 pandemic in Ontario. Qualitative research is best suited to the research objectives of gaining detailed and nuanced understandings of paramedics' experiences during this public health emergency, and identifying in paramedics' accounts what changes to policy and practice might strengthen their sense of safety in future infectious disease outbreaks (Bowling, 2002; Chafe, 2017). Data collection occurred over the course of 3.5 months, from June 2020 until September 2020.FindingsParticipants described several factors that heightened their feeling exposed to risk particular to working on the front lines of the COVID-19 public health response. These factors include stress connected to personal protective equipment (PPE) and equipment access, risks of infection to self and family, communications and feelings of being systematically under-considered. Recommendations from this research include, but are not limited to, ensuring a more equitable distribution of protective equipment to paramedics across unevenly funded services, and recognizing paramedics face unique and additional stressors in public health emergencies.Research limitations/implicationsA key limitation of this study was the relatively small sample, with 50% of potential participants deciding not to engage in an interview. The authors suspect this is likely a result of timing, as this was conducting during significant periods of the COVID-19 pandemic in Ontario. The study identifies and begins to shed light on the way in which feelings of compromised safety and specific stressors in a public health emergency context connect to one another and potentially increase risks of burnout for this healthcare provider group. This study's documentation of paramedics feeling uncertainty about their own and their family's safety, combined with feeling occupational pressure, decisional pressure within constrained frameworks of care delivery, a lack of autonomy and a lack of consideration within their healthcare system in general and within its pandemic response in particular, is important in and of itself. These stressors can have serious implications for the ability of paramedics to sustain their integral role in public health emergency response.Practical implicationsA series of pandemic-specific and generalizable recommendations emerged from this research and in collaboration with community-based medical leadership. (1) Consult paramedics on effectiveness of screening questions and equipment. Be sure to illicit and respond to paramedic feedback in a timely manner. (2) Implement operational changes during pandemics in the form of donning and doffing stations, disposable gowns, decontamination teams at hospitals, infectious disease paramedic (IDP) truck, anti-fog sprays for goggles, and safe and controlled areas for eating and taking breaks. (3) Develop an emergency pandemic plan that is resourced and maintained as part of EMS strategic planning. Involve EMS in decisions related to health system emergency planning and sustainability of EMS practice. (4) Establish equitable distribution of resources, such as ensuring PPE is distributed equitably and applying pandemic pay equally to all essential workers. (5) Validate and respect EMS, as they are essential workers. Recognize the expertise of paramedics and community healthcare providers. Finally, an overarching recommendation at the core of this research is the consideration for paramedic knowledge as expertise given their role as critical front line healthcare specialists and the protection of this crucial human resource as it relates to their resilience and mental wellbeing.Social implicationsEvidence-based awareness and improved understanding of paramedic stress during the pandemic is a first step to developing strategies to reduce that stress. This is essential in ensuring access to this essential service during emergencies and the safety of the communities they serve.Originality/valueFindings from this study can inform development of supports to sustain paramedic wellbeing during public health emergencies, during the ongoing pandemic, in Ontario and beyond.