Competence Of Health Care Workers Research Articles

Global lessons on delivery of primary healthcare services for people with non-communicable diseases: convergent mixed methods

ObjectiveTo extract key lessons on primary healthcare (PHC) service delivery strategies for non-communicable diseases (NCD) from the work of researchers funded by the Global Alliance for Chronic Diseases (GACD).DesignA convergent...

Achieving the Right to Health of Immigrants: Focusing on Intercultural Competence

In the clinical field that provides health care services to immigrants, various medical ethics issues are raised, including discrimination, prejudice, hatred, lack of cultural sensitivity, and lack of understanding of various disease belief systems. The development of intercultural competence of health care workers to resolve this is an urgent task. Within a cultural background and context, care of patients from different cultures can be effectively and appropriately performed. Intercultural competencies of healthcare workers must continuously develop and strive for must be dealt with in various aspects of attitude, cognition, knowledge, and skill. Behavioral changes of health care workers must be brought about. Through this paper, we will examine the concepts, components, and intercultural competency process models, and examine the implications of strengthening the intercultural competence of health care workers for achieving right to health, a universal human right that migrants should have.

Are the final-year medical students competent enough to tackle the immunization challenges in their practice?

Background/Aim. The competence of healthcare workers (HCWs) to advocate the importance of immunization to persons who are hesitant about vaccines is extremely important. The aim of this study was to evaluate the final-year medical students? competencies related to immunization challenges in their practice using their knowledge, attitudes, and study practices. Methods. The cross-sectional study was conducted among 442 final-year students of the Faculty of Medicine, University of Belgrade, Serbia. The instrument used for data collection was an anonymous questionnaire consisting of 38 questions. Hierarchical multiple regression analysis was conducted to identify the predictive value of different factors in immunization knowledge among medical students. Results. The median total knowledge score with the interquartile range was 7 ? 3.00 out of 13. There was a statistically significant positive correlation between the knowledge score and the grade point average (GPA) (r = 0.207, p < 0.001). Thirty-five percent of students felt moderately capable of conducting work regarding vaccination without supervision. Furthermore, 92.1% of students considered that additional training and information channels about immunization needed to be implemented in curricula for HCWs. The results of the hierarchical regression analysis showed that gender, age, GPA, study duration, self-confidence regarding immunization knowledge, the flu, and hepatitis B vaccination status explained a total of 36% of the variance in the immunization knowledge score. Less than two-thirds of students believed they had enough knowledge to reassure a person hesitant about immunization. Conclusion. The results of our study showed an average level of knowledge about immunization among final-year medical students. As less than two-thirds of students believe that they have enough knowledge to reassure a hesitant person, there is a need for a better understanding and improving the parts of the curricula of medical faculties regarding immunization.

CULTURAL COMPETENCE OF HEALTH CARE WORKERS: A STUDY OF SASARAM/BIHAR

The socio-cultural diversity within our society poses challenges for the healthcare professional to ensure the quality of health care services. Addressing the cultural competencies of the health care professional is the strategic approach to improve the quality and effectiveness of the health care services for socially and culturally diverse groups. Cultural competence is the ability of the professional to recognize, appreciate, and respect the values, preferences, and expressed needs of patients seeking health care services under their care. In Rural health care settings, the ethnics and cultural differences based on caste, class and gender create severe challenges for the health care professional to address the expectation and needs of the patients which leads to miscommunication and dissatisfaction among the patients which even challenges the ethical values of the health care professionals. Therefore cultural competence has to be integrated into health care practices very effectively. Evidence from various studies showcases that cultural competence training of the health care professional is quite effective in promoting the knowledge, attitudes, skills of the profession on cultural sensitiveness and practices which can be effective in fulfilling the goal of health for all. Therefore this study emphasized understanding the issues associated with the cultural competence of the healthcare professional in rural healthcare settings by outlining the concept of the cultural competence from rural healthcare settings and by exploring the existing consequence of deficiencies in cultural aspects in health care. It is evident from the study that many staff engaged in the rural health care setting recognise the importance of the issues and opinion that the issues must be addressed so that the health practices can be enhanced. Based on the opinion of the respondents finally through the study effort has been made to propose the possible social work intervention to address the issues and promote cultural competencies among the health care professionals. The social work intervention focused on intensive training on cultural competence and cross-cultural issues for health professionals and ensuring multidomain teams work so that the cultural barrier can be overcome effectively.

