Competent Healthcare Providers Research Articles

Rural veteran perception of healthcare access in South Carolina and Florida: a qualitative study

BackgroundAccess to mental and physical healthcare in rural areas is challenging for Veterans and their families but essential for good health. Even though recent research has revealed some of the challenges rural Veterans face accessing healthcare, a complete understanding of the gap in access is still unclear.MethodsThis qualitative study aimed to explore participants’ perceptions of healthcare access. Structured interviews were conducted with 124 Veterans and spouses of Veterans from rural qualifying counties in South Carolina and Florida.ResultsThe study’s results revealed five main dimensions of access: geographic proximity, transportation, communication, cultural competence, and resources. Distance to service needed can negatively impact access for Veterans and their families in general, especially for those whose health is declining or who cannot drive because of their age. Lack of transportation, problems with transportation services, and lack of public transportation can lead to delays in care. Additionally, the lack of communication with the Veterans Affairs (VA) Health System and with the healthcare team, as well as inefficient communication among the healthcare team, lack of coordination of care between the VA health system and community providers, and the lack of cultural competence of healthcare providers and contracted personnel made access to services even more challenging.ConclusionsImproving communication can help to develop a sense of trust between Veterans and the VA, and between Veterans and spouses with the healthcare team. It can also lead to increased patient satisfaction. Ensuring healthcare providers and contracted personnel are culturally competent to talk and treat Veterans can improve patient trust and adherence to treatment. Lastly, resource-related challenges included financial problems, lack of prompt access to appointments, lack of providers, limited access to local clinics and hospitals, limited local programs available, and reimbursement issues.

"Will you need this health at all? Will you be alive?": using the bioecological model of mass trauma to understand HIV care experiences during the war in Ukraine.

Russia's invasion of Ukraine in February 2022 has severely impacted the healthcare system, including the provision of HIV care. The ongoing war is a human-caused mass trauma, a severe ecological and psychosocial disruption that greatly exceeds the coping capacity of the community. The bioecological model of mass trauma builds on Bronfenbrenner's concept of interaction between nested systems to argue that social context determines the impact of life events on the individual and how an individual responds. This paper uses the bioecological model of mass trauma to explore the impact of Russia's aggression against Ukraine and the ongoing war on HIV-positive people who use drugs in Ukraine, a particularly vulnerable population that may be negatively affected by disruptions to social networks, healthcare infrastructure and economic conditions caused by mass trauma. Data were collected between September and November 2022. A convenience sample of 18 HIV-positive people who use drugs were recruited from community organizations that work with people living with HIV, drug treatment programmes, and HIV clinics through direct recruitment and participant referral. A total of nine men and nine women were recruited; the age ranged from 33 to 62 years old (mean = 46.44). Participants completed a single interview that explored how the war had affected their daily lives and access to HIV care and other medical services; their relationships with healthcare providers and social workers; and medication access, supply and adherence. Data were analysed using the Framework Method for thematic analysis. The war had a profound impact on the social, emotional and financial support networks of participants. Changes in social networks, coupled with limited job opportunities and rising prices, intensified financial difficulties for participants. Relocating to different regions of Ukraine, staying at somebody else's home, and losing connections with social workers impacted medication adherence and created lengthy treatment gaps. Participants also experienced a decreased supply of antiretroviral therapy, concerns about accessing medication for opioid use disorder, and overwhelming fears associated with the war, which overshadowed their HIV-related health concerns and negatively impacted medication adherence. Our analysis reveals the complex impact of war on social networks and healthcare access. Maintaining support networks and competent healthcare providers will be essential amid the ongoing war.

