Context-specific Interventions Research Articles

Integrating the concept of peacebuilding in sustainability impact assessment

This paper integrates peacebuilding components into sustainability impact assessment (SIA) for application in geographies vulnerable to, recovering from, or experiencing conflict. Based on the understanding that peace is a crucial pre-requisite for sustainable development and vice versa, it argues that integrating peacebuilding into SIA will enhance the development potential; particularly in conflict-affected countries. So far, SIA does not address this nexus of development and peace. Comprehensive SIA prior to implementation (i.e. ex-ante) facilitates reflections on outcomes (positive and negative), helping to design context-specific best-fit interventions. The objective of this study is to develop a set of peacebuilding indicators for future impact assessments. The study finds that existing SIA tools address many aspects, particularly economic and environmental impacts, but, although crucial to enhance societal relations and peace(building), these neglect societal aspects relating to social cohesion, agency, and transformation capacity. Thus, 17 indicators for assessing peacebuilding potential are proposed for integration in SIA in conflict-affected areas. The indicators are grouped into four components aligning with the key areas identified as missing in existing SIA frameworks but also crucial for positive peace: social cohesion, agency, negotiation capacities, and compensations.

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

UK obstetric sonographers' experiences of the COVID-19 pandemic: Burnout, role satisfaction and impact on clinical practice.

The COVID-19 pandemic placed additional demands and stressors on UK obstetric sonographers, who were required to balance parent safety and service quality, alongside staff safety. Increased pressure can negatively impact a healthcare worker's well-being and the provision of person-centred care. The aim of this study was to explore obstetric sonographers' experiences of performing pregnancy ultrasound scans during the pandemic and to assess the impact on burnout, role satisfaction and clinical practice. An online, anonymous cross-sectional survey was created to capture sonographers' experience alongside using the Oldenburg Burnout Inventory to evaluate burnout and Clinical Outcomes in Routine Evaluation 10 (CORE-10) to measure psychological distress. Responses were received from 138 sonographers. Of those completing the Oldenburg Burnout Inventory (n = 89), 92.1% and 91.0% met the burnout thresholds for exhaustion and disengagement, respectively. Sonographers with a higher burnout score also perceived that COVID-19 had a greater, negative impact on their practice (p < 0.05). The mean CORE-10 score of 14.39 (standard deviation = 7.99) suggests mild psychological distress among respondents. A significant decrease in role satisfaction was reported from before to during the pandemic (p < 0.001), which was associated with higher scores for burnout and psychological distress (p < 0.001). Change in role satisfaction was correlated with sonographers' perception of safety while scanning during the pandemic (R 2 = 0.148, p < 0.001). Sixty-five sonographers (73.9%) reported they were considering leaving the profession, changing their area of practice or working hours within the next 5 years. Job and context-specific interventions are required to mitigate burnout and its consequences on the workforce and service provision beyond the pandemic.

Perceptions, views and practices regarding antibiotic prescribing and stewardship among hospital physicians in Jakarta, Indonesia: a questionnaire-based survey

ObjectivesAntibiotic overuse is one of the main drivers of antimicrobial resistance (AMR), especially in low-income and middle-income countries. This study aimed to understand the perceptions and views towards AMR, antibiotic...

Factors associated with health insurance ownership among women of reproductive age: A multicountry study in sub-Saharan Africa.

BackgroundPromoting the coverage and ownership of health insurance constitutes a key strategy to achieving universal healthcare, thereby meeting the Sustainable Development Goal (SDG 3.8) of safeguarding the vulnerable population from financial risk resulting from catastrophic health expenditures. In sub-Saharan Africa, accessing medical services is particularly challenging among women due to inadequate opportunities for socio-economic empowerment and meeting their unique healthcare needs. The present study aimed to explore the sociodemographic factors associated with health insurance ownership among women in selected countries in sub-Saharan Africa.MethodsWe extracted cross-sectional data on health insurance ownership and conceptually relevant sociodemographic variables on women aged 15–49 years from Demographic and Health Surveys on five selected countries in sub-Saharan Africa (n = 55,438), including Burkina Faso, DR Congo, Cameroon, Gabon and Kenya. Data were analyzed using descriptive and multivariate regression analysis, and the associations were reported in terms of average marginal effects.ResultsData revealed considerable cross-country variation in health insurance ownership: Gabon (57.9%), Kenya (6.1%), DR Congo (2.8%), Cameroon (1.1%), Burkina Faso (0.4%). In the multivariate regression analysis, women’s age, marital status, place of residency, educational level, household wealth status, employment, and media access were significant predictors of insurance ownership. The associations were generally similar across the five countries, with higher age, better educational level and wealth status showing a consistently positive relationship with insurance ownership.ConclusionOur findings revealed striking inequality in health insurance ownership among the studied countries, which should be given due attention to achieving universal healthcare-related goals. There also exist considerable sociodemographic disparities in health insurance ownership among women that should be addressed using context-specific programmatic interventions. Our findings revealed striking inequality in health insurance ownership among the studied countries, which should be given due attention to achieving universal healthcare-related goals. There also exist considerable sociodemographic disparities in health insurance ownership among women that should be addressed using context-specific programmatic interventions.