Perceptions toward and practices regarding antibiotic stewardship and use among physicians at tertiary-care public hospitals in Bangladesh

Background: The emergence of antimicrobial resistance (AMR) is affecting public health management in developing countries, including Bangladesh. Irrational and inappropriate use of antibiotics in healthcare settings has led to widespread drug resistance. To optimize antimicrobial usage to combat AMR and enhance infection treatment, the competence of healthcare workers in antibiotic prescribing is indispensable. We sought to determine the perceptions about antimicrobial resistance, antibiotic stewardship programs (ASPs), and antibiotic prescribing approaches among physicians at tertiary-care public hospitals in Bangladesh. Methods: From September to December 2020, we conducted a mixed-methods study in 9 tertiary-care public hospitals. Using a self-administered, semistructured questionnaire, we collected data on antibiotic stewardship and prescribing practices from 452 on-duty physicians. In addition, we conducted 16 key-informant interviews to explore AMR perceptions and determinants. Results: Only 43.8% of physicians were aware of the ASP, and none of the hospitals had any ASP initiative in place. Most of the participants (70.6%) recommended tailored training and antibiotic prescribing guidelines (63.7%) for effective ASP initiatives. More than half of the physicians (54.7%) preferred to receive regular monitoring and feedback on their routine antibiotic prescriptions from the stewardship program. In terms of the antibiotic prescribing approach, only 25.9% of physicians relied on microbiology lab findings, whereas 69.5% routinely employed oral or intravenous antibiotics. Also, 40.0% of physicians considered the patient’s ability to afford the antibiotic cost when recommending antibiotics. The qualitative investigation identified the use of broad-spectrum antibiotics, absence of guidelines, and inadequate laboratory support as factors contributing to AMR in the healthcare setting. Self-medication, over-the-counter dispensing, and patients’ economic instability to complete the dosage were also attributed to the irrational use of antibiotics. As a priority step, physicians advocated for intensive training on antibiotic advising, mass awareness campaigns on safe antibiotic usage and dispensing, and a restriction on the widespread sale of antibiotics from pharmacies. Conclusions: Despite favorable perceptions, the fundamental understanding of physicians regarding ASPs and rational prescribing of antibiotics needs to be improved through context-specific educational interventions and capacity building. In addition, a coherent and comprehensive policy is required for the development and implementation of antibiotic usage guidelines along with integrated ASP initiatives to combat AMR.Funding: NoneDisclosures: None

Effect of in-hospital training in newborn resuscitation on the competence of health-care workers in resuscitating newborn infants at birth at Mboppi Baptist Hospital, Douala, Cameroon.

Introductionneonatal mortality accounts for the most significant proportion of under-five mortality worldwide, as in Cameroon. Birth asphyxia is the leading cause of neonatal deaths in Cameroon. Training of health care workers (HCWs) in newborn resuscitation reduces neonatal morbidity and mortality. In this study, we evaluated the effect of in-hospital training on the competence (knowledge and skills) of HCWs in newborn resuscitation at Mboppi Baptist Hospital, Douala, Cameroon.Methodsthis was a quasi-experimental study done in five weeks, in which we compared knowledge and skills before and after training. Assessment of knowledge and skills of HCWs in newborn resuscitation was done before training (simulations) and a week after training using World Health Organization (WHO) adapted Emergency Triage Assessment and Treatment (ETAT+) standard tool. Three key informant interviews (KIIs) and a focused group discussion (FGD) were held to determine barriers to effective newborn resuscitation. Data were analyzed using R software version 3.6.2. McNemar test and Cohen´s Kappa were used to analyze quantitative data, while major themes from KIIs and FGDs were selected for qualitative data.Resultswe enrolled 30 HCWs, each HCW was observed twice, a total of 60 deliveries observed before and 60 after training. Sixteen HCWs (53%) showed adequate knowledge before and after training. Median scores for skills significantly increased by 28% (p<0.00054) for real-life observations and 26% (p=0.0004) for newborn resuscitation scenario simulations. The main barriers to adequate newborn resuscitation were inadequate knowledge, equipment, shortage of trained staff and poor teamwork between midwives and anesthetists.Conclusionin-hospital training on newborn resuscitation improved the skills of HCWs but had no significant effect on their knowledge on newborn resuscitation. We would recommend that in-hospital training in newborn resuscitation be done often for HCWs.