Barriers and facilitators to care for agitation and/or aggression among persons living with dementia in long-term care

BackgroundAgitation and/or aggression affect up to 60% of persons living with dementia in long-term care (LTC). It can be treated via non-pharmacological and pharmacological interventions, but the former are underused in clinical practice. In the literature, there is currently a lack of understanding of the challenges to caring for agitation and/or aggression among persons living with dementia in LTC. This study assesses what barriers and facilitators across the spectrum of care exist for agitation and/or aggression among people with dementia in LTC across stakeholder groups.MethodsThis was a qualitative study that used semi-structured interviews among persons involved in the care and/or planning of care for people with dementia in LTC. Participants were recruited via purposive and snowball sampling, with the assistance of four owner-operator models. Interviews were guided by the Theoretical Domains Framework and transcribed and analyzed using Framework Analysis.ResultsEighteen interviews were conducted across 5 stakeholder groups. Key identified barriers were a lack of agitation and/or aggression diagnostic measures, limited training for managing agitation and/or aggression in LTC, an overuse of physical and chemical restraints, and an underuse of non-pharmacological interventions. Facilitators included using an interdisciplinary team to deliver care and having competent and trained healthcare providers to administer non-pharmacological interventions.ConclusionsThis study advances care for persons living with dementia in LTC by drawing attention to unique and systemic barriers present across local and national Canadian LTC facilities. Findings will support future implementation research endeavours to eliminate these identified barriers across the spectrum of care, thus improving care outcomes among people with dementia in LTC.

Human resources challenges in the management of diabetes and hypertension in Mozambique.

The major burden of non-communicable diseases (NCDs) globally occurs in low-and middle-income countries, where this trend is expected to increase dramatically over the coming years. The resultant change in demand for health care will imply significant adaptation in how NCD services are provided. This study aimed to explore self-reported training and competencies of healthcare providers, and the barriers they face in NCD services provision. A qualitative design was used to conduct this study. Data was collected through semi-structured interviews with government officials within the Mozambican Ministry of Health, district health authorities, health facility managers, and health providers at urban and rural health facilities of Maputo, in Mozambique. The data was then analyzed under three domains: provider´s capacity building, health system structuring, and policy. A total of 24 interviews of the 26 planed with managers and healthcare providers at national, district, and health facility levels were completed. The domains analyzed enabled the identification and description of three themes. First, the majority of health training courses in Mozambique are oriented towards infectious diseases. Therefore, healthcare workers perceive that they need to consolidate and broaden their NCD-related knowledge or else have access to NCD-related in-service training to improve their capacity to manage patients with NCDs. Second, poor availability of diagnostic equipment, tools, supplies, and related medicines were identified as barriers to appropriate NCD care and management. Finally, insufficient NCD financing reflects the low level of prioritization felt by managers and healthcare providers. There is a gap in human, financial, and material resources to respond to the country's health needs, which is more significant for NCDs as they currently compete against major infectious disease programming, which is better funded by external partners. Healthcare workers at the primary health care level of Mozambique's health system are inadequately skilled to provide NCD care and they lack the diagnostic equipment and tools to adequately provide such care. Any increase in global and national responses to the NCD challenge must include investments in human resources and appropriate equipment.

How Much Training Is Enough? Low-Dose, High-Frequency Simulation Training and Maintenance of Competence in Neonatal Resuscitation.

Facemask ventilation is a crucial, but challenging, element of neonatal resuscitation.In a previously reported study, instructor-led training using a novel neonatal simulator resulted in high-level ventilation competence for health care providers (HCPs) involved in newborn resuscitation. The aim of this study was to identify the optimal frequency and dose of simulation training to maintain this competence level. Prospective observational study of HCPs training through 9 months. All training was logged. Overall ventilation competence scores were calculated for each simulation case, incorporating 7 skill elements considered important for effective ventilation.Overall scores and skill elements were analyzed by generalized linear mixed effects models using frequency (number of months of 9 where training occurred and total number of training sessions in 9 months) and dose (total number of cases performed) as predictors. Training loads (frequency + dose) predictive of high scores were projected based on estimated marginal probabilities of successful outcomes. A total of 156 HCPs performed 4348 training cases. Performing 5 or more sessions in 9 months predicted high global competence scores (>28/30). Frequency was the best predictor for 4 skill elements; success in maintaining airway patency and ventilation fraction was predicted by performing training in, respectively, 2 and 3 months of 9, whereas for avoiding dangerously high inflating pressures and providing adequate mask seal, 5 and 6 sessions, respectively, over the 9 months, predicted success. Skills reflecting global performance (successful resuscitation and valid ventilations) and ventilation rate were more dose-dependent. Training frequency is important in maintaining neonatal ventilation competence. Training dose is important for some skill elements. This offers the potential for individualized training schedules.