Neuroinflammation, Stroke, Blood-Brain Barrier Dysfunction, and Imaging Modalities.

Maintaining blood-brain barrier (BBB) integrity is crucial for the homeostasis of the central nervous system. Structurally comprising the BBB, brain endothelial cells interact with pericytes, astrocytes, neurons, microglia, and perivascular macrophages in the neurovascular unit. Brain ischemia unleashes a profound neuroinflammatory response to remove the damaged tissue and prepare the brain for repair. However, the intense neuroinflammation occurring during the acute phase of stroke is associated with BBB breakdown, neuronal injury, and worse neurological outcomes. Here, we critically discuss the role of neuroinflammation in ischemic stroke pathology, focusing on the BBB and the interactions between central nervous system and peripheral immune responses. We highlight inflammation-driven injury mechanisms in stroke, including oxidative stress, increased MMP (matrix metalloproteinase) production, microglial activation, and infiltration of peripheral immune cells into the ischemic tissue. We provide an updated overview of imaging techniques for in vivo detection of BBB permeability, leukocyte infiltration, microglial activation, and upregulation of cell adhesion molecules following ischemic brain injury. We discuss the possibility of clinical implementation of imaging modalities to assess stroke-associated neuroinflammation with the potential to provide image-guided diagnosis and treatment. We summarize the results from several clinical studies evaluating the efficacy of anti-inflammatory interventions in stroke. Although convincing preclinical evidence suggests that neuroinflammation is a promising target for ischemic stroke, thus far, translating these results into the clinical setting has proved difficult. Due to the dual role of inflammation in the progression of ischemic damage, more research is needed to mechanistically understand when the neuroinflammatory response begins the transition from injury to repair. This could have important implications for ischemic stroke treatment by informing time- and context-specific therapeutic interventions.

Impact of a Novel Social Work Program on Access to Tertiary Care.

Background:In the movement for global health equity, increased research and funding have not yet addressed a shortage of evidence on effectively implementing context-specific interventions; one unmet need is facilitating access to specialty care within the public health sector in Mexico. Compañeros en Salud has been piloting a novel program, called Right to Healthcare (RTHC), to increase access to specialty care for the rural poor in Chiapas, Mexico. The RTHC program incorporates social work, patient navigation, referrals, direct economic support, and accompaniment for patients.Objectives:This study evaluates the effectiveness of the RTHC program. Primary outcomes analyzed included acceptance of any referral and attendance of any appointment. Secondary outcomes included acceptance of the first referral and rate of appointment attendance for patients with an accepted referral.Methods:Using referral process data for the years 2014 to 2019 from a public tertiary care hospital in Chiapas, 91 RTHC patients were matched using 2:1 optimal pair matching with a control cohort balancing covariates of patient age, sex, specialty referred to, level of referring hospital, and municipality.Findings:RTHC patients were more likely to have had an accepted referral (OR 17.42, 95% CI 3.68 to 414.16) and to have attended an appointment (OR 5.49, 95% CI 2.93 to 11.60) compared to the matched control group. RTHC patients were also more likely to have had their first referral accepted (OR 2.78, 95% CI 1.29 to 6.73). Among patients with an accepted referral, RTHC patients were more likely to have attended an appointment (OR 3.86, 95% CI 1.90 to 8.57).Conclusions:The results demonstrate that the RTHC model is successful in increasing access to specialty care by both increasing referral acceptance and appointment attendance.

Spatial dependency in child malnutrition across 640 districts in India: need for context-specific planning and interventions.