CULTURAL COMPETENCE OF HEALTH CARE WORKERS ON MATERNAL HEALTH CARE SERVICE UTILIZATION AMONG MOTHERS OF MOUNT ELGON CONSTITUENCY BUNGOMA, KENYA

Purpose: To determine cultural competence of health care workers on maternal health care service utilization among mothers of Mt. Elgon Constituency in Bungoma County.&#x0D; Methodology: A descriptive-analytical cross-sectional study design was adopted using mixed methods for data collection. Cultural competence tool was used to assess health care workers cultural competence. Qualitative data was collected using key informant interviews (KII) and focus group discussion (FGD). Data entry and analysis was done using SPSS Version 25 software. Descriptive and inferential statistical analyses were used. Bivariate and multivariate logistic regressions were applied and odds ratio used to determine the strength of association. A p-value of ≤ 0.05 was considered as statistical significance threshold.&#x0D; Findings: Unemployment (OR: 0.6; 95% CI: 0.4 – 0.9; p = 0.02); lack of mobile clinic (OR: 0.7; 95% CI: 0.4 – 1.0; p = 0.06 ); use of interpreter (OR: 0.2; 95% CI: 0.01 – 0.81; p = 0.02); service provided in public facilities (OR: 0.5; 95% CI: 0.3 – 0.8; p = 0.004); being too busy (OR: 0.5; 95% CI: 0.3 – 0.9; p = 0.02); consulting health care workers (OR: 0.5; 95% CI: 0.2 – 0.9; p = 0.03); not consulting elders (OR: 0.7; 95% CI: 0.4 – 1.0; p = 0.08) and culturally incompetent ( 100%) were significantly associated with utilization of maternal and child health services. The determinants of maternal health care service utilization in Mt. Elgon Sub-County are women who are employed (OR: 2.8; 95% CI: 1.1 – 7.3; p=0.03) and cultural incompetence of health care workers (100%).&#x0D; A unique contribution to theory, practice, and policy: The study findings have identified cultural competence gaps among health care workers which need to be addressed by policy makers to increase utilization in the study area and other similar environment

Development of an instrument to measure the cultural competence of health care workers.

ABSTRACTOBJECTIVETo validate an instrument measuring the cultural competence in health care workers from Chile.METHODSUsing Sue & Sue’s theoretical model of cultural competence, we designed a scale, which was assessed by health care workers and experts. Subsequently, the scale was applied to a sample of 483 different health care workers, during 2018 in Santiago de Chile. The analysis included: exploratory and confirmatory factor analysis, estimation of reliability, and analysis of measurement bias. Finally, the level of cultural competence was calculated for every professional who participated in this study.RESULTSThe final scale include 14 items that are grouped into three dimensions concordant with the theoretical model: sensitivity to own prejudices, cultural knowledge, and skills to work in culturally diverse environments. This scale showed good fit in factor models, adequate reliability and lack of evidence of measurement bias. Regarding the performance of health care workers, sensitivity showed a lower level compared with the other dimensions evaluated.CONCLUSIONThe scale for measuring the level of cultural competence in health care workers (EMCC-14) is a reliable instrument, with initial support for its validity, which can be used in the Chilean context. Additionally, the results of this study could guide some possible interventions in the health sector to strengthen the level of cultural competence.

Evidence-Based Genetic Education of Non-Genetic-Expert Physicians: Experiences Over Three Decades in Amsterdam.