Self-management support (SMS) in primary care practice: a qualitative focus group study of care professionals’ experiences

BackgroundTo support self-management of chronically ill persons, innovative approaches of care practice are being developed. Unfortunately, many self-management supporting interventions struggle to achieve reliable and consistent improvements at various levels (patient, provider and healthcare system level). One possible strategy to facilitate translating theory into practice, is to consider the healthcare professionals’ perspective prior to the development of new interventions. An exploration of their knowledge and opinion about barriers and facilitators is necessary before employing any self-management support (SMS) intervention. Therefore, our study aims to explore care professionals’ perspectives about SMS within the Flemish primary care setting.MethodsThis study used a qualitative study design to examine SMS in primary care setting. Five focus groups were conducted, grouped into three waves. Participants were healthcare professionals in Flanders representing different disciplines and settings. A maximum variation purposive sampling was used to recruit participants. For the data analysis, the framework of thematic networks by Attride-Stirling was applied.ResultsA total of 34 healthcare professionals participated. Three global themes related to SMS were derived from the thematic analysis: (1) Characteristics, (2) Support strategies, (3) Barriers and facilitators. SMS was characterised as a collaboration-based and person-centred approach. A variety of supporting strategies were mentioned by the focus group participants. Most strategies consisted of informing and educating patients. Complementary to individual strategies, collaborative strategies were deemed necessary to support self-management. Regarding barriers and facilitators, different patient-related factors were identified. Additionally, competencies of healthcare providers and external factors seem to hinder the implementation of SMS in practice.ConclusionsThis focus group study highlights the importance of a collaborative, person-centred approach to SMS in the context of chronic diseases. Our findings point to the need for interventions that raise awareness and address barriers associated with SMS. Since generic SMS does not exist, the road to success is a growth process in which support must be adapted to the individual patient.

Experiences of Successful PrEP Uptake Among Adolescent Sexual Minority Men in the United States: A Qualitative Exploration.

Male adolescent sexual minorities are at elevated risk of HIV acquisition yet demonstrate low rates of PrEP uptake. Understanding the experiences of adolescents who have successfully accessed PrEP may inform ways to best support adolescents seeking PrEP. Adolescent sexual minorities (N = 100) who reported utilizing PrEP responded to open-ended items asking about their initial PrEP experiences and advice for others. Qualitative analysis suggested that adolescents' ability to access PrEP is influenced by managing parental involvement and seeking culturally competent health care providers. Additionally, they reported how the benefits and drawbacks of taking PrEP played a role in their PrEP use. Findings suggest that educational PrEP interventions targeted at this population could improve uptake by incorporating discussions on side effects and mental health benefits associated with PrEP use. Structural interventions are warranted that improve adolescents' ability to seek sexual health care independently and make room for parental involvement when adolescents could benefit from their support.

Competence of Healthcare Providers in Managing Lymphedema Post Breast Cancer Treatment: A study in western Kenya hospitals