Child malnutrition remains a matter of concern in India as the current levels are high and the decline is slow. National Family Health Survey (NFHS-4, 2015-16) data, for the first time, provides credible, good quality data at district level on social, household and health characteristics. Techniques of spatial analysis on data in respect of 640 districts were used to identify spatial characteristics of the nutrition levels for children in the 0-60-month age group. Further, the principal component analysis (PCA) was used to identify 7 important correlates of the malnutrition out of 21 relevant components provided in the NFHS-4. The paper further uses three techniques, ordinary least squares (OLS), spatial lag model (SLM) and spatial error model (SEM) to assess the strength of correlation between the malnutrition levels and the shortlisted correlates. The use of SLM and SEM shows improvement in the strength of the association (high R-square) compared to OLS. Women's height and Iodized salt in stunting, child anaemia in wasting, women's height and child anaemia in underweight were found to be significant factors (P<0.01) along with spatial autoregressive constant. Such analysis, in combination with PCA, has shown to be more effective in prioritizing the programme interventions for tackling child malnutrition.

Antecedents of disruptive behaviours involving radiographers at central hospitals in Harare Metropolitan Province, Zimbabwe

IntroductionAlthough disruptive behaviours (DBs) are universal in healthcare, each healthcare setting, profession or department presents unique DBs antecedents. Gaining better insights into the antecedents of DBs is crucial in order to put together a tailor-made program designed to raise awareness, establish accountability, and provide resources to mitigate their impact. There are, however, a few studies exploring antecedents of DBs involving radiographers, more so in low resource settings like Africa. The aim of the study was to determine the antecedents of DBs involving radiographers employed by central hospitals in Harare Metropolitan Province, Zimbabwe. MethodsA descriptive cross-sectional survey was carried out from January to March 2021 at central hospitals in Harare Metropolitan Province, Zimbabwe. A self-administered questionnaire was used to capture the views of 100 randomly selected radiographers. ResultsThere was a significant agreement that the following are antecedents of DBs: frustration due to poor working conditions (Mean = 3.93.p < .0005); long waiting times for patients (Mean = 3.91.p < .0005); a sense of privilege and status for those at the top (Mean = 3.87.p < .0005); burnout or fatigue (Mean = 3.79.p < .0005); narcissism (Mean = 3.79.p < .0005); differences in communication styles (Mean = 3.68.p < .0005); divergence of opinions or thoughts (Mean = 3.59.p < .0005); personal conflicts or family problems (Mean = 3.57.p < .0005); self-protection against feelings of inadequacy (Mean = 3.42.p < .0005); dysfunctional organizational culture (Mean = 3.38.p < .0005) and cultural, generational or gender bias (Mean = 3.32.p < .0005). ConclusionThis study identifies the antecedents of DBs involving radiographers at central hospitals in Harare Metropolitan Province. It is crucial that any attempts at finding solutions to address the behaviours should be based on evidence of the antecedents in the setting concerned. Implications for practiceThis will help in the understanding of the antecedents of DBs involving radiographers so that context specific interventions to address these behaviours are formulated.

Context specific HIV risk: evidence from screening into the southern pre-exposure prophylaxis study (SPECS)

ABSTRACT While Pre-exposure prophylaxis (PrEP) is efficacious in preventing HIV, little is known about PrEP use among those on community supervision. The Southern Pre-Exposure Prophylaxis Study (SPECS) investigates barriers and facilitators for PrEP initiation and use among adults on community supervision (e.g., probation, parole). Challenges to PrEP use in this setting are abundant. SPECS uses a mixed-methods sequential design, including a multi-site, prospective cohort study in three southern states – North Carolina, Florida, and Kentucky. This analysis describes individual demographic, criminal legal, and HIV risk factor characteristics, by site and enrollment status. Pooled association analyses accounted for site via stratified statistical tests. Between June 2019-March 2020, SPECS screened 702 individuals and enrolled 276 participants (39%). Of those who were eligible, 98% agreed to enroll. Age, gender, and sexual orientation varied by enrollment and by site, while race/ethnicity varied by site but not enrollment status. Criminal legal histories varied by enrollment and HIV risk factors varied by site. SPECS provides a granular and detailed assessment of HIV risk in three diverse southern settings. It highlights how the level and type of HIV risk varies by location and by nature of criminal legal involvement and calls for the need for context-specific interventions for HIV prevention.