To study and improve the competences of health-care workers in the domain of genetics, attention needs to be paid to attitudes, activities, knowledge, and changes in performance. Three decades of research on genetic education for non-genetic-experts in Amsterdam are summarized, including both local and international collaborative efforts. Evidence shows that assessment of learners’ needs and the definition of competences have driven slow but gradual improvement in genetics competence among non-geneticists. Attitudes and behavior are mainly influenced by face-to-face training. eLearning modules can serve to increase knowledge in a large number of participants in a rapidly changing field. Materials developed for accredited courses will sometimes be used for reference or just in time learning. Taking a theoretically informed evaluation approach, it has been possible to demonstrate satisfaction, improved knowledge, and self-reported behavioral change, although measuring effects on health-care practice and population health remains challenging. A flexible approach is needed to serve learners’ needs in a field with many upcoming challenges.

Harmonization of European and Russian standards of evaluation of the quality of delivery of health care in educational organizations

Harmonization of European and Russian standards of the quality of the delivery of school health services and competencies for school health professionals allowed to justify the concept of the evaluation of the quality of the delivery of medical help to students in educational institutions. The concept does not prescribe a concrete methodfor the organizing school health services, unified process of the activity of health professionals. The concept consists of 7 groups of indices of quality and competences of health care workers. Quality criteria include the presence of a regulatory framework, indices of benevolence towards children, social equity and access to health care for students, requirements for premises, equipment of medical rooms in schools, cooperation with the administration and teachers of schools, parents and children, the medical community, the requirements for health care workers, a minimum list of services, covering both population and individual needs of students, the secure storage, the management and use ofpersonal medical data of children and adolescents. The competences of the staff of medical units are determined by provided medical services and technologies of the work. Properly medical competences of workers of medical care units for the delivery of medical aid to students are contributed by willingness to ensure the rights of children in the process of health care delivery in the educational organization, skills in the field of communication, sharing of information with children, parents and teachers, cooperation with colleagues, planning and coordination of the organization of medical care, the provision of sanitary epidemiological well-being of students, informational-elucidative activity for shaping of healthy lifestyle, research activity. Concept is the basis of the algorithm of the evaluation of the quality of the delivery of medical aid to students and quality assessment technology as well by medical organizations and institutions, as in the form of an independent audit of the quality of the delivery of medical aid to students in educational institutions.

The perceived needs-access gap for health services among persons with disabilities in a rural area within South Africa

Purpose: Health should be a universal phenomenon. However, little is known about the relationship between disability status and health issues – particularly in rural areas. This study looks at health issues of persons with disabilities in Madwaleni, a rural impoverished area in South Africa in 2011, and compares them to persons with no disabilities.Materials and Methods: Standardized questionnaires were used in the survey to assess disability and health status. The sample comprised of 773 individuals – 322 persons with disability and 451 comparisons (without disability) – covering 527 households. Children under the age of five were excluded from the sample. We used purposive sampling.Results and Conclusion: This study found that persons with disabilities have poorer reported health outcomes than persons with no disabilities. There is also an association between disability severity and mental health issues as assessed by the GHQ-12. A significantly higher percentage of persons with disability did not get health care when needed. Persons with disabilities also have less favorable attitudes toward competence of health care workers. This study has shown greater health needs and less satisfaction with services, which strongly indicates insufficient access for persons with disabilities in a rural impoverished are within South Africa.Implications for rehabilitationPersons with disabilities in rural South Africa have poorer reported health outcomes.Persons with disabilities have less favorable attitudes towards competence of health care workers in rural South Africa.Better access to health care for persons with disabilities is needed in rural South Africa.

Health Worker Focused Distributed Simulation for Improving Capability of Health Systems in Liberia.