Background: Globally, breast cancer, the most diagnosed cancer, affects around 2.3 million individuals. Approximately 28% to 38% of breast cancer patients develop lymphedema post-treatment, impacting one in five patients. Without intervention, the condition leads to serious complications, affecting daily tasks. Sub-Saharan Africa reports increasing comorbidities related to lymphedema, yet no data exists on its prevalence in Kenya. This study assessed clinical management strategies for breast cancer treatment-induced lymphedema in selected Western Kenya hospitals.
 Material And Methods: This was a cross-sectional analytic study. Simple random sampling was used to select healthcare facilities offering cancer screening and treatment. Healthcare providers were randomly selected from five health facilities depending on the number required at each health facility. 192 healthcare providers were selected to participate in the study. Data collection was by structured questionnaires, observation checklist and focus group discussion, analysed by SPSS version 23.1 and Qualitative data thematically analysed guided by questions on knowledge, skills and management strategies.
 Results: The results showed healthcare providers' knowledge ranging from low to average with a deficit in important areas of practice such as skincare (OR=0.56, p=0.01). stocking pressure (OR=1.841, P=0.004, positive stemmer's sign test (OR=2.217, p=0.001) with over 50% getting incorrect answers. Good history and assessment Skills were demonstrated (0R=1.6; CI;1.0-24; P=0.037) but patient education was poorly done. Focus group discussion showed a deficit in knowledge by failure to clearly define lymphedema.
 Conclusion: Structured education of lymphedema is needed to increase the knowledge of healthcare providers and improving knowledge may fill the gaps in knowledge and demonstrate good practical skills in patient management

Between Black mothers and daughters: a critical intergenerational duoethnography on the silence of health disparities and hope of loud healing

IntroductionBlack American women's health outcomes have been altered by a number of factors. Those factors include social determinants of health, lack of culturally competent healthcare providers, and generations of medical racism leading to prolonged pain, delayed care, and sometimes, untimely deaths.MethodsThis original research article centers Southern Black women's lived experiences through family storytelling. We explored generations of health narratives in regard to age, region, and at times, their own acts of silence. Building from theorizing on loud healing, two Black daughters turned the mic on for their mothers by engaging in a critical intergenerational double duoethnography to discuss decades of healing over a 3 months long conversation (in person, over the phone, and on video chat).ResultsThe analysis of the interviews/dialogue between Black mothers and daughters identified several themes connected to loud healing: (1) some healths lessons are quietly taught from intergenerational trauma; (2) the silencing of Black matriarchs occurs in generations not just spirals; (3) loud healing is a faith-filled call to action; (4) mothers and daughters help turn the mic on for each other; (5) Loud healing is affirming and produces visibility; (6) the body teaches culturally competent health lessons; (7) Trusting loud healing to leave the mic on and door open.DiscussionOur collective and individual lived experiences reveal the very real impacts of culture, identity, and power on Black women's health and storytelling. By interrogating the past with our stories, this group of Black mothers and daughters represents three generations of medical erasures, amplification of voice, and the need for loud healing for loud, tangible change.

Systematic Development of National Guidelines for Obesity Care: The Swedish Approach

Introduction: With the rapid development of treatment modalities for obesity management, there is an increasing demand for guidance to facilitate the prioritization of interventions. In 2020, the Swedish National Board of Health and Welfare started the process of producing the first national guidelines for obesity care directed to decision makers who allocate resources to the best knowledge-based care. The main aim of this paper was to describe the systematic development of these guidelines, designed to guarantee uniformly high standards of care throughout the whole country. Methods: The standardized procedures of the National Board of Health and Welfare were applied to construct guidelines in a systematic and transparent way, including priority setting of recommendations and quality indicators to evaluate the progress of implementation. The process involved independent expert committees including professionals and patient representatives, and the guidelines were reviewed through an open public consultation. Results: National guidelines were issued in 2023, encompassing a broad scope, from identification and diagnosis to multiple treatment modalities, embedded in a life-course perspective from pregnancy to the elderly, as well as highlighting the need for improved knowledge and competence of health care providers. Conclusions: National guidelines for improved standard care and evidence-based and efficient use of health care resources for obesity treatment can be developed in a systematic way with professionals and patient representatives.

Newborn and infant vision screening in primary care: A clinical review.