Understanding the Health and Well-being of Canadian Black Children and Youth during the COVID-19 pandemic: A Review

The COVID-19 pandemic has exacerbated health inequities and vulnerabilities in our society, with the Black population being disproportionately affected. As previous pandemics have resulted in an increase in adverse events to children and youth, we reviewed the literature to examine the impact of the COVID-19 pandemic on Black children and youth. We found Black children and youth experience psychosocial stressors related to uncertainties of the future. Differential gender effects related to COVID-19 are also apparent. Physical distancing related to the COVID-19 pandemic which resulted in differential impacts on physical activity levels in children. We also noted, increase levels of isolation may result in undetected child abuse. The review highlights the urgent need for multifaceted interventions that address disparities in social determinants of health and psychosocial needs of Black children and youth in Canada. Future research that addresses the effects of the COVID-19 pandemic on Black children and youth is needed to help create context-specific interventions.

Factors associated with men’s opinion about female genital mutilation in Ethiopia

BackgroundFemale genital mutilation (FGM) is considered a human rights violation against women and girls causing serious short and long-term health complications. Despite being a criminal offence in Ethiopia since 2004, the practice continues. Minimal research has been published on factors associated with men’s opinion about FGM in Ethiopia. Objective and AimsThe present cross-sectional study used secondary data to identify factors associated with men’s opinions about the practice of FGM. MethodsSecondary data analysis was conducted using data from 8,718 men who responded to the 2016 Ethiopian Demographic and Health Surveys (EDHS). The dependent variable was men’s opinion about FGM. Demographic, socioeconomic, and other characteristics were examined. ResultsVariables associated with men’s support for FGM were lack of education (AOR = 2.91; 95% CI: 1.93, 4.40, p = <0.001), poor wealth index (AOR, 1.76; 95% CI 1.32, 2.35, p = 0.001), ethnically Afar (AOR = 2.50, 95% CI: 1.27, 4.95, p = 0.009) and Somali (AOR = 2.02, 95% CI: 1.15, 3.54, p = 0.015), Muslim religion (AOR = 1.58, 95% CI 1.13, 2.50, p = 0.007), and support for wife beating with at least one justification (AOR = 2.04, 95% CI: 1.66, 2.50, p = <0.001). ConclusionLack of education, poor household wealth index, being Muslim and being a member of the Afar or Somali ethnicity and having a tendency that it is appropriate for a husband to beat his wife, were positively associated support for FGM. These findings suggest that context-specific interventions are needed to eradicate the practice.

Barriers and Facilitators in Preparation and Consumption of African Indigenous Vegetables: A Qualitative Exploration From Kenya

Malnutrition and food security continue to be major concerns in sub-Saharan Africa (SSA). In Western Kenya, it is estimated that the double burden of malnutrition impacts 19% of adults and 13–17% of households. One potential solution to help address the concern is increased consumption of nutrient-dense African Indigenous Vegetables (AIVs). The objectives of this study were to: (i) document current methods used for preparation and consumption of AIVs; (ii) identify barriers and facilitators of AIVs consumption and preparation; and (iii) identify a package of interventions to increase the consumption of AIVs to promote healthy diets. This study used qualitative data collected from 145 individual farmers (78 female and 67 male) in 14 focus group discussions (FGDs) using a semi-structured survey instrument. Most farmers reported that they prepared AIVs using the traditional method of boiling and/or pan-cooking with oil, tomato, and onion. However, there were large discrepancies between reported cooking times, with some as little as 1–5 min and others as long as 2 h. This is of importance as longer cooking times may decrease the overall nutritional quality of the final dish. In addition, there were seasonal differences in the reported barriers and facilitators relative to the preparation and consumption of AIVs implying that the barriers are situational and could be modified through context-specific interventions delivered seasonally to help mitigate such barriers. Key barriers were lack of availability and limited affordability, due to an increase cost, of AIVs during the dry season, poor taste and monotonous diets, and perceived negative health outcomes (e.g., ulcers, skin rashes). Key facilitators included availability and affordability during peak-season and particularly when self-produced, ease of preparation, and beneficial health attributes (e.g., build blood, contains vitamins and minerals). To promote healthy diets within at risk-populations in Western Kenya, the findings suggest several interventions to promote the preparation and consumption of AIVs. These include improved household production to subsequently improve affordability and availability of AIVs, improved cooking methods and recipes that excite the family members to consume these dishes with AIVs, and the promotion of the beneficial heath attributes of AIVs while actively dispelling any perceived negative health consequences of their consumption.