The main goal of this study was to produce an adaptable learning platform using virtual learning and distributed simulation, which can be used to train health care workers, across a wide geographical area, key safety messages regarding infection prevention control (IPC). A situationally responsive agile methodology, Scrum, was used to develop a distributed simulation module using short 1-week iterations and continuous synchronous plus asynchronous communication including end users and IPC experts. The module contained content related to standard IPC precautions (including handwashing techniques) and was structured into 3 distinct sections related to donning, doffing, and hazard perception training. Using Scrum methodology, we were able to link concepts applied to best practices in simulation-based medical education (deliberate practice, continuous feedback, self-assessment, and exposure to uncommon events), pedagogic principles related to adult learning (clear goals, contextual awareness, motivational features), and key learning outcomes regarding IPC, as a rapid response initiative to the Ebola outbreak in West Africa. Gamification approach has been used to map learning mechanics to enhance user engagement. The developed IPC module demonstrates how high-frequency, low-fidelity simulations can be rapidly designed using scrum-based agile methodology. Analytics incorporated into the tool can help demonstrate improved confidence and competence of health care workers who are treating patients within an Ebola virus disease outbreak region. These concepts could be used in a range of evolving disasters where rapid development and communication of key learning messages are required.

Competence of Healthcare Workers in Sexual Health Education for Female Adolescents at Schools

Background & aim: Sexual health education is one of the responsibilities of healthcare workers at schools, which can reduce the risk of sexually transmitted diseases such as AIDS, unwanted pregnancy, abortion, substance abuse, sexual violence, and suicidal tendencies. This study aimed to investigate healthcare workers’ competence in sexual health education for female adolescents at schools. Methods:This cross-sectional study was conducted on 300 healthcare workers, responsible for sexual health education at schools in 2015. A valid and reliable researcher-made questionnaire was completed by the healthcare workers in order to assess their competence in sexual health education at healthcare centers of Khuzestan, Iran. To assess the competence of the participants (i.e., knowledge, attitude, confidence, and performance), descriptive statistics were calculated for quantitative variables. Also, mean, standard deviation, frequency, and percentage were calculated for qualitative variables. Pearson’s correlation test was performed to assess the relationship between the subjects’ knowledge, attitude, confidence, and performance. Also, the association between demographic variables and participants’ knowledge, attitude, confidence, and performance was evaluated, using analysis of variance (ANOVA). Data were analyzed, using SPSS version 21.0. Results: Knowledge, attitude, and confidence of healthcare workers in sexual health education were desirable. However, the subjects showed a poor performance in teaching students the required skills to control their emotions, instincts, homosexual tendencies, and masturbation. There was a significant correlation between performance, attitude, and confidence, knowledge and attitude, performance and confidence, and confidence, performance, and attitude (P<0.05). Academic field and educational level had significant impacts on knowledge; also, employment status influenced the subjects’ knowledge and attitude. However, statistical analysis did not indicate a significant association between other variables (P<0.05). Overall, the knowledge, attitude, confidence, and performance of the midwifery staff were more desirable than other healthcare providers. Conclusion: Despite the adequate knowledge, positive attitude, and confidence of healthcare workers, their performance on sexual health education, especially taboo topics, was unacceptable. To eradicate the adolescents’ problems in sexual health, it is necessary to conduct broad investigations to identify the underlying causes of healthcare workers’ weak performance in this context.

A Model for Designing a Geriatric Physical Therapy Course Grounded in Educational Principles and Active Learning Strategies