Newborn and infant vision screening is an essential component of the health promotion visit, where the provider screens for ocular risk factors and abnormalities that may cause future impairment or vision loss. Providers may underestimate the importance of screening or find neonatal vision assessments difficult due to poor patient cooperation or time-consuming exams, but the reversibility of vision impairment in infants makes early detection paramount to proper treatment. This article provides a clinical review of evidence-based, practical guidance to providers who care for infants from birth through 6 months of age in the primary care setting. The comprehensive eye exam in infants should include a thorough history and physical examination of eye structures, visual acuity, evaluation of extraocular movements and alignment, and assessment of the red reflex. Recommended exam maneuvers differ with age as visual acuity improves and development advances through infancy. Early detection of ocular pathology is critical to avoid permanent vision loss, serious morbidity, and even mortality. The seemingly complex vision screening exam can be completed with little to no cooperation from the patient when a competent pediatric healthcare provider prioritizes opportunistic exam maneuvers. The opportunistic exam allows providers to maximize efficiency while maintaining thorough technique during vision exams and screenings.

Stakeholder development of an implementation strategy for fall prevention in Norwegian home care – a qualitative co-creation approach

BackgroundThe uptake of fall prevention evidence has been slow and limited in home care services. Involving stakeholders in the implementation process is suggested as a method to successfully tailor implementation strategies. The aim of this study was to develop an implementation strategy for fall prevention, targeting healthcare providers working in home care services.MethodsThis study used an explorative qualitative approach in a five-step co-creation process to involve researchers, service users, and healthcare providers. The first two steps consisted of workshops. This was followed by focus group interviews and individual interviews with key informants as steps three and four. Data from the first four steps were analyzed using reflexive thematic analysis. The fifth and final step was a workshop finalizing a strategy for implementing fall prevention evidence in home health services.ResultsOverall, our findings, resulted in an implementation strategy for fall prevention with four components: (1) Empower leaders to facilitate implementation, operationalized through what managers pay attention to regularly, resource priorities, and time spent on fall prevention, (2) Establish implementation teams, consisting of multidisciplinary healthcare providers from different levels of the organization, with formalized responsibility for implementation, (3) Tailor dual competence improvement, reflecting the need for knowledge and skills for fall prevention and implementation among healthcare providers and users, and (4) Provide implementation support, representing guidance through the implementation process.ConclusionsThis study advances our understanding of implementation in home care services. Implementation of fall prevention requires an implementation strategy involving a blend of essential components targeting leaders, competent healthcare providers and users, and establishing structures enhancing the implementation process.

Knowledge, Attitude and Practices of Health Care Providers towards Disaster and Emergency Preparedness in Mtwara, Tanzania

BackgroundOver the past decade, the magnitude and intensity of reported natural and human-made disasters have been rising globally with substantial mortality and long-term morbidity. ObjectivesTo assess the health care providers´ knowledge, attitude and practices towards disaster and emergency preparedness at Ligula Regional Referral Hospital in Mtwara, Tanzania.MethodsA descriptive and analytical cross-sectional study was conducted among 94 health care providers; and a stratified sampling technique was employed to recruit the participants. Bivariate and multivariable regression analyses were performed using IBM SPSS Statistics for Windows version 25.0 (IBM Corp, Armonk, NY, USA) to determine the association between independent and dependent variables. A P < 0.05 was considered statistically significant.Results More than half 50 (53.2%) and more than three-quarters 75 (79.8%) of the participants had adequate knowledge and positive attitude towards disaster and emergency preparedness respectively. Younger participants aged 20–29 years had 5.252 (95% CI 1.313–21.016) times higher odds of having adequate knowledge of disaster and emergency preparedness than the older groups. ConclusionsMore disaster and emergency preparedness training programs and clinical simulations are needed to enhance the competencies of health care providers in handling disastrous events efficiently.Rwanda J Med Health Sci 2023;6(3):303-314

Feeling uncomfortable in your own skin: a qualitative study of problematic skin picking in Italian women