A public health intervention package for increasing tuberculosis notifications from private practitioners in Bandung, Indonesia (INSTEP2): A cluster-randomised controlled trial protocol

Background. A significant proportion of tuberculosis (TB) patients globally make their initial visit for medical care to either an informal provider or a private practitioner, and many are not formally notified. Involvement of private practitioners (PPs) in a public–private mix for TB (TB-PPM) provides an opportunity for improving TB control. However, context-specific interventions beyond public–private agreements and mandatory notification are needed. In this study we will evaluate whether a tailored intervention package can increase TB notifications from PPs in Indonesia. Methods. This is a cluster-randomized trial of a multi-component public health intervention. 36 community health centre (CHC) areas will be selected as study locations and randomly allocated to intervention and control arms (1:1). PPs in the intervention areas will be identified using a mapping exercise and recruited into the study if they are eligible and consent. They will receive a tailored intervention package including in-person education about TB management along with bimonthly electronic refreshers, context-specific selection of referral pathways, and access to a TB-reporting app developed in collaboration with the National TB programme. The primary hypothesis is that the intervention package will increase the TB notification rate. The primary outcome will be measured by collecting notification data from the CHCs in intervention and control arms at the end of a 1-year observation period and comparing with the 1-year pre-intervention. The primary analysis will be intention-to-treat at the cluster level, using a generalised mixed model with repeated measures of TB notifications for 1 year pre- and 1 year post-intervention. Discussion. The results from this study will provide evidence on whether a tailored intervention package is effective in increasing the number of TB notifications, and whether the PPs refer presumptive TB cases correctly. The study results will guide policy in the development of TB-PPM in Indonesia and similar settings.

Interventions to eliminate hepatitis C: which ones suit your community?

In The Lancet Gastroenterology & Hepatology, Evan B Cunningham and colleagues1 present a systematic review and meta-analysis of many interventions to enhance the hepatitis C virus (HCV) care cascade. This analysis combined a broad range of studies and highlights the myriad ways in which health-care providers, pathology services, and people living with HCV can be engaged in testing and treatment. Achieving WHO's target of eliminating HCV as a public health threat by 2030 will require many tailored, context-specific interventions.

Measuring and Evaluating Clinical Context in Implementation Science Research.

Measuring and Evaluating Clinical Context in Implementation Science Research.

Characteristics, experiences and actions taken by women to address delayed conception: A mixed-methods cross-sectional study protocol

The impact of infertility on mental, emotional, physical and sexual health is grave, particularly in a pronatalist society. Literature is replete with evidence of wide ranging psychosocial consequences of infertility in women, indicating the need for identifying the gaps and designing appropriate context specific interventions to improve access and utilization of services. Data that are accessible, primarily from infertility clinics and women visiting hospitals for infertility treatment; information from community settings is rare. This is a protocol paper for a study to understand women's experiences and actions taken by them to cope with delayed conception. Mixed-methods cross-sectional design is used to obtain deep insights into the experiences of delayed conception, coping mechanisms, medical assistance and other help sought. Information is also being obtained on socio-demographic profile, fertility intentions, fertility quality of life, general medical history, obstetric, gynecological and sexual history, substance use and mental health status. A sample of 1530 women will be administered 4 modules of a quantitative survey. Focus group discussions, about four or till saturation point, will be conducted using purposive sampling. The study is recruiting from a population of women who previously participated in the 'Women and Infants Integrated Interventions for Growth Study (WINGS) and failed to conceive during 18 months follow up period. Data collected through questionnaire will be assembled, cleaned, analyzed and reported. The findings will be disseminated through reports with the ethics review committee, government entities, academic and research publications. This study will provide insights on the experiences and coping strategies of women with delayed conception in the study community. Results will assist in designing appropriate interventions to meet the holistic health and psychosocial needs of women with delayed conception and promote sexual and reproductive health within the broader framework of Sustainable Development Goals and Universal health coverage. Trial registration number: CTRI/2020/03/023955.