INTRODUCTIONThe goal of physical therapist education programs is to prepare practitioners to evaluate and treat movement dysfunction for individuals across the lifespan.1 The US Census Bureau projects that by 2050 the number of over age 65 in the United States is expected to reach 88.5 million-nearly double the 40.2 million over that age in 2010. 2 In 2008, the Institute of Medicine (IOM) of the National Academies published recommendations for preparing and growing the health care workforce in preparation for a graying America. This report emphasized the need to improve the geriatric-specific competence of health care workers, increase the number of geriatric specialists in all health professions, and develop new models for geriatric care delivery.3As the older segment of the population grows, so too does the proportion of older adults comprising the caseload of the typical physical therapist. The 2006 Practice Profile Survey from the American Physical Therapy Association tracked the mean percentage of patient care time spent with individuals by age group.4 persons (age 65 and over) comprised a majority of patient care time per week by practice setting, including: approximately 82% in skilled nursing facilities, 60% in home care, 54% in sub-acute rehabilitation hospitals, 52% in acute care hospitals, 31% in hospital-based outpatient clinics, and 27% in private practice. Specialized training is essential in both the academic and clinical environments to prepare physical therapist graduates to meet the needs of the older adult population across health care settings.John Rowe, chairman of the National Academy of Sciences Committee on the Future Healthcare Workforce for Older Americans, emphasized the need for all health care workers to demonstrate basic competence in geriatric care. This competence necessitates significant enhancements in educational curricula and training programs3(p xii) available to health care providers.3 A number of curriculum development models for physical therapist professional education have been described in the literature.59 These models discuss the development of curriculum on a larger program-level scale, considering factors that extend across academic courses of a given program. Shepard and Jensen discuss a general framework for stand-alone course design through their preactive teaching grid.7 The grid helps instructors to consider 10 different dimensions of instructional design, such as teaching methods, assessments, student preferences, and learning environment, in preparation for a course or single learning event. Models for content-specific course design in physical therapy, including geriatric physical therapy, are limited.10'13The purpose of this paper is to describe and evaluate a model for the design, development, and implementation of a dedicated course in a Doctor of Physical Therapy (DPT) program on the management of the aging adult. Educational theory that promotes student engagement, reflective practice, clinical decision making, and problem solving will be presented, followed by how these educational principles were incorporated into the course design. Grounded in educational principles, this model optimizes learning and preparedness for geriatric physical therapist clinical practice. The following describes the theoretical framework as the basis for this course design model, application of the design process to a course on the management of the older adult, and evaluation of the course outcomes to determine the efficacy of this model. We apply the model to a geriatrics course, but the model may be used to design or redesign courses related to a broad array of didactic content areas.Theoretical FrameworkCourse development is an iterative process requiring continuous assessment and alignment of objectives, instructional methods, and learner outcomes, incorporation of learner feedback, and integration of current evidence and trends in clinical practice (Figure 1). …

Patient Satisfaction with HIV/AIDS Care and Treatment in the Decentralization of Services Delivery in Vietnam

ObjectiveWe evaluated the patient satisfaction with HIV/AIDS care and treatment and its determinants across levels of health service administration in Vietnam.MethodsWe interviewed 1016 patients at 7 hospitals and health centers in three epicenters, including Hanoi, Hai Phong, and Ho Chi Minh City. The Satisfaction with HIV/AIDS Treatment Interview Scale (SATIS) was developed, and 3 dimensions were constructed using factor analysis, namely “Quality and Convenience”; “Availability and Responsiveness”; and “Competence of health care workers”.ResultsIn a band score of (0; 10), the mean scores of all domains were large; it was the highest in “Competence of health workers” (9.34±0.84), and the lowest in “Quality and Convenience” (9.03±1.04). The percentages of respondents completely satisfied with overall service quality and treatment outcomes were 42.4% and 18.8%, respectively. In multivariate analysis, factors related to higher satisfaction included female sex, older age, and living with spouses or partners. Meanwhile, lower satisfaction was found among patients who were attending provincial and district clinics; in the richest group; had higher CD4 count; and drug users.ConclusionThis study highlights the importance of improving the quality of HIV/AIDS services at the provincial and district clinics. Potential strategies include capacity building for health workers, integrative service delivery, engagements of family members in treatment supports, and additional attention and comprehensive care for drug users with HIV/AIDS.

Childhood sexual abuse: help make it ‘Safe to Say’

Childhood sexual abuse remains a taboo subject and requires sensitive handling by committed and caring services (Scottish Executive, 2004). By introducing a training programme, Safe to Say, the Scottish Association of Mental Health aims to improve the confidence and competence of healthcare workers when faced with the sensitive disclosure of childhood abuse. This article aims to explore the effects of childhood sexual abuse and the attitudes of health professionals when faced with adult survivors disclosing such abuse. Despite Government strategies, there still appears to be a lack of suitable services for adult survivors of childhood sexual abuse, even though health professionals have an essential role in supporting disclosure and promoting recovery (Read et al, 2005).