Skin picking disorder (SPD) is a body-focused repetitive behavior recently added to the DSM-V. It mainly affects women, with a prevalence ranging from 1.5 to 5.4%. Picking causes skin lesions that can lead to serious infections and permanent skin problems, usually on the face, scalp, arms, and legs. The behavior impairs quality of life and is associated with psychological distress and difficulties in managing emotions. The disorder causes social embarrassment, leading to avoidance and social withdrawal. As the literature on the perspectives of people with SPD is limited, our research aimed to analyze the meanings they attribute to the behavior and its consequences. A second aim was to explore how interacting with an online community can affect the management of the condition. Using a qualitative descriptive approach, we interviewed twenty-one Italian women (aged 18–50) who self-identified as having SPD and were recruited through an online forum dedicated to the disorder. Three themes framed our analysis: “A stick in the wheel of everyday life,” “Other people’s eyes make you realize what you are doing is wrong,” and “The struggling search for control.” These themes highlight the impact of SPD on different areas of life, the difficulties in accessing competent healthcare providers, the stigma experienced by participants, and the usefulness of the online group on an informative, emotional, and social level. A better understanding of these patients’ perspectives can be useful for those providing professional care and those planning services for them in a Health Co-Inquiry approach that values patients’ activation.

Establishing an evidence-based cultural competency program with advanced practice providers in a community oncology setting.

199 Background: The United States continues to grow in both population and diversity. The trigger for this project was the dramatic increase in patient diversity in Texas and the lack of adequate cultural competency training for providers at a Texas Oncology clinic network. Clinicians must increase their self-awareness and knowledge to provide culturally competent care. The literature review found multiple educational modalities, across many health care disciplines, used by researchers to improve the cultural competency of health care providers. Methods: This project sought to improve satisfaction and adherence of patients over the age of 25 diagnosed with cancer by increasing provider cultural sensitivity and self-awareness of bias within 1 month of cultural competency training. The project sample was 14 advanced practice providers, 10 APRNs and 4 PAs. The educational plan for this project included an evidence-based course and a follow-up focus group to reinforce learning. Quantitative data were analyzed using the Cultural Competence Assessment tool to compare participants’ anonymous pre- and posteducation with the Wilcoxon signed-rank test. Qualitative data was obtained during focus groups. Results: The quantitative data indicated that cultural awareness and sensitivity increased following training, with median scores increasing from 6.09 to 6.55, p = 0.03. However, the data do not suggest that cultural competence and behavior changed after training, as median scores went from 3.96 to 4.23 after training, p = 0.06. Overall, the focus group participants agreed about improving self-awareness, identifying biases, improving patient experience by asking more open-ended questions, and being vulnerable. Conclusions: Despite the small sample size, the quantitative and qualitative data suggest that cultural awareness and sensitivity improved following the EBP course and focus group meetings. Cultural competency and behavior did not change according to the data. However, the project implications include improvement in provider knowledge and increased self-awareness, which promote individualized, culturally sensitive care.

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.

Displaced Women and Sexual and Reproductive Health Services: Exploring Challenges Women With Sexual and Reproductive Health Face in Displaced Camps of Nigeria

Background: Displaced women are affected by sexual and reproductive health (SRH) challenges, often exacerbated by poor living conditions, limited access to healthcare, and cultural norms. The aim of this study was to explore SRH issues, the effects of displacement into camps on women’s SRH, and challenges with accessing and utilizing SRH services among women in camps for the displaced in Benue State, Nigeria. Methods: A qualitative phenomenological approach was employed to gain an in-depth understanding of the women’s SRH challenges, based on 12 focus group discussions between women of different age groups and eight in-depth interviews. The data were collected using tape recorders and notes. Data analysis followed a thematic approach. Ethical approval and appropriate consent were obtained for the study. Results: The majority of research participants stated that sexually transmitted disease/human immunodeficiency virus was the most serious SRH issue in the camp. Their stay in camp enhanced the women’s vulnerability and exposed them to sex in exchange for basic needs/palliatives, increasing their SRH challenges. Access to and use of SRH services were impacted by their migratory lifestyle, cultural and religious views, lack of SRH knowledge, and other difficulties. Short-term approaches to intervention, health providers’ poor communication, and attitudes were reported to affect SRH service use. Conclusion: There is an urgent need for comprehensive interventions to address SRH challenges among women in displaced settings, including proper coordination of humanitarian services, education on transactional sex, encouragement of men to participate in SRH initiatives, and expansion of access to services, as well as the training and hiring of culturally competent healthcare providers.