Mental healthcare-seeking behavior during the perinatal period among women in rural Bangladesh

IntroductionMental health conditions are of rising concern due to their increased contribution to the global burden of disease. Mental health issues are inextricably linked with other socio-cultural and health dimensions, especially in the rural areas in developing countries. The complex relationship between mental health issues and socio-cultural settings may largely toll upon healthcare-seeking behavior. So, it urges to document the current status of mental healthcare-seeking behavior during the perinatal period among rural women in Bangladesh to develop a context-specific intervention in the future.MethodsThis study was carried out in one sub-district in Bangladesh from April 2017 to June 2018. We conducted 21 In-depth Interviews (IDIs) and seven Focus Group Discussions (FGDs) with different groups of purposively selected participants. After collecting the recorded interview and making the verbatim transcription, the data were coded through Atlasti 5.7.a. Data were analyzed thematically to interpret the findings.ResultsTwo-thirds of the total respondents did not seek mental healthcare during the perinatal period at the community level. They also did not know about the mental health service provider or the facility to get set these services. Only one respondent out of twenty-one sought maternal mental healthcare from a gynecologist from a private hospital. Socio-cultural factors such as social stigma, traditional beliefs and practices, social and religious taboos, and social capital negatively influence healthcare-seeking behaviors. Besides, the community-level service providers were not found to be adequately trained and did not have proper guidelines regarding its management.ConclusionThe findings provide evidence that there is an urgent need to increase the awareness for service users and formulate a guideline for the community-level service provider to manage maternal mental problems during the perinatal period of women in rural Bangladesh.

Development of a Complex Intervention for Effective Management of Type 2 Diabetes in a Developing Country.

There has been little focus on designing tailored diabetes management strategies in developing countries. The aim of this study is to develop a theory-driven, tailored and context-specific complex intervention for the effective management of type 2 diabetes at a tertiary care setting of a developing country. We conducted interviews and focus groups with patients, health professionals, and policymakers and undertook thematic analysis to identify gaps in diabetes management. The results of our previously completed systematic review informed data collection. We used the United Kingdom Medical Research Council framework to guide the development of the intervention. Results comprised 48 interviews, two focus groups with 11 participants and three co-design panels with 24 participants. We identified a lack of structured type 2 diabetes education, counselling, and collaborative care of type 2 diabetes. Through triangulation of the evidence obtained from data collection, we developed an intervention called VICKY (patient-centred collaborative care and structured diabetes education and counselling) for effective management of type 2 diabetes. VICKY comprised five components: (1) patient-centred collaborative care; (2) referral system for patients across transitions of care between different health professionals of the diabetes care team; (3) tools for the provision of collaborative care and documentation of care; (4) diabetes education and counselling by trained diabetes educators; and (5) contextualised diabetes education curriculum, educational materials, and documentation tools for diabetes education and counselling. Implementation of the intervention may help to promote evidence-based, patient-centred, and contextualised diabetes care for improved patient outcomes in a developing country.

Hypertension determinants among Ghanaians differ according to location of residence: RODAM study.

Hypertension prevalence is high among African migrants, but the determinants of hypertension in migrants in Europe in relation to the population in the country of origin still needs to be elucidated. Therefore, the aim of this study was to assess the determinants of hypertension in Ghanaians residing in Ghana and Europe. The current study used baseline data of 5659 participants, aged 25-70 years, of the Research on Obesity and Diabetes among African Migrants study. Multivariate logistic regression analysis was used to assess sociodemographic, lifestyle, psychosocial, anthropometric and health factors independently associated with hypertension in Ghanaians living in rural and urban Ghana, and Ghanaian migrants living in Europe. Across all sites, older age (both sexes; odds ratio 1.07, 95% confidence interval 1.06-1.08) and diabetes (females only; 2.02, 1.54-1.67) were independently associated with hypertension. The other determinants of hypertension differed between geographical locations. Higher waist circumference (1.12, 1.05-1.20) was independently associated with hypertension in rural-Ghanaian males, as was higher body mass index (1.15, 1.03- 1.28) in urban-Ghanaian males, higher waist circumference (1.04, 1.01-1.07) and diabetes (1.75, 1.17-2.63) in European-Ghanaian males. In European-Ghanaian females, high alcohol intake (1.88, 1.01 -3.53) and waist circumference (1.04, 1.02- 1.06) were associated with hypertension, whereas in rural-Ghanaian females, a higher educational level (0.28, 0.08-0.98) was inversely associated with hypertension. The current study identified several modifiable determinants of hypertension in Ghanaians, with differences between populations residing in various geographical locations. This highlights the importance of development and implementation of context-specific interventions targeting these determinants to reduce the burden of hypertension among Ghanaian migrants and nonmigrants.