Design of a Blended Learning Course for Training Community Healthcare Providers on eHealth-enabled Newborn Hearing Screening

Objectives. We present in this article the design and evaluation of a blended learning approach for training community healthcare providers in performing newborn hearing screening (NHS).Methods. We developed a blended learning course for training community healthcare providers on eHealth-enabled NHS, following Bloom’s revised taxonomy of educational objectives. The training involved three components: computer-based training (CBT), face-to-face (FTF) training, and on-site coaching. We used surveys and post-training interviews following Level 1 Kirkpatrick’s training evaluation model to get initial feedback on the training program.Results. Thirty-one community healthcare providers from five rural health units and a private hearing screening center, with a mean age of 42.2 ± 12.0 years, participated in the pilot. 93.5% of the participants agreed that the program content met stated objectives and was relevant to their practice. The length of the course was perceived to be adequate. Overall satisfaction with the program was rated at 8.5 ± 0.9 (with ten as the highest). The majority expressed that the CBT and FTF course were satisfactory at 93.5% and 100%, respectively. All participants agreed that the course enhanced their knowledge of newborn hearing screening and telehealth. Positive reviews were received from participants on the use of CBT to improve theoretical knowledge before FTF training. Participants declared that FTF training and on-site coaching helped improved NHS skills and implementation.Conclusion. Competent community healthcare providers are critical to strengthening the performanceof the health system, and advances in the education and technology sectors offer promising potential inupskilling local healthcare providers. The increasing access of Filipino healthcare providers to improvedinformation and communications technology (ICT) is a significant catalyst for pedagogical innovation, like the use of blended learning in the continuous professional development of health practitioners. As ICTs gradually penetrate the health sector, the challenge we now face is not whether but how we can use innovations in education strategies to benefit healthcare providers.

Barriers to and Recommendations for Equitable Access to Healthcare for Migrants and Refugees in Aotearoa, New Zealand: An Integrative Review.

The health system in Aotearoa New Zealand is predicated on equity in access to health services as a fundamental objective yet barriers to equitable access for migrant and refugees continue to exist. There is a paucity of studies that synthesise the experiences and realities of migrants, refugees and healthcare providers that hinder access to healthcare and provide recommendations to improve services. This review synthesised these barriers and recommendations, with an aim to improve equitable access to healthcare to migrants and refugees. An integrative review of 13 peer-reviewed research studies from EBSCOhost research databases published between January 2016 and September 2022. Studies included: (i) related to Aotearoa; (ii) had a focus on equitable delivery of healthcare to migrants and refugees; and (iii) had a full English text available. The PRISMA framework guided the reporting of the review. The findings were thematically analysed and presented using a narrative empirical synthesis. The findings were organised into three broad themes: attitudinal barriers, structural barriers, and recommendations. Attitudinal barriers included the lack of culturally competent healthcare providers, discrimination by healthcare providers, and personal, social, and cultural attributes. Structural barriers referred to policies and frameworks that regulated the accessibility of health services such as the cost of healthcare, accessibility and acceptability of interpreter services, length of allocated appointments and long waiting times for an appointment, difficulties navigating the health system, and logistical barriers. Recommendations focused on promoting a sense of belonging, enabling a whole-of-society approach that brings together all sectors involved in providing health care for collective impact, and advocating for government policies to create a system that addresses the core health service access needs. This review provides rich context-specific findings on the barriers to equitable access to healthcare and proposed interventions to enhance equitable health outcomes for migrants and refugees in Aotearoa. The review contributes to relevant policy decisions and has practical implications to build responsive health systems which are inclusive, equitable and best address the health needs of populations from diverse cultural backgrounds.

Significance of shadowing and its contribution to the development of competent healthcare providers.

Significance of shadowing and its contribution to the development of competent healthcare providers.